CN101133971B - 能进行关节运动的弧形切割缝合器 - Google Patents
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Abstract
一种能进行关节运动的弧形切割缝合器,该关节运动外科缝合器具有近端和远端,并且包括位于近端的手柄和位于远端的端部执行器,用于选择性地进行关节运动以改进对需要治疗的组织的访问并易于使用该线性外科缝合器。支撑轴将所述手柄连接到所述端部执行器。关节运动机构定位在所述支撑轴和所述端部执行器之间,以允许所述端部执行器相对于所述支撑轴选择性地运动。
Description
技术领域
本发明涉及一种适于在通过缝合切除术来进行病理诊断和治疗中使用的外科缝合和切割器械。更具体地,本发明涉及一种通过提供端部执行器的旋转而对外科手术部位的访问进行改进的外科缝合和切割器械。
背景技术
外科缝合和切割器械通常用在由缝合切除术进行的病理诊断和治疗中。外科缝合器械提供了一种能够拓展借助肛管、口腔、胃以及操作入口(service access)引入的机械缝合装置的经腔利用的机构。虽然外科缝合和切割器械最常用于直肠病理学,但外科缝合和切割器械可在多种环境下使用。
随着时间的推进,外科缝合和切割器械已经得到了发展。这些器械通常包括支架,与所述支架连接的砧座和装载有多个钉的钉仓模块。所述器械还包括位于钉仓模块中的驱动器,该驱动器将所有钉同时推出并使其进入砧座中,以便使钉成形为大致B形形状,将组织缝合在一起。此外,这些器械包括接近机构,用于使钉仓模块从间隔位置运动到闭合位置,在所述间隔位置,钉仓模块相对于砧座分开以将组织容纳于钉仓模块和砧座之间,在所述闭合位置,组织被夹钳在砧座和钉仓模块之间。所述器械还包括击发部件,用于向前移动钉驱动器,以便使钉抵靠砧座成形。
一旦器械被定位在体腔中,需要端部执行器相对于需要切除的组织正确定位。一般说来,当手柄、轴和端部执行器沿着器械的纵向轴线刚性连接时,这通过重新定向整个器械来完成,也就是说重新定向手柄、轴和端部执行器。但是,当定向受到外科缝合和切割器械插入体内所借助的进入口的限制时,这限制了端部执行器重新定向的可能性。
这样,需要一种外科缝合和切割器械,该外科缝合和切割器械提供了端部执行器的重新定向,而不需要重新定向从身体开口延伸的手柄和轴。本发明提供了这样一种机构。
发明内容
因此,本发明的一个目的在于提供一种具有近端和远端的关节运动外科缝合器。所述外科缝合器包括:位于近端的手柄;位于远端的端部执行器,用于选择性进行关节运动以改进接近需要治疗的组织并易于使用所述线性外科缝合器。关节运动机构定位在所述支撑轴和所述端部执行器之间,以允许所述端部执行器相对于所述支撑轴选择性地运动。
本发明的另一个目的在于提供一种外科缝合器,其中所述关节运动机构包括将所述端部执行器连接到所述支撑轴的球形接头。
本发明的另一个目的在于提供一种外科缝合器,其还包括锁定机构,该锁定机构与所述球形接头连接,以使所述端部执行器沿所需朝向选择性地锁定,并且在需要时选择性地松开所述端部执行器,以便进行受控运动。
本发明的另一个目的在于提供一种外科缝合器,其中所述锁定机构包括球锁定释放管。
本发明的另一个目的在于提供一种外科缝合器,其中所述球形接头包括具有波形外表面的球,所述球的形状和尺寸能够与所述球锁定释放管的远端接合。
本发明的另一个目的在于提供一种外科缝合器,其中所述球形接头包括具有波形外表面的球,所述球的形状和尺寸能够与所述球锁定释放管的远端锁定,所述球的所述波形有助于确保所述球和所述球锁定释放管的远端之间的摩擦接合。
本发明的另一个目的在于提供一种外科缝合器,其中所述关节运动机构包括多个关节运动接头。
本发明的另一个目的在于提供一种外科缝合器,其中所述多个关节运动接头由齿轮和带转动机构来致动。
本发明的另一个目的在于提供一种外科缝合器,其中所述齿轮和带转动机构包括连接到齿轮上的关节运动调节器,所述齿轮又与第一控制杆和第二控制杆连接,所述第一控制杆和第二控制杆与旋转齿轮连接,该旋转齿轮驱动紧固到端部执行器上的固定齿轮。
