JP7325074B2 - Surgical retractor blades and surgical retractors - Google Patents

Description

The present invention relates to a surgical retractor blade and a surgical retractor including the surgical retractor blade.

Conventionally, in spinal surgery, surgical exposure has been performed according to the size of the surgical site so that the surgeon can perform the surgery while securing the surgical field (area that can be visually recognized during surgery). Surgical exposure usually begins with an incision in the skin and subcutaneous tissue of appropriate length and depth. A surgical instrument called a retractor is then inserted through the incision to hold the surgical site open and secure the surgical field by pushing the skin, subcutaneous tissue, and other soft tissues out of the surgical field. used for As a result, it is possible to access a desired surgical site, visually confirm the surgical site, and perform a necessary surgical procedure.

Since conventional surgical exposure according to the size of the surgical site is highly invasive, in recent years, minimally invasive surgery has been performed using smaller retractors and smaller incisions. there is Examples of such a retractor include a retractor having a plurality of annularly arranged blades (Patent Documents 1, 2, and 3) and a retractor having a pair of blades spaced apart from each other (Patent Document 4). )It has been known. Minimally invasive surgery using a small retractor results in smaller wounds and less damage to soft tissues such as muscles than conventional surgical exposure according to the size of the surgical site. It has many advantages such as less blood loss, less risk of infection, less postoperative wound pain, shorter patient hospital stay, and expanded application to the elderly and high-risk patients.

Special table 2007-514501 U.S. Patent Application Publication No. 2008/0015417 special table 2013-509982 special table 2013-524861

However, when conventional retractors such as those disclosed in Patent Documents 1 to 4 are used, the range of the operative field is limited by the motion area of the blade, so the operative length is long in the craniocaudal direction of the spine (also called the longitudinal direction of the spine). There is a problem that it is not possible to take a field when it is desired. As a specific example, in the spine model S of FIGS. 16 (A) and (B), the portion W circled by the solid line is the incision (wound), and the two curves B are as described in Patent Document 4. The dotted circled area OF is the operative field, where the pair of blades of the retractor are placed. In this case, the cross-sectional area of the operative field OF is approximately the same as or smaller than the area defined by the wound W and the area defined between the pair of installed blades.

Further, in the case of a retractor having a plurality of annularly arranged blades such as those disclosed in Patent Documents 1, 2, and 3, if the spinous process, which is bone tissue in the midline (central) portion of the spine, is not excised, the midline The left and right operative fields cannot be expanded at the same time. Therefore, normally, as shown in FIGS. 17(A) and 17(B), the blade must be inserted obliquely to the spine and placed at an angle to either the left or right side of the spine. The range in which field OF is deployed is limited. As a result, the range and angle that can be visually recognized by the operator are limited, and a highly difficult surgical technique is required in a narrow surgical field, which impairs the convenience and safety of various surgeries.

Furthermore, when a small retractor such as those disclosed in Patent Documents 1 to 4 is used, since the surgical field is narrow, conventional appropriate surgical instruments cannot be used, and the types and number of surgical procedures that can be performed are limited. . As a result, it becomes difficult to perform a highly difficult operation requiring complicated procedures, a multi-vertebral operation in which the operative field extends in the craniocaudal direction of the spine, and an operation to place implants using many surgical instruments. In addition, in surgery using a small retractor, there is also the problem that the surgical site becomes dark and the visibility of the surgical field deteriorates.

The problem to be solved by the present invention is to provide a surgical retractor blade that is less invasive and can secure a wider surgical field, and a surgical retractor that includes the surgical retractor blade. be.

In order to achieve the above object, the present inventors have found that after inserting a blade for a surgical retractor into an incision, the blade is widened along the craniocaudal direction of the spine to reduce the size of the incision. However, the inventors have found that a wider operative field can be secured, and have completed the present invention.

That is, the present invention includes the subject matter described in the following sections.

Section 1. A surgical retractor blade comprising a support having an elongated body and at least one movable member journalled on the support.

Section 2. 3. A surgical retractor blade according to clause 1, wherein the movable member comprises two movable members that can be moved toward and away from each other.

Item 3. 3. The surgical retractor blade according to paragraph 1 or 2, further comprising closing means capable of locking the movable member in the closest closed position.

Section 4. Item 4. The surgical retractor blade according to any one of Items 1 to 3, further comprising position fixing means capable of fixing the position of the movable member.

