JPH07255736A - Surgical operating implement - Google Patents

Abstract

PURPOSE:To provide a surgical operating implement which prevents carbonization of the viable tissues by frictional heat of an ultrasonic horn and thermal deterioration of the horn itself, minimizes denaturation of a cutting part, is suitable for meticulous operation, is insertable down into a deep part and is capable of precisely and safely cutting the hard tissues of the bones, etc. CONSTITUTION:The front end working part of a vibration transmitting means having a liquid passage extending in a longitudinal direction is formed to a spatula shape provided with a projecting part 3 projecting to one side relative to the axis of the longitudinal direction at the front end of the insertion part 7 having a specified sectional area and linear shape and is provided with at least one plane parts 8 having an angle of 20 to 90 deg. with the axis of the longitudinal direction on the operation side face of this projecting part. A liquid ejection hole 6 opened near the rear of the insertion part is so formed as to eject an irrigation liquid toward the projecting part. The projecting part is provided with a slope 10 at its opposite side peak part.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical instrument for cutting and separating ossified tissue, hard tissue and the like of biological tissue by ultrasonic vibration.

[0002]

2. Description of the Related Art Conventionally, a surgical scalpel has been used for cutting and separating biological tissue, particularly hard bone tissue and cartilage tissue, but the efficiency of the cutting work is poor and it takes a long time, which requires a great deal of labor for the operator. However, there is a drawback in that it requires a high level of technique for cutting and separating.

A large number of surgical tools utilizing ultrasonic waves have also been developed. Surgery for ultrasonically vibrating a working part connected to an ultrasonic vibration source to crush the contacted biological tissue and remove it by suction. Surgical tools (for example, Japanese Patent Publication No. 47-3919)
No. 7), and surgical tools having a saw-like operating portion connected to an ultrasonic vibration source, which are developed for cutting and separating hard and soft biological tissues.
However, a surgical tool that oscillates, emulsifies, and removes the surface layer of soft biological tissue by ultrasonic vibration using a vibrating body that has a working portion that is perpendicular to the vibration direction is Since the tissue is crushed by hitting the surface layer of the biological tissue by vibration, it is difficult to cut the tissue into the biological tissue by cutting it deeply into the biological tissue, and it is unsuitable for cutting hard biological tissue. there were.

[0004] In addition, a surgical instrument for cutting and separating biological tissue by a saw-like working portion that vibrates ultrasonically is devised in the shape of the working portion in order to improve the cutting efficiency. Due to the amplitude of the working part of about 50 μm, frictional heat is generated between the working part and the biological tissue to be cut, and even in the case of a working part, for example, a titanium alloy having excellent thermal conductivity, a surface temperature of several hundred degrees is reached. The tissue being cut is carbonized. Furthermore, the working portion having a thin wall such as a blade shape may be deteriorated by frictional heat and may be crushed.

When microscopically observing the operation of cutting hard tissue with ultrasonic vibration, as shown in FIG. 7 (a), when cutting the bone (21) in the vibration direction of arrow B, the blade shape is By the shearing force at the tip (22) of the vibration transmitter (20),
The fine fractured portions (24) are continuously generated, but the shape is macroscopically cut. Figure 7
(B) is the figure which looked at the front-end | tip part of the blade-shaped vibration transmission tool (20) from the front direction, and when finely shearing a bone with a thin-blade shape, the front-end | tip part (22) of the vibration transmission tool (20) is shown. Although the shearing force increases as the angle becomes acute, there is a drawback that the degenerated layer (25) other than the cut portion is widely generated and the bone regeneration state of the cut portion after the operation deteriorates. Further, when the cutting width is wide, the blade shape vibration transmitting tool (20) increases the wall thickness, so that the contact area of the side surface becomes too large and the cutting speed decreases, and the frictional heat due to ultrasonic vibration is generated. There was a possibility that a large amount would occur.

