CN114191014B - A meniscus suture device that can be turned from inside to outside and then all the way inside - Google Patents
A meniscus suture device that can be turned from inside to outside and then all the way inside Download PDFInfo
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- CN114191014B CN114191014B CN202111626104.XA CN202111626104A CN114191014B CN 114191014 B CN114191014 B CN 114191014B CN 202111626104 A CN202111626104 A CN 202111626104A CN 114191014 B CN114191014 B CN 114191014B
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- 210000002435 tendon Anatomy 0.000 abstract description 40
- 241000270923 Hesperostipa comata Species 0.000 abstract 2
- 238000003780 insertion Methods 0.000 description 19
- 230000037431 insertion Effects 0.000 description 19
- 210000004353 tibial menisci Anatomy 0.000 description 15
- 210000000281 joint capsule Anatomy 0.000 description 14
- 238000000034 method Methods 0.000 description 14
- 210000003813 thumb Anatomy 0.000 description 12
- 210000000629 knee joint Anatomy 0.000 description 11
- 238000003032 molecular docking Methods 0.000 description 8
- 208000027418 Wounds and injury Diseases 0.000 description 6
- 210000001519 tissue Anatomy 0.000 description 6
- 208000021945 Tendon injury Diseases 0.000 description 4
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- 230000009286 beneficial effect Effects 0.000 description 2
- 230000000694 effects Effects 0.000 description 2
- 208000014674 injury Diseases 0.000 description 2
- 210000001698 popliteal fossa Anatomy 0.000 description 2
- 208000024891 symptom Diseases 0.000 description 2
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0491—Sewing machines for surgery
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
Abstract
本发明提供了一种由内到外再转全内的半月板缝合器，包括导向管和准位线件，所述导向管为细长管，其内部设有导针通孔，所述准位线件包括套环和滑动部，所述套环的正面投影形状为顺时针旋转90°的L形，所述套环的远端面上设有过针线通孔，所述套环的近端与所述滑动部的远端连接，所述滑动部与所述导向管滑动连接。通过设有过针线通孔的套环，使缝线能避开腘肌腱进行缝合，从而使半月板缝合手术不会对腘肌腱造成任何影响，不会缩窄腘肌腱裂孔区，提高手术成功率，降低手术操作难度。
The present invention provides a meniscus suture device that can be used from inside to outside and then turned all the way inside, including a guide tube and an alignment line member, wherein the guide tube is a slender tube, and a guide needle through hole is provided inside the guide tube, and the alignment line member includes a collar and a sliding part, and the front projection shape of the collar is an L-shape rotated 90° clockwise, and a needle and thread through hole is provided on the distal end surface of the collar, and the proximal end of the collar is connected to the distal end of the sliding part, and the sliding part is slidably connected to the guide tube. By providing the collar with the needle and thread through hole, the suture can avoid the popliteus tendon for suturing, so that the meniscus suturing operation will not have any impact on the popliteus tendon, will not narrow the popliteus tendon fissure area, improve the success rate of the operation, and reduce the difficulty of the operation.
Description
Technical Field
The invention relates to a medical appliance of a stitching instrument, in particular to a meniscus stitching instrument capable of changing from inside to outside to inside.
Background
Existing meniscus suturing techniques mainly have three modes of inner-to-outer, outer-to-inner and total-inner suturing. Because of the existence of the popliteal tendon (popliteus tendon, PT), the lateral meniscus is separated by the popliteal tendon laceration hole at 1/3 of the middle and rear positions, and a 'lateral meniscus-popliteal tendon notch' with clear limit and free state is formed, so that the activity is high, the blood supply is poor, the injury is easy, the anterior cruciate ligament injury is frequently concurrent, and the longitudinal tearing is common. Three existing meniscal suturing techniques suture the popliteal tendon of the meniscus to the popliteal tendon Kong Oushi, often suturing the meniscus and popliteal tendon together or constricting the popliteal tendon laceration to cause clinical symptoms. In particular, with reference to fig. 1 of the specification, the prior art technique of inner-to-outer meniscal suture will be described: the joint capsule 1 of the knee joint is internally wrapped with the outer meniscus 2 and the inner meniscus 3, the popliteal tendon 4 is positioned between the joint capsule 1 and the outer meniscus 2, the popliteal tendon split hole area 10 is arranged around the popliteal tendon 4, the outer meniscus longitudinal tearing area 100 is arranged around the popliteal tendon split hole area, the outside of the joint capsule 1 is also provided with skin (not shown in the figure), when the outside of the joint capsule 1 is torn in the popliteal tendon split hole area, an arthroscope access (not shown in the figure), 1-2 needle access and 1 safety incision are required to be opened at the knee joint, 2 needle access ways 5 and 1 outer safety incision 6 are provided in the figure 1 of the specification, each suture is one needle, the suture sleeve 7 stretches into the body from an access needle way and abuts against the outer meniscus, the suture sleeve guides the suture needle 8 to puncture the outer meniscus, after the suture needle passes out of the joint capsule, the suture needle is led out of the body through the outer safety incision under the protection and guidance of the popliteal fossa draw hook, then the suture needle is removed, one end of the suture 9 stretches out of the body from the outer safety incision, the suture passing action is repeated for the last time, the two ends of the suture are led out of the body, then the knot is knotted outside the joint capsule in a separated mode, the redundant tail thread is cut off, one needle is sewn, the suture steps are repeated, 2-3 needles are sewn in total, and the suture of the popliteal tendon split area of the meniscus from inside to outside is completed after the operation is finished. In the operation process, the knee joint has more and more complicated tissue attached to the popliteal tendon region, so that more than the outer meniscus through which the suture passes often occurs, and the popliteal tendon can be pricked or the popliteal tendon lacerated hole can be narrowed, thereby causing clinical symptoms such as pain.
