CN108567509A - A kind of equipment for percutaneously conveying cardiac implant by directly applying driving force in vitro - Google Patents

Abstract

The present invention is a kind of equipment for percutaneously conveying cardiac implant by directly applying driving force in vitro, describes a kind of locked instrument for fastening one or more tensional elements.The locked instrument includes lock body, the channel extended through with tensional element；Movable link couples with lock body and crosses the channel；It suspend mode position of the movable link in channel and can be moved between the activated positon in channel, in the suspend mode position, wherein one or more of tensional elements can carry out activity relative to lock body；In the activated positon, wherein one or more of tensional elements are locked relative to lock body；Wheel hub is around lock body so that lock body can be shunk relative to the wheel hub；The retraction of lock body then causes movable link from first position distal motion to the second position.

Description

It is a kind of percutaneously to convey cardiac implant for passing through directly application driving force in vitro Equipment

Technical field

The present invention generally relates to used in surgical procedures catheter-based locker and other Such as carry out annuloplasty procedure used in the locker extend to biological tissue from corresponding tie point with tight Gu one or more tensional elements of such as suture.

Background technology

Surgical operation catheter-based can be used for repair tissue, such as defective bicuspid valve.It is catheter-based in this way Surgical operation, commonly referred to as annuloplasty.This operation is the length for reducing mitral valve by one or more folds Degree.For this purpose, anchor will be fastened on multiple positions of the distribution of the ring near mitral valve.Each anchor has therewith The suture of coupling, these sutures are collected tension.As these sutures are tightened up, between each pair of adjacent anchor Tissue is converted into fold, and then shortens the length of ring and draw rear leaf to realize mitral reparation towards frontal lobe.

In surgical procedures, the suture for each anchor will extend to cutting part across conduit.In order to Fold is preserved, then to fasten suture to prevent its movement.Since the operation is carried out based on conduit, it to be used for casing or conduit Small diameter when then usually using suture locker.

Thus exist for a kind of demand of improved locker, be used in surgical procedures catheter-based and One or more tensional elements of fastening such as suture are to prevent its relative motion after operation.

Invention content

The exemplary embodiment of the present invention describes a kind of locking for fastening one or more tensional elements Device.The locked instrument includes lock body, the channel extended through with tensional element；The movable link coupled with lock body, institute The channel can be crossed by stating movable link；Movable link can carry out between the second position in the first position and channel in channel Movement, in the first position, wherein one or more of tensional elements can be moved relative to lock body；Described second Position, wherein one or more of tensional elements are locked relative to lock body.Hub unit is around lock body so that lock body phase The wheel hub can be shunk；The contraction of lock body causes movable link to be moved from first position to the second position on distal side.

Another exemplary embodiment of the present invention describes another for fastening one or more tensional elements Locked instrument.The locked instrument includes lock body, and with the channel that tensional element extends through, movable link couples simultaneously with lock body Cross the channel.It suspend mode position of the movable link in channel and can be moved between the activated positon in channel, described Suspend mode position, wherein one or more of tensional elements can be moved relative to lock body；In the activated positon, wherein institute It is locked relative to lock body to state one or more tensional elements.Wheel hub is around lock body so that lock body can be carried out relative to the wheel hub It shrinks.The component extended to nearside extends into patient's body from lock body to cutting part.The component extended to nearside can carry out Operation is carried out on distal side from suspend mode position to activated positon with that will be shunk with the associated wheel hub of lock body so as to cause movable link Movement.

Another exemplary embodiment of the present invention describes another locked instrument.The locked instrument of the embodiment Including lock body, extend the channel that may pass through with tensional element.Movable link couples with lock body and crosses the channel.Movable structure It suspend mode position of the part in channel and can be moved between the activated positon in channel, in the suspend mode position, wherein described One or more tensional elements can be moved relative to lock body；In the activated positon, wherein one or more of tensions Component is locked relative to lock body.The locked instrument includes startup component, with close end and distal portion, wherein remote end part In the nearside of movable link.The close end of drawing startup component will cause distal portion movable from suspend mode position to activated positon movement Component.

In another exemplary embodiment, the present invention relates to another locked instruments, with lock body, the lock Body has the channel that tensional element extends through.Movable link couples with lock body and crosses the channel.Movable link is in channel Suspend mode position and channel in activated positon between can be moved, in the suspend mode position, wherein one or more of Tensional element can be moved relative to lock body；In the activated positon, wherein one or more of tensional elements relative to Lock body is locked.The locked instrument includes startup component, with distal side expansion element.Expansion distal side expansion element will cause can Dynamic component is moved from suspend mode position to activated positon.

