JP2002017826A - Heat sterilizing method and device for implanted bone - Google Patents

Abstract

PROBLEM TO BE SOLVED: To prevent local temperature rising from exceeding the permissible threshold by minimizing the time required for temperature rising in order to check that the temperatures of the respective parts of an implanted bone attains the temperature suitable for sterilization. SOLUTION: The implanted bone is housed in a hermetically closed container for sterilization and is subjected to heat sterilization by irradiation with microwaves. The output of a magnetron, a movable base on which the sterile container is placed and a movable reflector are monitored by a computer of a control unit and are controlled. The temperatures at a plurality of measurement points on the surface of the implanted bone are measured and are controlled while a data bank is referenced. Various methods, such as heat ray detection by a thermocouple, optical fiber thermometer and IR camera may be used according to the kinds of the sterile container for measuring of the surface temperature of the implanted bone. The implanted bone after the sterilization is stored in the container and is unsealed within an operating room just prior to use.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a sterilizing apparatus and a processing method applicable to bone grafts having various properties, shapes and sizes.

[0002]

2. Description of the Related Art In many cases, bone grafting is necessary in surgical operations. Examples of indications include filling repair after curettage of a lesion such as a bone tumor, bridging of a bone defect caused after resection of a malignant tumor or trauma. , Acquisition of osseous attachment, repair of a bone defect in revision of artificial joint replacement, and the like. In the case of a large bone defect, it cannot be filled with autologous bone alone, so that another supplementary material is required. As an artificial bone replacement material, an artificial bone replacement material has recently been developed, but allogeneic bone is more useful because it is replaced with autologous bone through the process of osteoinduction and osteoconduction. However, fresh allogeneic bone differs from autologous bone in that it has antigenicity. Therefore, the antigenicity is usually reduced by chemical treatment or cryopreservation.

Furthermore, in order to minimize the risk of infection, particularly the risk of viral infection during bone transplantation, the transplanted bone must undergo appropriate virus inactivation and sterilization before surgery. When the whole transplanted bone or a part of the bone is frozen and stored in the bone bank after collection, the sterilization treatment is performed before storage. Bactericidal treatment is performed to prevent infections, especially viral infections, but must not destroy the biomechanical properties of the bone and must maintain the protein structure. These two requirements can be met by heating the entire bone to a temperature of about 80 ° C. over a period of time.

[0004] Sterilization conditions in which the temperature of the bone graft is kept at a minimum of 80 ° C for a certain period of time, for example, 10 minutes, have already been widely adopted in the heating treatment of the femoral head. For example, a warm sterilizer “Lobator SD-2” for a femoral head collected from a donor who has undergone a surgical operation (living donor).
(Trade name) "is disclosed in USP 5,591,398 (EP 0
584484 A1) This condition is realized by the processing method described in the specification. However, this device is a processing device dedicated to the femoral head, and cannot be used for other bones.

[0005] In the sterilization method of Lobator SD-2, the femoral head is placed in a special plastic cylindrical container and heated. The special container is adapted to be closely housed in a cylindrical heating cavity of the device. The container is filled with Ringer's lactate solution to a predetermined level and sealed with a dedicated lid. The lid is equipped with a self-sealing stopper that can be inserted.
After the heating process is completed, the lactated Ringer's solution is removed from the dedicated container using another container equipped with an injection needle, and necessary ventilation is performed at that time. In this method, Ringer's lactate serves as a medium for convective heat transfer from the vessel wall to the femoral head. The dedicated container is equipped with a magnetic stirrer to eliminate the effects of different thermal resistances on the inside of the container wall, Ringer's lactate itself, and the surface of the femoral head, and to prevent local temperature peaks and local overheating. ing. The stirrer is provided below the femoral head in the container. Then, the femoral head is placed on the wire screen and the stirrer is rotated below the wire screen so that a certain distance is maintained between the inner bottom of the container and the femoral head.

[0006] The sealed plastic container into which the lactated Ringer's solution has been injected is placed in an electric heating cavity of the device, where it is heated. Due to the structure of the device,
It is not possible to measure the temperature of any part in the container, such as the temperature of each part of the implanted bone or the temperature of Ringer's lactate solution. Therefore, the temperature control of the heating cavity, such as the heating time or the heating power, must be set empirically.

