WO2017000850A1 - 穿刺针微创置入导管套件 - Google Patents

穿刺针微创置入导管套件 Download PDF

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Publication number
WO2017000850A1
WO2017000850A1 PCT/CN2016/087221 CN2016087221W WO2017000850A1 WO 2017000850 A1 WO2017000850 A1 WO 2017000850A1 CN 2016087221 W CN2016087221 W CN 2016087221W WO 2017000850 A1 WO2017000850 A1 WO 2017000850A1
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WO
WIPO (PCT)
Prior art keywords
handle
traction wire
tube
puncture needle
die
Prior art date
Application number
PCT/CN2016/087221
Other languages
English (en)
French (fr)
Inventor
周建明
Original Assignee
浙江康慈医疗科技有限公司
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Filing date
Publication date
Application filed by 浙江康慈医疗科技有限公司 filed Critical 浙江康慈医疗科技有限公司
Publication of WO2017000850A1 publication Critical patent/WO2017000850A1/zh

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3401—Puncturing needles for the peridural or subarachnoid space or the plexus, e.g. for anaesthesia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3415—Trocars; Puncturing needles for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3472—Trocars; Puncturing needles for bones, e.g. intraosseus injections

Definitions

  • the present invention relates to medical surgical instruments, and more particularly to a penetrating needle minimally invasive catheterization kit for spinal epidural nerve root release.
  • intra-arterial injection therapy is a traditional diagnosis and treatment technique, that is, direct injection of the drug into the epidural space, thereby generating fluid pressure, and fibrous adhesion to the epidural space.
  • the nerve root is pressed and mechanically impacted to achieve the purpose of release.
  • the traditional epidural injection method injects the drug solution into the epidural space, relying on the principle of drug diffusion in the epidural space, combined with special body drainage, some of the drug can penetrate into the epidural anterior or lateral anterior chamber.
  • the inflammatory pain factor secreted by the posterior small joint is attached to the acute or chronic disease caused by compression of the nerve root around the intervertebral foramen fibrous tissue or ligament.
  • Initial use of intervertebral foramen neurotomy has a certain effect, but patients with more severe inflammatory pain factor pastes will not significantly reduce pain with medication alone. Need to use a puncture needle to minimally invasion catheter kit nerve root release Effective release of the inflammatory pain factor attached to the compression nerve.
  • the technical problem to be solved by the present invention is to provide a minimally invasive needle that can perform fixed-point mechanical release and chemical release, convenient and flexible operation, small trauma, reduced bleeding volume after surgery, and rapid postoperative recovery.
  • Inlet kit The technical problem to be solved by the present invention is to provide a minimally invasive needle that can perform fixed-point mechanical release and chemical release, convenient and flexible operation, small trauma, reduced bleeding volume after surgery, and rapid postoperative recovery.
  • the kit includes a handle composed of an upper box body and a lower box body, and a guiding tube is disposed in the handle, and a front end of the handle is provided with a guiding column, and the guiding tube is The front end is connected to the rear end of the die through a flow guiding column, and the structural feature is that a circular turntable is fixed by bolts in the lower box body, and the edge of the circular turntable is provided with two convex and symmetrically arranged handle bases, two The inner surface of the handle base is provided with inner teeth, and the outer surfaces of the two handle bases are respectively provided with a left handle and a right handle; a convex circular base and a circular base are arranged in the upper box body.
  • the outer surface is provided with external ribs which are in mesh with the internal ribs; the left and right traction wires are arranged in the dies, and the rear ends of the left and right traction wires are respectively symmetrically
  • the guiding tube of the present invention is one, and the guiding tube communicates with the tube through the guiding column, and the front ends of the left pulling wire and the right pulling wire are fixed on the inner wall of the front end of the die.
  • the guide tube of the present invention is two, respectively a left guide tube and a right guide tube, a support tube is arranged in the die, and the head of the die is provided with an air bag, wherein the left guide tube and the die, the air bag In parallel, the right guide tube and the support tube are in communication, and the front ends of the left and right traction wires are fixed on the inner wall of the front end of the support tube.
  • the guide tube of the present invention is two, respectively a left guide tube and a right guide tube, and the left guide tube and the right guide tube are connected to the tube through the guide rod, the left traction wire and the right traction wire I wire
  • the front end is fixed to the inner wall of the front end of the die.
  • the left and right handles of the present invention are symmetrically arranged along the central axis of the circular turntable.
  • the rear ends of the left and right traction wires of the present invention are respectively fixed on the circular turntable and symmetrically arranged along the central axis of the circular turntable, and the rear end of the left and right pull wires and the left handle
  • the right handle is on the central axis of the same circular turntable.
  • the guide tube of the present invention is provided with a guide wire at the rear end thereof.
  • the rear end of the guide tube of the present invention is connected to a conduit communicating therewith.
  • the present invention has the following beneficial effects: 1.
  • the catheter can perform accurate fixation in the spinal canal or the lesion area of the nerve hole after performing spinal epidural nerve root release and dissection.
  • Mechanical release because there is a pulling wire in the die, the head of the die is loose, and the head of the die can be moved to the left or to the left by simply pulling the left or right handle The right 180 degree bend, so that the swinging and peeling in the controllable direction is performed, and the stenosis is enlarged at the same time, and the space of the epidural nerve root is formed into a void; 2.
  • the die is inserted into the outer sleeve of the puncture needle.
  • the circular turntable is turned up and down along the bolt, and the circular turntable can be controlled to be non-rotatable or loosely rotatable, thereby fixing the bending angle of the head of the die to the local part.
  • the targeted target is used for accurate drug injection, and the drug is inserted around the lesion through the guiding tube and the tube to form a local high drug concentration, thereby achieving sufficient anti-inflammatory and swelling effect, thereby performing chemical release. Chemical release can more effectively eliminate nerve root edema and adhesion, and eliminate nerve root compression. Clinically, the effect of minimally invasive catheterization of nerve root dissection is significantly improved compared with simple fistula injection.
