WO2018078833A1 - Ultrasonic probe - Google Patents

Ultrasonic probe Download PDF

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Publication number
WO2018078833A1
WO2018078833A1 PCT/JP2016/082189 JP2016082189W WO2018078833A1 WO 2018078833 A1 WO2018078833 A1 WO 2018078833A1 JP 2016082189 W JP2016082189 W JP 2016082189W WO 2018078833 A1 WO2018078833 A1 WO 2018078833A1
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Prior art keywords
probe
ultrasonic
main body
treatment
distal
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PCT/JP2016/082189
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French (fr)
Japanese (ja)
Inventor
弘之 荒木
喜一郎 澤田
宜瑞 坂本
藤崎　健
直樹 鳴海
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オリンパス株式会社
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Priority to PCT/JP2016/082189 priority Critical patent/WO2018078833A1/en
Publication of WO2018078833A1 publication Critical patent/WO2018078833A1/en

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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
    • A61B17/32—Surgical cutting instruments

Definitions

  • the present invention relates to an ultrasonic probe that performs treatment by ultrasonic vibration on a treatment-handling site in a joint.
  • Patent Document 1 WO2010 / 087060A1 includes an ultrasonic device that mounts an ultrasonic transducer, outputs ultrasonic waves from an ultrasonic probe, and performs arbitrary treatment by ultrasonic vibration. Proposed. *
  • Such an ultrasonic probe is provided with a treatment portion at the tip of a linearly extending probe body.
  • a cutting surface made of unevenness is provided on the lower surface of the treatment portion.
  • an arthroscopic operation for example, there is an operation in which a surgical treatment is performed on the meniscus of a torn knee joint.
  • the above-described ultrasonic probe that vibrates ultrasonically performs a treatment of excising the tearing portion and adjusting the shape.
  • the meniscus exists so as to be sandwiched between the knee joint of the femur and the tibia, so to perform the posterior segment or dorsal horn of the inner meniscus, It is necessary to pass through a narrow space between them and cannot be approached by existing ultrasonic probes. In this case, it is necessary to devise the position where the portal is provided, or it is necessary to newly open the portal.
  • an embodiment of the present invention provides an ultrasonic probe that can be accessed from a limited portal, reach a treatment target site deep in a narrow joint cavity, and perform a cutting treatment on the treatment target site within a narrow treatment area. To do.
  • An ultrasonic probe is provided at a distal end of a probe main body that receives ultrasonic vibration generated by an ultrasonic generator at a proximal end side and transmits the ultrasonic vibration to a distal end side,
  • a distal treatment section having a cutting surface for cutting a treatment target site using ultrasonic vibration, and the probe body is separated from the distal treatment section by a predetermined length on the proximal end side It has a curved portion that curves so as to warp to the side opposite to the surface side of the cutting surface provided in the distal treatment section at a position on the main body.
  • FIG. 1 is a diagram illustrating a system configuration example of an ultrasonic treatment apparatus according to the first embodiment of the present invention.
  • FIG. 2 is a diagram illustrating a configuration example of an operation system including the ultrasonic treatment instrument according to the first embodiment.
  • FIG. 3 is a diagram showing an external shape of the ultrasonic probe of the ultrasonic treatment device viewed from the side.
  • FIG. 4 is a diagram conceptually showing a distance and a positional relationship when the ultrasonic probe enters from the front of the knee joint and reaches the treatment target site at the back of the femur.
  • FIG. 5 is a diagram showing the position of the portal formed in the knee joint.
  • FIG. 6 is a diagram conceptually showing an arthroscopic surgery using an ultrasonic probe.
  • FIG. 1 is a diagram illustrating a system configuration example of an ultrasonic treatment apparatus according to the first embodiment of the present invention.
  • FIG. 2 is a diagram illustrating a configuration example of an operation system including the ultrasonic treatment instrument according
  • FIG. 7 is a diagram showing a meniscus for performing treatment with an ultrasonic probe.
  • FIG. 8 is a diagram showing the state of the treatment target site where the meniscus is damaged.
  • FIG. 9 is a diagram showing the state of the treatment target site where the meniscus has been treated.
  • FIG. 10 is a diagram for explaining a treatment for an ankle joint using an ultrasonic probe.
  • FIG. 11 is a diagram illustrating an example of a state of treatment of the talus surface and the tibia surface with an ultrasonic probe.
  • FIG. 1 is a diagram illustrating a system configuration example of an ultrasonic treatment apparatus according to the first embodiment.
  • the ultrasonic treatment instrument system 1 mainly includes an ultrasonic treatment instrument 2, a power supply unit 3, and a foot switch 4 that instructs on / off of ultrasonic vibration.
  • the ultrasonic treatment instrument 2 and the power supply unit 3 are connected by a cable 19 to supply drive power and communicate control signals.
  • the power supply unit 3 is provided with a plurality of connectors 20 for connecting to the cable 19 on the front surface 18, various operation switches 21, and a display screen 22 for displaying information necessary for treatment. Further, it is used separately in combination with an endoscope system depending on the procedure or the content of surgery.
  • the ultrasonic treatment instrument 2 includes a device body 11 and an ultrasonic probe 14.
  • the device main body 11 has a cylindrical shape with a grippable diameter
  • the ultrasonic probe 14 is disposed through the housing 11a
  • an ultrasonic transducer unit (ultrasonic wave generation unit) 11b that can be attached to and detached from the housing 11a. Consists of.
  • the ultrasonic transducer unit 11b accommodates therein an ultrasonic generator 12 made of an ultrasonic vibration element such as a piezoelectric body and a horn 13 for efficiently transmitting ultrasonic waves.
  • the proximal end side of the ultrasonic probe 14 and the distal end side of the horn 13 are acoustically connected, and the ultrasonic vibration generated by the ultrasonic generator 12 is obtained. Is transmitted to the distal treatment section 15 described later of the ultrasonic probe 14.
  • An operation switch 17 is provided on the upper surface of the housing 11a to instruct on / off of the ultrasonic vibration by a finger operation.
  • the foot switch 4 has a function equivalent to that of the operation switch 17.
  • the ultrasonic probe 14 is an elongated rod-shaped shaft member (probe main body) that transmits ultrasonic vibrations and is formed of a metal material, for example, a titanium alloy, and the distal end side of the horn 13 is acoustically connected to the base end thereof.
  • the distal end treatment portion 15 is integrally provided at the distal end.
  • the ultrasonic probe 14 has a configuration in which the probe main body and the distal treatment section 15 are integrally formed. Therefore, the distal end of the ultrasonic probe 14 is the distal end of the distal treatment section 15, and the distal end of the probe body is the boundary with the distal treatment section 15.
  • This distal treatment section 15 has a bone cutting function and a cartilage cutting function by ultrasonic vibration described later, and performs a desired surgical treatment (mainly excision treatment) on the treatment target site (or treatment target location) 100. Can do.
  • the ultrasonic probe 14 is covered with a sheath (outer pipe) 23 from the housing 11a to an arbitrary length. That is, in the present embodiment, the sheath 23 is covered so as to extend from the housing 11a to a position on the probe main body 20 mm to 30 mm before the distal end of the distal treatment section 15. Further, the range from the boundary between the distal treatment section 15 and the probe body to the sheath 23 is covered with a probe cover 16 made of a tube. By providing the sheath 23 and the probe cover 16, it is possible to eliminate the influence and protect each other when contacting a part other than the treatment target, or another treatment tool or endoscope.
  • the distal treatment section 15 provided at the distal end of the ultrasonic probe 14 is formed with a diameter larger than that of the extending probe body and has a constriction.
  • the probe cover 16 is attached so that the distal end of the sheath does not come out of the ultrasonic probe 14 due to the constriction of the distal treatment section 15.
  • the distal treatment section 15 of the ultrasonic probe 14 performs mechanical cutting by micro sliding with ultrasonic vibration.
  • the amount to be scraped off can be adjusted depending on the strength (pressing pressure) applied to the treatment target region 100. That is, the shaving is adjusted by the surgeon's manual control, and efficient cutting and cutting can be realized.
  • the distal treatment section 15 is ultrasonically vibrated even if not individually described.
  • the ultrasonic treatment tool 2 of the present embodiment is configured not to be provided with a perfusion liquid water supply and drainage mechanism, it is also possible to provide a perfusion liquid water supply and drainage mechanism depending on the application.
