CN109661209A - 关节镜装置及方法 - Google Patents
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Abstract
关节镜系统包括机动手持件和可拆卸探针。机动手持件包括旋转驱动器,该旋转驱动器被配置用于接合探针的轮毂内的可旋转驱动联轴器。探针具有带有铰接远侧区域的轴杆,并且可旋转驱动联轴器被配置用于将旋转驱动器的旋转运动转化为在探针的铰接区域内的铰接运动。
Description
相关申请的交叉引用
本申请要求于2016年7月1日提交的临时申请号62/357,786(代理人案号41879-726.101)的权益,其全部公开内容通过引用并入本文。
发明背景
1.技术领域。本发明涉及关节镜手术装置,通过该装置可以从关节消融、切割和/或去除膝关节、髋关节等中的解剖组织。更具体地,本发明涉及电外科探针,该电外科探针可以在关节镜手持件中与马达驱动器铰接。
关节镜关节手术及其他手术,诸如髋关节治疗、肩峰下减压、肩锁关节治疗,通常需要许多具有不同功能和结构的不同工具。为了降低与在单次手术中使用大量工具相关联的成本和库存负担,已经提出了具有一次性工作端和可重复使用的手持件的“可重复使用”工具。手持件将被设计成与具有不同功能和“工作端”的大量不同工具类型一起工作,从而可以减少必要工具的成本和库存。
虽然使用可重复使用工具具有很大的前景,但成功的可重复使用工具系统要求一种类型的手持件能够与尽可能多类型的工具和工作端相兼容。例如,许多手持件将具有带有旋转驱动轴杆的马达驱动器。这样的马达驱动器不仅需要与诸如钻、刨削器、研磨器等旋转末端执行器(effector)相兼容,还应与非旋转末端执行器相兼容。
本发明特别感兴趣的是,期望提供具有铰接的末端执行器的工具和工作端,该末端执行器可由具有可旋转驱动元件的机动手持件(motorized handpiece)来驱动。具有铰接工作端的关节镜探针允许医师到达以其他方式将难以接近的目标组织。因此,需要改进的和替代的能够快速地消融和提取软组织并且还与旋转驱动元件相兼容的铰接关节镜装置。这些目标中的至少一些将由本文描述和要求保护的发明来满足。
2.背景技术描述。关节镜组织消融和提取装置在以下共同拥有的专利和公开申请中描述:美国专利号9,603,656、9,585,675、9,592,085、9,277,954、9,204,918和8,323,280;以及美国专利公开号US 2016/0346036、US 2016/0157916和US 2016/0113706,它们的全部公开内容通过引用并入本文。
发明内容
本发明提供了关节镜及其他微创工具和工具系统。所述工具系统包括机动手持件和可拆卸工具,其中所述可拆卸工具通常旨在仅供单个患者单次使用(经常被称为一次性工具)并且所述机动手持件通常旨在供多个患者在多次手术中再利用(经常被称为“可重复使用的”)。所述机动手持件将提供旋转驱动元件或驱动轴杆,所述旋转驱动元件或驱动轴杆被配置用于与所述工具之中或之上的可旋转联轴器(rotatable drive coupling)接合或配合。所述可旋转联轴器进而将被配置用于将所述驱动轴杆或驱动器的旋转运动转化为所述工具的远侧区域内的铰接运动。以这种方式,所述“可重复使用的”手持件可以与常规的旋转工具及其他工具以及具有如下文祥述的铰接区域的本发明的特定工具一起使用。
在第一特定方面,本发明包括旨在与具有旋转驱动器的机动手持件一起使用的装置。所述装置包括具有近端和铰接远侧区域的轴杆。轮毂附接至所述轴杆的所述近端,并且所述轮毂适于或被配置成可拆卸地连接至所述机动手持件。所述轮毂之上或之内的可旋转驱动联轴器被配置成当所述轮毂连接至所述手持件时可拆卸地接合所述旋转驱动器。以这种方式,所述驱动联轴器通过所述驱动器的旋转导致所述轴杆的所述铰接远侧区域铰接。
在具体实施方式中,所述装置的所述轴杆包括外同心或同轴套筒和内同心或同轴套筒,其中所述外套筒的近端固定在所述轮毂中或固定至所述轮毂,并且所述内套筒的近侧部分响应于所述驱动器的旋转而轴向可移动或可平移地安装在所述外套筒的内部孔腔中。通常,所述轴杆将具有至少一个远侧组件,所述至少一个远侧组件将所述外套筒和所述内套筒的远端保持成固定关系,即,所述远侧组件将所述两个端部固定地耦合在一起。通常,在所述内套筒的近端上的螺纹轴环(threaded collar)螺纹地接合所述驱动联轴器,从而在所述可旋转驱动联轴器通过所述手持件的所述旋转驱动器而旋转时纵向地驱动所述螺纹轴环。
在替代实施方式中,所述可旋转驱动联轴器可以相对于固定至所述内套筒的近端的第一轴环沿第一方向旋转,并且所述驱动联轴器的旋转使其上的销钉抵靠所述第一轴环的接合表面而接合,从而纵向地驱动所述第一轴环以铰接所述轴杆的所述远侧区域。
在更进一步的实施方式中,可往复电极安设在所述轴杆的所述铰接远侧区域的远侧端头处,并且由具有远端和近端的第三同心套筒携带。所述第三套筒的所述远端附接至所述可往复电极,并且近端附接至所述驱动联轴器。所述可旋转驱动联轴器被配置成沿第二方向旋转,并且所述驱动联轴器和销钉相对于在所述第一轴环上的凸轮表面沿所述第二方向的旋转纵向地驱动所述第三套筒以使所述可往复电极往复运动。
