CN101095621A - 手动驱动外科切割和紧固器械 - Google Patents

手动驱动外科切割和紧固器械 Download PDF

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CN101095621A
CN101095621A CNA200710126814XA CN200710126814A CN101095621A CN 101095621 A CN101095621 A CN 101095621A CN A200710126814X A CNA200710126814X A CN A200710126814XA CN 200710126814 A CN200710126814 A CN 200710126814A CN 101095621 A CN101095621 A CN 101095621A
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percussion
assembly
trigger
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CN101095621B (zh
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F·E·谢尔顿四世
J·N·奥尔克克
J·R·摩根
J·S·斯韦兹
E·L·蒂姆珀曼
L·M·富吉卡瓦
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Ethicon Endo Surgery Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105Wound clamp magazines
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/0682Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B65CONVEYING; PACKING; STORING; HANDLING THIN OR FILAMENTARY MATERIAL
    • B65BMACHINES, APPARATUS OR DEVICES FOR, OR METHODS OF, PACKAGING ARTICLES OR MATERIALS; UNPACKING
    • B65B55/00Preserving, protecting or purifying packages or package contents in association with packaging
    • B65B55/02Sterilising, e.g. of complete packages
    • B65B55/12Sterilising contents prior to, or during, packaging
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00407Ratchet means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214Stapler heads
    • A61B2017/07271Stapler heads characterised by its cartridge
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214Stapler heads
    • A61B2017/07285Stapler heads characterised by its cutter

Abstract

一种外科切割和紧固器械,包括通过细长轴组件与手柄组件连接的细长通道。该细长通道能够容纳钉仓并具有与其连接的可枢转平移的砧座和被支承在其中的刀杆。所述砧座可通过操纵由手柄组件支撑的闭合触发器选择性地打开和闭合。所述刀杆可通过致动击发触发器经过细长通道向远端行进,所述击发触发器与由手柄组件支承的可逆旋转驱动器协作。刀杆还可通过在可逆旋转驱动器已经切换到回缩朝向之后致动击发触发器而被回缩到其开始位置。

Description

手动驱动外科切割和紧固器械
技术领域
本发明总的涉及外科器械,并具体涉及外科切割和紧固器械。本发明可具有常规内窥镜和开放式外科使用仪器方面的应用以及机器人辅助的外科手术方面的应用。
背景技术
外科缝合器在现有技术中已经被用于同时在组织中形成纵向切口并将钉线应用于切口的相对侧上。所述器械一般包括一对协作的钳口构件,如果器械将用于内窥镜或者腹腔镜应用,所述钳口构件能够穿过套管通道。其中一个钳口构件容纳具有横向间隔的至少两个钉排的钉仓。另一个钳口构件限定砧座,该砧座具有与钉仓中的钉排对准的钉形成槽。所述器械包括多个往复运动的楔形件,当向远端驱动时,所述楔形件穿过钉仓中的开口并与支撑钉的驱动器接合,以使钉向着砧座击发。
过去几年,已经对所述器械进行了多种改进。例如,一些外科缝合器已经被制造成具有电动或者气动驱动机构。尽管所述缝合器非常有效和易于使用,但是对于一些用户来说在成本上可能过于昂贵。
因此,需要这样的外科缝合装置,其有效并易于使用,而且比其它的带动力的外科缝合装置更经济。
发明内容
在一个总的方面,本发明涉及外科器械,包括手柄组件,该手柄组件支承被构造成产生闭合运动和打开运动的闭合驱动器。击发驱动器由手柄组件支撑并被构造成当手动致动可操作地连接到手柄组件的击发触发器时选择性地产生旋转击发运动和旋转回缩运动。细长轴组件与手柄组件连接并与闭合驱动器和击发触发器相连,以分别传递闭合运动和旋转击发运动。外科器械的各种实施方式还包括与细长轴组件连接的端部执行器。端部执行器包括细长通道,该细长通道的尺寸设置成将钉仓容纳在其中。砧座与细长通道枢转连接。砧座枢转响应于来自细长轴组件的打开和闭合运动。切割和切断构件可操作地支撑在细长通道中并响应于来自细长轴组件的旋转击发和回缩运动。在各种实施方式中,细长通道可利用常规顺序冲模技术由金属制成。类似地,砧座可由金属片压印而成,以降低生产成本。
在另一个总的方面,本发明涉及处理用于外科手术的器械的方法。该方法包括获得上述类型的外科器械,将其消毒然后存储在灭菌容器中。
