JPWO2020007865A5 - - Google Patents

Description

FIG. 24 shows high density for the purpose of allowing blood, living cells and / or oxygen to be transported from the inside of the high density bone layer 1 to the opposite outside of the high density bone layer using the apparatus according to the present invention. Two different methods of perforating the bone layer of the bone are shown. In FIG. 24A, the device used introduces some micropores. The holes can have various cross sections, such as rectangular, elliptical, or irregular shapes. The cross section is preferably circular and may have a diameter of 1 to 2 mm. The perforator used in this method may have a solid distal end, pushing dense bone material into the trabecular section of the bone, thereby compressing the trabecular section. Alternatively, as shown in FIG. 24B, the device used comprises a hollow perforator or at least a hollow cutting tube of the perforator and the bone core is not removed. FIG. 2 4B shows a method of perforating a dense bone layer for the purpose of transporting blood, living cells and / or oxygen from the inside of the dense bone layer to the opposite outside of the dense bone layer. The above method comprises providing the apparatus according to the present invention, wherein the apparatus is a vibration generator, a shaft defining a main shaft shaft, and a hollow hollow defining a main punch shaft. Featuring a distal end piece with a substantially cylindrical perforator, the method further comprises a main perforator axis oriented substantially perpendicular to the dense bone layer and distal to the perforator. Positioning the device so that the edges are positioned relative to the dense bone layer and substantially cylindrical to penetrate the dense bone layer or at least into the dense bone layer. It comprises activating the vibration generator to hold the perforator against the dense bone layer and removing the perforator from the opening for a sufficient period of time to create the opening, thereby substantially. The cross section of the cylindrical opening is substantially annular. That is, the bone core is left in a substantially cylindrical opening. This bone structure contacts the lower trabecular bone and optionally deeper parts of the dense bone, but in the central, dense bone with the full (original) thickness of the treated bone. There is a cut with a closed outer shape and a bone structure. The diameter of the annular cross section of the cylindrical opening may be 0.1 to 0.75 mm, preferably 0.25 to 0.5 mm.

Claims (28)

A device for perforating a dense bone layer (1), said device including a vibration generator for generating mechanical vibrations and a distal end including a shaft (12) and a perforator (13). The shaft (12) has a distal end, a proximal end, and a main shaft shaft (A) extending between the proximal end and the distal end. , The distal end piece is located at the distal end of the shaft (12), the proximal end of the shaft is connected to or connectable to the vibration generator, said perforator (13). Has a solid or hollow cylinder or square column defining a main perforator shaft (B), the vibration generator, the shaft (12), and the distal end piece, the shaft (12) actuating. When connected to the vibration generator, mechanical vibration is transmitted from the vibration generator to the distal end piece to move the punch (13) in a direction parallel to the main punch shaft (B). Devices that are adapted to each other to vibrate. 2. The shaft (12) and the distal end piece having the perforator (13) are made integrally or rigidly coupled to each other to form one vibrating element. The device described. The device according to claim 1 or 2, wherein the perforator 13 includes a cutting tube (40). The device according to any one of claims 1 to 3, wherein the perforator (13) or the shaft (12) has an opening (41) suitable for storing the removed bone fragment (42). The shaft (12) or the perforator (13) comprises a conduit (43) suitable for supplying liquid to the opening (41) or for applying a vacuum to the opening (41). The device according to claim 4. The device according to any one of claims 1 to 3, wherein the main shaft shaft (A) and the main punch shaft (B) form an angle of> 90 ° and <180 °. The shaft (12) is designed or designed to vibrate primarily in transverse or bending mode.
The shaft (12) is designed to vibrate primarily in longitudinal mode, with the distal end piece having the perforator (13) having the shaft vibrating longitudinally on the main perforator shaft (B). The device of claim 6, which is designed to deflect longitudinal vibrations in a direction. The apparatus according to any one of claims 1 to 7, wherein the perforator (13) is a solid cylinder and has a concave distal surface (14') having a distal outer edge (18). The device according to any one of claims 1 to 7, wherein the perforator (13) or a cutting tube ( 40) thereof is a hollow cylinder and includes a distal edge (18). The device of claim 9, wherein the distal edge (18) terminates the taper inside and / or outside the cylindrical wall. 10. The device of claim 10, wherein the distal edge (18) comprises a groove (52) and / or a groove (53). 19. The distal edge (18) of claim 9 or 10, wherein the distal edge (18) comprises a ring (54) clamped into the opening of the hollow perforator (13) or the hollow cutting tube (40). Equipment. 9. The device of claim 9, wherein the distal edge (18) is formed by a ring (55) welded to the perforator (13) or the cutting tube (40). 19. The distal edge (18) is formed by a portion (57, 58) of the cutting tube (40 ) or the perforator (13) that is alternately bent outward and inward, claim 9. Equipment. The apparatus according to any one of claims 9 to 13, wherein the distal edge (18) is sharp or serrated, and the serrated shape has a visible range or a size below the visible range. The device according to any one of claims 1 to 15, wherein the distal end of the shaft (12) or the perforator (13) comprises a depth limiting element. The device according to any one of claims 1 to 15, further comprising a cannula (30), wherein the shaft (12) extends into a flute of the cannula (30). 17. The apparatus of claim 17, wherein the distal edge of the cannula (30) is a sharp or serrated edge or has a pin-shaped protrusion extending from the cannula (30). The device of any one of claims 17-18, wherein the distal end piece having the perforator (13) is retractable into the distal end of the cannula (30). The device of any one of claims 17-19, wherein the instrument (12) and / or the cannula (30) comprises at least one portion (18) of a larger cross section. The device of any one of claims 17-20, wherein the cannula (30) further comprises at least one conduit for transporting fluid to and / or from the repair site. One of claims 1 to 21, wherein the perforator (13) or the cutting tube (40) is provided with a protruding element (50) such as a rib suitable for applying a torsional force to the cut bone on the inner surface. The device described in the section. The device according to any one of claims 1 to 21, wherein the perforator (13) or the cutting tube (40) is provided with a slice element (51) suitable for chopping bone in an internal space. An instrument suitable for the apparatus of any one of claims 1-23, wherein the instrument has a shaft (12) and a solid or hollow substantially cylindrical perforator (13). An instrument with a distal end piece. 24. The device of claim 24, further comprising a cannula (30). By a method of perforating the high density bone layer for the purpose of transporting blood, living cells and / or oxygen from the inside of the high density bone layer (1) to the opposite outside of the high density bone layer. So, the above method is
The apparatus (10) according to claim 1 is provided, wherein the apparatus defines a vibration generator, a shaft (12) defining a main shaft shaft (A), and a main punch shaft (B). The method further comprises a distal end piece having a solid or hollow substantially cylindrical perforator (13).
The main perforator axis (B) is oriented non-parallel to the dense bone layer (1), preferably substantially perpendicular, and the distal end of the perforator (13) is said dense. Positioning the device (10) so that it is positioned with respect to the bone layer (1),
The vibrations so as to penetrate the dense bone layer (1) or at least for a time sufficient to create a substantially cylindrical opening (20) in the dense bone layer (1). Activating the generator to hold the perforator (13) against the dense bone layer (1).
A method comprising removing the perforator (13) from the opening (20). 26. The method of claim 26, performed in open surgery or minimally invasive surgery. The method of claim 26 or 27, wherein the dense bone layer (1) is the subchondral bone plate of a human or animal patient's joint, or the cortical bone plate of the vertebral body of a human or animal patient.