JP2016158803A - Joint endoscope apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a joint endoscope apparatus for making it possible to secure a wide visual field and high operability while having a small diameter for reducing invasiveness upon a patient, in the case of observing a joint region such as a knee joint having a complex structure.SOLUTION: A joint endoscope apparatus comprises: a hollow shaft part; a bendable part approximately coaxially fixed at the distal end of the shaft part; an operation part for performing curvature operation on the bendable part; an optical fiber that has flexibility and transmits light from a light source through the inside of the shaft part and bendable part to irradiate an observation region of a joint from the bendable part's distal tip; and imaging means for imaging the observation region irradiated by the illumination means.SELECTED DRAWING: Figure 3

Description

The present invention relates to a joint endoscope apparatus for percutaneously observing a joint of a patient.

Conventionally, as a joint endoscope for observing the inside of a patient's joint, an optical camera is provided at the proximal end of a metal tube, and an objective lens and an illumination lens are provided at the distal end. Such a joint endoscope inserts a metal tube through a hole provided by incising the skin of a patient, and irradiates light from a separately provided light source to the joint via an illumination lens, and from one direction. The image is taken with an optical camera.

However, even if an attempt is made to observe the back side of a patient's joint using such a joint endoscope, it is often impossible to make an incision from another direction anatomically, making observation difficult. In addition, the joint endoscope is a uniaxial rotation only at the distal tip, so that the operability is poor, and a perspective mirror is used to secure a visual field. It was highly difficult and required skill.

Further, in the conventional joint endoscope, since the optical camera is arranged at the proximal end, the proximal end side is heavier than the distal end side, and the doctor always holds it with one hand, or separately, the assistant is arranged. Necessary and obstructing the movement of the doctor performing the observation, and in that sense, the technique using the joint endoscope has become more difficult.

JP-A-117624

The present invention has been created in view of the above problems, and is a joint endoscope that has a low invasiveness to a patient at a joint part such as a knee joint having a complicated structure and can ensure a wide field of view and high operability. An object is to provide an apparatus.

The present invention provides a joint endoscope apparatus for observing the inside of a joint. The joint endoscope apparatus includes a hollow shaft portion, a bendable portion that is substantially coaxially fixed at a distal end of the shaft portion, an operation portion that performs a bending operation of the bendable portion, and light from a light source. A flexible optical fiber that transmits the inside of the shaft portion and the bendable portion and irradiates the observation portion of the joint from the distal tip of the bendable portion, and the observation portion irradiated by the illumination means Imaging means for imaging.
The bendable portion has a cylindrical sheath member at a distal end and a cylindrical movable member coupled coaxially at the proximal end of the sheath member, and the optical fiber and the imaging means are disposed therein. Are arranged in parallel in the axial direction.

According to this joint endoscope apparatus, small-sized imaging means are arranged in the sheath member at the tip so as to be substantially coaxial with the optical axis of the optical fiber, and the sheath member is directly inserted into the joint and held with one hand. The entire face of the joint can be visually recognized by a doctor alone by simply bending the tip inside the joint or by directly rotating the shaft portion.

The sheath member is provided with a lens member at the distal tip, the imaging means is a C-MOS camera, the light source is an LED, and the focal position of the C-MOS camera through the lens member It is preferable that the diffusion degree of the light from the optical fiber through the lens member is larger or the same as the viewing angle at.

As a result, coupled with the fact that the optical axes of the small C-MOS camera and the optical fiber are substantially the same, the viewing angle (actual viewing angle) of the C-MOS camera is sufficient even for a small-diameter joint endoscope. Irradiation light can cover and provide a clear intra-articular image.

The light source preferably includes a plurality of LEDs and is built in the operation unit.

When the light source is composed of a plurality of LEDs, not only can the brightness of the irradiated light be ensured, but it is also easy to form white light mixed with a plurality of wavelengths, and the resolution of the C-MOS camera can be improved. . In addition, if a small LED with low power consumption and low temperature rise is used, it can also be built in the operation unit at hand, and the transmission distance by the optical fiber from the light source to the observation site is shortened. As a result, the light source intensity can also be reduced. Since the number of LEDs can also be reduced, the operation unit can be further downsized.

