CN103517679B - 外科缝合器械 - Google Patents
外科缝合器械 Download PDFInfo
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Abstract
本发明公开了一种外科缝合器,该外科缝合器包括弯曲砧座组件,该弯曲砧座组件包括形成于组织接触表面中的缝钉凹坑。所述缝钉凹坑沿弯曲路径定位,其中每个所述缝钉凹坑包括缝钉凹坑中线,其中第一缝钉凹坑的所述缝钉凹坑中线既不平行于第二缝钉凹坑的所述缝钉凹坑中线,也不与第二缝钉凹坑的所述缝钉凹坑中线共线。缝钉凹坑还包括第一成形杯和第二成形杯。
Description
相关专利申请的交叉引用
本非临时性专利申请为根据35U.S.C.§120的2010年8月12日提交的名称为“SURGICAL STAPLING INSTRUMENT WITH IMPROVED FIRING TRIGGER ARRANGEMENT”的美国专利申请序列号12/855,351的部分继续申请,所述专利申请序列号12/855,351为根据35U.S.C.§120的2010年3月17日提交的名称为“STAPLE CARTRIDGE”的美国专利申请序列号12/725,993的部分继续申请,所述专利申请序列号12/725,993为根据35U.S.C.§120的2008年9月19日提交的名称为“SURGICAL STAPLING INSTRUMENT WITH CUTTING MEMBERARRANGEMENT”的美国专利申请序列号12/234,149的部分继续申请,所述专利申请的全部公开内容据此以引用方式并入本文。本非临时性专利申请为根据35U.S.C.§120的2009年11月19日提交的名称为“SURGICAL STAPLER HAVING A CLOSURE MECHANISM”的美国专利申请序列号12/622,099的部分继续申请,所述专利申请序列号12/622,099要求根据35U.S.C.§119(e)的2009年10月9日提交的名称为“SURGICAL STAPLER”的美国临时专利申请61/250,377的有益效果,所述专利申请的全部公开内容据此以引用方式并入本文。本非临时性专利申请为根据35U.S.C.§120的2010年7月26日提交的名称为“SURGICAL STAPLING INSTRUMENTWITH IMPROVED FIRING TRIGGER ARRANGEMENT”的美国专利申请序列号12/843,436的部分继续申请,所述专利申请序列号12/843,436为根据35U.S.C.§120的2008年2月13日提交的名称为“SURGICAL STAPLING INSTRUMENT WITH IMPROVED FIRING TRIGGER ARRANGEMENT”的美国专利申请序列号12/030,424(现在为美国专利7,766,209)的继续申请,所述专利申请的全部公开内容据此以引用方式并入本文。
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
近年来,外科医生越来越倾向于使用缝合器械缝合身体组织,例如肺、食道、胃、十二指肠和/或肠道中的其它器官。在多种情况下使用适当的缝合器械可用更短的时间将手术做得更出色,并简化此前困难的外科手术,例如胃肠吻合术。早先的线性双排和四排切割缝合器包括将缝钉单独手动加载到其中的无钉仓器械。其它早先的装置包括预消毒的一次性缝钉加载单元和切割构件,其可用于同时分割组织并使各排缝钉成形。这种外科缝合器的例子在公布于1970年3月10的名称为“INSTRUMENT FOR PLACING LATERALGASTROINTESTINAL ANASTOMOSES”的美国专利3,499,591中有所公开,该专利的全部公开内容以引用的方式并入本文。
缝合器械可包括一对配合的细长钳口构件,其中每个钳口构件均可适于插入要吻合的内部管状身体器官内。在各种实施例中,钳口构件中的一个可支撑具有至少两个横向间隔的缝钉排的钉仓,同时另一个钳口构件可支撑与钉仓中的缝钉排对准的具有缝钉成形凹坑的砧座。一般来讲,缝合器械还可包括可相对于钳口构件而滑动的推杆和刀片,以通过推杆上的凸轮表面将缝钉从钉仓中依次弹出。在至少一个实施例中,凸轮表面能够启动由钉仓承载并与各个缝钉相关联的多个缝钉驱动器,以推压缝钉抵靠砧座并在夹持在钳口构件之间的组织内形成横向间隔的变形缝钉排。然而,在典型的缝合器械中,一旦将钳口构件装配在一起就无法相对于钉仓运动砧座,并且无法调整已形成的缝钉高度。在至少一个实施例中,刀片可跟随推杆并沿着缝钉排之间的路线切割组织。此类缝合器械的例子在公布于1984年2月7日的名称为“SURGICAL INSTRUMENTS”的美国专利4,429,695中有所公开,该专利的全部公开内容据此以引用方式并入本文。
发明内容
在至少一种形式中,外科缝合器可包括弯曲砧座组件,该弯曲砧座组件包括组织接触表面和形成于组织接触表面中的多个缝钉凹坑,其中缝钉凹坑沿曲线定位。每个缝钉凹坑可包括缝钉凹坑中心线,其中第一缝钉凹坑的缝钉凹坑中心线既不平行于第二缝钉凹坑的缝钉凹坑中心线,也不与第二缝钉凹坑的缝钉凹坑中心线共线。每个缝钉凹坑还可包括第一成形杯,该第一成形杯包括第一内部部分、第一外部部分以及在第一外部部分与第一内部部分之间延伸的第一内部侧壁,其中第一内部侧壁包括基本上垂直于组织接触表面的第一垂直部分。每个缝钉凹坑还可包括第二成形杯,该第二成形杯包括第二内部部分、第二外部部分,其中第一内部部分紧邻第二内部部分定位,其中第一内部部分和第二内部部分被定位成相对于缝钉凹坑中心线偏置,其中第一外部部分和第二外部部分被定位在第一内部部分和第二内部部分的相对侧上,并且其中第一外部部分和第二外部部分沿横向于缝钉凹坑中心线的方向来取向,并且第二内部侧壁在第二外部部分和第二内部部分之间延伸,其中第二内部侧壁包括基本上垂直于组织接触表面的第二垂直部分。
在至少一种形式中,外科缝合器包括弯曲砧座组件,该弯曲砧座组件包括组织接触表面和形成于组织接触表面中的多个缝钉凹坑,其中缝钉凹坑沿弯曲路径定位,其中每个缝钉凹坑包括缝钉凹坑中线,并且其中第一缝钉凹坑的缝钉凹坑中线既不平行于第二缝钉凹坑的缝钉凹坑中线,也不与第二缝钉凹坑的缝钉凹坑中线共线。每个缝钉凹坑还可包括第一成形杯,该第一成形杯包括第一内部部分、第一外部部分以及在第一外部部分与第一内部部分之间延伸的第一内部侧壁,其中第一内部侧壁包括基本上垂直于组织接触表面的第一垂直部分。每个缝钉凹坑还可包括第二成形杯,该第二成形杯包括第二内部部分、第二外部部分,其中第一内部部分紧邻第二内部部分定位,其中第一内部部分和第二内部部分被定位成相对于缝钉凹坑中线偏置,并且其中第一外部部分和第二外部部分被定位在第一内部部分和第二内部部分的相对侧上,并且第二内部侧壁在第二外部部分和第二内部部分之间延伸,其中第二内部侧壁包括基本上垂直于组织接触表面的第二垂直部分,其中第一垂直部分和第二垂直部分延伸穿过缝钉凹坑中线,并且其中第一内表面和第二内表面包括捕集器,该捕集器用于使缝钉的第一缝钉腿向缝钉凹坑中线的第一侧变形,并且用于使缝钉的第二缝钉腿向缝钉凹坑中线的第二侧变形。
附图说明
通过结合附图参考本发明实施例的以下说明,本发明的上述和其它特征及优点及其获取方法将会变得更加明显,并可更好地理解发明本身,其中:
图1为线性吻合缝合器械的透视图;
图2为示出了部分拆卸的图1的吻合缝合器械的侧正视图,其中其承载上砧座的钳口构件与其承载下钉仓的钳口构件分离;
图3为示出了呈装配构型的图1的吻合缝合器械的侧正视图;
图4为图1的吻合缝合器械的剖视图,其示出了用于促使上钳口构件和下钳口构件的后部分开的凸轮机构;
图5为图1的吻合缝合器械的承载砧座的钳口构件的底视图;
图6为图1的吻合缝合器械的承载钉仓的钳口构件的顶视图;
图7为图1的吻合缝合器械的底视图;
图8为图1的吻合缝合器械的前端视图;
图9为图1的吻合缝合器械的后端视图;
图10为图1的吻合缝合器械的推杆和刀片组件的透视图;
图11为推块和致动器旋钮的透视图,所述推块和致动器旋钮为图10的推杆和刀片组件的部件;
图12为图1的吻合缝合器械的后部的局部剖视图,其示出了处于无效位置的凸轮机构;
图13为图1的吻合缝合器械的后部的局部剖视图,其示出了处于有效位置的凸轮机构;
图14为图1的吻合缝合器械的钉仓的侧视图;
图15为图1的吻合缝合器械的钉仓的顶视图;
图16为图1的吻合缝合器械的钉仓的底视图;
图17为图5和6的承载砧座和钉仓的钳口构件的局部剖视图,其示出了图10的推杆和刀片组件的操作;
图18为图1的吻合缝合器械沿图4中的线18-18截取的剖视图;
图19为图1的吻合缝合器械沿图4中的线19-19截取的剖视图;
图20为示于图18中的砧座和钉仓的一部分的细部图;
图21为根据本发明的一个非限制性实施例的缝合器械的透视图;
图22为图21的缝合器械的透视图,其示出了处于伸长位置的第一致动器旋钮;
图23为图21的缝合器械的透视图,其示出了已向远侧推进之后的图22的延伸的致动器旋钮;
图24为用于使一个或多个致动器旋钮与图21的缝合器械的推杆可操作地接合的离合器机构的分解图;
图25为图24的离合器机构的导向构件的透视图;
图26为图21的缝合器械的致动器旋钮的透视图;
图27为图24的离合器机构的另一个透视图;
图28为图21的缝合器械的透视图,其示出了处于回缩位置的第一致动器旋钮和处于伸长位置的第二致动器旋钮;
图29为根据本发明的一个非限制性实施例的缝合器械的局部分解图;
图30为图29的缝合器械的局部透视图,其示出了已沿着缝合器械的第一侧向远侧推进之后的致动器旋钮;
图31为图29的缝合器械的局部透视图,其示出了正在第一位置和第二位置之间旋转的图30的致动器旋钮;
图32为图29的缝合器械的局部透视图,其示出了已沿着缝合器械的第二侧向远侧推进之后的图30的致动器旋钮;
图33为图29的缝合器械的推杆组件的分解图,所述推杆组件能够允许图30的致动器旋钮在其第一位置和第二位置之间进行旋转;
图34为根据本发明的至少一个实施例的外科缝合器械的透视图;
图35为图34的外科缝合器械的分解透视图;
图36为图34的外科缝合器械的分解正视图;
图37为图34的外科缝合器械的局部剖视图,其示出了被装配在一起的第一部分和第二部分;
图38为图34的外科缝合器械的局部剖视图,其示出了被锁定到图37的第二部分的近端的图37的第一部分的近端并示出了朝向第一部分旋转的第二部分;
图39为图34的外科缝合器械的局部剖视图,其示出了可旋转地安装到第一部分的闩锁,其中闩锁与第二部分接合并且其中闩锁已旋转到部分闭合位置;
图40为图34的外科缝合器械的局部剖视图,其示出了处于闭合位置的图39的闩锁;
图41为图34的外科缝合器械的钉仓组件的透视图;
图42为图41的钉仓组件的分解图;
图43为图41的钉仓组件沿图42中的线43-43截取的剖视图;
图44为图41的钉仓组件的缝钉滑动件和切割构件组件的分解图;
图45为图44的缝钉滑动件和切割构件组件的透视图;
图46为图34的外科缝合器械的透视图,其示出了沿着外科缝合器械的第一侧向远侧运动的击发致动器;
图47为图34的外科缝合器械的透视图,其示出了沿着外科缝合器械的第二侧向远侧运动的图46的击发致动器;
图48为根据本发明的至少一个可供选择的实施例的外科缝合器械的剖视图,其示出了处于部分闭合位置的闩锁以及与击发致动器接合的锁定机构;
图49为图48的外科缝合器械的剖视图,其中闩锁已运动到闭合位置并且已使锁定机构脱离击发致动器;
图50为图34的外科缝合器械的砧座组件的透视图;
图51为图50的砧座组件的分解透视图;
图52为图50的砧座组件的另一个分解透视图;
图53为图50的砧座组件的分解剖视正视图;
图54为图50的砧座组件的剖视组装图,其示出了处于第一位置的砧座调整构件;
图55为图50的砧座组件的剖视组装图,其示出了处于第二位置的图54的砧座调整构件;
图56为图50的砧座组件的剖视组装图,其示出了处于第三位置的图54的砧座调整构件;
图57为根据本发明的至少一个可供选择的实施例的外科缝合器械的透视图;
图58为图57的外科缝合器械沿图57中的线58-58截取的剖视图;
图59为图57的外科缝合器械的近端的局部分解图,所述近端包括用于可释放地使可旋转砧座调整构件固定就位的制动机构;
图60为图57的外科缝合器械的透视图,其中某些部件被移除而其它部件以剖视图示出;
图61为图57的外科缝合器械的部分的分解图,其示出了处于第一取向的可旋转砧座调整构件;
图62为图61的可旋转砧座调整构件的透视图;
图63为图57的外科缝合器械的端视图,其中某些部件被移除而其它部件以虚线示出,其示出了处于图61的第一取向的可旋转砧座调整构件;
图64为图57的外科缝合器械沿图57中的线64-64截取的剖视端视图;
图65为图57的外科缝合器械的端视图,其示出了以第一方向旋转到第二取向的图61的可旋转砧座调整构件;
图66为图57的外科缝合器械的剖视端视图,其示出了处于图65的第二取向的砧座调整构件;
图67为图57的外科缝合器械的端视图,其示出了以第二方向旋转到第三取向的图61的可旋转砧座调整构件;
图68为图57的外科缝合器械的剖视端视图,其示出了处于图67的第三取向的砧座调整构件;
图69为用于旋转图61的砧座调整构件的致动器的透视图;
图70为包括弹簧的外科缝合器械的局部剖视图,所述弹簧能够当缝合器械处于部分闭合构型时使第一柄部部分的远端偏离第二柄部部分的远端;
图71为类似于图50的外科缝合器械的透视图的图34的外科缝合器械的透视图;
图72为从根据本发明的至少一个可供选择的实施例的外科缝合器械的砧座延伸的闩锁突出的细部图;
图73为示意图,其示出了图72的闩锁突出以及能够接合闩锁突出并将闩锁突出运动至闩锁凹槽内的闩锁;
图74为图72的闩锁突出的正视图;
图75为根据本发明的至少一个实施例的缝钉凹坑的透视图;
图76为图75的缝钉凹坑的顶视图;
图77为图75的缝钉凹坑沿图76中的线77-77截取的剖视图;
图78为图75的缝钉凹坑沿图76中的线78-78截取的剖视图;
图79为图75的缝钉凹坑的另一个顶视图;
图80为图75的缝钉凹坑沿图79中的线80-80截取的剖视图;
图81为图75的缝钉凹坑沿图79中的线81-81截取的剖视图;
图82为处于未变形形状的外科缝钉的正视图;
图83为根据本发明的至少一个实施例的呈变形后形状的图82的外科缝钉的正视图;
图84为呈图83的变形后形状的图82的外科缝钉的侧视图;
图85为呈图83的变形后形状的图82的外科缝钉的平面图;
图85A为呈图83的变形后形状的图82的外科缝钉的另一个平面图;
图86为处于未变形形状的外科缝钉的正视图;
图87为呈未变形形状的图86的外科缝钉的底视图;
图88为根据本发明的至少一个实施例的呈变形后形状的图86的外科缝钉的底视图;
图89为图86的外科缝钉的局部剖视图;
图90为为根据本发明的至少一个实施例的呈变形后形状的外科缝钉的正视图;
图91为呈变形后形状的外科缝钉的正视图;
图92为图34的外科缝合器械的分解透视图;
图93为图34的外科缝合器械的分解正视图;
图94为图34的外科缝合器械的局部剖视图,其示出了可旋转地安装到第一部分的闩锁,其中闩锁与第二部分接合并且其中闩锁已旋转到部分闭合位置;
图95为图34的外科缝合器械的钉仓组件的透视图;
图96为图95的钉仓组件的分解图;
图97为图95的钉仓组件的剖视图;
图98为图95的钉仓组件的缝钉滑动件和切割构件组件的分解图;
图99为图98的缝钉滑动件和切割构件组件的透视图;
图100为能够可操作地连接到图98的缝钉滑动件与切割组件的驱动棒的远端的细部图,其中驱动棒远端在近侧位置示为实线并且在第二或远侧位置示为虚线;
图101为图95的钉仓组件的局部底视图;
图102为根据可供选择的实施例的钉仓组件的剖视图;
图103为包括处于部分推进位置的击发致动器的外科缝合器械的透视图;
图104为图103的外科缝合器械的剖视图,其示出了处于部分推进位置的击发致动器;
图105为图103的外科缝合器械的剖视图,其示出了正朝向未击发位置返回的击发致动器;
图106为图103的外科缝合器械的顶视图,其示出了正向远侧运动的击发致动器;
图107为图107的外科缝合器械的顶视图,其示出了正向远侧运动的击发致动器;
图108为图103的外科缝合器械的另一个透视图;
图109为图103的外科缝合器械的近端的剖视图,其示出了处于未击发位置的击发致动器;
图110为图103的外科缝合器械的近端的剖视图,其示出了旋转到外科缝合器械外壳的第一侧的击发致动器;
图111为图103的外科缝合器械的近端的剖视图,其示出了处于部分击发位置的击发致动器;
图112为外科缝合器械的局部透视图,该外科缝合器械包括根据本发明的至少一个实施例的圆形砧座和圆形钉仓;
图113为图112的砧座的透视图;
图114为外科缝合器械的局部透视图,该外科缝合器械包括根据本发明的至少一个实施例的弯曲砧座和弯曲钉仓;
图115为图114的弯曲砧座和弯曲钉仓的细部图;
图116为图114的弯曲砧座的弯曲砧板的细部图;
图117为根据本发明的至少一个实施例的变形缝钉的正视图;
图118为根据本发明的至少一个实施例的另一个变形缝钉的正视图;
图119为根据本发明的至少一个实施例的砧座的局部前视图;并且
图120为外科缝合器械的局部透视图,该外科缝合器械包括弯曲砧座和定位在其上的一块弯曲的可压缩材料。
在所述多个视图中,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本发明的优选实施例,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
现在将描述某些示例性实施例,以从整体上理解本文所公开的装置和方法的结构、功能、制造和用途的原理。这些实施例的一个或多个例子在附图中示出。本领域的普通技术人员将会理解,本文特别描述和在附图中示出的装置和方法为非限制性的示例性实施例,并且本发明多个实施例的范围仅由权利要求书限定。就一个示例性实施例进行图解说明或描述的特征,可与其它实施例的特征进行组合。这种修改形式和变型旨在包括在本发明的范围之内。
以下美国专利申请的全部公开内容据此以引用方式并入本文中:
2010年3月17日提交的名称为STAPLE CARTRIDGE的美国专利申请序列号12/725,993;
2008年9月19日提交的名称为SURGICAL STAPLING INSTRUMENT WITH CUTTINGMEMBER ARRANGEMENT的美国专利申请序列号12/234,149;
2008年9月19日提交的名称为SURGICAL STAPLER HAVING AN INTERMEDIATECLOSING POSITION的美国专利申请序列号12/234,143;
2008年9月19日提交的名称为SURGICAL STAPLER WITH APPARATUS FORADJUSTING STAPLE HEIGHT的美国专利申请序列号12/234,133;
2008年9月19日提交的名称为LOCKOUT ARRANGEMENT FOR A SURGICAL STAPLER的美国专利申请序列号12/234,113;
2009年11月19日提交的名称为SURGICAL STAPLER HAVING A CLOSURE MECHANISM的美国专利申请序列号12/622,099;
2009年11月19日提交的名称为METHOD FOR FORMING A STAPLE的美国专利申请序列号12/622,130;
2009年11月19日提交的名称为SURGICAL STAPLER COMPRISING A STAPLE POCKET的美国专利申请序列号12/622,113;
2010年7月26日提交的名称为SURGICAL STAPLING INSTRUMENT WITH IMPROVEDFIRING TRIGGER ARRANGEMENT的美国专利申请序列号12/843,436;
2008年2月13日提交的名称为SURGICAL STAPLING INSTRUMENT WITH IMPROVEDFIRING TRIGGER ARRANGEMENT的美国专利申请序列号12/030,424;以及
2009年10月9日提交的名称为SURGICAL STAPLER的美国临时专利申请61/250,377。
参见图1和2,线性吻合缝合器械(通常为20)可包括承载上细长的砧座的钳口构件22和承载下细长的钉仓的钳口构件24。承载上砧座的钳口构件22可由柄部26支撑,其中钳口构件的前部从其向前延伸。承载下钉仓的钳口构件24可由柄部28支撑,其中钳口构件的前部从其向前延伸。如图3所示,上柄部26和下柄部28可适当地成形为形成把手以有利于外科医生来处理和操作缝合器械。扩大的前突起27和狭小的后突起29可设置在每个柄部上以用于此目的。在各种实施例中,柄部26和28可由例如塑料或其它轻型材料制成,而钳口构件22和24可例如由不锈钢或其它类似材料制成。
如图5所示,上钳口构件22可包括一体式细长通道形框架,所述一体式细长通道形框架包括由顶壁31连接的一对相对的细长侧壁30。上柄部26可包括位于所述上柄部内的邻近其前端的一对附属耳部32。上钳口构件22可包括沿其顶壁31形成于中间位置处的狭槽34(图4),附属耳部32可穿过所述狭槽34向下突出。闩锁销36可延伸穿过形成于上钳口构件22的侧壁30中的圆孔和形成于附属耳部32中的圆孔,以将上钳口构件枢转地连接到上柄部26。
参见图5,上钳口构件22的前部可设有一对细长的向内延伸的凸缘38,所述凸缘38可限定缝合器械的砧座40。凸缘38可由沿着砧座40的整个长度延伸的中心纵向狭槽42隔开。在中心狭槽42的近端处,凸缘38可设有向内倾斜的导向表面41。每个凸缘38还可设有两个纵排的均匀间隔的缝钉成形凹坑44。参见图4和5,可将渐缩砧座末端46安装在承载砧座的钳口构件22的前部处以有利于将钳口构件插入例如中空、管状身体器官内。砧座末端46可包括细长主体48(图4),所述细长主体48可插入穿过位于砧座40上方的由上钳口构件的侧壁30和凸缘38限定的纵向通道。此细长主体48可在闩锁销36上方的附属耳部32之间延伸并且可包括位于耳部32后面的扩大的后部50以将砧座末端46保持就位在上钳口构件22上。
参见图2和6,承载下仓的钳口构件24可包括一体式细长通道形框架,所述一体式细长通道形框架包括由底壁53连接的一对相对的细长侧壁52。沿着下钳口构件24的向后部分,一对间隔开的、细长的直立侧凸缘54(图2)可从其相对侧壁52向上延伸。如图5和6所示,下钳口构件24在其侧凸缘54之间的宽度可大于上钳口构件22在其侧壁30之间的宽度,以在缝合器械为进行手术而被组装时允许上钳口构件的后部容纳在下钳口构件的侧凸缘54之间。如图2所示,下钳口构件24的每个侧凸缘54可包括定位成与上钳口构件22上的闩锁销36对准的竖直凹口56。当装配上钳口构件22和下钳口构件24时,闩锁销36的相对两端可容纳在凹口56内。
如图2和6所示,下钳口构件24可支撑钉仓60,所述钉仓60能够容纳布置在至少两个横向间隔的纵排中的多个外科缝钉61(图17)。钉仓60可安装在下钳口构件24中位于其侧壁52之间的前部处。钉仓60可被从钉仓近端朝向其远端延伸的中心细长狭槽62(图6)纵向分开。在各种实施例中,形成于钉仓60中的多个缝钉开口64可被布置成两对横向间隔排,其中每对排设置在中心纵向狭槽62的相对侧上。多个外科缝钉61(图17)可安装在仓60的开口64内。如图6所示,相邻排中的缝钉开口64可为交错排列的,以在操作该器械时提供组织的更有效缝合。参见图15和16,钉仓60可包括一对纵向狭槽66,所述纵向狭槽66位于细长中心狭槽62的相对侧上并且设置在中心狭槽的每一侧上的交错排的开口64之间。每个纵向狭槽66可从仓60的近端朝向其远端延伸。
如图17所示,多个缝钉驱动器65可滑动地安装在缝钉开口64中以用于致动加载到钉仓60内的缝钉61。参见图6,每个缝钉驱动器65可被设计为同时致动位于设在钉仓60内的相邻排中的两个缝钉61。因此,在各种实施例中,第一组缝钉驱动器65可被设置用于致动位于中心纵向狭槽62的一侧上的交错排中的缝钉61,并且第二组缝钉驱动器65可被设置用于致动位于中心纵向狭槽62另一侧上的一对相邻排中的缝钉61。
如图2和3所示,类似于上文所述,钉仓60的前端或远端可包括渐缩末端68以有利于将下钳口构件24插入例如中空、管状身体器官内。钉仓60可在紧邻其渐缩末端68后面设有一对向后延伸的突起70(一个示于图14中),所述突起可容纳在提供于下钳口构件24的侧壁52中的对应凹口内。在钉仓60的后部处,一对附属臂72可从钉仓向下延伸。每个臂72可具有凹口以提供侧开口74。当将仓60装配到下钳口构件24上时,其突起70可容纳在提供于侧壁52的前端处的对应凹口内并且其附属臂72向下延伸穿过形成于钳口构件24的底壁53中的开口76(图4)。下钳口构件24可包括在开口76的相对侧上从其侧壁52向下延伸的一对附属耳部78(图18)。枢轴销80可延伸穿过形成于下钳口构件24的附属耳部78中的孔并且延伸穿过钉仓60上的附属臂72的侧开口74以将钉仓紧固到下钳口构件。
