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WO2022091357A1 - Dispositif de guidage, système de traitement, et procédé traitement - Google Patents

Dispositif de guidage, système de traitement, et procédé traitement Download PDF

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Publication number
WO2022091357A1
WO2022091357A1 PCT/JP2020/040865 JP2020040865W WO2022091357A1 WO 2022091357 A1 WO2022091357 A1 WO 2022091357A1 JP 2020040865 W JP2020040865 W JP 2020040865W WO 2022091357 A1 WO2022091357 A1 WO 2022091357A1
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WO
WIPO (PCT)
Prior art keywords
guiding device
central axis
guide body
cutting
endoscope
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2020/040865
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English (en)
Japanese (ja)
Inventor
健 藤崎
宜瑞 坂本
嘉郎 有働
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Olympus Corp
Original Assignee
Olympus Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Olympus Corp filed Critical Olympus Corp
Priority to JP2022558761A priority Critical patent/JPWO2022091357A1/ja
Priority to PCT/JP2020/040865 priority patent/WO2022091357A1/fr
Publication of WO2022091357A1 publication Critical patent/WO2022091357A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned

Definitions

  • the present invention relates to a guiding device, a treatment system, and a treatment method.
  • the anterior cruciate ligament reconstruction is generally performed in a state where the joint cavity is filled with a perfusate such as physiological saline.
  • a perfusate such as physiological saline.
  • the perfusate is delivered into the joint cavity through an endoscope inserted into the joint cavity.
  • the perfusate in the joint cavity is discharged through a suction tool such as a shaver inserted in the joint cavity.
  • the portal that communicates between the inside of the joint cavity and the outside of the skin is for an endoscope, a suction tool such as a shaver, and an ultrasonic probe. There will be three. That is, there is a problem that the number of portals is three and it is difficult to perform treatment with minimal invasiveness.
  • the present invention has been made in view of the above, and an object of the present invention is to provide a guiding device, a treatment system, and a treatment method capable of performing a desired treatment with minimal invasiveness.
  • the guiding device includes a tubular guide body having a through hole through which a cutting treatment tool used in a liquid is inserted, and the guide body is provided.
  • a convex portion that protrudes toward the central axis of the guide body and extends along the central axis to guide the movement of the cutting treatment tool along the central axis, and the guide body.
  • a groove portion that is recessed toward the outer peripheral surface of the surface and extends along the central axis to serve as a flow path through which the liquid flows.
  • the treatment system according to the present invention includes an endoscope, a cutting treatment tool used in a liquid, and a guiding device having a tubular guide body having a through hole through which the cutting treatment tool is inserted.
  • a convex portion that protrudes toward the central axis of the guide body and extends along the central axis to guide the movement of the cutting treatment tool along the central axis.
  • a groove portion that is recessed toward the outer peripheral surface of the guide body and extends along the central axis to serve as a flow path for the liquid to flow is provided.
  • the treatment method according to the present invention is a treatment using an endoscope, a cutting treatment tool used in a liquid, and a guiding device having a tubular guide body having a through hole through which the cutting treatment tool is inserted.
  • the inner peripheral surface of the guide body projects toward the central axis of the guide body and extends along the central axis to guide the movement of the cutting tool along the central axis. It becomes a flow path that is recessed toward the outer peripheral surface of the guide body and extends along the central axis to discharge the liquid from the tip of the guide body toward the base end of the guide body.
  • a groove portion is provided, and in the treatment method, the guiding device is positioned in the field of view of the endoscope in the joint cavity, the cutting treatment tool is inserted into the through hole, and the cutting treatment tool is continuously inserted.
  • the living body is cut by driving it.
  • the desired treatment can be performed with minimal invasiveness.
  • FIG. 1 is a diagram showing a schematic configuration of a treatment system according to an embodiment.
  • FIG. 2 is a diagram illustrating an ultrasonic probe.
  • FIG. 3 is a diagram illustrating an ultrasonic probe.
  • FIG. 4 is a diagram illustrating a guiding device.
  • FIG. 5 is a diagram illustrating a guiding device.
  • FIG. 6 is a diagram illustrating a guiding device.
  • FIG. 7 is a diagram illustrating a treatment method.
  • FIG. 8 is a diagram illustrating a treatment method.
  • FIG. 9 is a diagram illustrating a treatment method.
  • FIG. 10 is a diagram illustrating a treatment method.
  • FIG. 11 is a diagram illustrating a treatment method.
  • FIG. 12 is a diagram illustrating a treatment method.
  • FIG. 1 is a diagram showing a schematic configuration of a treatment system according to an embodiment.
  • FIG. 2 is a diagram illustrating an ultrasonic probe.
  • FIG. 3 is a diagram
  • FIG. 13A is a diagram illustrating a treatment method.
  • FIG. 13B is a diagram illustrating a treatment method.
  • FIG. 13C is a diagram illustrating a treatment method.
  • FIG. 14 is a diagram illustrating a treatment method.
  • FIG. 15 is a diagram illustrating a treatment method.
  • FIG. 16 is a diagram illustrating a treatment method.
  • FIG. 17 is a diagram illustrating a treatment method.