Further, the bendable portion is at least 180 degrees in each direction from the substantially straight state in the vertical direction or the horizontal direction, depending on the distance in which the slide portion of the operation unit is moved in a linear direction from a predetermined position. Bendable and
The bendable portion has a diameter of approximately 2 mm, and preferably has a bending outer diameter of approximately 10 mm when bent at approximately 180 °.
The viewing angle of the C-MOS camera is preferably 100 to 110 °.

Thereby, even if it is an endoscope with a small diameter of 2 mm or less with little bioinvasiveness by the axial rotation of a shaft part and bending of a bendable part, a visual field can be secured in all directions.

Further, the movable member is configured by integrally connecting a plurality of metal cylindrical members in the axial direction by connecting portions positioned on the same phase at positions opposed to each other in the radial direction,
Each cylindrical member can be bent as the entire movable member by maximizing the gap between each cylindrical member and inclining in the same direction with respect to the axis,
The movable member is constituted by two wires connected to the slide portion of the operation unit from positions facing each other at a phase shifted by approximately 90 ° with respect to the coupling portion of the cylindrical member at the distal end of the movable member. It can be bent.

This movable member is formed by connecting metal cylindrical members with a gap between each other, and has a structure that bends as a whole by using the bending of a connecting portion of the same material that connects the cylindrical members. Yes. Furthermore, it has a structure that can be easily operated using an operation part and a wire.

Furthermore, it is preferable that a scale for confirming the insertion length of the shaft portion into the body is printed on the shaft portion.

Thereby, when the endoscope is inserted / removed into / from the joint, a doctor or the like can easily confirm the position in the joint.

As described above, according to the joint endoscope apparatus of the present invention, when observing a joint part such as a knee joint having a complicated structure, the patient has a small field of invasiveness but a wide field of view and a high field of view. It becomes possible to ensure operability.

BRIEF DESCRIPTION OF THE DRAWINGS It is the schematic explaining the structure of the joint endoscope apparatus which concerns on one Embodiment of this invention, (a) is a general view, (b) is an enlarged view of the area | region B shown to (a). BRIEF DESCRIPTION OF THE DRAWINGS It is the schematic explaining the structure of the joint endoscope apparatus which concerns on one Embodiment of this invention, Comprising: (a) is an axial sectional view of the area | region B, (b) saw the edge part in the arrow A direction. It is an enlarged view. It is the photograph figure which showed the small C-MOS camera, and has shown contrast with a finger and a ruler in order to understand the size image of a C-MOS camera. It is the photograph figure which showed an example of the movable member. It is the figure which showed the structure of the movable member, (a) is the whole figure seen from radial direction, (b) is sectional drawing of radial direction. It is the schematic explaining the bending operation | movement of the bendable part which comprises the joint endoscope apparatus which concerns on one Embodiment of this invention.

Hereinafter, specific embodiments of the joint endoscope apparatus of the present invention will be described in detail with reference to the drawings. In addition, embodiment shown how is illustration enumeration, it is not limited to this.

FIG. 1 is a schematic diagram illustrating a configuration of a joint endoscope apparatus 50 according to an embodiment of the present invention, where (a) shows an overall view of the joint endoscope 50 and (c) The enlarged view of the area | region A of the shaft part 10 shown to (a) is shown. Further, FIG. 2A shows an enlarged cross-sectional view along the axial direction in the region B of the bendable portion 12 of FIG. 1A, and FIG. 2B shows the state shown in FIG. The figure which looked at the distal end of the joint endoscope apparatus 50 from the direction of arrow A is shown.

