CN1669534A - 用于弯曲切刀钉紧器的闭合盘式锁止件 - Google Patents
用于弯曲切刀钉紧器的闭合盘式锁止件 Download PDFInfo
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Abstract
一种适用于将多个外科紧固件施加于人体生理组织的外科装置,该医用装置包括:基座;容纳有多个医用紧固件的钉筒外壳,钉筒外壳和基座可在第一相间隔位置和第二相邻的位置之间相对运动;与钉筒外壳关联的击发机构,该击发机构用于将医用紧固件从将被驱动抵靠在基座上的钉筒外壳射出;和与钉筒外壳相互作用来选择致动和停止的锁止机构,该锁止机构包括旋转地安装在该医用装置的闭合元件上的锁止杆,该锁止杆包括远端,近端和位于其间的中间部分,该中间部分枢转地安装到闭合元件上来使锁止臂以可控方式旋转。
Description
技术领域
本发明涉及钉紧切除手术中进行病理诊断和治疗所用的一种医用钉紧、切断装置。更特别地,本发明涉及一种与医用钉紧和切割器械一起使用的锁止机构。
背景技术
医用钉紧和切割装置通常用在利用钉紧切除手术进行的病理诊断和治疗中。医用钉紧和切割装置设置有一种机构,这种机构扩展通过肛门、嘴、胃和设备附件进入的机械缝合机构的经皮实施(tranluminal exploitaiton)。尽管医用钉紧和切割装置通常用于直肠的病理诊断,但是医用钉紧和切割装置也可以用于其它场合。
医用钉紧和切割装置的发展已经有很长时间了。这些装置通常包括一支架,一连接到支架上的基座和一携带有多个钉子的钉筒外壳。这些装置还包括一位于钉筒外壳内的驱动件,该驱动件将所有钉子同时推出并进入基座,将钉子形成大体为B形的形状,从而将生理组织缝合在一起。此外,这些装置包括允许钉筒外壳和基座彼此相对移动来接受位于其间的生理组织的靠近机构。最后,这些装置还包括一用于将驱动件向前移动来抵靠基座形成钉子的击发机构。
除了钉紧和切割装置的上述基本部件外,这些装置还需要一锁止机构,该锁止机构控制靠近机构的致动和/或停止,使得钉筒组件在紧急情况下当需要时可以用做一夹紧件。
现有的医用钉紧装置包括一由驱动件致动的击发杆锁止件。当一个新的钉筒组件装到该钉紧装置上时,驱动件相对于钉紧装置中的钉筒组件的位置是以让钉紧装置击发钉子的方式干涉锁止臂。当该钉紧装置击发钉子后,驱动件的位置以不再干涉锁止臂的方式向远端移动。该锁止臂转到一此时干涉击发杆的位置,但是阻止击发杆向远端移动。
此外,现有的锁止机构没有设置用于确定锁止件是否已经被致动或钉紧装置是否被简单阻挡的装置。这些锁止机构仅仅是以与一阻挡装置类似的方式简单地阻止钉紧装置的运动。
因此,需要提供一种改进的锁止机构,这种锁止机构用于靠近机构的致动和/或停止来确保仅仅由未使用的钉筒组件进行夹紧动作。此外,现有技术的机构没有提供提醒使用者该装置被锁止及未被阻挡的触觉反馈特征。本发明提供了这样的锁止机构。实际上,本发明装置提供了部分再靠近,其能够提供给使用者该装置被锁止的触觉反馈特征,而不会有现有装置的堵塞的反馈。
附图概述
图1是根据本发明的线性医用钉紧器的透视图;
图2是拆去了钉筒组件的线性医用钉紧器的透视图;
图3是将钉筒组件移动到一中间位置的线性医用钉紧器的透视图;
图4是将钉筒组件移动到一关闭位置的线性医用钉紧器的透视图;
图5是击发致动扳机处于致动位置的线性医用钉紧器的透视图;
图6是钉筒组件的分解图;
图7是固定有保持器的钉筒组件的前部透视图;
图8是拆去了保持器的钉筒组件的前部透视图;
图9是钉筒组件的后部透视图,其详细地显示了钉子筒外壳体狭槽;
图10,11和12显示了保持器的组成;
图13是线性医用钉紧器处于未致动状态的部分横截面图;
图14是销致动机构的分解图;
图15是线性医用钉紧器的闭合扳机稍稍缩回时的部分横截面图;
图16是线性医用钉紧器的闭合扳机接近完全缩回时的部分横截面图;
图17是线性医用钉紧器的闭合扳机完全缩回时的部分横截面图;
图18是线性医用钉紧器的致动扳机和闭合扳机完全缩回时的部分横截面图;
图19是医用医生压下释放按钮后的线性医用钉紧器的部分横截面图;
图20是在释放了关闭和致动扳机后但还没有回到中间制动位置时的线性医用钉紧器的部分横截面图;
图21-29显示了钉筒组件的插入和保持器的拆除情况;
图30-38显示了本线性医用钉紧器的致动过程包括的各个步骤;和
图39和40是钉子筒外壳的详细前视图。
具体实施方式
这里将披露本发明的详细实施例。应当理解的是,所披露的实施例仅仅是本发明的示例,其可以以多种形式体现。因此,这里披露的细节不是作为限制内容来解释的,而仅仅是作为教导本领域技术人员如何制作和/或使用本发明的基础提出的。
参照各附图,一医用器械20适于将多个医用紧固件施加到一人体的生理组织上。该医用器械20包括一基座122和一个容纳有多个医用紧固件的钉筒外壳121和基座122。钉子筒外壳121和基座122可以在分隔开的彼此相互靠近的第一位置和第二位置之间相对移动。一个与钉筒外壳121相关联的击发机构将医用紧固件从钉筒外壳121中击出,这些医用紧固件被驱动并抵靠在基座122上。一个锁止机构180与钉筒外壳121相互作用来可选择地致动和停止闭合机构。该锁止机构致动或停止靠近机构,而不是击发机构。只要使用者不开启医用器械20,他就可以根据需要关闭医用器械20,击发医用器械20和多次循环钉子击发系统。一旦开启,医用器械20就不能完全关闭,直到一个新的钉筒组件120被装上。该锁止机构180包括一个旋转地安装在医用器械20的闭合件28上的锁止杆181。该锁止杆181包括一个远端185,一个近端184和位于两者间的中间部分,该中间部分枢轴地安装在闭合件28上,从而允许锁止杆181以一种可控方式旋转。
