Medical drilling device and drilling system

Abstract

The invention relates to a medical drilling device comprising a cannulated drill having a longitudinal channel extending coaxially with its longitudinal axis, the drilling device comprising at its proximal end a drilling device coupling for coupling in a rotationally fixed manner to a handle or a drilling machine. The drill has a proximal end and a distal end, the drilling device comprising a stylet having a distal stylet part and a proximal stylet part, the distal stylet part being adapted to be inserted in the longitudinal channel of the drill at a drilling position and to block said longitudinal channel over its entire length or almost its entire length. The drill comprises in the region of the proximal end a drill coupling part which together with the proximal stylet part forms the drilling device coupling part. Furthermore an improved medical drilling system is proposed.

Description

[Technical field]

[0001] The present invention relates to a medical drilling device having a cannulated drill having a longitudinal channel extending coaxially with the longitudinal axis of the drill, the drilling device having a drilling device coupling portion at a proximal end for coupling to a handle or drilling machine in a rotationally fixed manner, the drill having a distal end and a proximal end.

[0002] The invention further relates to a medical drilling system comprising at least one medical drilling device. [Background technology]

[0003] In spinal surgery, many procedures are performed minimally invasively. Pedicle screws are used in particular as part of the spinal stabilization system. The pedicle screws are placed in the cortical layer of the vertebral region in the pedicle channel. It is known to open the cortex with a drill. After removing the drill, a Kirschner wire or drill wire (hereinafter referred to as "K-wire") is placed in the cortex previously drilled by the drill, and through the K-wire, the pedicle screw is fed into the vertebra so as to be fixed in the desired manner in the vertebra. The problem with this technique is that after removing the drill, the entrance of the cortex is struck by the K-wire, since there is no guide for the K-wire. Moreover, the minimally invasive access site is practically invisible. In this regard, medical drilling devices with cannulated drills as described above are also useless, because during drilling, the bone is pushed into the longitudinal channel (tubular part), so that the K-wire cannot be placed directly through the drill. Therefore, the cannulated drill also needs to be removed first and the K-wire needs to be placed in a second step after the drill is removed.

[0004] SUMMARY OF THE DISCLOSURE The object of the present invention is therefore to improve a medical drilling device and a medical drilling system of the type described in the introduction, in particular to simplify their handling. Summary of the Invention

[0005] This object is achieved according to the invention in a medical drilling device of the type mentioned in the introduction, which comprises a stylet with a distal stylet part and a proximal stylet part, which is adapted to be inserted into the longitudinal channel of the drill at a drilling position and to block said longitudinal channel over its entire length or almost its entire length, and which comprises in the region of its proximal end a drill coupling part which, together with the proximal stylet part, forms the drilling device coupling part.

[0006] The further developed medical drilling device proposed by the invention makes it possible, in particular, to open bones in a minimally invasive procedure, without the need to remove the drill to place the K-wire. Instead, according to the invention, it is sufficient to remove the stylet from the longitudinal channel. The stylet completely or almost completely blocks the longitudinal channel, in particular in the engaged state, and therefore prevents the ingress of bone material into the longitudinal channel. After removing the stylet, the longitudinal channel of the drill is completely free of bone material, so that the drill itself can be used as a guide for the K-wire, which allows the K-wire to be placed in a defined manner (in a defined orientation and at a defined position) in the bone (e.g. vertebrae). In particular, the stylet forms a closure element in the form of a plug for the longitudinal channel, in order to prevent bone material or other tissue from entering and clogging the longitudinal channel during drilling. As mentioned above, the drill does not have to be removed before placing the K-wire, as in the case of conventional methods, but rather the drill itself serves as a guide for the K-wire. This allows for easier finding of the entry point in the bone when placing the K-wires and easier handling of the drilling device, among other things, which can improve the quality of surgery and shorten the surgical time.

[0007] The drilling device connection is preferably configured rotationally asymmetric with respect to the longitudinal axis, so that the drilling device can be connected in a defined manner to a handle or a drilling machine, e.g. a drill chuck or a connection thereof. In particular, a rotationally fixed connection between the handle or the drilling machine and the drilling device can be achieved in a simple manner.

[0008] Advantageously, the drill coupling has at least one drill engaging surface (drill driving surface) and the proximal stylet part has at least one stylet engaging surface (stylet driving surface), the at least one drill engaging surface and the at least one stylet engaging surface abutting or nearly abutting each other (close enough to substantially abut) at the drilling position. In particular, if the aforementioned surfaces (drill engaging surface and stylet engaging surface) extend parallel to the longitudinal axis, it is possible to engage the drill and the stylet with each other in the region of the drilling device coupling, such that the stylet rotates together when the drill rotates. In other words, the drill and the stylet are thus rotated together. The proximal stylet part and the drill coupling form a drive with each other to transmit a torque to the respective other component. In particular, this depends on which component the torque is introduced into by the handle or the drilling machine.

[0009] In particular, the drill coupling portion has two of the drill engagement surfaces, and the proximal stylet portion has two of the stylet engagement surfaces, so that good coupling and good guiding between the stylet and the drill can be achieved. In particular, the two drill engagement surfaces may be configured to extend parallel to each other in a pair, and the two stylet engagement surfaces may be configured to extend parallel to each other in a pair. For example, the two stylet engagement surfaces may be provided so as to face away from each other, and the two drill engagement surfaces may be provided so as to face each other. Of course, the arrangement or orientation of such engagement surfaces may also be configured inversely.

[0010] Preferably, the longitudinal channel has an elliptical cross section. In particular, the longitudinal channel may have a circular cross section. An elliptical cross section also has the advantage that when the drill is rotated, the stylet is rotated with it. A circular cross section is advantageous in that a K-wire with a circular cross section can be guided through the longitudinal channel and rotated in a defined manner within the longitudinal channel.

