WO2018078825A1

WO2018078825A1 - Ultrasonic probe

Info

Publication number: WO2018078825A1
Application number: PCT/JP2016/082175
Authority: WO
Inventors: 藤崎　健; 宜瑞坂本; 弘之荒木; 英人吉嶺
Original assignee: オリンパス株式会社
Priority date: 2016-10-28
Filing date: 2016-10-28
Publication date: 2018-05-03

Abstract

A treatment unit of this ultrasonic probe is provided with a first outer surface, a second outer surface facing opposite the direction the first outer surface faces, and a tip outer surface facing the tip side, and has a through hole that passes from the first outer surface to the second outer surface. The treatment unit is provided with a blade which is formed along the edge of the through hole opening in the first outer surface, and two side surfaces extending between the blade and the second outer surface. The side surfaces face opposite each other, have tips connected to the aforementioned tip outer surface, and have a planar shape parallel to the central axis of the treatment unit.

Description

Ultrasonic probe

The present invention relates to an ultrasonic probe that treats a treatment target using transmitted ultrasonic vibration.

US2016 / 0157884A1 discloses an ultrasonic probe that cuts bone or cartilage to be treated using transmitted ultrasonic vibration. A treatment portion is provided at the distal end portion of the probe, and in one example, the treatment portion is formed in a so-called curette shape. Here, the direction along the central axis of the treatment portion is defined as the extending direction of the treatment portion. The curette-shaped treatment portion includes a first outer surface facing in a direction intersecting with the extending direction of the treatment portion, and a second outer surface facing away from the side on which the first outer surface faces. And having a through hole penetrating from the first outer surface to the second outer surface. In the first opening in which the through hole opens at the first outer surface, the first blade is formed along the edge of the first opening, and in the second opening in which the through hole opens at the second outer surface. A second blade is formed along the edge of the second opening. The treatment target is cut by vibrating the treatment portion by ultrasonic vibration while the first blade or the second blade is in contact with the treatment target.

In US2016 / 0157884A1, the outer relay surface extends between the first blade and the second blade on the outer surface of the treatment portion in a state of facing away from the central axis of the through hole. The outer relay surface includes a tip outer surface facing the tip side. The outer surface of the tip is formed into a curved surface with a constant curvature, and forms a semicircular arc centered on the central axis of the through hole in projection from the first outer surface side and the second outer surface side. When the treatment target is cut with the ultrasonic probe having such a configuration and the treatment target is excised, due to the curved shape of the outer surface of the tip, that is, the curved shape of the outer relay surface, The part near the bottom tends to be curved. Since the portion in the vicinity of the bottom surface on the side surface has a curved surface shape, corners are hardly formed between the bottom surface and the side surface in the excision portion to be treated. In the state in which no corner is formed between the bottom surface and the side surface in the excision part, there is a possibility that the storage property of the chemical solution for treatment in the excision part to be treated decreases.

The present invention has been made paying attention to the above-mentioned problems, and its object is to provide a blade along the edge of the opening of the through-hole formed in the treatment portion, An object of the present invention is to provide an ultrasonic probe that easily forms an angle with a side surface.

An ultrasonic probe according to an aspect of the present invention includes a probe main body portion to which ultrasonic vibration generated by a vibrator is transmitted, and a bone that is provided on a distal end side of the probe main body portion and is a treatment target by the ultrasonic vibration. Or a treatment portion for cutting cartilage, wherein the treatment portion is opposite to a first outer surface facing in a direction intersecting a central axis of the treatment portion and a side facing the first outer surface. A second outer surface facing the side and a distal outer surface facing the distal end in the direction along the central axis, and the treatment portion penetrates from the first outer surface to the second outer surface. A through-hole having a first opening on the first outer surface and a second opening on the second outer surface, wherein the treatment section includes the through-hole. A first blade formed along an edge of the first opening The extending direction of the through hole extends between the first blade and the second outer surface, and the distal end is continuous with the outer surface of the distal end, with respect to the central axis of the treatment portion The first blade and the second blade with respect to the extending direction of the through-hole in a state where the first side surface becomes a parallel flat surface and the side facing the first side surface faces the opposite side. A second side surface extending between the outer surface and having a distal end continuous with the outer surface of the distal end and having a planar shape parallel to the central axis of the treatment portion.

FIG. 1 is a schematic view showing a treatment system according to the first embodiment. FIG. 2 is a schematic diagram illustrating the configuration of the treatment unit according to the first embodiment. FIG. 3 is a perspective view schematically showing the configuration of the treatment portion of the ultrasonic treatment apparatus according to the first embodiment. FIG. 4 is a cross-sectional view schematically showing the configuration of the treatment portion of the ultrasonic treatment apparatus according to the first embodiment. FIG. 5 is a schematic diagram illustrating the treatment unit according to the first embodiment as viewed from one side in the thickness direction. FIG. 6 is a schematic view showing the treatment portion according to the comparative example as viewed from one side in the thickness direction. FIG. 7 is a schematic diagram illustrating an example of a moving path of a treatment unit when cutting a cartilage that is a treatment target using the ultrasonic probe according to the comparative example or the ultrasonic probe according to the present embodiment. 8 shows the YY cross section of FIG. 7 after the entire cutting target region is cut by the first cutting operation by the ultrasonic probe according to the comparative example and before the second cutting operation is performed. It is sectional drawing shown roughly. FIG. 9 is a cross-sectional view of FIG. 7 after the entire cutting target region is cut by the first cutting operation by the ultrasonic probe according to the first embodiment and before the second cutting operation is performed. It is sectional drawing which shows a Y cross section roughly. FIG. 10 is a schematic diagram illustrating an example of a state in which the treatment unit is performing a cartilage cutting operation using an ultrasonic probe that is bent or curved with respect to the probe main body in the first embodiment. is there. FIG. 11 is different from FIG. 10 in the state in which the treatment unit is performing a cartilage cutting operation using an ultrasonic probe in which the treatment unit is bent or curved with respect to the probe main body in the first embodiment. It is the schematic which shows an example. FIG. 12 is a perspective view schematically showing a treatment portion of the ultrasonic probe according to the first modification.

(First embodiment)
A first embodiment of the present invention will be described with reference to FIGS.

FIG. 1 is a diagram showing a treatment system 1 of the present embodiment. As shown in FIG. 1, the treatment system 1 is used, for example, when treating a knee joint 100. The treatment system 1 includes an arthroscopic device 2, a treatment device 4, and a perfusion device 6.