参见图2,缝合器械20可包括闭锁机构(通常为90)以用于在沿钳口构件的中间位置处将上钳口构件22和下钳口构件24闩锁在一起。在各种实施例中,可在邻近砧座40和钉仓60的近端的位置处将钳口构件22和24闩锁在一起。在至少一个实施例中,闭锁机构90可包括锁臂92(图2),所述锁臂通过枢轴销80(图4)枢转地连接至下钳口构件24。锁臂92可呈通道形构型并且可包括一对相对的细长侧壁94(图6),所述侧壁以足以跨越下钳口构件24的侧壁52的距离间隔开。锁臂92的每个侧壁94可包括向上和向前延伸的吊钩构件96,所述吊钩构件设有面向前方的狭槽98以用于容纳闩锁销36。覆盖物100可安装在锁臂92的下表面上。当锁臂92闭合时,如图3所示,覆盖物100可与下柄部28的底部对准以有利于外科医生来处理和操作缝合器械20。在各种实施例中,覆盖物100可例如由塑料或其它轻型材料制成,而锁臂92可例如由不锈钢制成。如图7所示,覆盖物100可包括从其相对侧向外延伸的细长凸缘102和104,所述细长凸缘102和104可用作手指握把以允许锁臂92从其闩锁位置向下枢转到其非闩锁位置。当锁臂92运动到其闭合或闩锁位置时,吊钩构件96的狭槽98的表面可与可充当偏心闩锁的闩锁销36相配合,以将锁臂92保持在其闩锁位置。
参见图6和10,缝合器械20的优选实施例可包括改善的推杆和刀片组件(通常为110),所述推杆和刀片组件可进行可滑动地安装以用于分别相对于上钳口构件22和下钳口构件24的纵向运动、将缝钉61从钉仓60驱动到夹持在钳口构件之间的组织内、紧靠砧座40使缝钉61成形、以及沿着形成于组织中的缝钉排之间的线来切割组织。推杆和刀片组件110可包括推块112(图6),所述推块112可滑动地容纳在直立侧凸缘54之间的下通道形钳口构件24内。如图11所示,推块112可通过凸缘116附接到致动器旋钮114,所述凸缘116包括横向突出的指状物118,所述指状物118在其顶部表面上设有纵向延伸的凹口119。可将指状物118卡口配合到形成于推块112中的横向狭槽120内,以将凹口119定位在纵向锁定杆121下面,由此来将推块112和致动器旋钮114固定在一起。致动器旋钮114的凸缘116可延伸穿过并且骑靠形成于下钳口构件24的一个侧凸缘54中的细长狭槽122(图2)。
推杆和刀片组件110可包括一对缝钉推杆124(图10),所述缝钉推杆124从推块112向前突出并且可滑动地容纳在钉仓60的细长狭槽66(图16)中。推块112可设有其中固定推杆124的一对竖直狭槽126(图11)。如图10所示,每个缝钉推杆124的前端可设有楔形末端128,所述楔形末端限定倾斜的凸轮表面130以用于在将推杆124推进到钉仓60内时来接合缝钉驱动器65。如图21所示,每个缝钉驱动器65可设有与每个缝钉推杆124的凸轮表面130取向成相同角度的倾斜表面132,以提供这些表面之间的平坦、滑动接触。
参见图6和10,推杆和刀片组件110可包括刀架134,所述刀架可滑动地进行安装以用于沿直立侧凸缘54之间的下钳口构件24的纵向运动。刀架134可包括向前延伸到钉仓60的中心纵向狭槽62内的刀支撑杆136。设有斜切刃140的倾斜刀片138可位于刀支撑杆136的前端处。刀片138的斜切刃可相对于细长钳口构件22和24成一角度进行取向并且可滑动地容纳在钉仓60的中心纵向狭槽62中。
在各种实施例中,刀架134可包括从其延伸穿过的一对纵向狭槽135(图19),所述纵向狭槽可滑动地容纳缝钉推杆124以允许推块112相对于刀架滑动。因此,当通过致动器旋钮114朝向钉仓60推进推块112时,缝钉推杆124可滑动穿过刀架134,所述刀架保持为静止的直至推块运动成与刀架相接合。在刀架134被推块112接合之后,刀架和推块可同时朝向钉仓60推进。如图17所示,刀片138可与缝钉推杆124一起推进穿过钉仓60,由此使缝钉61在夹持在钳口构件之间的组织中成形并且切割缝钉排之间的组织。其后,当回缩致动器旋钮114时,推块112可使缝钉推杆124开始向后滑动穿过可保持静止的刀架134。每个缝钉推杆124可包括偏置部142,所述偏置部可在缝钉推杆124退回预定的距离之后运动成与刀架134相接合。当缝钉推杆124的偏置部142接合刀架134时,推块112和刀架134可通过致动器旋钮114同时进行回缩,以使推杆124和刀片138返回到起始位置。
根据本发明的各种实施例,缝合器械20可设有钳口夹紧装置,所述钳口夹紧装置用于将夹紧力施加到钳口构件以在缝钉61的成形期间迫使钉仓60和砧座40紧压在一起。钳口夹紧装置可包括如下装置,所述装置用于迫使钳口构件在远离闭锁机构的位置处分开以抵制在缝钉61成形时施加到钉仓60和砧座40上的力。在至少一个实施例中,凸轮装置可安装到钳口构件中的一个上并且可与另一个钳口构件接合,以用于将所述钳口构件在远程位置处运动分开,由此迫使钉仓60和砧座40紧压在一起。在各种实施例中,凸轮构件可在远离闭锁机构的位置处枢转地安装到钳口构件中的一个上。凸轮构件可从第一无效位置枢转到第二有效位置以将钳口构件的远端运动分开。可通过推杆和刀片组件110的推块112来操作凸轮构件以使其在推块推进时运动到其有效位置并且在推块回缩时返回其无效位置。
在各种实施例中,凸轮机构(通常为150)可邻近下钳口构件24的后端定位,如图4所示。凸轮机构150可包括凸轮构件152,所述凸轮构件枢转地安装到在下钳口构件24的直立侧凸缘54之间延伸的横向枢轴销154上。凸轮构件152可包括第一下凸轮表面156和第二较高凸轮表面158,所述第一下凸轮表面用于使上钳口构件22的顶壁31与处于其第一无效位置的凸轮152相接合(图12),所述第二较高凸轮表面用于使上钳口构件22的顶壁31与设置在其第二有效位置的凸轮152相接合(图13)。第一凸轮表面156可被布置成保持上钳口构件和下钳口构件基本上平行于处于其无效位置的凸轮152。第二凸轮表面158可被布置成当凸轮152从其无效位置枢转到其有效位置时将上钳口构件22的后端抬高例如大约0.125英寸(3.2mm)。另外,上钳口构件22可为足够柔性的,以在凸轮构件152从其无效位置运动到其有效位置时允许上钳口构件22的后部远离下钳口构件24向上弯曲。
如图4所示,凸轮构件152可包括径向延伸的凹口160,所述凹口将凸轮分成大的前指状物162和小的后指状物164。前凸轮指状物162可包括平坦的、面向后方的表面165,并且后凸轮指状物164可包括倾斜的、面向前方的表面166。当凸轮152处于其无效位置时,前凸轮指状物162和后凸轮指状物164可向下延伸穿过形成于下钳口构件24的底壁53中的细长狭槽168。
在各种实施例中,可通过推块112来操作凸轮构件152以使其在推块被推进时从其无效位置运动到其有效位置。如图11所示,推块112可包括一对向后延伸的臂170,所述臂170被间隔开以在其间限定间隙172。臂170的后端可被延伸横跨间隙172的凸轮致动器销174连接。参见图4和11,当凸轮构件152设置在其无效位置时,前凸轮指状物162可延伸穿过推块112的臂170之间的间隙172,而凸轮致动器销174可容纳在凸轮构件的前指状物162和后指状物164之间的凹口160中。
如图12所示,当凸轮构件152设置在其第一无效位置时,上钳口构件22的顶壁31可置于凸轮构件的第一凸轮表面156上。当凸轮构件152处于其无效位置时,上钳口构件22的顶壁31可基本上平行于下钳口构件24的底壁53。另外,推块112可位于从刀架134向后间隔开的起始位置处。当推进推块112时,如通过箭头182(图13)所示,凸轮致动器销174可接合前凸轮指状物162的后表面165以按逆时针方向旋转凸轮构件152,如通过箭头184所示,以将凸轮构件枢转到其第二有效位置并且将其第二凸轮表面158运动成与上钳口构件22的顶壁31相接合。当凸轮构件152枢转到其有效位置时,上钳口构件22的顶壁31可远离下钳口构件24的底壁53向上弯曲,如通过箭头186所示。凸轮构件可将力施加到上钳口构件22和下钳口构件24,由此将钳口构件的后部弯曲分开。由于上钳口构件22和下钳口构件24的后部的弯曲分开,可将额外的夹紧力施加到上钳口构件22和下钳口构件24的前部,由此使得砧座40和钉仓60顶靠夹持在钳口构件之间的组织夹紧。因此,可迫使砧座40和钉仓60紧压在一起,以抵制在推进推杆和刀片组件110以使缝钉61成形并且切割组织时施加到砧座和钉仓上的力。
参见图13,当推块112在缝钉61成形之后回缩时,凸轮致动器销174可接合后凸轮指状物164的倾斜表面166以按顺时针方向枢转凸轮构件152。当凸轮致动器销174沿着倾斜表面166运动到凹口160内时,凸轮构件152可按顺时针方向枢转并且返回至其第一无效位置(图12),由此使其第一凸轮表面156接合上钳口构件22的顶壁31。因此,可释放由凸轮152施加到上钳口构件22和下钳口构件24的后部上的力并且上钳口构件22的顶壁31可返回到与下钳口构件24的底壁53基本上平行的关系。相似地,可释放施加到钳口构件22和24的前部的夹紧力以松开砧座40和钉仓60。
在各种实施例中,缝合器械20可包括垫片装置,所述垫片装置安装到钳口构件中的一个上以用于保持缝合器械的钉仓60和砧座40之间的预定间隙。参见图4和6,此垫片装置可体现为邻近钉仓60的远端安装的垫片销190。垫片销190可从下钳口构件24的底壁53向上竖直地延伸穿过钉仓60并且从钉仓的顶部向上突出预定的距离。如图5所示,砧座40的一个凸缘38可包括邻近其远端的用于接合垫片销190的凸缘部分192。当缝合器械为进行手术而被组装时(图4),垫片销190可接合凸缘部分192以保持砧座40和钉仓60之间的预定间隙。
在缝合器械20的手术过程中,有待缝合和切割的组织可初始放置在钳口构件22和24之间并且由钳口构件夹紧。因此,柄部26和28可通过锁臂92向下枢转运动到其非闩锁位置(图2)而解闩锁。因此,闩锁销36的相对两端可从形成于锁臂92的吊钩构件96中的狭槽98脱离。其后,可通过使闩锁销36从形成于下钳口构件的侧凸缘54中的狭槽56脱离来使上钳口构件22和下钳口构件24分离。
接下来,可将有待缝合和切割的组织放置在钳口构件22和24上。例如,如图17所示,可将一块管状肠组织滑到每个钳口构件的前部上。在组织被放置到钳口构件上之后,可再装配缝合器械20。可通过将闩锁销36与形成于下钳口构件24的直立侧凸缘54中的竖直狭槽56对准来完成再装配。其后,可将下钳口构件24的侧凸缘54定位在上柄部26内以跨越上钳口构件22的侧壁30,同时可将闩锁销36的相对两端插入竖直狭槽56内。最后,可将锁臂92向上枢转到其闩锁位置(图3),其中其覆盖件100与下柄部28的底部齐平。因此,可将吊钩构件92枢转到闩锁销36之上并且狭槽98可容纳闩锁销的相对两端。因此,上钳口构件22和下钳口构件24可在沿其的邻近砧座40和钉仓60的中间位置处闩锁在一起。另外,垫片销190可穿过身体组织接合砧座40的凸缘部分192以保持砧座40和钉仓60之间的预定间隙。
当组织在钳口构件之间夹紧之后,可通过推进致动器旋钮114来致动推杆和刀片组件110来击发缝合器械20。最初,在凸轮机构150的致动过程中,推块112和推杆124(图4)可被推进,而刀架134可保持静止。由于仅推块112及其推杆124被推进以致动凸轮构件152,因此操作缝合器械20所需的初始力可为最小的。
参见图12,在推块112的初始推进期间,推杆124可滑动穿过刀架134并且推杆的楔形末端128可开始推进穿过钉仓60的狭槽66。当推块112朝刀架134推进时,其凸轮致动器销174可接合前凸轮指状物162的后表面165以逆时针地枢转凸轮152,如图13的箭头184所示,由此将凸轮构件的第二凸轮表面158运动成与上钳口构件22的顶壁31相接合。凸轮构件152可将力施加到上钳口构件22和下钳口构件24,由此将钳口构件的后部弯曲分开。因此,上钳口构件22的顶壁31的后端可例如相对于下钳口构件24的底壁53的后部向上弯曲大约0.125英寸(3.2mm)。钳口构件22和24的后端的弯曲分开可导致将额外的夹紧力施加到钳口构件的前部上,以使得砧座40和钉仓60顶靠夹持在钳口构件之间的组织夹紧。这些额外的夹紧力趋于抵制在切割组织以及使缝钉61紧靠砧座40成形期间施加到砧座40和钉仓60上的力,以保持砧座40和钉仓60之间的所需间距,由此产生具有基本上一致高度的成形缝钉61。
参见图13,在致动凸轮机构150之后,推块112可随后接合刀架134以开始刀架134朝钉仓60的纵向运动。在各种实施例中,推块112和刀架134之间的初始间距可被布置成使得推块112在凸轮构件152恰到达其有效位置之前来接合刀架134。作为另外一种选择,推块112和刀架134之间的初始间距可被布置成使得推块112在凸轮构件152完全运动到其有效位置之后开始接合刀架134。当推块112接合刀架134时,可启动刀片138沿砧座40和钉仓60的各自中心纵向狭槽42和62的推进。其后,缝钉推杆124和刀片138可同时进行推进以缝合和切割夹持在砧座40和钉仓60之间的组织。
当推进推块112时,缝钉推杆124可沿着提供于钉仓60中的狭槽66纵向运动。缝钉推杆124的双楔状凸轮表面130可穿过狭槽66运动成与缝钉驱动器65的倾斜表面相接合,以从仓60依次地驱动缝钉61并且使缝钉61紧靠砧座凸缘38形成B形构型。凸轮表面130可定位在距推块112相同的距离处,以同时地致动位于中心纵向狭槽62相对侧上的缝钉驱动器65。同时,可推进刀架134以使刀片138运动穿过砧座40的中心纵向狭槽42和钉仓60的中心纵向狭槽62,以切割夹持在钳口构件之间的组织。通过凸轮机构150施加到上钳口构件22和下钳口构件24的前部的额外夹紧力可趋于抵制缝钉61成形时施加到砧座40和钉仓60上的力。
在推块112被完全推进以使钉仓60中的全部缝钉成形之后,可通过回缩致动器旋钮114来使推块朝向其起始位置回缩。最初,仅推块112可从钉仓60向后运动,因为缝钉推杆124滑动穿过保持静止的刀架134。当缝钉推杆124的偏置部142接合刀架134的前部时,刀架可与推块112一起从钉仓60向后运动。因此,缝钉推杆124和刀片138可同时从钉仓60和砧座40回缩。
当推块112向其起始位置返回时,凸轮致动器销174可接合后凸轮指状物164的倾斜表面166以将凸轮构件152按顺时针方向朝向其无效位置枢转。凸轮致动器销174可沿着倾斜表面166运动到凸轮指状物162和164之间的狭槽160内以使凸轮构件152返回到其无效位置。因此,凸轮构件152的第二凸轮表面158可从上钳口构件22的顶壁以及上钳口构件22的顶壁31的后端脱离并且向下运动到与第一凸轮表面156相接合。同时,前凸轮指状物162可向下枢转到推块112上的指状物170之间的间隙172内,并且两个凸轮指状物162和164可向下枢转到形成于下钳口构件24的底壁53中的狭槽168内。其后,当凸轮构件152处于其无效位置时,可向下枢转锁臂92,如图2所示,以允许上钳口构件22和下钳口构件24被拆开。此时,可从钳口构件中移除切割和缝合的组织。
如上文所述,外科缝合器械可包括例如致动器旋钮(诸如致动器旋钮114(图1)),所述致动器旋钮能够在外科缝合器械的钉仓内推进推杆组件(诸如推杆组件110(图10))。在各种实施例中,致动器旋钮114能够由外科医生抓握以使得外科医生可对其施加力。在各种情况下,致动器旋钮114在向远侧推进时可接触或邻接围绕手术部位的组织。因此,在至少一种情况下,外科医生可不得不重新定位缝合器械,以使得致动器旋钮114可绕过组织。在其它情况下,外科医生可不得不推压致动器旋钮114绕过组织。在任一情况下,这些情况可为不利的,因此需要具有下述致动器旋钮的缝合器械,所述致动器按钮可被调控以降低致动器旋钮可碰撞周围组织的可能性。
在本发明的各种实施例中,参见图21,缝合器械220可包括从上柄部226延伸的承载砧座的钳口构件222、从下柄部228延伸的承载钉仓的钳口构件224、以及可与推杆组件(例如,如图24所示的推杆组件210)可操作地接合的致动器旋钮214a和214b。在各种实施例中,钉仓可例如可拆卸地附接到承载钉仓的钳口构件224,使得钉仓在已耗尽之后可利用另一个钉仓来进行替换。在至少一个实施例中,推杆组件210可包括与其一体地形成或可操作地安装于其上的缝钉驱动器,所述缝钉驱动器可运动穿过钉仓,如上文所概述。在至少一个其它实施例中,钉仓可包括容纳在其中的缝钉驱动器,所述缝钉驱动器可与推杆组件接合并且可通过推杆组件向远侧推动。在任何情况下,第一致动器旋钮214a例如可在第一位置(图21)(其中其从推杆组件210可操作地脱离)和第二位置(图22)(其中其与推杆组件210可操作地接合)之间进行旋转。相似地,第二致动器旋钮214b能够在第一位置和第二位置(其中其分别与推杆组件210可操作地脱离和可操作地接合)之间进行旋转。
在各种实施例中,由于以上所述,缝合器械的致动器旋钮可与推杆组件选择性地接合,使得在推进致动器旋钮时所述致动器旋钮可接触或邻接围绕手术部位的组织的情况中,致动器旋钮可保持在其回缩位置而另一个致动器旋钮可延伸以向远侧推进推杆组件。在至少一个此类实施例中,参见图22,第一致动器旋钮214a可旋转到其第二位置,以使其可与推杆组件210可操作地接合而第二致动器旋钮214b可保持在其回缩位置。其后,参见图23,第一致动器旋钮214a可沿着外科手术缝合器210的第一侧201相对上柄部226和下柄部228向远侧推进,以便致动推杆组件210。在至少一个实施例中,第一致动器旋钮214a可在限定于上柄部226和下柄部228之间或者内部的第一狭槽227内进行滑动。在各种其它情况下,参见图28,第一致动器旋钮214a可保持在其回缩位置而第二致动器旋钮214b可旋转到其伸长位置。类似于上文所述,第二致动器旋钮214b可沿着缝合器械210的第二侧203向远侧推进,以例如在第二狭槽229内推进推杆组件210。在至少一个实施例中,两个致动器旋钮214均可延伸以向远侧推进推杆组件210。在各种可供选择的实施例中,尽管未示出,但缝合器械可包括不止两个可被选择性地用于致动推杆和/或刀片组件的致动器旋钮。实际上,由于上文所述,外科器械的致动器旋钮可彼此独立地与推杆组件接合。
在各种实施例中,除了上文所述,缝合器械的致动器旋钮可位于第一位置,在所述第一位置中致动器旋钮可保持就位并且保持不与推杆组件可操作地接合。在至少一个实施例中,参见图24,缝合器械201还可包括导向构件209,所述导向构件209能够在致动器旋钮214在其第一位置和第二位置之间旋转时来对其进行导向。在各种实施例中,参见图24-26,导向构件209可包括导轨211,所述导轨211可滑动地容纳在致动器旋钮214的沟槽213内,使得当致动器旋钮214旋转时,导向构件209可指定致动器旋钮214运动的路径。此外,导轨211和沟槽213可包括互锁结构,所述互锁结构可协同地阻止致动器旋钮214例如向近侧和/或向远侧无意地移位。在至少一个此类实施例中,当推杆组件210如上文所述向远侧推进时,导向构件209可阻止致动器旋钮214中的一个或多个与推杆组件210一起进行平移。在各种实施例中,可在导轨211和沟槽213之间存在轻微摩擦或过盈配合,使得致动器旋钮214可无意中旋转到其伸长位置的可能性可得到降低。尽管未示出,但致动器旋钮可包括从其延伸的导轨,所述导轨可例如可滑动地容纳在导向构件内的沟槽中。在任何情况下,参见图25,导向构件209可包括一个或多个保持构件215,所述保持构件215能够将导向构件209保持就位在上柄部226和下柄部228中间。此外,参见图24和25,导向构件209可包括孔217,所述孔217能够容纳从中延伸穿过的保持销219,其中保持销219能够与上柄部226和/或下柄部228相接合以将导向构件209保持就位。
在各种实施例中,当致动器旋钮214如上文所述在其第一位置和第二位置之间进行旋转时,沟槽213可旋转为不与导轨211接合并且致动器旋钮214可与推杆组件210可操作地接合。在至少一个实施例中,主要参见图24,推杆组件210可包括第一离合器结构(例如狭槽或沟槽205)并且致动器旋钮214可各自包括第二离合器结构(例如突出207),其中第一离合器结构和第二离合器结构彼此能够可操作地接合,以便使致动器旋钮214中的一个或多个与推杆组件210可操作地接合。在至少一个此类实施例中,突出207可紧密地容纳在狭槽205内,使得当将力施加到致动器旋钮214中的一个或多个时,所述力可通过突出207以及狭槽205的侧壁传送到推杆组件210。在至少一个实施例中,类似于上文所述,可在突出207和狭槽205之间存在轻微摩擦或过盈配合以将致动器214保持在其伸长位置。在任何情况下,尽管未示出,但第一离合器结构可包括从推杆组件延伸的突出,所述突出能够容纳在致动器旋钮中的凹槽或狭槽内。此外或者取代上文所述,参见图24,推杆组件210还可包括第二导轨221,所述第二导轨221能够被滑动地容纳在致动器旋钮214中的狭槽或沟槽223内,其中导轨221和沟槽223能够将致动器旋钮214导向到其第二位置内并且/或者一旦处于其第二位置便将力从致动器旋钮214传送到推杆组件210。与导轨211相类似,导轨221能够与沟槽223产生轻微摩擦或过盈配合以将致动器旋钮214保持就位。除了上文所述,在各种实施例中,致动器杆210可包括柱225,致动器旋钮214可绕其旋转。在至少一个实施例中,致动器旋钮214可包括凹槽227,所述凹槽227可具有波状轮廓,以使得凹槽227的侧壁可紧密地容纳柱225并围绕其滑动,因此当致动器旋钮214例如在其第一位置和第二位置之间进行旋转时可通过柱225对其进行导向。
在本发明的各种实施例中,缝合器械可包括下述致动器旋钮,所述致动器旋钮能够沿着缝合器械的第一侧和缝合器械的第二侧选择性地推进。在至少一个实施例中,参见图29和30,缝合器械320可包括上柄部326、下柄部328、和致动器旋钮314,其中致动器旋钮314可类似于上文所述能够在钉仓内推进推杆组件。在至少一个实施例中,上柄部326和下柄部328可在其间限定第一狭槽327和第二狭槽329,其中狭槽327和329均能够允许致动器旋钮314从中滑动。更具体地,在各种实施例中,致动器旋钮314能够使其可选择性地沿着第一侧301滑动穿过第一狭槽327,或者作为另外一种选择,沿着第二侧303滑动穿过第二狭槽329。在各种实施例中,参见图31,缝合器械320还可包括第三狭槽331,所述第三狭槽能够允许致动器旋钮314从缝合器械的一侧运动到另一侧。因此,在至少一个此类实施例中,外科医生可选择性地定位致动器旋钮314,使得致动器旋钮314如果在缝合器械的一侧上向远侧推进时看起来可碰撞组织,则可将致动器旋钮314在推进之前旋转到缝合器械的另一侧。尽管图示实施例的第一侧和第二侧位于外科器械320的相对侧上,但可预想到其它实施例,其中例如第一狭槽和第二狭槽位于相邻侧和/或彼此不正对的侧上。此外,可预想到其它实施例,其中缝合器械的侧不易于分辨,例如具有圆形和/或弧形部分的器械。
在各种实施例中,主要参见图29,第一狭槽327能够使其限定致动器旋钮314的下述路径,所述路径平行于或至少基本上平行于由第二狭槽329限定的路径。在至少一个实施例中,第三狭槽331能够连接第一狭槽327和第二狭槽329,以使其可限定致动器旋钮314的下述路径,所述路径垂直于或至少基本上垂直于由狭槽327和329限定的路径。在此类实施例中,可将致动器旋钮314旋转到外科器械的顶上以使致动器旋钮314从第一侧301运动到第二侧303。在外科医生决定将致动器旋钮重新定位到第一侧301上的情况下,外科医生可通过狭槽311使致动器旋钮314向后运动直至其再次定位在第一狭槽327内。在各种可供选择的实施例中,尽管未示出,但第三狭槽可限定致动器旋钮314的下述路径,所述路径与由狭槽327和329限定的路径平行或至少基本上平行、和/或共面或至少基本上共面。在其它各种实施例中,第三狭槽可限定下述路径,所述路径相对于由狭槽327和329限定的路径为倾斜的。在任何情况下,第三狭槽能够连接第一狭槽和第二狭槽以使得致动器旋钮可在其内滑动。
如上文所述,缝合器械320可包括推杆组件,所述推杆组件可例如与致动器旋钮314可操作地接合,使得致动器旋钮314能够向远侧推进推杆组件。在各种实施例中,参见图33,缝合器械320可包括推杆组件310,所述推杆组件可包括例如与刀组件可操作地接合的第一部分333以及另外可旋转地安装到第一部分333的第二部分335。在至少一个实施例中,第一部分333可限定轴线337,第二部分335可绕其旋转。在至少一个此类实施例中,第二部分335可包括限定于其中的孔339,所述孔339能够紧密地容纳第一部分333。在至少一个实施例中,尽管未示出,但推杆组件310还可包括一个或多个保持构件,例如螺钉,所述保持构件能够延伸到第一部分333中的沟槽内例如用于将第二部分335保持到第一部分333。在各种实施例中,第二部分335可包括从其延伸的安装座341,所述安装座能够将致动器旋钮314保持到第二部分335。为了将致动器旋钮从缝合器械320的第一侧运动到另一个侧,如上文所述,致动器旋钮314和第二部分335可相对于第一部分333进行旋转,使得致动器旋钮314可选择性地定位在第一狭槽327和第二狭槽329内。在至少一个实施例中,尽管未示出,但缝合器械可具有不止两个狭槽以用于当在钉仓内推进致动器旋钮时来容纳致动器旋钮。在任何情况下,在各种可供选择的实施例中,第一部分333和第二部分335可固定地安装在一起,以使得它们一起围绕轴线337进行旋转。在至少一个此类实施例中,第一部分333能够相对于推杆组件310的基本上不旋转部分进行旋转。
