WO2006012797A1 - Instrument de chirurgie osseuse a ultrasons combinant les vibrations - Google Patents

Instrument de chirurgie osseuse a ultrasons combinant les vibrations Download PDF

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WO2006012797A1
WO2006012797A1 PCT/CN2005/001185 CN2005001185W WO2006012797A1 WO 2006012797 A1 WO2006012797 A1 WO 2006012797A1 CN 2005001185 W CN2005001185 W CN 2005001185W WO 2006012797 A1 WO2006012797 A1 WO 2006012797A1
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ultrasonic
handle
surgical
surgical tool
surgery
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PCT/CN2005/001185
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English (en)
French (fr)
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Wenyong Shi
Zhaoying Zhou
Yuli Zhang
Xiaoning Luo
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Wenyong Shi
Zhaoying Zhou
Yuli Zhang
Xiaoning Luo
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Application filed by Wenyong Shi, Zhaoying Zhou, Yuli Zhang, Xiaoning Luo filed Critical Wenyong Shi
Priority to JP2007524160A priority Critical patent/JP2008508065A/ja
Priority to DE112005001878T priority patent/DE112005001878T5/de
Publication of WO2006012797A1 publication Critical patent/WO2006012797A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/32007—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with suction or vacuum means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320082—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic for incising tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320084—Irrigation sleeves

Definitions

  • Another object of the present invention is to provide a composite vibrating ultrasonic bone surgery instrument, wherein the transducer adopts a discontinuous pulse driving method to avoid local heat accumulation in the wound portion and realize "cold cutting".
  • Figure 8 is an outline view of a spherical sharpening surgical tool with minute grinding teeth
  • the adapter is a conductive slip ring 6 or Other devices that can supply rotating components from a fixed wire, such as a brush-like structure in an electric motor or engine.
