WO1999058067A1 - Device for preparing a human tubular bone for implantation of a bone implant and method for operating said device - Google Patents

Device for preparing a human tubular bone for implantation of a bone implant and method for operating said device Download PDF

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Publication number
WO1999058067A1
WO1999058067A1 PCT/EP1999/002876 EP9902876W WO9958067A1 WO 1999058067 A1 WO1999058067 A1 WO 1999058067A1 EP 9902876 W EP9902876 W EP 9902876W WO 9958067 A1 WO9958067 A1 WO 9958067A1
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Prior art keywords
bone
implant
rasp
cavity
robot
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PCT/EP1999/002876
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German (de)
French (fr)
Inventor
Hans Grundei
Original Assignee
Eska Implants Gmbh & Co.
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Publication date
Application filed by Eska Implants Gmbh & Co. filed Critical Eska Implants Gmbh & Co.
Priority to EP99923482A priority Critical patent/EP1079742A1/en
Publication of WO1999058067A1 publication Critical patent/WO1999058067A1/en

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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
    • A61B17/1659—Surgical rasps, files, planes, or scrapers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • 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
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1703—Guides or aligning means for drills, mills, pins or wires using imaging means, e.g. by X-rays
    • 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
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1742—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • A61B17/175—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip for preparing the femur for hip prosthesis insertion

Definitions

  • the invention relates to a device for preparing a long bone for the implantation of a bone implant.
  • a (stem-shaped) endoprosthesis Before the implantation of a (stem-shaped) endoprosthesis in a long bone, for example in the human femur, the end of the joint is resected and the cancellous bone is usually milled and removed from the bone marrow.
  • the stem of the endoprosthesis can then be introduced into the milled space, which can be provided with a correspondingly open-meshed three-dimensional network structure through which bone trapezoids can grow for secondary fixation of the implant.
  • a typical example of such a stem-shaped endoprosthesis is the hip stem of an artificial hip joint.
  • Such millings are carried out with appropriate tools, i.e. milling cutters.
  • the milling has the disadvantage that the inner wall of the milling or the cavity created in the bone marrow space is tension-free. This means that after using the bone implant in the created cavity no area-wide pressure is exerted by the remaining cancellous bone on the inserted implant, so that practically no force or frictional connection between the implant and Residual cancellous bone works. This not only affects the primary fixation of the implant in situ, but also delays the ingrowth behavior of the bone trapezoids due to the open-mesh spatial network structure of the implant.
  • Another method for clearing the bone marrow space is to use a bone rasp, as is known for example from DE 43 23 873 C2 or DE 39 07 256 AI.
  • a bone rasp As is known for example from DE 43 23 873 C2 or DE 39 07 256 AI.
  • the surgeon pushes them in preparation for the implantation in the longitudinal direction of the bone marrow space, the surface of the rasps being provided with a scraping profile, which, depending on the design of the profile when the rasps are pushed into the bone marrow space, cuts through and if necessary. also when pulling out the bone marrow rasp from the bone marrow space.
  • the use of a rasp has a considerably different effect compared to the milling cutter mentioned at the beginning: when the cavity is rasped out, the side wall of the cavity is compressed when the rasp is driven into it.
  • the inner wall of the created cavity is not stress-free - as in the case of milling - but the bone material compressed in the area of the inner wall tends to relax again after removing the rasp from the cavity.
  • this leads to an increasingly force-fitting fit of the implant in the cavity and - if the implant is provided with an open-meshed three-dimensional network structure - that is, the separated, relaxing bone trapezoids reach directly into the 3D-open-mesh structure and subsequently a much faster growth of the implant.
  • the device consists of a programmable industrial robot which carries on its robot hand a machine tool with a tool head which operates in the manner of a rotary hammer.
  • the tool head performs an oscillating stroke movement in the direction of its longitudinal axis during operation of the machine tool and carries a rasp bone. This is used to clear out a cavity in the long bone in the form of the bone implant to be inserted.
  • the core of the invention is accordingly the combination of a programmable industrial robot with a machine tool which drives a bone rasp known per se into the tubular bones.
  • the combination of the components according to the invention enables extremely precise rasping of the cavity in the bone marrow space, in which the implant of the same shape is then inserted. Due to the high precision it is achieved that the surface pressure from the inner wall of the rasped cavity to the greatest possible extent on the implant surface is evenly distributed, so that a high stable primary fixation is guaranteed. If the implant has an open-meshed three-dimensional network structure on its surface, bony trapezoids are pressed from the inner wall of the cavity into the surface of the implant due to the relaxation after compression by using the rasp. This creates an excellent basis for organizing bone material through the surface of the implant.
  • the advancement of the robot arm is preferably program-controlled.
  • the software depicts the X-ray slices of this medullary bone that have been taken preoperatively. This increases the precision of the rasping of the cavity.
  • the robot head advances the bone rasp without pressure. This ensures that the cavity does not break out of bone material at places where this is not intended due to high loads.
  • the drawing shows a patient lying on an operating table 9, whose hip area has already been opened so that a cavity can be rasped into the femur bone 7, in which a hip stem of an artificial hip joint can then be inserted.
  • a bone rasp 6 is used to create the cavity, which is introduced into the bone marrow space in an oscillating manner in the direction of the longitudinal axis of the femoral bone 7 and is pulled out again.
  • the bone rasp 6 is coupled to an industrial robot 2 of a known type.
  • the coupling of the bone rasp 6 the robot 2 takes place via a machine tool 4, which essentially works in the manner of a rotary hammer.
  • the machine tool 4 is fastened to the robot hand 3, which in turn sits on the front of the robot arm 8.
  • the robot 2 is operated in a software-controlled manner in such a way that the software images the x-ray slice images of the bone marrow space of the femur 7 so that the bone rasp 6 can grate the respective cavity individually adapted to the patient's requirements.

