WO2018078833A1 - Sonde à ultrasons - Google Patents

Sonde à ultrasons Download PDF

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Publication number
WO2018078833A1
WO2018078833A1 PCT/JP2016/082189 JP2016082189W WO2018078833A1 WO 2018078833 A1 WO2018078833 A1 WO 2018078833A1 JP 2016082189 W JP2016082189 W JP 2016082189W WO 2018078833 A1 WO2018078833 A1 WO 2018078833A1
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WO
WIPO (PCT)
Prior art keywords
probe
ultrasonic
main body
treatment
distal
Prior art date
Application number
PCT/JP2016/082189
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English (en)
Japanese (ja)
Inventor
弘之 荒木
喜一郎 澤田
宜瑞 坂本
藤崎　健
直樹 鳴海
Original Assignee
オリンパス株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
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Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to PCT/JP2016/082189 priority Critical patent/WO2018078833A1/fr
Publication of WO2018078833A1 publication Critical patent/WO2018078833A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments

Definitions

  • the present invention relates to an ultrasonic probe that performs treatment by ultrasonic vibration on a treatment-handling site in a joint.
  • Patent Document 1 WO2010 / 087060A1 includes an ultrasonic device that mounts an ultrasonic transducer, outputs ultrasonic waves from an ultrasonic probe, and performs arbitrary treatment by ultrasonic vibration. Proposed. *
  • Such an ultrasonic probe is provided with a treatment portion at the tip of a linearly extending probe body.
  • a cutting surface made of unevenness is provided on the lower surface of the treatment portion.
  • an arthroscopic operation for example, there is an operation in which a surgical treatment is performed on the meniscus of a torn knee joint.
  • the above-described ultrasonic probe that vibrates ultrasonically performs a treatment of excising the tearing portion and adjusting the shape.
  • the meniscus exists so as to be sandwiched between the knee joint of the femur and the tibia, so to perform the posterior segment or dorsal horn of the inner meniscus, It is necessary to pass through a narrow space between them and cannot be approached by existing ultrasonic probes. In this case, it is necessary to devise the position where the portal is provided, or it is necessary to newly open the portal.
  • an embodiment of the present invention provides an ultrasonic probe that can be accessed from a limited portal, reach a treatment target site deep in a narrow joint cavity, and perform a cutting treatment on the treatment target site within a narrow treatment area. To do.
  • An ultrasonic probe is provided at a distal end of a probe main body that receives ultrasonic vibration generated by an ultrasonic generator at a proximal end side and transmits the ultrasonic vibration to a distal end side,
  • a distal treatment section having a cutting surface for cutting a treatment target site using ultrasonic vibration, and the probe body is separated from the distal treatment section by a predetermined length on the proximal end side It has a curved portion that curves so as to warp to the side opposite to the surface side of the cutting surface provided in the distal treatment section at a position on the main body.
  • FIG. 1 is a diagram illustrating a system configuration example of an ultrasonic treatment apparatus according to the first embodiment of the present invention.
  • FIG. 2 is a diagram illustrating a configuration example of an operation system including the ultrasonic treatment instrument according to the first embodiment.
  • FIG. 3 is a diagram showing an external shape of the ultrasonic probe of the ultrasonic treatment device viewed from the side.
  • FIG. 4 is a diagram conceptually showing a distance and a positional relationship when the ultrasonic probe enters from the front of the knee joint and reaches the treatment target site at the back of the femur.
  • FIG. 5 is a diagram showing the position of the portal formed in the knee joint.
  • FIG. 6 is a diagram conceptually showing an arthroscopic surgery using an ultrasonic probe.
  • FIG. 1 is a diagram illustrating a system configuration example of an ultrasonic treatment apparatus according to the first embodiment of the present invention.
  • FIG. 2 is a diagram illustrating a configuration example of an operation system including the ultrasonic treatment instrument according
  • FIG. 7 is a diagram showing a meniscus for performing treatment with an ultrasonic probe.
  • FIG. 8 is a diagram showing the state of the treatment target site where the meniscus is damaged.
  • FIG. 9 is a diagram showing the state of the treatment target site where the meniscus has been treated.
  • FIG. 10 is a diagram for explaining a treatment for an ankle joint using an ultrasonic probe.
  • FIG. 11 is a diagram illustrating an example of a state of treatment of the talus surface and the tibia surface with an ultrasonic probe.
  • FIG. 1 is a diagram illustrating a system configuration example of an ultrasonic treatment apparatus according to the first embodiment.
  • the ultrasonic treatment instrument system 1 mainly includes an ultrasonic treatment instrument 2, a power supply unit 3, and a foot switch 4 that instructs on / off of ultrasonic vibration.
  • the ultrasonic treatment instrument 2 and the power supply unit 3 are connected by a cable 19 to supply drive power and communicate control signals.
