CN109381234A - 可倾斜钉砧组合件 - Google Patents

可倾斜钉砧组合件 Download PDF

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CN109381234A
CN109381234A CN201810862841.1A CN201810862841A CN109381234A CN 109381234 A CN109381234 A CN 109381234A CN 201810862841 A CN201810862841 A CN 201810862841A CN 109381234 A CN109381234 A CN 109381234A
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贾斯汀·威廉斯
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Abstract

提供一种包含钉砧头组合件的可倾斜钉砧组合件，所述钉砧头组合件在启动圆形缝合器之后可从操作位置倾斜到后启动倾斜位置，以在所述钉砧头组合件从患者的体腔移除期间最小化所述钉砧头组合件的轮廓。为了简化在启动之后组织圆环从所述钉砧头组合件的移除，所述钉砧组合件包含用于将所述钉砧头组合件固持在后启动圆环移除位置中的锁定结构。

Description

可倾斜钉砧组合件
相关申请的交叉引用
本申请要求2017年8月8日提交的美国临时专利申请序列第62/542,338号的权益和优先权，所述申请的全部公开内容以引用的方式并入本文中。
技术领域
本公开涉及一种包含可倾斜钉砧头的钉砧组合件，以及更具体地说，涉及一种钉砧组合件，其包含可从后启动倾斜位置移动到圆环移除位置的可倾斜钉砧头且包含用于将钉砧头组合件固持在圆环移除位置中的结构。
背景技术
具有钉砧组合件的圆形缝合器是众所周知的，所述钉砧组合件包含钉砧头，所述钉砧头可在钉砧组合件被插入到患者中期间从倾斜位置倾斜到操作位置和/或在钉砧组合件被从患者移除期间从操作位置倾斜到倾斜位置。在将钉砧头插入患者的内腔和/或从患者的内腔移除钉砧头期间，通过使钉砧组合件的钉砧头倾斜，可减小钉砧头的轮廓以最小化对患者的损伤。
在具有含在圆形缝合器被启动到后启动倾斜位置之后倾斜的钉砧头的钉砧组合件的圆形缝合器中，通常通过偏置构件使钉砧头朝向后启动倾斜位置偏置。在后启动倾斜位置中，难以从钉砧头移除组织圆环。因此，在从钉砧头移除组织圆环期间，必须朝向操作位置手动向后枢转钉砧头且将其固持在此位置中。
在缝合器技术中一直需要一种圆形缝合器，其包含钉砧组合件，所述钉砧组合件具有可固持在一位置中以有助于在圆形缝合器被启动之后容易从钉砧头移除组织圆环的钉砧头。
发明内容
本公开的一个方面涉及一种治疗组织的方法，包含：在预启动倾斜位置中将具有钉砧中心杆组合件和钉砧头组合件的钉砧组合件插入到血管内腔中，在所述预启动倾斜位置中，由钉砧头组合件的钉砧表面和钉砧中心杆组合件的纵向轴线限定的平面限定小于三十度(30°)的角度β；将钉砧头组合件从预启动倾斜位置移动到操作位置，在所述操作位置中角度β是九十度(90°)；使组织夹紧在钉砧头组合件的钉砧表面与圆形缝合器的钉仓之间；启动圆形缝合器以推进缝合钉通过组织并进入钉砧头组合件以及用环形刀切割组织；将钉砧头组合件从操作位置移动到后启动倾斜位置，在所述后启动倾斜位置中角度β小于三十度(30°)；将钉砧头组合件从后启动倾斜位置往回移动到圆环移除位置，在所述圆环移除位置中角度β介于四十五度(45°)与九十度(90°)之间；和将钉砧头组合件固持在圆环移除位置中。
在一些实施例中，所述方法进一步包含当钉砧头组合件在圆环移除位置中时从钉砧头组合件移除组织圆环。
在某些实施例中，所述方法进一步包含使用缝合线将钉砧头组合件紧固在预启动倾斜位置中。