在其他特定实施方式中,在所述轴杆的所述远端处的所述至少一个远侧组件是陶瓷构件并且携带至少一个电极,通常携带至少第一极性电极,并且所述轴杆的远侧区域包括第二极性电极。在其他特定实施方式中,所述轴杆的所述铰接区域包括在所述外套筒和/或所述内套筒中的一系列狭槽。例如,所述外套筒中的狭槽可以径向地偏离所述内套筒中的狭槽。通过调整径向偏离的角度,可以调整所述铰接远侧区域的偏转的方向。在其他特定实施方式中,绝缘层可以安设在所述外套筒与所述内套筒之间,并且第一和第二电触点可以提供在所述轮毂中,用于分别连接至所述轴杆上的第一和第二极性电极,以提供射频(RF)电流向所述电极的递送。
所述机动手持件将通常包括在所述手持件的壳体内的马达,并且所述壳体将通常具有一个或多个致动器,用于实现所述手持件的各种功能。在一个示例中,所述手持件的外表面上的致动器提供用于手动地启动所述马达以弯曲所述铰接区域。在另一示例中,所述手持件的外表面上的致动器提供用于控制RF电流向所述第一和第二极性电极的递送。
在更进一步的示例中,所述轴杆的所述内套筒可以具有内部通道,所述内部通道延伸至所述轴杆的远侧区域中的开放末端。所述内部通道通常适于连接至负压源,以便当所述手持件连接至所述负压源时提供通过所述工具和所述手持件的抽吸。
在第二特定方面,关节镜系统包括具有马达驱动的驱动器或驱动轴杆的机动手持件。所述系统还包括探针,所述探针具有(a)适于可拆卸地连接至所述机动手持件的近侧轮毂和(b)具有铰接远侧区域的探针轴杆。安设在所述轮毂内的可旋转驱动联轴器适于耦合至所述马达驱动的驱动器或驱动轴杆,其中所述驱动联轴器通过所述驱动器的旋转将导致所述铰接远侧区域的铰接。
在关节镜系统的特定实施方式中,所述轴杆包括外同心套筒和内同心套筒,其中所述外套筒的近端固定在所述轮毂之中或之上,并且所述内套筒的近端固定在所述可旋转驱动联轴器中。所述内套筒的近侧部分通常在所述外套筒的内部孔腔中轴向或纵向可移动,使得所述套筒的相对轴向平移将导致所述远侧区域的铰接。陶瓷构件通常用于连接所述外套筒和所述内套筒的远端,并且第一和/或第二极性电极可以被携带在所述陶瓷构件上。绝缘层可以安设在所述内套筒与所述外套筒之间,并且所述手持件的电触点通常适于与所述轮毂中的协作或相应电触点耦合,以允许激发所述第一和第二极性电极。
所述关节镜系统还可以包括可往复电极,其处于所述轴杆的所述铰接远侧区域的远侧端头处,并且由具有远端和近端的第三同心套筒携带。所述远端附接至所述可往复电极,并且所述近端由所述可旋转驱动联轴器驱动,从而纵向地驱动所述第三电极以使所述可往复电极往复运动。
在第三特定方面,本发明提供了关节镜系统,其包括具有马达和马达致动器按钮的机动手持件。具有连接至具有铰接区域的轴杆的轮毂的探针能够可拆卸地连接至所述机动手持件。特别地,轮毂适于可拆卸地连接至所述机动手持件,其中所述手持件内的电机被配置用于铰接所述探针轴杆的所述铰接区域。所述致动器按钮和马达被配置用于或适于在向所述按钮施加压力时连续地铰接所述铰接区域以导致所述铰接区域在线性形状或配置与完全铰接的形状或配置之间变形,或者所述致动器按钮上压力的释放将停止这样的连续铰接。
在第四方面,关节镜系统包括具有马达和马达致动器按钮的机动手持件。具有连接至轴杆的轮毂的探针具有铰接远侧区域。所述轮毂适于可拆卸地连接至所述机动手持件,并且所述马达和马达致动器按钮被配置用于铰接所述探针轴杆的所述铰接区域,使得在所述致动器按钮上的压力使所述铰接区域在线性形状与完全铰接形状之间铰接。
在本发明的第五方面,关节镜系统包括具有马达和马达致动器按钮的机动手持件。具有连接至轴杆的轮毂的探针具有铰接远侧区域。所述轮毂适于可拆卸地连接至所述机动手持件,并且所述马达和马达致动器按钮被配置用于铰接所述探针轴杆的所述铰接区域,使得在所述致动器按钮上的压力和压力释放使所述铰链区域铰接成从线性形状到完全铰接形状的选定角度数。
在第六方面,本发明包括关节镜系统,所述关节镜系统包括具有马达和至少一个马达致动器按钮的机动手持件。探针上的轮毂适于可拆卸地连接至所述机动手持件,并且所述马达和马达致动器按钮被配置用于铰接所述探针轴杆的所述铰接区域以及用于启动或激发向所述探针轴杆上携带的双极或其他电极进行的不同模式的RF电流递送。所述RF电流递送模式可以包括用于向所述电极递送RF电流的消融波形或凝固波形。
附图说明
现将参考附图对本发明的各个实施方式进行讨论。应当理解,附图仅描绘了本发明的典型实施方式,因此不应视为限制本发明的范围。
图1是一次性关节镜RF探针的透视图,其具有带有静止的有源电极的铰接工作端,其中铰接机构通过关节镜手持件中的马达驱动器致动。
图2是与图1的RF探针组合使用的具有马达驱动器的关节镜手持件的透视图。
图3A是图1的RF探针的铰接工作端的透视图,示出了RF电极。
图3B是图3A的铰接工作端的截面透视图。
图4是图1的RF探针的近侧轮毂的截面图,示出了马达驱动铰接机构和RF电流运载构件。
图5是铰接RF探针的另一变型的透视图,该变型具有马达驱动的往复有源电极。
图6是图5的铰接RF电极的铰接区域和工作端的剖视图。
图7是图5的探针轮毂中的机构的示意图,该探针轮毂允许图2的马达驱动器铰接和去铰接(de-articulate)图5的探针轴杆以及使有源电极往复运动。