The arthroscopic device 2 includes an arthroscope 12 for observing the patient's knee joint 100, that is, the joint cavity 101, and an arthroscope controller 14 such as an image processor for performing image processing based on a subject image captured by the arthroscope 12. And a monitor 16 on which video generated by image processing by the arthroscopic controller 14 is displayed. The arthroscope 12 is inserted into the joint cavity 101 of the knee joint 100 through the first portal 102 that allows the inside of the patient's knee joint 100 to communicate with the outside of the skin. The position of the first portal 102 is not determined in one place, but is appropriately determined depending on the patient's condition, the position of the treatment target, and the like. It is also preferable that a cannula (not shown) is disposed on the first portal 102 and the arthroscope 12 is inserted into the joint cavity 101 of the knee joint 100 through the inside of the cannula.

The treatment device 4 includes a treatment unit 22, a controller 24, and an operation member 26. In the embodiment of FIG. 1, the operation member 26 is an operation button provided integrally with the treatment unit 22. However, in one embodiment, the operation member 26 is a foot switch or a keyboard separate from the treatment unit 22. There may be. The controller 24 controls the supply of electrical energy (electric power) to the treatment unit 22 in accordance with an operation input from the operation member 26. For example, when the operation member 26 is pressed, the output of electric energy from the controller 24 to the treatment unit 22 is maintained, and when the operation member 26 is released, the electric energy from the controller 24 to the treatment unit 22 is maintained. Output is stopped. In some embodiments, a plurality of operation members 26 are provided, and the magnitude of electrical energy output from the controller 24 when an operation input is performed may be different for each operation member 26.

The treatment unit 22 is inserted into the joint cavity 101 of the knee joint 100 through the second portal 104 that allows the inside of the patient's knee joint 100 to communicate with the outside of the skin. The position of the second portal 104 is not determined in one place, but is appropriately determined depending on the patient's condition, the position of the treatment target, and the like. It is also preferable that a cannula (not shown) is disposed on the second portal 104 and the treatment unit 22 is inserted into the joint cavity 101 of the knee joint 100 through the inside of the cannula. In FIG. 1, the arthroscope 12 and the treatment unit 22 face each other in the joint cavity 101, but the arthroscope 12 and the treatment unit 22 are arranged in an appropriate positional relationship according to the position of the treatment target and the like. .

The perfusion device 6 includes a liquid source 32 that contains a perfusion solution such as physiological saline, a perfusion pump unit 34, a liquid feed tube 35 having one end connected to the liquid source 32, a drain tube 36, and a drain tube. A suction bottle 38 to which one end of 36 is connected. The suction bottle 38 is connected to a suction source that is attached to the wall of the operating room. By driving the liquid feed pump 34 A of the perfusion pump unit 34, the perfusate is supplied from the liquid source 32 through the liquid feed tube 35. The perfusion pump unit 34 is provided with a pinch valve 34B as a drain valve. By switching the opening and closing of the pinch valve 34B, the state in which the perfusate in the joint cavity 101 of the knee joint 100 is sucked into the suction bottle 38 through the drainage tube 36 and the suction of the perfusate in the joint cavity 101 are stopped. Switch between states.

The other end of the liquid feeding tube 35 that is a liquid feeding pipe line is connected to the arthroscope 12. For this reason, the perfusate can be supplied into the joint cavity 101 of the knee joint 100 via the arthroscope 12. The other end of the drainage tube 36 that is a drainage conduit is connected to the arthroscope 12. For this reason, the perfusate can be discharged from the joint cavity 101 of the knee joint 100 via the arthroscope 12. The other end of the liquid feeding tube 35 may be connected to the treatment unit 22 so that the perfusate can be supplied into the joint cavity 101 of the knee joint 100 via the treatment unit 22. Further, the other end of the drainage tube 36 may be connected to the treatment unit 22 so that the perfusate can be discharged from the joint cavity 101 through the treatment unit 22. Further, the supply of the perfusate into the joint cavity 101 and the joint cavity of the perfusate through a portal different from the first portal 102 into which the arthroscope 12 is inserted and the second portal 104 into which the treatment unit 22 is inserted. The discharge from the inside 101 may be performed.

FIG. 2 is a diagram showing a configuration of the treatment unit 22. As shown in FIG. 2, the treatment unit 22 includes an ultrasonic treatment instrument 42 and a transducer unit 44. The ultrasonic treatment instrument 42 is preferably detachable from the transducer unit 44, but the ultrasonic treatment instrument 42 and the transducer unit 44 may be integrated. The transducer unit 44 includes a housing (vibrator case) 46 and a bolt-clamped Langevin type transducer (Bolt-clamped Langevin-type Transducer) 48. A connecting portion 48 A is formed at the tip of the vibrator 48. The connecting portion 48A preferably protrudes from the housing 46 toward the distal end side in the direction along the central axis C of the vibrator 48. Further, the housing 46 supports the supported portion 48 B of the vibrator 48.

One end of a cable 49 is connected to the housing 46 of the vibrator unit 44, and the other end of the cable 49 is connected to the controller 24. Inside the cable 49,

electrical wiring

51A, 51B is extended. One ends of the

electrical wirings

51A and 51B are connected to the vibrator 48, and the other ends of the

electrical wirings

51A and 51B are connected to the controller 24. The electric energy output from the controller 24 is supplied to the vibrator 48 through the

electric wirings

51A and 51B. AC power is supplied to the vibrator 48 as electric energy at any frequency within a predetermined frequency range. By supplying electric energy to the vibrator 48, ultrasonic vibration is generated in the vibrator 48.

The ultrasonic treatment instrument 42 includes a housing (handle) 52, a cylindrical body (outer cylinder) 54 extending from the housing 52 along the central axis C, and an ultrasonic probe inserted into the cylindrical body 54. 56. Here, in the ultrasonic treatment instrument 42, the side where the housing 52 is positioned with respect to the cylindrical body 54 is the base end side (arrow C1 side), and the side opposite to the base end side is the front end side (arrow C2 side). To do. The cylindrical body 54 is attached to the housing 52 from the distal end side. In the present embodiment, the cylindrical body 54 is substantially coaxial with the vibrator 48. The housing 52 and the cylindrical body 54 of the ultrasonic treatment instrument 42 are formed of a material having electrical insulation. A housing 46 of the transducer unit 44 is detachably connected to the housing 52 of the ultrasonic treatment instrument 42. It is also preferable that the housing 52 of the ultrasonic treatment instrument 42 and the housing 46 of the transducer unit 44 are integrated.

It should be noted that a rotation knob (not shown) that is a rotation operation member may be attached to the housing 52 of the ultrasonic treatment instrument 42. The rotation knob is rotatable with respect to the housing 52 around the central axis C of the cylindrical body 54. By rotating the rotary knob, the housing 46 and the vibrator 48 of the transducer unit 44, the cylindrical body 54, and the ultrasonic probe 56 are moved together with respect to the housing 52 around the central axis C of the cylindrical body 54. Rotate.