参见图34,外科缝合器械(通常为1100)可包括第一柄部部分1102和第二柄部部分1104。在各种实施例中,第一柄部部分1102和第二柄部部分1104能够例如由外科医生抓握,并可包括把手部分1106。在至少一个实施例中,第一柄部部分1102(参见图35和36)可包括附接到第一框架1110的第一覆盖件1108,并且类似地第二柄部部分1104可包括附接到第二框架1114的第二覆盖件1112。覆盖件1108和1112可以具有符合人体工程学的轮廓,或换句话讲具有合适轮廓,以帮助外科医生在手术部位内操作缝合器械1100。在各种实施例中,柄部覆盖件1108和1112例如可分别包括增大的突起1109和1113,其可有助于将缝合器械1100插入手术部位内。在各种实施例中,柄部覆盖件1108和1112可例如由塑性轻质材料和/或任何其它合适的材料制成,而柄部框架1110和1114可例如由不锈钢、钛和/或任何其它合适的材料制成。
在各种实施例中,再次参见图34-37,柄部部分1102和1104的远端可包括端部执行器1120,其能够例如可对手术部位内的组织进行处理。在至少一个此类实施例中,端部执行器1120可包括能够容纳和/或保持钉仓的钉仓通道1122,如下文更详细地进一步描述。在某些实施例中,钉仓通道1122可包括从第一柄部部分框架1110延伸的一体式细长通道形框架。在至少一个实施例中,钉仓通道1122可包括由底壁1126所连接的一对相对的细长侧壁1124。沿着钉仓通道1122的向后或近侧部分,一对间隔开的直立侧凸缘1128可从相对侧壁1124向上延伸。在各种实施例中,侧凸缘1128之间的钉仓通道1122的宽度可大于从第二柄部部分1104延伸的上夹具构件或砧座1130的宽度。在至少一个实施例中,凸缘1128之间的距离能够在缝合器械为进行手术而被装配时允许在侧凸缘1128之间容纳砧座1130的至少一部分。如图35所示,每个侧凸缘1128均可包括例如凹口或凹槽1127,其能够容纳例如从砧座1130和/或第二柄部部分1104的任何其它合适的部分延伸的一个或多个闩锁突出1131,如下文更详细地进一步描述。
如上文指出,再次参见图34-37,钉仓通道1122能够例如在端部执行器1120内支撑和/或保持钉仓,例如钉仓1150,其中钉仓可包括可移除地存放于其中的一个或多个缝钉(未示出)。在各种实施例中,参见图41-43,钉仓1150可包括一个或多个缝钉腔1151,其能够采用任何合适的布置方式来存放缝钉,例如采用例如至少两个横向间隔的纵排的布置方式。在至少一个实施例中,参见图42和43,钉仓1150可包括钉仓主体1152和底盘或保持器1154,其中钉仓主体1152和/或底盘1154能够限定用于在其中可滑动地容纳缝钉滑动件和/或切割构件的通道或路径。在至少一个实施例中,底盘1154可例如包括柔性臂1155,其能够以搭扣配合和/或压合方式来接合钉仓主体1152。参见图43-45,钉仓1150还可包括缝钉滑动件组件1160,其可包括缝钉滑动件部分1162,此外还包括切割构件1164。在各种实施例中,切割构件1164可例如包括切刃1165和锁臂1166,其中锁臂1166能够在切割构件1164装配到缝钉滑动件部分1162时被压合和/或搭扣配合进缝钉滑动件1162中的孔1163内。在其它多个实施例中,缝钉滑动件部分1162可整体模制到切割构件1164。
除了上文所述,参见图41-43,钉仓主体1152可包括狭槽,例如狭槽1156,其能够在其中容纳切割构件1164的至少一部分,和/或缝钉滑动件组件1160以及推杆组件1200(在下面进行讨论)的任何其它部分,其中狭槽1156能够允许切割构件1164在钉仓1150内的第一位置和第二位置之间运动。在各种实施例中,狭槽1156能够例如允许切割构件1164在近侧位置(图43)和远侧位置之间运动以便切割定位在钉仓1150和砧座1130中间的组织。再次参见图43-45,缝钉滑动件部分1162可包括凸轮、滑道或致动器表面1167,其能够接合定位在钉仓1150内的缝钉驱动器。在各种实施例中,参见图42,钉仓1150可包括缝钉驱动器1168,其可通过滑动件部分1162在缝钉腔1151内向上提起或滑动,使得缝钉驱动器1168的向上运动可顶出或部署至少部分地定位在缝钉腔1151内的缝钉。虽然缝钉驱动器1168事实上可垂直向上提起,但术语“向上”等等可表示例如使缝钉驱动器1168例如朝钉仓的顶部表面或平台1158和/或朝砧座1130运动。在某些实施例中,如图42所示,每个缝钉驱动器1168可包括以与凸轮表面1167相同的角度和/或任何其它合适的角度取向的一个或多个倾斜表面1169,其可在缝钉滑动件1162和缝钉驱动器1168之间提供相对平坦或至少基本上平坦的滑动接触表面。在各种实施例中,缝钉驱动器能够仅部署一个缝钉,而在某些实施例中,缝钉驱动器能够例如同时部署位于相邻排中的两个或更多个缝钉。其它装置在提交于2008年2月13日的名称为“SURGICAL STAPLING INSTRUMENT WITH IMPROVED FIRING TRIGGERARRANGEMENT”的美国专利申请12/030,424中有所公开,该专利申请的全部公开内容以引用的方式并入本文。
在各种实施例中,如上所述,外科缝合器械可包括能够切割组织和部署钉仓中的缝钉的切割构件/缝钉滑动件组件。然而,在某些实施例中,外科缝合器械可能不需要或不包括切割构件。在至少一个此类实施例中,钉仓可包括定位在其中的缝钉滑动件,并且/或者例如外科器械能够使缝钉滑动件运动至钉仓内以便缝合组织,而不另外将组织切开。在某些其它实施例中,钉仓可包括定位在其中的缝钉滑动件,其中外科器械可包括可运动至钉仓内或相对于钉仓运动的切割构件。在至少一个此类实施例中,切割构件可推进至与缝钉滑动件接触,使得切割构件和缝钉滑动件可一起被推进。其后,切割构件可以充分地回缩以允许钉仓脱离外科器械并由具有新缝钉滑动件的新钉仓替代。当缝钉滑动件在使用过程中可能被磨损或变形时此类实施例可能是有用的。可预想到其它实施例,其中钉仓可包括定位在其中的切割构件,其中外科器械可包括可运动至钉仓内或可相对于钉仓运动的缝钉滑动件。在至少一个此类实施例中,类似于上文所述,缝钉滑动件可推进至与切割构件接触,使得切割构件和缝钉滑动件可一起被推进。其后,缝钉滑动件可以充分地缩回以允许钉仓脱离外科器械并由具有新切割构件的新钉仓所替代。当切割构件在使用过程中可能被磨损或变形时此类实施例可能是有用的。在各种实施例中,如下文更详细描述,钉仓可包括保护外壳或覆盖件,其能够防止或至少降低例如当外科医生或其它临床医生抓握钉仓时触摸定位在钉仓中的切割构件的可能性。
在各种实施例中,除了上文所述,钉仓通道1122和/或钉仓1150例如可包括例如一个或多个配合的突出和/或凹槽,其能够使钉仓1150可移除地保持在钉仓通道1122内。在各种实施例中,一旦钉仓1150被插入钉仓通道1122内,就可将第一柄部部分1102装配到第二柄部部分1104。在其它各种实施例中,第一柄部部分和第二柄部部分装配在一起之后可将钉仓插入钉仓通道内。无论哪一种情况,参见图34-41,第一柄部部分1102和第二柄部部分1104可分别包括近端1103和1105,其可被装配在一起,使得第一柄部部分和第二柄部部分能够以旋转或枢转的方式彼此联接。在各种实施例中,参见图35和36,第一柄部部分1102可包括从中延伸的一个或多个销或突出1111,其能够滑动地容纳于第二柄部部分1104中的一个或多个沟槽、通道或狭槽1115内。在某些实施例中,狭槽1115可被限定于第二柄部框架1114中并且突出1111可从例如近端柱1107(其从第一柄部框架1110延伸)延伸。为了装配第一柄部部分1102和第二柄部部分1104,参见图37,狭槽1115的开口端可与突出1111对准,使得例如第二柄部部分1104可相对于第一柄部部分1102平移,并且突出1111可在狭槽1115内滑动。在至少一个实施例中,如图35和36所示,狭槽1115的开口端可相对于其闭合端向近侧定位。在至少一个此类实施例中,第二柄部部分1104的近端1105可相对于第一柄部部分1102的近端1103向远侧定位,使得第二柄部部分1104可向近侧运动以便将突出1111定位在狭槽1115内。在各种其它情况下,第一柄部部分1102可相对于第二柄部部分1104向近侧定位并向远侧滑动以便将突出1111定位在狭槽1115内。
在各种实施例中,参见图38,第二柄部部分1104可朝第一柄部部分1102旋转,使得砧座1130可相对于钉仓1150和/或钉仓通道1122运动就位。在某些实施例中,第一柄部部分1102可朝第二柄部部分1104旋转并且/或者第一柄部部分和第二柄部部分可朝彼此旋转。在任何情况下,突出1111和狭槽1115彼此接合时可包括枢轴,第一柄部部分和第二柄部部分中的一者或两者可相对于彼此绕该枢轴运动。在各种实施例中,第二柄部部分1104可相对于第一柄部部分1102运动,使得砧座1130运动至与钉仓1150紧密相对的位置。在某些实施例中,参见图39,第二柄部部分1104可相对于第一柄部部分1102运动,使得从第二柄部部分1104延伸的闩锁突出1131可与第一柄部部分1102内的凹槽1127对准和/或插入凹槽1127内。在各种实施例中,主要参见图35和36,第一柄部部分1102还可包括可旋转地安装于其上的闭锁机构1180,其可用于接合从第二柄部部分1104延伸的闩锁突出1131并将第一柄部部分和第二柄部部分固定在一起。虽然未作图示,但可预见到其它实施例,其中闭锁机构可旋转地安装于第二柄部部分并且闩锁突出可从第一柄部部分延伸。在任何情况下,在至少一个实施例中,闭锁机构1180可通过一个或多个枢轴销1182安装于第一框架1110,枢轴销1182能够限定闩锁1180可绕其旋转的轴线。
在某些实施例中,现在参见图37和38,闭锁机构1180可包括闩锁框架1184,此外还包括装配至闩锁框架1184的闩锁覆盖件1186。在其它各种实施例中,闩锁覆盖件和闩锁框架可包括整体单元,或在某些实施例中,闭锁机构可能甚至不包括覆盖件。在某些实施例中,闩锁框架1184可为通道形状并且可包括一对相对的细长侧壁1185,其以足以跨越第一框架部分1110的距离间隔开。在至少一个实施例中,闩锁覆盖件1186可例如由塑性轻质材料和/或任何其它合适的材料制成,而闩锁框架1184可例如由不锈钢和/或任何其它合适的材料制成。在某些实施例中,当闭锁机构1180关闭时,如图40所示,闩锁覆盖件1186可与第一柄部覆盖件1108对准。闩锁覆盖件1186可包括轮廓部分1187,其能够有助于外科医生操作外科器械1100,其中在至少一个实施例中,轮廓部分1187可与从第一柄部覆盖件1108延伸的突起1109对准或至少基本上与其对准。闭锁机构1180还可包括从中延伸的一个或多个锁臂1188,其能够接合从第二柄部部分104延伸的一个或多个闩锁突出1131并将突出1131牵拉和/或固定于凹槽1127内,如图40所示。在至少一个实施例中,锁臂1188中的至少一个可与闩锁框架1184一体地形成。在某些实施例中,参见图39,锁臂1188中的至少一个可包括远侧吊钩1189,其能够围绕突出1131的至少一部分卷绕,以包围或围绕、或至少部分地包围或围绕突出1131。在至少一个实施例中,锁臂1188可充当偏心闩锁以使闭锁机构1180保持在其锁闭或闭合位置。
在使用中,在各种情况下,第一柄部部分1102和第二柄部部分1104中的一者可定位在手术部位内的组织的第一侧上,同时另一柄部部分可旋转到所述组织的对侧就位。在此类实施例中,钉仓1150可定位在组织的一侧上并且砧座1130可定位在组织的另一侧上。此后,亦如上文所作概述,可致动闭锁机构1180使得其可在打开位置和闭合位置之间运动,以便将第二柄部部分1104锁闭至第一柄部部分1102并对定位在钉仓1150和砧座1130之间的组织施加夹紧力。在某些情况下,闭锁机构1180可在打开位置(图38)、部分闭合位置或中间位置(图39)和闭合位置(图40)之间运动。在至少一个此类实施例中,参见图38和39,闭锁机构1180可在其中锁臂1188未与突出1131接合的打开位置和其中锁臂1188与突出1131接合的部分闭合位置之间运动,使得尽管已使砧座1130至少部分地与钉仓1150相对,但砧座1130和钉仓1150之间可保持有足够间隙,从而可允许例如端部执行器1120相对于组织重新定位。一旦砧座1130和钉仓1150已相对于组织充分地定位,闭锁机构1180就可在其部分闭合位置和闭合位置之间运动,如图40所示。
在各种实施例中,除了上文所述,外科缝合器械还可包括偏置构件,其能够使缝合器械的第一柄部部分偏离第二柄部部分。在至少一个实施例中,如下文更详细地进一步描述,弹簧和/或任何合适的弹性材料可定位在第一柄部部分和第二柄部部分之间,使得缝合器械的砧座和钉仓可彼此偏离。在某些实施例中,弹簧能够至少部分地分离第一柄部部分和第二柄部部分,使得砧座和钉仓之间存在间隙,其中间隙可足以使组织定位在其间。在使用中,外科医生可定位此类外科缝合器械,而不必使第一柄部部分和第二柄部部分分离并保持彼此分开。当缝合器械处于部分闭合构型并且外科医生正在手术部位内操作该器械时,此类器械可能特别有用。在外科医生对缝合器械的定位感到满意之后,外科医生可压缩弹簧和/或使弹簧脱离并将缝合器械布置成闭合构型。
在各种情况下,如上面所概述,第一柄部部分1102的远端可相对于第二柄部部分1104的远端运动,特别是在闭锁机构1180与第二柄部部分1104的突出1131未接合或仅部分地接合时。在此类情况下,位于第一柄部部分和第二柄部部分近端处的突出1111和狭槽1115能够例如当第一柄部部分和第二柄部部分的远端相对于彼此运动时使至少第一柄部部分和第二柄部部分的近端保持在一起。换句话讲,突出1111和狭槽1115可相配合以防止或至少抑制第一柄部部分1102与第二柄部部分1104完全分离。在某些实施例中,第一柄部部分可包括第一锁定部,并且第二柄部部分可包括第二锁定部,其中第一锁定部和第二锁定部能够彼此接合并防止第一柄部部分与第二柄部部分完全分离。在至少一个实施例中,突出1111可包括第一锁定部并且狭槽1115可包括第二锁定部。先前的缝合器械缺少此类锁定部,相反其依靠唯一的闭锁机构使第一柄部部分和第二柄部部分保持在一起。在这样的情况下,其中这些先前的缝合器械的闭锁机构未与第一柄部部分和第二柄部部分两者完全接合,第一柄部部分和第二柄部部分可能会彼此完全分离,因此例如需要外科医生重新定位并重新装配柄部部分。在某些情况下,这些先前缝钉的第一柄部部分和第二柄部部分的完全分离可暴露切割构件的至少一部分。
在各种实施例中,如上面所概述,闭锁机构1180能够在打开位置、部分闭合位置和闭合位置之间运动。当闭锁机构1180位于其打开位置时,亦如上文所作概述,突出1111可插入狭槽1115中和/或从狭槽1115中移除。当闭锁机构1180位于其部分闭合位置时,参见图39,锁臂1188能够接合闩锁突出1131,使得无法从狭槽1115中移除突出1111。在至少一个此类实施例中,锁臂1188和闩锁突出1131能够防止或至少抑制第二柄部部分1104相对于第一柄部部分1102向远侧运动,并因此防止或至少抑制突出1111从狭槽1115脱离。相应地,锁臂1188和闩锁突出1131能够防止第一柄部部分1102相对于第二柄部部分1104向近侧运动。类似于上文所述,在各种实施例中,锁臂1188和闩锁突出1131也能够当闭锁机构1180位于其闭合位置(图40)时防止或至少抑制突出1111从狭槽1115移除。在某些实施例中,除了上文所述,闩锁突出1131可在位于其近端和远端中间的位置从第二柄部部分1104延伸。在至少一个此类实施例中,突出1111和狭槽1115能够使第一柄部部分和第二柄部部分在其近端处保持在一起,而闭锁机构1180可用于使第一柄部部分和第二柄部部分在中间位置处保持在一起。在任何情况下,在某些实施例中,第一柄部部分和第二柄部部分均无法彼此脱离,除非闭锁机构1180运动至其完全打开位置。在至少一个此类实施例中,当闭锁机构1180位于关闭和/或部分闭合位置时,突出1111和狭槽1115无法脱离彼此。
砧座1130和钉仓1150一旦被充分定位,则定位在砧座1130和钉仓1150中间的组织就可被缝合和/或切割。在各种实施例中,参见图36,外科缝合器械1100还可包括推杆组件1200,其能够例如使缝钉滑动件组件1160在钉仓1150内推进和/或回缩。在至少一个实施例中,推杆组件1200可包括推杆1202和击发致动器1204,其中击发致动器1204能够使推杆1202和缝钉滑动件组件1160向远侧运动以从钉仓1150部署缝钉并使缝钉紧靠砧座1130变形,如上所述。在至少一个实施例中,参见图44和45,缝钉滑动件1162可包括沟槽、通道或狭槽1161,其能够容纳推杆1202的远端1201(图36)并且能够可操作地连接到推杆1202的远端1201(图36)。在某些实施例中,将钉仓1150插入钉仓通道1122中时,缝钉滑动件组件1160能够可操作地与推杆1202接合。在至少一个实施例中,远端1201和狭槽1161可包括配合结构,其可使远端1201和狭槽1161在横向上装配,但防止或至少抑制远端1201和狭槽1161在近侧方向和/或远侧方向上彼此分离。在其它实施例中,推杆1202在接触并接合缝钉滑动件组件1160之前可向远侧推进。在至少一个此类实施例中,缝钉滑动件组件1160可保持静止,直至被推杆1202接触到为止。在任何情况下,如上文所概述,致动器1204可被可操作地连接到推杆1202,使得推力和/或拉力可被施加于致动器1204并传递到推杆1202。在某些实施例中,如下面更详细描述的,致动器1204可被枢转地连接到推杆1202的近端1203,使得致动器1204可在至少第一位置和第二位置之间有选择地旋转。
除了上文所述,参见图34、46和47,致动器1204可在外科缝合器械1100(图46)的第一侧1116上的第一位置、第二侧1117(图47)上的第二位置以及位于第一柄部部分1102的近端1103和第二柄部部分1104的近端1105的中间位置(图34)之间运动。一旦使致动器1204在第一侧1116和第二侧1117的一者上旋转就位,就可将致动器1204向远侧推进。因此,在各种情况下,外科医生可选择是使致动器1204沿着第一侧1116还是第二侧1117向远侧运动。可能会出现此类情况:例如当致动器1204沿着外科器械的一侧向远侧运动时,与沿着外科器械的另一侧相比,致动器1204更可能碰撞手术部位周围的组织。在各种实施例中,参见图35和36,致动器1204可包括从中延伸的臂1206,其中臂1206可以被枢转地安装于推杆1202的近端1203。在某些实施例中,再次参见图34、46和47,外科器械1100可包括沿着第一侧1116延伸的第一狭槽(未示出)和沿着第二侧1117延伸的第二狭槽1118,其中第一狭槽和第二狭槽能够滑动地容纳致动器1204的至少一部分。在至少一个实施例中,第一狭槽和第二狭槽的侧壁可限制或至少帮助限制致动器1204的运动,使得其可沿着预定路径运动。参见图47,例如第二狭槽1118可被限定于第一柄部部分1102和第二柄部部分1104之间,使得当致动器1204沿着第二侧1117向远侧运动时,致动器1204的臂1206可在第一柄部部分和第二柄部部分中间滑动。类似于上文所述,第一狭槽也可被限定于第一柄部部分和第二柄部部分中间。在各种实施例中,再次参见图46和47,外科器械1100还可包括中间狭槽1119,其也能够使臂1206和/或致动器1204的任何其它合适部分能够在其中滑动。在至少一个此类实施例中,中间狭槽1119可连接第一狭槽和第二狭槽,使得当致动器1204定位在其中间位置时,致动器1204可运动至第一位置和第二位置中的任何一者中。在某些实施例中,第一狭槽、第二狭槽1117和中间狭槽1119可彼此平行或至少基本上彼此平行和/或位于相同平面内,然而可预想到其它实施例,其中狭槽中的一者或多者与其它狭槽不平行和/或位于不同平面内。此外,尽管图示实施例的第一侧和第二侧位于外科器械1100的相对侧上,但可预想到其它实施例,其中第一狭槽和第二狭槽例如位于相邻侧和/或彼此不正对的侧上。此外,可预想到其它实施例,其中缝合器械的侧不易于分辨,例如具有圆形和/或弧形部分的器械。
在各种实施例中,除了上文所述,外科缝合器械1100还可包括锁定机构,其可防止或至少抑制致动器1204和相应的缝钉滑动件组件1160过早被推进。在至少一个实施例中,锁定机构能够在闭锁机构1180运动入闭合位置或至少部分闭合位置之前防止或至少抑制致动器1204向远侧推进。在某些实施例中,总体参见图38,外科缝合器械1100还可包括锁定机构1220,其可与致动器1204接合并可在闭锁机构1180处于完全打开位置(图38)和/或至少基本上打开位置时保持与致动器1204接合。在各种实施例中,锁定机构1220可包括锁扣1222,其可在例如由锁簧1224施加至其上的偏置力作用下偏压成与致动器1204接合。在至少一个此类实施例中,致动器1204可包括一个或多个沟槽、通道或狭槽(未示出),其能够容纳锁扣1222的至少一部分。在使用中,锁定机构1220可使致动器1204保持就位,直至闭锁机构1180运动入其完全闭合位置(图40)和/或至少基本上闭合位置。在此类情况下,在至少一个实施例中,闭锁机构1180能够接合锁定机构1220并使锁扣1222从致动器1204脱离。在至少一个此类实施例中,参见图38-40,闭锁机构1180还可包括凸轮1183,其能够在当闭锁机构1180运动入其闭合位置时接合锁扣1222上的凸轮表面1223,并因此使锁扣1222从致动器1204滑开和/或以其它方式运动开。在各种实施例中,凸轮1183可包括从闩锁覆盖件1186和/或闩锁框架1184延伸的壁、肋和/或脊。在任何情况下,一旦锁扣1222已充分从致动器1204脱离,则在至少一个实施例中,致动器1204就可从图34所示的其中间位置运动至图46和47所示的其第一位置和第二位置中的一者中。
如上所述,锁定机构1220能够例如在闭锁机构1180运动入例如闭合位置和/或部分闭合位置等预定位置之前,防止或至少抑制驱动棒1202向远侧推进。有利的是,锁定机构1220也可在将第一柄部部分1102和第二柄部部分1104装配在一起之前,防止或至少抑制缝钉滑动件组件1160推进。事实上,锁定机构1220可防止定位在砧座1130和钉仓1150中间的组织在砧座1130和钉仓1150相对于该组织正确定位之前被切割和/或缝合。另外,事实上,锁定机构1220可防止缝钉在对组织施加适当的夹紧力之前被部署至组织。在任何情况下,当闭锁机构1180返回其完全打开位置和/或部分打开位置时,凸轮1183可从锁扣1222运动开,使得锁簧1124可再一次将锁扣1222偏压成与致动器1204接合。在多个其它实施例中,参见图38和39,锁定机构1220’可包括具有凸轮表面1223’的锁扣1222’,此外还包括可限制锁扣1222’的相对运动的止挡件1226’。在至少一个实施例中,例如凸轮1183能够接触凸轮表面1223’,并且由于凸轮表面1223’的带轮廓的、斜的和/或倾斜表面,凸轮1183能够向远侧驱动锁扣1222’,如图49所示。可向远侧驱动锁扣1222’,使得从锁扣1222’延伸的销1228’可在第一位置(图48)和第二位置(图49)之间运动,其中位于第一位置时其定位在致动器1204’的孔1229’内,而位于第二位置时销1228’已从孔1229’充分移除。在各种实施例中,止挡件1226’能够使得在向远侧驱动锁扣1222’时,一旦锁扣1222’充分移位,则止挡件1226’就可与凸轮1183接触。在此类实施例中,止挡件1226’能够控制锁扣1222’的第二位置或已移位的位置。类似于上文所述,当致动器1180运动出其闭合位置并且凸轮1183已脱离锁定机构1220’时,锁簧1224’可再次使锁扣1222’运动成与致动器1204’接合。
在各种实施例中,如上所述,可利用击发致动器在第一位置和第二位置之间运动推杆、缝钉滑动件和/或切割构件。如上另外所述,例如推杆组件1200可用于例如在近侧位置(图43)和远侧位置之间运动缝钉滑动件组件,例如缝钉滑动件组件1160。在某些实施例中,诸如钉仓1150之类的钉仓例如可包括包含在其中的缝钉滑动件组件1160,其中缝钉滑动件组件1160可在钉仓装配至钉仓通道1122或插入钉仓通道1122内时定位在近侧位置,如图43所示。在至少一个此类实施例中,参见图41-43,钉仓1150还可包括外壳1170,其能够例如当缝钉滑动件组件1160位于其近侧位置时覆盖切割构件1164的至少一部分。在各种实施例中,外壳1170能够例如在抓握钉仓时、在将钉仓插入外科缝合器和/或将外科缝合器的两个或更多个部分装配在一起时对外科医生进行保护。在至少一个此类实施例中,切刃1165的至少上部可延伸到钉仓1150的平台或顶部表面1158上方,并且如果缺少保护外壳例如外壳1170,则切刃1165的上部可能会暴露。
