CN100574713C - 用于男性骨盆的弯曲切刀钉紧器 - Google Patents
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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
技术领域
本发明涉及一种适用于通过钉紧切除术对病理进行诊断和治疗的外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
外科钉紧切除装置普遍使用在通过钉切除术对病理进行诊断和处理上。外科钉紧器装置提供了一种机构,该机构扩展了通过肛门通道、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直肠病理,但是外科钉紧器和切除装置可以在各种环境下使用。
随着时间的推移,外科钉紧器和切除装置已经有了发展。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入基座中以形成将组织钉紧在一起的、通常为B形的钉。并且,这些装置包括靠近装置,用于从相对于基座分隔开的位置移动到闭合位置处,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靠着基座进行钉紧。
特别地,在男性骨盆中要进行许多程序。同样地,需要提供一种特别适用于男性骨盆的外科钉紧器和切除装置。因为男性骨盆朝直肠延伸,则在男性骨盆中所进行的程序会由于男性骨盆尺寸的减小而引起的空间限制而遭受麻烦。因为经常需要在邻近锯齿线的区域进行下前部切除,外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使用的外科钉紧器和切除装置。
附图说明
图1是根据本发明的线性外科钉紧器的透视图;
图2是被拆掉了钉筒组件的线性外科钉紧器的透视图;
图3是钉筒组件被移到中间位置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性外科钉紧器的透视图;
图5是击发扳机处于击发位置处的的线性外科钉紧器的透视图;
图6是钉筒组件的分解图;
图7是其上固定有保持件的钉筒组件的正视图;
图8是保持件被拆掉的钉筒组件的前透视图;
图9是钉筒组件的一个后视透视图,图中详细地显示了钉筒壳的狭槽;
图10,11和12表示保持件的组装;
图13是处于未击发状态的线性外科钉紧器的局部横断面视图;
图14是销致动机构的分解图;
图15是闭合扳机稍微缩进的线性外科钉紧器的局部横断面视图;
图16是闭合扳机基本上完全缩进的线性外科钉紧器的局部横断面视图;
图17是闭合扳机完全缩进的线性外科钉紧器的局部横断面视图;
图18是击发扳机和闭合扳机完全缩进的线性外科钉紧器的局部横断面视图;
图19是外科医生按压释放按钮之后线性外科钉紧器的局部横断面视图;
图20是闭合和击发扳机没有返回到扳机的中间位置时线性外科钉紧器的局部横断面视图;
图21-29表示钉筒组件的插入和保持件的拆卸;
图30-38表示本发明的线性外科钉紧器在致动过程中的各个步骤;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行解释,这些实施例可以不同的方式来实现。因此,不能对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/或使用本发明。
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外科钉紧器20。线性外科钉紧器20在第一近端具有手柄21,在相对的远端具有端部受动器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壳上的右手柄外壳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科钉紧器20(参见图2至5)。
根据本发明的线性外科钉紧器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)期间难以进入,这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的形状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×3.62英寸的椭圆形包膜之内装配和运行。
基于这种理念,根据本发明的优选实施例,线性外科钉紧器20具有远端,组织端部受动器80的曲率直径是7.8英寸或小于7.8英寸,优选地,小于或等于4英寸,以装配入男性骨盆的最小包膜中。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,包括一个钉筒壳120(参见图6-9)和一个U形支撑结构81。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还包括一个安全锁止机构180(从图31中可清楚观察到)以阻止先前已击发的钉筒组件120的击发。钉筒组件120包括一个与基座122相耦合的钉筒壳121。钉筒组件120还包括一个保持销125、一把刀具126、一个可拆卸的保持件160和一个生理组织接触表面127。所述生理组织接触表面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)的多个钉子容装槽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概念同样适用于单次击发装置。
端部受动器80的支撑结构81通过侧翼铆钉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。根据本发明的一个优选实施例,支撑结构81是由一个单片构件形成的。更具体地说,通过例如将铝片挤压、随后进行加工来制作本发明所披露的支撑结构81。通过以这种方式来构造支撑结构81,则不需要多个部件,从而显著降低了生产和组装成本。此外,应认识到:支撑结构81的整体式结构提高了本发明线性外科钉紧器20的整体稳定性。另外,支撑结构81的整体式挤压成形结构减轻了本发明的线性外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,由于通过挤压可形成平滑的外表面,因而对生理组织造成的损伤最小。
