KR102186438B1 - High-frequency nerve stimulation device for pain treatment accessing through epidural space - Google Patents

Abstract

The present invention relates to an epidural catheter device and a nerve stimulation device for pain treatment. The catheter device includes: a grip casing having a steering lever; An entry catheter fixed to the gripping casing and extending in the longitudinal direction and having a tip tip at the extension end; A steering wire fixed to the tip tip and extending into the gripping casing and connected to the steering lever; A power induction unit that connects the steering wire to the electric energy output unit so that electric energy generated from the electric energy output unit is applied to the tip tip through the steering wire; When the electric energy is output from the tip, it includes a temperature sensing unit for sensing the temperature of the tip.
The epidural access-type catheter device for pain treatment of the present invention and a nerve stimulation device having the same made as described above outputs electrical energy to the nerve through a metal tip that moves along the epidural space in the body, so it is more burdensome than percutaneous surgery. There is little and no worry of nerve damage. In addition, when a lesion is detected, the motor and sensory nerves are distinguished through electrical stimulation for each frequency, and the high frequency is concentrated on the sensory nerves, so the therapeutic effect is excellent.

Description

An epidural access-type catheter device for pain treatment and a nerve stimulation device equipped with the same {High-frequency nerve stimulation device for pain treatment accessing through epidural space}

The present invention relates to a nerve stimulation device used for pain treatment, and more particularly, detects abnormal nerves while moving along the epidural space, and when appropriate measures can be taken on the spot upon detection, enabling rapid and effective pain treatment. It relates to an epidural access-type catheter device for the treatment of pain and a nerve stimulation device having the same.

When the imbalance of electrolytes in the body becomes severe, the pain perception nerves in the spinal cord and brain become hypersensitive, and even if you touch or press it, you will feel large and small pain. These symptoms are refractory, and various treatment methods have been proposed, including pulsatile radiofrequency therapy.

Pulsatile high frequency used for pain treatment has the advantage of almost no nerve damage compared to persistent high frequency, and has the advantage of being able to replace injection of steroid-based drugs that can cause various complications, so its application is expanding. Various treatment tools are also being developed, designed to more effectively perform the treatment using.

In Korean Patent Publication No. 10-1185944 (catheter set equipped with a guide wire), a catheter set consisting of a cannula, a catheter, a guide wire, and a nerve stimulator has been proposed. The cannula, the catheter, and the guide wire are connected to each other, pierce the skin, and approach the nerve suspected to be a lesion to give electrical stimulation to the corresponding area. The electrical stimulation is output through the end of the guide wire.

However, the conventional catheter set described above is inconvenient in use in that the skin must be pierced several times in order to bring the end of the guide wire to the nerve. That is, at the end of the catheter set that is sharply formed, the skin at the point where the lesion is considered to be located should be pierced at least 3-4 times. This process places a burden on the patient and can scar the skin after surgery.

Moreover, in order to provide effective electrical stimulation to the nerve, the end of the guide wire must be close to the nerve within 3mm. Positioning it within 3mm itself requires a very skilled technique, and if a small mistake is made, the guidewire will stab the nerve. There is a risk that it can be cut at all.

For this reason, instead of bringing the guide wire close enough to the nerve, the guide wire is placed farther away (more than 3 mm) with respect to the nerve, and the electrical energy output from the nerve stimulator is often increased. However, if an electric stimulation of a large amount of energy is applied blindly, the nerve may be rather damaged by the electric energy.

Korean Patent Registration No. 10-1185944 (Catheter set equipped with a guide wire) Korean Patent Publication No. 2003-0065264 (Variation voltage output treatment device) Domestic Patent Publication No. 10-0973307 (Bipolar electrode type guide iron and catheter system using the same)

The present invention has less burden on the patient compared to percutaneous surgery, no fear of nerve damage, and has excellent pain treatment effect because it focuses high frequency on the sensory nerve when a lesion is found, and an epidural entrance catheter device for pain treatment without fear of overheating And it is an object to provide a nerve stimulation device having the same.

