CN103140180B - 钉仓 - Google Patents
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- 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
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Abstract
本发明提供了一种钉仓，所述钉仓可包括定位在仓体内的多个缝钉，其中所述仓体可包括组织接触平台和从所述组织接触平台延伸的多个脊部。所述脊部可在使用期间防止或者降低组织相对于所述钉仓运动的可能性。所述钉仓还可包括多个缝钉腔，其中每个缝钉腔可包括位于所述平台中的开口，所述开口至少部分地被脊部围绕。所述脊部可包含均匀的高度或者沿其长度变化的高度。所述高度可相对于所述仓体的近端和远端和/或在所述仓体的中心和侧部之间变化。
Description
背景技术
i.技术领域
本发明涉及缝合器械，并且在各种实施例中，涉及用于制备一排或多排缝钉的外科缝合器械。
ii.背景技术
缝合器械可包括一对相配合的细长钳口构件，其中每个钳口构件可适于插入患者体内并且相对于有待缝合和/或切割的组织定位。在各种实施例中，钳口构件中的一个可支撑其中容纳有至少两排横向间隔的缝钉的钉仓，并且另一个钳口构件可支撑具有与钉仓中的缝钉排对准的缝钉成形凹坑的砧。一般来讲，缝合器械还可包括推杆和刀片，所述推杆和刀片可相对于钳口构件滑动以通过推杆上的凸轮表面和/或由推杆推压的楔形滑块上的凸轮表面将缝钉从钉仓中依次顶出。在至少一个实施例中，凸轮表面能够启动由仓承载并与缝钉相关联的多个缝钉驱动器，以便推压缝钉靠在砧上并且在夹持于钳口构件之间的组织中形成横向间隔的变形缝钉排。在至少一个实施例中，刀片可跟随凸轮表面并且沿着缝钉排之间的路线切割组织。这种缝合器械的例子在名称为“SURGICAL STAPLES HAVINGCOMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUETHEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THESAME”的美国专利No.7,794,475中有所公开，该专利的全部公开内容以引用方式并入本文。
上述讨论仅是为了举例说明本发明技术领域中相关技术目前的每个方面，而不应当视为对权利要求范围的否定。
发明内容
在至少一种形式中，钉仓可包括多个缝钉以及仓体。仓体可包括组织接触平台、多个缝钉腔，其中每个缝钉腔包括位于平台中的开口，并且其中任一个缝钉定位在各一个缝钉腔中。仓体还可包括从组织接触平台延伸的多个脊部，其中每个开口至少部分地被脊部围绕。
在至少一种形式中，钉仓可包括多个缝钉以及仓体。仓体可包括中部；侧部；组织接触平台；多个缝钉腔，其中任一个缝钉定位在各一个缝钉腔中；以及从组织接触平台延伸的多个脊部，其中每个脊部在仓体的中部和侧部之间延伸。
在至少一种形式中，钉仓可包括多个缝钉以及仓体。仓体可包括近端；远端；组织接触平台；多个缝钉腔，其中任一个缝钉定位在各一个缝钉腔中；以及从组织接触平台延伸的多个脊部，其中每个脊部包含在近侧高度和远侧高度之间变化的高度，并且其中近侧高度比远侧高度更靠近近端。
上述讨论不应当被视为对权利要求范围的否定。
附图说明
本文所述的实施例的每个特征在所附权利要求书中进行了详细描述。然而，根据结合如下附图的以下描述，可以理解各种实施例（对手术的组织和方法来说皆是如此）及其优点。
图1为外科缝合器械的正视图。
图2为沿图1的线2-2截取的图1的外科缝合器械的端部执行器的剖视图。
图3为图1的端部执行器的剖视透视图。
图4为图1的端部执行器的剖视图，其示出了包括在其中的呈未击发构型的缝钉。
图5为示出了呈击发构型的图4的缝钉的示意图。
图6为示出了正用于缝合和横切组织的图1的端部执行器的示意图。
图7为根据至少一个实施例的包括从仓体延伸的多个脊部的钉仓的透视图。
图8为图7的钉仓的细部图。
图8A为图7的钉仓的剖视图。
图9为示出了定位在限定于图7的钉仓中的缝钉腔内的缝钉的细部图。
图10为根据至少一个可供选择的实施例的包括从仓体延伸的多个横向脊部的钉仓的局部透视图。
图11为根据至少一个可供选择的实施例的包括从仓体延伸的多个横向脊部的钉仓的局部透视图。
图12为根据至少一个可供选择的实施例的包括围绕限定于仓体中的缝钉腔开口的近端和远端的多个脊部的钉仓的局部透视图。
图13为根据至少一个可供选择的实施例的包括围绕限定于仓体中的缝钉腔开口的近端和远端的多个脊部的钉仓的局部透视图。
图14为根据至少一个可供选择的实施例的包括从仓体延伸的多个滚花脊部的钉仓的局部透视图。
图15为根据至少一个可供选择的实施例的包括从仓体延伸的多个滚花脊部的钉仓的局部透视图。
图15A为根据至少一个实施例的角锥形滚花的透视图。
图15B为根据至少一个实施例的截头圆锥形滚花的透视图。
图15C为根据至少一个实施例的三角形滚花的透视图。
图16为根据至少一个可供选择的实施例的包括完全围绕限定于仓体中的缝钉腔开口的多个脊部的钉仓的局部透视图。
图16A为根据至少一个可供选择的实施例的包括完全围绕限定于仓体中的缝钉腔开口的多个脊部的钉仓的局部透视图。
图17为根据至少一个可供选择的实施例的包括从仓体延伸的多个纵向脊部的钉仓的局部透视图。
