CN1883411B - 具有带双枢轴闭合器和单枢轴框架底的关节运动轴的外科器械 - Google Patents

具有带双枢轴闭合器和单枢轴框架底的关节运动轴的外科器械 Download PDF

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CN1883411B
CN1883411B CN2006100930523A CN200610093052A CN1883411B CN 1883411 B CN1883411 B CN 1883411B CN 2006100930523 A CN2006100930523 A CN 2006100930523A CN 200610093052 A CN200610093052 A CN 200610093052A CN 1883411 B CN1883411 B CN 1883411B
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肯尼思·S·威尔士
尤金·L·蒂姆珀曼
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Abstract

一种特别适用于内窥镜使用的外科钉合及切割器械，包括一个近侧部分，在患者体外对其进行操作，以将连接的细长轴和端部执行器定位到患者体内需要进行手术的部位。关节运动接头将端部执行器与细长轴以可枢转的方式连接，在以需要的角度到达组织方面提供额外的诊断灵活性。闭合管组件包括多枢轴部分，其越过关节运动接头，以向远侧平移，使端部执行器关闭，而不穿过进行关节运动的轴。从而在端部执行器定位时可获得额外的临床灵活性，而不会失去由轴传递的单独闭合和击发运动的能力。由此通过避免将机械运动传送通过严格限制以进行关节运动的细长轴的设计限制而实现设计灵活性。

Description

具有带双枢轴闭合器和单枢轴框架底的关节运动轴的外科器械
相关申请的交叉引用
本发明涉及Kenneth Wales和Chad Boudreaux于2005年2月18日提交的申请号为11/061,908、题为“SURGICAL INSTRUMENTINCORPORATING A FLUID TRANSFER CONTROLLEDARTICULATION MECHANISM”的共同拥有的美国专利申请，并要求其优先权，其内容在此通过全部引用而包含于本申请中。
技术领域
本发明总的涉及适合于将端部执行器(例如，内切割器、抓钳、切割器、缝合器、夹具施放器、接触装置、药物/基因治疗输送装置以及采用超声波、RF、激光等的能量装置)以可内窥的方式插入到手术部位的外科器械，更具体地说，涉及带有关节运动轴的这种外科器械。
背景技术
内窥镜外科器械通常比传统的开放式外科装置更受到偏爱，因为其切口较小，易于减少术后恢复时间和并发症。因此，在内窥镜外科器械的领域中已经有了显著发展，该内窥镜外科器械适于将远端执行器经套管针的套管精确放置到需要的手术部位。这些远端执行器以多种方式与组织接合，以达到诊断或治疗的效果(例如，内切割器、抓钳、切割器、缝合器、夹具施放器、接触装置、药物/基因治疗传送装置以及采用超声波、RF、激光等的能量装置)。
端部执行器的定位受到套管针的限制。通常，这些内窥镜外科器械包括一个位于端部执行器和医生操作的手柄部分之间的长轴。该长轴能够插入到所需的深度并围绕轴的纵向轴线转动，从而将端部执行器定位到某种程度。在正确设置套管针和例如通过另一个套管针使用抓钳的条件下，通常这种定位的量就足够了。例如在美国专利US5,465,895中描述的外科缝合和切割器械是通过插入和转动来成功定位端部执行器的内窥镜外科器械的例子。
更近地，在Shelton IV等于2003年5月20日提交的序列号为10/443,617、题为“SURGICAL STAMPLING INSTRUMENTINCORPORATING AN E-BEAM FIRING MECHANISM”的美国专利中公开了一种用于切割组织和致动钉的改进的“E形梁”击发杆，其全部内容在此通过引用而包含于本申请中。该装置的一些其它优点包括可确保将端部执行器的钳口间隔开，或者更具体地说是将钉施加组件间隔开，即使夹了比用于最佳钉形成略多或略少的组织也是如此。而且，E形梁击发杆与端部执行器和钉仓以能够采用多个有利的闭锁的方式接合。
这些外科钉合及切割器械包括带有框架的轴，所述框架导承进行击发的击发杆。闭合管在框架和击发杆之上滑动，以使钉施加组件的钳口闭合。由此提供了独立的闭合和击发能力，这增加了临床灵活性。医生可反复闭合和重新定位组织，直到对设置满意为止。
取决于操作的性质，可能需要进一步调整内窥镜外科器械的端部执行器的定位。特别地，通常需要在横切该器械的轴的纵向轴线的轴线上定向端部执行器。端部执行器相对于器械轴的横向运动通常称为“关节运动”。这可典型地通过被设置在靠近钉施加组件的伸长的轴中的枢轴(或关节)接头来实现。这使得医生可通过遥控方式使钉施加组件关节运动到任一侧，以更好的设置钉线，并更容易对组织进行操作和定向。在一些情况(例如在器官的后面)下，这种关节运动定位使医生能够更容易接合组织。另外，有利地，关节运动定位可使内窥镜定位于端部执行器的后面，而不会被器械轴挡住。
