CN101163456B - 植入体插入装置 - Google Patents

植入体插入装置 Download PDF

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CN101163456B
CN101163456B CN200680013339.9A CN200680013339A CN101163456B CN 101163456 B CN101163456 B CN 101163456B CN 200680013339 A CN200680013339 A CN 200680013339A CN 101163456 B CN101163456 B CN 101163456B
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axle
blade
knock
pin
screw thread
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CN101163456A (zh
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D·E·埃文斯
D·S·克法特
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Synthes GmbH
Synthes USA LLC
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Abstract

本发明涉及一种与脊椎植入体共同使用的装置，其包括带有通道的手柄结构。带有螺纹的轴可以在手柄结构的通道里移动。顶推块连接于轴上，并且具有构造成能够接合脊椎植入体的前向表面。螺纹离合器部件支撑于手柄结构上，以与轴上的螺纹相接合或脱离接合。

Description

植入体插入装置
相关申请的相互引用
本申请要求2005年2月25日记录在案的美国临时申请No.60/656707的优先权，该申请的所有内容通过引用被明确地结合于本发明中。 
技术领域
该技术涉及一种装置，用于安装植入体于(例如)人类的脊椎中。 
背景
脊椎植入体插入器是在人类的脊椎中两块(例如一对相邻的)椎骨之间、或者整个地或部分地在一块脊椎骨内安装植入体的装置。这样的装置典型地由手工操作，并且可能包括轴杆，操作者用它将脊椎植入体推入椎骨之间的空间内。插入器可以用于(例如)前向进入、后向进入、横向进入或以介于它们之间的任何变化方式进入。 
概要
与脊椎植入体共同使用的装置，脊椎植入体可以包括手柄结构、轴、顶推块(pusher block)和离合器部件(clutch member)，其中手柄结构可能具有纵轴线和通道，轴可以在通道里移动并且可以具有带有第一螺纹的至少一部分，顶推块可操作地连接于轴，并且可以具有构造成接合脊椎植入体的前向表面，而离合器部件可以被支持在手柄结构上，以与轴的第一螺纹相接合或脱离接合。该装置还可以包括一对叶片(paddle)，其具有远端、近端并且可以从手柄突出。插入器可以用于(例如)前向进入、后向进入、横向进入或以介于它们之间的任何变化方式进入。 
手柄结构可以具有内螺纹，并且轴可以具有第二螺纹，当离合器部件与轴的第一螺纹相接合或脱离接合时，该第二螺纹能够沿纵轴线移动以接合手柄结构上的内螺纹。在一些实施例中，手柄可以具有内螺纹，并且轴可以具有至少一部分，其可以具有与内螺纹隔开的第一螺纹，以使轴能轴向地穿过通道内的第一移动距离而滑动。轴的至少一个不同部分可以具有第二螺纹。第二螺纹可以移动至与内螺纹接合，以使轴只能旋转通过通道内的第二移动距离。轴可以构造成，当轴前移穿过通道时，第二移动距离可以跟随第一移动距离。 
