CN101516273A - 外科器械 - Google Patents

外科器械 Download PDF

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CN101516273A
CN101516273A CNA2007800340764A CN200780034076A CN101516273A CN 101516273 A CN101516273 A CN 101516273A CN A2007800340764 A CNA2007800340764 A CN A2007800340764A CN 200780034076 A CN200780034076 A CN 200780034076A CN 101516273 A CN101516273 A CN 101516273A
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CN101516273B (zh
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李佑镇
安德烈斯·查莫罗
李佑中
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Cambridge Endoscopic Devices Inc
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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
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0042—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping
    • A61B2017/00424—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping ergonomic, e.g. fitting in fist
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2905—Details of shaft flexible
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2925—Pistol grips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
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    • A—HUMAN NECESSITIES
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2946—Locking means

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Abstract

一种外科器械，包括：器械轴，其具有近端和远端；工具，其设置于所述器械轴的远端；控制手柄，其设置于所述器械轴的近端；远侧运动构件，其用于将所述器械轴的远端联接至所述工具；近侧运动构件，其用于将所述器械轴的近端联接至所述手柄；致动装置，其在所述远侧运动构件与所述近侧运动构件之间延伸，用于将所述近侧运动构件的运动联动至所述远侧运动构件以便控制所述工具的定位；以及锁定机构，其用于将所述工具的位置固定于选定位置并且具有锁定状态和解锁状态。

Description

外科器械
相关申请
根据35U.S.C.§119(e)(美国专利法35条119款)的规定，在此本申请要求2006年9月13日提交的共同拥有且共同待审的美国临时专利申请No.60/844,130的优先权。上述申请的所有内容在此以引用方式全部并入本申请。
技术领域
本发明总体上涉及医疗器械，更具体而言，涉及手动操作的外科器械，该器械旨在用于微创外科手术或其它形式的外科或内科程序。文中所描述的器械主要是用于腹腔镜程序，然而，应当理解，本发明的器械能够用于很多种其它程序，包括管腔内程序。
背景技术
目前在市场上可获得的内窥镜和腹腔镜器械极难学会操作和使用，主要是因为在它们的使用中缺少灵巧性。例如，在手术期间当使用典型的腹腔镜器械时，器械的工具的定向只受目标和切口的位置支配。这些器械通常通过支点效应工作，使用患者自身的切口区域作为支点。结果，普通任务例如缝合、打结和精细解剖对于医师来说变得复杂。数年来开发了各种一般通过提供额外的铰接装置而克服该缺陷的腹腔镜器械，所述铰接装置通常由单独设置的用于进行附加控制的控制元件进行控制。然而，即使如此，这些器械仍然不能提供足够的灵巧性以允许外科医生执行普通任务，例如缝合，特别是在任意选择的方位处。同时，这种类型的现有器械并未提供有效方式以将器械保持在特定位置。而且，现有器械需要使用双手以有效地控制器械。
因此，本发明的一个目的是提供一种改进的腹腔镜或内窥镜外科器械，该器械允许外科医生以更大的灵巧性来操纵外科器械的工具端部。
本发明的另一个目的是提供一种改进的外科或医疗器械，该器械具有经切口、经自然身体孔口或经腔管的很各种应用。
本发明的又一个目的是提供一种改进的医疗器械，其特征在于将器械锁定在预先选定的特定位置中的能力。
本发明的再一个目的是提供一种锁定特征件，该特征件对于器械的其它控制来说起到重要的辅助作用，使得一旦器械处于期望位置时外科医生能够锁定该器械。这使得外科医生在此后能够更容易地执行外科程序，而不必同时将器械保持在特定的弯曲构形中。
本发明还有一个目的是提供一种改进的医疗器械，该器械使用户能够以单手来进行有效控制。
发明内容
为了实现本发明前述和其它目的、特征和优点，提供了一种外科器械，包括：器械轴，其具有近端和远端；工具，其设置于所述器械轴的远端；控制手柄，其联接于所述器械轴的近端；远侧运动构件，其用于将所述器械轴的远端联接至所述工具；近侧运动构件，其用于将所述器械轴的近端联接至所述手柄；致动装置，其在所述远侧运动构件与所述近侧运动构件之间延伸，用于将所述近侧运动构件的运动联动至所述远侧运动构件以便控制所述工具的定位；以及锁定机构，其用于将所述工具的位置固定于选定位置并且具有锁定状态和解锁状态；其中，所述锁定机构包括绕所述近侧运动构件设置的球窝装置以及包括用于锁定所述球窝装置的束带构件。
