CN109862834B - 具有接合剂递送通道的可弯曲的骨凿 - Google Patents

具有接合剂递送通道的可弯曲的骨凿 Download PDF

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CN109862834B
CN109862834B CN201780065478.4A CN201780065478A CN109862834B CN 109862834 B CN109862834 B CN 109862834B CN 201780065478 A CN201780065478 A CN 201780065478A CN 109862834 B CN109862834 B CN 109862834B
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C·珀迪
D·巴尔别兹
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
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    • A61B17/8805—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
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    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
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    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
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    • A61B17/8819—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it characterised by the introducer proximal part, e.g. cannula handle, or by parts which are inserted inside each other, e.g. stylet and cannula
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    • A61B2018/00339—Spine, e.g. intervertebral disc

Abstract

本公开示出用于治疗硬组织的骨凿。本文描述的所述骨凿实施方案包括轴，所述轴具有工作端部，所述工作端部被构造成移位硬组织和管腔以通过所述轴递送材料。通过选择性地从线性构型转变到非线性构型，所述工作端部可形成通路。当所述工作端部处于线性构型或允许所述通路的精确填充的非线性构型时，所述管腔可通过所述轴递送材料。

Description

具有接合剂递送通道的可弯曲的骨凿
相关申请
本申请要求2016年10月27日提交的并且标题为“Articulating Osteotome withCement Delivery Channel(具有接合剂递送通道的可弯曲的骨凿)”的美国临时申请No.62/413,768的优先权，该申请据此全文以引用方式并入。
技术领域
本公开整体涉及用于治疗骨或硬组织的系统和方法。更特别地，一些实施方案涉及用于在锥骨中形成路径或腔并注射骨接合剂以治疗锥骨压缩骨折的医疗器械和方法。
