Device for providing spongy bone with bone substitute and/or bone reinforcing material, bone substitute and/or bone reinforcing material and method
The present invention relates to a device for providing spongy bone with bone substitute and/or bone reinforcing material, wherein at least one perforating device (4) is provided for making at least one hole (5) in the spongy bone (1) and wherein at least one flushing or rinsing device (6) is provided for flushing or rinsing the hole (5) with a rinsing agent (7). At least one vacuum source (9) is provided for generating a vacuum in the hole (5) in the spongy bone (1) for sucking and/or facilitating insertion or feeding of the bone substitute and/or bone reinforcing material (3) into said spongy bone (1). The invention also relates to bone substitute and/or bone reinforcing material and methods in connection with the invention.
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The present invention relates to a device for providing spongy bone with bone substitute and/or bone reinforcing material, wherein at least one perforating device is provided for making at least one hole in the spongy bone and wherein at least one flushing or rinsing device is provided for flushing or rinsing the hole with a rinsing agent. The invention further relates to a bone substitute and/or bone reinforcing material and a method.
BACKGROUND OF THE INVENTIONVertebroplasty is a technique according to which biocompatible material is injected into a spongy vertebra. After some time, the injected material hardens, whereby an inner support is obtained for fixing the vertebra and thereby alleviate pain and reduce the risk of vertebral collapse.
The material is injected into the vertebra through a needle and in doing so, it is necessary to subject the material to high pressure, often one or more MPa. Hereby, there is an obvious risk that tissue material, e.g. blood and fat, in the vertebra is pressed out into the blood vessels or into fracture gaps such that said material can affect adjacent nerves. There is also an obvious risk that the injected material is pressed out into fracture gaps or into adjacent tissue. This is well known and the material and fat being pressed out can reach the blood vessels and the lungs, resulting in a poorer oxygenation, blood pressure reduction and, in exceptional cases, death.
By inserting an extra needle into the vertebra, the risk of leakage (note publications in the enclosed reference list, point 1 and 2, in the end of the description). Normally, this extra needle is left open or preferably connected to a suction hose for generating a suction effect (note publication in the enclosed reference list, point 3). However, any decisive effect is not reached with the prior art.
Various hole making and rinsing devices for making holes in and rinsing of vertebrae are known from e.g. U.S. Pat. No. 6,440,138, U.S. Pat. No. 6,716,216, U.S. Pat. No. 6,719,761 and U.S. Pat. No. 6,740,090, but none of these publications describes generation of a vacuum in the vertebrae for providing safe suction of bone substitute and/or bone reinforcing material into said vertebrae.
SUMMARY OF THE INVENTIONThe object of the present invention has been to eliminate the abovementioned problem and this is arrived at while the invention has been given the characterizing features of each of subsequent claims 1, 44, 51, 53, 56 and 58.
By making a hole in the spongy bone and rinse it, tissue material and other material can be flushed away from the hole and the sides thereof, such that said sides get rough or uneven surfaces with depressions into which the bone substitute and/or bone reinforcing material can be brought to penetrate by generating a vacuum in the hole and without risking that said bone substitute and/or bone reinforcing material penetrates into the blood paths.
The invention will be further described below with reference to the accompanying drawings, in which:
In the figures, different parts of a device for preparing spongy bone 1, e.g. a vertebra 2, to receive bone substitute and/or bone reinforcing material 3, and for locating said material in said vertebra is schematically illustrated. Said device comprises at least one perforating device 4 for making at least one hole 5 in the vertebra 2, at least one flushing or rinsing device 6 for flushing or rinsing said hole with rinsing agent 7 and at least one supply device 8 which permits suction and/or insertion of bone substitute and/or bone reinforcing material 3 into the vertebra.
At least one vacuum source 9 is provided to generate a vacuum in the hole 5 in the vertebra 2 for sucking and/or facilitate insertion of bone substitute and/or bone reinforcing material 3 into said vertebra.
The perforating device 4 can be designed in many different ways and so can also the rinsing device 6. At the exemplary embodiment of
The movements of the perforating means 12 can be obtained by means of a drive unit 14 of a suitable type.
At the exemplary embodiment, the perforating means 12 is designed as an inner tube member 15. A rinsing agent container 16 is connected to this inner tube member 15 through a connecting device 17 which permits feeding of rinsing agent 7 from the container 16 into the inner tube member 15 irrespective of whether said inner tube member is rotatable or not. Alternatively, the rinsing agent container 16 may be connected to the outer tube member 11 and the collecting device 27 and the vacuum source 9 to the inner tube member 15, such that the outer tube member 11 can lead rinsing agent 7 into the hole 5 and be sucked out of said hole through the inner tube member 15. The perforating device 4 is used preferably for making at least two holes 5 in the vertebra 2. These holes 5 are located such that they communicate with each other either by extending into each other (as is illustrated in
The vacuum source 9 is provided to suck rinsing agent 7 through the hole 5 and it is preferably connected to the outer tube member 11 for sucking, through said outer tube member, rinsing agent 7 and tissue material and other material out of said hole 5.
Between the outer tube member 11 and the vacuum source 9 there is preferably a collecting device 27 for collecting rinsing agent 7 and tissue material and other material brought along therewith out of the hole 5.
The rinsing device 6 is preferably provided also to flush or rinse the sides 5a of the hole 5 such that depressions 5b and similar are formed therein while tissue material and other material is flushed off said sides. This is advantageous since bone substitute and/or bone reinforcing material 3, by means of the vacuum generated in the hole 5, can be brought to penetrate into the depressions 5b.
At the embodiment illustrated in
The supply device 8 illustrated in
The vacuum source 9 can be an injector pump 21 which is run or driven by a suitable compressed medium from a compressed-medium device 22. The injector pump 21 may e.g. be driven by compressed air and connected, through a compressed-air conduit 23, to a compressed-medium device 22 in the form of a compressed-air device. This device may be built into a hospital or other locality in which the injector pump 21 shall be used. Alternatively, the injector pump 21 can be run or driven by another commercially available gas as is indicated with broken lines in
The compressed-medium device 22 can operate the injector pump 21 with a compressed-medium pressure of 4.5-8.5 bar and the injector pump 21 may be of a type which is placed on the floor and which has a foot pedal 24 for its operation. Thus, the injector pump 21 can be started by tilting the foot pedal 24 in one direction and stopped by tilting the foot pedal 24 in the opposite direction. As an example of a usable injector pump 21 in this connection one can mention an injector pump of the type used for producing bone cement as defined in U.S. Pat. No. 5,328,262 and sold under the product name Scan Vacuum Pumps™ by the company Scandimed International AB, Sjöbo, Sweden.