Another exemplary embodiment describes another locked instrument, and with lock body, the lock body has tension The channel that component extends through.Movable link couples with lock body and crosses the channel.Movable link can be in the suspend mode position in channel Set and channel in activated positon between moved, in the suspend mode position, wherein one or more of tensional element phases Lock body can be moved；In the activated positon, wherein one or more of tensional elements are locked relative to lock body. The locked instrument includes elongated pin, has alignment keys on the distal end of elongated pin.The alignment keys are prolonged with from movable link to nearside The matching alignment keys engagement stretched.Distad push elongated pin that movable link will be caused to be moved from suspend mode position to activated positon It is dynamic.

Another exemplary embodiment describe it is a kind of will be one in one or more tensional elements and each embodiment Locked instrument fastening method.This method includes guiding locked instrument to operative site so that tensional element extends through Locked instrument.Start the component extended to nearside, causes movable link distal motion.The startup last up to movable link from Suspend mode position is moved to activated positon.

Another exemplary embodiment includes by the method for one or more tensional elements and locked instrument fastening.The lock It is fixedly mounted with the channel set and, including lock body, extended through with tensional element.Movable link couples with lock body and crosses the channel.It can Dynamic component can be moved between the second position in the first position and channel in channel, in the first position, wherein One or more of tensional elements can be moved relative to lock body；In the second position, wherein one or more of Tensional element is locked relative to lock body.Wheel hub is around lock body so that lock body can be shunk relative to the wheel hub.Fastening side Method includes guiding locked instrument to operative site, is then shunk with the associated lock body of wheel hub.The contraction of lock body causes movable structure Part is moved on distal side from first position to the second position.

Another exemplary embodiment of the present invention describes a kind of by one or more tensional elements and locked instrument The method of fastening.The locked instrument includes lock body, and with the channel that tensional element extends through, movable link is coupled with lock body And cross the channel.It suspend mode position of the movable link in channel and can be moved between the activated positon in channel, in institute Suspend mode position is stated, wherein one or more of tensional elements can be moved relative to lock body, in the activated positon, wherein One or more of tensional elements are locked relative to lock body.Locked instrument includes startup component, is contacted with movable link And extend from movable link to nearside.This method includes guiding locked instrument to operative site and starting the startup component, It is moved from suspend mode position to activated positon so as to cause movable link.

Start the startup component to cause the movable link to move, this can include distad pushing the startup structure The modes such as the distal side expansion element of part, the proximal end that startup component is pulled to nearside or the expansion startup component.

Description of the drawings

Fig. 1 is the front view of the suture locked instrument constructed according to embodiment of the present invention, wherein suture Locked instrument is shown in suspend mode position.

Fig. 2 is the front view of the suture locked instrument along Fig. 1 center lines 2-2 shown in Fig. 1.

Fig. 3 is the sectional view of the suture locked instrument along Fig. 2 center lines 3-3 shown in Fig. 1.

Fig. 4-8 is sectional view of the signal using the exemplary process of suture locked instrument shown in Fig. 1, show by Component is drawn to pass through suture locked instrument.

Fig. 9 is the sectional view for illustrating alternative embodiments, shows that tensional element passes through suture locked instrument.

Figure 10 is the front view of the suture locked instrument constructed according to another implementation of the invention, wherein suturing Line locked instrument is shown in suspend mode position.

Figure 11-13 is sectional view of the signal using the exemplary process of suture locked instrument shown in Figure 10, is shown Go out tensional element and passes through suture locked instrument.

Figure 14 is the sectional view for the suture locked instrument for illustrating alternative embodiments.

Figure 15 is the enlarged cross-sectional view for the alternative embodiments anticipated shown in Figure 14.

Figure 16 is sectional view of the signal using the exemplary process for the alternative embodiments anticipated shown in Figure 14.

Figure 17 is the enlarged cross-sectional view of alternative embodiments shown in Figure 16.

Figure 18-19 is the enlarged cross-sectional view of the suture locked instrument of another alternative embodiments shown in Figure 14-17.

Figure 20-21 is the sectional view for the suture locked instrument for illustrating other two embodiment.

