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WO1998017191A1 - Self-locking holding device with single-point fixation - Google Patents

Self-locking holding device with single-point fixation Download PDF

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Publication number
WO1998017191A1
WO1998017191A1 PCT/CH1997/000386 CH9700386W WO9817191A1 WO 1998017191 A1 WO1998017191 A1 WO 1998017191A1 CH 9700386 W CH9700386 W CH 9700386W WO 9817191 A1 WO9817191 A1 WO 9817191A1
Authority
WO
WIPO (PCT)
Prior art keywords
piece
hole
locking
slats
insert
Prior art date
Legal status (The legal status 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 status listed.)
Ceased
Application number
PCT/CH1997/000386
Other languages
German (de)
French (fr)
Inventor
René BERNAYS
Adriano Viganò
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
MAGNETIC VISION GmbH
Original Assignee
MAGNETIC VISION GmbH
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 MAGNETIC VISION GmbH filed Critical MAGNETIC VISION GmbH
Priority to IL12508497A priority Critical patent/IL125084A0/en
Priority to JP10518768A priority patent/JP2000502279A/en
Priority to EP97942749A priority patent/EP0884980A1/en
Priority to AU44493/97A priority patent/AU4449397A/en
Publication of WO1998017191A1 publication Critical patent/WO1998017191A1/en
Priority to NO982899A priority patent/NO982899L/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • 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
    • A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/11—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 for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
    • A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
    • A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
    • 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
    • A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B2090/103—Cranial plugs for access to brain
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
    • A61M39/02—Access sites
    • A61M39/0247—Semi-permanent or permanent transcutaneous or percutaneous access sites to the inside of the body

