CN1745720B - 具有电活化聚合物防倒退机构的多击发手术器械 - Google Patents
具有电活化聚合物防倒退机构的多击发手术器械 Download PDFInfo
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Abstract
一种特别适用于内窥镜操作的手术缝合和切割器械,包括一个产生分离的闭合和击发运动以启动端部执行器的手柄。具体地,该手柄产生多个击发动作以减少击发(如缝合和切割)端部执行器所需要的力的大小。击发部件在细长轴内往复运动端部执行器传递击发运动。一回拉弹簧在全击发完后回拉击发部件。在击发动作之间释放击发扳机时,防倒退机构激发电致动器(例如,电活化聚合物致动器),该致动器物理抵靠手柄,以束缚击发部件,防止无意的回拉。
Description
相关申请的交叉引用
本申请要求系列号为60/591,694、由SheltonIV于2004年7月28日提交的题为“包含电致动关节机构的外科器械”的美国临时申请的权益。
技术领域
本发明总的涉及能够将多行缝钉合线施加于身体组织,并同时对位于这些切割缝钉线之间的组织进行切割的外科缝合器械,更具体地说,涉及有关缝合器械的改进和用于形成这类缝合器械中可防止无意击发的不同部件的方法的改进。
背景技术
内窥镜和腹腔镜手术器械通常优于传统的开放手术设备,因为较小的切口容易缩短术后的康复时间并减少并发症。内窥镜和腹腔镜手术操作的使用相对已经普及并刺激进一步改进此手术。在腹腔镜操作中,通过一个较小的切口在腹腔内部进行手术。同样,在内窥镜操作中,通过皮肤内较小的创口插入细内窥镜管,通过该内窥镜管在体内的任何空腔脏器内进行手术。
内窥镜和腹腔镜操作通常要求喷洒消毒手术区。因此,任何进入人体的器械必须密封以确保气体不通过切口进入或退出身体。另外,内窥镜和腹腔镜操作经常要求外科医生对远离切口的器官、组织和/或血管进行操作。因此,用于这种操作的器械一般是细长的,而可从器械的近端进行功能控制。
内窥镜手术器械已经有了显著的发展,以适于穿过套管针的套管将远端执行器精确地放置在需要手术的部位。这些远端执行器以多种方式咬合组织以达到诊断和治疗的效果(例如,内切割器、抓取器、切割器、缝合器、夹具施放器、进入装置、药物/基因治疗传递装置及利用超声、射频、激光等的能量装置)。
已知的手术缝合器包括一个端部执行器,该端部执行器可在组织中切开纵向切口,同时在切口的相对两侧施加成排缝钉。端部执行器包括一对协同工作的夹钳构件,若将该器械用于内窥镜或腹腔镜时,夹钳构件能够穿过套管通道。其中一个夹钳构件容纳缝钉匣,该缝钉匣中至少有两排横向隔开的缝钉。另一个夹钳构件限定了一个砧板,该砧板上具有与缝钉匣中的缝钉排对准的缝钉成形凹槽。该器械包括多个往复式楔状物,当从远端驱动时,该楔状物穿过缝钉匣的开口并咬合支撑缝钉的驱动器,以实现缝钉向砧板的击发。
通常,一次闭合动作后进行一次击发动作是一种方便有效的进行切割和缝合的方法。但是,在某些情况下,需要多次击发动作。例如,外科医生可根据需要的切口长度从夹钳尺寸范围内选择相应长度的缝钉匣。较长的缝钉匣需要较长的击发冲程。因此,为了实现击发,需要产生发射的手压扳机,与较短的缝钉匣相比,对这些较长的缝钉匣施加较大的力,以便切割更多的组织并驱动更多的缝钉。人们希望这种力的大小低于或相当于较短的缝钉匣,以不超过某些外科医生手的力量。此外,某些不熟悉较大缝钉匣的外科医生当需要意想不到的较大力时会担心发生束缚或其他的故障。
共同未决、共同拥有的美国专利申请,公开号为2005/0067457A1,序号为10/673,929,由Shelton等人于2003年9月29日提交,名称为“具有防倒退机构的多冲程击发手术缝合器械”,其全部内容在此引入作为参考,在该申请中,一种改进的防倒退机构(anti-backupmechanism)在击发部件在每次击发动作期间向远端移动时机械脱离,然后在击发扳机在每次击发动作之间释放时咬合,从而防止无意的回拉。在击发全行程后,释放机械连接以便使防倒退机构脱离,让回拉弹簧回拉击发部件。以此,认识到多击发动作与自动回拉相结合的优点。
最近,一种类似的防倒退机构在如下两个美国专利申请中有所描述:申请序号为11/052,387、Shelton等人申请的、名称为“具有带回位弹簧旋转手动回拉系统的多冲程击发机构的手术缝合器械”的美国专利申请,和申请序号为11/052,632、Swayze等人申请的、名称为“具有带链接齿条传动的击发机构的手术缝合器械”的美国专利申请,这两项专利都于2005年2月8日提交,其全部内容都在此引入作为参考。
尽管这些机械控制的防倒退机构具有显著的临床效用,但是希望提供一种可替代的方法来防止无意的回拉,以利于其它功能。
因此,迫切需要一种改进的外科缝合和切割器械,该器械可进行多冲程击发,以增加击发冲程和/或减少击发用力,在结构上可靠地防止在击发动作之间无意的击发回拉。
发明内容
本发明克服了现有技术中上述和其它缺陷,提供一种外科缝合和切割器械,该器械具有一个多击发冲程手柄,该手柄不需要外科医生用过多的手力就可致动长的端部执行器。击发部件上的回拉偏压件在完整击发行程后帮助回拉击发机构。方便地,一个电致动器帮助阻止击发部件在击发动作之间无意回拉。
1.本发明的一种实施方案中提供一种外科器械,包括:端部执行器;纵向往复的击发杆,其远端连接到端部执行器;轴,其远端连接到端部执行器,并可操作地构造为引导击发杆;连接轴的近端的手柄,其可操作地构造为在一系列动作中向远端推进击发杆;以及电致动器,其物理连接到手柄,响应电信号与击发部件一起在非束缚和束缚位置之间运动,以此防止其纵向移动。
2.如上述1的外科器械,其中所述电致动器包括电活化聚合物致动器。
3.如上述1的外科器械,其中所述电致动器进一步包括:包围击发杆的锁定板通孔,其大小适合在垂直于击发杆的解锁状态时非束缚接触,以及在垂直倾斜一个角度的闭锁状态时束缚接触,所述电致动器的定位可使锁定板在解锁和闭锁状态中从一个选择的状态移动到另一个状态。