在另一个总的方面,本发明涉及外科缝合及切割器械,包括手柄组件,在其中可运动地支承闭合往复运动装置(shuttle)。闭合触发器可操作地由手柄组件支撑并可操作地将闭合和打开力应用到闭合往复运动装置。具有远端和近端的细长脊骨式组件(spineassembly)被定向为,近端由闭合往复运动装置支撑,远端与被构造成将钉仓容纳在其中的细长通道连接。砧座与细长通道枢转连接。闭合管组件被支撑在细长脊骨式组件上并与手柄组件连接。闭合管组件与砧座协作,当将闭合力施加到闭合往复运动装置上时使脊骨式组件在闭合管组件中向远端运动,引起砧座枢转到闭合位置,而当将打开力施加到闭合往复运动装置时,脊骨式组件在闭合管组件中向近端运动,引起砧座枢转到打开位置。切割和切断构件可操作地支撑在细长通道中并且切换器组件(shifter assembly)被支撑在细长组件中。切换器组件可选择性地在击发朝向和回缩朝向之间运动。切换器组件与击发触发器协作,当切换器组件处于击发朝向时,击发触发器的致动使切换器组件将旋转击发运动施加到切割和切断构件,以经过细长通道向远端驱动切割和切断构件,当切换器组件处于回缩朝向时,击发触发器的另一次致动使切换器组件将旋转回缩运动施加到切割和切断构件,以经过细长通道向近端驱动切割和切断构件。
更具体地说,本发明涉及了如下内容:
(1)、一种外科器械,包括:
手柄组件;
闭合驱动器,其由所述手柄组件支承并能够产生闭合运动和打开运动;
击发驱动器,其由所述手柄组件支承并能够选择性地在可操作地连接到所述手柄组件上的击发触发器致动时产生旋转击发运动并且在所述击发触发器的另一次致动时产生旋转回缩运动;
细长轴组件,其与所述手柄组件连接并与所述闭合驱动器和所述击发驱动器连接,以单独地传递所述闭合和打开运动以及所述旋转击发运动;和
端部执行器,其与细长轴组件连接,所述端部执行器包括:
细长通道,其尺寸能够将钉仓容纳在其中;
砧座,其与所述细长通道枢转连接,并且可枢转地响应
于来自所述细长轴组件的打开和闭合运动;和
切割和切断构件,其可操作地支承在所述细长通道中并
响应于来自所述细长轴组件的所述旋转击发和回缩运动。
(2)、根据第(1)项所述的外科器械,其中所述细长通道是金属的并通过冲压形成。
(3)、根据第(1)项所述的外科器械,其中所述砧座是金属的并通过冲压形成。
(4)、根据第(1)项所述的外科器械,其中所述细长轴组件包括:
与所述闭合驱动器和所述细长通道连接的脊骨式组件;和
与所述手柄组件连接并在所述脊骨式组件上方延伸的闭合管组件,所述脊骨式组件能够响应于由所述闭合驱动器产生的所述闭合和打开运动相对于所述闭合管组件轴向运动,所述闭合管组件能够响应于所述脊骨式组件在所述闭合管组件中的所述轴向运动在所述打开和闭合位置之间致动所述砧座。
(5)、根据第(4)项所述的外科器械,其中所述脊骨式组件包括:
与所述手柄组件连接的近端脊骨式部分;和
与所述近端脊骨式部分连接并能够相对于所述近端脊骨式部分旋转的远端脊骨式部分。
(6)、根据第(5)项所述的外科器械,其中所述闭合管组件能够相对于所述手柄组件选择性地旋转。
(7)、根据第(4)项所述的外科器械,其中所述闭合驱动器包括:
由所述手柄组件可动地支承的闭合往复运动装置,将所述脊骨式组件的近端支撑在所述闭合往复运动装置中;和
可操作地固定到所述手柄组件和所述闭合往复运动装置的闭合触发器,所述闭合触发器可操作地将所述闭合和打开力施加到所述闭合往复运动装置。
(8)、根据第(1)项所述的外科器械,其中所述击发驱动器包括:
支承在所述细长轴组件中的击发杆,用于在所述细长轴组件中选择性地进行轴向运动,所述击发杆与所述切割和切断构件相连,当旋转击发运动施加到所述击发杆上时,所述击发杆引起所述切割和切断构件沿着远端方向运动经过所述细长通道,当将旋转回缩力施加到所述击发杆上时,所述击发杆引起所述切割和切断构件沿着近端方向运动;和
支承在所述手柄组件中的切换器组件,其选择性地在用于产生所述旋转击发运动的击发朝向和用于产生所述旋转回缩运动的回缩朝向之间运动;所述切换器组件与所述击发杆相连,当所述切换器组件处于击发朝向、所述击发触发器被致动时,所述切换器组件将所述旋转击发运动施加到所述击发杆,并且当所述切换器组件处于所述回缩朝向、所述击发触发器被致动时,所述切换器组件将所述旋转回缩运动施加到所述击发杆。
(9)、根据第(8)项所述的外科器械,还包括由所述手柄组件支承的切换器按钮,用于使所述切换器组件在所述击发朝向和所述回缩朝向之间选择性地运动。
(10)、根据第(8)项所述的外科器械,其中所述切换器组件包括:
可操作地支承在所述手柄组件中的第一小齿轮;
可操作地支承在所述手柄组件中的第二小齿轮;
与所述第一和第二小齿轮啮合的中央锥齿轮;
与所述中央锥齿轮和所述击发触发器连接的棘轮组件,所述击发触发器的致动引起所述棘轮组件使所述中央锥齿轮沿着第一方向旋转;和
中央设置在所述第一和第二小齿轮之间的切换器齿轮,该切换器齿轮可在其中所述切换器齿轮与所述第一齿轮啮合并将所述旋转击发运动传递到所述击发杆的位置和其中所述切换器齿轮与所述第二齿轮啮合并将所述旋转回缩运动传递到所述击发杆的另一位置之间选择性地运动。
(11)、根据第(10)项所述的外科器械,还包括:
与所述切换器齿轮连接的切换器轴;
与所述切换器轴连接的齿轮组件;和
与所述齿轮组件和所述击发杆连接的第一螺杆,所述击发螺杆沿着一个方向的运动引起所述击发杆向远端运动,并且所述击发螺杆沿着相反方向的运动引起所述击发杆沿着近端方向运动。
(12)、一种用于处理用于外科手术的器械的方法,所述方法包括:
获得第(1)项所述的外科器械;
将所述外科器械灭菌;和
将所述器械储存在灭菌容器中。
(13)、一种切割和紧固器械,包括:
手柄组件;
闭合往复运动装置,其由手柄组件可动地支承;
闭合触发器,其由所述手柄组件可操作地支承并可操作地将闭合和打开力施加到所述闭合往复运动装置;
细长的脊骨式组件,具有近端和远端,所述近端由所述闭合往复运动装置支承,所述远端与能够将钉仓容纳在其中的细长通道连接;
砧座,与所述细长通道枢转连接,
闭合管组件,其支承在所述细长脊骨式组件上并与所述手柄组件连接,所述闭合管组件与所述砧座协作,当将所述闭合力施加到所述闭合往复运动装置时所述脊骨式组件在所述闭合管组件中向远端运动,引起所述砧座枢转到闭合位置,而当将所述打开力施加到所述闭合往复运动装置时,所述脊骨式组件在所述闭合管组件中向近端运动,引起所述砧座枢转到打开位置;
切割和切断构件,其可操作地支承在所述细长通道中;
切换器组件,其被支承在所述手柄组件中,并可选择性地在击发朝向和回缩朝向之间运动,所述切换器组件与所述击发触发器协作,当所述切换器组件处于所述击发朝向、所述击发触发器致动时,所述切换器组件将旋转击发运动施加到所述切割和切断构件,经过所述细长通道向远端驱动所述切割和切断构件,当所述切换器组件处于回缩朝向、所述击发触发器进行另一次致动时,所述切换器组件将旋转回缩运动施加到所述切割和切断构件,经过细长通道向近端驱动所述切割和切断构件。
(14)、根据第(13)项所述的外科器械,其中所述细长通道是金属的并通过冲压形成。
(15)、根据第(13)项所述的外科器械,其中所述砧座是金属的并通过冲压形成。
(16)、根据第(13)项所述的外科器械,其中所述细长通道能够相对于所述手柄组件选择性地运动。