  • a water injection frame 12 is provided, and the water injection frame 12 supports a water injection pipe 14 for cooling the surgical tool 16.
  • a protective cover 15 is also provided on the outside of the thicker portion of the surgical blade 16.
  • the driving motor 4 is disposed at the rear end of the outer casing 2, and the driving motor 4 drives the transducer 9 and the horn 10 to rotate, when performing the bone cutting operation
  • the surgical tool 16 mounted on the front end of the handle 1 vibrates longitudinally, and the surgical tool 16 is also rotated or oscillated by the rotation of the motor to generate a composite ultrasonic vibration, thereby cutting the bone of the surgical site, Drilling, grinding, etc.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Mechanical Engineering (AREA)
  • Biomedical Technology (AREA)
  • Dentistry (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Description

复合超声振动的超声骨骼手术仪
技术领域
本发明涉及一种手术医疗设备， 更具体地说， 涉及一种其中的超声手术刀具既可纵向 振动又可旋转或摆动的复合振动的超声骨骼手术仪。本发明还涉及利用上述超声手术仪进 行骨骼手术的方法。 背景技术
随着现代医学的迅速发展， 超声手术仪己越来越多地应用于临床外科手术治疗中， 它 将超声能量应用于外科手术，其突出的特点是切割精细、安全、组织选择性和低温止血等， 极大地丰富了外科手术的手段， 提升了外科手术的质量， 一定程度上减轻了患者的病痛。 图 1是常规超声骨骼手术仪的系统工作原理图， 该系统主要由主机、 手柄、 刀具和脚踏开 关组成。 其中主机主要包括超声信号发生器、 功率放大器和嵌入式计算机。 超声信号发生 器产生的小功率超声电信号经功率放大器放大后， 可驱动手柄中的超声换能器工作； 嵌入 式计算机主要负责协调和控制整机工作， 接收控制指令， 显示仪器工作状态， 实现人机交 互和脚踏控制等功能。 另外嵌入式计算机还要完成对超声换能器频率自动跟踪功能。手柄 包括超声换能器和变幅杆， 完成将超声电信号转化成超声机械波， 经变幅杆实现振幅放大 后， 传递到手术刀具。 此外， 手柄上还配有冷却液体灌注机构， 以降低手术刀具切割骨骼 时创面的温度。
在公开号为 CN1039780C的中国发明专利文献中， 公开了一种超声手术仪， 该超声手 术仪包括手柄和主机， 其中手柄内设有换能器、 变幅杆、 冲洗管、 电缆、 手术刀具等。
在公开号为 CN2435054Y所中国实用新型专利文献中， 公开了一种超声骨骼切割仪， 该切割仪的变幅杆端部结合一手术刀具， 该手术刀具的端部釆用立刃式结构。 手术时， 手 术刀具的立刃结构在变幅杆的驱动下产生最大幅度的超声波机械振动，立刃结构的超声振 动所产生的切割力可对手术部位的软组织或骨骼组织进行切割， 从而对患者进行手术。这 种骨骼切割仪在术中对患者创伤较小， 可降低出血量， 减轻患者的痛苦。
另外， 在美国专利文献 US5486162A、 US5562609A, US5562610A, US6033375A中， 也分别公开了可以产生纵向超声振动的超声手术仪。而且， 美国专利文献 US6497715A中 公幵了一种用于超声手术仪的超声骨骼刀具， 其可用于脊柱的减压手术。
但是， 在现有超声手术仪中， 超声信号发生器产生的超声电信号驱动手柄中的超声换 能器， 换能器将超声电信号转化成超声机械波， 再经变幅杆实现振幅放大后， 传递到手术 刀具。 这样， 手术刀具只能在纵向方向上前后振动， 其切割骨骼的效率低， 而且手术刀具 和创伤表面之间的摩擦力较大， 容易引起切割创伤表面温度的升高， 甚至会造成切割创伤 口附近的神经和血管的热损伤。