4.如上述3的外科器械,进一步包括一弹性部件,该弹性部件偏压锁定板到闭锁状态,而击发杆的对抗弹性部件向远侧的运动使锁定板移动到解锁状态,所述电致动器包括防倒退凸轮管,其位置设置为在激发弹性部件时可选择性地抵抗和被克服。
5.如上述4的外科器械,其中所述电致动器包括电活化聚合物致动器,其可操作地构造为被激发时纵向伸展,从手柄向远端推动防倒退凸轮管。
6.如上述4的外科器械,进一步包括:近侧凸出轭形件,它与防倒退凸轮管连接;手动释放机构,其可操作地构造为传递释放运动到近端凸出轭形件来手动致动防倒退凸轮管,释放锁定板。
7.如上述6的外科器械,进一步包括手动释放控制件,其可操作地构造为为使用者致动,手动释放机构可操作地构造为从手动释放控制件传递释放运动。
8.如上述6的外科器械,进一步包括为在手柄中动作而连接到击发杆的解锁部件,防倒退释放杆,其响应相应于击发杆的全击发行程运动到远侧位置的解锁部件,向远侧推动近端凸出轭形件以解锁锁定板。
9.如上述1的外科器械,其中所述电致动器包括径向缠绕击发杆的卷簧和一个电动装置,该装置可操作地构造为以下两种状态之间改变卷簧的内径:与击发杆束缚接触时较小直径的闭锁状态,和与击发杆非束缚接触时较大直径的解锁状态。
10.如上述9的外科器械,其中所述卷簧进一步包括由轴保持抵抗旋转的第一端,以及径向延伸端,所述电致动器包括电活化聚合物致动器,其定位使得可旋转径向延伸端,以达到所选择状态。
11.如上述1的外科器械,其中所述轴进一步包括由手柄纵向定位的结构机架,所述电致动器包括包围击发杆并与结构机架连接的电活化聚合物套管。
12.如上述11的外科器械,其中所述电活化聚合物套管可操作地构造为具有在选择的电激发状态和非电激发状态之一时束缚接触的内径和在非选择状态时非束缚接触的较大的内径。
13.如上述11的外科器械,其中所述电活化聚合物套管在非电激发、放松状态的内径大于击发杆,以便非束缚的解锁接触,电激发状态扩大了电活化聚合物套管的径向厚度,其中轴可操作地构造为限制电活化聚合物套管向外伸展,迫使电活化聚合物套管在电激发状态时与击发杆束缚接触。
14.如上述1的外科器械,其中所述端部执行器包括缝钉施加组件。
15.如上述1的外科器械,进一步包括:端部执行器;手柄;细长轴,包括连接端部执行器与手柄的结构机架,以及一击发部件,该部件被引导在手柄和端部执行器之间进行纵向往复运动;击发扳机,其与手柄接合以便运动;手柄内的多冲程击发机构,其可操作地构造为随击发扳机的每一个击发冲程逐渐地向远端推进击发部件;回拉偏压件,其推动击发部件到回拉位置;以及用于电锁定和解锁击发部件的部件,用以防止击发部件在击发扳机的击发动作之间的无意回拉。
16.本发明的另一种实施方案中提供一种外科器械,包括:端部执行器;手柄;细长轴,其包括连接端部执行器与手柄的结构机架,以及击发部件,该部件被引导在手柄和端部执行器之间进行纵向往复运动;击发扳机,其与手柄接合以便运动;手柄内的多冲程击发机构,其可操作地构造为随击发扳机的每一个击发冲程逐渐地向远侧推进击发部件;位于手柄内的回拉偏压部件,用于向击发部件上施加回拉偏压;防倒退机构,其包括电致动器,该电致动器可操作地构造为与击发部件一起在锁定和解锁状态之间移动;以及控制电路,其可操作地构造为激发电致动器。
17.如上述16的外科器械,其中所述防倒退机构进一步包括:锁定板,其具有一通孔,该通孔的尺寸为当垂直时从击发杆脱离接合而当成一角度时锁定;弹簧,其偏压锁定板到后倾斜角的位置;对抗弹簧的凸轮部件;以及电活化聚合物致动器,其定位可移动凸轮部件继而移动锁定板到闭锁状态。
18.如上述16的外科器械,进一步包括一卷簧,该卷簧具有由轴保持抵抗旋转的第一端,以及径向延伸端,所述电致动器包括电活化聚合物致动器,其定位使得可旋转径向延伸端,以改变卷簧的内径来改变选自闭锁状态和解锁状态的状态。
19.如上述16的外科器械,所述细长轴进一步包括由手柄纵向定位的结构机架,所述电致动器包括电活化聚合物套管,该套管包围击发杆并与结构机架接合,并且可操作地构造为具有在选择的电激发状态和非电激发状态之一时束缚接触的内径和在非选择状态时非束缚接触的较大的内径。
20.如上述19的外科器械,其中所述电活化聚合物套管在非电激发的放松状态时的内径大于击发杆,以便非束缚的解锁接触,电激发状态扩大了电活化聚合物套管的径向厚度,其中结构机架可操作地构造为限制电活化聚合物套管向外伸展,迫使电活化聚合物套管在电激发状态时与击发杆束缚接触。
本发明的这些和其它目的和优点参照附图和附图说明将会变得显而易见。
附图说明
合并到本说明书中作为说明书的一部分的附图描述了本发明的实施方案,并且与上述本发明的概述以及下面的实施方案详细描述一起用于解释说明本发明的原理。
图1是外科缝合和切割器械的左前侧透视图,包括多冲程击发机构,手柄部分中的电致动防倒退机构和部分切去的细长轴。
图2是手柄和细长轴的右后透视分解图,将图1的外科缝合和切割器械的端部执行器省略,带有一种电致动防倒退机构,包括混合式电活化聚合物(EAP)-机械致动防倒退锁定板。
图3是图2手柄上部的右侧视图,去除了右侧半个壳体和旋转按钮。
图3A是图3之电及机械致动的防倒退凸轮管的右侧详视图,以虚线示出致动(解锁)位。
图4是图1之电致动防倒退机构的另一种型式的左侧视图,其带有弹簧偏压锁定板和EAP-致动防倒退凸轮管。
图5是图4的EAP-致动防倒退凸轮管的后部透视图。
图6是图4-5的一种EAP致动器的透视图。
图7是图1的结构机架、手柄外壳的左半壳体和另一种形式的电致动防倒退机构的顶左侧透视图,包括EAP释放的束缚线圈。
图8是图7的防倒退束缚线圈的近端部和EAP致动器的顶左侧透视详图。
图9是图8的电致动防倒退机构的EAP释放束缚线圈沿9-9线的横截面的前视图。
图10是图7的电致动防倒退机构正视图中的左侧视图,将结构机架去除而暴露EAP释放束缚线圈。
图11是图7的电致动防倒退机构正视图中的左侧详视图,图中虚线示出结构机架和击发杆。
图12是图1之电致动防倒退机构的另一种型式的顶左侧详视图,包括EAP拼合式圆柱形束缚套管。
图13是图12的电致动防倒退机构和细长轴正视图沿13-13线的纵向截面的左侧视图。