As shown in FIG. 1A, the joint endoscope apparatus 50 includes a generally hollow shaft portion 10, a bendable portion 12 fixed to the distal end of the shaft portion 10, and a generally bendable portion 12. And an operation unit 20 that performs a bending operation. Further, in the vicinity of the distal end of the bendable portion 12 in FIG. 1A, illumination is applied to the inside of the joint by transmitting light from a light source (LED (not shown)) to an observation site in the joint. The optical fiber 14 as a means and the imaging means 18 which images the observation site | part irradiated by the optical fiber 14 are provided. The imaging means 18 is a photoelectric conversion element that detects light from the observation site and generates a charge, and an objective lens may be provided between the imaging device and the observation site. As this image sensor, a CMOS image sensor (hereinafter also referred to as “C-MOS camera”), a CCD image sensor, or the like can be used. As a result, an image of the observation site can be obtained as electronic data. Here, a small C-MOS camera (manufactured by Medigus) shown in the photograph of FIG. The C-MOS camera 18 has a head portion with a diameter of 1.2 mm and an actual field of view of 100 °. FIG. 4 is a photograph showing a small C-MOS camera, and shows a comparison between a finger and a ruler for understanding the dimensional image of the C-MOS camera.

As shown in FIG. 2, the C-MOS camera 18 and the optical fiber 14 are arranged in the radial direction and mounted in a sheath member 13 made of metal and having a hollow cylindrical shape. The ends of the C-MOS camera 18 and the optical fiber 14 are bonded to a lens member 15 that also functions as a dust cover. The lens member 15 is a transparent body such as glass that sufficiently transmits light, thereby adjusting the diffusion of radiated light from the optical fiber 14 and the viewing angle of the C-MOS camera 18, and blood or the like into the sheath member 13. Prevents intrusion of garbage. A signal cable 16 extends from the lower part of the C-MOS camera 18 (right side in FIG. 2A), and transmits an image pickup signal from the C-MOS camera 18 to an image detection device (not shown). Further, the imaging signal of the C-MOS camera 65 is transmitted to an endoscope processor (not shown) via a signal cable 71.

The light transmitted through the optical fiber 14 as the illumination means uses an LED (not shown) as a light source, and the LED is built in the endoscope processor. Thereby, it is possible to automatically control the light quantity of the LED and the like by the control of the endoscope processor. Since the LED is smaller and lighter than a conventional light source such as a halogen or xenon lamp, it can be easily built into an endoscope processor in the operation unit 20 (described later), and the power supply to the LED Is supplied from the cable 24.

Light emitted from the LED is incident on and transmitted to the proximal ends of the plurality of optical fibers 11 disposed inside the hollow shaft portion 10, and is emitted from the distal ends of the shaft portion 10. Is done. A desired observation site or the like is illuminated by light emitted from the distal end of the shaft portion 10, and an image of the observation site is obtained by receiving the reflected light with an imaging device included in the C-MOS camera 18. It becomes possible.

As described above, the light emitted from the LEDs is transmitted to the plurality of optical fibers 11 to form one irradiation light, and the distal end of the optical fiber 14 is connected to the C-MOS camera 18. It is desirable that the C-MOS camera 18 and / or an objective lens (not shown) included in the C-MOS camera 18 be arranged around the optical axis around the optical axis. As a result, the light from the light source can be uniformly irradiated to the observation site, and as a result, a wider range of the field of view obtained from the C-MOS camera 18 can be sufficiently illuminated, and a clearer image can be obtained to obtain the observation site. Can be confirmed more reliably.

The proximal end of the sheath member 13 is connected to the end of the movable member 17 as shown in the photograph of FIG. 4 by brazing or using an adhesive. The movable member 17 is made of metal such as SUS, and a plurality of cylindrical members are connected to each other as indicated by reference numerals 17a and 17, and the cylindrical members 17a and 17b are connected to each other at a part in the circumferential direction. And has a structure with a gap in the other part. FIG. 5 shows the connected state of the cylindrical members 17a and 17b of the movable member 17. FIG. 5A is a view of the cylindrical members 17a and 17b as viewed from the radial direction, and FIG. It is sectional drawing along line XX. The cylindrical members 17a and 17b are each provided with a connecting portion 23a at a position facing the radial direction, and are connected to each other by the connecting portion 23a. Moreover, the clearance gap 23b is formed except the connection part 23a.