(17)、根据第(13)项所述的外科器械,还包括用于可释放地将闭合触发器保持在锁定位置中的部件。
(18)、根据第(13)项所述的外科器械,还包括:
击发杆,其可被支承在所述细长脊骨式组件的一部分中,以便在所述细长脊骨式组件的一部分中选择性进行轴向运动,所述击发杆与所述切换器组件和所述切割和切断构件相连,当旋转击发运动施加到所述击发杆时,所述击发杆引起所述切割和切断构件经过所述细长轴沿着远端方向运动,当旋转回缩运动由所述切换器组件施加到所述击发杆时,所述击发杆引起所述切割和切断构件沿着远端方向运动。
(19)、根据第(13)项所述的外科器械,还包括由所述手柄组件支承的切换器按钮,用于使所述切换器组件在所述击发朝向和所述回缩朝向之间选择性地运动。
(20)、一种外科器械,包括:
手柄组件;
闭合部件,其由所述手柄组件支承,用于产生闭合运动和打开运动;
击发部件,其由所述手柄组件支承,当手动致动可操作地连接到所述手柄组件的击发触发器时该击发部件能够手动产生旋转击发运动和旋转回缩运动;
钉仓支承部件,其与所述手柄组件连接,用于在其中支承钉仓;
切割部件,支承在所述钉仓支承部件中;
力传递部件,其与所述手柄组件连接并与所述闭合部件和所述击发部件相连,以单独地将所述闭合运动、所述击发运动和所述回缩运动传递到所述切割部件;和
砧座部件,其与所述钉仓支承部件枢转连接,所述砧座部件能够枢转地响应于来自所述力传递部件的所述打开和闭合运动。
附图说明
在此作为例子并结合下列附图描述本发明的各种实施方式,其中相同的附图标记描述相同的部件,其中:
图1是本发明的外科切割和紧固器械的一种实施方式的透视图;
图2是沿着本发明的端部执行器实施方式的图1的线2-2截取的侧剖视图;
图3是图2的端部执行器实施方式的刀杆的一部分的放大侧剖视图;
图4是图3的端部执行器的刀杆的放大主视图;
图5是图2的端部执行器的等轴测图,其位于本发明各种实施方式的外科切割和紧固器械的远端,并且砧座处于打开位置;
图6是本发明各种实施方式的端部执行器或者执行部分和脊骨式组件的分解等轴测图;
图7是图2的端部执行器的等轴测图,其中砧座处于打开位置并且钉仓大部分被除去,暴露出单钉驱动器(single staple driver)和双钉驱动器(double staple driver),并且楔形滑车抵靠刀杆的中间销处于其开始位置;
图8是图2的端部执行器的等轴测图,其中砧座处于打开位置并且钉仓完全被除去,并且一部分细长通道被除去以暴露出刀杆的最下部销;
图9是沿着剖面的侧视图,显示图1的外科切割和紧固器械的处于闭合位置中的砧座、细长通道和钉仓之间的机械关系,所述剖面大致沿着图5中的线9-9截取,以暴露出楔形滑车、钉驱动器、钉,而且还沿着纵向中心线示出刀杆;
图10是本发明的外科切割和紧固器械实施方式的分解组件的等轴测图;
图11是本发明的外科切割和紧固器械的侧剖视图,其中砧座处于打开位置并且手柄组件以剖面被显示,以示出容纳在其中的各元件的位置;
图12是本发明的外科切割和紧固器械的侧剖视图,其中砧座处于闭合位置并且手柄组件以剖面被显示,以示出容纳在其中的各元件的位置;
图13是本发明的行星齿轮组件实施方式的分解组件的等轴测图;
图14是图13的行星齿轮组件的端视图,其中盖板被从其上除去;
图15是本发明的切换器组件实施方式的分解组件的等轴测图;
图16是处于开始位置中的本发明的手柄组件实施方式的剖视图,其中砧座处于打开位置;
图17是本发明的手柄组件实施方式的另一剖视图,其中闭合触发器被锁定在闭合或者夹钳位置,导致砧座被锁定在夹钳或者闭合位置;
图18是本发明的手柄组件实施方式的另一剖视图,显示闭合触发器运动到其未相对手柄部分解锁的位置;
图19是本发明的手柄组件实施方式的另一剖视图,显示闭合触发器运动到完全被致动位置;和
图20是本发明的替代砧座实施方式的等轴测图。
具体实施方式
转向附图,其中在所有附图中相同的附图标记表示相同的元件,图1示出了一种外科缝合和切割器械10,其能够实践本发明的一些独特优点。外科缝合和切割器械10包括端部执行器12,该端部执行器12通过与其连接的手柄组件200上的控制构件的操作来手动致动。各种不同的端部执行器结构是已知的。可被用于本发明的各种实施方式的一种类型的端部执行器12在图1、2和5至9中示出。如同在那些附图中的一些所示,端部执行器12采用有利地控制端部执行器12的间隔的E形梁击发机构(“击发杆”)30。E形梁击发机构的各个方面在Shelton IV等人的题为Surgical Stapling InstrumentIncorporating an E-Beam Firing Mechanism的美国专利US6,978,921中有描述,其相关部分通过引用而包含在本申请中。但是,随着对本发明具体实施方式的详细描述,本领域技术人员将会理解,在不脱离本发明的精神和范围的条件下,其他刀和击发杆构造也可有利地被采用。
应理解,这里使用的术语“近端”和“远端”是以握持器械手柄的医生为参照的。因此,端部执行器12相对于更近的手柄部分200为远端。还应理解,为了方便和清楚起见,这里使用的空间术语例如“垂直”和“水平”以附图为参照。但是,外科器械可以各种朝向和位置使用,这些术语并不是想要对其进行限制和绝对化。
如图2、6和7所示,端部执行器12包括细长通道20,该细长通道20具有与其连接的可枢转平移的砧座40。在一种实施方式中,通道20可利用常规顺序冲模技术由金属制成,并被提供有相应的开口,用于将刀杆30容纳在其中。所述生产方法可导致生产成本低于一般用于生产细长通道的那些常规方法的生产成本。
细长通道20被构造成容纳并支撑钉仓50,该钉仓50响应于刀杆而将钉70驱动成与砧座40成形接触。应当理解的是,尽管在本文中有利地描述容易置换的钉仓,但是,与本发明的各方面一致的钉仓可以永久固定到细长通道20上或者与细长通道20成为一体。
特别参照图2至4,在各种实施方式中,刀杆30包括三个垂直间隔开的销,用于在击发过程中控制端部执行器12的间隔。特别是,上部销32被分段,以便在砧座40和细长通道20之间的枢轴附近进入砧座凹槽42中。当被击发并且砧座40闭合时,上部销32在穿过砧座40向远端延伸的纵向砧座槽44中向远端行进。砧座40中任何微小的向上偏转都可通过由上部销32施加的向下的力克服。
刀杆30还包括最下部销34或者刀杆盖,其向上与在细长通道20中形成的通道槽23接合,从而与上部销32协作,在过多组织被夹钳在其间的情况下将砧座40和细长通道20拉得更近一些。在各种实施方式中,刀杆30可有利地包括中间销36,其穿过在钉仓50的下表面和细长通道20的上表面中形成的击发驱动器槽52,从而将钉70驱动到其间,如下所述。通过抵靠细长通道20滑动,中间销36有利地阻止了端部执行器12被夹紧闭合在其远端的任何趋势。但是,本发明的各种实施方式的独特和新颖的方面也可通过使用其它刀杆设置来获得。
