CN1754516A - 具有含有止退机构的多冲程发射的手术钉合器械 - Google Patents
具有含有止退机构的多冲程发射的手术钉合器械 Download PDFInfo
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Abstract
一种特别适用于内窥镜手术过程的手术钉合和切割器械,包括一个产生分离的闭合和发射运动以致动端部操纵装置的手柄。具体地,该手柄产生多个发射冲程以减少发射(如钉合和切割)端部操纵装置所需要的作用力的量。链节传递降低了所需手柄的纵向长度,并且当为发射而伸直时,达到刚性,坚固结构。一种牵拉偏压发射机构避免了驱动这种直线状链齿与止退机构相配合时的约束,利用一个锁定机构防止在发射过程中释放闭合扳机。而且,外部指示器向外科医生反馈发射进行的程度,并提供手动缩回能力。
Description
相互参照的有关申请
本申请涉及与此相同日期提交的四个共同未决的属于同一申请人的申请,每份申请的内容全部引入在此作为参考,这四个申请的名称分别为:
“具有带开口锁定的多冲程发射的手术钉合器械”,序列号---,FrederickE.Shelton,Jeffrey S.Swayze,Douglas B.Hoffman;
“含有具有链节齿条传递的发射机构的手术钉合器械”,序列号---,JeffreyS.Swayze,Frederick E.Shelton□;
“具有带牵拉-偏压齿合机构的多冲程发射的手术钉合器械”,序列号---,Jeffrey S.Swayze,Frederick E.Shelton□;和
“含有多冲程发射位置指示器和回拉机构的手术钉合器械”,序列号---,Jeffrey S.Swayze,Frederick E.Shelton□。
技术领域:
本发明总体上涉及手术钉合器械,能够将订线施加到组织并同时切割这些订线之间的组织,尤其是,涉及对钉合器械的改进,通过扳机的多冲程完成发射,以及对形成此类钉合器械的各种部件的方法改进。
背景技术:
内窥镜手术器械通常优于常规的开腔手术设备,因为较小的切口容易减少术后的康复时间和手术的复杂性。因此,内窥镜手术器械已经发生了巨大的进步,适应于通过套管针的套管在需要的手术位置精确放置远端部操纵装置。这些远端部操纵装置以多种方式咬合组织以达到诊断和治疗的效果(例如,内切器,抓取器,切割器,钉合器,夹式灌肠器,探查装置,药物/基因治疗传递装置,及利用超声、红外、激光的能量装置等)。
已知的手术钉合器包括一个可同时在组织上造成纵向切割并在切口的相对侧施加钉线的端部操纵装置。端部操纵装置包括一对协同工作的夹钳构件,若将器械用于内窥镜或腹腔镜时,夹钳构件能够穿过套管通道。其中一个夹钳构件容纳一个钉盒,钉盒中至少有两排从横向隔开的钉子。另一个夹钳构件限定了一个砧板,砧板上具有与钉盒中钉排对准的钉状凹槽。器械包括多个往复式楔状物,当从远端驱动时,该楔状物穿过钉盒的开口并使驱动器支撑钉合器以向砧板产生订钉发射。
适用于内窥镜的手术钉合器的一个实例如美国专利US5,465,895所述,它可以方便地提供明显的闭合与发射动作。因此,医生能够闭合组织上的夹钳以在发射前定位组织。一旦医生确定夹钳构件已经完全夹住组织,那么医生就可以通过单一的发射冲程发射手术钉合器,从而切割和钉合组织。切割和钉合的同时进行避免了用不同的切割或钉合手术器械完成此类动作而产生的复杂性。
能在发射前闭合组织的一个特有的优点是,医生能够通过内窥镜核实已经到达所需要的切割位置,包括在相对的夹钳间已经夹住了足够多的组织。否则,可能是相对的夹钳拉得太近了,尤其是用其远端捏夹时,因而不能在所切割的组织上有效地形成闭合的钉。另一个极端是,夹住过多量的组织可能引起约束和不完全发射。
通常,一个闭合冲程后跟随一个发射冲程是一种方便有效的执行切割和钉合的方式。但是,在某些情况下,需要多冲程发射。例如,外科医生能够根据需要的切割长度从夹钳尺寸范围内选择相应的钉盒长度。较长的钉盒需要较长的发射冲程。因此,需要一个产生发射的手挤压扳机,与较短的钉盒相比,对较长的钉盒施加较大的力以便切割更多的组织并驱动较多的钉子。对于较短的钉盒希望减少作用力,以不超出某些外科医生手的力量。此外,某些不熟悉较大钉盒的外科医生会关心当需要所不期望的较大作用力时钉盒会发生约束或其他的故障。
降低一个发射冲程所需作用力的一种方法是允许发射扳机多次被冲动的棘齿机构,如美国专利US5,762,256和6,330,965所描述的。这些已知的具有多冲程发射机构的手术钉合器械没有单独闭合和发射动作的优点。此外,棘齿机构依靠带齿的齿条和驱动棘爪以完成棘齿运动,因此,可以通过增加环绕这些部件的手柄长度来配合带齿的齿条。给定闭合范围时,要增加长度不方便,而且会增加手术所用的器械数量。
此外,在多冲程发射机构的每一个冲程之间,都应尽量避免任何无意的缩回。例如,端部操纵装置中组织承受的压力,倾向在冲程之间推后发射***。另外,在有些时候,发射机构包括一种缩回偏压,倾向在冲程之间拖后发射***,减弱了器械的有效性,例如使钉变形,发射冲程数目增多或全然不能完成整个发射过程。
因此,迫切需要一种具有多冲程发射机构的手术钉合器械,其避免在发射冲程之间发射机构的无意缩回。
发明内容
本发明克服了上文所述及其它现有技术的不足,提供一种手术钉合器械,明显避免了即使当发射机构在多冲程之间解偶时,如当发射扳机释放时,在发射期间发射元件的返回。这样,可以使用于进行外科手术的手术器械,其可能由于这种返回冲程而发射失误,更有效和可靠。
本发明的一个方面是,一种外科手术器械具有响应从轴上的发射元件接收的在未发射位置和完全发射位置之间的纵向发射动作的端部操纵装置,来进行外科手术。一个止退机构通过具有带环绕在发射元件周围的锁孔的锁盘在发射期间防止发射元件的返回。锁盘响应锁定装置在锁定位置和解锁位置之间枢轴转动,该锁定装置又响应处于发射过程的手术器械。一缩回机构使锁盘解锁,这样,可以避免会导致发射元件无意返回的阻力。
