JP2000333964A - Kit for separating peritenon from musculotendinous retinaculum - Google Patents

Abstract

PROBLEM TO BE SOLVED: To permit safer and more reliable separation of a peritenon from a musculotendious retinaculum and to permit early healing of wounds by reducing invasion. SOLUTION: This kit comprises: a cannula 10 formed of a small diameter tubular member with an inclined end and a fenestration part formed along a base line passing this inclined pointed end, and with an opening in the end of the small diameter tubular member serving as an entrance/exit for a scalpel for separating peritenon from musculotendionus retinacula, and an opening in the rear end of a large diameter tubular member serving as an entrance/exit for an obturator and an endoscope; a pin-shaped body with a conically shaped end; a base part connected to the pin-shaped body; and a handle part provided at the end of the base part. The pin-shaped body comprises: an obturator 30 passed through the small diameter tubular member via the large diameter tubular member of the cannula to close the inside of the small diameter tubular member, with the end of the obturator 30 projecting from the end of the small diameter tubular member; and a scalpel 50 for separating peritenon from musculotendinous retinacula, comprising a slender shaft with a width such that it can enter into the small diameter tubular member of the cannula, and a hooked separating blade disposed at the end of the shaft.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a kit for separating a tendon sheath and a muscular tendon band.

[0002]

2. Description of the Related Art Spring fingers and Dokerban's disease, which are stenotic tendonitis, are very common in daily medical care. Due to the strangulation, the finger is unable to flex and extend smoothly, and is a disease often accompanied by significant pain. Carpal tunnel syndrome is a disease in which the median nerve is strangled by the flexor ligament (transverse carpal ligament), resulting in median nerve paralysis, which impairs finger movement and perception. Conventionally, for these diseases for which conservative therapy is not effective, open surgery of the tendon sheath or flexor ligament under direct vision has been performed. However, problems have been pointed out in this direct-view operation, such as the fact that postoperative pain is strong and that it takes a long time to heal the surgical wound, which limits daily life including long-term water work. In addition, this disease is known to occur frequently in diabetic patients, for which the increase in the number of patients has become a problem in recent years.However, in diabetic patients, wound healing is extremely poor, so there is a problem in making a large skin incision. was there. Furthermore, since the hands and upper limbs are exposed parts, there are many patients who are reluctant to form conspicuous surgical wounds and hesitate to undergo necessary surgery. For the spring finger, a subcutaneous dissection method in which a needle-shaped scalpel is blindly inserted into a subcutaneous skin to dissect the tendon sheath has already been reported as a minimally invasive operation. However, since this is a complete blind operation, there is a high possibility that nerves and blood vessels will be damaged, and the surgical operation is uncertain, leading to many cases of reoperation. On the other hand, for carpal tunnel syndrome, a method has been reported in which a thin cannula is passed through the carpal tunnel from a small incision distal to the forearm and the flexor ligament is separated using an endoscope. However, this method
Inserting the cannula inside the flexor ligament and performing the cutting operation without looking at the nerves and blood vessels,
Injuries, such as flexor tendons, have been reported as serious complications. For the above reasons, there has been a demand for a technique for safely and surely separating a tunnel-like structure for strangling a tendon or nerve, that is, a tendon sheath or a muscular tendon with very small invasion.

[0003]

SUMMARY OF THE INVENTION The present invention has been made in view of the above-described circumstances of the prior art, and enables a safer and more reliable surgical operation for tendon sheath / muscle tendon ligament dissection, and invasiveness. It is an object of the present invention to provide a kit for separating tendon sheaths and muscle tendon ligaments that can be reduced and enable early wound healing.

[0004]