顶推块可以连接到轴上并能够与之一起移动。顶推块可以具有容纳部分，其尺寸和结构设置成能容纳顶出杆。顶出杆可以包括具有纵轴线的中央部分和从中央部分延伸的两个臂。在一个实施例中，臂可以偏离中央部分的纵轴线。顶出杆的中央部分可以包括多个凹部(indentation)和凹槽(groove)。顶推块可以具有至少一个紧固件以接合凹部和凹槽，以使顶出杆可以相对于顶推块旋转。在一些实施例，顶出杆可以具有至少一个臂，并且可操作地连接于顶推块且/或与之脱离接合。在实施例中，至少一个叶片具有槽口(slot)，该至少一个臂可以在处于叶片远端和近端之间的该槽口内移动。顶出杆可以可释放地连接于顶推块。叶片中至少一个可以包括开口，以使当顶出杆置于开口内时，顶出杆可以与顶推块脱离接合并且/或者相对于它旋转。 
轴的至少一部分可以位于叶片之间，并且可以移动穿过叶片的近端。叶片远端的尺寸和结构设置成可以放置在相邻的椎骨之间。并且，叶片可以设置成其远端能够偏置到一起。叶片近端的尺寸和结构设置成可以可操作地附接于手柄。在一个实施例中，至少一个叶片可以在其远端的具有至少一个凸棱(ridge)，凸棱可以改善该至少一个叶片与椎骨的接合。在一些实施例中，至少一个叶片可以具有用于接合至少一块椎骨的至少一个止挡结构，该至少一个止挡结构 可以设置成避免叶片远端过分穿入到相邻的椎骨内。一对叶片中至少一个可以具有槽口，以使顶出杆可以沿槽口移动。叶片可以被设置成，当顶推块从叶片近端移动到叶片远端时，叶片远端彼此相分离。 
离合器部件可以包括从中穿过的开口，所述开口具有第一部分和第二部分，其中第一部分可以包括螺纹部分而第二部分可以包括无螺纹部分。离合器部件还可以包括第一侧面部分和处于该侧面部分上的至少一对凹穴(pocket)。手柄可以具有第一紧固件，其用于选择性地一次只能接合所述这一对凹穴的其中一个凹穴。离合器部件还可以包括第二侧面部分和处于第二侧面部分上的第二对凹穴。手柄可以具有第二紧固件，其用于选择性地一次只能接合所述第二对凹穴的其中一个凹穴。在一个实施例中，第一和第二紧固件可以是穿过手柄放置的球形掣子(ball detent)。离合器部件可以被支撑在手柄上，以移动至与轴上的第一螺纹相接合或脱离接合，以使当离合器部件接合第一螺纹时，轴只可以旋转穿过通道内的第一移动距离。离合器部件可以被支撑在手柄结构上，以在第一位置和第二位置之间移动，在第一位置中轴能够在平行于纵轴线在手柄内滑动，在第二位置中轴能够以不同于纵向运动的第二方式在手柄内移动。该不同的第二运动方式可以包括至少部分地旋转轴。 
在相邻的椎骨之间插入植入体的方法可以包括，提供植入体插入器，该植入体插入器包括手柄结构、一对叶片、轴、顶推块以及离合器部件，其中手柄结构可以具有纵轴线和通道，一对叶片可以从手柄延伸且可以具有远端和近端，轴可以在通道以及具有第一螺纹部分的至少一部分内移动，顶推块可操作地连接于轴且可以具有设置成能够接合脊椎植入体的前向表面，离合器部件的至少一部分可以具有螺纹，用于选择性地与轴的第一螺纹部分相接合。该方法还可以包括，插入植入体，使之贴靠到顶推块并使之位于叶片之间，插入叶片远端于相邻椎骨之间，移动轴通过手柄通道以及从相邻椎 骨之间撤回叶片，其中移动轴通过手柄通道是为了使植入体可以向叶片远端移动且使叶片可以相互分离开。另外，该方法可以包括，移动离合器部件的螺纹以与轴的第一螺纹部分接合。并且，在一个实施例中，轴可以包括第二螺纹部分且手柄可以包括内螺纹，该方法还可以包括，使轴的第二螺纹部分与手柄的内螺纹相接合，并且相对于手柄旋转轴，以便在叶片之间移动顶推块。当植入体向叶片的远端移动时，叶片可以分开。在实施例中，植入体插入器可以包括可操作地连接于顶推块的顶出杆，顶出杆可以接合至少一块椎骨，以使当轴旋转时，叶片远端从相邻椎骨之间移出。此外，在实施例中，植入体插入器可以包括可操作地连接于顶推块的顶出杆，并且叶片中至少一个可以包括开口，该方法还可以包括，在开口内旋转顶出杆。 
附图简介
