JPS6137948B2 - - Google Patents

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Publication number
JPS6137948B2
JPS6137948B2 JP53137239A JP13723978A JPS6137948B2 JP S6137948 B2 JPS6137948 B2 JP S6137948B2 JP 53137239 A JP53137239 A JP 53137239A JP 13723978 A JP13723978 A JP 13723978A JP S6137948 B2 JPS6137948 B2 JP S6137948B2
Authority
JP
Japan
Prior art keywords
tube member
cutting
inner tube
instrument
outer tube
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired
Application number
JP53137239A
Other languages
English (en)
Other versions
JPS5477493A (en
Inventor
Josefu Bonneru Reonarudo
Hyuu Matsukuhyuu Edowaado
Dana Sajosutoroomu Dagurasu
Eru Jonson Ranii
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Dionics Inc
Original Assignee
Dionics Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Dionics Inc filed Critical Dionics Inc
Publication of JPS5477493A publication Critical patent/JPS5477493A/ja
Publication of JPS6137948B2 publication Critical patent/JPS6137948B2/ja
Granted legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Description

【発明の詳細な説明】 本発明は、外科用器具、特に関節鏡によつて関
節内の手術を行なう事が可能な外科用の器具に関
する。本明細書中の用語「関節内」とは、膝のよ
うな体の関節を指称しており、また用語「関節
鏡」とは、関節を切開せずに、関節部分に穿刺し
挿入された観察用の外科用プローブ（さぐり針）
を指称している。
人間の関節を観察用プローブによつて映像化さ
せる事は、何十年も前に実証されていたが、関節
の手術は切開法によつて行なわれ続けてきた。す
なわち、代表的な関節の手術においては、手術の
目的はたとえば、膝蓋骨上の腫瘍を除去するこ
と、あるいは膝関節から破損した軟骨を除去する
こと等であるけれども、大きな切開が必要であつ
た。このため、切開による外傷、苦痛、さらには
移動の制約によつて、治瘉するまでに多くの時間
を要するという結果になつていた。
膝あるいは、他の関節部分を切開せずに手術を
試みようとする者は誰しも、多数の制限的なそし
て明白に矛盾する必要条件に出合う。たとえば、
器具は移動させるため、また骨に接近可能である
ために小さくなければならない。一方、力を伝達
するためまた除去された物質を移送するために
は、器具は大きくなければならない。不必要な切
削は防止しなけばならないが、必要な時は一定の
強さの切削が可能でなければならない。そして終
局的には、種々の分野での外科医による使用が可
能で、確実でなければならない。
本発明の主目的は、このような予盾を克服すべ
く、体の膝又は他の関節又は局部に達するよう
に、小さな穿刺傷に挿入されたプローブを使用し
て首尾よく安全な手術を可能にする器具を提供す
る事にある。
本発明によれば、適当な回転外科用器具を用い
て特殊形状の器具の真空切削機能を利用すること
により、この目的が実現された。本発明の外科用
器具は、周壁部に切削口を有する外側チユーブ部
材と、この外側チユーブ部材の中に回転可能に設
けられた内側チユーブ部材と、この内側チユーブ
部材と連通する真空源と、上記内側部材を回転す
るための駆動装置とから構成されている。外側チ
ユーブ部材は外側チユーブ部材の長手方向に伸長
して上記切削口を境界付ける側部エツジを有して
する。内側チユーブ部材は上記切削口とほぼ整合
する切欠部を有している。またこの内側チユーブ
