CN110680426A - Recyclable achilles tendon minimally-invasive suture instrument and novel suture mode thereof - Google Patents
Recyclable achilles tendon minimally-invasive suture instrument and novel suture mode thereof Download PDFInfo
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- CN110680426A CN110680426A CN201910857764.5A CN201910857764A CN110680426A CN 110680426 A CN110680426 A CN 110680426A CN 201910857764 A CN201910857764 A CN 201910857764A CN 110680426 A CN110680426 A CN 110680426A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0482—Needle or suture guides
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0491—Sewing machines for surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/06004—Means for attaching suture to needle
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/06066—Needles, e.g. needle tip configurations
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
- A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
- A61B90/17—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins for soft tissue, e.g. breast-holding devices
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0464—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue
Abstract
The invention discloses a recyclable achilles tendon suture instrument and a novel suture mode thereof, and the recycled achilles tendon suture instrument comprises an outer side arm, a needle threading sleeve, a medical cutting cone, a double-ended needle with a thread, a suture needle guide tube, a single-side forceps body and an outer side arm of oval forceps which are mutually hinged into a whole, and a reverse meshing part arranged at the upper part of a handle part of the oval forceps, wherein the directions of the outer side arm and the front end of the oval forceps are consistent, and an included angle of 20 degrees is formed between the outer side arm and the handle part of the oval forceps in the longitudinal axis direction; the medical cutting awl can penetrate through the elliptic needle-penetrating sleeve with a rhombic through hole on the cross section and is matched with a rotary cross suture method to suture the broken end of the achilles tendon. The suture mode of the invention has the advantages of small wound, small tissue damage and less bleeding, effectively prevents the sagittal suture from being eccentric, has convenient disinfection of the whole set of instruments, low cost and simple and convenient operation, is beneficial to the early function training of patients and the popularization of basic medical institutions, and has potential industrialization prospect.
Description
Technical Field
The invention relates to the field of surgical operation instruments and methods, in particular to a recyclable novel minimally invasive suture instrument for achilles tendon rupture and a suture mode thereof.
Background
The achilles tendon is the thickest and strongest tendon in a human body, is about 15cm long, is positioned behind the lower section of the lower leg, is connected with the triceps surae and the calcaneus, has the main function of being responsible for plantar flexion of ankle joints, plays an important role in finishing actions such as walking, running, jumping and the like, is usually the fracture of achilles tendon tissues caused by sports injury or knife wound and the like, and can seriously affect the walking function of a patient after the fracture of the achilles tendon. Acute achilles tendon rupture is common in sports, and the incidence rate of the acute achilles tendon rupture is increased in recent years, which is related to the fact that people have increased interest in physical exercise and increased participation amount, thereby causing chronic strain of the achilles tendon; the device is also related to the fact that people have a high proportion of daily document work and static life, but the leisure time suddenly participates in the leisure activities with large exercise amount and high difficulty, so that the achilles tendon cannot bear the sudden overload movement; in addition, the tendon is easily broken due to the decrease in quality of tendons caused by various chronic diseases. Acute achilles tendon rupture is a common motor system injury at present, and is reported to show 18/10 ten thousands of incidence rate and to show an ascending trend; in all cases of achilles tendon rupture, more than 75% of cases are athletes in the age range of 30-50 years of life in physical activities.
The current treatment methods for achilles tendon rupture mainly comprise conservative treatment and traditional incision surgery treatment. Research shows that the incidence of recrudesce of the achilles tendon treated conservatively is 8-29%, and the motor function and the life quality of a patient are seriously influenced. The traditional incision operation can accurately and oppositely fracture the achilles tendon to obtain a certain curative effect, the recurrence rate of fracture is relatively low, but because the traditional incision operation is an open operation, the average length of an incision is about 10-15cm, the soft tissue is widely stripped, and the blood supply of the soft tissue around the achilles tendon is damaged secondarily, which are all reasons for complications such as slow healing of the achilles tendon, skin necrosis, sticky and heavy soft tissue, stiff ankle joint and the like after the traditional incision operation, the healing process of a patient is influenced, and the later-stage rehabilitation difficulty and pain of the patient are increased. Therefore, it is very necessary to find a new surgical treatment method.
