CN103930058A - 组织去除装置和方法 - Google Patents

组织去除装置和方法 Download PDF

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CN103930058A
CN103930058A CN201280040616.0A CN201280040616A CN103930058A CN 103930058 A CN103930058 A CN 103930058A CN 201280040616 A CN201280040616 A CN 201280040616A CN 103930058 A CN103930058 A CN 103930058A
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broaching tool
sections
tooth
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E·斯科特·格林哈尔希
罗伯特·A·基弗
格雷格·安德森
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FLEXMEDEX LLC
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FLEXMEDEX LLC
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1659—Surgical rasps, files, planes, or scrapers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine

Abstract

本发明公开了用于去除硬组织和/或软组织的组织去除装置。该装置具有与铰接式拉刀连接的细长刚性杆。可通过在骨内形成的穿骨输送通道将该装置插入。拉刀在经过穿骨输送通道后可以铰接。

Description

组织去除装置和方法
相关申请的交叉引用
本申请要求于2011年8月28日提交的美国临时申请No.61/526,630的优先权，其全文通过引用的方式并入本文。
背景技术
现有的治疗脊柱疾病的手术包括摘除椎间盘，称为椎间盘去除术。摘除的椎间盘可以由包括刚性金属植入物的其他装置代替。
在L5和S1椎骨之间进行的椎间盘去除术是困难的，因为通向L5-S1椎间隙的路径往往穿过骶骨前方的组织，其含有大量的敏感神经和动脉。椎间盘去除术和将植入物向L5-S1椎间隙的输送的副作用会引起严重损害的重大风险。
存在建立穿过髂骨和/或骶骨的传输通道以传输植入物的方法。然而，在通道内侧上操纵、定位和定向植入物是不容易的。而且，当装置从骨通道出去并在进入椎间隙前穿过软组织时，仍然是可能造成意外的软组织损伤。此外，如果不能穿过通道，则难以进行椎间盘去除术，因为进入盘间隙必须要通过通道。
因此，需要通过并在穿骨的或其他受限通道的远侧进行椎间盘去除的方法和装置。
发明内容
公开了用于去除组织的装置。所述装置具有与铰接式拉刀连接的刚性杆。拉刀可具有锥形的远端尖部。拉刀可具有从拉刀侧向或径向伸展的齿。
拉刀可具有纵向地位于第二节段远端的第一节段。第一节段可以可旋转地与第二节段连接。拉刀可具有位于第二节段纵向远端的第三节段。第三节段可以可旋转地与第二节段连接。第三节段可与刚性杆连接。
还公开了用于从生物目标位置去除组织的方法。该方法包括将多节段铰接式拉刀插入目标位置。该方法包括穿过阻碍的骨如髂骨和/或骶骨形成通道。在S1脊终板内，通道可具有出口。拉刀可以调入通道，或从通道调出。当拉刀位于目标位置时，拉刀可以是铰接的。
拉刀可以在目标位置捕获组织碎片，且可以从目标位置去除拉刀。当从目标位置去除拉刀时，拉刀可以从目标位置去除组织碎片。例如可以在L5-S1椎间盘间隙处进行该方法。
