CN101317781B - 具有多速率方向切换机构的外科器械 - Google Patents

具有多速率方向切换机构的外科器械 Download PDF

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CN101317781B
CN101317781B CN2008100986424A CN200810098642A CN101317781B CN 101317781 B CN101317781 B CN 101317781B CN 2008100986424 A CN2008100986424 A CN 2008100986424A CN 200810098642 A CN200810098642 A CN 200810098642A CN 101317781 B CN101317781 B CN 101317781B
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trigger
surgical instruments
drive member
ratchet
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CN101317781A (zh
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F·E·谢尔顿四世
R·W·蒂姆
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Ethicon Endo Surgery Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical 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
    • A61B17/07207—Surgical 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical 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
    • A61B2017/07214—Stapler heads
    • A61B2017/07285—Stapler heads characterised by its cutter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2923—Toothed members, e.g. rack and pinion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument

Abstract

本发明涉及一种具有多速率方向切换机构的外科器械，其包括驱动机构，该驱动机构能够使缝钉驱动器和/或切割构件以第一速率前进，并且能够使所述缝钉驱动器和/或切割构件以不同的速率缩回。在至少一种实施方式中，所述缝钉驱动器和切割构件前进和/或缩回的速率例如是扳机每次致动时所述缝钉驱动器和/或切割构件平移的距离。在各种实施方式中，切割构件能够以比其前进速率高的速率缩回。在这种实施方式中，由于较慢的前进速率，所述外科器械能够为切割构件提供较大的扭矩或推进力，并且由于较快的缩回速率，能够减少医生缩回所述切割构件所需的时间。

Description

具有多速率方向切换机构的外科器械
相关申请的交叉引用
本申请涉及如下同时提交的共有美国专利申请，这些申请通过引用全文结合入本文：
(1)题为SURGICAL INSTRUMENT HAVING A COMMON TRIGGER FORACTUATING AN END EFFECTOR CLOSING SYSTEM AND A STAPLE FIRINGSYSTEM的美国专利申请(律师档案号070060/END6090USNP)；以及
(2)题为SURGICAL INSTRUMENT HAVING A MULTIPLE RATEDIRECTIONAL SWITCHING MECHANISM的美国专利申请(律师档案号070059/END6089USNP)。
技术领域
本发明整体上涉及外科缝合器械，更具体而言，本发明涉及具有端部执行器闭合系统和用于展开缝钉的击发系统的外科缝合器。
背景技术
如同本领域已知的那样，外科缝合器通常用于将缝钉展开到软组织中以减少或者消除软组织出血，例如尤其是横切组织时。外科缝合器，例如内镜切割器，通常包括被构造成将软组织紧固在第一和第二钳口构件之间的端部执行器。第一钳口构件通常包括被构造成将缝钉可移除地存储在其中的钉仓，第二钳口构件通常包括钉砧。在使用时，缝钉通常由横过钉仓中的通道并且使缝钉抵靠钉砧引起变形的驱动器从钉仓展开，并将软组织层连接在一起。通常，如同本领域已知的那样，缝钉以多条缝钉线或多个缝钉排展开，以便更可靠地将组织层连接在一起。端部执行器还可包括切割构件，例如刀，其在两排缝钉之间行进以便在软组织层已经被缝合在一起之后切割软组织。
在驱动器和切割构件在端部执行器内被推进之后，通常有必要将驱动器和/或切割构件缩回到它们的起始位置。先前的外科缝合器包括复位弹簧，该复位弹簧在外科缝合器上的释放按钮或拨动开关被医生致动之后相对于钉仓缩回切割构件。然而，这种缝合器不能部分地缩回切割构件，因此，切割构件在被再次推进之前必须完全缩回。其它先前的外科缝合器包括多个扳机，所述扳机可操作地接合到用于闭合钳口构件和用于推进和/或缩回驱动器和切割构件的系统上。这种装置尽管满足了指定目的，但常常需要医生释放可操作地接合在闭合系统上的扳机并且重新定位他们的手以抓握可操作地接合在用于推进缝钉驱动器和切割构件的系统上的不同的扳机。尽管已经发展了先前的具有用于闭合钳口构件并推进驱动器和切割构件的单个扳机的外科缝合器，这种装置在扳机的初次致动时执行两种功能。尽管这在一些情况下是适当的，然而在扳机的同一次致动中执行两种功能的装置通常由于致动扳机所需的力较大所以异常难于操作。此外，这种装置在扳机的同一次致动中闭合钳口构件和展开缝钉时无法向医生提供在缝钉被展开到软组织内之前评估闭合钳口构件的位置和重新定位钳口构件的机会。因此有必要对上述器械进行改进。
发明内容
在本发明的至少一种形式中，外科器械可以包括切换机构，该切换机构能允许医生或其它临床医师有选择地在钉仓内推进或缩回缝钉驱动器和/或切割构件。在各种实施方式中，外科器械可以包括手柄、可操作地连接到手柄上的扳机、击发驱动器和端部执行器。在至少一种实施方式中，击发驱动器可以包括能够在端部执行器内推进切割构件的第一棘轮组件和能够缩回切割构件的第二棘轮组件。在各种实施方式中，扳机可以包括可枢转地安装在其上的第一棘爪和第二棘爪，所述第一和第二棘爪能够有选择地分别接合到第一和第二棘轮组件上。在至少一种这种实施方式中，扳机能够在第一位置和第二位置之间滑动，在第一位置，第一棘爪与第一棘轮组件接合，在第二位置，第二棘爪与第二棘轮组件接合。在这种实施方式中，医生能够快速地且便利地在切割构件的前进动作和缩回动作之间选择。
在本发明的至少一种形式中，外科器械可以包括驱动机构，该驱动机构能够以第一速率推进缝钉驱动器和/或切割构件并能以不同的速率缩回缝钉驱动器和/或切割构件。在至少一种实施方式中，驱动器和切割构件的行进速率和/或缩回速率是指驱动器和切割构件在例如扳机的每一次致动或冲程下平移的距离。因此，在这种实施方式中，如果扳机在每一次致动下推进或缩回切割构件更远的距离，那么可以认为第一速率大于第二速率。在各种实施方式中，与切割构件被推进的速率相比，切割构件可以较大的速率缩回。在这种实施方式中，由于推进速率较小，外科器械可以向切割构件提供较大的扭矩或推进力，而由于缩回速率较大，则能够缩短医生缩回切割构件所需的时间。在各种实施方式中，如上所述，外科器械可以包括切换机构，该切换机构能够有选择地使第一驱动系统和第二驱动系统中的一个与可旋转的传动轴接合。在至少一种这种实施方式中，第一驱动系统可以包括具有第一节圆半径的第一齿轮，第二驱动系统可以包括具有不同的节圆半径的第二齿轮，其中，第一齿轮和第二齿轮可以不同速率旋转传动轴。
