Apparatus for repairing bone structure using laser

The invention relates to a medical instrument and more particularly to a system for repairing damaged bone structure. A hand-held instrument is formed with a plurality of channels allowing connection of the instrument to a source of laser beam, to a television monitor, to a vacuum suction tube, to a connector for delivering medication or bone sealant to the treatment area. A foot pedal allows a dentist or physician to control delivery of the electrical, mechanical, and vacuum forces to the damaged area, as well as examine and monitor the treatment procedure on a television monitor.

BACKGROUND OF THE INVENTION 
The present invention relates to medical technology, and more particularly 
to an apparatus adapted for use when conducting minor surgeries on a 
patient with laser. 
Conventionally, during invasive procedures, a doctor needs to determine the 
extent of damage existing in a bone structure of a patient. The 
examination is usually conducted with a low-powered optical device or even 
without any assistance from optical devices. The difficulty in a thorough 
examination is further complicated if an emergency patient is delivered to 
a medical facility not equipped with sophisticated medical equipment. 
Additionally, some of the medical procedures, for example dental procedure 
in removing caries is conducted at a dentist's office with the dentist 
using his eyesight to detect damage to the teeth or bone structure of the 
patient. In recent years, various improvements have been achieved with 
regards to performing conventional dental procedures, such as removal of 
caries and filling of teeth. Laser technology has been incorporated into 
the tools for treatment of caries and periodontal diseases. Laser drills 
have been tested in place of conventional dental drills for eliminating 
the decay that causes small cavities. Laser technology has also been 
approved by the Federal Drug Administration for surgery on soft tissue, 
such as gum surgery for periodontal disease. 
When using lasers, great care should be exercised in properly aiming the 
beam to the repair cite, so as to avoid damage to other parts of the bone 
structure or soft tissue. Even though heat from the laser is better 
absorbed by the decay than the solid enamel-covered teeth, still caution 
must be exercised when operating with a laser instrument. Dentists who are 
qualified to practice laser dentistry usually undergo many hours of 
training and are considered specialists in highly specialized equipment. 
It has been observed that the use of laser eliminates pain and allows to 
form smaller incisions in the soft tissue of the patient, since a laser 
beam can be precisely pinpointed to the area that needs treatment. Still, 
the need remains for a tool that will allow to inspect the cite of injury 
or damage prior to using a laser. The present invention contemplates 
provision of a medical apparatus that can be used for various treatment 
procedures, particularly adapted for treatment of a damaged bone structure 
of the patient. 
SUMMARY OF THE INVENTION 
It is an object of the present invention to provide an apparatus for 
repairing bone structure using laser. 
It is another object of the present invention to provide an apparatus 
suitable for use in a variety of medical procedures involving different 
areas of a patient's body. 
It is a further object of the present invention to provide a medical device 
that can be utilized for treatment of patients both in the hospital and on 
an outpatient basis. 
These and other objects of the present invention are achieved through a 
provision of an apparatus for repairing the damaged bone structure which 
comprises a hand-held instrument having a generally cylindrical body with 
a plurality of channels formed in the body. One of the channels retains a 
television fiber optic cable that delivers light of different colors and 
intensity to the damaged site an is operationally connected to a 
television monitor to allow a treating physician to inspect the damaged 
bone tissue. 
A second channel houses a laser cable for delivering a laser beam through 
the hand-held instrument and allowing to make a skin incision and then 
painless incision into the bony tissue of the patient, then penetrate the 
tip of the hand-held instrument close to the damaged area. The third 
channel formed in the body houses, in one of the embodiments, a 
monofilament cleaner that can be selectively extended through an open 
distal end of the instrument body and separate the damaged tissue from the 
remainder of the bone structure when a rotational force is imparted on the 
monofilament cleaner. The cleaner is connected to an external source of 
rotational power, forcing the cleaner to move at high speeds and break 
away the damaged tissue. 
The fourth of said channels is fluidly connected to a source of liquid, for 
example, hydrogen peroxide, water or other means for irrigating the site 
and stopping bleeding. Still another of the channels is adapted for 
connection to a vacuum source to establish a suction force through the 
body of the instrument and remove the separated tissue, blood, clots, and 
fluids from the treatment site. 
