JPH10192297A - Securing device of cavity for bone operation - Google Patents

Abstract

PROBLEM TO BE SOLVED: To easily operate under a good observation view field, by inserting a sheath into body tissue and engaging the tip end of the sheath with a bone to hold the sheath and operating the bone in a working space for bone operation under observation. SOLUTION: The outer shape of the tip end of a sheath 1 is constituted as a first engaging means to engage with a vertebral body of the spine and formed into nearly the shape of the vertebral body, and the tip end of the sheath 1 is rounded. A top wide taper part is formed on the inner face part on the tip end edge of the sheath 1. A spike channel 21 for inserting a fixing means to be fixed to the vertebral body is equipped on the tip end part of the sheath 1, and a spike 5 of the fixing means is inserted through the spike channel 21. The spike channel 21 is formed with a pipe material and housed in along the inside of the inner wall of the sheath up to the vicinity of the tip end, and placed evading in right and left positions of the scope channel 12.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an instrument for securing a cavity for bone surgery used for securing a working space for performing a surgical operation on a bone, for example, a spine under an endoscope.

[0002]

2. Description of the Related Art In recent years, endoscopic surgery, such as laparoscopic surgery and arthroscopic surgery, has been actively performed due to its low invasiveness, and various surgical fields have been developed. It has been applied to.

[0003] In the meantime, introduction of a similar technique to the field of the spine has begun to be considered.

[0004] For example, in the case of operating the spine under laparoscopic surgery, USP No. 5, in which the peritoneum is peeled off under laparoscopic surgery while the stomach is insufflated and the organs are exhausted, and the vertebral body is treated with a treatment tool
313,962, and those in which the organ is evacuated through the insufflated peritoneal cavity and the vertebral body is treated with a treatment tool. In addition, the first from the patient's back
US Pat. No. 5,439,46, which inserts a treatment instrument through a second cannula to inject fluid and maintain a working space at the pressure of the fluid to perform a vertebral body treatment
No. 4 is also proposed.

[0005]

[Problems to be solved by the invention]

(Problem) However, in the laparoscopic procedure, the surgical operation must be performed while excluding the organs. Therefore, it is necessary to use many treatment tools such as an exclusion element, and the exclusion operation is extremely complicated. . In addition, organs such as the intestine and blood vessels move easily in the cavity. For this reason, the pressure exclusion becomes insufficient during the treatment, which tends to cause poor visual field. Further, if the exclusion is not sufficiently performed, there is a possibility that the organ may be unexpectedly damaged by another treatment tool or the like. In particular, the anterior approach to the lumbar vertebrae was a delicate procedure with the great artery and vein in front of the lumbar vertebrae. In addition, if the operator is unfamiliar, it is difficult to obtain a certain field of view, and it is necessary to use many extruders and treatment tools, which is a difficult procedure and requires high skill. there were.

[0006] In addition, in a technique of injecting a fluid through a cannula inserted from the back of a patient and inserting a treatment tool through another cannula while maintaining a working space with the fluid pressure to perform an operation on a vertebral body, the operation is also required. Poor visual field due to insufficient compression to maintain the space can be considered.

(Purpose) The present invention is intended to facilitate the operation of the bones such as the spine under the observation by the observation means and to perform the operation in a minimally invasive manner. Provided is an instrument for securing a cavity for bone surgery that allows a user to easily perform an operation without being aware of damage to other organs under the observation visual field and without requiring a high level of skill in the operation. It is in.

[0008]

[Means for Solving the Problems]

(Means) The present invention relates to a sheath for securing a cavity, which is inserted into a body tissue and forms a working space for bone surgery with an internal cavity, and a sheath attached to this sheath for observing a surgical field in the working space for bone surgery. An observation means, such as a scope channel for guiding an endoscope, for observing an operation field in the working space for bone surgery; and a treatment tool attached to the sheath and used for treating bone, the working space for bone surgery. Treatment channel, and an engaging means provided at the distal end of the sheath, the engaging means for engaging the distal end of the sheath with bone, inserting the sheath into body tissue, and applying the sheath to the bone by the engaging means. A bone surgery cavity securing instrument characterized in that a distal end is engaged to hold a sheath, and a bone treatment is performed by a treatment tool in the bone surgery working space under observation.

(Operation) The sheath of the cavity securing device is inserted under the body tissue from the skin incision, and a working space for bone surgery is secured in the lumen of the sheath. The distal end of the sheath is placed on the front surface of the bone, and the sheath is engaged with the bone by the engagement means, thereby positioning the front end of the sheath with respect to the treatment site. Thus, a space for performing a treatment operation on the bone is reliably secured. Next, for example, an endoscope is inserted into the scope channel, a treatment tool is inserted into the treatment channel, and the inside of the working space can be viewed in a mirror, and the distal end of the sheath is engaged with the bone at the treatment site positioned. Then, a treatment is performed by inserting a treatment tool from the treatment channel under a mirror.

[0010]

BEST MODE FOR CARRYING OUT THE INVENTION

<First Embodiment> A first embodiment of the present invention will be described with reference to FIGS.

(Structure) The instrument for securing a cavity for bone surgery according to the first embodiment includes a sheath system for spine surgery comprising a plurality of components as shown in FIG. In this system, a sheath 1 for securing a cavity to be inserted into body tissue, a mandolin (inner needle) 2 for expansion, a rod 3, an inner cylinder 4 for airtightness, a spike 5, a plug 6 for a scope channel, and a plug 7 for a spike channel are arranged. In addition, a suction tube 8 is additionally provided in advance.

The sheath 1 has a plurality of types of channels (CH).
Is attached. First, the treatment channel 11 through which the treatment tool is inserted is formed in a straight tubular shape by utilizing the inner cavity of the sheath 1 itself. This treatment channel 11 is shown in FIG.
As shown in the figure, the cross-sectional shape linearly disposed from the front end to the rear end of the sheath 1 is a linear hole having a circular cross section. To form

The upper wall of the sheath 1 is provided with a scope channel 12 into which an endoscope is inserted. The scope channel 12 has an inclination with respect to the treatment channel 11 and is disposed adjacent to the treatment channel 11. The distal end opening of the scope channel 12 faces the lumen of the sheath 1 and directly communicates with the inside of the treatment channel 11. The scope channel 12 is disposed linearly with a gentle inclination away from the center of the scope channel 12 on the distal end side toward the center side of the treatment channel 11 on the distal end side and on the proximal end side. The central axis of the scope channel 12 is offset from the treatment channel 11 at the distal end of the sheath 1,
This is to prevent the endoscope introduced through the tube 1 from jumping into the sheath 1 as much as possible.

As shown in FIG. 2A, the upper wall of the sheath 1 forming the scope channel 12 is raised according to its inclination, and the outer surface of the upper wall is shown in FIG. 2B.
As shown by, it is formed as round as possible, and is formed in a shape in which a recess is not formed even if at least a flat surface portion is formed. Therefore, the entire outer surface shape of the sheath 1 is formed by a combination of only convex portions or linear portions in any cross section, and has a cross-sectional outer shape having no concave portion.

A flange 13 is attached to the proximal end of the sheath 1. Holes 11 a and 12 a communicating with the treatment channel 11 and the scope channel 12 are formed in the flange 13. Hole 12 for scope channel 12
An O-ring 14 is provided on the inner periphery of a. The O-ring 14 is a fixing means for fixing an optical viewing tube 16 of a rigid endoscope, for example, a laparoscope 15 inserted in this portion at an arbitrary position, and a portion thereof. It also serves as an airtight means to keep the airtight.

The laparoscope 15 is of the direct-view type, and an eyepiece 17 is provided at the base end of the optical viewing tube 16. The optical viewing tube 16 and the eyepiece 17 are arranged linearly, and are of a general-purpose type that is generally commercially available.

The outer shape of the distal end of the sheath 1
As a first engaging means for engaging the vertebral body of the vertebral body, it has a shape close to the shape of the vertebral body part, that is, as shown in FIG. Are provided with a radius (R). In addition, a tapered portion 19 is formed on the inner surface of the distal end edge of the sheath 1 so as to expand.

Means for engaging the sheath 1 with the vertebral body are provided at the distal end of the sheath 1. Further, two spike channels are used to pass fixing means (anchor means) for fixing to the vertebral body. 21 are provided. The spikes 5 of the fixing means are respectively inserted into the spike channels 21. The spike channel 21 is formed of a pipe material, is housed along the inside of the inner wall of the sheath up to the vicinity of the sheath distal end, and is evacuated to the left and right portions of the scope channel 12. The rear end of the spike channel 21 is the flange 1 of the sheath 1
3 and is open to the outside through the inside of the wall. The spike channel 21 in the present embodiment is on one side of the sheath 1,
That is, two sheaths are provided at positions deviated upward in the transverse section of the sheath 1. The two spike channels 21 are oriented in the direction of the radius (R) of the front surface of the vertebral body in FIG.
They are arranged at the relational positions as shown in FIG.

The inner wall of the distal end portion of the sheath 1 is provided with a relief portion 23 formed of a concave portion formed by cutting out a part of the inner wall. The opening at the tip end of the spike channel 21 is arranged so as to open inside the escape portion 23. That is, the end opening portion of the spike channel 21 is the sheath 1
In the vicinity of the distal end of the sheath 1, it is disposed in the wall of the sheath 1 and communicates with the distal end of the lumen of the sheath 1. Further, the inside of the escape portion 23 falls within the range of the angle of view of the endoscope, and an object that protrudes from the spike channel 21, that is, the spike 5
Can be seen from the inside of the sheath 1 with an endoscope. The inner surface of the tapered portion 19 at the distal end of the sheath 1 is also within the range of the angle of view of the endoscope, and can be seen through the endoscope.

On the left and right outer walls at the distal end of the sheath 1, there are provided depressions 24 for organ retraction. The material of the sheath 1 is made of resin and is X-ray permeable. Further, it is desirable that the transparent material (for example, polysulfone, polycarbonate, acrylic, or the like) be used. The distal end wall of the sheath 1 is rounded to prevent damage to organs such as blood vessels.

The expansion mandolin 2 is the treatment channel 1
1 and serves as a so-called inner needle (adapter) at the time of insertion. In the mandolin 2, a portion of the insertion portion 31 inserted into the treatment channel 11 is formed to be longer than the treatment channel 11, and a distal end portion 32 projects from the distal end of the sheath 1. The tip portion 32 is formed in a conical tapered portion. An O-ring 33 is mounted on the outer periphery of the proximal end of the expansion mandolin 2 as a means for airtightness with the sheath 1 and a means for fixing to the sheath 1. A flange 34 is provided at the rear end of the extension mandolin 2. Further, a rubber cap 36 is provided at the rearmost end of the expansion mandolin 2 as an airtight means that airtightly penetrates a tool inserted into the lumen (channel) 35 of the mandolin 2. The rubber cap 36 is provided with a rubber stopper 37 as an airtight means for closing the hole when the tool is pulled out.

The flange 34 of the extension mandolin 2 has a cutout in the upper portion where the scope channel 12 and the spike channel 21 are located, and forms a relief portion 38 so as not to obstruct parts inserted into the scope channel 12 and the spike channel 21. doing. As shown in FIG. 2, a position regulating pin 39 is provided on the lower surface of the flange 34, and the pin 39 is formed on the flange 13 of the sheath 1 when the expansion mandolin 2 is attached to the treatment channel 11. And a restricting means for restricting the fitting position of the mandolin 2 so that the position of the escape portion 38 is always correctly directed upward.

The rod 3 is a rod-shaped tool inserted into the extension mandolin 2.
Longer than. The outer diameter of the rod 3 is smaller than a commonly used trocar. Both ends of the rod 3 are similarly rounded and pointed so that they can be easily inserted into the expansion mandolin 2 from either end.

The airtight inner cylinder 4 is, like the expansion mandolin 2, a cylindrical one inserted into the treatment channel 11 of the sheath 1, and has a length of the insertion portion 41 inserted into the treatment channel 11. When the endoscope is inserted into the scope channel 12 of the sheath 1 when the endoscope is inserted into the treatment channel 11, the endoscope and the airtight inner cylinder 4 are inserted in the treatment channel 11.
Is a short length that does not interfere.

Air-tight means for sealing the space between the sheath 1 and the sheath 1
An O-ring 42 is provided as fixing means for fixing the gap between the two. A flange 43 is provided at a rear end of the airtight inner cylinder 4, and a lumen 4 is provided at a rear end of the airtight inner cylinder 4.
Rubber cap 4 that penetrates the tool to be inserted into the airtight 4
5 are provided. The rubber cap 45 is provided with a rubber stopper 46 for closing a hole that is opened when the tool is pulled out. At the center of the rubber stopper 46 of the rubber cap 45 is a puncture portion 47 having a thin portion of rubber and convex toward the lumen side.
Here, it is formed so that a steel wire or the like can be pierced while maintaining insufficiency. After being removed, the puncture unit 47 is naturally kept substantially airtight. The flange 43 has a cut-out upper portion, and a relief portion 48 for a component to be inserted into the scope channel 12 or the spike channel 21 is formed.

The material of the spike 5 is made of a hard material, for example, a metal such as a stainless steel wire. In addition, the thickness of the spike 5 is the spike channel 2
It is made with a diameter that can be inserted into one. The tip of the spike 5 is sharp and formed as a puncture portion 49, and this puncture portion 49 is formed, for example, in a tetrahedral shape. A knob 50 is attached to the rear end of the spike 5.

Each of these spikes 5 is inserted through a spike channel 21, the tip of which is inserted into the vertebral body of the spine, thereby constituting a means for fixing the sheath 1 to the vertebral body. It constitutes second engagement means for engaging the distal end of the sheath 1 with the bone.

The scope channel plug 6 is a sealing plug that is inserted into the proximal end of the scope channel 12 when the endoscope is not inserted into the scope channel 12.
And closes so as to keep the airtight.

The spike channel plug 7 is a plug for closing the spike channel 21 of the sheath 1. When the spike 5 is not inserted into the spike channel 21, it is inserted into the base end of the spike channel 12 to close the spike channel 21. The spike channel plug 7 is made of an elastic member such as nylon, Teflon, or the like.
1 and a grip portion 52. The insertion portion 51 has a tip portion smaller than the inner diameter of the spike channel 21 and an airtight portion located closer to this end and having an outer diameter slightly larger than or approximately equal to the inner diameter of the spike channel 21.

In this embodiment, a suction tube 8 as shown in FIG. 1 is added as a system. This suction tube 8
Has a suction pipe main body 55, and the suction pipe main body 55 is bent at a substantially right angle on the hand side. A base 56 connected to a suction tube (not shown) is provided at a base end of the suction tube main body 55.

A connection adapter 57 is attached to the suction pipe main body 55 of the suction pipe 8. As shown in FIG. 8, the connection adapter 57 is fitted into the suction tube main body 55 and is slidably and elastically tightened and fixed. An arm 59 extending from the ring 58 and made elastic is provided. The sheath 1 includes a fixing portion 60 composed of a pair of pieces for elastically sandwiching and fixing the base opening edge, and these are integrally formed from one elastic plate material.

The treatment channel 11 at the rear end of the sheath 1 is provided with a stopper mechanism as a means for restricting a treatment tool inserted into the treatment channel 11, particularly a chisel or a drill in a depth direction. (Not shown).

(Operation) An example of how to use the instrument for securing a cavity for bone surgery according to the present embodiment will be described below. The example here is shown in FIG.
This is an application example in which the extraction and fixation of the L5-S disc between the fifth lumbar vertebra L5 and the sacrum S in the spine are performed transperitoneally and laparoscopically.

On the front side of the vertebral body 70 of the spine, major arteries and veins (aorta 71a, vena cava 7) as shown in FIG.
1b) 71 is running. Aorta 71a and vena cava 71
b branches off on the sacrum S side, but almost overlaps. Therefore, in order to reach the treatment site from the front, it is necessary to approach the vertebral body 70 from the side of the arrow B in FIG.

Therefore, as shown in FIG.
Being angry as it is being done, the trocar 7
3 and insert the laparoscopic device 15 and the retraction element 74 into the trocars 73 so that the vascular portion of the large artery and vein 71 on the front surface of the vertebral body 70 is sufficiently exposed under endoscopic observation to perform treatment. The site of the vertebral body 70 and its vicinity are exposed.

Next, a cut is made in the abdominal wall 72 at an ideal position for approaching the cavity securing device to the vertebral body, and the rod 3 is inserted there, or the trocar is moved to a position close to the ideal position. If there is, the rod 3 is inserted into the abdominal cavity using the trocar hole. When a trocar is used, the trocar is removed while the hole through which the trocar is punctured is secured by the rod 3. Since the rod 3 is a rod having a constant outer diameter as described above, only the trocar can be easily pulled out while the rod 3 is inserted into the body.

The expansion mandolin 2 is inserted into the treatment channel 11 in the sheath 1, the scope channel plug 6 is inserted into the scope channel 12, and the spike channel plug 7 is inserted into the spike channel 21. At this time, each channel of the sheath 1 is closed. The O-ring 33 provided on the extension mandolin 2, the O-ring 14 provided on the scope channel 12, and the spike channel plug 7 are each made of an elastic material, and each airtightness is obtained by being pushed into each channel and deforming. Achieved.

Next, the sheath 1 is inserted into the hole into which the rod 3 is inserted.
Add enough incision to insert. In this state, the sheath 1 is covered so that the rear end portion of the rod 3 inserted into the abdominal wall 72 is inserted into the lumen 35 of the expansion mandolin 2 inserted into the sheath 1. Then, the sheath 1 is pushed forward, the distal end thereof is placed on the skin incision, and the mandolin 2 for expansion is screwed in with the rod 3 inserted into the body as a guide. Since the distal end portion 32 of the expanding mandolin 2 is tapered, the muscular layer is expanded and the sheath 1 can be introduced into the body (see FIG. 3B).

