JP5142785B2 - Pin driving device - Google Patents

Description

  The present invention relates to a pin driving device for puncturing a living tissue with a pin in a living body.

  Conventionally, when treating an aneurysm, the aneurysm is surgically removed, and an artificial blood vessel (a tube made of an artificial material) is transplanted to that portion, or another new blood flow called bypass surgery. Therapies were to form tracts and secure blood. However, patients who develop aneurysms are generally elderly, and such major surgery is often difficult due to the heavy burden on the patient, and complications during and after surgery are likely to occur. It was accompanied by.

  In addition, a device for treating an aneurysm by placing and transplanting a stent graft (a medical device having a metal skeleton (stent) sewn on an artificial blood vessel (graft)) percutaneously without performing such a surgical operation, and A method has been proposed (see, for example, Patent Document 1). This treatment has the advantage of significantly reducing the risk of surgery and the burden on the patient.

  Stent grafts are broadly classified as follows: (1) The diameter is expanded in a natural state where no external force is applied, and a radial compressive force is applied to the stent graft to reduce the diameter. A so-called self-expanding type that is transferred to a target site in the artery (a treatment site where an aneurysm is formed) in a state, where the compressive force is removed to self-expand the diameter, and (2) In a natural state where external force is not applied, the diameter is reduced, and after transferring to the target site in the artery, the balloon of the separately inserted balloon catheter is inflated, and the metal member installed at the end of the stent graft is expanded. There is a so-called balloon expanding type structure in which the expanded state is maintained by the plastic deformation of the metal member accompanying the expansion.

  However, all of these stent grafts are obtained by fixing a cloth-like graft to a stent that is a metal skeleton, and have a relatively large diameter as a tube for transferring the stent graft when the stent graft is placed. It is necessary to use a tube. For this reason, it is desired to reduce the diameter of the tube.

  Therefore, a method has been proposed in which only the graft is fixed to the blood vessel wall with a pin, and the graft is placed and transplanted to treat the aneurysm. According to this treatment method, the graft can be folded smaller than the stent graft, and a tube having a relatively small diameter can be used as a tube for transferring the graft, thereby further reducing the burden on the patient. can do.

  However, when fixing the graft to the blood vessel wall with a pin, there has been no suitable device for puncturing the pin into the blood vessel wall.

JP 2000-279434 A

  An object of the present invention is to provide a pin driving device capable of easily and reliably puncturing a living tissue with a pin in a living body.

Such an object is achieved by the present invention of the following (1) to ( 17 ).
(1) A pin driving device for puncturing a living tissue with a pin in a living body,
An elongate main body having an accommodating portion for accommodating the pin, and an opening through which the pin accommodated in the accommodating portion is discharged;
Pressing means for pressing the vicinity of the opening of the main body portion against a living tissue ,
The pin is for fixing an indwelling object to a biological tissue, and a rod-shaped head,
Extending from the head and projecting at least one stick-like puncture part into the living tissue together with the indwelling object;
A portion extending from the head and projecting, having a portion that comes into contact with the indwelling object, and a spine for closely attaching the indwelling object to a living tissue,
The axis of the puncture part is inclined with respect to the axis of the head, so that the angle θ formed by the axis of the puncture part and the axis of the head is less than 90 °,
The main body includes a casing in which the opening is formed;
An inner member that is movably installed in the casing and moves the pin in a proximal direction relative to the casing;
A pusher for moving the pin in the distal direction relative to the casing;
When the pin is moved in the distal direction with respect to the casing by the pusher and the puncture portion reaches the position of the opening, the distal end side of the puncture portion protrudes outside from the opening, and the pin is moved by the inner member. A pin driving apparatus configured to move in a proximal direction relative to the casing and to puncture the living tissue .

(2) The opening is formed on a side of the tip of the main body,
The pressing means has an expandable body that can be expanded and contracted, and the expanded body is decentered in the direction opposite to the opening with respect to the central axis of the main body portion, thereby expanding the vicinity of the opening of the main body portion. The pin driving device according to (1), wherein the pin driving device is configured to press against a living tissue.

  (3) The pinning device according to (1) or (2), wherein the expansion body includes a balloon.

  (4) The pin driving apparatus according to (3), wherein a flow path through which a working fluid that expands and contracts the balloon is formed along the main body.

  (5) The pinning device according to (1) or (2), wherein the expansion body is configured by a plurality of linear bodies that bend and deform.

  (6) The pin driving device according to (5), wherein an insertion passage through which a wire for operating the plurality of linear bodies is inserted is formed along the main body.

( 7 ) The pin has elasticity, and is elastically deformed so that the axis of the head, the axis of the puncture portion, and the axis of the spine portion are substantially parallel or substantially coincident with each other, And the pin driving device according to any one of (1) to (6), wherein the pin is stored in the storage portion such that the head side is the front end side.

( 8 ) When the pin is moved in the distal direction with respect to the inner member by the pusher and the puncture portion reaches the position of the opening, the puncture portion is restored, and the distal end side of the puncture portion is the opening. The pin driving device according to ( 7 ), wherein the pin driving device is configured to protrude from the outside.

(9) the inner member has at its distal end, the pin hammering device according to any one of (1) to that having a contact portion that may contact with the head of the pin (8).

( 10 ) L1 is a length from the head portion to the puncture portion of the pin in a state of being housed in the housing portion, and L3 is a length from the contact portion of the inner member to the proximal end of the opening. Then, the pin driving device according to (9) , wherein the L3 is longer than the L1.

( 11 ) When the length from the contact portion of the inner member to the base end of the opening is L3, and the length of the pin in the state of being housed in the housing portion is L4, the L4 is the L3 The pin driving device according to (9) or (10) , which is longer than the above.

( 12 ) When the length from the head to the puncture portion of the pin in the state of being housed in the housing portion is L1, and the length of the casing in the longitudinal direction of the casing is L2, the L1 is The pin driving device according to any one of ( 9 ) to ( 11 ), which is longer than L2.

( 13 ) The pin has elasticity, and is housed in the housing portion so that the puncture portion and the spine portion are elastically deformed so that the head side is the distal end side. The pin driving device according to any one of (1) to (6) .

( 14 ) When the pin is moved in the distal direction with respect to the casing by the pusher and the puncture portion reaches the position of the opening, the puncture portion is restored, and the distal end side of the puncture portion is moved from the opening. The pin driving device according to ( 13 ), which is configured to protrude outward.

