WO2000067645A1 - Outil chirurgical a rotation - Google Patents

Outil chirurgical a rotation Download PDF

Info

Publication number
WO2000067645A1
WO2000067645A1 PCT/EP2000/002253 EP0002253W WO0067645A1 WO 2000067645 A1 WO2000067645 A1 WO 2000067645A1 EP 0002253 W EP0002253 W EP 0002253W WO 0067645 A1 WO0067645 A1 WO 0067645A1
Authority
WO
WIPO (PCT)
Prior art keywords
tool
tool according
bone
receiving device
ultrasonic transducer
Prior art date
Application number
PCT/EP2000/002253
Other languages
German (de)
English (en)
Inventor
Bernhard V. Kleffner
H. Michael Mayer
Charles Wing
Original Assignee
Aesculap Ag & Co. Kg
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Aesculap Ag & Co. Kg filed Critical Aesculap Ag & Co. Kg
Priority to JP2000616678A priority Critical patent/JP3662851B2/ja
Priority to EP00912604A priority patent/EP1115338B1/fr
Publication of WO2000067645A1 publication Critical patent/WO2000067645A1/fr
Priority to US10/004,274 priority patent/US6719692B2/en

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
    • A61B17/16—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

Definitions

  • the invention relates to a rotating surgical tool for producing a recess in bone material.
  • a wide variety of rotating tools are known for producing depressions in bone material, for example drills, milling cutters, reamers, etc. All these tools have in common that they can be used to introduce depressions in various forms into the bone material, for example receiving bores for bone screws. It is of the utmost importance that these bores and depressions are placed in the bone in the desired manner, since in many cases there is only little 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 area of the spine in such a way that on the one hand they are fixed in the desired manner in the vertebral body and on the other hand they do not cause any injuries.
  • This object is achieved according to the invention in a rotating surgical tool of the type described in the introduction in that an ultrasound transducer is arranged in it which can transmit and receive ultrasound waves, and in that the ultrasound transducer can be connected to an ultrasound generator and a receiving device which depends on the strength of the Ultrasound radiation received by the ultrasound transducer and the time period between the emission of the ultrasound radiation and the reception of reflected ultrasound radiation generates signals which are a measure of the nature of the bone material in the radiation direction.
  • the 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 surfaces on which the structure of the bone material changes.
  • the reflected ultrasound radiation is captured by the transducer, and from the strength of the received signal and the time that has passed since the ultrasound radiation was emitted, information can be given about the nature of the bone material adjacent to the tool, in particular about the layer thickness of the bone material and possibly also about changes in the structure of the bone material. The surgeon can use this information to check the position of the tool in the bone and thus the position of the depression created by the tool.
  • separate transducers can be provided for the transmission and for the reception of the ultrasound radiation, but it is also possible to emit the ultrasound radiation with the same transducer and then to take up the reflected radiation again. This can be done, for example, with a so-called pulse-echo method.
  • 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 how the bone material is made in the machining direction, and is therefore given the opportunity to control the feed direction of the tool accordingly.
  • a particularly favorable embodiment results if the ultrasound transducer is arranged in the tool in such a way that its direction of transmission and reception for the ultrasound waves is inclined with respect to the axis of rotation, for example with an angle of inclination between 30 and 60 °, in particular in the order of magnitude of approximately 45 °.
  • the ultrasound radiation is emitted on a conical jacket that opens in the distal direction, and in this way the surgeon receives information not only exactly in the direction of advance of the rotating tool, but about the entire angle of rotation of the tool in a region that is distal Direction in front of the tool. This results in an optimal orientation over the bone areas still to be processed.
  • the tool has an inner receiving space for the ultrasound transducer, which is connected to a channel running in the tool up to its proximal end. Connection lines for the ultrasound transducer can run through this channel.
  • the tool is a drilling tool with a conical cutting surface and the ultrasound transducer is arranged in the region of the conical cutting surface.
  • the tool comprises a sensor for its angular position and if the sensor feeds a signal corresponding to the angular position to the receiving device, which thus generates the signals for the condition of the bone as a function of the angular position of the tool.
  • the ultrasound transducer forms, as it were, a camera arranged on a rotatable carrier, which covers the entire area in front of the tool in all directions.
  • the receiving device is assigned an optical display device which displays the signals generated by the receiving device for the bone quality. Such a display device can therefore be used to directly read how the bone is made in the direction of radiation of the ultrasound radiation, what bone wall thickness is available here and which structural changes may occur.