具体实施方式
本发明涉及关节镜系统以及相关的使用方法。现将描述本发明的若干种变型以提供对本文公开的装置的形式、功能和使用方法的原理的总体理解。大体上,本公开内容提供了包括单次使用的铰接RF探针的铰接关节镜系统,该RF探针能够可拆卸地耦合至可重复使用的机动手持件。这种对本发明的一般原理的描述并不意味着限制随附权利要求中的发明构思。
现参考附图及其上标记的参考编号,图1和图2图示了提供用于治疗关节组织的关节镜系统,其中图1示出了具有工作端102的一次性铰接探针100,工作端102具有带有远侧有源电极110的铰接区域105。图2图示了其中携带有马达驱动器115的可重复使用手柄或手持件112,其中图1的探针100适于可拆卸地耦合至图2的手持件112。铰接工作端102允许高达90°或更多的选定铰接,从而允许医师根据需要在关节中定向远侧电极110以消融和/或平滑关节组织,例如,以治疗髋关节、膝关节、肩关节、踝关节或其他关节中的关节面的受损区域。
更具体地,如图1中所示的铰接探针100具有近侧轮毂组件118,近侧轮毂组件118连接至细长轴杆120,细长轴杆120围绕纵向轴杆122延伸至远侧工作端102。参考图3A-图3B和图4,轴杆120包括外套筒125和可滑动地安设在外套筒125的孔腔127中的内套筒126。内套筒125和外套筒126可以由合适的金属合金,如不锈钢或NiTi制成。内套筒125和外套筒126的壁厚可以在约0.005”至0.010”的范围内,外套筒125的外径在约2.0mm至6.0mm的范围内。
图3A-图3B更详细地示出了轴杆120的铰接区域105。在图3A中,可以看出外套筒125具有允许其铰接的开槽区域128。图3B示出了内套筒126具有类似的开槽区域130,每个套筒中的狭槽132彼此旋转偏移180°。在图1和图3A-图3B的变型中,内开槽套筒部分128和外开槽套筒部分130可以具有狭槽深度、角度、取向和形状的任何配置,以提供所需范围的铰接形状、扭矩阻力等等。狭槽可以具有接合特征(未示出),以接合狭槽132任一侧上的套筒部分,从而增加扭矩阻力。
参考图3B,外套筒126的远端135和内套筒126的远端136通过连接而耦合至远侧介电构件140(下面进一步描述),以允许轴向力相对于外套筒125施加到内套筒126,从而如本领域中已知地铰接铰接区域105。下面进一步描述铰接机构。分别在套筒125和126的铰接区域128和130中的凹口或狭槽132可以具有沿着工作端102中的开槽区域均匀的宽度W,或者狭槽可以具有变化的宽度。或者,狭槽宽度W可以在套筒的不同部分中不同,以在完全铰接时实现特定的弯曲轮廓。在其他变型中,狭槽宽度W可沿工作端增加或减小,以产生具有变化半径的曲线。显然,应理解,任何数目的变型都在本公开内容的范围内。
图4是图1的轮毂118的剖视图,其中外套筒125的近端142固定在轮毂118的远端144中。图4还示出了内套筒126的近端146固定在螺纹轴环148中,螺纹轴环148适于轴向移动,以使内套筒126相对于外套筒125平移。在图4中,驱动联轴器155可在轮毂118的近端156中旋转。驱动联轴器155具有狭槽配置158,其适于与手持件112中的马达驱动单元115的轴杆160(图2)配合。驱动联轴器155的内部具有螺纹区域162,螺纹区域162与螺纹轴环148的螺纹区域164接合。因此,可以看出,驱动联轴器155的旋转将使螺纹轴环148和内套筒126根据驱动联轴器155的旋转方向而轴向地来回移动以铰接工作端102,如图1所示。在一个变型中,当工作端102处于笔直配置时,驱动联轴器155可以旋转约90°至720°或约90°至360°的选定量,从而使内套筒126在近侧方向上相对于外套筒125移动,因此将工作端102弯曲成铰接配置。如下面将进一步描述的,铰接由手持件102中的马达驱动器115驱动。
可以参考图3A-图3B和图4描述探针100的电外科功能。在图3B中可以看到,内套筒125和外套筒126在其远端135和136处连接至远侧介电构件140。外套筒125和内套筒126用作相反极性的电引线,该电引线将RF电流运载至以及运载出有源电极110和返回电极170,返回电极170构成外套筒125的外表面。因此,内套筒和外套筒(125,126)必须通过绝缘体间隔开,该绝缘体位于包括陶瓷构件140的轴杆120的远端处。在图3B中可以看出,外套筒125的远端135通过陶瓷构件140的突出部分172a和172b机械地锁定到陶瓷构件140,突出部分172a和172b由外套筒125的壁中的开口174a和174b接收。内套筒126具有远端136,远端136具有至少两个突出元件165a和165b,突出元件165a和165b延伸穿过陶瓷构件140中的第一和第二孔腔,突出元件165a和165b的远侧端头焊接至有源电极110。
参考图3A,陶瓷构件140可以由具有非常高硬度等级和较高断裂韧性等级的技术陶瓷材料制造,其中以维氏量表衡量“硬度”并以MPam1/2衡量“断裂韧性”。断裂韧性是指描述含有瑕疵或裂缝的材料抵抗进一步断裂的能力的性质并表示材料对脆性断裂的抵抗力。瑕疵的发生在任何组件的制造和加工中都是无法完全避免的。