The ultrasonic probe 56 is formed of a material having high vibration transmission properties such as a titanium alloy material. A connection portion 56 A is formed at the proximal end of the ultrasonic probe 56. By connecting the transducer unit 44 to the housing 52, the connection portion 56 A of the ultrasonic probe 56 is connected to the connection portion 48 A of the transducer 48. By connecting the ultrasonic probe 56 to the distal end side of the vibrator 48, the ultrasonic vibration generated by the vibrator 48 is transmitted to the ultrasonic probe 56. In the ultrasonic probe 56, ultrasonic vibration is transmitted from the proximal end side to the distal end side.

In a state where the ultrasonic vibration generated by the vibrator 48 is transmitted by the ultrasonic probe 56, the vibrator 48 and the ultrasonic probe 56 become the vibrating body 50 that vibrates together by the ultrasonic vibration. As described above, the AC power is supplied to the vibrator 48 at any frequency within the predetermined frequency range. For this reason, in a state where ultrasonic vibration is transmitted in the ultrasonic probe 56, the vibrating body 50 vibrates at any resonance frequency within a predetermined frequency range. At this time, the vibration direction of the vibrating body 50 is substantially parallel to the longitudinal direction of the vibrating body 50, that is, the direction along the central axis C of the cylindrical body 54. Further, when the vibrating body 50 vibrates at any resonance frequency within a predetermined frequency range, vibration antinodes are generated at the distal end and the proximal end of the vibrating body 50.

In the embodiment in which a plurality of operation members 26 are provided and the magnitude of electric energy output from the controller 24 when an operation input is performed is different for each operation member 26, the vibrator 48 is provided for each operation member 26. The magnitude of the electric energy supplied to is different. For this reason, the vibration energy of the generated ultrasonic vibration is different for each operation member 26, and the magnitude of the amplitude at the ultrasonic probe 56 when an operation input is performed is different.

As shown in FIG. 2, the ultrasonic probe 56 includes a probe main body portion 62, a treatment portion 64 that is provided on the distal end side of the probe main body portion 62 and can cut bone and cartilage that are treatment targets by ultrasonic vibration, Is provided. The probe main body 62 is substantially coaxial with the cylindrical body 54 and has the same central axis C as the cylindrical body 54. The treatment portion 64 protrudes from the distal end of the cylindrical body 54 toward the distal end side. The ultrasonic vibration generated by the vibrator 48 is transmitted to the probe main body 62, and the ultrasonic vibration is transmitted to the treatment section 64 through the probe main body 62.

In one embodiment, the treatment portion 64 is provided coaxially with the probe main body portion 62 and extends straight from the probe main body portion 62 to the distal end side. In this case, the central axis L of the treatment portion 64 coincides with the central axis C of the probe main body portion 62. In another embodiment, the treatment portion 64 is bent or curved with respect to the probe body portion 62. In this case, the central axis L of the treatment portion 64 is bent or curved with respect to the central axis C of the probe main body portion 62.

3 to 5 are diagrams showing the configuration of the treatment section 64. FIG. As shown in FIGS. 3 to 5, the treatment portion 64 extends along the central axis L. The treatment portion 64 has an outer surface 70 exposed to the outside. Here, the direction along the central axis L of the treatment portion 64 is the extending direction of the treatment portion 64. The outer surface 70 faces a first outer surface 72 facing a predetermined direction (substantially perpendicular) intersecting with the extending direction of the treatment portion 64 and facing a side opposite to the side facing the first outer surface 72. A second outer surface 74. The treatment portion 64 is formed with a through-hole 76 that penetrates the treatment portion from the first outer surface 72 to the second outer surface 74. The through hole 76 extends along the central axis P. The extending direction of the through hole 76, that is, the direction along the central axis P intersects with the extending direction of the treatment portion 64 (substantially perpendicular). Here, the extending direction of the through hole 76 is substantially parallel to the thickness direction of the treatment portion 64 (directions indicated by arrows T1 and T2). Further, the direction intersecting the central axis L of the treatment portion 64 (substantially perpendicular) and intersecting the central axis P of the through-hole 76 (substantially perpendicular) is the width direction of the treatment portion 64 (arrow W1 and arrow W2). Direction). For this reason, in the present embodiment, the first outer surface 72 faces one side (arrow T1 side) in the thickness direction of the treatment portion 64, and the second outer surface 74 extends in the thickness direction of the treatment portion 64. It faces the other side (arrow T2 side). 4 shows the treatment portion 64 in a cross section substantially perpendicular to the width direction, and FIG. 5 shows a state in which the treatment portion 64 is viewed from the first outer surface 72 side, which is one side in the thickness direction. .

The through hole 76 opens at the first outer surface 72 at the first opening 77 and at the second outer surface 74 at the second opening 78. Further, the first outer surface 72 has a first blade 82 formed along the edge of the first opening 77, and the second outer surface 74 has the first blade 82 formed along the edge of the second opening 78. Two blades 84 are formed. Each of the first blade 82 and the second blade 84 extends along the center axis P of the through hole 76. The first blade 82 is provided at the tip side portion at the edge of the first opening 77, and the second blade 84 is provided at the tip side portion at the edge of the second opening 78. Since it is the above-mentioned composition, in this embodiment, treatment part 64 serves as a curette shape. Further, in the present embodiment, the cross-sectional shape substantially perpendicular to the central axis P of the through hole 76 is a substantially pentagonal shape, and the shape of the range surrounded by the edge of the first opening 77 and the edge of the second opening 78 is It becomes a substantially pentagonal shape.

The treatment section 64 includes an inner relay surface 85 that forms the outer edge of the through hole 76. The inner relay surface 85 extends along the thickness direction of the treatment portion 64 from the first opening 77 of the first outer surface 72 to the second opening 78 of the second outer surface 74. The through hole 76 is surrounded by the inner relay surface 85. The inner relay surface 85 faces the side closer to the central axis P of the through hole 76 in the radial direction of the through hole 76. The inner relay surface 85 includes a first inner inclined surface (first blade forming surface) 86 extending from the first opening 77 toward the second outer surface 74 side, and a second opening 78 to the second inner surface 85. A second inner inclined surface (second blade forming surface) 87 extending toward the outer surface 72 side of the first inner surface, and a first inner inclined surface 86 and a second inner side in the extending direction of the through hole 76. An inner extending surface 88 that is continuous with the inclined surface 87.

Each of the first inner inclined surface 86 and the second inner inclined surface 87 is inclined with respect to the thickness direction of the treatment portion 64, that is, the extending direction of the through hole 76. In the first inner inclined surface 86, the distance from the central axis P of the through hole 76 decreases as the distance from the first opening 77 (first blade 82) increases. For this reason, in the range where the first inner inclined surface 86 is extended in the through hole 76, the cross-sectional area substantially perpendicular to the extending direction of the through hole 76 decreases as the distance from the first opening 77 increases. Moreover, in the 2nd inner side inclined surface 87, the distance from the central axis P of the through-hole 76 reduces as it leaves | separates from the 2nd opening 78 (2nd blade 84). For this reason, in the range where the second inner inclined surface 87 extends in the through hole 76, the cross-sectional area substantially perpendicular to the extending direction of the through hole 76 decreases as the distance from the second opening 78 increases. The inner extending surface 88 extends substantially parallel to the extending direction of the through hole 76. For this reason, in the range where the inner extending surface 88 extends in the through hole 76, the cross-sectional area substantially perpendicular to the extending direction of the through hole 76 is uniform or substantially uniform.