Accordingly, the cylindrical members 17a and 17b are inclined with respect to the gap 23b by the elasticity of the connecting portion 23a (inclined in the left-right direction in FIG. 5A). The inclination of each cylindrical member 17a, 17b is continuously accumulated in the axial direction, thereby forming a curve of the entire movable member 17 (see FIG. 4). In the movable member 17 of this embodiment, as shown in FIG. 5, it is bent at a maximum of about 180 °, and at the time of the maximum bending, its tip is separated by about W = 15 mm. The connecting portion 23a may be formed by cutting a gap 23b from an integral cylinder, or may be formed by bonding separately created cylindrical members 17a, 17b and the like at the connecting portion 23.

Moreover, although detailed description is abbreviate | omitted, the curve of the movable member 17 is performed by the wire 21 shown in FIG. The two wires 21 are a pair of steel wires 21a and 21b, which are respectively inserted into the inside from the proximal end side of the movable member 17, and facing the inner wall of the distal end (a phase substantially in the middle of each gap 23b). The tip of the wire 21 is bonded to the position). The movable member 17 is bent by pulling only one of the wires 21a and 21b. For example, when the wire 21a of FIG. 6B is pulled downward (proximal side), the wire 21b is extended by the amount of the pull, so that the left side of the gap 23b shown in FIG. 6A is narrowed and the right side is expanded. Thus, the movable member 17 curves to the left. Conversely, when the wire 21a is stretched when the wire 21b is pulled downward, the movable member 17 bends to the right.

In addition, as shown in FIG. 2, the movable member 17 preferably covers a part of the outer periphery of the movable member 17 and the sheath member 13 with a resin exterior 19. This is to prevent biological fluid and dust from entering the surface and the inside of the movable member 17 and the sheath member 13.

Refer to FIG. 1 again. The bendable portion 12 is operated by moving the slide portion 22 included in the operation portion 20 in a linear direction from a predetermined position. At this time, the slide portion 22 and the wire 21 described above are connected, and the movement of the slide portion 22 and the pulling operation of the wires 21a and 21b are interlocked. Accordingly, as shown in FIG. 3, the slide portion 22 is configured to bend at an angle of at least 180 degrees in the vertical direction or the horizontal direction according to the moving distance from the predetermined position of the slide portion 22 as shown in FIG. . The bendable portion 12 has a diameter of approximately 2 mm, and a bending outer diameter of approximately 10 mm when bent at approximately 180 °.

This will be described in detail with reference to FIG. In FIG. 3A, the slide part 22 is in an initial position with respect to the operation part 20. At this time, the bendable portion 12 fixed to the operation portion 20 via the shaft portion 10 has a substantially linear shape which is an initial shape.

From this initial state FIG. 3A, as shown in FIG. 3B, when the slide part 22 is slid linearly toward the proximal end side of the operation part 20, the bendable part 12 moves the slide part 22. One wire 21 (not shown in FIG. 3) in the shaft portion 10 is pulled according to the distance, and is bent in the upward direction in FIG.

Similarly, as shown in FIG. 3 (c), when the slide portion 22 is slid linearly toward the distal end side of the operation portion 20, the bendable portion 12 moves to the other wire according to the movement distance of the slide portion 22. 21 is pulled and curved in the downward direction in FIG.

As described above, in the joint endoscopic device 50 of the present invention, the bendable portion 12 can be bent at least at an angle of 180 ° in the vertical direction by an easy operation of sliding the slide portion 22 linearly. .

A combination of rotating the bendable part 12 360 ° as shown in FIGS. 3A to 3C and rotating the bendable part 12 by rotating the shaft part 10 in the circumferential direction, By using the imaging means (C-MOS camera) 18 and the illumination means 14 (details will be described later), a wide field of view can be obtained without using a perspective mirror or the like, and a doctor can easily find a desired position in the joint from multiple directions. It becomes possible to observe.

