CN103025253B - 多入口导引器 - Google Patents
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Abstract
本公开涉及一种导引组件。所述组件包括导引器(1000),导引器包括具有第一组标记(1020a-g)的主体和包括至少一个通孔的接头(1010),接头被设置用于沿主体的长度滑动,所述组件还包括具有第二组标记(1030a-g)的第一手术设备(1100),其中导引器被连接至第一手术设备并且在接头位于第一组标记中的一标记处时通孔的纵向轴线与第二组标记中的一标记同心共径。也公开了其他的导引器。
Description
相关申请的交叉引用
本申请是2010年6月4日提交的申请号为12/794,142的美国专利申请的PCT国际专利申请,通过全文引用将其公开内容并入本文。
技术领域
本公开涉及用于在手术中使用的医疗设备,并且更具体地涉及用于在手术期间创建多个入口的导引器。
背景技术
在关节镜手术期间,身体的关节区域例如髋部、膝部、肩部和其他关节区域可通过使用内窥镜来接近。某些关节比其他关节更难接近。例如,髋关节与其他关节的不同之处在于在其周围有更厚的被称为髋关节囊的软组织层。该厚层使得难以改变放入关节内的器械的轨迹并且设置入口或组织通道的重要性与其他的关节相比就显得更为关键。
目前,荧光透视法被用于设置入口以容纳内窥镜和手术期间使用的其他器械。在医生使用细针尝试各种到达关节的途径时要多次使用X射线,细针可能要重复插入若干次,直到获得理想的入口设置为止。该过程将手术团队暴露在辐射中、耗时并且可能会造成创伤,特别是对脆弱的关节软骨以及在髋关节的情况下对髋臼唇造成创伤。
对能够允许创建多个入口同时明显减小可能的伤害效果并缩短现有方法所需时间量的装置和方法存在需求。
发明内容
在一方面中,本公开涉及一种导引组件。所述组件包括导引器,导引器包括具有第一组标记的主体和包括至少一个通孔的接头,接头被设置用于沿主体的长度滑动,所述组件还包括具有第二组标记的第一手术设备。导引器被连接至第一手术设备并且在接头位于第一组标记中的某一标记处时通孔的纵向轴线与第二组标记中的某一标记同心共径。
在另一方面中,本公开涉及一种导引组件。所述导引组件包括导引器和第一手术设备,导引器包括具有至少一个通孔的主体,第一手术设备包括具有标记的末端。导引器被连接至第一手术设备并且通孔的纵向轴线与第一手术设备末端上的标记同心共径。
本公开的更多可应用领域将根据以下提供的详细说明而变得显而易见。应该理解详细说明和具体示例尽管给出了本公开的优选实施例,但这仅仅是为了解释性的目的而并不是为了限制本公开的范围。
附图说明
并入说明书并且构成其一部分的附图示出了本公开的实施例,并且与所定的说明内容一起用于解释本公开的原理、特性和特征。在附图中:
图1-4示出了本公开中第一导引组件的正视图。
图5示出了本公开中第二导引组件的正视图。
图6示出了本公开中第三导引组件的正视图。
图7示出了本公开中第四导引组件的正视图。
图8示出了本公开中第四导引组件的等距视图。
图9A示出了第四导引组件的杠杆臂在第一位置的顶视图。
图9B示出了第四导引组件的杠杆臂在第二位置的顶视图。
图10示出了第四导引组件的第二连接部分的透视图。
图11A-11D示出了用于将本公开的导引器连接至内窥镜套管的方法的透视图。
图12示出了本公开的第一导引器连接至瞄准臂的正视图。
图13示出了本公开的第一导引器连接至另一瞄准臂的正视图。
图14示出了本公开的第四导引器连接至瞄准臂的正视图。
图14A示出了图14中导引器的瞄准臂远端的展开视图。
具体实施方式
以下对优选实施例的说明内容在本质上仅仅是示范性的而绝不是为了限制本公开、其应用或用途。
