WO2016177271A1 - 一种治疗椎管狭窄的微创手术器械 - Google Patents

一种治疗椎管狭窄的微创手术器械 Download PDF

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Publication number
WO2016177271A1
WO2016177271A1 PCT/CN2016/079609 CN2016079609W WO2016177271A1 WO 2016177271 A1 WO2016177271 A1 WO 2016177271A1 CN 2016079609 W CN2016079609 W CN 2016079609W WO 2016177271 A1 WO2016177271 A1 WO 2016177271A1
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minimally invasive
spinal canal
canal stenosis
surgical instrument
ultrasonic
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PCT/CN2016/079609
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English (en)
French (fr)
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罗宗平
杨惠林
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苏州博习医疗科技有限公司
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Publication of WO2016177271A1 publication Critical patent/WO2016177271A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3209—Incision instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00087—Tools
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00091—Nozzles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00094—Suction openings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00096—Optical elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
    • A61B1/3135—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes for examination of the epidural or the spinal space
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00163—Optical arrangements
    • A61B1/00165—Optical arrangements with light-conductive means, e.g. fibre optics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/564—Methods for bone or joint treatment

Definitions

  • the invention relates to a minimally invasive surgical instrument for treating spinal canal stenosis, belonging to the technical field of medical instruments.
  • the surgical method for treating spinal stenosis usually uses an open surgical method to cut off the lamina with spinous processes, increase the space of the vertebral foramen, relieve the nerve compression in the spinal canal, and achieve the purpose of decompressing the nerve.
  • this method will cause instability of the vertebral body due to the removal of the lamina. It is usually necessary to further increase the internal fixation structure by surgery, thereby increasing the stability of the vertebral body, thus making the operation complicated and the wound surface large. Great damage to the human body.
  • the present invention provides a minimally invasive surgical instrument for treating spinal stenosis, which improves the accuracy and safety of the operation.
  • a minimally invasive surgical instrument for treating spinal canal stenosis comprising: a cannula and an ultrasonic osteotome, the sleeve having an axial passage through which the ultrasonic bone cutter can be accommodated;
  • the front end of the sleeve has a long body having a hollow axial passage therein; the rear end of the long main body is an insertion opening of the ultrasonic bone cutter; and the rear side of the long main body is provided with one or more axial directions in the long main body
  • the access port through which the passage passes is used to connect the flushing pipe, the suction pipe, the endoscope conduit and the lamp tube together or separately, so that the flushing pipe, the suction pipe, the endoscope conduit and the lamp tube pass through the long body
  • the axial passage reaches the front end of the long body.
  • the ultrasonic osteotome includes a cutter head at the front end, a blade body at the rear end adapted to be hand held, and a long knife bar connecting the cutter head and the blade body.
  • the cannula is prevented from extending from the side of the human body into the body to reach the position of the vertebral foramen or intervertebral foramen by minimally invasive surgery.
  • the ultrasonic osteotome is controlled by a manual switch.
  • the manual switch is disposed in a position suitable for holding on the ultrasonic bone cutter.
  • the manual switch is configured to be a touch or photoelectric inductive manual switch that is not exposed to the outside.
  • the outer surface of the manual switch covers a protective layer.
  • the protective layer is formed integrally with the outer surface of the blade body.
  • the ultrasonic osteotome is an ultrasonic osteotome with bone function or an ultrasonic osteotome with osteotomy function.
  • the present invention provides a minimally invasive surgical instrument for treating spinal canal stenosis, which can treat spinal canal stenosis by minimally invasive surgery, and place the cannula into the vertebral foramen or intervertebral foramen from the lateral side of the human body by minimally invasive manner. .
  • a flushing pipe, a suction pipe, an endoscope catheter, a lamp tube are integrated in the casing, and an ultrasonic osteotome having a bone or bone function is guided from a channel in the cannula to a position of a vertebral hole or an intervertebral foramen,
  • the inner side of the tube or the intervertebral foramen is used for ossifying or cutting the bone, increasing the space of the vertebral foramen or intervertebral foramen, and relieving the nerve compression in the vertebral foramen or intervertebral foramen to achieve the purpose of decompressing the nerve.
  • the ultrasonic bone cutter can avoid the accidental damage to the nerve; at the same time, the flushing pipe, the suction pipe, the endoscope catheter and the lamp tube are all guided by the casing, so as to avoid the penetration into the body respectively. Trauma.
  • the flushing pipe flushes the surgical operation surface to prevent bleeding from affecting the line of sight. At the same time, the flushed water can simultaneously cool down the ultrasonic bone cutter head.