  • FIG. 18 is a diagram illustrating a treatment method.
  • FIG. 19 is a diagram illustrating a treatment method.
  • FIG. 20 is a diagram illustrating a treatment method.
  • FIG. 21 is a diagram illustrating a treatment method.
  • FIG. 22 is a diagram illustrating a treatment method.
  • FIG. 23 is a diagram illustrating a treatment method.
  • FIG. 21 is a diagram illustrating a treatment method.
  • FIG. 24 is a diagram illustrating a treatment method.
  • FIG. 25A is a diagram showing a modification 1 of the embodiment.
  • FIG. 25B is a diagram showing a modification 1 of the embodiment.
  • FIG. 26A is a diagram showing a modification 2 of the embodiment.
  • FIG. 26B is a diagram showing a modified example 3 of the embodiment.
  • FIG. 26C is a diagram showing a modified example 4 of the embodiment.
  • FIG. 27 is a diagram showing a modified example 5 of the embodiment.
  • FIG. 28 is a diagram showing a modified example 6 of the embodiment.
  • FIG. 1 is a diagram showing a schematic configuration of a treatment system 1 according to an embodiment.
  • the treatment system 1 treats a living tissue such as bone by applying ultrasonic vibration to the living tissue.
  • the treatment means, for example, removal or cutting of a living tissue such as bone.
  • FIG. 1 illustrates a treatment system for performing anterior cruciate ligament reconstruction as the treatment system 1.
  • the treatment system 1 includes an endoscope device 2, a treatment device 3, a guiding device 4, and a perfusion device 6.
  • the guiding device 4 will be described later.
  • the endoscope device 2 includes an endoscope 21 and a first control device 22.
  • the tip portion of the insertion portion 211 is inserted into the joint cavity C1 through the first portal P1 that communicates the inside of the joint cavity C1 of the knee joint J1 and the outside of the skin.
  • the endoscope 21 irradiates the inside of the joint cavity C1 and captures the illumination light (subject image) reflected in the joint cavity C1 to image the subject image.
  • the first control device 22 performs various image processing on the captured image captured by the endoscope 21, and displays the captured image after the image processing on a display device (not shown).
  • the treatment device 3 includes a cutting treatment tool 31, a second control device 32, and a foot switch 33.
  • the cutting treatment tool 31 includes a treatment tool main body 311, an ultrasonic probe 312 (see FIG. 2), and a sheath 313.
  • the treatment tool main body 311 is formed in a cylindrical shape.
  • An ultrasonic transducer 311a (Bolt-clamped Langevin-type transducer) that generates ultrasonic vibration according to the supplied drive power is configured inside the treatment tool main body 311. Figure 1) is stored.
  • the second control device 32 supplies the driving power to the ultrasonic vibrator 311a in response to the operation of the foot switch 33 by the operator.
  • the supply of the driving power is not limited to the operation to the foot switch 33, and may be performed, for example, in response to the operation to the operation unit (not shown) provided on the cutting treatment tool 31.
  • FIGS. 2 and 3 are views illustrating the ultrasonic probe 312.
  • FIG. 2 is a perspective view of the ultrasonic probe 312 as viewed from the tip side.
  • FIG. 3 is a diagram showing how the ultrasonic probe 312 forms the bone hole 101.
  • the ultrasonic probe 312 is made of, for example, a titanium alloy or the like, and has a substantially cylindrical shape.
  • the base end portion of the ultrasonic probe 312 is connected to the ultrasonic transducer 311a in the treatment tool main body 311. Then, the ultrasonic probe 312 transmits the ultrasonic vibration generated by the ultrasonic vibrator 311a from the base end to the tip end.
  • the ultrasonic vibration is longitudinal vibration along the longitudinal direction (vertical direction in FIGS.
  • a tip treatment portion 312a is provided at the tip portion of the ultrasonic probe 312.
  • the tip treatment portion 312a includes a base portion 312b and a tip portion 312c, as shown in FIG. 2 or FIG.
  • the substrate portion 312b has a shape that defines the contour shape of the bone hole formed in the bone by the ultrasonic probe 312.
  • the cross-sectional shape orthogonal to the axis extending along the longitudinal direction of the ultrasonic probe 312 has a side length of a1 and another side length of b1 (as shown in FIG. 2). It is a rectangle of ⁇ a1).
  • the surface including the side of the length a1 is referred to as the surface 312d (FIG. 2) and the surface including the side of the length b1 is described as the surface 312e (FIG. 2) in the substrate portion 312b. do.
  • the tip portion 312c has a shape in which the cross-sectional area decreases toward the tip.
  • the tip surface of the tip portion 312c is a flat surface.
  • the sheath 313 is formed in a cylindrical shape elongated from the treatment tool main body 311 and covers a part of the outer circumference of the ultrasonic probe 312 from the treatment tool main body 311 to an arbitrary length.
  • the tip portion of the ultrasonic probe 312 in the cutting treatment tool 31 described above is guided by the guiding device 4 inserted into the joint cavity C1 through the second portal P2 that communicates the inside of the joint cavity C1 and the outside of the skin. At the same time, it is inserted into the joint cavity C1. Then, as shown in FIG. 3, when ultrasonic vibration is generated in a state where the tip treatment portion 312a is in contact with the bone treatment target portion 100, the hammer ring action mechanically causes the tip treatment portion 312a and the tip treatment portion 312a. The part of the bone that collided is crushed into fine particles.