Abstract

The invention relates to a device for preparing a human tubular bone for implantation of a bone implant. Said device comprises a programmable industrial robot (2) which on its hand (3) carries a machine tool (4) which has a tool head (5) and works like a hammer drill. When the machine tool (4) is operating the tool head carries out an oscillating stroke movement in the direction of its longitudinal axis and carries a bone rasp (6) by means of which a hollow space having the shape of the bone implant to be inserted is created in the tubular bone (7).

Description

Vorrichtung zur Präparation eines menschlichen Röhrenknochens für die Implantation eines Knochenimplantates sowie Verfahren zum Betreiben dieser VorrichtungDevice for preparing a human long bone for the implantation of a bone implant and method for operating this device
Beschreibungdescription
Die Erfindung betrifft eine Vorrichtung zur Präparation eines Röhrenknochens für die Implantation eines Knochenimplantates.The invention relates to a device for preparing a long bone for the implantation of a bone implant.
Vor der Implantation einer (stielförmigen) Endoprothese in einen Röhrenknochen, beispielsweise in den menschlichen Femur, wird dieser an seinem gelenkseitigen Ende reseziert und üblicherweise eine Auffräsung der Spongiosa und Entfernung vom Knochenmark vorgenommen. In dem ausgefrästen Raum kann sodann der Stiel der Endoprothese eingebracht werden, die mit einer entsprechend offenmaschigen dreidimensionalen Raumnetzstruktur versehen sein kann, durch welche Knochentrapekel zur Sekundärfixation des Implantats hindurchwachsen können. Ein typisches Beispiel für eine derartige stielfömrige Endoprothese ist der Hüftstiel eines künstlichen Hüftgelenks.Before the implantation of a (stem-shaped) endoprosthesis in a long bone, for example in the human femur, the end of the joint is resected and the cancellous bone is usually milled and removed from the bone marrow. The stem of the endoprosthesis can then be introduced into the milled space, which can be provided with a correspondingly open-meshed three-dimensional network structure through which bone trapezoids can grow for secondary fixation of the implant. A typical example of such a stem-shaped endoprosthesis is the hip stem of an artificial hip joint.
Derartige Ausfräsungen werden mit entsprechenden Werkzeugen, also Fräsern, durchgeführt. Die Ausfräsung hat jedoch bei der zementlosen Fixation des Implantates im Röhrenknochen den Nachteil, daß die Innenwandung der Ausfräsung bzw. des geschaffenen Hohlraumes im Knochenmarkraum spannungsfrei ist. Dies bedeutet, daß nach Einsatz des Knochenimplantates in den geschaffenen Hohlraum kein flächenhaft wirkender Druck von der verbliebenen Spongiosa auf das eingesetzte Implantat ausgeübt wird, so daß praktisch kein Kraft- oder Reibschluß zwischen dem Implantat und Restspongiosa wirkt. Dies beeinträchtigt nicht nur die Primärfixation des Implantates in situ sondern verzögert auch das Einwachsverhalten der Knochentrapekel durch die offenmaschige Raumnetzstruktur des Implantates.Such millings are carried out with appropriate tools, i.e. milling cutters. However, in the case of cementless fixation of the implant in the long bone, the milling has the disadvantage that the inner wall of the milling or the cavity created in the bone marrow space is tension-free. This means that after using the bone implant in the created cavity no area-wide pressure is exerted by the remaining cancellous bone on the inserted implant, so that practically no force or frictional connection between the implant and Residual cancellous bone works. This not only affects the primary fixation of the implant in situ, but also delays the ingrowth behavior of the bone trapezoids due to the open-mesh spatial network structure of the implant.