[0011] The distal stylet part preferably has a cross-section which corresponds to the cross-section of the longitudinal channel, in particular so that the longitudinal channel can be plugged by the distal stylet part in a snap-fit ​​manner, thus making it possible to prevent bone material from entering the longitudinal channel in a simple and reliable manner.

[0012] Advantageously, the distal end of the distal stylet section is formed with a point, which facilitates the placement of the drilling device on the bone, in particular by which slippage of the drill tip can be prevented simply and reliably.

[0013] According to a further preferred embodiment, the distal end of the distal stylet part at the drilling position may reach or even protrude beyond the distal end of the longitudinal channel (stylet channel). In either case, it is ensured that the longitudinal channel is sufficiently closed at the distal side to prevent the ingress of bone tissue, in particular when drilling the bone. If the distal stylet part protrudes beyond the distal end of the longitudinal channel, it may be used, for example, to position the drill on the bone. For this purpose, the distal end of the distal stylet part is preferably configured in the shape of a pointed tip.

[0014] If the perforation device connection part is constructed mirror-symmetrically with respect to a mirror plane containing the longitudinal axis, perforation devices of medical volume can be formed in a simple manner, in particular perforation device connection parts with non-circular cross sections can be formed.

[0015] Furthermore, the construction of the medical drilling device can be simplified if the drill coupling part and the proximal stylet part are each constructed in mirror symmetry with respect to the mirror surface. In other words, the proximal stylet part and the drill coupling part can be transformed into themselves via the mirror surface. Such a construction makes it possible in particular to construct the drill coupling part with a slot for receiving the proximal stylet part. The slot is preferably constructed in mirror symmetry with respect to the mirror surface.

[0016] In order to ensure torque transmission from the drill coupling portion to the proximal stylet portion and vice versa, it is advantageous for the at least one stylet engagement surface and the at least one drill engagement surface to extend parallel to the mirror surface.

[0017] It is preferable that the stylet and the drill are engaged with each other in a rotationally fixed manner (fixed so as not to rotate relative to each other) so that the stylet rotates integrally with the drill. Rotation of the drill forcibly rotates the stylet (integrally).

[0018] According to a further preferred embodiment, the stylet may be configured to be movable together with the distal stylet part from a separated position, in which the stylet and the drill are not engaged, to a drilling position by inserting the distal stylet part into the longitudinal channel from the proximal end. This configuration allows in particular to couple the stylet to the drill in a simple manner. This is particularly advantageous when, during a surgical procedure, it is necessary to place several pedicle screws in the manner described at the outset. After the K-wires have been placed, the cannulated drill may be removed. The stylet may then be re-engaged to the drill in the aforementioned manner so as to occlude the longitudinal channel of the drill. Thus, in such a procedure, at least in theory, only a single drill with an associated stylet is required, i.e. only a single drilling device is required.

[0019] A depth stop for the stylet is preferably arranged or formed on the drill so as to limit the insertion depth of the distal stylet part into the longitudinal channel, thereby ensuring, in particular, that the stylet blocks the longitudinal channel in the desired manner. For this purpose, the user only needs to insert the stylet into the longitudinal channel until it reaches the depth stop. When the stylet cannot move any further distally relative to the drill, the stylet has reached the desired position.

[0020] When the depth stop is provided with the stop surface of the drill facing in the proximal direction and, at the drilling position, the proximal stylet portion abuts against the stop surface on the distal side, a drilling device can be formed in a simple manner.

[0021] Preferably, the stop surface extends transversely, in particular perpendicularly, to the longitudinal axis, whereby the depth stop can be produced in a simple manner.

[0022] It is advantageous if the stop surface adjoins the proximal insertion opening of the longitudinal channel and at least partially (in particular completely) surrounds the insertion opening. Such an arrangement makes it possible in particular to form a distal stylet part which corresponds exclusively to the longitudinal channel so as to fill (fill) the longitudinal channel at the piercing position. In this case, the proximal stylet part may exclusively form part of the piercing device coupling. Furthermore, deformation (in particular bending) of the distal stylet part relative to the proximal stylet part can be prevented in a simple manner.

[0023] Advantageously, the drill coupling comprises a coupling slot extending parallel to the longitudinal axis, the proximal stylet part engaging in the coupling slot at the drilling position. This arrangement in particular simplifies and makes clear the relative positioning of the proximal stylet part and the drill coupling. In particular, the proximal stylet part can be guided on both sides by the drill coupling.

[0024] The coupling slot preferably has two slot faces facing each other, said two slot faces forming the two drill-engagement faces. In particular, said two slot faces may be arranged parallel to each other and to the above-mentioned mirror plane, which may include the longitudinal axis or extend parallel to the longitudinal axis.

[0025] Furthermore, a rotationally asymmetric drilling device connection can be formed in a simple manner, in particular by the drilling device connection having a connection surface which runs parallel to the longitudinal axis and transversely (in particular perpendicularly) to the at least one drill engagement surface, for example, this connection surface can also be formed on a rotationally symmetrically constructed drilling device connection.

[0026] Preferably, the coupling surface is configured as a flat or substantially flat surface and comprises at least two coupling surface portions, at least one of which is formed by a side surface of the drill coupling portion and at least one of which is formed by a side surface of the proximal stylet portion. In this way, in particular when coupling the drilling device coupling portion to a drilling device handle or drilling machine, it is possible to transmit torque not only to the drill but also to the stylet at the same time. In particular, this can prevent twisting of the proximal stylet portion and the distal stylet portion relative to each other.

[0027] The connection surface can be formed in a simple manner if the drilling device connection part has a rotationally symmetric basic shape and a flat portion along the side of the drilling device connection part, which flat portion extends parallel to the longitudinal axis.

