KR0137223B1 - Surgical clip - Google Patents

Abstract

Technical Field

The present invention relates, for example, to an improved surgical clip for clamping vascular tissue to separate brain aneurysms.

Background of the Invention

The cerebral aneurysm clip is a surgical instrument that forceps the base of the cerebral aneurysm to temporarily or permanently separate the base of the cerebral aneurysm from the cerebral artery.

To achieve this, the clip must maintain forceps pressure with great reliability without damaging the walls of blood vessels.

Possible causes of damage include shearing of clamping jaws due to improper jaw alignment, improper forceps pressure, cracks in the clip material and introduction of foreign material into the cracks, tissue. Surface defects that can tear, and the use of inappropriate materials.

Various cerebral aneurysm clips are known in the art.

In general, however, these clips have the disadvantage of being undesirable for use as designed.

To provide satisfactory and long-term service when properly implanted, cerebral aneurysm clips should, among other things, meet the following criteria.

1. Forceps pressure in the encounter of the clip should be sufficient to separate the aneurysm, but not high enough to damage the vessel wall during temporary or permanent implantation.

2. Forceps pressure of the clip should be kept constant over a long period of time to prevent slipping or displacement of the clip.

3. The clip should be small enough to be permanently implanted in the brain.

4. The material of the clip structure is to be nonmagnetic so that magnetic resonance does not interfere with the imaging.

5. The shape of the clip should not interfere with the physician's vision during implantation.

6. Clips should be designed to facilitate proper application implantation.

7. In order to prevent spontaneous cutting and pressure points, the non-uniform ends shall not be on the surface of the clip.

8. The surface of the clip shall be free of cracks and cracks from which foreign debris and contaminants are introduced and which are prone to spread by stress erosion.

9. Proper encounter alignment should be maintained at all times to prevent vascular tissue shearing between encounters.

Base clips without provision for maintaining encounter alignment, as disclosed in US Pat. No. 3,827,438, US Pat. No. 4,024,868 or US Pat. No. 4,340,061, are not suitable for implantation under the above criteria.

Numerous aneurysm clips with variously designed encounter guides have been proposed and are being usefully used.

In this solution to encounter alignment, problems arise with other criteria for acceptable aneurysm clips.

U.S. Patent No. 4,484,581 discloses one clip that limits the movement of another arm through the window in an arrangement similar to an electric clamp in one arm.

The window is formed as a recess in one arm that is connected by a plate-shaped piece attached to an arm having a recess.

This typical clip is formed of a wide metallic strip, which obstructs the physician's field of view and hinders precise forceps fixation of the arterial base.

When the size of the clip is reduced to the size of a typical brain implant (1-2 nm wide, 0.5-2 cm long), the clip provides sufficient strength to the material forming the window frame and to the thin portion of the arm passing through the window frame. It is made of stainless steel.

The use of stainless steel is undesirable for brain transplantation because its magnetic properties interfere with magnetic resonance imaging.

The use of highly desirable graft grade titanium 6-A1 4-V alloys avoids this problem but introduces another problem.

Typically the recess in the window arm is formed by making the width of the arm less than half the full width of the arm.

The guided arm is similarly manufactured to fit inside the window.

The reduction in the width of the arms significantly weakens the arms, resulting in stress concentrations.

In addition, titanium metals and alloys thereof are notches that are sensitive to phase separation and undergo phase separation when mechanized.

The mechanical processes used to form the sharp edges of the recesses and the guide means result in the generation and propagation of micro cracks on the metal surface and increase the likelihood that these styled clips are unsuitable for use as brain implants.

Wire guide means are disclosed in US Pat. No. 4,360,023.

The wire inhibits the movement of the arm in a similar manner to the window in the arm of the clip in US Pat. No. 4,484,581.

The method of securing the wire in the clip is to drill two holes in one arm and then rivet the wire ends into this hole.

In the machining zone of the clip described above, this arrangement is susceptible to microcracks at the perimeter of the holes and also in the riveting zones.

Due to the resulting potential for propagating cracks and unnecessary dirt trapping in the cracks, this type of clip is unsuitable for safe implantation.