另外， 现有超声手术仪的手术刀具的形状一般是由安装在变幅杆上的、较粗的一端逐 渐过渡到进行切割的、 较细的一端， 这样切割应力就主要集中在过渡结束的部位， 使该部 位容易发生疲劳断裂， 致使手术刀具损坏。 发明内容
本发明的一个目的是提供一种复合振动的超声骨骼手术仪，其手柄在超声换能器上配 置驱动电机， 使手术刀具既可纵向振动又可旋转， 从而实现扭向复合超声振动， 提高切割 效率。
本发明的再一目的是提供一种复合振动的超声骨骼手术仪，其手术刀具可以进行扭向 复合超声振动。
本发明的另一目的是提供一种复合振动的超声骨骼手术仪，其换能器采用断续脉冲驱 动的方式， 可避免创伤部位局部热量的积累， 实现 "冷切割"。
本发明的还一目的是提供一种复合振动的超声骨骼手术仪，其安装在手柄上的手术刀 具设有多个过渡阶梯， 从而使刀具的疲劳应力均匀分布在刀具的多个位置， 避免了手术刀 具由于疲劳应力的集中而引发的断裂。
本发明的最后目的是提供一种利用上述超声手术仪进行骨骼手术的方法。
本发明的其它方面和 /或优点将在下面的详细描述中进行说明。
根据本发明的第一方面， 提供一种复合超声振动的超声骨骼手术仪， 其包括手柄、 安 装在所述手柄前端的手术刀具以及超声信号发生器， 其特征在于， 所述手柄的外壳内依次 安装有驱动机构、 适配器、 超声换能器和变幅杆， 驱动电机通过传动机构与换能器和变幅 杆连接，其中：所述超声换能器将所述超声信号发生器发出的超声信号转换成超声机械波； 所述变幅杆将发自所述超声换能器的超声机械波进行振幅放大后再传递到所述手术刀具， 以使所述手术刀具纵向超声振动；所述驱动机构用于驱动所述超声换能器和变幅杆旋转或 摆动； 所述适配器设置在所述驱动机构和超声换能器之间， 用于将所述超声信号发生器发 出的超声电信号提供给所述超声换能器。
在上述超复合振动的超声骨骼手术仪中， 由于在所述外壳的后端设置驱动电机， 而且 该驱动电机驱动换能器和变幅杆旋转，这样就使安装在手柄前端的手术刀具在纵向振动的 同时， 还可进行旋转， 从而产生扭向超声复合振动， 对手术部位的骨骼进行切割、 钻孔、 磨削等， 使手术者可以像握笔一样平稳地控制超声手术仪的手柄对骨骼实施手术， 既降低 了刀具与创伤面之间的摩擦力， 从而降低了创伤面的切割温度， 同时还提高了切割效率。 在靠近神经和血管这种关键部位切割时，这种超声复合振动对病变骨骼的磨削比传统 的单一超声振动对病变骨骼的切割安全性大大提高。这种超声复合振动， 除了用于骨骼的 切割以外， 也可以应用在切割或者磨削软组织的手术中， 如神经外科的胶质肿瘤的摘除、 白内障摘除等等。
优选地， 在上述骨骼手术仪中， 所述适配器是导电滑环， 所述导电滑环包括内环和与 所述内环电连接的外环， 所述外环固定在所述外壳内并电连接外部信号发生器， 所述内环 与所述换能器同步转动并相互电连接。 最好是， 内环和外环之间为电刷式电连接。
优选地， 在上述骨骼手术仪中， 所述超声信号发生器向所述换能器间断地发出脉冲超 声信号， 以使所述换能器间断地产生超声机械波， 以降低手术刀具对骨骼进行切割或磨削 或钻孔时产生的温度。
优选地， 在上述骨骼手术仪中， 所述手术刀具从较粗的一端到较细的一端设有多个过 渡阶梯。
优选地，在上述骨骼手术仪中，所述手术刀具为带有锯齿的片状切刀或者圆头状切刀。 优选地， 在上述骨骼手术仪中， 所述手术刀具为带有滚花和滚槽、 或螺纹状切刃、 或 微小磨齿、 或砂砾的具有磨削功能的球形或者圆柱形或者锥形磨头。 这里， 通过这种具有 磨削功能的球形或圆柱形磨头所产生的超声波能量磨削病变骨质， 与薄片状切刀相比较， 提高了切削的精确度和安全性。
优选地， 在上述骨骼手术仪中 ， 所述手术刀具为平滑的、 或带有细小滚花和滚槽、 或 带有细小砂砾的球形止血刀。
优选地， 在上述骨骼手术仪中， 所述手术刀具为中空结构， 并且该中空结构的开口分 别位于手术刀具的端部和侧部。
优选地， 在上述骨骼手术仪中， 还设有液体灌注机构， 用于向手术区域灌注液体以使 手术区域局部冲洗和降温。
采用具有上述结构的超声骨骼手术仪， 进一步提高了操作安全性和精确性。其独特的 手术刀具结构可以将超声能量集中送到刀具的前端， 切割骨骼时刀具前端的能量密度很 大， 可以获得很好的切割骨骼的效果。 而且， 手术刀具的疲劳应力更加均匀分布， 延长了 刀具的使用寿命。 此外， 手术时手术人员手持的手柄部分静止不动， 减轻了劳动强度， 有 利于提高手术质量。 另外， 这种超声骨骼手术仪在切割骨骼时， 对周围的软组织具有良好 的保护作用， 尤其在人体的关键部位脊柱手术中， 可保证脊髓不受损伤。 更进一步地， 由 于超声骨骼手术仪具有低温凝血功能， 使得创面不出血， 无焦痂， 并发症少。