在一种变型中,陶瓷构件140为氧化锆的一种形式。基于氧化锆的陶瓷已被广泛用于牙科学,并且这样的材料来源于在航空航天和军事装甲中使用的结构陶瓷。对这样的陶瓷进行改性以满足生物相容性的附加要求并掺杂稳定剂以实现高强度和高断裂韧性。本发明中使用的陶瓷类型已经用于牙科植入物,并且这样的基于氧化锆的陶瓷的技术细节可以在Advances in Ceramics-Electric and Magnetic Ceramics,Bioceramics,Ceramics and Environment(2011)中的第17章,Volpato等人,“Application of Zirconia inDentistry:Biological,Mechanical and Optical Considerations”中找到。
陶瓷构件140可以由技术陶瓷领域中已知的氧化钇稳定的氧化锆制造,并且可以由CoorsTek Inc.,16000Table Mountain Pkwy.,Golden,CO 80403或Superior TechnicalCeramics Corp.,600Industrial Park Rd.,St.Albans City,VT 05478提供。其他可以使用的技术陶瓷包括氧化镁稳定的氧化锆、氧化铈稳定的氧化锆、氧化锆增韧的氧化铝和氮化硅。
图3B还以部分透视图示出了围绕内套筒126外部的薄壁绝缘套筒175,用于在外套筒125与内套筒126之间提供电绝缘。绝缘套筒175可以包括柔性耐温材料,如聚对二甲苯、PFTE、PEEK等等。如图3A中的部分透视图所示,外套筒125可以具有合适聚合物的柔性薄壁鞘套180,其围绕轴杆组装件120的铰接区域105。在该变型中,返回电极170构成外套筒125的靠近铰接区域105的表面部分(图3A)。
现在可以描述轮毂118和协作手持件的组件,其提供用于将RF电流递送到探针工作端105和从探针工作端105递送出RF电流的电通路。如在图1和图4中可以看到,探针100的近侧轮毂118配置有突出元件182,突出元件182与手持件102(图2)中的J形锁槽配合,用于将轮毂组装件118可拆卸地锁定到手持件112的接收通道185中。
在图4中可以看出,第一弹簧加载电触头205A和205B安设在轮毂118的相对侧上,并适于接合手持件112的接收通道185中的相应金属电触头(未示出)。探针轮毂118可以在“上”或“下”位置插入手持件112中的接收通道185中,因此电触头205A和205B提供在轮毂的两侧上,从而提供与手持件中相应的电触头的接触,无论轮毂定向如何。然后,弹簧加载电触头205A和205B在轮毂118中向内延伸,以接触旋转螺纹联轴器148,旋转螺纹联轴器148是金属的并且导电地固定至内套筒126的近端146。因此,RF电流可以通过螺纹联轴器148运载至内套筒126和有源电极110(图3B)。
图4示出了轮毂118中的第二弹簧加载电触头210,其被配置用于接合手持件112的接收通道185(图2)中的另一电触头(未示出)。电触头210在轮毂118中向内延伸,以接触金属芯202,金属芯202固定地耦合至外套筒125的近端142,其中外套筒126的一部分是暴露的并包括如上所述和图3A-图3B所图示的返回电极170。轮毂118中的金属芯202的内部是其中具有孔腔214的绝缘塑料块208,孔腔214允许内套筒126的轴向移动,从而铰接工作端102。
现在转向系统的操作,图2示出了手持件112通过电缆184可操作地耦合至控制器185和RF源190。控制器185适于控制马达驱动器115的所有操作以及RF功能。致动器按钮186a、186b、186c和操纵杆188提供在手持件112上,用于致动探针100的某些功能。在一个变型中,操纵杆188可操作地耦合至控制器185以启动马达驱动器115,其中向前推动操纵杆188沿第一旋转方向启动马达驱动器,进而接合并旋转轮毂118中的驱动联轴器155,从而铰接探针的工作端102,如图1所示。在该变型中,推动操纵杆188可以使工作端在线性配置与完全铰接配置之间逐渐地移动,如图1所示。通过释放操纵杆188上的压力,马达驱动器115将被停用,并且工作端102将保持铰接在图1的线性配置与完全铰接配置之间的任何中间位置。
在另一变型中,可以操作操纵杆188和控制器算法,使得操纵杆188上的单个推动将使工作端102从线性配置铰接成图1的完全铰接配置。或者,操纵杆188的单次触摸可以使工作端铰接成预定的角度数,其中操纵杆188的2到10次触摸将使工作端102从线性配置铰接到完全铰接配置。
在另一变型中,可以向后按压操纵杆188以沿相反的旋转方向启动马达驱动器115的旋转,从而与图2中所示的铰接方向相比沿相反方向铰接工作端102。
仍然参考图2,手持件112上的致动器按钮186a、186b或186c中的一个可操作地耦合至控制器185和RF源190,以激发RF电极110和170。在另一变型中,致动器按钮186a,186b或者186c中的一个耦合到控制器185和RF源190以选择特定模式或RF波形,例如本领域中已知的(1)用于消融的RF波形或(2)用于凝固的RF波形。