In view of the problems caused by excessive stripping and exposure in the traditional operation, the best solution is to reduce the damage range and degree of soft tissues around the tendon to the maximum extent in the operation process, protect blood circulation around the tendon to the maximum extent and reduce secondary damage in the operation process. In recent years, the minimally invasive treatment of the achilles tendon rupture has been developed to a certain extent, and some progress is made. The broken achilles tendon is sutured through the skin of some people, but the method belongs to 'blind suturing', easily damages the sural nerve and other peritendinous tissues, and sometimes even needs to be operated again to loosen the nerve; in addition, because the broken end of the Achilles tendon can not be directly viewed, the quality of repair of the broken end can not be ensured, and complications such as recrudescence and Achilles tendon elongation are easy to occur. The effect of percutaneous suture for treating the rupture of the fresh closed achilles tendon under the assistance of the arthroscope is satisfactory, but the arthroscope equipment is expensive and is difficult to popularize in primary hospitals. At present, a stitching instrument for stitching the achilles tendon by using a small incision is also available at home and abroad. In general, the technical features of the existing achilles tendon suture instrument include: 1. the radian of the main body frame is not provided or does not conform to the shape of a human body, and the main body frame is difficult to be accurately positioned under a minimally invasive condition; 2. the surgical operation instrument is formed by assembling a plurality of parts, the parts need to be reassembled before the surgical operation, the operation instrument is complex and time-consuming, the parts are easy to lose, and the manufacturing cost is high. 3. The needle hole is simple in design, and the sewing mode is too single, so that the sewing strength is insufficient; because the achilles tendon belongs to the cord-shaped ligament tissue and the broken end is mostly in a horsetail shape, if the suture strength is insufficient, the reunion rate of the achilles tendon is higher.
For example, patent application publication No. CN 107736904A provides an Achilles tendon suturing device, which comprises a guide device, the guide device comprises a bracket, a first inner arm and a second inner arm, the bracket is U-shaped and comprises a first outer arm and a second outer arm which are oppositely arranged, the first outer arm and the second outer arm are respectively provided with free ends, the free end of the first outer arm and the free end of the second outer arm are used for being inserted between the achilles tendon and the tendon sheath, the free end of the first outer arm and the free end of the second outer arm are respectively positioned at the same end of the bracket in the length direction, the first inner arm and the second inner arm are positioned between the first outer arm and the second outer arm, the first inner arm and the first outer arm are oppositely arranged, the second inner arm and the second outer arm are oppositely arranged, and, first inner arm and second inner arm can just move towards opposite direction along the width direction of support, and then realize that first inner arm and second inner arm press from both sides tight or loosen with the leg. The achilles tendon stitching instrument realizes that the small incision finishes the achilles tendon stitching, but the achilles tendon stitching mode matched with the achilles tendon stitching instrument is not substantially improved, so that complications such as the reoccurrence of the achilles tendon or the lengthening of the achilles tendon are easy to occur in the postoperative rehabilitation period, and the achilles tendon stitching instrument is designed into a disposable instrument due to the material, so the cost is high, and the medical burden of a patient is increased.
Disclosure of Invention
The invention aims to provide a set of novel minimally invasive suture instruments for achilles tendon rupture and an improved suture mode thereof, which can be recycled, so as to solve the problems mentioned in the background technology.
