JP2010510841A - 脊柱の最小侵襲処置装置および方法 - Google Patents
脊柱の最小侵襲処置装置および方法 Download PDFInfo
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Abstract
【解決手段】切削工具の対称軸線に対して傾斜した形状をもつ遠位端部を備えるカニューレと、カニューレの空洞へ差し込むための光学プローブ(内視鏡)とを備え、前記カニューレは中空の切削工具として構成され、この中空の切削工具において遠位端部の遠位領域は切削工具の壁部の縁部に刻設された切れ刃26を有している。
【選択図】図5.1
Description
2 切削工具
3 カニューレ
4 手段
6 エンドリーマ
6.1 遠位端部
6.1 テーパ状の先端部
6.2 把持端部
6.3 目盛り
7 エンドスパーテル
7.1 遠位端部領域
7.2 円弧状の平坦部
7.3 エッジ
7.4 外面
8 エンドエレベータ
8.1 遠位端部領域
8.2 平坦な領域
8.3 アンダーカット
9 フライス
9.1 近位端
9.2 遠位端部
9.3 歯
9.4 切削エッジ
9.5 外套面
21 カニューレ壁
22 遠位端部
23 目盛り
25 対称軸線
26 エッジ
27 切断部
30 カニューレ
101 長尺状の案内部材
1000 脊柱
1001 椎間板
1001a 環
1002 核
1003 神経組織
1004 椎骨
1005 棘突起
1006 脊柱管
1007 前縦靭帯
1008 後縦靭帯
1009 神経
1010 骨増殖
1011 横突起
Claims (42)
- 切削工具(2)の対称軸線に対して傾斜した形状(22)をもつ遠位端部を備えるカニューレと、
前記カニューレの空洞へ差し込むための光学プローブ(内視鏡)と
を備えた、骨格領域での、特に脊柱の内視鏡処置装置であって、
前記カニューレは中空の切削工具(2)として構成され、この中空の切削工具(2)において遠位端部の遠位領域は前記切削工具(2)の壁部の縁部に刻設された切れ刃(26)を有している内視鏡処置装置。 - 前記切れ刃(26)は円錐形の表面を介して前記切削工具(2)の壁部の外面とつながっている請求項1に記載の装置。
- 前記切削工具(2)の壁部の内面に対する前記切れ刃(26)の半径方向の間隔は、該壁部の外面に対する前記切れ刃(26)の間隔の多くとも4分の1である請求項1または2に記載の装置。
- 前記切れ刃(26)は前記切削工具(2)の壁部の内面の端部と一致している請求項3に記載の装置。
- 前記切削工具(2)を収容するための外側の中空カニューレを有している請求項1乃至4の1つに記載の装置。
- 前記切削工具(2)を動かす装置を有している請求項1乃至5の1つに記載の装置。
- 前記切削工具(2)を動かす装置は、前記切削工具(2)の長手方向への周期的な運動を惹起する請求項6に記載の装置。
- 前記切削工具を動かす装置は、前記切削工具(2)の対称軸線を中心とする周期的な揺動運動を惹起する請求項6又は7に記載の装置。
- 前記切削工具を動かす装置は、平衡位置に対してそれぞれ最大15°の、好ましくはそれぞれ6°以下の揺動半径にわたる周期的な運動を前記切削工具(2)の長手対称軸線を中心として惹起する請求項8に記載の装置。
- 前記切削工具(2)の空洞は2.7mm〜7.3mm、好ましくは3.2mm〜6.1mmの内径を有している請求項1乃至9の1つに記載の装置。
- 前記切れ刃(26)は鋸形に構成されている請求項1乃至10の1つに記載の装置。
- 内視鏡に押込み可能なフライス(9)を有している請求項1乃至11の1つに記載の装置。
- 前記フライス(9)は中空円筒状に構成されている請求項12に記載の装置。
- 内視鏡に押込み可能な少なくとも1つの固定工具(6,7,8)を有している請求項1乃至13の1つに記載の装置。
- 前記固定工具(6,7,8)はその遠位端部で脊柱の後縦靭帯に固定可能である請求項14に記載の装置。
- 前記固定工具(6,7,8)はその後方(近位)端部にグリップ等と回転不能に結合するための結合構造を備えている請求項14又は15に記載の装置。
- 前記固定工具(6,7,8)はその後方領域で前記結合構造に対して遠位に、特に結合工具の部分周囲の回りでその結合工具の長手軸線に対して垂直に延びる切込みの形態の目盛りを備えている請求項14乃至16の1つに記載の装置。
- 前記固定工具はエンドリーマである請求項14乃至17の1つに記載の装置。
- 前記エンドリーマ(6)は鋭い遠位先端部を有している請求項18に記載の装置。
- 前記固定工具はエンドスパーテルである請求項14乃至17の1つに記載の装置。
- 前記エンドスパーテル(7)はその遠位端部に端面側の切れ刃を備えている請求項20に記載の装置。
- 前記固定工具はエンドエレベータ(8)である請求項14乃至17の1つに記載の装置。
- 前記エンドエレベータ(8)はその遠位端部領域に先ず先細部を有し、そのもっとも外側の遠位端部に肉厚部を有している請求項22に記載の装置。
- 前記固定工具(6,7,8)に結合可能なグリップ部分を有している請求項14乃至23の1つに記載の装置。
