CN113693660B

CN113693660B - Tendon positioning anastomat

Info

Publication number: CN113693660B
Application number: CN202111018627.6A
Authority: CN
Inventors: 周健; 任国清
Original assignee: Qingdao Municipal Hospital
Current assignee: Qingdao Municipal Hospital
Priority date: 2021-09-01
Filing date: 2021-09-01
Publication date: 2023-05-09
Anticipated expiration: 2041-09-01
Also published as: CN113693660A

Abstract

The invention relates to a medical surgical instrument, in particular to a tendon positioning anastomat. The positioning pliers comprise a left clamping plate, a right clamping plate and a positioning mechanism, wherein the lower end of the positioning pliers is provided with a wire slot, the wire slot is provided with through holes and slits which are specially arranged, suture threads are installed on the wire slot in a 8-shaped penetrating manner according to a certain sequence, when the positioning pliers are used, the tendon ends are placed into the wire slot, the thread ends of the suture threads can be tightly tied by pulling the thread ends of the suture threads, then the tied tendon ends are butted together by the positioning pliers, and the thread ends of the two suture threads are tied. The tendon positioning anastomat is simple to operate, easy to operate, high in binding standardization degree, high in anastomosis quality and low in dependence on individual experience of operators; the broken end of the tendon has no puncture injury, the binding is firm, and the tendon cannot be torn.

Description

Tendon positioning anastomat

Technical Field

The invention relates to a medical surgical instrument, in particular to a tendon positioning anastomat.

Background

Tendons of mammals including humans are composed of bundles of longitudinal fibers connected together by loose connective tissue between the bundles, which are strong in longitudinal tensile strength but weak in transverse tear strength. Tendon rupture and defect are mostly caused by injury or pathological changes, and in order to restore the functions of limbs, the tendon rupture or defect should be anastomosed and repaired in time. Tendinosis refers to a procedure in which broken tendons are repaiied and sutured to restore their function. Because the tendon is mainly composed of longitudinal fibers, the broken end is easy to split or is broken by the suture during the suture, and the puncture suture is completely manually operated, the degree of dependence on individual experience of an operator is very high as that of manual sewing, and the operator can be skillfully mastered after a plurality of long-time practical operations. Chinese patent 2013104175123 discloses a three-dimensional tendon anastomat with lock, wherein the broken ends of tendons are bound by 8-shaped suture lines, and then the thread ends of the two suture lines are bound and fixed. However, since tendons are smooth and soft in appearance and the surgical incision is small, tendons are generally thin, and manual suture binding and using a binding auxiliary tool are very time-consuming and labor-consuming. The three-dimensional tendon anastomat with the lock provided by the Chinese patent only can provide the auxiliary function of fixing the suture line to the broken end of the tendon, and the operation is still more complicated, so that the positioning and the butt joint of the broken end of the tendon can not be realized.

Disclosure of Invention

The invention aims to provide the tendon positioning anastomat which is firm in binding and convenient to operate, so that puncture-free binding of tendon broken ends can be conveniently realized, and meanwhile, the tendon broken ends can be butted together, and high-efficiency and high-quality tendon anastomosis can be realized.

The technical scheme adopted by the invention for solving the technical problems is as follows:

the tendon positioning anastomat comprises a left clamping plate, a right clamping plate and a positioning mechanism arranged between the right clamping plate and the left clamping plate, wherein the upper ends of the left clamping plate and the right clamping plate are fixedly connected together to form a clamping mechanism with an opening at the lower end, the lower ends of the left clamping plate and the right clamping plate are provided with a wire slot, the wire slot is of a slot-shaped structure with an arc-shaped section and a changeable arc-shaped curvature, one end of the wire slot is provided with a first through hole and a second through hole, the other end of the wire slot is provided with a third through hole and a fourth through hole, a first slit is arranged between the first through hole and the second through hole, and a second slit is arranged between the third through hole and the fourth through hole; the suture thread is positioned on the inner side surface of the wire slot, one end of the suture thread passes through the second through hole and then passes through the first through hole to return to the inner side surface of the wire slot, and the other end of the suture thread passes through the third through hole and then passes through the fourth through hole to return to the inner side surface of the wire slot.

