CN1911183B - 具有关节运动轴锁定机构的外科器械 - Google Patents
具有关节运动轴锁定机构的外科器械 Download PDFInfo
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
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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
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
- A61B2017/00557—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
- A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2946—Locking means
Abstract
一种特别适于以内窥方式使用的外科器械,通过包括位于轴的近侧部分中的横向滑动构件使端部执行器进行关节运动,所述轴将端部执行器枢转到所选的一侧。通过在横向滑动构件和轴的框架之间包括导向机构,有差别的相反致动力(例如液压的、流体的、机械的致动力)作用于该横向滑动构件而不会发生束缚。有利地,当关节运动由阻止反向驱动的机构控制时,锁定构件自动解除锁定。
Description
相关申请的交叉引用
本申请要求Kenneth Wales和Chad Boudreaux于2005年2月18日提交的申请号为11/061,908、题为“SURGICAL INSTRUMENTINCORPORATING A FLUID TRANSFER CONTROLLEDARTICULATION MECHANISM”的共有的美国专利申请的优先权,其内容通过引用而全部包含于本申请中。
技术领域
本发明总的涉及适合于将端部执行器(例如,内切割器、抓钳、切割器、缝合器、夹具施放器、接触装置、药物/基因治疗输送装置和使用超声波、RF、激光等的能量装置)以可内窥的方式插入到手术部位的外科器械,更具体地说,涉及具有关节连接轴的这种外科器械。
背景技术
内窥镜外科器械通常比传统的开放式外科装置更受到偏爱,这是因为较小的切口易于减少术后恢复时间和并发症。因此,在内窥镜外科器械的领域中已经有了显著发展,该内窥镜外科器械适合于将远端执行器通过套管针的套管精确地放置在所需的手术部位。这些远端执行器以多种方式接合组织以实现诊断或治疗作用(例如,内切割器、抓钳、切割器、缝合器、夹具施放器、接触装置、药物/基因治疗输送装置和使用超声波、RF、激光等的能量装置)。
通过套管针限制端部执行器的定位。通常,这些内窥镜外科器械包括在端部执行器和由医生操作的手柄部分之间的长轴。这个长轴能够插入到所需深度并围绕轴的纵向轴线转动,从而将端部执行器定位到一定程度。在正确定位套管针和例如通过另一套管针使用抓钳的条 件下,通常这个定位量是足够的。诸如在美国专利No.5,465,895中描述的外科缝合和切割器械是通过插入和转动成功定位端部执行器的内窥镜外科器械的一个例子。
取决于操作的性质,可能希望进一步调整内窥镜外科器械的端部执行器的定位。特别是,通常希望在横切该器械的轴的纵向轴线的轴线上定向端部执行器。通常将端部执行器相对器械轴的横向运动称为“关节运动”。这典型地通过被放置在靠近钉施加组件的伸长的轴中的枢轴(或关节)接合来实现。这允许医生远程致动钉施加组件到任一侧,用于更好的手术放置钉线和更简单的组织操作和定向。这种关节连接定位允许医生在一些情况下更简单地接合组织,例如在器官后。另外,关节连接定位有利地允许将内窥镜定位在端部执行器后方,而不会被器械轴挡住。
由于将关节运动控制与在内窥镜器械的小直径的限制下闭合端部执行器以夹住组织和击发端部执行器(即,缝合和切割)的控制结合在一起,使外科缝合和切割器械进行关节运动的方法很复杂。通常,将三个控制动作都通过轴转换为纵向平移。例如美国专利No.5,673,840披露了手风琴状的关节运动机构(“柔性颈”),该关节运动机构由有选择地通过执行轴拉回两个连接杆中的一个而进行关节运动,每个杆分别在轴中心线的相对侧处偏移。连接杆通过一系列不连续位置渐进运动。
关节运动机构的纵向控制的另一例子是美国专利No.5,865,361,该关节运动机构包括关节运动连接件,其与凸出枢轴偏置,从而推动或拉动关节运动连接件的纵向平移实现向相应侧的关节运动。同样,美国专利No.5,797,537公开了类似的穿过轴以实现关节运动的杆。
在美国专利US5,673,841中,已经认识到用于内镜外科缝合、切割、夹具施放以及抓取的关节运动外科器械的某些不足。特别地,当外科关节运动器械被加载时,器械上的关节连接头易于运动。这种运动通常是关节运动机构中零部件的偏转和松动(或后冲)的组合。器械远侧末端的高负荷(例如组织夹钳和击发钉)通过关节运动装置 反应到位于手柄附近的关节运动控制器,并可使关节运动控制机构运动(或旋转)。过去,关节运动接头设计为具有能执行双重用途的关节运动装置,其用作定位和锁定器械的关节头的工具。对负载的施力点(器械的末端)和关节运动装置(关节运动接头附近)的检查表明关节运动装置具有机械学缺点。该缺点自身表现为放大了在关节运动装置中的偏差和间隙,因而导致头部的明显运动。
作为对认识到的不足的回应,提出了一些锁定机构。特别的是,除当需要使头部相对于轴进行关节运动的时候以外,锁定机构在所有时刻都将头部锁定在某一关节运动角度。在例如通过向着器械的近端拉动关节运动带致动关节运动装置时,锁定机构松开,从而使头部解锁并允许其进行关节运动。关节运动步骤例如由于中断关节运动带上的拉力而造成的不连续性导致锁定机构重新接合,从而将器械的头部锁定在新的关节运动角度。在另一方案中,位于两侧上的一对流体皮囊允许流体从一侧到另一侧的改变,从而允许头部枢转,并且由夹紧囊阻塞流体流来“锁定”关节运动枢转轴。
虽然关节运动带有效地实现了关节运动并同时锁定关节运动接头,但是可以理解,在一些应用中需要控制器和关节运动接头之间的直接连接。实现正确地确定带的尺寸而不滑动或断裂被认为很难。由关节运动控制器给出的松动程度的触觉响应还可能是不需要的。
因此,对于外科器械的关节接头存在这样的迫切需要,即:关节接头直接与关节运动控制器连接,该关节运动控制器有利地包括用于防止端部执行器的反向驱动的关节接头的自动锁定。
发明内容
通过提供其细长轴响应于关节运动连接机构进行枢转关节运动的外科器械,本发明克服了现有技术的上述和其它的缺点。通过防止端部执行器的反向负载的关节接头锁定来避免关节运动角度的因疏忽而导致的变化和/或对关节运动连接机构的损害。因此,关节运动连接机构可具有所需的小横截面。