参见附图1和附图2至5,它们显示了一种医用钉紧和切割器械,特别是一种设计用来钉紧和切割生理组织的线性医用钉紧器20。该线性医用钉紧器20具有一个位于第一近端处的手柄21和位于相对的远端处的端部受动器80。根据本发明的最佳实施例,该端部受动器80呈曲线形。右侧和左侧手部结构板(通常称为“手柄板”)34,35分别将手柄21连接到器械的端部受动器80(右侧手部结构板在图1中未显示)。手柄21具有与左手侧板连接的右手侧板22(左手侧板在图1中未显示)。手柄21还具有用于抓握和操纵该线性医用钉紧器的主体部分23(参见图2-5)。
端部受动器80是一个医用紧固组件,其包括一个钉筒组件120(参见图6-9)和一个U形支撑结构81。闭合件28的末端30布置成容纳钉筒组件120。端部受动器80还包括一个安全停止机构180(最好参见图31)以用于阻止先前已经击发过的钉筒组件120的击发。该钉筒组件120包括一个与一基座122连接的钉筒外壳121。该钉筒组件120还包括一个保持销125、一个刀具126、一个可拆除的保持器160、一个生理组织接触表面127,该表面上具有位于刀具126两侧的一行或多行(也就是钉子行)以交错方式排列的多个钉子容纳狭槽128。钉子(未显示)抵靠着基座122的钉子形成表面129从钉子筒121外壳击发,该钉子形成表面129与钉子筒外壳121的生理组织接触表面127相对。
正如通过下面的描述而可明确的那样,本发明的线性医用器械20设计为一个带有可更换钉筒组件120的多击发装置。但是,应当理解的是,本发明的许多根本理念完全可以等同地应用于单击发装置,这并不脱离本发明的精神。
端部受动器80的支撑结构81分别通过一个带肩部的铆钉82和栓件83和右侧及左侧手柄板34,35连接,其中栓件83从支撑结构81延伸进入手柄板34,35中的容纳孔。根据本发明的最佳实施例,支撑结构81由一个整体件构成。更特别地,该支撑结构通过诸如铝的挤压及随后的加工制成本发明所披露的支撑结构81。通过以这种方式构造支撑结构81,不再需要多个部件,从而显著地降低了加工和组装等相关费用。此外,支撑结构81的整体结构加强了本线性医用钉紧器20的整体稳定性。此外,支撑结构81的整体挤压结构将导致重量上的减轻、钴辐射有效地渗透该挤压铝制品而使杀菌更容易,挤压得到的平滑外表面也使得对生理组织的损伤更小。
线性医用钉紧器20的手柄21包括一个医生用手掌抓住的手持部分24(见图2-5)。该手持部分24由右手侧板手柄25(见图1)和左手侧板手柄构成(左手侧板手柄在图1中未显示)。从手柄21的下侧枢轴延伸的是闭合扳机26和击发板机27。图1中显示的线性医用钉紧器20的关闭板机和击发扳机26、27处于非致动位置,并插有一钉筒组件120,而保持器160已经被拆除了。因此,钉筒外壳121与基座122分开,以将生理组织放置在钉筒外壳121和基座122之间。
线性医用钉紧器20的手柄21包括一个生理组织保持销致动机构100。该生理组织保持销致动机构100包括一个位于手柄21顶面的鞍形滑动件101。手工移动鞍形滑动件101将导致推杆102向远端运动。该推杆102与钉筒120的保持销125连接。推杆102向远端运动或向近端缩回将导致保持销125的相应运动。保持销致动机构100也是可释放地连接到手柄21内的闭合扳机26上,这样如果保持销还没有手工移动到其最近端位置,闭合扳机26的致动将导致保持销125的自动进行的向远端运动。
参见图2-5,显示了钉筒组件120被装上,且闭合扳机26和击发扳机27顺序压向手持部分24以致动线性医用钉紧器20的端部受动器80时的情况。该线性医用钉紧器20装在钉筒组件120内,如图2所示意,其中保持器160被拆除了。现在该线性钉紧器20准备接收生理组织,如图1中所示。
如图3所示,当部分推压闭合扳机26使其到达其第一停止位置时,钉筒外壳121从其完全开启位置到达位于开启和关闭位置间的中间位置,这将在下面更详细地描述。同时,生理组织保持销致动机构100将保持销125从钉筒外壳121通过基座122上的一个开口向前移动。在该位置,放置在钉筒外壳121和基座122间的生理组织被适当定位,处于钉筒外壳121和基座122之间的生理组织的保持是有保证的。因此,当闭合扳机26已经被致动到其中间位置时,钉筒外壳121和基座122也对应地位于它们的生理组织保持位置。
如图4所示,当闭合扳机26完全被推压得与手持部分24的前端邻接时,钉筒外壳121的生理组织接触表面127和基座122的钉紧形成表面129彼此相邻,该已经适当定位并保持的生理组织随后被完全夹紧。此外,击发板机27朝着手持部分24逆时针旋转,来使医生能够握住击发扳机27来击发钉紧。因此,击发扳机27目前处于被医生挤压来钉紧并切割生理组织的位置。如图5所示,当击发扳机27被完全挤压来击发钉紧时,击发扳机27位于靠近闭合扳机26处。
现在参照图6-9对钉筒组件120进行更详细的描述。该钉筒组件120设置有在线性医用钉紧器20内使用的切割和缝合机构,其中在装置致动期间,钉紧和切割功能在同一方向上作用。尽管本钉筒组件120特别适于与线性医用钉紧装置一起使用,但是本钉筒组件120的原理也可以用于其它医用装置,这并不脱离本发明的精神。特别地,本钉筒组件120设置有在切割过程中与相应垫圈123一起使用的刀具126。本钉筒组件120确保了线性医用钉紧器20的多次击发不会影响切割性能。这是通过基座122,特别是切割垫圈123和钉筒组件120协同完成的。通过将垫圈123和钉筒组件120组装在一起,每次更换钉筒组件120时均提供一个新的垫圈123,从而改进了切割性能。
通过平行定位基座122和钉筒外壳121从而使它们的相对表面保持平行地彼此移动来进一步改进性能。这使得压力均匀分布在生理组织上,防止了下述方式的生理组织挤压:即可能集拢生理组织并迫使部分生理组织脱离基座122和钉筒外壳121间形成的预定空间。
