JPS58501657A - プラスチック状材料の外科用留め具 - Google Patents
プラスチック状材料の外科用留め具Info
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- JPS58501657A JPS58501657A JP57502722A JP50272282A JPS58501657A JP S58501657 A JPS58501657 A JP S58501657A JP 57502722 A JP57502722 A JP 57502722A JP 50272282 A JP50272282 A JP 50272282A JP S58501657 A JPS58501657 A JP S58501657A
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- A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
- A61L31/14—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
- A61L31/148—Materials at least partially resorbable by the body
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0643—Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
- A61L31/04—Macromolecular materials
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
- A61L31/04—Macromolecular materials
- A61L31/042—Polysaccharides
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
- A61L31/04—Macromolecular materials
- A61L31/043—Proteins; Polypeptides; Degradation products thereof
- A61L31/047—Other specific proteins or polypeptides not covered by A61L31/044 - A61L31/046
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- A—HUMAN NECESSITIES
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- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
- A61L31/04—Macromolecular materials
- A61L31/048—Macromolecular materials obtained by reactions only involving carbon-to-carbon unsaturated bonds
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
- A61L31/04—Macromolecular materials
- A61L31/06—Macromolecular materials obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
- Y10T24/00—Buckles, buttons, clasps, etc.
- Y10T24/45—Separable-fastener or required component thereof [e.g., projection and cavity to complete interlock]
- Y10T24/45225—Separable-fastener or required component thereof [e.g., projection and cavity to complete interlock] including member having distinct formations and mating member selectively interlocking therewith
- Y10T24/45602—Receiving member includes either movable connection between interlocking components or variable configuration cavity
- Y10T24/45775—Receiving member includes either movable connection between interlocking components or variable configuration cavity having resiliently biased interlocking component or segment
- Y10T24/45785—Requiring manual force applied against bias to interlock or disengage
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Abstract
(57)【要約】本公報は電子出願前の出願データであるため要約のデータは記録されません。
Description
【発明の詳細な説明】
本発明は外科用留め具装置に関し、より詳細には、プラスチック又はプラスチッ
ク状材料の外科用留め具に関する。また、本発明はかかる外科用留め具を身体の
組織に付けるための装置に関する。
外科用ステープル止めが、糸、ガツトワイヤ等の個々の縫合線を付ける困難性を
回避するために開発されてきた。外科用ステーゾル止め装置によって、外科医は
ステーゾル止め器具に応じ外科用ステープルを1つずつ続けて又は同時に平行に
付けることによって身体組織を留めることができる。外科用ステーゾルは、身体
