JP2007098120A - Medical treatment instrument, its rotation operation device, and medical treatment apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To prevent transmission of an excessive torque to a distal end part in the case of rotating a medical treatment instrument by a rotation operation device to enter a lesion block part. <P>SOLUTION: The rotation operation device 201 is composed of a first rotation body 210, a second rotation body 211 and an over torque prevention part 230. The first rotation body 210 is provided with a luer locking part 202, a first gear 203, and a shaft section 208. The second rotation body 211 is provided with a second gear 204, a holding shaft hole, and a rotation operation part 209. The first rotation body 210 is fitted rotatably to the second rotation body 211. The first gear 203 is biased to engage with the second gear 204 by a coned disc spring 206 and a fixing nut 221. The first gear 203, the second gear 204, the coned disc spring 206 and the fixing nut 221 constitute the over torque prevention part 230. The torque over a fixed value from the rotation operation part 209 is not transmitted by idling of the second gear 204, and the transmission of the excessive torque is prevented. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a medical treatment tool used for a catheter or the like for examining or treating a state of a blood vessel or the like, a rotary operation device thereof, and a medical treatment device.

  As a medical treatment instrument, a catheter or the like inserted into a blood vessel is used in order to inspect the state of an affected part in a blood vessel of a human body or treat the affected part. Generally, a catheter is inserted along the outer periphery of a guide wire previously inserted into a blood vessel, and has a tubular hollow structure. A guide wire inserted into a blood vessel or the like is used as a guide member when a balloon catheter or a stent for inserting a catheter for injecting an X-ray contrast medium or enlarging a stenotic site is sent. As such a guide wire and a medical treatment instrument, a tip having a distal end and a proximal portion, the tip is formed of a coil spring body, and a tip is fixed to the tip to be flexible is used. ing.

  As a technique relating to such a medical treatment instrument, for example, in Patent Document 1, a catheter body having a spiral convex portion at a distal end portion and a catheter sheath having a blade at a distal end are combined and the catheter main body is narrowed by rotation. A technique is disclosed in which a stenosis is excised with a distal edge of a catheter sheath after entering the catheter. Further, Patent Document 2 adopts a configuration in which an outer cylindrical body (hollow wire) in which the distal end portion is formed in a reduced diameter taper shape is provided on the outer peripheral portion of the guide wire without using a balloon catheter. In addition, a medical treatment instrument is disclosed that enables diameter expansion treatment to expand the inner surface of a stenosis.

Furthermore, Patent Document 3 discloses a blood vessel catheter that can eliminate bending creases and improve flexibility and kinking resistance by forming a plurality of concave and convex portions on the outer surface or the inner surface and dispersing bending stress. ing. Further, Patent Document 4 discloses a blood vessel having a shaft portion formed of a multi-strand coil in which a plurality of wires are spirally wound at a constant pitch angle, and a leading plug fixed to the tip portion of the shaft portion. A treatment guidewire is disclosed.
JP 63-262160 A Japanese Utility Model Publication No. 5-63554 JP-A-6-47094 Special Table 2002-539901

  By the way, in general, both ends of the completely closed portion are in a mortar-like cup shape, and the near side cup has a concave shape in the central portion. Is thick, it is difficult to perforate it. Furthermore, although the distal cup has a thin hard portion as compared with the proximal cup, the central portion tends to deviate from the central passage because the central portion is convex with respect to the traveling direction. Such a tendency is particularly strong when hard calcified pieces are scattered in front of the distal cup. The reason for this is that if hard and soft tissue are scattered, the direction of travel is changed in a form guided to the soft tissue, and a false cavity is easily formed, which in turn tends to cause blood vessel perforation.

  As an example of a conventional treatment instrument, a medical tube body having a cylindrical tip at the tip is commercially available. However, in the conventional medical treatment tool, the rotation on the distal end side may be delayed with respect to the rotation on the proximal side due to the twist when rotating and entering the blood vessel. For this reason, an excessive torque is transmitted to the tip, which may cause problems such as blood vessel perforation.

  In addition, the medical tube body having a tip having a cylindrical tip is a simple circular tube having the same or similar cross-sectional shape at the tip and does not have a perforating function. For this reason, as the hard portion of the proximal cup becomes thicker, the advance input is lost and the idle state becomes idle, and the front side is greatly bent and cannot proceed. Further, even if the proximal cup is penetrated, if calcified pieces are scattered in front of the distal cup, they are trapped in the same manner and become idle so that they cannot enter.

  The present invention has been made in view of such technical problems. It is an object of the present invention to prevent excessive torque transmission to the distal end when rotating and entering the lesion occlusion, and to easily and accurately cut the lesion occlusion It is providing the rotation operating device of the treatment tool. Another object of the present invention is to provide a medical treatment tool capable of easily and accurately entering a lesion occlusion and cutting the lesion occlusion, a medical treatment apparatus having the same, and a guide wire. An object is to provide a medical treatment apparatus.

  In order to achieve the above object, the present invention provides a medical treatment instrument comprising a tube body that is inserted along the outer periphery of a medical guide wire. The tube body includes a metal coil body and a distal end of the coil body. A metal hollow tip to be attached to the blade, and a blade surface that is formed at the distal end of the hollow tip and scrapes the lesion site when the hollow tip rotates in contact with the lesion site when the tube body is in use. It is characterized by providing.

  In addition, the present invention is characterized in that the tip of the hollow tip is formed in a tapered shape. And it is preferable that the said blade surface is comprised from the U-shaped or V-shaped groove | channel formed in the front end surface and outer peripheral surface of the said hollow tip so that it may extend in the substantially axial direction of this hollow tip. Moreover, it is preferable that the said blade surface is comprised from the notch which has the notch surface which inclines with respect to the axial center of the said hollow chip over the front end surface and outer peripheral surface of this hollow chip. Moreover, it is preferable that the said blade surface is comprised from the spiral groove | channel which opens in the front end surface of the said hollow tip, and is arrange | positioned spirally on the outer peripheral surface of this hollow tip.

  The coil body is composed of a multi-strand coil body obtained by winding a plurality of metal wires in a spiral shape. The coil body is formed of a multi-strand coil body in which a plurality of metal wires are twisted and wound in a spiral shape. And when the said coil body is the 1st rotation direction which diameter-reduces by rotation, the said lesioned part is shaved with the said blade surface, It is characterized by the above-mentioned. Moreover, it is preferable that the said coil body is formed in the taper in which a diameter becomes small gradually toward the front-end | tip. The hollow tip is preferably made of a radiopaque material.

  Further, the present invention provides the first rotating body having a guide wire insertion hole that rotates together with the tube body and through which the guide wire is inserted, in the rotation operation device that rotates the medical treatment tool on the hand side, A second rotating body, which is rotatably attached to the first rotating body and is operated to rotate on the hand side, is brought into contact with the first rotating body and the second rotating body, and a second torque is applied with a torque equal to or less than a predetermined value. An over-torque prevention unit that transmits the rotation of the rotating body to the first rotating body and causes the second rotating body to idle in response to torque transmission exceeding a certain value is provided.

  One of the contact surfaces of the first rotating body and the second rotating body has a locking projection, and the other of the contact surfaces of the first rotating body and the second rotating body has a locking recess, The torque preventing unit is relatively movable between the first rotating body and the second rotating body between a locking position for locking the locking protrusion and the locking recess and a locking release position for releasing the locking. The holding member to be held and the first rotating body or the second rotating body so as to be in the locking position, and the rotating bodies rotate together to transmit a torque of the predetermined value or less, For torque transmission exceeding the predetermined value, the second rotating body is provided with an urging member that idles with respect to the first rotating body at the unlocking position.

  The second rotating body is attached to be rotatable in the rotation direction of the first rotating body, and the locking protrusions are formed on the end surface of the first rotating body in a plurality of first directions radially about the axis. The locking recesses are a plurality of second locking ridges formed radially on the end surface of the second rotating body about the axis, and the second locking ridges The first locking ridge is fitted in a valley portion between the first locking ridges to become the locking position, and the first locking ridge gets over the second locking ridge to become the unlocking position. It is preferable. Further, it is preferable that the first and second locking ridges are constituted by a ridge body having a substantially triangular cross section perpendicular to the radiation with the radiation passing through the axis as a ridgeline. Further, the over-torque preventing portion includes a first gear formed on the first rotating body, a second gear formed on the second rotating body and meshing with the first gear, and the second gear. An urging member that presses against the gear, and it is preferable that when the torque acting between the first gear and the second gear exceeds a certain value, the second gear idles with respect to the first gear. .

  In the present invention, the first rotating body has a shaft portion, the second rotating body is rotatably attached to the shaft portion, and the over-torque preventing portion includes a locking recess formed in the shaft portion. A lock ball that is locked to the locking recess, and a holding member that is movably held between a locking position where the lock ball is locked to the locking recess, and an unlocking position where the locking is released. , Urging the lock ball toward the locking position, the first rotating body and the second rotating body rotate together to transmit torque below the predetermined value, and torque transmission exceeding the predetermined value In contrast, the lock ball is provided with an urging member in which the lock ball is in an unlocking position and the second rotating body idles with respect to the first rotating body.

  In addition, it is preferable to have an urging force adjusting member that adjusts the urging force of the urging member. In this case, the transmission torque can be changed by changing the urging force. Further, the second rotating body preferably has a large-diameter gripping part and a small-diameter gripping part. In this case, the second rotating body is rotated by selectively using the large-diameter gripping part or the small-diameter gripping part depending on the lesion site. The torque transmitted to the part can be easily changed.

  A medical treatment apparatus according to the present invention includes the medical treatment tool described above and a rotation operation device for the medical treatment tool described above, and the tube body is detachably connected to the first rotary body via a connector. It is characterized by being. The medical treatment apparatus of the present invention includes the medical treatment apparatus described above and a guide wire having a coil body at least at a distal end portion, and the tube body and the first rotating body along an outer periphery of the guide wire. Is inserted, and the wire winding directions of the coil body of the tube body and the coil body of the guide wire are opposite to each other.

