CN101502430A - 带有齿轮传动式复位机构的外科钉合器械 - Google Patents
带有齿轮传动式复位机构的外科钉合器械 Download PDFInfo
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Abstract
本发明涉及带有齿轮传动式复位机构的外科钉合器械。外科器械包括击发驱动装置以及反向驱动装置,该击发驱动装置用于选择性地相对于端部执行器推进击发件和/或切割件,该反向驱动装置用于选择性地相对于端部执行器回缩击发件和/或切割件。击发驱动装置可包括棘爪,该棘爪可选择性地与击发件接合以推进击发件,其中,当反向驱动装置与击发件接合时,棘爪可从击发件脱开。反向驱动装置可包括具有第一齿轮、第二齿轮的齿轮组,第一齿轮与击发件可操作地接合,第二齿轮与第一齿轮可操作地接合,其中第二齿轮可以选择性地与扳机可操作地接合,使得扳机的致动可经由第一齿轮和第二齿轮回缩击发件和/或切割件。
Description
相关申请的交叉引用
本申请是要求于2007年6月22日提交的、题为“SURGICALSTAPLING INSTRUMENTS”、序列号为No.11/821,277的共同未决美国专利申请的优先权的部分继续申请,该文献的所有内容通过引用接合入本文。
技术领域
本发明总的涉及一种外科钉合器械,更具体地,涉及具有用来闭合端部执行器的闭合系统和用于展开钉的击发系统的外科钉合器。
背景技术
在现有技术中已知,外科钉合器通常用于将钉展开到软组织中,以减少或消除软组织的出血,尤其是例如在组织被切割时。诸如内镜切割器的外科钉合器例如可包括端部执行器,该端部执行器可相对于细长轴组件移动或进行关节运动。端部执行器通常用于将软组织固定在第一钳口件和第二钳口件之间,其中第一钳口件通常包括钉仓并且第二钳口件通常包括砧座,钉仓用于将钉可移除地存放在其中。这样的外科钉合器可包括闭合系统,用于使砧座相对于钉仓枢转。但是,这些闭合系统在钳口件已被闭合时不会防止端部执行器相对于轴组件进行关节运动。因此,当端部执行器进行关节运动时,端部执行器可能会将剪切力施加到被捕获在钳口件之间的软组织上。
如上所述,外科钉合器可用于使端部执行器的砧座相对于钉仓枢转,以在钉仓和砧座之间捕获软组织。在各种情况下,砧座可用于将夹紧力施加在软组织上,以将软组织紧紧地保持在砧座和钉仓之间。然而,如果外科医生不满意端部执行器的位置,那么外科医生通常必须启动外科钉合器上的释放机构,以使砧座枢转进入打开位置,然后重新定位端部执行器。此后,钉通常被驱动器从钉仓中展开,该驱动器横向通过钉仓中的通道并且引起钉顶靠在砧座上变形,将软组织层固定在一起。通常,在现有技术中已知,钉以若干钉排或钉列的形式展开,以更可靠地将组织层固定在一起。端部执行器还可包括例如切割件(诸如刀),该切割件在两个钉排之间推进,以在软组织层已被钉合在一起之后切断软组织。
在驱动器和切割件在端部执行器内被推进之后,通常必须将驱动器和/或切割件回缩到它们的初始位置。以前的外科钉合器具有复位弹簧,在例如外科医生致动了外科钉合器上的释放按钮或拨动开关之后,该复位弹簧相对于钉仓将切割件回缩。在各种实施方式中,复位弹簧的第一端可连接到外科器械的壳体上并且复位弹簧的第二端可连接到切割件上。然而,这样的钉合器通常很难使用,因为在切割件推进时拉伸复位弹簧所需的力通常很大。而且,这样的复位弹簧通常在切割件推进时将偏压力施加到切割件上,这在各种情况下可过早地使切割件返回,尤其是在需要扳机的多个冲程来完全推进切割件的实施方式中。需要对以前的钉合器进行改进。
发明内容