图14是图12的细长轴和限制壳体内的EAP拼合式圆柱形套管(伸展则锁定)沿14-14线的横断面的前视图。
图15是图14的伸展则锁定的EAP拼合式圆柱形套管和击发杆沿15-15线的纵向截面的左侧详视图。
图16是图14的电致动防倒退机构和细长轴沿14-14线的横断面的前视图,其带有一个可替代的EAP圆柱形套管(收缩则锁定)。
图17是图16的收缩则锁定的EAP圆柱形套管和击发杆沿17-17线的纵向截面的左侧详视图。
发明详述
在图1中,描述了一个适合内窥镜和腹腔镜应用的外科器械,该器械有利地组合了多击发冲程、击发部件的自动回拉以及符合本发明的方便的电致动防倒退机构,以防止在击发动作之间的无意回拉。在图2-3、3A中描述了图1的防倒退机构的一种型式。具体而言,一种电-机械式(混合式)防倒退机构改进了上述美国专利申请号Nos.11/052,387及11/052,632较详细描述的全机械机构,这两份专利申请较全面地描述了与这里的说明性实例相同的手柄的闭合及击发操作。
在图4-6中,一种型式的电致动防倒退机构进一步省略了机械部分,该部分用于击发行程的机械结束和防倒退机构的手动释放,仅依靠弹簧偏压锁定板防止与电活化聚合物(EAP)致动防倒退凸轮管进行释放相反的回拉,类似于图2-3,3A所描述的。在图7-11中,一种型式的电致动防倒退机构使用了紧紧缠绕的线圈连接击发机构,该击发机构被EAP致动器松开得以释放。在图12-15中,一种型式的电致动防倒退机构使用了一个EAP拼合式圆柱形套筒,该套筒伸展则锁定,被包围的壳体向内推动与击发杆接触,收缩则解锁。在图16-17中,一种型式的电致动防倒退机构使用了一个EAP圆柱形套筒,该套筒向内收缩以接触击发杆,伸展则解锁。参照附图,其中在几个视图中相同的数字表示相同的部件;在图1中,外科缝合和切割器械10包括了端部执行器的多冲程击发,在说明性型式中是缝钉施放装置12。砧板14可以绕连接到延长(缝钉)通道16的枢轴联接反复张合。缝钉施放组件12近端与细长轴18连接,而细长轴18的近端与手柄20连接。具体而言,细长轴16的结构机架21在它的近端与手柄20可旋转地接合,并且在它的远端与缝合槽16连接。轴18和缝钉施放组件12共同组成了执行部分22。缝钉施放组件12通过向远端推动包围结构机架21的闭合管24闭合。执行部分22的闭合的缝钉施放组件12呈现了较小的截面面积,适合通过在外部操作手柄20穿过套针的套管(未示出)插入。执行部分22定位后,缝钉施放组件12随后在组织上闭合并夹持。示为击发杆25的击发部件在结构机架21内向远端推动,以在缝钉施放组件12内实现切割和缝合。
手柄20在其手柄罩26上安装有用户控制装置,例如使执行部分22绕轴18的纵轴旋转的旋钮27。闭合扳机28在手枪式握把30的前面绕连接于手柄罩27的联接枢轴转动,它被按下时将通过向远端推动闭合管24闭合缝钉施放组件12。多冲程击发扳机32在闭合扳机28前面枢轴转动通过向远端推动击发杆25使缝钉施放组件12同时切割和缝合所夹持的组织。由于多击发动作可用来减少外科医生的手每个动作所需施加的力量,右及左指示轮34,36(后者在图2中示出)旋转并显示表示击发进程的标记。例如,一个完整的击发行程可能需要三个完整的击发冲程,因此指示轮34,36在每个冲程时转过三分之一圈。手动回拉杆38允许在需要时在完全击发行程之前通过手动脱离机械-电混合式防倒退装置40进行回拉,也能够在锁合或回拉偏压件失效时帮助回拉。当闭合扳机28被夹紧且未发生不完全击发时,闭合释放按钮41将显露在外,以防止松开闭合扳机28。
手柄20中的回拉偏压件在击发之后回拉击发杆25。当击发扳机释放准备下一动作时,防倒退装置40与击发杆25咬合,以防止无意的回拉。有利地,一个防倒退电致动器42位于击发杆25的近端,以便有选择地在闭锁与解锁状态间移动。控制模块44用以激活防倒退电动致动器42。电力可由外部电源提供,或者由所示的电池46提供,电池46经接通时会发光的电源按钮48连接到控制模块44上。控制模块44监视外科手术切割和缝合器械10的运行,以决定何时闭锁以及解锁击发,例如击发解锁传感器50所显示的,以虚线示出处于击发扳机32上的磁性锚点52,而击发扳机32则相对于安装在手柄罩26内的霍尔效应传感器54运动。应当认识到,也可使用其他传感器探测可保证锁定或释放击发杆25的状况。
图1中防倒退装置40的一种型式在图2-3中显示,它包含带有通孔58(图2)的防倒退锁定板56,锁定板56在击发杆25向远端移动时顶端向前倾斜至横向非束缚(解锁)位置,当击发杆25试图回拉时顶端向后倾斜至成一定角度的束缚(“闭锁”)位置,并由包围击发杆25且位于锁定板58远端的弹性部件60辅助。下部附加突出物62从结构机架21近端的下部唇缘64近端伸出,穿过位于防倒退锁定板56下部边缘的孔66延伸。下部附加突出物62拉住接近结构机架21的防倒退锁定板56的下部,以使防倒退锁定板56在击发杆25向远端前进时是垂直的,而在击发杆25试图回拉时使其顶端向后倾斜至束缚状态。
防倒退弹性偏压部件68包围着击发杆25并且位于锁定板56的远端。偏压部件68和锁定板56之间的接合仅限于两部件顶端边缘之间的抵靠,以推动锁定板56回到闭锁位置。偏压部件68的远端抵靠结构机架21,因此只允许其向近端伸长。在锁定板56的近端,防倒退凸轮管70包围着击发杆25并被限制只能纵向运动。更具体的说,指向近端的防倒退凸轮型轭形件72连接到防倒退凸轮管70的近端上表面上,并且能滑动并被手柄罩26接纳,限制旋转动作,并用这种型式充当机械式释放致动器。防倒退凸轮管70自身可以被防倒退凸轮型轭形件72向远端推进,也可以方便地由一对电致动器推进,这一对致动器被表示为圆柱形EAP致动器74,76。防倒退凸轮管70和圆柱形EAP致动器74,76与图4-6中的一种型式的防倒退机构40是一样的,在这些图中,缩短了的凸轮轭72a仅起引导防倒退凸轮管70的作用,并没有与机械式释放致动器连接。参照图3A,可以预期通过选择数个构造中的一个,可以实现锁定板56的被动和/或主动偏压。防倒退凸轮轭72用于通过使用者手动输入或击发行程的自动结束传递机械释放动作。