附图说明
本文的书面公开内容描述了非限制性和非详尽的示例性实施方案。对附图中示出的此类示例性实施方案中的某些进行了参照，其中：
图1是根据一个实施方案的用于治疗硬组织的医疗装置的透视图。
图2是根据一个实施方案的用于治疗硬组织的医疗装置的尖端的透视图。
图3是根据一个实施方案的用于治疗硬组织的医疗装置的可弯曲的部分的透视图。
图4是根据一个实施方案的用于治疗硬组织的医疗装置的侧剖视图。
图5是根据一个实施方案的具有半圆柱形部分的轴的内杆的透视图。
图6是根据一个实施方案的具有管心针的管腔的透视图。
图7是根据一个实施方案的医疗装置的顶部剖视图。
图8示出处于线性构型的轴的可弯曲的部分的剖视图。
图9示出处于第一弯曲构型的图8的可弯曲的部分。
图10示出处于第二弯曲构型的图8的可弯曲的部分。
图11示出插入椎体中的导引器。
图12示出在图11的椎体中形成通路的骨凿。
图13是正通过骨凿中的管腔注射到图12的通路中的骨接合剂的剖视图。
图14是根据一个实施方案的用于治疗流体地耦接到骨接合剂注射器的硬组织的医疗装置的透视图。
具体实施方式
本公开提供通过在骨或其他硬组织内形成和填充腔来治疗硬组织的方法和系统。用于治疗硬组织的医疗装置可包括具有可弯曲的部分的轴、被构造成操纵可弯曲的部分的柄部、延伸到轴的可接取部分的侧端口、以及在插入到侧端口中的管腔。在一个实施方案中，医师可将轴的可弯曲的部分推进到椎体中。医师可操纵柄部以引起可弯曲的部分从线性构型移动到非线性构型。可弯曲的部分的构型的改变可使椎体中的组织移位，从而形成通路。当可弯曲的部分处于允许通路的精确填充的非线性构型时，医师可通过管腔注射骨接合剂。
轴可包括导管和杆。导管可具有沿着远侧部分的第一侧的一系列狭槽。狭槽可允许远侧部分偏转，从而形成导管的可弯曲的远侧部分。杆可包括延伸穿过导管的半圆柱形部分。半圆柱形部分的形状可允许杆在施加力时挠曲，并在力被移除时返回到线性位置。
杆可耦接到导管的远侧端部。在一些实施方案中，杆和导管可直接附接。例如，杆和导管可在远侧端部处焊接在一起。焊接可沿着杆和导管的远侧尖端。在一些实施方案中，焊接可设置在导管的附加的凹口、孔或狭槽处，由此增大导管和杆的焊接表面区域。换句话讲，焊接接头可围绕凹口、孔或狭槽的周边形成，以将杆附接到导管。
杆可延伸穿过导管。杆可沿着导管的第一侧上的狭槽延伸。狭槽在导管中的位置，以及杆相对于导管的相对位置，可限制可弯曲的远侧部分在一个平面中的移动。在一些实例中，当杆在近侧方向上平移时(不移位导管)，在杆和导管之间的耦接和定位可引起杆和导管在可弯曲的远侧部分处挠曲。
轴还可包括位于导管的可弯曲的远侧部分的端部处的尖锐尖端以刺透硬组织。在一些实施方案中，尖端可由导管和/或杆形成。在另一实施方案中，尖锐尖端可为耦接到导管和/或杆的单独的部分。可弯曲的远侧部分和尖端可具有足够的强度以机械地移位在患者的椎骨内的组织。
柄部可包括耦接到杆的近侧端部的致动部分。致动部分的移动可导致杆的相关联的移动。例如，致动部分可控制杆的轴向移动。在一些实施方案中，致动部分的旋转可导致杆的近侧移动。因此，通过将致动部分旋转所选择的量，可弯曲的部分可可弯曲的至所选择的角度，并且可弯曲的远侧部分可选择性地在线性构型和可弯曲的构型之间移动。
柄部还可包括力限制器。如果目标力施加在致动部分上，则力限制器可使致动部分与杆的近侧端部脱离接合。目标力可在可弯曲的远侧部分的断裂点附近。力限制器可防止可弯曲的远侧部分断裂。
类似地，在一些实例中，整个导管和杆组件可经由离合器或扭矩限制组件耦接到柄部。此类组件可限制可从柄部传输到导管和杆组件的扭矩的量。该扭矩限制组件可减少由于柄部施加的过大的力而导致的杆和/或导管的断裂。
