CN1961840B - 使端部执行器关节运动的带改进力矩臂延伸件的关节接头 - Google Patents

使端部执行器关节运动的带改进力矩臂延伸件的关节接头 Download PDF

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CN1961840B
CN1961840B CN2006101366576A CN200610136657A CN1961840B CN 1961840 B CN1961840 B CN 1961840B CN 2006101366576 A CN2006101366576 A CN 2006101366576A CN 200610136657 A CN200610136657 A CN 200610136657A CN 1961840 B CN1961840 B CN 1961840B
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CN1961840A (zh
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弗雷德里克·E·谢尔顿四世
杰弗里·S·斯韦兹
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Ethicon Endo Surgery Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00539—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated hydraulically
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07285—Stapler heads characterised by its cutter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
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    • A—HUMAN NECESSITIES
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320052—Guides for cutting instruments

Abstract

一种与外科器械结合使用的关节运动接头，所述外科器械的一部分必须穿过套管针或类似结构，然后相对于接纳在套管针中的器械的另一部分进行关节运动。所述关节运动接头的各种实施方式在致动器以及近侧和远侧管部分间的枢轴点之间提供了增加的力矩臂，所述管部分使外科器械的手柄组件与外科执行器、例如内切割器端部执行器互连。

Description

使端部执行器关节运动的带改进力矩臂延伸件的关节接头
技术领域
本发明总的涉及适于通过内窥镜插入端部执行器(例如内切割器，抓钳，切割器，缝合器，夹具施放器，进入装置，药物/基因治疗输送装置，和使用超声、RF、激光的能量装置，等等)的外科器械，尤其涉及带有关节运动端部执行器的内切割器。
背景技术
与传统的开放式外科器械相比，内窥镜外科器械更受欢迎，原因是更小的切口往往减小术后恢复时间和并发症。通常，这些内窥镜外科器械包括“端部执行器”、手柄组件和在端部执行器和手柄组件之间延伸的长轴。端部执行器是器械的被配置成以各种方式接合组织以实现期望诊断或治疗效果的部分(例如内切割器，抓钳，切割器，缝合器，夹具施放器，进入装置，药物/基因治疗输送装置，和使用超声、RF、激光的能量装置，等等)。端部执行器和轴部分的尺寸被设定成通过放置在患者体内的套管针插入。细长轴部分能使端部执行器插入到期望深度并且也便于端部执行器的一些旋转以将其定位在患者体内。在该套管针合理放置和例如通过另一套管针使用抓钳的条件下，通常这种定位程度就足够了。外科缝合和切割器械(例如在美国专利No.5,465,895中描述的)是通过插入和旋转成功地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，可能期望进一步调整内窥镜外科器械的端部执行器的定位。特别地，常常期望将端部执行器定向成相对于器械轴的纵向轴线成一个角度。端部执行器相对于器械轴的横向或非轴向运动常常习惯上被称为“关节运动”。该关节运动定位允许医生在一些情况下更容易地接合组织，例如在器官之后。另外，关节运动定位有利地允许内窥镜定位在端部执行器之后而不会被器械轴阻碍。
使外科缝合和切割器械进行关节运动的方法往往由于在内窥镜器械的小直径限制内集成关节运动的控制以及闭合端部执行器以夹住组织并击发端部执行器(即缝合和切割)的控制而变复杂。通常，三种控制运动都作为纵向平移通过轴传递。例如，美国专利No.5,673,840公开了一种手风琴状关节运动机构(“柔性颈”)，其通过选择性地通过执行轴收回两个连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上偏移。所述连杆通过一系列不连续部分渐进运动。
纵向控制关节运动机构的另一个例子是美国专利No.5,865,361，其包括偏离凸轮枢轴的关节运动连杆，使得关节运动连杆的推或拉纵向平移实现向一侧的关节运动。类似地，美国专利No.5,797,537公开了一种穿过轴以实现关节运动的类似的杆。可进行关节运动的外科缝合装置的又一个例子公开于美国专利Nos.6,250,532和6,644,532中。
由于端部执行器击发系统通常使用的类型，用于使端部执行器进行关节运动的致动器布置常常产生弯曲击发结构的高扭矩。缺少用于容纳致动装置的可用空间(其足够大以产生那些所需的力)加剧了该问题。
因此，迫切需要一种包含关节运动机构的关节运动外科器械，其中所述关节运动机构可以产生以预期方式选择性地使其端部执行器进行关节运动所需的扭矩。
发明内容
根据本发明的一个实施方式提供了一种外科器械，其包括手柄组件和联接到所述手柄组件的细长管组件。在一个非限制性实施方式中，所述细长管组件包括近侧管部分，该近侧管部分具有近侧壁并且连接到所述手柄组件。所述管组件进一步包括远侧管部分，该远侧管部分可枢转地连接到所述近侧管部分，使得它选择性地可在所述远侧管部分与所述近侧管部分基本上轴向对准的位置和所述远侧管部分与所述近侧管部分基本上不轴向对准的位置之间枢转。所述远侧管部分也具有远侧壁。致动器组件由所述近侧和远侧管部分中的至少一个支承并且联接到所述近侧和远侧壁之一的至少一部分，使得当致动所述致动器组件时，所述近侧和远侧壁之一的所述部分被枢转到与所述近侧和远侧壁之一的相应部分不对准，从而导致所述远侧管部分关节运动成与所述近侧管部分基本上不轴向对准。外科执行器连接到所述远侧管部分。
根据本发明的另一非限制性实施方式提供了一种外科器械，其包括手柄组件和联接到所述手柄组件的细长管组件。在一个非限制性实施方式中，所述细长管组件包括连接到所述手柄组件的近侧管部分和通过枢销可枢转地联接到所述近侧管部分的远侧管部分。致动器由所述近侧和远侧管部分之一支承并且具有可延伸和可缩回的致动杆。力矩臂杆联接到所述致动杆并且可滑动地延伸通过所述枢销中的开口，使得通过延伸和缩回所述致动杆，所述远侧管部分围绕所述枢销相对于所述近侧管部分枢转。外科执行器连接到所述远侧管部分。
根据本发明的另一实施方式提供了一种通过安装在患者中的套管针执行外科手术的方法。所述方法的一种形式包括提供一种外科器械，该外科器械具有手柄组件和通过管组件可关节运动地连接到所述手柄组件的可操作外科执行器。所述管组件包括连接到所述手柄组件的近侧管部分。所述近侧管部分的尺寸被设定成允许所述近侧管部分轴向地穿过所述套管针。所述管组件进一步包括远侧管部分，该远侧管部分连接到所述外科执行器并且可枢转地联接到所述近侧管部分以用于围绕枢轴选择性地作枢转运动。所述远侧管部分的尺寸被设定成允许所述远侧管部分轴向地穿过所述套管针。致动器由所述近侧和远侧管部分之一支承。所述致动器具有选择性可延伸和可缩回的致动杆，其中所述致动杆的一部分在连接点连接到所述近侧和远侧管部分的另一个，以在所述枢轴和所述连接点之间限定力矩臂。所述方法进一步包括基本上共轴对准所述近侧和远侧管部分并且使所述外科执行器和所述共轴对准的远侧和近侧管部分穿过所述套管针进入患者。所述方法也包括增加所述力矩臂的长度以将所述远侧管部分和外科执行器枢转成不与所述近侧管部分共轴对准。
本发明的各种实施方式的一个特征是提供一种关节运动接头，其能使所述近侧和远侧管部分基本上共轴对准，以用于通过套管针中的通道插入，然后当所述接头穿过所述套管针之后能使它们相对于彼此进行关节运动。所述关节运动接头的各种实施方式提供了一种机构，用于增加所述致动器与所述近侧和远侧管部分之间的枢轴点之间的力矩臂的长度，使得可以获得增大的关节运动力。因此，本发明的各种实施方式为设计成穿过套管针或类似结构的其他关节运动外科器械的缺陷提供了解决方案。
根据本发明的一个方面，提供一种外科器械，包括：
手柄组件；
联接到所述手柄组件的细长管组件，所述细长管组件包括：
连接到所述手柄组件的近侧管部分，所述中空的近侧管部分具有近侧壁；和
