DE29908259U1 - Rotating surgical tool - Google Patents
Rotating surgical toolInfo
- Publication number
- DE29908259U1 DE29908259U1 DE29908259U DE29908259U DE29908259U1 DE 29908259 U1 DE29908259 U1 DE 29908259U1 DE 29908259 U DE29908259 U DE 29908259U DE 29908259 U DE29908259 U DE 29908259U DE 29908259 U1 DE29908259 U1 DE 29908259U1
- Authority
- DE
- Germany
- Prior art keywords
- tool
- tool according
- bone
- ultrasonic
- ultrasonic transducer
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Lifetime
Links
- 210000000988 bone and bone Anatomy 0.000 claims description 60
- 239000000463 material Substances 0.000 claims description 30
- 230000005855 radiation Effects 0.000 claims description 28
- 239000007943 implant Substances 0.000 claims description 9
- 230000003287 optical effect Effects 0.000 claims description 9
- 238000005553 drilling Methods 0.000 claims description 7
- 230000005540 biological transmission Effects 0.000 claims description 2
- 238000002604 ultrasonography Methods 0.000 description 14
- 238000000034 method Methods 0.000 description 2
- 238000003801 milling Methods 0.000 description 2
- 244000309464 bull Species 0.000 description 1
- 239000003795 chemical substances by application Substances 0.000 description 1
- 230000006378 damage Effects 0.000 description 1
- 238000013500 data storage Methods 0.000 description 1
- 238000002513 implantation Methods 0.000 description 1
- 238000012806 monitoring device Methods 0.000 description 1
- 239000007787 solid Substances 0.000 description 1
- 210000001519 tissue Anatomy 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
- A61B17/7092—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for checking pedicle hole has correct depth or has an intact wall
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1637—Hollow drills or saws producing a curved cut, e.g. cylindrical
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00106—Sensing or detecting at the treatment site ultrasonic
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
- A61B2090/3782—Surgical systems with images on a monitor during operation using ultrasound transmitter or receiver in catheter or minimal invasive instrument
- A61B2090/3784—Surgical systems with images on a monitor during operation using ultrasound transmitter or receiver in catheter or minimal invasive instrument both receiver and transmitter being in the instrument or receiver being also transmitter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
- A61B8/0875—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of bone
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C1/00—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design
- A61C1/02—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design characterised by the drive of the dental tools
- A61C1/07—Dental machines for boring or cutting ; General features of dental machines or apparatus, e.g. hand-piece design characterised by the drive of the dental tools with vibratory drive, e.g. ultrasonic
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
- A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
- A61C8/0089—Implanting tools or instruments
Landscapes
- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Neurology (AREA)
- Medical Informatics (AREA)
- Animal Behavior & Ethology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Veterinary Medicine (AREA)
- Molecular Biology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Dentistry (AREA)
- Surgical Instruments (AREA)
- Ultra Sonic Daignosis Equipment (AREA)
- Dental Tools And Instruments Or Auxiliary Dental Instruments (AREA)
Description
A 55018 u Aesculap AG & Co. KGA 55018 u Aesculap AG & Co. KG
u-234 Am Aesculap-Platzu-234 Am Aesculap-Platz
5. Mai 1999 D - 78532 Tuttlingen5 May 1999 D - 78532 Tuttlingen
Die Erfindung betrifft ein rotierendes chirurgisches Werkzeug zur Erzeugung einer Vertiefung in Knochenmaterial. The invention relates to a rotating surgical tool for creating a depression in bone material.
