JP2015009137A - Surgical instrument for incision - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a surgical instrument for incision with which less invasive surgery which has a low risk of damaging tissues including tendons, nerves, and blood vessels can be performed safely and easily.SOLUTION: A surgical instrument for incision includes: incision receiving means 2 for receiving an incision part of a tendon sheath and aponeurosis; guide fixing means 3 for fixing the incision receiving means 2 outside the body of a patient; and incision means for performing incision by being guided by the guide fixing means 3. In the surgical instrument for incision, a tendon sheath and aponeurosis are incised by making the incision means travel while pressing the incision means against the incision receiving means 2. The use of the surgical instrument for incision has the effects that a tendon sheath and aponeurosis can be safely incised without making a large incision in skin and subcutaneous tissue, and that minimally invasive surgery can be performed percutaneously.

Description

  The present invention relates to a surgical instrument for incision for performing tendon sheath incision for stenotic tendonitis and aponeurosis for dupuytren contracture.

The pathological condition of stenotic tendonitis (hereinafter referred to as elastic finger) is thickened by “A1 pullley” which is a ligamentous tendon sheath (hereinafter referred to as tendon sheath) existing on the palm side of the finger MP joint and is referred to as a finger flexor tendon (hereinafter referred to as tendon). ) Is prevented from sliding between the tendon and the tendon sheath, so that it is difficult for the finger to physically bend and stretch, causing pain.
When performing surgical treatment, the thickened A1 pullley is cut in the long axis direction for the purpose of improving the sliding of the tendon, and the strangulation on the tendon is released. By releasing the strangulation, it is often possible to quickly improve finger flexion and pain. In the conventional surgical operation for a repellent finger, an open tendon sheath incision is generally performed in which the skin of the palm is incised about 2 cm and the A1 pullley is incised while looking directly at the tendon sheath and the tendon. There were problems such as symptoms such as pain due to tissue scarring and difficulty in grasping fingers, and problems such as restriction of daily living activities using hands during the period until thread removal.

In addition, the pathological condition of Dupuytren's contracture is that the palmar aponeurosis (hereinafter referred to as the aponeurosis) existing under the palm of the palm from the palm is abnormally hardened and shortened, resulting in a significant finger stretch disorder.
As a conventional surgical method in Dupuytren's contracture, a aponeurosis in which a wide range of incisions are made from the palm to the finger and the abnormal aponeurosis is excised is common. However, this method is highly invasive and has technical problems required for surgical operation and problems related to wound healing at the skin incision.

  As an improvement measure for the invasion of a relatively large skin incision in bullet finger surgery, a special surgical instrument, a single-use injection needle, etc. are inserted from a small skin incision of about several millimeters, and the A1 pullley is incised blindly. There is a method called percutaneous surgery.

There is also a method called needle aponeurosis for Dupuytren's contracture. This method is performed for the purpose of improving hand extension failure by blindly cutting the abnormally hardened aponeurosis present under the skin using a single-use injection needle inserted from the palm. .
However, these surgical methods using blind operations have a relatively high risk of damaging tissues such as nerves, blood vessels, and tendons of fingers with a needle.

Hereinafter, a surgical instrument used for a percutaneous tendon incision operation which has been conventionally performed will be described with reference to FIG.
The tendon sheath knife shown in Patent Document 1 can be used in both open surgery and percutaneous surgery. The tendon sheath knife has a grip 101, a shaft 102 attached to the grip, a blade portion 103 provided on the side surface of the tip portion of the shaft 102, and a guide portion 104 extending from the lower portion of the blade portion in the protruding direction of the blade portion. The blade provided at the tip of the blade portion 103 is formed in an arc shape with respect to the rising portion of the blade portion 103 from the upper surface of the guide portion 104, and the intermediate portion of the blade above the rising portion formed in this arc shape. The upper portion of the blade is linearly formed so as to be substantially parallel to the axial direction of the shaft 102, and the upper portion of the blade portion 103 is formed in a step shape protruding from the side surface of the shaft 102. This tendon sheath incision knife is inserted into the skin to incise the tendon sheath.

A surgical instrument used in another percutaneous tendon sheath operation will be described with reference to FIG.
The cutting knife shown in Non-Patent Document 1 is a technique in which the tip of a blade portion 105 to be inserted into the skin is thin, a special female blade portion for incising a tendon in a minimally invasive manner, and a handle 106. The tendon sheath is incised blindly based on the sense and experience of the hand.

Japanese Patent No. 3736877

Hiroshi Yasunaga, “Invention of Percutaneous Tendon-Scissors for Spring Fingers”, Separate Orthopedic Surgery 21, Nanedo Publishing, 1992, p. 266-269

Tendon sheath and aponeurosis using the surgical instruments described above have been performed for many years, but have the following problems.
(1) In conventional surgical treatment of the tendon sheath and aponeurosis, the skin and subcutaneous tissue of the hand are incised so that a sufficient field of view is obtained and the treatment part is directly viewed, but it involves an incision of a certain width. Therefore, there are problems such as pain due to scarring of the tissue at the skin incision and symptoms such as difficulty in gripping fingers, and problems such as restriction of daily life operations using the hand during the period until thread removal.
(2) Since some of the percutaneous operations are performed by blind operation, there are many parts that depend on the operator's experience and fingertip sensation during the operation. There is a high risk that a surgical instrument may accidentally damage tissues such as tendons, nerves and blood vessels.
(3) Although there is a surgical instrument having a guide structure in the existing percutaneous tendon sheath incision, the surgical instrument having the existing guide structure is used for simultaneously incising the tendon sheath in an instrument for insertion into the tendon sheath. Therefore, it is indispensable for the surgical technique to accurately insert the guide part into the inside of the tendon sheath and the surface of the tendon. If the guide part enters too deeply toward the tendon, the tendon may be damaged at the blade part. Or, if the guide part is difficult to enter into a pathologically thickened tendon sheath, there is a risk that the blade may damage nerves and blood vessels that run parallel to the tendon or tendon sheath while attempting to insert a surgical instrument into the tendon sheath . In addition, when the range of the tendon sheath that causes strangulation to be incised is wide, the elastic phenomenon may not be sufficiently improved by a single incision procedure. At this time, it is necessary to insert the device blindly again to a farther site, increasing the risk of the procedure.
(4) In addition to the surgeon, an assistant and a surgical instrument are required to ensure the visibility of the surgical site.
(5) In addition to the above-mentioned reasons for the risk of percutaneous surgery, when performing open surgery, an assistant and surgical equipment environment are required, and it is difficult to perform surgery in a small clinic. Facilities where surgery can be performed are limited.
An object of the present invention is to solve the above-mentioned conventional problems, and to provide a surgical instrument for incision that can be safely and easily operated with minimal invasiveness with little risk of damaging tissues such as tendons, nerves and blood vessels. is there.

