CN101242785A - 用于将结应用到缝线的方法和设备 - Google Patents

用于将结应用到缝线的方法和设备 Download PDF

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CN101242785A
CN101242785A CNA2006800303544A CN200680030354A CN101242785A CN 101242785 A CN101242785 A CN 101242785A CN A2006800303544 A CNA2006800303544 A CN A2006800303544A CN 200680030354 A CN200680030354 A CN 200680030354A CN 101242785 A CN101242785 A CN 101242785A
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knot
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inner chamber
suture
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安东尼·A·诺贝莱斯
史蒂芬·E·戴克尔
艾格伯特·耐特瑞
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Excellence medical technology Ltd.
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White Box Consultant LLC
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0491Sewing machines for surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0485Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0448Additional elements on or within the anchor
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    • A61B17/0401Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446Means for attaching and blocking the suture in the suture anchor
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0487Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks
    • A61B2017/0488Instruments for applying suture clamps, clips or locks

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Abstract

结放置装置(100)允许医师应用结以使从病人的血管或器官中的切开延伸的两个或多个缝线端相对于彼此稳固,从而密封血管或器官中的开口。结放置装置(100)具有手柄(102)和细长轴(104)和可滑动地插在所述轴(104)中的推杆(118)。结设置在轴(104)的远端中。手柄上的致动器(106)可以被按下以相对于所述轴(104)远端地推进所述推杆(118)并由此远端地推进所述结。所述结可包括具有内腔的结体(124)和插头(126),插头的尺寸可稳固地配合在内腔中。在使用中,插头(126)可以插入结体(124)的内腔中以将两个或多个缝线端(34)固定地保持在结体(124)和插头(126)之间。

Description

用于将结应用到缝线的方法和设备
本申请要求2005年6月20日递交的美国临时申请No.60/693,582和2005年8月19日递交的美国临时申请No.60/709,485的权益,其全文此处并入以供参考。
技术领域