图1示出的导引器10包括主体11,主体11具有第一端12、第二端13、沿主体11长度为L的圆弧和至少一个通孔14。图1中还示出了第一手术器械20例如内窥镜,其包括第一端21和第二端22。导引器10的第二端13正如以下进一步介绍的那样通过套管40被连接至内窥镜20的第一端21,并且通孔14的纵向轴线15与内窥镜20的第二端22相交或者同心共径。同样如图1所示,主体11可以包括多个通孔14,每一个通孔都包括与内窥镜20的第二端22相交或者同心共径的纵向轴线15。
在关节镜手术特别是髋关节镜手术期间,第一入口31在患者身体32内相对安全的位置创建,在此对内部结构的损伤被最小化。入口31可以如上所述通过使用荧光透视法或者本领域普通技术人员已知的其他方法来创建。第一套管40和内窥镜20随后通过入口31插入以使医生能够获得患者身体32内部特别是要执行手术的区域35(也就是髋关节和围绕关节的关节囊)的清晰视野。该视野还向医生示出了必须避免的解剖以及用于设置另一个入口的安全区域所在的位置。正如以下进一步介绍的那样,内窥镜20被设置在第一套管40内以使内窥镜20的第二端22通过套管40的第二端42伸出。在将内窥镜20的第二端22定位在医生想要设置第二入口(图4中的33)的区域36例如髋关节囊的内表面之后,导引器10就通过套管连接至内窥镜20的第一端21,然后通过插入第二手术设备(图4中的34)例如第二套管穿过一个通孔14并进入患者身体32内以相对于内窥镜20的第二端22设置第二入口(图4中的33)。由于通孔14的纵向轴线15与内窥镜20的第二端22相交或者同心共径,因此第二套管34也与内窥镜20的第二端22同心共径。而且,正如以下要介绍的那样,第二套管34和内窥镜20的第二端22之间这种同心共径的关系就允许针或者可以放入第二套管34内并在上述区域35内使用的其他手术器械与内窥镜20的第二端22相交。
在导引器10内具有多个通孔14就允许灵活地设置第二入口33以使得能够最小化对内部结构的损伤。但是,也可以使用仅有一个通孔14的导引器10。
图2示出了如上所述设置在第一套管40中的内窥镜20,以使内窥镜20的第二端22通过套管40的第二端42伸出。导引器10被连接至第一套管40的第一端41。套管40具有位于第二端42的尖端43,尖端43从内窥镜20偏移或者沿内窥镜20的视野方向37偏移的距离为d。如图2和随后的附图中所示以及如下所述,距离d是从内窥镜20的光学中心23开始测量。内窥镜20的视野方向37相对于内窥镜20的纵向轴线26以约为70度的角度α定位。有时,身体的解剖结构会阻止将内窥镜20的第二端22定位在区域36内例如上述医生想要设置第二入口(图4中的33)的髋关节囊内表面。当发生这种情况时,具有尖端43的套管40可以被用于识别该区域36并且可以使导引器通孔14的纵向轴线15与尖端43相交或者同心共径。除了使用具有尖端的套管以外,内窥镜20也可以装有与套管40的尖端43相类似的尖端。内窥镜20和尖端可以通过开槽的套管引入患者身体内。
图3与图2的类似之处是通孔14的纵向轴线15与区域36相交,区域36从内窥镜20偏移或者沿内窥镜20的视野方向37偏移的距离为d。但是,除了使用套管40的尖端43来识别该区域36以外,还要确定内窥镜20以及与区域36的交点之间的平均距离d并且将等于该平均距离d的偏移量应用于导引器10内以使通孔14的纵向轴线15与该区域36相交。例如,在髋关节镜手术期间,医生可能想要将针引入髋关节囊35内,但是髋部的解剖结构可能会阻止内窥镜20的第二端22靠向髋关节囊的内表面36。由于内窥镜20可能与关节囊内表面36之间有一定的距离,因此就会造成针刺穿关节囊的位置误差。为了克服该问题,可以使用如上所述的尖端43或内置偏移量d。对于本公开来说,距离d约为1厘米。但是,距离d可以根据内窥镜20相对于区域36的位置而改变。
图4示出了设置在通孔14和第二入口33内的第二套管34。套管34包括深度止挡件38,通过使针39的第二端39b靠接深度止挡件38的第二端38b而明显降低设置在套管34内的针39的第一端39a或其他手术器械前进超过内窥镜20的第二端22的可能性。深度止挡件38可以是第二套管34的一部分或者独立于第二套管34。这就允许将第二套管34设置在通孔14内的任意深度,但是仍然拥有相对于导引器10的固定深度止挡件。
