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用于男性骨盆的弯曲切刀钉紧器

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CN100574713C
CN100574713C CN 200410095439 CN200410095439A CN100574713C CN 100574713 C CN100574713 C CN 100574713C CN 200410095439 CN200410095439 CN 200410095439 CN 200410095439 A CN200410095439 A CN 200410095439A CN 100574713 C CN100574713 C CN 100574713C
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end
effector
surgical
positioned
cartridge
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CN 200410095439
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CN1636524A (zh )
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W·凯利
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伊西康内外科公司
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214Stapler heads
    • A61B2017/07221Stapler heads curved
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214Stapler heads
    • A61B2017/07271Stapler heads characterised by its cartridge
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214Stapler heads
    • A61B2017/07285Stapler heads characterised by its cutter
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2927Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2946Locking means
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10TTECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T29/00Metal working
    • Y10T29/49Method of mechanical manufacture
    • Y10T29/49826Assembling or joining
    • Y10T29/4984Retaining clearance for motion between assembled parts
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10TTECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T29/00Metal working
    • Y10T29/49Method of mechanical manufacture
    • Y10T29/49826Assembling or joining
    • Y10T29/49888Subsequently coating

Abstract

一种适于用多个外科固定件固定身体的生理组织的外科装置,该外科装置包括:支架,其具有近端和远端,手柄位于近端处,端部受动器位于远端处;端部受动器的形状和尺寸被设置成用于支撑钉筒壳和基座,钉筒壳和基座结构可在第一分离位置和第二相互邻近位置之间相对移动;击发机构与端部受动器和钉筒壳相连以选择地进行致动;其特征在于:端部受动器具有适于男性骨盆的最佳曲率半径。

Description

200410095439.3 用于男性骨盆的弯曲切刀钉紧器

技术领域

本发明涉及一种自于M31钉紧切除术对病ffitfiH会断和治疗的夕卜科钉紧 器和切除装置。尤其,本发明涉及一种具有曲率的外科钉紧切除装置,特别适 于男性骨盆的解剖结构。

背景技术

夕卜科钉紧切除装置普遍^^在«:钉切除术对病«《»断和«上。外 科钉紧器装置提供了一种鹏,该机构扩展了舰肛门鹏、嘴、胃和连接通

道引入到内腔中的机械钉紧装置的经皮实施(transluminal exploitation)。尽管外

科钉紧切除装置普遍用于翻病理,但慰卜科钉紧器和切除體可以在各种环

随着时间的推移,夕卜科钉紧器和切除體已经有了发展。这些装置通常包 括支撑框架,连接到支撑框架上的基座和具有多个钉的钉筒组件。这些装置也 包括位于钉筒组件内的驱动件,其将所有的钉同时推A^座中以形,组织钉 紧在一起的、通常为B形的钉。并且,这些装置包括^^置,用于从相对于 基座分隔开的位置移动到闭合皿处,在闭合位置处组织被夹紧在基座和钉筒 组件之间。最后,该装置包括击发装置,用于向前移动钉紧驱动件以«基座 进行钉紧。

特别地,在男性骨盆中要进衍午多辦。同样地,需要Hf共一种特别适用 于男性骨盆的外科钉紧器和切除縫。因为男性骨盆朝飾延伸,则在男性骨 盆中所进行的禾ii^由于男性骨盆尺寸的减小而引起的空剛蹄U而遭魏烦。 因为经常需要在邻近锯齿线的区^a行下前部切除,夕卜科钉紧切除装置被构造 的形状和尺寸必须使其位于由男性骨盆所提供的有限空间内最优化。本发明提 供了这样一种适用于在男性骨盆内4OT的夕卜科钉紧器和切除装置。

附图说明

图1是根据本发明的幾砂附钉紧器的透视图;

图2是被拆掉了钉筒组件的缘性外科钉紧器的透视亂

3图3是钉筒组件被移到中间錢处的线性外科钉紧器的透视图;

图4是钉筒组件被移到闭合位置处的线齢卜科钉紧器的透视图; 图5是击发扳机处于击发位置处的的统齢卜科钉紧器的透视图;

图6是钉筒组件的^M图;

图7是其上固定有保謝牛的钉筒组件的正视图;

图8是保^f牛被J斥掉的钉筒组4牛的前透视图;

图9是钉筒组件的一个后Hit视图,图中详细地显示了钉筒壳的狭槽; 图10, U和12^^保^j牛的组装;

图13是处于未击发状态的线傲卜禾4CT紧器的局部横断面视图; 图14是销致动机构的,图;

图15是闭合扳棚肖^L缩进的线性外科钉紧器的局^I黄断面视图;

图16是闭合扳丰腿本上完^l进的线性外科钉紧器的局辦黄断面视图;

图17是闭合扳机完^fl进的线性外禾4^紧器的局辦黄断面视图;

图18是击发扳机和闭合扳机完全縮进的线性夕卜科钉紧器的局繊断面视

图;

图19是外科医生按压释放按te后线桫卜科钉紧器的局繊断面视图; 图20是闭合和击发扳机没有返回到扳机的中间位置时统龄卜科钉紧器的 局部廣断面视图;