Further, an outer relay surface 90 is provided on the outer surface 70 of the treatment portion 64. The outer relay surface 90 extends from the first blade 82 of the first outer surface 72 to the second blade 84 of the second outer surface 74 along the thickness direction of the treatment portion 64. The outer relay surface 90 faces the side away from the central axis P of the through hole 76 in the radial direction of the through hole 76. In the present embodiment, a first blade 82 is formed at the boundary between the first inner inclined surface 86 and the outer relay surface 90, and the second blade is formed at the boundary between the second inner inclined surface 87 and the outer relay surface 90. 84 is formed.

The outer relay surface 90 includes a distal outer surface 91 that faces the distal end in the direction along the central axis L. In the present embodiment, the distal end outer surface 91 forms the distal end of the treatment portion 64, that is, the distal end of the ultrasonic probe 56. Further, in the present embodiment, the distal end outer surface 91 is a curved surface, and in the projection from the first outer surface 72 side and the second outer surface 74 side in the thickness direction of the treatment portion 64, an arc shape or substantially the same. It becomes an arc shape. Further, the outer relay surface 90 has a first side surface 93 facing one side (arrow W1 side) in the width direction of the treatment portion 64 and a side opposite to the side facing the first side surface 93 (arrow W2). A second side surface 95 facing side. The tip of the first side surface 93 and the tip of the second side surface 95 are continuous with the tip outer surface 91. In the present embodiment, each of the first side surface 93 and the second side surface 95 has a planar shape that is substantially parallel to the central axis L of the treatment portion 64. Therefore, in the projection from the first outer surface 72 side and the second outer surface 74 side in the thickness direction of the treatment portion 64, the first side surface 93 and the second side surface 95 are respectively The linear shape is substantially parallel to the extending direction of the treatment portion 64. Further, in the present embodiment, the outer relay surface 90 including the tip outer surface 91 and the side surfaces 93 and 95 is changed from the first blade 82 of the first outer surface 72 to the second blade of the second outer surface 74. Continuous over a range of up to 84.

In the present embodiment, the side surfaces 93 and 95 are continuous over a range from the first blade 82 to the second blade 84. Each of the side surfaces 93 and 95 is parallel or substantially parallel to the thickness direction of the treatment portion 64, that is, the extending direction of the through hole 76. For this reason, the first side surface 93 and the second side surface 95 are parallel or substantially parallel to each other. Because of such a configuration, the first blades in the respective cross sections that pass through the first side surface 93 (blades 82 and 84) and are substantially perpendicular to the direction around the central axis P of the through hole 76. A reference distance in which the distance from the central axis P of the through-hole 76 to the first side surface 93 is the distance from the central axis P to the first blade 82 over the range from 82 to the second blade 84. Is the same or substantially the same. Similarly, in each cross section that passes through the second side surface 95 (blades 82 and 84) and is substantially perpendicular to the direction around the central axis P of the through-hole 76, the first blade 82 to the second Over the range up to the blade 84, the distance from the central axis P of the through hole 76 to the second side surface 95 is the same or substantially the same as the reference distance that is the distance from the central axis P to the first blade 82. become.

Further, the distal end outer surface 91 may protrude toward the distal end side which is the side away from the central axis P of the through hole 76 with respect to the first blade 82 and the second blade 84, and the first blade 82 and the second blade 82. The blade 84 may be recessed toward the proximal end, which is the side approaching the central axis P of the through hole 76. In the configuration in which the tip outer surface 91 protrudes to the tip side with respect to the first blade 82 and the second blade 84, the tip outer surface 91 passes through the tip outer surface 91 (blades 82, 84), and the center axis P of the through-hole 76. In each of the cross sections substantially perpendicular to the direction around the axis, the distance from the central axis P of the through hole 76 to the tip outer surface 91 is the center at least at a part between the first blade 82 and the second blade 84. It is larger than the reference distance from the axis P to the first blade 82 (second blade 84). In the configuration in which the distal outer surface 91 is recessed proximally with respect to the first blade 82 and the second blade 84, the distal outer surface 91 passes through the distal outer surface 91 and in the direction around the central axis P of the through hole 76. In each of the substantially vertical cross sections, the distance from the central axis P of the through-hole 76 to the outer surface 91 of the tip is at least a part between the first blade 82 and the second blade 84. It is smaller than the reference distance to one blade 82 (second blade 84).

In one embodiment, the first blade 82 extends in any cross section that passes through the outer peripheral surface 91 (blade 82, blade 84) and is substantially perpendicular to the direction around the central axis P of the through hole 76. Over the range up to the second blade 84, the distance from the central axis P of the through hole 76 to the outer surface 91 of the tip is substantially the same as the reference distance that is the distance from the central axis P to the first blade 82. . In this case, the distal end outer surface 91 is substantially parallel to the thickness direction of the treatment portion 64, that is, the extending direction of the through hole 76. However, in the configuration in which the treatment portion 64 has a curette shape as in the present embodiment, the treatment portion 64 passes through the outer relay surface 90 (blades 82 and 84) and is substantially perpendicular to the direction around the central axis P of the through hole 76. Also in the cross section, the distance from the center axis P of the through-hole 76 to the tip outer surface 91 is the center axis P over the range from the first blade 82 to the second blade 84 of the second outer surface 74. It is preferable that the distance is not more than a reference distance from the first blade 82 (second blade 84) to the first blade 82. That is, it is preferable that the outer relay surface 90 including the tip outer surface 91 and the side surface surfaces 93 and 95 do not protrude from the first axis 82 and the second blade 84 to the side away from the central axis P.

