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具有中间闭合位置的外科钉合器

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CN101675897B
CN101675897B CN 200910175666 CN200910175666A CN101675897B CN 101675897 B CN101675897 B CN 101675897B CN 200910175666 CN200910175666 CN 200910175666 CN 200910175666 A CN200910175666 A CN 200910175666A CN 101675897 B CN101675897 B CN 101675897B
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surgical
stapler
intermediate
closing
position
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CN101675897A (zh )
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C·O·巴克斯特三世
J·J·贝迪
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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
    • A61B17/10Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105Wound clamp magazines
    • 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
    • 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
    • A61B17/07207Surgical 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 the staples being applied sequentially
    • 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
    • A61B17/2909Handles
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0042Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping
    • A61B2017/00446Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping for use only by lefthanded or only by righthanded persons
    • 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
    • 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
    • A61B2017/07242Stapler heads achieving different staple heights during the same shot, e.g. using an anvil anvil having different heights or staples of different sizes
    • 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
    • A61B2017/0725Stapler heads with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
    • 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
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03Automatic limiting or abutting means, e.g. for safety
    • A61B2090/037Automatic limiting or abutting means, e.g. for safety with a frangible part, e.g. by reduced diameter
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08Accessories or related features not otherwise provided for
    • A61B2090/0801Prevention of accidental cutting or pricking
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08Accessories or related features not otherwise provided for
    • A61B2090/0801Prevention of accidental cutting or pricking
    • A61B2090/08021Prevention of accidental cutting or pricking of the patient or his organs
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08Accessories or related features not otherwise provided for
    • A61B2090/0813Accessories designed for easy sterilising, i.e. re-usable
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08Accessories or related features not otherwise provided for
    • A61B2090/0814Preventing re-use

Abstract

本发明涉及一种具有中间闭合位置的外科钉合器,其中外科钉合器械包括可相互枢转连接并通过锁栓相对固定就位的第一和第二钳口构件。第一和第二钳口构件可包括第一和第二锁定构件,第一和第二锁定构件允许第一和第二钳口构件相对转动,但是防止或至少禁止第一和第二钳口构件相互分开。这种实施方式在锁栓位于部分闭合位置并且第一和第二钳口构件被操纵以便将组织定位在其中时尤其有用。第一和第二钳口构件可充分连接在一起以便防止或至少减小第一和第二钳口构件变得相互脱离并暴露切割构件的可能性。

Description

具有中间闭合位置的外科钉合器

技术领域

[0001] 本发明涉及一种钉合器械,并且在多个实施方式中,涉及用于产生一排或多排缝钉的外科钉合器械。

背景技术

[0002] 近年来,外科医生越来越趋于使用钉合器械来缝合例如肺、食道、胃、十二指肠和/或肠道内的其它器官的身体组织。适当钉合器械在许多场合的使用可以在较短时间内进行更好操作,并且简化以往难度大的外科手术,例如胃肠吻合术。现有的线性的两排和四排切割钉合器包括无钉仓器械,缝钉被单独手动加载到无钉仓器械中。其它的现有装置包括预先消毒的一次性缝钉加载单元和切割构件,该切割构件可用来分割组织并同时形成多排缝钉。这种外科钉合器的实施例在1970年3月10授权的题为“INSTRUMENT FORPLACINGLATERAL GASTROINTESTINAL ANASTOMOSES”的 U.S.专利 N0.3499591 中披露,该专利的整体披露通过引用结合于此。

[0003] 钉合器械可包括一对协作的细长钳口构件,其中每个钳口构件可适用于插入待吻合的内部、管状身体器官。在多个实施方式中,钳口构件之一可支承具有至少两排横向隔开的缝钉的钉仓,并且另一钳口构件可支承具有与钉仓内多排缝钉对准的缝钉成形袋口的钉砧。通常,钉合器械还可包括可相对于钳口构件滑动以便随后经由推杆上的凸轮表面将缝钉从钉仓弹出的推杆和刀片。在至少一个实施方式中,凸轮表面可被构造成致动多个缝钉驱动器,该缝钉驱动器由钉仓承载并与单个缝钉相关联以便将缝钉推靠钉砧并在钳口构件之间夹持的组织内形成横向隔开的多排变形缝钉。但是在典型的钉合器械中,一旦钳口构件被组装在一起,钉站就相对于钉仓固定,并不能调节缝钉的成形高度。在至少一个实施方式中,刀片可跟随推杆,并且沿着缝钉排之间的线切割组织。这种钉合器械的实施例在1984年2月7日授权的题为“SURGICALINSTRUMENTS”的U.S.专利N0.4429695中披露,该专利的整体披露通过引用结合于此。

[0004] 在多个实施方式中,典型的钉合器械可包括通过锁栓固定在一起的第一和第二钳口构件,其中锁栓可在打开位置、部分闭合位置和闭合位置之间运动。但是在锁栓的打开位置和部分闭合位置上,典型钉合器械的第一和第二钳口构件会意外相互脱离,由此需要另外的时间来重新组装钳口构件。在一些情况下,第一和第二钳口构件的脱离会将刀片暴露。进一步地,在多种情况下,钉合器械可包括从推杆延伸的致动器手柄,致动器手柄被构造成由外科医生抓握,并向远侧前进,以便在钉仓内前进推杆和刀片。但是在一些情况下,即使第一和第二钳口构件没有被组装,致动器手柄也可相对于钳口构件前进。在至少一种情况下,一旦被组装,由于致动器手柄可从外科器械向外延伸,因此可能会意外接触外科手术部位周围的组织,并因此组织会阻碍致动器手柄前进。在这种情况下,外科医生必须强迫致动器手柄经过组织和/或重新定位钉合器械,这会增加完成手术所需的时间。需要的是对以上情况进行改进。

发明内容

[0005] 在本发明的至少一种形式中,外科钉合器械可包括相互可枢转连接并通过锁栓相互固定就位的第一和第二钳口构件。在多个实施方式中,第一和第二钳口构件可包括第一和第二锁定构件,第一和第二锁定构件使得第一和第二钳口构件相对转动,但是防止或至少禁止第一和第二钳口构件相互分开。这种实施方式在锁栓位于部分闭合位置并且第一和第二钳口构件被操纵以便在两者之间定位组织的情况下尤其有用。在至少一个这样的实施方式中,第一和第二钳口构件可充分连接在一起,以便防止或至少减小第一和第二钳口构件变得相互脱离并暴露切割构件的可能性。在本发明的至少一种形式中,外科钉合器械可包括可至少部分在切割构件之上和/或围绕切割构件延伸的壳体。在多个实施方式中,在使用过程中,壳体可在第一和第二钳口构件相互脱离时至少部分覆盖切割构件,仍可使得切割构件相对于第一和第二钳口构件运动。

[0006] 在多个实施方式中,外科钉合器械还可包括相对于第一和第二钳口构件前进和/或后退的切割构件和/或缝钉滑座。在一些实施方式中,缝钉滑座可通过切割构件前进和/或与切割构件一起前进,以便从钉仓中将缝钉部署在第一和第二钳口构件之一内。在本发明的至少一种形式中,外科钉合器械可包括锁定件,该锁定件可在锁栓闭合之前防止或至少禁止切割构件和/或缝钉滑座相对于第一和第二钳口构件运动或至少前进。在至少一个实施方式中,锁栓可被构造成在锁栓从完全打开位置运动到完全闭合位置时接合锁定件,并可操作地将锁定件从切割构件和/或缝钉滑座脱离。在至少一个实施方式中,第一和第二钳口构件之一可包括钉砧,该钉砧具有至少一个成形表面,该至少一个成形表面可被构造成在从钉仓部署缝钉时使缝钉变形。在本发明的至少一种形式中,钉砧可相对于钉仓可运动地调节,以便调节缝钉变形量。在多个实施方式中,钉砧可通过可滑动调节的板和/或可转动凸轮来调节。

[0007] 本发明具体涉及:

[0008] (I) 一种外科钉合器,包括:

[0009] 第一手柄部分,包括:

[0010]近端;

[0011] 远端;以及

[0012] 钉仓通道,其能够接收钉仓;

[0013] 第二手柄部分,包括:

[0014]近端;

[0015] 远端;以及

[0016] 钉砧,其中所述第一手柄部分和所述第二手柄部分之一的近端包括销,并且所述第一手柄部分和所述第二手柄部分的另一个的近端包括细槽,所述细槽能够可滑动地接收所述销;以及

[0017] 锁栓,其可转动地连接到所述第一手柄部分和所述第二手柄部分之一,其中所述锁栓能够在其近端和其远端中间的位置处接合所述第一手柄部分和所述第二手柄部分的另一个,其中所述锁栓能够在打开位置、部分闭合位置和闭合位置之间转动,并且其中所述细槽和所述销能够使得所述销在所述锁栓位于所述部分闭合位置时不能与所述细槽脱离。

[0018] (2)如第⑴项所述的外科钉合器,其中所述锁栓能够转动地安装到所述第一手柄部分,其中所述第二手柄部分包括从其延伸的突出部,并且其中所述锁栓能够接合所述突出部,以便在所述锁栓在所述打开位置和所述闭合位置之间运动时将所述钉砧运动与所述钉仓通道靠近对置。

[0019] (3)如第⑴项所述的外科钉合器,其中所述销和所述细槽能够包括枢轴,所述第二手柄部分能够围绕所述枢轴朝着所述第一手柄部分转动。

[0020] (4)如第(I)项所述的外科钉合器,其中所述第一手柄部分包括所述销,其中所述第二手柄部分包括所述细槽,并且其中所述细槽包括开口端和闭合端,并且其中所述开口端相对于所述闭合端位于近侧。

[0021] (5)如第(I)项所述的外科钉合器,其中所述销能够在所述锁栓位于所述打开位置时与所述细槽脱离。

[0022] (6) 一种外科钉合器,包括:

[0023] 第一手柄部分,包括:

[0024] 近端;以及

[0025] 钉仓通道,其能够接收钉仓;

[0026] 第二手柄部分,包括:

[0027] 近端;以及

[0028] 钉砧,其中所述第一手柄部分和所述第二手柄部分之一的近端包括销,并且所述第一手柄部分和所述第二手柄部分的另一个的近端包括细槽,所述细槽能够可滑动地接收所述销;以及

[0029] 锁栓,其可转动地连接到所述第一手柄部分和所述第二手柄部分之一,其中所述锁栓能够接合所述第一手柄部分和所述第二手柄部分的另一个,其中所述锁栓能够在完全打开位置和完全闭合位置之间转动,并且其中所述细槽和所述销能够使得所述销只在所述锁栓位于所述完全打开位置时与所述细槽脱离。

[0030] (7)如第(6)项所述的外科钉合器,其中所述锁栓能够转动地安装到所述第一手柄部分,其中所述第二手柄部分包括从其延伸的突出部,并且其中所述锁栓能够接合所述突出部,以便在所述锁栓在所述完全打开位置和所述完全闭合位置之间运动时将所述钉砧运动与所述钉仓通道靠近对置。

[0031] (8)如第(7)项所述的外科钉合器,其中所述锁栓和所述突出部之间的接合防止所述销与所述细槽脱离。

[0032] (9)如第(6)项所述的外科钉合器,其中所述销和所述细槽能够包括枢轴,所述第二手柄部分能够围绕所述枢轴朝着所述第一手柄部分转动。

[0033] (10)如第(6)项所述的外科钉合器,其中所述第一手柄部分包括所述销,其中所述第二手柄部分包括所述细槽,并且其中所述细槽包括开口端和闭合端,并且其中所述开口端相对于所述闭合端位于近侧。