When the sheath 1 is inserted as described above, the insufflation is possible, so that the inside of the body cavity can be checked with the laparoscope 15 under the insufflation. Since the outer shape of the sheath 1 has a sectional shape without a concave portion, the sheath 1
Is easy to insert, and it is easy to keep airtight with the abdominal wall.

Next, the mandolin 2 for expansion is extended from the sheath 1.
And the rod 3 are removed, and the treatment channel 1 of the sheath 1 is removed.
1, the airtight inner cylinder 4 is attached. The O-ring 42 of the airtight inner cylinder 4 maintains airtightness in the abdominal cavity. Airtight inner cylinder 4
Lumen 44 is closed with a rubber stopper 46.

Since the insufflation is maintained in this state, the rubber stopper 46 of the airtight inner cylinder 4 can be opened, and the laparoscope 15 can be inserted therein to observe the inside of the abdomen. If necessary, the laparoscope 15 inserted in the trocar 73 may be pulled out, and the laparoscope 15 may be used. Alternatively, the scope channel plug 6 may be removed, and the laparoscope 15 may be inserted therein to observe the inside of the abdominal cavity. At this time, the airtightness is maintained by the rubber cap 45 provided on the airtight inner cylinder 4 and the O-ring 14 provided on the scope channel 12. The treatment instrument can be inserted while maintaining the airtightness in the lumen 44 of the airtight inner cylinder 4.

Next, the tissue 62 such as blood vessels, visceral organs, and muscles is sufficiently exhausted to create a space where the distal end of the sheath 1 can be placed in front of the vertebral body 70 (see FIG. 3C). The sheath 1 is pushed in under the view, and the distal end of the sheath 1 is placed there. Here, the scope channel plug 6 of the sheath 1 is pulled out, the laparoscope 15 is inserted therein, the laparoscope 15 is fixed at an arbitrary position where a good visual field can be obtained, and the vertebral body 70 is removed from the lumen of the sheath 1. Is viewed from the front. In the visual field inside the sheath 1, the distal end of the sheath 1 is finely moved and positioned so that the target L5-S disc is almost at the center of the sheath 1. Here, since the distal end of the sheath 1 is formed in a round shape along the outer shape of the vertebral body 70, the distal end of the sheath 1 is applied to the vertebral body 70 to conform to the vertebral body 70. (See FIG. 3D). Also, as shown in FIG. 6, the two spike channels 21 are arranged so as to be located on one side of the upper and lower vertebral bodies of the L5-S disc.

Here, the blood vessels and muscles are suppressed by the wall of the sheath 1 and are caught by the depression 24 for organ retraction and do not come out under the visual field inside the sheath 1. If a blood vessel or the like enters under the sheath 1,
Even if the tip of the sheath 1 is laid, the tapered portion 19 is provided inside the tip of the sheath 1, so that the situation can be immediately and easily confirmed by the laparoscope 15 from the inside of the sheath 1.

At this stage, in order to confirm that the disc is properly approaching the disc to be treated, a thin rubber puncture portion 47 at the center of the rubber plug 46 is kept with the rubber plug 46 closed. A metal wire is inserted into the disc, and the metal wire is stabbed into the intervertebral disc under a mirror, and an X-ray is taken in this state.
The disc to be treated can also be identified. Even after the metal wire is pulled out, the rubber stopper 46 can be kept airtight, so that there is no problem in the subsequent work, and since the sheath 1 is made of resin, it does not hinder X-ray photography.

The sheath 1 is placed in front of the vertebral body 70, the laparoscopic device 15 is inserted into the sheath 1, and when the positioning is completed, the spike 5 is inserted into the spike channel 21 of the sheath 1.
Is inserted, the spike 5 is projected from the opening at the tip of the spike channel 21, and the spike 5 is driven into the vertebral body 70 to fix the sheath 1 (FIG. 4). At this time, since the escape portion 23 is provided in the endoscope visual field in the sheath 1, this can be performed under the mirror view when the spike 5 is driven. Further, since the opening at the distal end of the spike channel 21 opens toward the lumen side of the sheath wall and communicates with the lumen of the sheath 1, the spike 5 strikes an organ outside the sheath 1 when the spike 5 is driven. I will not let you.

Hereinafter, the treatment of the vertebral body 70 is performed based on the image observed by the laparoscope 15 inserted into the sheath 1.
Through directly through. No organs enter the sheath 1, the sheath 1 is fixed to the vertebral body 70, and the laparoscopic
Communicates with the treatment channel 11 within the sheath 1,
Subsequent operations can be performed in the sheath 1 using a vertebral body treatment instrument such as a sharp spoon 75. In addition, the endoscope is fixed to the sheath 1 and always keeps a fixed field of view. The insufflation may be dropped in this state (see FIG. 4A). of course,
If necessary, you may insufflate.

The inner tube 4 for airtightness is removed from the sheath 1 and a device for spinal treatment is inserted through the treatment channel 11 to perform a spine treatment (FIG. 5). For example, in the case of anterior fusion with autogenous bone, a scalpel 76 is inserted into the L5-S disc as shown in FIG.
6B, the nucleus pulposus and the intervertebral disc are excised with a sharp forceps 75 or the like, and as shown in FIG. 6C, the bones on the vertebral body L5 and the vertebral body S side are resected with a chisel 77. Do. Since these treatment tools are performed through a straight tubular lumen formed in the sheath 1, the treatment tools can be treated by applying a linear force, and are generally suitable for this type of operation requiring a strong force.

Next, the vertebral body parts on both sides are dilated using a dilation treatment tool (not shown). At this time, since the spike 5 is driven into only one vertebral body, it does not hinder its expansion. Then, as shown in FIG. 6D, the implanted bone 78 is driven between the expanded vertebral body parts, and the anterior fusion is completed. Further, for example, an implant material as shown in WO 94/17759, which is inserted between the vertebrae and fixed, may be used under the sheath through the treatment channel 11 to perform the fixing operation. It is needless to say that the present invention can be used not only for fixing these vertebral bodies but also for all procedures that approach the vertebral bodies.

In addition to the L5-S disc, for example, L4-
If you want to approach the 5 discs extraperitoneally,
As described above, the peritoneum 79 is peeled under the laparoscope to reach the vertebral body 70, and the large arteries and veins 71 are collectively evacuated so as to be moved sideways to form a cavity 80, and the sheath 1 is placed in the cavity 80. insert. Further, the sheath 1 is indwelled and fixed using the engaging and fixing means as described above. And the vertebral body 7 from the arrow C side of FIG.
Approach 0.

Next, the case where the suction tube 8 is used will be described. A connection adapter 57 is attached to the base opening edge of the sheath 1, and a suction tube 8 is attached to the ring portion 58 of the connection adapter 57.
Various usage examples are possible by inserting and holding. First, when exhausting smoke in the sheath 1, FIG.
As shown by, the suction tube 8 is fixed at a position where the suction tube 8 is slightly removed. Since the distal end of the suction tube 8 opens into the bottom space of the sheath 1, it is possible to suck and discharge the smoke accumulated in the sheath 1 when performing treatment using electric heat.

When bones are treated, bleeding generally continues frequently. In this case, as shown in FIG.
Of the sheath 1 until the tip of the
A good visual field is always obtained by continuously sucking blood 81 from the inside.

The arm 59 of the connection adapter 57
Can be elastically tilted, so that the suction tube 8 held by the ring portion 58 can be tilted, and the position of the tip of the suction tube 8 can be freely selected by sliding the suction tube 8 forward and backward. it can. Therefore, it is also possible to perform suction at a pinpoint. FIG. 10A shows the cutout concave portion 82.
The distal end of the suction tube 8 is positioned inside, and the blood 81 collected in the cutout concave portion 82 is sucked up and eliminated, thereby obtaining a good visual field.

Further, as shown in FIG. 10B, in combination with a scope 83 having a water supply channel, the suction pipe 8 is set at a slightly removed position, water is supplied from the scope 83, and suction is performed by the suction pipe 8. Allows for more continuous perfusion.

(Effects) In this embodiment, the sheath 1 is engaged and fixed to the vertebral body by providing the sheath 1 with the spike channel 21 through which the spike 5 as the anchoring means is inserted as the means for engaging with the vertebral body. be able to. After the sheath is fixed, the organ does not need to be evacuated, and it is not necessary to pay attention to the exclusion. In addition, the working space for the bone surgery is secured by the lumen of the sheath 1 and separated from other organs.
You don't have to worry about organ damage. Also, a good visual field can always be obtained.

After the sheath 1 has been engaged and fixed to the vertebral body, no organs enter the sheath 1 so that the insufficiency may be reduced and there is no need to constantly insufflate with carbon dioxide gas. For this reason, insufflation work is unnecessary and treatment workability is good. In addition, the insufflation time is shortened, and the burden on the patient can be reduced. It is economical because it can reduce the consumption of carbon dioxide. Further, the influence of carbon dioxide absorption on the living body can be reduced.

Further, since the endoscope and the treatment tool can be inserted and installed in the sheath 1, the operation after the sheath 1 is placed can be performed only in the sheath 1.

Further, since a round (R) close to the shape of a vertebral body is provided at the distal end of the sheath 1 as means for engaging with the vertebral body, not only is it possible to prevent the sheath 1 from slipping relative to the vertebral body, This prevents the invasion of the organ into the sheath 1 from the distal end of the organ 1 and eliminates the need to pay attention to organ damage.

Since the spike channel 21 communicates with the inside of the sheath 1 at its tip, there is a possibility that when the spike 5 is driven after the sheath 1 is fixed to the vertebral body, other organs may be damaged by the tip of the spike 5. Absent.

The spike channel 21 is connected to the sheath 1
Since it is designed so as to be within the field of view of the endoscope inserted therein, it is possible to confirm the place where the spike 5 is driven by the endoscope, and it is possible to perform a secure placement operation.

Since the spikes 5 are provided on one side of the sheath 1, it is possible to expand the vertebrae with the sheath 1 fixed to the vertebral body in the case of anterior fusion.

At the rear end of the spike channel 21, a spike channel plug 7 is provided as an airtight means for the spike channel 21, so that the spike channel 21 can be used for an operation requiring airtightness.

Since the spike channel 21 is provided in the wall of the sheath 1, there is little possibility that the channel is broken.

Since a part of the spike channel 21 is disposed inside the sheath 1, even if the channel is broken, the spike 5 does not come out of the sheath 1 and the safety is high.

The present embodiment is a system comprising a sheath 1 having a scope channel 21 and a treatment channel 11, a mandolin 2 as an inner needle, and an airtight inner cylinder 4 as an airtight adapter. 1 can be inserted, and by replacing the mandolin 2 with the airtight inner cylinder 4, it is possible to obtain an image from within the sheath 1 even under insufflation. In addition, the treatment tool can be inserted into the lumen of the airtight inner cylinder 4 while maintaining the airtightness, and the operation from the inside of the sheath 1 is possible.

The suction tube 8 and the connection adapter 57 can be fixed at an arbitrary position inside the sheath 1.
Utilizing the method enables continuous suction, smoke exhaustion, continuous perfusion, and the like. In addition, when necessary, the suction tube 8 can be suctioned with a pinpoint, and when unnecessary, the suction tube 8 may be fixed to the wall of the sheath 1, so that the trouble of handling the suction tube 8 can be reduced.

Since the scope channel 12 communicates with the treatment channel 11 in the oblique direction, the axis of the endoscope and the axis of the treatment channel 11 expand on the rear end side of the sheath 1. For this reason, the interference of the instruments and tools to be inserted into the treatment channel 11 and the scope channel 12 at the hand side is small.

The axis of the endoscope is shifted from the center axis of the treatment channel 11 at the distal end of the sheath 1 so that the endoscope does not protrude into the lumen of the sheath 1 as much as possible. A treatment for a large treatment site can be performed by effectively utilizing the cross-sectional area of the treatment channel 11.

The scope channel 12 is provided with an O-ring 14 as a means for fixing the endoscope at an arbitrary position, and the endoscope is fixed at an arbitrary position. It is easy just to support. In addition, the image does not blur, and a constant surgical field can always be seen.

Since at least a part of the distal end of the sheath 1 is transparent, it is possible to observe the outside of the sheath 1 when performing treatment inside the sheath 1 and also under laparoscopic treatment. The organ on the opposite side can be seen through the sheath 1 and the operation inside the sheath 1 can be observed, which is safe and simple.

Also, since the sheath 1 is made of resin and is transparent to X-rays, it does not hinder the need for X-ray photography or fluoroscopy during X-ray surgery.

The outer shape of the sheath 1 is formed by a convex portion or a straight line in a cross-sectional shape.
There is little resistance, and the tissue at the insertion site is tightly attached to the sheath 1, so that airtightness is maintained.

The present embodiment can be applied to all bones including the cervical vertebra except for the lumbar vertebra.

The sheath 1 according to the present embodiment is applied to a bone facing a site without a cavity (a bone covered with a subcutaneous tissue such as a muscle) by separating or cutting the muscle to reach the bone. By inserting, the treatment on the site can be performed similarly. For example, it is the backward approach of the lumbar spine, the bones of the upper limb and the lower limb, and the like.

In the first embodiment, the direction of the radius (R) formed at the distal end of the sheath 1 is curved inward as viewed from the vertical direction of the arrow A in FIG. However, as shown in FIG. 13, the sheath 1 may be curved inward when viewed from the left and right. Of course, both may be combined as appropriate to match the shape of the bone to be engaged.

The present embodiment can naturally be used in a technique that does not cause insufficiency (for example, surgery under a cavity securing method by lifting the abdominal wall with steel or the like and other cavity securing methods).

<Second Embodiment> Referring to FIGS. 14 and 15, a second embodiment of the present invention will be described. (Structure) The sheath 1 in the second embodiment has a structure without a spike channel. Then, the means for engaging with the vertebral body and the fixing means are inserted into the treatment channel 11 of the sheath 1 for use as a fixing inner cylinder (inner sheath) 85.
It is constituted by. The fixing inner cylinder 85 is a substantially cylindrical member having an outer portion substantially equal to the inner diameter of the sheath 1 (outer sheath), and includes a distal fixing portion 86 and a proximal arm portion 87. The fixing portion 86 is a ring-shaped portion, and a plurality of needle-like members 88 are provided to protrude on the leading end circumference thereof.
The needle-like member 88 pierces the vertebral body, engages with its bone, and fixes the sheath 1.

The length of the fixing portion 86 is determined from the distal end of the sheath 1.
The length inside the sheath 1 is shorter than the length up to the site where the scope channel 12 communicates. Fixed part 86
A notch 89 through which the endoscope passes is formed at a portion on the rear end side. Other configurations are substantially the same as those of the above-described first embodiment.

(Operation) The same operation as in the first embodiment can be used. However, when fixing the sheath 1 to the front surface of the vertebral body, the airtight inner cylinder 4 is removed and the sheath 1 is connected to the treatment channel 11 of the sheath 1. The fixing inner cylinder 85 is inserted. The laparoscope 15 is retracted to a position where it does not protrude into the treatment channel 11 of the sheath 1 only when inserted. After the fixing portion 86 of the fixing inner tube 85 passes through the intersection of the treatment channel 11 and the scope channel 12 of the sheath 1, the endoscope 15
Is moved to a position where a good visual field can be obtained.
The distal end of the fixing portion 86 is viewed from the lumen 5. While seeing from the inside with the endoscope 15, the fixing inner tube 85 is further advanced, hits against the vertebral body, hits the rear end of the arm portion 87, and the distal end of the fixing portion 86 with the needle-like member 88 is viewed under the mirror. Into the vertebral body (FIG. 15).

The outer shape of the fixing inner cylinder 85 is substantially equal to the inner diameter of the treatment channel 11 of the sheath 1, and the sheath 1 is fixed to the vertebral body. Hereinafter, the procedure for the vertebral body is performed in the same manner as described above. However, the sheath 1 is rotatable with respect to the fixing inner cylinder 85, and when the viewing angle with respect to the vertebral body is to be changed, the sheath 1 is rotated. I do.

(Effect) The sheath 1 is rotatable, so that the visual field of the endoscope can be easily changed.

<Modification of Second Embodiment> A modification of the second embodiment will be described with reference to FIG. (Configuration) This modified example is different from the second embodiment described above in that the needle-like member 88 provided at the distal end of the fixing inner cylinder 85 is not provided over the entire circumference. Needle-like member 8 only on one side, for example, only on the upper part
8 is provided.

(Operation) When the intervertebral space needs to be enlarged, the side of the fixing inner cylinder 85 where the needle-like member 88 is located is fixed to only one vertebral body.

(Effect) Since the needle-like member 88 is provided only on one side, it can be fixed on one side of the vertebral body.
The intervertebral space can be enlarged while looking inside from the inside.

<Third Embodiment> A third embodiment of the present invention will be described with reference to FIG. (Configuration) The third embodiment differs from the first embodiment described above in that the sheath 1 has a mutually rotatable double sheath structure.

The inner sheath 91 is substantially the same as the sheath 1 of the first embodiment described above, except that there is no spike channel, and a plurality of fixing needle members 92 are provided at the tip of the inner sheath 91. I have.

The outer sheath 93 can be fixed to the inner sheath 91 at a position covering the distal end of the inner sheath 91 (not shown in particular), and as shown in FIG. Is slidably provided so that the tip of the outer sheath 93 protrudes from the outer sheath 93. Further, the distal end of the outer sheath 93 is provided with a round shape so as to be compatible with the vertebral body, as in the first embodiment, and constitutes means for engaging with the bone. Airtight means (not particularly shown) is provided between the inner sheath 91 and the outer sheath 93.