图18为图17的钉仓的细部图。
在所述这些图式中，对应的参考符号表示对应的部件。本文示出的范例（以一种形式）示出了本发明的各种实施例，不应将这种范例理解为是以任何方式限制本发明的范围。
具体实施方式
示出了许多特定的细节，从而得到对说明书中所述和附图中所示的实施例的整体结构、功能、制造和用途的彻底理解。然而，本领域技术人员将会理解，可以在没有这样的特定细节的情况下实施该实施例。在其它实例中，没有详细描述熟知的操作、部件和元件，以免使说明书中描述的实施例模糊不清。本领域普通技术人员将会理解，本文所述和所示的实施例为非限制性例子，从而可认识到，本文所公开的特定结构和功能细节可为代表性和示例性的。在不脱离权利要求的范围的情况下可对这些实施例进行变型和改变。
本说明书通篇引用的“各种实施例”、“一些实施例”、“一个实施例”或“实施例”等，是指结合所述实施例描述的具体特征、结构或特性包括在至少一个实施例中。因此，本说明书通篇出现的短语“在各种实施例中”、“在一些实施例中”、“在一个实施例中”或“在实施例中”等并不一定都指相同的实施例。此外，在一个或多个实施例中，具体特征、结构或特性可按任何合适的方式结合。因此，在没有限制的情况下，结合一个实施例示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其它实施例的特征、结构或特性结合。此外，应当理解，为简明和清楚起见，本文可例如参考所示实施例使用诸如“竖直”、“水平”、“上”和“下”之类的空间术语。然而，这些术语用于辅助读者且并不旨在是限制和绝对的。
转到图1，外科缝合和切割器械10可包括可被操纵以便将工具部分14定位在手术部位中的柄部12。在各种实施例中，工具部分14可包括附接到细长轴18的端部执行器16。在多种情况下，工具部分14的尺寸和构造可设定成通过套管针（未示出）的插管插入手术部位中，以便执行例如内窥镜式或腹腔镜式外科手术。端部执行器16可包括上钳口或砧20以及下钳口22，其中当朝柄部12的手枪式握把26运动或按压柄部12的闭合触发器24时，砧20可在打开位置和闭合位置之间运动。在各种实施例中，按压闭合触发器24可推进细长轴18的外部闭合套管28，其中外部闭合套管28可接触砧20并且将砧20枢转到其闭合位置。在某些情况下，外科医生可通过扭转轴旋钮30来使工具部分14围绕其纵向轴线旋转。在任何情况下，一旦端部执行器16已插入注气体腔中时，例如，就可释放闭合触发器24，从而允许砧20通过弹簧（未示出）偏置并且相对于靶组织定位。在各种实施例中，闭合触发器24可锁定在其压下状态，并且在至少一个实施例中，柄部12还可包括可进行按压以对闭合触发器24解锁的锁定释放致动器44。一旦砧20和下钳口22已相对于手术部位中的组织适当定位时，就可再次压下闭合触发器24以便闭合砧20并且紧靠附接到底钳口22的钉仓42来压缩组织。
一旦砧20已闭合时，就可朝闭合触发器24和手枪式握把26来拉引或按压击发触发器32，以便将击发力或运动施加到击发构件并且从未击发位置来推进击发构件。在各种实施例中，击发构件可包括附接到远侧击发杆36的近侧击发杆34。在至少一个此类实施例中，击发杆34和/或击发杆36可支撑在轴18中的框架38内，所述轴可在柄部12和端部执行器16之间延伸。由于施加到击发构件的击发运动，则击发杆36可在下钳口22的细长钉仓通道40以及定位在仓通道40内的钉仓42内朝远侧推进。在各种实施例中，参见图2，击发杆36可包括附接部分48，所述附接部分附接到可在端部执行器16内平移的E柱杆50。E柱杆50可包括竖直部分52，所述竖直部分可当E柱杆50朝远侧推进时穿过延伸穿过砧20中的组织接触表面60的狭窄纵向砧狭槽58、钉仓42中的狭窄竖直狭槽62、以及细长缝钉通道40中的狭窄纵向通道狭槽64。现在参见图2和3，砧狭槽58可向上延伸到砧20中并且可包括通入横向加宽的纵向通道66中的末端，所述横向加宽的纵向通道66的尺寸和构造设定成容纳从竖直部分52横向延伸的上销轴54。相似地，通道狭槽64可向下延伸到通道40中并且可包括通入横向加宽的纵向通道68中的末端，所述横向加宽的纵向通道68的尺寸和构造设定成容纳从竖直部分52横向延伸的一个或多个下引脚70。
在各种实施例中，如针对上文进一步所述，E柱杆50还可包括一个或多个中销轴72，所述中销轴可从竖直部分52横向延伸并且能够沿着钉仓42的底盘74的顶表面滑动。在某些实施例中，中销轴72能够用于固定钉仓42，或者确保钉仓42保持位于通道40中。形成于底盘74上方的钉仓42中的纵向击发凹槽75的尺寸设定成允许中销轴72平移穿过钉仓42。在各种实施例中，E柱杆50还可包括远端驱动表面76，所述远端驱动表面能够平移穿过钉仓42中的竖直狭槽62并且朝远侧驱动楔形滑块78穿过钉仓42。在某些实施例中，楔形滑块78可整体成型在E柱杆50内，而在其它实施例中，楔形滑块78可存在于钉仓42中并且可在E柱杆50朝远侧推进时接触驱动表面76。E柱杆50的竖直部分52还可包括在远侧驱动表面76上方以及上销轴54下方沿着远侧边缘延伸的切割表面80，所述切割表面在组织46正被缝合时来切断所夹持组织46。现在参见图4，楔形滑块78能够接合一个或多个缝钉驱动器82并且朝砧20向上驱动缝钉驱动器82。在各种实施例中，缝钉（例如缝钉83）例如可位于和/或以其它方式支撑在缝钉驱动器82上，使得当缝钉驱动器82向上提升时，也可向上提升缝钉83。在至少一个此类实施例中，缝钉83也可至少部分地定位在钉仓42的钉仓本体85中的缝钉腔或凹坑84内，其中当缝钉83向上提升时，缝钉83可接触砧20并且可从缝钉腔84顶出。在至少一个实施例中，再次参见图4，底盘74可附接到仓体85，以便将缝钉驱动器82和缝钉83保持在钉仓42内直至如上文所述来从其部署缝钉83。