远侧管部分，其可枢转地连接到所述近侧管部分，并且可选择性地在所述远侧管部分与所述近侧管部分基本上轴向对准的位置和所述远侧管部分与所述近侧管部分基本上不轴向对准的位置之间枢转，所述远侧管部分具有远侧壁；
致动器组件，其由所述近侧和远侧管部分中的至少一个支承并且联接到所述近侧和远侧壁之一的至少一部分，使得当致动所述致动器组件时，所述近侧和远侧壁之一的所述部分被枢转成与所述近侧和远侧壁之一的相应部分不对准，从而使所述远侧管部分关节运动成与所述近侧管部分基本上不轴向对准；和
连接到所述远侧管部分的外科执行器；
其中，所述近侧壁和远侧壁的所述至少一部分包括：
第一壁部分，其可枢转地联接到所述近侧壁的剩余部分并且可选择性地在所述第一壁部分与所述近侧壁的所述剩余部分基本上轴向对准的位置和所述第一壁部分与所述近侧壁的所述剩余部分基本上不轴向对准的位置之间枢转；
第二壁部分，其可枢转地联接到所述第一壁部分并且连接到所述致动器组件，所述第二壁部分可选择性地在所述第二壁部分与所述第一壁部分和所述近侧壁的所述剩余部分基本上轴向对准的另一位置和所述第二壁部分与所述第一壁部分基本上不轴向对准的其他位置之间枢转；
第三壁部分，其可枢转地联接到所述近侧壁的所述剩余部分的另一部分并且可选择性地在所述第三壁部分与所述近侧壁的所述剩余部分的所述另一部分基本上轴向对准的位置和所述第三壁部分与所述近侧壁的所述剩余部分的所述另一部分基本上不轴向对准的位置之间枢转；和
第四壁部分，其可枢转地联接到所述第三壁部分并且连接到所述致动器组件，所述第四壁部分可选择性地在所述第四壁部分与所述第三壁部分和所述近侧壁的所述剩余部分的所述另一部分基本上轴向对准的第三位置和所述第四壁部分与所述第三壁部分基本上不轴向对准的其他位置之间枢转。
更具体地说，本发明涉及如下内容：
(1)一种外科器械，包括：
手柄组件；
联接到所述手柄组件的细长管组件，所述细长管组件包括：
连接到所述手柄组件的近侧管部分，所述中空的近侧管部分具有近侧壁；和
远侧管部分，其可枢转地连接到所述近侧管部分，并且可选择性地在所述远侧管部分与所述近侧管部分基本上轴向对准的位置和所述远侧管部分与所述近侧管部分基本上不轴向对准的位置之间枢转，所述远侧管部分具有远侧壁；
致动器组件，其由所述近侧和远侧管部分中的至少一个支承并且联接到所述近侧和远侧壁之一的至少一部分，使得当致动所述致动器组件时，所述近侧和远侧壁之一的所述部分被枢转成与所述近侧和远侧壁之一的相应部分不对准，从而使所述远侧管部分关节运动成与所述近侧管部分基本上不轴向对准；和
连接到所述远侧管部分的外科执行器。
(2)如第(1)项所述的外科器械，其中，所述近侧和远侧壁的所述至少一部分包括：
第一壁部分，其可枢转地联接到所述近侧壁的剩余部分并且可选择性地在所述第一壁部分与所述近侧壁的所述剩余部分基本上轴向对准的位置和所述第一壁部分与所述近侧壁的所述剩余部分基本上不轴向对准的位置之间枢转；和
第二壁部分，其可枢转地联接到所述第一壁部分并且连接到所述致动器组件，所述第二壁部分可选择性地在所述第二壁部分与所述第一壁部分和所述近侧壁的所述剩余部分基本上轴向对准的另一位置和所述第二壁部分与所述第一壁部分基本上不轴向对准的其他位置之间枢转。
(3)如第(2)项所述的外科器械，其中，所述致动器组件包括：
第一致动器，其由所述远侧管部分支承并且连接到所述第二壁部分；和
第二致动器，其由所述近侧管部分支承并且连接到所述第二壁部分。
(4)如第(3)项所述的外科器械，其中，所述第一和第二致动器分别包括第一和第二液压缸。
(5)如第(4)项所述的外科器械，其中，所述第一液压缸包括：
由所述远侧管部分支承的第一缸体外壳，所述第一缸体外壳可动地支承在其中的第一活塞；和
第一致动杆，其从所述第一外壳延伸并且响应所述第一活塞在所述第一外壳内的运动选择性地相对于第一外壳可延伸和缩回，所述第一致动杆连接到所述第二壁部分的一部分，并且其中所述第二液压缸包括：
由所述近侧管部分支承的第二缸体外壳，所述第二缸体外壳可动地支承在其中的第二活塞；和
第二致动杆，其从所述第二外壳延伸并且响应所述第二活塞在所述第二外壳内的运动选择性地相对于第二外壳可延伸和缩回，所述第二致动杆连接到所述第二壁部分的另一部分。
(6)如第(1)项所述的外科器械，其中，所述近侧和远侧壁的所述至少一部分包括：
第一壁部分，其可枢转地联接到所述近侧壁的剩余部分并且可选择性地在所述第一壁部分与所述近侧壁的所述剩余部分基本上轴向对准的位置和所述第一壁部分与所述近侧壁的所述剩余部分基本上不轴向对准的位置之间枢转；
第二壁部分，其可枢转地联接到所述第一壁部分并且连接到所述致动器组件，所述第二壁部分可选择性地在所述第二壁部分与所述第一壁部分和所述近侧壁的所述剩余部分基本上轴向对准的另一位置和所述第二壁部分与所述第一壁部分基本上不轴向对准的其他位置之间枢转；
第三壁部分，其可枢转地联接到所述近侧壁的所述剩余部分的另一部分并且可选择性地在所述第三壁部分与所述近侧壁的所述剩余部分的所述另一部分基本上轴向对准的位置和所述第三壁部分与所述近侧壁的所述剩余部分的所述另一部分基本上不轴向对准的位置之间枢转；和
第四壁部分，其可枢转地联接到所述第三壁部分并且连接到所述致动器组件，所述第四壁部分可选择性地在所述第四壁部分与所述第三壁部分和所述近侧壁的所述剩余部分的所述另一部分基本上轴向对准的第三位置和所述第四壁部分与所述第三壁部分基本上不轴向对准的其他位置之间枢转。
(7)如第(6)项所述的外科器械，其中，所述致动器组件包括：
第一致动器，其由所述远侧管部分支承并且连接到所述第二壁部分；
第二致动器，其由所述近侧管部分支承并且连接到所述第二壁部分；
第三致动器，其由所述远侧管部分支承并且连接到所述第四壁部分；
第四致动器，其由所述近侧管部分支承并且连接到所述第四壁部分的另一部分。
(8)如第(7)项所述的外科器械，其中，所述第一、第二、第三和第四致动器分别包括第一、第二、第三和第四液压缸。
(9)如第(8)项所述的外科器械，其中，所述第一液压缸包括：
由所述远侧管部分支承的第一缸体外壳，所述第一缸体外壳可动地支承在其中的第一活塞；和
第一致动杆，其从所述第一外壳延伸并且响应所述第一活塞在所述第一外壳内的运动选择性地相对于第一外壳可延伸和缩回，所述第一致动杆连接到所述第二壁部分的一部分，并且其中所述第二液压缸包括：
由所述近侧管部分支承的第二缸体外壳，所述第二缸体外壳可动地支承在其中的第二活塞；和
第二致动杆，其从所述第二外壳延伸并且响应所述第二活塞在所述第二外壳内的运动选择性地相对于第二外壳可延伸和缩回，所述第二致动杆连接到所述第二壁部分的另一部分，并且其中所述第三液压缸包括：
由所述远侧管部分支承的第三缸体外壳，所述第三缸体外壳可动地支承在其中的第三活塞；和
第三致动杆，其从所述第三外壳延伸并且响应所述第三活塞在所述第三外壳内的运动选择性地相对于第三外壳可延伸和缩回，所述第三致动杆连接到所述第四壁部分的一部分，并且其中所述第四液压缸包括：
由所述近侧管部分支承的第四缸体外壳，所述第四缸体外壳可动地支承在其中的第四活塞；和
第四致动杆，其从所述第四外壳延伸并且响应所述第四活塞在所述第四外壳内的运动选择性地相对于第四外壳可延伸和缩回，所述第四致动杆连接到所述第四壁部分的另一部分。
(10)如第(1)项所述的外科器械，其中，所述外科执行器包括内切割器端部执行器。
(11)如第(1)项所述的外科器械，其中，所述近侧和远侧壁之一的所述部分与它所连接的所述近侧和远侧壁的所述一个的所述剩余部分基本上轴向对准，所述管组件和所述外科执行器可以通过套管针插入。
(12)一种外科器械，包括：
手柄组件；
联接到所述手柄组件的细长管组件，所述细长管组件包括：
连接到所述手柄组件的近侧管部分；和
通过枢销可枢转地联接到所述近侧管部分的远侧管部分；
由所述近侧和远侧管部分之一支承的致动器，所述致动器具有可延伸和缩回的致动杆；
力矩臂杆，其联接到所述致动杆并且可滑动地延伸通过所述枢销中的开口，使得所述远侧管部分通过延伸和缩回所述致动杆而围绕所述枢销相对于所述近侧管部分枢转；和
连接到所述远侧管部分的外科执行器。
(13)如第(12)项所述的外科器械，进一步包括：
在所述远侧管部分的近端上的第一轭形件，所述第一轭形件具有第一上部腿和第一下部腿，所述第一上部腿中具有第一上部销接收孔，所述第一下部腿与所述第一上部腿间隔开并且在其中具有第一下部销接收孔；和
在所述近侧管部分的远端上的第二轭形件，所述第二轭形件具有第二上部腿，该第二上部腿对应于所述第一轭形件的所述第一上部腿并且具有贯穿其中的与所述第一销接收孔对准的第二上部销接收孔，所述第二轭形件进一步包括第二下部腿，该第二下部腿对应于所述第一轭形件的所述第一下部腿并且具有通过其中的与所述第一下部销接收孔对准的第二下部销接收孔，并且其中所述枢销延伸通过所述对准的第一和第二下部孔以及所述第一和第二上部孔，使得所述第一轭形件连接到所述枢销，以随其作枢转运动，并且所述销在所述第二轭形件中的所述第二上部孔和第二下部孔内自由旋转。
(14)如第(12)项所述的外科器械，其中，所述外科执行器包括内切割器端部执行器。
