CN102448389A - 用于将骨钉驱动到断骨中的手持式工具 - Google Patents
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Abstract
提供了一种用于通过将断骨保持在复位状态中而将骨钉驱动到断骨中以稳定断骨的工具及方法。该工具可以是手持式装置，其包括具有容纳骨钉的至少一个通道的钉筒。该工具还可包括气动活塞，该气动活塞具有尺寸确定成用于容纳在钉筒的通道内的针状件，该针状件将足够大的力施加至骨钉以驱动该骨钉离开钉筒并进入到断骨中。
Description
相关申请的交叉引用
本申请要求于2009年5月26日提交的、名为“骨固接(bonefixation)”的美国临时专利申请No.61/181,024的优先权，由此，将该专利申请的公开内容全部以参引的方式特意结合到本文中。
技术领域
本公开内容涉及一种用于将骨钉驱动到断骨中以稳固断骨的工具及方法。更具体地，本公开内容涉及一种用于通过将断骨保持于复位状态中而将骨钉驱动到断骨中以稳固断骨的工具及方法。
背景技术
复杂的或粉碎性骨折产生多个骨碎片。在手术中，可以将这些碎片复位并在将这些碎片例如利用外部镶片更为永久性地固定在一起之前临时地紧固在一起。
用于将骨碎片复位并临时紧固在一起的现有装置具有多个缺陷。诸如夹具之类的外部固定装置是笨重的并且会需要侵入式外科技术。除此以外，诸如金属销钉和导引丝之类的内部固定装置会难以驱动到骨碎片中并且可能从碎片向外延伸，同时妨碍外部镶片。
发明内容
本公开内容涉及一种用于通过将断骨保持在复位状态中而将骨钉驱动到断骨中以稳定断骨的工具及方法。在某些实施方式中，骨钉可用于在更为永久地固定碎片之前临时地稳定断骨。该工具可以是手持式装置，其包括具有容纳骨钉的至少一个通道的钉筒。该工具还可包括气动活塞，该气动活塞的尺寸确定成用于容纳在钉筒的通道内的针状件，该针状件将足够大的力施加至骨钉以驱动骨钉离开钉筒并进入到断骨中。
根据本公开内容的实施方式，提供了一种用于稳定断骨的手持式工具，该手持式工具具有近端和远端。该手持式工具包括：壳体；至少一个固定，其构造成用于被驱动到断骨中以稳定断骨；钉筒，其由壳体支承并且包括至少一个容纳骨钉的通道，该通道的尺寸确定成适应骨钉通过通道的轴向运动，同时限制骨钉在通道中的径向运动；以及活塞，其相对于壳体轴向地平移，该活塞包括朝向手持式工具的近端设置的头部以及朝向手持式工具的远端设置的针状件，该针状件的尺寸确定成容纳在钉筒的通道内，该针状件将足够大的力施加至骨钉以将骨钉从钉筒轴向地驱动到断骨中。
根据本公开内容的另一个实施方式，提供了一种用于稳定断骨的手持式工具，该手持式工具具有近端和远端。该手持式工具包括：壳体；至少一个骨钉，其构造成用于被驱动到断骨中以稳定断骨；钉筒，其由壳体支承于手持式工具的远端，该钉筒包括容纳骨钉的至少一个通道；以及活塞，其相对于壳体轴向地平移，该活塞包括朝向手持式工具的近端设置的头部以及朝向手持式工具的远端设置的针状件，该针状件的尺寸确定成容纳在钉筒的通道内，该针状件将足够大的力施加至骨钉以将骨钉从钉筒轴向地驱动到断骨中。
根据本公开内容的又一个实施方式，提供了一种用于将骨钉驱动到断骨中以稳定断骨的手持式工具，该手持式工具具有近端和远端。该手持式工具包括：壳体；钉筒，其由壳体支承并且包括尺寸确定成容纳骨钉的至少一个通道；活塞，其相对于壳体轴向地平移，该活塞包括朝向手持式工具的近端设置的头部以及朝向手持式工具的远端设置的针状件，该针状件的尺寸确定成容纳在钉筒的通道内，该针状件将足够大的力施加至骨钉以将骨钉从钉筒轴向地驱动到断骨中；压缩气体源，其联接至壳体，用于将气动力供应至活塞的头部以使活塞相对于壳体轴向地平移；阀组件，其具有常闭状态以关闭压缩气体从压缩气体源到活塞的头部的流动，并具有打开状态以打开压缩气体从压缩气体源到活塞的头部的流动；以及扳机组件，其联接至阀组件以将阀组件从常闭状态调节到打开状态，在打开状态之后阀组件自动地返回至常闭状态。
附图说明
本发明的上述和其它特征和优点以及获得这些特征和优点的方式将会变得更加明显，并且通过参照结合附图对本发明的实施方式进行的下列描述将会更好地理解本发明自身，其中：
图1A是表示本公开内容的示例性工具的示意图，示出了该工具的与第一骨碎片和第二骨碎片对准的针状件；
图1B是图1A的工具的示意图，示出了该工具的插过第一骨碎片并插入到第二骨碎片中的针状件；
图1C是图1B的工具的示意图，示出了工具的正在被取出以暴露骨碎片中的孔的针状件，并且示出了正被注入到孔中的生物相容性聚合物材料；
图1D是类似于图1C的示意图，示出了工具的被取出以暴露骨碎片中的孔的针状件，并且示出了被注入到孔中以形成球状纤维部的生物相容性聚合物材料；
图1E是图1C的工具的示意图，示出了正被注入到邻近的孔中以形成环的生物相容性聚合物材料；
图2A是表示本公开内容的另一工具的示意图，示出了与第一骨碎片和第二骨碎片对准的工具；
图2B是图2A的工具的示意图，示出了将由聚合体组成的杆驱动穿过第一骨碎片并驱动到第二骨碎片中的工具；
图2C是图2B的工具的示意图，示出了从骨碎片上移除同时留下由聚合体组成的杆以将骨碎片紧固在一起的工具；
图3是本公开内容的示例性工具的立体图；
图4是图3的工具的分解立体图，示出阀组件和活塞组件；
图5是图4是阀组件和活塞组件的选定部件的分解立体图；
图6是图3的工具的另一分解立体图，示出扳机组件和供气组件；
图7是图3的工具的被示出为在被发射前处于停止状态的截面图；
图8是图7的工具的一部分的截面图；
图9是图3的工具被示出为正被发射时的截面图；
图10是图9的工具的一部分的截面图；
图11是图3的工具的一部分被示出为在发射后处于中间状态中的截面图；
图12是图3的工具的一部分被示出为在发射后处于静止状态的截面图；
图13是本公开内容的另一示例性工具的一部分的立体图，该工具包括具有调节器的供气组件；
图14是图13的工具的截面图；
图15是图13的调节器被示出为处于打开状态的截面图；
图16是图13的调节器被示出为处于闭合状态的截面图；
图17是图13的调节器的分解立体图。
遍及多个附图，对应的附图标记表示对应的部件。于此陈述的范例示出了本发明的示例性实施方式，并且这种范例不应当被解释为以任何方式限制本发明的范围。