在包括扭矩限制器的一些实施方案中，接合剂或其他物质可借助梭动部件沿着通过扭矩限制器组件的注射路径为能够移位的。梭动部件可为相对于导管能够旋转地移位的，并且可包括围绕其圆周的开口以形成流体路径，无论梭动件相对于导管的旋转位置为何。
侧端口可耦接到柄部。侧端口可具有延伸到导管的可接取部分或工作通道的插入引导件。导管的工作通道或可接取部分可为未由杆的半圆柱形部分占据的部分。管腔可插入到可接取部分中。
插入的管腔可延伸穿过导管到达可弯曲的远侧部分中的开口。管腔可为中空半圆柱体，其为材料提供穿过导管的路径。管腔可包括表面，该表面包括润滑聚合物材料。例如，材料可包括具有低摩擦性能的任何生物相容材料(例如
Figure GDA0003422738300000031
聚四氟乙烯(PTFE)、FEP(氟化乙烯丙烯)、聚乙烯、聚酰胺、ECTFE(乙烯氯三氟-乙烯)、ETFE、PVDF、聚氯乙烯和有机硅)。与杆类似，管腔可为半圆柱形。半圆柱形杆和管腔可定位在导管内以形成填充导管的圆柱体。
管腔端口可耦接到管腔。管腔端口可包括夹具。夹具可通过夹具皮套将管腔端口固定到侧端口。由于在半圆柱形可接取部分内难以旋转半圆柱形管腔，杆和管腔的半圆柱形形状可防止使用螺纹连接器固定管腔。夹具提供将不需要管腔旋转的附接方法。管腔端口可选择性地耦接到热能递送探头、接合剂递送筒及活体组织检查工具。管腔也可为能够选择性地移除和替换的。例如，如果接合剂开始阻塞管腔，新的管腔可替换阻塞的管腔。
在一些实施方案中，可选择性地将管心针插入管腔中。管心针可延伸穿过管腔用于对可弯曲的远侧部分的附加的支撑。管心针可为填充管腔的柔性材料。可移除管心针以允许使用附加的工具和接合剂。
短语“耦接到”足够宽泛至指在两个或更多个实体之间的任何合适的耦接或其他形式的相互作用，包括机械、流体和热相互作用。因此，两个部件可耦接到彼此，即便其不与彼此直接接触。短语“附接到”或“直接附接到”是指彼此直接接触和/或仅通过任何合适的种类的紧固件(例如，安装硬件或粘合剂)彼此分开的在两个或更多个实体之间的相互作用。短语“流体连通”以其普通意义被使用，并且足够宽泛至指其中当元件彼此流体连通时流体(例如，气体或液体)可从一个元件流向另一个元件的布置方式。
术语“近侧”和“远侧”是相反的方向术语。例如，装置或部件的远侧端部是在正常使用期间距离医师最远的部件的端部。近侧端部是指相反的端部，或者是在正常使用期间最靠近医师的端部。
如本文的图中总体描述且示出的实施方案的部件可被布置并设计成多种不同的构型。因此，以下对在图中所表示的各种实施方案的更详细描述不旨在限制本公开的范围，而是仅仅表示各种实施方案。尽管在附图中呈现了实施方案的各种方面，除非明确指示，否则附图未必按比例绘制。
图1是根据一个实施方案的用于治疗硬组织的医疗装置100的透视图。在一个实施方案中，医疗装置100可为骨凿，该骨凿被构造成用于进入椎体的内部、在锥骨松质骨中形成通路、以及用骨接合剂填充通路。医疗装置100可包括轴102、柄部104、侧端口106、以及管腔108。
在使用中，医师可通过患者脊柱的椎弓根将轴102引入。轴可包括导管112和半圆柱形杆114。导管112和杆114可由合适的金属合金诸如不锈钢或NiTi制成。轴可构造有可弯曲的部分110。可弯曲的部分110可基于在导管112和半圆柱形杆114之间的耦接沿着一个平面偏转。例如，如图所示，半圆柱形杆114可与导管112上的一系列狭槽邻接并沿着导管112上的一系列狭槽延伸。一系列狭槽可允许导管112弯曲并且半圆柱形杆的形状可允许半圆柱形杆弯曲。可弯曲的部分110可位于轴的远侧端部处。
可弯曲的部分110可渐进地致动以弯曲所选择的角度和/或旋转以在椎体中形成弯曲通路和腔。管腔108可通过侧端口106插入并延伸穿过轴102以提供骨接合剂经过的通路。可弯曲的部分110可保持处于弯曲状态，而骨接合剂可直接注射到腔中。
