WO2021065848A1 - Elongate medical device - Google Patents

Abstract

The present invention provides an elongate medical device capable of reducing the difference between the rotation angle at a hand-side portion and the rotation angle at the tip end of a shaft.　Provided is an elongate medical device (1) having: an elongate shaft (2) that is inserted into a living body; and a rotation speed changing part (4) that transmits rotation from the hand side to the shaft (2), wherein the rotation speed changing part (4) has a grip part (20) held so as not to be rotated and an operation part (37) rotationally operated with respect to the grip part (20), and changes the speed of the rotation from the operation part (37) and transmits the rotation to the shaft (2).

Description

Medical long body

The present invention relates to a medical long body having a long shaft that is inserted into a living body.

As a medical long body used for various procedures, a catheter device such as a support catheter provided with a shaft on which a guide wire lumen is formed, a balloon catheter, and the like are known. In a long medical body, the operation is performed at the hand portion on the base end side of the shaft. Examples of such a long medical body include those listed in Patent Document 1.

U.S. Pat. No. 5,891,114

It is necessary to rotate the shaft when selecting a bifurcated blood vessel or when selecting a microchannel in a stenosis while the shaft is inserted into the living body and curved. When a catheter having a relatively long shaft is rotated in a curved state, there is a difference between the rotation angle at the hand and the rotation angle at the tip of the shaft. For example, when a support catheter having an effective length of 180 to 250 cm is rotated, it is necessary to rotate the tip of the shaft more at hand in order to rotate it once.

In this way, in order to rotate the tip of the shaft, more rotation operations are required at the hand, which may lead to a delay in the procedure.

The present invention has been made to solve the above-mentioned problems, and an object of the present invention is to provide a medical long body capable of reducing the difference between the rotation angle at the hand portion and the rotation angle at the tip portion of the shaft. And.

The medical long body according to the present invention that achieves the above object has a long shaft that is inserted into a living body and a rotary transmission unit that transmits rotation from the hand side to the shaft. The unit has a grip portion that is held so as not to rotate, and an operation portion that is rotated with respect to the grip portion, and the rotation of the operation portion is speed-shifted and transmitted to the shaft.

In the medical long body configured as described above, the difference between the rotation angle due to the rotation operation of the operation unit and the rotation angle at the tip of the shaft can be reduced by shifting the rotation of the shaft.

The rotary transmission has a sun gear at the center of rotation, an internal gear around the rotation, and a planetary gear arranged between the sun gear and the internal gear, and the center position of the sun gear is the shaft. If it is placed on the rotation axis of, the rotation input from the operation unit can be changed and output to the shaft with a simple structure.

If the internal gear is supported by the grip portion, the operating portion rotationally drives the planetary gear, and the sun gear rotationally driven by the planetary gear rotates the shaft, a set of planets The gear mechanism allows the shaft to rotate at an accelerated speed in the forward direction with the rotation operation direction.

If a casing member is provided as the grip portion and the sun gear and the planetary gear are rotated with respect to the casing member, the planetary gear mechanism can be housed in the casing member to compactly configure the rotary transmission portion. it can.

If the internal gear is provided on the inner peripheral portion of the casing member, it is not necessary to provide a component for the internal gear, so that the number of parts can be reduced.

If the planetary gear is rotationally supported and has a support plate that rotates with respect to the internal gear, and the support plate is provided with a handle portion as the operation portion, the handle portion is moved in the circumferential direction of the casing member. By operating in this way, the rotation operation can be easily performed.

If the grip portion has a lock portion that prevents the handle portion from rotating with respect to the grip portion, it is possible to prevent the shaft from being unexpectedly accelerated and rotated when the rotation operation is not performed.

