JP2016019921A - 脊椎高周波神経切断術のための方法およびシステム - Google Patents
脊椎高周波神経切断術のための方法およびシステム Download PDFInfo
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- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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- A61B2018/00636—Sensing and controlling the application of energy
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- A61B2018/00791—Temperature
- A61B2018/00821—Temperature measured by a thermocouple
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
- A61B2018/1246—Generators therefor characterised by the output polarity
- A61B2018/1253—Generators therefor characterised by the output polarity monopolar
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
- A61B2018/1246—Generators therefor characterised by the output polarity
- A61B2018/126—Generators therefor characterised by the output polarity bipolar
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1467—Probes or electrodes therefor using more than two electrodes on a single probe
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- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
- A61B2090/3762—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy using computed tomography systems [CT]
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Abstract
Description
このプロセスは、ニードルの中心長手方向軸からオフセットされた損傷部を生成することが可能なニードルの使用を含んでもよい。このプロセスは、図12の第五腰椎1101に対して、および図2Aのニードル103を使用して実施されるものとして説明する。本明細書において説明する他の実施形態のニードルをこれらの手術において使用してもよいことを理解されたい。
このプロセスは、ニードルの中心長手方向軸からオフセットされた損傷部を生成することが可能なニードルの使用を含む。この手術は、図13を参照とするSIJの後枝1201に対して、および図2A〜図6のニードル103を使用して実施されるようなものとして説明される。本明細書において説明するニードルの他の実施形態のニードルをこの手術において使用してもよいことを理解されたい。
このプロセスは、ニードルの中心長手方向軸からオフセットされた損傷部を生成することが可能なニードルの使用を含んでもよい。関連する内側枝神経の高周波アブレーションを利用した胸椎Z関節痛の治療の成功は、特に第五胸椎〜第八胸椎の高さにおける横突起間スペース内の一貫性のない内側枝位置によって、困難なものとなっている。従来のRFカニューレは、正常な内側枝神経切断術のために十分な組織アブレーションを達成するために、横突起間スペース内の複数の箇所に位置決めされなければならない。この手術は、図14の第五胸椎から第八胸椎の中の隣接し合う胸椎1301、1302間の横突起間スペースに対して、および図2A〜図6のニードル103を用いて実施されるものとして説明されることとなる。本明細書において説明する他の実施形態のニードルをこの手術において使用してもよいことを理解されたい。
本明細書において説明するニードルの実施形態(例えば図2のニードル103)は、第二頸椎/第三頸椎の頸椎関節突起間関節(Z関節)を含む頸椎関節突起間関節の完全な神経除去に必要な組織アブレーション体積に損傷を与えることが可能である。本明細書において説明する実施形態のニードルを用いた頸椎Z関節に対する組織アブレーションは、1度の配置および1度の加熱からなるサイクルを利用して遂行されてもよい。かかる1度の配置および1度の加熱からなるサイクルにより、従来のプローブの複数回の配置による不要な組織への損傷、および過剰に損傷を与えることにより引き起こされる側副組織に対する意図しない損傷が回避され得る。このデバイスの種々の実施形態により生成されるアブレーション区域は、正常な手術にとって十分かつ必要な組織凝固をもたらすように設計され、したがって、この脊椎高周波神経切断術を受けている患者の成果を向上させることが予期され得る。
101 患者
102 RF発生器
103 ニードル
103’ ニードル
104 対極板
105 撮像システム
106 X線源
107 X線検出器
108 制御装置
109 台
201 先端部
201’ 先端部
201’’ 先端部
201’’’ 先端部
202 遠位端部
203 細長部材
204 ハブ
205 近位端部
206a フィラメント
206b フィラメント
207 チューブ
210 流体ポート
213 空洞部
215 突出部、突起部
216 アクチュエータ
217 インターフェース部分
218 突出部
219 螺旋路
220 ルアー継手
221 フィラメントハブ
222 ルーメン
223 中心長手方向軸
224 マーカ
225 インジケータ
226 内方空洞部
231 ハブ
232 アクチュエータ
233 細長部材
234 空洞部
235 突出部
236 摺動部材
237 キー溝またはキースロット
238 ハブ突起部
239 環状特徴部
240 環状スロット
241 螺旋路
242 螺旋ねじ山
243 ルアー継手
301 突端
302 テーパ状部分
303 本体部分
304a フィラメントポートまたはフィラメントスロット