The exterior of the instrument body carries two or more normally closed pin 
connectors. One of the connectors can be connected to the vacuum suction 
line, while the second connector is adapted for attachment to a syringe 
holding medication, bone sealant, dental cavity filler and other suitable 
containers for delivering the treatment medication to the damaged area. 
A control pad, such as a foot pedal is provided for connecting the 
hand-held instrument to a variety of external devices. One of the switches 
mounted on the control pad allows to control direction of the tip of the 
fiber optic light source cable for proper examination of the injured site. 
Other control knobs allow to deliver a desired color and intensity light 
beam through the fiber optic cable. Still another switch allows to control 
operation of the television monitor and magnify the site of the injury 
viewed on the television screen. 
Other switches mounted on the control pad allow to operationally connect 
the hand-held instrument to a source of fluid, such as water for 
irrigation of the damaged site, to a vacuum creating motor, and to a 
rotational motor that transmits torque to the monofilament cleaner. 
Alternatively, when a bi-polar cautery is used for burning away the 
damaged tissue, this motor can be substituted by an electrical current 
generator. 
The exterior of the instrument body carries two manual switches. One of the 
switches moves the fiber optic cable in and out of the body, while the 
second switch allows to move the monofilament cleaner or the bi-polar 
cautery in and out of the instrument body. Microforceps could be extended 
through tool for removal of bone foreign bodies. 
Provision of the various cables and conduits in the instrument body allows 
to expeditiously conduct an exploratory and treatment procedure on dental 
patients, perform orthopedic repair procedure, perform a spinal surgery or 
neurosurgery.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
Turning now to the drawings in more detail, numeral 10 designates the 
handheld medical tool in accordance with the present invention. The tool 
10 comprises an elongated tubular body 12 having a proximal end 14 and a 
distal end 16. An enlargement 18 is formed adjacent the proximate end 14, 
and a second enlargement 20 is formed on a diametrically opposite side of 
the body 12 adjacent the proximate end 14. 
The first enlarged portion 18 is formed with a normally closed opening with 
a two-part plug 22. The plug 22 is comprised of a first plug member 24 
(FIG. 2) permanently secured in the enlargement member 18 and a second 
removable plug member 26 (FIG. 2) threadably engageable with an internal 
threaded opening (not shown) formed in the free end of the plug member 24. 
The plug member 24 is provided with a through axial opening (not shown) 
extending in co-alignment with an aperture 28 formed in the first 
enlargement portion 18. The plug member 26 normally closes the access to 
the opening 28 through a threaded engagement with a plug member 24. The 
plug member 26 has a solid cap 30 which prevents communication between the 
aperture 28 and exterior of the tool 10. 
A syringe 30 having a threaded nose portion 32 is adapted for engagement 
with the plug member 24, as shown in FIG. 2, for the purposes that will be 
described in more detail hereinafter. The syringe 30 can be a conventional 
one-plunger syringe, or a multi-plunger syringe 32, as shown in FIG. 3. 
The syringes 30 and 32 have openings (not shown) formed in the nose 
portions 32 and 34, respectively. When the syringes 30 or 32 are engaged 
with a first plug member 30 with the help of the exteriorly threaded nose 
portions 32 and 34, a fluid communication is established between interior 
of the syringes 30, 32 and the aperture 28. The syringes 30 and 32 can be 
quickly connected and disconnected from the plug member 24 by using 
internal threads in the plug member 24 and external threads on the nose 
portions 32 and 34. 
The second enlarged portion 20 is similarly provided with a plug 40 that is 
formed with a threaded internal opening suitable for receipt of a threaded 
distal end 42 of a vacuum suction tube 44. The plug 40 is formed with a 
through central opening 46 (FIG. 2) which communicates with an aperture 48 
defined in the second enlargement portion 20. A fluid communication is 
established between the aperture 48 and the vacuum suction tube 44 when 
the tube is threadably engaged, with the help of the pin 50, to the plug 
40. 
The aperture 28 communicates with a channel 52 extending through the body 
12, terminating in an open tip 54 of the distal end 16. The aperture 48 
communicates with a channel 56 (FIGS. 2 and 4) extending through 
substantially entire length of the body 12 and terminating in the tip 54. 