  In order to achieve the above object, the surgical instrument for incision of the present invention includes an incision receiving means inserted into a body through a skin incision part in which a skin surface in the vicinity of a treatment object is incised in advance, and receiving an incision part of a tendon sheath and a aponeurosis, and the incision A guide fixing means for fixing the receiving means outside the body; and an incision means such as a single use injection needle (hereinafter referred to as an incision means) for incising along the guide by the guide fixing means. The tendon sheath and the aponeurosis are incised by pressing against the means and running.

  According to this surgical instrument for incision, the incision base part of the incision receiving means is inserted under the lesion part in the body from the skin incision part in which the skin surface in the vicinity of the treatment target is incised in advance, and then the incision receiving means is fixed by the guide fixing means. The incision means is punctured into the body from the slit by the guide fixing means, and the incision means is brought into contact with the incision base portion of the incision receiving means, and then the incision means runs on the incision receiving means to incise the tendon sheath and the aponeurosis To do.

  According to this surgical instrument for incision, the tendon sheath and the aponeurosis can be safely incised without largely incising the skin and subcutaneous tissue, and an effect of realizing a percutaneous and extremely invasive operation can be realized.

  The surgical instrument for incision of the present invention further includes a partially bent tissue perforation means for inserting a skin surface in the vicinity of the treatment target into a body from a skin incision portion that has been incised in advance and creating a route to the vicinity of the treatment site. It can also be set as the structure provided.

  As a result, the incision receiving means can be easily inserted into the body from the path without damaging tissues such as tendons, nerves and blood vessels in the vicinity of the treatment site.

  Furthermore, the surgical instrument for incision according to the present invention may further comprise a dissection means retaining means for retaining dissection means for dissecting the tendon sheath and aponeurosis.

  As a result, the holding means for the incision means can be grasped and a sufficient force can be applied to the incision means, and the incision of the tendon sheath and the aponeurosis is facilitated.

  The surgical instrument for incision of the present invention includes an incision base with a guide groove that is inserted into the body from a skin incision part in which a skin surface in the vicinity of a treatment target is incised in advance and serves as a guide for incision of the tendon sheath and aponeurosis. The incision receiving means and the guide fixing means for fixing the incision receiving means and having an arm portion with a slit corresponding to the guide groove of the incision receiving means, and the incision means from the slit of the guide fixing means. The tendon sheath and the aponeurosis are incised by being punctured into the body, pressed against the guide groove of the incision receiving means, and running the incision means along the guide groove and slit.

According to this surgical instrument for incision, the incision of the tendon sheath and the aponeurosis can be safely performed without largely incising the skin and subcutaneous tissue, and the incision means can be incised without shaking. And it has the effect that the operation which is percutaneous and has very little invasion can be realized.

  The incision receiving means used in the surgical instrument for incision according to the present invention comprises a handle portion and an incision base portion formed at the tip of the handle portion, and the incision base portion has a guide groove along its longitudinal direction. And having a recess at the tip of the guide groove.

  Accordingly, when the tendon sheath and the aponeurosis are incised, the tip of the incision means is pressed against the guide groove and moved along the guide groove, so that the tendon sheath and the aponeurosis can be accurately incised, and the tip of the incision means is recessed. It is possible to know that the incision has been completed by the feeling of falling into the body, and the risk of damaging tissues such as tendons, nerves and blood vessels near the treatment site can be greatly reduced.

Further, the handle portion of the incision receiving means used in the surgical instrument for incision of the present invention and the arm portion of the guide fixing means are mutually synchronized scales for specifying the position of the incision base portion of the incision receiving means fixed to the guide fixing means. Is provided.

  Thereby, it is clear where the incision receiving means is located with respect to the guide fixing means, the relative relationship between the treatment site, the guide fixing means and the incision receiving means can be grasped, and the operation can be performed accurately.

  Further, the guide fixing means used in the surgical instrument for incision of the present invention comprises a base part and an arm part extending from the base part, and the base part holds and holds the handle part of the incision receiving means. The arm portion is provided so as to face the incision base portion of the incision receiving means held and fixed to the base portion, and the arm portion is provided with a slit facing the guide groove of the incision base portion of the incision receiving means. As a configuration.

  Thereby, the site to be treated can be firmly held by the incision receiving means and the guide fixing means to stabilize the incision operation, and at the same time, the incision means is inserted from the slit of the arm portion and punctured into the body. When the incision means is run by pressing the tip against the guide groove of the incision receiving means incision table, the incision means can be stably run without being swayed from side to side, guided by the slit and the guide groove. An incision becomes possible.

  In the guide fixing means of the present invention, the lower part of the arm part between the base part and the column part is a relief space. As a result, when the guide fixing means is installed, the arm part is placed away from the skin, so that the operator can easily observe the incision means punctured through the slit and the skin and the subcutaneous tissue of the meat removal part are easily moved. This contributes to widening the range in which the incision means can move with a single skin puncture.

  Further, the tissue perforation means used in the incision surgical instrument of the present invention is formed at the handle portion and the tip of the handle portion, and can be inserted into the human body without the blade portion to perforate the aponeurosis or tendon sheath. The distal end has a distal end portion and an extended portion wider than the distal end portion, and is bent smoothly with respect to the handle portion, and the bottom surface portion has an arc shape.

