CN103505264B - 经椎弓根通道治疗胸腰椎爆裂骨折的微创手术器械 - Google Patents

经椎弓根通道治疗胸腰椎爆裂骨折的微创手术器械 Download PDF

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CN103505264B
CN103505264B CN201310429840.5A CN201310429840A CN103505264B CN 103505264 B CN103505264 B CN 103505264B CN 201310429840 A CN201310429840 A CN 201310429840A CN 103505264 B CN103505264 B CN 103505264B
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李经民
李涛
刘冲
段亚杰
甘露
王蕾
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
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Abstract

经椎弓根通道治疗胸腰椎爆裂骨折的微创手术器械，属于微创医疗器械领域。目的是提供一种可以经过胸腰椎椎弓根通道进入椎体髓核，进行肿物取病理活检、肿物切除及骨折减压等操作的微创手术器械。其特征是：在进行微创手术时，主体（1）可带动整个器械在椎弓通道的轴向进行来回移动，并可围绕轴进行转动；定位钳子（8）和活动钳子（9）可在垂直于主体（1）的平面内进行摆动，整个微创手术器械的运动设计使其可对椎体髓核内的肿物或碎骨进行全面的处理。

Description

经椎弓根通道治疗胸腰椎爆裂骨折的微创手术器械
技术领域
本发明涉及微创手术器械，特别是涉及治疗胸腰椎爆裂骨折的微创手术器械。
背景技术
微创脊柱外科的目的是通过微创技术以最小损伤取得与传统开放手术相同或者更好的治疗效果。近年来，随着手术器械设备和计算机成像技术的飞速发展，微创手术技术已从经皮穿刺髓核化学溶解、经皮穿刺激光髓核气化和显微镜下腰椎间盘切除技术发展到脊椎减压、融合和内固定，取得了令人瞩目的成就。
尽管微创脊柱手术存在许多优势，但亦有其缺点和局限性。相对于传统开放手术而言，目前微创手术在手术时间、学习曲线、具体手术效果、对手术设备的要求、对图像引导系统的依赖等几个方面均存在一定的差距。
1.手术时间长、学习曲线长。与其他外科新技术一样，微创式手术比传统术式所需要的时间更长，学习曲线也更加依靠手术经验的积累，虽然对于每一种新的术式，随着手术操作的逐渐熟练，手术时间将大大缩短，但有些前方或者侧方微创入路手术，由于要避免显露和移动血管，其手术时间仍然会较长。
2.手术效果不确切。即使术者已经充分考虑并熟悉脊柱病变的三维解剖，但在复杂的脊柱微创手术中，由于小切口对脊柱周围的解剖结构显示不清晰，术野显露不充分，常影响手术操作和安全。因此，即使微创理念具有很大的吸引力，微创手术最终可能达不到预期的手术效果。
3.对手术的设备要求高。为避免影响手术视野，微创管道技术常需要一些较窄的长柄枪形器械。但与管道技术不同的是，微创小切口技术可以使用常规的手术器械并进行直接照明，降低了手术的技术难度，缩短了学习曲线。
4.依赖图像引导系统。图像引导和影像学的作用在非直视操作下显得特别重要，但要熟练掌握这些方法需要花费大量的时间和费用，术者对放射线的暴露也随之增加。为此，人们不断研究和改进计算机导航系统，但由于费用昂贵、使用复杂、准确性较差等缺陷未能得到广泛投入使用。
技术方案
本发明旨在解决上述问题，提供了一种经椎弓根通道治疗胸腰椎爆裂骨折的微创手术器械，由主体、活动手柄、固定手柄、上拉杆、下拉杆、上拉杆滑槽、下拉杆滑槽、定位钳子、活动钳子、齿条、转子部件、活动手柄限位槽、齿条滑槽组成：
上下并列固定在一起的上拉杆滑槽和下拉杆滑槽的杆状结构与固定手柄、活动手柄、及活动手柄限位槽构成了枪形主体。
上拉杆在上拉杆滑槽内定向移动，下拉杆在下拉杆滑槽内定向移动。
