JP5379631B2 - Clip forceps - Google Patents

Description

  The present invention relates to a clip forceps for operating a medical clip to pinch a cerebral aneurysm or the like.

  For example, to treat a cerebral aneurysm, after making a hole in the head and reaching the cerebral aneurysm with various treatment tools, grasp the cerebral aneurysm clip with the clip forceps, approach the affected area, and release the clip. This is done by inserting a cerebral aneurysm.

  However, since conventional clip forceps hold the clip in a stationary state, the tip of the forceps depends on the position, posture, etc. of the cerebral aneurysm to approach the intricately affected area in the brain. The surgeon must change the direction of the clip held by the finger with the finger or replace the clip with another type, and the forceps must be inserted into and removed from the brain each time. Therefore, the work of attaching the clip to the affected part becomes complicated, and there are problems that a plurality of types of clips and forceps must be prepared.

  As a clip forceps capable of solving such a problem, one that can easily approach the affected area in the brain by swinging the clip by hand operation while holding the clip has been proposed (for example, , See Patent Document 1).

  However, the clip forceps described in Patent Document 1 have a problem that it is difficult to grip the clip, and that it is troublesome to swing the clip.

  As a clip forceps that can solve this problem, a pair of holding pieces each formed with a groove into which a handle portion of the clip is fitted is rotatably attached to the clip holding portion via a fulcrum pin. (For example, see Patent Document 2).

JP 2005-177053 A JP 2006-304968 A

  The clip forceps described in Patent Literature 2 is provided with a swing operation means for swinging the clip by integrally rotating the pair of holding pieces by operating the hand having the handle portion. Although it can be gripped firmly by biting into the groove of the piece, the link of the link device that constitutes the swing operation means moves over a wide range, so the link contacts the brain when rotating the clip within the skull there's a possibility that.

  Therefore, an object of this invention is to provide the clip forceps which can eliminate the said malfunction.

  In order to solve the above-mentioned problem, the invention according to claim 1 is a clip gripping portion and a clip in which the front and rear of the pair of lever members (1a, 1b) that intersect with each other with the pivot (6) as a fulcrum sandwich the clip (4). A pair of holding pieces (10a, 10b) each having a groove (11) into which a handle portion (4a) of the clip (4) is fitted are provided as fulcrum pins on the clip holding portion. (12) is pivotably attached, and the swinging operation of swinging the clip (4) by pivoting the pair of holding pieces (10a, 10b) together by the operation of the hand having the handle portion. In the clip forceps provided with the means, the swing operation means includes a pair of triggers (13) attached to the handle and a pair of front ends fixed to the pair of holding pieces (10a, 10b). A swing lever (18a, 18b) and a pair of lift levers (26a, 18b) that have front ends connected to the rear ends of the swing levers (18a, 18b) and can enter and exit from the crotch of the clip gripping portion. 26b), a pair of opening / closing levers (19a, 19b) whose front ends are connected to the rear ends of the elevating levers (26a, 26b), and the rear ends of the pair of opening / closing levers (19a, 19b) A connecting rod (17) connected to (13), and pulling the trigger (13) causes the connecting rod (17) and the pair of opening / closing levers (19a, 19b) to move to the lever member (1a, 1b), the slide motion is converted into a swing motion around the crotch of the clip gripping portion of the pair of lift levers (26a, 26b). The pair of swing levers (18a, 18b) and the pair of holding pieces (10a, 10b) are converted into a rotational motion with the fulcrum pin (12) as a fulcrum, and the clip (4 ) Adopt clip forceps for swinging motion.

  Further, as described in claim 2, in the clip forceps according to claim 1, the connecting rod (17) is slid to one of the pair of lever members (1a, 1b) by the guide body (28). The pair of elevating levers (26a, 26b) are constrained so as to be movable, and the connecting rod (17) and the swing lever (18a, 18b) are bent along the crotch of the clip gripping portion. It can be concatenated.

  Further, as described in claim 3, in the clip forceps according to claim 1 or 2, the pair of swing levers (18a, 18b) is stopped at a predetermined position on the clip gripping portion. The stopper (27) to be made can be provided.