  • cross sections through the tool and the adjacent bone material can be displayed on the optical display device, the nature of the bone material being determined by the signals generated by the receiving device.
  • These cross sections simultaneously show the signals generated by the receiving device, which result from different angular positions of the tool, so that information about the condition of the bones is obtained simultaneously over the entire angular range.
  • the cross-sectional area shown is a conical surface, the axis of which coincides with the axis of rotation of the tool and which opens in the distal direction.
  • Cross sections of implants that show in can also be shown on the optical display device how certain implants should be placed in the bone after implantation.
  • the surgeon thus has the possibility, with knowledge of the implant shape and the desired position of the implant, to set depressions, for example boreholes, in such a way that their position corresponds to the shape and position of the implant.
  • the image of the implant can be generated from a data memory in which the display data for this implant are stored. From this data, the image of the image that results from the ultrasound signals can be superimposed.
  • the receiving device can also be assigned, for example, an optically or acoustically operating warning device which warns the operator that the wall thickness of the bone material in the area to be processed is below a certain value, so that there is a risk of breakthrough.
  • Figure 1 is a schematic view of a drilling tool attached to a vertebral body with an ultrasound monitoring device with an optical display and
  • Figure 2 is an enlarged sectional view in area A in Figure 1 with a drilling tool equipped with an ultrasonic transducer.
  • the invention is discussed below using the example of a drilling tool, but in principle the invention can also be used in other rotating machining tools, for example in milling cutters, reamers, trephines, etc., by means of which the bone material is machined by rotary movement, in particular for the production of Holes and other recesses.
  • 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 which produces a bore 5 with its tip 3 in a bone 4, in the exemplary embodiment shown in a vertebral bone in the pedicle area.
  • this twist drill 2 is provided with an inner channel 6 which extends from the proximal end to the distal end region and which ends in a receiving space 7 which in turn is located directly behind the conical cutting surface 8 of the twist drill 2.
  • An ultrasound transducer 9 is arranged in this receiving space 7, which can radiate ultrasound radiation essentially perpendicular to the cutting surface 8 and can absorb ultrasound radiation impinging on it from this direction. This can be a single ultrasound transducer 9 or two separate ultrasound transducers, each of which is designed to emit or receive ultrasound radiation.
  • the ultrasound transducer is connected via a line (not shown in the drawing) which leads through the inner channel 6 to a line 10 which, starting from the hand drill 1, ends at a transmitting and receiving device 11, which in turn has a line 12 with a display device 13 connected is.
  • the transmitting and receiving device 11 can work, for example, as a so-called pulse-echo system and generate and record ultrasound radiation with frequencies in the order of 15 MHz.
  • This ultrasound radiation is emitted in the form of a pulse by the ultrasound transducer 9 into the surrounding bone 4 and is reflected there at inhomogeneities and at interfaces, for example at the interface 14 with the medullary cavity 15 of the vertebral bone.
  • the reflected radiation then hits the ultrasonic transducer 9 again and is converted there into an electrical signal, which is fed to the transmitting and receiving device 11.
  • the size of the signal corresponding to the reflected radiation depends on the strength of the reflection of 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 to an interface and the nature of the bone material, because of this nature affects the speed of propagation of ultrasound radiation.
  • the reflection signals supplied 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 jacket, that is to say in an area which is distally in front of the twist drill 2 and into which the twist drill 2 will enter during further processing.
  • the signals picked up 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 twist drill 2, the area of the bone swept by the ultrasound radiation around the twist drill 2 is displayed, so that the operator can perform one receives an optical display of how the bone material around the twist drill 2 is made in a region lying distally in front of the twist drill, for example how large the distance is to the next cavity or to an interface of the bone.
  • This enables the surgeon to direct the twist drill 2 so that when it penetrates further into the bone 4 it is always centered as precisely as possible in the bone material and maintains a sufficient distance from the interfaces of the bone. It is also possible in this way to direct the drill bit into areas of particularly strong bone material, since the reflected ultrasound signals le also provide information about the nature of the bone material, for example the speed of propagation of the ultrasound waves in the bone tissue changes with differently structured bone tissue.
  • An ultrasound camera with a receiving device is thus installed in the tip of the twist drill 2, which observes the area which is arranged in front of the tip of the twist drill 2 and which thus provides the operator with information about which bone areas the twist drill 2 will get into upon further penetration.

