CN101073509B - 包括具有多种缝合钉尺寸的钉仓的外科缝合器 - Google Patents
包括具有多种缝合钉尺寸的钉仓的外科缝合器 Download PDFInfo
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Abstract
一种外科缝合器,包括钉仓和砧部件。该钉仓包括位于若干行保留槽中的多个手术紧固钉。该钉仓可具有环形或直线形结构的保留槽。该钉仓的组织接触表面呈锥形或阶梯形。该砧部件具有组织接触表面,该组织接触表面包括与该保留槽基本对准的多个凹陷。此外,该砧部件的组织接触表面可补充该钉仓的组织接触表面。
Description
技术领域
本发明涉及手术缝合工具,特别涉及包括具有多种缝合钉尺寸的手术缝合工具。本申请是序列号为11/204060的共同未决(co-pending)美国专利申请的部分延续,其于2005年8月15日提出,在此将其全部内容引入作为参考。
背景技术
有一些专门适用于诸如首尾相接缝合、胃肠缝合、内窥镜胃肠缝合和横向缝合的各种操作的已知类型的外科缝合器。用于这些各种操作的缝合器的例子可在序号为5,915,616、6,202,914、5,865,361和5,964,394的美国专利中找到。
每种外科缝合器包括一个相对于钉仓接近设置的砧。钉仓典型地具有一个或多个侧向间隔的钉排,依据特定的缝合器,可将该钉排布置成线型或非线型构造。该砧包括与钉仓内的缝钉的钉槽对准和/或重合的缝钉成形凹陷。使用中,每种外科缝合器包含夹紧待固定组织、弹射单个缝钉、施加压力使缝钉贯穿夹紧组织以及相对于砧的缝钉成形凹陷闭合和/或形成缝钉。
应用上面所公开的任何一种外科缝合器,在横断组织时和/或缝合操作中的共有问题是缝合强度和止血可完成程度间的平衡。众所周知在砧和钉仓之间具有固定间隙(即一致的距离)的外科缝合器中包括不同尺寸的缝钉。
发明内容
本公开直接涉及被构造成在组织界面上实现缝合强度和止血程度间改善平衡的外科缝合器。尤其是,本公开的实施例包括不同尺寸的手术紧固钉。更进一步,砧部件和钉仓之间的距离(即间隙)从钉仓的中心线向钉仓的外边缘发生变化。优选地,与中心线处的间隙相比,在钉仓外边缘处的间隙更大。这可通过改变钉仓和/或砧部件的轮廓而实现。将不同尺寸的手术紧固钉与砧部件和钉仓之间变化的间隙结合起来在组织界面处提高了缝合强度和止血程度。
根据本公开的一个方面,外科缝合器包括界定了具有可操作地与其联接的砧部件的第一结构,以及界定了可操作地与其联接的钉仓的第二结构。钉仓包括具有阶梯状剖面轮廓的组织接触表面。钉仓的组织接触表面还包括多个形成于其中以保留手术紧固钉的保留槽。在外科缝合器的使用期间,砧部件和钉仓相对于彼此接近。
钉仓的阶梯状接触表面界定了多个组织接触表面,其每一个具有不同的高度。在一个实施例中,钉仓的阶梯状组织接触表面包括具有一高度的内组织接触表面、具有高度比内组织接触表面高度低的中间组织接触表面以及具有高度比中间组织的接触表面高度低的外组织接触表面。
内、中和外组织接触表面每个包括至少一行形成于其中的保留槽。多个手术紧固钉被一一地布置在各保留槽中。每个手术紧固钉包括一个背跨(backspan)和一对向下的脚。
保留在内组织接触表面中所形成的保留槽内的手术紧固钉具有第一腿长,保留在中间组织接触表面中所形成的保留槽内的手术紧固钉 具有第二腿长,以及保留在外组织接触表面中所形成的保留槽内的手术紧固钉具有第三腿长。在一个实施例中,保留在内组织接触表面中所形成的保留槽内的手术紧固钉具有大约2.3mm的腿长,而保留在中间组织接触表面中所形成的保留槽内的手术紧固钉具有大约3.5mm的腿长,以及保留在外组织接触表面中所形成的保留槽内的手术紧固钉具有大约4.1mm的腿长。
可以想到外科缝合器可以是圆形外科缝合器,其中砧部件和钉仓可以是环形的。在一个实施例中,多个组织接触表面在径向朝外的方向上高度降低。因此,内组织接触表面最接近环形钉仓的中心而外组织接触表面离环形钉仓的中心最远。而且,具有相对较短腿长的手术紧固钉保留在离环形钉仓的中心最近的保留槽中,而具有相对较长腿长的手术紧固钉保留在离环形钉仓的中心最远的保留槽中。
进一步可以想到外科缝合器可以是线型外科缝合器,其中砧部件和钉仓是线型的。在这些器械中,钉仓和/或砧部件能界定一刀割线。因此,多个组织接触表面在与刀割线垂直朝外的方向上高度降低。特别地,内组织接触表面最接近刀割线而外组织接触表面离刀割线最远。另外,具有相对较短腿长的手术紧固钉保留在离刀割线最近的保留槽中,而具有相对较长腿长的手术紧固钉保留在离刀割线最远的保留槽中。
可以想到砧部件可具有包括多个组织接触表面的呈阶梯状剖面轮廓的组织接触表面,其中每个组织接触表面具有不同的高度。另外,多个组织接触表面的每一个可包括至少一行形成于其中的环形和/或线型手术紧固钉成形凹陷。
在一个实施例中,砧部件可具有与钉仓的阶梯状组织接触表面形状互补(即阶梯状的)的组织接触表面。在另一个实施例中,砧部件可具有阶梯状的组织接触表面而钉仓的组织接触表面基本上是平坦的。在又一实施例中,砧部件可具有与钉仓的阶梯状组织接触表面形状基本互补的组织接触表面(即砧部件的阶梯状组织接触表面的深度不等于钉仓组织接触表面的单个组织接触表面的高度)。在再一实施例中,砧部件可具有与钉仓的组织接触表面成镜像对称的阶梯状组织接触表面(即砧部件组织接触表面的单个组织接触表面的深度基本上等于钉仓单个组织接触表面的深度)。
在本公开的其他实施例中,外科缝合器包括在其一端设置的操作工具。该操作工具包括砧部件和钉仓。可将钉仓包括在可抛弃的手术缝合装置或者重复使用的手术缝合装置中。更进一步,可在可抛弃的或者重复使用的手术缝合装置中设置可替换的加载单元。在一个实施例中,可替换的加载单元包括钉仓,而可替换的加载单元的可选实施例包括钉仓和砧部件。特别地,钉仓包括布置在多行保留槽中的多个手术紧固钉。该手术紧固钉可具有不同的腿长,其中将具有基本上相同腿长的多个手术紧固钉布置在一行中。将许多紧固钉弹射部件布置在钉仓内,其中每个紧固钉弹射部件包括多个缝钉推动器以便与致动机构协同弹射手术紧固钉。紧固钉弹射部件的每个缝钉推动器的形状与砧部件的缝钉凹陷和钉仓的保留槽的形状大致符合。
钉仓可包括以钉仓的中心线为顶点并朝着钉仓的外壁成锥形的成角度的组织接触表面。可选的,钉仓的组织接触表面可具有一表面,该表面平行于钉仓底部表面或者平行于由布置在所选行中的手术紧固 钉的背跨所界定的表面。组织接触表面的平行表面具有足够容纳至少一行手术紧固钉的宽度尺寸。该钉仓可包括刀具路径。
与当前公开的钉仓协作,砧部件可包括基本平行于钉仓底部表面或者基本平行于由布置在所选行中的手术紧固钉的背跨所界定的表面的平坦的组织接触表面。在备选方案中,砧部件的组织接触表面是以与钉仓的组织接触表面的角相反的方式成角度的。更进一步,砧部件的组织接触表面可具有基本平行于钉仓的底部表面或者基本平行于由布置在所选行中的手术紧固钉的背跨所界定的表面的平面以及界定了与钉仓的组织接触表面所界定的角度呈相反角度的锥形表面。砧部件的平行表面具有的宽度尺寸对应于钉仓的平行表面的宽度尺寸。
进一步可以想到的是手术缝合装置的一个实施例包括用于补充密封所扣紧的组织层的结构。在一个实施例中,手术缝合装置包括具有储腔和供应管线的伤口闭合组件。该储腔适合存储一些伤口闭合物质并经过供应管线流体地连通到钉仓以用来将一定量的伤口闭合物质传送到多个保留槽中。
在当前公开的外科缝合器的又一个实施例中,钉仓可包括靠近钉仓中心线的平坦表面和邻近该平坦表面的弓形表面。该弓形表面从中心线向外延伸并朝向钉仓底部向下延伸,该弓形表面相对于钉仓底部形成凹陷结构。每个表面包括至少一行保留槽并形成组织接触表面。此外,该钉仓的实施例包括多个紧固钉弹射部件和多个手术紧固钉。未发射的手术紧固钉的末端可位于弓形表面和平坦表面下方,或者伸入保留槽,其中多个末端与组织接触表面齐平。该钉仓的实施例可结合具有平坦组织接触表面的砧部件,该砧部件的组织接触表面与钉仓的组织接触表面共同作用,定位其间的组织层并形成完成后的手术紧 固钉。可选地,砧部件可具有在宽度上与钉仓的平坦表面对应的平坦表面和在相反方向上曲率与钉仓的弓形表面相同的弓形表面。该钉仓可包括沿钉仓的中心线设置的手术刀通道。
在当前公开的外科缝合器的进一步实施例中,钉仓可包括第一平坦表面和第二平坦表面,其中每个平坦表面包括至少一行保留槽。第一平坦表面和第二平坦表面基本平行于该钉仓的底面并相互平行,但被垂直分隔开以便不会相互共面。与前面的实施例中相同,该钉仓包括多个紧固钉弹射部件和多个手术紧固钉。第一间隙位于砧部件的平坦组织接触表面和钉仓的第一平坦表面之间,第二间隙位于砧部件的平坦组织接触表面和第二平坦表面之间。该钉仓可包括位于沿该钉仓的中心线的手术刀通道。可选地,具有互补表面结构的砧部件可结合该钉仓使用,其中对该钉仓的第二平坦表面和该砧部件的相应表面之间的间隔限定了一个大于第二间隙的间隙。
在当前公开的外科缝合器的进一步实施例中,钉仓具有多个紧固钉弹射部件和多个手术紧固钉。该钉仓包括与底面相对的平坦表面。填充层位于平坦表面顶部。该填充层可由支撑材料构成。该填充层大致呈三角形,并从该钉仓的中心线向下和向外延伸,以便其最大高度靠近该中心线。具有平坦表面的砧部件可结合该钉仓使用,以形成完成后的手术紧固钉。可选地,可使用补足该填充层的具有锥形(即成角度的)表面的砧部件。该钉仓可包括手术刀通道。