が次第に吸収するマグネシウムのような金属も知られているが、代表的には、通
常タンタル又はステンレススチールのような不活性材料の金属ワイヤである。
成る外科手術では、非金属の縫合線を使用するのが望まれる。例えば、身体の中
に金属ステーゾルがあるとX線を散乱させそれによってレントケ゛ン写真の質を
低下させることがある。また、成る場合には、金属ステーブルが不利には、手術
後数ケ月又は数年の間身体の中で移動するかも知れない。これらの理由及び他の
理由のために、X線の透過を妨げずまた、比較的迅速に身体によって吸収される
天然又は合成、71Jマー、又は樹脂若しくはコラーケ゛ンのような非金属縫合
材を使用するのが望ましい。
本明細書及び添付C特許請求の範囲の便宜のためて、本発明の実例において使用
するのに適当なかかる全ての非金属縫合材を[プラスチック状材料]と称する。
本発明の使用に適当であるためKは、縫合材は比較的、可撓性及び弾力性がなけ
れば々らず、従って、ここに使用する「プラスチック状材料」という用語はかか
る材料に限定される。しかしながら、この用語は生分解吸収能力に関しては限定
されず、従って、ここに称する「プラスチック状材料」は吸収性、非吸収性のい
ずれであってもよい。
上述したプラスチック状材料は、一般的に、金属の物理的特性とは実質的に異な
る物理的特性を有す。これらのプラスチック状材料は一般的に、外科用ステープ
ル止め装置の金属ワイヤの代用にはならない。というのは、これらの材料の留め
具構造は、通常、留めようとする組織を突き刺すには強くなく即ち硬くないから
である。寸だ、これらの材料の留め具構造は、付ける際、金属を折り曲げるよう
には折シ曲げることはでき々い。これらの材料は一般的に、非常に撓むのでステ
ーゾルの仕上り形状を保持することができない。
したがって、本発明の目的は、改良外科用留め装置を提供するにある。
本発明のさらに特定の目的は、プラスチック状材料の改良外科用留め具を提供し
、さらにかかる留め具を付けるだめの改良装置を提供するにある。
発明の概要
本発明のこれら及“′び他の目的は、本発明の原理によれば、最初は別々である
が互いに係合し合う留め具部材と保持器部材とから成9、両部材はプラスチック
状材料のものである外科用留め具を提供することによって達成される。留め具部
材は、基部及び該基部に対して垂直な、間隔をへたて実質的に平行な少なくとも
2つの枝部を有する。保持器部材は、留め具部材の各枝部と関連した開口部を有
する。各枝部の自由端は、保持器部材の開口部に受け入れられてこれと互いに係
合し合うようになっている。各枝部の自由端部分及び各保持器部材開口部の内面
は、枝部が開口部に入ってきたときに協働して枝部をその長さ方向軸線のまわり
にねじるカム面部を有す。これは、協働するカム面部が外れ、枝部をねじってこ
れを保合面部が留め具部材と保持器部材とを共に保持するその最初の整合に戻し
た後、枝部及び開口部の係合面部を互いにノぐイパスさせる。
本発明の外科用留め具を付けるための装置は、留めようとする身体の組織の一方
の側に配置され且つ少なくとも1つの保持器部材を最初に収容する保持器部材支
持装置と、身体の組織の他方の側に配置され且つ各保持器部材と一線を成した保
持器部材を最初に収容する留め具部付保持組立体とから成る。留め具部付保持組
立体は各留め具部材の枝部に平行で且つこれと接触した先のとがった金属ピンを
包含し、各ピンの先のとがった端は枝部の自由端を越えて延びる。また、留め具
部付保持組立体は、ピン及び留め具部材を保持器部材の支持装置の保持器部材の
ほうへ駆動するだめの装置を包含し、従って、ビン及び枝部は留めようとする組
織を突き刺して貫通しそして枝部の端は保持器部材の開口部に入シこれと互いに
係合し合う。ビンは組織への枝部の貫通を容易にする。好ましくは、このビンを
引っ込める装置は留められた組織が留め具付は装置から取出される前に自動的に
ビンから引っ込むようにする。
本発明の一層の特徴、その本質及び種々の利点は、本発明の添付図面及び以下の
詳細な説明から明らかになる第1a図は、本発明の外科用留め具を付けるための
例示的装置の斜視図であり、カートリッジを使用する作動器組立体から分離した
留め具付はカートリッツを示す図である。第1b図(は第1a図と同様であるが
、作動器組立体に装着された留め具付はカートリッジ及び留め具を身体組織に付
けるための阜備ができている装置を示す斜視図である。
第2図は、第1b図の2−2線における第1図の装置の一部の部分断面立面図で
あり、組織を留める前の装置を示す図である。
第3図は、第2図の3−3紳における断面図である。
第4図は、第2図と同様であるが、組織を留めた後の装置を示す図である。
第5図は、第4図の5−5線における断面図である。
第6図は、第1図乃至第5図の装置の一部の分解斜視図である。
第7図は、第6図の7−7線における断面図である。
第8図(は、第6図で詳細に示した部品の1つを作るだめのブランクの平面図で
ある。
第9図は、本発明の外科用留め具の部分断面立面図である。
第10図は、第9図の10−10線における図である。
第11図は、留め具の2つの部品を合わせる際の中間段階を示す、第10図と同
様々図である。
第12図は、第11図の12−12線における断面図である。第12図の留め具
の枝部は断面で(はない。
第13図は、留め具の2つの部品を合わせる際の最終段階を示す、第11図と同
様な図である。
第14図は、第16図の14−14線における断面図である。第14図の留め具
の枝部は断面ではない。
第15図は、第9図の留め具の一部の端面図である。
第16図は、第9図の留め具の一部の立面図である。
第17図、第18図は、第16図のそれぞれ17−17線、18−18線におけ
る図である。
第19図、第20図、第21図は、第16図のそれぞれ19−19線、20−2
0線、21−21線における断面図である。
発明の詳細な説明
第1図に示され且つ参照番号10で指示された装置は2つの主部分から成ってい
る。これらは、作動器組立体12と留め具付はカートリッジ14である。作動器
具組立体12は、1981年5月26日に出願された米国特許同時係属出願第2
67 、D8[]号に示されている装置の相当部分と同一であるのが良い。した
がって、作動器組立体12は本発明の一部をなさず、ここでは詳細に説明しない