To achieve the above object, the present invention is achieved by:
the minimally invasive suture instrument capable of recycling achilles tendon rupture comprises an oval forceps body, an outer side arm, a needle threading sleeve, a medical cutting cone, a double-ended needle with a thread and a suture needle guide tube; the oval forceps body comprises oval forceps unilateral forceps bodies hinged with each other and also comprises reverse meshing parts arranged between the forceps bodies on the two sides, the forceps bodies on the two sides are hinged with outer side arms on the two sides into a whole, the walking directions of the two outer side arms and the front end of the oval forceps are consistent, and the walking directions of the two outer side arms and the front end of the oval forceps are at an angle of 20 degrees with the handle part of the oval forceps, so that the insertion of the proximal end of the Achilles tendon can be conveniently carried out; elliptical holes are formed in the same positions of the front parts of the two lateral arms, needle penetrating sleeves can be installed and fixed, and the connecting line of the centers of the elliptical holes at the far ends of the two lateral arms and the center of a clamp hole of the oval clamp is perpendicular to the walking direction of the oval clamp; the reverse meshing part is positioned at the handle end of the oval forceps and can fix the single-side forceps body of the oval forceps at a certain specific angle by using a rodent; the suture needle guiding tube is of a hollow structure, and the middle section of the guiding tube is bent to the tip in an arc shape of 30 degrees; the tip of the guide tube is also smoothed to avoid damage to the surrounding tissue of the distal Achilles tendon, and a hollow handle is fixed to the trailing end thereof.
In a further improvement, the needle threading sleeve is of an elliptic cylinder hollow structure, the surface of the cylinder of the needle threading sleeve is provided with a pair of ventilation grooves, the cross section of the needle threading sleeve comprises four wire threading holes which are connected at the center and distributed in a diamond shape, and the wire threading holes are 3/4 circular through holes.
In a further improvement, the medical cutting cone can penetrate through the needle penetrating sleeve, the cone body part of the cutting cone is in a flat diamond shape, the tail part of the cutting cone is thin and wide, and the tip of the cone head and the diamond-shaped edge of the cone body are polished smooth edges.
In a further improvement, the double-ended needle with thread is integrated with the suture, and the needle bodies at the two ends of the suture needle can be distinguished by including but not limited to the methods marked with numbers 1301 and 1302 respectively.
The achilles tendon suture instrument is made of stainless steel except that the suture is a disposable consumable, and can be repeatedly recycled after strict disinfection treatment.
The novel mode for minimally invasive suture of the broken achilles tendon mainly comprises the following steps:
(1) making longitudinal incisions of 2.0-2.5cm long on the skin at the broken end of the Achilles tendon, exposing the broken Achilles tendon tissue and its surrounding soft tissue, observing that the broken end of the Achilles tendon is mostly split like horse tail, and its surrounding tissue is hyperemic and edema is obvious;
(2) inserting the front end of the oval forceps body between the broken end of the proximal achilles tendon and the achilles tendon fascia, and fixing the included angle position of the left forceps body and the right forceps body by using the rodent of the reverse meshing part to clamp and fix the achilles tendon; the lateral arm is now placed on the outside of the skin; then the needle-threading sleeve is sleeved into the sleeve through hole of the outer side arm;
(3) respectively making longitudinal incisions with the length of about 1.0cm on the skin at the corresponding positions of the needle penetrating sleeves, peeling the skin to the subcutaneous part by using hemostatic forceps to protect sural nerves, penetrating the medical cutting awl into the needle penetrating sleeves, and taking out the medical cutting awl after piercing the achilles tendon fascia at the position needing threading;
(4) a No. 1301 double-headed needle connected with a suture thread penetrates into a threading hole at the most proximal end of the threading sleeve at the initial needle inserting side of the achilles tendon and penetrates through the achilles tendon tissue and then penetrates out from a corresponding threading hole at the opposite side, and a No. 1302 needle is still left at the needle inserting side for standby;
(5) a No. 1301 needle penetrates into a threading hole above the needle-out side threading sleeve, penetrates through achilles tendon tissue and then penetrates out of a corresponding threading hole on the opposite side for standby;
(6) a needle with the number of 1302 penetrates through a threading hole below the needle inserting side threading sleeve, penetrates through achilles tendon tissue and then penetrates out of a corresponding threading hole on the opposite side for standby;
(7) a No. 1301 needle penetrates through a threading hole at the farthest end of the needle inserting side threading sleeve and penetrates through achilles tendon tissues and then penetrates out of a corresponding threading hole at the opposite side for standby;
(8) a No. 1302 needle penetrates through a threading hole at the farthest end of the needle threading sleeve at the needle outlet side, penetrates through Achilles tendon tissue and then penetrates out of a corresponding threading hole at the opposite side for standby;
(9) after the threading operation is finished, the threading sleeve is pulled out, the reverse meshing part is loosened, the front end of the oval forceps body is slowly withdrawn from the proximal achilles tendon, the suture line is taken out, and the suture line is tightened for later use;
(10) as the far end of the achilles tendon is stopped at the calcaneal tubercle, a 1.5mm Kirschner wire is used for driving the calcaneal tubercle to the opposite side to form a bony hollow channel in the direction vertical to the longitudinal axis of the calcaneal.