Item 5. The movable member has a proximal end portion which is the end portion on the side closer to the point where the movable member is pivotally supported by the support, a distal end portion located on the side opposite to the proximal end portion, and a portion between the proximal end portion and the distal end portion. Item 5. The surgical retractor blade according to any one of items 1 to 4, further comprising a flat intermediate portion, the surface of the intermediate portion extending substantially parallel to the surface of the body portion.

Item 6. the support includes a top portion connected to a proximal end of a body portion of the support and extending at an angle to the body portion;
Item 6. The surgical retractor blade according to any one of Items 1 to 5, wherein at least one of the body portion and the top portion or the movable member is attached with a lighting device.

Item 7. A surgical retractor comprising the surgical retractor blade according to any one of items 1 to 6 and an arm supporting the surgical retractor blade.

The surgical retractor blade and surgical retractor of the present invention enable less invasive surgery with a wider surgical field.

1 is a schematic perspective view of an example surgical retractor; FIG. 1 is a schematic front view of a surgical retractor blade according to a first embodiment of the present invention in a closed position; FIG. 1 is a schematic front view of a surgical retractor blade according to a first embodiment of the present invention in an open position; FIG. 4 is a schematic rear view of the underside of the surgical retractor blade of FIG. 3; FIG. 3 is a schematic side view of the surgical retractor blade of FIG. 2; FIG. (A) Partially enlarged schematic cross-sectional view taken along line 6-6 of FIG. 2 showing a position fixing means for a surgical retractor blade. (A) A schematic front view for explaining the relationship between an incision, a blade, and an operative field when the retractor blade of the first embodiment of the present invention is used. (B) Schematic side view. S: spine model, W: incision (wound), B1, B2: blade position, OF: surgical field. FIG. 4 is a schematic front view of a surgical retractor blade according to a second embodiment of the present invention in a closed position; 9 is a schematic side view of the surgical retractor blade of FIG. 8 in an open position; FIG. 9 is a schematic side view of the surgical retractor blade of FIG. 8; FIG. 9 is a schematic end view of the surgical retractor blade of FIG. 8; FIG. (A) Schematic front view showing an alternative surgical retractor blade in a closed position. (B) Schematic front view of the surgical retractor blade of FIG. 12 (A) in an open position. (A) Schematic front view showing an alternative surgical retractor blade in a closed position. (B) Schematic front view of the surgical retractor blade of FIG. 13 (A) in an open position. (C) A schematic cross-sectional view of the surgical retractor blade of FIG. 13(A). (A) and (B) are partially enlarged schematic cross-sectional views showing another example of position fixing means for a surgical retractor blade. FIG. 11 is a schematic rear view of another exemplary surgical retractor blade; (A) Schematic front view explaining the relationship between an incision, a blade, and an operative field when a conventional retractor is used. (B) Schematic side view. S: spine model, W: incision (wound), B: blade position, OF: surgical field. (A) A schematic end view illustrating the relationship between the incision, blade, and surgical field when another conventional retractor is used. (B) Schematic side view. S: spine model, W: incision (wound), B: blade position, OF: surgical field.

BEST MODE FOR CARRYING OUT THE INVENTION Hereinafter, embodiments of the present invention will be described with reference to the drawings.

As shown in FIG. 1, a surgical retractor 1 includes a frame 2, arms 3 attached to the frame 2 for supporting a surgical retractor blade 10, and a surgical retractor blade attached to the arms 3. A blade 10 is provided. The arm 3 is attached proximally to the frame 2 and distally to a surgical retractor blade 10 . Two assemblies consisting of arms 3 and blades 10 are shown in FIG. A connector 4 is provided at the proximal end of the arm 3 , the frame 2 is inserted through a through hole (not shown) of the connector 4 , and the connector 4 is movable along the frame 2 .

The manual adjusting pin 5a acts as positioning means for the arm 3 with respect to the frame 2. As shown in FIG. Specifically, when the pin 5a erected through the upper surface of the connector 4 is turned in one direction, the gear (gear) at the tip of the pin 5a comes into contact with the gear (serrated portion) of the frame 2, thereby causing the frame 2 to move. When the pin 5a is turned in the direction opposite to the above direction, the arm 3 moves in the opposite direction. The position of the arm 3 is fixed by a claw-like stopper (not shown). Therefore, the arm 3 can be fixed at an arbitrary position on the frame 2, and the space between the two arms 3 can be appropriately changed and fixed. By changing the distance between the two arms 3 according to the size of the surgical site, the surgical retractor 1 can be adapted to various operations.