The injector pump 21 is preferably provided to generate a vacuum in all the holes 5 of the spongy bone 1 such that said holes are filled or can be filled with bone substitute and/or bone reinforcing material 3 and/or a vacuum such that the bone substitute and/or bone reinforcing material 3 is distributed therein, preferably without any or any substantial portions thereof being sucked into the second cannula 20.
The injector pump 21 can be provided to generate a vacuum of between −0.5 bar and −0.92 bar in the spongy bone 1, which vacuum corresponds to a 70% and 90% absolute vacuum. In many cases it is sufficient that the injector pump 21 generates a vacuum of between −0.7 bar and −0.8 bar in the spongy bone 1.
The injector pump 21 is preferably provided to suck tissue material such as blood and fat out of the holes 5 of the spongy bone 1 and into the second cannula 20 before bone substitute and/or bone reinforcing material 3 is sucked into the spongy bone 1 through the first cannula 19.
In at least one connecting conduit 25 between the second cannula 20 (the inlet end of which is the end which is inserted into a hole 5 of the spongy bone 1) and the injector pump 21, there may be provided a non-return valve device 26 and/or a collecting device 27 and/or a monomer filter 28 (if the bone substitute and/or bone reinforcing material 3 is of bone cement type) and/or a bacteria filter 29.
The collecting device 27 may be a container which is placed on the floor and closed or sealed by means of a cap. A portion of the connecting conduit 25, which is connected to the second cannula 20, is directed through the cap and a small distance down into the container. Another portion of the connecting conduit 25 is also directed through the cap and a small distance down into the container. When tissue material is sucked from the holes 5 of the spongy bone 1 to the collecting device 27, said material is collected down below in the container and is therefore prevented from being sucked further towards the injector pump 21 and into said pump. If there is a monomer filter 28 and/or a bacteria filter 29 between the collecting device 27 and the injector pump 21, the tissue material is prevented also from being sucked thereto.
The monomer filter 28 may be a carbon filter and is adapted to prevent monomer gases, generated during production of bone substitute and/or bone reinforcing material 3 in the form of bone cement, from being sucked into the injector pump 21 and discharged to the surroundings. The advantages with such a monomer filter 28 are described in the publication according to the enclosed reference list, point 4. The bacteria filter 29 is provided to prevent bacteria from entering or getting into the holes 5 of the spongy bone 1 if the connecting conduit 25 is opened or opens unintentionally and air is sucked therethrough to the holes 5 if there is a vacuum therein.
The monomer filter 28 and bacteria filter 29 may be provided in that portion of the connecting conduit 25 which connects the collecting device 27 with the injector pump 21.
The non-return valve device 26, which preferably can be provided in the connecting conduit 25 between the collecting device 27 and the second cannula 20, is adapted to prevent tissue material from being sucked out of the collecting device 27 and into the holes 5 of the spongy bone 1 if the connecting conduit 25 is opened or opens unintentionally such that a suction is generated therein towards the holes 5 of the spongy bone 1 if there is a vacuum therein.
The container 18 may include a feeding device 30 for feeding bone substitute and/or bone reinforcing material 3 out of the container 18 and into the holes 5 of the spongy bone 1 at the same time the injector pump 21 generates a vacuum therein or thereafter.
The feeding device 30 is schematically illustrated with a feed means 31 which is displaceably mounted relative to the container 18 and which can be displaced manually for discharge of bone substitute and/or bone reinforcing material 3 from the container 18 and through the first cannula 19 into the holes 5 of the spongy bone 1.
The container 18 may eventually be used as mixing container for mixing the components required for the production of such bone substitute and/or bone reinforcing material 3 that can be brought to harden after insertion thereof into the holes 5 of the spongy bone 1. This mixing can occur with a mixing means or in any other way. Such a mixing means can preferably be moved manually back and forth in the container 18 and is eventually rotated relative thereto for mixing the components.
A valve device 32 may be provided for, on one hand, close or interrupt the supply of bone substitute and/or bone reinforcing material 3 through the first cannula 19 to the holes 5 of the spongy bone 1 until the injector pump 21 has generated a suitable vacuum therein. When this is done, the valve device 32 may be opened for permitting suction of bone substitute and/or bone reinforcing material 3 into the holes 5 of the spongy bone 1 by means of the injector pump 21. The valve device 32 may be located on the first cannula 19 or on a connecting conduit between the container 18 and the first cannula 19. The valve device 32 may be manually operable by means of a control handle 33.
As an alternative to the embodiment of the flushing or rinsing device 6 described above, said device may be combined with the supply device 8. At this alternative, the rinsing agent container 16 of the rinsing device 6 may be connected to the first cannula 19 e.g. through the valve device 32 which in this case can be a three way valve permitting either that the supply of rinsing agent to the vertebra 2 is open and the supply of bone substitute and/or bone reinforcing material 3 to the vertebra 2 is closed or that said supply of rinsing agent is interrupted and said supply of material open.
The rinsing agent 7 may be of different types and it may e.g. be distilled water or a sodium chloride solution and/or be detergent and/or include at least one trombolytic substance, e.g. heparin, streptokinase, urokinase, TPA and/or other substances dissolving coagulum and thrombi.
The bone substitute and/or bone reinforcing material 3 may consist of primarily minerals or ceramics which can be mixed with a hardener, e.g. water. These substances may be selected from the group comprising calcium sulphate-α-hemihydrate, calcium sulphate-β-hemihydrate, calcium sulphate-dihydrate, calcium carbonate, α-tricalcium phosphate, hydroxyapatite, dicalcium phosphate-dihydrate, anhydrous dicalcium phosphate, tetracalcium phosphate, β-tricalcium phosphate, calcium deficient hydroxyapatite, monocalcium phosphate-monohydrate, mono-calcium phosphate, calcium-pyurophosphate, precipitated hydroxyapatite, carbonaceous apatite (dahlite), octa-calcium phosphate, amorphous calcium phosphate, oxyapatite, carbonate apatite and calcium aluminate.
