HU214568B - Instrument-set for implantation of chondrus, like a mosaic - Google Patents

Abstract

The instrument set according to the invention comprises at least one drill (11) and a grafting machine (3), from which the graft receiver (3) may be a pile knife, the inside diameter (d) of which on a blade is the nominal diameter (D) of the drill (11) and at least 3 of the cutting edge. mm smaller than or less than hornbeam, with an internal diameter equal to the nominal diameter of the drill (11) and a portion of the main bore outward. At the end of the drill bits (11) there is a tapered section of at least 10 mm helix, and the retaining needles are preferably formed as a drill bit (14) in the form of a plate or disc in which the diameter of the drill bits having a diameter corresponding to the annual diameter (D) of the drill bits (11) is in the form of a shroud, with a heat connection of 0.5. - a minimum wall thickness of 1.5 mm, preferably 1 mm. In addition, the finished bead can be provided with a graft socket (8) and sleeve, and the mandrel (8) has an outer diameter and a sleeve inner diameter less than one of the nominal diameters of the drills (11). ŕ

Description

EXTRACT

The instrument kit of the present invention comprises at least one drill (11) and a graft receiver (3), wherein the graft receiver (3) may be a punch having an internal diameter (d) in one section equal to the nominal diameter (D) of the drill (11) less than or equal to 3 mm in length, or a crown saw having an inside diameter equal to the nominal diameter of the drill (11) and a portion of the teeth bent outwards. The drills (11) have a conical section at least 10 mm long at their ends and are preferably provided with a saw blade (14) in the form of a plate or disc in which guide bores with a diameter corresponding to the nominal diameter (D) of the drills (11) are arranged. , 5-1.5 mm, preferably 1 mm minimum wall thickness. In addition, the kit may be provided with a graft embossing mandrel (8) and a sleeve, and the outer diameter of the mandrel (8) and the inner diameter of the sleeve are at least at one section the same as the nominal diameter of the drills (11).

HU 214 568 B

The length of the description is 8 pages (including 4 pages)

HU 214 568 Β

A kit for transferring osteochondral grafts using a mosaic technique comprising at least one drill and graft receiving device.

One of the most common problems in everyday orthopedic and accident surgery is the resolution of knee replacement cartilage damage. In the event of any damage to the joint sliding surfaces, replacement of the original cartilage surface with known methods can only be performed at a reduced value. Considering the age of the patients most frequently affected by such a disease, these injuries result in a reduction in the working capacity or disability of a significant portion of the population.

Replacements were initially solved by transplanting pieces of the appropriate size, but this did not work in practice. During surgery, too large pieces of the cartilage had to be removed, causing significant discomfort to the patient, and the fit between the removed cartilage and the implanted cavity was incomplete, resulting in inadequate fit between the replacement and the original, resulting in joint movement. it was not equivalent to the previous one, on the other hand, too large a disruption hindered the process of bone fusion.

Many attempts have been made to regenerate joint slip surfaces using bone cylinders taken from other, less important, joints in the body. Such solutions are described by dr. László Hangody and dr. Zoltán Kárpáti, "New Possibilities for Surgical Treatment of Severe Circumference of Knee Articular Cartilage" (Hungarian Traumatology, Orthopedics, Hand Surgery, Plastic Surgery, 3 p. 237-243, 1994) or Hangody, Kárpáti, Tóth, Diószegi, Kendik and Bay "Osteocondral autograft on the exposed surface and in the patellofeboral joint of dogs' (Sportor Medical Review, 1994/35/2, pp. 117-123.) c. Article. In the described procedures, cartilage bone cartilage (osteochondral grafts) obtained from the edge of the femoral knee joint surface was replaced with good results.

Experiments and initial results have revealed that replacement with bone cylinders is significantly better than previous solutions, but that it requires a specialized and precise set of instruments, which, however, has not yet been available.

It is therefore an object of the present invention to provide a set of instruments for the implantation of osteochondral grafts, i.e. cartilage of bone cartilage, which allows

- safe transplantation with minimal defect removal,

- ensuring the integrity of the removed bone cylinders,

- the exact design and, where appropriate, standardization of transplantation sites,

- performing the intervention without exploration using a covered technique (arthroscopically), and

- sterilization in the usual way.

The object is solved by a kit comprising at least one drill and at least one grafting device, wherein the grafting device according to the invention may be a punch having an internal diameter in one section equal to the nominal diameter of the drill and less than 3mm from the cutting edge. .

In a second embodiment, the kit comprises a graft receiver having a gauge having an inside diameter equal to the nominal diameter of the drill and a portion of the teeth on the crown, preferably every second tooth, being bent outward.

The drill or drills used in the kit are designed to have an initial tapered section of at least 10 mm. Preferably, the taper is reduced to a diameter less than about 0.5 mm from the original nominal diameter at the tip of the drill.