在各种实施例中,如上所述,切割构件1165可至少部分地定位在狭槽或通道1156内,并且如图43所示,切割构件1164的至少上部或顶部可延伸到平台1158上方。在至少一个实施例中,参见图41-43,外壳1170可包括从钉仓主体1152的第一部分1157延伸的第一壁或部分1172,从钉仓主体1152的第二部分1159延伸的第二壁或部分1174,以及在第一壁1172和第二壁1174之间延伸的顶壁或顶部1176。在某些实施例中,外壳可包括仅一个从钉仓主体延伸的支撑壁或支撑部分,此外还包括从其延伸的顶壁或顶部。在其它实施例中,外壳可包括一个或多个侧壁或部分,并且不包括顶壁。在至少一个此类实施例中,外壳的侧壁能够例如使得它们延伸到切割构件的顶部上方,或至少延伸到切割构件的切刃上方。在任何情况下,如图43所示,当缝钉滑动件组件1160位于其近侧位置时,切割构件1164的至少一部分可定位在顶壁1176下面和/或侧壁1172和1174之间。在某些实施例中,切割构件1164可完全定位在顶壁1176下面,和/或完全定位在外壳1170内。在至少一个实施例中,切割构件1164可定位在顶壁1176下面,使得切割表面1165不延伸超过顶壁1176的远侧边缘1175和/或近侧边缘1177。在至少一个实施例中,外壳1170可包括后壁1178,其能够限制缝钉滑动件组件1160的切割构件1164和/或任何其它部分的近侧运动。在各种实施例中,外壳1170的至少一部分例如可与钉仓主体1152一体地形成。在至少一个此类实施例中,例如当注塑钉仓主体1152时,可形成第一壁1172、第二壁1174、顶壁1176和/或后壁1178。在某些实施例中,外壳1170的至少一部分可通过搭扣配合方式、压合方式和/或任何其它合适的方式装配至钉仓主体1152。
在各种实施例中,除了上文所述,切割构件1164可由平坦或至少基本上平坦的主体限定,该主体具有沿着切割构件主体的至少一侧延伸的刀刃。在至少一个此类实施例中,第一壁1172和/或第二壁1174可被构造和布置成使得它们可包括平坦或至少基本上平坦的内表面1173,其与切割构件1164的侧面平行或至少基本上平行。在某些实施例中,可在侧壁1172和1174的内表面1173之间贴近地容纳切割构件1164。在至少一个此类实施例中,壁1172和1174之间的距离可与狭槽1156的宽度相同或至少基本上相同。在任何情况下,外壳能够使得例如外壳的至少一部分延伸到狭槽1156的至少一部分之上。在某些实施例中,外壳1170可完全包封或围绕切割构件1164和/或切割表面1165。在至少一个实施例中,虽然未示出,但外壳可包括可断开和/或可切割部分,其可至少部分地分离、分隔和/或以其它方式变形,以便允许切割构件退出外壳。在至少一个此类实施例中,组织切割表面能够例如与外壳接触以断开和/或切割外壳壁。在各种实施例中,外壳壁可包括薄的部分、厚度减小的部分、划痕和/或任何其它构型以便于外壳壁的变形和/或切割。在某些实施例中,切割构件例如可包括一个或多个额外的切割表面和/或砧座,其能够使外壳变形和/或切割外壳。在至少一个实施例中,外壳可包括活动的和/或柔韧的部分,例如铰接构件和/或柔韧的翼,其能够充分运动和/或挠曲以使切割构件能够通过。在任何情况下,可预想到这样的实施例,其中切割构件可具有用来切割组织的任何合适构型,并且保护外壳可具有至少部分地包封或围绕切割构件的任何合适构型。此外,尽管切割构件可包括上述锋利刀刃,但可预想到其它合适的切割构件,例如那些供给有足以切开组织的电流的切割构件。
如上所述,外壳1170能够当它处于其近侧位置时至少部分地覆盖、包封和/或围绕切割构件。在各种实施例中,切割构件例如可向远侧推进以切割组织,并且随后向近侧回缩以便再次将切割构件定位在外壳1170内。在此类实施例中,将钉仓装配至外科缝合器械以及从外科缝合器械中取出钉仓时,切割构件可至少部分地被外壳1170覆盖。在某些实施例中,新的或未用完的钉仓可插入钉仓通道内以替换至少部分用尽的钉仓。在至少一个此类实施例中,新钉仓可包括定位在其中的新切割构件和/或缝钉滑动件组件,但可预想到这样的实施例,其中之前使用的切割构件和/或缝钉滑动件组件可从用尽的钉仓充分退出并推进至新钉仓中以便再次使用。在其中每个新钉仓均设有新切割构件和/或缝钉滑动件组件的实施例中,每个钉仓可使用例如锋利刀刃。
在各种实施例中,尽管未示出,但钉仓可包括两个或更多个外壳,其能够当钉仓处于两个或更多个位置时至少部分地覆盖切割构件。在至少一个实施例中,钉仓可包括近侧外壳,其能够例如当钉仓处于其近侧位置时至少部分地覆盖切割构件,并且此外还包括远侧外壳,其能够例如当钉仓处于其远侧位置时至少部分地覆盖切割构件。在至少一个此类实施例中,将钉仓装配至外科缝合器械时切割构件可定位在近侧外壳内,并且在某些实施例中,切割构件在横切了例如定位在端部执行器内的组织之后可被推进至远侧外壳内。因此,在此类实施例中,当从外科缝合器中移除钉仓时,切割构件可至少部分地定位在远侧外壳内。当血管例如定位在钉仓的近侧外壳和远侧外壳中间时,此类实施例可能特别有用。在各种实施例中,虽然未示出,但切割构件可从远侧位置向近侧运动至近侧位置,和/或任何其它合适的位置。
在各种实施例中,如上文所述,可将钉仓1150插入钉仓通道1122内。现在参见图92,钉仓1150的近端1213可定位在钉仓通道1122的近端1123内,而钉仓1150的远端1211可定位在钉仓通道1122的远端1121内。在至少一个实施例中,钉仓通道1122的远端1121可包括一个或多个突出和/或一个或多个凹槽,所述一个或多个突出和/或一个或多个凹槽可例如相应地与钉仓1150的远端1211的一个或多个突出和/或一个或多个凹槽对准。在至少一个此类实施例中,钉仓通道1122的每个侧壁1124可包括突出或突出部1279以及凹槽或狭槽1278,其中钉仓1150的每个侧可包括(参见图95)能够定位在凹槽1278内的突出1274和此外能够容纳突出1279的凹槽1270。在各种实施例中,钉仓1150的每个凹槽1270可包括相对的侧壁1272和1273以及远侧表面1271,其中当钉仓1150定位在钉仓通道1122中时,远侧表面1271可紧靠定位在其中的突出1279进行定位。在各种情况下,如下文更详细所述,凹槽1270的远侧表面1271可充当基准面,可从所述基准面预定钉仓1150的某些特征。在一些情况下,可在钉仓1150的近端1213插入钉仓通道1122的近端1123内之前将钉仓1150的远端1211与钉仓通道1122的远端1121对准和/或插入钉仓通道1122的远端1121内。例如,钉仓通道1150的远端1211可与钉仓通道1122对准以使得突出1279定位在凹槽1270内,其中随后可朝钉仓通道1122来摇动或旋转钉仓1150以使得钉仓1150的近端1213插入钉仓通道1122的近端1123内。
当钉仓1150的远端1211与钉仓通道1122的远端1121接合时,如上文所述,可通过将突出1274钩挂在钉仓通道1122的突出1278下面来将钉仓1150的突出1274插入钉仓通道1122的凹槽1279内。在这种情况下,突出1274和1278以及凹槽1270和1279的协作可将钉仓1150的远端1211附接至钉仓1122的远端并且另外可将钉仓1150与钉仓通道1122对准,使得钉仓1150可插入钉仓通道1122的侧壁1124之间。一旦钉仓1150的远端1211已钩挂至钉仓通道1122,钉仓1150和钉仓通道1122中的至少一者就可朝另一者进行旋转。在各种情况下,再次参见92和95,钉仓1150可朝钉仓通道1122进行枢转以使得钉仓通道1150中的对准狭槽1280变得与侧凸缘1128对准。在各种实施例中,钉仓1150可包括位于其相对侧上的对准狭槽1280,所述对准狭槽1280各自能够容纳侧凸缘1128。在至少一个实施例中,各个对准狭槽1280可包括横向侧壁1283和1284以及在侧壁1283和1284之间延伸的基壁1281。除了上文所述,可测量从凹槽1270的远侧基准面1271到对准狭槽1280的远侧底壁1281的预定的距离1289。现在参见图93和95,使得突出1279的远端和侧凸缘1128的远端之间的预定的距离1288可短于凹槽1270的远侧表面1271和对准狭槽1280的基壁1281之间的距离1289。由于距离1288短于距离1289,因此钉仓1150可旋转就位(如上文所述)以使得侧凸缘1128可进入对准狭槽1280。在各种实施例中,对准狭槽1280的尺寸和构型被设定成使得侧凸缘1128被贴近地容纳在侧壁1283和1284之间,使得例如在侧凸缘1128和对准狭槽1280的侧壁之间存在极少(如果有的话)的相对运动。
在各种替代实施例中,除了上文所述,可将钉仓1150的近端1213插入钉仓通道1122的远端1121内并且在侧壁1124之间向近侧滑动,以使得钉仓通道1150的近端1213进入钉仓通道1122的近端1123。在这种滑动运动期间,侧凸缘1128可进入对准狭槽1280,并且另外突出1279可进入凹槽1270。在某些实施例中,可将钉仓1150滑动和旋转到钉仓通道1122内。在任何情况下,在各种实施例中,钉仓1150和钉仓通道1122能够使得钉仓1150能够可拆卸地固定在钉仓通道1122内。在至少一个实施例中,现在主要参见图95和100,钉仓1150可包括一个或多个保持结构,所述一个或多个保持结构能够可释放地接合钉仓通道1122中的一个或多个保持结构。更具体地,在至少一个此类实施例中,钉仓1150可包括一个或多个保持狭槽1190,所述一个或多个保持狭槽能够接合钉仓通道1122中的一个或多个保持键1195。在各种实施例中,再次参见图95,每个保持狭槽1190可包括第一或入口部分1191和另外的第二部分1192,所述第一或入口部分1191能够在其中容纳保持键1195,所述第二部分1192能够在保持键1195穿过入口部分1191之后容纳该保持键1195。在某些实施例中,入口部分1191可限定位于保持狭槽1190的近侧侧1193和远侧侧1194之间的第一宽度,并且另外第二部分1192可限定位于近侧侧1193和远侧侧1194之间的第二宽度,所述第二宽度比入口部分1191的第一宽度宽。在各种实施例中,入口部分1191的第一宽度可比保持键1195的宽度更窄,并且第二部分1192的第二宽度可比保持键1195的宽度宽。在至少一个此类实施例中,保持狭槽1190能够以压合和/或搭扣配合方式中的至少一种来接合保持键1195。在某些实施例中,近侧侧1193和/或远侧侧1194中的至少一者能够当将保持键1195插入保持狭槽1190内时向外挠曲或扩张。在至少一个此类实施例中,近侧侧1193可向近侧移位。在任何情况下,参见图100,一旦保持狭槽1190已容纳保持键1195,则保持狭槽1190的近侧侧1193就可定位在保持键1195的近侧侧1196上并且保持狭槽1190的远侧侧1194就可定位在保持键1195的远侧侧1197上。
如上文所概述,可通过将钉仓1150的远端1211联接至钉仓通道1122的远端1121并且随后将钉仓1150的近端1213旋转到钉仓通道1122的近端1123内来将钉仓1150装配到钉仓通道1122内。在至少一个此类实施例中,保持狭槽1190能够当钉仓1195旋转到其在钉仓通道1122中的坐置位置内时接合保持键1195。现在参见图93,凹槽1270的远侧基准面1271和保持狭槽1190之间的预定的距离1199的尺寸和构型被设定成使得当钉仓1150旋转就位(如上文所述)时保持狭槽1190与保持键1195对准。因此,在至少一个实施例中,突出1279和保持键1195的远端之间的距离可等于、或至少基本上等于距离1199。在各种情况下,上述距离可被测量至包括保持狭槽1190和保持键1195的结构的中心。例如,距离1199可被测量至例如位于狭槽1190的近侧侧壁和远侧侧壁中间的中心处的位置。在各种实施例中,保持狭槽1190还可包括能够将保持键1195引导或导向到保持狭槽1190内的引入、倾斜、和/或圆角表面。在至少一个此类实施例中,这些引入表面可比第一部分1191宽。
当钉仓1150旋转到钉仓1122内时,定位在钉仓1150内的切割构件和/或缝钉部署滑动件能够可操作地与推杆1202接合。更具体地,现在参见图97-99,钉仓1150可包括切割构件1160,所述切割构件1160能够可操作地与推杆1202联接以使得在钉仓1150已坐置在钉仓通道1122内之后,推杆1202和切割构件1160可一起推进,如上文所述。在至少一个实施例中,切割构件1160可包括狭槽1161,所述狭槽1161能够容纳推杆1202的远端处的远侧驱动突出1294(图93)。更具体地,现在参见图101,切割构件1160的狭槽1161可与钉仓1150底面中的接入狭槽1290对准以使得当钉仓1150的近端1213坐置在钉仓通道1122的近端1123中时,推杆1200的驱动突出1294可穿过接入狭槽1290延伸到切割构件1160的狭槽1161内。在各种实施例中,狭槽1161和驱动突出1294的尺寸和构型被设定成使得在两者间存在极少(如果有的话)的相对运动。更具体地,再次参见图98和99,狭槽1161可包括远侧侧壁1291和近侧侧壁1292,其中驱动突出1294可固定地容纳在侧壁1291和1292之间。在各种实施例中,再次参见图93和101,推杆1202还可包括相对于驱动突出1294向近侧定位的凹槽或狭槽1295,其中狭槽1295能够容纳从切割构件1160延伸的近侧突出1293(图97)。类似于上文所述,可通过侧壁来限定狭槽1295,所述侧壁能够贴近地容纳近侧突出1293以使得两者间存在极少(如果有的话)的相对运动。
如上文所述,切割构件1160的狭槽1161可定位在钉仓1150内以使得其在钉仓1150坐置在钉仓通道1122内时与推杆1202的驱动突出1294对准。现在参见图96,可在凹槽1270的远侧表面1271和狭槽1161之间限定预定的距离1299,其中距离1299可等于或至少基本上等于突出1279的远端和驱动突出1294之间的预定的距离1297。在各种情况下,切割构件1160可运动穿过在最近侧位置(其定位在外壳1170中的位置)和最远侧位置(其已通过切割狭槽1156进行推进后)之间的位置范围。在各种实施例中,可在切割构件1160处于其最近侧位置时相对于该切割构件1160来测量距离1299。类似于上文所述,距离1297和1299可分别测量至驱动突出1297和狭槽1161的中心或中点。在各种实施例中,外科器械1100还可包括锁定机构,所述锁定机构能够当切割构件1160与驱动突出1294接合时来将推杆1202保持就位。类似于上文所述,在某些实施例中,可在突出1279的远端和推杆1202的凹槽1295之间限定距离1298,其中距离1298可等于或至少基本上等于凹槽1270的远侧表面1271和切割构件1160的突出1293之间的距离。在各种实施例中,现在主要参见图97和100,钉仓1150可包括限定在钉仓主体1152的近端1295和钉仓底盘1154的近端1294之间的间隙区域,其中这种间隙区域能够例如在其中容纳推杆1202和/或钉仓通道1122的一部分。在任何情况下,一旦推杆1202已与切割构件1160接合就可将其向远侧推进,其中这种运动示于图100中,该图示出了例如处于近侧位置(以实线示出)和第二远侧位置(以虚线示出)中的推杆1202的远端1201。
在各种实施例中,如上文所述,可将钉仓1150的远端1211与钉仓通道1122的远端1121接合并且随后枢转到钉仓通道1122内,使得钉仓1150的近端1213可坐置在钉仓通道1122的近端1123内。此过程可包括将钉仓1150的突出1274接合在钉仓通道1122的突出1276下面并且随后如上文所述来旋转钉仓1150直至对准狭槽1280邻近凸缘1182定位。此时,在各种实施例中,切割构件1160可未与推杆1202接合,并且另外保持狭槽1190可未与保持键1195接合。因此,外科医生或临床医生可在将钉仓1150锁定就位之前来调整钉仓1150在钉仓通道1122内的位置。一旦侧凸缘1182已至少部分地定位在对准狭槽1280内,近端1213就可进一步地朝钉仓通道1122旋转。此时,切割构件1160可实现与推杆1202的可操作接合,并且另外保持狭槽1190可接合保持键1195。在各种实施例中,切割构件1160能够与保持狭槽接合保持键1195同时或基本上同时可操作地接合推杆1202。更具体地,在至少一个实施例中,在保持键1195进入或按扣到狭槽1190的第二部分1192内的同时,推杆1202的驱动突出1294可进入切割构件1160的狭槽1161。在至少一个此类实施例中,直到钉仓1150按扣或坐置就位才可通过推杆1202来推进切割构件1160。在某些替代实施例中,当钉仓1150的近端1213坐置到钉仓通道1122的近端1123内时,切割构件1160可在保持键1195完全坐置到保持狭槽1190内之前与推杆1202可操作地接合。在各种实施例中,保持狭槽1190可彼此对准以使得它们同时地或至少基本上同时地接合保持键1195。在至少一个此类实施例中,保持狭槽可使得保持键1195同时进入保持狭槽1190的第二部分1192。在至少一个实施例中,可沿如下轴线来定位保持狭槽1190,所述轴线横向于或垂直于由切割狭槽1156限定的纵向轴线。在各种实施例中,保持狭槽1190以及其间限定的轴线可相对于切割构件1160向近侧定位,无论切割构件1160的位置如何,例如包括当切割构件1160处于其最近侧位置时。
在各种实施例中,切割狭槽1156可限定位于其第一侧上的第一主体部分1152a和位于其第二或相对侧上的第二主体部分1152b。参见图95和98,第一主体部分1152a可包括第一多个缝钉腔1151,并且另外第二主体部分1152b可包括第二多个缝钉腔1151。在至少一个实施例中,第一主体部分1152a可包括最近侧缝钉腔1151a,所述最近侧缝钉腔可相对于第一主体部分1152a的其它缝钉腔1151向近侧定位。在至少一个实施例中,整个缝钉腔1151a可相对于第一主体部分1152a中的对准狭槽1280的基壁1281向近侧定位,而在其它实施例中,缝钉腔1151a的至少一部分可相对于基壁1281向近侧定位。如图97所示,第一主体部分1152a中的对准狭槽1280可相对于最近侧缝钉腔1151a横向地并且另外相对于切割狭槽1156横向地定位。除了上文所述,第一主体部分1152a可包括第二最近侧缝钉腔1151c,所述第二最近侧缝钉腔可相对于第一主体部分1152a中除最近侧缝钉腔1151a之外的其它缝钉腔1151向近侧定位。在至少一个实施例中,整个缝钉腔1151c可相对于第一主体部分1152a中的对准狭槽1280的基壁1281向近侧定位,而在其它实施例中,缝钉腔1151c的至少一部分可相对于基壁1281向近侧定位。如图97所示,第一主体部分1152a中的对准狭槽1280相对于第二最近侧缝钉腔1151c至少部分地横向定位。仍参见图97,第一主体部分1152a可包括其中的保持狭槽1190,所述保持狭槽1190可相对于其中的缝钉腔1151(例如包括缝钉腔151a和1151c)向近侧定位。
参见图95,除了上文所述,第二主体部分1152b可包括最近侧缝钉腔1151b,所述最近侧缝钉腔可相对于第二主体部分1152b中的其它缝钉腔1151向近侧定位。在至少一个实施例中,整个缝钉腔1151b可相对于第二主体部分1152b中的对准狭槽1280的基壁1281向近侧定位,而在其它实施例中,缝钉腔1151b的至少一部分可相对于基壁1281向近侧定位。如图95所示,第二主体部分1152b中的对准狭槽1280相对于最近侧缝钉腔1151b和切割狭槽1156横向地定位。除了上文所述,第二主体部分1152b可包括第二最近侧缝钉腔1151d,所述第二最近侧缝钉腔可相对于第二主体部分1152b中除最近侧缝钉腔1151b之外的其它缝钉腔1151向近侧定位。在至少一个实施例中,整个缝钉腔1151d可相对于第二主体部分1152b中的对准狭槽1280的基壁1281向近侧定位,而在其它实施例中,缝钉腔1151d的至少一部分可相对于基壁1281向近侧定位。如图95所示,第二主体部分1152b中的对准狭槽1280相对于第二最近侧缝钉腔1151d至少部分地横向定位。仍参见图95,第二主体部分1152b可包括其中的保持狭槽1190,所述保持狭槽可相对于其中的缝钉腔1151(例如包括缝钉腔1151b和1151d)向近侧定位。
在各种实施例中,除了上文所述,钉仓主体1152可由塑料构成并且可利用注塑方法形成。其后,在各种实施例中,可将缝钉驱动器1168(图42)装配到缝钉腔1151内并且可将切割构件1160定位到钉仓主体1152内,使得切割构件1164位于外壳1170内,如上文所述。然后可将钉仓底盘1154装配至钉仓主体1152。在各种实施例中,现在参见图96,钉仓底盘1154的远端1277可与钉仓主体1152的近端1295对准,使得例如钉仓主体可在钉仓底盘1154内在相对壁1154a和1154b之间滑动。在底盘突出1276定位到凹槽1270内并且突出1274定位到底盘凹槽1275内之前,钉仓主体1152和底盘1154可相对于彼此进行滑动。同时,从钉仓主体1152延伸的锁突出1288可容纳在钉仓底盘1154中的锁孔1287内,以使得底盘1154可锁定至钉仓主体1152。在各种实施例中,1154的侧壁1154a和1154b在经过锁突出1288时可向外挠曲或扩张并且随后当锁孔1287与锁突出1288对准时可向内弹性返回。此时,从底盘1154延伸的臂1155可与钉仓主体1152中的保持狭槽1287对准并且定位在所述保持狭槽1287内。在某些实施例中,现在参见图101,钉仓1150还可包括保持构件,例如保持构件1300,例如所述构件能够例如选择性地阻挡钉仓主体1152中的狭槽1301。在至少一个实施例中,保持构件1300可包括可枢转臂1303,所述可枢转臂可在其横跨狭槽1301延伸的第一位置(示为实线)和其邻近狭槽1301定位的第二位置(示为虚线)之间进行旋转。在至少一个此类实施例中,一体式枢轴销1302(图95)可从臂1303延伸到钉仓主体1152中的孔内,所述一体式枢轴销1302可限定臂1303可绕其旋转的轴线。在某些实施例中,臂1303可包括从其延伸的锁定构件1304,所述锁定构件1304能够与钉仓主体1152中的锁腔体1305可释放地接合,以便将臂1303保持在例如其第一位置和第二位置中的至少一者中。在某些实施例中,横跨狭槽1301的臂1303的定位可防止或至少抑制切割构件1160例如从钉仓1150滑出。
为了有利于从钉仓通道1122插入和移除钉仓1150,在各种实施例中,钉仓1150可例如包括定位在其相对侧上的抓握部分。在至少一个实施例中,现在参见图97和101,钉仓主体1152可包括邻近对准狭槽1280定位的横向部分1285,其中横向部分1285可由临床医生抓握和/或推进,以便例如将钉仓1150的近端1213坐置到钉仓通道1122的近端内。当将钉仓1150的近端1213旋转就位时(如上文所述),可将这样的力施加至横向部分1285的顶部或组织接触表面。在各种实施例中,可将提升力施加至横向部分1285,以便从钉仓通道1122提出钉仓1150的近端1213。在至少一个此类实施例中,主要参见图101,每个横向部分1285可包括一个或多个步位、脊、和/或抬高件,例如抬高件1287a,1287b和/或1287c,所述步位、脊、和/或抬高件例如能够改善临床医生对于横向部分1285的抓握。在各种实施例中,抬高件1287a,1287b和/或1287c可相对于彼此定位在不同的高度。在任何情况下,可通过下述方式从通道1122移除钉仓1150:例如,将钉仓1150的近端1213从通道1122提出并且随后将钉仓1150的远端1211从通道1122的远端1121取下或使其脱离。当钉仓1150从通道1122移除时,切割构件1160内的狭槽1161可例如从推杆1202的驱动突出1294移开和脱离。
在各种情况下,除了上文所述,推杆1202和切割构件1160可在从钉仓通道1122移除钉仓1150之前返回其近侧位置。在这种位置下,如上文所述,切刃1165可定位在外壳1170内。在各种实施例中,现在参见图102,示出了不存在外壳1170的钉仓1150’的替代实施例。在至少一个此类实施例中,切刃1165可例如在其近侧位置和/或任何其它向远侧推进位置中至少部分地在钉仓主体1152的平台表面1158上方延伸。
在各种实施例中,除了上文所述,砧座1130可包括一个或多个孔、狭槽或凹槽1179(图50),其能够例如当砧座1130与钉仓1150紧密相对时容纳外壳1170的至少一部分。在至少一个实施例中,外壳1170和凹槽1179之间可存在足够的间隙,使得砧座1130和钉仓1150可相对于彼此运动,并且两者间没有干涉或至少基本上没有干涉。在上面概述的具有不止一个切割构件外壳的实施例中,相对的砧座可具有不止一个用于容纳外壳的对应孔。在各种实施例中,砧座可包括活动的切割构件和至少一个外壳,用于至少部分地覆盖、包封和/或围绕切割构件。在某些实施例中,虽然未示出,但砧座和钉仓两者均可包括至少一个可动的切割构件和/或至少一个外壳,其能够例如当它们位于近侧位置时至少部分地覆盖、围绕或包封切割构件。