本发明和本发明的进一步发展将在下列示例性的附图中作更详细的解释。参考下列附图，能更好地理解本发明，其中相似的参考数字标号代表相似的元件。附图仅仅示例性地举例说明了某些特征，这些特征将被单独地或者结合其它特征应用，并且本发明不应该局限于所示的实施例。 
图1是带有脊椎植入体的脊椎植入体插入器的透视图； 
图2是图1所示的插入器的部分剖视图； 
图3是沿着图2中的线3-3上的剖视图； 
图4是图1所示的插入器的部分侧视图； 
图5是图1所示的植入体和插入器一部分的放大图； 
图6是沿着图5中的线6-6上的剖视图； 
图7是图5和图6所示部分的透视图； 
图7A是图7所示部分的可选实施例的透视图； 
图8是图1所示的插入器的一部分的侧视图； 
图9是在图8所示部分的俯视图； 
图10是图1所示的植入体和插入器的侧视图，其中某些部分显示的是剖面图； 
图11是沿着图10中的线11-11视图； 
图12是图1所示的插入器的一部分的剖视图； 
图13是图1所示的插入器的一部分的侧面剖视图； 
图14是在图13所示部分的俯视图； 
图15是沿着图13中的线15-15的端视图； 
图16是沿着图13中的线16-16的端视图； 
图17是图13所示部分的部分放大视图； 
图18是沿着图13中的线18-18的剖视图； 
图19是沿着图13中的线19-19的剖视图；并且 
图20是图1所示的插入器的部分侧视图； 
详细描述 
在附图中所示的装置10是一种脊椎植入体插入器，其中有些部分是在权利要求所引用的结构元件的示例。如此，插入器10包括本领域普通技术人员如何制造和应用本发明的示例，并且在这里被描述旨在提供本发明的实现可能和最佳模式，而不是要强加上在权利要求中未陈述的限制。因此，附图只是插入器的举例说明，且是用于描述目的。在这点上，虽然装置被描述并举例说明成用于插入植入体于脊椎内，然而它也可以用于把其它类型的植入体插入其它位置，并且用于插入除了人类外的动物体或其它物体内。 
在图1所示的插入器10的部分包括握持式手柄12、轴14和处于轴14端部上的T形手柄16。一对可被称为叶片的牵开弹簧18可以从握持式手柄12处向前突出。轴14可以延伸穿过握持式手柄12，并且在叶片18之间从握持式手柄12处向前突出。 
顶推块20可以容纳于叶片18之间。顶推块20可以连接于轴14 或与之相关联，当操作者向前朝向握持式手柄12移动T形手柄16时，顶推块20可以被向前驱动。然后顶推块20可以在叶片18的远端24之间向前推动脊椎植入体22，这迫使叶片18彼此分开以使一对椎骨同时岔开而使植入体22向前进入椎骨之间的空间内。 
如在图2和图3中分别所示的，握持式手柄12可以具有带有纵向中心轴线25的大致圆柱形的结构，并且可以向它的两相对端部径向地向内逐渐变细。于图右可见，沉孔(counterbore)31可以从握持式手柄12的近端32轴向地向内延伸。于图左可见，类似的沉孔35可以从远端36轴向地向内延伸。沉孔31、35和内孔39一起可以限定通道41沿轴线25纵向地延伸穿过握持式手柄12。在实施例中，手柄12的长度可以为从约10cm至约15cm。 
另一个通道43可以横向延伸穿过握持式手柄12。该通道43可以与纵向通道41交叉，并且垂直于纵轴线25的横轴线45可以位于其中部。如图2中最佳地显示，一对窄的螺纹孔47可以从横向通道43反向向外延伸。图1最佳地显示出，槽口49也可以横向延伸穿过手柄12，并可以沿握持式手柄12的纵向延长。 
轴14可以具有一些不同长度和直径的、明显不同的截面。如图4所示，这些可以包括带有轴14上最大直径d1的近端区段50和带有最小直径d2的远端区段52。近端区段50可以设置成能够容纳T形手柄16(图1)。远端区段52可以设置成能够容纳顶推块20(图1)。在一个实施例中，轴14的长度可以是从约30cm至约40cm。在一个实施例中，插入器10的长度可以是从约35cm至约45cm。 