A ceramic material may be calcium aluminate, which forms part of the product Doxa T from the company Doxa (www.doxa.se/pdf/nyhet—1.pdf).
X-ray contrast agents can be added to said ceramic bone substitute and/or bone reinforcing material 3, e.g. water soluble non-ionic X-ray contrast agents selected from the group comprising iohexol, ioversol, iopamidol, iotrolan, metrizamide, iodecimol, ioglucol, ioglucamide, ioglunide, iogulamide, iomeprol, iopentol, iopromide, iosarcol, iosimide, iotusal, ioxilan, iofrotal and iodecol.
Alternatively, the bone substitute and/or bone reinforcing material 3 can be a hardenable bone cement comprising polymer and monomer components. The polymer may be polymethylmethacrylate (PMMA) and the monomer methylmethacrylate (MMA). A polymer base material can be the product Cortoss™ from the company Orthovita in the U.S. For composition see www.orthovita.com/products/cortoss/oustechspecs.html. Another polymer base material can be the product SECOUR® Acrylic Resin PMMA from parallax medical inc. (www.parallax-medical.com/go/9192b550-5642-1157-a432-d7a2b98310fe).
The bone substitute and/or bone reinforcing material 3 may consist of a mineral and/or a ceramic in combination with polymer material.
The advantages with the invention is obvious when comparing the degree or ratio of fullness of the vertebra 2 of
It is also obvious from
The invention is not limited to what is described above and illustrated in the drawings, but may vary within the scope of subsequent claims. Thus, the vacuum source 9 may instead of an injector pump 21 be another vacuum pump which can be electrically operated or operated by gas or by hand or operated in any other way, that the hole 5 may be more than one hole and surrounding parts thereto, that the rinsing agent 7 may be another than those described and that the bone substitute and/or bone reinforcing material 3 may be of another type than those described.
There may be a device for imparting pulse like suction and/or insertion movements to the bone substitute and/or bone reinforcing material 3 into the hole(s) 5 in the spongy bone 1. Furthermore, there may be a device for imparting reciprocating suction and/or insertion movements to the bone substitute and/or bone reinforcing material 3 into the hole(s) 5 in the spongy bone 1.
There may also be a device for pulse like suction and/or feeding of the rinsing agent 7 through the hole(s) 5 in the spongy bone 1.
Said device may be defined by pulsating the vacuum source 9 and/or its vacuum generation and/or by generating pulses by means of the feeding device 30.
REFERENCE LIST
- 1) Aebli N, Krebs J, Schwenke D, Davis G. Theis J C. Cardiovascular charges during multiple vertebroplasty with and without vent-hole: an experimental study in sheep. Spine 2003; 28(14):1504-11.
- 2) Koessler M J, Aebli N, Pitto R P. Fat and Bone Marrow Embolism During Percutaneous Vertebroplasty. Anesth Analg 2003; 97:293-294.
- 3) Lidgren, Lars. Bone Substitutes. Karger Gazette No. 65 2003; Bone and Joints.
- 4) Kirby B S, Doyle A, Gilula L A. Acute bronchospasm due to exposure to polymethacrylate vapours during percutaneous vertebroplasty. AJR J Roentgenol. 2003 February; 180 (2):543-4.
Claims
1. A system for providing spongy bone with bone substitute and/or bone reinforcing material, including:
- at least one perforating device (4) configured to make at least one hole (5) in the spongy bone (1),
- at least one flushing or rinsing device (6) configured to flush or rinse the hole (5) with a rinsing agent (7),
- at least one supply device (8) configured to supply the bone substitute and/or bone reinforcing material (3) to the hole (5) in the spongy bone (1), and
- at least one vacuum source (9) configured to generate a vacuum in the hole (5) in the spongy bone (1), suck the rinsing agent (7) into the hole (5) in the spongy bone (1), and to suck rinsing agent (7) and tissue material out of said hole (5), wherein
- said vacuum source (9) is further configured to suck the bone substitute and/or bone reinforcing material (3) into the hole (5) in the spongy bone (1) from the supply device, and wherein
- said vacuum source (9) is configured to generate a vacuum of between −0.5 bar and −0.92 bar in the hole (5) of the spongy bone (1).
2. The system according to claim 1, wherein the vacuum source (9) is configured to generate a vacuum in the hole (5) of the spongy bone (1) such that the bone substitute and/or bone reinforcing material (3) is sucked into said hole (5) and distributed therein without substantial portions thereof being sucked out of the hole (5).
3. The system according to claim 1, wherein a collecting device (27) is configured to collect tissue material that has been sucked out of the hole (5) of the spongy bone (1) by the vacuum source (9) thereby preventing tissue material from being sucked into one or more of the vacuum source (9), monomer filter (28), and a bacteria filter (29).
4. The system according to claim 1, further comprising a monomer filter (28) configured to prevent poisonous gases, which are generated during production of bone substitute and/or bone reinforcing material (3), from being discharged into the surroundings.
5. The system according to claim 1, further comprising a bacteria filter (29) configured to prevent bacteria from getting into the hole (5) of the spongy bone (1) if a connection between the vacuum source (9) and the spongy bone (1) is opened unintentionally.
6. The system according to claim 1, further comprising a non-return valve device (26) configured to prevent tissue material and/or any other material and/or bacteria from being sucked into the hole (5) of the spongy bone (1) if the connection between the vacuum source (9) and the hole (5) in the spongy bone (1) is opened unintentionally.
7. The system according to claim 3, further including a non-return valve device (26) configured to be located between the hole (5) in the spongy bone (1) and the collecting device (27).
8. The system according to claim 3, further including a non-return valve device (26) configured to be located between the monomer filter (28) and/or bacteria filter (29) and the hole (5) in the spongy bone (1).
9. The system according to claim 1, further including container (18) configured to produce and/or store bone substitute and/or bone reinforcing material (3), wherein the container (18) includes a feeding device (30) configured to feed bone substitute and/or bone reinforcing material (3) out of the container (18) and into the hole (5) of the spongy bone (1) at the same time the vacuum source (9) generates a vacuum therein.