The proximal end 14 of the body 12 is provided with a cap 60 carrying a 
plurality of pin connectors 62, 64 and 66. The connector 62 carries a 
monofilament cleaner line 68 extending through the connector pin 62 and 
the channel 52. An irrigation tube 70 extends through the connector pin 62 
and communicates with a channel 71 for delivering cleaning fluid to a 
treatment site. The pin connector 64 carries a laser tube 72, with the pin 
connector 64 communicating with central opening 74 (FIG. 4) formed in the 
body 12. The laser tube 72 surrounds a laser cable 76 adapted for delivery 
of laser beam to a treatment site through extension of the tube 72 to the 
tip 54. 
The connector pin 66 is normally closed with a cap 78 but can be used for 
connecting to a tube 80 to deliver a medication or other suitable fluids 
to the treatment site. 
A first up/down switch 84 is mounted on an exterior of the body 12 (FIGS. 
1, 2 and 4), the switch 84 being adapted to move up and down the fiber 
optic cable tip 86, causing it to extend is through an opening 88 formed 
in the body 12. A second up/down switch 90 is mounted adjacent to the 
first switch 84 on the exterior of the body 12. The second switch 90 
allows to extend or retract the monofilament cleaner 68 from a channel 92 
defined through the body 12. 
The switches 84 and 90 slide within openings 94 and 96, respectively, 
formed in the body 12, causing the monofilament cleaner 68 and the optical 
cable 88 through the tip 54 of the body 12. The monofilament cleaner is 
moved outwardly from the tip 54 when the treatment site needs to be 
cleaned and decay removed, in conjunction with the irrigation of the site 
with a fluid delivered through a tube 70. The fiberoptic cable 88 is 
extended through the tip 54 when the doctor needs to inspect the treatment 
site before or during a medical procedure. 
A channel 110 formed in the body of the tool 10 is left spare. The channel 
110 is normally closed and can be utilized for connection of additional 
syringes, tubes for delivery of medication, insertion of microforceps for 
removal of foreign bodies, or other necessary means to the treatment site. 
It is envisioned that microforceps can be used with the instrument of the 
present invention in order to grasp small foreign bodies and retrieve them 
through the instrument. The foreign bodies can be placed in front of laser 
beam in a safe location and disk fragments can be destroyed, thus causing 
a minimum of surgical trauma. 
Turning now to FIGS. 5 and 6, the operation of the tool 10 will be 
discussed in more detail. The monofilament cleaner 68 normally rests 
within the channel 92, within the limits of the body 12. When cleaning of 
a treatment site needs to be performed, for example, site of a damaged 
bone structure, the filament cleaner 68 is extended from the body 12, as 
shown in FIG. 6, such that a filament carrier 98 and the monofilament 
fibers 100 move out of the channel 92 outside of the body 12. Torque is 
imparted on the cleaner body 68, rotating the fibers 100 at a considerable 
speed, and forcing the fibers 100 into a contact with the damaged bone 
structure or a decayed tooth structure. 
High speed rotation of the fibers 100 causes soft damaged tissue to become 
loose and separate from the bone structure which is shown schematically at 
102 in FIG. 6. The separated particles of the bone are removed from the 
treatment site with the help of a fluid delivered through the irrigation 
tube 70 and a suction force established with the tube 104 and acting on 
the treatment site through the channels 48 and 56. In this manner, the 
irrigation fluid, as well as the loose particles of the damaged tissue can 
be removed from the treatment site, leaving the bone area 102 clean and 
ready for subsequent treatment steps. 
FIGS. 7 and 8 illustrate in more detail the manner of using a television 
cable which forms a part of the tool 10. As shown in FIG. 7, the 
television cable 86 is normally retained in the channel 88 within the body 
12. When it is necessary to perform inspection of the site of treatment, 
the switch 84 is manually operated, causing the cable 86 to move outwardly 
from the tip 54 of the body 12 and extend, to a discrete distance, from 
the opening formed in the tip 54. The most distal end 110 of the cable 86 
oscillates right and left, forward and backward in response to an 
electrical signal delivered through the cable 86. 
By moving the most distal end 110 in different directions, thanks to a 
flexible connector 112, an inspection of a site 114 in the bone structure 
102 can be performed. Once the inspection is completed, in response to a 
control command sent through the cable 86, the distal end 110 is withdrawn 
from the site 114 back into the channel 88. 