Eine andere Methode zum Ausräumen des Knochenmarkraumes besteht in der Anwendung einer Knochenraspel, wie sie beispielsweise bekannt sind aus der DE 43 23 873 C2 oder der DE 39 07 256 AI. Bei der Anwendung von Raspeln wird diese vom Operateur in Vorbereitung der Implantation in Längsrichtung des Knochenmarkraumes gestoßen, wobei die Raspel auf ihrer Oberfläche mit einem Schabeprofil versehen ist, welches je nach Ausbildung des Profils beim Hineinstoßen der Raspel in den Knochenmarksraum Knochentrapekel durchtrennt und ggfls. ebenfalls beim Herausziehen der Knochenmarksraspel aus dem Knochenmarksraum. Zusätzlich zum Ausräumen des Hohlraumes im Knochen hat die Anwendung einer Raspel gegenüber dem eingangs erwähnten Fräser aber noch einen erheblichen anderen Effekt: Beim Ausraspeln des Hohlraumes wir die Seitenwandung des Hohlraumes beim Hineintreiben der Raspel verdichtet. Dies bedeutet, daß die Innenwandung des geschaffenen Hohlraumes nicht spannungsfrei - wie im Falle der Ausfräsung - ist, sondern das im Bereich der Innenwandung verdichtete Knochenmaterial nach dem Entfernen der Raspel aus dem Hohlraum dazu neigt, sich in den Hohlraum hinein wieder zu entspannen. Dies führt beim Einsetzen des Implantates zu einem vermehrt kraftschlüssigen Sitz des Implantates im Hohlraum und - sofern das Implantat mit einer offenmaschigen dreidimensionalen Raumnetzstruktur versehen ist - also zu einem Hineingreifen der abgetrennten, sich entspannenden Knochentrapekel direkt in die 3D- offenmaschige Struktur hinein und in Folge zu einem wesentlich rascheren Verwachsen des Implantates.Another method for clearing the bone marrow space is to use a bone rasp, as is known for example from DE 43 23 873 C2 or DE 39 07 256 AI. When using rasps, the surgeon pushes them in preparation for the implantation in the longitudinal direction of the bone marrow space, the surface of the rasps being provided with a scraping profile, which, depending on the design of the profile when the rasps are pushed into the bone marrow space, cuts through and if necessary. also when pulling out the bone marrow rasp from the bone marrow space. In addition to clearing the cavity in the bone, the use of a rasp has a considerably different effect compared to the milling cutter mentioned at the beginning: when the cavity is rasped out, the side wall of the cavity is compressed when the rasp is driven into it. This means that the inner wall of the created cavity is not stress-free - as in the case of milling - but the bone material compressed in the area of the inner wall tends to relax again after removing the rasp from the cavity. When the implant is inserted, this leads to an increasingly force-fitting fit of the implant in the cavity and - if the implant is provided with an open-meshed three-dimensional network structure - that is, the separated, relaxing bone trapezoids reach directly into the 3D-open-mesh structure and subsequently a much faster growth of the implant.
Es hat sich nun gezeigt, daß selbst erfahrene Operateure die Ausraspelung des Hohlraumes mit einer Knochenraspel nicht mit einer solchen Präzision durchzuführen in der Läse sind, daß der beschriebene Flächendruck von der Innenwandung des Hohlraums auf das Implantat an jeder Stelle gleichgroß ist. Je nach Ansatz der Raspel kann es sogar Bereiche des Implantates geben, auf die keinerlei Flächendruck wirkt, wohingegen auf andere Flächenbereiche des Implantates sehr hohe Drücke lasten. Diese Ungleichverteilung des Flächendruckes fördert die gleichmäßige Durchwachsung des Implantates im Knochen nicht.It has now been shown that even experienced surgeons are unable to rasp the cavity with a bone rasp in the lens with such precision that the surface pressure described is different from the Inner wall of the cavity on the implant is the same size at every point. Depending on the approach of the rasp, there may even be areas of the implant that are not subjected to any surface pressure, whereas very high pressures exert pressure on other surface areas of the implant. This uneven distribution of the surface pressure does not promote the uniform growth of the implant in the bone.