  • the minimally invasive surgical instrument for treating spinal canal stenosis of the present invention changes the traditional open surgical approach for the treatment of spinal stenosis, and the minimally invasive surgery for the treatment of spinal stenosis meets the need for accuracy and safety of the surgical procedure.
  • FIG. 1 is a schematic structural view of an ultrasonic osteotome of the present invention
  • FIG. 2 is a schematic structural view of a channel device
  • Figure 3 is a schematic cross-sectional view of the sleeve.
  • the minimally invasive surgical instrument for treating spinal canal stenosis of the present invention comprises a cannula 2 and an ultrasonic osteotome having a bone function.
  • the sleeve 2 has an axial passage 23 through which the ultrasonic osteotome 1 can be received.
  • the front end of the cannula 2 has a long body 21 so that the open bone can be prevented from extending into the body from the side of the human body to reach the vertebral foramen or the intervertebral foramen.
  • the elongated body 21 has a hollow axial passage 23 therein.
  • the rear end of the long main body 21 is the insertion opening 22 of the ultrasonic osteotome 1.
  • One end side of the rear end of the long main body 21 adjacent to the insertion opening 22 is provided with one or more inlets 24 extending through the axial passages 23 in the long main body 21 for respectively or separately being connected to the flushing pipe 3, the suction pipe 4, and the inside.
  • the speculum catheter 5 and the lamp tube 6 allow the flush tube 3, the suction tube 4, the endoscope catheter 5, and the tube 6 to pass through the axial passage 23 in the elongated body 21 to reach the front end of the elongated body 21.
  • the ultrasonic osteotome 1 includes a sharpening head 13 for the bone grinding at the front end, a blade body 11 adapted to be held at the rear end, and a blade bar 12 connecting the sharpening head 13 and the blade body 11, the blade bar 12 being long so as to be placed in the sleeve 2 from the human body The side enters the surgical operation surface that reaches the patient's body.
  • the ultrasonic bone knife with bone function is guided by the channel in the cannula to the position of the vertebral foramen or intervertebral foramen, and the inner side of the vertebral foramen or intervertebral foramen is ground, and the space of the vertebral foramen or intervertebral foramen is enlarged, and the space is removed.
  • the nerve compression in the vertebral foramen or intervertebral foramen achieves the purpose of decompressing the nerve.
  • the ultrasonic injury can be avoided when the ultrasonic bone cutter is operated; at the same time, the flushing pipe 3, the suction pipe 4, the endoscope conduit 5 and the lamp tube 6 are guided by the casing, thereby avoiding the difference Piercing the wounds caused by the body.
  • the ultrasonic osteotome 1 is inserted into the elongated body 21 from the insertion opening 22, and the sharpening head 13 can be extended to reach the front end of the elongated body 21 to honinate the surgical operation surface.
  • the lens at the front end of the endoscope catheter 5 performs image acquisition on the surgical operation surface, and can observe the state of the surgical operation surface in real time in real time; the micro lamp at the front end of the lamp tube 6 illuminates the operation operation surface to increase the brightness;
  • the ultrasonic bone knife will heat up for a long time, and the flushing water pipe 3 can flush the surgical operation surface, and the water can be cooled and cooled by the ultrasonic bone cutter.
  • the suction pipe 4 has a larger diameter than the flush pipe 3 to prevent accumulation of sewage.
  • the control switch of the ultrasonic bone cutter 1 is changed from a conventional foot switch to a manual switch, and the manual switch is disposed on the ultrasonic bone cutter body 11 for holding the position to avoid the doctor in the process of standing for a long time, and also needs Free one foot to step on the foot switch, increase the load on the other foot, cause the body to be unbalanced, increase the fatigue, and the hand control switch is placed on the ultrasonic bone cutter body 11 for the hand-held position, in the hand-held At the same time as the ultrasonic bone knife, the finger can be controlled by touching the manual control switch without increasing the complexity and extra fatigue of the doctor.
  • the manual switch is disposed not to be exposed to an external touch or photoelectric inductive hand switch, for example, the outer surface may be covered by a protective layer and integrated with the outer surface of the blade body, so that the ultrasonic bone knife is easier to clean and disinfect. It is not necessary to separately clean and disinfect the manual switch.
  • the ultrasonic osteotome may also be an ultrasonic osteotome with a bone-cutting function.
  • the cannula is placed from the side of the human body by minimally invasive surgery, and the ultrasonic osteotome with osteotomy function is used to cut the surrounding bone tissue at the nerve surface of the surgical operation surface, and some bone tissue is removed by cutting to increase the space around the nerve.
  • the ultrasonic osteotome with osteotomy function is used to cut the surrounding bone tissue at the nerve surface of the surgical operation surface, and some bone tissue is removed by cutting to increase the space around the nerve.
  • the cannula can be placed into the vertebral foramen or intervertebral foramen from the side of the human body in a minimally invasive manner, and the position is subjected to bone grinding or cutting of the bone to increase the space for accommodating the nerve, and change Traditionally, only open surgery can be used to enter the surgical position from the posterior aspect of the human body. Because the bone structure that constitutes the vertebral body cannot be avoided, only the lamina can be cut to treat the spinal canal stenosis.