。確かに、他の作動器組立体が図示した作動器組立体の代わりに容易に用いられ
る。適当々別の作動器組立体の例が、1980年9月29日に出願された米国同
時係属出願第188,691号に示されている。かくして、第1図に示す特定の
作動器組立体は本発明の成る可能な態様をのみ示し、本発明を理解又は実施する
のに必要ではない。
作動器組立体12は、フレーム20と、回動要素22及び往復運動要素24を包
含するクランプ作動機構と、回動ゾツシャ作動部材26とから成っている。留め
具付はカートリッジ14が、フレームの遠い方の脚28と留め具保持器支持部材
30との間のデテント又は他の同様な連結装置によってフレーム20の遠い方の
部分に取外し自在に装着されろ。
第2図及び第5図で最もよく分かるように、留め具付はカートリッジ14ば、長
さ方向の留め具保持器支持部材30及び留め具保持組立体40を包含している。
留め具保持組立体40は、部材30の一端に隣接したビン32によって部材30
に回動的に連結されている。保持器支持部材30は、平行な2つの列に構成され
た複数の留め具保持器部材80を有し7ている。留め具保持組立体40も、平行
な2つの列に構成された複数の留め具部材100を有している。留め具保持組立
体40が、例えば第2図に示すように保持器支持部材30に対し実質的に平行に
回動するとき、各留め具部材100は保持器部材800それぞれの1つと向い合
っている。各列の留め具部材及び保持器部材は他の列の留め具部材及び保持器部
材から片寄っており、千鳥状構造の仕上り留め具を留める組織に提供する。
第1図の装置は、以下のように身体組織を留めるのに使用される。第1a図に示
すように回動クランプ作動要素22をフレーム20から上方に回動させ、往復運
動クランプ作動要素24を手前に引っ込める。留め具付はカートリッツ14をフ
レ一台20に差し込む。寸だ、第1a図に示すように、要素24が手前に引っ込
められ、るので留め具保持組立体40は回動して保持器支持部材30から遠ざか
ることができる。かくしてカートリッツ14を開いて、留めようとする組織16
をカートリッツ要素30と40の向の合う面の間に配置する。次に、第1b図に
示すように、回動フランジ要素22をフレーム20に対し平行に回動させクラン
プ作動要素24を遠Jjへ延ばす。要素24の遠い方の端が留め具保持組立体4
0の手前の側に接触し、それを保持器支持部材3oの方へ回動させ留めようとす
る組織を要素3oと40の向い合っている面の間にクランプする。留め具保持組
立体40が保持器支持部材3oに対して実質的に平行になると、組織は完全にク
ランプされ且つ留められる準備が出来ている。留め具付はカートリック14のこ
の状態は第2図及び第6図で最もよく分かる。次に、回動ブツシャ作動部材26
をフレーム2oの握りの方へ回動させ留め具保持組立体40を作動して第4図及
び第5図に示すよに留め具部材100を駆動させて組立体4oがら組織を通して
保持器部材80と互いに係合させる。今や、組織の留めは完了しており、留めら
れた組織は装置から取外されるのが良い。回動ブツシャ作動部材26を解放して
その最初の位置へ戻す。回動フランジ作動部材22をフレーム20から回動させ
、往復運動クランプ作動部材24を引っ込める。これによって留め具保持組立体
4゜を保持器支持部材30から遠ざけるように回動させ、従って、装置を留めら
れた組織から取外すことができる。
保持器部材80は部材3oがら離れ、留め具部材100と互いに係合した寸まで
組織を固着させる。使用済みの留め具付はカートリッジ14をフレーム2oがら
取外して捨てる。追加的に組織を留めようとする場合には新しいカートリッジを
入れる。
本発明の外科用留め具は細部が第6図、第9図乃至第21図で最もよく分かる。
各留め具は、最初、別々の保持器部材80と留め具部材lOOとを包含している
。各留め具部材100は長さ方向の基部102及び実質的に平行な少なくとも2
つの枝部104.106を有し、枝部104.106は、基部の長さに沿って間
隔をへだてだ位置で基部から実質的に垂直に延びている。各留め具部材について
枝部は少なくとも2つ必要である。というのは、各枝部は保持器部材80と合わ
さる際、その長さ方向軸線のまわシにねじれるからであシ、2つ又はそれ以上の
枝部のあることによって基部102は、枝部のねじれの際(さらに、留め具が組
織の所定位置にある後)、保持器部材に対して平行−に保たれる。図面に示した
特定の実施態様では、各留め具部材100は枝部を2つしか有さないが、所ψな
らば2つ以上の枝部を使用しうろことは明らかである。
各保持器部材80ば、留め具部材100の基部102に対し実質的に平行な長さ
方向の部材である。各保持器部材は、少なくとも2つの開口部84.86を有し
ておシ、これらは各々、一連した留め具部材の枝部のそれぞれの1つの自由端と
受入れるようになっている。各留め具部材には枝部が2つ必要であるのと同じ理
由で、各保持器部材80には開口部が少なくとも2つ必要である。
保持器部材によって留め具の枝部は保持器部材と合わさる際にねじれ、又、保持
器部材は枝部のこのねじれの際(さらに留め具が組織の所別位置にある後)、留
め具部材に対して平行のオ′マであるように2つの開口部が必要である。
留め具要素80及び1ooは両方とも、条件を上記のように構成するようなプラ
スチック状の材料で作られる。
代表的に外科用ステーゾルを作る金属と比較して、留め具要素80.100のプ
ラスチック状材料は比殻的軟らかく可撓性、弾力性がある。従って、留め具部材
の枝部104.106は一般的に、独力で留めようとする組織を突き刺すことは
できない。留め具の枝部を助けて組織を突き刺すためK、ステーブル保持組立体
4oは金属ビン52(第2図及び第6図)を包含し、この金属ピンは各留め具部
材の各枝部と接触し、又、装置の駆動ストロークの際、枝部と一緒に移動する。
各ピン52は枝部の自由端を越えて短い距離延び且つ組織の突き刺しを容易にす
るために先がとがっている。ピン52と接触する各枝部の側面108はピンの側
面に適合し、従って枝部は少なくとも部分的にピンによって支持される。図示し
た特定の実施態様では、側面108は実質的に平らである。
各枝部の残シの側面(集合的に自由側面と称される)は、種々の機能を行なうよ
うに形づくられておシ、これらの全てを以下に詳述する。これらの機能のうちの