附图说明
图1示出了组织去除装置的实施例。
图2是拉刀的实施例处于非铰接构形时的侧视图。
图3是图2的拉刀处于铰接构形时的侧视图。
图4是拉刀的实施例处于铰接构形时的透视图。
图5示出下脊骨和骨盘。
图6-9示出了组织去除装置的使用方法的实施例。
图10-12分别示出了穿骨传输通道位置的实施例从顶部位置的横向平面、从侧面位置的矢状平面和从前面位置的冠状平面的视图。
图13a-13d示出了组织去除装置的使用方法的实施例的顶部视图，出于示意性目的，其解剖学上示出了髂骨和骶骨，但没有L5-S1盘或脊柱其余部分。
图14a-14d示出了组织去除装置的使用方法的实施例的后部透视图，出于示意性目的，其示出了髂骨和骶骨，但没有L5-S1盘或脊柱其余部分。
图15a-15c是在L5-S1椎间隙目标位置处组织去除装置的使用方法的实施例的射线显象可视化图。
具体实施方式
图1示出了组织去除工具10或装置可具有连接于杆的远端的拉刀12、麻花钻或镗孔刀。工具10可构造成从患者体内的目标部位去除硬组织和/或软组织，例如骨、软骨、韧带、胶原组织如椎间盘，受感染的组织或其组合。工具10可构造成通过在患者体内形成的孔道或通道去除组织。
在拉刀12内和/或在拉刀与杆14的连接处，拉刀12可以是刚性的、柔性的、固定的（即非可铰接的）、可铰接的，或其组合。拉刀12的远末端可以创伤性或防止创伤地削尖和/或锐化，以例如在穿过组织推进时，剖开组织。拉刀表面的部分或全部可以是平滑和/或有纹理的。杆14可在杆锥16处逐渐变细直到拉刀12。
杆14沿整个长度可以是刚性或柔性的，或具有交替的柔性和刚性的长度。杆14可以是单节且非可铰接的，或者可以是分节且可铰接的。杆14可以具有的控制杆（未示出），其设置于杆14内或杆14的外侧，以控制拉刀12的铰接（例如关节的锁定和解锁，并控制每一节的铰接的角度）。
杆14的远末端可在杆锥16处逐渐变细直到与拉刀12连接。杆14的远端可固定地或可拆卸地与拉刀12连接。
杆14的近端可逐渐变细直到杆颈部18。杆14的近端可以与手柄20连接，或与手柄20一体形成。手柄20可具有一个、两个、三个、四个或五个手指（和拇指）座24，从而例如沿与杆颈部18在人体工程学上符合使用者的手。手柄20在一个或多个手指座24中可具有关节控制面，如按钮、开关或扳机。关节控制面可控制拉刀12相对于杆14的远端的铰接、安装、拆卸或其组合。
杆14的近末端可具有杆头22。可以将杆头固定到杆14的其余部分，或从杆14的其余部分移除。可以从杆14的其余部分将杆头22移除，使得能够例如移除和更换手柄20（例如，用较大或较小的手柄20来替换手柄20，以适应使用者的手）。杆14可例如在杆头22与未示出的辅助装置连接。辅助装置可以是或者具有：电子、液压或气动的超音速、高超音速或亚音速振荡器；配置为使拉刀12铰接的电源和/或控制单元；可视化和照明装置，其用于向杆14和/或拉刀12的末端发送和从杆14和/或拉刀12的末端接收可视化显示和照明功率和信号；抽吸和/或冲洗工具，其用于向杆14和/或拉刀12或其组合的远端递送和从杆14和/或拉刀12或其组合的远端接收固体和流体（例如生理盐水、止痛剂、麻醉剂、抗生素、碎屑）或其组合。
图2示出了拉刀12可具有固定地或可旋转地连接到杆14上的连接节段26a。连接节段26a可具有连接节段纵向轴线28a。连接节段26a可以固定于杆14或相对于杆14围绕连接节段纵向轴线28a和/或围绕垂直于连接节段纵向轴线26a的一条或多条轴线旋转。
拉刀12可具有第二尾部节段26b。在第二尾部节段26b的近端，第二尾部节段26b可以具有第二后铰链30a。在第二后铰链30a处，第二尾部节段26b可以可旋转地与连接节段26a连接。