  • the balloon can be bulged through the head of the die, or a flexible endoscope can be inserted into the die for illumination and video observation to better facilitate epidural fibrotic nerve root adhesion.
  • a flexible endoscope can be inserted into the die for illumination and video observation to better facilitate epidural fibrotic nerve root adhesion.
  • Surgical fistula only need to make a small hole with a diameter of 5 mm at the patient's cleft of the fistula. The operation can be completed in only half a small operation. After four hours, the patient can get out of bed and have a wound.
  • Embodiment 1 is a front view of Embodiment 1 of the present invention.
  • FIG. 2 is a front view of the first embodiment of the present invention with the upper case removed.
  • FIG 3 is a cross-sectional view showing a first embodiment of the present invention.
  • FIG. 4 is an enlarged view of a portion A of FIG. 3.
  • Embodiment 5 is a cross-sectional view of a circular turntable in Embodiment 1 of the present invention.
  • FIG. 6 is a schematic structural view of a puncture needle used in the present invention.
  • 7 is a front view of a second embodiment of the present invention.
  • FIG. 8 is a front view of the second embodiment of the present invention with the upper case removed.
  • FIG. 9 is a cross-sectional view showing a second embodiment of the present invention.
  • FIG. 10 is an enlarged view of a portion B of FIG. 8.
  • FIG. 11 is an enlarged view of a portion C of FIG. 9.
  • Embodiment 12 is a cross-sectional view of a circular turntable in Embodiment 2 of the present invention.
  • Embodiment 3 of the present invention is a front elevational view of Embodiment 3 of the present invention.
  • FIG. 14 is a front view of the embodiment 3 of the present invention with the upper case removed.
  • 15 is a cross-sectional view showing a third embodiment of the present invention.
  • FIG. 16 is an enlarged view of a portion D of FIG. 15.
  • FIG. 17 is a cross-sectional view of a circular turntable in Embodiment 3 of the present invention.
  • Embodiment 1 is a diagrammatic representation of Embodiment 1 :
  • the embodiment includes a handle 1 composed of an upper case 101 and a lower case 102.
  • a guide tube 2 is disposed in the handle 1, and a front end of the handle 1 is provided with a guide column 4.
  • the front end of the guiding tube 2 is connected to the rear end of the die 3 through the guiding column 4, and the guiding tube 2, the guiding column 4 and the die 3 communicate with each other.
  • the rear end of the guide tube 2 is provided with a guide wire 14, and the rear end of the guide tube 2 is connected with a catheter 15 communicating therewith.
  • a circular turntable 6 is fixed in the lower casing 102 by bolts 5, and the circular turntable 6 is rotatable around the bolt 5.
  • the edge of the circular turntable 6 is provided with two handle bases 7 which are convexly and symmetrically arranged, and The inner surfaces of the two handle bases 7 are respectively provided with inner teeth 8 , and the outer surfaces of the two handle bases 7 are respectively provided with a left handle 91 and a right handle 92, and the left handle 91 and the right handle 92 are along The central axis of the circular turntable 6 is symmetrically arranged.
  • a convex circular base 11 is provided in the upper casing 101.
  • the outer surface of the circular base 11 is provided with external ribs 12 which are in mesh with the internal ribs 8.
  • traction wires in the die 3 which are respectively a left traction wire 131 and a right traction wire 132.
  • the front ends of the left traction wire 131 and the right traction wire 132 are fixed on the inner wall of the front end of the die 3, and the rear end thereof passes the screw.
  • 10 are respectively fixed on the circular turntable 6 and symmetrically arranged along the central axis of the circular turntable 6.
  • the rear ends of the left pull wire 131 and the right pull wire 132 are on the same circular turntable 6 as the left handle 91 and the right handle 92. On the central axis.
  • the left handle 91 is turned toward the rear end of the handle 1, and the left handle 91 drives the circular dial 6 to rotate in the direction of the needle.
  • the left traction wire 131 is tightened, and the head of the die 3 is bent to the right under the tension of the left traction wire 131; the right handle 92 is dialed toward the rear end of the handle 1.
  • the right handle 92 drives the circular turntable 6 to rotate in the reverse direction.
  • the right pull wire 132 is tightened, and the tension of the head of the die 3 on the right pull wire 132 acts. Bend down to the left.
  • the bending angle of the head of the die 3 is arbitrarily controlled with the toggle angle of the left lever 91 and the right lever 92, up to 180 degrees.
  • This embodiment uses the need for a puncture needle 18, and the specific method is as follows:
  • a small hole having a diameter of 5 mm is placed at the patient's cleft, and the puncture needle 18 is pierced into the cleft hole at a 45 degree angle in the side of the C-arm X-ray machine, in the case of resistance or bone.
  • Extramembranous fibrotic nerve root adhesion is loosened to form a void for fixed mechanical release; the guide wire 14 is pulled out, the mixed drug is injected from the rear end of the guide tube 2, and the mixed drug is guided along the guide tube 2.
  • the flow column 4 and the die 3 are subjected to local targeted target injection for chemical release.
  • the circular turntable 6 In order to facilitate the surgical operation, after the mechanical release is completed, in order to more accurately perform the chemical release of the fixed target, the circular turntable 6 needs to be fixed so that it cannot rotate, thereby fixing the die 3 head.
  • the bending angle of the part is as follows:
  • the circular turntable 6 is swung in the direction of the circular base 11 along the bolt 5, and the internal rib 8 on the circular turntable 6 and the circular base 11 are The outer teeth 12 are meshed with each other, and the circular turntable 6 is fixed; if the circular turntable 6 is loosened so that it can be rotated, the circular turntable 6 is moved along the bolt 5 in the direction of the bolt 5, circular The inner ribs 8 on the turntable 6 are dislocated from the outer sipe 12 on the circular pedestal 11, and the circular turntable 6 is loosened.
  • Embodiment 2 is a diagrammatic representation of Embodiment 1:
  • the embodiment includes a handle 1 composed of an upper case 101 and a lower case 102.
  • Two guide tubes 2 are provided in the handle 1, respectively, a left guide tube 21 and a right guide.