(11) A first double-head needle connected with a suture is penetrated into the osseous hollow channel at the calcaneus initial needle inserting side and is penetrated out to the opposite side, and a second double-head needle is still left at the needle inserting side for standby;
(12) penetrating a suture needle guide tube into the space between the subcutaneous fascia and the peritendinous tissue of the achilles tendon to a bony channel, penetrating the suture needle guide tube through the double-headed needle at the side, withdrawing the suture needle after withdrawing the suture needle guide tube for standby;
(13) repeating the step (12) to complete the threading-out action of the suture on the other side of the calcaneus;
(14) maintaining the plantar flexion position, gradually tightening and knotting the suture lines on the two sides of the broken end of the Achilles tendon, paying attention to keep the proper tension of the Achilles tendon, and completing the suture work of the broken end of the Achilles tendon;
(15) weaving and anastomosing the broken end of the horsetail Achilles tendon by using a 4-0 absorbable suture to strengthen the suture strength and recover the smoothness of the Achilles tendon anastomosed end;
(16) peritendinous tissue is sutured and the skin incision is closed after good blood circulation is checked.
The incision required by the surgical instrument is only 2.0-2.5cm and 1cm, the soft tissue stripping is less, and the injury of the sural nerve is avoided by matching the skillfully designed medical cutting cone with the hemostatic forceps to strip the subcutaneous tissue; and unique "rotatory alternately" suture mode is through increasing the achilles tendon tissue volume that contains between the suture and greatly reduced the suture to the cutting injury of achilles tendon tissue, avoid the suture to break out in the achilles tendon tissue moreover, the anastomotic firm reliability of maximum guarantee broken end to avoid postoperative fracture risk again.
The invention has the advantages of small surgical wound, less soft tissue stripping, small secondary damage of peritendinous tissue blood circulation, fast achilles tendon healing, low skin necrosis rate, light tissue adhesion and the like; the improved sewing mode can greatly increase the firmness and reliability of the broken end sewing and effectively prevent the sagittal suture from being eccentric; the two points are beneficial to the early rehabilitation exercise of the patient, further avoid the adhesion aggravation and the joint dysfunction caused by the failure of the early functional exercise, greatly relieve the pain of the patient and facilitate the patient to return to the normal life and work early. Meanwhile, the most common fracture part of the achilles tendon is 2-6cm away from the calcaneus stop, which is the application range of the instrument; in addition, except that the suture is a disposable consumable, the other parts are metal products which can be recycled after being sterilized, and compared with most of the existing disposable achilles tendon minimally invasive instruments, the medical instrument obviously reduces the economic burden of patients; the instrument is simple and convenient to operate, short in learning curve and suitable for popularization and use in primary medical institutions; therefore, the invention has potential industrialization prospect and good social effect, and accords with the medical improvement trend of reducing medical burden formulated by the current state.
Drawings
FIG. 1 is a top view of the oval forceps body and two side arms of the invention;
FIG. 2 is a side view of the oval forceps body and side arm of the present invention;
fig. 3 is an enlarged cross-sectional view of the threading sleeve of the present invention;
FIG. 4 is a top view of the medical cutting cone of the present invention;
FIG. 5 is an enlarged cross-sectional view of the forward end of the medical cutting cone of the present invention;
FIG. 6 is a view showing the structure of a double-ended needle with thread according to the present invention;
FIG. 7 is a longitudinal cross-sectional view of the needle guide of the present invention;
FIG. 8 is a longitudinal cross-sectional view of the proximal end of the Achilles tendon after suturing in accordance with an embodiment of the present invention.