具体实施方式
本公开内容提供了一种用于将骨碎片复位并紧固在一起的工具和方法，该工具和方法可用作在将骨碎片更为永久地固定之前的一种临时解决方案。根据本公开内容的示例性实施方式，可将生物相容性聚合物插到骨碎片中以将骨碎片紧固在一起。该聚合物可以随着时间的推移保留在患者的体内，或者该聚合物可以吸收到患者的体内。
在一个实施方式中，可将该聚合物以液体或半液体的状态注入到骨碎片中，然后固化以将骨碎片紧固在一起。例如，这种聚合物一旦与光或水接触就固化。可以注入到骨碎片中的适当的聚合物包括快凝氰基丙烯酸酯(通常以诸如Super Glue
和Krazy Glue
之类的商标进行销售)。处于本公开内容的范围内的是：该聚合物可以与诸如弹性线状纤维之类的用于注入到骨碎片中的其它材料混合。
在另一实施方式中，可将该聚合物以固体状态驱动到骨碎片中以将骨碎片紧固在一起。可以驱动到骨碎片中的适当的聚合物包括诸如聚交酯(PLA)之类的可生物降解的聚合物。
首先参照图1A-1C，示意性地示出了一种用于将骨碎片复位并紧固在一起的示例性方法。在结构上与注射器相似的工具10被设置成用于实施该方法并包括针状件12、其中限定腔15的管或筒14、柱塞16和壳体18。
在所示方法的第一步骤中，如在图1A中所示，第一骨碎片F1与邻近的第二骨碎片F2对准。工具10放置在第一骨碎片F1的附近或放置成与该第一骨碎片F1接触。
接下来，如图1B中所示，将足够大的力施加至工具10的筒14以将针状件12驱动穿过第一骨碎片F1并驱动到第二骨碎片F2中。工具10可设有具有多种尺寸的针状件12以适应不同类型的断口和骨骼类型。例如，针状件12的长度可设置为约0.25英寸、0.5英寸、1.0英寸、1.5英寸、2.0英寸或更大。除此以外，针状件12的直径可设置为例如约1毫米(mm)、1.5mm、2mm、2.5mm、3mm或更大。
最后，如图1C中所示，将工具10的针状件12从骨碎片F1、F2拔出以露出骨碎片F1、F2中的孔H。当针状件12从骨碎片F1、F2缩回时，可向柱塞16施加压力以将生物相容性聚合物材料P从筒14的腔15输送到孔H中。根据本方法的示例性实施方式，生物相容性聚合物材料P包括含有一束线状纤维的液态氰基丙烯酸酯。筒14的沿腔15形成分界线的内壁包括诸如聚四氟乙烯(PTFE)之类的不沾涂层，以防止聚合物材料P在其上变干。除此以外其，筒14的腔15可包括至少足够多的聚合材料P以充分地填充孔H。随着时间的逝去，诸如少于几分钟，生物相容性聚合物材料P在孔H中固化或硬化以将骨碎片F1、F2结合在一起。
根据本方法的示例性实施方式，可将多股聚合物材料P输送到孔H中，以在孔H中形成球状纤维部B，如图1D中所示。这些球状纤维部B可以用作固定器以防止聚合物在孔H中松脱。为了形成球状纤维部B，在致动柱塞16输送最初的一股聚合物材料P时，可以减缓或延迟针状件12从孔H中的最初移除。然后，针状件12可以缩回以输送从孔H中延伸出的聚合物材料的均匀的线状流。
根据本方法的另一示例性实施方式，并且如图1E中所示，在将生物相容性聚合物材料P输送到孔H中后，可将工具10移至第一骨碎片F1上的不同位置，例如邻近第一骨碎片F1中的第二孔H′。孔H′可以通过针状件12或通过另一针状件形成。如在图1E中所示，在从孔H到孔H′的移动期间，可以继续从工具10分配生物相容性聚合物材料P，从而形成聚合物材料P的连续的环L，该环L延伸跨过第一骨碎片F1的表面并且连接邻近的填充孔H、H′，类似于缝纫机的行为。将邻近孔H、H′中的聚合物缝合在一起可以稳定骨碎片F1、F2之间的连接。
可以气动地、液压地、电动地(例如利用电池)为工具10提供动力。例如，工具10可以类似于压缩空气钉枪的方式工作。当拉动工具10的扳机(未示出)时，可释放压缩空气以迫使筒14和联接于其上的针状件12在壳体18内向前运动直到针状件12伸出超过壳体18、穿过第一骨碎片F1并且伸到第二骨碎片F2中，如图1B中所示。当释放工具10的扳机时，针状件12和筒14可以缩回到壳体18中，在骨碎片F1、F2中留下孔H，如图1C中所示。可以通过包括例如弹簧或磁体之类的任何适当机构将工具10的针状件12和筒14相对于壳体18偏置在图1C的缩回位置中。
为了将生物相容性聚合物材料P输送到孔H中，工具10可以设有用于阻挡柱塞16缩回的适当的闭锁机构。该闭锁机构可例如包括闭锁件19，如图1C中所示，或者磁体。当拉动工具10的扳机(未示出)以使针状件12和筒14在壳体18内向前移动，如图1A-1B中所示，闭锁件19可以处于解锁位置中，从而使柱塞16能够与针状件12一起向前行进。如图1C中所示，当释放该工具10的扳机以使针状件12和筒14缩回到壳体18中时，闭锁件19可以移动至锁定位置以接合柱塞16。滑动筒14将会遍及由闭锁件19保持就位的固定的柱塞16行进，从而迫使包含在筒14的腔15内的生物相容性聚合物材料P从针状件12分配出去。在从针状件12输送足量的生物相容性聚合物材料P之后，可以释放闭锁件19，从而使柱塞16能够相对筒14缩回到壳体18中。
工具10能够控制针状件12行进到骨碎片F1、F2中的深度(图1A-1C)。根据本公开内容的示例性实施方式，针状件12在骨碎片F1、F2中的深度可通过限制针状件12从壳体18伸出的距离来控制。例如，如图1B中所示，壳体18包括至少一个与筒14的凸缘42协作的止挡件40，以限制针状件12从壳体18朝向骨碎片F1、F2移出的前向行程。
接下来参照图2A-2C，示意性地示出了用于将骨碎片复位并紧固在一起的另一示例性方法。在结构上类似于注射器的工具20被设置成用于实施该方法并且包括由聚合体组成的针状件或杆22、其中限定腔25的管或筒24、以及柱塞26。
在所示方法的第一步骤中，并且如图2A中所示，将第一骨碎片F1与邻近的第二骨碎片F2对准，将工具20放置在第一骨碎片F1的附近或放置成与第一骨碎片F1接触。
接下来，如在图2B中所示，将足够大的力施加至工具20的柱塞26以驱动杆22穿过第一骨碎片F1并驱动到第二骨碎片F2中。根据本方法的示例性实施方式，杆22由诸如聚交酯(PLA)、聚苯乙烯、聚甲基丙烯酸甲酯、聚碳酸酯、或纤维加强聚合物之类的刚性聚合物构成。根据本方法的另一示例性实施方式，杆22由诸如镁之类的生物相容性的、非铁金属构成。