当前公开的外科缝合器的替换实施例包括钉仓和砧部件。该钉仓包括多个手术紧固钉和多个紧固钉弹射部件。顶板在钉仓的内壁和外壁之间延伸,并为基本平行于钉仓底面的平面结构。垂直组件邻接内壁。横向组件与该顶板垂直间隔,可柔性地附着于该垂直组件。横向 组件的顶面限定了与砧部件的组织接触表面相对的组织接触表面。在手术紧固钉的接近和/或形成过程中,横向组件弯曲以使组织接触表面之间的间隙在靠近钉仓中心线处最小,在靠近钉仓外壁处最大。该钉仓可包括手术刀通道。可选地,该砧部件可包括限定该组织接触表面的锥形表面,其中该锥形表面从该钉仓的中心线向外并向上延伸,以便该砧部件在靠近中心线处具有最大厚度,在靠近该砧部件外边缘处具有最小厚度。
所有现公开的外科缝合器的实施例向使用手术紧固钉连接在一起的组织层提供了一种可变压力斜度(即负载轮廓)。因此,靠近外科缝合器中心(即钉仓中心)的组织层承受较高的压力(即负载),从而与进一步远离外科缝合器中心的组织层相比,形成较薄的组织层。由于靠近外科缝合器中心的组织层可被更大程度地压缩,较小尺寸的手术缝钉或紧固钉可用于机械缝合(即扣紧)横切的组织层。进一步地,对要连接的组织层提供逐渐压缩的斜度可导致较高程度的止血。由于钉仓的轮廓形状,在外科缝合器的中心,组织层可被更大程度地压缩,由于组织层随着砧部件相对于钉仓的移动,可从较高压力的区域(即中心)转变(即移动)到较低压力的区域(即边缘),从而形成压力斜度。
通过附图的描述和实施例的详细描述将在下面更清楚地阐述本公开的外科缝合器,以及伴随的优点。
通过考虑结合附图的以下描述,本公开的其他目的和特征将变得很明显。
附图说明
在此结合附图描述本发明公开的手术缝合装置的实施例,其中:
图1是根据本公开所构造的外科缝合器的立体图;
图2是从图1的2-2向剖开而得到的图1的外科缝合器远端部分的示意性剖面侧视图;
图2A是根据本公开的一个实施例的手术紧固钉的立体图;
图3A是图2的指示区域的放大示图,阐明了根椐本公开的可选实施例的组织接触表面;
图3B是图2的指示区域的放大示图,阐明了根椐本公开的另一实施例的组织接触表面;
图3C是图2的指示区域的放大示图,阐明了根椐本公开的又一实施例的组织接触表面;
图3D是图2的指示区域的放大示图,阐明了根椐本公开的再一实施例的组织接触表面;
图4是根据本公开所构造的可选外科缝合器的立体图;
图5是根据本公开所构造的又一外科缝合器的立体图;
图6是根据本公开所构造的再一外科缝合器的立体图;
图6A是图6的砧部件的一部分的立体图;
图7是从图4-6每一个的7-7向看去,图4-6的外科缝合器远端部分的示意性剖面侧面正视图;
图7A是图6的外科缝合器远端部分的备选实施例的示意性剖面侧视图;
图8是根据本公开的另一个实施例的钉仓的立体图;
图9A是图8的钉仓的横截面端视图,表示手术紧固钉的第一种排布;
图9B是图8的钉仓的横截面端视图,表示手术紧固钉的第二种排布;
图9C是图8的钉仓的替换实施例,表示手术紧固钉的第二种排布和砧部件的替换实施例;
图10是图9A的钉仓的替换实施例,表示手术紧固钉的第二实施例;
图11是图10的砧部件和钉仓的替换实施例;
图12是图8的钉仓的进一步实施例;
图13是图12的砧部件和钉仓的另一个实施例;
图14是图8的钉仓和砧部件的另一个实施例;
图15是图14的具有钉仓的砧部件的替换实施例;
图16A是传统的外科缝合器发射之后组织表面的剖面侧视图;
图16B是图7和图10-15的外科缝合器发射之后完成的组织界面的剖面侧视图;
图17A是图8的钉仓的另一实施例的横截面端视图,表示手术紧固钉的第一种排布;
图17B是图17A的钉仓的替换实施例,表示手术紧固钉的第二种排布;
图17C是图17A的砧部件和钉仓的替换实施例;
图17D是图17B的砧部件和钉仓的替换实施例;
图17E是图17A的钉仓的进一步实施例;
图17F是图17E的砧部件和钉仓的替换实施例;
图18A是图8的钉仓的进一步实施例的横截面端视图;
图18B是图18A的砧部件和钉仓的替换实施例;
图19A是图8的钉仓的进一步实施例的横截面端视图,表示置于钉仓的组织接触表面上的成形支撑部件,和虚像所示的置于砧部件的组织接触表面上的成形支撑部件;
图19B是图19A的砧部件和钉仓的替换实施例;
图20A是图7A的钉仓的另一个实施例的横截面端视图;
图20B是图20A的砧部件和钉仓的替换实施例的横截面端视图;
图20C是图20B的砧部件和钉仓的进一步实施例;
图21A是图8的钉仓的另一实施例的横截面端视图;
图21B是图21A的砧部件和钉仓的另一实施例;
图22A是图8的钉仓的进一步实施例和砧部件的进一步实施例的横截面端视图;
图22B是图22A的钉仓和砧部件的替换实施例;
图22C是图22B的具有钉仓的砧部件的进一步实施例。
具体实施方式
现在将参照附图详细地描述本公开的外科缝合器的实施例,其中图中相同的附图标记表示相似或同样的元件。在图中和下面的描述中,术语“近端”按照惯例将表示最接近操作者的外科缝合器的端部,而术语“远端”将表示离操作者最远的该设备的端部。
本公开涉及用于可抛弃的或者可重复使用的外科缝合器的钉仓和砧部件。本次所公开的钉仓和砧部件,如以下所详细讨论的,可与在图1、4、5或者6中所示的任何外科缝合器一起使用。另外,可将可替换的加载单元设置在可抛弃的或者可重复使用的外科缝合器中。在一个实施例中,可替换的加载单元包括一钉仓,包括在此所公开的任何一种钉仓。可选地,可替换的加载单元包括钉仓和砧部件,包括在此所公开的任何一种砧部件。与可抛弃的或可重复使用的手术缝合装置结合,可替换的加载单元提供各个外科缝合器改进的灵活性,因为各个外科缝合器容易适应不同的缝合操作。在以下公开的每个实施例中,置于钉仓中的缝钉或手术紧固钉的排列使手术紧固钉的末端可以与钉仓的组织接触表面充分匹配。可选地,手术紧固钉的末端可位于该组织接触表面上方或下方。
现在详细参考图1-2,其中相同的附图标记表示相似或同样的元件,根据本公开的第一实施例,外科缝合器通常指代为100。
如图1中所见,外科缝合器100包括具有至少一个枢转致动手柄部件103的手柄组件102,并进一步包括推进装置。从手柄组件102处延伸出来,设置有管体部分104,其可以如此构造使得沿其长度具有弯曲的形状。管体部分104终止于具有圆形钉仓118的紧固钉弹射部件组件106,该钉仓包括设置于其远端的组织接触表面121。砧杆110将砧组件108可操作地连接于手柄组件102。砧组件108从与钉仓118共同精密对准的位置到与钉仓118间隔开的位置可以重定位。砧组件108包括砧头109。进一步地,外科缝合器100可包括伤口闭合组件50。伤口闭合组件50包括至少一个存储装置或储存器52和至少一个供应管线54。供应管线54将储存器52流体地连接于砧轴110,其中砧轴包括至少一个用于分配伤口闭合材料“W”的开口56。通过提供伤口闭合材料“W”并结合手术紧固钉,组织层之间形成的结合物的强度得以改善。
如图2中所见,组织接触表面121是阶梯状的,包括一个外组织接触表面121a、一个中间组织接触表面121b和一个内组织接触表面121c。从缝钉推动器或者紧固钉弹射部件130的底面上的点131测量,每个组织接触表面121a-121c具有彼此不同的高度。在紧固钉弹射部件130的底面基本为平坦的区域内,点131最为接近杆111。特别地,组织接触表面121a-121c是彼此基本平行的平面结构,但彼此不是共面的(即阶梯状的)。另外,每个组织接触表面121a-c界定了穿过各自组织接触表面121a-c延伸的平面轴。第一壁面使组织接触表面121a和121b相互连接,同时第二壁面使组织接触表面121b和121c相互连接。第一和第二壁面是平面结构,其中每个壁面界定了一个平面轴。在一个实施例中,壁面的平面轴垂直于组织接触表面121a-c的平面轴。
内组织接触表面121c具有最高的高度,外组织接触表面121a具有最低的高度,而中间组织接触表面121b具有介于外和内组织接触表面121a、121c高度之间的高度。虽然组织接触表面121a-121c显示成从外组织接触表面121a到内组织接触表面121c(即径向向内)高度逐渐增加,但是每个组织接触表面的高度依据特定手术操作而改变也是在本公开的范围内。例如,组织接触表面121a-121c可以在径向向外的方向上高度增加,中间组织接触表面121b可以是最高或者是最低的组织接触表面,或者组织接触表面121a-121c中的至少两个具有相同的高度。
在一个实施例中,每个组织接触表面121a-121c包括形成于其中的保留槽123的各自环形排119a-119c。环形排119a-119c的每个保留槽123被构造并定制尺寸成能够在其中保留一个缝钉或手术紧固钉125。如图2A所示,每个手术紧固钉125包括一个背跨(backspan)27和一对悬垂的脚25。每个脚25相对背跨27形成直角。在一个实施例中,槽123的每个环形排119a-119c包括具有其自身特有特征的各自的手术紧固钉125a-125c。
如图2中所见,手术紧固钉125a的脚25a具有第一腿长,手术紧固钉125b的脚25b具有第二腿长,而手术紧固钉125c的脚25c具有第三腿长。特别地,在径向向外的方向上手术紧固钉125a-125c高度增加。在一个实施例中,手术紧固钉125c的脚25c具有大约2.3mm的腿长,手术紧固钉125b的脚25b具有大约3.5mm的腿长,而手术紧固钉125a的脚25a具有大约4.1mm的腿长。同样地,内组织接触表面121c具有最高的高度并保留具有最短腿长的手术紧固钉125c,而外组织接触表面121a具有最低的高度并保留具有最长腿长的手术紧固钉125a。 使组织接触表面121逐步阶梯状下降到中间组织接触表面121b然后再下降到外组织接触表面121a,分别导致了手术紧固钉125b和125c的形成。可以想见且在本次公开范围内的是任何数量的布置都是可能的。
虽然将保留槽123的单个环形排119a-119c显示成用于各自的组织接触表面121a-121c,但是每个组织接触表面121a-121c可包括多个保留槽的环形排是可以想到并在本次公开范围内的。