在本发明的至少一种形式中,外科器械可包括轴组件、可相对于轴组件运动的端部执行器以及锁定机构,该锁定机构用于接合轴组件和/或端部执行器,以固定或锁定轴组件和端部执行器之间的相对关系。在各种实施方式中,端部执行器可包括砧座和通道,其中通道可用于接收钉仓并且砧座可动地联接到通道上。在至少一种实施方式中,外科器械还可包括用于产生闭合动作的闭合系统,其中砧座可响应于闭合动作。在各种实施方式中,闭合系统还可用于接合锁定机构并且防止锁定机构解锁轴组件和端部执行器之间的相对关系。
在本发明的至少一种形式中,外科器械可包括闭合系统,该闭合系统例如用于使端部执行器的砧座在打开位置、部分闭合位置和闭合位置之间运动。在各种实施方式中,外科器械还可包括锁定件,当砧座被定位在其部分闭合位置和闭合位置中的一个处时,该锁定件用于选择性地接合并锁定闭合系统。在至少一种实施方式中,外科器械可包括扳机,该扳机用于枢转例如砧座,其中扳机可包括凸轮面和在凸轮面中的第一切口。在各种实施方式中,锁定件可包括从动部分并且闭合驱动装置可包括锁定弹簧,该锁定弹簧用于将从动部分偏压在扳机的凸轮面上,使得当砧座被枢转到其部分闭合位置时,从动部分可接合扳机的第一切口。在至少一种实施方式中,当从动部分与第一切口接合时,第一切口可防止砧座枢转进入其打开位置。在各种实施方式中,凸轮部分还可包括第二切口并且当砧座被枢转进入其闭合位置时,从动部分可接合该第二切口。
在本发明的至少一种形式中,外科器械可包括具有击发件和柔性带的击发驱动装置,该击发件例如用于在端部执行器内推进切割件,该柔性带连接到击发件上并且用于回缩击发件。在至少一种实施方式中,外科器械可包括制动器,该制动器例如用于接合带,由此限制击发件的运动。在各种实施方式中,击发驱动装置还可包括卷轴,当击发件被回缩时,该卷轴卷绕至少一部分带。在至少一种实施方式中,击发驱动装置还可包括扳机,该扳机可选择性地与击发件和卷轴接合,使得当扳机可操作地与击发件接合时,扳机的致动可用于推进击发件,并且当扳机可操作地与卷轴接合时,扳机的致动可用于使卷轴转动并经由带回缩击发件。
在本发明的至少一种形式中,外科器械可包括击发驱动装置和反向驱动装置,该击发驱动装置用于选择性地相对于端部执行器推进击发件和/或切割件,该反向驱动装置用于选择性地相对于端部执行器回缩击发件和/或切割件。在各种实施方式中,随着扳机的致动,击发驱动装置可用于推进击发件,并且反向驱动装置可包括齿轮,该齿轮用于随着扳机的下一次致动来回缩击发件。在至少一种实施方式中,击发驱动装置可包括棘爪,该棘爪可选择性地与击发件接合,以推进击发件,其中当反向驱动装置与击发件接合时,棘爪可从击发件脱开。在各种实施方式中,反向机构可包括齿轮组,该齿轮组具有第一齿轮和第二齿轮,第一齿轮与击发件可操作地接合,第二齿轮与扳机可操作地接合,其中第二齿轮可选择性地与第一齿轮协作,使得扳机的致动可经由第一齿轮和第二齿轮回缩击发件和/或切割件。在各种实施方式中,外科器械还可包括开关,该开关包括可相对地运动的第一部分和第二部分,其中,第一部分可用于使击发驱动装置从击发件可操作地脱开,并且使反向驱动装置与击发件可操作地接合。在至少一种实施方式中,第二部分可包括从第二部分延伸出的手柄,该手柄可由外科医生启动,以使第二部分与第一部分接合并且使第一部分运动就位。
更具体地说,本发明涉及如下内容:
(1).一种外科器械,包括:
端部执行器;
击发件;
扳机;
击发驱动装置,该击发驱动装置能选择性地与所述击发件接合,其中,所述击发驱动装置包括齿条,该齿条在所述扳机致动时用于相对于所述端部执行器推进所述击发件;
反向驱动装置,该反向驱动装置能选择性地与所述齿条接合,其中,所述反向驱动装置包括齿轮,该齿轮在所述扳机随后致动时用于相对于所述端部执行器回缩所述齿条和所述击发件;
(2).根据第(1)项所述的外科器械,其中,所述齿轮包括第一齿轮,所述扳机包括齿轮部分,并且所述反向驱动装置还包括:
第二齿轮,该第二齿轮与所述第一齿轮可操作地接合;
第三齿轮,该第三齿轮与所述扳机的齿轮部分可操作地接合,其中所述第二齿轮能与所述第三齿轮选择性地接合。
(3).根据第(2)项所述的外科器械,其中,当所述击发驱动装置与所述击发件接合时,所述第二齿轮不与所述第三齿轮可操作地接合。
(4).根据第(2)项所述的外科器械,其中,所述第三齿轮包括棘齿面,该棘齿面用于接合所述第二齿轮,当所述第三齿轮沿着第一方向旋转时,所述棘齿面能够相对于所述第二齿轮滑动,当所述第三齿轮沿着相反方向旋转时,所述棘齿面用于驱动所述第二齿轮。
(5).根据第(2)项所述的外科器械,其中,所述第二齿轮能与所述第三齿轮可操作地接合,使得所述扳机的所述随后致动能够使所述第三齿轮、所述第二齿轮和所述第一齿轮旋转并且回缩所述击发件。
(6).根据第(5)项所述的外科器械,其中,所述反向驱动装置还包括:
键销,该键销能选择性地在第一位置和第二位置之间运动,其中当所述键销在所述第一位置中时,所述键销不与所述第三齿轮可操作地接合,并且当所述键销在所述第二位置中时,所述键销与所述第二齿轮可操作地接合;和
弹簧,该弹簧用于将所述键销偏压到所述第二位置中。
(7).根据第(6)项所述的外科器械,其中,所述反向驱动装置还包括致动器,当所述击发驱动装置与所述击发件可操作地接合时,该致动器能够将所述键销定位在所述第一位置中,并且所述致动器能运动进入致动位置中,以允许所述弹簧将所述键销偏压到所述第二位置中,并且由此使所述反向驱动装置与所述击发件可操作地接合。
(8).根据第(7)项所述的外科器械,其中,当所述致动器运动进入所述致动位置中时,所述致动器还用于使所述击发驱动装置从所述击发件脱开。
(9).根据第(2)项所述的外科器械,其中,所述反向驱动装置还包括离合器,该离合器用于可操作地接合和脱开所述第二齿轮和所述第三齿轮。
(10).根据第(9)项所述的外科器械,其中,所述离合器包括键销和止动件,该键销与所述第二齿轮可操作地接合,该止动件从所述第三齿轮延伸出,并且所述止动件用于允许所述键销相对于所述第三齿轮沿着第一方向旋转,并且所述止动件能够沿着与所述第一方向相反的方向旋转所述键销。
(11).根据第(2)项所述的外科器械,其中,所述反向驱动装置还包括与所述第二齿轮可操作地接合的指示器齿轮,并且所述指示器齿轮包括用于指示所述扳机已被致动的次数的至少一个标记。
(12).根据第(11)项所述的外科器械,其中,所述齿条的推进能够使所述第一齿轮、所述第二齿轮和所述指示器齿轮旋转。
(13).根据第(1)项所述的外科器械,还包括防反向机构,该防反向机构能够基本上防止所述击发件在所述扳机的所述随后致动之前被相对于所述端部执行器回缩。
(14).一种用于处理外科器械的方法,该方法包括:
获取根据第(1)项所述的外科器械;
对所述外科器械进行消毒;和
将所述外科器械存放在无菌容器中。
(15).一种外科器械,包括:
端部执行器;
击发驱动装置,该击发驱动装置包括:
扳机;
击发件;和
棘爪,该棘爪与所述扳机可操作地接合,其中所述扳机用于推进所述棘爪,并且所述棘爪能选择性地与所述击发件接合,以在所述扳机致动时用于相对于所述端部执行器推进所述击发件;
复位机构,该复位机构能选择性地与所述击发件接合,以在所述扳机的随后致动中相对于所述端部执行器回缩所述击发件,当所述复位机构与所述击发件接合时,所述复位机构能够选择性地将所述棘爪从所述击发件脱开。
(16).根据第(15)项所述的外科器械,其中,所述复位机构包括齿轮组,该齿轮组能选择性地与所述扳机接合。
(17).根据第(15)项所述的外科器械,其中,所述扳机包括从所述扳机延伸出的齿轮部分,并且所述复位机构包括:
第一齿轮,该第一齿轮与所述齿轮部分可操作地接合;和