The extension and withdrawal of the portion of the fiber optic cable 86 can 
be done at any time during the treatment procedure either for the purpose 
of evaluation of the damage to the bone structure 102, or to evaluate the 
success of cleaning of the site 114, or subsequent to treatment, to 
evaluate whether any hidden damage, cracks or imperfections remain in the 
treated bone structure (tooth). 
Turning now to FIGS. 10-12, a tool 120 is illustrated in use for treatment 
of sinuses. The tool 120, similar to the tool 10, comprises an elongated, 
generally cylindrical body 122 provided with a plurality of channels 
extending through the body. A channel 124 is adapted for retaining an 
irrigation tube 126 therein. The irrigation tube 126 delivers a fluid to a 
treatment site 128 during the use of the device 120. A channel 130 is in 
fluid communication with the first enlarged portion 132 adapted for 
connecting a syringe with a medication to a normally closed end of the 
channel 130. 
A suitable pin 134, similar in structure to the pin 22 is secured at one 
end of the first enlargement portion 132. The second enlargement portion 
136 carries a pin 138 that is adapted for engagement with a vacuum tube 
140 by threadably engaging a connector pin on the end of the tube 140 with 
the pin 138. The tube 140 communicates with a channel 142 creating a 
suction force in the channel 142 and allowing to evacuate fluids and find 
tissue particles from the treatment site 128. A laser cable 144 extends 
through a central channel 146 formed in the body 122, the laser cable 144 
delivering a light beam to the treatment site to help treat the damaged 
area. 
A television fiberoptic cable 150 extends through a channel 152 formed in 
the body 122, allowing the doctor to inspect the treatment site during the 
treatment procedure. An up/down switch 154 slidably engaged with the wall 
of the body 122 allows to extend and retract the fiberoptic cable 150, 
similarly to the cable 86 of the tool 10. 
A pinpoint bipolar cautery 156 extends through a channel 158 and is caused 
to move in and out of the body 122 in response to activation of an up/down 
switch 160 slidably engaged with the wall of the body 122. The cautery 156 
normally rests in the channel 156, as shown in solid line in FIG. 12, and 
can be moved outwardly from the body 122 in the direction shown in phantom 
lines in FIG. 12 during a treatment procedure. 
The cautery 156 is adapted to destroy dead or damaged tissue in the 
treatment site 128, so as to prevent the spread of infection, help seal 
blood vessels and the like. When electrical current is delivered through 
the cautery 156, it is transmitted through the body of the cautery to the 
damaged tissue, burning the unwanted tissue with a pinpoint accuracy. 
An additional channel 164 formed in the body 122 is left intentionally 
spare, with a view to using the channel 164 by either connecting 
additional syringes or tubes for delivery of microforceps, medication or 
other treatment means to the site 128. 
As can be seen in FIG. 10, an incision 170 is made in the body of the 
patient, and a tip 125 of the body 122 is introduced through the incision 
to the treatment site 128. The incision 170 can be made of much smaller 
dimensions, due to a reduced diameter of the tip 125, as compared with 
conventional tools and methods. By holding the tool 120, as shown phantom 
line in FIG. 10, a physician can perform the necessary examination of the 
sinuses of the patient, manipulate television camera, extension of the 
cautery and removal of the unwanted tissue. 
FIGS. 13 and 14 illustrate a tool 180 particularly adapted for use in 
orthopaedic procedures. The tool 180 comprises a generally cylindrical 
body 182 provided with a plurality of channels passing through the body. 
Similarly to the embodiments shown in FIGS. 1-12, the body 182 has an open 
tip 194 formed in a distal end of the body 192 and a cap 186 secured on 
the proximate end of the body 182. A pair of up/down switches 188 and 190 
are mounted in slidable engagement with the body 182 and are adapted to 
extend and retract a television camera cable and a pinpoint bipolar 
cautery, respectively. The switch 198 is in operational communication with 
a television cable 194 extending through a channel 196 formed in the body 
182. A bipolar cautery cable 198 extends in the channel 200 and can be 
extended outwardly from the tip 194 or be retracted into the body 182 upon 
a signal transmitted by the switch 190. 