[0028] Preferably, said flat portion comprises said coupling surface. Such an arrangement makes it possible in particular to simply and reliably engage the drilling device with a handle or a drill machine, for example in a rotationally fixed manner.

[0029] According to a further preferred embodiment, the drill coupling portion and the proximal stylet portion, respectively, may be configured rotationally asymmetrically with respect to the longitudinal axis, such that the drill coupling portion and the proximal stylet portion, respectively, may be configured in a simple manner as a drive portion for the other portion in order to transmit torque.

[0030] Furthermore, it is advantageous if at least one coupling element is arranged or formed on the drilling device connection for predetermining the relative axial position of the drilling device and the handle or drilling machine (drilling press), which makes it possible in particular to prevent a relative axial movement of the drilling device and the handle or drilling machine in the coupled position.

[0031] If the at least one coupling element is configured to be radially oriented, the handle or the drill can be coupled to the drilling device in a simple manner, for example the at least one coupling element may be configured in the form of a radially oriented recess, for example in the form of an annular groove or in the form of a part of said annular groove relative to the longitudinal axis.

[0032] The connection of the drilling device to the handle or drilling machine can be further simplified if the at least one coupling element is configured in the form of a coupling projection or coupling receiver, which can be engaged in a press-fit and / or snap-fit ​​manner with a corresponding coupling element on the handle or drilling machine.

[0033] The at least one coupling element is preferably formed to at least partially surround the longitudinal axis. For example, an annular groove may be formed which extends over a circumferential angle of less than 360° with respect to the longitudinal axis. In particular, when a coupling surface is formed on the drilling device coupling as described above, which results in a non-circular cross section of the drilling device coupling, the at least one coupling element does not have to extend over the entire circumference with respect to the longitudinal axis, but instead only over a part of the circumference (part of the circumference) (for example only over an angular range of 180° or 270°).

[0034] Preferably, the at least one coupling element is interrupted by the flat, in other words there are no coupling elements in the area of ​​the flat, in other words this can be achieved, for example, in a rotationally symmetric drilling device coupling originally with a circumferential coupling element relative to the longitudinal axis (extending all around), by dimensioning the flat in such a way that the coupling element is completely removed in the area of ​​the flat.

[0035] Furthermore, it may be advantageous if at least one operating element is arranged or formed on the proximal stylet part. Such an operating element may in particular be used for engaging a finger or a corresponding pulling element to move the stylet proximally or distally relative to the drill. In particular, it is conceivable to provide a pulling element corresponding to the at least one operating element on the handle or on the drill chuck of the drilling machine. In this case, the pulling element can be engaged or disengaged in a defined manner with the at least one operating element in order to move the stylet distally or, in particular, proximally relative to the drill as described above. In particular, when the drill is in the bone and the stylet is housed in the longitudinal channel, the stylet can be withdrawn proximally from the drill in a simple manner.

[0036] Preferably, the operating element is configured in the form of an operating recess or an operating protrusion. For example, the operating element may be formed by a part of said at least one coupling element, which part is formed on the proximal stylet part. In particular, this further simplifies the construction of the drilling device.

[0037] Advantageously, the at least one control element is configured to be oriented radially relative to the longitudinal axis to facilitate exerting a proximal or distal force on the stylet, for example, the at least one control element may be configured as part of a circumferential groove on the punch device coupling to the longitudinal axis.

[0038] Handling of the drilling device is further simplified if, in the drilling position, the at least one operating element has an end face extending transversely (in particular perpendicularly) to the longitudinal axis, which in particular can indicate whether the stylet is engaged with the drill in the desired manner, i.e. whether the longitudinal channel of the drill is blocked (filled), in particular at the distal stylet part.

[0039] It is further preferred that the proximal stylet portion defines a proximal stylet end face and the drill interface portion defines a proximal drill end face, said end faces being formed in part by the stylet end face and in part by the drill end face, among other things, so that a user can directly see whether the stylet and drill are engaged in a desired manner, and thus said end faces can be used as a kind of visual indicator for the user.

[0040] In order to be able to form a sufficiently stable drilling device, it is advantageous if the drill is made of a metallic material, in particular it may be made of stainless steel or titanium.

[0041] Furthermore, the stylet is preferably made of a metal material or a plastic material. In particular, a plastic stylet can be manufactured in a cost-effective manner. In particular, if not only the drill but also the stylet is made of a metal material, the heat generated during drilling can be dissipated well.

[0042] The perforation device is preferably made from at least one sterilizable material. In particular, the perforation device may be manufactured using only one sterilizable material. For example, the stylet and the drill may be made from the same material.

[0043] The object stated at the outset is further achieved by the invention in a drilling system of the type stated at the outset, in which a medical drilling device is configured in the form of one of the above-mentioned advantageous embodiments, and in which the drilling system according to the invention comprises a handle and / or a drilling machine for coupling in a rotationally fixed manner to the drilling device.

[0044] The drilling device can be manipulated in a desired manner using a handle or a drilling machine, particularly to drill a bone, for example, to place a K-wire as a guide for a pedicle screw. The drilling system may include multiple drilling devices of different shapes and sizes. For example, the drilling system may be provided with multiple types of drills (e.g., twist drills, crown drills, core drills, center drills, countersink drills, countersink drills, etc.).

[0045] The drilling system preferably comprises at least one K-wire. The K-wire in this context is a drilling wire. Thus, these terms are used synonymously. In particular, the drilling system may comprise several K-wires, for example of different diameters and lengths. After removing the stylet, the K-wire can be placed through the longitudinal channel into the bone opened by the drilling device, as described above. For this purpose, the K-wire must be long enough to pull out the drill. After the drill is pulled proximally along the K-wire and removed, a cannulated pedicle screw can be slid distally along the K-wire to the bone and screwed into it. To ensure such a guided removal, the K-wire is preferably longer than the drill.