如上面所概述,推杆组件1200可向远侧推进以便使缝钉滑动件组件1160运动至钉仓组件1150内。在各种实施例中,如上面另外所概述,缝钉滑动件1162的楔状凸轮表面1167可运动至与缝钉驱动器1168上的倾斜表面1169接合,以依次和/或同时驱动钉仓1150中的缝钉紧靠砧座1130并使缝钉形成任何合适的构型,例如B形构型。在至少一个此类实施例中,参见图50,砧座1130可包括一个或多个缝钉成形表面,例如缝钉凹坑1132,其能够使缝钉变形。在某些实施例中,砧座1130还可包括狭槽、通道或沟槽1133,其能够例如可滑动地容纳缝钉滑动件1162、切割构件1164和/或推杆1202的至少一部分。在至少一个实施例中,虽然未示出,但砧座可包括砧板,其可固定地和/或不可动地定位在限定于砧座内的砧座通道内。在多个其它实施例中,如图51和52所示以及下面更详细描述的,砧座1130可包括可动地定位在砧座通道1136内的砧板1134。在某些实施例中,砧座通道1136可包括相对的侧壁1137,此外还包括在侧壁1137之间延伸的基部1138。在至少一个实施例中,砧座1130还可包括例如装配至其上的远侧前缘部分1139,其中前缘部分1139能够例如压合和/或搭扣配合至砧座通道1136内,使得前缘部分1139可牢固地保持在其中。在某些实施例中,前缘部分1139可由柔性和/或柔韧材料构成,例如橡胶,并且可具有任何合适形状,其可有助于例如将砧座1130插入手术部位内。在一些实施例中,参见图51,前缘部分(例如前缘部分1139’)可通过一个或多个紧固件1139a’保持至砧座。类似地,参见图34,钉仓通道和/或钉仓(例如钉仓1150)可包括前缘部分,例如前缘部分1153,其可有助于例如将钉仓1150插入手术部位内。
如上面所指出的那样,缝钉可从钉仓部署并紧靠砧座变形。在各种情况下,砧座1130和缝钉滑动件1162上的缝钉成形表面之间的距离可决定缝钉变形的程度。例如,如果砧座1130上的砧座凹坑1132和缝钉滑动件1162上的顶部表面1135(图43-45)之间的距离相对较大,则与砧座凹坑1132和滑动件表面1135之间的距离相对较小时相比,缝钉所变形的程度会较小。相应地,如果砧座凹坑1132和滑动件表面1135之间的距离相对较小,则与砧座凹坑1132和滑动件表面1135之间的距离相对较大时相比,缝钉所变形的程度会较大。通常,砧座凹坑1132和滑动件表面1135之间的距离称为缝钉的成形高度。有时可在钉仓的顶部表面或平台和砧座上的缝钉成形表面之间测量缝钉的成形高度。然而,就本专利申请而言,任何涉及缝钉成形高度等的内容均可酌情包括一种或两种测量方式和/或任何其它合适的测量方式。在任何情况下,如下文更详细描述的,外科缝合器械(例如缝合器械1100)可包括用于调整缝钉成形高度的装置。
在各种实施例中,除了上文所述,砧座可包括一个或多个成形表面,其可朝向和/或远离钉仓运动,以便设定缝钉的成形高度。在至少一个实施例中,参见图50-56,砧座1130可包括砧板1134,其可以可运动和/或可滑动地定位在砧座通道1136内。在某些实施例中,砧座1130还可包括一个或多个保持销或导销1140,其中砧板1134可包括一个或多个保持槽或导向槽1141,其能够滑动地容纳销1140的至少一部分。在至少一个此类实施例中,销1140和/或槽1141能够限定预定路径,砧板1134可沿着该预定路径运动。参见图51,销1140和槽1141被构造和布置成使得砧板1134可沿着线性、或至少基本上线性的路径运动,其中线性路径可至少部分地由例如轴线1142和1143限定。还可预想到其它实施例,其中砧板可沿着非线性路径,例如弯曲和/或曲线路径运动。在某些实施例中,销1140的至少一部分可保持在侧壁1137的孔1144内,其中,在至少一个实施例中,销1140可被压合于孔1144内。在任何情况下,如本文所述,销1140可随着例如其朝向和/或远离钉仓1150运动而引导砧板1134。
在各种实施例中,除了上文所述,外科缝合器械(例如缝合器械1100)可包括一个或多个调整构件,所述调整构件能够定位砧座的一部分(例如砧板1134)相对于砧座组件其它部分和/或相对的钉仓的位置。在某些实施例中,参见图51和52,缝合器械1100可包括砧板调整构件1230,该构件能够限制砧板1134的运动范围。在至少一个此类实施例中,参见图120和121,调整构件1230可定位在砧板1134中间的第一位置,其中调整构件1230的第一表面或步位1231定位在砧座通道1136的基部1138和砧板1134上的第一定位表面1145中间。在这样的第一位置,第一步位1231可限定砧板1134和砧座通道1136之间可能或允许的相对运动量。例如,当如上所述砧座1130紧靠组织夹紧时,砧板1134可接触组织并朝基部1138向上滑动,直到第一定位表面1145接触第一步位1231。一旦表面1145和步位1231接触,调整构件1230即可防止或至少抑制砧板1134进一步朝基部1138运动。在至少一个此类实施例中,因此,调整构件1230可作为止挡件,使得基部1138和砧板1134上的组织接触表面1148之间的距离可由第一距离1234限定。虽然本例中基部1138用作参考基准,但砧座1130的其它部分和/或相对的钉仓例如也可用作参考基准。当调整构件1230位于其第一位置时,如上所述,调整构件1230的第二表面或步位1232可定位在基部1138和砧板1134上的第二定位表面1146中间,此外,第三表面或步位1233可定位在基部1138和第三定位表面1147中间。参见图53,调整构件1230可包括两组或更多组步位1231,1232和/或1233,并且砧板1134可包括两组或更多组定位表面1145,1146和/或1147。虽然第一步位1231和第一定位表面1145如上文所述能够控制砧板1134的位置,但调整构件1230的第二步位1232和第三步位1233以及砧板1134的第二定位表面1146和第三定位表面1147分别也能够控制砧板1134的位置。虽然为简洁起见,本例将针对第一表面或步位1231被描述为控制砧板1134位置的表面,但是读者应当理解,步位1232和1233也可控制砧板1134的位置。
在某些实施例中,调整构件1230的第一位置可提供相对较小或较短的缝钉成形高度。在其它实施例中,尽管未示出,但调整构件的第一位置可提供中等、相对较大和/或任何其它合适的缝钉成形高度。在与调整构件第一位置相关的成形高度合适的情况下,外科医生可如上文所述着手用外科缝合器械缝合和/或切割组织。然而,在缝钉成形高度不合适的情况下,外科医生或其它临床医生可运动调整构件1230,使得当砧板1134接触定位在砧座1130和钉仓1150中间的组织时,调整构件1230可允许砧板1134向上滑动另一段距离。在至少一个此类情况下,允许砧板1134向上滑动的距离可以更大,从而提供更大的缝钉成形高度。相应地,在其它情况下,可运动调整构件,使得例如当砧板1134接触组织时,砧板1134可向上滑动较短的距离,从而提供更短的缝钉成形高度。尽管术语“向上”等可表示竖直向上,但该术语不受这样的限制;相反,“向上”可表示例如朝向砧座基部和/或远离钉仓的任何方向。在任何情况下,调整构件1230可在其第一位置(如图54所示)和第二位置(如图55所示)之间运动,以便增加缝钉成形高度。如图55中的箭头“P”所指示,调整构件1230可向近侧滑动,以便使调整构件1230在其第一位置和第二位置之间运动,但可预想到这样的实施例,其中调整构件可向远侧和/或任何其它合适的方向滑动,以便调节调整构件1230。一旦调整构件1230已运动至其第二位置,参见图55,第一表面或步位1231即可定位于基部1138和砧板1134的第二定位表面1146中间。在这样的第二位置,第一步位1231可再次限定砧板1134和砧座通道1136之间允许的相对运动量。在至少一个实施例中,类似于上文所述,调整构件1230可作为止挡件,使得基部1138和砧板1134上的组织接触表面1148之间的距离可由第二距离1235限定。
除了上文所述,调整构件1230可在其第二位置(如图55所示)和第三位置(如图56所示)之间运动,以便再次增加缝钉成形高度。如图56中的箭头“P”所指,调整构件1230可向近侧滑动,以在其第二位置和第三位置之间运动调整构件1230。一旦调整构件1230运动至其第三位置,参见图56,第一表面或步位1231即可定位于基部1138和第三定位表面1147中间。在此第三位置中,第一步位1231可再次限定砧板1134和砧座通道1136之间的相对运动量。在至少一个实施例中,类似于上文所述,调整构件1230可作为止挡件,使得基部1138和砧板1134上的组织接触表面1148之间的距离可由第三距离1236限定。虽然调整构件1230可在上述三个位置之间选择性运动以提供三种不同的缝钉成形高度,但可预想到其它实施例,其包括可在超过三个位置之间运动的调整构件以提供超过三种不同的缝钉成形高度。例如,调整构件可在四个位置之间运动,以便提供四种缝钉成形高度。还可预想到这样一些实施例,其包括可在两个位置之间运动的调整构件以提供两种缝钉成形高度。此外,虽然调整构件1230的表面或步位1231,1232和1233以降序排列,但可预想到其它排列,其中所述表面或步位以升序排列。可预想到其它排列,其中表面或步位不必以升序或降序排列。类似地,砧板1134的定位表面1145,1146和1147可以升序、降序(图53)和/或任何其它合适的顺序排列。此外,虽然调整构件1230可沿轴线滑动,但可预想到其它实施例,其中调整构件可沿任何合适的路径,例如弯曲和/或曲线路径运动。
如上文所述,参见图54,调整构件1230可包括三个表面或步位1231,1232和1233,而砧板1134可包括三个相应的调整表面1145,1146和1147。当调整构件1230位于其第一位置时,例如,第一表面1231可被定位成使其邻接或邻近第一调整表面1145,第二表面1232可被定位成使其邻接或邻近第二调整表面1146,并且第三表面1233可被定位成使其邻接或邻近第三调整表面1147。由于调整构件1230相对于砧板1134滑动,如上文所述并参见图55和56,调整构件1230的表面1231,1232和1233可相对于砧板1134的表面1145,1146和1147顺序地换位。在至少一个此类实施例中,调整构件的步位数可与砧板上的定位表面数相同。还可预想到其它实施例,其中调整构件的步位多于砧板上的定位表面。在至少一个此类实施例中,例如砧板可包括一个定位表面,其中调整构件的步位可有选择地用来限制砧板的向上运动。在各种实施例中,总体参见调整构件1230和砧板1134,砧板可包括一个定位表面,例如定位表面1145,其中调整构件1230的步位1231,1232和1233例如可有选择地定位在基部1138和定位表面1145中间。在此类实施例中,第一步位1231可具有第一厚度或高度,所述第一厚度或高度可阻挡或限制砧板1134的向上运动,以便限定第一缝钉成形高度,第二步位1232可具有第二厚度或高度,所述第二厚度或高度可阻挡或限制砧板1134的向上运动,以便限定第二缝钉成形高度,此外,第三步位1233可具有第三厚度或高度,所述第三厚度或高度可阻挡或限制砧板1134的向上运动,以便限定第三缝钉成形高度。在至少一个实施例中,步位1231,1232和/或1233的厚度或高度可在调整构件1230的后表面1237和会接触砧板1134的步位1231,1232,1233上的表面之间测量。在各种实施例中,第一步位1231和第二步位1232之间的高度或厚度差值可与第二步位1232和第三步位1233之间的高度或厚度差值相同或至少基本上相同。在至少一个此类实施例中,因此,步位的高度可以按线性速率或至少基本上线性速率增加。在替代实施例中,第一步位和第二步位之间的高度或厚度差值可与第二步位和第三步位之间的高度或厚度差值不同。在至少一个此类实施例中,第一、第二和第三步位的高度或厚度不会以线性速率增加或减少;相反,尽管未示出,但步位的高度或厚度可以非线性和/或几何速率增加或减少。
如上文所述,调整构件(例如调整构件1230)可在两个或更多个位置之间运动。在各种实施例中,外科缝合器械可包括能够运动调整构件的致动器。在至少一个实施例中,参见图50-53,外科缝合器械1100可包括致动器1250,该致动器被可操作地附接于调整构件1230,以使力可被施加于致动器1250并传递给调整构件1230。在某些实施例中,如上文所述,致动器1250可包括抓握部或柄部1252,所述抓握部或柄部例如能够由外科医生抓握,以便在砧座1130内推进或回缩调整构件1230。在某些实施例中,抓握部1252可从致动器主体1251延伸,其中致动器主体1251可包括一个或多个孔、狭槽或腔1253,所述孔、狭槽或腔能够容纳调整构件1230的至少一部分。在至少一个此类实施例中,参见图52,调整构件1230可包括由其延伸的锁扣1254,其中锁扣1254的至少一部分可被容纳于孔1253内,以便将致动器主体1251保持在调整构件1230上。在各种实施例中,锁扣1254可包括一个或多个弹性或柔性腿1255,当插入孔1253时,所述腿可挠曲,但是当腿1255的脚1256充分推过孔1253后,会弹性返回或至少部分地返回到它们的未挠曲位置。在至少一个此类实施例中,脚1256可防止或至少抑制致动器主体1251从调整构件1230分离。
在各种实施例中,除了上文所述,外科缝合器械1100还可包括制动机构,所述制动机构能够使致动器1250和/或调整构件1230固定就位,或可释放地固定就位。在至少一个实施例中,参见图52,制动构件1260可附接于致动器1250,其中在至少一些实施例中,致动器主体1251可包括一个或多个通道、沟槽或凹槽1257,它们能够容纳制动构件1260的制动主体1261和/或将其保持在其中。在至少一个实施例中,制动主体1261可包括一个或多个孔1263和/或任何其它合适的通道、狭槽或沟槽,它们例如能够容纳一个或多个紧固件,用于将制动主体1261固定于致动器1251。制动构件1260还可包括制动腿1262,所述制动腿例如能够接合第一框架部分1110中的一个或多个凹槽、孔或沟槽1101(图35-40)。更具体地,参见图34和35,每个侧凸缘1128可包括一个或多个限定于其中的凹槽1101(1101a,1101b,和1101c),其中制动腿1262可被偏压成与侧凸缘1128的顶部表面接合,使得制动腿1262可滑入和滑出凹槽1101。在示出的实施例中,每个侧凸缘可包括三个凹槽1101,所述凹槽能够将致动器1250可运动地保持在第一远侧位置、第二中间位置和第三近侧位置,其中致动器1250的第一、第二位置和第三位置可分别对应于上述调整构件1230的第一、第二位置和第三位置。例如,当致动器1250位于其第一远侧位置时,制动构件1260的制动腿1262可定位于凹槽1101a中,以便将致动器1250和调整构件1230可运动地保持在它们的第一位置。当施加足够的力时,致动器1250可向近侧运动到其第二位置,使得制动腿1162定位于凹槽1101b内,并且致动器1250和调整构件1230保持在它们的第二位置。类似地,当施加足够的力时,致动器1250可向近侧运动到其第三位置,使得制动腿1162定位于凹槽1101c内,并且致动器1250和调整构件1230保持在它们的第三位置。在各种实施例中,制动腿1162能够使得致动器1250可返回其第一和/或第二位置。
如上文所述,致动器1250可使调整构件1230沿着两个或更多个位置之间的预定路径运动。在各种实施例中,外科缝合器械1100例如可包括用于控制或限制调整构件1230和/或致动器1250运动的一个或多个导向装置。在一些实施例中,可在砧座1130的侧壁1137之间贴近地容纳调整构件1230,使得侧壁1137可引导调整构件1230。在至少一个此类实施例中,侧壁1137能够控制或限制调整构件1230的侧向或左右运动。在各种实施例中,制动构件1160的制动腿1162可包括弹性构件,所述弹性构件能够对调整构件1230施加向上的偏置力或拉力,从而将调整构件1230定位在紧靠或至少邻近基部1138和中间侧壁1137的位置。在某些实施例中,参见图52,砧座1130的基部138还可包括导向槽1149,所述导向槽能够在其中容纳调整构件1230和/或致动器1250的至少一部分,使得导向槽1149可限制调整构件1230和致动器1250的运动。在至少一个此类实施例中,调整构件1230的锁扣1254能够延伸穿过导向槽1149,使得当锁扣1254插入上述致动器1250的孔1253时,可将砧座1130的基部1138捕获在调整构件1230和致动器1250中间。在某些实施例中,导向槽1149能够限制锁扣1254的运动,使得当调整构件1230位于其第一或最远侧位置时防止或至少抑制调整构件1230向远侧运动,和/或相似地当调整构件1230位于其第三或最近侧位置时防止或至少限制其向近侧运动。
在各种实施例中,除了上文所述,制动构件(类似于例如制动构件1260)可用于偏置第一柄部部分1102和第二柄部部分1104,使它们彼此离开。在至少一个实施例中,参见图70,外科缝合器械1100’可包括制动构件1260’,其能够定位第一柄部部分1102和第二柄部部分1104,使得砧座1130和钉仓1150之间存在间隙。此类结构,如上文所概述,可让外科医生能够轻松操纵外科器械,而无需保持第一柄部部分和第二柄部部分彼此分开。在某些实施例中,制动构件1260’可充分安装到第二柄部部分1104,使得从制动构件1260’延伸的制动腿1262’可接触凸缘1128,并且当被挤压时,将偏置力施加到第一柄部部分和第二柄部部分。如图70所示,腿1262’可接触凸缘1128上的表面1101d。为了挤压制动腿1262’,闩锁机构1180可运动到部分闭合位置,使得锁臂1188可接合并至少部分地围绕闩锁突出1131。在此构型中,外科医生可操纵器械,并且当对其位置感到满意时,将闩锁机构1180运动到闭合位置,并进一步挤压制动腿1262’。类似于上文所述,制动构件1260’可与致动器1250固定或换句话讲可操作地接合,使得当致动器1250在其上述第一、第二位置和第三位置之间运动时,腿1262’可分别接合凹槽1101a,1101b和1101c。在至少一个此类实施例中,因此,致动器1250可具有预置位置,其中致动器1250相对于其第一位置定位在远侧,此外,表面1101d可包括预置表面,当致动器1250位于其预置位置时,制动腿1262’可被定位成紧靠所述预置表面。
如上文所概述,调整构件可在第一位置和第二位置之间滑动或平移,以便调整外科缝合器械所部署的缝钉的成形高度。在各种实施例中,尽管未示出,但调整构件例如能够使砧板朝向和/或远离相对的钉仓正向位移。在至少一个此类实施例中,外科缝合器械可包括一个或多个偏置构件,例如弹簧,其能够使砧板紧靠调整构件定位,使得当调整构件在其第一位置和第二位置之间运动时,调整构件可使砧板在第一位置和第二位置之间位移,以便设定第一缝钉成形高度和第二缝钉成形高度。在各种实施例中,由以上可得出,调整构件能够将一部分砧座用凸轮使之就位。在至少一个此类实施例中,调整构件可沿轴线滑动,以使砧板正向位移。在其它实施例中,可旋转调整构件例如能够使砧板朝向和/或远离钉仓正向位移。
除了上文所述,如下文更详细描述,调整构件可被旋转来调整缝钉成形高度。参见图57-69,类似于上文所述,外科器械1100’可包括第一柄部部分1102’、第二柄部部分1104’和闭锁机构1180’,所述闭锁机构可用于将组织夹在砧座1130’和钉仓1150’中间。参见图58,同样类似于上文所述,闭锁机构1180’可通过一个或多个枢轴销1182’枢转地联接到第一部分1102’,其中闭锁机构1180’可包括一个或多个锁臂1188’,所述锁臂能够接合第二部分1104’,并将第一柄部部分和第二柄部部分闩锁在一起。同样类似于上文所述,参见图58和60,外科器械1100’还可包括推杆组件1200’,所述推杆组件能够在端部执行器1120’内推进切割构件和/或缝钉滑动件。在至少一个此类实施例中,推杆组件1200’可包括近端1203’和致动器1204’,其中致动器1204’可被可旋转地安装在近端1203’,并被有选择地定位在缝合器械1100’的第一侧和第二侧上。在各种实施例中,外科缝合器械1100’可具有与结合外科缝合器械1100描述的那些特征相同或类似的特征,并且可以按与器械1100相同的方式或类似的方式操作,因此这里不再重复这类细节。
在各种实施例中,参见图60,外科器械1100’可包括可旋转调整构件1230’,所述可旋转调整构件可有选择地定位于至少第一位置和第二位置,以便提供不同的缝钉成形高度。在某些实施例中,外科器械1100’可包括致动器1250’,所述致动器可操作地连接到调整构件1230’,使得致动器1250’可在至少其第一位置和第二位置之间运动调整构件1230’。在至少一个实施例中,参见图61,致动器1250’可包括致动器主体1251’和抓握部或柄部1252’。致动器主体1251’可包括孔1258’,所述孔能够容纳调整构件1230’的近端1238’,使得旋转运动、扭矩和/或力可在致动器1250’和调整构件1230’之间传递。在至少一个此类实施例中,参见图69,孔1258’可具有非圆形轮廓和/或包括一个或多个平坦驱动面的轮廓,所述驱动面能够在致动器主体1251’和致动器1230’之间传递旋转运动。在某些实施例中,孔1258’的尺寸和构型被设定成贴近地容纳致动器1230’的近端1238’。在至少一个实施例中,孔1258’能够以压合和/或搭扣配合装配方式容纳近端1238’。在各种实施例中,再次参见图61,柄部部分1104’可包括一个或多个狭槽1259’,所述狭槽能够允许致动器主体1251’的至少一部分延伸穿过其中,使得抓握部1252’可装配到致动器主体1251’,其中柄部部分1104’的至少一部分定位于其间。在至少一个此类实施例中,第二柄部部分1104’还可包括凹槽1253’,所述凹槽能够使得抓握部1252’的至少一部分(如果不是全部)定位于凹槽1253’内。在某些实施例中,凹槽1253’能够使得抓握部1252’不在第二柄部部分1104’的顶部表面上方延伸,但是在其它实施例中,如图63所示,抓握部1252’的上部可延伸到第二柄部部分1104上方,使得外科医生能够轻松地触及抓握部1252’。
在各种实施例中,如上文所概述,调整构件可在至少第一位置和第二位置之间旋转,以便调整外科缝合器所部署的缝钉的成形高度。在某些实施例中,参见图61,外科缝合器械可包括可旋转地定位在砧座内的调整构件,其中调整构件能够限制活动的砧座部分的相对运动。在至少一个此类实施例中,外科缝合器械1100’可包括砧板1134’,所述砧板可通过保持销或导销1140’可滑动地保持在砧座通道1136’内,其中导销1140’能够允许砧板1134’在接触组织时向上滑动,如上文所述。参见图60、63和64,调整构件1230’可定位于第一位置或取向,使得其可限制砧板1134’在砧座通道1136’内的向上运动,并规定缝钉的缝钉成形高度。在至少一个此类实施例中,参见图63和64,调整构件1230’可包括相对的第一表面1231’,所述相对的第一表面可定位于砧座通道1136’的基部1138’和砧板1134’的定位表面1145’中间,使得例如当定位表面1145’接触第一表面1231’中的一者时,砧板1134’的组织接触表面1148’可定位成距砧座1130’上的基准面1129’第一距离1234’。相应地,成形表面1132’可定位成距钉仓第一距离,使得从钉仓部署缝钉时,缝钉可变形至第一缝钉高度。除了上文所述,第一直径1241’可在第一表面1231’之间限定,其中第一直径1241’可限定砧板1134’在砧座通道1136’内的最大向上位置。
如上文指出,调整构件1230’可被旋转来调整缝钉的成形高度。在各种实施例中,调整构件1230’可在其第一位置或取向(图63和64)和第二位置或取向(图65和66)之间旋转。在至少一个实施例中,参见图65和66,柄部1252’可在箭头“A”指示的方向上旋转,以使调整构件1230’在其第一位置和第二位置之间运动。类似于上文所述,当致动器1230’位于其第二位置或取向时,致动器1230’可限制砧板1134’在砧座通道1136’内的向上运动,并规定缝钉的缝钉成形高度。在至少一个此类实施例中,参见图65和66,调整构件1230’可包括相对的第二表面1232’,所述相对的第二表面可定位于基部1138’和定位表面1145’中间,使得例如当定位表面1145’接触第二表面1232’中的一者时,砧板1134’的组织接触表面1148’可定位成距基准面1129’第二距离1235’。相应地,成形表面1132’可定位成距钉仓第二距离,使得从钉仓部署缝钉时,缝钉可变形至第二缝钉高度。在各种实施例中,类似于上文所述,第二直径1242’可被限定在第二表面1232’之间,其中第二直径1242’可限定砧板1134’在砧座通道1136’内的最大向上位置。虽然第一表面1231’和第二表面1232’通过平坦或至少基本上平坦的表面限定,但可预想到其它实施例,其中第一表面1231’和第二表面1232’可包括至少部分弓形或弯曲的轮廓。在任何情况下,参见图60,调整构件1230’可包括一个或多个空隙槽1240’,所述空隙槽能够提供致动器1230’和保持销1140’之间的空隙。空隙槽1240’能够在致动器1230’位于其第一位置、第二位置和/或任何其它合适位置时提供致动器1230’和保持销1140’之间的空隙。