  According to the present invention, the front and rear of the pair of lever members (1a, 1b) intersecting with the pivot (6) as a fulcrum respectively hold the clip (4), and the handle part for opening and closing the clip holding part. The pair of holding pieces (10a, 10b) each having a groove (11) into which the handle (4a) of the clip (4) is fitted are rotatable to the clip gripping part via a fulcrum pin (12). In a clip forceps provided with a swinging operation means for swinging the clip (4) by rotating the pair of holding pieces (10a, 10b) integrally by operating the hand having the handle portion. The swing operation means includes a trigger (13) attached to the handle and a pair of swing levers (18a, 18) whose front ends are fixed to the pair of holding pieces (10a, 10b), respectively. ) And a pair of elevating levers (26a, 26b) that can be moved into and out of the crotch of the clip gripping portion and the elevating levers (26a, 26b). 26a, 26b) a pair of opening / closing levers (19a, 19b) whose front ends are connected to the rear ends, and connecting rods connecting the rear ends of the pair of opening / closing levers (19a, 19b) to the trigger (13). (17), when the trigger (13) is pulled, the connecting rod (17) and the pair of opening / closing levers (19a, 19b) slide in the longitudinal direction of the lever member (1a, 1b). This sliding motion is converted into a swinging motion around the crotch of the clip gripping portion of the pair of lift levers (26a, 26b), and this swinging motion is converted into the pair of swing levers (18 , 18b) and the pair of holding pieces (10a, 10b) are converted into a pivoting motion using the fulcrum pin (12) as a fulcrum, and the pivoting motion causes the clip (4) to swing. Therefore, the elevating levers (26a, 26b) can be firmly gripped by biting the clip (4) into the grooves (11) of the holding pieces (10a, 10b) as well as the lever member (1a). , 1b) by swinging in the crotch of the clip gripping part ahead of the pivot (6), the sliding motion of the connecting rod (17) is converted into the rotational motion of the swing lever (18a, 18b). Therefore, it is possible to prevent the swing levers (18a, 18b) from greatly protruding outside the crotch of the clip gripping portion of the lever member (1a, 1b). Therefore, the risk of damaging the brain when the forceps (1) is taken in and out of the brain is significantly reduced.

It is a top view which shows the forceps for clip concerning this invention, (A) shows a releasing state, (B) shows a pressing state, respectively. It is a front view of the forceps for clip. It is an enlarged top view of the clip holding part of the forceps for clip, (A) shows before clip press, (B) shows after clip press. It is a partial notch longitudinal cross-sectional view of the clip forceps, (A) shows before swinging, (B) shows after swinging. It is an expanded longitudinal cross-sectional view of the clip holding part of the forceps for clip. It is a perspective view which shows the clip release state of the clip holding part of clip forceps, (A) shows before swinging, (B) shows after swinging. It is a perspective view which shows the clip press state of the clip holding part of clip forceps, (A) shows before swinging, (B) shows after swinging. (A) is explanatory drawing which inserts a clip in a head with the forceps for clip, (B) is explanatory drawing which shows the state which mounted | wore the cerebral aneurysm.

  The best mode for carrying out the invention will be described below with reference to the drawings.

  As shown in FIG. 8A, the clip forceps 1 is an instrument for inserting the clip 4 into the skull through the hole 3 formed in the head 2 and transporting the clip 4 to the affected part such as the cerebral aneurysm 5. .

  As illustrated in FIGS. 3A, 3B, 5 and 8A, 8B, the clip 4 has a handle portion 4a and a sandwiching portion 4b. The handle portion 4a has a spring 4c. It is formed integrally.

  As shown in FIG. 3 (A), the clip 4 closes the pinching portion 4b by the biasing force of the spring 4c in the released state, but when the handle portion 4a is pressed as shown in FIG. 3 (B), the pinching portion 4b. Is supposed to open.