  • the tip treatment portion 312a when the tip treatment portion 312a is pushed into the treatment target site 100 by the operator, the tip treatment portion 312a enters the inside of the treatment target site 100 while crushing the bone. As a result, a bone hole 101 having a rectangular cross section having the same cross-sectional shape as that of the base portion 312b is formed in the treatment target site 100.
  • the first and second bone holes 511 with respect to the anterior cruciate ligament attachment portion on the lateral surface of the lateral condyle of the femur as the treatment target site 100. , 512 (see FIG. 18).
  • the first and second bone holes 511, 512 each have a rectangular cross section of vertical a1 ⁇ horizontal b1, and are formed side by side with a certain interval d1.
  • a bone hole 510 having a rectangular cross section (see FIG. 24) having a side length of a1 and a other side length of 2b1 + d1 is finally formed. Will be done.
  • the guiding device 4 is inserted into the joint cavity C1 through the second portal P2, and guides the insertion of the tip portion of the ultrasonic probe 312 in the cutting treatment tool 31 into the joint cavity C1.
  • the detailed configuration of the guiding device 4 will be described later.
  • the inside of the joint cavity C1 is filled with a perfusate such as physiological saline. Then, the perfusate is sent out into the joint cavity C1 by the perfusion device 6 and discharged out of the joint cavity C1.
  • the perfusion device 6 includes a liquid source 61, a liquid feed tube 62, a liquid feed pump 63, a liquid drain bottle 64, a liquid drain tube 65, and a liquid drain pump 66.
  • the liquid source 61 houses the perfusate.
  • One end of the liquid feeding tube 62 is connected to the liquid source 61, and the other end is connected to the endoscope 21.
  • the liquid feed pump 63 delivers the perfusate from the liquid source 61 toward the endoscope 21 through the liquid feed tube 62. Then, the perfusate delivered to the endoscope 21 is delivered into the joint cavity C1 from the liquid feeding hole 211a (see FIG. 12) formed in the tip portion of the insertion portion 211.
  • the drainage bottle 64 contains the perfusate drained out of the joint cavity C1.
  • One end of the drainage tube 65 is connected to the guiding device 4, and the other end is connected to the drainage bottle 64.
  • the drainage pump 66 follows the flow path of the guiding device 4 to the drainage tube 65 inserted into the joint cavity C1 and discharges the perfusate in the joint cavity C1 to the drainage bottle 64.
  • the drainage pump 66 will be described, but the present invention is not limited to this, and a suction device provided in the facility may be used.
  • FIG. 4 is a perspective view showing the appearance of the guiding device 4.
  • FIG. 5 is a view of the guiding device 4 as viewed from the tip side (left side in FIG. 4).
  • FIG. 6 is a cross-sectional view showing a state in which the ultrasonic probe 312 is inserted through the guiding device 4.
  • the guiding device 4 includes a guide main body 41, a protrusion 42, a handle portion 43 (FIGS. 4 and 6), and a cocked drainage portion 44 (FIGS. 4 and 6).
  • the guide main body 41 has a tubular shape having a through hole 411 through which the ultrasonic probe 312 is inserted. Then, the guide main body 41 regulates the progress of the ultrasonic probe 312 inserted through the through hole 411 in a certain direction, and guides the movement of the ultrasonic probe 312.
  • the cross-sectional shapes of the outer peripheral surface and the inner peripheral surface of the guide main body 41 orthogonal to the central axis Ax are substantially circular, respectively.
  • the guide main body 41 becomes thinner toward the tip (left side in FIGS. 4 and 6). That is, the tip surface of the guide main body 41 is not a plane orthogonal to the central axis Ax, but a slope 412 diagonally intersecting the plane. As a result, a space is created in the vicinity of the protrusion 42 in the guide main body 41, so that the visibility of the tip treatment portion 312a in the ultrasonic probe 312 inserted through the through hole 411 can be improved.
  • the base end portion (the right side portion in FIGS. 4 and 6) is referred to as the slope base end portion 412a (FIGS. 4 to 6) on the slope 412, and the tip portion (FIG. 4). And in FIG. 6, the left side portion) is referred to as a slope tip portion 412b (FIGS. 4 to 6).
  • the guide main body 41 is provided with a notch portion 413 (FIGS. 4 to 6) which is linearly cut out from the slope base end portion 412a toward the base end side. Further, as shown in FIG. 6, the guide main body 41 is provided with a slit 414 that penetrates the inside and outside of the guide main body 41.
  • the slit 414 extends linearly from the position on the proximal end side toward the proximal end side by a predetermined dimension from the slope tip portion 412b. That is, the slit 414 is provided on the side facing the notch 413.
  • a convex portion 415 and a groove portion 416 are provided on the inner peripheral surface of the guide main body 41.
  • the convex portion 415 projects toward the central axis Ax and extends along the central axis Ax. Then, the convex portion 415 guides the movement of the ultrasonic probe 312 inserted through the through hole 411 along the central axis Ax.