在本发明的一个方面中,外科器械具有关节运动控制器,用户对其进行致动来引起端部执行器围绕细长轴的关节运动接头枢转。特别的,关节运动构件从细长轴伸出一个远端与端部执行器接合,该端部执行器响应于关节运动控制器而横向偏转,以便进行关节运动。与这种运动共同作用,将锁定致动器从关节运动接头向近侧拉动,从而使其与固定在端部执行器上的弧形制动表面脱离接合,并围绕关节运动接头的关节轴向近侧扩展(radiating)。因此,关节运动控制器的直接控制可通过关节运动锁定器来辅助,该关节运动锁定器将端部执行器保持在选定的关节运动角度,而且不需要为了防止所述反向负载而增加关节运动控制器的大小和强度。
在本发明的另一方面中,外科器械包括一个关节运动接头,该关节运动接头由细长轴中的滑杆的横向运动来控制。与端部执行器连接并围绕关节运动接头的关节轴布置的指向近侧的扇形齿轮与滑杆上的指向远侧的齿条接合。细长轴中的锁定构件还沿纵向向远侧平移成与扇形齿轮接合,从而将关节运动接头锁定就位。在利用关节运动锁定器来保持所需的关节运动角度的保证下实现通过诸如各种形式的动力使滑杆差分运动而提供的各种优点。
在本发明的又一方面中,外科器械具有进行关节运动的轴,其由容纳在细长轴中用于横向运动的滑杆控制。响应于端部执行器上的反向负载作用力使与滑杆连接的锁定机构有利地运动成与细长轴接合。
更具体地说,本发明还涉及如下内容:
(1)一种外科器械,包括:
构造为在患者体外进行操作的近侧部分;
连接到所述近侧部分的细长轴;
端部执行器;
将端部执行器以可枢转的方式连接到所述细长轴的关节运动接头;
弧形制动表面,其被连接到该端部执行器并围绕关节运动接头的关节运动轴线向近侧伸展;
连接到该近侧部分的关节运动控制器;
关节运动构件,其从所述细长轴的远端延伸成与该端部执行器接合,所述远端响应于关节运动控制器横向偏转,以便进行关节运动;
由所述细长轴导引的锁定致动器,其近端连接到关节运动控制器,远端终止于锁定表面,并且被定位成可选择地与该锁定表面接合。
(2)如第(1)项所述的外科器械,其中,所述关节运动控制器包括横向控制器,该横向控制器可操作地设置为在其运动期间向近侧推压锁定致动器,使该锁定致动器与端部执行器脱离接合。
(3)如第(2)项所述的外科器械,其中,所述锁定构件向远侧偏压,并且接合表面包括近侧销,横向扇形齿轮包括带齿的表面,该带齿的表面在致动期间使销向近侧伸出,允许该近侧销向远侧运动,当关节运动控制器停止时使该近侧销与带齿表面的相应齿根接合。
(4)如第(2)项所述的外科器械,其中,所述横向控制器包括差动流体控制器。
(5)如第(1)项所述的外科器械,还包括:
用于在细长轴中横向运动的受约束的滑杆;
定位在关节运动接头中的滑杆的远端;和
端部执行器的近侧表面,其与关节运动的远端接合,用于将滑杆的横向运动转化成端部执行器的枢转运动。
(6)如第(1)项所述的外科器械,其中,所述细长轴还包括关节运动驱动管,其将旋转运动传递到关节运动接头,使端部执行器进行枢转关节运动,并且所述锁定致动器包括介于关节运动驱动管和关节运动控制器之间的反向驱动锁定机构。
(7)如第(6)项所述的外科器械,其中,所述反向驱动锁定机构包括:
具有孔口的匡架;
锁定构件,其与所述框架的孔口横向锁定就位并被连接到横向齿条;和
偏转构件,其被连接到关节运动控制器,并被定位成使锁定构件 脱离接合和横向定位。
(8)如第(6)项所述的外科器械,其中,所述关节运动驱动管包括可旋转连接件,其与滑杆平行对准,并与所述细长轴的垂直中心线对准,该可旋转连接件与滑杆的近侧表面以可枢转的方式连接,当可旋转连接件旋转时引起滑杆的横向运动。
(9)如第(8)项所述的外科器械,其中,可旋转连接件包括沿着其纵向长度间隔开的与滑杆连接的多个枢转连接点,用于在致动期间保持对准。
(10)一种外科器械,包括:
构造为在患者体外进行操作的近侧部分;
连接到所述近侧部分的细长轴;
端部执行器;
将端部执行器以可枢转的方式连接到所述细长轴的关节运动接头;
扇形齿轮,其指向近侧并被连接到端部执行器,并且被布置成围绕关节运动接头的关节运动轴线旋转;
用于在细长轴中的横向运动的受限的滑杆;
指向远侧的齿条,其被连接到定位在关节运动接头中的滑杆,与端部执行器的扇形齿轮接合;
端部执行器的近侧表面,其与关节运动的远端接合,用于将滑杆的横向运动转化成端部执行器的枢转运动;以及
细长轴中的锁定构件,其可选择地向远侧纵向平移成与端部执行器的扇形齿轮接合,从而锁定关节运动接头。
(11)如第(10)项所述的外科器械,其中,所述锁定构件向远端偏压并具有近侧销,关节运动控制器包括带齿的表面,该带齿的表面定位成在致动期间使所述销向近侧伸出,并且当关节运动控制器停止时允许近侧销向远侧运动成与带齿表面的相应齿根接合。
(12)如第(10)项所述的外科器械,还包括定位在滑杆的各相对侧的差动关节运动致动器。
(13)如第(12)项所述的外科器械,其中,所述关节运动致动器包括流体致动器。
(14)如第(12)项所述的外科器械,其中,所述关节运动致动器包括电磁致动器。
(15)如第(12)项所述的外科器械,其中,所述关节运动致动器包括纵向平移凸轮致动器。
(16)如第(12)项所述的外科器械,其中,所述关节运动致动器包括具有可定位的近端的挠曲构件。
(17)一种外科器械,包括:
构造为在患者体外进行操作的近侧部分;
连接到所述近侧部分的细长轴;
端部执行器;
将端部执行器以可枢转的方式连接到所述细长轴的关节运动接头;
滑杆,其被容纳在细长轴中用于横向运动,并包括接合成使端部执行器围绕关节运动接头枢转的远端和响应于端部执行器上的反向驱动力运动成与细长轴束缚接合的锁定机构。
(18)如第(17)项所述的外科器械,还包括与端部执行器连接的扇形齿轮,滑杆还包括与扇形齿轮接合的在远端连接的齿条。
(19)如第(17)项所述的外科器械,其中,所述锁定机构包括沿横向形成于细长轴中的通道和与滑杆垂直连接并容纳于所述通道中的肋,滑杆还包括将肋与滑杆的远端连接的挠性纵向部分,其中端部执行器的反向驱动使该纵向部分弯曲,从而将肋旋塞成在所述通道中束缚接合。
(20)如第(17)项所述的外科器械,其中,所述锁定机构包括靠近与细长轴连接的横向接合表面沿横向平移的接合齿,该外科器械还包括偏压构件,该偏压构件向远侧推压滑杆和接合齿,使它们与横向接合表面脱离结合,直到端部执行器被反向驱动。
通过下面的附图和对附图的说明将清楚地了解本发明的这些和 其它目的及优点。
附图说明
包括在该说明书中并构成该说明书的一部分的附图图示出本发明的实施例,并且与上述本发明的概述以及下述实施例的详细说明一起用来解释本发明的原理。
图1是外科缝合和切割器械的从前侧上部看的透视图,示出了打开的端部执行器或说钉施加组件,其中除去了钉仓。
图2是图1的外科缝合和切割器械的从前侧上部看的透视图,其中关节运动机构由流体致动控制器致动。
图3是图1的外科缝合和切割器械的细长轴和关节运动机构的分解透视图。