  • the power supply unit 3 is provided with a plurality of connectors 20 for connecting to the cable 19 on the front surface 18, various operation switches 21, and a display screen 22 for displaying information necessary for treatment. Further, it is used separately in combination with an endoscope system depending on the procedure or the content of surgery.
  • the ultrasonic treatment instrument 2 includes a device body 11 and an ultrasonic probe 14.
  • the device main body 11 has a cylindrical shape with a grippable diameter
  • the ultrasonic probe 14 is disposed through the housing 11a
  • an ultrasonic transducer unit (ultrasonic wave generation unit) 11b that can be attached to and detached from the housing 11a. Consists of.
  • the ultrasonic transducer unit 11b accommodates therein an ultrasonic generator 12 made of an ultrasonic vibration element such as a piezoelectric body and a horn 13 for efficiently transmitting ultrasonic waves.
  • the proximal end side of the ultrasonic probe 14 and the distal end side of the horn 13 are acoustically connected, and the ultrasonic vibration generated by the ultrasonic generator 12 is obtained. Is transmitted to the distal treatment section 15 described later of the ultrasonic probe 14.
  • An operation switch 17 is provided on the upper surface of the housing 11a to instruct on / off of the ultrasonic vibration by a finger operation.
  • the foot switch 4 has a function equivalent to that of the operation switch 17.
  • the ultrasonic probe 14 is an elongated rod-shaped shaft member (probe main body) that transmits ultrasonic vibrations and is formed of a metal material, for example, a titanium alloy, and the distal end side of the horn 13 is acoustically connected to the base end thereof.
  • the distal end treatment portion 15 is integrally provided at the distal end.
  • the ultrasonic probe 14 has a configuration in which the probe main body and the distal treatment section 15 are integrally formed. Therefore, the distal end of the ultrasonic probe 14 is the distal end of the distal treatment section 15, and the distal end of the probe body is the boundary with the distal treatment section 15.
  • This distal treatment section 15 has a bone cutting function and a cartilage cutting function by ultrasonic vibration described later, and performs a desired surgical treatment (mainly excision treatment) on the treatment target site (or treatment target location) 100. Can do.
  • the ultrasonic probe 14 is covered with a sheath (outer pipe) 23 from the housing 11a to an arbitrary length. That is, in the present embodiment, the sheath 23 is covered so as to extend from the housing 11a to a position on the probe main body 20 mm to 30 mm before the distal end of the distal treatment section 15. Further, the range from the boundary between the distal treatment section 15 and the probe body to the sheath 23 is covered with a probe cover 16 made of a tube. By providing the sheath 23 and the probe cover 16, it is possible to eliminate the influence and protect each other when contacting a part other than the treatment target, or another treatment tool or endoscope.
  • the distal treatment section 15 provided at the distal end of the ultrasonic probe 14 is formed with a diameter larger than that of the extending probe body and has a constriction.
  • the probe cover 16 is attached so that the distal end of the sheath does not come out of the ultrasonic probe 14 due to the constriction of the distal treatment section 15.
  • the distal treatment section 15 of the ultrasonic probe 14 performs mechanical cutting by micro sliding with ultrasonic vibration.
  • the amount to be scraped off can be adjusted depending on the strength (pressing pressure) applied to the treatment target region 100. That is, the shaving is adjusted by the surgeon's manual control, and efficient cutting and cutting can be realized.
  • the distal treatment section 15 is ultrasonically vibrated even if not individually described.
  • the ultrasonic treatment tool 2 of the present embodiment is configured not to be provided with a perfusion liquid water supply and drainage mechanism, it is also possible to provide a perfusion liquid water supply and drainage mechanism depending on the application.
  • FIG. 2 is a diagram illustrating a configuration example of an operation system including the ultrasonic treatment instrument according to the first embodiment.
  • the surgical system 10 according to the present embodiment includes an ultrasonic treatment tool 2 and an endoscope system 30 including an arthroscope 31.
  • the ultrasonic treatment instrument 2 includes the ultrasonic wave generation unit 12, the ultrasonic probe 14, the power supply unit 3, and the operation switch 17.
  • the endoscope system 30 includes an arthroscope 31 that is a rigid endoscope that is a kind of endoscope, a visible light source 32 that emits visible illumination light as a light source of illumination light, and the entire endoscope system 30.
  • a control unit 33 for controlling the operation an input unit 34 such as a keyboard and a touch panel, a display unit 35 for displaying surgical information including the photographed surgical situation, and a physiological saline solution and drainage around the treatment target region 100 Or it is comprised with the water supply drainage part 36 to perfuse.