In the present embodiment, the distance D1 in the direction along the central axis L between the distal end position E1 of the side surfaces 93 and 95 and the distal end of the treatment portion 64 is preferably 1.5 mm or less. Here, the tip position E1 of the side surfaces 93 and 95 is the boundary between the tip outer surface 91 and the first side surface 93 and the boundary between the tip outer surface 91 and the second side surface 95. . In the present embodiment, the edge of the first opening 77, that is, the first blade 82 is located in the width direction of the treatment portion 64 (arrow W 1) at the distal end side of the base end position E 2 of the side surfaces 93 and 95. And both edges of the first outer surface 72 in the direction indicated by the arrow W2. Further, the edge of the second opening 78, i.e., the second blade 84, is located on the second outer surface 74 in the width direction of the treatment portion 64 at the distal end side of the base end position E 2 of the side surfaces 93 and 95. Form both edges. And in the site | part of the base end position E2 of the

side surface

93,95, the edge of the 1st opening 77 is inner side with respect to the both edges of the 1st outer surface 72 about the width direction of the treatment part 64 Located in. Similarly, the edge of the 2nd opening 78 is the both ends of the 2nd outer surface 74 about the width direction of the treatment part 64 in the site | part of the base end position E2 of the

side surface

93,95. Located inside. Furthermore, in the site | part of the base end position E2 of the side part surfaces 93 and 95, each of the edge of the 1st opening 77 and the edge of the 2nd opening 78 is extended in the shape of a curve.

Further, in the present embodiment, the respective opening width dimensions of the first opening 77 and the second opening 78 in the width direction of the treatment portion 64 (directions indicated by arrows W1 and W2) are directions along the central axis L. In the range in which the side surfaces 93 and 95 are extended, the maximum value B1 is obtained. And in the site | part of the base end side from the base end position E2 of the side part surfaces 93 and 95, each opening width dimension of the 1st opening 77 and the 2nd opening 78 reduces as it goes to a base end side. At the base end of the edge of the first opening 77, the opening width dimension of the first opening 77 becomes substantially zero, and at the base end of the edge of the second opening 78, the opening width dimension of the second opening 78. Becomes almost zero. In the present embodiment, the base end position E2 of the side surfaces 93 and 95 (the base end position E2 of the outer relay surface 90) is on the front end side with respect to the central axis P of the through hole 76 in the direction along the central axis L. To position. Further, in the present embodiment, the first opening 77 has the first end over the entire region on the front end side from the base end position E2 of the side surfaces 93 and 95 (base end position E2 of the outer relay surface 90) at the edge of the first opening 77. The blade 82 is formed. A second blade 84 is formed at the edge of the second opening 78 over the entire region on the distal end side from the proximal end position E2 of the side surfaces 93 and 95 (the proximal end position E2 of the outer relay surface 90). Is done.

Next, the operation and effect of the treatment system 1 of the present embodiment will be described. Here, a procedure for cutting cartilage mainly in the knee joint 100 will be described. When performing treatment using the treatment system 1, the arthroscope 12 is inserted into the joint cavity 101 through the first portal 102, and the ultrasonic treatment tool of the treatment unit 22 is inserted into the joint cavity 101 through the second portal 104. 42 is inserted. Then, while observing the subject with the arthroscope 12, treatment is performed using the ultrasonic treatment tool 42. In the treatment, it is preferable that the perfusion device 6 supplies the perfusate into the joint cavity 101 and discharges the perfusate from the joint cavity 101 as described above.

Here, the knee joint 100 is mainly composed of a femur 112 shown in FIG. 1, a tibia 114 shown in FIG. 1, a fibia not shown, and a patella not shown. Further, in the knee joint 100, the cartilage 112A is present on the surface of the femur 112 facing the tibia 114, and the femur 112 includes a subchondral bone (not shown) that forms the surface and a cancellous bone 112B that forms the inside. Is provided. In addition, a cartilage 114A is present at a site facing the femur 112 on the surface of the tibia 114. Further, in the knee joint 100, cartilage (not shown) is present at a portion facing the femur 112 on the surface of the patella. In the present embodiment, in the joint cavity 101, the treatment unit 64 of the treatment unit 22 cuts any of the above-described cartilages and excises the cartilage. For example, when cartilage degeneration occurs in a certain part of the cartilage, the cartilage is excised at the degenerated part.

When cutting the cartilage, the first blade 82 or the second blade 84 of the treatment section 64 is brought into contact with the cartilage that is the treatment target. Then, in the state where the first blade 82 or the second blade 84 is in contact with the cartilage, an operation input is performed by the operation member 26, and electric energy is output from the controller 24 to the vibrator 48. Thereby, ultrasonic vibration is generated in the vibrator 48, and the generated ultrasonic vibration is transmitted to the treatment unit 64 through the ultrasonic probe 56. In a state where ultrasonic vibration is transmitted to the treatment portion, the vibrating body 50 including the vibrator 48 and the ultrasonic probe 56 vibrates at any resonance frequency within a predetermined frequency range. When the treatment portion 64 vibrates in a state where the first blade 82 or the second blade 84 is in contact with the cartilage, the cartilage is cut and excised. At this time, while maintaining the state in which the first blade 82 or the second blade 84 is in contact with the cartilage, the treatment portion 64 is moved in the joint cavity 101 to cut and cut the cartilage. In the curette-shaped treatment portion 64 as in the present embodiment, the first blade 82 or the second blade 84 is brought into contact with the cartilage, and extends in the extending direction of the through hole 76, that is, along the thickness direction of the treatment portion 64. Then, the cartilage is cut while moving the treatment portion 64. Here, in a state where the vibrating body 50 vibrates at any resonance frequency within a predetermined frequency range, the distal end of the treatment section 64 becomes a vibration antinode.

Here, an ultrasonic probe 56 'shown in FIG. 6 is shown as a comparative example. In the ultrasonic probe 56 ′ of the comparative example, similarly to the present embodiment, the treatment portion 64 ′ has a first outer surface 72 ′ and a second outer surface 74 ′, and from the first outer surface 72 ′. A through hole 76 ′ that penetrates to the second outer surface 74 ′ is formed. As in the present embodiment, the first outer surface 72 ′ has a first blade 82 ′ formed along the edge of the first opening 77 ′ of the through hole 76 ′, and the second outer surface. At 74 ′, a second blade 84 ′ is formed along the edge of the second opening 78 ′ of the through hole 76 ′. Similarly to the present embodiment, the treatment section 64 ′ includes an inner relay surface 85 ′ and an outer relay surface 90 ′, and the inner relay surface 85 ′ includes inner inclined surfaces 86 ′ and 87 ′ and an inner extension surface 88. 'Is provided. However, in the comparative example, the side surfaces 93 and 95 that are planes parallel to the direction along the central axis L are not provided, and the outer relay surface 90 ′ is formed only from the distal outer surface 91 ′ facing the distal end side. The FIG. 6 shows a state in which the treatment portion 64 ′ is viewed from the first outer surface 72 ′ side, which is one side in the thickness direction.