A second connector 6 is provided at the tip of the arm 3 . The second connector 6 has a hole (not shown) for attaching a surgical retractor blade 10, which is attached to the second connector 6 for attaching the surgical retractor blade 10 to the second connector 6. A fixing means 14 is provided. The fixing means may be screws, rivets or the like.

By turning the manual adjustment pin 5b, the angle of the connector 6 can be changed, and thus the angle of the blade 10 fixed via the connector 6 with respect to the frame 2 can be changed. The angle between the two blades on both sides can be adjusted appropriately according to the size of the surgical site.

FIG. 2 shows the surgical retractor blade 10 of the first embodiment of the present invention in the closed position and FIG. 3 shows the surgical retractor blade 10 in the open position. FIG. 4 shows the underside of surgical retractor blade 10 and FIG. 5 is a schematic side view of surgical retractor blade 10 .

A surgical retractor blade 10 comprises a support 11 and two movable members 20, 21 journalled on the support 11. As shown in FIG. The positions at which the two movable members 20 and 21 are pivotally supported by the support 11 by the pivot pins 20a and 21a are on both sides of the longitudinal centerline C (FIG. 4) of the body portion 12. As shown in FIG.

The support 11 has an elongated body portion 12 and a top portion 13 connected to the base end of the body portion 12 and extending at an angle to the body portion 12 . The angle α (FIG. 5) formed between the top portion 13 and the plane extending from the upper surface 12a of the body portion 12 is greater than 0 degrees and less than 180 degrees, preferably 45 to 135 degrees, more preferably 70 to 110 degrees. .

In this embodiment, the body portion 12 and the top portion 13 are continuous. As shown in FIG. 4, the top portion 13 has a hole 15 for passing and mounting a lighting fixture such as a fiber optic light source such as an LED or other light source, and a hole 16 for mounting a fixing means 14 . is provided. One end of the hole 15 opens into the top portion 13 and the other end opens into the body portion 12 .

Each of the movable members 20 and 21 has base ends 20b and 21b, which are ends near the pivot pins 20a and 21a that are pivotally supported by the support 11, and opposite base ends 20b and 21b. and flat intermediate portions 20d, 21d between the proximal portions 20b, 21b and the distal portions 20c, 21c. In the present embodiment, the proximal end portion 20b, the intermediate portion 20d, and the distal end portion 20c form one substantially flat plate-shaped surface, and the proximal end portion 21b, the intermediate portion 21d, and the distal end portion 21c are formed in the shape of a flat plate. form one substantially flat surface of the Therefore, as understood from FIG. 5, the surfaces of the movable members 20 and 21 extend substantially parallel to the lower surface 12b (FIG. 5) of the body portion 12. As shown in FIG.

The surface of the main body 12 on which the movable members 20 and 21 are mounted has an upper surface 12a and a lower surface 12b that is continuous with the upper surface 12a and forms an angle with the upper surface 12a. An angle β (FIG. 5) formed between a plane extending the upper surface 12a and the lower surface 12b is preferably greater than 0 degrees and less than or equal to 15 degrees. The pivot pins 20a and 21a pass through the movable members 20 and 21, respectively, and are fitted and fixed in holes (not shown) provided in the lower surface 12b. , and can move toward and away from each other.

As shown in FIGS. 2 and 6, the movable members 20 and 21 are provided with one or a plurality of substantially rectangular parallelepiped projecting portions 27 spaced apart from each other on the proximal side of the pivot pins 20a and 21a, and the surface of the body portion 12 is is provided with one or a plurality of recesses 28 that fit with the protrusions 27 that conform to the shape of the protrusions 27 . When the movable members 20 and 21 rotate around the pivot pins 20a and 21a, the projections 27 provided on the movable members 20 and 21 draw arc-shaped trajectories, and a plurality of recesses 28 provided on the body portion 12 are formed. is provided at a position corresponding to the trajectory. The positions of the movable members 20 and 21 are fixed step by step by such a configuration of the protrusion 27 and the recess 28 .

In the closed position of FIG. 2, the side portion 20e of the movable member 20 closer to the movable member 21 and the side portion 21e of the movable member 21 closer to the movable member 20 come into contact with each other and are in the most closed state.