  • Tube 22 the front end of the handle 1 is provided with The front end of the guide column 4, the left guide tube 21 and the right guide tube 22 are connected to the rear end of the die 3 through the flow guide column 4.
  • the support tube 17 is disposed in the die 3, and the head of the die 3 is provided with an air bag 16, wherein the left guide tube 21 is in communication with the die 3 and the air bag 16, and the right guide tube 22 and the support tube 17 are in communication.
  • the rear end of the left guiding tube 21 is provided with a left guide wire 141, and the rear end of the left guiding tube 21 is connected with a left duct 151 communicating therewith; the rear end of the right guiding tube 22 is provided with a right guide wire 142, and the right guiding tube The rear end of 22 is connected to a right duct 152 that is in communication therewith.
  • a circular turntable 6 is fixed in the lower casing 102 by bolts 5, and the circular turntable 6 is rotatable around the bolt 5.
  • the edge of the circular turntable 6 is provided with two handle bases 7 which are convexly and symmetrically arranged, and The inner surfaces of the two handle bases 7 are respectively provided with inner teeth 8 , and the outer surfaces of the two handle bases 7 are respectively provided with a left handle 91 and a right handle 92, and the left handle 91 and the right handle 92 are along The central axis of the circular turntable 6 is symmetrically arranged.
  • a convex circular base 11 is provided in the upper casing 101.
  • the outer surface of the circular base 11 is provided with external ribs 12 which are in mesh with the internal ribs 8.
  • Two traction wires are arranged in the support tube 17 in the die 3, which are respectively a left traction wire 131 and a right traction wire 132.
  • the front ends of the left traction wire 131 and the right traction wire 132 are fixed on the inner wall of the front end of the support tube 17,
  • the rear ends thereof are respectively fixed on the circular turntable 6 by screws 10 and symmetrically arranged along the central axis of the circular turntable 6.
  • the rear ends of the left and right pull wires 131 and 132 are in the left and right handles 91 and 92.
  • the left handle 91 is turned toward the rear end of the handle 1, and the left handle 91 drives the circular dial 6 to rotate in the direction of the needle.
  • the left traction wire 131 is tightened.
  • the head of the core 3 is bent to the right under the tension of the left traction wire 131;
  • the right handle 92 is turned toward the rear end of the handle 1, and the right handle 92 drives the circular turntable 6 to rotate in the direction of the reverse stitch, with
  • the right pulling wire 132 is pulled, and the head of the die 3 is bent to the left by the tension of the right pulling wire 132.
  • the bending angle of the head of the die 3 is arbitrarily controlled by the toggle angle of the left lever 91 and the right lever 92, up to 180 degrees.
  • This embodiment uses the need for a puncture needle 18, and the specific method is as follows:
  • a small hole having a diameter of 5 mm is placed at the patient's cleft, and the puncture needle 18 is inserted into the cleft hole at a 45-degree angle in the side of the C-arm X-ray machine, in the case of resistance or bone.
  • the left guide wire 141 can be pulled out, air is injected into the left guide tube 21, air enters the balloon 16 through the die 3, and the balloon 16 is supported, which can better adhere to the epidural fibrotic nerve root.
  • the loosening is performed to form a void for a fixed mechanical release; then the right guide wire 142 is pulled out, the mixed drug is injected from the rear end of the right guide tube 22, and the mixed drug is carried along the right guide tube 22 and the support tube 17.
  • Local targeted target injection for chemical release can be used to form a void for a fixed mechanical release.
  • the circular turntable 6 In order to facilitate the surgical operation, in order to more accurately perform the chemical release of the fixed target after the mechanical release, the circular turntable 6 needs to be fixed so that it cannot rotate, thereby fixing the die 3 The bending angle of the part.
  • the specific method is as follows:
  • the circular turntable 6 is slid along the bolt 5 toward the circular pedestal 11, and the internal rib 8 on the circular turntable 6 and the circular pedestal 11 are The outer teeth 12 are meshed with each other, and the circular turntable 6 is fixed; if the circular turntable 6 is loosened so that it can be rotated, the circular turntable 6 is moved along the bolt 5 in the direction of the bolt 5, circular The inner ribs 8 on the turntable 6 are dislocated from the outer sipe 12 on the circular pedestal 11, and the circular turntable 6 is loosened.
  • the air and the mixed drug are inconvenient from the left guide wire as affected by the patient's lying posture.
  • the iliac crest is injected into the 1 and right guide wires 14, and can also be injected through the left catheter 151 and the right catheter 152.
  • the embodiment includes a handle 1 composed of an upper case 101 and a lower case 102.
  • Two guide tubes 2 are disposed in the handle 1, respectively, and left guide tubes 21 are respectively provided.
  • the right guiding tube 22 the front end of the handle 1 is provided with a flow guiding column 4, the front ends of the left guiding tube 21 and the right guiding tube 22 are connected to the rear end of the die 3 through the guiding column 4, and the left guiding tube 21 and the right
  • the guiding tubes 22 communicate with the guiding columns 4 and the die 3, respectively.
  • the rear end of the left guiding tube 21 is provided with a left guide wire 141, and the rear end of the left guiding tube 21 is connected with a left catheter 151 communicating therewith; the rear end of the right guiding tube 22 is provided with a right guiding wire 142, and the right guiding tube The rear end of 22 is connected to a right duct 152 that is in communication therewith.
  • a circular turntable 6 is fixed in the lower casing 102 by bolts 5, and the circular turntable 6 is rotatable around the bolt 5.
  • the edge of the circular turntable 6 is provided with two handle bases 7 which are convexly and symmetrically arranged, and The inner surfaces of the two handle bases 7 are respectively provided with inner teeth 8 , and the outer surfaces of the two handle bases 7 are respectively provided with a left handle 91 and a right handle 92, and the left handle 91 and the right handle 92 are along The central axis of the circular turntable 6 is symmetrically arranged.
  • a convex circular base 11 is provided in the upper casing 101, and the outer surface of the circular base 11 is provided with external ribs 12 which are in mesh with the internal ribs 8.
