A kind of complete interior stitching devices of tissue repairTechnical field
Patent of the present invention is related to a kind of complete interior stitching devices of tissue repair, can realize tissue damage with simple and efficientSutured in complete.
Background technology
Meniscus injury is the damage of common motion of knee joint, its treatment method according to damage location, scope, type andIt is different.Such as expectant treatment, ablation, total resection, suture prosthetic, meniscus prosthetic displacement technique, allogeneic meniscusTransplantation, engineered reconstruction etc., respectively there is each applicable part, clinically generally use arthroscope lower meniscus resection and halfMonth plate suture and neoplasty.Now, it is increasingly recognised that the importance of meniscus biomechanical function, increasing evidenceSupport retain periphery rupture meniscus, in addition meniscus joint nutrition, lubrication, stably, load transmit, buffering, this body-sensingEffect in terms of feel and prevention osteoarthrosis, the rupture to meniscus periphery are repaired, and retain first quarter moon plate shape as far as possibleState, function and biomechanics characteristic, have become the standard for the treatment of.At present in the case where clinical setting allows, arthroscope is carried out as far as possibleLower meniscus sutures, it has also become the main method of meniscus injury treatment.
Traditional arthroscope lower meniscus suture, surgeon can insert two sewing needles for being connected with suture in tissuePortion, the wound site of organization internal is passed a suture through, suture knots in tissue and fixed.Meniscus injury sewing methodMainly there are three kinds：Outside-interior suture；Interior-outer suture and complete interior suture.Outside-interior suture the advantages of be that otch is small, without special-purpose deviceTool, torn suitable for meniscus anterior angle；Interior-out-seam is properly used for relief angle and the outside of meniscus, and the visual field is good, and operation is more convenient,But since it is desired that posterior incisions, damage the risk for hindering neurovascular structure；The advantages of being sutured in complete is that otch is small, without special-purpose deviceTool, the visual field is good, safe and simple, convenient and swift, is sutured suitable for first quarter moon board body part and relief angle.
Meniscus suture is required for extra otch by the way of interior-outer or outer-interior, to avoid neural blood vessel damage alsoNeed to separate institutional framework, and it is also possible to cause capsular ligament contracture, limitation of activity, neuroma row into.Due toExcessive tissue has been ligatured in suture knots, it is not good enough to also result in suture tension force.Sewing method can be in no neural blood vessel in completeHorizontally or vertically formula mattress suture is carried out under the risk of damage, is provided for doctor that firm, repetition has been given birth to, credible and time savingMeniscus repair technology.
At present, the meniscus sewing system of Clinical practice has easy to operate, the advantages, wherein meniscus spiral shell such as development is fastNail, meniscus arrow are most popular meniscal repairs methods, but external biological mechanics study shows that its fixing intensity is relatively low.Existing meniscus stitching unstrument has Meniscal CinchTM, SEQUENTTM,Deng product, generally existing is fixedThe problems such as nail individual is big, easily abjection, easily causes secondary injury to tissue, and doctor can not puncture again.
The content of the invention
For overcome the deficiencies in the prior art, the invention provides a kind of complete interior stitching devices of tissue repair.It is described complete interiorStitching devices limit pipe by the first holdfast, the second holdfast, suture, interior pin, outer pin, depth and the part of handle 7 forms, and described theOne holdfast and the second holdfast are connected by suture Slipped Clove Hitch, the suture Slipped Clove Hitch can make between the first holdfast and the second holdfast away fromIt can not extend from that can only shorten, first holdfast, the second holdfast and suture can be embedded into outer pin, and the outer pin can carryFirst holdfast, the second holdfast and suture, which puncture, enters organization internal, and the depth limits pipe and can limited in outer pin insertion tissueDepth, the handle part is made up of multiple parts such as push rod, and the handle push rod can promote interior needle movement to make the first anchorNail and the second holdfast individually skid off outer pin and are anchored in tissue surface.
It is preferred that the first holdfast of the complete interior stitching devices has one or more threading holes.
It is preferred that the aperture of the threading hole of the first holdfast of the complete interior stitching devices is between 0.1-0.6mm.
It is preferred that it is described it is complete in stitching devices the first holdfast thickness between 0.1-2mm, it is described it is complete in stitching devicesThe first holdfast length between 1-10mm, it is described it is complete in stitching devices the first holdfast width between 0.5-5mm.
It is preferred that the second holdfast of the complete interior stitching devices has one or more threading holes.
It is preferred that the aperture of the threading hole of the second holdfast of the complete interior stitching devices is between 0.1-0.6mm.
It is preferred that it is described it is complete in stitching devices the second holdfast thickness between 0.1-2mm, it is described it is complete in stitching devicesThe second holdfast length between 1-10mm, it is described it is complete in stitching devices the second holdfast width between 0.5-5mm.
