CN102098969B - 外科装置 - Google Patents
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
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Abstract
本发明涉及一种外科装置,其包括具有外部构件和可滑动地接收在外部构件内的内部构件的轴;联接到轴的手柄;以及用于向内部构件提供运动并且联接到内部构件的机构。还公开了一种修复组织的方法。
Description
相关申请的交叉引用
本申请是PCT国际专利申请,其要求于2008年7月17日提交的美国专利申请No. 61/081,462的优先权,该文献以引用的方式全文结合到本文中。
技术领域
本发明涉及用于修复组织的外科装置。
背景技术
关节镜手术通常需要将软组织再附连到骨上。为了实现该目的,锚定器被植入骨中,附连到锚定器的缝线穿过组织以将组织牢固地固定到位。当进行软组织到骨的修复时,有利的是尽可能在骨和组织之间具有大的接触面积。彼此成排地间隔开的锚定器点导致在修复中具有更大的接触面积。需要这样的手术和用于这种手术的装置,其使用在大接触面积上的多个附连点来将组织牢固地附连到骨上。
发明内容
本发明涉及一种外科装置,其包括具有外部构件和可滑动地接收在外部构件内的内部构件的轴;连接到轴的手柄;以及用于向内部构件提供运动并且联接到内部构件的机构。在一个实施例中,外科装置还包括联接到该装置的锚定器组件,其中所述锚定器组件包括限定腔的锚定器以及容纳在腔中的***构件。在另一实施例中,外部构件包括配置成接合锚定器的远端部分,内部构件包括配置成接合***构件的远端部分。在又一实施例中,外科装置还包括联接到轴的缝线穿线器,其中所述穿线器包括夹子和联接到夹子的缝线环。在另一实施例中,缝线环设置在延伸穿过锚定器的横向通孔内。
在另一实施例中,用于向内部构件提供运动的机构包括:具有远端和近端的插管本体;插塞,所述插塞包括配置成接合本体近端的顶部部分和联接到顶部部分的底部部分;第一部分,所述第一部分设置在插塞的底部部分上;第二部分,所述第二部分设置在插塞的底部部分上;和弹簧,所述弹簧位于第一部分和第二部分之间。在又一实施例中,本体的近端包括齿轮。在一个实施例中,第一部分包括齿轮,所述齿轮配置成与本体的近端的齿轮啮合。在另一实施例中,外部构件比内部构件短。
在另一方面,本发明涉及一种修复组织的方法,包括:将第一锚定器***到骨中,第一锚定器具有联接到其上的柔性构件;将柔性构件的端部穿过组织;提供外科装置,所述外科装置包括具有外部构件和可滑动地接收在外部构件内的内部构件的轴、联接到轴的手柄、用于向内部构件提供运动并且联接到内部构件上的机构、以及联接到轴的锚定器组件,所述锚定器组件包括限定腔和横向通孔的锚定器以及容纳在腔内的***构件;将柔性构件的至少一端穿过锚定器组件的通孔;将锚定器组件植入到骨中;将***构件朝向柔性构件的至少一端推进,以将柔性构件紧固到通孔中以及将组织紧固到骨上。
在一个实施例中,该方法还包括在推进***构件之前张紧柔性构件。在另一实施例中,推进***构件包括旋转用于向内部构件提供运动的机构。该机构包括:具有远端和近端的插管本体;插塞,所述插塞包括配置成接合本体近端的顶部部分和联接到顶部部分的底部部分;第一部分,所述第一部分设置在插塞的底部部分上;第二部分,所述第二部分设置在插塞的底部部分上;和弹簧,所述弹簧位于第一部分和第二部分之间。在又一实施例中,本体的近端包括齿轮。在另一实施例中,第一部分包括齿轮,所述齿轮配置成与本体的近端的齿轮啮合,其中,旋转该机构以推进***构件,直到第一部分的齿轮和近端的齿轮不再直接啮合为止。
在一个实施例中,该方法还包括提供外科装置,所述外科装置包括具有外部构件和可滑动地接收在外部构件内的内部构件的轴、联接到轴的手柄、用于向内部构件提供运动并且联接到内部构件上的机构,其中,外部构件比内部构件短;将外科装置放置成接合锚定器组件,使得内部构件接合***构件,外部构件接合锚定器;将***构件远离柔性构件的所述至少一端移动;张紧柔性构件;以及将***构件往回朝向柔性构件推进,以再紧固柔性构件。