在各种实施例中,除了上文所述,调整构件1230’可在其第一位置或取向(图63和64)和第三位置或取向(图67和68)之间旋转。在至少一个实施例中,参见图67和68,柄部1252’可在箭头“B”指示的方向上旋转,以使调整构件1230’在其第一位置和第三位置之间运动。类似于上文所述,当致动器1230’位于其第三位置或取向时,致动器1230’可限制砧板1134’在砧座通道1136’内的向上运动,并规定缝钉的缝钉成形高度。在至少一个此类实施例中,参见图67和68,调整构件1230’可包括相对的第三表面1233’,所述相对的第三表面可定位于基部1138’和定位表面1145’中间,使得例如当定位表面1145’接触第三表面1233’中的一者时,砧板1134’的组织接触表面1148’可定位成距基准面1129’第三距离1236’。相应地,成形表面1132’可定位成距钉仓第三距离,使得从钉仓部署缝钉时,缝钉可变形至第三缝钉高度。在各种实施例中,类似于上文所述,第三直径1243’可被限定在第三表面1233’之间,其中第三直径1243’可限定砧板1134’在砧座通道1136’内的最大向上位置。再次参见图67和68,第三表面1233’可由至少部分弓形的轮廓限定,但可预想到其它实施例,其中第三表面1233’可包括平坦或至少基本上平坦的轮廓。在至少一个实施例中,调整构件1230’能够使得弓形的第三表面1233’之间的最大距离或直径可用于限定第三缝钉高度。
如上文所述,参见图63和64,调整构件1230’可定位于第一位置或取向,以设定外科缝合器械1100’部署的缝钉的第一成形高度。同样如上文所述,参见图65和66,致动器1250’可用于将调整构件1230’运动至其第二位置或取向,以设定缝钉的第二成形高度。要做到这一点,在至少一个实施例中,可将力施加到柄部1252’,从而引起柄部1252’和连接到该处的调整构件1230’在箭头“A”指示的方向上旋转。在至少一个实施例中,调整构件1230’和/或致动器1250’可被充分地保持,使得例如当调整构件1230’旋转时,调整构件1230’能够绕轴线,例如轴线1245’(图60)旋转。在至少一个实施例中,参见图58,推杆组件1200’的近端1203’可包括一个或多个沟槽、通道或凹槽1205’,所述沟槽、通道或凹槽能够在其中容纳和/或保持调整构件1230’和/或致动器1250’的至少一部分。在任何情况下,如图63-66所示,与调整构件1230’位于其第一位置时相比,调整构件1230’的第二位置或取向可允许砧板1134’在砧座通道1136’内滑动更长的距离。在至少一个实施例中,因此,第二缝钉成形高度可大于第一缝钉成形高度。同样如上文所述,参见图67和68,致动器1250’可用于将调整构件1230’运动至其第三位置或取向,以设定缝钉的第三成形高度。要做到这一点,在至少一个实施例中,可将力施加到柄部1252’,从而引起柄部1252’和连接到该处的调整构件1230’在箭头“B”指示的方向上旋转。如图63、64、67和68所示,与调整构件1230’位于其第一位置时相比,调整构件1230’的第三位置或取向可允许砧板1134’在砧座通道1136’内滑动更短的距离。在至少一个实施例中,因此,第一缝钉成形高度和第二缝钉成形高度可大于第三缝钉成形高度。在至少一个此类实施例中,调整构件1230’和致动器1250’的第一位置可代表中间位置,其中调整构件1230’可直接从其第一位置有选择地运动至其第二位置和第三位置。事实上,调整构件1230’的第一位置可代表中间缝钉高度,其中调整构件1230’的第二缝钉位置和第三缝钉位置可分别代表更高和更低的缝钉高度。在某些实施例中,参见图57,外科缝合器械1100’可包括一个或多个位于其上的标记,所述标记能够呈现缝钉成形高度或至少相对成形高度,这些高度是可选择的。例如,第二柄部部分1104’可包括第一标记1245’、第二标记1246’和第三标记1247’,所述第一标记可指示中间缝钉高度或第一缝钉高度,所述第二标记可指示较高缝钉高度或第二缝钉高度,所述第三标记可指示较低缝钉高度或第三缝钉高度。
在各种实施例中,除了上文所述,第一表面1231’、第二表面1232’和第三表面1233’中的一个或多个可构成或限定、或至少部分地构成或限定调整构件1230’的周边或外周。如上文所讨论,由于第一表面1231’、第二表面1232’和第三表面1233’分别限定了第一直径1241’、第二直径1242’和第三直径1243’,调整构件1230’的周边或外周可以是非圆形的。然而,在某些实施例中,调整构件1230’的周边或外周可以是对称的、基本上对称的和/或非对称的。在各种实施例中,除了上文所述,例如调整构件可包括可旋转地定位在砧座1130’的基部1138’和砧板1134’的调整表面1145’中间的凸轮。在至少一个此类实施例中,第一表面1231’、第二表面1232’和第三表面1233’中的一个或多个例如可构成或限定凸轮轮廓,类似于上文所述,所述凸轮轮廓能够正向定位砧板1134’和/或提供可由砧板1134’靠贴而定位的止挡件。在任何情况下,虽然未示出,可预想到各种实施例,其中调整构件可被滑动和旋转以设定外科缝合器械部署的缝钉的两个或更多个缝钉成形高度。在至少一个此类实施例中,调整构件可包括凸轮轮廓,所述凸轮轮廓可沿着调整构件的长度限定,其中纵向和/或旋转运动可用于在至少第一位置和第二位置之间运动凸轮轮廓。
在各种实施例中,类似于上文所述,外科器械1100’还可包括制动机构,所述制动机构能够使致动器1250’固定就位或至少可释放地固定就位。在至少一个实施例中,参见图58和59,外科器械1100’还可包括制动构件1260’,所述制动构件包括制动主体1261’和一个或多个制动腿1262’。参见图59,制动主体1261’可包括一个或多个沟槽、凹槽或通道1263’,所述沟槽、凹槽或通道能够在其中容纳第二柄部部分1104’近端1105’的至少一部分,使得制动构件1260’可保持就位。在至少一个此类实施例中,近端1105’还可包括一个或多个沟槽、通道或凹槽1265’,所述沟槽、通道或凹槽能够贴近地容纳制动构件1260’。在某些实施例中,制动主体1261’的至少一部分(例如通道1263’)可压合、搭扣配合和/或以其它方式合适地保持于凹槽1265’中。同样如图59所示,制动构件1260’的每个制动腿1262’可包括一个或多个从其延伸的突出1264’,所述突出能够接合致动器主体1251’,并将致动器1250’可释放地固定就位。在至少一个实施例中,参见图69,致动器主体1251’可包括一个或多个凹槽或孔1269’,所述凹槽或孔能够容纳突出1264’。突出例如能够在突出1264’定位于凹槽1269’内时将致动器1250’保持在其第一位置,直到有足够的力施加于致动器1250’而使突出1264’移出凹槽1269’。更具体地,施加到致动器1250’的力可传递到突出1264’,并且由于突出1264’和凹槽1269’之间具有配合表面,与突出1264’相关联的制动腿1262’可向近侧挠曲或运动,以允许致动器主体1251’相对于该处运动。为了适应此近侧运动,参见图58,凹槽1265’可包括细长部分1266’,所述细长部分各自能够容纳腿1262’的至少一部分,以使得腿1262’可相对于柄部部分1104’运动。当致动器1250’运动到其第二位置或第三位置时,致动器主体1251’可接触从另一条腿1262’延伸的突出1264’,并使腿1262’向近侧挠曲,使得致动器1250’一旦位于其第二位置或第三位置,腿1262’即可向前或向远侧回弹,使突出1264’可固定于凹槽1269’内。在至少一个实施例中,除了上文所述,突出1264’和凹槽1269’侧壁之间的相互作用使得致动器1250’可被牢固地保持在例如其第一位置、第二位置和第三位置中的一者上,但在施加足够的力时允许致动器1250’运动。在此类实施例中,制动构件1260’可防止或至少抑制致动器1250’以及相应地调整构件1230’被意外地移位。
如上文所讨论,并且如图35所示,第一柄部部分1102的每个侧凸缘1128可包括例如凹口或凹槽1127,所述凹口或凹槽能够容纳例如从砧座1130和/或第二柄部部分1104的任何其它合适的部分延伸的一个或多个闩锁突出1131。同样如上文所讨论,主要参见图35和36,第一柄部部分1102还可包括可旋转地安装于其上的闭锁机构1180,所述闭锁机构可用于接合从第二柄部部分1104延伸的闩锁突出1131并将第一柄部部分1102和第二柄部部分1104固定在一起。闭锁机构1180可包括从其中延伸的一个或多个锁臂1188,所述锁臂能够接合闩锁突出1131,并且将突出1131牵拉和/或固定于凹槽1127内,如图40所示。参见图39,至少一个锁臂1188可包括远侧吊钩1189,所述远侧吊钩能够环绕突出1131的至少一部分,从而包围或围绕、或至少部分地包围或围绕突出1131。在至少一个实施例中,锁臂1188可充当偏心闩锁以使闭锁机构1180保持在其锁闭或闭合位置。
在各种实施例中,现在参见图71,每个突出1131可包括定位于突出1131的侧壁1191和扩大末端或头部1192中间的狭槽或沟槽1190,其中狭槽1190能够容纳锁臂1188的至少一部分。更具体地,在至少一个实施例中,狭槽1190的宽度可大于锁臂1188的宽度,使得当锁臂1188与突出1131接合时,锁臂1188可进入狭槽1190。在一些情况下,每个狭槽1190的宽度可略大于锁臂1188的宽度,使得锁臂贴近地容纳于狭槽1190内。在各种情况下,突出1131的狭槽1190、侧壁1191和头部1192的尺寸和构型被设定成防止或至少限制相对的侧向运动,即远离或朝向砧座1130侧在锁臂1188和突出1131之间的运动。然而,除了上文所述,当锁臂1188将突出1131运动到第一部分1102的凹槽1127内时,锁臂1188可在沟槽1190内纵向滑动。由于锁臂1188和突出1131之间存在这样的相对滑动,在这二者之间会产生摩擦力,所述摩擦力可阻止锁臂1188运动。在各种情况下,当锁臂1188和沟槽1190侧壁之间法向或垂直接触力很大时,此类摩擦力大小会很大。因此,在很多情况下,外科器械操作者在致动夹紧机构1180时必须克服这些摩擦力。
在多个可供选择的实施例中,现在参见图72和73,外科器械可包括一个或多个具有可旋转轴承的闩锁突出,所述轴承可减少闭锁机构的锁臂和闩锁突出之间的摩擦力大小。在至少一个实施例中,砧座1330在很多方面可基本上类似于砧座1130,可包括从其每个侧延伸的闩锁突出1331,其中每个闩锁突出1331可包括可旋转轴承1393。在使用中,闭锁机构1180的锁臂1188例如可接触可旋转轴承1393,以便将闩锁突出1331定位于凹槽1127内。在各种情况下,锁臂1188可在轴承1393的整个表面或外径上滑动;然而,由于轴承1393可相对于锁臂1188旋转,则锁臂1188和突出1331之间的摩擦力大小可小于锁臂1188和突出1131之间的摩擦力大小。由于存在这样的较小摩擦力,例如夹紧机构1180的致动可需要较小的闭合或夹紧力。
在各种实施例中,主要参见图74,每个可旋转轴承1393可包括环状或圆形外径1394,此外还包括从其延伸的环状或圆形轴承孔1395。在某些实施例中,每个突出1331还可包括从侧壁1391延伸的轴部1396,以及从轴部1396延伸的增大的末端或头部1392,其中,如图64所示,轴部1396可延伸通过可旋转轴承1393的轴承孔1395。在各种实施例中,轴部1396可包括环状或圆形外径,从而可贴近地容纳于轴承孔1395内,使得其间的相对径向运动(如果有的话)很小。然而,轴承孔1395的直径可足够大于轴部1396的外径,使得轴承1393可相对于轴部1396绕轴线1399旋转。在各种实施例中,可旋转轴承1393可通过增大的头部1392保持在轴部1396上。更具体地,在至少一个实施例中,增大的头部1392可大于或限定的直径大于轴承孔1395的直径,使可旋转轴承1393不能滑出轴部1396的末端。在某些实施例中,侧壁1391和头部1392可限定其间的间隙距离,此外,轴承1393可具有宽度,其中间隙距离可大于轴承1393的宽度。在至少一个实施例中,间隙距离可略大于轴承1393的宽度,使得轴承1393不会或至少基本上不会相对于例如轴线1399倾斜。
如上文所讨论,闭锁机构1180的锁臂1188能够接合轴承1393,并将轴承1393定位于凹槽1127内。在多个可供选择的实施例中,主要参见图73,外科器械可包括闭锁机构1380,所述闭锁机构可包括在砧座1331和钉仓通道1324的相对的侧上从其延伸的第一锁臂和第二锁臂1388。在使用中,类似于上文所述,锁臂1388可接触轴承1393,以将轴承1393移入钉仓通道1324中的凹槽1327内,并且将砧座1331朝向钉仓通道1324运动。此类运动在图74中用虚线示出。在各种实施例中,每个锁臂1388可至少部分地限定其中的沟槽或狭槽1397,其中每个狭槽1397能够容纳轴承1393。在至少一个实施例中,狭槽1397可包括第一驱动面或侧壁1398a,所述第一驱动面或侧壁可紧靠轴承1393定位,并且当闭合力施加到闭锁机构1380上时,锁臂1388可将闭合力施加到轴承1393。在此类情况下,当闭锁机构1380旋转到其闭合位置时,轴承1393可被进一步移入狭槽1397。在各种情况下,狭槽1397还可包括第二驱动面或侧壁1398b,所述第二驱动面或侧壁可紧靠轴承1393的另一侧和/或相对侧定位,使得开启力可通过锁臂1388施加到轴承1393。当闭锁机构1380被移入其打开位置时,轴承1393可移出狭槽1397。在任何情况下,第一驱动面1398a和第二驱动面1398b可限定其间的狭槽宽度,所述狭槽宽度可大于轴承1393的外径,使得轴承1393可在狭槽1397内运动。在一些实施例中,狭槽宽度可略大于轴承1393的外径。在至少一个实施例中,第一驱动面1398a和第二驱动面1398b的至少部分可以是彼此平行的、或至少基本上平行的。在至少一个此类实施例中,第一驱动面1398a的至少部分可定位成与第二驱动面1398b相对。
如上文所述,外科缝合器械能够使一个或多个外科缝钉在第一未部署构型和第二已部署构型之间变形。在各种实施例中,现在参见图72,外科缝钉(例如缝钉1400)可包括基部1402、从基部1402延伸的第一腿部或可变形构件1404,此外还包括从基部1402延伸的第二腿部或可变形构件1406。在某些实施例中,基部1402、第一腿部1404和第二腿部1406可由连续线材构成,其中在至少一个实施例中,在缝钉1400插入外科缝合器并在外科缝合器作用下变形之前,第一腿部1404和第二腿部1406均可以在与基部1402垂直的方向上弯曲。更具体地,缝钉1400可被制造成使得基部1402沿基线1401取向,并且使得腿部1404和1406分别沿线1409和1411取向,所述线与基线1401垂直、或至少基本上垂直。在各种实施例中,第一腿部1404可定位于基部1402的第一末端处,并且第二末端1406可定位于基部1402的第二末端处,其中,在至少一个实施例中,可限定中线1403,所述中线延伸通过基部1402的中点,并且在与基线1401垂直的方向上延伸。当缝钉1400处于其第一或未部署构型时,缝钉1400能够使得基部1402、第一腿部1404和第二腿部1406位于、或至少基本上位于相同或共同平面。在此类实施例中,基线1401以及垂直线1409和1411可位于相同的平面,其中基部1402沿基线1401取向,腿部1404和1406沿垂直线1409和1411取向。
在各种实施例中,除了上文所述,包括基部1402、第一腿部1404和第二腿部1406的连续线材可由例如钛和/或不锈钢构成。在至少一个实施例中,第一腿部1404可包括第一末端1405,并且第二腿部1406可包括第二末端1407,其中末端1405和1407均可包括尖锐或凿形末端,所述末端能够刺穿骨头和/或组织。在使用中,缝钉1400可在外科缝合器作用下变形,以将例如组织捕获在缝钉1400内。在各种实施例中,缝钉1400可从钉仓部署,使得缝钉腿1404的末端1405和缝钉腿1406的末端1407分别接触面对缝钉1400定位的砧座。在此类情况下,第一压缩力F1可施加到第一腿部1404,并且第二压缩力F2可施加到第二腿部1406,而基部1402由钉仓的至少一部分支持。如下面更详细地描述,砧座可包括缝钉凹坑,所述缝钉凹坑可将第一压缩力F1施加到第一腿部1404,使得腿部1404的末端1405向基部1402运动。类似地,缝钉凹坑可将第二压缩力F2施加到第二缝钉腿1406,使得缝钉腿1404的末端1407也向基部402运动。除上述之外,下面还将更详细地讨论,现在参见图83-85,缝钉凹坑可将第一缝钉腿1404弯曲到基部1402的第一侧,并且将第二缝钉腿1406弯曲到基部1402的第二或相对侧。
在各种实施例中,参见图82和83,缝钉1400的第一腿部1404可弯曲,以使得当第一腿部1404受到第一压缩力F1变形时,第一腿部1404的末端1405向基部402和第二腿部1406运动。在至少一个实施例中,末端1405可从中线1403的第一侧1410(如图82所示)运动到中线1403的第二侧1412(如图83所示)。类似地,缝钉1400的第二腿部1406可弯曲,以使得当第二腿部1406受到第二压缩力F2而变形时,第二腿部1406的末端1407向基部1402和第一腿部1404运动。在至少一个实施例中,末端1407可从中线1403的第二侧1412(如图82所示)运动到中线1403的第一侧1410(如图83所示)。在缝钉1400的已部署或变形构型中,如图83所示,缝钉腿1404的末端1405和缝钉腿1406的末端1407可以它们之间成一角度的方式延伸穿过中线1403。更具体地,当处于变形构型时,第一腿部1404的末端1405可沿着或关于第一轴线1414延伸,并且类似地当处于变形构型时,第二腿部1406的末端1407可沿着或关于第二轴线1416延伸,使得第一轴线1414和第二轴线1416限定两者间的角度1417。在一些实施例中,角度1417可以为例如大约90度。在某些实施例中,角度1417的范围可在例如大约0.1度和大约89度之间。在各种实施例中,角度1417可大于90度,而在至少一个实施例中,角度1417例如可大于大约90度但小于180度。
在各种实施例中,除了上文所述,第一轴线1414和第二轴线1416在各种实施例中可相对于彼此以横向角取向或交叉,即至少在缝钉1400被从图83的侧或正视视角观看时。更具体地,在查看图85时显见,虽然从侧面观察时轴线1414和1416在横向上延伸(图83),但是在至少一个实施例中,轴线1414和1416实际上并不彼此相交。在此类实施例中,例如当从顶部或底部观察缝钉1400时(图85),轴线1414和1416可在平行的或至少基本上平行的方向上延伸。此外,在各种实施例中,读者会注意到,第一轴线1414和第二轴线1416不与基线1401垂直。换句话讲,第一缝钉腿1404的末端1405和第二缝钉腿1406的末端1407不向下直指基部1402和基线1401。在至少一个此类实施例中,第一轴线1414和第二轴线1416例如可以各自相对于基线1401成锐角延伸。
如上文所述,外科器械能够使图82的缝钉1400例如在未变形形状(图82)和变形形状(图83)之间变形。在各种实施例中,同样如上文所述,外科器械可包括具有缝钉凹坑的砧座,所述缝钉凹坑能够容纳缝钉的至少一部分并使之变形。在某些实施例中,现在参见图75,砧座可包括组织接触表面1501和多个在其中形成的缝钉凹坑1500,其中每个缝钉凹坑1500能够使缝钉1400变形。在各种实施例中,每个缝钉凹坑1500可包括纵向轴线1599(图76),此外还包括相对于纵向轴线1599定位的第一成形杯1502和第二成形杯1504。在使用中,第一成形杯1502能够容纳缝钉1400的第一缝钉腿1404,并且第二成形杯1504能够容纳第二缝钉腿1406。更具体地,在至少一个实施例中,缝钉凹坑1500可相对于缝钉1400定位,使得例如当缝钉1400从钉仓顶出时,第一腿部1404的末端1405可进入第一成形杯1502,并且第二腿部1406的末端1407可进入第二成形杯1504。除了上文所述,第一缝钉腿1404的末端1405可接触第一成形杯1502的基部1506,使得第一压缩力F1可施加到第一腿部1404,并且类似地,第二缝钉腿1406的末端1407可接触第二成形杯1504的基部1508,使得第二压缩力F2可施加到第二腿部1406。
在各种实施例中,除了上文所述,第一成形杯1502可包括内部部分1510和外部部分1512,其中,当第一缝钉腿1404的末端1405进入第一成形杯1502时,末端1405可进入外部部分1512。在进入成形杯1502的外部部分1512时,末端1405可接触基部1506,并且由于基部1506的凹形曲线,末端1405可朝向内部部分1510向内导向。更具体地,现在参见图77-81,基部1506可朝向组织接触表面1501弯曲,使得当缝钉腿1404接触基部1506时,末端1405可被向下导向,即远离组织接触表面1501导向,并向内沿弯曲凹形表面朝拐点1595导向。在各种实施例中,拐点1595可代表这样的点,基部1506的凹形表面在该点处将开始使第一腿部1404的末端1405朝向组织接触表面1501向上挠曲。在各种实施例中,凹形表面沿其长度在纵向上的曲率半径r可为恒定的或至少基本上恒定的,如图80和81所示。在某些实施例中,基部1506的凹形表面在第一内部侧壁1516和第一外部侧壁1517之间的整个基部1506的宽度上的曲率半径r可为恒定的。在任何情况下,当第一腿部1404的末端1405推进至成形杯1502的内部部分1510时,末端1405可接触到定位在基部1506和第一内部侧壁1516中间的半径过渡段1514。在此类实施例中,半径过渡段1514能够引导末端1405靠在第一内部侧壁1516上。
如图76所示,除了上文所述,第一内部侧壁1516可以相对于缝钉凹坑纵向轴线1599成一角度取向。在某些实施例中,第一内部侧壁1516可以相对于纵向轴线1599成锐角(例如10度)取向。在各种实施例中,第一内部侧壁1516和纵向轴线1599可以彼此既不垂直也不平行。在任何情况下,第一内部侧壁1516可延伸通过轴线1599,使得第一内部侧壁1516的第一部分定位于轴线1599的第一侧1515上,并且第一内部侧壁1516的第二部分定位于轴线1599的第二侧1517上。在各种实施例中,因此,第一内部侧壁1516可在第一外部部分1512和第一内部部分1510之间延伸。当第一腿部1404的末端1405接触第一内部侧壁1516时,如上文所述,末端1405可沿第一内部侧壁1516并远离纵向轴线1599导向,使得缝钉腿1404远离缝钉1400的共同平面朝向轴线1599的第一侧1515弯曲。当第一腿部1404的末端1405沿第一内部侧壁1516导向或被第一内部侧壁1516弯曲时,如上文所述,缝钉腿1404也可通过基部1506导向或弯曲。换句话讲,第一侧壁1516和第一基部1506可配合使第一缝钉腿1404变形,使得末端1405朝向基部1402并且同时向基部1402的第一侧改变方向,如上文所述。在第一缝钉腿1404插入第一成形杯1502过程的某个时间点,第一缝钉腿1404的末端1405可从第一成形杯1502的第一内部部分1510露出,并且当缝钉腿1404被缝钉凹坑1500进一步变形时,末端1405可沿第一轴线1414导向(图83),如上文所述。
在各种实施例中,除了上文所述,第一内部侧壁1516可沿第一基部1506的内侧延伸,其中,在至少一个实施例中,第一成形杯1502还可包括沿第一基部1506的相对侧延伸的第一外部侧壁1517。在某些实施例中,类似于上文所述,第一成形杯1502还可包括定位在基部1506与外部侧壁1517之间的过渡半径1519。在至少一个实施例中,现在参见图76,外部侧壁1517可沿平行于或至少基本上平行于缝钉凹坑纵向轴线1599的方向延伸。同样如图76所示,第一内部侧壁1516和第一外部侧壁1517可沿彼此横向的方向延伸。在至少一个实施例中,内部侧壁1516可以例如相对于外部侧壁1517成锐角(例如大约15度)延伸。在各种实施例中,因此,第一成形杯1502的外部部分1512可比内部部分1510宽。在至少一个此类实施例中,外部部分1512和内部部分1510的宽度可在第一宽度和第二宽度之间渐缩。
在各种实施例中,再次参见图76,第一成形杯1502的外部部分1512可包括第一外壁1513,所述第一外壁可沿垂直于第一外壁1517和/或纵向轴线1599的方向延伸并且可限定成形杯1502的最外部分。在至少一个实施例中,除了上文所述,第一外壁1513的宽度可使得外部部分1512可捕获第一腿部1404的末端1405并将其导引进杯1502的内部部分1510中,如上所述。在至少一个此类实施例中,第一外壁1513的宽度可至少为第一腿部1404的直径的两倍。在某些实施例中,第一成形杯1502还可包括围绕第一内部部分1510和第一外部部分1512的导引面1528,所述第一外部部分1512能够将缝钉腿1404导向进和/或导向出成形杯1502。在各种实施例中,内部部分1510还可包括内壁1511,其可限定成形杯1502的最内部分。类似于上文所述,内壁1511还可限定成形杯1502的最窄部分。在至少一个实施例中,内壁1511的宽度可与第一腿部1404的直径相同或至少基本上相同,使得内壁1511可控制末端1405从缝钉成形杯1502露出的位置。
