Technisch-wirtschaftliche Analyse des Knochenbohrprozesses in der Chirurgie und Ableitung von Verbesserungspotentialen

Publikation: StudienabschlussarbeitMasterarbeitForschung

Abstract

Chirurgisches Knochenbohren ist ein wichtiger Vorgang während der Osteosynthese. Jedes Jahr werden ca. 220.000 Bohrungen in Österreich an menschlichen Knochen durch Chirurgen vorgenommen. Die Qualität der Bohrungen beeinflusst die Stabilität der Fixierung der Knochenfraktur. Übermäßige Wärmeentwicklung während des Bohrens verursacht das Absterben von Zellen (thermische Nekrose), was wiederum die Haltefestigkeit des Implantates verringert. Die daraus resultierenden postoperativen Komplikationen beeinträchtigen den Patienten und verursachen zusätzliche volkswirtschaftliche Kosten. Das Ziel dieser Arbeit war es, den Knochenbohr-Prozess zu analysieren und zu verbes-sern. Für die technische Analyse wurde die entsprechende Forschungsliteratur studiert. Daraus wurden die Haupteinflussfaktoren auf die Temperatur während des Bohrens bestimmt. Des Weiteren wurden aus dem Operationssaal ausgeschiedene Knochenbohrer mit dem Stereomikroskop untersucht. Für die wirtschaftliche Analyse wurden die biomedizinischen und volkswirtschaftlichen Auswirkungen auf Grund von thermischer Nekrose untersucht. Dafür wurden Interviews mit involvierten Personen und relevante Statistiken verwendet. Chirurgisches Knochenbohren erfordert Tätigkeiten vor und nach dem Bohren. Der Gesamtprozess wurde mit speziellen wirtschaftswissenschaftlichen Methoden erfasst und daraus mögliche Schwachstellen ermittelt. Die untersuchten Knochenbohrer aus dem Operationssaal zeigten starke Verschleißer-scheinungen. Die Untersuchungen ergaben, dass gebräuchliche Knochenbohrer hinsichtlich der Geometrie und des Materials nicht optimal sind. Alternative Materialien können sowohl korrosions- als auch verschleißbeständig sein. Kühlung ist der wichtigste Einflussfaktor, um die Knochentemperatur während des Bohrens zu senken und sollte daher bei jeder Gelegenheit eingesetzt werden. Weiters wurde eine einfache Richtlinie für die Verbesserung des Knochebohr-Prozesses entwickelt. Die volkswirtschaftlichen Auswirkungen sind bemerkenswert: Komplikationen auf Grund von unzureichender Knochenbohrungen erhöhen die volkswirtschaftlichen Kosten maßgeblich. Deshalb rechtfertigt nicht nur die Patientensicherheit weitere Anstrengungen um den Prozess des chirurgischen Knochenbohrens zu verbessern.
Titel in Übersetzung Technisch-wirtschaftliche Analyse des Knochenbohrprozesses in der Chirurgie und Ableitung von Verbesserungspotentialen
Originalspracheenglisch
Gradverleihende Hochschule
  • Technische Universität Graz (90000)
Betreuer/-in / Berater/-in
  • Vallant, Rudolf, Betreuer
  • Kleindienst, Mario, Betreuer
Datum der Bewilligung27 Feb 2015
PublikationsstatusVeröffentlicht - 27 Feb 2015

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Economic analysis
Drilling
Bone
Economics
Bone and Bones
Mandrillus
Hot Temperature
Necrosis
Theaters
Costs and Cost Analysis
Temperature
Corrosion
Bone Fractures
Patient Safety
Cause of Death
Cell Death
Guidelines
Interviews
Heat generation
Cell death

Schlagwörter

  • Knochenbohren
  • Thermische Nekrose
  • Osteosynthese
  • Chirurgische Knochenbohrer
  • Verschleiß
  • Bohrparamter

ASJC Scopus subject areas

  • !!Surgery
  • !!Biomaterials

Fields of Expertise

  • Advanced Materials Science

Dies zitieren

Technical and Economic Analysis of the Process of Surgical Bone Drilling and Improvement Potentials. / Höller, Christian.