由于在内镜器械限定的很小直径内进行关节运动控制，并且进行闭合端部执行器以钳夹组织并击发端部执行器(即钉合和切割)的控制，使外科钉合及切割器械进行关节运动的方法显得非常复杂。通常，当进行纵向平移时，这三种控制运动都通过轴来传送。例如，在Frederick E.Shelton IV等的未审结并共同拥有的序列号为10/615,973、题为“SURGICAL INSTRUMENT INCORPORATING ANARTICULATION MECHANISM HAVING ROTATION ABOUT THELONGITUDINAL AXIS”的美国专利申请中，作为纵向运动的替代，将旋转运动用于传递关节运动，其内容在此通过引用而全部包含于本申请中。
因此，非常需要这样一种外科钉合和切割器械，其具有包括独立闭合管的轴，可单独使钳口打开及关闭的所述闭合管能够进行关节运动。
发明内容
本发明通过提供这样一种外科器械克服了现有技术的上述及其它缺点，所述外科器械包括一个轴，所述轴具有与端部执行器枢轴连接的框架，所述端部执行器又包括一个可枢转的上钳口或砧座。一个闭合管在框架之上滑动，以使砧座枢转来闭合并钳夹组织。为了纵向平移以引起进行关节运动的接头上方的这种闭合，闭合末端本身具有双枢转接头。
在本发明的一个方面中，一种外科器械包括一个近侧部分，在患者的体外操纵该近侧部分，以将相连的细长轴和端部执行器定位于患者体内需要手术的部位。一个关节运动接头将端部执行器与细长轴可枢转地连接，从而在以期望的角度达到组织时提供进一步的临床灵活性。一个闭合管包括一个多枢轴接头，其越过(override)关节运动接头，以向远侧平移来闭合端部执行器，而不通过关节运动轴。由此在端部执行器定位时获得了额外的临床灵活性，而不会失去由轴传递的单独闭合和击发运动的能力。
(1)本发明涉及一种外科器械，其包括：
细长轴，该细长轴包括框架组件和闭合套管组件；
端部执行器，其包括下部钳口和以可枢转的方式连接的上部钳口；
关节运动接头，其将端部执行器的下部钳口以可枢转的方式连接到所述框架组件的远端；
手柄部分，其与细长轴的近端连接，并可操作地构造为能将闭合运动沿纵向联接到闭合套管组件；以及
闭合套管组件的多枢轴接头，所述枢轴接头包围关节运动接头并在远侧与所述上部钳口接合，以使上部钳口枢转。
(2)如第(1)项所述的外科器械，其中，所述闭合套管组件还包括一个与砧座接合的远侧闭合管部分和一个连接到所述手柄部分的近侧闭合管部分，所述闭合套管组件的所述多枢轴接头包括上部双枢轴连接件和下部双枢轴连接件，它们分别在其两个端部的每个端部处以可枢转的方式连接到远侧和近侧闭合管部分。
(3)如第(2)项所述的外科器械，其中，所述远侧闭合管部分还包括朝近侧定向的叉形头，一个第一圆柱形构件与其相连；并且近侧闭合管部分还包括一个朝远侧定向的叉形头，一个第二圆柱形构件与其连接。
(4)如第(1)项所述的外科器械，其中，所述框架组件还包括一个与所述下部钳口相连的远侧框架部分，和一个与手柄部分相连的近侧框架部分，一个框架枢转臂在一端刚性连接于远侧和近侧框架部分的任选一端，并在另一端以可枢转的方式连接于远侧和近侧框架部分的另一个。
(5)如第(4)项所述的外科器械，其中，框架枢转臂包括用于导承击发棒的刀槽。
(6)如第(1)项所述的外科器械，其中，所述下部钳口包括一个容纳有钉仓的细长通道，并且以可枢转方式连接的上部钳口包括一个提供钉形成表面的砧座。
(7)如第(1)项所述的外科器械，其中，框架组件还包括一个与下部钳口相连的远侧框架部分，和一个与手柄部分连接的近侧框架部分，所述远侧和近侧框架部分为彼此提供叠置的和可枢转地连接的端部。
(8)如第(1)项所述的外科器械，其中，闭合套管组件的多枢轴接头还包括一个远侧圆柱形构件，一个弹性闭合接头与其连接，以及一个与弹性闭合接头连接的近侧圆柱性构件。
(9)如第(8)项所述的外科器械，其中，弹性闭合接头包括一个由弹性材料形成的圆柱形套管，并包括左和右两排垂直的狭缝。
(10)本发明还涉及一种外科器械，其包括：
细长轴，该细长轴包括一个框架组件和一个包围并纵向滑动接收的闭合套管组件；
钉施加组件，其包括细长通道，一个接合在所述细长通道中的钉仓，以及一个与所述细长通道可枢转地连接从而为钉仓提供钉形成表面的砧座；
框架组件，其包括一个与所述细长通道连接的远侧框架部分，和与远侧框架部分可枢转地连接的近侧框架部分；
手柄部分，其与近侧框架部分的近端连接，并可操作地构造为将闭合运动沿纵向连接到闭合套管组件；以及
闭合套管组件的多枢轴接头，其围绕关节运动接头并在远侧与上部钳口接合，以使上部钳口枢转。
(11)如第(10)项所述的外科器械，其中，所述闭合套管组件还包括一个与砧座接合的远侧闭合管部分和一个连接到手柄部分的近侧闭合管部分，所述闭合套管组件的所述多枢轴接头包括上部双枢轴连接件和下部双枢轴连接件，它们分别在其两个端部的每个端部处以可枢转的方式连接到远侧和近侧闭合管部分。
(12)如第(11)项所述的外科器械，其中，所述远侧闭合管部分还包括朝近侧定向的叉形头，一个第一圆柱形构件与其相连；并且近侧闭合管部分还包括一个朝远侧定向的叉形头，一个第二圆柱形构件与其连接。