Abstract

L'invention vise à optimiser la manipulation d'un outil chirurgical à rotation servant à pratiquer un évidement dans un matériau osseux. A cet effet, un transducteur ultrasonore pouvant émettre et recevoir des ondes ultrasonores est placé dans ledit outil chirurgical. De plus, ce transducteur ultrasonore peut être relié à un générateur d'ultrasons et à une unité réceptrice qui, en fonction de l'intensité du rayonnement ultrasonore reçu par le transducteur ultrasonore et en fonction du laps de temps qui s'écoule entre l'émission du rayonnement ultrasonore et la réception du rayonnement ultrasonore réfléchi, produit des signaux permettant de déterminer la structure du matériau osseux dans le sens d'émission du rayonnement.
PCT/EP2000/002253 1999-05-07 2000-03-15 Outil chirurgical a rotation WO2000067645A1 (fr)

Priority Applications (3)

Application Number Priority Date Filing Date Title
JP2000616678A JP3662851B2 (ja) 1999-05-07 2000-03-15 回転外科用工具
EP00912604A EP1115338B1 (fr) 1999-05-07 2000-03-15 Outil chirurgical a rotation
US10/004,274 US6719692B2 (en) 1999-05-07 2001-10-23 Rotating surgical tool

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
DE19921279.1 1999-05-07
DE29908259U DE29908259U1 (de) 1999-05-07 1999-05-07 Rotierendes chirurgisches Werkzeug
DE19921279A DE19921279C1 (de) 1999-05-07 1999-05-07 Rotierendes chirurgisches Werkzeug

Related Child Applications (1)

Application Number Title Priority Date Filing Date
US10/004,274 Continuation US6719692B2 (en) 1999-05-07 2001-10-23 Rotating surgical tool

Publications (1)

Publication Number Publication Date
WO2000067645A1 true WO2000067645A1 (fr) 2000-11-16

Family

ID=26053277

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP2000/002253 WO2000067645A1 (fr) 1999-05-07 2000-03-15 Outil chirurgical a rotation

Country Status (2)

Country Link
DE (2) DE19921279C1 (fr)
WO (1) WO2000067645A1 (fr)

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DE102010042012A1 (de) 2010-10-05 2012-04-05 Aces Gmbh Instrument mit Ultraschallsonde zur Pedikelpräparation
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US9037250B2 (en) 2001-07-11 2015-05-19 Nuvasive, Inc. System and methods for determining nerve proximity, direction and pathology during surgery
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US9743853B2 (en) 1999-11-24 2017-08-29 Nuvasive, Inc. Electromyography system
US9827109B2 (en) 1999-03-07 2017-11-28 Nuvasive, Inc. Methods and apparatus for performing spine surgery
US9949840B1 (en) 2011-04-01 2018-04-24 William D. Smith Systems and methods for performing spine surgery
US10245043B2 (en) 2013-07-09 2019-04-02 Stryker Corporation Surgical drill having a brake that, upon the drill bit penetrating through bone, prevents further insertion of the drill
US10299756B1 (en) 2005-09-27 2019-05-28 Nuvasive, Inc. System and methods for nerve monitoring
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US9743853B2 (en) 1999-11-24 2017-08-29 Nuvasive, Inc. Electromyography system
US9931077B2 (en) 2001-07-11 2018-04-03 Nuvasive, Inc. System and methods for determining nerve proximity, direction and pathology during surgery
US10716509B2 (en) 2001-07-11 2020-07-21 Nuvasive, Inc. System and methods for determining nerve proximity, direction and pathology during surgery
US9456783B2 (en) 2001-07-11 2016-10-04 Nuvasive, Inc. System and methods for determining nerve proximity, direction and pathology during surgery
US9037250B2 (en) 2001-07-11 2015-05-19 Nuvasive, Inc. System and methods for determining nerve proximity, direction and pathology during surgery
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