本发明的另一个目的在于提供一种外科缝合器,其中所述多个关节运动接头由连接到安装于所述端部执行器上的齿轮传动结构上的索来致动。
本发明的另一个目的在于提供一种外科缝合器,其中所述端部执行器可释放地紧固到所述支撑轴上。
本发明的另一个目的在于提供一种外科缝合器,其中位于所述端部执行器和所述支撑轴之间的卡口型锁允许进行选择性的释放。
本发明的另一个目的在于提供一种外科缝合器,其中所述端部执行器是弧形的。
本发明的另一个目的在于提供一种外科缝合器,其中所述端部执行器是包括钉仓模块和支撑结构的外科紧固组件。
本发明的另一个目的在于提供一种外科缝合器,其中所述钉仓模块包括连接到砧座上的钉仓外壳。
本发明的另一个目的在于提供一种外科缝合器,还包括从所述手柄延伸到所述端部执行器的驱动索,用于致动所述钉仓模块。
本发明的另一个目的在于提供一种外科缝合器,其中所述钉仓外壳包括凹槽,该凹槽的形状和尺寸能够用于滑动地容纳推动卡圈,所述驱动索的带螺纹远端接合在所述推动卡圈中,以便使所述钉仓外壳和所述推动卡圈向着所述砧座运动。
本发明的另一个目的在于提供一种外科缝合器,其中所述推动卡圈能够选择性地断开与所述钉仓外壳的接合,从而允许所述推动卡圈继续地向前运动,以迫使刀和钉与所述钉仓外壳一起向着所述砧座运动。
本发明的另一个目的在于提供一种外科缝合器,还包括防倒退机构,用于防止所述钉仓外壳不需要的向后运动。
本发明的另一个目的在于提供一种外科缝合器,其还包括用于致动止动销的柔性止动销驱动索。
更具体地说,本发明涉及如下内容:
(1)、一种具有近端和远端的关节运动外科缝合器,包括:
位于近端的手柄和位于远端的端部执行器,所述端部执行器用于选择性地进行关节运动,以改进对需要治疗的组织的访问并易于使用该线性外科缝合器;
将所述手柄连接到所述端部执行器的支撑轴;和
定位在所述支撑轴和所述端部执行器之间的关节运动机构,以允许所述端部执行器相对于所述支撑轴选择性地运动。
(2)、根据第(1)项所述的外科缝合器,其中所述关节运动机构包括将所述端部执行器连接到所述支撑轴上的球形接头。
(3)、根据第(2)项所述的外科缝合器,还包括锁定机构,该锁定机构与所述球形接头连接,以使所述端部执行器沿所需朝向选择性地锁定,并且在需要时选择性地松开所述端部执行器,以便进行受控运动。
(4)、根据第(3)项所述的外科缝合器,其中所述锁定机构包括球锁定释放管。
(5)、根据第(4)项所述的外科缝合器,其中所述球形接头包括具有波形外表面的球,所述球的形状和尺寸能够与所述球锁定释放管的远端接合。
(6)、根据第(2)项所述的外科缝合器,其中所述球形接头包括具有波形外表面的球,所述球的形状和尺寸能够与所述球锁定释放管的远端锁定,所述球的所述波形有助于确保所述球和所述球锁定释放管的远端之间的摩擦接合。
(7)、根据第(1)项所述的外科缝合器,其中所述关节运动机构包括多个关节运动接头。
(8)、根据第(7)项所述的外科缝合器,其中所述多个关节运动接头由齿轮和带转动机构来致动。
(9)、根据第(8)项所述的外科缝合器,其中所述齿轮和带转动机构包括连接到齿轮上的关节运动调节器,所述齿轮又与第一控制杆和第二控制杆连接,所述第一控制杆和第二控制杆连接到旋转齿轮,该旋转齿轮驱动紧固到端部执行器上的固定齿轮。
(10)、根据第(7)项所述的外科缝合器,其中所述多个关节运动接头由连接到安装于所述端部执行器上的齿轮传动结构上的索来致动。
(11)、根据第(1)项所述的外科缝合器,其中所述端部执行器可释放地紧固到所述支撑轴上。
(12)、根据第(11)项所述的外科缝合器,其中位于所述端部执行器和所述支撑轴之间的卡口型锁允许进行选择性的释放。
(13)、根据第(1)项所述的外科缝合器,其中所述端部执行器是弧形的。
(14)、根据第(1)项所述的外科缝合器,其中所述端部执行器是包括钉仓模块和支撑结构的外科紧固组件。
(15)、根据第(14)项所述的外科缝合器,其中所述钉仓模块包括连接到砧座上的钉仓外壳。
(16)、根据第(15)项所述的外科缝合器,还包括从所述手柄延伸到所述端部执行器的驱动索,用于致动所述钉仓模块。