如图2中所见,外科缝合器100的紧固钉弹射组件106包括设置在钉仓118内的紧固钉弹射部件130。紧固钉弹射部件130包括具有通常的截头圆锥状的近端部分132和界定了周围有所间隔的缝钉推动器134a-c的同心环的远端部分,每一个缝钉推动器容纳于各自的缝钉保留槽123内并与设置在环形排119a-c内的其对应的手术紧固钉125a-c协同作用。在一个实施例中,可以想到将紧固钉弹射部件130的近端部分132构造并定制尺寸成能与驱动管138的远端接触。因此,当通过推进驱动管138推进紧固钉弹射部件130时,缝钉推动器134a-c将进一步进入保留槽123从而轴向向外推动包含于其中的手术紧固钉125。
在可选实施例中,紧固钉弹射部件130的缝钉推动器134a-c具有不同的高度用来与不同尺寸的手术紧固钉协同作用。特别地,将缝钉推动器134a-c制成这样的尺寸,使得在将手术紧固钉125a-c布置在它们各自环形排119a-c中时,尽管每行手术紧固钉之间腿长不同,但是手术紧固钉125a-c的尖端基本上被定位在相同的平面上。
外科缝合器100(图1)包括具有砧头109和砧杆110的圆形砧组件108,该砧杆从其近端延伸并适于接合从钉仓118朝远侧延伸的杆 111。砧头109包括布置在其近端的环形砧部件112,其中砧部件112包括至少一行沿其圆周附近形成的紧固钉成形凹陷114。在一个实施例中,外科缝合器100包括沿其圆周附近形成的三行横向间隔的紧固钉成形凹陷114。每个紧固钉成形凹陷114与相应的保留槽123对齐。
虽然在图2中砧部件112显示成具有基本平面的组织接触表面,但是具有多种可选构造的外科缝合器100是可以想到并且在本公开的范围内。例如,如图3A中所见,砧部件112a可具有包括表面116a-116c的组织接触表面,该表面116a-116c成形(使成阶梯状)为与钉仓118的阶梯状组织接触表面121形状互补,或者如图3B中所见,砧部件112b可具有包括表面116a-c的阶梯状组织接触表面而钉仓118的组织接触表面121基本上是平面的。另外,例如,如图3C中所见,砧部件112c可具有比砧钉凹陷114a或114c向砧部件112c内延伸更长距离的—行砧钉凹陷114b,用来容纳具有更长腿长的手术紧固钉,或者如图3D中所见,砧部件112d可具有包括表面116a-c的组织接触表面,该组织接触表面与钉仓118的组织接触表面121呈对称的阶梯状(即砧部件112d的组织接触表面的单个组织接触表面的深度基本上等于钉仓118的单个组织接触表面121a-121c的深度)。
选择手术紧固钉125a-125c的尺寸并计划用在肥胖症处理时典型所需的胃灼烧(gastric firings)中。然而,将所选的手术紧固钉125a-125c的尺寸选定为用于在不同类型组织中进行施用,例如结肠、肠、肺、支气管、肺血管、肝等等,是可以想到并在本次公开范围内的。
应用中,将外科缝合器100放置在患者身体内的管状器官中并将待连接的脏器的端部放置在钉仓118和砧组件108之间的间隙中。按照惯例,在砧组件108接近钉仓118之前通过荷包缝合可将脏器的端 部固定在砧杆110的周围。接着将外科缝合器100靠近并弹射。手术缝合装置和其使用方法的例子公开在美国专利No.5,915,616中,该专利目前转让给Tyco医疗健康集团,其整个内容在此编入作为参考。
现在转到图4和图7,根据本公开的另一实施例,用于执行手术吻合缝合的胃肠缝合类型的外科缝合器通常指代为200。外科缝合器200包括第一手柄202,该第一手柄具有界定了从其远端延伸的钉仓接收部分的钳夹203,在钳夹203中可接纳钉仓204,第二手柄206,该第二手柄具有界定了从其远端延伸的砧部件接收部分的钳夹205,以及与钳夹205可操作地连接的砧部件208。第一和第二手柄202、206构造成这样使得钉仓204基本上与砧部件208对准。
如图7中所见,钉仓204包括阶梯状组织接触表面121,其包括外组织接触表面121a、中间组织接触表面121b和内组织接触表面121c,从钉仓204的底面上的点231测量它们时,每一个组织接触表面具有相互不同的高度。其中点231沿钉仓204的中心线存在。组织接触表面121a-121c是基本上彼此平行的平面结构,但不是彼此共面的。例如,如图7中所示,组织接触表面121a-121c在从刀具路径222垂直向外的方向上高度降低。在不包括刀具路径222的实施例中,组织接触表面121a-c在从钉仓204的中心线垂直向外的方向上高度降低。
每个组织接触表面121a-121c包括形成于其中的保留槽123的各自线型排119a-119c。将每个线型排119a-119c的保留槽123构造并定制尺寸成能够在其中保留手术紧固钉125。槽123的每个线型排119a-119c包括具有其自身特有特征的相应的手术紧固钉125a-125c。
如图7中所见,手术紧固钉125a的脚25a具有大约4.1mm的第一腿长,手术紧固钉125b的脚25b具有大约3.5mm的第二腿长,以及手术紧固钉125c的脚25c具有大约2.3mm的第三腿长。特别地,手术紧固钉125a-125c在相对朝向与可选刀具路径222相垂直向外的方向上高度增加。刀具路径222沿钉仓204、310或者412的中心线布置并适于可滑动地接钠可选刀具(未显示)。使组织接触表面121逐步阶梯状下降到中间组织接触表面121b然后再下降到外组织接触表面121a分别导致了手术紧固钉125b和125c的形成。可以想见且在本次公开范围内的是任何数量的布置是可能的。
应用中,类似于或者依照其他已知的外科缝合器使外科缝合器200进行弹射。手术缝合装置和其使用方法的例子公开在美国专利No.6,202,914中,该专利目前转让给Tyco医疗健康集团,其整个内容在此编入作为参考。
另外参考图16B,在外科缝合器200进行弹射后,在截面上可看见缝合后的组织界面。因此,手术紧固钉125a-125c中的一些或全部用来彼此握持组织“A”和“B”,而手术紧固钉125c也用来提供止血。
虽然外科缝合器200是线型手术缝钉,但是可以想到并在本次公开范围内的是,外科缝合器200的砧部件和钉仓中的至少一个的组织接触表面可具有的剖面轮廓,基本类似于如图3A-3D中所示的外科缝合器100砧部件和钉仓的的组织接触表面。
现在转到图5和7,根据公开的另一实施例,用于执行手术吻合缝合的腹腔镜类型的外科缝合器通常指代为300。外科缝合器300包括手柄302、操作用具306,和用于使操作用具306和手柄302相互连接的 伸长杆304。通常,操作用具306被设计用来夹在组织上面然后钉住组织并将握持于其中的组织分离开。因此,如图5中所见,操作用具306是一对包括彼此枢转连接的砧部件308和钉仓310的相对的钳夹。
外科缝合器300的钉仓310包括类似于外科缝合器200的钉仓204的组织接触表面121的阶梯状组织接触表面121。因此,为了阐明和讨论外科缝合器300的钉仓310的组织接触表面121可参考图7和上面对钉仓204的组织接触表面121的详细讨论。
应用中,类似于或者依照其他已知的外科缝合器使外科缝合器300进行激发。为了详细描述外科缝合器300的靠近和弹射,参考共同转让的美国专利No.5,865,361,该专利目前转让给Tyco医疗健康集团,其整个内容在此编入作为参考。
外科缝合器300弹射之后产生的组织界面,如剖面图中所见,基本上类似于如剖面图中所见的外科缝合器100和200弹射之后产生的组织界面。因此,如图16B中所见,手术紧固钉125a-125c中的一些或全部用来彼此握持组织“A”和“B”而手术紧固钉125c也用来提供止血。
虽然外科缝合器300与外科缝合器100相比是线型手术缝钉,但是可以想到并在本次公开范围内的是外科缝合器300的砧部件和钉仓中的至少一个的组织接触表面可具有的剖面轮廓,基本类似于如图3A-3D中所示的外科缝合器100砧部件和钉仓的的组织接触表面。
现在转到图6、6A、7和7A,根据公开的又一实施例,用于执行手术吻合缝合的横向缝合类型的外科缝合器通常指代为400。外科缝合器400包括手柄402、从手柄402延伸出的管筒404以及从管筒404的 远端延伸出的臂406。外科缝合器400进一步包括垂直固定于臂406远端的砧部件408以及可操作地连接到管筒404的远端用于将可抛弃的钉仓412保持在其上的钉仓接收器410。砧部件408在图6A中做进一步详细地描述,其包括组织接触表面420,其中组织接触表面420具有多个与保留槽123(图7)基本对准的凹陷425。当外科缝合器400内的致动机构致动时凹陷425和保留槽123之间协同对准形成了完成的手术紧固钉125。
外科缝合器400的钉仓412包括类似于外科缝合器200的钉仓204的组织接触表面121的阶梯状组织接触表面121。因此,为了阐明和讨论外科缝合器400的钉仓412的组织接触表面121可参考图7和上面对钉仓204的组织接触表面121的详细讨论。更进一步地,钉仓412可包括用于滑动地将刀具(未示出)接收于其中的刀具路径222。
在本公开的进一步实施例中,钉仓412′在图7A中进行阐明并在下文中进行详细讨论。钉仓412′类似于钉仓412,但是仅包括布置在钉仓412′外壁之间的保留槽123的三排119a-c。如以前所讨论的实施例中,每排119a-c包括多个手术紧固钉,其中排119a中的手术紧固钉具有与布置在排119b中的手术紧固钉不同的腿长,而布置在排119c中的手术紧固钉具有不同于排119a和排119b的至少其中一个的腿长。钉仓的这个实施例不包括刀具路径。组织接触表面121a-c的布置和相互关系与参见图7的前面所公开的类似。
应用中,类似于或者依照其他已知的外科缝合器使外科缝合器400进行激发。为了详细描述外科缝合器400的靠近和激发,参考共同转让的美国专利No.5,964,394,该专利目前转让给Tyco医疗健康集团,其整个内容在此编入作为参考。