Definitions

  • the invention relates to a holder according to the preamble of claim 1. This can be used in a wide variety of fields.
  • biopsies are generally performed as stereotactic interventions.
  • the biopsy path is defined based on the trepanation and target point chosen by the surgeon.
  • stereotaxy rings and target arcs were used (e.g. the Kelly System, Riechert & Mundinger, CRW, BRW; see also: “Neurosurgery”, RH Wilkins and SS Rengachary, 2nd edition 1996, volume m, pages 4067 f ⁇ where a good overview about the current state of the art). These require a multi-point fixation in the tabula externa of the skull cap (outer layer of the skull bone). This stereotaxi ring fixed in this way must be worn by the patient for several hours, which means a considerable burden for the patient. In addition, the surgical radius of action for the surgeon is limited by the stereotaxy system.
  • the invention solves tasks in the field of neurosurgery, for example, which arise from the further development of the magnetic resonance scanner or magnetic resonance device (MRI) to become an interventional magnetic resonance device (IMR).
  • IMR interventional magnetic resonance device
  • the IMR generates high-quality slice images of the body in real time and, as a technological innovation, allows interventions to be carried out on the patient while the image is being generated.
  • individual images generated before the intervention are used as the calculation basis for planning the operation. This method cannot take into account changes between the generation of the slice images and the intervention.
  • the fixed auxiliary reference system created and required by the conventional stereotaxic method is no longer required in the IMR since the patient is in the IMR with the reference system defined by the auxiliary device "Flashpoint System" (FPS) connected to the IMR during the entire procedure.
  • FPS Flashpoint System
  • the FPS is a two- or three-LED guide whose position in three-dimensional space is measured by three cameras.
  • the FPS allows the planning of an intervention by defining an axis, which is included in the image generated by the IMR and displayed on a monitor at the same time.
  • the virtual axis generated by the FPS is brought into line with the biopsy path.
  • the task now is to maintain the found biopsy axis by fixing the FPS in three-dimensional space.
  • the manufacturer of the FPS designed this for fixation on a gooseneck.
  • the goosenecks known to date do not allow reliable fixation.
  • the invention permits perfect fixation in three-dimensional space, since in the selected example it is fixed on the patient's skull. Furthermore, the invention takes up little space and reduces inconvenience and operational stress on the patient to a minimum.
  • FIG. 1-18 show an application example of the invention in the field of medicine.
  • An MR-compatible version for a biopsy in neurosurgery was chosen as an example. It shows: Fig. 1: Exploded view of the bracket.
  • Fig. 2 Assembled and inserted into the skull cap 7 holder with inserted biopsy needle 6.
  • Fig. 3 Explosion plan of the localizer.
  • Fig. 4 Locator assembled; with attached FPS 10.
  • Fig. 5 ram.
  • Fig. 6 Exploded view of the combination tool: Duralos and measuring device.
  • Fig. 7 Combination tool assembled.
  • Fig. 8 Exploded view of the locking sleeve remover.
  • Fig. 9 Locking sleeve remover assembled.
  • Fig. 10 Insert piece 4 and preload wheel 5 screwed together, before insertion in
  • Fig. 11 Insert 4 and preload wheel 5 inserted in skull cap 7.
  • Fig. 12 Locking sleeve 3 is inserted with the aid of the plunger 11.
  • Fig. 13 Fixing wheel 1 and guide sleeve 2 are inserted into the insert 4.
  • Fig. 14 The holder is assembled and ready for use in the skull cap
  • Fig. 15 Locking sleeve remover in a relaxed state before removing the
  • Fig. 16 Locking sleeve remover snapped into locking sleeve 3 but not yet locked.
  • Fig. 17 Locking sleeve remover locked by pressure on the head 15a.
  • 18 Removal of the locking sleeve 3.
  • the invention is based on the idea of inserting a self-locking holder into the borehole necessary for brain surgery.
  • the holder uses the shape of a cylindrical borehole to find a hold without having to rely on third fixing points.
  • the FPS 10 is placed on the target pin 9 of the locator (FIG. 4).
  • the locator is assembled as shown in FIG. 3.
  • the ball joint of the aiming pin 9b is guided through the upper la and lower 8c joint spans contained in the fixing wheel 1 and in the locating stand 8.
  • the swivel radius of the target pin 9 is limited by the conical inner surface of the fixing wheel 1 as the guide sleeve in the fixing wheel 1 is later limited.
  • the localizer is now held against the patient's head with the pedicles 8a and moved around until the target pin 9 or the axis calculated by the FPS point to the location to be operated.
  • the flexible pedicles 8a now make it possible to press the central marker 8b onto the scalp by pressing on the locator and thus to mark the location where drilling is to be carried out.
  • the drill and outer radius of the blades 4b are now selected to be the same size.
  • the meninges are detached from the inside of the skull cap 7 using the duraloser 12 (FIG. 6).
  • the thickness of the skull cap 7 (FIG. 7) can then be measured by means of the measurement scale 12a, which is attached to the duralosolator 12, and the optimum size of the insert 4 can thus be selected.
  • the flexible lamellae 4b are reduced to a smaller radius by the protruding hooks 4c compressed.
  • the flexible blades 4b spring back into their starting position, whereby the hooks 4c are pressed over the edge of the borehole (FIGS.
  • the locking sleeve 3 is then inserted into the insert 4 with the aid of the plunger 11 (FIG. 12). Due to its fit with the inner radius of the flexible slats 4c, the locking sleeve 3 prevents the slats from springing back again.
  • the skull cap 7 is clamped between the hook 4b and the preload wheel 5.
  • the preload wheel 5 allows different wall thicknesses of the cap 7 to be taken into account.
  • the locking sleeve 3 in turn is fixed in position by screwing on the fixing wheel 1.
  • Locking sleeve 3 and screwed on fixing wheel 1 form the upper la and lower 3 a integrated joint spans for the ball joint of the guide sleeve 2b.
  • the guide sleeve 2 can be pivoted through this joint 2b in a selectable radius. Cones are therefore recessed in the axis of the guide sleeve 2 in the fixing wheel 1 and the locking sleeve 3.
  • the guide sleeve 2 can be fixed in its position by turning the fixing wheel 1 (FIGS. 13, 14).
  • the biopsy needle 8 can now be inserted into the guide sleeve 2 and the sample removed (FIG. 14).
  • the fixing wheel 1 is unscrewed.
  • the locking sleeve 3 is then removed with the aid of the locking sleeve remover (FIGS. 8, 9) (FIGS. 15 to 18).
  • the pin of the locking sleeve remover 15 is pressed as far as the upper stop of the locking pin 15b in the pin lock 14c.
  • the locking sleeve remover can be inserted into the locking sleeve 3, since the expansion slats 14b can be pressed together (FIGS. 15, 16).
  • the expansion slats 14b are fixed in their position (FIGS.

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Pathology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Prostheses (AREA)
  • Connection Of Plates (AREA)

Abstract

The insert (4) of the holding device possesses fins (4b) that are arranged according to the shape of a hole so that, after being introduced into the hole, they are form-fitting, and make the hooks (4c) engage at the edge of the hole. The locking piece (3), which fits non-positively to the inside of the fins (4b), fixes the fins (4b) in position. The locking piece (3) in turn is prevented from slipping out unintentionally by the fixing piece (1). Depending on the embodiment, a pretensioning wheel (5) can increase the hold and allow adjustment to different wall thicknesses (7), and a guide sleeve (2) can enable intruments (6) to be guided precisely.

Description

Einpunktfixierte, selbstverriegelnde HalterungSingle-point fixed, self-locking bracket

Die Erfindung betrifft eine Halterung gemass dem Oberbegriff des Anspruches 1. Diese kann in verschiedensten Gebieten eingesetzt werden.The invention relates to a holder according to the preamble of claim 1. This can be used in a wide variety of fields.