柄部104可耦接到轴102的近侧端部。柄部104可包括抓持部分116以及致动器部分118。抓持部分116可耦接到导管112。并且致动器部分118可操作地耦接到半圆柱形杆114。轴102可耦接到柄部104，以允许医师将轴102驱动到骨中，同时将可弯曲的部分110致动到可弯曲的构型或弯曲构型。柄部104可由聚合物、金属或任何其他材料制成。在一些实施方案中，柄部104的材料可适于承受用于将组件驱动到骨中的锤击力或冲击力(例如，经由在柄部104上使用锤或类似装置)。
致动器部分118可为相对于抓持部分116能够旋转的。当致动器部分118转动时，可弯曲的部分110可相关联地偏转。一些实施方案可具有用于止动致动器部分118的移动并由此保持可弯曲的部分110的偏转的系统或元件。例如，在一个实施方案中，抓持部分的一个或多个塑料挠曲突片可被构造成接合能够旋转的致动器部分中的凹口以在一定程度的旋转中提供触觉指示和临时锁定。
侧端口106可提供孔口，该孔口穿过柄部104进入未由半圆柱形杆、可接取部分或工作通道124占据的轴102的一部分。管腔108可插入侧端口106中并沿着工作通道124延伸穿过轴102。管腔108可通过夹具120固定到侧端口106。管腔108还可包括螺纹端口122以接受接合剂递送装置、活体组织检查工具以及其他医疗器械。在图1中示出的实施方案中，管心针126经由螺纹端口122耦接到管腔108。
图2是根据一个实施方案的用于治疗硬组织的医疗装置的尖端200的透视图。如图所示，导管202可涵盖杆204以及管腔206。图2中示出的尖端200的实施方案是图1的医疗装置100的尖端的示例。换句话讲，图2的尖端200的各种特征可结合图1的医疗装置100使用，并且反之亦然。结合图1所述的公开内容可不结合图2进行重复，但是此类公开内容类似地适用于图2的尖端200，并且反之亦然。该公开的图案适用于本申请中所述的每个图和实施方案，每个实施方案的特征可被理解为类似地应用到其他实施方案。
导管可具有一系列狭槽208。套筒中的任一个中的凹口或狭槽可沿着工作端部的长度包括均匀的宽度或者可包括变化的宽度。另选地，可在特定区域中选择宽度以实现特定弯曲轮廓。在其他变型中，宽度可沿着工作端部增大或减小以形成具有变化半径的曲线。
如图所示，杆204和管腔206二者可均为半圆柱形。当配对在一起时，它们的形状和尺寸设定可形成圆柱体，该圆柱体填充导管202的中心。管腔可对尖端200提供附加的支撑。
图3是根据一个实施方案的用于治疗硬组织的医疗装置的可弯曲的部分300的底部视图。图3中示出的可弯曲的部分300的实施方案是图1的医疗装置100的尖端的示例。换句话讲，图2的可弯曲的部分300的各种特征可结合图1的医疗装置100使用，并且反之亦然。结合图1所述的公开内容可以不结合图3进行重复，但是此类公开内容类似地适用于图3的可弯曲的部分300，并且反之亦然。
半圆柱形杆302可以各种方式附接到导管304。例如，半圆柱形杆的弧形的周边可在端部处焊接到导管304。其他附接点可用于将半圆柱形杆302固定到导管304。例如，所示焊接凹口306提供焊接区域以将半圆柱形杆302附接到导管304。在一些实施方案中，多个附接装置可用于将导管304附接到半圆柱形杆302。
图4是根据一个实施方案的用于治疗硬组织的医疗装置400的剖视图。如图所示，医疗装置400可包括杆402、柄部406、侧端口408、管腔410和导管412。医疗装置400的该剖视图是图1的医疗装置100的示例。换句话讲，图4的医疗装置400的各种特征可结合图1的医疗装置100使用，并且反之亦然。结合图1所述的公开内容可不结合图4进行重复，但是此类公开内容类似地适用于图4的医疗装置400，并且反之亦然。