Vor diesem Hintergrund ist es nun die Aufgabe der vorliegenden Erfindung, eine Vorrichtung anzugeben, mit welcher der auszuraspelnde Hohlraum mit hoher Präzision patientenindividuell herstellbar ist.Against this background, it is the object of the present invention to provide a device with which the cavity to be rasped out can be produced individually for the patient with high precision.
Gelöst wird diese Aufgabe durch eine Vorrichtung mit den Merkmalen des Anspruchs 1. Weitere vorteilhafte Ausführungen sind in den Unteransprüchen angegeben.This object is achieved by a device with the features of claim 1. Further advantageous embodiments are specified in the subclaims.
Die Vorrichtung besteht erfindungsgemäß aus einem programmierbaren Industrieroboter, der an seiner Roboterhand eine nach Art eines Bohrhammers arbeitende Werkzeugmaschine mit einem Werkzeugkopf trägt. Der Werkzeugkopf führt im Betrieb der Werkzeugmaschine eine oszillierende Hubbewegung in Richtung seiner Längsachse auf und trägt eine Knochenraspel. Mit dieser wird ein Hohlraum im Röhrenknochen in Form des einzusetzenden Knochenimplantates ausgeräumt. Kern der Erfindung ist demnach die Kombination eines programmierbaren Industrieroboters mit einer Werkzeugmaschine, welche eine an sich bekannte Knochenraspel in den Röhrenknochen hineintreibt.According to the invention, the device consists of a programmable industrial robot which carries on its robot hand a machine tool with a tool head which operates in the manner of a rotary hammer. The tool head performs an oscillating stroke movement in the direction of its longitudinal axis during operation of the machine tool and carries a rasp bone. This is used to clear out a cavity in the long bone in the form of the bone implant to be inserted. The core of the invention is accordingly the combination of a programmable industrial robot with a machine tool which drives a bone rasp known per se into the tubular bones.
Die erfindungsgemäße Kombination der Komponenten ermöglicht eine äußerst präzise Ausraspelung des Hohlraumes im Knochenmarkraum, in welchen danach das formengleiche Implantat eingesetzt wird. Aufgrund der hohen Präzision wird erreicht, daß der Flächendruck von der Innenwandung des ausgeraspelten Hohlraumes auf die Implantatoberfläche weitestgehend gleichverteilt ist, so daß eine hohe stabile Primärfixation gewährleistet ist. Wenn das Implantat eine offenmaschige dreidimensionale Raumnetzstruktur an seiner Oberfläche aufweist, werden Knochentrapekel von der Innenwandung des Hohlraums in die Oberfläche des Implantates aufgrund der Entspannung nach der Verdichtung durch Anwendung der Raspel hineingedrückt. So wird eine hervorragende Basis für das Einorganisieren von Knochenmaterial durch die Oberfläche des Implantates hindurch gebildet.The combination of the components according to the invention enables extremely precise rasping of the cavity in the bone marrow space, in which the implant of the same shape is then inserted. Due to the high precision it is achieved that the surface pressure from the inner wall of the rasped cavity to the greatest possible extent on the implant surface is evenly distributed, so that a high stable primary fixation is guaranteed. If the implant has an open-meshed three-dimensional network structure on its surface, bony trapezoids are pressed from the inner wall of the cavity into the surface of the implant due to the relaxation after compression by using the rasp. This creates an excellent basis for organizing bone material through the surface of the implant.