现在参见图5和6，使用时，可将砧20定位在组织46的一侧并且可将底钳口22定位在组织46的相对侧，使得当砧20闭合到组织上时，砧20的组织接触表面60和钉仓42的组织接触平台90可在未压缩厚度91和压缩厚度92之间来压缩组织46。为了缝合和横切组织46，如上文所述，可在钉仓42内朝远侧推进楔形滑块78以便朝砧20提升缝钉驱动器82并且使缝钉83变形。在各种实施例中，每个缝钉驱动器82可包括限定于其中的一个或多个狭槽，所述狭槽能够容纳缝钉83的基座87并将其可释放地保持在适当位置。在至少一个此类实施例中，每个缝钉83可包括从基座87延伸的一个或多个缝钉腿88，其中缝钉腿88可向上延伸到缝钉腔84中。在各种实施例中，当缝钉83处于其未击发位置时，缝钉腿88的末端可相对于仓体85的平台或组织接触表面90凹陷。当通过驱动器82向上提升缝钉83时，缝钉腿88的末端可顶出缝钉腔84、穿透组织46、并且接触定位在缝钉腔84对侧的砧成形凹坑89。砧成形凹坑89能够使缝钉83变形成任何合适的形状，例如示于图5中的B形形状。现在参见图6，当部署缝钉83时，刀刃80可将组织46横切缝合部分94。
如上文所述，端部执行器的钳口构件能够将压缩压力或压缩力施加到正被缝合的组织。然而，在多种情况下，组织可例如为易滑脱的并且组织的至少一部分可相对于钳口构件滑动。在某些情况下，组织可沿着纵向方向从端部执行器的远端滑出并/或可沿着横向于纵向方向的方向从端部执行器的侧面滑出。在一些情况下，当压缩组织时，组织的部分可从端部执行器的远端和/或端部执行器的侧面挤出。在本文所公开的多种实施例中，钉仓可包括一个或多个组织保持结构，所述组织保持结构能够防止或者至少降低定位在端部执行器内的组织相对于端部执行器运动的可能性。
在各种实施例中，现在参见图7和8，钉仓（例如钉仓142）例如可包括仓体185和例如定位在仓体185内的多个缝钉，例如缝钉187（图9）。仓体185可包括近端141和远端143，其中近端141能够插入钉仓通道的近端中并且远端143能够插入钉仓通道的远端中。在至少一个实施例中，仓体185可包括多个缝钉腔184，所述缝钉腔中可各自能够容纳缝钉187。在某些可供选择的实施例中，尽管未示出，但缝钉腔可包括定位在其中的多于一个的缝钉。在任何情况下，缝钉腔184可以多个排布置在仓体185内。更具体地，在至少一个实施例中，缝钉腔184可例如在仓体185的第一侧145以三个缝钉排布置并且可例如以三个缝钉排布置在仓体185的第二侧147。在至少一个此类实施例中，仓体185的第一侧145和第二侧147可由刀狭槽162间隔开，所述刀狭槽中能够可滑动地容纳切割构件。在多种其它实施例中，钉仓可例如在刀狭槽162的每一侧包括任何其它合适数量的缝钉排，例如两个缝钉排或四个缝钉排。参见图9，在各种实施例中，钉仓142还可包括能够支撑缝钉187和/或将缝钉187从缝钉腔184顶出的多个缝钉驱动器182。在某些实施例中，每个缝钉腔184可包括位于仓体185的平台190中的开口端或开口110，缝钉187穿过该开口端或开口110顶出。
在各种实施例中，主要参见图8，缝钉腔184可被布置成使得它们为彼此纵向交错的。例如，仓体185的第一侧145上的缝钉腔184例如可以缝钉腔184的最内排、缝钉腔184的中间排和缝钉腔184的最外排布置，其中一个排中的缝钉腔184可并不与其它排中的一者或两者中的缝钉腔184横向地对齐。在至少一个实施例中，每个缝钉腔184可包括近端111和远端112，其中每个缝钉腔184的近端111可定位成比远端112更靠近仓体185的近端141。同样，每个缝钉腔184的远端112可定位成比近端111更靠近仓体185的远端143。在各种实施例中，缝钉腔184的最内排可被定位成使得最内排内的缝钉腔184的远端112相对于中间排缝钉腔184中的缝钉腔184的远端112在远侧定位。相似地，缝钉腔184的最外排可被定位成使得最外排内的缝钉腔184的远端112相对于中间排缝钉腔184中的缝钉腔的远端112在远侧定位。例如，最内排中的最远侧缝钉腔184可相对于中间排中的最远侧缝钉腔184在远侧定位，并且相似地，最外排中的最远侧缝钉腔184可相对于中间排中的最远侧缝钉腔184在远侧定位。在某些实施例中，最内一排缝钉腔184和最外一排缝钉腔184可彼此横向地对齐，使得（一）最内缝钉腔184的远端112与最外缝钉腔184的远端112对齐并且（二）最内缝钉腔184的近端111与最外缝钉腔184的近端111对齐。在各种实施例中，每个缝钉腔184及其开口110可具有相同或至少大致相同的构型，并且在至少一个实施例中，缝钉腔184在缝钉排内相对于彼此可等间距地或至少基本上等间距地间隔开。