图4中的型式的不同在于,其弹性部件60包含一个防倒退压缩弹簧60a,该弹簧有一个远端窄线圈78,该线圈78夹住击发杆25a的较细部分80,其远端被该部分限制。防倒退压缩弹簧60a还有一个加宽的近端线圈82,其尺寸能抵靠防倒退锁定板56。这样,防倒退压缩弹簧60a提供了全时程的锁定偏压,该锁定偏压由击发杆25或防倒退凸轮管72a向远端移动来克服。
在图3A中,EAP致动器74,76有放松、收缩状态,这允许弹性部件60向近端压迫防倒退锁定板56以向近端推动防倒退凸轮管70至手柄罩26。当给EAP致动器74,76加电时,EAP致动器74,76纵向伸展,如图中虚线所示,向远端推动防倒退凸轮管70,同样如图中虚线所示。可以预期,图2-3,3A的型式可以配置有弹性部件60,该弹性部件60由具有放松、收缩状态和激活、伸展状态的EAP致动器(例如有一个通孔以在电激发时适于纵向伸展的圆柱形组合EAP层片)构成。从而,锁闭偏压件可选择性移动以减少击发力。击发扳机32要求用更小的力使锁定板56向弹性部件60运动。此外,弹性部件60也可以有一个放松的收缩状态和一个激活的伸展状态。进而,弹性部件60可以是一个组合压缩弹簧,该弹簧在EAP纤维致动器内纵向缠绕或者由EAP组合层片致动器支持和/或限制。
电活化聚合物(EAPs)是一组导电涂层聚合物,当施加电压时其形状改变。实质上,导电聚合物与某些形式的离子液或凝胶和电极配合。离子从流体/凝胶中流入导电聚合物或者从导电聚合物中流入的流动通过施加的电压引导,并且这种流动引导聚合物的变形。依据所使用的聚合物和离子流体,电压在1V到4KV的范围内。一些EAPs在施加电压时收缩,而一些膨胀。EAPs可以与机械装置配合,比如弹性或柔性盘,来改变施加电压时产生的效果。
有两种基本类型的EAPs并且每种有多种构造。该两种基本类型是纤维束和层压形式。纤维束包括大约在30-50微米的纤维。这些纤维可以织成非常类似于织物的束并且因此常称为EAP纱线。这种类型的EAP在施加电压时收缩。电极通常由芯线和导体外壳组成以便还用来包含围绕纤维束的离子液。一种可以买到的纤维EAP材料是由Santa Fe Science and Technology生产并且以商标PANIONTM纤维出售并且在美国专利6,667,825中有描述,其内容在此全部引人以供参考。
另一种类型是层压结构,其由一EAP聚合物层、一离子凝胶层和两个连接到所述的层压层的每一侧的柔性板组成。当施加电压时,正方形的层压板沿一个方向膨胀并且沿垂直方向收缩。一种可以买到的层压(板形)EAP材料来自于Artificial Muscle Inc,其为SRI实验室的一个部门。板形EAP材料还可以从日本的EAMEX得到,其成为薄膜EAP。
应当注意的是,EAPs在被激励时,体积不变;它们仅仅是沿一个方向膨胀或收缩而在横向上与之相反。层压形式可以通过将一侧包含到刚性结构上并将另一侧如活塞似的使用而以其基本形式使用。层压形式还可以粘结到柔性板的任意侧。当柔性板EAP的一侧被激励时,其沿相反方向扩张柔性板。依据受激励侧的不同,这允许该板在任意方向弯曲。
EAP致动器通常由许多层或者纤维束一起组成以便配合工作。EAP的机械构造确定由EAP致动器和其运动的能力。EAP可以形成长绳并且围绕单中心电极缠绕。柔性外部外套管将为致动器形成另一个电极并且装有该装置的功能所需的离子液。在这种结构中,当将电场加到电极上时,EAP绳缩短。由EAP致动器的这种结构称为纤维由EAP致动器。同样,可以将层压结构在柔性板的每一侧放置多层或者仅仅在其自身上放置多层以增加其性能。典型的纤维结构具有2-4%的有效张力,在典型的层压形式中使用更高的电压可获得20-30%。
例如,层压EAP材料可以由连接到EAP层上的正板电极层形成,该EAP层又连接到离子细胞层,离子细胞层又连接到负板电极层。多层EAP材料可以通过它们之间的粘合层大量固定以形成EAP板致动器。可以理解的是相对的由EAP致动器可以形成为在任意方向可以选择性地弯曲。
收缩EAP纤维致动器可以包括一根纵向铂阴极线,该阴极线穿过绝缘的聚合物近端帽,然后穿过长形的圆柱形腔体,该圆柱形腔体形成于经导电涂层以作为正极使用的塑料圆柱形壁内。铂电极线的远端嵌入绝缘聚合物远端帽内。许多收缩聚合物纤维与电极线平行地并且围绕电极线设置并且使它们的端部嵌入到各自的端帽中。塑料圆柱形壁沿圆周围绕各个端帽连接以便闭合圆柱形腔体来将填充到收缩聚合纤维和电极线之间的空间内的离子液或凝胶密封。当将电压穿过圆柱形壁(正极)和电极线施加时,离子液进入收缩纤维内,使它们的外径膨胀,同时长度相应缩短,由此使各端帽彼此拉动。
在图2-3中,手柄20的部件与前述美国专利申请11/052,387和11/052,632相同,实现防倒退凸轮管72的闭合及击发和机械致动。结构机架21与手柄20可转动地接合,这样,扭动旋钮27将导致执行部分22的转动。旋钮27壳体的每一半都有一向内的凸起90(图2),该凸起分别伸入闭合管24内的长侧开口92,并向内移动与结构机架21接合,以确定执行部件22的转动位置。长开口92的纵向长度足够长,允许闭合管24的纵向闭合运动。
闭合扳机28绕闭合扳机销93转动,从侧面在手柄罩26内接合。在闭合扳机销95上方的闭合扳机28的上部94通过闭合链98向前推动闭合轭96。闭合链98在其远端通过闭合轭销100枢轴连到闭合轭96,在其近端通过闭合链销102枢轴连接。闭合扳机28被闭合扳机拉伸弹簧104推至开放位置,该弹簧近端连接到闭合扳机28的上部94及手柄罩26。
闭合扳机28的上部94包括一个有后凹口108的近端凸缘106。闭合释放按钮41和枢轴锁臂110通过中心横向枢轴112相连接。压缩弹簧114向近端偏压闭合释放按钮41(从右面看绕中心横向枢轴112顺时钟转动)。当闭锁扳机28松开时随着上部94的回退,枢轴锁臂110抵靠在近端凸缘106上,拉动闭合释放按钮41。当闭锁扳机28到达其完全压缩位置时,应当知道,后凹口108将置于枢轴锁臂110之下,而枢轴锁臂110将在压缩弹簧114的压迫下落入并闭锁后凹口108。随着击发部件回拉,手动压迫闭锁释放按钮41将使枢轴锁臂110向上旋转,松开闭锁扳机28。