  • Two traction wires are arranged in the support tube 17 in the die 3, which are respectively a left traction wire 131 and a right traction wire 132.
  • the front ends of the left traction wire 131 and the right traction wire 132 are fixed on the inner wall of the front end of the support tube 17, Its rear end passes the screw 1 0 is fixed on the circular turntable 6 and symmetrically arranged along the central axis of the circular turntable 6.
  • the rear ends of the left pull wire 131 and the right pull wire 132 are on the same circular turntable 6 as the left handle 91 and the right handle 92. On the central axis.
  • the left handle 91 is turned toward the rear end of the handle 1, and the left handle 91 drives the circular dial 6 to rotate in the direction of the needle.
  • the left traction wire 131 is tightened.
  • the head of the core 3 is bent to the right under the tension of the left traction wire 131;
  • the right handle 92 is turned toward the rear end of the handle 1, and the right handle 92 drives the circular turntable 6 to rotate in the direction of the reverse stitch, with
  • the right pulling wire 132 is pulled, and the head of the die 3 is bent to the left by the tension of the right pulling wire 132.
  • the bending angle of the head of the die 3 is arbitrarily controlled by the toggle angle of the left lever 91 and the right lever 92, up to 180 degrees.
  • the puncture needle 18 is required to be used, and the specific method is as follows:
  • a small hole having a diameter of 5 mm is placed at the cleft of the patient's cleft, and the puncture needle 18 is inserted into the cleft hole at a 45 degree angle in the side perspective of the C-arm X-ray machine, in the case of resistance or bone.
  • the left guide wire 141 can be pulled out, and the flexible endoscope is inserted into the left guide tube 21, and the flexible endoscope enters the body through the left guide tube 21, the guide column 4, and the die 3, and is illuminated and video through the flexible endoscope. Observing and releasing the epidural fibrotic nerve root adhesion to form a void can better perform mechanical mechanical release. After the mechanical release is completed, the flexible endoscope is taken out, the right guide wire 142 is pulled out, and the mixed medicine is injected from the rear end of the right guide tube 22, and the mixed medicine is along the right guide tube 22, the guide column 4, and the die 3 Local targeted target injections were performed for chemical release.
  • the circular turntable 6 In order to facilitate the surgical operation, after the mechanical release is completed, in order to more accurately perform the chemical release of the fixed target, the circular turntable 6 needs to be fixed so that it cannot rotate, thereby fixing the die 3 heads.