根据本发明的第二方面， 提供一种用于骨骼手术的超声手术仪， 其包括主机、 手柄和 安装在手柄前端的手术刀具， 主机与手柄通过导线连接， 其特征在于， 所述手柄内安装有 超声换能器， 所述超声换能器能将超声电信号转换成超声机械波， 并带动刀具振动， 所述 手术刀具的刀头为球形或者柱形磨头， 该刀头发出超声波能量， 用于骨组织的切割、 磨削 或钻孔。
根据本发明的第三方面， 提供一种用于骨骼手术的超声手术仪， 其包括主机、 手柄和 安装在手柄前端的手术刀具， 主机与手柄通过导线连接， 其特征在于， 所述手柄内安装有 超声换能器， 所述超声换能器能将超声电信号转换成超声机械波， 并带动刀具振动， 所述 手术刀具能在刀头发出超声波能量， 使得被切割、 磨削或钻孔的组织局部升温， 达到凝血 的目的， 用于实现骨骼手术中的止血功能。
根据本发明的第四方面， 提供一种用于骨骼手术的超声手术仪， 其包括主机、 手柄和 安装在手柄前端的手术刀具， 主机与手柄通过导线连接， 所述手柄内设有驱动机构、 传动 机构和超声换能器， 其特征在于， 所述超声换能器用于将超声电信号转换成超声机械波， 并带动刀具以超声频率振动， 所述驱动机构用于产生低于超声频率的扭向运动， 所述传动 机构用于将驱动机构产生的扭向运动传递到超声换能器， 带动超声换能器做复合运动， 从 而使手术刀具实现扭向超声复合振动。
优选地， 在上述超声手术仪中， 所述驱动机构通过电动、 气动、 或人工辅助方法使刀 具做扭向复合振动。
根据本发明的第五方面， 提供一种用于骨骼手术的超声手术仪， 包括主机、 手柄和安 装在手柄前端的手术刀具， 主机与手柄通过导线连接， 所述手柄内设有驱动机构、 传动机 构和超声换能器， 其特征在于， 所述超声换能器用于将超声电信号转换成超声机械波， 并 带动刀具以超声频率振动， 所述驱动机构用于产生低于超声频率的纵向运动， 所述传动机 构用于将驱动机构产生的纵向运动传递到超声换能器，通过超声换能器带动手术刀具实现 纵向超声复合振动。 '
优选地， 在上述超声手术仪中， 所述驱动机构通过电动、 气动、 或人工辅助方法使刀 具前后纵向移动。
优选地， 在上述超声手术仪中， 还设有液体灌注机构， 用于向手术区域灌注液体以使 手术区域局部冲洗和降温。
优选地， 在上述超声手术仪中， 所述手术刀具前端的手术部分设有一组有利于通畅排 屑的凹槽， 以降低磨削温度。
优选地， 在上述超声手术仪中， 所述手术刀具为中空结构， 并且该中空结构的一端开 口处外连有抽吸装置， 用于吸除手术残渣。
优选地， 在上述超声手术仪中， 所述中空结构是指手术刀具是中空的， 并与抽吸装置 的抽吸管相连。
优选地，在上述超声手术仪中，所述中空结构的开口分别位于手术刀具的端部和侧部 优选地， 在上述超声手术仪中， 所述超声换能器为中空结构， 并和手术刀具一起与所 述抽吸管相连。
优选地， 在上述超声手术仪中， 所述驱动机构为中空结构， 并和超声换能器及手术刀 具一起与所述抽吸管相连。
本发明所述的超声手术仪， 还适用于骨骼手术以外的其它手术。 根据本发明的第六方面， 提供一种利用超声手术仪进行骨骼手术的方法， 超声手术仪 包括主机、 手柄和安装在手柄前端的手术刀具， 手柄内设有驱动机构和超声换能器， 该方 法包括以下步骤： 所述超声手术仪的手柄将脉冲超声电信号间断地转换成超声机械波， 用 间断产生的超声机械波带动所述手术刀具振动，用手术刀具完成骨组织的切割或磨削或钻 孔， 并降低手术刀具对骨骼组织产生的温度。
优选地， 在上述方法中， 所述手术刀具的刀头从较粗的一端到较细的一端设有多个过 渡阶梯。
优选地， 在上述方法中， 所述手术刀具的刀头是球形或柱形或锥形磨头。
优选地， 在上述方法中， 所述手术刀具的刀头是平滑的、 或带有细小滚花和滚槽或细 小砂砾的球形止血刀， 用该球形止血刀实现手术时的止血功能。
根据本发明的第七方面， 提供一种利用超声手术仪进行骨骼手术的方法， 超声手术仪 包括主机、 手柄和安装在手柄前端的手术刀具， 手柄内设有驱动机构和超声换能器， 该方 法包括以下步骤： 所述超声手术仪的手柄将超声电信号转换成超声机械波， 用超声机械波 带动所述手术刀具振动， 使得被切割或磨削或钻孔的骨骼组织局部升温， 达到凝血， 实现 骨骼手术中的止血功能。
根据本发明的第八方面， 提供一种利用超声手术仪进行手术的方法， 超声手术仪包括 主机、 手柄和安装在手柄前端的手术刀具， 手柄内设有驱动机构和超声换能器， 该方法包 括以下步骤： 所述超声手术仪的手柄将超声电信号转换成超声机械波， 用超声机械波带动 手术刀具振动， 使手术刀具实现纵向或者扭向复合振动， 完成手术组织的切割或磨削或钻 孔。 就是说， 本发明的超声骨骼手术仪， 除了适用于骨骼手术外， 还适用于骨骼手术以外 的其他手术。
优选地， 在上述方法中， 利用一种液体灌注机构向手术区域灌注液体， 使手术区域的 局部冲洗和降温。
优选地， 在上述方法中， 所述超声手术仪外连有抽吸装置， 通过下列方法之一将手术 区域的手术残渣吸除：
a) 将手术刀具设计成中空结构并与抽吸装置的抽吸管相连接，
b) 将手术刀具和超声换能器设计成中空结构并与抽吸装置的抽吸管相连，