(13)如第(10)项所述的外科器械，其中，所述框架组件还包括一个与所述下部钳口相连的远侧框架部分，和一个与手柄部分相连的近侧框架部分，一个框架枢转臂在一端刚性连接于远侧和近侧框架部分的任选一端，并在另一端以可枢转的方式连接于远侧和近侧框架部分的另一个。
(14)如第(13)项所述的外科器械，其中，框架枢转臂包括用于导承击发杆的刀槽。
(15)如第(10)项所述的外科器械，其中，所述下部钳口包括一个容纳有钉仓的细长通道，并且以可枢转的方式连接的上部钳口包括一个提供钉形成表面的砧座。
(16)如第(10)项所述的外科器械，其中，框架组件还包括一个与下部钳口相连的远侧框架部分，还一个与手柄部分连接的近侧框架部分，所述远侧和近侧框架部分为彼此提供叠置的和可枢转地连接的端部。
(17)如第(10)项所述的外科器械，其中，闭合套管组件的多枢轴接头还包括一个远侧圆柱形构件，一个弹性闭合接头与其连接，以及一个与弹性闭合接头连接的近侧圆柱性构件。
(18)如第(17)项所述的外科器械，其中，弹性闭合接头包括一个由弹性材料形成的圆柱形套管，并包括左和右两排垂直的狭缝。
(19)本发明还涉及一种外科器械，其包括：
细长轴，所述细长轴包括一个框架组件和一个包围并纵向滑动接收的闭合套管组件；
端部执行器，其包括致动构件；
框架组件，其包括一个与所述端部执行器连接的远侧框架部分，和与远侧框架部分可枢转地连接的近侧框架部分；
手柄部分，其与近侧框架部分的近端连接，并可操作地构造为将纵向运动沿纵向连接到套管组件；以及
套管组件的多枢轴接头，其围绕关节运动接头并在远侧与端部执行器的致动构件接合，以进行致动。
(20)如第(19)项所述的外科器械，其中，套管组件还包括一个与端部执行器的致动构件接合的远侧管部分，和一个与手柄部分连接的近侧管部分，套管组件的所述多枢轴接头包括上部和下部双枢轴连接件，它们分别在其两个端部的每个端部处以可枢转的方式连接到远侧和近侧管部分。
(21)如第(19)项所述的外科器械，其中，闭合接头的多枢轴接头包括一个由弹性材料形成的圆柱形套管，并包括左和右两排垂直的狭缝。
通过附图及其说明，本发明的这些和其它目的和优点将更加明显。
附图说明
包含在本说明书中并构成该说明书的一部分的附图解释了本发明的实施例，并与上面给出的本发明的总体说明以及下面给出的实施例的详细描述一起用于解释本发明的原理。
图1是外科钉合及切割器械的从前侧上部看的透视图，显示出带有张开的端部执行器或说钉施加组件，并且其中移除了钉仓。
图2是图1中的外科钉合及切割器械从前侧上部看的透视图，其关节机构由流体致动控制器致动。
图3是图1的外科钉合及切割器械的细长轴和铰接机构的分解透视图。
图4是图1的外科钉合及切割器械的执行部分的远侧部分的分解透视图，包括了钉施加组件和关节运动机构。
图5是图1及图4的钉施加组件的从上部看的透视图，其中除去了钉仓的侧半部，以暴露由击发运动驱动的组成元件。
图6是图1的外科器械的执行部分的从前侧看的透视图，其中除去了双枢轴闭合套管组件和端部执行器，以露出通过流体关节运动机构连接的单枢轴框架底(frame ground)。
图7是图1的外科器械的一种作为替代的关节运动接头的详细透视图，显示了双枢轴闭合套管组件在近侧位置具有一个单枢轴框架底。
图8是图7的作为替代的关节运动接头的从底部右侧看的分解透视图，包括双枢轴固定壁狗骨形连接件(dog bone link)和具有导承横向运动构件(T型杆)的导轨的框架底。
图9是图1的外科器械的另一种作为替代的关节运动接头的从上部左侧看的分解透视图，包括一个包含在下部双枢轴连接件中以支撑击发杆的作为替代的整体壁支撑板机构，并包括由导轨引导的沿横向运动的构件(T型杆)。
图10是用于图1的外科器械的一种作为选择的关节运动锁定机构的俯视示意图，其中除去了闭合的套管组件，以显示出用于自动关节运动锁定接合和脱离接合的反向加载的脱开的T型杆。
图11是用于图1的外科器械的另一种作为选择的关节运动机构的俯视示意图，其中一弹簧偏压T型杆上的齿条，所述T型杆带有由于端部执行器的反向加载(backloading)而接合的锁定零件。
图12是用于图1的外科器械的一种作为选择的T型杆和带有横向导槽的框架底。
图13是用于图1的外科器械的另一种作为选择的T型杆和带有横向导槽的框架底。
图14是一种作为选择的关节运动机构的从左侧上部看的分解透视图，包括一个双枢轴框架组件和一个单枢轴闭合套管组件，用于图1的外科器械。
图15是图14的作为选择的关节运动机构的从左侧底部看的透视图。
图16是一种作为替代的用于图1的外科钉合及切割器械的执行部分的从前侧看的透视图，其具有多枢轴闭合套管组件。
具体实施方式
关节运动轴概述
