KR101744459B1 - Surgical instrument set to perform the posterior biportal endoscopic spinal surgery - Google Patents

Abstract

The present invention relates to a surgical instrument set for posterior two-channel spinal endoscopic surgery. The set of surgical instruments for performing the posterior two-channel spinal endoscopic surgery of the present invention can secure and effectively maintain the two minimally invasive surgical holes in the surgical site, thereby avoiding unnecessary incisions in the skin or muscles, It is possible to perform surgery by inserting an endoscope and a surgical instrument capable of ensuring a visual field through the operation of the endoscope.

Description

{Surgical instrument set to perform the posterior biportal endoscopic spinal surgery}

The present invention relates to a surgical instrument set for posterior two-channel spinal endoscopic surgery.

Generally, the vertebra of the human body is a bone structure that forms the spinal column, and includes seven cervical spine, twelve thoracic vertebra, five lumbar vertebrae, , Which consists of a sacrum (补骨) with five sacrum (薦 精 椎), and a coccygeal bone (尾骨) with four cauda vertebrae (tail bone), which are connected by joints. And a disc (aka "disc"). These spines not only support the human posture while cushioning, but also serve as the basis of exercise and protect the organs of all organs.

In such vertebrae, when the intervertebral disc connecting the vertebrae is degenerated or ruptured and deviates from the normal position, or when the joint composed of the proximal vertebrae is damaged or deformed, the vertebrae are deformed and dislocated from the normal position It is known that external force is applied to the nerves passing through the spinal column, or when the nerve is pressed, it causes pain.

In particular, in patients with disc herniation called discs of the lumbar disc, if slight nerve compression or inflammation of the nerve periphery is the cause of pain, in the past, non-surgical treatment such as medication or physical therapy or pain injection therapy is performed, Or when the strength of the toe or ankle is significantly weakened, or when severe rupture of the disc or difficulty in moving the leg or paralysis is present. However, surgical spinal surgery is performed by incising the skin of the affected area and removing the escaped discs under general anesthesia, resulting in complications such as anesthesia complications, spinal anxiety and disk collapse, Spinal surgery has been performed with relatively large incisions or ruptures in the soft tissues, requiring long recovery times for patients.

Percutaneous endoscopic lumbar discectomy (PELD) and percutaneous endoscopic cervical discectomy (PECD) have been developed to overcome the problems associated with the surgical procedure described above. In other words, endoscopic disc removal is a state-of-the-art surgical technique in which a medical special endoscope made for vertebrae is inserted into a disc site and treated by removing the disc that is pressing the nerve while observing it with an endoscope monitor. The patient's satisfaction is very high due to the fact that the elderly patients are safe and have few scarring and adhesions at the surgery site and there is no scarring and the hospitalization period (within 3 ~ 4 days) is short and it is easy to return to daily life. Recently, the number of procedures is the highest among spinal surgery.

Especially, the two posterior spinal endoscopic procedures for the posterior segment are performed with two small treatment balls on the skin, so there is little tissue damage including muscles, there is little surgical infection, and there is an advantage of quick return to daily life after surgery. In addition, there is a difference from the one - channel spinal endoscopy which can be performed by putting a spinal endoscope and a surgical instrument into two operation balls. One pathway vertebral endoscopy is performed by inserting an endoscope and a device through a thin one-piece metal tube. Therefore, since there is limited scope and equipment to insert into a narrow pathway, There is a difficulty. However, the two-channel spinal endoscopic surgery is performed by inserting the endoscope and the surgical instrument into the different passages, so that it is easy to obtain the visual field and the procedure space, and it is possible to remove the surrounding tissues including the bones and remove the lesion in a difficult position.

The two-channel spinal endoscopy can treat almost all spinal diseases including spinal stenosis, spinal fusion, neurogenic stenosis, and disk removal, which are difficult to operate with conventional single-passaged vertebral endoscopy as well as disk removal.