外科缝合器400弹射之后产生的组织界面,如剖面图中所见,基本上类似于如剖面图中所见的外科缝合器100-300弹射之后产生组织界面。因此,如图16B中所见,手术紧固钉125a-125c中的一些或全部用来彼此握持组织“A”和“B”而手术紧固钉125c也用来提供止血。
虽然外科缝合器400与外科缝合器100相比是线型手术缝钉,但是可以想到并在本次公开范围内的是外科缝合器400的砧部件和钉仓中的至少一个的组织接触表面可具有的剖面轮廓,基本类似于如图3A-3D中所示的外科缝合器100砧部件和钉仓的的组织接触表面。
虽然将上面所述和在此所示的每个外科缝合器构造成为且适合弹射手术紧固钉125,但是可以想到并在本次公开的范围内的是用于连接专用两部分紧固钉的手术器具的组织接触表面也可具有如在此所示和所述的阶梯状构造。典型的两部分手术紧固钉专用器具显示并描述在共同转让的美国专利No.5,573,169中,该专利目前转让给Tyco医疗健康集团,其整个内容在此编入作为参考。
在本公开的一个进一步实施例中,如图8-10所示,外科缝合器300包括位于加长轴304一端的操作工具506。操作工具506包括砧部件308和钉仓510。钉仓510可包含在可抛弃的外科缝合器中或可再利用的外科缝合器中。特别地,钉仓510包括具有设置于其中的多个保留槽523的组织接触表面520,多个保留槽523按照基本与钉仓510的纵轴对齐的行进行排列。如图8中所见,保留槽523的每一行从保留槽的相邻行纵向偏移。特别地,可选手术刀通道530沿钉仓510的纵轴设置,适于可滑动地容纳手术刀(未示出)。
现参照图9A,操作工具506显示为剖面图,说明了包含于钉仓510中的若干元件。砧部件308包括基本平坦的组织接触表面320,该表面基本平行于底面512或平行于由手术紧固钉125a、125b或125c的背跨所限定的平面。钉仓510包括具有第一高度的外壁514和具有第二高度的内壁516,其中第二高度大于第一高度。组织接触表面520附着于内壁516和外壁514,并相对于与内壁516垂直的平面形成一定角度。组织接触表面520在外壁514之间形成大体弯曲的路径(如剖面图所见,大体呈凸面或椭圆形)。另外,多个手术紧固钉125a-c置于钉仓510中,其中每行保留槽523包括多个基本相同的紧固钉(即125a、125b或125c)。类似于前面的实施例,手术紧固钉125a-c的脚25a-c具有不同的长度。在本实施例中,手术紧固钉25a具有大约3.8mm的腿长,手术紧固钉25b具有大约3.5mm的腿长,手术紧固钉25c具有大约2.5mm的腿长。
如图9A中所见,手术紧固钉125a-c置于钉仓510中以使手术紧固钉125c接近外壁514,手术紧固钉125a置于接近内壁516处,手术紧固钉125b置于前两者之间。结合各种高度的手术紧固钉,钉仓510包括紧固钉弹射组件540,紧固钉弹射组件540包括不同高度的缝钉推杆542、544和546。缝钉推杆542具有最大的高度尺寸,缝钉推杆546具有最小的高度尺寸,缝钉推杆544具有介于其间的高度尺寸。在本实施例中,手术紧固钉125a-c分别被安排与缝钉推杆546、544和542协作。当紧固钉弹射组件540与致动机构(未示出)协同啮合时,适于基本垂直的移动。合适的致动机构的实例在美国专利No.5,865,361中公开,其参照前面公开的外科缝合器300进行描述。
如图9A所示,紧固钉弹射组件540包括通过连接组件548相互连接的缝钉推杆542、544和546,以便全部推杆平板基本同时通过钉仓510得以转化。在可选实施例中,紧固钉弹射组件540’包括独立设置在钉仓510中的推杆平板542、544和546。在本实施例中,每行缝钉推杆可被单独致动,并独立于其它行的缝钉推杆。紧固钉弹射组件540、540’的任一实施例可用于任一公开的钉仓中。紧固钉弹射组件540’如图9A所示,为清楚起见,不在公开的外科缝合器的其它实施例中描述。
另外,钉仓510可包括多个缝钉导向件或通道525,如虚像所示,从组织接触表面520的内表面向紧固钉弹射组件540或540’延伸。特别地,缝钉通道525向缝钉推杆542、544和546延伸,并可根据其在钉仓510中的位置而有不同高度。每个缝钉通道525的宽度基本等于其相应缝钉推杆542、544和546的宽度。缝钉通道525与保留槽523协同作用,形成缝钉容器并提高手术紧固钉125a-c的稳定性,从而使手术紧固钉125a-c的侧向移动或旋转最小,并因此改善完成后所有紧固钉的编组。更进一步地,缝钉通道525典型具有的形状对应于缝钉推杆542、544和546的形状。尽管缝钉通道525可包括在钉仓的任一公开的实施例中,但是为清楚起见,缝钉通道525仅在图9A中表示。
操作工具506的替换实施例在图9B和图9C中表示。这些替换实施例分别表示为操作工具506a和506b。首先参照图9B,操作工具506a包括与上述操作工具506基本相同或类似的元件,其区别如下面所述。与操作工具506(图9A)相比,操作工具506a的手术紧固钉125a-c设置在钉仓510a中,以使手术紧固钉125a靠近外壁514,手术紧固钉125c靠近内壁516,手术紧固钉125b位于前两者之间。此外,操作工具506a包括具有第一表面522a和第二表面524a的组织接触表面520a。 第一表面522a和第二表面524a中每一个的宽度都足以容纳至少一行手术紧固钉。第一表面522a基本平行于底面512,而第二表面524a定义了一个基本一致的角度。特别地,第二表面524a从第一表面522a的外边缘向外向下延伸,并形成相对于底面512基本一致的角度。
现参照图9C,操作工具506b包括根据图9B所述的钉仓510a和砧部件308c。砧部件308c包括组织接触表面320c。特别地,组织接触表面320c包括表面322c和324c。表面324c基本平行于底面512,表面324c的宽度尺寸基本等于第一表面522a加上手术刀通道530的宽度尺寸,而每个表面322c基本与相应的第二表面524a互补。砧部件308c和组织接触表面520a表面之间的这种设置在从操作工具506b的中心线到其外壁514的组织接触表面之间保持基本一致的间隙。
如图10所示,可选择地,手术紧固钉125a-c被置于钉仓510’中,以使手术紧固钉125a靠近外壁514,手术紧固钉125c靠近内壁516,手术紧固钉125b位于前两者之间。与前面的实施例相反,手术紧固钉125a-c分别与缝钉推杆542、544和546相结合。将多层体组织定位在组织接触表面320和520之间后,致动机构被致动,从而通过保留槽523弹射手术紧固钉125a-c,凭借手术紧固钉125a-c和砧部件308之间的相互作用形成用于连接体组织层的完成的全部手术紧固钉。
当砧部件308的组织接触表面320被重定位到接近于钉仓510’的组织接触表面520时,施加于前两者之间的组织层的压力量沿着与钉仓510’的纵轴横切的平面而变化。由于组织接触表面320和520之间的距离在最靠近内壁516的区域(即钉仓510’的中心线)最小,最大的压力施加于置于该区域中的组织层。相反,组织接触表面320和520之间的距离在靠近外壁514的区域最大,最小的压力施加于该区域中 的层。另外,砧部件308和钉仓510’之间的紧密联系在其间限定出多个间隙。第一间隙被限定在组织接触表面320和520之间(即沿着钉仓510’的中心线),而第二间隙沿着外壁514被限定在组织接触表面320和520之间。如图10中所见,第一间隙不等于第二间隙。更进一步地,在钉仓510’的中心线和外壁514之间存在的其它参考点处,多个其它的间隙可被限定在组织接触表面320和520之间。由于组织接触表面520朝外壁514倾斜从而形成基本一致的角度,因此施加于组织接触表面320和520之间的组织层的压力从内壁516向外壁514均匀地减小。
通过从钉仓510’的中心线向下调节组织接触表面520的角度,渐减的压力被施加于置于组织接触表面320和520之间的组织层,从而使其间的组织层的损伤最小化。因此,置于组织接触表面320和520之间的组织层将在最接近手术刀通道530(即最接近钉仓510’的中心线)处具有最小厚度并在最接近外壁514处具有最大厚度。此外,砧部件308和钉仓510’被形成所需尺寸并设置为使施加于组织层的压力最小,从而进一步减小对组织层的损伤。该结构在组织接触表面320和520之间限定了一个间隙,沿手术刀通道530(即钉仓510或510’的中心线)为最大值,沿钉仓510(图9A)或510’(图10)的外壁为最小值。
更进一步地,该结构可应用于类似的钉仓和砧部件,如下面对于图11-15的详细描述。当砧部件308’被重定位在靠近钉仓510’的位置(即预激发位置)以保持其间的体组织层时,组织层被压缩。最大压缩沿着中心线(即第一或最小间隙)产生,促使组织层中积存的流体流向组织的外边缘(即远离钉仓510’的中心线)。通过减小保留在靠近中心线的组织层中的流体量,该组织层的总体厚度减小。组织厚度的 总体减小使具有较短腿长的缝钉(即手术紧固钉125c)能够扣紧组织的两层,同时对被扣紧的组织层的损伤最小。该间隙朝钉仓510’的外壁增大(即压缩量减小),具有较长腿长的手术紧固钉(即手术紧固钉125a和125b)能够扣紧组织的两层。
手术紧固钉125c、125b和125a的腿长在从内壁516向外壁514移动的方向上增大。通过提供沿垂直于内壁516的平面具有渐增腿长的手术紧固钉,完成的(即形成的)手术紧固钉连接渐增的组织厚度而不会对连接的组织层产生不当损伤。