Zur Herstellung von Vertiefungen in Knochenmaterial sind die unterschiedlichsten rotierenden Werkzeuge bekannt, beispielsweise Bohrer, Fräser, Reibahlen, etc. All diesen Werkzeugen ist gemeinsam, daß mit ihnen Vertiefungen in verschiedenster Form in das Knochenmaterial eingebracht werden, beispielsweise Aufnahmebohrungen für Knochenschrauben. Es ist dabei von größter Wichtigkeit, daß diese Bohrungen und Vertiefungen in der gewünschten Weise im Knochen plaziert werden, da in vielen Fällen nur wenig Knochenmaterial zur Fixierung von Knochenschrauben und anderen Implantatteilen zur Verfügung steht. Beispielsweise ist es äußerst schwierig, im Wirbelsäulenbereich Pedikelschrauben so im Wirbelkörper zu plazieren, daß sie einerseits in der gewünschten Weise im Wirbelkörper festgelegt werden und andererseits keine Verletzungen hervorrufen.A wide variety of rotating tools are known for creating depressions in bone material, such as drills, milling cutters, reamers, etc. What all of these tools have in common is that they are used to create depressions in the bone material in a wide variety of shapes, such as holes for bone screws. It is of the utmost importance that these holes and depressions are placed in the bone in the desired way, since in many cases there is only a small amount of bone material available for fixing bone screws and other implant parts. For example, it is extremely difficult to place pedicle screws in the vertebral body in the spine area in such a way that they are fixed in the vertebral body in the desired way and do not cause injuries.
Bisher war dies im wesentlichen unter Sicht des Operateurs durchzuführen oder allenfalls unter Röntgenkontrolle, und dies war unter Umständen mit einer erhöhten Strahlenbelastung für Patient und Operateur verbunden.Until now, this had to be done essentially under the surgeon's supervision or, at most, under X-ray control, and this was potentially associated with increased radiation exposure for both patient and surgeon.
Es ist Aufgabe der Erfindung, ein gattungsgemäßes Werkzeug so auszubilden, daß mit ihm Vertiefungen in Kno-It is the object of the invention to design a generic tool in such a way that it can be used to create depressions in bones.
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chenmaterial kontrolliert in der gewünschten Position und Richtung erzeugt werden können.material can be produced in a controlled manner in the desired position and direction.
Diese Aufgabe wird bei einem rotierenden chirurgischen Werkzeug der eingangs beschriebenen Art erfindungsgemäß dadurch gelöst, daß in ihm ein Ultraschallwandler angeordnet ist, der Ultraschallwellen aussenden und empfangen kann, und daß der Ultraschallwandler mit einem Ultraschallgenerator und einer Empfangseinrichtung verbindbar ist, die abhängig von der Stärke der vom Ultraschallwandler empfangenen Ultraschallstrahlung und der Zeitdauer zwischen Aussendung der Ultraschallstrahlung und dem Empfang reflektierter Ultraschallstrahlung Signale erzeugt, die ein Maß für die Beschaffenheit des Knochenmaterials in Ausstrahlungsrichtung sind.This object is achieved according to the invention in a rotating surgical tool of the type described at the outset in that an ultrasonic transducer is arranged in it, which can emit and receive ultrasonic waves, and in that the ultrasonic transducer can be connected to an ultrasonic generator and a receiving device, which, depending on the strength of the ultrasonic radiation received by the ultrasonic transducer and the time period between the emission of the ultrasonic radiation and the reception of reflected ultrasonic radiation, generates signals that are a measure of the nature of the bone material in the direction of radiation.