It is preferred that the first holdfast and the second holdfast of the complete interior stitching devices are connected by suture Slipped Clove Hitch.
It is preferred that the suture of the complete interior stitching devices continues to pass through the threading hole of the first holdfast and the second holdfast, lead toThe mode for crossing Slipped Clove Hitch connects with the first holdfast, the second holdfast respectively so that the suture length between the first holdfast and the second holdfastIt can shorten, but can not extend.
It is preferred that it is described it is complete in the sutures of stitching devices formed by polyester fiber braiding, polyester include terephthalic acid (TPA),Dimethyl terephthalate (DMT), ethylene glycol, ultra-high molecular weight polyethylene, PETP, PET,One or more in polypropylene, polybutylene terephthalate, oxirane.
It is preferred that the first holdfast of the complete interior stitching devices is prepared by high polymer material, including polyethylene, poly- ammoniaOne or more in ester, PLA, makrolon, polyether-ether-ketone Polymer material.
It is preferred that the second holdfast of the complete interior stitching devices is prepared by high polymer material, including polyethylene, poly- ammoniaOne or more in ester, PLA, makrolon, polyether-ether-ketone Polymer material.
It is preferred that the outer pin of the complete interior stitching devices is hollow tubular structure.
It is preferred that a part for the outer pin of the complete interior stitching devices is placed in the tube chamber that depth limits pipe, outer needle tipIt is exposed to limit pipe cladding without depth.
It is preferred that the outer needle tip of the complete interior stitching devices has needle point cross section, beneficial to tissue penetration.
It is preferred that the outer pin of the complete interior stitching devices is the arc or straight of certain length close to one end of needle point.
It is preferred that it is described it is complete in the outer pin needle point trailing edges of stitching devices slotted away from the direction of needle point, outer needle tray andThe hollow tube chamber of outer pin communicates.
It is preferred that the length of the outer pin needle tray of the complete interior stitching devices, between 5-30mm, the width of outer pin needle tray existsBetween 0.1-1.5mm.
It is preferred that the first holdfast, the second holdfast and the suture of the complete interior stitching devices are first connected and are embedded into outerIn pin.
It is preferred that it is described it is complete in stitching devices the first holdfast be connected with suture after be embedded into completely in outer needle lumen orThe part of first holdfast is embedded into outer needle lumen.
It is preferred that the first holdfast, suture and the second holdfast of the complete interior stitching devices can be outside along outer pin needle trayPin needle point direction is slided and skidded off outside pin, discharges into tissue.
It is preferred that the second holdfast of the complete interior stitching devices is coated and fixed in outer pin needle tray away from pin by flexible pipe for medical purposeThe rear end of point.
It is preferred that the interior pin of the complete interior stitching devices is placed in the hollow lumen of outer pin.
It is preferred that the described complete interior one end of the interior pin of stitching devices away from handle part has certain radian.
The interior needle set of stitching devices has certain radian, and pin can be by outer needle tray in reciprocatory movement in guaranteeFirst holdfast, suture and the second holdfast release outer pin, discharge into tissue.
It is preferred that the interior pin and outer pin of the complete interior stitching devices are all fixed on the part of handle.
It is preferred that the handle part of the complete interior stitching devices can promote interior pin to be carried out in outer needle lumen towards needle pointOr the reciprocating motion away from needle point direction.
Interior pin, the first holdfast, the second holdfast are all located in outer pin hollow lumen, can be driven by the motion of handle partThe reciprocating motion of interior pin, so as to realize the slip of the first holdfast, the second holdfast and suture in outer needle tray, and finally from outer pinDischarged in groove.
It is preferred that the interior pin of the complete interior stitching devices can promote the first holdfast and suture individually to skid off outer pin.
It is preferred that the interior pin of the complete interior stitching devices can promote the second holdfast and suture individually to skid off outer pin.
It is preferred that it is described it is complete in stitching devices handle on depth limiting pole can promote depth limit pipe carry out towards needle point orReciprocating motion away from needle point direction, limit outer pin puncture depth.
It is preferred that the depth of the complete interior stitching devices limits and is labeled with graduation mark on pipe.
It is preferred that the push rod of the handle of the complete interior stitching devices is centrosymmetric structure, the operation of push rod is not by angleLimitation.