  • the bending angle of the part is as follows:
  • the circular turntable 6 is swung in the direction of the circular base 11 along the bolt 5, and the internal rib 8 on the circular turntable 6 and the circular base 11 are The outer teeth 12 are meshed with each other, and the circular turntable 6 is fixed; if the circular turntable 6 is loosened so that it can be rotated, the circular turntable 6 is moved along the bolt 5 in the direction of the bolt 5, circular The inner ribs 8 on the turntable 6 are dislocated from the outer sipe 12 on the circular pedestal 11, and the circular turntable 6 is loosened.
  • the flexible endoscope and the mixed drug are inconveniently injected into the fistula from the left wire 141 and the right guide wire 14 as well as the left catheter 151 and the right catheter 152.

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Abstract

一种用于脊柱硬膜外神经根松解剥离术的穿刺针微创置入导管套件，其包括上盒体（101）和下盒体（102）组成的手柄（1），在手柄（1）内设置有引导管（2），手柄（1）的前端设置有导流柱（4），引导管（2）的前端通过导流柱（4）与管芯（3）的后端相连接，其在下盒体（102）内通过螺栓（5）固定有圆形转盘（6），圆形转盘（6）的边缘设有两个外凸并对称布置的手柄基座（7），两个手柄基座（7）的内表面均设有内齿纹（8）、外表面分别设有左拨柄（91）和右拨柄（92）；在上盒体（101）内设有外凸的圆形基座（11），圆形基座（11）的外表面设有与内齿纹（8）互相啮合的外齿纹（12）；管芯（3）内设有左牵引丝（131）和右牵引丝（132），左牵引丝（131）和右牵引丝（132）的后端对称的分别固定在圆形转盘（6）上。该套件具有可进行定点机械性和化学性松解、操作便捷灵活、创伤小、降低手术出血量、术后恢复快的优点。

Description

说明书 穿刺针微创置入导管套件 技术领域
[0001] 本发明涉及医疗手术器械， 尤其是一种用于脊柱硬膜外神经根松解剥离术的穿 刺针微创置入导管套件。
背景技术
[0002] 腰椎间盘突出、 退变等引起的硬膜外腔和神经根通道的粘接， 可导致腰背痛和 坐骨神经痛， 其临床表现多样化， 病程长， 鉴别诊断复杂， 治疗较困难。
[0003] 临床表明， 正常神经受压并无病痛发生， 只有当炎症和压迫同吋存在吋才会引 起疼痛。 针对这一问题， 在目前的临床实践中， 骶管内注射治疗是传统的诊疗 技术， 即直接快速地将药物注射到硬膜外腔， 从而产生液体压力， 可对硬膜外 腔的纤维性粘接、 神经根压迫进行机械性冲击， 达到松解的目的。 传统的硬膜 外注药方法将药液注射于硬膜外后腔， 依靠药物在硬膜外腔扩散的原理， 结合 特殊体位引流作用， 部分药液可渗透到硬膜外前腔或侧前腔， 即腰椎间盘突出 症的病变部位， 而相当一部分药液在硬膜外腔中向其他方向扩散， 起不到治疗 作用。 这种间接治疗方法， 药液很难完全集中于病灶周围， 是治疗效果不佳的 原因之一。
[0004] 患者具有一侧或双下肢疼痛、 麻木等症状的原因是腰间盘突出、 韧带肥厚、 骨 质疏松、 滑脱性结构改变、 外伤性脊柱损伤引起的炎症性物质分泌等， 同吋炎 症性物质未有效排出病变部位， 会粘接在椎间孔韧带， 堵塞脊柱唯一出入口。 以上症状多发于青壮年， 会严重影响患者的工作、 学习和生活。 腰、 臀、 腿痛 是因为大部分脊柱椎间盘突出， 后路小关节失稳后分泌出的炎症疼痛因子粘贴 在椎间孔纤维组织或韧带周围压迫神经根引起的急性或慢性疾病。 初期用椎间 孔阻断神经术治疗有一定效果， 但炎症疼痛因子粘贴比较严重的患者只用药物 治疗不会明显减轻疼痛， 需用穿刺针微创置入导管套件神经根松解剥离术来有 效松解剥离粘贴在压迫神经的炎症疼痛因子。
技术问题 [0005] 本发明所要解决的技术问题是提供一种可进行定点机械性松解和化学性松解、 操作便捷灵活、 创伤小、 降低手术的出血量、 术后恢复快的穿刺针微创置入导 管套件。
问题的解决方案
技术解决方案
[0006] 本发明解决上述问题所采用的技术方案是： 该套件包括由上盒体和下盒体组成 的手柄， 在手柄内设置有引导管， 手柄的前端设置有导流柱， 引导管的前端通 过导流柱与管芯的后端相连接， 其结构特点是在下盒体内通过螺栓固定有圆形 转盘， 圆形转盘的边缘设有两个外凸并对称布置的手柄基座， 两个手柄基座的 内表面均设有内齿纹， 两个手柄基座的外表面分别设有左拨柄和右拨柄； 在上 盒体内设有外凸的圆形基座， 圆形基座的外表面设有与内齿纹互相啮合的外齿 纹； 管芯内设有左牵引丝和右牵引丝， 左牵引丝和右牵引丝的后端对称的分别 固定在圆形转盘上。
[0007] 本发明所述引导管为一根， 且引导管通过导流柱与管芯相连通， 左牵引丝和右 牵引丝的前端固定在管芯前端的内壁上。
[0008] 本发明所述引导管为两根， 分别为左引导管和右引导管， 管芯内设有支撑管， 且管芯的头部设有气囊， 其中左引导管和管芯、 气囊相连通， 右引导管和支撑 管相连通， 左牵引丝和右牵引丝的前端固定在支撑管前端的内壁上。