在另一变型中,参考图2,手持件112具有显示器195(例如,LCD屏幕),当马达驱动器铰接工作端时,显示器195显示工作端102的铰接形状的图像或其他指标。这样的显示器将是有用的,因为工作端可能不总是在关节镜手术中可见,如在插入和拔出期间是不可见的,并且向医师提供工作端102的铰接形状的指示是重要的。
在另一变型中,参考图2和图3A-图3B,远侧陶瓷构件140之中可具有抽吸端口230,抽吸端口230连接至内套筒126中的通道232,通道232通过轮毂118和手持件112与负压源220(图2)连通。在图3A-图3B中所示的实施方式中,抽吸端口230延伸穿过电极110,但是应当理解,可以在有源电极110中或附近的工作端中提供任何数目的端口。
在图3A-图3B中所示的工作端102的实施方式中,有源电极110安设在陶瓷构件140的远端,但是应当理解,有源电极110可以具有任何合适的形状和配置。例如,有源电极可以位于陶瓷构件140的侧面,或者可以被配置为围绕陶瓷构件140的圆周的环形电极。此外,有源电极可以包括多个间隔开的线状电极元件,该线状电极元件已知在快速形成和维持用于组织消融的RF等离子体方面是有效的。在另一变型中,有源电极可以包括从陶瓷构件140向远侧延伸的钩或刀形电极。在又一变型中,这样的钩或刀形电极可能是可从陶瓷构件140延伸和缩回的。在另一变型中,电极可以是本领域已知的马达驱动的旋转切割套筒,其可以耦合至负压源220以切割和提取组织。这样的切割套筒将具有柔性部分以与工作端102的铰接部分105协作。
现在转向图5-图6,示出了铰接探针400的另一变型,其同样具有轮毂404和具有纵轴412的细长轴杆410,细长轴杆410携带远侧电外科工作端415。在该变型中,有源电极420由马达驱动并由工作端415携带,并且适于相对于陶瓷体或壳体422往复运动,其中在图1和图3A-图3B的前述实施方式中,有源电极110被固定并静止在工作端102中。在图5-图6的变型中,工作端415是2017年1月19日提交的题为ARTHROSCOPIC DEVICES AND METHODS(代理人案号41879-713.201)的共同未决美国专利申请号15/410,723中描述的类型,其中有源电极420在轴杆410的铰接区域440的远端处携带的陶瓷壳体422中的窗口428中往复运动。在图5的变型中,与前述实施方式一样,第一同心开狭槽套筒445和第二同心开狭槽套筒448用于提供探针的铰接区域440。在图5-图6的变型中,第三套筒或构件450被携带在第二套筒448的内部通道454内,第二套筒448被配置成往复运动并延伸穿过轴杆410并携带有源电极420。应当理解,在这样的实施方式中,第三套筒450还可以被配置成旋转,或旋转振荡,或旋转和往复运动的组合。
图5的变型同样适于可拆卸地耦合至图2的手持件112和马达驱动器115。图5的探针400的轮毂404同样具有与图1的前述实施方式相同的特征,包括用于耦合至手持件112的电触点。
从图2中可以理解,手持件112和马达驱动器115基本上仅提供两个不同的操作输出,其首先沿顺时针方向旋转,其次沿逆时针方向旋转。在图1-图3的前述实施方式中,马达驱动器115适于沿第一方向旋转以铰接远侧铰接区域105(参考图1和图3A),然后沿相反方向或第二方向旋转以将铰接区域105去铰接,从而将轴杆返回为线性形状。
然而,图5的探针需要三个功能:(i)将工作端铰接,(ii)将工作端去铰接;以及(iii)使有源电极420往复运动。
图7是轮毂404(图5)内部的机构的剖视和分解示意图,其提供了上面列出的三种功能。图2的马达驱动器115在与远侧压缩弹簧455协作地沿第一方向旋转时,可以将工作端铰接和去铰接。然后,马达驱动器115可以在第二或相反的旋转方向上旋转,以使远侧壳体422中的有源电极420往复运动,如下面将进一步详细描述的。
参考图6-图7,可以理解的是,提供铰接功能的轴杆410和工作端415包括第一或外套筒445和第二同心内套筒448。第一套筒445固定在携带轮毂芯460的远侧轮毂体458中。第一套筒445具有开槽的远侧部分462,如图5-图6所示。
参考图7,第二套筒448适于在第一套筒445和轮毂芯460的孔腔464中轴向移动。第二套筒448还具有开槽的远侧部分466和在焊缝470处焊接到第一或外套筒445(参见图6)以提供如前所述的铰接的远侧末端。第二套筒448固定到远侧轴环475,远侧轴环475携带横向销钉476,横向销钉476适于在轮毂芯460中的弧形狭槽477中移动,从而相对于第一或外套筒445轴向移动轴环475。第二套筒448的近端478也固定到下面进一步描述的中间轴环480。携带有源电极420(图6)的第三或最内侧套筒450固定到近侧轴环485,近侧轴环485适于分别相对于第一套筒445和第二套筒448轴向地来回移动。
最后,图7以示意图示出了驱动联轴器490,其适于在轮毂404(参考图5)的近端492中的周向凹槽中自由旋转而不轴向移动。示出了图7中的自由旋转驱动联轴器490远离近侧轴环485向近侧移动。