  • a plurality of convex portions 415 are provided.
  • the plurality of convex portions 415 are provided in a state of rotational symmetry about the central axis Ax.
  • the number of convex portions 415 is not limited to the number shown in FIG. 5, and other numbers may be provided. The same applies to the number of grooves 416.
  • the groove portion 416 is recessed toward the outer peripheral surface of the guide main body 41 and extends along the central axis Ax.
  • the groove 416 serves as a flow path through which the perfusate flows.
  • the groove portions 416 are provided between the adjacent convex portions 415, respectively.
  • the plurality of groove portions 416 are provided in a state of rotational symmetry about the central axis Ax. Further, the plurality of groove portions 416 serve as a flow path for discharging the perfusate liquid from the tip end to the base end of the guide main body 41. In the case of the present embodiment, the plurality of groove portions 416 are extended to the positions where they are guided to the flow path of the drainage portion 44 with a cock.
  • the liquid can be drained only from the inside of the body.
  • the depth of the groove portion 416 is 0.1 mm or more and 1.0 mm or less.
  • the width of the groove portion 416 is 0.1 mm or more, and is 1/3 or less of the entire circumference centered on the central axis Ax.
  • the protrusion 42 has a plate shape that linearly protrudes from the outer peripheral surface of the slope tip portion 412b side of the guide main body 41 toward the tip side. That is, the protrusion 42 is provided at a position avoiding the projection region in which the through hole 411 is projected along the central axis Ax.
  • a flat plate surface located on the central axis Ax side and parallel to the central axis Ax is referred to as a first surface 421 (FIGS. 4 to 6). do.
  • the surface on the side separated from the central axis Ax and forming the front and back surfaces with the first surface 421 is referred to as a second surface 422 (FIGS. 4 to 6).
  • the second surface 422 is formed in a stepped shape in which the region on the distal end side is located closer to the central axis Ax than the region on the proximal end side.
  • the region on the distal end side is described as the second distal end side surface 422a
  • the region on the proximal end side is described as the second proximal end side surface 422b.
  • the stepped portion that is the boundary between the tip side surface 422a and the second base end side surface 422b is referred to as a stepped portion 422c.
  • the second tip end side surface 422a and the second base end side surface 422b are flat surfaces parallel to the first surface 421, respectively.
  • the stepped portion 422c is a surface substantially orthogonal to the second tip end side surface 422a and the second base end side surface 422b.
  • the cross-sectional shape cut by the plane passing through the second base end side surface 422b and orthogonal to the central axis Ax has a plurality of protrusions when the through hole 411 is viewed along the central axis Ax. It has a rectangular shape slightly smaller than the rectangular shape 411a (FIG. 5) inscribed in the circle (shown by the alternate long and short dash line in FIG. 5) formed by the tip of the portion 415.
  • the diameter of the through hole 411 is set to be between 3 mm and 10 mm.
  • the cross-sectional shape is substantially the same as the cross-sectional shape cut in a plane orthogonal to the central axis Ax in the tip treatment portion 312a. That is, the protrusion 42 is set to a size that can be inserted into the bone hole formed by the tip treatment portion 312a.
  • the handle portion 43 has a plate shape connected to the base end of the guide main body 41 and is a portion held by the operator.
  • the shape of the handle portion 43 is not limited to the plate body shape, and may be any other shape.
  • the handle portion 43 is arranged on the same side as the side on which the protrusion 42 is arranged with respect to the central axis Ax of the guide main body 41. That is, when the handle portion 43 is gripped, the protrusion portion 42 is located on the same side as the handle portion 43.
  • the notch 413 is located on the opposite side.
  • the drainage portion 44 with a cock is provided on the outer peripheral surface of the guide main body 41 and has a tubular shape that communicates with the inside of the guide main body 41. Then, one end of the drainage tube 65 is connected to the drainage portion 44 with a cock. That is, the drainage portion 44 with a cock serves as a flow path for communicating the groove portion 416 and the drainage tube 65.
  • the flow path is referred to as a drainage flow path.
  • the drainage unit 44 with a cock is configured to be able to open and close the drainage flow path by operating the cock (not shown).
  • FIG. 7 to 24 are views illustrating a treatment method.
  • the operator closes the drainage flow path by operating the cock (not shown) of the drainage unit 44 with a cock.
  • the operator inserts the guiding device 4 into the joint cavity C1 through the second portal P2.
  • the operator operates the guiding device 4 while checking the captured image captured by the endoscope 21 and displayed on the display device (not shown).
  • the surgeon aligns the central axis Ax of the guiding device 4 with respect to the femoral lateral condyle 500 in the direction in which the bone hole should be formed, and as shown in FIG. 7, the femoral lateral condyle 500 and the like.
  • the protrusion 42 is inserted between the bones of the knee joint.
  • the guiding device 4 is in a posture in which the notch portion 413 side faces the arrangement side of the endoscope 21.
  • the guiding device 4 is in a posture in which the slit 414 side faces the side opposite to the arrangement side of the endoscope 21. Then, as shown in FIG. 8, the operator abuts the first surface 421 against the posterior wall 501 of the femoral lateral condyle 500.