[0009] 本发明所述引导管为两根， 分别为左引导管和右引导管， 且左引导管和右引导 管通过导流柱与管芯相连通， 左牵引丝和右牵弓 I丝的前端固定在管芯前端的内 壁上。
[0010] 本发明所述左拨柄和右拨柄沿圆形转盘的中轴线对称布置。
[0011] 本发明所述左牵引丝和右牵引丝的后端分别固定在圆形转盘上并沿圆形转盘的 中轴线对称布置， 且左牵引丝和右牵引丝的后端与左拨柄、 右拨柄在同一条圆 形转盘的中轴线上。
[0012] 本发明所述引导管的后端设置有导丝。
[0013] 本发明所述引导管的后端连接有与其相连通的导管。
[0014] 本发明所述左牵引丝和右牵引丝的后端分别通过螺钉固定在圆形转盘上。 发明的有益效果
有益效果
[0015] 本发明与现有技术相比， 具有以下有益效果： 1、 该导管在进行脊柱硬膜外神 经根松解剥离术吋， 可准确地在椎管内或神经孔的病变区域进行定点机械性松 解， 因为管芯内有牵引丝， 管芯的头部松解有利， 且只需轻轻拨动左拨柄或右 拨柄， 即可由牵引丝带动管芯头部向左或向右 180度弯曲， 从而进行可控方向的 摆动松解剥离， 同吋扩大狭窄部位， 让硬膜外神经根压迫部位形成空隙； 2、 机 械性松解完成后， 将管芯插入穿刺针外套管， 管芯头部弯曲到所需位置后， 将 圆形转盘沿螺栓上下拨动， 可控制圆形转盘锁紧不可转动或松幵可转动， 从而 固定管芯头部的弯曲角度， 以对局部定向靶点进行准确的药物注射， 药物经引 导管和管芯介入到病灶周围， 使其形成局部较高的药物浓度， 达到充分消炎消 肿的作用， 从而进行化学性松解， 化学性松解可更有效消除神经根水肿和粘连 ， 消除神经根压迫， 临床表明， 穿刺针微创置入导管套件神经根松解剥离术较 单纯骶管注射治疗的疗效有明显提高； 3、 在机械性松解的同吋， 可以通过撑幵 管芯头部的球囊， 或者在管芯内插入柔性内窥镜进行照明和视频观察， 以更好 的对硬膜外纤维化神经根粘连进行松解剥离； 4、 手术吋， 只需在患者骶裂口处 幵一个直径为 5毫米的小孔， 手术仅需半小吋即可完成， 术后四小吋便可下床活 动， 具有创口小、 出血量少、 痊愈快等优点， 有效弥补了幵放性手术的缺陷， 且不破坏纤维环、 不干预突出物， 最大限度保护椎间盘， 复发率低， 术后配合 功能训练， 以及一到两次的神经阻滞治疗， 疗效更加确切。
对附图的简要说明
附图说明
[0016] 图 1为本发明实施例 1的主视图。
[0017] 图 2为本发明实施例 1拿掉上盒体后的主视图。
[0018] 图 3为本发明实施例 1的剖面图。
[0019] 图 4为图 3的 A处放大图。
[0020] 图 5为本发明实施例 1中圆形转盘的剖面图。
[0021] 图 6为本发明所使用到的穿刺针的结构示意图。 [0022] 图 7为本发明实施例 2的主视图。
[0023] 图 8为本发明实施例 2拿掉上盒体后的主视图。
[0024] 图 9为本发明实施例 2的剖面图。
[0025] 图 10为图 8的 B处放大图。
[0026] 图 11为图 9的 C处放大图。
[0027] 图 12为本发明实施例 2中圆形转盘的剖面图。
[0028] 图 13为本发明实施例 3的主视图。
[0029] 图 14为本发明实施例 3拿掉上盒体后的主视图。
[0030] 图 15为本发明实施例 3的剖面图。
[0031] 图 16为图 15的 D处放大图。
[0032] 图 17为本发明实施例 3中圆形转盘的剖面图。
本发明的实施方式
[0033] 实施例 1 :
[0034] 参见图 1一图 6， 本实施例包括由上盒体 101和下盒体 102组成的手柄 1， 在手柄 1 内设置有一根引导管 2， 手柄 1的前端设置有导流柱 4， 引导管 2的前端通过导流 柱 4与管芯 3的后端相连接， 且引导管 2、 导流柱 4与管芯 3互相连通。 引导管 2的 后端设置有导丝 14， 且引导管 2的后端连接有与其相连通的导管 15。
[0035] 在下盒体 102内通过螺栓 5固定有圆形转盘 6， 圆形转盘 6可绕螺栓 5转动， 圆形 转盘 6的边缘设有两个外凸并对称布置的手柄基座 7， 且两个手柄基座 7的内表面 均设有内齿纹 8， 两个手柄基座 7的外表面则分别设有左拨柄 91和右拨柄 92， 左 拨柄 91和右拨柄 92沿圆形转盘 6的中轴线对称布置。 在上盒体 101内设有外凸的 圆形基座 11， 圆形基座 11的外表面设有与内齿纹 8互相啮合的外齿纹 12。 管芯 3 内设有两根牵引丝， 分别为左牵引丝 131和右牵引丝 132， 左牵引丝 131和右牵引 丝 132的前端均固定在管芯 3前端的内壁上， 其后端通过螺钉 10分别固定在圆形 转盘 6上并沿圆形转盘 6的中轴线对称布置， 左牵引丝 131和右牵引丝 132的后端 与左拨柄 91、 右拨柄 92在同一条圆形转盘 6的中轴线上。
[0036] 将左拨柄 91向手柄 1后端方向拨动， 左拨柄 91带动圆形转盘 6顺吋针方向转动， 随着圆形转盘 6的转动， 左牵引丝 131被拉紧， 管芯 3的头部在左牵引丝 131的拉 紧力作用下向右弯曲； 将右拨柄 92向手柄 1后端方向拨动， 右拨柄 92带动圆形转 盘 6逆吋针方向转动， 随着圆形转盘 6的转动， 右牵引丝 132被拉紧， 管芯 3的头 部在右牵引丝 132的拉紧力作用下向左弯曲。 管芯 3头部的弯曲角度随左拨柄 91 和右拨柄 92的拨动角度任意控制， 最大可达 180度。
[0037] 本实施例使用吋需配合穿刺针 18， 具体方法如下：
[0038] 在患者骶裂口处幵一个直径为 5毫米的小孔， 在 C形臂 X线机骶尾部侧位透视下 ， 将穿刺针 18以 45度角度刺入骶裂孔， 如遇阻力或骨骼， 则调整穿刺针 18角度 ， 直至进入骶管， 在透视下再一次确认针尖的位置； 注入造影剂， 在腰骶椎正 、 侧位透视下， 观察硬膜外神经根是否受压或粘连； 拔出穿刺针 18的针芯， 将 管芯 3插入穿刺针 18外套管， 通过拨动左拨柄 91和右拨柄 92， 将管芯 3的头部准 确置入到椎间盘突出部位， 对硬膜外纤维化神经根粘连进行松解， 使形成空隙 ， 以进行定点机械性松解； 拔出导丝 14， 将混合药物从引导管 2的后端注入， 混 合药物沿着引导管 2、 导流柱 4、 管芯 3进行局部定向靶点注射， 以进行化学性松 解。
[0039] 为方便手术操作， 在完成机械性松解后， 为了更精确的进行定点靶点的化学性 松解， 需对圆形转盘 6进行固定， 使其不能转动， 从而固定管芯 3头部的弯曲角 度。 具体方法如下：