[0046] If the handle and / or the drilling machine are provided with a connecting device for connecting to the drilling device connecting portion in a press-fit and / or fitted state at the connecting position, the handle or the drilling machine can be connected to the drilling device in a simple manner.

[0047] Preferably, the coupling device is movable from the coupling position to a release position in which it is disengaged from the drilling device coupling, in which the drilling device can be removed from the handle or drill machine in a simple and reliable manner.

[0048] It is furthermore advantageous if the coupling device comprises a pulling element for engaging the at least one operating element when the coupling device is in the release position. As mentioned above, the stylet can be easily and reliably removed from the drill. For this purpose, only the coupling device needs to be moved to the release position and the pulling element needs to be engaged with the at least one operating element. When the handle or drill is removed from the drilling device in said position, it disengages from the drill while still being coupled to the stylet and is pulled back in the proximal direction to withdraw the stylet from the longitudinal channel of the drill. [Brief description of the drawings]

[0049] To aid in further explanation, preferred embodiments of the invention will now be described in conjunction with the following drawings, in which:

[0050] [Figure 1] 1 shows a schematic overall perspective view of a drilling system when drilling a vertebra with a drill. [Diagram 2] 2 shows a partially cutaway side view of the drilling system of FIG. 1; [Diagram 3] 1 shows a partial cutaway view of an embodiment of a drilling device in a drilling position. [Figure 4] 4 shows a partially cutaway exploded view of the configuration of FIG. 3. [Diagram 5] 4 shows an enlarged view of the proximal and distal ends of the piercing device in the piercing position of FIG. 3. [Figure 6] FIG. 6 shows a longitudinal sectional view of the configuration of FIG. 5. [Figure 7] FIG. 4 is a view similar to FIG. 3 showing a drilling device according to another embodiment. [Figure 8] FIG. 8 is a view similar to FIG. 4 showing the drilling device of FIG. 7; [Figure 9] FIG. 8 is an enlarged view of the proximal end of the punching device of FIG. 7. [Figure 10] FIG. 10 shows a longitudinal cross-sectional view of the configuration of FIG. [Figure 11] 1 shows a schematic diagram of the placement of a drilling device on a bone. [Figure 12] 1 shows a schematic cutaway view of a drilling device being applied to a pedicle. [Figure 13] FIG. 12 is a schematic view similar to FIG. 11 showing the drill remaining in the pedicle after the stylet has been removed and a K-wire has been inserted into the pedicle through the longitudinal channel of the drill. [Figure 14] FIG. 13 is a schematic view similar to FIG. 12 showing the drill removed along the K-wire and the pedicle screw introduced into the pedicle along the K-wire. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0051] 1 shows a schematic diagram of a medical drilling system according to one embodiment, generally designated by the reference numeral 10. The medical drilling system 1 comprises a drilling device 12 for performing drilling by a drill, and a handle 14 for coupling to the drilling device 12 in particular in a rotationally fixed manner (a fixed manner in which relative rotation is not possible).

[0052] The drilling device 12 includes a cannulated drill 16 having a longitudinal channel 20 extending coaxially with a longitudinal axis 18 of the drill 16.

[0053] At its proximal end, the drilling device 12 includes a drilling device coupling 22 for coupling to the handle 14 or a drilling machine in a rotationally fixed manner (not shown).

[0054] The drill 16 has a proximal end 24 and a distal end 26. The distal end 26 is provided with a number of cutting edges 28 that are particularly suited for cutting bone.

[0055] The perforation device 12 also includes a stylet (mandrel) 30. The stylet 30 has a distal stylet portion (distal mandrel portion) 32 and a proximal stylet portion (proximal mandrel portion) 34. The distal stylet portion 32 is configured in the shape of an elongated rod and has a circular cross section.

[0056] The distal end 36 of the distal stylet portion 32 is formed with a tip 38 .

[0057] The drill 16 has a drill shaft 40. The outer diameter of the drill shaft 40 increases proximally from the distal end 26 in a stepped manner at a transition region 42. The drill shaft 40 thus defines a distal shaft portion 44 and a proximal shaft portion 46, with the transition region 42 being formed between the distal shaft portion 44 and the proximal shaft portion 46.

[0058] Proximally adjacent to the proximal shaft portion 46 is a cylinder body 48. A proximal end face 50 of the cylinder body 48 defines a cylindrical stopper body 52 projecting proximally. The stopper body 52 has an outer diameter slightly smaller than the cylinder body 48, thereby forming a proximally facing annular surface 54 on the cylinder body 48. A proximally facing end face 56 of the stopper body 52 defines a stopper surface 58.

[0059] A drill interface 60 projects proximally from the stop face 58. That is, the drill 16 has the drill interface 60 in the region of its proximal end 24. The drill interface 60 together with the proximal stylet portion 34 forms the drilling device interface 22.

[0060] The distal stylet portion 32 is configured to be inserted into the longitudinal channel 20 of the drill 16 over its entire length to block the longitudinal channel 20 in a drilling position (i.e., a drilling operation position) shown diagrammatically in Figures 1 to 3, 5, and 6.

[0061] The cross section of the distal stylet portion 32 perpendicular to the longitudinal axis 18 corresponds to the cross section of the longitudinal channel 20 such that, in the mated state, the distal stylet portion 32 blocks the longitudinal channel 20. In the piercing position, the distal end 36 of the distal stylet portion 32 extends to or protrudes slightly beyond the distal end 26 of the longitudinal channel 20.