图21 —29标钉筒组件的插A^保劍牛的拆亂

图30—38^^本发明的线't^卜科钉紧ll^致动MI呈中的各^骤;和

图39和40是钉筒壳的详细正视图。

具体实施方式

在下面的内容中将对本发明的具体实施例进行描述,但是,应认识到:此 处所披露的实施例仅是对本发明进行进fiH释,这些实施例可以不同的方式来 实现。因此,不育树此处所披露的内容作限定性解释,而仅可将其作为基本依 据以指导本领域技术人员来如何实现和/或1OT本发明。

结合图2至5并参见图1,显示了一种外科钉紧器和切除装置,尤其是一 种被设计成来钉紧和切除组织的线性夕卜科钉紧器20。线性外辦丁紧器20在第 一近端具有手柄21, ^fc相对的远端具有端部^动器80。根据本发明的优选实 施例,使端部受动器80弯曲。左右手持结构板(通常称之为手柄板)34, 35

4分别将手柄21连接到装置的端部受动器80上(左手柄板显示在图1中)。手

柄21具有连接到左手柄外^i:的右手柄外壳22 (左右手柄外壳没有显示在图 1中)。手柄21具有支架部分23以抓住和控制线性外禾4CT紧器20 (参见图2 至5)。

根据本发明的线f鈔卜科钉紧器20特别适用于男性骨盆。具体地,男性骨 盆包括相对小的部分,因此在下前部切除(LAR)期间难以^A,逸就要求装 置到达锯齿线附近的骨盆内。本发明的外科钉紧器20的微和尺寸被设置得 特别用于在下前部切除期间进入男性骨盆内。特别地,线性外科钉紧器20的 端部受动器80适用于以3.00英寸x3.62英寸的椭圆形包膜之内装配和运行。

基于这种理念,根据本发明的雌实施例,线性夕卜禾將丁紧器20具有远端, 组织端部受动器S0的曲率直径是7.8英寸或小于7.8英寸,ttiiitk,小于或等 于4英寸,以装KA男性骨盆的最小繊中。特别地,端部受动器80的曲率 直径在大约1英寸和大约4英寸之间,特别是在大约2英寸和大约4英寸之间。 根据最佳实施例,端部受动器80的曲率直径大约是3英寸。

端部受动器80是一个医用紧固组件,包括一^HT筒壳120 (参见图6—9) 和一个U形支撑结构810闭合件28的远端30被布置来接收钉筒组件120。端 部受动器80还包括一个安^ljM机构180 (从图31中可清^M察到)以阻止 先前已击发的钉筒组件120的击发。钉筒组件i20包括一个与基座122相耦合 的钉筒壳121。钉筒组件120还包括一,擀肖125、一把刀具126、一个可拆 卸的保iff牛160和一个生M织、^I虫表面127。 ^fi^生理组织^^面127显 露出处于刀具126的两侧并以一排或多排的形式交错布置(钉件线)的多^H丁 子容装槽128。来自钉筒壳121的钉子被射向基座122的钉形成表面129,该 钉形成表面129面向钉筒壳121的生理组织接触表面127。

根据下面的内容可明确认识到:本发明的线性外科钉紧器20被设计成具 有一个可更换钉筒组件120的多次击发装置。但是,应理解:在不脱离本发明 主旨的情况下,下文中本发明的多个齢同样适用于单次击发装置。

端部受动器80的支撑结构81 ilii侧翼铆钉82和栓杆83分别连接到左右 手柄盘34、 35上,所述栓杆83从支撑结构81延伸入手柄盘34的接收孔中。 根据本发明的一^ii实施例,支撑结构81是由一个单片构件形成的。更具 体地说,iia例如将铝片挤压、随后进行加工来制作本发明所披露的支撑结构

581。舰以这种方微构造支撑结构81,则不需要多4^M牛,从而显著P斜氐了

生产和组装成本。此外,应认识到:支撑结构81的»|^式结构提高了本发明

线性外科钉紧器20的»^急定性。另外,支撑结构81的整体式挤压娜结构 减轻了本发明的线'龄卜科钉紧器的重量且更易于杀菌消毒,这是因为钴辐射可 有效地穿透被压制的铝片,由于通鄉压可形成平滑的夕卜表面,因而对生理组

织遗成的损伤最小。

线性外科钉紧器20的手柄21包括一个由医生的手掌握持的«持部24 (参见图2-5)。手握持部24由一个右手护板柄25 (参见图1)和一个左手 护板柄(图中未显g左,板柄)构成。 一个闭合扳机26和一^^发扳机27 从手柄21的下侧可枢转性地延伸出来。图1所示线'砂卜禾4I丁紧器20显示:闭 合扳机26和击发扳机27处于其未致g?^fi,钉筒组件120繊入且保劍牛160 被拆掉。因此,钉筒壳121与基座122相分离以将生理组织遣于钉筒壳121和 基座122之间。

线性外科钉紧器20的手柄21包括一个生理组织保^l肖致动机构100。该 生理组织保糊致动机构100包括布置在手柄21的顶表面上的一个马鞍麟 动件101。人工移动该滑动件101榭吏推杆102的远端移动。推杆102与钉筒 组件120的保持销125相配合。推杆102向远端的移动或向近端的回缩会使保 持销125产生相应的运动。保繊致动,100也可释放性地与手柄21中的 闭合扳机26相配合,这样,如果保^f肖125还没有被AX移动至其最近^^ 置,闭合扳机26的致动将使保持销125自动朝着远端运动。