10. The system according to claim 1, further including container (18) configured to produce and/or store bone substitute and/or bone reinforcing material (3), wherein the container (18) includes a feeding device (30) configured to feed bone substitute and/or bone reinforcing material (3) into the hole (5) of the spongy bone (1) after the vacuum source (9) has generated a vacuum therein.
11. The system according to claim 9, wherein the feeding device (30) is manually operable.
12. The system according to claim 1, wherein the vacuum source (9) is configured to generate a vacuum of between −0.7 and −0.8 bar in the hole (5) of the spongy bone (1).
13. The system according to claim 1, further comprising a valve device (32) configured to close or interrupt the supply of bone substitute and/or bone reinforcing material (3) to the hole (5) of the spongy bone (1) until the vacuum source (9) has generated a suitable vacuum therein, the valve device (32) being configured to open and permit supply of bone substitute and/or bone reinforcing material (3) into the hole (5) of the spongy bone (1) via suction when said suitable vacuum has been measured therein.
14. The system according to claim 1, further comprising at least a first cannula or needle and a second cannula or needle (19, 20) configured to be insertable into the spongy bone (1) such that they are simultaneously directed into the hole (5) thereof, wherein the first cannula or needle (19) is connected to a container (18) for producing and/or storing the bone substitute and/or bone reinforcing material (3) while the second cannula or needle (20) is connected to the vacuum source (9).
15. The system according to claim 14, wherein the flushing or rinsing device (6) comprises a rinsing agent container (16) which is connected to the first cannula or needle (19) and is configured to direct rinsing agent (7) into the hole (5) of the spongy bone (1) through said first cannula (19) and out of said hole (5) to the second cannula or needle (20).
16. The system according to claim 15, wherein a valve device (32) is configured to either open for supply of bone substitute and/or bone reinforcing material (3) or of rinsing agent (7) through the first cannula or needle (19).
17. The system according to claim 1, wherein the rinsing device (6) is configured to form depressions (5b) on the sides (5a) of the hole (5) by flushing or rinsing the sides (5a) of the hole (5) to remove tissue material and/or other material, and wherein the depressions may be configured to receive bone substitute and/or bone reinforcing material.
18. The system according to claim 1, wherein the perforating device (4) includes:
- an outer tube member (11) located at the spongy bone (1); and
- a perforating means (12), wherein the perforating means (12) is configured to be movable in said outer tube member (11) in coaxial and/or rotary direction and includes and/or cooperates with a perforating member (13) for making the hole (5) in the spongy bone (1).
19. The system according to claim 18, wherein the perforating means (12) further includes an inner tube member (15) configured to direct rinsing agent (7) into or out of the hole (5) in the spongy bone (1).
20. The system according to claim 19, wherein the outer or inner tube member (11 or 15) is connected to a vacuum source (9) for sucking rinsing agent (7) through the hole (5) in the spongy bone (1) and out of said hole through the other tube member (11).
21. The system according to claim 1, wherein the perforating device (4) further includes several units configured to make at least two holes (5) in the spongy bone (1), wherein the at least two holes (5) are configured to either extend into each other, or be separated from one another with spongy bone (1) remaining therebetween, wherein the spongy bone (1) remaining between the at least two holes (5) is penetrated by air and provided with bone substitute and/or bone reinforcing material (3).
22. The system according to claim 1, wherein the vacuum source (9) is an injector pump (21) operatable by a compressed medium.
23. The system according to claim 22, wherein the injector pump (21) is connected to a compressed-medium device (22) which is designed as a compressed-air device and is positionable in localities in or close to which the vacuum source (9).
24. The system according to claim 23, wherein the injector pump (21) is connected to a compressed-medium device (22) with commercial gas.
25. The system according to claim 23, wherein the injector pump (21) is connected to a compressed-medium device (22) which is configured to operate said pump with a compressed-medium pressure of 4.5-8.5 bar.
26. The system according to claim 1, wherein the vacuum source (9) is an electrically operated vacuum pump.
27. The system according to claim 1, wherein the vacuum source (9) is a pump operated by gas.
28. The system according to claim 1, wherein the vacuum source (9) is operated by hand.
29. The system according to claim 1, wherein the spongy bone (1) is a spongy vertebra (2).
30. The system according to claim 1, wherein the spongy bone (1) is a fracture due to osteoporosis.
31. The system according to claim 1, wherein the spongy bone (1) is a femoral or knee fracture.
32. The system according to claim 1, wherein the rinsing agent (7) is a sodium chloride solution.
33. The system according to claim 1, wherein the flushing or rinsing device contains the rinsing agent, wherein the rinsing agent (7) contains a detergent.
34. The system according to claim 1, wherein the flushing or rinsing device contains the rinsing agent, wherein the rinsing agent (7) contains at least one trombolytic substance.
35. The system according to claim 1, wherein the flushing or rinsing device contains the rinsing agent, wherein the rinsing agent (7) is distilled water.
36. The system according to claim 1, further including a secondary device (9 and/or 30) configured to impart pulse like suction and/or insertion movements to the bone substitute and/or bone reinforcing material (3) into the hole (5) in the spongy bone (1).
37. The system according to claim 1, further including a secondary device (9 and/or 30) configured to impart reciprocating suction and/or insertion movements to the bone substitute and/or bone reinforcing material (3) into the hole (5) in the spongy bone (1).
38. The system according to claim 1, further including a secondary device (9 and/or 30) configured to impart for pulse like suction and/or feeding of the rinsing agent (7) through the hole (5) in the spongy bone (1).
39. The system according to claim 1, further including a bone substitute and/or bone reinforcing material, wherein the bone substitute and/or bone reinforcing material (3) is at least one of a mineral material, a substantially mineral material, a ceramic material, and a substantially ceramic material.
40. The system according to claim 39, wherein the mineral material or ceramic material is a hardenable mineral or ceramic which can be brought to harden in the spongy bone (1).
41. The system according to claim 40, wherein the mineral material or ceramic can be brought to harden by being mixed with a hardening agent.