在实施例中，将钉砧头组合件从预启动倾斜位置移动到操作位置包含剪断缝合线。
在一些实施例中，将钉砧头组合件从预启动倾斜位置移动到操作位置包含朝向钉砧头组合件推动中心杆组合件的柱塞以使钉砧头组合件从预启动倾斜位置倾斜到操作位置。
在某些实施例中，将钉砧头组合件从操作位置移动到后启动倾斜位置包含在钉砧头组合件的壳体内将钉砧头组合件的支承构件从缩回位置移动到推进位置。
在实施例中，将钉砧头组合件从操作位置移动到后启动倾斜位置包含朝向钉砧头组合件推动柱塞以使钉砧头组合件从操作位置倾斜到后启动倾斜位置。
在一些实施例中，将钉砧组合件从后启动倾斜位置往回移动到圆环移除位置包含将钉砧头组合件手动枢转到圆环移除位置。
在某些实施例中，将钉砧头组合件固持在圆环移除位置中包含将钉砧头组合件的锁定结构定位成与中心杆组合件的柱塞接触。
本公开的另一方面涉及一种可倾斜钉砧组合件，其具有钉砧头组合件和中心杆组合件。钉砧头组合件包含：壳体；立柱，其居中安置在壳体内；支承板，其围绕立柱支撑，可从缩回位置移动到推进位置；和切割环，其支撑在支承板的近端表面上。立柱包含锁定结构。壳体限定围绕立柱定位的环形凹陷且支撑围绕环形凹陷定位的限定一平面的钉砧表面。中心杆组合件包含限定纵向轴线的中心杆和由中心杆支撑的柱塞。中心杆具有适于与圆形缝合器可释放地连接的近端部分。中心杆的远端部分通过枢转构件可枢转地连接到钉砧头组合件的立柱，使得钉砧头组合件可相对于中心杆在操作位置与后启动倾斜位置之间移动。由钉砧表面和中心杆的纵向轴线限定的平面限定角度β，其中当钉砧头组合件在操作位置中时角度β是九十度，且当钉砧头组合件在后启动倾斜位置中时角度β小于三十度。钉砧头组合件可从后启动倾斜位置移动到圆环移除位置，其中角度β介于四十五度与九十度之间。立柱的锁定结构被配置成接合中心杆组合件以将钉砧头组合件固持在圆环移除位置中。
在实施例中，支承板包含指状物且中心杆包含具有接合表面的远端部分。当支承板在缩回位置中时，支承板的指状物被定位成与中心杆的接合表面接触以将钉砧头组合件固持在操作位置中。
在一些实施例中，中心杆的接合表面包含至少一个平面。
在某些实施例中，锁定结构包含从立柱朝向中心杆向近端延伸的延伸部。
在实施例中，延伸部限定锥形表面，所述锥形表面被定位成接合中心杆组合件以将钉砧头组合件固持在圆环移除位置中。
在一些实施例中，中心杆组合件包含偏置构件，所述偏置构件被定位成将柱塞推动到钉砧头组合件中以朝向后启动倾斜位置推动钉砧头组合件。
在某些实施例中，延伸部被定位成接合柱塞以将钉砧头组合件固持在圆环移除位置中。
在实施例中，钉砧组合件包含支撑在钉砧头组合件上的凸轮卡锁板。当支承板在后启动倾斜位置中时，凸轮卡锁板被定位成接合支承板以防止支承板从推进位置往回移动到缩回位置。
在一些实施例中，立柱限定横向狭槽且凸轮卡锁构件围绕枢转构件可枢转地支撑在横向狭槽内。
在某些实施例中，在操作位置中，延伸部由凸轮卡锁构件覆盖，而在后启动位置中，延伸部从凸轮卡锁构件径向向外延伸。
附图说明
本发明所公开的可倾斜钉砧组合件的各种实施例在本文中在以下参考图式进行描述，在图式中：
图1是从本发明所公开的支撑在钉砧递送系统上的可倾斜钉砧组合件的示范性实施例的远端的侧透视图，其中钉砧组合件被倾斜；
图2是图1中所示出的所指示区域的细节放大视图；
图3是图1中所示出的可倾斜钉砧组合件和钉砧递送系统的远端的侧透视图；
图4是图1中所示出的可倾斜钉砧组合件的分解侧透视图；
图5是图4中所示出的所指示区域的细节放大视图；
图6是图4中所示出的可倾斜钉砧组合件的凸轮卡锁构件的侧视图；
图7是沿着图3的截面线7-7截取的截面视图；
图8是在图7中所示出的可倾斜钉砧组合件的钉砧头从预倾斜位置朝向操作位置移动时所述钉砧组合件的侧视截面视图；
图9是图1中所示出的可倾斜钉砧组合件的侧透视图，其中钉砧头在操作位置中；