部材は上記側部エツジとは周方向において対向す
る側において上記切欠部を境界付けかつ側部エツ
ジとは平行せずに内側チユーブ部材の長手方向に
伸長する切削刃を有している。上記内側チユーブ
部材はまた上記切欠部に関して長手方向において
相対向した位置に設けられる１対のラジアル軸受
部材によつて上記外側チユーブ部材の中に支持さ
れている。
切削口が内側チユーブ部材および切欠部を介し
て真空源と連通されるために、切削口に負圧を作
用させることができ、これによつて切削されるべ
き組織を切削口の中へ引込むことが可能となる。
また側部エツジと刃とは周方向において相対向す
る側に設けられかつ互いに平行になされていない
ために、内側チユーブ部材が回転すると切削口お
よびこれと整合される切欠部の中に負圧の作用に
より引込まれた組織は、側部エツジと切削刃との
間に挟まれた状態で切削され、したがつて組織の
切削が確実に行なわれるのである。更に内側チユ
ーブ部材を外側チユーブ部材の中に支持する１対
のラジアル軸受は、切削エツジと切削刃との間の
半径方向における確実な切削関係を維持する。
本願発明の外科用器具をこのように構成するこ
とによつて、内側チユーブ部材および切欠部を介
する真空圧の作用により切削口の中に引込まれた
組織を内側チユーブ部材が回転するときの側部エ
ツジおよび切削刃の相互作用により切削し、この
切削された組織を真空圧の作用により器具を通つ
て排出することを可能とするのである。駆動モー
タは、物質をどろどろにではなく、分離した削除
片に切断するような剪断速度で刃を回転するよう
に調整される。つまることなく器具内を通して切
削片を送り、器具自身の浄化を行なうために、切
削片が分離していることが重要であることが理解
されよう。
本発明は特に、膝の手術に有効である。実用器
具においては、海藻灰状で関節の内壁に付着する
比較的柔軟な滑液物質や、膝蓋骨の軟骨軟化症の
患者に見られる様な、より堅い物質を除去し、ま
た膝関節に見られる半月メニスカスの軟骨状物質
を除去する困難さを解消できることが大変望まし
い。これらの物質のすべてを削除するのに特に好
結果を示す器具は、ある重要な関係を観察するこ
とによつて得られることがわかつた。即ち、切削
口の長さと除去されるべき物が通る通路の内部直
径との比が、1.5から2.0の範囲内にあることであ
る。切断刃はらせん形をしていて、切削口の長さ
にわたつてほぼ１回転以下程度であり、刃は
100rpmから200rpmの間の速度で回転する。これ
らの限界を観察する事によつて、除去すべき種々
の膝関節組織を効率的に切削口に送り、分離され
た切削片に切削することができる。これらの分離
された切削片は、流体の圧力がそれを器具内を通
つて進行させることができる様に正面の地域に生
じる。と同時に、切削物質は、障害なく器具を通
つて吸出される様に（そして患者の関節から取り
出されるように）非常に短い時間だけしか停滞し
ない。上述のラジアル軸受は、切断刃の両端にお
いて効果的なのであるが、刃が半径方向のみずみ
に対して堅固で、そしてその結果として穀粉状の
軟骨質のメニスカス物質又はその他の切削片は、
作動部材と固定部材間につまらなくなるようにな
る事が重要である。
好ましい実施例においては、切削口の軸線方向
の両端は固定した切削刃として形成されており、
また内部刃部材は、好ましくは切り込みのあるチ
ユーブの形で、両方向へ回転する際に切断できる
ようになつている。これにより、外科医は、望ま
しくない物質を除去するために膝関節内をどちら
の方向へも動かすことが可能になる。
さらに、望ましくは切削口の末端部と中心に近
い端部の両方が、器具の軸線方向の動きの際に物
質を除去しさらに流動体の流れの影響によつて切
削口へと自由に動くのに効果的であるようなそぎ
取りエツジになつている。本発明はまた、バツテ
リ動力を備えた装置のような、内部関節手術を最
適に実施する大きさの器具であることに特色を有
している。つぎに好ましい実施例を参照しながら
さらに詳細に説明する。
第１図、第２図を参照すると、本発明に係る外
科用器具１０が、膝蓋骨下方の関節内へ挿入され
た状態が示されている。同時に、フアイバー光学
装置１４が光源１２から関節の内部へ光を導き、
分離したフアイバーの管束に沿つて画像を転送す
る。画像は、記録カメラとさらに外科用の接眼レ
ンズへと向けて送られるが、この好ましい実施例
においては、画像はデイスプレイ１８を映し出す
テレビカメラ１６へと送られる。その画面を外科
医は自分の動作をコントロールするために観察す
る。こうして画面を観察し、第２図に示した外科
用器具と膝蓋骨を操作することによつて、この器
具はテレビ画面に示された滑液組織を切削するた
めに膝蓋骨下を前後に運動する。これのより詳細
な図は第８図に示し、またその説明は後述する。