[0034] (11) 一种外科钉合器,包括:

[0035] 第一手柄部分,包括:

[0036]近端;

[0037] 第一锁定部分;以及

[0038] 钉仓通道,其能够接收钉仓;

[0039] 第二手柄部分,包括:

[0040]近端;

[0041] 第二锁定部分,以及

[0042] 钉砧,其中所述第一锁定部分能够与所述第二锁定部分接合,以便将所述第一手柄部分的所述近端和所述第二手柄部分的所述近端可枢转地连接;以及

[0043] 锁栓,其可转动地连接到所述第一手柄部分和所述第二手柄部分之一,其中所述锁栓能够接合所述第一手柄部分和所述第二手柄部分的另一个,并且相对于所述钉仓通道将所述钉站运动就位。

[0044] (12)如第(11)项的外科钉合器,其中所述锁栓能够在打开位置、部分闭合位置和闭合位置之间转动,并且其中所述第一锁定部分和所述第二锁定部分能够在所述锁栓位于所述部分闭合位置和所述闭合位置时防止所述第一手柄部分与所述第二手柄部分脱离。

[0045] (13)如第(11)项所述的外科钉合器,其中所述锁栓能够在完全打开位置和完全闭合位置之间转动,并且其中所述第一锁定部分和所述第二锁定部分能够只在所述锁栓位于所述完全打开位置时相互脱离。

[0046] (14)如第(11)项所述的外科钉合器,其中所述锁栓能够转动地安装到所述第一手柄部分,其中所述第二手柄部分包括从其延伸的突出部,并且其中所述锁栓能够接合所述突出部,以便在所述锁栓在打开位置和闭合位置之间运动时将所述钉砧运动与所述钉仓通道靠近对置。

[0047] (15)如第(11)项所述的外科钉合器,其中所述第一手柄部分和所述第二手柄部分之一包括销,其中所述第一手柄部分和所述第二手柄部分的另一个包括细槽,并且其中所述销和所述细槽能够包括枢轴,所述第二手柄部分能够围绕所述枢轴朝着所述第一手柄部分转动。

[0048] (16) 一种外科钉合器,包括:

[0049] 第一手柄部分,包括:

[0050] 近端;以及

[0051] 钉仓通道,其能够接收钉仓;

[0052] 第二手柄部分,包括:

[0053] 近端;以及

[0054]钉砧;

[0055] 枢轴装置,其用于将所述第一手柄部分的所述近端枢转地连接到所述第二手柄部分的所述近端;以及

[0056] 锁栓,其可转动地连接到所述第一手柄部分和所述第二手柄部分之一,其中所述锁栓能够接合所述第一手柄部分和所述第二手柄部分的另一个,并且相对于所述钉仓通道将所述钉站运动就位。

[0057] (17)如第(16)项的外科钉合器,其中所述锁栓能够在打开位置、部分闭合位置和闭合位置之间转动,并且其中所述第一手柄部分在所述锁栓位于所述部分闭合位置和所述闭合位置时不能与所述第二手柄部分脱离。

[0058] (18)如第(16)项所述的外科钉合器,其中所述锁栓能够在完全打开位置和完全闭合位置之间转动,并且其中所述第一手柄部分能够只在所述锁栓位于所述完全打开位置时与所述第二手柄部分脱1¾。

[0059] (19)如第(16)项所述的外科钉合器,其中所述锁栓能够转动地安装到所述第一手柄部分,其中所述第二手柄部分包括从其延伸的突出部,并且其中所述锁栓能够接合所述突出部,以便在所述锁栓在所述打开位置和所述闭合位置之间运动时将所述钉砧运动与所述钉仓通道靠近对置。

[0060] (20)如第(16)项所述的外科钉合器,其中所述第一手柄部分和所述第二手柄部分之一包括销,其中所述第一手柄部分和所述第二手柄部分的另一个包括细槽,并且其中所述销和所述细槽包括所述枢轴装置。

[0061] (21) 一种外科钉合器,包括:

[0062] 第一手柄部分,其包括能够接收钉仓的钉仓通道;

[0063] 第二手柄部分,其包括钉砧;

[0064] 锁栓,其能够转动地连接到所述第一手柄部分和所述第二手柄部分之一,其中所述锁栓能够接合所述第一手柄部分和所述第二手柄部分的另一个,并且其中所述锁栓能够在打开位置和闭合位置之间转动;以及

[0065] 偏压构件,其能够将所述钉砧偏压离开所述钉仓通道。

[0066] (22)如第(21)项所述的外科钉合器,其中所述偏压构件定位在所述第一手柄部分和所述第二手柄部分中间。

[0067] (23)如第(21)项所述的外科钉合器,其中所述锁栓能够转动到部分闭合位置,并且其中所述偏压构件能够相对于所述钉仓定位所述钉砧,使得在所述锁栓位于所述部分闭合位置时在所述钉砧和所述钉仓通道之间具有组织接收间隙。

[0068] (24)如第(21)项所述的外科钉合器,其中所述第一手柄部分包括具有第一锁定部分的近端,其中所述第二手柄部分包括具有第二锁定部分的近端,并且其中所述第一锁定部分能够接合所述第二锁定部分,以便将所述第一手柄部分的所述近端和所述第二手柄部分的所述近端可枢转地连接。

附图说明

[0069] 结合附图,参考本发明实施方式的以下描述,将更加明白本发明的所述和其它特征和优点以及获得它们的方式,并更好地理解本发明本身,附图中:

[0070] 图1是按照本发明的至少一个实施方式的外科钉合器械的透视图;

[0071] 图2是图1的外科钉合器械的分解透视图;

[0072] 图3是图1的外科钉合器械的分解正视图;

[0073] 图4是图1的外科钉合器械的局部截面图,表示第一和第二部分组装在一起;

[0074] 图5是图1的外科钉合器械的局部截面图,表示图4的第一部分的近端被锁定在图4的第二部分的近端,并且表示第二部分朝着第一部分转动;

[0075] 图6是图1的外科钉合器械的局部截面图,表示锁栓可转动地安装到第一部分,其中锁栓与第二部分接合,并且其中锁栓转动到部分闭合位置;

[0076] 图7是图1的外科钉合器械的局部截面图,表示图6的锁栓位于闭合位置;

[0077] 图8是图1的外科钉合器械的钉仓组件的透视图;

[0078] 图9是图8是钉仓组件的分解视图;

[0079] 图10是沿着图9的线10-10截取的图8的钉仓组件的截面图;

[0080] 图11是图8的钉仓组件的缝钉滑座和切割构件组件的分解视图;

[0081] 图12图11的缝钉滑座和切割构件组件的透视图;

[0082] 图13是图1的外科钉合器械的透视图,表示击发致动器沿着外科钉合器械的第一侧朝远侧运动;

[0083] 图14是图1的外科钉合器械的透视图,表示图13的击发致动器沿着外科钉合器械的第二侧朝远侧运动;

[0084]图15是按照本发明的至少一个替代实施方式的外科钉合器械的截面图,表示锁栓位于部分闭合位置上并且锁定机构与击发致动器接合;

[0085] 图16是图15的外科钉合器械的截面图,其中锁栓运动到闭合位置,并且将锁定机构与击发致动器脱离;

[0086] 图17是图1的外科钉合器械的钉砧组件的透视图;

[0087] 图18是图17的钉砧组件的分解透视图;

[0088] 图19是图17的钉砧组件的另一分解透视图;

[0089] 图20是图17的钉砧组件的分解的剖视正视图;

[0090] 图21是图17的钉砧组件的剖视组装视图,表示钉砧调节构件位于第一位置;

[0091] 图22是图17的钉砧组件的剖视组装视图,表示图21的钉砧调节构件位于第二位置;

[0092] 图23是图17的钉砧组件的剖视组装视图,表示图21的钉砧调节构件位于第三位置;

[0093] 图24是按照本发明的至少一个替代实施方式的外科钉合器械的透视图;

[0094] 图25是沿着图24的线25_25截取的图24的外科钉合器械的截面图;

[0095] 图26是图24的外科钉合器械的近端的局部分解视图,包括用于将可转动钉砧调节构件可松开地保持就位的制动器机构;

[0096] 图27是图24的外科钉合器械的透视图,其中一些部件被去除并且其它部件以截面图表示;

[0097] 图28是图24的外科钉合器械的各部分的分解视图,表示可转动钉砧调节构件位于第一取向;

[0098] 图29是图28的可转动钉砧调节构件的透视图;

[0099] 图30是图24的外科钉合器械的端视图,其中一些部件被去除,并且其它部件以虚线表示,表示可转动钉砧调节构件位于图28的第一取向上;

[0100] 图31是沿着图24的线31-31截取的图24的外科钉合器械的截面端视图;

[0101] 图32是图24的外科钉合器械的端视图,表示图28的可转动钉砧调节构件在第一方向上转动到第二取向;

[0102] 图33是图24的外科钉合器械的截面端视图,表示钉砧调节构件位于图32的第二取向上;

[0103] 图34是图24的外科钉合器械的端视图,表示图28的可转动钉砧调节构件在第二方向上转动到第三取向;

[0104] 图35是图24的外科钉合器械的截面端视图,表示钉砧调节构件位于图34的第三取向上;

[0105] 图36是用于转动图28的钉砧调节构件的致动器的透视图;以及

[0106] 图37是包括弹簧的外科钉合器械的局部截面图,该弹簧被构造成在钉合器械位于部分闭合构型时偏压第一手柄部分的远端离开第二手柄部分的远端。

[0107] 相应的附图标记在多个视图中指示相应的部件。这里给出的范例以一种形式表示本发明的优选实施方式,并且不认为这种范例以任何方式限制本发明的范围。

具体实施方式

[0108] 现在将描述一些示例性的实施方式,以便提供对这里披露的装置和方法的结构原理、功能、制造和使用的总体理解。这些实施方式的一个或多个实施例在附图中描述。本领域普通技术人员将理解这里特别描述以及附图所示的装置和方法是非限定性的示例性实施方式,并且本发明的多个实施方式的范围只由权利要求来限定。结合一个示例性实施方式说明或描述的特征可与其它实施方式的特征组合。这种改型和变型旨在包含在本发明的范围内。

[0109] 与本申请同时提交了三个共同所有的非临时美国专利申请。在提交时,这三个申请分别是:

[0110] SURGICAL STAPLING INSTRUMENT WITH CUTTINGMEMBER ARRANGEMENT,律师案卷号为 END6414USNP/080203,发明人为:Chester Baxter 和 James Bedi ;

[0111] SURGICAL STAPLER HAVING AN INTERMEDIATECLOSING POSIT1N,律师案卷号为END6411USNP/080200,发明人为:Chester Baxter 和 James Bedi ;以及

[0112] SURGICAL STAPLER WITH APPARATUS FOR ADJUST INGSTAPLE HEIGHT,律师案卷号为END6406USNP/080195,发明人为:Chester Baxter和James Bedi,这三个申请的整体披露通过引用结合于此。

[0113] 参考图1,总体表示为100的外科钉合器械可包括第一手柄部分102和第二手柄部分104。在多个实施方式中,第一手柄部分102和第二手柄部分104可被构造成例如由外科医生抓握,并且可包括手抓握部分106。在至少一个实施方式中,参考图2和3,第一手柄部分102可包括附接到第一框架110的第一盖108,并且类似地,第二手柄部分104可包括附接到第二框架114的第二盖112。盖108和112可被符合人机工程地成形,或者以其它方式适当成形,以有助于外科医生在外科手术部位内操纵钉合器械100。在多个实施方式中,手柄盖108和112例如可分别包括增大的突出部109和113,增大的突出部可有助于钉合器械100插入外科手术部位。在多个实施方式中,手柄盖108和112可例如由塑料、重量轻的材料和/或任何其它适当材料制成,而手柄框架110和114可例如由不锈钢、钛和/或任何其它适当材料制成。