In the closed position of FIG. 2, the movable members 20, 21 are fixed by the engagement of projections 27 and recesses 28 (FIG. 6). The configuration of fixing the movable members 20, 21 in the closed position is advantageous because it prevents the movable members 20, 21 from opening when the surgical retractor blade 10 is advanced through the incision and into the surgical site.

In the open position of FIG. 3, the side portion 20e of the movable member 20 and the side portion 21e of the movable member 21 are separated from each other. The movable member 20 and the movable member 21 are in contact with each other at the proximal end portions 20b and 21b, and are restricted from rotating in the direction of approaching any more. Therefore, the distal end portion 20c of the movable member 20 and the distal end portion 21c of the movable member 21 are in the most open state. In FIG. 3, the angle γ (FIG. 3) formed by the longitudinal axis of the movable member 20 and the longitudinal axis of the movable member 21 through the pivot pins 20a and 21a is preferably 0 to 180 degrees.

In the open position of FIG. 3, the movable members 20, 21 are fixed by the engagement of the protrusion 27 and the recess 28 (FIG. 6). The configuration in which the movable members 20 and 21 are fixed in the open position allows the operator to move away from the surgical retractor blade 10 and perform another operation while the surgical retractor blade 10 is in the open position during surgery. It is advantageous because it can

In the surgical retractor blade 10 of the first embodiment, the protrusions 27 and the recesses 28 function as position fixing means capable of fixing the movable members 20 and 21 at desired positions.

Movable member 20 and movable member 21 are movable in a rotational manner between the closed position of FIG. 2 and the open position of FIG. The movement of the movable member 20 and the movable member 21 to the open position and the closed position may be performed manually or may be performed using any tool.

When the surgical retractor blade 10 is in the closed position of FIG. 2, the distal ends 20f, 21f of the movable members 20, 21 and the distal end 12f of the body portion 12 are substantially at the same height, and the surgical retractor blade 10 is 3, the distal ends 20f and 21f of the movable members 20 and 21 rotate closer to the proximal side than the distal end 12f of the body portion 12. As shown in FIG. This configuration allows the movable members 20 and 21 to be stably opened and closed using this as a support after the tip 12f of the main body 12 of the surgical retractor blade 10 is brought into contact with the surgical site during surgery. Advantageous.

The frame 2 and arms 3 of the retractor 1 and the support 11 and movable members 20, 21 of the surgical retractor blade 10 may be made of any suitable material. For example, it can be formed from arbitrary metal materials such as stainless steel, titanium alloys, or aluminum, or materials with high rigidity and easy processing such as carbon fiber reinforced polymer (CFRP) and polyetheretherketone (PEEK). It can also be formed from Alternatively, support 11 and movable members 20, 21 of surgical retractor blade 10 can be formed from a resilient material such as silicone resin.

The surgical retractor blade 10 of the first embodiment of the present invention and the surgical retractor 1 comprising the surgical retractor blade 10 can preferably be used for spinal surgery. More specifically, the surgical retractor blade 10 and the surgical retractor 1 of the first embodiment of the present invention are useful for spinal (cervical, thoracic, lumbar) fusion surgery, laminoplasty, laminectomy, It can be used for intervertebral discectomy and the like.

For example, the surgical retractor blades and surgical retractors of embodiments of the present invention are used in cervical spine surgery (e.g., cervical laminoplasty, cervical laminectomy, posterior cervical decompression, anterior cervical decompression). , etc.), thoracic surgery (e.g., anterior and lateral fusion, posterior thoracic decompression, posterior thoracic decompression, vertebral body replacement, etc.), or lumbosacral surgery (e.g., lumbar discectomy, Lumbar laminoplasty, anterior and lateral lumbar fusion, posterior lumbar decompression, posterior lumbar fusion, vertebral body replacement, interbody fusion, etc.), scoliosis surgery, kyphosis surgery, spine It can be used for spinal cord tumor resection, cervical occipital surgery, etc. Furthermore, the surgical retractor blade and surgical retractor of the embodiments of the present invention are not limited to the field of spinal surgery, and can be appropriately applied to various other surgical procedures as required.

Here, the operation of the surgical retractor blade 10 of the first embodiment will be described.