A laser cable 202 extends through the central channel 204 for delivery of a 
high power light beam to the treatment site. An irrigation channel 206 
delivers fluid to the treatment site to help clean the site and remove 
unwanted or damaged tissue. A vacuum channel 208 is connected to the 
vacuum tube 210 for evacuating the fluids and particles of damaged bone or 
tissue from the treatment site. 
The tool body 192 is provided with a first enlarged portion 210 that is 
adapted for connection to a syringe, or a vial 212 containing a pain 
medication for delivering the medication through the channel 214 formed in 
the body 182. A second enlarged portion 216 is adapted for connection to a 
syringe, or vial 218 containing bone cement or other similar adhesive 
substance for delivering the substance through a channel 220 to the 
treatment site. A spare channel 222 is formed in the body 192 in case 
other medications or treatment agents need to be used during an 
orthopaedic procedure. 
The television cable 194, the cautery wire 198, and an irrigation tube 224 
extend through corresponding openings formed in the cap 196, as shown in 
FIG. 13. As further shown in FIG. 13, the orthopaedic tool 180 is held in 
the hand of a doctor, similarly to a pen, allowing the doctor to 
manipulate the switches 188 an 190 for inspecting the damaged site and for 
delivering a cauterization wire 198 closer to the damaged area. 
When in use, a reduced diameter distal end 226 of the tool 180 is inserted 
through an incision 228 formed in the soft tissue of the patient, in 
immediate proximity to a bone 230, particularly to a damaged area 232, 
where the treatment is to be performed. By alternatively connecting and 
disconnecting the various attachments to the tool 180, the doctor can 
inspect the site of a bone damage by using the television cable 194, 
deliver a laser beam to the site through the laser cable 202, use 
cauterization by using the pinpoint cautery 198, and to irrigate and clean 
the site by using the vacuum tube 210 and the microforceps and the 
irrigation tube 224. 
Pain medication or antibiotic can then be delivered through the syringe or 
vial 212 in fluid communication with the channel 214, and a strengthening, 
sealing bone cement can be delivered from a vial or syringe 218 in fluid 
communication with the channel 220 and, thereby, with the treatment site 
232. Preferably, the vacuum channel 208 is formed with a greater diameter 
in comparison with the channels shown in the embodiments of FIGS. 1-12. 
The enlarged vacuum channel 208 is needed to successfully evacuate larger 
particles of bone tissue from the treatment site 232. 
FIG. 15 illustrates the use of the tool 180 in relation to a procedure 
performed on a spinal cord of a patient. In that case, it is preferred 
that the vial 212 contain an antibiotic liquid, and vial 218 contain a 
pain medication. The operation of the tool 180 during a spinal surgery 
would be similar to the operation of the device during an orthopaedic 
procedure, allowing the surgeon to manipulate the up/down switches 188 and 
190 with his thumb, and connecting and disconnecting various attachments 
to the tool 180 with his other hand, if necessary, or allowing attendant 
personnel to connect, disconnect syringes 212 and 218. 
FIG. 16 illustrates the use of the tool shown in FIG. 10 during a 
neurosurgery. The tool, as described above, contains a tool body 122 
formed with a plurality of channels for delivering medications, irrigation 
and other necessary fluids to a treatment site 240. The switches 154 and 
160 can be manipulated either by an index finger of a surgeon or a thumb 
of a surgeon, as shown in phantom lines in FIG. 16, similarly to the use 
of the tool during a sinus operation. The plug connectors 134 and 138 are 
similarly adapted for connection to a syringe and a vacuum tube, 
respectively. The cap 121 is similarly formed with a plurality of openings 
allowing extension of irrigation, laser, pinpoint bipolar cautery and 
television cable conduits from the tool 120 for connection to external 
devices. 
Turning now to FIG. 9, the operation of the tools shown in FIGS. 1-8 and 
10-16 will be described with reference to a tool 10. It is to be 
understood that the tools 120 and 180 are similar in operation, with minor 
modifications for delivery of different types of medications, irrigation 
or treatment fluids to a damaged site. 
As shown in FIG. 9, the apparatus of the present invention comprises the 
tool 10 connected by a plurality of electrical and fluid lines to the 
control and monitoring equipment. A foot pedal 250 is provided for use by 
a surgeon or dentist. The foot pedal 250 has a plurality of switches for 
controlling a magnifying picture of a television camera, light, 
magnification and the like. 