c ) 将手术刀具、 超声换能器和驱动机构设计成中空结构并与抽吸装置的抽吸管相 连，
d ) 在手柄外附设所述抽吸装置的抽吸管。
根据本发明的第九方面， 提供一种利用超声手术仪进行骨骼手术的方法， 超声手术仪 包括主机、 手柄和安装在手柄前端的手术刀具， 手柄内设有驱动机构和超声换能器， 该方 法包括以下步骤： 所述超声手术仪的手柄将超声电信号转换成超声机械波， 用超声机械波 带动手术刀具振动， 完成骨组织的切割或磨削或钻孔， 其中， 所述手术刀具是一种具有磨 削功能的球形或圆柱形磨刀， 所述磨刀的前端带有滚花和滚槽、 或者螺紋状切刃、 或者微 小磨齿、 或者砂砾、 或者具有利于通畅排屑的凹槽。
本发明所述的利用超声手术仪进行骨骼手术的方法，还适用于骨骼手术以外的其它手 术。 附图说明
通过结合附图对本发明具体实施例的详细描述，将会对本发明的发明目的和技术构思 有更清楚的了解， 其中：
图 1是常规超声骨骼手术仪的系统工作原理图；
图 2是本发明所述复合振动的超声骨骼手术仪手柄的立体示意图；
图 3是图 2所示复合振动的超声骨骼手术仪手柄的纵向剖面图；
图 4是图 3所示导电滑环的剖面图；
图 5是带有锯齿的片状切刀式手术刀具的外形图；
图 6是带有锯齿的圆头状切刀式手术刀具的外形图；
图 7是带有微小磨齿的圆柱形磨刀式手术刀具的外形图；
图 8是带有微小磨齿的球形磨刀式手术刀具的外形图；
图 9是平滑的球形止血刀式手术刀具的外形图；
图 10是具有中空结构的超声手术仪的剖视图， 图中手术刀具连接有抽吸装置。 发明的最佳实施方式
下面将对本发明的最佳具体实施方式进行详细描述， 在附图中只是示出了其实例， 其 中相同的标号表示相同的部件。 图 2是本发明复合振动的超声骨骼手术仪手柄的立体示意图， 图 3是图 2所示手柄的 纵向剖面图。 参照图 2和图 3 , 该复合振动的超声骨骼手术仪包括手柄 1、 安装在手柄 1 前端的手术刀具 16以及超声信号发生器。 其中， 手柄 1的外壳 2内依次安装有驱动电机 4、 适配器、 换能器 9和变幅杆 10。 换能器 9将超声信号发生器发出的超声信号转换成超 声机械波，变幅杆 10将发自换能器 9的超声机械波进行振幅放大后再传递到手术刀具 16， 以使手术刀具 16纵向超声振动。 驱动电机 4通过固定在外壳 2上的支架 3安装在外壳 2 的后端。驱动电机 4的输出轴 5通过联轴器 7连接至换能器 9的后部， 以驱动换能器 9和 变幅杆 10旋转； 同时， 驱动电机也可以通过联轴器 7与换能器 9和变幅杆 10连接， 以使 安装在变幅杆 10前端的手术刀具 16产生摆动。 优选地， 联轴器 7通过绝缘垫 20与换能 器 9连接， 以在联轴器 7和换能器之间进行电绝缘。所述适配器设置在驱动电机 4和换能 器 9之间， 用于将所述超声信号发生器发出的超声信号提供至所述换能器， 优选地， 适配 器是导电滑环 6， 也可以是其它能够从固定的导线给旋转部件供电的装置， 比如类似电动 机或发动机中的电刷式结构。 进一步地， 在外壳 2前端的夕卜部， 设有注水架 12， 该注水 架 12上支撑有注水管 14， 用于对手术刀具 16进行降温。 手术刀具 16后部较粗的部分外 面还套设有保护套 15。
参照图 4， 在上述骨骼手术仪中， 导电滑环 6包括内环 8和与该内环 8电连接的外环 11。 更具体地说， 外环 11固定在外壳 2内， 外环 11上设置有导电凹槽 13， 外部信号发生 器通过设置在导电凹槽 13中的导线连接至固定在外环 11上的导电刷 17。内环 8设置成与 换能器 9同步转动， 在一优选实施例中， 驱动电机 4可通过穿过内环 8中心通孔的联轴器 7驱动换能器 9。 内环 8与联轴器 7之间通过顶丝 （或键槽） 固定连接， 这样， 驱动电机 4便可带动内环 8做与换能器同步的摆动或旋转运动， 其中可通过使换能器连续的正反向 转动而实现手术刀具的摆动。 在内环 8上设置有导电体 18, 该导电体 18的位置与导电刷 17的位置相对应并且紧密地电接触。 这样， 当内环 8转动时， 外部信号发生器的电信号 可传输到随内环 8转动的导电体 18， 并进一步通过设置在内环 8中的凹槽 19内的导线传 输到与内环 8同步转动的换能器 9， 从而将信号发生器产生的超声信号传输到换能器 9。 在上述导电滑环 6的结构中， 内环 8和外环 11之间为电刷式电连接， 但本发明并不局限 于此， 也可以采用其它结构代替， 只要可将信号发生器的超声信号传输到做摆动或旋转运 动的换能器 9即可。
在上述复合振动超声骨骼手术仪的手柄中， 由于在外壳 2的后端设置驱动电机 4， 而 且该驱动电机 4驱动换能器 9和变幅杆 10旋转， 这样在进行骨骼切割手术时， 在外部信 号发生器的控制下， 安装在手柄 1前端的手术刀具 16纵向振动， 同时手术刀具 16还由于 电机的旋转而进行旋转或摆动， 以产生复合超声振动， 进而对手术部位的骨骼进行切割、 钻孔、 磨削等， 使手术者可以像握笔一样平稳地控制超声手术仪的手柄对骨骼 "雕刻"出 任何形状， 既提高了切割效率， 又由于降低了刀具与创伤面之间的摩擦力， 从而降低了创 伤面的切割温度。