本发明的另一个方面是,一种外科手术器械具有通过轴连接到手柄的端部操纵装置。在手柄里,一个齿条在远侧偶联到发射元件。一个发射控制部件响应操作者沿发射方向和返回方向移动。一个发射机构,响应发射方向将发射控制部件偶联到齿条以传递发射动作,并响应返回方向使发射控制部件从齿条解偶。该发射控制部件与锁定机构协同工作,该锁定机构响应在初始、未发射位置和已发射位置间移动的发射元件,阻止发射元件沿返回方向运动。这种方法的特殊优点在于在多冲程发射步骤,其中发射元件可在多冲程之间释放。本发明的这些和其它目的和优点在以下的附图和附图说明中将会变得更明显。
附图说明
合并到本说明书中并作为说明书的一部分的附图描述了本发明实施例,并且与上述本发明的概述以及下面的详细描述,一起用于解释说明本发明的原理。
图1是手术钉合/切割器打开(开始)状态的右侧视图,其中轴部分切去以露出闭合管和发射杆。
图2为图1中手术钉合器远侧部分处的端部操纵装置的沿线2-2处的左侧视图。
图3为图2中端部操纵装置的前透视图。
图4为图1中手术钉合/切割器执行部分的分解透视图。
图5描述了图1中手术器械的图3中端部操纵装置截面的左侧视图,该截面通常沿图3的线5-5截取以露出钉盒部分,同时也描绘了沿纵向中心线的发射杆。
图6描述了发射杆完全射出后的图5的端部操纵装置截面的左侧视图。
图7为图1中手术钉合/切割器手柄的左侧视图,其中左侧手柄罩已去除。
图8为图7中手柄的分解透视图。
图9为图7中手柄的链节传动发射机构的从正、后左侧的有利位置得到的透视图。
图10为图9中发射机构的链节齿条的详细左侧视图。
图11-14为链节齿条的斜坡中央轨道和发射机构的棘爪沿纵轴的截面左侧视图,另外显示了发射扳机,偏压轮和牵拉偏压机构的斜坡,描述发射动作期间的一个顺序。
图15为部分分解的右侧视图,露出图1中手术钉合和切割器锁定状态下的止退机构的远端部分。
图16为图15中止退机构去除止退凸轮管后的从顶、后、右侧有利位置得到的透视图。
图17为部分分解的右侧视图,露出图1中手术钉合和切割器在解锁状态下止退机构的远端部分。
图18为部分分解的右侧视图,露出图1中手术钉合和切割器在解锁状态下止退机构的远端部分。
图19是图1中手术钉合和切割器的后视图,将手柄外壳的右半部去除后,露出锁定状态和解锁状态下用虚线表示的止退释放杆。
图20-25为图18中止退释放杆详图,分别描绘了未发射,一个发射冲程,两个发射冲程,三个发射冲程,返回或者释放按下的按钮及完全返回的发射顺序。
图26-27为手术钉合和切割器从顶、左、远侧有利位置得到的透视图,将手柄外壳的右半部去除后,露出闭合释放锁定机构,分别处于去除锁定和压下闭合释放按钮时的初始位置,然后在初始发射期间致动锁定。
图28类似图1为手术钉合和切割器处于开口状态的透视图,但装有顶部可接近的缩回杆。
图29为图28中手术钉合和切割器的左侧视图,手柄左半外壳已去除,露出间断排列的带齿指示齿轮,其对于惰轮呈现第一停顿区。
图30为图28中手术钉合和切割器的左侧视图,手柄左半外壳已去除,露出间隔排列的带齿指示器齿轮,其对于惰轮呈现第二停顿区。
具体实施方式
再回到附图,在所有的几个视图中,同样的附图标记表示同样的部件,图1和2描述了能够实现本发明独有优势的手术钉合和切割器械10。手术钉合和切割器械10包括具有砧板14的端部操纵装置12,砧板14枢轴连接到细长通道16,形成用于夹住待切割和钉合的组织的相对夹钳。端部操纵装置12通过轴18偶联到手柄20。由端部操纵装置12和轴18形成的执行部分22具有较佳尺寸,适于通过套管针或者小的腹腔镜开口***,在由外科医生抓紧控制手柄20控制时,进行内窥镜外科手术。手柄20有利地包括以下特点,它允许端部操纵装置12的闭合冲程与发射冲程分开,以及在向外科医生指示发射程度的同时,能够执行多个发射冲程以产生端部操纵装置12的发射(即切割和钉合)。
在这些端部,轴18的闭合管24偶联于闭合扳机26和砧板14间使端部操纵装置12闭合。在闭合管24内,框架28偶联于细长通道16和手柄20间以沿纵向定位和支撑端部操纵装置12。旋钮30与框架28偶联,两个元件均相对于轴18的纵轴旋转运动而旋转偶联到手柄20上。因此,外科医生可通过调节旋钮30来旋转端部操纵装置12。闭合管24也可通过旋钮30旋转,但要保持对该处的一定的纵向运动以闭合端部操纵装置12。在框架28中,安置了用于纵向运动并偶联到末端操纵装置12的砧板14和多冲程发射扳机34之间的发射杆32。闭合扳机26在手柄20的***式握把36的远侧,而发射扳机34在***式握把36和闭合扳机26两者的远侧。
在内窥镜手术中,一旦执行部分22***病人体内接近手术位置时,外科医生参照内窥镜或其他诊断用成像器具在砧板14和细长通道16间定位组织。外科医生握住闭合扳机26和***式握把36可反复抓取和定位组织。一旦对相对端部操纵装置12的组织位置及组织数量满意,外科医生将闭合扳机26完全压向***式握把36,夹住端部操纵装置12中的组织,并锁定闭合扳机26于此夹闭(关闭)位置。若对此位置不满意,外科医生可以通过压下闭台释放按钮38以释放闭合扳机26,此后重复夹住组织的步骤。
若夹闭操作正确,外科医生可以着手发射手术钉合和切割器10。具体地说,外科医生抓紧发射扳机34和***式握把36,以预定的次数压下发射扳机34。所需发射动作的数目根据手掌的最大尺寸,每个发射动作期间传递给器械的最大力,以及在发射过程中需要通过发射杆32传递给端部操纵装置12的纵向距离和力从人类工程学的角度加以确定。正如下面讨论中将要提到的,每个外科医生可以选择在不同的运动角度范围内轮转操作发射扳机34,因而增加或减少发射冲程的数目,而手柄20仍然可以无束缚地进行发射。
在这些冲程期间,外科医生可以参照一个指示器,该指示器表现为指示缩回旋钮40,其响应多发射冲程定位地转动。另外,缩回旋钮的位置可以确保当发射扳机34进一步轮转遇到阻力时,已达到完全发射。应该知道,手柄20上可以增加各种标记和说明以提高指示缩回旋钮40的指示效果。在发射杆32的全程运动中和当发射扳机34释放时,手柄20自动缩回发射杆32。可选择地,外科医生根据指示缩回旋钮40了解到器械10尚未完全发射,可以压下止退释放按钮42并释放发射扳机34。所有这些动作使手柄20自动缩回发射杆32。
