WO2008061645A1

WO2008061645A1 - Medical appliance for treatment of the human or animal body with mechanical pressure waves or shock waves

Info

Publication number: WO2008061645A1
Application number: PCT/EP2007/009745
Authority: WO
Inventors: Ernst H. Marlinghaus; Oliver Kraut; Josef Katona; Peter Muelhauser; Dieter Welti
Original assignee: Storz Medical Ag
Priority date: 2006-11-23
Filing date: 2007-11-10
Publication date: 2008-05-29
Also published as: DE102006057268A1; EP2097016A1

Abstract

A medical appliance for treatment of the human or animal body with mechanical pressure waves or shock waves has a device (16) for generating the pressure waves or shock waves, which device (16) comprises at least one periodically movable impact part (18), a drive (42) for the at least one impact part (18), and at least one baffle element (26) against which the at least one impact part (18) strikes in order to generate the pressure waves or shock waves in the baffle element (26). The at least one impact part (18) is movable along a circular trajectory (28) and, in moving along the circular trajectory (28), strikes against the at least one baffle element (26).

Description

Medical device for treating the human or animal body with mechanical pressure or shock waves

The invention relates to a medical device for treating the human or animal body with mechanical pressure or shock waves, with a device for generating the pressure or shock waves, which has at least one periodically movable impact part, a drive for the at least one impact part and at least one impact body against which proposes the at least one impact member for generating the pressure or shock waves in the impact body.

Such a medical device is known from the document DE 197 25 477 C2.

For the purposes of the present invention, "treatment of the human or animal body" is, for example, the treatment of soft tissue, in particular for pain therapy, the treatment of bone tissue, the destruction of body stones, the removal of plaque in vessels, the treatment of the teeth, but also that Removal of bone cement or the driving of bone nails or wire to understand. The known from the above-mentioned document DE 197 25 477 C2 medical device is used for treatment of fractures, Enthesiopathien, Tendopathien or even in periodontal disease. Another field of application of this known device is the pain therapy in the bony soft tissue area of the musculoskeletal system. All of these applications of the known medical device are also feasible with the medical device of the present invention.

The known device has as a device for generating the pressure or shock waves on a periodically movable impact member, a drive for the at least one impact member and at least one impact body. The impact part of the known medical device is a projectile which can be moved back and forth along a straight acceleration path and which is moved by means of a pneumatic drive between a proximal starting position and a distal end position in which the striking part strikes against the impact body.

The embodiment of the device for generating the pressure or shock waves with a linearly reciprocating impact member has the disadvantage that the impact member for each beat from a rest position in which the impact member has the speed zero, must be accelerated to a certain final speed, with which the striker strikes against the baffle body. This requires a sufficiently long acceleration distance for the impact part to reach the required final speed. If the acceleration distance is not sufficiently dimensioned, or if the impact part has too high a mass, the impact part can not hit the impact body with the required end speed, so that the generation of the pressure or shock waves can not take place with the energy required for the treatment. Also, by the reciprocating motion of the percussion part, the beat frequency in the known device is limited to about 30 hertz, because the impact part must return to its original position after each stroke. The linear reciprocation of the percussion part also requires a complex drive, both in the case of a drive electromagnetic type and in the case of a pneumatic or other type of drive. Further medical devices for the treatment of the human or animal body with mechanical pressure or shock waves are known from the documents DE 198 59 135 A1 ₁ DE 196 18 972 A1 and DE 196 24 446 C1. The instrument known from the first mentioned document is used to drive wire pins into bone material, which in the present case is also understood as a treatment of the human or animal body. The second document discloses a medical device for disintegrating body stones, and the third document refers to a medical device for removing bone cement. These known medical devices are based on the principle of generating pressure or shock waves by means of a linearly reciprocable striker. The various known devices differ only in each case by the distal-side configuration of the impact body, via which the pressure or shock wave is applied to the treatment site.

From the document WO 94/17771 a further device for pain therapy and / or for influencing the autonomic nervous system is known, in which a plurality of percussion parts are shot one after the other directly on the skin surface of a patient along a linear acceleration section, after which it emerges from a distal opening of the patient Device fall out.

The invention has for its object to provide a medical device of the type mentioned, in which the generation of the pressure or shock waves takes place in other ways than in the known devices.

According to the invention, this object is achieved in that the at least one impact part is movable along an orbit and, when circulating along the orbit, strikes against the at least one impact body.