更特别地,钉筒组件120包括一个钉筒外壳121,该外壳121容纳有多个定位在钉子容纳槽128中的钉子。紧接钉子后面设置的是一个将钉子从钉槽128中推出的驱动件131。一个刀具保持器130放置在钉筒外壳121内的驱动件131附近。刀具保持器130包括一个狭槽172和凸缘173以与一个刀具牵引器的钩形件45(见图37)相互作用,该作用将在下面更详细地描述。刀具保持器130与一刀具126连接,该刀具126通过保持器131内的狭槽200和钉筒外壳内的狭槽199从刀具保持器130的末端延伸。
刀具保持器130具有延伸通过钉筒外壳121上的狭槽137的定位支柱138。该刀具保持器130的定位支柱138定位成在刀具126和刀具保持器130的纵向运动过程中与钉筒狭槽137的定位突起139接触。类似地,驱动件131具有一个定位成分别与钉筒狭槽137的近端定位突起141和远端定位突起142接触的定位支柱140。
刀具126和狭槽199、200定位成在刀具126任一侧具有至少一排钉子。根据本发明的最佳实施例,两排钉槽128(和两排钉子)设置在钉筒外壳121的狭槽199的每侧。
钉筒外壳121容纳有位于刀具狭槽199两端的通常为圆形的开口143、144。位于钉筒外壳121的基部的通常为圆形的开口143的形状和尺寸设计成用作引导销124通过钉筒外壳121的通道。位于钉筒外壳121的顶部的通常为圆形的孔144的形状和尺寸设计成用作保持销125通过钉筒外壳121的通道。钉槽128布置成钉子横向延伸通过这两个通常为圆形的孔143、144的形式。
根据本发明的最佳实施例,基座122包括一个塑料垫圈123和一个金属的钉紧形成表面129。该基座122设置成将钉紧形成表面129保持为一相配结构的形式。通过保持销125的周向狭槽135和联接件133上的凹槽134,保持销125与一个联接件133相连接(最好参见图14)。联接件133设置在钉筒外壳121的一支臂145内并通过端帽146保持在该支臂145内。
引导销124和保持销125分别包括狭槽147a、147b(最好参见图8,9,36,39和40),刀具126的端部126a、126b分别设置在狭槽147a、147b内。引导销124的近端148与基座122的近端149相连。引导销124的远端150从钉筒外壳121延伸并延伸通过基座122的一狭槽151。通过将基座122的凹槽152设置在垫圈123的舌边153之下而将切割垫圈123塞入基座122中。切割垫圈123的相对端154塞入基座支臂155之下并通过销钉156销接在基座支臂155上。在该位置,垫圈123的切割表面157向上延伸通过基座122的一狭槽151。切割垫圈123组装到基座122上将引导销124限制在由基座狭槽151和切割表面157形成的开口内,从而,可操作地将基座122连接到钉筒外壳121上。如图7所示,保持器160连接到钉筒组件120上来将钉筒组件120的部件保持在预定方向上,直到插入端部受动器80。
现在参照附图6至12和附图25至29,更详细地描述保持器160。该保持器160具有一设置在钉筒外壳121的突起159周围的凹槽161。该保持器160包括一弹性的内部弹力支臂162,该弹性的内部弹力支臂162用于在保持器160内的往复运动。该保持器160包括围绕引导销124部分地延伸的容纳狭槽163。该弹力支臂162包括围绕引导销124部分地延伸的容纳狭槽164,但是该容纳狭槽164构造在面向容纳狭槽163的相对方向上。该保持器160定位于钉筒组件120上,使得容纳狭槽163、164围绕着引导销124并将保持器160限制在钉筒组件120上。弹力支臂162包括一从位于基座臂155之下的保持器160向下延伸的脱离突起165。这样,在钉筒组件120适当地位于端部受动器80之前,保持器160不会容易地从钉筒组件120上拆除。当钉筒组件120适当地位于端部受动器80时,脱离突起165脱离端部受动器80以释放保持器160。
现在参照图1和图2及图13,更详细地描述线性医用钉紧器20的各部件。该线性医用钉紧器20包括一个细长的闭合件28,该闭合件28具有一通常为U形的横截面并从手柄21延伸进入端部受动器80的医用紧固组件。根据本发明的最佳实施例,闭合件28是一个模制的塑料件,其形成为可以实现本发明的运动和功能的形状。通过用塑料制造该闭合件28,线性医用钉紧器20的制造费用和重量均降低了。此外,该线性医用钉紧器20更易于消毒,这是因为相对与金属来说,钴辐射更易于穿透塑料。根据一可变实施例,该闭合件可以通过挤压铝制品并将最终的特征加工在其位置上来得到。尽管挤压铝制品构成的闭合件的制造可能不象塑料制品的制造那么容易,但是其仍旧具有一些优势(如,减少部件数量、组装容易、重量轻、易于消毒等)。
闭合件28的端部通过支撑结构81的壁面84。末端设置成容纳和保持钉筒组件120的钉筒外壳121的形式。闭合件28的中部位于右侧和左侧手柄板34、35之间。通过一第一整体闭合连接销38,右手和左手闭合连接件36、37分别枢轴连接到闭合件28的右端和左端。在闭合连接件36、37的另一端,闭合连接件36、37枢轴连接到一第二整体闭合连接销39。该第二整体闭合连接销39将闭合连接件36、37连接到一带狭槽的闭合支臂连接件40上。该带槽的闭合支臂连接件40在一闭合扳机枢转销41处枢轴地安装到线性医用钉紧器20的手柄板34、35上。该闭合扳机26从带槽闭合臂式连接件40处向下延伸以围绕闭合扳机枢转销41朝着或远离手握持部24进行枢轴转动。容装在手柄21的手持部分24中的一根闭合弹簧42固定在带槽闭合臂式连接件40上,在医生朝着手持部分24按压闭合扳机26时,该闭合弹簧42提供所需的阻力以将闭合扳机26偏压向开启位置。