The rotary transmission includes a first rotary transmission having a first solar gear, a first internal gear, and a first planetary gear, and a second solar gear provided at different positions in the axial direction from the first rotary transmission. It has a second rotary transmission unit having a second internal gear and a second planetary gear, and the first sun gear is connected so as to rotationally drive the second internal gear, and is connected to the first planetary gear and a second. The first sun gear is supported by the grip portion, the operating portion rotationally drives the first internal gear, and is rotationally driven by the first internal gear via the first planetary gear. If the second sun gear is rotationally driven via the second internal gear and the second planetary gear and the second sun gear rotationally drives the shaft, the first rotary transmission unit rotates the operation unit. Is reversed while accelerating, and the rotation of the first rotation transmission unit is reversed while accelerating at the second rotation transmission unit. Therefore, the shaft can be rotated in the forward direction while accelerating the rotation operation of the operation unit. ..

It is a front view which shows the whole structure of the catheter of 1st Embodiment. It is a front view of the planetary gear mechanism provided in the rotary transmission part. It is an enlarged cross-sectional view around the rotary transmission part cut by the plane including the central axis of a shaft. FIG. 5 is an enlarged cross-sectional view of the vicinity of the first rotary transmission section and the second rotary transmission section cut along a plane including the central axis of the shaft in the second embodiment.

Hereinafter, embodiments of the present invention will be described with reference to the drawings. The dimensional ratios in the drawings may be exaggerated and differ from the actual ratios for convenience of explanation. In the present specification, the side of the catheter 10 to be inserted into the living lumen is referred to as "tip" or "tip side", and the hand side to be operated is referred to as "base end" or "base end side".

In this embodiment, the catheter 1 will be described as a medical long body. As shown in FIG. 1, the catheter 1 has a shaft 2 which is a long tubular body, a hub 3 provided at a base end portion of the shaft 2, and a rotary transmission unit 4 attached to the hub 3. .. The shaft 2 is made of a flexible material. Therefore, the shaft 2 can be inserted along the shape of the blood vessel.

The material of the shaft 2 is, for example, a thermoplastic elastomer such as styrene-based, polyolefin-based, polyurethane-based, polyester-based, polyamide-based, polybutadiene-based, transpolyisoprene-based, fluororubber-based, chlorinated polyethylene-based, or among these. A combination of two or more of the above can be used. Alternatively, a metal blade or a metal coil wire embedded as a reinforcing material may be used.

The rotary transmission unit 4 is held by hand to perform a rotation operation, thereby accelerating the rotation due to the rotation operation and rotating the shaft 2. Since the speed increase ratio is set to 1: 3 in the present embodiment, when the rotary transmission unit 4 is rotated once, the shaft 2 is rotated three times.

The rotary transmission unit 4 will be described in detail. The rotary transmission unit 4 of the present embodiment is a casing member 10 having a grip portion 20 that is held by hand so as not to rotate, and a handle that is an operation unit that protrudes from the base end portion of the casing member 10 and is manually rotated. It has a part 37.

As shown in FIG. 2, a planetary gear mechanism is housed inside the casing member 10. The casing member 10 has a hollow inside, and an internal gear 22 is formed on the inner peripheral surface thereof. Inside the internal gear 22, a sun gear 30 is provided via three planetary gears 33 in the circumferential direction. The sun gear 30 has a hole portion 31 in the central portion for inserting and fixing the central shaft member 40 communicating with the shaft 2.

The planetary gear 33 is rotatably supported by a ring-shaped support plate 35. By rotating the support plate 35 with respect to the casing member 10 having the internal gear 22, the planetary gear 33 can revolve around the sun gear 30 in the circumferential direction of the internal gear 22. The support plate 35 is formed with handle fixing portions 36 at three locations in the circumferential direction, and the handle portions 37 are fixed to these handle fixing portions 36, respectively. Therefore, three handle portions 37 are provided in the circumferential direction, and by moving these in the circumferential direction with respect to the casing member 10, the planetary gear 33 can be rotationally driven via the support plate 35.

The ratio of the inner diameter of the internal gear 22 to the outer diameter of the sun gear 30 is 1: 3, and the ratio of the number of teeth of the internal gear 22 to the sun gear 30 is 1: 3. Therefore, while the planetary gear 33 makes one revolution in the circumferential direction of the internal gear 22, the sun gear 30 makes three rotations. Hereinafter, the gear ratio is a multiple of the number of teeth of the internal gear 22 with respect to the sun gear 30. In this embodiment, the gear ratio is 3.