FIG. 9 is a schematic view of a distal end of an Achilles tendon sutured in accordance with an embodiment of the present invention;
figure 10 is an isometric view of the body and two side arms of the oval forceps of the invention.
The labels in the figure are: 1. a suture needle guide tube; 2. a unilateral forceps body of the oval forceps; 3. an oval forceps handle; 4. a needle threading sleeve; 5. an outer side arm; 6. a medical cutting cone; 7. a reverse engagement portion; 8. a sleeve via hole; 9. a hinge screw; 10. a vent groove; 11. a hollow handle; 12. sewing; 13. a double-ended needle with a thread, wherein 1301 and 1302 are needle bodies on two sides of the suture thread; 14. cutting the handle of the cone; 15. achilles tendon fascia; 16. bony hollow passage opening, 17, calcaneal tuberosity.
Detailed Description
The invention will be further explained and illustrated with reference to the figures and examples.
Example 1: referring to fig. 1-7, the minimally invasive suture instrument for achilles tendon rupture capable of being recycled comprises an oval forceps body, an outer side arm 5, a needle threading sleeve 4, a medical cutting cone 6, a double-ended needle with thread 13 and a suture needle guide tube 1; the egg circular clamp body comprises egg circular clamp single-side clamp bodies 2 which are hinged with each other and hinged with outer side arms 5 into a whole, and the two outer side arms 5 are consistent with the walking direction of the front end of the egg circular clamp and bent in an arc shape of 20 degrees with the horizontal direction of an egg circular clamp handle 3; the front parts of the two outer side arms 5 are provided with elliptical sleeve through holes 8, the needle threading sleeves 4 can be installed and fixed, and the connecting line of the centers of the elliptical holes at the far ends of the two outer side arms 5 and the center of the oval hole at the front end of the oval forceps is vertical to the walking direction of the oval forceps; the reverse meshing part 7 is positioned at the handle end of the articulation part of the oval forceps and can fix the forceps bodies at two sides at a certain specific angle; the needle threading sleeve 4 is of an elliptic cylinder hollow structure, the surface of the needle threading sleeve is provided with a pair of ventilation grooves 10, the cross section of the needle threading sleeve comprises four thread holes which are connected at the center and distributed in a diamond shape, and the thread holes are all 3/4 circular through holes; the medical cutting cone 6 can penetrate through the needle penetrating sleeve 4, the cone body part of the cutting cone 6 is in a flat diamond shape, the rear part of the cutting cone is thin and wide, and the diamond edges of the cone head tip and the cone body are polished smooth edges; the suture needle guide tube 1 is of a hollow structure, the middle section of the guide tube is bent in an arc shape of 30 degrees to the tip, the opening of the tip is polished to be a smooth edge without sharp edges, and the tail end of the guide tube is connected with a hollow handle 11; the double-ended needle with thread 13 is a whole, and the needle bodies on the two sides are distinguished by the modes of marking as No. 1 and No. 2 respectively, but not limited to.
Referring to fig. 8, the recyclable minimally invasive suture method for achilles tendon rupture mainly includes the following steps:
(1) making a longitudinal incision with the length of about 2.0-2.5cm on the skin at the broken end of the Achilles tendon, exposing the broken Achilles tendon tissue and the peripheral tissue, and observing that the broken end of the Achilles tendon is mostly split like a horsetail, and the peripheral tissue is obvious in congestion and edema;
(2) inserting the front end of the oval forceps body between the proximal Achilles tendon broken end and the Achilles tendon fascia, and fixing the single-side forceps body 2 of the oval forceps at a proper position by using the rodent of the reverse meshing part 7, so that the front end of the oval forceps is enough to clamp and fix the Achilles tendon tissue; the two lateral outer arms 5 are arranged on the outer side of the skin; sleeving the needle-threading sleeve 4 into the sleeve through hole 8 of the outer side arm 5;
(3) respectively making longitudinal incisions with the length of about 1.0cm on the skin at the corresponding positions of the needle threading sleeve 4, peeling the skin to the subcutaneous part by using hemostatic forceps to protect sural nerves, penetrating the medical cutting awl 6 into the needle threading sleeve 4, and taking out the medical cutting awl after piercing the achilles tendon fascia through which threading is needed;