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Abstract

一种治疗椎管狭窄的微创手术器械，包括套管（2）和超声骨刀（1）；套管（2）前端具有一长主体（21），后端为超声骨刀（1）的插入口；长主体（21）后端侧面设有接入口（24），用于接入冲水管（3）、吸水管（4）、内窥镜导管（5）和灯线管（6）。套管（2）通过微创的方式从人体侧面置入椎孔或椎间孔的位置，超声骨刀（1）由套管（2）内的通道引导进行磨骨或切削骨，由于有套管（2）的空间限制，操作超声骨刀（1）时可以避免对神经的误损伤。冲水管（3）、吸水管（4）、内窥镜导管（5）、灯线管（6）均由套管（2）引导，避免了分别穿入体内造成的创伤；冲水管（3）冲洗的同时，还可以对超声骨刀（1）进行降温冷却。微创手术器械改变了传统器械开放式方式治疗椎管狭窄，而采用了微创手术方式治疗椎管狭窄，满足了外科手术对精确性和安全性的需要。

Description

一种治疗椎管狭窄的微创手术器械 技术领域
本发明涉及一种治疗椎管狭窄的微创手术器械，属于医疗器械技术领域。
背景技术
目前治疗椎管狭窄的手术方法通常是采用开放式的手术方式切掉带有棘突的椎板，增大椎孔的空间，解除对椎管中的神经压迫，达到对神经减压的目的。但是这种方式由于切除了椎板，将造成椎体的不稳定，通常还需要进一步通过手术增加额外的内固定结构，以此增加椎体的稳定，因此，使得手术复杂，且创伤面大，对人体损害大。
发明内容
目的：为了克服现有技术中存在的不足，本发明提供治疗椎管狭窄的微创手术器械，提高了手术的精确性和安全性。
技术方案：为解决上述技术问题，本发明采用的技术方案为：
一种治疗椎管狭窄的微创手术器械，其特征在于：包括套管和超声骨刀，套管内具有一可容纳超声骨刀通过的轴向通道；
套管前端具有一长主体，长主体内具有中空的所述轴向通道；长主体后端为超声骨刀的插入口；长主体后端侧面设有一个或多个与长主体内的轴向通道相贯通的接入口，用于一起或分别接入冲水管、吸水管、内窥镜导管和灯线管，使冲水管、吸水管、内窥镜导管和灯线管均穿过长主体内的轴向通道抵达长主体的前端。
所述超声骨刀包括前端的刀头、后端适于手持的刀身和连接刀头与刀身的长刀杆。
所述套管通过微创手术的方式从人体侧面避让开骨组织伸入体内抵达至椎孔或椎间孔的位置。
超声骨刀由手控开关进行控制。
所述手控开关设置在超声骨刀刀身上适于手持的位置。
所述手控开关设置成不暴露于外部的触摸式或光电感应式手控开关。
所述手控开关外表面覆盖一保护层。
所述保护层与刀身外表面形成一体。
所述超声骨刀为具有磨骨功能的超声骨刀或具有切骨功能的超声骨刀。
有益效果：本发明提供的一种治疗椎管狭窄的微创手术器械，可通过微创手术治疗椎管狭窄，通过微创的方式从人体侧面将套管置入椎孔或椎间孔的位置。在套管中集成设置冲水管、吸水管、内窥镜导管、灯线管，具有磨骨或切骨功能的超声骨刀由套管内的通道引导至椎孔或椎间孔的位置，对椎管或椎间孔的内侧面进行磨骨或切骨，增大椎孔或椎间孔的空间，解除对椎孔或椎间孔中的神经压迫，达到对神经减压的目的。由于有套管的空间限制，操作超声骨刀时可以避免对神经的误损伤；同时，冲水管、吸水管、内窥镜导管、灯线管均由套管引导，避免了分别穿入体内造成的创伤。冲水管对手术操作面进行冲洗防止出血影响视线的同时，冲出的水还可以同时对超声骨刀头部进行降温冷却。本发明的治疗椎管狭窄的微创手术器械改变了传统的开放式手术方式治疗椎管狭窄，而采用了微创手术方式治疗椎管狭窄，满足了外科手术对精确性和安全性的需要。