  • the surgeon inserts the ultrasonic probe 312 through the through hole 411, images the ultrasonic probe 312 by the endoscope 21, and confirms the captured image displayed on the display device (not shown). It is projected from the tip (slope 412) of the guide body 41. Further, the operator sets the rotation position of the ultrasonic probe 312 about the central axis Ax to the rotation position where the surface 312d is parallel to the first surface 421 (FIG. 9). Then, the operator brings the tip treatment portion 312a of the ultrasonic probe 312 set at the rotation position into contact with the surface of the femoral lateral condyle 500. At this time, the ultrasonic probe 312 is guided by the tips of the plurality of protrusions 415 so that it can proceed in the direction in which the bone hole should be formed with respect to the femoral lateral condyle 500.
  • the operator opens the drainage flow path by operating the cock (not shown) of the drainage unit 44 with a cock. That is, the drainage of the perfusate in the joint cavity C1 is started. Specifically, the perfusate in the joint cavity C1 sent out from the liquid feeding hole 211a (see FIG. 12) of the endoscope 21 is sucked to the tip portion (notch portion 413 and slit) of the guide main body 41. 414) -Groove portion 416-Drainage flow path-Drainage tube 65-Drainage is discharged by following the flow path of the drainage bottle 64.
  • the operator makes the ultrasonic probe 312 ultrasonically vibrate by operating the foot switch 33.
  • the tip treatment portion 312a cuts the femoral lateral condyle 500 as shown in FIG.
  • the femoral lateral condyle 500 has a first rectangular cross-sectional shape having a side length of a1 and another side length of b1 at a position separated from the posterior wall 501 by a distance d1.
  • Bone hole 511 is formed. The operator forms the first bone hole 511 without penetrating the femoral lateral condyle 500.
  • the granular fine bone crushed by the ultrasonic probe 312 is released into the perfusate in the joint cavity C1. Then, the fine bone released into the perfusate follows the flow of the perfusate, as shown by the arrow in FIG. 12, from the tip of the guide body 41, the position of the notch 413, and the position of the slit 414 to the groove 416. Is sucked into. As a result, the turbidity of the visual field of the endoscope 21 is eliminated.
  • the ultrasonic probe 312 By driving the ultrasonic probe 312 as described above, the first bone hole 511 is formed.
  • the ultrasonic probe 312 becomes invisible (the state shown in FIGS. 13A to 13B).
  • the operator operates the foot switch 33 to intermittently drive the ultrasonic probe 312 to temporarily stop the operation.
  • fine bones are represented by dots.
  • the operator drives the ultrasonic probe 312 again. By driving the ultrasonic probe 312 as described above, the first bone hole 511 is formed.
  • the operator pulls out the ultrasonic probe 312 from the through hole 411 and separates the first surface 421 from the rear wall 501.
  • the operator confirms the image captured by the endoscope 21 and displayed on the display device (not shown), and as shown in FIGS. 14 and 15, the protrusion 42 is the first bone. Fit into the hole 511. More specifically, the surgeon abuts the second proximal side surface 422b on the first inner wall surface 511a on the posterior wall 501 side in the first bone hole 511, and the operator makes a second in the first bone hole 511.
  • the first surface 421 is set to be in contact with the second inner wall surface 511b facing the inner wall surface 511a of 1.
  • the guiding device 4 is positioned with respect to the lateral femoral condyle 500.
  • the surgeon inserts the ultrasonic probe 312 through the through hole 411, images the ultrasonic probe 312 by the endoscope 21, and confirms the captured image displayed on the display device (not shown). It is projected from the tip (slope 412) of the guide body 41. Further, the operator sets the rotation position of the ultrasonic probe 312 about the central axis Ax to the rotation position where the surface 312d is parallel to the first surface 421 (FIG. 16). Then, the operator brings the tip treatment portion 312a of the ultrasonic probe 312 set at the rotation position into contact with the surface of the femoral lateral condyle 500.
  • the ultrasonic probe 312 is guided by the tips of the plurality of protrusions 415 so that it can proceed in the direction in which the bone hole should be formed with respect to the femoral lateral condyle 500.
  • the operator makes the ultrasonic probe 312 ultrasonically vibrate by operating the foot switch 33.
  • the tip treatment portion 312a cuts the femoral lateral condyle 500 as shown in FIG.
  • the femoral lateral condyle 500 has a rectangular cross-section with a side length of a1 and another side length of b1 at a position separated from the first bone hole 511 by a distance d1.
  • the second bone hole 512 is formed.
  • the surgeon forms the second bone hole 512 without penetrating the femoral lateral condyle 500. Further, as described with reference to FIGS. 13A to 13C, when the operator forms the second bone hole 512, the field of view of the endoscope 21 is obscured by the fine bone, and the ultrasonic probe 312 is invisible. If this happens, the foot switch 33 is operated to intermittently drive the ultrasonic probe 312 to temporarily stop the operation. Further, when the turbidity of the visual field of the endoscope 21 is eliminated and the ultrasonic probe 312 becomes visible, the operator drives the ultrasonic probe 312 again.