根据本发明的另一方面，所述外科器械可进一步包括：旋转装置，其设置为邻近所述控制手柄并且能够相对于所述控制手柄旋转以便导致所述器械轴和所述工具的相应旋转；至少所述近侧运动构件可包括近侧可弯曲构件，其中，所述旋转装置包括适于使所述工具绕远侧工具滚动轴线旋转的旋钮并且设置在所述控制手柄与所述近侧可弯曲构件之间；所述控制手柄可包括***握把式手柄，所述***握把式手柄具有接合角状件从而有助于保持所述手柄；所述旋转装置可包括设置于所述手柄的远端处的旋钮，并且所述角状件设置为处于所述旋钮的近侧且位于所述***握把式手柄之上；优选地，所述外科器械还包括致动杆，其在所述手柄的近端的枢轴点处支撑于所述***握把式手柄；所述致动杆可具有带手指环的自由端部，所述手指环用于接纳用户手指以控制所述杆；优选地，所述外科器械还包括工具致动缆线、滑动件和致动杆，所述工具致动缆线从所述工具延伸至所述手柄，所述滑动件用于抓持所述工具致动缆线的近端，并且所述致动杆支撑于所述手柄处以便控制所述滑动件的平移；优选地，所述外科器械还包括用于接纳所述滑动件的滑道、设置在所述滑动件中的一对弹簧以及设置在所述弹簧之间且用于保持所述工具致动缆线的近端的旋转筒体；所述球窝装置可包括球构件，所述球构件具有与所述手柄中的凹形承窝相匹配的局部球形部；所述手柄可具有所述承窝形成在其内表面上的远侧套环，并且所述束带构件可包括绕所述远侧套环设置的环形束带圈；优选地，所述外科器械还包括位于所述束带圈与所述套环之间的凸舌和沟槽互连装置，以便允许在所述束带圈与所述套环之间进行旋转同时阻止轴向移动；优选地，所述外科器械还包括位于所述束带圈上的、具有相对的锁定位置和解锁位置的枢转件；以及优选地，所述远侧套环具有一个或多个狭槽，使得在所述束带圈锁定时所述承窝能够绕所述球构件收缩。
根据本发明的另一个特征，提供了一种外科器械，包括：器械轴，其具有近端和远端；工具，其设置于所述器械轴的远端；控制手柄，其设置于所述器械轴的近端；远侧运动构件，其用于将所述器械轴的远端联接至所述工具；近侧运动构件，其用于将所述器械轴的近端联接至所述手柄；致动装置，其在所述远侧运动构件与所述近侧运动构件之间延伸，用于将所述近侧运动构件的运动联动至所述远侧运动构件以便控制所述工具的定位；所述控制手柄包括***握把式手柄；致动杆，其用于控制所述工具并枢转地支撑于所述手柄；以及调节构件，其安装在所述杆上以便调节所述致动杆相对于所述手柄的中心平面的姿势或角度。
根据本发明的又一方面，提供了一种外科器械，其中，所述调节构件包括用于在正值与负值之间改变姿势或角度的调节杆；所述调节构件包括斜面垫圈装置；所述调节杆支撑于与用于所述致动杆的枢转支撑件相同的枢转支撑件；并且，所述外科器械进一步包括有助于保持所述手柄的接合角状件以及设置于所述手柄的远端处的旋钮，并且所述角状件设置成处于所述旋钮的近侧且位于所述***握把式手柄之上。
根据本发明的另一个特征，提供了一种医疗器械，其具有：近侧控制手柄和远侧工具，所述近侧控制手柄和所述远侧工具通过长形器械轴互相联接，所述器械轴用于穿过解剖体内部；近侧可移动构件和远侧可移动构件，所述近侧可移动构件和所述远侧可移动构件分别将所述近侧控制手柄和所述远侧工具与所述器械轴互相联接；缆线致动装置，其设置在所述可移动构件之间；所述控制手柄具有近端和远端；致动杆，其用于控制所述远侧工具；用于使所述致动杆在其一侧枢转地支撑于所述手柄的近端的装置；角状件以及用于使所述角状件在其相反侧固定地支撑于所述手柄的远端的装置。
根据本发明的其它方面，提供了一种医疗器械，其中，所述缆线致动装置包括一组致动缆线，所述缆线充分硬从而各条缆线在对所述工具的控制中能够进行拉拔动作或能够进行顶推动作；所述医疗器械还包括用于各条缆线的约束装置，以便在各条缆线在所述近侧可移动构件与所述远侧可移动构件之间延伸时大致地束缚各条缆线；并且，所述控制手柄包括***握把式手柄，并且所述致动杆包括安装在所述杆上的、用于调节所述致动杆相对于所述手柄的中心平面的姿势的调节构件。
根据本发明的进一步特征，提供了一种医疗器械，该器械具有：近侧控制手柄和远侧工具，所述近侧控制手柄和所述远侧工具通过长形器械轴互相联接，所述器械轴用于穿过解剖体内部；近侧可移动构件和远侧可移动构件，所述近侧可移动构件和所述远侧可移动构件分别将所述近侧控制手柄和所述远侧工具与所述器械轴互相联接；缆线致动装置，其设置在所述可移动构件之间，用于控制所述远侧工具的定位；以及用于沿其长度方向约束所述缆线装置使其能够进行拉拔动作和顶推动作的装置。
根据本发明的进一步方面，提供了一种医疗器械，其中，所述缆线装置沿着其大致整个长度方向受约束；并且，所述约束装置包括绕所述缆线装置设置在所述器械轴中的轴填充件。
根据本发明的另一个特征，提供了一种医疗器械，该器械具有：近侧控制手柄和远侧工具，所述近侧控制手柄和所述远侧工具通过长形器械轴互相联接，所述器械轴用于穿过解剖体内部；近侧可移动构件和远侧可移动构件，所述近侧可移动构件和所述远侧可移动构件分别将所述近侧控制手柄和所述远侧工具与所述器械轴互相联接；缆线致动装置，其设置在所述可移动构件之间，用于控制所述远侧工具的定位；以及具有锁定位置和解锁位置的锁定机构，其绕所述近侧可移动构件设置并且受到手动控制以便在其所述锁定位置中固定近侧可移动构件相对于所述手柄的位置。
根据本发明的其它方面，提供了一种医疗器械，其中，所述锁定机构包括球构件以及限定承窝构件的可压缩毂；所述毂是拼合毂，并且所述锁定机构进一步包括绕所述拼合毂设置的束带圈以及安装在所述束带圈上的、用于使所述束带圈绕所述拼合毂闭合以将所述毂锁定在所述球构件上的锁定杆；当处于所述解锁位置时所述束带圈与所述毂互锁但是能够相对于所述毂旋转；并且，所述医疗器械还包括邻近所述近侧可移动构件、用于控制所述远侧可移动构件和所述工具的方位的旋转控制构件。
附图说明
应当理解的是，提供附图的目的仅仅是为了示例，而不是旨在限制本公开发明的范围。在结合附图时操着以下的详细描述，文中所述的实施方式的前述和其它的目的和优点将显而易见，在所述附图中：
图1是本发明的器械的优选实施方式的立体图，示出了由用户持握的器械且进一步示意性地示出了置于手术部位的器械；
图2是图1的器械自身的侧视截面图，该截面图主要示出器械的近端或手柄端；
图3是示出图的2器械的放大侧视截面图，所述器械处于倾斜关系且钳口闭合于针上；