一旦闭锁扳机28在近端被握紧,击发杆25即响应被拉向手枪式握把30的多冲程击发扳机32远离手柄20向远端运动,而击发行程量可以让外科医生在右及左指示轮34,36上看到。击发扳机32围绕击发扳机销118枢转,击发扳机销118横向穿过手柄罩26并与其横跨接合。
连接传动击发机构120开始时回拉,被固定在手柄20的手枪式握把30内部的组合拉伸/压缩弹簧122压迫而保持在此位置,其不动端124与罩26连接,而移动端126与钢带130的可向下弯曲的回拉近端128连接。
钢带130的置于远端的端部132与连接零件134在多个连接件136a-136d的前连接件136a上连接,这些连接件构成了链接齿条140。齿条导引管141有一个近端开口的内腔142和较小的远端开口143,内腔142的形状能接受向远端推动的多个连接件136a-136d,而较小的远端开口143的形状允许与最远端连接件136a连接的击发杆25通过。左侧和右侧的夹持零件144,145,手柄罩通过分别在闭合轭96和齿条通道盖148内的细长槽146,147与手柄罩26相反地向内延伸,与齿条导引管141内形成的各自的近端边侧凹槽149接合。由此,链接齿条140可伸缩,并具有构成直刚性齿条组件的近端连接件,该齿条组件可以通过执行部分22中的击发杆25传递明显的击发力,并且可容易地拉回至手枪式握把30内以将手柄20的纵向长度减至最小。应当理解,组合拉伸/压缩弹簧122增加了有效击发行程,而相比单一弹簧使最小长度降低一半。
如上所述,防倒退凸轮轭72运动而实现防倒退锁定扳56的机械释放。自动触发基于远端连接件136d,连接件136d包括柄脚150,柄脚150在远端连接件136d被推进到在闭合轭96中形成的齿条通道152内时将向上凸出。该柄脚150对齐,以触发防倒退释放杆156上的底部近端凸轮154。手柄罩26中形成的结构限制防倒退释放杆156的运动。分别在手柄罩26的右和左半壳体之间形成的销插孔158及环形销160通过纵向细长孔162接合,细长孔162在防倒退释放杆156中形成,位于底部近端凸轮154远端,从而允许纵向平移以及绕环形销160转动。在手柄罩26的右半壳体内,近端开口的通道164包括近端水平部分166,该部分与向上的、远端成角的部分168互相连接,而该部分容纳接近防倒退释放杆156的右向后缘销170,从而当防倒退释放杆156达到其平移的最远端部分时触发向上旋转。在手柄罩26右半壳体内于防倒退释放杆156近端形成的阻挡结构172防止其向近端运动,装配后使右向后缘销170保持在近端开口通道164内。
防倒退释放杆156的远端174被向远端及下方推动,导致右向前缘销176落入在手柄罩26的右半壳体内形成的远端开口阶梯结构178中,压缩弹簧180推动该接合,压缩弹簧180钩住左向钩182,左向钩182位于防倒退释放杆156上右向前缘销176和纵向细长孔162之间。压缩弹簧180的另一端安装于在手柄罩26的右半壳体内形成的钩子184上,钩子184恰位于闭合轭96之上一个更近端且更低的位置上。压缩弹簧180向下方和后方推防倒退释放杆156的远端174,导致向远端行进时右向前缘销176锁入远端开口的阶梯结构178内。
一旦松开,防倒退释放杆156即向前垂直夹持防倒退锁定板56,这样就使链接齿条140可以回拉。当闭合轭96随着松开端部执行器12而回拉时,闭合轭96上向上凸起的重置柄脚86与防倒退释放杆156上的底部远端凸轮188接触,使得右向前销176从远端开口阶梯结构178中升起,以使防倒退弹性部件60可以把防倒退凸轮管70和防倒退释放杆156向近端推动到达它们的回拉位置。
击发扳机32以击发扳机销118为枢轴,向远端及近端往复推动击发扳机32的上部190,拉动一个放在近端的击发扳机拉伸弹簧192,该拉伸弹簧的近端连接在击发扳机32的上部190与罩26之间。在每次击发扳机被一个弹簧偏压边爪机构194压下期间,击发扳机32的上部190与链接齿条140接合,在击发扳机32释放时也会脱离接合。
具体的,由每个连接件136a-136d中的近端右向斜面198形成的右侧倾斜轨道196与侧爪机构194接合。具体的,一个棘爪滑动件(梭动件)200有左右下部导向件202,导向件分别在左轨道204和右轨道206内滑动,左轨道204是在位于齿条通道152下方的闭合轭96上形成的,而右轨道206是在闭合轭导轨208上形成的,闭合轭导轨208与齿条通道152平行,接在齿条通道盖148上,齿条通道盖148封闭了位于棘爪滑动件200行程远端的闭合轭96内齿条通道152上一个向右开口的部分。在图3和图6中,压缩弹簧212连在位于闭合轭导轨208顶端近侧位置的钩子214和位于棘爪滑动件200远端右侧的钩子216之间,以使棘爪滑动件200向近端牵引,与击发扳机32的上部190接触。
棘爪固定件218置于以垂直后销220为枢轴的棘爪滑动件200上,垂直后销220穿过棘爪固定件218和棘爪滑动件200的左侧近角。冲出(Kick-out)固定凹槽222是在固定件218顶面远端部分形成的,以容纳在此处用垂直销226枢轴钉住的冲出(kick-out)固定件224,销226的底端延伸入处于棘爪滑动件200的顶面的爪簧凹槽228。爪簧凹槽228内的爪簧230延伸至垂直前缘销226的右侧,压迫棘爪固定件218从上向下看反时针旋转至与倾斜右侧轨道196接合。冲出(kick-out)固定凹槽内的小卷簧232推动冲出(kickout)固定件224从上向下看顺时针旋转,推动其近端接触在齿条通道152上的闭合轭内形成的轮廓缘234。
爪簧230相对于小卷簧232更强的机械优势在于棘爪固定件218趋向于与顺时针旋转的冲出(kick-out)固定件224接合。当击发扳机32完全压缩并开始释放时,冲出(kick-out)固定件224在棘爪滑板200回拉时碰撞在轮廓缘234内的凸脊236,迫使冲出(kick-out)固定件224从上向下看顺时针旋转,由此将棘爪固定件218从与链接齿条140接合处碰出。冲出(kick-out)固定凹槽222的形状阻挡了冲出(kick-out)固定件224以垂直方向顺时针旋转至轮廓缘234,并在整个回拉过程保持此脱离接合状态,以此消除棘齿的噪音。