  • FIG. 2 is a diagram illustrating a configuration example of an operation system including the ultrasonic treatment instrument according to the first embodiment.
  • the surgical system 10 according to the present embodiment includes an ultrasonic treatment tool 2 and an endoscope system 30 including an arthroscope 31.
  • the ultrasonic treatment instrument 2 includes the ultrasonic wave generation unit 12, the ultrasonic probe 14, the power supply unit 3, and the operation switch 17.
  • the endoscope system 30 includes an arthroscope 31 that is a rigid endoscope that is a kind of endoscope, a visible light source 32 that emits visible illumination light as a light source of illumination light, and the entire endoscope system 30.
  • a control unit 33 for controlling the operation an input unit 34 such as a keyboard and a touch panel, a display unit 35 for displaying surgical information including the photographed surgical situation, and a physiological saline solution and drainage around the treatment target region 100 Or it is comprised with the water supply drainage part 36 to perfuse.
  • the water supply / drainage unit 36 is configured to supply and drain physiological saline to the treatment site through the arthroscope 31, but is configured to supply and drain perfusate containing physiological saline and the like from the ultrasonic treatment instrument 2. It may be.
  • FIG. 3 is a diagram showing an external shape of the ultrasonic probe 14 of the ultrasonic treatment device viewed from the side.
  • the ultrasonic probe 14 is an elongated rod-like member that is formed of, for example, a titanium alloy and extends in the longitudinal axis direction.
  • the proximal end of the ultrasonic probe 14 is acoustically connected to the distal end side of the horn 13 described above, and the ultrasonic vibration generated by the ultrasonic generator 12 is transmitted.
  • the distal end side of the ultrasonic probe 14 has a bend (curved portion) so that the distal end side bends or bends upward when the operator holds the probe in a normal manner.
  • the distal treatment section 15 is integrally provided.
  • the cutting surface 15a that contacts and cuts the treatment target portion has irregularities formed like a cross hatch pattern or a cross pattern in which a plurality of grooves intersect each other.
  • the cutting surface 15a of the treatment portion is provided on either the lower surface or the upper surface of the distal treatment portion 15 depending on the position of the target treatment target portion.
  • the cutting surface 15a can be formed on both the upper and lower surfaces of the distal treatment section 15.
  • cutting surfaces 15 b are formed by a plurality of vertical grooves.
  • a cutting surface with a plurality of grooves may be formed on the distal end surface of the distal treatment section 15.
  • the ultrasonic probe 14 is not limited to the shape extended in a straight line, The length and shape are set according to the treatment object.
  • FIG. 4 conceptually shows the distance and positional relationship when the ultrasound probe 14 enters from the front of the knee joint and reaches the treatment target site at the back of the femur when the meniscus in the joint is the treatment target.
  • FIG. This example shows the approximate average distance and position of the human knee joint from the published adult size. Of course, it is not limited to this range due to physical differences (individual differences).
  • the distal treatment section 15 passes through the lowermost part of the femur 61.
  • the gap L13 between the femur and the tibia is about 4 mm. Furthermore, it reaches the rear corner or the rear node of the meniscus 71b at a distance of about 10 mm from the lowermost part.
  • the meniscus 100 has a width of about 10 mm.
  • the meniscus 71a, 71b is a triangle whose section has an inclined surface on the upper surface, as shown in FIG.
  • the length L1 of the ultrasonic probe 14 extending from the housing 11a is required to be 20 mm to 30 mm as shown in the example shown in FIG.
  • the ultrasonic probe 14 (probe main body) is curved upward so as to warp at a position of 10 mm from the distal end of the distal treatment section 15.
  • the bending angle ⁇ is preferably 3 degrees or 5.5 degrees, for example.
  • the thickness is at least 4 mm or less.
  • a curved portion that is curved upward at a position of about 10 mm from the distal end of the distal treatment section 15 is formed.
  • FIG. 5 is a diagram showing the position of a portal formed in the knee joint
  • FIG. 6 is a diagram conceptually showing an arthroscopic surgery using an ultrasonic treatment tool
  • FIG. 7 is a diagram showing a meniscus to be treated with an ultrasonic treatment device
  • FIG. 8 is a diagram showing a state of a treatment target portion where the meniscus is damaged
  • FIG. 9 is a treatment with meniscus treated. It is a figure which shows the state of an object location.
  • an example will be described in which treatment for damage occurring in the posterior corner or posterior segment of the inner meniscus is performed.
  • FIG. 5 shows an anterior-lateral (subpatellar) portal 51, a transpatellar ligament portal 52, an anterior medial portal 53, and a posterior medial portal 54 that are provided to insert the ultrasonic treatment instrument 2 and the arthroscope 31 into the knee joint.
  • Each position example is shown.
  • an example using the portal 51 and the portal 53 will be described.
  • the positions of the portals shown in FIG. 5 are representative examples, and should be set as appropriate according to individual differences among patients, treatment targets, treatment details, and the like.
  • FIG. 6 shows a state where the knee of the patient is bent and the joint portion is opened.
  • the patella surface 61a of the femur 61 is in a state of facing forward.
  • the arthroscope 31 is inserted from the portal 51, and the ultrasonic probe 14 is inserted from the portal 53.
  • both the arthroscope 31 and the ultrasonic probe 14 pass between the femur 61 and the tibia 41, and as shown in FIG. 8, the dorsal corner of the meniscus 71 (inner meniscus 71a) or near the posterior node.
  • Each distal end portion reaches the treatment target location (or treatment target site) 100 generated in step (b).
  • the cross section of the meniscus 100 includes a dense blood flow region A [blood circulation area: dense blood flow region (Red zone)] through which a large number of blood flows (blood vessels) pass on the outer peripheral side.
  • a region B blood field: rough blood flow region (White-Red zone)] that has blood flow but is smaller than region A.
  • region C bloodless area: bloodless zone (White zone)] where no blood flow flows.
  • the ultrasonic probe 14 is curved upward so that the distal end side of the probe body is warped, and a distal treatment section 15 is provided. For this reason, when excising the treatment target location 100 that is a longitudinal tear of the meniscus 71, the cutting surface 15 a of the distal treatment section 15 can be applied along the inclined upper surface of the meniscus 71.
  • the distal treatment section 15 excises the longitudinal tear of the meniscus 71 and treats the excision surface 100a to be an inclined surface having an inclination.
  • the location of the normal meniscus which does not have a tear shown in FIG. 8 becomes an inclined surface, and the stress applied from a femur is disperse
  • conventional cutting with a tool such as a punch results in a cut surface cut perpendicularly from the upper surface of the meniscus, resulting in a corner portion.
  • the distal end treatment portion 15 is provided at the tip curved upward, so that it can easily pass between the femur 61 and the tibia 41 and the posterior corner of the meniscus 71. It can be cut into an inclined cut surface so that it reaches the treatment target location and no corners are generated on the upper surface of the meniscus.
  • the treatment of the damaged ankle joint by the surgery system 10 comprised of the ultrasonic treatment instrument 2 and the endoscope system 30 will be described.
  • the tibia 41 and the talus 42 are slidably connected by a ligament (not shown).
  • the lower joint surface (cartilage) 41a of the tibia 41 and the talus pulley surface (cartilage) 42a of the talus 42 slide to bend the joint.
  • a treatment for excising and removing the separated or separated portion is performed.
  • the ultrasonic probe 14 is provided with the distal treatment section 15 at the tip curved upward, so that the treatment is performed beyond the talus pulley surface 42 a of the talus 42. It reaches the target location and can be excised on an inclined excision surface that matches the curved surface of the lower joint surface 41a.
  • a cutting surface 15a provided on the lower surface of the distal treatment section 15 shown in FIG. 3 is formed on the upper surface, and the device body 11 is turned 180 degrees. And treat.
  • the device body 11 may be returned 180 degrees to cut the cartilage.
  • osteophytes (not shown) may be formed.
  • the ultrasonic probe 14 of the present embodiment can easily excise the osteophyte regardless of the position where the osteophyte is formed.
  • the tip of the probe body is curved or bent so that the tip of the probe body is warped upward even at a location where the distal treatment section 15 has not reached the treatment target location with the conventional ultrasonic probe. Since the distal treatment section 15 is provided, it can be easily reached. In addition, even when the treatment target part is bent or inclined after reaching the treatment target part, the treatment target part can be excised as necessary along the direction.