最后，如在图2C中所示，将工具20从骨碎片F1、F2上拉离，从而将由聚合体组成的杆22留在骨碎片F1、F2内以将骨碎片F1、F2结合在一起。根据本方法的示例性实施方式，杆22具有带有纹理的外表面以防止从骨碎片F1、F2松脱或拉出。杆22无需附接于柱塞26，以在将工具20从骨碎片F1、F2上拉离时，留下杆22。所示筒24的腔25的尺寸可以相对于由聚合体组成的杆22扩大。例如，筒24的尺寸可以被确定成在允诺由聚合体组成的杆22在筒24的腔25内轴向滑动的同时，径向上受到筒24限制。
如图2A-2C中所示，将由聚合体组成的杆22设置成具有适当的长度以延伸到骨碎片F2中，并且端部与骨碎片F1大致齐平。同样处于本公开内容的范围内的是：杆22可以具有可以在将杆22植入前或植入后进行修整的额外长度，使得杆22端部与骨碎片F1大致齐平。例如，在将工具20从骨碎片F1、F2中拉离之前，可沿筒24的面对骨骼的端部对杆22进行修整，以从杆22上移除任何额外的长度。作为另一个示例，在将工具20从骨碎片F1、F2上拉离之后，可沿骨碎片F1对杆22进行修整，以从杆22上移除任何额外的长度。
可以气动地、液压地、电动地(例如利用电池)和/或电磁地为工具20提供动力。例如，工具20可以类似于压缩空气钉枪的方式工作。当拉动工具20的扳机(未示出)时，可释放压缩空气以迫使柱塞26在筒24内向前运动直到杆22伸出超过筒24、穿过第一骨碎片F1并且伸到第二骨碎片F2中，如图2B中所示。当释放工具10的扳机时，柱塞26可以缩回到筒24中，使杆22留在骨碎片F1、F2中。可以通过包括例如弹簧或磁体之类的任何适当机构将工具10的柱塞26相对于筒24偏置在缩回位置中。
除了将骨碎片紧固在一起外，上述方法还可以用于将人体的软组织紧固在一起。上述方法还可用于将包括切割导引器、骨板、和/或环扎丝在内的整形部件安装到骨骼上。
接下来参照图3-12，将一种示例性手持式气动工具100设置成用于将骨碎片复位并将其紧固在一起。工具100在第一近端102与第二远端104之间延伸。如在图3中所示，工具100的近端102包括左侧壳体106a、右侧壳体106b和扳机108。工具100的左侧壳体106a和右侧壳体106b配合以限定手柄110。工具100的远端104包括管筒112和突出部114。在操作中，在工具100的远端104置靠在骨碎片上的情况下，外科医生可以抓握住手柄110并拉动扳机108。
参照图4，工具100还包括钉筒116、调节控制盘118、阀组件120和活塞组件130。工具100的阀组件120包括阀体122、阀回位弹簧124、膨胀螺栓126和插塞128。工具的活塞组件130包括活塞132、活塞回位弹簧134、缓冲器136、以及导向器138。下面进一步说明图4的每个部件。
参照图6，工具100还包括供气组件140和扳机组件150。工具100的供气组件140包括封头142、气罐144、刺破阀146和调节器148。工具100的扳机组件150包括扳机108、扳机簧151、弓形连杆152、旋转爪153、轴154、止挡销155、左侧护套156a、右侧护套156b、左侧保持器157a、右侧保持器157b、锁或扣机(seer)158、以及U形扣机弹簧159。下面进一步说明图6的每个部件。
工具100的左侧壳体106a和右侧壳体106b配合以遮住和支承工具100的阀组件120、供气组件140、以及扳机组件150。如图3中所示，壳体106a限定外部开口160以使得能够通过壳体106a触及调节控制盘118。壳体106a和106b配合以限定将气罐144连接于调节器148的第一气道162和将调节器148连接于阀体122的第二气道164，如图6中所示。在操作中，压缩气体经由壳体106a、106b的第一气道162从气罐144行进至调节器148，并经由壳体106a、106b的第二气道164从调节器148行进至阀体122。
工具100的管筒112是从壳体106a、106b延伸的中空部件，如图3中所示。管筒112包括朝向工具100的近端102定位的近端部166以及朝向工具100的远端104定位的远端部168。管筒112的尺寸被确定成用于在其中容纳活塞组件130。更为具体地，管筒112的近端部166的尺寸被确定成用于在其中容纳活塞组件130的活塞回位弹簧134和缓冲器136，并且管筒112的远端部168的尺寸被确定成用于在其中容纳活塞组件130的导向器138，活塞组件130的活塞132大致沿管筒112的全长在管筒112的近端部166与远端部168之间延伸。如图4中所示，管筒112的近端部166的直径可以大于管筒112的远端部168以容置活塞组件130的活塞132、活塞回位弹簧134、和缓冲器136。
工具100的突出部114是从管筒112延伸以限定工具100的远端104的中空部件，如图3中所示。突出部116包括构造成置靠在患者的骨骼上的骨骼接触表面169。突出部116的骨骼接触表面169可以是带有纹理的(例如齿状的、有尖顶的)以实现在患者的骨骼上抓紧而不会滑动。突出部114的尺寸被确定成在其中容纳钉筒116。除此以外，突出部114的尺寸可以被确定成在其中容纳管筒112的包括管筒112的狭窄的远端部168的至少一部分。
工具100的钉筒116是套管式部件，其尺寸被确定成用于容纳在工具100的突出部114内，使得钉筒116可以定位于工具100的远端104。如图5中所示，钉筒116包括被至少一个平坦部分172定界的套管170。在套管170的周围，钉筒116还包括多个细长的狭槽或通道174。钉筒116的每个通道174的尺寸被确定成在其中容纳生物相容性的杆或销钉176。每个通道174可以是完全分开的，或者，如图5中所示，多个通道174可以互连。根据本公开内容的示例性实施方式，钉筒116的通道174的尺寸被确定成限制每个销钉176通过对应的通道174的轴向运动，从而稳定销钉176并确保沿笔直的路径输送销钉176以避免弯曲和/或断裂。在使用后，可以将钉筒116从工具100上移除，并且或者用新的销钉176重新填充该钉筒116或对该钉筒116进行更换。