(Operation) Basically, it is used in the same manner as in the first embodiment. When inserting the sheath, the distal end of the inner sheath 91 is fixed at a position where the distal end is covered with the outer sheath 93, and inserted into a living body. After positioning the distal end of the outer sheath 93 of the sheath 1 against the front surface of the vertebral body, the endoscope is inserted into the scope channel 12 of the inner sheath 91, and the fixing of the inner sheath 91 and the outer sheath 93 is released. The inner sheath 91 is pushed forward while looking at the distal end from the inner cavity, and the needle-like member 92 at the distal end is applied to the vertebral body and fixed. After the fixation, the vertebral body is subjected to treatment through the treatment channel 11 under a mirror view similarly to the first embodiment.

(Effects) The same effects as in the first embodiment can be obtained.

<Fourth Embodiment> Referring to FIGS. 18 and 19, a fourth embodiment of the present invention will be described. (Structure) In this embodiment, the difference from the first embodiment is in the shape of the distal end of the sheath 1. This embodiment is intended particularly for the treatment of the disc L4-5 between the fourth lumbar vertebra L4 and the fifth lumbar vertebra L5 and the disc L3-4 between the third lumbar vertebra L3 and the fourth lumbar vertebra L4. .

As shown in FIG. 18, the distal end of the sheath 1 is provided with a distal tip 96 provided with a single-leaf, wing-like (tongue-like) rejection member 95 on one side. The wing-shaped exclusion member 95 is preferably made of an elastic member.

(Operation) As shown in FIG. 7, the large artery and vein 71 of the aorta and the large vein are running on the front surface of the L4-5 disc, but when the sheath 1 is placed on the front surface of the vertebral body 70, The sheath 1 is placed on the front surface of the vertebral body such that they are sufficiently separated by the retraction member 95 at the distal end of the sheath 1 (FIG. 1).
9).

(Effect) A major blood vessel such as the large artery and vein 71 can be reliably removed by the exclusion member 95, and the exclusion work is easy and the safety is further increased.

<Fifth Embodiment> A fifth embodiment of the present invention will be described with reference to FIGS. (Construction) The difference of this embodiment from the first embodiment is the shape of the distal end of the sheath 1. The present embodiment is particularly intended for treatment of an intervertebral disc between L5-S. The shape near the L5-S intervertebral disc is as shown in FIG. 21, and the distal end shape of the sheath 1 is obliquely dropped as shown in FIG.

(Effect) As shown in FIG. 7, a branch portion 71c of each of the large arteries and veins 71 is provided on the front of the L5-S disc, and as shown in FIG. The sheath 1 is placed according to the shape of 70.

(Effect) Since the shape conforms to the shape of the vertebral body, there is less possibility of damaging other organs.

<Sixth Embodiment> Referring to FIGS. 22A and 22B, a sixth embodiment of the present invention will be described. (Construction) In this embodiment, a different point from the above-described first embodiment is an engagement means with a vertebral body, and a cylindrical engagement member 97 as shown in FIG. Is provided. This engagement member 97 is a rubber-like soft member,
Specifically, it is made of an elastic member such as Teflon having elasticity, or a rubber-like member such as silicon, and the soft member constitutes a deforming means which deforms according to the shape of the partner when pressed.

(Function) When the sheath 1 is fixed to the front surface of the vertebral body, as shown in FIG.
Is pressed against the vertebral body 70 to deform according to the outer shape of the portion, and elastically deforms and engages in a state conforming to the shape of the contact target.

(Effect) Since the sheath 1 is joined to the outer surface of the vertebral body 70 with almost no gap, there is no invasion of other organs into the sheath 1, and a treatment lumen can be secured and the treatment can be performed safely. . Further, since the engaging member 97 is deformable, it can be adapted to various shapes of vertebral bodies.

<Seventh Embodiment> A seventh embodiment of the present invention will be described with reference to FIG. (Construction) A pair of opening / closing members 98 are pivotally attached to the distal end of the sheath 1 of this embodiment. This opening / closing member 98
Is configured to open to conform to the contour of the vertebral body 70, engage the contour to be joined, and
An engaging means for engaging the distal end of the sheath 1 with the indwelling portion is configured. Further, each opening / closing member 98 is connected to a wire 99, and the wire 99 is guided to the proximal side through the inside of the sheath 1, and can be opened / closed by operating the wire 99 at the proximal side.

(Operation) The opening / closing member 98 is closed as shown in FIG. 23A when the sheath is inserted or until the sheath 1 is fixed, and when the sheath is placed on the front surface of the vertebral body, the opening / closing member 98 is closed.
8 is opened to form an open shape conforming to the shape of the vertebral body as shown in FIG. Further, the opening / closing member 98 in a closed state
Is inserted between the organs in front of the vertebral bodies, and the opening / closing member 98 is opened, whereby the organs can be evacuated.

(Effect) The opening and closing member 98 can be opened and closed.
When the tissue in front of the vertebral body is to be excised, the distal end of the sheath 1 can be inserted, the opening / closing member 98 thereof can be opened, and the vertebral body 70 can be indwelled in front of the vertebral body 70.

<Eighth Embodiment> An eighth embodiment of the present invention will be described with reference to FIG. (Construction) This embodiment is different from the first embodiment in that a gripper 101 provided at the rear end of the sheath 1 is provided with an airtight cock 102 at each mouth of the scope channel 12 and the spike channel 21. 103a and 103b are provided.

(Operation) The mouths of the scope channel 12 and the spike channel 21 are connected to the respective cocks 10.
It is opened and closed by 2, 103a, 103b. When inserting the sheath 1 under insufflation, each cock 102, 103
a, 103b are closed, the respective channels 12, 21
Is closed.

(Effect) To close each mouth of the scope channel 12 and the spike channel 21, it is only necessary to close the cocks 102, 103a and 103b, and the operation is easy. In addition, it is not always necessary to prepare a sealing application, and it can be handled easily.

<Ninth Embodiment> A ninth embodiment of the present invention will be described with reference to FIG.

(Structure) This embodiment is different from the first embodiment in that a screw member 105 protruding into the scope channel 12 is used as a means for fixing an endoscope inserted into the scope channel 12 at an arbitrary position. It is provided on the collar 13 of the sheath 1.

(Operation) An endoscope, for example, an optical viewing tube 16 of a laparoscope 15 is inserted into the scope channel 12, and a screw member 105 is screwed at a position determined at that position. Hold down and fix the laparoscope 15.

(Effect) By providing such a fixing means, the endoscope can be securely fixed at an arbitrary position.

<Tenth Embodiment> Referring to FIGS. 26 and 27, a tenth embodiment of the present invention will be described. (Construction) In this embodiment, one or a plurality of channels 111a, 111b are provided in the wall of the sheath 1, and smoke exhaustion, water absorption, water supply, or all or any of these treatments is performed using the channels 111a, 111b. It is intended to be used for. Channels 111a, 11
One end of 1b is led to a base 112 at the hand, and the base 112 is provided with a cock 113 for opening and closing the mouths of the channels 111a and 111b.

A channel 111a shown in FIG. 26 is a channel for exhausting and absorbing water, and its tip is opened at a distance from the tip of the sheath 1 to the inner surface of the sheath in the middle of the sheath 1. The channel 111b shown in FIG. 27 is a channel for washing and water absorption, and its distal end opens to the tapered portion 19 at the distal end of the sheath 1. The sheath 1 is provided with both the channels 111a and 111b shown in FIGS. Others are the same as those of the first embodiment described above.

(Function) At the time of smoke exhaustion, a suction tube (not shown) is connected to the base 112 of the smoke and water absorption channel 111a, and the base 11 of the cleaning and water absorption channel 111b is connected.
2, a water supply tube (not shown) is connected at the time of washing, and a water absorption tube is connected at the time of water absorption. If necessary, a connector that can selectively use both may be attached.

Specifically, when an electric scalpel is used for performing a treatment under the mirror in the sheath 1, the channel 111a is used.
The cock 113 is opened, and smoke is exhausted.

When the bone is resected, the bleeding continues from the bone.
Perform continuous aspiration of blood from If the suction is continuously performed during the osteotomy, the blood remaining at the bottom of the sheath 1 is automatically sucked by the channel 111b extending to the distal end of the sheath 1.

When it is desired to clean the operative field during the operation, water is supplied from the channel for cleaning and water absorption 111b, and then suction is performed from the same channel 111b.

When it is desired to return blood and the like by reflux and obtain a good visual field, an endoscope having a water supply channel is attached to the scope channel 12 or the end of the sheath 1 from the cleaning / water absorption channel 111b. Water supply,
Water is flowed into the sheath 1, suction is performed from the same channel 111b or the other channel 111a, and continuous reflux is performed.

Smoke exhaustion, water absorption and water supply are performed in channel 1 in FIG.
11a or the channel 111b of FIG. 27 can be used, but in general, in the case of smoke exhaustion or reflux (water supply, water absorption), FIG.
The channel 111a shown in FIG. 27 is suitable for washing and water absorption such as blood suction.

(Effect) Smoke exhaust / water absorption channel 111a
Alternatively, by providing the washing / water absorbing channel 111b in the sheath 1, smoke exhaustion, washing, continuous suction, and connection reflux can be easily performed.

<Eleventh Embodiment> An eleventh embodiment of the present invention will be described with reference to FIG. (Configuration) In this embodiment, the sheath 1 has a double sheath structure of an outer sheath 115 and an inner sheath 116. The outer sheath 115 is made of a circular member as shown in FIG. 28 (a), and its sheath wall has a scope channel escape groove 11 for allowing the scope channel 119 of the inner sheath 116 to escape.
Seven. The inner sheath 116 includes a treatment channel 118.
And a scope channel 119 having a tubular shape. The scope channel 119 is provided obliquely with respect to the treatment channel 118. A spike channel is attached to the wall of the outer sheath 115 (not shown).

The outer sheath 115 and the inner sheath 116 are shown in FIG.
As shown in FIG. 8 (c), it is possible to combine and fix, and when assembled, the scope channel 119 of the inner sheath 116 is combined with the escape groove 117 for the scope channel of the outer sheath 115. The configuration of the sheath 1 in this assembled state other than its outer shape is the same as the configuration of the first embodiment described above. In addition, the expansion mandolin and the airtight inner cylinder are combined with the outer sheath 115, and have an airtight means with the outer sheath 115 (not shown).

(Operation) When the sheath 1 of the present embodiment is inserted into a body cavity, the outer sheath 115 and the expansion mandolin 2 are combined and screwed into a skin incision. Next, the extension mandolin 2 is removed from the outer sheath 115, the airtight inner cylinder 4 is inserted, other organs are sufficiently evacuated under a laparoscopic procedure, the sheath 1 is placed in front of the vertebral body, and the laparoscopic apparatus 15 is placed.
Is inserted into the lumen of the airtight inner cylinder 4, and the spike 5 is driven into the vertebral body in the visual field inside the sheath 1. Pull out the airtight inner cylinder 4 and insert it into the scope channel escape groove 117 of the outer sheath 115.
The inner sheath 116 is inserted so that the scope channel 119 of the inner sheath 116 enters, and the inner and outer sheaths 115 and 116 are inserted.
Is fixed. The following operations are the same as in the first embodiment.

(Effect) Since the outer shape of the outer sheath 115 is circular and does not have an irregular cross section, it is easy to insert the sheath 1 into the body wall. By combining the outer sheath 115 and the inner sheath 116, the configuration becomes the same as that of the sheath 1 of the first embodiment, and the same effect as that of the first embodiment is obtained.

<Twelfth Embodiment> A twelfth embodiment of the present invention will be described with reference to FIG. (Structure) In this embodiment, a vertebral body treatment guide member 121 is added to the sheath system of the first embodiment. The vertebral body treatment guide member 121 is used in combination at the time of anterior fusion of the vertebral body.

[0123] The prosthetic treatment guide member 121 is inserted into the treatment channel 11 of the sheath 1 and fixed in combination. The length of the guide member 121 is shorter than the distance from the rear end position of the sheath 1 to the position where the distal end of the endoscope comes out of the scope channel 12. Further, the vertebral body treatment guide member 121 is provided with a plurality of guide holes 122 for inserting, for example, a drill. In this embodiment, stopper means for regulating the insertion depth of a treatment tool such as a drill alone is provided (not shown in particular). Vertebral body treatment guide member 12
A grip portion 123 is provided at the proximal end of the handle 1.

(Operation) When the sheath 1 is fixed to the vertebral body and the vertebral body is to be treated later, the vertebral body treatment guide member 121 is inserted into the sheath 1 and the sheath 1 and the vertebral body treatment guide member 12 are inserted.
Fix 1 Next, a treatment tool such as a drill or forceps is inserted along the guide hole 122 of the guide member 121, and a treatment is performed on the vertebral body while the treatment tool is positioned. Do. The length of the guide member 121 is shorter than the distance from the rear end position of the sheath 1 to the position where the distal end of the endoscope is inserted into the treatment channel 11 from the scope channel 12. It does not disturb the field of view.

(Effect) Since a treatment is performed on a predetermined site along the guide member 121, stable and reliable treatment results can be obtained regardless of the skill of the operator.

<Modification of Twelfth Embodiment> A modification of the twelfth embodiment will be described with reference to FIGS. (Construction) This embodiment shows a modification of the guide member. The guide member 125 has a plate-like shape fitted along one side wall in the treatment channel 11 of the sheath 1 as shown in FIG. It has a main body part 126, and a circular plate 127 that fits into the inner diameter of the treatment channel 11 of the sheath 1 is connected to the distal end of the main body part 126. Plate 127 is bent to fit the vertebral body. The center of the plate 127 is provided with a guide hole 128 that determines the range of the procedure to be performed on the vertebral body.

(Operation) The guide member 125 is used for, for example, anterior fusion. After the sheath is fixed to the vertebral body, the guide member 125 is placed in the sheath 1 and the plate 127 is placed on the front surface of the vertebral body exposed in the sheath 1 (see FIG. 31). The following is the guide hole 12 of the plate 127
The treatment is performed according to 8. For example, when creating a mother for autologous bone transplantation, it is possible to easily create a mother of a certain size by inserting only the four sides of the guide hole 128.

(Effect) Guide hole 12 of guide member 125
Since the treatment is performed according to 8, stable therapeutic results can be obtained.

<Thirteenth Embodiment> A thirteenth embodiment of the present invention will be described with reference to FIGS. (Construction) This embodiment is an example of a cavity securing device to be introduced into the lumbar vertebra by invasion of the posterior part. This cavity securing device is a sheath 131
And a rod-shaped inner needle (rod) 132 to be inserted and mounted on the sheath 131, and a sheath 131 has a treatment channel 133 having a lumen thereof. The inner needle 132 is inserted so as to penetrate the treatment channel 133. The sheath 131 has a configuration similar to that of the sheath of the above-described first embodiment, such as a scope channel 134, a spike channel, and the like, and components are also attached.

On the circumference of the distal end of the sheath 131, a plurality of needle-like members 135 protruding from the vertebral body are provided. The needle member 135 of the sheath 131 pierces and engages the bone of the vertebral body to constitute an anchor means for engaging and fixing.

The inner needle 132 has a tip portion 136 which is sharpened in a substantially conical shape, so that the inner needle 132 can be punctured into muscles, subcutaneous tissues or the like or inserted between tissues.
An operation section 137 is provided at the proximal end of the inner needle 132.

(Operation) In order to secure a surgical cavity by invading from the back of the lumbar vertebra 140, first, the inner needle 13 is inserted into the sheath 131.
2 and insert the distal end portion 136 of the inner needle 132 into the sheath 131.
To protrude greatly from the tip of. Then, a skin incision is formed at the back of the spine 140, the inner needle 132 is pierced from the skin incision, and the muscle is further cut or peeled so that the inner needle 132 reaches the bone.

Next, using the inner needle 132 as a guide, the sheath 1
31 is advanced, and the distal end of the sheath 131 reaches the bone (see FIG. 33). Further, by inserting the needle-like member 135 into the bone of the vertebral body and engaging it, the sheath 131 is
Is engaged and fixed to the bone part (see FIG. 34).

Thereafter, the inner needle 132 is pulled out and the sheath 1
The 31 treatment channels 133 are opened. Thereby, a surgical cavity is secured by the inside of the treatment channel 133 of the sheath 131. So, scope channel 13
4, the endoscope 141 is inserted to observe the inside of the distal end of the sheath 131, and a treatment tool 142 such as forceps is inserted through the treatment channel 133 to perform a bone operation. In this case, a herniated disc or laminectomy can be performed.

<Fourteenth Embodiment> A fourteenth embodiment of the present invention will be described with reference to FIGS. (Configuration) The cavity securing device of this embodiment is a modification of the cavity securing sheath 1 of the first embodiment. The sheath 1 for securing a cavity of this modified example has a scope channel 12 with respect to a straight tubular treatment channel 11 through which a treatment tool is inserted.
Are arranged in parallel (see FIG. 35). The distal end portion of the scope channel 12 and the distal end portion of the treatment channel 11 communicate with each other through an opening 151 formed by cutting out the vicinity thereof.

An endoscope, for example, a distal end portion of the optical viewing tube 153 of the oblique rigid endoscope 152 inserted into the scope channel 12 is positioned facing the opening 151, and is positioned in the treatment channel 11 through the opening 151. The work space for bone treatment is observed. An eyepiece 154 on the proximal side of the rigid endoscope 152 is bent with respect to the optical viewing tube 153 so as to escape from the treatment channel 11.

(Effects) The same operation as in the first embodiment is used, but since the scope channel 12 is disposed in parallel with the treatment channel 11, the bone treatment work space in the treatment channel 11 is provided. It can be used without the endoscope entering. Since the endoscope uses the oblique rigid endoscope 152 in particular, the inside of the treatment channel 11 can be sufficiently observed without bias.