The medical device of the invention dissolves from the drive concept of the known from the prior art devices for generating pressure or shock waves, by the device according to the invention the impact part in an orbit is moved. This means that the at least one impact part can always be moved in the same direction and does not have to reverse its direction of movement between the individual impacts against the impact body. Accordingly, it is also not necessary to accelerate the at least one impact part before each stroke again from a rest position.

The embodiment of the device for generating the pressure or shock waves with a guided in an orbit impact part has the further advantage that the size of the device can be kept smaller than in the conventional pressure or shock wave devices, due to the linear movement of the striker a must have much greater axial length to accelerate the impact part to the required final speed. In addition, the possibility is created to circulate a plurality of percussion parts in the same orbit, which is not possible with a linearly reciprocating striker.

In preferred embodiments, the orbit of the at least one percussion part is circular, elliptical or in the shape of an eight or spiral.

The circular configuration of the orbit has the advantage of the least design effort.

The at least one baffle advantageously sits at a circumferential position of the orbit. In the embodiment of the orbit in the form of an eight, the advantage is achieved that the impact body can be arranged centered at the intersection of the orbital path sections and thus, for example, with respect to the drive.

In a further preferred embodiment, a plurality of impact members are provided, which are arranged distributed along the orbit and rotate together along the orbit and beat successively against the at least one impact body. The provision of a plurality of impact parts has, on the one hand, the advantage that, with a symmetrical arrangement of the impact parts, an imbalance in the device can be avoided, and, on the other hand, that a higher impact frequency can be achieved with simultaneously lower rotational speed of the impact parts.

In a further preferred embodiment, the at least one impact part with a movement component is movable in the direction transverse to the orbit in order to be able to run past it after being hit against the at least one impact body.

Since the at least one impact part has to run past it due to the movement along an orbit after the impact against the impact body, this measure has the advantage that the impact body does not have to perform a stroke due to the impact, as in certain applications of pressure or shock waves of Advantage is, especially in soft tissue treatment or lithotripsy.

Alternatively, however, it is also possible for the at least one baffle body to be movable with a movement component in the direction transverse to the orbit, so that the at least one impact part can run past the at least one baffle body after impact.

In this embodiment, therefore, the impact body deviates after impact of the impact part of this, whereby the impact part can pass without or substantially without changing its direction of movement of the impact body. This measure has the advantage of a simpler guidance of at least one impact part, which may be rigidly connected, for example, in this embodiment with a rotor.

In a further preferred refinement, the at least one impact body has a movable element against which the at least one impact part strikes, and which thereby transmits the impact pulse to the remaining part of the impact body. This embodiment is now particularly advantageous in order to make it possible for the impact part to strike the baffle body after impact, without the baffle body or the impact part having to have a movement in the direction transverse to the orbit, since the movable element is at the beater end the impact body moves accordingly and evades the impact part by the impact, so that it can pass the impact body.

In a further preferred embodiment, the at least one impact part is connected to a rotatable by the drive in rotation rotor, via which the circulating movement of the at least one impact member is generated.

This embodiment is particularly suitable for driving the at least one impact member by means of an electric motor, wherein the rotor is then preferably seated on the output shaft of the electric motor and at the periphery of the rotor or spaced from the at least one impact member is arranged and connected to the rotor.

In this case, the at least one impact part can preferably be connected to the rotor via a flexible element.

This embodiment is suitable in connection with one of the abovementioned embodiments, according to which the at least one impact part with a movement component is movable transversely to the orbit. As a flexible element, for example, a strand, a thread or rope can be used, wherein the impact member is held during orbit along the orbit via centrifugal forces in conjunction with the flexible member in orbit.

Alternatively, the at least one impact part can preferably be connected to the rotor via a rod-shaped element. A connection of the percussion part via a rod-shaped element produces an advantageously stable connection with the rotor, which has the further advantage of a well-defined guidance of the percussion part along the orbit, wherein, if a mobility of the percussion part with movement component transverse to the orbit is required, the rod-shaped Element, for example, movably connected to the rotor or movably connected to the striker.

In a further preferred embodiment, the at least one impact member is designed to be movable relative to the rotor or as immovable projection on the rotor itself.

This configuration is advantageously very simple in terms of production since the design of the impact part can be made in one piece with the rotor, for example by molding protrusions, teeth or the like on the circumference of the rotor.

As an alternative to the above-mentioned embodiments with a rotor, it is also preferred if the at least one impact part runs in a guide along the orbit and is set in motion directly by the drive.

This embodiment is particularly suitable for a drive by means of compressed air, which acts directly on the at least one impact member and thereby set this in motion.

