JP2000175922A - Suturing tool for under arthroscopic vision - Google Patents

Abstract

PROBLEM TO BE SOLVED: To guide a suture thread to the outside of a joint from the optional site of a visual field at the time of suturing in a visual field of an arthroscope to a lesion of the meniscus of a knee. SOLUTION: In order to put an inner cylinder 2 with a notch 4 through an outer cylinder 1 to penetrate a skin 11, an articula capsule 10 and the meniscus 12, the tips of the cylinder 1 and the cylinder 2 are made acute and at the time of piercing, the notch 4 is hidden in the cylinder 1. The suture 8 is held by the notch 4 and a tilting part 3 at the tip of the outer cylinder and the holding part 7 of the cylinder 2 is rotated, thereby biting of the recess part 5 of the outer cylinder and the projecting part 6 of the inner cylinder can be moved to strongly fix the suture 8. Thus, it is possible to put to the suture 8 through the meniscus 12 by inserting a torn part 13. The cylinder 1 can be installed at an optionally desired position under the view of the arthroscope and the suture thread 8 can easily be guided to the outside of the joint.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

The present invention relates to a technique for suturing damaged tissue under arthroscopic vision.

[0002]

2. Description of the Related Art Currently, meniscus is sutured almost arthroscopically, but three kinds of methods have been established so far. One is a double lumen suture instrument.
The second is a method in which a suture is introduced into the joint from outside the skin using an injection needle or the like, and is sutured. The third is a method in which the suture instrument has a loop shape, the inside of which is hollow, and the suture is passed through both ends of the torn portion with a loop.

[0003]

In a double-lumen suture instrument, the sutable portion is limited, only one route for two sutures to pass through the meniscus, and two to the skin. It was necessary to make an incision by the width when passing the wire. A second method is to introduce a suture into the joint from outside the skin using an injection needle or the like and suturing the suture. However, it is difficult to pull out the suture introduced into the joint to the outside of the joint. That is, a loop is formed with another thread, the loop is pulled out of the joint through a syringe needle or the like, and the above-described suture is put in the loop and pulled out of the joint. However, this procedure is very difficult. The third method, which is a looped suture instrument, also has a limited area through which the suture passes.

[0004] It is an object of the present invention to easily pass a suture through a target site in any part of a meniscus of a visual field under arthroscopy. Another object of the present invention is to reduce the length of the skin to be incised at the time of putting a suture onto the skin and suturing the suture, or to establish a suture method that does not require an incision.

[0005]

In order to achieve the above object, a suturing device according to the present invention incorporates an inner tube having a notch inside an outer tube so as to hold a suture in a joint. It is.

Under arthroscopy, the inner cylinder and the outer cylinder are guided to a target place on the meniscus from the skin outside the joint. Next, the inner cylinder is inserted into the joint from inside the outer cylinder. Insert the suture held by a coniotome etc. from the front of the knee joint into the joint, insert the end of the suture into the notch of the inner cylinder, hold the suture between the same part and the outer cylinder, and hold the skin outside the joint Pull out the suture. Similarly, an outer tube is inserted from the same part of the skin and is placed on the opposite side of the meniscal tear, and similarly, the opposite end of the suture is held and pulled out of the skin outside the joint.
Both ends of one suture come out of the same point on the skin, and only a minimal skin incision is required when both are sutured and implanted under the skin.

[0007]

Embodiments of the present invention will be described with reference to the drawings. As shown in FIG. 1, this suture instrument has a very simple structure, is composed of an outer cylinder 1 and an inner cylinder 2, and has an inclined portion 3 at the tip of the outer cylinder. The distal end of the inner cylinder 2 is sharp to penetrate the skin, joint capsule, and meniscus. In addition, a notch 4 having a width of about one third of the diameter of the inner cylinder 2 is provided behind the distal end. When inserted into the joint, the notch 4 is hidden in the outer cylinder 1 so as not to damage the tissue. Inner cylinder 2 in joint
From the outer cylinder 1 and hold the suture under the notch 4 of the inner cylinder 2 and the inclined portion 3 at the tip of the outer cylinder. At the time of holding, by rotating the inner tube 2, the concave portion 5 of the outer tube and the convex portion 6 of the inner tube are engaged, and the suture can be firmly fixed. The rotation is performed by rotating the holding portion 7 of the inner cylinder.