Means for Solving the Problems The present inventors have conducted intensive studies to solve the above-mentioned problems, and as a result, have completed the present invention. That is, according to the present invention, in order to solve the above-mentioned problems, a small-diameter tubular member and a large-diameter tubular member that is continuous with the small-diameter tubular member, and the distal end of the small-diameter tubular member has an inclined shape. A fenestration is formed along a generatrix passing through the sloped tip, the opening at the distal end of the small-diameter tubular member serves as an entrance and exit for a scalpel for separating tendon sheaths / muscular tendon bands, and the opening at the rear end of the large-diameter tubular member is an obturator A pin-shaped body having a conical tip, a base connected to the pin-shaped body, and a handle provided at an end of the base. The body was inserted into the inside of the small-diameter tubular member through the large-diameter tubular member of the cannula, closed the inside of the small-diameter tubular member, and formed so that its tip protruded from the tip of the small-diameter tubular member. With an obturator; inserted inside the small tubular member of the cannula Tendon sheath / muscle tendon scalpel comprising a slender shaft having a width that can be inserted and a scalpel for severing a tendon sheath / muscular tendon with a hook-shaped or L-shaped cutting blade provided at the tip of the shaft. A band cutting kit is provided. Further, according to the present invention, in the above configuration,
A kit for dissecting a tendon sheath / muscle tendon ligament further comprising an elongated shaft and a dissector composed of a flat spatula-like portion for removing a tendon and a subcutaneous tissue provided at the tip of the shaft. Further, according to the present invention, in the above-described configuration, an elongated shaft having a width capable of entering the inside of the small-diameter tubular member of the cannula, and a search portion provided at the tip of the shaft by being bent substantially in an L-shape. A kit for separating a tendon sheath / muscle tendon ligament further comprising a probe comprising:

[0005]

DESCRIPTION OF THE PREFERRED EMBODIMENTS Embodiments of the present invention will be described below in detail based on embodiments. FIG. 1 shows a tendon sheath of one embodiment of the present invention.
FIG. 2 is a perspective view showing a muscular tendon band separation kit (hereinafter also simply referred to as a separation kit). The kit includes a cannula 10, an obturator 30, and a scalpel (hereinafter referred to as an endoscopic scalpel) 50 for tendon sheath and muscular tendon band. This kit is very suitable for separating a tendon sheath / muscle tendon band under an endoscope. In a state where the obturator 30 is attached to the cannula 10, the kit is directly above the tendon sheath / muscle tendon band. In addition, by inserting the obturator 30 immediately after being inserted along the midline, a route for inserting an endoscopic scalpel, a probe, or an endoscope is secured, and the neurovascular system is protected. Then, an endoscope is inserted through an opening on one side of the cannula 10, and an endoscope scalpel 50 is inserted through an opening on the other side to enable the tendon sheath / muscle tendon ligament to be separated.

First, the structure of the cannula 10 will be described. 2A is a right side view of the cannula 10, and FIG.
3A is a plan view, FIG. 3A is a left side view, FIG.
FIG. 4 is a sectional view taken along line AA of FIG. The cannula 10 is basically composed of a slightly longer small-diameter tubular member 11 and a slightly shorter large-diameter tubular member 12. The small-diameter tubular member 11 and the large-diameter tubular member 12 are made of a metal material such as stainless steel, a synthetic resin material, or tempered glass.

The small-diameter tubular member 11 has an opening 13 at one end thereof.
The opening 13 serves as an entrance of the scalpel 50. The end 14 of the small diameter tubular member has an inclined shape, as is apparent from FIG. 3 (b). In the small-diameter tubular member 14, as shown in FIG. 3A, a fenestration 17 is formed along a generatrix passing through an inclined point 16 of the end 14. The fenestration 17 is formed in an elongated shape starting from a position away from the point 16, as shown in FIG.
The fenestration 17 serves as a window for observing the cut portion, and also defines a cut range of the endoscope knife 50 and serves as a window for cutting. That is, the fenestration 17 prevents unnecessary separation. It is preferable that a scale 18 is formed on the outer wall of the small-diameter tubular member 11 as shown in FIG.

The large-diameter tubular member 12 has an opening 19 on one end side, and the opening serves as an entrance for the obturator 30 and the endoscope. The other end 20 of the large-diameter tubular member 12 is shown in FIG.
As shown in (a), it is formed in a tapered shape and is connected to the other end of the small-diameter tubular member 11. Large diameter tubular member 12
As shown in FIG. 4, a large-diameter hollow portion 21, a small-diameter hollow portion 22, a truncated cone-shaped hollow portion 23, and a small-diameter tubular member 1 are provided.
It has a small-diameter hollow portion 24 that is continuous with one. An elastic member 26 such as rubber is mounted on an inner tube wall shoulder 25 that defines a boundary between the large-diameter hollow portion 21 and the medium-diameter hollow portion 22. Further, in the large-diameter tubular member 12, a handle portion 27 is attached to an appropriate place on the opposite side to the side where the fenestration portion 17 is formed. On the other hand, a projection of the locking portion 28 is attached inside the large-diameter tubular member 12. The inner diameter of the large-diameter tubular member 12 is set to a shape and dimensions that allow the obturator 30 and the endoscope to easily enter.