轴14的其它区段可以包括主要长度区段56，而其可以包括处于两个中间区段60和62之间的中部区段58。中部区段58可以是轴14的最长的单个区段，并且可以具有沿其几乎整个长度延伸的第一螺纹64。中部区段58可以在螺纹64边上具有第三直径d3，并且也可以在螺纹64处具有第四直径d4。中间区段60和62也可以具有第四直径d4。带有较大直径d5的另一个中间区段66，可以在近端区段50 和相邻的无螺纹的中间区段62之间轴向地延伸。轴14的该区段66可以具有带有最大直径d1的第二螺纹68。 
如图5和图6所详细地显示的，顶推决20可以被安装在轴14的远端区段52上，并且可以通过保持环80保持在轴14上。顶推块20的前向表面82具有轮廓，其匹配于脊椎植入体22的相对表面84的轮廓。图5和图6中还显示了，顶出杆86可以安装在顶推块20上。如图7所单独示出，顶出杆86可以具有带有圆截面的中央部分88，并且可以具有一对臂90，其可以具有卵形、椭圆形、或任何其它的适当的横截面。应该注意的是，顶出杆86可以具有至少一个臂90。如图6所示，顶出杆86的中央部分88可以容纳于延伸穿过顶推块20的圆孔91内。如图5所示，臂90可以从顶推块20突出。一对紧固件92可以紧固顶出杆86于顶推块20上。 
可以设有一个叶片18或多个叶片18。在所列举的实施例中，插入器10具有两个叶片18。叶片18可以是(如所例举的)单一弹簧结构100的分开的挠性部分，或在另一个实施例中，可以是附于基部的多个(例如，两个)弹簧的组件。如图8和图9所示，弹簧结构100可以在它的近端具有管状的基部102。叶片18可以是相似的，并且可以构造成细长的片簧，其从基部102弓形地横着向外，并且在它们的远端24会合。至少一个叶片18可以具有位于中心的槽口109，其在基部102的附近带有钥匙孔形的开口111。开口111可以提供这样的手段，借助此手段，顶出杆86可以与顶推块20分离，使得更换的顶出杆或者具有不同构造的顶出杆可以与插入器10一起使用。例如，当顶出杆86被放置于靠近开口111或者置于其内时，紧固件92可以与顶出杆86脱离接合，而顶出杆86可以从顶推块20移除，并且从开口111处取出。 
如图7A所示，可选的顶出杆86a可以与插入器10一起使用。顶出杆86a可以具有臂90a和具有纵轴线86b的中央部分88a。应该注意的是，顶出杆86a可以具有至少一个臂90a。臂90a相对于中央 部分88a的纵轴线86b可以是偏离中心的。并且，顶出杆86a可以具有一个或多个凹部89及凹槽93。顶出杆86a可以通过紧固件92固定在顶推块20中，紧固件92可以是(例如)可以接合凹部89的球形掣子(未显示)。当臂90a位于叶片18的开口111内时，中央部分88可以在开口111内旋转。一位外科医生可以旋转顶出杆86a以使紧固件92可以从凹部89脱离接合并且沿凹槽93移动。然后，紧固件92可以与另一个凹部89接合，以使臂90a靠近或远离叶片18的远端24。这样的构造可以使得外科医生能够控制椎骨之间的植入体22的锥口孔(countersink)深度。例如，在中央部分88a的第一侧88b面对远端24的位置，植入体22的锥口孔深度可以是约3毫米，而在中央部分88a的第二侧88c面对远端24的位置，植入体22的锥口孔深度可以是约6个毫米。臂90a可以具有带有标记I的表面90b，当顶出杆86a在不同方向时，标记I提供植入体22的锥口孔深度的可见指示。 
一对止挡结构110可以在靠近叶片18的远端24从槽口109的相对两侧突出。止挡结构110能够防止插入器10过于推进到椎骨之间的空间内。作为另外的选择，该止挡功能可以调整以预先选定所希望的插入距离。例如，根据仪器使用者的选择，可能存在两个插入距离选项，它们由双端螺栓(stud)或者小块(nub)来实现，该双端螺栓或者小块铰接式地附接于止挡结构110上，以定位在离止挡结构110更远或更近的位置。 
每个叶片18还可以具有一对平行的、狭窄的凸棱112，其在止挡结构110前面的位置，彼此小距离地隔开。狭窄的凸棱112可以作为保持构造起作用，以防止插入器10在工作时移位。每对凸棱112可以被相邻槽口109阻止，但是也可以完全延伸穿过相应的叶片18。在一个实施例中，叶片18的长度可以是从约17cm至约27cm。 