(4) a No. 1 double-headed needle 1301 connected with a suture thread penetrates into a threading hole at the most proximal end of a threading sleeve 4 at the initial needle inserting side of the achilles tendon, penetrates through the achilles tendon tissue and then penetrates out from a corresponding threading hole at the opposite side, and a No. 2 needle 1302 is still left at the needle inserting side for standby;
(5) a No. 1 needle 1301 is inserted into a threading hole above the needle-out side threading sleeve 4, penetrates through achilles tendon tissue and then penetrates out of a corresponding threading hole on the opposite side for standby;
(6) a No. 2 needle 1302 penetrates through a threading hole below the needle inserting side threading sleeve 4, penetrates through achilles tendon tissue and then penetrates out of a corresponding threading hole on the opposite side for standby;
(7) a No. 1 needle 1301 is inserted into a threading hole at the farthest end of the needle inserting side threading sleeve 4, penetrates through achilles tendon tissues and then penetrates out of a corresponding threading hole at the opposite side for standby;
(8) a No. 2 needle 1302 penetrates through the most distal threading hole of the needle outlet side threading sleeve 4, penetrates through the achilles tendon tissue and then penetrates out of the corresponding threading hole on the opposite side for standby;
(9) after the threading operation is finished, the tooth of the reverse meshing part 7 is loosened, the threading sleeve 4 is withdrawn, the oval forceps body is slowly withdrawn from the proximal end of the achilles tendon, the threaded suture is taken out, and the suture is tightened for later use;
(10) as the far end of the achilles tendon is stopped at the calcaneal tubercle, a 1.5mm Kirschner wire is used for driving the calcaneal tubercle into the opposite side to form a bony hollow channel in the direction vertical to the longitudinal axis of the calcaneal before suturing;
(11) a No. 1 double-headed needle 1301 connected with a suture is penetrated into a bone hollow channel from the initial insertion side of the calcaneus to the opposite side and is penetrated out, and a No. 2 double-headed needle 1302 is still left at the insertion side for standby;
(12) penetrating a suture needle guide tube 1 into the space between subcutaneous fascia and tissues around the Achilles tendon to a bony hollow passage port, penetrating the suture needle guide tube 1 through a double-headed needle at the side, withdrawing the suture needle guide tube 1, and then withdrawing the double-headed needle with suture for standby;
(13) repeating the operation of the step (12) to finish the extraction action of the suture on the other side of the calcaneus;
(14) maintaining the plantar flexion of the affected foot, gradually tightening and knotting the suture lines on the two sides of the broken end of the Achilles tendon, and paying attention to keep the proper tension of the Achilles tendon in the process to finish the main body suture work of the broken end of the Achilles tendon;
(15) the severed Achilles tendon tissue was woven into the anastomosis with a 4-0 absorbable suture to strengthen the suture and maximize the recovery of the smooth Achilles tendon anastomotic end.
(16) The tissue surrounding the Achilles tendon was sutured and finally the skin incision was closed after checking good blood circulation.
In another embodiment of the invention, when the fracture position of the achilles tendon is higher (about 6cm from the calcaneal tubercle), the steps (10) - (13) can be replaced by the steps (2) - (8) according to requirements, and the suture mode is only fine-tuned in the way that the unilateral forceps body of the oval forceps is inserted into the distal end of the achilles tendon and the needle threading direction is opposite.
In the description of the present invention, it is to be understood that the terms "the side", "the needle insertion side", "the needle withdrawal side", "the other side", "1301", "1302", "the opposite side", "both sides", etc., indicate orientations or positional relationships based on those shown in the drawings, and are only for convenience of describing the present invention and simplifying the description, but do not indicate or imply that the device or element referred to must have a specific orientation, be constructed in a specific orientation, and be operated, and thus should not be construed as limiting the present invention.
Although embodiments of the present invention have been shown and described, it will be appreciated by those skilled in the art that changes, modifications, substitutions and alterations can be made in these embodiments without departing from the principles and spirit of the invention, the scope of which is defined in the appended claims and their equivalents.