手術の間、膝関節は、流体源２０によつて作ら
れる塩水の流体静力学的力によつて膨脹させられ
る。
本器具は、前述したような構造の重要な特徴に
よつて成功している。第３図乃至第７図を参照す
ると、好ましい実施例の器具は、ここでは外径
4.2mm、内径3.4mm、長さ約12.7mmの皮下管である
外被チユーブすなわち外側チユーブ部材２２を有
している。チユーブは、チユーブ物質によつて形
成された球形端部２４でもつてその端部が閉鎖さ
れている。一方、その中心に近い方の端部は、ハ
ウジング２６の端部に固着している。側面に設け
られた切削口２８は、チユーブの末端付近に形成
されており、その長さはＬが6.4mm、また弦の横
寸法ｄが3.2mmである。外被チユーブ２２の中の
内部チユーブすなわち内側チユーブ部材３２は、
切削口と摺動係合し、両端とは例えば0.025mm以
下の隙間を持つて接しながら伸縮自在に収容され
ている。刃の末端部と中心に近い端部において、
切削刃の内側チユーブ３２の末端部のリング３と
中央に近い端部のリング３５とは、内側チユーブ
３２を外被チユーブに軸支するラジアル軸受とな
つている。軸支リング３５の下流では、内部チユ
ーブ３２の外径は摩擦力を少なくするため研摩し
ているかの如く仕上げてある。リング３７は、リ
ング３３、リング３５と同様であるが、しかし内
部チユーブの中心に近い端部において外被チユー
ブに内部チユーブを軸支するために、軸受として
取付けられている。第６図に示す様に、切削刃を
提供するために、外被チユーブ内の切削口２８に
対応する内部チユーブの部分は削り取られてお
り、またこの切り欠き部分を通成する縁部は適当
に鋭利ならせん状剪断エツジ３４となる。第４
図、第６図と第７図と比較してわかるように、こ
れらの内部刃は刃が切削口の端を越えて重なり合
うように切削口より少し長くなつている。切削口
を境界付ける外被チユーブの長手方向の側部エツ
ジEeは、内部チユーブ上に形成されている切削
刃Eiとかみ合うように、同様に鋭利になつてい
る。内部チユーブは、外被チユーブを貫通してハ
ウジング２６の端面を越え、伝達部材３６へと延
びている。該伝達部材３６は、流体輸送粒子を放
出するために、内部チユーブの内口径に連結して
いるところの半径方向に広がつた貫通穴３８を有
している。ハウジング２６には、伝達部材３６が
設けられる中空室４０がある。そしてこの中空室
４０には、切削チユーブの回転位置にかかわらず
物質が容易に流れる真空源に連結している側面出
口部分４２がある。このように、切削口２８は、
切欠部、内側チユーブ部材、貫通穴３８および側
面出口部分４２を介して真空源に連通される。軸
方向に延びたスプライン４４は、伝達部材３６を
越えて延びており、駆動輪列５０から突出してい
る駆動部材４６に係合している。このように器具
は組立てられているが、内部チユーブハウジング
２６には、その中心に近い方の端部において、駆
動輪列５０の外周とねじ係合しているねじフイツ
テイング部分４８がある。駆動輪列５０は、第１
図に示してあるように、減速装置５２とモータ５
４とを有し、このモータは、遠隔位置に設置され
ていて可逆スイツチ５８によつて制御されている
電池によつて駆動される。
再び第３図について述べると、切削口において
外被チユーブの長手方向のエツジEeは、のこぎ
り状の切り込みが入れられていることがわかる。
これらの切り込みは、切削動作の際の軸方向の物
質と器具との間の相対的な動きを防止するのに役
立つている。一方切削口において、外被チユーブ
２２によつて形成されている中心部に近いエツジ
と末端エツジとは、それぞれ中心部に近い中心側
そぎ取りエツジSpと末端そぎ取りエツジSdとを
形成しながら切り取られている。
内部チユーブ３２が、切削片の両側において半
径方向の軸受リング３３と３５を有しているとい
う事は重要な事である。これらの軸受部分は、静
止エツジとの剪断方向の関係において半径方向の
ひずみを防ぐ事によつて切削刃の安全性を提供し
ている。（40分の１mm又は20分の１mm程度のオー
ダーの静止刃と回転刃との半径方向のわずかなひ
ずみも、膝から組織を切削するのに妨害となるこ
とが知られている。）また上述した如く、バツテ
リ駆動で低トルクの安全な機器によつて、好まし
いトルクを可能にするように、機器の摩擦力を低
くすることは、軸受の提供によつて可能となる。
第１図と第２図に示した手術の間、患者は局部
麻酔され、また套管カニユーレによつて関節付近
に好ましい身体の場所に貫通穴があけられる。流
体は関節部分を膨脹させるために、流体源２０か
ら一方のカニユーレへ導入され、またフアイバー
光学装置１４は、他方のカニユーレを通して挿入
される。第３のカニユーレには、第３図に示した
器具が挿入される。その器具とカニユーレの関係