The process described in US Pat. No. 5,591,398 is effective for relatively small implants of the same type, such as a femoral head, for economic and technical reasons, but with different properties, volumes and shapes. Implanted bones are not suitable for processing by this method either because they do not fit into the dedicated cylindrical container or cannot be completely immersed in Ringer's solution. Therefore, it is necessary to develop an entirely new device to sterilize other types of bone graft.

This method has limitations, besides economic reasons. Enlarge the cylindrical container, for example, about 2
In order to be able to place a 0 cm sterile container for the proximal tibia on the wire screen, it is necessary to use not only a dedicated container for holding the bone graft and the liquid for heat transfer, but also auxiliary equipment and a stirrer. All objects to be heated must be enlarged. Therefore, the heat capacity of the object to be heated increases, and it takes a considerably long time to raise the temperature. In the heating step alone, the implanted bone is exposed to a high temperature for a long time, and an effective sterilization of at least 10 minutes is performed. Before the time to be done, it can damage the biological properties of the implanted bone. Thus, the ratio of the time that is effective for heating, the actual sterilization, and the cooling time deteriorates as the size of the container increases.

As another processing method, DE 40 378
06 A1. This processing method
Although the technology is relatively satisfactory, it has the disadvantage of complex and expensive equipment. The implanted bone (for example, consisting of sterile water)
It is stored in a thermostat filled with a liquid for heat transfer. Warming requires two separate and different warming systems. The constant temperature bath itself is placed in a second liquid bath filled with a second heat transfer liquid. This second heat transfer liquid, usually consisting of water, is circulated by a pump through an outer loop that includes a buffer tank, a heat exchanger and an electric heater. In addition, microwave energy is irradiated through the lid of the thermostatic bath, and the bone graft is directly absorbed by the water while being directly absorbed by this energy. Therefore, the lid of the thermostat must be permeable to high frequency electromagnetic energy irradiation.

[0010] In the case where an attempt is made to heat the implanted bone only by circulating the second heat transfer liquid through the outer loop, the heat capacity of the object to be heated is excessive, so that much time is required for heating. Therefore, the second heating system using microwave energy is indispensable in order to shorten the heating time to within an allowable range.

[0011] These two heating systems are controlled by two separate temperature sensors. One of the temperature sensors must be placed at the center inside the bone graft. Therefore, in order to install a temperature sensor at the center of the bone graft, a hole must be formed in the bone graft by drilling. According to this processing method, by providing such two heating systems, bones of various types, shapes and sizes can be suitably sterilized. However, this method requires two types of heating devices, two liquid water tanks, an external loop line, a pump, a valve, a buffer tank, and the like, and has a disadvantage that it is complicated and expensive.

[0012]

SUMMARY OF THE INVENTION In view of the above-mentioned problems of the prior art, a main object of the present invention is to provide a sterilizing method and a sterilizing method suitable for sterilizing various types, shapes and sizes of transplanted bones. It is to provide a device.

A second object of the present invention is to provide a sterilizing method and apparatus which can economically sterilize a transplanted bone without requiring a complicated auxiliary device.

A third object of the present invention is to provide a sterilization method and apparatus which are small in size and easy to operate, so that they are suitable for use directly in an operating room.

[0015]

According to the present invention, there is provided a method for heating and sterilizing a transplanted bone, which comprises heating the transplanted bone only at a predetermined temperature for a predetermined time only by microwave irradiation. Achieved by providing. in this case,
It is desirable to heat the implanted bone in a sealed sterile container at least partially made of a material that transmits microwaves.

To implement such a method, a housing defining a microwave cavity, a microwave irradiation source provided in the housing to irradiate microwaves into the cavity, and a microwave irradiation source disposed in the cavity. A sealed sterile container for implanted bone, at least partially formed of a material that transmits microwaves, a temperature sensor for measuring the surface temperature of the implanted bone in the sealed sterile container, And a control unit for controlling the microwave irradiation source based on the output.