要注意的是,这里使用的术语“近侧”和“远侧”是参考临床医生紧握仪器手柄的状态。因此,端部操纵装置20相对于更近的手柄20为远侧。更要注意的是为了方便和清晰,这里使用的空间术语如”垂直“和“水平”是相对于附图而言。但是,外科手术器械可用于多个方向和位置,这些术语不是限制和绝对的。
本发明是根据内窥镜操作过程和装置而讨论的。但是,这里使用的术语如“内窥镜”不应将本发明局限于只与内窥镜管(即,套管)相连使用的手术钉合和切割器。相反,可以相信,本发明可以用于任何得到小切口的手术过程,包括但不局限于腹腔镜手术以及开腔手术。
E-形梁端部操纵装置
通过带有一个如图2-6所示的端部操纵装置12,手柄20能够提供多冲程发射运动的优点已应用于多个仪器。由于包括一个连到砧板近端52的砧板面50(图2,4,6),末端操纵装置12首先响应来自手柄20(图2-6中未示出)的闭合运动,砧板近端52包括一对位于垂直伸出的砧板部件56(图4)远侧的横向伸出砧板旋转销54。砧板旋转销54在细长通道16上的肾形开口(kidneyshape)58内平移以相对于细长通道16打开和关闭砧板14。砧板部件56与在闭合管24的远端62上的突片孔60中向内伸出的弯片59啮合,后者在远侧终止于推抵砧板面50的远侧边缘64。因此,当闭合管24从其打开位置向近侧移动时,闭合管24的弯片59向近侧拉动砧板部件56,砧板旋转销54顺着通道16的肾形开口58使砧板14同时向近侧平移并向上旋转至打开位置。当闭合管24向远侧移动时,突片孔60从砧板部件56上释放,远侧边缘64推到砧板面50上,闭合砧板14。
继续参考图4,执行部分22还包括响应发射杆32发射动作的部件。具体说,发射杆32与具有纵向凹槽68的发射槽行件66啮合。发射槽行件66在框架28内纵向移动以直接响应发射杆32的纵向运动。在闭合管24上的纵向槽70可操作地与旋钮30(未在图2-6上示出)偶联。在闭合管24上的纵向槽70的长度足够使相对旋钮30的纵向运动分别完成发射和闭合运动。
框架槽形件66的远端附着在与框架28一起移动的发射杆76的近端,其中包括的一个导轨78,将E形梁80向远侧伸进端部操纵装置12。端部操纵装置12包括一个由E形梁80致动的钉盒82。钉盒82有一个保持钉盒体86、楔橇驱动器88、钉驱动器90和钉92的托盘84。可以看出楔橇驱动器88可在位于钉盒托盘84和钉盒体86间的凹槽94内纵向移动。楔橇驱动器88呈有接触并向上抬起钉驱动器90的凸轮表面,从钉孔96处向上驱动钉92与砧板14的钉成形槽98相接触,产生如图6中100所示的“B”形钉。具体参考图3,钉盒体86又包括一个用于E形梁通过的近侧张开的垂直槽102。切割面104沿E形梁80的远端设置以在钉合组织后切割组织。
分别在图2,5,6中,端部操纵装置12按打开(即,开始)状态,夹闭和未发射状态,及完全发射状态的顺序示出。特别示出了利于端部操纵装置12发射的E形梁80的特征。在图2中,楔橇驱动器88处于最近侧位置,指示一个未发射的钉盒82。中间销106对准进入钉盒82内的发射凹槽94中,用于向远侧驱动楔橇驱动器88。E形梁80的底销或帽108沿细长通道16的底面滑动,从而中间销和底销106,108与细长通道16滑动地接合。在图2中的打开和未发射状态中,E形梁80的顶销110已进入并停在砧板14的砧板套112内,因此不会妨碍砧板14的反复打开和关闭。
在图5中,端部操纵装置12显示为夹闭和准备发射状态。E形梁80的顶销110与砧板14的砧板槽114对准,在砧板套112的远侧并与其相通。在图6中,E形梁80已经完全发射,上方销110沿砧板槽114下移,确保当切割面104切割被夹组织时隔开砧板14与细长通道16。同时,中间销106已经如前所述致动了钉盒82。此后,E形梁80在端部操纵装置12打开之前缩回并替换钉盒82执行附加操作。
端部操纵装置12在五个共同未决的属于同一申请人的美国专利申请中进行了更为详细的描述,每个申请的内容全部引用在此作为参考:(1)“具有用于防止发射的单一锁定机构的手术钉合器械”,序列号10/441,424,FrederickE.Shelton,Mike Setser,Bruce Weisenburg,2003年6月20日提交;(2)“具有明显分离的闭合和发射***的手术钉合器械”,序列号10/441/632,FrederickE.Shelton,Mike Setser,Brian J.Hemmelgarn,2003年6月20日提交;(3)“具有用完钉盒锁定的手术钉合器械”,序列号10/441,565,Frederick E.Shelton,Mike Setser,BruceWeisenburg,2003年6月20日提交;(4)“具有用于未闭合砧板的发射锁定的手术钉合器械”,序列号10/441,580,Frederick E.Shelton,Mike Setser,BruceWeisenburg,2003年6月20日提交;(5)“含有E型梁发射机构的手术钉合器械”,序列号10/443,617,Frederick E.Shelton,Mike Setser,Bruce Weisenburg,2003年6月20日提交。
应该注意到,虽然这里举例说明的是非铰接轴18,但是本发明的申请可包括可铰转的器械,如五个共同未决的属于同一申请人的美国专利申请中所描述的,每个申请的内容全部引用在此作为参考:(1)“含有可绕纵轴旋转的铰接机构的手术钉合器械”,序列号10/615,973,Frederick E.Shelton,BrianJ.Hemmelgarn,Jeff Swayze,Kenneth S.Wales,2003年7月9日提交;(2)“含有用于发射杆轨迹的铰接关节的手术钉合器械”,序列号10/615,962,,BrianJ.Hemmelgarn,2003年7月9日提交;(3)“带有横向移动铰接控制装置的手术器械”,序列号10/615972,JeffSwayze,2003年7月9日提交;(4)“含有用于增加铰接关节周围灵活性的锥形发射杆的手术钉合器械”,序列号10/615,974,Frederick E.Shelton,Mike Setser,Bruce Weisenburg,2003年7月9日提交;(5)具有用于支撑发射杆的铰接关节支撑盘的手术钉合器械”,序列号10/615,971,Jeff Swayze,Joseph Charles Hueil,2003年7月9日提交。