The side wall of left splint and right splint is provided with the spout, slidable mounting has the guide arm in the spout, wire casing fixed connection is at the lower extreme of guide arm, the lower extreme of left splint and right splint is provided with the extrusion claw respectively, thereby the extrusion claw can restrict and extrude the curvature of changing the wire casing cross-section to the both sides of wire casing when the wire casing goes up.

The positioning mechanism is an elastic body with one end fixedly connected to one of the left clamping plate or the right clamping plate, ratchets are arranged on the side wall of the free end of the elastic body, through holes penetrating through the plate body are formed in the corresponding positions of the left clamping plate or the right clamping plate opposite to the free end of the elastic body, and the free end of the elastic body is installed in the through holes.

The inner walls of the first through hole, the second through hole, the third through hole, the fourth through hole, the first crack and the second crack are provided with elastic damping layers.

The sliding groove is of a tubular structure, the guide rod is inserted into the sliding groove in an axially movable manner, and a handle is arranged at the upper end of the guide rod; the radian of the section of the wire slot is more than 180 degrees and less than 360 degrees; the extrusion claw is a groove-shaped section bar which is opened towards the back of the wire groove and is parallel to the axis of the wire groove, and the width of the notch of the extrusion claw is smaller than the outer diameter of the wire groove and larger than half of the outer diameter of the wire groove.

Due to the adoption of the structure, the tendon positioning anastomat adopts the left wire slot and the right wire slot to assist in achieving 8-shaped binding of two broken ends of the tendon, is simple to operate, easy to operate and high in binding standardization degree, and has low dependence on individual experience of operators; after the two broken ends of the tendon are fixed with the suture, the two broken ends are butted together by using the left clamping plate and the right clamping plate, and then the suture is tied together to complete the positioning anastomosis of the tendon. The anastomosis quality is high, the broken ends of the tendons are free from puncture injury, the binding is firm, and the tendons cannot be torn.

Drawings

Fig. 1 is a schematic diagram of the structure of an embodiment of the present invention.

Fig. 2 is an expanded plan view of the trunking.

Figure 3 is an expanded plan view of another embodiment trunking. .

Fig. 4 is a schematic perspective view of a trunking.

Fig. 5 is a schematic view of the structure of the suture ends tied together in the trunking.

FIG. 6 is a schematic view of a broken tendon end with a figure-8 ligature suture after removal of the trunking.

Fig. 7 is a schematic cross-sectional view of the extrusion jaw and wire chase.

FIG. 8 is a schematic cross-sectional view of the elastic damping layer in the first through hole.

Detailed Description

As shown in fig. 1, the tendon positioning anastomat comprises a left splint 1, a right splint 2 and a positioning mechanism arranged between the right splints 2 of the left splint 1, wherein the left splint 1 and the right splint 2 are made of elastic materials such as stainless steel plates, the upper ends of the left splint 1 and the right splint 2 are fixedly connected together, the lower ends of the left splint 1 and the right splint 2 are separated into a jaw shape, and the distance from the lower ends of the left splint 1 and the right splint 2 can be changed by pressing fingers inwards from two sides of the left splint 1 and the right splint 2. The lower ends of the left clamping plate 1 and the right clamping plate 2 are provided with wire slots 3. The two wire slots 3 on the left clamping plate 1 and the right clamping plate 2 are coaxially arranged, and the axes of the wire slots are parallel to the movement track of the clamping plates when the left clamping plate 1 and the right clamping plate 2 are pressed.