The present invention is allowed to compared with prior art, have the advantages that due to using above technical scheme：
(1) suture passes through the threading hole on the first holdfast and the second holdfast in the present invention, and is connected by way of Slipped Clove HitchIt is connected on the first holdfast and the second holdfast, suture can only slide along the single direction of Slipped Clove Hitch so that the first holdfast and secondLength between holdfast can only shorten, it is impossible to extends, and suture Slipped Clove Hitch is preset, medical personnel knot without scene, as long as closingThe free end can of the outer drawing suture of section tightens up suture, plays a part of closing wound, and without worrying that suture is anti-The problem of direction is slided, and wound splits again, solves the problems, such as suture way quick closedown wound in complete；
(2) first holdfasts, suture and the second holdfast are built in outer needle lumen, enter the process of tissue in outer pin punctureIn, seamless carrying holdfast enters in tissue, while the first holdfast and the second holdfast profile are smaller, and holdfast outer surface is designed to streamlineType structure, during penetrating tissue and entering release site, resistance is smaller, minimizes wound face, reduces to tissueInjury；
The threading hole of (3) first holdfasts and the second holdfast is distributed on the axis of holdfast, is ensured in surgical procedure and holdfastWhen suture is pulled after implanting, holdfast entirety uniform force, holdfast contacts with tissue maximum area, and " holdfast-tissue " connectsContacting surface uniform force, avoid being chronically implanted in physiological disposition, holdfast discontinuity wound to caused by contact tissue surface；
(4) first holdfasts are embedded in outer needle lumen, and the second holdfast is coated and fixed in outer needle tray by one section of flexible pipe for medical purposeRear end away from needle point, during outer pin puncture is into tissue or from tissue pumpback, the first holdfast and the second holdfast are all the timeIt is positioned in outer needle tray, without worrying that the first holdfast and the second holdfast are deviate from, this just repositions suture site to doctor and providedFeasibility, when doctor excites the second holdfast if can deciding in its sole discretion, facilitate doctor's clinical manipulation；
(5) depth of depth restriction pipe can adjust as needed, to establish minimum, safest paracentesis depth, ensure anchorFollow closely optimal indwelling site.
(6) handle and push rod are centrosymmetric structure, it is possible to achieve 360 degree of forward operations, do not limited by work angle,Whole one-handed performance can be achieved, facilitate Clinical practice.
Brief description of the drawings
, can the clearer above-mentioned and other feature for understanding the present invention and excellent by detailed description below with reference to accompanying drawingPoint, wherein：
Fig. 1 is the staight needle structural representation of the complete interior stitching devices of the present invention；
Fig. 2 is the first anchor structure schematic diagram of the complete interior stitching devices of the present invention；
Fig. 3 is the second anchor structure schematic diagram of the complete interior stitching devices of the present invention；
Fig. 4 is the outer needle construction schematic diagram of the complete interior stitching devices of the present invention；
Fig. 5 is the interior needle construction schematic diagram of the complete interior stitching devices of the present invention；
Fig. 6 is that the depth of the complete interior stitching devices of the present invention limits tubular construction schematic diagram；
Fig. 7 is complete interior first holdfast of stitching devices of the present invention and the distribution schematic diagram of the second holdfast；
Fig. 8 is that the first holdfast of the complete interior stitching devices of the present invention discharges schematic diagram；
Fig. 9 is the first default bitmap of holdfast tissue of the complete interior stitching devices of the present invention；
Figure 10 is that the second holdfast of the complete interior stitching devices of the present invention discharges schematic diagram；
Figure 11 is the second default bitmap of holdfast tissue of the complete interior stitching devices of the present invention；
Figure 12 is the staight needle structural representation of the complete interior stitching devices of the present invention；
Figure 13 is the recurvation needle construction schematic diagram of the complete interior stitching devices of the present invention.
Embodiment
The invention provides a kind of complete interior stitching devices of tissue repair, can realize the complete of tissue damage with simple and efficientInterior suture.The stitching devices limit several portions such as pipe and handle by the first holdfast, the second holdfast, suture, interior pin, outer pin, depthIt is grouped into, wherein suture is connected to by way of Slipped Clove Hitch between the first holdfast and the second holdfast, and handle part includes push rodAnd other parts.
In stitching devices in use, connecting and being embedded in advance outer by suture Slipped Clove Hitch between the first holdfast and the second holdfastIn pin needle tray, depth limits pipe can slide the depth limited in outer pin insertion tissue along outer pin, and the push rod of handle can promote interior pinThe release for completing the first holdfast and the second holdfast is moved back and forth, the first holdfast and the second holdfast can individually discharge outer pinGroove.
The application method of full inner tissue stitching unstrument is as follows：A, stitching devices include the first holdfast, the second holdfast, suture canThat slides is connected on holdfast；B, the first holdfast is placed in tissue；C, suture is passed through into wound；D, the second holdfast is placed inTissue；E, the length of the suture between first, second holdfast is shortened in the free end for pulling suture, therefore sews up a wound.
Below with regard to specific embodiment, it is described further.Following examples are only used for carrying out technical schemeFor example, to help those skilled in the art to further appreciate that technical scheme, embodiment therein is to thisThe protection domain of invention does not produce restriction effect.