Abstract

This ultrasonic probe (14) has a tip treatment unit (15). The tip treatment unit (15) is provided on the tip of the probe main body. On the lower surface of the tip treatment unit (15), an uneven cutting surface (15a) is provided. The probe main body is curved at an angle θ in a curved area, and the tip side is warped upwards from the curved area. In the case of resecting a site of injury (100) near the rear horn or posterior portion of the medial meniscus (71a), the ultrasonic probe (14) is inserted into the knee joint through the anteromedial portal (53). Because the probe main body is curved, it is possible to apply the cutting surface (15a) along the inclined upper surface of the meniscus (71). In this state, ultrasonic vibration is received by the probe main body at the base and is transmitted to the tip treatment unit (15). In this way, the vibrating cutting surface (15a) is pressed against the injured site (100) and the meniscus (71) can be cut such that the resected surface (100a) forms an inclined surface.

Description

超音波プローブUltrasonic probe
　本発明は、関節内の処置対処部位に対して超音波振動による処置を施す超音波プローブに関する。 The present invention relates to an ultrasonic probe that performs treatment by ultrasonic vibration on a treatment-handling site in a joint.
　一般に、節近傍に２箇所程度のポータルを開けて、これらのポータルから関節鏡となる硬性鏡、及び治療デバイスを挿入し、関節内を関節手術用環流水で満たした状態でモニタ表示される映像を確認しながら処置を行う関節鏡視下手術が知られている。 In general, two portals are opened in the vicinity of a node, rigid endoscopes that serve as arthroscopes, and treatment devices are inserted from these portals, and the images displayed on the monitor are filled with reflux water for joint surgery. Arthroscopic surgery for performing treatment while confirming the above is known.
　また治療デバイスとしては、例えば、特許文献１：ＷＯ２０１０／０８７０６０Ａ１には、超音波振動子を搭載して、超音波プローブより超音波出力を行い、超音波振動による任意の処置を施す超音波デバイスが提案されている。　 Moreover, as a therapeutic device, for example, Patent Document 1: WO2010 / 087060A1 includes an ultrasonic device that mounts an ultrasonic transducer, outputs ultrasonic waves from an ultrasonic probe, and performs arbitrary treatment by ultrasonic vibration. Proposed. *
　このような超音波プローブは、直線的に延出したプローブ本体の先端に処置部が設けられている。通常、術者が超音波プローブを把持した際に、処置部の下面に凹凸からなる切削面が設けられている。 Such an ultrasonic probe is provided with a treatment portion at the tip of a linearly extending probe body. Usually, when the surgeon holds the ultrasonic probe, a cutting surface made of unevenness is provided on the lower surface of the treatment portion.
　関節鏡視下手術として、例えば、断裂した膝関節の半月板に外科的処置を施す手術がある。前述した超音波振動する超音波プローブは、断裂部を切除したり、形状を整えたりする処置を行う。しかし前述したように、半月板は、大腿骨と脛骨の膝関節の間に挟まれるように存在するため、内側の半月板の後節又は後角の処置を行うには、前側のポータルから関節間の狭いスペースを通る必要があり、既存の超音波プローブではアプローチできない。この場合、ポータルを設ける位置を工夫せねばならず、又は、新たにポータルを開口することが必要となる。 As an arthroscopic operation, for example, there is an operation in which a surgical treatment is performed on the meniscus of a torn knee joint. The above-described ultrasonic probe that vibrates ultrasonically performs a treatment of excising the tearing portion and adjusting the shape. However, as described above, the meniscus exists so as to be sandwiched between the knee joint of the femur and the tibia, so to perform the posterior segment or dorsal horn of the inner meniscus, It is necessary to pass through a narrow space between them and cannot be approached by existing ultrasonic probes. In this case, it is necessary to devise the position where the portal is provided, or it is necessary to newly open the portal.
　また、足関節の距骨面及び脛骨面の処置についても、距骨面及び脛骨面が曲面であるため、前側のポータルからアプローチすると後側の距骨面及び脛骨面には、超音波プローブの処置部をあてがうことができない。　
　そこで本発明の実施形態は、限られたポータルからアクセスして狭い関節腔の深部の処置対象部位に到達し、狭い処置エリア内で処置対象部位の切削処置を行うことができる超音波プローブを提供する。 Also, regarding the treatment of the talus surface and tibia surface of the ankle joint, since the talus surface and tibia surface are curved surfaces, when approaching from the front portal, the treatment portion of the ultrasonic probe is placed on the posterior talus surface and tibia surface. I can't assign it.
Therefore, an embodiment of the present invention provides an ultrasonic probe that can be accessed from a limited portal, reach a treatment target site deep in a narrow joint cavity, and perform a cutting treatment on the treatment target site within a narrow treatment area. To do.
　本発明の実施形態の係る超音波プローブは、超音波発生部が発生させた超音波振動を基端側で受けて、先端側に伝達するプローブ本体と、前記プローブ本体の先端に設けられ、前記超音波振動を用いて処置対象部位を切削する切削面を有する先端処置部と、を備え、前記プローブ本体は、前記先端処置部から前記基端側に予め設定された長さを離れた前記プローブ本体上の位置で前記先端処置部に設けられた前記切削面の面側とは反対側に反り返るように湾曲する湾曲部分を有する。 An ultrasonic probe according to an embodiment of the present invention is provided at a distal end of a probe main body that receives ultrasonic vibration generated by an ultrasonic generator at a proximal end side and transmits the ultrasonic vibration to a distal end side, A distal treatment section having a cutting surface for cutting a treatment target site using ultrasonic vibration, and the probe body is separated from the distal treatment section by a predetermined length on the proximal end side It has a curved portion that curves so as to warp to the side opposite to the surface side of the cutting surface provided in the distal treatment section at a position on the main body.
図１は、本発明の第１の実施形態に係る超音波処置具のシステム構成例を示す図である。FIG. 1 is a diagram illustrating a system configuration example of an ultrasonic treatment apparatus according to the first embodiment of the present invention. 図２は、第１の実施形態に係る超音波処置具を備えた手術システムの構成例を示す図である。FIG. 2 is a diagram illustrating a configuration example of an operation system including the ultrasonic treatment instrument according to the first embodiment. 図３は、超音波処置具の超音波プローブを側方から見た外観形状を示す図である。FIG. 3 is a diagram showing an external shape of the ultrasonic probe of the ultrasonic treatment device viewed from the side. 図４は、超音波プローブが膝関節の前方から侵入して大腿骨奥の処置対象部位に到達させる際の距離と位置関係を概念的に示す図である。FIG. 4 is a diagram conceptually showing a distance and a positional relationship when the ultrasonic probe enters from the front of the knee joint and reaches the treatment target site at the back of the femur. 図５は、膝関節に形成するポータルの位置を示す図である。FIG. 5 is a diagram showing the position of the portal formed in the knee joint. 図６は、超音波プローブを用いた関節鏡視下手術を概念的に示す図である。FIG. 6 is a diagram conceptually showing an arthroscopic surgery using an ultrasonic probe. 図７は、超音波プローブにより処置を行う半月板を示す図である。FIG. 7 is a diagram showing a meniscus for performing treatment with an ultrasonic probe. 図８は、半月板の損傷した処置対象部位の状態を示す図である。FIG. 8 is a diagram showing the state of the treatment target site where the meniscus is damaged. 図９は、半月板の処置された処置対象部位の状態を示す図である。FIG. 9 is a diagram showing the state of the treatment target site where the meniscus has been treated. 図１０は、超音波プローブによる足関節に対する処置について説明するための図である。FIG. 10 is a diagram for explaining a treatment for an ankle joint using an ultrasonic probe. 図１１は、超音波プローブによる距骨面及び脛骨面の処置の状態の一例を示す図である。FIG. 11 is a diagram illustrating an example of a state of treatment of the talus surface and the tibia surface with an ultrasonic probe.