<Fifteenth Embodiment> A fifteenth embodiment of the present invention will be described with reference to FIGS. (Construction) The present embodiment relates to an intervertebral implant system. The intervertebral implant system includes an implant guide sheath system as shown in FIG. 37 and a treatment instrument system as shown in FIGS. 39 to 45. Have been. Among them, the system of the implant guide sheath as shown in FIG. 37 mainly includes an outer sheath 201, an expanded mandolin 202, an outer sheath airtight outer sheath cap 203,
An inner sheath 204, a spike 205, and a spike channel plug 206 are provided.

[0139] The outer sheath 201 is formed of a straight tubular member having a circular cross section, and is provided with a treatment channel 201a for forming a working space for bone surgery using the inner cavity thereof. The distal end of the outer sheath 201 is provided with a round escape portion 201b so as to fit the surface of the spine, thereby constituting a means for fitting and positioning and holding the spine. The vicinity of the distal end of the outer sheath 201 is formed by a transparent portion 201c made of a transparent material, and constitutes an observation means for transmitting the transparent portion and observing an operation field in a bone surgery working space. Further, in the outer wall of the outer sheath 201, two spike channels 201d penetrating from the distal end to the proximal end of the outer sheath 201 are provided so as to be embedded close to each other. In the present embodiment, the escape portion 201b is formed by devising the shape of the distal end of the outer sheath 201, but is formed of an elastic member (for example, a material such as silicone rubber, polyurethane, or vinyl chloride) that is freely deformed in conformity with the vertebral shape. Means for positioning and holding the spine by fitting it to the spine may be provided by adding a member to be in close contact with the spine.

The expansion mandolin 202 is inserted into and attached to the treatment channel 201a of the outer sheath 201, and is used as a guide for inserting the outer sheath 201 into a body cavity. The extended mandolin 202 is
2a, an intermediate shaft portion 202b, and a rear end portion 202c. The tip portion 202a is formed in a conical shape, and the tip end portion is formed to be blunt. It is desirable that the maximum outer diameter of the distal end portion 202a be substantially the same as the inner diameter of the treatment channel 201a of the outer sheath 201. Also, the rear end portion 202
A flange 202d is provided at the rear end of c, and an O-ring 202f for sealing when mounted on the outer sheath 201 is mounted on the small-diameter portion 202e located on the distal end side of the flange 202d. The small diameter portion 20
2e has a diameter substantially equal to the inner diameter of the outer sheath treatment channel 201a. The length of the shaft portion 202b is such that the tapered portion of the conical portion of the distal end portion 202a completely projects from the distal end of the outer sheath 201 when the flange 202d of the expanded mandolin 202 is inserted until the flange 202d abuts on the rear end of the outer sheath 201. Is set.

A spike 205 having an outer diameter substantially the same as the inner diameter is inserted into the spike channel 201d. The tip of the spike 205 is sharp like a triangular pyramid or a cone, and a knob 205a is provided at the rear end of the spike 205. When the spike 205 is inserted until the knob 205a of the spike 205 comes into contact with the rear end of the outer sheath, the tip of the spike 205
1 is provided so as to protrude by about 1.5 cm from the tip.

When the spike 205 is not inserted into the spike channel 201d, the spike channel plug 206 is inserted into the spike channel 201d. The spike channel plug 206 includes a plug portion 206a formed in a tapered shape and a knob portion 206b.

The outer sheath cap 203 is the outer sheath 201
And is detachably attached to the rear end.
The outer sheath cap 203 is provided with a cylindrical side wall 203a, and an O-ring 203c is mounted on an inner peripheral surface portion 203b near the tip of the cylindrical side wall 203a. Note that the inner peripheral surface portion 203b is formed to have a diameter substantially equal to the outer diameter of the outer sheath 201. Further, the outer sheath cap 203
A treatment tool insertion port (not shown) is provided at the rear end side portion, and a rubber cap 203d is provided at the rear end. The rubber cap 203d is configured such that an opening 203e and a plug 203f are integrally connected via a connecting portion 203g. The diameter of the opening 203e is formed to be substantially the same as the inner diameter of the outer sheath 201.

When the outer sheath cap 203 is attached to the outer sheath 201, the spike channel 201d
Are provided and small holes 203h are provided at positions not blocking the spike channels 201d (see FIG. 38).

The inner sheath 204 is used by being inserted into the treatment channel 201a of the outer sheath 201. The inner sheath 204 comprises a cylindrical straight tubular sheath portion 204a and a main body 204b provided at the proximal end thereof. The inner cavity of the inner sheath 204 is the same as the outer sheath 201.
It is used as a treatment channel that forms a surgical operation space when attached to the device. The sheath portion 204a is provided with a sharp puncture tooth 204c at the tip thereof,
A window portion 204d is provided on a side portion near the distal end to form an observation unit. The sheath portion 204a is made of metal, and its outer diameter is substantially the same as the inner diameter of the treatment channel 201a of the outer sheath 201. A main body 204b is provided on the rear end side of the sheath 204a.
The inside of the main body 204b is hollow, and is provided with an airtight valve (not shown) including a flap valve, a duckbill valve, and the like. A rubber cap 204f having an opening 204e is provided at the rearmost end of the main body 204b.

[0146] The diameter of the opening 204e is designed to ensure airtightness when a treatment instrument used in combination with this instrument is inserted. The main body 204b also has a role of a flange, and when the inner sheath main body 204b is inserted until it completely abuts the rear end of the outer sheath 201, the fenestration 204d of the sheath portion 204a becomes
The length of the sheath portion 204a is adjusted so as to overlap the transparent portion 201c near the front end of the first portion 204.

Next, the treatment instrument system will be described.
As shown in FIGS. 39 to 45, the present treatment instrument system
A drill 207, an intervertebral opening tool 208, a hammer 209, a reamer 210, a bone tap 211, an implant driver 212, and an implant 213 are provided.

First, as shown in FIG.
Consists of a handle 207a, a handle 207b, and a drill portion 207c from the rear end side.
Are provided so as to be orthogonal to the T-shape. Pattern 2
The outer diameter of 07b is the treatment channel 201 of the outer sheath 201.
a is substantially the same as the inner diameter of the outer sheath 201, and the overall length is at least longer than the overall length of the outer sheath 201. A drill 207c is provided at the tip of the handle 207b.
Are the same in the longitudinal center axis and the drill center axis. Pattern 20
A flange 207d is provided near the rear end of 7b. The outer diameter of the drill portion 207c is set to be equal to or less than the outer diameter of the handle 207b.

[0149] As shown in FIG.
It consists of a handle 208a and an enlarged plug 208b. Handle 208a
A knurl 208c is formed on the rear end surface of the handle 208.
Male screw 208d is provided at the tip of “a”. Pattern 20
The outer diameter of 8a is the treatment channel 20 of the outer sheath 201.
1a is made substantially the same as the inner diameter, and the overall length is at least longer than the overall length of the outer sheath 201. A flange 208e is provided near the rear end of the handle 208a. The widening plug 208b is connected to the cylindrical portion 208f and the conical portion 20 from the rear end side.
The outer surface of the cylindrical portion 208f is subjected to sand processing to form an uneven surface. Further, a female screw 208h corresponding to the male screw 208d of the handle 208a is provided at the center of the rear end surface of the cylindrical portion 208f. The outer diameter of the cylindrical portion 208f of the widening plug 208b is set to about 1 so that the surgeon can greatly cope with the desired intervertebral opening.
There are several types that are different for each mm.

As shown in FIG. 41, the hammer 209 includes a hitting portion 209a and a handle 209b. The hitting portion 209a is provided in a T-shape at the tip of the handle 209b. Pattern 209
b and most of the striking portion 209a are formed of metal such as stainless steel. At both ends of the striking portion 209a, shock absorbing portions 209c made of rubber or plastic material having autoclave resistance are provided.

As shown in FIG. 42, the reamer 210 has a handle 210a, a handle 210b, and a reamer 210 from the proximal end side.
c, and the handle 210a is provided to be orthogonal to the handle 210b in a T-shape. Handle 210
The outer diameter of b is made substantially the same as the inner diameter of the treatment channel of the inner sheath 204, and the entire length is at least longer than the entire length of the inner sheath 204. A reamer 210c is provided at the tip of the handle 210b, and the central axis in the longitudinal direction of the handle 210b is the same as the central axis. A flange 210d is provided near the rear end of the handle 210b. Reamer 210
The outer diameter of c is less than or equal to the outer diameter of the handle 210b, and is slightly larger than the diameter of the drill portion 207c of the drill 207.

As shown in FIG. 43, the bone tap 211 is provided with a handle 211a, a handle 211b, and a tap portion 211c from the rear end side.
1b so as to be orthogonal to the T-shape.
The outer diameter of the handle 211b is substantially the same as the inner diameter of the treatment channel of the inner sheath 204, and the overall length is at least longer than the entire length of the inner sheath 204. A tap portion 211c is provided at the tip of the handle 211b, and the central axis in the longitudinal direction of the handle 211b is the same as the central axis. A flange 211d is provided near the rear end of the handle 211b. The outer diameter of the tap portion 211c is equal to or less than the outer diameter of the handle 211b, and is formed to have a diameter that allows appropriate tapping of the hole prepared by the reamer 210.

As shown in FIG. 44, the implant driver 212 has a handle 212a and a handle 212b from the rear end side.
The handle 212a is provided so as to be orthogonal to the handle 212b in a T-shape. Handle 212b
Is provided with a male screw 212c at the front end. Handle 212
The outer diameter of b is made substantially the same as the inner diameter of the treatment channel of the inner sheath 204, and the entire length is at least longer than the entire length of the inner sheath 204. A flange 212d is provided near the rear end of the handle 212b.

The implant 213 is configured as shown in FIG. That is, the implant 213 has a hollow cylindrical main body 213a and the lower lid 2 attached to both ends thereof.
13b and an upper lid 213c. These members are desirably formed of a titanium material, a ceramic material, an apatite material, or the like. On the outer surface of the main body 213a, a male screw 213d corresponding to a female screw formed between the vertebrae by the bone tap 211 is provided. The main body 213a has a large number of small holes 21 penetrating from the outer surface to the inner cavity.
3e, and a large hole 213f penetrating in a straight line from one wall to the opposite wall.
The lower lid 213b and the upper lid 213c are disc-shaped cap portions 21.
3g and a hook 213h having a claw shape. When the hook 213h is attached to the main body 213a, the hook 213h is caught by a step on the inner surface of the main body 213a, so that the lower lid 213b and the upper lid 213c do not easily fall off the main body 213a. The lumen of the implant 213 is filled with autogenous bone fragments collected from the patient himself or artificial bone made of β-TCP (calcium phosphate) or the like. Note that a female screw 213i corresponding to the male screw 212c provided at the tip of the implant driver 212 is provided at the center of the upper lid 213c.

(Operation) Next, how to use the implant guide sheath system according to the present embodiment will be described. Here, an application example in which two implants are laparoscopically implanted in an intervertebral disc of the lumbar spine will be described.

[0156] The large arteries and veins are running on the front surface of the vertebral body of the lumbar vertebra almost overlapping each other, and the front surface of the vertebral body is surrounded by the psoas major muscle. Therefore, in order to safely perform a treatment on the vertebral body, it is necessary to sufficiently exclude these blood vessels and muscles to completely expose the vertebral body, as in the case of the first embodiment described above. Therefore, as in normal laparoscopic surgery, a trocar is inserted into the abdominal wall after insufflation, and a treatment tool such as a laparoscope or a retraction element 74 is inserted into the body cavity through these trocars. Blood vessels / muscles 6 under endoscope observation
By excluding the second and the like, the vicinity of the vertebral body 70 to be treated is exposed (see FIG. 46). At this time, the first implant embedding site 214 and the second implant embedding site 215 of the intervertebral disc 216 are cauterized using the high-frequency current cauterizer 217, and marked (see FIG. 46).

Next, a cut is made in the abdominal wall so as to form an optimal approach path for placing the implant guide sheath in the vertebral body, and an insertion port for the implant guide sheath is formed. The incision length is the outer sheath 2 of the implant guide sheath.
It is provided to such an extent that airtightness is completely maintained when 01 is inserted. Also, instead of incising, preparing several types of trocars with different outer diameters of the insertion section, and inserting the trocars in order from the smaller diameter to the larger diameter to form the insertion port for the implant guide sheath You may do so.

Here, the expansion mandolin 202 is inserted into the treatment channel 201a of the outer sheath 201, and the spike channel plug 206 is inserted into the rear end portion of the spike channel 201d. At this time, since the expansion mandolin 202 has been inserted to a position where the flange 202d abuts on the rear end of the outer sheath 201, the O-ring 202f provided on the outer periphery of the small-diameter portion 202e contacts the inner wall of the treatment channel 201a. Contact and ensure airtightness between the treatment channel 201a and the extended mandolin 202. Further, the tapered outer peripheral portion of the spike channel plug 206 is sufficiently inserted into the end surface of the spike channel 201d until the spike channel 201d is tightly fitted, so that the spike channel 201d is also airtight.

[0159] Next, the expanded mandolin 202 is attached to the outer sheath 2.
01 and the extended mandolin 20 protruding from the distal end of the outer sheath 201 while firmly grasping it.
2 is pressed against the insertion opening formed in the abdominal wall, and the outer sheath 201 is inserted into the body cavity as it is. As described above, the treatment channel 201a and the spike channel 201d of the outer sheath 201 are kept airtight, so that insufflation gas does not leak when the outer sheath 201 is inserted.

When the outer sheath 201 is inserted into the body cavity, the expanded mandolin 20
2 is pulled out, and the outer sheath cap 203 is attached to the rear end of the outer sheath 201. The rubber cap opening 203e of the outer sheath cap 203 is closed by a plug 203f, and the outer sheath 201 is kept airtight to the outside.

Next, the escape portion 20 at the tip of the outer sheath 201
The outer sheath 201 is rotated so that 1b fits the vertebral body 70, and the distal end of the outer sheath 201 is pressed against the vertebral body 70 so as to surround the first implant implantation site 214. Next, the spike channel plug 206 is removed from the spike channel 201d, and the spike 205 is inserted into the spike channel 201d. Then, hold the knob 205a at the rear end of the spike 205 with the hammer 209.
To pierce the tip of the spike 205 into the vertebral body 70 to a desired depth, thereby attaching the outer sheath 201 to the vertebral body 70.
And fix it. At this time, since the two spike channels 201d are provided close to each other in the outer wall of the outer sheath 201, both spikes 205 are pierced into either the upper or lower vertebral body 70, and will be described later. Even when the outer sheath 201 is expanded while the outer sheath 201 is fixed to the vertebral body 70, the expansion is not hindered.

In this embodiment, even if the spike 205 is punctured into the vertebral body 70 until the knob 205a of the spike 205 abuts the rear end of the outer sheath 201, the spike 2
Since the tip of 05 protrudes only about 1.5 cm from the tip of the outer sheath 201, it does not damage the underlying organ more than 1.5 cm. Thus, as shown in FIG.
By fixing the outer sheath 201 in close contact with the vertebral body 70, invasion of an organ or the like into the outer sheath 201 can be prevented, and it is possible to eliminate the trouble of excluding the organ after fixing the outer sheath 201. Therefore, the following surgical operation in the space inside the outer sheath 201 is facilitated.

Next, the rubber cap plug 203f of the outer sheath cap 203 is opened, a drill 207 is inserted into the treatment channel 201a of the outer sheath 201, and the handle is held while the drill 207 is pressed against the vertebral body 70. 207a
To form a drill hole 218 for embedding the implant 213 in the disc 216 (see FIG. 48). At this time, since the handle 207b of the drill 207 is provided with substantially the same diameter as the outer sheath treatment channel 201a, the center axis does not shift during rotation of the drill 207, and a smooth drill operation can be performed. In addition, when the drill hole 218 is formed to a certain depth, the flange 207d provided on the handle 207b of the drill 207 hits the rear end of the outer sheath 201 and does not enter any further. Therefore, there is no fear that the drill hole 218 is erroneously made deeper than necessary and the spinal cord or the like is damaged. When the drill 207 is inserted into the treatment channel 201a, the inside of the outer sheath 201 is kept airtight by the rubber cap 203d.

The state of the drill operation performed in the outer sheath 201 can be observed under a laparoscopic scope through the transparent portion 201c provided near the distal end of the outer sheath 201. Even if an organ or the like enters the inside of the patient 201, a safe treatment can be performed by taking a pre-treatment such as re-extracting the organ without continuing the treatment.

The drill 207 is removed from the outer sheath 201, and a sharp spoon or a sharp spoon 2 is inserted into the outer sheath 201 instead.
Insert 25. The tip of a spoon or spoon forceps 225 is inserted into the drill hole 218 to sufficiently extract the nucleus pulposus and annulus from the disc 216 (see FIG. 49). Intervertebral disc 21
By removing the nucleus pulposus and annulus fibrosus in disc 6
Implant 213 can be safely implanted.
Also, the state of this procedure can be observed under a laparoscope, as in the case described above. Even during this procedure, the inside of the outer sheath 201 is kept airtight by the rubber cap 203d.