U.S. Patent No. 4,192,315 discloses an aneurysm clip in which the forceps of the clip are supported by an arm across the ring loop. Such clips suffer from a number of problems. First, the curved guide portion protrudes from the clip, unduly obstructs the physician's field of view, and the clip's arm can be narrowed in the transverse zone to allow the use of smaller, non-obtrusive rings. Reduces the strength of the clip and the ability to maintain the desired forceps pressure.

The ring must also be loose to allow free movement of the arm across the ring.

Therefore, the ring may fail to accurately guide the forceps to avoid shearing the tissue between the forceps.

Finally, if the clip is formed of a very desirable titanium metal or titanium alloy, the welding of the ring will have weak strength and irregular surface problems.

Summary of the Invention

The surgical clip according to the present invention is formed of a continuous elastic member and includes two arms and a coil spring between the arms.

The first arm has (i) a bend extending along an axis extending along the longitudinal direction of the clip and (ii) a forceps jaw extending from the bend at the free end of the elastic member.

The second arm extends along (i) the coollip axis and is bent from the bend of the first arm on the opposite side of the clip axis, (ii) the first arm extends from and through the bend of the second arm. A curved guide portion, and (i) a forceps jaw extending from the curved guide at the second free end of the elastic member.

The two bends are elastically deformable at their positions with respect to the clip axis.

A coil spring located between the first and second bends presses the forceps jaws.

In a preferred embodiment of the present invention, the clip is formed of a material which is nonmagnetic and compatible with body tissue, for example titanium metal or titanium alloy.

Description

Surgical clip

1 and 2 are a plan view and a bottom view of a first embodiment of a surgical clip according to the present invention,

3 and 4 are a plan view and a side view of the elastic member that can be formed in the first and second degrees,

5 is a perspective view of the second embodiment of the surgical clip according to the present invention,

6 is a plan view of the surgical clip shown in FIG.

Referring to the drawings, the surgical clip 10 shown in FIGS. 1 and 2 manufactured in accordance with the present disclosure is shown in FIGS.

It is formed of the continuous elastic member 12 shown in FIG.

The clip 10 includes a first arm 14, a second arm 16, and a coil spring 18.

The arm 14 is comprised from the bending part 20 and the forceps jaw 22.

The bend 20 extends along an axis 24 extending along the longitudinal direction of the clip 10.

For the embodiment of the present invention shown in FIG. 1, the bent portion 20 extends away from the axis 24 and extends away from one end of the coil spring 18, interior of the first straight length portion 26. The elbow 28 bent toward the side and the second straight length portion 30 extending across the shaft 24 toward the elbow 31 and then towards the forceps jaw 22 at one free end of the elastic member 12. It includes.

The 2nd arm 16 is comprised from the bending part 32, the curved guide part 34, and the forceps jaw 36. As shown in FIG.

The bend 32, which is the same as the bend 20, extends symmetrically about the bend 20 along the axis 24 and about the axis 24, the first straight length 38, It includes an elbow 40 bent inwardly and a second straight length portion 42 extending toward the axis 24 and ending at the elbow 44 before the transverse axis 24.

The curved guide portion 34 extends across the axis 24 and from the bend 32 approximately perpendicular to the axis 24 around the arm 14.

In particular, the curved guide portion 34 has a reverse bend 46 extending from the elbow 44 across the axis 24 and leading to another elbow 48 from which the forceps jaw 36 extends.

Portions of the curved guide portion 34 are shaped and dimensioned such that the arms 14 extending through the curved guide portion are in contact with the curved guide portion but can slide within the curved guide portion.

In addition, the reverse bend 46 is positioned such that when the jaws 22 and 36 are pressed against each other, the jaws 22 and 36 are contacted before the arm 14 comes into contact with the inner surface of the reverse bend. .

In the illustrated embodiment of the invention, the curved guide portion 34 is an open loop that does not completely surround the arm 14.

The coil springs 18 located between the lengths 26 and 38 of the arms 14 and 16 press the bends 20 and 32 apart with a predetermined amount of force and press the forceps 22 and 36 in close contact, respectively. do.

In the illustrated embodiment of the present invention, the forceps jaws 22 and 36 are disposed on opposite sides of the shaft 24.

The forceps (22, 36) are separated by force using a suitable tool and moved away from the shaft (24), which forces the elbows (28, 40) inward to each other with respect to the action of the spring (18). It is.