回到图2至4,在刀杆30上的上部销32和中间销36之间向远端呈现的切割边缘38横向穿过钉仓50中向近端呈现的垂直槽54,以切割夹钳的组织。刀杆30相对于细长通道20和砧座40的确定定位确保进行有效切割。
外科缝合和切割器械的端部执行器12在图5至10中进一步详细显示。如同将在下面进一步详细解释的那样,手柄组件200上的各种控制元件的操作产生独立和不同的致动端部执行器12的闭合和击发运动。端部执行器12有利地保持这种独立和不同的闭合和击发(即缝合和切割)的临床灵活性。
图5示出了端部执行器12,其通过回缩的脊骨式组件100(图6)处于打开位置,并且钉仓50安装在细长通道20中。在砧座40的下表面41上排列有多个缝合形成凹槽46,对应于钉仓50的上表面56中的多个钉孔58。刀杆30处于其近端位置,并且上部销32以非干扰方式与砧座凹槽42对准。砧座凹槽42被显示为与砧座40中的纵向砧座槽44连通。刀杆30的向远端呈现的切割边缘38与钉仓50的垂直槽54对准并可相对于该垂直槽54向近端移开,从而允许用尽的钉仓50被去除并插入未击发的钉仓50,钉仓50可被扣合到细长通道20中。特别是,钉仓50的延长元件60、62分别与细长通道20的凹槽24、26接合(在图7中显示)。
图6以拆开形式显示了外科缝合和切割器械10的执行部分12的实施方式。钉仓50被显示未包括钉仓主体51、楔形滑车64、单和双驱动器66、钉70和钉仓托架68。当组装时,钉仓托架68将楔形滑车64、单和双驱动器66和钉70保持在钉仓主体51内。
细长通道20借助包括远端脊骨式部分110和近端脊骨式部分130的脊骨式组件100与手柄组件200连接。细长通道20具有设置在近端的连接腔22,每个连接腔容纳相应的通道锚定元件114,所述通道锚定元件114在远端脊骨式部分110的远端112上形成。细长通道20还具有砧座凸轮槽28,其可枢转地容纳砧座40上的相应砧座枢轴43。闭合套筒组件170被接收在脊骨式组件100上方并包括远端闭合管段180和近端闭合管段190。参见图6。远端闭合管段180包括向远端呈现的接片182,该接片与近侧但位于砧座40上的砧座枢轴43远侧的砧座闭合接片48接合,从而通过脊骨式组件100在闭合管组件170中的轴向运动来使砧座40打开和闭合(将在下面进一步详细讨论)。
特别参考图7,钉仓50的一部分被除去以暴露部分细长通道20,诸如凹槽24、26,并在它们的未击发位置暴露钉仓50的一些元件。特别是,钉仓主体51(在图6中显示)已经被除去。楔形滑车64以其近端未击发位置被显示,并且推杆块65与刀杆30的中间销36(在图7中未显示)接触。楔形滑车64与钉仓托架68纵向滑动接触并包括当楔形滑车64向远端运动时向上促动单和双驱动器66的楔形件69。静置在驱动器66上的钉70(图7中未显示)也被向上促动成与砧座40上的钉形成凹槽42接触,从而形成闭合的钉。还显示的是细长通道20中的通道槽21,其与钉仓50中的垂直槽54对准。
图8示出了图7的端部执行器12,其中钉仓50全部被除去以显示刀杆30的中间销36,并且邻近通道槽21的细长通道20也被除去以暴露出下部销或者刀杆盖34。在枢轴附近从砧座40向下突出的一对相对的组织限位器45防止组织在夹钳过程中被过度定位到端部执行器12中。
在本发明的其它实施方式中,所采用的砧座可包括砧座40’,其可由金属或者其它合适材料冲压或塑造成型(如图20中所示),以降低生产成本。如该图中所示,砧座40’可被提供有槽44’,用于调节击发杆穿过其中的运动,并且还可以形成有砧座枢轴43’和闭合接片(未显示),以利于其以上面参照砧座40描述的方式操作。在该实施方式中,砧座的下表面41’没有设置砧座形成凹槽。当钉与硬的下表面41’接触时它们以简单的方式闭合。而且,图20所示的实施方式被形成有组织限位器45’。但是,本领域技术人员将会理解,如果需要,砧座40’可被形成有或者没有钉形成凹槽和组织限位器。另外,在不脱离本发明的精神和范围的条件下,也可采用冲压砧座的其它变化。
图9示出了闭合在组织夹钳位置中的端部执行器12,其中刀杆30未被击发。上部销32处于砧座凹槽42中,与砧座槽44垂直对准以用于在击发过程中使刀杆30向远端纵向运动。中间销36被定位成向远端推动楔形滑车64,使楔形件69相继接触并提升双驱动器66,并且将相应的钉70推动成与砧座40的下表面41中的钉形成凹槽42形成接触。
如上所述,通道20通过脊骨式组件100与手柄组件200连接,在各个实施方式中,脊骨式组件100由远端脊骨式部分110和近端脊骨式部分130构成。如图6中所示,远端脊骨式部分110具有与细长通道20连接的远端114和与近端脊骨式部分130的远端132连接的近端116。刀杆30可滑动地容纳在远端脊骨式部分110的远端中的远端槽118中。刀杆30的近端31具有在其上形成的直立连接片33,该连接片33适于容纳在连接块160中的槽162中。连接块160连接到可滑动支撑在近端脊骨式部分130中的击发杆210。连接块160的大小设置成可滑动地容纳在远端脊骨式部分110中的近端槽120中。
击发杆210可由聚合物或者其它合适材料制成,并被构造成具有中空轴部分212,该中空轴部分212的大小设置成允许其在远端脊骨式部分110中的近端槽120中轴向行进。击发杆210还具有近端连接器部分220,其大小设置成可在近端脊骨式部分130中的轴向通道中轴向行进(将在下面进一步详细描述)。连接块160具有从其上突出的连接片164,其大小设置成可摩擦插入到击发杆210的中空轴部分212的锥形末端214中。锥形末端214可具有围绕其圆周设置的一组狭缝,以便使连接块160上的突出连接片164能够被插入到锥形末端214中并可与其摩擦连接。
还如图6中所示,近端脊骨式部分130可被制成两件式,以便于击发杆210容易地安装到其中并与远端脊骨式部分110连接。更特别地,近端脊骨式部分130可包括右侧近端脊骨式片段140和左侧近端脊骨式片段150。右侧近端脊骨式片段140具有右侧轴向通道部分146,其与左侧近端脊骨式片段150中的左侧轴向通道部分156协作以形成近端脊骨式部分130中的轴向通道132,该轴向通道的大小设置成轴向并可运动地将击发杆210的连接器部分220支撑在其中。此外,右侧脊骨式片段140的远端142中具有沟槽144,其与左侧脊骨式片段150的远端152中的沟槽154协作在近端脊骨式片段130中形成环形止动沟槽(未显示),以便可旋转地容纳从近端脊骨式部分130的远端132突出的连接片124。所述设置允许远端脊骨式部分110相对于近端脊骨式部分130旋转。见图6中的箭头“A”。