参考附图13、14,下面将对保持销致动机构100的部件进行描述。手柄21包括安装在手柄21顶部上的一个马鞍形滑动件101以进行线性运动。滑动件101通过手柄21中的槽105(参见图2)而与从一个推杆驱动件104向外延伸的一个栓杆103相连。推杆驱动件104受到槽105的限制而沿着线性医用钉紧器20的长轴进行纵向运动。推杆驱动件104通过推杆102上的周向槽107而与推杆102相连,所述推杆102卡持在推杆驱动件104的一个槽108中。推杆102通过位于其远端的一个周向槽109而与钉筒组件120的接合件133近端中的一个槽132相连(最好参见图22)。接合件133通过其远端的一个槽134而与保持销125上的一个周向槽135相连。
闭合件28包含有栓件29,栓件29在处于手柄21内侧的闭合件28的两侧上横向延伸。这些栓件29与轭件111的一个L形槽110滑动连接。轭件111通过其上的一个枢转销112枢轴地连接在手柄21上。轭件111包括有凸轮销113,该凸轮销113定位成推动推杆驱动件104上的凸轮表面114。
参考图13和图37,下面将对击发传动组件的部件进行描述。击发传动组件具有一个细长的击发杆43,该击发杆43从手柄21延伸入端部受动器80的医用紧固组件中。击发杆43布置在闭合件28的U形截面中。击发杆43的远端延伸入钉筒外壳121中且与刀具保持件130和驱动件131的近端相邻布置。击发杆43的远端连接在具有刀具回收钩45的一个刀具回收件44上。
击发杆43具有矩形的接收槽46,其中,击发杆43上具有接收槽46的这一部分容装在手柄21中(参见图13)。第一整体式闭合连结销38延伸通过所述接收槽46。击发杆43还具有一个近端部分47。击发杆43的近端部分47的下侧具有一个滑动表面48。近端部分47还具有一个从滑动表面48延伸出的止动侧向接合面49。击发扳机27通过与闭合扳机枢转销41相分离的一个击发枢转销50而可枢转地安装在手柄板34、35上,这样,每个枢转销就可围绕各自的轴线进行枢轴转。击发扳机27包括一个弓形的击发扳机连接件51,该击发扳机连接件51从击发扳机枢转销50处的击发扳机27处延伸至一个顶点52处,该顶点52处于击发杆43的近端部分47的滑动表面48上。在手柄21中,击发扳机27分别连接到第一和第二击发扳机弹簧臂53、54上。击发扳机弹簧臂53、54支撑处于击发扳机43右半边上的一根扭转弹簧(图中未显示)。最后,一根击发杆回复弹簧55固定在手柄21内的击发杆43的下侧部分处以将击发杆43偏压向其未致动位置。
当朝着手持部分24推压闭合扳机26时,带槽的闭合臂式连接件40和闭合连接件36在击发杆43的接收槽46中朝着远端运动。这种朝着远端的运动使闭合件28相应地向远端运动。同样,击发杆43与闭合件28同时向远端运动,这是因为其上连接有闭合连接件36、37的第一整体式闭合连结销38延伸过击发杆43中的接收槽46。
下面将参考附图1并结合附图13-20而对限定中间闭合止动位置所用的机构及闭合扳机26从致动位置释放至其初始的未致动位置的情况进行描述。带槽的闭合臂式连接件40的顶侧具有一个夹紧滑动表面56,该夹紧滑动表面56显露出一个中间止动件57和一个闭合止动件58。一个释放棘爪59在该夹紧滑动表面56上滑动且可与中间止动件和闭合止动件57、58相接合。在释放棘爪59的远端具有一个横向延伸的棘爪片60(最好参见图1)。释放棘爪59定位在手柄21内且其整体式连接在处于手柄21外部的一个释放按钮61上。释放按钮61具有一个拇指放置部62,释放按钮61通过一个释放耳轴63枢轴地连接在手柄21上。释放按钮61被从手柄21向外偏压,这样,释放棘爪59就由一根释放弹簧64向下朝着夹紧滑动表面56偏压,释放弹簧64通过一个弹簧止动销65安装在手柄21上且通过一个按钮弹簧栓66安装到释放按钮61上。带槽的闭合臂式连接件40具有位于中间止动件57和闭合止动件58之间的一个弓形凹槽67。在该弓形凹槽67中布置有用于旋转运动的整体相连的一个左手套环68和一个右手套环(图中未显示该右手套环)。每个套环68具有可与棘爪片60相配合的一个套环臂69。棘爪片60具有一个凹形的近端表面70以在套环臂69和棘爪片60之间提供间隙。
现在参考附图31(钉筒和支撑结构的剪切视图),下面将对击发装置锁止机构180的部件进行描述。根据本发明的最佳实施例,锁止机构180包括一个旋转地安装到闭合板上的锁止杆。该锁止杆包括第一端,第二端和位于两者间的中间部分。该中间部分枢轴地安装到闭合板上,使得锁止杆以下面将要更详细描述的方式旋转。
锁止机构180包括一个锁止杆181,该锁止杆181通过一个销182而可枢转地安装到闭合件28的远端30上。锁止杆181由一根弹簧(图中未显示)朝着支撑结构81的基部向下弹性偏压。锁止杆181分别具有一个近端和一个远端184、185。近端184具有一个凸轮表面186和锁止槽187。端部受动器80的支撑结构81包括一个凸缘85,当锁止结构180接合时,凸缘85与锁止槽187相互作用。支撑结构81具有处于壁部84之间的一个基面86。在锁止杆181未被接合时,基面86被布置成与所述凸轮表面186相互作用。
锁止杆181的远端185的形状和尺寸设计成当将一个新的钉筒组件120装载到端部受动器80上时,该远端185与驱动件131接合。在这种想法下,锁止杆181的远端185包括一顶端,该顶端的形状和尺寸设计成与驱动件131接合。从而,使驱动件131与锁止杆181的远端185接合以将锁止机构180设置在未致动位置。
锁止杆181的近端184包括面朝下的锁止槽187,锁止槽187的形状和尺寸设计成当锁止机构180位于锁止位置时,该锁止槽187与线性医用钉紧器20的支撑结构81接合,这将在下面详细描述。参照附图31,将一个新的钉筒组件120装载到线性医用钉紧器20的动作促使锁止杆181进入一未致动位置,这时钉筒组件120与驱动件131邻接,而驱动件131被迫与锁止杆181的远端185接合。远端185的这种接合使锁止杆181转动,这将使锁止杆181的近端184脱离与线性医用钉紧器20的支撑结构81的接合。