A switch 252 is an on/of switch designed to control a monofilament cleaner 
68 by sending a signal to a motor 254 that imparts rotational force on the 
cleaner body and transmits it through the filaments 100. A switch 256 
controls operation of a vacuum motor 258, adapted to establish a vacuum in 
the suction line 104. A switch 260 is connected through a solenoid valve 
262 to a water line 264 which, in turn, is connected by suitable tubing 
266 to an irrigation tube 70. 
An on/off switch 270 controls operation of a laser through appropriate 
wiring 272 delivering a signal to the cable 76. A cover 274 is provided 
for protecting the switch 270 and preventing accidental energizing of the 
laser beam when not required by the surgeon or dentist. 
Occupying a central position on the foot pedal 250 is a control pad 276 
with directional arrows 278 for controlling movement of a fiber optic 
cable during examination of the damaged site. By moving foot in different 
directions, as shown by arrows 278, the doctor can transmit the signal 
through corresponding wiring 280 to the fiber optic cable, moving the tip 
110 of the cable in different directions, as shown in FIG. 8. The fiber 
optic cable is also operationally connected through appropriate wiring 282 
to a television monitor 284 positioned within a visual distance of the 
working physician. The monitor 284 is also controlled by an on/off switch 
286 mounted on the foot pedal 250. A switch 288 is connected to a multiple 
light source control line 290 on the monitor 284, and a control button 292 
on the foot pedal 250 is connected by a suitable wiring 294 to the 
television monitor 284. The switch 292 allows the physician to magnify the 
image received by the fiber optic cable 268 of the damaged site and 
display a magnified image on the monitor 284 with various light sources. 
By switching the control buttons on the foot pedal 250, in conjunction with 
the up/down switches 84 and 90, the treating doctor can inspect the 
damaged site, affect cleaning of the site and removal of the damaged 
tissue by using either laser, a monofilament cleaner, or a bipolar 
cautery, remove the unwanted tissue by irrigating the site and 
establishing a vacuum connection to remove the unwanted tissue from the 
treatment site and deliver a medication, bone cement or other necessary 
fluids to stabilize and repair the bone structure. If desired, a follow up 
examination, after the cement has set, can be similarly conducted through 
the use of the fiber optic cable and the TV monitor, to make sure that all 
areas are properly sealed and protected. 
A pain killer medication can be delivered during the surgery by using the 
syringes 30, 32. The syringe 32, as described above, can deliver multiple 
treatment fluids to the treatment site by using the two-chamber 
construction and two plungers. The use of laser and pinpoint cautery 
allows the sealing of the blood vessels and prevents excessive bleeding. 
Additionally, the physician can deliver various diagnostic colored or 
staining liquid to the repair site by using the same syringe connector and 
a different type of syringe. It is possible to dye the tissue in the 
damaged area with, for example, fluorescein stain to highlight the damaged 
tissue prior to the examination by the television camera. By lowering or 
raising the intensity of various colors and sources of light, it is 
possible to better observe the bone structure and make a better 
examination of the damaged area. 
It is also possible to illuminate the treatment site with different colors, 
for example the switch 288 can be used to deliver a cobalt blue, or 
infrared, or green light to the site to enhance the pathology of the bone. 
The cleaning of the wound can be made with hydrogen peroxide or other 
similar liquids delivered through the irrigation line, in conjunction or 
separately from the water connection. 
The device of the present invention allows to use various types of sealers, 
in addition to the bone cement. For example, an epoxy, a thermal plastic 
resin and other fast curing substances can be used for repair of the 
damaged bone structure. In addition, particularly in use during dental 
procedures, a cavity dissolving solution can be injected into a tooth 
cavity, and a solution to highlight residual dental caries as well as a 
sealer, for example using the syringe 32. 
By using the system of the present invention, the surgeon can perform the 
exploratory and treatment procedures in several minutes, as opposed to 30 
or more minutes usually required for such procedures. The use of the 
television camera with a possibility to magnify the damaged area 
facilitates better results and allows more complete sealing and protection 
of the damaged bone structure then with the naked eye. 
Many changes and modifications can be made in the apparatus of the present 
invention without departing from the spirit thereof. I, therefore, pray 
that my rights to the present invention be limited only by the scope of 
the appended claims.