( 15 ) The pin driving device according to (13) or (14) , wherein the inner member includes a contact portion having an inclined surface capable of contacting the head of the pin at a base end portion thereof.

( 16 ) The pin driving apparatus according to any one of ( 13 ) to ( 15 ), further including an urging unit that urges the inner member in a distal direction.

( 17 ) The pin driving apparatus according to any one of (1) to ( 16 ), further including a marker indicating the position of the opening in a living body.

  According to the present invention, since the pressing means is provided, it is possible to perform an operation of puncturing the pin into the living tissue in a state where the vicinity of the opening of the main body is pressed against the living tissue (in a close contact state). As a result, it is possible to easily and reliably puncture a living tissue with a pin in a living body (for example, a site with blood flow in a living body such as a blood vessel or a heart), and to reliably puncture a pin at a target position. Can do.

  Hereinafter, a pin driving device of the present invention will be described in detail based on a preferred embodiment shown in the accompanying drawings.

  The present invention can be applied to a device for puncturing a living tissue with a pin in a living body. However, in the following embodiment, the present invention is typically inserted and placed in the vicinity of a blood vessel aneurysm. A case where the pin for fixing the graft to the blood vessel wall (inside the blood vessel) is applied to a device that penetrates (pierces) the blood vessel wall will be described.

<First Embodiment>
FIG. 1 is a side view showing a first embodiment of the pin driving apparatus of the present invention. 2 is a diagram showing the pin driving device shown in FIG. 1, in which FIG. 2 (a) is a cross-sectional view and FIG. 2 (b) is a front view. 3 is a view showing an embodiment of a pin for fixing a graft, and FIG. 4 is a cross-sectional view showing a state where a graft inserted and placed in the vicinity of an aneurysm of a blood vessel is fixed to a blood vessel wall with the pin shown in FIG. FIGS. 5 to 9 are cross-sectional views for explaining the operation of the pin driving device shown in FIG.

  In the following, the left side in FIGS. 1, 2, and 5 to 9 is referred to as “tip”, the right side is referred to as “base end (rear end)”, and the lower side in FIGS. 3 and 4 is referred to as “tip”. The upper side is described as “base end”.

  1 and 2 show a state where the balloon is expanded. Moreover, in FIGS. 6-9, the graft | graft and the blood vessel wall are shown typically.

  As shown in FIG. 4, the pin driving device (pin driving catheter) 1 shown in FIGS. 1 and 2 penetrates the blood vessel wall (in vivo tissue) 310 in the blood vessel 300 (in vivo). A device (a puncture device), that is, a graft (an indwelling object) 200 that is an artificial blood vessel inserted and placed in the vicinity of an aneurysm 320 in a blood vessel 300 such as an aorta is fixed to the blood vessel wall 310 with a pin 5 in the blood vessel 300. It is a device to do.

First, the graft 200 will be described.
As shown in FIG. 4, the graft 200 has a shape and size corresponding to the shape and size of the blood vessel 300 to which the graft 200 is fixed, and is usually cylindrical. The graft 200 can be folded or expanded from the folded state.

  The graft 200 may be any membrane (membrane) that does not allow permeation of blood flow. For example, a fibrous porous membrane such as a woven fabric, a knitted fabric, a nonwoven fabric, or a paper material, a non-fibrous porous membrane, and a polymer sheet. A dense film such as

  Examples of the material (fiber) of the graft 200 include cellulose fibers, cotton, linter, kapok, flax, cannabis, ramie, silk, wool, and other natural fibers, nylon (polyamide), tetron, rayon, cupra, acetate, Examples thereof include chemical fibers such as vinylon, acrylic, polyethylene terephthalate (polyester), and polypropylene, or combinations (blends and the like) of two or more of these natural and chemical fibers.

  Other examples of the material of the graft 200 (polymer sheet) include, for example, polyesters such as polyethylene, polypropylene, polyurethane, polyethylene terephthalate, and polybutylene terephthalate, polyvinyl chloride, polytetrafluoroethylene, natural rubber, and isoprene rubber. And various rubbers such as silicone rubber, styrene-butadiene rubber and latex rubber, and various thermoplastic elastomers such as polyamide, polyester and polyurethane.

  The graft 200 may be a laminate of two or more layers made of the same or different materials. Further, the graft 200 may be hydrophilized or hydrophobized.

  The graft 200 is fixed to a normal site of the blood vessel 300 by a pin 5 described later. In addition, the graft 200 is fixed at a plurality of locations along the circumferential direction (over one circumference) at a site upstream of the blood flow by the plurality of pins 5. A fixed state is shown.

Next, the pin 5 will be described.
The pin (fixing tool) 5 shown in FIGS. 3 and 4 includes a graft (indwelling object) 200, which is an artificial blood vessel inserted and placed in the vicinity of the aneurysm 320 in the blood vessel 300 such as the aorta. This pin is fixed to the wall (in vivo tissue) 310.

  As shown in FIGS. 3 and 4, the pin 5 includes a head 51, a puncture part (penetration part) 52 that extends and protrudes from the head 51, and a spine part 53 that extends and protrudes from the head 51. have. In the present embodiment, the puncture part 52 extends and protrudes from the tip part 511 of the head 51, and the spine part 53 extends and projects from the middle of the head 51.

The head 51 of the pin 5 is rod-shaped and has a substantially straight shape.
Further, the puncture part 52 is a part that penetrates (pierces) the blood vessel wall 310 together with the graft 200, and has a rod shape and a linear shape. The puncture portion 52 penetrates the blood vessel wall 310 together with the graft 200, so that the graft 200 is fixed to the blood vessel wall 310. Further, the distal end portion (end portion opposite to the head portion 51) 521 of the puncture portion 52 is pointed, so that the puncture portion 52 can penetrate the graft 200 and the blood vessel wall 310 easily and reliably. it can.

  The spine portion 53 is rod-shaped and is curved or bent (curved in the configuration shown) so that the puncture portion 52 side is concave. A distal end portion (an end portion opposite to the head portion 51) 531 of the spine portion 53 is a portion that comes into contact (pressure contact) with the graft 200. The distal end portion 531 comes into contact with the graft 200, and the graft 200 is attached to the blood vessel wall. The graft 200 is brought into close contact with the blood vessel wall 310 by being pressed against the blood vessel 310. In this way, the graft 200 can be reliably adhered to the blood vessel wall 310.