拉刀12可具有第一尾部节段26c。在第一尾部节段26c的近端，第一尾部节段26c可以具有第一后铰链30b。在第一后铰链30b处，第一尾部节段26c可以可旋转地与第二尾部节段26b连接。
在拉刀12的远末端处，拉刀12可具有远节段26d。在远节段26d的近端，远节段26d可以具有主铰链26c。在主铰链26c处，远节段26d可以与第一尾部节段26c可旋转地连接。
拉刀12可具有在远端或头部节段26d与连接节段26a或杆14之间可具有旋转地依次连接的零、一、二、三、四或更多的尾部节段26，类似于图2所示的配置。
如图2所示，当拉刀12处于线性配置时，第一后铰链30b、第二后铰链30a和主铰链30c可以处于相同平面（如图所示）或不同的平面。
拉刀12可具有下侧32a和上侧32b。使用过程中，下侧32a可朝向着患者的下端，且上侧32b可朝向患者的上端。
在拉刀12的下侧32a和/或上侧32b上，拉刀12的任何或所有节段26可具有一个或多个齿34。在拉刀的侧面上，例如在垂直于下侧32a和上侧32b的平面，拉刀12的任何或所有节段26可具有一个或多个齿34。节段26可具有切削面齿34a和铰链齿34b。切削面齿34a可以和铰链齿34b具有相同或不同的形状。切削面齿34a可以对称地成形并相对齿34位于拉刀12的相对侧，或不对称地成形或相对齿34位于拉刀12的相对侧。铰链齿34b可以在拉刀12的一侧，例如在拉刀12的上侧32b，但是，如图所示，铰链齿34不能沿拉刀12以相同长度设在拉刀12的下侧32a作为相应的铰链齿34b。铰链齿34b可以在长度上符合铰链30的定位。每个节段26在节段26的一侧或每侧（如图所示）可具有一个、两个、三个、四个（如图所示）、五个或更多的切削面齿34a。
每个切削面齿34a可具有切削面齿主刃面36a和切削面齿后刃面36b。每个铰链齿可以具有铰链齿主刃面和铰链齿后刃面，其可以分别类似于切削面齿主刃面36a和切削面齿后刃面36b。齿34可以具有形成于齿的主刃面和后刃面之间的切削面齿或铰链齿的角38。齿角38可以是约3°至约90°，更窄地约10°至约45°，例如约25°。
齿34可具有平的后刃面或凹的后刃面。齿34可具有平的主刃面或凸的主刃面。
后刃面可垂直于各自的节段的纵轴线或指向近端方向。齿34可以是单向的，以在拉刀12相对组织向远推进时提供较小的阻力，并在拉刀12从相对组织向近拉动时提供较大的阻力。
远节段26d可具有主齿34c。主齿34c可构造成与切削面齿34a或铰链齿34b一致，或者可以更小。例如，主齿34c可具有径向上平的远尖部。主齿34c可以在远节段26d的上侧和/或下侧。
任何或全部的齿34可以是构造成在拉刀12通过组织向远推进时提供较小的阻力，而在当拉刀12通过组织向近拉动时提供较大的阻力。例如，切削面齿主刃面36a可以垂直于各自的节段26的纵轴线，而随着切削面齿后刃面36b延伸离开节段26，切削面齿后刃面36b可以向近端延伸。齿34可以构造成当拉刀12通过组织向远推进时将组织分离和去除，而当拉刀12通过组织向近拉动时不分离和去除组织或最小程度地低分离和去除组织。
远节段26d的近末端可具有远尖部40。远节段26d可逐渐变细直到远尖部40。远节段26d的底面和/或顶面可以是平的和/或凸的和/或凹的。远尖部40可以是平的、弹头形的尖端或凿子形的尖端（如图所示）。
远尖部40可形成远尖端角42。远尖端角42测量为远节段26d的下侧的面的平面与远节段26d的上侧的面的平面的夹角。远尖端角42可以是从约1°至约90°，更窄地从约3°至约45°，还更窄地从约5°至约35°，还更窄地从约15°至约30°。
图3示出了拉刀12可以是所示的随箭头44铰接。连接节段的纵轴线28a可以与杆的纵轴线在同一直线上。
拉刀12可以以拉刀关节角46铰接。拉刀关节角46可以测量为连接节段的纵轴线28a与远节段纵轴线28d之间的角。如图2所示，拉刀关节角46可以是约180°。拉刀关节角46可控制为最小约155°，还更窄地约135°，还更窄地约90°，还更窄地约60°，还更窄地约45°。