  In addition, the rotational operation device for a medical treatment instrument of the present invention is a medical device comprising a tube body that is inserted along the outer periphery of a medical guide wire and has a metal hollow tip attached to the tip of a metal coil body. In the rotary operation device that rotates the treatment instrument on the hand side, the first rotary body that rotates together with the tube body and has a guide wire insertion hole through which the guide wire is inserted, and the first rotary body are rotatable. A second rotating body, which is attached and is operated to rotate on the hand side, and the first rotating body and the second rotating body are brought into contact with each other to rotate the second rotating body with a torque of a predetermined value or less. And an over-torque prevention unit in which the second rotating body idles in response to torque transmission exceeding a certain value.

  According to the present invention, the first rotating body that rotates together with the tube body and has a guide wire insertion hole through which the guide wire is inserted, and the first rotating body that is rotatably attached to the first rotating body and is operated to rotate on the hand side. The second rotating body, the first rotating body and the second rotating body are brought into contact with each other, and the rotation of the second rotating body is transmitted to the first rotating body with a torque equal to or less than a certain value, and the torque transmission exceeding the certain value is transmitted. In contrast, when the second rotating body is provided with an over-torque preventing portion that idles, the second rotating body is rotated to move the distal end of the tube body into the lesion occlusion portion. Is prevented from being transmitted to the distal end portion of the tube body, and blood vessel perforation due to the excessive torque being transmitted to the distal end portion can be prevented. In addition, since an appropriate torque is transmitted to the distal end portion of the tube body, the lesion obstruction portion can be easily and accurately cut.

  Further, the hollow tip has a blade surface at the tip, and when the hollow tip rotates in contact with the lesioned part in a use state, the lesioned part is scraped off to enter the lesioned part. The lesion site can be easily and reliably bitten accurately.

  Embodiments of the present invention will be specifically described below with reference to the drawings. FIG. 1 is a side view showing an overall schematic configuration of a medical treatment tool according to an embodiment of the present invention. In FIG. 1, a medical treatment instrument 100 according to the present embodiment has a hollow tube structure in which a through hole (guide wire insertion hole) is formed over the entire length from a hand portion on the right side of the drawing to a tip portion on the left side of the drawing. ing. And the connector 120 which has the lure (screw) 110, the protector 130, the protection tube 140, the coil spring body 50, and the front-end | tip tip (hollow chip | tip) 60 are arrange | positioned in order toward a front-end | tip part from a hand part. When this medical treatment tool 100 is used in a medical procedure, it is inserted along the outer periphery of a guide wire (for example, guide wire 170 in FIG. 2) previously inserted into the blood vessel as in the case of a vascular catheter or the like. Then, treatments such as diameter expansion processing of the stenosis part and cutting removal of the occluding substance are performed by biting into the lesion stenosis part and rotating or pushing.

  FIG. 2 is a longitudinal sectional view of a predetermined length region of the distal end portion of the medical treatment tool according to the embodiment of the present invention. FIG. 2 shows a portion corresponding to the region P in FIG. FIG. 2 shows a state where the medical treatment tool 100 according to this embodiment is inserted through the outer periphery of the guide wire 170. In FIG. 2, the hollow medical treatment instrument 100 is guided by the guide wire 170 by inserting the insertion hole 100 a through the guide wire 170. The guide wire 170 has a structure in which the distal end portion of the core wire 171 which is a wire body is reduced in diameter to be a reduced distal end portion 172, and the periphery of the reduced distal end portion 172 is covered with a coil spring body 180. Reference numeral 173 denotes a base portion of the core wire 171. As the core wire 171, for example, a stainless steel wire or nickel titanium alloy wire having a base portion 173 with a diameter of 0.355 mm and a length of about 1.5 m to 3 m is used. The length up to about 110 mm to 150 mm is reduced to a diameter of 0.142 mm, and the tip portion is further reduced to a taper within a range of about 40 to 50 mm.

  A leading plug 174 is fixed to the tip (distal end) of the tip reduced diameter portion 172 of the guide wire 170 by brazing or the like. The coil spring body 180 of the guide wire 170 is fixed to the core wire 171 by brazing or the like at its proximal end (proximal end) 180a, and fixed to the leading plug 174 by brazing or the like at its distal end (distal end). Has been. The core wire 171 having the leading plug 174 is a guide member for inspecting the condition of the affected part in the blood vessel of the human body and treating the affected part while operating the proximal part (the proximal end part on the front side) of the base part 173. Is inserted into the blood vessel in advance. The coil spring body 180 as an exterior part wound around the outer periphery of the core wire 171 is formed by winding a metal wire having an outer diameter of 0.065 mm in a coil shape with an outer diameter of about 0.355 mm, for example.

  In the medical treatment tool 100 according to the present embodiment, as shown in a region Q of FIG. 2, the range of the predetermined length in the axial direction from the tip of the tip is between the coil spring body 50 and the tip of the coil spring body 50. It is composed of a fixed cylindrical tip 60. FIG. 3A is an enlarged view of the region Q of FIG. 2, and the blade tip 10 is formed on the tip tip 60. In addition, the medical treatment tool 100 has a hollow shape (hollow structure) in which an insertion hole 100a is formed over the entire length including the distal end region shown in FIG. The tip tip 60 is formed of a hollow cylindrical member made of a straight shape having a through hole 60a, a tip diameter reduction (taper taper) shape, or a combination thereof. The tip 60 is preferably formed of a radiopaque material such as gold or platinum, or a brazing material of radiopaque material.

  In the present embodiment, a blade surface structure composed of the blade surface 10 is formed at the distal end portion of the distal tip 60. The “blade surface structure” in the present embodiment has a function as a “breaking blade surface” for entering the stenosis part, which is an affected part of the human blood vessel in the use state, and a “blade blade surface” for cutting the stenosis part by rotation. It also functions as a “cutting blade surface”. Therefore, according to the embodiment shown in FIGS. 1 and 2, since the blade surface structure is formed at the tip of a hollow medical treatment instrument having a tube structure, the following operations and effects are achieved. can get.

  First, for example, even when a thrombus is highly calcified or a hard and fibrotic tissue exists in a coronary artery completely occluded lesion, the guide wire 170 cannot penetrate, and the structure having the blade surface 10 is used. Due to the biting force due to the function as the “cutting blade surface” and the cutting force due to the function as the “cutting blade surface”, a true lumen (central passage in the blood vessel) with a smooth inner wall can be obtained by drilling and penetrating the inside of the blood vessel. It can be formed easily.

  FIG. 4 is a cross-sectional view showing a state in which the completely closed portion 301 in the blood vessel 300 is punctured and penetrated by the medical treatment tool 100 according to the embodiment. FIG. 26 is a partial cross-sectional view illustrating inconvenience when a lesion occlusion 401 is treated with a medical treatment tool (medical tube body) 400 to which the present invention is not applied. FIG. 5 is a partial cross-sectional view illustrating a state when a lesion occlusion portion 304 is treated with the medical treatment tool 100 to which the present invention is applied. As shown in FIG. 4, generally, both end portions of the completely closed portion 301 are in a mortar-shaped cup shape, and the near-side cup 301a is thick in a concave shape at the center portion, so that it is easy to capture the true lumen. On the other hand, it is difficult to pierce and penetrate this because the hard part is thick. Further, although the hard portion of the distal cup 301b is thin, since the central portion is convex in the traveling direction, it is easy to deviate from this central passage. This tendency is remarkable especially when hard calcified pieces 305 are scattered in front of the distal cup 301b. The reason is that if hard and soft tissue are scattered, the direction of travel of the treatment instrument 100 is changed so that it is guided to the soft tissue, and a false cavity is easily formed, and as a result, the blood vessel is displayed as a two-dot chain line. It is easy to invite perforation.

  As shown in FIG. 26, as an example of the prior art, a medical treatment instrument 400 including a coil spring body 403 having a tip tip 402 having a cylindrical tip is commercially available. However, the medical treatment tool 400 has a simple annular shape with the same or similar cross-sectional shape at the tip, and does not have the blade surface 10 in the present embodiment, and thus does not have a drilling function. is there. Further, as the hard portion 401a of the proximal cup 401 becomes thicker, the advance input of the tip tip 402 is eliminated, and the idle state is set in the hard portion 401a. For this reason, as shown by the broken line, the coil spring body 403 is greatly bent and deformed on the near side, and cannot move forward. Similarly, even if the proximal cup 401 is penetrated, if calcified pieces are scattered in front of the distal cup, they are trapped by this and become the idle state similar to the above, and the entry is stopped. To do.

  On the other hand, according to the medical treatment tool 100 according to the present embodiment, it is possible to prevent the occurrence of problems such as idling. The mechanism will be described with reference to FIGS. As shown in FIG. 5, the distal end side and proximal side (base end side) of the distal end tip 60 have different cross-sectional shapes, and have a tapered shape with a reduced sectional area on the distal end side, thereby increasing the surface pressure. It has become. Therefore, when the tip tip 60 is pressed against the hard portion 310, the blade surface 10 acts as a biting blade surface, bites into the hard portion 310 and bites into the hard tissue, and the hard tissue pushed out by this biting is put on the blade surface 10. It gets excited. Therefore, by rotating the medical treatment tool 100, the hard tissue piece can be scraped off by the function of the blade surface 10 as a cutting blade surface. And by this repeated operation, continuous drilling and entry are always possible regardless of the form of the diseased tissue.