Die vom Wandler im rotierenden Werkzeug ausgesandte Ultraschallstrahlung dringt in die umgebenden Knochenstrukturen ein und wird dort reflektiert, insbesondere an den Oberflächen des Knochenmaterials und an Inhomogenitäten im Knochenmaterial, beispielsweise an Flächen, an denen sich die Struktur des Knochenmaterials verändert. Die reflektierte Ultraschallstrahlung wird vom Wandler aufgefangen, und aus der Stärke des aufgefangenen Signals und der Zeit, die seit der Aussendung der Ultraschallstrahlung vergangen ist, lassen sich Angaben über die Beschaffenheit des an das Werkzeug angrenzenden Knochenmaterials machen, insbesondere über die Schichtdicke des Knochenmaterials und gegebenenfalls auch über Strukturänderungen des Knochenmaterials. Diese Information kann der Operateur nutzen, umThe ultrasound radiation emitted by the transducer in the rotating tool penetrates into the surrounding bone structures and is reflected there, in particular on the surfaces of the bone material and on inhomogeneities in the bone material, for example on areas where the structure of the bone material changes. The reflected ultrasound radiation is captured by the transducer, and the strength of the captured signal and the time that has passed since the ultrasound radiation was emitted can be used to determine the nature of the bone material adjacent to the tool, in particular the layer thickness of the bone material and, if applicable, structural changes in the bone material. The surgeon can use this information to
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die Position des Werkzeugs im Knochen zu überprüfen und damit die Lage der vom Werkzeug erzeugten Vertiefung.to check the position of the tool in the bone and thus the position of the depression created by the tool.
Dabei können getrennte Wandler für das Aussenden und für das Empfangen der Ultraschallstrahlung vorgesehen sein, es ist aber auch möglich, die Ultraschallstrahlung mit demselben Wandler auszusenden und die reflektierte Strahlung anschließend wieder aufzunehmen. Dies läßt sich beispielsweise mit einem sogenannten Impuls-Echo-Verfahren durchführen.Separate transducers can be used to send and receive the ultrasound radiation, but it is also possible to send the ultrasound radiation with the same transducer and then receive the reflected radiation again. This can be done, for example, using a so-called pulse-echo method.
Günstig ist es, wenn der Ultraschallwandler im Bereich des distalen Endes des Werkzeuges angeordnet ist, so daß von der vom Werkzeug ausgesandten Ultraschallstrahlung der Bereich vor dem distalen Ende des Werkzeugs "gesehen" wird. Dem Operateur wird somit eine Information darüber geliefert, wie das Knochenmaterial in Bearbeitungsrichtung beschaffen ist, und es wird ihm daher die Möglichkeit gegeben, die Vorschubrichtung des Werkzeugs entsprechend zu steuern.It is advantageous if the ultrasound transducer is arranged in the area of the distal end of the tool so that the area in front of the distal end of the tool is "seen" by the ultrasound radiation emitted by the tool. The surgeon is thus provided with information about the nature of the bone material in the direction of processing and is therefore given the opportunity to control the feed direction of the tool accordingly.
Eine besonders günstige Ausgestaltung ergibt sich, wenn der Ultraschallwandler im Werkzeug derart angeordnet ist, daß seine Aussende- und Empfangsrichtung für die Ultraschallwellen gegenüber der Drehachse geneigt ist, beispielsweise mit einem Neigungswinkel zwischen 30 und 60°, insbesondere in der Größenordnung von etwa 45°. Die Ultraschallstrahlung wird bei einer solchen Ausgestaltung auf einem Kegelmantel ausgesandt, der sich in distaler Richtung öffnet, und auf diese Weise erhält der Operateur Informationen nicht nur genau in Vor-A particularly advantageous design is obtained if the ultrasonic transducer is arranged in the tool in such a way that its direction of transmission and reception for the ultrasonic waves is inclined relative to the axis of rotation, for example with an angle of inclination between 30 and 60°, in particular in the order of about 45°. With such a design, the ultrasonic radiation is emitted on a conical surface that opens in the distal direction, and in this way the operator receives information not only precisely in advance
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schubrichtung des rotierenden Werkzeugs, sondern über den gesamten Drehwinkel des Werkzeugs in einem Bereich, der in distaler Richtung vor dem Werkzeug liegt. Dadurch ergibt sich eine optimale Orientierung über die noch zu bearbeitenden Knochenbereiche.thrust direction of the rotating tool, but over the entire angle of rotation of the tool in an area that lies distally in front of the tool. This results in optimal orientation of the bone areas that still need to be worked on.