Ein mögliches Anwendungsgebiet ist die Medizin, zum Beispiel für eine Biopsie in der Neurochirurgie. Biopsien werden in der Neurochirurgie generell als Stereotaktische Eingriffe vorgenommen. Bei Stereotaktischen Eingriffen wird anhand des vom Chirurgen gewählten Trepanations- und Zielpunktes der Biopsiepfad definiert.One possible area of application is medicine, for example for a biopsy in neurosurgery. In neurosurgery, biopsies are generally performed as stereotactic interventions. In the case of stereotactic interventions, the biopsy path is defined based on the trepanation and target point chosen by the surgeon.

Für die herkömmliche Stereotaxie wurden Stereotaxieringe und Zielbogen verwendet (zB. das Kelly System, Riechert&Mundinger, CRW, BRW; siehe auch: "Neurosurgery", R.H. Wilkins und S.S. Rengachary, 2. Auflage 1996, Band m, Seiten 4067 fζ wo ein guter Überblick über den aktuellen Stand der Technik zu finden ist). Diese bedingen eine Mehrpunktefixierung in der tabula externa der Schädelkalotte (äussere Schicht des Schädelknochens). Dieser so fixierte Stereotaxiering muss während mehrerer Stunden vom Patienten getragen werden, was eine erhebliche Belastung für den Patienten bedeutet. Zudem wird der operative Aktionsradius für den Chirurgen durch das Stereotaxiesystem eingeschränkt.For conventional stereotaxy, stereotaxy rings and target arcs were used (e.g. the Kelly System, Riechert & Mundinger, CRW, BRW; see also: "Neurosurgery", RH Wilkins and SS Rengachary, 2nd edition 1996, volume m, pages 4067 fζ where a good overview about the current state of the art). These require a multi-point fixation in the tabula externa of the skull cap (outer layer of the skull bone). This stereotaxi ring fixed in this way must be worn by the patient for several hours, which means a considerable burden for the patient. In addition, the surgical radius of action for the surgeon is limited by the stereotaxy system.

Die Erfindung löst z.B. auf dem Gebiet der Neurochirurgie Aufgaben, welche sich durch die Weiterentwicklung des Kernspintomographen oder Magnetresonanzgerätes (MRI) zum Interventionellen Magnetresonanzgerät (IMR) stellen. Das IMR erzeugt real time qualitativ hochwertige Schichtbilder des Körpers und gestattet es als bahnbrechende Neuerung, Eingriffe am Patienten während der Bilderzeugung vorzunehmen. Demgegenüber werden bei der konventionellen Stereotaxie vor dem Eingriff erzeugte Einzelbilder als Berechnungsgrundlage für die Operationsplanung verwendet. Diese Methode vermag Änderungen zwischen der Erzeugung der Schichtbilder und dem Eingriff nicht zu berücksichtigen. Das durch die herkömmliche Stereotaxiemethode geschaffene und erforderliche fixe Hilfsreferenzsystem ist im IMR nicht mehr erforderlich, da sich der Patient während dem ganzen Eingriff im IMR mit dem durch das am IMR angeschlossenen Hilfsgerät "Flashpointsystem" (FPS) definierte Referenzsystem befindet.The invention solves tasks in the field of neurosurgery, for example, which arise from the further development of the magnetic resonance scanner or magnetic resonance device (MRI) to become an interventional magnetic resonance device (IMR). The IMR generates high-quality slice images of the body in real time and, as a groundbreaking innovation, allows interventions to be carried out on the patient while the image is being generated. In contrast, in conventional stereotaxy, individual images generated before the intervention are used as the calculation basis for planning the operation. This method cannot take into account changes between the generation of the slice images and the intervention. The fixed auxiliary reference system created and required by the conventional stereotaxic method is no longer required in the IMR since the patient is in the IMR with the reference system defined by the auxiliary device "Flashpoint System" (FPS) connected to the IMR during the entire procedure.

Das FPS ist eine zwei- oder drei- LED Führung deren Position im dreidimensionalen Raum durch drei Kameras erfesst wird. Das FPS erlaubt die Planung eines Eingriffes durch Definierung einer Achse, welche in das vom IMR erzeugte Bild eingerechnet und auf einem Monitor zeitgleich dargestellt wird.The FPS is a two- or three-LED guide whose position in three-dimensional space is measured by three cameras. The FPS allows the planning of an intervention by defining an axis, which is included in the image generated by the IMR and displayed on a monitor at the same time.

Die vom FPS erzeugte virtuelle Achse wird mit dem Biopsiepfad zur Deckung gebracht. Es stellt sich nun die Aufgabe, die gefundene Biopsie- Achse durch eine Fixation des FPS im dreidimensionalen Raum beizubehalten. Der Hersteller des FPS konzipierte dieses für eine Fixation an einem Schwanenhals. Die bis heute bekannten Schwanenhälse gestatten keine zuverlässige Fixation.The virtual axis generated by the FPS is brought into line with the biopsy path. The task now is to maintain the found biopsy axis by fixing the FPS in three-dimensional space. The manufacturer of the FPS designed this for fixation on a gooseneck. The goosenecks known to date do not allow reliable fixation.