[0114] 在多个实施例中,再参考图1-3,手柄部分102和104的远端可包括端部执行器120,端部执行器120可例如被构造成在外科手术部位内处理组织。在至少一个这样的实施方式中,端部执行器120可包括被构造成接收和/或保持钉仓的钉仓通道122,如下面更加详细描述的那样。在一些实施方式中,钉仓通道122可包括从第一手柄部分框架110延伸的单件式细长通道形框架。在至少一个实施方式中,钉仓通道122可包括通过底壁126连接的一对相对的细长侧壁124。沿着钉仓通道122的向后或近侧部分,一对隔开、直立的侧凸缘128可从相对的侧壁124向上延伸。在多个实施方式中,钉仓通道122在侧凸缘128之间的宽度可大于从第二手柄部分104延伸的上部钳口构件或钉砧130的宽度。在至少一个实施方式中,凸缘128之间的距离可被构造成在钉合器械被组装以便操作时使得钉砧130的至少一部分接收在侧凸缘128之间。如图2所示,每个侧凸缘128可包括缺口或凹口 127,例如被构造成接收例如从钉砧130延伸的一个或多个锁栓突出部131和/或第二手柄部分104的任何其它适当部分,如下面更加详细描述那样。

[0115] 如上所述,再次参考图1-3,钉仓通道122可被构造成将例如钉仓150的钉仓支承和/或保持在端部执行器120内,其中钉仓可包括可去除地存储于其中的一个或多个缝钉(未示出)。在多个实施方式中,参考图8-10,钉仓150可包括一个或多个缝钉空腔151,一个或多个缝钉空腔151可被构造成以任何适当方式存储例如至少横向隔开的两纵排缝钉。在至少一个实施方式中,参考图9和10,钉仓150可包括钉仓主体152和底盘154,其中钉仓主体152和/或底盘154可被构造成限定用于在其中可滑动地接收缝钉滑座和/或切割构件的通道或路径。在至少一个实施方式中,底盘154可例如包括柔性臂155,柔性臂155可被构造成以卡扣配合和/或压配合方式接合钉仓主体152。参考图10-12,钉仓150还可包括缝钉滑座组件160,缝钉滑座组件160可包括缝钉滑座部分162以及切割构件164。在多个实施方式中,切割构件164可例如包括切割刃165和锁定臂166,其中锁定臂166可被构造成在切割构件164被组装到缝钉滑座部分162时压配合和/或卡扣配合在缝钉滑座162内的开口 163内。在其它的多个实施方式中,缝钉滑座部分162可被整体模制到切割构件164。

[0116] 如上所述,参考图8-10,钉仓主体152可包括例如细槽156的细槽,细槽156可被构造成在其中接收切割构件164的至少一部分,和/或缝钉滑座组件160和推杆组件200 (下面描述)的任何其它部分,其中细槽156可被构造成使得切割构件164在钉仓150内在第一和第二位置之间运动。在多个实施方式,细槽156可被构造成允许切割构件164在近侧位置(图10)和远侧位置之间运动,以便切割例如定位在钉仓150和钉砧130之间的组织。再次参考图10-12,缝钉滑座部分162可包括凸轮、斜面或致动器表面167,表面167可被构造成接合定位在钉仓150内的缝钉驱动器。在多个实施方式中,参考图9,钉仓150可包括可在缝钉空腔151内通过滑座部分162向上升高或滑动的缝钉驱动器168,使得缝钉驱动器168的向上运动可弹出或部署至少部分定位在缝钉空腔151内的缝钉。虽然实际上缝钉驱动器168向上垂直升高,但术语“向上”和类似术语可指缝钉驱动器168例如朝着钉仓的顶表面或顶板158和/或朝着钉砧130运动。在一些实施方式中,如图9所示,每个缝钉驱动器168可包括一个或多个倾斜表面169,倾斜表面169以与凸轮表面167相同的角度和/或以可以在缝钉滑座162和缝钉驱动器168之间提供相对平或至少大致平的滑动接触表面的任何其它适当角度定向。在多个实施方式中,缝钉驱动器可被构造成只部署一个缝钉,而在一些实施方式中,缝钉驱动器可被构造成同时部署例如相邻排中的两个或多个缝钉。其它的装置在 2008 年 2 月 13 日提交的题为 SURGICAL STAPLING INSTRUMENT WITHIMPROVEDFIRING TRIGGER ARRANGEMENT、序列号为12/030424的U.S.专利申请中披露,该申请的整体披露通过引用结合于此。

[0117] 在多个实施方式中,如上所述,外科钉合器械可包括被构造成切割组织并从钉仓部署缝钉的切割构件/缝钉滑座组件。但在一些实施方式中,外科钉合器械可能不需要或不包括切割构件。在至少一个这样的实施方式中,钉仓可包括定位其中的缝钉滑座和/或外科器械可被构造成将缝钉滑座运动到钉仓内,以便例如钉合组织,而不使其切开。在一些其它的实施方式中,钉仓可包括定位其中的缝钉滑座,外科器械可包括可运动到钉仓内或相对于钉仓运动的切割构件。在至少一个这样的实施方式中,切割构件可前进,与缝钉滑座接触,使得切割构件和缝钉滑座可一起前进。随后,切割构件可充分后退,使得钉仓从外科器械上脱离并由具有新的缝钉滑座的新钉仓来更换。这样的实施方式在缝钉滑座在使用过程中变得磨损或变形的情况是有用的。可以设想其它的实施方式,其中钉仓可包括定位其中的切割构件,其中外科器械可包括可运动到钉仓内或相对于钉仓运动的缝钉滑座。在至少一个这样的实施方式中,类似于以上内容,缝钉滑座可前进,与切割构件接触,使得切割构件和缝钉滑座可一起前进。随后,缝钉滑座可充分后退,使得钉仓从外科器械上脱离并由具有新的缝钉滑座的新钉仓来更换。这样的实施方式在切割构件在使用过程中变得磨损或变形的情况是有用的。在多个实施方式中,如下面更加详细描述的那样,钉仓可包括被构造成防止或至少减小外科医生或其它医护人员例如在操纵钉仓的同时触摸定位在钉仓内的切割构件的可能性的保护壳体或盖。

[0118] 进一步地,在多个实施方式中,钉仓通道122和/或钉仓150例如可包括一个或多个相互协作的突出部和/或凹口,相互协作的突出部和/或凹口可被构造成将钉仓150可拆卸地保持在钉仓通道122内。在多个实施方式中,一旦钉仓150插入钉仓通道122,第一手柄部分102可被组装到第二手柄部分104。在其它多个实施方式中,钉仓可在第一和第二手柄部分组装在一起之后插入钉仓通道。在任一情况下,参考图1-7,第一手柄部分102和第二手柄部分104可分别包括近端103和105,近端103和105可被组装在一起,使得第一和第二手柄部分相互可转动或可枢转连接。在多个实施方式中,参考图2和3,第一手柄部分102可包括从其延伸的一个或多个销或突出部111,销或突出部111可被构造成可滑动地接收在第二手柄部分104内的一个或多个凹槽、通道或细槽115内。在一些实施方式中,细槽115可限定在第二手柄框架114内,并且突出部111可从近端柱107延伸,近端柱107从例如第一手柄框架110延伸。为了将第一手柄部分102和第二手柄部分104组装在一起,参考图4,细槽115的开口端可与突出部111对准,使得例如第二手柄部分104可相对于第一手柄部分102平移,并且突出部111可在细槽115内滑动。在至少一个实施方式中,如图2和3所示,细槽115的开口端可相对于其闭合端向近侧定位。在至少一个这样的实施方式中,第二手柄部分104的近端105可相对于第一手柄部分102的近端103向远侧定位,使得第二手柄部分104可向近侧运动,以便将突出部111定位在细槽115内。在多种其它情况下,第一手柄部分102可相对于第二手柄部分104向近侧定位,并且向远侧滑动,以便将突出部111定位在细槽115内。

[0119] 在多个实施方式中,参考图5,第二手柄部分104可朝着第一手柄部分102转动,使得钉砧130可相对于钉仓150和/或钉仓通道122运动就位。在一些实施方式中,第一手柄部分102可朝着第二手柄部分104转动和/或第一和第二手柄部分可朝彼此转动。在任何情况下,突出部111和细槽115在相互接合时可包括枢轴,第一和第二手柄部分之一或两者可围绕枢轴相对运动。在多个实施方式中,第二手柄部分104可相对于第一手柄部分102运动,使得钉站130运动到与钉仓150靠近对置。在一些实施方式中,参考图6,第二手柄部分104可相对于第一手柄部分102运动,使得从第二手柄部分104延伸的锁栓突出部131可对准和/或插入第一手柄部分102内的凹口 127。在多个实施方式中,主要参考图2和3,第一手柄部分102还可包括可转动地安装于其上的锁栓机构180,锁栓机构180可用来接合从第二手柄部分104延伸的锁栓突出部131,并将第一和第二手柄部分固定在一起。虽然未示出,但可以设想到其它的实施方式,其中锁栓机构可转动地安装到第二手柄部分,并且锁栓突出部可从第一手柄部分延伸。在任何情况下,在至少一个实施方式中,锁栓机构180可通过一个或多个枢销182安装到第一框架110,枢销182可被构造成限定锁栓180绕着转动的轴线。

[0120] 在一些实施方式中,现在参考图4和5,锁栓机构180可包括锁栓框架184以及组装到锁栓框架184的锁栓盖186。在其它多个实施方式中,锁栓盖和锁栓框架可包括整体单元,或者在其它实施方式中,锁栓机构可甚至不包括盖。在一些实施方式中,锁栓框架184是通道形状的,并且可包括一对相对的细长侧壁185,侧壁185隔开足以横跨第一框架部分110的距离。在至少一个实施方式中,锁栓盖186可例如由塑料、重量轻的材料和/或任何其它适当材料制成,而锁栓框架184可例如由不锈钢和/或任何其它适当材料制成。在一些实施方式中,在锁栓机构180闭合时,如图7所示,锁栓盖186与第一手柄盖108对准。锁栓盖186可包括成形部分187,成形部分187可被构造成有助于外科医生操纵外科器械100,其中在至少一个实施方式中,成形部分187可与从第一手柄盖108延伸的突出部109对准或大致对准。锁栓机构180还可包括从其延伸的一个或多个锁栓臂188,锁栓臂188可被构造成接合从第二手柄部分104延伸的一个或多个锁栓突出部131并将突出部131拉动和/或固定在凹口 127内,如图7所示。在至少一个实施方式中,至少一个锁栓臂188可与锁栓框架184—体形成。在一些实施方式中,参考图6,至少一个锁栓臂188可包括远侧钩189,远侧钩189可被构造成围绕突出部131的至少一部分卷绕,以便包围或围绕或至少部分包围或围绕突出部131。在至少一个实施方式中,锁栓臂188可用作过中心锁栓,从而将锁栓机构180保持在其锁定或闭合位置上。