图4是图1的外科缝合和切割器械的执行部分的远侧部分的分解透视图,包括钉施加组件和关节运动机构。
图5是图1和图4中的钉施加组件的从前侧上部看的透视图,其中钉仓的侧半部被除去以暴露由击发运动驱动的元件。
图6是图1的外科器械的执行部分的从前侧看的透视图,其中除去了双枢轴闭合套管组件和端部执行器,暴露出通过流体关节运动机构进行关节运动的单枢轴框架底。
图7是用于图1的外科器械的替代的关节运动接头的详细透视图,示出了双枢轴闭合套管组件,在近侧位置带有单枢轴框架底。
图8是图7的替代的关节运动接头的从底部右侧看的分解透视图,包括双枢轴固定壁狗骨型连接件和具有用于横向运动构件(T型杆)的轨道的框架底。
图9是用于图1的外科器械的另一种替代关节运动接头的从上部左侧看的分解透视图,包括作为替代的实心壁支撑板机构,该实心壁支撑板机构被结合到下部双枢轴连接件中用于支撑击发杆并包括轨道导引的横向运动构件(T型杆)。
图10是用于图1的外科器械的作为替代的关节运动锁定机构的 俯视示意图,其中除去了闭合套管组件,暴露出用于自动关节运动锁定接合和脱离接合的用反向载荷脱开的T型杆。
图11是用于图1的外科器械的另一种替代关节运动机构的俯视示意图,其中位于T型杆上的弹性偏压齿条带有由于来自端部执行器的反向载荷而接合的锁定零件。
图12是用于图1所示外科器械的作为替代的T型杆和具有横向导向件的框架底。
图13是用于图1所示外科器械的又一种作为替代的T型杆和具有横向导向件的框架底。
图14是用于图1的外科器械的作为替代的关节运动机构的左侧上部看的透视图,该关节运动机构包括双枢轴框架底组件和单枢轴闭合套管组件。
图15是作为图14的替代的关节运动机构的从左侧底部看的透视图。
图16是横向运动流体关节运动机构的示意图,其中枢转的齿条和扇形齿轮示出为未进行关节运动的状态。
图17是图16的流体关节运动机构沿着线17-17截取的主剖视图。
图18是横向运动流体关节运动机构的示意图,其中枢转的齿条和扇形齿轮示出为进行关节运动的状态。
图19是图18的流体关节运动机构沿着线19-19截取的主剖视图。
图20是由至少一个纵向运动构件使外科器械进行关节运动的俯视示意图,所述纵向运动构件将滑杆横向顶起,该滑杆又使端部执行器进行关节运动。
图21是图20的外科器械处于关节运动状态的俯视示意图。
图22是用于图16或20所示外科器械的作为选择的旋转连接机械控制系统的主剖视图,图示为未进行关节运动的状态,该旋转连接机械控制系统分别使T型杆或者滑杆横向平移。
图23是处于进行关节运动状态的图22的可旋转连接机械控制系统的一种替代的主剖视图。
图24示出了用于图22中的可选的旋转连接机构控制系统的替代横向关节运动控制机构的分解透视图。
图25示出了图24的横向关节运动控制机构的剖面的主视图。
图26示出了图24的横向关节运动控制机构的接合状态中的锁定块的详示图。
图27示出了处于脱离接合状态的图24所示横向关节运动控制机构的详示图。
具体实施方式
关节轴概述
参照附图,其中在所有附图中相同的附图标记代表相同的组成构件。图1示出了一种外科器械,更具体地,在示例性方案中为外科缝合和切割器械10,其能够实践本发明的独特优点。特别地,在图1中所示的未进行关节运动的状态下,该外科缝合和切割器械10的大小适于通过套管针的插管通道插入到患者(未显示)体内的手术部位,以进行外科手术。一旦执行部分12经过插管通道插入,该执行部分12的细长轴16的远侧部分中包含的关节运动机构14可通过关节运动控制器18远距离的进行关节运动,如图2所示。端部执行器(在示例性方案中示为钉施加组件20)从远侧与关节运动机构14连接。因此,远距离地使关节运动机构14进行关节运动由此使钉施加组件20相对于细长轴16的纵向轴线进行关节运动。这种带角度的位姿具有如下优点:以所需的角度接近组织以进行切割和缝合,接近那些否则受其它器官和组织阻挡的组织,和/或允许将内窥镜定位在钉施加组件20的后面并与其对准,以确认放置。
手柄
外科缝合和切割器械10包括与执行部分12从近侧连接的手柄部分22,用于向该执行部分提供定位、关节运动、闭合和击发运动。该手柄部分22具有手枪式把手24,医生朝着该把手24枢转地向近侧拉 动闭合触发器26,导致钉施加组件20的夹紧和闭合。击发触发器28在所述闭合触发器26的外侧,医生以枢转的方式拉动该击发触发器28,使夹钳在钉施加组件20中的组织被缝合和切割。此后,按压闭合释放按钮30释放夹紧的闭合触发器26,并由此释放被夹钳的组织的切割和缝合端部。手柄部分22还包括与细长轴16一起运动的连接的旋钮32,以使轴16和关节连接的钉施加组件20围绕轴16的纵向轴线旋转。手柄部分22还包括击发回缩手柄34,用于在产生束缚时辅助缩回击发机构(在图1-2中未显示),从而使钉施加组件20此后可以打开。
应当理解,这里使用的术语“近侧”和“远侧”是以握持器械手柄的医生为参照。因此,钉施加组件20相对于更近侧的手柄部分处于远侧。还应理解,为了方便和清楚起见,这里使用的空间术语,诸如“垂直”和“水平”均相对于附图而言。然而,外科器械可以多种方向和位置使用,这些术语并不是限制性的和绝对的。
在如下的未审结和共有的美国专利申请中更详细地描述了图1-2中用于外科缝合和切割器械10的示例性多冲程手柄部分22,该申请是Swayze和Shlton IV的序列号为10/674,026、名称为“SURGICALSTAPLING INSTRUMENT INCORPORATING A MULTISTROKEFIRING POSITION INDICATOR AND RETRACTION MECHANISM”的申请,上述申请公开的内容在此通过引用全部并入本文,附加特征和变化在此进行描述。虽然多冲程手柄部分22有利地支持在长距离上高击发力的应用,但是与本发明一致的应用可以采用单一击发冲程,例如在Frederick E.Shelton IV、Michael E.Setser和Brian J.Hemmelgarn的序列号为10/441,632、名称为“SURGICAL STAPLINGINSTRUMENT HAVING SEPARATE DISTINCT CLOSING ANDFIRING SYSTEMS”的未审结和共有的美国专利申请中所描述的,该申请的公开内容在此通过引用全部并入本文。
执行部分(进行关节运动的细长轴和钉施加组件)
在图1-5中,有利地,执行部分12包括在适于内窥镜和腹腔镜手术的较小直径内的纵向旋转、关节运动,闭合和击发的多种致动运动。钉施加组件20(“端部执行器”)具有一对可枢转地相对的钳口,图示为一个具有可枢转地连接的砧座42的细长通道40(图1-2,4-5)。砧座42相对于细长通道40的闭合和夹钳通过用可旋转地连接到手柄部分20的框架组件44(图3)、甚至用图2中所示的关节连接的钉施加组件20沿纵向支撑该细长通道40来实现,其中,一个双枢轴闭合套管组件46在所述框架组件44的上方沿纵向运动,以向砧座42施加分别对应于向远侧和近侧运动的闭合和打开。