  • the water supply / drainage unit 36 is configured to supply and drain physiological saline to the treatment site through the arthroscope 31, but is configured to supply and drain perfusate containing physiological saline and the like from the ultrasonic treatment instrument 2. It may be.
  • FIG. 3 is a diagram showing an external shape of the ultrasonic probe 14 of the ultrasonic treatment device viewed from the side.
  • the ultrasonic probe 14 is an elongated rod-like member that is formed of, for example, a titanium alloy and extends in the longitudinal axis direction.
  • the proximal end of the ultrasonic probe 14 is acoustically connected to the distal end side of the horn 13 described above, and the ultrasonic vibration generated by the ultrasonic generator 12 is transmitted.
  • the distal end side of the ultrasonic probe 14 has a bend (curved portion) so that the distal end side bends or bends upward when the operator holds the probe in a normal manner.
  • the distal treatment section 15 is integrally provided.
  • the cutting surface 15a that contacts and cuts the treatment target portion has irregularities formed like a cross hatch pattern or a cross pattern in which a plurality of grooves intersect each other.
  • the cutting surface 15a of the treatment portion is provided on either the lower surface or the upper surface of the distal treatment portion 15 depending on the position of the target treatment target portion.
  • the cutting surface 15a can be formed on both the upper and lower surfaces of the distal treatment section 15.
  • cutting surfaces 15 b are formed by a plurality of vertical grooves.
  • a cutting surface with a plurality of grooves may be formed on the distal end surface of the distal treatment section 15.
  • the ultrasonic probe 14 is not limited to the shape extended in a straight line, The length and shape are set according to the treatment object.
  • FIG. 4 conceptually shows the distance and positional relationship when the ultrasound probe 14 enters from the front of the knee joint and reaches the treatment target site at the back of the femur when the meniscus in the joint is the treatment target.
  • FIG. This example shows the approximate average distance and position of the human knee joint from the published adult size. Of course, it is not limited to this range due to physical differences (individual differences).
  • the distal treatment section 15 passes through the lowermost part of the femur 61.
  • the gap L13 between the femur and the tibia is about 4 mm. Furthermore, it reaches the rear corner or the rear node of the meniscus 71b at a distance of about 10 mm from the lowermost part.
  • the meniscus 100 has a width of about 10 mm.
  • the meniscus 71a, 71b is a triangle whose section has an inclined surface on the upper surface, as shown in FIG.
  • the length L1 of the ultrasonic probe 14 extending from the housing 11a is required to be 20 mm to 30 mm as shown in the example shown in FIG.
  • the ultrasonic probe 14 (probe main body) is curved upward so as to warp at a position of 10 mm from the distal end of the distal treatment section 15.
  • the bending angle ⁇ is preferably 3 degrees or 5.5 degrees, for example.
  • the thickness is at least 4 mm or less.
  • a curved portion that is curved upward at a position of about 10 mm from the distal end of the distal treatment section 15 is formed.
  • FIG. 5 is a diagram showing the position of a portal formed in the knee joint
  • FIG. 6 is a diagram conceptually showing an arthroscopic surgery using an ultrasonic treatment tool
  • FIG. 7 is a diagram showing a meniscus to be treated with an ultrasonic treatment device
  • FIG. 8 is a diagram showing a state of a treatment target portion where the meniscus is damaged
  • FIG. 9 is a treatment with meniscus treated. It is a figure which shows the state of an object location.
  • an example will be described in which treatment for damage occurring in the posterior corner or posterior segment of the inner meniscus is performed.
  • FIG. 5 shows an anterior-lateral (subpatellar) portal 51, a transpatellar ligament portal 52, an anterior medial portal 53, and a posterior medial portal 54 that are provided to insert the ultrasonic treatment instrument 2 and the arthroscope 31 into the knee joint.
  • Each position example is shown.
  • an example using the portal 51 and the portal 53 will be described.
  • the positions of the portals shown in FIG. 5 are representative examples, and should be set as appropriate according to individual differences among patients, treatment targets, treatment details, and the like.
  • FIG. 6 shows a state where the knee of the patient is bent and the joint portion is opened.
  • the patella surface 61a of the femur 61 is in a state of facing forward.
  • the arthroscope 31 is inserted from the portal 51, and the ultrasonic probe 14 is inserted from the portal 53.
  • both the arthroscope 31 and the ultrasonic probe 14 pass between the femur 61 and the tibia 41, and as shown in FIG. 8, the dorsal corner of the meniscus 71 (inner meniscus 71a) or near the posterior node.
  • Each distal end portion reaches the treatment target location (or treatment target site) 100 generated in step (b).
  • the cross section of the meniscus 100 includes a dense blood flow region A [blood circulation area: dense blood flow region (Red zone)] through which a large number of blood flows (blood vessels) pass on the outer peripheral side.