Actually, the diameter of the bendable portion 12 inserted into the joint is approximately 2 mm as shown in FIG. 3A, so that the size of the hole provided by incising the skin of the patient can be suppressed. As a result, it becomes possible to suppress invasiveness to the patient. Further, as shown in FIGS. 3B and 3C, the bendable portion 12 has a bending outer diameter of approximately 10 mm when bent at approximately 180 °, so that even in the vicinity of a joint having a complicated structure. Can be curved freely.

Thus, when the bendable part 12 is moved and the part in the joint is imaged, the image of the observed part can be obtained as electronic data via the signal code 16 connected to the C-MOS camera 18. The electronic data of the image of the observation site is displayed on a display (not shown) via the cable 24, the processing circuit, etc. shown in FIG. The joint can be observed.

As described above, it is not necessary for the doctor or assistant to hold the optical camera as in the prior art, and the doctor rotates the shaft portion 10 appropriately in the circumferential direction with one hand while the slide disposed on the operation unit 20 with the other hand. The observation part can be observed by operating the part 22 and appropriately bending the bendable part 12. As a result, it is possible to perform observation while ensuring a wide field of view with an easy operation without separately inserting a perspective mirror into the patient's joint.

As mentioned above, although embodiment about the joint endoscope apparatus of this invention was described, this invention is not limited to this, The range which does not deviate from the mind and teaching as described in a claim, a description, etc. It will be understood by those skilled in the art that other variations and improvements can be obtained.

DESCRIPTION OF SYMBOLS 10 Shaft part 12 Bendable part 13 Sheath member 14 Illumination means (optical fiber)
15 Lens member 16 Light source (LED)
17 Movable member 18 Imaging means (C-MOS camera)
20 Operation part 21 Wire 22 Slide part 24 Cable 26 Scale 50 Joint endoscope apparatus

Claims (7)

A joint endoscopic device for observing the inside of a joint,
A hollow shaft portion, a bendable portion fixed substantially coaxially at the distal end of the shaft portion, an operation portion for performing a bending operation of the bendable portion, and light from a light source for the shaft portion and the bendable portion And a flexible optical fiber that irradiates the observation site of the joint from the distal end of the bendable part through the inside of the bendable part,
Imaging means for imaging the observation site irradiated by the illumination means,
The bendable portion has a cylindrical sheath member at a distal end and a cylindrical movable member coupled coaxially at the proximal end of the sheath member, and the optical fiber and the imaging means are disposed therein. Are arranged in parallel in the axial direction,
A joint endoscope apparatus characterized by the above. A distal end of the sheath member includes a lens member, the imaging means is a C-MOS camera, and the light source is an LED.
The diffusivity of light from the optical fiber through the lens member is greater than or equal to a viewing angle at a focal position in the C-MOS camera through the lens member. The joint endoscope apparatus according to 1. The light source has a plurality of LEDs and is built in the operation unit;
The joint endoscope apparatus according to claim 1, wherein: The bendable portion is bent at an angle of at least 180 degrees in a vertical direction or a horizontal direction from a substantially linear state according to a distance in which the slide portion of the operation unit is moved in a linear direction from a predetermined position. Is possible,
The bendable part has a diameter of approximately 2 mm, and a bending outer diameter of approximately 10 mm when bent at approximately 180 °;
The joint endoscope apparatus according to any one of claims 1 to 3. The viewing angle of the C-MOS camera is 100 to 110 °,
The joint endoscope apparatus according to any one of claims 1 to 4. The movable member is configured by integrally connecting a plurality of metal cylindrical members in the axial direction by connecting portions positioned in the same phase at positions opposed to each other in the radial direction,
Each cylindrical member can be bent as the entire movable member by maximizing the gap between each cylindrical member and inclining in the same direction with respect to the axis,
The movable member is constituted by two wires connected to the slide portion of the operation unit from positions facing each other at a phase shifted by approximately 90 ° with respect to the coupling portion of the cylindrical member at the distal end of the movable member. Bend,
The joint endoscope apparatus according to claim 1, wherein The joint endoscope apparatus according to any one of claims 1 to 6, wherein a scale for confirming an insertion length of the shaft portion into the body from outside the body is printed on the shaft portion.