[0040] 管芯 3头部弯曲到所需位置后， 将圆形转盘 6沿螺栓 5向圆形基座 11方向拨动， 圆形转盘 6上的内齿纹 8与圆形基座 11上的外齿纹 12互相啮合在一起， 圆形转盘 6 被固定； 如需将圆形转盘 6松幵， 使其可以转动， 再将圆形转盘 6沿螺栓 5向螺栓 5方向拨动， 圆形转盘 6上的内齿纹 8与圆形基座 11上的外齿纹 12脱幵， 圆形转盘 6被松幵。
[0041] 此外， 进行化学性松解吋， 如受患者躺卧姿势影响， 混合药物不便从导丝 14处 注入， 也可以通过导管 15处注入。
[0042] 实施例 2:
[0043] 参见图 6—图 12， 本实施例包括由上盒体 101和下盒体 102组成的手柄 1， 在手柄 1内设置有两根引导管 2， 分别为左引导管 21和右引导管 22， 手柄 1的前端设置有 导流柱 4， 左引导管 21和右引导管 22的前端通过导流柱 4与管芯 3的后端相连接。 管芯 3内设有支撑管 17， 且管芯 3的头部设有气囊 16， 其中左引导管 21和管芯 3、 气囊 16相连通， 右引导管 22和支撑管 17相连通。 左引导管 21的后端设置有左导 丝 141， 且左引导管 21的后端连接有与其相连通的左导管 151 ; 右引导管 22的后 端设置有右导丝 142， 且右引导管 22的后端连接有与其相连通的右导管 152。
[0044] 在下盒体 102内通过螺栓 5固定有圆形转盘 6， 圆形转盘 6可绕螺栓 5转动， 圆形 转盘 6的边缘设有两个外凸并对称布置的手柄基座 7， 且两个手柄基座 7的内表面 均设有内齿纹 8， 两个手柄基座 7的外表面则分别设有左拨柄 91和右拨柄 92， 左 拨柄 91和右拨柄 92沿圆形转盘 6的中轴线对称布置。 在上盒体 101内设有外凸的 圆形基座 11， 圆形基座 11的外表面设有与内齿纹 8互相啮合的外齿纹 12。 管芯 3 内的支撑管 17内设有两根牵引丝， 分别为左牵引丝 131和右牵引丝 132， 左牵引 丝 131和右牵引丝 132的前端均固定在支撑管 17前端的内壁上， 其后端通过螺钉 1 0分别固定在圆形转盘 6上并沿圆形转盘 6的中轴线对称布置， 左牵引丝 131和右 牵引丝 132的后端与左拨柄 91、 右拨柄 92在同一条圆形转盘 6的中轴线上。
[0045] 将左拨柄 91向手柄 1后端方向拨动， 左拨柄 91带动圆形转盘 6顺吋针方向转动， 随着圆形转盘 6的转动， 左牵引丝 131被拉紧， 管芯 3的头部在左牵引丝 131的拉 紧力作用下向右弯曲； 将右拨柄 92向手柄 1后端方向拨动， 右拨柄 92带动圆形转 盘 6逆吋针方向转动， 随着圆形转盘 6的转动， 右牵引丝 132被拉紧， 管芯 3的头 部在右牵引丝 132的拉紧力作用下向左弯曲。 管芯 3头部的弯曲角度随左拨柄 91 和右拨柄 92的拨动角度任意控制， 最大可达 180度。
[0046] 本实施例使用吋需配合穿刺针 18， 具体方法如下：
[0047] 在患者骶裂口处幵一个直径为 5毫米的小孔， 在 C形臂 X线机骶尾部侧位透视下 ， 将穿刺针 18以 45度角度刺入骶裂孔， 如遇阻力或骨骼， 则调整穿刺针 18角度 ， 直至进入骶管， 在透视下再一次确认针尖的位置； 注入造影剂， 在腰骶椎正 、 侧位透视下， 观察硬膜外神经根是否受压或粘连； 拔出穿刺针 18的针芯， 将 管芯 3插入穿刺针 18外套管， 通过拨动左拨柄 91和右拨柄 92， 将管芯 3的头部准 确置入到椎间盘突出部位， 同吋可拔出左导丝 141， 向左引导管 21内注入空气， 空气经管芯 3进入球囊 16， 将球囊 16撑幵， 可更好的对硬膜外纤维化神经根粘连 进行松解， 使形成空隙， 以进行定点机械性松解； 接着拔出右导丝 142， 将混合 药物从右引导管 22的后端注入， 混合药物沿着右引导管 22、 支撑管 17进行局部 定向靶点注射， 以进行化学性松解。
[0048] 为方便手术操作， 在完成机械性松解后， 为了更精确的进行定点靶点的化学性 松解， 需对圆形转盘 6进行固定， 使其不能转动， 从而固定管芯 3头部的弯曲角 度。 具体方法如下：
[0049] 管芯 3头部弯曲到所需位置后， 将圆形转盘 6沿螺栓 5向圆形基座 11方向拨动， 圆形转盘 6上的内齿纹 8与圆形基座 11上的外齿纹 12互相啮合在一起， 圆形转盘 6 被固定； 如需将圆形转盘 6松幵， 使其可以转动， 再将圆形转盘 6沿螺栓 5向螺栓 5方向拨动， 圆形转盘 6上的内齿纹 8与圆形基座 11上的外齿纹 12脱幵， 圆形转盘 6被松幵。
[0050] 此外， 进行手术吋， 如受患者躺卧姿势影响， 空气和混合药物不便从左导丝 14
1和右导丝 14处注入吋， 也可以通过左导管 151和右导管 152处注入。
[0051] 实施例 3:
[0052] 参见图 6和图 13—图 17， 本实施例包括由上盒体 101和下盒体 102组成的手柄 1， 在手柄 1内设置有两根引导管 2， 分别为左引导管 21和右引导管 22， 手柄 1的前端 设置有导流柱 4， 左引导管 21和右引导管 22的前端通过导流柱 4与管芯 3的后端相 连接,且左引导管 21和右引导管 22分别与导流柱 4、 管芯 3互相连通。 左引导管 21 的后端设置有左导丝 141， 且左引导管 21的后端连接有与其相连通的左导管 151 ； 右引导管 22的后端设置有右导丝 142， 且右引导管 22的后端连接有与其相连通 的右导管 152。
[0053] 在下盒体 102内通过螺栓 5固定有圆形转盘 6， 圆形转盘 6可绕螺栓 5转动， 圆形 转盘 6的边缘设有两个外凸并对称布置的手柄基座 7， 且两个手柄基座 7的内表面 均设有内齿纹 8， 两个手柄基座 7的外表面则分别设有左拨柄 91和右拨柄 92， 左 拨柄 91和右拨柄 92沿圆形转盘 6的中轴线对称布置。 在上盒体 101内设有外凸的 圆形基座 11， 圆形基座 11的外表面设有与内齿纹 8互相啮合的外齿纹 12。 管芯 3 内的支撑管 17内设有两根牵引丝， 分别为左牵引丝 131和右牵引丝 132， 左牵引 丝 131和右牵引丝 132的前端均固定在支撑管 17前端的内壁上， 其后端通过螺钉 1 0分别固定在圆形转盘 6上并沿圆形转盘 6的中轴线对称布置， 左牵引丝 131和右 牵引丝 132的后端与左拨柄 91、 右拨柄 92在同一条圆形转盘 6的中轴线上。