在本发明的至少一种形式中，外科器械可以包括扳机，该扳机能够在扳机的第一次致动时例如将钳口构件闭合在软组织上，并且在扳机的随后或者第二次致动时推进缝钉驱动器和/或切割构件。在各种实施方式中，这种外科器械能允许医生将外科器械定位在手术部位并且在扳机的初次致动时闭合钳口构件，而不将任何缝钉展开到组织内或切割组织。因此，在这种实施方式中，医生能操作定位外科器械并随后第二次致动扳机以将缝钉展开到组织内和/或切割组织。在至少一种这种实施方式中，扳机的第一次致动能闭合钳口构件，也能将击发驱动器释放，该击发驱动器能在扳机的第二次致动过程中推进缝钉驱动器和切割构件。在各种实施方式中，外科器械可以包括切换机构，该切换机构能允许医生重新打开钳口构件，并且如果他们这样选择则将钳口构件重新定位在更加合适的位置处。
具体而言，本发明公开了如下内容：
(1).一种外科器械，包括：
手柄；
击发驱动器，包括：
可操作地连接到所述手柄上的击发扳机，其中所述击发驱动器能够在所述击发扳机第一次致动时产生旋转击发动作，并且在所述击发扳机的另一次致动时产生旋转缩回动作；
第一驱动构件，其中所述击发扳机能够可选择地与该第一驱动构件接合；以及
第二驱动构件，其中所述击发扳机能够可选择地与该第二驱动构件接合；
连接到所述手柄上的细长轴组件，该细长轴组件与所述第一驱动构件和所述第二驱动构件可操作地接合；以及
连接到所述细长轴组件上的端部执行器，所述端部执行器包括：
能够在其中可操作地支承钉仓的细长通道；
可动地连接到所述细长通道的钉砧；以及
能够操作地支承于所述细长通道中的切割构件，其中所述切割构件与所述细长轴组件可操作地接合，并且在所述击发扳机与所述第一驱动构件接合时，所述第一次致动使所述切割构件前进第一距离，在所述击发扳机与所述第二驱动构件接合时，所述另一次致动使所述切割构件缩回第二距离，并且所述第二距离大于所述第一距离。
(2).如第(1)项所述的外科器械，其中，所述击发扳机能够在第一位置和第二位置之间运动，其中在所述第一位置，所述击发扳机与所述第一驱动构件接合，在所述第二位置，所述击发扳机与所述第二驱动构件接合。
(3).如第(1)项所述的外科器械，包括闭合驱动器，该闭合驱动器能够选择性地产生闭合动作和打开动作，其中所述钉砧可操作地与所述闭合驱动器接合并且能够响应于所述打开动作和闭合动作而运动。
(4).如第(1)项所述的外科器械，其中，所述第一驱动构件包括多个第一齿轮齿，并且所述第二驱动构件包括多个第二齿轮齿，所述细长轴组件包括与所述切割构件可操作地接合的可转动的传动轴，所述传动轴包括与所述第一齿轮齿可操作地接合的第一齿轮和与所述第二齿轮齿可操作地接合的第二齿轮。
(5).如第(4)项所述的外科器械，其中，所述传动轴限定一轴线，所述第一驱动构件定位在所述轴线的第一侧上并且能够使所述传动轴围绕所述轴线在第一方向上旋转，所述第二驱动构件定位在所述轴线的第二侧上并且能够使所述传动轴围绕所述轴线在第二方向上旋转，并且所述第二方向与所述第一方向相反。
(6).如第(1)项所述的外科器械，还包括能够将所述击发驱动器偏压到第一状态和第二状态中的一个的双稳态挠性机构，其中所述击发扳机在所述第一状态被偏压成与所述第一驱动构件接合，并且在所述第二状态被偏压成与所述第二驱动构件接合。
(7).如第(6)项所述的外科器械，还包括机架，其中所述双稳态挠性机构包括与所述击发扳机和所述机架可操作地接合的弹簧，其中所述弹簧能够使所述击发扳机滑动，使得所述击发扳机与所述第一驱动构件或者所述第二驱动构件接合。
(8).如第(1)项所述的外科器械，其中，当所述击发扳机与所述第一驱动构件接合时，所述击发扳机不与所述第二驱动构件接合，并且当所述击发扳机与所述第二驱动构件接合时，所述击发扳机不与所述第一驱动构件接合。
(9).如第(1)项所述的外科器械，其中，所述击发扳机能够同时与所述第一驱动构件和第二驱动构件接合，从而防止所述击发驱动器产生所述旋转击发动作和所述旋转缩回动作。
(10).一种处理外科器械的方法，所述方法包括：
获取如第(1)项所述的外科器械；
对所述外科器械进行消毒；以及
将所述外科器械保存在无菌容器中。
(11).一种外科器械，包括：
手柄；
击发驱动器，包括：
可操作地连接到所述手柄上的击发扳机，其中所述击发驱动器能够在所述击发扳机第一次致动时产生击发动作，并且在所述击发扳机的另一次致动时产生缩回动作；
第一棘轮组件，包括：
具有多个棘齿的第一棘轮；以及
能够枢转地连接到所述击发扳机上的第一棘爪，其中所述第一棘爪能够可选择地与所述第一棘轮的所述棘齿接合；以及
第二棘轮组件，包括：
具有多个棘齿的第二棘轮；以及
能够枢转地连接到所述击发扳机上的第二棘爪，其中所述第二棘爪能够可选择地与所述第二棘轮的所述棘齿接合；
连接到所述手柄上的细长轴组件，该细长轴组件与所述第一棘轮和所述第二棘轮可操作地接合；以及
连接到所述细长轴组件上的端部执行器，所述端部执行器包括：
能够在其中可操作地支承钉仓的细长通道；
可动地连接到所述细长通道的钉砧；以及
能够操作地支承于所述细长通道中的切割构件，其中所述切割构件与所述细长轴组件可操作地接合，并且在所述击发扳机与所述第一棘轮接合时，所述第一次致动使所述切割构件前进第一距离，在所述击发扳机与所述第二棘轮接合时，所述另一次致动使所述切割构件缩回第二距离，并且所述第二距离大于所述第一距离。
(12).如第(11)项所述的外科器械，还包括闭合驱动器，该闭合驱动器能够选择性地产生闭合动作和打开动作，其中所述钉砧可操作地与所述闭合驱动器接合并且能够响应于所述打开动作和闭合动作而运动。
(13).如第(11)项所述的外科器械，还包括：
第一弹簧，其能够使所述第一棘爪和所述第一棘轮的所述棘齿之间产生棘轮接合；以及
第二弹簧，其能够使所述第二棘爪和所述第二棘轮的所述棘齿之间产生棘轮接合。
(14).如第(11)项所述的外科器械，其中，所述第一棘轮还包括围绕第一直径定位的多个第一齿轮齿，并且所述第二棘轮包括围绕第二直径定位的多个第二齿轮齿，其中所述第二直径大于所述第一直径，所述细长轴组件包括与所述切割构件可操作地接合的可转动的传动轴，所述传动轴包括与所述第一齿轮齿可操作地接合的第一齿轮和与所述第二齿轮齿可操作地接合的第二齿轮。
(15).如第(14)项所述的外科器械，其中，所述传动轴限定一轴线，所述第一棘轮定位在所述轴线的第一侧上并且能够使所述传动轴围绕所述轴线在第一方向上旋转，所述第二棘轮定位在所述轴线的第二侧上并且能够使所述传动轴围绕所述轴线在第二方向上旋转，并且所述第二方向与所述第一方向相反。
(16).如第(11)项所述的外科器械，还包括能够将所述击发驱动器偏压到第一状态和第二状态中的一个的双稳态挠性机构，其中所述第一棘爪在所述第一状态被偏压成与所述第一棘轮接合，并且所述第二棘爪在所述第二状态被偏压成与所述第二棘轮接合。
(17).如第(16)项所述的外科器械，还包括机架，所述击发驱动器还包括可滑动构件，所述第一棘爪和第二棘爪安装在所述可滑动构件上，其中所述双稳态挠性机构包括与所述可滑动构件和所述机架可操作地接合的弹簧，其中所述弹簧能够促动所述可滑动构件，使得所述第一棘爪与所述第一棘轮接合或者使所述第二棘爪与所述第二棘轮接合。
(18).如第(11)项所述的外科器械，其中，当所述第一棘爪与所述第一棘轮接合时，所述第二棘爪不与所述第二棘轮接合，并且当所述第二棘爪与所述第二棘轮接合时，所述第一棘爪不与所述第一棘轮接合。
(19).如第(11)项所述的外科器械，其中，在所述第二棘爪与所述第二棘轮接合的同时，所述第一棘爪能够与所述第一棘轮接合，从而防止所述击发驱动器产生所述击发动作和所述缩回动作。
(20).一种处理外科器械的方法，所述方法包括：
获取如第(11)项所述的外科器械；
对所述外科器械进行消毒；以及
将所述外科器械保存在无菌容器中。
(21).一种外科器械，包括：
手柄；
击发驱动器，包括：
可操作地连接到所述手柄上的击发扳机；
与所述击发扳机可操作地接合的传动轴，其中所述击发扳机的致动使所述传动轴绕轴线旋转；
细长轴组件；
传动装置，其能够设置在第一构型和第二构型，设置在所述第一构型时用于使所述细长轴组件围绕轴线在第一方向上旋转，设置在所述第二构型时用于使所述细长轴组件围绕所述轴线在与所述第一方向相反的方向上旋转，所述传动装置包括小齿轮，在所述第一构型时所述传动轴与所述细长轴组件配合，在所述第二构型时所述传动轴和所述细长轴组件配合所述小齿轮；以及
连接到所述细长轴组件上的端部执行器，所述端部执行器包括：
能够在其中可操作地支承钉仓的细长通道；
可动地连接到所述细长通道的钉砧；以及