Therefore, there is an urgent need to study surgical instruments that can effectively perform the above-described surgical procedure.

Korean Patent Registration No. 10-0942226 "Rod holder and minimally invasive surgical system for spine using the same" Korean Patent Laid-Open Publication No. 10-2007-0012706 entitled "

The present invention was developed to solve the problems of the prior art as described above. In the present invention, when performing percutaneous endoscopic lumbar disc removal or percutaneous endoscopic cervical disc removal, two procedures are performed by minimally invaginating We provide a set of surgical instruments that can be applied to the spinal surgery area by inserting a surgical instrument capable of ensuring endoscopy and visual field through the secured space, and to apply the posterior two-channel spinal endoscopic surgery to limit the movement of the surgical instrument. .

In order to realize the above object,

The present invention relates to a treatment space securing tool including an expanding tubular body expanding a treatment ball formed at a surgical site and a maintenance tubular body holding an expanded treatment ball; And

A cartilage remover for removing the cartilage attached to the bone, a nerve retractor for traction of the nerve at the surgical site, a cartilage remover for removing the cartilage attached to the bone, An inhaler for sucking out residue or liquid material generated during surgery and discharging it to the outside, a bone extractor for removing bone, a bone injector for injecting autogenous bone or an artificial bone substance, and a surgical instrument including a treatment ball expander for expanding the treatment ball The present invention provides a set of surgical instruments for posterior two-channel vertebral endoscopic surgery.

In this case, the extension tube separately includes an interpolation tube and an extracorporeal tube, and the interpolation tube has a sharp point formed at one end to reach the surgical site, a grip at the other end, a length longer than the extrapolation tube, The extracorporeal tubular body may be formed with a sharp portion at one end and a grasping portion at the other end in order to separate the tissue around the bone and secure a treatment space.

At this time, the maintenance tube includes an insertion portion and a projection, and the insertion portion is flexible as a portion to be inserted into the treatment hole, and the projection is a portion protruding outside the treatment hole and is harder than the insertion portion, Lt; / RTI >

At this time, the peeling machine and the lesion remover are each formed on both end portions of the first integral type mechanism, and the peeling machine is formed in a flat and rounded shape at one end of the first integral type mechanism, The distal end of the exfoliation device and the lesion remover may be bent toward the lower side in the direction of the surgical site.

At this time, the cartilage remover and the lesion remover are each formed at the ends of the second integral type device, the cartilage remover includes a blade part and is formed in a flat shape at one end of the second integral type device, And a distal end portion of the cartilage remover and the lesion remover may be bent to a lower side in a direction of a surgical site.

At this time, the nerve retractor may include a connection portion connected to the grip portion, bent to the lower side in the direction of the surgical site, and bent at the distal end toward the surgical site and formed with a flat pulling tip.

In this case, the inhaler may include a suction pipe portion connected to the grip portion, bent toward the lower side in the direction of the surgical site, and having a suction hole formed at the distal end thereof.

At this time, the bone resecting device may have a blade portion at one end, a grip portion at an intermediate portion, and a striking portion capable of being struck by another mechanism at the other end portion.

In this case, the bone injector includes an injection tube body having a funnel portion formed at one end thereof, an injection material storage portion formed on the funnel portion, and an injection tube portion connected to the funnel portion and having an injection hole formed at a distal end thereof, And a pushing portion for pushing the injection material in the air direction.

At this time, the surgical ball expander may be formed in the form of a closed rod having both ends rounded to secure a cage insertion path during interbody fusion operation.

The set of surgical instruments for performing the posterior two-channel spinal endoscopic surgery of the present invention can secure and effectively maintain the two minimally invasive surgical holes in the surgical site, thereby avoiding unnecessary incisions in the skin or muscles, It is possible to perform surgery by inserting an endoscope and a surgical instrument capable of ensuring a visual field through the operation of the endoscope.