图4A-4C是医疗器械的远端处的示例性侧视截面图，其中可移动钳口处于不同的相应位置；
图4D是沿着图4C的线4D-4D截取的径向截面图；
图5是沿着图2的线5-5截取的图1的器械的前视截面图，示出了处于锁定位置的锁定杆；
图6是图5中所述器械的前视截面图，示出了处于解锁位置的锁定杆，并且进一步示出了器械某些部件被拆卸的情形以示出能够进行的以适应器械用户的某些调节；
图7是沿着图2的线7-7截取的平面截面图；
图8是沿着图5的线8-8截取的局部截面图，但是示出处于倾斜关系的器械；
图9是沿着图8的线9-9截取的器械轴处的放大截面图；
图10是沿着图8的线10-10截取的器械的转接件处的截面图；
图11是沿着图7的线11-11截取的器械的旋钮处的截面图；
图12-14是基本上沿着图7的线12-12截取的手柄的大致示意性的局部放大截面图，示出了钳口夹紧杆装置在其不同位置中的操作；
图15是文中所示的器械的示意性立体图。
具体实施方式
本发明的器械可用来执行微创程序。这里“微创程序”指的是外科医生经小缺口或切口来操作的外科程序，小切口用于进入到手术部位。在一种实施方式中，切口长度范围从直径1毫米至20毫米，优选从直径5毫米至10毫米。这种程序与需要大缺口以进入到手术部位的那些程序形成对比。所以，优选地使用挠性器械以便经这种小切口和/或经自然身体管腔或空腔***，从而针对特定外科或医疗程序将器械定位在内部目标部位。将外科器械引入解剖组织中也可通过经皮或外科进入管腔、脉管或空腔的方式进行，或者通过经解剖组织中的自然孔口引入的方式进行。
除了用在腹腔镜程序中之外，本发明的器械可用在多种其它医疗或外科程序中，包括但不局限于结肠镜、上胃肠道、关节镜、窦、胸腔、***、经***、整形外科和心脏程序。取决于特定程序，器械轴可以是刚性的、半刚性的或挠性的。
虽然这里参照的是“外科器械”，但是可以预期本发明的原理也适用于其它医疗器械，而不必用于外科，包括但不局限于诸如导管等其它器具以及诊断及治疗器械和器具。
在本发明的器械中包括有许多独特特性。例如，设有构造为使用球窝装置的锁定机构，该球窝装置设置为进行弯曲动作的近侧运动构件，其中用环形束带圈将球窝装置保持在固定的特定位置，从而也将近侧可弯曲构件和远侧可弯曲构件保持在特定的弯曲状态，或者换句话说，锁定在该位置。束带圈包括锁定杆，该锁定杆方便地邻近器械手柄定位，而且易于操作以锁定和释放束带圈，进而锁定和释放末端执行器。束带圈优选地还能够旋转以使得锁定杆能够方便定位或者能够在左手用户和右手用户之间切换(旋转)。该锁定控制允许外科医生执行某个任务时需关注的自由度少一个。通过在特定位置锁定可弯曲部分，这使得外科医生不必用手就能控制器械的其它自由度，诸如操纵旋钮进而控制末端执行器的方位。
本发明的另一个特征涉及进行弯曲的方式。过去，用较小直径的挠性缆线来控制近侧可弯曲构件与远侧可弯曲构件之间的弯曲。然而，这会导致略微不均匀的控制，因为只有通过一条缆线来进行的“拉拔”动作，而同时相对的缆线会松弛。本发明使用更具刚性的缆线装置，使得在“拉拔”动作和反向的“顶推”动作下都能够发生弯曲。为了做到这一点，缆线的直径要较大并且有些刚性，但是还必须具备足够的挠性，使得它们易于弯曲。同时，缆线在沿其长度方向上受到约束以便防止缆线偏转或翘曲，尤其是在对缆线进行“顶推”阶段。
还有一个特征是***握把式手柄装置和控制杆，该控制杆具有端部万向节结构，该结构更精确地控制致动杆并提供末端执行器的相应动作。同时根据本发明的控制杆设有控制杆的姿势进行控制的装置以补偿不同的手柄结构，尤其是补偿用户手指的不同长度。
图1是本发明的外科器械10的一种实施方式的立体图。在该外科器械中，工具和手柄运动构件或可弯曲构件都能够沿任意方向弯曲。它们经由缆线(优选为四个缆线)互相连接，使得近端构件处的弯曲动作提供了远端构件处的相关弯曲。近侧弯曲由器械用户所进行的控制手柄的动作或偏转来控制。换句话说，外科医生握持手柄，一旦该器械就位，手柄处的任何运动(偏转)就直接控制近侧可弯曲构件，近侧可弯曲构件进而经由缆线控制远侧可弯曲构件处的相应弯曲或偏转。该动作进而控制远侧工具的定位。
近端构件优选通常大于远端构件以便提供增强的人机控制。在所示实施方式中，近侧可弯曲构件与远侧可弯曲构件的直径比可以在三比一左右。在根据本发明的一种方案中，可以提供远侧可弯曲构件沿与近侧可弯曲构件相同的方向弯曲的弯曲动作。在可替代实施方式中，可弯曲、可转动或挠性构件可被布置为通过使致动缆线旋转达180度而沿相反方向弯曲，或者可被控制为沿实际上任意其它方向弯曲，取决于缆线的远端支撑点与近端支撑点之间的关系。
如已指出的，产生于远侧弯曲构件处的弯曲动作量由近侧可弯曲构件的尺寸与远侧可弯曲构件的尺寸对比决定。在所述实施方式中，近侧可弯曲构件通常大于远侧可弯曲构件，结果，在远侧可弯曲构件处产生的运动幅度大于近侧可弯曲构件处的运动幅度。近侧可弯曲构件能够沿任意方向(大约360度)弯曲，从而控制远侧可弯曲构件以沿相同或相反方向但同时又在同一平面内弯曲。而且，如图1所示，外科医生能够仅仅通过绕旋转方向R1滚动轴向旋钮而使器械的工具绕其纵向轴线T弯曲和滚动至任意方位。
在该描述中参照的是可弯曲构件。这些构件也可称为可转动构件，可弯曲部分或挠性构件。在文中所给出的该描述中，诸如“可弯曲部分”、“可弯曲节段”、“可弯曲构件”或“可转动构件”等术语指的是这样的器械元件，该元件与在接合点处枢转的元件对比能够以可控制方式弯曲。术语“可移动构件”被当作可弯曲部分和接合点的总称。本发明的可弯器元件使得能够制造出这样的器械，该器械能够沿任意方向弯曲而没有任何奇异性，该器械的特征还在于沿任意方向弯曲的备用能力，所有均优选地采用单一的一体或单体结构。“一体”或“单体”结构的定义是--仅仅由单一的整体构件构成的结构，而不是由多个组装或匹配部件形成的结构。
这些可弯曲构件的定义是--一种器械元件，其形成为控制装置或受控装置，也就是能够受到张力或压缩力的约束而从直线偏转至曲线构形而没有任何锐断点或奇异点。可弯曲构件可以采用如文中图1和2所示的一体结构形式，可以由可接合盘等构成，可以包括波纹装置或可以包括可移动环组件。对于其它形式的可弯曲构件请参照共同待审的2006年8月16日提交的序号为No.11/505,003的申请和2006年9月19日提交的序号为No.11/505,003的申请，在此这两个申请以引用方式全部并入本申请中。