远节段26d可具有远节段纵轴线28d。第一尾部节段26c可具有第一尾部节段纵轴线28c。第二尾部节段26b可具有第二尾部节段纵轴线28b。
第二尾部节段26b随所示箭头44a方向绕第二后铰链30a相对于连接节段26a铰接。第二尾部节段纵轴线28b相对于连接节段纵轴线28a可形成第二尾部节段关节角46a。如图1所示，第二尾部节段关节角46a可以是约180°。第二尾部节段关节角46a可控制为最小约155°，还更窄地约135°，还更窄地约90°，还更窄地约60°，还更窄地约45°。
第一尾部节段26c随所示箭头方向绕第一后铰链30b相对于第二尾部节段26d铰接。第一尾部节段纵轴线28c相对于第二尾部节段纵轴线28a可形成第一尾部节段关节角46b。如图1所示，第一尾部节段关节角46b可以是约180°。第二尾部节段关节角46b可控制为最小约155°，还更窄地约135°，还更窄地约90°，还更窄地约60°，还更窄地约45°。
远节段26d随所示箭头方向绕主铰链30c相对于第一尾部节段26c铰接。远节段纵轴线28d相对于第一尾部节段纵轴线28c可形成远节段关节角46c。如图1所示，远节段关节角46c可以是约180°。远节段关节角46c可控制为最小约155°，还更窄地约135°，还更窄地约90°，还更窄地约60°，还更窄地约45°。
铰链30可以垂直于各个节段26的纵轴线28。
图4示出了连接节段26a可具有一个或多个连接节段通孔48a。第二尾部节段26b可具有一个或多个第二尾部节段通孔48b。第一尾部节段26c可具有一个或多个第一尾部节段通孔48c。远节段26d可具有一个或多个远节段通孔。
任何或全部通孔48可通过整个装置或拉刀12延伸。除一个或多个（例如全部的）通孔48之外，拉刀12可具有凹槽或孔洞。使用过程中，通孔、凹槽、孔洞或其组合可填充有组织碎片82，例如被齿34清除的硬组织或软组织。
任何或全部铰链30可具有铰链齿34b，其在拉刀12的上侧32b和/或下侧34a的方向从铰链30径向地延伸出去。铰链齿34b可以可旋转地固定于铰链30或与相应的铰链30相邻的节段26之一。
图5示出了穿过髂骨52和/或骶骨54可通过钻孔、凿、开洞或其组合形成直的或弯曲的穿骨输送通道50。穿骨输送通道50可具有在骶骨和/或髂骨52外侧的位于侧面的通道进入孔56。穿骨输送通道50可具有通道出口58，其与L5-S1椎间盘62间隙相邻。例如，通道出口58可以在S1椎体终板60中。可将通道出口58设置成通道出口58的圆周在切线上贴合或紧密地邻接于S1椎体终板60的边缘（例如约2cm内，更窄地在约1cm内，更窄地在约5mm内，还更窄地在约2mm内）。为了清楚起见，还示出了L5椎骨64、骶髂关节66、骶骨68和合生耻骨70。
图6示出了按照箭头72将组织去除装置10的拉刀12居中地穿过穿骨输送通道50的通道入口56插入。
图7示出了可以按照所示箭头76将杆14进一步调入穿骨输送通道50。拉刀12可以朝着L5-S1椎间盘62间隙调动，或调入其中。拉刀12的远尖部刺入L5-S1椎间盘62，和/或远尖部可以挤入L5-S1椎间盘62和L5或S1椎骨。拉刀12可从穿骨传输通道50直接进入L5-S1椎间盘62的目标位置，而不必通过L5-S1椎间盘62和髂骨52之间的任何软组织。
图8示出了可以按照所示箭头76将杆14居中地穿过穿骨输送通道50进一步调动。拉刀12可以按照所示箭头78穿过L5-S1椎间盘和/或在L5-S1椎间盘62和L5和/或S1椎骨之间调动。拉刀12可以如箭头102所示铰接。一个或多个铰链30可以旋转。铰链30可以可控地旋转锁定或解锁，例如通过手柄20控制。