First, the surgeon makes an incision in the patient's skin above the surgical target site in the patient. An incision is made in the skin surrounding the spine craniocaudal (longitudinal) to the spine. Subcutaneous tissue and soft tissue such as muscle and fat are developed from the skin incision. Next, with the movable members 20 and 21 of the blade 10 arranged in the closed position of FIG. Insert 10. Next, the movable members 20, 21 of the blade 10 are rotated around the pivot pins 20a, 21a to place the movable members 20, 21 of the blade 10 in the open position shown in FIG. At this time, the lateral width of the blade 10 becomes greater than that of the closed position of FIG. 2, and the position of the blade 10 is expanded in the craniocaudal direction (longitudinal direction) of the spine. This allows the surgical channel to be expanded cranio-caudal (longitudinal) of the spine and the surgical field to be expanded craniocaudal (longitudinal) of the spine while keeping the incision (wound) small. .

Specifically, referring to the spine model S of FIGS. 7A and 7B, using the surgical retractor 1 having the surgical retractor blade 10 of the first embodiment of the present invention, the solid line The encircled incision (wound) portion W is small, but the locations where the pair of blades are placed are expanded from B1 (2 locations) to B2 (2 locations), and the operative field OF is also indicated by a white arrow. It extends craniocaudally (longitudinally) to the spine. The cross-sectional area of the operative field OF becomes larger toward the deeper part than the region defined by the wound W.

After servicing the surgical target site, the surgeon returns movable members 20 and 21 of blade 10 to the closed position of FIG. 2, closes the surgical passageway, removes surgical retractor blade 10 from the patient, and closes the surgical wound. , to complete the surgery.

As described above, according to the surgical retractor blade 10 of the present embodiment and the surgical retractor 1 having the same, the spinal cord is significantly reduced compared to the conventional surgical exposure according to the size of the surgical site. The operative field can be expanded in the cranio-caudal direction (longitudinal direction), enabling less invasive surgery with a wider operative field. For this reason, compared to conventional surgical exposure according to the size of the surgical site, the wound is smaller, the muscle damage is smaller, the amount of bleeding is smaller, and the risk of infection is reduced. It has many effects, such as mild wound pain, short hospitalization period, and expanded application to the elderly and high-risk patients.

Furthermore, with a cylindrical retractor using a plurality of conventional blades, it is difficult to expand both the left and right sides unless the bony tissue in the median region is excised (Fig. 17). It can be done with a single small skin incision.

A surgical retractor blade 10 according to a second embodiment of the present invention will now be described with reference to FIGS. 8-11. Description of the same reference numerals as in the first embodiment is omitted.

The surgical retractor blade 10 of the second embodiment comprises plate-like movable members 20, 21, which rotate about pivot pins 20a, 21a, respectively, and can approach and separate from each other.

An intermediate portion 20d of the movable member 20 is provided with a recess 20g, and an intermediate portion 21d of the movable member 21 is provided with a protrusion 21g. The recess 20g provided on the movable member 20 and the projection 21g provided on the movable member 21 are matched in shape.

In the closed position shown in FIG. 8, the recess 20g and the projection 21g are engaged with each other, and the side portion 20e of the movable member 20 closer to the movable member 21 and the side portion 21e of the movable member 21 closer to the movable member 20 are connected. are in contact with each other. The recess 20g provided on the movable member 20 and the protrusion 21g provided on the movable member 21 constitute closing means capable of locking the movable members 20, 21 in their closest closed position.

In the open position of FIG. 9, the protrusion 21g is separated from the recess 20g, and the movable member 20 and the movable member 21 are entirely separated.

In the surgical retractor blade 10 of the second embodiment, the main body portion 12 and the top portion 13 of the support 11 are continuous, and as shown in FIG. Two grooves 24 spaced apart from each other are provided in a direction substantially perpendicular thereto and in the width direction of the top portion 13 .

As shown in FIG. 11, proximal end portions 20h and 21h of the proximal ends 20b and 21b of the movable members 20 and 21 are folded back onto the top portion 13 of the support 11. As shown in FIG. Each of the portions 20h and 21h has a hole (not shown) for inserting the bolt 25, and the bolt 25 is passed through the hole provided in the portions 20h and 21h of the movable members 20 and 21 and tightened, The movable members 20 , 21 are positioned relative to the support 11 by crimping into grooves 24 on top 13 .

When the bolt 25 is loosened, the movable members 20, 21 can be rotated about the pivot pins 20a, 21a, moving the movable members 20, 21 along the groove 24, thereby moving them toward and away from each other. Is possible. When the bolt 25 is tightened, the movable members 20 and 21 become non-rotatable, and the movable members 20 and 21 can be fixed at an arbitrary position. Thus, in the surgical retractor blade 10 of the second embodiment, the bolts 25 and grooves 24 function as position fixing means capable of fixing the movable members 20 and 21 at arbitrary positions.