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手握持部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(图中未显示该左手护板柄)构成。一个闭合扳机26和一个击发扳机27从手柄21的下侧可枢转性地延伸出来。图1所示线性外科钉紧器20显示:闭合扳机26和击发扳机27处于其未致动位置,钉筒组件120被插入且保持件160被拆掉。因此,钉筒壳121与基座122相分离以将生理组织置于钉筒壳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持销致动机构100。该生理组织保持销致动机构100包括布置在手柄21的顶表面上的一个马鞍形滑动件101。人工移动该滑动件101将使推杆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。保持销致动机构100也可释放性地与手柄21中的闭合扳机26相配合,这样,如果保持销125还没有被人工移动至其最近端位置,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,图中显示了在对钉筒组件120进行加载以及随后朝着手握持部24推压击发扳机26、27以致动线性外科钉紧器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加载到线性外科钉紧器20上且将保持件160拆掉。如图1所示,此时的线性外科钉紧器20已准备好来接收生理组织。
在部分推压闭合扳机26以将其置于图3所示的第一制动位置时,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,生理组织保持销致动机构100将保持销125从钉筒壳121向前移动过基座122中的一个开口。在该位置中,可将置于钉筒壳121和基座122之间的生理组织进行适当定位,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持位置中。
如图4所示,在闭合扳机26受到完全推压时而使其靠近手握持部24的前端时,钉筒壳121的生理组织接触表面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转动以使医生握持击发扳机27,从而射击钉子。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以射击钉子时,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进行详细描述。该钉筒组件120布置有一个在线性外科钉紧器20中使用的切割和钉紧机构,其中,该机构在装置的致动过程中在同一方向上进行钉紧和切割操作。虽然该钉筒组件120特别适于与线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他外科装置。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割性能。这种功能是通过将基座122特别是切割垫圈123与钉筒组件120相结合来实现的。通过将垫圈123与钉筒组件120相结合,则在每次更换钉筒组件120时可提供一个新垫圈123,从而提高切割性能。
通过下述布置方式可进一步提高装置的性能: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。这样就可使压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,即,将生理组织挤成一束及将部分生理组织从基座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包括一个钉筒壳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被布置成来将钉子推出钉槽128。在钉筒壳121中的驱动件131临近位置布置有一个刀具保持件130。刀具保持件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的功能进行详细描述。刀具保持件130连接在刀具126上,该刀具126从刀具保持件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。
刀具保持件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分别接触。
这样布置刀具126和槽199、200以使刀具126的两侧至少布置一排钉子。根据本发明的一个优选实施例,在钉筒壳121的槽199的每侧上布置两排钉槽128(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过通常为圆形的孔143、144。
根据本发明的一个优选实施例,基座122包括一个塑性垫圈123和一个金属钉形成表面129。基座122被布置成使钉形成表面129保持匹配的构造形式。保持销125通过保持销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(最好参考图14)。接合件133布置在钉筒壳121的一个臂145中且通过一个端帽146而保持在所述臂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布置在所述槽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上的一个舌部153之下。切割垫圈123的相反端154在基座臂155之下滑动且通过一个销子156而销紧到基座臂155上。在该位置中,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组装到基座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操作性地连接到钉筒壳121上。如图7所示,保持件160连接到钉筒组件120上以将钉筒组件120的部件保持所需的定位直至插入到端部受动器80中。
现在参考图6-12、25-29,对保持件160进行更详细的描述。保持件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包括一个被设置成在保持件160中进行往复运动的弹性内弹簧臂162。保持件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延伸的容装槽164,但该容装槽164在相反的方向上面向容装槽163。保持件160布置在钉筒组件120上,这样容装槽163、164就围绕导引销124且将保持件160限定在钉筒组件120上。弹簧臂162包括一个分离片165,该分离片165在基座臂155之下从保持件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上拆卸下来。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相配合以释放保持件160。