は、第３図において点線で示されており、器具は
カニユーレに挿入時にロツクされて固定されてい
る。
ハウジングから側面出口部分４２を通過した流
れは、バルブ４３によつて制御される。外科医は
防爆モーターでもつて器具を挿入する。外科医が
膝関節の物質を切削したいときは、流体流を起す
ためバルブ４３を開き、切削のため組織に器具を
導入し、望ましい方向に切削刃が回転するように
フードペダル５８を踏む。第１図のテレビデイス
プレイ１８と第８図の拡大図に示すように、器具
は膝関節の膝蓋骨の下側の組織層を切削するため
に使用される。この器具と膝蓋骨との間の相対的
な動きは、器具を前後に運動させたり内外に器具
を押すことによるのと同じように、外科医の手に
よる膝蓋骨の動きによつても達成される。これら
の動作の間、切削口側面位置は観察用プローブに
よつて観察可能となつており、そして器具の閉鎖
端は、損傷の危険のない突き器具として用いられ
ている。流体流は切削された物質を切削口へと運
ぶ。そして切削刃は、100rpmから200rpmの範囲
で回転するのが効果的である。この回転によつ
て、第９図に示した様な「鉄道列車」式の連続物
として、器具内を通して流れに乗つて進むことの
できる分離した切削片６０を作ることができる。
内部チユーブの内径に関連して切削口を特定の寸
法にしてあることにより、また切削スピードによ
り、分離した切削片部分はつまることなく器具内
を進むことができる。非切削物質は、そのままの
姿を保つことによつて病理学者により迅速に分析
がなされる。
外科医は、第１図と第２図に示したように、こ
の器具を用いて手術を行う。滑液分泌組織が浮い
て水中で海草状になりうる量だけ置換できる様
に、膨脹用液体はその組織を活動的にさせる。器
具を動かすことにより、滑液分泌組織は連続的に
切削され、軸方向に反復する往復運動により促進
され、一方から他方へと進んでいく。このとき第
５図に示した方向に回転している切削刃では、残
存組織が効果的に切削できないという問題点が生
じるかも知れない。外科医は、その時逆回転する
ような方向にスイツチを動かす。そして、刃の反
対側のエツジは物質に達する事が可能なように切
削口の反対側において働く。この動作の間、器具
の球形端部はプローブとして役立ち、またプロー
ブで観察されたり経路からはみ出たような物質を
不注意によつて切らないようにしている。
第７ａ図を参照すると、この実施例において器
具の末端部は雪かき２４ａの形になつており、そ
して矢印の方向の軸方向の動きで物質を切削口２
８のある器具の側へ導く。この「かく」動作によ
つて、流体流は切削動作のため物質を切削口へ導
くのに効果的である。第１０図と第１１図には、
膝関節の裂けたゴム状メニスカスの軟骨を取り除
く際に関係している器具と、切削しにくい堅い物
質にも作用することができる真空切削器を図示し
ている。第１１図の点線は、メニスカスがしだい
に切削されて行くにしたがつて器具が進行する位
置を示してある。第１２図は、単に病害を取り除
く際の器具の進行動作を示している。第１３図
は、病害部分を平滑化するために脛骨の大皿と交
差している真空切削器を示している。第１４図
は、器具が矢印Ａの方向に押され膝蓋骨の下表面
Ｕに押えられているときのそぎ取り刃Spの動き
を示している。そぎ取り刃Spが物質を除去した
とき、その除去物は流体流の作用を受けて切削口
へ流され、器具を通つて患部から押し出される。
結論として、注意を払つて実験された多くの手
術がこの器具を用いて成功し、患者がすぐに歩け
る様になつたこと、無痛であること、あるいは膝
辺の軽症の貫通穴を除いては形跡が残らない事な
どに注目すべきである。
器具そのものは、コンパクトで丈夫で操作が静
かでまた、簡単に殺菌消毒することができる。
【図面の簡単な説明】
第１図は本発明に係る外科用器具を組立状態で
示す斜視図、第２図は外科医の手で操作される状
態を示す斜視図、第３図は器具の一部破断断面
図、第３ａ図は第３図の一部の側面図、第４図は
器具の先端部の拡大断面図、第５図は第４図の線
５−５に沿う断面図、第６図は内部チユーブの先
端部の拡大断面図、第７図は外被チユーブの先端
部の拡大断面図、第７ａ図は変形例による外被チ
ユーブの側面図、第８図は患者の組織と器具の端
面を示す端面図、第９図は器具を通して切削片を
移送する状態を示す外被チユーブの断面図、第１
０図、第１１図、第１２図は組織の障害による裂
け目と器具の端面を示す端面図、第１３図は脛骨
の皿と器具とを示す斜視図、第１４図は器具の切
削動作を示す側断面図である。 １０…外科用切削器具、２２…外被チユーブ、
２８…切削口、３２…内部チユーブ、３３，３５
…軸受、３４，Ee，Ei…剪断エツジ、４２…側
面出口部分、５４…駆動モータ。