第1は、枝部がピン52から離れないで、組織への枝部の貫通を容易にすること
である。この目的のために、枝部の自由端は、ピン52の側面と接触する先端1
10となシ、又、自由側面の隣接部分112は、先端110から遠ざかる方向に
ピン52から傾斜している。図面に示した特定の実施態様では、自由側面部分1
12は円錐形外面の一部である。かくして、枝部104又は106は組織を貫通
するピア52に続くので、側面部分112への組織の圧力は枝部をピンと接触さ
せたままにしようとする。−752は多くの方法で作ることができるが、図示し
た特定の実施態様では、各ピンは基部54及び、基部の両端から垂直に延びる平
行な2つの溝形部分56を有するU形部材50(第6図で最も良く分かる)の端
部である。各ピン52は溝部分56のそれぞれの1つの自由端から延びている。
ピン部材50を作る平らなブランク53が第8図に示されている。
留め具部材10.0の枝部104.106がピン52の助けで組織を貫通した後
、以下に説明するように枝部の自由端が保持器部材の開口部84.86に入り保
持器部材を互いに係合する。保持器部材の開口部84.86の各々は、最初の比
較的小さな部分88及び最終の比較的大きな部分90を有している。最初の部分
88と最終の部分90との間に保合面部92があり、この係合面部は留め具部材
の枝部104又は106の長さ方向@線に対して実質的に垂直である。開口部8
4.86の各々は、保持器部材の長さ方向中心軸線及び留め具部材の枝部の長さ
方向@線によって構成された平面に関し実質的に対称である。(この平面は保持
器部材の開口部の対称面と称される。)第10図から明らかなように、各保持器
部材の開口部の最初の部分88は、余りに小さいので、以下に詳細に説明するよ
うに枝部のねじれなしには留め具部材の枝部の自由端を通すことができない。し
かしながら、第13図から明らかなように、各開口部の最終の部分90はねじれ
た又はねじれていない状態の枝部の自由端を受入れるのに足るだけ大きい。
第9図、第10図及び第17図で最も良く分かるように、各留め具部材の枝部の
円錐状自由側面部分112以外のところは実質的に平らな2つの面部114と1
16を、枝部の長さ方向軸線のそれぞれの対向した側に作るように切除されてい
る。平らな面部114.116は、枝部の長さ方向軸線且つ互いに対し実質的に
平行であるが、それらは保持器の開口部84又は86の前述の対称面に対して傾
斜しており即ち平行ではない。各保持器開口部の最初の部分88は余りに小さい
ので枝部の自由端を枝部の最初の角度の向きで通すことはできないが、枝部がそ
の長さ方向軸線のまわりにねじれ従って平らな面部114.116が保持器部材
の開口部の前述の対称面に対して実質的に平行になるとき、枝部の自由端は開口
部の最初の部分88を貫通することができる。これは、保持器部材の開口部の最
初の部分88を貫通するためにねじれた枝部の端を示す第11図から明らかであ
る。枝部の適当なねじシは以下に説明するように自動的に達成される。
例えば第10図で最も良く分かるように、平らな面部112の向き及び角度は、
円錐状面部112の部分112aが平らな面部108と116との間に残るよう
なものである。平らな面部108と114との間には比較しうるような円、唯状
面部112の部分は残らない。というのは、これらの2つの平らな面部は隣接し
ているからである。他方、平らな面部108から所定圧離隔てたところに平らな
面部114と隣接している円錐状面部112の部分112bがあり、一方、平ら
な面部116を有する枝部の側には平らな面部108から同−距離隔てたところ
に円錐状面部112の相当部分がない。かくして、平らな面部114.116は
各枝部の自由端を保持器部材の開口部の前述の対称面に関して実質的に非対称に
する。
枝部の自由端が、第10図に示した最初の角度の向きで保持器部材の開口部の最
初の部分88へ押し込められると、枝部の非対称の面部112a及び112bは
、開口部の最初の部分88の側面に接触し、ねじシ偶力即ちトルクを枝部に加え
るだめのカム面として作用する。この偶力即ちトルクは、平らな面部114及び
116を保持器部材の開口部の前述の対称面と平行にさせるような方向に作用す
る。枝部ば、平らな面部114及び116が第11図及び第12図に示すように
保持器部材の開口部の対称面と実質的に平行になるまで、第11図の矢印118
で指示された方向においてその長さ方向軸線のまわりにねじれることによってこ
の偶力即ちトルクに応答するほど十分に撓む。こうした状態になると、枝部の自
由端は開口部の1!初の部分88から開口部の最終の部分90へ自由に貫通する
ことができる。保持器部材の開口部も、留め具部材の枝部のねじシ中、ある程度
まで外方に伸びるのが注目される。保持器部材の開口部は代表的には、以下に説
明するように枝部がねじられないときの最初の寸法及び形状に戻る。
円錐状面部112の全てが開口部の最終の部分9oの中へ通ると、カム面112
a及び112bは開口部の最初の部分88との接触を失う。したがって、ねじり
の偶力即ちトルクはもはや枝部に加わらず、又、枝部は第13図の矢印120で
指示した方向において第13図及び第14図に示すような最初の角度の向きにね
じれない。
これは留め具部材の枝部の係合面部122と保持器部材の開口部の保合面部92
の重なりによって、留め具部材と保持器部材を恒久的に互いに係合させる。
今、留め具カートリッジ14の構造及び操作をさらに詳細に考慮する。第2図及
び第3図に示すように、留め具保持組立体40は、外側ハウジング6oを包含し
、このハウジングは一方の側からハウジングの内部に片持された停止部材62を
有している。U−形溝部材64が留め具部材100の枝部と平行に往復動可能に
ハウジング60の内部に配置されている。溝部材64の一方の脚は停止部材62
の手前の側に位置決めされ、溝部材64の他方の脚は停止部材62から遠い方の
側に位置決めされている。圧縮板ばね・66が停止部材62と溝部材64の手前
の脚との間に配置されておシ、溝部材64を手前の方向へ弾性的に押圧する。
ブツシャ部材68が、溝部材とシソツヤ部材の基部との間のありつぎ連結部によ
って溝部材64の遠い方の脚に固着されている。第6図で最も良く分かるように
、ブツシャ部材68は長さ方向の基部7o及び基部に垂直な複数のプッンヤフィ