In the surgical retractor blade 10 of the second embodiment, the movable members 20 and 21 can be fixed at arbitrary positions by tightening the bolts 25. Therefore, the arrangement of the movable members 20 and 21 of the surgical retractor blade 10 is the first. Unlike the surgical retractor blade 10 of the embodiment, the surgical retractor blade 10 is not limited to being inserted into the incision in the closed position shown in FIG. 2 and then extended to the open position shown in FIG. For example, the surgical retractor blade 10 is inserted into the incision at a first position where the angle γ′ between the longitudinal axis of the movable member 20 and the longitudinal axis of the movable member 21 is a first angle, and then the angle γ The surgical retractor blade 10 can be expanded to a second position where ' is a second angle greater than the first angle. The first angle is preferably between 0 and 30 degrees and the second angle is preferably between 30 and 180 degrees.

Although the present invention has been described with reference to the first and second embodiments, the present invention is not limited to this, and various modifications are possible as follows.
- You may reverse the protrusion part 27 and the recessed part 28 of 1st Embodiment. That is, the movable members 20 and 21 may be provided with one or a plurality of recesses 28 and the body portion 12 may be provided with the projections 27 .
- In the first and second embodiments, the tips 20f and 21f of the movable members 20 and 21 and the tip 12f of the main body 12 are set to have substantially the same height. may be shorter than the tip 12f of the body portion 12, or may be longer than the tip 12f of the main body portion 12.
- As shown in FIGS. 12A and 12B, the proximal end 20b of the movable member 20 is provided with one or a plurality of protruding portions 27 spaced apart from each other, and the proximal end 21b of the movable member 21 is provided with one or A plurality of recesses 28 may be provided. In this example, the movable members 20 and 21 not only rotate about the pivot pins 20a and 21a, but the proximal end 20b of the movable member 20 is closer to the body of the support 11 than the proximal end 21b of the movable member 21 is. A position close to the part 12 can be taken. When the movable members 20 and 21 are rotated from the closed position shown in FIG. 12(A), the base end portion 20b of the movable member 20 overlaps the base end portion 21b of the movable member 21 at the open position shown in FIG. 12(B). A projecting portion 27 provided on the end portion 20b and a recess 28 provided on the base end portion 21b are engaged to fix the positions of the movable members 20 and 21 . Also in this example, the protrusion 27 and the recess 28 function as position fixing means capable of fixing the movable members 20 and 21 at desired positions. It should be noted that the base end portion 20b of the movable member 20 may be provided with the recess 28 and the base end portion 21b of the movable member 21 may be provided with the projecting portion 27 .
- As shown in FIGS. 13A to 13C, a groove 29 is provided at the base end of the top portion 13 in a direction substantially perpendicular to the top surface 13a of the top portion 13 and in the width direction of the top portion 13. Alternatively, claw-like portions 20 h and 21 h formed by folding the base ends 20 b and 21 b of the movable members 20 and 21 over the top portion 13 of the support 11 may be configured to hook the grooves 29 . The shape of the groove 29 is not limited, and may be a shape that conforms to the outer shape of the claw-shaped portions 20h, 21h, or any other shape that can accommodate the claw-shaped portions 20h, 21h. By providing a plurality of grooves 29 via partitions 30, the positions of claw-like portions 20h and 21h can be changed between the closed position in FIG. 13(A) and the open position in FIG. 13(B). In the open position of FIG. 13(A), the claw-shaped portions 20h, 21h are fixedly arranged in the grooves 29 at the outermost ends of the top portion 13, and in the closed position of FIG. 13 are fixedly positioned in the innermost grooves 29 . The claw-shaped portions 20h and 21h and the grooves 29 function as position fixing means capable of fixing the movable members 20 and 21 at desired positions.
- The shape of the projecting portion 27 and the recess 28 is not limited to the substantially rectangular parallelepiped shape shown in FIG. For example, as shown in FIG. 14A, the protruding portion 27 may be a columnar portion having a triangular cross-section, and the recess 28 may be shaped to match it. Alternatively, as shown in FIG. 14B, the protruding portion 27 may be a columnar portion having a substantially semicircular cross section, and the recess 28 may be shaped to conform thereto.
・As shown in FIG. 15, the tip 12f of the main body 12 of the support 11 and the tips 20f and 21f of the movable members 20 and 21 are formed in a serrated shape for better engagement with the skin and other soft tissues. may be
- In the first and second embodiments, the surgical retractor blade 10 has two movable members 20, 21, but the number of movable members may be at least one, such as one, three, or four. There may be more than one.
- In the first and second embodiments, the hole 15 for mounting the lighting fixture that opens to the top portion 13 and the main body portion 12 is provided, but the hole 15 may be omitted. Alternatively, the luminaires may be attached to the movable members 20,21. As for the method of attaching the lighting fixture to the main body 12 or the movable members 20 and 21, in addition to the method of installing in the hole 15, a method of attaching using a hooking member, attaching by magnetic force, etc. may be used. good.
The structure of the frame 2 and the arms 3 of the surgical retractor 1 supporting the surgical retractor blade 10 is not limited to the configuration shown in FIG. It can have any configuration with an arm that supports a surgical retractor blade and a frame to which the arm is attached.