然后，例如居中地和横向地，和/或向上和向下地，和/或向前和向后地调动拉刀12，例如使其震动（例如手动地、超声地）。拉刀12中的通孔48和/或腔和/或凹槽可以部分地或完全地被软组织（例如，L5-S1椎盘的部分或全部）和/或硬组织（例如L5或S1椎骨其中一个或两个的部分）碎屑82填充。拉刀12可以输送电麻能量。拉刀12和杆14可具有一个或多个纵向内腔，其可用于冲洗（例如，用止痛剂、盐水、麻醉剂、骨形态发生蛋白、显像剂、其他本文所述制剂，或其组合）和/或用于抽吸（例如去除所冲洗的物质和/或碎屑82）目标位置（例如L5-S1椎间盘间隙）。
图9示出了杆14可以横向地调动，例如从L5-S1椎间盘62间隙和穿骨传输通道50移开拉刀12。在将拉刀12从穿骨传输通道50移开之前或之后，可被动地或主动地将从L5-S1椎间盘62移开的且在离开穿骨传输通道50后由拉刀12保留的碎屑82从通孔48、腔、凹槽或其组合去除。组织的去除部分可保留部分或完整的椎间盘突出84。可重复进行图6-9示出的方法以去除其他组织。
图10-12示出了穿骨传输通道50可以具有相对冠状平面88测量的冠状输送角86、相对矢状平面92测量的矢状输送角90和相对横向平面96测量的横向输送角94。冠状输送角86可以是从约0°至约25°，例如约12°。矢状输送角90可以是从约65°至约90°，例如约75°。横向输送角94可以是从约0°至约20°，例如约10°。拉刀12和杆14可构造成拉刀12可从通道出口58出去（例如直接进入L5-S1椎间盘62）和充分地铰接以进入和穿过L5-S1椎间隙宽度的全部或很大的部分（例如大于约40%，还更窄地大于约50%，还更窄地大于约75%）。为示意性目的，示出了股骨98。
图13a-13d和分别的图14a-14c示出了拉刀向如图5-8所示的L5-S1椎间盘间隙目标位置104的调配。
图14d示出了在将拉刀12放置于L5-S1椎间盘62间隙目标位置内之前、期间或之后，可以使轴绕杆14的纵轴线旋转。拉刀12可在L5-S1椎间盘62间隙处旋转。杆14可以按所示箭头106绕轴的纵轴线旋转，以进一步将齿34刺入组织。
图15a-15c示出了拉刀12穿过穿骨传输通道50和进入L5-S1椎间盘62的输送。拉刀12可具有一个或多个不透射线的标记100，例如在每节段26上的一个标记100。
装置10和/或本文描述的其他装置或器材可以由例如单个或多个不锈钢合金、镍钛合金（例如镍钛诺）、钴铬合金（例如来自ElginSpecialty Metals,Elgin,IL的来自Carpenter Metals Corp.,Wyomissing,PA的）、镍钴合金（例如来自MagellanIndustrial Trading Company,Inc.,Westport,CT的）、钼合金（例如钼TZM合金，例如2003年10月9日公开的国际公开号WO03/082363A2中所公开的，其全文以引用的方式并入本文）、钨铼合金，例如国际公开号WO03/082363中所公开的，聚合物，例如聚乙烯对苯二甲酸酯（PET）、聚酯（例如来自E.I.Du Pont de Nemours andCompany,Wilmington,DE的）、聚酯酰胺（PEA）、聚丙烯、芳香族聚酯例如液晶高分子（例如来自Kuraray Co.,Ltd.,Tokyo,Japan的Vectran）、超高分子量聚乙烯（即扩链、高模量或高性能聚乙烯）纤维和/或纱（例如来自Honeywell International,Inc.,MorrisTownship,NJ的Fiber和Guard，或来自RoyalDSM N.V.,Heerlen,the Netherlands的）、聚四氟乙烯（PTFE）、膨体聚四氟乙烯（ePTFE）、聚醚酮（PEK）、聚醚醚酮（PEEK）、聚醚酮酮（PEKK）（也是聚聚芳基醚酮酮）、尼龙、聚醚嵌节段共聚酰胺聚合物（例如来自ATOFINA,Paris,France的)、脂肪族聚醚聚氨酯（来自Thermedics Polymer