As shown in fig. 2-4, the slot 3 is a slot-shaped structure with an arc-shaped cross section and a variable arc curvature, and can be made of metal materials such as stainless steel sheets or plastic sheets, and the unfolding plane of the slot is rectangular. One end of the wire slot 3 is provided with a first through hole 31 and a second through hole 32, the other end of the wire slot 3 is provided with a third through hole 33 and a fourth through hole 34, the first through hole 31 and the third through hole 33 are positioned on the same side of the wire slot 3, the second through hole 32 and the fourth through hole 34 are positioned on the other side of the wire slot 3, that is, the four through holes are symmetrically distributed at four end corners of the wire slot 3. A first slit 35 is formed between the first through hole 31 and the second through hole 32, and a second slit 36 is formed between the third through hole 33 and the fourth through hole 34; the first slit 35 is located on the shortest distance connecting line between the first through hole 31 and the second through hole 32, and two ends of the first slit are respectively communicated with the first through hole 31 and the second through hole 32; the second slit 36 is located on the shortest distance connecting line between the third through hole 33 and the fourth through hole 34, and two ends of the second slit are respectively communicated with the third through hole 33 and the fourth through hole 34, the first slit 35 and the second slit 36 can be narrow strip slits or naturally closed slits, a certain width interval is arranged between two side edges of the strip slits, two side edges of the slits are mutually abutted but not fixedly connected, and the two side edges of the slits can be separated by external force when stressed.

The suture thread 4 is also located on the inner side of the wire groove 3, i.e. in the notch of the wire groove 3. The diameter of the suture 4 is slightly larger than the width of the first slit 35 and the second slit 36 so that the suture cannot pass through the slits under no stress, but the suture 4 can pass through the slits when being tensioned due to the elasticity of the material of the wire slot 3.

As shown in fig. 4, one end of the suture thread 4 passes through the second through hole 32, bypasses the outer side surface of the wire groove 3, forms a half loop around the outer side surface of the wire groove 3, passes through the first through hole 31, returns to the inner side surface of the wire groove 3, and leads out the left lateral line head 41; the other end of the suture thread 4 passes through the third through hole 33, bypasses the outer side surface of the wire groove 3, forms a half loop surrounding the outer side surface of the wire groove 3, passes through the fourth through hole 34 and returns to the inner side surface of the wire groove 3, and leads out the right thread end 42. Since the second through hole 32 and the third through hole 33 are respectively positioned at two sides of the wire slot 3, the suture 4 is inclined at the notch of the wire slot 3. As shown in fig. 5, if the left end 41 of the first through hole 31 and the right end 42 of the fourth through hole 34 are tied together, a crisscross line is formed at the notch of the wire groove 3, and the entire suture thread 4 constitutes a figure 8 coil. If the wire slot 3 is provided with the tendon breaking end 39, two wire ends are pulled, the half lantern ring positioned on the outer side surface of the wire slot 3 passes through the first slit 35 or the second slit 36 to be bound on the outer wall of the tendon breaking end 39, then the wire ends are tied, the 8-shaped coil can be firmly bound on the tendon breaking end 39, and the wire slot 3 separated from the suture 4 can be removed.

The right splint 2 of the left splint 1 has the functions of forming a jaw at the lower end thereof, conveniently adjusting the interval between the two trunking 3, and the other function of utilizing the guide rod 6 to control the curvature of the section of the trunking 3, changing the width of the notch of the trunking 3, leading the trunking 3 to hug tightly and clamp the tendon broken end 39 before binding the suture 4 or loosening the tendon broken end 39 after binding is completed.

As shown in fig. 1, the side walls of the left clamping plate 1 and the right clamping plate 2 are provided with sliding grooves 5, the sliding grooves 5 can be in an integrated structure with the left clamping plate 1 or the right clamping plate 2, or can be in a split structure and welded together, the sliding grooves connected to the left clamping plate 1 in fig. 1 adopt a cross-sectional drawing method, and the sliding grooves connected to the right clamping plate 2 adopt a front drawing method. The chute 5 is internally provided with a guide rod 6 in a sliding way, and the wire slot 3 is fixedly connected to the lower end of the guide rod 6 and can move up and down along with the guide rod 6; the lower ends of the left clamping plate 1 and the right clamping plate 2 are respectively provided with an extrusion claw 7, and the extrusion claws 7 can restrict and extrude two sides of the wire slot 3 when the wire slot 3 goes up so as to change the curvature of the section of the wire slot 3. In this embodiment, the sliding groove 5 is of a tubular structure, the guide rod 6 is axially movably inserted in the sliding groove 5, the sliding groove 5 and the guide rod 6 can be in sliding fit with a round tube and a cylindrical rod, or in sliding fit with a square tube and a square rod, in order to avoid rotation of the guide rod 6 around an axis in the sliding groove 5, the sliding groove 5 is preferably of a square tube structure with a rectangular inner cavity, the guide rod 6 is of a square rod with a rectangular section, the section of the guide rod 6 is matched with the section of the inner cavity of the sliding groove 5, so that the guide rod 6 can axially move in the sliding groove 5, but cannot rotate, and the axis of the two wire grooves 3 is ensured not to change direction all the time. Of course, as other embodiments of the present invention, the sliding groove 5 may be a trapezoidal guide rail, and the guide rod 6 is slidingly engaged with the sliding groove 5 through a dovetail groove installed in the trapezoidal guide rail.