Embodiment one
This implementation provides a kind of complete interior stitching devices of tissue repair, and stitching devices are by the first holdfast, the second holdfast, seamZygonema, interior pin, outer pin, depth limit a few part compositions such as pipe and handle, refer to Fig. 1.In the present embodiment, to handle, outerAciculiform shape, the quantity of the shape of the first holdfast and the second holdfast and its threading hole, size are only to illustrate, shape shown in it,Quantity, size do not form the limitation of the quantity, size to each building block of patent of invention.
In the present embodiment, the first holdfast, the second holdfast be different from other stitching unstruments holdfast, holdfast it is smaller, outsideThe smooth tissue preferably that penetrates of shape is positioned at tissue surface, and in the present embodiment, single holdfast sets two threading holes altogether, and this twoThe holdfast of position relationship first of individual threading hole refers to Fig. 2, and the second holdfast refers to Fig. 3, threaded in other embodiments in additionHole may be alternatively provided as other quantity and other distributions.
Threading hole is distributed on the axis of holdfast, is ensured when pulling suture after surgical procedure and holdfast implant,Holdfast entirety uniform force, holdfast contact with tissue maximum area, " holdfast-tissue " contact surface uniform force.
The size of first holdfast threading hole is 0.1-0.6mm, preferably in the range of 0.25-0.45mm；
The thickness of first holdfast is between 0.1-2mm, preferably in the range of 0.4-1.2mm；First holdfast length is in 1-Between 10mm, preferably in the range of 3-8mm；The width of first holdfast is between 0.5-5mm, preferably in the range of 1-3mm；
The size of second holdfast threading hole is 0.1-0.6mm, preferably in the range of 0.25-0.45mm；
The thickness of second holdfast is between 0.1-2mm, preferably in the range of 0.4-1.2mm；Second holdfast length is in 1-Between 10mm, preferably in the range of 3-8mm；The width of second holdfast is between 0.5-5mm, preferably in the range of 1-3mm；
In the present embodiment, outer pin as shown in figure 4, interior pin as shown in figure 5, interior pin is placed in inside outer pin, outer pin is placed in depthDegree is limited in pipe, and it is as shown in Figure 6 that depth limits pipe.First holdfast is completely disposed in the hollow tube chamber of outer pin, the positioning of the second holdfastIn the outer one end of pin needle tray away from needle point, as shown in Figure 7.
In use, depth restriction pipe, is adjusted to by depth needed for being determined first with meniscus depth probe outside jointRequired length, the graduation mark of outer pin needle point is referred to as reference, depth limits pipe without taking out, and taking-up can cause suture to relaxWith prefabricated knot suture " tangling ".Depth limits pipe and can also used as slot sleeve pipe, can reduce scraping of the fat pad to implant,Positioning of the sewing needle in intracavitary is helped, application method is to pin the deep sliding block of limit to cross outer pin needle point up to depth limits pipe, is suturedDevice enters in articular cavity along slot sleeve pipe, is removable sleeve pipe after sewing needle enters joint, limits deep sliding block and reposition limitDeep degree continues to use as depth restriction pipe.
After the outer pin of the stitching devices of the invention enters joint, outer pin is positioned at the upper of tear portion under arthroscopeSide, distance tear edge about 5mm, outer pin puncture meniscus in place after, the push rod on driving handle, push rod connection interior pin promoteFirst holdfast moves to outside needle point, as shown in figure 8, push rod " " the first holdfast is released after sound, unclamping push rod resets push rod,The positioning of the first holdfast is completed, as shown in Figure 9；Outer pin is repositioned to the lower section at tear position under arthroscope, now stitchedZygonema tears edge about 5mm perpendicular through wound, entry point distance, after puncturing meniscal tissue in place, pushing away on driving handleBar, the interior pin of push rod connection promote the second holdfast to be moved to outside needle point, as shown in Figure 10, promote push rod " " the is released after soundTwo holdfasts, the positioning of the second holdfast is completed, as shown in figure 11；After second holdfast excites, stitching unstrument can take out out of articular cavity.SeamClutch exposes the free end of preset Slipped Clove Hitch suture, the first anchor can be shortened by pulling the free end of suture after intracavitary taking-upDistance between nail and the second holdfast, close wound.Suture through knot thread cutter and is tightened up into free end, finally promotes trimmingDevice top shoe, trimming action is completed, that is, completes the complete interior suture of meniscus.
In the present embodiment, the outer needle set of complete interior stitching devices has certain radian, in other embodiments, can also use straightThe outer pin of line style, meet the needs of meniscus multi-angle suture.
Embodiment two
Present embodiments provide the complete interior stitching devices of another tissue repair, the present embodiment it is different from embodiment one itIt is in the radian of outer pin front end is different, see Figure 12.
Embodiment three
Present embodiments provide the complete interior stitching devices of another tissue repair, the present embodiment it is different from embodiment one itIt is in the direction of the bending of outer pin front end is different, see Figure 13.