销钉176被构造成用于驱动到骨碎片中以将骨碎片紧固在一起。销钉176可以由生物相容性聚合物构成，并且在特定的实施方式中，该生物相容性聚合物可以是可生物降解的。例如，销钉176可以由诸如聚交酯(PLA)之类的可生物降解的聚合物构成。例如，销钉176还可以由聚苯乙烯、聚甲基丙烯酸甲酯、聚碳酸酯或者纤维加强聚合物构成。同样处于本公开内容的范围内的是：销钉176可以由诸如镁之类的生物相容性的非铁金属构成。每个销钉176的长度可以小至约0.5英寸、0.6英寸、0.7英寸、0.8英寸、0.9英寸、或更小，并且大至约1.0英寸、1.1英寸、1.2英寸、1.3英寸、1.4英寸、1.5英寸或更大。每个销钉176的直径可以小至约0.03英寸、0.04英寸、0.05英寸、或0.06英寸，并且大至约0.07英寸、0.08英寸、0.09英寸、0.10英寸、或更大。取决于销钉176的尺寸和用于构成销钉176的材料，销钉176的重量可以少于约0.01克，例如约0.005克、0.006克或0.007克。示例性销钉176可不妨碍随后的固定。例如，销钉176可以在尺寸上是足够小的和/或在密度上是足够低的，以使得外科医生可以在随后的手术期间钻穿该销钉176。
工具100的调节控制盘118包括大体上中空的头部180和轴182，该头部180的尺寸被确定成用于容纳在壳体106a、106b内，该轴182轴向延伸穿过管筒112并延伸到突出部114中，如图4中所示。多个间隔开的轮缘181将头部180结合至轴182，如图5中所示，以容置通过头部180且围绕调节控制盘118的轴182的气流。
调节控制盘118联接至钉筒116用于与其一起旋转。例如，如图5中所示，调节控制盘118的轴182延伸穿过钉筒116的套管170并且包括至少一个与钉筒116的平坦部分170相匹配的平坦部分183以将调节控制盘118的旋转运动传递至钉筒116。调节控制盘118的头部180可以包括带纹理的或刻槽的外表面184以便于调节控制盘118的转动。如图3中所示，调节控制盘118的刻槽的外表面184通过壳体106a中的外部开口160暴露以使得外科医生可以触及并转动调节控制盘118。
调节控制盘118可以包括适当的定位机构以确保钉筒116的适当对准。例如，如图5中所示，调节控制盘118的头部180中包括多个均匀间隔开的定位孔186。每个定位孔186的尺寸可以被确定成容纳球187(图8)或另一适当的定位件以确保将调节控制盘118和联接于其上的钉筒116旋转至多个离散位置中的一个。
工具100的阀组件120容纳在壳体106a、106b内，并且包括阀体122、阀回位弹簧124、膨胀螺栓126、以及插塞128。如图7中所示，阀体122为在其中限定气腔188的大致中空的部件。阀体122的气腔188包括与壳体106a、106b的第二气道164连通的入口188a，以接收来自供气组件140的压缩气体。阀体122的气腔188还包括密封的斜切出口188b，该斜切出口188b与活塞组件130连通以将压缩气体从供气组件140输送至活塞组件130。
阀组件120的膨胀螺栓126为环绕阀体122并在阀体122上轴向平移的大致中空的部件。如在图5中所示，膨胀螺栓126包括头部190和用于支承插塞128的平台192，如在下面进一步讨论的那样。膨胀螺栓126还包括多个从平台192径向向外延伸的间隔开的轮缘194以容置通过膨胀螺栓126的气流。
阀组件120的插塞128的尺寸被确定成用于容纳在阀体122的出口188b内，如图7中所示。插塞128相对于阀体122轴向平移以关闭和打开阀组件120。在插塞128密封阀体122的出口188b使之关闭时，阀组件120闭合，如图8中所示，从而阻止来自阀体122的气腔188的气流。在插塞128的锥形端196平移到阀体122的出口188b中并打开该出口188b时，阀组件120打开，如图9中所示，从而使压缩气体能够从阀体122的气腔188逸出。
工具100的活塞组件130容纳在管筒112和突出部114内并且包括活塞132、活塞回位弹簧134、缓冲器136、和导向器138，如图4中所示。
活塞组件130的活塞132是在管筒112内轴向平移的套管式部件。活塞132包括头部200、轴202以及联接至轴202的径向偏置的针状件204。该针状件204的尺寸被确定成用于容纳在钉筒116的各个单独的通道174内。根据本公开内容的示例性实施方式，钉筒116的通道174的尺寸被确定成用以限制针状件204在其中的轴向运动，从而稳定该针状件204。如图7中所示，调节控制盘118的轴182完全延伸穿过套管式活塞132以到达钉筒116。在操作中，外科医生旋转调节控制盘118以选择性地将钉筒116的所需通道174与活塞132的针状件204对准。
活塞组件130的缓冲器136是尺寸被确定成在其中容纳活塞132的轴202的套管式部件，如图4中所示。缓冲器136可以由例如塑料或橡胶构成以抵抗或减慢活塞132的轴向平移。
活塞组件130的导向器138是尺寸和形状被确定成在其中容纳活塞132的轴202和针状件204的套管式部件，如图5中所示。导向器138的外形可以被确定成与活塞132的外部轮廓紧密配合，从而导引和稳定活塞132的轴向平移。
工具100的供气组件140容纳在壳体106a、106b内，并且包括封头142、气罐144、刺破阀146、和调节器148。如图6中所示，封头142可拆卸地联接于壳体106a、106b，用于移除和更换气罐144。
供气组件140的气罐144包括压缩气体源，优选地，气罐144包括压缩的二氧化碳气(CO2)或氮气(N2)。有利地，气罐144是廉价的，易于在市场上购得的，并且能够在没有诸如电池之类的任一其它辅助电源的情况下单独为工具100提供动力。压缩气体通常能够以供应量为12克的方式在市场上购得，但是工具100可被设计成容置具有多种类型和尺寸的气罐144。气罐144内的压力可以低至约300psi、400psi、500psi、或600psi，并且高达约700psi、800psi、900psi、1000psi、或更高，但气罐144内的压力将会随着温度而改变。供应量为12克的压缩CO2源例如在室温下的压力可以为约850psi。当将每个新的气罐144插到壳体106a、106b中时，刺破阀146将会打开气罐144以将气流经由第一气道162从气罐144引入至调节器148，如图6中所示。
供气组件140的调节器148被设置成控制输送至阀组件120的气体的压力。当阀组件120的阀体122中的压力达到诸如约100psi、200psi、300psi、400psi、500psi、或600psi之类的预期阈值时，调节器148切断压缩气体至阀体122的连续流动。因此，即使气罐144中的压力波动，调节器148也能够将压缩气体以基本上恒定的压力输送至阀体122。例如，调节器148可以类似于在彩弹枪中使用的那些调节器。