- 駆動装置、特に回転駆動装置、特に前記フライス(9)の彫刻作用をもたらす回転駆動装置を有している請求項12乃至24の1つに記載の装置。
- 前記エンドリーマ(6)、前記エンドスパーテル(7)、および前記エンドエレベータ(8)の固定工具のうち少なくとも2つを有している請求項12乃至25の1つに記載の装置を備える手術用備品
- 中空カニューレの形態の部材を備え、その遠位端部に切れ刃(26)が構成されている、特に脊柱の領域における内視鏡手術で組織、特に骨組織を除去するための切削工具であって、前記カニューレの遠位端部にある開口部はカニューレの形態の前記部材の長手対称軸線に対して傾斜した形状を有し、光学プローブ(内視鏡)を収容するためのカニューレ空洞が構成されている切削工具。
- 前記切削工具(2)の壁部の内面に対する前記切れ刃(26)の半径方向の間隔は、該壁部の外面に対する前記切れ刃(26)の間隔の多くとも4分の1である請求項27に記載の工具。
- 前記切れ刃(26)は前記切削工具(2)の壁部の内面の端部と一致している請求項27又は28に記載の工具。
- 前記切削工具(2)の空洞は2.7mm〜7.3mm、好ましくは3.2mm〜6.1mmの内径を有している請求項27乃至29の1つに記載の工具。
- 前記切れ刃(26)は鋸形に構成されている請求項27乃至30の1つに記載の工具。
- 少なくとも1つのロッドの遠位端部を経皮的に少なくとも処置領域まで入れるステップと、傾斜した遠位端部をもつ中空管を少なくとも処置領域まで挿入するステップと、前記中空管を通して内視鏡を挿入するステップとを少なくとも有する脊柱領域での最小侵襲処置方法であって、
前側の(最遠位)端部に切れ刃を備える切削器具として構成された中空管を、除去されるべき骨領域に向かって少なくとも突き当たるように動かす脊柱領域での最小侵襲処置方法。 - 前記切削工具は限定された角度範囲だけ揺動する請求項32に記載の方法。
- 前記切削工具は最大30°、好ましくは12°以下の角度範囲にわたって揺動する請求項33に記載の方法。
- 脊柱領域まで挿入された内視鏡の作業用空洞を通じて固定工具が挿入され、後縦靭帯の領域に固定される請求項32乃至34の1つに記載の方法。
- 固定工具としてエンドリーマが挿入され、その鋭い先端部で突き当たるように後縦靭帯の領域または隣接する骨領域に軸線方向に固定される請求項35に記載の方法。
- 作業工具として、平坦化された遠位端部を備えるエンドスパーテルが挿入され、後縦靭帯と骨との間に軸線方向の力作用によって固定される請求項35に記載の方法。
- 作業工具として、アンダーカットを備える肉厚部を遠位端部に有するエンドエレベータが挿入され、骨と後縦靭帯との間で後縦靭帯に引張力で固定される請求項35に記載の方法。
- 案内工具としての作業工具を介してフライスが挿入され、除去されるべき骨物質が前記フライスの少なくとも揺動運動によって除去される請求項35乃至38の1つに記載の方法。
- 前記フライスは回転する請求項39に記載の方法。
- 前記フライスは周期的に軸線方向へ動く請求項39又は40に記載の方法。
- 前記フライスはモータによって動く請求項39乃至41の1つに記載の方法。
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ES200603026A ES2279733B1 (es) | 2006-11-27 | 2006-11-27 | Dispositivo para eliminacion de tejido en operaciones endoscopicas. |
PCT/EP2007/010238 WO2008064842A2 (de) | 2006-11-27 | 2007-11-24 | Vorrichtung und verfahren zum minimal-invasiven eingriff an der wirbelsäule |
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EP2096982A2 (de) | 2009-09-09 |
KR20090086561A (ko) | 2009-08-13 |
ES2279733B1 (es) | 2008-08-16 |
ES2279733A1 (es) | 2007-08-16 |
KR101451287B1 (ko) | 2014-10-15 |
WO2008064842A2 (de) | 2008-06-05 |
EP2096982B1 (de) | 2016-04-13 |
US20110184234A1 (en) | 2011-07-28 |
ES2581356T3 (es) | 2016-09-05 |
US8821378B2 (en) | 2014-09-02 |
CN101573069B (zh) | 2014-09-17 |
CN101573069A (zh) | 2009-11-04 |
JP5242585B2 (ja) | 2013-07-24 |
WO2008064842A3 (de) | 2008-11-20 |
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