在又一实施例中,朝向柔性构件推进***构件包括旋转用于向内部构件提供运动的机构。所述机构包括:具有远端和近端的插管本体;插塞,所述插塞包括配置成接合本体近端的顶部部分和联接到顶部部分的底部部分;第一部分,所述第一部分设置在插塞的底部部分上;第二部分,所述第二部分设置在插塞的底部部分上;和弹簧,所述弹簧位于第一部分和第二部分之间。在另一实施例中,本体的近端包括齿轮。在又一实施例中,第一部分包括齿轮,所述齿轮配置成与本体的近端的齿轮啮合,其中,旋转该机构以推进***构件,直到第一部分的齿轮和近端的齿轮不再直接啮合为止。
本发明进一步的应用领域将从下文提供的详细说明变得显而易见。应当理解的是,详细说明和具体示例虽然示出了本发明的优选实施例,但是它们仅旨在描述目的且不旨在限制本发明的范围。
附图说明
被包括在说明书中并形成说明书一部分的附图描述了本发明的实施例,并且连同书面说明书一起用于解释本发明的原理、特性和特征,在附图中:
图1示出了本发明的第一外科装置的透视图。
图2示出了图1的外科装置的另一透视图。
图3示出了图1的外壳装置的手柄的截面图。
图4示出了用于向图1的外科装置的内部构件提供运动的机构的截面图。
图5示出了用于向图4的内部构件提供运动的机构的分解图。
图6示出了用于向图4的内部构件提供运动的机构的另一分解图。
图7示出了图1的外科装置的内部构件和外部构件的远端部分的透视图。
图8示出了本发明的锚定器组件的透视图。
图9示出了本发明的锚定器组件的另一透视图。
图10示出了本发明的锚定器组件的俯视图。
图11示出了本发明的第二外科装置的透视图。
图12示出了图11的第二外科装置的截面图。
图13示出了图11的第二外科装置的另一透视图。
图14示出了用于向图11的第二外科装置的内部构件提供运动的手柄和机构的透视图。
图15A-15D示出了本发明的第一外科装置在修复组织中的使用。
具体实施方式
优选实施例的下述描述本质上仅为示例性的,并且决不旨在限制本发明、其应用或使用。
图1-3示出了本发明的第一外科装置10的透视图。装置10包括具有外部构件11a和内部构件11b的轴11,内部构件11b可滑动地接收在外部构件11a内。手柄12联接至轴11,该手柄具有本体12a和位于本体12a外表面12d上的凸起部12c,该本体12a带有延伸穿过其的沟槽12b。如图4-6更清楚地示出的以及如下文更完整解释的,用于向内部构件提供运动的机构13容纳在手柄12上的开口12e内,并且联接到内部构件11b的近端部分11b’。
锚定器组件14也联接到轴11,尤其是外部构件11a和内部构件11b的远端部分11a’’和11b’’(图7),其在图8-10中更清楚地示出以及在下文被更完整地解释。外部构件11a的远端部分11a’’包括第一激光标记11e(将在下文描述其目的)以及用于容纳缝线的至少两个凹穴(divet)11d,其将在下文被更完整地描述。第二激光标记11e延伸外部构件11a的部分长度。至少两个叉部11a’’’从远端部分11a’’纵向延伸并且配置成接合锚定器组件14的锚定器,其将在下文被进一步地描述。凹穴11d大约180°分隔开并且与位于锚定器组件14上的沟槽对齐,其将在下文被进一步地描述。内部构件11b的远端部分11b’’还包括配置成接合锚定器组件14的***构件的至少两个叉部11b’’’,其将在下文被进一步地描述。
缝线穿线器15也可释放地联接到轴11。穿线器15包括夹子15a和联接到夹子15a上的缝线环15b。缝线环15b设置在锚定器组件14的横向通孔内并且在手术期间使用,以将来自于另一锚定器的缝线端部缝制到通孔中,其将在下文被进一步地描述。