简要参考附图2—5,图中显示了^钉筒组件120进行加载以及随后朝 着手握持部24推压击发扳机26、27以致动线'酵卜科钉紧器20的端部受动器80 时所发生的情况。如图2所示,将钉筒组件120力口载到线性外科钉紧器20上 且将保劍牛160拆掉。如图】所示,此时的线'齢卜科钉紧器20已准备棘接 收生理组织。

在部分推压闭合扳机26以将其置于图3所示的第4恸健时,钉筒组 件121从其完全开启位置移动至处于开启位置和闭合位置之间的一个中间位 置,在下文中将详述该内容。与此同时,生理组织保擀肖致动机构100将保持 销125从钉筒壳121向前移动)i^座122中的一个开口。在iM^中,可将置 于钉筒壳121和基座122之间的生理组纟,^yt行适当定位,这样可确保将生理组织留置在钉筒壳121和基座122之间。因此,当将闭合扳机26致动至其中间 位置时,钉筒壳121和基座122则被相应地定位在其生理组织保,置中。

如图4所示,在闭合扳机26穀皖全推压时而使其誕雜持部24的前 端时,钉筒壳121的生理组织激婊面127与基座122的钉紧成形表面129相 互靠近,这样则可将被正确定位且保持的生理组织完全夹持住。此外击发扳机 27逆时针朝着手握持部24糊以使医生握持击发扳机27,从而射^l了子。因 此,击发扳机27现在处于合适位置以便于外科医生推压以钉紧和切割生理组 织。如图5所示,在完全推压击发扳机27以射^II子时,击发扳机27就处于 与闭合扳机26相靠近的位置处。

现在参考图6—9,下面将对钉筒组件120进蹄细描述。该钉筒组件120 布置有一个在线性外科钉紧器20中顿的切害卿钉紧机构,其中,该机构在 装置的致动过程中在同一方向i^行钉紧和切害蝶作。虽然该钉筒组件120特 别适于与统性外科钉紧器结合使用,但在不脱离本发明主旨的情况下,该钉筒 组件120的原理也可适用于其嫩卜禾爐。特别地,该钉筒组件120布置有在 切割过程中与相应的垫圈123相结合使用的刀具126。该钉筒组件120确保了 线性外科钉紧器20的多次击发不削弱切害胜能。这种功能魏过^S座122 特别是切害U垫圈123与钉筒组件120相结合来实现的。MM;将垫圈123与钉筒 组件120相结合,贝陆每次更换钉筒组件120时可^i共一个新垫圈123,从而 提高切割性能。

m下述布置方式可进"^提高装置盼性能即,将基座122与钉筒壳121 平行布置以使它们相对移动且使基座122和钉筒壳121相面对的表面保持平行 定位。这样就可^E力在生理组织上均匀分布,从而避免以下述方式挤压生理 组织,艮P,将生理组织挤成一束及将部分生理组织J人基座122和钉筒壳121之 间所限定的所需空间中迫压出来。

更具体地说,钉筒组件120包括—^H丁筒壳121,该钉筒壳121包括布置 在钉子容装槽128中的多个钉子(图中未显示)。紧接在钉子之后布置有一个 驱动件131,该驱动件131被布置a将钉子推出钉槽128。在钉筒壳121中 的驱动件131临近^S布置有一个刀具保^ff牛130。刀具保## 130上具有一 个槽172和边缘173以与刀具回收钩45相互作用(参见图37),在下文中将

对回收钩45的功能进fi^细描述。刀具保持件130连接在刀具126上,该刀具126从刀具保劍牛130向远端延伸过驱动件131中的一个槽200并延伸过钉 筒壳121中的一个槽199。

刀具保^f牛130还具有一个止动栓138,该止动栓139延伸过钉筒壳121 中的一个槽137。在刀具126和刀具保持件130的纵向运动过程中,刀具保持 件的止动栓138被布置成与钉筒槽137的止动凸出部137相接触。同样,驱动 件131具有一个止动栓140,该止动栓140被布置成与钉筒槽137的近端止动 凸出部和远端止动凸出部141、 142分别,。

这样布置刀具126禾赠199、 200以使刀具126的两侧至少布置一排钉子。 根据本发明的一个«实施例,在钉筒壳121的槽199的^lh布置两排钉槽 】28 (和两排钉子)。

钉筒壳121在刀具槽199的两端包括有两个通常为圆形的开口 143、 144。 处于钉筒壳121基部处的总体上为圆形的开口 143的形状和尺寸被设置成使导 引销124穿过钉筒壳121。处于钉筒壳121顶部处的总体上为圆形的开口 144 的形状和尺寸被设置成使导引销125穿过钉筒壳121。钉槽128这样布置以使 钉子横向延伸ia常为圆形的?L 143、 144。