参考附图，其中在所有这些图中，相同的附图标记代表相同的组成元件，图1描绘了一种外科器械(特别地，在一种解释性方案中，其为一种外科钉合及切割器械10)，其能够体现本发明的独特优点。特别地，该外科钉合及切割器械10的尺寸设置为能够在如图1所示的非关节运动状态下通过套管针的插管通道插入到患者(未显示)体内的手术部位，以进行手术过程。一旦执行部分12通过插管通道插入，如图2中所示，就可通过关节运动控制器18远距离地使执行部分12的细长轴16的远侧部分中带有的关节运动机构14进行关节运动。在解释性方案中描述为钉施加组件20的端部执行器在远侧与关节运动机构14相连。因此，远距离的使关节运动机构14进行关节运动可使钉施加组件20相对细长轴16的纵向轴线进行关节运动。这种带角度的定位可具有如下优点，即，以切割和钉合所需的角度来接近组织，可接近在其它情况下被其它器官和组织遮挡的组织，和/或使内窥镜能够定位于钉施加组件20的后面并与之对准，以确保其设置。
手柄
外科钉合及切割器械10包括一个手柄部分22，其与执行部分12在近侧连接，以对其进行定位、关节运动、闭合和击发运动。手柄部分22具有一个手枪式把手24，医生向着该把手向近侧枢转地拉动闭合触发器26，导致钉施加组件20的夹紧或闭合。一个击发触发器28设置在闭合触发器26的外侧，并可由医生以可枢转的方式拉动，从而导致在钉施加组件20中钳夹的组织的钉合和切割。此后，压下闭合释放按钮30，松开夹紧的闭合触发器26，从而松开被夹紧的组织的被切断和钉合的末端。手柄部分22还包括一个旋钮32，其被联接成用于与细长轴16一起运动，以围绕轴16的纵向轴线旋转轴16和关节连接的钉施加组件20。手柄部分22还包括一个击发回缩手柄34，以辅助在发生束缚时回缩击发机构(在图1-2中未显示)，从而使钉施加组件20此后可张开。
应当理解，这里使用的术语“近侧”和“远侧”是以握持该器械手柄的医生为参照。因此，相对于更近侧的手柄部分22，外科钉合组件20处于远端。还应理解，为了方便和清楚起见，这里使用的空间术语，例如“垂直”和“水平”是相对于附图而言。然而，外科器械可以多种定向和位置使用，这些术语并不是限制性的和绝对的。
在Swayze和Shelton IV的题为“SURGICAL STAPLINGINSTRUMENT INCORPORATING A MULTISTROKE FIRINGPOSITION INDICATOR AND RETRACTION MECHANISM”、序列号为10/374,026的未审结和同一申请人拥有的美国专利申请中更详细地描述了用于图1-2中的外科钉合及切割器械10的示例性多冲程手柄部分22，该文献的内容在此通过引用而全部包含于本申请中，并具有如这里所描述的其它零件和变化。有利地，尽管多冲程手柄部分22支持以较大发射力远距离施加，根据本发明的应用可包括单击发冲程，例如在Frederick E.Shelton IV，Michael E.Setser以及Brian J.Hemmelgarn共同拥有的序列号为10/441,632、题为“SURGICALSTAPLING INSTRUMENT HAVING SEPARATE DISTINCTCLOSING AND FIRING SYSTEMS”的未审结美国专利申请中所描述的，该文献的内容在此通过引用而全部包含于本申请中。
执行部分(关节运动细长轴和钉施加组件)
在图3-5中，有利地，执行部分12包括在适于内窥镜和腹腔镜手术的较小直径内的纵向旋转、关节运动、闭合和击发的多种致动运动。钉施加组件20(“端部执行器”)具有一对可枢转地相对的钳口，图示为一个带有可枢转地连接的砧座42的细长通道40(图1-2，4-5)。砧座42相对细长通道40的闭合和夹紧通过用框架组件44(图3)沿纵向支撑细长通道40来实现，所述框架组件44与手柄部分22可转动地连接，一个双枢轴闭合套管组件46在所述框架组件44上沿纵向运动，以将分别对应于远侧运动和近侧运动的闭合和张开施加到砧座42，即使在钉施加组件20如图2所示地进行关节运动时亦如此。
特别参照图3，框架组件44包括一个单枢轴框架底48，其近端与旋钮32接合，其中图3所示的该旋钮上带有右侧半壳。应当理解，闭合套管组件46、特别是闭合直管52的近端包围框架底48的近端，所述近端进一步穿过其内部到达手柄部分22，与使闭合套管组件46纵向平移的闭合元件(未显示)接合。位于闭合直管52近端的圆形凸缘54提供了与所述元件的旋转接合。旋钮32的接合元件穿过闭合直管52的近侧部分上的纵向狭槽56与在近侧定位于框架底48上的孔口58接合。纵向狭槽56具有足够的长度，从而以由旋钮32为闭合套管组件46和框架底48设定的各种旋转角度使闭合套管组件46的闭合纵向平移。
细长轴16通过容纳与手柄部分22的击发元件(未显示)旋转接合的击发杆60来支持击发运动。击发杆60沿着框架底48的纵向中心线进入近侧开口62。框架底48的远侧部分包括一个沿着其底部的击发棒狭槽64，该击发棒狭槽与近侧开口62相通。击发棒66在击发棒狭槽64中沿纵向平移，并且该击发棒包括一个向上突出的近侧销68，其与击发杆60的远端70接合。
细长轴16通过带有矩形储存腔72(在旋钮32的远侧部分中描绘为横向部分)来支持关节运动。一个位于矩形储存腔72中的底部分隔室74具有横向间隔开的左和右挡板76、78。一个关节运动致动器80在底部分隔室74的上方沿横向滑动，该关节运动致动器的位于挡板76、78外侧的左和右凸缘82、84向下沿横向间隔开，每个凸缘与从旋钮32的相应半壳向外伸出的左和右按钮86、88沿横向相连。关节运动致动器80的横向运动拉动左和右凸缘82、84分别更靠近或更远离左和右挡板76、78，从而抵抗流体关节运动系统94的左和右储存囊90、92进行操作，每个囊90、92分别在远侧与左和右流体导管或通道96、98连通，该左和右流体导管或通道又分别与左和右致动囊100、102连通。后者与关节运动机构14的T型杆104相对并且使之沿横向枢转。