Next, the treatment channel 2 of the outer sheath 201
01a is inserted into the intervertebral opening tool 208, the back end of the handle 208a of the intervertebral opening tool 208 is hit with a hammer 209, and the flange 208e provided on the handle 208a abuts the rear end of the outer sheath 201. Open plug 208b to position
Into the drill hole 218 (see FIG. 50A).
Several types of the widening plugs 208b having different outer diameters by about 1 mm are prepared, and a plug suitable for a desired widening is selected and used. At this time, since the handle 208a of the intervertebral opening tool 208 and the outer sheath treatment channel 201a are provided to have substantially the same diameter, the drill hole 218 is formed only by inserting the intervertebral opening tool 208 into the outer sheath treatment channel 201a.
And the central axis of the expansion plug 208b automatically matches. Therefore, there is no need to perform an operation of aligning the enlarged plug 208 b with the drill hole 218. The widening plug 208b is driven only to a depth at which the flange 208e abuts the rear end of the outer sheath 201.
There is no need to worry about burying 08b deep. In addition, since the conical portion 208g is provided at the distal end of the enlarged plug 208b, the plug can be smoothly inserted into the intervertebral disc 216. Further, since the sand portion processing is applied to the cylindrical portion 208f of the enlarged plug 208b, the cylindrical portion 208f has an effect of preventing slippage, so that the inserted enlarged plug 208b does not easily fall off. With the expansion plug 208b being driven into the disc 216, the expansion plug 208b and the handle 2
Remove the screw between 08a and leave only the enlarged plug 208b in the disc 216 (see FIG. 50 (b)). The state of driving of the widening plug 208b is also determined by the outer sheath 20.
1 can be observed under a laparoscope through the transparent portion 201c provided near the tip. In addition, the intervertebral opening tool 208
Is inserted into the treatment channel 201a, the inside of the outer sheath 201 is airtightly secured by the rubber cap 203d.

Here, the rubber cap opening 203e of the outer sheath cap 203 is closed by the stopper 203f, and the spike 205 inserted into the spike channel 201d of the outer sheath 201 and pierced into the vertebral body 216 is pulled out. The fixing of the outer sheath 201 to the body 216 is released. Subsequently, the second implant embedding site 21
The outer sheath 201 is fixed to the vertebral body 70 by pressing the tip of the outer sheath 201 against the vertebral body 216 so as to surround the vertebral body 70 as described above. And
For the second implant embedding site 215, the nucleus pulposus and the annulus fibrosus are removed by the sharp spoon / sharp forceps 225 in the same manner as described above. It is the same as described above that the state of this treatment can also be observed under laparoscopic conditions. Also, during this procedure, the inside of the outer sheath 201 is kept airtight by the rubber cap 203d.

Next, the inner sheath 204 is inserted into the outer sheath treatment channel 201a, and the rear end of the inner sheath 204 is hit with a hammer 209 to puncture the distal end of the inner sheath 204.
04c is driven into the vertebral body 70. At this time, the fenestration 204d provided on the inner sheath 204 is positioned in front of the field of view of the laparoscope so as not to be hidden by the inner sheath 204 when observing the inside of the outer sheath 201 under a laparoscope. By driving the outer sheath 201 until it hits the rear end of the outer sheath 201, the transparent portion 2
01c and the fenestration 204d of the inner sheath 204, for example, using a scope 219 such as a laparoscope,
It is in a state where the state of the treatment in the work space in 1,204 can be observed (see FIG. 51). By puncturing the inner sheath 204 into the vertebral body 70 while observing with the observation means in this manner, the fixation of the present sheath system to the vertebral body 70 becomes stronger, and there is a concern that the sheath system may come off from the vertebral body during surgery. It is reduced more.

Further, as described above, the inner sheath 204 is
0, the inner sheath 204 and the outer sheath 2 are fixed by the rubber cap 203d of the outer sheath cap 203.
01 is secured, and when the treatment tool is not inserted into the treatment channel of the inner sheath 204, the treatment tool is inserted again by an airtight valve provided in the inner sheath main body 204b. Sometimes inner sheath 2
The insufflation gas is prevented from leaking from inside the inner sheath 204 by the rubber cap 204f provided at the rear end of the inner sheath 204. In addition, by fixing the outer sheath 201 to the vertebral body 70 as it is even after the inner sheath 204 is fixed, it is possible to prevent an organ or the like from entering the inner sheath 204 from the fenestration 204d of the inner sheath 204. .

Next, the reamer 210 is inserted into the treatment channel of the inner sheath 204, and the reamer portion 210c is inserted into the intervertebral disc 2.
16, the reamer handle 210 a is turned to a position where the flange 210 d provided on the handle 210 b of the reamer 210 abuts against the rear end of the inner sheath 204, and the drill hole 218 is finished finely (FIG. 52). See). At this time, handle 2 of reamer 210
Since the treatment channel 10b and the treatment channel of the inner sheath 204 are provided with substantially the same diameter, the center axis of the drill hole 218 and the center axis of the reamer 210 automatically coincide with each other only by inserting the reamer 210 into the treatment channel of the inner sheath 204. For this reason, there is no particular need for the operation of aligning the reamer 210 with the drill hole 218. In addition, the flange 210d is attached to the inner sheath 20.
Since the reamer 210 can be inserted only to the depth that abuts the rear end of the reamer 4, there is no risk of accidentally inserting the reamer 210 too deeply and damaging the spinal cord and the like. By using the reamer 210 to clean the drill hole 218 in this manner, the drill hole 218 having an optimal diameter for embedding the implant 213 can be formed, and the placement of the implant 213 in the intervertebral disc 216 can be more ensured. be able to.

After the reaming operation, the bone tap 211 is inserted into the treatment channel of the inner sheath 204, and the tap portion 2 is inserted.
11c is inserted into the drill hole 218, and the bone tap 21 is inserted.
The bone tap handle 211a is rotated until the flange 211d provided on the first handle 211b abuts on the rear end of the inner sheath 204.
Screw thread 216a that serves as a guide when screwed into
Is formed on the inner peripheral surface of the drill hole 218 formed in the vertebral body 70 (see FIGS. 53 (a) and 53 (b)). At this time, since the handle 211b of the bone tap 211 and the treatment channel of the inner sheath 204 are provided with substantially the same diameter, only by inserting the bone tap 211 into the treatment channel of the inner sheath 204, the drill hole 218 and the Since the center axes are automatically matched, there is no need to perform an operation of aligning the bone tap 211 with the drill hole 218. Also,
Since the bone tap 211 can be inserted only to a depth at which the flange 211d abuts against the rear end of the inner sheath 204, there is no fear that the bone tap 211 may be accidentally inserted too much to damage the spinal cord or the like. Bone tap 2 like this
By forming the thread 216 a in the drill hole 218 by the screw 11, the operation of screwing the implant 213 into the drill hole 218 can be smoothly performed, and
Since the position where the screw 3 is screwed in is regulated in advance, the screw 213 is prevented from being screwed at an incorrect angle and depth, and the implant 213 can always be placed at the optimal position of the disc 216.

Next, the implant 213 is mounted on the distal end of the implant driver 212 by screw connection, and the implant 213 is inserted into the treatment channel of the inner sheath 204. The implant 213 is inserted into the drill hole 218, and the implant driver handle 212a is rotated and advanced until the flange 212d provided on the handle 212b of the implant driver 212 abuts against the rear end of the inner sheath 204, and the implant 213 is screwed into the drill hole 218 ( See FIG. 54 (a)). At this time, the depth at which the implant 213 is screwed into the intervertebral disc 216 depends on the flange 2 provided on the handle 212 b of the implant driver 212.
Since it is regulated by 12d, the implant 213 can always be placed at a certain optimum depth of the intervertebral disc 216, and there is no possibility that the spinal cord or the like may be damaged due to accidental excessive screwing. Further, the handle 212b of the implant driver 212
Is provided with substantially the same diameter as the treatment channel of the inner sheath 204, so that the implant driver 212 and the central axis of the drill hole 218 automatically match just by inserting the implant driver 212 into the treatment channel of the inner sheath 204. In addition, the operation of positioning the implant 213 with respect to the drill hole 218 is not required.

When placing the implant 213, the large hole 213f provided in the implant 213 is used.
Is preferably placed so as to face the end surfaces of the upper and lower vertebral bodies. In this state, the screw between the implant 213 and the implant driver 212 is removed, and only the implant 213 is placed on the disc 216 (FIG. 54).
(B)).

Thus, the implant placement operation for the second implant embedding site 215 is completed. By placing the implant 213 in the intervertebral disc 216 in this manner, the implant 213 can be safely and easily placed in the intervertebral disc 216, and the upper and lower vertebral bodies 70 can be placed.
213 through the large hole 213f facing the
Since the autogenous bone fragments or artificial bones filled in the inside of the body are integrated with the upper and lower vertebral bodies by bone fusion, the promotion of bone fusion and the strength of intervertebral body fixation after bone fusion can be further improved.

Next, the inner sheath 204 is removed, the rubber cap 203d of the outer sheath cap 203 is closed, the spike 205 inserted into the vertebral body 70 is pulled out, and the fixing of the outer sheath 201 to the vertebral body 70 is released. I do. continue,
The outer sheath 201 is pressed against the vertebral body 70 so as to surround the first implant implantation site 214 where the expansion plug 208b is placed, and the spike 205
Is punctured into the vertebral body 70 and fixed again to the vertebral body 70.

The handle 208a of the intervertebral expansion tool 208 is inserted into the outer sheath treatment channel 201a, and the male screw 208d provided at the tip of the handle 208a is inserted into the female screw 208h of the expansion plug 208b retained in the disc 216. Screwed in,
The handle 208a is firmly grasped, and the widening plug 208b is withdrawn from the intervertebral space and collected. Handle 208a on enlarged plug 208b
When screwing is performed, the inside of the sheath can be observed under a laparoscope through the transparent portion 201c provided on the outer sheath 201, so that the operation can be smoothly performed.

[0177] The treatment channel 201a of the outer sheath 201
The inner sheath 204 is inserted into the inner sheath 204, and the rear end of the inner sheath 204 is hit with a hammer 209 to puncture the puncture teeth 20 at the tip of the inner sheath 204.
4c is inserted into the vertebral body 70. At this time, the inner sheath 204
By positioning the fenestration 204d in front of the laparoscopic field of view, the inside of the sheath system can be observed laparoscopically.
As described above. The reaming operation, the bone tap operation, and the implant embedding operation are performed on the first implant embedding site 214 in the same manner as described above, and all the implant embedding operations are completed. In the state where the implant 213 is embedded in the vertebral body 70 in this manner, since the two implants 213 are parallel (see FIG. 55), it is possible to stably support the vertebral body 70 when the patient stands up. Can be. In addition, the implant 21 has a width corresponding to the width of the intervertebral expansion plug 208b expanded by the intervertebral disc 216.
Since the tension is applied to sandwich the implant 3, the implant 213 does not fall off the intervertebral disc 216 after the operation in combination with the screw structure of the implant 213.

(Effect) In the present embodiment, since the implant guide sheath is provided with the means for engaging with the vertebral body 70, there is no need to evacuate the organ after the sheath is fixed. Therefore, the implant guide sheath is fixed to the vertebral body 70. There is no risk of damaging the organ when performing the procedure in the sheath later. In particular, in the present embodiment, the inner sheath 20 having the puncture teeth 204c at the distal end
4 can be punctured into the vertebral body 70 and fixed to the vertebral body 70, so that the sheath system can be more firmly fixed. The used surgery can be performed more intensively. At the same time, the inner sheath 204
By fixing the outer sheath 201 to the vertebral body 70 as it is after fixing the vertebral body to the vertebral body 70, there is no possibility that an organ enters the sheath from the fenestration 204d of the inner sheath 204.

[0179] The airtightness between the outer sheath 201 and the inner sheath 204 is maintained by the rubber cap 203d provided on the outer sheath cap 203, so that even when the inner sheath 204 is fixed to the vertebral body 70, the airtightness is maintained. Since the abdominal gas is prevented from flowing out of the body and blood or the like is not blown into the sheath treatment channel together with the insufflation gas, the observation inside the sheath treatment channel is not hindered.

Further, since the observation means for laparoscopically observing the state of the treatment in the sheath through the outer sheath transparent portion 201c and the inner sheath window portion 204d is provided, the organs and the like can be connected to the vertebral body 70 by any means. Even if the sheath enters the sheath from the gap at the distal end of the sheath, safety can be confirmed in advance, and there is no risk of damaging the organ. More particularly, when removing the nucleus pulposus and annulus fibrosus from the intervertebral disc 216, when checking the depth of embedding of the enlarged plug 208b and the implant 213 into the intervertebral disc 216, and when collecting the enlarged plug 208b from the intervertebral disc 216, Open the handle 208a of the opening tool 208 with the opening plug 20
When screwing into the 8b, the operation can be performed accurately under visibility, so that the operation can be performed safely and smoothly.

Each treatment tool of the treatment system has an outer sheath 2 having a handle.
01 or the same diameter as the treatment channel of the inner sheath 204, the treatment tool and the central axis of the drill hole 218 automatically coincide with each other only by inserting the treatment tool into the treatment channel. Therefore, the operation and operation for guiding the treatment tool to the drill hole 218 are not required, and there is no fear that the center axis is shifted and the drill hole 218 is suddenly enlarged.

Since the handle of the treatment tool of the treatment tool system is provided with a flange near the base end thereof, the treatment tool is inserted to a depth at which the flange abuts against the rear end of the sheath to perform the treatment. The intended treatment can always be performed on the body 70, and it is possible to prevent the treatment instrument from being accidentally inserted deep enough to damage the spinal cord and the like.

<Modification of Fifteenth Embodiment> A modification of the fifteenth embodiment of the present invention will be described with reference to FIG. (Construction) This modification is different from the fifteenth embodiment described above in that the outer sheath 201 and the inner sheath 204 are electrically insulated, and the inner sheath 204 and the spike 20 are electrically insulated.
5 are provided with terminals 221, respectively.
Is connected to the high-frequency power supply 222 via the. Therefore, it is preferable that the outer sheath 201 and the outer sheath cap 203 are entirely formed of resin or the like, and the inner sheath 204 and the spike 205 are formed of metal or the like. Other configurations are the same as in the fifteenth embodiment.

(Function) As shown in FIG. 56, both the outer sheath 201 and the inner sheath 204 are pierced into the abdominal wall 231 and the spike 205 and the inner sheath A high-frequency power supply 222 is connected to a terminal 221 provided at 204 to supply a high-frequency current. At this time, the high-frequency current passes through the vertebral body 70 from the tip of the spike 205 to the tip of the inner sheath 204 in a so-called bipolar manner.

(Effect) Spike 2 caused by the high-frequency current
Since the vertebral body puncture portion 05 and the inner sheath 204 are cauterized, bleeding from cancellous bone inside the vertebral body 70 can be stopped, and blood can be prevented from flowing into the sheath. for that reason,
It is possible to always observe the state of treatment in the sheath. Further, it is possible to save the trouble of inserting an object such as a suction tube into the sheath and suctioning the inflowing blood.

<Sixteenth Embodiment> A sixteenth embodiment of the present invention will be described with reference to FIGS. (Structure) As compared with the fifteenth embodiment, the sheath system of the present embodiment omits the inner sheath 204 from the structure. Therefore, among the treatment systems, the reamer 21
0, bone tap 211, implant driver 212
The handle portion is provided with the same diameter as the outer sheath treatment channel 201a, and the flange provided on the handle portion comes into contact with the rear end of the outer sheath 201, and the reamer portion 210c,
The tap portion 211c and the implant 213 are located so that they can be inserted into the disc at an appropriate depth.

As shown in FIG. 57, in the outer wall of the outer sheath 201, one spike channel 201d is provided in addition to the two spike channels 201d provided close to each other, and a total of three spike channels 201d are provided. Spike channel 20
1d. The three spike channels 201d are provided so as to be located at the vertices of a triangle when viewed from the distal end of the outer sheath 201. Along with this, three spikes 205 and three spike channel plugs 206 used in the present sheath system are prepared.

As shown in FIG. 59, the outer sheath cap 2
The small holes 203h provided on the outer sheath 201 are also provided at positions that do not block the three spike channels 201d when attached to the outer sheath 201. In addition, outer sheath cap 2
The diameter of the rubber cap opening 203e provided in the 03 is such that airtightness can be secured when a treatment tool used in combination with this instrument is inserted. Other configurations are the same as those of the fifteenth embodiment.

(Operation) The outer sheath 201 can be used in the same manner as the fifteenth embodiment described above, except that the outer sheath 201 is first fixed to the vertebral body 70 so as to surround the first implant embedding portion 214, and the drilling operation and opening are performed. Until the large plug is implanted, two spikes 205 are punctured and fixed only in the upper vertebral body 70a. Thereafter, when fixing the outer sheath 201 to the second implant implantation site 215, two spikes 205 are punctured into the upper vertebral body 70a, and the lower vertebral body 70a is punctured.
b, the third spike 2 newly provided in the present embodiment
05, the outer sheath 201 is firmly fixed to the vertebral body 70.

Next, when the outer sheath 201 is fixed again to the first implant embedding site 214, two spikes 205 are punctured into the upper vertebral body 70a and one spike 205 is punctured into the lower vertebral body 70b. By properly using the number of spikes 205 to puncture the vertebral body 70 in this manner, the intervertebral disc 216 can be expanded while the outer sheath 201 is fixed to the vertebral body 70, and can be firmly fixed by the vertebral body 70 when performing a treatment.

The operation of the reamer 210, the bone tap 211, and the implant 213 is also performed in the outer sheath treatment channel 201.
a. At this time, by inserting the flange provided on the handle of the treatment tool until the flange abuts against the rear end of the outer sheath 201, it is possible to prevent the spinal cord and the like from being accidentally inserted too deeply into the intervertebral disc 216 and damage the spinal cord and the like. 70 can always be treated at a constant depth.