在进一步的实施例中,如图11所示,操作工具506”包括钉仓510’和砧部件308’。钉仓510’在上文中参照图10进行了详细描述。组织接触表面520可限定比图9A和图10的实施例中更加均匀的角度(图11),其中组织接触表面的角度或斜度在内壁516和外壁514之间基本恒定。砧部件308’包括具有锥形表面322’和324’的组织接触表面320’。表面322’和324’与砧部件308’的外壁相连,同时向内(即朝向钉仓510’中心线)向下(即朝向组织接触表面520)延伸以形成一个角度。可以想到由锥形表面322’和324’形成的角度基本类似于由组织接触表面520限定的角度,但在相反方向上形成大致V形的结构。这样,施加于组织层的压力将进一步减小,从而进一步减小对置于组织接触表面520和320’之间的组织层的损伤。与图10的实施例相同的是,施加到组织层的最大压力将存在于靠近手术刀通道530的区域,同时施加于组织层的压力朝向外壁514均匀减小。手术紧固钉125a-c的形成和定位以及伴随的优点基本类似于图10的实施例。
现参照图12,本公开的进一步实施例显示为部分操作工具606。操作工具606包括钉仓610和砧部件308。在本实施例中,组织接触表 面620包括表面622和624。表面622沿其纵轴被手术刀通道630等分,并基本平行于底面612或平行于由手术紧固钉125a、125b或125c的背跨所限定的平面。此外,表面622的宽度尺寸在手术刀通道630的每一侧足以容纳至少一行保留槽623。表面624将表面622的外边缘与外壁614相连,在手术刀通道630的每一侧相对于基本垂直于内壁616(即基本平行于表面622)的平面形成一个角度,其宽度尺寸在手术刀通道630的每一侧足以容纳至少一行保留槽。钉仓610包括多个手术紧固钉125a-c和紧固钉弹射部件540,如前面图9A和图10的详细描述。特别地,钉仓610包括手术紧固钉125a-c和紧固钉弹射部件540的设置,如钉仓510’所描述(图10和图11)。
类似于操作工具506,组织接触表面320被重定位于靠近钉仓610的组织接触表面620处。在该结构中,施加于置于其间的组织层的压力量沿着与钉仓610的纵轴横切的平面而变化。特别地,组织接触表面320和表面622之间的距离最小,最大的压力施加于该区域中的组织层。相反,组织接触表面320和表面624之间的距离在靠近外壁614的区域最大,最小的压力施加于该区域中的层。由于表面624朝外壁614倾斜从而形成基本一致的角度,因此施加于置于组织接触表面320和表面624之间的组织层的压力从表面622的外边缘向外壁614均匀地减小。
通过从表面622的边缘向下调节表面624的角度,渐减的压力被施加于置于组织接触表面320和表面624之间的组织层,从而使置于两者之间的组织层的损伤最小。置于组织接触表面320和620之间的组织层将在最接近手术刀通道630处具有最小厚度并在最接近外壁614 处具有最大厚度。此外,砧部件308和钉仓610被形成所需尺寸并设置为,使施加于组织层的压力最小,从而进一步减小对组织层的损伤。
手术紧固钉125c、125b和125a的腿长在从内壁616向外壁614移动的方向上增大。通过提供沿垂直于内壁616的平面具有渐增腿长的手术紧固钉,完成的(即形成的)手术紧固钉连接渐增的组织厚度而不会对连接的组织层产生不当损伤。
在进一步实施例中,操作工具606’如图13所示。操作工具606’包括如上面图12所详细描述的钉仓610和砧部件308”。砧部件308”包括由表面332”和336”形成的组织接触表面320”。表面336”基本平行于表面622,其宽度尺寸与表面622的宽度尺寸基本相似。表面332”呈锥形并与砧部件308”的外壁相连,同时向内(即朝向钉仓610中心线)向下(即朝向组织接触表面620)延伸以形成一个角度。可以想到由锥形表面332”形成的角度与由表面624限定的角度基本相似,只是位于相反的方向上。这样,施加于组织层的压力将进一步减小,从而进一步减小对置于表面624和332”之间的组织层的损伤。与图10的实施例类似的是,施加于组织层的最大压力将存在于沿着表面622的区域中,而施加于组织层的压力将沿着表面624朝向外壁614均匀减小。手术紧固钉125a-c的形成和定位以及伴随的优点基本类似于图12的实施例。
在又一个实施例中,操作工具706如图14所示。钉仓710类似于钉仓610。钉仓610和钉仓710之间的不同将在下面描述。与在钉仓610(图12)中一样,钉仓710包括由表面722和724形成的组织接触表面720。表面722与表面622的不同点在于其宽度足以容纳至少两行手术紧固钉。与在钉仓610中一样,表面724固定于表面722的外边 缘且固定于外壁714以限定角度。钉仓710和砧部件308之间用于捕捉组织并形成手术紧固钉的相互作用基本类似于钉仓610和砧部件308之间的相互作用,为简短起见,这里不作重复。
在图15中,阐明了操作工具706’的替换实施例。操作工具706’包括上面详细描述的钉仓710和和砧部件308”。砧部件308”包括由表面332”和336”形成的组织接触表面320”。表面336”基本平行于表面722,其宽度尺寸基本与于表面722的宽度尺寸相似。表面332”呈锥形并与砧部件308”的外壁相连,同时向内(即朝向钉仓710中心线)向下(即朝向组织接触表面720)延伸以形成一个角度。可以想到由锥形表面332”形成的角度基本类似于由表面724形成的角度,只是位于相反的方向上。这样,施加于组织层的压力将进一步减小,从而进一步减小对置于表面724和332”之间的组织层的损伤。与图14中的实施例一样,施加于组织层的最大压力将存在于沿着表面722的区域中,而施加于组织层的压力沿着表面724朝向外壁714均匀减小。手术紧固钉125a-c的形成和定位以及伴随的优点基本类似于图14的实施例。
现参照图16B,其中表示激发钉仓510’之后,最终的组织界面的剖视图。如图16B中所见,组织界面具有基本锥形的轮廓。特别地,手术紧固钉125a-125c中的一些或全部用作将组织“A”和“B”彼此握持而手术紧固钉125c还用来提供止血。该最终的剖视图还可适用于钉仓610和710的激发。当钉仓510被激发时,手术紧固钉125a-125c中的一些或全部用来将组织“A”和“B”彼此固定而手术紧固钉125a还用来提供止血。如图16A所示,当组织“A”和“B”的层通过传统的手术缝合装置和传统的缝钉“S”被扣紧时,从未扣紧的组织层到扣紧的组织层存在急剧变化。这可能导致更大的负载被施加于组织层上 并对组织层产生不良的影响。比较来说,如图16B所示,组织界面从非扣紧的组织层向扣紧的组织层逐渐过渡,并且在扣紧的组织层中也是逐渐过渡。这样的设置基于所形成的手术紧固钉125a-c的变化的尺寸,提供了渐变的组织负载或压缩,从而最小化组织损伤,同时维持较高程度的止血和缝合力。
在本公开进一步的实施例中,如图8和图10所示,操作工具506’包括伤口闭合组件50。伤口闭合组件50包括至少一个存储装置或储存器52和至少一个供应管线54。供应管线54将储存器52流体地连接于钉仓510’,以提供相当数量的伤口闭合材料“W”。特别地,供应管线54向手术刀通道530内提供伤口闭合材料“W”,以便当手术紧固钉125a-c形成时,伤口闭合材料“W”沿着邻近组织接触表面520(即目标点)的组织层移动。通过提供伤口闭合材料“W”并结合手术紧固钉125a-c,在组织层之间形成的结合物的强度得以改善。
储存器52的压缩引起其中包含的伤口闭合材料“W”被驱动通过供给线54并经由手术刀通道530送出。更佳的是,伤口闭合材料“W”在缝钉激发过程中送出,以便伤口闭合材料“W”沿着缝钉线和/或手术刀切割线的长度方向送出。尽管参照图10讨论并描述了伤口闭合组件,但可以想到伤口闭合组件50适于与钉仓510’的其它实施例(即510、610或710)结合使用。进一步可以想到,可包括附加的储存器以通过组合两种物质形成伤口闭合材料,或者储存器52可包括多个内室(在虚像中示出),以储存要组合形成伤口闭合材料“W”的大量物质。
可以想到伤口闭合材料“W”可包括粘合剂、止血剂、密封剂的其中一种或其组合。外科的生物适应性伤口闭合材料可使用于或应用 于外科仪器,特别是手术缝钉,该伤口闭合材料包括:粘合剂其功能是连接或保持器官、组织或结构,密封剂用于防止流体泄漏和止血剂用于中止或避免流血。可使用的粘合剂的实例包括衍生蛋白质,醛基粘合材料,例如以Cryolife公司的注册商标BIOGLUETM出售的商用白蛋白/戊二醛材料,以及分别以Tyco医疗健康集团的注册商标INDERMILTM和Ethicon Endosurgery公司的注册商标DERMABONDTM出售的丙烯腈基材料。可使用的密封剂的实例包括纤维密封剂和胶原基和合成聚合体基的组织密封剂。商用密封剂的实例为以Cohesion Technologies and Baxter International公司的注册商标COSEALTM出售的乙二醇基合成聚乙烯、水凝胶材料。可使用的止血剂材料的实例包括纤维基、胶原基、氧化再生纤维素基和凝胶基局部止血剂。商用止血剂材料的实例包括以Tyco医疗健康集团的注册商标COSTASISTM和Baxter International公司的注册商标TISSEELTM出售的纤维蛋白原-凝血酶组合材料。这里的止血剂包括收敛剂,例如铝硫酸盐或凝血剂。
应理解伤口闭合材料“W”的送出可为任意适量的流体包括薄雾的临时、连续或频繁应用的喷射。颗粒状材料,例如细粉末可用作本公开范围内的流体。
大量不同的伤口闭合材料“W”或大量不同的伤口闭合材料“W”的组合可通过伤口闭合组件50而送出。通过伤口闭合组件50送出的伤口闭合材料可以是收敛剂,例如铝硫酸盐,它会引起小血管的闭合并有助于血液凝结。伤口闭合材料“W”可以是Styptic Pencils fromRequa公司注册商标为NO NIXTM的商用材料中的收敛剂。