　以下、図面を参照して、本発明の実施形態に係る超音波処置具の超音波プローブについて説明する。　
　図１は、第１の実施形態に係る超音波処置具のシステム構成例を示す図である。　
　本実施形態の超音波処置具システム１は、主として、超音波処置具２と、電源部３と、超音波振動のオンオフを指示するフットスイッチ４と、で構成される。超音波処置具２と電源部３とは、ケーブル１９により接続され、駆動電力の供給や制御信号の通信が行われている。電源部３は、前面１８にはケーブル１９と接続するための複数のコネクタ２０と、各種操作スイッチ２１と、処置に必要な情報を表示する表示画面２２が設けられている。また、手技又は手術内容に応じて、別途、内視鏡システムと組み合わせて使用される。 Hereinafter, an ultrasonic probe of an ultrasonic treatment device according to an embodiment of the present invention will be described with reference to the drawings.
FIG. 1 is a diagram illustrating a system configuration example of an ultrasonic treatment apparatus according to the first embodiment.
The ultrasonic treatment instrument system 1 according to the present embodiment mainly includes an ultrasonic treatment instrument 2, a power supply unit 3, and a foot switch 4 that instructs on / off of ultrasonic vibration. The ultrasonic treatment instrument 2 and the power supply unit 3 are connected by a cable 19 to supply drive power and communicate control signals. The power supply unit 3 is provided with a plurality of connectors 20 for connecting to the cable 19 on the front surface 18, various operation switches 21, and a display screen 22 for displaying information necessary for treatment. Further, it is used separately in combination with an endoscope system depending on the procedure or the content of surgery.
　超音波処置具２は、デバイス本体１１と、超音波プローブ１４とで構成される。デバイス本体１１は、把持可能な径で筒形状を成し、超音波プローブ１４が貫通して配置されるハウジング１１ａと、ハウジング１１ａに着脱可能な超音波振動子ユニット（超音波発生部）１１ｂとで構成される。超音波振動子ユニット１１ｂは、内部に、圧電体等の超音波振動素子からなる超音波発生部１２及び超音波を効率よく伝達するホーン１３が収容されている。このハウジング１１ａに超音波振動子ユニット１１ｂが装着された状態においては、超音波プローブ１４の基端側とホーン１３の先端側が音響的に接続され、超音波発生部１２で発生された超音波振動が超音波プローブ１４の後述する先端処置部１５まで伝達される。ハウジング１１ａの上面には、超音波振動のオンオフを指操作により指示する操作スイッチ１７が設けられている。フットスイッチ４は、操作スイッチ１７と同等の機能を有している。 The ultrasonic treatment instrument 2 includes a device body 11 and an ultrasonic probe 14. The device main body 11 has a cylindrical shape with a grippable diameter, the ultrasonic probe 14 is disposed through the housing 11a, and an ultrasonic transducer unit (ultrasonic wave generation unit) 11b that can be attached to and detached from the housing 11a. Consists of. The ultrasonic transducer unit 11b accommodates therein an ultrasonic generator 12 made of an ultrasonic vibration element such as a piezoelectric body and a horn 13 for efficiently transmitting ultrasonic waves. In a state where the ultrasonic transducer unit 11b is mounted on the housing 11a, the proximal end side of the ultrasonic probe 14 and the distal end side of the horn 13 are acoustically connected, and the ultrasonic vibration generated by the ultrasonic generator 12 is obtained. Is transmitted to the distal treatment section 15 described later of the ultrasonic probe 14. An operation switch 17 is provided on the upper surface of the housing 11a to instruct on / off of the ultrasonic vibration by a finger operation. The foot switch 4 has a function equivalent to that of the operation switch 17.
　超音波プローブ１４は、超音波振動を伝達する細長い棒状の軸部材（プローブ本体）で金属材料、例えば、チタン合金等により形成され、その基端には、前述したホーン１３の先端側が音響的に接続され、先端には先端処置部１５が一体的に設けられている。以下の説明において、超音波プローブ１４は、プローブ本体と先端処置部１５が一体的に形成される構成である。よって、超音波プローブ１４の先端は、先端処置部１５の先端であり、プローブ本体の先端は、先端処置部１５との境とする。この先端処置部１５は、後述する超音波振動による骨切削機能と軟骨切削機能とを併せ持ち、処置対象部位（又は、処置対象箇所）１００に所望する外科的処置（主に切除処置）を行うことができる。 The ultrasonic probe 14 is an elongated rod-shaped shaft member (probe main body) that transmits ultrasonic vibrations and is formed of a metal material, for example, a titanium alloy, and the distal end side of the horn 13 is acoustically connected to the base end thereof. The distal end treatment portion 15 is integrally provided at the distal end. In the following description, the ultrasonic probe 14 has a configuration in which the probe main body and the distal treatment section 15 are integrally formed. Therefore, the distal end of the ultrasonic probe 14 is the distal end of the distal treatment section 15, and the distal end of the probe body is the boundary with the distal treatment section 15. This distal treatment section 15 has a bone cutting function and a cartilage cutting function by ultrasonic vibration described later, and performs a desired surgical treatment (mainly excision treatment) on the treatment target site (or treatment target location) 100. Can do.
　また、超音波プローブ１４は、ハウジング１１ａから任意の長さまでシース（アウターパイプ）２３に覆われている。即ち、本実施形態では、ハウジング１１ａから先端処置部１５の先端から２０ｍｍ～３０ｍｍ手前までのプローブ本体上の位置まで掛かるようにシース２３に覆われている。さらに、先端処置部１５とプローブ本体との境からシース２３までの範囲をチューブからなるプローブカバー１６に覆われている。このシース２３及びプローブカバー１６を設けることで、処置対象以外の部位又は、他の処置具や内視鏡とに接触した際に、影響を無くし互いに保護することができる。 The ultrasonic probe 14 is covered with a sheath (outer pipe) 23 from the housing 11a to an arbitrary length. That is, in the present embodiment, the sheath 23 is covered so as to extend from the housing 11a to a position on the probe main body 20 mm to 30 mm before the distal end of the distal treatment section 15. Further, the range from the boundary between the distal treatment section 15 and the probe body to the sheath 23 is covered with a probe cover 16 made of a tube. By providing the sheath 23 and the probe cover 16, it is possible to eliminate the influence and protect each other when contacting a part other than the treatment target, or another treatment tool or endoscope.
　また、超音波プローブ１４の先端に設けられた先端処置部１５は、延伸するプローブ本体よりも径が大きく形成され、くびれを有した構成となる。プローブカバー１６は、先端処置部１５のくびれにより、シース先端が超音波プローブ１４から抜け出ないように装着されている。 Also, the distal treatment section 15 provided at the distal end of the ultrasonic probe 14 is formed with a diameter larger than that of the extending probe body and has a constriction. The probe cover 16 is attached so that the distal end of the sheath does not come out of the ultrasonic probe 14 due to the constriction of the distal treatment section 15.