The epidural access-type catheter device for pain treatment of the present invention as a means of solving the problems to achieve the above object, while moving along the epidural space of the patient's spine, the abnormal nerve, the required frequency applied from the external electrical energy output unit A gripping casing having a steering lever operated by a user to apply electric energy; A flexible entry catheter fixed to the gripping casing and extending in a longitudinal direction so as to enter the epidural cavity and having a metal tip tip at the extension end, and having a first passage extending parallel to each other therein; A metal steering wire fixed to the tip tip, extended into the gripping casing through the first passage, and connected to the steering lever, and tensioned when the steering lever is operated to cause the entry catheter to bend; A power induction unit for connecting the steering wire to the electric energy output unit so that the electric energy generated from the electric energy output unit is applied to the tip tip through the steering wire to be released from the tip tip to the surrounding nervous tissue; When electric energy is output from the tip tip, it includes a temperature sensing unit for sensing the temperature of the tip tip, and a central passage for guiding the drug injected from the outside toward the tip tip is further formed in the central axis of the entry catheter, , The first passage is disposed symmetrically around a central passage, and one or more steering wires are accommodated inside each first passage.

In addition, a second passage extending in parallel with the first passage is further formed inside the entry catheter, and the temperature sensing portion; It is constructed by bonding two dissimilar wires of different properties, and the bonding part is located inside the tip tip, and after extending into the gripping casing through the second passage, temperature information is provided to the controller controlling the electric energy output part. It is provided with a thermocouple that transmits the control unit to control the electrical energy output unit.

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In addition, the tip tip takes the form of a hollow tube having an outer diameter equal to the outer diameter of the entry catheter, and has a wire fixing means for fixing the tip end of the steering wire.

In addition, a locking portion is formed at an end of the steering wire, and the wire fixing means includes; It is fixed to the inside of the tip tip, a wire fixing plate having a locking slit for fastening the locking portion of the steering wire.

In addition, a locking portion is formed at an end of the steering wire, and the wire fixing means includes; It is formed on the tip tip, and is a side hole of an inner diameter through which the steering wire is passed but the locking portion does not pass.

In addition, the nerve stimulation device of the present invention as a means of solving the problem to achieve the above object, a grip casing having a steering lever operated by a user, a length to be fixed to the grip casing and to enter the epidural space of the patient's spine A flexible entry catheter that extends in the direction and has a metal tip tip at the extension end and has a first passage extending parallel to each other therein, and extends into the gripping casing through the first passage while being fixed to the tip tip. A catheter device having a metal steering wire that is connected to the steering lever and is tensioned when the steering lever is operated to cause the entry catheter to bend, and a temperature sensing unit for sensing a temperature of the tip tip; A control unit connected to the temperature sensing unit and outputting a control signal according to temperature; Electrically connected to the steering wire through a power induction unit, controlled by the control unit, to apply electrical energy of a required frequency to the steering wire side, and output electrical energy for impedance measurement while the tip tip moves inside the epidural space. An impedance measurement unit that measures the impedance of the tissue around the tip of the tip, an electrical stimulation unit that outputs an electrical signal that stimulates the sensing or motor nerves around the tip according to the measurement result by the impedance measurement unit, and the tip is abnormal. A high-frequency generator for outputting high-frequency electrical energy in a state located around the sensing nerve of the state is provided.

In addition, the impedance measuring unit; While the tip tip moves along the epidural space, a current of a frequency of 50 hertz or less is continuously applied to measure a change in impedance according to the movement of the tip tip.

In addition, the electrical stimulation unit; Based on the change trend of the impedance found through the impedance measuring unit, in a state in which the tip tip is stopped at a point where the change in impedance is detected, a current of a frequency that stimulates the motor and sensory nerves is sequentially applied.

In addition, the high frequency generator; After grasping the position of the sensory nerve through the electrical stimulation unit, while the tip tip is positioned close to the sensory nerve, a pulsatile high frequency of about 500 kilohertz is output.

In addition, the temperature sensing unit; Consisting of joining two different types of wires with different properties, the joint is located inside the tip, and after extending into the gripping casing through the entry catheter, temperature information is transmitted to the control unit to allow the control unit to generate electricity. It is a thermocouple that controls the energy output.

In addition, a central passage for guiding the drug injected from the outside toward the tip tip is further formed at the central axis of the entry catheter, and the first passage is symmetrically disposed around the central passage, and the steering wire One or more are accommodated inside the first passage.

In addition, the tip tip takes the form of a hollow tube having an outer diameter equal to the outer diameter of the entry catheter, and has a wire fixing means for fixing the tip end of the steering wire.

In addition, a locking portion is formed at an end of the steering wire, and the wire fixing means includes; It is fixed to the inside of the tip tip, and includes a locking slit for fastening the locking portion of the steering wire.

In addition, a locking portion is formed at an end of the steering wire, and the wire fixing means includes; It is formed on the tip tip, and is a side hole of an inner diameter through which the steering wire is passed but the locking portion does not pass.