在钉筒外壳121靠近基座122的过程中,通过锁止杆181上的凸轮表面186和支撑结构181的凸缘85间的相互作用,锁止杆181的近端184提升到支撑结构81的基面86上。如图32和33所示,这种运动使锁止杆181的远端185脱离与驱动件131的结合。
如图36所示,一旦该线性医用钉紧器20被击发,驱动件131向远端移动来击发钉子。随着该线性医用钉紧器20的开启,闭合元件28和枢转安装的锁止杆181回缩。当该回缩到达了锁止杆181的近端184已经移动到非常靠近支撑结构81的锁止凸缘85的位置时,锁止杆181将顺时针自由旋转,而驱动件131不再位于阻止锁止杆181的远端185运动的位置。锁止杆181的顺时针旋转导致锁止槽187向下转动到位于支撑结构81的凸缘85之下。当试图关闭该已经击发的线性医用钉紧器20时,将使锁止槽187与凸缘85接合,如图38所示,这导致了部分的再靠近,但阻止一个先前的已击发钉子的闭合行程的完成。
通过将锁止机构180设置在闭合元件28上,锁止机构180遭受的负荷最小,从而改进了线性医用钉紧器20的结构整体性。通过允许线性医用钉紧器20的部分再靠近,为使用者提供了钉子是可使用的但被锁止的触觉反馈。
下面将对钉筒组件120、闭合机构、保持销机构、击发传动组件、中间止动件57、闭合止动件58、释放机构及锁止机构180的加载操作进行描述。参考附图7-12和附图21-28而对将钉筒组件120加载到生理组织端部受动器80中的情况进行描述。该钉筒组件120的形状和尺寸设计成可以选择性地插入线性医用钉紧器20的生理组织端部受动器80中或从其上拆除。
如图7所示,在将钉筒组件120插入线性医用钉紧器20的端部受动器80中之前,由于槽161围绕在保持件160的顶端处的凸起159布置而阻止分离,这样就不容易将保持件160从钉筒组件120上拆卸下来。此外,如图25所示,保持件的容装槽163、164在保持件160的底部处围绕导引销124布置而阻止分离。
所连接的保持件160对钉筒组件120的结构及用于握持的一个延伸表面进行支撑,这些特征均使加载变得更为容易。保持件160可阻止钉子在不经意的处理过程中从钉筒外壳121中掉落下来且可阻止刀具126在不经意的处理过程中偶然暴露出来。
在加载之前及在加载过程中可通过一系列的止动部件进一步阻止刀具126和钉子的移动。参考图9,通过钉筒外壳槽137上的止动凸起139则可阻止刀具保持件130上的止动栓138向远端和近端运动。通过止动栓140与钉筒外壳槽137上的止动凸起141的相互作用则可阻止由于不经意的处理而使驱动件131向远端运动,且在将钉筒组件120加载到线性医用钉紧器20的过程中阻止驱动件131向远端运动。
如图21-24所示,将钉筒组件120加载到生理组织端部受动器80中,从而使钉筒外壳121滑入闭合件28的远端30中。在加载过程中,闭合件28上的壁部31a、31b滑入钉筒外壳121的槽170a、170b中。与此同时,凸片174(参见图8)滑入U形支撑结构81的槽88中。如图21-24所示,当止动部171卡持到闭合件远端30的止动槽32上时则完成了钉筒组件120的加载。
在如图24所示的位置中,钉筒组件120被完全加载,接合件133的近端槽132与推杆102的远端周向槽109相结合,这样,钉筒组件120中的保持销125就与保持销推进机构100相连。在加载过程中,刀具保持件131的槽172与刀具回收钩45相接合,从而使回收钩45在完成钉筒组件120的加载时与刀具保持件130上的牵引凸缘173相接合。
在完成钉筒组件120的加载时,布置在驱动件131上的一个栓件188与锁止杆181的远端185相接触(参见图31)。这种接触使锁止杆181围绕锁止杆销182而转动至一个位置,从而使凸轮表面186与U形的支撑结构81的基面86水平对准。
现在将保持件160从端部受动器80上拆除。特别地,钉筒组件120的加载的完成使脱开凸片165与支撑结构81相接触(参见图23),这样,如图24所示,当将钉筒组件120完全加载后,弹簧臂162向上移动。这种向上移动使容装槽164向上偏移而不再容装导引销124(参见图25和图26)。现在参考附图27-29,向拇指垫166施加一个拆卸作用力而使保持件160围绕凸起159向外枢转,直至所述槽161可从凸起159上滑脱下来。将保持件160拆除则可使用该已被加载的线性医用钉紧器20。
在附图15中,闭合扳机26已从图1和图13所示的开启、未被致动位置处部分推压。在部分推压闭合扳机26时,该闭合扳机26就围绕闭合扳机枢转销41而在逆时针方向中朝着手持部分24转动。在闭合扳机26转动时,带槽的闭合臂式连接件40和闭合盘闭合连接件36、37向前移动,并随后向远端移动闭合件28和击发杆43。当带槽的闭合臂式连接件40向前移动时,释放棘爪59的棘爪片60在夹紧滑动表面56上滑动。棘爪片60与套环68的套环臂69的远端相配合,从而使套环68在顺时针方向中枢转。当带槽的闭合臂式连接件40相应于闭合扳机26的枢转朝着手持部分24继续向前运动时,释放棘爪59的棘爪片60最终会容纳在中间止动部57中。一旦定位在中间止动部57中,闭合弹簧42就不能将闭合扳机26回复至其初始的未致动位置。闭合扳机26现在处于其中间部分的闭合位置中以将生理组织适当定位和保持在钉筒外壳121和基座122之间,就如在图15中所示的那样。此外,在闭合件28和击发杆43向远端移动时,弓形击发扳机连接件51的顶点52就在击发杆43的近端部分47的滑动表面48上滑动。