[0121] 在使用中,在多种情况下,第一手柄部分102和第二手柄部分104之一可在外科手术部位内定位在组织的第一侧上,并且另一手柄部分可在组织的相对侧上转动就位。在这种实施方式中,钉仓150可定位在组织的一侧上,并且钉砧130可定位在组织的另一侧上。随后,如上所述,锁栓机构180可被致动,从而可在打开位置和闭合位置之间运动,以将第二手柄部分104锁定在第一手柄部分102上,并且将夹紧力施加到定位在钉仓150和钉砧130之间的组织上。在一些情况下,锁栓机构180可在打开位置(图5)、部分闭合或中间位置(图6)和闭合位置(图7)之间运动。在至少一个这样的实施方式中,参考图5和6,锁栓机构180可在打开位置和部分闭合位置之间运动,在打开位置上锁栓臂188不接合突出部131,在部分闭合位置上锁栓臂188接合突出部131,虽然钉砧130已经至少部分与钉仓150对置,但在钉砧130和钉仓150之间也保持足够的间隙,该间隙例如允许端部执行器120相对于组织重新定位。一旦钉砧130和钉仓150相对于组织充分定位,锁栓机构180就可在其部分闭合位置和闭合位置之间运动,如图7所示。

[0122] 进一步地,在多个实施方式中,外科钉合器械还可包括偏压构件,偏压构件可被构造成偏压钉合器械的第一手柄部分离开第二手柄部分。在至少一个实施方式中,如下面更加详细描述的那样,弹簧和/或任何适当的弹性材料可在第一和第二手柄部分之间定位,使得钉合器械的钉砧和钉仓可被偏压远离彼此。在一些实施方式中,弹簧可被构造成至少部分分开第一和第二手柄部分,使得钉砧和钉仓之间存在间隙,其中该间隙可足以使得组织定位在其间。在使用中,外科医生可定位这种外科钉合器械,而不必分开和保持第一和第二手柄部分远离彼此。这样的器械在外科医生在外科手术部位内操纵器械且钉合器械处于部分闭合构型时尤其有用。在外科医生对钉合器械的定位满意之后,外科医生可压缩和/或脱开弹簧并将钉合器械置于闭合构型。

[0123] 在多种情况下,如上所述,特别是在锁栓机构180不接合或只部分接合第二手柄部分104的突出部131时,第一手柄部分102的远端可相对于第二手柄部分104的远端运动。在这种情况下,在第一和第二手柄部分的近端处,突出部111和细槽115可被构造成例如在第一和第二手柄部分的远端正相对彼此运动时将第一和第二手柄部分的至少近端保持在一起。换言之,突出部111和细槽115可相互协作,以防止或至少禁止第一手柄部分102变得完全脱离第二手柄部分104。在一些实施例中,第一手柄部分可包括第一锁定部分,并且第二手柄部分可包括第二锁定部分,其中第一和第二锁定部分被构造成相互接合并且防止第一手柄部分变得完全脱离第二手柄部分。在至少一个实施方式中,突出部111可包括第一锁定部分,并且细槽115可包括第二锁定部分。前面的钉合器械没有这种锁定部分,相反依赖于唯一的锁栓机构来将第一和第二手柄部分保持在一起。在这些前面的钉合器械的锁栓机构没有完全接合第一和第二手柄部分两者的情况下,第一和第二手柄部分会变得完全相互脱离,由此需要例如外科医生重新定位和重新组装手柄部分。在一些情况下,这些前面的钉合器械的第一和第二手柄部分的完全脱离会暴露切割构件的至少一部分。

[0124] 在多个实施方式中,如上所述,锁栓机构180可被构造成在打开位置、部分闭合位置和闭合位置之间运动。在锁栓机构180位于其打开位置时,如上所述,突出部111可插入细槽115和/或从细槽115去除。在锁栓机构180位于其部分闭合位置时,参考图6,锁栓臂188可被构造成接合锁栓突出部131,使得突出部111不能从细槽115去除。在至少一个这样的实施方式中,锁栓臂188和锁栓突出部131可被构造成防止或至少禁止第二手柄部分104相对于第一手柄部分102向远侧运动,并因此防止或至少禁止突出部111脱离细槽115。因此,锁栓臂188和锁栓突出部131可被构造成防止第一手柄部分102相对于第二手柄部分104向近侧运动。类似于以上内容,在多个实施方式中,锁栓臂188和锁栓突出部131还可被构造成在锁栓机构180位于其闭合位置(图7)时防止或至少禁止突出部111从细槽115去除。进一步地,在一些实施方式中,锁栓突出部131可在其近端和远端之间的位置处从第二手柄部分104延伸。在至少一个这样的实施方式中,突出部111和细槽115可被构造成在其近端处将第一和第二手柄部分保持在一起,而锁栓机构180可用来在中间位置处将第一和第二手柄部分保持在一起。在任何情况下,在一些实施方式中,除非锁栓机构180运动到其完全打开位置,否则第一和第二手柄部分不能相互脱离。在至少一个这样的实施方式中,在锁栓机构180位于闭合和/或部分闭合位置时,突出部111和细槽115不能相互脱离。

[0125] 一旦钉砧130和钉仓150充分定位,钉砧130和钉仓150之间定位的组织可被钉合和/或切割。在多个实施方式中,参考图3,外科钉合器械100还可包括推杆组件200,推杆组件200可被构造成例如使缝钉滑座组件160在钉仓150内前进和/或后退。在至少一个实施方式中,推杆组件200可包括推杆202和击发致动器204,其中击发致动器204可被构造成向远侧运动推杆202和缝钉滑座组件160,以便如上所述的从钉仓150部署缝钉并使缝钉贴靠钉砧130变形。在至少一个实施方式中,参考图11和12,缝钉滑座162可包括可被构造成接收并可操作地连接到推杆202的远端201 (图3)的凹槽、通道或细槽161。在一些实施方式中,在钉仓150插入钉仓通道122时,缝钉滑座组件160可操作地接合推杆202。在至少一个实施方式中,远端201和细槽161可包括可使得远端201和细槽161在横向上组装但是防止或至少禁止远端201和细槽161在近侧方向和/或远侧方向上相互脱开的协作构造。在其它实施方式中,推杆202可在接触和接合缝钉滑座组件160之前向远侧前进。在至少一个这样的实施方式中,缝钉滑座组件160可保持固定,直到由推杆202接触。在任何情况下,如上所述,致动器204可操作地连接到推杆202,使得推动和/或拉动力施加到致动器204并传递到推杆202。在一些实施方式中,如下面更加详细描述的那样,致动器204可枢转连接到推杆202的近端203,使得致动器204可在至少第一和第二位置之间有选择地转动。

[0126] 进一步地,参考图1、13和14,致动器204可在外科钉合器械100的第一侧116上的第一位置(图13)、第二侧117上的第二位置(图14)以及位于第一和第二手柄部分102和104的近端103和105处的中间位置(图1)之间运动。一旦致动器204在第一和第二侧116、117之一上转动就位,致动器204可向远侧前进。因此在多种情况下,外科医生可选择是否沿着第一侧116或第二侧117向远侧运动致动器204。这种情况可出现在致动器204更可能撞击在外科手术部位周围的组织上时,例如与另一侧相比,在致动器204沿着外科器械的一侧向远侧运动时。在多个实施方式中,参考图2和3,致动器204可包括从其延伸的臂206,其中臂206可枢转安装到推杆202的近端203。在一些实施方式中,再次参考图1、13和14,外科器械100可包括沿着第一侧116延伸的第一细槽(未不出)和沿着第二侧117延伸的第二细槽118,其中第一和第二细槽可被构造成可滑动地接收致动器204的至少一部分。在至少一个实施方式中,第一和第二细槽的侧壁可限制或至少有助于限制致动器204的运动,使其沿着预定路径运动。参考图14,第二细槽118例如可限定在第一手柄部分102和第二手柄部分104之间,使得在致动器204沿着第二侧117向远侧运动时,致动器204的臂206可在第一和第二手柄部分之间滑动。类似于以上内容,第一细槽也可限定在第一和第二手柄部分之间。在多个实施方式中,再次参考图13和14,外科器械100还可包括中间细槽119,中间细槽119也可被构造成使得臂206和/或致动器204的任何其它适当部分在其中滑动。在至少一个这样的实施方式中,中间细槽119可连接第一和第二细槽,使得在致动器204定位在其中间位置时,致动器204可运动到其第一位置或其第二位置。虽然可以设想到其中一个或多个细槽不平行于其它细槽和/或位于不同平面内的其它实施方式,但在一些实施方式中,第一细槽、第二细槽118和中间细槽119可以相互平行或至少大致平行和/或位于相同平面内。另外,虽然所示实施方式的第一和第二侧位于外科器械100的相对侧上,但可以设想到其它实施方式,其中第一和第二细槽例如位于相邻侧和/或不直接相对的侧上。另外,可以设想到其它实施方式,其中钉合器械的侧容易辨别,例如具有圆形和/或弓形部分的器械。

[0127] 进一步地,在多个实施方式中,外科钉合器械100还可包括锁定机构,锁定机构可防止或至少禁止致动器204以及相应的缝钉滑座组件160过早前进。在至少一个实施方式中,锁定机构可被构造成防止或至少禁止致动器204在锁栓机构180运动到闭合或至少部分闭合位置之前向远侧前进。在一些实施方式中,总体参考图5,外科钉合器械100还可包括锁定机构200,锁定机构200可接合致动器204并在锁栓机构180位于完全打开位置(图5)和/或至少大致打开位置的同时保持与致动器204接合。在多个实施方式中,锁定机构220可包括锁定件222,锁定件222可例如被锁定弹簧224向其施加的偏压力偏压与致动器204接合。在至少一个这样的实施方式中,致动器204可包括被构造成接收锁定件222的至少一部分的一个或多个凹槽、通道或细槽(未示出)。在使用中,锁定机构220可将致动器204保持就位,直到锁栓机构180运动到其完全闭合位置(图7)和/或至少大致闭合位置。在这种情况下,在至少一个实施方式中,锁栓机构180可被构造成接合锁定机构220,并将锁定件222从致动器204脱离。在至少一个这样的实施方式中,参考图5-7,锁栓机构180还可包括凸轮183,凸轮183可被构造成在锁栓机构180运动到其闭合位置时接合锁定件222上的凸轮表面223,并且因此将锁定件222滑动和/或以其它方式运动离开致动器204。在多个实施方式中,凸轮183可包括从锁栓盖186和/或锁栓框架184延伸的壁、凸肋和/或凸脊。在任何情况下,一旦锁定件222与致动器204充分脱离,在至少一个实施方式中,致动器204可从图1所示的其中间位置运动到图13和14所示的其第一和第二位置之一O

[0128] 如上所述,锁定机构220可被构造成防止或至少禁止在锁栓机构180运动到例如闭合位置和/或部分闭合位置的预定位置之前驱动杆202向远侧前进。有利的是,锁定机构220还可防止或至少禁止缝钉滑座组件160在第一手柄部分102和第二手柄部分104组装在一起之前前进。实际上,锁定机构220可防止定位在钉砧130和钉仓150之间的组织在钉砧130和钉仓150相对于组织适当定位之前被切割和/或钉合。同样,实际上,锁定机构220可防止缝钉在适当夹紧力施加到组织之前被部署到组织内。在任何情况下,在锁栓机构180返回到其完全打开位置和/或部分打开位置时,凸轮183可运动离开锁定件222,使得锁定弹簧224可偏压锁定件222与致动器204再次接合。在多种其它实施方式中,参考图15和16,锁定机构220’可包括锁定件222’,锁定件222’包括凸轮表面223’以及另外的可以限制锁定件222’相对运动的止挡226’。在至少一个实施方式中,凸轮183例如可被构造成接触凸轮表面223’,并且由于凸轮表面223’的成形、斜切和/或倾斜的表面,凸轮183可被构造成如图16所示向远侧驱动锁定件222’。锁定件222’可被向远侧驱动,使得从锁定件222’延伸的销228’在第一位置(图15)和第二位置(图16)之间运动,在第一位置上销定位在致动器204’的开口 229’内,在第二位置上销228’已经从开口 229’充分去除。在多个实施方式中,止挡226’可被构造成随着锁定件222’被向远侧驱动,止挡226’能够在锁定件222’充分移动后与凸轮183接触。在这种实施方式中,止挡226’可被构造成控制锁定件222’的第二或移动部分。类似于以上内容,在致动器180运动离开其闭合位置并且凸轮183脱离锁定机构220’时,锁定弹簧224’可运动锁定件222’与致动器204’再次接合。