Figure 22-23 is the sectional view for the suture locked instrument for showing other other two embodiments, wherein suspend mode position It is shown in solid and to start position shown in dotted line.

Figure 24 is the sectional view for the suture locked instrument for showing another embodiment, and wherein suspend mode position is shown with solid line Go out and to start position shown in dotted line.

Figure 25-27 is the partial cutaway schematic of another exemplary embodiment of the present invention, including uses this reality Apply the exemplary process of mode.

Figure 28-30 is the partial cutaway schematic of another exemplary embodiment of the present invention, including uses this reality Apply the exemplary process of mode.

Specific implementation mode

Referring to Fig.1, the capture of 50 selectivity of suture locked instrument constructed according to first embodiment of the invention is utilized Across one or more tensional elements 54,58 (Fig. 4) of suture locked instrument 50.Tensional element 54,58 (Fig. 4) may be used Different from the form of suture material, such as cable or any other minor diameter, flexibility, semi-rigid or rigid material, the material With the high tensile for meeting operation purpose purposes.In addition, although the embodiments of the present invention cover suture locking dress It sets, but suture locked instrument of the present invention can be used together with other tensional elements different from suture.

Suturing locked instrument 50 has first, suspend mode position (Fig. 4), and wherein tensional element 54,58 (Fig. 4) is with reference to suture Locked instrument 50 can be moved；Suturing locked instrument 50 also has second, activated positon (being shown in lower Fig. 6), wherein with tension The associated suture locked instrument of component 54,58 (Fig. 4) 50 is captured or is locked to prevent from moving.50 energy of suture locked instrument Enough to cooperate with use with tensional element 54,58 that is extending from tissue anchor (not shown), such as those are in shared U.S. Shen Please series 11/174,951 shown in and description.In addition, although the embodiments of the present invention generally refer to tensional element 54,58 (Fig. 4), it is to be appreciated that suture locked instrument 50 can also with single tensional element, i.e. single stitch cooperates makes With.

Suture locked instrument 50 includes a series of component comprising lock body 62 and movable link, such as pin 66 are used for Fasten tensional element 54,58 (Fig. 4).Lock body 62 includes basal component 74 and molding cap 78 and it seals opening for basal component 74 Mouth end.Basal component 74 and cap 78 constitute the separate part for the component for including lock body 62, to which pin 66 can be located in lock body 62 It is interior.Therefore, cap 78 can include multiple protrusions 82, they are spaced apart, to which engagement is limited to the opposite distal side edge of lock body 62 Respective slot.In surgical procedures, cap 78 is positioned on the distal end of suture locked instrument 50 and (does not show close to patient Go out) internal operative site, tensional element 54,58 (Fig. 4) extends from the position.

Lock body 62 can be tubulose and open end, the chamber of channel 86 (Fig. 2) be limited, from 62 proximal end of lock body The first aperture of nearside 90 extends towards distal end, and distal end is attached in cap 78.94,98 points of the opposing sidewalls of 62 basal component 74 of lock body Not Bao Kuo slit 102,106, they usually in the proximal-distal direction orient and can be connected to channel 86 (Fig. 2).Each slit 102,106 include the relatively short segment 110 close to 62 proximal end of lock body and relatively long segment 114, is distad prolonged from here It stretches and is intersected with relatively short segment 110 with shallow sharp angle α (Fig. 1).When angle [alpha] is enough that pin 66 is made to be located in short segment 110, Tensional element 54,58 (Fig. 4) can be moved relative to lock body 62 so that the direction of long section 114, which is more nearly, is parallel to nearside-far Side direction.

Cap 78 includes channel 118, when assembling suture locked instrument 50, allows to reach across distal end aperture 122 and lock The access in 62 channel 86 (Fig. 2) of body.The channel 118 of cap 78 smoothly combines (Fig. 2) with the channel 86 in lock body 62.Tensional element 54,58 (Fig. 4) pass through channel 86,118.As shown, the forming part from the second aperture of distal side 122 towards channel 118 of cap 78 Dividing can be with the inside smooth curved of the ethod of remittance, and when to be observed in proximally-distal direction, the sectional area in channel 118 can It is narrow in distal side to proximal direction.The sectional area in channel 118 can be accumulated than the respective cross-section of 62 internal channel 86 (Fig. 2) of lock body It is small.