框架组件44通过包括框架底48的一个顶部和远侧带凹槽的台面106来限制这些流体致动，在所述框架底的台面上有流体通路96、98和致动囊100、102。T型杆104也可滑动地停留于带凹槽的台面106的上面，并位于致动囊100、102之间。在T型杆104的近侧，一个升起的阻挡肋108与其对准，用于防止流体通路96、98向内膨胀。框架组件44具有一个圆形顶部框架盖(隔离件)110，其在框架底48的上方滑动，防止流体通路96、98和致动囊100、102的垂直膨胀，以及限制T型杆104的任何垂直运动。特别地，框架盖110包括能使其还提供关节运动锁定构件111的零件，下面将作为关节运动锁定机构113的一部分详细描述。
T型杆104的远端(“齿条”)112与关节运动机构14的关节连接的远侧框架构件114的向近侧定向的扇形齿轮115结合以使之枢转。关节连接的闭合管116包围关节连接的框架构件114，并具有一个与砧座42接合的马蹄形孔口118。在闭合直管52和进行关节运动的闭合环116之间在关节运动机构14之上形成一个双枢转连接，从而可进行纵向闭合运动，即使当关节运动机构14进行关节运动时也是如此。特别地，在闭合直管52上的带有销孔122、124的顶部和底部向远侧突出的枢轴翼片118、120分别与关节运动闭合环116上的具有销孔130、132的相应的顶部和底部向近侧突出的枢轴翼片126、128沿纵向间隔开。一个上部双枢轴连接件134具有分别与销孔122、130接合的纵向间隔的向上定向的远侧和后部销136、138，一个下部双枢轴连接件140具有分别与销孔124、132接合的纵向间隔的向下突出的远侧和后部销142、144。
特别参照图4，为了增强可制造性，关节运动闭合环116显示为包括一个短管146，其与包括近侧突出的枢轴翼片126、128的进行关节运动的连接卡圈148相连。同样地，闭合直管52由与后部连接卡圈152相连的长闭合管150组装而成，所述后部连接卡圈152包括向远处突出的枢轴翼片118、120。短闭合管146中的马蹄形孔口118与在横向枢轴销156稍邻侧的向上突出的砧座零件154接合，所述枢轴销156与细长通道40中的枢轴槽158接合。
图4的解释性方案包括狗骨形连接件160，其近侧销157可枢转地连接到框架底48的框架孔161中，并且其近侧销159与进行关节运动的框架构件114的近侧下表面162刚性连接，从而在其间提供枢轴支撑。狗骨形连接件160的底部纵向刀槽163导承击发棒66的进行关节运动的部分。进行关节运动的框架构件114还包括一个底部纵槽164，以导承击发棒66的远侧部分。
钉施加器械(端部执行器)
参照图4-5，击发棒66在远侧终止于E-形梁165中，所述E-形梁165包括上部导销166，其插入砧座42中的砧座槽168中，以便在钉形成和切割期间检验并辅助将砧座42保持为关闭状态。细长通道40和砧座42之间的间隔还可通过如下方式由E-形梁165来维持，该E-形梁的中间销170沿着细长通道40的顶面滑动，同时底脚172由细长通道40中的纵向开口174导承以沿着细长通道40的下表面相对滑动。E形梁165的位于上部导销166和中间销170之间的在远侧的切割表面176对夹钳的组织进行切割，同时E形梁通过向远侧运动楔形滑轨180致动可更换的钉仓178，该楔形滑轨会导致钉驱动器182向上进行凸轮运动，从而驱动抵靠砧座42的钉形成下表面190形成的钉184脱离钉仓主体188中向上张开的钉孔186。钉仓托架192从底部包围钉仓178的其它元件，将它们保持在恰当的位置。钉仓托架192包括一个向后开口的槽194，其位于细长通道40中的纵向开口174上，从而使中间销170穿过钉仓托架192的内部。
在Frederick E.Shelton IV等于2004年9月30日提交的序列号为10/955,042的“ARTICULATING SURGICAL STAPLINGINSTRUMENT INCORPORATING A TWO-PIECE E-BEAM FIRINGMECHANISM”的未审结和共同拥有的美国专利申请中，对钉施加组件20有详细描述，该文献的内容在此通过引用而全部包含于本申请中。
关节运动锁定机构
在图3-4和6-8中，有利地包括一个关节运动锁定机构200，以将钉施加组件20保持在需要的关节运动角度。关节运动锁定机构200减小了左和右致动囊100、102上的负载。特别地，压缩弹簧202(图3)在近侧定位于关节运动锁定构件111的近端204和手柄部分22之间，向远侧偏压关节运动锁定构件111。特别参照图4，关节运动锁定构件111远端210上的两个平行的狭槽206、208分别容纳框架底48上的向上突出的导向肋212、214。导向肋212、214的纵向长度比平行狭槽206、208短，从而使其具有相对纵向行程范围。由此，特别参照图8，远侧摩擦表面(示为从关节运动锁定构件111向远侧突出的带齿的槽216)的选择性抵接接合用于与容纳在进行关节运动的框架构件114的顶部近侧凹槽220中的制动板218中的相应锁定扇形齿轮217接合。制动板218的远侧和近侧孔221、222容纳从顶部近侧凹槽220向上突出的远侧和近侧销223、224。