[0129] 在多个实施方式中,如上所述,击发致动器可用来在第一和第二位置之间运动推杆、缝钉滑座和/或切割构件。同样如上所述,推杆组件200例如可用来在近侧位置(图10)和远侧位置之间运动例如缝钉滑座组件160的缝钉滑座组件。在一些实施方式中,例如钉仓150的钉仓例如可包括包含于其中的缝钉滑座组件160,其中在钉仓组装或插入钉仓通道122时,缝钉滑座组件160可定位在远侧位置上,如图10所示。在至少一个这样的实施方式中,参考图8-10,钉仓150可包括另一壳体170,壳体170可被构造成在缝钉滑座组件160例如位于其远侧位置时覆盖切割构件164的至少一部分。在多个实施方式中,壳体170可被构造成例如在操纵钉仓、将钉仓插入外科钉合器和/或将外科钉合器的两个或多个部分组装在一起时保护外科医生。在至少一个这样的实施方式中,切割刃165的至少上部可在钉仓150的顶板或顶表面158之上延伸,并且在没有例如壳体170的保护壳体的情况下,切割刃165的上部被暴露。

[0130] 在多个实施方式中,如上所述,切割构件165可至少部分定位在细槽或通道156中,并且如图10所示,切割构件164的至少上部或顶部在顶板158之上延伸。在至少一个实施方式中,参考图8-10,壳体170可包括从钉仓主体152的第一部分157延伸的第一壁或部分172、从钉仓主体152的第二部分159延伸的第二壁或部分174以及在第一壁172和第二壁174之间延伸的顶壁或部分176。在一些实施方式中,壳体可只包括一个从钉仓主体延伸的支承壁或支承部分以及另外的从其延伸的顶壁或顶部。在其它实施方式中,壳体可包括一个或多个侧壁或部分,并且没有顶壁。在至少一个这样的实施方式中,壳体的侧壁可被构造成例如使其在切割构件的顶部之上延伸或者至少在切割构件的切割刃之上延伸。在任何情况下,如图10所示,在缝钉滑座组件160位于其近侧位置时,切割构件164的至少一部分可定位在顶壁176之下和/或侧壁172和174之间。在一些实施方式中,切割构件164可整体定位在顶壁176之下和/或整体定位在壳体170内。在至少一个实施方式中,切割构件164可定位在顶壁176之下,使得切割表面165不延伸超过顶壁176的远侧边缘175和/或近侧边缘177。在至少一个实施方式中,壳体170可包括后壁178,后壁178可被构造成限制切割构件164和/或缝钉滑座组件160的任何其它部分向近侧的运动。在多个实施方式中,壳体170的至少一部分例如可与钉仓主体152形成整体。在至少一个这样的实施方式中,第一壁172、第二壁174、顶壁176和/或后壁178可例如在钉仓主体152注射模制时形成。在一些实施方式中,壳体170的至少一部分可经由卡扣配合、压配合和/或任何其它适当方式组装到钉仓主体152。

[0131] 进一步地,在多个实施方式中,切割构件164可通过平面或至少大致平面的主体限定,该主体具有沿着切割构件主体的至少一侧延伸的刀刃。在至少一个这样的实施方式中,第一壁172和/或第二壁174可被构造和配置成使其可包括平面或至少大致平面的内表面173,该内表面平行或至少大致平行于切割构件164的侧表面。在一些实施方式中,切割构件164可被紧密接收在壁172和174的内表面173之间。在至少一个这样的实施方式中,壁172和174之间的距离可以与细槽156的宽度相同或至少大致相同。在任何情况下,壳体可被构造成使得壳体的至少一部分例如在细槽156的至少一部分之上延伸。在一些实施方式中,壳体170可完全包围或围绕切割构件164和/或切割表面165。在至少一个实施方式中,虽然未不出,壳体可包括被剖去和/或切除的部分,该部分可至少部分脱尚、分尚和/或以其它方式变形,使得切割构件离开壳体。在至少一个这样的实施方式中,组织切割表面可被构造成接触壳体,以便例如破坏和/或切开壳体壁。在多个实施方式中,壳体壁可包括薄部分、减小厚度部分、切痕标记和/或任何其它构造,以有助于壳体壁的变形和/或切开。在一些实施方式中,切割构件可包括例如一个或多个另外的切割表面和/或钉站,这些另外的切割表面和/或钉砧可被构造成变形和/或切开壳体。在至少一个实施方式中,壳体可包括可动和/或柔性部分,例如铰接构件和/或柔性折片,铰接构件和/或柔性折片被构造成充分运动和/或柔曲,从而使得切割构件经过。在任何情况下,可以设想多个实施方式,其中切割构件可具有切开组织的任何适当构造,并且保护壳体可具有至少部分包围或围绕切割构件的任何适当构造。另外,虽然切割构件可包括如上所述的锋利刃,可以设想到其它适当的构件,例如具有足以切开组织的电流的那些构件。

[0132] 如上所述,壳体170可被构造成在位于其近侧位置时至少部分覆盖、包围和/或围绕切割构件。在多个实施方式中,切割构件可例如向远侧前进以便切割组织,并且接着向近侧后退,从而将切割构件再次定位在壳体170内。在这种实施方式中,在钉仓组装到外科钉合器械或从中去除时,切割构件可至少部分通过壳体170覆盖。在一些实施方式中,新的或未使用的钉仓可插入钉仓通道以便更换至少部分使用的钉仓。虽然可以设想到以前使用的切割构件和/或缝钉滑座组件可从使用的钉仓充分后退并前进到新的钉仓内以便再次重新使用的实施方式,但在至少一个上述实施方式中,新的钉仓可包括新的切割构件和/或在钉仓中定位的缝钉滑座组件。在新的切割构件和/或缝钉滑座组件各自设置新钉仓的实施方式中,锋利的切割刃例如可用于每个钉仓。

[0133] 在多个实施方式中,虽然未示出,钉仓可包括两个或多个壳体,壳体被构造成在它位于两个或多个位置时至少部分覆盖切割构件。在至少一个实施方式中,钉仓可包括近侧壳体以及远侧壳体,近侧壳体被构造成在它例如位于近侧位置时至少部分覆盖切割构件,远侧壳体被构造成在它例如位于远侧位置时至少部分覆盖切割构件。在至少一个这样的实施方式中,切割构件可在钉仓组装到外科钉合器械时定位在近侧壳体内,并且在一些实施方式中,切割构件可例如在它切割定位在端部执行器内的组织之后前进到远侧壳体内。因此在这样的实施方式中,在钉仓从外科钉合器去除时,切割构件可至少部分定位在远侧壳体内。这样的实施方式在导管定位在钉仓的近侧壳体和远侧壳体之间的情况下尤其有用。在多个实施方式中,虽然未示出,切割构件可从远侧位置向近侧运动到近侧位置和/或任何其它的适当位置。

[0134] 进一步地,在多个实施方式中,钉砧130可包括被构造成在钉砧130与例如钉仓150靠近对置时接收壳体170的至少一部分的一个或多个开口、细槽或凹口 179 (图17)。在至少一个实施方式中,在壳体170和凹口 179之间具有足够的间隙,使得钉砧130和钉仓150可相对运动,而没有干涉,或者在两者之间具有少量干涉。在具有一个以上的所述切割构件壳体的实施方式中,相对的钉砧可具有一个以上的用于接收壳体的相应开口。在多个实施方式中,钉砧可包括可动切割构件和至少一个用于至少部分覆盖、包围和/或围绕切割构件的壳体。在一些实施方式中,虽然未示出,钉砧和钉仓两者可包括至少一个可动切割构件和/或至少一个被构造成例如在位于近侧位置时至少部分覆盖、围绕或包围切割构件的壳体。

[0135] 如上所述,推杆组件200可向远侧前进,以便在钉仓组件150内运动缝钉滑座组件160。在多个实施方式中,同样如上所述,缝钉滑座162的楔形凸轮表面167可运动与缝钉驱动器168上的倾斜表面169接合,以便顺序和/或同时向着钉砧130驱动缝钉离开钉仓150,并且将缝钉形成任何适当构造,例如B形构造。在至少一个这样的实施方式中,参考图17,钉砧130可包括一个或多个缝钉成形表面,例如缝钉袋口 132,缝钉袋口 132可被构造成使缝钉变形。在一些实施方式中,钉砧130还可包括可被构造成可滑动接收例如缝钉滑座162、切割构件164和/或推杆202的至少一部分的细槽、通道或凹槽133。在至少一个实施方式中,虽然未示出,钉砧可包括钉砧板,钉砧板可被牢固和/或不动地定位在钉砧内限定的钉砧通道内。在多种其它的实施方式中,如图18和19所示和在下面更加详细描述的那样,钉砧130可包括可动定位在钉砧通道136内的钉砧板134。在一些实施方式中,钉砧通道136可包括相对的侧壁137以及在侧壁137之间延伸的底座138。在至少一个实施方式中,钉砧130还可包括例如组装到其上的远侧鼻部139,其中鼻部139可被构造成压配合和/或卡扣配合到钉砧通道136内,使得鼻部139可牢固地保持其中。在一些实施方式中,鼻部139可由柔软和/或柔顺的材料,例如橡胶构成,并且可包括有助于钉砧130插入外科手术部位的任何适当形状。在一些实施方式中,参考图28,例如鼻部139’的鼻部可通过一个或多个紧固件139a’保持到钉砧。类似地,参考图1,钉仓通道和/或例如钉仓150的钉仓可包括例如鼻部153的鼻部,鼻部153可有助于钉仓150插入例如外科手术部位。

[0136] 如上所述,缝钉可从钉仓部署,并贴靠钉砧变形。在多种情况下,钉砧130上的缝钉成形表面和缝钉滑座162之间的距离可确定缝钉变形量。例如,如果钉砧130上的钉砧袋口 132和缝钉滑座162上的顶表面135 (图10-12)之间的距离相对大,则与钉砧袋口 132和滑座表面135之间的距离相对小的情况相比,缝钉将变形较少的量。相应地,如果钉砧袋口 132和滑座表面135之间的距离相对小,则与钉砧袋口 132和滑座表面135之间的距离相对大的情况相比,缝钉将变形较大的量。通常,钉砧袋口 132和滑座表面135之间的距离被称为缝钉成形高度。有时缝钉成形高度可在钉仓的顶表面或顶板和钉砧上的缝钉成形表面之间测量。但是为了这种应用,对于缝钉成形高度或类似术语的任何参考可包括进行适当测量的一种或两种方式,和/或测量的任何其它适当方式。在任何情况下,如下面更加详细描述的那样,例如钉合器械100的外科钉合器械可包括用于调节缝钉成形高度的装置。