能够操作地支承于所述细长通道中的切割构件，其中所述切割构件与所述细长轴组件可操作地接合，并且在所述传动装置处于所述第一构型时，所述致动使所述切割构件前进第一距离，在所述传动装置处于所述第二构型时，所述致动使所述切割构件缩回第二距离，并且所述第二距离大于所述第一距离。
(22).一种处理外科器械的方法，所述方法包括：
获取如第(21)项所述的外科器械；
对所述外科器械进行消毒；以及
将所述外科器械保存在无菌容器中。
附图说明
通过参考结合附图的本发明的实施方式的下列描述，本发明的各种实施方式的上述和其它特征和优点以及实现它们的方式将更加明显，本发明本身也更好理解，其中：
图1是根据本发明的外科器械的一种实施方式的透视图；
图2是图1的外科器械的轴部分和端部执行器的分解图；
图3是图1的外科器械的手柄部分的分解图；
图4是图3的手柄部分的局部侧视图，其中，外科器械的一些部件被移除；
图5是图3的移除了外科器械的一些部件的手柄部分的俯视图，示出的外科器械处于用于在端部执行器内推进切割构件的结构；
图6是图3的移除了外科器械的一些部件的手柄部分的仰视图，示出的外科器械处于用于在端部执行器内推进切割构件的结构；
图7是图3的手柄部分的局部透视图，其中，外科器械的一些部件被移除；
图8是图1的外科器械的透视图，示出了外科器械在扳机的第一次致动时的结构，显示“压缩”的第一手柄行程；
图9是图1的处于图8所示结构中的外科器械的局部透视图，其中，外科器械的一些部件被移除；
图10是图1的外科器械的端部执行器闭合系统的凸轮的透视图；
图11是图10的凸轮的主视图，示出了钉砧闭合系统的锁定件的各种相对位置；
图12是图1的外科器械的透视图，示出了外科器械在扳机在其第一次致动后被释放之后的结构，显示出“释放”的第一手柄行程；
图13是图1的外科器械的透视图，示出了外科器械在扳机的第二次致动时的结构，显示“压缩”的第二手柄行程；
图14是图1的处于图13所示的结构中的外科器械的局部透视图；
图15是图1的外科器械的透视图，示出了外科器械在扳机的第三次致动时的结构，显示“压缩”的第三手柄行程；
图16是图1的外科器械的透视图，示出了外科器械在扳机的第四次致动时的结构；
图17是图1的外科器械的透视图，示出了外科器械在扳机在其第四次致动后被释放并且外科器械的切换机构被操作之后的结构；
图18是图1的外科器械的透视图，示出了外科器械在扳机的第七次致动时的结构，其中，切割构件完全缩回；
图19是图1的处于图18所示结构中的外科器械的局部主视图，其中，外科器械的一些部件被移除；
图20是图1的外科器械的壳体的局部透视图，示出了击发驱动器和壳体在扳机的第七次致动之后的相互作用；
图21是根据本发明的一种替代实施方式的用于外科器械的齿轮减速机构的透视图，其中，齿轮减速机构壳体的一部分未被装配；
图22是图21的齿轮减速机构的分解图；
图23是根据本发明的一种替代实施方式的外科器械的透视图；
图24是图23的外科器械的端部执行器和轴组件的分解图；
图25是图23的外科器械的手柄部分的分解图；
图26是图23的外科器械的分解图，其中，外科器械的一些部件被移除；
图27是图23的外科器械的透视图，其中，外科器械的一些部件被移除；
图28是图23的外科器械的第二透视图，其中，外科器械的一些部件被移除；
图29是图23的被构造成在端部执行器内推进切割构件的外科器械的侧视图；
图30是图23的被构造成在端部执行器内缩回切割构件的外科器械的侧视图；
图31是根据本发明的一种替代实施方式的方向切换机构的透视图，其中，一些部件未被装配，其它部件以剖视图示出；
图32是图31的方向切换机构的平面图，其中，一些部件被移除，其它部件以剖视图示出；以及
图33是根据本发明的一种替代实施方式的双稳态挠性机构的图示。
具体实施方式
相同附图标记在所有附图中表示相同的部件。在本文中阐明的范例以一种形式示出了本发明的优选实施方式，这些范例不以任何方式构成对本发明的范围的限制。
现在将描述一些示例性实施方式，以提供在此公开的装置和方法的原理、结构、功能、制造和使用的全面理解。在附图中示出了这些实施方式的一个或多个实施例。本领域技术人员可以理解，在此具体描述和在附图中示出的装置和方法是非限制性的示例性实施方式，而本发明的各种实施方式的范围仅由权利要求书限定。就一种示例性实施方式示出或描述的特征可与其它实施方式的特征相结合。这种变型和改变应包括在本发明的范围内。
在各种实施方式中，根据本发明的外科器械例如可以包括用于将外科缝钉插入到软组织内的系统。在至少一种实施方式中，外科器械可以包括被构造成在其中可移除地存储缝钉的钉仓和用于使缝钉在从钉仓展开时变形的钉砧。外科器械可以包括被构造成横过钉仓的缝钉驱动器和用于推进钉仓内的缝钉驱动器的击发驱动器，以便展开缝钉。在各种实施方式中，击发驱动器可以包括驱动杆，该驱动杆通过与其可操作地接合的扳机在大致线性方向上平移。在其它实施方式中，击发驱动器可以包括通过扳机旋转的传动轴。在这种实施方式中，外科器械可以包括轴组件，该轴组件能将传动轴的旋转运动转换成线性运动并且平移钉仓内的缝钉驱动器。尽管图1至20中以及下面示出的示例性实施方式包括具有旋转传动轴的击发驱动器，但本发明并不限于此。此外，以下对具有旋转传动轴的击发驱动器进行了整体上的描述，其它这种装置被更加详细地描述和示出于2006年6月27日提交的题为MANUALLY DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT的序列号为11/475412的共同拥有且共同未决的美国共有专利申请中，该申请的全部内容通过引用结合入本文。
参考图1，外科器械50可以包括手柄部分52、扳机54、细长轴组件56和端部执行器58。在各种实施方式中，端部执行器58可以包括钉砧62和钉仓通道64，通道64可以被构造成容纳钉仓66，钉砧62可枢转地连接到通道64上。在至少一种实施方式中，钉砧62和通道64中的至少一个能可操作地连接到扳机54上，使得在扳机54致动时，钉砧62可以旋转到如图8所示的闭合位置。在各种实施方式中，参考图2-4，扳机54能与闭合驱动系统可操作地接合，该闭合驱动系统能够相对于细长轴组件56的外部护套57平移钉砧62和通道64。主要参考图4，闭合驱动器可以包括凸轮68，该凸轮68与扳机54可操作地接合，使得扳机54的第一次致动能使凸轮68绕销70旋转并且在大致线性方向上驱动闭合连接件72。更具体而言，扳机54可以包括从其延伸的提升销55(图3)，该提升销55能够接触凸轮68的表面71并且将凸轮68提升到图8所示的位置。凸轮68还可以包括凸轮槽69，当凸轮68从其图4中所示位置旋转到其图8中所示位置时，凸轮槽69的侧壁可以接合闭合连接件销76，并且在本实施方式中使闭合连接件72沿箭头A所示方向滑动(图4)。
参考图2和4，外科器械50还可以包括细长轴组件56内的脊组件(图1)，该脊组件可以包括近侧通道部分78和远侧通道部分80。在各种实施方式中，通道部分78和80可以通过凸起或舌形部84与凹槽86协作接合来相互连接。更具体而言，参考图2，近侧通道部分78在各种实施方式中可以包括第一半部77和第二半部79，它们能装配到远侧通道部分80上，使凸起84紧固在凹槽86内。在至少一种实施方式中，近侧通道部分的第一半部77和第二半部79可以包括被构造成在近侧通道部分的各半部77和79之间提供扣合或压合接合的凸起81和/或孔83。在其它各种实施方式中，通道部分78和80可以通过任何适当的方式相互连接，在至少一种实施方式中，尽管未示出，部分78和80可以一体地形成。与上述类似，参考图2，远侧通道部分80可以包括远端88，该远端88能连接到钉仓通道64上。更特别地，远侧通道部分80和钉仓通道64可以包括例如协作的舌形元件和凹槽元件，所述舌形元件和凹槽元件能在其间提供压合或扣合互连，但是在其间也可以利用其它任何适当的相互连接方式。
