CN103702619A - 外科手术锚定件传送*** - Google Patents

外科手术锚定件传送*** Download PDF

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CN103702619A
CN103702619A CN201280038677.3A CN201280038677A CN103702619A CN 103702619 A CN103702619 A CN 103702619A CN 201280038677 A CN201280038677 A CN 201280038677A CN 103702619 A CN103702619 A CN 103702619A
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M.E.豪斯曼
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Smith and Nephew Inc
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
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Abstract

本发明涉及一种外科手术锚定件传送***(10)，其包括传送装置(11)，该传送装置(11)具有轴(14)和柄(13)、用于沿轴(14)向远侧推进外科手术锚定件(12)的推进装置(15)；以及加载于轴(14)上的多个外科手术锚定件(12)。

Description

外科手术锚定件传送***
技术领域
本发明涉及外科手术器械，且更具体而言，涉及用于传送外科手术锚定件的外科手术器械。
背景技术
外科手术锚定件通常供有单次使用的一次性传送装置，其中各个锚定件传送***均包括预加载有单个锚定件的传送装置。通常，外科手术程序将涉及两个或多个的外科手术锚定件的使用，需要使用若干传送装置。然而，从程序角度来看，这样既效率低也昂贵，因为对于大多数锚定件传送***，大部分成本都归因于一次性传送装置而不是锚定件自身的成本。因此，成本效益更合算且程序上更有效的途径是期望的。
发明内容
在其广义上，本发明提供了一种包括传送装置的外科手术锚定件传送***，其包括传送装置，传送装置具有联接有柄的长形轴，以及用于沿轴而向远侧推进外科手术锚定件的器件；以及加载于传送装置的轴上的多个外科手术锚定件。
根据本发明的方面，提供了一种包括传送装置的外科手术锚定件传送***，该传送装置具有联接有柄的长形轴和用于沿轴而向远侧推进外科手术锚定件的推进装置；以及加载于轴上的多个外科手术锚定件。
适合的是，多个外科手术锚定件由连续地加载于长形轴上的两个、三个、四个、五个或五个以上的锚定件构成。
外科手术锚定件可为有孔的或可为无孔的。
优选地，外科手术锚定件加载有缝线。适合的是，各个外科手术锚定件均加载有两组或更多组缝线。
可选的是，外科手术锚定件通过缝线彼此相连接。该缝线可为可调整的且包括活结。
优选地，多个外科手术锚定件中的至少一个包括延伸穿过锚定件的纵向轴线的内腔。该布置允许锚定件可滑动地安装在传送装置轴上，该传送装置轴穿过锚定件内腔以便整个锚定件都安装在轴上。适合的是，所有多个外科手术锚定件都包括延伸穿过各个锚定件的纵向轴线的内腔。作为备选，多个外科手术锚定件中的一个包括闭合的远端和沿其纵向轴线部分地延伸穿过锚定件的内腔。适合的是，闭合的远端是渐缩的；优选地，渐缩至一点。在该备选实施例中，多个外科手术锚定件中的其余锚定件全部都包括延伸穿过锚定件的纵向轴线的内腔。这些锚定件可滑动地安装到传送装置轴上，而具有闭合的远端的锚定件安装在传送装置轴的远侧末端上。