[0062] The longitudinal channel 20 has a circular cross-section. In alternative embodiments, the longitudinal channel 20 may have an elliptical or other non-circular cross-section.

[0063] The stop body 52, together with the stop surface 58, forms a depth stop 62 for the stylet 30 so as to limit the insertion depth of the distal stylet portion 32 into the longitudinal channel 20. As can be readily seen in Figures 5 and 6, the proximal stylet portion 34 in the drilling position abuts distally against the proximally facing stop surface 58 of the drill 16.

[0064] Stop surface 58 extends transversely, i.e., perpendicularly, to longitudinal axis 18. Stop surface 58 is adjacent to an insertion opening 64 proximal to longitudinal channel 20. As can be readily seen in FIG. 5, stop surface 58 at least partially (e.g., completely) surrounds insertion opening 64.

[0065] The proximal stylet portion 34 complements the drill coupling portion 60 in the region of a portion 66 which forms a right circular cylinder so as to extend the stopper body 52 proximally at the drilling position.

[0066] The piercing device interface 22 extends from a distally facing end face 68 of the proximal stylet portion 34 to a proximal end face 70 of the piercing device interface 22. The proximal end face 70 extends transversely, or perpendicularly, to the longitudinal axis 18.

[0067] At the drilling location, the proximal end face 70 is formed by the proximal stylet end face 72 and the proximal drill end face 74 of the proximal stylet portion 34. The end face 68 of the proximal stylet portion 34 is formed in part by the proximal stylet end face 72 and in part by the drill end face 74.

[0068] The piercing device coupling portion 22 has a cylindrical basic shape, but has a non-circular cross-section due to the formation of a flat 76, specifically a bonding region 78 proximally adjacent the portion 66 and extending to the end face 70. The flat 76 is formed along a side of the piercing device coupling portion 22 and extends parallel to the longitudinal axis 18. The flat 76 thereby defines a bonding surface 80 on the piercing device coupling portion 22, i.e., the bonding surface 80 also extends parallel to the longitudinal axis 18.

[0069] The mating surface 80 is flat except for a short transition region 82 and has two mating surfaces 84, 86. Specifically, the mating surface 80 has a first mating surface 84 formed by a side surface 88 of the drill mating portion 60 and a second mating surface 86 formed by a side surface 90 of the proximal stylet portion 34.

[0070] Due to the formation of the flat portion 76, the drilling device coupling portion 22 is configured to be rotationally asymmetric with respect to the longitudinal axis 18.

[0071] The drill interface portion 60 is configured to define a drill engaging surface (drill driving surface) 92. The proximal stylet portion 34 defines a stylet engaging surface (stylet driving surface) 94. In the drilling position, the drill engaging surface 92 and the stylet engaging surface 94 abut one another, as can be readily seen in Figures 5 and 6.

[0072] The drilling tool interface 22 is configured as a mirror image with respect to a mirror plane 96 that contains the longitudinal axis 18. The drill engaging surface 92 and the stylet engaging surface 94 extend parallel to the mirror plane 96.

[0073] As a result of the above-described configuration of the proximal stylet portion 34 and the drill coupling portion 60, the stylet 30 and drill 16 engage one another in a rotationally fixed manner at the drilling position.

[0074] In this embodiment, the drill interface portion 60 and the proximal stylet portion 34 are each configured to be rotationally asymmetric about the longitudinal axis 18 .

[0075] Additionally, the drilling device mating portion 22 is formed with a mating element 98 for predetermining the relative axial position of the drilling device 12 and the handle 14. The mating element 98 is configured to be radially oriented with respect to the longitudinal axis 18.

[0076] In the drilling device 12 according to one embodiment shown in Figures 1 to 6, the coupling element 98 is configured in the form of a coupling receptacle 100. The coupling receptacle 100 partially surrounds the longitudinal axis 18. The coupling receptacle 100 is configured in such a way that it has the shape of an annular groove 102 if the flats 76 are not provided in the drilling device coupling part 22. In other words, this annular groove 102, i.e. the coupling element 98, is interrupted by the flats 76.

[0077] The coupling element 98 is formed partially on the proximal stylet portion 34 and partially on the drill coupling portion 60 .

[0078] The proximal stylet section 34 also defines a handling element 104. The handling element 104 has the shape of a handling recess 106. The handling element 104 is configured to be oriented radially relative to the longitudinal axis 18.

[0079] In the embodiment of FIGS. 1-6, the steering element 104 is formed by a portion of the coupling element 98 that extends circumferentially along an outer circumferential surface 108 of the proximal stylet portion 34 relative to the longitudinal axis 18 .

[0080] The exemplary handle 14 includes a knob 110 at its proximal end, adjacent to its distal end is a retention area 112 including a number of grooves 114 extending parallel to the longitudinal axis 18. The grooves 114 are evenly distributed around the entire circumference of the retention area 112.

[0081] The coupling device 116 forms the distal end region of the handle 14. The coupling device 116 is configured in the form of a quick coupling with a coupling sleeve 120 movable on a shaft 118 of the handle 14. The coupling device 116 makes it possible to couple the handle 14 to the drilling device 12 in a coupled position.

[0082] The coupling sleeve 120 is displaceable in the proximal direction against the action of a spring 122. When the pushed back coupling sleeve 120 is released, the spring 122 acts to automatically move the coupling sleeve 120 in the distal direction.

[0083] A number of balls 126 are inserted into through holes 124 drilled along the radial direction of the shaft 118 and are retained on the shaft 118. In the coupled position, in which the spring 122 retains the coupling sleeve 120 in a distal position, the balls 126 are pressed in a direction toward the longitudinal axis 18 (radially inward) and protrude slightly beyond an inner wall surface 128 of a coupling receptacle 130 formed in the shaft 118 coaxially with the longitudinal axis 18.