(15)如第(12)项所述的外科器械，其中，所述远侧管部分具有远侧轴线，并且其中所述近侧管部分具有近侧轴线，所述远侧管部分相对于所述近侧管部分可选择性地在所述远侧和近侧轴线基本上共轴对准的位置和所述远侧和近侧轴线基本上不共轴对准的其他位置之间枢转。
(16)如第(15)项所述的外科器械，其中，所述致动杆具有致动轴线，该致动轴线基本上平行于支承所述致动器的所述远侧管部分或近侧管部分的轴线，并且其中所述力矩臂杆具有力矩轴线，该力矩轴线基本上在所述致动轴线的横向。
(17)一种通过安装在患者体内的套管针执行外科手术的方法，所述方法包括：
提供一种外科器械，该外科器械具有手柄组件和通过管组件可关节运动地连接到所述手柄组件的可操作外科执行器，所述管组件包括：
连接到所述手柄组件的近侧管部分，所述近侧管部分的尺寸被设定成允许所述近侧管部分轴向地穿过所述套管针；
远侧管部分，其连接到所述外科执行器并且可枢转地联接到所述近侧管部分，以用于围绕枢转轴线选择性地作枢转运动，所述远侧管部分的尺寸被设定成允许所述远侧管部分轴向地穿过所述套管针；和
由所述近侧和远侧管部分之一支承的致动器，所述致动器具有选择性地可延伸和缩回的致动杆，其中所述致动杆的一部分在连接点连接到所述近侧和远侧管部分的另一个，以在所述枢转轴线和所述连接点之间限定力矩臂；
基本上共轴对准所述近侧和远侧管部分；
使所述外科执行器和所述基本共轴对准的远侧和近侧管部分穿过所述套管针进入患者；和
增加所述力矩臂，以将所述远侧管部分和外科执行器枢转成不与所述近侧管部分共轴对准。
(18)如第(17)项所述的方法，其中，所述近侧管部分具有壁部分和可动壁部分，所述可动壁部分可枢转地连接到所述壁部分并且可选择性在所述可动壁部分与所述壁部分基本上共轴对准的位置和所述壁部分与所述壁部分基本上不共轴对准的位置之间枢转，并且其中所述致动杆在所述连接点连接到所述可动壁部分，并且其中所述增加力矩臂包括将所述可动壁部分枢转成与所述壁部分基本上不共轴对准。
(19)如第(18)项所述的方法，其中，所述近侧管部分还包括第二可动壁部分，该第二可动壁部分可枢转地联接到第一枢转壁部分并且可选择性地在第二枢转壁部分与第一枢转壁部分和所述壁部分基本上共轴对准的位置和第二枢转壁部分与第一枢转壁部分和所述壁部分基本上不共轴对准的位置之间枢转，并且所述连接点位于所述致动杆连接到第二可动壁部分的位置，并且所述增加力矩臂包括将第二可动壁部分枢转成与第一可动壁部分和近侧管部分的第一壁部分基本上不共轴对准。
(20)如第(19)项所述的方法，其中，所述管组件还包括由所述近侧管部分支承的另一致动器，该致动器具有连接到第二壁部分的另一部分的另一致动杆，并且所述增加力矩臂包括致动第一和第二致动器以将第二壁部分枢转成与所述第一壁部分和近侧管部分的第一壁部分基本上不共轴对准。
本领域的普通技术人员将容易理解，随着以下具体描述的进行，这些和其他细节、特征和优点将变得更显而易见。
附图说明
包含在该说明书中并且构成其一部分的附图示出了本发明的实施方式，并且与上述给出的概述以及下面给出的实施方式的具体描述一起用于解释本发明的各种实施方式的各种原理。
图1是与液压操作内切割器结合使用的力矩臂延伸件布置的一个非限制性例子的部分透视图，其中的管部分处在第一基本共轴对准位置；
图2是图1的力矩臂延伸件布置和内切割器的另一透视图，其中的管部分相对于彼此成一个角度进行关节运动；
图3是用在图1和2所示的内切割器中采用的端部执行器的部分剖视图，其中的砧座处在打开或未夹紧位置，为了清楚起见省略了其中的一些元件；
图4是处在闭合或夹紧位置的图3的端部执行器的另一剖视图，其中切刀杆处在伸长位置；
图5是图3和4的端部执行器的另一剖视图，其显示了在其中被切割和缝合之后的组织；
图6是在图1-5中显示的端部执行器的分解透视图；
图7是端部执行器和钉仓的另一分解装配图；
图8是安装在图6和7所示的端部执行器中的钉仓的俯视图；
图9是显示插入到套管针通道中的端部执行器的横截面端视图；
图10是安装在端部执行器中的钉仓的透视图，其中的砧座处在打开或未夹紧位置；
图11是本发明的一种液压系统实施方式的示意图；
图12是本发明的关节运动接头的一个实施方式的部分剖视图，其中远侧管部分与近侧管部分基本上共轴对准；
图12A是图12的关节运动接头实施方式的另一部分剖视图，为了清楚起见以及当远侧和近侧管部分基本上共轴对准时显示致动器力矩臂，省略了一些元件编号；
图13是图12的关节运动接头的另一部分剖视图，其中远侧管部分与近侧管部分基本上不共轴对准；
图13A是图12A的关节运动接头的另一部分剖视图，为了清楚起见和当远侧和近侧管部分基本上不共轴对准时显示致动器力矩臂，省略了一些元件编号；
图14是本发明的关节运动接头实施方式的部分透视图；
图15是图14所示的关节运动接头的部分透视图；
图16是处在关节运动位置的本发明的另一关节运动接头的部分剖视图；
图17是处在关节运动位置的本发明的另一关节运动接头的部分剖视图；
图18是图17的关节运动接头的部分透视图，其中远侧和近侧管部分基本上共轴对准；
图19是处在关节运动位置的图17中所示的关节运动接头的部分透视图；
图20是可以使用本发明的各种实施方式的另一液压系统实施方式的示意图；
图21是本发明的另一关节运动接头实施方式的部分剖视图，其中远侧管部分相对于近侧管部分被关节运动；以及
图22是图21的关节运动接头的部分剖视图，其中远侧管部分和近侧管部分共轴对准。
具体实施方式
参照附图，其中在所有若干视图中相同的附图标记表示相同的部件，图1和2显示了能够实践本发明的独特优点的外科器械10的一个实施方式。在图1和2中可以看出，器械10包括手柄组件200和外科执行部分12。当在此使用时，术语“外科执行器”指的是被配置成接合组织以实现完成外科任务的部件或部件组。外科执行器的例子包括但不限于：内切割器，抓钳，夹钳，切割器，缝合器，夹具施放器，探针或进入装置，药物/基因治疗输送装置，使用例如超声、RF的能量装置，或激光装置，等等。
在图中所示的非限制性实施方式中，外科器械10包括液压致动端部执行器22和手柄结构200，其公开于序列号为No_____.、发明名称为“SURGICAL INSTRUMENT HAVING A HYDRAULICALLY ACTUATEDEND EFFECTOR”、申请人为Frederick E.Shelton IV和JeromeR.Morgan的美国专利申请中，上述申请与这里的申请同一天提交并且共同为本申请人所有，并且上述申请的全文公开被援引于此以作参考。然而，随着本具体描述的进行，本领域技术人员将容易理解，本发明的各种实施方式的独特而新颖的特征也可以与电动或气动端部执行器结合使用。因此，在不脱离本发明的精神和范围的情况下，本发明的各种实施方式可以有利地与除了在附图中描述的典型实施方式之外的各种外科执行器结合使用。因此，给予本发明的各种实施方式的保护范围不应当被限制在仅仅使用在此具体描述的特定类型的外科执行器。
被说成是援引于此以作参考的任何专利、出版物或其他公开材料(全文地或部分地)仅仅在一定程度上被援引于此，使得被援引的材料不会与在该公开中阐述的现有定义、声明或其他公开材料冲突。照这样，以及在需要的程度上，在此清楚阐述的公开弃除了被援引于此以作参考的任何冲突材料。被说成是援引于此以作参考，但是与在此阐述的现有定义、声明或其他公开材料冲突的任何材料或其部分将仅仅在一定程度上被援引，使得在所述被援引的材料和现有的公开材料之间不发生冲突。
图3-10显示了根据本发明的各种实施方式被配置成执行组织的夹紧、切断和缝合的端部执行器22的一种类型的视图。在一个实施方式中，端部执行器22具有主体部分24，该主体部分带有用于在其中接纳钉仓60的细长通道26。砧座28联接到主体部分24并且能够选择性地朝着和远离安装在细长通道26中的钉仓60枢转。图3和10示出了处在打开位置的砧座28，图4和5示出了处在闭合位置的砧座28。砧座28可以采用液压方式被闭合并且通过诸如弹簧23的储能装置返回到其打开位置。在图3-5中可以看出，致动囊40可以策略地安装在砧座28的一部分的下方，使得当用加压流体或空气膨胀囊40时，它将砧座28偏压到其打开位置。供给管线42联接到囊40以用于从容器232供应加压流体，这将在下面进一步具体描述。在备选的非限制性实施方式中，一个或多个附加液压缸可以有利地用于打开和闭合砧座。在其他的非限制性实施方式中，可以通过连接到那里的远侧管部分410的滑动动作打开和闭合砧座28。
在图3-10中也显示了可以用于这种端部执行器的钉仓的一种类型。缝合钉仓60具有由细长切割槽64分隔的仓体62，所述细长切割槽从钉仓60的近端65朝着锥形外尖端66延伸。参见图10，多个钉接收通道68形成于钉仓体64内并且布置在细长切割槽64的每一侧上的纵向间隔行69中。钉驱动器70定位在钉接收通道内，从而每个钉驱动器在其上支承一个或多个钉72。通过在向上的方向上朝着砧座28运动它们各自的驱动器70，钉72被推进或“击发”。
图10显示了处在打开位置的端部执行器22的三维视图，其中钉仓60安装在细长通道26中。在砧座28的下表面30上，当钉仓60安装在端部执行器22中时多个钉形成槽32排布成对应于仓体62中的每个钉接收通道68。更具体而言，砧座28中的每个形成槽32可以对应于位于钉仓60内的单个钉72。钉仓60可以卡扣配合在细长通道26中。例如，钉仓60的延伸部件63接合细长通道26的凹槽27(如图6中所示)。
