JP4181599B2 - Puncture device - Google Patents

Description

  The present invention relates to a puncture device capable of performing drug injection or laser irradiation on a target site in the body or aspirating a substance in the body from a target site.

  The spine is formed by vertically overlapping 24 vertebrae, and an intervertebral disc is connected between the vertebrae. As shown in FIG. 5, the intervertebral disc is a discoid cartilage and has a structure in which the annulus fibrosus surrounds the central jelly-like nucleus pulposus, and has a function of softening the impact. The vertebra is composed of a vertebral body and a back vertebral arch, and a vertebral foramen is formed between the vertebral arches. The spinal cord runs through this vertebral foramen.

  Intervertebral hernia occurs in vertebrae such as the cervical vertebrae and lumbar vertebrae, and the annulus fissures are cracked, and the nucleus pulposus inside is protruding (escape type), or there is no fissure in the annulus and the nucleus pulposus and annulus fibrosus It is a state of swelling together (bulging type), and the spinal cord and nerve roots on the dorsal side are pressed by the protruding (bulging) nucleus pulposus, causing symptoms such as severe pain and swelling.

  Treatment includes conservative therapy and surgery. If conservative therapy does not cure, surgery is performed. Surgery includes the Love method to remove the hernia, vertebral body fusion, puncture method, injecting enzyme into the intervertebral disc to reduce internal pressure, and depressing the nerve root under pressure stimulation, There is a percutaneous nucleusectomy that partially removes the nucleus pulposus by using external approach without using it, and lowers the internal disc pressure.

  Of these, when treatment is performed using a drug, such as intravertebral enzyme injection therapy, it is necessary to accurately inject the drug into the affected area. Similarly, accuracy is required when a contrast agent is injected. In order to inject a drug or a contrast medium, a needle is usually punctured using a puncture device, and a drug or the like is injected from the tip opening of the needle.

  However, in the operation, the direction of puncturing the needle is limited to a certain direction from the oblique back side due to the positional relationship of the spinal cord, internal organs, bones, and the like (FIG. 5). Therefore, since the drug or the like is injected only in the needle puncture direction (needle insertion direction), the drug is injected into the entire intervertebral disc, and the drug acts on the part other than the affected part. Thus, conventionally, it is difficult to inject a drug in a direction different from the puncture direction, and it is difficult to make the drug act on the affected area in a limited manner.

Therefore, Patent Document 1 discloses an apparatus and a method for entering the inside of an intervertebral disc in order to perform a function inside the intervertebral disc. The device is configured to have a lumened catheter, a distal portion and a proximal portion, and to be located within and move relative to the lumen of the catheter A guide wire, which can guide itself to a selected portion of the disc within the inner portion of the intervertebral disc, and the catheter guides to the selected portion within the inner portion of the disc It can be advanced with respect to the guide wire so as to follow the path of the wire.
Special table 2003-523258 gazette

  However, since the device described in Patent Document 1 extends the guide wire from the distal end of the catheter, the mouth of the catheter cannot be forcibly directed in a direction different from the puncture direction. In addition, the guide wire only moves forward through the inner wall of the annulus, and its movement cannot be controlled, and it is difficult to guide the catheter to the target location.

  An object of this invention is to provide the puncture apparatus which can act on the target location reliably in view of the said subject.

  In order to achieve the above object, the present invention provides a lumen-like puncture body having a projecting opening on a side surface, an action body accommodated in the puncture body and having an action portion acting on the body, and a action portion of the action body protruding. A puncture device comprising a guiding means for projecting laterally from the mouth.

  Since the action part can be protruded laterally from the protrusion formed on the side surface of the puncture body, the action part can be directed in a direction different from the puncture direction. Therefore, it can be preferably used when the puncture direction is limited by the arrangement of nerves, bones, viscera, etc., as in the case of surgery for intervertebral disc herniation. Moreover, since an action part can be turned to the opening direction of a protrusion port, directivity is high.

  The number of protrusions may be at least one, but may be plural. Further, the formation position is preferably the tip side of the puncture body, but is not limited to this.

  The action part is a part that exerts some action on the body, for example, an injection port for injecting a substance such as a drug, a contrast agent, an implant, a suction port for removing a body substance, heat, light, Examples include, but are not limited to, an electrical working point such as a laser and a lens of an imaging device. That is, the action body can be changed according to the purpose, such as a tube (catheter) for injecting or sucking a substance into the body, a member for giving an electric action such as laser irradiation, an imaging device, or the like. The formation position of the action part may be the tip of the action body or the side surface.