Next, the obturator 30 will be described. 5 is a front view of the obturator 30, FIG. 6 is an explanatory perspective view showing how the obturator 30 is mounted on the cannula 10, and FIG.
FIG. 4 is a partially cutaway front view showing a state of being attached to a zero.

The obturator 30 includes a pin 31 having a conical tip 32, a base 33 connected to the pin 31, and a handle 34 provided at an end of the base 33. Consists of The obturator 30 is made of a metal material such as stainless steel, a synthetic resin material, or tempered glass. The base 33 has a medium diameter portion 35 having a diameter slightly larger than the pin-shaped body 31, a large diameter portion 36 larger than the medium diameter portion 35, and a handle portion 34 connected to the large diameter portion 36. The obturator 30 is integrally formed as a whole. The end portion 37 of the handle portion 34 on the side connected to the large diameter portion 36 is formed in a tapered shape. On the circumferential portion 38 of the handle portion 34, irregularities 39 for non-slip are engraved as appropriate. As shown in FIG.
A locked portion 40 having a U-shaped groove is provided, and is engaged with the locking portion 28 when the obturator 30 is mounted. The state of the engagement is shown in FIG. As shown in FIG. 7, the middle diameter portion 35 enters into close contact with the elastic member 26. The outer diameter of the pin-shaped body 31 is the cannula 10
It is preferable that the size be such that it fits the inner wall of the small-diameter tubular member 11. The pin-shaped body 31 is
Is inserted into the small-diameter tubular member 11 through the large-diameter tubular member 12 to close the inside of the small-diameter tubular member 11, and the tip 32 is formed in a shape protruding from the tip of the small-diameter tubular member 11. Have been.

Next, the endoscope knife 50 will be described. FIG. 8 is a front view of the endoscope knife 50, FIG. 9 is an enlarged perspective view of a portion B of FIG. 8, and FIGS. 10A and 10B are an enlarged front view and a bottom view of the portion B of FIG.

The endoscope knife 50 has an elongated shape as a whole, and includes a shaft 51 and a cutting blade 52. The shaft 51 has an elongated shape having a width capable of entering the inside of the small-diameter tubular member 11 of the cannula 10, and a hook-shaped or L-shaped cutting blade 52 is formed at the tip thereof. The endoscope knife 50 is made of a metal material such as stainless steel. A handle may be provided on the front side of the shaft 51 so that the endoscope knife 50 can be easily held.

The cutting blade 52 has a hook shape or an L shape as shown in FIGS. That is, the contour of the hook-shaped portion is defined by an inner distal end 53 of the shaft 51, an inner curved portion 54 curved from the inner distal end 53 and extending in the lateral direction, and an outer distal end 55 of the shaft 51.
And an outer curved portion 56 which is curved from the outer distal end portion 55 and extends in the lateral direction, and a side end portion 57 substantially parallel to the longitudinal direction of the shaft 51. A double-sided cutting blade is formed over the inner front end portion 53, the inner curved portion 54, and the side end portion 57 of the shaft 51.

As shown in FIG. 11, the endoscope knife 50 is
Inserted through the opening 13 of the cannula 10, FIG.
And as shown in FIG. 13, the separating operation is performed. Of course, this operation is performed under observation by an endoscope.

The endoscope scalpel 50 is shown in the preferred embodiment, and the present invention is not limited to this. Various types of endoscope scalpels can be used.
The endoscope scalpel is preferably used in a disposable manner because of its cutting performance. In addition, the endoscope scalpel has a sharp edge that may inadvertently damage the fingers of the surgeon, etc., so a protective cap of an appropriate shape made of plastic material or the like must be attached when not in use. Is desirable.

The configuration of the separation kit according to one embodiment of the present invention has been described above. According to the present invention, the dissector 70 shown in FIG. 14 and / or the probe 90 shown in FIG. The kit may be added as a kit.

Referring to the dissector 70, it comprises a shaft 71 and a flat, spatula-like portion 72 for removing tendons and subcutaneous tissue. The dissector 70 is made of a metal material such as stainless steel.

Next, the probe 90 will be described. The probe 90 has an elongated rod shape as a whole, and includes a shaft 91 and a probe 92. The shaft 91 has an elongated shape having a width capable of entering the inside of the small-diameter tubular member 11 of the cannula 10, and a search element 92 bent in a substantially L-shape is formed at the tip thereof. The probe 90 is made of a metal material such as stainless steel.