  • the perforation direction of the second bone hole 512 becomes parallel to the perforation direction of the first bone hole 511.
  • the femoral lateral condyle 500 is left with a partition wall 513, which is a bone portion having a thickness of a distance d1 between the first and second bone holes 511, 512, and the first and second bone holes are left.
  • the second bone holes 511, 512 are formed adjacent to each other.
  • the operator pulls out the ultrasonic probe 312 from the through hole 411.
  • the surgeon pulls out the proximal end portion of the protrusion 42 from the first bone hole 511 while checking the captured image imaged by the endoscope 21 and displayed on the display device (not shown). It is assumed that the tip portion of the protrusion 42 is inserted into the first bone hole 511. Then, the surgeon abuts at least a part of the stepped portion 422c on the edge of the first bone hole 511, and abuts the second tip side surface 422a on the first inner wall surface 511a (FIGS. 19 and 20). ). As a result, the guiding device 4 is positioned with respect to the lateral femoral condyle 500.
  • the guiding device 4 is in close contact with the bone wall of the first bone hole 511 in the direction of the width a1 of the protrusion 42 up to the depth inserted into the first bone hole 511. At this time, the guiding device 4 can be stably fixed and positioned in the first bone hole 511.
  • the surgeon inserts the ultrasonic probe 312 through the through hole 411, images the ultrasonic probe 312 by the endoscope 21, and confirms the captured image displayed on the display device (not shown). It is projected from the tip (slope 412) of the guide body 41. Further, the operator sets the rotation position of the ultrasonic probe 312 about the central axis Ax to the rotation position where the surface 312d is parallel to the first surface 421 (FIG. 21). Then, the operator brings the tip treatment portion 312a of the ultrasonic probe 312 set at the rotation position into contact with the surface of the partition wall 513.
  • the ultrasonic probe 312 is guided by the tips of the plurality of protrusions 415 so that it can proceed in the direction in which the bone hole should be formed with respect to the femoral lateral condyle 500.
  • the operator makes the ultrasonic probe 312 ultrasonically vibrate by operating the foot switch 33.
  • the tip treatment portion 312a cuts the partition wall 513 as shown in FIG. 22.
  • the first and second bone holes 511, 512 communicate with each other, and the femoral lateral condyle 500 has a side length of a1 and a side length of 2b1 + d1.
  • a bone hole 510 having a rectangular cross section is formed.
  • the field of view of the endoscope 21 is obscured by fine bones, and the ultrasonic probe 312 becomes invisible. Operates the foot switch 33 to intermittently drive the ultrasonic probe 312 to temporarily stop. Further, when the turbidity of the visual field of the endoscope 21 is eliminated and the ultrasonic probe 312 becomes visible, the operator drives the ultrasonic probe 312 again.
  • the first bone hole 511 is formed at a position separated from the rear wall 501 by a distance d1, but the present invention is not limited to this, and the distance d1'is different from the distance d1 from the rear wall 501.
  • the first bone hole 511 may be formed at a position only distant from each other. In this case, when forming the first bone hole 511, for example, another guiding device different from the guiding device 4 is used.
  • the treatment system 1 according to the present embodiment includes the guiding device 4 described above. Therefore, by using the guiding device 4, the axis of the ultrasonic probe 312 can be accurately directed to the direction and position where the bone hole should be formed, and the desired cutting (treatment) can be performed. Further, in the guiding device 4 according to the present embodiment, a groove portion 416 that serves as a flow path for the perfusate is provided on the inner peripheral surface of the guide main body 41. Therefore, there are two portals for communicating the inside of the joint cavity C1 and the outside of the skin for the endoscope 21 and the ultrasonic probe 312 (guiding device 4) for sending and discharging the perfusate. That is, the number of portals is two, and treatment can be performed with minimal invasiveness. From the above, according to the treatment system 1 according to the present embodiment, the desired treatment can be performed with minimal invasiveness.
  • the protrusion 42 is provided at a position avoiding the projection region where the through hole 411 is projected along the central axis Ax. Therefore, by using the protrusion 42, the guiding device 4 can be easily positioned, and the movement of the ultrasonic probe 312 along the central axis Ax can be satisfactorily guided.
  • the groove portion 416 is a flow path for discharging the perfusate from the tip end to the base end of the guide main body 41. Therefore, the fine bone crushed by the ultrasonic probe 312 and released into the perfusate in the joint cavity C1 can be discharged to the outside of the joint cavity C1 together with the perfusate through the groove 416. That is, the turbidity of the visual field of the endoscope 21 can be satisfactorily eliminated, and the desired treatment can be satisfactorily performed.
  • the depth and width of the groove portion 416 are each 0.1 mm or more. Therefore, the fine bone crushed by the ultrasonic probe 312 and released into the perfusate in the joint cavity C1 can be satisfactorily sucked into the groove 416 together with the perfusate.
  • the depth of the groove portion 416 is 1.0 mm or less. Therefore, the wall thickness of the guide main body 41 does not become unnecessarily thin, and the strength of the guide main body 41 can be sufficiently maintained.