  Further, as shown in FIG. 4, according to the medical treatment tool 100 according to the present embodiment, the inner wall surface after perforating and penetrating the completely closed portion 301 can be made smooth, and as a result, the balloon catheter In addition, it is possible to improve the passage of the balloon catheter with a stent through the lesion. Accordingly, introduction of a catheter or the like to a desired position is facilitated, and the lesion is expanded at an appropriate position and the stent is easily expanded and placed. The reason why this smooth surface is obtained is the structure of the tip tip 60 having a smooth uniform diameter on the front side, followed by rotational cutting with a cutting blade surface similar to a drill of a drilling tool, for example. In addition, if the outer peripheral surface of the front-end | tip tip 60 is grind | polished, a smoother surface will be obtained and it will become a preferable aspect.

  Furthermore, as shown in FIG. 6, according to the medical treatment tool 100 according to the present embodiment, the guide wire 170 (FIG. 2) is obtained by biting the blade surface 10 into the coronary artery complete occlusion lesion 312 and locking it. The backup force that is the force that pushes forward (see) can be increased. Therefore, even if it is the same guide wire 170, the remarkable effect that the penetration force in the obstruction | occlusion part 313 can be increased significantly is acquired. In the conventional product having a simple cylindrical shape having substantially the same cross section at the tip and rear ends of the tip, for example, a highly-circumferential calcified lesion consisting of a hard tissue with almost all of the lesion 312 organized and superficial In calcified lesions or long and chronic lesions with a lesion length of 25 mm or more, the above-described treatment device is likely to be idle.

  The reason is that the above-mentioned conventional product does not have the blade surface (blade surface structure) 10 having the function of biting and excising the diseased tissue as in the present embodiment. In other words, in the conventional product, even if a pushing force is applied to push the guide wire forward in the idle state, it cannot be supported as a reaction force of the pushing operation force. As a result, there is an inconvenience that the tip is displaced from the lesion position.

  FIG. 6 is a partial cross-sectional view illustrating a state when treating a lesion 312 of a highly bent portion using the medical treatment tool 100 to which the present invention is applied in comparison with the conventional example (two-dot chain line display) 315. It is. As the guide wire 170 (see FIG. 2) that penetrates the completely-occluded lesion 312, a guide wire having a high bending rigidity (for example, a core wire having a large diameter of about 0.1 mm) is preferably used. However, as shown in FIG. 6, when a high-level bending meandering portion 314 exists on the distal side of the lesioned portion 312, the guide wire 315 having high bending rigidity cannot follow the bending meandering. It becomes easy to invite blood vessel perforation. For example, such a tendency strongly appears in a lesion near the right coronary artery bifurcation.

  In such a case, according to the medical treatment tool 100 according to the present embodiment, the distal tip 60 is bitten into and locked in the lesion tissue on the near side of the highly occluded lesion portion 312 that is highly bent / meandering, The reaction force of the force that pushes the guide wire 170 (see FIG. 2) can be supported by this locking. Thereby, even in the case of a soft guide wire with a low bending rigidity at the tip, the penetration force can be increased several times. Then, it is possible to follow the bent meandering portion 314 with a soft guidewire, and to penetrate the bent meandering portion 314, so that a remarkable function and effect of realizing a backup function that supports the pushing force of the guidewire can be obtained. .

  In the present invention, various structures and shapes are used as the blade surface (blade surface structure) 10 of the distal tip 60 or the coil spring body 50 and the distal tip 60 in the medical treatment instrument 100 according to the above embodiment. Specific examples will be described below with reference to preferred examples.

  3A and 3B are perspective views illustrating a structure example of the blade surface of the distal tip of the medical treatment tool according to the first embodiment. FIG. 3A is a first structure example, FIG. 3B is a second structure example, and FIG. ) Shows a third structure example, and (D) shows a fourth structure example. In this embodiment, U-shaped or V-shaped groove-shaped blade surfaces 10, 11, 12, and 13 are formed in the substantially axial direction of the tip tips 60 to 63. In FIG. 3, in the first structural example of FIG. 3A, the blade surface 10 formed of V-shaped grooves is formed at two locations opposite to each other in the diameter direction of the distal end surface of the distal tip 60, and the second structure of FIG. In the structural example, the blade surface 11 formed of a V-shaped groove is formed at four locations in the circumferential direction of the distal end surface of the distal end tip 61 (for example, positions corresponding to four equal parts). In the third structural example of (C), The blade surface 12 formed of an inclined V-shaped groove is formed at two locations in the circumferential direction of the tip surface of the tip tip 62 (for example, a position corresponding to two equal parts). Further, in the fourth structure example of (D), a blade surface 13 of a U-shaped groove is formed on the tip chip 63 instead of the blade surface 10 formed of the V-shaped groove of the first structure example of (A). Instead of the blade surfaces 11 and 12 of the V-shaped grooves in (B) and (C), a blade surface of a U-shaped groove may be formed.

  FIGS. 7A to 7D are explanatory views for illustrating the effects of the blade surface of the distal tip of the medical treatment tool according to the first embodiment. In the present embodiment, the blade surfaces 10 to 12 are formed by V-shaped grooves or U-shaped grooves formed in the axial direction from the distal end surfaces of the distal tips 60 to 62. For example, as shown in FIG. 7A, in the split type in which two blade surfaces 10 are formed at a 180 ° pitch in the circumferential direction, a cutting blade comprising a substantially V-shaped biting blade surface 10a and a substantially V-shaped side wall. A blade surface structure having a surface 10b is formed. Further, in this embodiment, the cylindrical tip tips 60 to 62 have a shape in which the tip side is reduced so that the cross-sectional area on the tip side becomes smaller than the proximal side, the tip end portion has a biting blade surface, And it has the blade surface structure which has the cutting blade surface for cutting in a rotation direction in a longitudinal direction. As a result, the biting force and cutting ability on the diseased tissue can be improved, and even a hard diseased tissue can be easily perforated and penetrated. And the biting force to a lesioned tissue can be improved by providing a V-shaped groove or a U-shaped groove at the tip end.

  This is because the advance input to the diseased tissue is improved by reducing the cross-sectional area on the tip side and increasing the surface pressure. Since the V-shaped or U-shaped wall forms the cutting blade surface, by rotating the V-shaped or U-shaped wall, it is possible to excise the lesion tissue that has risen to this region and has bitten. Further, by increasing the number of V-shaped grooves, it is possible to further improve the biting force on the diseased tissue and the excision ability. Moreover, the torque transmission force to the front end side can be improved by making the front end side of the front-end | tip tips 60-63 into a taper shape. This is because the torque force is determined by the length ratio of the arm. In the first embodiment described above, for example, the outer diameter on the proximal side of the distal tips 60 to 63 is 1 mm and the outer diameter of the distal end surface on the distal side is 0.75 mm. Sometimes the torque can be increased about 1.33 times.

  As shown in FIG. 7D, there are two types of V-shaped grooves 15 and 16 viewed from the side. One is an A-type V-shaped groove 15 disposed at an equal angle with respect to the axial center CL1 of the tip. The other is a B-type V-shaped groove 16 disposed so that one blade surface is parallel to the axis CL1 of the tip. The blade surfaces 10 and 11 in FIGS. 7A and 7B are configured by A-type V-shaped grooves 15, and FIG. 7C is configured by B-type V-shaped grooves 16. In addition, the U-shaped groove can be constituted by a type parallel to the axis and an inclined type, similarly to the V-shaped groove.

  As in the above B type, by making one wall of the V-shaped groove or U-shaped groove parallel to the axial direction, there is a difference in the cutting ability by the groove wall, and the cutting ability in one direction rotation is increased. It is possible to improve further, to slightly reduce the cutting ability in the reverse rotation direction, and to give the cutting ability rotational directionality. By doing so, the surgeon can select and use the directionality to the site that requires high cutting ability and the directionality to the site that does not need it according to the lesion mode. Also according to Example 1, the same effects as those of the above-described embodiment can be achieved in other aspects such as ease of introduction of a balloon catheter by forming a smooth surface by perforation and penetration, and backup characteristics of a guide wire.

  8A and 8B are perspective views illustrating a structural example of the blade surface of the distal tip of the medical treatment tool according to the second embodiment. FIG. 8A is a first structural example, FIG. 8B is a second structural example, and FIG. ) Shows a third structure example, and (D) shows a fourth structure example. In the present embodiment, the blade surfaces 20 to 23 are formed of notched blade surfaces or drill-like blade surfaces having inclined surfaces in the axial direction. 8A, in the first structural example of FIG. 8A, the notch blade surface 20a extending in the axial direction at one place in the circumferential direction of the tip surface 70a of the tip 70 and the opposed notch blade surface inclined in the axial direction. The blade surface 20 having 20b is formed.

  In the second structural example of (B), the blade surface 21 having the tip inclined blade surface 21c is formed by further cutting the cut blade surface 20b with respect to the blade surface 20 of (A). That is, a notch blade surface 21a extending in the axial direction at one circumferential position on the tip surface 71a of the tip 71, a notch blade surface 21b opposed in the axial direction, and a tip formed at the tip thereof. A blade surface 21 having an inclined blade surface 21c is provided. Further, in the third structural example of (C), the blade surface 22 has an inclined blade surface 22d in which the notched blade surface 21a is inclined at an inclination angle θ2 with respect to the axial center with respect to the blade surface 21 of (B). Is formed. That is, the inclined notch blade surface 22a extending at an inclination angle θ1 in the axial direction at one place in the circumferential direction of the tip surface 72a of the tip tip 72, the notch blade surface 22b continuous therewith, and the blade surfaces 22a and 22b. A blade surface 22 having the inclined blade surface 22d facing each other is provided.

  In the fourth structural example of (D), it has the notch blade surface 23a extended in the axial direction at two places in the circumferential direction of the tip surface 73a of the tip 73, and the opposite notch blade surfaces 23b inclined in the axial direction. A blade surface 23 is formed. 3C is different from the tip tip 62 shown in FIG. 3C in that the notch blade surfaces 23a and 23b intersect at the tip so that the tip surface has a pointed shape. This is a point that is formed in a spiral shape. Thus, in the fourth structure example, a drill-like blade surface is formed.