优选地，至少传送装置轴的远侧区域具有非圆形的截面。适合的是，至少轴的远侧区域具有六边形截面。作为备选，轴具有大体上圆形的截面且包括在轴表面中由纵向凹槽形成的一个或多个切口区域。适合的是，纵向凹槽形成于轴的远侧区域中且沿轴长度的至少一部分向近侧延伸。这防止具有内腔且加载于传送装置上的锚定件相对于轴旋转。结果，传送装置可用于将锚定件旋转地推进到组织中。
可选的是，传送装置轴包括内腔。该内腔可为轴向的或偏离轴的纵向轴线。作为备选或此外，传送装置轴包括在其外表面中的一个或多个纵向槽口。例如，轴可包括一个、两个、三个、四个或更多的此类槽口。在以内腔和槽口为特征的实施例中，槽口或多个槽口与内腔相连接。以上特征的目的在于容许通过装置的至少一部分输送缝线，该缝线可附接于一个或多个外科手术锚定件上，且允许缝线退出柄区域。此类特征有助于防止缝线在外科手术部位中的漏针(snagging)。在下文中更详细地描述的备选实施例中，推进装置为可滑动地安装到轴上的管状部件或套筒，且缝线可穿过推进套筒与轴之间。根据该备选实施例，轴和/或套筒可包含分别在其外表面或内表面中的通道或凹槽，以容纳缝线和用以防止在轴与套筒之间的漏针。
适合的是，传送装置轴包括尖的远侧末端。适合的是，尖的远侧末端为锋利的或钝的。适合的是，远侧末端包括螺纹区域。该末端可用于在可旋转地直接将锚定件驱动或敲打到骨中之前制备较小的导孔。
适合的是，推进装置为安装在传送装置轴上的管状部件或套筒。适合的是，推进装置安装在加载于装置轴上的最近侧外科手术锚定件的近侧上且其远端抵靠加载于装置轴上的最近侧外科手术锚定件。适合的是，推进装置包括用于向远侧推进管状部件或套管的器件。适合的是，推进装置包括可旋转地安装在轴上的把手(knob)。适合的是，管状部件或套筒包括螺纹近侧区域而把手包括用于接合螺纹近侧区域的器件。作为备选，管状部件或套管在其近端处或在其近侧区域处联接到适配器上，而适配器包括可与把手的螺纹近侧区域接合的螺纹部分。此类布置提供了当把手沿第一方向旋转时，管状部件或套筒相对于轴而向远侧推进。可选的是，把手可沿相对于第一方向的第二方向旋转，以相对于轴而向近侧缩回管状部件或套筒。
作为备选，管状部件或套筒联接到销或凸片上。销或凸片可与使得管状部件或套筒能够有预先限定的远侧推进量的分度器(indexer)联接。例如，传送装置轴可包括用于收纳与套筒相联接的且可相对于套筒移动的销或凸片的一个或多个定位槽(detent)或孔口。销或凸片可移动以与定位槽或孔口接合或脱离。推进装置还可包括用于控制套筒相对于轴的移动的柄或把手；或把手可形成有销或凸片，以使销或凸片与定位槽或孔口接合/脱离，以及还相对于轴推进套筒。还备选的是，管状部件或套筒包括在其壁中的一系列孔口，该壁至少部分地沿其长度延伸，且传送装置轴包括用于与一个或多个孔口接合的一个或多个弹簧销。例如，一个或多个弹簧销中的每一个都沿径向向外偏压且与套筒的孔口接合。为了推进套筒，偏压的销被压缩以使其与孔口脱离，套筒向远侧移动，且一旦套筒已经推进到其中销可接合套筒壁中的另一个孔口的位置，就除去销上的压缩力。推进装置还可包括用于向远侧推进管状部件或套管的棘齿(rachet)机构。
在使用中，管状部件或套筒抵靠多个外科手术锚定件的最近侧的近端。当已经部署了最远侧锚定件时，管状部件或套筒向远侧移动以推进加载于传送装置轴上的其余的锚定件或多个锚定件到其中最远侧锚定件处于传送装置轴的远端且准备用于部署的位置。该过程可重复直到所有锚定件都已经部署好。
还备选的是，推进装置为可在形成于传送装置轴内的纵向通道内移动的杆。适合的是，杆包括从纵向通道突出的径向延伸的销。适合的是，销抵靠多个外科手术锚定件的最近侧的近端，且用于在已经部署了最远侧外科手术锚定件之后向远侧推进保持在传送装置轴上的任何外科手术锚定件。适合的是，推进装置包括可旋转地安装在轴上的把手。适合的是，杆包括螺纹近侧区域，而把手包括用于接合螺纹近侧区域的器件。此类布置提供了当把手沿第一方向旋转时，杆相对于轴而向远侧推进。杆可由任何其它适合的机构移动以推进外科手术锚定件，该任何其它适合的机构包括上文关于套筒所描述的那些。