Claims (8)
1. The minimally invasive suture instrument for achilles tendon rupture capable of being recycled comprises a single-side clamp body of an oval clamp, an outer side arm, a needle threading sleeve, a medical cutting cone, a double-ended needle with a thread, a suture needle guide tube and a suture thread, and is characterized in that: the medical cutting awl, the double-ended needle with the thread and the suture needle guiding tube are also included, the forceps bodies on the single sides of the oval forceps on the two sides are hinged with the outer side arms into a whole, the medical cutting awl further comprises a reverse meshing part arranged between the forceps bodies on the two sides of the handle part, the walking directions of the two outer side arms and the front end of the oval forceps are consistent, and an included angle of 20 degrees is formed between the two outer side arms and the handle part of the oval forceps on the rear end in the longitudinal axis direction; the front parts of the two outer arms at the two sides are provided with symmetrically distributed elliptical holes at the same position, needle penetrating sleeves can be installed and fixed, and the connecting line of the elliptical holes at the far ends of the two outer arms and the center of the clamp hole of the oval clamp is vertical to the walking direction of the oval clamp; the reverse meshing part is positioned at the handle end of the oval forceps, and can fix the included angle of the forceps bodies at two sides of the oval forceps at a certain specific angle by using a rodent; the tail end of the suture needle guiding tube is fixedly connected with a hollow handle.
2. The set of minimally invasive recycled achilles tendon suturing instruments of claim 1, wherein: the needle threading sleeve is of a hollow elliptic cylinder structure, the outer surface of the needle threading sleeve is provided with a pair of ventilation grooves, the cross section of the needle threading sleeve comprises four threading holes which are connected at the center and distributed in a diamond shape, and the threading holes are 3/4 circular through holes.
3. A set of recyclable achilles tendon suturing instruments as claimed in claim 1, wherein: the oval hole clamping end at the front end of the oval forceps is a smooth surface, and no lines exist.
4. The set of recyclable minimally invasive achilles tendon suturing instruments according to claim 1, characterized in that: the reverse meshing part can fix the left and right clamp bodies of the oval clamp at a fixed included angle, and the included angle ranges from 15 degrees to 35 degrees.
5. The set of recyclable minimally invasive achilles tendon suturing instruments according to claim 1, characterized in that: the suture needle guide tube is of a hollow structure penetrating through the head and the tail, and the top end of the suture needle guide tube is subjected to smoothness treatment.
6. The set of recyclable minimally invasive achilles tendon suturing instruments according to claim 1, characterized in that: the needle bodies at the two sides of the double-ended needle with the thread are combined with the middle suture thread into a whole, and the needle bodies at the two ends of the double-ended needle with the thread can be distinguished in a mode including but not limited to marking No. 1301 and No. 1302.
7. The novel mode for minimally invasive suture of the Achilles tendon rupture as claimed in claim 1, characterized in that: the method mainly comprises the following steps:
(1) making longitudinal incisions of 2.0-2.5cm long on the skin at the broken end of the Achilles tendon, exposing the broken Achilles tendon tissue and its surrounding soft tissue, observing that the broken end of the Achilles tendon is mostly split like horse tail, and its surrounding tissue is hyperemic and edema is obvious;
(2) the front end of the oval forceps body is inserted between the broken end of the proximal achilles tendon and the achilles tendon sheath, and the included angle positions of the left forceps body and the right forceps body are fixed by using the rodent of the reverse meshing part, so that the left forceps body and the right forceps body clamp and fix the achilles tendon; the lateral arm is now placed on the outside of the skin; then the needle-threading sleeve is sleeved into the sleeve through hole of the outer side arm;
(3) respectively making a longitudinal incision with the length of about 1.0cm on the skin at the corresponding position of the needle penetrating sleeve, peeling off the skin to the subcutaneous part by using hemostatic forceps to protect the sural nerve, penetrating the medical cutting cone into the needle penetrating sleeve, and taking out the medical cutting cone after puncturing the achilles tendon sheath at the position needing threading;
