JP6158494B2 - Percutaneous endoscopic disc herniation device - Google Patents

Description

  The present invention relates to a percutaneous endoscopic instrument that enables removal of a displaced lumbar disc herniation in percutaneous endoscopic surgery.

  A cross-sectional view of the lumbar spine is shown in FIG. The lumbar disc herniation 1 is a disease in which an intervertebral disc 2 between vertebral bodies rises toward the spinal canal 3 and the nerve roots there are compressed to cause neurological symptoms.

  Among the operations for removing the herniated disc, there is a percutaneous endoscopic lumbar disc herniation (PELD) performed using a percutaneous endoscopic system as a minimally invasive surgery. Surgery using a percutaneous endoscope system has a long cylindrical outer tube, a perfusion tube, and a light source of about 250 mm in an elongated cylindrical outer tube having a diameter of 7 to 8 mm and a length of about 170 mm. The resulting device is inserted, and an elongated instrument is inserted into the remaining space having a diameter of 3 to 4 mm to perform the operation. An endoscope is placed in a very narrow space, but a good visual field can be secured by flowing perfusion water. PELD is a very less invasive method, but the insertable instrument shaft is only 350mm long and 3mm to 4mm in diameter, so only thin and small instruments can be inserted. There are restrictions such as the need for a simple structure.

A conventional percutaneous endoscopic disc herniation forceps (or an instrument called percutaneous endoscopic grasping forceps) has two jaws at the end of a long shaft 8 as shown in FIG. 7 is a pair, and only one of them opens and closes, that is, moves and opens or bites in the direction of the mouth and mouth, or two jaw portions 9 pair and simultaneously open and close the mouth and mouth as shown in FIG. There are instruments. Some jaws move separately, but the structure is complicated and the size becomes large, and a large outer cylinder is required, making it difficult to adapt to normal PELD.
The mouth opening is a portion that contacts the object in the jaw, and exists in a direction in which the two pieces of the jaw face each other, and there is a dent in the center or a blade or a saw tooth on the edge. The chin mouth side direction is a direction in which the chin mouth is facing.

  As shown in FIG. 1, the PELD transvertebral foramen approach is a general approach in which the outer cylinder 5 is inserted from the lumbar posterior outer side and enters the intervertebral disc 2 via the intervertebral hole 4. The intervertebral foramen 4 is a space between the upper and lower pedicles, the upper joint process 6 and the intervertebral disc 2. FIG. 4 is a sagittal cross-sectional view of the intervertebral disc, and shows a state in which a conventional percutaneous endoscopic disc herniation forceps is inserted into the intervertebral disc and the jaw 7a is opened. The movement is restricted by the intervertebral foramen 4 and only the intervertebral hernia in the range from the vertebral body edge to the 5 mm length of the jaw part 7a of the forceps can reach. Even if the tip of the jaw 7a reaches the intervertebral disc herniation 10 with respect to the displaced disc herniation 10, the other jaw 7b is separated and cannot be removed because it cannot be pinched.

Spine Endoscopic Surgery-From Basic Techniques to Technology Certification-Chapter 4 Percutaneous Endoscopic Disc Herniation (PELD) P165-174 (Nanedo) Richard Wolf company catalog VERTEBRIS lumbar thoracic vertebra

As described above, it is difficult to remove a disc herniation that has been highly displaced under a percutaneous endoscope with a conventional instrument.
An instrument that can be inserted into a percutaneous endoscope system is small and long, and therefore needs to have a simple structure in order to obtain strength.

  Therefore, the percutaneous endoscopic instrument of the present invention is intended to enable extraction of a highly displaced intervertebral disc herniation while having a simple structure.

The percutaneous endoscopic instrument of the present invention has a single jaw at the tip of the shaft, and the jaw and the shaft are connected by a pivot shaft parallel to the mouth-mouth side direction of the jaw base. The sliding rod passing through the shaft is connected to the jaw by an axis parallel to the mouth-mouth side direction of the jaw base. The sliding bar is slid by the handle, and the jaw portion rotates in a plane perpendicular to the mouth-mouth side direction with the pivot shaft as a fulcrum.
The mouth opening, which is the portion of the jaw that contacts the object, has a dent in the center, and has a blade and a saw blade on the edge. The chin mouth side direction is a direction in which the chin mouth is facing.

  As shown in FIGS. 2 and 3, the conventional forceps has a pair of jaw parts, and the jaw part moves in a direction parallel to the mouth-mouth side direction, and the jaw part opens and closes. The present invention differs from them in that the jaw is only one piece, and the movement direction of the jaw is perpendicular to the mouth-mouth direction.

  FIG. 10 is a sagittal cross-sectional view of the intervertebral disc portion into which the instrument of the present invention is inserted. After the instrument of the present invention is inserted into the outer cylinder for a percutaneous endoscope and the jaw portion 22 reaches the intervertebral disc 2, the jaw portion 22 is rotated around the pivot shaft by a handle operation, and the jaw portion 22 is brought into contact with the displaced disc herniation 13 (FIG. 10 illustrates this state), and then the entire device is rotated about the long axis of the shaft so that the disc herniation is between the jaw opening and the vertebral bone surface 12. Then, the jaw 22 is pulled back while being rotated and moved to a range where it can be extracted with normal forceps, so that even a highly displaced intervertebral disk hernia can be extracted. In other words, only one piece of the jaw has reached the herniated disc, but it can be removed.