In all of the abovementioned embodiments, the at least one impact member preferably has a surface which is round or rounded at least in its region coming into contact with the impact body.

It is advantageous that the at least one impact member can easily run past the baffle without hooking with this, on the other hand is not in this embodiment for an exact relative positioning of the striker to Impact body in the strike exercise concern, because a more or less point-like contact between the impact part and impact body occurs.

The at least one impact member may be formed according to a further preferred embodiment as a ball, cylinder or as part thereof.

In the event that the at least one impact member is a ball, this is preferably performed in at least one centrifugal force-side or a centrifugal force remote channel, in particular in a ball-bearing-like cage.

The advantage of this measure is that the at least one impact part is guided well defined on its orbit.

According to a further preferred embodiment, the at least one impact part of a schlagharten material, in particular of metal, ceramic and / or plastic.

This measure not only contributes advantageously to increasing the life of the percussion part, but also to an improved generation of pressure or shock waves, since the impact energy is not converted into deformation energy. For example, zirconium oxide can be used as the ceramic and, for example, plexiglass and / or fiber-reinforced PEEK as plastic.

Furthermore, the at least one impact part preferably has a mass in the range from 0.5 to 150 g.

In yet another preferred embodiment, a plurality of baffles are provided which are distributed along the orbit.

In this case, on the one hand, it is advantageous that with an appropriate arrangement of the impact body, the pressure or shock waves are distributed over a larger area to the treatment area. be transferred. On the other hand, this measure has the advantage that different impact bodies with different properties with regard to the generation of pressure or shock waves can be provided on the same device, one of which can be used for a particular application. Thus, for example, a baffle body without a movement stroke, a baffle body with a small movement stroke, an impact body with a larger movement stroke, etc. or baffle bodies made of different materials or different application geometries can be provided on the same device.

The at least one impact part preferably strikes against the at least one impact body at a speed in the range from 1 to 100 m / s.

Furthermore, it is preferred if the at least one impact part is replaceable.

It is advantageous that impact parts of different masses or materials for generating pressure or shock waves of different energies can be used without changing the drive.

In a further preferred embodiment, the at least one baffle body at its end against which strikes the at least one impact member, flat, rounded, spherical, beveled, pointed or conical.

Depending on the choice of this impact end of the baffle body either different pressure or shock wave shapes can be generated.

In a further preferred embodiment, the at least one impact body is mounted with damping in a receptacle.

It is advantageous that the at least one baffle body can be decoupled from the housing of the device, so that vibrations in the housing of the device can be reduced or avoided. The storage of the at least one impact body with damping can be realized by an additional damping element against which the at least one baffle body is supported distally and / or proximally, or, as provided in a further preferred embodiment by the at least one baffle itself consists of a damping material, for example of a damping plastic ,

The at least one baffle body preferably executes a stroke of at most 10 mm, preferably less than 2 mm, due to the impact of the at least one striking part.

Preferably, the above-mentioned stroke is adjustable.

In a further preferred embodiment, the at least one impact body is transparent.

It is advantageous that the state of the baffle body controlled by visual inspection without loss of impact body from the device and in particular damage or signs of wear can be easily detected.

In a further preferred embodiment, the at least one baffle body constitutes a section of a geometric body defining two focal points, a focal point of which is located in the abutment region of the at least one impact member on the baffle body and a second focal point located distally of the distal end of the baffle body.

It is advantageous that the impact body has a self-focusing effect on the pressure or shock waves generated in it, wherein the second focal point distal from the distal end of the baffle body then in the application of the device in or at the treatment location. Such a geometric body can be, for example, a full ellipsoid, a paraboloid or the like.

The at least one impact body preferably consists of a schlagharten material. For this purpose, the materials come into question, as they were called above for the impact part.

Furthermore, the at least one impact body preferably has a pressure or shock wave focusing or scattering element at the distal end, depending on whether a treatment with focused pressure or shock waves or unfocused pressure or shock waves is desired.

In a further preferred embodiment, the at least one impact body is replaceable.

It is advantageous that the device can be adapted to the intended application case by selecting the appropriate impact body without further changes to the device, in particular on the drive or impact part, must be made.

In a further preferred embodiment, the at least one impact body can be sterilized, in particular autoclavable.

This embodiment has the advantage that the impact body can be used several times in the event that it comes into contact with the patient. However, it is also an embodiment of the impact body as a disposable part, for example as a plastic part, possible.