如上所述,外科缝合和切割器械10包括手动回拉功能,它提供击发位置指示、击发机构的手动释放和链接齿条140的手动回拉。前空转齿轮240与链接齿条140的带齿的左上表面242接合。前空转齿轮240也和有较小的右边棘齿齿轮246的后空转齿轮244接合。前空转齿轮240和后空转齿轮244都分别在前空转轮轴148和后空转轮轴250处与手柄罩26可旋转地连接。后空转轮轴250的两端延伸并分别穿过手柄罩的右和左半壳体并与左和右指示轮34,36连接。由于后空转轮轴250自由销合于手柄罩26上且与后空转齿轮244用键接合,指示轮34,36与后空转齿轮244同时旋转。链接齿条140、前空转齿轮240和后空转齿轮244之间的齿轮关系可以择优选取以使带齿的上表面242的齿的尺寸能够使齿有足够的强度以使后空转齿轮244在链接齿条140的整个击发行程中旋转不超过一周。
后空转齿轮244的较小的右侧棘齿轮246伸进手动回拉杆38的毂260内,与把毂260分成两份的垂直的纵向排列的槽262精确地对齐。毂260的侧面通孔264与上部凹槽266互相连接。上部凹槽266的前部具有能容纳定向于近端的锁定棘爪268的形状,棘爪268以在上部凹槽266的远端形成的右向侧面销270为枢轴。上部凹槽266的后部的形状能容纳一个L形弹簧突起272,该弹簧突起272使锁定棘爪268向下与较小的右侧棘齿轮246啮合。支撑结构274从手柄罩26的右半边壳体上伸出,伸入上部凹槽266内,当手动回拉杆38放下时,支撑构件266撑起锁定棘爪268使其与较小的右侧棘齿轮246脱离啮合。卷簧276迫使手动回拉杆38放下。当手动回拉杆38升起时,锁定棘爪268顺时针转动(从右边看),并且不再被支撑结构274撑起,从而与较小的右侧棘齿轮246啮合,令后空转齿轮244从右边看逆时针旋转。这样,前向空转齿轮240做出响应顺时针转动,回拉链接齿条140。另外,右向弯曲凸脊278从毂260伸出,其尺寸使其能与防倒退释放杆156接触并使后者向远端移动,在手动回拉杆38转动时机械释放防倒退机构40。
在图7-11中,用于外科手术缝合与切割器械310的一种型式的电致动防倒退机构40包括一个紧紧包围着击发杆314的防倒退盘簧312。具体的,防倒退盘簧312的远端316沿纵向伸展,具体参照图8,在结构机架322中形成的开口向上的致动器凹槽320包含一个常规直角棱柱开口324,开口上有一远端的垂直槽326用以接收并阻止防倒退盘簧312的远端316转动。开口向上的致动器凹槽320上的左向垂直槽328被安排来当抵靠开口向上的致动器凹槽320右近侧的EAP块致动器330将盘簧顶部向左转动时,接收防倒退盘簧312的朝上的近端328。在图11中,防倒退盘簧312的绕向满足当朝上的近端328向左转时盘簧收紧。应该注意到,EAP致动器330的电激发状态(例如,横向伸展和收缩)以及防倒退盘簧312的收紧方向可以根据偏压闭锁或偏压解锁来选择。
此外,应该注意到盘簧(未示出)可以纵向缩短至径向伸长的解锁状态,并且可以纵向伸长至径向收缩的闭锁状态,以一个联结盘簧全长两端的电致动器来完成这一改变。此外,盘簧的一端可以相对于结构机架固定,而盘簧自由端由电致动器相对于结构机架推动,来完成这一改变。
具体参照图8,固定凸缘332有一被触点336触接的远端导电圆环334,该环作为EAP块致动器330的一个电极,有一由结构机架322提供的接地通道。在图7-10中,近端突臂338附于固定凸缘332的近端的顶面上,并与手柄罩340接合以防止固定凸缘332转动或轴向移动。在图8-9中,闭锁套筒342有一个细长的顶部凹槽344,其尺寸适合接点336在闭合平移过程中延伸。应该注意到,旋钮(未示出)横放在闭锁套筒342上的细长的顶部凹槽344和结构机架322上的开口向上的致动器凹槽320上。
在图12-15中,用于外科手术缝合与切割器械410的一种型式的电致动防倒退机构410包括一个圆柱形EAP拼合式致动器412,致动器412紧紧包围着击发杆414,在加上电压后将径向伸长。刚性套筒316包围在圆柱形EAP拼合式致动器412外,迫使其向内伸长,与击发杆414束缚接触。具体参照图12,在结构机架422上形成的开口向上的致动器器凹槽420包含一个常规直角棱柱开口424。固定凸缘432有一被第一触点436触接的外部远端导电圆环434以及一个被第二触点440触接的内部远端导电圆环438,它们作为圆柱形EAP拼合式致动器412的电极(即,阴极,阳极)。近端突臂442附在固定凸缘432的顶部近端面上,并与手柄罩444接合,以防止固定凸缘432转动或沿纵向移动。在图12-14中,闭锁套筒446有一个细长的顶部凹槽448,其尺寸适合触点436,440在闭合平移过程中延伸。应该注意到,旋钮(未示出)卧放在闭锁套筒446上的细长顶部凹槽448和结构机架422上开口向上的致动器凹槽420上。
在图16-17中,用于外科缝合和切割器械510的一种型式的电致动防倒退机构40包括EAP圆柱形致动器412,该致动器紧密包围击发杆514,有与击发杆514束缚接触的放松的收缩状态,当受激发解除束缚接触时径向伸展。在结构机架520内形成的向上开口的致动器凹槽520包括一般为矩形的棱柱开口524。固定凸缘532有一个被第一触点536触接的外部远端导电圆环534和被第二触点540触接的内部远端导电圆环538,它们作为EAP拼合式圆柱形致动器512的电极(即阴极,阳极)。近端突臂542与固定凸缘532的顶部近端表面连接并与手柄罩(未示出)接合,以防止固定凸缘532旋转或纵向运动。在图16中,闭锁套筒546有一个细长的顶端孔548,该孔的尺寸适合触点536,540在闭合平移过程中延伸。应当注意到,旋钮(未示出)覆盖于闭锁套筒546的细长顶端孔548和结构机架522上向上开口的致动器凹槽520之上。