参考图4，通道部分78的近端82可以通过销53连接到闭合连接件72上，使得当通过凸轮68平移闭合连接件72时，通道部分78在细长轴组件56内平移。在至少一种实施方式中，通道部分78还可以包括从其延伸的凸起87，该凸起87能在壳体部分90中的凹口85(图3)内滑动并且基本上限制通道部分78沿轴线的平移。由于钉仓通道64经由远侧通道部分80连接到近侧通道部分78上，当凸轮68如上述通过扳机54旋转时，通道64和可枢转地连接到其上的钉砧62可以沿方向A移动。在至少一种实施方式中，参考图2，当通道64和钉砧62相对于外部护套57平移时，钉砧62的近端63能够抵接细长轴组件56的外部护套57。在钉砧62的近端63接触外部护套57之后，钉砧62能够朝向通道64和钉仓66旋转，以便闭合钉砧62，如图8所示。在各种实施方式中，参考图2，通道64可以包括在其中的槽65，该槽65能够在钉砧62相对于通道64枢转时引导钉砧62。一旦钉砧62闭合，外科器械还可以包括锁定件，该锁定件将钉砧62保持在其闭合位置。在各种实施方式中，参考图9至11，外科器械50可以包括安装在壳体90上的弹簧锁定件92，弹簧锁定件92可释放地将凸轮68保持在适当位置，由此将闭合连接件72、通道部分78和80、通道64以及钉砧62锁定在适当位置，直到医生希望打开钉砧62为止，如下面详细描述的那样。
在各种实施方式中，在钉砧62被设置在其闭合位置之后，可以第二次致动扳机54以操作击发驱动器，该击发驱动器在端部执行器58内推进切割构件96。在至少一种实施方式中，击发驱动器可以在扳机54第一次致动之前从扳机54脱离。在这种实施方式中，扳机54的第一次致动可操作地使扳机54与击发驱动器接合和/或释放击发驱动器的部件，使得击发驱动器与扳机54可操作地接合。在所示实施方式中，参考图3和4，击发驱动器可以包括从扳机54延伸的扳机齿轮部分100、齿轮系102、齿轮架130和可旋转的传动轴106，它们能在端部执行器58内推进切割构件96，如下面更加详细描述的那样。如图3至7所示，齿轮系102可以包括棘轮108、主传动齿轮110、传动锥齿轮112和锥齿轮114，在扳机54的第一次致动之前，凸轮68能偏压棘轮108，使之与主传动齿轮110脱离接合。更具体而言，参考图3，棘轮108可以包括轴116和套环118，凸轮68能够接触套环118并偏压棘轮108远离主传动齿轮112，使得棘轮108上的棘轮面109不与主传动齿轮110上的棘轮面111接合。
在扳机54的第一次致动时，如上所述，凸轮68能够旋转到图8中所示位置，作为这种旋转的结果，凸轮68中的凹槽120(图4和5)能够释放棘轮108。更具体而言，参考图5至7，凹槽120的尺寸可以被设置成当凸轮68的旋转使凹槽120与套环118对准时，套环118能滑过凸轮68并且允许棘轮弹簧122偏压棘轮108，使其与主传动齿轮110作用接合。之后，扳机54可以被释放并且随后通过扳机弹簧124回复到其起始位置，该扳机弹簧124可以连接到从壳体90延伸的销126以及从扳机54延伸的销128上。特别地，即使扳机54回复到其起始位置，凸轮68可以通过锁定件92保持锁定在其第二位置，如上所述，由此保持凹槽120与套环118对准。由于此时棘轮108与传动齿轮110可操作地接合，扳机54的第二次致动可以在端部执行器58内推进切割构件96和缝钉驱动器。
主要参考图3和4，扳机54的致动可以使扳机齿轮部分100围绕由销70限定的轴线旋转。扳机齿轮部分100可以包括沿其周边延伸的齿轮齿，参考图5和6，齿轮齿可以与例如围绕棘轮108的圆周延伸的齿轮齿接合。因此，在使用中，扳机54的致动或旋转可以使棘轮108绕由轴116和销117限定的轴线旋转(图3)。如上所述，参考图5和6，棘轮108可以包括棘轮面109，该棘轮面109能与主传动齿轮110的棘轮面111接合。在至少一种实施方式中，棘轮面109和111能在扳机54的第二次致动或其它随后的致动时将扳机54的旋转运动传递到主传动齿轮110，并且当扳机54被释放且回复到其未致动的位置时允许其间的相对滑移运动。在实践中，棘轮面109和111能在棘轮108沿一个方向旋转时将旋转运动传递到主传动齿轮110，但当棘轮108沿相反方向旋转时则不将旋转运动传递到主传动齿轮110。尽管在此描述和示出了棘轮机构，然而任何其它适当的用于在扳机54和主传动齿轮110之间传递运动的机构都可以被使用。此外，尽管扳机54被描述和示出为杆，然而任何其它适当的装置都可以用于激发在此描述的击发和闭合驱动器。
主要参考图5至7，主传动齿轮110可以包括例如围绕其圆周延伸的齿轮齿，所述齿轮齿可以与例如围绕传动锥齿轮112的周边延伸的齿轮齿接合。因此，在使用中，例如从棘轮108传递到主传动齿轮110的旋转运动可以传递到传动锥齿轮112。在各种实施方式中，传动锥齿轮112可以安装到轴113上或者与轴113形成为一体，其中，轴113可以限定轴线，传动锥齿轮112可以围绕该轴线旋转。在至少一种实施方式中，参考图3，外科器械50还可以包括托架115，传动锥齿轮112和轴113可以围绕该托架115旋转。如下面更加详细的描述那样，托架115也可以包括被构造成可滑动地支撑齿轮架130的至少一部分的支撑件119。在各种实施方式中，参考图5至7，锥齿轮114可以连接到传动锥齿轮112上，或者替代地，锥齿轮114可以安装到轴113上或与轴113形成为一体。在上述任何一种情况下，传递到传动锥齿轮112的旋转运动都可以传递到锥齿轮114。
在各种实施方式中，尽管未示出，锥齿轮114可以经由协作的锥齿轮齿与传动轴106直接接合。在至少一种这样的实施方式中，锥齿轮114可以例如沿顺时针方向旋转传动轴106，并且在端部执行器58内推进切割构件96，如下面所述。在这种实施方式中，扳机54的致动可以在端部执行器58内推进切割构件96，然而，切割构件96必须手动地或者借助附加的缩回系统缩回。在本发明的所示实施方式中，参考图3和5-7，外科器械50还可以包括切换机构，该切换机构能允许传动轴106沿顺时针方向或逆时针方向旋转，并且相应地允许切割构件96经由扳机54的致动前进或缩回。在各种实施方式中，主要参考图5和6，切换机构可以包括齿轮架130，该齿轮架130可以在第一位置和第二位置之间切换，其中，在第一位置，锥齿轮114的旋转运动例如沿顺时针方向旋转传动轴106，在第二位置，锥齿轮114的旋转运动沿逆时针方向旋转传动轴106。
在各种实施方式中，参考图5至7，齿轮架130可以包括壳体132、前向齿轮134和换向齿轮136，其中，前向齿轮134和换向齿轮136可旋转地安装到壳体132上。在至少一种实施方式中，传动轴106可以包括例如大致六边形形状的端部107，该端部107能容纳在前向齿轮134和换向齿轮136中的孔(未示出)内，使得齿轮134和136可旋转地接合到传动轴106上。在其它各种实施方式中，端部107可以包括任何其它适当的形状或结构，使得齿轮134和136可旋转地接合到传动轴106上。在上述任何一种情况中，参考图5，齿轮架130可以沿着端部107滑动，使得前向齿轮134或换向齿轮136能与锥齿轮114接合。在使用中，例如当前向齿轮134与锥齿轮114接合时，锥齿轮114的旋转运动能传递到前向齿轮134，并且由于端部107与前向齿轮134中的孔具有配合的几何结构，齿轮134的旋转运动可以传递到传动轴106。为了沿相反的方向旋转传动轴，可以使齿轮架130向近侧或向后滑动，使得换向齿轮136接合锥齿轮114。用于以这种方式致动齿轮架130的机构将在下面进一步描述。
在各种实施方式中，当前向齿轮134与锥齿轮114接合时，如图5所示，换向齿轮136能从锥齿轮114脱离，使得换向齿轮136自由地与传动轴106一起旋转。在至少一种实施方式中，齿轮架130还可以包括间隔件135，该间隔件135可旋转地支撑齿轮134和136并且使它们对准，且允许齿轮134和136彼此独立地旋转。在一些实施方式中，齿轮架130可以被设置在前向位置和后向位置中间的位置上，使得齿轮134和136都与锥齿轮114接合并且将传动轴106保持在“锁定”状态下，从而扳机54无法被致动。在其它各种实施方式中，齿轮架130可以被设置在中间位置，使得齿轮134和136均不与锥齿轮114接合。在这种实施方式中，击发驱动器处于“自由”状态，锥齿轮114的旋转运动不会传递到传动轴106。
在各种实施方式中，主要参考图2，传动轴106还可以包括能与击发螺母140可操作地接合的螺纹驱动部分138。在至少一种实施方式中，螺纹驱动部分138能够响应于传动轴106的旋转运动可滑动地前进和/或缩回击发螺母140。更具体而言，击发螺母140可以包括螺纹孔141，该螺纹孔141能与螺纹驱动部分138螺纹接合，使得传动轴106的旋转产生向远侧推进击发螺母140的反作用力。在至少一种实施方式中，击发螺母140可以包括从其延伸的凸起142，该凸起142能延伸通过在近侧通道部分的各半部77和79之间限定的槽，以便限制击发螺母140沿轴线的运动。在实践中，槽可以防止击发螺母140与传动轴106一起旋转，并且可以在击发螺母140在通道部分78内平移时限定凸起142的路径。