  This allows insertion into the synovial tendon sheath parallel to the tendon without damaging the surface of the tendon, etc., and forming the insertion path for the incision receiving means while confirming the degree of insertion by the pressure feeling applied to the distal end portion and the extension portion In addition, the route of the target site can be created without being deeply stabbed in the living body.

  The incision means holding means used in the incision surgical instrument of the present invention includes a shaft portion having a fitting portion for mounting and holding the incision means, a main body portion that supports the shaft portion so as to be fixed or swingable, A fastening means such as a bolt for loosely fastening the shaft portion with respect to the main body portion is used.

  As a result, by using the incision means attached to the shaft portion, a sufficient force can be applied to the incision means and the incision can be easily performed. The incision can be performed with good cutting performance, and the fastening means is loosened to make the shaft portion swingable, whereby the incision means can be easily attached to the fitting portion.

The surgical instrument for incision of the present invention has the following effects.
Unlike conventional percutaneous blind surgery, it does not rely heavily on intuition and experience, and even with surgery using instruments, other tissues are damaged to the incised part There is no such thing, and it can be provided as an instrument that can perform reliable surgery. Details will be described below.

(1) The incision of the tendon sheath and the aponeurosis is possible without greatly incising the skin and subcutaneous tissue, and there is an effect that an operation with very little invasion can be realized. As a result, it is possible to prevent damages such as scars on the skin and subcutaneous tissue that occur after surgery to a minimum. That is, there are many cases where post-operative skin sutures are not required, and the daily life operation restriction by suture wound management until the removal of the thread is reduced, which can contribute to the improvement of the quality of life of the patient.

(2) Incision receiving means to be inserted into the body as an incision guide, incision means for incising the tendon sheath and aponeurosis, and extracorporeal guide fixing means for limiting the travel range of the incision means for performing incision Is used in combination, and the possibility of damaging important tissue around the lesion is eliminated, and safety to surrounding tissue that has been insufficient in conventional percutaneous surgery is ensured.

(3) When performing percutaneous tendon sheath incision for the elastic finger, unlike existing dedicated surgical instruments, the incision receiving means for insertion into the tendon sheath has no blade, so tendons and surrounding tissues Can be safely inserted as a guide into the tendon sheath without damaging the skin. The skin incision, which is the insertion part for incising the tendon sheath, is structurally safe even if it is slightly away from the lesion site, and if the tendon sheath is constricted over a wide range, or the strangulation is released by a single tendon sheath incision operation The tendon sheath can be safely incised even when the inadequate amount is insufficient.

(4) In addition, in the conventional open operation, an assistant and an instrument for securing the visual field of the operation site in addition to the operator are necessary for the operation, but the surgical instrument for incision according to the present invention should be used. Thus, a single operation operation is possible.

(5) Pre-preparation of equipment environment is simple and can be introduced in small medical facilities such as clinics.

Schematic side view showing the usage state of the surgical instrument for incision in Embodiment 1 of the present invention The perspective view of the tissue perforation means of the surgical instrument for incision of this invention The perspective view of the incision receiving means of the surgical instrument for incision of this invention The perspective view of the guide fixing means of the surgical instrument for incision of this invention The front view which fitted the incision means to the holding means for incision means of the surgical instrument for incision of this invention Pathological explanation diagram for explaining the method of using the tissue perforation means shown in FIG. 2 of the present invention Schematic sectional view showing an example of use of the surgical instrument for incision of the present invention Pathology explanatory diagram for explaining the incision position on the palm surface of the surgical instrument for incision of the present invention Pathology explanatory diagram for explaining a method of using the surgical instrument for incision in Embodiment 2 of the present invention Pathology explanatory drawing for demonstrating the usage method of the incision receiving means in the other Example of the surgical instrument for incision of this invention Explanatory drawing which shows one Example of a prior art example Explanatory drawing which shows one Example of a prior art example

  Hereinafter, embodiments of the present invention will be described in detail with reference to the accompanying drawings.

Embodiment 1

  The first embodiment will be described based on an example of the surgical instrument 1 for incision according to the present invention with a resilient finger.

  1 is a schematic side view showing a use state of an incision surgical instrument according to Embodiment 1 of the present invention, FIG. 2 is a perspective view of a tissue perforation means of the incision surgical instrument, and FIG. 3 is an incision of the surgical instrument for incision. 4 is a perspective view of the guide fixing means of the surgical instrument for incision, FIG. 5 is a front view of the incision means fitted to the holding means for the incision means of the surgical instrument for incision, and FIG. FIG. 7 is a schematic sectional view showing an example of use of the surgical instrument for incision, and FIG. 8 shows an incision position on the palm surface of the surgical instrument for incision. It is a pathological condition explanatory diagram for explaining.

  In FIG. 1, reference numeral 1 denotes an incision surgical instrument of the present invention. The incision surgical instrument 1 is inserted into a ligamentous tendon sheath 38 (hereinafter referred to as a tendon sheath) to be treated and fixed in the tendon sheath 38. The incision receiving means 2 having a guide function for supporting the tendon sheath 38 at the same time as indicating the position of the tendon sheath 38, and a function as a guide for holding and fixing the incision receiving means 2 to limit the range of incision. It comprises guide fixing means 3 and incision means 28 for incising the tendon sheath 38 by the guide by the guide fixing means 3. The guide fixing means 3 is provided with a slit 18 for inserting the incision means 28. Here, the guide function of the guide fixing means 3 will be described with the slit 18, but a hole other than the slit 18 or a concave portion may be formed so that one side is used as a ruler. The incision means holding means 4 to which the incision means 28 is attached will be described here. Furthermore, the configuration in the case of using the tissue perforation means 5 (see FIG. 2) for creating a surgical route for inserting the incision receiving means 2 into the tendon sheath 38 will be described.

