Paulsen K
Arch Otorhinolaryngol. 1976 Jul 20;212(3):163-70. doi: 10.1007/BF00456693.
High frequency cinematographic films were made of the mode of operation of common oto-surgical drilling instruments on bone and cartilage. Rose bits and surgical fraises of different sizes were used at 5,000-80,000 R.P.M. The evaluation of the slow motion pictures was performed on the running films and by review of single frames. In detail: The preparation of the drilling head on the bone without simultaneous flushing leads to a filling of the cutting channel and decreased cutting. Drop flushing only prevents the increasing soiling of the drilling head if the drop sequence is rapid and which must be markedly increased with increasing R.P.M. of the drilling instrument. Flushing with a stream of water, which definitely prevents soiling, is preferable. Both drop flushing as well as the water stream must continuously wet the drilling head, i.e. must be absolutely centric in every case. Safest is the automatic spray flusing which is mounted on the handpiece, but which has so far not been used in oto-surgery. During the preparation, the air space of the working area is always filled with drilling dust or haze. Cutting is always performed tangenitally. The cutting speed lies between 2,9 m/s to 16 m/s. It depends on the R.P.M. of the drilling instrument. A drill head running out of true, even with a gently percussing shaft, touches the bone only with a part of its cutting surface which strikes more vigorously than desired and easily gets soiled, despite flushing. Cutting is therefore less and uncontrolled. An increased feeding energy (pressure on the support) in order to speed up cutting leads to heavy wear of the drilling instrument and unsafety in handling due to jumping of the drilling head. During each contact of a cutter with the bone, coarse fraises with low R.P.M. (5,000 R.P.M. = 83 R/s) show a short stopping of the rotation which results in a jerk and vibration of the whole preparation and can thus lead to a damage of the inner ear.
用高频电影胶片记录了常见耳科手术钻孔器械在骨和软骨上的操作模式。使用了不同尺寸的玫瑰头钻头和手术铣刀，转速为5000 - 80000转/分钟。对慢动作影片的评估是在连续播放的胶片上以及通过查看单帧画面进行的。详细情况如下：在骨上准备钻头时若不同时冲洗，会导致切削通道堵塞并降低切削效果。点滴冲洗只有在滴注顺序快速时才能防止钻头污染加剧，且随着钻孔器械转速的增加，滴注速度必须显著提高。用水流冲洗肯定能防止污染，更为可取。点滴冲洗和水流冲洗都必须持续湿润钻头，也就是说在每种情况下都必须绝对居中。最安全的是安装在手持件上的自动喷雾冲洗，但目前尚未在耳科手术中使用。在手术过程中，工作区域的空气空间总是充满钻孔灰尘或雾气。切削总是沿切线方向进行。切削速度在2.9米/秒至16米/秒之间。这取决于钻孔器械的转速。即使轴有轻微敲击，钻头偏离正确位置时，其切削面只有一部分接触骨头，敲击力度比预期更大且容易被污染，尽管有冲洗。因此切削量减少且不受控制。为了加快切削而增加进给能量（支撑上的压力）会导致钻孔器械严重磨损，并因钻头跳动而在操作时不安全。在每个刀具与骨头接触时，转速低（5000转/分钟 = 83转/秒）的粗铣刀会出现短暂的旋转停止，这会导致整个手术过程出现颠簸和振动，从而可能对内耳造成损伤。