BRIEF DESCRIPTION OF THE DRAWINGS Fig. 1 is a diagram showing the entire configuration of a surgical instrument set of the present invention. Fig.
2 is a view showing an extension tube of the present invention.
3 is a view showing a maintenance tube of the present invention.
4 is a view showing a first integrated device of the present invention.
Fig. 5 is a view showing a second integral type mechanism of the present invention. Fig.
6 shows a neurotractor of the present invention.
7 is a view showing the inhaler of the present invention.
8 shows an osteotomy device of the present invention.
9 is a view showing a bone injector of the present invention.
10 is a view showing a surgical ball expander of the present invention.

Hereinafter, embodiments of the present invention will be described in detail with reference to the accompanying drawings. However, the present invention is not limited to the embodiments described herein but may be embodied in other forms.

As used herein, the term "one end" means one end, and "the other end" means the opposite end of the other end. Also, the term "tubular" means having a shape of a tube, for example, a cylinder, and may be hollow or not hollow.

The surgical instrument set of the present invention is used in the posterior two-channel spinal endoscopic surgery, wherein the two posterior two-channel spinal endoscopic surgery forms two treatment holes in the back of the body of the human body, Since the surgical instrument set of the present invention is inserted into the operation hole, it is easy to secure the visual field and the procedure space, and it is possible to remove the surrounding tissues including the bone and to remove the lesion at a position difficult to approach.

The present invention relates to a treatment space securing device (100) comprising an extension tube (110) for expanding a treatment ball formed at a surgical site and a maintenance tube (120) for holding an expanded treatment ball; And

A peeler 211 for separating or peeling the surrounding tissues adjacent to the bone, muscle, adipose tissue, ligament or nerve, a lesion remover 212 or 222 for removing the lesion, a cartilage remover 221 for removing the cartilage attached to the bone, A neuro-retractor 230 for traction of the nerve at the operation site, an inhaler 240 for sucking out the debris or liquid material generated during the operation and discharging the same to the outside, a bone cutter 250 for cutting the bone, And a surgical instrument (200) including a bone injector (260) for injecting a substance and a surgical ball expander (270) for expanding the treatment ball. do.

Referring to FIG. 1, the rear two-pass vertebra operative surgical instrument set of the present invention includes an insertion tube 111, an expanding tube 110 including an extracorporeal tube 112, and a surgical procedure including a maintenance tube 120 A space retaining tool 100 and a peeler 211, a pathology removers 212 and 222, a cartilage remover 221, a neurotrainer 230, an inhaler 240, a bone cutter 250, And a surgical ball expander 270, as shown in FIG.

Referring to FIG. 2, the extension tube 110 is an operation site for an endoscopic spine surgery. When the surgical instrument approaches the skin, the extension tube 110 minimizes the skin incision at the initial surgery and does not approach the skin or muscle. And the extracorporeal tubular body 111 is separately formed so as to have a pointed end at one end and a grip at the other end to reach the surgical site, The extracorporeal tubular body 112 is formed with a sharp portion at one end and a grip at the other end in order to separate the tissue around the bone and secure a treatment space . Therefore, the extension tube 110 is configured to expand the treatment ball while sequentially inserting the surgical instrument into the treatment ball on the skin formed by using a needle at the surgical site. The extracorporeal tubular body 111 may be a cylindrical shape having only a diameter because the hollow is not hollow, and the extracorporeal tubular body 112 may have a tubular shape having an outer diameter and an inner diameter because the hollow is hollow. The extracorporeal tubular body 112 may have an inner diameter of 6 to 7 mm, an outer diameter of 7 to 9 mm, and a length of 150 to 170 mm. The diameter of the insertion tube body 111 may be 5 to 6 mm and the length may be 160 to 180 mm. Lt; / RTI >

The extracorporeal tubular body 112 is extruded into the inserted tubular body 111 after inserting the treatment ball formed on the skin with needles using a pointed one end of the interpolative tubular body 111 to a desired depth. When the extracorporeal tubular body 112 is extrapolated by the depth of the interpolative tubular body 111 on the procedure tube, the interpolative tubular body 111 is exposed on the extracorporeal tubular body 112 and the externally tubular body 111 is taken out Or may be omitted. In this manner, the treatment ball can be expanded while inserting the interpolation tube 111 and the extracorporeal tube 112 in order.

