JP2005296391A - Scalpel holder for carpal canal opening operation - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a low-cost scalpel holder for carpal canal opening operation which does not impose a burden to a patient. <P>SOLUTION: An inner side holder part 1 has a slit 11 for storing the scalpel on the side face of a long and slender body 10, and also has a tip part 12 extending farther from the distal end of the slit. The base part 32 of the scalpel is stored in the slit 11 in the state that a blade part 31 protrudes out of the slit 11 at the time of mounting the scalpel 3. An outer side holder part 2 is constituted of a cylindrical body 20 for example so that the base part 32 of the scalpel 3 stored in the slit 11 of the inner side holder part 1 is held from outside. A slit groove 21 to which the blade part 31 of the scalpel is inserted and fixed is formed at the tip end 2b of the outer side holder part 2. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to a scalpel holder for carpal tunnel opening surgery, and in particular, a carpal that is inserted under the skin without greatly incising the skin of the palm and is suitable for a minimum incision of only a specific affected part (carpal tunnel). The present invention relates to a scalpel holder for opening a tube.

In surgical instruments for carpal tunnel opening using an endoscope, a cannula is inserted under the skin so as to penetrate the palm of the patient back and forth, and an endoscope and a scalpel are attached. . This method can make the skin incision smaller than the conventional surgical method (open method) (1 or 2 incisions of 1 cm length), so the burden on the patient can be reduced. There are problems that the risk of (damage to nerves, blood vessels, and tendons) is increased, and that the device and the disposable knife are expensive. In Patent Document 1 below, a surgical instrument for carpal tunnel opening using an arthroscope is disclosed. In this surgical instrument, a cannula is inserted under the skin of the palm, And insert a scalpel. This method also reduces the burden on the patient because the skin incision can be made smaller than the conventional surgical method (one incision of 1 cm length), but on the other hand, the operation becomes difficult, so complications (nerves, blood vessels, tendons) There is a problem that the risk of damage) increases and the device and the disposable knife are expensive. Further, in Patent Document 2 below, a guide groove is provided in a flat plate-like insertion portion to be inserted under the skin of the palm, and the carpal canal is incised by pushing and moving a dedicated knife along the guide groove. A surgical instrument for open carpal tunnel is shown. Since this instrument is large and requires a larger skin incision (one incision of 1.5 to 2 cm length) than the method using an endoscope, it imposes a burden on the patient.
JP-A-5-253231 JP 11-299800 A

  The present invention has been made in view of the above-described points, and an object thereof is to provide a low-cost carpal tunnel opening scalpel holder while ensuring safety. In addition, by reducing the skin incision smaller than the endoscopic method, the burden on the patient is further reduced, and the scalpel canal opening scalpel holder is suitable for incision only on the specific affected area (carpal tunnel) by inserting it under the skin. Is to provide.

  A carpal tunnel opening scalpel holder according to the present invention is a carpal tunnel opening scalpel holder for holding a scalpel composed of an elongated base and a blade rising from the base, and is a side surface of an elongated body. Has a slit for storing a knife, and has a tip extending beyond the distal end of the slit, and the blade of the knife protrudes from the slit when the knife is mounted. An inner holder portion that stores the base portion of the knife in the slit and an outer holder portion that holds the base portion of the knife stored in the slit of the inner holder portion from the outside. .

  Accordingly, the knife stored in the slit of the inner holder part is held from the outside by the outer holder part, that is, the knife is held and fixed between the inner holder part and the outer holder part. A possible scalpel can be used to construct a carpal tunnel opening scalpel at a low cost. In addition, since it can be formed into an elongated and small shape as a whole, it is suitable for a minimum incision of only a specific affected part (carpal tunnel) by inserting it under the skin without burdening the patient.

  As one embodiment, the outer holder part is composed of a cylindrical body that is fitted on the outer periphery of the inner holder part. Moreover, if the groove | channel which inserts and fixes the knife part of a knife is formed in the front-end | tip of an outer side holder part, the fixation of the knife in a holder can be performed reliably. Moreover, it can make it easy to insert under the skin by making the front-end | tip part of an inner side holder part into a tapered shape. Further, by rounding the tip of the inner holder part, it is possible to make it difficult to damage the patient's living tissue.