  In this embodiment, the axis 520 of the puncture unit 52 is inclined with respect to the axis 510 so that the angle (angle) θ formed by the axis 520 and the axis 510 of the head 51 is less than 90 °. . The pin 5 is installed so that the head 51 is positioned upstream of the blood flow from the puncture portion 52 when the graft 200 is fixed to the blood vessel wall 310.

  Thereby, the puncture unit 52 is punctured so as to be inclined with respect to the blood vessel wall 310, and the blood flow acts on the pin 5 in the direction in which the puncture unit 52 pierces the blood vessel wall 310, thereby the puncture unit 52. Becomes difficult to escape from the blood vessel wall 310, and the graft 200 can be reliably fixed to the blood vessel wall 310. Further, as will be described later, the puncture unit 52 can penetrate the graft 200 and the blood vessel wall 310 easily and smoothly.

  Here, the angle θ is preferably greater than 0 ° and less than 90 °, and more preferably about 40 to 50 °. As a result, the graft 200 can be reliably fixed by the blood vessel wall 310, and the puncture portion 52 can penetrate the graft 200 and the blood vessel wall 310 more easily and smoothly.

Moreover, when the length of the head 51 is a and the length b of the puncture portion 52 is, a / b is more preferably about 0.1 to 2, and about 0.5 to 1.5. Is more preferable. In particular, it is preferable that the length a of the head 51 and the length b of the puncture portion 52 are set to be approximately equal. In the present embodiment, the length a of the head 51 and the length b of the puncture unit 52 are set to be approximately equal.
Further, the length of the spine 53 is set longer than the length b of the puncture portion 52.

  Note that the dimensions of the head 51, the puncture unit 52, and the spine 53 are not particularly limited and are appropriately set according to various conditions. The length a of the head 51 is, for example, about 1 to 20 mm. It is preferable that it is about 2-20 mm.

  Moreover, the length b of the puncture part 52 is preferably about 2 to 40 mm, for example, and more preferably about 5 to 10 mm.

  Moreover, it is preferable that the length of the spine part 53 is about 4-100 mm, for example, and it is more preferable that it is about 8-80 mm.

  Moreover, the pin 5 has elasticity. That is, when the pin 5 is deformed by applying an external force to the pin 5, the puncture portion 52 and the spine 53 approach or contact each other and the external force is released (natural state), and a restoring force (elastic force). Thus, the original shape is restored.

  Examples of the constituent material of the pin 5 include pseudoelastic metals such as stainless steel, Ni—Ti alloys, Cu—Zn alloys, Ni—Al alloys, tungsten, tungsten alloys, titanium, titanium alloys, tantalum, nickel, Various metals such as chromium, iridium, and cobalt-based alloys are listed.

Next, the pin driving device 1 will be described.
As shown in FIG. 1 and FIG. 2, a pin driving device (pin driving catheter) 1 has a flexible main body portion 10 and a balloon (expanded body) that can be expanded and contracted. 6 is provided.

  The main body 10 includes an outer cylinder (outer tube) 2 that is a casing, an inner cylinder (inner tube) 3 that is an inner member, and a pusher 4 that pushes a pin 5. The distal end sides of the outer cylinder 2 and the inner cylinder 3 are closed, and the proximal end sides are open.

  The pusher 4 is installed in the inner cylinder 3 so as to be movable along the longitudinal direction of the inner cylinder 3 (the pusher 4). The inner cylinder 3 is installed in the outer cylinder 2 so as to be movable along the longitudinal direction of the outer cylinder 2 (inner cylinder 3). The inner cylinder 3 is regulated so as not to move (rotate) in the circumferential direction with respect to the outer cylinder 2, and as shown in FIG. 2, in the initial state (assembled state), the distal end portion of the inner cylinder 3 Is in contact with the tip wall of the outer cylinder 2.

  A hub (branching hub) 7 is installed (fixed) at the base end of the outer cylinder 2. The hub 7 has a port 71 and a port (branch port) 72. The port 71 communicates with a lumen of the outer cylinder 2, and the port 72 communicates with a lumen 22 (to be described later) of the outer cylinder 2. Yes. The outer cylinder 2 can be operated by holding the hub 7.

  Further, the base end portion of the inner cylinder 3 protrudes from the port 71 of the hub 7 to the base end side (outside). A grip 34 is installed (fixed) at the base end of the inner cylinder 3 so that the inner cylinder 3 can be operated by gripping the grip 34.

  Further, the base end portion of the pusher 4 protrudes from the grip portion 34 of the inner cylinder 3 to the base end side (outside). A gripping portion 41 is installed (fixed) at the proximal end of the pusher 4 so that the pusher 4 can be operated by gripping the gripping portion 41.

  Moreover, the front-end | tip part of the pusher 4 is expanded in diameter. The diameter of the tip of the pusher 4 is preferably set to be slightly smaller than the inner diameter of the inner cylinder 3. Thereby, the pin 5 can be pushed reliably. The pusher 4 can move the pin 5 in the distal direction with respect to the inner cylinder 3.

  A portion of the inner cylinder 3 on the tip side of the pusher 4 constitutes a storage portion 33 in which the pin 5 is stored. The pin 5 has a shaft 510 of the head 51, a shaft 520 of the puncture portion 52, and a shaft of the spine 53 in the storage portion 33, that is, a portion on the tip side of the pusher 4 in the inner cylinder 3. In a state of being elastically deformed so as to be substantially parallel or substantially coincident, the head 51 side is the tip side, and the puncture portion 52 side is the lower side in FIG. 2A (the opening 21 side described later). Is done. In this embodiment, it is comprised so that the some pin 5 can be accommodated, and in the example of illustration, the two pins 5 are accommodated. It goes without saying that only one pin 5 may be accommodated.

  Further, an opening 21 for discharging the outlet of the pin 5, that is, the pin 5 stored in the storage portion 33, is formed on the side of the distal end portion of the outer cylinder 2 (lower side in FIG. 2A). Yes. The lumen of the outer cylinder 2 is formed further to the tip side than the tip of the opening 21.

  Further, in the vicinity of the opening 21, for example, around the opening 21, there is a marker (not shown) for confirming the position of the opening 21 in the living body under X-ray fluoroscopy (indicating the position of the opening 21 in the living body). Preferably it is installed.

  This marker is made of a radiopaque material such as a metal such as platinum, gold, silver, tungsten, or an alloy thereof. Further, the marker may be a layer (for example, a coating film) in which the X-ray opaque material or other X-ray opaque materials such as barium sulfate, barium carbonate, bismuth oxide and the like are blended.