图1示出了本发明的器械的优选实施方式。在图2至15中示出了进一步细节。图1示出了就位的外科器械10，如同外科手术期间会发生的那样。例如，器械可以经腹壁用于腹腔镜外科手术，该腹壁如图1中以附图标记4所示。为此，设有***部位，在该部位处设置有插管或套针6。器械10的轴14适于穿过插管或套针6以便将器械的远端设置于手术部位。在图1中出出末端执行器16处于这种手术部位，其中插管或套针6处于皮肤4上的切口点。图1中所示的器械的实施方式一般与护套98一起使用以阻止体液进入远侧弯曲构件20。
对本发明的器械而言能够进行滚动运动。这能够依靠旋钮24相对于手柄12绕轴线T(参照图3)旋转而发生。这在图1中由旋转箭头R1表示。当旋钮24沿任一方向旋转时，这导致了器械轴14的相应旋转。这在图1中由旋转箭头R2示出。该相同的运动还导致远侧可弯曲构件和末端执行器16绕对应于器械尖端的轴线旋转，在图1和3中示出为绕着纵向尖端或工具轴线P。
在器械锁定时(或者解锁时)旋钮24的任何旋转都会使器械尖端维持于相同的角度位置，但是会使尖端(工具)的方位旋转。对于尖端旋转特征的进一步说明请参照2005年12月14日提交的共同待审的序号为No.11/302,654的申请，尤其是图25-28，在此该申请以引用方式全部并入。
经由近侧可弯曲构件18，可以使手柄12相对于器械轴纵向中心轴线倾斜一定角度。这种倾斜、偏转或弯曲可被当作是处在纸张的平面内。借助缆线装置，该动作会导致远侧可弯曲构件20相应地弯曲至一位置，在该位置中尖端定向为沿着轴线并与器械轴纵向中心轴线成相应角度。近侧可弯曲构件18处的弯曲由外科医生借助手柄12通过沿基本上任意方向操纵手柄来进行控制，所述任意方向包括图1中的纸张平面之内和之外。该操纵直接控制近侧可弯曲构件处的弯曲。参照图3，图中示出了对应于器械轴纵向轴线的轴线U。另外，参照轴线T与U之间的近侧弯曲角度B1以及轴线U与P之间的相应的远侧弯曲角度B2。
因此，手柄处的控制用来在近侧运动构件处弯曲器械，进而控制远侧运动构件和工具的定位。工具的“位置”主要由这种弯曲或运动动作决定，而且可以被当作远侧运动构件的远端处的坐标位置。实际上，可以考虑近侧运动构件和远侧运动构件处以及器械尖端处的坐标轴。该定位处在三维空间。当然，器械定位还在一定程度上受到外科医生在切口点(套管6)处枢转器械的能力的控制。另一方面，工具的“方位”涉及工具借助近端旋转控制构件绕所示远端尖端或工具轴线P的旋转定位。
在附图中，示出了一组钳口，然而，其它工具或器件可以容易地适于与本发明的器械一起使用。这些其它工具或器件包括但不局限于摄像机、检测器、光学器件、观测装置、流体输送器件、注射器等。工具可包括诸如钳口、剪刀、握持器、持针器、微型解剖器、卡钉施用器、缝线器、抽吸冲洗工具和夹子施用器等多种铰接工具。此外，工具可包括诸如切割刀片、探针、冲洗器、导管或抽吸孔口等非铰接工具。
图1的外科器械示出了使用中的根据本发明的外科器械10的优选实施方式，该外科器械可以经***部位处的穿过患者皮肤的插管***。这里所示的许多部件，诸如器械轴14、末端执行器16、远侧弯曲构件20和近侧弯曲构件18等，可类似于在2005年7月20日提交的共同待审的序号为No.11/185,911的美国申请中描述的器械部件，而且以与之相同的方式相互作用，在此该申请以引用方式全部并入本申请中。文中所示的许多其它部件，尤其是器械手柄端部处的部件，可类似于在2006年9月27日提交的共同待审的序号为No.11/528,134的美国申请中描述的部件，在此该申请以引用方式全部并入本申请中。同样以引用方式全部并入的还有2004年4月12日提交的序号为No.10/822,081的美国申请；2005年10月3日提交的序号为No.11/242,642的美国申请和2005年12月14日提交的序号为No.11/302,654的美国申请，所有这些申请共同归本受让人所有。
如图3-8所示，近侧可弯曲构件18与远侧可弯曲构件20之间的控制借助于弯曲控制缆线100来提供。在所示实施方式中，设置有四条这样的控制缆线100，以便提供期望的全方向弯曲。然而，在本发明的其它实施方式中，可以使用更少或更小数量的弯曲控制缆线。弯曲控制缆线100延伸穿过器械轴14，并穿过近侧可弯曲构件和远侧可弯曲构件，如图3和4所示。弯曲控制缆线100沿着其大致整个长度方向受约束，以便有助于如下文进一步详细描述地进行如本发明一个方面所述的“顶推”和“拉拔”动作。缆线100还在经过近侧可弯曲构件的锥形缆线引导部19以及穿过近侧可弯曲构件时受约束。例如，参照图7和8。
本发明的锁定装置与新颖的球窝装置相互作用以对缆线的定位进行锁定和解锁，缆线进而控制近侧弯曲构件的角度以及远侧可弯曲构件和末端执行器的角度。该锁定控制允许外科医生在执行某些任务时要关注的自由度少一个。通过将可弯曲部分锁定于特定位置，通过在特定位置锁定可弯曲部分，这使得外科医生能够腾出更多的手以便控制器械的其它自由度，比如旋钮24的操纵进而末端执行器的方位等。
图1中所示的器械是***握把式。然而，本发明的原理也可适用于其它形式的手柄，比如直线手柄等。在图3中，示出了钳口夹紧装置30，其主要包括杆22，该杆22具有用于控制该杆的单指孔，还包括由杆22而不是由单独的释放按钮直接控制的相关释放功能件。释放功能件用来释放被致动或闭合的工具，并且下文将对其进行进一步详细讨论。
在所示器械中，该器械的手柄端部可以沿任意方向偏斜，因为近侧可弯曲构件构造和布置为能够进行完全360度弯曲。手柄相对于器械轴的这种移动使器械在近侧可弯曲构件18处弯曲。该动作进而经由弯曲控制缆线100而使远侧可弯曲构件沿相同方向弯曲。如前所述，通过旋转或扭转控制缆线从其一端至另一端达180度，则能够利用相反方向的弯曲。参照图15的示意性立体图，可看到用在所示器械中的直线型缆线装置的图示。
在文中所述实施方式中，手柄12采用***握把形式，且包括有助于在外科医生的手的动作与器械之间实现舒适接触的角状件13。图1-3中示出工具致动杆22枢转地附接于手柄基部。杆22致动滑动件28，该滑动件28控制从滑动件延伸至器械远端的工具致动缆线38。该缆线38控制钳口的打开和闭合，并且杆的不同位置控制施加于钳口的力。