图10是图9中所示出的在操作位置中的可倾斜钉砧组合件和定位在钉砧组合件的中心杆内的剖面示出的外科手术钉合装置的钉砧固持器的远端部分的侧视截面视图；
图11是图10中所示出的在操作位置中的可倾斜钉砧组合件和在钉合装置被启动时以虚线示出的外科手术钉合装置的远端部分的侧透视图；
图12是在将图11中所示出的在操作位置中的可倾斜钉砧组合件的支承环向远端推动到钉砧头组合件的壳体中之后从所述钉砧组合件的近端的透视图；
图13是图12中所示出的在启动和倾斜位置中的可倾斜钉砧组合件的侧视截面视图；
图14是在图13中所示出的在启动和倾斜位置中的可倾斜钉砧头组合件朝向操作位置部分地向后旋转时所述钉砧组合件的侧视截面视图；
图14A是在图13中所示出的在启动和倾斜位置中的可倾斜钉砧头组合件朝向操作位置部分地向后旋转时所述钉砧组合件的侧视截面视图，其中凸轮卡锁构件被移除；且
图15是在图13中所示出的在启动和倾斜位置中的可倾斜钉砧头组合件朝向操作位置部分地向后旋转且组织圆环被从钉砧头组合件的壳体移除时所述钉砧组合件的侧透视图。
具体实施方式
现在将参考图式详细描述本发明所公开的预倾斜钉砧组合件，其中在若干视图中的每一个中，类似参考标号指定相同或对应元件。在此描述中，术语“近端”大体上用于指代装置的更接近于临床医生的部分，而术语“远端”大体上用于指代装置的距临床医生更远的部分。另外，术语“内窥镜”大体上用于指代内窥镜、腹腔镜、关节镜和/或通过小直径切口或插管实施的任何其它程序且术语“临床医生”大体上用于指代医务人员，包含医生、护士和支持人员。
本发明所公开的可倾斜钉砧组合件具有钉砧头组合件，在从患者的体腔移除钉砧头组合件期间所述钉砧头组合件可在圆形缝合器被启动之后从操作位置倾斜到后启动倾斜位置以最小化钉砧头组合件的轮廓。为了简化在启动之后从钉砧头组合件移除组织圆环，钉砧组合件包含用以将钉砧头组合件固持在后启动圆环移除位置中的锁定结构。如本文中所使用，圆环移除位置是一种位置，在所述位置中由钉砧头组合件的钉砧表面和钉砧组合件的纵向轴线限定的平面限定一角度(角度β)，所述角度介于约45度与约90度之间，且在一些实施例中介于约60度与90度之间。
在使用时，在启动圆形缝合器且使钉砧组合件与圆形缝合器断开连接之后，在从患者的内腔移除钉砧组合件期间通过偏置构件将钉砧头组合件自动从操作位置枢转到后启动倾斜位置以最小化对患者的损伤。在已经从患者移除钉砧组合件之后，可手动将钉砧头组合件从后启动倾斜位置枢转到圆环移除位置以使得能够获取定位在钉砧头组合件内的组织圆环。在下文中进一步详细描述的锁定结构设置在钉砧组合件上以将钉砧头组合件固持在圆环移除位置中，从而简化组织圆环的移除。
图1到3说明大体上示出为钉砧组合件110的本发明所公开的可倾斜钉砧组合件的示范性实施例的侧透视图。钉砧组合件110支撑在钉砧递送系统10的远端上。钉砧组合件110包含钉砧头组合件112和中心杆组合件114。钉砧头组合件110包含限定开口118a的钉砧头或壳体118。钉砧递送系统10包含柔性管12和接合器14。接合器14具有固定地紧固到柔性管12的一个末端的第一末端和通过缝合线“S1”紧固到中心杆组合件114的第二末端。接合器14限定贯穿孔16(图2)。缝合线“S1”接收在钉砧递送系统10的接合器14的贯穿孔16和钉砧头组合件112的壳体118中的开口118a中，从而以预启动倾斜位置将钉砧头组合件112紧固到钉砧递送系统10。为了获得本发明所公开的钉砧递送系统10的构造和操作的更详细描述，参见美国公布第2015/0366563号(“'563公布”)，所述公开的全部内容以引用的方式并入本文中。
参考图4，钉砧组合件110包含钉砧头组合件112和中心杆组合件114。钉砧头组合件112包含立柱116、壳体118、支承构件或支承板120、切割环122、切割环底座123、钉砧表面124、套筒125、凸轮卡锁构件126和固持器构件127。在实施例中，立柱116与壳体118整体地形成且居中定位在壳体118内。或者，壳体118和立柱116可单独地形成且使用任何已知紧固技术紧固在一起，所述任何已知紧固技术例如焊接或压接。钉砧表面124围绕立柱116支撑在壳体118上且限定用于接收缝合钉和使缝合钉变形的多个缝合钉变形凹处130。立柱116限定在下文中进一步详细描述的横向狭槽172。