The channel 118 of cap 78 can be from extending through the symmetry axis in channel 86 (Fig. 2) laterally or be offset laterally from.Cause This compares antetheca 130, and channel 118 can be closer to the rear wall 126 of lock body 62, and approaches simultaneously and be maintained at side wall 94,98 Between center.But these structure sizes illustrated should not be construed restrictive.

Cap 78 with basal component 74 when fitting together close to the distal end of slit 102.Which has limited pins 66 with respect to lock body 62 distal movement.The proximal movement of pin 66 is limited to opposite end by the blind end of slit 102,106.Therefore, pin 66 is narrow Movement in slot 102 is limited in along the path limited by short and long segment 110,114.

Although not specific signal, lock body can alternatively be configured to single component, the pin is then inserted into leading to Cross the expansion section of a slot distal end.

Pin 66 can include interlude 134 (Fig. 5) and from two distally extending end segments of interlude 134 (Fig. 5) 138.Section 138,134, each of 138 can arrange along the longitudinal axis of pin 66, and be cylindrical section when along axial spotting. When along axial spotting, the diameter smaller of the diameter of end segment 138 than interlude 134 (Fig. 5).

Although not specifically illustrated, pin 66 can also be included in the cap of the far-end positioning of each end segment 138.The cap is also Can have cylindrical section, diameter of the diameter usually than end segment 138 big when along axial spotting.

End segment 138 has the length along the longitudinal axis, is mainly determined by the wall thickness of the side wall of lock body 62 94,98.End The diameter or full-size of section 138 are selected with the width less than the slit 102,106 across each side wall 94,98.

When suture locked instrument 50 assembles and pin 66 is meshed with slit 102,106, interlude 134 (Fig. 5) is bordered on The exposed surface of side wall 94,98 opposite sides and inside is being parallel to face with banking pin 66 by the opposite of contacting side wall 94,98 Transverse movement on the direction of the longitudinal axis.

Wheel hub 146 (Fig. 4) can surround lock body 62.Wheel hub 146 (Fig. 4) can be tubulose and distal opening, be similar to substrate The shape of component 74.In some embodiments, wheel hub can include the terminal part that groove 150 (Fig. 5) is used for receiving pin 66 138, from the side wall 94,98 of basal component 74 to extending laterally.Although it is not shown, wheel hub can also be with distal catheter component phase Connection, extends to the cutting part (not shown) of patient's body on nearside.

Lock body 62 can be coupled (Fig. 4) with the conduit tube component 154 of an embodiment, be used to manipulate across patient's arteries and veins For guard system to the suture locked instrument 50 of operative site, this is well known to those skilled in the art.Catheter main body 158 (Fig. 4) Construction includes channel 162 (Fig. 4), is extended from the nearside aperture 90 of lock body 62 on nearside, so that tensional element 54,58 it can extend through channel and not limited.

It anticipates as shown in figs 1-9, suture locked instrument 50 can include draught line 166, be used for lock body 62 relative to wheel Hub 146 is retracted.The other structure for shrinking lock body 62 is also described below.Draught line 166 passes through nearside shown in Fig. 2 and 3 Disk 168,172, which is fixed, with distal side is limited to basal component 74.Proximal disc and distal disc 168,172 can by with 74 phase of basal component Same material molding, or individually construct and be attached during its construction and with 74 phase of basal component.Disk 168,172 can be in slit 102,106 close to crossing channel 86 at nearside, to interfere or the movement of banking pin 66 and tensional element 54,58, And allow each channel of opposite draught line 166 or movement.Nearside and distal disc 168,172 can also include that latch 184 is horizontal The hole 176,180 worn.

Draught line 166 can be constructed by suture filamentary material, but construction or material here and its be made and be managed Solution is restrictive, and alternative embodiments are described in detail further below.As indicated, draught line 166 enters channel from aperture 90 86, the distal loop 188 around latch 184 and between nearside and distal disc 168,172 is formed, and return across aperture 90. In this way, latch 184 limits removal of the draught line 166 from lock body 62.

Referring to Fig.1 and 4-7, in surgical procedures catheter-based, suture locked instrument 50 and wheel hub 146 are drawn It leads across vascular network to operative site.Tensional element 54,58 can pass through channel 118,86,162, and usually can be such as to scheme 4 it is discribed come self-marketing 66 negligible resistance free movement.The pin 66 of suture locked instrument 50 is initially maintained at suspend mode Position, i.e., at short segment 110, doctor passes through the distal direction force in catheter main body 158 and promotes suture locked instrument 50 Across vascular network.Conduit tube component 154 conveys suture locked instrument 50 to operative site.It can be locked by suture fills It sets the fluorescent marker on 50 or the ray for structural basement component 74 is not through the internal visualization of material to confirm.