First, an arthroscope is inserted into the knee joint by the lateral subpatellar approach, and the tear 13 of the meniscus 12 is confirmed.
Next, the details of the tearing portion 13 are grasped from below the inner patella using a hook. For example, in the case of the longitudinally torn portion 13 of the inner meniscus 12, as shown in FIG.
Is held, and is pulled out below the meniscus 12, and again in the joint capsule 10, the suture 8 is drawn out from below the meniscus 12 and again over the tearing portion 13. The skin 1 on the inner side of the knee is seen while viewing the tear 13 with an arthroscope inserted from below the outer patella.
A suturing device is inserted into the joint so as to penetrate the meniscus 12 from below to above. Next, the tip of the suture 8 is introduced into the joint held by the coniotome 9 or the like from below the inner patella. Holding the suture 8 under the notch 4 of the inner cylinder and the inclined portion 3 of the tip of the outer cylinder under the mirror view, and pulling out the suture instrument from the skin 11 as it is, the suture 8 passes through the meniscus 12 from above to below, Guided on the skin. The suture 8 is pulled from the skin 11 so that the opposite end of the suture 8 comes into the joint.
A 1-2 mm skin incision is made in the area where the suture 8 extends from the skin 11, and the suture is again withdrawn through the joint, now through the torn side of the inner meniscus 12.
The opposite end of the suture 8 in the joint is held by a coniotome 9 or the like, and is held by the notch 4 of the inner tube and the inclined portion 3 of the outer tube, as described above, and is led out onto the skin 11. The both ends of the suture 8 are sutured and buried under the skin.

In the embodiment shown in FIG. 3, suturing is possible within the joint. The suturing device is inserted into the joint under arthroscopic vision by penetrating the meniscus 12 from above to below. After holding the suture 8 with the notch 4 of the inner cylinder and the inclined portion 3 of the tip of the outer cylinder, the suturing device is pulled downward and returned to below the meniscus 12. Next, with the suture thread 8 held, the distal end of the suture instrument is made to penetrate the meniscus 12 from the lower side to the upper side on the side opposite to the tearing portion 13. Release the suture 8 and pull the suture instrument out of the joint. With this operation, the suture 8 forms a loop with the meniscus 12 tearing portion 13 interposed therebetween. Next, the suturing device is inserted into the joint so as to come out from above the meniscus 12, and the suture 8 is wound so as to form a knot, and then the tip protruding from the meniscus 12 is held.
Pull it out of the joint. The distal end on the opposite side remains from under the medial patella, and by pulling the distal end and the distal end pulled out of the joint with a suture instrument with both hands, secure suturing is possible. Next, once again, the tip of the suture thread 8 that has come out of the joint by a hook or the like is returned to the inside of the joint, a further knot is created, and the knot is pulled out of the joint in the same manner, and the suture formed in the joint is doubled. A knot is also formed in the joint,
No incision is needed.

[0010]

Since the present invention is configured as described above, the following effects can be obtained.

The suture is passed through the meniscus, and the two penetration points can be set at any positions.

[0012] It is easier to pass the suture through the meniscus.

When suturing a suture on the skin, the skin incision may be as small as 1-2 mm.

In the suturing method described with reference to FIG. 3, since the suture is sewn in the joint, there is no need to cut the skin.

In the suturing method described with reference to FIG. 3, since the knot is localized within the joint, there is no possibility of involving a nerve or blood vessel outside the joint.

In the suturing method described with reference to FIG. 3, since both ends are pulled and tied with both hands, strong suturing is possible.

[Brief description of the drawings]

FIG. 1 is a front view of an arthroscopic suture instrument. A Inner cylinder B Outer cylinder C Combination of AB

FIG. 2 is an explanatory view of a meniscal suture method using an actual arthroscopic suture instrument.

FIG. 3 is an explanatory diagram of a meniscal suture method that does not require skin incision using an arthroscopic suture instrument.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Outer cylinder 2 Inner cylinder 3 Inclined part of tip of outer cylinder 4 Notch 5 Concave part of outer cylinder 6 Convex part of inner cylinder 7 Holding part of inner cylinder 8 Suture 9 Coniotome (forceps holding suture) 10 Joint capsule 11 Skin 12 meniscus 13 rupture

Claims (2)

[Claims] 1. An outer cylinder used under arthroscopic vision and inserted into a joint through a meniscus from outside a knee joint, and a notch portion of a notched inner cylinder extending into the joint from inside the outer cylinder. An arthroscopic suturing device characterized in that a suture is held by the guide and the suture is guided into and out of the joint. 2. An outer cylinder used under arthroscopy and inserted into a joint through a tissue or the like damaged from outside the joint, and a notch portion of a notched inner cylinder coming into the joint from inside the outer cylinder. An arthroscopic suturing device characterized in that a suture is held in between the suture and a suture is guided into and out of the joint.