现在更详细地描述携带轮毂404的图7的双重旋转机构,可以看出,驱动联轴器490在由虚线箭头AA指示的第一方向上的旋转将使第二套筒448相对于第一套筒445在远侧方向上移动,从而将铰接区域440铰接。更详细地,控制器和马达驱动器115可以被配置用于使驱动联轴器490在第一方向上以低速和仅预定的角度数旋转。控制器185(图2)接收来自霍尔传感器的信号,霍尔传感器感测驱动联轴器490中的磁体以确定驱动联轴器490的旋转位置,如2017年4月24日提交的题为ARTHROSCOPIC DEVICES AND METHODS的共同未决且共同拥有的美国专利申请号15/495,620中所述。在该变型中,控制器185同样可以初始确定驱动联轴器490的旋转位置,并且继而根据需要将驱动联轴器旋转到任何期望的位置。
现在参考图6,可以看出,驱动联轴器490携带延伸构件495,延伸构件495轴向延伸并且与近侧轴环485的凸轮表面500相接。当驱动联轴器490沿第一方向旋转时,延伸构件495沿凸轮表面500移动直到与垂直表面505相接。在延伸构件495与垂直表面505相接之后,延伸构件495沿第一方向的进一步旋转继而使近侧轴环485旋转。如在图7中可以看到,近侧轴环485具有轴向延伸部分508,其可滑动地接合中间轴环480中的凹口510。此外,中间轴环480固定到第二套筒448,并且组装件继而在旋转时轴向移动,同时横向销钉476在轮毂芯460中的弧形狭槽477中移动。从图7可以理解的是,中间轴环480的旋转引起横向销钉476在弧形狭槽477中的运动,从而沿着远侧方向轴向推动铰接探针的第二套筒448。
在图7的右下部分中,轮毂芯460的孔腔515中的弧形狭槽477以平坦的平面示出,该平坦平面图示了当销钉476在轮毂芯460中的孔腔515的表面内移动时狭槽477的形状。可以理解的是,远侧轴环475和横向销钉476的旋转可以沿着弧形狭槽477从初始销钉位置X移动,其中探针未铰接到第二销钉位置Y,其中探针部分地铰接到第三销钉位置Z,其中探针是完全铰接的。弧形狭槽477可以具有带有可选的棘爪522a和522b的平坦部分520a和520b,其中销钉476可以停滞以将铰接区域440保持在特定的铰接配置中。应当理解的是,在弧形狭槽477中可以存在若干不同的平坦区域,以提供多个铰接角度。从图7可以理解,远侧压缩弹簧455适于相对于第一套筒445在近侧方向上推进第二套筒448以拉直铰接的工作端,并且平坦狭槽部分520a和520b防止弹簧沿着狭槽477的斜面移动到销钉。在图7中,第二套筒445相对于静止的第一套筒445的最大轴向移动以延伸距离DD表示,延伸距离DD是销钉476销钉狭槽477的最大轴向移动。
在图7中还可以看到,远侧弹簧455可具有固定在中间轴环480中的近端526和固定在轮毂芯460中的远端528,使得弹簧抵抗压缩并且还抵抗旋转。因此,远侧弹簧455适于将探针的铰接区域440(图5)推向线性配置。再次参考图7右下部分的图,可以理解的是,轴环475和销钉476到位置ZZ的马达驱动旋转继而将使销钉476移动到弧形狭槽477的返回部分532中,然后在远侧弹簧455的力的作用下返回到初始位置X。
现在转向图7所示机构所提供的往复机构,其可以描述驱动轴环490在由实线箭头BB指示的第二方向上的旋转会如何使第三套筒450相对于工作端415在任何铰接位置往复运动,从而使有源电极420往复运动(参考图5-图6)。应该理解的是,第三套筒450的远侧部分535(图6)可以在多个取向上开有狭槽,从而在通过第一套筒445和第二套筒448的内部的通道内起到柔性驱动轴杆(无论是笔直还是铰接的)的作用。
在图7中可以看出,驱动联轴器490沿第二方向(实线箭头BB)的旋转使得延伸销钉495沿着凸轮表面500行进,从而使近侧轴环485向近侧移动,直到延伸销钉495在垂直表面505上旋转,这继而允许近侧轴环485在近侧弹簧540的力的作用下沿近侧方向移动。因此,图7图示了在CC处指示的往复运动的行程等于垂直表面505的高度。抵抗压缩的近侧弹簧540定位在近侧轴环485与中间轴环480之间并且始终在近侧方向上推进近侧轴环。
因此,可以理解的是,通过使用马达驱动器115,控制器185如何可以在工作端的任何铰接角度期间铰接探针400的工作端并使有源电极420(图5)在工作端415中往复运动。
仍然参考图7,示意性地示出了RF源190,其中第一电引线160耦合至弹簧触头162,弹簧触头162接合作为导电金属的近侧轴环485,从而将RF电流传导至第三套筒450和在工作端的有源电极420。来自RF源190的第二引线172延伸至远侧轮毂458并连接至第一套筒445,第一套筒445包括如前所述的返回电极。应当理解,套筒445、448和450中的每一个均可以具有薄的绝缘涂层(图7中未示出),从而将RF电流路径相对于工作端415绝缘。
尽管上文已经详细描述了本发明的特定实施方式,但是将理解的是,该描述仅用于说明的目的,并且本发明的上述描述并非详尽无遗的。本发明的具体特征在一些附图中示出而在其他附图中没有示出,这仅仅是为了方便,并且可以根据本发明将任何特征与另一特征组合。对于本领域普通技术人员来说,许多变化和替代将是显而易见的。这样的替代和变化旨在包含在权利要求的范围内。在从属权利要求中呈现的特定特征可以被组合并且落入本发明的范围内。本发明还包括从属权利要求可选地以引用其他独立权利要求的多项从属权利要求的形式书写的实施方式。