As shown in figure 5, the end segment 138 of pin 66 is maintained in the groove 150 of wheel hub 146.

Once suture locked instrument 50 is accurately located at operative site, then pin 66 can move to activated positon.For It is allowed to reach the activated positon, doctor forces in draught line 166 to keep the relative position of wheel hub 146 proximally directed.Refer to 62 relativeatoeterahub 146 of lock body will be caused to retract to the force of nearside.The end segment 138 of pin 66 is captured on the groove of wheel hub 146 In 150, prevent pin 66 with respect to the relative motion of lock body 62.With unceasingly proximally directed force, between lock body 62 and pin 66 Relative motion so that pin 66 towards 78 displacement of cap, is followed by the profile of slit 102,106 in a distal direction.In this way, Suspend mode position of the suture locked instrument 50 just shown by the Figure 4 and 5 is moved to the activated positon shown by Fig. 6 and 7.

Once pin 66 is located in the long segment 114 of slit 102,106, i.e. activated positon, its intermediate stage 134 in pin 66 Between the part of the lock body 62 of the joint passage 86 shrink or compress tensional element 54,58, pin 66 can by with slit 102, 106 friction engagement and keep in the position.Doctor can then cut tensional element 54,58 to suitable length, such as close The length of pin 66, or tensional element 54,58 is made to maintain to extend through suture locked instrument 50, as shown in Figure 8.

Fig. 8 also shows the completion of surgical operation catheter-based.That is, having moved to activated positon in pin 66 Afterwards, so that it may to remove draught line 166.In order to remove draught line 166, latch 184 is retracted from lock body 62 first, so that leading It retracts between nearside of the distal loop 188 out of basal component 74 and distal disc 168,172 of lead 166.In latch 184 and lead After lead 166 is removed, wheel hub 146 and conduit tube component 154 can retract, and the suture locked instrument 50 left is just in and needs The position performed the operation.

Fig. 9 shows the alternative position for latch 184 in 74 antetheca 130 of draught line 166 and basal component；So And draught line 166 can also position in the arbitrary wall of basal component 74.The specific device is by eliminating nearside and distal disc 168,172 basal component 74 is simplified, and simplifies conduit tube component 154, allow the conduit tube component 154 of single tube chamber.Far Side ring 188 is formed in the window 192 around latch 184.In operation, draught line 166 and latch 184 with Fig. 4-8 institutes The similar manner of description carries out.

In another embodiment, suture locked instrument 190 includes at least one retraction component 196, on nearside Extend from lock body 62, as shown in Figure 10.The retraction component 196 can be made of rigid, semi-rigid or flexible material.As shown Meaning, used two retraction components 196, each include elongate portion 200 and on distal side from elongate portion 200 extend and at Angle beta at corner 204.It is disposed through in 62 side wall 94,98 of lock body at corner 204 and close to the window of slit 102,106 208,212 protrusions enter in lock body 62.Window 208,212 is arranged with the angle for being substantially similar to above-mentioned β, so that each contracting Returning component 196 can be positioned in window 208,212 at corner 204, and elongate portion 200 extends and basic on nearside simultaneously It is parallel to lock body 62.The slight cohesion that can make retraction component 196, to enable lock body 62 and retraction component 196 to be limited in and lead It (is not shown) in pipe transport system or usually in vascular network.

Each retraction component 196 includes transverse opening 218 at corner 204, for receiving latch 184.Latch 184 Prevent movement of the retraction component 196 from lock body 62.The elongate portion 200 of each retraction component 196 extends to patient's body on nearside External side, such doctor just can manipulate the suture locked instrument 190 in surgical site body.Each latch 184 is being locked The transverse opening 218 of each retraction component 196 is extended across in peripheral channel 222,226 in 62 side wall 94,98 of body.

As described in related embodiment above, and as shown in Figure 11-13, the suture with wheel hub 146 is locked It is fixedly mounted with and sets 190 and be directed to operative site.Tensional element 54,58 extends through channel 118,86.190 quilt of suture locked instrument After accurate positionin, doctor pulls retraction component 196 by proximally directed force, and keeps the position of wheel hub 146 simultaneously.It is directed toward The end segment 138 of pin 66 by being trapped in the groove 150 of wheel hub 146 by suture locked instrument 190 by the force of nearside It retracts relative to wheel hub 146.With continuing for proximally directed force, lock body 62 is moved relative to pin 66 in slit 102,106 It is dynamic, as shown in figure 13.