The epidural access-type catheter device for pain treatment of the present invention and the nerve stimulation device provided with the same as described above outputs electrical energy through a metal tip that moves along the epidural space in the body, so it is suitable for percutaneous surgery. In comparison, there is no burden, there is no fear of nerve damage, and the range of high-frequency electrical energy is wide.

In addition, when a lesion is detected, the motor and sensory nerves are distinguished through electrical stimulation for each frequency, and the high frequency is concentrated on the sensory nerves, so the therapeutic effect is excellent.

1 is a block diagram illustrating an overall configuration of an epidural access-type catheter device for pain treatment and a nerve stimulation device having the same according to an embodiment of the present invention.
2 is an exploded perspective view of the catheter device shown in FIG. 1.
3 is a plan view of the catheter device shown in FIG. 2.
4 is a cross-sectional view taken along line AA of FIG. 3.
5 is a partial cross-sectional view illustrating a method of coupling a steering wire to a tip tip in the catheter device shown in FIG. 2.
6A and 6B are views showing another modified example of coupling the steering wire to the tip tip shown in FIG. 2.
FIG. 7 is a view showing another modified example of coupling a steering wire to the tip of FIG. 2.
8A and 8B are diagrams illustrating an installation method of the tip of the thermocouple shown in FIG. 2.
9 is a plan view showing a state in which the steering wire is coupled to the steering lever shown in FIG. 2.
10 is a plan view illustrating another example of a method of installing a steering wire for the steering lever shown in FIG. 2.
11 is a block diagram illustrating a method of using a nerve stimulation device according to an embodiment of the present invention.

Hereinafter, an embodiment according to the present invention will be described in more detail with reference to the accompanying drawings.

Basically, the neurostimulation device of the present invention has the purpose of removing the pain of a patient complaining of pain. Since pain is felt through sensory nerves, pain can be eliminated by finding a sensory nerve connected to a region where pain is felt, and applying a therapeutic high frequency near the sensory nerve. These medical theories are general.

In particular, the nerve stimulation device of the present invention includes a catheter device, which may search for abnormal nerves while moving along the spinal epidural space of a patient, and apply a high frequency to the vicinity of the found abnormal nerve. Compared to conventional percutaneous surgical methods, there is no risk of nerve damage and the burden of repeatedly piercing the skin.

1 is a block diagram for explaining the overall configuration of a nerve stimulation device 10 having an epidural access-type catheter device for pain treatment according to an embodiment of the present invention.

As shown, the nerve stimulation device 10 according to the present embodiment includes a catheter device 20, a control unit 50, and an electric energy output unit 100. In addition, the electric air output unit 100 includes an impedance measurement unit 60, an electric stimulation unit 70, and a high frequency generation unit 80.

The catheter device 20 is a surgical tool handled in a state held by the user by hand, and has the structure shown in FIG. 3. The catheter device 20 is provided with a distal tip 43, which is inserted into the epidural cavity of the patient and moves along the epidural cavity to generate a current of a predetermined frequency. In other words, it applies electrical energy to surrounding tissues.

Electric energy emitted from the tip tip 43 is transferred from the electric energy output unit 100. The electric energy output unit 100 is electrically connected to the tip tip 43 through a power induction unit (induction wire 33 to be described later) and is controlled by the control unit 50.

The electric energy output unit 100 includes an impedance measurement unit 60, an electric stimulation unit 70, and a high frequency generation unit 80. It goes without saying that a ground pad (not shown) must be attached to the patient's leg for the electric energy output unit 100 to operate.

The impedance measurement unit 60 serves to measure the impedance of the tissue around the tip tip by outputting electrical energy for impedance measurement while the tip tip 43 moves inside the epidural space. That is, while the tip tip 43 moves along the epidural space, a current of a frequency of 50 hertz or less is continuously output. A current of 50 Hz or less output from the impedance measurement unit 60 is transmitted to the tip tip 43 and applied to the surrounding tissues. The vibration wave of 50 Hz or less is transmitted to the tissue around the tip tip 43. The frequency output from the impedance measurement unit 60 can be adjusted by the control unit 50.

While the current for impedance measurement is discharged from the tip tip 43, the user continuously moves the tip tip 43 inside the epidural space and observes whether the impedance changes. If the impedance value maintained to some extent changes, the electrolyte at the point where the impedance was changed is considered to be in an unbalanced state. If the electrolyte is unbalanced, pain is caused, so the point where the impedance is changed is the target site of high frequency irradiation.

The electrical stimulation unit 70 serves to output an electrical signal that stimulates a sensory nerve or a motor nerve around the tip tip according to a measurement result by the impedance measuring unit 60. In other words, based on the change in impedance learned through the impedance measurement unit, in a state where the tip tip is stopped at the point where the change in impedance is detected, a current of a frequency that stimulates the motor and sensory nerves is sequentially applied Is to do. A description of this will be described later.

