SE462417B - SETTING AND DEVICE FOR WORKING BENCEMENT FOR FIXING A PROTECTION IN ONE BONE - Google Patents
SETTING AND DEVICE FOR WORKING BENCEMENT FOR FIXING A PROTECTION IN ONE BONEInfo
- Publication number
- SE462417B SE462417B SE8804078A SE8804078A SE462417B SE 462417 B SE462417 B SE 462417B SE 8804078 A SE8804078 A SE 8804078A SE 8804078 A SE8804078 A SE 8804078A SE 462417 B SE462417 B SE 462417B
- Authority
- SE
- Sweden
- Prior art keywords
- cavity
- bone
- bone cement
- cement
- fixing
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—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
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8802—Equipment for handling bone cement or other fluid fillers
- A61B17/8805—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
- A61B17/8808—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it with sealing collar for bone cavity
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30721—Accessories
- A61F2/30723—Plugs or restrictors for sealing a cement-receiving space
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
- A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2002/30433—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0041—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Surgery (AREA)
- Biomedical Technology (AREA)
- Engineering & Computer Science (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Prostheses (AREA)
Description
462 417 10 15 20 25 30 35 2 beskrives ett blandningsförfarande, vid vilket inbland- ningen av luft i bencementen reduceras genom att bland- ningen av komponenterna utföres under vakuum. Enligt den amerikanska patentskriften 4 373 217 reduceras antalet luftblåsor i polymeriserad bencement genom att bland- ningen utsättes för högt tryck under en speciell fas av polymerisationen. 462 417 10 15 20 25 30 35 2 describes a mixing process in which the mixing of air in the bone cement is reduced by carrying out the mixing of the components under vacuum. According to U.S. Pat. No. 4,373,217, the number of air bubbles in polymerized bone cement is reduced by subjecting the mixture to high pressure during a particular phase of the polymerization.
Bencementens inträngning i det spongiösa benet är beroende av hur noggrant hàligheten, t ex en märgkanal, är rengjord med avseende på devitaliserad vävnad. In- trängningen är också beroende av cementviskositet och appliceringstryck. Ju lägre cementviskositeten är och ju högre appliceringstrycket är, desto lättare sker inträng- ningen. Vid avtagande viskositet och ökande tryck ökar emellertid PMMA-massans avgivning av lättflyktiga mono- merer, vilka visat sig vara cytotoxiska, dvs ha skadlig inverkan på vitala celler, och därmed kan förorsaka väv- nadsskador. Lokalt kan monomererna härvid förorsaka stör- ningar i blodflödet, intravasal hemolys och inflammato- riska reaktioner, som leder till ischemi, nekroser och resorption av bensubstans. Monomererna har emellertid visat sig ge inte bara lokalskadliga effekter utan också skadliga systemeffekter, exempelvis i form av hjärtpåver- kan och fettembolier i lungorna.Penetration of the bone cement into the spongy bone depends on how thoroughly the cavity, such as a medullary canal, is cleaned with respect to devitalized tissue. The penetration is also dependent on cement viscosity and application pressure. The lower the cement viscosity and the higher the application pressure, the easier the penetration. With decreasing viscosity and increasing pressure, however, the PMMA mass' release of volatile monomers, which have been shown to be cytotoxic, ie have a detrimental effect on vital cells, and thus can cause tissue damage. Locally, the monomers can cause disturbances in blood flow, intravascular hemolysis and inflammatory reactions, which lead to ischemia, necrosis and resorption of bone substance. However, the monomers have been shown to have not only local harmful effects but also harmful system effects, for example in the form of cardiac effects and fat embolisms in the lungs.
Vävnadsskador kan också uppkomma på annat sätt. För att göra plats för en protes i exempelvis ett lârben av- lägsnas större delen av benmärgen, vilket medför skador på blodkärl och därmed leder till försämrat blodflöde med risk för ischemi och vävnadsdöd. PMMA-cementens polymeri- sation sker under värmeavgivning, varvid den lokala tem- peraturökningen är proportionell mot mängden cement. En för hög temperatur kan i sig förorsaka vävnadsskador, och dessutom ökar avgivningen av skadliga monomerer med ökande temperatur. Ändamålet med föreliggande uppfinning är att åstad- komma ett sätt, som gör det möjligt att ástadkomma en ordentlig och varaktig fixering av en protes i en hålig- 10 15 20 25 30 35 462 417 3 het med hjälp av bencement, varvid de ovan beskrivna nackdelarna i största möjliga utsträckning elimineras genom att en ordentlig och jämnt fördelad inträngning av bencement i det spongiösa benet åstadkommes med minsta möjliga skador på benvävnad och blodkärl och minsta möj- liga förekomst av luftblåsor i bencementen.Tissue damage can also occur in other ways. To make room for a prosthesis in, for example, a femur, most of the bone marrow is removed, which causes damage to blood vessels and thus leads to impaired blood flow with a risk of ischemia and tissue death. The polymerization of PMMA cement takes place during heat dissipation, with the local temperature increase being proportional to the amount of cement. Too high a temperature can in itself cause tissue damage, and in addition, the release of harmful monomers increases with increasing temperature. The object of the present invention is to provide a method which makes it possible to achieve a proper and permanent fixation of a prosthesis in a cavity by means of bone cement, the disadvantages described above is eliminated as far as possible by achieving a proper and evenly distributed penetration of bone cement into the spongy bone with the least possible damage to bone tissue and blood vessels and the least possible occurrence of air bubbles in the bone cement.