Of course, the kit usually includes several drills of different diameters and a graft receiver having the same internal diameter. Preferably, the kit also includes a blade template with a handle, in the form of a sheet or disc, with guide holes of nominal diameter corresponding to the drills, with a minimum wall thickness of 0.5 mm to 1.5 mm, preferably 1 mm. The saw template preferably has orientation pins corresponding to the diameter of the guide holes.

The kit is equipped with a graft press mandrel and a sleeve. They have the same diameter as the drill bits for at least one section. Conveniently, the sleeve mantle has inspection openings that allow the position of the bone cylinder to be checked.

The upper part of the graphite receivers, preferably with a larger diameter, has opposed radial bores having the same internal diameter, i.e. the outer diameter of the drill, and thus suitable for receiving graft embossing mandrels.

The kit of the present invention enables the implementation of an optimum joint sliding surface replacement technique by allowing safe and minimal damage to accurate bone rollers, while ensuring accurate, well-fitting and reliable insertion of bone rollers into the injured joint.

As a result of precise implantation, the joints become equivalent to the original joint and the implants are safely integrated over the long term.

At the same time, the kit of the invention is extremely simple, inexpensive, reliable in operation and easy to sterilize.

Further details of the invention will be illustrated by way of example in the drawings. In the drawing it is

Figure 1 is a sectional view of an embodiment of a graft recipient according to the invention, in a first phase of graft receiving,

Figure 2 is an enlarged view of the graft receiving edge, a

Figure 3 shows the graft recipient shown in Figures 1 and 2 after removing the bone drum, a

Figure 4 is a perspective view of the first phase of grafting, as shown in Figure 4;

Figure 5 is a perspective view of the second phase of graft acquisition, a

Figure 6 is a sectional view of another embodiment of the graft recipient during the first step of graft receiving, a

Fig. 7 shows the cutting edge configuration of the graft receiver shown in Fig. 6, a

HU 214 568 Β

Fig. 8 is a view of the graft recipient of Figures 6 and 7 in the second phase of reception, a

FIG. Figs. 4A and 3B are perspective views of the graft receiving device shown in Figs

Figure 10 is a top view of a detail of a drilling template according to the invention, a

Figure 11 is a side view of the drilling template shown in Figure 10, a

Figure 12 is a perspective view of the device, a

Figure 13 is a drawing of the drill used in the kit according to the invention, with the saw template and the joint shown in the section, after making the hole,

Figure 14 is a sectional view of the first phase of bone marrow implantation, a

Figure 15 is a sectional view of the second phase of implantation of the bone cylinder and a

Figure 16 is a perspective view of the implant.

1-5. 1 to 8 show one embodiment of a kit according to the invention. From the intact part of the sliding surface 2 of the joint 1, a bone cylinder is taken with the graft receiver 3. In this embodiment, the graft receiver 3 is configured as a punch, correspondingly with a stem 4 at one end and a cutting edge 5 at the other end. 1-3. 2 and 3, the wall thickness of the graft recipient 3 is greater than the cutting edge 5 at a defined distance 6, i.e. the perforator is thickened around the cutting edge 5 so that its inner diameter d is smaller than the diameter D of the bone cylinder 7 to be received.

The bone cylinder 7 is extracted by punching the graft receiver 3 in the direction of the arrow shown in Figure 1 into the intact portion of the joint 1 (see Figure 4) and, after tilting and rotating it, tearing the bone cylinder 7 in the direction of the arrow. To do this, the mandrel 8 of Fig. 5 is used, the smallest diameter portion of which can be inserted into the radial holes made in the mantle 4 of the stem 4 of the graft recipient.

1-5. In the embodiment shown in Figures 1 to 4, the graft receiving section 6 has a length of about 4 mm and the narrowed inner diameter d is 0.3 mm smaller than the additional inner diameter D. The kit contains graft receivers 3 with different internal diameter D, the 2.7, 3.5 and 4.5 mm size ranges proved to be expedient. Preferably, the depth of the 3 grafting recesses is approx. 15 mm. To denote this, the stem 4 has a larger outer diameter and this larger diameter section begins 15 mm from the cutting edge 5.

6-9. Figures 3 to 5 show another embodiment of the graft recipient 3. Here, the graft receiver 3 is designed as a crown drill with teeth 9 at the end. A portion of the teeth 9, preferably every other tooth 9, is bent outwardly so that the size of the bore left is larger than the diameter of the bone cylinder 7.

The graft receiver 3 is folded in as shown in Fig. 9 by inserting a connector 10 and drilled and then pulled out in a similar manner to a graft receiver.

The graft recipient, which is designed as a corona screw, is preferably used for hard bone surfaces.