图5示出的导引器60包括主体61,主体61具有第一端62、第二端63以及沿主体61长度为L的圆弧。导引器60还包括被设置用于沿主体61的长度L滑动的接头64。接头64包括至少一个通孔65。类似于图1-4中公开的导引器10,导引器60也被连接至第一手术设备20例如内窥镜。内窥镜20可以被设置在与图2中公开和以上所述的第一套管相类似的第一套管40内以使内窥镜20的第二端22通过套管40的第二端42伸出。套管40具有与图2中所示和以上所述的尖端相类似的尖端43。与图4所示的第二手术设备相类似的第二手术设备34被设置在通孔65内。通孔65的纵向轴线66并且因此第二手术设备34的纵向轴线与尖端43相交或同心共径。但是,纵向轴线66可以如图1和图3所示被制成为与内窥镜20的第二端22或者与从内窥镜20偏移距离d的区域36相交或同心共径。
接头64可以沿主体61的长度L滑动以决定在何处设置第二入口33从而使得能够最小化对内部结构的损伤。由于通孔65和第二手术设备34的纵向轴线66与尖端43同心共径,因此无论在何处设置第二入口33,设在第二手术设备34内的针或其他的手术器械都会与尖端43相交。接头64和主体61可以包括开口67以使导引器60轻质并确保接头64和主体61在高压消毒之后快速冷却。
类似于图5所示的导引器60,图6示出的导引器70包括主体71,主体71具有第一端72和第二端73。导引器70还包括被设置用于沿主体71滑动的接头74。接头74包括至少一个通孔75。类似于图1-4中公开的导引器10,导引器70也通过套管40被连接至第一手术设备20例如内窥镜。与图4所示的第二手术设备相类似的第二手术设备34被设置在通孔75内。通孔75的纵向轴线76并且因此第二手术设备34的纵向轴线与从内窥镜20偏移距离d的区域36相交或同心共径。但是,纵向轴线76可以如图2,5,1和4所示被制成为与套管40的尖端43或内窥镜20的第二端22相交或同心共径。
同样如图5所示和如上所述,接头74可以沿主体71滑动以根据内窥镜20的第二端22和关节囊内表面36之间的距离来改变距离d。由于第二手术设备34与区域36同心共径,因此无论在何处设置第二入口33,设在第二手术设备34内的针或其他的手术器械都会与区域36相交。导引器70还包括机构77例如锁定螺母用于接合接头74并将其固定在沿主体71的某一位置。一旦医生确定了第二入口33的位置,锁定螺母77即可被拧紧以接合接头74并将其固定在沿主体71的某一位置。第二手术设备34可以随后插入通孔75内并穿过患者的身体32以制成第二入口33。
类似于图5和图6中示出的导引器60,70,图7示出的导引器80包括主体81,主体81具有第一端81a、第二端81b以及沿主体81长度为L的圆弧。导引器80还包括被设置用于沿主体81的长度L滑动的接头84。接头84包括至少一个通孔85。类似于图1-6公开的导引器10,60,70,导引器80也通过内窥镜20的第一端21和套管40的第一端41被连接至第一手术设备20例如内窥镜。与图4-6所示第二手术设备相类似的第二手术设备34被设置在通孔85内。通孔85的纵向轴线86并且因此第二手术设备34的纵向轴线与内窥镜20的第二端22相交或同心共径。但是,纵向轴线86也可以如图4,5和3所示被制成为与套管40的尖端43或从内窥镜20偏移距离d的区域36相交或同心共径。