优选地， 在本发明所述的骨骼手术仪中， 控制超声信号发生器向换能器 9间断地发出 超声信号， 以使所述换能器间断地产生超声机械波。实验证明：在有灌注水冷却的情况下， 超声手术仪的刀具切割骨骼时， 创面附近 1到 2mm的小范围内产生的温度为 50— 90°C。 由于在本发明中， 超声手术刀具 16所释放出的能量是瞬间爆破型的， 在发射超声能量的 间隙，切割创伤表面因摩擦产生的热量可得到充分地扩散，避免了创伤面的局部热量积累， 这样可实现 "冷切割"， 创面温度为 40°C以下， 防止对创伤面以及周围神经和血管过度热 损伤。
这种超声复合振动也可以应用在切割或者磨削软组织的手术中， 如神经外科的胶质 肿瘤的摘除、 白内障摘除等等。
图 5— 9示出了各种手术刀具 16的具体实施例， 图中所示的手术刀具从较粗的一端到 较细的一端设有多个过渡阶梯。众所周知， 超声手术刀具 16—般工作在 20至 60KHz， 在 这样高的频率下工作， 手术刀具 16很容易因为高度疲劳而断裂。现有技术中的手术刀具， 为避免其断裂， 所采取的技术措施往往是增加刀具的厚度， 但这样不能适应精细骨骼手术 的需要。 为此， 有人把手术刀具设计成由较粗的安装端逐渐过渡到较细的手术端， 但试验 表明， 这样的刀具其工作应力都作用在过渡结束的部位， 因此过渡结束的部位容易断裂。 而本发明的手术刀具结构可以将超声能量集中送到切割刀具的前端，切割骨骼时刀具前端 的能量密度很大，可以获得很好的切割骨骼的效果，而手术刀具的疲劳应力却均匀分布开， 避免了由于疲劳应力的集中而引发刀具断裂的现象， 提高了刀具的使用寿命。
为适应各种临床骨骼手术的需要， 在本发明中， 手术刀具 16可以为带有锯齿 21的片 状切刀和圆头状切刀， 这样可实现对骨骼的切割。 手术刀具 16也可以为带有滚花和滚槽 22的球形、 锥形或圆柱形磨刀， 以实现对骨骼的钻孔、 磨削等。 进一步地， 手术刀具 16 还可以为平滑的、 或带有细小滚花和滚槽或细小砂砾的球形止血刃， 以实现对创伤部位的 止血， 使创面不出血， 无焦痴， 并发症少。
本发明的超声手术仪的手柄或手术刀具可以为中空结构。 图 10为其中的一种中空结 构。 如图所示， 手术刀具 16、 超声换能器和驱动机构均为中空结构， 该中空结构的后端 与一个抽吸装置的抽吸管相连。 该抽吸装置包括储存室 23和负压系统 24。 手术时， 该抽 吸装置利用负压系统 24的抽吸力，可把手术刀具 16产生的骨渣等残留物通过手术刀具的 中空部分抽出， 并储存在储存室 23 中， 这样可使手术部位清晰可见， 清晰手术人员的视 野， 避免误伤人体的神经等不需手术的部位。 当然， 作为选择， 中空结构的开口也可以分 别位于手术刀具的前端部和侧部， 这样就可以从手术刀具的侧部开口处连接抽吸装置。 在上文中， 已经对本发明的超声骨骼手术仪做了详细描述。 下面， 将对利用上述超声 手术仪进行骨骼手术的方法进行简要说明。
一种利用上述超声手术仪进行骨骼手术的方法， 包括： 超声手术仪的手柄将脉冲超声 电信号间断地转换成超声机械波， 用间断产生的超声机械波带动手术刀具振动， 用手术刀 具完成骨组织的切割或磨削或钻孔， 并降低手术时手术刀具对骨骼组织产生的温度。
一种利用上述超声手术仪进行骨骼手术的方法， 包括： 超声手术仪的手柄将超声电信 号转换成超声机械波， 用超声机械波带动手术刀具振动， 使得被切割或磨削或钻孔的骨骼 组织局部升温， 达到凝血的目的， 实现骨骼手术中的止血功能。
一种利用上述超声手术仪进行手术的方法， 包含： 超声手术仪的手柄将超声电信号转 换成超声机械波， 用超声机械波带动手术刀具振动， 使手术刀具实现纵向或者扭向复合振 动， 完成病变组织的切割或磨削或钻孔。
一种利用上述超声手术仪进行骨骼手术的方法， 包含： 超声手术仪的手柄将超声电信 号转换成超声机械波，用超声机械波带动手术刀具振动，完成骨组织的切割或磨削或钻孔， 其中， 手术刀具是一种具有磨削功能的球形或圆柱形磨刀， 磨刀的前端带有滚花和滚槽、 或螺纹状切刃、 或微小磨齿、 或砂砾、 或利于通畅排屑的凹槽。
本发明的上述实例和实施方式只是示例性的， 而不是限定性的， 本发明并不局限于本 说明书所给出的细节， 而是在随附权利要求书及其等同替换的范围之内， 可以进行改进。 工业实用性
本发明的复合超声振动的超声骨骼手术仪以及利用超声骨骼手术仪进行骨骼手术的 方法， 可以广泛应用于医疗领域， 不仅适用于对骨骼实行手术， 而且适用于骨骼手术以外 的其它医疗手术， 具有工业实用性。

Claims

1 . 一种复合超声振动的超声骨骼手术仪， 包括手柄、 安装在所述手柄前端的手术刀 具以及超声信号发生器， 其特征在于： 所述手柄的外壳内安装有驱动机构、 适配器、 超声 换能器和变幅杆， 驱动机构通过传动机构与换能器和变幅杆连接， 其中：