Die Erfindung gestattet eine perfekte Fixation im dreidimensionalen Raum, da sie bei dem gewählten Beispiel an der Schädelkalotte des Patienten fixiert wird. Des weiteren beansprucht die Erfindung nur wenig Raum und reduziert Inkonvenienz und operationsbedingte Belastung des Patienten auf ein Mindestmass.The invention permits perfect fixation in three-dimensional space, since in the selected example it is fixed on the patient's skull. Furthermore, the invention takes up little space and reduces inconvenience and operational stress on the patient to a minimum.

Die Aufgabe ist erfindungsgemäss durch die im Kennzeichen des Anspruches 1 angegebenen Merkmale gelöst.The object is achieved by the features specified in the characterizing part of claim 1.

Die Fig. 1-18 zeigen ein Anwendungsbeispiel der Erfindung im Bereiche der Medizin. Als Beispiel wurde eine MR kompatible Ausführung für eine Biopsie in der Neurochirurgie gewählt. Dabei zeigt: Fig. 1 : Explosionszeichnung der Halterung.1-18 show an application example of the invention in the field of medicine. An MR-compatible version for a biopsy in neurosurgery was chosen as an example. It shows: Fig. 1: Exploded view of the bracket.

Fig. 2: Zusammengesetzte und in die Schädelkalotte 7 eingesetzte Halterung mit eingeführter Biopsienadel 6. Fig. 3: Explosionsplan des Lokalisierers. Fig. 4: Lokalisierer zusammengesetzt; mit aufgesetztem FPS 10. Fig. 5: Stössel.Fig. 2: Assembled and inserted into the skull cap 7 holder with inserted biopsy needle 6. Fig. 3: Explosion plan of the localizer. Fig. 4: Locator assembled; with attached FPS 10. Fig. 5: ram.

Fig. 6: Explosionsplan des Kombiwerkzeuges: Duralöser und Messvorrichtung. Fig. 7: Kombiwerkzeug zusammengesetzt. Fig. 8: Explosionsplan des Verriegelungshülsen-Entferners. Fig. 9: Verriegelungshülsen-Entferner zusammengesetzt.Fig. 6: Exploded view of the combination tool: Duralos and measuring device. Fig. 7: Combination tool assembled. Fig. 8: Exploded view of the locking sleeve remover. Fig. 9: Locking sleeve remover assembled.

Die Fig. 10-18 zeigen einen möglichen Ablauf einer Anwendung der Erfindung. Dabei zeigt:10-18 show a possible sequence of application of the invention. It shows:

Fig. 10: Einsetzstück 4 und Vorspannrad 5 zusammengeschraubt, vor Einsetzen inFig. 10: Insert piece 4 and preload wheel 5 screwed together, before insertion in

Schädelkalotte 7. Fig. 11: Einsetzstück 4 und Vorspannrad 5 in Schädelkalotte 7 eingesetzt. Fig. 12: Verriegelungshülse 3 wird mit Hilfe des Stössels 11 eingesetzt. Fig. 13: Fixierrad 1 und Führungshülse 2 werden in das Einsetzstück 4 eingesetzt. Fig. 14: Die Halterung ist zusammengesetzt und funktionsbereit in die SchädelkalotteSkull cap 7. Fig. 11: Insert 4 and preload wheel 5 inserted in skull cap 7. Fig. 12: Locking sleeve 3 is inserted with the aid of the plunger 11. Fig. 13: Fixing wheel 1 and guide sleeve 2 are inserted into the insert 4. Fig. 14: The holder is assembled and ready for use in the skull cap

7 eingelassen; 1/4 Schnitt mit eingeführter Biopsienadel 6. Fig. 15: Verriegelungshülsen-Entferner in entspanntem Zustand vor Entfernen der7 recessed; 1/4 cut with inserted biopsy needle 6. Fig. 15: Locking sleeve remover in a relaxed state before removing the

Verriegelungshülse 3. Fig. 16: Verriegelungshülsen-Entferner in Verriegelungshülse 3 eingerastet jedoch noch nicht verriegelt. Fig. 17: Verriegelungshülsen-Entferner durch Druck auf den Kopf 15a verriegelt. Fig. 18: Entfernen der Verriegeiungshülse 3.Locking sleeve 3. Fig. 16: Locking sleeve remover snapped into locking sleeve 3 but not yet locked. Fig. 17: Locking sleeve remover locked by pressure on the head 15a. 18: Removal of the locking sleeve 3.