尽管通过几个实施例对本发明进行了阐述,并且尽管所示的实施例已经相当详细地进行了描述,但是本发明的意图不是限制或以任何方式对所附权利要求的范围限制到如此详细。其它的优点和改进对于本领域技术人员来说是显而易见的。
应当意识到,在此使用的术语“近端”和“远端”是参照紧握器械的握柄的临床医生而言。因此,端部执行器12相对于更近端的手柄20在远端。还应当意识到,为了方便和清楚起见,在此使用的空间术语如“垂直”和“水平”是相对于附图而言的。但是,外科器械被用于许多方向和位置,而且这些术语并不具有限制性和绝对性。
本发明按照内窥镜操作和装置进行了叙述。然而,这里使用的术语,如“内窥镜”,不应解释为将本发明限于仅与内窥镜管(即套管针)联合使用的外科缝合与切割器械。相反,可以认为本发明可用于入口限定于小创口内的任何操作,包括但不限于腹腔镜操作和开放操作。
与本发明相关的申请可包括单击发器械和具有整体击发齿条而不是链接齿条的器械。
作为另一个例子,可以向约束接点内放置一个摆动靴型防倒退杠杆。一种手动摆动靴型防倒退杠杆公开在美国专利申请序号No.10/881,105中,其发明名称为“具有带旋转传动的多冲程击发机构的手术缝合器械”,由Whitacre等人于2004年6月30日申请,其公开内容在此全文引用作为参考。
Claims (19)
1.一种外科器械,包括:
端部执行器;
纵向往复的击发杆,其远端连接到端部执行器;
轴,其远端连接到端部执行器,并可操作地构造为引导击发杆;
连接轴的近端并且具有多冲程击发扳机的手柄,该多冲程击发扳机可操作地构造为在一系列动作中向远端推进击发杆;以及
防倒退机构,当所述多冲程击发扳机释放准备下一动作时,所述防倒退机构与所述击发杆咬合以防止击发杆的无意拉回;
其中,所述防倒退机构包括电致动器,该电致动器物理连接到手柄,响应电信号与击发杆一起在非束缚和束缚位置之间运动,以此防止击发杆纵向移动。
2.如权利要求1的外科器械,其中所述电致动器包括电活化聚合物致动器。
3.如权利要求1的外科器械,其中所述电致动器进一步包括:
包围击发杆的锁定板通孔,其大小适合在垂直于击发杆的解锁状态时与所述击发杆非束缚接触,以及在垂直倾斜一个角度的闭锁状态时与所述击发杆束缚接触,所述电致动器的定位可使锁定板在解锁和闭锁状态中从一个选择的状态移动到另一个状态。
4.如权利要求3的外科器械,进一步包括一弹性部件,该弹性部件偏压锁定板到闭锁状态,而击发杆的对抗弹性部件向远侧的运动使锁定板移动到解锁状态,所述电致动器包括防倒退凸轮管,其位置设置为在激发弹性部件时可选择性地抵抗和被克服。
5.如权利要求4的外科器械,其中所述电致动器包括电活化聚合物致动器,其可操作地构造为被激发时纵向伸展,从手柄向远端推动防倒退凸轮管。
6.如权利要求4的外科器械,进一步包括:
近侧凸出轭形件,它与防倒退凸轮管连接;
手动释放机构,其可操作地构造为传递释放运动到近端凸出轭形件来手动致动防倒退凸轮管,释放锁定板。
7.如权利要求6的外科器械,进一步包括手动释放控制件,其可操作地构造为为使用者致动,手动释放机构可操作地构造为从手动释放控制件传递释放运动。
8.如权利要求6的外科器械,进一步包括为在手柄中动作而连接到击发杆的解锁部件,防倒退释放杆,其响应相应于击发杆的全击发行程运动到远侧位置的解锁部件,向远侧推动近侧凸出轭形件以解锁锁定板。
9.如权利要求1的外科器械,其中所述电致动器包括径向缠绕击发杆的卷簧和一个电动装置,该装置可操作地构造为以下两种状态之间改变卷簧的内径:与击发杆束缚接触时较小直径的闭锁状态,和与击发杆非束缚接触时较大直径的解锁状态。
10.如权利要求9的外科器械,其中所述卷簧进一步包括由轴保持抵抗旋转的第一端,以及径向延伸端,所述电致动器包括电活化聚合物致动器,其定位使得可旋转径向延伸端,以达到所选择状态。
11.如权利要求1的外科器械,其中所述轴进一步包括由手柄纵向定位的结构机架,所述电致动器包括包围击发杆并与结构机架连接的电活化聚合物套管。
12.如权利要求11的外科器械,其中所述电活化聚合物套管可操作地构造为具有在选择的电激发状态和非电激发状态之一时与所述击发杆束缚接触的内径和在非选择状态时与所述击发杆非束缚接触的较大的内径。
13.如权利要求11的外科器械,其中所述电活化聚合物套管在非电激发、放松状态的内径大于击发杆,以便非束缚的解锁接触,电激发状态扩大了电活化聚合物套管的径向厚度,其中轴可操作地构造为限制电活化聚合物套管向外伸展,迫使电活化聚合物套管在电激发状态时与击发杆束缚接触。
14.如权利要求1的外科器械,其中所述端部执行器包括缝钉施加组件。
15.一种外科器械,包括:端部执行器;手柄;细长轴,其包括连接端部执行器与手柄的结构机架,以及击发部件,该部件被引导在手柄和端部执行器之间进行纵向往复运动;击发扳机,其与手柄接合以便运动;手柄内的多冲程击发机构,其可操作地构造为随击发扳机的每一个击发冲程逐渐地向远侧推进击发部件;位于手柄内的回拉偏压部件,用于向击发部件上施加回拉偏压;防倒退机构,当所述多冲程击发机构释放准备下一动作时,所述防倒退机构与所述击发部件咬合以防止击发部件的无意拉回,防倒退机构包括电致动器,该电致动器可操作地构造为与击发部件一起在锁定和解锁状态之间移动;以及控制电路,其可操作地构造为激发电致动器。
16.如权利要求15的外科器械,其中所述防倒退机构进一步包括:锁定板,其具有一通孔,该通孔的尺寸为当垂直时从击发部件脱离接合而当成一角度时锁定;弹簧,其偏压锁定板到后倾斜角的位置;对抗弹簧的凸轮部件;以及电活化聚合物致动器,其定位可移动凸轮部件继而移动锁定板到闭锁状态。
17.如权利要求15的外科器械,进一步包括一卷簧,该卷簧具有由轴保持抵抗旋转的第一端,以及径向延伸端,所述电致动器包括电活化聚合物致动器,其定位使得可旋转径向延伸端,以改变卷簧的内径来改变选自闭锁状态和解锁状态的状态。
18.如权利要求15的外科器械,所述细长轴进一步包括由手柄纵向定位的结构机架,所述电致动器包括电活化聚合物套管,该套管包围击发部件并与结构机架接合,并且可操作地构造为具有在选择的电激发状态和非电激发状态之一时与所述击发部件束缚接触的内径和在非选择状态时与所述击发部件非束缚接触的较大的内径。