Bei einer bevorzugten Ausführungsform der Erfindung ist vorgesehen, daß das Werkzeug einen inneren Aufnahmeraum für den Ultraschallwandler aufweist, der mit einem im Werkzeug bis zu dessen proximalem Ende verlaufenden Kanal in Verbindung steht. Durch diesen Kanal können Anschlußleitungen für den Ultraschallwandler verlaufen.In a preferred embodiment of the invention, the tool has an internal receiving space for the ultrasonic transducer, which is connected to a channel running in the tool up to its proximal end. Connection lines for the ultrasonic transducer can run through this channel.
Bei einer bevorzugten Ausfuhrungsform ist das Werkzeug ein Bohrwerkzeug mit einer kegeligen Schneidfläche und der Ultraschallwandler ist im Bereich der kegeligen Schneidfläche angeordnet. Mit einem solchen Bohrer kann der Operateur während des Bohrvorgangs genau sehen, ob er beim weiteren Vortritt des Bohrers von allen Begrenzungen des Knochens einen ausreichenden Abstand hat, so daß die Bohrung mit Sicherheit im Knochenmaterial verläuft und nicht unerwünscht in Hohlräume oder anderes Gewebe eindringt.In a preferred embodiment, the tool is a drilling tool with a conical cutting surface and the ultrasonic transducer is arranged in the area of the conical cutting surface. With such a drill, the surgeon can see exactly during the drilling process whether he has sufficient distance from all the boundaries of the bone as the drill advances, so that the drilling runs safely in the bone material and does not undesirably penetrate into cavities or other tissue.
Besonders günstig ist es, wenn das Werkzeug einen Sensor für seine Winkelstellung umfaßt und wenn der Sensor ein der Winkelstellung entsprechendes Signal der Empfangseinrichtung zuführt, die damit die Signale für die Knochenbeschaffenheit in Abhängigkeit von der Winkelstellung des Werkzeugs erzeugt. Damit erhält der Operateur ein umfassendes Bild der Beschaffenheit des Kno-It is particularly advantageous if the tool includes a sensor for its angular position and if the sensor supplies a signal corresponding to the angular position to the receiving device, which then generates the signals for the bone condition depending on the angular position of the tool. This gives the surgeon a comprehensive picture of the condition of the bone.
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chenmaterials vor dem Werkzeug, und zwar in allen Winkelrichtungen. Der Ultraschallwandler bildet gleichsam eine auf einem drehbaren Träger angeordnete Kamera, die den gesamten vor dem Werkzeug liegenden Bereich in allen Richtungen überstreicht.material in front of the tool, in all angular directions. The ultrasonic transducer is like a camera arranged on a rotating support, which scans the entire area in front of the tool in all directions.
Weiterhin kann vorgesehen sein, daß die Empfangseinrichtung
ein optisches Anzeigegerät zugeordnet ist,
welches die von der Empfangseinrichtung erzeugten Signale
für die Knochenbeschaffenheit anzeigt. Auf einem solchen Anzeigegerät ist also direkt ablesbar, wie der
Knochen in Ausstrahlungsrichtung der Ultraschallstrahlung beschaffen ist, welche Knochenwandstärke hier zur
Verfügung steht und welche Strukturänderungen gegebenenfalls
auftreten.Furthermore, it can be provided that the receiving device
an optical display device is assigned,
which the signals generated by the receiving device
for the bone structure. On such a display device, it is possible to read directly what the bone structure is in the direction of the ultrasound radiation, what bone wall thickness is available here and what structural changes may have occurred.
appear.