在各种实施例中，再次参见图7和8，钉仓142的仓体185还可包括例如能够接触和压缩靶组织的一个或多个脊部，例如脊部113、114和115。更具体地，现在参见图8A，可闭合端部执行器的砧120以便紧靠钉仓142来压缩组织T，其中在此类情况下，组织接触平台190以及从其延伸的脊部113、114和115可接合组织。在某些情况下，当闭合砧120时，砧120可朝钉仓142推压组织，使得组织首先接触脊部113、114和115并且随后接触仓平台190。在其它情况下，钉仓142可紧靠组织定位，使得脊部113、114和115接触组织，然后该组织接触仓平台190。在任何情况下，脊部113、114和115一旦接触组织就可防止或至少限制组织和钉仓142之间的相对运动。在某些实施例中，脊部113、114和115可从平坦的或至少基本上平坦的仓平台190向上延伸并且可限定一个或多个凹坑或通道，所述凹坑或通道中例如能够容纳组织的一部分，并且因此抑制组织在端部执行器的纵向方向和/或横向方向上的相对运动，尤其是当组织至少部分地压缩在砧120与脊部113、114和115之间时。在各种实施例中，当脊部113、114和115延伸到仓平台190上方时，可首先压缩定位在砧120与脊部113、114和115中间的组织，然后压缩定位在砧120和仓平台190中间的组织。因此，在一些此类情况下，可预压缩（即，至少部分地压缩）定位在砧120与脊部113、114和115之间的组织，然后压缩定位在砧120和仓平台190之间的组织的其它部分。在多种情况下，在组织得到完全压缩之前，由于这种预压缩才控制或防止组织的部分从端部执行器滑出，如下文更详细所述。
在各种实施例中，再次参见图7和8，从仓平台190延伸的脊部113围绕缝钉腔开口110的近端111延伸。相似地，从仓平台190延伸的脊部114可围绕缝钉腔开口110的远端112延伸。在各种实施例中，这些近侧脊部113和远侧脊部114能够接合定位在缝钉腔184上方和/或周围的组织并且当组织正被压缩和/或缝合时将组织的这些部分保持固定。换言之，保持定位在缝钉腔184上方和/或周围的组织可对于即将进行缝合的组织的部分提供局部控制，并且由此防止或至少限制组织的这些部分和钉仓142之间的相对运动。在各种实施例中，脊部113和114可围绕全部缝钉腔184或仅一些缝钉腔184的开口110定位。在至少一个实施例中，仓体可包括仅围绕第一侧145和第二侧147的最外排中的缝钉腔184的脊部113和114。在此类实施例中，围绕最外排缝钉腔184的脊部可足以阻碍组织在端部执行器内的横向运动。在某些实施例中，仓体可仅包括围绕最近侧缝钉腔184的近端111的近侧脊部113和/或围绕最远侧缝钉腔184的远端112的远侧脊部114。在此类实施例中，围绕最近侧端和最远侧缝钉腔184的脊部可足以阻碍组织在端部执行器内的纵向运动。
在各种实施例中，如针对上文进一步所述，每个近侧脊部113可包括例如围绕开口110的近端111的弓形或弯曲外形。每个近侧脊部113的弓形外形可由一种曲率半径或多于一种的曲率半径来限定。相似地，每个远端脊部114可包括例如围绕开口110的远端112的弓形或弯曲外形。每个远端脊部114的弓形外形可由一种曲率半径或多于一种的曲率半径来限定。在某些实施例中，如针对上文进一步所述，每个脊部113和114可形成凹坑，所述凹坑可容纳正被压缩的组织的一部分并且防止组织的该部分相对于钉仓142纵向和/或横向地运动。在各种实施例中，钉仓142还可包括中间脊部115，所述中间脊部可在缝钉腔184的相邻排中的相邻脊部113和114之间延伸并/或连接相邻脊部113和114。在至少一个此类实施例中，一个或多个脊部113、114和115可共同操作地形成横跨仓体185的第一侧145或第二侧147延伸的波形脊部，其中在至少一个实施例中，波形脊部可在仓体142的中心部分和侧部之间延伸。在各种实施例中，每个波形脊部可包括例如围绕缝钉腔184的近端和远端卷绕的多个波浪部分。在各种实施例中，每个脊部113、114和115可包含由仓平台190限定的高度，其中在某些实施例中，每个脊部113、114和115横跨其长度的高度可为均匀的或者至少基本上均匀的。在至少一个实施例中，每个脊部113、114和115可具有相同的或至少基本上相同的高度。
在各种实施例中，如上文所述，限定于钉仓本体中的缝钉腔可包括定位在其中的缝钉，其中当缝钉处于其未击发位置时，缝钉的全部可定位在仓平台的顶表面或组织接触表面下方。在某些其它实施例中，当缝钉处于其未击发位置时，缝钉的至少一部分（例如缝钉腿的末端）例如可延伸到仓平台的顶表面或组织接触表面上方。在一些此类实施例中，缝钉的末端可从平台突出并且可在钉仓插入手术部位中时在组织上造成障碍。在至少一个实施例中，现在参见图9，当缝钉在其未击发位置延伸到仓平台190上方时，延伸到例如组织接触仓平台190上方的脊部113和114可至少部分地围绕和保护缝钉187的缝钉腿183。尽管脊部113和114可未完全地围绕每个开口110延伸，但在各种实施例中，近侧脊部113可充分地围绕缝钉腿末端之一，并且远端脊部114可充分地围绕另一个缝钉腿末端，使得在组织紧靠钉仓142进行压缩并/或缝钉187从钉仓142顶出之前，缝钉腿末端未接触组织。在至少一个实施例中，缝钉腿末端可定位在脊部113和114的顶表面116下方。在某些实施例中，缝钉腿末端可与脊部113和114的顶表面116共面。在各种实施例中，由于脊部113和114所提供的防护，例如可使用具有较高缝钉高度的缝钉，而缝钉末端在其未击发位置不从钉仓142突出。在某些实施例中，再次参见图9，脊部113和114可延伸或增加其中可控制和/或支撑缝钉187的缝钉腿183的长度。在至少一个此类实施例中，每个脊部113和114可延长或增加其中可在其三个侧面上支撑缝钉腿183的长度。此类实施例可防止或者至少降低缝钉腿183在插入穿过致密组织（例如支气管组织）时屈曲的可能性。