10-13. Figures 1 to 5 show drilling and drilling templates used in the kit of the invention. All drill bits have a nominal diameter equal to the inside diameter of the graft receivers 3, i.e. the outer diameter D of the bone drum 7. At the apex, the drill is provided with a 12-tapered section, in the embodiment shown about 12 mm long. The original nominal diameter is reduced by about 0.5 mm along the 12 conical sections. Thus, the end of the prepared hole 13 will also have a tapered end, which will ensure a close fit of the bone cylinders 7.

The holes 13 in the damaged part are preferably made using a drilling template 14. The drilling template 14 shown in Figures 11 and 12 not only serves to guide the drill 11 but also ensures that the bore 13 is optimally arranged. The guide holes 17 corresponding to the size of the graft receivers or drills are arranged in the disc 15 of the saw template 14 so as to ensure optimum utilization of the available surface area and at the same time to prevent tearing or drilling of the walls of the prepared holes. Therefore, the minimum distance between each guide hole 17, i.e. the distance v between the guide holes 17 of the drilling template 14, is always at least 0.5 mm, preferably 1 mm.

As shown in Figure 13, guide pins 18 are inserted into the first bore holes drilled by the respective drilling template 14 to prevent the drilling template 14 from moving between the various bores.

14-16. 7 to 9 show the insertion of the bone cylinders 7 into the bores 13 by means of the mandrel 8 and a sleeve 19. The sleeve 19 is fitted to the sliding surface 2 of the joint 1 at the bore 13, and then a bone cylinder 7 is inserted inside the sleeve 19. The punching into the bore 13 is performed by means of the mandrel 8 as shown in FIG. The position of the bone cylinder 7 can be checked through the openings 20 on the sleeve 19. The insertion must be made so that the sliding surface on the bone cylinder 7 is in the same plane or surface as the sliding surface 2 of the joint 1.

During implantation, the bone cylinders 7 fit snugly in the holes 13, since the lower part of the holes 13 is conical. This not only enhances stability but also promotes bone fusion.

Note that the sequence of operations during surgery is different from that shown in the figures, first the boreholes in the damaged area are to be prepared, and then the bone cylinders are removed and implanted.

Clinical examination of the kit according to the invention has shown that with its help the mosaic technique of autologous cartilage replacement can be safely performed with very good results. The instruments are preferably made of corrosion-resistant steel, of appropriate quality and in accordance with normal sterilization conditions.

Grafting results in minimal damage to the transmission area and the integrity of the removed bone rolls is assured during the procedure.

Transplants can be positioned very precisely and rationally at the site of injury with the help of a drilling template, thus practically standardizing the position of the drillings.

The device allows the intervention to be performed without exploration using a covered technique.

HU 214 568 Β

Of course, the embodiments shown are merely illustrative of the invention and the device may be embodied in many other forms within the scope of the appended claims.

Claims (9)

PATENT CLAIMS A kit for implanting osteochondral grafts by mosaic technique, comprising at least one drill and graft receiver, characterized in that the graft receiver has a cutting edge (5) having an internal diameter (d) in one section equal to the nominal diameter (D) of the drill (11). and smaller by at least 3 mm from the cutting edges (5). A kit for implanting osteochondral grafts by mosaic technique, comprising at least one drill and graft recipient, characterized in that the graft recipient has teeth (9) having an inside diameter equal to the nominal diameter of the drill (11) and a portion of the teeth (9). bent outwards. Tool set according to claim 1 or 2, characterized in that the drill (11) has a tapered section (12) at least 10 mm long. 4. Tool set according to any one of claims 1 to 3, characterized in that it comprises a plurality of drill bits (11) of different diameters and a graft receiver (3) having the same internal diameter. 5. A tool set according to any one of claims 1 to 4, characterized in that it comprises a drilling template (14) with a handle (16) in the form of a plate or disc (15), in which guide holes (17) of a nominal diameter (D) are drilled. with a minimum wall thickness (v) between 0.5 mm and 1.5 mm, preferably 1 mm. 6. Tool set according to any one of claims 1 to 3, characterized in that it has a graft embossing mandrel (8) and a sleeve (19) and the outer diameter of the mandrel (8) and the inner diameter of the sleeve (19) are at least at one section the nominal diameter of the drills. An instrument kit according to claim 6, characterized in that inspection sleeves (20) are provided on the periphery of the sleeve (19). Tool set according to Claim 6 or 7, characterized in that the upper section of the graft recipients (3) has opposed radial holes having the same diameter as the graft recipient (3). Tool set according to Claim 8, characterized in that the drilling template (14) comprises orientation pins (18) of the same diameter as the guiding holes (17). HU 214 568 Β Int Cl ⁶ : HU 214 568 Β Int Cl ⁶ : HU 214 568 Β Int Cl ⁶ : HU 214 568 Β