在从开启位置至中间位置的闭合行程中,保持销机构100被致动。闭合件28向前的运动使整体式栓件29向远端移动。栓件29与轭件111的L形槽110相接触。因此,栓件29向远端的运动使L形槽110进行凸轮转动,从而使所述轭件围绕销子112进行枢转。所述转动使轭件111上的支撑栓件113与推杆驱动件104上的凸轮表面114相接触。轭件111进一步的转动使支撑栓件113通过与表面114进行凸轮接触而向远端移动推杆驱动件104。推杆驱动件104与推杆102相接触而向远端移动所述推杆102。推杆102再顺次向远端移动接合件133和保持销125。至中间止动部57位置处所进行的闭合行程的完成使保持销125向远端移动通过钉筒外壳121的孔144、基座151的槽及垫圈170中的孔而进入支撑结构81中的孔89(图中未显示)。处于钉筒外壳121的接触表面127和基座122之间的生理组织现在被卡持在保持销125和导引销124之间。
在闭合之前通过人工将马鞍形滑动件101向远端移动也可实现同样的效果。所述滑动移动使推杆102、接合件133和保持销向前运动,直至保持销125完全布置在支撑结构81内的基座122、垫圈123和孔89中。在将保持销125人工向前移动之后的闭合行程的致动仍会使轭件111进行上述的枢转,但不会使保持销致动机构100进行额外的运动。
如图31(开启位置)和附图32(中间位置)所示,当锁止杆181通过销182连接在闭合件28上时,从开启位置至中间止动部57位置处的闭合行程使锁止杆181向远端移动。锁止杆181向远端移动使凸轮表面186与支撑结构81的锁止凸缘85相接触,从而使锁止杆181顺时针转动且与支撑结构81的基面86滑动接触。在该位置中,锁止杆181的远端185已转动远离起动件131上的栓件188。
现在特别参考附图16,当将闭合扳机26从中间止动部57的位置朝着手持部分24推压时,套环68的套环臂69与棘爪片60脱离配合。这样,当套环68继续在顺时针方向中转动时,释放棘爪片60跨越在套环臂69上,闭合扳机26继续运动而落入闭合止动部58中。当释放棘爪59跨越在套环臂69上时,它就使释放按钮61围绕枢轴63顺时针转动。当释放棘爪片60落入闭合止动部58中时,会产生可听得见的咔哒声以提醒医生已到达闭合位置。
此外,在击发杆43继续向前移动时,弓形的致动击发扳机连接件51的顶点52与击发杆43的近端部分47的滑动接合表面49相接触。这样,击发扳机27就移动至一个位置中,在该位置处,击发扳机27继续向远端移动击发杆43以在完全夹持住生理组织之后击发钉子。当弓形击发扳机连接件51的顶点52与近端部分47的接合表面相接合时,击发扳机27相应于扳机27右手侧上的扭转弹簧(图中未显示扭转弹簧)的动作而在逆时针方向中朝着手持部分24枢轴转动。击发扳机27的枢转独立于闭合扳机26的枢转,但是其枢转受到阻挡直至击发杆43向远端移动而使击发扳机连接件51与击发杆43的最终接合表面相接合。
现在特别参考附图17,当闭合扳机47被完全推压而与手持部分24相邻时,处于释放棘爪59远端处的棘爪片60进入闭合止动部58中。在闭合止动部58的位置中,生理组织被完全夹紧在钉筒外壳121和基座122之间,闭合弹簧42不能使闭合扳机26回复至其初始位置。因此,闭合扳机26就被保持在图4所示的位置中。
在闭合扳机26逆时针转动的同时,击发扳机27在扭力击发杆回复弹簧55的作用下继续逆时针转动,直至击发扳机27相对于线性医用钉紧器20的手柄21处于相对垂直的位置。在完全夹持的位置中,弓形击发扳机连接件51的顶点52与击发杆43的近端部分47的接合表面完全接合,这样,击发扳机27就处于一个进一步向远端移动击发杆43的位置中,从而将钉子射击到生理组织中。
如图33所示,在完全闭合位置中,钉筒外壳121的钉袋128与基座122的钉形成表面129相对准。保持销125使基座122的顶部与钉筒外壳121相对准,导引销124使钉筒外壳121的底部与基座122的底部相对准。
如图18和图34所示,可推压击发扳机27而使其朝着手持部分24转动直至使其与闭合扳机26相邻定位。在击发扳机27的转动过程中,击发杆43向远端移动而与刀具保持件130相接触。这样就使刀具保持件130向远端移动而与刀具126和驱动件131相接触。驱动件131向远端移动会将钉子(图中未显示)向远端推进到基座122的钉紧形成表面129中而将钉子形成为总体上为B形的形状。刀具126在与钉子形成相结合的导引销124和保持销125的槽147中向远端推进。这些槽147将刀具126导引到切割垫圈123的切割表面157上,从而切断被卡持在两部件之间的任何生理组织。
作用到击发扳机27的人力导致击发杆回复弹簧55将击发杆43和击发扳机27回复至图17所示的位置。这种运动使回收钩45回撤到刀具保持件130和刀具126上的牵引凸缘173上。向近端的运动将刀具126回撤到钉筒外壳121中,就如在附图35中所示的那样。刀具保持件130上的止动栓138回撤而与钉筒外壳121上的止动部139相接合从而将刀具保持件130和刀具126保持在该回撤位置中。通过驱动件131上的止动栓140与钉筒槽137的止动部142相接合则将驱动件131保持在其最远端位置(被击发位置)中。
由于使用者的失误可能会使刀具126与其他医用装置产生干涉,这样,击发杆回复弹簧55的作用力就不足以使击发杆43回撤而将刀具126牵引至钉筒外壳121中,使用者可通过顺时针拉动击发扳机27来人工回撤切割系统。这种人工顺时针移动使弓形击发扳机连接件51顺时针转动直至它冲击到击发杆43的近端47上的击发杆回收片71。顺时针移动的击发扳机连接件51和击发杆回收片71之间的接触使击发杆43向近端回撤且回复至图17所示的位置。这样再使回收钩45回撤到刀具保持件130和刀具126的牵引凸缘173上。这样,这种安全特征可使使用者将切割机构回撤至一个安全的位置并将击发系统回复至可允许将线性医用钉紧器20开启的一个位置,在下文中将对该内容进行描述。