Besonders vorteilhaft ist es dabei, wenn auf dem optischen Anzeigegerät Querschnitte durch das Werkzeug und
das angrenzende Knochenmaterial darstellbar sind, wobei die Beschaffenheit des Knochenmaterials durch die von
der Empfangseinrichtung erzeugten Signale bestimmt
wird. Diese Querschnitte zeigen gleichzeitig die von
der Empfangseinrichtung erzeugten Signale an, die sich bei unterschiedlicher Winkelstellung des Werkzeugs ergeben,
so daß man über den gesamten Winkelbereich
gleichzeitig eine Information über die Knochenbeschaffenheit erhält.It is particularly advantageous if cross-sections through the tool and the adjacent bone material can be displayed on the optical display device, whereby the nature of the bone material can be determined by the
signals generated by the receiving device
These cross sections also show the
signals generated by the receiving device, which result from different angular positions of the tool, so that over the entire angular range
at the same time receives information about the bone condition.
Insbesondere kann dabei vorgesehen sein, daß die dargestellte Querschnittsfläche eine Kegelfläche ist, deren Achse mit der Drehachse des Werkzeugs zusammenfällt undIn particular, it can be provided that the cross-sectional area shown is a conical surface whose axis coincides with the axis of rotation of the tool and
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die sich in distaler Richtung öffnet. Damit wird ein
Anzeigebereich dargestellt, der den Bereich vor dem
Werkzeug abtastet und somit die Knochenbeschaffenheit
in dem Bereich anzeigt, in dem das Werkzeug erst in Zukunft eindringen wird.which opens in a distal direction. This creates a
Display area is shown, which covers the area in front of the
Tool scans and thus the bone texture
in the area where the tool will penetrate in the future.
Auf dem optischen Anzeigegerät können auch Querschnitte von Implantaten eingeblendet werden, die zeigen, in
welcher Weise bestimmte Implantate nach der Implantation
im Knochen angeordnet werden sollen. Der Operateur hat damit die Möglichkeit, bei Kenntnis der Implantatform
und der gewünschten Lage des Implantats Vertiefungen, beispielsweise Bohrlöcher, so zu setzen, daß deren
Lage mit der Form und der Position des Implantats korrespondiert.
Die Abbildung des Implantats kann dabei
aus einem Datenspeicher erzeugt werden, in denen die
Darstellungsdaten für dieses Implantat gespeichert
sind. Aus diesen Daten kann die Abbildung der Abbildung überlagert werden, die sich aus den Ultraschallsignalen
ergibt.The optical display device can also show cross-sections of implants, showing in which
how certain implants are treated after implantation
in the bone. The surgeon has the opportunity, with knowledge of the implant shape, to
and the desired position of the implant, recesses, such as drill holes, must be made in such a way that their position corresponds to the shape and position of the implant.
The image of the implant can
generated from a data storage in which the
Display data stored for this implant
From this data, the image can be superimposed on the image resulting from the ultrasound signals.
Der Empfangseinrichtung kann auch eine beispielsweise
optisch oder akustisch arbeitende Warneinrichtung zugeordnet sein, die den Operateur davor warnt, daß die
Wandstärke des Knochenmaterials in dem zu bearbeitenden Bereich einen bestimmten Wert unterschreitet, daß also
die Gefahr eines Durchbruchs besteht.The receiving device can also be a
optical or acoustic warning device that warns the operator that the
Wall thickness of the bone material in the area to be processed falls below a certain value, so that
there is a risk of a breakthrough.
Die nachfolgende Beschreibung einer bevorzugten Ausführungsform der Erfindung dient im Zusammenhang mit der
Zeichnung der näheren Erläuterung. Es zeigen:The following description of a preferred embodiment of the invention serves in connection with the
Drawing for further explanation. Shown are:
• · · · ft• · · · ft
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Figur 1: eine schematisehe Ansicht eines an einem Wirbelkörper angesetzten Bohrwerkzeugs mit einer Ultraschallüberwachungseinrichtung mit optischer Anzeige undFigure 1: a schematic view of a drilling tool attached to a vertebral body with an ultrasonic monitoring device with optical display and
Figur 2: eine vergrößerte Schnittansicht im Bereich A in Figur 1 mit einem mit einem Ultraschallwandler ausgerüsteten Bohrwerkzeug .Figure 2: an enlarged sectional view in area A in Figure 1 with a drilling tool equipped with an ultrasonic transducer.