还参考图5，立柱116包含锁定结构，所述锁定结构被配置成在圆形缝合器被启动之后将钉砧头组合件112固持在圆环移除位置中。在实施例中，锁定结构包含一对延伸部131，所述一对延伸部131从立柱116朝向中心杆组合件114向近端延伸。延伸部131限定在下文中进一步详细描述的横向狭槽172的形成在立柱116中的一部分。延伸部131中的每一个的近端具有同样在下文中进一步详细描述的锥形表面132。
钉砧头组合件112的壳体118限定定位在立柱116与钉砧表面124之间的内部环形凹陷136。钉砧头组合件112的支承板120包含中心开口134，所述中心开口134接收钉砧头组合件112的立柱116，使得支承板120可在壳体118的内部环形凹陷136内在缩回位置(图10)与推进位置(图11)之间移动。支承板120包含围绕中心开口134定位的环形凸缘120a。支承板120还包含在下文中进一步详细描述的一对向内延伸指状物138。
切割环122限定开口122a。钉砧头组合件112的套筒125固定地支撑在切割环122的开口122a内且限定开口125a，所述开口125a的配置对应于支承板120的平台120a的配置。在实施例中，套筒125围绕环形凸缘120a压入配合以将套筒125和切割环122紧固到支承板120。或者，切割环122和套筒125可具有整体构造和/或切割环122可使用各种紧固技术紧固到支承板120。尽管凸缘120a被说明为具有圆形形状，但设想其它配置，例如，正方形、长方形、三角形等。在实施例中，切割环122由聚乙烯形成且支承板120由更硬质材料形成，所述更硬质材料例如金属，如不锈钢。或者，其它构造材料可用于构造支承板120和切割环122。此外，支承板120和切割环122可形成为单一结构或整体结构。切割环122紧固到支承板120，使得切割环122和支承板120形成可围绕立柱116从缩回位置(图10)滑动到远端位置(图11)的组合件。
在实施例中，切割环底座123使用例如胶粘剂紧固到切割环122的向内对向表面。在一个实施例中，切割环底座123由一材料形成，所述材料的硬度大于切割环的硬度，所述材料例如聚酯薄膜。或者，设想切割环122无需具有底座123。
固持器构件127定位在壳体118的内部环形凹陷136内、介于支承板120与壳体118的后壁118a之间。在实施例中，固持器构件127是环形且包含接合支承板120的远端表面的多个可变形突出部127a。固持器构件127被定位成防止支承板120和切割环122组合件在壳体118的内部环形凹陷136内从缩回位置移动到推进位置，直到足以使突出部127a变形的预定力被施加到支承板120和切割环122组合件为止。在圆形缝合器被启动期间，预定力可接近但小于当圆形缝合器的切割刀片接合钉砧组合件110的切割环122时由所述切割刀片施加的力。在实施例中，预定力介于约十磅与约九十磅之间且可以是约三十磅。当达到预定力时，支承板120被按压到固持器127的突出部127a中，使得突出部127a发生变形且支承板120和切割环122组合件朝向推进位置移动到内部环形凹陷136中。设想其它可压碎、可变形、可折叠或移动限制构件可用于将支承板/切割环组合件固持在固定位置中，直到预定力已经被施加到支承板/切割环组合件为止。