特别参照图3,框架组件44包括一个单枢轴框架底48,其近端与旋钮32接合,并且如图3所示旋钮32上带有右侧半壳50。应当理解,闭合套管组件46的近端、特别是闭合直管52(其一端包围框架底48的近端,另一端进入手柄部分22内部)的近端与使闭合套管组件46纵向平移的闭合构件(未显示)接合。一个位于闭合直管52近端的圆形凸缘54提供了与所述元件的旋转接合。旋钮32的接合元件穿过闭合直管52的近侧部分上的纵向槽56与在框架底48上在近侧定位的孔口58接合。纵向槽56具有足够的长度,以允许闭合套管组件46以由闭合套管组件46和框架底48的旋钮32设定的各种旋转角度沿纵向闭合平移。
细长轴16通过容纳与手柄部分22(未显示)旋转接合的击发杆60来支持击发运动。击发杆60沿着框架底48的纵向中心线进入近侧开口62。框架底48的远侧部分包括一个沿着其与近侧开口62相通的底部的击发杆槽64。击发杆66在击发杆槽64中纵向平移,并包括一个向上突出的近侧销68,该近侧销与击发杆60的远端70接合。
细长轴16通过具有矩形容器腔72来支持关节运动,该容器腔72在旋钮32的远侧部分中描绘为横向部分。位于矩形容器腔72中的底部分隔室74具有横向间隔开的左和右挡板76、78。关节运动致动器80在底部分隔室74的上方横向滑动,该关节运动致动器的向下的横向间隔开的左和右凸缘82、84位于挡板76、78外侧,每个凸缘与分 别从旋钮32的每个半壳向外伸出的左和右按钮86、88横向相通。抵抗流体关节运动系统94的左和右储存囊90、92而运转,关节运动致动器80的横向运动使左和右凸缘82、84分别更靠近或更远离左和右挡板76、78,每个囊90、92分别向远侧与左和右流体导管或通道96、98连通,该左和右流体导管或通道96、98又分别与左和右致动囊100、102连通。后者(也就是左和右致动囊100、102)相对并横向枢转关节运动机构14的T型杆104。
框架组件44通过包括框架底48的顶部和远侧带凹槽的板106来限制这些流体致动,流体通道96、98和致动囊100、102位于所述框架底的所述板106上面。T型杆104在致动囊100、102之间滑动地位于带凹槽的板106上面。在T型杆104的近侧,一个凸出的阻挡肋108与其对准,用于防止流体通道96、98向内膨胀。框架组件44具有一个圆形的顶部框架盖(隔离件)110,其在框架底48的上方滑动,从而防止流体通道96、98和致动囊100、102的垂直膨胀,同时限制T型杆104的任何垂直运动。特别地,框架盖110包括能使其还可提供关节运动的锁定构件111的零件,下面将作为关节运动锁定机构200的一部分进行详细描述。
T型杆104的远端(“齿条”)112用于使关节运动机构14的关节连接的远侧框架构件114的指向近侧的扇形齿轮115枢转。关节连接的闭合管116包围关节连接的框架构件114,并包括一个与砧座42接合的马蹄形孔口118。在闭合直管52和关节运动闭合环116之间关节运动机构14的上方形成一个双枢轴连接,从而允许即使当关节运动机构14进行关节运动时也可进行纵向闭合运动。特别地,带有销孔122、124的闭合直管52上的顶部和底部向远侧伸出的枢轴翼片119、120分别与具有销孔130、132的关节运动闭合环116上相应的顶部和底部向近侧伸出的枢轴翼片126、128沿纵向间隔开。一个上部双枢轴连接件134具有分别与销孔130、122接合的沿纵向间隔开的向上的远侧和后部销136、138,一个下部双枢轴连接件140具有分别与销孔132、124接合的沿纵向间隔开的向下伸出的远侧和后部销 142、144。穿过框架底48在远侧定位的垂直销孔169用于容纳框架枢轴销171,该框架枢轴销171在远侧框架构件114的下面枢转。
特别参照图4,为了增强可制造性,关节运动闭合环116显示为包括一个短管146,该短管146与包括向近侧伸出的枢轴翼片126、128连接的关节连接卡圈148相连。类似地,闭合直管52由与后部连接卡圈152连接的长闭合管150组装而成,所述连接卡圈152包括向远侧伸出的枢轴翼片119、120。短闭合管146中的马蹄形孔口118与略微靠近横向枢轴销156的向上伸出的砧座零件154接合,所述枢轴销156与细长通道40中的枢轴槽158接合。
图4的可选方案包括狗骨型连接件160而不是框架枢轴销171,该狗骨型连接件160的近侧销157被可枢转地连接到框架底48的框架孔161中,并且其近侧销159与关节运动远侧框架构件114的近侧下表面162刚性连接,从而在各销之间提供可枢转地支撑。狗骨型连接件160的底部纵向刀槽163导引击发杆66的关节运动部分。关节运动远侧框架构件114还包括一个用于导引击发杆66的远侧部分的底部纵槽164。
钉施加器械(端部执行器)
参照图4-5,击发杆66在远侧终止于E-形梁165,所述E-形梁165包括上部导销166,该上部导销166插入砧座42中的砧座槽168中,以便在形成钉和切割期间检验并辅助将砧座42保持为闭合状态。细长通道40和砧座42之间的间隔还可通过如下方式来保持,即,E-形梁165具有沿着细长通道40的顶面滑动的中间销170,同时其底脚172由细长通道40中的纵向开口174导引沿着该细长通道40的下表面相对地滑动。位于上部导销166和中间销170之间的E形梁164的在远侧的切割表面176对夹钳的组织进行切割,同时E形梁通过向远侧运动楔形滑动件180致动可拆卸的钉仓178,该楔形滑动件180引起钉驱动器182向上凸出,以驱动钉184向上脱离钉仓体188中的钉孔186,从而抵靠砧座42的钉形成下表面190形成钉。钉仓座192 从底部包围钉仓178的其它元件,将它们保持在适当的位置。钉仓座192包括一向后开口的槽194,该槽194覆盖在细长通道40中的纵向开口174上,从而使中间销170穿过钉仓座192的内部。
钉施加组件20由Frederick E.Shelton IV等共有的于2004年9月30日提交的申请号为10/955,042、名称为“ARTICULATINGSURGICAL STAPLING INSTRUMENT INCORPORATING ATWO-PIECE E-BEAM FIRING MECHANISM”的美国未审结专利申请中有详细描述,其公开的内容在此通过引用全部并入本文。
关节运动锁定机构