本发明的特定实施方式涉及缝合切口,并且更具体地,涉及用于闭合体内脉管或器官中的切口的缝线的使用。
背景技术
外科医生频繁地需要利用缝线闭合切口、伤口或以其它连接组织部分。在将缝线穿过组织部分之后,外科医生必须打结并系紧缝线以将组织部分拉在一起并防止它们分开。当在受限获取的区域、诸如通向动脉的组织束的端部中打结缝线时,外科医生受到特殊的挑战。缝线经常难以处理,由此增加了外科医生给缝线打结的时间。因此,需要一种更快并更有效的打结和系紧缝线的方法。
发明内容
本发明的特定实施例说明了用于将结应用到缝线的各种方法和设备。当缝线的两端远离病人的脉管或器官的切口延伸时,优选实施例提供了一种用于符合要求地将两个缝线部分相对于彼此固定的方法和设备,固定部(securement)同时与切口相邻设置以保持切口闭合。如在此使用地,术语“结”是一个广义的术语,包括其一般意义并包括但不限于,设计以相对于要求的结位置固定地保持缝线的任意布置、部件或部件的结合。更优选地,结可以包括设计以相对于要求的结位置固定地保持缝线的两个部分的任何布置、部件或部件的结合。因而,结包括其中缝线部分被打结的布置,并还包括其中缝线部分不打结而相对于彼此稳固地保持的布置。所需的结位置可以包括切口、伤口、体腔、体组织的开口和两个相邻的体组织,其中两个相邻的体组织之间的空间需要闭合。两个缝线部分可以是相同缝线或不同缝线的部分。
在一个实施例中,提供了一种结放置装置。结放放置装置优选地包括手柄和轴。手柄包括近端和远端。轴包括近端和远端地从手柄延伸的远端。结部分地或完全地,设置在轴的远端内。手柄进一步包括致动器,所述致动器将结围绕两个缝线部分以使两个缝线部分相对于彼此固定
在一个实施例中,致动器可以是设计用于与凸轮合作的拇指或手指按钮。凸轮可以固定地连接到推杆。推杆同心地并可滑动地布置在外管内。外管可以固定地连接到手柄的远端部分。结放置装置可进一步包括中间管,所述中间管同心地并可滑动地布置在外管和推杆之间。中间管包括近端和远端。中间管的近端可位于凸轮和手柄的远端部分之间。致动器的部分按下远端地推进推杆。在一定程度按下时,致动器接触中间管的近端,因而远端地推进中间管。
在一个实施例中,中间管可包括键。外管、端部或两者可以包括设计用于与键合作的键槽(keyway)。键和相关的键槽保持中间管相对于外管的旋转对齐。在另一实施例中,中间管可包括键槽,且外管或端部可以包括键。
在一个实施例中,所述轴包括具有近端和远端的外管。外管可以包括靠近其远端的孔。所述轴可进一步包括同心地并可滑动地布置在外管内的中间管。中间管可包括在其远端处或靠近其远端处的狭槽(slot)。推杆可以同心地并可滑动地布置在中间管和外管内。结被部分或者完全地布置在外管的远端内。
在一个实施例中,结包括插头和结体,其中插头适于容纳在结体内。插头包括近端和远端,并可以是大致恒定的外径。可选择地,插头可以从近端到远端呈大致锥形。可选择地,插头可以包括大致恒定外径的部分和大致锥形的部分。插头也可包括在远端处的圆形或倒角的边缘。插头也可包括靠近近端的具有增大外径的肩部。
所述结体可以是大致管形并包括近端、远端和纵向轴线。结体可以是大致恒定的内径和外径。可选择地,内径、外径或者两者都可沿结体的纵向轴线呈大致锥形。可选择地,内径、外径或者两者可以沿纵向轴线的一部分呈锥形,并可在纵向轴线的一部分上为大致恒定内径、外径或者具有大致恒定的内径和外径。
结体可包括在其远端处的开口。在一些实施例中,在结体远端处的开口可以为减小的直径。结体也可包括在近端处的开口。在一些实施例中,近端处的开口可以为减小的直径。结体可进一步包括从结体的内表面朝向纵向轴线的突起。
在一个实施例中,结体可远离插头定位在外管之内。在另一实施例中,插头可远离结体定位在外管之内。
在一个实施例中,一种方法被提供以用于将结放在缝线上以闭合身体中的开口。一对缝线端穿过穿线机(threader)。穿线机被拉动通过结放置装置的轴的远端中的通道。当穿线机拉过通道时,缝线部分穿过通道被拉出,并且有利地定位在位于轴的远端处的结体内。随着结放置装置沿缝线部分朝一对组织部分滑动,张力可被施加到缝线部分。结放置装置可被推进直到结体或装置的远端接触组织部分。致动器被按下,其在一个实施例中相对插头推进轴内的推杆,并将插头推入结体中。这将缝线限制在插头和结体之间。在一个优选的实施例中,致动器的连续的按下使中间管被推进以切断缝线部分,使结从放置装置弹出或者两者。装置然后从病人收回。