Detta ändamål uppnås enligt uppfinningen med ett sätt att bearbeta i en hålighet i ett ben, exempelvis i märgkanalen i ett lårben, införd bencement för fixering av en protes i håligheten, vilket sätt kännetecknas därav, att den i håligheten införda bencementen vibreras meka- niskt.This object is achieved according to the invention with a method of machining in a cavity in a bone, for example in the medullary canal in a femur, inserted bone cement for fixing a prosthesis in the cavity, which method is characterized in that the bone cement inserted in the cavity is mechanically vibrated.
Genom att bencementmassan vibreras elimineras en del av de vid blandningen av komponenterna erhållna luftblà- sorna medan andra sönderdelas till mindre blåsor, som i mindre utsträckning än de större luftblåsorna utgör brottanvisningar i bencementen. Vibrationerna gör ben- cementmassan mer formbar och lättrörlig, vilket gör att .den lättare och på ett mer jämnt fördelat vis intränger i det spongiösa benet. Genom att cementens inträngning underlättas behöver något större tryck inte appliceras på cementen. Genom att bencementmassans formbarhet ökar kan härdnings- eller polymerisationsprocessen få fortgå något längre än tidigare, innan massan appliceras i hå- ligheten, vilket gör att PMMA-cementens avgivning av skadliga monomerer i håligheten reduceras. Då PMMA-cemen- tens polymerisation tillåtes fortgå längre tid utanför håligheten avges en stor del av det vid polymerisationen utvecklade värmet redan innan cementen kommer i beröring med vävnaderna i håligheten.By vibrating the bone cement mass, some of the air bubbles obtained from the mixing of the components are eliminated, while others are broken down into smaller bubbles, which to a lesser extent than the larger air bubbles constitute fracture indications in the bone cement. The vibrations make the bone cement mass more malleable and easily mobile, which makes it penetrate the spongy bone more easily and in a more evenly distributed manner. By facilitating the penetration of the cement, no greater pressure needs to be applied to the cement. As the formability of the bone cement mass increases, the curing or polymerization process may be allowed to proceed slightly longer than before, before the mass is applied in the cavity, which means that the release of harmful monomers in the cavity of the PMMA cement is reduced. As the polymerisation of the PMMA cement is allowed to continue for a longer period of time outside the cavity, a large part of the heat developed during the polymerization is given off even before the cement comes into contact with the tissues in the cavity.
Den i håligheten införda bencementen kan tryckbelas- tas något medan den vibreras. Ändamålet med föreliggande uppfinning är också att åstadkomma en anordning för genomförande av detta sätt.The bone cement inserted into the cavity can be pressurized slightly while it is vibrating. The object of the present invention is also to provide a device for carrying out this method.
Detta ändamål uppnås enligt uppfinningen med en an- ordning för bearbetning av i en hålighet i ett ben, exem- pelvis i märgkanalen i ett lårben, införd bencement för 10 15 20 25 30 35 462 417 4 fixering av en protes i håligheten, vilken anordning kännetecknas av ett vibrationsorgan, som är anordnat att vibrera den i håligheten införda bencementen.This object is achieved according to the invention with a device for processing in a cavity in a bone, for example in the medullary canal of a femur, inserted bone cement for fixing a prosthesis in the cavity, which device characterized by a vibrating means, which is arranged to vibrate the bone cement inserted into the cavity.
Vibrationsorganet är lämpligen anordnat att utföra en rotationsrörelse.The vibrating means is suitably arranged to perform a rotational movement.
Vid en föredragen utföringsform har anordningen ett tryckbelastningsorgan, som har mot hálighetens tvärsek- tionsform svarande tvärsektionsform och är anordnat att införas i håligheten för att anpressas mot den däri in- förda bencementen.In a preferred embodiment, the device has a pressure loading means which has a cross-sectional shape corresponding to the cross-sectional shape of the cavity and is arranged to be inserted into the cavity to be pressed against the bone cement introduced therein.