The high frequency generator 80 outputs a pulsatile high frequency of about 500 kilohertz after grasping the position of the sensory nerve through the electrical stimulation unit 70, while the tip tip is positioned close to the sensory nerve. Of course, the pulsatile high frequency output from the high frequency generator 80 is transmitted to the sensory nerves through the tip tip 43. This will also be described later with reference to FIG. 11.

The control unit 50 controls the overall operation of the electric air output unit 100 to generate a pulsatile high frequency in a pattern suitable for the patient's symptoms. In particular, based on the temperature information transmitted from the temperature sensing unit installed in the catheter device 20, that is, the temperature information of the tip tip 43, overheating of the tip tip 43 is prevented. A description of this will be described later.

FIG. 2 is an exploded perspective view of the catheter device shown in FIG. 1, and FIG. 3 is a plan view of the catheter device shown in FIG. 2. In addition, FIG. 4 is a cross-sectional view taken along line A-A of FIG. 3, and is a partial cross-sectional view illustrating a method of coupling a wire to a tip tip.

As shown, the catheter device 20 includes a grip casing 30, an entry catheter 41, a steering wire 27, a power induction unit, and a temperature sensing unit.

First, the gripping casing 30 is a handle held by a user by hand, and includes an upper case 21 and a lower case 23 that are coupled to each other to provide an interior space.

Lever operation grooves 21a are provided on both sides of the upper case 21 in the width direction. The lever operation groove 21a is a groove for exposing the operation projection 24b of the steering lever 24 to the outside. The manipulation protrusions 24b are exposed to both sides of the gripping casing 30 and can rotate in the direction of the arrow a or the opposite direction.

In addition, button installation holes 21c are formed between the lever operation grooves 21a on both sides. The button mounting hole 21c is a hole through which the fitting shaft 22a of the retaining button 22 passes. The fitting shaft 22a is a portion fitted into the button groove 24a formed in the central shaft portion of the steering lever 24. The steering lever 24 is supported by the fitting shaft 22a and the support shaft 23b to maintain a stable state and rotational motion is possible.

The lower case 23 is provided with a fixed tooth portion 23a and a support shaft 23b. The fixed tooth portion 23a is a ring-shaped portion whose outer circumferential surface is formed in a serrated shape, and the lower case 23 is integrated with the bottom surface. A part of the fixed teeth 23a is exposed outward in the width direction of the lower case 23. The support shaft 23b is a shaft formed in the central portion of the fixed tooth portion 23a and rotatably supports the central shaft 24f of the steering lever 24.

The steering lever 24 is a member that is interposed between the upper case 21 and the lower case 23 and is operated by the user and rotates in the direction of the arrow a or the opposite direction, and is located on both sides of the central axis 24f. It has an inwardly toothed portion 24d. When the steering lever 24 is rotated in the direction of the arrow a, the tip tip to be described later is bent in the direction of the arrow z. The same is true for the opposite direction.

The inwardly toothed portion 24d corresponds to the fixed toothed portion 23a, and is normally spaced from the fixed toothed portion 23a, and is pressed when the user presses the retaining button 22, and thus the fixed toothed portion 23a Conform to. Accordingly, when the holding button 22 is pressed while the steering lever 24 is rotated to one side, the steering lever 24 is fixed to the fixed teeth 23a as it is rotated.

In addition, as shown in Fig. 9, fixing tool mounting grooves 24e are provided on both sides of the central shaft 24f. The fixture mounting groove 24e has a hole into which the wire fixture 26 is fitted.

The wire fixture 26 is mounted in the fixture mounting groove 24e in a state coupled to the rear end of the steering wire 27, and serves as a connector connecting the steering wire 27 to the steering lever 24.

As shown in Fig. 2, the wire fixing tool 26 has a substantially cylindrical shape and has slits 26b on both sides. The slit 26b is a groove through which the steering wire 27 passes. When the pressure screw 26c is screwed to the wire fastener 26 while passing the steering wire 27 through the slit 26b, the steering wire 27 is trapped inside the slit 26b and is not separated.

The steering wire 27 is a wire formed of a conductive metal, and one end is fixed to the inside of the tip 43 by a welding method, and the other end is coupled to the pressing member 31. The crimping member 31 is a component made of copper or aluminum and is plastically deformed by an external force in a state in which the steering wire 27 is passed therein, and is coupled to the steering wire 27.