手柄的形状允许如图1所示地对器械进行舒适且大致单手的操作。如图1所示，外科医生可以将手柄12抓握在他的手掌与中指之间，同时角状件13搁置在其拇指与食指之间的虎口处。这使食指和拇指得以释放和定位，以利用手指锯齿部31转动旋钮24，该手指锯齿部31设置在旋钮的外周表面上，如图11所示。在器械的锁定位置和解锁位置中，旋钮都能够进行受控旋转以控制器械尖端处的绕远侧工具尖端轴线P的轴向旋转，如图1中由旋转箭头R3所示。
在所公开的实施方式中，在工具闭合杆22处万向球27中设有指尖接合凹部23。杆22的自由端部支撑具有通孔或凹部23的万向球27，该通孔或凹部23接纳用户的一个手指。球27自由地在杆端部的三维空间中至少部分地旋转。外科医生可以将手柄抓握在手掌、无名指和小指之间，同时角状件13搁置在其拇指与食指之间的虎口处，而后可以如先前所述地操作旋钮24。接着，外科医生可以用食指或中指操作钳口夹紧杆22。
万向节采用处于承窝中的球的形式，其中球27在承窝中自由旋转，并且承窝限定在杆的自由端部中。在该实施方式中，不是具有完全贯穿球的孔或凹部23，而是优选地在球中设有盲孔。在图5和6中示出了该盲孔。球在杆端部中自由旋转，因而球还能够对应于右手用户(图5)或左手用户(图6)旋转至交替位置。盲孔(与通孔对比)使得用户能够更牢固地抓握杆，因而能够增强对杆动作的控制。
下面参照图2-4。在该器械中，远侧可弯曲构件20示出为没有保护套，以便示出远侧可弯曲构件20的一些细节。远侧可弯曲构件包括其间限定有间隔狭槽112的间隔盘110。在相邻盘之间可以以类似于序号为No.11/185,911的前述美国申请中所述的方式连接有肋111。
下面还参照图4A-4D，可看到器械的工具端部的进一步细节。图4A示出处于完全打开位置的钳口。图4B示出握持针的钳口。图4C示出完全闭合的钳口。图4D是沿着图4C的线4D-4D截取的截面图。末端执行器16包括一对钳口44和46。钳口44和46可用来握持针45或如图3所示的其它物件。上钳口44装配在下钳口46中的槽道47内。在钳口之间使用枢销48来实现两者间的旋转。平移销42延伸穿过钳口46的狭槽50和钳口44的狭槽52，并与远端缆线末端连接件40中的孔相接合。连接件40紧固到钳口致动缆线38的极远端，并且定位在钳口44的槽道内。当杆22处于休息位置时，如图2所示，钳口完全打开。在该位置中，销42处于使钳口维持在打开位置的较远侧位置。当拉拔缆线38时，如图3中近侧所示，则销42移动至狭槽50和52的右侧，造成钳口44和46朝向闭合位置枢转。
图4A-4D还示出了钳口46的端壁或端板54。远侧可弯曲构件20的一端顶靠着该端壁54。构件20可通过合适的装置紧固到壁54。在一种实施方式中，器械的缆线装置张力自身使构件保持在一起。在端壁54上设置有一对用于柔性控制缆线100的锚固件56和58。图4D示出四条这种缆线100。远侧可弯曲构件20的远端可设有用于接纳锚固件56和58的凹穴。锚固件56和58坚固地附接到端壁54。还参照图15，可看到各条缆线100的相反端部处的缆线连接和缆线布设的图示。
旋钮24设有近端毂25，该近端毂25支撑近侧弯曲构件18的近端。在组装期间，从近侧弯曲构件18的近端伸出的缆线100在组装了末端执行器16、内轴34和外轴32、转接件26以及近侧弯曲构件18之后穿过四个终端线卷或线耳102，这些线卷或线耳102嵌入毂25中的通道中。使缆线张紧和卷曲，并将多余的缆线材料剪除。这种配置使所有元件一起保持在末端执行器16与旋钮毂25进而与旋钮24之间。
如前所示，旋钮24在其近侧形成有毂25，该毂25支撑在从旋钮24向后延伸至滑动件28的中新导线管64上。e型环65以相对于导管64的旋转关系夹持毂25。导管64通过手柄12的内部装置支撑在固定位置。通过拼合毂202与手柄远端之间的间隙232能够容易地接近旋钮24。在图7中可看到间隙232。旋钮24具有四个钥匙孔状狭槽103(图11)，所述狭槽103与终端线卷102A-102D相匹配，与缆线相对于旋钮处于弹簧加载式“拉拔”关系的过去方案对比，当使手柄相对于轴弯曲时，所述终端线卷102A-102D能够在缆线100上产生“推拉”作用。由于这种“推拉”动作，所以不使用与各条缆线相关联的偏置弹簧。
如前所示，末端执行器或工具16借助于钳口致动机构或钳口夹紧装置30来致动，钳口致动机构或钳口夹紧装置30主要包括长形杆22。该杆22在杆枢销72处支撑于外壳。参照图2和3，杆22相对于手柄12的闭合对滑动件28发生作用，该滑动件28用来抓持致动缆线38的极近端。当滑动件28处于图2中所示的位置时，可看到末端执行器的钳口完全打开。在该位置中，滑动件28置于滑道84的较远端。滑道84是手柄12中的内部支撑装置的一部分。当滑动件28向近侧移动时，如图3所示，则钳口朝向握持针45的闭合位置移动。
器械轴14包括可由轻质金属材料构成或可以是塑料材料的外轴管32。参见图9中的穿过器械轴截取的截面图。管32的近端由转接件26接纳，如图7和8所示。管32的远端紧固到远侧可弯曲构件20。在外轴管32内设有优选由塑料材料构成的支撑管34。管34在远侧可弯曲或挠性构件20与近侧可弯曲或挠性构件18之间延伸。钳口致动缆线38在该支撑管34内延伸。
本发明的一个特征是缆线设计，该设计使用的是相对较硬而又能够弯曲的弯曲控制缆线。较硬的缆线不仅允许其进行“拉拔”动作而且允许其进行“顶推”动作。这使得能够经由缆线装置而使控制得以增强，因为不仅在“拉拔”缆线时而且在“顶推”缆线时都可提供控制。这使得经由缆线而可实现更一致的控制。为了不仅能够进行“拉拔”动作而且能够进行“顶推”动作，缆线100支撑在相对较窄的管腔或通路中以防止在被顶推时发生翘曲。除了其它因素以外，这方面通过设置轴填充件36来促成。为使能够进行特别是“顶推”动作，缆线被限制为使得其不会在器械自身内发生扭曲。
在管32与34之间设置有轴填充件36，轴填充件36用来在器械轴自身内将缆线保持就位。如图9中可看到，轴填充件具有用于内轴支撑管34的中心管腔36A和容置缆线10且允许缆线100紧密滑动配合的四个纵向沟槽36B。近侧弯曲构件18的锥形部19具有绕其外表面以90度间距设置的缆线引导沟槽106，引导沟槽106抓持与转接件26处于滑动关系的各条缆线。各个引导沟槽在锥形部19的单独的径向设置的翼状件108中形成。转接件26还可设有用于缆线100的容置沟槽。还参照图10的截面图，可看到缆线引导和约束装置的图示。因而，缆线沿着其长度方向被约束在沟槽或通道中。各条缆线优选仅仅短距离无支撑，比如图2和3中所示狭槽132的距离，或者如同远侧可弯曲构件处的狭槽。