Vorzugsweise erfolgt der Vorschub des Roboterarms programmgesteuert. Dabei bildet die Software die Röntgen-Schichtaufnahmen dies Markraumes des Röhrenknochens ab, die präoperativ angefertigt worden sind. Hierdurch wird die Präzision der Ausraspelung des Hohlraumes noch erhöht.The advancement of the robot arm is preferably program-controlled. The software depicts the X-ray slices of this medullary bone that have been taken preoperatively. This increases the precision of the rasping of the cavity.
Gemäß einer vorteilhaften Ausführungsform treibt der Roboterkopf die Knochenraspel drucklos vor. Hierdurch bleibt gewährleistet, daß der Hohlraum nicht aufgrund von hohen Belastungen Knochenmaterial herausbricht an Stellen, an denen dies nicht vorgesehen ist.According to an advantageous embodiment, the robot head advances the bone rasp without pressure. This ensures that the cavity does not break out of bone material at places where this is not intended due to high loads.
Die Erfindung wird nachfolgend anhand eines Ausführungsbeispiels gemäß der einzigen Zeichnungsfigur kurz näher erläutert.The invention is briefly explained below using an exemplary embodiment according to the single drawing figure.
Die Zeichnungsfigur zeigt einen auf einem Operationstisch 9 liegenden Patienten, dessen Hüftbereich bereits geöffnet worden ist, damit in den Femurknochen 7 ein Hohlraum geraspelt werden kann, in welchen danach ein Hüftstiel eines künstlichen Hüftgelenkes eingesetzt werden kann.The drawing shows a patient lying on an operating table 9, whose hip area has already been opened so that a cavity can be rasped into the femur bone 7, in which a hip stem of an artificial hip joint can then be inserted.
Zur Erzeugung des Hohlraums wird vorliegend eine Knochenraspel 6 verwendet, die in Richtung der Längsachse des Femurknochens 7 in dessen Knochenmarkraum oszillierend eingebracht und wieder herausgezogen wird. Hierzu ist die Knochenraspel 6 erfindungsgemäß an einen Industrieroboter 2 durchaus bekannter Art gekoppelt. Die Ankopplung der Knochenraspel 6 an den Roboter 2 erfolgt über eine Werkzeugmaschine 4, die im wesentlichen nach Art eines Bohrhammers arbeitet. Die Werkzeugmaschine 4 ist an der Roboterhand 3 befestigt, welche seinerseits vorne am Roboterarm 8 sitzt.In the present case, a bone rasp 6 is used to create the cavity, which is introduced into the bone marrow space in an oscillating manner in the direction of the longitudinal axis of the femoral bone 7 and is pulled out again. For this purpose, the bone rasp 6 is coupled to an industrial robot 2 of a known type. The coupling of the bone rasp 6 the robot 2 takes place via a machine tool 4, which essentially works in the manner of a rotary hammer. The machine tool 4 is fastened to the robot hand 3, which in turn sits on the front of the robot arm 8.
Der Roboter 2 wird softwaregesteuert betrieben, derart, daß die Software die Röntgen-Schichtaufnahmen vom Knochenmarkraum des Femurs 7 abbildet, damit die Knochenraspel 6 individuell an die Patientenerfordermsse angepaßt den jeweiligen Hohlraum raspeln kann. The robot 2 is operated in a software-controlled manner in such a way that the software images the x-ray slice images of the bone marrow space of the femur 7 so that the bone rasp 6 can grate the respective cavity individually adapted to the patient's requirements.