杆402可包括圆柱形近侧端部414和半圆柱形远侧端部416。圆柱形近侧端部414可机械地耦接到柄部406的致动器部分404。在致动器部分404和圆柱形近侧端部414之间的机械耦接可将致动器部分404的旋转转换成沿着杆402的轴线的力。半圆柱形远侧端部416可延伸穿过导管412并占据导管的底部部分。半圆柱形远侧端部416由于其形状与圆柱形近侧端部414相比可为柔性的。
致动器部分404可移位圆柱形近侧端部414。圆柱形近侧端部414的移位在半圆柱形远侧端部416上施加力。半圆柱形远侧端部416可附接到导管412，引起半圆柱形远侧端部416上的力将杆402和导管706弯曲。
管腔410可经由侧端口408进入导管412。如图所示，侧端口408可位于柄部406的上部部分上。侧端口408可包括孔口418，该孔口通向导管412的上部部分。医师可通过孔口418插入管腔。管腔410可延伸穿过导管412，使得侧端口在导管412的远侧端部处具有第一开口420，并在侧端口408处具有第二开口422。
在一些实施方案中，管腔410可通过夹具424固定到侧端口。由于杆402和管腔410的半圆柱形形状，标准的螺纹固定机构可不能正常工作。例如，在其中管腔410在导管412中没有旋转空间的实施方案中，标准的螺纹固定机构将不会工作。夹具424提供将管腔固定到侧端口408的另选方案，无需管腔410旋转。管腔还可包括螺纹附接点426以选择性地耦接到管心针、热能递送探头、接合剂递送筒、或活体组织检查工具。
图5是轴的内杆500的透视图。图5的内杆500是图1中的杆114的示例。结合图1所述的公开内容可不结合图5进行重复，但是此类公开内容类似地适用于图5的医疗装置500，并且反之亦然。
内杆可包括圆柱形部分502和半圆柱形部分504。圆柱形部分502可提供非旨在弯曲的内杆500的刚性长度。半圆柱形部分504可经由其形状被构造成在向其施加力时挠曲。如图所示，在圆柱形部分502和半圆柱形部分504之间的变窄可为迅速的。在另选的实施方案中，圆柱形部分502可逐渐变窄到半圆柱形部分504以允许在内杆500的一些点处的柔性比其他点更大。
图6是根据一个实施方案的具有管心针608的管腔600的透视图。如图所示，管腔600可包括衬里602、侧端口夹具604、以及螺纹配合机构606。图6的管腔600是图1中的管腔108的示例。结合图1所述的公开内容可不结合图6进行重复，但是此类公开内容类似地适用于图6的管腔600，并且反之亦然。
管腔600可以附加的强度对医疗装置提供附加的支撑以治疗硬组织，并允许材料从一个端部经过另一个端部。第一开口612可允许材料诸如骨接合剂进入管腔600。第二开口614可允许通过第一开口612进入管腔600中的材料流出。另选地，可从第二开口614将材料从第一开口612抽出，用于诸如活体组织检查的程序。侧端口夹具604可将管腔600固定到医疗装置，并且螺纹配合机构606可将管腔固定到附加的工具诸如热能递送探头、接合剂递送筒、或活体组织检查工具。
管心针可包括盖610以经由螺纹配合机构606将管心针608固定到管腔600。盖610还可防止异物通过管腔600进入椎骨。管心针608可为支撑性的，使得当管心针608插入管腔600时，所得的组合比单独管腔600更具刚性。这可对医疗装置提供附加的强度以治疗硬组织。在一些实施方案中，管心针608可为非常柔性的以更大程度地移动医疗装置。在另选的实施方案中，管心针608可为半刚性的用于额外支撑。