第二齿轮,该第二齿轮与所述击发件可操作地接合,所述第二齿轮能选择性地与所述第一齿轮接合。
(18).根据第(17)项所述的外科器械,其中,所述复位机构还包括指示器齿轮,该指示器齿轮与所述第二齿轮可操作地接合,并且所述指示器齿轮包括至少一个标记,用于指示所述扳机已被致动的次数。
(19).根据第(15)项所述的外科器械,还包括防反向机构,当所述棘爪和所述复位机构从所述击发件脱开时,所述防反向机构能够基本上防止所述击发件相对于所述端部执行器回缩。
(20).一种用于处理外科器械的方法,该方法包括:
获取根据第(15)项所述的外科器械;
对所述外科器械进行消毒;和
将所述外科器械存放在无菌容器中。
(21).一种外科器械,包括:
端部执行器;
击发件;
扳机;
击发驱动装置,该击发驱动装置能选择性地与所述击发件接合,其中,所述击发驱动装置包括齿条,该齿条在所述扳机致动时用于相对于所述端部执行器推进所述击发件;
齿轮组,该齿轮组包括:
第一齿轮,该第一齿轮与所述击发件可操作地接合;
第二齿轮,该第二齿轮与所述扳机可操作地接合,其中,所述第二齿轮选择性地与所述第一齿轮可操作地接合,使得所述扳机的随后致动将所述齿条和所述击发件相对于所述端部执行器回缩;
(22).根据第(21)项所述的外科器械,其中,所述齿轮组还包括与所述第二齿轮可操作地接合的指示器齿轮,所述指示器齿轮包括用于指示所述扳机已被致动的次数的至少一个标记。
(23).根据第(21)项所述的外科器械,其中,所述第一齿轮是小齿轮,并且所述小齿轮用于沿着预定的路径驱动所述齿条。
(24).根据第(21)项所述的外科器械,还包括防反向机构,当所述击发驱动装置从所述击发件脱开并且所述第一齿轮从所述第二齿轮可操作地脱开时,所述防反向机构能够基本上防止所述击发件被相对于所述端部执行器回缩。
(25).一种用于处理外科器械的方法,该方法包括:
获取根据第(21)项所述的外科器械;
对所述外科器械进行消毒;和
将所述外科器械存放在无菌容器中。
(26).一种外科器械,包括:
端部执行器;
击发件;
扳机;
击发驱动装置,该击发驱动装置能选择性地与所述击发件接合,其中,所述击发驱动装置在所述扳机第一次致动时用于相对于所述端部执行器推进所述击发件;
反向驱动装置,该反向驱动装置选择性地与所述击发件接合,以在所述扳机随后致动时用于相对于所述端部执行器回缩所述击发件;和
防反向机构,该防反向机构基本上防止了所述击发件在所述扳机的所述随后致动之前被相对于所述端部执行器回缩。
(27).根据第(26)项所述的外科器械,其中,所述所述防反向机构包括:
可旋转的销,该销包括从该销延伸出的键,其中所述销与所述击发件可操作地关联,使得所述击发件的推进沿着第一方向转动所述销;和
索引元件,该索引元件包括第一凹槽和第二凹槽,其中所述键在所述扳机的第一次致动之前能够容纳在所述第一凹槽内,所述键在所述扳机的第一次致动后且在所述扳机的随后致动之前能够容纳在所述第二凹槽内,并且所述键和所述第二凹槽能够防止所述销在所述扳机的所述随后致动之前回到所述第一凹槽。
(28).根据第(27)项所述的外科器械,其中,所述索引元件能够在第一位置和第二位置之间运动,以允许所述键从所述第一凹槽运动进入所述第二凹槽中。
(29).根据第(27)项所述的外科器械,其中,所述索引元件包括弹簧,所述弹簧能够在第一构型和第二构型之间弯曲,以允许所述键从所述第一凹槽运动进入所述第二凹槽中。
(30).一种用于处理外科器械的方法,该方法包括:
获取根据第(27)项所述的外科器械;
对所述外科器械进行消毒;和
将所述外科器械存放在无菌容器中。
附图说明
参照以下接合附图对本发明的实施方式的描述,本发明的上述及其它特征和优点以及获得这些特征和优点的方式将变得更加清楚,本发明本身可被更好地理解,其中:
图1是根据本发明的实施方式的外科器械的正视图;
图2是图1的外科器械的手柄部分的正视图;
图3是图1的外科器械的端部执行器的正视图;
图4是图3的端部执行器的俯视图;
图5是图1的外科器械的关节运动接头的立体图,其中外科器械的一些部件被去除;
图6是图1的外科器械的关节运动接头和细长轴组件的立体图,其中外科器械的一些部件被去除;
图7是图1的外科器械的手柄部分和细长轴组件的局部立体图,其中外科器械的一些部件被去除;
图8是图2的手柄部分的正视图,其中外科器械的一些部件被去除;
图9是图2的手柄部分的正视图,其中外科器械的附加部件被去除;
图10是根据本发明的替代实施方式的外科器械的关节运动锁定机构的致动器和端部执行器闭合系统的正视图,其中外科器械的一些部件被去除;
图11是图10的外科器械的正视图,示出了处于解锁位置的关节运动锁定机构的致动器和处于打开构型的端部执行器闭合系统;
图12是图10的外科器械的正视图,示出了处于解锁位置的关节运动锁定机构和处于部分闭合构型的端部执行器闭合系统;
图13是图10的外科器械的正视图,示出了处于锁定位置的关节运动锁定机构和处于闭合构型的端部执行器闭合系统;
图14是图1的外科器械的端部执行器闭合系统的闭合扳机的正视图;
图15是图14的闭合扳机的局部立体图;
图16是图14的闭合扳机的局部正视图;
图17是图1的外科器械的扳机锁定件的立体图;
图18是图17的扳机锁定件的正视图;
图19是图1的外科器械的击发驱动装置的细节图,其中外科器械的一些部件被去除;
图20是图19的击发驱动装置的立体图;
图21是图19的击发驱动装置的击发扳机、棘爪和倾斜机构的局部细节图;
图22是图19的击发驱动装置的棘爪、倾斜机构和棘爪复位弹簧的正视图;
图23是图22的棘爪的正视图;
图24是图19的击发驱动装置的细节图,示出了枢转进入与击发驱动装置的击发连杆接合的位置中的棘爪;
图25是图22的倾斜机构的立体图;
图26是图1的外科器械的机架的立体图;
图27是根据本发明的替代实施方式的外科器械的击发驱动装置的细节图,其中外科器械的一些部件被去除;
图28是图27的击发驱动装置的细节图,示出了击发驱动装置从击发连杆脱开的棘爪;
图29是图1的外科器械的复位机构的立体图,示出了处于未致动位置的击发扳机,其中外科器械的一些部件被去除;
图30是图29的复位机构的局部立体图,示出了处于致动位置的击发扳机,其中复位机构的一些部件被去除;
图31是图29的复位机构被设置成如图30所示的构型时的正视图;
图32是图29的复位机构的正视图,示出了处于致动位置的复位机构的复位滑架;
图33是图29的复位机构的局部立体图,其中复位机构的一些部件被去除;
图34是图19的击发驱动装置的棘爪和击发销的立体图;
图35是图29的复位机构的立体图,示出了处于致动位置中的复位滑架和回到其未致动位置的击发扳机;
图36是图29的复位机构被设置成图35所示的构型时的局部立体图,示出了复位机构的复位销可操作地与击发扳机接合;
图37是图29的复位机构的局部立体图,示出了在旋转复位销后处于致动位置中的击发扳机;
图38是图29的复位机构被设置成图37所示构型时的另外的立体图;
图39是图29的复位机构的局部立体图,示出了回到其未致动位置的击发扳机;
图40是图29的复位机构的立体图,示出了回到其未致动位置的复位滑架;
图41是图29的复位机构被设置成图40的构型时的立体图,示出了复位机构的偏压弹簧和复位销之间的相对关系,其中复位机构的一些部件被去除;
图42是图29的复位机构被设置成图40的构型时的立体图,示出了复位滑架可操作地与击发驱动装置的击发销和复位机构的复位销接合,以便将击发驱动装置和复位机构重设到它们的初始构型;