[0137] 进一步地,在多个实施方式中,钉砧可包括可朝着和/或离开钉仓运动的一个或多个成形表面,以便设置缝钉成形高度。在至少一个实施方式中,参考图17-23,钉砧130可包括可动和/或可滑动定位在钉砧通道136内的钉砧板134。在一些实施方式中,钉砧130还可包括一个或多个保持或引导销140,其中钉砧板134可包括被构造成可滑动接收销140的至少一部分的一个或多个保持或引导细槽141。在至少一个这样的实施方式中,销140和/或细槽141可被构造成限定钉站板134可沿其运动的预定路径。参考图18,销140和细槽141可被构造和配置成使得钉砧板134可沿着线性或至少大致线性的路径运动,其中线性路径可至少部分通过例如轴线142和143限定。可以设想到其它的实施方式,其中钉砧板可沿着例如弯曲和/或弯曲-线性路径的非线性路径运动。在一些实施方式中,销140的至少一部分可保持在侧壁137的开口 144内,其中在至少一个实施方式中,销140可被压配合在开口 144内。在任何情况下,如这里描述那样,销140可在例如朝着和/或离开钉仓150运动时引导钉砧板134。

[0138] 进一步地,在多个实施方式中,例如钉合器械100的外科钉合器械可包括一个或多个调节构件,该调节构件被构造成相对于钉砧组件和/或相对的钉仓的其它部分定位例如钉站板134的钉站的一部分。在一些实施方式中,参考图18和19,钉合器械100可包括钉砧板调节构件230,钉砧板调节构件230可被构造成限制钉砧板134的运动范围。在至少一个这样的实施方式中,参考图20和21,调节构件230可靠近钉砧板134定位在第一位置上,在第一位置上调节构件230的第一表面或台阶231定位在钉砧通道136的底座138和钉砧板134的第一定位表面145之间。在这种第一位置上,第一台阶231可限定在钉砧板134和钉砧通道136能够或可以进行的相对运动的大小。例如,在钉砧130如上所述贴靠组织夹紧时,钉砧板134可接触组织并且朝着底座138向上滑动,直到第一定位表面145接触第一台阶231。一旦表面145和台阶231接触,调节构件230可防止或至少禁止钉砧板134进一步朝着底座138运动。因此在至少一个这样的实施方式中,调节构件230可用作止挡,使得底座138和钉砧板134上的组织接触表面148之间的距离通过第一距离234来限定。虽然底座138在当前实施例中用作参考基准,但例如钉砧130的其它部分和/或相对的钉仓可用作参考基准。在调节构件230如上所述位于其第一位置时,调节构件230的第二表面或台阶232可在底座138和钉砧板134的第二定位表面146之间定位,并且另外第三表面或台阶233可在底座138和第三定位表面147之间定位。参考图20,调节构件230可包括两组或多组台阶231、232和/或233,并且钉砧板134可包括两组或多组定位表面145、146和/或147。虽然第一台阶231和第一定位表面145如上所述被构造成控制钉砧板134的位置,调节构件230的第二和第三台阶232、233以及钉砧板134的第二和第三定位表面146、147同样可分别构造成控制钉砧板134的位置。为了简明起见,虽然当前实施例将第一表面或台阶231描述为控制钉砧板134的位置的表面,读者将会理解到台阶232和233也可控制钉砧板134的位置。

[0139] 在一些实施方式中,调节构件230的第一位置可设置相对小或短的缝钉成形高度。在其它实施方式中,虽然未示出,调节构件的第一位置可设置中间、相对大的和/或任何其它适当的缝钉成形高度。在与调节构件的第一位置相关联的成形高度适当的情况下,外科医生可继续使用外科钉合器械来如上所述地钉合和/或切割组织。但是在该缝钉成形高度不适当的情况下,外科医生或其它医护人员可运动调节构件230,使得在钉砧板134接触定位在钉砧130和钉仓150之间的组织时,调节构件230允许钉砧板134向上滑动不同的距离。在至少一个这样的情况下,钉砧板134可以向上滑动的距离可以较大,由此为缝钉提供较大的成形高度。相应地,在其它情况下,调节构件可以运动,使得在钉砧板134接触组织时,钉砧板134能够向上滑动较小距离,由此提供较短的缝钉成形高度。虽然术语“向上”和类似术语可指的是垂直向上,该术语不局限于此;相反,“向上”可指的是例如朝着钉砧的底座和/或离开钉仓的任何方向。在任何情况下,调节构件230可在图21所示的其第一位置和图22所示的第二位置之间运动,以便增加缝钉成形高度。如图22中的箭头“P”所示,调节构件230可向近侧滑动,以便在其第一和第二位置之间运动调节构件230,但是可以设想到调节构件向远侧和/或向任何其它适当方向滑动以便调节调节构件230的实施方式。一旦调节构件230运动到其第二位置,参考图22,第一表面或台阶231可定位在底座138和钉砧板134的第二顶表面146之间。在这种第二位置上,第一台阶231可再次限定钉砧板134和钉砧通道136之间可以相对运动的大小。在至少一个实施方式中,类似于以上内容,调节构件230可用作止挡,使得底座138和钉砧板134上的组织接触表面148之间的距离通过第二距离235来限定。

[0140] 进一步地,调节构件230可在图22所示的其第二位置和图23所示的第三位置之间运动,以便再次增加缝钉成形高度。如图23中的箭头“P”所示,调节构件230可向近侧滑动,以便在其第二和第三位置之间运动调节构件230。一旦调节构件230运动到其第三位置,参考图23,第一表面或台阶231可定位在底座138和第三定位表面147之间。在这种第三位置,第一台阶231可再次限定钉砧板134和钉砧通道136之间的相对运动的大小。在至少一个实施方式中,类似于以上内容,调节构件230可用作止挡,使得底座138和钉砧板134上的组织接触表面148之间的距离可通过第三距离236限定。虽然调节构件230可如上所述在三个位置之间有选择地运动以便提供三种不同的缝钉成形高度,但可以设想到包括可在三个以上位置之间运动以便提供三个以上的不同缝钉成形高度的调节构件的其它实施方式。例如,调节构件可在四个位置之间运动,以便提供四个缝钉成形高度。可以设想到包括可在两个位置之间运动以便提供两个缝钉成形高度的调节构件的其它实施方式。另夕卜,虽然调节构件230的表面或台阶231、232和233以递减次序配置,但可以设想到其中表面或台阶以递增次序配置的其它实施方式。可以设想到其中表面或台阶不需要以递增或递减次序配置的其它配置。类似地,钉砧板134的定位表面145、146和147可以递增次序、递减次序(图20)和/或任何其它适当次序配置。另外,虽然调节构件230可沿着轴线滑动,可以设想到调节构件可沿着例如弯曲和/或弯曲-线性路径的任何适当路径运动的调节构件。

[0141] 如上所述,参考图21,调节构件230可包括三个表面或台阶231、232和233,而钉砧板134可包括三个相应的调节表面145、146和147。在调节构件230例如位于第一位置时,第一表面231可被定位成使其邻靠或邻近第一调节表面145,第二表面232可被定位成使其邻靠或邻近第二调节表面146,并且第三表面233可被定位成使其邻靠或邻近第三调节表面147。在调节构件230如上所述并参考图22和23相对于钉砧板134滑动时,调节构件230的表面231,232和233可顺次相对于钉砧板134的表面145、146和147转位。在至少一个这样的实施方式中,调节构件可具有与钉砧板上的定位表面数量相同数量的台阶。可以设想到调节构件具有比钉砧板上的定位表面更多的台阶的其它实施方式。在至少一个这样的实施方式中,钉砧板可包括一个定位表面,其中调节构件的台阶可有选择地用来限制例如钉砧板的向上运动。在多个实施方式中,总体参考调节构件230和钉砧板134,钉砧板可包括例如定位表面145的一个定位表面,其中例如调节构件230的台阶231、232和233可有选择地定位在底座138和定位表面145之间。在这样的实施方式中,第一台阶231可具有可停止或限制钉砧板134向上运动以限定第一缝钉成形高度的的第一厚度或高度,第二台阶232可具有可停止或限制钉砧板134向上运动以便限定第二缝钉成形高度的第二厚度或高度,并且另外第三台阶233可具有可停止或限制钉砧板134向上运动以便限定第三缝钉成形高度的第三厚度或高度。在至少一个实施方式中,台阶231、232和/或233的厚度或高度可在调节构件230的后表面237和台阶231、232、233的接触钉砧板134的表面之间测量。在多个实施方式中,第一台阶231和第二台阶232之间的高度或厚度差别可以与第二台阶232和第三台阶233之间的高度或厚度差别相同或者至少大致相同。因此在至少一个这样的实施方式中,台阶高度可以线性速率或者至少大致线性的速率增加。在可替代的实施方式中,第一和第二台阶之间的高度或厚度差别可以不同于第二和第三台阶之间的高度或厚度差别。在至少一个这样的实施方式中,第一、第二和第三台阶不以线性速率增加或减小高度或厚度;相反,虽然未示出,台阶可以非线性和/或几何速率增加或减小高度或厚度。

[0142] 如上所述,例如调节构件230的调节构件可在两个或多个位置之间运动。在多个实施方式中,外科钉合器械可包括致动器,致动器被构造成运动调节构件。在至少一个实施方式中,参考图17-20,外科钉合器械100可包括致动器250,致动器250可操作地附接到调节构件230,使得力可施加到致动器250并且传递到调节构件230。在一些实施方式中,致动器250可包括抓握部分或手柄252,抓握部分或手柄252可被构造成通过例如外科医生抓握,以便如上所述在钉砧130内前进或后退调节构件230。在一些实施方式中,抓握部分252可从致动器主体251延伸,其中致动器主体251可包括可被构造成接收调节构件230的至少一部分的一个或多个开口、细槽或空腔253。在至少一个这样的实施方式中,参考图19,调节构件230可包括从其延伸的锁定件254,其中锁定件254的至少一部分可接收在开口253内,以便将致动器主体253保持到调节构件230。在多个实施方式中,锁定件254可包括一个或多个弹性或柔性的腿部255,腿部255可在它们插入开口 253时被偏转,但是可在腿部255的支脚256被充分推过开口 253之后弹性返回或至少部分返回到其未柔曲位置,在至少一个这样的实施方式中,支脚256可防止或至少禁止致动器主体251从调节构件230脱离。

[0143] 进一步地,在多个实施方式中,外科钉合器械100还可包括可被构造成将致动器250和/或调节构件230保持或可松开地保持就位的制动器机构。在至少一个实施方式中,参考图19,制动器构件260可附接到致动器250,其中在至少一些实施方式中,致动器主体251可包括可被构造成在其中接收和/或保持制动器构件260的制动器主体261的一个或多个通道、凹槽或凹口 257。在至少一个实施方式中,制动器主体261可包括一个或多个开口 263,和/或可被构造成例如接收一个或多个紧固件以便将制动器主体261固定到致动器251的任何其它适当通道、细槽或凹槽。制动器构件260还可包括可被构造成接合例如第一框架部分110中的一个或多个凹口、开口或凹槽101 (图2-7)的制动器腿部262。更特别是,参考图2和3,每个侧凸缘128可包括其中限定的一个或多个凹口 101 (101a、1lb和1lc),其中制动器腿部262可被偏压与侧凸缘128的顶表面接合,使得制动器腿部262可滑动进入和滑动离开凹口 101。在所示实施方式中,每个侧凸缘可包括可被构造成将致动器250可去除地保持在第一远侧位置、第二中间位置和第三近侧位置上的三个凹口 101,其中致动器250的第一、第二和第三位置分别与如上所述的调节构件230的第一、第二和第三位置相对应。例如,在致动器250位于其第一远侧位置时,制动器构件260的制动器腿部262可定位在凹口 1la内,以便将致动器250和调节构件230可去除地保持在其第一位置。在施加足够的力时,致动器250可向近侧运动到其第二位置,使得制动器腿部262定位在凹口1lb内,并且致动器250和调节构件230被保持在其第二位置。类似地,在施加足够力时,致动器250可向近侧运动到其第三位置,使得制动器腿部262定位在凹口 1lc内,并且致动器250和调节构件230被保持在其第三位置。在多个实施方式中,制动器腿部262可被构造成使得致动器250可返回到其第一和/或第二位置。