ンガ72を包含している。各ブツシャフィンガ72は、留め具部材1ooのそれ
ぞれの1つの基部102の手前の側へ延びている。かくして、カートリッジ14
を作動するとき、ブツシャフィンガ72ば、留め具部材100を留め具保持組立
体4oがら実際に駆動する要素である。ピン部材5oの基部54は、シソツヤ部
材の基部70と溝部材64の遠い方の脚との間に捕えられる。各ピン部材の各溝
形部分56は、ブツシャ部材の基部70に対応して形作られた開口部74を貫通
する(第7図も参照)。溝形部分56も各プノンヤフィン ′ガフ2の両側に沿
って延ひ、留め具部材100の基部102の端に隣接して終っている。各溝形部
分56と関連したピン52との間の渡りのところで、ピン部材5゜はデテクト5
8を包含し、このデテクト58は留メ具部材100の対応するデテント面124
と解放可能に係合する。デテクト要素58と124との協働によって留め其保持
組立体4oを作動して留め具部材を駆動する前に、留め具部材100は留め具保
持組立体内に保持される。
板ばね42がハウ・ジンク6oの手前の側にピデノトピン32に隣接して取付け
られている。ばね42の自由端(ハクランプ60へのばね42の取付けと反対側
の)は整合ビン44に係合している。整合−ン44は留め具100の枝部に平行
なノ・クランプ60の上方部分を貫通し、・・クランプ60内に長さ方向往復動
可能に取付けられている。ばね42は第1a図に示すようにノ・クランプ60の
手前の面から離れるように偏向し、従って、整合ピン44の自由端(見えない)
は普通ノ\ウノング60内へ手前の方向に引っ込められている。しかしながら、
作動器組立体1企のクランプ作動要素22.24が第1b図に示すように位置決
めされるとき、ばね42はノ・クランプ60の手前の面に押付けられ、それによ
って整合ピン44を遠方方向へ駆動する。この状態では、整合ピン44の遠い方
の端は、ノ・クランプ60の遠い方の側から、ピボットピン32から遠い方の保
持器支持部材30の端の開口部34内へ延びている。このように、整合ピン44
は、留め具保持組立体40と保持器支持部材30とが互に実質的に平行になり、
それらの間にクランプされた組織に留め具をつける準備ができたとき、保持器支
持部材30との留め具保持組立体40の整合を助ける。留め具保持組立体40が
保持器支持部材30に対して平行でない場合、ばね42は整合ピン44の遠い方
の端を7・クランプ60内へ自動的に引っ込め、従って、整合ピンは装置への組
織の差し込み又は装置からの組織の取出しを妨げない。
保持器部材80は、適当な任意の手段、例えば保持器部材80と保持器支持部材
30との間の軽い摩擦嵌めによって保持器支持部材30の開口部に取外し可能に
保持されており、従って、留め具部材100が組織を貫通して保持器部材の中へ
駆動された後、保持器部材は比較的容易に保持器支持部材から出て来る。
留めようとする組織を保持器支持部材30と留め具保持組立体40の向い合った
面の間にクランプさせて留めようとしたとき、ブツシャ作動器部材26(第1図
)をフレーム20の握りの方へ回動させブツシャ作動器ロッド130(作動器組
立体12の一部である)を第4図及び第5図に示すように遠方方向へ駆動させる
。ブツシャ作動器ロッド130の遠い方の端は、ばね42のスロット46及びハ
ウジング60のスロット76を貫通し、溝部材64の手前の脚に接触する。これ
によって、溝部材64は遠方方向へ移動し、それによシ圧縮板ばね66を圧縮さ
せ、プツンヤ部材68も遠方方向へ移動させる。
ゾツンヤ部材68の遠方への移動によって、ピン52及び、留め具部材100の
枝部104.106は組織を貫通し保持器部材80の開口部84.86の中へ駆
動される。ピン52の端は開口部84.86に入るが、それらの開口部はピンに
隣接するにはかなり大きく、従って、ピンは保持器部材によって保持されない。
ピン52は枝部104.106が組織を突き刺すのを助は且つ枝部が曲がらない
ように補強する。しかしながら、ピン52は、枝部が先に詳述したように保持器
部材の開口部84.86に入るときにねじれを妨げない。
ブツシャ作動器ロッド130がその駆動行程を完了すると、溝部材64の手前の
脚は第4図及び第5図に示すように停止部材62に密接している。加うるに、留
め具部材100の全ての枝部の自由端は第13図及び第14図で示した方法で保
持器部材80と互いに係合し合う。
組織の留めが完了すると、回動作動器部材26を解放してブツシャ作動器ロッド
130を手前の方向に引っ込める。
ブツシャ作動器ロッド130が引っ込むとすぐ、圧縮板ばね66は溝部材64を
第2図及び第3図に示したその最初の位置へ押し戻す。これによってピン52は
引っ込んでハウジング60の中へ戻り、それによってピンは仕上った外科用留め
具、さらに留められた組織から引き離される。かくして、留められた組織が装置
から取出される前に、ピン52は、装置からの組織の取出し中、ピンとの接触に
よる組織への起シうる損傷を回避するために、装置によって自動的に引っ込めら
れる。
留められた組織を装置から取出そうとするとき、回動クランプ作動器要素22(
第1図)をフレーム20から回動させ往復動要素24を引っ込める。これによっ
て、ばね42は整合ピン44を引っ込め、又、留め具保持組立体40は回動して
保持器支持部材30から離れる。しだがって、留められた組織を装置から取出す
ことができる。使用済みの留め具付はカートリッツ14を作動器組立体12から
取外して捨てる。新しいカー) IJソノ14を作動器組立体に配置すると本装
置は再使用のだめの準備が出来ている。
本発明を特定の実施態様の背景で例示的に説明したが、他型式の外科用留め装置
に均等に適用しうろことが理解されよう。例えば、上述したよりな回動留め具付
はカートリッジ14の代わシに、保持器支持部材及び留め具保持組立体を、米国
特許第3,494,533号に示された外科用ステープラの分離したアンビル及
びステーブル保持組立体と類似の方法で互いに対して直線的に移動する完全に分
離した2つのカートリッジ要素にしても良い。
また、本発明は外科用留め具を真直ぐな列でつけるのに特定されない。例えば、
本発明は、外科用留め具をConta氏等・に付与された米国特許第4,304
,236号に示された外科用円形吻合ステープラのような環状パターンでつける
のに適用しうる。本発明のその型式の装置に適用するにあたっては、保持器支持