图43是图29的复位机构的卷轴的细节图,示出了复位机构的复位带和图26所示的钉合器机架之间的相对关系;
图44是图43的卷轴的细节图,示出了复位带和图26的另一种实施方式的钉合器之间的相对关系;
图45是根据本发明的替代实施方式的外科器械的复位机构的立体图,该复位机构带有防反向棘轮机构;
图46是图45的复位机构的正视图,该复位机构具有处于未致动位置的复位滑架;
图47是图45的复位机构的立体图,其中外科器械的一些部件被去除;
图48是图45的棘轮机构的复位齿轮、复位销和防反向棘爪的立体图;
图49是图45的复位机构的另一正视图;
图50是图5的关节运动接头的立体图;
图51是图5的关节运动接头的立体图,其中外科器械的一些部件被去除;
图52是图5的关节运动接头的立体图,其中外科器械的附加部件被去除;
图53是图3的端部执行器的锁定件的立体图;
图54是图53的端部执行器锁定件的另一立体图;
图55是图53的端部执行器锁定件的仰视图;
图56是图53的端部执行器锁定件的正视图;
图57是之前的外科器械的关节运动接头的局部立体图;
图58是图5的关节运动接头的立体图,其中端部执行器和细长轴组件的一些部件被去除;
图59是图5的关节运动接头的另一立体图,其中端部执行器和细长轴组件的一些部件被去除;
图60是图53的端部执行器锁定件的立体图,该锁定件与细长轴组件的锁定件可操作地接合;
图61是图60的细长轴组件锁定件的立体图;
图62是图53的端部执行器锁定件与图60的轴组件锁定件可操作地接合时的仰视图;
图63是根据本发明的替代实施方式的外科器械的关节运动接头的立体图,其中外科器械的一些部件被去除;
图64是端部执行器锁定件与图63的外科器械的轴组件锁定件可操作地接合时的俯视图;
图65是端部执行器锁定件与图64所示的轴组件锁定件可操作地接合时的立体图;
图66是图64的端部执行器锁定件的立体图;
图67是图64的端部执行器锁定件的正视图;
图68是根据本发明的实施方式的外科器械的正视图,其中外科器械的一些部件被去除;
图69是图68的外科器械的正视图,示出了处于致动位置的闭合扳机;
图70是图68的外科器械的正视图,示出了在击发扳机的第一次致动后处于致动位置的击发扳机;
图71是图68的外科器械用于回缩击发件的反向机构的齿轮组的立体图;
图72是图68的外科器械的正视图,示出了在击发扳机被从其第一次致动释放后处于未致动位置时的击发扳机;
图73是图68的外科器械的正视图,示出了在击发扳机的第二次致动后处于致动位置的击发扳机;
图74是图68的外科器械的正视图,示出了在击发扳机被从其第二次致动释放后处于未致动位置的击发扳机;
图75是图68的外科器械的正视图,示出了在击发扳机的第三次致动后处于致动位置的击发扳机;
图76是图68的外科器械的另一正视图,示出了在反向机构的复位滑架被向下旋转入致动位置后的复位滑架;
图77是图71的反向机构的齿轮组的扳机齿轮、键齿轮和复位销的立体图;
图78是图68的外科器械的剖视图,示出了图77的复位销与图71的反向机构的扳机齿轮和键齿轮可操作地接合;
图79是图77的复位销的立体图;
图80是图76的复位滑架处于致动位置时的另一立体图;
图81是图68的外科器械的击发驱动装置的击发销与棘爪接合的立体图;
图82是图68的外科器械的复位滑架处于致动位置并且反向机构与击发件可操作地接合时的正视图;
图83是图68的外科器械的正视图,示出了在将击发件回缩的第四次致动后处于致动位置的击发扳机;
图84是图76的反向机构的立体图,其中反向机构的一些部件被去除;
图85是图68的外科器械的正视图,示出了在击发扳机被从其第四次致动释放后处于未致动位置的击发扳机;
图86是图68的外科器械的正视图,示出了图76的复位滑架向上旋转进入未致动位置并且还示出了处于其未致动位置的闭合扳机;