在各种实施方式中,击发杆210可在近端脊骨式部分130中通过击发螺杆240轴向运动,其操作将在下面进一步详细讨论。击发螺杆240通过包括螺母片段246和248的分叉击发螺母244与击发杆210连接。螺母片段246具有从其上突出的直立接片247,该直立接片的大小设置成穿过击发杆210的连接部分220中的槽222伸出。同样地,螺母片段248具有直立接片249,其大小设置成穿过击发杆210的连接部分220中的槽(未显示)伸出。接片247、249从连接部分220向外突出的部分被容纳在近端脊骨式片段140、150中形成的轴向槽中。所述接片247、249和槽用于促进击发杆210在近端脊骨式片段140中轴向行进而不允许击发杆210相对于近端脊骨式片段130旋转。
轴颈连接在脊骨式组件100上的是闭合管组件170。见图6。闭合管组件170包括远端闭合管段180和近端闭合管段190。远端闭合管段180和近端闭合管段190可由聚合物或者其它合适材料制成。近端闭合管段190是中空的,具有穿过其中延伸的轴向通道192,其大小适于将脊骨式组件100容纳在其中。轴向延伸的狭缝193可设置在近端闭合管190中以便易于将脊骨式组件100安装在其中。近端闭合管段190的远端194可设置有延伸部分196,中空远端闭合管段180的近端184插入其上方。两个闭合管段180、190然后可用合适的粘结材料连接在一起。近端闭合管段的近端196可设置有凸缘197,其目的将在下面讨论。
图10示出了本发明各种实施方式的用于控制脊骨式组件100和刀杆30的运动的手柄组件200和容纳在其中的元件。从该图中可以看出,手柄组件200包括由两件制成的手枪把手式外壳250。例如,外壳250可包括右侧罩构件260和左侧罩构件280,它们由聚合物材料模制或者制造成并被设计成配合在一起。所述罩构件260和280可通过扣合元件、在其中模制或成形的钉和插孔和/或通过粘合剂、螺钉等连接在一起。
支撑在外壳250中的是闭合往复运动装置300,其通过连杆组件330与闭合触发器连接。闭合往复运动装置300可被构造成如图10中所示,具有远端鞍架部分310和近端鞍架部分314。远端鞍架部分310被构造成将近端脊骨式片段130的近端136置于其中。基部凸缘138在近端脊骨式片段130的近端136上形成并容纳在闭合往复运动装置300中的槽312中。基部凸缘138由在右侧近端脊骨式片段140的近端145上形成的右侧凸缘片段149和在左侧近端脊骨式片段150的近端154上形成的左侧凸缘片段159形成。见图6。
如图10所示,闭合往复运动装置300设置有横向延伸的导轨302,它们被构造成分别滑动容纳在右侧罩构件260和左侧罩构件280中的导轨引导件262和282中。所述设置允许闭合往复运动装置300沿着远端方向(箭头“B”)和近端方向(箭头“C”)在手柄外壳250中轴向运动。闭合往复运动装置300(和脊骨式组件100)沿着远端方向的轴向运动通过使闭合触发器320向着手柄外壳250的手枪把手部分252运动形成,闭合往复运动装置300沿着近端方向(箭头“C”)的轴向运动通过使闭合触发器320远离手枪把手部分252运动形成。
在各种实施方式中,闭合往复运动装置300设置有连接片304,其便于闭合连杆组件330与闭合往复运动装置300连接。见图10至12。闭合连杆组件330包括闭合臂340和闭合连杆350。闭合臂340通过经过闭合臂340中的第一枢轴孔342延伸的闭合销344可枢转地插入外壳250中。闭合销344的末端容纳在右侧罩构件260和左侧罩构件280中形成的插孔264中。所述设置允许闭合臂340围绕第一闭合轴346枢转。见图10。闭合臂340的远端341插入闭合连杆350的近端351中,使闭合连杆350的近端351可相对于闭合臂340的远端341围绕近端枢轴355枢转。同样地,闭合连杆350的远端351插入闭合往复运动装置300上的连接片304中,使远端355可相对于连接片304围绕远端枢轴357枢转。见图11。
图11示出了处于打开(未夹钳)位置中的端部执行器12。从该图中可以看出,闭合触发器320枢转远离手枪把手部分252并且闭合往复运动装置300处于其近端位置中。当闭合往复运动装置300处于近端位置中时,其在闭合管组件170中沿着近端“C”方向拉动脊骨式组件100。脊骨式组件100在闭合管组件170中的这种轴向运动引起砧座上的闭合接片48与远端闭合管段180上的接片182接合,从而使砧座40枢转到打开位置。
当医生希望闭合砧座40并将组织夹钳在端部执行器12中时,医生向着手枪把手252拉动闭合触发器320,如图12中所示。当医生向着手枪把手252拉动闭合触发器320时,闭合连杆组件330使闭合往复运动装置300沿着远端“B”方向运动,直到闭合连杆组件330运动到图12中所示的锁定位置中。当处于该位置中时,连杆组件330将趋于将闭合往复运动装置300保持在该锁定位置中。当闭合往复运动装置300运动到锁定位置中时,脊骨式组件100在闭合管组件170中向近端运动,引起砧座上的闭合接片48与远端闭合管段180上的接片182接触,从而将砧座40枢转到闭合(夹钳)位置。
在各种实施方式中,为了进一步将闭合往复运动装置300保持在闭合位置中,闭合触发器320可设置有可释放锁定机构,其适于与手枪把手252接合并可释放地将闭合触发器保持在锁定位置中。其它锁定装置也可被用于可释放地将闭合往复运动装置300保持在锁定位置中。在图11和12中所示的实施方式中,弹簧钢片或者其它柔性材料形式的锁定元件322与闭合触发器320连接。锁定元件322的自由端被安放以进入手柄250的手枪把手部分252中的限位凹槽254中。锁定元件322与限位凹槽254摩擦接合并将闭合触发器320保持在闭合位置中。
为了释放闭合触发器320并由此允许其被枢转到打开位置,医生简单地进一步向内向着手枪把手部分252拉动闭合触发器320,如图18所示。当锁定元件322进一步运动到限位凹槽254中时,锁定元件322的端部与限位凹槽254后部的倾斜表面258接触,这引起锁定元件322挠曲足够的量,允许其从限位凹槽254释放,从而允许闭合触发器320运动远离手枪把手252(图16)。也可采用其它可释放锁定设置。
如上所述,刀杆30的行进和回缩由击发杆210和旋转驱动击发螺杆240控制。击发螺杆240具有带键的近端242,其被构造成与被支撑在闭合往复运动装置300的近端鞍架部分314中的行星齿轮组件400连接。行星齿轮组件400的一种实施方式在图13和14中显示。从这些附图中可以看出,行星齿轮组件400包括行星齿轮盒410,该行星齿轮盒410中形成有环形齿轮412。行星齿轮盒410支撑传动比为3∶1的第一级齿轮组件420和传动比为3∶1的第二级齿轮组件430。
第一级齿轮组件420包括第一中心齿轮422,该第一中心齿轮422使用键416连接到输入轴414上。输入轴414穿过盖板418伸出,盖板418与行星齿轮盒410配合并用于将第一级齿轮组件420和第二级齿轮组件440密封在其中。在各种实施方式中,第一级齿轮组件420包括三个第一行星齿轮424、426、428,它们分别轴颈连接在与第一行星齿轮板430连接的对应行星齿轮心轴425、427、429上。第一行星齿轮424、426、428与第一中心齿轮422和行星齿轮盒410中的环形齿轮412啮合地结合。从图13中可以看出,第一输出轴432使用键434与第一行星齿轮板430连接。