部材を再び、Conta氏等の装置の分離したアンビル及びステーブル保持組立
体と類似の方法で留め具保持組立体から完全に分離するように作る。
また、本発明は、留め具付は部分が恒久的な作動器組立体から分離している処分
可能なカートリッツとして作られる留め具付は装置に特定されない。留め具付は
部分を作動器組立体と!・体に作ってもよいし、装置全体を1回使用した後に処
分できるように作ってもよい。
吸収性、又は生分解性の外科用留め具としての使用に適当なプラスチック状材料
は、ネコの腸(ひつじの腸の粘膜下組織から出てくるコラーケ゛ン(colla
gen ) ) 、ポリグリコール酸、ポリ乳酸、ポリグリコール酸とポリ乳酸
トのコポリマーブレンド、再構成されたコラ−f+ y、ポリエステル、カゼイ
ン、アルブミン等のようなポリアミノ酸、ポリビニルアルコールのような多価ア
ルコールポリマー、セルロースグリコール酸エーテル、メチルα−シアノアクリ
レートのようなα−シアンアクリル酸のエステルを包含する。ポリグリコール酸
は米国特許第3.463,158号、第3.739,773号、第3.772,
420号に開示されている。適当なポリ乳酸は米国特許第3,636,956号
に開示されている。
吸収性ポリエステルの例は米国特許第3,225,766号、第3.883,9
01号に開示されている。吸収性セルロースグリコール駿馬ステルは米国特許第
2.764,159号に示されている。適当なα−シアンアクリル酸のエステル
は米国特許第3,527,841号、第3,564,078号、第3,759,
264号に発見される。好ましい実施態様では、本発明の留め具は、10−50
%重肝0グリコライドと50−90%重量のラクタイドとの吸収性無定形コポリ
マーを射出成形することによって製造される。コポリマーの分子量は約30、O
DD〜40“−,000から約130,000までのものである。前記のものは
適当な生分解性の吸収性プラスチック状材料の例示にすぎない。適当な他の吸収
性プラスチック状留め具材(例えば、p−ノオキサンの?図示してここに説明し
た実施態様は本発明の原理の単なる例示であシ、種々の修正が本発明の範囲と精
神から逸脱することなく当業者によってなされるのが理解されよう。例えば、本
発明の外科用留め具は、種々の型式の留め具材は装置、上述されているいくつか
の実施例に使用されてもよい。
Claims (1)
- 【特許請求の範囲】 1 基部及び該基部から実質的に垂直に延びる、間隔をへだで実質的に平行な少 なくとも2つの枝部を包含する留め具部材と、少なくとも2つの開口部を包含す る保持器部材とから成り、各開口部は枝部のそれぞれの1つの自由端を受け入れ て保持するようになっておシ、各開口部によって枝部は最初に開口部に入るとき その長さ方向軸線のまわシにねじれ、次に、ねじれていない状態になって開口部 と互すに係合し合うことを特徴とするプラスチック状材料の外科用留め具。 2、留め具部材は、枝部を各枝部の側面の一部に平行で且つこれと接触する金属 ビンの助けで留めようとする組織に貫通させることによって付けられ、又、各枝 部の側面の残部はカム面部及び係合面部を包含し、カム面部は保持器部材の開口 部と協働して枝部をねじり、又、枝部がねじれていない状態になると、係合面部 は保持器部材の開口部と互いに係合し合うことを特徴とする請求の範囲第1項記 載の外科用留め具。 3、長さ方向の基部及び該基部の長さ方向軸線に対して実質的に垂直に該基部か ら延びる、間隔をへだて互いに平行な少なくとも2つの枝部を包含する留め具部 材と、少なくとも2つの開口部を有する長さ方向の保持器部材とから成り、各開 口部は枝部のそれぞれの1つの°自由端を受け入れこれと互いに係合し合って留 め具部材と保持具部材を互いに固定するよゲになっており、枝部が最初に入る各 開口部の最初の部分は大変狭くて枝部の自由端を枝部の長さ方向軸線のまわりに おいて枝部の最初の角度の向きで通すことができず、枝部の自由端及び開口部の 最初の部分は、枝部の自由端を、それが開口部の最初の部分を貫通することがで きる角度の向きにその長さ方向軸線のまわシにねじるだめの協働カム面を有し、 その後、枝部の自由端がその最初の角度の向きを再び取って保持器部材と互すに 係合し合うことを特許とするプラスチック状材料の外科用留め具。 4、 留め具部材は枝部を各枝部の側面の一部に平行で且つこれと接触する金属 ピンの助けで留めようとする組織に貫通させることによって付けられ、又、各枝 部の側面の残部はカム面部及び係合面部を包含し、カム面部は保持器部材の開口 部のカム面と協働して枝部の自由端をねじり、又、枝部がその最初の角度の向き を再び取ると、係合面部は保持器部材の開口部と互いに係合し合うことを特徴と する請求の範囲第3項記載の外科用留め具。 5、 長さ方向の基部及び該基部の長さ方向軸線に対して実質的に垂直に該基部 から延びる、間隔をへだて互いに平行な少なくとも2つの枝部を包合する留め具 部材と、少なくとも2つの開口部を有する保持器部材とから成り、各開゛迫部は 枝部のそれぞれの1つの自由端をの長さ方向軸線のまわりにおいて、開口部の最 初の部分を枝部の正規の角度の向きで貫通しないが、正規の角度の向きから移動 される第2の角度の向きでは開口部の最初の部分を貫通するように形作られ、各 枝部の自由端及び開口部は、枝部が開口部に押し込められるとき、枝部を正規の 角度の向きから第2の角度の向きにねじるための協働カム面を有し、次に枝部は 開口部の最初の部分を貫通してその正規の角度の向きに戻り、それによって開口 部内に恒久的に保持されることを特徴とするプラスチック状材料の外科用留め具 。 、6. 留め具部材は枝部を各枝部の側面の一部に平行で且つこれと接触する金 属ビンの助けで留めようとする組織に貫通させることによって付けられ、又、各 枝部の側面の残部はカム面部及び保合面部を包含し、カム面部は保持器部材の開 口部のカム面と協働して枝部の自由端を正規の角度の向きから第2の角度の向き にねじり、又、枝部がその正規の角度の向きに戻ると、保合面部は保持器部材の 開口部と互いに係合し合うことを特徴とする請求の範囲第5項記載の外科用留め 具。 