如图3-6更清楚地示出的,机构13包括具有远端13a’和近端13a’’的本体13a,其中远端13a’容纳在手柄12的开口12e内。机构13还包括具有顶部部分13b’、中间部分13b’’和底部部分13b’’’的内腔13b。顶部部分13b’和中间部分13b’’位于近端13a’’中,而底部部分13b’’’位于近端13a’’与远端13a’之间。中间部分13b’’包括齿轮13c。机构13还包括具有顶端13d’和底端13d’’的插塞13d。顶端13d’容纳在腔13b的顶部部分13b’内,底端13d’’在中间部分13b’’与底部部分13b’’’之间延伸。底部部分13d’’包括用于容纳内部构件11的近端部分11b的通道13h,并且配置成接合第一部分13e和第二部分13f,其将在下文被进一步地描述。
第一部分13e设置在插塞13d的底端13d’’上并且包括齿轮13c’,该齿轮配置成啮合位于中间部分13b’’上的齿轮13c,其将在下文被进一步地描述。第二部分13f也设置在插塞13d的底端13d’’上并且包括沟槽13f’,该沟槽配置用于接收位于第一部分13e和第二部分13f之间的弹簧13g。弹簧13g允许将力应用到第一部分13e上,藉此提供齿轮13e’和13c的啮合。
图8-10示出了本发明的锚定器组件14。锚定器组件14包括限定腔16a的锚定器16和容纳在腔16a内的***构件17。锚定器16包括近端部分16b和远端部分16c。近端部分16b包括用于容纳在外部构件11a上的叉部11a’’’的至少两个沟槽16b’。***构件17包括配置成接合内部构件11b的叉部11b’’’的头部17a。此外,锚定器16包括横向通孔16d以及从通孔16d的开口16d’、16d’’延伸至锚定器16的近端部分16b的槽16e,其目的将在下文描述。锚定器组件的其它特征在美国专利申请公布No. 2009112270中描述并示出,该文献以引用的方式全文结合到本文中。
图11-14示出了本发明的第二外科装置20。类似于第一外科装置10,装置20包括具有外部构件21a和内部构件21b的轴21,该内部构件可滑动地接收在外部构件21a内。手柄22连接到轴21,用于向内部构件21b提供运动的机构23(类似于机构13)联接到内部构件21b的近端部分21b’。外部构件21a短于内部构件21b,使得外部构件21a的远端部分21a’’终止于内部构件21b的远端部分21b’’附近,如在图11和12中更清楚地示出的。外部构件21a的叉部24、凹穴25和激光标记26都与第一外科装置10的外部构件11a的叉部11b、凹穴11d和激光标记11e相同。类似地,内部构件21b的叉部27与装置10的内部构件11b的叉部11b’’’相同。此外,机构23与装置10的机构13相同。
在手术期间,第一外科装置10用于将锚定器组件14植入到骨中。图15A-15C示出了第一外科装置10在回旋肌腱群的关节镜修复期间的使用。图15A示出了已经被***到骨40(例如,肱骨)的侧面部分中的第一锚定器30。具有联接到其上的柔性构件50(例如,缝线)的锚定器30被***到骨40中;诸如回旋肌腱群肌腱的软组织60被放置到骨40上,邻近于锚定器30布置;以及柔性构件50的至少一个端部51放置成穿过软组织60。
接下来,柔性构件50的至少一个端部51穿过环15b(如图15A所示);通过拉动环15b将其穿线通过横向通孔16d;以及经由使用夹子15a使得柔性构件50穿过横向通孔16d,如图15B所示。在柔性构件50穿过通孔16d之后,缝线穿线器15被丢弃。随后,锚定器组件14被***到骨40的中间部分中的先前钻好的孔41,如图15C所示,使得柔性构件50被容纳在横向通孔16d中并且端部51从孔41延伸出。通过敲击机构13,锚定器组件14以轴向定向的方式推进到孔41中。如上所述,第一和第二激光标记11c、11e用于锚定器16进入孔41中的正确定向和深度。也就是说,锚定器16放置在孔41内,使得第一激光标记11c与骨40的表面齐平,第二激光标记11e允许锚定器16在放置在骨40中时正确视觉定向。