工具100的扳机组件150容纳在壳体106a、106b内，并且包括扳机108、扳机簧151、弓形连杆152、旋转爪153、轴154、止挡销钉155、左侧护套156a、右侧护套156b、左侧保持器157a、右侧保持器157b、扣机158、以及U形扣机弹簧159，如图6中所示。扳机组件150的扳机108可枢转地联接至壳体106a、106b以驱动爪153的旋转，如下面进一步讨论的那样。
扳机组件150的爪153包括长圆形的中央开口210、向外延伸的指部212、以及凹槽214，如图6中所示。轴154延伸穿过爪153的长圆形的中央开口210，使得爪153能够围绕轴154旋转并且相对于轴154平移。爪153可以被护套156a、156b至少部分覆盖，该护套156a、156b包括从护套156b上突出的导向臂216。
扳机组件150的锁或扣机158可枢转地联接至壳体106a、106b。扣机158包括与爪153的指部212接触的第一端218a和接触阀组件120的膨胀螺栓126的第二端218b，如图8中所示。扣机158的第二端218b包括面对工具100的近端102的阻挡表面220和面对工具100的阀组件120的斜面222。
现在将参照图7-12描述工具100的操作。图7和8描绘了发射前处于静止状态的工具100，图9和10描绘了正被发射时的工具100，图11描绘了发射后处于中间状态的工具100，并且图12描绘了发射后处于静止状态的工具100。
参照图7和8，将工具100示出为发射前处于静止状态。在该静止状态中，在扳机簧151的力的作用下向外偏压扳机108。弓形连杆152联接于扳机108，并且将爪153的指部212向下拉使其远离扣机158。如图8中所示，在扣机弹簧159的力的作用下向上偏压扣机158，以使扣机158的阻挡表面220接合膨胀螺栓126的头部190，以防止膨胀螺栓126朝向工具100的远端104轴向平移。
压缩气体从气罐144经由壳体106a、106b的第一气道162行进至调节器148，并且从调节器148经由壳体106a、106b的第二气道164行进到阀体122的气腔188中。然而，由于膨胀螺栓126的平台192将插塞128保持密封在阀体122的出口188b内，因此，压缩气体不能够从阀体122的气腔188中逸出。扣机158防止膨胀螺栓126进而防止插塞128朝向工具100的远端104轴向平移以从阀体122上脱落。
在不存在来自阀体122的压缩气体的流动的情况下，活塞132在活塞回位弹簧134的作用下缩到工具100中，如图7中所示。活塞132的针状件204与钉筒116的通道174和定位在其中的销钉176对准，但是该活塞132的针状件204同样在活塞回位弹簧134的力的作用下缩到工具100中。
参照图9和10，工具100被示出为处于正被发射时。在该发射状态下，外科医生克服扳机簧151的力向内拉动扳机108。弓形连杆152迫使爪153的指部212向上旋转，这导致扣机158的第一端218a向上枢转并导致扣机158的第二端218b克服扣机弹簧159的力向下枢转。如此枢转扣机158将扣机158的阻挡表面220移动远离膨胀螺栓126，从而释放膨胀螺栓126以朝向工具100的远端104轴向平移，如图10中所示。
阀体122的气腔188中的高压迫使膨胀螺栓126和插塞128朝向工具100的远端104轴向运动，这将插塞128从阀体122的出口188b释放出来。如上所述，膨胀螺栓126的该轴向运动不再受到扣机158的阻挡。压缩气体从阀体122的出口188b逸出并在插塞128的周围流动，流过膨胀螺栓126，流过调节控制盘118的头部180，并在调节控制盘118的轴182的周围流动。
压缩气体随后到达活塞132的头部200，这迫使活塞132克服活塞回位弹簧134的力朝向工具100的远端104轴向平移，如图9中所示。活塞132的该平移运动可以被围绕活塞132的轴202设置的缓冲器136减速，并且可以被围绕活塞132的轴202和针状件204设置的导向器138导引并稳定。在发射位置中，针状件204进入钉筒116的通道174并且从那里驱动销钉176。在工具100的远端104置靠在断骨上的情况下，施加在活塞132上的力可以是足够大的以将销钉176驱动到骨骼中，用于将相邻的骨碎片紧固在一起。例如，销钉176可以在约70psi的压力下驱动穿过骨皮质约1mm，并且在介于约400psi到500psi之间的压力下驱动穿过骨皮质约4mm。
当活塞132的头部200被向前驱动足够远的距离以输送销钉176时，可以暴露管筒112中的通气口224，如图9中所示。压缩气体可以从活塞132的头部200的后方通过通气口224逸出，从而降低了工具100中的压力。根据本公开内容的示例性实施方式，通气口224可以将压缩气体从管筒112径向向外地引导，以使得不干扰位于工具100的远端104附近的患者或位于工具100的近端102附近的外科医生。
参照图11，将工具100示出为处于发射后的中间状态中。根据本公开内容的示例性实施方式，即使外科医生继续拉动扳机108，工具100也会在发射状态后自动地且快速地到达该中间状态。弓形连杆152继续迫使爪153的指部212向上旋转，直到止挡销钉155进入爪153的凹槽214，这限制了爪153的进一步旋转。如图11中所示，爪153的指部212旋转超过扣机158的第一端218a，从而使扣机158能够在扣机弹簧159的力的作用下返回至其最初的起始位置，扣机158的第二端218b延伸回到膨胀螺栓126的路径中。
在工具100发射后，由于压缩气体能够通过通气口224逸出，因此，阀体122的气腔188中的压力下降(图9)。在该现下降低的压力下，阀回位弹簧124能够迫使膨胀螺栓126和插塞128返回到阀体122的出口188b中，以切断压缩气体的供应。具体地，并且如在图11中所示，阀回位弹簧124迫使膨胀螺栓126的头部190越过扣机158的斜面222，膨胀螺栓126将插塞128承载回到阀体122的出口188b中。