  FIG. 2 shows the tissue piercing means 5. In FIG. 2, 6 is inserted through a previously cut skin incision 43 (see FIG. 8), a distal end having a relatively thin tip for piercing the synovial tendon sheath 34, and 7 is a complete tip 6 An extension portion for expanding the perforated portion of the synovial tendon sheath 34 after entering the synovial tendon sheath 34, 8 is a parallel portion having the tip portion 6 and the extension portion 7 at the tip portion thereof, and R It is bent into a shape, and its bottom surface is arcuate and rounded. In this operation, the parallel part 8 is inserted by utilizing bending after the synovial tendon sheath 34 existing around the finger flexor tendon 33 (hereinafter referred to as a tendon) is perforated at the tip part 6. The portion 6 is inserted into the synovial tendon sheath 34 in parallel with the tendon 33 so that the surface of the tendon 33 is not damaged. Reference numeral 9 denotes a handle portion connected to the parallel portion 8, which has a circular cross-section with the upper surface cut. By cutting the upper surface, the operator can easily hold the handle portion 9 and slide the parallel portion 8. Even after insertion into the membranous tendon sheath 34, the direction in which the distal end portion 6 is facing can be recognized.

  FIG. 3 shows the incision receiving means 2. In FIG. 3, reference numeral 10 denotes a distal end portion of the incision receiving means 2, which has a blunt tip compared to the distal end portion 6 of the tissue perforation means 5 and has a structure that is difficult to damage the tissue when inserted into a living body. Reference numeral 11 denotes an incision base portion on which the distal end portion 10 is formed, and the width is designed to be slightly narrower than that of the insertion portion 8 of the tissue perforation means 5 so that it can be smoothly inserted into the surgical path formed by the tissue perforation means 5. The incision table 11 has a shallow guide groove 11a formed on the upper surface thereof, and the tip 31 of the incision means 28 used for incision runs inside the guide groove 11a. Reference numeral 12 denotes a recessed portion formed on the pointed end side of the guide groove 11a, which forms a recess deeper than the guide groove 11a, and indicates that the incision means 28 that travels through the guide groove 11a has reached the extreme end of the guide groove 11a. It is to make a person recognize. Reference numeral 13 denotes a bent portion that is bent into an R having the same shape as the parallel portion 8 of the tissue punching means 5. Reference numeral 14 denotes a handle portion connected to the incision table portion 11 via the bent portion 13, which is shorter than the handle portion 9 of the tissue perforation means 5 and has a structure that is difficult to hold with force. A scale 14 a is engraved on the upper surface of the handle portion 14, and it is visually observed how deeply the distal end portion 10 of the incision receiving means 2 is inserted under the skin when the guide fixing means 3 is connected and held. It has come to understand. Reference numeral 15 denotes a base end portion which is narrowed at an angle to facilitate connection with the guide fixing means 3.

  The incision receiving means 2 is a surgical instrument that is inserted into the surgical path secured by the tissue perforation means 5 from the skin incision 43 at the same position as the tissue perforation means 5. The tissue perforation means 5 and the incision receiving means 2 are bent at the same angle, and have an advantage that they can be easily operated by a common operation. The incision receiving means 2 has a plurality of lengths, and it is possible to perform an operation by changing the length of the surgical instrument depending on the distance from the skin incision 43 to the tendon sheath or aponeurosis to be incised.

  FIG. 4 shows the guide fixing means 3. In FIG. 4, 16 is a support | pillar part. Reference numeral 17 denotes an arm portion having a support column portion 16 at its distal end, which extends from the base portion 19. The base portion 19 has a sufficiently large bottom area within a range that does not interfere with the operation, and is configured to prevent the guide fixing means 3 from becoming unstable. Reference numeral 20 denotes an oblique hole provided through the base 19 from the upper surface to the bottom. The handle 14 of the incision receiving means 2 is inserted from the base end 15 through the lower opening and is slid. Hold in position. Reference numeral 22 denotes a knurled knob 22 for fixing the handle portion 14 of the incision receiving means 2 inserted into the oblique hole portion 20, and by fastening, the tip thereof is pressed against the handle portion 14 of the incision receiving means 2 to fix it. Hold.

  Here, when the incision receiving means 2 is fixedly held on the base part 19, the arm part 17 is positioned immediately above the incision base part 11 of the incision receiving means 2, and in the longitudinal direction thereof, The slit 18 is formed. The slit 18 is formed as a long hole slightly thicker than the incision means 28 for incision, and is positioned immediately above the guide groove 11 a of the incision receiving means 2 fixedly held on the base portion 19. The incision means 28 moves smoothly in the slit 18 and at the same time prevents the incision means 28 from facing in the direction other than the slit 18 thickness of the arm portion 17. With this structure, when the incision receiving means 2 is coupled to the guide fixing means 3, the incision means 28 inserted from above the slit 18 does not deviate to the side of the incision receiving means 2. A scale 17 a is formed on the upper surface of the arm portion 17 along the slit 18. The scale 17 a is synchronized with the scale 14 a formed on the handle portion 14 of the incision receiving means 2 and is fixedly held on the base portion 19. The position of the subcutaneous portion at the tip of the incision table 11 of the receiving means 2 is shown. Further, the support column 16 at the tip of the arm 17 has a sufficiently large bottom area for contacting the skin 37, thereby contributing to the stability of the guide fixing means 3. In addition, the incision receiving means 2 has a function of guiding the distal end of the incision base 11 so that it does not enter the living body too deeply, and a meat removal part as a relief space from the skin contact surface between the base 19 and the base part 19. 21 is formed. When the guide fixing means 3 is installed, the meat removal part 21 is installed away from the skin 37, so that the operator can easily observe the incision means 28 inserted through the slit 18 and punctured into the skin 37. By making the skin 37 and the subcutaneous tissue 36 of the lightening portion 21 easy to move, it contributes to widening the range in which the incision means 28 can move by one skin puncture.