Microwaves are converted directly to heat by water and other electric dipoles. The degree of heat generation is represented by the microwave absorption coefficient of the material, which varies according to the constituents in the relevant part of the bone, i.e., the proportions of organic and inorganic components and the distribution of moisture, and thus varies from part to part. . Also, depending on the structure of the bone, trace components may cause a significant change in the coefficient. The change in the absorption coefficient for each part causes the degree of heat generation in each part to be different, resulting in a temperature distribution in the bone. Generally, a portion containing a large amount of organic matter and moisture generates more heat than a portion having a high mineral density. On the other hand, the temperature is equalized by heat conduction. Depending on the nature of the bones in each part, the distance between each part and the rate of heating, together with the maximum allowable temperature difference, 80
The minimum time required to warm to ° C is determined. By humidifying the bone surface before or during the sterilization treatment, the rate of temperature rise of the bone surface having a low water content and a high mineral density can be increased. For various types of implanted bones, physical data necessary for controlling the processing steps corresponding to the types may be stored in the data bank of the sterilizer.

In this case, it is possible to combine another heat source as the heat source. However, in order to simplify the configuration and ensure the control, it is preferable to use only the microwave irradiation as the heat source. The microwaves are absorbed by the implanted bone material and converted into heat. The frequency is the international standard 2.5
There is an advantage that 4 GHz can be adopted. The magnetron generates a microwave and is guided by a metal waveguide into a heating bath of the sterilizer, that is, a microwave cavity.
Because of the high frequency, microwave irradiation generally follows the law of optical dispersion, and appropriately arranges a movable reflection device in the heating device to affect, that is, control the irradiation dose distribution of each part in the device. Can be. Alternatively, a sealed sterile container can be placed on a movable installation table to control the distribution of microwave irradiation. As the movable installation table, one that performs a linear motion and / or a rotary motion can be considered. However, it is simple and effective to use a turntable and control the rotation angle thereof. In particular, the surface temperature of the implanted bone is measured at a plurality of locations, these measured values are compared with a predetermined reference value, and the microwave irradiation amount and / or the microwave irradiation distribution may be controlled, in which case, The microwave irradiation distribution can be controlled via the above-mentioned reflection device or movable mount, and the amount of microwave irradiation can be controlled by adjusting the power of a microwave irradiation source such as a magnetron.

The control conditions such as the energy to be irradiated into the heating tank, the degree of heating and the distribution of the energy, the intensity at each part of the radiation and irradiation, the position of the mounting table, that is, the position of the implanted bone placed in the container, are as follows: Determined experimentally. The surface temperature of the implanted bone measured at one or several points functions as a reference when various programs stored in the memory of the computer in the control unit of the sterilization apparatus are operated, and is controlled based on experimental data. Is performed. Different computer programs are created and stored for different types of bone grafts, such as the femoral head, proximal tibia, distal tibia, and patella. When actually disinfecting a transplanted bone, characteristic values such as the type, size, length, diameter, and weight of the transplanted bone must be registered in a computer of the disinfection device. Physical and thermodynamic parameters, thermodynamic formulas, and the like for processing for displaying the characteristics and specialty of various bone grafts are registered in a computer data bank. In addition, a series of data obtained by systematically measuring the temperature of the inside and the surface of the implanted bone is input to this data bank. By such a measurement, the irradiation intensity, heating time, distribution of irradiation, and the temperature of each part depending on the position of the implanted bone placed in the heating tank of the sterilization device, as well as on the installation table in the heating tank Changes are recorded.

The sealed sterile container is preferably made of a material that does not easily absorb microwave irradiation. Such materials include:
There are PTFE, polyethylene, polypropylene, polystyrene, porcelain, fiberboard, paper, non-woven paper, and the like. After the transplanted bone is sealed in a container and sterilized, it can be transported or stored without being opened, and is opened and used for the first time in an operating room. Therefore, it is possible to eliminate the possibility that the graft bone is contaminated after the sterilization treatment.

The sealed sterile container may be a rigid container or a deformable container made of a flexible material. For example, a bag made of a flexible material can be used. further,
The container may be made entirely of a microwave permeable material or only partially made of a microwave permeable material.

If necessary, microwave irradiation can be performed while humidifying the surface of the bone graft. To this end, a screen can be provided at the bottom of the closed sterile container to support the bone graft and adapted to receive humidifying water below the screen.