根据本发明的一^Hm实施例,基座122包括一个塑(«圈123和一个金 属钉形成表面129。基座122被布置成使钉形戯面129保持匹配的构造形式。 保持销125 iKl保持销125中的一个周向槽135和接合件133中的一个槽134 而与接合件133相连(;1^参考图14)。接合件133布置在钉筒壳121的--个 臂145中5Jlil—个端帽146而保持^^?述臂145中。

导引销124和保持销125具有相应的槽147a、 147b (最好参考附图8、 9、 36、 39、 40),刀具126的端部126a、 126b布置在戶;f^槽147a、 147b中。导 引销124的近端148与基座122的近端149相连。导引销124的远端150从钉 筒壳121处延伸出来且延伸过基座122的一个槽151。 一个切割垫圈123通过 基座122上的一个槽152而滑到基座122上,槽152配合在垫圈123上的--个 舌部153之下。切割垫圈123的相反端154在基座臂155之下滑动Mi--个 销子156而销紧到基座臂155上。在该錢中,垫圈123的切割表面157向上 延伸过基座122的槽151。将切割垫圈123组装至瞎座122上则将导引销124 限定在由基座槽151和切割表面157所形成的开口中,从而将基座122操作性 :t隨接到钉筒壳121丄如图7所示,保謝牛160连接到钉筒组件120上以将钉筒组件120的部fH呆持所需的定CEMM入至iJ端部魏器80中。

现在参考图6—12、 25—29,对保掛牛160迸行更详细的描述。保^# 160 具有围绕钉筒壳121的凸出部159布置的一个槽161。保持件160包括一个被 设置鹏保掛牛160中进份主复运动的弹性内弹簧臂162。保樹牛160具有一 个容装槽163,该容装槽163部分围绕导引销124延伸。弹簧臂162包括部分 围绕导引销124魁申的^^槽164,但该容装槽164在相反的方向上面向容装 槽163。保謝牛160布置在钉筒组件120上,这样機槽163、 164就围绕导引 销124且将保劍牛160 P艮定在钉筒组件120上。弹簧臂162包括一个分离片165, 该分离片165在基座臂155之下从保劍牛160处向下延伸。这样,只有将钉筒 组件120适当定位在端部受动器80中才可容易地将保持件160从钉筒组件120 」二拆卸下来。一旦将钉筒组件120正确定位在端部受动器80中,分离片165 就与端部受动器80相配合以释放保新牛160。

再次参考图1并结合图2和图13,对线傲卜禾辨T紧器20的部件进,述。 线性外科钉紧器20包括一个较长的闭合j牛28,该闭合件28具有通常为U形 的截面且从手柄21延伸A^部受动器80的外科紧固组件中。根据本发明的一 个优选实施例,闭合件28是一个模制塑料件,其被,成用于进行运动及实 现本发明的作用。利用塑料来制作闭合件28则降低了制誠本瓶小了线性 外科钉紧器20的重量。此外,由于塑料比不锈钢更易于穿透,因此这样可更 容易禾佣钴辐射对线性夕卜科钉紧器20进行杀菌消毒。根据本发明的另一个实 施例,司'由被加工成具有最终特征的挤压铝片来制作该闭合件。虽然挤压铝闭 合件不象塑料件那样容易制作,但其仍具有一^ifc势(例如,减少了部件的数 量,易组装,重量轻,易消毒)。闭合件28的远端部分穿过支撑结构81的壁 84。该远端部分被布置成接收且保持钉筒组件120的钉筒壳121 。闭合件28的 中心部分布置^E右手柄盘34、 35之间。左右手闭^接件36、 37通过--个 第一整体式闭合连接销38可枢转性地分别连接在闭合件28的左右近端上。在 闭合连接件36、 37的相反端处,闭合3i^j牛36、 37可枢转性i鹏接在一个第 二整体式闭合连接销39上。第二»1^式闭合连接销39将闭M接销36、 37 与一个带槽的闭合臂式连接件40相连。带槽的闭合臂式连掛牛40在一个闭合 扳机枢转销41处可枢^i也安装在线性外禾辨丁紧器20的手柄盘34、 35上。闭 合扳机26从带槽闭合臂式连接件40处向下延伸以围绕闭合扳机枢转销41朝着或远离手握持部24进行枢轴式转动。,在手柄21的手握持部24中的一 根闭合弹簧42固定在带槽闭合臂式连銜牛40上,以当医生朝着手握持部24 按压闭合扳机26时提供所需的阻力,并朝开启位置偏压闭合扳机26。

参考附图13、 14,对保持销致动机构100的部件进行描述。手柄21包括 安装在手柄21顶部上的一个马鞍^»件101以进fi^性运动。滑动件101 M手柄21中的槽105 (参见图2)而与从一个推杆驱动件104向外延伸的一 个栓杆103相连。推杆驱动件腸穀赠105的限制而、歸线'砂卜科钉紧器20 的纵轴进行纵向运动。推杆驱动件104 ]13«杆102上的周向槽107而与推杆 102相连,所述推杆102卡持在推杆驱动件104的一个槽108中。推杆102的 远端具有一个周向槽109,其与钉筒组件120的接合件133近端中的一个槽132 相互连接(从图22中可清楚鹏见察到)。接合件133的远端具有一个与保持 销125上的周向槽135相,接的槽134。