再次参考图1并结合图2和图13,对线性外科钉紧器20的部件进行详述。线性外科钉紧器20包括一个较长的闭合件28,该闭合件28具有通常为U形的截面且从手柄21延伸入端部受动器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,其被塑造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则降低了制造成本并减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,因此这样可更容易利用钴辐射对线性外科钉紧器20进行杀菌消毒。根据本发明的另一个实施例,可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,但其仍具有一些优势(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的中心部分布置在左右手柄盘34、35之间。左右手闭合连接件36、37通过一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,闭合连接件36、37可枢转性地连接在一个第二整体式闭合连接销39上。第二整体式闭合连接销39将闭合连接销36、37与一个带槽的闭合臂式连接件40相连。带槽的闭合臂式连接件40在一个闭合扳机枢转销41处可枢转地安装在线性外科钉紧器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。容装在手柄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接件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顶部上的一个马鞍形滑动件101以进行线性运动。滑动件101通过手柄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104受到槽105的限制而沿着线性外科钉紧器20的纵轴进行纵向运动。推杆驱动件104通过推杆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中可清楚地观察到)。接合件133的远端具有一个与保持销125上的周向槽135相互连接的槽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。这些栓件29与轭件111的一个L形槽110滑动连接。轭件111通过其上的枢转销112而可枢转地安装在手柄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。击发传动组件具有一个较长的击发杆43,该击发杆43从手柄21延伸入端部受动器80的外科紧同组件中。击发杆43布置在闭合件28的U形截面中。击发杆43的远端延伸入钉筒壳121中且与刀具保持件130和驱动件131的近端相邻布置。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)。第一整体式闭合连结销38延伸过所述接收槽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通过与闭合扳机枢转销41相分离的一个击发枢转销50可枢转性地安装在手柄盘34、35上,这样,每个枢转销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机连接件51,该击发扳机连接件51从击发扳机枢转销50处的击发扳机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21中,击发扳机27分别连接到第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,带槽闭合臂式连接件40和闭合连接件36在击发杆43的接收槽46中朝着远端运动。这种朝着远端的运动使闭合件28相应地向远端运动。同样,击发杆43与闭合件28同时向远端运动,这是因为其上连接有闭合连接件36、37的第一整体式闭合连结销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对限定中间闭合止动位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滑动表面56,该夹紧滑动表面56显露出一个中间止动件57和一个闭合止动件58。一个释放棘爪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。在释放棘爪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)。释放棘爪59位于手柄21内且其整体地连接到处于手柄21外部的一个释放按钮61上。释放按钮61具有一个拇指放置部62,释放按钮61通过一个释放耳轴63可枢转性地连接到手柄21上。释放按钮61从手柄21被向外偏压,这样,释放棘爪59就由一根释放弹簧64向下朝着夹紧滑动表面56偏压,释放弹簧64通过一个弹簧止动销65安装在手柄21上且通过一个按钮弹簧栓66安装在释放按钮61上。带槽闭合臂式连接件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(图中未显示该右手套环)整体相连的一个左手套环68。每个套环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包括一个锁止杆181,该锁止杆181通过一个销子182可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具有一个近端和一个远端184、185。近端184具有一个凸轮表面186和锁止槽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180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、保持销机构、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的加载操作进行描述。参考附图7-12和附图21-28对将钉筒组件120加载到生理组织端部受动器80中的情况进行描述。该钉筒组件120的形状和尺寸被设置成选择性地插入线性外科钉紧器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插入线性外科钉紧器20的端部受动器80中之前,由于槽161在保持件160的顶端处围绕凸起159布置来防止分离,这样就不容易将保持件160从钉筒组件120上拆卸下来。此外,如图25所示,保持件的容装槽163、164在保持件160的底部处围绕导引销124布置以防止分离。