Disclosure of Invention
The technical problems to be solved by the invention are as follows: the meniscus stitching instrument is capable of avoiding the popliteal tendon to stitch the meniscus in the popliteal tendon laceration area, is simple to operate, is firm in stitching, is particularly suitable for patients with narrow gap outside knee joints, and provides a brand-new stitching technology and tool for the popliteal tendon laceration in the external meniscus.
In order to solve the technical problems, the invention adopts the following technical scheme:
the utility model provides a from interior to outside to turn meniscus suture ware in entirely, includes stand pipe and level line spare, the stand pipe is the slender tube, and its inside is equipped with the guide pin through-hole, the level line spare includes lantern ring and sliding part, the lantern ring is annular structure, the hole of lantern ring is the needle line through-hole of crossing, the lantern ring with the distal end of sliding part is connected, the sliding part with stand pipe sliding connection, the needle line through-hole of crossing with the export of guide pin through-hole sets up relatively.
Further, the shape of the lantern ring is circular or elliptical.
Further, the outer circular surface of the guide tube is provided with a slideway/at least two sliding protrusions, the sliding part of the level line piece is provided with at least two sliding protrusions/slideways, the sliding protrusions are limited and slide in the slideways, and the side projection shape of the sliding protrusions is circular, more semicircular, T-shaped or inverted trapezoid.
Further, the sliding part of the level wire piece is of a tubular structure, and the sliding part is sleeved on the outer circular surface of the guide tube in a sliding manner.
Further, the near end of the sliding part of the level wire piece is of a tubular structure, a front guide ring is arranged on the far end of the sliding part, the near end of the sliding part is slidably sleeved on the outer circular surface of the near end of the guide tube, and the front guide ring is slidably sleeved on the outer circular surface of the far end of the guide tube.
Further, the diameter of the outer circle of the proximal end of the guide tube is larger than that of the outer circle of the distal end.
Further, still include adaptor and locating part, be equipped with the pipe mounting hole on the distal end terminal surface of adaptor, be equipped with first advance the pinhole on the proximal end terminal surface of adaptor, first advance the pinhole with the coaxial intercommunication of pipe mounting hole, the proximal end of stand pipe inserts in the pipe mounting hole of adaptor, the locating part is cyclic annular structure, first ring, first accommodation space and first internal thread have been set gradually from distal end to proximal end in the hole of locating part, be equipped with first external screw thread on the distal end of adaptor, the sliding part proximal end of level line spare is equipped with spacing flange, the proximal end slip of sliding part is in the hole of first internal ring, the spacing flange slip of sliding part is arranged in the first accommodation space, first internal thread with first external screw thread spiro union.
Further, the novel handle comprises a handle and a locking piece, wherein a butt joint hole is formed in the distal end face of the handle, a second needle inlet hole is formed in the proximal end face of the handle, the butt joint hole is coaxially communicated with the second needle inlet hole, the proximal end of the adapter piece is inserted into the butt joint hole of the handle, the locking piece is of an annular structure, a second inner ring, a second accommodating space and second inner threads are sequentially arranged in an inner hole of the locking piece from the distal end to the proximal end, second outer threads are arranged on the distal end of the handle, a clamping flange is arranged in the middle of the adapter piece, the distal end of the adapter piece extends into the inner hole of the second inner ring, and the clamping flange is arranged in the second accommodating space, and the second inner threads are in threaded connection with the second outer threads.
Further, the distal end of the guide tube and the distal end of the alignment wire piece are raised upwards by 10-45 degrees.
Further, the included angles among the distal end of the guide tube, the distal end of the level line piece and the horizontal transverse line are-15 degrees to-45 degrees, 0 degrees and 15 degrees to 45 degrees.
The invention has the beneficial effects that: during operation, the collar is placed in the popliteal tendon split hole area and is close to the outer meniscus, the collar provided with the needle thread through hole enables the needle to be accurately penetrated on one hand, the suture thread can be removed from the far end of the suture needle to be quickly brought back into the body and led out of the body from the needle inlet path after the suture needle is penetrated out of the body and sheared off on the other hand, the suture thread can be wound on the outer meniscus only, the popliteal tendon split hole area is avoided to suture the lateral meniscus longitudinal tearing, the popliteal tendon split hole area can not be narrowed, the operation is simple, the suture is firm, the device is particularly suitable for patients with knee joint outer gap stenosis, and a brand-new suture technology and tool are provided for the lateral meniscus tendon split hole area tearing.