在将锚定器组件14放置在孔41中之后,柔性构件50的端部51可被拉动以在柔性构件50和软组织60上提供优选量的张力。该柔性构件50上的张力可在图15D看出,尤其是将该图与图15C比较时。***构件17随后经由内部构件11b以旋转方式推进,以将柔性构件50紧固到通孔16d中并且将组织60紧固到骨40。为了清楚起见,在图15C和15D未示出***构件17。锚定器组件14位于内部构件11a和外部构件11b的远端部分11a’’和11b’’上,使得槽16e与凹穴11d对齐,藉此允许柔性构件50滑动并因而基本减少构件50被捕获在远端部分11a’’与孔41之间。
通过旋转机构13,旋转内部构件11a。通过机构13的初始旋转,齿轮13c、13c’彼此完全啮合。然而,一旦***构件17接合柔性构件50并且柔性构件50被紧固到通孔16d中,机构13的进一步旋转将导致第一部分13e朝向第二部分13f的向下运动,藉此使得齿轮13e’掉落出与内腔13b的齿轮13c的完全啮合。机构13的进一步旋转将导致内腔13b的齿轮13c在第一部分13e的齿轮13e’上滑动,藉此不允许***构件17的进一步旋转。机构13不仅用于向内部构件提供运动,而且也用于限制应用到***构件17上的扭矩的量。
在放置锚定器组件14之后,第二外科装置20可用于使得柔性构件50再张紧。装置20被***到锚定器组件14中,使得位于内部构件21b的远端部分21b’’上的叉部27接合***构件17上的头部17a。然后手柄22用于朝向锚定器组件14滑动外部构件21a(如在图13和14中更清楚地示出的),并且将叉部24***到锚定器16的沟槽16b’中。一旦内部构件21b和外部构件21a被***到锚定器组件14中,机构23旋转以将***构件17与柔性构件50分离。然后,柔性构件50再张紧且机构23随后旋转以推进***构件17并且将柔性构件50再紧固到通孔16d中,如上所述。第一外科装置10可用于再张紧柔性构件50而不是第二外科装置20。
第一和第二外科装置10、20的轴11、21包括不锈钢材料,但是可由生物兼容的并且足够强韧以承受在手术期间设置在轴11、21上的力的任何其它金属或非金属材料制成。轴11、21可机加工、模拉并随后机加工、或通过本领域技术人员已知的任何其它方法制成。轴11、21经由压配合工艺联接到手柄12、22和旋转机构13、23。然而,将手柄12、22和旋转机构13、23联接到轴11、21的其它方法也在本发明的范围内。手柄12、22和旋转机构13、23采用非金属材料,但是可使用金属材料制成,并且均通过注模成型工艺制成。然而,其它制造方法也在本发明的范围内。
夹子15a由非金属材料制成并且注模成型。然而,包括金属材料的其它材料以及工艺均在本发明的范围内。通过将环15b的第一端穿过夹子15a中的孔并接着将该端扎到环15b的第二端,缝线环15b被联接到夹子15a,如图2所示。将缝线环15b联接到夹子15a的其它方法也在本发明的范围内。此外,将来自于先前放置的锚定器的缝线端部穿线穿过横向通孔16d的其它装置和方法也在本发明的范围内。
弹簧13g采用金属材料,但是可采用非金属材料。此外,还可使用提供阻力的其它机构,而不是弹簧13g。凹穴11d经由机加工工艺或用于制造标记(例如,轴11、21上的凹穴11d)的本领域技术人员已知的其它工艺来制造。
由于在不偏离本发明的范围的前提下可对如上关于相应附图描述的示例性实施例进行各种修改,因此本发明旨在应将包含在前述说明以及在附图中示出的所有内容解释为描述性而不是限制性的。因而,本发明的广泛性和范围不应受任何上述示例性实施例限制,而是仅应当根据所附下述权利要求书及其等同物限定。
Claims (8)
1.一种外科装置,包括:
轴,其包括外部构件和可滑动地接收在外部构件内的内部构件;
联接到轴的手柄;和
用于向内部构件提供运动并且联接到内部构件的机构;
其中,用于向内部构件提供运动的机构包括:
具有远端和近端的插管本体;
插塞,所述插塞包括配置成接合插管本体近端的顶部部分和联接到顶部部分的底部部分;
第一部分,所述第一部分设置在插塞的底部部分上;
第二部分,所述第二部分设置在插塞的底部部分上;和
弹簧,所述弹簧位于第一部分和第二部分之间。
2.根据权利要求1所述的外科装置,还包括联接到该装置的锚定器组件,所述锚定器组件包括限定腔的锚定器以及容纳在腔中的***构件。