同样如图7所示和如上所述,接头84可以沿主体81的长度L滑动以决定在何处设置第二入口从而使得能够最小化对内部结构的损伤。由于第二手术设备34与内窥镜20的第二端22同心共径,因此无论在何处设置第二入口,设在第二手术设备34内的针90或其他的手术器械都会与第二端22相交。主体80包括沿主体80的整个长度L延伸并且容纳接头84的槽81c。另外,类似于图6中的导引器70,导引器80包括机构87例如锁定螺母用于接合接头84并将其固定在沿主体81的某一位置。在手术期间,用与如上所述相同的方式使用锁定螺母87完成对第二入口的创建。在第二手术设备34或第二套管已经插入患者身体内之后,针90或其他器械即可通过套管34插入以用于完成手术过程。与内窥镜20的第二端22相交或同心共径的针90可以在针90的第一端90a包括深度止挡件90c,其靠接套管34的第一端34a以明显降低针90的第二端90b前进超过内窥镜20的第二端22的可能性。
如图7和图8所示,导引器80包括第一连接部分88和第二连接部分89,这两部分都被设置用于通过第一手术设备20和套管40将主体81连接至第一手术设备20。包括防旋转锁的第一连接部分88位于主体81的第一端81a并且基本上垂直于内窥镜20的轴线26延伸。如图9A和9B所示,防旋转锁88包括位于防旋转锁88的顶面88a和底面88b之间的杠杆臂88c。杠杆臂88c通过枢转销或螺钉88d和弹簧88e连接至表面88a,88b。当内窥镜20未被连接至防旋转锁88时,杠杆臂88c如图9A所示处于第一位置以使弹簧88e处于松弛状态。但是,当内窥镜20被连接至防旋转锁88时,杠杆臂88c就如图9B所示处于第二位置以使杠杆臂88c被推向内窥镜20的轻质立柱24并明显降低轻质立柱24沿着将使套管40与内窥镜20解除连接的方向旋转的可能性。
如图7和图8所示,第二连接部分89位于主体81的第二端81b附近并且基本垂直于内窥镜20的纵向轴线26延伸。部分89包括都从部分89纵向伸出的两个分叉89a,89b以及位于分叉89a,89b之间纵向伸入部分89内的开口89c。如图10所示,套管40包括被设置用于将第二连接部分89连接至套管40的连接部分45。连接部分45包括两个孔45a以及从连接部分45纵向伸出的凸起45b。第二连接部分89被连接至连接部分45以使分叉89a,89b被设置在孔45a内且凸起45b被设置在开口89c内。
如图7所示,主体81的第二端81b不会延伸超出位于第二连接部分89和第一手术设备20的纵向轴线26之间的平面90并且其与纵向轴线26形成约为60度的角β。
图11A-11D示出了用于将导引器10的第二端13连接至套管40的第一端41的方法。如图11A所示,第二端13包括第一臂13a、第二臂13b以及位于第一臂和第二臂13a,13b之间的槽13c。套管40的第一端41包括与图10所示连接部分45相类似的连接部分46,只是用通道46a代替了孔45a。导引器10的第二端13被连接至套管40的第一端41以使第一臂和第二臂13a,13b被装在通道46a内且凸起46b被装在槽13c内。两臂13a,13b都包括边缘13a',13b',其中每一个边缘13a',13b'都被设置用于在导引器10被连接至连接部分46时连接至连接部分46的背侧46c,由此在两臂13a,13b和连接部分46之间建立搭扣配合连接。
如图11B所示,导引器10的第二端13包括第一臂13a和第二臂13b。套管40的第一端41包括在套管40上滑动的适配器47。导引器10的第一臂和第二臂13a,13b被连接至适配器47以使得在两臂13a,13b和适配器47之间建立起过盈配合或卡合连接。
如图11C所示,导引器10的第二端13包括局部围绕套管40的第一端41的底部13d并且包括设置在连接至套管40的冲洗延长器50上的吊钩13e。图11D中示出的导引器10包括具有臂13f的第二端13,臂13f包括成形在臂13f内的开口13f''和槽13f'。套管40的第一端41包括与图10和11A所示连接部分45,46相类似的连接部分49,只是不具有孔或通道。导引器10的第二端13被连接至套管40的第一端41以使套管40的第一端41被设置在开口13f''内并且凸起(未示出)被容纳在槽13f'内。通过将开口13f''设置到第一端41上并且围绕连接部分49滑动臂13f即可将导引器10设置在第一端41上,由此建立臂13f和第一端41之间的搭扣配合连接。也可以使用其他的方法将导引器连接至套管。