在各种实施例中,除了上文所述,第二成形杯1504可包括内部部分1520和外部部分1522,其中,当第二缝钉腿1406的末端1407进入第二成形杯1504时,末端1407可进入外部部分1522。在进入成形杯1504的外部部分1522时,末端1407可接触基部1508,并且由于基部1508的凹形曲线,末端1407可朝向内部部分1520向内导向。更具体地,类似于上文所述,基部1508可朝向组织接触表面1501弯曲,使得当缝钉腿1406接触基部1508时,末端1407可被向下导向,即远离组织接触表面1501导向,并向内沿弯曲凹形表面朝向拐点1596导向。在各种实施例中,拐点1596可代表这样的点,基部1508的凹形表面在该点处能够开始使第二腿部1406的末端1407朝向组织接触表面1501向上挠曲。在各种实施例中,凹形表面沿其长度在纵向上的曲率半径r可为恒定的或至少基本上恒定的,这与图80和81所示的第一成形杯1502的基部1506类似。在任何情况下,当第二腿部1406的末端1407推进到成形杯1504的内部部分1520中时,末端1407都可与定位在基部1508和第二内部侧壁1526之间的半径过渡段1524接触。在此类实施例中,半径过渡段1524能够将末端1407靠着第二内部侧壁1526导引。
如图76所示,除了上文所述,第二内部侧壁1526可相对于缝钉凹坑纵向轴线1599成一角度取向。在某些实施例中,第二内部侧壁1526可例如相对于纵向轴线1599成锐角(例如10度)取向。在各种实施例中,第二内部侧壁1526与纵向轴线1599彼此可以既不垂直也不平行。在任何情况下,第二内部侧壁1526可延伸穿过轴线1599,使得第二内部侧壁1526的第一部分定位在轴线1599的第一侧1515上,并且第二内部侧壁1526的第二部分定位在轴线1599的第二侧1517上。在各种实施例中,因此,第二内部侧壁1526可在第二外部部分1522和第二内部部分1520之间延伸。当第二腿部1406的末端1407以如上所述方式接触内部侧壁1526时,末端1407可被沿内部侧壁1526导引,使得缝钉腿1406远离缝钉1400的共同平面朝向轴线1599的第二侧1517弯曲。当第二腿部1406的末端1407以如上所述沿内部侧壁1526导引并被内部侧壁1526弯曲时,缝钉腿1406还可被基部1508导引和弯曲。换句话讲,第二内部侧壁1526和第二基部1508可配合使第二缝钉腿1406变形,使得末端1407朝基部1402改变方向并同时朝基部1402的第二侧或相对侧改变方向,如上所述。在第二缝钉腿1406插入第二成形杯1504过程的某个时间点,第二缝钉腿1406的末端1407可从第二成形杯1504的第二内部部分1520露出,并且当缝钉腿1406被缝钉凹坑1500进一步变形时,末端1407可沿第二轴线1416导向(图83),如上文所述。
在各种实施例中,除了上文所述,第二内部侧壁1526可沿第二基部1508的内侧延伸,其中,在至少一个实施例中,第二成形杯1504还可包括沿第二基部1508的相对侧延伸的第二外部侧壁1527。在某些实施例中,类似于上文所述,第二成形杯1504还可包括定位在基部1508与外部侧壁1527之间的过渡半径1529。在至少一个实施例中,现在参见图76,外部侧壁1527可沿平行于或至少基本上平行于缝钉凹坑纵向轴线1599的方向延伸。同样如图76所示,第二内部侧壁1526和第二外部侧壁1527可在横向于彼此的方向上延伸。在至少一个实施例中,内部侧壁1526可以例如相对于外部侧壁1527成锐角(例如大约15度)延伸。在各种实施例中,因此,第二成形杯1504的外部部分1522要比内部部分1520宽。在至少一个此类实施例中,外部部分1522和内部部分1520的宽度可在第一宽度和第二宽度之间渐缩。
在各种实施例中,再次参见图76,第二成形杯1504的外部部分1522可包括第二外壁1523,所述第二外壁可沿垂直于第二外部壁1527和/或纵向轴线1599的方向延伸并且可限定成形杯1504的最外部分。在至少一个实施例中,除了上文所述,第二外壁1523的宽度可使得外部部分1522可捕获第二腿部1406的末端1407并将其导引进杯1504的内部部分1520中,如上所述。在至少一个此类实施例中,第二外壁1523的宽度可至少为第二腿部1406的直径的两倍。在某些实施例中,第二成形杯1504还可包括围绕第二内部部分1520和第二外部部分1522的导引面1529,所述第二外部部分1522能够将缝钉腿1406导向进和/或导向出成形杯1504。在各种实施例中,内部部分1520还可包括内壁1521,其可限定成形杯1504的最内部分。类似于上文所述,内壁1521还可限定成形杯1504的最窄部分。在至少一个实施例中,内壁1521的宽度可与第二腿部1406的直径相同或至少基本上相同,使得内壁1521可控制末端1407从缝钉成形杯1504露出的位置。
如上所述,再次参见图76-78,第一成形杯1502可包括第一内部侧壁1516并且第二成形杯1504可包括第二内部侧壁1526。如图76所示,成形杯1502的第一内部部分1510可定位成与成形杯1504的第二内部部分1520紧密接近或紧密相关,使得第一内部侧壁1516可定位成邻近第二内部侧壁1526。在至少一个实施例中,第一内部1510或其至少主要部分可在第一方向1515上偏离缝钉凹坑纵向轴线1599,同时第二内部1520或其至少主要部分可在第二方向1517上偏离纵向轴线1599。在各种实施例中,缝钉凹坑1500可包括定位在第一内部部分1510和第二内部部分1520之间的壁1530,其中壁1530的第一侧可包括第一内部侧壁1516,并且其中壁1530的第二侧可包括第二内部侧壁1526。在至少一个此类实施例中,第一内部侧壁1516可平行于或至少基本上平行于第二内部侧壁1526。更具体地,在至少一个实施例中,第一内部侧壁1516可限定第一平面,并且第二内部侧壁1526可限定第二平面,其中第一平面与第二平面彼此平行或至少基本上平行。在各种实施例中,再次参见图77和78,第一内部侧壁1516可垂直于或至少基本上垂直于组织接触表面1501,并且类似地,第二内部侧壁1526可垂直于或至少基本上垂直于组织接触表面1501。
在各种实施例中,除了上文所述,第一内部侧壁1516可包括第一垂直部分1516a,所述第一垂直部分垂直于或至少基本上垂直于组织接触表面1501。在至少一个实施例中,第一垂直部分1516a可延伸穿过或横切纵向轴线1599。在各种实施例中,第一垂直部分1516a可沿第一内部侧壁1516的整体或仅一部分延伸。类似地,第二内部侧壁1526可包括第二垂直部分1526a,所述第二垂直部分垂直于或至少基本上垂直于组织接触表面1501。在至少一个实施例中,此类第二垂直部分1526a可延伸穿过或横切纵向轴线1599。在各种实施例中,第二垂直部分1526a可沿第二内部侧壁1526的整体或仅一部分延伸。在部署缝钉1400过程中,除了上文所述,在第二腿部1406的末端1407接触第二内部侧壁1526的第二垂直部分1526a的同时,第一腿部1404的末端1405可接触第一内部侧壁1516的第一垂直部分1516a。在此类情况下,第一垂直部分1516a和第二垂直部分1526a可构成垂直捕集器。更具体地,当腿部1404和1406分别接触成形杯1502和1504的内部侧壁1516和1526时,垂直部分1516a和1526a可沿相对的方向(即在朝共同平面两侧的方向,如上所述)相配合而控制、挠曲和弯曲缝钉腿1404和1406。例如,再次参见图75,第一垂直部分1516a能够将缝钉腿1404挠曲和弯曲到基部1402的第一侧,并且第二垂直部分1526a能够将缝钉腿1406挠曲和弯曲到基部1402的第二侧或相对侧。
在各种实施例中,除了上文所述,包括垂直部分1516a和1526a的垂直捕集器可沿第一内部侧壁1516和第二内部侧壁1526的全长延伸,而在其它实施例中,垂直捕集器可仅沿侧壁1516和1526的一部分延伸。在至少一个实施例中,垂直捕集器可为大约0.05英寸长,即第一垂直表面1516a与第二垂直表面1526a沿内表面1516和1526长度的重叠可为例如大约0.05英寸。在各种实施例中,垂直捕集器的长度可在例如大约0.03英寸和大约0.10英寸之间。在某些实施例中,垂直捕集器的长度可为例如基部1506的弯曲凹形表面的曲率半径(r)的大约两倍。在各种实施例中,垂直捕集器的长度可例如大约等于基部1506的曲率半径(r)。在至少一个实施例中,垂直捕集器的长度可在例如大约0.5*r和大约2*r之间。在各种实施例中,除了上文所述,垂直捕集器可延伸穿过缝钉凹坑1500的纵向轴线1599,使得在至少一个实施例中,垂直捕集器的至少一部分可定位在轴线1599的第一侧和/或第二侧。在某些实施例中,垂直捕集器可延伸穿过第一成形杯1502和第二成形杯1504的中心部分。
在各种实施例中,第一内部侧壁1516还可包括第一倾斜部分,其在至少一个实施例中可相对于组织接触表面1501成锐角取向。在至少一个此类实施例中,第一倾斜部分可相对于第一垂直部分1516a朝外定位。在某些实施例中,第一内部侧壁1516可包括朝向外部部分1512定位的倾斜部分,所述外部部分朝第一成形杯1502的内部部分1510逐渐变得更垂直,直到倾斜部分过渡到第一垂直部分1516a。在各种实施例中,第二内部侧壁1526还可包括第二倾斜部分,其在至少一个实施例中可相对于组织接触表面1501成锐角取向。在至少一个此类实施例中,第二倾斜部分可相对于第二垂直部分1526a向外定位。在某些实施例中,第二内部侧壁1526可包括朝向外部部分1522定位的倾斜部分,所述外部部分朝向第二成形杯1504的内部部分1520逐渐变得更垂直,直到倾斜部分过渡到第二垂直部分1526a。
在各种实施例中,现在参见图85A,缝钉凹坑1500能够使第一缝钉腿1404变形,使得第一末端1405偏离基线1401第一距离X1。类似地,第二缝钉腿1406可变形成使得第二末端1407偏离基线1401第二距离X2。在某些实施例中,距离X1和距离X2可相同或至少基本上相同。在多个其它实施例中,距离X1和X2可不同。在至少一个此类实施例中,第一腿部1404可变形成使得例如第一末端1405定位成比第二末端1407更邻近基部1402。在此类实施例中,变形的缝钉腿1404的第一轴线1414和变形的缝钉腿1406的第二轴线1416可以不平行。更具体地,在至少一个实施例中,第一轴线1414可相对于基线1401成第一角度延伸,并且第二轴线1416可相对于基线1401成第二角度延伸,其中第二角度不同于第一角度。在各种实施例中,第一腿部1404和第二腿部1406可以不同角度延伸穿过中线1403。在某些其它实施例中,第一腿部1404和第二腿部1406可相对于基线1401成不同角度延伸,但腿部1404和1406中的一者或两者可以不延伸穿过中线1403。
在各种实施例中,除了上文所述,外科缝合器可包括缝钉凹坑,所述缝钉凹坑能够使缝钉1400的一个缝钉腿变形,使得其与基部1402位于或基本上位于共同平面,此外还使缝钉1400的另一个缝钉腿向基部1402的一侧变形,如上所述。在至少一个实施例中,第一腿部1404可变形成使得其在与基部1402共面或至少基本上共面的方向上延伸穿过中线1403,此外,第二腿部1406可变形成使得其在横切于该平面的方向上延伸穿过中线1403。换句话讲,在至少一个实施例中,缝钉1400的轴线1414和基线1401可彼此共面或至少近似共面,而第二轴线1416可在延伸穿过该平面的方向上延伸。在某些实施例中,第一腿部1404和第二腿部1406中的至少一者可以不延伸穿过中线1403。
在各种实施例中,除了上文所述,缝钉凹坑1500能够同时或至少基本上同时使缝钉1400的缝钉腿1404和1406变形。在至少一个实施例中,在第二成形杯1504的基部1508接触第二缝钉腿1406的末端1407的同时或基本上同时,第一成形杯1502的基部1506可接触第一缝钉腿1404的末端1405。在某些其它实施例中,缝钉凹坑能够使缝钉腿1404和1406依次变形。在至少一个此类实施例中,例如可先使第一成形杯接触第一缝钉腿1404,再使第二成形杯接触第二缝钉腿1406。在多个可供选择的实施例中,尽管未示出,但外科缝钉可包括超过两个缝钉腿,例如三个缝钉腿或四个缝钉腿,并且缝钉凹坑可包括用于使缝钉腿变形的相应数量的缝钉成形杯。
在各种实施例中,除了上文所述,由线材构成的外科缝钉1400可具有圆形或至少基本上圆形的横截面。在多个其它实施例中,现在参见图86-89,外科缝钉(例如缝钉1600)例如可以具有非圆形横截面。在至少一个实施例中,缝钉1600可以包括基部1602、第一腿部1604和第二腿部1606,其中基部1602及腿部1604和1606可由连续线材构成。在各种实施例中,连续线材可具有例如矩形横截面。在至少一个实施例中,参见图89,矩形横截面可包括底(b)和高(h),其中可相对于中心横向轴线(x)限定底(b),并且其中可相对于中心纵向轴线(y)限定高(h)。在各种情况下,矩形横截面可被限定为具有两个惯性矩,即相对于轴线(x)限定的第一惯性矩(Ix)和相对于轴线(y)限定的第二惯性矩(Iy)。在至少一种情况下,第一惯性矩(Ix)可按(b*h^3)/12计算,而第二惯性矩(Iy)可按(h*b^3)/12计算。虽然缝钉1600具有矩形或至少基本上矩形的横截面,但也可使用任何其它合适的非圆形横截面,例如扁圆形、椭圆形和/或梯形横截面。
如图89所示,外科缝钉1600的底(b)大于高(h),鉴于以上情况,矩形横截面的惯性矩(Iy)大于惯性矩(Ix)。在各种实施例中,因此,矩形横截面的惯性矩比即Iy/Ix可大于1.0。在某些实施例中,惯性矩比可在例如大约2.0和大约2.7之间。在某些其它实施例中,惯性矩比可在例如大约1.1和大约3.0之间。由以上可得出,当在腿部1604上施加力(例如压力载荷F1)时,腿部1604更可能绕轴线(x)弯曲,而不是绕轴线(y)弯曲。在任何情况下,不考虑所有其它因素,腿部1604在此类实施例中更可能在由处于未变形状态时的缝钉1600限定的共同平面内弯曲,而不是弯向缝钉基部1602的一侧。然而,在各种实施例中,可使用包括砧座和根据本文所述实施例的缝钉凹坑(例如缝钉凹坑1500)的外科缝合器,使缝钉1600的腿部1604和1606在变形时弯离其共同平面。在此类实施例中,尽管事实上抵抗此类扭曲的惯性矩Iy大于惯性矩Ix,但还是会发生这种横向偏转。如图88所示,缝钉1600的第一腿部1604可变形成使得其相对于其横截面的轴线(x)和轴线(y)弯曲,因此,第一缝钉腿1604可扭曲或变形成使得第一缝钉腿1604的末端1605定位在基部1602的第一侧。类似地,第二腿部1606可变形成使得其相对于其横截面的轴线(x)和轴线(y)弯曲,因此,第二缝钉腿1606可扭曲或变形成使得第二缝钉腿1606的末端1607定位在基部1602的第二侧上。
在各种实施例中,现在参见图90,外科缝钉(例如外科缝钉1700)可包括基部1702,此外还包括从基部1702延伸的第一腿部1704和第二腿部1706。在某些实施例中,类似于上文所述,当缝钉1700为未变形或未部署构型(即,被例如外科缝合器的砧座变形前的构型)时,基部1702、第一腿部1704和第二腿部1706可位于或至少基本上位于共同平面内。在缝钉1700的已变形或已部署构型中,如图90所示,第一腿部1704可变形成使得末端1705指向基部1702和第二腿部1706。更具体地,在至少一个实施例中,末端1705可处于沿第一轴线1714或相对于第一轴线1714的方向,第一轴线1714相对于中线1703成一角度取向。类似地,第二腿部1706可变形成使得末端1707指向基部1702和第一腿部1704。更具体地,在至少一个实施例中,末端1707可处于沿第二轴线1716或相对于第二轴线1716的方向,第二轴线1716相对于中线1703成一角度取向。在多个实施例中,腿部1704的末端1705和腿部1706的末端1707可以不越过中线1703。在某些实施例中,类似于上文所述,第一腿部1704的末端1705可变形成使得其延伸到基部1702的第一侧,并且第二腿部1706的末端1707可变形成使得其延伸到基部1702的第二侧或相对侧,从而例如构造发生变形的腿部1704和1706并不完全被定位成与基部1702共面。
在各种实施例中,外科缝钉例如缝钉1800(图91)可包括基部1802、第一腿部1804和第二腿部1806,其中缝钉1800在处于未变形或未部署构型时可包括基本上U形的构型。在至少一个此类实施例中,腿部1804和1806可相对于基部1802沿垂直或至少基本上垂直的方向延伸。在各种情况下,缝钉1800可变形成如图91所示的B形构型。在至少一个此类实施例中,第一腿部1804可朝基部1802向下弯曲,使得延伸穿过末端1805的轴线1814垂直于或至少基本上垂直于基线1801。类似地,第二腿部1806可朝基部1802向下弯曲,使得延伸穿过末端1807的轴线1816垂直于或至少基本上垂直于基线1801。在至少一个此类情况下,腿部1804和1806可弯曲成使得轴线1814和1816彼此平行或至少基本上彼此平行。在各种实施例中,再次参见图91,缝钉腿1804和1806可变形成使得它们不越过中心线1803。缝钉腿1804和1806可变形成使得它们与基部1802保持共面或至少基本上共面。
下述各种例子可被预想到,这些例子体现了上述多个实施例的一个或多个方面。此类例子为示例性的,并且本专利申请中所述的各种实施例的多个方面可合并在单个实施例中。在下述每个例子中,外科缝钉可包括限定基线的基部、从基部延伸的第一腿部和第二腿部、以及第一腿部和第二腿部之间的中线。
实例1
外科缝钉可变形成使得:
实例2
外科缝钉可变形成使得:
实例3
外科缝钉可变形成使得:
实例4
外科缝钉可变形成使得:
实例5
外科缝钉可变形成使得:
实例6
外科缝钉可变形成使得:
实例7
外科缝钉可变形成使得:
实例8
外科缝钉可变形成使得:
实例9
外科缝钉可变形成使得:
上述已变形缝钉中的若干种包括一个或多个越过缝钉基部中线的缝钉腿。在各种实施例中,因此,已变形缝钉腿可至少部分地相互重叠。更具体地,(从侧面观察)已变形缝钉腿可相配合以从缝钉基部一端穿到另一端,其间不留间隙。此类实施例可特别有用,尤其是用于缝合血管组织时。更具体地,重叠的缝钉腿可挤压组织内的血管,无论血管在何处延伸穿过缝钉。腿部之间有间隙或者变形时腿部不沿缝钉基部全长延伸的缝钉可能不能够适当地挤压组织内的每条血管,因而一条或多条血管可能会渗漏。
在各种实施例中,除了上文所述,外科器械能够以上文所述和图83-85所示的方式部署多个缝钉1400。在至少一个此类实施例中,外科缝合器可例如同时地和/或沿缝钉路径顺序地部署缝钉1400。在某些实施例中,外科器械能够以上文所述和图88所示的方式部署多个缝钉1600。在至少一个此类实施例中,类似于上文所述,外科缝合器可例如同时地和/或沿缝钉路径顺序地部署缝钉1600。在各种实施例中,除了上文所述,外科器械能够以上文所述和图90所示的方式部署多个缝钉1700。在至少一个此类实施例中,外科缝合器可例如同时地和/或沿缝钉路径顺序地部署缝钉1700。
在各种实施例中,现在参见图103-108,外科缝合器械2100可类似于上文所述包括彼此可通过闩锁2180可操作地连接在一起的第一外壳部分2102和第二外壳部分2104。闩锁2180可包括框架2184,所述框架2184能够枢转地安装到第一外壳部分2102的框架2110。使用时,闩锁2180能够接合第二外壳部分2104的框架2114、将第二外壳部分2104朝向第一外壳部分2102牵拉、并且将第二外壳部分2104的砧座支撑部分2130朝向第一外壳部分2102的钉仓支撑部分2124运动。在各种实施例中,第一外壳部分2102、第二外壳部分2104、和闩锁2180可各自包括例如一个或多个波状轮廓的外部外壳或紧握部分。在至少一个此类实施例中,第一外壳部分2102可包括外部外壳2108,第二外壳部分2104可包括外部外壳2112,并且闩锁2180可包括外部外壳2186。外科缝合器械2100还可包括击发致动器2204,所述击发致动器可类似于上文所述能够选择性地定位在外科缝合器械的相对侧上。更具体地,除了上文所述,致动器2204可选择性地定位在外壳部分2102,2104的第一侧上以使得致动器2204可沿着第一侧向远侧进行运动,或者可选择性地定位在外壳部分2102,2104的第二侧上以使得致动器2204可沿着第二侧向远侧运动。在至少一个实施例中,第一外壳部分2102和第二外壳部分2104可在其间限定一个或多个狭槽2118,所述狭槽2118可允许致动器2204沿着第一侧和第二侧运动。在至少一个此类实施例中,狭槽2118可由中间狭槽2331连接,所述中间狭槽2331可围绕和/或穿过外科缝合器械2100的近端延伸。
除了上文所述,参见图103-111,击发致动器2204能够可旋转地安装到驱动棒2220,其中在至少一个实施例中,致动器2204能够通过联接件2206可旋转地安装到驱动棒2220。主要参见图109-111,致动器2204可在中间或中性位置(图109)(其中驱动棒2220锁定就位并且不能向远侧推进)和解锁位置(图110)(其中驱动棒2220和致动器2204准备用于向远侧进行击发)之间旋转。尽管图110示出了位于外科缝合器械外壳的第一侧上的解锁位置中的致动器2204,但致动器2204也可运动到位于外科缝合器械外壳的相对侧或第二侧上的解锁位置内。下述例子尽管结合沿外壳的第一侧运动的致动器2204进行论述,但这些例子也可适用于沿外壳的第二侧运动的致动器2204。在任何情况下,致动器2204和第一外壳部分2102例如可包括各种互锁结构,所述互锁结构可防止或至少限制驱动棒2220和第一外壳部分2102之间的相对运动。更具体地,在至少一个实施例中,第一外壳部分2102可包括一个或多个狭槽和/或一个或多个突出,所述一个或多个狭槽和/或一个或多个突出能够与致动器2204的一个或多个狭槽和/或一个或多个突出相配合,以使得驱动棒2220不能向远侧推进,直至致动器2204已充分旋转离开其中性位置并且旋转到解锁位置内。在各种实施例中,第一外壳部分2102的近端可包括端柱2107,所述端柱2107可包括保持狭槽2213,所述保持狭槽2213能够在其中容纳致动器联接件2206(例如保持突出2214)的至少一部分。当致动器2204处于其中性位置时,保持突出2214定位在保持狭槽2213内并且致动器2204和驱动棒2220均不能向远侧推进。当致动器2204朝向解锁位置旋转时,保持突出2214可从端柱2107中的保持狭槽2213移出并且运动到驱动棒2220中的容纳狭槽2215内,如图110所示。在至少一个实施例中,驱动棒2220和致动器2204可保持在锁定状态下,直至保持突出2214已完全离开保持狭槽2213。其后,可向远侧推进致动器2204。除上文所述之外或者取代上文所述,端柱2107还可包括保持壁2211,所述保持壁2211可类似于上文所述可阻止致动器2204和驱动棒2220的远侧运动。更具体地,致动器联接件2206还可包括保持突出2216,当致动器2204处于其中性位置时保持突出2216可相对于保持壁2211定位在后面或向远侧定位,并且由于这种对准,保持壁2211可提供防止保持突出2216的远端运动的支承表面。一旦致动器2204已充分离开其中性位置朝向解锁位置旋转,保持突出2216就可运动到通道2217中的位置,使得不与保持壁2211纵向对准,从而允许其间的相对纵向运动。
如上文所述,一旦致动器2204已运动到解锁位置(图110)内,致动器2204就可向远侧推进到击发位置(图111)。在此类情况下,现在参见图106,可将力施加到致动器2204,以便向远侧推进驱动棒2220并切割组织并且/或者从钉仓部署缝钉,如上文所述。在此类情况下,所述力可将致动器2204旋转和坐置到完全部署或至少近完全部署位置内。在至少一个实施例中,驱动棒2220可包括一个或多个止挡件(例如止挡件2221(图111)),所述止挡件可限制致动器2204沿远侧方向的旋转。在至少一个此类实施例中,驱动棒2220可包括第一止挡件2221和第二止挡件2221,所述第一止挡件能够限制致动器2204朝器械的第一侧旋转,所述第二止挡件能够限制致动器朝器械的第二侧旋转。在某些实施例中,参见图106,止挡件2221能够使得致动器2204沿下述轴线定位,所述轴线垂直于或至少基本上垂直于外科缝合器械2100的纵向轴线2299。致动器2204的这种定位还示于图104中。现在参见图107,可将力施加到致动器2204以便向近侧回缩致动器2204。在此类情况下,所述力可引起致动器2204向近侧旋转,直至其接触第一外壳部分2102和/或第二外壳部分2104。致动器2204的这种定位还示于图105中,其中致动器2204可紧靠例如锁定导轨2131和/或锁定导轨2132进行定位,以便防止致动器2204的任何其它旋转。