(17)、根据第(16)项所述的外科缝合器,其中所述钉仓外壳包括凹槽,该凹槽的形状和尺寸能够用于滑动地容纳推动卡圈,所述驱动索的带螺纹远端接合在所述推动卡圈中,以便使所述钉仓外壳和所述推动卡圈向着所述砧座运动。
(18)、根据第(17)项所述的外科缝合器,其中所述推动卡圈能够选择性地断开与所述钉仓外壳的接合,从而允许所述推动卡圈继续地向前运动,以迫使刀和钉与所述钉仓外壳一起向着所述砧座运动。
(19)、根据第(18)项所述的外科缝合器,还包括防倒退机构,用于防止所述钉仓外壳不需要的向后运动。
(20)、根据第(1)项所述的外科缝合器,还包括用于致动止动销的柔性止动销驱动索。
通过下列结合用于阐明本发明的某些实施方式的附图的详细描述,本发明的其它目的和优点将会更加清楚。
附图说明
图1是显示根据本发明的外科缝合器的详细透视图。
图2是图1所示外科缝合器的透视图,其中钉仓模块被致动。
图3是图1所示外科缝合器的透视图,其中钉仓模块被去除。
图4、5、6和7是端部执行器的剖视图,显示出钉仓模块的致动。
图8是显示根据本发明的优选实施方式的传递机构的详细视图。
图9是根据图8中显示的实施方式中使用的曲柄的透视图。
图10是传动机构的剖视图。
图11、12、13和14显示了根据参照图1显示的实施方式中采用的球形接头的各个视图。
图15和16显示了根据本发明的又一种实施方式。
图17和18显示了根据本发明的再一种优选实施方式。
图19、20和21显示了根据本发明使用的拆卸机构。
图22和23显示了根据本发明的提供端部执行器的旋转的系统。
具体实施方式
这里公开了本发明的详细实施方式。但是应理解,所公开的实施例仅仅作为可以多种形式体现的本发明的示范性例子。因此,这里公开的细节不应解释为限定性的,而仅仅作为权利要求书以及教导本领域技术人员如何制造和/或使用本发明的基础。
参照图1到10,公开了一种外科缝合和切割器械10,具体地说是线性外科缝合器。所述线性外科缝合器10被设计用于缝合和切割组织。所述线性外科缝合器10具有位于近端14的手柄12和位于相对的远端18的端部执行器16。如同下面相当详细讨论的那样,端部执行器16受到支撑,使其可选择性地进行关节运动,以便改善对需要处理的组织的访问并便于本发明的线性外科缝合器10的使用。
根据本发明的优选实施方式,端部执行器16是弧形的,但本领域技术人员将会理解,在不背离本发明精神的条件下可采用各种形状的端部执行器。支撑轴20将手柄12与器械的端部执行器16连接。根据本发明的优选实施方式,手柄12具有右侧和左侧手柄护罩24、22。手柄12还具有主体部分,用于抓持并操纵该线性外科缝合器10。
端部执行器16是外科紧固组件,包括钉仓模块26和C形支撑结构28。术语“C形”在整个说明书中被用于描述支撑结构28和钉仓模块26的凹形特征。C形结构有利于增强功能性,并且在本说明书中术语C形的使用应当被解释为包括各种凹形,这些凹形能类似地增强外科缝合和切割器械的功能性。端部执行器16的形状和尺寸能够容纳钉仓模块26。端部执行器16还包括安全锁定机构,用于防止先前已被击发的钉仓模块的击发。虽然下面公开的本发明的端部执行器适于与具有各种组成元件的可更换钉仓模块结合使用,但是在不背离本发明的精神的条件下,本发明的构思可被应用于各种端部执行器和钉仓模块结构。
如同基于下列公开的内容会更加清楚的那样,本发明的线性外科缝合器10设计为具有可更换钉仓模块26的多击发装置。然而应当理解,在不背离本发明的精神的条件下,本发明的许多基本构思可同样应用于单击发装置。
更具体地,根据优选实施方式,钉仓模块26包括与砧座32连接的钉仓外壳30。钉仓模块26还包括止动销34;刀36;可动止动器38;组织接触表面40,该组织接触表面40在刀36的两侧上显示出一排或多排(即钉线)交错形成的多个钉容纳槽42。从钉仓外壳30击发钉(未显示),使其抵靠砧座32的钉成形表面44,所述钉成形表面44面向钉仓外壳30的组织接触表面40。