优选地，柄包括一个或多个缝线夹(cleat)。
附图说明
现在将参考以下附图描述本发明的以上方面及其它方面，在附图中：
图1为根据本发明的第一实施例的外科手术锚定件传送***的侧视图；
图2为图1的实施例的远侧区域的近视局部侧视图；
图3为沿图2的线A-A的截面视图；
图4为图1的实施例的远侧区域的近视局部透视图，其中已经部署了第一外科手术锚定件；
图5为图4的实施例的近视局部透视图，其中已经向远侧推进了第二锚定件；
图6A-C为在部署了第一外科手术锚定件之前和之后的图1的实施例的侧视图和截面侧视图；
图7A和B为根据本发明的第二实施例的传送***轴的远侧末端的近视局部视图；
图8A和B为根据本发明的第三实施例的传送***轴的远侧末端的近视局部视图；
图9为根据本发明的第四实施例的传送***的远侧区域的近视局部视图；
图10为根据本发明的第五实施例的传送***的远侧区域的近视局部视图；
图11A-C为根据本发明的第六实施例的传送***的侧视图和截面视图；以及
图12A-C为图10的传送***的侧视图和截面视图，其中已经部署了第一外科手术锚定件且已经向远端推进了第二外科手术锚定件。
具体实施方式
参看图1，示出了由传送装置11和具有缝线锚定件12的形式的两个或多个外科手术锚定件形成的外科手术锚定件传送***10。该传送装置11包括具有从其延伸的轴14的近端柄13，连续地安装在轴14的远端处的两个缝线锚定件12，以及用于向远侧推进锚定件的机构15。
机构15由套筒20和驱动器21形成。套筒20可滑动地安装在轴14上且具有抵靠最近侧的外科手术锚定件的远端。驱动器21形成有柄13，且可旋转地安装在轴14上，而在使用中可促动以向远侧推进套筒20，一旦已经部署了最远侧的锚定件，就将最近侧的锚定件移动到适合于部署的位置中。下文将参看图4至图6更详细地描述该过程。
在图1中，以及在示出本发明的其它附图中，描绘了连续的锚定件之间的间隙。这完全是出于示例性目的，以表示多个锚定件的存在。实际上，锚定件抵靠彼此，如在图2的近视图中所示，这防止最远侧锚定件在其部署期间往回向近侧滑动。
所示出的实施例大体上描绘为包括两个外科手术锚定件。然而，***可预加载有三个、四个、五个或五个以上的外科手术锚定件。
在图2中，更详细地示出了传送装置的远端。这里，两个缝线锚定件12a、12b可滑动地安装且连续地布置在轴14上。在图1至图8中示出的实施例中，锚定件具有螺旋形本体22，该螺旋形本体22包括在螺旋形本体的匝24之间的孔口23。孔口23通过允许细胞和含营养物的流体流过锚定件来容许组织生长。锚定件还包括螺旋形本体22围绕其设置的两个支承柱25(图3)。支承柱45提供了锚定件的结构刚性和完整性，这允许锚定件的旋转部署。
如图3(沿图2的线A-A的视图)中可见的，轴14具有非圆形的截面。这防止锚定件在部署期间旋转。在示出的实施例中，轴具有大体上圆形的截面且包括由沿其长度的至少一部分在其外表面中的纵向凹槽引起的相对的切口区域，其容纳了锚定件的支承柱25。在未示出的备选实施例中，轴具有多边形的截面。例如，至少轴的远侧区域具有三角形、正方形或六边形的截面。如以上所提到地，轴的非圆形的截面对防止锚定件在其部署期间旋转来说很重要。虽然将认识到的是，仅锚定件位于其上的轴的远侧区域需要非圆形截面来实现预定目的，但整个轴也可具有非圆形的截面。
各个缝线锚定件12加载有双倍的缝线30，该缝线30从组件的远端行进到***近端处的柄。柄还包括用于固定自由的缝线端部的缝线夹32。在未示出的备选实施例中，缝线锚定件加载有单根缝线、三根、四根或更多的缝线。例如，如图所示，缝线可暴露，或可穿过传送***的至少一部分、穿过内腔或轴中的槽口，或穿过轴与套筒之间。