In a further preferred embodiment, the drive has an electric motor with variable speed. This embodiment of the drive is particularly suitable together with the above-mentioned embodiment, according to which the at least one impact member is connected to a rotor. The rotor can then sit directly on the output shaft of the electric motor. Due to the variable speed of the electric motor, the web speed of the striker on its orbit and thus the energy of the generated pressure or shock waves can be varied.

For a self-sufficient operation of the device, it is preferred in this context, when the electric motor is battery-powered.

As an alternative to an electric motor, the drive is preferably a pneumatic drive, in particular a compressed-air motor.

In this case, it is further preferred if the pneumatic medium acts directly on the at least one impact part and drives it, as already described above.

Another preferred alternative is that the drive is a mechanical drive, in particular a spring motor.

Such a spring motor, as it is known for example from movements, has the advantage that it is independent of an energy source and in particular can be built very low in weight.

The drive in one of the aforementioned embodiments is preferably arranged in a handle for holding the device in the hand.

The handle can thereby extend transversely to the orbit, which is particularly advantageous in a drive with an electric motor, since then no transmission is required for transmitting the rotational movement of the output shaft of the electric motor to the striker. In an alternative embodiment, the handle preferably extends parallel or obliquely to the orbit.

In the case of an electric drive, this can be realized by providing a transmission between the rotor, with which the impact member is connected, and the output shaft of the electric motor, in a pneumatic drive can be dispensed with such a transmission.

In a preferred application of the device according to the invention, the at least one impact body for the treatment of soft tissue by means of the pressure or shock waves on a blunt distal end for placement on the body surface.

The distal end of the at least one impact body is in this case preferably convex or concave.

Furthermore, in the above-mentioned application case, the distal end of the at least one baffle body is preferably provided with a cap for impedance matching to the body so that the generated pressure or shock waves can be coupled into the body via the skin as far as possible without reflection losses. Of course, an impedance matching gel may also be placed between the distal end of the baffle and the skin.

In another preferred application, the at least one impact body has a wire-shaped extension, via which the generated pressure or shock waves for body stone fragmentation or plaque removal are transferred into vessels.

The wire-shaped extension can be introduced endoscopically or by catheter to the place in the body where the body stones are to be smashed or the plaque in the vessels to be removed. In yet another application, the at least one baffle preferably has a chisel-like tool via which the generation of pressure or shock waves for bone cement removal are transmitted.

In another application, the at least one baffle body for the application of pressure and shock waves to the tooth or gums is formed.

It is also possible to form the at least one impact body as a receptacle for a bone wire in order to drive the bone wire into the bone material via the pressure or shock waves.

Further advantages and features will become apparent from the following description and the following drawings.

It is understood that the features mentioned above and those yet to be explained can be used not only in the particular combination given, but also in other combinations or in isolation, without departing from the scope of the present invention.

Embodiments of the invention are illustrated in the drawings and will be described in more detail with reference to this. Show it:

Figure 1 is a side view of a medical device for the treatment of the human or animal body with mechanical pressure or shock waves;

Figure 2 shows the device in Figure 1 in section along a line H-II in Figure 1;

Figure 3 shows the device in Figure 1 in a section along the line III-III in Figure 1; Figure 4 shows another embodiment of a medical device for

Treatment of the human or animal body with mechanical pressure or shock waves in a side view;

5 shows the device in Figure 4 in a section along the line V-V in Figure 4 and

Figure 6 is a plan view of the device in Figure 4 in a section along the

Line VI-VI in Figure 4.

In Figures 1 to 3 a provided with the general reference numeral 10 medical device for the treatment of the human or animal body is shown with mechanical pressure or shock waves.

The device 10 is used in the illustrated embodiment, for example, for the treatment of soft tissue in pain therapy.

The device 10 generally has a handle 12 and a treatment head 14, wherein the treatment head 14 is preferably designed to be detachable from the handle 12.

The device 10 has a device 16 for generating pressure or shock waves.

The device 16 has at least one, in the embodiment shown, four periodically movable impact parts 18, 20, 22 and 24. It can also be provided significantly more than four impact parts, but also less than four.

The device 16 further comprises at least one baffle 26, against which the beating parts 18 to 24 beat one after the other to produce a pressure or shock wave by each impact in the baffle 26. The periodic movement of the impact parts 18 to 24 is realized according to the invention in that the impact parts 18 to 24 circulate on an orbit 28. The direction of rotation of the striking parts 18 to 24 is illustrated in FIG. 3 by an arrow 30, but the direction of rotation may also be directed in the opposite direction.