Claims (1)

    【特許請求の範囲】
  1. １ 関節部を切開することなく関節鏡的に行う関
    節内手術のための外科用器具であつて、周壁部に
    切削口２８を有する外側チユーブ部材２２と、該
    外側チユーブ部材の中に回転可能に設けられた内
    側チユーブ部材３２と、該内側チユーブ部材と連
    通する真空源と、前記内側チユーブ部材を回転す
    るための駆動装置５４とを備えて成り、前記外側
    チユーブ部材は該外側チユーブ部材の長手方向に
    伸長して前記切削口２８を境界付ける側部エツジ
    Eeを有しており、前記内側チユーブ部材は前記
    切削口とほぼ整合する切欠部を有しており、また
    前記内側チユーブ部材は前記側部エツジEeとは
    周方向において対向する側において前記切欠部を
    境界付けかつ前記側部エツジEeとは平行せずに
    前記内側チユーブ部材の長手方向に伸長する切削
    刃Eiを有しており、更に、前記内側チユーブ部
    材は前記切欠部に関して長手方向において相対向
    した位置に設けられる１対のラジアル軸受部材に
    よつて前記外側チユーブ部材の中に支持されてお
    り、これによつて、前記内側チユーブ部材および
    前記切欠部を介する真空圧の影響により前記切削
    口の中に引き込まれた組織は前記内側チユーブ部
    材が回転するときの前記側部エツジおよび前記切
    削刃の相互作用により切削され、この切削された
    組織が前記真空圧により器具を通つて排出される
    ようになされたことを特徴とする外科用器具。
JP13723978A 1977-11-07 1978-11-07 Surgical cutting instrument Granted JPS5477493A (en)

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
US05/848,982 US4203444A (en) 1977-11-07 1977-11-07 Surgical instrument suitable for closed surgery such as of the knee

Publications (2)

Publication Number Publication Date
JPS5477493A JPS5477493A (en) 1979-06-20
JPS6137948B2 true JPS6137948B2 (ja) 1986-08-26

Family

ID=25304776

Family Applications (1)

Application Number Title Priority Date Filing Date
JP13723978A Granted JPS5477493A (en) 1977-11-07 1978-11-07 Surgical cutting instrument

Country Status (4)

Country Link
US (1) US4203444A (ja)
JP (1) JPS5477493A (ja)
DE (1) DE2848314C2 (ja)
GB (1) GB2007098B (ja)

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GB2007098B (en) 1982-05-06
US4203444B1 (ja) 1987-07-21
DE2848314C2 (de) 1982-12-23
US4203444A (en) 1980-05-20
JPS5477493A (en) 1979-06-20
DE2848314A1 (de) 1979-05-10
GB2007098A (en) 1979-05-16

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