如图10和图11所示，弹簧结构100的基部102可以容纳于的握持式手柄12的远端沉孔35中。紧固件114可以紧固基部142于沉孔35内。在握持式手柄12的另一端，紧固件116可以紧固套筒120 于近端沉孔31内。在套筒120上的内螺纹122(图12)可以位于沿轴线25延伸穿过握持式手柄12的通道41中。轴14可以延伸并且可以轴向移动穿过通道41，而轴14上的第一螺纹64则在通道41中径向地向内与内螺纹122隔开。在顶出杆86上的臂90可以穿过叶片18上的槽口109向外突出，以在顶推块20跟随轴14轴向地移动时沿槽口109滑动。 
轴14和顶推块20的轴向运动能够以两种不同操作模式的任何一个完成。在第一模式中，轴14能自由地滑动穿过通道41，直到轴14上的第二螺纹68(与T形手柄16相邻)向前移动至与握持式手柄12上的套筒120中的内螺纹122形成接合。顶推块20和植入体22的进一步推进可以通过相对握持式手柄12旋转T形手柄16以沿轴线25向前拧转轴14来完成。在第二操作模式中，轴14并不自由滑动穿过握持式手柄12的通道41，而是只能够通过旋拧T形手柄16以旋转方式转动轴14穿过通道41来轴向地向前移动。操作者能够通过对安装在握持式手柄12上的离合器机构130的切换来在两种不同的操作模式之间切换插入器10。 
离合器机构130可以包括可移动的离合器部件132和一对紧固件(例如球形掣子134)，紧固件可操作地连接于手柄12。如图13至图19所示，离合器部件132可以是带有扁平的上侧表面136及下侧表面138的圆柱形部。如图15和图16所示，离合器部件132的端面140和142可以具有促动标记。一对凹陷表面144可以位于(例如在中心)相对而置的侧面136和138中的至少一个上。凹陷表面144可以是相似的，并且其中每个都可以具有限定一对凹穴147和149的凸轮面部分146(图19)。如图14中所最佳地显示，在所列举的示例中，凹穴147和149可以具有沿离合器部件132的纵向、彼此反向远离延伸的泪滴形状。 
离合器部件132的内表面150可以限定通道151。内表面150可以在通道151的相对两侧具有明显不同的部分152和154。内表面150 的第一侧面部分152可以具有以第一轴线157为中心的、半圆柱形的轮廓。第二侧面部分154可以具有以第二轴线159为中心的、半圆柱形的轮廓，并且限定了部分地围绕第二轴线159延伸的螺纹160，其中第二轴线159与第一轴线157是隔开的。 
参考图10和图11，离合器部件132可以延伸穿过握持式手柄12中的横向通道43。延伸穿过离合器部件132的通道151可以对准握持式手柄12中的纵向通道41。球形掣子134可以接合离合器部件132并且可以在握持式手柄12上保持离合器部件132。具体地，如图20所示，每个球形掣子134都可以具有带有外螺纹166的外壳164。球形掣子134可以拧入握持式手柄12内的窄孔47(图2)之内，直到处于外壳164的端部的球体168突入通道43内的位置。当离合器部件132安装在通道43中时，两球体168可以处于离合器部件132的第一或第二凹穴147或149内。通过交替地推压两个端面140和142，操作者可以迫使凸轮面146克服球形掣子134的阻力滑动，以使离合器部件132在第一位置与第二位置之间来回地切换，其中在第一位置时，球体168处于第一凹穴147内，而在第二位置时，球体168处于第二凹穴149内。 
如图11所示，当离合器部件132处于第一位置时，该无螺纹内表面152可以置于轴14上的第一螺纹64旁。然后，在通道151的相反侧的内螺纹160可以与轴14上的第一螺旋64横向隔开。因此，螺纹160与螺纹64不配合，而轴14可以自由地沿轴线25滑动。 