在不存在来自阀体122的压缩气体的流动的情况下，活塞132在活塞回位弹簧134的力的作用下缩回到工具100中，如图11中所示。活塞132的针状件204(图7)也在活塞回位弹簧134的力的作用下缩回到工具100中，留下钉筒116的空通道174。
参照图12，将工具100示出为处于发射后的静止状态。根据本公开内容的示例性实施方式，即使外科医生继续拉动扳机108，工具100也在中间状态后自动地且快速地到达该静止状态。由于爪153的中央开口210的长圆形状，爪153向下平移越过轴154。爪153的指部212也向下平移，直到到达扣机158的第一端218a下方的位置，以等待扳机108的下次拉动。
阀回位弹簧124继续迫使膨胀螺栓126和插塞128回到阀体122的出口188b中，以切断压缩气体的供应。具体地，并且如图12中所示，阀回位弹簧124迫使膨胀螺栓126的头部190越过扣机158的斜面222，并且最终处于扣机158的阻挡表面220的后面。一旦将插塞126的头部190锁定在扣机158的阻挡表面220的后面，就能够通过再次拉动扳机108而重新打开阀体122。
在再次发射工具100前，外科医生可以转动调节控制盘118以旋转钉筒116。旋转钉筒116将推进钉筒116的下一通道174和定位在其中的销钉176，使其与针状件204对准。
接下来参照图13-17，提供了用于将骨碎片复位和紧固在一起的另一个示例性手持式气动工具100′的一部分。图13-17的工具100′类似于图3-12的工具100，除了如下所述的之外，相同的附图标记表示相同的元件。
如在图13中所示，工具100′的近端102′包括与对应的左侧壳体(未示出)协作的右侧壳体106b′，以便支承适当的扳机组件(未示出，但其类似于工具100的扳机组件150)、活塞组件(未示出，但其类似于工具100的活塞组件130)、包括阀体122′的阀组件120′、以及包括气罐144′和调节器148′的供气组件140′。壳体106b′限定将气罐144′连接至调节器148′的气道162′。壳体106b′还限定通气口224′和手柄110′中的减压腔226′。
如图17中所示，供气组件140′的调节器148′包括调节器本体300′、隔板302′、致动器弹簧304′、密封件306′、螺栓308′、以及选择器310′。将在下面进一步描述调节器148′的每个部件。
调节器148′的调节器本体300′为在其中限定气腔312′的基本上中空的部件，如图15中所示。调节器本体300′的气腔312′包括与壳体106b′的气道162′连通的入口312a′以容纳来自气罐144′(图14)的压缩气体。调节器本体300′的气腔312′还包括与阀体122′连通的出口312b′。根据本公开内容的示例性实施方式，调节器本体300′可以与阀体122′一体地形成，使得调节器本体300′的出口312b′限定或直接连接于阀体122′的入口188a′。
调节器148′的隔板302′的尺寸被确定成用于容纳在调节器本体300′的气腔312′内并且构造成在其中轴向平移。如图17中所示，隔板302′限定通过调节器148′的一个或更多个轴向通道314′。
调节器148′的螺栓308′的尺寸也被确定成用于容纳在调节器本体300′的气腔312′内。螺栓308′包括头部316′和轴318′。螺栓308′的头部316′限定环状通道320′以及一个或更多个通过调节器148′的轴向通道322′。环状通道320′与每个轴向通道322′配合以限定一个或更多个通过调节器148′的L形气体路径。
调节器148′的选择器310′的尺寸被确定成用于容纳在螺栓308′内。选择器310′包括插口324′，该插口324′构造成容纳用于将选择器310′旋到螺栓308′中的适当工具(未示出)。选择器310′构造成调整调节器148′的阈值压力，并因此调节阀体122′中的阈值压力。将选择器310′旋紧到螺栓308′中迫使致动器弹簧304′进一步远离螺栓308′，这增加了阀体122′中的阈值压力。将选择器310′从螺栓308′上松开使致动器弹簧304′能够进一步缩回到螺栓308′中，这减小了阀体122′中的阈值压力。
参照图14-16描述工具100′的操作。压缩气体经由气道162′从气罐144′流至调节器本体300′的入口312a′，如图14中所示。压缩气体随后朝向隔板302′流过螺栓308′的环形通道320′和轴向通道322′。首先，致动器弹簧304′迫使隔板302′远离螺栓308′，如图15中所示，以使得压缩气体能够在密封件306′的周围流动、流过隔板302′的轴向通道314′并流到阀体122′中。随着时间的流逝，当压缩气体继续进入阀体122′时，在调节器本体300′的出口312b′和阀体122′的入口188a′处的压力增加，从而迫使隔板302′克服致动器弹簧304′的力朝向螺栓308′移动。最后，当到达阈值压力时，密封件306′变得被充分压缩以阻挡隔板302′的轴向通道314′，如图16中所示。此时，调节器148′止挡住压缩气体继续流至阀体122′的入口188a′，从而限制阀体122′中的压力。
当外科医生操作工具100′的扳机组件(未示出，但其类似于工具100的扳机组件150)时，压缩气体能够从阀体122′的出口188b′逸出。例如，操作工具100′的扳机组件可以将螺栓(未示出，但其可类似于工具100的螺栓128)从调节器本体300′的出口312b′释放。从阀体122′逸出的压缩气体可以将销钉(未示出，但其类似于工具100的销钉176)气动地输送到患者的骨骼中。
在输送销钉后，压缩气体可以通过手柄110′中的通气口224′逸出，如图14中所示，从而降低了工具100′中的压力。在气体不断离开手柄110′前，逸出气体的压力可以在减压腔226′中降低。根据本公开内容的示例性实施方式，通气口224′和减压腔226′可以将气体从手柄110′向下引导以不妨碍患者或外科医生保持手柄110′。
尽管已将本发明描述为具有优选设计，但本发明可以在本公开内容的精神和范围内进一步改进。本申请因此意在涵盖使用其普遍原理的任何变型、用途或修改。此外，本申请意在涵盖对于本公开内容的这种背离，只要其处本发明所属的并落在所附权利要求的范围内的该领域的已知或惯常做法的范围内。
Claims (22)
1.一种用于稳定断骨的手持式工具，所述手持式工具具有近端和远端，所述手持式工具包括：
壳体；
至少一个骨钉，所述至少一个骨钉构造成被驱动到所述断骨中以稳定所述断骨；