如图12所示,与图1-4中的导引器10相类似的导引器100被连接至第一手术设备200例如瞄准臂,其包括吊钩形状的远端200b。瞄准臂200的远端200b被定位在髋关节300的后端区域300b内。第二手术设备400例如套管被设置在导引器100的通孔104内。套管400的纵向轴线401与瞄准臂200的远端200b上的尖端200c同心共径。这种同心共径的关系就允许通过手术工具例如设置在套管400内的钻头(未示出)经股骨颈部300a操作髋关节300的后端区域300b。瞄准臂200可以用与如上所述引入内窥镜20相同的方式或者本领域普通技术人员已知的其他方式引入到身体32内。类似地,导引器100可以用与图7中将导引器80连接至套管40相同的方式、用与图11A-11D中将导引器10连接至套管40相同的方式或者本领域普通技术人员已知的其他方式来连接至瞄准臂200。瞄准臂200可以通过位于瞄准臂200近端200a的旋转连接(未示出)而围绕瞄准臂200的纵向轴线201旋转。
如图13所示,与图12中的导引器100相类似的导引器500被连接至第一手术设备600例如瞄准臂,其中包括吊钩形状的远端600b。瞄准臂600的远端600b被定位在髋关节700的后端区域700b内。第二手术设备800例如套管被设置在导引器500的通孔504内。套管800的纵向轴线801与瞄准臂600的远端600b上的标记600c同心共径。这种同心共径的关系就允许通过手术工具例如设置在套管800内的钻头(未示出)经股骨颈部700a操作髋关节700的后端区域700b。瞄准臂600可以用与如上所述引入内窥镜20相同的方式或者本领域普通技术人员已知的其他方式引入到身体内。类似地,导引器500可以用与图11A-11D中将导引器10连接至套管40相同的方式或者本领域普通技术人员已知的其他方式来连接至瞄准臂600。而且,可通过激光或其他能够用于建立标记的技术创建的标记600c可以位于沿吊钩600b的任何位置。标记600c也可以是物理特征例如凸块、孔或任意其他的能够在X射线中看到的物理特征。
如图14和14A所示,与图7中的导引器80相类似的导引器1000被连接至第一手术设备1100例如瞄准臂,其包括吊钩形状的远端1100b。瞄准臂1100的远端1100b被定位在髋关节1200的后端区域1200b内。第二手术设备1300例如套管被设置在接头1010的通孔1010a内。正如图14A中更加清楚示出的那样,导引器1000包括第一组标记1020a-1020g并且设备1100的远端1100b包括第二组标记1030a-1030g。第一组标记1020a-1020g中的标记和第二组标记1030a-1030g中的标记是同心共径的关系。例如,如图14所示,在接头1010位于标记1020g处时,设备1300的纵向轴线1400与标记1030g同心共径。这种同心共径的关系允许通过手术工具例如设置在套管1300内的钻头(未示出)经股骨颈部1200a操作髋关节1200的后端区域1200b。在使用期间,接头1010被移动至第一组标记1020a-1020g中的某一标记处并且随后将钻头(未示出)插入套管1300内。
瞄准臂1100可以用与如上所述引入内窥镜20相同的方式或者本领域普通技术人员已知的其他方式引入到身体内。类似地,导引器1000可以用与图11A-11D中将导引器10连接至套管40相同的方式或者本领域普通技术人员已知的其他方式来连接至瞄准臂1100。而且,标记1020,1030可以通过激光或其他能够用于建立标记的技术创建。
对于本公开来说,手动或自动铣床被用于创建如上所述的导引器中的通孔。其他创建通孔的装置和方法也可以使用。导引器由金属材料例如不锈钢或钛制成,但是也可以用本领域普通技术人员已知的其他材料制成。另外,上述的第一和第二套管以及瞄准臂是由生物相容性金属材料例如不锈钢制成,但是也可以用本领域普通技术人员已知的其他生物相容性材料制成。而且,对于本公开来说,导引器包括主体,主体沿主体的长度具有一段圆弧,但是该圆弧不是必需的,而且主体可以是直的或者加入本领域普通技术人员已知的其他形状。尽管本公开涉及使用上述的导引器在髋关节镜手术期间设置入口,但是基本原理和方法也可以应用于身体的其他关节区域。