如同将在下面详细讨论的那样,钉仓模块26以下列方式操作。一旦钉仓模块26被正确加载,沿着手柄12安装的曲柄48被致动,使驱动索50转动,从而致动线性外科缝合器10的端部执行器16。驱动索50的最初致动引起钉仓模块26开始闭合。也就是说,驱动索50使钉仓外壳30从其完全打开位置运动到打开和闭合位置之间的中间位置。一旦钉仓外壳30被运动到其中间位置,止动销驱动索52被致动,使止动销34从钉仓外壳30向前运动穿过砧座32中的开口。在该位置中,已经被设置在钉仓外壳30和砧座32之间的组织可被正确定位,并且能够确保钉仓外壳30和砧座32之间的组织保持。当驱动索50已经被致动使钉仓外壳30运动到其中间位置时,钉仓外壳30和砧座32被相应地定位在它们的组织保持位置中。
当驱动索50进一步转动以向前驱动钉仓外壳30时,钉仓外壳30的组织接触表面40和砧座32的钉成形表面44彼此邻近,正确定位和保持的组织由此被完全夹钳住。此后,驱动索50进一步转动,以向前驱动钉驱动器54,从而击发钉并向前运动刀36,以切割组织。
线性外科缝合器10的手柄12包括医生用其手掌握持的把手56。把手56包括右手护罩24和左手护罩22。前面描述的曲柄48或者其它用户致动机构用于驱动本发明的外科缝合和切割器械10的击发机构,并且由用户沿着线性外科缝合器10的手柄12访问。
由于端部执行器16相对于支撑轴20和手柄12的关节运动需要能够随着端部执行器16的关节运动而弯曲的击发机构,如上所述,所以手柄12借助柔性驱动索50与端部执行器16连接。更具体地,本发明的线性外科缝合器的击发机构由具有近端58和远端60的柔性驱动索50致动。驱动索50以受控方式致动钉仓外壳30、钉和刀36的驱动器54,使之运动。特别是,驱动索50从线性外科缝合器10的手柄12延伸到钉仓外壳30、钉和刀36的驱动器54,该驱动器54被定位在线性外科缝合器10的端部执行器16处。
用户可用接口48被设置在驱动索50的近端58。例如,根据优选实施方式,用户可用接口是可由用户选择性旋转以沿着驱动索50的长度施加扭矩的曲柄48,所述扭矩最终被转化成钉仓外壳30、用于钉和刀36的驱动器54的线性运动。
驱动索50的远端60与钉仓外壳30、用于钉和刀36的驱动器54螺纹接合,以便在驱动索50受控旋转时允许这些组成元件线性运动。这样,通过转动驱动索50,钉仓外壳30、用于钉和刀36的驱动器54以受控方式向着砧座32运动,允许缝合并切割组织。
更具体地,参考图4、5、6和7,显示了在驱动钉和刀36的过程中钉仓外壳30的操作。根据优选实施方式,钉仓外壳30包括凹槽140,所述凹槽140的形状和尺寸能够容纳推动卡圈142,驱动索50的带螺纹远端144以下面详细讨论的方式接合在推动卡圈142中,以便进行运动。如同将在下面详细讨论的那样,推动卡圈142被保持在凹槽140中,以便进行相对于凹槽140的受控运动。
当驱动索50沿预定方向旋转时,钉仓外壳30和推动卡圈142向前向着砧座32运动。钉和刀36类似地被向前向着砧座32驱动。驱动索50的连续旋转使钉仓外壳30运动,更接近砧座32。一旦钉仓外壳30非常接近砧座32,推动卡圈142与钉仓外壳30的接合断开,从而允许推动卡圈142和驱动器54继续向前运动,以迫使刀36和钉向着砧座32运动。
更具体地,驱动器54被安装在形成于钉仓外壳30中的凹槽146中。驱动器54由弹簧148沿着远离砧座32并向着推动卡圈142的方向偏压。这样,当推动卡圈142被松开并能够相对于钉仓外壳30自由运动时,克服弹簧148的偏压向着砧座32推动驱动器54,直到钉和刀36被驱动穿过组织进入砧座32,在砧座32中钉被弯曲,从而固定到组织。
如同本领域技术人员当然会理解的那样,重要的是钉仓外壳30不会易于意外倒退。这样,提供了防倒退机构。防倒退机构一般包括防倒退爪150,防倒退爪150的形状和尺寸能够与沿着端部执行器16形成的齿152接合,以防止钉仓外壳30的向后运动。特别是,防倒退爪150是纵向延伸构件154,纵向延伸构件154可枢转地连接到钉仓外壳30并被偏压以便向着端部执行器16的壁旋转。防倒退爪150由弹簧(未示出)向着端部执行器16的壁偏压,使防倒退爪150可接合端部执行器16中形成的齿152,从而防止钉仓外壳30倒退。