Die Erfindung wird nachstehend am Beispiel eines Bohrwerkzeugs erörtert, grundsätzlich kann die Erfindung aber auch bei anderen drehenden Bearbeitungswerkzeugen verwendet werden, beispielsweise bei Fräsern, Reibahlen, Trephinen, etc., mit deren Hilfe durch Drehbewegung eine spanabhebende Bearbeitung des Knochenmaterials erfolgt, insbesondere zur Herstellung von Bohrungen und anderen Vertiefungen.The invention is discussed below using the example of a drilling tool, but in principle the invention can also be used with other rotating processing tools, for example milling cutters, reamers, trephines, etc., with the help of which the bone material is machined by means of a rotary movement, in particular for producing bores and other depressions.
Eine chirurgische Handbohrmaschine 1 ist mit einem Spiralbohrer 2 bestückt, der durch einen Antrieb im Inneren der Handbohrmaschine 1 um seine Längsachse verdreht wird und mit seiner Spitze 3 in einem Knochen 4, im dargestellten Ausführungsbeispiel in einem Wirbelknochen im Pedikelbereich, eine Bohrung 5 erzeugt.A surgical hand drill 1 is equipped with a twist drill 2, which is rotated about its longitudinal axis by a drive inside the hand drill 1 and creates a hole 5 with its tip 3 in a bone 4, in the illustrated embodiment in a vertebral bone in the pedicle area.
Im Gegensatz zu einem herkömmlichen Spiralbohrer ist dieser Spiralbohrer 2 mit einem vom proximalen Ende bis in den distalen Endbereich durchgehenden Innenkanal 6 versehen, der in einem Aufnahmeraum 7 endet, der sichIn contrast to a conventional twist drill, this twist drill 2 is provided with an inner channel 6 that runs from the proximal end to the distal end area and ends in a receiving space 7 that
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seinerseits unmittelbar hinter der kegeligen Schneidfläche 8 des Spiralbohrers 2 befindet. In diesem Aufnahmeraum 7 ist ein Ultraschallwandler 9 angeordnet, der im wesentlichen senkrecht zur Schneidfläche 8 Ultraschallstrahlung abstrahlen und aus dieser Richtung auf ihn auftreffende Ultraschallstrahlung aufnehmen kann. Es kann sich dabei um einen einzigen Ultraschallwandler 9 handeln oder zwei getrennte Ultraschallwandler, die jeweils für Abstrahlung oder Aufnahme von Ultraschallstrahlung ausgebildet sind.which in turn is located directly behind the conical cutting surface 8 of the twist drill 2. In this receiving space 7 an ultrasonic transducer 9 is arranged, which can emit ultrasonic radiation essentially perpendicular to the cutting surface 8 and can absorb ultrasonic radiation striking it from this direction. This can be a single ultrasonic transducer 9 or two separate ultrasonic transducers, each of which is designed to emit or absorb ultrasonic radiation.