图87是根据本发明的替代实施方式的外科器械的立体图,其中外科器械的一些部件被去除;
图88是图87所示外科器械的包括齿轮组的反向机构的立体图,示出了当外科器械的击发件被推进时齿轮组的齿轮可旋转的方向;
图89是图88的反向机构的扳机齿轮和复位销的立体图,示出了扳机齿轮的横截面;
图90是图89的扳机齿轮和复位销的另一立体图,示出了复位销脱开与扳机齿轮的操作性接合;
图91是图89的扳机齿轮和复位销的另一立体图,示出了复位销与扳机齿轮重新接合;
图92是图88的反向机构的立体图,示出了在击发件被回缩时齿轮组的齿轮的旋转方向;
图93是图88的反向机构的另一立体图;
图94是图87的外科器械的立体图,示出了扳机锁定件,该扳机锁定件除了与扳机接合外还与图88的反向机构的齿轮接合;
图95是根据本发明的替代实施方式的外科器械的反向机构的正视图,示出了处于未致动位置的复位滑架,其中外科器械的一些部件被去除;
图96是图95的反向机构的立体图,示出了具有棘齿面的扳机齿轮以及具有棘齿面的键齿轮,其中外科器械的另外一些部件被去除;
图97是图95的反向机构的横剖视图,示出了处于图96的构型;
图98是图95的反向机构的复位销的立体图;
图99是图95的反向机构的正视图,示出了处于致动位置的复位滑架;
图100是图95的反向机构的立体图,其中扳机齿轮和键齿轮的棘齿面彼此接合;
图101是根据本发明的替代实施方式的外科器械的正视图,该外科器械包括图68的外科器械的击发驱动装置和反向驱动装置,外科器械的一些部件被去除,其中击发驱动装置的棘爪显示成当其被相对于击发件回缩时出现;
图102是图101的外科器械的正视图,示出了与击发件可操作地接合地棘爪;
图103是图101的外科器械的正视图,示出了当击发件被相对于其需要的位置无意地倒退时,棘爪和击发件中的凹槽不对准;
图104是根据本发明的替代实施方式的外科器械的正视图,该外科器械包括防反向机构,其中外科器械的一些部件被去除;
图105是图104的防反向机构的复位销的立体图;
图106是从图105的复位销延伸出的键的细节图;
图107是图104的防反向机构的索引元件的立体图;
图108是图105的复位销与图107的索引元件可操作地接合时的立体图;
图109是复位销和索引元件的立体图,示出了复位销的键被定位在索引元件的第一孔内;
图110a是图109的复位销的键和索引元件的另一立体图;
图110b是复位销的键的立体图,在复位销的键从索引元件的第一孔向索引元件的第二孔运动时,该键下压索引元件;
图110c是定位在索引元件的第二孔内的复位销的键部分的立体图;
图110d是复位销的键的立体图,在复位销的键从索引元件的第二孔向索引元件的第三孔运动时,该键下压索引元件;
图110e是定位在索引元件的第三孔内的复位销的键部分的立体图;
图110f是复位销的键的立体图,在复位销的键从索引元件的第三孔向索引元件的第四孔运动时,该键下压索引元件;
图110g是定位在索引元件的第四孔内的复位销的键部分的立体图;
图111是图107的索引元件的横剖视图;
图112是根据本发明的替代实施方式的索引元件以及与索引元件可操作地接合的复位弹簧的立体图;
图113是图112的索引元件的横剖视图;
图114是根据本发明的另一替代实施方式的索引元件的立体图;
图115是根据本发明的替代实施方式的包括防反向机构的外科器械,其中外科器械的一些部件被去除;
图116是图115的防反向机构的横剖视图;
图117是图115的外科器械的立体图,示出了处于致动位置的防反向机构的复位滑架;
图118是在图117的复位滑架处于其致动位置时图115的防反向机构的横剖视图;
图119是根据本发明的替代实施方式的外科器械的立体图,其中外科器械的一些部件被去除,以示出用于致动外科器械的反向驱动装置的开关;