如同上面简要讨论的那样,驱动器54的运动通过将推动卡圈142设置在钉仓外壳30的凹槽140中来实现。当与驱动索50和驱动爪156一起被操纵时,推动卡圈142允许克服弹簧148的阻力向前推动驱动器54,从而将驱动器54偏压到闭合位置。更具体地,驱动爪156可枢转地安装在钉仓外壳30上,以便在锁定位置(见图4)和松开位置(见图5和6)之间运动。在锁定位置中,驱动爪156具有第一端部158,该第一端部158与形成于钉仓外壳30的凹槽140中的推动卡圈142接合。当与推动卡圈142接合时,驱动爪156防止推动卡圈142相对于钉仓外壳30的运动。推动卡圈142包括内螺纹160,驱动索50的远端144设在该内螺纹160中。这样,当驱动爪156将推动卡圈142安全地保持在合适位置中时,当驱动索50旋转时整个钉仓外壳30向前运动。
当钉仓外壳30到达相对于砧座32的预定点时,驱动爪156的第二端部162沿着端部执行器16与斜面164接合,该斜面164使第二端部162沿着逆时针方向转动,将驱动爪156的第一端部158从其与推动卡圈142的接合锁定位置运动开。这样,当驱动索50在钉仓外壳30中旋转时,允许推动卡圈142相对于钉仓外壳30向着远端运动。推动卡圈142相对于驱动索50的旋转由键条166防止,所述键条166从推动卡圈延伸到钉仓外壳30中。当驱动索50被旋转时,并且驱动爪156与推动卡圈142脱离结合,所以推动卡圈142被向着砧座32推动,由此克服弹簧148的阻力向着砧座32推动驱动器54,以迫使钉和刀穿过组织。
根据本发明的优选实施方式,对于驱动索的构造来说绞股线或索是理想的。因为这样的结构能提供比单根金属丝更大的强度和柔性。这些高度工程化产品常常利用复杂的结构或者工艺来增加疲劳寿命、强度、柔性、扭矩、硬度和光滑度。驱动索可以是直径低于大约0.003″的特细或者微型绞股线直到直径大约为0.125″的索。
更具体地,参照图8、9和10,用于旋转驱动索50的曲柄48与传动装置62连接。更具体地,传动装置62包括与曲柄48连接的输入正齿轮66、与输入正齿轮66连接的增速正齿轮68、以及与增速正齿轮68连接的冠齿轮70。冠齿轮70与小齿轮72接合,该小齿轮72与驱动索50连接,使该驱动索50旋转。
根据本发明的优选实施方式,能量储存飞轮74与驱动索50连接。或者,飞轮74和驱动索50可以是单个模制品。飞轮74使曲柄48的操作平稳,否则曲柄48在其旋转过程中要求施加更大的力,当曲柄48开始旋转时,驱动索50使击发机构前进。本领域技术人员将会理解,为了更加有效,飞轮74优选设置有相对较大的旋转质量以便储存能量。当飞轮74通过曲柄48的转动而转动(旋转)时,一些能量被用于增加飞轮74的动能。这些能量的一部分随时间由于摩擦而损耗。但是,一些用于使飞轮74转动的能量以动能的形式被储存。之后,能够通过直接机械传递(translation)收回该能量。在本发明的情形中,当曲柄48最初旋转时,驱动索50施加的阻力很小,并且大多数施加到曲柄48的能量被用于使飞轮74旋转。在曲柄旋转接近结束时,驱动索50因为接近循环结束而使扭转阻力增大。此时,飞轮74中的动能被释放并使剩下的曲柄循环变得容易。优选地,根据本发明,选择飞轮74,使得在对于进行单次夹持时所需的整个曲柄48的运动期间段使施加到曲柄48的力大致均匀(例如变化不超过25%)。
如图9和10最清楚显示的,曲柄48设置有止动锁76,该止动锁76必须在曲柄48被转动之前松开,并且该止动锁76用于在一次旋转之后自动锁定曲柄48。优选地,曲柄48还设置了棘轮机构(未显示),用于防止曲柄48被向后旋转。曲柄48优选设置有锁(未显示),用于防止曲柄48被转动,直到钳口闭合。曲柄48还可设置有转数计(未显示),该转数计可与输入正齿轮66连接,且该转数计可计数曲柄48已经旋转的次数并指示钉仓外壳30、用于钉和刀36的驱动器54的位置。该转数计还可被用于防止曲柄48在击发循环已经完成之后旋转。