Drawings
FIG. 1 is a schematic illustration of the operation of a meniscus inside-out suture procedure in a patient position in the background;
FIG. 2 is a schematic illustration of the operation of a meniscal stapler of an embodiment of the present invention resting on a lateral meniscus;
FIG. 3 is a schematic view showing a combination of a guide tube and a level wire in accordance with an embodiment of the present invention;
FIG. 4 is a schematic view showing a combination of a guide tube and a level wire in accordance with an embodiment of the present invention;
FIG. 5 is a schematic view showing a combination of a guide tube and a level wire in accordance with an embodiment of the present invention;
FIG. 6 is a schematic diagram showing a combination of a guide tube and a level wire in accordance with an embodiment of the present invention;
FIG. 7 is an exploded view of a meniscus suture instrument according to an embodiment of the present invention;
FIG. 8 is a half-sectional view of a meniscus stapler of an embodiment of the invention;
FIG. 9 is an enlarged view of part A of FIG. 8 in accordance with an embodiment of the present invention;
FIG. 10 is a top view of a meniscus suture instrument according to an embodiment of the present invention with an angle of-30℃between the distal end of the guide tube and the horizontal transverse line;
FIG. 11 is a top view of a distal end of a guide tube of a meniscal stapler of an embodiment of the present invention at an angle of 0 from horizontal;
FIG. 12 is a top view of a 30℃angle between the distal end of the guide tube and the horizontal transverse line of a meniscal stapler according to an embodiment of the present invention;
FIG. 13 is a perspective view of a meniscal stapler handle of an embodiment of the present invention disposed perpendicular to the adapter;
FIG. 14 is a schematic view of the structure of a suture needle and suture used during a procedure using a meniscal stapler in accordance with an embodiment of the present invention;
fig. 15 is a schematic illustration of the operation of a meniscus from inside-out to total internal suturing procedure at a patient position in accordance with an embodiment of the present invention.
Description of the reference numerals:
1. A joint capsule; 2. a lateral meniscus; 3. medial meniscus; 4. popliteal tendon; 5. a needle entering path; 6. a safety incision; 7. suturing the cannula; 8. stitching; 9. a suture; 10. the popliteal fossa zone; 100. lateral meniscus longitudinal tear zone;
11. a guide tube; 12. a level line member; 13. an adapter; 14. a limiting piece; 15. a handle; 16. a locking member;
111. A pin through hole; 112. a slideway;
121. A collar; 1211. a needle-line passing through hole; 122. a sliding part; 1221. leading guide ring; 1222. a sliding protrusion; 1223. a limit protrusion; 123. a limit flange;
131. A tube mounting hole; 132. a first needle inlet hole; 133. a first external thread; 134. a detent flange;
141. a first inner ring; 142. a first accommodation space; 143. a first internal thread;
151. A butt joint hole; 152. a second needle inlet hole; 153. a second external thread; 154. a needle insertion notch;
161. A second inner ring; 162. a second accommodation space; 163. and a second internal thread.
Detailed Description
In order to describe the technical contents, the achieved objects and effects of the present invention in detail, the following description will be made with reference to the embodiments in conjunction with the accompanying drawings.
Referring to fig. 2 to 15, the embodiment provided by the present invention is as follows:
The utility model provides a meniscus suture instrument from inside to outside changes total internal, includes stand pipe 11 and level line piece 12, stand pipe 11 is long and thin pipe, and its inside is equipped with guide pin through-hole 111, level line piece 12 includes lantern ring 121 and sliding part 122, lantern ring 121 is annular structure, the hole of lantern ring 121 is needle line through-hole 1211, lantern ring 121 with the distal end of sliding part 122 is connected, sliding part 122 with stand pipe 11 sliding connection, needle line through-hole 1211 with the export of guide pin through-hole 111 sets up relatively.
The guide needle through hole 111 of the guide tube 11 provides a passage for suture needle and suture in the suture device during operation, the sliding part 122 of the quasi-position wire 12 is connected with the guide tube 11 in a sliding way, the distance between the sleeve ring 121 and the distal end of the guide tube 11 can be adjusted, the sleeve ring 121 of the quasi-position wire 12 can be accurately placed into the popliteal tendon split hole during operation, thereby guiding the suture needle penetrating from the guide needle through hole 111 to accurately penetrate out from the needle through hole 1211, the distal end of the suture after the suture needle is removed is firstly carried back into the knee joint by the sleeve ring 121 and then carried out into the needle access way, particularly referring to figure 2 of the specification, during operation, the sleeve ring 121 can be placed into the popliteal tendon split hole region between the vertical outer side surface of the outer meniscus and the popliteal tendon, the distal end of the guide tube 11 is abutted against the inclined inner upper surface of the outer meniscus to provide a needle-in-force-bearing point, the sleeve ring 121 can provide a needle-out stress supporting point for the suture needle to puncture on the outer meniscus during operation, so that the suture needle can accurately and rapidly penetrate out of the outer meniscus, the sleeve ring 121 is provided with a needle thread through hole 1211, the suture needle enters the outer meniscus from the outlet of the guide needle through hole 111, the suture needle penetrates out of the outer meniscus, then passes through the needle thread through hole 1211 and then passes through the joint capsule, then passes through the skin of a patient to reach the outside of the patient, when the suture needle is sheared, the suture device is taken out of the body from the needle-in access way, the quasi-position wire 12 with the sleeve ring 121 also brings the far end of the suture out of the body into the loop and out of the body from the needle-in access way, at the moment, the suture thread is accurately wound on the outer meniscus, after two ends of the suture thread are knotted, the popliteal tendon splitting hole area can be sutured without any influence on the popliteal tendon, the popliteal tendon splitting hole can not be narrowed, the overall nerve can not be injured, the success rate of the popliteal tendon can also be improved, the operation time can be reduced, in the meniscus suture operation process of using the meniscus suture device, the suture is led out from inside to outside and then is turned into the whole inside for knotting, an outside safety incision is not required to be formed in the operation process, a suture needle is not required to be led out of the body by a popliteal nest drag hook, only 2-3 needle eyes are left on the skin, the injury to the skin of a patient is small, the suture is not required to be grasped from an access needle to enter a joint capsule by a thread grasping device, the used devices are few, and the suture device is accurate, quick and convenient to operate, thereby being a brand new meniscus suture technology and tool.