在一个实施例中,在结弹出之后并在缝线端被切断之前,推杆与轴的远端大致齐平。轴的远端用于朝组织部分推动结,以进一步固定结并将组织部分拉得更近。
附图说明
图1是具有一对从其延伸的缝线端的伤口位置的立体图。
图2是结放置装置的一个实施例的侧视图。
图3是图2的结放置装置的轴、凸轮和远端部分的侧视图,其中轴中的结显示为虚线。
图4是图2的结放置装置的手柄的部分横截面侧视图。
图5是图2的结放置装置的轴的远端的部分横截面侧视图。
图6是图2的结放置装置的外管的远端的立体图。
图7是图2的结放置装置的中间管的远端的立体图。
图8是图6的外管的侧视图。
图9a是图7的中间管的俯视图。
图9b是图7的中间管的侧视图。
图10是结的一个实施例的立体图。
图11是结的另一实施例的横截面侧视图。
图12是结的另一实施例的横截面侧视图。
图13是结的另一实施例的立体图。
图14是图13的结的横向横截面视图。
图15是结的另一实施例的横截面侧视图。
图16a是结的另一实施例的横截面侧视图,并显示了缝线穿过结体的路径。
图16b是图16a的结的实施例的横截面侧视图,并显示了缝线穿过结体的选择路径。
图17a是结的另一实施例的立体图。
图17b是图17中所示的结的实施例的横截面侧视图。
图18a是结的另一实施例的横截面侧视图。
图18b是图18a的结的横截面侧视图。
图18c是图18a-b的结的横截面侧视图。
图19是结放置装置的部分横截面视图,缝线端穿过穿线机。
图20图示说明了两个缝线部分穿过其中的图19的装置,并且装置的远端与组织部分接触。
图21图示说明了图19-20的装置,其中推杆前进直到插头插入结体中,将缝线部分限制在插头和结体之间。
图22图示说明了图19-21的装置,推杆进一步前进,中间管也前进以使结从装置排出并切断缝线部分。
图23图示说明了在其最终位置中的图19-22的结。
图24和25图示说明了具有防损伤顶端的结的另一实施例。
具体实施方式
以下说明的本发明的优选实施例尤其涉及将结应用到缝线的两部分。更具体地,优选实施例涉及将结应用到从病人的治疗位置延伸的缝线部分。治疗位置可以是任意要求位置,诸如动脉血管、静脉血管或者任何其它体组织。缝线端可以是同一缝线的端部,或者可以是分开的缝线的端部。
图1图示说明了会需要将结应用到缝线的病人的伤口位置。更具体地,图1显示了用于在病人上执行任意种类治疗的病人皮肤中的切口30。在病人被治疗之后,缝线34通过导管鞘导引器(CSI)44被引入病人体内,以便将组织部分36和38(图1中以虚线显示)拉在一起。缝线34的两个端部40和42分别从组织部分36,38延伸,这例如会是血管或器官中伤口或内部切口所导致。可以通过任何合适的方式将缝线34引入病人体内,所述方式包括美国专利No.5,860,990,美国专利No.6,117,144,美国专利No.6,562,052,和2005年9月27日递交的申请人的同时待审申请序列号11/235,751目前为美国公开No.2006-0069397中所说明的方法,所有这些以其整体此处并入以供参考。缝线34可以是(但不限于)0.007”直径的生物可降解材料或非生物可降解材料,诸如聚丙烯。缝线34也可以是编织的,或者是其它材料并具有其它结构。图1中的缝线34显示为从导管鞘导引器44延伸。缝线34也可以从病人体内的切口直接延伸。
图2-4图示说明了结放置装置100的一个实施例,其可用于应用结到缝线34。结放置装置100包括手柄102和从手柄远端延伸的轴104。手柄102优选地包括从近端延伸到远端的细长管体,并包括致动器106和远端部分110。手柄102可进一步包括凸轮108和显示为处于其歇置位置的弹簧112,弹簧112布置在凸轮108和端部分110之间。致动器106可以是与凸轮108接触的拇指或手指按钮。端部分10可以通过胶水、压配合、注塑或者其它本领域普通技术人员已知的合适方式固定地连接到外管114。中间管116可以同心地并可滑动地布置在外管114内。推杆118同心地并可滑动地布置在中间管116内并固定地连接到凸轮108。应当理解的是,可以设想、结放置装置100并不必然地包括中间管116;然而,包括其也提供特定的优点。
如图4中所示,致动器106的按下引起凸轮108向远端移动,挤压弹簧112(未显示),由此移动推杆108。在运行一定所需的距离之后,凸轮108接合中间管116的近端,引起中间管116也朝远端移动。一旦释放致动器106,弹簧112膨胀以使凸轮108和推杆118向近端移动。在所示实施例中,中间管116在推杆118上自由地可滑动。