3.根据权利要求2所述的外科装置,其中,外部构件包括配置成接合锚定器的远端部分,内部构件包括配置成接合***构件的远端部分。
4.根据权利要求1所述的外科装置,还包括联接到轴的缝线穿线器,所述穿线器包括夹子和联接到夹子的缝线环。
5.根据权利要求4所述的外科装置,其中,缝线环设置在延伸穿过锚定器的横向通孔内。
6.根据权利要求1所述的外科装置,其中,插管本体的近端包括齿轮。
7.根据权利要求6所述的外科装置,其中,第一部分包括齿轮,所述齿轮配置成与插管本体的近端的齿轮啮合。
8.根据权利要求1所述的外科装置,其中,外部构件比内部构件短。
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-
2009
- 2009-07-15 CN CN2009801278581A patent/CN102098969B/zh active Active
- 2009-07-15 AU AU2009270960A patent/AU2009270960B2/en not_active Ceased
- 2009-07-15 EP EP09790428A patent/EP2303143A1/en not_active Withdrawn
- 2009-07-15 JP JP2011518863A patent/JP5698130B2/ja active Active
- 2009-07-15 WO PCT/US2009/050620 patent/WO2010009184A1/en active Application Filing
- 2009-07-15 US US12/503,180 patent/US8974494B2/en active Active
- 2009-07-15 CN CN201310240147.3A patent/CN103381098B/zh not_active Expired - Fee Related
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2015
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- 2015-02-10 JP JP2015023946A patent/JP5996686B2/ja not_active Expired - Fee Related
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US20170020514A1 (en) | 2017-01-26 |
US20150150551A1 (en) | 2015-06-04 |
JP5698130B2 (ja) | 2015-04-08 |
AU2009270960B2 (en) | 2015-09-03 |
JP2015128607A (ja) | 2015-07-16 |
WO2010009184A1 (en) | 2010-01-21 |
CN102098969A (zh) | 2011-06-15 |
US9486205B2 (en) | 2016-11-08 |
US8974494B2 (en) | 2015-03-10 |
AU2009270960A1 (en) | 2010-01-21 |
JP2011528270A (ja) | 2011-11-17 |
CN103381098B (zh) | 2016-08-10 |
EP2303143A1 (en) | 2011-04-06 |
CN103381098A (zh) | 2013-11-06 |
US20100016869A1 (en) | 2010-01-21 |
JP5996686B2 (ja) | 2016-09-21 |
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