The probe 90 is similar to the endoscopic scalpel 50,
It is inserted through the opening 13 of the cannula 10 to check the tendon sheath / muscle-tendon ligament and to peel off the synovium and adipose tissue attached to it. As a result, a good visual field is secured, and preparations for reliably separating the target object are completed. Of course, this operation is performed under observation by an endoscope.

Next, an example of a surgical procedure using the above-described separation kit will be described. When the tendon sheath / muscle tendon band is cut using the cutting kit of the present invention, as shown in FIG. 16, unlike the conventional method, the cannula 10 is inserted just above the tendon sheath / muscle tendon band, The treatment is performed with the fenestration 16 facing downward in the figure, that is, with the fenestration 17 facing the target to be cut off. As a result, damage to the median nerve and blood vessels can be prevented extremely effectively, and a satisfactory and satisfactory patient surgical treatment can be performed.

More specifically, although not shown, a hand on the side to be operated is placed on a curved support table, and the palm is fixed in a state where the palm faces upward.
Next, after marking the skin incision line, local anesthesia is performed under anastomosis.

Next, for example, when the tendon sheath is to be cut, FIG.
As shown in Fig. 7, two small incisions were made at the front and back of the tendon sheath using a regular scalpel, and the subcutaneous tissue and the tendon were separated using the dissector 70. Then, the cannula 10 was inserted subcutaneously just above the tendon. I do. At this time, as shown in FIG. 7, the obturator 30 is attached to the cannula 10 in order to facilitate the insert, to reinforce the strength of the cannula 10, and to prevent soft tissue pieces such as fat from entering the cannula 10. And insert it (Fig. 1
8). Insertion is performed so that the fenestration 17 of the cannula 10 faces the tendon or tendon sheath. After the insertion, the handle portion 34 is rotated to release the engagement between the locking portion 28 and the locked portion 40, and the obturator 30 is removed (FIG. 1).
9). Next, a 30-degree oblique endoscope is inserted from the opening 19 of the cannula 10 to observe a stenosis site (FIG. 2).
0). The position of the fenestration 17 is set to an appropriate position by moving the handle 27 in the circumferential direction. After observing the disease state, for example, the probe 9 is inserted through the opening 13 of the cannula 10.
Insert 0 and check the position of the tendon sheath. At this time, if the visual field is obstructed by the synovium or adipose tissue, the probe 90
This is peeled off. Then, the opening 13 of the cannula 10
Then, the endoscopic scalpel 50 is inserted (FIG. 21), and the tendon sheath is cut off while observing with the endoscope. By the above operation, it is possible to confirm that the strangulation and adhesion are released and the flexor tendon smoothly slides. After the cannula 10 is removed, compression dressing is performed without skin suturing in principle.

[0023]

According to the kit for separating tendon sheath and muscular tendon of the present invention, since only a small incision is made in two places, the wound is 3
Healing takes about 5 days and water work is possible at least 5 days after surgery. Particularly for a large number of cases of finger onset and for diabetic patients who are liable to fail to heal the wound, the merits of reducing the invasiveness and early healing of the wound are great. Also, since there is no skin suture, thread removal is not required. Furthermore, after the wound is closed, the surgical wound is healed so that it cannot be recognized. In addition, since the cannula 10 is inserted just above the tendon sheath / muscle tendon ligament and the target object and surrounding tissue can be surely observed with an endoscope, the tendon sheath / muscle tendon ligament can be cut off. It is possible to prevent damage to tendons and the like very effectively, and to perform surgical treatment reliably and safely. The kit for separating tendon sheath and muscular tendon ligament of the present invention can be used for appropriate tendon sheath / muscle tendon ligament resection surgery by deforming and modifying its size and shape. It has a remarkable effect on the treatment of spring fingers, Dokervan tenosynovitis, carpal tunnel syndrome and elbow tunnel syndrome.

[Brief description of the drawings]

FIG. 1 is a perspective view showing a kit for separating a tendon sheath and a muscular tendon band according to an embodiment of the present invention.

2A is a right side view of the cannula, and FIG. 2B is a plan view thereof.

3A is a left side view of the cannula, and FIG. 3B is a front view thereof.

FIG. 4A is a sectional view taken along line AA of FIG. 3A.

FIG. 5 is a front view of the obturator.

FIG. 6 is a perspective view showing a state in which an obturator is mounted on a cannula.