在一个未显示的实施例中,凸轮108在与致动器106接触的表面中包括制动件。该制动件可提示使用者推杆118、中间管116或者两者的前进的具体程度。例如,制动件可提示推杆已前进充分远以将插头插入结体中,如以下说明。制动件也可提示行进直到但不包括凸轮108接合中间管116的点。制动件可被成型以防止致动器106返回至其原始位置。凸轮可包括多个制动件以提示行进的多个增量。为使致动器返回至其初始位置,致动器和凸轮可包括机构以便在致动器被完全按下之后,致动器会自动地返回至其初始位置。可选择地,致动器可以在一个制动件处或者在完全按下结构中具有锁定结构,并且手柄可包括一个机构,利用所述机构第二致动器用于释放凸轮和致动器以返回至它们的初始位置。在2005年9月27日递交的申请No.11/235,751中可找到这种机构的进一步细节,其整体并入以供参考。
在一个未显示的实施例中,中间管116可包括键槽,并且外管114,端部分110、或者两者都可包括键。可选择地,中间管116可包括键,和外管114、端部分110、或者两者都可包括键槽。设置这种键和键槽可以用于使中间管116保持与外管对齐。其它实施例预期保持中间管的旋转对齐,诸如使中间管相对于推杆旋转地固定。设置这种键和键槽也可用于限制中间管116的滑动运动的范围。
如图5中所示,包括结体124和插头126的结在其远端处布置在外管114内。结体124可通过净配合(net fit)或者压配合保持在外管114中。可选择地,结体124和外管114之间的配合不会将结体124保持在外管114中。结体124优选地在外管114的远端,并且可略微地远离外管114的远端突出。插头126靠近结体124定位,并可滑动地布置在中间管116中,具有靠近结体并远离推杆118的远端。插头126的外径配置为插入结体124的内腔中。中间管116优选地调整尺寸并被定位以便其远端可邻接所述结体124。
如图5、6和8中所示,外管114可包括靠近其远端的侧孔120。如图5、7、9a和9b所示,中间管116可包括从其远端向近端地延伸的狭槽122,形成C形横截面。在狭槽122的近端处,变尖锐的切割表面123可以被设置以切割缝线34,如下所述。狭槽122优选地与开口120旋转地对齐,诸如通过使用如上所述的键/键槽。狭槽122也优选地与开口120轴向地对齐,但应当理解为,由于中间管116能够相对于推杆118滑动,中间管可以被定位成狭槽122靠近开口120且其远端靠近插头126。狭槽122也可与中间管的远端分开,以便管的远端在横截面中仍形成完整的圆。外管114、中间管116和推杆118可以由任意合适材料制成,包括但不限于金属、塑料和金属及塑料的结合。
如图5中所示,在预加载结构中,结放置装置100可包括穿线机128,穿线机128包括穿过外管114中侧孔120的调整片(tab)132和环线130。线130优选地穿过中间管116中的狭槽122,并穿过结体124延伸,且通过结体124的远端处的开口136离开。穿线机128用于将缝线装入如下所述的结放置装置中。当结体的外径与外管114的内壁相同或更小的尺寸时,穿线机128还防止结体124从放置装置100脱落。
参照图5和10,结体124可以为大致管状并包括近端、远端和纵向轴线。结体124优选地进一步限定内腔并包括在其远端处的开口136。结体可以为大致恒定的内径和外径。可选择地,内径、外径或者两者都可以沿纵向轴线的一部分呈锥形,和在纵向轴线的一部分上可以为大致恒定的内径、外径或具有大致恒定的内径和外径。
在一些实施例中,结体远端处的开口136可以为相对于结体124的内腔减小的直径。结体也包括近端处的开口138。在一些实施例中,近端处的开口138可以为相对于结体124的内腔减小的直径。结体可进一步包括从结体124的内表面朝纵向轴线延伸的突起134。突起134可以如所示形成为环形,或者螺旋形、长钉形、凸块形或者其它合适的结构或结构的结合。