第二级齿轮组件440包括第二中心齿轮442,其同样使用键434连接在第一输出轴432上。第二行星齿轮444、446、448与第二中心齿轮442和环形齿轮412啮合地结合。第二行星齿轮444、446、448分别轴颈连接在与第二行星齿轮板450连接的三个对应的第二行星齿轮心轴445、447、449上。第二输出轴460通过键462键连接到第二行星齿轮板450。第二输出轴460具有经过止推轴承组件470延伸的细长轴部分464。从图13中可以看出,止推轴承组件470包括支撑多个轴承474的轴承罩472。轴承罩472和轴承474定位在第一和第二止推垫圈476和478之间。细长轴部分464经过行星齿轮盒410的远端突出并使用销或者固定螺钉482与轴联接器480连接。轴联接器480内部开有键槽并适于将击发螺杆240的带键近端242容纳在其中。
如同上面所指出的那样,刀杆30沿远端方向(“B”)的运动最终由击发螺杆240的旋转控制,该击发螺杆240驱动击发杆210并最终驱动刀杆30。因此,通过沿顺时针方向(图13中的箭头“D”)旋转击发螺杆240,击发杆210向远端(“B”)行进。击发螺杆240的旋转最终由独特新颖的切换器组件500控制。如同将在下面详细讨论的那样,切换器组件500将旋转动力传递到行星齿轮组400并最终传递到击发螺杆240。
在各种实施方式中,切换器组件500包括被支撑在外壳250中的切换器盒510。从图15中可以看出,切换器盒510包括由中央支撑元件530分隔的左侧支撑臂520和右侧支撑臂540。左侧小齿轮550旋转支撑在左侧支撑臂520中的孔522中。右侧小齿轮560类似地旋转支撑在右侧支撑臂540中的孔542中。中央锥齿轮570旋转支撑在中央支撑元件530中的孔532中,并设置在右侧小齿轮560和左侧小齿轮550中央且啮合地结合在其间,使中央锥齿轮的旋转引起右侧小齿轮560沿顺时针“D”方向旋转,并且左侧小齿轮550沿逆时针“E”方向旋转。
从图15中可以看出,棘轮盘580使用键572与中央锥齿轮570键连接。因此,当棘轮盘580旋转时,其引起中央锥齿轮570随着其旋转。在各种实施方式中,切换器组件500还包括驱动盘590,该驱动盘590具有一系列围绕其圆周从其上突出的驱动弹簧594。驱动弹簧594可由弹簧钢或者类似材料制成并且每个具有插入到驱动盘590中的对应槽592中的连接柄部分595。驱动弹簧594可借助摩擦配合或者也可使用合适的粘接剂保持在对应的槽592中。驱动弹簧594的末端596从驱动盘590突出以接合在棘轮盘580中形成的齿状棘轮槽582。因此,当驱动盘590沿着由图15中的箭头“F”表示的方向旋转时,驱动弹簧594的末端596接合棘轮盘580中对应的齿状棘轮槽582,并引起棘轮盘580和中央锥齿轮570沿着“F”方向旋转。但是,当驱动盘590沿着由图15中的箭头“G”表示的相反方向旋转时,驱动弹簧594简单地在棘轮盘580中的齿状棘轮槽582之上棘轮接合或者滑动,并且不将旋转传递到棘轮盘580和中央锥齿轮570。另外,传动齿轮600通过键602键连接到盒心轴604上,该盒心轴604旋转支撑在设置在右侧罩构件260中的心轴插孔266中。见图10和15。
传动齿轮600适于通过在击发触发器610的上端部分612上形成的击发齿轮段620驱动结合。更具体地,参见图10,击发触发器610旋转支撑在从右侧罩构件260突出并容纳在左侧罩构件280中的对应插孔(未显示)中的击发柱268上。击发柱268延伸穿过击发触发器610的上端中的孔614,使击发触发器610可在其上自由枢转。击发触发器610可由聚合物材料制成并具有在击发触发器610的上端612上形成的一段齿轮齿622,如图所示。齿轮齿622适于选择性啮合传动齿轮600的齿602。从图16至19中可以看出,击发手柄610的上端部分612具有拱形形状。齿轮段620在上端部分612的近端部分613上形成,并且限位元件626在上端部分612的远端部分614上形成。
图16示出了处于空档(未击发)位置中的击发触发器610。从该图中可以看出,当处于该位置时,临近击发触发器610的上端612的传动齿轮600的齿轮齿602不与击发触发器610的上端612上的齿轮段620啮合结合。击发手柄回复弹簧630在左侧罩构件280上的柱284和击发触发器610的上端612上的柱617之间延伸。弹簧630用于将击发触发器610拉到图16中显示的位置中。传动齿轮600上的齿轮齿602与击发触发器610的上端612上形成的限位元件626接触,将击发触发器610保持在该位置并防止击发触发器610沿着“ G”方向旋转超过该位置。本领域技术人员将会理解,当医生向着手枪把手252(方向“H”)拉动击发触发器610时,齿轮段620开始与传动齿轮600上的齿轮齿602啮合(图17)并引起传动齿轮600沿着方向“I”旋转。一旦达到冲程结束,击发触发器610被释放并且回复弹簧630引起击发触发器610运动到图16中所示的未击发位置。
击发螺杆240的旋转方向由定位在切换器组件500中的切换器齿轮650控制。从图15中可以看出,切换器齿轮650中央设置在右侧锥齿轮560和左侧锥齿轮550之间,并可通过切换臂轭660运动成与那些齿轮550、560啮合。更具体地,切换器齿轮650具有在其上形成的一组近端齿轮齿652,用于选择性啮合右侧小齿轮560。另外,切换器齿轮650具有在其上形成的一组远端齿轮齿654,用于选择性啮合左侧小齿轮550。
在各种实施方式中,切换器轴680与行星齿轮组400的第一输入轴414以及切换器齿轮650连接。特别是,切换器轴680具有远端682,远端682通过固定螺钉、粘合剂、焊接等与第一联接器684连接,该联接器684又通过固定螺钉、粘合剂、焊接等与第一输入轴414连接。切换器轴680具有带键部分686,其经过左侧小齿轮550中的孔552延伸。左侧小齿轮550不与切换器轴680的带键部分686接合并可相对于其沿着任一方向自由旋转。切换器轴686的带键部分686还可延伸到右侧小齿轮560中的孔562中。但是,右侧小齿轮560不与带键部分接合并可相对于其自由旋转。切换器轴680的带键部分686延伸到切换器齿轮650的键槽孔655中,使切换器齿轮650可在带键部分上轴向运动(箭头“J”),但通过其间的键连接将旋转传递到切换器轴680。