The upper end of the guide rod 6 is provided with a handle 61 for manually pulling up or pressing down the guide rod 6, the handle 61 can be in a circular ring shape or a semicircular arc shape, and only one finger can conveniently complete hooking and pushing operations, when in use, two fingers pinch the two sides of the left clamping plate 1 and the right clamping plate 2, and the size of the jaws is controlled, namely the distance between the two wire slots 3; in addition, the idle finger can operate the handle 61 to hook and push the handle 61, so that the guide rod 6 can ascend or descend.

The radian of the section of the wire slot 3 is larger than 180 degrees and smaller than 360 degrees, and the width of the notch of the wire slot is smaller than the diameter of the section; as shown in fig. 7, the extrusion claw 7 is a groove-shaped section bar which is opened towards the back of the wire groove 3 and is parallel to the axis of the wire groove 3, the opening of the section of the extrusion claw 7 is in a horn mouth shape with a small upper part and a large lower part, and the width of the notch of the extrusion claw 7 is smaller than the outer diameter of the wire groove 3 and larger than half of the outer diameter of the wire groove 3. When the guide rod 6 drives the wire slot 3 to descend, the wire slot 3 is separated from the constraint of the extrusion claw 7, the curvature radius of the wire slot 3 is larger, the notch opening of the wire slot 3 is wider, the broken end of the tendon is conveniently inserted into the wire slot 3, and the binding operation of the suture is also convenient; when the guide rod 6 drives the wire slot 3 to ascend, the wire slot 3 goes deep into the bottom of the extrusion claw 7, two sides of the wire slot 3 are constrained and extruded by the extrusion claw 7 and shrink inwards, the curvature radius of the wire slot 3 is reduced, the width of the opening of the notch is narrowed, the wire slot 3 can clamp and fix the broken end of the tendon, and the two sides of the broken end of the tendon are conveniently butted and fixed.

As shown in fig. 1, the positioning mechanism is an elastic body 8 with one end fixedly connected to one of the left clamping plate 1 or the right clamping plate 2, and in this embodiment, the elastic body 8 is fixedly connected to the left clamping plate 1; the side wall of the free end of the elastic body 8 is provided with a ratchet 81, the corresponding position of the left clamping plate 1 or the right clamping plate 2 opposite to the free end of the elastic body 8 is provided with a through hole 82 penetrating through the plate body, and the free end of the elastic body 8 is arranged in the through hole 82; the present embodiment provides the through hole 82 on the right clamping plate 2. Of course, as other embodiments of the present invention, the elastic body 8 may be fixedly installed on any one of the left splint 1 and the right splint 2, the other splint where the elastic body 8 is not installed is provided with a through hole 82 penetrating through the splint, when the free end of the splint is installed in the through hole 82, the ratchet 81 on the free end of the elastic body 8 and the side wall of the through hole 82 form a unidirectional blocking mechanism, when the splint is pressed inwards, the ratchet 81 can smoothly slide through the side wall of the through hole 82, the distance between the two splints is reduced, the two trunking 3 are closed, and at this time, if the tendon broken ends are clamped in the two trunking 3, the tendon broken ends can be butted together. After the tendon broken ends are butted, the fingers of the pressing clamp plates are loosened, the ratchet 81 on the free end of the elastic body 8 moves reversely and is clamped on the side wall of the through hole 82, the distance between the two clamp plates is fixed, and the butted tendon broken ends keep a butted state; when the suture thread 4 is bound and the wire slot 3 is removed, and the clamping plates are required to return, the two clamping plates can be restored to the original state only by pressing down the free end of the elastic body 8 to separate the ratchet 81 from the side wall of the through hole 82. The specific structure and working principle of the ratchet 81 are common general knowledge, and will not be further described herein.