根据图9中所示的实施方式,曲柄48具有多个间隔设置的周缘指握槽78和滚花外周80。如果需要的话,曲柄手柄82可选择性地移除,使曲柄48可像旋钮一样旋转。止动锁76包括具有凸缘86的按钮84,具有凸缘90的锁定销88和弹簧92。锁定销88设置在阶梯式的腔94中并由弹簧92偏压到曲柄48中的阶梯式的腔94中。当按钮84受压时,锁定销88抵抗弹簧92运动并脱离腔94,从而松开曲柄48,以便进行旋转。
根据一种示例性实施方式,当曲柄48转动一转时,传动装置62使驱动索50旋转预定的转数。当曲柄48转动一转时,位于驱动索50远端60处的螺纹98的螺距使钉仓外壳30、用于钉和刀36的驱动器54前进预定距离。为特定夹具长度选择齿轮和螺距。根据本发明的本优选实施方式,仅需要改变冠齿轮(通过增加或减少齿数)以容纳不同长度的夹具。
本发明的外科缝合器10还设置有止动销致动机构102。但是,考虑本发明要求沿着关节运动接头挠曲,止动销34的致动通过柔性止动销驱动索52的执行来实现。柔性止动销驱动索52包括近端104和远端106。止动销驱动索52致动止动销34,使之进行运动。特别是,止动销驱动索52从线性外科缝合器10的手柄12延伸到定位在线性外科缝合器10的端部执行器16上的止动销34。用户可用接口108设置在止动销驱动索52的近端104。例如,根据一种优选实施方式,用户可用接口是曲柄108,该曲柄108可由用户选择性旋转,以沿着止动销驱动索52的长度施加扭矩。
止动销驱动索52的远端106与止动销34螺纹接合,以便在止动销驱动索52进行受控旋转时允许运动止动销34。这样,通过旋转止动销驱动索52,止动销34以受控方式向着砧座32运动,允许止动销34延伸穿过端部执行器16。止动销驱动索52的运动与上面讨论的驱动索50的相同。
如图11、12、13和14所示,端部执行器16的支撑结构28借助球形接头110连接到支撑轴20上,所述球形接头110定位在支撑轴20的远端112处(将在下面详细讨论)。球形接头110包括球114,球114受到保持,以便在定位于支撑轴20的远端112上的凹槽116中运动,并且球114与端部执行器16固定地连接,以便与端部执行器16一起运动。
根据本发明的一种优选实施方式,支撑结构28由单件式结构形成。更具体地说,根据本发明公开的支撑结构28由挤压件、例如铝挤压件随后机加工形成。通过以这种方式构建支撑结构28,不需要多个部件,生产和组装的相关成本被显著降低。另外,支撑结构28的整体结构增强了本发明线性外科缝合器10的整体稳定性。另外,支撑结构28的整体挤压结构使得重量减轻,更容易灭菌(因为钴辐射将有效地穿透挤压的铝),并且由于经过挤压形成的光滑外表面对组织的损伤更小。
更具体地,端部执行器16连接到支撑轴20,允许端部执行器16相对于支撑轴20围绕多个轴选择性地运动。如同将在下面详细讨论的那样,端部执行器16选择性地连接到支撑轴20,以便在外科缝合器10被定位在患者体内时移除端部执行器16以及对端部执行器16重新进行组装。
更具体地,如上简单讨论的那样,球形接头110连接端部执行器16和支撑轴20。球形接头110被保持在支撑轴20的远端112上,并且凹槽或者插槽116的形状和尺寸能够将球114保持在支撑轴20的远端112处,同时允许球114相对于远端112的旋转运动。这样,球114相对于在支撑轴20远端112中形成的插槽116运动,导致该球114连接的端部执行器16进行受控运动。
根据一种优选实施方式,参照图13和14,球形接头110设置有锁定机构118,从而允许医生以所需朝向选择性地锁定端部执行器16,并在需要时选择性地释放端部执行器16以进行受控运动。具体地说,球锁定释放管120从手柄12延伸到球形接头110。球锁定释放管120定位成能够沿着支撑轴20的长度进行轴向运动。这样,球锁定释放管120可以在其与球形接头110接合的锁定位置和其离开球形接头110在近侧定位的未锁定位置之间运动。
弹簧122与球锁定释放管120连接,以便将球锁定释放管120偏置到其锁定位置。但是,当需要运动球锁定释放管120时,与球锁定释放管120连接的释放臂124被致动,以拉动球锁定释放管120远离球形接头110。当球锁定释放管120以这种方式被回缩时,球形接头110可自由地进行旋转,从而使端部执行器16以需要的方式进行关节运动。