7 長さ方向の基部及び該基部の長さ方向軸線に対して実質的に垂直に該基部か ら延びる、開隔をへだで互いに平行な少なくとも2つの枝部を包含する留め具部 材と、各々、枝部のそれぞれの1つの自由端を受け入れるようになっている、少 なくとも2つの開口部を有する保持器部材とから成り、各枝部と開口部は互いに 係合し合ったときに、枝部の自由端を開口部内に恒久的に保持する、相互の保合 面部を包含し、又、各枝部及び開口部は枝部の自由端が開口部内に導入されたと き互いに協働して、係合面部が互いにパイAスするよう最初に枝部をその長さ方 向軸線のまわシにねじるカム面部を包含し、その後カム面が外れ、それによって 枝部をねじれていない状態にし係合面部を互いに係合させることを特徴とするプ ラスチック状材料の外科用留め具・ 8、留め具部材は枝部を各枝部の側面の一部に平行で且つこれと接触する金属ビ ンの助けで留めようとする組織に貫通させることによって付けられ、又、各枝部 の側面の残部は枝部のカム面部及び保合面部を包含することを特徴とする請求の 範囲第7項記載の外科用留め具。 9 長さ方向の基部及び該基部の長さ方向軸線に垂直に基部から延びる、間隔を へたて実質的に平行な少くとも2つの枝部を包含する少なくとも1つの留め具部 材を収容する留め具保持組立体と、各々、枝部のそれぞれの1つの自由端を受け 入れて保持するようになった少なくとも2つの開口部を包含する少なくとも1つ の保持器部材を取外し可能に収容する保持器支持部材と、枝部が留め具保持組立 体と支持器支持部材との間に配置された身体の組織を貫通し、又、枝部の自由端 が保持器部材の開口部に入ってこれによって保持されて組織を留めるように、留 め具部材を留め具保持組立体から押すだめの留め具保持組立体と関連したノッシ ャ装置とから成り、ノッンヤ装置は各枝部に実質的に平行で且つこれと接触する 金属ビンを包含し、各ビンは枝部の自由端を越えて延び且つ留め具部材を押す際 に枝部と共に移動して組織への枝部の貫通を容易にし、さらに留め具保持組立体 か留められた組織から遠ざかるときに、自動的に、ビンを留め具保持組立体の中 へ引っ込めるための留め具部材保持組立体と関連した装置とから成ることを特徴 とする外科用留め具を身体の組織−に付けるための装置。 10 留め具保持組立体は保持器支持部材の一端に隣接するように回動的に取付 けられていることを特徴とする請求の範囲第9項記載の装置。 11 枝部が開口部に入るとき、各開口部によって枝部はその長さ方向軸線のま わりにねじれ次にねじれていない状態になって開口部と互いに係合し合うことを 特徴とする請求の範囲第9項記載の装置。 12、各ビンは枝部を補強して、枝部の能力を妨害しないで長さ方向に座屈させ ないようにし、望み通シにねじって留め具部材と保持器部材とを互いに係合させ ることを特徴とする請求の範囲第11項記載の装置。 16 各ビンは、枝部の側面の一部に隣接し、枝部の側面の残部はカム面部及び 保合面部を包含し、カム面部は保持器部材の開口部と協働して枝部をねじ如、係 合面部は、カム面部が枝部をねじれていない状態にしたとき、保持器部材の開口 部と互いに係合し合うことを特徴とする請求の範囲第12項記載の装置。 14各ピン及び枝部は、プツンヤ装置の操作の前に、留め具部材を留め具保持組 立体内に保持するだめの協働デテント装置を包含することを特徴とする請求の範 囲第13項記載の装置。 15 長さ方向の基部及び該基部の長さ方向軸線と垂直に基部から延びる、間隔 をへだで実質的に平行な少なくとも2つの枝部を包含する少なくとも1つの留め 具部材を収容する留め具保持組立体と、少なくとも2つの開口部を包含する少な くとも1つの保持器部材を取外し可能に収容する保持器支持部材とから成シ、各 開口部は枝部のそれぞれの1つの自由端を受け入れて保持するようになっており 、枝部が最初に開口部に入ってきたときに枝部をその長さ方向軸線のまわシにね じシ、次に、ねじれていない状態として開口部と互いに係合させ、さらに、枝部 が留め具保持組立体と支持器支持部材との間に配置された身体の組織を貫通し、 又、枝部の自由端が保持器部材の開口部に入ってこれによって保持されて組織を 留めるように、留め具部材を留め具保持組立体から押すための留め具保持組立体 と関連したゾノンヤ装置とから成り、プソノヤ装置は各枝部に実質的に平行で且 つこれと接触する金属ビンを包含し、各ビンは枝部の自由端を越えて延び且つ留 め具部材を押す際に枝部と共に移動して組織への枝部の貫通を容易にし、ピンは 望み通りに枝部をねじるのを可能にして、留め具部材と保持器部材とを互いに係 合させ、ピンは、留め具部材と保持器部材が係合した後に留め具部材から引っ込 むことができることを特徴とする外科用留め具を身体の組織に付けるための装置 。 16、留め具保持組立体は保持器支持部材の一端に隣接して回動的に取付けられ ていることを特徴とする請求の範囲第15項記載の装置。 1Z さらに、留め具保持組立体は、それが留められた組織から遠ざかるとき、 自動的にピンを留め具保持組立体の中へ引っ込めるための装置を包含することを 特徴とする請求の範囲第15項記載の装置。 18 各ピンは枝部の側面の一部に隣接し、枝部の側面の残部はカム面部及び係 合面部を包含し、カム面部は保持器部材の開口部と協働して枝部をねじり、係合 面部は、カム面部が枝部をねじれていない状態にしたとき、保持器部材の開口部 と互いに係合し合うことを特徴とする請求の範囲第15項記載の装置。 19 各ピン及び枝部は、ノツシャ装置の操作の前に留め具部材を留め具保持組 立体の中に保持するための協働デテント装置を包含することを特徴とする請求の 範囲第18項記載の装置。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US310065 | 1981-10-08 | ||
US06/310,065 US4402445A (en) | 1981-10-09 | 1981-10-09 | Surgical fastener and means for applying same |
Related Child Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP2298731A Division JPH03155851A (ja) | 1981-10-09 | 1990-11-02 | 外科用留め具を付けるための装置 |
Publications (1)
Publication Number | Publication Date |