  Since the structure is simple, the contact area between the jaw and the shaft can be widened, the pivot shaft connecting the jaw and the shaft can be thickened, and the strength can be obtained, so that the jaw can be lengthened. As shown in FIG. 10, even if the jaw part is inserted into the back of the vertebral body, a space can be taken between the jaw part 22 and the vertebral body bone surface 12. Mirror work can be done.

  An embodiment of the present invention will be described with reference to FIGS. 5 is a side view of the distal end side of the instrument, FIG. 6 is a bottom view of the distal end side of the instrument (viewed from the mouth opening side), and FIG. 7 is a rear view of the distal end side of the instrument (a pair of jaw mouth sides). 8 is a mid-sectional view parallel to the pivot shaft 24 on the distal end side of the device, FIG. 9 is a mid-sectional view perpendicular to the pivot shaft 24 on the distal end side of the device, and FIG. It is a side view of a handle. The main structure includes a shaft 21, a front jaw portion 22, and a handle 27 on the proximal side of the shaft 21.

  A piece of jaw portion 22 is provided at the end of a shaft 21 having a length of about 350 mm, and the jaw portion 22 and the shaft 21 are connected by a pivot shaft 24 that is parallel to the mouth-mouth side direction 23 of the jaw portion base portion 22b. The sliding rod 25 passing through the shaft is connected to the jaw 22 by an axis 26 parallel to the mouth-mouth side direction 23 of the jaw base 22b (FIGS. 8 and 9). The sliding rod 25 is connected to the handle 27b and slides by operating the handle (FIG. 12). The jaw mouth surface of the jaw part 22 has a recess 28 at the center, and the edge part 29 has a blade-like or saw-tooth structure (FIG. 6).

  As shown in FIGS. 5, 8, and 10, the jaw tip 22a is slightly bent with respect to the jaw base 22b or straight like the jaw 22c of FIG.

It is an axial sectional view of a lumbar vertebra. This is a state in which an outer cylinder for a percutaneous endoscope is inserted. In the conventional percutaneous endoscopic disc herniation forceps, one piece is operated and the other piece is fixed, and an enlarged view of the front side. In a conventional percutaneous endoscopic intervertebral disc herniation forceps, two jaws are opened and closed simultaneously. It is a sagittal cross-sectional view of an intervertebral disc portion into which a conventional percutaneous endoscopic disc herniation forceps is inserted. It is a side view of the front end side of embodiment of this invention. It is a bottom view of the front end side of the embodiment of the present invention. It is a rear view of the front end side of embodiment of this invention. A mid-sectional view parallel to the pivot shaft on the distal end side according to the embodiment of the present invention The median sectional view perpendicular to the pivot shaft on the distal end side of the embodiment of the present invention It is a sagittal cross-sectional view of the intervertebral disc part into which the instrument of the embodiment of the present invention is inserted. It is a sagittal cross-sectional view of an intervertebral disc portion into which a device having a straight jaw portion according to an embodiment of the present invention is inserted. It is a side view of the handle of the embodiment of the present invention.

2 Intervertebral disc 11 Vertebral body 12 Vertebral bone surface 10, 13 Intervertebral disc herniation 21 Shaft 22 Jaw 23 Jaw mouth side direction 24 Pivot shaft 25 Slide rod 26 Shaft 27 Handle

Claims (4)

In a grasping and extracting device having an elongated shaft that can be inserted into a percutaneous endoscope system used for disc herniation, and having a jaw opening that is a portion that comes into contact with an object on a jaw,
It has a single jaw on the front side of the shaft, a handle on the hand side of the shaft,
The jaw part and the shaft tip side part are connected by a pivot shaft that penetrates the base part of the jaw part and is parallel to the mouth mouth side direction.
By the action of the sliding bar in the shaft which slides in steering, as a fulcrum jaws of the pivot shaft, it has rows rotation movement about the pivot shaft,
A transcutaneous endoscope characterized by sandwiching the displaced disc herniation between the jaw opening and the vertebral bone surface, pulling it back while rotating the jaw, and moving it to a range that can be removed with normal forceps Appliances. The sliding rod is connected to the jaw by an axis parallel to the jaw mouth side direction of the jaw,
2. The percutaneous endoscopic instrument according to claim 1, wherein the sliding bar is connected to the handle and is slid by the handle operation so that the jaw portion performs a rotating motion. The percutaneous endoscopic instrument according to claim 1 or 2, wherein the jaw portion has a blade or a saw blade at a marginal portion on the mouth opening side. 4. The percutaneous endoscopic instrument according to claim 1, wherein the tip of the jaw is straight with respect to the base or is slightly bent in the direction of the mouth and mouth.