  As the guiding means, the working body itself may be formed of a shape memory material, and the working part may protrude from the projecting port under a predetermined condition, or the working body may be supported by another material such as a wire, You may make it protrude from a protrusion port. In the latter case, another material such as a wire may be made of a shape memory material, and the action part may be projected from the projecting port under a predetermined condition. However, the guiding means is housed in the puncture body and the action body is guided. And a moving means for moving the wire from the protruding port to the side of the puncture body. As the wire exits and retracts from the projecting port, the action portion can be projected or accommodated.

  The moving means can move the wire in the length direction with respect to the puncture body. When the wire is moved to the distal end side of the puncture body, the wire is bent in the puncture body, and a part of the wire can be protruded from the projection opening. As the wire protrudes, the action portion supported by the wire can protrude from the protrusion. On the other hand, if the wire is moved to the proximal side of the puncture body, the bending of the wire in the puncture body is eliminated and the wire returns to a straight line. As the wire moves, the action portion can be accommodated in the puncture body. With such a simple configuration, the operation portion can be protruded and accommodated. In order to cause the wire to bend, the vicinity of the tip of the wire may be fixed to the puncture body or brought into contact with the stopper.

  More specifically, the moving means is composed of an operation portion that is rotatable about the puncture body, and a wire support portion that is screwed to the operation portion and is restricted from rotating. By doing so, the wire support portion and the wire supported by the wire support portion can be moved in the longitudinal direction with respect to the puncture body.

  As another configuration of the moving means, the operation unit may be screwed and coupled to the puncture body so as to advance and retreat in the length direction, and the wire may be rotatably supported. If the operation part is moved to the distal end side of the puncture body, the wire is bent in the puncture body, and the action part can be protruded from the projection opening. At this time, since the wire is supported by the operating portion so as to be rotatable about the axis, the wire does not need to be rotated.

  Furthermore, as another configuration of the moving means, the wire portion may be bent or restored to a linear shape by operating a pistol type lever, or the operating portion may be shaped like a piston like a syringe. By pushing and pulling, the wire portion may be bent or restored to a straight line.

Moreover, the moving means can adjust the protrusion amount of the action part. Since the amount of movement of the wire, the amount of protrusion of the wire, and the amount of protrusion of the action portion are proportional to each other, the amount of protrusion of the action portion can be adjusted by adjusting the movement distance of the wire by the moving means.

  Furthermore, the moving means can change the direction of the action portion. According to this configuration, a more accurate operation is possible.

  In addition, the support of the action body by the wire may be fixed to the action body by means such as adhesion or fastening, but when the action body is in a tube shape, it is supported by inserting the wire into the cylinder. can do. Inserting it into the cylinder is preferable because the movement of the wire can be accurately transmitted to the working body.

  According to the present invention, since the action part can be protruded from the protrusion port formed on the side surface of the puncture body, the action part can be directed in a direction different from the puncture direction. Therefore, it can be preferably used when the puncture direction is limited by the arrangement of nerves, bones, viscera, etc., as in the case of surgery for intervertebral disc herniation.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. 1A and 1B are perspective views of the puncture device of the present embodiment, in which FIG. 1A is a diagram showing a protruding state of the action portion, FIG. 1B is a diagram showing a storage state of the action portion, and FIG. FIG. 3 is an exploded perspective view of the device, FIG. 3 is a cross-sectional view of the puncture device of the present embodiment, (a) is a side cross-sectional view showing the protruding state of the action part, and (b) is a side cross-sectional view showing the storage state of the action part FIG. 4 is an enlarged cross-sectional view of a main part of the puncture device of the present embodiment, in which FIG. 4A is a side cross-sectional view showing a protruding state of the action part, and FIG. FIG. 5 is a diagram showing a usage state of the puncture device of the present embodiment.

  As shown in FIGS. 1 to 4, the puncture device 1 according to the present embodiment includes a lumen-like puncture body 2 having a protruding port 2 a on a side surface, and an action portion 3 a that is accommodated in the puncture body 2 and acts on the body. And a guiding means 4 for projecting the acting portion 3a of the tube 3 from the projecting opening 2a and guiding it in a predetermined direction. The guiding means 4 includes a wire 5 that is accommodated in the puncture body 2 and guides the acting body, and a moving means 6 that moves the wire 5 so as to be retractable and retractable from the protruding port 2a.