  FIG. 5 shows a state in which the incision means 28 is fitted to the incision means holding means 4. In FIG. 5, reference numeral 23 denotes a single use injection needle of a general managed medical device as the incision means 28, and a fitting portion having a standard angle for fitting with the needle base 29 of the incision means 28. The shaft portion 26 is integrally formed. Reference numeral 25 denotes an arm portion for fixing and holding the shaft portion 26. The arm portion 25 has a through hole through which the stripper bolt 27 passes in the upper left portion and a female screw portion in which the screw 27 stops parallel to the upper right portion. The shaft portion 26 is fixed and held by tightening the stripper bolt 27. Here, when the stripper bolt 27 is tightened, the left and right upper portions of the main body portion 25 are bent toward the center portion, but the left side deflection having the through hole is reduced by deliberately reducing the left side volume having the through hole. Since it becomes larger and the right side having the female screw portion is stable, the male screw portion of the stripper bolt 27 is strongly tightened. (This drawing shows right-handed use, and left-handed use is configured so that the stripper bolt 27 is tightened from the right side with the left and right sides turned upside down during processing). Reference numeral 24 denotes a grip portion formed with a reduced thickness on the distal end side of the arm portion 25. A groove 24a slightly larger than the diameter of the needle tube 30 of the incision means 28 is provided in the center, and the incision means 28 for incision is provided. The needle tube 30 is fitted to increase the gripping force of the incision means 28. Further, it has a knurl 24b that prevents slipping when gripped, and is gripped from both sides and side surfaces with a fingertip during use.

Based on the above configuration, the usage and utility of the surgical instrument for incision will be described.
First, the pathological state of the elastic finger in Embodiment 1 will be described with reference to FIGS. 6 and 7.
First, the subcutaneous structure of the palm and fingers will be described. Bone 32 and joints such as metacarpal bone 39 and proximal phalanx 40 exist in the deepest layer, and tendon 33 and synovial tendon sheath 34 exist on the palm side. There are nerves and blood vessels 35 for maintaining finger perception and blood circulation on both sides of the tendon 33, and subcutaneous tissue 36 is present in the shallower layer. The skin 37 is present on the outermost layer. The subcutaneous tissue 36 is mainly composed of adipose tissue and functions as a pad when grasping an object with a finger or palm. A palm aponeurosis 44 (see FIG. 9), which is a connective tissue having appropriate elasticity and tensile strength, is present in the subcutaneous tissue 36, which helps the subcutaneous tissue 36 maintain the palm shape.

  A tendon 33 runs in the major axis direction on the palm side in contact with the MP joint 41 existing between the metacarpal bone 39 and the proximal phalanx 40. When the tendon 33 is pulled by the muscle in the central direction, the fingers are automatically bent. The tendon 33 is wrapped almost entirely in a bag-like soft synovial tendon sheath 34, and the inside of the synovial tendon sheath 34 is filled with a small amount of synovial fluid, thereby enabling smooth finger movement. ing. On the palm side of the MP joint 41, there is not only the synovial tendon sheath 34 but also an A1 pully 38a which is one of tendon sheaths 38 composed of a relatively hard and strong connective tissue. The A1 pullley 38a is considered to be a tissue that exists to fix the tendon 33 to a tissue such as the bone 32 and the MP joint 41. However, in humans, because of the anatomical features, the finger flexion and extension motion even without the tendon sheath 38 It will not cause any trouble. On the palm side of the synovial tendon sheath 34 that encloses the tendon 33 and the A1 pullley 38a, there is a subcutaneous tissue 36 of the palm part mainly composed of adipose tissue and connective tissue.

  The pathological condition of the elastic finger is that the tendon sheath 38 is pathologically thickened and the tendon 33 is squeezed to prevent sliding of the tendon 33 and the tendon sheath 38, so that the finger is not physically bent and stretched, and pain is caused. It is what happens.

  When performing surgical treatment, the tendon sheath 38 thickened for the purpose of improving the sliding of the tendon 33 is incised in the long axis direction, and the strangulation on the tendon 33 is released. Usually, the tendon sheath 38 is incised at the palmar center. The tendon sheath 38 may be left after the incision is completed. By releasing the strangulation, it is often possible to quickly improve finger flexion and pain.

Next, the operation of the tendon sheath incision for the actual elastic finger in Embodiment 1 will be described.
First, the insertion path of the incision receiving means 2 is formed using the tissue perforation means 5. This is because the tissue perforation means 5 is inserted into the synovial tendon sheath 34 in the synovial tendon sheath 34 from the tendon 33 to the surface layer in the major axis direction from the skin incision 43 of about 3 mm, which is incised about 2 cm from the tendon sheath 38 to be incised. Do. The tissue perforation means 5 is not a simple taper at the distal end, and the width of the tissue perforation means 5 extends from the distal end portion 6 to the expanded portion 7, so that two operations of perforating and expanding the synovial tendon sheath 34 can be performed safely in one. It contributes to that.

  The distal end portion 6 for drilling into the synovial tendon sheath 34 is designed to be relatively thin, and the synovial tendon sheath 34 can be drilled with little resistance. The expanded portion 7 expands the perforated portion of the synovial tendon sheath 34 after the distal end portion 6 has completely entered the synovial tendon sheath 34. During expansion, the distal end portion 6 extends into the synovial tendon sheath 34. Since it is inside, even if a strong force is applied to expand, the tissue perforation means 5 does not fall out of the synovial tendon sheath 34.

  When the surgeon punctures the synovial tendon sheath 34 at the distal end portion 6, the resistance is sensed by the fingertip, but once the distal end portion 6 completely enters the synovial tendon sheath 34, the resistance once disappears. When the tissue perforation means 5 is further inserted and the expansion portion 7 expands the synovial tendon sheath 34, it can be sensed that the resistance increases again. When the expansion is sufficiently performed and the parallel part 8 is inserted into the synovial tendon sheath 34, it can be sensed that the resistance has disappeared again. There is an advantage that an operator can confirm each stage of puncture / expansion of the synovial tendon sheath 34 by feeling resistance increase and reduction at the time of expanding the perforated part during the procedure.

  The parallel part 8 is inserted into the synovial tendon sheath 34 in parallel with the tendon 33 by manipulating the parallel part 8 after bending the synovial tendon sheath 34 using the bending provided at the tip. You can avoid damaging the surface. Moreover, the upper surface from the front-end | tip part 6 of the tissue punching means 5 to the insertion part 8 is a plane, and reflects an ultrasonic wave favorably. For a series of procedures, it is possible to confirm the positional relationship between tissue such as the tendon 33 and the synovial tendon sheath 34 and the tissue perforation means 5 using an ultrasonic diagnostic apparatus during the operation, and the operation is performed more safely. I can do things. This creates a sufficient surgical path for inserting the incision receiving means 2 into the synovial tendon sheath 34.