Further, as one embodiment, the outer holder portion has a proximal end when the carpal tunnel opening scalpel holder with the scalpel is inserted from the distal end portion of the inner holder portion under the affected skin. Has a length that can be exposed to the outside of the skin, and the outer holder portion extends along the length direction of the inner holder portion while holding the base portion of the knife accommodated in the slit by the outer holder portion. The outer holder part is moved closer to the distal end along the inner holder part, so that the blade part of the knife is moved to the distal end of the slit of the inner holder part and the outer holder. In this state, it is possible to make an incision of the affected area with the scalpel by moving the entire scalpel holder in this state.
As a result, the scalpel is not firmly fixed when the base of the scalpel is simply held by the outer holder part, so that the incision action does not occur and the scalpel can be moved safely and easily to the required surgical site under the skin. When the scalpel reaches the required surgical site under the skin, only the outer holder part is moved distally to move the scalpel blade part to the distal end of the slit of the inner holder part and the end of the outer holder part. It is possible to make an incision by sandwiching and fixing between the two parts.

Hereinafter, embodiments of the present invention will be described in detail with reference to the accompanying drawings.
A female holder for carpal tunnel opening operation according to an embodiment of the present invention includes an inner holder part 1 and an outer holder part 2. 1, (a) is a side view of the inner holder part 1, (b) is a top view of the inner holder part 1, (e) is a side view of the outer holder part 2, and (f) is an upper face of the outer holder part 2. FIG. 4H is a side view showing an example of the knife 3 attached to the knife holder. As an example, the knife 3 includes an elongated base 32 having a length of about 30 to 40 mm, and a blade 31 that rises from the base 32 at an appropriate angle (appropriate angle of less than 90 degrees). The blade 31 is formed with a blade 31a at a distal edge, and a proximal edge is a spine 31b. Throughout the drawings, for the sake of convenience of illustration, the holder length dimension is reduced relative to the radial dimension (the radial dimension is relative to the length dimension relative to the length dimension). (Enlarged).

  The inner holder portion 1 is composed of an elongated cylindrical body 10 made of an appropriate material such as stainless steel, for example, having a length of about 150 mm / outer diameter of about 1.5 to 1.8 mm. The slit 11 has a slit 11 for accommodating a knife, and has a tip 12 that extends somewhat beyond the distal end 11 a of the slit 11. The slit 11 has a size that can accommodate the base 32 of the knife 3 and has, for example, a length of about 50 mm and a width of about 1 mm. FIGS. 1C and 1D respectively show cross-sectional examples of the body 10 at the slit 11 portion. In the example of (c), the slit 11 is formed by making a cut in the radial direction of the cylindrical cross section of the body 10. In the example of (d), the slit 11 is formed by making a cut so as to slice the cylindrical side surface of the body 10 in the length direction. (C) and (d) may be used to form the slit 11, but the example of (c) has the advantage that the knife 3 housed in the slit 11 can be stably held. The example of d) has an advantage that the slit 11 can be easily formed. The front end portion 12 of the inner holder portion 1 has a length of about 10 to 20 mm, for example, and the front end 12a is cut obliquely to have a tapered shape, thereby facilitating insertion under the skin. Yes. Further, the tip 12a is rounded (blunted) to make it difficult to damage the patient's living tissue when inserted under the skin.