Preferably, the collar 121 is disposed perpendicular to the distal outlet of the guide tube 11, so that the collar 121 can provide a good supporting point for the needle to be pulled out when the needle is pulled out from the outer meniscus, thereby improving the accuracy and rapidity of the surgical operation.
Further, the collar 121 is in a circular or elliptical shape, so that the surface of the collar is smooth and is not easy to scratch the tissue in the patient.
Further, the collar 121 and the sliding portion 122 are integrally manufactured, so that the outer surface of the level wire 12 is smooth and is not easy to scratch the tissue of the patient; preferably, the collar 121 and the sliding portion 122 are integrally manufactured by using the same circular tube.
Or the collar 121 and the sliding portion 122 are welded and connected, so that the collar 121 and the sliding portion 122 are respectively convenient to process, the structural design is more free, and the collar 121 and the sliding portion are polished after being welded and connected, and the internal tissues of a patient are not easily scratched.
Further, the outer circumferential surface of the guide tube 11 is provided with at least two sliding protrusions/sliding tracks, the sliding portion 122 of the level wire 12 is provided with at least two sliding protrusions/sliding tracks, the sliding protrusions are limited in and slide in the sliding tracks, and the side projection shape of the sliding protrusions is circular, semi-circular, T-shaped or inverted trapezoid.
The guide tube 11 and the level wire 12 are arranged in parallel, and the guide tube 11 and the level wire 12 are connected in a sliding manner by sliding ways and sliding protrusions, as shown in fig. 3 of the specification, the sliding ways 112 are laid along the direction of the guide tube 11, the sliding ways 112 can be spot-welded on the outer wall of the guide tube 11, or a sliding way groove can be processed on the outer wall of the guide tube 11, the number of the sliding protrusions 1222 is at least two, the sliding protrusions 1222 are spot-welded on the sliding portion 122 of the level wire 12, and the sliding protrusions 1222 with circular, semi-circular, T-shaped or inverted trapezoid side projection shapes are not easy to separate after being inserted into the sliding ways 112, so that the guide tube 11 and the level wire 12 can slide mutually.
Further, referring to fig. 3 of the present disclosure, the sliding portion 122 of the alignment member 12 further includes a limiting protrusion 1223, the limiting protrusion 1223 is located at a proximal end and a distal end of the sliding portion 122, the limiting protrusion 1223 is opposite to the sliding protrusion 1222, a side projection width of the limiting protrusion 1223 is greater than a side projection width of the sliding protrusion 1222, and two limiting protrusions 1223 located at the proximal end and the distal end of the sliding portion 122 limit movement limit positions of two ends of the alignment member 12 when sliding relative to the guide tube 11, respectively, so as to prevent separation between the alignment member 12 and the guide tube 11.
Further, referring to fig. 4 of the present application, the sliding portion 122 of the alignment member 12 is in a tubular structure, the sliding portion 122 is slidably disposed on the outer circumferential surface of the guide tube 11, so that the alignment member 12 is easy to process, the surface of the alignment member 12 is smooth, the proximal end of the guide tube 11 is held by a left hand, the proximal end of the alignment member 12 is pinched by a right hand during operation, the position of the alignment member 12 relative to the guide tube 11 is adjustable by a left hand or a right hand, or the proximal end of the guide tube 11 is held by one hand, and the upper surface of the proximal end of the alignment member 12 is pressed by the thumb of the hand, so that the position of the alignment member 12 relative to the guide tube 11 is shifted distally or proximally by the thumb of the hand.
Further, referring to fig. 5 of the disclosure, the proximal end of the sliding portion 122 of the alignment wire 12 is in a tubular structure, a front guide ring 1221 is disposed at the distal end of the sliding portion 122, the proximal end of the sliding portion 122 is slidably sleeved on the proximal outer circumferential surface of the guide tube 11, the front guide ring 1221 is slidably sleeved on the distal outer circumferential surface of the guide tube 11, the tubular proximal end of the sliding portion 122 and the front guide ring 1221 at the distal end are slidably disposed with respect to the guide tube 11, the sliding between the alignment wire 12 and the guide tube 11 is smooth through the tubular proximal end of the sliding portion 122, and the distal end of the alignment wire 12 is guided in azimuth through the front guide ring 1221 at the distal end of the sliding portion 122, and when the distal end of the guide tube 11 is bent, the alignment wire 12 is slidably connected with the distal end of the guide tube 11 only through the bent section of the front guide ring 1221, so that good sliding performance of the alignment wire 12 with respect to the guide tube 11 can be maintained.
Further, the middle part of the sliding part 122 of the level wire 12 is in a narrow and long sheet structure, and is slidably attached to the outer wall of the guide tube 11, so that the quality of the level wire 12 is lighter, and the total width of the distal end of the stapler is smaller.
Further, referring to fig. 6 of the present disclosure, the diameter of the proximal outer circle of the guide tube 11 is larger than the diameter of the distal outer circle, the tubular proximal inner hole of the sliding portion 122 is adapted to the size of the proximal outer circle of the guide tube 11, and the inner hole of the distal front guide ring 1221 of the sliding portion 122 is adapted to the size of the distal outer circle of the guide tube 11, so that the limit position of the level wire 12 along the sliding direction from the distal end to the proximal end of the guide tube 11 can be limited by the arrangement that the diameter of the distal end of the guide tube 11 is smaller than the diameter of the proximal end.