  • the width of the groove portion 416 is 1/3 or less of the entire circumference centered on the central axis Ax. That is, by setting the width of the groove portion 416 to 1/3 or less of the entire circumference centered on the central axis Ax, three or more convex portions 415 are provided, and the ultrasonic probe 312 is provided by the three or more convex portions 415. Can be stably supported.
  • the groove portion 416 is provided in a state of rotational symmetry about the central axis Ax. Therefore, the fine bone crushed by the ultrasonic probe 312 and released into the perfusate in the joint cavity C1 together with the perfusate is evenly distributed in the circumferential direction centered on the central axis Ax from the tip of the guide body 41. It can be sucked into the groove 416.
  • the guide main body 41 is provided with the notch portion 413 described above on the arrangement side of the endoscope 21. Therefore, among the fine bones crushed by the ultrasonic probe 312 and released into the perfusate in the joint cavity C1, the fine bones located between the ultrasonic probe 312 and the endoscope 21 are cut out. It can be effectively sucked from the portion 413 to the groove portion 416. That is, the turbidity of the visual field of the endoscope 21 can be effectively eliminated.
  • the guide main body 41 is provided with the slit 414 described above on the side opposite to the arrangement side of the endoscope 21. Therefore, among the fine bones crushed by the ultrasonic probe 312 and released into the perfusate in the joint cavity C1, the fine bones that wrap around to the side opposite to the placement side of the endoscope 21 are removed from the slit 414. It can be effectively sucked into the groove 416. That is, the fine bone that wraps around to the side opposite to the placement side of the endoscope 21 does not move between the ultrasonic probe 312 and the endoscope 21, and the field of view of the endoscope 21 can be seen. Can be maintained well.
  • the perfusion device 6 includes a drainage pump 66. Therefore, the fine bone crushed by the ultrasonic probe 312 and released into the perfusate in the joint cavity C1 can be positively sucked into the groove 416. That is, the turbidity of the visual field of the endoscope 21 can be effectively eliminated.
  • the present invention should not be limited only to the above-described embodiments.
  • the flow path for sending the perfusate into the joint cavity C1 is set on the endoscope 21 side, and the flow path for discharging the perfusate to the outside of the joint cavity C1 is set in the groove 416.
  • the flow path of transmission and discharge may be set in reverse.
  • the guide main body 41 is formed in a cylindrical shape, but the guide body 41 is not limited to this, and may have any other shape as long as it is a cylindrical shape.
  • the ultrasonic probe 312 is used as the cutting treatment tool according to the present invention, but the present invention is not limited to this, and other cutting treatment tools such as a drill may be used.
  • the cross-sectional shape of the tip treatment portion 312a is not limited to a rectangular shape, but may be another polygonal shape, a circular shape, or an elliptical shape.
  • the cross-sectional shape of the inner peripheral surface of the guide main body 41 is not limited to a circular shape, and may be, for example, any other shape capable of defining the orientation of the cutting treatment tool.
  • FIG. 25A and 25B are diagrams showing a modification 1 of the embodiment.
  • FIG. 25A is a perspective view showing a tip portion of the guiding device 4A according to the first modification.
  • the protrusion 42 is not shown for convenience of explanation.
  • FIG. 25B is a cross-sectional view of the guiding device 4A cut through the notch 413 and at a plane orthogonal to the central axis Ax (the plane at position S shown by the alternate long and short dash line in FIG. 25A).
  • the groove portion 416 is provided in a state of rotational symmetry about the central axis Ax.
  • FIGS. 1 is a perspective view showing a tip portion of the guiding device 4A according to the first modification.
  • the protrusion 42 is not shown for convenience of explanation.
  • FIG. 25B is a cross-sectional view of the guiding device 4A cut through the notch 413 and at a plane orthogonal to the central axis Ax (the plane at position S shown by the alternate
  • the groove portion 416 is provided in a state of not being rotationally symmetric with respect to the central axis Ax. More specifically, the groove portion 416 is provided on the notch portion 413 side. That is, the groove portion 416 is provided on the arrangement side of the endoscope 21. Even when the present modification 1 is adopted, the same effect as that of the above-described embodiment is obtained.
  • FIGS. 26A to 26C are diagrams showing modified examples 2 to 4 of the embodiment. Specifically, FIGS. 26A to 26C are cross-sectional views corresponding to FIG. 25B.
  • the number of groove portions 416 is 5 or more, but the number is not limited to this.
  • the number of the groove portions 416 may be four.
  • the four groove portions 416 are provided at positions that are rotationally symmetric at 90 ° with respect to the central axis Ax.
  • One of the four groove portions 416 is provided at the same position as the notch portion 413 when viewed along the central axis Ax.
  • the number of the groove portions 416 may be three.
  • the three groove portions 416 are provided at positions that are not rotationally symmetric with respect to the central axis Ax. Further, the three groove portions 416 are provided at positions avoiding the notch portion 413 when viewed along the central axis Ax. It should be noted that a configuration may be adopted in which any of the three groove portions 416 is provided at the same position as the notch portion 413 when viewed along the central axis Ax.
  • the number of the groove portions 416 may be two.
  • the two groove portions 416 are provided at positions that are rotationally symmetric at 180 ° with respect to the central axis Ax. Further, the two groove portions 416 are provided at positions avoiding the notch portion 413 when viewed along the central axis Ax.