  The outer holder part 2 is made of an appropriate material such as stainless steel similar to the inner holder part 1, and includes a cylindrical body 20 that is fitted on the outer periphery of the inner holder part 1. Therefore, the inner diameter of the cylindrical body 20 of the outer holder portion 2 is somewhat larger than the outer diameter of the inner holder portion 1. Further, the outer diameter of the cylindrical body 20 of the outer holder portion 2 is, for example, about 2.5 mm. The length of the outer holder part 2 is such that the proximal end 2a of the outer holder part 2 can be exposed outside the skin when a holder equipped with a scalpel 3 is inserted under the skin of the affected part during surgery. For example, it is about 100 mm. This is for enabling the outer holder 2 to be picked and operated by the practitioner's hand. A slit groove 21 for fixing a knife is formed at the distal end 2b of the outer holder portion 2. The length of the slit groove 21 is, for example, about 5 mm, and the width thereof is a dimension that allows the spine 31b of the blade 31 of the knife 3 to be fitted, for example, about 0.5 mm. FIG. 1 (g) shows a cross section of the outer holder portion 2 (tubular body 20) in the slit groove 21. In the illustrated example, the distal end 2b of the outer holder part 2 is formed somewhat obliquely in order to facilitate insertion when the inner holder part 1 is inserted into the cylinder of the outer holder part 2. .

  FIG. 2 shows a state in which the scalpel 3 is mounted on the scalpel canal for surgical operation according to the present embodiment. As shown in FIG. 2A, the base 32 of the knife 3 is accommodated in the slit 11 of the inner holder 1 so that the blade 31 of the knife 3 protrudes upward from the slit 11 of the inner holder 1. . Then, from the proximal end side of the inner holder part 1, the outer holder part 2 is fitted into the inner holder part 1 with the distal end 2 b of the outer holder part 2 as the head. The outer holder portion 2 is movable along the length direction of the inner holder portion 1, and the outer holder portion 2 is moved (pushed) toward the distal end along the inner holder portion 1 to move the outer holder portion 2. When the knife base 32 in the slit 11 is covered, the knife 3 is held between the inner holder part 1 and the outer holder part 2 so that the knife 3 does not fall easily. FIG. 2B shows that the blade 31 of the scalpel 3 is pushed into the inner holder portion 1 by pushing the outer holder portion 2 inward, and the distal end 11 a of the slit 11 of the inner holder portion 1 and the slit of the distal end 2 b of the outer holder portion 2. The state sandwiched between the grooves 21 is shown. In this state, the proximal end of the inner holder part 1 comes out before the proximal end of the outer holder part 2 and is exposed. FIG. 2C schematically shows this state in a sectional view. Thus, the scalpel 3 is mounted on the carpal tunnel opening scalpel holder according to the present embodiment, which is constituted by the inner holder part 1 and the outer holder part 2.

  The operation of the affected area is performed by the “US guide method” using a US (ultrasonic wave) monitor using the scalpel holder for carpal tunnel opening according to the present embodiment. While confirming on the US monitor screen, a small incision is made in a predetermined part of the patient's palm so that the median nerve and the ulnar arterial center line (safe line) are separated, and then the hand according to this embodiment is used. The distal end 12 of the inner holder 1 of the root canal opening surgical holder is inserted under the skin, the holder is pushed forward, and the distal end 12 is inserted immediately below the ligament to be separated from the carpal tunnel. Next, the blade 31 of the scalpel 3 is inserted into the slot 11 of the inner holder portion 1, and the spine 31b is passed through the skin incision from the proximal end. Subsequently, the base 32 of the scalpel 3 is housed in the slot 11 of the inner holder part 1, and the distal end 2 b of the outer holder part 2 is inserted from the proximal end of the inner holder part 1 and pushed forward in the distal direction. As a result, the blade 31 of the knife 3 is fixed in a state of being sandwiched between the distal end 11a of the slot 11 of the inner holder part 1 and the slit groove 21 of the distal end 2b of the outer holder part 2, and the knife 3 is fixed. The incision function is exhibited, and a predetermined site (ligament) of the carpal tunnel is cut off. When the separation of the predetermined part of the carpal canal is completed, the proximal part of the inner holder part 1 is grasped and pulled out (proximal direction) until the distal end 2b of the outer holder part 2 comes to the skin incision part. Next, the outer holder part 2 is grasped and pulled out completely, the base 32 of the scalpel 3 is taken out from the slot 11 of the inner holder part 1, and the spine 31b of the blade part 31 of the scalpel 3 is pulled out from the distal end of the skin incision part.