附图说明
图1为本发明的超声骨刀的结构示意图；
图2为通道装置的结构示意图；
图3为套管剖面示意图。
具体实施方式
下面结合附图对本发明作更进一步的说明。
如图1、图2和图3所示，本发明的治疗椎管狭窄的微创手术器械，包括套管2和具有磨骨功能的超声骨刀1。套管2内具有一可容纳超声骨刀1通过的轴向通道23。
套管2前端具有一长主体21，以便可以通过过微创手术的方式从人体侧面避让开骨组织伸入体内抵达至椎孔或椎间孔的磨骨部位。长主体21内具有中空的轴向通道23。长主体21后端为超声骨刀1的插入口22。长主体21后端靠近插入口22的一端侧面设有一个或多个与长主体21内的轴向通道23贯通的接入口24，用于一起或分别接入冲水管3、吸水管4、内窥镜导管5和灯线管6，使冲水管3、吸水管4、内窥镜导管5和灯线管6均穿过长主体21内的轴向通道23抵达长主体21的前端。
超声骨刀1包括前端用于磨骨的磨刀头13、后端适于手持的刀身11和连接磨刀头13与刀身11的刀杆12，刀杆12较长，以便可以置于套管2中从人体 侧面进入抵达至患者体内的手术操作面。具有磨骨功能的超声骨刀1由套管内的通道引导至椎孔或椎间孔的位置，对该椎孔或椎间孔内侧面进行磨骨，增大椎孔或椎间孔的空间，解除对椎孔或椎间孔中的神经压迫，达到对神经减压的目的。由于有套管的空间限制，操作超声骨刀时可以避免对神经的误损伤；同时，冲水管3、吸水管4、内窥镜导管5和灯线管6均由套管引导，避免了分别穿入体内造成的创伤。
超声骨刀1由插入口22插入长主体21，并且磨刀头13可伸入抵达至长主体21的前端，对手术操作面进行磨骨。与此同时，内窥镜导管5前端的镜头对手术操作面进行影像采集，可以实时窥视体内手术操作面状态；灯线管6前端的微型灯为手术操作面照射，增加亮度；[微软用户1]更重要的是，超声骨刀长时间工作会发热，冲水管3对手术操作面进行冲洗的同时，冲出的水还可以对超声骨刀进行降温冷却。较佳地，吸水管4直径大于冲水管3，以防止污水积蓄。
超声骨刀1的控制开关由传统的脚踩开关改变为手控开关，手控开关设置在超声骨刀刀身11上适于手持的位置，以避免医生在长时间站立手术的过程中，还需要腾出一只脚来踩脚踩开关，增加另一只脚的负荷，造成身体不平衡，增加了疲劳感，而手控开关设置在超声骨刀刀身11上适于手持的位置时，在手持超声骨刀的同时，手指碰触手控开关即可进行控制，不增加医生操作时的复杂性和额外疲劳感。较佳地，手控开关设置成不暴露于外部的触摸式或光电感应式手控开关，如外表面可由保护层覆盖，与刀身外表面形成一体，使超声骨刀清洗、消毒时更简便，不需要单独对该手控开关进行清洗、消毒。
在其他实施例中，超声骨刀也可以是具有切骨功能的超声骨刀。通过微创手术的方式从人体侧面置入套管，引导具有切骨功能的超声骨刀对手术操作面压迫神经处的周围骨组织进行切削，切削去掉部分骨组织以增加该处神经周围的空间，从而达到对神经减压的目的，起到治疗椎管狭窄的作用。
采用本发明的微创手术器械，可以通过微创的方式从人体侧面将套管置入椎孔或椎间孔的位置，并对该位置进行磨骨或切削骨，增加容纳神经的空间，改变了传统的只能采用开放式手术从人体后背面进入手术位置，因无法避让构成椎体的骨结构，只能切割椎板治疗椎管狭窄的方式。
以上所述仅是本发明的优选实施方式，应当指出：对于本技术领域的普 通技术人员来说，在不脱离本发明原理的前提下，还可以做出若干改进和润饰，这些改进和润饰也应视为本发明的保护范围。