  The puncture body 2 is a cylindrical body made of stainless steel having a lumen portion inside and a protruding port 2a on the side surface, and the tip is closed in a tip shape. The material of puncture body 2 is not limited to the above, and other materials such as nitinol may be used. The protrusion port 2a is formed with one vertically long opening in the axial direction on the side surface on the distal end side of the puncture body 2. In addition, a connecting portion 2b for connecting to a handle portion 7 to be described later is provided at the open end on the proximal side of the puncture body 2. The connecting portion 2b includes an insertion portion 2c that is inserted into the handle portion 7 and a stopper 2d.

  The tube 3 is a cylindrical resin tube, and the opening on the distal end side serves as the action portion 3a. In addition, you may provide the opening used as the action part 3a in the side of the tube 3. As shown in FIG. The material of the tube 3 can be changed to other materials such as rubber as long as the material is flexible enough to protrude from the protrusion 2a. The tube 3 has a wire 5 inserted therein, and a proximal end thereof is fixed to a wire support portion 9 described later together with the wire 5. The tip (acting portion 3a) of the tube 3 is disposed at a position facing the protruding port 2a.

  The wire 5 is made of Nitinol and is formed in a linear shape, and the tip of the wire 5 is disposed at a position where the tip of the wire 5 comes into contact with the tip of the puncture body 2 and is fixed to the inner surface of the puncture body 2. The material of the wire 5 may be any material as long as it has rigidity enough to guide the tube 3, and other materials such as other metals such as stainless steel and resin may be used. The shape of the wire 5 is not limited to a linear shape, and may be formed in other shapes such as a tape shape. Furthermore, a form in which the tip of the wire 5 is not fixed to the puncture body 2 or a form in which the tip of the wire 5 is separated from the tip of the puncture body 2 may be adopted. If the wire 5 is moved toward the distal end side of the puncture body 2 by the moving means 6, the distal end of the wire 5 comes into contact with the distal end of the puncture body 2, so that the wire 5 can be bent.

  The moving means 6 includes a lumen-like handle portion 7 fixed to the puncture body 2 and a lumen-like operation portion 8 that is supported by the handle portion 7 so as to be axially rotatable and has a screw portion 8a formed on the inner peripheral surface thereof. And a wire support portion 9 which is accommodated in the handle portion 7 and the operation portion 8 and is screwed with the screw portion 8a of the operation portion 8 and formed on the outer peripheral surface. The handle portion may be formed integrally with the puncture body.

  The handle part 7 and the operation part 8 are made of metal or resin. The handle portion 7 has a threaded portion 7a formed on an end peripheral surface on the distal end side, and after the insertion portion 2c of the connecting portion 2b of the puncture body 2 is inserted into the threaded portion 7a, the handle portion 7 is fixed by a nut 10 The handle portion 7 and the puncture body 2 can be connected and fixed. Further, an enlarged portion 7b having an inner diameter larger than the other is formed in a step shape at the proximal end portion of the handle portion 7, and the operation portion 8 is fitted into the enlarged portion 7b so as to be rotatable about the shaft. . A groove 8b is formed on the outer peripheral surface of the operation portion 8 in the circumferential direction, and the handle portion 7 moves in the axial direction of the operation portion 8 by fitting the fixing pin 7c on the inner surface of the enlarged portion 7b into the groove 8b. regulate. Furthermore, a grip portion 7d is provided on the outer peripheral surface of the proximal end portion of the handle portion 7 so that the side view is substantially T-shaped. The grip portion 7d makes it easy to grip the handle portion 7.

  The wire support portion 9 is a cylindrical body, and fixes the wire 5 and the proximal end of the tube 3. The wire support portion 9 is accommodated in the handle portion 7 and the operation portion 8. Further, a screw portion 9 a is formed on the peripheral surface of the wire support portion 9, and is screwed and coupled to the screw portion 8 a of the operation portion 8. In addition, a groove 9c extending in the axial direction is formed on the outer peripheral surface of the wire support portion 9, and the handle portion 7 is attached to the shaft of the wire support portion 9 by fitting the fixing pin 7e on the outer surface of the handle portion 7 into the groove 9c. The rotation is restricted. In addition, it is connected from the opening 9b of the proximal end of the wire support part 9 to the action part 3a of the tube 3, and a chemical | medical agent can be inserted from the opening 9b of the wire support part 9, and can be discharged | emitted from the action part 3a.