42. The system according to claim 39, wherein the mineral material or ceramic is selected from the group comprising calcium sulphate-α-hemihydrate, calcium sulphate-β-hemihydrate, calcium sulphate-dihydrate, calcium carbonate, α-tricalcium phosphate, hydroxyapatite, dicalcium phosphate-di-hydrate, anhydrous dicalcium phosphate, tetracalcium phosphate, β-tricalcium phosphate, calcium deficient hydroxyapatite, monocalcium phosphate-monohydrate, mono-calcium phosphate, calcium-pyrophosphate, precipitated hydroxyapatite, carbonaceous apatite (dahlite), octa-calcium phosphate, amorphous calcium phosphate, oxyapatite, carbonate apatite and calcium aluminate.
43. The system according to claim 39, wherein an X-ray contrast agent is mixed with the ceramic material.
44. The system according to claim 43, wherein the X-ray contrast agent is water soluble and non-ionic.
45. The system according to claim 44, wherein the water soluble, non-ionic X-ray contrast agent is selected from the group comprising iohexol, ioversol, iopamidol, iotrolan, metrizamide, iodecimol, iodecimol, ioglucol, ioglucamide, ioglunide, iogulamide, iomeprol, iopentol, iopromide, iosarcol, iosimide, iotusal, ioxilan, iofrotal and iodecol.
46. The system according to claim 1, further including a bone substitute and/or bone reinforcing material, wherein the bone substitute and/or bone reinforcing material (3) is a bone cement including a polymer and a monomer, wherein the polymer and monomer harden to bone cement after mixing with each other and after said sucking and/or insertion or feeding thereof into the spongy bone (1).
47. The system according to claim 46, wherein the bone substitute and/or bone reinforcing material (3) consists of mineral and/or ceramic in combination with polymer material.
48. The system according to claim 34, wherein the at least one trombolytic substance is chosen from heparin, streptokinase, urokinase, TPA, and other substances dissolving coagulum and thrombi, and mixtures thereof.
49. The system according to claim 46, wherein the components polymer is polymethyl-methacrylate (PMMA)-type, and the components monomer is methylmethacrylate (MMA)-type.
50. A method for providing spongy bone with bone substitute and/or bone reinforcing material, wherein:
- at least one hole (5) is made in the spongy bone (1) by at least one perforating device,
- the at least one hole (5) is flushed or rinsed with rinsing agent (7) by at least one flushing or rinsing device (6),
- the at least one hole (5) is supplied with bone substitute and/or bone reinforcing material by at least one supply device (8), and
- a vacuum is generated in the hole (5) for sucking and/or facilitating insertion or feeding of the bone substitute and/or bone reinforcing material (3) into the hole (5) by at least one vacuum source (9), such that the bone substitute and/or bone reinforcing material (3) is sucked into the hole (5) in the spongy bone (1), the vacuum generated is between −0.5 bar and −0.92 bar.
51. The method according to claim 50, wherein a vacuum is generated in the hole (5) for sucking rinsing agent (7) through said hole (5).
52. The method according to claim 50, wherein the rinsing agent (7) is brought to flush tissue material and other material away from the sides (5a) of the hole (5) such that depressions (5b) are formed therein and that bone substitute and/or bone reinforcing material (3) is brought to penetrate into said depressions (5b).
53. A method for providing spongy bone with bone substitute and/or bone reinforcing material (3) comprising, applying bone substitute material and/or bone reinforcing material (3) from at least one supply device (8) in at least one hole (5) in spongy bone (1) by generating a pulsating vacuum in the hole (5) by at least one vacuum source (9) such that the bone substitute and/or bone reinforcing material (3) is brought to pulsate during its application in the spongy bone (1), the vacuum generated is between −0.5 bar and −0.92 bar.
54. The method according to claim 53, wherein reciprocating movements are imparted to the bone substitute and/or bone reinforcing 22 material (3) during its application in the hole (5) in the spongy bone (1).
55. A method for providing spongy bone with bone substitute and/or bone reinforcing material (3) comprising:
- rinsing at least one hole (5) in spongy bone (1) with rinsing agent by at least one flushing or rinsing device, wherein the rinsing agent (7) is sucked pulsatingly through the hole (5) in the spongy bone (1) by generating a pulsating vacuum by at least one vacuum source (9) in said hole (5), such that the rinsing agent (7) is sucked into the hole (5) in the spongy bone (1), where the vacuum generated in the hole (5) is of between −0.5 bar and −0.92 bar,
- applying bone substitute and/or bone reinforcing material (3) from at least one supply device (8) in the hole (5) in the spongy bone (1) by generating a vacuum by the at least one vacuum source (9).
56. A system for providing spongy bone with bone substitute and/or bone reinforcing material, including:
- at least one supply device (8) configured to permit the supply of bone substitute and/or bone reinforcing material (3) to a hole (5) in a spongy bone (1); and
- at least one vacuum source (9) configured to generate a vacuum in the hole (5) in the spongy bone (1), and suck the bone substitute and/or bone reinforcing material (3) from the at least one supply device (8) into the hole (5) in the spongy bone (1);
- wherein the vacuum source (9) is configured to generate a vacuum of between about −0.5 bar and about −0.92 bar in the hole (5) of the spongy bone (1).