在各种实施例中，再次参见图4，仓体85可包括例如限定于其中的可降低仓体85的强度的腔84、狭槽62和通道86。在多种情况下，尤其是当仓体85被砧20压缩时，例如，仓体85可因其上施加的负荷而挠曲。在至少一个此类实施例中，仓平台90在通道86上延伸的部分例如可为尤其薄的并且尤其可经受挠曲和/或破损。在某些实施例中，再次参见图7和8，脊部113、114和/或115能够使仓体185强化和/或变硬。在至少一个此类实施例中，脊部113和114例如可围绕开口110延伸，以便使仓体185围绕缝钉腔184的部分强化和/或变硬。在某些实施例中，脊部115例如可在限定于仓体185内的通道86等上横向延伸，使得脊部115可使围绕通道86的仓体185强化和/或变硬。在多种其它实施例中，仓体185可包括从其延伸的任何合适数量和构型的脊部以便实现本文所述的优点。
在各种实施例中，钉仓本体185可包含例如塑性材料、金属材料、和/或陶瓷材料。一些此类材料可包含液晶聚合物（例如Vectra）、热塑性聚合物（例如聚碳酸酯、ABS、Noryl、聚酰胺（尼龙）、聚醚砜、聚醚酰亚胺（例如Ultem））、和/或上述热塑性聚合物中的两种或更多种的聚合物共混物，其中在各种实施例中，仓体185可由例如注塑工艺形成。一些此类材料可包含热固性聚合物（例如热固性聚酯）、熔模铸造不锈钢（例如17-4PH）和/或金属注塑不锈钢（例如17-4PH）。在至少一个此类实施例中，脊部113、114和/或115可与仓体185的仓平台190整体成型。在某些实施例中，可例如通过至少一种粘合剂将脊部113、114和/或115附接到仓平台190。
在各种实施例中，现在参见图12，钉仓（例如钉仓342）例如可包括仓体385、限定于仓体385中的多个缝钉腔384、以及定位在缝钉腔384中每一个中的缝钉。在某些实施例中，仓体385还可包括具有第一组缝钉腔384的第一侧345、具有第二组缝钉腔384的第二侧347、以及仓平台390。在各种实施例中，仓体385还可包括从仓平台390延伸的可定位在一排缝钉腔384中的相邻缝钉腔384中间的多个脊部315。在至少一个实施例中，每个脊部315可包含例如十字形或X形构型。在至少一个此类实施例中，例如，每个脊部315可包括可至少部分地围绕缝钉腔开口310的近端311的V形部分313以及此外可至少部分地围绕另一个缝钉腔开口310的远端312的V形部分314。在某些实施例中，仓体385中的仅最外排缝钉腔384可至少部分地被脊部315围绕。在某些其它实施例中，现在参见图13，钉仓本体385'可包括脊部315，所述脊部至少部分地围绕仓体中的每个缝钉腔384的开口310。在任何情况下，在各种实施例中，每个脊部315能够如上文所述压缩和控制紧靠钉仓342定位的组织并/或围绕延伸到平台390上方的缝钉的缝钉腿。
在各种实施例中，现在参见图16，钉仓（例如钉仓542）例如可包括仓体585、限定于仓体585中的多个缝钉腔584、以及定位在缝钉腔584中每一个中的缝钉。在某些实施例中，仓体585还可包括具有第一组缝钉腔584的第一侧545、具有第二组缝钉腔584的第二侧547、以及仓平台590。在各种实施例中，仓体585还可包括从仓平台590延伸的多个脊部515，其中每个脊部515可完全围绕或包绕缝钉腔开口510。如图16所示，仓体585中的一些腔开口510可未被脊部515围绕；然而，在多种可供选择的实施例中，现在参见图16A，仓体585'中的每个腔开口510均可被脊部515围绕。可设想仓体包括被脊部515围绕的第一组缝钉腔584和未被脊部515围绕的第二组缝钉腔584的多种实施例，其中具有较高缝钉高度的缝钉可定位在第一组缝钉腔584中并且其中具有较低缝钉高度的缝钉可定位在第二组缝钉腔584中，使得较高缝钉和较低缝钉均未从钉仓542突出。在至少一个此类实施例中，例如，仓体能够在一排缝钉腔584中使用较高缝钉并且在另一排缝钉腔584中使用较低缝钉。在某些实施例中，脊部515可围绕仓体中的最外排缝钉腔584中的全部缝钉腔584，使得较高缝钉可用于最外排中并且较低缝钉可用于例如缝钉腔584的最内排和/或中间排中。
在各种实施例中，现在参见图14，钉仓（例如钉仓442）例如可包括仓体485、限定于仓体485中的多个缝钉腔484、以及定位在缝钉腔484中每一个中的缝钉。在某些实施例中，仓体485还可包括具有第一组缝钉腔484的第一侧445、具有第二组缝钉腔484的第二侧447、以及仓平台490。在各种实施例中，仓体445还可包括从仓平台490延伸的多个脊部415，其中每个脊部415可包括多个滚花或滚花阵列。在使用时，砧可用于紧靠滚花来定位组织，使得组织适形于滚花的轮廓。在各种实施例中，每个脊部415可包括例如至少部分地围绕一个或多个缝钉腔开口410的多个角锥形或菱形滚花，其中在至少一个实施例中，角锥形滚花可从仓平台490指向上。在至少一个实施例中，每个角锥形滚花可包括四个三角形侧面，所述四个三角形侧面可会聚在一起形成尖点。在某些实施例中，参见图15A，脊部415的角锥形滚花可为截短的，其中每个滚花的顶部可包括被倾斜侧面围绕的平坦顶表面。