钳口致动缆线38在末端执行器(连接件40)和旋转筒体66(见图3)处的其相应端部处终止。在各个可弯曲部分或可弯曲构件18和20内设有塑料管。这包括远端管60和近端管62。这些管均可以由诸如聚醚醚酮(PEEK)等塑料构成。管的材料充分硬以夹持缆线38，而又足够挠性从而其能够容易地与可弯曲构件18和20的弯曲一起弯曲。所述管具有充分的强度以接纳和引导缆线，而又足够挠性从而其不会纽结或扭曲，从而使缆线保持在启动的正确状态，同时还为缆线限定固定的长度。所述管在纵向具有刚性，而在侧向具有挠性。
近侧可弯曲构件18，如同远侧可弯曲构件20，也可以构造为包括一组挠性盘130的一体或单体开槽结构，在所述挠性盘130之间限定有狭槽132，如图2所示。“一体”或“单体”结构可以定义为一种构造为以单件使用且无需对零件进行组装的结构。连接肋131示出为在相邻盘130之间延伸。两种可弯曲构件均优选地具有这样的肋型式，即在该肋型式中，肋设置为从一个肋至相邻肋以优选的60度错位。已发现这可提供改进的弯曲动作。还发现通过以其间小于90度的间距设置肋可以改进弯曲。肋可以设置为从一个肋至相邻肋的间距在大约35度至大约75度之间。通过使用小于90度的间距，肋的分布将更均匀。结果，在任意方位上的弯曲运动更一致。在本发明中，两种可弯曲构件都可以由诸如PEBAX(嵌段聚醚酰胺)等高弹性聚合物制成，但是也可由其它弹性和回弹性材料制成。
在图2中杆22示出为处于可视为“休息”位置的最低位置。该位置也大致是图7和12中所示的相同位置。在某些器械中可通过滑动件28的钻孔80中的复位弹簧82的动作来获得该位置，或者在没有使用复位弹簧的器械的其它实施方式中可通过外科医生手动将杆移至该位置来获得该位置。
图2和3示出穿过手柄中的狭槽73且安装至枢销72的杆22。杆22的臂70具有圆柱形头部71，该头部71与滑动件28的近端处的凸起部75中的凹部74相匹配。滑动件28坐落在滑道84中，而且响应于杆位置和/或复位弹簧动作而向近侧和向远侧移动。滑动件28承栽可旋转筒体66，该筒体66借助于调节螺钉67等而被夹紧至推/拉缆线38。筒体66能够响应于器械轴和末端执行器的旋转而旋转。还参照图7，可看到滑动件机构的进一步细节。筒体66坐落在狭槽68中，该狭槽68在一端处向邻接狭槽78开口并在其另一端处由壁69封闭。壁69具有用作推/拉缆线38的引导件的通孔，该缆线38从筒体66的近端伸出，因而引导筒体动作本身。筒体66通过压缩弹簧76而顶靠着壁，该压缩弹簧76设置在狭槽78中。如图2中所示，杆的位置使钳口也如图4A中所示地完全打开。参照2006年9月27日提交的共同待审的序号为No.11/528,134的申请，可知杆和滑动件的操作的进一步细节。
钳口夹紧杆22还能够调节成用于左手操作和右手操作以及从图5中的角度C至图6中的角度D的范围。这借助于手柄基部处的绕轴72旋转大概180度的凸轮杆240来实现，该轴72还支撑钳口夹紧杆22。通过杆240进行的控制还可以通过达其它角度的旋转来进行。凸轮杆240基本上调节夹紧杆22相对于手柄的中心线或中心平面的姿势，中心线或中心平面在图5和6中由线或平面W表示，图5和6示出的是取决于杆240的位置的相反方向的姿势。能够基于用户是右手还是左手来进行这种调节，或者能够基于用户的手的一些其它特征比如手指长度等来进行这种调节。
凸轮杆240包括带有截顶球244的楔形垫圈242，该截顶球244形成在垫圈部的内侧倾斜表面。球和垫圈具有通孔246，该通孔246配合在轴72上，并允许杆绕轴72从相对于手柄基部的前方位置向后方位置向上或向下枢转，如图5和6中所见。球244具有在图6中以248示出匹配特征件，并且所述特征件优选地采用与凸轮盘250上的两个凸耳相匹配的两个狭槽形式。这些匹配特征件使杆240和凸轮盘250的旋转同步。凸轮盘250基本上也是带有通孔252的楔形垫圈，该通孔252允许凸轮盘250响应于凸轮杆240的旋转而绕轴72枢转。在图6中将凸轮盘250示出为在其外面上具有两个制动凹槽254，所述两个制动凹槽254与狭槽73侧面上的两个突出部(未图示)相互作用，以优选地将其保持在图5和6中所示的两个位置中的任一个中。球244坐落在杆22的钻孔256中，并允许杆22响应于凸轮杆240的旋转以及盘242和250的倾斜面的相对位置而改变角度。
钳口夹紧装置30使用棘齿及释放机构，在图12-14中示出其一组位置。棘齿机构由带有倾斜端94的板簧92示出，当挤压杆22时，该倾斜端94接合滑动件28上的齿86。图12示出了处于初始位置的机构，比如图2中所示对应于钳口打开位置的位置。图13示出了处于提升位置的夹紧杆，同时弹簧92的端部94接合滑动件28上的其中一个齿86。为了释放钳口，将杆22一直挤压至图14的位置，在该处，壁69接触闩部96，并使闩部96绕枢轴90逆时针旋转直到通过闩部面96B接合弹簧92的下侧而使得弹簧92被提起成与齿86的脱离接合。图14示出了板簧92被提起以便与棘齿86脱离接合。该动作使得滑动件28自由移动至如图14中所见的左侧直到壁79接触闩部96并使其绕枢轴90顺时针旋转直到表面96A与弹簧的下侧对准，从而允许其降落到与滑动件28的端部相接合的位置中，正好至齿86的后部，如图12中所示的位置。
弹簧92和齿86形成棘齿装置，其中在闭合末端执行器并使末端执行器的钳口绕诸如针等物件紧夹中杆22可通过若干位置被卡夹住。随着将杆22朝向手柄向内按压，板簧92的自由端部94与滑动件上的各个不同齿接合。通过各个相续的卡夹而紧夹钳口直到正被握持的物件被完全接合。为了释放致动程序，并非使用单独的释放按扭，杆22简单地移动至其最内位置，如图14所示，在该位置中闩部96接合壁79。这使闩部枢转至其提起弹簧92的位置，因而使弹簧与滑动件上的齿脱离接合，并使得滑动件因此而能够在弹簧偏置力的作用下移动至其释放位置。
本发明的锁定机构或角度锁定装置140包括球窝装置，该承窝装置基本上设置在近侧可弯曲构件上并在跟随近侧可弯曲构件处的弯曲。锁定机构具有锁定位置和解锁位置，绕近侧可移动或可弯曲构件设置并被手动控制成使得在其锁定位置中固定近侧可移动构件相对于手柄的位置。锁定机构包括球构件和限定承窝构件的可压缩毂。在所公开的实施方式中，毂是拼合毂，并且锁定机构进一步包括束带圈和锁定杆，该束带圈绕拼合毂设置，该锁定杆安装在束带圈上，用于绕毂闭合束带圈，从而使毂相对于球形球构件锁定。束带圈与毂互锁，但是当处于解锁位置时能够相对于毂旋转。