  • a configuration provided at the same position as the notch portion 413 may be adopted.
  • FIG. 27 is a diagram showing a modified example 5 of the embodiment. Specifically, FIG. 27 is a cross-sectional view of the guiding device 4E according to the present modification 5 cut along a plane orthogonal to the central axis Ax.
  • the flow path 416E through which the perfusate is circulated is provided within the wall thickness of the guide main body 41 instead of the groove portion 416. Even when the present modification 5 is adopted, the same effect as that of the above-described embodiment is obtained.
  • FIG. 28 is a diagram showing a modified example 6 of the embodiment. Specifically, FIG. 28 is a perspective view showing the guiding device 4F according to the present modification 3. As shown in FIG. 28, in the guiding device 4F according to the present modification 6, the drain portion 44 with a cock is omitted from the guiding device 4 described in the above-described embodiment. That is, when the guiding device 4F according to the present modification 3 is adopted, the drainage bottle 64, the drainage tube 65, and the drainage pump 66 are also omitted.
  • the groove portion 416 according to the present modification 6 is provided so as to extend from the tip end to the base end of the guide main body 41.
  • the perfusate in the joint cavity C1 is not discharged to the outside of the joint cavity C1 by being sucked, but is discharged in a state of being drained from the base end of the guide main body 41 through the groove portion 416.
  • the guiding device 4F is positioned in the field of view of the endoscope 21 in the joint cavity C1, the ultrasonic probe 312 is inserted into the through hole 411, and the ultrasonic probe 312 is inserted.
  • the foot switch 33 is operated to intermittently drive the ultrasonic probe 312.
  • the ultrasonic probe 312 is temporarily stopped, and when the ultrasonic probe 312 becomes visible, the ultrasonic probe 312 is driven again, and when the cutting of the living body is completed, the ultrasonic probe 312 is driven. Stop.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Medical Informatics (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Ophthalmology & Optometry (AREA)
  • Endoscopes (AREA)

Abstract

Selon l'invention, un dispositif de guidage (4) qui est destiné à effectuer un traitement avec effraction minimale, y compris dans le cas de trois entrées pour endoscope, pour instrument d'aspiration d'un rasoir, ou similaire, et pour sonde ultrasonore, lors de l'envoi ou de l'évacuation d'un liquide de perfusion, est équipé d'un corps principal de guide (41) en forme de tube qui possède un trou traversant (411) traversé par un instrument de traitement par coupe mis en œuvre dans un liquide. L'objet de l'invention est configuré de sorte qu'une partie relief (415) qui forme une saillie vers l'axe central (Ax) dudit corps principal de guide tout en se prolongeant suivant cet axe central, et qui guide le déplacement de l'instrument de traitement par coupe suivant ledit axe central, et une partie rainure (416) qui tout en s'enfonçant vers une face périphérique externe dudit corps principal de guide, se prolonge suivant ledit axe central, forme un trajet d'écoulement dans lequel s'écoule un liquide, sont agencées sur une face périphérique interne dudit corps principal de guide.
PCT/JP2020/040865 2020-10-30 2020-10-30 Dispositif de guidage, système de traitement, et procédé traitement Ceased WO2022091357A1 (fr)

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PCT/JP2020/040865 WO2022091357A1 (fr) 2020-10-30 2020-10-30 Dispositif de guidage, système de traitement, et procédé traitement

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2013519435A (ja) * 2010-02-11 2013-05-30 エシコン・エンド−サージェリィ・インコーポレイテッド 回転切断用具を備える、超音波駆動の外科用器具
WO2016171014A1 (fr) * 2015-04-22 2016-10-27 オリンパス株式会社 Instrument de traitement et système de traitement
WO2018078829A1 (fr) * 2016-10-28 2018-05-03 オリンパス株式会社 Instrument chirurgical à ultrasons

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US3937222A (en) * 1973-11-09 1976-02-10 Surgical Design Corporation Surgical instrument employing cutter means
US4649919A (en) * 1985-01-23 1987-03-17 Precision Surgical Instruments, Inc. Surgical instrument
US4842578A (en) * 1986-03-12 1989-06-27 Dyonics, Inc. Surgical abrading instrument
US5405348A (en) * 1993-02-12 1995-04-11 Anspach, Jr.; William E. Surgical cutting instrument
US6132448A (en) * 1998-06-19 2000-10-17 Stryker Corporation Endoscopic irrigated bur
US6638289B1 (en) * 2000-10-16 2003-10-28 Stryker Corporation Elongated endoscopic cutting accessories

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Publication number Priority date Publication date Assignee Title
JP2013519435A (ja) * 2010-02-11 2013-05-30 エシコン・エンド−サージェリィ・インコーポレイテッド 回転切断用具を備える、超音波駆動の外科用器具
WO2016171014A1 (fr) * 2015-04-22 2016-10-27 オリンパス株式会社 Instrument de traitement et système de traitement
WO2018078829A1 (fr) * 2016-10-28 2018-05-03 オリンパス株式会社 Instrument chirurgical à ultrasons

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