在图3-4和6-8中,有利地包括一个关节运动锁定机构200,以将钉施加组件20保持在预定的关节运动角度。关节运动锁定机构200减小了左和右致动100、102上的反向驱动负载。特别地,压缩弹簧202(图3)在近侧定位于关节锁定构件111的近端204和手柄部分22之间,向远侧偏压关节锁定构件111。特别参照图4,关节锁定构件111远端210上的两个平行的狭槽206、208分别容纳框架底48上的向上伸出的导向肋212、214。导向肋212、214的纵向长度比平行的狭槽206、208的长度短,使其具有相对纵向行程范围。特别参照图8,由此使远侧摩擦表面(示为从关节锁定构件111向远侧伸出的带齿的槽216)的可选抵接接合部分与容纳在关节运动框架构件114的顶部近侧凹槽220(图4)中的制动板218中的相应锁定扇形齿轮217接合。制动板218的远侧和近侧孔221、222容纳从顶部近侧凹槽220向上伸出的远侧和近侧销223、224。
特别参照图6,细长轴16示为处于进行关节运动的位置,其中闭合套管组件46被从框架组件44周围除去,而且没有细长通道40和砧座42。关节运动致动器80显示为横向运动到左侧,以压缩右侧近侧储存92,并使远侧右侧致动102膨胀,从而将T型杆104运动到所示位置。因此,当从上方看时,关节运动致动器80的横向运动使远侧框架114围绕单枢轴框架底48沿顺时针进行关节运动。有 利地,关节运动致动器80还自动地与关节运动锁定机构200接合和脱离接合。特别地,沿着关节运动致动器80的近侧上表面的带齿止动表面225容纳从关节锁定构件111的近端204向下伸出的锁定销226(图6中未示出)。锁定销226在带齿止动表面225根部的接合为关节锁定构件111提供了足够的向远侧的运动,将锁定扇形齿轮217锁定接合于制动板218中。由操作人员造成的关节运动致动器80向近侧的横向运动向近侧推压锁定销226,由此使关节锁定构件111与制动板218脱离接合。当操作人员释放关节运动致动器80时,锁定销226被压缩弹簧202推压到止动表面225的相邻止动槽中,以使锁定机构111锁定,由此锁定钉施加组件20,从而通过限制和膨胀所述左和右侧近侧储存囊90、92的膨胀形状来将关节运动机构14限制在所需的关节运动位置。
作为替代或者附加,可在平行的流体导管96、98中提供开口,来控制远侧致动囊100、102和近侧储存囊90、92之间的流速。
在图10中,外科器械2004的关节运动机构2002的一种替代的锁定机构2000通常是未锁定的,并通过使横向运动的T型杆2006由于反向载荷而歪斜来启动。一个狭槽2008位于框架底2010中,以容纳并导引从T型杆2006向下伸出的肋2012。如果端部执行器2016受反向载荷,则一个与肋2012成直角连接的细长纵向部分2014偏斜。例如,当端部执行器2016受到如箭头2018所示向右的力,其近侧扇形齿轮2020作用在T型杆2006的齿条2022上,从而施加非垂直的反向驱动力,如箭头2114所示。因此,细长纵向部分2014偏斜,将肋2012旋塞到狭槽2008中。这种旋塞产生了相反的束缚力(如箭头2026、2028所示),将T型杆2006锁定并阻止其继续进行关节运动。当关节运动囊的致动使横向运动T型杆2006释放时,则解除锁定。此后,肋2016可辅助导引T型杆2006。
在图11中,显示了外科器械2102的又一种关节运动锁定机构2100,其通常是未锁定的,并通过由端部执行器2106的齿轮齿2104和T型杆2110的齿条齿2108以20度压力角形成的近侧力向量来致 动。当端部执行器2106受到反向载荷(如非垂直箭头2112所示)时,压力角的纵向向量(如箭头2114所示)使T型杆2110向近侧运动。该纵向力向量施加到位于T型杆2110的齿条2120后面的牵引弹簧2118上。当弹簧2118随着T型杆2110向近侧运动而偏斜时,从齿条2120向近侧伸出的锁定齿2126与在底部框架2124上向远侧伸出并横向对准的锁定元件2122接合。当通过除去端部执行器2106的反向载荷并且T型杆2110由于弹簧2118的推压向远侧运动使近侧力向量2014减小或消除时,锁定齿2126和锁定构件2122脱离接合。
双枢轴闭合套管和单枢轴框架底的组合
参照图3-4和7,有利地,执行部分12包括双枢轴闭合套管组件46,该双枢轴闭合套管组件46围绕一个单枢轴框架底48并在其上方纵向平移。下面将进一步详细描述这些机构和它们的操作。特别参照图7,关节运动机构14显示为处于进行关节运动的状态,其中闭合套管46向近侧回缩到砧座处于打开状态。在砧座42的打开的情况下(在图7中未示出),关节运动控制器18的致动引起关节连接的闭合环116分别围绕上部和下部双枢轴闭合连接件134、140的向上的远侧销136和向下的远侧销142(在图7中未示出)枢转。框架底48围绕单个销(图示为连接框架底48与远侧框架构件114的框架枢轴销171(图3))枢转。随着砧座42的打开,框架底48的框架枢轴销171与闭合套管组件46的上部和下部双枢轴连接件134、140的最远位置对准。当砧座42打开时,这样定位很容易使钉施加组件20进行枢转和旋转。当闭合套管组件46向远侧运动来枢转闭合砧座42时,闭合直管52围绕框架底48向远侧运动,并且关节连接的闭合环116由于枢轴连接件134、140的促动沿着关节连接的远侧框架构件114的轴向远侧运动。当所述装置进行关节运动时(未显示),随着它们向着远侧闭合位置的致动,连接件134、140上的双枢轴销136、138以及142、144有利于与闭合直管52和关节连接的闭合环116的接合。在远侧闭合位置,框架枢轴销171在进行完全关节运动时与近侧枢轴销 138、144垂直对准,或者当有效运行时落在远侧销136、142和近侧销138、144之间的任一点上。
实心击发杆支撑件
在图8中,图7中的关节运动机构14被局部分解并从底部图示,显示图4中的实心壁击发杆支撑设计(狗骨型连接件160),其提供了传统弹性支撑板所不具备的优点。支撑板用于间隙的桥接,并通过单框架底枢轴关节运动接头1801导引并支撑击发杆66。弹性击发杆是已知的,但是采用实心壁击发杆(例如图4、8、9中显示的那些)提供了独特的优点。下面参见图8,框架底48包括一个沿着框架底48的底部延伸的框架刀槽1802,和一个沿着进行关节运动的远侧框架构件114的底部延伸用于将击发杆66(未显示)滑动容纳于其中的远侧刀槽164。如上所述的框架底48还包括一个在框架枢轴销171处与远侧框架构件114的直接单枢轴连接。可旋转地连接于近侧销端部157并可动地连接在远侧销端部159上的固定壁狗骨型连接件160包括左和右横向导向件1818、1820,在这两个导向件之间限定了一个导槽1822,作为击发杆66的滑动通道(图4)。