Der Ultraschallwandler ist über eine in der Zeichnung nicht näher dargestellte Leitung, die durch den Innenkanal 6 führt mit einer Leitung 10 verbunden, die von der Handbohrmaschine 1 ausgehend an einer Sende- und Empfangseinrichtung 11 endet, die ihrerseits über eine Leitung 12 mit einer Anzeigeeinrichtung 13 verbunden ist. Die Sende- und Empfangseinrichtung 11 kann beispielsweise als sogenannte Impuls-Echo-Anlage arbeiten und Ultraschallstrahlung mit Frequenzen in der Größenordnung von 15 MHz erzeugen und aufnehmen. Diese Ultraschallstrahlung wird in Form eines Impulses durch den Ultraschallwandler 9 in den umgebenden Knochen 4 ausgesandt und dort an Inhomogenitäten und an Grenzflächen reflektiert, beispielsweise an der Grenzfläche 14 zum Markraum 15 des Wirbelknochens.The ultrasonic transducer is connected via a line (not shown in detail in the drawing) that runs through the inner channel 6 to a line 10 that starts from the hand drill 1 and ends at a transmitting and receiving device 11, which in turn is connected via a line 12 to a display device 13. The transmitting and receiving device 11 can, for example, work as a so-called pulse-echo system and generate and record ultrasonic radiation with frequencies in the order of 15 MHz. This ultrasonic radiation is emitted in the form of a pulse by the ultrasonic transducer 9 into the surrounding bone 4 and is reflected there at inhomogeneities and at interfaces, for example at the interface 14 to the medullary cavity 15 of the vertebral bone.
Die reflektierte Strahlung trifft anschließend wieder auf den Ultraschallwandler 9 auf und wird dort in ein elektrisches Signal umgewandelt, das der Sende- und Empfangseinrichtung 11 zugeführt wird. Die Größe desThe reflected radiation then hits the ultrasonic transducer 9 again and is converted there into an electrical signal that is fed to the transmitting and receiving device 11. The size of the
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der reflektierten Strahlung entsprechenden Signals hängt ab von der Stärke der Reflexion an die Inhomogenität, die Zeitdauer zwischen Aussendung des Impulses und Aufnahme der reflektierten Strahlung hängt ab von der Dicke des Knochenmaterials bis zu einer Grenzfläche und der Beschaffenheit des Knochenmaterials, da diese Beschaffenheit die Ausbreitungsgeschwindigkeit der Ultraschallstrahlung beeinflußt.The signal corresponding to the reflected radiation depends on the strength of the reflection from the inhomogeneity, the time between the emission of the pulse and the reception of the reflected radiation depends on the thickness of the bone material up to an interface and the nature of the bone material, since this nature influences the propagation speed of the ultrasound radiation.
Auf diese Weise ist es möglich, bei Kenntnis des Aufbaus des Knochens festzustellen, in welchem Abstand Grenzflächen und Inhomogenitäten des Knochens von dem Ultraschallwandler angeordnet sind und zwar jeweils in Richtung der Ausstrahlung und des Empfangs des Ultraschallwandlers. Dieser Ultraschallwandler dreht sich zusammen mit dem Spiralbohrer 2 und kann daher bei der Aussendung und dem Empfang der Ultraschallstrahlung einen Kegelmantel überstreichen, der durch einen koaxial zu der Drehachse des Spiralbohrers 2 angeordneter und sich in distaler Richtung öffnenden Kegel gebildet wird. Die der Sende- und Empfangseinrichtung 11 zugeführten Reflexionssignale sind somit ein Maß für die Knochenbeschaffenheit und die Dicke des Knochenmaterials auf diesem Kegelmantel, also in einem Bereich, der dem Spiralbohrer 2 distal vorgelagert ist und in den der Spiralbohrer 2 bei weiterer Bearbeitung eintreten wird.In this way, it is possible, with knowledge of the structure of the bone, to determine the distance at which interfaces and inhomogeneities of the bone are arranged from the ultrasonic transducer, in each case in the direction of the emission and reception of the ultrasonic transducer. This ultrasonic transducer rotates together with the twist drill 2 and can therefore, when emitting and receiving the ultrasonic radiation, sweep over a conical surface that is formed by a cone arranged coaxially to the axis of rotation of the twist drill 2 and opening in the distal direction. The reflection signals fed to the transmitting and receiving device 11 are thus a measure of the bone quality and the thickness of the bone material on this conical surface, i.e. in an area that is distally in front of the twist drill 2 and into which the twist drill 2 will enter during further processing.