On the other hand, for the purpose of cooling the frictional heat between the biological tissue and the working part, physiological saline is externally added to the cutting site by a syringe, or a surgical instrument and a cover installed on the outer periphery near the working part. A method of ejecting physiological saline from a gap between the surgical instrument and the surgical instrument has been tried. However, in the former case, tools such as syringes and assistants who hold them obstructed the visual field of the operator who operates the surgical tools, and physiological saline was applied to the parts that did not come into contact with biological tissues. Sometimes fog also obstructs the field of view.

[0007] In the latter case, a tool that hinders the operator's visual field is not used, but physiological saline is randomly ejected to a portion other than the working portion that is in contact with the biological tissue. It becomes difficult to distinguish the surroundings, and extra work such as interrupting the work and checking the cutting position is required, which causes the operator to be tired.

Further, in the operation of the cervical spine or the like, which requires a precise cutting work, the conventional blade-shaped mold is operated depending on the ultrasonic vibration at the time of cutting start and the surface condition of the vertebral arch or the like which becomes the blade-shaped contact portion. There was a risk that the part would come off the planned cutting site.
Further, when the osteophyte in the deep portion of the lumbar spine is removed, there is a risk that the working portion that is not in contact with the osteophyte may come into contact with the cauda equina or the like around it.

[0009]

SUMMARY OF THE INVENTION The present invention is intended to solve the above-mentioned problems of the conventional surgical tools, and heats the horn to carbonize biological tissue or deteriorate the horn itself. The surgical tool has a shape suitable for safely performing fine work while confirming the position of the cut portion and securing the field of view while minimizing the degeneration of the cut portion and minimizing the degeneration of the cut portion. Is to provide.

[0010]

Means for Solving the Problems That is, according to the present invention, the rear end portion of a surgical operating apparatus for cutting and separating ossified tissue or hard tissue of living tissue by ultrasonic vibration is connected to an ultrasonic vibration source, A tip is a vibration transmitter having a working portion that serves as an antinode of ultrasonic vibration and is in contact with living tissue, and has a liquid passage that extends in the lengthwise direction. It has a spatula shape in which a protrusion is formed so as to protrude to one side with respect to the axis in the vertical direction, and at least 1 which makes an angle of 20 to 90 degrees with the axis in the length direction on the proximal side surface of the protrusion.
In addition to having two flat portions, an insertion portion is provided in the vicinity of the rear end side following the projection portion, and the tip end side of the liquid passage is opened near the rear of the insertion portion in the direction of the projection portion of the working portion. A surgical instrument characterized in that a liquid ejection hole for ejecting an irrigation liquid is provided.

The present invention will be described in detail below with reference to the drawings. FIG. 1 is a diagram showing an entire surgical instrument according to an embodiment of the present invention, and FIG. 2 is a diagram showing the shape of a distal working portion thereof.

The vibration transmitter (1) is connected to an ultrasonic vibration source (not shown) having the same resonance frequency by a connecting screw (4) at the rear end portion, and the ultrasonic vibration source is supplied with high frequency power having the resonance frequency. The ultrasonic vibration generated by the application is transmitted to the biological tissue via the working section (2) at the tip. The connection between the ultrasonic vibration source and the vibration transmission tool (1) can be performed by screw connection, welding, crimping, or the like, as long as it is performed on the surface of the ultrasonic vibration, and is not particularly limited. Further, the vibration transmitting tool itself may be connected by using a cap nut or the like without providing a screw portion.

As the ultrasonic vibration source, either an electrostrictive type or a magnetostrictive type vibrator having a liquid passage inside can be used, and it is not particularly limited, but BL excellent in electrical and mechanical conversion efficiency is used.
It is preferable to use a T oscillator. The ultrasonic vibration generated by the ultrasonic vibration source is transmitted and expanded by the vibration transmitting tool (1) and reaches the maximum amplitude at the tip of the working unit (2), and the amplitude reaches 100 to 200 μm. If the amplitude is increased more than this, the cutting speed becomes apparently higher, but problems such as charring of the cutting portion, durability of the working portion (2), and cutting noise occur. Therefore, the upper limit amplitude is preferably 200 μm. However, it is not particularly limited technically. The resonance frequency is preferably 20 to 45 KHz, and particularly good vibration is obtained at 22 to 40 KHz.