In the comparative example, the cross-sectional shape substantially perpendicular to the central axis P ′ of the through hole 76 ′ and the shape of the range surrounded by the edge of the first opening 77 ′ and the edge of the second opening 78 ′ are circular. Alternatively, it is formed in a substantially circular shape. Further, the outer end surface 91 ', that is, the outer relay surface 90' is formed in a curved surface having a constant curvature (bending radius). In the comparative example, in the projection from the first outer surface 72 ′ side and the second outer surface 74 ′ side in the thickness direction of the treatment portion 64 ′, the distal end outer surface 91 ′ (outer relay surface 90 ′) is A semicircular arc centering on the central axis P ′ of the through hole 76 ′ is formed. Since the configuration is as described above, in the comparative example, the extending direction of the treatment portion 64 ′, that is, the portion parallel to the central axis L ′ is not formed on the outer relay surface 90 ′. Further, since the configuration is as described above, in the comparative example, the proximal end position E ′ of the distal outer surface 91 ′ (the proximal end position E ′ of the outer relay surface 90 ′) penetrates in the direction along the central axis L ′. The position substantially coincides with the central axis P ′ of the hole 76 ′. In the comparative example, the distance D in the direction along the central axis L ′ between the base end position E ′ (the central axis P ′ of the through hole 76 ′) of the outer relay surface 90 ′ and the distal end of the treatment portion 64 ′. '1 is about 2.25 mm, for example.

FIG. 7 shows a treatment portion (64; 64 ′) when cutting a cartilage (for example, a portion indicated by reference numeral 112A) to be treated using the ultrasonic probe 56 ′ of the comparative example or the ultrasonic probe 56 of the present embodiment. It is a figure which shows an example of the movement path | route of (). Here, a first surface parallel direction (direction indicated by an arrow Z1) that is substantially parallel to the surface of the cartilage (112A) is defined, is substantially parallel to the surface of the cartilage (112A), and is also a first surface parallel direction. The second surface parallel direction (direction indicated by the arrow Z2) that intersects (substantially perpendicular) is defined. As shown in FIG. 7, when cutting the cartilage (112A), first, the blade (82; 84; 82 '; 84; 84') is cut into the cartilage (112A) in the resection target area (115; 115 '). The treatment portion (64; 64 ') that is brought into contact with and is vibrated by ultrasonic vibration is moved along the first surface parallel direction. Thereby, a treatment part (64; 64 ') cuts cartilage (112A) along the 1st surface parallel direction. Here, in the region to be excised (115; 115 ′), the treatment section (64; 64 ′) cuts the cartilage (112A) along the first surface parallel direction from one end to the other end. Let it be an operation (operation of arrow X1 in FIG. 7). Here, the central axis (62; 62 ′) of the probe main body (62; 62 ′) along a virtual plane that is substantially perpendicular to the surface of the cartilage (112A) and substantially parallel to the first surface parallel direction (the direction of the arrow Z1). The first cutting operation is performed in a state where the central axis (L; L ′) of C; C ′) and the treatment portion (64; 64 ′) is extended. Therefore, in the state in which the first cutting operation is performed, the blade (82; 84; 82 ′; 84 ′) enters the inside of the cartilage (112A) from the tip.

In the example of FIG. 7, the first cutting operation is repeated a plurality of times until the entire excision target region 115 is cut by the first cutting operation. Specifically, each time the first cutting operation is performed once, the treatment portion (64; 64 ′) is moved to a site where the first cutting operation is not performed in the excision target region (115; 115 ′). The first cutting operation is performed at the site where the treatment section (64; 64 ') is moved. For example, each time the first cutting operation is performed once, the treatment portion (64; 64 ′) is moved to a portion adjacent to the second surface parallel direction with respect to the portion where the first cutting operation was performed immediately before. Then, a first cutting operation is performed by the moved treatment portion (64; 64 ').

When the first cutting operation is performed a plurality of times and the entire region to be cut (115; 115 ′) is cut by the first cutting operation, the blade (82; 84; 82) is cut in the region to be cut (115; 115 ′). '; 84; 84') is brought into contact with the cartilage (112A), and the treatment portion (64; 64 ') is moved along the second surface parallel direction. Thereby, the treatment portion (64; 64 ′) cuts the cartilage (112A) along the second surface parallel direction. Here, in the region to be excised (115; 115 ′), the treatment section (64; 64 ′) cuts the cartilage (112A) along the second surface parallel direction with the second cutting operation (FIG. 7). Operation of arrow X2).

In a state in which only the first cutting operation is performed in the region to be excised (115; 115 ′), the residue that has not been cut by the first cutting operation on the bottom surface (116; 116 ′) of the excision portion of the cartilage (112A). There is a part, and the bottom surface (116; 116 ') of the excised part is not flat. In the second cutting operation, the remaining portion that has not been cut by the first cutting operation is cut. The second cutting operation is repeated a plurality of times until the bottom surface (116; 116 ') of the excision portion becomes substantially flat.

FIG. 8 is a cross-sectional view of the Y-section of FIG. 7 after the entire cutting target region 115 ′ is cut by the first cutting operation by the ultrasonic probe 56 ′ of the comparative example and before the second cutting operation is performed. FIG. 9 is a view showing a Y cross section, and FIG. 9 shows that the entire cutting target region 115 is cut by the first cutting operation by the ultrasonic probe 56 of the present embodiment, and the second cutting operation is performed. It is a figure which shows the YY cross section of previous FIG. 8 and 9 show a cross section substantially perpendicular to the first surface parallel direction. As shown in FIGS. 8 and 9, the cartilage (112A) adheres in a layered manner to the surface of the bone (for example, the subchondral bone of the femur 112). Here, the thickness δ1 of the cartilage (112A) in the stacking direction is about 2 mm to 4 mm.

By performing the first cutting operation described above by the treatment portion (64; 64 ′), as shown in FIGS. 8 and 9, the region to be cut (115; 115 ′) is along the first surface parallel direction. A cutting groove (120; 120 ') is formed. Then, as shown in FIG. 7, the first cutting operation is repeated a plurality of times, so that the plurality of cutting grooves (120; 120 ′) along the first surface parallel direction are aligned in the second surface parallel direction. Established. At this time, on the bottom surface (116; 116 ') of the cartilage excision portion, the cartilage (112A) not cut by the first cutting operation between the cutting grooves (120; 120') in the second surface parallel direction. ) Remaining portion (121; 121 ') is formed. Since the remaining portion (121; 121 ′) is formed, the bottom surface (116; 116 ′) is not flat when only the first cutting operation is performed.

As described above, in the ultrasonic probe 56 ′ of the comparative example, the side surfaces 93 and 95 that are planes parallel to the direction along the central axis L are not provided, and the outer relay surface 90 ′ is the tip that faces the tip side. It is formed only from the outer surface 91 '. The tip outer surface 91 ′ is formed in a curved surface with a constant curvature, and the central axis P ′ of the through hole 76 ′ is projected from the first outer surface 72 ′ side and the second outer surface 74 ′ side. A semicircular arc with a center is formed. For this reason, when the first cutting operation is performed in the excision target region 115 ′ using the ultrasonic probe 56 ′ of the comparative example, it is caused by the curved surface shape of the distal outer surface 91 ′, that is, the curved surface shape of the outer relay surface 90 ′. As shown in FIG. 8, in the excised portion of the cartilage (112A), the portion near the bottom surface 116 'tends to be curved on the side surface 118'. Since the portion in the vicinity of the bottom surface 116 ′ is curved on the side surface 118 ′ of the excision portion, it is difficult to form a corner between the bottom surface 116 ′ and the side surface 118 ′ in the excision portion of the cartilage (112 A).