  The present embodiment has notched V-shaped blade surfaces 20 to 22 or drill-shaped blade surfaces 23 having inclined surfaces in the major axis direction from the tips of the tip tips 70 to 73. The notch blade surfaces 20 to 23 of the present embodiment also have the same biting blade surface and cutting blade surface as in the first embodiment. Among the structural examples in FIG. 8, the level of biting into the diseased tissue and the ability to bite is as follows: (D) fourth structural example> (C) third structural example≈ (B) second structural example> ( This is the order of the first structure example of A). This is because the tip-side cross-sectional area of the tip tips 70 to 73 is the smallest because of the drill-shaped blade surface 23 of the fourth structure example. Further, the cutting ability by rotation is high in the drill-shaped blade surface 23 of the fourth structure example. This is because the main cutting edge surfaces that are substantially orthogonal to the rotation direction are provided in two places instead of one place as in the other embodiments.

  Thus, the cutting ability can be improved by forming a cutting blade surface parallel to the axis. Moreover, drilling and approach capability can be improved by providing the inclined surface (inclination angle (theta) 1, (theta) 2) continuous to a front-end | tip end surface like the 2nd and 3rd structural examples. Also in Example 2, the same effects as those of the above-described embodiment can be obtained in other aspects such as ease of introduction of the balloon catheter by forming a smooth surface by perforation and penetration, and backup characteristics of the guide wire.

  FIGS. 9A to 9D are diagrams showing the side surfaces (a) and the end surface (b) of various structures of the blade surface of the distal tip of the medical treatment tool according to the third embodiment, and FIG. The first structure example, (B) shows the second structure example, (C) shows the third structure example, and (D) shows the fourth structure example. In FIG. 9A, the blade surface 30 is formed from crocodile-shaped blade surfaces 30 a and 30 b that are symmetrical with respect to a straight line passing through the center of the cross section of the tip tip 80. In (B), the blade surface 31 is formed from alligator-shaped blade surfaces 31 a and 31 b that are asymmetrical with respect to a straight line passing through the center of the cross section of the tip 81. Moreover, in (C), the blade surface 32 is formed from crescent-shaped blade surfaces 32 a and 32 b having a symmetrical shape with respect to a straight line passing through the center of the cross section of the tip tip 82. In (D), the blade surface 33 is formed of crescent-shaped blade surfaces 33 a and 33 b that are asymmetrical with respect to a straight line passing through the center of the cross section of the tip tip 83.

  FIG. 10 is an explanatory diagram for illustrating the operational effect of the blade surface structure of the distal tip of the medical treatment tool according to the third embodiment. In this embodiment, the tip tips 80 to 83 are provided with a blade surface structure having an alligator blade surface 30, 31 or a crescent blade surface 32, 33. The blade surface structure of the present embodiment is a crocodile mouth structure having protrusions at two upper and lower portions, so that the hard structure held is maintained in a state where it is added, and this is not removed, and the cutting blade surface is rotated. The diseased tissue is removed with In the symmetrical structure of the first structure example of FIG. 9A and the third structure example of FIG. 9C, since it rotates around either x1 or x2 of FIG. Unlike the example, the remarkable effect that the diameter of the perforation can be increased is obtained.

  On the other hand, in the blade surface structure in which the position differences y1 and y2 are provided at the two protruding portions as in the second structure example of FIG. 9B and the fourth structure example of FIG. Thus, since the rotational motion is always centered on x3, the rotational position of the tip can be stabilized more than in the case of the first and third structural examples while slightly increasing the diameter of the hole at the tip. Therefore, an appropriate medical treatment can be performed by arbitrarily selecting these according to the lesion mode. Also in Example 3, the same effects as those of the above-described embodiment can be obtained in other aspects such as ease of introduction of the balloon catheter by forming a smooth surface by perforation and penetration, and backup characteristics of the guide wire. .

  FIG. 11 is a diagram showing perspective side surfaces (a) and distal end surfaces (b) of various structures of the blade surface of the distal tip of the medical treatment instrument according to the fourth embodiment, and (A) shows a first structural example, B) shows a second structural example, respectively. In FIG. 11A, the tip end portion of the tapered tip tip 85 is cut obliquely to form an arc inclined blade surface 35 composed of an inclined surface 35a and a vertical end surface 35b. Further, in (B), the tip tip 86 having the inclined surface 36a is further inclined by slanting the tip surface from both sides to form knife edge blade surfaces 36b and 36c, thereby forming the tip tip 86. ing. And the knife edge 36d is formed in the front-end | tip of the front-end | tip tip 86 by the front-end | tip intersection part of these knife edge blade surfaces 36b and 36c.

  The first structural example of FIG. 11A has a tip end surface from the inclined surface of the inclined end surface 35a and the arc of the vertical end surface 35b, and thereby the biting blade surface and the inclined surface whose transverse area gradually changes and decreases toward the tip side. The cutting blade surface at the surface is formed. In the second structural example shown in FIG. 11 (B), the blade surfaces 36a, 36b, 36c made of inclined surfaces are formed, and the knife edge 36d is formed by the knife edge blade surfaces 36b, 36c. Puncture and pushing force can be improved by the tearing effect. The knife edge 36d has a shape in which the inner peripheral side protrudes forward compared to the outer peripheral side. This is because it is easy to puncture the blood vessel wall when inclined in the opposite direction (inclined so that the outer peripheral side protrudes forward).

  Which one of the first structure example and the second structure example in FIG. 11 is selected is determined by the situation of the lesioned part such as the hardness of the lesioned tissue and the bending meandering form of the blood vessel. It should be noted that the penetration of the biting blade surface into the diseased tissue by reducing the cross-sectional area on the tip side of the tip tips 85 and 86 and the ability to rotate and cut the cutting blade surface are the same as in the previous embodiment. Moreover, also in Example 4, in other aspects, such as the ease of introduction of the balloon catheter by forming a smooth surface by perforation and penetration, and the backup characteristics of the guide wire, the same operational effects as those of the above-described embodiment can be achieved.

  FIG. 12 is a diagram showing perspective side surfaces (a) and distal end surfaces (b) of various structures of the blade surface of the distal tip of the medical treatment tool according to the fifth embodiment, (A) is a first structural example, B) shows a second structural example, respectively. In the first structural example of FIG. 12A, the blade surface 40 is formed of one V-shaped groove 40a formed on the distal end surface of the distal end tip 90 and one spiral groove 40b connected to the V-shaped groove 40a. Further, in the second structural example of (B), it is constituted by a tip chip 91 provided with two blade surfaces 40 of the first structural example at a 180 ° pitch in the circumferential direction.

  FIG. 13 is an explanatory diagram for illustrating the effect of the blade surface 40 of the distal end tip 91 of the medical treatment tool according to the fifth embodiment, and shows the relationship between the wire winding direction of the coil spring body 50 and the cutting rotation direction. ing. In the present embodiment, the V-shaped groove 40a is provided on the distal end surface of the distal tip 91, and the spiral groove 40b connected to the V-shaped groove 40b is provided on the outer peripheral portion, thereby improving the biting force on the lesion. According to the present embodiment, the excision function by the rotation of the spiral groove 40b on the cutting blade surface is exhibited, and the entry into the hard lesion can be performed more easily. Moreover, these functions can be enhanced by providing a plurality of spiral grooves.

  In FIG. 13, when the spiral groove 40b is in the left-handed screw direction, the winding ability of the coil spring body 50 on the proximal side is changed to the reverse right-handed screw direction (Z-winding direction), so that the drilling ability can be improved. it can. The reason for this is that when a rotational force is applied in the counterclockwise direction, the coil spring body 50 is Z-wound so that it becomes torsionally reduced in diameter and becomes rigid, and the tip 91 is rotated in the left-handed direction and screwed. It is because a high drilling force and advance input can be exhibited due to the effect. This is particularly effective when the diseased tissue is hard. Furthermore, also in Example 5, the same effects as those of the above-described embodiment can be achieved in other aspects such as ease of introduction of the balloon catheter by forming a smooth surface by perforation and penetration, and backup characteristics of the guide wire.

  FIG. 14 is a partial cross-sectional perspective view showing a structural example of the coil spring body of the medical treatment tool according to the sixth embodiment, where (A) shows a first structural example and (B) shows a second structural example. In the first structure example of FIG. 14A, in the embodiment and each example described above, for example, the coil spring body 53 fixed to the tip tip 70 is formed of a multi-strand coil body. Further, in the second structural example of (B), the proximal side of the coil spring body 50 is fixed to the spiral groove 52 of the hollow metal body 51. FIG. 15 is an explanatory view showing the twist pitch of the coil spring body 50 made of the multi-strand coil body of the medical treatment instrument according to the sixth embodiment in comparison with the case of the single-strand coil body. FIG. 16 is an explanatory diagram illustrating a case where the coil spring body of the medical treatment tool according to the sixth embodiment is a multi-strand coil body made of wires having different wire diameters.

  According to the present embodiment, the torque transmission force to the tip tip 70 is improved by making the coil spring body 53 fixed to the tip tip 70 into a multi-row coil body formed by winding a plurality of wires. The cutting ability and puncture ability of the tip 70 can be improved. The reason for this is that while the single coil spring body 50 transmits the rotational force to the tip side while being supported by one wire, the multiple coil spring body 53 supports the rotational force by a plurality of wires, This is because the use of a plurality of them increases the twisting pitch and increases the inclination angle θ2, making it easier to transmit the rotational force to the tip side.