(4) a No. 1301 needle of a double-ended needle connected with a suture thread penetrates into a threading hole at the most proximal end of the threading sleeve at the initial needle inserting side of the achilles tendon and penetrates through the achilles tendon tissue and then penetrates out from a corresponding threading hole at the opposite side, and a No. 1302 needle is still left at the needle inserting side for standby;
(5) a No. 1301 needle penetrates into a threading hole above the needle-out side threading sleeve, penetrates through the achilles tendon tissue and then penetrates out of a corresponding threading hole on the opposite side for later use;
(6) a needle with the number of 1302 penetrates through a threading hole below the needle inserting side threading sleeve, penetrates through achilles tendon tissue and then penetrates out of a corresponding threading hole on the opposite side for later use;
(7) a No. 1302 needle penetrates through a threading hole at the farthest end of the needle threading sleeve at the needle inserting side, penetrates through Achilles tendon tissue and then penetrates out of a corresponding threading hole at the opposite side for standby;
(8) a No. 1302 needle penetrates into a threading hole at the farthest end of the needle threading sleeve at the needle outlet side, penetrates through Achilles tendon tissue and then penetrates out of a corresponding threading hole at the opposite side for standby;
(9) after the threading operation is finished, the threading sleeves in the elliptical holes at the front ends of the two side arms are pulled out, the reverse meshing parts on the handles are loosened, the front end of the oval forceps body is slowly withdrawn from the proximal achilles tendon, the suture line is taken out, and the suture line is tightened for later use;
(10) since the distal end of the Achilles tendon is stopped at the calcaneal tubercle, a 1.5mm Kirschner wire is required to be used to drive into the opposite side of the calcaneal tubercle perpendicular to the longitudinal axis of the calcaneus to form a bony hollow channel.
8. The novel mode for minimally invasive suture of the Achilles tendon rupture as claimed in claim 1, characterized in that: the main steps also include: (11) a No. 1301 needle of a double-ended needle connected with a suture is penetrated into the osseous hollow channel at the initial insertion side of the calcaneus and is penetrated out from the opposite side, and a No. 1302 needle is still left at the insertion side for standby;
(12) penetrating a suture needle guide tube into a position between a subcutaneous tendon sheath and achilles tendon peritendinous tissues to a bony channel, penetrating a No. 1301 needle into the guide tube in a proper way, and withdrawing the suture thread for later use after withdrawing the guide tube;
(13) repeating the step (12) to complete the threading out operation of the suture line on the other side of the calcaneus;
(14) maintaining the natural plantarflexion of the affected foot, gradually tightening and knotting the suture lines at the two sides of the broken end of the Achilles tendon, wherein the process needs to pay attention to keep the proper tension of the Achilles tendon, and the main body suture work of the broken end of the Achilles tendon is completed;
(15) weaving and anastomosing the broken end of the horsetail Achilles tendon by using a medical 4-0 absorbable suture to strengthen the suture strength and recover the smoothness of the Achilles tendon anastomotic end;
(16) the tissues around the severed Achilles tendon were sutured and the skin incision was closed after checking good blood circulation.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201910857764.5A CN110680426A (en) | 2019-09-09 | 2019-09-09 | Recyclable achilles tendon minimally-invasive suture instrument and novel suture mode thereof |
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| CN201910857764.5A CN110680426A (en) | 2019-09-09 | 2019-09-09 | Recyclable achilles tendon minimally-invasive suture instrument and novel suture mode thereof |
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Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN111481249A (en) * | 2020-04-24 | 2020-08-04 | 复旦大学附属中山医院厦门医院 | Blood vessel suturing device |
| CN111920469A (en) * | 2020-05-20 | 2020-11-13 | 沈平平 | Anastomat for achilles tendon |
-
2019
- 2019-09-09 CN CN201910857764.5A patent/CN110680426A/en active Pending
Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN111481249A (en) * | 2020-04-24 | 2020-08-04 | 复旦大学附属中山医院厦门医院 | Blood vessel suturing device |
| CN111481249B (en) * | 2020-04-24 | 2021-03-26 | 复旦大学附属中山医院厦门医院 | Blood vessel suturing device |
| CN111920469A (en) * | 2020-05-20 | 2020-11-13 | 沈平平 | Anastomat for achilles tendon |
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