949163 | February 1910 | Stapley |
1644173 | October 1927 | Carr |
3367783 | February 1968 | Billerbeck |
3475010 | October 1969 | Cook et al. |
3837379 | September 1974 | McDonald et al. |
3965910 | June 29, 1976 | Fischer |
4001323 | January 4, 1977 | Felder et al. |
4139605 | February 13, 1979 | Felder et al. |
4269331 | May 26, 1981 | Watson |
4338925 | July 13, 1982 | Miller |
4348377 | September 7, 1982 | Felder et al. |
4487766 | December 11, 1984 | Mach |
4496342 | January 29, 1985 | Banko |
4583974 | April 22, 1986 | Kokernak |
4619655 | October 28, 1986 | Hanker et al. |
4676655 | June 30, 1987 | Handler |
4721390 | January 26, 1988 | Lidgren |
4752479 | June 21, 1988 | Briggs et al. |
4994442 | February 19, 1991 | Gil et al. |
5047030 | September 10, 1991 | Draenert |
5071040 | December 10, 1991 | Laptewicz, Jr. |
5073362 | December 17, 1991 | Blaszkiewicz et al. |
5149368 | September 22, 1992 | Liu et al. |
5168757 | December 8, 1992 | Rabenau et al. |
5232024 | August 3, 1993 | Williams |
5262166 | November 16, 1993 | Liu et al. |
5269785 | December 14, 1993 | Bonutti |
5281265 | January 25, 1994 | Liu |
5328262 | July 12, 1994 | Lidgren et al. |
5342441 | August 30, 1994 | Manadel et al. |
5360823 | November 1, 1994 | Griffel et al. |
5403318 | April 4, 1995 | Boehringer et al. |
5447711 | September 5, 1995 | Almen et al. |
5462722 | October 31, 1995 | Liu et al. |
5501520 | March 26, 1996 | Lidgren et al. |
5549380 | August 27, 1996 | Lidgren et al. |
5551778 | September 3, 1996 | Hauke et al. |
5605885 | February 25, 1997 | Bernton et al. |
5614206 | March 25, 1997 | Randolph et al. |
5650108 | July 22, 1997 | Nies et al. |
5681873 | October 28, 1997 | Norton et al. |
5695742 | December 9, 1997 | Felder et al. |
5698186 | December 16, 1997 | Weeks |
5797873 | August 25, 1998 | Franz et al. |
5829875 | November 3, 1998 | Hagel et al. |
5842786 | December 1, 1998 | Solomon |
5866100 | February 2, 1999 | Tournier et al. |
5871549 | February 16, 1999 | Jayashankar et al. |
5891423 | April 6, 1999 | Weeks |
5965772 | October 12, 1999 | Desantis |
5997544 | December 7, 1999 | Nies et al. |
6018095 | January 25, 2000 | Lerch et al. |
6071982 | June 6, 2000 | Wise et al. |
6074358 | June 13, 2000 | Andrew et al. |
6075067 | June 13, 2000 | Lidgren |
6080801 | June 27, 2000 | Draenert et al. |
6118043 | September 12, 2000 | Nies et al. |
6120174 | September 19, 2000 | Hoag et al. |
6206957 | March 27, 2001 | Driessens et al. |
6231615 | May 15, 2001 | Preissman |
6248110 | June 19, 2001 | Reiley et al. |
6251139 | June 26, 2001 | Lin et al. |
6309420 | October 30, 2001 | Preissman |
6365218 | April 2, 2002 | Borschel et al. |
6431743 | August 13, 2002 | Mizutani et al. |
6440138 | August 27, 2002 | Reiley et al. |
6447809 | September 10, 2002 | Krumhar et al. |
6488651 | December 3, 2002 | Morris et al. |
6586009 | July 1, 2003 | Lidgren |
6596904 | July 22, 2003 | Dunn et al. |
6689375 | February 10, 2004 | Wahlig et al. |
6706069 | March 16, 2004 | Berger |
6716216 | April 6, 2004 | Boucher et al. |
6719761 | April 13, 2004 | Reiley et al. |
6723334 | April 20, 2004 | McGee et al. |
6736537 | May 18, 2004 | Coffeen et al. |
6740090 | May 25, 2004 | Cragg et al. |
6897339 | May 24, 2005 | Turchetta et al. |
7160306 | January 9, 2007 | Matsuzaki et al. |
7393342 | July 1, 2008 | Henniges et al. |
7417077 | August 26, 2008 | Lidgren et al. |
7524103 | April 28, 2009 | McGill et al. |
20010012968 | August 9, 2001 | Preissman |
20010051670 | December 13, 2001 | Goupil et al. |
20020055143 | May 9, 2002 | Bell et al. |
20020076378 | June 20, 2002 | Wolfe et al. |
20020156483 | October 24, 2002 | Voellmicke et al. |
20020169506 | November 14, 2002 | Matsushima et al. |
20030028251 | February 6, 2003 | Mathews |
20030050702 | March 13, 2003 | Berger |
20030055512 | March 20, 2003 | Genin et al. |
20030109883 | June 12, 2003 | Matsuzaki et al. |
20030161858 | August 28, 2003 | Lidgren |
20040049202 | March 11, 2004 | Berger |
20040151751 | August 5, 2004 | Cooper |
20040191897 | September 30, 2004 | Muschler |
20040244651 | December 9, 2004 | Lemaitre et al. |
20050023171 | February 3, 2005 | Delaney et al. |
20050105385 | May 19, 2005 | McGill et al. |
20050119746 | June 2, 2005 | Lidgren |
20050128868 | June 16, 2005 | Vries |
20050241535 | November 3, 2005 | Bohner |
20050251149 | November 10, 2005 | Wenz |
20050257714 | November 24, 2005 | Constanz et al. |
20050287071 | December 29, 2005 | Wenz |
20060004358 | January 5, 2006 | Serhan et al. |
20060036211 | February 16, 2006 | Solsberg et al. |
20060041033 | February 23, 2006 | Bisig et al. |
20060122621 | June 8, 2006 | Truckai et al. |
20070041906 | February 22, 2007 | Lidgren et al. |
20070161943 | July 12, 2007 | Lidgren et al. |
20070217282 | September 20, 2007 | Lidgren et al. |
20080318862 | December 25, 2008 | Ashman et al. |
20100008181 | January 14, 2010 | Lidgren et al. |
44 09 610 | September 1995 | DE |
0 023 992 | February 1981 | EP |
0 109 310 | May 1984 | EP |
0 308 364 | March 1989 | EP |
0 495 284 | July 1992 | EP |
0 639 382 | February 1995 | EP |
0 639 382 | February 1995 | EP |
0 657 208 | June 1995 | EP |
0 520 690 | November 1995 | EP |
0 807 432 | November 1997 | EP |
0 950 420 | October 1999 | EP |
1 155 704 | November 2001 | EP |
1 208 850 | May 2002 | EP |
1 132 061 | August 2004 | EP |
1 155 704 | November 2001 | ES |
2 178 556 | December 2002 | ES |
2 239 818 | July 1991 | GB |
64-22256 | January 1989 | JP |
64-22257 | January 1989 | JP |
1-139516 | June 1989 | JP |
5-168692 | July 1993 | JP |
5-507862 | November 1993 | JP |
6-84289 | June 1994 | JP |
2935708 | June 1999 | JP |
2000-295 | January 2000 | JP |
2001-106638 | April 2001 | JP |
2001-517997 | October 2001 | JP |
2002-325831 | November 2002 | JP |
8903538 | April 1991 | SE |
WO 85/01727 | April 1985 | WO |
WO 87/05521 | September 1987 | WO |
WO 88/06023 | August 1988 | WO |
WO 89/03695 | May 1989 | WO |
WO 91/00252 | January 1991 | WO |
WO 91/17722 | November 1991 | WO |
WO 96/39202 | December 1996 | WO |
WO 97/47334 | December 1997 | WO |
WO 99/17710 | April 1999 | WO |
WO 99/62570 | December 1999 | WO |
WO 99/65597 | December 1999 | WO |
WO 00/02597 | January 2000 | WO |
WO 00/45867 | August 2000 | WO |
WO 01/34216 | May 2001 | WO |
WO 02/05861 | January 2002 | WO |
WO 03/041753 | May 2003 | WO |
WO 03/053488 | July 2003 | WO |
WO 2004/000374 | December 2003 | WO |
WO 04/002615 | January 2004 | WO |
WO 2004/026377 | April 2004 | WO |
WO 2006/041365 | April 2006 | WO |
- Aebli et al., “Cardiovascular Changes During Multiple Vertebroplasty With and Without Vent-Hole: An Experimental Study in Sheep”, Spine 2003; 28(14)1504-11.