Further, referring to fig. 6 of the specification, the outer circumferential surface of the proximal end of the guide tube 11 is connected with the outer circumferential surface of the distal end of the guide tube 11 by a tapered outer circumferential surface, so that the outer circumferential surface of the guide tube 11 is smooth and is not easy to scratch tissues of a patient.
Further, referring to fig. 7 to 9 of the present disclosure, the connector 13 is further connected to the proximal end of the guide tube 11, the limiter 14 is fixed to the proximal end of the connector 13, the limiter 14 is used for sliding and limiting the proximal end of the sliding portion 122, specifically, a tube mounting hole 131 is formed in the distal end surface of the connector 13, a first needle inlet hole 132 is formed in the proximal end surface of the connector 13, the first needle inlet hole 132 is coaxially communicated with the tube mounting hole 131, the proximal end of the guide tube 11 is inserted into the tube mounting hole 131 of the connector 13, the limiter 14 is in an annular structure, a first inner annular 141, a first accommodating space 142 and a first inner thread 143 are sequentially formed in an inner bore of the limiter 14 from the distal end to the proximal end, a first outer thread 133 is formed in the distal end of the connector 13, a limit flange 123 is formed in the proximal end of the sliding portion 122 of the connector 12, and the first annular flange 123 is disposed in the first inner annular flange 142 of the sliding portion 122.
The pipe mounting hole 131 inside the distal end of the adaptor 13 is used for fixing the proximal end of the guide pipe 11, so that the proximal end of the guide pipe 11 can be thickened and reinforced, the first external thread 133 on the outer surface of the distal end of the adaptor 13 is used for fixing the proximal end of the limiting piece 14, the length of the first accommodating space 142 is larger than the thickness of the limiting flange 123, the first accommodating space 142 of the limiting piece 14 provides a sliding space of the limiting flange 123, the limiting flange 123 of the level piece 12 slides to the limit position distally and can touch the first internal ring 141, the limiting flange 123 of the level piece 12 slides to the limit position proximally and can touch the first internal thread 143 or the first external thread 133, namely, the sliding range of the level piece 12 is limited by the limiting piece 14, the proximal end of the adaptor 13 can be gripped more conveniently relative to the proximal end of the gripping guide pipe 11, at this time, the proximal end of the adaptor 13 can be gripped by a left hand, the proximal end of the level piece 12 can be gripped by a right hand, or the proximal end of the adaptor 13 can be gripped by a thumb of the user, and the proximal end of the level piece 12 can be gripped by the thumb.
Further, the outer circumferential surface of the proximal end of the guiding tube 11 is tightly matched with the tube mounting hole 131, and the proximal end of the guiding tube 11 is not easy to be separated after being inserted into the tube mounting hole 131.
Further, the diameter of the first needle inlet hole 132 is smaller than that of the tube mounting hole 131, and the step surface, which is switched by the tube mounting hole 131 and the first needle inlet hole 132, defines the mounting position of the proximal end of the guide tube 11 in the tube mounting hole 131.
Further, the handle 15 is fixed at the distal end of the adaptor 13, the locking member 16 is used for locking the handle 15 on the adaptor 13, a butt joint hole 151 is formed in the distal end face of the handle 15, a second needle inlet hole 152 is formed in the proximal end face, the butt joint hole 151 is coaxially communicated with the second needle inlet hole 152, the proximal end of the adaptor 13 is inserted into the butt joint hole 151 of the handle 15, the locking member 16 is of an annular structure, a second inner circular ring 161, a second accommodating space 162 and a second inner thread 163 are sequentially formed in an inner hole of the locking member 16 from the distal end to the proximal end, a second outer thread 153 is formed in the distal end of the handle 15, a clamping flange 134 is arranged in the middle of the adaptor 13, when the adaptor is mounted, the distal end of the adaptor 13 is firstly inserted into the inner hole of the second inner circular ring 161 until the clamping flange 134 is placed in the second accommodating space 162, and then the second outer thread 153 is connected with the second outer thread 153, namely, the adaptor 13 is connected with the second outer thread 153, and the adaptor 13 is fixed by the second inner thread.
The proximal end of the adapter 13 extends into the butt joint hole 151 of the handle 15, so that the handle 15 can be grasped by the left hand during operation, and the operation is more comfortable and stable; after the locking member 16 is screwed with the handle 15, the locking flange 134 of the adapter 13 is locked in the second accommodating space 162 of the locking member 16, so that the handle 15 and the adapter 13 are firmly connected by the locking member 16, and the handle 15 and the adapter 13 are effectively prevented from being separated.
Further, the diameter of the second pin hole 152 is smaller than that of the docking hole 151, and the step surface, which is switched by the docking hole 151 and the second pin hole 152, limits the mounting position of the proximal end of the adaptor 13 in the docking hole 151.
Further, the width of the second accommodating space 162 is the same as the width of the locking flange 134, so that the adaptor 13 cannot move relative to the handle 15.
Further, the shape of the abutting hole 151 of the handle 15 is round or square, and the shape of the proximal end of the adaptor 13 is matched with the shape of the abutting hole 151.
Further, the outer surface of the proximal end of the adaptor 13 is tightly or loosely fitted with the docking hole 151, if the outer surface of the proximal end of the adaptor 13 is tightly fitted with the docking hole 151, the proximal end of the adaptor 13 is not easy to be separated after being inserted into the docking hole 151, and if the adaptor 13 is loosely fitted with the docking hole, the adaptor 13 is connected with the docking hole by the locking member 16.