参考附图19,当医生按下释放按钮61时,释放棘爪59围绕释放耳轴63在顺时针方向中枢转而将棘爪片60从闭合止动部58的位置处驱出。在棘爪片60被驱出时,它跨越在套环臂69上而从夹紧连接件40上的中间止动件的位置57的旁边经过。在这种方式中,闭合扳机和击发扳机26、27可相应于由闭合弹簧42和击发杆回复弹簧55所产生的偏压力而回复至其初始未致动位置。当棘爪片60跨越在套环68的套环臂上时,套环臂69逆时针转动,而闭合扳机26和击发扳机27顺时针转动而回复至其初始的未致动位置。因此,医生就可释放闭合扳机和击发扳机26、27,这样在回复中间止动件57的位置的情况下,闭合扳机和击发扳机26、27就可回复至图20所示的位置。
线性医用钉紧器20释放至如图20所示的开启位置使闭合件28和连接的锁止杆181回撤至图36所示的完全开启位置。在该位置中,驱动件131上的栓件188不再布置得向下保持锁止杆的远端185。如上所述,驱动件131已由栓件140和钉筒止动部142止动在向前的位置中。因此,当锁止杆181完全回撤时,它就自由逆时针转动且使锁止槽187下降到U形支撑结构81的凸缘85的下面,锁止杆181的近端184沿着支撑臂表面86进行滑动。如图37所示,当钉筒组件120拆除掉时,锁止杆181仍将处于该位置中。
对已被击发的线性医用钉紧器20所作的任何关闭尝试均会导致锁止槽187钩持在图38所示的凸缘85中,从而向原击发装置的使用者进行反馈。如果在加载前将保持件160拆除且在钉筒组件120未处于适当位置的情况下对钉筒组件120进行错误加载,也会产生这样的特征。在这种情况下,驱动栓188将不能处于正确位置而将锁止杆181移动到被凸轮运动到上述表面86上的位置中。同样,已被击发的钉筒组件120也不能释放锁止机构180。应特别注意到:在将锁止槽187钩持到凸缘85中之前在锁止机构180中允许进行闭合行程的运动。这种运动对使用者显示出:该装置不会产生由于某些故障导致的拥堵,如果锁止机构180还没有运行的话则可将其撤回。因此,使用者知道:当锁止机构接合时该装置不会产生拥堵但却不能正确加载。
在所述装置释放而返回至图1和图2所示的开启位置后,必需通过人工的方式向近端拉动马鞍形件101而使保持销机构100回撤。这种回撤使保持销125回退入钉筒外壳121中。在完成所述人工回撤时,已被击发的钉筒组件120可被卸载而利用新的钉筒组件120来更换。
在上面的内容中已对优选实施例进行了显示和描述,应认识到:本发明并不受所披露的内容所限制,对所述所述实施例所作的全部变更和变化的结构均落入本发明的精神实质和范围之内。
Claims (5)
1.一种适用于将多个外科紧固件施加于人体生理组织的外科装置,该医用装置包括:
基座;
容纳有多个医用紧固件的钉筒外壳,钉筒外壳和基座可在第一相间隔位置和第二相邻的位置之间相对运动;
与钉筒外壳关联的击发机构,该击发机构用于将医用紧固件从将被驱动抵靠在基座上的钉筒外壳射出;和
与钉筒外壳相互作用来选择致动和停止的锁止机构,该锁止机构包括旋转地安装在该医用装置的闭合元件上的锁止杆,该锁止杆包括远端,近端和位于其间的中间部分,该中间部分枢转地安装到闭合元件上来使锁止臂以可控方式旋转。
2.根据权利要求1所述的外科装置,其中,锁止杆是朝着外科机构的支撑结构的基部向下偏压的弹簧。
3.根据权利要求1所述的外科装置,其中,锁止杆的近端包括凸轮表面和锁止槽。
4.根据权利要求1所述的外科装置,其中,锁止杆的远端的形状和尺寸设计成当一个新的钉筒外壳装载到该外科装置时锁止杆的远端与钉筒外壳的驱动件接合。
5.根据权利要求1所述的外科装置,其中,在装置击发之后可以进行部分再靠近。
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US5735445A (en) * | 1995-03-07 | 1998-04-07 | United States Surgical Corporation | Surgical stapler |
US5706998A (en) * | 1995-07-17 | 1998-01-13 | United States Surgical Corporation | Surgical stapler with alignment pin locking mechanism |
US6817508B1 (en) † | 2000-10-13 | 2004-11-16 | Tyco Healthcare Group, Lp | Surgical stapling device |
US6592597B2 (en) * | 2001-05-07 | 2003-07-15 | Ethicon Endo-Surgery, Inc. | Adhesive for attaching buttress material to a surgical fastening device |
CN2494182Y (zh) * | 2001-08-17 | 2002-06-05 | 西安朗瑞医疗产品有限公司 | 一次性直线型缝合器 |
US7380695B2 (en) * | 2003-05-20 | 2008-06-03 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a single lockout mechanism for prevention of firing |
-
2004
- 2004-12-20 US US11/014,906 patent/US7147139B2/en active Active
- 2004-12-23 AU AU2004242483A patent/AU2004242483B2/en not_active Ceased
- 2004-12-24 CA CA2491072A patent/CA2491072C/en not_active Expired - Fee Related