由于可以对以上参照对应附图介绍的示范性实施例进行各种修改而并不背离本公开的保护范围,因此应该意识到以上说明中包含的和附图中示出的所有内容都应被解读为解释性而非限制性的。
Claims (10)
1.一种导引组件,包括:
导引器(1000),所述导引器包括具有第一组多个标记(1020a-1020g)的主体和包括至少一个通孔的接头(1010),所述接头被设置用于沿主体的长度滑动;以及
具有第二组多个标记(1030a-1030g)的第一手术设备(1100),
其中导引器被连接至第一手术设备并且在接头位于第一组标记中的一标记处时通孔的纵向轴线(1400)与第二组标记中的一标记同心共径;第二组标记中的多个标记中的每个标记与第一组标记中的多个标记中的不同的一个标记同心共径。
2.根据权利要求1所述的导引组件,其中第一组和第二组标记中的标记选自由激光标记、凸块和孔组成的组。
3.根据权利要求1所述的导引组件,其中第一组和第二组标记中的标记包括数字。
4.根据权利要求1至3中任一项所述的导引组件,其中第二组标记位于第一手术设备的远端(1100b)处。
5.根据权利要求4所述的导引组件,其中第一手术设备的远端包括吊钩形状。
6.根据权利要求5的导引组件,其中第一手术设备的远端被成形为基本与髋关节的后端区域相符。
7.根据权利要求1至3中任一项所述的导引组件,进一步包括设置在通孔中的第二手术设备(1300)。
8.根据权利要求7所述的导引组件,其中第二手术设备是套管。
9.根据权利要求8所述的导引组件,其中套管被构造用于接收钻头。
10.根据权利要求1至3中任一项所述的导引组件,其中引导器可移除地连接至第一手术设备。
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- 2011-05-27 RU RU2012157126/14A patent/RU2573049C2/ru not_active IP Right Cessation
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- 2011-05-27 JP JP2013513252A patent/JP5890401B2/ja not_active Expired - Fee Related
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RU2573049C2 (ru) | 2016-01-20 |
WO2011153094A1 (en) | 2011-12-08 |
AU2011261677A1 (en) | 2013-01-10 |
CN103025253A (zh) | 2013-04-03 |
EP2575646A1 (en) | 2013-04-10 |
JP2013529120A (ja) | 2013-07-18 |
US20170245884A1 (en) | 2017-08-31 |
JP5890401B2 (ja) | 2016-03-22 |
BR112012030751A2 (pt) | 2016-11-08 |
AU2011261677B2 (en) | 2016-03-31 |
US9826992B2 (en) | 2017-11-28 |
US20100241106A1 (en) | 2010-09-23 |
RU2012157126A (ru) | 2014-07-20 |
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