从图15中可以看出,轭槽656围绕切换器齿轮650的圆周形成。轭660包括两个相对的轭臂662,每个轭臂662上面具有向内延伸的销664,销664容纳在轭槽656中。所述设置允许切换器齿轮650相对于轭660旋转。但是,轭660可用于使切换器齿轮650在左侧小齿轮550和右侧小齿轮560之间的切换器轴680的带键部分686上轴向运动。切换器组件500具有顶部元件514,其通过粘合剂或者其它合适的紧固方式与切换器盒510连接。切换器臂667从轭部分660突出并延伸经过顶部元件514的开口513并通过切换器臂销517可枢转销接到其上。切换器按钮519通过粘合剂等与切换器臂667的顶端连接。
在各种实施方式中,切换器弹簧700销接或者固定到切换器臂667的顶部,并销接或者以其他方式连接到左侧罩构件280,使切换器弹簧700用于将切换器臂667拉动到图12中显示的位置中,从而引起切换器齿轮650上的近端齿轮齿652与右侧小齿轮560上的齿轮齿564啮合。当处于该位置中时,医生可通过使击发触发器610进行棘轮运动来触发刀杆30(将在下面讨论)。
在使用时,外科缝合和切割器械10如图1、11、12和16至19中所示被使用。在图11和16中,器械10处于其开始位置,具有未击发的完全加载且被扣合在细长通道20的远端中的钉仓50。触发器320、610都朝向前并且端部执行器12打开,诸如典型地在将端部执行器12经过套管针或者其它开口插入到体腔中之后。器械10然后由医生操作,使待缝合和切割的组织定位在钉仓50和砧座40之间。
参照图12和17,接着,医生向近端运动闭合触发器320,直到直接定位在手枪把手252附近,从而使限位元件256与外壳250中的限位凹槽252摩擦接合,将闭合触发器320锁定在闭合和夹钳位置中。当处于该位置中时,闭合连接330还用于将闭合触发器320保持在该位置中,如图12中所示。端部执行器12中的回缩的刀杆30不会阻止端部执行器12的选择性打开和闭合,而是保留在砧座凹槽42中。随着砧座40被闭合和夹钳,E形梁刀杆30被对准以便经过端部执行器12击发。特别是,上部销32与砧座槽44对准,并且细长通道20通过中间销36和击发杆盖34围绕通道槽21牢固结合。
参照图16至19,在已经发生组织夹钳之后,医生使击发触发器610向着手枪把手部分252向近端运动。所述动作引起击发触发器的上端612上的齿轮段620与传动齿轮600接合并沿着“I”方向旋转该传动齿轮600。传动齿轮600沿“I”方向的旋转引起驱动盘590也沿该方向旋转。当驱动盘590沿着该方向旋转时,驱动弹簧594与棘轮盘580上的棘轮齿582接合并引起棘轮盘580也沿着“I”方向旋转。中央锥齿轮570也随着棘轮盘580旋转,因为其键连接到棘轮盘上。当中央锥齿轮570旋转时,它还引起左侧小齿轮550沿着“E”方向旋转并且右侧小齿轮560沿着“D”方向旋转。见图15。
当切换器齿轮650与右侧小齿轮560形成接合时,如图11和12所示,中央锥齿轮570的运动引起右侧小齿轮560和切换器齿轮650沿着“D”方向旋转。由于切换器轴680和切换器齿轮650之间的键连接,切换器轴680也被引起沿着“D”方向旋转。所述旋转驱动运动经过行星齿轮组件400被传递到击发螺杆240。当击发螺杆240沿着“D”方向旋转时,击发杆210被向远端驱动,引起连接块160和刀杆30向近端运动。医生继续使击发触发器进行棘轮运动,直到刀杆30回到未击发位置。
当医生使击发触发器610运动到与闭合触发器320相邻的近端位置时,医生可释放击发触发器610并且回复弹簧630将击发触发器610回复到未击发位置(图16)。当击发触发器610返回到未击发位置时,其上的齿轮段620将沿着“H”方向的旋转施加到传动齿轮600。传动齿轮600也引起驱动盘590沿着“H”方向旋转。但是,驱动弹簧594在棘轮盘580中的棘轮齿592上方进行棘轮运动,由此旋转运动不被传递到其上。医生继续使击发触发器610进行棘轮运动,直到刀杆30可不再经过钉仓50向着远端行进。
医生然后可通过使切换器按钮519沿着远端方向运动引起切换器齿轮650与右侧小齿轮560脱离接合并与左侧小齿轮550啮合,从而将刀杆30返回到未击发位置。此后,医生简单地使击发触发器610以同样的方式进行棘轮运动,这引起左侧小齿轮550沿着“E”方向旋转。所述旋转运动经过行星齿轮组件400被传送到切换器轴680和击发螺杆240。当击发螺杆240沿着“E”方向旋转时,螺母247向近端拉动击发杆210。击发杆210然后向近端拉动连接块247和刀杆30,直到刀杆30到达未击发位置,在该位置中用过的钉仓50可从细长通道中被除去,并用新的未击发钉仓代替,或者作为替代,整个单元10可被正确抛弃。
从上述击发和回缩顺序可以理解,击发和回缩运动通过击发触发器的多次致动来实现。例如,在一种实施方式中,医生必须致动(即使击发手柄从其未击发位置(图16)运动到击发位置(图19))六次,以完全击发60mm常规端部执行器中所有的钉。同样地,为了将刀杆30完全回缩到未击发位置(在该未击发位置中钉仓50可从细长通道中除去),医生将不得不使切换器按钮519运动到回缩位置并致动击发触发器相等的次数——在该例子中为六次。但是,本发明的独特新颖的特征和优点可与不同尺寸的端部执行器主系统结合使用。因此,当采用更短的端部执行器时,只需要击发触发器的较少致动来完全击发钉并在此后将刀杆返回到完全回缩位置。例如,在本发明的范围内可采用这种端部执行器,其仅仅需要一次或者一次以上的击发触发器的击发来击发钉,以及仅仅一次或者以上的致动使击发和切割装置运动到完全回缩位置。
如上所述,远端脊骨式部分110与近端脊骨式部分130连接,使其可相对于近端脊骨式部分自由旋转。同样地,闭合管组件170可在脊骨式组件100上自由旋转。为了便于端部执行器12相对于手柄组件200旋转,手柄组件200设置有旋转握持组件710,其可相对于手柄组件200旋转并引起端部执行器12旋转。更具体地,参照图1和10,握持组件710包括右侧握持片段720和左侧握持片段730(在图1中显示),它们适于彼此配合并围绕外壳250的远端251旋转。右侧握持片段720和左侧握持片段730可由聚合物或者其它合适的材料制成并通过扣合零件、粘合剂、螺钉等彼此连接。每个片段720、730都具有在其中形成的拱形导轨片段722,当右侧罩构件260和左侧罩构件280连接在一起时导轨片段722适于骑设在外壳250中形成的沟槽259中。因此,导轨片段722用于将握持组件710保持在外壳250上并利于其相对于外壳旋转。每个握持片段720、730还具有在其中形成的管旋转片段724,它们一起协作延伸到近端闭合管段190中的孔191中。因此,握持外壳710相对于手柄外壳250的旋转引起闭合管组件170在近端脊骨式部分130上旋转。应当理解,远端闭合管段180不相对于远端脊骨式部分110旋转,而是引起引起远端脊骨式部分110随着其一道相对于近端脊骨式部分130旋转。近端闭合管段的近端196上的凸缘197被容纳在握持组件710中的相应沟槽中。在端部执行器12已经经过套管针插入到患者之后,这种设置允许医生容易相对于手柄组件200旋转端部执行器12。