[0144] 如上所述,调节构件230可通过致动器250沿着两个或多个位置之间的预定路径运动。在多个实施方式中,外科钉合器械100例如可包括用于控制或限制调节构件230和/或致动器250的运动的一个或多个引导件。在一些实施方式中,调节构件230可被紧密地接收在钉砧130的侧壁137之间,使得侧壁137可引导调节构件230。在至少一个这样的实施方式中,侧壁137可被构造成控制或限制调节构件230的横向或侧到侧运动。在多个实施方式中,制动器构件160的制动器腿部162可包括弹性构件,弹性构件可被构造成在调节构件230上施加向上偏压或拉动力,以便贴靠或至少邻近底座138并在侧壁137之间定位调节构件230。在一些实施方式中,参考图19,钉砧130的底座138还可包括可被构造成在其中接收调节构件230和/或致动器250的至少一部分的引导细槽149,使得引导细槽149可限制调节构件230和致动器250的运动。在至少一个这样的实施方式中,调节构件230的锁定件254可被构造成延伸穿过引导细槽149,使得在锁定件254如上所述插入致动器250的开口 253时,钉砧130的底座138可截留在调节构件230和致动器250之间。在一些实施方式中,引导细槽149可被构造成限制锁定件254的运动,使得在调节构件230位于其第一或最远侧位置时可防止或至少限制调节构件230向远侧运动,和/或类似地,在调节构件230位于其第三或最近侧位置时防止或至少禁止调节构件230向近侧运动。

[0145] 进一步地,在多个实施方式中,类似于例如制动器构件260的制动器构件可用来偏压第一手柄部分102和第二手柄部分104相互离开。在至少一个实施方式中,参考图37,外科钉合器械100’可包括制动器构件260’,制动器构件260’被构造成定位第一手柄部分102和第二手柄部分104,使得钉砧130和钉仓150之间存在间隙。如上所述,这种特征可使得外科医生方便地操纵外科器械,而不必保持第一和第二手柄部分相互隔开。在一些实施方式中,制动器构件260’可充分安装到第二手柄部分104,使得从制动器构件260’延伸的制动器腿部262’可接触凸缘128,并且在被压缩时,将偏压力施加到第一和第二手柄部分。如图37所示,腿部262’能够接触凸缘128上的表面101d。为了压缩制动器腿部262’,锁栓机构180可运动到部分闭合位置,使得锁栓臂188可接合并至少部分围绕锁栓突出部131。在此构造中,外科医生可操纵器械,并且在对其位置满意时,将锁栓机构180运到闭合位置并且进一步压缩制动器腿部262’。类似于以上内容,制动器构件260’可固定或以另外方式可操作地接合致动器250,使得在致动器250如上所述在其第一、第二和第三位置之间运动时,腿部262’可分别接合凹口 1laUOlb和101c。因此在至少一个这样的实施方式中,致动器250可具有前置级位置,其中致动器250相对于其第一位置向远侧定位,并且另外表面1ld可包括前置级表面,腿部262’在致动器250位于其前置级位置时可贴靠该前置级表面定位。

[0146] 如上所述,调节构件可在第一和第二位置之间滑动或平移,以便调节通过外科钉合器械部署的缝钉成形高度。在多个实施方式中,虽然未示出,调节构件可被构造成例如朝着和/或离开相对的钉仓可靠地移动钉砧板。在至少一个这样的实施方式中,外科钉合器械可包括例如弹簧的一个或多个偏压构件,该偏压构件被构造成贴靠调节构件定位钉砧板,使得在调节构件在其第一和第二位置之间运动时,调节构件可在第一和第二位置之间移动钉砧板,以便设置第一和第二缝钉成形高度。由于以上所述,在多个实施方式中,调节构件可被构造成将钉砧的一部分通过凸轮作用就位。在至少一个这样的实施方式中,调节构件可沿着轴线滑动,以便可靠地移动钉砧板。在其它实施方式中,可转动的调节构件可被构造成例如朝着和/或离开钉仓可靠地移动钉砧板。

[0147] 进一步地,如下面更加详细描述的那样,调节构件可被转动,以便调节缝钉成形高度。参考图24-36,类似于以上内容,外科器械100’可包括第一手柄部分102’、第二手柄部分104’和可用来夹紧钉砧130’和钉仓150’之间的组织的锁栓机构180’。参考图25,同样类似于以上内容,锁栓机构180’可通过一个或多个枢销182’可枢转地连接到第一部分102’,其中锁栓机构180’可包括一个或多个锁栓臂188’,锁栓臂188’可被构造成接合第二部分104’并且将第一和第二手柄部分锁定在一起。同样类似于以上内容,参考图25和27,外科器械100’还可包括推杆组件200’,推杆组件200’可被构造成在端部执行器120’内前进切割构件和/或缝钉滑座。在至少一个这样的实施方式中,推杆组件200’可包括近端203’和致动器204’,其中致动器204’可转动地安装到近端203’并且有选择地定位在钉合器械100’的第一和第二侧上。在多个实施方式中,外科钉合器械100’可包括与结合外科钉合器械100描述的那些特征相同或类似的特征,并且可以与器械100相同或类似的方式操作,并且因此这些细节不在这里重复。

[0148] 在多个实施方式中,参考图27,外科器械100’可包括可转动的调节构件230’,调节构件230’可有选择地定位在至少第一和第二位置上,以便提供不同的缝钉成形高度。在一些实施方式中,外科器械100’可包括致动器250’,致动器250’可操作地连接到调节构件230’,使得致动器250’可至少在其第一和第二位置之间运动调节构件230’。在至少一个实施方式中,参考图28,致动器250’可包括致动器主体251’和抓握部分或手柄252’。致动器主体251’可包括开口 258’,开口 258’可被构造成接收调节构件230’的近端238’,使得转动运动、扭矩和/或力可在致动器250’和调节构件230’之间传递。在至少一个这样的实施方式中,参考图36,开口 258’可包括非圆形型面和/或包括一个或多个平驱动表面的型面,该驱动表面被构造成在致动器主体251’和致动器230’之间传递转动运动。在一些实施方式中,开口 258’可设置尺寸并被构造成紧密接收致动器230’的近端238’。在至少一个实施方式中,开口 258’可被构造成以压配合和/或卡扣配合接收近端238’。在多个实施方式中,再次参考图28,手柄部分104’可包括一个或多个细槽259’,细槽259’可被构造成允许致动器主体251’的至少一部分延伸经过其中,使得抓握部分252’可组装到致动器主体251’,其中手柄部分104’的至少一部分定位在抓握部分252’和致动器主体251’之间。在至少一个这样的实施方式中,第二手柄部分104’还可包括凹口 253’,凹口 253’可被构造成使得抓握部分252’的至少一部分(如果不是全部的话)定位在凹口 253’内。虽然在其它实施方式中,抓握部分252’的上部可在第二手柄部分104之上延伸,如图30所示,使得抓握部分252’可容易由外科医生接近,但在一些实施方式中,凹口 253’可被构造成使得抓握部分252’不在第二手柄部分104’的顶表面之上延伸。

[0149] 在多个实施方式中,如上所述,调节构件可至少在第一和第二位置之间转动,以便调节由外科钉合器部署的缝钉成形高度。在一些实施方式中,参考图28,外科钉合器械可包括可转动地定位在钉砧内的调节构件,其中调节构件可被构造成限制可动钉砧部分的相对转动。在至少一个这样的实施方式中,外科钉合器械100’可包括钉砧板134’,钉砧板134’可通过保持或引导销140’可滑动地保持在钉砧通道136’内,其中引导销140’可被构造成使得钉砧板134’在钉砧板134’如上所述接触组织时向上滑动。参考图27、30和31,调节构件230’可定位在第一位置或取向上,使其可限制钉砧板134’在钉砧通道136’内的向上运动,并且确定缝钉的缝钉成形高度。在至少一个这样的实施方式中,参考图30和31,调节构件230’可包括相对的第一表面231’,第一表面231’可定位在钉砧通道136’的底座138’和钉砧板134’的定位表面145’之间,使得在定位表面145’接触第一表面231’之一时,钉砧板134’的组织接触表面148’可例如定位在距钉砧130’的基准表面129’第一距离234’处。相应地,成形表面132’可定位在距钉仓第一距离处,使得在缝钉从钉仓部署时,缝钉可被变形到第一缝钉高度。进一步地,第一直径241’可在第一表面231’之间限定,其中第一直径241’可限定钉砧板134’在钉砧通道136’内的最大向上位置。

[0150] 如上所述,调节构件230’可转动,以便调节缝钉的成形高度。在多个实施方式中,调节构件230’可在其第一位置或取向(图30和31)和第二位置或取向(图32和33)之间转动。在至少一个实施方式中,参考图32和33,手柄252’可在箭头“A”所示的方向上转动,以便使调节构件230’在其第一和第二位置之间运动。类似于以上内容,在致动器230’位于其第二位置或取向时,致动器230’可限制钉砧板134’在钉砧通道136’内的向上运动,并且确定缝钉的缝钉成形高度。在至少一个这样的实施方式中,参考图32和33,调节构件230’可包括相对的第二表面232’,该第二表面232’定位在底座138’和定位表面145’之间,使得在定位表面145’接触第二表面232’之一时,钉砧板134’的组织接触表面148’可例如定位在距基准表面129’第二距离235’处。相应地,成形表面132’可定位在距钉仓第二距离处,使得在缝钉从钉仓部署时,缝钉被变形到第二缝钉高度。在多个实施方式中,类似于以上内容,第二直径242’可限定在第二表面232’之间,其中第二直径242’可限定钉砧板134’在钉砧通道136’的最大向上位置。虽然第一表面231’和第二表面232’可通过平或至少大致平的表面限定,但可以设想到其中第一和第二表面231’和232’可包括至少部分弓形或弯曲轮廓的其它实施方式。在任何情况下,参考图27,调节构件230’可包括一个或多个间隙细槽240’,间隙细槽240’可被构造成在致动器230’和保持销140’之间提供间隙。间隙细槽240’可被构造成在致动器230’位于其第一位置、第二位置和/或任何其它适当位置时在致动器230’和保持销140’之间提供间隙。

[0151] 进一步地,在多个实施方式中,调节构件230’可在其第一位置或取向(图30和31)和第三位置或取向(图34和35)之间转动。在至少一个实施方式中,参考图34和35,手柄252’可在箭头“B”所示的方向上转动,以便使调节构件230’在其第一和第三位置之间运动。类似于以上内容,在致动器230’位于其第三位置或取向时,致动器230’可限制钉砧板134’在钉砧通道136’内的向上运动,并且确定缝钉的缝钉成形高度。在至少一个这样的实施方式中,参考图34和35,调节构件230’可包括相对的第三表面233’,该第三表面233’定位在底座138’和定位表面145’之间,使得在定位表面145’接触第三表面233’之一时,钉砧板134’的组织接触表面148’可例如定位在距基准表面129’第三距离236’处。相应地,成形表面132’可定位在距钉仓第三距离处,使得在缝钉从钉仓部署时,缝钉被变形到第三缝钉高度。在多个实施方式中,类似于以上内容,第三直径243’可限定在第三表面233’之间,其中第三直径243’可限定钉砧板134’在钉砧通道136’内的最大向上位置。再次参考图34和35,虽然可以设想到其中第三表面233’可包括平或至少大致平的轮廓的其它实施方式,但第三表面233’可通过至少部分弓形轮廓限定。在至少一个实施方式中,调节构件230’可被构造成使得弓形第三表面233’之间的最大距离或直径可用来限定第三缝钉高度。