  As a specific example of the coil spring body 53 made of a multi-strand coil body, a structure in which 8 to 12 wires having a wire diameter of 0.16 mm are wound and formed to have an outer diameter of 1.0 mm is used. In this method, a large number of wires may be wound around a mandrel and wound into a coil shape, or a large number of wires may be twisted to twist a rope to form a coil spring body. In the mandrel winding method, a gap is likely to occur due to insufficient initial tension between adjacent wires of a large number of winding unit wire bundles. However, the twisted wire method in which a rope is twisted does not cause such a gap and is more preferable. It is an aspect. Moreover, as a material of the wire, a stainless steel wire, a tungsten wire, a Ni—Ti wire, or a radiopaque material such as gold or platinum may be used in combination.

  By increasing the twist pitch using the coil spring body 53 made of a multi-strand coil body, the inclination angle θ2 of each wire is increased as shown in FIG. 15, and the moving distance of the tip tip 60 in one rotation is increased. can do. And since a twist pitch becomes large, the moving distance to the back of the excised tissue piece can be enlarged, and a conveyance and discharge | emission effect | action can be improved. Further, as shown in FIG. 16, the coil spring body 54 may have a structure in which a thick wire 54a and a thin wire 54b are combined. The excised tissue piece is conveyed and discharged at the groove between the strands of the coil spring body 54, and the effect becomes higher as the twist pitch is larger.

  As shown in FIG. 14B, the torque transmission force to the tip 70 can be greatly improved by providing the hollow metal body 51 at the proximal end of the coil spring body 50. Further, when the coil spring body 50 is used, the rotation is not transmitted to the tip tip 70 unless the hand side is rotated more as the length becomes longer. This is because the twist angle is proportional to the number of turns of the coil, and the twist angle becomes larger as the length becomes longer.

  Therefore, by providing the hollow metal body 51 on the hand side and shortening the overall length of the coil spring body to reduce the number of turns, the twist angle is reduced, and the rotation speed on the hand side is reduced to reduce the number of turns to the tip 70. The rotation transmission force can be ensured. At the same time, since the bending rigidity on the hand side is increased, the indentation characteristics are improved. For example, if 300 mm on the proximal side is the hollow metal body 51 with respect to the coil spring body 50 having a total length of 1200 mm, the rotational speed on the proximal side for transmitting the same rotational force to the tip tip 70 is about one-fourth less. You can do it. As a result, fatigue of hands and fingers due to the operator's hand side rotation can be reduced, and the operator can concentrate on the technique.

  In addition, as a method for connecting the hollow metal body 51, the spiral metal groove 52 is provided in the hollow metal body 51, and the end portion of the coil spring body 50 is wound and fixed by brazing or the like (FIG. 14B). Or a method in which each end face is brought into contact with each other and welded. Moreover, as the hollow metal body 51, for example, a stainless steel pipe material or an Ni—Ti pipe material having an inner diameter of 0.6 mm and an outer diameter of 1 mm can be used.

  FIG. 17 is a partial cross-sectional perspective view illustrating a structural example of a coil spring body of a medical treatment tool according to a seventh embodiment, where (A) illustrates a first structural example and (B) illustrates a second structural example. In this embodiment, the coil spring body 55 is partially or entirely tapered in the embodiment and each example described above. By making the coil spring body 55 tapered and tapered, it is possible to improve the rotational transmission force toward the distal end side. As shown in (A), the wire 56 having the same wire diameter may be formed by tapering from the proximal side to the tip side as shown in (A), or, as shown in (B), the wire with the same wire diameter may be formed. The tapered portion 58a may be formed by gradually changing the diameter of the coil spring body 58 having the same outer diameter from the proximal side to the distal end side by cutting the wire 57. According to the latter, it is possible to realize a gradually tapered shape by gradually changing and reducing the outer diameter of the gradually changing taper characteristic with the inside diameter being equal and the tapered shape having a further reduced diameter.

  In the first structural example of FIG. 17A, for example, when the outer diameter of the coil spring body 55 is 1 mm to 0.8 mm from the proximal side to the distal side and the outer diameter of the distal end surface of the distal tip 70 is 0.6 mm, Since the torsional moment (ie, torque force) is determined by the arm length ratio, the tip torque force can be improved by about 1.25 times, and the tip end face can be improved by about 1.66 times. In the second structural example shown in FIG. 17B, by providing the straight portion 58b having the same diameter at the tip of the spring body 58, the flexibility of the tip can be ensured accordingly.

  FIG. 18 is a partial perspective view of the distal tip of the medical treatment tool according to the eighth embodiment. In this embodiment, in each of the medical treatment tools according to Embodiments 1 to 7, for example, the distal tip 75 is formed of a radiopaque material. Specifically, a method of fixing a separate piece made of a radiopaque material to the tip 75, a method of fixing a separate piece plated with a radiopaque material, or a brazing material of a radiopaque material is used. The method can be carried out in various modes, such as a method using a tip tip structure having a blade surface. According to the present embodiment, it is possible to easily and accurately recognize the tip position of the blade surface when treating a lesioned part under radioscopy. Gold, platinum, tungsten or the like is used as the radiopaque material.

  This example relates to a method for manufacturing a medical treatment tool according to this embodiment including the above examples. The manufacturing method of the present embodiment has a hollow structure that can be fitted to the outer periphery of the guide wire 170, and a predetermined axial length range from the tip of the tip is fixed to the coil spring body 50 and the tip of the coil spring body 50. In the manufacturing method of the medical treatment instrument 100 configured with the cylindrical tip tip 60 formed, the step of forming the coil spring body 50 by winding or twisting a metal wire, and the radiation having the blade surface 10 formed in advance And a step of fixing a cylindrical tip tip 60 made of an impermeable material to the tip end portion of the coil spring body 50.

  Another manufacturing method of the present embodiment has a hollow structure that can be fitted to the outer periphery of the guide wire 170, and the coil spring body 50 and the distal end of the coil spring body 50 have a predetermined axial length range from the distal end of the distal end portion. In the manufacturing method of the medical treatment instrument 100 constituted by the cylindrical tip chip 60 fixed to the metal tip, the coil spring body 50 is formed by winding or twisting a metal wire, and a radiopaque material. A step of forming a blade surface 10 on the tip after the cylindrical tip 60 is fixed to the tip end of the coil spring body 50.

  This example also relates to a method for manufacturing a medical treatment instrument according to this embodiment including the above examples. The manufacturing method of the present embodiment has a hollow structure that can be fitted to the outer periphery of the guide wire 170, and a predetermined axial length range from the tip of the tip is fixed to the coil spring body 50 and the tip of the coil spring body 50. In the manufacturing method of the medical treatment instrument 100 configured with the cylindrical tip tip 60 formed, the step of forming the coil spring body 50 by winding or twisting a metal wire, and the blade surface 10 was previously formed. Fixing the cylindrical tip chip 60 made of a radiopaque material to the coil spring body 50 by aligning the cutting rotation direction of the blade surface 10 with the torsional diameter reducing direction of the coil spring body 50; It is characterized by having.

  Another manufacturing method of the present embodiment has a hollow structure that can be fitted to the outer periphery of the guide wire 170, and the coil spring body 50 and the distal end of the coil spring body 50 have a predetermined axial length range from the distal end of the distal end portion. In the manufacturing method of the medical treatment instrument 100 constituted by the cylindrical tip chip 60 fixed to the metal tip, the coil spring body 50 is formed by winding or twisting a metal wire, and a radiopaque material. After the cylindrical tip tip 60 is fixed to the coil spring body 50, the blade surface 10 is formed on the tip tip in a direction in which the cutting rotation direction of the tip tip and the torsional diameter reduction direction of the coil spring body coincide. And a process.

  The present embodiment relates to an assembly of a medical treatment instrument and a guide wire, and is an assembly of the medical treatment instrument 100 according to each embodiment described above and a guide wire 170 fitted therein. Thus, a predetermined axial length range of the tip portion is constituted by the coil spring body 50 and the cylindrical tip tip 60 fixed to the tip of the spring body 50, and the blade surface 10 is formed on the tip tip 60. A medical treatment instrument 100 having a hollow structure is inserted into the outer periphery of a guide wire 170 having a coil spring body 180 that is externally fixed to a core material (core wire) 171, thereby treating a lesioned part. .

  FIG. 19 is an explanatory view of using a medical treatment tool to which the present invention is applied and deflating a balloon catheter that is in a fixed state at a lesion and collecting it. FIG. 20 is a partial cross-sectional view showing a state where a balloon catheter is perforated using an assembly of a medical treatment tool and a guide wire according to one embodiment. By using the assembly of the medical treatment tool 100 and the guide wire 170 according to any of the above-described embodiments, it becomes possible to very easily collect the balloon catheter that has become uncollectable from the body.

  At the medical site, as shown in FIG. 19A, after passing the guide wire 170 into the lesioned part 350, the stenosis part 353 is fixed to the stent 351 by using a balloon catheter 352 in which a stent 351 made of a net-like pipe body is sheathed. Then, the diameter is expanded, and the stent 351 is placed therein to perform the diameter expansion treatment. (B) has shown the contraction state of the balloon part 352a. In diameter expansion treatment using such a stent 351, in recent years, due to the appearance of the drug-eluting stent 351, after the diameter of the balloon portion 352a is expanded, as shown in the region R of FIG. In some cases, the stent 351 adheres to the balloon portion 352a for some reason and becomes fixed. When such a bonded or fixed state of the stent 351 occurs, the balloon 352a may not be contracted by being pulled by the expanded stent 351. In addition, the balloon portion 352a is enlarged or reduced using the physiological saline 355 or the like, but in this case, if the balloon portion 352a cannot be reduced, it cannot be recovered from the body to the outside of the body, so a surgical operation is necessary. become. In this case, there is a problem with the physical strength of the patient, and the surgeon is forced to take an emergency response.