The wire slot 3 can be integrally made of flexible materials such as plastic sheets, silicon sheets and the like, so that the suture 4 can smoothly pass through the gaps among all the through holes. The suture thread 4 can also be made of metal materials such as stainless steel sheets, and when the metal materials are adopted, the suture thread 4 is in direct contact with the metal materials and is seriously damaged by friction due to the fact that the metal materials have high rigidity. For this purpose, as a further improvement of the present invention, as shown in fig. 3, the inner walls of the first through hole 31, the second through hole 32, the third through hole 33, the fourth through hole 34, the first slit 35, and the second slit 36 are provided with an elastic damping layer 37. The elastic damping layer 37 is made of flexible materials such as silica gel and rubber, and isolation pads are formed on the inner walls of the through holes and the slits, and the suture thread 4 is only in contact with the elastic damping layer 37 when the elastic damping layer is used, so that the suture thread 4 can be prevented from being cut by sharp edges of metal materials, the narrow slits with the elastic damping layer 37 have a certain clamping and positioning effect on the suture thread 4, the suture thread 4 can be prevented from being randomly strung, the shaping and positioning effects are good, a certain damping force is achieved when the suture thread 4 is pulled, the operation hand feeling is good, and the binding quality of the suture thread 4 is improved. When the thickness of the wire slot 3 is smaller, the inner walls of the through holes and the slits are difficult to combine with the elastic damping layer 37, and at this time, a structure as shown in fig. 8 can be adopted, and flanges 371 are arranged at two ends of the upper end of the elastic damping layer 37 and clamped at the edges of the through holes or the slits by the flanges.

When the suture is used, the operation wound is exposed, the broken ends of tendons which need to be anastomosed are cleaned, the positioning mechanism between the left splint 1 and the right splint 2 is loosened, the left splint 1 and the right splint 2 are in a natural open state, then the suture is installed on the two wire slots 3 according to the conditions shown in fig. 2 and 4, at the moment, the suture 4 can be smoothly installed on the wire slots 3 because the widths of the first slit 35 and the second slit 36 are smaller than the diameter of the suture 4, the two ends of the suture 4 are positioned at the opening of the wire slots 3, and the next binding operation is convenient; after the suture line 4 is installed, the two broken ends of the tendon are placed in the left wire groove and the right wire groove respectively, the handle 61 is held, the left clamping plate 1 and the right clamping plate 2 are pushed downwards, or the handle 61 is lifted upwards, the extrusion claw 7 descends and extrudes the two sides of the wire groove 3, and the wire groove 3 contracts and is tightly held on the tendon to grasp the tendon; at this time, two broken ends of the tendon are respectively fixed on the two wire slots 3; subsequently and according to fig. 5, the thread ends at the two ends of the suture thread 4 are pulled and tightened, the suture thread 4 is tightened on the tendon through the slit, the two thread ends of the suture thread 4 are bound together, and one longer thread end is reserved for binding with the suture thread on the other thread groove; after two tendon broken ends are bound by using the suture, the suture 4 is located on the inner side of the wire slot 3, and is tightly tied on the tendon in a 8-shaped binding mode, as shown in fig. 6, the binding is not easy to fall off, no puncture damage exists, and tendon fibers cannot be torn. After binding the broken ends of two tendons, the wire slot 3 is still held tightly on the broken ends of the tendons, and the two sides of the left clamping plate 1 and the right clamping plate 2 are pressed to enable the wire slot 3 to gradually draw together the broken ends of the two tendons until the broken ends of the tendons are completely drawn together and butted together. At this time, the two reserved longer thread ends can be bound together, the two suture lines are connected into one, and meanwhile, the broken ends of the tendons are bound and connected together, as shown in fig. 5. After the broken ends of the tendons are butted and connected together, the wire chase 3 can be removed, the handle 61 is pressed, or the left clamping plate 1 and the right clamping plate 2 are pushed upwards, so that the extrusion claw 7 releases the wire chase 3, the wire chase 3 is loose from the tendons, and then the wire chase 3 is removed. The last suture joint of the step is positioned on one side of the butted tendon, if the suture on one side is insufficient to enable the tendon to be firmly anastomosed, the suture joint can be turned to the other side of the tendon, the steps are repeated, a group of sutures are bound on the other side of the tendon, and therefore the two groups of sutures are symmetrically distributed on the two sides of the tendon, and a good anastomosis effect can be achieved.