  Note that the marker is not limited to fluoroscopy, and may be one that can confirm the position of the opening 21 in, for example, CT scan, MRI, or the like.

  The tip wall of the inner cylinder 3 constitutes a contact portion 32 that can contact the head 51 of the pin 5. Accordingly, the pin 5 can be moved in the proximal direction with respect to the outer cylinder 2 by the inner cylinder 3 (contact portion 32).

  Further, an opening 31 serving as an outlet of the pin 5 is formed at a position corresponding to the opening 21 on the side (lower side in FIG. 2A) of the tip of the inner cylinder 3. The opening 31 is larger than the opening 21. That is, when viewed from the lower side in FIG. 2A (in FIG. 2B), the opening 31 includes the opening 21 of the outer cylinder 2. Specifically, the opening 31 is formed from the base end of the opening 21 to the contact portion 32 positioned on the tip side of the opening 21 (the base end of the opening 31 and the base end of the opening 21 are substantially equal to each other). The tip of the opening 31 is located closer to the tip than the tip of the opening 21).

  Here, the length from the head 51 of the pin 5 in the state accommodated in the inner cylinder 3 to the puncture portion 52 is L1, the length of the opening 21 in the longitudinal direction of the outer cylinder 2 is L2, and the initial state (FIG. 2). The length from the contact portion 32 of the inner cylinder 3 to the proximal end of the opening 21 (opening 31) in the state shown in FIG. When the length from the head 51 of the pin 5 to the spine 53 (the length of the pin 5) in the state in which the pin 5 is set to L4, it is preferable that the following formulas (1) to (3) are satisfied. That is, it is preferable that the dimensions and positions of the openings 21 and 31 and the dimensions of each part of the pin 5 are set so as to satisfy the following expressions (1) to (3).

L2 <L1 (1) Equation L1 <L3 (2) Equation L3 <L4 (3) Equation

  A balloon 6 that can be expanded and contracted by injecting (supplying) and extracting (discharging) the working fluid is installed at the distal end of the outer cylinder 2 (main body portion 10).

  The balloon 6 is installed on the opposite side of the opening 21 of the outer cylinder 2 via the central axis 23 of the outer cylinder 2 (main body part 10), and is expanded eccentrically with respect to the central axis 23 in the direction opposite to the opening 21. It is configured to When the balloon 6 is expanded, the vicinity of the opening 21 of the outer cylinder 2 is pressed against the blood vessel wall 310 via the graft 200 and closely contacts (see FIG. 6). Therefore, the balloon 6 constitutes the main part of the pressing means for pressing the vicinity of the opening 21 of the outer cylinder 2 of the main body 10 against the blood vessel wall (biological tissue) 310.

  The balloon 6 is formed by forming a film-like material into, for example, a sheet shape or a cylindrical shape, and is fixed to the outer peripheral surface of the outer cylinder 2 in an airtight or liquid tight manner. This fixing is performed by, for example, fusion or bonding with an adhesive.

  The balloon 6 is in a state of being collapsed and folded before expansion (when deflated), but when the working fluid is supplied to the inside of the balloon 6 and expanded, conversely, when the working fluid is discharged from the inside, Shrink.

  The balloon 6 is made of various polymer materials (particularly thermoplastic resin). In this case, the balloon 6 is preferably made of a material having flexibility as a whole.

  The constituent material of the balloon 6 is, for example, a polyester resin such as polyethylene terephthalate or polybutylene terephthalate or a polyester elastomer containing the same, an olefin resin such as polyethylene or polypropylene, or a material subjected to crosslinking treatment (particularly by electron beam irradiation). Cross-linked), polyamide resins such as nylon 11, nylon 12, nylon 610 or the like, polyamide elastomers containing the same, polyurethane resins, ethylene-vinyl acetate copolymers or those obtained by crosslinking these, silicone resins or these Examples thereof include materials such as polymer blends and polymer alloys containing at least one of them.

  Furthermore, you may comprise the balloon 6 with the laminated body which laminated | stacked the film | membrane which consists of these materials. In this case, for example, a laminate can be obtained by coextrusion molding of each layer, joining each layer by adhesion, fusion, or the like, or forming another layer by coating on one layer. . In addition, a soft resin layer, a hard resin layer, a lubrication material layer, an antithrombotic material layer, or the like may be provided outside or inside the layer made of the above material.

  Examples of the constituent material of the balloon 6 include antithrombotic materials such as heparin, prostaglandin, urokinase, and arginine derivatives, and X such as barium sulfate, barium carbonate, bismuth oxide, and tungsten that function as the aforementioned markers. A radiopaque material may be blended.

  Further, a lumen 22 is formed in the outer cylinder 2 as a flow path along which the working fluid for expanding and contracting the balloon 6 flows. The lumen 22 is formed over substantially the entire length of the outer cylinder 2. The distal end of the lumen 22 opens (opens) to the side of the distal end portion of the outer cylinder 2, that is, the outer peripheral surface of the outer cylinder 2 positioned inside the balloon 6, and the proximal end side communicates with the port 72 of the hub 7. doing. Thereby, the inside of the balloon 6 and the port 72 communicate with each other via the lumen 22.

  Further, for example, a syringe 400 filled with working fluid is connected to the port 72 as supply / discharge means for supplying / discharging the working fluid to / from the balloon 6.

  As the working fluid, a liquid whose volume does not change due to pressure fluctuation can be used and is preferably harmless to a living body. Among the liquids, a liquid having X-ray contrast properties is more preferable. For example, a liquid obtained by diluting an X-ray contrast agent such as an arterial contrast agent several times with physiological saline can be used. . In this case, the position of the balloon 6 can be confirmed under fluoroscopy.

  The dimensions (length, outer diameter, inner diameter, etc.) of the outer cylinder 2, the inner cylinder 3, and the pusher 4 are not particularly limited, and the use site of the pin driving device 1 (the type and site of an aneurysm blood vessel) ) And cases are determined as appropriate. Usually, the lengths of the outer cylinder 2, the inner cylinder 3 and the pusher 4 are each preferably about 50 to 150 cm, and more preferably about 80 to 120 cm. Moreover, it is preferable that the outer diameter of the outer cylinder 2 is about 2-6 mm, and it is more preferable that it is about 3-5 mm.