Products,Wilmington,MA的）、聚氯乙烯（PVC）、聚氨酯、热塑性塑料、氟化乙烯丙烯（FEP）、可吸收或可再吸收的聚合物例如聚乙醇酸（PGA）、聚-L-羟基乙酸共聚物（PLGA）、聚乳酸（PLA）、聚-L-乳酸（PLLA）、聚己内酯（PCL）、聚乙基丙烯酸酯（PEA）、聚二恶烷酮（PDS）和基于伪聚氨基酪氨酸的酸（pseudo-polyaminotyrosine-based acid）、挤出胶原、硅树脂、锌、能反射声波的、放射性的、不透射线的材料、生物材料（例如，尸体组织、胶原、异体移植物、自体移植物、异种移植物、骨接合剂、颗粒骨、生骨粉、骨珠）、本文所列其它材料中的任何一种或者它们的组合。不透射线的材料的实例为硫酸钡、氧化锌、钛、不锈钢、镍钛合金、钽和金。
装置10可由基本为100%的PEEK、基本为100%的钛或钛合金、或其组合制造。
装置的任何或全部元件和/或本文所述的其他装置或器材可具有和/或完全地或部分地涂覆有用于细胞长入的制剂。
装置10和/或装置和/或本文所述的其它装置或器材的元件可以填充有、涂覆有，分层堆积和/或本领域普通技术人员已知的接合剂、填料和/或胶水，和/或治疗和/或诊断剂，和/或由和/或从其制成。这些接合剂和/或填料和/或胶水中任意一个可以是成骨细胞和骨诱导生长因子。
这种接合剂和/或填料的实例包括骨碎屑、脱钙骨基质（DBM）、硫酸钙、珊瑚羟基磷灰石、生物陶瓷（biocoral）、磷酸三钙、磷酸钙、聚甲基丙烯酸甲酯（PMMA）、可生物降解的陶瓷、生物活性玻璃、透明质酸、乳铁蛋白、骨形态发生蛋白（BMPs）如重组人骨形态发生蛋白（rhBMPs），本文所述的其他材料，或它们的组合。
这些基体内的制剂可包括本文公开任何制剂或它们的组合，包括：放射性材料；不透射线的材料；细胞生成剂；细胞毒性剂；细胞生长抑制剂；血栓形成剂，例如聚氨酯、混有三氧化二铋的纤维素乙酸酯聚合物和乙烯-乙烯醇；亲水材料;磷酸胆碱（phosphor cholene）；消炎剂，例如非类固醇消炎剂（NSAIDs）如环加氧酶-1（COX-l）抑制剂（例如乙酰水杨酸，例如Bayer AG，Leverkusen，Germany的布洛芬，例如Wyeth,Collegeville,PA的消炎痛；朴湿痛）、COX-2抑制剂（例如，Merck&Co.,Inc.,WhitehouseStation,NJ的Pharmacia Corp.,Peapack，NJ的COX-1抑制剂）；免疫抑制剂，例如Sirolimus（Wyeth,Collegeville,PA的），或在炎症反应过程中较早地起作用的基质金属蛋白（MMP）抑制剂（例如，四环素和四环素衍生物）。其它制剂的示例可见：Walton等,Inhibition of Prostoglandin E2Synthesis in Abdominal Aortic Aneurysms,Circulation,July6,1999,48-54;Tambiah等,Provocation of Experimental Aortic InflammationMediators and Chlamydia Pneumoniae,Brit.J.Surgery88(7),935-940;Franklin等,Uptake of Tetracycline by Aortic Aneurysm Wall and ItsEffect on Inflammation and Proteolysis,Brit.J.Surgery86(6),771-775;Xu等,Sp1Increases Expression of Cyclooxygenase-2in HypoxicVascular Endothelium,J.Biological Chemistry275(32)24583-24589;and Pyo等,Targeted Gene Disruption of Matrix Metalloproteinase-9(Gelatinase B)Suppresses Development of Experimental AbdominalAortic Aneurysms,J.Clinical Investigation105(11),1641-1649，它们的全部内容以引用的方式并入本文。