[0152] 如上所述,参考图30和31,调节构件230’可定位在第一位置或取向上,以便为通过外科钉合器械100’部署的缝钉设置第一成形高度。同样如上所述,参考图32和33,致动器250’可用来将调节构件230’运动到其第二位置或取向,以便为缝钉设置第二成形高度。为此,在至少一个实施方式中,力可被施加到手柄252’,这可造成手柄252’以及附接于其上的调节构件230’在箭头“A”所示的方向上转动。在至少一个实施方式中,调节构件230’和/或致动器250’可被充分保持,使得在调节构件230’转动时,调节构件230’可围绕例如轴线245’(图27)的轴线转动。在至少一个实施方式中,参考图25,推杆组件200’的近端203’可包括可被构造成在其中接收和/或保持调节构件230’和/或致动器250’的至少一部分的一个或多个凹槽、通道或凹口 205’。在任何情况下,如图30-33所示,与调节构件230’位于其第一位置时的情况相比,调节构件230’的第二位置或取向可使得钉砧板134’在钉砧通道136’内滑动较大距离。因此在至少一个实施方式中,第二缝钉成形高度可大于第一缝钉成形高度。同样如上所述,参考图34和35,致动器250’可用来将调节构件230 ’运动到其第三位置或取向,以便为缝钉设置第三成形高度。为此,在至少一个实施方式中,力可被施加到手柄252’,这可造成手柄252’以及附接于其上的调节构件230’在箭头“B”所示的方向上转动。如图30、31、34和35所示,与调节构件230’位于其第一位置的情况相比,调节构件230’的第三位置或取向可使得钉砧板134’在钉砧通道136’内滑动较小的距离。因此在至少一个实施方式中,第一和第二缝钉成形高度可大于第三缝钉成形高度。在至少一个这样的实施方式中,调节构件230’的第一位置和致动器250’可代表中间位置,其中调节构件230’可直接从其第一位置有选择地运动到其第二和第三位置。实际上,调节构件230’的第一位置可代表中间缝钉高度,其中调节构件230’的第二和第三缝钉位置可分别代表更高和更短的缝钉高度。在一些实施方式中,参考图24,外科钉合器械100’上可包括一个或多个标示,该标示可被构造成传达可被选择的缝钉成形高度或至少相对成形高度。例如,第二手柄部分104’可包括可指示中间或第一缝钉高度的第一标示245’、可指示更高或第二缝钉高度的第二标示246’以及可指示更短或第三缝钉高度的第三标示247’。

[0153] 进一步地,在多个实施方式中,第一表面231’、第二表面232’和第三表面233’中的一个或多个表面可包括或限定或至少部分包括或限定调节构件230’的周边或周围。如上所述,由于第一直径241’、第二直径242’和第三直径243’分别通过第一表面231’、第二表面232’和第三表面233’限定,调节构件230’的周边或周围可以是非圆形的。但在一些实施方式中,调节构件230’的周边或周围可以是对称、大致对称和/或不对称的。进一步地,在多个实施方式中,调节构件可包括例如可转动地定位在钉砧130’的底座和钉砧板134的调节表面145’之间的凸轮。在至少一个这样的实施方式中,第一表面231’、第二表面232’和第三表面233’中的一个或多个表面可例如包括或限定凸轮型面,该凸轮型面类似于以上内容可被构造成可靠地定位钉砧板134’和/或提供钉砧板134’与其贴靠定位的止挡。在任何情况下,虽然未示出,可以设想到调节构件可以滑动和转动以便为外科钉合器械部署的缝钉设置两个或多个缝钉成形高度的多个实施方式。在至少一个这样的实施方式中,调节构件可包括可沿着调节构件的长度限定的凸轮型面,其中纵向和/或转动运动可被用来在至少第一和第二位置之间运动凸轮型面。

[0154] 在多个实施方式中,类似于以上内容,外科器械100’还可包括制动器机构,该制动器机构被构造成将致动器250’保持或至少可松开地保持就位。在至少一个实施方式中,参考图25和26,外科器械100’还可包括制动器构件260’,制动器构件260’包括制动器主体261’和一个或多个制动器腿部262’。参考图26,制动器主体261’可包括可被构造成在其中接收第二手柄部分104’的近端105’的至少一部分的一个或多个凹槽、凹口或通道263’,使得制动器构件260’可被保持就位。在至少一个这样的实施方式中,近端105’还可包括可被构造成紧密接收制动器构件260’的一个或多个凹槽、通道或凹口 265’。在一些实施方式中,制动器主体261’的例如通道263’的至少一部分可被压配合、卡扣配合和/或以其它方式适当保持在凹口 265’内。同样如图26所示,制动器构件260’的每个制动器腿部262’可包括从其延伸的一个或多个突出部264’,该突出部264’可被构造成接合致动器主体251’,并且将致动器250’可松开地保持就位。在至少一个实施方式中,参考图36,致动器主体251’可包括可被构造成接收突出部264’的一个或多个凹口或孔269’。在突出部264’定位在凹口 269’内时,突出部可被构造成将致动器250’例如保持在其第一位置上,直到足够的力被施加到致动器250’,以便造成突出部264’移动离开凹口 269’。更特别是,被施加到致动器250’上的力可被传递到突出部264’,并且由于突出部264’和凹口 269’之间的协作表面,与突出部264’相关联的制动器腿部262’可向近侧柔曲或运动,使得致动器器主体251’相对于其运动。为了适应这种向近侧的运动,参考图25,凹口 265’可包括细长部分266’,细长部分266’可各自被构造成接收腿部262’的至少一部分,使得腿部262’可相对于手柄部分104’运动。在致动器250’运动到其第二或第三位置时,致动器主体251’可接触从另一腿部262’延伸的突出部264’并且向近侧偏转腿部262’,使得一旦致动器250’位于其第二或第三位置时,腿部262’可向前或向远侧弹动,使得突出部264’可固定在凹口269’内。进一步地,在至少一个实施方式中,突出部264’和凹口 269’的侧壁之间的相互作用使得致动器250’可被牢固地保持在其第一、第二和第三位置之一,但仍然使得致动器250’在充分施加力的情况下运动。在这样的实施方式中,制动器构件260’可防止或至少禁止致动器250’以及调节构件230’意外移动。

[0155] 这里披露的装置可被设计成在一次使用之后丢弃,或者它们可被设计成多次使用。但是在任何情况下,该装置可被修复以便在至少一次使用之后重新使用。修复可包括拆卸装置、随后清洁或更换特定部件并随后重新组装的步骤的任何组合。特别是,该装置可被拆卸,并且该装置的任何数量的特定部件或部分可以任何组合的方式被有选择地更换或去除。在特定部分被清洁和/或更换时,该装置可被重新组装以便在修复设施或在外科手术之前由外科手术团队随后使用。本领域普通技术人员将理解到装置的修复可采用多种拆卸、清洁/更换和重新组装的技术。使用这些技术以及所得的修复装置都在本申请的范围内。

[0156] 优选的是,这里描述的本发明将在外科手术之前被处理。首先,获得新的或使用过的器械,并且在需要的情况下进行清洁。该器械可接着被消毒。在一种消毒的技术中,该器械被放置在封闭和密封的容器内,例如塑料或TYVEK袋中。容器和器械接着被放置在可穿透容器的例如伽马辐射、X射线或高能电子的辐射场内。这些辐射杀灭器械和容器内的细菌。被消毒的器械可接着存放在无菌容器内。被密封的容器保持器械无菌,直到它在医疗设施中打开。

[0157] 虽然本发明被描述成具有示例性结构,本发明还可在此披露的范围内进一步改造。本申请因此用来使用其总体理论来覆盖本发明的任何变型、使用和改型。另外,由于来自于与本发明相关联的领域内的公知或常规实践,本申请打算覆盖偏离当前披露的内容。

Claims (8)

1.一种外科钉合器,包括: 第一手柄部分,包括: 近端; 远端;以及 钉仓通道,其接收钉仓; 第二手柄部分,包括: 近端; 远端;以及 钉砧,其中所述第一手柄部分和所述第二手柄部分之一的近端包括销,并且所述第一手柄部分和所述第二手柄部分的另一个的近端包括细槽,所述细槽可滑动地接收所述销;以及 锁栓,其可转动地连接到所述第一手柄部分和所述第二手柄部分之一,其中所述锁栓在所述第一手柄部分和所述第二手柄部分的另一个的近端和远端中间的位置处接合所述第一手柄部分和所述第二手柄部分的另一个,其中所述锁栓在打开位置、部分闭合位置和闭合位置之间转动,并且其中所述细槽和所述销使得所述销在所述锁栓位于所述部分闭合位置时不能与所述细槽脱离; 其中所述锁栓转动地安装到所述第一手柄部分,其中所述第二手柄部分包括从其延伸的突出部,并且其中所述锁栓接合所述突出部,以便在所述锁栓在所述打开位置和所述闭合位置之间运动时将所述钉砧运动与所述钉仓通道靠近对置。
2.如权利要求1所述的外科钉合器,其中所述销和所述细槽包括枢轴,所述第二手柄部分围绕所述枢轴朝着所述第一手柄部分转动。
3.如权利要求1所述的外科钉合器,其中所述第一手柄部分包括所述销,其中所述第二手柄部分包括所述细槽,并且其中所述细槽包括开口端和闭合端,并且其中所述开口端相对于所述闭合端位于近侧。
4.如权利要求1所述的外科钉合器,其中所述销在所述锁栓位于所述打开位置时与所述细槽脱离。
5.一种外科钉合器,包括: 第一手柄部分,包括: 近端;以及 钉仓通道,其接收钉仓; 第二手柄部分,包括: 近端;以及 钉砧,其中所述第一手柄部分和所述第二手柄部分之一的近端包括销,并且所述第一手柄部分和所述第二手柄部分的另一个的近端包括细槽,所述细槽可滑动地接收所述销;以及 锁栓,其可转动地连接到所述第一手柄部分和所述第二手柄部分之一,其中所述锁栓接合所述第一手柄部分和所述第二手柄部分的另一个,其中所述锁栓在完全打开位置和完全闭合位置之间转动,并且其中所述细槽和所述销使得所述销只在所述锁栓位于所述完全打开位置时与所述细槽脱离; 其中所述锁栓转动地安装到所述第一手柄部分,其中所述第二手柄部分包括从其延伸的突出部,并且其中所述锁栓接合所述突出部,以便在所述锁栓在所述完全打开位置和所述完全闭合位置之间运动时将所述钉砧运动与所述钉仓通道靠近对置。
6.如权利要求5所述的外科钉合器,其中所述锁栓和所述突出部之间的接合防止所述销与所述细槽脱离。
7.如权利要求5所述的外科钉合器,其中所述销和所述细槽包括枢轴,所述第二手柄部分围绕所述枢轴朝着所述第一手柄部分转动。
8.如权利要求5所述的外科钉合器,其中所述第一手柄部分包括所述销,其中所述第二手柄部分包括所述细槽,并且其中所述细槽包括开口端和闭合端,并且其中所述开口端相对于所述闭合端位于近侧。
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