Next, the incision receiving means 2 is inserted into the incision receiving means 2 insertion path created as described above.
The incision receiving means 2 is inserted into the body from the distal end portion 10, but has a dull tip as compared with the tissue perforation means 5, so that it is difficult to damage the tissue when inserted into the living body. The inserted incision receiving means 2 confirms that the incision table portion 11 is installed in contact with the palm surface of the tendon 33 by an ultrasonic inspection short axis image. Further, by confirming the recessed portion 12 of the incision receiving means 2 with an ultrasonic examination long axis image, the range of the tendon sheath 38 to be incised can be confirmed before the incision.

  Next, the operator does not remove the incision receiving means 2 inserted in the synovial tendon sheath 34 from the skin incision portion 42 and in the surface layer from the tendon 33, without removing the incision receiving means 2 from the synovial tendon sheath 34. The hole 20 is inserted and slid from the bottom surface side using the aperture angle of the base end 15. The guide fixing means 3 is slid with respect to the incision receiving means 2 until it is put on the palm and is installed on the palm, and the incision receiving means 2 is connected to the oblique hole portion 20 of the guide fixing means 3. After the connection between the two, the arm portion 17 of the guide fixing means 3 and the slit 18 provided in the arm portion 17 are positioned immediately above the incision table 11 of the incision receiving means 2.

  In this state, the handle portion 14 of the incision receiving means 2 is guided to the incision receiving means 2 in a state in which the tendon sheath 38 is pulled toward the skin 37 while the tendon sheath 38 is pulled toward the skin 37 side while keeping the incision base 11 of the incision receiving means 2 parallel. The fixing means 3 is fixed. This fixing is performed by fastening the knurled knob 22. By fixing the incision receiving means 2 and the guide fixing means 3, the patient's tendon sheath 38 and the skin 37 on the bottom surface of the incision base portion 11 and the base portion 19 of the guide fixing means 3 and the bottom surface of the column portion 16 of the incision receiving means 2. The guide fixing means 3 and the incision receiving means 2 are stably fixed. By pulling up the incision receiving means 2, the incision base 11 of the incision receiving means 2 is fixed immediately above the tendon 33 at the most palm side position in the synovial tendon sheath 34.

  At this time, the surgeon can know the position of the recessed portion 12 of the incision receiving means 2 by looking at the scale 17 a on the upper surface of the arm portion 17 of the guide fixing means 3. That is, the scale 17a on the upper surface of the arm portion 17 of the guide fixing means 3 is synchronized with the scale 14a indicated by the incision receiving means 2, and the scale 14a engraved on the upper surface of the handle 14 of the incision receiving means 2 is guided. The height of the upper surface of the oblique hole portion 20 of the fixing means 3 indicates the subcutaneous depth of the incision table portion 11 of the incision receiving means 2. Therefore, when the scale 14a on the upper surface of the incision receiving means 2 indicates 2 mm subcutaneously, it indicates that the recessed portion 12 of the incision receiving means 2 is located immediately below the position indicating 2 mm on the scale 17a on the upper surface of the arm portion 17. It is easy for an operator to confirm the range in which the tendon sheath 38 should be incised.

  After the incision receiving means 2 and the guide fixing means 3 are installed and fixed on the surface of the skin 37 in the vicinity of the treatment object as described above, the incision of the tendon sheath 38 is started.

  Before that, the incision means 28 is fitted into the fitting portion 23 of the incision means holding means 4 in order to facilitate the grasping of the incision means 28 in advance. At this time, the operator can change the position of the fitting portion 23 by loosening the stripper bolt 27 and rotating the shaft portion 26 with respect to the arm portion 25, and the fitting of the incision means 28 to the fitting portion 23 can be performed. It can be done easily. At the same time, the operator fits the cut surface of the distal end 31 of the incision means 28 into the fitting portion 23 so that the cut surface can be easily cut.

  The incision means 28 set as described above rotates the shaft portion 26 with respect to the arm portion 25, tightens with the stripper bolt 27 in a state where the needle tube 30 is fitted in the groove 24a on the front surface of the grip portion 24, and incises. It fixes to the holding means 4 for means.

  Next, the distal end 31 of the incision means 28 fixed to the incision means holding means 4 is inserted from above the slit 18 of the guide fixing means 3, and the target position to be incised is determined by anatomical observation from the body surface. The skin puncture portion 42 is advanced through the skin 37 and the subcutaneous tissue 36 until it contacts the tendon sheath 38. At this time, the incision base 11 of the incision receiving means 2 exists on the opposite side of the tendon sheath 38, and the distal end 31 of the incision means 28 is guided by the slit 18 of the guide fixing means 3 to guide the guide groove of the incision base 11. 11a. Therefore, damage to the tendon 33 can be prevented when the incision means 28 is punctured.

  In this state, the tendon sheath 38 is incised by running while pushing the distal end 31 of the incision means 28 against the guide groove 11a. That is, the tip of the incision means 28 is pressed against the guide groove 11a and travels along the guide groove 11a and the slit 18 immediately above the guide groove 11a to incise the tendon sheath 38. As a result, the incising means 28 is guided by both the guide groove 11a and the slit 18, so that the incising means 28 does not shake from side to side when traveling. Further, since the recessed portion 12 is provided at the distal end portion of the guide groove 11a, the distal end of the incising means 28 falls into the recessed portion 12 when the incising means 28 runs along the guide groove 11a. As a result, the presenter can know that the incision has been completed by the touch at that time, and can prevent the incision means 28 from running further to incise to an unnecessary portion. .