闭合件28包含有栓件29,栓件29在处于手柄21内侧的闭合件28的两 侧上横向延伸。3^^栓件29与轭件111的一个L形槽110滑动连接。轭件111 M其上的枢^ll肖112而可枢,安装在手柄21上。轭件111包括有推动推 杆驱动件104上的凸轮表面114的凸轮销113。

参考图13和图37,对击发传动组件的部件进行描述。击发传动组件具有 --个较长的击发杆43,该击发杆43从手柄21延伸A^部受动器80的夕卜科紧 固组件中。击发杆43布置在闭合件28的U臓面中。击发杆43的远端延伸 入钉筒壳m中且与刀具保^f牛130和驱动件131的近端相令蹄置。击发杆43 的远端连接到具有刀具回收钩45的刀具回收件44上。

击发杆43具有矩形的接收槽46,其中,击发杆43上具有接收槽46的这 一部分容装在手柄21中(参见图13)。第一»式闭链结销38延伸掛万述 換l夂槽46。击发杆43还具有一个近端部分47。击发杆43的近端部分47的下 侧具有一个滑动表面48。近端部分47还具有一个从滑动表面48延伸出的终端 侧结合面49。击发扳机27 ffiil与闭合扳^Ug转销41相分离的一^发枢转销 50可枢转性地安装在手柄盘34、 35上,这样,^"枢辩肖就可围绕各自的轴 线进行转动。击发扳机27包括一个弓形的击发扳IJU^I牛51,该击发扳机连 接件5】从击发扳机枢ffl肖50处的击,机27处延伸至一个顶点52处,该顶 点52处于击发杆43的近端部分47的滑动表面48上。在手柄2】中,击发扳机27分别连接至嘮一和第二击发扳机弹簧臂53、 54上。击发扳机弹簧臂53、 54支撑处于击发扳机43右半边上的一根扭转弹簧(图中未显示)。最后,一 根击发杆回复弹簧55固定在手柄21中的击发杆43的下侧部分处以朝其未致 动位置偏压击发杆43。

当朝着手握持部24推压闭合扳机26时,带槽闭合臂式连銜牛40和闭合 连接件36在击发杆43的接收槽46中朝^^^i动。这种卓膽远端的运动使 闭合件28相应地向远驗动。同样,击发杆43与闭合件28同时向远端运动, 这是因为其上连,M闭^3^件36、 37的第一»式闭^^销38延伸过击 发杆43中的接收槽46。

下面将参考附图1并结合附图13—20对限定中间闭合止^置所用的机 构及闭合扳机26从致动位置释放至其未致动位置的情况进行描述。带槽闭合 臂式连接件40的顶侧具有一个夹紧m^J表面56,棘紧驗表面56显露出一 个中间止动件57和一个闭合止动件58。 一"^#方«爪59在该夹紧滑动表面56 上滑动且可与中间止动件和闭合止动件57、 58相结合。在释M^爪59的远端 具有一个横向延伸的棘爪片60 (从图1中清楚可见)。释娜爪59位于手柄 21内且其整体it^到处于手柄21外部的一个释放按钮61上。释放按钮61 具有一个拇指方嫘部62,释方娥钮61 Mil—个释放耳轴63可枢转性*^接到 手柄21上。释放按钮61从手柄21被向夕Hi压,这样,释^|$爪59就由一-根 释放弹簧64向下朝着夹紧滑动表面56偏压,释,簧64通过一个弹簧止动 销65安装在手柄2】上liM—个按钮弹簧栓66安装在释放按钮61上。带糟 闭合臂式连接件40具有一个位于中间止动件57和闭合止动件58之间的弓形 凹槽67。在该弓形凹槽67中布置有与一个右手套环(图中未显;^右手套环) 整体相连的一个左手套环68 。旨套环68具有可与棘爪片60相配合的一个套 环臂69。棘爪片60具有一个凹形的近端表面70以在套环臂69和棘爪片60之 间提供间隙。

现在参考附图31 (钉筒和支撑结构的剪切视图),对击发装置锁止机构180 的部件进行描述。锁止机构180包括一^H贞止杆181,该锁止杆181通过—-个 销子182司枢转地安装到闭合件28的远端30上。锁止杆181由一根弹簧(图 中未显示)朝着支撑结构81的基座被向下弹性偏压。锁止杆181具有一# 端和一个远端184、 185。近端184具有一个凸轮表面186和fUh槽187。端部受动器80的支撑结构81包括一个突出架85,当锁止结构:i80结合时,突出架 85与锁止槽187相互作用。支撑结构81具有处于壁部84之间的一个基面86。 在锁止杆181未被结合时,基面86被布置成与所述凸轮表面186相互作用。

下面将对钉筒组件120、闭合机构、保擀肖,、击发传动组件、中间止 动件57、闭合止动件58、释放机构及锁止机构180的加i^作进行描述。参 考附图7—12和附图21—2S对将钉筒组件120加载到生M织端部受动器80