  The outer cylinder 2, the inner cylinder 3 and the pusher 4 each have desired flexibility, and examples of the constituent material thereof include polyolefin resin, polyamide resin, urethane resin, and polyimide resin. Various thermoplastic resins such as resins or thermosetting resins can be used. Specifically, for example, polyolefin such as polyethylene, polypropylene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer (EVA), polyvinyl chloride, polyethylene terephthalate (PET), polybutylene terephthalate (PBT), etc. Various thermoplastic elastomers such as polyester, polyurethane, polyamide, polyimide, polystyrene resin, fluorine resin, styrene, polyolefin, polyvinyl chloride, polyurethane, polyester, polyamide, polybutadiene, fluorine rubber, etc. It is done.

  Next, an example of a method for using (operating) the pin driving device 1 and the pin 5, that is, a procedure for fixing the graft 200 introduced in the vicinity of the aneurysm 320 of the blood vessel 300 to the blood vessel wall 310 with the pin 5. This will be described with reference to FIGS.

  As shown in FIG. 5A, the graft 200 is already introduced into a target site of the blood vessel 300 (in the vicinity of the aneurysm 320) using, for example, a tubular introduction sheath (not shown). And

  First, as shown in FIG. 2, a plurality (two in the illustrated configuration) of pins 5 are stored in the storage portion 33 of the inner cylinder 3 of the pin driving device 1.

  Next, the pinning device 1 is percutaneously introduced into the blood vessel 300 from the thigh or the like under fluoroscopy, and the distal end portion of the main body portion 10 is transferred to a portion where the aneurysm 320 of the blood vessel 300 is present. And the opening 21 is positioned in the site | part fixed with the pin 5 of the graft 200. FIG. This positioning can be performed using a marker provided around (periphery) the opening 21.

  Next, as shown to Fig.5 (a), a working fluid is supplied to the balloon 6 with a balloon dilator (syringe 400), and the balloon 6 is expanded. Thereby, the vicinity of the opening 21 of the outer cylinder 2 is pressed against the blood vessel wall 310 through the graft 200 and is brought into close contact therewith.

  Next, as shown in FIG. 6B, the pusher 4 is pushed in the distal direction (left side in FIG. 6) in a state where the outer cylinder 2 and the inner cylinder 3 of the pin driving device 1 are fixed to the blood vessel wall 310. (Move it) Thereby, the pin 5 is pushed by the pusher 4 in the distal direction and moves. Specifically, the proximal end side pin 5 is pushed and moved in the distal direction by the pusher 4, and the distal end side pin 5 is pushed and moved in the distal direction by the pin 5.

  At this time, since L2 <L1, as shown in FIG. 6B, until the proximal end portion 512 of the head 51 moves beyond the opening 21 to the front end side (left side in FIG. 6) beyond the opening 21. The tip portion 521 of the puncture portion 52 does not reach the position of the opening 21. Since L1 <L3, the tip portion 521 of the puncture portion 52 reaches the position of the opening 21 until the head portion 51 of the pin 5 contacts the contact portion 32 of the inner cylinder 3, and the puncture portion 52 Is restored to its original shape by a restoring force (elastic force). As a result, as shown in FIG. 6C, the distal end side of the puncture portion 52 protrudes from the opening 21, and the puncture portion 52 penetrates the graft 200 and the blood vessel wall 310 slightly.

  The pin 5 stops when its head 51 abuts against the abutting portion 32 of the inner cylinder 3, but since L3 <L4, the distal end portion 531 of the spine 53 is positioned at the positions of the openings 21 and 31. It does not reach and is located in the inner cylinder 3 (storage portion 33) on the base end side with respect to the openings 21 and 31.

  Next, as shown in FIG. 7D, the inner cylinder 3 is pulled (moved) in the proximal direction (right side in FIG. 7) in a state where the outer cylinder 2 is fixed to the blood vessel wall 310. Thereby, the pin 5 is pushed in the proximal direction by the inner cylinder 3 and moves. Specifically, the distal end side pin 5 is pushed and moved in the proximal direction by the inner cylinder 3, and the proximal side pin 5 is pushed and moved in the proximal direction by the pin 5.

  At this time, the puncture portion 52 of the pin 5 penetrates the graft 200 and the blood vessel wall 310, and when the proximal end portion 512 of the head 51 reaches the opening 21 as shown in FIG. Restore the original shape by restoring force. Thereby, the head 51 protrudes outside from the opening 21.

  In the present embodiment, as described above, since the length a of the head 51 and the length b of the puncture portion 52 are set to be substantially equal, the puncture portion 52 is substantially completely separated from the graft 200 and the blood vessel wall 310. , The proximal end portion 512 of the head 51 reaches the opening 21, the spine 53 is restored to its original shape, and the head 51 protrudes from the opening 21 to the outside.

  Therefore, the puncture portion 52 can be penetrated through the graft 200 and the blood vessel wall 310 by moving only the inner cylinder 3 without moving the outer cylinder 2. That is, after the vicinity of the opening 21 of the outer cylinder 2 is fixed to the blood vessel wall 310 through the graft 200, the graft 5 is moved by the pin 5 only by moving the pusher 4 and the inner cylinder 3 without moving the outer cylinder 2. 200 can be secured to the vessel wall 310.

  Moreover, since the head 51 is substantially linear, when the pin 5 is pushed in the proximal direction by the inner cylinder 3 and moved, the pin 5 can move stably, The head 51 can be prevented from protruding outside from the opening 21 before the puncture portion 52 penetrates the graft 200 and the blood vessel wall 310 almost completely.

  In addition, the shaft 520 of the puncture unit 52 is inclined with respect to the axis 510 of the head 51, whereby the puncture unit 52 is punctured so as to be inclined with respect to the blood vessel wall 310. By moving in the proximal direction, the puncture unit 52 can penetrate the graft 200 and the blood vessel wall 310 easily and smoothly.

  Thereby, the operation | work which fixes the graft 200 to the blood vessel wall 310 with the pin 5 can be performed easily, quickly and safely.

  Next, the working fluid is discharged from the balloon 6 by the balloon dilator (syringe 400), the balloon 6 is deflated, and then, as shown in FIG. The cylinder 2 and the inner cylinder 3 are pulled (moved) in the proximal direction (right side in FIG. 8). As a result, as shown in FIGS. 8G and 9H, the pin 5 is prevented from moving in the proximal direction by the pusher 4 and discharged from the opening 21 to the outside.