When the separate forceps (22, 36) are properly positioned around the tissue to be forceps fixed, the force exerted on the elbows (28, 40) is released and the coil spring (18) is fixed between the forces (22,36) and them. Press the prepared tissues into close contact.

As mentioned above, when closing the clip or when the clip is in a forceps locked position, the misalignment of the jaws 22,36 causes damage to the forceps fixed tissue with shear by the jaws 22,36 and is effective. The reduced forceps results in incomplete separation of the forceps-fixed tissue.

The loop 34 functions to restrict the arm 14 in two directions of freedom to move relative to the arm 16 to prevent the misalignment of the jaws 22 and 36.

As the length 30 of the arm 14 extends through the curved guide portion 34, it firmly and elastically contacts the curved guide portion 34.

This elastic contact is maintained as the length 30 slides through the bent guide portion 34 during opening and closing of the clip 10 and along the longitudinal direction of the bent guide portion.

Thus, the arms 14 and 16 allow only two degrees of freedom to be moved to ensure alignment of the jaws 22 and 36 during positioning and implantation of the clip 10.

5 and 6 are, respectively, a perspective view and a plan view of a second embodiment of a surgical clip according to the present invention.

Except that the curved guide portion of the second embodiment is formed differently from the curved guide portion in the first embodiment, this embodiment of the invention is generally the same as the embodiment of the invention illustrated in FIGS. similar.

In the surgical clip illustrated in Figs. 1 to 4, the surgical clip 60 shown in Figs. 5 and 6 is formed of a continuous elastic member as shown in Figs. , A first arm 64, a second arm 66, and a coil spring 68.

The arm 64 includes a bent portion 70 and a forceps jaw 72. The bend 70 extends along an axis 74 extending along the longitudinal direction of the clip 60.

In the embodiment of the present invention shown in FIGS. 5 and 6, the bent portion 70 extends away from the axis 74 and extends away from one end of the coil spring 68. ), One free end of the elbow 78 bent inwardly, and a continuous elastic member across the shaft 74 towards the elbow 82 and then a surgical clip formed.

A second straight length portion 80 extending toward the forceps jaw 72 at the end is included.

The arm 66 includes a bent portion 84, a bent guide portion 86, and a forceps jaw 88.

The bend 84 extends along the axis 74 opposite the bend 70 and extends away from the second end of the coil spring 68 to a first straight length 90, inwardly curved yellow ( 92 and a second straight length portion 94 extending across the axis 74.

The bent guide portion 86 extending from the bend 84 and extending so that the straight length 80 of the bend 70 passes therethrough is the reverse bend 96, the straight length 97, and the second reverse bend. A portion 98, and a second straight length portion 99 and ends in the elbow 100 extending forceps jaw 88 at the second free end of the continuous elastic member on which the surgical clip is formed. In the embodiment of the present invention as illustrated in FIGS. 5 and 6, the bent guide portion 86 extends in parallel to the straight length portion 94 of the bend portion 84 and the straight length of the bent portion 70. It is in the form of a flat ovate surrounding the portion 80.

The portions of the bent guide portion 86 are preferably shaped and dimensioned such that the arms 64 extending through the bent guide portion are in contact with the bent guide portion but can slide within the bent guide portion.

The reverse bend 96 is positioned so that the arm 64 contacts the inner surface of the reverse bend 96 after the forceps jaws 72 and 88 are brought into contact when pressed against each other.

Coil springs 68, located between lengths 76 and 90 of arms 64 and 66, are pressed against the forceps jaws 72 and 88 by dropping bends 70 and 84, respectively, with a predetermined amount of force. do.

In the embodiment of the present invention illustrated in FIGS. 5 and 6, the forceps jaws 72, 88 are disposed on opposite sides of the shaft 74.

Forceps (72, 88) are separated by applying a force using a suitable tool and moved away from shaft (74), which forces elbows (78, 92) against each other with respect to the action of spring (68). To attract.

When the separated forceps (72,88) are properly positioned around the forceps to be clamped, the force exerted on the elbows (78,92) is released and the coil spring (68) between the forceps (72,88) and them It is pressurized to adhere the tissue fixed to it.