- Koessler et al., “Fat and Bone Marrow Embolism During Percutaneous Vertebroplasty”, Anesth Analg 2003; 97:293-294.
- Lidgren., “Bone Substitutes”, Karger Gazette No. 65 2003; Bone and Joints.
- Kirby et al., “Acute Bronchospasm Due to Exposure to Polymethacrylate Vapours During Percutaneous Vertebroplasty”, AJR J Roentgenol. Feb. 2003; 180(2):543-4.
- English language abstract of JP 5-168692 A.
- English language abstract of JP 2000-295 A.
- English language abstract of JP 2001-106638 A.
- English language abstract of JP 5-507862 A.
- English language translation of Jun. 2, 2009, Office Action in Japanese Application No. 2003-554244.
- English language translation of JP 64-22256.
- English language translation of JP 64-22257.
- Office Action in copending U.S. Appl. No. 10/547,671 dated Aug. 5, 2009.
- Office Action in copending U.S. Appl. No. 12/122,873 dated Jun. 19, 2009.
- Office Action in copending U.S. Appl. No. 12/219,542 dated Jun. 19, 2009.
- Barbalace, K. “Chemical Database: Calcium sulfate”, Environmental Chemistry.com, 2009, 3 pages.
- Bohner, M., “Physical and chemical aspects of calcium phosphates used in spinal surgery”, Eur. Spine J. (2001) 10:S114-S121.
- Copending U.S. Appl. No. 12/122,873, filed May 19, 2008.
- Copending U.S. Appl. No. 12/219,542, filed Jul. 23, 2008.
- Copending U.S. Appl. No. 12/219,543, filed Jul. 23, 2008.
- Eromosele et al., “Characterization and viscosity parameters of seed oils from wild plants”, Science Direct: Bioresource Technology, 2002, 7 pages.
- Nilsson et al., “The Effect of Aging an Injectable Bone Graft Substitute in Simulated Body Fluid,” Key Engineering Materials, vols. 240-242 (2003), pp. 403-406.
- “Powder (substance)” entry from www.wikipedia.com, <<http://en.wikipedia.org/wiki/Powder—(substance)>> (last visited Dec. 1, 2008)(4 pgs.).
- Bohner et al., “Effects of Sulfate Ions on the In Vitro Properties of β-TCP-MCPM-Water Mixtures. Preliminary In Vivo Results,”Bioceramics: Materials and Applications, Ceramic Transactions, vol. 48 (1995), pp. 245-259.
- Bohner, “New hydraulic cements based on α-tricalcium phosphate-calcium sulfate dihydrate mixtures,” Biomaterials (2004) 25, 741-749.
- Cabanas, “Setting Behavior and in Vitro Bioactivity of Hydroxyapatite/Calcium Sulfate Cements,” Chem. Mater. (2002) 14, 3550-3555.
- Database Derwent WPI: Week 198928, Derwent Publications Ltd., JP 1139516.
- Database Derwent WPI: Week 199126, Derwent Publications Ltd., SE 8903538.
- Database Derwent WPI: Week 199433, Derwent Publications Ltd., London, GB: Class A 96, AN 1994-269325 & JP 61-99623 A (Lion Corp. et al.), Jul. 19, 1994.
- Database Derwent WPI: Week 200138, Derwent Publications Ltd., WO 2001/34216 A1.
- Database Derwent WPI: Week 199734, Derwent Publications Ltd., EP 0807432 B1.
- English-Language Abstract of EP 0 657 208 A1.
- English-Language translation of JP 1-139516.
- English-language translation of SE 8903538, “Implant material and method for the manufacture thereof,” Bioapatite AB.
- Engqvist et al., “Chemical Stability of a Novel Injectable Bioceramic for Stabilisation of Vertebral Compression Fractures,” Trends Biomater. Artif. Organs (2008) 21(2):98-106.
- Ima-Nirwana et al., “Palm vitamin E improves bone metabolism and survival rate in thyrotoxic rats, ” Gen. Pharmacol. (1999) 32:621-626.
- International Preliminary Examination Report for PCT/SE01/00789 dated Jan. 11, 2002, related to U.S. Appl. No. 10/257,561.
- International Preliminary Examination Report for PCT/SE01/01627 dated Oct. 14, 2002, related to U.S. Appl. No. 10/333,026.
- International Preliminary Examination Report for PCT/SE02/02428 dated Mar. 16, 2004, related to U.S. Appl. No. 10/499,023.
- International Preliminary Examination Report for PCT/SE2004/000328 dated Aug. 30, 2005, related to U.S. Appl. No. 10/547,671.
- International Preliminary Report on Patentability for PCT/SE2004/001626 dated Feb. 13, 2006.