19.如权利要求18的外科器械,其中所述电活化聚合物套管在非电激发的放松状态时的内径大于击发部件,以便非束缚的解锁接触,电激发状态扩大了电活化聚合物套管的径向厚度,其中结构机架可操作地构造为限制电活化聚合物套管向外伸展,迫使电活化聚合物套管在电激发状态时与击发部件束缚接触。
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CNB2005100895192A Active CN100500104C (zh) | 2004-07-28 | 2005-07-28 | 具有电活化聚合物致动的医疗物质投放器的外科缝合器械 |
CN200510089521XA Active CN1732859B (zh) | 2004-07-28 | 2005-07-28 | 具有两件式e形梁发射机构的铰接手术缝合器 |
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- 2005-07-27 JP JP2005217080A patent/JP4902973B2/ja not_active Expired - Fee Related
- 2005-07-27 RU RU2005123961/14A patent/RU2005123961A/ru not_active Application Discontinuation
- 2005-07-28 CN CNB2005100895309A patent/CN100569189C/zh active Active
- 2005-07-28 CN CNB2005100895192A patent/CN100500104C/zh active Active
- 2005-07-28 MX MXPA05008046A patent/MXPA05008046A/es unknown
- 2005-07-28 CN CN200510089521XA patent/CN1732859B/zh active Active
- 2005-07-28 CN CN200510087334A patent/CN100579467C/zh active Active
- 2005-07-28 CN CNB2005100873329A patent/CN100479769C/zh active Active
- 2005-07-28 CN CNB2005100895205A patent/CN100515349C/zh active Active
- 2005-07-28 CN CN2005100895296A patent/CN1745720B/zh active Active
- 2005-07-28 CN CNB2005100873390A patent/CN100566667C/zh active Active
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- 2005-07-28 CN CN200510087335A patent/CN100579468C/zh active Active
- 2005-07-28 CN CN200510087341A patent/CN100579470C/zh active Active
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CN1732859B (zh) | 2010-07-07 |
CN1726877A (zh) | 2006-02-01 |
CN100579470C (zh) | 2010-01-13 |
JP4902973B2 (ja) | 2012-03-21 |
CN100515349C (zh) | 2009-07-22 |
CN1726876A (zh) | 2006-02-01 |
BRPI0503041A (pt) | 2006-03-14 |
US20060022015A1 (en) | 2006-02-02 |
US7143925B2 (en) | 2006-12-05 |
MXPA05008046A (es) | 2006-02-10 |
CN1726874A (zh) | 2006-02-01 |
CN1726875A (zh) | 2006-02-01 |
CN100569189C (zh) | 2009-12-16 |
CN100579468C (zh) | 2010-01-13 |
CN100579467C (zh) | 2010-01-13 |
RU2005123961A (ru) | 2007-02-10 |
CN1732857A (zh) | 2006-02-15 |
CN100566667C (zh) | 2009-12-09 |
CN1745719A (zh) | 2006-03-15 |
CN1732859A (zh) | 2006-02-15 |
CN1732856A (zh) | 2006-02-15 |
JP2006034980A (ja) | 2006-02-09 |
CN1732855A (zh) | 2006-02-15 |
CA2512977C (en) | 2014-12-09 |
CN1726878A (zh) | 2006-02-01 |
CA2512977A1 (en) | 2006-01-28 |
RU2005123979A (ru) | 2007-02-10 |
CN100569188C (zh) | 2009-12-16 |
CN100500104C (zh) | 2009-06-17 |
BRPI0503039A (pt) | 2006-03-14 |
CN100479769C (zh) | 2009-04-22 |
CN1745720A (zh) | 2006-03-15 |
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