尽管可使用四侧面角锥形滚花，现在参见图15C，可设想具有少于四个侧面或多于四个侧面（例如三个侧面）的其它角锥形形状。在各种实施例中，一个或多个脊部415可包括多个圆锥形滚花，其中每个圆锥形滚花可包括圆形的或至少基本上圆形的基座，所述基座向上逐渐变细形成尖点。在某些实施例中，现在参见图15B，圆锥形滚花可为截短的，其中每个滚花的顶部可包括被环形侧面围绕的平坦顶表面。在各种实施例中，再次参见图14，脊部415的滚花可沿着缝钉腔开口410的侧面和/或在相邻缝钉腔开口410之间延伸。在至少一个实施例中，滚花可围绕缝钉腔开口410的近端411和/或远端412延伸。在某些实施例中，脊部415的滚花可仅围绕缝钉腔484中的一些，而在某些其它实施例中，参见图15，脊部415的滚花例如可覆盖仓平台490的全部或至少基本上全部。
在各种实施例中，现在参见图10，钉仓（例如钉仓242）例如可包括仓体285、限定于仓体285中的多个缝钉腔284、以及定位在缝钉腔284中每一个中的缝钉。在某些实施例中，仓体285还可包括具有第一组缝钉腔284的第一侧245、具有第二组缝钉腔284的第二侧247、以及仓平台290。在各种实施例中，仓体285还可包括从仓平台290延伸的多个脊部或隆起块215。在至少一个此类实施例中，每个脊部215可在邻近刀狭槽262定位的仓体245的中心或中间部分与仓体245的侧部之间横向延伸。更具体地，尤其是参见仓体285的第一侧245，每个脊部215可包括邻近刀狭槽262定位的第一末端213和邻近仓体285的第一侧261定位的第二末端214。相似地，现在参见仓体285的第二侧247，每个脊部215可包括邻近刀狭槽262定位的第一末端213和邻近仓体285的第二侧263定位的第二末端214。在至少一个实施例中，每个脊部215可包含从平台290测量的高度，其中在至少一个此类实施例中，每个脊部215的高度可沿其长度变化。在某些实施例中，第二末端214可高于第一末端213，并且每个脊部215的高度可在第二末端214和第一末端213之间渐缩。在某些可供选择的实施例中，尽管未示出，但脊部215的第一端部213可高于第二端部214。在至少一个实施例中，每个脊部215的高度可在端部213和214之间线性地或至少基本上线性地渐缩。在至少一个此类实施例中，每个脊部215的高度可从第二端部214处的最大高度渐缩到第一端部213处的零高度。在某些实施例中，每个脊部215的高度可在端部213和214之间几何变化。在某些可供选择的实施例中，现在参见图11，每个脊部215'可包含横跨其长度的均匀的高度。
如上文所述，脊部215的内端213可短于脊部215的外端214。因此，在多种情况下，相比于外端214，内端213可向夹持在砧和钉仓242之间的组织施加更小的压力。在各种实施例中，如上文所述，每个脊部215可横跨仓平台290延伸。在某些实施例中，每个脊部215可沿着脊部轴线延伸，所述脊部轴线横切仓体285的纵向轴线299。在至少一个此类实施例中，脊部轴线可垂直于或者至少基本上垂直于纵向轴线299。在各种实施例中，缝钉腔284可以多个排布置，其中可沿着纵向轴线限定各排缝钉腔284，所述纵向轴线可平行于或者至少基本上平行于纵向轴线299。在至少一个实施例中，脊部215的脊部轴线可沿着横切缝钉腔284的纵向轴线的方向延伸。在至少一个此类实施例中，脊部215的脊部轴线可沿着垂直于或者至少基本上垂直于缝钉腔284的纵向轴线的方向延伸。在各种实施例中，再次参见图10，每个脊部215可包括冠部209以及此外在冠部209和仓平台290之间延伸的倾斜表面208。在某些实施例中，每个倾斜表面208可包括例如一个或多个平坦表面、弯曲表面、凹表面、和/或凸表面。在各种实施例中，每个脊部215可沿着如下路径延伸，所述路径横跨缝钉腔284的一个或多个开口210延伸。在至少一个此类实施例中，此类开口210可向上延伸穿过脊部215。当脊部215横跨仓平台290横向延伸时，脊部215（类似于脊部115）可增加仓体285的强度和/或硬度。
在各种实施例中，现在参见图17和18，钉仓（例如钉仓642）例如可包括仓体685、限定于仓体685中的多个缝钉腔684、以及定位在每个缝钉腔684中的缝钉。在某些实施例中，仓体685还可包括具有第一组缝钉腔684的第一侧645、具有第二组缝钉腔684的第二侧647、以及仓平台690。在各种实施例中，仓体685还可包括从仓平台690延伸的多个脊部或隆起块615。在至少一个此类实施例中，每个脊部615可沿着纵向方向延伸，其中每个脊部615可包括远端613和近端614，其中脊部615的远端613可定位成较靠近仓体685的远端643，并且其中脊部615的近端614可定位成较靠近近端641。在至少一个实施例中，每个脊部615可包含从平台690测量的高度，其中在至少一个此类实施例中，每个脊部615的高度可沿其长度变化。在某些实施例中，近端614可高于远端613并且每个脊部615的高度可在近端614和远端613之间渐缩。在某些可供选择的实施例中，尽管未示出，但脊部615的远端613可高于近端614。在至少一个实施例中，每个脊部615的高度可在末端613和614之间线性或至少基本上线性地渐缩。在至少一个此类实施例中，每个脊部615的高度可从近端614处的最大高度渐缩到远端613处的零高度。在某些实施例中，每个脊部615的高度可在末端613和614之间几何变化。在某些可供选择的实施例中，每个脊部615可包含横跨其长度的均匀的高度。