Claims

Patentansprüche claims
1. Vorrichtung zur Präparation eines menschlichen Röhrenknochens für die Implantation eines Knochenimplantates, aufweisend einen programmierbaren Industrieroboter (2) der an seiner Roboterhand (3) eine nach Art eines Bohrhammers arbeitende Werkzeugmaschine (4) mit einem Werkzeugkopf (5) trägt, welcher im Betrieb der Werkzeugmaschine (4) eine oszillierende Hubbewegung ausführt in Richtung seiner Längsachse und der eine Knochenraspel (6) trägt, mit welcher ein Hohlraum im Röhrenknochen (7) in Form des einzusetzenden Knochenimplantates ausgeräumt wird.1. Device for the preparation of a human tubular bone for the implantation of a bone implant, comprising a programmable industrial robot (2) which carries on its robot hand (3) a machine tool (4) working in the manner of a hammer drill with a tool head (5) which operates the Machine tool (4) performs an oscillating lifting movement in the direction of its longitudinal axis and which carries a bone rasp (6) with which a cavity in the tubular bone (7) is cleared in the form of the bone implant to be inserted.
2. Vorrichtung nach Anspruch 1, bei dem der Vorschub des Roboterarms (8) programmgesteuert erfolgt, wobei das Programm die zuvor angefertigten Röntgen-Schichtaufnahmen des Markraumes des Röhrenknochens abbildet.2. Device according to claim 1, in which the advancement of the robot arm (8) takes place under program control, the program depicting the previously made x-ray slice images of the medullary cavity of the long bone.
3. Vorrichtung nach Anspruch 1 oder 2, bei dem die Roboterhand (3) die Knochenraspel (6) drucklos vortreibt.3. Device according to claim 1 or 2, wherein the robot hand (3) drives the bone rasp (6) without pressure.
4. Verfahren zum Betreiben der Vorrichmng nach einem der Ansprüche 1 bis 3, bei dem die Knochenraspel (6) an den resezierten Knochen (7) herangeführt und nach Justierung ihrer Lage der Roboter (2) und die Werkzeugmaschine (4) in Betrieb genommen werden, wobei der Roboterarm (8) manuell vorgeschoben wird. 4. The method for operating the device according to one of claims 1 to 3, in which the bone rasp (6) is brought up to the resected bone (7) and, after adjusting its position, the robot (2) and the machine tool (4) are put into operation , the robot arm (8) being advanced manually.
PCT/EP1999/002876 1998-05-08 1999-04-28 Device for preparing a human tubular bone for implantation of a bone implant and method for operating said device WO1999058067A1 (en)

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DE19820506A DE19820506C1 (en) 1998-05-08 1998-05-08 Device for preparing a human long bone for the implantation of a bone implant and method for operating this device
DE19820506.6 1998-05-08

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