被连接的保持件160对钉筒组件120的结构及用于握持的一个延伸表面进行支撑,这些特征均使加载变得更为容易。保持件160可防止钉子在不经意的处理过程中从钉筒壳121中掉落下来且可防止刀具126在不经意的处理过程中偶然暴露出来。
在加载之前及在加载过程中可通过一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。通过止动栓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加载到线性外科钉紧器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。在加载过程中,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上时则完成了钉筒组件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中的保持销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与刀具保持件130上的牵引突出架173相配合。
在完成钉筒组件120的加载时,布置在驱动件131上的一个栓件188与锁止杆181的远端185相接触(参见图31)。这种接触使锁止杆181围绕锁止杆销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。
现在将保持件160从端部受动器80拆卸。特别地,完成钉筒组件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向上偏移而不再容装导引销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持件160围绕凸起159向外枢转直至所述槽161可从凸起159上滑脱下来。将保持件160拆卸是考虑到将要使用的被加载的线性科钉紧器20。
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就围绕闭合扳机枢转销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和闭合盘闭合连接件36、37向前移动,从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,释放棘爪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在顺时针方向上转动。当带槽闭合臂式连接件40相应于闭合扳机26朝着手握持部24的枢转运动而继续向前运动时,释放棘爪59的棘爪片60最终会容纳在中间止动部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,弓形击发扳机连接件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行程中,保持销机构100被致动。闭合件28的向前运动使整体式栓件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形槽110进行凸轮转动,从而使所述轭件围绕销子112进行转动。所述转动使轭件111上的支撑栓件113与推杆驱动件104上的凸轮表面114相接触。轭件111进一步的转动使支撑栓件113通过在表面114上的凸轮转动接触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再顺次向远端移动接合件133和保持销125。至中间止动部57位置处所进行的闭合行程的完成使保持销125向远端移动过钉筒壳121的孔144、基座151的槽及垫圈170中的孔而进入支撑结构81中的孔89(图中未显示)。处于钉筒壳121的接触表面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。
在闭合之前通过人工将马鞍形滑动件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和保持销向前运动直至保持销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行程仍会使轭件111进行上述的转动,但不会使保持销致动机构100进行其它的运动。
如图31(开启位置)和附图32(中间位置)所示,当锁止杆181通过销子182被连接到闭合件28上时,从开启位置至中间止动部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从棘爪片60脱离。从而,当套环68继续在顺时针方向上转动时,释放棘爪片60跨越在套环臂69上,并且闭合扳机26继续运动而落入闭合止动部58中。当释放棘爪59跨越在套环臂69上时,它就使释放按钮61围绕枢轴63顺时针转动。当释放棘爪片60落入闭合止动部58中时,会产生可听得见的咔哒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的滑动配合表面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。当弓形击发扳机连接件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的枢轴转动独立于闭合扳机26的枢轴运动,但是其枢轴转动受到阻止直至击发杆43向远端移动而使击发扳机连接件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,处于释放棘爪59远端处的棘爪片60进入闭合止动部58中。在闭合止动部58的位置处,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逆时针转动的同时,击发扳机27在击发杆回复弹簧55的扭转作用下继续逆时针转动直至击发扳机27相对于线性外科钉紧器20的手柄21处于相对垂直的位置上。在被完全夹持的位置上,弓形击发扳机连接件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,击发扳机27就处于一个位置上以进一步向远端移动击发杆43,从而将钉子射击到生理组织中。
