Patent Application
20200000481
The subject-matter of the present invention is a guide for a flexible bone drill.
Furthermore, the present invention relates to a bone resection instrument, in particular to an instrument comprising a flexible bone drill for use in arthroscopic surgery, preferably on the hip or shoulder.
However, the use of the instrument on other parts of the body is not excluded.
Such instruments are particularly useful in surgical procedures to remove pathological or congenital bony outgrowths, specifically on the hip or on the shoulder, or also during operations to fit or replace hip prostheses when preliminary cleaning of the acetabular cup is required.
Femoral acetabular conflict, or impingement, is caused by a series of congenital or acquired hip pathologies due to an imperfect conformation and abnormal contact between the parts of the hip joint (the acetabulum and the proximal part of the femur).
The femur head is normally spherical in form and articulates in a cup (acetabulum) without creating any friction or contact (impingement).
If one or both of the parts, the femur head and the acetabulum, do not fit together perfectly, this results in a condition where there is friction, known as Femoral Acetabular Impingement (FAI). A first type of femoral acetabular impingement may be due to an abnormal curvature of the femoral neck with an osteophyte on the surface surrounding the femur head, close to the neck, which interacts with and damages the acetabular lip; a second type of impingement may be caused when the acetabulum is abnormally pincer-shaped: also in this case there is interference between the neck of the femur and the lip of the acetabulum.
Femoral Acetabular Impingement is one of the most frequent causes of arthrosis of the hip joint and typically affects young adults and athletes in particular, whereas in people with a sedentary lifestyle such deformities may go unnoticed for their entire lifetime.
The worsening of this condition is due to the repeated strain that is exerted to repeatedly and forcefully perform extreme degrees of movement.
When diagnosed early the condition can be treated before the joint is compromised, improving the prognosis for patients affected by this condition.
To that end, arthroscopic surgery is performed to restore the correct femoral head-neck offset ratio by removing the bone formation on the neck.
At present, several arthroscopic instruments are used, typically motorised bone drills, which can be inserted at the site of the surgical procedure to reach the bony outgrowths to be removed at pre-set angles of entry, or which have a pre-set curvature to guide the flexible drill to the point to be operated on. However, besides involving the use of several instruments, such technique does not provide the surgeon with a high degree of flexibility when handling the drill during the operation.
Another situation that requires the removal of bony protrusions is the fitting or replacement of hip prostheses.
In the case of first-time hip replacement, when the femur is removed the concave surface of the acetabular cup is jagged and uneven and must be smoothed before fitting the prosthesis; likewise, in the case of revision surgery, after removing the old acetabular cup, which will generally have become osseointegrated with the rest over time, the acetabular surface will have osteophytes that will have caused bulging around the cup and must be removed.
Before fitting the prosthesis, not only must the acetabular seat be cleaned thoroughly to smooth its surface, but the edge of the acetabulum must also be free of any osteophytes that could make it impossible to reach the bottom of the acetabulum and prevent the correct orientation of the definitive cup.
Surgeons currently use a semi-circular bone drill with a handle that has a convex outer surface with a roughness designed to remove the bony spurs.
The bone drill is inserted into the acetabulum and manoeuvred manually to scrape the concave surface of the acetabular cup using the rough convex surface.
The Applicant has found that the bone drills of the type known in the prior art have some drawbacks associated with the excessively reduced mobility of said instrument by the surgeon during the operation, the need to use several instruments and the need to have a more flexible instrument that can be used in arthroscopic and other surgical procedures.
Therefore, the Applicant has come to the conclusion that it would be far more advantageous to be able to use a single instrument, that allows the angle of inclination to be arbitrarily defined in order to operate on the bony protrusion to be removed.
The purpose of the present invention is therefore to provide a guide for a flexible bone drill and a respective bone resection instrument, capable of overcoming the inconveniences of the prior art described above.
More precisely, the purpose of the present invention is to provide a guide for a flexible bone drill which enables said drill to be positioned easily and used effectively during a surgical procedure.
A further purpose of the present invention is to provide a bone resection instrument for removing bony protrusions in the case of femoral acetabular impingement or shoulder impingement, and for cleaning the acetabular seat when necessary in order to fit a prosthesis.
Lastly, a purpose of the present invention is to produce a bone resection instrument which allows the surgeon to have great flexibility of manoeuvre, by allowing the surgeon to adjust the angle of inclination at which the drill acts on the osteophyte during the surgical procedure, according to each patient's anatomy, while at the same time guaranteeing the utmost safety of the patient by preventing the drill from accidentally interfering with soft tissue or bone structures that must not be removed or damaged by accidentally coming into contact with the motorised instrument.
These and other aims of the invention are substantially achieved with a guide for a flexible bone drill and a bone resection instrument of the type disclosed in one or more of the following claims. The dependent claims describe some alternative embodiments of the invention.
In any case, these and further characteristics, and the respective technical advantages, will become more apparent from the description that follows of a preferred and non-exclusive embodiment of a guide for a flexible bone drill and a bone resection instrument, represented solely by way of non-limiting example.
This description is provided with reference to the accompanying figures, which are also provided solely by way of non-limiting examples, in which:
With reference to the accompanying figures, denoted as a whole by reference numeral 1 is a guide for flexible bone drill according to the present invention.
The guide 1 comprises a first body 2 and a second body 3 which can be inserted one inside the other and are movable with respect to one another. The guide preferably extends substantially longitudinally, advantageously in the form of a cylinder, along an axis 1a.
The second body 3 is internally hollow and has an open first end 3′ through which the first body 2 is inserted, and a second end 3″ opposite the first end. The first body 2 also has an open first end 2′ and a second end 2″ opposite the first end, which is inserted into the second body 3.