304b フィラメントポートまたはフィラメントスロット
305 移行領域
309 ニードル
310 遠位端部
311 先端部
312 突端
313 テーパ状部分
314 第1の本体部分
315 第2の本体部分
316 角度
317 細長部材
318a フィラメントスロット
318b フィラメントスロット
319a フィラメント
319b フィラメント
320 流体ポート
400 RFプローブアセンブリ
401 RFプローブ
402 遠位端部
403 コネクタ
404 ケーブル
501a 遠位端部
501b 遠位端部
502 中間点
503 フィラメント角度
504 フィラメント不在角度
601 角度
602 距離
603 距離
701 第3のフィラメント
702 先端部
703 多角形
704 図心
801a フィラメント
801b フィラメント
801c フィラメント
801d フィラメント
802 多角形
803 図心
804 フィラメント角度
805 フィラメント不在角度
901a フィラメント
901b フィラメント
901c フィラメント
902a 角度
902b 角度
902c 角度
1001a フィラメント
1001b フィラメント
1010a 等温線
1010b 等温線
1010c 等温線
1011 損傷部
1012 表面
1020 単一フィラメントニードル
1021 フィラメント
1022 損傷部
1101 第五腰椎
1102 溝
1103 横突起
1104 上関節突起
1105 内側枝神経
1106 外側面
1200 仙骨
1201 後枝
1203 標的体積
1203a 標的体積
1203b 標的体積
1203c 標的体積
1203d 標的体積
1203e 標的体積
1203f 標的体積
1203g 標的体積
1203h 標的体積
1204 第1の点
1205a 矢印方向
1205b 矢印方向
1208 損傷部
1209 第五腰椎
1211 仙骨孔、後仙骨孔
1212 仙骨孔、後仙骨孔
1213 仙骨孔、後仙骨孔
1301 胸椎
1302 胸椎
1303 内側枝神経
1401 第二頸椎
1402 第三頸椎
Claims (1)
- RFアブレーション手術の際に患者内に挿入するためのニードルであって、
ハブと、
前記ハブに固定される細長部材と、
前記ニードルの遠位端部にて前記細長部材に固定される先端部であって、前記患者の組織を穿刺する形に形成された先端部と、
前記細長部材の少なくとも一部分の中に配設される複数のフィラメントと、
前記複数のフィラメントに相互接続されるアクチュエータであって、アクチュエータを前記ハブに対して相対的に移動させることにより、前記複数のフィラメントが前記先端部に対して相対的に移動される、アクチュエータと、
前記細長部材内に配設されるルーメンと、
を備え、前記ルーメンおよび前記先端部は、RFプローブを受容するように構成されており、これにより、挿入されたRFプローブの電極、前記先端部、ならびに前記第1のフィラメントおよび前記第2のフィラメントが単一の単極RF電極を形成するように作動可能となる、ニードル。
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US28055709P | 2009-11-05 | 2009-11-05 | |
US61/280,557 | 2009-11-05 | ||
US34735110P | 2010-05-21 | 2010-05-21 | |
US61/347,351 | 2010-05-21 |
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JP2012538056A Division JP5836964B2 (ja) | 2009-11-05 | 2010-11-05 | 脊椎高周波神経切断術のための方法およびシステム |
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JP2015215570A Pending JP2016019921A (ja) | 2009-11-05 | 2015-11-02 | 脊椎高周波神経切断術のための方法およびシステム |
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US (5) | US20110213356A1 (ja) |
EP (2) | EP2496166B1 (ja) |
JP (2) | JP5836964B2 (ja) |
AU (1) | AU2010314930C1 (ja) |
BR (1) | BR112012010199B8 (ja) |
CA (1) | CA2778997C (ja) |
ES (1) | ES2971446T3 (ja) |
WO (1) | WO2011057157A1 (ja) |
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EP2496166A4 (en) | 2014-06-11 |
AU2010314930A1 (en) | 2012-05-24 |
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AU2010314930B2 (en) | 2013-10-24 |
EP2496166B1 (en) | 2018-12-26 |
BR112012010199A2 (pt) | 2016-06-07 |
BR112012010199B1 (pt) | 2021-12-21 |
CA2778997C (en) | 2022-03-08 |
US20240032990A1 (en) | 2024-02-01 |
US11806070B2 (en) | 2023-11-07 |
WO2011057157A1 (en) | 2011-05-12 |
BR112012010199B8 (pt) | 2022-08-23 |
US20200345412A1 (en) | 2020-11-05 |
US20110213356A1 (en) | 2011-09-01 |
CA2778997A1 (en) | 2011-05-12 |
US20170065335A1 (en) | 2017-03-09 |
EP3556308C0 (en) | 2023-12-20 |
US20210100609A1 (en) | 2021-04-08 |
AU2010314930C1 (en) | 2014-04-03 |
US10925664B2 (en) | 2021-02-23 |
EP3556308B1 (en) | 2023-12-20 |
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