As shown in FIG. 3, on the inner peripheral surface of the casing member 10, an internal gear 22 is formed on the tip end side, and a support plate holding portion 24 for rotatably holding the support plate 35 is formed on the base end side. There is. The base end surface of the casing member 10 has a large opening, and the handle portion 37 fixed to the support plate 35 projects from the casing member 10 toward the base end side.

A central shaft member 40 having a lumen 42 is inserted through the central portion of the casing member 10. The central axis of the central shaft member 40 is on the rotation axis of the shaft 2. Further, the central shaft member 40 has a tip insertion portion 41 that is inserted from the base end side of the hub 3. The base end portion of the hub 3 has a tapered inclined surface 3a on the inner surface, and the tapered tip insertion portion 41 is inserted so as to abut the inclined surface 3a. As a result, the space between the hub 3 and the central shaft member 40 is sealed, and blood on the shaft 2 side can be prevented from entering the rotary transmission unit 4. Further, the central shaft member 40 has a base end opening 43, and a guide wire can be inserted through the shaft 2 via a lumen 42. The center of the sun gear 30 is on the central axis of the central shaft member 40 communicating with the shaft 2, and the central shaft member 40 is fixed to the hole 31 of the sun gear 30. Therefore, the shaft 2 can rotate together with the sun gear 30 via the central shaft member 40. The central shaft member 40 is rotatable with respect to the casing member 10 and the support plate 35.

The outer peripheral surface of the casing member 10 is a grip portion 20 held by the operator by hand. The operator holds the grip portion 20 by hand and moves the handle portion 37 in the circumferential direction of the casing member 10, so that the planetary gear 33 is rotationally driven by the handle portion 37 while the internal gear 22 is fixed in the circumferential direction. Then, the sun gear 30 connected to the central shaft member 40 by the planetary gear 33 is rotationally driven. When the operator rotates the handle portion 37 in the forward direction, the sun gear 30 also rotates in the forward direction.

As described above, since the gear ratio is 3 in the present embodiment, the shaft 2 connected to the central shaft member 40 has an angle three times the angle at which the operator rotates the handle portion 37 with respect to the grip portion 20. Rotates in the forward direction with. The shaft 2 is flexible, and in a curved state, the rotation angle at the tip portion is smaller than that at the base end portion. In this embodiment, the length of the shaft 2 is 180 to 250 cm. In this case, the tip end portion of the shaft makes approximately one rotation when the base end portion makes three rotations. Therefore, the angle at which the operator rotates the handle portion 37 with respect to the grip portion 20 and the rotation angle of the tip portion of the shaft 2 are substantially the same, and the rotation operation of the shaft 2 can be performed with a small number of rotations.

Next, a second embodiment of the present invention will be described. The rotary transmission unit 7 of the second embodiment is provided with the first rotation transmission unit 8 and the second rotation transmission unit 9. The first rotation speed change unit 8 and the second rotation speed change unit 9 are arranged at different positions in the axial direction of the shaft 2.

As shown in FIG. 4, the first rotation transmission unit 8 has an inner first casing member 51, and the second rotation transmission unit 9 has an inner second casing member 52. The inner first casing member 51 and the inner second casing member 52 are housed in the outer casing member 50. The inner first casing member 51 and the inner second casing member 52 each have a planetary gear mechanism inside. In the present embodiment, the outer peripheral surface of the outer casing member 50 is the grip portion 60, and the outer peripheral surface exposed from the outer casing member 50 of the inner first casing member 51 is the operation portion 55.