  As described above, the object is blindly moved by running along the slit 18 provided in the guide fixing means 3 at the incision portion of the pathological condition determined by the three means of the incision receiving means 2, the guide fixing means 3, and the incision means 28. It became possible to position by instrument instead of intuition and experience in operation. As a result, according to the surgical instrument for incision according to the present invention, the tendon sheath 38 and the aponeurosis 44 can be accurately incised without damaging tissues such as nerves and blood vessels 35 in the vicinity of the tendon sheath 38. In addition, since accurate incision is possible, it is not necessary to make a large incision in the skin 37 and the subcutaneous tissue 36, an operation with very little invasion can be realized, and obstacles such as scars of the skin 37 and the subcutaneous tissue 36 that occur after the operation. Can also be prevented to a minimum.

  Further, since the guide fixing means 3 is formed with a thinned portion 21 below the arm portion 17 provided with the slit 18, the skin puncture portion 42 of the incision means 28 inserted into the slit 18 of the guide fixing means 3 is directly visually recognized. Accordingly, the incision of the tendon sheath 38 can be performed, and the incision operation can be performed easily and with a sense of security.

  Further, since the incision means 28 is used by being attached to the incision means holding means 4, a sufficient force can be applied to the incision means 28 at the time of incision, and easy and accurate incision is possible. In addition, since the incision means 28 can be detachably attached to the fitting portion 23 of the shaft portion 26, the incision means 28 can be always incised with good cutting performance by replacing the incision means 28 in a single use, and the stripper bolt. By loosening 27 and making the shaft portion 26 swingable, the incision means 28 can be easily attached to the fitting portion 23.

  Hereinafter, another embodiment of the present invention will be described in detail with reference to the accompanying drawings.

Embodiment 2

  In the second embodiment, another example of the surgical instrument for incision 1 according to the present invention in Dupuitlan contracture will be described.

  First, FIG. 9 is a disease state explanatory diagram for explaining a method of using the incision surgical instrument 1 according to Embodiment 2 of the present invention.

Based on the configuration of the surgical instrument for incision 1, the usage and effect of the surgical instrument for incision in another embodiment will be described.
First, the pathological condition of Dupuitlan contracture in the second embodiment will be described with reference to FIG.
Dupuytren's contracture is a disease of unknown cause that causes palmar aponeurosis 44 (hereinafter referred to as aponeurosis) to have abnormal fibrous thickening and contraction, resulting in flexion contracture of the fingers. In many cases, it develops as a subcutaneous induration lesion near the distal palmar skin line of the palmar part of the ring finger, little finger, and middle finger, gradually hardening the aponeurosis 44 down to the finger PIP joint, and simultaneously contracting the aponeurosis 44 To do. The pathological aponeurosis 44a having undergone thickening contraction can be palpated from the body surface as a cord in the longitudinal direction of the skin. If left unattended and the symptoms progress, the finger cannot stretch as shown in Fig. 10, and only the limb position in the gripped state can be taken, and the function of the entire affected hand is extremely deteriorated because the finger that cannot be stretched gets in the way. To do.

When surgical treatment is performed, it is divided roughly. 1) When the thickened aponeurosis 44 is excised as open as possible. 2) The aponeurosis 44 is stretched like a cord and is only involved in the restriction of finger extension. There are two types of cuts percutaneously. In the latter operation, the aponeurosis 44 that is stretched subcutaneously in the longitudinal direction at the palm is palpated, and a single-use injection needle or the like is punctured subcutaneously and the tip of a single-use injection needle or the like is used. The fiber of the aponeurosis 44 is cut and the flexure contracture of the finger is released. The former 1) requires extensive subcutaneous deployment from the palm to the finger and is highly invasive. In the latter 2), finger nerves / blood vessels 35 and tendons 33 run deeper than the aponeurosis 44, and blind operation The main disadvantage is that there is a risk of damage at the needle tip.

  Clinically, what kind of operation is performed for Dupuytren's contracture is determined by the range of motion of the fingers at the time and the limitations and hopes of the patient's life. The latter method, which releases the contracture percutaneously, is considered to be useful for patients as a method that is relatively light in surgical invasion and has few limitations on life, but the safety of the surgical technique itself is low. It cannot be said that it is sufficiently secured and there is room for improvement. The present invention contributes to increasing safety in percutaneous surgery of Dupuytren's contracture.

Next, the operation of the aponeurosis for the actual Dupuitlan contracture will be described with reference to FIGS. 9 and 10.
First, in percutaneous surgery for actual Dupuitlan contracture, the tissue perforation means 5 is moved from the distal end portion 6 to the deeper layer than the aponeurosis 44 from the skin incision portion 46 previously incised in the vicinity of the aponeurosis 44 to be cut. Insert in the short axis direction. At this time, the probe 45 of the ultrasonic diagnostic apparatus is applied to the palm of the hand using the ultrasonic diagnostic apparatus, the positions of the nerve / blood vessel 35 and the tendon 33 are confirmed, and the tissue under the ultrasonic guide is shallower than these tissues. By inserting the piercing means 5, a safe subcutaneous route can be created.

  The shape of the tissue perforation means 5 contributes to the fact that two operations of perforation and expansion can be performed safely with one instrument as in the first embodiment, and even when perforating the aponeurosis 44, the aponeurosis is less resistant. 44, and the tissue perforation means 5 is sufficiently inserted deeper than the aponeurosis 44 up to the distal end portion 6, the expansion portion 7, and the parallel portion 8, and the skin 37, the aponeurosis 44, and the subtenon A sufficient path is created to insert the incision receiving means 2 into the tissue. Similarly to the first embodiment, the tissue perforation means 5 does not fall off the aponeurosis 44 even if a strong force is applied to the expansion during perforation.

  By using the tissue perforation means 5 as in the first embodiment, the surgeon can feel an increase in resistance and reduction during expansion of the perforated part during the procedure, and each stage of puncture and dilation of the aponeurosis 44 can be performed. I can confirm. After piercing the aponeurosis 44, there is an advantage of avoiding damaging the nerve / blood vessel 35 or tendon 33 by inserting the tip 6 in parallel with the skin 37 by operating using the bending provided at the tip. . Further, the top surface of the distal end portion 6 of the tissue punching means 5 is flat and reflects ultrasonic waves well.