图7是根据一个实施方案的医疗装置700的顶部剖视图。如图所示，医疗装置700可包括用于致动的机构702，用于相对于导管706致动杆704。医疗装置700的该顶部剖视图是图1的医疗装置100的示例。换句话讲，图7的医疗装置700的各种特征可结合图1的医疗装置100使用，并且反之亦然。该医疗装置700也是图4的医疗装置400的示例，其中横截面沿着不同平面截取。结合图1所述的公开内容可不结合图7进行重复，但是此类公开内容类似地适用于图7的医疗装置700，并且反之亦然。
导管706可静态地附接到柄部708。在一些实施方案中，导管706可经由焊接、O形环、模塑、和/或夹紧件附接到柄部708。该附接可防止导管706相对于柄部708移动或旋转。导管706还可在远侧尖端712处或附近附接到杆704。
杆704可附接到在近侧端部处用于致动的机构702。用于致动的机构702可选择性地朝向或远离远侧尖端712平移杆704。平移可引起杆704在导管706和杆704之间的附接点处推动或拉动。因为导管706相对于柄部是静止的，推动或拉动可引起杆704和导管706偏转。
用于致动的机构702可耦接到柄部的致动器部分716。用于致动的机构702可包括螺纹致动器718以及具有螺纹配合轴承722的蛤壳720。螺纹致动器718可耦接到致动器部分，使得当医师旋转致动器部分716时，螺纹致动器718也旋转。蛤壳720可附接到杆704并通过螺纹配合轴承722接合螺纹致动器718。随着螺纹致动器718旋转，螺纹配合轴承722可沿着螺纹致动器718的螺纹滑动，防止蛤壳720旋转，同时朝向或远离远侧尖端712平移蛤壳。
用于致动的机构702可移位杆704的近侧端部。杆704的近侧端部的移位在杆704的远侧端部上施加力。因为杆704的远侧端部附接到导管706，杆704的远侧端部上的力引起杆704和导管706挠曲。
图8至图10示出处于线性构型和第一弯曲构型及第二弯曲构型的轴的可弯曲的部分800的剖视图。可弯曲的部分800可类似于图1的可弯曲的部分110。图1的可弯曲的部分110可类似于图8的可弯曲的部分800操作，并且反之亦然。
可弯曲的部分800弯曲的能力由于导管806中的凹口804以及杆802的形状。杆的半圆柱形形状引起其具有比杆为圆柱形时更大的柔性，以允许杆802弯曲。可弯曲的部分800的方向可由导管806中凹口804的位置限制。例如，可弯曲的部分800可仅沿着凹口804的平面弯曲。可弯曲的部分800在任何其他方向上是刚性的。任何可弯曲的构型的曲率通过凹口的间距以及在每个凹口峰之间的距离控制。
图8示出处于线性构型的可弯曲的部分800。图9示出处于第一弯曲构型的可弯曲的部分800。当杆802在远侧方向上推动导管806时，引起第一弯曲构型。例如，杆802可在尖端附近焊接到导管806。因为杆附接到导管，所以当导管806保持静止时推动杆802的力将引起杆802推动导管806的尖端，引起其挠曲以允许杆在远侧方向上移动。图10示出处于第二弯曲构型的可弯曲的部分800。当杆802在近侧方向上拉动导管806时，引起第二弯曲构型。例如，杆802可在尖端附近焊接到导管806。因为杆附接到导管，所以当导管806保持静止时拉动杆802的力将引起杆802拉动导管806的尖端，引起其挠曲以允许杆在近侧方向上移动。
图11至图13是根据一个示例性方法的使用中的骨凿的剖视图。该方法可包括获得具有尖锐尖端的医疗装置，该尖锐尖端被构造用于刺入锥骨中，该医疗装置包括，并将工作端部推进到椎体中。一旦进入椎体，医师可引起工作端部从线性构型移动到非线性构型以在椎体中形成通路。医师可在工作端部处于非线性构型时进一步通过管腔注射流体，从而以精确模式用流体填充通路。
图11示出正插入椎体1106中的导引器1100。医师通常将导引器1100和套筒1105轻击或以其他方式驱动到椎体1106中，直至导引器尖端1108朝向皮质骨1110在椎体的前部1/3内。