  The clip 4 used in this embodiment is a small and lightweight clip for sandwiching the cerebral aneurysm 5, and is made of a material having high biocompatibility, such as a titanium alloy or a cobalt base alloy.

  Various types of clips other than those shown in the drawings are prepared, but each clip is provided with a handle portion 4a that can be held by the clip forceps 1.

  As shown in FIGS. 1A, 1B, and 2, the clip forceps 1 has two lever members 1a and 1b intersecting each other like a saddle in the middle and rotated by a longitudinal pivot 6 at the intersection. The structure is freely connected. The two lever members 1a and 1b connected to each other have a clip gripping portion having the clip 4 sandwiched between the pivots 6 and a rear portion serving as a handle portion for opening and closing the clip gripping portion.

  The space between the facing portions of the lever members 1a and 1b in the clip gripping portion can be expanded at an angle that allows the handle 4a of the clip 4 to be inserted.

  The curved leaf springs 8a and 8b are fixed to the lever members 1a and 1b in the handle portion, respectively. Both leaf springs 8a and 8b extend rearward of the lever members 1a and 1b, and their rear ends are connected to each other. Due to the spring action of both leaf springs 8a and 8b, both lever members 1a and 1b are always urged in the expanding direction, so that as shown in FIG. Keep open. When a grip force is applied to the handle portion, the clip gripping portion is closed as shown in FIG. At this time, as shown in FIG. 3 (A), when the handle 4a of the clip 4 is inserted into the clip holding portion, the clip holding portion removes the handle 4a of the clip 4 as shown in FIG. 3 (B). Since it presses, the clip part 4b of the clip 4 expands.

  As shown in FIG. 1 (A), a locking tool is provided inside the lever members 1a and 1b in the handle portion. The locking tool includes hook-shaped locking pieces 9a and 9b protruding from the lever members 1a and 1b. When gripping force is applied to the handle portion to close the clip gripping portion as shown in FIG. 1B, the clip gripping portion is kept closed when the engaging pieces 9a and 9b are engaged with each other. Accordingly, after inserting the handle 4a of the clip 4 into the clip gripping portion as shown in FIG. 3 (A), the handle portion is gripped and the locking pieces 9a and 9b of the locking tool are engaged with each other as shown in FIG. 1 (B). Even when the gripping force is released from the handle portion, the clip 4 is held by the forceps 1 with the clip portion 4b open as shown in FIG.

  As shown in FIGS. 3 (A), (B), 4 (A) (B), 5, 6, 6 (A), (B), and 7 (A), (B), the clip of the clip forceps 1 The grip portion is provided with a groove 11 into which the handle portion 4a of the clip 4 is fitted in order to grip the clip 4 firmly. Specifically, the pair of holding pieces 10a and 10b are rotatably attached to the clip gripping part via the fulcrum pin 12, and the grooves 11 into which the handle 4a of the clip 4 is fitted are formed in the pair of holding pieces 10a and 10b, respectively. It is formed. The fulcrum pin 12 extends in the opening / closing direction of the clip gripping portion.

  The clip forceps 1 is provided with a swing operation means for swinging the clip 4 with respect to the clip gripping portion by rotating the pair of holding pieces 10a and 10b integrally by operating the hand having the handle portion. It is done.

  As shown in FIGS. 1 to 5, the swinging operation means includes the fulcrum pin 12, the operation part attached to the handle part, and the movement of the operation part with the holding pieces 10a and 10b as the center and the fulcrum pin 12 as the center. And a transmission device for transmitting the clip 4 in the vertical direction on the clip gripping portion via the holding pieces 10a and 10b.

  As shown in FIGS. 2, 4 (A), (B) and FIG. 5, the operating portion is formed as a trigger 13, and one of the two lever members 1 a and 1 b which is a handle portion is one of the lever members 1 b. It is attached to the inner surface via a cylinder 22 and a bracket 14 which will be described later. The bracket 14 is fixed to the cylindrical body 22 by welding or the like, and the cylindrical body 22 is fixed to the lever member 1b with another bracket 15. The trigger 13 is supported by the bracket 14 via a support pin 16 so as to be rotatable in the front-rear direction of the clip forceps 1. The upper end of the trigger 13 is coupled to a connecting rod 17 of a transmission device described later by a pin or the like.