钉筒，所述钉筒由所述壳体支承并且包括容纳所述骨钉的至少一个通道，所述通道的尺寸确定成适应所述骨钉通过所述通道的轴向运动，同时限制所述骨钉在所述通道中的径向运动；以及
活塞，所述活塞相对于所述壳体轴向地平移，所述活塞包括朝向所述手持式工具的所述近端设置的头部以及朝向所述手持式工具的所述远端设置的针状件，所述针状件的尺寸确定成用于容纳在所述钉筒的所述通道内，所述针状件向所述骨钉施加足够大的力以将所述骨钉从所述钉筒轴向地驱动到所述断骨中。
2.如权利要求1所述的手持式工具，还包括压缩气体源，所述压缩气体源由所述壳体支承，用于向所述活塞的所述头部供应气动力以使所述活塞相对于所述壳体轴向地平移。
3.如权利要求2所述的手持式工具，还包括调节器，所述调节器用于限制向所述活塞的所述头部供应的气动力，所述调节器包括：入口，所述入口与所述压缩气体源连通；出口，所述出口与所述活塞连通；通道，所述通道位于所述入口与所述出口之间；以及滑动隔板，当在所述出口处达到阈值压力时，所述滑动隔板关闭所述入口与所述出口之间的所述通道。
4.如权利要求2所述的手持式工具，所述压缩气体源向所述活塞的所述头部供应至少70psi的气动压力以便将所述骨钉驱动到所述断骨中。
5.如权利要求2所述的手持式工具，其中，所述压缩气体源向所述活塞的所述头部供应介于约400psi到500psi之间的气动压力以便将所述骨钉驱动到所述断骨中。
6.如权利要求2所述的手持式工具，其中，所述压缩气体源包括压缩二氧化碳和压缩氮气中的至少一种。
7.如权利要求2所述的手持式工具，其中，所述活塞在所述气动力的作用下从静止位置平移到发射位置，所述壳体限定位于处于所述静止位置中的所述活塞的所述头部与处于所述发射位置中的所述活塞的所述头部之间的通气口，所述通气口将压缩气体向下引导通过所述手持式工具的手柄。
8.一种用于稳定断骨的手持式工具，所述手持式工具具有近端和远端，所述手持式工具包括：
壳体；
至少一个骨钉，所述至少一个骨钉构造成用于被驱动到所述断骨中以稳定所述断骨；
钉筒，所述钉筒由所述壳体支承在所述手持式工具的远端处，所述钉筒包括至少一个容纳所述骨钉的通道，以及
活塞，所述活塞相对于所述壳体轴向地平移，所述活塞包括朝向所述手持式工具的所述近端设置的头部以及朝向所述手持式工具的所述远端设置的针状件，所述针状件的尺寸确定成用于容纳在所述钉筒的所述通道内，所述针状件向所述骨钉施加足够大的力以将所述骨钉从所述钉筒轴向地驱动到所述断骨中。
9.如权利要求8所述的手持式工具，其中，所述骨钉由可生物降解的聚合材料构成。
10.如权利要求8所述的手持式工具，其中，所述骨钉的重量小于约0.01克。
11.如权利要求8所述的手持式工具，还包括联接于用于支承所述钉筒的所述壳体的突出部，所述突出部包括位于所述手持式工具的所述远端处的、置靠在所述断骨上的骨骼接触表面。
12.如权利要求8所述的手持式工具，其中，所述钉筒包括用于容纳多个骨钉的多个通道，所述手持式工具还包括调节控制盘，所述调节控制盘用于使所述钉筒旋转以选择性地将所述多个通道中的一个与所述针状件对准。
13.如权利要求12所述的手持式工具，其中，所述调节控制盘包括朝向所述手持式工具的所述近端设置的头部和朝向所述手持式工具的所述远端设置成与所述钉筒连通的轴，并且所述活塞为套管式的，所述调节控制盘的所述轴延伸穿过所述套管式活塞以到达所述钉筒。
14.如权利要求8所述的手持式工具，其中，所述活塞还包括在所述头部与所述针状件之间延伸的中心轴，所述针状件相对于所述中心轴径向地偏置。
15.如权利要求8所述的手持式工具，还包括缓冲器，所述缓冲器环绕所述活塞以减缓所述活塞相对于所述壳体的轴向平移。
16.如权利要求8所述的手持式工具，其中，所述活塞在气动力的作用下朝向所述手持式工具的所述远端行进并在弹簧力的作用下返回至所述手持式工具的所述近端。
17.一种用于将骨钉驱动到断骨中以稳定所述断骨的手持式工具，所述手持式工具具有近端和远端，所述手持式工具包括：
壳体；
钉筒，所述钉筒由所述壳体支承，并且包括至少一个尺寸确定成容纳所述骨钉的通道；
活塞，所述活塞相对于所述壳体轴向地平移，所述活塞包括朝向所述手持式工具的所述近端设置的头部以及朝向所述手持式工具的所述远端设置的针状件，所述针状件的尺寸确定成用于容纳在所述钉筒的所述通道内，所述针状件向所述骨钉施加足够大的力以将所述骨钉从所述钉筒轴向地驱动到所述断骨中；
压缩气体源，所述压缩气体源联接于所述壳体，用于向所述活塞的所述头部供应气动力以使所述活塞相对于所述壳体轴向地平移；
阀组件，所述阀组件具有关闭压缩气体从所述压缩气体源到所述活塞的所述头部的流动的常闭状态和打开压缩气体从所述压缩气体源到所述活塞的所述头部的流动的打开状态；以及
扳机组件，所述扳机组件联接于所述阀组件以将所述阀组件从所述常闭状态调节至所述打开状态，在所述打开状态之后所述阀组件自动地返回至所述常闭状态。
18.如权利要求17所述的手持式工具，其中，所述扳机组件包括扳机、枢转锁、和旋转爪，所述旋转爪联接至所述扳机，从而所述扳机的运动使所述旋转爪从第一区域自动地且连续地旋转至第二区域，当所述旋转爪在所述第一区域中旋转时，所述旋转爪接合所述枢转锁以将所述阀组件调节至所述打开状态，当所述旋转爪在所述第二区域中旋转时，所述旋转爪与所述枢转锁脱离接合以使所述阀组件自动地返回至所述常闭状态。
19.如权利要求18所述的手持式工具，其中，所述扳机组件还包括轴，所述旋转爪限定长圆形的中央开口，所述长圆形的中央开口容纳所述轴，使得所述旋转爪围绕所述轴旋转并且相对于所述轴平移。
20.如权利要求17所述的手持式工具，还包括调节器，所述调节器用于限制向所述活塞的所述头部供应的气动力，所述调节器包括：入口，所述入口与所述压缩气体源连通；出口，所述出口与所述阀组件连通；通道，所述通道位于所述入口与所述出口之间；以及滑动隔板，当在所述出口处达到阈值压力时，所述滑动隔板关闭所述入口与所述出口之间的所述通道。
21.如权利要求20所述的手持式工具，其中，所述调节器与所述阀组件一体地形成，所述调节器的所述出口限定所述阀组件的入口。
22.如权利要求20所述的手持式工具，其中，所述调节器的所述滑动隔板在所述调节器的所述入口与所述出口之间限定至少一个轴向通道。