The inner first casing member 51 has a first internal gear 70, a first sun gear 72, and a first planetary gear 76 inside. The first internal gear 70 is formed on the inner peripheral surface of the inner first casing member 51. Further, in the inner first casing member 51, a first support plate 78 that rotatably supports the first planetary gear 76 is provided. The first support plate 78 is rotatable with respect to the inner first casing member 51. The central shaft member 90 is inserted into the hole 73 of the first sun gear 72, but the central shaft member 90 is not fixed to the first sun gear 72. The first sun gear 72 has a connecting portion 74 whose tip portion projects toward the tip side, and the connecting portion 74 is fixed to the inner second casing member 52. The fixing structure of the central shaft member 90 to the hub 3 is the same as in the case of FIG. 3, and the tip insertion portion 91 is inserted into the base end side of the hub 3. Further, the central shaft member 90 has a base end opening 93.

The inner second casing member 52 has a second internal gear 80, a second sun gear 82, and a second planetary gear 86 inside. The second internal gear 80 is formed on the inner peripheral surface of the inner second casing member 52. Further, a second support plate 88 that rotatably supports the second planetary gear 86 is provided in the inner second casing member 52. The second support plate 88 is rotatable with respect to the inner second casing member 52. A central shaft member 90 is inserted and fixed in the hole 83 of the second sun gear 82, and the shaft 2 can be rotationally driven by the second sun gear 82 via the central shaft member 90.

The outer casing member 50 has a planetary gear support portion 61 that rotationally supports the first planetary gear 76 of the inner first casing member 51 and the second planetary gear 86 of the inner second casing member 52, respectively. Due to the planetary gear support portion 61, neither the first support plate 78 nor the second support plate 88 rotates with respect to the outer casing member 50.

The gear ratio between the first internal gear 70 and the first sun gear 72 is √3, and the gear ratio between the second internal gear 80 and the second sun gear 82 is also √3. As a result, the first sun gear 72 rotates √3 times the rotation of the operation unit 55, and the second sun gear 82 rotates √3 times the rotation of the first sun gear 72. The speed of 82 is increased so as to rotate three times as much as the rotation of the operation unit 55. The inner diameter of the first internal gear 70 is √3 times the outer diameter of the first sun gear 72, and the inner diameter of the second internal gear 80 is also √3 times the outer diameter of the second sun gear 82.

The operator holds the grip portion 60 of the outer casing member 50 by hand, and rotates the operation portion 55, which is the outer peripheral surface of the inner first casing member 51, in the circumferential direction of the outer casing member 50, whereby the first internal gear 70 is generated. It rotates with respect to the outer casing member 50, and the first planetary gear 76 is rotationally driven in a state where the circumferential position with respect to the outer casing member 50 is fixed. The rotation of the first planetary gear 76 causes the first sun gear 72 to rotate, and the inner second casing member 52 connected by the connecting portion 74 is rotationally driven. When the operator rotates the operation unit 55 in the forward direction, the rotation direction of the first sun gear 72 is opposite, and the inner second casing member 52 also rotates in the opposite direction.

By rotating the inner second casing member 52, the second planetary gear 86 is rotated by the second internal gear 80. The second planetary gear 86 also rotates in a state where the circumferential position with respect to the outer casing member 50 is fixed by the planetary gear support portion 61. The rotation of the second planetary gear 86 drives the rotation of the second sun gear 82, and the shaft 2 rotates via the central shaft member 90. As described above, since the inner second casing member 52 rotates in the opposite direction, the rotation direction of the second sun gear 82 is in the forward direction, and the shaft 2 also rotates in the forward direction.

In this way, with the planetary gear fixed in the circumferential direction, the mechanism that rotates the sun gear in the direction opposite to the operation direction by rotating the internal gear by operation to drive the sun gear is provided in the axial direction of the shaft 2. By connecting two of them along the above, the speed of the shaft 2 connected to the second sun gear 82 can be accelerated in the forward direction. With this mechanism as well, the operator can roughly match the angle at which the operation portion 55 is rotated with respect to the grip portion 60 and the rotation angle of the tip portion of the shaft 2, and can perform the rotation operation of the shaft 2 with a small number of rotations. .. In the present embodiment, the first rotation transmission unit 8 and the second rotation transmission unit 9 are required, but since the gear ratios of the respective gear ratios are smaller than those in the first embodiment, the overall diameter can be reduced.