The orbit 28 is self-contained, i. The percussion parts 18 to 24 move on the orbit 28 without reversal of movement periodically around a center 32 of the orbit 28 around. In the embodiment shown, the orbit 28 is circular in shape, but it come for the geometry of the orbit 28, other shapes such as ellipses, spirals or the shape of an eight in question.

When circulating the percussion parts 18 to 24 along the orbit 28 beat the individual percussion parts 18 to 24 respectively against a proximal end 34 of the impact body 26, wherein each stroke of one of the percussion parts 18 to 24 against the proximal end of 34 a pressure or shock wave in the impact body 26 is generated, which is transmitted according to an arrow 36 to a distal end of the impact body 26, wherein the shock or pressure wave then emerges from the distal end 38 of the impact body 26 and for the treatment of the human or animal body with the pressure or shock waves is available.

The impact parts 18 to 24 are formed in the present embodiment as balls, which consist of a solid material, in particular a schlagharten material, in particular wholly or partly made of metal. The impact parts 18 to 24 may each have a mass in the range of 0.5 to ISO g, wherein the mass in connection with the path velocity of the individual impact parts 18 to 24 determine the pulse with which the impact parts 18 to 24 strike against the impact body 26 , The web speed of the individual impact parts 18 to 24 is preferably in the range of 1 to 100 m / s when they strike against the impact body 26.

Each of the impact members 18 to 24 is connected to a rotor 40 which is connected to a drive 42. The drive 42 is in the illustrated embodiment, an electric motor 44, which is preferably battery operated, but may also be connected to an external power supply and control. In particular, the rotational speed of the electric motor 44 is variable in order to vary the rotational speed of an output shaft 46, to which the rotor 40 is connected, and thus to vary the path velocity of the impact parts 20. By varying the rotational speed of the electric motor 44, the beat frequency is also varied, with which the individual impact parts 18 to 24 strike against the impact body 26 for generating the pressure or shock waves. Since four impact parts 18 to 24 are provided in the exemplary embodiment shown, the fourfold impact frequency is already reached at the same speed of the electric motor 44 as if only a single impact part were provided. With the device according to the invention beat frequencies of far more than 30 Hz can be achieved, but it is possible to set also beat frequencies below 30 Hz.

The individual impact parts 18 to 24 are connected to the rotor 40 via a connecting element 48 or 50, 52 and 54. The connecting elements 48 to 54 are designed as flexible elements which permit movement of the individual impact parts 18 to 24 with a component of movement that is transverse to the orbit, i. in the present case of a circular orbit, are movable radially towards the center 32, in order to be able to pass after the impact against the impact body 26 in the circumferential direction 30 at this.

As a flexible element, a thread part or a flexible strand can be used for the individual connecting elements 48 to 54. However, the connecting elements 48 to 54 may also be formed as a rigid, rod-shaped elements, in which case the impact members 18 to 24 have a relative mobility to the connecting elements 48 to 54 with component of movement transverse to the orbit 28, as with a double arrow 56 for the impact member 18th indicated, or the connection element Mente 48 to 54 are correspondingly movable relative to the rotor in the longitudinal direction of the connecting elements 48 to 54.

When the impact parts 18 to 24 have a movement component with a movement component transverse to the orbit 28 as described above, the impact body 26 can be received in a receptacle 58 substantially without a stroke, or with a stroke of less than 1 mm.

In other embodiments, however, the baffle 26 may be accommodated with a larger stroke in the receptacle 58, for example with a stroke of more than 2 mm, or even with a stroke of 10 mm. Preferably, the stroke of the impact body 26 in the receptacle 58 is adjustable.

If the baffle 26 is received in the receptacle 58 so that it can perform a stroke greater than 1 mm therein, can be dispensed with the mobility of the impact members 18 to 24 with component of movement transverse to the orbit 28, but can also be considered in that both the impact parts 18 to 24 and the impact body 26 have a mobility with a component of movement transverse to the orbit.

Likewise, it is possible for the proximal end 34 of the impact body 26 to have a movable element, for example a ball spring-mounted in a ball socket at the proximal end 34 of the impact body 26, against which the impact parts 18 to 24 abut, whereby this movable element is proximal End 34 of the impact body 26 transmits the impact pulse to the remaining part of the impact body 26.

The impact parts 18 to 24, in particular in the case that they are connected to the rotor 40 via flexible connecting elements 48 to 54, run in a guide 60 in which the impact parts 18 to 24 are centripetally and / or centrifugally supported in a channel. In the case of the design of the impact parts 18 to 24 as balls, the guide 60 may be formed as a ball cage similar to a ball bearing cage. The provision of such a guide for the impact parts 18 to 24 is particularly advantageous when the impact parts 18 to 24 are not driven by a rotor, such as the rotor 40, and a rotary drive, such as the electric motor 44, but when the impact parts 18th are applied to 24 directly with compressed air, which moves the impact members 18 to 24 along the orbit 28.