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JPS58501657A true JPS58501657A (ja) | 1983-10-06 |
Family
ID=23200859
Family Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP57502722A Pending JPS58501657A (ja) | 1981-10-09 | 1982-08-09 | プラスチック状材料の外科用留め具 |
JP2298731A Granted JPH03155851A (ja) | 1981-10-09 | 1990-11-02 | 外科用留め具を付けるための装置 |
Family Applications After (1)
Application Number | Title | Priority Date | Filing Date |
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JP2298731A Granted JPH03155851A (ja) | 1981-10-09 | 1990-11-02 | 外科用留め具を付けるための装置 |
Country Status (10)
Country | Link |
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US (1) | US4402445A (ja) |
EP (1) | EP0077262B1 (ja) |
JP (2) | JPS58501657A (ja) |
AT (1) | ATE21328T1 (ja) |
AU (1) | AU548370B2 (ja) |
BR (1) | BR8207918A (ja) |
CA (2) | CA1191416A (ja) |
DE (2) | DE3249678C2 (ja) |
GB (1) | GB2118665B (ja) |
WO (1) | WO1983001193A1 (ja) |
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1981
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- 1981-10-09 US US06/310,065 patent/US4402445A/en not_active Expired - Lifetime
-
1982
- 1982-08-09 WO PCT/US1982/001093 patent/WO1983001193A1/en active Application Filing
- 1982-08-09 DE DE3249678A patent/DE3249678C2/de not_active Expired
- 1982-08-09 DE DE3249117T patent/DE3249117C2/de not_active Expired
- 1982-08-09 JP JP57502722A patent/JPS58501657A/ja active Pending
- 1982-08-09 GB GB08314597A patent/GB2118665B/en not_active Expired
- 1982-08-09 BR BR8207918A patent/BR8207918A/pt unknown
- 1982-08-11 CA CA000409193A patent/CA1191416A/en not_active Expired
- 1982-10-06 AT AT82401834T patent/ATE21328T1/de not_active IP Right Cessation
- 1982-10-06 EP EP82401834A patent/EP0077262B1/en not_active Expired
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1984
- 1984-09-11 CA CA000462902A patent/CA1193938A/en not_active Expired
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1990
- 1990-11-02 JP JP2298731A patent/JPH03155851A/ja active Granted
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CA1191416A (en) | 1985-08-06 |
BR8207918A (pt) | 1983-09-13 |
DE3249117C2 (de) | 1986-03-20 |
DE3249678A1 (ja) | 1986-04-03 |
AU8485082A (en) | 1983-12-08 |
CA1193938A (en) | 1985-09-24 |
DE3249117T1 (de) | 1983-12-01 |
WO1983001193A1 (en) | 1983-04-14 |
EP0077262B1 (en) | 1986-08-13 |
US4402445A (en) | 1983-09-06 |
JPH0364129B2 (ja) | 1991-10-04 |
ATE21328T1 (de) | 1986-08-15 |
GB2118665B (en) | 1985-08-07 |
DE3249678C2 (de) | 1986-04-03 |
JPH03155851A (ja) | 1991-07-03 |
GB2118665A (en) | 1983-11-02 |
EP0077262A2 (en) | 1983-04-20 |
GB8314597D0 (en) | 1983-06-29 |
AU548370B2 (en) | 1985-12-05 |
EP0077262A3 (en) | 1984-02-22 |
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