  With the above configuration, the operation unit 8 is restricted from moving in the axial direction, and the wire support unit 9 is restricted from rotating in the axial direction. Therefore, the operation unit 8 is pivoted with respect to the handle unit 7 (puncture body 2). By rotating, the wire support portion 9 and the wire 5 screwed to the operation portion 8 can be moved in and out of the puncture body 2 in the length direction. That is, the operation portion 8 is configured such that the wire 5 is bent by moving the wire support portion 9 toward the distal end, and conversely, the bending of the wire 5 is released by moving the wire support portion 9 toward the proximal side. The amount of bending of the wire 5 can be adjusted by the rotating operation. Further, since the amount of bending of the wire 5 is proportional to the amount of protrusion of the wire 5 from the protrusion 2a, that is, the amount of protrusion of the action portion 3a, the amount of protrusion of the action portion 3a can be adjusted. Furthermore, since the wire 5 protrudes in a mountain shape from the protrusion 2a, the angle of the inclined surface of the mountain can be changed by the amount of protrusion of the wire 5, and the direction of the action portion 3a can be changed.

  A case of performing an operation for intervertebral disc herniation using the puncture apparatus 1 having such a configuration will be briefly described with reference to FIG. In the case of intravertebral enzyme injection therapy in which a drug such as an enzyme is injected into the intervertebral disc to reduce the internal pressure and the nerve root under pressure stimulation is decompressed, the patient is first placed in the puncture body 2 while the tube 3 is accommodated in the puncture body The portion of the puncture body 2 is punctured obliquely from the back side of the limb. Then, the handle portion 7 is rotated about the axis so that the direction of the protrusion 2 a is directed toward the affected area, and then the operating portion 8 is rotated about the axis, so that the action portion 3 a is protruded together with the wire 5. And after adjusting the protrusion amount of the wire 5 so that the action part 3a may face an affected part, a chemical | medical agent is thrown in from the opening 9b, and a chemical | medical agent is discharged | emitted from the action part 3a through the wire support part 9 and the tube 3. FIG. Thus, since the action part 3a can be directed to an affected part, a chemical | medical agent can be made to act on an affected part effectively.

  In addition, this invention is not limited to the said embodiment, Of course, many corrections and changes can be added to the said embodiment within the scope of the present invention. For example, in the above-described embodiment, the case of performing an operation for intervertebral hernia has been described. However, the present invention can be applied to the operation of other body parts such as an eyeball.

It is a perspective view of the puncture apparatus of this embodiment, (a) is a figure which shows the protrusion state of an action part, (b) is a figure which shows the accommodation state of an action part. An exploded perspective view of the puncture device of the present embodiment It is sectional drawing of the puncture apparatus of this embodiment, Comprising: (a) is side sectional drawing which shows the protrusion state of an action part, (b) is side sectional drawing which shows the accommodation state of an action part It is principal part expanded sectional drawing of the puncture apparatus of this embodiment, Comprising: (a) is side sectional drawing which shows the protrusion state of an action part, (b) is front sectional drawing which shows the accommodation state of an action part The figure which shows the use condition of the puncture apparatus of this embodiment

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Puncture apparatus 2 Puncture body 2a Protrusion port 3 Tube 3a Action part 4 Guide means 5 Wire 6 Movement means 7 Handle part 8 Operation part 9 Wire support part 10 Nut

Claims (6)

A lumen-like puncture body having a projecting opening on the side surface, an action body housed in the puncture body and having an action portion acting on the body, and a guiding means for projecting the action portion of the action body sideways from the protrusion opening It equipped with a door,
The guide means includes a wire that is housed in the puncture body and guides the working body, and a moving means that moves the wire from the protruding port to the side of the puncture body so as to be retractable and retractable.
The tip of the wire is fixed to the puncture body, and the moving means moves the wire in the length direction with respect to the puncture body, thereby bending the wire and causing a part of the wire to protrude from the projection opening. A puncture device characterized in that the action portion is protruded laterally from the protrusion . The puncture apparatus according to claim 1 , wherein the action body is a tube, and the wire is inserted into the tube. The moving means is composed of an operation portion that is rotatable about the puncture body, and a wire support portion that is screwed to the operation portion and whose rotation is restricted, and the puncture body is rotated by rotating the operation portion. lancing device according to claim 1 or 2, characterized in that to move the wire in its longitudinal direction relative to the body. Said moving means, puncturing apparatus according to claim 1, characterized in that it is capable of adjusting the amount of projection of the working portion. The puncture apparatus according to any one of claims 1 to 4 , wherein the moving means is capable of changing a direction of the action portion. The puncture device according to any one of claims 1 to 5, which is used for an intervertebral disc.

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