齿条滑槽位于主体内部下拉杆的下方，且平行于下拉杆滑槽；齿条滑槽中的齿条与下拉杆固定连接。
转子部件一端为与齿条啮合的圆柱体，另一端是截面积稍大的正六边形柱体手柄端；通过手工转动转子部件的手柄端，带动齿条沿其滑槽定向移动，当齿条移动到一定的位置后，可将手柄端推入并嵌入位于主体侧壁上与转子部件手柄端相同大小的正六边形的孔中。
上拉杆的前端通过上拉杆前鞘及活动钳子铰接部件与活动钳子铰接；上拉杆末端通过上拉杆末端鞘与上拉杆末端铰接部件与活动手柄的顶端铰接，活动手柄的上端同时与固定手柄铰接。
下拉杆的前端通过下拉杆前鞘及定位钳子铰接部件与定位钳子铰接；下拉杆的末端与安装于主体上的齿条固定连接。
固定手柄采用直杆形结构；活动手柄为三段互有夹角的直杆组成的易于剪切操作的固定折杆结构，其中活动手柄的上下两段直杆较长，中间段直杆较短。活动手柄把手位置的横截面积尺寸大于其上部分直杆的横截面积尺寸。活动手柄尺寸变化的位置位可以于手柄的中间位置。
所有零部件均采用高硬度防锈材料。
转子部件的手柄端横截面和与其相互对应的主体侧壁的嵌入孔可以是大于六的其它正多边形柱体。
本发明的有益效果在于除了手术创伤小、术中出血少外，更在于方便将脊椎碎骨取出，保证后续的治疗。优化的活动手柄结构方便人的一般用力方式，同时，此结构可加大执行单元的运动范围。
附图说明
图1是本发明整体的机械结构视图。
图2是本发明主体结构视图。
图3是活动钳子结构视图。
图4是定位钳子结构视图。
图5是滑槽盖子结构视图。
图6是活动钳子铰接结构视图。
图7是定位钳子铰接结构视图。
图8是手柄铰接结构视图。
图9是转子部件结构视图。
图10是两个钳子打开到极限位置示意图。
图中：1主体；2活动手柄；3固定手柄；4上拉杆；5下拉杆；6上拉杆滑槽；7下拉杆滑槽；8定位钳子；9活动钳子；10定位钳子铰接部件；11活动钳子铰接部件；12齿条；13活动手柄滑槽；14齿条滑槽；15转子部件；16上拉杆前鞘；17上拉杆末端鞘；18下拉杆前鞘；20上拉杆末端铰接部件；21滑槽盖子。
具体实施方式
下面，结合附图对本发明的具体实施方式进行说明：
上下并列固定在一起的上拉杆滑槽6和下拉杆滑槽7的杆状结构与固定手柄3、活动手柄2、及活动手柄限位槽13构成了枪形主体1。
上拉杆4在上拉杆滑槽6内定向移动，下拉杆5在下拉杆滑槽7内定向移动。
齿条滑槽21位于主体1内部下拉杆的下方，且平行于下拉杆滑槽7；齿条滑槽21中的齿条12与下拉杆3固定连接。
转子部件15一端为与齿条12啮合的圆柱体，另一端是截面积稍大的正六边形柱体手柄端；通过手工转动转子部件15的手柄端，带动齿条12沿其滑槽定向移动，当齿条12移动到一定的位置后，可将手柄端推入并嵌入位于主体1侧壁上与转子部件手柄端相同大小的正六边形的孔中。
上拉杆4的前端通过上拉杆前鞘16及活动钳子铰接部件11与活动钳子8铰接；上拉杆末端通过上拉杆末端鞘17与上拉杆末端铰接部件20与活动手柄2的顶端铰接，活动手柄2的上端同时与固定手柄3铰接。
下拉杆5的前端通过下拉杆前鞘18及定位钳子铰接部件10与定位钳子6铰接；下拉杆的末端与安装于主体上的齿条16固定连接。
固定手柄3采用直杆形结构；活动手柄2为三段互有夹角的直杆组成的易于剪切操作的固定折杆结构，其中活动手柄2的上下两段直杆较长，中间段直杆较短。活动手柄2把手位置的横截面积尺寸大于其上部分直杆的横截面积尺寸。活动手柄2尺寸变化的位置在手柄的中间位置。
具体的操作过程如下：
手工操作活动手柄2，将活动钳子9打开到极限位置。旋转转子部件15，使得定位钳子8与下拉杆达到最大角度；此时的器械前端即可进入微创手术通道内进入病变脊椎骨段。先控制整体器械的进入深度和钳口的朝向，旋转转子部件15，将定位钳子8调节到需要处理的碎脊椎骨附近，将转子部件15压入主体1侧壁，由于转子部件15与齿条12的相啮合，定位钳子8将被固定住；握住手柄，使活动钳子9向定位钳子8运动，实现钳口的闭合，达到取出或者碎化病变脊椎骨的目的。
当需要在处理别的位置的脊椎骨时，可通过外部调节器械的进入深度和钳口方向，将转子部件15脱离主体六边形嵌入槽，重复上述过程。
若手术完毕，将两个钳子调整到之前进入时的位置，即可方便的取出手术器械。