(Effect) Since the inner sheath 204 is not used, the efficiency of the surgical operation and the cost of the sheath system can be reduced. In addition, since the spike 205 has a small diameter, the puncture teeth 204c provided on the inner sheath 204 are formed.
Since there is less damage to the vertebral body 70 and less bleeding from the cancellous bone in the vertebral body 70, there is no need to provide a hemostatic means as described in the modification of the fifteenth embodiment.

<Seventeenth Embodiment> Referring to FIGS. 60 and 61, a seventeenth embodiment of the present invention will be described. (Configuration) The outer sheath 201 used in this embodiment is the first sheath.
What differs from the sixth embodiment is that the outer sheath 2
01 is provided with a scope engaging means near the distal end, and an insertion portion of the scope 219 such as a laparoscope is engaged with the engaging means.

That is, a circular hole 220 is provided near the distal end of the outer sheath 201, and an elastic member 220a made of a rubber material is provided all around its edge. The inner diameter of the circular hole 220 is formed so that the insertion portion of the scope 219 can be freely inserted and removed, and the inner diameter of the circular hole 220 is gripped by an elastic member so as not to easily fall off when the scope 219 is mounted.

(Operation) When observing the state of treatment in the sheath, the distal end of the scope 219 is inserted into the circular hole 220 at the distal end of the outer sheath 201, and the scope 219 is fixed to the outer sheath 201. In addition, in observing the inside of the sheath, the circular hole 220 may not be used, and the observation may be made from the transparent portion 201c at the distal end of the sheath as in the sixteenth embodiment.

(Effect) Since the observation means in this embodiment can directly observe the inside of the sheath instead of observing the inside of the sheath through the transparent part 201c provided on the outer sheath 201, the observation means adheres to the transparent part 201c. There is no concern that the inside of the sheath cannot be clearly observed due to blood or fat, and the observation can always be performed in a good state. Further, after the scope 219 is fixed to the outer sheath 201, it is not necessary to hold the scope 219, so that the burden on the operator can be reduced. Further, by fixing the scope 219 to the outer sheath 201, a constant observation field of view can be always obtained.

<First Modification of Seventeenth Embodiment> (Configuration) This modification is different from the sixteenth embodiment described above in that a circular hole 2 provided near the distal end of the outer sheath 201 is provided.
20 is that a magnetic body is provided instead of the elastic member 220a.

(Operation) When the scope 219 is inserted into the circular hole 220, the distal end of the scope 219 is connected to the outer sheath 201 by the magnetic material. In addition, since a stainless steel pipe is generally used for an outer tube of a scope used for endoscopic surgery, it can be magnetically coupled to the magnetic material.

(Effect) By using the magnetic body 220b for the coupling means of the scope 219, it is not necessary to push the scope 219 into the circular hole 219 of the outer sheath 219, and the scope 220 can be attached and detached more smoothly. it can. In addition, since the magnetic body 220b is not a consumable member, the fixing force of the scope 219 does not become weak even if it is repeatedly used. Other effects are the same as those of the third embodiment.

<Second Modification of Seventeenth Embodiment> FIG. 62
A second modification of the seventeenth embodiment will be described with reference to FIG. (Configuration) This modification is different from the seventeenth embodiment in that a click unit is added to the unit for connecting the scope 219 to the outer sheath 201 circular hole 220. A groove 223 into which the elastic member 220a of the circular hole 220 is fitted is provided on the outer periphery of the distal end portion of the scope 219.

(Operation) When the distal end of the scope 219 is inserted into the circular hole 220 of the outer sheath 201, the scope 219
The elastic member 220a fits into the groove 223 provided at the distal end of the outer sheath 201 with a click feeling.
19 is fixed.

(Effect) The scope 219 is connected to the outer sheath 201.
At the time of coupling, it can be recognized that the scope 219 is securely fixed to the outer sheath 201 by a click feeling. Other effects are the same as those of the seventeenth embodiment.

<Eighteenth Embodiment> The eighteenth embodiment of the present invention will be described with reference to FIGS. (Configuration) The present embodiment differs from the sixteenth embodiment in that a scope channel 224 is provided in the outer sheath 201, and a scope 219 is inserted into the scope channel 224.

As shown in FIG. 63, the scope channel 224 is disposed adjacent to the treatment channel 201a with an inclination. The distal end of the scope channel 224 is provided in communication with the treatment channel 201a, and the rear end is provided. The outer sheath 201 is provided so as to open at the rear end. The inside diameter of the scope channel 224 is formed to be substantially the same as the diameter of the scope 219 inserted into the scope channel 224. An O-ring 226 is provided near the rear end of the scope channel 224, and a scope channel plug 227 is inserted into the scope channel 224 to ensure airtightness.

The outer sheath cap 203 has the outer sheath 20
A scope channel hole 228 is provided at a position that does not block the scope channel 224 when the scope channel hole 228 is attached to the first device. As shown in FIG. 64, the outer sheath 201 is formed in a round shape so as to have a substantially oval cross section. Note that the treatment system described with reference to FIGS. 39 to 45 described in the fifteenth embodiment is also used in combination with the implant guide sheath of the present embodiment.

(Operation) The outer sheath 201 is
Is formed in a substantially oval cross-section, so that it can be inserted in the same manner as a normal circular sheath. In addition, the outer sheath 201 and the incised portion 23 of the abdominal wall 231
Airtightness is maintained between the two.

When observing the state of the treatment in the sheath, the scope channel plug 227 inserted in the scope channel 224 is removed, and the scope 21 is removed to a depth at which a good observation image can be obtained in the scope channel 224.
Insert 9 At this time, the scope 219 is O-ring 2
26, the insufflation gas is prevented from leaking from the scope channel 224, and the scope 219 is mechanically held by the O-ring 226. Note that the scope channel 224 may not be used to observe the inside of the sheath, but may be observed from the transparent portion 201c at the distal end of the sheath as in the sixteenth embodiment.

(Effect) Instead of observing the inside of the sheath through the transparent portion 201c provided on the outer sheath 201,
Since the inside of the sheath can be directly observed from the scope channel 224, there is no concern that the inside of the sheath cannot be clearly observed due to blood or fat adhering to the transparent portion 201c, and the observation can always be performed in a good state.

[0209] After the scope 219 is inserted into the scope channel 224, it is not necessary to hold the scope 219, and the burden on the operator can be reduced. Also, the scope 21
By inserting 9 into the scope channel 224, a constant observation field of view can always be obtained.

Further, since the scope channel 224 is provided at the rear end of the outer sheath 201 so as to be opened, there is no need to separately provide a cutout for inserting the scope 219 into the body. Therefore, the burden on the patient can be reduced, the number of trocars used can be saved, and the efficiency of the operation can be increased.

<Nineteenth Embodiment> A nineteenth embodiment of the present invention will be described with reference to FIGS. (Structure) The sheath system for spinal surgery of the present embodiment is mainly used when deploying muscles into the lumbar vertebra from the rear and entering the lumbar vertebrae to reach between the vertebrae and performing a disc herniation or the like therefrom. This embodiment is for a case where the spinous process enters from the left side.

[0212] As shown in FIG.
Is a surgical cavity securing section formed by a ring-shaped member provided on the distal end side (referred to as a cavity securing section and a ring-shaped member).
231, an operating member 232 extending from one end of the ring-shaped member 231 as a positioning means of the surgical sheath 230, and a flexible sheet member 233 connected to the cavity securing portion 231.

The cavity securing section 231 is formed of a hard or semi-hard member formed in a band shape and a ring shape. The distal end shape of the cavity securing portion 231 is formed in a shape substantially matching the shape of the bone between the vertebrae to which the cavity securing portion 231 is applied, and serves as a means for engaging with the bone.

Specifically, as shown in FIG. 66, the distal end of the cavity securing portion 231 has one piece protruding so as to match the position corresponding to the lower vertebral arch, and the spinous process side is oblique. Has been cut. Further, the portion corresponding to the upper vertebral arch has a concave shape. In this figure, the flexible sheet is omitted.

The operating member 232, which is a positioning means of the surgical sheath 230, is formed of a rigid member extending from one end of the ring-shaped member 231, and is formed in a bent shape at the rear end. , A grip portion 234 is provided at the proximal end thereof.

The flexible sheet member 233 is formed in a tapered funnel shape by a rubber-like flexible sheet member, and this flexible sheet member is fitted to and connected to the outer periphery of the cavity securing portion 231. The soft sheet member 233 communicates with the inner cavity of the ring-shaped member 231 and forms a treatment passage for communicating outside the body during the operation. That is,
The flexible sheet member 233 constitutes a means for guiding the instrument into the cavity formed by the cavity securing member 231, and also forms an instrument insertion tool channel 235.

In this embodiment, a trocar is punctured. This trocar is composed of a guide needle 241, a dilator 242, and a trocar port 243, as shown in FIGS. . The lumen of the trocar port 243 is
It is possible to cover the part of the maximum diameter of 42,
The inside diameter is such that an endoscope and various treatment instruments can be inserted. In addition, the tip is formed in a shape cut obliquely.

In the present embodiment, a dilator 242 is provided to introduce this into a deep body. The dilator 242 is a commonly used antenna-type dilator, and includes a guide needle 241 and a plurality of tubular members (not shown) having different diameters in a stepwise manner. Can be An outer sheath of the dilator 242 having the largest diameter is covered with a surgical sheath 230. In addition, surgical sheath 2
As a member to be used when it is difficult for the member 30 to enter, a tubular member for covering the dilator 242 having the largest diameter and further expanding the member may be prepared.

The observation means in this embodiment is an endoscope, and the flexible sheet member 23 in the surgical sheath 230 is used.
3 is inserted into the instrument insertion channel 235 constituted by 3. Also, as described below, the flexible sheet member 23
The endoscope is also inserted into a trocar for instrument insertion that is inserted by breaking through 3 (see FIG. 70).

(Operation) First, the guide needle 241 is punctured into the body tissue toward the target site between the vertebrae. At this time, the puncture may be performed under X-ray fluoroscopy or under ultrasound guidance. Then, when the puncture is completed to the vicinity of the target lamine, the dilator 242 is inserted stepwise using the guide needle 241 as a guide to expand the body tissue 250. After inserting the dilator 242 up to the maximum diameter, the surgical sheath 230 is further covered and inserted until it hits the bone (FIG. 67).
(A), FIG. 67 (b)). The surgical sheath 23
When it is difficult to enter 0, a larger diameter tubular member is inserted to further expand the tubular member, and then only the tubular member is pulled out, and the surgical sheath 230 is inserted.

The distal end shape of the surgical sheath 230 is formed so as to conform to the shape of the bone between the vertebrae. For this reason, as shown in FIG. 67 (b), while pushing the surgical sheath 230 against the bone, the sheath is pushed to the deepest position by rotating or shifting the position, and the sheath is placed at a position where it is difficult to rotate. Put. Then, at this position, a state shown in FIG. 67 (c) is obtained in which the shape of the sheath distal end and the shape of the vertebral arch 251 are most suitable. Therefore, since the appropriate sheath position is detected based on the amount of movement of the sheath in the depth direction, sheath positioning is easy. Here, the inner needle is removed, and the direction of the surgical sheath 230 is adjusted to the most stable position. In this state, the surgical sheath 230 is substantially engaged with the target position of the vertebral arch 251.

At this time, since the distal end shape of the cavity securing portion 231 conforms to the shape of the vertebral arch portion 251, even if the guide needles are slightly different in their entry positions and are misaligned,
The surgical sheath 230 is easily guided to the target position of the lamine 251. Further, when the cavity securing section 231 is configured to be semi-rigid, the wall itself in contact with the shape of the circular cavity (the lumen of the cavity securing section 231) and the tip bone can be appropriately deformed. Therefore, the operation member 232 is operated to perform an operation such as pressing the surgical sheath 230 against the bone,
It is possible to adapt the shape of the vertebral body for use.

Subsequently, a treatment instrument such as an endoscope 240 or a surgical tool 245 is inserted from the rear end side of the flexible sheet member 233, and a body tissue such as a muscle clinging to a vertebral arch located in front of the cavity securing portion 231 is inserted. To remove and expand between the lamines.

In this state, the body tissue is excluded by the cavity securing section 231 in the region in front of the vertebral arch, and the operation cavity is securely secured (see FIG. 68). A flexible sheet member 233 extends from the cavity securing part 231 to the outside of the body. The flexible sheet member 233 extending outside the body
Does not particularly exclude the body tissue, the pressure of the body tissue causes the soft sheet member 233 to be in a collapsed state.

However, since the surgical sheath 230 is a sheet-like tubular member and forms the instrument insertion channel 235 communicating with the cavity secured by the cavity securing section 231, a path for instrument insertion is secured. Have been. That is, the treatment instrument such as the endoscope 240 or the surgical tool 245 is inserted and the treatment instrument can be easily inserted simply by spreading the body tissue. At this time, since the surgical sheath 230 and the instrument insertion channel 235 are flexible, the insertion angle of the treatment instrument can be freely set and the handling can be easily performed without interference with the sheath 230. Further, as shown in FIG. 68, it is easy to insert a plurality of treatment instruments, and interference between the instruments is small. Also, since there is no pressure rejection of the tissue by the soft flexible sheet member 233, damage to the muscle is small.

An operation similar to a normal hernia removal operation and the like using various treatment instruments will be described with reference to FIGS. 69 and 70.

When the operation is difficult to perform due to interference between instruments when performing this procedure, a trocar 246 can be additionally used. That is, in order to additionally insert a treatment instrument into the cavity secured by the cavity securing section 231, first, the guide needle 241 is inserted into a body tissue from a part where the treatment instrument outside the body is to be inserted. (FIG. 69
At this time, the endoscope 2 is placed inside the flexible sheet member 233.
In this state, the guide needle 241 punctures the cavity from outside the flexible sheet member 233.

Next, the dilator 242 is sequentially inserted into the guide needle 241 from outside the body, and the body tissue and the puncture hole of the soft sheet member 233 are sequentially expanded. Finally, the trocar 246 is inserted, and the flexible sheet member 233 is inserted.
Through the trocar 246. (See FIG. 70).

At this time, since the flexible sheet member 233 has a rubbery property and extends, the actual puncture hole is small. Therefore, the tip of the inserted trocar 246 is tightened by the elastic force of the flexible sheet member 233, and is in a connected and fixed state. Accordingly, the trocar 246 inserted from outside the body communicates with the cavity secured by the cavity securing section 231. In addition, the trocar 2
Since the sheath 46 and the surgical sheath 230 are connected and fixed by the elastic force of the sheet, it is possible to prevent muscles, blood, and the like from protruding from the gaps and obstructing the visual field. Further, since the trocar and the sheath are connected and fixed, the trocar does not easily come off, and the device can be smoothly inserted into the cavity.

By puncturing the trocars 246 appropriately from the required number and directions as shown in FIG. 70, various necessary treatment instruments can be inserted into the cavity via these trocars 246. At this time, since the insertion directions are different, the operation can be performed smoothly without interference between the instruments.

Also, by inserting the endoscope 240 from the added trocar 246 and inserting the main treatment instruments from the soft sheet side, a special shape or a special size so as not to enter the inner hole of the trocar 246. Can be introduced through the instrument insertion channel 235 of the surgical sheath 230. (See FIG. 70.) Also, in the actual treatment, when it is desired to slightly shift the target portion or to push out the body tissue that has entered the cavity from under the sheath, the operating member 232 is operated to shift the position. , Or by pressing.

Further, in this embodiment, the surgical sheath 230 is inserted into the body tissue by using the dilator 242. It is also possible to insert it after peeling it off and leaving it in a shielded state. Further, the surgical sheath 230 may be attached to the inner needle and inserted as in the thirteenth embodiment.

(Effect) The distal end of the cavity securing portion 231 constituting the distal end of the surgical sheath 230 is shaped to fit the vertebral body, and the surgical sheath 230 is arranged at a comfortable position, so that the position is inevitable. And the appropriate sheath position is detected by the amount of movement of the sheath in the depth direction, so that the sheath can be easily guided to the target site. In addition, when the operation field is small, it is difficult to grasp the whole image, and it is easy to lose track of the treatment site. However, a necessary treatment site is determined, and the surgical sheath 230 is stably held with respect to the treatment site. Less. Further, even when the insertion direction position deviates from the treatment site when the surgical sheath 230 enters, the surgical sheath 230 can be disposed at a predetermined position only by searching for a comfortable position.

After the surgical sheath 230 is placed in a comfortable position, the distal end of the cavity securing portion 231 is shaped to engage with the vertebral body.
Is less likely to shift and the field of view is shifted.

[0235] Further, since the shape is adapted to the vertebral body, after the tissue stuck to the vertebral body is removed, the invasion of the body tissue into the cavity is small and a good visual field is maintained.

Further, since the soft sheet member 233 is used for the surgical sheath 230, this soft sheet member 233 is used.
Can be pierced and an additional trocar 246 can be placed within the cavity, allowing the introduction of a treatment instrument through the trocar 246. Therefore, interference between the instruments is small.

Further, since a rubber-like sheet is used for the flexible sheet member 233, the added trocar 246 is used.
Since the trocar 246 is integrally connected and fixed to the flexible sheet member 233 by the elastic force of the sheet, it is possible to prevent the trocar 246 from coming off unexpectedly. further,
Tissue and blood can be prevented from entering between the flexible sheet member 233 and the trocar 246 to obstruct the visual field. Further, since the soft sheet member 233 is sufficiently soft, the trocar 246 connected and fixed is used.
It does not impair the mobility of the device and does not hinder the operation of the instrument.

When the ring-shaped member 231 is made of a semi-rigid material, this member can be appropriately deformed, so that it can be deformed in conformity with the shape adapted to the vertebral body.