Further, the handle 15 is disposed coaxially with the adapter 13, and the second needle inlet hole 152 penetrates the proximal end surface of the handle 15, and the suture needle enters the meniscus suture device from the second needle inlet hole 152 of the handle 15 during operation.
Further, a needle insertion notch 154 is provided in the middle of the handle 15, the bottom of the needle insertion notch 154 is flush with the bottom of the second needle insertion hole 152, and since the handle 15 has a certain length and the guide tube 11 has a certain length, in order to make the needle pass through the inside of the meniscus suture device of the present application smoothly, after the needle enters the second needle insertion hole 152, the needle is pushed forward by finger force at the needle insertion notch 154, so that the needle can be pulled out of the suture device smoothly.
Preferably, the front projection shape of the needle insertion notch 154 is an inverted right trapezoid, the downward inclined surface at the proximal end of the needle insertion notch 154 is used for guiding the thumb to reach the bottom of the needle insertion notch, the vertical surface at the distal end of the needle insertion notch 154 is used for limiting the forward sliding position of the thumb, when the needle is pushed forward at the needle insertion notch, the handle is held by one hand, the thumb slides downward along the inclined surface of the needle insertion notch and contacts the needle penetrating from the second needle insertion hole at the bottom of the needle insertion notch, the thumb presses the needle and pushes the needle distally, when the thumb touches the vertical surface of the needle insertion notch, the thumb is tilted, the steps are repeated, and the needle is pushed by the thumb again until the needle reaches the designated position.
Further, referring to fig. 13 of the specification, the handle 15 is disposed perpendicular to the adapter 13, and the structure makes the length of the needle passing through the handle 15 shorter, so that the needle can be easily pushed out of the stapler.
Further, the distal end of the guide tube 11 and the distal end of the level wire 12 are raised up by 10 ° to 45 °, and the structure is to adapt to the operation space requirement in the knee joint, and a proper raising angle is selected according to the actual requirement.
Preferably, the distal end of the guide tube 11 and the distal end of the level wire 12 are raised up by 15 °.
Preferably, the distal end of the guide tube 11 and the distal end of the level wire 12 are raised up by 20 °.
Furthermore, the included angles between the distal end of the guide tube 11, the distal end of the level wire 12 and the horizontal transverse line are-15 degrees to-45 degrees, 0 degrees and 15 degrees to 45 degrees, and a suture device with a proper angle is selected and manufactured according to different positions of meniscus suture.
Preferably, the included angles between the distal end of the guide tube 11, the distal end of the level wire 12 and the horizontal line are-30 °,0 °, 30 °, please refer to fig. 10 of the specification, the included angles between the distal end of the guide tube 11, the distal end of the level wire 12 and the horizontal line are-30 °, please refer to fig. 11 of the specification, the included angles between the distal end of the guide tube 11, the distal end of the level wire 12 and the horizontal line are 0 °, and please refer to fig. 12 of the specification, the included angles between the distal end of the guide tube 11, the distal end of the level wire 12 and the horizontal line are 30 °; during operation, one suture device is prepared according to operation requirements, or two of three suture devices with included angles of-30 degrees, 0 degrees and 30 degrees between the distal end of the guide tube 11 and the horizontal transverse line are prepared, or three suture devices with included angles of-30 degrees, 0 degrees and 30 degrees between the distal end of the guide tube 11 and the horizontal transverse line are prepared together for operation.
Preferably, the alignment wire 12 is made of soft plastic material, such as polyethylene, polypropylene, polystyrene, polyvinyl chloride, nylon, polycarbonate, polyurethane, polytetrafluoroethylene, polyethylene terephthalate, etc., so that the alignment wire 12 can slide smoothly along the guide tube 11 having a distal curved shape.
Preferably, the guide tube 11 is made of stainless steel, and can be reused after being sterilized.
Further, a lower notch and an upper notch are arranged on the distal end face of the guide tube 11, the front projection shape of the lower notch is an L shape rotating 180 degrees clockwise and the opening is an obtuse angle, the front projection shape of the upper notch is a trapezoid rotating 90 degrees clockwise, and the distal corners of the guide tube 11 are rounded corners; the setting of lower breach makes the inclined interior upper surface of meniscus of difficult damage of distal end of stand pipe 11, makes the distal end of stand pipe 11 fine with the inclined interior upper surface laminating of meniscus, and the setting of upper breach makes stand pipe 11 distal end be convenient for process the fillet on the one hand, on the other hand is convenient for observe the seam needle and wears out the position.
Further, in the description, fig. 14 shows a schematic view of a suture needle 8 and a suture 9 used in the meniscus suture device of the present application, where two ends of one suture are respectively connected to a long straight needle, and of course, in the actual use process, only one end of one suture is connected to a long straight needle, and the other end is suspended.