[0084] The coupling sleeve 120 has an inner wall surface 132 facing in the direction toward the longitudinal axis 18 (radially inward) formed with a recess 134 in the form of an annular groove facing in the direction toward the longitudinal axis 18 (radially inward). The annular groove (recess 134) has a depth such that the ball 126 can sink into the recess 134 to release the coupling receiver 130.

[0085] Additionally, the coupling receiver 130 has a rotationally asymmetric cross-section extending transversely to the longitudinal axis 18. The cross-section of the coupling receiver 130 matches the cross-section of the drilling device coupling 22 such that the drilling device coupling 22 can be matingly received within the coupling receiver 130. As a result, the drilling device coupling 22 and the handle 14 engage one another in a rotationally fixed manner.

[0086] To couple the drilling device 12 to the handle 14, the drilling device coupling 22 is inserted into the distally open coupling receiver 130 of the shaft 118 of the handle 14 with the proximal end face 70 facing forward. At this time, the ball 126 blocks the path of the drilling device coupling 22. Now, when the coupling sleeve 120 is pressed toward the holding area 112 against the action of the spring 122, the ball 126 sinks into the recess 134 as described above, and the drilling device coupling 22 becomes capable of further moving in the proximal direction. Specifically, the drilling device coupling 22 can be moved until the coupling receiver 100 is positioned opposite the ball 126. When the coupling sleeve 120 is released, the spring 122 moves the coupling sleeve 120 distally relative to the holding area 112, thereby fixing the ball 126 against movement in a direction away from the longitudinal axis 18 (radially outward). FIG. 2 shows the above-mentioned coupling position, in which the handle 14 is coupled by its coupling device 116 to the punching device coupling portion 22 in a press-fit and / or snap-fit ​​manner.

[0087] Alternatively, the coupling device 116 may be similarly configured on a drilling machine such that the drilling device 12 is coupled to the drilling machine.

[0088] As mentioned above, the coupling device 116 is movable from said coupling position to a release position in which it is disengaged from the drilling device coupling 22. The release position is not shown but is as described above. In the release position, the coupling sleeve 120 moves against the action of the spring 122 towards the retention area 112, so that the ball 126 sinks into the recess 134, releasing the drilling device coupling 22.

[0089] Optionally, the coupling device 116 may comprise a pulling element for engaging at least one of the manipulating elements 104 when the coupling device 116 assumes the released position, whereby the punching device 12 may be disassembled into its components with the aid of the handle 14 when the pulling element engages only the manipulating element 104 formed on the proximal stylet portion 34. When the pulling element engages the manipulating element 104 as the handle 14 is withdrawn proximally, the stylet 30 is pulled proximally from the longitudinal channel 20.

[0090] A punching device 12 according to a second embodiment is shown diagrammatically in Figures 7 to 10. The punching device 12 of the embodiment shown in Figures 7 to 10 differs from the punching device 12 of the embodiment shown in Figures 1 to 6 only in the configuration of the punching device coupling portion 22. Therefore, in describing the second embodiment, the same reference numerals are used for components that are identical or functionally similar to those of the first embodiment.

[0091] In the second embodiment, the drill coupling 60 is configured to be mirror-symmetrical with respect to the mirror plane 96. Specifically, the drill coupling 60 comprises two parts 136, 138 separated from each other. The two parts 136, 138 are separated from each other, i.e., spaced at a certain distance from each other, by a coupling slot 140 extending parallel to the longitudinal axis 18. The coupling slot 140 has two slot faces 142 facing each other. The two slot faces 142 form the drill engagement surface (drill driving surface) 92.

[0092] In the second embodiment, the proximal stylet portion 34 is configured as a mirror image relative to the mirror surface 96 and engages the coupling slot 140 to fill the coupling slot 140 at the piercing location. The piercing location in the second embodiment is shown generally in Figures 7, 9, and 10.

[0093] The outer contour of the punching device coupling part 22 is the same as the outer contour of the punching device coupling part 22 in the embodiment of FIGS.

[0094] Due to the slotted structure of the drill coupling portion 60, the drill coupling portion 60 has two drill engagement surfaces (drill drive surfaces) 92 that extend parallel to the longitudinal axis 18 and parallel to each other and face each other. Correspondingly, the proximal stylet portion 34 has two stylet engagement surfaces (stylet drive surfaces) 94. The two stylet engagement surfaces 94 face in opposite directions and extend parallel to each other and parallel to the longitudinal axis 18. As can be easily seen in FIG. 10, the drill engagement surface 92 and the stylet engagement surface 94 abut each other in the drilling position.

[0095] The stop surface 58 extends between the opposing drill-engaging surfaces 92 and is defined by the end surface 56 of the stop body 52 .

[0096] Also in the second embodiment, an operating element 104 in the form of an operating recess 106 is configured as part of the coupling element 98 .

[0097] In the embodiment of FIGS. 7-10, the bonding surface 80 is formed by two first bonding surface portions 84 on portions 136, 138 of the drill bonding portion 60 and a second bonding surface portion 86 on the proximal stylet portion 34.

[0098] Accordingly, the proximal end face 70 is also formed by three portions, specifically by a proximal stylet end face 72 that is disposed between two proximal drill end faces 74 at the drilling position.

[0099] The functions of the punching device 12 according to the embodiment of FIGS. 7 to 10 completely correspond (are identical) to the functions of the punching device 12 according to the embodiment of FIGS. 1 to 6, and therefore the above description may be referred to.

[0100] In the above embodiment, the drill 16 is made of a metallic material, and the stylet 30 is also made of a metallic material.

[0101] In another embodiment, the stylet 30 may be made from a plastic material.