中的情况进行描述。该钉筒组件120的形状和尺寸被设置自择性iWA^性 外科钉紧器20的生理组织端部受动器80中并从其中拆卸。

如图7所示,在将钉筒组件120插A^性外科钉紧器20的端部魏器80 中之前,由于槽161在,件160的顶端处围绕凸起159布置来防止分离,这 样就不容易将保謝牛160从钉筒组件120上拆卸下来。财卜,如图25所示, 保持件的容装槽163、 164在保榭牛160的底部处围绕导引销124布置以防止 分离。

被连接的保劍牛160对钉筒组件120的结构朋于握持的一个延伸表面进 行支撑,这些持征均使加t^得更为容易。保掛牛160可防止钉子在不经意的 处理过程中从钉筒壳121中掉^T来且可防止刀具126在不经意的处Mf呈中 偶然暴露出来。

在加载之前及在加i^中可M31—系列的止动部进一步阻止刀具126和 钉子的移动。参考图9,通过钉筒壳槽137上的止动凸起139则可防止刀具保 持件130上的止动栓138向远端和近端运动。iKijJ:动栓140与钉筒壳槽137 上的止动凸起141的相互作用则可防止驱动件131由于不经意的处理和在将钉 筒组件120加载至lM14夕卜禾4IT紧器20的过程中而向远端运动。

如图21—24所示,将钉筒组件120加载到生理组织端部受动器80中,从 而使钉筒壳121滑入闭合件28的远端30中。在加载雖中,闭合件28上的 壁部31a、 31b滑入钉筒壳121的槽170a、 170b中。与此同时,凸片174 (参 见图8)滑入U形支撑结构81的槽88中。如图21—24所示,当止动部171 卡持到闭合件远端30的止动槽32上时贝院成了钉筒组件120的加载。

在如图24所示的位置中,钉筒组件120被完全加载,接合件133的近端 槽132与推杆102的远端周向槽109相结合,这样,钉筒组件120中的保辦肖 125就与保持销进给机构100相连。在加载过程中刀具保持件131的槽172与

12刀具回收钩45相配合,从而在完成钉筒组件120的加载时回收钩45与刀具保 掛牛130上的牵弓l突出架173相配合。

在^钉筒组件120的加载时,布置在驱动{牛131上的一个栓件188与锁 止杆181的远端185相接触(参见图31) 0这种接触使锁止杆181围^Hlh杆 销182转动至一个位置,从而使凸轮表面186与U形的支撑结构81的基面86 水平对准。

现在将保謝牛】60从端部受动器80摊卩。特别地,誠钉筒组件120的 加载使分离片165与支撑结构81相接触(参加图23),这样,如图24所示, 当将钉筒组件120被完全加载后,弹簧臂162向上移动。这种向上移动使容装 槽164向上偏移而不再皿导引销124 (参见图25和图26)。现在参考附图27 —29,向拇指垫166施加一个拆卸作用力而使保新牛160围绕凸起159向夕卜枢 转錢所述槽161可从凸起159上滑脱下来。将保擀牛160拆卸是考虑到将要 使用的被加载的缘龄卜禾賴丁紧器20 o

在附图15中,闭合扳机26已从图1和图13所示的开启、未被致动位置 处被局部推压。当局部推压闭合扳机26时,该闭合扳机26就围绕闭合扳l應 转销41在逆时针方向上朝着手握持部24转动。当闭合扳机26转动时,带槽 闭合臂式连接件40和闭合盘闭合,件36、 37向前移动,/人而向远端移动闭 合件28和击发杆43。当带槽闭合臂式连接件40向前移动时,释^H爪59的 棘爪片60在夹紧滑动表面56上滑动。棘爪片60与套环68的套环臂69的远 端相配合,从而使套环68招顿时针方向上转动。当带槽闭合臂式连接件40相 应于闭合扳机26朝着報持部24的枢能动而继续向前运动时,释繊爪59 的棘爪片60最^容纳在中间止动部57中。一旦闭合弹簧42定位在中间止 动部57中,闭合弹簧42就不能将闭合扳机26回复至其初始的未致动位置。 闭合扳机26现在处于其中间的、局部闭合的位置上以将生理组织适当定位并 保持在钉筒壳121和基座122之间,如图15中所示。此外,当闭合件28和击 发杆43向远端移动时,弓形击发扳fL3^j牛51的顶点52就在击发杆43的近 端部分47的滑动表面48上滑动。

在从开启位置至中间位置的闭合fi^呈中,保持销机构100被致动。闭合件 28的向前运动4«#式栓件29向远端移动。栓件29与轭件111的L形槽110

相接触。因此,栓件29向远端的运动使L斜曹110进行凸轮转动,从而傲万述轭件围纟激肖子112进行转动。所述转动^lg件111上的支撑栓件113与推杆

驱动件104上的凸轮表面114相,。轭件111进一步的转动j鼓撑栓件113 通过在表面114上的凸轮转动»而向远端移动推杆驱动件104。推杆驱动件 104与推杆102相接触而向远端移动所述推杆102。推杆102翔顷次向远端移 动接合件133和保持销125。至中间止动部57 ,处戶;?a行的闭合很呈的^ 使保辦肖125向远端移动过钉筒壳121的孔144、基座151的槽及垫圈170中 的孔而駄支撑结构81中的孔89 (图中未显示)。处于钉筒壳m的,表 面127和基座122之间的生理组织现在被卡持在保持销125和导引销124之间。