参考图4到7，凸轮卡锁构件126包含具有贯穿孔126b的主体126a。贯穿孔126b的尺寸被设定成接收中心杆组合件114的枢转构件162，使得凸轮卡锁构件126围绕枢转构件162可枢转地安装在立柱116的横向狭槽172(图3)内。凸轮卡锁构件126包含第一主体部分126c，在钉砧头组合件112在预启动倾斜位置中的情况下所述第一主体部分126c从立柱116的横向狭槽172部分地延伸，使得凸轮卡锁构件126的第一主体部分126c由中心杆组合件114的柱塞154的指状物166接合。第一主体部分126c被配置成使得第一主体部分126c的外边缘与贯穿孔126b之间的距离围绕凸轮卡锁构件126在逆时针方向上增大，如在图6和7中所观察。以此方式，当凸轮卡锁构件126在逆时针方向上从预启动倾斜位置(图7)旋转到操作位置(图10)时柱塞154能够向远端移动。
凸轮卡锁构件126还包含边缘126f和突出部126g。边缘126f的前导部分被定位和配置成当钉砧头组合件112在预启动倾斜位置中时接合支承板120的内周边120b以防止在圆形缝合器被启动之前凸轮卡锁构件126发生逆时针旋转，如下文所描述。突出部126g被定位成接合壳体118的限定立柱116的横向狭槽172的远端壁172a(图8)以防止凸轮卡锁构件126发生如在图7中所观察的在预启动倾斜位置中的凸轮卡锁构件126的顺时针旋转。
钉砧中心杆组合件114包含中心杆152、柱塞154和柱塞弹簧或偏置构件156。中心杆152的远端包含彼此间隔开以限定腔159a的一对臂159。每个臂159限定：横向贯穿孔158，其与中心杆152的中心纵向轴线对齐；远端平面或接合表面152a；和止动表面153，其从中心杆152的远端向远端突出。或者，贯穿孔158可从中心杆152的纵向轴线偏移。钉砧头组合件112的立柱116的尺寸被设定且被配置成定位在腔159a内且还限定横向贯穿孔116a。枢转构件162通过中心杆152的贯穿孔158和钉砧头组合件112的立柱116的贯穿孔116a定位以将钉砧头组合件112的立柱116可枢转地紧固到中心杆组合件114的中心杆152，使得钉砧头组合件112可枢转地紧固到中心杆组合件114。柱塞154包含在下文中进一步详细论述的指状物166。
继续参考图4，中心杆152的近端包含限定孔182的多个柔性臂180。柔性臂182各自包含开口180a，所述开口180a的尺寸被设定成接收形成在套管针(未示出)上或连接到套管针的凸起以将套管针紧固到中心杆152。可替代地，开口180a可接收用于准许从外科手术部位取回钉砧组合件110的缝合线(未示出)。柔性臂182中的每一个的近端包含内部肩部184(图7)，所述内部肩部184的尺寸被设定成可释放地接合圆形缝合器(未示出)的钉砧固持器或套管针200(图10)以将钉砧组合件110紧固到圆形缝合器。多个齿条186围绕中心杆152形成。齿条186作用来使钉砧组合件110与如所属领域中已知的圆形缝合器的缝合钉固持部分对齐。参见例如美国专利第7,303,106号(“'106专利”)，所述美国专利的全部内容以引用的方式并入本文中。
中心杆组合件114的柱塞154可滑动地定位在形成在中心杆152的第一末端中的孔164(图7)中。柱塞154的接合指状物166与钉砧头组合件112的枢转轴线偏移，且如上文所论述被偏置构件156偏置成与凸轮卡锁构件126的主体部分126c的外边缘接合。指状物166与凸轮卡锁构件126的主体部分126c的外边缘的接合在逆时针方向上推动凸轮卡锁构件126以抵靠后板120的内周边120b推动凸轮卡锁构件126的边缘126f，从而在中心杆152上将钉砧头组合件112从预启动倾斜位置朝向操作位置推动。
参考图7，缝合线S1对抗偏置构件156的推动将钉砧头组合件112紧固在预启动倾斜位置中。更具体地说，在钉砧组合件110的预启动倾斜位置中，由钉砧表面124限定的平面“P”与中心杆152的纵向轴线“L”限定锐角β。在此位置中，柱塞1154的指状物166与凸轮卡锁构件126的主体部分126c的外边缘接合且柱塞154被偏置构件156向远端推动以朝向操作位置推动钉砧头组合件112和凸轮卡锁构件126。在预启动倾斜位置中，角度β可限定小于约三十度(30°)的角度。设想取决于正执行的外科手术程序，角度β可大于约三十度(30°)。