Once pin 66 is in activated positon, retraction component 196 can be moved by retraction latch 184 from lock body 62 first It removes.After removing latch 184, for retraction component 196 just from window 208,212 sides to above skidding off, doctor then can be tension structure Part 54,58 cuts into suitable length or tensional element 54,58 is allowed freely and on nearside to extend from lock body 62.

Figure 14-17 shows the another embodiment of suture locked instrument 228, this includes extending from pin 66 on nearside And across the elongated pin 230 in the channel 86 of basal component 74.Elongated pin 230 can be rigid or semirigid rodding structure, Such as stainless steel；It further includes the alignment keys 234 on distal end.The proximal end of elongated pin 230 extends beyond nearside aperture 90 to patient It is external.In this way, doctor can remotely manipulating pin 66 be allowed to be moved to activated positon from suspend mode position in the following manner.

Matched alignment keys 238 are engaged with the alignment keys 234 of elongated pin 230, are extended from pin 66 on nearside.Such as Figure 14 institutes It has been shown that, matched alignment keys 238 can be the balls of interlocking, can also use other shapes, this will be described by below.In pin 66 be in suspend mode position when, elongated pin 230 alignment keys 234 engagement matching alignment keys 238, position restriction is in narrow sheath In 242.By the way that alignment keys 234,238 are limited in narrow sheath 242, suture locked instrument 228 can be maintained at suspend mode Position is until it is accurately located at operative site.

In order to which suture locked instrument 228 is placed in activated positon, doctor applies elongated pin 230 at distally directed place Power, so that alignment keys 234 adjoin the interstitial segment 134 of pin 66 while pin being caused to be moved towards cap 78 in slit 102,106 It is dynamic.Pin 66 then follows the profile of slit 102,106, and the suspend mode position shown by Figure 14 is moved to the activation shown by Figure 16 Position.As pin 66 is moved along slit 102,106, alignment keys 234,238 extend through narrow sheath 242 and exist relative to each other Laterally upper free movement.The freedom of motion is gradually increased so that and interlocking ball detaches, as shown in Figure 16 and 17, such doctor It just can be from 62 retraction elongated pin 230 of lock body.

Likewise, alignment keys 234,238 can be limited in narrow shield with 66 distal motion of pin to activated positon holding In set 242, in order to detach alignment keys 234,238, doctor can also retract narrow sheath 242.

The structure of alignment keys is also designed to other patterns, such as including interlocking step shown in Figure 18 and 19.

Figure 20 and 21 is shown to be replaced for alignment keys 234,238 in elongated pin 230 and suture locked instrument 246 Subrogate and sets.As indicated, elongated pin 230 is located in 74 antetheca 130 of basal component, however, elongated pin 230 can also be located in one In a side wall 94,98 or in back face wall 126.In use, elongated pin 230 and alignment keys 234,238 are to be similar to draught line 166 The mode of (Fig. 1) or retraction component 196 (Figure 10) is operated.That is, alignment keys 234,238 are fully limited to channel In 250 and lock body 62 is allowed to retract relative to wheel hub 146.

In another not specifically illustrated embodiment, alignment keys 234,238 can be limited in the narrow shield in channel 250 In set, and lock body 62 is retracted relative to wheel hub 146.The retraction of narrow sheath then makes alignment keys 234,238 detach, so that Elongated pin 230 can retract from lock body.Alignment keys 234,238 engage in sheath 242, can be on nearside from lock body 62 Extended.

Figure 22-24 shows other three kinds of embodiments of suture locked instrument, they have moving pin 66 to activation The alternative of position.

In Figure 22, suture locked instrument 254 includes startup component 258, can be made of suture or filament materials. Startup component 258 is included in the protrusion in distal side, shows to be knot 262 on 258 distal end of startup component here, close to suspend mode position The pin 66 set positions.Startup component 258 is on distal side from the window extended through at pin 66 in 74 antetheca 130 of basal component.It opens Dynamic component 258 extends to notch laterally from traverses window 266 from channel 86 in the outer surface of nearside upper edge antetheca 130 Position.