In this way, the graft 200 is fixed to the blood vessel wall 310 by the pin 5. The same applies to the case where the graft 200 is fixed to the blood vessel wall 310 with another pin 5.
When the above operation is completed, the pin driving device 1 is extracted from the blood vessel 300.

  As described above, according to this pin driving device 1, the puncture portion 52 of the pin 5 is placed in the blood vessel while the vicinity of the opening 21 of the outer tube 2 is pressed against the blood vessel wall 310 by the balloon 6 (in a close contact state). Since the operation of penetrating the wall 310 can be performed, the puncture portion 52 of the pin 5 can be easily and surely punctured into the blood vessel wall 310, and the pin 5 can be reliably placed (detained) at the target position. Can do.

  In particular, since the balloon 6 is installed on the opposite side of the opening 21, the vicinity of the opening 21 of the outer cylinder 2 can be reliably pressed against the blood vessel wall 310 with the opening 21 facing the blood vessel wall 310 side.

  Further, when the vicinity of the opening of the main body portion is separately pressed against the blood vessel wall using a catheter having a balloon, the balloon may be accidentally punctured with a pin. Since the balloon 6 is installed on the opposite side of 21, the balloon 6 is never punctured with the pin 5.

  Here, in the present invention, as shown in FIG. 10, the outer cylinder 2 is branched into two parts of a first part 24 and a second part 25 from the middle of the distal end side, and the inner cylinder 3 is placed in the first part 24. May be inserted, and the balloon 6 may be installed in the second portion 25.

  In the present invention, two lumens are provided concentrically, one of the lumens (for example, the outer side) is used as a flow path for the working fluid to flow, and the other (for example, the inner side) is inserted through the guide wire. It may be used as a passage.

  Moreover, in this invention, a pin is not limited to the thing of the structure mentioned above, A various pin can be used.

  For example, the puncture part 52 of the pin 5 may be curved or bent, and the pin 5 may have a plurality of puncture parts 52.

Further, the angle θ may be 90 °.
Further, the spine 53 of the pin 5 may be substantially linear. In this case, the spine 53 can be brought into contact with the graft 200 over substantially the entire length, whereby the graft 200 can be reliably adhered to the blood vessel wall 310.

Second Embodiment
FIG. 11 is a side view showing a second embodiment of the pin driving device according to the present invention. FIG. 11A shows a state in which the wire frame is contracted, and FIG. The expanded state of the wire frame is shown. In the following description, the left side in FIG. 11 is referred to as the “front end” and the right side as the “base end (rear end)”.

  Hereinafter, the second embodiment of the pin driving device of the present invention will be described. The description will focus on the differences from the first embodiment described above, and the description of the same matters will be omitted.

  As shown in FIG. 11, the pin driving device 1 according to the second embodiment has a plurality of linearly deformed (elastically deformed) linear bodies, that is, basket forceps (basket type), as expandable bodies that can be expanded and contracted. The wire frame 9 is provided. In the illustrated configuration, the wire frame 9 has three (a plurality of) wires 91 that bend and deform, and the distal ends of the wires 91 are bound (fixed) by the distal tip 92, and the proximal ends are connected to each other. Are bound by a proximal tip 93.

  Further, a lumen 26 is formed in the outer cylinder 2 along the longitudinal direction as an insertion passage through which an operation wire 94 described later is inserted. The lumen 26 is formed over substantially the entire length of the outer cylinder 2. The distal end of the lumen 26 opens (opens) forward (distal side) of the distal end portion of the outer cylinder 2, and the proximal end side communicates with a port 72 (see FIG. 1) of the hub 7.

  The pin driving device 1 is inserted into the lumen 26 and is inserted into the rod-like moving body 95 movably installed along the lumen 22 and an operation wire (wire) that operates the wire frame 9 through the lumen 26. 94). The distal end side of the moving body 95 protrudes from the distal end of the lumen 26 to the distal end side (outside).

  The distal end tip 92 of the wire frame 9 is fixed to the distal end portion of the moving body 95 and can move together with the moving body 95, and the proximal end tip 93 is located on the upper end in FIG. It is fixed to the site.

  The distal end portion of the operation wire 94 is fixed to the proximal end portion of the moving body 95, and the proximal end side of the operation wire 94 protrudes from the port 72 of the hub 7 to the proximal end side (outside).

  As shown in FIG. 11A, the wire frame 9 is contracted in a natural state (a state in which no external force is applied to the wire frame 9), and as shown in FIG. When pulled in the proximal direction, the distal tip 92 moves together with the moving body 95 toward the proximal side and expands. Then, as shown in FIG. 11A, when the pulling of the operation wire 94 in the proximal direction is stopped, the wire frame 9 is restored (contracted) to the original shape by the restoring force, and at this time, it moves. The body 95 moves to the distal end side by the restoring force of the wire frame 9.

According to this pin driving device 1, the same effects as those of the first embodiment described above can be obtained.
And in this pin driving device 1, since the blood flow is not inhibited while the wire frame 9 is expanded, the burden on the patient can be further reduced.

<Third Embodiment>
12 and 13 are cross-sectional views showing a third embodiment of the pin driving device of the present invention, and FIG. 14 is a cross-sectional view showing a state in which the graft is fixed to the blood vessel wall with the pins shown in FIG. . In the following description, the left side in FIGS. 12 and 13 is referred to as the “front end” and the right side is referred to as the “base end (rear end)”. Moreover, in FIG. 12 to FIG. 14, the graft and the blood vessel wall are schematically shown.

  Hereinafter, the third embodiment of the pin driving device of the present invention will be described, but the description will focus on the differences from the first embodiment described above, and description of similar matters will be omitted.

  As shown in FIG. 12, in the pin driving apparatus 1 according to the third embodiment, the main body 10 has a pressing member (second pressing element) 81 that presses the pin 5 as an inner member. The push member 81 is a member for mainly pushing the pin 5 in the proximal direction, and the pusher (first pusher) 4 is a member for mainly pushing the pin 5 in the distal direction. It is.

  Each of the pusher 4 and the push member 81 is installed in the outer cylinder 2 so as to be movable along the longitudinal direction of the outer cylinder 2 (the pusher 4).

  The pressing member 81 is regulated so as not to move (rotate) in the circumferential direction with respect to the outer cylinder 2, and is positioned on the distal end side of the opening 21 of the outer cylinder 2 in the initial state (assembled state) ( (See FIG. 12). The position of the pushing member 81 in this initial state is set as the initial position of the pushing member 81.