更应注意到,链节齿条200通过至少部分伸入执行部分22的轴18中并环绕拐角,进而伸到手柄的***式握把36内,还可以提高手柄20设计的紧凑性。此外,根据发明的链节齿条可进而移向端部操纵装置12以包括一个铰接机构,而不是向发射杆32传递发射力。因而,链节间的枢轴连接可提高器械铰接的能力。
多冲程发射手柄
在图7-8中,更详细显示了手术钉合和切割器械10的手柄20,举例说明了提供诸如提高强度,减小手柄尺寸,最小化约束等特性的链节传递发射机构150。
通过朝手柄20的***式握把36方向按压闭合扳机26导致端部操纵装置12(图7-8中未示出)的闭合。闭合扳机26绕闭合扳机销152枢轴旋转,该闭合扳机销152偶联到由左右半外壳156,158组成的手柄外壳154上的,带动闭合扳机26的上部160向前移动。闭合管24通过闭合轭162接受该闭合运动,闭合轭162分别通过闭合轭销166和闭合链节销168钉到闭合链节164和闭合扳机26上部160上。
在图7的完全打开位置,闭合扳机26的上部160在所示的位置接触并支持旋转闭合释放按钮38的锁臂172。当闭合扳机26达到完全压下位置时,闭合扳机26释放锁臂172并且邻接面170与旋转锁臂172的远侧右向槽口171接合,保持闭合扳机26于此夹闭或闭合位置。锁臂172的近端绕横向枢轴连接装置174旋转,外壳154上露出闭合释放按钮38。闭合释放按钮38的中间、远侧边178由压缩在外壳结构182和闭合释放按钮38之间的压缩弹簧180从近侧推动。结果是闭合释放按钮38沿逆时针(从左边看去)推动锁臂172到锁定接触闭合扳机26的邻接面170,其当链节传递发射***150处于未缩回状态时,防止闭合扳机26未夹闭,如下面详述。
随着缩回的闭合扳机26完全压下,发射扳机34解除锁定并可以朝***式握把36方向多压下,以产生端部操纵装置12的发射。如所述,链节传递发射机构150开始时被缩回,在手柄20的***式握把36内的拉伸/压缩弹簧组184的推动下保持在此位置,其非移动端186连接到外壳154,移动端188连接到一个钢带192的向下弯曲的近侧缩回端190。
钢带192的远侧设置端194附着到用于结构加载的链节偶合器195和形成链节齿条200的多个链节196a-196d中的前链节196a上。链节齿条200是可弯曲的,但具有形成直线形刚性齿条组件的远侧链节,该刚性齿条组件可以通过执行部分22中的发射杆32传递较大的发射力,还稳妥地缩回入***式握把36以使手柄20的纵向长度最小化。
应该意识到,双拉伸/压缩弹簧184增大了有效的发射行程却基本上可将最小长度降低了单个弹簧的一半。
发射扳机34绕连接到外壳154上的发射扳机销202旋转。当发射扳机34压向***式握把36时,发射扳机34的上部204绕发射扳机销202向远侧移动,拉伸一个近侧安放的发射板机拉伸弹簧206,此弹簧在近侧连接在发射扳机34的上部204和外壳154之间。在每一次发射扳机被牵拉偏压机构210压下时,发射扳机34的上部204接合于链节齿条200,而发射扳机34释放时,则可以脱离开。当释放和脱离牵拉偏压机构210时,发射扳机拉伸弹簧206从远侧推动发射扳机34。
当发射机构150致动时,惰轮220通过与链节齿条220的带齿上表面222啮合而逆时针(从左侧看)转动。这种转动偶联到指示器齿轮230,它因此响应惰轮220而顺时针转动。惰轮220和指示器齿轮230都可旋转地连接到外壳154上。链节齿条220,惰轮220和指示器齿轮230间的传动关系可从优选择使得带齿上表面222具有强度合适的齿的尺寸,并且在发射机构150的全程发射运动期间,指示器齿轮230转动不大于一周。
如下面所详细描述的,指示器齿轮230至少执行四种功能。首先,当链节齿条200被完全缩回,且扳机26,34都如图7所示打开,指示器齿轮230左侧上的圆形***部242上的开口240朝向锁臂172的上表面244。锁臂172通过与闭合扳机26接触偏压入开口240,闭合扳机26又被闭合拉伸弹簧246推到打开位置。闭合扳机拉伸弹簧246从近端连到闭合扳机26和手柄外壳154的上部160,因此在闭合扳机26的闭合过程中储存能量,从远端推动闭合扳机26到其未闭合位置。
指示器齿轮230的第二种功能是它连接到从外面安装在手柄20上的指示缩回旋钮40。因此,指示器齿轮230将发射机构150的相对位置传递给指示缩回旋钮40,使得外科医生可以看到需要多少个发射扳机34的动作来完成发射。
指示器齿轮230的第三种功能是在操作手术钉合和切割器械10时,沿纵向并有角度地移动止退机构250的止退释放杆248。在发射动作期间,由指示器齿轮230产生的止退释放杆248的近端移动致动单向离合机构或止退机构250(图15-16),允许发射杆32的远端移动并防止发射杆32的近端移动。这种运动也使来自外壳154近端的止退释放按钮42延伸,当需要在发射动作期间缩回发射机构时,用于操作者致动该止退释放按钮42。发射动作完成后,随着发射机构150缩回,指示器齿轮230反向旋转。这种反向旋转使止退机构250不活动,将止退释放按钮42收回入手柄20,并侧向转动止退释放杆248(图19)以允许指示器齿轮230连续反向旋转。
指示器齿轮230的第四种功能是接受来自指示缩回旋钮40(图7中顺时针画出)的手动旋转以缩回发射机构150,而止退机构250处于解锁状态,因此克服了发射机构150上的任何束缚,而此束缚不易被拉伸/压缩弹簧组合184所克服。发射机构150部分发射后,可采用手动缩回,否则会因为按下止退释放按钮42,横向移动止退释放杆248而受到止退机构250的阻碍。