  In such a case, as shown in FIG. 20, using the guide wire 170 as a guide, the medical treatment instrument 100 is introduced to the vicinity of the balloon portion 352a of the balloon catheter 352, and the medical treatment instrument 100 on the guide wire 170 is projected. The balloon portion 352a can be perforated and forcedly contracted by rotating it. Thereby, the balloon catheter 352 can be collected. In particular, according to the medical treatment tool 100 according to the present embodiment, the distal tip 60 has both a biting blade surface for entering the lesion occlusion part and a cutting blade surface for rotationally cutting the lesion occlusion part. Since the combined blade surface 10 is provided, the balloon portion can be surely bitten and can be easily perforated by rotation.

  Further, in this embodiment, when a configuration in which the winding direction of the coil spring body 50 of the medical treatment instrument 100 and the winding direction of the coil spring body 180 of the guide wire 170 are opposite to each other is used, the following effects are obtained. FIG. 21 is an explanatory diagram showing the operational effects when the winding direction of the coil spring body of the medical treatment instrument according to one embodiment and the winding direction of the coil spring body of the guide wire fitted in the inside are reversed. FIG. A guide wire 170 having a coil spring body 180 fixed to the distal end portion is used, and the winding direction of the guide wire 170 and the winding direction of the coil spring body 50 of the medical treatment instrument 100 are opposite to each other. By using a combination of windings, it is possible to easily and accurately perform both the approach to the lesioned part and the rotary cutting.

  In FIG. 21, when the winding direction of the coil spring body 50 of the medical treatment instrument 100 is S winding (left screw), the coil spring is rotated by a counterclockwise direction when viewed from the hand side to the tip side, thereby providing a coil spring. The body 50 enters the lesion. At this time, the guide wire 170 in the medical treatment instrument 100 tends to rotate together, but even if this rotation occurs, the winding direction of the coil spring body 180 of the guide wire 170 is reversed, that is, Z winding (right In the case of a screw), the coil spring body 180 is torsionally reduced in diameter as shown in FIG. Therefore, when the distal end side of the medical treatment instrument 100 is viewed from the proximal side, the diameter of the coil spring body 50 is increased by the counterclockwise rotation (see (B)) and the diameter of the coil spring body 180 of the guide wire 170 is reduced. By the interaction of the action (see (C)), the clearance between the guide wire 170 and the medical treatment instrument 100 can be secured, and the mutual operation can be easily and accurately performed even if the diameter is small. .

  In the medical treatment instrument 100 that is perforated by the rotation as described above, the rotation on the proximal side and the rotation on the distal end side cause a rotation delay, so that an excessive proximal rotational force is easily generated. The rotational force is transmitted to the distal side with a delay, which may lead to blood vessel perforation. For this reason, by providing an overtorque prevention unit that idles when a certain torque is exceeded, it is possible to prevent blood vessel perforation due to an excessive rotational torque being transmitted to the distal end side. In particular, in a structure using a coil spring body, after twisting, this force is transmitted to the tip side. For this reason, a rotation delay occurs between the proximal side and the distal end side, and the above-described problem may occur due to this delay. Therefore, by using the overtorque prevention unit, the operator can perform treatment safely and reliably. In addition, the medical treatment tool in this embodiment can use what does not have a blade surface other than what has a blade surface in a front-end | tip tip.

  FIG. 22 is a partially broken perspective view showing a first embodiment of the rotational operation device for a medical treatment instrument of the present invention, and FIG. 23 is a sectional view thereof. The present embodiment has an overtorque prevention unit having a meshing structure of two gears. 22 and 23, the rotary operation device 201 according to the present embodiment includes a luer lock portion 202 joined to the proximal side of the medical treatment instrument 100, and a meshing gear portion including a first gear 203 and a second gear 204. A spring 206 that urges the gears 203 and 204 to mesh with each other, an adjustment screw part 207 that adjusts the urging force of the spring 206, a shaft part 208 to which the adjustment screw part 207 is attached, and a rotation operation part 209. Yes. The shaft portion 208 is provided with an insertion hole 208a through which the guide wire 170 can be inserted.

  As shown in FIG. 23, the luer lock portion 202, the first gear 203, and the shaft portion 208 are integrally formed, and the first rotating body 210 is constituted by these. The luer lock 202 is formed at the tip of the first rotating body 210. The luer lock portion 202 is fixed by screwing the luer 110 of the medical treatment instrument 100. A thin shaft portion 208 is coaxially formed at the rear end portion (right direction in the drawing) of the luer lock portion 202. A male screw portion 208 b for attaching a lock nut of the adjustment screw portion 207 is formed at the rear end portion of the shaft portion 208. A guide wire insertion hole 208 a is formed along the axis of the shaft portion 208.

  The first gear 203 is formed on the rear end surface of the luer lock portion 202. The first gear 203 includes gear teeth 215 as a plurality of first locking protrusions that are formed radially about the axis. The gear tooth 215 includes a ridge main body having a substantially triangular cross section perpendicular to the radiation with the radiation passing through the axis as a ridgeline.

  The second gear 204 and the rotation operation unit 209 are integrally formed, and the second rotating body 211 is configured by these. A second rotator 211 is coaxially and rotatably attached to the shaft portion 208 of the first rotator 210. The second rotating body 211 has a second gear 204 that meshes with the first gear 203 on the tip side. The second gear 204 also includes gear teeth 216 having the same shape as the gear teeth 215 of the first gear 203. The second rotating body 211 has a shaft hole 212 formed along the axis. The shaft portion 208 is rotatably attached to the shaft hole 212 via a synthetic resin sleeve 213. A spring housing hole 214 is formed in the rear portion of the shaft hole 212. A bearing may be provided instead of or in addition to the sleeve 213.

  In the spring accommodation hole 214, three disc springs 220 are accommodated by alternately switching their directions. The disc spring 220 acts as a biasing member that biases the second rotating body 211 toward the first rotating body 210. A fixing nut 221 and a lock nut 222 are screwed to the male screw portion 208b of the shaft portion 208. The fixing nut 221, the lock nut 222, and the shaft portion 208 constitute a holding portion 223 that holds the second rotating body 211 on the first rotating body 210 in a freely rotatable manner. Further, the holding portion 223 and the urging member allow the first gear 203 and the second gear 204 to be engaged between a locking position where the first gear 203 and the second gear 204 mesh with each other and a locking release position where the second gear 204 rides over the first gear 203 and idles. Move with. As a result, torque below a certain value is transmitted from the second rotating body 211 to the first rotating body 210 when the first gear 203 and the second gear 204 are engaged. Further, the torque exceeding the certain value is interrupted because the second gear 204 gets over the first gear 203 and the second rotating body 211 idles. As described above, the over-torque prevention unit 230 is configured by the first gear 203, the second gear 204, the disc spring 220 as the urging member, and the holding unit 223 including the shaft unit 208, the fixing nut 221 and the lock nut 222. Is done.

  Further, the biasing force by the disc spring 220 can be adjusted by adjusting the fixing position of the fixing nut 221 at the shaft portion 208. The transmitted torque can be changed by adjusting the urging force.

  The outer peripheral surface of the rotation operation part 209 is formed in two steps, a small diameter part and a large diameter part. The outer diameter of the small diameter portion is formed to be the same as the outer diameter of the first rotating body 210, and this small diameter portion becomes the small diameter grip portion 209a, and the large diameter portion becomes the large diameter grip portion 209b.

  Next, the operation of the rotary operation device 201 for the medical treatment tool of the present invention will be described. The medical treatment tool 100 is inserted along the outer periphery of the guide wire 170. The medical treatment instrument 100 is connected to the first rotating body 210 of the rotary operation device 201. By holding the small-diameter gripping part 209 a or the large-diameter gripping part 209 b of the second rotating body 211 and rotating it, the rotation of the second rotating body 211 is transmitted to the first rotating body 210 via the overtorque prevention unit 230. Then, the medical treatment tool 100 rotates. Further, when a torque exceeding a certain value is applied to the second rotating body 211, the second gear 204 is disengaged from the first gear 203, gets over the gear teeth 215 and 216, and the second gear 204 idles. This prevents excessive torque from being transmitted to the distal end portion of the medical treatment instrument 100.

  In the configuration of FIG. 22, three disc springs 220 that can obtain a high load in a narrow space and can easily change the spring constant are used. Instead of this, one or a plurality of compression coil springs may be used. Further, the rotation operation unit 209 of the second rotating body 211 includes a small-diameter gripping part 209a and a large-diameter gripping part 209b, and creates a light state and a heavy state of the rotation operation, and a small-diameter gripping when careful operation is required. The portion 209a can be selected, for example, but it may be a single outer diameter gripping portion, or may be a gripping portion including three or more different diameter portions. Further, although the luer lock unit 202 connected to the connector 120 is provided, the rotation operation device 201 may be provided directly at the proximal end of the medical treatment instrument 100 instead of the connector 120.

  FIG. 24 is a partially broken perspective view showing a second embodiment of the rotary operation device for the medical treatment tool to which the present invention is applied. The present embodiment includes an overtorque prevention unit having a lock ball structure. In FIG. 24, the rotary operation device 250 according to the present embodiment includes a luer lock portion 251 joined to the proximal side of the medical treatment instrument 100, a shaft portion 253 with a recess for receiving the lock ball 252, and a lock ball 252. And a gripping rotating body 257 incorporating a fixing screw 256 for adjusting the compression force of the compression coil spring 255. The shaft portion 253 is provided with an insertion hole 253a through which the guide wire 170 can be inserted. A lock nut 254 is attached to the end of the shaft portion 253 to prevent the second rotating body 261 from falling off the shaft portion 253.