Im folgenden wird die Herstellung und Verwendung der Erfindung anhand eines Anwendungsbeispieles aus der Neurochirurgie dargestellt. Für diesen Anwendungsbereich ist es sinnvoll, die Erfindung aus Kunststoffen (PEEK, POM) herzustellen, um störende Artefaktbildungen im IMR zu verhindern.In the following, the manufacture and use of the invention is illustrated using an application example from neurosurgery. For this Application area, it makes sense to manufacture the invention from plastics (PEEK, POM) in order to prevent disturbing artifact formation in the IMR.

Die Erfindung beruht auf der Idee, eine selbstverriegelnde Halterung in das für eine Gehirnoperation notwendige Bohrloch einzulassen. Die Halterung benutzt in diesem Anwendungsbeispiel die Form eines zylinderfbrmigen Bohrloches, um Halt zu finden, ohne auf dritte Fixierpunkte angewiesen zu sein.The invention is based on the idea of inserting a self-locking holder into the borehole necessary for brain surgery. In this application example, the holder uses the shape of a cylindrical borehole to find a hold without having to rely on third fixing points.

Um den Punkt genau zu bestimmen, wo das Bohrloch anzulegen ist, wird das FPS 10 auf den Zielstift 9 des Lokalisierers (Fig. 4) aufgesetzt. Der Lokalisierer wird wie in Fig. 3 gezeigt zusammengesetzt. Dabei wird das Kugelgelenk des Zielstiftes 9b durch die im Fixierrad 1 und im Lokalisierstativ 8 enthaltenen oberen la und unteren 8c Gelenkspfannen geführt. Der Schwenkradius des Zielstiftes 9 wird durch die kegelförmige Innenfläche des Fixierrades 1 so begrenzt, wie später die Führungshülse im Fixierrad 1 begrenzt ist. Durch Zudrehen des Fixierrades 1 kann der Zielstift 9 in seiner Position fixiert werden.In order to determine exactly where the borehole is to be drilled, the FPS 10 is placed on the target pin 9 of the locator (FIG. 4). The locator is assembled as shown in FIG. 3. The ball joint of the aiming pin 9b is guided through the upper la and lower 8c joint spans contained in the fixing wheel 1 and in the locating stand 8. The swivel radius of the target pin 9 is limited by the conical inner surface of the fixing wheel 1 as the guide sleeve in the fixing wheel 1 is later limited. By turning the fixing wheel 1, the target pin 9 can be fixed in its position.

Der Lokalisierer wird nun mit den Pedikeln 8a gegen den Kopf des Patienten gehalten und so lange herumbewegt, bis der Zielstift 9, bzw. die durch das FPS errechnete Achse an den zu operierenden Ort weisen. Die flexiblen Pedikel 8a erlauben es nun, durch Drücken auf den Lokalisierer den Zentralmarker 8b auf die Kopfhaut zu drücken und so die Stelle zu markieren, wo gebohrt werden soll. Es werden nun Bohrer und Aussenradius der Lamellen 4b gleich gross gewählt.The localizer is now held against the patient's head with the pedicles 8a and moved around until the target pin 9 or the axis calculated by the FPS point to the location to be operated. The flexible pedicles 8a now make it possible to press the central marker 8b onto the scalp by pressing on the locator and thus to mark the location where drilling is to be carried out. The drill and outer radius of the blades 4b are now selected to be the same size.