The first body 2 is provided with an internal through channel 4 comprising an axial portion 41 that extends partially along a longitudinal axis 2a of the first body 2, from a first end 2′ outside the second body 3, to an intermediate point 5 along the longitudinal axis 2a, and a transverse portion 42 that extends from the intermediate point 5, along the longitudinal axis 2a, towards a side wall 2c of the first body 2.
Advantageously, the transverse portion 42 is inclined at a variable angle α of between 30° and 80°, preferably between 40° and 60°, with respect to the longitudinal axis 2a of the first body 2.
The axial portion 41 and the transverse portion 42 are communicating, consecutive and in fluidic connection with the external environment.
As shown in
The second body 3, instead, is provided with a through hole 6 in one side wall 3c that is placed in fluidic connection with the internal cavity 30; when the guide is mounted, the hole 6 is placed in fluidic connection with the through channel 4 in the first body 2.
The second body 3 may have weight-reducing slits 40 along the side wall 3c.
The first 2 and the second body 3 slide relative to one another to vary the relative position of the hole 6 in the second body 3 with respect to the through channel 4 in the first body 2.
The guide 1 cooperates with a flexible scraping element 10 to define a bone resection instrument.
Said flexible scraping instrument 10 is, preferably, a flexible bone drill suitable to be inserted into the guide 1. Advantageously, said bone drill is made, for example, of Nitinol.
Specifically, the scraping element 10 can be inserted into the channel 4 in the first body 2, from the first end 2′ so as to pass through the axial portion 41 and the transverse portion 42 of the channel 4 and emerge from the second body 3 through the through hole 6.
The exit angle β of the scraping element from the guide 1 can be adjusted by adjusting the axial position of the first body 2 relative to the second body 3.
Advantageously, the exit angle β of the flexible scraping element 10 varies between 60° and 90° with respect to an axis 6a orthogonal to the longitudinal axis 1a of the guide, passing through the hole 6.
The guide 1 further comprises movement limiting means 7 suitable to limit the relative movement between the first 2 and the second 3 body both in the axial direction, to prevent the first body 2 from accidentally coming away from the second body 3, and in the rotational direction, to prevent the relative rotation of one with respect to the other about the axis of rotation 2a.
Said limiting means 7 are also capable of controlling the relative movement between the first 2 and the second 3 body both in the axial and rotational direction.
The movement limiting means 7 comprise an anti-rotation device 20 comprising a pin 8 that protrudes externally from a side wall 2c of the first body 2 and a slot 9 obtained in a side wall 3c of the second body 3.
The pin 8 is movable inside the slot 9, so as to prevent any relative rotation between the first 2 and the second 3 body.
Said device 20 in fact prevents the relative rotation, about the longitudinal axis 1a of the guide 1, of the first body 2 with respect to the second body 3, so that the hole 6 is always radially aligned with the transverse portion 42 of the channel 4, in order to prevent any deformation, undesirable bending or tearing of the scraping element 10.
The anti-rotation device 20 further defines a bayonet-type coupling to connect the first body 2 to the second body 3. As can be seen in
According to a preferred embodiment, which is not illustrated, there may be a rectilinear slot 9 closed at both ends, inside which a pin 8 is able to slide. Said movement limiting means 7 further comprise a restraint device 300 which prevents the first body 2 and the second body 3 from becoming completely detached from one another. Said restraint device 300 permits a limited relative axial translation between said two bodies.
In detail, the restraint device 300 comprises an annular flange 200 which extends radially from the first body 2.
The annular flange 200 is integral with the first annular body 2 and therefore follows its axial translatory movements.
Arranged on the outside of the first 2 and of the second 3 body there is a sleeve 11, removably constrained to the second body 3.
The annular flange 200 is movable within a housing 12 obtained inside said sleeve 11 and extending between an end portion 11′ of the sleeve 11 and the first end 3′ of the second body 3.
An elastic element 13, preferably a coil spring, is housed between the annular flange 200 and the first end 3′ of the second body 3. Said elastic element 13 permits the controlled and limited axial travel of the first body 2 inside the second body 3, both in the compression stage, when the first body 2 is inserted into the second body 3, and in the extension stage, when the first body 2 is extracted from the second body 3.
The sleeve 11 is also part of a control device 15 the purpose of which is to operate the guide 1 and axially move the first body 2 with respect to the second body 3 in a controlled manner.
The control device 15 further comprises a first thread 14 arranged around the second body 3 and able to engage with a second internal thread 16 of the sleeve 11.
When the sleeve 11 is screwed with its thread 16 onto the thread 14 of the second body 3, it acts, via an end portion 11′ thereof, on the annular flange 200, pushing the first body 2 inside the second body 3.
The annular flange 200 presses the spring 13 against the first end 3′ of the second body 3: the effect of the spring 13 is to slow down and control the travel of the first body inside the second body and to facilitate the extraction of the first body 2 from the second body 3 when the sleeve 11 is operated in the opposite direction.
Simply operating the control device 15, and thus screwing or unscrewing the sleeve 11 on the second body 3, results in the relative translation of the first body 2 with respect to the second body 3.
The relative axial position between the transverse portion 42 of the channel 4 and the exit hole 6 of the second body 3 is determined, and hence the inclination of the scraping element 10 varies, depending on how far the first body 2 is inserted into the second body 3.
The invention described above achieves some important advantages.
With the guide according to the invention, the exit angle of the flexible scraper element can be adjusted simply by acting in a controlled manner on a control device in order to vary the relative axial position of the first body with respect to the second body. In this way the surgeon can operate in a precise and targeted manner at the site of the operation, to remove the bony protrusions and prepare the area to receive the new prosthesis.
| Number | Date | Country | Kind |
|---|---|---|---|
| 102016000132039 | Dec 2016 | IT | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/IB2017/058191 | 12/20/2017 | WO | 00 |