  The lure lock portion 251 and the shaft portion 253 constitute a first rotating body 260. Further, the second rotating body 261 is configured by the gripping rotating body 257. An overtorque prevention unit 266 is configured by the recess 253 b of the shaft portion 253, the lock ball 252, the compression coil spring 255, and the adjustment fixing screw 256. In addition, although the holding | grip rotation body 257 is comprised from the elliptical thick board, it may replace with this and may use an egg-shaped holding | grip rotation body.

  Since the compression coil spring 255 is adjusted by the fixing screw 256 so as to have a constant compressive force, when the gripping rotating body 257 is rotated, the shaft portion 253 and the gripping rotating body 257 rotate together at a certain torque or less. . On the other hand, when a torque exceeding the compressive force applied to the shaft portion 253 is applied, the lock ball 252 gets over the recess 253b formed in the shaft portion 253, and the gripping rotating body 257 is idled. Thereby, transmission of an excessive torque to the distal end portion of the medical treatment instrument 100 is prevented. Although the compression coil spring 255 is used in FIG. 24, one or a plurality of disc springs may be used instead. Further, regarding the adjustment fixing screw 256, the adjustment fixing screw 256 may be omitted if the spring constant used is stably obtained. In this case, the fixing screw 256 functions as a spring receiving portion. Further, the luer lock unit 251 may be omitted, and the rotation operation device 250 may be provided directly at the proximal end of the medical treatment instrument 100.

  Further, the over-torque prevention units 230 and 266 may perform torque transmission by friction instead of torque transmission by the locking means as described above. In this case, a flat surface is formed instead of the first gear 203 and the second gear 204 in FIG. 23, and a friction member is disposed between these flat surfaces. Also in this case, when torque exceeding the integral rotation of the first rotating body and the second rotating body due to friction is applied to the second rotating body, the second rotating body is idled and no further torque transmission is performed. .

  In FIG. 23, the first gear 203 and the second gear 204 are exaggerated so that the meshing state can be clearly understood, and the height of each gear tooth 215, 216 is actually the transmitted torque and the spring used. It is determined according to the spring constant and the like, and is not limited to the illustrated example. FIG. 25 shows an example of the shape of the gear teeth. In addition to the gear teeth 215 and 216 having the vertical gear surface 241 and the inclined gear surface 242 as shown in FIG. Thus, the gear teeth 246 having the isosceles triangular inclined gear surfaces 244 and 245 whose apex angles are obtuse angles, and the gears in which the inclined angles of the inclined gear surfaces 247 and 248 are changed as shown in FIG. Teeth 249 may be used.

  In the case of the gear teeth 215 and 216 of (A), the normal gears 241 are engaged with each other during rotation in the A direction, so that normal rotation transmission can be performed and rotation without using the overtorque prevention function can be performed. . Further, since the torque is transmitted by contact between the inclined surfaces during rotation in the B direction, an overtorque prevention function can be activated. In this way, by changing the rotation direction, it is possible to select rotation transmission with an overtorque prevention function or normal rotation transmission. Further, as shown in (B), in the gear teeth 246 having the isosceles triangular inclined gear surfaces 244 and 245, the over-torque prevention function in both the A and B rotation directions can be exerted. Further, with the gear teeth 249 in which the inclination angles of the inclined gear surfaces 247 and 248 are changed as shown in (C), the transmitted torque can be varied in the rotational direction.

  In the above-described embodiment, the medical treatment instrument 100, the method for manufacturing the medical treatment instrument, and the rotational operation devices 201 and 250 for the medical treatment instrument, and further, the medical treatment instrument 100 and the rotational operation device 201 , 250 and the medical treatment device with a guide wire have been described. The technical items relating to the medical treatment instrument 100 will be described below.

  First, by making the cutting rotation direction of the cutting blade surface of the tip tip 60 coincide with the torsional diameter reduction direction of the coil spring body 50, the cutting ability of the tip tip 60 can be further enhanced. This is because the coil spring body 50 is temporarily stiffened and the torque transmission force of the tip tip 60 is increased by making the torsional diameter rotation direction and the cutting rotation direction of the coil spring body 50 the same. It is. This is suitable when the lesion length is relatively short and hard tissue.

  On the other hand, when the lesion length is relatively long and hard and soft tissues are scattered, the cutting rotation direction of the cutting blade surface and the torsional diameter expansion rotation direction of the coil spring body 50 may be matched. preferable. The reason for this is that the coil spring body 50 advances forward due to the screwing effect by rotation like the screw, and at the same time advances while expanding its diameter by the rotational force, and transmits the rotational cutting force toward the blade surface 10 of the tip tip 60. Because. In addition, if the reverse rotation is performed, the coil spring body 50 is reduced in diameter and is easily pulled out from a long lesion. Which one is adopted is determined by the lesion form.

  In order to improve the slidability with the guide wire 170 inserted into the medical treatment instrument 100, a resin tube body may be inserted into the medical treatment instrument 100, and a coil spring used for the medical treatment instrument 100 As the body 50, a coil spring body in which a wire material coated with a resin is wound may be used. In addition, by applying a thin film resin coating to the exterior portion of the coil spring body 50, it is possible to reduce the degree of adhesion of thrombus and prevent liquid leakage due to the gap between the coil spring wires. In the above-described embodiment, the case where the hollow metal body is fixed to the proximal side of the medical treatment instrument 100 is shown. However, instead of the metal tube, a thin metal wire is braided on the outer periphery of the resin tube, and the outer layer is made of resin. A coated medical tube body may be used.

It is a side view showing the schematic structure of the whole medical treatment instrument concerning one embodiment of the present invention. It is a longitudinal cross-sectional view of the predetermined length area | region of the front-end | tip part of the medical treatment tool which concerns on one Embodiment of this invention. It is a perspective view which shows the structural example of the blade surface of the front-end | tip tip of the medical treatment tool which concerns on Example 1, (A) is a 1st structural example, (B) is a 2nd structural example, (C) is a 1st. 3 structural examples, (D) shows a 4th structural example, respectively. It is sectional drawing which shows the state which punctures the complete obstruction | occlusion part in the blood vessel with the medical treatment tool which concerns on one Embodiment of this invention, and penetrates. It is a fragmentary sectional view which illustrates a state when treating a lesion obstruction | occlusion part with the medical treatment tool to which this invention is applied. It is a fragmentary sectional view which illustrates the state at the time of treating the lesioned part of an advanced bending part using the medical treatment tool to which the present invention is applied compared with the conventional example. It is explanatory drawing for demonstrating the effect of the blade surface structure of the front-end | tip tip of the medical treatment tool which concerns on Example 1. FIG. It is a perspective view which shows the structural example of the blade surface of the front-end | tip tip of the medical treatment tool which concerns on Example 2, (A) is a 1st structural example, (B) is a 2nd structural example, (C) is a 1st. 3 structural examples, (D) shows a 4th structural example, respectively. It is a figure which shows the side surface (a) and front-end | tip end surface (b) of the various structures of the blade surface of the front-end | tip tip of the medical treatment tool which concerns on Example 3, (A) is a 1st structural example, (B) is the 1st. Two structural examples, (C) shows a third structural example, and (D) shows a fourth structural example. It is explanatory drawing for demonstrating the effect of the blade surface structure of the front-end | tip tip of the medical treatment tool which concerns on Example 3. FIG. It is a figure which shows the perspective side (a) of various structures of the blade surface of the front-end | tip tip of the medical treatment tool which concerns on Example 4, and a front-end | tip end surface (b), (A) is a 1st structural example, (B) is. Second structural examples are shown respectively. It is a figure which shows the perspective side (a) of various structures of the blade surface of the front-end | tip tip of the medical treatment tool which concerns on Example 5, and a front-end | tip end surface (b), (A) is a 1st structural example, (B) is. Second structural examples are shown respectively. It is explanatory drawing which shows the relationship between the wire winding direction and cutting rotation direction of the coil spring body of a medical treatment tool. It is a fragmentary sectional perspective view which shows the structural example of the coil spring body of the medical treatment tool which concerns on Example 6, (A) shows a 1st structural example, (B) shows a 2nd structural example, respectively. It is explanatory drawing which shows the twist pitch of the coil spring body which consists of a multi-strand coil body of the medical treatment tool which concerns on Example 6 compared with the case of a single strip coil body. It is explanatory drawing which shows the case where the coil spring body of the medical treatment tool which concerns on Example 6 is a multi-strand coil body which consists of a wire with a different wire diameter. It is a fragmentary sectional perspective view which shows the structural example of the coil spring body of the medical treatment tool which concerns on Example 7, (A) shows a 1st structural example, (B) shows a 2nd structural example, respectively. It is a fragmentary perspective view of the front-end | tip tip of the medical treatment tool which concerns on Example 8. FIG. It is explanatory drawing which deflates and collects the balloon catheter which became the adhering state in the lesioned part using the medical treatment tool to which this invention is applied. It is a fragmentary sectional view which shows the state which punctures a balloon catheter using the assembly of the medical treatment tool and guide wire which concern on one Embodiment. It is explanatory drawing which shows an effect when the winding direction of the coil spring body of the medical treatment tool which concerns on one Embodiment and the winding direction of the coil spring body of the guide wire fitted inside this are made into a reverse direction. . BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a partially cutaway perspective view showing a first embodiment of an overtorque prevention portion of a medical treatment tool to which the present invention is applied. It is the longitudinal section. It is a partially broken perspective view which shows 2nd Embodiment of the overtorque prevention part of the medical treatment tool to which this invention is applied. It is a side view which shows an example of the shape of a gear tooth. It is a fragmentary sectional view which illustrates the inconvenience when treating a lesion obstruction | occlusion part with the conventional medical treatment tool.