参考图8，当临床医生使用例如剪刀或解剖刀(未示出)剪断缝合线S1时，偏置构件156使柱塞154在由箭头“A”所指示的方向上向远端移动以在由箭头“B”所指示的方向上朝向操作位置推动凸轮卡锁构件126和钉砧头组合件112。在凸轮卡锁构件126围绕枢转构件162旋转时，中心杆组合件114的柱塞154的指状物166沿着凸轮卡锁构件126的主体部分126c的外边缘滑动。
参考图9和10，在钉砧头组合件112和凸轮卡锁构件126的预启动操作位置中，支承板120的指状物138定位在限定在中心杆152的远端上的平面152a的顶部且与从中心杆152的远端向远端延伸的止动表面153接合。指状物138与中心杆152的平面152a和止动表面153的接合会将钉砧头组合件112固持在操作位置中且防止偏置构件156朝向后启动倾斜位置(图13)推动钉砧头组合件112而使其超出操作位置。在操作位置中，由钉砧表面124限定的平面“P”基本垂直于由中心杆152限定的纵向轴线“L”(图10)。
参考图10，当钉砧组合件110紧固到圆形缝合器时(仅示出圆形缝合器的钉砧固持器或套管针200)，圆形缝合器的套管针200被插入到由中心杆152的柔性臂180限定的孔182中。当套管针200被完全插入到孔182中时，套管针200的远端接合柱塞154的近端，使得柱塞154被锁定在推进位置中。在柱塞154的推进位置中，其中圆形缝合器在预启动状态中，钉砧头组合件112被锁定在操作位置中(图10)。
在使用时，使用钉砧递送系统10将钉砧组合件110递送到外科手术部位。为了获得此程序的具体实施方式，参见'563公布。在钉砧组合件110恰当地定位在外科手术部位处之后，可剪断缝合线S1以释放钉砧头组合件112且允许钉砧头组合件112和凸轮卡锁构件126围绕枢转构件162从预启动倾斜位置(图7)枢转到操作位置(图8)，如上文所论述。或者，可使用各种插入技术和工具将钉砧组合件110递送到外科手术部位。另外，可在钉砧组合件在操作位置中的情况下将钉砧组合件递送到外科手术部位。
参考图11和12，当启动圆形缝合器(未示出)以推进缝合钉通过组织进入钉砧表面124时(参见'106专利以获得此操作的具体实施方式)，在由图11中的箭头“C”所指示的方向上将壳组合件212(图11)的环形刀210推进成与切割环122接触以将切割环122和支承板120组合件进一步推进到钉砧头组合件112的壳体118的环形凹陷136中。在支承板120推进到环形凹陷136中时，支承板120的指状物138移动到与中心杆152的平面152a和止动表面153向远端间隔开的位置。当这种情况发生时，柱塞154使凸轮卡锁构件126在由图11中的箭头“D”所指示的方向上旋转，使得凸轮卡锁构件126的限定边缘126f的部分移动到支承板120近端的位置。凸轮卡锁构件126的此定位防止了当在圆形缝合器被启动之后缩回环形刀210时支承板120向近端移动。应注意，凸轮卡锁构件126的突出部126g被旋转到与限定横向狭槽172的远端壁172a间隔开的位置且被定位成与支承板120接触。支承板120的向近端移动可将支承板120的指状物138重新定位到中心杆152的平面152a上且阻碍钉砧头组合件112从操作位置枢转移动到后启动倾斜位置(图13)。凸轮卡锁构件126的第二部分126d(图11)还接合支承板120的相反侧以防止支承板120与环形刀210一起缩回。
参考图13，当钉砧头组合件112移动到与壳组合件212间隔开的位置时(图11)，中心杆组合件114的偏置构件156将使钉砧头组合件112在由图13中的箭头“E”所指示的方向上枢转到后启动倾斜位置。在类似于预启动倾斜位置的后启动倾斜位置中，角度β可限定小于约三十度(30°)的角度。设想取决于正执行的外科手术程序，角度β可大于约三十度(30°)。如上文所论述，在后启动倾斜位置中，钉砧头组合件112具有减小轮廓，使得可在对患者造成最小损伤的情况下将钉砧组合件110从患者的体腔移除。