　この超音波プローブ１４の先端処置部１５は、超音波振動が与えられた微小摺動による機械的な切削を行う。処置対象部位１００へ押し当てる強さの度合い（押し付け圧）により、削り取る量を加減することができる。即ち、手術者による手加減により、削り加減が調節されて、効率的な切削や切断等を実現できる。尚、以下の説明において、先端処置部１５による切削又は処置を行っている場合には、個別に記載されていなくとも、先端処置部１５は超音波振動しているものとする。さらに、本実施形態の超音波処置具２は、灌流液の送水及び排水機構は設けられていない構成であるが、用途に応じて灌流液の送水及び排水機構を設けることも可能である。 The distal treatment section 15 of the ultrasonic probe 14 performs mechanical cutting by micro sliding with ultrasonic vibration. The amount to be scraped off can be adjusted depending on the strength (pressing pressure) applied to the treatment target region 100. That is, the shaving is adjusted by the surgeon's manual control, and efficient cutting and cutting can be realized. In the following description, when cutting or treatment is performed by the distal treatment section 15, it is assumed that the distal treatment section 15 is ultrasonically vibrated even if not individually described. Furthermore, although the ultrasonic treatment tool 2 of the present embodiment is configured not to be provided with a perfusion liquid water supply and drainage mechanism, it is also possible to provide a perfusion liquid water supply and drainage mechanism depending on the application.
　次に、超音波処置具及び内視鏡システムを備えた手術システムについて説明する。　
　図２は、第１の実施形態に係る超音波処置具を備えた手術システムの構成例を示す図である。本実施形態の手術システム１０は、超音波処置具２と、関節鏡３１を含む内視鏡システム３０で構成される。 Next, a surgical system including an ultrasonic treatment tool and an endoscope system will be described.
FIG. 2 is a diagram illustrating a configuration example of an operation system including the ultrasonic treatment instrument according to the first embodiment. The surgical system 10 according to the present embodiment includes an ultrasonic treatment tool 2 and an endoscope system 30 including an arthroscope 31.
　超音波処置具２は、前述したように、超音波発生部１２と、超音波プローブ１４と、電源部３と、操作スイッチ１７を備えている。 As described above, the ultrasonic treatment instrument 2 includes the ultrasonic wave generation unit 12, the ultrasonic probe 14, the power supply unit 3, and the operation switch 17.
　内視鏡システム３０は、内視鏡の一種である硬性鏡からなる関節鏡３１と、照明光の光源として、可視光の照明光を照射する可視光光源３２と、内視鏡システム３０の全体を制御する制御部３３と、キーボードやタッチパネル等の入力部３４と、撮影された手術状況を含む手術情報を表示する表示部３５と、処置対象部位１００を含む周辺に生理食塩水を送水、排水又は灌流する送水排水部３６と、で構成される。本実施形態では、送水排水部３６が関節鏡３１を通じて処置箇所に生理食塩水を送水、排水する構成であるが、超音波処置具２から生理食塩水等を含む灌流液を送水、排水する構成であってもよい。 The endoscope system 30 includes an arthroscope 31 that is a rigid endoscope that is a kind of endoscope, a visible light source 32 that emits visible illumination light as a light source of illumination light, and the entire endoscope system 30. A control unit 33 for controlling the operation, an input unit 34 such as a keyboard and a touch panel, a display unit 35 for displaying surgical information including the photographed surgical situation, and a physiological saline solution and drainage around the treatment target region 100 Or it is comprised with the water supply drainage part 36 to perfuse. In the present embodiment, the water supply / drainage unit 36 is configured to supply and drain physiological saline to the treatment site through the arthroscope 31, but is configured to supply and drain perfusate containing physiological saline and the like from the ultrasonic treatment instrument 2. It may be.
　次に、本実施形態の超音波処置具２の超音波プローブ１４の構成について説明する。図３は、超音波処置具の超音波プローブ１４を側方から見た外観形状を示す図である。　
　超音波プローブ１４は、例えば、チタン合金等により形成され、長手軸方向に延出する細長い棒状の部材である。超音波プローブ１４の基端は、前述したホーン１３の先端側が音響的に接続され、超音波発生部１２が発生させた超音波振動が伝達される。 Next, the configuration of the ultrasonic probe 14 of the ultrasonic treatment instrument 2 of the present embodiment will be described. FIG. 3 is a diagram showing an external shape of the ultrasonic probe 14 of the ultrasonic treatment device viewed from the side.
The ultrasonic probe 14 is an elongated rod-like member that is formed of, for example, a titanium alloy and extends in the longitudinal axis direction. The proximal end of the ultrasonic probe 14 is acoustically connected to the distal end side of the horn 13 described above, and the ultrasonic vibration generated by the ultrasonic generator 12 is transmitted.
　超音波プローブ１４の先端側は、後述するように、術者が通常の持ち方で把持した際に、先端側が上方に湾曲又は屈曲する様に曲がり（湾曲部分）を有し、そのプローブ先端には、先端処置部１５が一体的に設けられている。先端処置部１５は、処置対象部位に接触し切削する切削面１５ａは、複数の溝が互いに交差するクロスハッチ模様や綾目模様のように形成される凹凸を有している。 As will be described later, the distal end side of the ultrasonic probe 14 has a bend (curved portion) so that the distal end side bends or bends upward when the operator holds the probe in a normal manner. The distal treatment section 15 is integrally provided. In the distal treatment section 15, the cutting surface 15a that contacts and cuts the treatment target portion has irregularities formed like a cross hatch pattern or a cross pattern in which a plurality of grooves intersect each other.
　この処置部の切削面１５ａは、目標となる処置対象部位の位置により、先端処置部１５の下面または上面のいずれかに設けられる。尚、この切削面１５ａは、先端処置部１５の上下両面に形成することも可能である。また、図３に示すように先端処置部１５の両側面には、複数の縦溝による切削面１５ｂが形成されている。尚、処置内容によっては、先端処置部１５の先端面に複数の溝による切削面に形成してもよい。また、超音波プローブ１４は、直線に延伸する形状に限定されるものではなく、処置対象に応じて、その長さや形状が設定される。 The cutting surface 15a of the treatment portion is provided on either the lower surface or the upper surface of the distal treatment portion 15 depending on the position of the target treatment target portion. The cutting surface 15a can be formed on both the upper and lower surfaces of the distal treatment section 15. Further, as shown in FIG. 3, on both side surfaces of the distal treatment section 15, cutting surfaces 15 b are formed by a plurality of vertical grooves. Depending on the content of the treatment, a cutting surface with a plurality of grooves may be formed on the distal end surface of the distal treatment section 15. Moreover, the ultrasonic probe 14 is not limited to the shape extended in a straight line, The length and shape are set according to the treatment object.
　図４は、関節内の半月板を処置対象とした場合に、超音波プローブ１４が膝関節の前方から侵入して大腿骨奥の処置対象部位に到達させる際の距離と位置関係を概念的に示す図である。この例は、人体の膝関節に関して、公表されている成人の大きさから大凡の平均的な距離と位置関係を示すものである。勿論、身体差（個体差）によりこの範囲以外もあり、限定されているものではない。 FIG. 4 conceptually shows the distance and positional relationship when the ultrasound probe 14 enters from the front of the knee joint and reaches the treatment target site at the back of the femur when the meniscus in the joint is the treatment target. FIG. This example shows the approximate average distance and position of the human knee joint from the published adult size. Of course, it is not limited to this range due to physical differences (individual differences).