特别参照图6，细长轴16描绘为处于进行关节运动的位置，其中闭合套管组件46从框架组件44周围被除去，并且没有细长通道40和砧座42。关节运动致动器80显示为横向运动到左侧以压缩右侧近侧储存囊90，并使远端右侧致动囊100膨胀，使T型杆104移动到所示的位置。因此，如图所示，关节运动致动器80的横向运动使远侧框架114围绕单枢轴框架底48顺时针进行关节运动。有利地，关节运动致动器80还自动与关节运动锁定机构200接合和脱离接合。特别地，沿着关节运动致动器80的近侧上表面的齿棘表面225从关节运动闭合构件111的近端204容纳向上突起的锁定销226。锁定销226在齿棘表面225根部的接合为关节运动锁定构件111提供了足够的向远端的运动，将锁定扇形齿轮217锁定接合于制动板218中。由操作人员进行的压缩构件272向近侧的横向运动，向近侧促动锁定销226，由此使关节运动锁定构件111与制动板218脱离接合。当操作人员释放关节运动致动器80时，锁定销226被压缩弹簧202推压到止动表面225中的相邻槽中，使锁定机构111锁定，从而锁定钉施加组件20，通过限制和膨胀近侧左和右储存囊90、92的膨胀形状，将关节运动机构14限制在所需的关节运动位置。
关于关节运动锁定机构200的部分在Dale R.Schulze和Kenneth S.Wales等于1996年3月10日提交的题为“SURGICAL INSTRUMENT”的共同拥有的美国专利US5,673,841A中有更详细地描述，其内容在此通过引用而全部包含于本中请中。
作为选择或者另外，可在平行的流体囊236、238中设置孔，以控制近侧致动囊100、102和远侧储存囊90、92之间的流速。在图16中，流体通路258、264的尺寸可设置为提供改变关节运动的角度的阻力，起孔的作用，或者它们可包括流体流速限制结构。
在图10中，一种替代的外科器械2004的关节运动机构2002的锁定机构2000通常是通过旋接(cocking)由于反向加载而沿横向运动的T型杆2006来释放和致动。狭槽2008定位于框架底2010中，以容纳并导承从T型杆2006向下伸出的肋2012。如果端部执行器2016反向加载，则与肋2012成直角连接的细长纵向部分2014偏斜。例如，当端部执行器2016受到如箭头2018所示使其向右的力，例如，其近侧扇形齿轮2020作用于T型杆2006的导轨2022，施加非垂直的逆驱动力，如箭头2024所示。因此，细长纵向部分2014弯曲，将肋2012旋塞到狭槽2008中。这种旋塞产生了相对的约束力，如箭头2026、2028所示，将T型杆2006锁定并阻止进一步的关节运动。当关节运动囊的致动使横向运动的T型杆2006松开时，则产生释放。此后，肋2016可辅助导承T型杆2006。
在图11中，显示了另一种外科器械2102的关节运动锁定机构2100，其通常由端部执行器2106的齿轮齿2104和T型杆2110的齿条齿2108以20度压力角形成的近侧力向量来释放和致动。当端部执行器2106反向加载时，以非垂直箭头2112表示，压力角的纵向向量(以箭头2114表示)使T型杆2110向近侧运动。该纵向力向量施加到位于T型杆2110的齿条2120后面的牵引弹簧2118上。当弹簧2118随着T型杆2110向近侧运动而偏斜时，从齿条2120向近侧突出的锁定齿2126开始接合，并且在底部框架2124上在近侧沿横向排列的锁定构件2122与从齿条2120向近侧突出的锁定齿2126接合。当通过除去端部执行器2106的反向加载并通过弹簧2118的促动使T型杆2110向远侧运动，使近侧力向量减小或消除时，锁定齿2126和锁定构件2122脱离接合。
双枢轴闭合套管和单枢轴框架底的结合
参照图3-4和7，有利地，执行部分12包括一个双枢轴闭合套管组件46，其在单枢轴框架底48上纵向平移并环绕单枢轴框架底48。下面将进一步详细描述这些机构和其它操作。特别参照图7，关节运动机构14显示为处于进行关节运动的状态，其中闭合套管组件46向近侧回缩到砧座处于打开状态。随着砧座42的打开，关节运动控制器18的致动引起关节连接的闭合环116分别以上部和下部双枢轴闭合连接件134、140的向上定向的远侧销136和向下定向的远侧销142为枢轴枢转。框架底48围绕单个销(图示为将框架底48与远侧构件114连接的近侧销157)枢转。随着砧座42的打开，框架底48的近侧销147与闭合套管组件46的上部和下部双枢轴连接件134、140的最远侧位置对准。当砧座42打开时，该位置很容易使钉施加组件20进行枢转运动及旋转。当闭合套管组件46向远侧运动以枢转闭合的砧座42时，随着枢轴连接件134、140的推压，闭合直管52围绕框架底48向远侧运动，并且关节连接的闭合环116沿着关节连接的远侧框架构件114的轴向远侧移动。当装置进行关节运动时(未显示)，随着它们向着远侧闭合位置的促动，连接件134、140上的双枢轴销136、138以及142、144有利于与闭合直管52和关节连接的闭合环116的接合。当有效运行时，在远侧闭合位置，框架底枢轴销(“近侧销”)147与近侧枢轴销138、144以完全关节运动的方式垂直对准，或者落在远侧销136、142和近侧销138、144之间的任一点上。