The curved guide portion 86 functions to restrict the arm 64 in two directions of freedom to move relative to the arm 66 to prevent unalignment of the forceps (72, 88).

As the length 80 of the arm 64 extends through the guide portion 86, the length portion 80 at the top and bottom faces the lengths 97,99 of the guide portion between the reverse bends 96.98. ).

This contact is maintained as the claw 80 slides along the length of the bent guide portion 86 during opening and closing of the clip 60.

Thus, arms 64 and 66 are limited to move in two directions of freedom to ensure alignment of forceps jaws 72 and 88 during positioning and implantation of clip 60.

In a preferred embodiment of the present invention, the elastic member 12 is made of titanium metal or titanium alloy that is nonmagnetic and compatible with body tissues and body fluids.

However, other materials having desirable properties can be used for clips made in accordance with the present invention.

Incidentally, surgical clips constructed in accordance with the present invention may take other forms from one form described and illustrated to suit a particular required application.

For example, the forceps jaws may be oriented at an angle or the jaws themselves may be of a curved shape suitable for the shape and position of the forceps being fixed.

In the above, the exemplary and preferable embodiment of this invention was proposed.

It is contemplated that the present invention may be modified in various ways by those skilled in the art without departing from the spirit and scope of the present invention.

Claims (34)

16. A surgical clip formed along a shaft and composed of a single continuous elastic member, free of mechanical processing or material addition, or joining operations, the coil spring being positioned on the shaft and at one end of the clip; (Iii) extending from the spring to the point farthest from the grip axis and extending toward the clip axis and disposed longitudinally along the clip axis, elastically deformable from its position with respect to the clip axis, and a first arm A first bending portion forming a first forceps-gripping elbow at a point furthest from the clip axis at (ii) a first forceps jaw located at one free end of the elastic member, and (iii) A first arm having a guided element that makes only a simple direction change of less than 180 degrees between the first forceps-fixed elbow and the first forceps; And (iii) extends from the spring to the point farthest from the clip axis and then toward the clip axis, and is disposed in the grinding direction along the clip axis on an opposite side of the clip axis from the first bend, with respect to the clip axis. A first bend that is elastically deformable from its position and forms a second forceps-fixed elbow at a point farthest from the clip axis at the second arm, (ii) located at the second free end of the elastic member A second forceps jaw, and (iii) between the second forceps-fixed elbow and the second forceps jaw, two points essentially located on a plane on one side of the guided element and a third point being guided Located on the opposite side of the element, i.e. limiting the movement of the guided element at three points, the image of the guided element A second arm having a curved guide portion for limiting the movement in two directions of freedom; wherein the coil spring is positioned between the first and second bends and presses the first and second forceps towards each other. Surgical clip characterized in that 2. The forceps of claim 1 wherein said first forceps jaw and said second forceps jaw are each straight and of equal length, ending at the free end of said resilient member at the same position along said clip axis, and fixing forceps in contact with tissue. Surgical clip, characterized in that each facing the plane toward the opposite forceps. The surgical clip of claim 2, wherein the elastic member is formed of a material compatible with body tissues and body fluids. The surgical clip of claim 2, wherein the elastic member is a nonmagnetic material. The surgical clip of claim 4, wherein the nonmagnetic material is titanium. The surgical clip of claim 4, wherein the nonmagnetic material is a titanium alloy. 3. Surgical clip according to claim 2, wherein the forceps are symmetrically disposed on opposite sides of the axis when pressed against each other by the coil spring. 8. Surgical clip according to claim 7, wherein each of the forceps is disposed opposite the axis with respect to the bending portions they extend from. The method of claim 8, wherein the first bent portion; (Iii) a first integrally connected to said coil spring at one end, extending away from said coil spring at an oblique angle at said clip axis, and integrally connected to said first forceps-fixed elbow at its opposite end; (Ii) a second straight length portion integrally connected to said first forceps-fixed elbow at one end and extending at an oblique angle towards said clip axis, said second bend portion; (Iii) a third integrally connected to the coil spring at one end, extending away from the coil spring at an oblique angle at the clip axis, and integrally connected to the second forceps-fixed elbow at its opposite end Integrally connected to the second forceps-fixed elbow at one end with the straight length part and integrally connected to the bent guide part at the opposite end thereof and extending toward the bent guide part at an inclination angle with respect to the clip axis; A surgical clip further comprising a fourth straight length portion. 