现参照图17A-F,其中表示了本公开的操作工具的进一步实施例。如图17A所示,操作工具806a包括砧部件308和钉仓810a。前面参照图9A描述了砧部件308,为简短起见不再描述。此外,钉仓810a类似于钉仓710(图14),下面详细描述其不同点。类似于钉仓710,钉仓810a包括组织接触表面820、外壁814和内壁816、手术刀通道830以及底面812。钉仓810a内有多个前面已经参照钉仓710进行过描述的手术紧固钉125a、125b和125c。此外,钉仓810a包括前面已经参照图9进行过描述的多个紧固钉弹射部件540。
在本实施例中,表面822和824限定了组织接触表面820。如所公开的钉仓的前面的实施例,组织接触表面820包括多个保留槽823。表面822是与底面812基本平行的平面,而表面824是大致弓形的表面。每个表面822、824包括至少一行保留槽823。另外,内壁816具有第一高度,外壁814具有第二高度,其中第一高度大于第二高度。表面824的一个边缘连接于外壁814,而反向的边缘连接于表面822的一个边缘,从而形成相对于表面822大致凹陷的表面。
类似于本公开的操作工具的前面的实施例,砧部件308的组织接触表面320在靠近钉仓810a的组织接触表面820处被重定位。在该结构中,施加于其间组织层的压力量沿着与钉仓810a的纵轴横切的平面变化。特别地,组织接触表面320和表面822之间的距离最小,所以最大的压力施加于该区域中的组织层。相反,组织接触表面320和表面824之间的距离在靠近外壁814的区域最大,所以最小的压力施加于该区域中的层。由于当表面824接近外壁814时,表面824向下弯曲,因此施加于组织接触表面320和表面824之间的组织层的压力从 表面822的外边缘向外壁814减小。压力减小的量是表面824的曲率的函数。
通过使表面824从表面822的边缘向下弯曲,减小的压力施加于组织接触表面320和表面824之间的组织层,从最小化对其间的组织层的损伤。置于组织接触表面320和820之间的组织层将在最接近手术刀通道830处具有最小厚度并在最接近外壁814处具有最大厚度。此外,砧部件308和钉仓810a被形成所需尺寸并设置为,使施加于组织层的压力最小,从而进一步减小对组织层的损伤。
手术紧固钉125c、125b和125a的腿长在从内壁816向外壁814移动的方向上增大。通过提供沿垂直于内壁816的平面具有渐增腿长的手术紧固钉,完成的(即形成的)手术紧固钉连接渐增的组织厚度而不会对连接的组织层产生不当损伤。对于手术紧固钉125a-c和紧固钉弹射部件540更详细的描述在上文中已经参照图9给出。
在图17B所示的实施例中,操作工具806b包括基本类似于钉仓810a的钉仓810b,其不同点将在下面描述。在钉仓810b中,外壁814’和内壁816’的高度低于钉仓810a的外壁814和内壁816。在该结构中,组织接触表面820靠近底面812,以便手术紧固钉125a、125b和125c的末端伸入保留槽823并基本随组织接触表面820被激发。
现参照图17C和图17D,其中示出了操作工具806c和806d。操作工具806c和806d分别包括钉仓810a和810b(如上所述)。在这些实施例中,砧部件308a替换了砧部件308。在本实施例中,砧部件308a包括由表面332a和336a形成的组织接触表面320a。表面336a基本平行于表面822,其宽度尺寸基本与表面822的宽度尺寸相似。表面332a 基本呈弓形,使砧部件308a的厚度在其外边缘附近的区域最小,并沿表面336a最大。可以想到由表面332a形成的弧度基本类似于由表面824形成的弧度,只是位于相反的方向上(即相对于表面822形成凸起的位置关系)。这样,施加于组织层的压力将进一步减小,从而进一步减小对表面824和332a之间的组织层的损伤。
与图17A和图17B的实施例中相同,施加于组织层的最大压力存在于沿着表面822的区域中,而施加于组织层的压力沿着表面824朝向外壁814、814’减小。沿着由表面824和332a限定的斜度,压力的减小与每个表面的曲率成比例。手术紧固钉125a-c的形成和定位以及伴随的优点基本类似于图17A和图17B的实施例。
在进一步的实施例中,操作工具906如图18A所示。操作工具906包括砧部件308和钉仓910。钉仓910基本类似于钉仓810,其中相同或相似的元件相应重新编号,下面详细描述其不同点。组织接触表面920包括表面922和924,其中每个表面包括多个保留槽923。类似于图17A-D所示的实施例,表面922是大致平坦的表面,基本平行于底面912并在其连接处与内壁916形成直角。表面924也是大致平坦的表面,基本平行于底面912和表面922,其中表面922和924垂直间隔,以使它们相互不共面。另外,内壁916具有第一高度,外壁914具有第二高度,其中第一高度大于第二高度。
与本公开的操作工具的前面的实施例一样,砧部件308的组织接触表面320在靠近钉仓910的组织接触表面920处被重定位。在该结构中,施加于其间组织层的压力量沿着与钉仓910的纵轴横切的平面变化。特别地,组织接触表面320和表面922之间的距离最小,所以最大的压力施加于该区域中的组织层。相反,组织接触表面320和表 面824之间的距离最大,所以最小的压力施加于该区域中的层。由于表面924大致是平坦的,因此施加于置于组织接触表面320和表面924之间的组织层的压力是基本一致的,而且小于施加于组织接触表面320和表面922之间的组织层的压力。
手术紧固钉125c、125b和125a的腿长在从内壁916向外壁914移动的方向上增大。通过提供沿垂直于内壁916的平面具有渐增腿长的手术紧固钉,完成的(即形成的)手术紧固钉连接渐增的组织厚度而不会对连接的组织层产生不当损伤。手术紧固钉125a-c和紧固钉弹射部件540更详细的描述已经参照图9给出。
现参照图17E,其中示出了操作工具806的进一步实施例,表示为操作工具806e。操作工具806e包括与操作工具806a(图17A)基本相同或相似的元件,其不同点将在下面描述。特别地,操作工具806e包括砧部件308和钉仓810b。钉仓810b与钉仓810a的不同点在于组织接触表面824a为从钉仓810b的中心线向外壁514延伸的弓形结构。组织接触表面824a和组织接触表面320之间的这种设置提供了与图17A-D的实施例的设置相同的优点和益处。
可选地,钉仓810b可与砧部件308d一起使用,以形成图17F所示的操作工具806f。砧部件308d包括与组织接触表面824a基本互补的组织接触表面320d。在该结构中,基本一致的间隙保持在从操作工具806f的中心线到其外壁814的表面之间。
本公开的操作工具的进一步实施例在图18B中表示,其中砧部件308被砧部件308b代替。操作工具906a包括钉仓910和砧部件308b。特别地,砧部件308b包括由表面332b和336b形成的组织接触表面 320b。类似于图17D所示的实施例,砧部件308b的组织接触表面320b与钉仓910的组织接触表面920互补,以便在表面924和332b之间形成比在表面924和组织接触表面320之间(图18A)更大的间隙。在该结构中,减小的压力量作用于其间捕获的组织层。
现参照图19A和图19B,其中示出了操作工具1006a和1006b。操作工具1006a包括砧部件308和钉仓1010。钉仓1010基本类似于钉仓510,其中相同或相似的元件被相应重新编号,其不同点将在下面详细描述。表面1020大致是平坦的,并基本平行于底面1012。在该实施例中,填料层1070定位于表面1020。填料层1070由具有足够的回弹力以便支撑组织层的材料形成,同时在形成完成的手术紧固钉的过程中,使手术紧固钉125a-c通过。填料层1070可以是用于加固位于缝钉线上的组织的有机或合成组织的支撑材料。合适的材料的一个实例包括W.L.Gore&Associates公司的SEAMGUARD
填料层1070为大致三角形的结构,从接近手术刀通道1030的最大高度向接近外壁1014的最小高度逐渐变细。这样,在组织接触表面320和填料层1070之间形成的间隙在靠近手术刀通道1030处最小,在靠近外壁1014处最大。同样地,在该结构中,作用于在组织接触表面320和填料层1070之间捕获的组织层的压力量在靠近手术刀通道1030处最小,在靠近外壁1014处最大,从而像前面的实施例那样提供关于形成手术紧固钉并使组织层的损伤最小化的伴随的优点。此外,填料层1070可由弹性或半弹性材料形成,从而进一步最小化对在组织接触表面320和表面1020之间捕捉的组织层的损伤。
可选地,虚像所示的第二填料层1070可定位于组织接触表面320。根据要执行的手术步骤,钉仓1010可包括位于组织接触表面1020上、 位于组织接触表面320上或位于两个组织接触表面320和1020上的填料层1070。
在图19B中,操作工具1006b包括前面描述的结合砧部件308’的钉仓1010。砧部件308’包括具有锥形表面322’和324’的组织接触表面320’。表面322’和324’连接于砧部件308’的外壁,同时向内(即向钉仓1010的中心线)并向下(即向组织接触表面1020)延伸,从而形成一个角度。可以想到由锥形表面322’和324’形成的角度与由填料层1070形成的角度基本相似,但在相反方向上形成大致V形的结构。这样,施加于组织层的压力将进一步减小,从而进一步减小对置于组织接触表面320’和填料层1070之间的组织层的损伤。施加于组织层的最大压力存在于靠近手术刀通道1030的区域中,同时施加于组织层的压力朝向外壁1014均匀地减小。手术紧固钉125a-c的形成和定位以及伴随的优点基本类似于图19A的实施例。