整体(solid)击发棒支撑件
在图8中，图7中的关节运动机构14被局部分解并从底部观察，显示出整体壁击发棒支撑设计(狗骨形连接件160)，其提供了传统挠性支撑板所不具备的优点。支撑板用于间隙的桥接，并通过单框架底枢轴关节运动接头1801导承和支撑击发棒66。挠性击发棒是公知的，但采用例如图4、8、9中显示的那些整体壁击发棒能提供独特的优点。现在参见图8，框架底48包括一个沿着框架底48的底部延伸的框架刀槽1802，并且一个远侧刀槽164沿着进行关节运动的远侧框架构件114的底部延伸，以将击发棒66(未显示)滑动容纳于其中。如上所述的框架底48包括一个带远侧框架构件114的直接单枢轴连接器157。可旋转地连接于近侧销端部157并可动地连接在远侧销端部159上的固定壁狗骨形连接件160包括左和右侧导向件1818、1820，从而在其间限定了一个导槽1822，作为击发棒66的滑动通道(图4)。
因此，为了桥接框架底48和远侧框架构件114之间的间隙，将固定壁枢轴狗骨形连接件160可枢转地连接到框架底48，并与框架构件114滑动连接。枢转的狗骨形件160的近侧销157可枢转地容纳于框架底48中的孔1824中，从而使枢转的狗骨形件160能够围绕凹处1824枢转。一个远侧销159从枢转的狗骨形件160向上伸出，并滑动地容纳于远侧框架114中的狭槽1826中。钉施加组件20与纵向轴线成例如45度角的关节运动使枢转的狗骨形件160在孔1824中在其近侧销157处枢转，并且远侧销157在其远端1814滑进狭槽1826中，使击发棒66弯曲成两个隔开(spaced-apart)的角，它们的角度是钉施加组件20的一半。与以前参照的将击发棒66弯曲成45度角的弹性支撑板不同，固定壁枢转的狗骨形件160将击发棒66弯曲成两个隔开的角，例如每个22.5度。通过将一个或多个弹性击发棒66弯曲成角度的一半可将击发棒66中的弯曲应力减小到传统的关节运动支撑件中的一半。击发棒66中的弯曲应力的减小降低了击发棒中的永久弯曲或位置固定的可能性，降低了击发阻塞的可能性，确保了较小的击发棒回缩力，并为击发系统提供了更平稳的运行。
在图9中，外科器械1900包括双闭合枢轴一框架枢轴关节运动接头1902，显示出了一种作为替代的整体壁支撑板机构1904，其用于替代下部双枢轴连接件140和狗骨形连接件1812。左和右击发棒支架1906、1908从闭合套管组件1912的下部双枢轴连接件1914向上伸出。在框架底1916中提供间隙1914，当闭套管组件1912向远侧运动以闭合砧座42(在图9中未显示)以及向近侧运动张开砧座42时，该间隙使击发杆1906、1908能够运动。与上述的枢转的狗骨形件1812相同，作为替代的下部双枢轴连接件1910也可弯曲并支撑击发棒66(在图9中未显示)，以形成两个隔开的弯曲角，其中的每个达到钉施加组件20的弯曲角的一半。
横向构件导承机构
继续参照图9，框架底1916上的左和右向上的凸缘1918、1920包括远侧和近侧横向销导向件1922、1924，它们横向穿过T型杆1926中的孔，以辅助使关节运动机构1928中形成的束缚最小。作为另一个例子，在图7中，有利地，T型杆104包括一个燕尾状横向导向件1930，其可在T型杆104中形成的燕尾状通道1932中横向滑动。作为另一个例子，在图12中，框架底1936上的一个突出肋1934容纳于在T型杆1940中形成的矩形狭槽1938中。为了进一步便于无束缚的横向平移，每个近侧和远侧横向支撑轨道分别包括多个独立的滚珠1946、1948。作为另一个例子，在图13中，与T型杆1964中的T型杆横向沟槽1958-1962相对应，在框架底1956中形成多个框架横向沟槽1950-1954。滑动辊1966-1970位于每对横向沟槽1950/1958、1952/1960、1954/1962中。但这些决不是对防止T型杆1940不需要的旋接或旋转的纵向导承构件的穷举。
双枢轴框架底和单枢轴闭合的结合
在图14-15中，一种替代的框架底和闭合机构2200包括具有双枢轴框架组件2204的外科器械2202。特别地，框架底2206通过双枢轴框架狗骨形件2210与远侧框架构件2208连接，所述双枢轴框架狗骨形件2210具有一个与框架底2206中的近侧孔2214可枢转地接合的近侧枢轴销2212，和一个与远侧框架构件2208的远侧孔2218接合的远侧枢轴销2216。一个导向槽2220设置于狗骨形件2210的下侧，以在其中导承击发棒66(在图14-15中未显示)。刀槽2222设置在远侧框架构件2208中。如图所示，闭合环2230以45度角的关节运动使远侧框架构件2208以45度角进行关节运动，并使框架狗骨形件2210以该角度的一半相进行关节运动。相应地，击发棒66经受到隔开的两个浅的半弯曲，并达到上述列举的所有优点。