2015. 137 S.

Publikation: StudienabschlussarbeitMasterarbeitForschung

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title = "Technical and Economic Analysis of the Process of Surgical Bone Drilling and Improvement Potentials",
abstract = "Surgical bone drilling is an important preparative procedure for osteosynthesis. Every year, Austrian surgeons drill around 220,000 holes into human bone. The quality of drill holes affects the stability of the fixation after bone fractures. Excessive heat generation during drilling can cause cell death (thermal necrosis) which again weakens the holding strength of the implant. As a result, post-operative complications can compromise the patient’s recovery and cause additional economic costs. The aim of this thesis was to analyse and improve the process of manual surgical bone drilling. For the technical analysis, related research literature has been reviewed. Hence, the most influential factors for the drilling temperature were identified. Furthermore, discarded surgical drill bits from the operation theatre were investigated with the stereo microscope. For the economic analysis, the consequences of thermal necrosis were determined from a biomechanical and economic perspective. For this purpose, interviews with involved people and statistics were used. Surgical bone drilling requires pre- and post-drilling tasks. The overall process was analysed with specific methods from business economics to determine possible weak points. The investigated surgical drill bits from the operation theatre showed excessive signs of wear. The study showed that both geometry and material of common surgical drill bits have room for improvement. Alternative materials with adequate corrosion and wear resistance as well as improved geometrical parameters are recommended. Cooling is the most influential cutting parameter to decrease the bone temperature during drilling and has to be applied wherever possible. Furthermore, a simple practical guideline was developed to improve the drilling process. Also the economic consequences are remarkable, i.e. complications due to inadequate bone drilling increase the economic costs significantly. These results, and more importantly the safety of the patients justify additional efforts to improve the process of surgical bone drilling.",
keywords = "Knochenbohren, Thermische Nekrose , Osteosynthese , Chirurgische Knochenbohrer , Verschlei{\ss} , Bohrparamter, Bone Drilling , Thermal Necrosis, Osteosynthesis, Surgical Drill Bits , Wear , Drilling Parameters",
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AB - Surgical bone drilling is an important preparative procedure for osteosynthesis. Every year, Austrian surgeons drill around 220,000 holes into human bone. The quality of drill holes affects the stability of the fixation after bone fractures. Excessive heat generation during drilling can cause cell death (thermal necrosis) which again weakens the holding strength of the implant. As a result, post-operative complications can compromise the patient’s recovery and cause additional economic costs. The aim of this thesis was to analyse and improve the process of manual surgical bone drilling. For the technical analysis, related research literature has been reviewed. Hence, the most influential factors for the drilling temperature were identified. Furthermore, discarded surgical drill bits from the operation theatre were investigated with the stereo microscope. For the economic analysis, the consequences of thermal necrosis were determined from a biomechanical and economic perspective. For this purpose, interviews with involved people and statistics were used. Surgical bone drilling requires pre- and post-drilling tasks. The overall process was analysed with specific methods from business economics to determine possible weak points. The investigated surgical drill bits from the operation theatre showed excessive signs of wear. The study showed that both geometry and material of common surgical drill bits have room for improvement. Alternative materials with adequate corrosion and wear resistance as well as improved geometrical parameters are recommended. Cooling is the most influential cutting parameter to decrease the bone temperature during drilling and has to be applied wherever possible. Furthermore, a simple practical guideline was developed to improve the drilling process. Also the economic consequences are remarkable, i.e. complications due to inadequate bone drilling increase the economic costs significantly. These results, and more importantly the safety of the patients justify additional efforts to improve the process of surgical bone drilling.

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KW - Verschleiß

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KW - Wear

KW - Drilling Parameters

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M3 - Master's Thesis

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