在一个实施方式中，钉驱动器70由一系列液压致动囊90、92、94、96、98、100沿“向上”方向(朝着砧座28)驱动，所述囊位于端部执行器22的细长槽26内并且被布置成使得当囊90、92、94、96、98、100被膨胀时，它们朝着砧座28驱动或“击发”相应的驱动器70及其各自的钉72。当钉腿的末端接触砧座28中的相应钉形成槽32时，它们弯曲以闭合钉72。在发明名称为“SURGICALINSTRUMENT HAVING A HYDRAULICALLY ACTUATED END EFFECTOR”的上述专利申请公开了各种击发设置，上述申请已被援引于此以作参考。加压流体或空气通过如图6和11中所示的一系列供给管线供应到囊90、92、94、96、98、100。
同样在一个实施方式中，为了便于切割夹钳在端部执行器22中的组织8，液压致动切刀杆110可操作地安装在细长通道26内并且当钉仓60安装在端部执行器22内时被布置成容纳在仓体62中的细长槽64内。切刀杆110沿着细长槽64纵向地延伸并且机械地联接到或以另外方式支承在支杆111上，所述支杆连接到液压切割囊102。通过将加压流体或空气引入到切割囊102中，迫使切刀杆110向上(由图4中的箭头A表示)，由此导致切刀杆110切断夹钳在砧座28和钉仓60之间的组织8。当切刀杆110切断组织8之后，允许加压流体离开切割囊102，由此允许囊102收缩和允许切刀杆110向下(图3中的箭头“B”)运动到其缩回或未击发位置。加压流体或空气由供给管线256供应到切割囊102。
在图1和2中可以看出，手柄组件200可以容纳通常被标示为210的液压系统，该液压系统用于控制端部执行器22的操作。可以用于控制端部执行器22的液压系统210的一个实施方式示意性地在图11中示出。在该非限制性实施方式中，包括流体容器232的传统的液压泵组件230用于将加压流体供应到各种囊。在一个实施方式中，泵230由支承在手柄组件200中的电池234供电。然而，泵230也可以由其他手段供电，例如交流电或机械致动器。泵230可以通过供给管线236流体联接到容器232，所述供给管线在其中具有传统的止回阀238。参见图11，当在此使用时，术语“流体联接”表示元件与合适的供给、回流、排放等管线或其他装置联接在一起以允许加压流体介质、空气等在它们之间通过。当在此使用时，如用在“供给管线”、“排放管线”或“回流管线”中的术语“管线”指的是由沟道、管道、管系等形成的合适流体通道，用于在部件之间输送加压流体、空气等。
在一个实施方式中，连接到泵230的排放端口231的排放管线240管接到歧管242，该歧管具有用于联接到那里的每个囊的指定供给管线。例如，在图11所示的实施方式中，供给管线244联接到囊90并且在其中具有控制阀260以用于控制加压流体通过管线244流到囊90。供给管线246联接到囊92并且在其中具有控制阀262。供给管线248联接到囊94并且在其中具有控制阀264。供给管线250联接到囊96并且在其中具有控制阀266。供给管线252联接到囊98并且在其中具有控制阀268。供给管线254联接到囊100并且在其中具有控制阀270。供给管线256联接到囊102并且在其中具有控制阀272。供给管线42由管线241联接到囊40和供给管线240。供给阀274设在管线241中用于控制加压流体朝那里流动，并且提供回流阀276以允许流体从囊40返回到歧管管线242中并通过连接到歧管242和容器232的回流管线259’。在图11中可以看出，回流管线259’可以在其中具有回流阀278。阀262、264、266、268、270、272、274、276、278包括一个阀单元，通常标示为280。在各种非限制性实施方式中，阀262、264、266、268、270、272、274、276、278均可以包括电气致动阀，例如压电阀或电活性聚合物(EAP)阀，其可以被配置成响应电信号。然而，也可以使用其他合适的阀和阀布置。
上述阀可以由控制电路300响应从输入按钮(例如位于手柄上的按钮308、310、312、314和/或316)接收的输入进行操作。控制电路也可以由电池234供电并且包括能够响应来自按钮308、310、312、314、316和/或来自手柄的其他部分(例如可枢转地联接到那里的闭合触发器206和/或击发触发器208)的输入产生用于配置阀单元280的信号的合适电路。在一个非限制性实施方式中，控制电路300可以包括微处理器和其他相关部件，包括随机存取存储器(RAM)、只读存储器(ROM)等。在其他非限制性实施方式中，控制电路300可以包括各种逻辑电路元件。
在图1和2中可以看出，在一个非限制性实施方式中，器械10的手柄组件200包括手枪式握把204，该手枪式握把包括可枢转地连接到那里以开始闭合砧座28的闭合触发器206。在一个实施方式中，闭合触发器传感器205用于感测何时闭合触发器206已枢转到闭合位置。闭合触发器传感器205与控制电路通信，以打开回流阀276和回流阀278并且闭合供给阀274以允许加压流体从砧座囊28返回到容器232中。砧座28然后由复位弹簧23枢转到闭合位置。闭合触发器206可以由释放按钮栓锁布置36保持在闭合位置，所述栓锁布置所属的类型公开于申请人为Jeffery S.Swayze和FrederickE.Shelton，IV、发明名称为“SURGICAL STAPLING INSTRUMENTINCORPORATING A FIRING MECHANISM HAVING A LINKED RACKTRANSMISSION”的美国专利No.6,905,057中，上述申请的全文公开被援引于此以作参考。另一非限制性实施方式将闭合触发器206连接到管组件452并且使之向远侧运动，在端部执行器组件24上驱动远侧管410而使系统闭合。
当端部执行器22处在闭合位置时，它可以通过套管针490插入。参见图9，为了再打开端部执行器22，按压释放按钮36以解锁闭合触发器206，从而能使它枢转离开击发触发器208到达打开位置。当处在打开位置时，闭合触发器传感器205发信号通知控制电路300为泵230供电和打开供给阀274并闭合回流阀276。加压流体然后被泵送到砧座囊40中以将砧座28枢转到打开位置。当医生已将端部执行器22定向成使得所需组织位于打开的砧座28和钉仓60之间时，闭合触发器206被枢转到闭合位置并且被栓锁。阀276和278被打开并且阀241被闭合。阀276和278被打开足够长的时间以允许砧座囊40中的流体从那里通过管线42、242和259返回。其后，那些阀被闭合。如上所述，使用在此描述的液压动力囊和复位弹簧布置仅是可以用于打开和闭合砧座28的结构的一种类型。在不脱离本发明的精神和范围的情况下也可以利用其他砧座控制布置，所以给予本发明的各种实施方式的保护应当不仅仅限制在这种囊和复位弹簧布置。
输入按钮308、310、312、314、316可以以任何合适的方式将输入信号提供给控制电路300。在一个非限制性实施方式中，每个输入按钮308、310、312、314、316可以对应于一个或多个特定阀，这些阀用于控制一个或多个囊的膨胀。尽管对于该非限制性实施方式显示了五个致动按钮，读者将会理解，可以采用其他数量的按钮。例如，如果希望的是仅仅一次致动一个缝合囊，可以为每个囊提供独立致动按钮。例如，按钮308可以控制切割器供给管线256中的阀272。通过致动所述阀272，允许由泵230供应到歧管242中的加压流体通过供应管线256流入到切割囊102中。类似地，如果致动按钮310用于控制阀260、262，则致动按钮310将导致缝合囊90和92膨胀并击发它们相应的缝合钉72。可以选择多个按钮以产生包括一个以上执行器的击发模式。在其他非限制性实施方式中，每个输入按钮308、310、312、314、316可以代表预定的击发顺序和/或模式。例如，选择按钮308、310、312、314、316可以导致控制电路318配置阀单元304，使得当击发触发器28被压下时对应于特定外科执行器的液压装置被击发。将会理解，各种实施方式可以具有比所示更多或更少的输入按钮。在一个实施方式中，击发触发器208在闭合触发器206的外侧可枢转地连接到手柄200，并且一个或多个击发传感器(未示出)可以被定位成检测击发触发器的位置。击发传感器然后可以与控制电路300通信以控制各种阀，从而允许加压流体流到各种缝合囊，从而实现预期击发序列。
在各种非限制性实施方式中，阀单元280可以被配置成将延迟引入到包含在端部执行器12中的一个或多个外科执行器的驱动中。例如，可能希望驱动切割执行器，然后在驱动缝合执行器的一个或多个区域之前延迟预定时间。延迟可以根据任何合适的方法实现。在一个非限制性实施方式中，控制电路30可以配置阀单元280以打开液压泵230和包括在端部执行器12中的第一外科执行器之间的液压流体路径。当击发触发器28被致动时，泵302可以产生加压液压流体，该加压液压流体驱动第一外科执行器。控制电路300可以感测第一外科执行器何时被驱动(例如通过感测击发触发器208的位置)并且开动定时器，该定时器报数预定延迟时间。在预定延迟时间截止时，控制电路318可以配置阀单元280以将加压液压流体提供给第二外科执行器。在致动击发触发器208时产生的液压压力可以足够驱动第二外科执行器，或者在各种实施方式中，液压泵230可以用于产生附加的液压压力。