参考图14到15，如所属领域中已知，当启动包含例如环形刀210等环形刀的圆形缝合器时(图13)，在正进行治疗的组织中剪断组织圆环220(图15)。组织圆环220定位在壳体118的环形凹陷136中、介于壳组合件212(图11)与切割环122之间。当钉砧头组合件112在后启动倾斜位置中时，难以从钉砧头组合件112移除组织圆环220。为了简化组织圆环220的移除，包含立柱116的延伸部131的锁定结构被定位成接合柱塞152的指状物166以将钉砧头组合件112固持在圆环移除位置中，从而使得能够更大地获取组织圆环。如上文所论述，在圆环移除位置中，角度β介于约45度与约90度之间。在某些实施例中，角度β介于约60度与约90度之间。
更具体地说，在从患者移除钉砧组合件110之后，临床医生可手动使钉砧头组合件112在由图14中的箭头“F”所指示的方向上朝向操作位置向后倾斜到圆环移除位置。应注意，在凸轮卡锁构件126被旋转到图13中所示出的位置的情况下，延伸部131的锥形表面132从凸轮卡锁构件126径向向外延伸。因此，当钉砧头组合件112在由箭头“F”所指示的方向上旋转时，立柱116上的延伸部131接近且接合中心杆组合件114的柱塞154的指状物166。当延伸部131的锥形表面132接合柱塞154的指状物166时，锥形表面132使柱塞154向下滑动，使得延伸部131的一部分经过指状物166且在指状物166的外表面与中心杆152的纵向轴线之间的位置处接合指状物166。延伸部131与柱塞154的指状物166之间的此接合会将钉砧头组合件112固持在圆环移除位置中(图15)。尽管延伸部131被示出为被配置成将钉砧头组合件112固持在预启动倾斜位置与操作位置之间的位置中，但设想延伸部131和凸轮卡锁构件126的配置可被修改以将钉砧头组合件112固持在预启动与后启动倾斜位置之间的各种不同位置中。
所属领域的技术人员将理解，在本文中具体地描述且在附图中所说明的装置和方法是非限制性的示范性实施例。设想在不脱离本公开的范围的情况下，结合一个示范性实施例说明或描述的元件和特征可与另一实施例的元件和特征组合。此外，所属领域的技术人员将了解本公开的基于上文所描述的实施例的另外特征和优点。因此，本公开不应受特定示出和描述的内容限制，而是由所附权利要求书指示。

Claims (19)

1.一种治疗组织的方法，其包括：
在预启动倾斜位置中将包含钉砧中心杆组合件和钉砧头组合件的钉砧组合件插入到血管内腔中，在所述预启动倾斜位置中，由所述钉砧头组合件的钉砧表面和所述钉砧中心杆组合件的纵向轴线限定的平面限定小于三十度(30°)的角度β；
将所述钉砧头组合件从所述预启动倾斜位置移动到操作位置，在所述操作位置中，所述角度β是九十度(90°)；
使组织夹紧在所述钉砧头组合件与圆形缝合器的钉仓之间；
启动所述圆形缝合器以推进缝合钉通过所述组织并进入所述钉砧头组合件以及用环形刀切割所述组织；
将所述钉砧头组合件从所述操作位置移动到后启动倾斜位置，在所述后启动倾斜位置中，所述角度β小于三十度(30°)；
将所述钉砧头组合件从所述后启动倾斜位置往回移动到圆环移除位置，在所述圆环移除位置中，所述角度β介于四十五度(45°)与九十度(90°)之间；
将所述钉砧头组合件固持在所述圆环移除位置中。
2.根据权利要求1所述的方法，其进一步包含当所述钉砧头组合件在所述圆环移除位置中时从所述钉砧头组合件移除组织圆环。
3.根据权利要求1所述的方法，其进一步包含使用缝合线将所述钉砧头组合件紧固在所述预启动倾斜位置中。
4.根据权利要求3所述的方法，其中将所述钉砧头组合件从所述预启动倾斜位置移动到所述操作位置包含剪断所述缝合线。
5.根据权利要求4所述的方法，其中将所述钉砧头组合件从所述预启动倾斜位置移动到所述操作位置包含朝向所述钉砧头组合件推动所述中心杆组合件的柱塞，以使所述钉砧头组合件从所述预启动倾斜位置倾斜到所述操作位置。