[0054] 将左拨柄 91向手柄 1后端方向拨动， 左拨柄 91带动圆形转盘 6顺吋针方向转动， 随着圆形转盘 6的转动， 左牵引丝 131被拉紧， 管芯 3的头部在左牵引丝 131的拉 紧力作用下向右弯曲； 将右拨柄 92向手柄 1后端方向拨动， 右拨柄 92带动圆形转 盘 6逆吋针方向转动， 随着圆形转盘 6的转动， 右牵引丝 132被拉紧， 管芯 3的头 部在右牵引丝 132的拉紧力作用下向左弯曲。 管芯 3头部的弯曲角度随左拨柄 91 和右拨柄 92的拨动角度任意控制， 最大可达 180度。
[0055] 本实施例使用吋需配合穿刺针 18， 具体方法如下：
[0056] 在患者骶裂口处幵一个直径为 5毫米的小孔， 在 C形臂 X线机骶尾部侧位透视下 ， 将穿刺针 18以 45度角度刺入骶裂孔， 如遇阻力或骨骼， 则调整穿刺针 18角度 ， 直至进入骶管， 在透视下再一次确认针尖的位置； 注入造影剂， 在腰骶椎正 、 侧位透视下， 观察硬膜外神经根是否受压或粘连； 拔出穿刺针 18的针芯， 将 管芯 3插入穿刺针 18外套管， 通过拨动左拨柄 91和右拨柄 92， 将管芯 3的头部准 确置入到椎间盘突出部位， 同吋可拔出左导丝 141， 向左引导管 21内插入柔性内 窥镜， 柔性内窥镜经左引导管 21、 导流柱 4、 管芯 3进入体内， 通过柔性内窥镜 一边照明和视频观察、 一边对硬膜外纤维化神经根粘连进行松解， 使形成空隙 ， 可以更好的进行定点机械性松解。 机械性松解完成后， 取出柔性内窥镜， 拔 出右导丝 142， 将混合药物从右引导管 22的后端注入， 混合药物沿着右引导管 22 、 导流柱 4、 管芯 3进行局部定向靶点注射， 以进行化学性松解。
[0057] 为方便手术操作， 在完成机械性松解后， 为了更精确的进行定点靶点的化学性 松解， 需对圆形转盘 6进行固定， 使其不能转动， 从而固定管芯 3头部的弯曲角 度。 具体方法如下：
[0058] 管芯 3头部弯曲到所需位置后， 将圆形转盘 6沿螺栓 5向圆形基座 11方向拨动， 圆形转盘 6上的内齿纹 8与圆形基座 11上的外齿纹 12互相啮合在一起， 圆形转盘 6 被固定； 如需将圆形转盘 6松幵， 使其可以转动， 再将圆形转盘 6沿螺栓 5向螺栓 5方向拨动， 圆形转盘 6上的内齿纹 8与圆形基座 11上的外齿纹 12脱幵， 圆形转盘 6被松幵。 此外， 进行手术吋， 如受患者躺卧姿势影响， 柔性内窥镜和混合药物不便从左 丝 141和右导丝 14处注入吋， 也可以通过左导管 151和右导管 152处注入。

Claims

权利要求书
一种穿刺针微创置入导管套件， 包括由上盒体 （101) 和下盒体 （102 ) 组成的手柄 （1) ， 在手柄 （1) 内设置有引导管 （2) ， 手柄 （1) 的前端设置有导流柱 （4) ， 引导管 （2) 的前端通过导流柱 （4) 与 管芯 （3) 的后端相连接， 其特征是： 在下盒体 （102) 内通过螺栓 （ 5) 固定有圆形转盘 （6) ， 圆形转盘 （6) 的边缘设有两个外凸并对 称布置的手柄基座 （7) ， 两个手柄基座 （7) 的内表面均设有内齿纹 (8) ， 两个手柄基座 （7) 的外表面分别设有左拨柄 （91) 和右拨柄 (92) ； 在上盒体 （101) 内设有外凸的圆形基座 （11) ， 圆形基座 (11) 的外表面设有与内齿纹 （8) 互相啮合的外齿纹 （12) ； 管芯 (3) 内设有左牵引丝 （131) 和右牵引丝 （132) ， 左牵引丝 （131) 和右牵引丝 （132) 的后端对称的分别固定在圆形转盘 （6) 上。
根据权利要求 1所述的穿刺针微创置入导管套件， 其特征是： 所述引 导管 （2) 为一根， 且引导管 （2) 通过导流柱 （4) 与管芯 （3) 相连 通， 左牵引丝 （131) 和右牵引丝 （132) 的前端固定在管芯 （3) 前 端的内壁上。
根据权利要求 1所述的穿刺针微创置入导管套件， 其特征是： 所述引 导管 （2) 为两根， 分别为左引导管 （21) 和右引导管 （22) ， 管芯
(3) 内设有支撑管 （17) ， 且管芯 （3) 的头部设有气囊 （16) ， 其 中左引导管 （21) 和管芯 （3) 、 气囊 （16) 相连通， 右引导管 （22 ) 和支撑管 (17) 相连通， 左牵引丝 (131) 和右牵引丝 (132) 的前 端固定在支撑管 （17) 前端的内壁上。
根据权利要求 1所述的穿刺针微创置入导管套件， 其特征是： 所述引 导管 （2) 为两根， 分别为左引导管 （21) 和右引导管 （22) ， 且左 引导管 （21) 和右引导管 （22) 通过导流柱 （4) 与管芯 （3) 相连通 ， 左牵引丝 （131) 和右牵引丝 （132) 的前端固定在管芯 （3) 前端 的内壁上。
根据权利要求 1所述的穿刺针微创置入导管套件， 其特征是： 所述左 拨柄 （91) 和右拨柄 （92) 沿圆形转盘 （6) 的中轴线对称布置。
[权利要求 6] 根据权利要求 1所述的穿刺针微创置入导管套件， 其特征是： 所述左 牵引丝 （131) 和右牵引丝 （132) 的后端分别固定在圆形转盘 （6) 上并沿圆形转盘 （6) 的中轴线对称布置， 且左牵引丝 （131) 和右牵 引丝 （132) 的后端与左拨柄 （91) 、 右拨柄 （92) 在同一条圆形转 盘 （6) 的中轴线上。
[权利要求 7] 根据权利要求 1或 2或 3或 4所述的穿刺针微创置入导管套件， 其特征是
： 所述引导管 （2) 的后端设置有导丝 （14) 。
[权利要求 8] 根据权利要求 1或 2或 3或 4所述的穿刺针微创置入导管套件， 其特征是
： 所述引导管 （2) 的后端连接有与其相连通的导管 （15) 。
[权利要求 9] 根据权利要求 1或 6所述的穿刺针微创置入导管套件， 其特征是： 所述 左牵引丝 （131) 和右牵引丝 （132) 的后端分别通过螺钉 （10) 固定 在圆形转盘 （6) 上。
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CN105030308B (zh) * 2015-07-02 2018-05-22 周建明 穿刺针微创置入导管套件
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