Claims (9)

  1. 一种治疗椎管狭窄的微创手术器械，其特征在于：包括套管和超声骨刀，套管内具有一可容纳超声骨刀通过的轴向通道；
    套管前端具有一长主体，长主体内具有中空的所述轴向通道；长主体后端为超声骨刀的插入口；长主体后端侧面设有一个或多个与长主体内的轴向通道相贯通的接入口，用于一起或分别接入冲水管、吸水管、内窥镜导管和灯线管，使冲水管、吸水管、内窥镜导管和灯线管均穿过长主体内的轴向通道抵达长主体的前端。
  2. 根据权利要求1所述的一种治疗椎管狭窄的微创手术器械，其特征在于：所述超声骨刀包括前端的刀头、后端适于手持的刀身和连接刀头与刀身的长刀杆。
  3. 根据权利要求1所述的一种治疗椎管狭窄的微创手术器械，其特征在于：所述套管通过微创手术的方式从人体侧面伸入体内抵达至椎孔或椎间孔的位置。
  4. 根据权利要求1所述的一种治疗椎管狭窄的微创手术器械，其特征在于：超声骨刀由手控开关进行控制。
  5. 根据权利要求4所述的一种治疗椎管狭窄的微创手术器械，其特征在于：所述手控开关设置在超声骨刀刀身上适于手持的位置。
  6. 根据权利要求4或5所述的一种治疗椎管狭窄的微创手术器械，其特征在于：所述手控开关设置成不暴露于外部的触摸式或光电感应式手控开关。
  7. 根据权利要求6所述的一种治疗椎管狭窄的微创手术器械，其特征在于：所述手控开关外表面覆盖一保护层。
  8. 根据权利要求7所述的一种治疗椎管狭窄的微创手术器械，其特征在于：所述保护层与刀身外表面形成一体。
  9. 根据权利要求1所述的一种治疗椎管狭窄的微创手术器械，其特征在于：所述超声骨刀为具有磨骨功能的超声骨刀或具有切骨功能的超声骨刀。
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