Claims (6)

1.经椎弓根通道治疗胸腰椎爆裂骨折的微创手术器械由主体(1)、活动手柄(2)、固定手柄(3)、上拉杆(4)、下拉杆(5)、上拉杆滑槽(6)、下拉杆滑槽(7)、定位钳子(8)、活动钳子(9)、齿条(12)、转子部件(15)、活动手柄限位槽(13)、齿条滑槽(14)组成；其特征在于：
上下并列固定在一起的上拉杆滑槽(6)和下拉杆滑槽(7)的杆状结构与固定手柄(3)、活动手柄(2)、及活动手柄限位槽(13)构成了枪形主体(1)；
上拉杆(4)在上拉杆滑槽(6)内定向移动，下拉杆(5)在下拉杆滑槽(7)内定向移动；
齿条滑槽(21)位于主体(1)内部下拉杆的下方，且平行于下拉杆滑槽(7)；齿条滑槽(21)中的齿条(12)与下拉杆(3)固定连接；
转子部件(15)一端为与齿条(12)啮合的圆柱体，另一端是截面积稍大的正六边形柱体手柄端；通过手工转动转子部件(15)的手柄端，带动齿条(12)沿其滑槽定向移动，当齿条(12)移动到一定的位置后，可将手柄端推入并嵌入位于主体(1)侧壁上与转子部件手柄端相同大小的正六边形的孔中；
上拉杆(4)的前端通过上拉杆前鞘(16)及活动钳子铰接部件(11)与活动钳子(8)铰接；上拉杆末端通过上拉杆末端鞘(17)与上拉杆末端铰接部件(20)与活动手柄(2)的顶端铰接，活动手柄(2)的上端同时与固定手柄(3)铰接；
下拉杆(5)的前端通过下拉杆前鞘(18)及定位钳子铰接部件(10)与定位钳子(6)铰接；下拉杆的末端与安装于主体上的齿条(12)固定连接。
2.根据权利要求1所述的经椎弓根通道治疗胸腰椎爆裂骨折的微创手术器械，其特征在于固定手柄(3)采用直杆形结构；活动手柄(2)为三段互有夹角的直杆组成的易于剪切操作的固定折杆结构，其中活动手柄(2)的上下两段直杆较长，中间段直杆较短。
3.根据权利要求1所述的经椎弓根通道治疗胸腰椎爆裂骨折的微创手术器械，其特征在于活动手柄(2)把手位置的横截面积尺寸大于其上部分直杆的横截面积尺寸。
4.根据权利要求1或3所述的经椎弓根通道治疗胸腰椎爆裂骨折的微创手术器械，其特征在于活动手柄(2)尺寸变化的位置位于活动手柄(2)的中间位置。
5.根据权利要求1所述的经椎弓根通道治疗胸腰椎爆裂骨折的微创手术器械，其特征在于所有零部件均采用高硬度防锈材料。
6.根据权利要求1所述的经椎弓根通道治疗胸腰椎爆裂骨折的微创手术器械，其特征在于转子部件(15)的手柄端横截面和与其相互对应的主体(1)侧壁的嵌入孔是大于六的其它正多边形柱体。
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