因此,为了桥接框架底48和远侧框架构件114之间的间隔,将固定壁枢轴狗骨型连接件160可枢转地连接到框架底48,并与框架构件114滑动连接。枢转的狗骨型连接件160的近侧销157可枢转地容纳于框架底48的孔1824中,使枢转的狗骨型连接件160能够围绕孔1824枢转。远侧销159从枢轴狗骨型连接件160向上伸出,并滑动容纳于远侧框架构件114中的狭槽1826中。钉施加组件20与纵向轴线成例如45度角的关节运动使枢转狗骨型连接件116以其近侧销157为轴在孔1824中枢转,并且远侧销157滑进在远侧框架构件114中形成的狭槽1826中,使击发杆66弯曲成两个分开的角,它们的角度是钉施加组件20的角度的一半。与前面引用的将击发杆66弯曲成45度角的弹性支撑板不同,固定壁枢转狗骨型连接件160将击发杆66弯曲成两个分开的角,例如每个22.5度。将一个或多个弹性击发杆 66弯曲成所述角度的一半可以在击发杆66中将弯曲应力减小到传统的关节运动支撑件中的一半。击发杆66中的弯曲应力的减小降低了击发杆中的永久弯曲或造成形变的可能性,降低了击发阻塞的可能性,确保了较小的击发杆回缩力,并为击发系统提供了更平稳的运行。
在图9中,外科器械1900包括双闭合枢轴。单框架枢轴关节运动接头1902给出了一种作为替代的实心壁支撑板机构1904,其可替代图8中的下部双枢轴连接件140和狗骨型连接件1812。左和右击发杆支撑件1906、1908从闭合套管组件1912的下部双枢轴连接件1904向上伸出。在框架底1916中提供间隙1914,当闭合套管组件1912向远侧运动闭合砧座42(在图9中未显示)以及向近侧运动打开砧座42时,使击发杆1906、1908能够在该间隙中运动。与上述的枢转狗骨型连接件160类似,作为替代的下部双枢轴连接件1910也可弯曲并支撑击发杆66(在图9中未显示),从而形成两个分开的弯曲角,其中的每个达到钉施加组件20的弯曲角的一半。
横向构件导向机构
继续参照图9,框架底1916上的左和右向上凸缘1918、1920包括远侧和近侧横向销导向件1921、1922,它们横向穿过T型杆1926中的通孔1923、1924,从而辅助将关节运动机构1928中的束缚降到最低。这些销导向件1921、1922还结合到图7的框架底48中。作为另一个例子,在图7中,有利地,T型杆104包括一个燕尾状横向导向件1930,其可在框架底48中形成的燕尾状通道1932中横向滑动。作为另一个例子,在图12中,一个从框架底1936上的凸出的肋1934容纳于在T型杆1940中形成的矩形狭槽1938中。为了进一步有利于无束缚的横向平移,每个远侧和近侧横向支撑轨道都包括多个滚珠1946、1948。作为又一个例子,在图13中,与T型杆1964中的T型杆横向沟槽1958-1962相对应,在框架底1956中形成多个框架横向沟槽1950-1954。滑动滚柱1966-1970被捕获停留在每对横向沟槽1950/1958、1952/1960、1954/1962中。这些决不意味着对防止T型杆 1964不期望的倾斜或旋转的横向导向构件的穷尽列举。
双枢轴框架底和单枢轴闭合件的组合
在图14-15中,外科器械2202包括一种替代的框架底和闭合机构2200,该框架底和闭合机构2200包括双枢轴框架组件2204。特别地,框架底2206通过双枢轴框架狗骨型件2210与远侧框架构件2208连接,所述双枢轴框架狗骨型件2210具有一个与框架底2206中的近侧孔2214枢转接合的近侧枢轴销2212和一个与远侧框架构件2208的远侧孔2218接合的远侧枢轴销2216。导向槽2220设置于狗骨型件2210的下侧,以在其中导引击发杆66(在图14-15中未显示)。刀槽2222设置在远侧框架构件2208中。如图所示,闭合套管组件2224的闭合环2230以四十五(45)度角进行关节运动,使远侧框架构件2208以四十五(45)度角相进行关节运动,并使框架狗骨型件2210以该角度的一半进行关节运动。因此,击发杆66仅受到分开的两个小的半弯曲,并能获得上述列举的优点。
最外层闭合套管组件2224的不同之处在于,框架组件2204的双枢轴设计中仅有一个枢轴适于纵向闭合运动。如图所示,闭合管轴2226在其远端具有一个叉形头(clevis)2228。叉形头2228与闭合环2230可枢转地接合。闭合环2230在其近端形成有近侧齿轮2232,并且销2234穿过近侧齿轮2232并与叉形头2228的上柄脚2236枢转接合。下臂2238通过定位销2241与叉形头2228的下柄脚2240可枢转地接合。叉形头2228中的孔2242容纳横向导销2243,并且T型杆2244可滑动地连接于其中,以接合闭合环2230的近侧齿轮2232。因此,这种替代机构2200使用与前面描述的机构相反的单/双枢轴替代构想。也就是说,这种作为替代的闭合机构2200具有单枢轴,而作为替代的框架底具有双枢轴,这与前面描述的具有单枢轴框架底的双枢轴闭合机构不同。
横向运动关节运动机构
在图16-19中示意性地描绘出了横向运动关节运动机构230,显示出用于执行端部执行器232的关节运动的横向运动。横向运动是至少一个元件向着或离开外科装置234的纵向轴线的运动。这种运动一般与纵向轴线(该纵向轴线是将机构230二等分的水平线)成直角,并不涉及旋转运动或者纵向运动。横向运动关节运动机构可以如图16-19所示地流体致动,也可以如图20-23所示地机械致动。
横向运动流体关节运动机构
在图16-19中示意性地显示了横向运动关节运动机构230,其包括流体控制系统235,该流体控制系统235具有流体填充的平行的左和右流体囊236、238,所述流体囊236、238在其间纵向延伸,通过流体242的运动使横向构件或者T型杆240横向运动。所有方向均以纵向轴线为参照。参见没有进行关节运动的图16、17,位于远侧的端部执行器232围绕销244枢转,并在其近端具有扇形齿轮246。枢轴销244与框架(未显示)连接。位于T型杆240远端的齿条248可操作地与扇形齿轮246接合。T型杆240和齿条248可沿着轴线A-A横向运动。长的左和右流体囊236、238的每个远侧部分位于可横向运动的T型杆240的侧部,并在横向上被限制于闭合套管250中,在垂直方向上由下面的框架252和上面的定位片254限制。特别地,左侧致动流体囊236具有左侧远侧致动囊256、左侧流体通道258以及左侧近侧储存囊260。右侧流体囊238具有右侧远侧致动囊262、右侧流体通道264以及右侧近侧储存囊266。固定的分隔器270从框架252伸出并隔开囊260、266以及流体通道258、264。固定分隔器270和闭合套管250限制该流体通道258、264,防止在囊236、238的流体通道258、264部分的膨胀。可横向运动的“C”形压缩构件272包括于关节运动控制机构273中,用于压缩近侧储存囊260、266中的一个,并用于端部执行器232的关节运动。另外,也可采用其它元件,诸如穿过框架252中的击发杆槽276的击发杆274(图17、19)。