在各种实施方式中，参考图2，切割构件96能与击发螺母140可操作地接合，使得击发螺母140的平移(如上所述)能导致切割构件96在端部执行器58内平移。在至少一种实施方式中，外科器械50还可以包括连接在击发螺母140上的击发杆144、连接在切割构件96上的驱动杆146和被构造用于连接驱动杆146和击发杆144的连接器148。在各种实施方式中，击发杆144可以包括近端145，该近端145可以包括被构造用于以压合方式容纳击发螺母140的至少一部分的孔。在至少一种实施方式中，击发杆144的近端145可以包括可变形构件147，该可变形构件147能在其被朝向击发螺母140中的凹口143向下按压或向内发生变形之后接合凹口143。在上述任何一种情况下，击发杆144还可以包括远端149，该远端149能够例如以压合方式容纳塞子150，塞子150可以包括从其延伸的凸起152，该凸起152能容纳在连接器148中的槽154内。在各种实施方式中，连接器148还可以包括槽151，该槽151能容纳驱动杆146的连接翼154，使得当连接器148通过击发杆144平移时，驱动杆146能在远侧保持部分80内平移。在至少一种实施方式中，驱动杆146还可以包括远端156，该远端156能接合切割构件96中的凹口97并且在端部执行器58内推进和/或缩回切割构件96。如上所述，切割构件96可以包括刀99，刀99能在切割构件96在端部执行器58内行进时切割定位在钉砧62和钉仓66之间的组织。此外，如上所述，切割构件96可以包括部分95，该部分95被构造用于推动钉仓66内的缝钉驱动器(未示出)，以展开可移除地存储在钉仓66内的缝钉(未示出)。
在各种实施方式中，外科器械能在扳机54的单次致动，即在实施方式中扳机54的总的第二次致动时将切割构件96推进期望的距离，在该实施方式中，扳机54的第一次致动闭合钉砧62，如上所述。然而，在其它实施方式中，可以利用扳机54的多次致动将切割构件96推进期望的距离。在至少一种这样的实施方式中，参考图12至16，扳机54可以被致动三次以将切割构件96从端部执行器58的近端59推进到远端61。然而，在其它实施方式中，这种致动的次数主要取决于切割构件96的总的移动距离以及切割构件96在每次致动后的位移。特别地，在扳机54的第二次致动之前，切割构件96可以被定位在端部执行器58的近端59，击发螺母140可以被定位在其最近侧位置。在扳机54第二次致动时，参考图13和14，切割构件96可以行进近端59和远端61之间的大约三分之一距离，类似地，击发螺母140可以沿着传动轴106向远侧行进。之后，参考图15，切割构件可以在扳机54的第三次致动时行进近端59和远端61之间的另外三分之一距离，类似地，参考图16，切割构件96可以在扳机54第四次致动时行进到端部执行器58的远端61中。
在各种实施方式中，为了帮助医生监测扳机54被致动的次数，外科器械50可以包括计数机构，该计数机构能显示扳机54已被致动的次数和/或用于展开钉仓内的所有缝钉的剩余致动次数。在上述任何一种情况下，主要参考图3和9，计数机构170的一种实施方式可以包括指示螺母172、指示板174和壳体90上的指示窗口171(图1)。在至少一种实施方式中，指示板174可以包括其上的标记，该标记可以向医生示出为推进切割构件96而致动扳机54的次数。在这种实施方式中，指示扳174可以包括空白部分173，该空白部分173在扳机54的第一次致动、即如上所述使钉砧62闭合的扳机54的致动之前和之后通过窗口171可见。在扳机54第二次致动时，传动轴106的旋转可以向远侧推进指示螺母172和安装在指示螺母172上的指示板174，使得指示板174上的数字“1”或其它合适的标记通过指示窗口171可见。因此，该标记可以向医生示出切割构件96已通过扳机54的一次致动行进。与击发螺母140类似，指示螺母172可以包括螺纹孔，该螺纹孔可以与传动轴106的螺纹部分176螺纹接合，使得传动轴106的旋转向指示螺母172施加反作用力并且向远侧推进指示螺母172。扳机54随后的致动可以在指示窗口171下方显示数字‘2’和‘3’。
为了如上所述缩回切割构件96，可以切换齿轮架130，使得前向齿轮134从锥齿轮114脱离，参考图17和18，换向齿轮136与锥齿轮114接合。之后，扳机54随后的致动可以使传动轴106沿相反的方向旋转并且向近侧平移击发螺母140。更具体而言，由于击发螺母140与传动轴106的螺纹部分138之间螺纹接合，轴106沿相反方向的旋转将向击发螺母140施加反作用力，该反作用力使击发螺母140向近侧移动。因此，如上所述可以连接到击发螺母140上的击发杆144、驱动杆146和切割构件96也向近侧移动，由此在端部执行器58内缩回切割构件96。类似地，轴106沿相反的方向旋转也能使指示组件170的指示螺母172向近侧移动。更具体而言，扳机54在齿轮架130被切换之后的第一次致动、即扳机54的总的第五次致动可以导致传动轴106向指示螺母172施加反作用力并且使螺母172向近侧移动。在这种情况下，指示螺母172能相对于窗口171移动指示板174，从而通过指示窗口171可以看到数字‘2’，这可以提醒医生要完全缩回切割构件96需要再致动扳机54两次。
尽管在本实施方式中扳机54被致动三次以推进和/或缩回切割构件96，然而在其它实施方式中推进切割构件96所需的致动次数可以与缩回切割构件96所需的致动次数不同。下面还将详细描述包括用于以不同速率推进和缩回切割构件96的特征的示例性的实施方式。此外，在至少一种实施方式中，切割构件96的部分95可以与缝钉驱动器接合，使得切割构件96的缩回也使缝钉驱动器缩回。然而，在其它实施方式中，可以将缝钉驱动器留在钉仓中，仅缩回切割构件96。在使用其中包含有自带的缝钉驱动器的新的钉仓组件替代用过的钉仓组件时可能因此需要将用过的缝钉驱动器留在用过的钉仓内，此时可以利用这种实施方式。
为了如上所述地致动齿轮架130，外科器械50可以包括切换机构160，参考图3至5。在至少一种实施方式中，切换机构160可以包括轴切换器162、从轴切换器162延伸的切换手柄164、和切换连接件166，其中，切换连接件166可以经由切换销169连接到轴162上，并且可以经由销168连接到齿轮架壳体132上。为了如上所述地使齿轮架130相对于传动轴106滑动，切换手柄164可以被构造用于旋转轴162，使得从轴162延伸的曲柄臂163移动切换连接件166并且沿着传动轴106的轴线105驱动齿轮架130。在所示实施方式中，当切换手柄164定向为基本上向下时，如图8所示，曲柄臂163定向为基本上向上。在该结构中，参考图5，齿轮架130被定位在其最后侧或最近侧位置上，前向齿轮134与锥齿轮114可操作地接合。为了将外科器械50切换到切割构件96被缩回的结构中，可以向上旋转切换手柄164，如图17所示，以向前或向远侧旋转曲柄臂163。相应地，曲柄臂163可以被构造用于向远侧移动切换连接件166并且将齿轮架130拉入到其最远侧位置，由此使换向齿轮136与锥齿轮114接合。如果医生期望在至少部分地缩回切割构件96之后推进切割构件96，那么医生可以向下旋转切换手柄164并且使前向齿轮134与锥齿轮114重新接合。
在各种实施方式中，参考图3和5，外科器械50还可以包括双稳态挠性机构，其用于将切换机构160偏压到齿轮134或136与锥齿轮114接合的结构中。换句话说，当医生仅部分地旋转切换手柄164时，该双稳态挠性机构导致切换机构160动态上不稳定。在这种情况下，双稳态挠性机构可以将切换机构160偏压到两种稳定结构中的任一种中，即前进结构或换向结构。在各种实施方式中，主要参考图3，双稳态挠性机构180可以包括接收器182、弹簧184、活塞186和肘接销钉188。在至少一种实施方式中，肘接销钉188可以将活塞186连接到切换轴162上，接收器182可以连接到从壳体90延伸的凸起183上。在使用中，弹簧184可以被构造成经由活塞186向轴162施加偏压力，并且能在轴162仅在其前进和换向方向之间部分地旋转的情况下旋转轴162。