Applications Claiming Priority (3)
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|---|---|---|---|
| US18102409P | 2009-05-26 | 2009-05-26 | |
| US61/181,024 | 2009-05-26 | ||
| PCT/US2010/036126 WO2010138538A1 (en) | 2009-05-26 | 2010-05-26 | Handheld tool for driving a bone pin into a fractured bone |
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| Publication Number | Publication Date |
|---|---|
| CN102448389A true CN102448389A (zh) | 2012-05-09 |
| CN102448389B CN102448389B (zh) | 2014-10-15 |
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| CN201080022735.4A Expired - Fee Related CN102448389B (zh) | 2009-05-26 | 2010-05-26 | 用于将骨钉驱动到断骨中的手持式工具 |
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| Country | Link |
|---|---|
| US (3) | US8221433B2 (zh) |
| EP (1) | EP2434970B1 (zh) |
| CN (1) | CN102448389B (zh) |
| WO (1) | WO2010138538A1 (zh) |
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| CN103815957A (zh) * | 2014-03-20 | 2014-05-28 | 张英泽 | 一种可自动送丝的四肢长骨骨折髓内复位器 |
| US10299846B2 (en) | 2014-03-20 | 2019-05-28 | Yingze Zhang | Automatic wire-directing intramedullary reduction device used for long bone fracture |
| CN106456225A (zh) * | 2014-04-03 | 2017-02-22 | 捷迈有限公司 | 用于骨固定的整形工具 |
| US10179017B2 (en) | 2014-04-03 | 2019-01-15 | Zimmer, Inc. | Orthopedic tool for bone fixation |
| CN106456225B (zh) * | 2014-04-03 | 2019-02-26 | 捷迈有限公司 | 用于骨固定的整形工具 |
| CN107106211B (zh) * | 2014-09-16 | 2020-02-04 | A.M.外科有限公司 | 用于将固定元件驱动到骨骼中的装置及其使用方法 |
| CN107106211A (zh) * | 2014-09-16 | 2017-08-29 | A.M.外科有限公司 | 用于将固定元件驱动到骨骼中的装置及其使用方法 |
| CN104921792A (zh) * | 2015-06-12 | 2015-09-23 | 季欣然 | 一种骨折固定用钉骨器 |
| CN108430353A (zh) * | 2016-01-07 | 2018-08-21 | 迈克尔·D·史密斯 | 具有可缩回部的手持式手术装置 |
| CN108430353B (zh) * | 2016-01-07 | 2021-06-11 | 迈克尔·D·史密斯 | 具有可缩回部的手持式手术装置 |
| CN106821440A (zh) * | 2017-02-28 | 2017-06-13 | 苏州法兰克曼医疗器械有限公司 | 一种气动吻合器及其驱动装置 |
| CN109381252A (zh) * | 2017-08-04 | 2019-02-26 | 美敦力控股有限责任公司 | 分配系统和使用方法 |
| CN109381252B (zh) * | 2017-08-04 | 2023-09-12 | 美敦力控股有限责任公司 | 分配系统和使用方法 |
| CN108771564A (zh) * | 2018-06-01 | 2018-11-09 | 温州医科大学附属第二医院、温州医科大学附属育英儿童医院 | 骨钉导入器 |
| CN110037788A (zh) * | 2019-04-27 | 2019-07-23 | 张继美 | 应用于髌骨骨折修复术的医疗器械 |
Also Published As
| Publication number | Publication date |
|---|---|
| US8852202B2 (en) | 2014-10-07 |
| US20100305624A1 (en) | 2010-12-02 |
| US8603102B2 (en) | 2013-12-10 |
| WO2010138538A1 (en) | 2010-12-02 |
| EP2434970B1 (en) | 2016-11-30 |
| CN102448389B (zh) | 2014-10-15 |
| US20140094863A1 (en) | 2014-04-03 |
| US8221433B2 (en) | 2012-07-17 |
| US20120253411A1 (en) | 2012-10-04 |
| EP2434970A1 (en) | 2012-04-04 |
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