Although the impact members 18 to 24 are formed as a ball in the illustrated embodiment, other geometries for the impact members may be provided, but it is preferred in any case, when the impact members 18 to 24 in their coming into contact with the baffle 26 area are round or rounded, as is always the case in the case of the design as balls.

The impact body 26 has at its proximal end 34, against which the striking parts 18 to 24 beat, a flat, rounded, spherical, beveled, pointed or conical shape, wherein in the illustrated embodiment, the proximal end 34 is rounded and flat.

Furthermore, it is provided that the impact parts 18 to 24 or individual thereof are replaceable, so that the impact parts 18 to 24 can be exchanged, for example, for impact parts with other shapes or with other masses or from other materials.

The same applies to the impact body 26, which is preferably also designed to be interchangeable, so that it can be exchanged for various impact bodies, which are adapted to the respective application in a suitable manner, which will be described below.

Likewise, it is preferred if distributed along the orbit 28 a plurality of baffles 26 are present, which may be configured differently among themselves, to 26 without replacing the baffle body 26 different applications allow or to achieve different effects with the pressure or shock waves within the same application.

Furthermore, the impact body 26 is mounted in the receptacle 58 in particular with damping, wherein the hardness of the damping is adjusted according to the desired application. The damping can be realized in that the impact body 26 is supported in the receptacle 58 via a damping element to the distal and / or proximal, or by the impact body 26 itself is made of a damping material, for example of a damping plastic. Likewise, the stroke of the impact body 26, if it has such a, preferably adjustable. The impact body 26 is formed at least at its proximal end 34 of a schlagharten material, in particular of metal. Other materials that are suitable for the baffle 26, schlagharte plastics such as Plexiglas or fiber reinforced PEEK and ceramics, such as zirconia. These materials are also suitable as materials for the impact parts 18 to 24, as well as metal.

The baffle 26 may also be made of a transparent material such as Plexiglas.

Depending on the desired medical application, the impact body 26 can have a pressure or shock wave focusing or scattering element at its distal end 38.

The at least one impact body 26 is preferably sterilizable, in particular autoclave, which is given in an embodiment of the impact body 26, for example made of metal, at least on its surface.

As is apparent from Figures 1 and 2, the handle 12 extends perpendicular to the orbit 28 of the impact members 18 to 24, which lends itself to the drive of the impact members 18 to 24 by means of the electric motor 44. With the handle 12, the medical device 10 is held in his hand during use. On the handle 12 is According to Figure 1, a switch 62 for switching on and off of the device 10 is arranged, wherein the switch 62 may be formed as a controller for the rotational speed of the electric motor 44 to the speed and thus the beat frequency and the web speed of the impact parts 18 to 24 in the desired Set way.

Instead of an arrangement of the handle 12 perpendicular to the orbit 28 of the impact parts 18 to 24 or perpendicular to the treatment head 14 and the effective direction of the impact body 26, an arrangement can be selected in which the handle 12 is aligned parallel to the drive 42. In the case of using a drive with an electric motor, this can be realized via a spur gear, as is known to the person skilled in the art.

Instead of a drive with an electric motor, a pneumatic drive may also be provided, in particular a compressed air motor. In the case of using a pneumatic drive, the impact parts 18 to 24 can also be driven directly via the pneumatic medium, without the impact parts 18 to 24 having to be connected to a rotor such as the rotor 40.

As a further alternative to an electromagnetic or a pneumatic drive, a purely mechanical drive may be provided, in particular a spring motor, as it is known from movements, and only has to be mounted before the use of the device 10.

FIGS. 4 to 6 show a modification of the exemplary embodiment in FIGS. 1 to 3, with only the differences from the exemplary embodiment in FIGS. 1 to 3 being described below. All features of the embodiment in Figures 4 to 10 are provided with the same reference numerals as the corresponding features in Figures 1 to 3, supplemented by '.

In the device 10 'in Figures 4 to 6, the impact parts 18' to 24 'are formed on the rotor 40' itself, in the embodiment shown even in one piece with this educated. The impact parts 18 'to 24' are formed as spherical cap-shaped ends of the connecting elements 48 'to 54'. Since the impact parts 18 'to 24' in this case are rigidly connected to the rotor 40 'in the simplest version, this configuration is particularly suitable if the impact body 26' can make a lift in the receptacle 58 ', or the proximal end 34 'of the impact body 26' is provided with a relative to the remaining part of the impact body 26 'movable member against which the impact members 18' to 24 'when circulating along the orbit 28' beat.