Nach Anlegen des zylinderformigen Bohrlochs (üblicherweise 15 mm Durchmesser) in der Schädelkalotte 7 wird mit dem Duralöser 12 die Hirnhaut von der Innenseite der Schädelkalotte 7 gelöst (Fig. 6). Daraufhin kann mittels der Massskala 12a, welche am Duralöser 12 angebracht ist, die Dicke der Schädelkalotte 7 ausgemessen (Fig. 7) und damit die optimale Grosse des Einsetzstücks 4 ausgewählt werden. Beim Hindurchführen des Einsetzstücks 4 durch das Bohrloch werden die flexiblen Lamellen 4b durch die vorstehenden Häkchen 4c auf einen kleineren Radius komprimiert. Nachdem die Häkchen 4c des Einsetzstückes 4 die Schädelinnenseite erreicht haben, federn die flexiblen Lamellen 4b in ihre Ausgangsposition zurück, wodurch die Häkchen 4c über den Rand des Bohrloches gedrückt werden (Fig. 10 und Fig. 11) und ein Zurückgleiten der Halterung aus dem Bohrloch verhindern. Die am Einsetzstück 4 ringförmig angeordneten flexiblen Lamellen 4b liegen, nachdem sie durch das Bohrloch hindurch geführt wurden, satt am Bohrloch an. Darauf wird unter Zuhilfenahme des Stössels 11 die Verriegelungshülse 3 in das Einsetzstück 4 eingesetzt (Fig. 12). Die Verriegelungshülse 3 verhindert durch ihre Passung mit dem Innenradius der flexiblen Lamellen 4c ein erneutes Zurückfedern der Lamellen. Nun wird mittels Zudrehen des Vorspannrades 5 die Schädelkalotte 7 zwischen Häkchen 4b und Vorspannrad 5 eingeklemmt. Das Vorspannrad 5 gestattet es, verschiedenen Wanddicken der Kalotte 7 Rechnung zu tragen. Die Verriegelungshülse 3 ihrerseits wird durch Aufschrauben des Fixierrades 1 in ihrer Position fixiert. Verriegelungshülse 3 und aufgeschraubtes Fixierrad 1 bilden die obere la und untere 3 a integrierten Gelenkspfannen für das Kugelgelenk der Führungshülse 2b. Die Führungshülse 2 kann durch dieses Gelenk 2b in einem wählbaren Radius geschwenkt werden. Im Fixierrad 1 und der Verriegelungshülse 3 sind deshalb Kegel in der Achse der Führungshülse 2 ausgespart. Sobald die Führungshülse 2 die gewünschte Stellung erreicht hat, kann durch Drehen am Fixierrad 1 die Führungshülse 2 in ihrer Position fixiert werden (Fig. 13, 14). Nun kann die Biopsienadel 8 in die Führungshülse 2 eingeführt und die Probe entnommen werden (Fig. 14).After the cylindrical borehole (usually 15 mm in diameter) has been drilled in the skull cap 7, the meninges are detached from the inside of the skull cap 7 using the duraloser 12 (FIG. 6). The thickness of the skull cap 7 (FIG. 7) can then be measured by means of the measurement scale 12a, which is attached to the duralosolator 12, and the optimum size of the insert 4 can thus be selected. When the insert 4 is passed through the borehole, the flexible lamellae 4b are reduced to a smaller radius by the protruding hooks 4c compressed. After the hooks 4c of the insert 4 have reached the inside of the skull, the flexible blades 4b spring back into their starting position, whereby the hooks 4c are pressed over the edge of the borehole (FIGS. 10 and 11) and the holder slides back out of the borehole prevent. The flexible lamellae 4b arranged in a ring on the insert piece 4, after they have been passed through the borehole, lie snugly against the borehole. The locking sleeve 3 is then inserted into the insert 4 with the aid of the plunger 11 (FIG. 12). Due to its fit with the inner radius of the flexible slats 4c, the locking sleeve 3 prevents the slats from springing back again. Now, by tightening the preload wheel 5, the skull cap 7 is clamped between the hook 4b and the preload wheel 5. The preload wheel 5 allows different wall thicknesses of the cap 7 to be taken into account. The locking sleeve 3 in turn is fixed in position by screwing on the fixing wheel 1. Locking sleeve 3 and screwed on fixing wheel 1 form the upper la and lower 3 a integrated joint spans for the ball joint of the guide sleeve 2b. The guide sleeve 2 can be pivoted through this joint 2b in a selectable radius. Cones are therefore recessed in the axis of the guide sleeve 2 in the fixing wheel 1 and the locking sleeve 3. As soon as the guide sleeve 2 has reached the desired position, the guide sleeve 2 can be fixed in its position by turning the fixing wheel 1 (FIGS. 13, 14). The biopsy needle 8 can now be inserted into the guide sleeve 2 and the sample removed (FIG. 14).

Zum Entfernen der Halterung wird das Fixierrad 1 herausgeschraubt. Darauf wird unter Zuhilfenahme des Verriegelungshülsen Entferners (Fig. 8, 9) die Verriegelungshülse 3 entfernt (Fig. 15 bis 18). In der Ausgangsposition ist der Stift des Verriegelungshülsen Entferners 15 bis zum oberen Anschlag des Arretierungsstiftes 15b in der Stiftarretierung 14c gedrückt. So kann der Verriegelungshülsen Entferner in die Verriegelungshülse 3 eingeführt werden, da die Expansionslamellen 14b zusammengedrückt werden können (Fig. 15, 16). Durch Drücken auf den Kopf 15a des Verriegelungshülsen Entferners werden die Expansionslamellen 14b in ihrer Position fixiert (Fig. 17, 18), so dass die Verriegelungshülse 3 entfernt werden kann. Es wird nun das Vorspannrad 5 im Gegenuhrzeigersinn gedreht, wodurch die Schädelkalotte 7 nicht mehr eingeklemmt ist. Durch eine leichte Dreh- und Kippbewegung kann das Einsetzstück 4 aus dem Bohrloch entfernt werden. To remove the bracket, the fixing wheel 1 is unscrewed. The locking sleeve 3 is then removed with the aid of the locking sleeve remover (FIGS. 8, 9) (FIGS. 15 to 18). In the starting position, the pin of the locking sleeve remover 15 is pressed as far as the upper stop of the locking pin 15b in the pin lock 14c. In this way, the locking sleeve remover can be inserted into the locking sleeve 3, since the expansion slats 14b can be pressed together (FIGS. 15, 16). By pressing the head 15a of the locking sleeve remover, the expansion slats 14b are fixed in their position (FIGS. 17, 18), so that the Locking sleeve 3 can be removed. The biasing wheel 5 is now turned counterclockwise, as a result of which the skull cap 7 is no longer clamped. The insert 4 can be removed from the borehole by a slight turning and tilting movement.