止退机构250由操作者可触及到的止退释放杆248组成,其近端可操作地偶联到止退释放杆42,其远端连到止退轭256。具体说,止退释放杆248的远端254通过止退轭销258连接到止退轭256上。止退轭256纵向移动向被外壳154纵向束缚的止退凸轮槽管252传递旋转运动,从远端包绕发射杆32将其连接到链节齿条200的前链节196a。止退轭256通过一个凸轮槽管销260将来自止退释放杆248的纵向运动传递到止退凸轮槽管252。也就是说,在止退凸轮槽管252中沿成角度的槽的凸轮槽管销260的纵向运动转动槽管252。
陷入框架28近端和止退凸轮槽管252之间的分别是止退压缩弹簧264,止退盘266和止退凸轮管268。如所述,发射杆32的远端移动引起止退盘266由顶部旋转到后部,增加了与发射杆32的摩擦接触,其阻止发射杆32的向近侧移动。
当止退凸轮槽管252与止退凸轮管268隔离时,这种止退盘266的旋转方式类似于保持屏风门打开的屏风门锁。尤其是,止退压缩弹簧264能够作用在盘266的顶面以将盘266顶到其锁定位置。止退凸轮槽管252的旋转引起止退凸轮管268远侧凸轮的移动,从远侧在盘266的顶部施力,克服了来自止退压缩弹簧264的作用力,因此将止退盘266置于允许发射杆32的向近侧缩回的解锁位置。
特别参考图8-10,示出了由棘爪270组成的牵拉偏压机构210,棘爪270有一个向远端突出的窄尖272和一个在其近端向右侧突出的侧销274,它可转动地插过发射扳机34上部204的孔276。在发射扳机34的右侧,侧销274承纳一个偏压构件,图中示出为偏压轮278。随着发射扳机34前后平移,偏压轮278横过邻近手柄外壳154的右半壳156的弧形,在其行程的远侧部分,越过一个整体形成于右半壳156上的偏压斜面280。偏压轮278可以优选地由弹性摩擦材料形成,其引起棘爪270的侧销274逆时针旋转(当从左侧面看时),因此,将向远侧突出的窄尖272向下牵拉偏压入最近链节196a-d的斜坡中央轨道282以与链节齿条200接合。当发射扳机34被释放,偏压轮278就会反向牵拉偏压棘爪270,从链节齿条200的斜坡中央轨道282处抬高窄尖272。为确保在高负载状态下和棘爪270在接近最远行程时,窄尖272的脱离,窄尖272向上倾斜到闭合轭162上的近侧和面向上的倾斜表面284上,以使窄尖272从斜坡中央轨道282处脱离。若发射扳机34在除完全闭合外的任意点处释放,就采用偏压轮278从斜坡中央轨道282上抬起窄尖272。尽管所示出的是偏压轮278,应该注意到偏压构件或偏压轮278的形状是示范性的,其可以变化为适合利用摩擦力或牵拉力接合或脱离端部操纵装置发射的各种形状。
链节齿条
特别参考图10,详细描绘了链节齿条200的若干优点。每个链节196a-d的都销连到相邻链节196a-d上以向下、近侧旋转入***式握把36。虽然链节齿条200可在此方向弯曲,但是当对抗柱体纵向负载尤其是推动远侧链节196a-d向上弯曲的负载时,链节齿条200形成刚性结构。特别是,每个链节196a-d在近侧终止于一个下部有横向通孔的凸性延伸300。每个链节196a-d的左侧边304包括带齿上表面222,而右侧306与左侧边304平行,二者之间形成终止于凸性延伸300的斜坡中央轨道282。
中央轨道282的近侧部分终止于右侧边和左侧边304,306前方,形成用于接纳来自导向链节196a-d的凸性延伸300的U形夹308,其由旋转销310铰链连接。每个导向链节196a-d在近端具有平坦部分312,其通常垂直于来自发射杆32的柱体纵向负载方向。每一个拖动链节196a-d在远端具有接触面314,其通常也垂直于柱体纵向负载方向。横向通孔302留出足够的间隔以在相邻平坦部分312的下部和接触面314间形成槽口316,为相对于导向链节196a-d的拖动链节196a-d向下旋转提供间隙。但是,当导向和拖动链节196a-d纵向排列时,相邻平面312的上部和接触平面314配准对接,从而阻止进一步向上偏斜。如所示,当相邻链节196a-d处于水平位置时,孔302和销310位于发射杆32的作用线下方。当向发射扳机34加载时,牵拉偏压机构210沿作用线施推力,同时将连续的水平链节196a-d偏压在一起。因此,使发射力的作用线在旋转销310之上方传递,保持使任何导向链节196a-d处于刚性直线结构。拖动链节196a-d的斜坡中央轨道282引导棘爪270的远侧突出窄尖272与导向链节196a-c的凸性延伸300相接合。
前链节196a在远侧附着于连接偶合器195,其包括偶联到发射杆32的近端的部件以及包括类似于链节196a-d的凸性延伸300和平坦部分312,具有足够的空间以容纳钢带192的远侧安置端194的突片320、322(图8),突片320、322附着在将前链节196a连接到链节偶合器195上的同一旋转销310上。通过沿发射杆32纵轴和链节齿条200的直线部分施力,缩回力在该力上的施加有利于降低摩擦力。
与斜坡中央轨道282不同的是左侧边304上具有带齿上表面222可很好地允许棘爪270和链节齿条200之间的无约束强啮合,即使发射扳机34已经在不同的运动范围内被触动。同时,带齿上表面222与惰轮220发生连续啮合,保证了上述优越性。
应该注意到,虽然已经优选描述了链节196a-d间钉住的U形夹连接,但还可以使用弹性或柔性连接。此外,虽然描述了四种链节196a-d,还可根据发射轨迹,曲率半径等选择不同的链节数目和长度。
牵拉-偏压机构
在图11-14中,按顺序描述链节传递发射机构150,说明牵拉偏压机构210(即,棘爪270,偏压轮278,以及偏压斜坡280)如何确保响应发射扳机34的运动方向。此外,因为偏压轮278与偏压斜坡280间形成摩擦接触,当完成棘爪270的完全脱离或接合运动时,偏压轮278发生滑动。