　図４に示すように、例えば、ポータル５３から超音波プローブ１４を侵入させると、先端処置部１５が大腿骨６１の最下部を通過する。の大腿骨と頚骨の隙間Ｌ１３は、４ｍｍ程度である。さらに、この最下部から１０ｍｍ程度の距離で半月板７１ｂの後角又は後節に到達する。また、半月板１００は、１０ｍｍ程度の幅を有している。また、半月板７１ａ，７１ｂは、後述する図８に示すように、断面が上面に傾斜面を持つ三角形である。 As shown in FIG. 4, for example, when the ultrasonic probe 14 enters from the portal 53, the distal treatment section 15 passes through the lowermost part of the femur 61. The gap L13 between the femur and the tibia is about 4 mm. Furthermore, it reaches the rear corner or the rear node of the meniscus 71b at a distance of about 10 mm from the lowermost part. The meniscus 100 has a width of about 10 mm. The meniscus 71a, 71b is a triangle whose section has an inclined surface on the upper surface, as shown in FIG.
　このような関節に対応する超音波プローブ１４は、図３に示す一例のように、ハウジング１１ａから延出する超音波プローブ１４の長さＬ１は、２０ｍｍ～３０ｍｍが必要とされる。また、超音波プローブ１４（プローブ本体）は、先端処置部１５の先端から１０ｍｍの位置で反り返るように上方に湾曲している。この湾曲角度θは、例えば、３度又は５．５度が好適している。また、先端処置部１５も大腿骨最下部と脛骨の隙間Ｌ１３を通り抜ける必要があるため、厚さが少なくとも４ｍｍ以下である。尚、先端処置部１５の先端から約１０ｍｍの位置で上方に湾曲させる湾曲部分を形成している。 For the ultrasonic probe 14 corresponding to such a joint, the length L1 of the ultrasonic probe 14 extending from the housing 11a is required to be 20 mm to 30 mm as shown in the example shown in FIG. Further, the ultrasonic probe 14 (probe main body) is curved upward so as to warp at a position of 10 mm from the distal end of the distal treatment section 15. The bending angle θ is preferably 3 degrees or 5.5 degrees, for example. Further, since the distal treatment section 15 needs to pass through the gap L13 between the lowermost part of the femur and the tibia, the thickness is at least 4 mm or less. In addition, a curved portion that is curved upward at a position of about 10 mm from the distal end of the distal treatment section 15 is formed.
　次に、図５乃至図９を参照して、超音波処置具２と内視鏡システム３０で構成される手術システム１０による損傷した半月板７１の切除処置について説明する。図５は、膝関節に形成するポータルの位置を示す図、図６は、超音波処置具を用いた関節鏡視下手術を概念的に示す図である。さらに、図７は、超音波処置具により処置を行う半月板を示す図、図８は、半月板の損傷した処置対象箇所の状態を示す図、及び図９は、半月板の処置された処置対象箇所の状態を示す図である。ここでは、内側半月板の後角又は後節に生じた損傷の処置を行う例について説明する。 Next, with reference to FIG. 5 to FIG. 9, the excision treatment of the damaged meniscus 71 by the surgical system 10 including the ultrasonic treatment instrument 2 and the endoscope system 30 will be described. FIG. 5 is a diagram showing the position of a portal formed in the knee joint, and FIG. 6 is a diagram conceptually showing an arthroscopic surgery using an ultrasonic treatment tool. Further, FIG. 7 is a diagram showing a meniscus to be treated with an ultrasonic treatment device, FIG. 8 is a diagram showing a state of a treatment target portion where the meniscus is damaged, and FIG. 9 is a treatment with meniscus treated. It is a figure which shows the state of an object location. Here, an example will be described in which treatment for damage occurring in the posterior corner or posterior segment of the inner meniscus is performed.
　図５には、超音波処置具２及び関節鏡３１を膝関節内に挿入するために設けられる前外側（膝蓋下）ポータル５１、経膝蓋靱帯ポータル５２、前内側ポータル５３及び後内側ポータル５４のそれぞれの位置例を示している。以下の説明では、ポータル５１とポータル５３を用いた例で説明する。尚、図５に示すそれぞれのポータルの位置は、代表例であって、患者の個体差、処置対象又は処置内容等によって適宜、設定されるべきものである。 FIG. 5 shows an anterior-lateral (subpatellar) portal 51, a transpatellar ligament portal 52, an anterior medial portal 53, and a posterior medial portal 54 that are provided to insert the ultrasonic treatment instrument 2 and the arthroscope 31 into the knee joint. Each position example is shown. In the following description, an example using the portal 51 and the portal 53 will be described. Note that the positions of the portals shown in FIG. 5 are representative examples, and should be set as appropriate according to individual differences among patients, treatment targets, treatment details, and the like.
　図６は、患者の膝を曲げて、関節部分を開いた状態を示している。ここでは、大腿骨６１の膝蓋面６１ａが前方を向く状態となっている。まず、関節鏡３１をポータル５１から挿入し、超音波プローブ１４をポータル５３から挿入する。 FIG. 6 shows a state where the knee of the patient is bent and the joint portion is opened. Here, the patella surface 61a of the femur 61 is in a state of facing forward. First, the arthroscope 31 is inserted from the portal 51, and the ultrasonic probe 14 is inserted from the portal 53.
　前述したように、関節鏡３１及び超音波プローブ１４は、共に大腿骨６１と脛骨４１の間を抜けて、図８に示すように半月板７１（内側半月板７１ａ）の後角又は後節付近に生じた処置対象箇所（又は、処置対象部位）１００にそれぞれの先端部が到達する。 As described above, both the arthroscope 31 and the ultrasonic probe 14 pass between the femur 61 and the tibia 41, and as shown in FIG. 8, the dorsal corner of the meniscus 71 (inner meniscus 71a) or near the posterior node. Each distal end portion reaches the treatment target location (or treatment target site) 100 generated in step (b).
　半月板１００の断面は、図５に示すように、外周側に多数の血流（血管）が通っている密な血流領域Ａ［血行野：密血流領域(Red zone)］が存在し、弧の内側に向かって、血流はあるが領域Ａよりも少ない領域Ｂ［血行野：粗血流領域(White-Red zone)］とが存在する。さら領域Ｂよりも内側においては、全く血流が流れていない領域Ｃ［無血行野：無血流領域(White zone)］が存在する。この半月板７１は、損傷を受けた場合に、血流が流れる領域Ａ及び領域Ｂは、再生することができるため、損傷した面を超音波プローブ１４で整えて、縫合処置を行う。一方、血流がない無血流領域の領域Ｃが損傷した場合には、再生できないため、超音波プローブ１４による切除処置となる。本実施形態では、無血流領域の領域Ｃが損傷した例について説明する。 As shown in FIG. 5, the cross section of the meniscus 100 includes a dense blood flow region A [blood circulation area: dense blood flow region (Red zone)] through which a large number of blood flows (blood vessels) pass on the outer peripheral side. Toward the inner side of the arc, there is a region B [blood field: rough blood flow region (White-Red zone)] that has blood flow but is smaller than region A. Further, on the inner side of the region B, there is a region C [bloodless area: bloodless zone (White zone)] where no blood flow flows. When the meniscus 71 is damaged, the region A and the region B through which blood flow flows can be regenerated, so that the damaged surface is prepared with the ultrasonic probe 14 and a suture treatment is performed. On the other hand, when the region C of the non-blood flow region where there is no blood flow is damaged, it cannot be regenerated, so that the excision treatment with the ultrasonic probe 14 is performed. In the present embodiment, an example in which the region C of the non-blood flow region is damaged will be described.