在图1、2、12和13中可以看出，端部执行器22可以由关节运动接头组件(通常标示为400)连接到手柄组件200。在一个非限制性实施方式中，关节运动接头组件400包括远侧管部分410，该远侧管部分具有远端412、近端414和远侧轴线H-H(如图13中所示)。远端412机械地(例如刚性地或可滑动地连接-取决于使用的砧座闭合布置)联接到端部执行器主体24。关节运动接头组件400进一步包括近侧管部分450，该近侧管部分具有近端452、远端454和近侧轴线I-I。近端452机械地连接到手柄组件200。在一个实施方式中，例如，近端452可以由承接在手柄组件上的内部通道保持器连接到手柄组件200。然而，也可以利用其他机械紧固布置。在一个实施方式中，远侧管部分410是中空的或者具有通过其中的软管接收通道416。类似地，近侧管部分450是中空的或者具有通过其中的软管接收通道456。
在图1、14和15中可以看出，远侧管部分410的近端414可枢转地联接到近侧管部分450的远端454以用于围绕枢转轴线C-C在远侧管部分410与近侧管部分450基本上共轴对准的位置(即，其中轴线H-H和I-I基本上共轴对准)和它们基本上不共轴对准的位置作枢转运动。在一个非限制性实施方式中，例如，远侧管部分410的近端414具有在其上形成的轭形件组件420，该轭形件组件具有第一和第二腿部422、424。参见图2，近侧管部分450的远端454具有从那里伸出的舌状件460，该舌状件的尺寸被设定成容纳在轭形件420的腿422、424之间。销462延伸通过轭形件420的腿422、424和舌状件460中的孔，以可枢转地将舌状件460联接到轭形件420，用于围绕轴线C-C作枢转运动。销262可以通过螺纹配合、粘合、干涉配合等保持在轭形件的腿中。在其他非限制性实施方式中，销462可以具有凸缘端。在一个非限制性实施方式中，舌状件460通过螺钉、销、胶等机械地固定在近侧管部分450的远端454内。
当如上所述可枢转地连接在一起时，近侧和远侧管部分450、410形成管组件470，该管组件具有一个通道472或多个通道以用于支承端部执行器22和手柄200之间的供给管线(集体标示为480)。将会理解，管组件470具有如下的圆周“C”和形状，使得当远侧管部分410与近侧管部分450共轴对准时，管组件470可以通过通道492插入到套管针490中。参见图9，在一个实施方式中，第一和第二管部分410、450具有圆形横截面形状并且尺寸被设定成通过圆形套管针通道492轴向地插入。远侧和近侧管部分410、450的外径均小于套管针通道492的内径，以便于通过套管针内径492插入管组件470，并且需要时或必要时，便于管组件470在套管针通道492内旋转。例如，如果套管针通道492具有的内径大约为12.8mm(0.503英寸)，则管组件470(和每个管部分410、450)的最大外径可以大约为12.7mm(0.500英寸)。可以想象，对于不必要或不需要具有在套管针通道492内旋转管组件470的能力的应用中，可以利用其通道具有非圆形横截面的套管针。在那些情况下，管组件将具有这样的横截面形状，其能够便于管组件通过套管针通道轴向插入并且可以非常类似于套管针通道的横截面形状。因此，本发明的各种实施方式应当并不限于具有圆形横截面形状的管组件的装置。
当外科执行器12和远侧管部分410已通过套管针通道492插入到患者中之后，为了便于相对于近侧管部分450枢转操作外科执行器12，可采用致动器组件，整体标示为500。另外，为了增加由致动器组件500产生的枢转力，当接头组件400已穿过套管针通道492进入患者之后，提供至少一个、优选两个枢转壁部分550、560，以有效地加长致动器组件500的力矩臂。
更特别地，参照图12和13，本发明的一个非限制性实施方式包括具有近端552的第一壁部分550，所述近端可枢转地连接到近侧管部分450的壁451的剩余部分，以用于相对于那里选择性地作枢转运动。第一壁部分550的相对端554可枢转地连接到第二壁部分560，以用于相对于那里选择性地作枢转运动。图12示出了处在第一非延伸位置的第一和第二壁部分550、560，在所述第一非延伸位置壁部分550、560不向外延伸超出管部分410、450的非枢转部分的预期圆周边界。图13示出了枢转到力生成位置的壁部分550、560，在所述力生成位置第一和第二壁部分550、560向外延伸超出由第一和第二管部分410、450的非枢转部分确定的圆周边界。
在图12和13中可以看出，在一个非限制性实施方式中，利用第一和第二关节运动缸体510、520。第一关节运动缸体510可以包括传统的液压或气压缸体，该缸体具有在其中包含第一活塞514的第一外壳512。第一活塞杆或第一致动杆516连接到第一活塞514并且伸到第一外壳512之外。活塞514响应加压流体或空气在活塞514的一侧或另一侧的进入而在第一外壳512内运动导致第一致动杆516延伸到第一缸体外壳512之外或进入第一缸体外壳512。第一缸体外壳512的远端518可枢转地连接到凸耳419，该凸耳连接到或形成于远侧管部分410的壁418中。第一致动杆516的自由端519可枢转地连接到第二壁部分560。当第一和第二壁部分550和560处在如图12中所示的非延伸位置时，为了提供第一致动杆516必需的间隙，在第二壁部分550中提供了狭槽559。同样，必要时，可以在远侧管部分410的近端414中提供间隙槽415，从而为第一缸体外壳512提供间隙以围绕销417枢转，所述销将第一缸体外壳512固定到凸耳419。因此，当处在非延伸位置时，第一关节运动缸体510没有部分从管组件470的外圆周向外伸出这样一段距离，该距离将导致第一关节运动缸体510的任何部分阻止或以另外方式妨碍管组件470轴向插入到套管针通道492中。
同样在该非限制性实施方式中，第二关节运动缸体520可以包括传统的液压或气压缸体，该缸体具有在其中包含第二活塞524的第二外壳522。第二活塞杆或第二致动杆526连接到第二活塞524并且伸到第二外壳522之外。第二活塞524响应加压流体或空气在第二活塞524的一侧或另一侧的进入而在第二缸体外壳522内运动，导致致动杆526延伸到第二缸体外壳522之外或进入第二缸体外壳522。第二缸体外壳522通过胶粘、销连接、螺钉连接等机械地连接到近侧管部分450。第二致动杆526的自由端527可枢转地连接到在第二壁部分560上形成的侧向延伸的凸耳562。
接着参照图12A和13A，读者可以获得本发明的各种实施方式的效果的更好理解。在这些图中可以看出，第一致动杆516的末端519连接第二壁部分560的点被标示为连接点“L”。因此，当远侧管部分410处在未关节运动位置时(图12A)，由第一致动器510产生的力矩臂由连接点“L”和枢销462的中心之间的距离“M”标示。在图13A中可以看出，通过将第一和第二壁部分550、560枢转到不轴向对准，现在力矩臂已被增加到M+，由此产生的用于围绕枢销462枢转远侧管部分的枢转力的大小增加。
第一和第二关节运动缸体510、520可以由液压系统210供电或者它们可以由独立的液压系统供电。图11显示了控制第一和第二关节运动缸体510、520的一种方法。在所述图中可以看出，供给管线570从泵230连接到供给管线240。供给管线570的第一部分572连接到第一缸体外壳512中的第一供给端口，以用于在第一活塞514的一侧将加压流体或空气供应到第一缸体外壳512中，并且供给管线570的第二部分574连接到第一缸体外壳512中的第二供给端口，以用于在第一活塞514的另一侧将加压流体或空气供应到第一缸体外壳512中。第一供给阀576安装在供给管线570的第一部分572中，第二供给阀578安装在第一供给管线570的第二部分574中。提供排放或回流管线580以将加压流体从第一外壳512返回到流体容器232中。回流管线580具有连接到第一外壳512的端口的第一部分582和第二部分584。第一回流阀586安装在回流管线580的第一部分582中，第二回流阀588安装在回流管线的第二部分584中。
供给管线570还具有在第二活塞524的一侧联接到第二外壳522中的第三供给端口的第三部分590，并且供给管线570具有在第二活塞524的另一侧联接到第二外壳522中的第四供给端口的第四部分592。阀596安装在第三部分590中，另一阀598安装在供给管线570的第四部分592中。提供另一回流管线600以允许在缸体520的致动期间加压流体、空气等从外壳522返回到容器232。回流管线600具有在第二活塞524的一侧连接到第二外壳522的第三回流端口的第三部分602，和在第二活塞524的另一侧连接到第二外壳522的第四回流端口的回流管线600的第四部分604。回流阀606设在回流管线600的第三部分602中，并且另一回流阀608设在回流管线600的部分604中。
所述阀可以由上述类型的控制电路300或第二控制电路300’控制，所述第二控制电路可以包括微处理器和其他相关部件，包括随机存取存储器(RAM)、只读存储器(ROM)等。在其他非限制性实施方式中，控制电路300’可以包括各种逻辑电路元件。传统的多位置开关610可以连接到第二控制电路300’以用于控制阀576、578、586、588、594、596、606、608。