如图18、19中所示,C形压缩构件272向左侧的横向运动压迫右 侧近侧储存囊266,迫使流体242进入右侧流体通道264和右侧远侧致动囊262中。随着右侧远侧致动囊262使T型杆240横向运动到左侧,左侧远侧致动囊256被压缩,端部执行器232被致动到右侧(从图示的顶部顺时针方向观察)。左侧远侧致动囊256的压缩引起流体242经过左侧固定流体通道258向近侧流动,并进入左侧近侧储存囊260中。具体地,与C形压缩构件272相连的右侧壁280向左侧运动,引起右侧近侧储存囊266的压缩。当流体流进膨胀的左侧近侧储存囊260时,与C形压缩构件272相连的左侧壁278的相应的左向运动为来自受压缩的左侧制动器囊256的流体提供了空间。
该用于关节运动机构230的流体控制系统235提供了至少多个优点。首先,致动囊256、262靠近关节运动接头或者机构230的定向允许在外科装置234中使用长的囊236、238和更长的T型杆240。作为流体驱动系统,可以两种方式来实现流体控制系统235的输出力的增加。第一种,对于在T型杆240上的固定流体面积,可增大作用在固定面积上的流体压力。第二种,对于固定的流体压力,可增加T型杆240上的流体接触面积。第一种方法使设计更紧凑,系统压力更高。第二种方法导致设计更大,系统压力更小。为了降低成本,简化设置,降低系统应力,并减小囊破裂的风险,示例性方案示出了长的远侧致动囊256、262,它们处于外科装置234中靠近关节运动机构230的有利位置。正是囊256、262的这种设置使囊256、262可以很长,而且对较低的输入压力而言,关节运动的输出力可以很高。
因此,可以简单地通过增加T型杆240上的远侧致动囊(球囊)256、262的压力接触面积来增大关节运动机构230的输出力(对相同的输入压力而言)。压力接触面积的增大受到高度和长度的限制。由于传统内窥镜外科器械的直径是用于穿过注入口的固定直径,这限制了高度的变化。压力接触面积的长度变化具有最大效果,并使装置的横向输出力可(通过改变长度)有利地调节,以符合系统对各种输出力的需求。
在横向运动装置中使用的流体既可以是可压缩的,也可以是不可 压缩的。如这里所指,术语“流体”包括液体、气体、凝胶、微粒和能够在压力梯度之间流动的任何其它材料。虽然可使用任何流体,但特别优选灭菌溶液,诸如盐水、矿物油或者硅氧烷。
横向运动机械关节运动机构
尽管上面描述了用流体机构引起横向运动和关节运动,但机械机构可实现与流体囊236、238产生的横向运动相同的横向运动。在图20-21中,作为替代的横向运动关节运动机构300采用机械控制系统(具体地说是纵向运动构件)为外科器械301施加横向运动和关节运动。在示例性方案中,特别参考图20,横向运动滑杆302具有至少一对倾斜的左和右凸出表面304、306,它们从滑杆302向细长纵轴308的相对侧横向伸出。在示例性方案中,还可包括另一对近侧左和右倾斜凸出表面310、312。右侧纵向运动连接件314包括对应的方向向内的远侧和近侧反向倾斜表面316、318,该远侧和近侧反向倾斜表面316、318与远侧和近侧的右侧凸出表面306、312对准并滑动接合,从而使运动连接件314的远侧纵向运动引起滑杆302的左向横向运动。应当理解,这种倾斜接触可颠倒,从而使远侧运动引起向右运动。
应当理解,在滑杆302上可包括弹性偏压件(未显示),以用于促动滑杆302向右与右侧纵向运动连接件314接合,从而使右侧纵向运动连接件314的反向近侧运动允许滑杆302的向左运动。作为替代,在示例性方案中,左侧纵向运动连接件320包括相应的方向向内的远侧和近侧反向倾斜表面322、324,该远侧和近侧反向倾斜表面322、324与远侧和近侧的右侧凸出表面304、310对准并滑动接合,凸出表面304、310向远侧倾斜,反向倾斜表面322、324向近侧倾斜,从而使左侧纵向运动连接件320的远侧纵向运动引起滑杆302的向右横向运动。应当理解,这种倾斜接触可颠倒,使远侧运动引起向左运动。应当理解,右侧和左侧纵向运动连接件314、320和滑杆302支撑于细长轴308中,这允许纵向运动连接件314、320的这种纵向运动和滑杆302的横向运动。
图示为窝球(socket ball)328的滑杆302的远端容纳于V形凸轮槽330中,该V形凸轮槽330向近侧设置并靠近侧部执行器334的枢轴销332。因此,在图21中,右侧纵向运动连接件314的近侧运动和左侧纵向运动连接件320的远侧运动引起滑杆302的向右运动以及窝球328的相应的向右运动。这样V形凸轮槽330被向右驱动,其最远端336向左枢转。作为替代,滑杆302的横向运动可通过参见图16-19描述的齿条和扇形齿轮转化成端部执行器334的关节运动。因此,采用纵向运动的机械系统可用于为外科器械301提供横向关节运动。
可旋转连接件
在图22和23中,又一种作为替代的关节运动机构400采用可旋转连接件402使图示为横向运动滑杆404的横向构件运动,从而导致外科器械406进行关节运动。该横向运动滑杆404可操作地在端部执行器(未显示)的近端与上面图16和20中所示的旋转齿轮或者凸轮槽接合。可旋转连接件402可定位在滑杆404的下面,并具有至少一个臂408,所述臂408从该可旋转连接件402的纵向轴线横向地可旋转地伸出,以便接合到滑杆404中的插槽410内。滑杆404在顶部定位片412和底部框架414之间受到垂直限制,该底部框架414具有容纳可旋转连接件402并适于臂408旋转的纵向沟槽416。定位片412和框架414由管状套管418包围。可旋转连接件402的旋转使臂408沿着弧形运动,由此使滑杆404沿着旋转方向横向运动。
横向到旋转单向控制致动器
在图24到27中,提供一种防止可旋转连接件402反向驱动的自动锁定零件。为了达到这一目的,将可旋转连接件402连接到横向关节运动控制器500,在未审结的共有的美国专利申请No.10/615,972中描述了与各种关节运动接头一起使用的横向关节运动控制器500,该美国申请的题目为“SURGICAL INSTRUMENT WITH ALATERAL-MOVING ARTICULATION CONTROL”,其公开的内容 在此通过引用全部并入本文。横向关节运动控制器500可适于在可选的关节运动外科器械502(与图1-6中描述的类似)的关节运动控制器18中使用。具体地说,横向关节运动控制器500将横向运动转化成由关节运动驱动管504传送到关节运动机构(在图24-27中未显示)的旋转运动。如将其应用到前述关节运动控制器18,其可用作在两个横向运动表面之间的单向离合器。仍参照图24-27,向下伸出的齿条506被连接到横向关节运动控制致动器510的下侧508,该下侧508用于与位于关节运动驱动管504的顶面上的纵向对准的槽512接合。