  In this way, the median nerve and the ulnar artery are separated at the center line (safe line) while checking on the US monitor screen, so that the median nerve, the ulnar artery, and the ulnar nerve on the ulnar side are protected and superficial. The arterial arch is protected by a cut decision under US monitoring, and the flexor tendon is also protected. In addition, since the cannula does not penetrate the carpal tunnel, pain and nerve compression associated therewith do not occur. In addition, since the scalpel canal open surgical knife holder according to the present embodiment itself is thin and small, there is little burden and pain on the patient during insertion under the skin. Moreover, since a simple operation is sufficient, an assistant is not necessary. Further, since the knife 3 can be a small and inexpensive one, it is easy to dispose of the knife 3 and does not cost much. The inner holder part 1 and the outer holder part 2 can be reused a plurality of times by disinfection after use.

  In the said Example, although the body 10 of the inner holder part 1 is a hollow cylindrical shape, it does not need to be hollow not only in this. In short, it is only necessary to have a slit 11 that can appropriately store the base 32 of the knife 3 or a storage space that performs the same function. Moreover, although the outer side holder part 2 is comprised by the cylindrical body 20 as a whole, not only this but the function which hold | maintains the knife 3 from the outside by the distal end 2b, and the operation by a practitioner are possible. As long as it has a configuration including the proximal end 2a protruding out of the palm.

It is a figure which shows an example of each component which comprises the female holder for carpal tunnel opening operation concerning one Example of this invention, (a) is a side view of an inner side holder part, (b) is a top view of an inner side holder part, c) is a cross-sectional view showing an example of forming a slit provided in the inner holder part, (d) is a cross-sectional view showing another example of forming a slit provided in the inner holder part, (e) is a side view of the outer holder part, (F) is a top view of the outer holder part, (g) is a sectional view of a slit groove provided at the tip of the outer holder part, and (h) is a side view showing an example of a knife attached to the knife holder. It is a figure which shows the state which mounts | wears the scalpel with the scalpel canal for surgical operation which concerns on the Example, (a) is a perspective view which shows the state which accommodated the scalpel in the slit of an inner side holder part, (b) is the inside of a slit It is a perspective view which shows the state which inserted and inserted the outer side holder part in the outer periphery of the inner side holder part which accommodated the knife.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Inner holder part 10 Body 11 Slit 12 Tip part 2 Outer holder part 20 Cylindrical body 21 Slit groove 3 Female 31 Blade part 32 Base

Claims (6)

A scalpel holder for carpal tunnel opening for holding a scalpel composed of an elongated base and a blade standing up from the base,
The side of the elongated body has a slit for storing a knife, and has a tip that extends ahead of the distal end of the slit, and the blade of the knife protrudes from the slit when the knife is mounted. An inner holder portion for accommodating the base of the knife in the slit in the state of
A carpal tunnel opening scalpel holder composed of an outer holder part that holds the base part of the scalpel housed in the slit of the inner holder part from the outside.   The carcass opening surgical knife holder according to claim 1, wherein the outer holder part is formed of a cylindrical body that is fitted on the outer periphery of the inner holder part.   The carcass opening surgical knife holder according to claim 1 or 2, wherein a groove for fitting and fixing the blade part of the knife is formed at a tip of the outer holder part. When the scalpel canal opening scalpel holder with the scalpel is inserted from the distal end of the inner holder into the affected skin, the proximal end of the outer holder can be exposed outside the skin. Has a length like
The outer holder part is movable along the length direction of the inner holder part while holding the base part of the knife housed in the slit by the outer holder part,
The knife part of the knife is moved between the distal end of the slit of the inner holder part and the end part of the outer holder part by moving the outer holder part toward the distal end along the inner holder part. The injured part can be incised by the scalpel by moving the entire scalpel holder in this state, so that the affected part can be incised. Female holder for carpal tunnel opening.   The carpal tunnel opening scalpel holder according to any one of claims 1 to 4, wherein the distal end portion of the inner holder portion has a tapered shape.   The scalpel canal open surgical knife holder according to any one of claims 1 to 5, wherein the distal end portion of the inner holder portion is rounded.

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