现参看图4至图6，在使用中，使用传送装置来将传送***的最远侧锚定件12a可旋转地直接驱动到骨中或驱动到预先钻取的导孔或骨道31中。如在图4中所示，第一锚定件12a已部署到骨中(锚定件12a从视图中隐藏)。然后移除传送装置(图4)，且通过旋转驱动器21来向远侧推进套筒20。在该过程期间，套筒20抵靠锚定件12b的近端，且在其向远侧移动时，推动锚定件12b到轴14的端部以准备用于其随后的部署(图5)。
图6B和图6C提供了在最远侧锚定件12a的部署，以及随后最近侧锚定件12b向远侧推进到准备用于其部署的位置之前和之后的沿图6A的线B-B的传送***的截面侧视图。
轴14固定在柄13的近侧区域内。如图所示，驱动件21包括内毂18和外毂19，两个毂都与轴14同轴地安装。套筒20的近侧部分20'经由内毂18联接到外毂19上。内毂18包括远侧部分18a、近侧部分18b，以及插管18c。内毂近侧部分18b包括在其外表面上的螺纹18b'。内毂18位于外毂19的腔19a中。腔19a包括远侧部分19a'和近侧部分19a''。近侧部分19a''包括接合内毂18的近侧部分外表面上的螺纹18b'的螺纹19b。由于在螺纹18b'与螺纹19b之间的螺纹接合，驱动件21的旋转以及因此外毂19的旋转引起套筒20沿轴14的长度轴向地移动。外毂19的旋转在最远侧锚定件(之前的最远侧锚定件部署之后)定位在轴的远端上以准备用于部署时，或当内毂远侧部分18a的端部18a'接合腔远侧部分19a'的端部19c时停止。当最近侧锚定件已经推进且定位在轴的远端上以准备用于部署时，满足了该最后的条件。
现参看图7A和图7B，示出了具有改变的渐缩远侧末端14'的轴14，该远侧末端14'包括具有与所示出的锚定件12b'相同的螺纹形式的螺旋螺纹14''。该特征旨在帮助锚定件在不需要预先钻取的导孔或具有最小孔的准备的情况下直接***骨中。
图8a和图8b示出了备选的轴末端设计，其中该末端为尖的。尖的末端可为锋利的或可为钝的。
在图9中，示出了具有备选的非有孔的螺旋螺纹锚定件33的传送***的远侧区域，其中在匝24'之间不存在孔口。
图10中示出了另一个备选的传送***的远侧区域。根据该实施例，锚定件为敲入型，其中锚定件通过锤击或敲打传送装置的柄的近端来推进到骨中，而不是像之前描述的实施例那样旋转地驱动到骨中。根据这些实施例，锚定件包括径向的翅片、翼或肋条。
现参看图11和图12，示出了具有备选的推进机构的传送装置。该传送装置包括具有从其延伸的轴41的近侧柄13'，连续地安装在轴41的远端处的两个缝线锚定件12a',12b'，以及用于向远侧推进锚定件的机构。根据该实施例，且如沿截面C-C和D-D所示，轴41固定在柄13'的近侧区域内。传送装置包括可滑动地安装在轴41上，且在近侧部分40'处通过连接销36与轴孔口37的接合来联接到轴41上的套筒40。如在图11A-11C中所示，在最远侧缝线锚定件12a'的部署之前，套筒40通过连接销36与轴孔口37的接合而相对于轴41固定在第一位置中。在最远侧缝线锚定件12a'***修复部位时，连接销36暂时地与轴孔口37和轴41脱离，且套筒40通过推动把手35来轴向地换位(index)，把手35安装在套筒40上，使得锚定件12b'移动到轴41的远端。如图12A-图12C中所示，一旦锚定件12b'已正确地定位在轴的远端处，就通过连接销36与第二轴孔口38的接合来相对于轴41固定套筒40的位置。
所描述的传送***优选为无菌的、单次使用的传送装置，该传送装置具有加载于单个传动轴上的多个缝线锚定件。传送***旨在用于外科手术锚定件，该外科手术锚定件允许驱动器直接地穿过它们。最远侧锚定件可由包括部分插管和实心末端的锚定件替代。在示出的实施例中，缝线附接于各个锚定件的近端上。在未示出的备选实施例中，缝线附接于其近侧区域中的锚定件上，或附接在锚定件的远端与近端之间的任何位置。一旦已经部署了最远侧锚定件且下一个最远侧锚定件已经推进到传送装置轴的端部，则近侧锚定件就可使用所描述的旋转机构或借助于可向远侧推进和锁定的所描述的分度器推进到传送装置的轴的末端。推动机构可包括棘齿机构，和/或适合的杆和具有适合的接合销的槽口机构。