参照图5和10,在一个实施例中,结体124可以远离插头126地定位在外管114中。插头优选地被加工尺寸以插入结体124的内腔,并可具有如图10所示的锥形结构。可选择地,插头126可在其大部分长度上具有恒定的横截面,诸如图5所示,并具有锥形、倒角或圆的远端以便于插入结体124中。插头126的外尺寸可略微地大于结体124的腔的内尺寸,以便当插头插入腔内时,在两者之间提供相对稳固的配合。结体内的突起134进一步有助于相对稳固。插头126也可包括未显示的用于容纳突起134的凹槽(indentation),以将插头126更稳定地稳固在结体124中。设想其它实施例,其中突起形成在插头126上,有凹槽或没有凹槽形成在结体124的内腔中。还设想在一些实施例中,插头126和结体124两者都可分别地包括突起和凹槽。在特定的实施例中,插头126插入结体124中会引起结体124轻微地膨胀。结和结体两者都可由任意合适的弹性材料形成,并且在一个实施例中,由与缝线相同的材料、更优选地聚丙烯制成。
图19-23图示说明了用于利用如上所述的结放置装置100放置结的一个实施例。参照图19,一对缝线端40和42可以穿过穿线机128的圈130。穿线机预装入如上所述的结放置装置100。穿线机128的调整片132可以朝近端拉以将缝线34设置在所述装置中,如图20所示。缝线34可以通过手或其它方式保持拉紧,同时装置100前进直到结体124或轴104接触组织部分36和38中的至少一个,如图20中所示。致动器106可以按下以推进推杆118,由此将插头126远端地推入结体124中并将那里的缝线34限制在插头126和结体124之间,如图21中所示。致动器可以进一步按下直到凸轮108接触中间管116的近端,引起中间管116接触结体124并使结从轴104排出。如图22所示,中间管116的前进还会引起切割表面123在其延伸出开口120处切断缝线34。结放置装置然后可以移除,留下结在相对于组织部分的位置处,如图24所示。
在一个实施例中,结可以从轴104弹出同时留下未被切断的缝线34。例如,结可以在切割表面123到达缝线34之前弹出。在另一实施例中,未提供中间管,并且缝线可以被手动地切割。
在包括中间管的实施例中,装置100可以被配置以便外管114、中间管116,和推杆118的远端相对于彼此齐平并相对于地保持在位。例如可以通过按下致动器直到其停留在凸轮108中的制动件中而保持该位置。制动件可以提示使用者插头126已被插入结体124中,但缝线34未被切割。此时,放置装置可用于使用轴的远端表面进一步相对于组织部分36和38推进结。致动器可进一步按下以推进推杆18和中间管116以切割缝线34。
致动器106和凸轮108也可设置有防止致动器106返回到其原始位置的锁定机构。在2005年9月27日递交的申请No.11/235,751中提供了进一步的细节,其整体并入以供参考。该实施例的优点在于保持推杆与外管的远端齐平,以提供可用于相对组织部分36和38进一步推进并定位结的表面。
应当理解为,设想其它实施例不使用中间管,也仍然能够切割缝线。例如,推杆可设置有不同直径的部分。远端的、较小的直径的尺寸可以接合插头126以将插头推入结体124中。近端的、较大的直径可以设置在推杆上,其包括在较大和较小直径部分之间的过渡处的尖锐的表面。一旦推杆的较小部分将插头126推入结体124中,推杆的较大部分可接合结体124以将结推出放置装置,同时推杆上的尖锐表面可切断缝线。
在上述实施例中,当如上所述的结体124和插头126被稳固在一起时,穿过结体的内腔从开口136延伸到开口138的缝线部分将固定地稳固在其中,形成结。应当理解为,许多其它实施例也可用于形成结,包括各种用于结体和插头的其它形状和结构,以及仅一个部件被用于提供相对于缝线固定的实施例。还应当理解为,在结包括结体和插头的那些实施例中,插头可位于靠近结体的轴内,或者结体位于靠近插头的轴内。
例如,在图11所示的结的另一实施例中,提供的插头146具有一对孔148,一对孔148从插头的一端(例如近端)分叉地延伸到插头的直径相对的外表面。增大外径的肩部149可位于插头146的一端(例如近端)处。当插头146插入中空的结体中时,插头146和结体144合作以将缝线固定在其间。
在图12中所示的另一实施例中,插头156可包括具有不同外径的两部分。结体154具有带内表面160的开口136。插头156的表面162可具有比结体154的内表面164更小的直径。插头156的表面158可具有这样的直径,以便表面158接合结体154的表面160并合作以在其中稳定地保持缝线部分。