虽然已经通过一些实施方式的描述对本发明进行了解释,虽然已经相当详细地描述了典型实施方式,但这并不意味着发明人想要将所附的权利要求书的范围限制或者以任何方式限定得如此详细。其它优点和修改对本领域技术人员来说也是可以想到的。
例如,通过利用常规模压技术生产细长通道可使该元件的生产成本降低。同样地,通过利用常规冲压技术由金属冲压砧座也可降低生产成本,这是当生产这些元件所通常遇到的问题。另外,用于击发装置的独特新颖的棘轮驱动设置消除了对电池或者气动动力元件的需要,而这些元件会增加装置的总体成本。
在本文中公开的装置可被设计成在单次使用后被抛弃,或者他们可被设计成可多次使用。但是,在任一种情况下,装置可再生用于至少一次使用之后的重新使用。再生可包括装置拆卸步骤的组合,然后清洁或者替换特定部件,随后从新组装。特别是,装置可被拆卸,并且装置的任意数目的特定部分或部件可选择性的以任何组合被替换或者除去。当清洁和/或替换特定部件时,装置可在再生工厂或者由外科团队在外科手术之前立即被拆卸用于随后使用。本领域普通技术人员将会理解,装置的再生可利用各种不同技术来拆卸、清洁/替换并重新装配。这些技术的使用和产生的再生装置都在本发明的范围之内。
优选地,在本文中描述的本发明在外科手术之前被处理。首先得到新的或者用过的器械,如果需要的话对其进行清洁。器械然后可被灭菌。在一种灭菌技术中,器械设置在闭合并密封的容器中,诸如塑料袋或者TYVEK袋。容器和器械然后被置于可穿透容器的辐射场中,诸如伽马射线、X-射线或者更高能量的电子中。射线杀死器械上和容器中的细菌。灭菌的器械然后可储存在灭菌容器中。密封容器保持器械无菌直到其在医疗设备中被打开。
声称通过引用而包含在本文中的任何专利、出版物或者信息,全部或部分,仅仅被包含到所包含的材料不与在本文献中阐明的现有定义、陈述或者其它公开材料相矛盾的程度。这样,在本文中清楚地阐明的公开内容代替了通过引用而包含在本文中的任何相矛盾的材料。
将要保护的本发明不将所公开的特定实施方式解释为限制。各种实施方式因此被认为时典型的而不是限定性的。在不偏离本发明的精神的前提下可由他人进行各种变化和改变。因此,这里明确表示,落入由权利要求书所限定的本发明的精神和范围被的所有等同物、改变和变化由此而被包括在本发明中。

Claims (10)

1、一种外科器械,包括:
手柄组件;
闭合驱动器,其由所述手柄组件支承并能够产生闭合运动和打开运动;
击发驱动器,其由所述手柄组件支承并能够选择性地在可操作地连接到所述手柄组件上的击发触发器致动时产生旋转击发运动并且在所述击发触发器的另一次致动时产生旋转回缩运动;
细长轴组件,其与所述手柄组件连接并与所述闭合驱动器和所述击发驱动器连接,以单独地传递所述闭合和打开运动以及所述旋转击发运动;和
端部执行器,其与细长轴组件连接,所述端部执行器包括:
细长通道,其尺寸能够将钉仓容纳在其中;
砧座,其与所述细长通道枢转连接,并且可枢转地响应
于来自所述细长轴组件的打开和闭合运动;和
切割和切断构件,其可操作地支承在所述细长通道中并
响应于来自所述细长轴组件的所述旋转击发和回缩运动。
2、根据权利要求1所述的外科器械,其中所述细长通道是金属的并通过冲压形成。
3、根据权利要求1所述的外科器械,其中所述砧座是金属的并通过冲压形成。
4、根据权利要求1所述的外科器械,其中所述细长轴组件包括:
与所述闭合驱动器和所述细长通道连接的脊骨式组件;和
与所述手柄组件连接并在所述脊骨式组件上方延伸的闭合管组件,所述脊骨式组件能够响应于由所述闭合驱动器产生的所述闭合和打开运动相对于所述闭合管组件轴向运动,所述闭合管组件能够响应于所述脊骨式组件在所述闭合管组件中的所述轴向运动在所述打开和闭合位置之间致动所述砧座。
5、根据权利要求4所述的外科器械,其中所述脊骨式组件包括:
与所述手柄组件连接的近端脊骨式部分;和
与所述近端脊骨式部分连接并能够相对于所述近端脊骨式部分旋转的远端脊骨式部分。
6、根据权利要求5所述的外科器械,其中所述闭合管组件能够相对于所述手柄组件选择性地旋转。
7、根据权利要求4所述的外科器械,其中所述闭合驱动器包括:
由所述手柄组件可动地支承的闭合往复运动装置,将所述脊骨式组件的近端支撑在所述闭合往复运动装置中;和
可操作地固定到所述手柄组件和所述闭合往复运动装置的闭合触发器,所述闭合触发器可操作地将所述闭合和打开力施加到所述闭合往复运动装置。
8、根据权利要求1所述的外科器械,其中所述击发驱动器包括:
支承在所述细长轴组件中的击发杆,用于在所述细长轴组件中选择性地进行轴向运动,所述击发杆与所述切割和切断构件相连,当旋转击发运动施加到所述击发杆上时,所述击发杆引起所述切割和切断构件沿着远端方向运动经过所述细长通道,当将旋转回缩力施加到所述击发杆上时,所述击发杆引起所述切割和切断构件沿着近端方向运动;和
支承在所述手柄组件中的切换器组件,其选择性地在用于产生所述旋转击发运动的击发朝向和用于产生所述旋转回缩运动的回缩朝向之间运动;所述切换器组件与所述击发杆相连,当所述切换器组件处于击发朝向、所述击发触发器被致动时,所述切换器组件将所述旋转击发运动施加到所述击发杆,并且当所述切换器组件处于所述回缩朝向、所述击发触发器被致动时,所述切换器组件将所述旋转回缩运动施加到所述击发杆。
9、根据权利要求8所述的外科器械,还包括由所述手柄组件支承的切换器按钮,用于使所述切换器组件在所述击发朝向和所述回缩朝向之间选择性地运动。
10、根据权利要求8所述的外科器械,其中所述切换器组件包括:
可操作地支承在所述手柄组件中的第一小齿轮;
可操作地支承在所述手柄组件中的第二小齿轮;
与所述第一和第二小齿轮啮合的中央锥齿轮;
与所述中央锥齿轮和所述击发触发器连接的棘轮组件,所述击发触发器的致动引起所述棘轮组件使所述中央锥齿轮沿着第一方向旋转;和
中央设置在所述第一和第二小齿轮之间的切换器齿轮,该切换器齿轮可在其中所述切换器齿轮与所述第一齿轮啮合并将所述旋转击发运动传递到所述击发杆的位置和其中所述切换器齿轮与所述第二齿轮啮合并将所述旋转回缩运动传递到所述击发杆的另一位置之间选择性地运动。
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US20160199061A1 (en) 2016-07-14
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ATE480189T1 (de) 2010-09-15
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US9320521B2 (en) 2016-04-26
US11272938B2 (en) 2022-03-15
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