6.根据权利要求5所述的方法，其中将所述钉砧头组合件从所述操作位置移动到所述后启动倾斜位置包含在所述钉砧头组合件的壳体将所述钉砧头组合件的支承构件从缩回位置移动到推进位置。
7.根据权利要求6所述的方法，其中将所述钉砧头组合件从所述操作位置移动到所述后启动倾斜位置包含朝向所述钉砧头组合件推动柱塞，以使所述钉砧头组合件从所述操作位置倾斜到所述后启动倾斜位置。
8.根据权利要求1所述的方法，其中将所述钉砧头组合件从所述后启动倾斜位置往回移动到所述圆环移除位置包含将所述钉砧头组合件手动枢转到所述圆环移除位置。
9.根据权利要求1所述的方法，其中将所述钉砧头组合件固持在所述圆环移除位置中包含将所述钉砧头组合件的锁定结构定位成与所述中心杆组合件的柱塞接触。
10.一种可倾斜钉砧组合件，其包括：
钉砧头组合件，其包含：壳体；立柱，所述立柱居中安置在所述壳体内且包含锁定结构；环形凹陷，所述环形凹陷围绕所述立柱定位；钉砧表面，所述钉砧表面限定围绕所述环形凹陷定位的平面；支承板，所述支承板围绕所述立柱支撑，能够从缩回位置移动到推进位置；和切割环，所述切割环支撑在所述支承板的近端表面上；和
中心杆组合件，其包含限定纵向轴线的中心杆和由所述中心杆支撑的柱塞，所述中心杆具有适于与圆形缝合器可释放地连接的近端部分，所述中心杆的远端部分通过枢转构件可枢转地连接到所述钉砧头组合件的所述立柱，使得所述钉砧头组合件相对于所述中心杆在操作位置与后启动倾斜位置之间可移动，由所述钉砧表面和所述中心杆的所述纵向轴线限定的平面限定角度β，其中当所述钉砧头组合件在所述操作位置中时所述角度β是九十度，且当所述钉砧头组合件在所述后启动倾斜位置中时所述角度β小于三十度；
其中所述钉砧头组合件从所述后启动倾斜位置可移动到圆环移除位置，在所述圆环移除位置中，角度β介于四十五度与九十度之间，所述立柱的所述锁定结构被配置成接合所述中心杆组合件以将所述钉砧头部组合件固持在所述圆环移除位置中。
11.根据权利要求10所述的可倾斜钉砧组合件，其中支承板包含指状物且所述中心杆包含具有接合表面的远端部分，所述支承板的所述指状物被定位成当所述支承板在所述缩回位置中时与所述中心杆的所述接合表面接触，以将所述钉砧头组合件固持在所述操作位置中。
12.根据权利要求11所述的可倾斜钉砧组合件，其中所述中心杆的所述接合表面包含至少一个平面。
13.根据权利要求12所述的可倾斜钉砧组合件，其中所述锁定结构包含从所述立柱朝向所述中心杆向近端延伸的延伸部。
14.根据权利要求13所述的可倾斜钉砧组合件，其中所述延伸部限定锥形表面，所述锥形表面被定位成接合所述中心杆组合件以将所述钉砧头组合件固持在所述圆环移除位置中。
15.根据权利要求14所述的可倾斜钉砧组合件，其中所述中心杆组合件包含偏置构件，所述偏置构件被定位成将所述柱塞推动到所述钉砧头组合件中以朝向所述后启动倾斜位置推动所述钉砧头组合件。
16.根据权利要求15所述的可倾斜钉砧组合件，其中所述延伸部被定位成接合所述柱塞以将所述钉砧头组合件固持在所述圆环移除位置中。
17.根据权利要求13所述的可倾斜钉砧组合件，其进一步包含支撑在所述钉砧头组合件上的凸轮卡锁板，当所述支承板在所述后启动倾斜位置中时，所述凸轮卡锁板被定位成接合所述支承板以防止所述支承板从所述推进位置往回移动到所述缩回位置。
18.根据权利要求17所述的可倾斜钉砧组合件，其中所述立柱限定横向狭槽，所述凸轮卡锁构件围绕所述枢转构件可枢转地支撑在所述横向狭槽内。
19.根据权利要求18所述的可倾斜钉砧组合件，其中在所述操作位置中，所述延伸部由所述凸轮卡锁构件覆盖，且在所述后启动倾斜位置中，所述延伸部从所述凸轮卡锁构件径向向外延伸。
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