在各种实施例中,如上文所述,可使用闩锁2180来将第一外壳部分2102和第二外壳部分2104锁定在一起。在某些实施例中,致动器2204可用于限制外壳部分2102,2104之间的相对运动并且/或者使外壳部分2102,2104朝向彼此进行运动。在至少一个实施例中,主要参见图103、104和108,致动器2204可包括凹槽或通道2130,所述凹槽或通道能够当致动器2204沿外科缝合器械2100的第一侧运动时来容纳锁定导轨2131和2132、或者作为另外一种选择当致动器2204沿外科缝合器械2100的第二侧运动时来容纳锁定导轨2133和2134。在任一情况下,凹槽2130能够捕获相对组的导轨(例如导轨2131和2132)并且防止或至少限制其间的相对运动。更具体地,在至少一个实施例中,凹槽2130可包括定位成与第一锁定导轨2131相对的第一支承表面2135和定位成与第二锁定导轨2132相对的第二支承表面2136,以使得支承表面2135,2136可防止或至少限制第一外壳部分2102和第二外壳部分2104彼此远离的运动。在一些情况下,当支承表面2135,2136邻近锁定导轨2131,2132时可在支承表面2135,2136与相应锁定导轨2131,2132之间存在间隙,而在其它情况下,例如,支承表面2135可接触锁定导轨2131并且/或者支承表面2136可接触锁定导轨1232。使用时,在各种情况下,致动器2204可从其中性位置(图109)运动到解锁位置(图110),其中在此位置,凹槽2130可与一组导轨2131,2132或一组导轨2133,2134对准,这取决于致动器2204已旋转到第一侧还是第二侧。在一些情况下,当致动器2204向远侧推进时,致动器2204可接触导轨或凸轮、或者朝向彼此驱动导轨。在此类情况下,第一外壳部分2102和第二外壳部分2104可被朝向彼此凸轮或驱动。
在各种实施例中,如上文所述,致动器2204可容纳、捕获、和/或接合从第一外壳部分2102和第二外壳部分2104中的每一个延伸的锁定导轨。在各种可供选择的实施例中,致动器2204能够容纳、捕获、和/或接合从第一外壳部分2102和/或第二外壳部分2104延伸的两个或多个锁定导轨。在某些实施例中,第一外壳部分2102和/或第二外壳部分2104可包括一个或多个锁定通道,所述锁定通道能够容纳致动器的至少一部分。在各种实施例中,外科缝合器械的外壳部分和致动器可包括任何合适的锁定部分,所述锁定部分能够容纳、对准、保持、捕获、锁定、运动、凸轮外科器械外壳部分、和/或限制外科器械外壳部分的运动。在各种实施例中,主要参见图106和107,锁定导轨2131,2132,2133和/或2134可沿着缝合器械2100纵向延伸,以使得在至少一个实施例中,它们沿纵向方向从外科缝合器械2100的近端朝向该器械的远端延伸,所述纵向方向平行于或至少基本上平行于纵向轴线2299。此外,在至少一个实施例中,锁定导轨2131,2132,2133和/或2134可沿着彼此平行或至少基本上彼此平行的方向延伸。
在各种实施例中,如上所述,外科缝合器械可包括砧座,该砧座包括多个缝钉凹坑1500。在某些实施例中,缝钉凹坑1500可以首尾相连方式被布置成在砧座的近端和远端之间延伸。现在参见图119,砧座可包括一排或多排缝钉凹坑1500,其中每个缝钉凹坑1500的第一成形杯1502可例如相对于其相应的第二成形杯1504向远侧定位。在某些其它实施例中,第一成形杯1502可相对于其相应的第二成形杯1504向近侧定位。在各种实施例中,每个第一成形杯1502可包括大体三角形形状,该大体三角形形状包括第一腿部、第二腿部以及在第一腿部和第二腿部之间延伸的斜边。第一腿部包括第一外侧壁1513,第二腿部包括垂直于或至少基本上垂直于第一腿部延伸的第一外部侧壁1517,斜边包括第一内部侧壁1516。在至少一个此类实施例中,第一成形杯1502的第一腿部、第二腿部和斜边可形成直角三角形或至少基本上直角三角形。如图119所示,砧座诸如砧座2430例如可包括第一侧2431、第二侧2432、在第一侧2431和第二侧2432之间延伸的刀槽2433、和多个缝钉凹坑1500。多个缝钉凹坑1500可包括第一组缝钉凹坑1500(以下称为第一缝钉凹坑1500a)、以及第二组缝钉凹坑1500(以下称为第二缝钉凹坑1500b)。每个第一缝钉凹坑包括第一构型并且每个第二缝钉凹坑包括第二构型。参照第一缝钉凹坑1500a,其中的第一成形杯1502可包括第一外部侧壁1517和第一内部侧壁1516。第一外部侧壁可面朝和/或可平行于刀槽2433,并且第一内部侧壁可面朝砧座2430的第一侧2431。
类似于上文所述,每个第二成形杯1504可包括大体三角形形状,该大体三角形形状包括第一腿部、第二腿部以及在第一腿部和第二腿部之间延伸的斜边。第一腿部包括第二外侧壁1523,第二腿部包括垂直于或至少基本上垂直于第一腿部延伸的第二外部侧壁1527,斜边包括第二内部侧壁1526。在至少一个此类实施例中,第二成形杯1504的第一腿部、第二腿部和斜边可形成直角三角形或至少基本上直角三角形。相似地,第一缝钉凹坑1500a的第二成形杯1504包括第二外部侧壁1527,该第二外部侧壁可面朝和/或可平行于砧座2430的第一侧2431,而第二内部侧壁1526可面朝刀槽2433。在各种实施例中,第二缝钉凹坑1500b可包括几何形状,该几何形状为镜像或基本上为第一缝钉凹坑1500a的镜像。类似于第一缝钉凹坑1500a的第一成形杯1502,第二缝钉凹坑1500b的第一成形杯1502可包括第一外部侧壁1517和第一内部侧壁1516。第一外部侧壁可面朝和/或平行于刀槽2433,并且第一内部侧壁可面朝砧座2430的第二侧2432。此外,类似于第一缝钉凹坑1500a的第二成形杯1504,第二缝钉凹坑1500b的第二成形杯可包括第二外部侧壁1527和第二内部侧壁1526。第二外部侧壁可面朝和/或可平行于砧座2430的第二侧2432,并且第二内部侧壁可面朝刀槽2433。
在各种实施例中,外科缝合器的砧座可包括一排第一缝钉凹坑1500a和一排第二缝钉凹坑1500b。再次参见图119,砧座2430可包括刀槽2433的第一侧上的多排第一缝钉凹坑1500a和刀槽2433的相对侧上的多排第二缝钉凹坑1500b。在使用期间,在至少一个此类实施例中,例如由第一成形杯1502形成的缝钉腿可朝向刀槽2433至少部分地弯曲,而由第二成形杯1504形成的缝钉腿可远离刀槽2433至少部分地弯曲。可在刀槽2433的两侧产生已成形缝钉的此类布置。在某些可供选择的实施例中,例如缝钉凹坑1500可被布置成使得由第一成形杯1502形成的缝钉腿可远离刀槽2433至少部分地弯曲,而由第二成形杯1504形成的缝钉腿可朝刀槽2433至少部分地弯曲。在某些实施例中,砧座可包括交替的多排缝钉凹坑1500a和1500b。在至少一个实施例中,砧座可包括多排缝钉凹坑,该多排缝钉凹坑例如包括缝钉凹坑1500a和缝钉凹坑1500b两者。在至少一个此类实施例中,可实现朝向和远离彼此形成的各种型式的缝钉腿。
在各种实施例中,除了上文所述并且再次参见图76,外科缝合器的砧座可包括多个缝钉凹坑1500。在某些实施例中,缝钉凹坑1500可沿直的或至少基本上直的线布置和定位,使得缝钉凹坑1500的纵向轴线1599彼此共线、基本上彼此共线、彼此平行、和/或基本上彼此平行。在各种实施例中,外科缝合器械可包括弯曲砧座。现在参见图112,外科缝合器械2200例如可包括端部执行器,该端部执行器包括圆形的或至少基本上圆形的砧座2230。例如,砧座2230可包括圆形的或至少基本上圆形的内排缝钉凹坑1500以及圆形的或至少基本上圆形的外排缝钉凹坑1500。在各种实施例中,圆形的内排缝钉凹坑1500和圆形的外排缝钉凹坑1500可彼此同心或至少基本上同心。在各种其它实施例中,例如砧座可包括仅一排圆形的缝钉凹坑1500或两排以上的圆形的缝钉凹坑1500。
在各种实施例中,再次参见图112,外科缝合器械2200还可包括被定位成与砧座2230相对的圆形钉仓2250。钉仓2250可包括存储在其中的多个缝钉。在钉仓使用期间,缝钉可从钉仓2250弹出并且与缝钉凹坑1500接触。在各种实施例中,缝钉可存储于在钉仓2250内限定的缝钉腔中。缝钉腔和缝钉可与缝钉凹坑1500对齐,使得缝钉腿可进入如上所述的缝钉凹坑1500的第一成形杯1502和第二成形杯1504中。在各种实施例中,外科缝合器械可包括击发驱动,该击发驱动可从钉仓弹出缝钉,此外还能使切割构件相对于钉仓和砧座运动。各种外科缝合器械在公布于1994年2月14日的名称为“SURGICAL ANASTOMOSISSTAPLING INSTRUMENT”的美国专利5,285,945中有所公开,该专利的全部公开内容以引用方式并入本文。
在各种实施例中,现在首先参见图113,缝钉凹坑1500可例如沿内环路2231和/或外环路2232定位。如上所述,每个缝钉凹坑1500可包括纵向轴线1599,在某些实施例中,该纵向轴线延伸穿过其相应的缝钉凹坑1500的中心。如图113所示,每根纵向轴线1599可横向延伸穿过内环路2231和/或外环路2232。在至少一个此类实施例中,内排缝钉凹坑1500的纵向轴线1599可横向延伸穿过内环路2231,并且外排缝钉凹坑1500的纵向轴线1599可横向延伸穿过外环路2232。在各种实施例中,再次参见图76,每个缝钉凹坑1500可由在第一外壁1513与第二外壁1523之间延伸的纵向长度限定,其中在至少一个此类实施例中,每个纵向长度可包括中点。在某些实施例中,缝钉腔1500可被定位和布置成使得纵向长度的中点被定位在内环路2231和/或外环路2232上和/或附近。在至少一个实施例中,纵向长度的中点可被定位成相对于内环路2231和/或外环路2232偏置。
在各种实施例中,除了上文所述,缝钉凹坑1500的轴线1599可相对于内环路2231和外环路2232倾斜。在至少一个此类实施例中,每个缝钉凹坑1500可包括第一成形杯1502和第二成形杯1504。第一成形杯至少部分地定位在环路的一侧上,并且第二成形杯至少部分地定位在环路的另一侧上。在某些其它实施例中,缝钉凹坑1500可例如成轮廓为使得缝钉凹坑的纵向中心线弯曲,以匹配或至少基本上匹配内环路2231和/或外环路2232的曲率半径。在各种实施例中,每个环路可由恒定的或至少基本上恒定的曲率半径限定,并且缝钉凹坑1500可成轮廓以匹配或至少基本上匹配该曲率半径。
在各种实施例中,现在参见图114,外科器械诸如外科器械2300例如可包括弯曲砧座2330。类似于上文所述,弯曲砧座2330可包括沿多个弯曲排定位的多个缝钉凹坑1500。在所示实施例中,砧座2330可包括例如四排弯曲的凹坑1500,其中,首先参见图115和116,缝钉凹坑1500可沿第一弯曲路径2331、第二弯曲路径2332、第三弯曲路径2333、和/或第四弯曲路径2334定位。在至少一个此类实施例中,每个弯曲路径可由不同的曲率半径限定。在某些实施例中,每个弯曲路径可由恒定的或至少基本上恒定的曲率半径限定。在某些其它实施例中,每个弯曲路径可由不止一个曲率半径限定。类似于上文所述,缝钉凹坑1500的纵向轴线1599可相对于弯曲路径横向延伸,并且在某些实施例中,轴线1599可中心位于弯曲路径上。在各种实施例中,外科器械2300还可包括钉仓2350,该钉仓包括可移除地存储在其中的多个缝钉。外科器械2300还可包括击发驱动,该击发驱动可从钉仓弹出缝钉,此外还能使切割构件或刀相对于钉仓2350和砧座2330运动。各种外科缝合器械公开于2004年12月20日提交的名称为“CURVED CUTTER STAPLER SHAPED FOR MALE PELVIS”的美国专利申请11/014,910中,该专利申请的全部公开内容以引用方式并入本文。
如上关于外科缝钉1400和图82-85所述,外科缝钉可包括在缝钉腿1404和1406之间延伸的平坦的或至少基本上平坦的基部1402。在使用期间,在至少一个实施例中,钉仓可包括多个缝钉驱动器,在缝钉驱动器将缝钉1400弹出钉仓时,该缝钉驱动器能够支撑缝钉1400的基部1402。在各种实施例中,缝钉驱动器可包括一个或多个平坦的或至少基本上平坦的支撑托架,该支撑托架可支撑平坦的或至少基本上平坦的基部1402。在各种其它实施例中,现在参见图118,外科缝钉诸如缝钉2500例如可包括基部2502、第一腿部2504和第二腿部2506。与缝钉1400的缝钉腿1404和1406类似,当缝钉2500处于未成形或未部署的状态时,缝钉腿2504和2506可以基本上U形的构型和/或基本上V形的构型向上延伸。当缝钉2500从钉仓弹出时,与缝钉1400类似,缝钉腿2504和2506可接触被定位成与钉仓相对的砧座,该砧座能够使缝钉腿变形并且使缝钉腿朝缝钉的基部卷曲,如上所述。图118绘出了处于此类已变形或已部署状态的缝钉2500。还如图118所示,缝钉2500的基部2502可被弯曲。在各种实施例中,基部2502可包括弯曲部分2501,该弯曲部分可向上、向内、朝向缝钉腿2504和2506弯曲。更具体地,当将缝钉1400(图117)和缝钉2500(118)并排比较时,可看到基部2502在由基部1402限定的水平面的上方延伸。在各种实施例中,除了上文所述,弯曲部分2501可由单个曲率半径或不止一个曲率半径限定。在至少一个实施例中,弯曲部分2501可包括弓形构型。在各种实施例中,弯曲部分2501可包括拱形构型和/或弓形构型。在某些实施例中,弯曲部分2501可包括抛物线的或至少基本上抛物线的构型。不管构型为何,在各种实施例中,弯曲部分2501可包括弹簧,该弹簧可弹性地施加弹簧力到被捕获的组织。
在各种实施例中,弯曲部分2501能够施加压缩力或压力到被捕获在已变形或已部署的缝钉2500内的组织。在使用期间,当缝钉腿2504和2506抵靠砧座发生变形时,缝钉腿2504和2506可开始抵靠基部2502的弯曲部分2501挤压组织,并且因此弯曲部分2501可由于施加到其的负荷而至少部分地挠曲。在各种情况下,弯曲部分2501能够弹性地和/或可塑性地变形,其中变形的量可取决于例如组织厚度。更具体地,如果被捕获在缝钉2500内的组织相对较薄,则弯曲部分2501可产生极小的变形(如果真的发生变形的话),并且如果被捕获在缝钉2500内的组织相对较厚,则会产生相对较大的变形。在某些实施例中,每个缝钉2500可被制造成具有弯曲部分2501,使得缝钉2500的基部2502在被组装到钉仓中之前为预先弯曲的。在至少一个实施例中,定位在钉仓内的缝钉驱动器可包括弯曲的支撑托架,该弯曲的支撑托架可支撑弯曲部分2501的底部表面。在至少一个此类实施例中,支撑托架可包括与弯曲部分2501的曲率匹配或至少基本上匹配的弯曲表面。在某些实施例中,例如缝钉2500的基部2502可在缝钉形成过程期间变形,以包括向上悬垂的弯曲部分,诸如弯曲部分2501。在至少一个此类实施例中,缝钉2500可包括平坦的或至少基本上平坦的基部2502,其中缝钉驱动器中的每一个可包括能够接触基部2502并使基部2502变形的一个或多个弯曲芯轴。在某些其它实施例中,缝钉2500可包括在被插入钉仓之前就预先弯曲的基部,其中最终的弯曲形状可在缝钉形成过程期间获得,该过程类似于上文所述的过程。
在各种实施例中,除了上文所述,缝钉2500的例如弯曲部分2501可施加足够的压力到组织,该压力可使组织减少或停止出血。在某些实施例中,弯曲部分可横跨第一缝钉腿2504和第二缝钉腿2506之间的整个距离而延伸。在某些其它实施例中,弯曲部分可仅横跨缝钉腿2504和2506之间的仅部分距离而延伸。在至少一个实施例中,例如基部2502可包括弯曲部分和平坦部分两者。在某些实施例中,可压缩材料可例如被定位在钉仓和/或砧座上,和/或附接到钉仓和/或砧座。该可压缩材料可压靠组织,并且在缝钉已被部署后被捕获在缝钉内。类似于弯曲部分2501,当缝钉腿发生变形并且朝缝钉基部向下弯曲时,可压缩材料能够弹性地和/或可塑性地挠曲。在各种情况下,变形的量可取决于例如被捕获在缝钉内的组织厚度。更具体地,如果被捕获在缝钉内的组织相对较薄,则可压缩材料可产生极小的变形(如果真的发生变形的话),并且如果被捕获在缝钉内的组织相对较厚,则可压缩材料可产生相对较大的变形。在任何情况下,可压缩材料可包括一层助剂、止血材料、和/或可有利于减少或阻止缝钉组织出血和/或换句话讲治疗组织的任何其它合适的治疗材料。如上所述,现在参见图120,可压缩材料诸如可压缩材料2340,例如可被附接到砧座和/或钉仓。在某些实施例中,可压缩材料可例如使用一种或多种粘合剂被粘附到砧座和/或钉仓。在各种实施例中,可压缩材料可包括保持结构,该保持结构能够接合砧座和/或钉仓并将可压缩材料保持到砧座和/或钉仓。在至少一个此类实施例中,可压缩材料可例如至少部分地定位在限定于钉仓中的缝钉腔内,和/或定位在限定于砧座中的缝钉凹坑内。在某些实施例中,当部署缝钉时,切割构件或刀相对于钉仓和砧座的运动可使可压缩材料与砧座和/或钉仓分离或脱离。
在各种实施例中,除了上文所述,外科缝钉可由钛构成,例如钛丝。在某些实施例中,外科缝钉可由含有例如钛、铝和/或钒的合金构成。在至少一个实施例中,外科缝钉可由例如外科不锈钢和/或合金构成,所述合金由钴和铬构成。在任何情况下,外科缝钉可由金属(例如钛)和金属氧化物外表面(例如氧化钛)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,涂层材料可包括例如聚四氟乙烯(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)。某些涂料可包含硅。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,砧座或缝钉凹坑可靠贴于这些表面而接触缝钉,以降低它们之间的摩擦力。在各种情况下,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。
可将本发明所公开的装置设计为单次使用后即进行处理,或者可将它们设计为可多次使用。然而,在任一种情况下,所述装置均可进行修复,以在至少一次使用后再次使用。重新恢复可包括如下步骤的任意组合:拆卸该装置、然后清洗或置换某些零件以及随后组装。特别是,所述装置可以拆卸,而且可以任意组合选择性地置换或移除该装置任意数目的特定零件或部分。清洗和/或置换特定部分后,该装置可以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,装置的修复可利用多种用于拆卸、清洗/置换和重新组装的技术。这些技术的使用以及所得的再修复装置均在本发明的范围内。
优选的是,在手术前处理本文所述的装置。首先,获取新的或用过的器械,并在必要时对器械进行清洁。然后对器械进行消毒。在一种消毒技术中,将该器械置于闭合并密封的容器中,例如塑料或TYVEK袋中。然后将容器和器械置于能够穿透该容器的辐射区,例如γ辐射、x-射线或高能电子。辐射将器械上和容器中的细菌杀死。然后将灭菌后的器械保存在消毒容器中。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型式、用途或适应型式。此外,本专利申请旨在涵盖本发明所属领域中出自已知或惯有实践范围内的背离本公开的型式。
Claims (10)
1.一种外科缝合器,包括:
弯曲砧座组件,所述弯曲砧座组件包括:
组织接触表面;
形成于所述组织接触表面中的多个缝钉凹坑,其中所述缝钉凹坑沿弯曲路径定位,其中每个所述缝钉凹坑包括:
缝钉凹坑中线,其中第一缝钉凹坑的所述缝钉凹坑中线既不平行于第二缝钉凹坑的所述缝钉凹坑中线,也不与第二缝钉凹坑的所述缝钉凹坑中线共线;
第一成形杯,所述第一成形杯包括:
第一内部部分;
第一外部部分;和
在所述第一外部部分和所述第一内部部分之间延伸的第一内部侧壁,其中所述第一内部侧壁包括基本上垂直于所述组织接触表面的第一垂直部分;以及
第二成形杯,所述第二成形杯包括:
第二内部部分;
第二外部部分,其中所述第一内部部分紧邻所述第二内部部分定位,其中所述第一内部部分和所述第二内部部分被定位成相对于所述缝钉凹坑中线偏置,并且其中所述第一外部部分和所述第二外部部分被定位在所述第一内部部分和所述第二内部部分的相对侧上;和
在所述第二外部部分和所述第二内部部分之间延伸的第二内部侧壁,其中所述第二内部侧壁包括基本上垂直于所述组织接触表面的第二垂直部分,其中所述第一垂直部分和所述第二垂直部分延伸穿过所述缝钉凹坑中线,并且其中所述第一垂直部分和所述第二垂直部分构成捕集器,其中在缝钉的第二腿部的末端接触第二内部侧壁的第二垂直部分的同时,缝钉的第一腿部的末端接触第一内部侧壁的第一垂直部分,由此使缝钉的第一腿部向所述缝钉凹坑中线的第一侧变形,并且使所述缝钉的第二腿部向所述缝钉凹坑中线的第二侧变形。
2.根据权利要求1所述的外科缝合器,其中所述第一内部侧壁还包括第一倾斜部分,所述第一倾斜部分相对于所述组织接触表面成锐角取向,其中所述第一倾斜部分相对于所述第一垂直部分向外定位,其中所述第二内部侧壁还包括第二倾斜部分,所述第二倾斜部分相对于所述组织接触表面成锐角取向,并且其中所述第二倾斜部分相对于所述第二垂直部分向外定位。
3.根据权利要求1所述的外科缝合器,其中所述第一内部部分和所述第二内部部分由壁分开,其中所述壁由所述第一内部侧壁和所述第二内部侧壁限定。
4.根据权利要求1所述的外科缝合器,其中所述第一内部部分由第一宽度限定,并且所述第一外部部分由第二宽度限定,并且其中所述第二宽度比所述第一宽度宽。
5.根据权利要求1所述的外科缝合器,其中所述第一成形杯还包括第一外部侧壁,其中所述第二成形杯还包括第二外部侧壁,其中所述第一内部侧壁和所述第一外部侧壁彼此成锐角取向,并且其中所述第二内部侧壁和所述第二外部侧壁彼此成锐角取向。
6.根据权利要求5所述的外科缝合器,其中所述第一成形杯包括第一细长基部,其中所述第一细长基部沿所述缝钉凹坑中线凹进弯曲,其中所述第二成形杯包括第二细长基部,并且其中所述第二细长基部沿所述缝钉凹坑中线凹进弯曲。
7.根据权利要求6所述的外科缝合器,其中所述第一细长基部由曲率半径(r)限定,并且其中所述第一垂直部分由大约0.5*r和大约2.0*r之间的长度限定。
8.根据权利要求1所述的外科缝合器,其中所述第一内部侧壁平行于所述第二内部侧壁。
9.根据权利要求1所述的外科缝合器,还包括被聚四氟乙烯和硅中的至少一者至少部分涂覆的缝钉。
10.根据权利要求1所述的外科缝合器,还包括附接到所述组织接触表面的至少一块可压缩材料。
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PCT/US2012/026531 WO2012118708A2 (en) | 2011-02-28 | 2012-02-24 | Surgical stapling instrument |
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2011
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2012
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- 2012-02-24 JP JP2013556748A patent/JP6113667B2/ja active Active
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BR112013022045B1 (pt) | 2020-11-24 |
RU2627599C2 (ru) | 2017-08-09 |
JP2017077488A (ja) | 2017-04-27 |
US20140042205A1 (en) | 2014-02-13 |
JP6113667B2 (ja) | 2017-04-12 |
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US20140014705A1 (en) | 2014-01-16 |
CA2828470A1 (en) | 2012-09-07 |
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BR112013022045A2 (pt) | 2017-10-31 |
US9687231B2 (en) | 2017-06-27 |
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AU2012223619B2 (en) | 2015-12-24 |
WO2012118708A2 (en) | 2012-09-07 |
AU2012223619A1 (en) | 2013-09-05 |
WO2012118708A3 (en) | 2012-12-06 |
EP2680758B1 (en) | 2019-04-03 |
US8561870B2 (en) | 2013-10-22 |
EP2680758A2 (en) | 2014-01-08 |
US10765424B2 (en) | 2020-09-08 |
CN103517679A (zh) | 2014-01-15 |
JP2014514009A (ja) | 2014-06-19 |
JP6370869B2 (ja) | 2018-08-08 |
WO2012118708A8 (en) | 2013-09-26 |
RU2013143784A (ru) | 2015-04-10 |
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