所述超声换能器将所述超声信号发生器发出的超声信号转换成超声机械波； 所述变幅杆将发自所述超声换能器的超声机械波进行振幅放大后再传递到所述手术 刀具， 以使所述手术刀具纵向超声振动；
所述驱动机构用于驱动所述超声换能器和变幅杆旋转或摆动；
所述适配器设置在所述驱动机构和超声换能器之间，用于将所述超声信号发生器发出 的超声电信号提供给所述超声换能器。
2. 如权利要求 1所述的骨骼手术仪， 其特征在于： 所述适配器是导电滑环， 该导电 滑环包括内环和与所述内环电连接的外环，所述外环固定于所述外壳内并与外部的信号发 生器电连接， 所述内环与所述超声换能器同步转动并相互电连接。
3. 如权利要求 2所述的骨骼手术仪， 其特征在于： 所述内环和外环之间为电刷式电 连接。
4. 如权利要求 1一 3任一项所述的骨骼手术仪， 其特征在于： 所述超声信号发生器向 超声换能器间断地发出脉冲超声信号， 使超声换能器间断地产生超声机械波， 以降低手术 刀具对骨骼进行切割或磨削或钻孔时产生的温度。
5. 如权利要求 1一 4任一项所述的骨骼手术仪， 其特征在于： 所述手术刀具从较粗的 一端到较细的一端设有多个过渡阶梯。
6. 如权利要求 1一 5任一项所述的骨骼手术仪， 其特征在于： 所述手术刀具为带有锯 齿的片状切刀或圆头状切刀。
7. 如权利要求 1一 5任一项所述的骨骼手术仪， 其特征在于： 所述手术刀具为带有滚 花和滚槽、 或螺纹状切刃、 或微小磨齿、 或砂砾的具有磨削功能的球形或圆柱形磨刀。
8. 如权利要求 1一 5任一项所述的骨骼手术仪， 其特征在于： 所述手术刀具为带有滚 花和滚槽、 或螺纹状切刃、 或微小磨齿、 或砂砾的具有磨削功能的锥形磨刀。
9.如权利要求 1一 5任一项所述的骨骼手术仪，其特征在于：所述手术刀具为平滑的、 或带有细小滚花和滚槽、 或带有细小砂砾的球形止血刀。
10. 如权利要求 6— 9任一项所述的骨骼手术仪， 其特征在于： 所述手术刀具为中空 结构， 并且该中空结构的开口位于手术刀具的端部或侧部。
11 .如权利要求 1一 10任一项所述的骨骼手术仪，其特征在于：还设有液体灌注机构， 用于向手术区域灌注液体以使手术区域局部冲洗和降温。
12. —种用于骨骼手术的超声手术仪， 其包括主机、 手柄和安装在手柄前端的手术刀 具， 主机与手柄通过导线连接， 其特征在于：
所述手柄内安装有超声换能器， 所述超声换能器能将超声电信号转换成超声机械波， 并带动刀具振动；
所述手术刀具的刀头为球形或者柱形磨头， 该刀头发出超声波能量， 用于骨组织的切 割、 磨削或钻孔。
13. 一种用于骨骼手术的超声手术仪， 其包括主机、 手柄和安装在手柄前端的手术刀 具， 主机与手柄通过导线连接， 其特征在于：
所述手柄内安装有超声换能器， 所述超声换能器能将超声电信号转换成超声机械波， 并带动刀具振动；
所述手术刀具能在刀头发出超声波能量， 使得被切割、 磨削或钻孔的组织局部升温， 达到凝血， 用于骨骼手术止血。
14.一种用于骨骼手术的超声手术仪，包括主机、手柄和安装在手柄前端的手术刀具， 主机与手柄通过导线连接， 所述手柄内设有驱动机构、 传动机构和超声换能器， 其特征在 于：
所述超声换能器用于将超声电信号转换成超声机械波， 并带动刀具以超声频率振动； 所述驱动机构用于产生低于超声频率的扭向运动；
所述传动机构用于将驱动机构产生的扭向运动传递到超声换能器，带动超声换能器做 复合运动， 从而使手术刀具实现扭向超声复合振动。
15. 如权利要求 14所述的超声手术仪， 其特征在于： 所述驱动机构通过电动、 气动、 或人工辅助方法使刀具做扭向复合振动。
16.一种用于骨骼手术的超声手术仪，包括主机、手柄和安装在手柄前端的手术刀具， 主机与手柄通过导线连接， 所述手柄内设有驱动机构、 传动机构和超声换能器， 其特征在 于：
所述超声换能器用于将超声电信号转换成超声机械波， 并带动刀具以超声频率振动， 所述驱动机构用于产生低于超声频率的纵向运动，
所述传动机构用于将驱动机构产生的纵向运动传递给超声换能器，通过超声换能器带 动手术刀具实现纵向超声复合振动。
17. 如权利要求 16所述的超声手术仪， 其特征在于： 所述驱动机构通过电动、 气动、 或人工辅助方法使刀具前后纵向移动。
18. 如权利要求 12— 17任一项所述的超声手术仪， 其特征在于： 还设有液体灌注机 构， 用于向手术区域灌注液体以使手术区域局部冲洗和降温。
19. 如权利要求 12— 18任一项所述的超声手术仪， 其特征在于： 所述手术刀具前端 的手术部分设有一组有利于通畅排屑的凹槽， 以降低磨削温度。
20. 如权利要求 12— 19任一项所述的超声手术仪， 其特征在于： 所述手术刀具为中 空结构， 并且该中空结构的一端开口处外连有带抽吸管的抽吸装置， 用于吸除手术残渣。
21 . 如权利要求 20所述的超声手术仪， 其特征在于： 所述中空结构是指手术刀具是 中空的， 并与抽吸装置的抽吸管相连。