At this time, a gripping portion is formed on the other end of the extracorporeal tube 112 and the interpolation tube 111, and a plurality of depressions may be formed in the gripper portion to facilitate gripping.

In this way, the operation hole can be expanded to an appropriate size by using the extension tube 110, and the operation can be performed by inserting the surgical instrument through the extension tube 110, particularly, the extracorporeal tube 112. Or the extracorporeal tubular body 112 is inserted into the treatment hole, the tissue around the bone is separated and removed from the sharpened end, the retention tube 120 is inserted into the treatment hole, and the surgical instrument is inserted through the retention tube 120 The operation can be performed by inserting it into the treatment ball.

3, the maintenance tube 120 includes an insertion portion 121 and a projection 122. The insertion portion 121 is flexible as a portion to be inserted into a treatment hole, And a cleaning liquid outlet 123 may be formed on the protruding portion 122. The protruding portion 122 may be formed with a plurality of protrusions. The maintenance tube 120 may be in the form of an empty tube, and the maintenance tube 120 may be inserted into the expansion hole of the extension tube 110 to secure and maintain a stable operation channel. The insertion portion 121 of the maintenance tube 120 may be inserted into the operation hole when the insertion portion 121 is inserted into the operation hole and may be disposed inside the body of the user. The portion 121 is preferably formed of a flexible material such as rubber. At this time, the protrusion 122 protrudes outside the treatment ball to support the maintenance tube 120 on the skin. The protrusion 122 is formed of a hard material such as plastic for ensuring the view of the treatment space and easy insertion of the surgical instrument. . In addition, since a liquid or a washing liquid generated in a surgical procedure may be interfered with the field of view of the operator when formed in the holding tube 120, the washing liquid outlet 123 may be formed on the protrusion 122. A valve is formed in the cleaning liquid discharge port 123 so that the valve can be opened and discharged only when it is necessary to discharge the cleaning liquid or the like. The diameter of the protrusion 122 may be 20 to 30 mm and the length of the holding tube 120 may be 50 to 100 mm.

The procedure space securing tool 100 is provided as the extension tube 110 and the maintenance tube 120 described above.

4, the peeler 211 and the lesion remover are respectively formed at both ends of the first integrated device 210, and the peeler 211 is disposed at one end of the first integrated device 210 And the lesion remover is a first lesion remover 212 formed in a flat shape at the other end of the first integrated device 210. The end of the lesioner 211 and the lesion remover may be formed by a surgical operation And can be bent toward the lower side in the site direction. The first integrated device 210 is a multifunctional device including both a peeler 211 and a first lesion remover 212 at both ends and is a multifunctional device that simultaneously includes a peeler 211 at both ends or a first lesion remover (212) can be alternately used. In addition, the first integrated device 210 may be knurled or a plurality of depressed portions may be formed in the intermediate portion to facilitate gripping.

The peeler 211 separates or exfoliates bone, muscle, adipose tissue, ligaments, or adjacent tissues adjacent to the nerve, and does not damage the bones and muscles, and is formed so that the ends are not excessively sharp and rounded It is preferable to flatten. Also, the distal end of the peeling machine 211 may be bent to the lower side in the direction of the surgical site to secure the view of the surgeon during surgery, and the bending angle is preferably 135 to 145 degrees, but is not limited thereto. Can be used.

The first lesion remover 212 separates or exfoliates the lesion. It is preferable that the first lesion remover 212 is flat to effectively remove the lesion without damaging the bones and muscles. In addition, the end of the lesion remover may be bent to the lower side in the direction of the surgical site in order to easily secure the field of view of the practitioner during operation and easily remove the lesion or the lesion formed on the back of the nerve, But it is not limited thereto and can be adjusted within a suitable range.