在图11中,发射扳机已被部分压下到使牵拉偏压机构210开始致动发射扳机34向链节齿条200运动的位置。具体地,偏压轮278已经接触偏压斜坡280的近端,并随后开始逆时针旋转,当从左侧看去时,将这种旋转传递给初始时与链节齿条200脱离的棘爪270。在图12中,发射机构150已经前进一段距离足以使棘爪270完全旋转到与第一链节196a的斜坡中央轨道282接合,对接链节偶合器195并因而传递发射运动到发射杆32。在图13中,发射扳机34和整个发射机构150已经运行到接近全程的位置,在该运动过程中,偏压轮278已经沿偏压斜坡280滑动。在发射动作结束时,棘爪270的底边远侧(图8)与闭合轭162的近侧朝上的斜面284接触,并使从链节196啮合的棘爪270抬起,使得链节齿条200缩回。
在图14中,发射扳机34已经被充分释放,使偏压轮278在偏压斜坡280上从近侧受到牵拉,产生从左侧看去呈顺时针的转动,并抬高棘爪270。由于具有从近侧引导的链节齿条200的斜坡中央轨道282的斜面,发射机构150在向近侧移动以准备另一个发射动作或缩回周期时不会受阻。
应该意识到,牵拉偏压机构210可以在完成至少一个动作的器械中实施。
止退机构
如上所述,止退机构250在发射动作过程中锁定以阻止发射杆32以及发射机构150缩回,直到完成全发射行程或由用户选择缩回时。在图15中,画出了处于锁定状态的止退机构250。止退释放杆248处于最近侧位置并旋转止退凸轮槽管252与止退凸轮管268接合形成最小的纵向长度,为锁盘266产生增加的空间。锁盘266倾斜到止退压缩弹簧264所示的一个角度,并夹在发射杆32上,如图16所示。
在图16中,框架28的近端400包括容纳套在其远侧圆环404上的止退压缩弹簧264的半部绕线部分402。在弹簧264的近侧,框架28具有一个顶部和与框架28内部相通的近侧开口槽406。止退盘266通常为扁平盘形状以配合在与弹簧264相邻的开口槽406中。中央孔408延伸穿过盘266。具体说,从开口槽406中露出的止退盘266的顶部向上突出以接受来自弹簧264的作用力。止退盘266的下部受纵向束缚不与弹簧264接触。因此,除非受到止退凸轮管268的束缚,止退盘266的顶部向尖端近侧推动,引起止退盘266的中央孔408约束住发射杆32。
在图17中,止退机构250绘制成解锁状态。止锁释放杆248已经横移到右侧,向止退轭256的右侧传递运动,因此传递止退凸轮槽管252的顺时针旋转,当从近侧位置看去时。止退凸轮槽管252的凸轮面410与止退凸轮管268上的近端切口412分离,迫使后者向远侧移动抵住止退盘266,止退盘266又移向一个垂直解锁位置并进而压缩止退压缩弹簧264。
在图18中,描绘了发射扳机34已经发射两次后,止退释放杆248和指示器齿轮230右侧边之间的相互作用。杆开口420延伸穿过止退释放杆248以接受并与从指示器齿轮230右侧向外延伸的弯曲斜面434相互作用。指示器齿轮的230旋转从远侧驱动止退释放杆248,其将止退释放按钮42按到底进入按钮座422并使止退机构250脱离,如所示,从近侧露出止退释放按钮42,并使止退释放杆248向右侧以致动止退机构250。止退轭256允许这种用止退轭销258(未显示)纵向槽连接的运动。止退释放杆248的这些移动是由环绕指示器销432周长近四分之一的弯曲斜面430引起的,指示器齿轮230绕指示器销432转动。弯曲斜面430沿顺时针的绝大部分(当从右侧看去)或峰部434伸到远离指示器齿轮230表面的最右端。弯曲斜面430沿逆时针的绝大部分或入口436因此与指示器齿轮230的表面相平齐。
在图18-25中,杆开口420与水平槽440一起成形,限定了止退释放杆248可获得的近侧和远侧移动,指示器销432留在此水平槽440内。顶部凹口442和底部凹口444垂直加宽并与水平槽440连通,并限定弯曲斜面430沿顺时针的大部分434在哪一角度位置纵向平移止退释放杆248。顶部和底部凹口442、444的尺寸使弯曲斜面430在无需倾斜止退释放杆248的情况下进入各凹口442、444,直至正常的发射完成。杆开口420在止退机构250纵轴的上方,因此向右的力生成止退凸轮槽管252的旋转力。
在图20中,显示了止退释放杆248和指示器齿轮230的初始状态,并在闭合扳机26被致动的过程中保持此状态。具体说,止退释放杆248位于远侧,使止退释放按钮42降低到其按钮座422中。弯曲斜面430位于其逆时针的极限位置,其峰部434在大约6点钟位置,远侧相邻于杆凹口420下部凹口444的近侧垂直面,斜坡430的入口436在3点钟位置。
在图21中,发射扳机34的第一个发射动作已经发生,其中顶峰434已经作用在底部凹口444的近侧垂直面上,并且弯曲斜面430已经顺时针旋转到大约9点钟的位置。因此,止退释放杆248已经向近侧平移,露出按钮钮座422中的止退释放按钮42并致动止退机构250。选定指示器齿轮230的顺时针旋转速率与所需要的完全发射动作次数间的关系,使得在进行后续发射动作时弯曲斜面430一直不受阻,如图22所示,其中已经完成了两个发射动作将最高点移到近似12点钟的位置。因此,顶峰434接近并邻接上部凹口442的远侧垂直边缘,该位置使得后续发射动作将作用在止退释放杆248上以引起远侧水平移动。注意在这些发射动作工作间,弯曲斜面430保持在指示器销432的近侧。压下释放按钮42会造成杆开口420的近侧边缘骑到弯曲斜面430上,如图19所示,倾斜止退释放杆248。
在图23中,最后发射动作结束,其间峰部434已经移到接近3点钟处,此时移动水平槽440的近端向上移动抵住指示器销432,降低止退释放按钮42,释放止退机构250并初始化链节传递发射机构150的缩回。
在图24中,解锁状态的止退机构250使链节齿条200弹簧动力式缩回发生,这又导致当从右侧看去进指示器齿轮230的逆时针旋转。当发射机构150开始缩回时,指示器齿轮230的逆时针旋转使弯曲斜面430的成角度的表面滑动到与顶部凹口442的近侧边缘成斜面接触。指示器齿轮230的继续旋转驱动释放杆248上部下方的弯曲斜面430并倾斜或偏转杆248到图19所示的位置。由弯曲斜面430提供的止退释放杆248的倾斜运动可以在链节齿条200的缩回过程中防止杆248的纵向运动。如果止退机构250在发射动作步骤结束自动解锁后,链节齿条200未在最后一个动作结束时缩回,则转动指示器旋钮40(图20-25中未画出)会产生额外的力以缩回链节齿条200。更应该注意到,在发射机构150部分发射过程中,如图22所示,按下按钮42也会通过从远侧移动释放杆248以解锁止退机构250来缩回链节齿条200。缩回运动持续到指示器齿轮回到其初始位置,如图25所示。