Nummerierung der einzelnen Bestandteile des PatentesNumbering of the individual components of the patent

1 Fixierrad1 fixing wheel

1a obere Gelenkspfanne 1b Griffmulden1a upper joint socket 1b recessed grips

2 Führungshülse2 guide sleeve

2a Adapter für FPS (Flash point system) 2b Kugelgelenk der Führungshülse2a adapter for FPS (Flash point system) 2b ball joint of the guide sleeve

3 Verriegelungshülse 3a untere Gelenkspfanne3 locking sleeve 3a lower joint socket

3b innerer Konus der Verriegelungshülse3b inner cone of the locking sleeve

4 Einsetzstück4 insert

4a Griffmulden4a recessed grips

4b Lamellen4b slats

4c Häkchen4c check mark

4d Lamellenschlitze4d slit slots

5 Vorspannrad5 preload wheel

5a Äusserer Konus des Vorspannrades5a Outer cone of the preload wheel

5b Griffmulden5b recessed grips

6 Biopsienadel6 biopsy needle

7 Schädelkalotte7 skull cap

8 Lokalisiererstativ8 Localization tripod

8a Pedikel 8b Zentralmarker 8c Untere Gelenksfpanne8a pedicle 8b central marker 8c lower joint span

9 Zielstift9 target pin

9a Adapter für FPS9a adapter for FPS

9b Kugelgelenk des Zielstiftes9b ball joint of the target pin

10 Flash-Point-System (FPS)10 flash point system (FPS)

11 Stössel11 pestles

12 Duralöser12 More Dural

12a Massskala12a scale

12b Unterminierungskopf12b undermining head

13 Messhülse13 measuring sleeve

14 Mantel des Verriegelungshülsen-Entfemers (VHE) 14a Führungsbohrung14 Sheath of the locking sleeve remover (VHE) 14a guide hole