  • a region B blood field: rough blood flow region (White-Red zone)] that has blood flow but is smaller than region A.
  • region C bloodless area: bloodless zone (White zone)] where no blood flow flows.
  • the ultrasonic probe 14 is curved upward so that the distal end side of the probe body is warped, and a distal treatment section 15 is provided. For this reason, when excising the treatment target location 100 that is a longitudinal tear of the meniscus 71, the cutting surface 15 a of the distal treatment section 15 can be applied along the inclined upper surface of the meniscus 71.
  • the distal treatment section 15 excises the longitudinal tear of the meniscus 71 and treats the excision surface 100a to be an inclined surface having an inclination.
  • the location of the normal meniscus which does not have a tear shown in FIG. 8 becomes an inclined surface, and the stress applied from a femur is disperse
  • conventional cutting with a tool such as a punch results in a cut surface cut perpendicularly from the upper surface of the meniscus, resulting in a corner portion.
  • the distal end treatment portion 15 is provided at the tip curved upward, so that it can easily pass between the femur 61 and the tibia 41 and the posterior corner of the meniscus 71. It can be cut into an inclined cut surface so that it reaches the treatment target location and no corners are generated on the upper surface of the meniscus.
  • the treatment of the damaged ankle joint by the surgery system 10 comprised of the ultrasonic treatment instrument 2 and the endoscope system 30 will be described.
  • the tibia 41 and the talus 42 are slidably connected by a ligament (not shown).
  • the lower joint surface (cartilage) 41a of the tibia 41 and the talus pulley surface (cartilage) 42a of the talus 42 slide to bend the joint.
  • a treatment for excising and removing the separated or separated portion is performed.
  • the ultrasonic probe 14 is provided with the distal treatment section 15 at the tip curved upward, so that the treatment is performed beyond the talus pulley surface 42 a of the talus 42. It reaches the target location and can be excised on an inclined excision surface that matches the curved surface of the lower joint surface 41a.
  • a cutting surface 15a provided on the lower surface of the distal treatment section 15 shown in FIG. 3 is formed on the upper surface, and the device body 11 is turned 180 degrees. And treat.
  • the device body 11 may be returned 180 degrees to cut the cartilage.
  • osteophytes (not shown) may be formed.
  • the ultrasonic probe 14 of the present embodiment can easily excise the osteophyte regardless of the position where the osteophyte is formed.
  • the tip of the probe body is curved or bent so that the tip of the probe body is warped upward even at a location where the distal treatment section 15 has not reached the treatment target location with the conventional ultrasonic probe. Since the distal treatment section 15 is provided, it can be easily reached. In addition, even when the treatment target part is bent or inclined after reaching the treatment target part, the treatment target part can be excised as necessary along the direction.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne une sonde à ultrasons (14) comportant une unité de traitement de pointe (15). L'unité de traitement de pointe (15) est disposée sur la pointe du corps principal de sonde. Sur la surface inférieure de l'unité de traitement de pointe (15), une surface de coupe irrégulière (15a) est prévue. Le corps principal de sonde est incurvé selon un angle θ dans une zone incurvée, et le côté pointe est déformé vers le haut à partir de la zone incurvée. Dans le cas de la résection d'un site de lésion (100) près de la corne arrière ou de la partie postérieure du ménisque interne (71a), la sonde à ultrasons (14) est insérée dans l'articulation du genou par l'intermédiaire du portail antéro-médial (53). Du fait que le corps principal de sonde est incurvé, il est possible d'appliquer la surface de coupe (15a) le long de la surface supérieure inclinée du ménisque (71). Dans cet état, une vibration ultrasonore est reçue par le corps principal de sonde au niveau de la base et est transmise à l'unité de traitement de pointe (15). De cette manière, la surface de coupe vibrante (15a) est pressée contre le site lésé (100) et le ménisque (71) peut être découpé de telle sorte que la surface réséquée (100a) forme une surface inclinée.
PCT/JP2016/082189 2016-10-28 2016-10-28 Sonde à ultrasons WO2018078833A1 (fr)

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
USD974558S1 (en) 2020-12-18 2023-01-03 Stryker European Operations Limited Ultrasonic knife

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2008119250A (ja) * 2006-11-13 2008-05-29 Miwatec:Kk 超音波手術器用ハンドピースおよびホーン
WO2016111055A1 (fr) * 2015-01-07 2016-07-14 オリンパス株式会社 Sonde à ultrasons

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2008119250A (ja) * 2006-11-13 2008-05-29 Miwatec:Kk 超音波手術器用ハンドピースおよびホーン
WO2016111055A1 (fr) * 2015-01-07 2016-07-14 オリンパス株式会社 Sonde à ultrasons

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
USD974558S1 (en) 2020-12-18 2023-01-03 Stryker European Operations Limited Ultrasonic knife

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