  As shown in FIGS. 1 (A), 1 (B) to 7 (A), (B), the transmission device includes a pair of swing levers 18a, 18b each having a front end fixed to each of the pair of holding pieces 10a, 10b. A pair of lifting levers 26a, 26b whose front ends are pin-coupled to the rear ends of the swing levers 18a, 18b, and a pair of opening / closing levers whose front ends are pin-coupled to the rear ends of the lifting levers 26a, 26b, respectively. 19a, 19b, and a connecting rod 17 having a front end pin-coupled to the rear ends of the pair of opening / closing levers 19a, 19b and a rear end connected to the trigger 13.

  The pair of swing levers 18a and 18b integrally has the holding pieces 10a and 10b at their front ends, as shown in FIGS. 3 (A) (B) to 7 (A) (B), These holding pieces 10a and 10b are connected to the inner side at the distal ends of the lever members 1a and 1b via the fulcrum pins 12. As a result, the pair of swing levers 18a and 18b can rotate in the vertical direction of the clip forceps 1 within the crotch of the clip gripping portion with the fulcrum pin 12 as a fulcrum.

  On the opposing surfaces of the pair of holding pieces 10a and 10b, as shown in FIGS. 3A and 3B to FIGS. 7A and 7B, the grooves 11 are formed to extend in the same direction. By fitting the handle 4a of the clip 4 into the groove 11, the clip 4 is firmly held between the pair of holding pieces 10a and 10b.

  Further, a stopper 27 made of a protrusion for restricting the rotation range of the swing levers 18a and 18b is provided at the tip of the lever members 1a and 1b. The stopper 27 enables the swing levers 18a and 18b in FIG. 5 to rotate from the inside of the clip gripping portion to the lower side of the lever members 1a and 1b, and the clip 4 extends along the lever members 1a and 1b. It becomes possible to rotate upward from a position parallel to the direction.

  The pair of elevating levers 26a and 26b is coupled to the rear ends of the swing levers 18a and 18b by connecting pins 20 as shown in FIGS. 3 (A), 3 (B) to 7 (A) and 7 (B). Is done. The elevating levers 26a and 26b are curved links. Since the connecting pin 20 extends substantially in the left-right direction of the clip forceps 1, that is, in the opening / closing direction of the clip gripping portion, as shown in FIGS. 5 to 7A and 7B, the lift levers 26 a and 26 b It extends so as to draw an arc from the rear ends of the swing levers 18a, 18b on the inner side of the crotch to the upper surface of the lever member 1b.

  The pair of opening / closing levers 19a, 19b has a connecting pin 24 at their rear ends at the rear ends of the lift levers 26a, 26b, as shown in FIGS. 3 (A), 3 (B) to 7 (A), (B). Connected through. The connecting pin 24 extends substantially in the left-right direction of the clip forceps 1, that is, in the opening / closing direction of the clip holding portion. The rear ends of the pair of opening / closing levers 19 a and 19 b are connected to the front end of the connecting rod 17 by a shaft pin 21 extending in the vertical direction of the clip forceps 1. As a result, as shown in FIGS. 3A and 3B and FIGS. 6A and 6B, the opening and closing levers 19a and 19b are moved to the swing levers 18a and 18b in accordance with the opening and closing operation of the lever members 1a and 1b. At the same time, it can be opened and closed.