然后，移除导引器1100并朝近侧移动套筒1105(图12)。如在图12中可见，工具或骨凿1200通过导引器套筒1105插入并且可弯曲的。骨凿1200可为图1中的医疗装置100。在向骨凿的柄部施加驱动力和任选地旋转力以推进工作端部穿过松质骨1212以形成路径或腔1215时，工作端部1210可间歇地可弯曲。然后轻击工具以进一步将工作端部1210驱动到椎骨的中线、朝向或超过椎骨的中线驱动工作端部。医师可另选地可弯曲的工作端部1210，并进一步驱动和旋转工作端部，直至成像显示工作端部1210已形成最佳构型的腔1215。
然后，如图13中所示，医师可在工作端部1210处于非线性构型时，通过管腔1324注射骨接合剂1322。在工作端部1210处于非线性构型时注射骨接合剂1322的能力为医师提供对于如何填充路径或腔的精准控制。
图14是根据一个实施方案的用于治疗流体地耦接到骨接合剂注射器1402的硬组织的医疗装置1400的透视图。如图所示，注射器1402可通过接合管腔1408的螺纹配合机构1406耦接到医疗装置1400。医师可使用注射器1402来通过管腔1408推动接合剂。接合剂可行进通过医疗装置1400并流出远侧尖端1410。
本文所公开的任何方法包括用于执行所述方法的一个或多个步骤或动作。所述方法步骤和/或动作可彼此互换。换句话讲，除非对于实施方案的正确运行需要特定顺序的步骤或动作，否则可修改特定步骤和/或动作的顺序和/或用途。此外，本文所述方法的子程序或仅一部分可是在本公开范围内的单独的方法。换句话讲，一些方法可仅包括在更详细的方法中描述的步骤的一部分。
本说明书通篇对“实施方案”或“所述实施方案”的提及意指，结合该实施方案所述的特定特征、结构或特性包括在至少一个实施方案中。因此，如本说明书通篇所述，引用的短语或其变型不一定全部涉及相同实施方案。
类似地，受益于本公开的本领域的技术人员应当认识到，为了使本公开简化，在上述实施方案的描述中，有时将多个特征一起集中在单个实施方案、图或其描述中。然而，这种公开的方法不应解释为反映以下意图，即任何权利要求需要比该权利要求中明确列举的那些特征更多的特征。相反，如以下权利要求书所反映，本发明的方面在于比任何单个前述公开的实施方案的所有特征更少的特征的组合。因此，该具体实施方式后的权利要求书据此明确地并入到该具体实施方式中，其中每个权利要求独立地作为单独的实施方案。本公开包括独立权利要求与其从属权利要求的所有排列。
权利要求书中关于特征或元件的术语“第一”的叙述不一定暗示存在第二或附加的此类特征或元件。对于受益于本公开的本领域的技术人员将显而易见的是，可在不脱离本公开的基本原理的情况下对上述实施方案的细节作出改变。

Claims (21)

1.一种医疗装置，所述医疗装置用于治疗硬组织，包括：
导管，所述导管具有沿着所述导管的可弯曲的远侧部分的第一侧的一系列狭槽；
杆，所述杆延伸穿过所述导管，所述杆包括柔性部分；
柄部，所述柄部包括耦接到所述杆的近侧端部的致动部分，其中所述致动部分的移动导致所述杆和所述导管的相关联的移动，以选择性地在线性构型和可弯曲的构型之间移动所述可弯曲的远侧部分；
侧端口，所述侧端口通过插入引导件耦接到所述柄部，所述插入引导件延伸到所述导管的可接取部分，所述导管的可接取部分沿着所述导管延伸到所述导管的远侧端部；以及
在所述插入引导件中插入并延伸穿过所述导管的管腔。
2.根据权利要求1所述的医疗装置，还包括管腔端口，所述管腔端口具有耦接到所述管腔的夹具，并且其中所述侧端口包括夹具皮套以将所述管腔端口固定到所述侧端口。
3.根据权利要求2所述的医疗装置，其中所述管腔端口被构造成选择性地耦接到热能递送探头、接合剂递送筒、以及活体组织检查工具。
4.根据权利要求1至3中任一项所述的医疗装置，其中所述管腔为能够选择性地移除和替换的。