其他变化也在本发明的精神内。因此,尽管本发明易于进行各种修改和替代构建,但本发明的某些图示的实施方式在附图中示出并且已在上文详细描述。但应该理解的是,无意将本发明限制于所公开的特定形式,相反,其目的是在于涵盖落入如所附权利要求中限定的本发明的精神和范围内的所有修改、替代构建和等同物。
除非本文另有说明或与上下文明显矛盾,否则在描述本发明的上下文中(特别是在以下权利要求的上下文中),术语“一个”和“一种”和“该”的使用以及类似的指示物应被解释为涵盖单数和复数。除非另有说明,否则术语“包含”、“具有”、“包括”和“含有”应被解释为开放式术语(即,意味着“包括但不限于”)。术语“连接”应被解释为部分或全部地包含在内、附接至或接合在一起,即使存在某些干预。除非本文另有说明,否则本文中对数值范围的记载仅旨在用作单独提及落入该范围内的每个单独值的简写方法,并且每个单独的值都被包括在本说明书中,如同它们在本文中被单独记载。除非本文另有说明或上下文明显矛盾,否则本文所述的所有方法都可以以任何合适的顺序进行。除非另外声明,否则本文提供的任何和所有示例或示例性语言(例如,“诸如”)的使用仅旨在更好地说明本发明的实施方式,并不对本发明的范围构成限制。说明书中的任何语言都不应被解释为表明任何未要求保护的元素对于本发明的实践是必不可少的。
本文描述了本发明的优选实施方式,包括发明人已知的实施本发明的最佳方式。在阅读前面的描述时,那些优选实施方式的变化可以对于本领域普通技术人员来说变得显而易见。发明人预期熟练的技术人员能够根据需要采用这些变化,并且发明人希望本发明以不同于如本文具体描述的方式实施。因此,本发明包括适用法律所允许的对所附权利要求中记载的主题的所有修改和等同物。此外,除非本文另有说明或上下文明显矛盾,否则本发明涵盖上述元素的所有可能变化的任何组合。
本文引用的包括出版物、专利申请和专利在内的所有参考文献均通过引用并入本文,其程度如同每个参考文献被单独且具体地指出通过引用并入本文并且在本文中完整阐述。
Claims (41)
1.一种用于与具有旋转驱动器的机动手持件一起使用的装置,所述装置包括:
轴杆,其具有近端和铰接远侧区域;
轮毂,其附接至所述轴杆的所述近端,所述轮毂适于可拆卸地连接至所述机动手持件;以及
可旋转驱动联轴器,其处于所述轮毂内,并被配置成当所述轮毂连接至所述手持件时可拆卸地接合所述旋转驱动器,其中所述旋转联轴器通过所述驱动器的旋转导致所述轴杆的所述铰接远侧区域铰接。
2.如权利要求1所述的医疗装置,其中所述轴杆包括外同心套筒和内同心套筒,其中所述外套筒的近端固定在所述轮毂中,并且所述内同心套筒的近侧部分响应于所述驱动器的旋转而在所述外同心套筒的内部孔腔中轴向可移动。
3.如权利要求2所述的医疗装置,其中所述轴杆具有至少一个远侧组件,所述至少一个远侧组件将所述外同心套筒和所述内同心套筒的远端保持成固定关系。
4.如权利要求3所述的医疗装置,还包括在所述内套筒的近端上的第一轴环,其中所述可旋转驱动联轴器接合所述第一轴环,从而在所述可旋转驱动联轴器通过所述手持件的所述旋转驱动器而旋转时纵向地驱动所述轴环。
5.如权利要求4所述的医疗装置,其中所述第一轴环是有螺纹的,并且所述可旋转驱动联轴器螺纹地接合所述轴环,从而纵向地驱动所述第一轴环以铰接所述轴杆的所述远侧区域。
6.如权利要求4所述的医疗装置,其中所述第一轴环具有接合表面,并且所述可旋转驱动联轴器使一销钉相对于所述接合表面而旋转,从而纵向地驱动所述第一轴环以铰接所述轴杆的所述远侧区域。
7.如权利要求6所述的医疗装置,还包括在所述轴杆的所述铰接远侧区域的远端处的可往复电极。
8.如权利要求7所述的医疗装置,还包括具有远端和近端的第三同心套筒,其中所述远端附接至所述可往复电极并且近端附接至所述驱动联轴器,所述可旋转驱动联轴器被配置用于使所述销钉相对于所述第一轴环上的凸轮表面以相反方向旋转,从而纵向地驱动所述第三套筒以使所述可往复电极往复运动。
9.如权利要求3所述的医疗装置,其中所述至少一个远侧组件包括陶瓷构件。
10.如权利要求2所述的医疗装置,其中所述驱动联轴器的旋转使所述内套筒相对于所述外套筒轴向移动。
11.如权利要求2所述的医疗装置,其中所述铰接区域包括在所述内套筒和所述外套筒中的一系列狭槽。
12.如权利要求11所述的医疗装置,其中所述外套筒中的所述狭槽径向地偏离所述内套筒中的所述狭槽。
13.如权利要求9所述的医疗装置,还包括在所述轴杆的远端处携带的第一极性电极。
14.如权利要求13所述的医疗装置,其中所述第一极性电极由所述陶瓷构件携带。
15.如权利要求13所述的医疗装置,其中外同心套筒的表面包括第二极性电极。
16.如权利要求2所述的医疗装置,还包括安设在所述外同心套筒与所述内同心套筒之间的绝缘层。
17.如权利要求15所述的医疗装置,还包括在所述轮毂中的第一电触点和第二电触点,所述第一电触点和所述第二电触点分别连接至所述第一极性电极和所述第二极性电极。
18.如权利要求1所述的医疗装置,其中所述可旋转驱动联轴器被配置成顺时针旋转以沿第一方面弯曲所述铰接区域,以及被配置成逆时针旋转以沿第二方向弯曲所述铰接区域。
19.如权利要求1所述的医疗装置,其中所述机动手持件包括电马达。
20.如权利要求19所述的医疗装置,其中所述手持件具有在其外表面上的致动器,用于手动地启动所述马达以弯曲所述铰接区域。