  As shown in FIGS. 1 and 2, the connecting rod 17 extends in the front-rear direction of the clip forceps 1 along the lever member 1b, and its front end is shown in FIGS. 3 (A), 3 (B), 4 (A) ( B), as shown in FIGS. 6A and 6B and FIGS. 7A and 7B, the shaft pins 21 are connected to the rear ends of the pair of opening / closing levers 19a and 19b. In addition, as shown in FIGS. 3A, 3B, 4A, 4B, 6A, 7B, and 7A, 7B, the connecting rod 17 is partially opened and closed. It is held by a ring-shaped guide body 28 fixed to the lever 19b. As a result, the connecting rod 17 can reciprocate in the longitudinal direction of the clip forceps on the lever member 1b. The rear part of the connecting rod 17 extends to the trigger 13 and is connected to the upper end of the trigger 13 by a pin 29 parallel to the support pin 16. Thus, when the trigger 13 is pulled to the rear side of the clip forceps 1, as shown in FIGS. 4B, 6B, and 7B, the connecting rod 17 is pushed forward to open and close. The pair of swing levers 18a and 18b rotate downward about the fulcrum pin 12 through the levers 19a and 19b and the lift levers 26a and 26b. As a result, as shown in FIG. 5, the clip 4 sandwiched between the holding pieces 10 a and 10 b tilts by swinging upward from the broken line position to the two-dot chain line position.

  As shown in FIGS. 4A and 4B, the connecting rod 17 extends further rearward from the position of the trigger 13 and enters the cylindrical body 22 fixed to the lever member 1b. A stopper portion 23 is inserted into the cylindrical body 22, and the rear end of the connecting rod 17 is screwed into the stopper portion 23. A male screw 30 is screwed to the rear end of the cylindrical body 22, and a tool insertion hole is provided at the center of the male screw 30. By inserting a tool (not shown) from the tool insertion hole, the stopper portion 23 can be turned, the stopper portion 23 can be screwed back and forth on the connecting rod 17, and the stroke of the connecting rod 17 can be adjusted.

  A compression coil spring (not shown), which is an elastic member, is inserted into the cylindrical body 22, and the connecting rod 17 is constantly urged to the rear side of the clip forceps 1 by the elasticity of the compression coil spring to release the trigger 13. In the state, it is held at the position shown in FIG. Further, the transmission system from the trigger 13 to the holding pieces 10a and 10b is also held in a constant posture.

  In addition, as shown in FIG.1 and FIG.2, the finger rest 25 is attached to the handle part in lever member 1a, 1b of the forceps for clip as needed.

  Next, the operation of the clip forceps having the above configuration will be described.

  As shown in FIG. 8A, for example, an operation in which the clip 4 is attached to the cerebral aneurysm 5 will be described. The operator forms a hole 3 in the head 2 of the patient.

  Further, the surgeon attaches the cerebral aneurysm clip 4 to the clip gripping portion of the clip forceps 1.

  The operator inserts the handle 4a of the clip 4 into the clip gripping portion of the clip forceps 1 in the state shown in FIGS. 1 (A) and 6 (A) as shown in FIG. Hold and press. As a result, the clip gripping portion is closed as shown in FIG. 7A, and the holding pieces 10a and 10b of the clip gripping portion press the handle portion 4a of the clip 4 as shown in FIG. Expand. The handle 4a of the clip 4 is fitted into the groove 11 of the holding pieces 10a and 10b, and is firmly held by the clip holding part.

  Further, by engaging the engaging pieces 9a and 9b of the locking tool as shown in FIG. 1 (B), the clip gripping portion is shown in FIG. 3 (B) even if the operator releases the pressing force from the handle portion. The clip 4 shown is held in an expanded state.

  Next, the operator inserts the forceps 1 into the brain through the hole 3 of the head 2 as shown in FIG. 8A, and brings the clip 4 close to the cerebral aneurysm 5. And the trigger 13 is pulled back like FIG.4 (B) with the finger | toe of the hand which grasps the handle part of the forceps 1. FIG. As shown in FIG. 7B, the holding pieces 10a and 10b are inclined according to the pulling amount of the trigger 13, so that the clip 4 swings the neck at a desired angle as shown in FIG. 5 at the tip of the clip forceps 1. Tilt. As a result, the surgeon changes the orientation of the clip 4 according to the position, posture, etc. of the cerebral aneurysm 5 and introduces the cerebral aneurysm 5 into the pinched portion 4 b of the clip 4.