在图13和14所示的另一实施例中,插头176包括纵向延伸的狭槽178,以便插头176为大致叉形。狭槽178从远端部分地延伸到近端。缝线34延伸穿过结体174、穿过狭槽178、并从插头176出来,优选地在插头176的相对侧上。插头176插入结体174中优选地引起狭槽的压缩以将缝线部分稳固地固定在狭槽内。应当理解为,在此实施例中,结放置装置或者被可驱动以将插头远端地移动入结体内,或者选择性地,可被驱动以将结体远端地在插头上移动。
在图15所示的另一实施例中,一对侧孔188设置在沿插头186的长度隔开的位置处。缝线部分从插头186的一端处的端孔经过,穿出侧孔的一个向外,并然后向内返回到插头的体内并穿出相对的端孔。当结体184在插头上滑动时,或者通过在插头上远端地推进或者通过使插头远端地推进入结体中,缝线34相对地固定在插头和结体之间。
在图16a和16b所示的另一实施例中,结体194包括两个侧孔198。缝线34可以或者从体内穿过结体194,穿出侧孔中的一个,并通过另一侧孔返回入体中,如图16a所示,或者可以从体外进入侧孔中的一个,进入体内,并然后穿出另一侧孔,如图16b所示。在任一实施例中,插头196然后可用于使缝线相对于结体固定。
在图17a和17b所示的另一实施例中,结200包括单一件或结体。诸如扁平弹性部件的板、环或者其它结构,可以设置有两个孔202。如图17b中所示,板被弯曲以形成“U”形,以允许缝线34从其中通过。所述板可以由弹性或形状记忆材料制成,所述板块可以弹回到其变平的结构,如图17a所示,所述变平的结构将缝线相对于板锁定在位。也可设想其它实施例,其中缝线部分穿过结体的弯曲路径设置。如上所述的穿线机可用于在缝线部分位于结放置装置中的同时引导缝线部分穿过结体。一旦从结放置装置弹出,结体可采用将缝线相对于结体锁定在位的不同结构。
在图18a、18b和18c中所示的另一实施例中,结204包括具有上壁206和下壁208的管。上壁包括三个线性隔开的孔210。下壁包括两个孔212,以在下壁208中产生可位移部分214。可位移部分208通过任意合适方式、诸如图18b中所示的弯曲轴216朝向结204的中心位移。缝线34穿入并穿出上壁中的孔210并围绕下壁的可位移部分214。当结204从结放置装置弹出时,可位移部分214被允许朝其原始位置移动,以更确定地将缝线34固定在结204内,如图18c中所示。
在图24和25所示的另一实施例中,结包括如上所述的结体124和插头126,但同时结体具有防损伤顶端300。该顶端300可以是圆的并具有与外管114的外径大致相同的外径。如图25中更具体地所示,顶端也可具有扁平过渡部分302。顶端300可以与结体124整体地形成,或者可以单独地连接。如所示,顶端300可具有孔304,其穿过顶端轴向地延伸,开口向结体内的腔。当结如上所述地导入病人体内时,防损伤顶端防止对病人的伤害。
可以设想用于结的各种其它实施例。例如,结可以简单地包括具有充分小的内径的管,缝线部分可穿过其被定位并保持。在未显示的另一实施例中,插头可以包括靠近具有增大外径的近端的肩部。肩部可以不插入结体内,但可用于在一旦插头已插入结体内时将结推出放置装置。
应当理解为,对于本领域普通技术人员而言,本发明的某些变化和修改是不言自明的。本发明的范围并不受其图示或前述说明的限制。

Claims (35)

1.一种用于固定从体内的开口延伸的两个缝线部分的方法,包括以下步骤:
将所述两个缝线部分定位在结体内;
将所述结体推进到靠近开口的组织附近的位置;以及
将插头移入所述结体内以将所述缝线部分固定地稳固在所述结体和所述插头之间。
2.根据权利要求1所述的方法,进一步包括以下步骤:在推进结体的同时施加张力到所述缝线部分。
3.根据权利要求1所述的方法,其中缝线部分从靠近伤口位置的切口的两个组织部分延伸。
4.根据权利要求1所述的方法,其中缝线部分初始地定位在结体内,并且所述插头插入所述结体中。
5.根据权利要求1所述的方法,其中缝线部分初始地定位在插头内,并且所述结体在所述插头上推进。
6.根据权利要求1所述的方法,其中将所述两个缝线部分定位在结体内包括:
将穿线机穿过所述结体,所述穿线机具有近端和远端和在远端中的孔;
使两个缝线部分穿过所述穿线机中的孔;和
近端地使穿线机穿过所述结体收回。
7.根据权利要求1所述的方法,进一步包括:切开靠近结体的近端的缝线部分。
8.根据权利要求1所述的方法,其中结体和插头可滑动地设置在结放置装置内,并进一步包括将结放置装置推进到开口。
9.根据权利要求8所述的方法,其中推进所述结体包括驱动结放置装置以远端地推进所述结体。
10.根据权利要求9所述的方法,其中移动所述插头包括驱动结放置装置以将插头远端地推入所述结体内。