Uppfinningen ska nu beskrivas närmare under hänvis- ning till bifogade ritning, som schematiskt och delvis i sektion visar en försöksanordning vid genomförande av ett försök.The invention will now be described in more detail with reference to the accompanying drawing, which schematically and partly in section shows an experimental device when carrying out an experiment.
Den vid försöket utnyttjade och på ritningen schema- tiskt visade anordningen har en böjlig axel 1, som vid sin ena ände är kopplad till en motor (icke visad) med ett varvtal av 16.000 varv/minut och som vid sin andra ände är kopplad till en chuck 2, vars normala användning är i en tandläkarborrutrustning. Ett metallrör 3 är an- ordnat kring chucken 2. Ett stålstift 4 med en diameter av ca 2,5 mm är infört i chucken 2 och sträcker sig axiellt ett stycke utanför metallröret 3. Stâlstiftet 4 har ett radiellt utsprâng 5 vid sin fria ände. En gummi- packning 6, som har ett centrumparti och ett runtomgàende kragparti, är med sitt centrumparti infäst i metallrörets 3 fria ände medelst låsskruvar 7. Gummipackningen 6 har en genomgående centrumborrning, i vilken en vid sin fria ände tillsluten metallhylsa 8 är infäst.The device used in the experiment and shown schematically in the drawing has a flexible shaft 1, which at its one end is connected to a motor (not shown) at a speed of 16,000 rpm and which at its other end is connected to a chuck 2, the normal use of which is in dental equipment. A metal pipe 3 is arranged around the chuck 2. A steel pin 4 with a diameter of about 2.5 mm is inserted into the chuck 2 and extends axially a distance outside the metal pipe 3. The steel pin 4 has a radial projection 5 at its free end. A rubber gasket 6, which has a center portion and a circumferential collar portion, is fixed with its center portion to the free end of the metal tube 3 by means of locking screws 7. The rubber gasket 6 has a continuous center bore, in which a metal sleeve 8 closed at its free end is attached.
Stâlstiftet 4 sträcker sig in i metallhylsan 8, och dess radiella utsprâng 5 anligger mot metallhylsans 8 in- sida och snedställer metallhylsan något. På ritningen visas stålstiftet 4 i ett sådant rotationsläge, att det radiella utsprànget 5 är riktat åt höger och därmed sned- ställer metallhylsan 8 åt höger. Då stàlstiftet 4 rote- rar, utför metallhylsan 8 en rotationsrörelse, i vilken den väsentligen beskriver en kon. 10 15 20 462 417 5 Anordningen visas på ritningen införd i en hålighet 9 i ett ben 10, vilket i det genomförda försöket utgjor- des av ett nekroben från nöt. I benet 10, vilket utgjor- des av den distala delen av femur som kapats horisontellt strax ovanför kondylerna, har borrats ett vertikalt, ca 4 cm djupt hål med en diameter av ca 34 mm. Det inter- spongiösa fettet har avlägsnats genom uppvärmning i vat- ten. I hålet, vilket bildar hâligheten 9, infördes efter blandning av de ingående komponenterna en PMMA-bencement- massa ll. Försöksanordningen nedfördes sedan i hålig- heten 9 på sådant sätt, att metallhylsan 8 nedfördes i bencementmassan ll och gummipackningens 6 krage, vilken såsom framgår har väsentligen samma diameter som hålig- heten 9, anlades lätt mot bencementmassan ll. Det axiella trycket var ca 0,2 kp/cmz. Stålstiftet 4 och därmed me- tallhylsan 8 roterades under 30 sekunder, så att ben- cementmassan ll vibrerades, varefter anordningen togs bort.The steel pin 4 extends into the metal sleeve 8, and its radial projections 5 abut against the inside of the metal sleeve 8 and tilt the metal sleeve slightly. The drawing shows the steel pin 4 in such a rotational position that the radial projection 5 is directed to the right and thus tilts the metal sleeve 8 to the right. As the steel pin 4 rotates, the metal sleeve 8 performs a rotational movement, in which it essentially describes a cone. The device is shown in the drawing inserted in a cavity 9 in a bone 10, which in the experiment carried out consisted of a necrobe from a nut. In the leg 10, which consisted of the distal part of the femur which was cut horizontally just above the condyles, a vertical hole, about 4 cm deep with a diameter of about 34 mm, was drilled. The interpongious fat has been removed by heating in the water. After mixing the constituent components, a PMMA bone cement pulp 11 was introduced into the hole, which forms the cavity 9. The test device was then lowered into the cavity 9 in such a way that the metal sleeve 8 was lowered into the bone cement mass 11 and the collar of the rubber gasket 6, which as can be seen has substantially the same diameter as the cavity 9, was easily applied to the bone cement mass 11. The axial pressure was about 0.2 kp / cm 2. The steel pin 4 and thus the metal sleeve 8 was rotated for 30 seconds, so that the bone cement mass 11 was vibrated, after which the device was removed.