Claims

1. Tendon positioning anastomat comprises a left clamping plate (1), a right clamping plate (2) and a positioning mechanism arranged between the left clamping plate (1) and the right clamping plate (2), wherein the upper ends of the left clamping plate (1) and the right clamping plate (2) are fixedly connected together, and the tendon positioning anastomat is characterized in that: the lower ends of the left clamping plate (1) and the right clamping plate (2) are respectively provided with a wire groove (3), the wire groove (3) is of a groove-shaped structure with an arc section and a rectangular unfolding plane with variable arc curvature, one end of the wire groove (3) is provided with a first through hole (31) and a second through hole (32), the other end of the wire groove (3) is provided with a third through hole (33) and a fourth through hole (34), the four through holes are symmetrically distributed at four end corners of the wire groove (3), a first slit (35) is arranged between the first through hole (31) and the second through hole (32), and a second slit (36) is arranged between the third through hole (33) and the fourth through hole (34); the novel wire slot is characterized in that a suture thread (4) is positioned on the inner side surface of the wire slot (3), one end of the suture thread (4) passes through a second through hole (32) and then passes through a first through hole (31) to return to the inner side surface of the wire slot (3), the other end of the suture thread (4) passes through a third through hole (33) and then passes through a fourth through hole (34) to return to the inner side surface of the wire slot (3), sliding grooves (5) are formed in the side walls of the left clamping plate (1) and the right clamping plate (2), guide rods (6) are slidably arranged in the sliding grooves (5), the wire slot (3) is fixedly connected to the lower ends of the guide rods (6), extrusion claws (7) are respectively arranged at the lower ends of the left clamping plate (1) and the right clamping plate (2), and the extrusion claws (7) can restrict and extrude two sides of the wire slot (3) when the wire slot (3) is in a running mode, so that the curvature of the section of the wire slot (3) is changed; the positioning mechanism is an elastic body (8) with one end fixedly connected to one of the left clamping plate (1) or the right clamping plate (2), a ratchet (81) is arranged on the side wall of the free end of the elastic body (8), a through hole (82) penetrating through the plate body is formed in the corresponding position of the left clamping plate (1) or the right clamping plate (2) opposite to the free end of the elastic body (8), and the free end of the elastic body (8) is arranged in the through hole (82).

2. The tendon positioning stapler of claim 1, wherein: the inner walls of the first through hole (31), the second through hole (32), the third through hole (33), the fourth through hole (34), the first slit (35) and the second slit (36) are provided with elastic damping layers (37).

3. Tendon positioning stapler according to claim 1 or 2, characterized in that: the sliding groove (5) is of a tubular structure, the guide rod (6) is inserted into the sliding groove (5) in an axially movable mode, and a handle (61) is arranged at the upper end of the guide rod (6); the radian of the section of the wire groove (3) is more than 180 degrees and less than 360 degrees; the extrusion claw (7) is a groove-shaped section bar with an opening facing the back of the wire groove (3) and parallel to the axis of the wire groove (3), and the width of the notch of the extrusion claw (7) is smaller than the outer diameter of the wire groove (3) and larger than half of the outer diameter of the wire groove (3).