在各种实施方式中，一旦切割构件96完全缩回，端部执行器闭合系统和缝钉击发系统能够复位，用尽的钉仓可以从外科器械50中移除，新的钉仓66可以被定位在钉仓通道64内，外科器械50可以如上所述用于进一步缝合和切割组织。在所示实施方式中，凸轮68可以从锁定件92释放，以打开钉砧62并复位端部执行器闭合系统。类似地，棘轮108可以从主传动齿轮110脱离，以使扳机54从齿轮系102脱离并且复位缝钉击发系统。在至少一种实施方式中，凸轮68和棘轮108可以被手动复位，然而，主要参考图3至5、9、10、19和20，外科器械50可以包括复位系统，该复位系统可以如上所述自动地复位端部执行器闭合系统和缝钉击发系统。在各种实施方式中，扳机54的最终回复致动可以复位这些系统，如下面详细描述的那样。
如上所述，扳机54的第一次致动可以使凸轮68旋转到图8所示位置，弹簧锁定件92能在击发驱动器通过扳机54随后的致动操作时将凸轮68保持在适当位置。同样如图8所示，外科器械50还可以包括凸轮弹簧67，该凸轮弹簧67能向下偏压凸轮68，参考图9和10，并且保持从凸轮68延伸的凸轮锁定臂73抵靠弹簧锁定件92。在这种实施方式中，凸轮锁定臂73可以包括凹口74，该凹口74能够容纳弹簧锁定件92的至少一部分。为了辅助凸轮弹簧67在扳机54的随后致动过程中阻止凸轮68向上提升并且阻止凸轮68从弹簧锁定件92脱离，指示螺母172可以被构造用于接触凸轮轨道75并且保持凸轮锁定臂73抵靠弹簧锁定件92。更具体而言，随着指示螺母172向远侧行进，如上所述，指示螺母172可以沿着接触轨道75滑动，由此提供前挡块，凸轮68抵靠其上无法旋转。然而，一旦指示螺母172回复到其最近侧位置，指示螺母172可以与斜面89对准，因此，扳机54的第三次回复致动可以导致凸轮68稍向上旋转，由此使锁定臂73从弹簧锁定件92脱离，如图10所示。
在凸轮68从锁定件92释放之后，凸轮复位弹簧67能使凸轮68向下旋转并且使其回复到其起始位置。随着凸轮68向下旋转，凸轮槽69的壁能够向远侧驱动闭合连接件72，并且相应地也向远侧驱动通道部分78和80以及钉仓通道64。在至少一种实施方式中，端部执行器58还可以包括弹簧(未示出)，该弹簧能在钉仓通道64向远侧滑动、即远离细长轴组件56的外部护套57时向上偏压钉砧62。在其它各种实施方式中，尽管未示出，外科器械50还可以包括致动器，其中，医生可以操作该致动器以拉动或推动钉砧62到打开位置。在上述任一种情况下，在至少一种实施方式中，凸轮复位弹簧67可以向凸轮68提供足够的力，以使棘轮108移出，脱离与主传动齿轮110的接合，并且由此复位击发驱动器。在其它各种实施方式中，凸轮复位弹簧67的强度不足以提供向下拉动凸轮68以使棘轮108从主传动齿轮110脱离的力。在至少一种这种实施方式中，外科器械50还可以包括拨动开关组件，参考图3至5和19，该拨动开关组件可以有选择地偏压棘轮108远离主传动齿轮110。
在各种实施方式中，主要参考图3、4和9，拨动开关组件190可以包括安装在传动轴106上的拨动致动器192，该拨动致动器192可以包括从其延伸的肘节臂193。在扳机54的最终回复致动时，在至少一种实施方式中，指示螺母172可以接触拨动致动器192并且使其绕传动轴106旋转，使得肘节臂193朝向棘轮108旋转。在至少一种这种实施方式中，参考图9，指示螺母172还可以包括斜面179，该斜面179能够接合从拨动致动器192延伸的凸起191并且使拨动致动器192绕传动轴106沿顺时针方向旋转。在各种实施方式中，肘节臂193能够在其绕传动轴106旋转时接触棘轮108并且移动棘轮108远离主传动齿轮110。在至少一种实施方式中，棘轮108可以被充分移至远离传动齿轮110处，以允许凸轮复位弹簧67将凸轮68定位在套环118附近。之后，凸轮68可以将棘轮108保持在该位置，直到凸轮68如上所述向上旋转为止。
尽管上述机构可以将凸轮68和棘轮108复位到它们的初始位置，然而至少在所示实施方式中拨动致动器192的肘节臂193可以保持抵靠棘轮108的套环118定位。因此，即使在扳机54第一次致动时凸轮68向上旋转使得凹槽120与套环118对准，棘轮108也不可以如上所述被释放以接合主传动齿轮110。鉴于此，在至少一种实施方式中，外科器械50可以包括用于旋转肘节臂193使其不与棘轮108接合的复位机构。在各种实施方式中，这种机构可以手动操作和/或响应于例如扳机54的致动自动地操作。在至少一种实施方式中，如图20所示，壳体90可以包括从其延伸的凸起91，该凸起91可以被构造用于使拨动致动器192围绕传动轴106旋转并且将其回复到其初始的未致动的位置，如图9所示。更具体而言，在各种实施方式中，凸起91可以被构造成随着齿轮架130从其远侧位置移动到其近侧位置接合肘杆194(图3)，其中，在远侧位置，换向齿轮136与锥齿轮114接合，在近侧位置，前向齿轮134与锥齿轮114接合。当切换手柄164向下旋转以向近侧移动齿轮架130并且将外科器械50设置在其上述‘前进’结构时，这种移动可以通过切换机构160来实现。由于肘杆194与凸起91接触，肘杆194可以围绕销195旋转使得肘杆194接触致动臂193并且使拨动致动器192沿逆时针围绕传动轴106旋转。在各种实施方式中，拨动开关组件190还可以包括双稳态挠性机构196，该双稳态挠性机构196有助于确保拨动开关组件190不在中间结构中卡住。
如上所述，根据本发明的外科器械可以包括用于致动端部执行器闭合系统和缝钉击发系统的单个扳机。尽管就这种单个扳机外科器械描述了上述特征，然而一些上述特征可以用在具有第一扳机和第二扳机的外科器械中，该第一扳机用于致动端部执行器闭合系统，该第二扳机用于致动缝钉击发系统。参考图23至30，例如，外科器械200可以包括用于致动端部执行器闭合系统的扳机201和用于致动缝钉击发系统的扳机204。在各种实施方式中，参考图25，端部执行器闭合系统可以包括闭合连接件203，该闭合连接件203可操作地经由销209与闭合扳机201接合。端部执行器闭合系统还可以包括滑块205和闭合管207(图23)，其中，闭合管207能经由滑块205和销211可操作地连接到闭合连接件203上。更具体而言，参考图29，闭合管207可以包括位于其最近端的凸缘213，该凸缘213可以被构造成容纳在滑块205中的槽215内，使得滑块205的滑移运动传递到闭合管207。
在使用中，主要参考图29和30，扳机201的致动可以使闭合连接件203向远侧平移，相应地，使滑块205和闭合管207也向远侧平移。在各种实施方式中，闭合管207可以包括协作地与钉砧62接合的元件，使得闭合管207的平移导致钉砧62朝向钉仓通道64旋转。更具体而言，参考图24，钉砧62可以包括从其延伸的凸起51，该凸起51可以容纳在闭合管207的孔217内，使得孔217的侧壁可以抵接凸起51并且使钉砧62向下旋转。为了引导钉砧62，如上所述，钉仓通道64可以包括槽65，该槽65可以限定钉砧62在旋转时的路径。外科器械200还可以包括锁定件219，该锁定件219可以被构造成将扳机201保持在致动位置，由此将钉砧62保持在闭合位置。为了打开钉砧62，锁定件219(图28)可以从扳机201处脱离，使得扳机201可以回复到其未致动位置。在扳机201回复到其未致动位置时，扳机201可以向近侧驱动滑块205和闭合管207，并且由于凸起51和孔217之间作用接合而使钉砧62向上旋转。
如上所述，根据本发明的外科器械可以包括击发驱动器，该击发驱动器可以被构造用于例如以第一速率推进切割构件并以不同速率缩回切割构件。在各种实施方式中，参考图23至30，外科器械200可以包括击发驱动器202，该击发驱动器202可以包括扳机204、传动轴206、第一棘轮组件210和第二棘轮组件212。在至少一种实施方式中，棘轮组件210和212可以被构造成使传动轴206分别沿顺时针方向和逆时针方向旋转，以便在端部执行器58内推进或缩回切割构件96。在各种实施方式中，参考图25，扳机204可以有选择地与棘轮组件210和212接合，使得当扳机204被致动时，棘轮组件210和212中仅一个被扳机204驱动。在至少一种这种实施方式中，扳机204能沿销214滑动，以使扳机204与棘轮组件210和212中的一个接合。在所示实施方式中，销214可旋转地容纳在壳体部分218中的孔216内，并且为扳机204提供旋转轴线。