Further, since the flexible sheet member 233 is used as the instrument insertion channel 235, the tissue is not evacuated by the flexible sheet member 233, and the damage to the tissue is small. Furthermore, this instrument insertion channel 2
In 35, it is possible to use a modified treatment instrument and to insert a plurality of treatment instruments. At this time, there is little interference between the treatment instruments and the surgical sheath 230, and the handling is good.

<Twentieth Embodiment> A twentieth embodiment of the present invention will be described with reference to FIG. (Configuration) The cavity securing means of the surgical sheath 260 of the present embodiment is a cavity securing portion 261 having a ring-shaped tip.
The cavity securing portion 261 is formed of a semi-hard ring-shaped member 262.
And a hard exclusion hook 263 that has reached the tip of the ring portion of the ring-shaped member 262. The distal end shape of the cavity securing portion 261 is configured to have a shape compatible with the vertebral arch, including the most advanced shape of the exclusion hook 263, and this shape constitutes a means for engaging with the bone. doing.

Note that a relatively sharp edge portion 263a is provided at the tip of the exclusion hook 263. The retraction hook 263 is directly connected to the operation member 232 at the rear end side of the ring-shaped member 262.

(Operation) In the present embodiment, the first
In the same manner as in the ninth embodiment, the lumbar part
51 is introduced into the target site at the rear end. The shape of the distal end of the cavity securing portion 261 is basically the same as in the nineteenth embodiment, and the operation is also the same. That is, the surgical sheath 2
60 can be easily guided to the target site, and at the same time, after formally engaging the vertebral body, effectively preventing body tissue from entering the cavity.

If the body tissue stuck around the treatment site at the time of introducing the sheath remains in the cavity of the cavity securing section 261, the edge of the exclusion hook 263 provided at the forefront of the surgical sheath 260 may be used. At the part 263a, the body tissue is scraped off from the bone tissue. At this time, the operation of the exclusion hook 263 can be performed by operating the operation member 232 because the operation member 232 and the exclusion hook 263 are directly connected.

When the operation member 232 is operated, the semi-rigid ring-shaped member 262 can be slightly deformed, so that the ring-shaped member 262 can be operated so as to be crushed. For this reason, the ring-shaped member 2
Without shifting the position of 62 so much,
That is, the retraction hook 263 can be used without allowing tissue to enter the cavity.
Can be operated. Hereinafter, the same operation as in the above-described nineteenth embodiment is performed to proceed with the surgery.

(Effect) By directly operating the exclusion hook 263 provided at the forefront of the cavity securing section 261 with the operating member 232, the exclusion of body tissue or the like that obstructs the operation field existing in the cavity can be easily performed. It can be carried out.

The ring-shaped member 26 of the cavity securing portion 261
Since 2 is a semi-rigid, deformable member, the operation of the exclusion hook 263 can be performed without significantly displacing the ring-shaped member 262, that is, without invading body tissue into the cavity. Other effects are the same as those of the nineteenth embodiment.

<Twenty-First Embodiment> A twenty-first embodiment of the present invention will be described with reference to FIGS. 72 and 73. The cavity securing section 27 which is a cavity securing means of the surgical sheath 270 of the present embodiment.
Reference numeral 1 denotes a belt-shaped member 272 formed in a pipe shape as shown in FIGS. 72 (a) and 72 (b). That is, the tubular portion 2 having a lumen serving as an expanding means whose inner diameter is deformable.
73.

As shown in FIG. 72 (b), the belt-like member 2
One end of 72 is fixed to the wall of the exclusion member 274.
Further, as shown in FIGS. 72 (b) and 72 (c), a groove 274a into which the other end serving as the moving side end of the band-shaped member 272 is inserted is formed in the rejecting member 274. The groove 274
a urges the band-shaped member 272 so as to press it. A taper 274b is formed at the tip of the exclusion member 274. The distal end of the exclusion member 274 and the distal end of the tubular portion 273 form a shape that serves as a means for engaging with bone. Further, the entire tip shape of the cavity securing section 271 is shown in FIG.
The shape is symmetrical with respect to the DD section line of FIG. With such a shape, the spinous process can be engaged with the right vertebral arch or the left vertebral arch.

(Operation) The method of using the surgical sheath 270 is the same as that of the twentieth embodiment, and
A more protruding retraction member 274 enters the deepest portion between the lamines and engages the lamine.

When the visual field is small and the lumen is narrow, FIG.
As shown in (1), the band-shaped member rounded into a cylinder is expanded in the outer peripheral direction to enlarge the lumen. At this time, the moving end of the band-shaped member 272 may be moved by forceps or the like, which is an inserted treatment instrument, to enlarge the lumen. Also,
The distal end of the moving end of the band-shaped member 272 may be pushed in a direction to directly expand, thereby expanding the lumen. This strip 2
Numeral 72 is urged by the groove 274a of the exclusion member 274, and the expanded cavity maintains its inner cavity shape by urging the band-like member 272 with an appropriate force. Since the distal end of the surgical sheath 270 has a target shape,
One surgical sheath can be engaged with both vertebrae.

(Effect) Since the cavity securing section 271 has an enlarging means for enlarging the cavity, it is possible to create a cavity larger in the body than the hole at the time of insertion. Therefore, the approach can be made with a small incision.

Further, since the cavity securing section 271 is formed of a movable band-shaped member 272, if it is desired to secure a long field of view with respect to the vertebral arch, for example, the band-shaped member 272 is moved in the vertical direction. The cavity can be enlarged so as to spread out. That is, the cavity can be expanded in any direction.

Further, since the surgical sheath 270 has a symmetrical distal end shape, the present sheath can be engaged with the vertebral arch on both sides of the spinous process.

[Supplementary Note 1 Group] A bone surgery cavity securing instrument that is inserted into a body tissue and includes a cavity securing sheath forming a working space for bone surgery in a lumen, and performs a treatment on a bone to be treated in the working space for bone surgery, The cavity securing sheath is provided with a scope channel through which an endoscope for observing the inside of the working space for bone surgery is inserted, and a treatment channel through which a treatment tool used to treat bone is inserted. And the treatment channel communicates with the lumen of the sheath (directly or indirectly through an opening), and further, an anchor means is provided at the distal end of the sheath as a type of means for engaging with the bone. It is characterized by.

[0255] 2. In the above item 1, the anchor means may include a spike channel provided on a sheath wall of the cavity securing device;
It is a spike that pierces the bone through this spike channel. 3. In Additional Item 2, the tip of the spike channel communicates with either the scope channel or the treatment channel, and is disposed within the observation field of the endoscope.

[0256] 4. In Additional Item 2, the spike channel is provided on one side with respect to the cross section of the sheath. 5. In Additional Item 2, the spike channel is at least partially embedded in the sheath wall. 6. In claim 2, at least one of the channels
A part is disposed on the inner wall side of the sheath. 7. In Additional Items 1 and 2, each channel has an airtight means.

[0257] 8. A bone surgery cavity securing instrument that is inserted into a body tissue and includes a cavity securing sheath forming a working space for bone surgery in a lumen, and performs a treatment on a bone to be treated in the working space for bone surgery, The cavity securing sheath is provided with a scope channel through which an endoscope for observing the inside of the working space for bone surgery is inserted, and a treatment channel through which a treatment tool used to treat bone is inserted. And the treatment channel is in the lumen of the sheath (directly,
Or indirectly through an opening), and further, the distal end of the sheath is formed into a shape adapted to the shape of the bone portion to be engaged as a type of means for engaging with the bone. I have.

[0258] 9. In Additional Item 8, a radius (R) is provided along the bone at the distal end of the sheath.

[0259] 10. In Supplementary Item 8, one leaf retraction member is provided at the distal end of the sheath. 11. In Additional Item 9, the distal end of the sheath is oblique.

[0260] 12. A bone surgery cavity securing instrument that is inserted into a body tissue and includes a cavity securing sheath forming a working space for bone surgery in a lumen, and performs a treatment on a bone to be treated in the working space for bone surgery, The cavity securing sheath is provided with a scope channel through which an endoscope for observing the inside of the working space for bone surgery is inserted, and a treatment channel through which a treatment tool used to treat bone is inserted. And the treatment channel communicate with the lumen of the sheath (directly or indirectly through an opening), and the distal end of the sheath is engaged with the distal end of the sheath as a means for engaging with the bone. It has a deforming means for deforming in conformity with the shape of the target bone portion.

13. In Additional Item 12, the deforming means includes a rubber-like soft member provided at a distal end of the sheath. 14． In the supplementary item 12, in the deformation means, an elastic member is provided at a distal end of the sheath. 15. In the supplementary item 12, the deforming means includes a member movable so as to conform to the shape of the bone part to be engaged. 16. What is claimed is: 1. A bone surgery cavity securing device having a sheath inserted into a body tissue and performing a treatment on bone and surrounding tissue in a lumen of the sheath, comprising: a scope channel into which an endoscope is inserted; The scope channel and the treatment channel communicate with each other, and a sheath engaging means is provided at the distal end of the sheath. An inner needle used as a body tissue insertion aid for the cavity securing device, and means for maintaining airtightness with the sheath, which is disposed in the sheath lumen of the cavity securing device, and It has an airtight adapter with a treatment channel into which a surgical instrument can be inserted in a state.

[0262] 17. Having a sheath inserted into body tissue,
What is claimed is: 1. A bone surgery cavity securing device for performing treatment on bone and its surrounding tissue in the lumen of the sheath, comprising: a scope channel into which an endoscope is inserted; and a treatment channel through which a treatment tool used for the treatment is inserted. A channel, wherein the treatment channel is formed by a lumen of the sheath, the scope channel is obliquely communicated with the treatment channel in the lumen of the sheath, and further, a bone is provided at a distal end of the sheath. And engagement means.

18. Having a sheath inserted into body tissue,
A bone treatment cavity securing tool for performing treatment on bone and its surrounding tissue in the lumen of the sheath, comprising a scope channel into which an endoscope is inserted, and a treatment tool through which a treatment tool used for the treatment is inserted. A channel, wherein the scope channel and the treatment channel communicate with each other, an engagement means with the bone is provided at the distal end of the sheath, and an endoscope inserted through the scope channel is fixed at an arbitrary position. Fixing means were provided. 19. In Additional Item 18, the mechanism of the fixing means is an O-ring.

20. Having a sheath inserted into body tissue,
What is claimed is: 1. A bone surgery cavity securing device for performing treatment on bone and its surrounding tissue in the lumen of the sheath, comprising: a scope channel into which an endoscope is inserted; and a treatment channel through which a treatment tool used for the treatment is inserted. A channel, wherein the scope channel and the treatment channel communicate with each other,
Means for engaging with the bone are provided at the distal end of the sheath, and at least a part of the distal end of the sheath is transparent.

21. A suction tube used in combination with the cavity securing device, wherein a means for attaching and detaching to and from the cavity securing device is provided. 22. An adapter when the cavity securing tool and the suction tube are used in combination, wherein an elastic ring member for slidably clamping the outer periphery of the suction tube and an angle variable having elasticity further extending from the ring member along the suction tube. An adapter comprising a member and fixing means for fixing the member to the cavity securing device. 23. The sheath of each of the cavity securing devices has a double structure of an outer sheath and an inner sheath, and an engagement means is provided at a tip portion of the inner sheath.

24. Having a sheath inserted into body tissue,
A bone surgery cavity securing device for performing treatment on bone in the lumen of the sheath, comprising a scope channel into which an endoscope is inserted, and a treatment channel through which a treatment tool used for the treatment is inserted. The scope channel and the treatment channel communicate with each other, and a distal end of the sheath is provided with a means for engaging with the bone. The treatment channel further includes means for regulating a treatment depth of the treatment tool to the bone. Have.

25. Having a sheath inserted into body tissue,
In a lumen of the sheath, a bone surgery cavity securing instrument for performing treatment on bone, comprising a scope channel into which an endoscope is inserted and a treatment channel through which a treatment tool used for the treatment is inserted. The scope channel and the treatment channel communicate with each other, and the outer shape of the sheath has a cross-sectional shape and an outer surface formed by a combination of a convex portion or a linear portion.

26. In the above item 1, the anchor means is an anchor member that is inserted into the treatment channel, protrudes from the treatment channel, and has a tubular portion and a needle-like member at the tip thereof.

27. A bone surgery cavity securing instrument to be inserted into a body tissue for treating a bone from the cavity at the tip thereof, comprising a scope channel into which an endoscope is inserted and a treatment channel, wherein the scope channel and the treatment channel A channel for communicating within a cavity and having means for engaging a bone at a distal end thereof. Inserting a cavity securing device through the skin incision; b. Engaging a cavity securing device with the bone; c. Placing a scope in a scope channel; d. Placing the treatment instrument in the treatment channel and performing a treatment on the bone under a mirror.

(Purpose, Function, and Effect of Additional Items) Additional Items 1 to
7, 26 <Purpose> In order to facilitate bone surgery under an endoscope, these can directly approach a bone as a treatment site and provide a treatment cavity capable of performing an arthroscopic surgery. It is an object of the present invention to provide a tool that can be formed, does not require the exclusion of other organs, can provide a good visual field, and can perform a work that does not care about damage to other organs.

<Effect> A sheath of a device for securing a cavity is inserted below the body tissue from the skin incision, placed in front of the bone, and the sheath is directly fixed to the treatment site using anchor means as engaging means. I do. Next, the endoscope is inserted into the scope channel, a treatment tool is inserted from the treatment channel, and the treatment is performed under the scope.

<Effect> A surgical cavity is formed by a sheath directly fixed to a treatment site by an anchor means, and it is realized that there is no need to reject other organs, a good visual field, and no risk of damage to other organs. Under the circumstances, it is possible to safely and easily perform arthroscopic surgery. Since the sheath is securely fixed by the anchoring means, the surgical cavity is not accidentally shifted.

Supplementary Item 3 <Purpose> It is an object of the present invention to prevent accidental damage to other organs when driving the anchor means when driving the anchor means. <Operation> Since the spike channel communicates with the lumen of the sheath of the cavity securing instrument, when the endoscope is inserted, spikes appearing in the lumen of the sheath can be directly seen by the endoscope. Perform the driving work while checking under the mirror. <Effect> Since the spike channel communicates with the lumen of the sheath of the cavity securing instrument, the spike that hits the lumen side is hit while seeing under a mirror, so there is no danger of spikes damaging other organs. .

Supplementary Item 4 <Purpose> The purpose of the present invention is to easily perform an arthroscopic operation even for an operation requiring an enlargement of the vertebrae, such as anterior fusion. <Operation> The spike is provided on the sheath of the cavity securing device from one side, and strikes the spike only on one side of the vertebral body. The other vertebral body that spans the field of view is not spiked and allows for dilation between the two vertebral bodies through a cavity securing device. <Effect> Since the spike is fixed to one vertebral body, the intervertebral space can be enlarged. In addition, anterior fusion can be performed.

Supplementary Item 6 <Effect> It is safer to be on the inner wall side.

Supplementary items 8 to 11 <Purpose> In order to facilitate bone surgery under an endoscope, a cavity securing device for forming a surgical cavity with respect to a bone at a treatment site is properly arranged. It is an object of the present invention to prevent an organ from entering a treatment cavity, prevent damage to other organs, and enable an arthroscopic surgery to be performed with a good visual field. <Operation> The distal end of the sheath of the cavity securing device is shaped to fit the bone. If the sheath of the cavity securing device is placed at the target site, the sheath of the cavity securing device fits the bone. Without entering the cavity, the endoscope is inserted into the scope channel, and the treatment is performed. <Effect> After placing the sheath of the cavity securing device, the tip is formed in a shape compatible with bone, preventing other organs from entering the surgical cavity and preventing damage to other organs. Because there is no invasion of organs, a good visual field can be obtained, and surgery can be performed safely.

Supplementary Notes 12 to 15 <Purpose> Same as in Supplementary Note 8. <Operation> Since a means for deforming in conformity with the shape of the bone is provided at the distal end of the sheath of the cavity securing device, the cavity securing device is adapted to the shape of the bone. Of the sheath is deformed, and the sheath tip of the cavity securing device is joined to the bone without any gap. <Effect> The distal end of the sheath of the cavity securing device is arranged in conformity with the bone, preventing invasion of other organs without invasion of organs, obtaining a good visual field, and enabling safe surgery. It is also adaptable to bones of various shapes.

Supplementary Item 16 <Purpose> It is an object of the present invention to provide a bone surgery cavity securing instrument that can be used under pneumoperitoneum. <Effect> Insert the sheath of the cavity securing device with the inner needle below the insufflation, insert the sheath, remove the inner needle, attach the airtight adapter, maintain the airtightness, and install the cavity securing device under the insufflation. Engage with bone. Below, insert the endoscope into the scope channel,
The treatment is performed from the treatment channel. At this stage, you may be hungry. <Effect> In a means using a pneumoperitoneum, it is possible to place a cavity securing device in a bone.

Additional Item 17 <Effect> Interference between the treatment instrument inserted into the treatment instrument channel and the endoscope hand can be prevented.

Additional Items 18, 19 <Effect> The visual field is fixed, and the operation can be easily performed. The holding of the endoscope becomes easy.

Supplementary Item 20 <Effect> Since the distal end portion of the sheath is transparent, it is possible to check the inside of the sheath for the surgical cavity securing device from outside, and to see the inside from outside the sheath of the cavity securing device, And then
It is possible to check beyond that, which is more secure.

Supplementary Item 21 <Purpose> When using the cavity securing device, it is possible to reduce annoyance of a feeling of suction. Improve operability. <Operation> After placing the cavity securing device, if you want to use pinpoint suction, just use it as it is, and if you want it to be sucked in a connected manner (for example, the bone does not stop bleeding easily), use it as a cavity securing device. The suction tube is attached by attaching / detaching means, and the accumulated blood or the like is sucked in a connected manner. <Effect> When you want to aim and use the suction tube with pinpoint,
It can be used as usual, and when you want to make it suck continuously, it is sufficient to attach it to the cavity securing device, so that the operator can do other work and the operability is improved.