球形接头110的锁定还通过为球114设置波状外表面来增强,该波状外表面的形状和尺寸能够与球锁定释放管120的远端126“锁定”。球114的外形帮助确保球114和球锁定释放管120的远端126之间的摩擦接合。
注意上述内容,释放管120和球114允许端部执行器16的相对定向。但是,根据本发明的一种优选实施方式,这种关节运动必须在器械使用之前事先设置。然而,可以想到,端部执行器16的定向在体腔内可通过松开释放管120并将适当的力施加到端部执行器16上以调节端部执行器16的位置来调节。之后,释放管120运动回到与球114的接合中,从而将端部执行器16返回锁定到所需的位置。
根据一种可选实施方式,参见图15和16,端部执行器216的关节运动由多个关节运动接头控制。端部执行器216围绕大致与线性外科缝合器210的纵向轴线成一直线的轴线的旋转通过将端部执行器216连接到支撑轴220并允许支撑轴220相对于手柄212旋转来实现。支撑轴220包括固定地连接到端部执行器216的远端222,使端部执行器216可与支撑轴220一起运动。支撑轴220的近端224与手柄212连接,以便相对于手柄212旋转。
支撑轴220相对于手柄212的受控运动由遥控关节运动构件226来促进,该遥控关节运动构件226作用于支撑轴220,使支撑轴220围绕线性外科缝合器210的纵向轴线旋转并最终使端部执行器216围绕同一轴线旋转。
端部执行器216围绕与线性外科缝合器210的纵向轴线垂直的轴线的旋转由齿轮和带转动机构228控制。具体地,手柄212设置有与齿轮232连接的关节运动调节器230,齿轮232又与第一和第二控制杆234a、234b连接。类似地,端部执行器216包括固定齿轮236,该固定齿轮236借助位于支撑轴220远端222处的旋转齿轮238与控制杆234a、234b的另一端连接。端部执行器216的固定齿轮236与端部执行器216固定地连接,但被安装成当旋转齿轮238旋转时使端部执行器216也旋转的方式旋转。这样,在实践中,当调节器230被旋转时,手柄212的齿轮232同样被旋转,从而通过控制杆234a、234b使旋转齿轮238运动并转动,该旋转齿轮238又使端部执行器的固定齿轮236转动,并最终使端部执行器216转动。以这种方式旋转可被用于以顺时针和逆时针两个方向旋转端部执行器216,以便于更宽范围的定向。
类似地,参考图17和18,控制杆可由索234’代替,所述索234’能够致动与端部执行器216’连接的齿轮传动结构232’。
参见图19、20和21,采用上述讨论的任一种关节运动机构,端部执行器316可释放地连接到支撑轴320,从而允许在本发明的线性外科缝合器310的使用中有更大的通用性。根据一种优选实施方式,支撑轴320设置有卡口型锁334,所述锁334的形状和尺寸能够与可拆卸锁头330接合,该可拆卸锁头330借助螺纹轴332连接到端部执行器316的近端338。如同本领域技术人员理解的那样,为了与卡口型锁334接合,仅仅需要将锁紧螺母330插入到卡口型锁334之上并旋转锁紧螺母330以接合在卡口槽338中。配合键条336设置在卡口型锁334和锁头330中,以确保元件的正确定位。如同本领域技术人员理解的那样,上述连接可设置有中央通道,以允许控制索和致动端部执行器所需的其它机构通过。
根据一种前面描述的那些实施方式的替代方式,参见图22,参照图11、12、13和14公开的球形接头可与转动轴480组合,该转动轴480延伸穿过在球形接头410中形成的通道482并延伸到端部执行器416。在使用固定地连接到端部执行器416中的转动轴480的条件下,转动轴480的旋转可引起端部执行器416围绕支撑轴420的纵向轴线的旋转运动。通过在球形接头410和支撑轴420之间设置轴承484可促进以这种方式的旋转,从而当转动轴480被致动时使球形接头410可同样旋转。