As described above, the medical long body 1 according to the present embodiment has a long shaft 2 inserted into a living body and a rotary transmission unit 4 for transmitting rotation from the hand side to the shaft 2. The rotary speed change unit 4 has a grip portion 20 that is held so as not to rotate, and an operation unit (handle portion 37) that is rotated with respect to the grip portion 20. Communicate to. As a result, the rotation of the shaft 2 is changed, so that the difference between the rotation angle due to the rotation operation of the operation portion and the rotation angle at the tip portion of the shaft 2 can be reduced.

Further, the rotary transmission unit 4 has a sun gear 30 at the center of rotation, an internal gear 22 at a peripheral portion of rotation, and a planetary gear 33 arranged between the sun gear 30 and the internal gear 22. If the center position of is on the rotation axis of the shaft 2, the rotation input from the operation unit can be changed and output to the shaft 2 with a simple structure.

Further, if the internal gear 22 is supported by the grip portion 20, the operation portion rotationally drives the planetary gear 33, and the sun gear 30 rotationally driven by the planetary gear 33 rotationally drives the shaft 2, one set The planetary gear mechanism allows the shaft 2 to accelerate and rotate in the forward direction with the rotation operation direction.

Further, if the casing member 10 is provided as the grip portion 20 and the sun gear 30 and the planetary gear 33 are rotated with respect to the casing member 10, the planetary gear mechanism is housed in the casing member 10 to accommodate the rotary transmission unit 4. It can be configured compactly.

Further, if the internal gear 22 is provided on the inner peripheral portion of the casing member 10, it is not necessary to provide the parts for the internal gear 22, so that the number of parts can be reduced.

Further, if the planetary gear 33 is rotationally supported and the support plate 35 is rotated with respect to the internal gear 22, and the support plate 35 is provided with the handle portion 37 as an operation portion, the handle portion 37 can be attached to the casing member 10. The rotation operation can be easily performed by operating the gear so as to move it in the circumferential direction.

Further, if the grip portion 20 has a lock portion that prevents the handle portion 37 from rotating with respect to the grip portion 20, it is possible to prevent the shaft 2 from being unexpectedly accelerated and rotated when the rotation operation is not performed. it can.

Further, the rotary transmission unit is provided at a position different in the axial direction from the first rotation transmission unit 8 having the first sun gear 72, the first internal gear 70, and the first planetary gear 76, and the first rotation transmission unit 8. It has a second rotary transmission unit 9 having a second sun gear 82, a second internal gear 80, and a second planetary gear 86, and the first sun gear 72 is connected so as to rotationally drive the second internal gear 80. , The first planetary gear 76 and the second planetary gear 86 are supported by the grip portion 60, and the operating portion 55 rotationally drives the first internal gear 70 and is rotationally driven by the first internal gear 70 via the first planetary gear 76. The first sun gear 72 is driven by rotating the second sun gear 82 via the second internal gear 80 and the second planetary gear 86, and the second sun gear 82 is driven to rotate the shaft 2. The first rotary transmission 8 reverses the rotation operation of the operation unit 55 while accelerating it, and the second rotary transmission 9 reverses the rotation of the first rotation gear 8 while accelerating the rotation of the operation unit 55. The shaft 2 can be rotated in the forward direction while accelerating the operation.

The present invention is not limited to the above-described embodiment, and various modifications can be made by those skilled in the art within the technical idea of the present invention. For example, in the above-described embodiment, the gear ratio is set to 3, but any other gear ratio can be used if necessary. The gear ratio can be set to greater than 1 and less than 4, preferably 1.5 to 3. When the gear ratio is 1, there is no difference from manual rotation, and when it exceeds 4, the rotation speed of the tip is too fast and there is a possibility of blood vessel damage.