In particular, the manner in which the full-interior meniscal stapler of the present application is used will be described with reference to FIG. 15 of the drawings, which illustrates the present application: the joint capsule 1 of the knee joint is internally wrapped with the outer meniscus 2 and the inner meniscus 3, the popliteal tendon 4 is positioned between the joint capsule 1 and the outer meniscus 2, the popliteal tendon split hole area 10 is arranged around the popliteal tendon 4, the lateral meniscus longitudinal tearing area 100 is arranged around the popliteal tendon split hole area, the outside of the joint capsule 1 is also provided with skin (not shown in the figure), when the lateral meniscus longitudinal tearing area around the lateral meniscus popliteal tendon split hole area is subjected to the internal-to-external-to-total internal suture operation, an arthroscope access (not shown in the figure) is required to be opened at the knee joint, 1 needle-inserting path 5, each of which is sewed with one needle, distal ends of guide tube 11 and quasi-position wire member 12 extend from needle-inserting path 5 into knee joint (meniscus suture instrument in fig. 15 of the specification is a top view, so that quasi-position wire member 12 can only be seen, guide tube 11 cannot be seen, guide tube 11 is not marked), and in operation, a doctor holds arthroscope with one hand, holds handle 15 with the other hand thumb on the proximal upper surface of quasi-position wire member 12, holds arthroscope with the assistant doctor, holds handle 15 with the left hand, pushes quasi-position wire member 12 with the right hand holding the proximal end of quasi-position wire member 12 to the distal end, pulls the distal end of quasi-position wire member 12 a certain distance from the distal end of guide tube 11, Placing collar 121 into the popliteal tendon split hole, then placing collar 121 in contact with the outer surface of the lateral meniscus, then aiming at the needle insertion position on the lateral meniscus, holding the level wire 12 in the right hand, holding the handle 15 in the left hand to push the guide tube 11 distally, placing the distal end of the guide tube 11 against the obliquely inner upper surface of the lateral meniscus, at which time the distal end of the guide tube 11 provides the needle insertion force support point on the lateral meniscus, placing collar 121 can provide a needle extraction force support point on the lateral meniscus, then placing the needle from the second needle insertion hole 152 of the handle 15 into the stapler, pushing the needle forward continuously, passing through the second needle insertion hole 152, The first needle inlet hole 132 and the guide needle through hole 111, the needle penetrates the outer meniscus after penetrating the distal end of the guide tube 11, then penetrates through the needle passing through hole 1211 of the sleeve ring 121, penetrates through the joint capsule and the skin, and then reaches the outside of the body, the needle is sheared out of the body, the level wire 12 is held by the right hand, the handle 15 is held by the left hand to pull proximally, the guide tube 11 moves proximally, the distance between the distal end of the guide tube 11 and the sleeve ring 121 is pulled, the suture device is taken out from the needle inlet path, in the process, the sleeve ring 121 brings the suture penetrating through the needle passing through hole 1211 into the body and then brings the suture out of the body from the needle inlet path, the suture accurately winds the upper surface of the outer meniscus, Knotting the two ends of the suture, pushing the suture into the body from the needle inlet path by using a knot pusher, tying the suture, taking out the knot pusher after knotting, extending the suture from the needle inlet path into the body by using a thread cutter to cut off redundant suture, sewing a needle, selecting a proper meniscus suture device to continue sewing the needle according to the longitudinal tearing area 100 of the outer meniscus, needing sewing 2-3 needles, and ending the operation. Specifically, in fig. 15 of the specification, two needles are co-stitched, the first needle performs a suture operation using a meniscus suture device having an angle of 0 ° between the distal end of the guide tube 11 and the distal end of the quasi-position wire 12 and the horizontal transverse line, and the second needle performs a suture operation using a meniscus suture device having an angle of-30 ° between the distal end of the guide tube 11 and the distal end of the quasi-position wire 12 and the horizontal transverse line.
In summary, the meniscus suture device provided by the invention has the beneficial effects that:
1. when the meniscus suture device is used for operation, the needle-in stress supporting point and the needle-out stress supporting point of the suture needle on the outer meniscus can be provided, so that the suture needle can rapidly and accurately puncture the outer meniscus; after the suture needle passes through the body to be sheared, the suture can be quickly pulled into the body and pulled out from the needle inlet path, the suture can be accurately wound on the meniscus at the outer side, only the meniscus is pricked after the suture is knotted, the influence on the popliteal tendon is avoided, the popliteal tendon split hole area is not narrowed, the common fibular nerve is not hurt, the operation accuracy is improved, the operation success rate is improved, the operation is simple, accurate and quick, and the operation time is saved;
2. the distal end of the guide tube is manufactured into different elevation angles and deflection angles relative to the horizontal transverse line according to the actual operation requirement, and is suitable for suturing at different positions around the popliteal tendon;
3. The meniscus suture device provided by the application can directly penetrate out of the body after the suture needle pierces the meniscus in the operation process, only an eye wound is left on the skin after the suture needle cuts out of the suture needle and is pulled back into the body, an outer side safety incision is not required to be formed on the skin of a patient, the influence on the tissue of the patient is small, the suture needle is not required to be guided out of the body from the safety incision by using a popliteal retractor, a thread grabbing device is not required to be used for grabbing the suture thread in a joint capsule, and the medical equipment is few, so that medical resources and cost are saved;
4. The meniscus suture instrument can realize a brand new operation mode of turning from inside to outside and can accurately perform operation even for patients with narrow gap outside knee joints.
The foregoing description is only illustrative of the present invention and is not intended to limit the scope of the invention, and all equivalent changes made by the specification and drawings of the present invention, or direct or indirect application in the relevant art, are included in the scope of the present invention.