　図８及び図９に示すように、超音波プローブ１４は、プローブ本体の先端側が反り返るように上方に湾曲し、先端処置部１５が設けられている。このため、半月板７１の縦断裂となる処置対象箇所１００を切除する際に、半月板７１の傾斜する上面に沿うように先端処置部１５の切削面１５ａをあてがうことができる。 8 and 9, the ultrasonic probe 14 is curved upward so that the distal end side of the probe body is warped, and a distal treatment section 15 is provided. For this reason, when excising the treatment target location 100 that is a longitudinal tear of the meniscus 71, the cutting surface 15 a of the distal treatment section 15 can be applied along the inclined upper surface of the meniscus 71.
　先端処置部１５は、図９に示すように、半月板７１の縦断裂を切除し、且つ切除面１００ａが傾斜を持つ傾斜面になるように処置する。これは、図８に示す断裂がない正常な半月板の箇所は、傾斜面となっており、大腿骨から掛かる応力を分散させている。しかし、従来のパンチ等の器具による切除は、半月板の上面から垂直にカットした切断面となるため、角部分が生じる。この角部は、大腿骨の内顆軟骨および外顆軟骨が球状であるため、接触する半月板７１の角部分に対して応力が集中し易くなり、新たな損傷を招く虞がある。この応力の集中を防止するためには、切除面１００ａが内顆軟骨および外顆軟骨と対向する傾斜を持つ傾斜面になるように切除することは重要である。 As shown in FIG. 9, the distal treatment section 15 excises the longitudinal tear of the meniscus 71 and treats the excision surface 100a to be an inclined surface having an inclination. As for this, the location of the normal meniscus which does not have a tear shown in FIG. 8 becomes an inclined surface, and the stress applied from a femur is disperse | distributed. However, conventional cutting with a tool such as a punch results in a cut surface cut perpendicularly from the upper surface of the meniscus, resulting in a corner portion. In this corner, since the inner condylar cartilage and the outer condyle cartilage of the femur are spherical, stress tends to concentrate on the corner portion of the meniscus 71 that comes into contact with the corner, which may cause new damage. In order to prevent this concentration of stress, it is important to cut the cut surface 100a so as to be an inclined surface having an inclination facing the inner condylar cartilage and the outer condylar cartilage.
　本実施形態の超音波プローブ１４は、上向きに沿って湾曲した先に先端処置部１５が設けられているため、大腿骨６１と脛骨４１の間を容易に抜けて、半月板７１の後角の処置対象箇所に到達し、半月板上面に角部が発生しないように、傾斜する切除面に切除することができる。 In the ultrasonic probe 14 of the present embodiment, the distal end treatment portion 15 is provided at the tip curved upward, so that it can easily pass between the femur 61 and the tibia 41 and the posterior corner of the meniscus 71. It can be cut into an inclined cut surface so that it reaches the treatment target location and no corners are generated on the upper surface of the meniscus.
　次に、図１０及び図１１を参照して、超音波処置具２と内視鏡システム３０で構成される手術システム１０による損傷した足関節の処置について説明する。　
　図１０に示すように、足関節は、脛骨４１と距骨４２とが図示しない靱帯により摺動可能に連結されている。脛骨４１の下関節面（軟骨）４１ａと距骨４２の距骨滑車面（軟骨）４２ａとが摺動し、関節が曲がることとなる。例えば、距骨滑車面４２ａに距骨骨軟骨損傷が生じた場合には、剥離又は分離した箇所等を切除し除去する処置を行うこととなる。 Next, with reference to FIG.10 and FIG.11, the treatment of the damaged ankle joint by the surgery system 10 comprised of the ultrasonic treatment instrument 2 and the endoscope system 30 will be described.
As shown in FIG. 10, in the ankle joint, the tibia 41 and the talus 42 are slidably connected by a ligament (not shown). The lower joint surface (cartilage) 41a of the tibia 41 and the talus pulley surface (cartilage) 42a of the talus 42 slide to bend the joint. For example, when damage to the talus bone cartilage occurs on the talus pulley surface 42a, a treatment for excising and removing the separated or separated portion is performed.
　同様に、図１１に示すように、脛骨４１の下関節面４１ａに損傷が生じた場合には、切除処置を行う必要がある。例えば、脛骨４１の下関節面４１ａの踵側が処置対象箇所であった場合に、足首の前側にポータル４４を形成すると、従来の直線的に延伸する超音波プローブ又は、先端が下方に湾曲された超音波プローブでは、凸形状の距骨４２の距骨滑車面４２ａが障害となって奥まで届かない事態が生じる。 Similarly, as shown in FIG. 11, when the lower joint surface 41a of the tibia 41 is damaged, it is necessary to perform resection. For example, when the portal 44 is formed on the front side of the ankle when the heel side of the lower joint surface 41a of the tibia 41 is the treatment target portion, the conventional linearly extending ultrasonic probe or the tip is bent downward. In the ultrasonic probe, a situation occurs in which the talus pulley surface 42a of the convex talus 42 does not reach the back because of an obstacle.
　本実施形態では、図３に示したように、超音波プローブ１４は、上向きに反って湾曲した先に先端処置部１５が設けられているため、距骨４２の距骨滑車面４２ａを越えて、処置対象箇所に到達し、下関節面４１ａの曲面に合わせた傾斜する切除面に切除することができる。尚、距骨滑車面４２ａの奥側の曲面の軟骨を切除処置する場合には、図３に示す先端処置部１５の下面に設けた切削面１５ａを上面に形成し、デバイス本体１１を１８０度返して、処置する。また、脛骨４１の下関節面４１ａの前方側において、同様に、デバイス本体１１を１８０度返して、軟骨を切除してもよい。 In the present embodiment, as shown in FIG. 3, the ultrasonic probe 14 is provided with the distal treatment section 15 at the tip curved upward, so that the treatment is performed beyond the talus pulley surface 42 a of the talus 42. It reaches the target location and can be excised on an inclined excision surface that matches the curved surface of the lower joint surface 41a. When the cartilage of the curved surface on the back side of the talus pulley surface 42a is excised, a cutting surface 15a provided on the lower surface of the distal treatment section 15 shown in FIG. 3 is formed on the upper surface, and the device body 11 is turned 180 degrees. And treat. Similarly, on the front side of the lower joint surface 41a of the tibia 41, the device body 11 may be returned 180 degrees to cut the cartilage.
　また、その他、例えば、脛骨４１の下関節面４１ａと距骨４３が衝突すると、骨棘（図示せず）が形成される場合がある。本実施形態の超音波プローブ１４は、骨棘の形成された位置に関係なく、容易にその骨棘を切除することができる。 In addition, for example, when the lower joint surface 41a of the tibia 41 and the talus 43 collide, osteophytes (not shown) may be formed. The ultrasonic probe 14 of the present embodiment can easily excise the osteophyte regardless of the position where the osteophyte is formed.
　以上のように、本実施形態によれば、これまでの超音波プローブで先端処置部１５を処置対象箇所に到達しなかった箇所においても、プローブ本体の先端が上側に反るように湾曲又は屈曲して先端処置部１５が設けられているため、容易に到達できる。　
　また、処置対象部位に到達した後、処置対象部位に曲がりや傾斜があった場合でも、その方向に沿って必要なだけ処置対象部位を切除を行うことができる。 As described above, according to the present embodiment, the tip of the probe body is curved or bent so that the tip of the probe body is warped upward even at a location where the distal treatment section 15 has not reached the treatment target location with the conventional ultrasonic probe. Since the distal treatment section 15 is provided, it can be easily reached.
In addition, even when the treatment target part is bent or inclined after reaching the treatment target part, the treatment target part can be excised as necessary along the direction.