如上文所述，脊部615的远端613可短于脊部615的近端614。因此，在多种情况下，相比于近端614，远端613可向夹持在砧和钉仓642之间的组织施加较小的压力。在各种实施例中，如上文所述，每个脊部615可横跨仓平台690纵向延伸。在某些实施例中，每个脊部615可沿着脊部轴线延伸，所述脊部轴线平行于或者至少基本上平行于仓体685的纵向轴线699。在各种实施例中，缝钉腔684可被布置成多个排，其中可沿着如下纵向轴线来限定各排缝钉腔684，所述纵向轴线可平行于或者至少基本上平行于脊部615的脊部轴线。在至少一个实施例中，再次参见图18，每个脊部615可包括倾斜表面，所述倾斜表面可包括例如一个或多个平坦表面、弯曲表面、凹表面、和/或凸表面。在至少一个此类实施例中，倾斜表面的底部可面向远侧，这样使得当将组织定位在端部执行器中时有利于组织在整个钉仓642上滑动。在各种实施例中，每个脊部615可沿着如下路径延伸，所述路径横跨缝钉腔684的一个或多个开口610延伸。在至少一个此类实施例中，这种开口610可向上延伸穿过脊部615。当脊部615横跨仓平台690横向延伸时，脊部615可增加仓体685的强度和/或硬度。
在各种实施例中，除了上文所述，外科缝钉可包含钛，例如钛丝。在某些实施例中，外科缝钉可包含例如合金，所述合金包含钛、铝和/或钒。在至少一个实施例中，手术缝钉可包含例如外科不锈钢和/或合金，所述合金包含钴和铬。在任何情况下，外科缝钉可包含金属（例如钛）和金属氧化物外表面（例如三氧化钛）构成。在各种实施例中，可用材料涂覆金属氧化物外表面。在某些实施例中，涂层材料可包含例如聚四氟乙烯(PTFE)（例如）和/或四氟乙烯(TFE)（例如乙烯-四氟乙烯(ETFE)、全氟烷氧基乙烯-四氟乙烯(PFA)）和/或氟化乙烯丙烯(FEP)。某些涂层可包含硅。在各种实施例中，此类涂层材料可防止或至少抑制金属进一步氧化。在某些实施例中，涂层材料可提供一个或多个润滑表面，砧或缝钉凹坑可紧靠这些表面而接触缝钉，以便降低它们之间的摩擦力。在多种情况下，缝钉和缝钉凹坑之间的较低摩擦力可降低使缝钉变形所需的力。
虽然文中结合某些公开的实施例对装置的多种实施例作了描述，但这些实施例的许多修改和变化形式也可被实现。另外，凡是公开了用于某些组件的材料的，均可使用其它材料。此外，根据多种实施例，单个部件可替换为多个部件，并且多个部件也可替换为单个部件，以执行给定的一种或多种功能。上述描述和以下权利要求旨在涵盖所有这类修改形式和变型。
可将本发明所公开的装置设计成单次使用后即进行处理，或者可将它们设计成是多次使用的。然而，在任一种情况下，所述装置均可重新修复，以在至少一次使用后再使用。重新修复可包括以下步骤中的任意组合：拆卸该装置、然后清洗或更换特定零件、以及随后组装。具体地，所述装置可以拆卸，而且可任意组合选择性地更换或移除该装置的任意数目的特定零件或部件。清洗和/或更换特定部件后，该装置可在修复设施处重新组装以便随后使用，或者在即将进行外科手术前由外科手术队重新组装。本领域的技术人员将会知道，装置的重新修复可利用多种用于拆卸、清洗/更换和重新组装的技术。这些技术的用途以及得到的重新修复装置均在本发明的范围内。
优选地，在手术前处理本文所述的装置。首先，获取新的或用过的装置，并在必要时对装置进行清洁。然后对装置进行杀菌。在一种消毒技术中，将该装置放置在闭合且密封的容器中，例如塑料或TYVEK袋中。然后将容器和装置放置在可穿透该容器的辐射区，例如γ辐射、x-射线或高能电子。辐射杀死装置上和容器中的细菌。然后将灭菌后的装置保存在无菌容器中。该密封容器将器械保持无菌，直到在医疗设备中打开该容器。
尽管已经将本发明作为示例性设计进行了描述，但还可以在本公开的实质和范围内对本发明进行修改。因此本专利申请旨在涵盖采用本发明一般原理的任何变型、用途或修改型式。此外，本专利申请旨在涵盖本发明所属领域中属于已知或惯有实践范围内的与本公开不同的型式。
以引用方式全文或部分地并入本文的任何专利、公布或其它公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其它公开材料相冲突的范围内并入本文。由此，在必要的程度下，本文所明确阐述的公开内容将取代以引用方式并入本文的任何相冲突材料。如果据述以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分，仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
Claims (7)
1.一种钉仓，包括：
多个缝钉；和
仓体，所述仓体包括：
组织接触平台；
多个缝钉腔，其中每个所述缝钉腔包括位于所述平台中的开口，并且其中所述缝钉定位在每个所述缝钉腔中；以及
多个脊部，所述脊部从所述组织接触平台延伸，其中每个所述开口包括近端和远端，并且其中每个所述近端和每个所述远端被相应的所述脊部围绕。
2.根据权利要求1所述的钉仓，其中每个所述开口完全被相应的所述脊部包绕。
3.根据权利要求1所述的钉仓，还包括能够从所述缝钉腔顶出所述缝钉的多个缝钉驱动器，其中每个所述缝钉由缝钉驱动器支撑，其中每个所述缝钉包括至少一个末端，并且其中所述缝钉的所述末端定位在所述组织接触平台上方。