Efter avslutad polymerisation undersöktes benet l0, varvid klart framgick att bencementmassans inträngning i det spongiösa benet var djupare och avsevärt jämnare för- delad än vad fallet var då samma försök utfördes utan vibration av bencementmassan.After completion of the polymerization, the bone 10 was examined, and it was clear that the penetration of the bone cement mass into the spongy bone was deeper and considerably more evenly distributed than was the case when the same experiment was performed without vibration of the bone cement mass.
Claims (5)
Priority Applications (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| SE8804078A SE462417B (en) | 1988-11-11 | 1988-11-11 | SETTING AND DEVICE FOR WORKING BENCEMENT FOR FIXING A PROTECTION IN ONE BONE |
| PCT/SE1989/000648 WO1990004953A1 (en) | 1988-11-11 | 1989-11-10 | Method and apparatus for working bone cement for fixing a prosthesis in a bone |
| AU45128/89A AU4512889A (en) | 1988-11-11 | 1989-11-10 | Method and apparatus for working bone cement for fixing a prosthesis in a bone |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| SE8804078A SE462417B (en) | 1988-11-11 | 1988-11-11 | SETTING AND DEVICE FOR WORKING BENCEMENT FOR FIXING A PROTECTION IN ONE BONE |
Publications (3)
| Publication Number | Publication Date |
|---|---|
| SE8804078D0 SE8804078D0 (en) | 1988-11-11 |
| SE8804078L SE8804078L (en) | 1990-05-12 |
| SE462417B true SE462417B (en) | 1990-06-25 |
Family
ID=20373912
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| SE8804078A SE462417B (en) | 1988-11-11 | 1988-11-11 | SETTING AND DEVICE FOR WORKING BENCEMENT FOR FIXING A PROTECTION IN ONE BONE |
Country Status (3)
| Country | Link |
|---|---|
| AU (1) | AU4512889A (en) |
| SE (1) | SE462417B (en) |
| WO (1) | WO1990004953A1 (en) |
Families Citing this family (11)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP0598964B1 (en) * | 1992-11-20 | 1999-07-07 | Sulzer Orthopädie AG | Bone cement dispenser body for implant fixation |
| GB2277448A (en) * | 1993-04-19 | 1994-11-02 | Paul Albert Thodiyil | Ultrasound apparatus and method for securing or removing a prosthesis |
| DE4316655C2 (en) * | 1993-05-11 | 2003-10-30 | Biomet Merck Deutschland Gmbh | Filling device for bone cement |
| DE29919110U1 (en) * | 1999-11-01 | 2000-01-27 | Dunsch-Herzberg, Renate, 22880 Wedel | Device for introducing bone cement into a bone tube |
| AU2002245702A1 (en) | 2001-03-19 | 2002-10-03 | Cambridge Polymer Group Inc. | System and methods for reducing interfacial porosity in cements |
| US20050010231A1 (en) * | 2003-06-20 | 2005-01-13 | Myers Thomas H. | Method and apparatus for strengthening the biomechanical properties of implants |
| US7261717B2 (en) | 2003-09-11 | 2007-08-28 | Skeletal Kinetics Llc | Methods and devices for delivering orthopedic cements to a target bone site |
| US8118812B2 (en) | 2004-03-09 | 2012-02-21 | Skeletal Kinetics, Llc | Use of vibration in composite fixation |
| US9707024B2 (en) | 2004-03-09 | 2017-07-18 | Skeletal Kinetics, Llc | Use of vibration in composite fixation |
| GB0419338D0 (en) * | 2004-09-01 | 2004-09-29 | Univ Dundee | Method for improving orthopaedic implants |
| US8057090B1 (en) * | 2005-08-31 | 2011-11-15 | Subrata Saha | Automated bone cement mixer |
Family Cites Families (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| GB2104390B (en) * | 1981-08-25 | 1984-08-01 | Univ Exeter | Pressurisation of cement in bones |
| US4462394A (en) * | 1982-05-03 | 1984-07-31 | Howmedica, Inc. | Intramedullary canal seal for cement pressurization |
| US4787751A (en) * | 1986-06-20 | 1988-11-29 | Marinus Bakels | Bone cement mixing device |
-
1988
- 1988-11-11 SE SE8804078A patent/SE462417B/en not_active IP Right Cessation
-
1989
- 1989-11-10 AU AU45128/89A patent/AU4512889A/en not_active Abandoned
- 1989-11-10 WO PCT/SE1989/000648 patent/WO1990004953A1/en unknown
Also Published As
| Publication number | Publication date |
|---|---|
| SE8804078L (en) | 1990-05-12 |
| AU4512889A (en) | 1990-05-28 |
| WO1990004953A1 (en) | 1990-05-17 |
| SE8804078D0 (en) | 1988-11-11 |
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