  In this case, as is apparent from FIGS. 4A, 4B, 5, 6A, 7B, and 7A, 7B, the connecting rod 17 is a lever member by the restriction of the guide body 28. The lift levers 26a and 26b swing in the crotch at the clip gripping part ahead of the pivot 6 of the lever members 1a and 1b, and the sliding movement of the connecting rod 17 is swung. Since the levers 18a and 18b are converted into rotational movements, the swing levers 18a and 18b do not protrude greatly below the lever members 1a and 1b. Therefore, the risk of damaging the brain when the forceps 1 is taken in and out of the brain is significantly reduced.

  Therefore, when the operator firmly grasps the handle portion of the forceps 1 to release the engagement of the locking pieces 9a and 9b and loosens the force applied to the handle portion, the forceps 1 is restored by the restoring action of the leaf springs 8a and 8b. As shown in FIGS. 3A and 6B, the clip 4 closes its pinch portion 4b and clips and closes the cerebral aneurysm 5 as shown in FIG. 8B.

  Thereafter, the forceps 1 is removed from the hole 3 of the head 2 by the operator, and the clipping procedure is completed.

  If the type and position of the clip 4 is inappropriate and needs to be replaced, removed, etc., the clip forceps are again released as shown in FIG. 1 and inserted into the brain through the hole 3 in the head 2, The holding part 10a, 10b is set in a desired direction by pulling the trigger 13, and the handle part of the clip forceps 1 is grasped and pressed. In this case, since the grooves 11 of the pair of holding pieces 10a and 10b are kept in the same direction, both sides of the handle portion 4a of the clip 4 are accurately fitted in both the grooves 11 and firmly held. As a result, the clip 4b of the clip 4 is expanded as shown in FIG. 3B, and the clip 4 can be separated from the cerebral aneurysm 5.

  Thereafter, a new clip is attached to the clip forceps by the same operation as described above, and inserted again into the brain, and the cerebral aneurysm 5 is clipped and closed.

  In addition, this invention is not limited to the said embodiment, For example, although the said embodiment demonstrated the treatment of a patient's head, it is applicable also to the treatment of another site | part.

1a, 1b ... lever member 4 ... clip 4a ... handle 6 ... pivot 10a, 10b ... holding piece 11 ... groove 12 ... fulcrum pin 13 ... trigger 17 ... connecting rod 18a, 18b ... swing lever 19a, 19b ... for opening and closing Lever 26a, 26b ... Elevating lever

Claims (3)

  A pair of lever members that intersect with each other with the pivot as a fulcrum are a clip gripping part that holds the clip and a handle part that opens and closes the clip gripping part, and a pair of grooves in which the handle part of the clip is fitted are formed. A swinging operation means that a holding piece is rotatably attached to the clip gripping part via a fulcrum pin, and the pair of holding pieces are rotated together by operating the hand having the handle part to swing the clip. In the clip forceps, the swing operation means includes a trigger attached to the handle, a pair of swing levers whose front ends are fixed to the pair of holding pieces, and the swing A front end is connected to the rear end of the lever, a pair of elevating levers that can enter and exit the crotch of the clip gripping part, and a front end connected to the rear end of the elevating lever. A pair of opening / closing levers and a connecting rod for connecting rear ends of the pair of opening / closing levers to the trigger, and when the trigger is pulled, the connecting rod and the pair of opening / closing levers are the lever member. The sliding motion is converted into a swinging motion around the crotch of the clip gripping portion of the pair of lifting levers, and this swinging motion is converted into the pair of swing levers and the pair of swinging levers. A clip forceps, wherein the clip is converted into a rotational motion using the fulcrum pin of the holding piece as a fulcrum, and the swing motion of the clip is caused by the rotational motion.   2. The clip forceps according to claim 1, wherein the connecting rod is restrained by a guide body so as to be slidable to one of the pair of lever members, and the pair of lift levers is curved along the crotch of the clip gripping portion. A clip forceps which is connected to the connecting rod and the swing lever in a state of being attached.   The clip forceps according to claim 1 or 2, wherein a stopper for stopping the pair of swing levers at a predetermined position is provided in the clip gripping portion.

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