Two of these steering wires 27 form a pair and are always held in a taut state while being supported by the tip tip 43 and the steering lever 24.

Meanwhile, an induction wire 33 is connected to one of the two steering wires 27 described above. The induction wire 33 is a power induction unit that connects the steering wire 27 to the electric air output unit 100 so that electric energy generated from the electric energy output unit is applied to the tip tip through the steering wire.

A wire connecting member 33a is used to connect the induction wire 33 to the steering wire 27. The wire connecting member 33a is a conductive part fixed to one end of the induction wire 33 and is electrically connected to the crimping member 31 through a connection pin 33b. The induction wire 33 passes through the wire tube 34 and extends to the outside of the gripping casing 30 and is then connected to the electric energy output unit 100.

In addition, a connector 25 is fitted to the front end of the gripping casing 30. The connector 25 has a catheter coupling portion 25d as being bit and fixed to the tip of the gripping casing 30. The catheter coupling portion 25d is a portion for fixing and supporting the rear end of the entry catheter 41.

Inside the connector 25, an induction tube passage 25c, a thermocouple passage 25a, and a wire passage 25b are formed. The guide tube passage (25c) is a hole through which the inner tube (29) is inserted and is located in the central axis of the connector (25). Further, the thermocouple passage 25a is a passage formed above and below the induction tube passage 25c, and the wire passage 25b is formed on the left and right sides of the induction tube passage 25c.

Thermocouple wires 28a and 28b pass through each thermocouple passage 25a. The thermocouple wires 28a and 28b are conductive wires having different properties, and one end thereof is positioned inside the tip tip 43 in a bonded state as shown in FIGS. 8A and 8B.

In addition, the steering wire 27 is fitted in both wire passages 25b. As mentioned above, the other end of the steering wire 27 is coupled to the pressing member 31 with one end fixed to the tip 43.

On the other hand, the entry catheter 41 is a flexible member having a thickness and length that can be inserted into the epidural space of the patient, and as shown in Fig. 4, the central passage 41c, the first passage 41b, and the second passage Has (41a).

That is, as shown in Figure 4, the central passage (41c) is formed in the central portion of the entry catheter 41, the second passage (41a) in the upper and lower portions of the central passage (41c), the first passage ( 41b) is formed. Further, the central passage 41c communicates with the induction tube passage 25c, the first passage 41b communicates with the wire passage 25b, and the second passage 41a communicates with the thermocouple passage 25a. Naturally, the thermocouple wires 28a and 28b are accommodated in the upper and lower second passages 41a, and the steering wire 47 is accommodated in the left and right first passages 41b.

A metal tip 43 is fixed to the tip of the entry catheter 41. The tip tip 43 is a member made of stainless steel and has a predetermined diameter and has both ends open as shown in FIG. 5. The tip tip 43 receives power from the electric energy output unit 100 and discharges it to its surroundings. That is, it is a part that outputs the current at the frequency for impedance measurement, the current at the frequency for electrical stimulation, and the pulsatile high frequency current for treatment.

Reference numeral 35 denotes a chemical liquid guide tube. The injection pipe 36 is connected to the chemical liquid induction tube 35 in communication. When the necessary chemical solution is injected through the injection pipe 36, the chemical solution is transferred to the outside of the tip tip 43 through the internal tube 29, the guide tube passage 25c, the central passage 41c, and the tip tip 43. Is supplied. By using the catheter device 20, it is possible to apply necessary drugs to the target point of the epidural space.

A nut part 37 and a cap part 38 are sequentially fixed to the rear of the chemical liquid guide tube 35. The nut part 37 is a hollow tube-like member and serves to fix the cap part 38 to the rear of the chemical liquid guide tube 35. The cap portion 38 is coupled to the rear end of the nut portion 37 to prevent leakage of the chemical solution through the chemical solution guide tube 35.

In addition, the guide wire 39 may be fixed to the cap portion 38. The guide wire 39 is a metal member having a predetermined length and supports the entry catheter 41 while being inserted into the interior of the entry catheter 41 through the internal tube 29. That is, the entry catheter 41 is to be in a stiff state. The guide wire 39 may not be applied.

5 is a partial cross-sectional view for explaining a method of coupling the steering wire 27 to the tip 43 in the catheter device 20 shown in FIG. 2.

Referring to the drawings, it can be seen that one end of the steering wires 27 on both sides is fixed to the inner peripheral surface of the tip 43 by a welding method. The reference numeral w denotes the welding area. In FIG. 5, the steering wire 27 is fixed by a welding method, but the connection method can be variously changed as long as the steering wire 27 can be electrically connected and fixed with respect to the tip 43. For example, it may be implemented as shown in FIG. 6 or 7.