EXAMPLES The present invention will be described in more detail with reference to Examples below, but the present invention is not limited to these.

A surgical retractor equipped with a retractor blade according to an embodiment of the present invention was used to perform a laminoplasty on a patient with cervical myelopathy. The length of the wound was about 3 cm, and laminoplasty of 4 vertebral arches was possible. Using a conventional retractor, a four-arch cervical laminoplasty typically requires a skin incision of the order of 10 cm. Moreover, it was confirmed that the surgical retractor according to the embodiment of the present invention causes less postoperative wound pain and quicker recovery than conventional highly invasive laminectomy.

DESCRIPTION OF SYMBOLS 1... surgical retractor, 3... arm, 10... blade for surgical retractor, 11... support, 12... main body, 13... top, 20, 21... - Movable member 20b, 21b ... base end portion of movable member, 20c, 21c ... tip portion of movable member, 20d, 21d ... middle portion of movable member.

Claims (7)

1. A surgical retractor blade comprising a support having an elongate body and two or more movable members pivotally supported by the support, comprising:
The movable member has a proximal end portion which is the end portion on the side closer to the point where the movable member is pivotally supported by the support, a distal end portion located on the side opposite to the proximal end portion, and a portion between the proximal end portion and the distal end portion. a middle portion forming a flat surface;
a base end portion of the movable member is located on the base end side in the longitudinal direction of the support;
the surface of the intermediate portion extends substantially parallel to the flat surface of the body portion of the support;
A surgical retractor blade, wherein the movable member is rotatable about a pivot point substantially parallel to the planar surface of the body. the movable member has two movable members that can move toward and away from each other;
2. The surgical retractor blade of claim 1, further comprising closure means intermediate each of said two movable members capable of locking said two movable members in their closest closed position. 3. Any one of claims 1 and 2, further comprising position fixing means capable of fixing the position of said movable member, provided so as to match each other at the base end portion of said movable member and the main body portion of said support. The surgical retractor blade described. the support includes a top portion connected to a proximal end of a body portion of the support and extending at an angle to the body portion;
The surgical retractor blade according to any one of claims 1 to 3, wherein at least one of the body portion and the top portion or the movable member is attached with a lighting device. The surface of the main body on which the movable member is mounted comprises an upper surface and a lower surface that is continuous with the upper surface and forms an angle with the upper surface,
the support includes a top portion connected to a proximal end of a body portion of the support and extending at an angle to the body portion;
the top portion and the bottom surface are located on the same side with respect to a plane extending from the top surface;
The angle formed by the plane extending the upper surface and the lower surface is greater than 0 degrees and equal to or less than 15 degrees,
The surgical retractor blade according to any one of claims 1 to 3, wherein the angle formed by the apex with a plane extending from the upper surface of the body is 70 to 110 degrees. The surgical retractor blade according to any one of claims 1 to 5, wherein the tip of the main body of the support and the tip of each of the movable members have a serrated shape. a straight frame,
Only two surgical retractor blades according to any of claims 1-6;
Each of the two surgical retractor blades proximally attached to the frame and distally to permit movement of each arm along the frame to vary the spacing between the two arms. two arms attached to the
with
each of the surgical retractor blades is attached to a connector provided at the distal end of each arm;
A surgical retractor wherein the angle of the surgical retractor blade with respect to the frame can be changed by changing the angle of a connector provided at the distal end of each arm.

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