Claims (8)
1. The meniscus suture instrument is characterized by comprising a guide tube and a quasi-position line piece, wherein the guide tube is an elongated tube, a guide needle through hole is formed in the guide tube, the quasi-position line piece comprises a lantern ring and a sliding part, the lantern ring is of an annular structure, an inner hole of the lantern ring is a needle passing through hole, the lantern ring is connected with the distal end of the sliding part, the sliding part is in sliding connection with the guide tube, the needle passing through hole is opposite to the outlet of the guide needle through hole, and the lantern ring is of a circular ring shape or an elliptical ring shape;
Still include adaptor and locating part, be equipped with the pipe mounting hole on the distal end terminal surface of adaptor, be equipped with first advance the pinhole on the proximal end terminal surface of adaptor, first advance the pinhole with the coaxial intercommunication of pipe mounting hole, the proximal end of stand pipe inserts in the pipe mounting hole of adaptor, the locating part is the annular structure, first ring, first accommodation space and first internal thread have been set gradually from distal end to proximal end in the hole of locating part, be equipped with first external screw thread on the distal end of adaptor, the sliding part proximal end of standard bit line spare is equipped with spacing flange, the proximal end slip of sliding part is in the hole of first ring, the spacing flange slip of sliding part is arranged in the first accommodation space, first internal screw thread with first external screw thread spiro union.
2. The inside-to-outside-to-inside meniscus suture apparatus according to claim 1, wherein the guide tube has a sliding track/at least two sliding protrusions on an outer circumferential surface thereof, the sliding portion of the alignment wire member has at least two sliding protrusions/sliding tracks, the sliding protrusions are limited and slide in the sliding track, and a side projection shape of the sliding protrusions is a circle, a more semicircular shape, a T shape or an inverted trapezoid shape.
3. The inside-to-outside-to-inside meniscus suture apparatus according to claim 1, wherein the sliding part of the level wire is of a tubular structure and is slidably sleeved on the outer circumferential surface of the guide tube.
4. The full-interior-to-exterior meniscus suture instrument of claim 1, wherein the proximal end of the sliding part of the level wire is of a tubular structure, a front guide ring is arranged on the distal end of the sliding part, the proximal end of the sliding part is slidably sleeved on the proximal outer circular surface of the guide tube, and the front guide ring is slidably sleeved on the distal outer circular surface of the guide tube.
5. The inside-out total internal meniscus suture apparatus of claim 4, wherein the proximal outer diameter of the guide tube is greater than the distal outer diameter.
6. The full-internal meniscus suture instrument of claim 1, further comprising a handle and a locking member, wherein a butt joint hole is formed in the distal end face of the handle, a second needle inlet hole is formed in the proximal end face of the handle, the butt joint hole is coaxially communicated with the second needle inlet hole, the proximal end of the adapter is inserted into the butt joint hole of the handle, the locking member is of an annular structure, a second inner circular ring, a second accommodating space and a second inner thread are sequentially arranged in an inner hole of the locking member from the distal end to the proximal end, a second outer thread is arranged on the distal end of the handle, a clamping flange is arranged in the middle of the adapter, the distal end of the adapter stretches into the inner hole of the second inner circular ring, and the clamping flange is arranged in the second accommodating space and is in threaded connection with the second outer thread.
7. The full-inside-out re-interior meniscus suture instrument of claim 1, wherein the distal end of the guide tube, the distal end of the level wire, is raised up by 10 ° to 45 °.
8. The inside-to-outside-to-inside meniscus suture instrument of claim 1 or 7, wherein the angle between the distal end of the alignment wire and the horizontal transverse line is-15 ° to-45 ° or 0 ° or 15 ° to 45 ° in a top view projection plane.
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202111626104.XA CN114191014B (en) | 2021-12-28 | 2021-12-28 | A meniscus suture device that can be turned from inside to outside and then all the way inside |
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| Application Number | Priority Date | Filing Date | Title |
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| CN202111626104.XA CN114191014B (en) | 2021-12-28 | 2021-12-28 | A meniscus suture device that can be turned from inside to outside and then all the way inside |
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| CN114191014B true CN114191014B (en) | 2024-11-22 |
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| CN103476346A (en) * | 2011-02-14 | 2013-12-25 | 史密夫和内修有限公司 | Method and device for suture retrieval |
| CN219271001U (en) * | 2021-12-28 | 2023-06-30 | 郑佳鹏 | Meniscus suture instrument capable of being changed from inside to outside to inside |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| US6893448B2 (en) * | 2001-10-23 | 2005-05-17 | Arthrex, Inc. | Endoscopic capsular suture plication instrument and method |
| US7118583B2 (en) * | 2001-10-23 | 2006-10-10 | Arthrex, Inc. | Meniscal suturing instrument and method |
| US8951263B2 (en) * | 2011-07-08 | 2015-02-10 | Smith & Nephew, Inc. | Orthopedic suture passer and method |
| DE102016122545A1 (en) * | 2015-11-23 | 2017-05-24 | Serag-Wiessner Gmbh & Co. Kg | Surgical suturing instrument for antegrade or screwing single sutures |
| CN208287039U (en) * | 2016-09-30 | 2018-12-28 | 广州迪克医疗器械有限公司 | Lead puncture needle |
| CN209059303U (en) * | 2018-05-30 | 2019-07-05 | 马佳 | A humerus locator and humerus locating system |
| CN210354795U (en) * | 2019-06-07 | 2020-04-21 | 张宪 | Novel meniscus full-internal stitching instrument |
| CN214318067U (en) * | 2020-08-19 | 2021-10-01 | 上海市浦东新区周浦医院 | Bone threading device |
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Patent Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN103476346A (en) * | 2011-02-14 | 2013-12-25 | 史密夫和内修有限公司 | Method and device for suture retrieval |
| CN219271001U (en) * | 2021-12-28 | 2023-06-30 | 郑佳鹏 | Meniscus suture instrument capable of being changed from inside to outside to inside |
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