In use, doctor guides suture locked instrument to extended element 54,58, is allowed to the Surgery extended through Position.After suture locked instrument 254 is accurately located at operative site, doctor then pulls the proximal end of startup component 258 close Cutting part is extended through on side.The proximally directed force causes the beginning of knot 262 to be moved in a distal direction, Jin Er From suspend mode position to activated positon (dotted line is shown) displacement pin 66 in slit 102,106.When pin 66 is in activated positon, pin 66 Proximal end and window 266 between there is enough spaces knot 262 to be allowed to be upward through window 266 in side carry out movement and from pin 66 Separation.Startup component 258 is then retracted from suture locked instrument 254.

Figure 23 show the alternative configuration of the startup component 258 of Figure 22.In fig 23, startup component 258 can be by phase The material more rigid than the suture shown by Figure 22 is constituted, and includes the shim liner 270 of distal side protrusion, it is lateral on from opening Extended at the main shaft of dynamic component 258.It in use, can be to shim liner 270 to be similar to previously for described in knot 262 Mode is operated.

Figure 24 shows the another embodiment of suture locked instrument 274 comprising startup component 278, it is described to open Dynamic component 278 has distal side expansion element 282, such as sacculus, for the displacement in the slit 102 of basal component 74 and 106 Pin 66.Though being not shown, startup component 278 further includes the interior inflation channel being in fluid communication with distal side expansion element 282；Substrate structure Part 74 further includes proximal lip 286, distal side expansion element 282 is limited in basal component 74 until it deflates completely.

In use, after the positioning of suture locked instrument 274, doctor then guides aerated fluid to pass through startup component Filling channel in 278 is to distal side expansion element 282.It presses and increases with the gap in distal side expansion element 282, distal side expansion member Part 282 is inflated.Distal side expansion element 282 can be designed to that expansion is made to occur mainly on longitudinal direction.Shown in dotted line, after It is continuous to expand the proximal end for causing 282 contact plug 66 of distal side expansion element, and enter towards distal guide pin 66 in slit 102,106 and swash Position living.

Figure 25-27 shows the suture locked instrument 290 and its occupation mode of another embodiment.As shown in figure 25, Suture locked instrument 290 includes retraction component 294, and the distal portion at least about 62 outside of lock body simultaneously extends on nearside Cutting part.Retraction component 294 can be manufactured by rigidity or semi-rigid material.

Retraction component 294 is fixed on by retaining ring 298 on the outside of lock body 62.Retaining ring 298 surrounded in notch 302 and with Lock body 62 engages.In design, retaining ring 298 can bias outward, can be made of stainless steel, Nitinol or similar material.

In order to manufacture and design the suture locked instrument 290 for surgical operation, retaining ring 302 is located in retraction component 294 In interior groove 306, and it is aligned with the notch 302 in lock body 62.Retraction component 294 passes through relative to the relative position of lock body 62 Postposition retraction component 294, lock body 62 and retaining ring 302 are kept to wheel hub 146.The inner surface limitation retaining ring of wheel hub 146 is located at In groove 306 and notch 302.

In use, after suture locked instrument 290 is located in operative site, doctor pulls retraction component at nearside 294 make lock body 62 be retracted relative to wheel hub 146 to be similar to previously described embodiment.During drawing, pin 66 is effectively From suspend mode position distal motion to activated positon (shown in Figure 26).In addition, being fully retracted relative to wheel hub 146 in lock body 62 Afterwards, retaining ring 302 is just aligned with the groove 310 on 146 inner surface of wheel hub.After retaining ring 302 is aligned, just outside bias draws retaining ring 302 It plays retaining ring 302 to move into groove 310, while eliminating the constraint between retraction component 294 and the notch 302 of lock body, this Sample retraction component 294 and wheel hub 146 can retract (as shown in figure 27) from lock body 62.

Figure 28-30 shows the another embodiment and application method of suture locked instrument 314.Lock with suture Device 290 (Figure 25) is similar, and suture locked instrument 314 includes retraction component 318, at least about the nearside in 62 outside of lock body Portion simultaneously extends proximally to cutting part.Retraction component 318 further includes distal side biasing portion 322, outwardly bias.Distal side biasing portion 322 include the protrusion 326 for being directed toward inside, is inserted into the notch 302 of lock body 62.Retraction component 318 can by by stainless steel, Nitinol or other similar materials are made.

Alternatively, distal side biasing portion 322 can be designed as individual top, then welded, glued or be fixed to and lead Tubular structure extends to cutting part on nearside.