22. 如权利要求 21所述的超声手术仪， 其特征在于： 所述超声换能器为中空结构， 并和手术刀具一起与所述抽吸管相连。
23. 如权利要求 22所述的超声手术仪， 其特征在于： 所述驱动机构为中空结构， 并 和超声换能器及手术刀具一起与所述抽吸管相连。
24. 如权利要求 12— 23任一项所述的超声手术仪， 其特征在于： 适用于骨骼手术和 骨骼手术以外的其他手术。
25. 如权利要求 13— 23 任一项所述的超声手术仪， 其特征在于： 所述手术刀具的刀 头为具有磨削功能的球形或者柱形磨头， 该刀头发出超声波能量， 用于磨削病变骨质。
26. 如权利要求 25 所述的超声手术仪， 其特征在于： 所述磨头的表面带有滚花和滚 槽、 或者螺纹状切刃、 或者微小磨齿、 或者砂砾。
27. 一种利用超声手术仪进行骨骼手术的方法， 所述超声手术仪包括主机、 手柄和安 装在手柄前端的手术刀具， 手柄内设有驱动机构和超声换能器， 该方法包括以下步骤： 所述手柄将脉冲超声电信号间断地转换成超声机械波，
用间断产生的超声机械波带动所述手术刀具振动，
用手术刀具完成骨组织的切割或磨削或钻孔， 并降低手术刀具对骨骼组织产生的温 度。
28. 一种利用超声手术仪进行骨骼手术的方法， 所述超声手术仪包括主机、 手柄和安 装在手柄前端的手术刀具， 手柄内设有驱动机构和超声换能器， 该方法包括以下步骤： 所述手柄将超声电信号转换成超声机械波，
用超声机械波带动所述手术刀具振动， 进行骨骼手术，
所述手术刀具的刀头从较粗的一端到较细的一端设有多个过渡阶梯，用来延长手术刀 具的寿命。
29. 一种利用超声手术仪进行骨骼手术的方法， 所述超声手术仪包括主机、 手柄和安 装在手柄前端的手术刀具， 手柄内设有驱动机构和超声换能器， 该方法包括以下步骤： 所述手柄将超声电信号转换成超声机械波，
用超声机械波带动所述手术刀具振动，
所述手术刀具的刀头是球形或柱形或锥形磨头， 用来完成对骨骼磨削或钻孔。
30. 一种利用超声手术仪进行骨骼手术的方法， 所述超声手术仪包括主机、 手柄和安' 装在手柄前端的手术刀具， 手柄内设有驱动机构和超声换能器， 该方法包括以下步骤： 所述手柄将超声电信号转换成超声机械波，
用超声机械波带动所述手术刀具振动，
所述手术刀具的刀头是平滑的、 或带有细小滚花和滚槽或细小砂砾的球形止血刀， 用 该球形止血刀实现手术时的止血功能。
31 . 一种利用超声手术仪进行骨骼手术的方法， 所述超声手术仪包括主机、 手柄和安 装在手柄前端的手术刀具， 手柄内设有驱动机构和超声换能器， 该方法包括以下步骤： 所述手柄将超声电信号转换成超声机械波，
用超声机械波带动所述手术刀具振动，
用手术刀具使得被切割或磨削或钻孔的骨骼组织局部升温， 达到凝血， 实现骨骼手术 中的止血功能。
32. 一种利用超声手术仪进行手术的方法， 所述超声手术仪包括主机、 手柄和安装在 手柄前端的手术刀具， 手柄内设有驱动机构和超声换能器， 该方法包括以下歩骤：
所述竽柄将超声电信号转换成超声机械波，
用超声机械波带动手术刀具振动， 使手术刀具实现纵向或者扭向复合振动， 用超声手术仪完成手术组织的切割或磨削或钻孔。
33. 如权利要求 27— 32任一项所述的方法， 其特征在于： 利用一种液体灌注机构向 手术区域灌注液体， 使手术区域的局部冲洗和降温。
34. 如权利要求 27— 32任一项所述的方法， 其特征在于： 所述超声手术仪外连有抽 吸装置， 通过下列方法之一将手术区域的手术残渣吸除：
e ) 手术刀具为中空结构并与抽吸装置的抽吸管相连接，
f) 手术刀具和超声换能器为中空结构并与抽吸装置的抽吸管相连，
g) 手术刀具、 超声换能器和驱动机构为中空结构并与抽吸装置的抽吸管相连， h) 在手柄外附设所述抽吸装置的抽吸管。
35. 如权利要求 27— 34任一项所述的方法， 适用于骨骼手术和骨骼手术以外的其他 手术。
36. 一种利用超声手术仪进行骨骼手术的方法， 所述超声手术仪包括主机、 手柄和安 装在手柄前端的手术刀具， 手柄内设有驱动机构和超声换能器， 该方法包括以下步骤： 所述手柄将超声电信号转换成超声机械波，
用超声机械波带动手术刀具振动，
用超声手术仪完成骨组织的切割或磨削或钻孔，
其中， 所述手术刀具是一种具有磨削功能的球形或圆柱形磨刀， 所述磨刀的前端带有 滚花和滚槽、或者螺纹状切刃、或者微小磨齿、或者砂砾、或者具有利于通畅排屑的凹槽。
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DE112005001878T5 (de) 2007-06-28
JP2008508065A (ja) 2008-03-21
US20060030797A1 (en) 2006-02-09
CN1732861A (zh) 2006-02-15

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