21.如权利要求17所述的医疗装置,其中所述手持件具有在其外表面上的致动器,用于控制RF能量向所述第一极性电极和所述第二极性电极的递送。
22.如权利要求17所述的医疗装置,其中所述内套筒具有内部通道,所述内部通道延伸至所述轴杆的远侧区域中的开放末端。
23.如权利要求22所述的医疗装置,其中所述内部通道适于连接至负压源。
24.一种关节镜系统,包括:
机动手持件,其具有马达轴杆;
探针,其具有(a)适于可拆卸地连接至所述机动手持件的近侧轮毂和(b)具有铰接远侧区域的轴杆;以及
可旋转驱动联轴器,其处于所述轮毂内,适于耦合至所述马达轴杆,其中所述驱动联轴器通过所述马达轴杆的旋转导致所述铰接区域的铰接。
25.如权利要求24所述的关节镜系统,其中所述轴杆包括外同心套筒和内同心套筒,其中所述外套筒的近端固定在所述轮毂中,并且所述内套筒的近端被所述可旋转驱动联轴器沿第一方向驱动以铰接所述铰接远侧区域。
26.如权利要求24所述的关节镜系统,其中所述内套筒的近侧部分可在所述外套筒的内部孔腔中轴向移动。
27.如权利要求24所述的关节镜系统,还包括连接所述外套筒和所述内套筒的远端的陶瓷构件。
28.如权利要求24所述的关节镜系统,还包括由所述陶瓷构件携带的第一极性电极。
29.如权利要求28所述的关节镜系统,其中外套筒的表面包括第二极性电极。
30.如权利要求29所述的关节镜系统,还包括安设在所述外套筒与所述内套筒之间的绝缘层。
31.如权利要求30所述的关节镜系统,还包括在所述手持件中的电触点,所述电触点适于与所述轮毂中的协作电触点耦合以激发所述第一极性电极和所述第二极性电极。
32.如权利要求25所述的关节镜系统,还包括在所述轴杆的所述铰接远侧区域的远侧端头处的可往复电极。
33.如权利要求32所述的关节镜系统,还包括具有远端和近端的第三同心套筒,其中所述远端附接至所述可往复电极并且所述近端由所述驱动联轴器向相反方向驱动,从而纵向地驱动所述第三套筒以使所述可往复电极往复运动。
34.一种关节镜系统,包括:
机动手持件,其具有电子显示器;以及
探针,其具有连接至具有铰接远侧区域的轴杆的轮毂,所述轮毂适于可拆卸地连接至所述机动手持件,其中马达被配置用于铰接所述探针轴杆的所述铰接区域;
其中所述显示器提供视觉指示,所述视觉指示显示由所述机动手持件造成的所述铰接区域的形状。
35.如权利要求34所述的关节镜系统,其中所述视觉显示器上的所述视觉指示可以在线性形状与完全铰接形状之间变化。
36.一种关节镜系统,包括:
机动手持件,其具有马达致动器按钮;
探针,其具有连接至具有铰接远侧区域的轴杆的轮毂,所述轮毂适于可拆卸地连接至所述机动手持件,其中马达被配置用于铰接所述探针轴杆的所述铰接区域;并且
其中所述致动器按钮被配置成使得所述致动器按钮上的持续压力使所述铰接区域在线性形状与完全铰接形状之间连续铰接,反之亦然,并且其中所述致动器按钮上压力的释放使所述铰接区域停止在选定形状。
37.一种关节镜系统,包括:
机动手持件,其具有马达致动器按钮;
探针,其具有连接至具有铰接远侧区域的轴杆的轮毂,所述轮毂适于可拆卸地连接至所述机动手持件,其中马达被配置用于铰接所述探针轴杆的所述铰接区域;并且
其中所述致动器按钮被配置成使得所述致动器按钮上的压力和压力释放使所述铰链区域从线性形状铰接成完全铰接形状,反之亦然。
38.一种关节镜系统,包括:
机动手持件,其具有马达致动器按钮;
探针,其具有连接至具有铰接远侧区域的轴杆的轮毂,所述轮毂适于可拆卸地连接至所述机动手持件,其中马达被配置用于铰接所述探针轴杆的所述铰接区域;并且
其中所述致动器按钮被配置成使得所述致动器按钮上的压力和压力释放使所述铰链区域铰接成从线性形状到完全铰接形状的选定角度数,反之亦然。
39.一种关节镜系统,包括:
机动手持件,其具有至少一个致动器按钮;
RF探针,其具有连接至具有铰接远侧区域的轴杆的轮毂,所述轮毂适于可拆卸地连接至所述机动手持件,其中马达被配置用于铰接所述探针轴杆的所述铰接区域;并且
其中致动器按钮被配置用于选择向由所述探针轴杆携带的双极电极进行的不同模式的RF电流递送。
40.如权利要求39所述的关节镜系统,其中RF电流递送的模式包括向所述电极递送消融波形。
41.如权利要求39所述的关节镜系统,其中RF电流递送的模式包括向所述电极递送凝固波形。
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US20180000534A1 (en) | 2018-01-04 |
WO2018005382A1 (en) | 2018-01-04 |
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US11766291B2 (en) | 2023-09-26 |
JP2019524202A (ja) | 2019-09-05 |
US20210177493A1 (en) | 2021-06-17 |
JP7015797B2 (ja) | 2022-02-03 |
US20230389981A1 (en) | 2023-12-07 |
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