5, the cartilage remover 221 and the lesion remover are respectively formed at both ends of the second integral type device 220. The cartilage remover 221 includes a blade part 251 and the second integral type device 220 and the lesion remover is formed in the shape of a hook on the other end of the second integral type device 220. The cartilage remover 221 and the lesion The distal end of the eliminator can be bent to the lower side in the direction of the surgical site. The second integrated device 220 is a multifunctional device that includes a cartilage remover 221 and a second lesion remover 222 at both ends at the same time. The cart is provided with a cartilage remover 221 or a second lesion remover (222) can be alternately used. In addition, the second integrated type mechanism 220 may be formed by a knurling process or a plurality of depressed portions to facilitate gripping the intermediate portion.

The cartilage remover 221 is not limited to this, but may be configured to include a blade 251 and be formed to be flat when separating or removing the cartilage attached to the vertebral end plate during interbody fusion. In addition, the distal end of the cartilage remover 221 may be bent to the lower side in the direction of the surgical site to secure the view of the surgeon during the surgery, and the angular bending angle is preferably 110 to 130 degrees, but is not limited thereto, Can be used.

The second lesion remover 222 removes or removes a lesion, and is preferably in the form of a hook to remove a lesion located in a place where the lesion eliminator of a flat type does not damage the bones and muscles and is difficult to reach Do. In addition, the end of the lesion remover may be bent to the lower side in the direction of the surgical site in order to easily secure the field of view of the practitioner during operation and easily remove the lesion or the lesion formed on the back of the nerve, But it is not limited thereto and can be adjusted within a suitable range.

Referring to FIG. 6, the nerve retractor 230 is connected to the grip portion 232, is bent to the lower side in the direction of the surgical site, is bent again toward the surgical site, . The bending angle of the connecting portion is preferably 80 to 110 ° in order to secure the visibility of the operator, but is not limited thereto and may be adjusted within a suitable range. Further, the bending angle of the pulling tip 231 is preferably 110 to 130 ° to facilitate pulling, but is not limited thereto and may be adjusted within a suitable range.

Referring to FIG. 7, the inhaler 240 sucks the wash water to be sprayed and the residues, liquid substances, and the like generated during the surgery without leaving it at the surgical site and discharges it to the outside. The suction unit 240 may include a suction pipe unit 242 connected to the grip unit 232 and bent toward the lower side in the direction of the surgical site to secure a view of the operator and having a suction hole 241 at a distal end thereof. In addition, the suction unit 240 is configured to selectively use a suitable size according to the size of the residue to be removed. The bending angle is preferably 130 to 150 °, but is not limited thereto and may be adjusted within a suitable range. The inhaler 240 may use various sizes depending on the situation.

Referring to FIG. 8, a cutter 251 is formed at one end of the bone cutter 250 to remove bone of the vertebral body covering the nerve tissue during interbody fusion, and a grip portion 232 And a striking portion capable of striking with another mechanism can be formed at the other end portion. The blade portion 251 may be flat without being bent, and the blade portion 251 may contact the bone to be cut, and the bone may be excised by striking the striking portion with another mechanism such as a hammer.

9, the bone injector 260 includes a funnel portion 264 formed at one end thereof and an injection material storage portion 263 formed on the funnel portion 264 and connected to the funnel portion 264 And an injection tube 262 including an injection tube 265 formed at the end thereof and a pusher 261 for pushing the injection material from the funnel 264 toward the injection hole. The bone inserter 260 may be used for inserting an autogenous bone or an artificial bone component into an unfilled gap after a cage is inserted during interbody fusion.