Depending on the intended use, for which the medical device 10 or 10 'is provided, the impact body 26 is designed in various ways.

In the embodiments shown, the baffle 26 or 26 'for treating soft tissue is formed with a blunt distal end 38 and 38', respectively, which can be placed directly on a patient's skin to focus the pressure or shock waves across the skin into the body or not focused to couple. In the embodiment shown, the blunt distal end 38 'of the baffle 26' is convex, providing some focussing, but the distal end 38 'may also be flat or concave to prevent focussing or even dispersion of the pressure or pressure To reach shock waves.

In the event that the baffle 26 'and the distal end 38' are made of metal, a cap may be provided for the distal end 38 'which is made of a material which allows impedance matching to the impedance of the body surface and also focussing or can have a scattering effect.

If the device 10 or 10 'is to be used for body stone fragmentation or for piaqueening in vessels, the at least one impact body 26 or 26' has a wire-shaped extension, via which the generated pressure or shock waves are transmitted to the treatment site. The wire-shaped extension can be in the form of an elongated wire with a length of more than 10 cm can be formed, in which case this wire can be introduced, for example via a catheter or an endoscope to the treatment site in the body. The configuration of the impact body 26 or 26 'can be selected in this case, as disclosed in the document DE 196 18 972 Al. In this regard, reference is made to that document.

When device 10 or 10 'is to be used for bone cement removal, praline body 26 or 26' comprises a chisel-like tool via which the generated pressure or shock waves are transmitted to the treatment site. A chisel-like tool is described for example in the document DE 196 24 446 Cl, to which reference is made here.

Likewise, the impact body 26 or 26 'for use of the device 10 or 10' may be formed so that the device 10 or 10 'can be used for pressure or shock wave treatment on the tooth or gums.

Likewise, the impact body 26 or 26 'according to the document DE 198 59 135 Al for receiving a wire pin, in particular a Kirschner wire, be formed to drive the wire pin by means of the impact body 26 and 26' generated pressure or shock waves in the bone material ,

Claims

claims

1. A medical device for the treatment of the human or animal body with mechanical pressure or shock waves, with a device (16) for generating the pressure or shock waves, the at least one periodically movable impact member (18), a drive (42) for the at least an impact member (18) and at least one impact body (26) against which the at least one impact member (18) for generating the pressure or shock waves in the impact body (26) suggests, characterized in that the at least one impact member (18) along a Orbital path (28) is movable and during rotation along the orbit (28) strikes against the at least one baffle body (26).

2. Apparatus according to claim 1, characterized in that the orbit (28) is circular, elliptical or in the shape of an eight or spiral.

3. Apparatus according to claim 1 or 2, characterized in that a plurality of impact members (18, 20, 22, 24) are provided, which are distributed along the orbit (28) and together along the orbit (28) rotate and successively strike against the at least one baffle (26).

4. Device according to one of claims 1 to 3, characterized in that the at least one impact member (18) with movement component in the direction transverse to the orbit (28) is movable to pass after the impact against the at least one baffle (26) on this to be able to.

5. Device according to one of claims 1 to 4, characterized in that the at least one impact body (26) with movement component in the direction transverse to the orbit (28) is movable so that the at least one impact member (18) after striking against the at least one baffle (26) can pass.

6. Device according to one of claims 1 to 5, characterized in that the at least one impact body (26) has a movable element, on which the at least one impact member (18) abuts, and thereby the impact pulse on the remaining part of the impact body ( 26) transmits.

7. Device according to one of claims 1 to 6, characterized in that the at least one impact member (18) with a by the drive (42) rotatable in the rotor (40) is connected, via which the orbital movement of the at least one impact member (18 ) is produced.

8. Apparatus according to claim 7, characterized in that the at least one impact member (18) with the rotor (40) via a flexible element (48) is connected.

9. Apparatus according to claim 7, characterized in that the at least one impact member (18) via a rod-shaped element (48) with the rotor (40) is connected.

10. Apparatus according to claim 7, characterized in that the at least one impact member (18) is formed as relative to the rotor (40) movable or immovable projection on the rotor (40) itself.

11. Device according to one of claims 1 to 6, characterized in that the at least one impact member (18) in a guide (60) along the orbit (28) and is directly offset by the drive in motion.