Further, in the above-described embodiment, the rotation of the shaft 2 is accelerated by the rotary transmission units 4 and 7, but the shaft may be decelerated. For example, in the configuration of the first embodiment, if the internal gear is fixed to the grip portion in the circumferential direction, the sun gear is rotated by the operation portion, and the shaft is connected to the planetary gear, the operator can perform the operation. By holding the grip portion by hand and rotating the operation portion, the shaft decelerates and rotates in the forward direction according to the gear ratio. By decelerating the shaft, the rotation angle can be made smaller than the rotation operation, so that it can be used when a precise rotation operation is required.

Further, if necessary, a lock mechanism may be provided to prevent the handle portion 37 from rotating with respect to the grip portion 20. In this case, the handle portion of the handle portion 37 is allowed to move along the axial direction of the shaft 2, and the casing member 10 serving as the grip portion 20 is provided with a recess for accommodating the handle portion of the handle portion 37. .. As a result, the recess becomes a lock portion that prevents the handle portion 37 from rotating.

This application is based on Japanese Patent Application No. 2019-179473 filed on September 30, 2019, and the disclosure contents thereof are referred to and incorporated as a whole.

1 Catheter 2 Shaft 3 Hub 3a Inclined surface 4 Rotating gear 7 Rotating gear 8 1st gear 9 2nd gear 10 Casing member 20 Grip 22 Internal gear 24 Support plate holding 30 Sun gear 31 Hole 33 Planetary gear 35 Support plate 36 Handle fixing part 37 Handle part 40 Central shaft member 41 Tip insertion part 42 Lumen 43 Base end opening 50 Outer casing member 51 Inner first casing member 52 Inner second casing member 55 Operation part 60 Grip part 61 Planetary gear support 70 1st internal gear 72 1st sun gear 73 Hole 74 Connecting part 76 1st planetary gear 78 1st support plate 80 2nd internal gear 82 2nd sun gear 83 Hole 86 2nd planetary gear 88th 2 Support plate

Claims (8)

1. A long shaft that is inserted into the living body and
   The shaft has a rotary transmission unit that transmits rotation from the hand side.
   The rotary transmission has a grip portion that is held so as not to rotate, and an operation portion that is rotated with respect to the grip portion, and has a medical length that shifts the rotation of the operation portion and transmits it to the shaft. Scale body.
2. The rotary transmission has a sun gear at the center of rotation, an internal gear around the rotation, and a planetary gear arranged between the sun gear and the internal gear, and the center position of the sun gear is the shaft. The medical elongated body according to claim 1, which is on the rotation axis of the above.
3. The medical length according to claim 2, wherein the internal gear is supported by the grip portion, the operating portion rotationally drives the planetary gear, and the sun gear rotationally driven by the planetary gear rotationally drives the shaft. Scale body.
4. The medical long body according to claim 3, which has a casing member as the grip portion, and the sun gear and the planetary gear rotate with respect to the casing member.
5. The medical long body according to claim 4, wherein the internal gear is provided on the inner peripheral portion of the casing member.
6. The medical length according to any one of claims 3 to 5, which has a support plate that rotationally supports the planetary gear and rotates with respect to the internal gear, and the support plate is provided with a handle portion as the operation portion. Scale body.
7. The long medical body according to claim 6, wherein the grip portion has a lock portion that prevents the handle portion from rotating with respect to the grip portion.
8. The rotary transmission includes a first rotary gear having a first sun gear, a first internal gear, and a first planetary gear, and a second sun gear provided at a position different from that of the first rotary gear in the axial direction. It has a second rotary transmission unit having a second internal gear and a second planetary gear,
   The first sun gear is connected so as to rotationally drive the second internal gear.
   The first planetary gear and the second planetary gear are supported by the grip portion, and the operating portion rotationally drives the first internal gear and is rotationally driven by the first internal gear via the first planetary gear. The medical use according to claim 2, wherein the first sun gear rotationally drives the second sun gear via the second internal gear and the second planetary gear, and the second sun gear rotationally drives the shaft. Long body.

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