10. The surgical clip of claim 9, wherein the first arm extends through the curved guide portion of the second arm. 3. The surgical club according to claim 2, wherein the elastic member has a dimension within a range in which a brain can be transplanted. The surgical club of claim 1, wherein the curved guide portion surrounds the first arm. 13. The surgical club according to claim 12, wherein the curved guide portion is flat and ovoid. 15. The forceps of claim 13, wherein the first forceps jaw and the second forceps jaw are each straight and of the same length, terminate at the free end of the elastic member at the same position along the clip axis, and contact and fix the forceps. Surgical clips, characterized in that the planes facing each other to face opposite forceps The surgical clip of claim 13, wherein the elastic member is formed of a material compatible with body tissues and body fluids. The surgical clip of claim 13, wherein the elastic member is a nonmagnetic material. The surgical clip of claim 16, wherein the nonmagnetic material is titanium. 17. The surgical clip of claim 16, wherein the nonmagnetic material is a titanium alloy. 14. A surgical clip according to claim 13, wherein the forceps are disposed symmetrically on opposite sides of the axis when pressed against each other by the coil springs. 20. A surgical clip according to claim 19, wherein each of the forceps is disposed opposite the axis with respect to the bending portions they extend from. The method of claim 20, wherein the first bent portion; (Iii) a first straight line integrally connected to said coil spring at one end, extending away from said coil splice at an oblique angle at said clip axis, and integrally connected to said first forceps-fixed elbow at its opposite end; And (ii) a second straight length portion integrally connected to said first forceps-fixed elbow at one end and extending toward said clip axis at an oblique angle, and said second bend portion; (iii) A third straight length portion integrally connected to the coil spring at one end and extending away from the coil spring at an inclination angle at the clip axis, and integrally connected to the second forceps-fixed elbow at its opposite end, and ( Iii) integrally connected to the second forceps-fixed elbow at one end and integrally connected to the bent guide at its opposite end; The extending in a tilt angle for the bending guide ripchuk toward the surgical clip 4, characterized in that further comprises a straight length portion 22. The surgical clip of claim 21, wherein the first arm extends through the curved guide portion of the second arm. 23. The surgical clip of claim 22, wherein a dimension of said elastic member is in a range capable of brain transplantation. The surgical clip of claim 1, wherein the curved guide portion is open. 25. The method of claim 24, wherein the second forceps jaw and the second forceps jaw are each straight and of the same length, end at the free end of the elastic member at the same position along the clip axis, and face to contact and fix forceps to the tissue. Surgical clip characterized in that each facing the plane to the forceps. 25. The surgical clip of claim 24, wherein said elastic member is formed of a material compatible with body tissues and body fluids. The surgical clip of claim 24, wherein the resilient member is a nonmagnetic material. 28. The surgical clip of claim 27, wherein the nonmagnetic material is titanium. 28. The surgical clip of claim 27, wherein the nonmagnetic material is a titanium alloy. 25. The surgical clip of claim 24 wherein the forceps are disposed symmetrically on opposite sides of the axis when pressed against each other by the coil springs. 31. The surgical clip of claim 30, wherein the forceps are each disposed on opposite sides of the axis with respect to the bending portions they extend from. 32. The device of claim 31, wherein: the first bent portion is integrally connected to the coil spring at one end and extends away from the coil spring at an inclination angle at the clip axis, the first forceps at its opposite end. A first straight length portion integrally connected to the fixed elbow, and (ii) a second straight length portion integrally connected to the first forceps-fixed elbow at one end and extending toward the clip axis at an inclination angle, The second bend is integrally connected to the coil spring at one end and extends away from the coil spring at an inclination angle at the clip axis and integrally connected to the second forceps-fixed elbow at its opposite end; (3) integrally connected to said second forceps-fixed elbow at one end and said bent guide portion at its opposite end And integrally linked to, a surgical clip to that further comprises an inclination angle with respect to the time axis of the curved guide which extends toward the fourth straight length portions to feature 33. The surgical clip of claim 32, wherein the first arm extends through the curved guide portion of the second arm. 25. The surgical clip according to claim 24, wherein the elastic member has a dimension in a range capable of brain transplantation.