锚定件组件的构件，以及传送装置的柄和毂可由聚合材料和由注入模制工艺形成。然而，可使用其它材料和工艺。虽然可使用其它联接工艺，但柄和毂可经由干涉配合来联接。轴的构件可经由挤压或拉制工艺由金属材料制成，且可经由螺纹配合或过盈配合联接到柄和毂上。还可使用其它适合的材料和联接方法。
除锚定件的近端上的套筒轴承外，锚定件可由其它分度机构推进到轴下方。
在构造上，除了近侧缝线附接外，缝线槽口还附加到锚定件的外部以容纳缝线。
本发明允许由单个传送装置部署多个锚定件，由于这些种类的装置较小的性质，故不需要再加载，再加载在外科手术台中将是十分困难的。这可能随着对外科手术场打开以及引入外科手术场的无菌植入物的数目减少而减少了程序时间。此外，该***通过减少一次性器械和包装的数量来减少每次程序产生的浪费量，从而支持绿色举措和对可持续的关注。

Claims (19)

1. 一种外科手术锚定件传送***，包括传送装置，所述传送装置包括轴和柄，以及用于沿所述轴而向远侧推进外科手术锚定件的推进装置；以及加载于所述轴上的多个外科手术锚定件。
2. 根据权利要求1所述的传送***，其特征在于，所述多个外科手术锚定件中的至少一个包括延伸穿过所述锚定件的纵向轴线的内腔。
3. 根据权利要求2所述的传送***，其特征在于，所述多个外科手术锚定件中的一个包括闭合的远端和延伸穿过所述锚定件的纵向轴线的一部分的内腔。
4. 根据权利要求1所述的传送***，其特征在于，所述传送装置轴的远侧区域包括非圆形截面。
5. 根据权利要求1所述的传送***，其特征在于，所述传送装置轴包括内腔。
6. 根据权利要求1所述的传送***，其特征在于，所述传送装置轴包括在其外表面中的一个或多个纵向槽口或凹槽。
7. 根据权利要求1所述的传送***，其特征在于，所述传送装置轴包括尖的远侧末端。
8. 根据权利要求1至7中的任一项所述的传送***，其特征在于，所述推进装置包括在所述最近侧外科手术锚定件的近侧上可滑动地安装在所述传送装置轴上的管状部件或套筒，且还包括用于向远侧推进所述管状部件或套筒的器件。
9. 根据权利要求8所述的传送***，其特征在于，用于推进的所述器件包括可旋转地安装在所述轴上的把手。
10. 根据权利要求9所述的传送***，其特征在于，所述管状部件或所述套筒包括螺纹近侧区域，而所述把手包括用于接合所述螺纹近侧区域的器件。
11. 根据权利要求8所述的传送***，其特征在于，所述管状部件或套筒联接到销或凸片上。
12. 根据权利要求11所述的传送***，其特征在于，所述销或所述凸片与分度器相联接，所述分度器使所述管状部件或套筒可相对于所述轴有预先限定的远侧推进量。
13. 根据权利要求1所述的传送***，其特征在于，所述推进装置包括用于向远侧推进所述管状部件或所述套筒的棘齿机构。
14. 根据权利要求1所述的传送***，其特征在于，所述推进装置包括杆，所述杆可在形成于所述传送装置轴内的纵向通道内移动。
15. 根据权利要求14所述的传送***，其特征在于，所述杆包括从所述纵向通道突出的径向延伸的销。
16. 根据权利要求1所述的传送***，其特征在于，所述柄包括一个或多个缝线夹。
17. 根据权利要求1所述的传送***，其特征在于，所述多个外科手术锚定件包括2个、3个、4个、5个或更多的锚定件。
18. 根据权利要求17所述的传送***，其特征在于，所述外科手术锚定件加载有缝线；优选为两组或更多组的缝线。
19. 根据权利要求17或18所述的传送***，其特征在于，所述外科手术锚定件通过包括活结的可调整的缝线连接到彼此。
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WO2012170662A3 (en) 2013-07-18
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