“球”部分基本上由球构件120形成，而“承窝”部分则基本上由手柄延伸部即拼合毂202形成。锁定机构将近侧可弯曲构件锁定在期望位置，并且通过这样做锁定机构也锁定了远侧可弯曲构件和工具的位置。尽管近侧弯曲构件18由球窝装置包围，但是它仍然允许器械轴14和近侧弯曲构件18连同缆线100自由旋转，同时也允许器械轴的轴线相对于手柄的轴线以自由或可替代的锁定模式倾斜。
为此参照在图5-8中进一步详细示出的球构件120。球构件120包括远端颈部206，该远端颈部206与具有球形外表面204的不完全球形球端部邻接。颈部206基本上设置在近侧可弯曲构件18的锥形部19和转接件26上，而球部主要设置在于近侧可弯曲构件18的主要部分之上。球构件120适于坐落于承窝内，该承窝以毂202形式形成在手柄中，通过径向压缩束带圈200会使该毂202绕球构件120坍缩。
球构件120以万向节方式接合在拼合毂202中，该拼合毂202包括四个扇形体202A-202D，这些扇形体202A-202D能够借助于束带圈200而被夹紧在球构件120的球形表面204上。参照图8。拼合毂202借助于三个支柱230支撑于手柄的远端，所述三个支柱230大概间隔开120度(见图11)。球构件120具有为近侧可弯曲构件18的远端提供支撑的颈部206。在这点上，在颈部206的近端与转接件26之间设置有支承表面208，如图7和8所示。这使得近侧可弯曲构件连同转接件26能够相对于球构件120自由旋转。图7和8还示出颈部206的极远端与外管32之间的支承面210。这些支承面208、210可以通过这些位置处的实际轴承来形成。
图5-8示出了束带圈200。还参照图2和3以看到束带圈200的图示。束带圈200是具有内脊部或花键201的环形构件，该内脊部或花键201适于与拼合毂202的外表面上的通道或沟槽203相匹配。通道和脊部的这种结合限制环形束带构件只能绕毂202旋转。图8还示出了拼合毂的各个部分200A-200B经由相应的支柱230连接至器械手柄(也见图11)。当束带圈200被闭合时，这进而闭合了开槽毂，并实质上将承窝(毂202)压缩在球构件120的球形表面204上。因而球构件的锁定固定了近侧可弯曲构件的位置，进而固定了远侧可弯曲构件和工具的位置。
借助于偏心锁定杆220对束带圈200进行操作，该锁定杆220分别借助于销222和224连接至束带圈200的端部200A和200B。图5示出的是处于锁定位置的锁定杆220，而图6示出的是处于释放位置或解锁位置的锁定杆。束带圈200的端部200A采用可拆卸钩子形式，当圈被锁定时，该钩子卡扣配合在销222上并坐落在杆220的狭槽226中。束带圈200的另一端200B采用两个卡板形式，所述两个卡板卡扣配合在形成在杆220的侧面上的销224上。当借助于花键201释放杆220时，束带圈200可以环绕拼合毂202自由旋转，该花键201骑坐在拼合毂202圆周的沟槽203中。这允许对器械进行左手操作或右手操作。图5示出了右手操作的设定状态，其中角度锁定杆220示出为处于锁定位置，图6示出了左手操作的设定状态，其中角度锁定杆220示出为处于解锁位置。
当锁定杆220移动至其锁定位置时，这压缩了束带圈200，从而使毂闭合在球构件120的球形外表面204。这将手柄锁定在球构件120上，从而当发生锁定时，使球构件保持在任何其所处的位置中。通过使球构件保持在固定位置，这同样地使近侧可弯曲构件保持在特定位置并固定在该位置。这进而使远侧可弯曲构件和工具维持在固定位置，但是能够经由对旋钮的控制而控制器械的方位，通过使远侧可弯曲构件和工具绕尖端轴线P旋转，该旋钮控制了器械尖端的方位(见图3)。
本发明的器械提供了一种改进的器械，尤其是站在外科医生易于使用的立场上。工具致动杆装置允许用户进行精确控制，尤其是使用具有凹入万向节的器械装置，在该万向节处用户的手指能够容易地与杆接合。这种装置还使得器械能够通过简单地在承窝中在相反位置之间旋转万向节而容易地适于进行右手控制或左手控制。同样优选的是万向节中的凹部由盲孔(带有底壁)形成，因为已经发现这样能够提供对杆定位的增强的手动控制。
对本发明的器械的另一种改进涉及能够对工具进行容易地控制，包括对旋转构件的便利安置和对锁定装置的便利安置，其中用户拇指和食指能够容易地用于控制尖端旋转和锁定。这些功能能够以单手来执行，而无需用户移动手的位置。
现在已经描述了本发明的有限数目的实施方式，对于本领域普通技术人员而言显而易见的是，可以设想属于所附权利要求书限定的本发明的范围内的众多其它实施方式和改型。例如，在本发明的另一种变型中，可以使用不同形式的器械尖端旋转装置，诸如用滑动机构来控制绕着工具尖端轴线的远端旋转。甚至采用这种可替代装置，锁定工具仍然可以与器械相关联以提供锁定功能。这里所描述的锁定装置描述为使用的是***握把式手柄，然而，这种锁定装置还可以设置于诸如2005年7月20日提交的序号为No.11/185,911的申请中所描述类型的直列式器械。同样，在这里所描述的器械中，可移动构件已经描述为可弯曲部分，而且更具体而言是描述为一体可弯曲部分。然而，可替代地，可移动构件可以是其它结构，包括但不局限于可接合盘、波纹装置、可移动圈装置或球窝构件。其它形式的可弯曲构件参照2006年5月23日提交的共同待审的序号为No.60/802,885的临时申请和2006年6月5日提交的共同待审的序号为No.60/811,046的临时申请，这两个申请以引用方式全部并入本申请。同样，在这里所描述的器械中，球窝装置具有在单独构件上的球部分，该单独构件与连接手柄的承窝相匹配。在本发明的又一种实施方式中，球窝装置包括单独的承窝构件，该承窝构件与手柄的突出球相匹配。

Claims (31)

1.一种外科器械，包括：
器械轴，其具有近端和远端；
工具，其设置于所述器械轴的远端；
控制手柄，其联接于所述器械轴的近端；
远侧运动构件，其用于将所述器械轴的远端联接至所述工具；
近侧运动构件，其用于将所述器械轴的近端联接至所述手柄；
致动装置，其在所述远侧运动构件与所述近侧运动构件之间延伸，用于将所述近侧运动构件的运动联动至所述远侧运动构件以便控制所述工具的定位；
以及锁定机构，其用于将所述工具的位置固定于选定位置并且具有锁定状态和解锁状态；
所述锁定机构包括绕所述近侧运动构件设置的球窝装置以及包括用于锁定所述球窝装置的束带构件。
2.如权利要求1所述的外科器械，进一步包括旋转装置，其设置为邻近所述控制手柄并且能够相对于所述控制手柄旋转以便导致所述器械轴和所述工具的相应旋转。