4.根据权利要求3所述的钉仓，其中每个所述脊部包括顶表面，并且其中所述末端定位在所述顶表面下方。
5.根据权利要求1所述的钉仓，其中所述多个缝钉腔包括容纳第一排缝钉的第一排缝钉腔和容纳第二排缝钉的第二排缝钉腔，并且其中围绕所述第一排缝钉腔的开口的所述脊部连接到围绕所述第二排缝钉腔的开口的所述脊部。
6.根据权利要求1所述的钉仓，其中所述多个缝钉腔包括容纳一排缝钉的一排缝钉腔，并且其中所述脊部定位在所述一排缝钉腔中的所述缝钉腔中间。
7.根据权利要求6所述的钉仓，其中每个所述脊部包括X形构型。
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- 2011-09-23 WO PCT/US2011/053040 patent/WO2012050798A1/en active Application Filing
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2018
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2020
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Patent Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5452837A (en) * | 1994-01-21 | 1995-09-26 | Ethicon Endo-Surgery, Inc. | Surgical stapler with tissue gripping ridge |
| EP1090592A1 (en) * | 1999-10-05 | 2001-04-11 | Ethicon Endo-Surgery | Surgical stapler having two staple forming surfaces |
| CN1951333A (zh) * | 2005-09-26 | 2007-04-25 | 伊西康内外科公司 | 具有端部执行器夹持表面的外科缝合器械 |
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| US10898191B2 (en) | 2021-01-26 |
| EP3689262A1 (en) | 2020-08-05 |
| EP2621360A1 (en) | 2013-08-07 |
| EP3689262B1 (en) | 2023-11-08 |
| US11944303B2 (en) | 2024-04-02 |
| JP2013540519A (ja) | 2013-11-07 |
| US8733613B2 (en) | 2014-05-27 |
| US20130161375A1 (en) | 2013-06-27 |
| US20220378429A1 (en) | 2022-12-01 |
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| US20210204942A1 (en) | 2021-07-08 |
| RU2579738C2 (ru) | 2016-04-10 |
| US20120074198A1 (en) | 2012-03-29 |
| CA2811950A1 (en) | 2012-04-19 |
| EP4218613A1 (en) | 2023-08-02 |
| BR112013007613B1 (pt) | 2021-02-09 |
| US20150265276A1 (en) | 2015-09-24 |
| US10130363B2 (en) | 2018-11-20 |
| JP5902176B2 (ja) | 2016-04-13 |
| AU2011314209A1 (en) | 2013-02-21 |
| AU2011314209B2 (en) | 2014-02-13 |
| WO2012050798A1 (en) | 2012-04-19 |
| EP2621360B1 (en) | 2019-10-23 |
| US9131940B2 (en) | 2015-09-15 |
| EP4137065A1 (en) | 2023-02-22 |
| US11571213B2 (en) | 2023-02-07 |
| BR112013007613A2 (pt) | 2016-08-09 |
| RU2013119673A (ru) | 2014-11-10 |
| US20190105042A1 (en) | 2019-04-11 |
| CA2811950C (en) | 2018-12-18 |
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Effective date of registration: 20220318 Address after: Zug City Patentee after: CILAG GMBH INTERNATIONAL Address before: Ohio, USA Patentee before: ETHICON ENDO-SURGERY, Inc. |