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,导引销124使钉筒壳121的底部与基座122的底部相对准。
如图18和图34所示,可推压击发扳机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。在击发扳机27的枢轴转动过程中,击发杆43向远端移动而与刀具保持件130相接触。这样就使刀具保持件130向远端移动,从而与刀具126和驱动件131相接触。驱动件131向远端移动会将钉子(图中未显示)向远端推入基座122的钉紧形成表面129中而将钉子形成为总体上为B形的形状。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。
通过人力释放击发扳机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回撤到刀具保持件130和刀具126上的牵引突出架173上。这样所引起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。刀具保持件130上的止动栓138回撤而与钉筒壳121上的止动部139相结合从而将刀具保持件130和刀具126保持在该回撤位置上。通过驱动件131上的止动栓140与钉筒槽137的止动部142相结合则将驱动件131保持在其最远端位置(被击发位置)上。
由于使用者失误地将刀具126切入其他医用装置,则刀具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回撤从而刀具126回撤到钉筒壳121中,使用者可通过顺时针拉动击发扳机27来人工回撤切割系统。这种人工顺时针移动使弓形击发扳机连接件51顺时针转动直至它撞击击发杆43的近端47上的击发杆回收片71。顺时针移动的击发扳机连接件51和击发杆回收片71之间的接触使击发杆43向近端回撤且回复至图17所示的位置。这样会使回收钩45回撤到刀具保持件130和刀具126上的牵引突出架173上。因而,这种安全特征可使使用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科钉紧器20的一个位置,在下文中将对该内容进行描述。
参照附图19,当外科医生按下释放按钮61时,释放棘爪59围绕释放耳轴63在顺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,它跨越在套环臂69上而从夹紧连接件40上的中间止动位置57的旁边经过。以这种方式,闭合扳机和击发扳机26、27可相应于由闭合弹簧42和击发杆回复弹簧55所产生的偏压而返回至其初始未致动位置。当棘爪片60跨越在套环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的位置。
线性外科钉紧器20被释放至图20所示的开启位置而使闭合件28和被连接的锁止杆181回撤至图36所示的完全开启位置。在该位置处,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止动在向前的位置上。因此,当锁止杆181完全回撤时,它就自由逆时针转动且使锁止槽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。
将来对已被击发的线性外科钉紧器20所作的任何闭合尝试均会将锁止槽187钩持在图38所示的突出架85中,从而向原击发装置的使用者进行反馈。如果在加载前将保持件160拆卸且在钉筒组件120未处于适当位置的情况下对钉筒组件120进行错误加载,也会产生这种相同的特征。在这种情况下,驱动栓188将不能处于正确位置而将锁止杆181移动至其被凸滑到上述表面86上的位置上。同样,已被击发的钉筒组件120也不能释放锁止机构180。应特别注意到:在将锁止槽187钩持到突出架85中之前在锁止机构180中允许进行闭合行程的运动。这种运动对使用者显示出: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,使用者知道:当锁止机构结合时该装置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所示的开启位置之后,必需通过人工方式向近端拉动马鞍形件101而使保持销机构100回撤。这种回撤使保持销125回退入钉筒壳121中。在完成所述人工回撤时,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些优选实施例,应该认识到:本发明并不受所披露的内容的限制,但是对所述实施例所作的全部变化和改变均落入本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所述的外科装置,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、根据权利要求1所述的外科装置,其特征在于:端部受动器具有适于装入3.00英寸×3.62英寸的椭圆形包膜中的曲率直径。
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Also Published As
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MXPA05000218A (es) | 2005-08-26 |
US20050246881A1 (en) | 2005-11-10 |
CN1636524A (zh) | 2005-07-13 |
EP1550408A1 (en) | 2005-07-06 |
US20050247753A1 (en) | 2005-11-10 |
BRPI0405957A (pt) | 2005-09-20 |
US20050143759A1 (en) | 2005-06-30 |
JP2005193039A (ja) | 2005-07-21 |
US20050247752A1 (en) | 2005-11-10 |
CA2491783A1 (en) | 2005-06-30 |
AU2004242491A1 (en) | 2005-07-14 |
US20050246880A1 (en) | 2005-11-10 |
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