最外层闭合套管组件2224的不同之处在于，框架组件2204的双枢轴设计中仅有一个枢轴为其提供纵向闭合运动。如图所示，一个闭合管轴2226在其远端具有一个叉形头2228。叉形头2228与闭合环2230可枢转地接合。闭合环2230具有一个在远端形成的近侧齿轮2232，并且销2234与叉形头2228的上柄脚2236可枢转地接合，下臂2238与叉形头2228的下柄脚2240接合。叉形头2228中的孔2242容纳横向导销2243，并且T型杆2244可滑动地连接于其中，以接合闭合环2230的近侧齿轮2232。因此，这种替代机构2200使用与前面描述的机构相反的单/双枢轴替代设计。也就是说，这种替代的闭合机构具有单枢轴，而替代的框架底具有双枢轴，这与前面描述的具有单枢轴框架底的双枢轴闭合机构不同。
横向运动关节运动机构
在图16中，用于外科器械2402的执行部分2412包括多枢轴闭合组件2204。最外层闭合套管组件2424通过一个包围单枢轴框架关节运动接头(在图16中未显示)的弹性闭合接头2425与闭合管轴2426连接。作为选择，可包围一个挠颈型框架关节运动接头。多枢轴闭合组件2446通过具有在弹性材料(例如，聚合物、硅树脂)中形成的左和右垂直狭缝2427、2429而具有横向挠性。材料的顶部和底部带2451保持挠性闭合接头2425的纵向长度并传送击发运动。
通过对多个实施例的描述对本发明进行了解释，这些解释性的实施例描述得非常详细，但申请人并不是想将所附的权利要求书的范围限制或以任何方式限定得如此详细。其它优点和变化对本领域技术人员来说是显而易见的。
例如，这里公开了水压动力关节运动方法，此处还应理解，与本发明的一些方面一致的应用还可以是机械动力或电力动力的。
作为另一个例子，外科器械的端部执行器可包括多种类型的致动构件，其可被连接成接收通过套管组件在进行关节运动的轴之上进行的选择性往复纵向运动。

Claims (9)

1. 一种外科器械，其包括：
细长轴，该细长轴包括框架组件和闭合套管组件；
端部执行器，其包括下部钳口和以可枢转的方式连接的上部钳口；
关节运动接头，其将端部执行器的下部钳口以可枢转的方式连接到所述框架组件的远端；
手柄部分，其与细长轴的近端连接，并可操作地构造为能将闭合运动沿纵向联接到闭合套管组件；以及
闭合套管组件的多枢轴接头，所述枢轴接头包围关节运动接头并在远侧与所述上部钳口接合，以使上部钳口枢转。
2. 如权利要求1所述的外科器械，其中，所述闭合套管组件还包括一个与砧座接合的远侧闭合管部分和一个连接到所述手柄部分的近侧闭合管部分，所述闭合套管组件的所述多枢轴接头包括上部双枢轴连接件和下部双枢轴连接件，它们分别在其两个端部的每个端部处以可枢转的方式连接到远侧和近侧闭合管部分。
3. 如权利要求2所述的外科器械，其中，所述远侧闭合管部分还包括朝近侧定向的叉形头，一个第一圆柱形构件与其相连；并且近侧闭合管部分还包括一个朝远侧定向的叉形头，一个第二圆柱形构件与其连接。
4. 如权利要求1所述的外科器械，其中，所述框架组件还包括一个与所述下部钳口相连的远侧框架部分，和一个与手柄部分相连的近侧框架部分，一个框架枢转臂在一端刚性连接于远侧和近侧框架部分的任选一端，并在另一端以可枢转的方式连接于远侧和近侧框架部分的另一个。
5. 如权利要求4所述的外科器械，其中，框架枢转臂包括用于导承击发棒的刀槽。
6. 如权利要求1所述的外科器械，其中，所述下部钳口包括一个容纳有钉仓的细长通道，并且以可枢转方式连接的上部钳口包括一个提供钉形成表面的砧座。
7. 如权利要求1所述的外科器械，其中，框架组件还包括一个与下部钳口相连的远侧框架部分，和一个与手柄部分连接的近侧框架部分，所述远侧和近侧框架部分为彼此提供叠置的和可枢转地连接的端部。
8. 如权利要求1所述的外科器械，其中，闭合套管组件的多枢轴接头还包括一个远侧圆柱形构件，一个弹性闭合接头与其连接，以及一个与弹性闭合接头连接的近侧圆柱性构件。
9. 如权利要求8所述的外科器械，其中，弹性闭合接头包括一个由弹性材料形成的圆柱形套管，并包括左和右两排垂直的狭缝。
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JP5179024B2 (ja) 2013-04-10
JP2007000633A (ja) 2007-01-11
IL175761A0 (en) 2006-10-05
EP1736105A1 (en) 2006-12-27
AU2006202051B2 (en) 2012-06-14
AU2006202051A1 (en) 2007-01-11
KR20060134840A (ko) 2006-12-28
US20060289602A1 (en) 2006-12-28
SG128563A1 (en) 2007-01-30
CN1883411A (zh) 2006-12-27
BRPI0602333A (pt) 2007-02-21
CA2550548A1 (en) 2006-12-23
MXPA06007225A (es) 2007-01-10

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