12. Device according to one of claims 1 to 11, characterized in that the at least one impact member (18) has a surface which at least in ih- rem with the impact body in contact area is round or rounded.

13. Device according to one of claims 1 to 12, characterized in that the at least one impact member (18) is formed as a ball, cylinder or as part thereof.

14. Apparatus according to claim 13, characterized in that the at least one impact member (18) is a ball which is guided in at least one centrifugal force-side or a centrifugal force-remote channel, in particular in a ball-bearing-like cage.

15. Device according to one of claims 1 to 14, characterized in that the at least one impact member (18) is made of a schlagharten material.

16. Device according to one of claims 1 to 15, characterized in that the at least one impact member (18) has a mass in the range of 0.5 to 150 g.

17. Device according to one of claims 1 to 16, characterized in that a plurality of impact bodies (26) is present, which are distributed along the orbit (28).

18. Device according to one of claims 1 to 17, characterized in that the at least one impact member (18) strikes against the at least one impact body (26) at a web speed in the range of 1 to 100 m / s.

19. Device according to one of claims 1 to 18, characterized in that the at least one impact member (18) is replaceable.

20. Device according to one of claims 1 to 19, characterized in that the at least one impact body (26) at its end, against which the at least one impact member (18) strikes, flat, rounded, spherical, bevelled, pointed or conical ,

21. Device according to one of claims 1 to 20, characterized in that the at least one impact body (26) is mounted with damping in a receptacle (58).

22. Device according to one of claims 1 to 21, characterized in that the at least one impact body (26) consists of a damping material.

23. Device according to one of claims 1 to 22, characterized in that the at least one impact body (26) by the impact of at least one impact member (18) carries out a stroke of a maximum of 10 mm, preferably less than 2 mm.

24. Apparatus according to claim 23, characterized in that the stroke is adjustable.

25. Device according to one of claims 1 to 24, characterized in that the at least one impact body (26) is transparent.

26. Device according to one of claims 1 to 25, characterized in that the at least one baffle body (26) consists of a schlagharten material.

27. Device according to one of claims 1 to 26, characterized in that the at least one baffle (26) constitutes a portion of a geometric body defining two focal points, wherein a focal point thereof in the abutment region of the at least one impact member on the baffle body and a second focal point located distal to the distal end of the baffle.

28. Device according to one of claims 1 to 27, characterized in that the at least one impact body (26) at the distal end (38) has a pressure or shock waves focusing or scattering element.

29. Device according to one of claims 1 to 28, characterized in that the at least one impact body (26) is replaceable.

30. Device according to one of claims 1 to 29, characterized in that the at least one impact body (26) sterilizable, in particular autoclavable.

31. Device according to one of claims 1 to 30, characterized in that the drive (42) has an electric motor (44) with variable speed.

32. Apparatus according to claim 31, characterized in that the electric motor (44) is battery operated.

33. Device according to one of claims 1 to 30, characterized in that the drive is a pneumatic drive, in particular a compressed air motor.

34. Apparatus according to claim 33, characterized in that the pneumatic medium acts directly on the at least one impact member (18) and drives this.

35. Device according to one of claims 1 to 30, characterized in that the drive is a mechanical drive, in particular a spring motor.

36. Device according to one of claims 1 to 35, characterized in that the drive in a handle (12) for holding the device (10) is arranged in the hand.

37. Apparatus according to claim 36, characterized in that the handle (12) extends transversely to the orbit (28).

38. Apparatus according to claim 36, characterized in that the handle (12) extends parallel or obliquely to the circulation path (28).

39. Device according to one of claims 1 to 38, characterized in that the at least one baffle (26) for the treatment of soft tissue by means of the pressure or shock waves has a blunt distal end (38) for placing on the body surface.

40. Apparatus according to claim 39, characterized in that the distal end (38) of the at least one impact body (26) is convex or concave.

41. Apparatus according to claim 39 or 40, characterized in that the distal end of the at least one impact body (26) is provided with a cap for Imedanzan- adaptation to the body.

42. Device according to one of claims 1 to 38, characterized in that the at least one baffle body has a wire-shaped extension, via which the generated pressure or shock waves for Körpersteinzertrümmerung or plaque removal in vessels are transmitted.

43. Device according to one of claims 1 to 38, characterized in that the at least one baffle body has a chisel-like tool, via which the generated pressure or shock waves are transmitted to the bone cement removal.

44. Apparatus according to one of claims 1 to 38, characterized in that the at least one baffle body is designed to apply the pressure or shock waves to the tooth or gum.