Inside the vibration transmitting tool (1), there is a liquid passage (5) communicating with the liquid passage inside the ultrasonic vibration source and extending in the lengthwise direction, and the tip end side of the liquid passage (5) is Working unit (2)
It is opened by a liquid ejection hole (6) provided near the rear of the. Then, as shown in FIG. 2, the working portion (2) has a straight cross-section with a constant cross-sectional area, and is projected to one end with respect to the longitudinal axis at the tip of the insertion portion (7). The protrusion (3) is in the shape of a spatula, and a flat surface (8) is formed on the proximal side surface of the protrusion (3) to form an angle with the longitudinal axis.

FIG. 4 shows an example of a shape for expanding the amplitude of ultrasonic vibration by changing the cross-sectional area of the vibration transmitting tool (1). The amplitude necessary for cutting is generated by the vibrating body. When the amplitude is approximately equal to the above-mentioned amplitude, it is preferable that the sectional area up to the working portion (2) is not changed and the shape is thin as shown in FIG.

As shown in FIGS. 4 (a) and 4 (b), even when the diameter of the rear side of the vibration transmitting tool (1) is made thick, the tip side is made thin. Further, the insertion part (7) following it is not particularly limited, but its cross-sectional area is made constant within a range of 3 to 50 mm from the distal end depending on durability against ultrasonic vibration and anatomy such as spine to be treated. Is good. As a result, when the deep groove shape (14) as shown in FIG. 6 is cut, or when the internal osteophyte is cut by inserting it through the gap between the vertebral arches in spinal surgery, the tip projection part (3) of the working part is cut. ) Can be inserted deeply. The outer shape of the insertion portion (7) is not particularly limited, and may be any cylindrical shape, a prismatic shape as shown in FIG. It is also preferable that the width of the insertion portion (7) is equal to or smaller than the width of the tip protrusion portion (3), because the work at the time of cutting is easy.

The width of the working section (2) or the insertion section (7) is different from the shape of the blade, but is about 1.5 to 4.0 mm, although it varies depending on the operation method and the structure of the part to be treated of the living body. Preferably. This suppresses the spread of the modified layer other than the cut portion.

Further, as shown in FIG. 2, the proximal surface of the protrusion (3) provided on the distal end side of the insertion portion (7) has a longitudinal axis, that is, an ultrasonic vibration direction. Is a flat surface portion (8) that forms an angle of 20 to 90 degrees, and further, an elongated flat contact surface (9) is provided at the tip of the projection portion (3), and at the time of the operation, as shown in FIG. As shown in, the structure is such that the surface of the living tissue (13) is cut and separated by scratching. Further, the edge of the contact surface (9) is not limited to a straight line, and may be a curved line or a combination of a plurality of straight lines and a curved line, for example, a saw blade shape, and the contact surface (9) is composed of a plurality of planes. It may be provided that one side of the plane portion (8) is included.

The tip of the protrusion (3) or the contact surface (9)
It is preferable that both side portions of (1) have a curved surface shape (11). When cutting, the conventional blade-shaped cutting tool that uses ultrasonic vibration may cause the working part to deviate from the target cutting site due to the surface condition of the lamina, etc. was there. However, in the working portion tip shape of the present invention, the cutting is started after the projection of the osteophyte or the like to be cut or separated is hooked on the flat surface (8) of the projection (3) for positioning. , There is no fear of getting out of the target area. Further, since the curved shape (11) starts cutting in such a manner that the central portion of the contact surface (9) is embedded in the bone first, the impact given to the operator at the start of cutting is reduced.

The radius of curvature of the curved surface shape (11) is 0.1.
It is preferably in the range of up to 1.5 mm, but not limited to this.