Further, since the outer relay surface 90 ′ has the above-described configuration, the cutting groove 120 ′ is formed in a state where the entire excision target region 115 ′ is cut by the first cutting operation by the ultrasonic probe 56 ′ of the comparative example. In the remaining portion 121 ′ formed between them, the projecting dimension of the remaining portion 121 ′ from the bottom of the cutting groove 120 ′ is large. Actually, in the state in which the entire excision target region 115 ′ is cut by the first cutting operation by the ultrasonic probe 56 ′ of the comparative example, the protruding dimension from the bottom of the cutting groove 120 ′ of the remaining portion 121 ′ is outside. The distance D′ 1 in the direction along the central axis L ′ between the base end position E ′ (the central axis P ′ of the through hole 76 ′) of the relay surface 90 ′ and the distal end of the treatment portion 64 ′ is approximately the same size. That is, a large value of about 2.25 mm. Therefore, in the state where the entire resection target region 115 ′ is cut by the first cutting operation by the ultrasonic probe 56 ′ of the comparative example, the remaining amount of the cartilage (112A) in each of the remaining portions 121 ′ is large. When the remaining amount of the cartilage (112A) in the remaining portion 121 ′ increases, the number of times the second cutting operation is performed when the bottom surface 116 ′ of the cut portion is made substantially flat by the second cutting operation described above. Increases labor and time.

On the other hand, in the ultrasonic probe 56 of the present embodiment, the outer relay surface 90 includes side surfaces 93 and 95 in addition to the tip outer surface 91. The distal ends of the side surfaces 93 and 95 are continuous with the distal outer surface 91, and each of the side surfaces 93 and 95 has a planar shape parallel to the central axis L of the treatment portion 64. For this reason, when the first cutting operation is performed in the excision target region 115 using the ultrasonic probe 56 of the present embodiment, due to the planar side surfaces 93 and 95 substantially parallel to the central axis L, FIG. 9, in the excised portion of the cartilage (112A), a portion of the side surface 118 near the bottom surface 116 is likely to be substantially flat, and the side surface 118 is formed by the side surfaces 93 and 95 as compared with the comparative example. It is formed in an upright state. Since the portion in the vicinity of the bottom surface 116 on the side surface 118 of the excision portion becomes substantially planar, a corner is easily formed between the bottom surface 116 and the side surface 118 in the excision portion of the cartilage (112A). By forming an angle between the bottom surface 116 and the side surface 118 in the excised portion of the cartilage (112A), a medical solution or the like for treatment is easily and reliably stored in the excised portion of the cartilage (112A). Further, bone perforation (microfracture method) performed under arthroscopy is to form a perforation in the subchondral bone and promote regeneration of cartilage with blood and bone marrow fluid. Accumulation of more blood and bone marrow fluid in the excision target region 115 contributes to promoting regeneration of cartilage tissue.

Further, since each of the tips of the side surfaces 93 and 95 parallel to the central axis L is continuous with the tip outer surface 91, the entire ablation target region 115 is subjected to the first cutting operation by the ultrasonic probe 56 of the present embodiment. In the cut state, in the remaining portion 121 formed between the cutting grooves 120, the projecting dimension of the remaining portion 121 from the bottom of the cutting groove 120 is small. Actually, in the state in which the entire excision target region 115 is cut by the first cutting operation by the ultrasonic probe 56 of this embodiment, the protruding dimension of the remaining portion 121 from the bottom of the cutting groove 120 is the side surface 93. , 95, and the distance D1 in the direction along the central axis L between the distal end position E1 and the distal end of the treatment portion 64, and a small value of 1.5 mm or less. Therefore, in the state where the entire excision target region 115 is cut by the first cutting operation by the ultrasonic probe 56 of the present embodiment, the remaining amount of the cartilage (112A) in each of the remaining portions 121 is small. By reducing the remaining amount of the cartilage (112A) in the remaining portion 121, the number of times of performing the second cutting operation is reduced when the bottom surface 116 of the excision portion is made substantially flat by the above-described second cutting operation. , Labor is reduced. That is, workability is improved when the bottom surface 116 of the cut portion is made substantially flat by the above-described second cutting operation.

Also, the distal end outer surface 91 is a curved surface, and is arcuate in the projection from the first outer surface 72 side and the second outer surface 74 side in the thickness direction of the treatment portion 64. Therefore, the distal outer surface 91 is not a plane parallel to the width direction of the treatment portion 64 and is not formed in a plane substantially perpendicular to the central axis L. Since the tip outer surface 91 has the shape as described above, the cutting amount of the cartilage (112A) is prevented from becoming excessively large in the first cutting operation. Thereby, it is prevented that the amount of operation force required for the movement of the treatment portion 64 in the first cutting operation becomes excessively large.

10 and 11, the treatment unit 64 uses the ultrasonic probe 56 that bends or curves with respect to the probe main body 62, and the treatment unit 64 performs the cutting operation (first cutting operation or It is a figure which shows an example of the state which is performing 2nd cutting operation | movement. In FIG.10 and FIG.11, the location where cutting operation is performed in cartilage differs with respect to each other. Since the treatment portion 64 is bent or curved with respect to the probe main body portion 62, even when cutting the cartilage to be treated at a location where the approach angle is narrow, as shown in FIGS. ) In the state where the extending direction of the treatment portion 64 (that is, the central axis L) is perpendicular to the surface of), the treatment portion 64 can be reliably brought into contact with the cartilage. As a result, even when the approach angle is narrow, the cartilage cutting operation can be performed easily and reliably in a state where the extending direction of the treatment portion 64 (that is, the central axis L) is perpendicular to the surface of the cartilage (112A). Is called.

In this embodiment, the first blade 82 is provided on the first outer surface 72, and the second blade 84 is provided on the second outer surface 74. That is, the blades (82, 84) are provided on the outer surfaces (72, 74) on both sides in the thickness direction of the treatment portion 64. For this reason, when the treatment portion 64 is bent or curved with respect to the probe main body portion 62, the blades (82, 84) can be brought into contact with various places in the cartilage (112A) in the joint cavity 101. Thus, the cutting operation of the cartilage (112A) that is the treatment target can be performed at various locations. For example, when the location shown in FIG. 10 is a treatment target, the second blade 84 is brought into contact with the cartilage (112A) to cut the cartilage. And when the location shown in FIG. 11 becomes a treatment target, the first blade 82 is brought into contact with the cartilage (112A) to cut the cartilage.