在各种实施方式中，参考图27，扳机204可以被定位成使得可枢转地安装在扳机204上的棘爪220与棘轮222接合，并且在扳机204致动时，棘轮222通过棘爪220围绕销214旋转。在扳机204释放时，棘爪220可以滑过棘轮222的棘齿224，允许其间的相对运动。在至少一种实施方式中，棘轮组件210还可以包括棘爪簧(未示出)，该棘爪簧被构造成将棘爪220偏压到与棘齿224接合，并且当扳机204被重新致动时使棘爪220与棘齿224重新接合。为了将棘轮222的旋转传递到传动轴206，该传动轴206可以包括连接在其上的前向齿轮226。更具体而言，在至少一种实施方式中，棘轮222还可以包括齿轮齿228，齿轮齿228能与前向齿轮226可操作地接合，使得棘轮222的旋转使前向齿轮226和传动轴206围绕轴线230旋转(图25)。在各种实施方式中，前向齿轮226可以例如压合到传动轴206上，或者在其它各种实施方式中，前向齿轮226可以与传动轴206一体地形成。
在各种实施方式中，与上述外科器械类似，参考图24，传动轴206能与击发螺母140可操作地接合，以便使击发螺母140在近侧保持部分232中平移。同样如上所述，击发螺母140的平移可以经由驱动杆146传递到切割构件96，以便在端部执行器58内推进切割构件96。为了在端部执行器58内缩回切割构件96，在至少一种实施方式中，扳机204可以滑动成与第二棘轮组件212接合，使得当扳机204被致动时传动轴206沿相反的方向旋转。与棘轮组件210类似，参考图28，棘轮组件212可以包括棘轮234和棘爪236，其中，棘爪236能可枢转地安装到扳机204上，并且能经由棘齿238与棘轮234可操作地接合。与棘轮222类似，棘轮234可以包括齿轮齿240，齿轮齿240能与安装在传动轴206上的换向齿轮242可操作地接合。当棘轮222和234在大致相对侧上与传动轴206接合时，棘轮222和234可以使传动轴206沿相反的方向旋转，即分别沿顺时针方向和逆时针方向。因此，为了选择在端部执行器58内推进或缩回切割构件96，扳机204可以滑动成与第一棘轮组件210或第二棘轮组件212作用接合。
在各种实施方式中，尽管未示出，第一棘轮222和第二棘轮234可以具有大致相同的直径或节圆半径。换句话说，棘轮的中心或旋转轴线与棘轮的齿轮齿之间的距离可以相等。在这种实施方式中，扳机204每致动一次切割构件96前进的距离与扳机204每致动一次切割构件96缩回的距离基本上相等。这种实施方式尽管在一些情况下是适当的，但可能需要医生在切割构件96完全缩回之前多次致动扳机204。鉴于此，在各种实施方式中，第一棘轮222的节圆半径可以与第二棘轮234的节圆半径不同。在至少一种实施方式中，第二棘轮234的节圆半径可以大于第一棘轮222的节圆半径，使得切割构件96在扳机204每一次致动时缩回的距离大于切割构件96在扳机204每一次致动时前进的距离。换句话说，在至少一种实施方式中，第二棘轮组件212可以比切割构件96前进时的速率大的速率缩回切割构件96。在这种实施方式中，由于推进速率较小，第一棘轮组件210向切割构件96提供较大的扭矩或推进力，而由于缩回速率较大，则第二棘轮组件212能够缩短医生缩回切割构件所需的时间。
尽管上面用到的术语‘速率’被用于描述切割构件96在扳机204每一次致动时可以前进或缩回的距离，但术语‘速率’并不限于此。在至少一种实施方式中，术语‘速率’可以用于描述切割构件移动的速度和/或加速度。在这种实施方式中，可能期望具有这样一种切割构件，该切割构件以较低的速度和/或加速度前进以更好地控制切割构件，并且以较高的速度和/或加速度缩回以减短缩回切割构件所需的时间。此外，尽管所示实施方式包括用于提供不同前进和缩回速率的棘轮组件，本发明并不限于此。相反地，可以设想其它实施方式，包括正齿轮系、锥齿轮和/或其它运动传递装置。
在各种实施方式中，根据本发明的外科器械可以包括用于增大或减小传动轴的转动速度的齿轮箱。在至少一种实施方式中，参考图25，外科器械200还可以包括齿轮箱250，该齿轮箱250能可操作地定位在传动轴206和棘轮组件210、212中间。在各种实施方式中，齿轮箱250可以用于‘降低’传动轴206的速度，使轴206以比不利用齿轮箱250时的速度低的速度转动。在替代实施方式中，齿轮箱可以用于‘增大’传动轴206的速度，使传动轴206以较高的速度转动。在至少一种实施方式中，齿轮箱250可以包括至少一组用于改变传动轴206的速度的行星齿轮。在其它各种实施方式中，诸如图21和22中所示的齿轮箱252之类的齿轮箱可以包括壳体253、安装在输入轴256上的输入齿轮254、小齿轮258和安装在输出轴262上的输出齿轮260。在这种实施方式中，由于输入齿轮254和输出齿轮260具有不同的节圆半径，输入轴256和输出轴262将以不同的速度旋转。为了便于齿轮254、258和260在壳体253内旋转运动，齿轮箱252还可以包括如图22所示的各种支撑板264、间隔件266和销268。除了上述，齿轮箱252也可以用于例如将输入轴256的顺时针运动转换成输出轴262的逆时针运动。
在上述各种实施方式中，外科器械200的扳机204可以在第一位置和第二位置之间滑动，其中，在第一位置，扳机204与第一棘轮组件210可操作地接合，在第二位置，扳机204与第二棘轮组件212可操作地接合。在至少一种实施方式中，击发驱动器202可以被构造成使例如第一棘爪220在第二棘爪236与第二棘轮234接合之前从第一棘轮222处脱离。在这种实施方式中，扳机204可以定位在中间位置，扳机204在该中间位置处既不与第一棘轮组件210可操作地接合也不与第二棘轮组件212可操作地接合。因此，在各种实施方式中，击发驱动器202可以处于‘自由’状态，在该状态下，扳机204的致动不会导致传动轴206旋转。在替代实施方式中，击发驱动器202可以被构造成使例如第二棘爪236在第一棘爪220从第一棘轮222可操作地脱离之前与第二棘轮234接合。在这种实施方式中，扳机204可以定位在中间‘锁定’状态，在该状态下，扳机204无法致动，由此向医生指示扳机204未与棘轮组件中的任一个完全接合，扳机204需要进一步调整。
在各种实施方式中，外科器械200可以包括将扳机204偏压到与第一棘轮组件210和第二棘轮组件212中的一个接合的装置。在至少一种实施方式中，参考图33，外科器械200还可以包括双稳态挠性机构270，该双稳态挠性机构270可以将扳机204偏压出上述中间位置，并且将其偏压到与第一棘轮组件210或第二棘轮组件212接合。在各种实施方式中，双稳态挠性机构270可以包括弹簧272和连接件274，其中，弹簧272可以经由连接件274向扳机204施加偏压力，该偏压力用于将扳机204移出其中间位置(如图33所示)，并且将其移入到与第一棘轮222或第二棘轮234接合。更具体而言，当扳机204定位在其中间位置时，弹簧272可以被拉伸至长度X1，由于弹簧272具有回弹力，弹簧272设法使自身缩短至其未拉伸的长度，或者例如至少比X1小的长度，诸如长度X2。为了使弹簧272将其自身缩短至长度X2，弹簧272可以使连接件274围绕销275旋转，其中，销275可以从外科器械壳体218延伸，并且将连接件274可枢转地安装到外科器械壳体218上。更具体而言，由于弹簧272的第一端安装到从壳体218延伸的销276上并且弹簧272的第二端安装到从连接件274延伸的销277上，弹簧272可以通过将销277移近销276来使自身变短，其中，将销277移近销276可以非常容易地通过使连接件274围绕销275旋转来完成。在连接件274围绕销275旋转的情况下，连接件274中的槽278的侧壁可以被构造用于接合从扳机204延伸的销279并且使扳机204滑动到与第一棘轮222或第二棘轮234接合。在实践中，图33所示的扳机204的中间位置表现为动态不稳定位置，扳机204的与棘轮222和234接合的位置表现为击发驱动系统的动态稳定位置。
在各种实施方式中，如上所述，根据本发明的外科器械可以包括用于沿第一方向和第二方向旋转传动轴的装置，在第一方向上，传动轴例如在端部执行器内推进切割构件，在第二方向上，传动轴缩回切割构件。在至少一种实施方式中，参考图31和32，外科器械例如可以包括传动装置280，该传动装置280可以允许医生选择利用传动轴推进或缩回切割构件。在各种实施方式中，传动装置280可以包括壳体282、内部输入轴284、外部输入轴285、输出传动轴286和切换机构288，其中，切换机构288可以被构造用于可选择地使内部输入轴284和外部输入轴285接合输出轴286。尽管未示出，外科器械还可以包括例如扳机，该扳机与外部传动轴285可操作地接合，以便例如使传动轴285绕轴线287沿顺时针方向旋转。在至少一种实施方式中，传动装置280可以包括可旋转地安装在壳体282内的小齿轮292、固定地安装到外部输入轴285上的输入齿轮293和安装到输出传动轴286上的输出齿轮294，其中，输入齿轮293能与小齿轮292的外齿轮齿290可操作地接合，使得外部输入轴285的旋转传递到小齿轮292。