There are three different methods for measuring the surface temperature of the transplanted bone during the sterilization treatment, which can be selected according to the difference in the design of the sterilization device and the like. The first method is to detect the temperature of infrared radiation emitted from the surface of the bone graft to determine the temperature. If this method is employed, the sterile container must be transparent or partially transparent to infrared radiation. The second method is a method of measuring the temperature at one to several measurement points on the surface of the implanted bone using an optical fiber thermometer. The third method is a method of measuring the temperature at one to several measurement points on the surface of the implanted bone with an electric thermometer.

When a temperature sensor is arranged on the surface of the implanted bone to measure the surface temperature of the implanted bone, the temperature sensor may be an electric thermometer such as a thermocouple, a thermistor, or a diode. The optical fiber thermometer is particularly suitable because it has no interference due to microwaves and has high accuracy. If necessary, the implanted bone can be irradiated with microwaves intermittently, and the temperature measurement by the temperature sensor can be performed during the rest period of the microwave irradiation. Thereby,
It is possible to avoid interference due to microwaves, or to avoid an error due to a transient temperature change such as an instantaneous temperature rise that may occur during microwave irradiation. In particular, when the sealed sterile container is formed of a hard material, it is preferable to provide a terminal for a signal line of the temperature sensor on the wall of the container. When a bag made of soft PVC, soft polyethylene, soft polypropylene, paper, nonwoven paper, or the like is used as a sterile container, the temperature measurement of the surface of the implanted bone may be performed from the outside of the bag. For example, the temperature sensor can be located on a clamp member for clamping against a bone graft from outside the sealed sterile container. In that case, the error caused by the temperature sensor coming into contact with the bone graft via the wall of the container may be compensated on the control unit side. Further, it is also possible to integrate the temperature sensor into an installation table on which a bag for heating treatment containing the transplanted bone is placed. Furthermore, if the hermetically sealed hermetic container made of a soft material has an automatic sealing stopper for closing the opening, the signal line of the temperature sensor is moved out of the hermetic sterile container via the self-sealing stopper. Can be withdrawn. When the sterilization process is completed, the thermometer is pulled out of the container through the self-sealing stopper. In the case of a rigid container, it is also possible to attach an attached temperature measuring device integrated with the container. In this case, it remains in the container even after sterilization.

In the processing method of the present invention, the minimum time required for heating is considerably shorter than that of the conventional method. In other methods, such as the Lobator SD-2, heat can only be transferred by convection of the liquid and only heat the implanted bone by contact with the heat. In such a method, the distance between the hottest point, the surface of the implant, and the coldest point, the center of the implant, is often half the diameter.
In the processing method developed this time, the distance between points and parts that are more likely to heat and parts that are less likely to heat is always shorter. In the case of the same type of graft bone, that is, a bone having the same average thermal conductivity coefficient, the time required for heating is always short if the maximum temperature difference allowed in each part is the same. This is because heat is generated inside the material itself, and the conduction distance required to average the temperature difference between the parts is short. Cooling of the transplanted bone which has been sterilized at 80 ° C. for 10 minutes or the like is performed by blowing air at room temperature into a heating tank of the sterilizing apparatus.

[0026]

FIG. 1 shows a sterilizer according to the present invention. In this device, the surface temperature is measured by infrared rays emitted from the surface of the bone graft. The heating tank 1 has a housing with a glass door that opens from the front like a normal household microwave oven. The transplant bone 4 is housed in the closed container 3, and the closed container 3 is
It is placed on. In the case of the present embodiment, the installation base 2 forms a turntable and can be rotated as appropriate. Other types of movable mounts can be used if desired. In any case, its movement and position are monitored throughout the sterilization process and are controlled by a control unit containing a computer. The inside of the container 3 is simply an atmosphere of atmospheric pressure air, and is not filled with a special liquid or the like. Further, the container 3 itself is made of a material that is permeable to microwaves and infrared rays, so that the bones for implantation are irradiated with microwaves, and infrared rays emitted from the surface can be detected from the outside. Has become. The movable reflecting device 5
The microwave irradiation distribution, that is, the irradiation intensity of each part in the heating tank can be controlled.

An infrared camera 6 as a temperature sensor is provided in the housing, and can measure the temperature distribution on the surface of the implanted bone during the process. The temperature distribution on the implanted bone surface
During the sterilization process, the control unit 10 controls not only the microwave irradiation amount but also the operation of the mounting table 2 and the reflecting device 5 based on the microwave irradiation amount. Is maintained for a predetermined time. A display 7 and keyboards 8 and 9 for operating the control unit 10 are provided on the front surface of the housing. If desired, a desired humidifying effect can be obtained by moistening the surface of the implanted bone with physiological saline prior to the sterilization treatment.