- International Preliminary Report on Patentability for PCT/SE2005/000932 dated Dec. 28, 2006.
- International Search Report for PCT/SE01/00789 dated Jul. 9, 2001, related to U.S. Appl. No. 10/257,561.
- International Search Report for PCT/SE01/01627 dated Dec. 18, 2001, related to U.S. Appl. No. 10/333,026.
- International Search Report for PCT/SE02/02428 dated Apr. 4, 2003, related to U.S. Appl. No. 10/499,023.
- International Search Report for PCT/SE2004/000328 dated Jun. 8, 2004, related to U.S. Appl. No. 10/547,671.
- International Search Report for PCT/SE2004/001626 dated Feb. 28, 2005.
- Mirtchi et al., “Calcium phosphate cements: action of setting regulators on the properties of the β-tricalcium phosphate-monocalcium phosphate cements,” Biomaterials (1989), 10(9), pp. 634-638.
- International Search Report for PCT/SE2005/000932 dated Oct. 10, 2005.
- Komath et al., “On the development of an apatic calcium phosphate bone cement,” Bull. Mater. Sci (2000) 23(2):135-140.
- Machine Translation of JP 1139516 (HO6(1994)-0842898) from http://www4.ipdl.inpit.go.jp/Tokujitu/tisogodbenk.ipdl, last viewed on Jan. 22, 2009.
- Nilsson et al., “Biodegradation and biocompatability of a calcium sulphate-hydroxyapatite bone substitute,” J. of Bone & Joint Surgery (Br) (2004) 86-B:120-125.
- Nilsson et al., “Characterization of a novel calcium phosphate/sulphate bone cement,” J. Biomedical Materials Research (2002) 61(4), 600-607.
- Nilsson et al., “New Perspectives of Bioactives Calcium Phosphate Cements for Biomedical Applications,” Research Centre in Biomedical Engineering, Dept. of Material Science and Metallurgy, Universitat Politecnica de Catalunya, Avda, Diagonal 647k Barcelona, E-08028, Spain, pp. 95-99, Nov. 2000.
- Notice of Allowance dated Apr. 25, 2008 in related U.S. Appl. No. 10/333,026.
- Office Action dated Jul. 2, 2008 in related U.S. Appl. No. 10/257,561.
- Office Action dated Jul. 22, 2008 in related U.S. Appl. No. 10/499,023.
- Office Action dated Mar. 21, 2006 in related U.S. Appl. No. 10/333,026.
- Office Action dated Mar. 28, 2007 in related U.S. Appl. No. 10/257,561.
- Office Action dated Oct. 10, 2007 in related U.S. Appl. No. 10/333,026.
- Office Action dated Oct. 15, 2007 in related U.S. Appl. No. 10/257,561.
- Office Action dated Oct. 31, 2006 in related U.S. Appl. No. 10/333,026.
- Office Action dated Oct. 4, 2007 in related U.S. Appl. No. 10/499,023.
- Office Action dated Sep. 5, 2006 in related U.S. Appl. No. 10/257,561.
- Written Opinion of the International Searching Authority for PCT/SE2004/001626 dated Feb. 28, 2005.
- Written Opinion of the International Searching Authority for PCT/SE2005/000932 dated Oct. 10, 2005.
- Cahn, R.W., ed. Materials Science and Technology: A Comprehensive Treatment, 1992, vol. 14, VCH, Weinheim, pp. 70-109.
- Elliott, J. C. “Chapter 1: General Chemistry of the Calcium Orthophosphates,” in Structure and Chemistry of the Apatites and Other Calcium Orthophosphates, 1994, Elsevier: Netherlands.
- English-language translation of ES 2 178 556 A1, “Calcium sulfate cement capable of controlled biodegradation.”
- De Robertis et al., “Solubility of some calcium-carboxylic ligand complexes in aqueous solution,” Talanta 45 (1995)1651-1662.
- English language translation of Japanese Office Action mailed on Jun. 1, 2010 in Japanese Application No. 2006-539432 related to U.S. Appl. No. 10/578,734.
- Office Action in copending U.S. Appl. No. 10/257,561, filed Apr. 27, 2010.
- Office Action in copending U.S. Appl. No. 10/499,023, filed Jun. 10, 2010.
- Office Action in copending U.S. Appl. No. 10/547,671, filed May 5, 2010.
- Office Action in copending U.S. Appl. No. 11/587,313, filed Jun. 18, 2010.
- Office Action in copending U.S. Appl. No. 12/219,542, filed Jun. 25, 2010.
- Office Action in copending U.S. Appl. No. 12/219,543, filed Mar. 19, 2010.
- Office Action in copending U.S. Appl. No. 10/257,561, filed Nov. 10, 2009.
- Office Action in copending U.S. Appl. No. 12/122,873, filed Mar. 19, 2010.
- Office Action in copending U.S. Appl. No. 12/122,873, filed Oct. 29, 2009.
- Office Action in copending U.S. Appl. No. 12/219,542, filed Jan. 11, 2010.
- Starling, S., “EFSA Says Clacium Sulphate Safe in Supplements”, 2008, Nutraingredients.com, 4 pages.
- Technical Specification, Calcium Suolfate Hemihydrate Food Grade, 2009, 1 page.
- Office Action in copending U.S. Appl. No. 10/547,671 dated Aug. 16, 2010 15 pages.
- Office Action in copending U.S. Appl. No. 12/122,873 dated Sep. 8, 2010 8 pages.
- Office Action in copending U.S. Appl. No. 12/219,542 dated Oct. 18, 2010 9 pages.
- Office Action in copending U.S. Appl. No. 12/219,543 dated Sep. 8, 2010 7 pages.
Type: Grant
Filed: Nov 10, 2004
Date of Patent: Dec 7, 2010
Patent Publication Number: 20070161943
Assignee: Bone Support AB (Lund)
Inventors: Lars Lidgren (Lund), Torgny Lundgren (Eslöv), Pär Arvidsson (Lund), Sven Jönsson (Staffanstorp)
Primary Examiner: Eduardo C Robert
Assistant Examiner: Jan Christopher Merene
Attorney: Finnegan, Henderson, Farabow, Garrett & Dunner, LLP
Application Number: 10/578,734
International Classification: A61M 37/00 (20060101);