14b Expansionslamellen14b expansion slats

14c Stiftarretierung14c pin lock

15 Stift des des Verriegelungshülsen-Entfemers (VHE) 15a Kopf15 Pin of the Locking Sleeve Remover (VHE) 15a head

15b Arretierungsstift15b locking pin

16 Druckfeder 16 compression spring

Claims

Patentansprüche claims 1. Einpunktfixierte selbstverriegelnde Halterung, dadurch gekennzeichnet, dass sie Lamellen mit Häkchen entsprechend der Form eines Loches am Einsetzstück so angeordnet hat, dass die Lamellen 4b nach Einlassen in das Loch formschlüssig am Loch anliegen und die Häkchen 4c auf der der Halterung abgewandten Seite des Loches über den Lochaussenrand vorstehen lassen. Das anschliessende Einführen des Verriegelungsstückes 3, welches kraftschlüssig auf die Innenseite der Lamellen passt, fixiert die Lamellen in ihrer Position. Der Klemmeffekt zwischen Häkchen 4c, Lamellen 4b und Einsetzstückboden 4e gewährt den Halt. Einsetzen eines Fixierstückes 1 verhindert das ungeplante Herausrutschen des Verriegelungsstückes 3.1. Single-point fixed self-locking bracket, characterized in that it has slats with hooks corresponding to the shape of a hole on the insert piece so that the slats 4b fit positively on the hole after insertion into the hole and the hooks 4c on the side of the hole facing away from the bracket Let it protrude over the outer edge of the hole. The subsequent insertion of the locking piece 3, which fits non-positively on the inside of the slats, fixes the slats in their position. The clamping effect between the hook 4c, the slats 4b and the insert bottom 4e ensures the hold. Inserting a fixing piece 1 prevents the locking piece 3 from slipping out unplanned. 2. Halterung nach Anspruch 1, dadurch gekennzeichnet, dass das Fixierstück einen Adapter zur Halterung oder Führung aufweist.2. Holder according to claim 1, characterized in that the fixing piece has an adapter for holding or guiding. 3. Halterung nach Anspruch 1, dadurch gekennzeichnet, dass das Einsetzstück ringförmig angeordnete Lamellen 4b und eine runde Verriegelungshülse 3 aufweist, so dass sie in ein rundes Loch eingesetzt werden kann.3. Holder according to claim 1, characterized in that the insert has annularly arranged slats 4b and a round locking sleeve 3, so that it can be inserted into a round hole. 4. Halterung nach einem der Ansprüche 1 bis 3, dadurch gekennzeichnet, dass sie ein Vorspannrad 5 aufweist. Die Halterung kann so verschiedenen Wanddicken 7 angepasst werden und der Halt wird durch Einklemmen der Wand zwischen Hacken und Vorspannrad erhöht.4. Holder according to one of claims 1 to 3, characterized in that it has a biasing wheel 5. The holder can thus be adapted to different wall thicknesses 7 and the hold is increased by clamping the wall between the heel and the preload wheel. 5. Halterung nach einem der Ansprücke 1 bis 4, dadurch gekennzeichnet, dass zwischen Fixierstück 1 und Verriegelungstück 3 ein Führungsstück 2 angebracht ist.5. Holder according to one of claims 1 to 4, characterized in that a guide piece 2 is attached between the fixing piece 1 and locking piece 3. 6. Halterung nach Anspruch 5, dadurch gekennzeichnet, dass das Führungsstück 2 schwenkbar ist. 6. Holder according to claim 5, characterized in that the guide piece 2 is pivotable. 7. Halterung nach Anspruch 1 bis 6, dadurch gekennzeichnet, dass Führungsstück 2, Einsetzstück 4 und Verriegelungsstück 3 je ein zueinander fluchtendes Loch aufweisen, welches das Durchführen von Instrumenten, Rohren, Schläuchen etc. gestattet7. Holder according to claim 1 to 6, characterized in that the guide piece 2, insert 4 and locking piece 3 each have an aligned hole which allows the passage of instruments, pipes, hoses, etc. 8. Vorrichtung zur Durchführung des Verfahrens nach Patentanspruch 3 und 8. Vorrichtung zum Entfernen der Verriegelungshülse 3, dadurch gekennzeichnet, dass Expansionslamellen 14b am Mantel des Entferners 14 so angeordnet sind, dass sie nach Einführen in eine Aussparung im Verriegelungsstück 3 formschlüssig auf der Innenseite des Verriegelungsstückes 3 anliegen. Ein Stift 15 fixiert darauf die Expansionslamellen 14b und gestattet ein Ausziehen des Verriegelungsstückes aus dem Einsetzstück.8. Device for performing the method according to claim 3 and 8. Device for removing the locking sleeve 3, characterized in that expansion lamellae 14b are arranged on the jacket of the remover 14 so that they are positively inserted on the inside of the locking piece 3 after insertion into a recess Apply locking piece 3. A pin 15 fixes the expansion lamellae 14b thereon and allows the locking piece to be pulled out of the insert piece. 9. Vorrichtung zur Durchführung des Verfahrens nach einem der Patentansprüche 1 bis 7 für die Anwendung mit einem Gerät zur Bestimmung des korrekten Ortes für das Bohrloch. Vorrichtung, welche dadurch gekennzeichnet ist, dass Zielstift 9 und Fixierstück 1 in Beweglichkeit und Konstruktion den entsprechenden Teilen der nachfolgend verwendeten Halterung gleichen. Zusätzlich gestatten es die flexiblen Pedikel 8a den Zentralmarker auf die gewünschte Stelle zu drücken. 9. Device for performing the method according to one of claims 1 to 7 for use with a device for determining the correct location for the borehole. Device, which is characterized in that aiming pin 9 and fixing piece 1 resemble the corresponding parts of the holder used below in terms of mobility and construction. In addition, the flexible pedicles 8a allow the central marker to be pressed onto the desired location.
PCT/CH1997/000386 1996-10-23 1997-10-13 Self-locking holding device with single-point fixation Ceased WO1998017191A1 (en)

Priority Applications (5)

Application Number Priority Date Filing Date Title
IL12508497A IL125084A0 (en) 1996-10-23 1997-10-13 Self-locking holding device with single-point fixation
JP10518768A JP2000502279A (en) 1996-10-23 1997-10-13 One point fixed type automatic locking type holding method
EP97942749A EP0884980A1 (en) 1996-10-23 1997-10-13 Self-locking holding device with single-point fixation
AU44493/97A AU4449397A (en) 1996-10-23 1997-10-13 Self-locking holding device with single-point fixation
NO982899A NO982899L (en) 1996-10-23 1998-06-22 Self-locking holding device with single point attachment

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
CH2587/96 1996-10-23
CH258796 1996-10-23

Publications (1)

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WO1998017191A1 true WO1998017191A1 (en) 1998-04-30

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JP (1) JP2000502279A (en)
AU (1) AU4449397A (en)
CA (1) CA2240456A1 (en)
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NO (1) NO982899L (en)
WO (1) WO1998017191A1 (en)

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Publication number Publication date
NO982899L (en) 1998-06-23
JP2000502279A (en) 2000-02-29
CA2240456A1 (en) 1998-04-30
IL125084A0 (en) 1999-01-26
EP0884980A1 (en) 1998-12-23
NO982899D0 (en) 1998-06-22
AU4449397A (en) 1998-05-15

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