Explanation of symbols

10-13 Blade surface 20-23 Blade surface 35, 36, 40 Blade surface 50 Coil spring body 51 Hollow metal body 52 Spiral groove 60-63 Tip tip 70-73 Tip tip 80-83 Tip tip 85, 86, 90, 91 Tip 100 Medical treatment tool 170 Guide wire 180 Coil spring body 201 Rotation operation device 203 1st gear 204 2nd gear 210 1st rotation body 211 2nd rotation body 230 Overtorque prevention part 260 1st rotation body 261 2nd Rotating body 266 Overtorque prevention unit

Claims (30)

In a medical treatment instrument comprising a tube body inserted along the outer periphery of a medical guide wire,
The tube body is formed at a metal coil body, a metal hollow tip attached to the tip of the coil body, and a tip of the hollow tip, and the hollow tip is a lesion site in the use state of the tube body. A medical treatment tool comprising: a blade surface that cuts the lesion site when rotating in contact with the body.   The medical treatment instrument according to claim 1, wherein a distal end portion of the hollow tip is formed in a tapered shape.   The blade surface is constituted by a U-shaped or V-shaped groove formed on the distal end surface and the outer peripheral surface of the hollow tip so as to extend in a substantially axial direction of the hollow tip. Item 3. A medical treatment instrument according to item 1 or 2.   The said blade surface is comprised from the notch which has the notch surface which inclines with respect to the axial center of the said hollow tip over the front end surface and outer peripheral surface of this hollow tip, The above-mentioned. The medical treatment instrument described.   The medical treatment instrument according to claim 1 or 2, wherein the blade surface is formed by a spiral groove that opens at a distal end surface of the hollow tip and is spirally disposed on an outer peripheral surface of the hollow tip. .   The medical treatment instrument according to any one of claims 1 to 5, wherein the coil body is configured by a multi-strand coil body in which a plurality of metal wires are wound in a spiral shape.   The medical treatment instrument according to any one of claims 1 to 5, wherein the coil body is composed of a multi-strand coil body in which a plurality of metal wires are twisted together and spirally wound.   The medical treatment instrument according to claim 6 or 7, wherein when the coil body is in a first rotation direction in which the diameter of the coil body is reduced by rotation, the lesion site is cut by the blade surface.   The medical treatment instrument according to any one of claims 1 to 8, wherein the coil body is formed in a taper having a diameter that gradually decreases toward the tip.   The medical treatment instrument according to any one of claims 1 to 9, wherein the hollow tip is made of a radiopaque material. In the rotation operation device for rotating the medical treatment tool according to any one of claims 1 to 10 on the hand side,
A first rotating body that rotates with the tube body and has a guide wire insertion hole through which the guide wire is inserted;
A second rotating body that is rotatably attached to the first rotating body and is operated to rotate on the hand side;
The first rotator and the second rotator are brought into contact with each other, and the rotation of the second rotator is transmitted to the first rotator with a torque equal to or less than a predetermined value. An over-torque prevention unit that causes the body to idle, and a rotation operation device for a medical treatment instrument. One of the contact surfaces of the first rotating body and the second rotating body has a locking projection,
The other of the contact surfaces of the first rotating body and the second rotating body has a locking recess,
The over-torque prevention unit is
A holding member that holds the first rotating body and the second rotating body relatively movably between a locking position for locking the locking protrusion and the locking recess and a locking release position for releasing the locking. When,
The first rotating body or the second rotating body is urged so as to be in the locking position, and the rotating bodies rotate together to transmit torque below the predetermined value, and the torque exceeding the predetermined value. The rotation operation of the medical treatment instrument according to claim 11, further comprising: a biasing member that becomes the unlocking position for transmission and the second rotating body idles with respect to the first rotating body. apparatus. The second rotator is rotatably mounted in the rotation direction of the first rotator,
The locking projections are a plurality of first locking ridges formed radially on the end surface of the first rotating body about the axis.
The locking recesses are a plurality of second locking protrusions formed radially on the end surface of the second rotating body around the axis.
The first locking ridges fit into the valleys between the second locking ridges to become the locking position, and the first locking ridges get over the second locking ridges. The rotation operating device for a medical treatment instrument according to claim 12, wherein the locking release position is achieved.   The said 1st and 2nd latching protrusion is comprised from the protrusion main body whose cross section orthogonal to the said radiation is made into the ridgeline the radiation which passes along the said axial center, and is comprised. Rotating device for medical treatment tools.   The over-torque prevention unit includes a first gear formed on the first rotating body, a second gear formed on the second rotating body and meshed with the first gear, and the second gear on the first gear. And an urging member that presses, and when the torque acting between the first gear and the second gear exceeds a certain value, the second gear is idle with respect to the first gear. The rotation operation apparatus of the medical treatment tool of Claim 11. The first rotating body has a shaft portion;
The second rotating body is rotatably attached to the shaft portion,
The over-torque prevention unit is
A locking recess formed in the shaft portion;
A lock ball to be locked in the locking recess;
A holding member that holds the lock ball in the locking recess, and a holding member that holds the lock ball movably between a locking release position that releases the locking; and
By energizing the lock ball toward the locking position, the first rotating body and the second rotating body rotate together to transmit torque below the predetermined value, and to transmit torque exceeding the predetermined value. The rotation of the medical treatment instrument according to claim 11, further comprising: an urging member in which the lock ball becomes an unlocking position and the second rotating body idles with respect to the first rotating body. Operating device.   The rotation operating device for a medical treatment instrument according to any one of claims 12 to 16, further comprising an urging force adjusting member for adjusting an urging force of the urging member.   The rotation operating device for a medical treatment instrument according to any one of claims 11 to 17, wherein the second rotating body includes a large-diameter gripping portion and a small-diameter gripping portion. The medical treatment instrument according to any one of claims 1 to 10,
A rotation operating device for a medical treatment instrument according to any one of claims 11 to 18,
The medical treatment apparatus, wherein the tube body is detachably connected to the first rotating body via a connector. The medical treatment device according to claim 19,
A guide wire having a coil body at least at the tip,
The tube body and the first rotating body are inserted along the outer periphery of the guide wire, and the wire winding direction of the coil body of the tube body and the coil body of the guide wire is reversed. Medical treatment device with guide wire. In a rotary operation device for rotating a medical treatment tool including a tube body inserted along the outer periphery of a medical guide wire and having a metal hollow tip attached to the tip of a metal coil body on the hand side,
A first rotating body that rotates with the tube body and has a guide wire insertion hole through which the guide wire is inserted;
A second rotating body that is rotatably attached to the first rotating body and is operated to rotate on the hand side;
The first rotator and the second rotator are brought into contact with each other, and the rotation of the second rotator is transmitted to the first rotator with a torque equal to or less than a predetermined value. An over-torque prevention unit that causes the body to idle, and a rotation operation device for a medical treatment instrument. One of the contact surfaces of the first rotating body and the second rotating body has a locking projection,
The other of the contact surfaces of the first rotating body and the second rotating body has a locking recess,
The over-torque prevention unit is
A holding member that holds the first rotating body and the second rotating body relatively movably between a locking position for locking the locking protrusion and the locking recess and a locking release position for releasing the locking. When,
The first rotating body or the second rotating body is urged so as to be in the locking position, and the rotating bodies rotate together to transmit torque below the predetermined value, and the torque exceeding the predetermined value. The rotation operation of the medical treatment instrument according to claim 21, further comprising: an urging member that idles with respect to the first rotating body in the unlocking position for transmission. apparatus. The second rotator is rotatably mounted in the rotation direction of the first rotator,
The locking projections are a plurality of first locking ridges formed radially on the end surface of the first rotating body about the axis.
The locking recesses are a plurality of second locking protrusions formed radially on the end surface of the second rotating body around the axis.
The first locking ridges fit into the valleys between the second locking ridges to become the locking position, and the first locking ridges get over the second locking ridges. 23. The rotation operating device for a medical treatment instrument according to claim 22, wherein the rotation operating device is in an unlocking position.   The said 1st and 2nd latching protrusion is comprised from the protrusion main body whose cross section orthogonal to the said radiation is made into the ridgeline the radiation which passes along the said axial center, and is comprised. Rotating device for medical treatment tools.   The over-torque prevention unit includes a first gear formed on the first rotating body, a second gear formed on the second rotating body and meshed with the first gear, and the second gear on the first gear. And an urging member that presses, and when the torque acting between the first gear and the second gear exceeds a certain value, the second gear is idle with respect to the first gear. The rotation operation device for a medical treatment instrument according to claim 21. The first rotating body has a shaft portion;
The second rotating body is rotatably attached to the shaft portion,
The over-torque prevention unit is
A locking recess formed in the shaft portion;
A lock ball to be locked in the locking recess;
A holding member that holds the lock ball in the locking recess, and a holding member that holds the lock ball movably between a locking release position that releases the locking; and
By energizing the lock ball toward the locking position, the first rotating body and the second rotating body rotate together to transmit torque below the predetermined value, and to transmit torque exceeding the predetermined value. The rotation of the medical treatment instrument according to claim 21, further comprising: an urging member in which the lock ball becomes an unlocking position and the second rotating body idles with respect to the first rotating body. Operating device.   27. The rotation operating device for a medical treatment instrument according to any one of claims 22 to 26, further comprising an urging force adjusting member for adjusting an urging force of the urging member.   The rotation operation device for a medical treatment instrument according to any one of claims 21 to 27, wherein the second rotating body includes a large-diameter gripping portion and a small-diameter gripping portion. A medical treatment instrument comprising a tube body that is inserted along the outer periphery of the medical guide wire and has a metal hollow tip attached to the tip of the metal coil body;
A rotational operation device for a medical treatment instrument according to any one of claims 21 to 28,
The medical treatment apparatus, wherein the tube body is detachably connected to the first rotating body via a connector. A medical treatment device according to claim 29;
A guide wire having a coil body at least at the tip,
The tube body and the first rotating body are inserted along the outer periphery of the guide wire, and the wire winding direction of the coil body of the tube body and the coil body of the guide wire is reversed. Medical treatment device with guide wire.

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