The container 20 shown in FIG. 2 has a structure suitable for microwave irradiation while humidifying the surface of the bone graft. The container 20 is made of a hard material, and has a screw lid 21 closed so that the inside can be sealed. Usually, a desired humidifying effect can be obtained by moistening the surface of the transplanted bone with physiological saline prior to the sterilization treatment. At the bottom of the container, a screen 22 for supporting the transplanted bone is provided.
To be acceptable. The humidifying water 23 has a function of maintaining the humidity in the container during the sterilization process and reliably preventing the surface of the implanted bone from drying. Humidifying water 23
Is preferably made of, for example, sterile water or physiological saline, and need not necessarily be discharged after the sterilization treatment.

In the sterilization apparatus shown in FIG. 3, the surface temperature of the implanted bone is measured by an optical fiber thermometer. In the case of the present embodiment, the sterile container 3 is made of a bag made of a soft material, that is, a soft material. Temperature sensor 6 consisting of an optical fiber thermometer
Is fixed by the clamp member 13. These clamp members 13 are attached from the outside. The clamp member 13 presses the temperature sensor 6 against the measurement point on the surface of the implanted bone 4 via the wall of the container 3 forming a bag. The slight temperature resistance due to the thin wall of the bag is compensated accordingly by the computer of the control unit 10 in monitoring the temperature of the bone graft surface. The cable 11, which forms the signal line of the optical fiber thermometer, is connected to the control unit 10 by the sensor 6.
It is led to. Otherwise, the embodiment is the same as the embodiment shown in FIG. 1. Corresponding parts are denoted by the same reference numerals, and detailed description thereof will be omitted.

In the embodiment shown in FIG. 4, an optical fiber thermometer is also used for measuring the surface temperature of a bone graft. However, in the case of this embodiment, the temperature sensor 6 is disposed directly on the surface of the bone graft 4. Sterile container 3 consisting of a soft bag
Is closed by the self-sealing stopper 12, and the cable 11 is led out through the self-sealing stopper 12 and is also connected to the control unit 10. Even in the case of a rigid container, such a self-sealing stopper can be used, and the cable 11 can be led outside through the stopper. In this case, it is preferable that the cable 11 can be extracted from the container 3 after the sterilization process is completed. Otherwise, the embodiment is the same as the embodiment shown in FIG. 1. Corresponding parts are denoted by the same reference numerals, and detailed description thereof will be omitted.

FIG. 5 shows an embodiment of a rigid container, in which a terminal board 32 is integrally provided on a bottom wall 31 screwed into the container 30, and the cable 11 of the temperature sensor 6 is connected to the terminal board 32. Through to the outside.

[0032]

As described above, the apparatus for sterilizing a transplanted bone according to the present invention is heated not only from the surface of the transplanted bone but also from the inside of the transplanted bone. The time required for warming can be reduced. In addition, since the heating conditions are controlled by computer, the type of transplanted bone,
By using a program according to conditions such as size and shape, a wide range of bone grafts can be efficiently sterilized.

[Brief description of the drawings]

FIG. 1 is a front view showing a first embodiment of a sterilization apparatus according to the present invention using an infrared temperature sensor.

FIG. 2 is a front view showing a modified example of the aseptic container.

FIG. 3 is a front view showing a second embodiment of the sterilizing apparatus according to the present invention in which a temperature sensor is brought into contact with a transplant bone from outside the container by a clamp member.

FIG. 4 is a front view showing a third embodiment of a sterilization apparatus according to the present invention in which a signal line of a temperature sensor is led out through an automatic sealing stopper.