应该注意到,杆开口420的形状及弧形斜坡430的弓形尺寸是作为例证的,可以改变以适应于不同发射动作数目的手柄构造。
应该注意到,由指示器齿轮230和杆开口420相互作用形成的旋转释放机构可以被其它联结方式取代。此外,止退盘266和发射杆32中的一个或二者可以优选地包括表面处理(例如,涂层、knerling、喷沙、纹理、脊等)以加强其间的磨擦啮合。
开口锁定
在图26中,手术钉合和切割器械10处于起始打开状态,闭合和发射扳机26、34都是向前的,而链节齿条200处于缩回状态。如前所述,在这种未发射状态下,指示器齿轮230的圆形脊背242中的开口240朝向锁臂172的上表面244,锁臂172平常依靠在外壳结构182和闭合释放按钮38中间远侧边178之间的压缩弹簧180的作用而向下旋转出开口240。在图26中,闭合释放按钮38已压下,使上表面244进入开口244。在图27中,向***式握把36方向关闭闭合扳机26并且发射扳机34摆到发射位置后,闭合扳机26和锁臂172处于夹闭邻接状态。闭合释放按钮38未压下,如伸长的闭合弹簧180所表明的。锁臂172的上表面244摆到圆形脊背242的下方且指示器齿轮230解锁并可自由逆时针旋转。锁臂172的向下运动解锁指示器齿轮230和所连接的链节传递发射机构150,使发射扳机34受到致动。因此,随着指示器齿轮230继续旋转以进一步发射,阻止闭合释放按钮38释放夹闭的闭合扳机26。
位置指示器和释放机构
在图28中,手术钉合和切割器械610用一个可选择的指示器装置640代替指示器缩回旋钮,此装置向上延伸成一个顶部可触及的缩回杆642,用作一个可易于用任一只手致动的粘带式(stuck)发射缩回器。该器械示出为打开和未发射状态,如远侧向前的闭合和发射扳机26、34和打开的端部操纵装置12所指示的。当还未开始发射时,在正常情况下缩回杆642与手柄外壳154从远侧旋转邻接。指示器640可以偶联(未显示)到前面所述的惰轮220和发射机构150上,根据前面所述,其中当链节传递发射时,缩回杆642会向近侧旋转,呈现可视的发射指示,并能够以通过向其施加手动远侧力辅助自动缩回的方式作为旋转位置指示器,旋转方向必须反转,因此在此实施例中指示器必须附着到惰轮220上。
在图29中,另一个可选择的发射机构650包括前面所描述的顶部可触及的缩回杆642和指示器装置640,指示器装置640偶联到具有在带齿区668内的第一和第二停顿区662,664的指示器齿轮660。当缩回杆642处于与手柄外壳154相邻的远侧位置时,第一停顿区662对准惰轮220。因此,惰轮220可以在纵向移动链节齿条220的驱动下自由地顺时针和逆时针旋转。如果E形梁80(在图29中未显示)由于任何原因在端部操纵装置12中受到粘连,不能被拉伸/压缩弹簧组184向近侧缩回,缩回杆642可以由外科医生向近侧拉动以从左侧看去顺时针旋转指示器齿轮660。缩回杆660的这种旋转运动转动指示器齿轮660并带动了位于第一和第二停顿区662、664之间的弯曲齿部670与惰轮220的齿相接触,以可操作地将缩回杆642偶联到发射机构650上。
一旦偶联,外科医生可以向缩回杆642施加更大的力以缩回发射机构650,从而逆时针旋转惰轮220并向近侧纵向移动链节齿条200以缩回E形梁80。当缩回杆642进一步旋转到图30的位置,惰轮220与弯曲带齿部分离并通过第二停顿区664与缩回杆642去偶联。在这方面,施力释放粘带的发射机构650,且拉伸/压缩弹簧组184将完全缩回链节齿条200。
另外一个设计(未显示)包括一个在缩回杆642和指示器齿轮660之间的单向滑动离合器如一个Sprague离合器或相同功能的机构(未显示)。在前面的设计中,缩回杆642的运动范围由在小于一整周的范围或运动的每个端点处与手柄外壳154接触而受到限制。这就限制了在缩回杆642的一个运动过程中发射***650能被缩回的距离。在缩回杆642和指示器齿轮660间增加单向滑动离合器允许当缩回杆642向后旋转(从远侧到近侧)时,缩回杆642可操作地与指示器齿轮660啮合,当杆向前移动(从近侧到远侧)时将两者分离。这样,通过多拉动缩回杆642保证了发射机构650的完全缩回。第二停顿区664可从指示器齿轮660上移开以确保更多齿与齿的啮合。另外,加入离合器机构可允许使用后缩回杆旋转与手柄相邻。
在使用中,外科医生使端部操纵装置12和轴18穿过套管或套管针定位到手术位置,定位的砧座14和细长通道16作为相对的夹钳抓紧要钉合和切割的组织。一旦对端部操纵装置12的位置满意,闭合扳机25被完全压向手柄20的***式握把36,导致闭合扳机26的上部160锁定枢轴连接到闭合释放按钮38上的锁臂172。因此,发射扳机34被压下并释放预定次数以作用于完全发射行程来驱动发射杆32沿轴18下降到端部操纵装置12的E形梁80。在发射过程中,止退机构250处于锁定状态,允许止退盘266倾回,约束发射杆32的任何向近侧的运动。向远侧的运动通过链节传递发射机构150传递给发射杆32,该链节传递发射机构150包括在近端附着在发射杆32的链节齿条200,每一个链节196a-d销到相邻的链节196a-d上以便可以向下弯曲到***式握把36内但不能向上弯,当与传递到链节196a-d间的旋转销310上方的作用力成直线时形成刚性结构。尤其是,偶联到发射扳机34的牵拉偏压机构210包括一个靠摩擦力偶联到手柄外壳154的偏压轮278,以便远侧发射运动向棘爪270传递一啮合偏压,推动棘爪270与链节齿条200啮合。在动作结束时,棘爪270通过与闭合轭162的斜面284相接触从与链节196的发射啮合中抬起。发射机构150的返回运动导致偏压轮278向棘爪270传递反向偏压,将棘爪270保持在由止退机构250保持在适当位置上的链节齿条200之上。在发射全程中,指示器齿轮230包括断开止退释放杆248的弯曲斜面430,止退释放杆248迫使止退盘266进入解锁状态,允许利用存储在拉伸/压缩弹簧组184内的压缩力收回链节齿条200及发射杆32。因此,链节齿条200收回到手柄把手36内。可选择地,在发射动作期间,外科医生可以压下使止退释放杆倾斜的止退释放按钮42。指示器旋钮40方便地使外科医生了解到发射进展的程度并辅助缩回遇到束缚的E形梁80。