当离合器部件132从第一位置切换至第二位置时，离合器部件132的无螺纹内表面152横向地远离轴14上的第一螺纹64。离合器部件132上的内螺纹160可以同时地横向移动至与轴14上的第一螺纹64相接合。因此，当离合器部件132处于第二位置时，操作者只有通过相对于握持式手柄12来旋转T形手柄16，以便旋拧转动轴14以螺旋前进的方式穿过握持式手柄12内的通道41，才能够沿轴线25来移动轴14。内螺纹160和122可以分别地定位，并且具有相同的 螺距，以使当轴14沿轴线25移动时，轴14上的螺纹64同时与内螺纹160和122配合。 
在插入器10使用过程中，操作者可以手动地使植入体22在这些叶片18之间滑动前进，以使这些叶片18展开，直到它们的弹力保持植入体22于适当的位置。在叶片18和植入体22之间可以建立轨条-凹槽型的关系，以使当植入体22向远端前进时，保持植入体22适当地对准叶片18。例如，每个叶片18都可以具有多个(例如，两个)轨条26以接合植入体22的外部(例如，上部和下部)表面上的相应凹槽。 
操作者可以轴向地向前移动轴14和顶推块20，直到顶推块20的前向表面82与植入体22的互补面相接合84。当叶片18的远端24插入于一对椎骨间，且随着止挡结构110邻接椎骨，顶推块20的进一步向前的运动对处于叶片18的远端24之间的植入体22施加压力。这使得叶片18彼此分开，以根据植入体22的厚度牵开椎骨，并同时把植入体22移入椎骨之间的空间内。如果离合器部件132处于第一位置，轴杆14和顶推块20可以仅仅通过沿轴线25向前滑动轴杆14，而并不需要旋转T形手柄16，就可以前向穿过第一移动距离。 
然而，如果离合器部件132处于第二位置，就只能通过旋转T型手柄16以便旋拧转动轴杆14以螺旋前进的方式穿过握持式手柄12，才能够使轴杆14和顶推块20前进通过第一移动距离(如上文所述)。在任一情况下，当轴14上第二螺纹68轴向地移动以接合套筒120内的内螺纹122时，就进入了第二移动距离。当轴14向前拧转穿过第二移动距离时，顶推块20把植入体22从叶片18的远端24之间驱使出来。当植入体22移动超过叶片18的远端24并处于相邻椎骨之间时，顶出杆86、86a的臂90、90a可以接合相邻椎骨的外壁。轴14的旋转可以导致臂90、90a推压椎骨，由此而使得在第二移动距离过程中，叶片18从椎骨之间撤回。在所列举的实施例中，受各种螺纹区段影响的各种类型螺纹运动，具有相同的相应螺距，其沿 相应的区段引起相同的运动速率或步距。 
当用前文的描述和附图来说明本发明的优选实施例的时候，应当理解，可以不脱离限定于随函所附的权利要求中的本发明的精神和范围而进行各种添加、修改和替换。具体地，本领域技术人员应当清楚，只要不脱离本发明的精神或其基本特性，本发明可以以其它的具体形式、结构、配置和比例实施，或使用其它的元件、材料和部件。本领域技术人员应当注意到，只要不脱离本发明的原则，本发明在使用中，可以有许多对结构、设置、比例、材料和部件及其它本发明实践中用以适应特定环境和工作需求的使用物的修改。因此目前公开的实施例应当在所有的方面都应被考虑成是说明性的且非限制性的，本发明的范围通过所附的权利要求指出，并且不受限于前文的描述。 

Claims (21)

1.一种用于在椎骨之间插入脊椎植入体的装置，包括：
具有纵轴线和通道的手柄结构；
能够在所述通道内移动的轴，且所述轴的至少一部分具有第一螺纹；
可操作地连接于所述轴上、且具有构造成接触所述脊椎植入体的前向表面的顶推块；
从所述手柄延伸的一对叶片，所述一对叶片包括可以定位在椎骨之间的远端、附接于所述手柄的近端，以及靠近所述远端从所述一对叶片中的至少一者处大体上远离所述纵轴线延伸的止挡结构，所述轴的至少一部分处于所述一对叶片之间，所述叶片构造为分开的挠性部分并使得所述远端能够偏置到一起，所述一对叶片中的至少一者具有从中穿过的大体上平行于所述纵轴线延伸的槽口，所述至少一个槽口从所述止挡结构向远端延伸；以及