Supplementary Item 22 <Purpose> To improve the operability of the suction tube when using the cavity securing device. In addition, it can be used for smoke exhaustion and continuous perfusion. <Operation> The sheath of the cavity securing device and the suction tube are connected via the adapter. The suction tube is slidable by the ring member and can be fixed at an arbitrary position. Further, the angle of the suction tube can be changed with a certain amount of force by the angle variable member. This allows the suction tube to move back and forth, rotate freely in an oblique direction, and can be fixed at any position. Therefore, this is possible when you want to suck at a pinpoint. Perfusion, connection suction, etc. can be performed without trouble. <Effect> In addition to the same effects as in Additional Item 21, smoke exhaustion, continuous perfusion, continuous suction, and the like are possible.

Additional Item 24 <Effect> By means of regulating the treatment depth of the treatment tool with respect to the bone, the treatment tool having a depth greater than a certain level does not advance, and a safer operation can be performed.

Supplementary Item 25 <Effect> The shape has no concave portion, and when inserted into the skin cut portion, the resistance is small and the damage to the tissue is small. Further, even in the case where airtightness is required, airtightness is maintained between the abdominal wall.

[Supplementary Note 2 Group] A sheath for securing a cavity which is inserted into a body tissue and forms a space for treating a vertebral body in a lumen, and a treatment which is attached to the sheath and guides a treatment instrument and an implant for treating a vertebral body to the vertebral body treatment space A channel, an engagement means provided at a distal end of the sheath, for engaging the sheath with a vertebral body, and an attachment means attached to the sheath for endoscopically observing a surgical field in the vertebral body treatment space. An implant guide sheath provided with observation means.

[0287] 2. The observation means in Additional Item 1 comprises a transparent member attached to the distal end of the cavity securing sheath. 3. The observation means described in Additional Item 1 includes providing a scope channel in the cavity securing sheath so as to communicate with the treatment channel, and inserting a scope into the scope channel. 4. The observation means described in Additional Item 1 comprises an engaging means for engaging the distal end of the scope near the distal end of the cavity securing sheath, and engaging the scope with the engaging means.

[0288] 5. The scope engaging means described in Additional Item 4 is made of an elastic member. 6. The scope engaging means described in Additional Item 4 is made of a magnetic material. 7. The scope engaging means described in Additional Item 4 comprises click means.

[0289] 8. The cavity securing sheath described in Additional Item 1 is characterized by comprising a double tube of an inner sheath and an outer sheath. 9. Item 9 is the cavity securing sheath according to Item 8, wherein the observation means includes an observation portion provided at a distal end of the inner sheath and a transparent member provided at the outer sheath. 10. The cavity securing sheath described in Additional Item 8 is characterized in that airtight means is provided between the inner sheath and the outer sheath.

[0290] 11. The cavity securing sheath according to Additional Item 8,
The means for engaging the inner sheath and the vertebral body is electrically insulated, and means for supplying a high-frequency current is provided between the inner sheath and the means for engaging the vertebral body.

[0291] 12. A cavity securing sheath that is inserted into body tissue and forms a space for treating a vertebral body with a lumen,
A treatment channel for guiding a treatment tool and an implant for treating a vertebral body to the vertebral body treatment space, an observation means for endoscopically observing an operation field in the vertebral body treatment space, and a sheath for the vertebral body Using an implant guiding sheath having engaging means for engaging: a. Inserting the implant guiding sheath into the body cavity through the skin incision; b. Securing the implant guide sheath to the vertebral body; c. Endoscopically viewing the vertebral body treatment space; d. Inserting a treatment tool into the treatment channel and performing a treatment on the vertebral body under an endoscope; e. Implanting an implant between the procedural channel and the vertebrae.

13. A cavity securing sheath that is inserted into body tissue and forms a space for treating a vertebral body with a lumen,
A treatment channel for guiding a treatment tool and an implant for treating a vertebral body to the vertebral body treatment space, an observation means for endoscopically observing an operation field in the vertebral body treatment space, and a sheath for the vertebral body Using an implant guiding sheath having engaging means for engaging: a. Inserting the implant guiding sheath into the body cavity through the skin incision; b. Securing the implant guiding sheath to the first implant implantation site; c. Inserting a treatment tool into the treatment channel and performing treatment on the vertebral body while observing the vertebral body treatment space endoscopically; d. Releasing the fixation of the implant guiding sheath to the first implant implantation site and securing the implant guiding sheath to the second implant implantation site; e. Inserting a treatment tool into the treatment channel and performing treatment on the vertebral body while observing the vertebral body treatment space endoscopically; f. Inserting the implant into the treatment channel and placing the first implant between the vertebrae while observing the vertebral body treatment space endoscopically; g. Releasing fixation of the implant guide sheath to the second implant implantation site and securing the implant guide sheath to the first implant implantation site; h. Inserting a treatment tool into the treatment channel and performing treatment on the vertebral body while observing the vertebral body treatment space endoscopically; i. Inserting an implant into the treatment channel and placing a second implant between the vertebrae while endoscopically observing the vertebral body treatment space.

[0293] 14. The steps of performing a procedure on a vertebral body as described in additional items 12 and 13 are a. Inserting a drill into the procedure channel to form a drill hole in the vertebral body; b. Inserting skull forceps into the treatment channel and removing the nucleus pulposus from the vertebrae; c. Inserting an intervertebral distractor into the procedural channel and dilating the intervertebral disc; d. Inserting a reamer into the treatment channel and shaping the drill hole; e. Inserting a bone tap into the treatment channel and forming a thread in the drill hole.

[Supplementary Note 3 Group] The bone surgery cavity securing instrument is a sheath for securing a cavity that is inserted into body tissue to form a bone surgery working space with a lumen, and is attached to the cavity securing sheath to treat bone in the bone surgery working space. A treatment channel for guiding the treatment instrument, and an engagement means provided at the distal end of the cavity securing sheath for engaging the distal end of the cavity securing sheath with bone.

[0295] 2. Supplementary note 1 for the bone securing device for bone surgery, wherein the engaging means is provided with a cavity securing portion conforming to a bone at the distal end of the cavity securing sheath.

[0296] 3. Supplementary note 2 to the instrument for securing a cavity for bone surgery, wherein the engaging means is formed such that the shape of the cavity securing portion matches the shape of the bone.

[0297] 4. Supplementary note 3 to the instrument for securing a cavity for bone surgery, wherein the engaging means is formed such that the shape of the cavity securing portion matches the bone shape of the posterior surface of the spine and the vertebral arch.

[0298] 5. Supplementary note 3 for the bone securing device for bone surgery, wherein the engaging means has a cavity securing portion formed of a substantially cylindrical member, and a distal end formed into a shape in which one piece of a wall of the cylindrical member is protruded. Have been.

[0299] 6. Supplementary note 3 for the bone securing instrument for bone surgery, wherein the engaging means includes a cavity securing portion formed of a substantially cylindrical member, and a retraction member extending in a distal direction from a part of a wall of the cylindrical member. Have.

[0300] 7. The surgical system has a cavity securing means for forming a surgical cavity, and a channel which communicates with a cavity formed by the cavity securing means, communicates one end of the cavity outside the body, and can insert a surgical instrument, A surgical cavity securing sheath provided with a soft member having elasticity in at least a part of a portion to be inserted into the body, a tubular instrument introduction tube into which the surgical instrument can be inserted, and a surgical instrument insertion tube that can be inserted into the instrument introduction tube. A guide member provided with a needle portion having a diameter and capable of piercing an elastic soft member at a distal end.

[0301]

As described above, according to the present invention, a sheath for securing a cavity is inserted under a body tissue, the position of the sheath is fixed to a bone by engaging means, and the sheath is formed in the lumen of the sheath. In the bone surgery work space, the bone or its surrounding tissue is treated by the treatment tool while observing the operation field with an endoscope. Work such as retraction to form a cavity is not required, and it is possible to easily and safely treat a bone with a treatment tool without worrying about damage to other organs. Since these operations can be performed while looking under a mirror, the treatment on the bone is simple and reliable. Therefore, it is possible to easily and quickly perform an operation on the bone under the endoscope.
In addition, there is a problem in laparoscopic surgery etc.
Even if the operator is unfamiliar with the laparoscope, there is no need for retraction,
This is effective in that the endoscope is positioned with respect to the operation field.

[Brief description of the drawings]

FIG. 1 is an exploded perspective view of parts of a bone surgery cavity securing instrument according to a first embodiment.

2 (a) is a longitudinal sectional view of the cavity securing sheath of the embodiment, FIG. 2 (b) is a transverse sectional view taken along line AA in FIG. 2 (a), and FIG.
Is a plan view of the distal end of the sheath for securing a cavity.

FIG. 3 is an explanatory diagram showing a procedure for using the bone surgery cavity securing instrument according to the embodiment;

FIG. 4 is an explanatory view showing a procedure for using the instrument for securing a cavity for bone surgery according to the embodiment;

FIG. 5 is an explanatory view showing a procedure for using the bone surgery cavity securing device according to the embodiment.

FIG. 6 is an explanatory diagram showing a procedure for using the instrument for securing a cavity for bone surgery according to the embodiment;

FIG. 7 is a schematic anatomical view showing the state of the spine and the great artery and vein.

FIG. 8 is a perspective view of a suction pipe connection adapter used in the bone surgery cavity securing instrument according to the embodiment.

FIGS. 9A and 9B are explanatory views of an example of use of the suction tube and the connection adapter.

FIGS. 10A and 10B are explanatory views of an example of use of the suction tube and the connection adapter.

FIG. 11 is an explanatory diagram of another use example of the bone surgery cavity securing device according to the embodiment.

FIG. 12 is an explanatory view showing a state where a sheath is engaged with a bone and fixed in position in another usage example.

FIG. 13 is a sectional view of a distal end portion of the sheath showing a modification of the sheath of the first embodiment.

FIG. 14 is an exploded perspective view of components of a sheath according to the second embodiment.

FIG. 15 is an explanatory diagram of a use state of the sheath of the second embodiment.

FIG. 16 is a perspective view of a distal end portion showing a modification of the sheath of the second embodiment.

FIG. 17 is an explanatory diagram of a sheath according to the third embodiment.

FIG. 18 is a perspective view of a distal end portion of a sheath according to the fourth embodiment.

FIG. 19 is an explanatory diagram of a use state of the sheath of the fourth embodiment.

FIG. 20 is a perspective view of a distal end portion of a sheath according to the fifth embodiment.

FIG. 21 is an explanatory diagram of a use state of the sheath of the fifth embodiment.

FIG. 22A is a perspective view of a distal end portion of a sheath according to a sixth embodiment, and FIG.

23A is a cross-sectional view of a distal end portion of a sheath according to a seventh embodiment, and FIG.

FIG. 24 is a perspective view of a proximal end of a sheath according to the eighth embodiment.

FIG. 25 is a cross-sectional view of the proximal end of the sheath according to the ninth embodiment.

FIG. 26 is a sectional view of a sheath according to the tenth embodiment.

FIG. 27 is a sectional view of a sheath according to a tenth embodiment.

FIG. 28 is an explanatory diagram of a sheath according to the eleventh embodiment.

FIG. 29 is a perspective view of a guide member according to a twelfth embodiment.

FIG. 30 is a perspective view showing a modification of the guide member of the twelfth embodiment.

FIG. 31 is an explanatory diagram of a use state of the guide member according to the twelfth embodiment.

FIG. 32 is a perspective view of a sheath and an inner needle according to a thirteenth embodiment.

FIG. 33 is an explanatory diagram of a use state of the sheath according to the thirteenth embodiment.

FIG. 34 is an explanatory view of a use state of the sheath according to the thirteenth embodiment.

FIG. 35 is an explanatory diagram of a sheath and an endoscope according to a fourteenth embodiment.

FIG. 36 is a perspective view of a distal end portion of the sheath according to the fourteenth embodiment.

FIG. 37 is an explanatory view of a system for an implant guide sheath according to a fifteenth embodiment.

FIG. 38 is an explanatory view showing a state where an outer sheath cap is attached to the outer sheath according to the fifteenth embodiment.

FIG. 39 is a side view of the drill according to the fifteenth embodiment.

FIG. 40 is an explanatory view of an intervertebral device according to a fifteenth embodiment.

FIG. 41 is a side view of the hammer according to the fifteenth embodiment.

FIG. 42 is a side view of the reamer according to the fifteenth embodiment.

FIG. 43 is a side view of the bone tap according to the fifteenth embodiment.

FIG. 44 is a side view of the implant driver according to the fifteenth embodiment.

FIG. 45 is an explanatory view of an implant according to a fifteenth embodiment.

FIG. 46 is an explanatory view showing a procedure for using the instrument for securing a cavity for bone surgery according to the embodiment.

FIG. 47 is an explanatory view showing a procedure for using the instrument for securing a cavity for bone surgery according to the embodiment;

FIG. 48 is an explanatory view showing a procedure for using the instrument for securing a cavity for bone surgery according to the embodiment.

FIG. 49 is an explanatory view showing a procedure of using the instrument for securing a cavity for bone surgery according to the embodiment;

FIG. 50 is an explanatory view showing a procedure of using the instrument for securing a cavity for bone surgery according to the embodiment;

FIG 51 is an explanatory view showing a procedure for using the instrument for securing a cavity for bone surgery according to the embodiment.

FIG. 52 is an explanatory view showing a procedure for using the instrument for securing a cavity for bone surgery according to the embodiment;

FIG. 53 is an explanatory view showing a procedure of using the instrument for securing a cavity for bone surgery according to the embodiment;

FIG. 54 is an explanatory view showing a procedure for using the instrument for securing a cavity for bone surgery according to the embodiment.

FIG 55 is an explanatory view showing a procedure for using the instrument for securing a cavity for bone surgery according to the embodiment;

FIG. 56 is an explanatory view of a use state of a modification of the fifteenth embodiment.

FIG. 57 is a perspective view of a distal end portion of the outer sheath according to the sixteenth embodiment.

FIG. 58 is an explanatory view showing a procedure of using the instrument for securing a cavity for bone surgery according to the embodiment;

FIG. 59 is an explanatory diagram showing a state where the outer sheath cap is attached to the outer sheath according to the embodiment;

FIG. 60 is a perspective view of the distal end portion of the outer sheath according to the seventeenth embodiment.

FIG. 61 is an explanatory view showing a procedure for using the instrument for securing a cavity for bone surgery according to the embodiment;

FIG. 62 is an explanatory view showing a procedure for using a bone surgery cavity securing instrument according to a second modification of the seventeenth embodiment.

FIG. 63 is an explanatory view showing a procedure for using the bone surgery cavity securing instrument according to the eighteenth embodiment.

FIG. 64 is a sectional view taken along the line AA in FIG. 63;

FIG. 65 is an overall view of a surgical sheath according to a nineteenth embodiment;

FIGS. 66A and 66B show the shape of the distal end portion of the cavity securing portion of the surgical sheath according to the nineteenth embodiment, where FIG. 66A is a diagram showing the shape of the distal end portion of the cavity securing portion that contacts the spinous process, and FIG. The figure which shows the shape of a securing part front-end | tip part.

FIGS. 67A and 67B are explanatory diagrams showing a procedure for using the surgical sheath according to the nineteenth embodiment, where FIG. 67A is a diagram illustrating a state in which the surgical sheath is guided to a target site, and FIG. FIG. 7C is a view for explaining a state in which the distal end of the cavity securing portion is searched for by placing the distal end on the bone, and FIG.

FIG. 68 is a diagram illustrating a state in which a surgical cavity is secured and a procedure is being performed according to the nineteenth embodiment;

FIG. 69 is a view showing a state in which the dilator is guided by a guide needle punctured in the flexible tubular sheet member of the surgical sheath according to the nineteenth embodiment.

FIG. 70 is a view showing a state in which a trocar is inserted into the flexible tubular sheet member of the surgical sheath according to the nineteenth embodiment.

FIG. 71 is an overall view of a surgical sheath according to a twentieth embodiment;

72 (a) and 72 (b) show the configuration of the distal end portion of the cavity securing portion of the surgical sheath according to the twenty-first embodiment, wherein FIG. 72 (a) is a front view of the distal end portion of the cavity securing portion, and FIG. Bottom view,
(C) is a sectional view taken along line DD of FIG.

FIG. 73 is a diagram showing a state in which the cavity securing portion formed by the band-shaped member according to the twenty-first embodiment is expanded.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Sheath for ensuring a cavity, 2 ... Mandolin for expansion, 3 ... Rod, 4 ... Airtight inner cylinder, 5 ... Spike, 6 ... Plug for scope channel, 7 ... Plug for spike channel, 8 ... Suction tube, 11 ... Treatment Channel, 12 ... scope channel, 14 ... O-ring, 15 ... laparoscope, 16 ... optical viewing tube,
19: tapered portion, 21: spike channel, 76: female, 77 ... only, 88: needle-like member, 92: needle-like member, 9
7 ... engaging member.

Claims (1)

[Claims] 1. A cavity securing sheath which is inserted into a body tissue and forms a bone surgery working space with a lumen, is attached to the sheath,
A treatment channel for guiding a treatment instrument used for treating a bone to the bone surgery working space, an observation means attached to the sheath, and for observing an operation field in the bone surgery working space; An engaging means provided at the distal end and engaging the distal end of the sheath with the bone, inserting the sheath into body tissue, engaging the distal end of the sheath with the bone by the engaging means, and holding the sheath. In addition, a bone surgery instrument for performing bone treatment by performing a treatment in the bone surgery working space under observation by the observation means.