虽然本发明已经通过一些实施例的描述进行了说明,而且这些示范性实施例已进行相当详细地描述,但申请人并不是将附加的权利要求书的范围限制得如此具体。其它的优点和修改对本领域技术人员来说都是显而易见的。
例如,虽然这里所描述的手术钉合和切割器械10优选具有分离和明显的发射和闭合动作,提供了临床使用的灵活性。但是应意识到,符合本发明的应用可以包括将单个用户动作转化为闭合和发射器械的发射运动的手柄。
另外,虽然示出的是手动手柄,电动或其它形式驱动的手柄也许可以受益于与这里描述链节齿条合并在一起,可减小手柄的尺寸或得到其它优点。例如,虽然将链节齿条部分收纳于***式握柄中比较方便,应当意识到在链节间的枢轴连接允许平行于由轴和手柄管所限定的直线部分收纳链节。
另一个例子,虽然优选描述了链节齿条200,具有不可弯曲齿条的外科器械也许可以受益于止退机构。
还有一个例子,应意识到所示出的是圆形发射杆32,其还可采用了许多截面形状。
Claims (5)
1.一种外科手术器械,包括
一个响应纵向发射运动以进行外科手术的端部操纵装置;
一个在远侧连接于该端部操纵装置的轴;
一个在未发射位置和完全发射位置间,滑动承纳于该轴以将发射运动传送到端部操纵装置的发射元件,以及
一种止退机构包括:
一个包括有环绕在发射元件周围的锁孔的锁盘,该锁盘在锁定位置和解锁位置之间枢轴转动,其中在锁定位置时,锁孔锁定地接合于发射元件,在解锁位置时,锁孔滑动地接合于发射元件。
一个锁定装置,其响应于发射元件由未发射位置向完全发射位置横移,以使锁盘倾斜到锁定位置,以及
一个响应缩回状态以把锁盘置于解锁位置的缩回机构。
2.据权利要求1所述的外科手术器械,其中止退机构包括一个用于在纵向发射动作过程中,在任何位置处均可从与发射元件的接合状态中释放所述锁盘的用户控制部件。
3.根据权利要求1所述的外科手术器械,其中缩回机构是一个用户控制部件,它接受作为用户控制输入的缩回状态。
4.根据权利要求1所述的外科手术器械,其中缩回状态是选自于由发射元件的完全发射位置和用于发射元件缩回的用户控制输入组成的组合之一。
5.根据权利要求1所述的外科手术器械,其中端部操纵装置进一步响应于闭合动作,手柄和轴设置为分别产生和传送闭合动作到端部操纵装置。
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CN109069150A (zh) * | 2016-04-18 | 2018-12-21 | 伊西康有限责任公司 | 包括闭锁件的外科器械 |
CN110167462A (zh) * | 2016-12-21 | 2019-08-23 | 爱惜康有限责任公司 | 用于在带有闭合行程减少特征部的闭合***以及关节运动和击发***之间转换的具有离合布置的外科工具组件 |
CN110167462B (zh) * | 2016-12-21 | 2022-05-31 | 爱惜康有限责任公司 | 用于在带有闭合行程减少特征部的闭合***以及关节运动和击发***之间转换的具有离合布置的外科工具组件 |
CN113197609A (zh) * | 2021-05-31 | 2021-08-03 | 苏州法兰克曼医疗器械有限公司 | 一种具有保险装置的管型吻合器 |
CN113197609B (zh) * | 2021-05-31 | 2022-04-12 | 苏州法兰克曼医疗器械有限公司 | 一种具有保险装置的管型吻合器 |
CN114176643A (zh) * | 2022-02-17 | 2022-03-15 | 天津恒宇医疗科技有限公司 | 血管内超声成像回撤装置 |
CN114176643B (zh) * | 2022-02-17 | 2022-04-26 | 天津恒宇医疗科技有限公司 | 血管内超声成像回撤装置 |
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US20050067457A1 (en) | 2005-03-31 |
AU2011202354B2 (en) | 2012-04-12 |
CA2482583C (en) | 2012-07-24 |
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JP2005103279A (ja) | 2005-04-21 |
BRPI0405162B8 (pt) | 2021-06-22 |
EP1520523A1 (en) | 2005-04-06 |
CA2482583A1 (en) | 2005-03-29 |
AU2011202354A1 (en) | 2011-06-09 |
US6959852B2 (en) | 2005-11-01 |
MXPA04009528A (es) | 2005-07-05 |
PL1520523T3 (pl) | 2018-01-31 |
BRPI0405162A (pt) | 2005-06-28 |
AU2004216574A1 (en) | 2005-04-14 |
JP4667813B2 (ja) | 2011-04-13 |
BRPI0405162B1 (pt) | 2014-12-09 |
CN100457053C (zh) | 2009-02-04 |
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