FIG. 5 is a front view showing still another modified embodiment of the aseptic container.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Microwave heating apparatus 2 Installation stand 3 Sterile container 4 Grafted bone 5 Reflector 6 Infrared temperature sensor 7 Display 8, 9 Keyboard 10 Control unit 11 Signal line 12 Automatic sealing stopper 13 Clamp member 20 Sterile container 21 Screw cover 22 Screen 23 Water for humidification 30 Sterile container 31 Bottom wall 32 Terminal board

──────────────────────────────────────────────────の Continued on the front page (51) Int.Cl. ⁷ Identification symbol FI Theme coat ゛ (Reference) H05B 6/68 320 H05B 6/68 320Q 6/80 6/80 Z F-term (Reference) 2G066 AC20 BA18 BB07 CA02 3K086 AA03 AA10 CA04 CA20 CB04 CC02 CD07 FA07 3K090 AA03 AA20 AB05 AB16 FA05 4C058 AA30 BB06 CC04 DD02 DD04 DD12 EE16 EE26 KK04 KK43

Claims (21)

[Claims] 1. A method for heating and sterilizing a transplanted bone, wherein the transplanted bone is heated at a predetermined temperature for a predetermined time only by microwave irradiation. 2. The method according to claim 1, wherein the transplanted bone is heated in a closed sterile container at least partially formed of a material that transmits microwaves. 3. At least a part of the sealed sterile container has an infrared transmission property, and controls a microwave irradiation amount by measuring a surface temperature of the implanted bone with an infrared temperature sensor from the outside of the sealed sterile container. The heating sterilization method according to claim 2, characterized in that: 4. The heat sterilization according to claim 2, wherein the surface temperature of the implanted bone is measured by a temperature sensor disposed on the implanted bone to control the amount of microwave irradiation. Method. 5. A heating sterilization method according to claim 4, wherein said temperature sensor comprises an optical fiber thermometer. 6. The method according to claim 4, wherein the implanted bone is irradiated with microwaves intermittently, and the temperature measurement is performed by the temperature sensor during a rest period of the microwave irradiation. Heat sterilization method. 7. The heating sterilization method according to claim 2, wherein said closed sterile container is formed of a hard material. 8. The heating sterilization method according to claim 2, wherein said closed sterile container is formed of a soft material. 9. The method according to claim 9, wherein the surface temperature of the implanted bone is measured at a plurality of locations, and the measured values are compared with a predetermined reference value to control a microwave irradiation amount and / or a microwave irradiation distribution. The heating sterilization method according to claim 2, characterized in that it is characterized in that: 10. The heat sterilization method according to claim 1, wherein microwave irradiation is performed while humidifying the surface of the transplanted bone. 11. A housing defining a microwave cavity, a microwave irradiation source provided in the housing to irradiate microwaves into the cavity, and at least a portion of a microwave to be placed in the cavity. A sealed sterile container for implanted bone formed of a material that transmits waves, a temperature sensor for measuring a surface temperature of the implanted bone in the sealed sterile container, and the microwave irradiation source based on an output of the temperature sensor. And a control unit for controlling the temperature of the transplanted bone. 12. The heating and sterilizing apparatus according to claim 11, wherein the sealed sterile container is disposed on a movable installation table provided in the cavity. 13. The sealed sterile container, wherein at least a part of the container has infrared transmittance, and the temperature sensor comprises an infrared temperature sensor for measuring the surface temperature of the bone graft from outside the sealed sterile container. The heating and sterilizing apparatus according to claim 11, wherein 14. The method according to claim 1, wherein the temperature sensor is disposed on a surface of the bone graft.
2. The heating sterilizer according to claim 1. 15. The heating sterilizer according to claim 14, wherein said temperature sensor comprises an optical fiber thermometer. 16. The heating and sterilizing apparatus according to claim 11, wherein said sealed sterile container is formed of a hard material. 17. The method according to claim 16, wherein a screen for supporting the implanted bone is provided at a bottom of the closed sterile container, and is adapted to receive humidifying water below the screen. A heating sterilizer according to item 9. 18. The apparatus according to claim 16, wherein a terminal for a signal line of the temperature sensor is provided on a wall of the sealed sterile container. 19. The heating and sterilizing apparatus according to claim 11, wherein said sealed sterile container is formed of a soft material. 20. The heating apparatus according to claim 19, wherein the temperature sensor is disposed on a clamp member for clamping the bone graft from outside the sealed sterile container. Heat sterilizer. 21. The sealed sterile container made of the soft material has an automatic sealing stopper for closing an opening thereof, and a signal line of the temperature sensor is connected to the outside of the sealed sterile container via the automatic sealing stopper. 20. The heating and sterilizing apparatus according to claim 19, wherein the heating and sterilizing apparatus is drawn out of the apparatus.