Die von der Sende- und Empfangseinrichtung 11 aufgenommenen Signale können auf der Anzeigeeinrichtung 13 so dargestellt werden, daß ausgehend von der Lage des Spi-The signals received by the transmitting and receiving device 11 can be displayed on the display device 13 in such a way that, starting from the position of the spinner,
- 10 A
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ralbohrers 2 das von der Ultraschallstrahlung überstrichene Gebiet des Knochen um den Spiralbohrer 2 herum
dargestellt wird, so daß der Operateur eine optische
Anzeige dafür bekommt, wie das Knochenmaterial um den
Spiralbohrer 2 herum in einem distal vor dem Spiralbohrer liegenden Bereich beschaffen ist, beispielsweise
wie groß der Abstand ist zum nächsten Hohlraum oder zu
einer Grenzfläche des Knochens ist. Dies ermöglicht dem Operateur den Spiralbohrer 2 so zu richten, daß er beim
weiteren Eindringen in den Knochen 4 immer möglichst
genau im Knochenmaterial zentriert wird und einen genügenden Abstand von den Grenzflächen des Knochens einhält.
Außerdem ist es möglich, auf diese Weise den Spiralbohrer in Bereiche von besonders festem Knochenmaterial
zu richten, da die reflektierten Ultraschallsignale auch Auskunft über die Beschaffenheit des Knochenmaterials
geben, beispielsweise ändert sich die Fortpflanzungsgeschwindigkeit
der Ultraschallwellen im Knochengewebe bei unterschiedlich strukturiertem Knochengewebe
.ral drill 2 the area of the bone covered by the ultrasound radiation around the twist drill 2
so that the surgeon has an optical
Display of how the bone material around the
Twist drill 2 in a region distal to the twist drill, for example
how big the distance is to the next cavity or to
a bone interface. This allows the surgeon to direct the twist drill 2 so that it always penetrates further into the bone 4 as far as possible
is precisely centered in the bone material and maintains a sufficient distance from the bone interfaces.
In addition, it is possible to direct the twist drill into areas of particularly solid bone material, as the reflected ultrasound signals also provide information about the nature of the bone material, for example, the propagation speed changes
of ultrasound waves in bone tissue with different structures
.
In der Spitze des Spiralbohrers 2 ist somit eine Ultraschallkamera
mit Empfangsgerät eingebaut, die den Bereich
beobachtet, der vor der Spitze des Spiralbohrers
2 angeordnet ist und die damit dem Operateur Informationen
darüber bietet, in welche Knochenbereiche der
Spiralbohrer 2 beim weiteren Eindringen gelangen wird.An ultrasound camera with a receiver is installed in the tip of the twist drill 2, which monitors the area
observed in front of the tip of the twist drill
2 and provides the operator with information
about which bone areas the
Twist drill 2 will penetrate further.
Claims (12)
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DE19921279A DE19921279C1 (en) | 1999-05-07 | 1999-05-07 | Rotating surgical tool |
PCT/EP2000/002253 WO2000067645A1 (en) | 1999-05-07 | 2000-03-15 | Rotating surgical instrument |
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DE29908259U DE29908259U1 (en) | 1999-05-07 | 1999-05-07 | Rotating surgical tool |
DE19921279A DE19921279C1 (en) | 1999-05-07 | 1999-05-07 | Rotating surgical tool |
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DE29908259U1 true DE29908259U1 (en) | 1999-07-15 |
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DE19921279A Expired - Fee Related DE19921279C1 (en) | 1999-05-07 | 1999-05-07 | Rotating surgical tool |
DE29908259U Expired - Lifetime DE29908259U1 (en) | 1999-05-07 | 1999-05-07 | Rotating surgical tool |
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DE19921279A Expired - Fee Related DE19921279C1 (en) | 1999-05-07 | 1999-05-07 | Rotating surgical tool |
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DE (2) | DE19921279C1 (en) |
WO (1) | WO2000067645A1 (en) |
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