(Modification)
In the first modification shown in FIG. 12, the edge of the first opening 77 extends in the width direction of the treatment portion 64 (arrows) also at the base end position E2 of the side surfaces 93 and 95 from the base end position E2. Both edges of the first outer surface 72 are formed in the direction indicated by W1 and the arrow W2. Then, the edge of the second opening 78 forms both edges of the second outer surface 74 in the width direction of the treatment portion 64 at the base end position E2 of the side surfaces 93 and 95. Further, in this modified example, at the base end position E2 of the side surfaces 93 and 95, the edge of the first opening 77 and the edge of the second opening 78 extend substantially linearly. Established. Further, in the present modification, the distal end outer surface 91 has a planar shape that is substantially perpendicular to the central axis L of the treatment portion 64 and substantially parallel to the width direction of the treatment portion 64 (directions indicated by arrows W1 and W2). It is formed. Therefore, the projection from the first outer surface 72 side and the second outer surface 74 side in the thickness direction of the treatment portion 64 is formed in a substantially linear shape along the width direction of the treatment portion 64.

In the present modification, a tip outer surface 91 and side surfaces 93 and 95 are provided, and the tip of the first side surface 93 and the tip of the second side surface 95 are continuous with the tip outer surface 91. That is, the tip position E1 of the side surfaces 93 and 95 is a boundary between the side surfaces 93 and 95 and the tip outer surface 91, respectively. Each of the side surfaces 93 and 95 has a planar shape substantially parallel to the central axis L of the treatment portion 64. In the present modification, the base end position E2 of the side surfaces 93 and 95 (the base end position E2 of the outer relay surface 90) is the base end side with respect to the central axis P of the through hole 76 in the direction along the central axis L. Located in. Therefore, in this modification, the dimension in the direction along the central axis L from the distal end position E1 to the proximal end position E2 of each of the side surfaces 93 and 95 is larger than that of the configuration of the first embodiment.

Further, in the above-described embodiment and the like, the first outer surface 72 is provided with the first blade 82, and the second outer surface 74 facing the opposite side to the side on which the first outer surface 72 faces is second on the second outer surface 74. Although the blade 84 is provided, it is not restricted to this. In some variations, only the first blade 82 is provided, and no blade may be formed on the second outer surface 74. Also in this modification, a through hole 76 that penetrates from the first outer surface 72 to the second outer surface 74 is formed. The inner relay surface 85 extends from the first opening 77 to the second opening 78, and the outer relay surface 90 extends from the first blade 82 to the second outer surface 74. Also in this modified example, the outer relay surface 90 includes a tip outer surface 91 and side surfaces 93 and 95. In this modification as well, the distal end of the first side surface 93 and the distal end of the second side surface 95 are continuous with the distal outer surface 91, and each of the side surfaces 93 and 95 is connected to the treatment portion 64. It is on a plane parallel to the central axis L.

Further, in the above-described embodiment and the like, an example in which cartilage is cut by the blades (82, 84) of the treatment unit 64 using ultrasonic vibration has been described, but the treatment target cut by the treatment unit 64 is limited to cartilage. It is not a thing. In a certain modification, the treatment part 64 is vibrated as described above by ultrasonic vibration, and the bones such as osteophytes or bonespur of the femur 112 are caused by the

blades

82 and 84 of the treatment part 64. Is cut as a treatment target. The treatment section 64 can also be applied to treatment of ankle joints and shoulder joints that are joints other than the knee joint 100.

In the above-described embodiment and the like, the ultrasonic probe is provided on the probe main body portion (62) to which the ultrasonic vibration generated by the vibrator (48) is transmitted, and on the distal end side of the probe main body portion (62). A treatment section (64) for cutting bone or cartilage to be treated by sound wave vibration. The treatment portion (64) is opposite to the first outer surface (72) facing the direction intersecting the central axis (L) of the treatment portion (64) and the side facing the first outer surface (72). A second outer surface (74) facing the side, and a distal outer surface (91) facing the distal end side in the direction along the central axis (L), from the first outer surface (72) to the second outer surface It has a through hole (76) that penetrates to the surface (74). The through hole (76) opens at the first opening (77) on the first outer surface (72) and opens at the second opening (78) on the second outer surface (74). The treatment portion (64) includes a first blade (82) formed along the edge of the first opening (77) of the through hole (76) and a first extending direction of the through hole (76). A first side surface (93) and a second side surface (95) extending between the blade (82) and the second outer surface (74). The second side surface (95) faces away from the side to which the first side surface (93) faces, and the tip of each of the side surfaces (93, 95) is the tip outer surface (91). Consecutive to. Each of the side surfaces (93, 95) has a planar shape parallel to the central axis (L) of the treatment portion (64).

The embodiments of the present invention have been described above, but the present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the spirit of the invention.

Claims

A probe main body to which ultrasonic vibration generated by the vibrator is transmitted;
A treatment part that is provided on the distal end side of the probe main body part and cuts bone or cartilage that is a treatment target by the ultrasonic vibration; and
Comprising
The treatment section includes a first outer surface facing a direction intersecting with a central axis of the treatment section, a second outer surface facing a side opposite to the side facing the first outer surface, and the center A tip outer surface facing the tip side in a direction along the axis, and
The treatment portion is a through-hole penetrating from the first outer surface to the second outer surface, and opens at the first opening on the first outer surface, and on the second outer surface. Having a through hole that opens at the second opening;
The treatment section is
A first blade formed along an edge of the first opening of the through hole;
The extending direction of the through hole extends between the first blade and the second outer surface, and the distal end is continuous with the outer surface of the distal end, with respect to the central axis of the treatment portion A first side surface that is parallel and planar;
The tip is extended between the first blade and the second outer surface in the extending direction of the through-hole in a state facing the side opposite to the side facing the first side surface, and the tip is A second side surface that is continuous with the outer surface of the distal end and has a planar shape parallel to the central axis of the treatment portion;
An ultrasonic probe.
Each of the first side surface and the second side surface is continuous over a range from the first blade to the second outer surface in the extending direction of the through hole. Item 1. The ultrasonic probe according to Item 1.
The ultrasonic probe according to claim 1, wherein the first side surface, the second side surface, and the extending direction of the through hole are parallel to and parallel to each other.
The ultrasonic probe according to claim 1, wherein the first side surface intersects a direction along a central axis of the treatment portion and faces one side in a direction intersecting the extending direction of the through hole.
The ultrasonic probe according to claim 1, wherein the outer surface of the tip is a curved surface having an arc shape in projection from each of the first outer surface side and the second outer surface side.
The treatment portion includes a second blade formed along an edge of the second opening of the through hole,
Each of the first side surface and the second side surface is continuous over a range to the first blade and the second blade,
The ultrasonic probe according to claim 1.