  On the other hand, the pusher 4 is located on the proximal end side with respect to the push member 81, and a portion between the push member 81 and the pusher 4 of the outer cylinder 2 constitutes a housing portion 28 in which the pin 5 is housed. doing.

  Further, the push member 81 has a contact portion 811 that can contact the head portion 51 of the pin 5 at the base end portion thereof, thereby moving the pin 5 in the base end direction with respect to the outer cylinder 2. It can be made to.

  The abutting portion 811 has an inclined surface 812 that is inclined with respect to the central axis 23 of the outer cylinder 2 (main body portion 10) so that the portion on the balloon 6 side is located on the proximal end side with respect to the portion on the opening 21 side. doing.

  In the outer cylinder 2, a coil spring (biasing member) is provided as an urging means for urging the pushing member 81 in the distal direction (means for returning the pushing member 81 moved in the proximal direction from the initial position to the initial position). 83 is installed. The distal end side of the coil spring 83 is fixed to the distal end wall of the outer cylinder 2, and the proximal end side is fixed to the distal end portion of the push member 81. In the initial state, the coil spring 83 is in a natural state (a state where no external force is applied to the coil spring 83).

  Further, the pin driving device 1 has an operation wire (wire) 82 for operating (moving operation) the push member 81, and the operation wire 82 is inserted into the outer cylinder 2 along the longitudinal direction thereof. A lumen 27 serving as an insertion passage is formed. The lumen 27 is formed over substantially the entire length of the outer cylinder 2. The distal end of the lumen 27 is opened (opened) to the inner peripheral surface (inside) of the distal end portion of the outer cylinder 2, and the proximal end side is installed (fixed) at the proximal end portion of the outer cylinder 2 (not shown) It communicates with a predetermined port of the branch hub.

  The distal end portion of the operation wire 82 is fixed to the proximal end portion of the push member 81, and the proximal end side protrudes from a predetermined port of the hub (not shown) to the proximal end side (outside).

  Further, as shown in FIG. 14, in the present embodiment, a pin 5 is used in which the spine portion 53 has a rod shape and is substantially linear. As a result, the spine 53 can contact the graft 200 over substantially the entire length, and thereby the graft 200 can be securely adhered to the blood vessel wall 310.

  The pin 5 is provided in the storage portion 28 so that an angle (angle) θ formed by the shaft 520 of the puncture portion 52 and the shaft 510 of the head portion 51 decreases (ie, decreases), that is, the puncture portion 52 and the spine portion. 53 in a state of being elastically deformed so as to approach 53, the head 51 side is the tip side, and the puncture portion 52 side is the lower side (opening 21 side) in FIG.

  Next, an example of a method for using (operating) the pin driving device 1 and the pin 5, that is, a procedure for fixing the graft 200 introduced in the vicinity of the aneurysm 320 of the blood vessel 300 to the blood vessel wall 310 with the pin 5. This will be described with reference to FIGS.

  The operation until the balloon 6 is expanded and the vicinity of the opening 21 of the outer tube 2 is pressed against the blood vessel wall 310 via the graft 200 is the same as that in the first embodiment. As shown, the pusher 4 is pushed (moved) in the distal direction (left side in FIG. 12) with the outer cylinder 2 of the pin driving device 1 fixed to the blood vessel wall 310. Thereby, the pin 5 is pushed and moved by the pusher 4 in the distal direction, the head 51 of the pin 5 comes into contact with the contact portion 811 of the push member 81, and the tip 521 of the puncture portion 52 is The position of the opening 21 is reached, and the puncture portion 52 is restored to its original shape by a restoring force (elastic force). As a result, the distal end side of the puncture part 52 protrudes from the opening 21 to the outside, and the puncture part 52 penetrates the graft 200 and the blood vessel wall 310 slightly.

  Next, as shown in FIG. 13, with the outer cylinder 2 fixed to the blood vessel wall 310, the operation wire 82 is pulled in the proximal direction (right side in FIG. 13) against the urging force of the coil spring 83. Thereby, the pushing member 81 moves in the proximal direction, and the pin 5 is pushed and moved in the proximal direction by the pushing member 81.

  At this time, the head 51 of the pin 5 moves to the opening 21 side along the inclined surface 812 of the contact portion 811, and the spine 53 is pushed toward the opening 21 by the contact portion 811 and elastically deformed, Thereby, the head 51 protrudes outside from the opening 21, while the puncture part 52 penetrates the graft 200 and the blood vessel wall 310.

  Next, the operation wire 82 is stopped from being pulled in the proximal direction. As a result, the pressing member 81 moves in the distal direction by the restoring force (biasing force) of the coil spring 83 and returns to the initial position.

  Subsequent operations are the same as in the first embodiment, that is, the outer tube 2 is pulled (moved) in the proximal direction (right side in FIG. 13) with the balloon 6 deflated and the pusher 4 fixed. ). As a result, the pin 5 is prevented from moving in the proximal direction by the pusher 4 and is released to the outside from the opening 21, and the graft 200 is fixed to the blood vessel wall 310 by the pin 5 as shown in FIG. 14. . Finally, the pin driving device 1 is extracted from the blood vessel 300.

According to this pin driving device 1, the same effects as those of the first embodiment described above can be obtained.
In this pin driving device 1, even when the pin 5 having the rod-like shape of the spine 53 is used as a straight line, the graft 200 is surely vascularized with the pin 5 without setting the shape and dimensions of each part strictly. It can be fixed to the wall 310.

  The pin driving device of the present invention has been described based on the illustrated embodiment. However, the present invention is not limited to this, and the configuration of each part is an arbitrary configuration having the same function. Can be replaced. In addition, any other component may be added to the present invention.

  Further, the present invention may be a combination of any two or more configurations (features) of the above embodiments.

  In addition, the pin driving device of the present invention is not limited to a device that fixes a graft to a blood vessel wall with a pin. In addition, for example, various placements such as a heart prosthetic valve (prosthetic heart valve), a stent graft, and a stent. It can be applied to a device for fixing an object to a living tissue with a pin at a site with blood flow in a living body, and to a device for fixing an indwelling object to a living tissue with a pin in the living body regardless of the presence or absence of blood flow. it can.

  Since the heart prosthetic valve is fixed at a location where the blood flow rate is high, it can be fixed securely by using the pin having the above-described configuration.

  For stent grafts, for example, when blood leaks from a part of the stent graft that is fixed to the blood vessel wall, the leakage of blood can be eliminated by fixing the leaking part with a pin. Can do.