[0102] In all embodiments, the perforation device 12 is made of at least one sterilizable material. The perforation device 12 may be made of a single sterilizable material, such as a sterilizable metallic material. For example, if the stylet 30 is made of a plastic material and the drill 16 is made of a metallic material, the perforation device 12 is made of two sterilizable materials.

[0103] In the following, the use of the drilling system 10 will be generally described based on possible applications in conjunction with Figures 11 and 14. For example, in spinal surgery, not only pedicle screws are present. In the case of the cervical spine, lateral mass screws are also present. The procedure described below does not limit the scope of use of the drilling device 12 for use in conjunction with pedicle screws 150.

[0104] In a first step, the drilling device 12 is inserted at its distal end 26 into the patient's body through a minimally invasive access site. Figures 11 and 12 show this procedure diagrammatically, but for ease of understanding, the handle 14 and a suitable corresponding drilling machine are omitted.

[0105] The drill 16 with the stylet 30 is secured to the pedicle 146 of the vertebra 144. During drilling, the stylet 30 prevents bone material from entering and clogging the longitudinal channel 20.

[0106] In the next step, the stylet 30 is withdrawn from the longitudinal channel 20 of the drill 16, but the drill 16 remains within the vertebra 144.

[0107] After the stylet 30 releases the longitudinal channel 20, a K-wire 148 included in the drilling system 10 can be inserted proximally through the insertion opening 64 into the longitudinal channel 20 and secured to the vertebra 144. The drill 16 serves as a guide for the K-wire 148.

[0108] As shown diagrammatically in FIG. 13, once the K-wire 148 is secured, in a next step the drill 16 may be removed from the vertebra 144 leaving the K-wire 148 in place within the vertebra 144 .

[0109] The K-wire 148 serves to guide a cannulated pedicle screw 150. The pedicle screw 150 may then be threaded into the pedicle 146 in a typical manner by means of a shaft 154 provided with external threads 152.

[0110] The K-wires 148 are removed once the pedicle screws 150 are sufficiently secured to the vertebrae 144. The pedicle screws 150 may be screwed deeper into the vertebrae 144, if desired.

[0111] The head 156 of the pedicle screw 150 is adapted to receive a rod-shaped connecting element (not shown) which can be fixed in the head 156 in a clamping manner by a fixing screw (not shown).

[0112] After placing the first pedicle screw 150 in the manner described above, the stylet 30, along with its distal stylet portion 32, may be returned from a separated position, in which the stylet 30 and drill 16 are fully disengaged, to a drilling position by inserting the distal stylet portion 32 proximally into the longitudinal channel 20. This allows multiple pedicle screws 150 to be secured to the vertebrae 144 in the manner described above using only a single drilling device 12 during a surgical procedure. [Explanation of symbols]

[0113] 10 Drilling System 12 Drilling device 14 Handle 16 Drill 18 Longitudinal Axis 20 Longitudinal Channels 22 Punching device coupling part 24 Proximal end 26 Distal end 28 Cutting Edge 30 Stylet 32 Distal stylet 34 Proximal stylet 36 Distal end 38 Point 40 Drill shaft 42 Transition region 44 Distal shaft 45 Proximal shaft 48 Cylinder body 50 End face 52 Stopper body 54 Annular Surface 56 End face 58 Stopper surface 60 Drill joint 62 Depth stopper 64 Insertion opening 66 parts 68 End face 70 Proximal end face 72 Proximal Stylet End Face 74 Proximal Drill End Face 76 Flat area 78 Combined area 80 Bonding surface 82 Transition region 84 first coupling surface 86 Second coupling surface 88 Side 90 Side 92 Drill engagement surface 94 Stylet engagement surface 96 Mirror surface 98 Bonding Elements 100 Joint Receptacle 102 Annular groove 104 Operational elements 106 Operation recess 108 Outer surface 110 Nobu 112 Holding area 114 Groove 116 Coupling device 118 Shaft 120 Connecting sleeve 122 Spring 124 Through hole 126 Ball 128 Wall 130 Joint Receptacle 132 Wall 134 Recess 136 parts 138 parts 140 Combined Slots 142 Slot surface 144 vertebrae 146 pedicle 148 K wire (Kirschner wire) 150 Pedicle Screw 152 Male thread 154 Shaft 156 Head

Claims

1. A medical drilling device (12) comprising a cannulated drill (16), The drill (16) has a longitudinal channel (20) extending coaxially with a longitudinal axis (18) of the drill (16); The drilling device (12) comprises, at its proximal end, a drilling device coupling (22) for coupling in a rotationally fixed manner to a handle (14) or a drilling machine; The drill (16) has a proximal end (24) and a distal end (26); The perforation device (12) comprises a stylet (30) having a distal stylet portion (32) and a proximal stylet portion (34); the distal stylet portion (32) is configured to be inserted into the longitudinal channel (20) of the drill (16) at a drilling position and to occlude the longitudinal channel (20) over its entire length or nearly its entire length; the drill (16) comprises a drill coupling (60) in the region of the proximal end (24); The drill coupling portion (60) is configured to form the drilling device coupling portion (22) with the proximal stylet portion (34). A medical piercing device.

2. the drilling device coupling (22) is configured rotationally asymmetric with respect to the longitudinal axis (18); 2. The medical drilling device according to claim 1.

3. The drill coupling portion (60) has at least one drill engaging surface (92); the proximal stylet portion (34) has at least one stylet engagement surface (94); the at least one drill engaging surface (92) and the at least one stylet engaging surface (94) abut or nearly abut one another at the drilling location; 3. The medical drilling device according to claim 1 or 2.

4. The drill coupling portion (60) has two of the drill engagement surfaces (92), and the proximal stylet portion (34) has two of the stylet engagement surfaces (94).