6A and 6B are views showing another modified example of the wire coupling to the tip tip shown in FIG. 2. 6A is a cut perspective view of the tip tip 43, and FIG. 6B is a plan view.

As shown, two wire fixing plates 43b are fixed on the inner circumferential surface of the tip tip 43 so as to face each other. The wire fixing plate 43b is a metal plate having a predetermined thickness and has a locking slit 43c opened upward in the center thereof.

In addition, a locking portion 27a is formed at an end of the steering wire 27. The locking portion 27a is a portion formed at the end of the steering wire 27 and is larger than the diameter of the steering wire 27. The locking part 27a may be a knot formed by tying the ends of the steering wire 27.

Anyway, with the end of the steering wire 27 having the above configuration inserted into the space between the wire fixing plate 43b and the inner circumferential surface of the tip 43, the steering wire 27 is inserted into the locking slit 43c and then steered. When the wire 27 is pulled in the direction of the arrow c, the locking portion 27a is caught by the locking slit 43c and fixed.

7 is a cut-away perspective view showing another example of coupling the steering wire to the tip tip 43.

Referring to the drawings, it can be seen that two side holes 43d are formed up and down on both sides of the tip tip 43, and a steering wire 27 is fitted in each side hole 43d. The side hole 43d is a hole having a size through which the steering wire 27 passes and the locking portion 27a does not pass.

After passing the other end of the steering wire 27 to the outside of the tip tip 43 through the upper side hole 43d, insert it into the inside of the tip tip 43 through the lower side hole 43d, and press the arrow When pulled in the direction d, the steering wire 27 is coupled to the tip 43.

8A and 8B are views showing an installation method of the tip of the thermocouple 28 shown in FIG. 2.

The illustrated thermocouple 28 is configured by joining ends of two thermocouple wires 28a and 28b having different physical properties. Each of the thermocouple wires 28a and 28b passes through the second passage 41a, the thermocouple passage 25a, and the wire tube 34 to be connected to the controller (50 in FIG. 1).

In addition, the junction 28c of the thermocouple wires 28a, 28b may be located in the inner space of the tip tip 43 as shown in FIG. 8A, and fixed to the inner wall surface of the tip tip 43 as shown in FIG. 8B. You can also make it.

The thermocouple 28 senses the temperature of the tip tip 43 while the tip tip 43 outputs electrical energy, and causes the controller 50 to properly control the electrical energy output unit 100.

9 is a plan view showing a state in which the steering wire 27 is coupled to the steering lever 24 shown in FIG. 2.

As shown, the wire fixing tool 26 fixing the other end of the steering wire 27 is fitted in the fixing tool mounting groove 24e. There are two fixture mounting grooves (24e) formed on both sides of the central shaft (24f), the wire fixture 26 can be selectively coupled to one of the two fixture mounting grooves (24e).

10 is a view showing a modified example of the steering lever 24 shown in FIG.

Referring to the drawings, three fixture mounting grooves 24e are formed on both sides of the central shaft 24f, and a wire fixture 26 is provided in two fixture mounting grooves 24e among three fixture mounting grooves 24e. ) Is inserted. Since the steering wire 27 is tied to each of the wire fasteners 26, all four rows of steering wires 27 can act. In the drawing, the left two rows of steering wires and the right two rows of steering wires are electrically connected to the tip tip 43 through the first passage 41b.

In addition, the induction wire 33 is connected to only one of the four steering wires 27.

11 is a block diagram for explaining a nerve stimulation method using the nerve stimulation device 10 according to an embodiment of the present invention.

As shown, the nerve stimulation method, the preparation step 201, the catheter insertion step 203, the catheter movement and impedance measurement step 205, the motor nerve scanning step 207, the sensory nerve electrical stimulation step 211, It includes a high frequency generating step 215, a catheter withdrawing step 219. Each step is controlled by the control unit 50 of the nerve stimulation device 10.

First, the preparation step 201 is a process of placing the patient on the operating table. Since the entry catheter 41 must be entered into the patient's epidural cavity, the prone position is taken and a ground pad is attached. In addition, the induction wire 33 and the thermocouple 28 of the catheter device are connected to the electric air output unit 100 and the control unit 50, and a C-arm (not shown) as an image photographing device is also installed. The C-arm serves to determine the position of the tip tip 43 inserted into the body.