Claims (4)

  1. 　超音波発生部が発生させた超音波振動を基端側で受けて、先端側に伝達するプローブ本体と、
    　前記プローブ本体の先端に設けられ、前記超音波振動を用いて処置対象部位を切削する切削面を有する先端処置部と、を備え、
    　前記プローブ本体は、前記先端処置部から前記基端側に予め設定された長さを離れた前記プローブ本体上の位置で前記先端処置部に設けられた前記切削面の面側とは反対側に反り返るように湾曲する湾曲部分を有する超音波プローブ。     A probe main body that receives ultrasonic vibration generated by the ultrasonic generator on the proximal end side and transmits it to the distal end side;
    A tip treatment section provided at the tip of the probe main body and having a cutting surface for cutting a treatment target site using the ultrasonic vibration,
    The probe main body is located on a side opposite to the surface side of the cutting surface provided in the distal treatment section at a position on the probe main body that is away from a predetermined length on the proximal end side from the distal treatment section. An ultrasonic probe having a curved portion that curves to warp.
  2. 　外部から伝達された超音波振動を基端側で受けて、先端側に伝達するプローブ本体と、
    　前記プローブ本体の先端に設けられ、前記超音波振動を用いて処置対象部位を切削する切削面を有する先端処置部と、を備え、
    　前記プローブ本体は、前記先端処置部から前記基端側に予め設定された長さを離れた前記プローブ本体上の位置で前記先端処置部に設けられた前記切削面の面側とは反対側に反り返るように湾曲する湾曲部分を有する超音波プローブ。     A probe body that receives ultrasonic vibration transmitted from the outside on the proximal end side and transmits it to the distal end side,
    A tip treatment section provided at the tip of the probe main body and having a cutting surface for cutting a treatment target site using the ultrasonic vibration,
    The probe main body is located on a side opposite to the surface side of the cutting surface provided in the distal treatment section at a position on the probe main body that is away from a predetermined length on the proximal end side from the distal treatment section. An ultrasonic probe having a curved portion that curves to warp.
  3. 　前記プローブ本体の前記湾曲部分は、前記先端処置部を含む前記超音波プローブの先端から少なくとも略１０ｍｍの位置に設けられる請求項１又は請求項２のいずれかに記載の超音波プローブ。 3. The ultrasonic probe according to claim 1, wherein the curved portion of the probe main body is provided at a position of at least approximately 10 mm from a distal end of the ultrasonic probe including the distal treatment section.
  4. 　前記プローブ本体は、前記先端処置部を含む先端から２０ｍｍ～３０ｍｍの範囲の位置からハウジングまでの前記プローブ本体を覆うシースを有し、さらに
    　前記先端処置部と前記プローブ本体の境から前記シースまで、伝達する前記超音波振動を減衰を生させない隙間を有して前記プローブ本体を覆うプローブカバーを有する請求項１又は請求項２のいずれかに記載の超音波プローブ。     The probe main body has a sheath covering the probe main body from a position in a range of 20 mm to 30 mm from the distal end including the distal treatment section to the housing, and further from the boundary between the distal treatment section and the probe main body to the sheath, The ultrasonic probe according to claim 1, further comprising a probe cover that covers the probe main body with a gap that does not cause attenuation of the transmitted ultrasonic vibration.
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Publication number Priority date Publication date Assignee Title
USD974558S1 (en) 2020-12-18 2023-01-03 Stryker European Operations Limited Ultrasonic knife

Citations (2)

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Publication number Priority date Publication date Assignee Title
JP2008119250A (en) * 2006-11-13 2008-05-29 Miwatec:Kk Handpiece for ultrasonic surgical instrument, and horn
WO2016111055A1 (en) * 2015-01-07 2016-07-14 オリンパス株式会社 Ultrasonic probe

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2008119250A (en) * 2006-11-13 2008-05-29 Miwatec:Kk Handpiece for ultrasonic surgical instrument, and horn
WO2016111055A1 (en) * 2015-01-07 2016-07-14 オリンパス株式会社 Ultrasonic probe

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
USD974558S1 (en) 2020-12-18 2023-01-03 Stryker European Operations Limited Ultrasonic knife

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