在闭合之前通过AX将马鞍形滑动件101向远端移动也可实现同样的效 果。所述滑动移动使推杆102、接合件133和保擀肖向前运动超保持销125 完全布置在支撑结构81内的基座122、垫圈123和孔89中。在将保持销125 人工向前移动之后致动闭合储條顿件111进行战的糊,但不会使保 持销致动机构層进行其它的运动。

如图31 (开启{體)和附图32 (中间隨)所示,当锁止杆181通过销 子182被连接到闭合件28上时,从开启錢至中间止动部57位置处的闭合行 程使锁止杆181向远端移动。锁止杆181向远端移动使凸轮表面186与支撑结 构81的突出架85相接触,从而使锁止杆181顺时针转动且与支撑结构81的 基面86滑动接触。在该位置处,锁止杆181的远端185远离起动件131上的 栓件188转动。

现在特别参考附图16,当将闭合扳机26从中间止动部57的位置朝着手 握持部24推压时,套环68的套环臂69 /满爪片60脱离。从而,当新68 继续招顿时针方向上转动时,释,爪片60 ,在套环臂69上,并且闭合扳 机26继续运动而落入闭合止动部58中。当释»爪59 ^«套环臂69上时, 它就使释放按钮61围会,轴63顺时针l^力。当释方j^爪片60落入闭合止动 部58中时,会产生可听得见的咔魅声以提醒医生已到达闭合位置。

此外,当击发杆43继续向前移动时,弓形致动击发扳机连接件51的顶点 52与击发杆43的近端部分47的滑动配錄面49相接触。从而,击发扳机27 就移动至一个位置中,在该位置处,击发扳机27继续向远端移动击发杆43以 在完全夹持住生理组织之后击发钉子。当弓形击发扳t/l3^接^牛51的顶点52与 近端部分47的结合表面49相配合时,击发扳机27相应于扳机27右手侧上的扭转弹簧(图中未显示扭转弹簧)的运动而在逆时针方向上朝着手握持部24

枢轴地转动。击发扳机27的枢轴转动3te于闭合扳机26的枢轴运动,但是其 枢轴转动受到阻lh^M^^:杆43向远端移动而〗吏击«|03^接件51与击发杆 43的最终结合表面相结合。

现在特别参考图17,当闭合扳机47被完全推压并与手握持部24相邻时, 处于释^1$爪59远端处的棘;H片60进入闭合止动部58中。在闭合止动部58 的傻置处,生理组织被完全夹紧在钉筒壳121和基座122之间,闭合弹簧42 不能使闭合扳机26回复至其初始位置。因此,闭合扳机26就被保持在图4所 示的位置中。

在闭合扳机26逆时针糊的同时,击^^机27在击发杆回复弹簧55的

扭转作用下继续逆时针^^力,击发扳机27相对于线性外禾4I了紧器20的手柄

2】处于相对垂直的位置上。在被完全夹持的#3上,弓形击发扳mii接件51

的顶点52与击发杆43的近端部分47的配合表面完全结合,因此,击^^机27 就处于一个位置上以迸^向远端移动击新43,从而将钉子射击到生翻激中。

如图33所示,在完全闭合位置上,钉筒壳121的钉袋128与基座122的 钉形成表面129相对准。保持销125使基座122的顶部与钉筒壳121相对准, 导弓條'124使钉筒壳121的底部与基座122的底鰣目对准。

如图18和图34所示,可推压击皿机27而使其朝着手握持部24枢轴转 动直至使其与闭合扳机26相邻。在击^^机27的枢轴線过程中,击发杆43 向远端移动而与刀具保謝牛130相^M。这样就使刀具保^# 130向远端移动, 从而与刀具126和驱动件131相接触。驱动件131向远端移^将钉子(图中 未显示)向远端IIA^座122的钉紧形戯面129中而将钉子形成为总体上为 B形的皿。刀具126在与钉子结构相结合的导引销124和保持销125的槽147 中向远端推进。这些槽147将刀具126导引到切割垫圈123的切割表面157上 而切断被卡持在两部件之间的任何生理组织。

ilil人力释放击,机27将导致击发杆回复弹簧55使击发杆43和击发 扳机27回复至图17所示的位置。这种运动使回收钩45回撤到刀具保謝牛130 和刀具126上的牵引突出架173上。这样所弓胞的向近端的运动使刀具126回 撤到钉筒壳121中,如附图35中所示的那样。刀具保^#130上的止动栓138

15回撤而与钉筒壳121上的止动部139相结合从而将刀具保^j牛130和刀具126 保持在该回撤位置上。M驱动件131上的止动栓140与钉筒槽137的止动部 142相结合贝ij将驱动件m保持在其最远^S (被击发位置)上。

由于4顿者失误ifej各刀具126切入其他医用體,贝ij刀具126会产生干扰, 这样,击发杆回复弹簧55的作用力就不足以使击发杆43回it!A而刀具126回 ,,j钉筒壳121中,舰者可ililH顷时针拉动击发扳机27来AX回撤切割系 统。这种人工顺时针移动使弓形击发扳,接件51顺时针转动,它撞3话 发杆43的近端47上的击发杆回收片71。顺时»动的击^^^^銜牛51和 击发杆回收片71之间的接触使击发杆43向近端回撒且回,图17所示的位 置。这样会使回收钩45回船ij刀具保^f牛130和刀具126上的牵引突出架173 上。因而,这种安封寺征可使^顿者将切割机构回撤至一个安全的位置并将击 发系统回复至可允许打开线性外禾4I丁紧器20的一^h位置,在下文中将对该内 容进行描述。