11.根据权利要求8所述的方法,进一步包括切割靠近结体的近端的缝线部分,其中所述切割包括远端地推进所述结放置装置的切割表面。
12.根据权利要求8所述的方法,进一步包括:
使结体从结放置装置弹出;和
抽回所述结放置装置。
13.一种结放置装置,包括:
细长轴,具有近端和远端和延伸穿过其的内腔;
结,所述结定位在腔内的细长轴的远端内;
推杆,所述推杆具有可滑动地布置在所述细长轴的内腔中的近端和远端;和
致动器,配置为相对于所述细长轴远端地推进所述推杆,以远端地接合所述结。
14.根据权利要求13所述的装置,其中致动器的按下远端地推进所述推杆。
15.根据权利要求13所述的装置,其中致动器包括配置以锁定推杆的位置的锁定机构。
16.根据权利要求13所述的装置,进一步包括中间管,所述中间管具有同心地并可滑动地设置在所述轴和所述推杆之间的远端和近端,所述中间管的近端穿过所述细长轴的近端延伸进入所述手柄。
17.根据权利要求16述的装置,其中致动器的部分按下远端地推进所述推杆,并且致动器的另外的按下远端地推进所述中间管。
18.根据权利要求16所述的装置,其中中间管的远端包括切割部件。
19.根据权利要求16所述的装置,其中所述轴包括键槽并且其中所述中间管包括配置以插入所述键槽中的键。
20.根据权利要求13所述的装置,其中所述结包括结体和插头,插头定位在结体近端的轴的内腔中,其中推杆的远端推进将插头远端地推入结体中并将结弹出所述轴。
21.根据权利要求13所述的装置,其中所述结被配置以在其中容纳至少一个缝线部分,并且其中推杆的远端推进使缝线部分相对于所述结固定并使结从轴的内腔弹出。
22.根据权利要求13所述的装置,其中所述轴进一步包括靠近远端的侧孔。
23.一种结放置装置,包括:
手柄;
细长轴,具有近端和远端和延伸穿过其的内腔,所述轴的近端连接到所述手柄,所述细长轴进一步包括靠近其远端的侧孔;
中间管,具有近端和远端和延伸穿过其的内腔,所述中间管可滑动地设置在所述细长轴的内腔中,所述中间管的近端穿过所述细长轴的近端延伸进入所述手柄,所述中间管进一步包括切割表面;
推杆,具有可滑动地布置在所述中间管的内腔内的近端和远端,所述推杆的近端穿过所述中间管的近端延伸进入所述手柄;
致动器,所述致动器安置在所述手柄上,所述致动器配置为相对于所述细长轴远端地推进所述推杆和所述中间管;和
结,所述结包括结体和在其远端定位在细长轴的内腔中的插头;
其中结体和插头中的至少一个被配置以容纳至少一个缝线部分,所述缝线部分在远端处延伸入细长轴的内腔中,所述至少一个缝线部分通过侧孔离开所述轴;
其中推杆的远端推进相对地移动插头进入结体以稳固所述至少一个缝线部分,并且推杆的进一步远端推进使中间管的切割表面切断所述至少一个缝线部分并使所述结弹出所述轴的内腔。
24.根据权利要求23所述的结放置装置,其中所述插头靠近轴的内腔中的结体定位,以便推杆的远端推进将插头推入所述结体中。
25.一种用于固定地稳固缝线的部分的结,包括:
结体,具有远端和近端,远端开口和近端开口,和延伸穿过其的内腔;和
插头,具有近端和远端,其中插头可操作地使尺寸适合通过近端开口而被容纳入结体的内腔;
其中结体和插头被调整尺寸并被配置以容纳并将缝线部分固定地稳固在其间。
26.根据权利要求25所述的结,其中所述插头的至少一部分与所述内腔的至少一部分形成摩擦配合。
27.根据权利要求25所述的结,其中插头从近端到远端呈锥形。
28.根据权利要求25所述的结,其中结体的内腔从近端到远端呈锥形。
29.根据权利要求25所述的结,其中结体的远端开口具有比插头的远端的横截面直径更小的直径。
30.根据权利要求25所述的结,其中内腔包括位于内腔的侧壁上的一个或更多个突起。
31.根据权利要求25所述的结,其中结体进一步包括从所述内腔穿过所述管形部件的侧壁延伸的一个或更多个孔。
32.根据权利要求31所述的结,其中内腔进一步包括位于内腔的相对侧壁上的一个或更多个孔。
33.根据权利要求25所述的结,其中内腔进一步包括位于插头的侧壁上并穿过插头的部分延伸的一个或更多个孔。
34.根据权利要求25所述的结,其中插头进一步包括从所述插头的所述远端纵向延伸的狭缝。
35.根据权利要求25所述的结,其中结体进一步包括防损伤顶端。
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