图12示出了处在未进行关节运动位置的接头组件，在所述未进行关节运动位置将能使管组件470插入到套管针中。当外科执行器12已通过套管针490被插入并且开始希望使执行器12进行关节运动时，医生通过开关610启动控制电路300’。控制电路300’启动泵230(如果它还未被启动的话)并且供给阀576被打开以允许加压流体或空气流入到外壳512中，以如图13中所示延伸致动杆519。回流阀588被打开以允许活塞514的相对侧的加压流体通过回流管线584离开外壳。类似地，阀594被打开以允许加压流体在活塞524的一侧流入到外壳522中并且缩回致动杆526以如图13中所示缩回到外壳522中。回流阀608被打开，以允许在活塞524的相对侧的加压流体离开外壳522。关节运动缸体510、522的这种致动导致第一和第二壁部分550、560如图13中所示向外枢转，以有效地增加关节运动缸体510的力矩臂效果，从而增加由此产生的关节运动力。
为了使第一和第二壁部分550、560返回到它们的非延伸位置，其中在所述非延伸位置它们基本上与管部分410和450的剩余部分对准，医生将开关610运动到一个位置，以发信号通知控制电路为第一关节运动缸体510闭合阀576和588并打开阀578和586，从而允许活塞514和致动杆516返回到图12中所示的位置。类似地，阀594和608被闭合并且阀596和602被打开，以允许活塞524和致动杆526返回到图12中所示的位置。上述用于致动关节运动缸体510、520的液压控制系统只是可以使用的控制系统的一个例子。读者将会理解，在不脱离本发明的精神和范围的情况下可以利用各种不同的控制布置来启动关节运动缸体。例如，上述的关节运动缸体510、520需要加压流体进入，以在两个方向上运动它们的各自活塞。利用弹簧或其他机构来将活塞返回到开始位置的其他缸体也可以与合适的阀一起使用，并且可以采用本领域技术人员的能力范围内的液压流体供给布置。进一步将会理解，尽管在此描述的第一和第二壁部分550、560可枢转地连接到近侧管部分450的壁部分451，在其他实施方式中，在不脱离本发明的精神和范围的情况下，第一和第二壁部分550、560可以连接到远侧管部分410的壁部分418。此外，尽管示出了两个枢转壁部分，本发明的其他实施方式可以利用仅仅一个枢转壁部分或两个以上的枢转壁部分。
图16示出了用于使外科执行器12关节运动到管组件470的右侧的稍稍不同的关节运动缸体布置。该非限制性实施方式的至少一个形式以与上述相同的方式操作。
图17示出了用于使外科执行器12关节运动到管组件470的轴的左侧或右侧的双关节运动布置。以与上述相同的方式，端部执行器22可以通过关节运动接头组件(整体标示为1400)连接到手柄组件200。在一个非限制性实施方式中，关节运动接头组件1400包括具有远端1412和近端1414的远侧管部分1410。远端1412机械地联接到端部执行器主体24。取决于使用的砧座闭合布置，远端1412可以不可动地连接到端部执行器主体或通过缆索、挠性构件或可枢转构件连接。接头组件1400进一步包括具有近端1452和远端1454的近侧管部分1450。近端1452机械地连接到手柄组件200。在一个实施方式中，远侧管部分1410是中空的或者具有通过其中的软管接收通道1416。类似地，近侧管部分1450是中空的或者具有通过其中的软管接收通道1456。
远侧管部分1410的近端1414可枢转地联接到近侧管部分1450的远端1454，以用于围绕枢转轴线G-G作枢转运动。在一个非限制性实施方式中，例如，远侧管部分1410的近端1414具有在其上形成的轭形件组件1420，该轭形件组件具有第一和第二腿部1422、1424。参见图2，近侧管部分1450的远端1454具有从那里伸出的舌状件1460，该舌状件的尺寸被设定成容纳在轭形件1420的腿1422、1424之间。销1462延伸通过轭形件1420的腿1422、1424和舌状件1460中的孔，以可枢转地将舌状件1460联接到轭形件1420，以用于围绕轴线G-G作枢转运动。销1462可以通过螺纹、胶等保持在轭形件1420的腿1422、1424中。在其他非限制性实施方式中，销1462可以具有凸缘端。在一个非限制性实施方式中，舌状件60通过螺钉、销、胶等机械地固定在近侧管部分1450的远端1454内。
当如上所述可枢转地连接在一起时，近侧和远侧管部分1450、1410形成管组件1470，该管组件具有一个通道1472或多个通道以用于支承端部执行器22和手柄200之间的供给管线(总地标示为480)。将会理解，管组件1470具有如下的圆周“C”和形状，使得当远侧管部分1410与近侧管部分1450共轴对准时，管组件1470可以通过通道492插入到套管针490中。在一个实施方式中，第一和第二管部分1410、1450具有圆形横截面形状并且尺寸被设定成通过圆形套管针通道492轴向地插入。远侧和近侧管部分1410、1450的外径均小于套管针通道492的内径，以便于通过套管针内径492插入管组件1470，并且需要时或必要时，便于管组件1470在套管针通道492内旋转。例如，如果套管针通道492具有的内径大约为12.8mm(0.503英寸)，则管组件1470(和每个管部分1410、1450)的最大外径可以大约为12.7mm(0.500英寸)。可以想象，对于不必要或不需要具有在套管针通道492内旋转管组件1470的能力的应用中，可以利用其通道具有非圆形横截面的套管针。在那些情况下，管组件将具有这样的横截面形状，其能够便于管组件通过套管针通道轴向插入并且可以非常类似于套管针通道的横截面形状。因此，本发明的各种实施方式应当并不限于具有圆形横截面形状的管组件的装置。
当外科执行器12和远侧管部分1410已通过套管针通道492插入到患者中之后，为了便于相对于近侧管部分1450枢转操作外科执行器12，可采用致动器组件，通常标示为1500。该实施方式包括至少一个左枢转壁部分和至少一个右枢转壁部分。在图17和18所示的实施方式中，提供了壁部分1610和1620的左壁部分对1600和壁部分1710和1720的右壁部分对1700。第一左壁部分1610具有近端1612，该近端可枢转地连接到近侧管部分1450的壁1451的剩余部分，以用于相对于那里选择性地作枢转运动。第一左壁部分1610的相对端1614可枢转地连接到第二左壁部分1620，以用于相对于那里选择性地作枢转运动。图18示出了处在第一非延伸位置的第一和第二左壁部分1610、1620，在所述第一非延伸位置，壁部分1610、1620不向外延伸超出管部分1410、1450的非枢转部分的预期圆周边界。图19示出了枢转到力生成位置的壁部分1610、1620，在所述力生成位置第一和第二壁部分1610、1620向外延伸超出由第一和第二管部分1410、1450的非枢转部分确定的圆周边界，使得外科执行器12相对于管组件1470的轴关节运动到右侧。
类似地，该实施方式也包括右壁部分1710和1720的壁部分对1700。第一右壁部分1710具有近端1712，该近端可枢转地连接到近侧管部分1450的壁1451的剩余部分，以用于相对于那里选择性地作枢转运动。第一右壁部分1710的相对端1714可枢转地连接到第二右壁部分1720，以用于相对于那里选择性地作枢转运动。尽管未示出，读者将会理解，第一和第二右壁部分1710、1720可从第一非延伸位置枢转，在所述第一非延伸位置壁部分1710、1720不向外延伸超出管部分1410、1450的非枢转部分的预期圆周边界。图17示出了枢转到力生成位置的壁部分1710、1720，在所述力生成位置，第一和第二壁部分1710、1720向外延伸超出由第一和第二管部分1410、1450的非枢转部分确定的圆周边界，使得外科执行器12相对于管组件1470的轴关节运动到右侧。
在图17中可以看出，在一个非限制性实施方式中，利用第一和第二左关节运动缸体1630、1640以及第一和第二右关节运动缸体1650、1660。第一左关节运动缸体1630可以包括传统的液压或气压缸体，该缸体具有包含活塞(未示出)的第一外壳1632，所述活塞具有与之连接的第一左活塞杆或第一左致动杆1634。活塞响应加压流体或空气在活塞的一侧或另一侧的进入而在第一外壳1632内运动，导致第一左致动杆1634延伸到第一左缸体外壳1632之外或进入第一左缸体外壳1632。第一左缸体外壳1632的远端1636可枢转地连接到凸耳1419，该凸耳连接到或形成于远侧管部分1410的壁1418中。第一左致动杆1634的自由端1638可枢转地连接到第二左壁部分1620。当第一和第二左壁部分1610、1620处在如图18中所示的非延伸位置时为了提供第一左致动杆1634必需的间隙，在第二左壁部分1620中提供了狭槽1639。同样，必要时，可以在远侧管部分1410的近端1414中提供间隙槽1419，从而为第一左缸体外壳1632提供间隙以在其中枢转。因此，当处在非延伸位置时，第一左关节运动缸体1610的各部分没有从管组件1470的外圆周向外伸出这样一段距离，该距离将导致第一左关节运动缸体1610的任何部分阻止或以另外方式妨碍管组件1470轴向插入到套管针通道492中。