在传动装置280的第一种结构中，输出齿轮294能与小齿轮292的内齿轮齿291可操作地接合，使得小齿轮292的旋转传递到输出传动轴286。更具体而言，输出齿轮294能经由带键槽端部296与输出传动轴286可操作地接合，使得输出齿轮294驱动输出传动轴286围绕轴线287旋转。在该第一种结构中，外部输入轴285的顺时针旋转例如可以转换成输出传动轴286的逆时针运动。在传动装置280的第二种结构中，输出齿轮294可以从小齿轮292处脱离，使得外部输入轴285的旋转无法经由小齿轮292传递到输出传动轴286。为了使输出齿轮294从小齿轮292处脱离，内部传动轴284可以相对于外部传动轴285滑动，使得输入齿轮297接触输出齿轮294中的凹口298并且推动输出齿轮294远离小齿轮292。在至少一种实施方式中，凹口298可以包括齿299，所述齿299能与内部输入轴284的输入齿轮297可操作地接合，使得内部输入轴284的旋转传递到输出传动轴286。在传动装置280的该第二种结构中，内部输入轴284的顺时针旋转可以直接传递到输出传动轴286，使得输出传动轴286也沿顺时针方向旋转。为了使输出齿轮294与小齿轮292再次接合，内部输入齿轮284可以从输出齿轮294处脱离，以允许弹簧281使输出齿轮294沿着带键槽端部296滑动。
在上述实施方式中，医生可以有选择地相对于外部输入轴285运动内部输入轴284，以将传动装置280设置在前进结构或换向结构中。在各种实施方式中，为了移动输入轴284，外科器械还可以包括被构造用于移动内部输入轴284的致动器或扳机。在至少一种实施方式中，外科器械可以包括用于旋转外部输入轴285的第一致动器或扳机和用于相对于外部输入轴285移动内部输入轴284的第二致动器或扳机。在这种实施方式中，内部输入轴284可以包括键槽283，该键槽283能与外部输入轴285可滑动地接合，使得外部输入轴285的旋转传递到内部输入轴284，也允许它们之间的滑移运动。在至少一种实施方式中，传动装置280还可以包括轴承300，该轴承300可旋转地支撑输入齿轮293，并且当输入齿轮293和壳体282之间压缩时提供偏压力以保持输入齿轮293与小齿轮292可操作地接合。在各种实施方式中，输出轴286可以包括从其延伸的构件302，该构件302可以被构造成容纳在壳体282的凹口301中，以便减小或者甚至消除输出轴286和壳体282之间的相对运动。在至少一种实施方式中，尽管未示出，传动装置280可以仅包括一个小齿轮292并且仍然以上述方式操作。
在各种实施方式中，传动装置280也可以被构造用于例如以与缩回速率不同的速率推进切割构件96。在至少一种实施方式中，参考图31和32，内部输入轴284和输出轴286之间的作用接合可以用于推进切割构件96，由于输入齿轮297和输出齿轮294之间直接接合，内部输入轴284和输出轴286可以1∶1的比率旋转，即，内部输入轴284每旋转一次，输出轴286旋转一次。在各种实施方式中，外部输入轴285和输出轴286之间的作用接合可以用于缩回切割构件96，由于输入齿轮293和输出齿轮294具有不同的节圆半径并且它们与小齿轮292作用接合，外部输入轴285和输出轴286可以不同于1∶1的比率旋转。在所示实施方式中，当输出轴286和外部输入轴285经由小齿轮292配合时，输出轴286的旋转速度大于外部输入轴285的旋转速度。因此，在各种实施方式中，切割构件96在外部输入轴285与输出轴286可操作地接合时的平移速率大于在内部输入轴284与输出轴286可操作地接合时的平移速率。
在本文中公开的装置可被设计成在一次使用后被抛弃，或者它们可被设计成多次使用。但在任一种情况下，装置可被修复以便在至少一次使用后重新使用。修复可包括装置的拆卸步骤、接着清洁或者替换特定部件并随后重新组装的任何组合。特别是，装置可被拆卸，任何数目的装置特定部件或部分可选择性地以任意组合被替换或者除去。当清洁和/或替换特定部件时，装置可重新组装以便在修复场所或者由外科团队在外科手术之前立即随后使用。本领域技术人员将会理解，装置的修复可利用各种用于拆卸、清洁/替换和重新组装的技术。所述技术的使用和产生的被修复装置都落在本申请的范围之内。
优选地，在本文中描述的发明可在外科手术之前处理。首先，得到新的或者使用过的器械并且在需要的时候对其进行清洁。器械然后可被灭菌。在一种灭菌技术中，器械被设置在闭合和密封容器中，诸如塑料袋或者高密度聚乙烯合成纸袋中。容器和器械然后设置在可穿透容器的辐射场中，诸如γ射线、x射线或者高能电子。辐射杀死器械和容器中的细菌。灭菌的器械然后可存储在灭菌容器中。密封的容器保持器械无菌直到其在医疗场合被打开。
虽然本发明已经以典型设计进行了描述，本发明还可在公开的精神和范围内进一步被修改。本申请因此将覆盖使用其一般原理的本发明的任何变化、使用、或者修改。此外，本申请将覆盖那些与本发明公开的内容有偏差但在本发明所属领域中已知或者商业实践的那些内容。

Claims (9)

1.一种外科器械，包括：
手柄；
击发驱动器，包括：
可操作地连接到所述手柄上的击发扳机，其中所述击发驱动器能够在所述击发扳机第一次致动时产生旋转击发动作，并且在所述击发扳机的另一次致动时产生旋转缩回动作；
第一驱动构件，所述第一驱动构件包括多个第一齿轮齿，其中所述击发扳机能够可选择地与该第一驱动构件接合；以及
第二驱动构件，所述第二驱动构件包括多个第二齿轮齿，其中所述击发扳机能够可选择地与该第二驱动构件接合；
连接到所述手柄上的细长轴组件，该细长轴组件包括可转动的传动轴，所述传动轴包括与所述第一齿轮齿可操作地接合的第一齿轮和与所述第二齿轮齿可操作地接合的第二齿轮；以及
连接到所述细长轴组件上的端部执行器，所述端部执行器包括：
能够在其中可操作地支承钉仓的细长通道；
可动地连接到所述细长通道的钉砧；以及
能够操作地支承于所述细长通道中的切割构件，其中所述切割构件与所述细长轴组件的传动轴可操作地接合，并且在所述击发扳机与所述第一驱动构件接合时，所述第一次致动使所述切割构件前进第一距离，在所述击发扳机与所述第二驱动构件接合时，所述另一次致动使所述切割构件缩回第二距离，并且所述第二距离大于所述第一距离。
2.如权利要求1所述的外科器械，其特征在于，所述击发扳机能够在第一位置和第二位置之间运动，其中在所述第一位置，所述击发扳机与所述第一驱动构件接合，在所述第二位置，所述击发扳机与所述第二驱动构件接合。
3.如权利要求1所述的外科器械，包括闭合驱动器，该闭合驱动器能够选择性地产生闭合动作和打开动作，其中所述钉砧可操作地与所述闭合驱动器接合并且能够响应于所述打开动作和闭合动作而运动。
4.如权利要求1所述的外科器械，其特征在于，所述传动轴限定一轴线，所述第一驱动构件定位在所述轴线的第一侧上并且能够使所述传动轴围绕所述轴线在第一方向上旋转，所述第二驱动构件定位在所述轴线的第二侧上并且能够使所述传动轴围绕所述轴线在第二方向上旋转，并且所述第二方向与所述第一方向相反。
5.如权利要求1所述的外科器械，还包括能够将所述击发驱动器偏压到第一状态和第二状态中的一个的双稳态挠性机构，其中所述击发扳机在所述第一状态被偏压成与所述第一驱动构件接合，并且在所述第二状态被偏压成与所述第二驱动构件接合。
6.如权利要求5所述的外科器械，还包括机架，其中所述双稳态挠性机构包括与所述击发扳机和所述机架可操作地接合的弹簧，其中所述弹簧能够使所述击发扳机滑动，使得所述击发扳机与所述第一驱动构件或者所述第二驱动构件接合。
7.如权利要求1所述的外科器械，其特征在于，当所述击发扳机与所述第一驱动构件接合时，所述击发扳机不与所述第二驱动构件接合，并且当所述击发扳机与所述第二驱动构件接合时，所述击发扳机不与所述第一驱动构件接合。
8.如权利要求1所述的外科器械，其特征在于，所述击发扳机能够同时与所述第一驱动构件和第二驱动构件接合，从而防止所述击发驱动器产生所述旋转击发动作和所述旋转缩回动作。
9.一种处理外科器械的方法，所述方法包括：
获取如权利要求1所述的外科器械；
对所述外科器械进行消毒；以及
将所述外科器械保存在无菌容器中。
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