The catheter insertion step 203 is a process of inserting the entry catheter 41 into the epidural space of the patient. At this time, the guide wire 39 may be inserted into the entry catheter 41. In addition, if necessary, saline solution or a drug may be injected and applied through the tip tip 43. In addition, it is possible to mount and operate a microscopic endoscope without using the guide wire 39. In other words, it is to enter the inner hair microscopic endoscope of the chemical solution guide tube (35). The endoscope reaches the tip tip 43 and informs an external monitor of the situation around the tip tip.

The subsequent catheter movement and impedance measurement step 205 is a process of finding a point where the electrolyte inside the epidural space is unbalanced, that is, a lesion while moving the tip tip 43. To this end, a current of a low frequency of 50 hertz or less is applied to the tip tip 43.

The principle of finding the point where the electrolyte is unbalanced is based on the change of the impedance value. That is to say, if the impedance is higher or lower no matter which level is maintained, there is a very high probability that there is an abnormality in the electrolyte in the corresponding region, which determines the imbalance of the electrolyte.

If the distal tip 43 outputs the frequency and moves, and the impedance value changes beyond the allowable range, the motor nerve scanning step 207 is performed. In the motor nerve scanning step 207, the electrical stimulation unit 70 outputs a current of a frequency that stimulates the motor nerve, and the motor nerve around the tip tip 43 is currently connected to the area where the patient complains of pain. As a process to check whether it is a nerve, it gives electrical stimulation and checks the patient's reaction.

The subsequent sensory nerve electrical stimulation step 211 is a step in which electrical stimulation is applied to the sensory nerves located around the motor nerves by avoiding the motor nerves whose location is identified. It gives electrical stimulation to sensory nerves and controls the intensity of stimulation.

The high frequency generation step 215 is a step of causing the high frequency generator 80 to output a pulsatile high frequency. As mentioned above, the high-frequency current generated through the high-frequency generation unit 80 is transmitted to the tip tip 43, spreads to the surrounding tissue, and is discharged. The pulsatile high frequency acts to block pain by causing physiological changes related to the structure of sensory nerves and pain transmission. The frequency of the high frequency can vary depending on the case, and is about 500 kHz.

At this time, since the tip tip 43 may overheat and destroy the surrounding tissue, it is necessary to continuously monitor the temperature through the thermocouple 28.

If sufficient high-frequency treatment for the abnormal sensory nerve is completed through the above process, the electric air output unit 100 is turned off, the entry catheter 41 is removed from the body, and the operation is completed.

As described above, the present invention has been described in detail through specific embodiments, but the present invention is not limited to the above embodiments, and various modifications are possible by those of ordinary skill within the scope of the technical idea of the present invention.

10: nerve stimulation device 20: catheter device 21: upper case
21a: lever operation groove 21c: button mounting hole 22: retention button
22a: fitting shaft 23: lower case 23a: fixed teeth
23b: support shaft 24: steering lever 24a: button groove
24b: operating protrusion 24d: inward tooth part 24e: fixing hole mounting groove
24f: central axis 25: connector 25a: thermocouple passage
25b: wire passage 25c: guide tube passage 25d: catheter coupling portion
26: wire fastener 26b: slit 27: steering wire
27a: jamming part 28: thermocouple 28a, 28b: thermocouple wire
28c: joint 29: built-in tube 30: grip casing
31: crimping member 33: connecting wire 33a: wire connecting member
33b: connection pin 34: wire tube 35: chemical liquid guide tube
36: injection pipe 37: nut portion 38: cap portion
39: guide wire 41: entry catheter 41a: second passage
41b: first passage 41c: central passage 43: tip tip
43b: wire fixing plate 43c: jamming slit 43d: side hole
50: control unit 60: impedance measurement unit 70: electrical stimulation unit
80: high frequency generator 100: electric air output

Claims (15)