  Further, each of the stent graft and the stent can be more reliably fixed by further fixing with a pin.

It is a side view which shows 1st Embodiment of the pin driving device of this invention. It is a figure which shows the pin driving device shown in FIG. It is a figure which shows embodiment of the pin which fixes a graft. FIG. 4 is a cross-sectional view showing a state in which a graft inserted and placed near a blood vessel aneurysm is fixed to a blood vessel wall with a pin shown in FIG. 3. It is sectional drawing for demonstrating an effect | action of the pin driving device shown in FIG. It is sectional drawing for demonstrating an effect | action of the pin driving device shown in FIG. It is sectional drawing for demonstrating an effect | action of the pin driving device shown in FIG. It is sectional drawing for demonstrating an effect | action of the pin driving device shown in FIG. It is sectional drawing for demonstrating an effect | action of the pin driving device shown in FIG. It is a side view which shows the other structural example of 1st Embodiment of the pin driving device of this invention. It is a side view which shows 2nd Embodiment of the pin driving device of this invention. It is sectional drawing which shows 3rd Embodiment of the pin driving device of this invention. It is sectional drawing which shows 3rd Embodiment of the pin driving device of this invention. It is sectional drawing which shows the state which fixed the graft to the blood vessel wall with the pin shown in FIG.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Pin driving device 10 Main body part 2 Outer cylinder 21 Opening 22, 26, 27 Lumen 23 Central axis 24 1st part 25 2nd part 28 Storage part 3 Inner cylinder 31 Opening 32 Contact part 33 Storage part 34 Gripping part 4 Push Child 41 Grasping part 5 Pin 51 Head 510 Shaft 511 Tip part 512 Base end part 52 Puncture part 520 Shaft 521 Tip part 53 Spine part 531 Tip part 6 Balloon 7 Hub 71, 72 Port 81 Push member 811 Contact part 812 Inclined surface 82 Operation wire 83 Coil spring 9 Wire frame 91 Wire 92 Tip tip 93 Base tip 94 Operation wire 95 Mobile body 200 Graft 300 Blood vessel 310 Blood vessel wall 320 Aneurysm 400 Syringe

Claims (17)

A pin driving device for puncturing a living tissue with a pin in a living body,
An elongate main body having an accommodating portion for accommodating the pin, and an opening through which the pin accommodated in the accommodating portion is discharged;
Pressing means for pressing the vicinity of the opening of the main body portion against a living tissue ,
The pin is for fixing an indwelling object to a biological tissue, and a rod-shaped head,
Extending from the head and projecting at least one stick-like puncture part into the living tissue together with the indwelling object;
A portion extending from the head and projecting, having a portion that comes into contact with the indwelling object, and a spine for closely attaching the indwelling object to a living tissue,
The axis of the puncture part is inclined with respect to the axis of the head, so that the angle θ formed by the axis of the puncture part and the axis of the head is less than 90 °,
The main body includes a casing in which the opening is formed;
An inner member that is movably installed in the casing and moves the pin in a proximal direction relative to the casing;
A pusher for moving the pin in the distal direction relative to the casing;
When the pin is moved in the distal direction with respect to the casing by the pusher and the puncture portion reaches the position of the opening, the distal end side of the puncture portion protrudes outside from the opening, and the pin is moved by the inner member. A pin driving apparatus configured to move in a proximal direction relative to the casing and to puncture the living tissue . The opening is formed on the side of the tip of the main body,
The pressing means has an expandable body that can be expanded and contracted, and the expanded body is decentered in the direction opposite to the opening with respect to the central axis of the main body portion, thereby expanding the vicinity of the opening of the main body portion. The pin driving device according to claim 1, wherein the pin driving device is configured to press against a living tissue.   The pin driving apparatus according to claim 1, wherein the expansion body is configured by a balloon.   The pin driving device according to claim 3, wherein a flow path through which a working fluid for expanding and contracting the balloon flows is formed along the main body.   3. The pin driving device according to claim 1, wherein the expansion body includes a plurality of linear bodies that are curved and deformed. 4.   The pin driving device according to claim 5, wherein an insertion passage through which a wire for operating the plurality of linear bodies is inserted is formed along the main body portion. The pin has elasticity, is elastically deformed so that the axis of the head, the axis of the puncture portion, and the axis of the spine portion are substantially parallel or substantially coincident with each other, and The pin driving device according to any one of claims 1 to 6, wherein the pin driving device is stored in the storage portion such that a head side is a tip side. When the pin is moved in the distal direction with respect to the inner member by the pusher and the puncture portion reaches the position of the opening, the puncture portion is restored and the distal end side of the puncture portion is moved outward from the opening. The pin driving device according to claim 7 , wherein the pin driving device is configured to protrude. The inner member is at its distal end, the pin hammering device according to any one of 請 Motomeko 1 to 8 that having a contact portion that may contact with the head of the pin. When the length from the head to the puncture part of the pin in the state of being stored in the storage part is L1, and the length from the contact part of the inner member to the base end of the opening is L3, The pin driving apparatus according to claim 9 , wherein the L3 is longer than the L1. When the length from the abutting portion of the inner member to the base end of the opening is L3, and the length of the pin in a state of being accommodated in the accommodating portion is L4, the L4 is longer than the L3. The pin driving device according to claim 9 or 10 . When the length from the head of the pin in the storage portion to the puncture portion is L1, and the length of the opening in the longitudinal direction of the casing is L2, the L1 is greater than the L2. pin hammering device according to any of even longer claims 9 to 11. The pin has elasticity, and is housed in the housing portion in a state in which the puncture portion and the spine portion are elastically deformed so that the piercing portion and the spine portion are close to each other, and the head side is a distal end side. Item 7. The pin driving device according to any one of Items 1 to 6 . When the pin is moved in the distal direction with respect to the casing by the pusher and the puncture portion reaches the position of the opening, the puncture portion is restored, and the distal end side of the puncture portion protrudes outside from the opening. 14. A pinning device according to claim 13 , configured to: The pin driving device according to claim 13 or 14 , wherein the inner member includes a contact portion having an inclined surface capable of contacting the head of the pin at a base end portion thereof. Pin hammering device according to any one of claims 13 to 15 having a biasing means for biasing the inner member in the distal direction. The pin driving device according to any one of claims 1 to 16 , further comprising a marker indicating a position of the opening in a living body.

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