FIG. 7 is a partially cutaway sectional view showing a state where an obturator is mounted on a cannula.

FIG. 8 is a front view of a scalpel for tendon sheath / muscle tendon bandage separation.

FIG. 9 is an enlarged perspective view of a portion B (cutting blade) in FIG. 8;

10A is an enlarged front view of a portion B, and FIG. 10B is an enlarged bottom view of the same.

FIG. 11 is an explanatory view showing a state where a scalpel for tendon sheath / muscle tendon band dissection is inserted into a cannula.

FIG. 12 is an explanatory diagram of a separating operation.

FIG. 13 is an explanatory diagram of a separating operation.

FIG. 14 is a front view of a dissector.

FIG. 15 is a front view of the probe.

FIG. 16 is a conceptual diagram for performing a tendon sheath / muscle tendon ligament dissection using the dissection kit of the present invention.

FIG. 17 is an explanatory view of a subcutaneous insert of a cannula.

FIG. 18 is an explanatory view of a subcutaneous insert of a cannula.

FIG. 19 is an explanatory view of a subcutaneous insert of a cannula.

FIG. 20 is an explanatory view of an insert of an endoscope.

FIG. 21 is an explanatory diagram of an insert of a scalpel for tendon sheath / muscular tendon band dissection.

[Explanation of symbols]

 Reference Signs List 10 cannula 11 small-diameter tubular member 12 large-diameter tubular member 13 opening 17 fenestration 19 opening 30 obturator 31 pin-shaped body 33 base 34 handle portion 50 scalpel for cutting tendon sheath / muscle tendon band 51 shaft 52 cutting blade Part 70 dissector 71 shaft 72 spatula-like part 90 probe 91 shaft 92 searcher

Claims (8)

[Claims] 1. A small-diameter tubular member and a large-diameter tubular member connected to the small-diameter tubular member, and a distal end portion of the small-diameter tubular member has an inclined shape, and is opened along a generatrix passing through a tip of the inclined shape of the small-diameter tubular member. A window is formed, the distal opening of the small-diameter tubular member serves as an entrance for a scalpel for dissecting tendon sheaths and muscular tendons, and the rear-end opening of the large-diameter tubular member serves as an obturator and a cannula that serves as an entrance and exit for an endoscope. A pin-shaped body having a conical tip, a base connected to the pin-shaped body, and a handle provided at an end of the base, wherein the pin-shaped body is a large-diameter tubular member of a cannula. An obturator that is inserted through the small-diameter tubular member through to close the small-diameter tubular member, and has a tip formed to project from the tip of the small-diameter tubular member;
A scalpel for cutting a tendon sheath / muscle tendon ligament comprising an elongated shaft having a width capable of entering the inside of the small-diameter tubular member of the cannula and a hook-shaped or L-shaped cutting blade provided at the tip of the shaft; A kit for separating tendon sheaths and muscular tendon ligaments. 2. The apparatus according to claim 1, further comprising an elongated shaft, and a dissector provided at a tip of the shaft, the dissector including a flat spatula-like portion for detaching tendons and subcutaneous tissue.
The kit for separating a tendon sheath / muscle tendon ligament according to [1]. 3. A probe comprising an elongated shaft having a width capable of entering the inside of the small-diameter tubular member of the cannula, and a probe comprising a search portion provided at the tip of the shaft in a substantially L-shape. Item 3. A kit for separating a tendon sheath / muscular tendon ligament according to item 1 or 2. 4. The tendon sheath / muscle tendon ligament according to claim 1, wherein a handle portion is provided on the large-diameter tubular member of the cannula so as to be opposite to the fenestration portion. Kit for separation. 5. A cannula, wherein a locking portion is mounted inside the large-diameter tubular member of the cannula, and a locked portion locked by the locking portion is formed at a base of the obturator. 4. The kit for separating tendon sheaths and muscular tendon bands according to any one of the items 4). 6. The tendon sheath / muscle tendon ligament incision according to claim 1, wherein the fenestration of the cannula is formed starting from a position apart from the tip of the small-diameter tubular member by a predetermined length. Release kit. 7. The tendon sheath / muscle tendon ligament according to claim 1, wherein an end of the large-diameter tubular member of the cannula on the connection side with the small-diameter tubular member is formed in a tapered shape. Kit for separation. 8. The kit for separating tendon sheath and muscular tendon according to any one of claims 1 to 9, further comprising a protective cap that covers the tip of a scalpel for separating tendon sheath and muscular tendon.