参照附图19,当夕卜科医生按下释放按钮61时,释鹏爪59围離放耳 轴63御顷时针方向上转动而将棘爪片60从闭合止动部58的位置处驱出。当 棘爪片60被驱出时,它^E套环臂69上而从夹紧连銜牛40上的中间止动 位置57的旁j^敏。以这种方式,闭合扳机和击^^机26、 27可相应于由闭 合弹簧42和击Mf回复弹簧55所产生的偏压而返回至其初始未致动位置。当 棘爪片60跨«套环68的套环臂上时,随着闭合扳机26和击发扳机27顺时 针转动以回复至它们的初始未致动位置,套环臂69逆时针转动。因此,医生 就可释放闭合扳机和击发扳机26、 27,这样它们就可回复至图20所示的位置 而不回复至中间止动部57的體。

线^卜科钉紧器20被释輕图20所示的开启位置而使闭合件28和被连 接的锁止杆181回赔图36所示的完舒启健。在该錢处,驱动件131 上的栓件188不再布置得向下固定锁止杆的远端185。如上所述,驱动件131 已被栓件140和钉筒止动部142止动在向前的健上。因此,当锁止杆181完 全回撤时,它就自由逆时针转动且使M:槽187下降到U形支撑结构81的突 出架85的下面,其中,锁止杆181的近端184沿着支撑臂表面86滑动。如图 37所示,当钉筒组件120被拆卸掉时,锁止杆181仍将处于该位置上。

将彩寸己被击发的缘性外,丁紧器20所作的任何闭合尝微会将锁止槽187钩持在图38所示的突出架85中,从而向原击发装置的4顿者迸行反馈。 如果在加载箭将保謝牛160拆卸且在钉筒组件120未处于适当錢的清况下对 钉筒组件120进fi^昔误加载,也会产生这种相同的特征。在这种情况下,驱动 栓潔将不能处于正确OT而将锁止杆181移动至其被凸滑至im表面86上 的位置上。同样,己被击发的钉筒组件120也不能释放锁ah机构勤。应特别 注意到:在将锁止槽187钩持到突出架85中之前在mih机构180中允许进行 闭合行程的运动。这种运动对iOT者显示出:该装置不会产生由于某些故障导 致的拥堵,其中,如果锁止机构180没有运行就会引起这些故障。因此,4顿

者知道:当锁止机构结合时该^g不会产生拥堵但不正确地被加载。

所述装置释放而返回至图1和图2所示的开启,之后,必需i!31人工方 式向近端拉动马鞍形件101而使保持销鹏100回撤。这种回撤使保麟125 回退入钉筒壳121中。在^^M人工回撤时,已被击发的钉筒组件120可被 卸载并用新的钉筒组件120来更换。

尽管已经显示并描述了这^ii实施例,应该认iKS'J:本发明并不势万披 露的内容的限制,但是对所述实施例所作的全部变化和改变均落A^发明的实 质和范围内。

Claims (3)

1、一种适于用多个外科固定件固定身体的生理组织的外科装置,该外科装置包括: 支架,其具有近端和远端,手柄位于近端处,端部受动器位于远端处; 端部受动器的形状和尺寸被设置成用于支撑钉筒壳和基座,钉筒壳和基座结构可在第一分离位置和第二相互邻近位置之间相对移动; 击发机构与端部受动器和钉筒壳相连以选择地进行致动; 其特征在于:端部受动器具有适于男性骨盆的最佳曲率半径,以致端部受动器的曲率直径最大是7.8英寸。
2、 根据权利要求1所述的外利装置,其特征在于:端部受动器的曲率直径 在2英寸和4英寸之间。
3、 根据ISl利要求1所述的外禾碟置,其特征在于.-端部受动器具有适于装 入3.00英寸x3.62英寸的椭圆形包膜中的曲率直径。
CN 200410095439 2003-12-30 2004-12-30 用于男性骨盆的弯曲切刀钉紧器 CN100574713C (zh)

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US20170281187A1 (en) 2016-04-01 2017-10-05 Ethicon Endo-Surgery, Llc Surgical stapling system comprising a tissue compression lockout
US20170281189A1 (en) 2016-04-01 2017-10-05 Ethicon Endo-Surgery, Llc Circular stapling system comprising an incisable tissue support
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US20170296172A1 (en) 2016-04-18 2017-10-19 Ethicon Endo-Surgery, Llc Surgical instrument comprising a lockout
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CA2491783A1 (en) 2005-06-30 application
US20050247753A1 (en) 2005-11-10 application
US20050143759A1 (en) 2005-06-30 application
EP1550408A1 (en) 2005-07-06 application
US20050247752A1 (en) 2005-11-10 application
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US20050246880A1 (en) 2005-11-10 application
JP2005193039A (ja) 2005-07-21 application

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