As it moves along the epidural space of the patient's spine, it applies electrical energy of a required frequency applied from an external electrical energy output to the abnormal nerve,
A gripping casing having a steering lever operated by a user;
A flexible entry catheter fixed to the gripping casing and extending in a longitudinal direction so as to enter the epidural cavity and having a metal tip tip at the extension end, and having a first passage extending parallel to each other therein;
A metal steering wire fixed to the tip tip, extended into the gripping casing through the first passage, and connected to the steering lever, and tensioned when the steering lever is operated to cause the entry catheter to bend;
A power induction unit for connecting the steering wire to the electric energy output unit so that the electric energy generated from the electric energy output unit is applied to the tip tip through the steering wire to be released from the tip tip to the surrounding nervous tissue;
When electric energy is output from the tip, it includes a temperature sensing unit for sensing the temperature of the tip,
In the central axis of the entry catheter, a central passage for guiding the drug injected from the outside toward the tip tip is further formed,
The first passage is disposed symmetrically around a central passage, and one or more steering wires are accommodated in each of the first passages. An epidural entrance-type catheter device for pain treatment. The method of claim 1,
In the interior of the entry catheter, a second passage extending in parallel with the first passage is further formed,
The temperature sensing unit;
It is constructed by bonding two dissimilar wires of different properties, and the bonding part is located inside the tip tip, and after extending into the gripping casing through the second passage, temperature information is provided to the controller controlling the electric energy output part. An epidural entrance-type catheter device for pain treatment having a thermocouple that allows the control unit to control the electrical energy output unit by transmitting the signal. delete The method of claim 1,
The tip tip,
An epidural entrance-type catheter device for pain treatment, which takes the form of a hollow tube having the same outer diameter as the outer diameter of the entry catheter and has a wire fixing means for fixing the tip end of the steering wire. The method of claim 4,
A locking portion is formed at the end of the steering wire,
The wire fixing means;
An epidural access-type catheter device for pain treatment, which is a wire fixing plate fixed to the inside of the tip tip and having a locking slit for fastening and fixing the locking part of the steering wire. The method of claim 4,
A locking portion is formed at the end of the steering wire,
The wire fixing means;
It is formed on the tip tip, the side hole of an inner diameter through which the steering wire is passed but the locking portion does not pass through the epidural space access catheter device for pain treatment. A gripping casing having a steering lever operated by a user, fixed to the gripping casing, extending longitudinally so that it can enter the epidural space of the patient's spine, and having a metal tip tip at the extension end, extending parallel to the inside thereof. A flexible entry catheter having a first passage, a metal steering that extends into the gripping casing through the first passage while being fixed to the tip tip, is connected to the steering lever, and is tensioned when the steering lever is operated to cause the entry catheter to bend A catheter device having a wire and a temperature sensing unit for sensing the temperature of the tip tip;
A control unit connected to the temperature sensing unit and outputting a control signal according to temperature;
Electrically connected to the steering wire through a power induction unit, controlled by the control unit, to apply electrical energy of a required frequency to the steering wire side, and output electrical energy for impedance measurement while the tip tip moves inside the epidural space. An impedance measurement unit that measures the impedance of the tissue around the tip of the tip, an electrical stimulation unit that outputs an electrical signal that stimulates the sensing or motor nerves around the tip according to the measurement result by the impedance measurement unit, and the tip is abnormal. A nerve stimulation device comprising an electrical energy output unit having a high frequency generator for outputting high frequency electrical energy in a state located around the sensing nerve of the state. The method of claim 7,
The impedance measuring unit;
While the tip tip moves along the epidural space, a current of a frequency of 50 hertz or less is continuously applied to measure a change in impedance according to the movement of the tip tip. The method of claim 8,
The electrical stimulation unit;
Nerve stimulation that sequentially applies a current of a frequency that stimulates motor and sensory nerves in a state where the tip tip is stopped at a point where the change in impedance is detected based on the change trend of impedance found through the impedance measuring unit Device. The method of claim 9,
The high frequency generator;
After grasping the position of the sensory nerve through the electrical stimulation unit, a nerve stimulation device that outputs a pulsatile high frequency of about 500 kilohertz while the tip tip is positioned close to the sensory nerve. The method of claim 7,
The temperature sensing unit;
Consisting of joining two different types of wires with different properties, the joint is located inside the tip, and after extending into the gripping casing through the entry catheter, temperature information is transmitted to the control unit to allow the control unit to generate electricity. Neurostimulation device that is a thermocouple that controls the energy output. The method of claim 7,
In the central axis of the entry catheter, a central passage for guiding the drug injected from the outside toward the tip tip is further formed,
The first passage is arranged symmetrically around a central passage, and the steering wire is accommodated in each of the first passage at least one nerve stimulation device. The method of claim 7,
The tip tip,
A nerve stimulating device having a shape of a hollow tube having an outer diameter equal to the outer diameter of the entry catheter and having a wire fixing means for fixing a tip end of the steering wire. The method of claim 13,
A locking portion is formed at the end of the steering wire,
The wire fixing means;
A nerve stimulation device which is a wire fixing plate fixed to the inside of the tip tip and having a locking slit for hooking and fixing the locking part of the steering wire. The method of claim 13,
A locking portion is formed at the end of the steering wire,
The wire fixing means;
A nerve stimulation device of an inner diameter side hole formed on the tip tip and passing the steering wire through the inside, but not passing the locking portion.

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