  After creating a path deeper than the skin 37 and the aponeurosis 44 using the tissue perforation means 5, from the same skin incision 46 to a layer shallower than the tendon 33 and the nerve / blood vessel 35, as shown in FIGS. The incision receiving means 2 is inserted in a single axis direction, but it is important in this operation to use an ultrasonic examination apparatus during the operation for a series of procedures, and thus the tendon 33, nerve / blood vessel 35, etc. It is possible to confirm the positional relationship between the tissue and the incision receiving means 2 and to confirm the incision range, and the operation can be performed more safely.

  Since the operations of the incision receiving means 2, the guide fixing means 3, and the incision means holding means 4 are the same as those in the first embodiment, the description thereof will be omitted.

  As described above, the embodiment of the incision surgical instrument 1 of the present invention has been described. However, the incision surgical instrument 1 is not limited to the configuration shown in the above embodiment, and the object of the present invention is achieved. Needless to say, it can be changed as appropriate.

  For example, although the incision receiving means 2 and the tissue perforation means 5 have been described as separate objects, they may be configured as those having the respective functions as an integrated object.

  In addition, the incision surgical instrument 1 according to the present invention is shown as an example of the tissue perforation means 5, the incision receiving means 2, the guide fixing means 3, the incision means holding means 4, and the incision means 28. The incision receiving means 2, the guide fixing means 3, and the incision means 28 may be provided, and the other tissue perforation means 5 and the incision means holding means 4 are preferably those described in the above embodiment. It may be a thing.

  In the present invention, as long as the object is the same, the surgical instrument 1 for incision can be used at any site in the body regardless of the above-described embodiments, and can be easily operated by the same method of use. Can provide.

  As described above, according to the present invention, the incision of the tendon sheath and the aponeurosis can be performed only by puncture without largely incising the skin or the subcutaneous tissue, and a safe and extremely invasive operation can be realized. Therefore, damages such as scars on the skin and subcutaneous tissue that occur after surgery can be prevented to a minimum, and there is no need for sutures with sutures. The surgical instrument for incision contributes to the improvement of quality and provides great industrial utility, such as providing instruments that can be easily operated by one person, and can be introduced even in small clinics. Can be used widely.

DESCRIPTION OF SYMBOLS 1 Surgical instrument for incision 2 Incision receiving means 3 Guide fixing means 4 Holding means for incision means 5 Tissue perforation means 6 Tip portion 7 Expansion portion 8 Parallel portion 9 Handle portion 10 Tip portion 11 Incision base portion 11a Guide groove 12 Depression recess 13 Bending part 14 Handle part 14a Scale 15 Base end part 16 Supporting part 17 Arm part 17a Scale 18 Slit 19 Base part 20 Oblique hole part 21 Loosening part 22 Knurling knob 23 Fitting part 24 Grasping part 24a Groove 24b Knurling 25 Arm Part 26 shaft part 27 stripper bolt 28 incision means such as single use injection needle (referred to as incision means)
29 needle base 30 needle tube 31 tip 32 bone 33 finger flexor tendon (referred to as tendon)
34 Synovial tendon sheath 35 Nerve / blood vessel 36 Subcutaneous tissue 37 Skin 38 Ligament tendon sheath (referred to as tendon sheath)
38a A1 pullley
39 metacarpal bone 40 proximal phalanx 41 MP joint 42 skin puncture portion 43 skin incision portion 44 palm aponeurosis (referred to as aponeurosis)
44a Pathological aponeurosis 45 Probe 46 Skin incision part 101 Grip 102 Shaft 103 Blade part 104 Guide part 105 Blade part 106 Handle part

Claims (10)

  An incision receiving means that is inserted into the body from a previously incised skin surface in the vicinity of the treatment target and receives an incision portion of the tendon sheath and aponeurosis, a guide fixing means for fixing the incision receiving means outside the body, and the guide fixing means An incision surgical instrument configured to incise the tendon sheath and the aponeurosis by running the incision means against the incision receiving means.   Insert the tissue perforation means for creating an insertion path to the vicinity of the treatment site by inserting the skin surface in the vicinity of the treatment target from the previously incised position into the body, and inserting the incision receiving means into the insertion path created by the tissue perforation means. The surgical instrument for incision according to claim 1.   The surgical instrument for incision according to claim 2, further comprising holding means for incision means for holding the incision means.   An incision receiving means having an incision base with a guide groove for incision of a tendon sheath and a aponeurosis, and a guide fixing means having an arm with a slit corresponding to the guide groove of the incision receiving means, The incision means is inserted through the slit of the guide fixing means, pressed against the guide groove of the incision receiving means, and the incision means is caused to travel along the guide groove and the slit. The surgical instrument for incision according to 1.   The incision receiving means comprises a handle portion and an incision base portion formed at the tip of the handle portion, the incision base portion has a guide groove along its longitudinal direction, and a recess is formed at the tip of the guide groove. An instrument for open surgery according to any one of claims 1 to 4.   6. A scale synchronized with each other for specifying the position of the incision base of the incision receiving means fixed to the guide fixing means is provided on the handle portion of the incision receiving means and the arm portion of the guide fixing means. An incision surgical instrument according to claim 1.   The guide fixing means consists of a base part and an arm part extending from the base part. The base part has a structure for holding and fixing the handle part of the incision receiving means, and the arm part is held on the base part. 7. The device according to claim 1, wherein the arm portion is provided with a slit that faces the guide groove of the incision base portion of the incision receiving means. The surgical instrument for incision according to Item.   8. The instrument for incision operation according to claim 7, wherein the guide fixing means is an escape space below the arm part between the base part and the column part.   The tissue perforation means has a handle and an insertion part that is formed at the tip of the handle and can be inserted into the human body to pierce the aponeurosis and tendon sheath. The insertion part is wider than the tip and the tip. The surgical instrument for incision according to any one of claims 2 to 8, wherein the surgical instrument is bent smoothly with respect to the handle portion and has a bottom surface with an arc shape.   The incision means holding means includes a shaft portion having a fitting portion for mounting and holding the incision means, a main body portion that supports the shaft portion so as to be fixed or swingable, and loosely tightens the shaft portion with respect to the main body portion. The surgical instrument for incision according to any one of claims 3 to 9, comprising fastening means.

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