可操作地连接于所述顶推块的顶出杆，所述顶出杆具有至少一个臂，所述顶出杆、所述顶推块和所述轴大体上平行于所述纵轴线移动使得所述至少一个臂在所述槽口内滑动，当所述顶推块从所述近端向所述远端运动时，所述一对叶片的远端彼此相分离。
2.根据权利要求1所述的装置，其特征在于，所述装置还包括支撑在所述手柄结构上的离合器部件，用以与所述第一螺纹相接合或脱离接合。
3.根据权利要求2所述的装置，其特征在于，所述手柄结构具有内螺纹，所述第一螺纹与所述内螺纹隔开，以使所述轴能够轴向地滑动穿过所述通道内的第一移动距离，所述轴还包括与所述第一螺纹隔开的第二螺纹，所述第二螺纹限定了第二移动距离，所述第二螺纹能够移动至与所述内螺纹相接合，以使所述轴只能旋转通过所述第二移动距离。
4.根据权利要求3所述的装置，其特征在于，所述轴构造成当所述轴移动穿过所述通道时，所述第二移动距离能够跟随所述第一移动距离。
5.根据权利要求3所述的装置，其特征在于，所述离合器部件的至少一部分包括螺纹，以使当所述离合器部件接合所述第一螺纹时，所述轴只能够旋转通过所述通道内的所述第一移动距离。
6.根据权利要求2所述的装置，其特征在于，所述手柄结构具有内螺纹且所述轴具有第二螺纹，当所述离合器部件接合或者脱离接合所述轴的所述第一螺纹时，所述第二螺纹能够沿所述纵轴线移动至与所述手柄结构上的所述内螺纹相接合。
7.根据权利要求1所述的装置，其特征在于，所述顶出杆包括具有纵轴线的中央部分和从所述中央部分延伸的两个臂。
8.根据权利要求7所述的装置，其特征在于，所述臂偏离所述中央部分的所述纵轴线。
9.根据权利要求7所述的装置，其特征在于，所述顶出杆的中央部分包括多个凹部和凹槽，所述顶推块包括至少一个紧固件以接合所述凹部和凹槽，以使所述顶出杆能够相对于所述顶推块旋转。
10.根据权利要求1所述的装置，其特征在于，至少一个叶片于其所述远端具有至少一个凸棱，所述至少一个凸棱作为保持构造起作用，以防止所述装置在工作期间移位。
11.根据权利要求2所述的装置，其特征在于，所述离合器部件包括从中穿过的开口，所述开口具有第一部分和第二部分。
12.根据权利要求11所述的装置，其特征在于，所述第一部分包括螺纹部分且所述第二部分包括无螺纹部分。
13.根据权利要求11和12中任一项所述的装置，其特征在于，所述离合器部件还包括第一侧面部分和处于所述侧面部分上的至少一对凹穴，所述手柄具有第一紧固件，其用于选择性地一次只能接合所述一对凹穴的其中一个凹穴。
14.根据权利要求13所述的装置，其特征在于，所述离合器部件还包括第二侧面部分和处于所述第二侧面部分上的第二对凹穴，所述手柄具有第二紧固件，其用于选择性地一次只能接合所述第二对凹穴的其中一个凹穴。
15.根据权利要求14所述的装置，其特征在于，所述第一紧固件和第二紧固件是穿过所述手柄放置的球形掣子。
16.根据权利要求1所述的装置，其特征在于，所述叶片构造成，当所述顶推块从所述叶片的所述近端向所述叶片的所述远端移动时，所述叶片的所述远端能够彼此分离开。
17.根据权利要求16所述的装置，其特征在于，所述顶出杆可释放地连接于所述顶推块。
18.根据权利要求2所述的装置，其特征在于，所述离合器部件的尺寸和结构设置成能够在第一位置和第二位置之间移动，其中，在所述第一位置中，所述轴能够平行于所述纵轴线在所述手柄内滑动，并且，在所述第二位置中，所述轴能够在所述手柄内以不同于沿纵向移动的第二方式移动。
19.根据权利要求18所述的装置，其特征在于，所述第二方式包括至少部分地旋转所述轴。
20.根据权利要求1所述的装置，其特征在于，所述叶片中至少一个包括开口，以使当所述顶出杆置于所述开口内时，所述顶出杆能够与所述顶推块脱离接合。
21.根据权利要求1所述的装置，其特征在于，所述叶片中至少一个包括开口，以使当所述顶出杆置于所述开口内时，所述顶出杆能够相对于所述顶推块旋转。
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