本文所述的单数形式的任何元件可复数化（即，任何描述成“一个”的可以是超过一个）。属元件的任何类元件可具有该属的任何其他类元件的性质和要素。上述的用于实施本发明的构形、元件或完整的组件和方法和要素，和本发明的各方面的变形可以和任意组合的方式相互组合和修改。

Claims (20)

1.一种组织去除装置，包括：铰接式拉刀。
2.如权利要求1所述的装置，其特征是，所述拉刀包括第一节段和第二节段，其中所述第一节段可旋转地与所述第二节段连接。
3.如权利要求2所述的装置，其特征是，所述拉刀进一步包括第三节段，其中所述第三节段可旋转地与所述第二节段连接。
4.如权利要求1所述的装置，其特征是，所述拉刀进一步包括刚性杆，且其中所述第三节段与所述刚性杆连接。
5.如权利要求1所述的装置，其特征是，所述拉刀与刚性杆连接。
6.如权利要求1所述的装置，其特征是，所述拉刀包括锥形末端部。
7.如权利要求1所述的装置，其特征是，所述拉刀包括从所述拉刀横向或径向伸展的齿。
8.如权利要求7所述的装置，其特征是，所述齿具有后刃面和主刃面，其中所述拉刀包括节段，其中所述节段具有节段纵轴线，且其中至少一个所述后刃面垂直于所述节段纵轴线。
9.如权利要求7所述的装置，其特征是，所述齿具有后刃面和主刃面，其中所述装置包括与所述拉刀连接的杆，其中当所述齿从所述装置的其余部分延伸出时，至少一个所述后刃面朝向所述杆。
10.一种用于从生物目标位置去除组织的方法，包括：
将多节段的铰接式拉刀插入所述目标位置，其中所述拉刀包括位于第二节段纵向远端的第一节段，且其中所述第一节段可旋转地与所述第二节段连接。
11.如权利要求10所述的方法，其特征是，进一步包括形成穿过阻碍骨的通道。
12.如权利要求11所述的方法，其特征是，插入包括调动穿过所述通道的所述拉刀。
13.如权利要求12所述的方法，其特征是，插入进一步包括当所述拉刀位于目标位置时使所述拉刀铰接。
14.如权利要求13所述的方法，其特征是，所述拉刀包括在整个所述拉刀宽度上伸展的齿。
15.如权利要求10所述的方法，其特征是，进一步包括从所述目标位置移开所述拉刀。
16.如权利要求10所述的方法，其特征是，进一步包括捕获在拉刀上的组织碎片。
17.如权利要求10所述的方法，其特征是，进一步包括从所述目标位置移开所述拉刀，其中从所述目标位置移开所述拉刀包括从所述目标位置去除组织碎片。
18.如权利要求10所述的方法，其特征是，所述目标位置包括L5-S1椎间盘间隙。
19.如权利要求10所述的方法，其特征是，所述拉刀包括在整个所述拉刀宽度上伸展的齿。
20.一种用于从生物目标位置去除组织的方法，包括：
将多节段的铰接式拉刀插入所述目标位置，其中所述拉刀包括齿，和
清除所述组织，包括在所述目标位置震动所述拉刀，还包括用至少一些所述齿刮削所述组织。
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EP2747682A4 (en) 2015-01-21
JP2014529445A (ja) 2014-11-13
WO2013028808A1 (en) 2013-02-28
US20130053852A1 (en) 2013-02-28
US9050112B2 (en) 2015-06-09

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