同样在该非限制性实施方式中，第二左关节运动缸体1640可以包括传统的液压或气压缸体，该缸体具有在其中包含第二左活塞1644的第二外壳1642。第二左活塞杆或第二左致动杆1646连接到第二左活塞1644并且伸到第二左缸体外壳1642之外。第二左活塞1644响应加压流体或空气在第二左活塞1644的一侧或另一侧的进入而在第二左缸体外壳1642内运动，导致第二左致动杆1646延伸到第二左缸体外壳1642之外或进入第二左缸体外壳1642。第二左缸体外壳1642通过胶粘、销连接、螺钉连接等机械地连接到近侧管部分1450。第二左致动杆1646的自由端1647可枢转地连接到在第二壁部分1620上形成的侧向延伸凸耳1624。
类似地，第一右关节运动缸体1650可以包括传统的液压或气压缸体，该缸体具有包含活塞(未示出)的第一外壳1652，所述活塞具有与之连接的第一右活塞杆或第一右致动杆1654。活塞响应加压流体或空气在活塞的一侧或另一侧的进入而在第一外壳1652内运动，导致第一右致动杆1654延伸到第一右缸体外壳1652之外或进入第一右缸体外壳1652。第一右缸体外壳1652的远端1656可枢转地连接到凸耳1421，该凸耳连接到或形成于远侧管部分1410的壁1418中。第一右致动杆1654的自由端1658可枢转地连接到第二右壁部分1720。当第一和第二右壁部分1710、1720处在非延伸位置时，为了提供第一右致动杆1654必需的间隙，在第二右壁部分1720中提供了狭槽1739。同样，必要时，可以在远侧管部分1410的近端1414中提供间隙槽1423，从而为第一右缸体外壳1652提供间隙以在其中枢转。因此，当处在非延伸位置时，第一右关节运动缸体1650的各部分没有从管组件1470的外圆周向外伸出这样一段距离，该距离将导致第一右关节运动缸体1650的任何部分阻止或以另外方式妨碍管组件1470轴向插入到套管针通道492中。
同样在该非限制性实施方式中，第二右关节运动缸体1660可以包括传统的液压或气压缸体，该缸体具有在其中包含第二右活塞1664的第二外壳1662。第二右活塞杆或第二右致动杆1666连接到第二右活塞1664并且伸到第二右缸体外壳1662之外。第二右活塞1664响应加压流体或空气在第二右活塞1644的一侧或另一侧的进入而在第二右缸体外壳1662内运动，导致第二右致动杆1666延伸到第二右缸体外壳1662之外或进入第二右缸体外壳1662。第二右缸体外壳1662通过胶粘、销连接、螺钉连接等机械地连接到近侧管部分1450。第二右致动杆1666的自由端1667可枢转地连接到在第二壁部分1720上形成的侧向延伸凸耳1724。
第一和第二左关节运动缸体1630、1640以及第一和第二右关节运动缸体1650、1660可以由为端部执行器22的切割和缝合部件供电的液压系统供电，或者它们可以由例如在图20中所示的独立液压系统供电。在所述图中可以看出，系统1800包括泵1802，该泵通过供给管线1806从容器1804抽吸加压流体或空气。泵1802的排放端口通过连接到歧管管线1810的管线1808排放加压流体。歧管管线1810联接到具有第一部分1814和第二部分1816的第一左供给管线1812，所述第一部分1814在其活塞1634的一侧联接到第一左缸体1630的外壳1632中的一个端口，所述第二部分1816在活塞1634的另一侧联接到外壳1632中的另一端口。歧管管线1810也联接到具有其中的一个部分1822和另一部分1824的第二左供给管线1820，所述一个部分1822在其活塞1644的一侧联接到第二左关节运动缸体1640的外壳1642中的一个端口，供给管线1820的所述另一部分1824在活塞1644的另一侧联接到外壳1642中的一个端口。歧管管线1810进一步联接到具有第一部分1832和另一部分1834的第三供给管线1830，所述第一部分1832联接到第一右关节运动缸体1650的外壳1652中的一个端口，供给管线1830的所述另一部分1834联接到第一右关节运动缸体的外壳1652中的另一端口。歧管管线1810也联接到具有第一部分1842和第二部分1844的第四供给管线1840，所述第一部分1842联接到第二右关节运动缸体1660的外壳1662中的一个端口，第四供给管线1840的所述第二部分1844在活塞1654的另一侧联接到外壳1662中的另一端口。
同样在该实施方式中，回流管线1850向容器1804中排放并且联接到具有第一部分1854和第二部分1856的第一回流管线1852，所述第一部分1854在活塞1634的一侧联接到第一左关节运动缸体1630的外壳1632中的一个端口，所述第二部分1856在活塞1634的另一侧联接到外壳1632中的另一端口。第二回流管线1860联接到回流管线1850并且具有第一部分1862和第二部分1864，所述第一部分1862在活塞1644的一侧联接到第二左关节运动缸体1640的外壳1642中的一个端口，所述第二部分1864在活塞1644的另一侧联接到第二左关节运动缸体1640的外壳1642中的另一端口。第三回流管线1870联接到回流管线1850并且具有第一部分1872和第二部分1874，所述第一部分1872在活塞1654的一侧联接到第一右关节运动缸体1650的外壳1652中的一个端口，所述第二部分1874在活塞1654的另一侧联接到外壳1652中的另一端口。第四回流管线1880联接到回流管线1850并且具有第一部分1882和第二部分1884，所述第一部分1882在活塞1664的一侧联接到第二右关节运动缸体1660的外壳1662中的一个端口，所述第二部分1884在活塞1664的另一侧联接到第二右关节运动缸体1660的外壳1662中的另一端口。
为了控制加压流体、空气等流到缸体，可采用一系列阀。阀1900安装在供给管线1812的第一部分1814中，阀1902安装在供给管线1812的第二部分中。阀1904安装在回流管线1850的第一部分1852中，阀1906安装在回流管线1850的第二部分1854中。阀1910安装在供给管线1820的第一部分1822中，阀1912安装在供给管线1820的第二部分1824中。阀1914安装在回流管线1860的第一部分1862中，阀1916安装在回流管线1860的第二部分1864中。阀1920安装在供给管线1830的第一部分1832中，阀1922安装在供给管线1830的第二部分1834中。阀1924安装在回流管线1870的第一部分1872中，阀1926安装在回流管线1870的第二部分1874中。阀1930安装在供给管线1840的第一部分1842中，阀1932安装在供给管线1840的第二部分1844中。阀1934安装在回流管线1880的第一部分1882中，阀1936安装在回流管线1880的第二部分1884中。
所述阀可以由上述控制电路3000或由第二控制电路2000控制，所述第二控制电路可以包括微处理器和其他相关部件，包括随机存取存储器(RAM)、只读存储器(ROM)等。在其他非限制性实施方式中，控制电路2000可以包括各种逻辑电路元件。传统的多位置开关2010可以连接到第二控制电路2000以用于控制阀1900、1902、1904、1906、1910、1912、1914、1916、1920、1922、1924、1926、1930、1932、1934、1936。
图18示出了处在未进行关节运动位置的接头组件1400，在所述未进行关节运动位置将能使管组件1470插入到套管针中。当外科执行器12已通过套管针490被插入并且开始希望使执行器12进行关节运动时，医生通过开关2010启动控制电路2000。控制电路2000启动泵1802并且供给阀1902被打开，以允许加压流体在活塞1634的一侧流入到第一左关节运动缸体1630的外壳1632中，以缩回致动杆1636。阀1904被打开，以允许在活塞1634的相对侧的加压流体进入回流管线1850并且阀1900和1906被闭合。阀1910和1916被打开并且阀1912和1914被闭合，以允许缩回第二左关节运动缸体的致动杆1646。阀1920和1926被打开并且阀1922和1924被闭合，以允许延伸第一右关节运动缸体1650的致动杆1656。阀1930和1936被打开并且阀1932和1934被闭合，以允许缩回致动杆1666。当所述阀处在前述位置时，管部分1410(和与之连接的端部执行器)如图17中所示被向左枢转。当预期手术完成后并且当医生希望通过套管针收回器械时，医生启动开关2010，该开关发信号通知控制电路打开阀1900、1906、1912、1914、1922、1924、1932、1934并且闭合阀1902、1904、1910、1916、1920、1926、1930、1936。
上述用于致动关节运动缸体1630、1640、1650、1660的液压控制系统只是可以使用的控制系统的一个例子。读者将会理解，在不脱离本发明的精神和范围的情况下可以利用各种不同的控制布置来启动关节运动缸体。例如，上述的关节运动缸体1630、1640、1650、1660均需要加压流体进入以在两个方向上移动它们的各自活塞。利用弹簧或其他机构来将活塞返回到开始位置的其他缸体也可以与合适的阀一起使用，并且也可以利用在本领域技术人员的能力范围内的液压流体供给布置。