Referring to FIG. 10, the surgical ball expander 270 may be formed in the form of a closed rod having both ends rounded to secure a cage insertion passage during interbody fusion. When the treatment ball is extended to the extension tube 110 and a cage larger than the diameter of the maintenance tube 120 is inserted into the treatment hole while the tube is maintained by the maintenance tube 120, The diameter of the holding tube 120 can be increased by inserting the holding tube 120 into the holding tube 120. Since the insertion portion 121 of the maintenance tube 120 is made of a soft material such as rubber, the diameter of the insertion portion 121 may be larger when the surgical ball expander 270 is inserted. The surgical ball expander 270 may use various sizes depending on the situation.

The cartilage remover 221, the neuro-retractor 230, the inhaler 240, the bone osteotome 250, the bone injector 260, and the surgical ball expander 270 are provided to provide a surgical space securing tool 100 and a surgical instrument 200 according to the present invention to constitute a set of surgical instruments for posterior two-channel spinal endoscopic surgery.

100: Procedure space securing tool 110: Expansion tube
111: interpolation tube 112: extrapolation tube
120: maintenance tube 121: insertion part
122: protrusion 123: cleaning liquid outlet
200: Surgical instrument 210: First integrated instrument
211: peeler 212: first pathology remover
220: second integrated device 221: cartilage remover
222: second lesion remover 230: nerve retractor
231: Towing tip 232:
240: inhaler 241: inhaler
242: Suction tube 250: Bone cutter
251: Flap 260: Bone injector
261: Whetstone 262: Injection pipe
263: Injection material storing section 264: Funnel section
265: injection tube 270: surgical ball expander

Claims (10)

A surgical space securing tool including an expanding tube extending a surgical hole formed in a surgical site and a maintenance tube holding an expanded surgical hole; And
A cartilage remover for removing the cartilage attached to the bone, a nerve retractor for traction of the nerve at the surgical site, a cartilage remover for removing the cartilage attached to the bone, An inhaler for sucking out residue or liquid material generated during surgery and discharging it to the outside, a bone extractor for removing bone, a bone injector for injecting autogenous bone or an artificial bone substance, and a surgical instrument including a treatment ball expander for expanding the treatment ball ≪ / RTI >
The extension tube separately includes an interpolation tube and an extracorporeal tube. The interpolation tube has a pointed end at one end to reach the surgical site and a grip at the other end. The extension tube is longer than the extracorporeal tube, Wherein the extracorporeal tubular body is formed with a sharp portion at one end and a grip at the other end to secure a treatment space by separating the tissue around the bone. delete The method according to claim 1,
Wherein the holding tube body includes an insertion portion and a projection portion, the insertion portion is flexible as a portion to be inserted into the treatment hole, the projection portion is a portion protruding outside the treatment hole and is harder than the insertion portion, Wherein the at least one posterior two-channel vertebral endoscopic surgical instrument is a surgical instrument. delete The method according to claim 1,
Wherein the cartilage remover and the lesion remover are each formed on both ends of the second integral type device, the cartilage remover includes a blade part and is formed in a flat shape at one end of the second integral type device, And a distal end of the cartilage remover and the lesion remover is bent to the lower side in the direction of the surgical site. delete The method according to claim 1,
Wherein the inhaler includes a suction pipe portion connected to the grip portion and bent toward a lower side in a direction of a surgical site and having a suction hole formed at a distal end thereof. The method according to claim 1,
Wherein the bone resecting device comprises a knife portion formed at one end thereof, a grip portion formed at an intermediate portion thereof, and a striking portion capable of being struck by another mechanism formed at the other end portion thereof. The method according to claim 1,
Wherein the bone injector comprises: an injection tube having a funnel portion formed at one end thereof and an injection material storage portion formed on the funnel portion, the injection tube portion being connected to the funnel portion and having an injection hole formed at an end thereof; And a pushing portion for pushing the injected material into the atrium. The method according to claim 1,
Wherein the surgical ball expander is formed in the form of a closed rod having both ends rounded in order to secure a cage insertion path during interbody fusion surgery.

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