5.根据权利要求1至3中任一项所述的医疗装置，其中所述导管包括在所述远侧部分的所述第一侧上的凹口，其中所述导管和杆通过围绕所述凹口的周边的焊接接头附接。
6.根据权利要求1至3中任一项所述的医疗装置，其中所述可弯曲的远侧部分具有足够的强度以机械地移位在患者的椎骨内的组织。
7.根据权利要求1至3中任一项所述的医疗装置，其中所述可弯曲的远侧部分被构造成仅在单个平面中从所述线性构型转变到非线性构型。
8.根据权利要求1至3中任一项所述的医疗装置，其中所述管腔为半圆柱形，并且其中所述杆的柔性部分和所述管腔被定位在所述导管内以形成填充所述导管的圆柱体。
9.根据权利要求1至3中任一项所述的医疗装置，还包括管心针，所述管心针选择性地插入所述管腔中并且延伸穿过所述管腔用于对所述可弯曲的远侧部分的附加的支撑。
10.根据权利要求1至3中任一项所述的医疗装置，其中所述柄部还包括力限制器，当目标力施加在所述致动部分上时，所述力限制器使所述致动部分与所述杆的所述近侧端部脱离接合。
11.根据权利要求1至3中任一项所述的医疗装置，其中所述柔性部分包括耦接到所述导管的所述可弯曲的远侧部分并且与所述导管的所述第一侧邻接的半圆柱形部分。
12.根据权利要求1至3中任一项所述的医疗装置，还包括位于所述导管的所述可弯曲的远侧部分的端部处的尖锐尖端以刺透硬组织。
13.一种医疗装置，所述医疗装置用于治疗在患者的椎骨内的硬组织，所述医疗装置包括：
轴，所述轴具有可弯曲的部分，所述轴包括：
中空导管，所述中空导管具有沿着第一侧的一系列狭槽以允许偏转，以及
半圆柱形杆，所述半圆柱形杆延伸穿过所述中空导管并与所述中空导管的所述第一侧邻接，
其中所述中空导管和半圆柱形杆在所述可弯曲的部分的远侧端部处耦接，使得沿着所述半圆柱形杆的轴线施加的力转换成所述可弯曲的部分中的偏转，以在线性构型和可弯曲的构型之间可逆地移动，其中所述系列狭槽和所述半圆柱形杆将在所述线性构型和所述可弯曲的构型之间的移动限制到单个平面；
侧端口，所述侧端口具有夹具皮套，所述夹具皮套延伸到所述轴的可接取部分，所述轴的可接取部分沿着所述中空导管延伸到所述导管的远侧端部；以及
管腔，所述管腔具有夹具，以选择性地将所述管腔固定到插入引导件，所述管腔延伸穿过在两个端部处具有开口的所述中空导管，以允许材料通过所述轴的移动而不会接触所述轴。
14.根据权利要求13所述的医疗装置，其中所述可弯曲的部分具有足够的强度以机械地移位在患者的椎骨内的组织。
15.根据权利要求13至14中任一项所述的医疗装置，其中所述轴还包括尖的远侧端部，所述尖的远侧端部被构造成刺透在患者的椎骨内的骨。
16.根据权利要求13至14中任一项所述的医疗装置，其中所述管腔包括螺纹接口，以选择性地耦接到热能递送探头、接合剂递送筒、以及活体组织检查工具。
17.根据权利要求13至14中任一项所述的医疗装置，还包括管心针，所述管心针选择性地插入所述管腔中并且延伸穿过所述管腔用于对所述可弯曲的部分的附加的支撑。
18.根据权利要求13至14中任一项所述的医疗装置，还包括柄部，所述柄部包括耦接到所述杆的近侧端部的致动部分，其中所述致动部分的操纵引起所述可弯曲的部分的偏转。
19.根据权利要求18所述的医疗装置，其中所述柄部还包括力限制器，当目标力施加在所述致动部分上时，所述力限制器使所述致动部分与所述杆的所述近侧端部脱离接合。
20.根据权利要求13至14中任一项所述的医疗装置，其中所述管腔为能够选择性地移除和替换的。
21.根据权利要求13至14中任一项所述的医疗装置，其中所述管腔还包括骨接合剂材料源，所述骨接合剂材料源流体地耦接到管腔以使所述骨接合剂材料穿过所述管腔以在所述可弯曲的部分的所述远侧端部处流出。
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