关节运动反向驱动锁定器516有利地包含于横向关节运动控制器500中,以防止施加到端部执行器(在图24-27中未显示)的作用力改变关节运动量。具体地说,介于关节运动控制致动器510和齿条506之间的是齿条板518,其包括能够容纳柔性的X形锁定构件522的中央开口520。关节运动控制器510包括两个偏转叶片524、526,它们向下伸入齿条板518的中央开口520中,并分别定位在由X形锁定构件522限定的远侧和近侧象限,以图26-27中所示的俯视图为参照。齿条506包括两个驱动叶片532、534,它们向上伸入齿条板518的中央开口520内,并分别定位在由X形锁定构件522限定的左侧和右侧象限中。所示的齿条板518的中央开口520大体上为矩形形状,但具有倾斜的齿540,每个齿形成朝内并纵向排列的抵接表面542。这些倾斜的齿540沿着远侧边缘548的右侧和左侧部分544、546设置,分别与X形锁定构件522的右和左远侧臂550、552以棘齿的方式接触。倾斜的齿540还沿着矩形孔口520的近侧边缘558的右侧和左侧部分554、556设置,分别与X形锁定构件522的右和左近侧臂560、562以棘齿的方式接触。
特别参照图25,齿条518显示为与旋钮564连接,因而不会与关节运动控制致动器510或者齿条506一起横向平移。关节运动控制致动器510的横向运动由形成于齿条框架518的矩形孔口520内的关节运动反向驱动锁定器516传递。相反,关节运动驱动管514和齿条506的反向驱动横向运动由进入齿条框架518和旋钮560的关节运动反向 驱动锁定器516抵抗。因此阻止了关节运动驱动管504的运动。
在使用中,如图26所示,横向关节运动控制器500定位在中央。因而通过关节运动控制致动器510的等量延伸的右侧和左侧端部566、568为医生提供了视觉指示。偏转叶片524、526定位在X形锁定构件522的中央,因而没有在臂550、552、560、562上施加作用力,因而这允许所述臂向着它们未压缩的状态延伸成与倾斜的齿540抵靠接触,从而防止X形锁定构件522的横向运动。齿条506的驱动叶片532、534与X形锁定构件522的每一侧相对接触。通过驱动叶片532、534从关节运动驱动管504传递到齿条506中的任何横向力通过进入齿条506的X形锁定构件522抵抗,以便防止运动。
相反,如图27中所示,当医生将关节运动控制致动器510运动到一侧时,偏转叶片524、526与一对近侧和远侧臂(在图27中为左侧的一对552、562)接触,压缩这对臂与矩形孔口520脱离接触。由此允许X形锁定构件522沿着该方向运动,并且后面的一对臂(例如,图27中右侧的一对臂550、560)随着一起进行棘齿运动。这种横向运动可持续,直到前面的臂552、562碰到矩形孔口520的横边,如图所示。齿条506的驱动叶片532、534随着X形锁定构件522一起运动,并因而最终使端部执行器(在图27中未显示)对此响应也进行关节运动。
尽管已通过多个实施例的描述对本发明进行了解释,并且这些解释性的实施例描述得非常详细,但申请人并不是想将所附的权利要求书的范围限制或以任何方式限定得如此详细。其它优点和变化对本领域技术人员来说是可以想到的。
例如,可包括单流体传输方法,其中单个流体致动器扩张和压缩来进行关节运动(也许在不与手柄流体或者气动连通的弹性相对构件的辅助下)。与该设计一致的应用例如可包括仅仅一个与T型杆连接的囊,当通过将流体抽出而压缩时,所述囊拉动T型杆与其一起运动。
Claims (8)
1.一种外科器械,包括:
构造为在患者体外进行操作的近侧部分;
连接到所述近侧部分的细长轴;
端部执行器;
将端部执行器以可枢转的方式连接到所述细长轴的关节运动接头;
弧形制动表面,其被连接到该端部执行器并围绕关节运动接头的关节运动轴线向近侧伸展;
连接到该近侧部分的关节运动控制器;
关节运动构件,其从所述细长轴的远端延伸成与该端部执行器接合,所述远端响应于关节运动控制器横向偏转,以便进行关节运动;
由所述细长轴导引的锁定构件,其近端连接到关节运动控制器,远端终止于锁定表面,并且被定位成可选择地与该锁定表面接合;
所述外科器械还包括:
用于在细长轴中横向运动的受约束的滑杆;
滑杆的远端,所述滑杆的远端定位在关节运动接头中;和
端部执行器的近侧表面,其与关节运动接头的远端接合,用于将滑杆的横向运动转化成端部执行器的枢转运动。
2.如权利要求1所述的外科器械,其中,所述关节运动控制器包括横向控制器,该横向控制器可操作地设置为在其运动期间向近侧推压锁定构件,使该锁定构件与端部执行器脱离接合。
3.如权利要求2所述的外科器械,其中,所述锁定构件向远侧偏压,并且接合表面包括近侧销,横向扇形齿轮包括带齿的表面,该带齿的表面在致动期间使销向近侧伸出,允许该近侧销向远侧运动,当关节运动控制器停止时使该近侧销与带齿表面的相应齿根接合。
4.如权利要求2所述的外科器械,其中,所述横向控制器包括差动式流体控制器。
5.如权利要求1所述的外科器械,其中,所述细长轴还包括关节运动驱动管,其将旋转运动传递到关节运动接头,使端部执行器进行枢转关节运动,并且所述锁定构件包括介于关节运动驱动管和关节运动控制器之间的反向驱动锁定机构。
6.如权利要求5所述的外科器械,其中,所述反向驱动锁定机构包括:
具有孔口的框架;
锁定构件,其与所述框架的孔口横向锁定就位并被连接到横向齿条;和
偏转构件,其被连接到关节运动控制器,并被定位成使所述反向驱动锁定机构的锁定构件脱离接合和横向定位。
7.如权利要求5所述的外科器械,其中,所述关节运动驱动管包括可旋转连接件,其与滑杆平行对准,并与所述细长轴的垂直中心线对准,该可旋转连接件与滑杆的近侧表面以可枢转的方式连接,当可旋转连接件旋转时引起滑杆的横向运动。
8.如权利要求7所述的外科器械,其中,可旋转连接件包括沿着其纵向长度间隔开的与滑杆连接的多个枢转连接点,用于在致动期间保持对准。
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- 2006-07-31 CN CN2006101089982A patent/CN1911183B/zh active Active
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JP5073240B2 (ja) | 2012-11-14 |
AU2006202972A1 (en) | 2007-02-15 |
EP1749485A1 (en) | 2007-02-07 |
CA2553499A1 (en) | 2007-02-01 |
US20070027468A1 (en) | 2007-02-01 |
CN1911183A (zh) | 2007-02-14 |
CA2553499C (en) | 2016-01-19 |
BRPI0603089A (pt) | 2007-03-13 |
JP2007038003A (ja) | 2007-02-15 |
AU2006202972B2 (en) | 2012-05-24 |
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