4. The medical drilling device according to claim 3.

5. The distal stylet portion (32) has a cross section that matches the cross section of the longitudinal channel (20).

3. The medical drilling device according to claim 1 or 2.

6. The drilling device coupling portion (22) is configured mirror-symmetrically with respect to a mirror plane (96) that includes the longitudinal axis (18).

3. The medical drilling device according to claim 1 or 2.

7. The drill coupling portion (60) and the proximal stylet portion (34) are each configured to be mirror-symmetric with respect to the mirror surface (96).

7. The medical drilling device according to claim 6.

8. The drilling device coupling portion (22) is configured to be mirror-symmetrical with respect to a mirror plane (96) including the longitudinal axis (18), The at least one stylet engaging surface (94) and the at least one drill engaging surface (92) extend parallel to the mirror surface (96).

4. The medical drilling device according to claim 3.

9. The stylet (30) and the drill (16) engage with each other in a rotationally fixed manner at the drilling position.

3. The medical drilling device according to claim 1 or 2.

10. a depth stop (62) for the stylet (30) disposed or formed on the drill (16) to limit the insertion depth of the distal stylet portion (32) into the longitudinal channel (20); 3. The medical drilling device according to claim 1 or 2.

11. The depth direction stopper (62) is provided so that the stopper surface (58) of the drill (16) faces the proximal direction, and at the drilling position, the proximal stylet portion (34) abuts against the stopper surface (58) on the distal side.

11. The medical drilling device according to claim 10.

12. The drill coupling portion (60) includes a coupling slot (140) extending parallel to the longitudinal axis (18); the proximal stylet portion (34) engages the coupling slot (140) at the piercing location; 3. The medical drilling device according to claim 1 or 2.

13. The drill coupling portion (60) has a coupling slot (140) extending parallel to the longitudinal axis (18), the proximal stylet portion (34) engages the coupling slot (140) at the piercing location; The coupling slot (140) has two opposing slot surfaces (142), which form the two drill-engaging surfaces (92).

4. The medical drilling device according to claim 3.

14. The drilling tool coupling portion (22) has a coupling surface (80) that extends parallel to the longitudinal axis (18) and perpendicular to the at least one drill engagement surface (92).

4. The medical drilling device according to claim 3.

15. The bonding surface (80) is composed of a flat or nearly flat surface and has at least two bonding surface portions (84, 86), at least one of the at least two bonding surface portions (84, 86) being formed by a side surface (88) of the drill bonding portion (60), and at least one of the at least two bonding surface portions (84, 86) being formed by a side surface (88) of the proximal stylet portion (34).

15. A medical drilling device according to claim 14.

16. the drilling device coupling part (22) has a rotationally symmetrical basic shape and flats (76) along the sides of the drilling device coupling part (22), the flats (76) extending parallel to the longitudinal axis (18); 3. The medical drilling device according to claim 1 or 2.

17. The drilling device coupling part (22) has a rotationally symmetric basic shape and a flat part (76) along a side of the drilling device coupling part (22), the flat part (76) extending parallel to the longitudinal axis (18); The flat portion (76) comprises the bonding surface (80).

15. A medical drilling device according to claim 14. １

18. The drill coupling portion (60) and the proximal stylet portion (34) are each configured rotationally asymmetric with respect to the longitudinal axis (18).

3. The medical drilling device according to claim 1 or 2.

19. At least one coupling element (98) is arranged or formed on the drilling device coupling portion (22) to predetermine the relative axial position of the drilling device (12) and the handle (14) or drilling machine.

3. The medical drilling device according to claim 1 or 2.

20. The at least one coupling element (98) is (a) configured to be radially oriented; and / or (b) configured in the form of a coupling projection or coupling receptacle (100); and / or (c) configured to at least partially surround said longitudinal axis (18); 20. The medical drilling device of claim 19.

21. The drilling device coupling (22) has at least one coupling element (98) arranged or configured to predetermine the relative axial position of the drilling device (12) and the handle (14) or drilling machine; The at least one coupling element (98) comprises: (a) configured to be radially oriented; and / or (b) configured in the form of a coupling projection or coupling receptacle (100); and / or (c) configured to at least partially surround said longitudinal axis (18); and / or (d) interrupted by said flat portion (76); 17. A medical drilling device according to claim 16.

22. At least one operating element (104) is disposed on or formed on the proximal stylet portion (34); 3. The medical drilling device according to claim 1 or 2.

23. A medical drilling system (10) comprising at least one medical drilling device (12) according to claim 1 or claim 2, a handle (14) and / or a drill for connecting in a rotationally fixed manner to the drilling device (12); Medical drilling system.

24. (a) comprising at least one K-wire (148); and / or (b) the handle (14) and / or the drilling machine includes a coupling device (116) for coupling to the drilling device coupling portion (22) in a press-fit and / or snap-fit ​​manner in a coupling position; 24. The medical drilling system of claim 23.

25. The coupling device (116) is movable from the coupling position to a release position in which it is disengaged from the drilling device coupling portion (22); 25. The medical drilling system of claim 24.

26. A medical drilling system (10) comprising at least one medical drilling device (12) according to claim 22, a handle (14) and / or a drill for connecting to the drilling device (12) in a rotationally fixed manner; (a) comprising at least one K-wire (148); and / or (b) the handle (14) and / or the drilling machine comprises a coupling device (116) for coupling in a press-fit and / or snap-fit ​​manner to the drilling device coupling portion (22) in a coupled position; the coupling device (116) is movable from the coupling position to a release position in which it is disengaged from the drilling device coupling portion (22); the coupling device (116) comprises a tension element for engaging the at least one operating element (104) when the coupling device (116) is in the released position; Medical drilling system.

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