图21和22示出了本发明的另一实施方式。在这些图中可以看出，远侧管部分410’通过枢销和标示为2100的轭形件布置连接到近侧管部分450’。更具体而言，在这些图中可以看出，第一轭形件组件2110形成于远侧管部分410’的近端上。第一轭形件组件2110具有第一上部腿2112和下部腿部分2116，第一上部腿2112在其中具有第一上部销接收孔2114，下部腿部分2116与上部腿部分2112间隔并且具有通过其中的第一下部销接收孔2118。
第二轭形件组件2120从近侧管部分450’的远端延伸并且包括第二上部腿部分2122，第二上部腿部分2122由近侧管部分450’的壁形成或者与其机械地连接。第二上部腿部分2122具有通过其中的第二上部销接收孔2124。第二轭形件组件2120进一步包括第二下部腿部分2126，第二下部腿部分2126由近侧管部分450’的壁形成或者与其机械地连接。第二下部腿部分具有通过其中的第二下部销接收孔2128。销接收孔2114、2118、2124、2128共轴对准，以接收通过其中的枢销2130。枢销2130不可动地连接到第一上部腿2112和第一下部腿2116并且以另外方式在分别位于第二上部腿2122和第二下部腿2126中的第二上部销接收孔2124和第二下部销接收孔2128内旋转。因此，销2130在孔2124、2128内的旋转导致远侧管部分410’相对于近侧管部分450’枢转。
为了便于销2130和远侧管部分410’的枢转，致动器2140支承在近侧管部分450’内。在一个实施方式中，致动器2140包括可以由上述的液压系统布置控制的液压缸。液压缸2140在其中具有可延伸和可缩回的致动杆2142。在一个实施方式中，致动杆2142具有轴线T-T，当远侧和近侧管部分410’、450’的轴线H-H和I-I共轴对准的时候，轴线T-T基本上平行于那些轴线H-H和I-I。从图21和22中可以看出，力矩杆2150可枢转地连接到致动杆2142的末端并且可滑动地延伸通过销2130中的开口2151。因此，当致动杆2142被延伸时，在销2130的中心点和致动杆2142的末端之间产生的力矩臂增加，由此增加产生的枢转力的大小，所述枢转力导致力矩杆2150在枢销2130的开口2151内滑动并且导致枢销2130和与之连接的远侧管部分410’枢转。为了使远侧管部分410’与近侧管部分450’轴向对准，致动杆2142被缩回并且力矩臂2150在销2130的开口2151内滑动并导致销2130沿相反方向枢转。本领域的普通技术人员将会理解，缸体2140可以位于近侧管部分内，使得以上述方式致动致动杆2142会导致远侧管部分向右枢转。
本发明的各种非限制性实施方式提供了胜过现有技术的关节运动外科器械的许多优点。特别地，本发明的各种实施方式能使管元件的将外科执行器连接到手柄的部分通过套管针或类似装置插入，然后在患者内选择性地被关节运动。各种关节运动接头和致动器布置能够通过增加致动器和枢转轴线或枢轴点之间的力矩臂的长度产生更高的枢转力。尽管在此结合液压操作内切割器的使用描述了各种实施方式，本领域的普通技术人员将会理解，本发明的各种实施方式可以与电动内切割器和与许多其他类型的外科执行器一起使用，而不管它们是电动的还是液压动力的。
尽管通过若干实施方式的描述举例说明了本发明以及尽管相当具体地描述了例举的实施方式，申请人并非想要限制或以任何方式将后附权利要求的范围限定在这样的细节。附加优点和改进对于本领域的技术人员来说是显而易见的。因此，根据内窥镜手术和装置论述了本发明。然而，在此诸如“内窥镜”这样的术语的使用不应当被理解成将本发明限定在仅仅结合内窥镜管(即套管针)使用的外科缝合和切割器械。相反，相信本发明可以应用于进入被限制在小切口的任何手术中，包括但不限于腹腔镜手术，以及开放式手术。

Claims (4)

1.一种外科器械，包括：
手柄组件；
联接到所述手柄组件的细长管组件，所述细长管组件包括：
连接到所述手柄组件的近侧管部分，所述中空的近侧管部分具有近侧壁；和
远侧管部分，其可枢转地连接到所述近侧管部分，并且可选择性地在所述远侧管部分与所述近侧管部分基本上轴向对准的位置和所述远侧管部分与所述近侧管部分基本上不轴向对准的位置之间枢转，所述远侧管部分具有远侧壁；
致动器组件，其由所述近侧和远侧管部分中的至少一个支承并且联接到所述近侧和远侧壁之一的至少一部分，使得当致动所述致动器组件时，所述近侧和远侧壁之一的所述部分被枢转成与所述近侧和远侧壁之一的相应部分不对准，从而使所述远侧管部分关节运动成与所述近侧管部分基本上不轴向对准；和
连接到所述远侧管部分的外科执行器；
其中，所述近侧壁和远侧壁的所述至少一部分包括：
第一壁部分，其可枢转地联接到所述近侧壁的剩余部分并且可选择性地在所述第一壁部分与所述近侧壁的所述剩余部分基本上轴向对准的位置和所述第一壁部分与所述近侧壁的所述剩余部分基本上不轴向对准的位置之间枢转；
第二壁部分，其可枢转地联接到所述第一壁部分并且连接到所述致动器组件，所述第二壁部分可选择性地在所述第二壁部分与所述第一壁部分和所述近侧壁的所述剩余部分基本上轴向对准的另一位置和所述第二壁部分与所述第一壁部分基本上不轴向对准的其他位置之间枢转；
第三壁部分，其可枢转地联接到所述近侧壁的所述剩余部分的另一部分并且可选择性地在所述第三壁部分与所述近侧壁的所述剩余部分的所述另一部分基本上轴向对准的位置和所述第三壁部分与所述近侧壁的所述剩余部分的所述另一部分基本上不轴向对准的位置之间枢转；和
第四壁部分，其可枢转地联接到所述第三壁部分并且连接到所述致动器组件，所述第四壁部分可选择性地在所述第四壁部分与所述第三壁部分和所述近侧壁的所述剩余部分的所述另一部分基本上轴向对准的第三位置和所述第四壁部分与所述第三壁部分基本上不轴向对准的其他位置之间枢转。
2.根据权利要求1所述的外科器械，其中，所述致动器组件包括：
第一致动器，其由所述远侧管部分支承并且连接到所述第二壁部分；
第二致动器，其由所述近侧管部分支承并且连接到所述第二壁部分；
第三致动器，其由所述远侧管部分支承并且连接到所述第四壁部分；
第四致动器，其由所述近侧管部分支承并且连接到所述第四壁部分的另一部分。
3.根据权利要求2所述的外科器械，其中，所述第一、第二、第三和第四致动器分别包括第一、第二、第三和第四液压缸。
4.根据权利要求3所述的外科器械，其中，所述第一液压缸包括：
由所述远侧管部分支承的第一缸体外壳，所述第一缸体外壳可动地支承在其中的第一活塞；和
第一致动杆，其从所述第一外壳延伸并且响应所述第一活塞在所述第一外壳内的运动选择性地相对于第一外壳可延伸和缩回，所述第一致动杆连接到所述第二壁部分的一部分，并且其中所述第二液压缸包括：
由所述近侧管部分支承的第二缸体外壳，所述第二缸体外壳可动地支承在其中的第二活塞；和
第二致动杆，其从所述第二外壳延伸并且响应所述第二活塞在所述第二外壳内的运动选择性地相对于第二外壳可延伸和缩回，所述第二致动杆连接到所述第二壁部分的另一部分，并且其中所述第三液压缸包括：
由所述远侧管部分支承的第三缸体外壳，所述第三缸体外壳可动地支承在其中的第三活塞；和
第三致动杆，其从所述第三外壳延伸并且响应所述第三活塞在所述第三外壳内的运动选择性地相对于第三外壳可延伸和缩回，所述第三致动杆连接到所述第四壁部分的一部分，并且其中所述第四液压缸包括：
由所述近侧管部分支承的第四缸体外壳，所述第四缸体外壳可动地支承在其中的第四活塞；和
第四致动杆，其从所述第四外壳延伸并且响应所述第四活塞在所述第四外壳内的运动选择性地相对于第四外壳可延伸和缩回，所述第四致动杆连接到所述第四壁部分的另一部分。
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CN1961840A (zh) 2007-05-16
BRPI0604548B1 (pt) 2018-02-06
CA2567382C (en) 2013-10-15
CA2567382A1 (en) 2007-05-09
JP5183908B2 (ja) 2013-04-17
US20070102474A1 (en) 2007-05-10
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BRPI0604548A (pt) 2007-08-28
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EP1785101A3 (en) 2009-07-22
AU2006233261A1 (en) 2007-05-24
EP1785101A2 (en) 2007-05-16
HK1104442A1 (zh) 2008-01-18
MXPA06012964A (es) 2007-06-11
AU2006233261B2 (en) 2012-03-22
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US7673780B2 (en) 2010-03-09

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