A liquid ejection hole (6) provided near the rear of the working portion (2) or the insertion portion (7) ejects the irrigation liquid in the direction of the tip projection (3) of the working portion (2). Has been adjusted to As shown in FIG. 5, the irrigation liquid ejected from the liquid ejection hole (6) by ultrasonic vibration is ejected around the cutting portion of the working part tip (3) or the living tissue (13) as shown in FIG. Used to cool frictional heat when cutting and to clean the surgical site.

At this time, the surgeon observes and operates the surgical site through the upper surface on the side opposite to the projection (3), and the projection of the projection (3) does not interfere with the operator's visual field (12) due to the ejection of the irrigation liquid. This can be prevented by forming the inclined surface (10) on the opposite side. The opening diameter of the liquid ejection hole (6) is not particularly limited, but is preferably smaller than the diameter of the liquid passage (5).

[0023]

According to the present invention, the work of cutting and separating ossified tissue or hard tissue of living tissue by ultrasonic vibration is performed.
It does not require technical skill compared to conventional surgical tools,
In addition, it can be rapidly cut and separated, and it prevents alteration of the osteocyte tissue around the cutting surface due to frictional heat and degeneration of the tissue due to mechanical pressure to promote postoperative treatment, and further It is suitable as a surgical instrument because it can perform a wide range of precise cutting operations safely and without obstructing the field of view, and can be used continuously for a long time with a high amplitude.

[Brief description of drawings]

FIG. 1 is a diagram showing an overall structure of a surgical instrument according to an embodiment of the present invention.

FIG. 2 is a view showing the shape of the tip working portion of the surgical instrument according to the embodiment of the present invention.

FIG. 3 is a view showing the shape of a distal end working unit of another embodiment of the surgical instrument according to the present invention.

FIG. 4 is a diagram showing an example of the shape of the rear side of the vibration transmission tool of the surgical instrument of the present invention.

FIG. 5 is a diagram showing a usage state and a jetting direction of an irrigation liquid of the surgical instrument of the present invention.

FIG. 6 is a view showing another usage situation of the surgical operating tool of the present invention.

FIG. 7 is a view showing a microscopic cutting state of a conventional surgical instrument, (a) is an example of a vibration transmission tool having a blade shape perpendicular to the vibration direction, and (b) is a blade shape parallel to the vibration direction. It is an example of a vibration transmission tool.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Vibration transmission tool 2 Working part 3 Projection part 5 Liquid passage 6 Liquid ejection hole 7 Insertion part 8 Plane part 9 Contact surface 10 Inclined surface 11 Curved shape 12 Operator's visual field

Claims (6)

[Claims] 1. A surgical operation apparatus for cutting and separating ossified tissue or hard tissue of living tissue by ultrasonic vibration, wherein a rear end portion is connected to an ultrasonic vibration source and a front end portion becomes an antinode of ultrasonic vibration. A vibration transmission tool having a working part in contact with a biological tissue and having a liquid passage extending in the lengthwise direction, wherein the working part has a tip end serving as a vibration antinode on one side with respect to the axis in the lengthwise direction. It has a spatula shape that protrudes to form a protrusion, and has at least one flat surface portion that forms an angle of 20 to 90 degrees with respect to the longitudinal axis on the proximal side surface of the protrusion and An insertion portion is provided near the rear end side, and a liquid ejection hole for ejecting the irrigation liquid is provided on the front end side of the liquid passage opening near the rear of the insertion portion and in the direction of the protrusion of the working portion. Surgical tool characterized by: 2. The surgical operating tool according to claim 1, wherein an inclined surface is provided on the apex on the opposite side of the protrusion formed to project to one side. 3. The surgical instrument according to claim 1, wherein both side portions of the tip of the protrusion formed to project to one side are curved. 4. The surgical instrument according to claim 1, wherein the width of the insertion portion following the rear end side of the protrusion is equal to or smaller than the width of the protrusion. 5. The surgical instrument according to claim 1, wherein the vibration transmitter is bent between the rear end portion of the vibration transmitter and the liquid ejection hole. 6. The surgical instrument according to claim 5, wherein the ultrasonic vibration direction of the distal working portion is parallel to the longitudinal axis.