3.如权利要求2所述的外科器械，其中，至少所述近侧运动构件包括近侧可弯曲构件，所述旋转装置包括适于使所述工具绕远侧工具滚动轴线旋转的旋钮，并且所述旋钮设置在所述控制手柄与所述近侧可弯曲构件之间。
4.如权利要求1所述的外科器械，其中，所述控制手柄包括***握把式手柄，所述***握把式手柄具有接合角状件从而有助于保持所述手柄。
5.如权利要求4所述的外科器械，其中，所述旋转装置包括设置于所述手柄的远端处的旋钮，并且所述角状件设置为处于所述旋钮的近侧且位于所述***握把式手柄之上。
6.如权利要求4所述的外科器械，包括致动杆，其在所述手柄的近端的枢轴点处支撑于所述***握把式手柄。
7.如权利要求6所述的外科器械，其中，所述致动杆具有带手指环的自由端部，所述手指环用于接纳用户手指以控制所述杆。
8.如权利要求1所述的外科器械，包括工具致动缆线、滑动件和致动杆，所述工具致动缆线从所述工具延伸至所述手柄，所述滑动件用于抓持所述工具致动缆线的近端，并且所述致动杆支撑于所述手柄处以便控制所述滑动件的平移。
9.如权利要求8所述的外科器械，包括用于接纳所述滑动件的滑道、设置在所述滑动件中的一对弹簧以及设置在所述弹簧之间且用于保持所述工具致动缆线的近端的旋转筒体。
10.如权利要求1所述的外科器械，其中，所述球窝装置包括球构件，所述球构件具有与所述手柄中的凹形承窝相匹配的局部球形部。
11.如权利要求10所述的外科器械，其中，所述手柄具有所述承窝形成在其内表面上的远侧套环，并且所述束带构件包括绕所述远侧套环设置的环形束带圈。
12.如权利要求11所述的外科器械，包括位于所述束带圈与所述套环之间的凸舌和沟槽互连装置，以便允许在所述束带圈与所述套环之间进行旋转同时阻止轴向移动。
13.如权利要求12所述的外科器械，包括位于所述束带圈上的、具有相对的锁定位置和解锁位置的枢转件。
14.如权利要求11所述的外科器械，其中，所述远侧套环具有一个或多个狭槽，使得在所述束带圈锁定时所述承窝能够绕所述球构件收缩。
15.一种外科器械，包括：
器械轴，其具有近端和远端；
工具，其设置于所述器械轴的远端；
控制手柄，其设置于所述器械轴的近端；
远侧运动构件，其用于将所述器械轴的远端联接至所述工具；
近侧运动构件，其用于将所述器械轴的近端联接至所述手柄；
致动装置，其在所述远侧运动构件与所述近侧运动构件之间延伸，用于将所述近侧运动构件的运动联动至所述远侧运动构件以便控制所述工具的定位；
所述控制手柄包括***握把式手柄；
致动杆，其用于控制所述工具并枢转地支撑于所述手柄；
以及调节构件，其安装在所述杆上以便调节所述致动杆相对于所述手柄的中心平面的姿势。
16.如权利要求15所述的外科器械，其中，所述调节构件包括用于在正值与负值之间改变姿势的调节杆。
17.如权利要求16所述的外科器械，其中，所述调节构件包括斜面垫圈装置。
18.如权利要求16所述的外科器械，其中，所述调节杆支撑于与用于所述致动杆的枢转支撑件相同的枢转支撑件。
19.如权利要求15所述的外科器械，进一步包括有助于保持所述手柄的接合角状件以及设置于所述手柄的远端处的旋钮，并且所述角状件设置成处于所述旋钮的近侧且位于所述***握把式手柄之上。
20.一种医疗器械，其具有：近侧控制手柄和远侧工具，所述近侧控制手柄和所述远侧工具通过长形器械轴互相联接，所述器械轴用于穿过解剖体内部；近侧可移动构件和远侧可移动构件，所述近侧可移动构件和所述远侧可移动构件分别将所述近侧控制手柄和所述远侧工具与所述器械轴互相联接；缆线致动装置，其设置在所述可移动构件之间；所述控制手柄具有近端和远端；致动杆，其用于控制所述远侧工具；用于使所述致动杆在其一侧枢转地支撑于所述手柄的近端的装置；角状件以及用于使所述角状件在其相反侧固定地支撑于所述手柄的远端的装置。
21.如权利要求20所述的医疗器械，其中，所述缆线致动装置包括一组致动缆线，所述缆线充分硬从而各条缆线在对所述工具的控制中能够进行拉拔动作或能够进行顶推动作。
22.如权利要求21所述的外科器械，包括用于各条缆线的约束装置，以便在各条缆线在所述近侧可移动构件与所述远侧可移动构件之间延伸时大致地束缚各条缆线。
23.如权利要求20所述的医疗器械，其中，所述控制手柄包括***握把式手柄，并且所述致动杆包括安装在所述杆上的、用于调节所述致动杆相对于所述手柄的中心平面的姿势的调节构件。
24.一种医疗器械，其具有：近侧控制手柄和远侧工具，所述近侧控制手柄和所述远侧工具通过长形器械轴互相联接，所述器械轴用于穿过解剖体内部；近侧可移动构件和远侧可移动构件，所述近侧可移动构件和所述远侧可移动构件分别将所述近侧控制手柄和所述远侧工具与所述器械轴互相联接；缆线致动装置，其设置在所述可移动构件之间，用于控制所述远侧工具的定位；以及用于沿其长度方向约束所述缆线装置使其能够进行拉拔动作和顶推动作的装置。
25.如权利要求24所述的医疗器械，其中，所述缆线装置沿着其大致整个长度方向受约束。
26.如权利要求24所述的医疗器械，其中，所述约束装置包括绕所述缆线装置设置在所述器械轴中的轴填充件。
27.一种医疗器械，其具有：近侧控制手柄和远侧工具，所述近侧控制手柄和所述远侧工具通过长形器械轴互相联接，所述器械轴用于穿过解剖体内部；近侧可移动构件和远侧可移动构件，所述近侧可移动构件和所述远侧可移动构件分别将所述近侧控制手柄和所述远侧工具与所述器械轴互相联接；缆线致动装置，其设置在所述可移动构件之间，用于控制所述远侧工具的定位；以及具有锁定位置和解锁位置的锁定机构，其绕所述近侧可移动构件设置并且受到手动控制以便在其所述锁定位置中固定近侧可移动构件相对于所述手柄的位置。
28.如权利要求27所述的医疗器械，其中，所述锁定机构包括球构件以及限定承窝构件的可压缩毂。
29.如权利要求28所述的医疗器械，其中，所述毂是拼合毂，并且所述锁定机构进一步包括绕所述拼合毂设置的束带圈以及安装在所述束带圈上的、用于使所述束带圈绕所述拼合毂闭合以将所述毂锁定在所述球构件上的锁定杆。
30.如权利要求29所述的医疗器械，其中，当处于所述解锁位置时所述束带圈与所述毂互锁但是能够相对于所述毂旋转。
31.如权利要求27所述的医疗器械，包括邻近所述近侧可移动构件、用于控制所述远侧可移动构件和所述工具的方位的旋转控制构件。
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