- 2004-12-28 JP JP2004380596A patent/JP4699024B2/ja not_active Expired - Fee Related
- 2004-12-29 DE DE602004021344T patent/DE602004021344D1/de active Active
- 2004-12-29 EP EP04258169A patent/EP1550413B2/en active Active
- 2004-12-29 AT AT04258169T patent/ATE432659T1/de not_active IP Right Cessation
- 2004-12-30 CN CNB2004101031959A patent/CN100418483C/zh active Active
- 2004-12-30 BR BRPI0405878-0B1A patent/BRPI0405878B1/pt active IP Right Grant
-
2005
- 2005-01-03 MX MXPA05000220A patent/MXPA05000220A/es active IP Right Grant
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CN104042276A (zh) * | 2013-03-13 | 2014-09-17 | 柯惠Lp公司 | 手术吻合装置 |
CN104042276B (zh) * | 2013-03-13 | 2018-04-17 | 柯惠Lp公司 | 手术吻合装置 |
CN103654904A (zh) * | 2013-12-19 | 2014-03-26 | 周玉梅 | 一种消化道组织切割吻合器 |
US10702269B2 (en) | 2014-12-25 | 2020-07-07 | Covidien Lp | Surgical stapling devices |
WO2016101206A1 (en) * | 2014-12-25 | 2016-06-30 | Covidien Lp | Surgical stapling devices |
CN109561895B (zh) * | 2016-04-01 | 2021-07-16 | 伊西康有限责任公司 | 包括切换机构的外科器械 |
CN109561895A (zh) * | 2016-04-01 | 2019-04-02 | 伊西康有限责任公司 | 包括切换机构的外科器械 |
CN109498086B (zh) * | 2018-12-25 | 2020-06-19 | 无锡博康医疗器械有限公司 | 吻合器 |
CN109498086A (zh) * | 2018-12-25 | 2019-03-22 | 无锡博康医疗器械有限公司 | 吻合器 |
CN113766884A (zh) * | 2019-04-26 | 2021-12-07 | 西拉格国际有限公司 | 用于直角外科缝合器的基于仓的闭锁机构 |
WO2021081984A1 (en) * | 2019-11-01 | 2021-05-06 | Covidien Lp | Surgical stapling device with knife blade lock |
US11806012B2 (en) | 2019-11-01 | 2023-11-07 | Covidien Lp | Surgical stapling device with knife blade lock |
WO2022233019A1 (en) * | 2021-05-07 | 2022-11-10 | Covidien Lp | Surgical stapling device with stopper for pusher/knife retention |
WO2023000127A1 (en) * | 2021-07-19 | 2023-01-26 | Covidien Lp | Stapling device with replaceable cartridge module |
Also Published As
Publication number | Publication date |
---|---|
DE602004021344D1 (de) | 2009-07-16 |
CA2491072A1 (en) | 2005-06-30 |
EP1550413A1 (en) | 2005-07-06 |
EP1550413B2 (en) | 2012-10-03 |
CN100418483C (zh) | 2008-09-17 |
US20050139632A1 (en) | 2005-06-30 |
BRPI0405878B1 (pt) | 2014-04-15 |
AU2004242483B2 (en) | 2011-09-08 |
BRPI0405878A (pt) | 2005-09-20 |
MXPA05000220A (es) | 2005-08-26 |
CA2491072C (en) | 2013-04-02 |
JP2005193041A (ja) | 2005-07-21 |
ATE432659T1 (de) | 2009-06-15 |
EP1550413B1 (en) | 2009-06-03 |
AU2004242483A1 (en) | 2005-07-14 |
JP4699024B2 (ja) | 2011-06-08 |
US7147139B2 (en) | 2006-12-12 |
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