根据又一种实施方式,参见图23,上述公开的实施方式可被简化,其中在仅仅需要提供端部执行器516围绕支撑轴520的纵向轴线的旋转调节的情况下去除球形接头510。端部执行器516相对于支撑轴520的运动通过包括轴承584来促进,所述轴承584位于端部执行器516的近端轴586和支撑轴520的远端588之间,其中端部执行器516的近端轴586的形状和尺寸能够配合在支撑轴520中。
虽然已经显示并描述了本发明的优选实施方式,但是应当理解,这并不是想将本发明限定在所公开的内容,而是想覆盖落入本发明的精神和范围内的所有修改和替代构造。
Claims (7)
1.一种具有近端和远端的关节运动外科缝合器,包括:
位于近端的手柄和位于远端的端部执行器,所述端部执行器用于选择性地进行关节运动,以改进对需要治疗的组织的访问并易于使用该线性外科缝合器;
将所述手柄连接到所述端部执行器的支撑轴,其中,所述端部执行器是包括钉仓模块和支撑结构的外科紧固组件,转动的驱动索将所述手柄连接到所述端部执行器,用于当所述驱动索转动时致动所述钉仓模块;和
定位在所述支撑轴和所述端部执行器之间的关节运动机构,以允许所述端部执行器相对于所述支撑轴选择性地运动,所述关节运动机构包括将所述端部执行器连接到所述支撑轴的球形接头和锁定机构,该锁定机构与所述球形接头连接,以使所述端部执行器沿所需朝向选择性地锁定并且在需要时选择性地松开所述端部执行器,以便进行受控运动,其中所述锁定机构包括球锁定释放管,所述球锁定释放管定位成相对所述支撑轴进行轴向运动,选择性地在与所述球形接头接合的锁定位置和离开所述球形接头定位的未锁定位置之间运动。
2.根据权利要求1所述的外科缝合器,其中所述球形接头包括具有波形外表面的球,所述球的形状和尺寸能够与所述球锁定释放管的远端接合。
3.根据权利要求1所述的外科缝合器,其中所述球形接头包括具有波形外表面的球,所述球的形状和尺寸能够与所述球锁定释放管的远端锁定,所述球的所述波形有助于确保所述球和所述球锁定释放管的远端之间的摩擦接合。
4.根据权利要求1所述的外科缝合器,其中所述关节运动机构包括多个关节运动接头。
5.根据权利要求4所述的外科缝合器,其中所述多个关节运动接头由齿轮和带转动机构来致动。
6.根据权利要求5所述的外科缝合器,其中所述齿轮和带转动机构包括连接到齿轮上的关节运动调节器,所述齿轮又与第一控制杆和第二控制杆连接,所述第一控制杆和第二控制杆连接到旋转齿轮,该旋转齿轮驱动紧固到端部执行器上的固定齿轮。
7.根据权利要求4所述的外科缝合器,其中所述多个关节运动接头由连接到安装于所述端部执行器上的齿轮传动结构上的索来致动。
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JP2008055165A (ja) | 2008-03-13 |
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TWI454243B (zh) | 2014-10-01 |
CA2599131A1 (en) | 2008-02-29 |
HK1115045A1 (en) | 2008-11-21 |
EP1894531B1 (en) | 2013-08-14 |
MX2007010535A (es) | 2009-02-10 |
AU2007203247A1 (en) | 2008-03-20 |
BRPI0703389B1 (pt) | 2018-01-30 |
BRPI0703389B8 (pt) | 2021-06-22 |
TW200822899A (en) | 2008-06-01 |
AU2007203247B2 (en) | 2012-08-02 |
ZA200707288B (en) | 2009-09-30 |
US7766207B2 (en) | 2010-08-03 |
JP5340570B2 (ja) | 2013-11-13 |
BRPI0703389A (pt) | 2008-04-22 |
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