When manufacturing and designing the suture locked instrument 314 for surgical operation catheter-based, distal side biasing portion 322 After protrusion 326 is aligned with the notch 302 of lock body 62, retraction component 318 and 62 postposition of lock body enter the distal side constriction of wheel hub 146 328.Distal side constriction 328 makes the contact of protrusion 326 into the notch 302 of lock body 62.

Suture locked instrument 314 is used with the embodiment shown by similar Figure 25-27.As shown in figure 29, suture After locked instrument 314 is located in operative site, it is sharp that doctor in nearside drawing retraction component 318 makes pin 66 be moved to from suspend mode position Position living.During retraction, biasing portion 322 retraction amount in distal side is beyond distal side constriction 328 and after reaching back cut 330, just Removing the constraint on distal side constriction 328 makes bias that it is subject to outwardly.Therefore, protrusion 326 is released from the notch 302 of lock body 62 It releases.Wheel hub 146 and retraction component can then retract from suture locked instrument 314, as shown in figure 30.

Although being specific schematically illustrate here, in some embodiments, lock body may also include spring clip and have The component of pass, such as in U.S.Application Serial Number 11/753, those of described in 921.Generally, spring clip can include spring Element is placed the channel into lock body.As pin is distally moved, interstitial segment is on the direction towards front wall inner surface Deflection spring element.Pin is placed at the position in spring element distal side by lasting distal movement.It is applied by interstitial segment eliminating After the deflection force added, the spring element of deformation is returned to its original non deflected situation, then just prevents pin in nearside side Pin is simultaneously trapped at the headspace between spring element and cap by upward movement.

Although the present invention has carried out several preferred embodiments to describe and illustrate signal in detail, applicant's Purpose is not configured to a this patent appended claims and restricts or in any way limits the scope of above-mentioned described range and details In, advantage and the variant of other modes are it will become apparent to those skilled in the art that but be all contained in this patent In power and requirement.Each embodiment and the operating method of the present invention can be based on user demand and preference or exclusive use Or the use arbitrarily combined, this is together with current known implementation the preferred method of the present invention and constitutes the present invention and illustrates to solve It releases, however, everything should be in the restriction of the appended claims of the present invention.

Claims (10)

1. a kind of locked instrument for fastening one or more tensional elements comprising：

Lock body has the first aperture, the second aperture and the channel extended between the first and second apertures, one Or multiple tensional elements are adapted to pass through the channel between the first and second apertures；

Movable link is coupling on lock body and crosses the channel, suspend mode position of the movable link usually in the channel It is moved between the activated positon in channel, in the suspend mode position, wherein one or more of tensional elements are relative to lock Body is movable, in the activated positon, wherein one or more of tensional elements are locked relative to lock body；

Wheel hub surrounds lock body；And

Nearside extended element, is suitable for extending to the notch of patient's body from lock body, nearside extended element can be operated so that Relative to wheel hub retraction lock body so that movable link engages with wheel hub and moves to activation from suspend mode position on distal side Position is to respond retraction of the lock body about wheel hub；

Nearside extended element includes startup component.

2. locked instrument described in claim 1, wherein

Startup component is included in the protrusion in distal side, protrudes the finger setting close to suspend mode position；

Startup component is on distal side from the window extended through at pin in basal component antetheca；

The startup component laterally traverses window from channel, and extend in the outer surface of nearside upper edge antetheca.

3. locked instrument described in claim 1, wherein startup component have distal side expansion element, for displacement in basal component Slit in pin.

4. the locked instrument described in claim 3, wherein basal component further include proximal lip, distal side expansion element is limited Until it deflates completely in basal component.

5. the locked instrument described in claim 3, wherein startup component further include the inside being in fluid communication with distal side expansion element Filling channel.

6. locked instrument described in claim 1, wherein the movable link includes on it is lateral from the end that lock body extends Segment.

7. the locked instrument described in claim 6, wherein the wheel hub includes groove, for being connect when lock body is retracted about wheel hub Receive the end sections of movable link.

8. locked instrument described in claim 1, wherein latch couple nearside extended element with lock body.

9. locked instrument described in claim 1, further includes：

At least one conduit, couples with lock body；At least one conduit can be positioned in the vascular of patient so that lock body Close to operative site.

10. locked instrument described in claim 1, wherein the locked instrument includes the wall for having channel, the nearside extends Component extends on nearside from channel.