现转向图20A,钉仓412’(图7A)的替换实施例将在下文中表示和描述。钉仓412”类似于钉仓412’,其中相同或相似的元件被相应重新编号,其不同点将在下文中详细描述。钉仓412”包括多个组织接触表面421a-c,其中每个组织接触表面为大致平坦的结构。在三个表面中,组织接触表面421b具有最大的高度,并与组织接触表面421a和421c垂直间隔。组织接触表面421a-c基本相互平行,其中组织接触表面421b与组织接触表面421a或421c不在同一平面上。
砧部件408包括凹陷450和组织接触表面430。凹陷450与保留槽123基本对齐,以形成完成的手术紧固钉。在该结构中,最小间隙在组织接触表面430和组织接触表面421b之间形成,同时最大间隙在组织接触表面430和组织接触表面421a、421c之间形成。手术紧固钉425a-c 分别与组织接触表面421a-c相关。手术紧固钉425a-c基本类似于手术紧固钉125a-c,其不同点在下文中详细描述。在一个实施例中,手术紧固钉425a和425c基本相同,其腿长大于手术紧固钉425b。通过提供这种组织接触表面和手术紧固钉的设置,减小的压力被施加于置于组织接触表面430和组织接触表面421a、421c之间的组织层,如同关于本公开的钉仓的其它实施例的在先描述。
在替换的实施例中,钉仓412”可与砧部件408a结合使用,如图20B所示。砧部件408a包括凹陷450和组织接触表面430’。进一步地,组织接触表面430’包括表面432和434。每个表面432、434为大致平坦的表面,基本平行于钉仓412”的组织接触表面421a-c。表面432与表面434垂直间隔,以使表面434和组织接触表面421b之间形成的间隙最小,同时表面432和组织接触表面421a、421c之间形成的间隙最大。这样,减小的压力被施加于组织接触表面421a、421c和砧部件408a的表面432之间的组织层。
可选地,钉仓412”可与砧部件408b结合使用,如图20C所示。砧部件408b包括表面432a和434a。与砧部件408a的表面432和434(图20B)相比,表面432a和434a大致呈弓形。在该结构中,对砧部件408b和钉仓412”之间的组织的任何潜在的损伤得以减小,同时维持砧部件408b的组织接触表面和钉仓412”之间的增大的间隙的优点和益处。
本公开的操作工具的进一步实施例在图21A中表示,一般表示为1106。操作工具1106包括钉仓1110和砧部件308。砧部件308参照图9在前面进行了详细描述。钉仓1110包括与钉仓510(图9)相同或基 本类似的元件,其中相同或类似的元件被相应重新编号,其不同点将在下面描述。
特别地,钉仓1110包括手术紧固钉125a-c和相应的推杆1140。此外,钉仓1110包括外壁1114、内壁1116和垂直组件1118。内壁1116被间隔开,以在其间形成手术刀通道1130。此外,垂直组件1118为大致平坦的结构,毗邻内壁1116且高度至少等于内壁1116。顶板1154为大致平坦的结构,连接内壁1116和外壁1114。在一个实施例中,顶板1154基本平行于底面1112。此外,顶板1154包括多个保留槽1123。在顶板1154上方垂直间隙的是横向组件1150。
横向组件1150包括与顶板1154的保留槽1123对齐的多个开口1125。此外,横向组件1150限定了在第一位置上基本平行于底面1112的组织接触表面1120。特别地,横向组件1150的内边缘柔性地连接于垂直组件1118的一个边缘,同时外部边缘1156与外壁1114的顶部边缘1114a分隔,在其间形成间隙1152。横向组件1150具有足够的刚性,以便当组织层被置于组织接触表面320和1120之间时,横向组件1150维持与底面1112基本平行的位置关系。间隙1152可包括弹性压缩组件,用于控制组织接触表面1120的偏转量。
砧部件308和钉仓1110形成相互靠近的共同设置(即在手术紧固钉的接近和/或形成过程中),砧部件308和钉仓1110之间的相对运动产生的压力促使外边缘1156朝向顶部边缘1114a,从而减小间隙1152。此外,横向组件1154(虚像所示)向底壁1112弯曲,从而在外壁1114处提供组织接触表面320和1120之间的增大的距离,同时在垂直组件1118处保持组织接触表面320和1120之间的固定(即非伸缩的)距离。当横向组件1154弯曲时,组织接触表面320和1120之间的距离沿着 与钉仓1110的纵轴横切的轴增大。在沿着横向轴的任意选定位置,组织接触表面320和1120之间的距离与横向组件1154的弯曲量相关。横向组件1150可位于多个位置,包括至少一个第一位置和第二位置,第一位置基本平行于底面1112,其中外边缘1156与顶部边缘1114a相接触。
当砧部件308的组织接触表面320被重定位于靠近砧部件1110的组织接触表面1120的位置时,施加于其间的组织层的压力量沿着与砧部件1110的纵轴横切的平面变化。由于组织接触表面1120向外壁1114倾斜,施加于置于组织接触表面320和1120之间的组织层的压力从内壁1116向外壁1114减小。更进一步地,当横向组件1150向顶板1154弯曲时,其形成了类似于组织接触表面520(图9)的弯曲表面。开口1125具有较大的宽度,以便当横向组件1150向顶板1154移动时,开口1125和保留槽1123的定位是这样的以便为手术紧固钉125a-c形成畅通的路径,从而使手术紧固钉125a-c将组织层相连结并接触到砧部件308。
通过从钉仓1110的中心线向下弯曲组织接触表面1120,减小的压力被施加于置于组织接触表面320和1120之间的组织层,从而使置于其间的组织层的损伤最小。因此,置于组织接触表面320和1120之间的组织层在最靠近手术刀通道1130(即最靠近钉仓1110的中心线)的位置具有最小的厚度,并在最靠近外壁1114的位置逐渐增大至最大厚度。
手术紧固钉125c、125b和125a的腿长在从内壁1116向外壁1114移动的方向上增大。通过提供沿垂直于内壁1116的平面具有渐增腿长 的手术紧固钉,完成的(即形成的)手术紧固钉连接渐增厚度的组织而不会对连接的组织层产生不当损伤。
现参照图21B,其中示出了本公开的操作工具的替换实施例,表示为1106a。操作工具1106a包括如上所述的钉仓1110,并结合参照图11所详细描述的砧部件308’。砧部件308’包括具有锥形表面322’和324’的组织接触表面320’。可以想到由锥形表面322’和324’限定的角度基本类似于由组织接触表面1120限定的角度,但在相反方向上形成大致V形的结构。这样,施加于组织层的压力将进一步减小,从而进一步减小对置于组织接触表面1120和320’之间的组织层的损伤。如同前面的实施例,施加于组织层的最大压力将存在于靠近手术刀通道1130的区域中,同时施加于组织层的压力朝向外壁1114均匀地减小。手术紧固钉125a-c的形成和定位以及伴随的优点基本类似于图21A的实施例。
进一步的实施例如图22A-C所示,在下文中描述。首先参照图22A,示出了操作工具1206a,其包括砧部件308d和钉仓1210。特别地,钉仓1210包括参照图9A在前面详细描述的手术紧固钉125a-c和紧固钉弹射组件540。类似于前面的实施例,钉仓1210包括底面1212、外壁1214、内壁1216以及手术刀通道1230。此外,钉仓1210包括由表面1222和1224形成的组织接触表面1220。表面1222和1224中的每一个具有的宽度尺寸足够容纳至少一行手术紧固钉。如图22A所示,表面1222基本平行于底面1212,而表面1224为大致弓形的结构。更进一步地,从底面1212测量的各个表面1224的最顶端部分的高度尺寸基本相同。操作工具1206a中提供有互补的砧部件308d,其中砧部件308d包括对应于表面1222和手术刀通道1230的基本平坦的表面322d。 另外,砧部件308d包括大致弓形的表面324d,以便对应于钉仓1210的表面1224。通过提供钉仓1210和砧部件308d之间的这种设置,基本一致的组织间隙形成在砧部件308d和钉仓1210的表面之间。
可选地,如图22B所示,操作工具1206b包括砧部件308e,结合钉仓1210a。钉仓1210a基本类似于钉仓1210(图22A),其不同点在下面描述。最值得关注的是,组织接触表面1220a包括表面1222a、1224a和1226a。表面1222a和1224a基本类似于图22A的表面1222和1224,而表面1226为大致弓形的结构,具有低于表面1224的高度(即相对于底面1212)。这样,表面1222、1224和1226从中心线向钉仓1210a的外壁1214“逐步降低”。砧部件308e具有与组织接触表面1220a基本互补的组织接触表面320e。同样地,组织接触表面320e包括对应于表面1222a和手术刀通道1230的基本平坦的表面322e。另外,砧部件308d包括基本呈弓形的表面324e和326e,以便对应钉仓1210a的表面1224a和1226a。通过提供钉仓1210a和砧部件308e之间的这种设置,基本一致的间隙形成在砧部件308e和钉仓1210a之间。
可选地,如图22C所示,钉仓1210a可与砧部件308结合使用。在该结构中,组织接触表面320和1220b之间形成的间隙从手术刀通道1230处的第一间隙向外壁1214处的第二间隙增大,其中第二间隙大于第一间隙。
本公开的外科缝合器的所有实施例向由手术紧固钉连接在一起的组织层提供了一种可变的压力斜度(即负载轮廓)。因此,靠近外科缝合器的中心线(即钉仓中心)的组织层承受较大的压力(即负载),从而与远离外科缝合器中心的组织层相比,形成较薄的组织层。由于最靠近外科缝合器中心的组织层可被压缩地更多,较小尺寸的外科缝钉 或紧固钉可用于机械缝合(即扣紧)横切的组织层。更进一步地,向要连接的组织层提供渐变的压缩斜度(见图16B)可导致较好程度的止血。由于钉仓的轮廓形状,组织层可在外科缝合器的中心被压缩地更多,因为当砧部件相对于钉仓移动时,组织层可从相对高的压力区域(即中心)向相对低的压力区域(即边缘)转化(即移动),从而形成压力斜度。
另外,当上面所述和这里所示的外科缝合器中的每一个包括具有阶梯轮廓的组织接触表面时,可以想到这里公开的任意外科缝合器可包括具有任意一种轮廓的组织接触表面,这些轮廓包括但不限于角度、圆锥形、锥形、弓形等等,如共同转让的申请序列号为10/411,686的美国专利申请所公开的,该申请于2003年5月11日提出,标题为“包括具有配合表面的砧和具有配合表面的仓的外科缝合装置”(SurgicalStapling Apparatus Including an Anvil Cartridge Each having CooperatingMating Surfaces),目前转让给Tyco医疗健康集团,在此将其全部内容引入作为参考。
可以理解,可对本公开的外科缝合器的实施例进行各种修改。因此,上面的描述不应解释为限定,而仅仅是实施例的举例。本领域技术人员可以想到本公开范围和精神内的其它修改。
Claims (10)
1.一种用于外科缝合器的钉仓,包括:
内壁和外壁,所述内壁的高度不等于所述外壁的高度;
具有第一侧面、第二侧面、限定在组织接触表面中的第一多个保留槽以及平面轴的第一表面,所述平面轴相对于所述内壁限定了一直角;
具有第一侧面、第二侧面以及限定在所述组织接触表面中的第二多个保留槽的第二表面,所述第二表面的第一侧面与所述第一表面的第二侧面连接并且所述第二表面的第二侧面与所述外壁的顶部边缘连接从而在所述内壁和外壁之间限定沿所述第二表面的弓形路径;以及
分别设置在所述第一多个保留槽和第二多个保留槽中的第一多个手术紧固钉和第二多个手术紧固钉,所述第一多个手术紧固钉和第二多个手术紧固钉包括背跨和一对腿,所述第一多个手术紧固钉具有第一腿长,所述第二多个手术紧固钉具有第二腿长,所述第二腿长不同于所述第一腿长。
2.如权利要求1的钉仓,其中设置在所述第一多个保留槽中的手术紧固钉的背跨基本平行于所述第一表面的所述平面轴。
3.如权利要求1的钉仓,进一步包括设置在第三多个保留槽中的第三多个手术紧固钉,所述第三多个保留槽限定在所述钉仓的组织接触表面中,所述第三多个手术紧固钉具有不同于第一腿长的第三腿长。
4.一种外科缝合器,包括:
用于外科缝合器的钉仓,其具有内壁和外壁,所述钉仓包括:
具有第一多个保留槽和第一平面轴的第一表面,所述第一表面包括第一侧面和第二侧面;
具有第一侧面、第二侧面以及第二多个保留槽的第二表面,所述第二表面的第一侧面与所述第一表面的第二侧面连接并且所述第二表面的第二侧面与所述外壁的顶部边缘连接从而在所述内壁和外壁之间限定沿所述第二表面的弓形路径;
分别设置在所述第一多个保留槽和第二多个保留槽中的第一多个手术紧固钉和第二多个手术紧固钉,所述第一多个手术紧固钉和第二多个手术紧固钉包括背跨和一对腿,所述第一多个手术紧固钉具有第一腿长,所述第二多个手术紧固钉具有第二腿长,所述第二腿长不同于所述第一腿长;以及
砧部件,其可相对于所述钉仓确定位置,并限定在所述砧部件和所述钉仓之间布置的多个不同间隙,以便当所述砧部件靠近所述钉仓时,所述钉仓的所述第一表面和所述砧之间的第一间隙小于所述钉仓的所述第二表面和所述砧之间的第二间隙。
5.如权利要求4的外科缝合器,其中所述砧部件包括平的组织接触表面。
6.如权利要求4的外科缝合器,其中所述砧部件包括多个表面,所述多个表面包括平的表面和至少一个弓形表面,所述平的表面具有至少等于所述钉仓的所述第一表面的宽度尺寸,并且所述至少一个弓形表面具有对应于所述钉仓的所述第二表面的曲率。
7.一种用于外科缝合器的钉仓,包括:
垂直部件;
具有多个保留槽和第一平面轴的第一平的表面,所述第一平的表面包括连接到所述垂直部件的第一侧面;
具有多个开口和第二平面轴的第二平的表面,所述第二平的表面包括第一侧面和第二侧面,所述第二平的表面的所述第一侧面柔性地连接到所述垂直部件并在第一位置上限定其间的垂直角度,所述第二平的表面与所述第一平的表面分隔开,在其间形成间隙,其中所述第二平的表面的第二侧面向所述第一平的表面的移动使所述第二平的表面弯曲;以及
设置在所述多个保留槽中的多个手术紧固钉,所述多个手术紧固钉包括背跨和一对腿。
8.如权利要求7的钉仓,其中当所述第二平的表面从第一位置移动到第二位置时,所述第二平的表面形成弯曲表面。
9.如权利要求7的钉仓,其中所述多个手术紧固钉被设置为多行,以便设置在第一行的手术紧固钉具有第一腿长,设置在第二行的手术紧固钉具有第二腿长,并且所述第二腿长不同于所述第一腿长。
10.如权利要求9的钉仓,进一步包括腿长不等于第一或第二腿长的第三行手术紧固钉。
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2006
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2007
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- 2007-05-16 CA CA2937565A patent/CA2937565C/en active Active
- 2007-05-16 ES ES07009831.4T patent/ES2617088T3/es active Active
- 2007-05-16 JP JP2007130154A patent/JP5306608B2/ja active Active
- 2007-05-16 EP EP07009831.4A patent/EP1857057B1/en active Active
- 2007-05-16 CA CA2864538A patent/CA2864538C/en active Active
- 2007-05-16 CA CA2588825A patent/CA2588825C/en active Active
- 2007-05-18 CN CN2007101266159A patent/CN101073509B/zh active Active
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- 2008-07-21 US US12/176,784 patent/US7828189B2/en active Active
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- 2010-06-01 US US12/791,219 patent/US8113407B2/en active Active
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Also Published As
Publication number | Publication date |
---|---|
JP2015013157A (ja) | 2015-01-22 |
CN101073509A (zh) | 2007-11-21 |
US20100270356A1 (en) | 2010-10-28 |
EP1857057B1 (en) | 2016-12-14 |
CA2937565C (en) | 2018-08-28 |
CA2588825C (en) | 2014-12-09 |
JP6734428B2 (ja) | 2020-08-05 |
JP2020138033A (ja) | 2020-09-03 |
US20070034667A1 (en) | 2007-02-15 |
JP2019162436A (ja) | 2019-09-26 |
ES2617088T3 (es) | 2017-06-15 |
US7828189B2 (en) | 2010-11-09 |
US7401721B2 (en) | 2008-07-22 |
JP5306608B2 (ja) | 2013-10-02 |
AU2007202085B2 (en) | 2012-08-09 |
CA2864538A1 (en) | 2007-11-18 |
US8113407B2 (en) | 2012-02-14 |
JP2007307373A (ja) | 2007-11-29 |
JP2016073824A (ja) | 2016-05-12 |
JP2022033944A (ja) | 2022-03-02 |
EP1857057A3 (en) | 2011-03-09 |
AU2007202085A1 (en) | 2007-12-06 |
US20080272175A1 (en) | 2008-11-06 |
CA2937565A1 (en) | 2007-11-18 |
JP2013223765A (ja) | 2013-10-31 |
CA2864538C (en) | 2017-03-28 |
JP5744113B2 (ja) | 2015-07-01 |
CA2588825A1 (en) | 2007-11-18 |
JP2018020149A (ja) | 2018-02-08 |
EP1857057A2 (en) | 2007-11-21 |
JP5939652B2 (ja) | 2016-06-22 |
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