图120是根据本发明的另一替代实施方式的外科器械的局部正视图,其中外科器械的一些部件被去除,以示出用于致动外科器械的反向驱动装置的开关;
图121是图120的外科器械的局部正视图,示出了处于致动位置的开关的第一部分;和
图122是图120的外科器械的局部正视图,示出了开关的第二部分,该第二部分用于将开关的第一部分定位在其致动位置中。
具体实施方式
在多个视图中,相应的附图标记表示相应的部件。本文给出的示例以一种形式示出了本发明的优选实施方式,但是这样的示例不应被认为以任何方式限定本发明的范围。
现在描述一些示例性的实施方式,以提供对本文所公开装置和方法的结构、功能、制造和使用的原理的总体理解。这些实施方式的一个或多个实施例在附图中示出。本领域技术人员将理解,本文具体描述并且在附图中示出的装置和方法是非限制性的实施方式,并且本发明的各种实施方式的范围完全通过权利要求书确定。在一种示例性实施方式中示出和描述的特征可以与其它实施方式的特征结合。
在各种实施方式中,根据本发明的外科器械可用于将外科钉插入例如软组织中。在至少一种实施方式中,参照图1至4,外科器械100可包括手柄部分102、细长轴组件104和端部执行器106。在各种实施方式中,参照图3和4,端部执行器106可包括钉仓通道108和钉仓110,其中,钉仓110可用于将钉可移除地存储在钉仓110中。在至少一种实施方式中,端部执行器106还可以包括砧座112,该砧座112能够被可枢转地连接到钉仓通道108并且能够通过端部执行器闭合系统在打开位置和闭合位置之间枢转。为了将钉从钉仓110展开,外科器械100还可以包括用于横贯钉仓110的钉驱动器以及用于在钉仓内推进钉驱动器的击发驱动装置。在各种实施方式中,在从钉仓展开钉时,砧座112可用于使钉的至少一部分变形。虽然下面更具体地描述了端部执行器闭合系统和击发驱动装置的各种实施方式,但是在2005年6月14日公告的、题为“SURGICALSTAPLING INSTRUMENT INCOPPORATING A FIRNIGMECHANISM HAVING A LINKED RACK TRANSMISSION”的美国专利No.6,905,057和2006年5月16日公告的、题为“SURGICALSTAPLING INSTRUMENT HAVING A SINGLE LOCKOUTMECHANISM FOR PREVENTION OF FIRING”的美国专利No.7,044,352中公开了端部执行器闭合系统和击发驱动装置的若干实施方式,上述文献的全部公开内容由此通过引用结合入本文。
在各种实施方式中,根据本发明的外科器械可包括用于使端部执行器相对于外科器械的细长轴组件运动或进行关节运动的系统。在至少一种实施方式中,参照图3至7,外科器械100可包括关节运动接头114,该关节运动接头114能够可动地连接端部执行器106和细长轴组件104。在各种实施方式中,关节运动接头114可允许端部执行器106相对于细长轴组件104在单个平面或者可替代的在多个平面中运动。在任意一种情况下,关节运动接头114可包括一根或多根枢转轴线116(图5),端部执行器106可围绕所述枢转轴线116进行关节运动。在各种实施方式中,参照图5和6,外科器械100还可包括锁定机构118,该锁定机构可固定或锁定端部执行器106和细长轴组件104之间的相对关系。在至少一种实施方式中,锁定机构118可包括锁定件120,该锁定件120可相对于端部执行器106滑动并且与端部执行器106接合,以便防止或至少部分地抑制端部执行器106和细长轴组件104之间的相对运动。在至少一种实施方式中,锁定件120可用于与端部执行器106的齿312的至少一个接合(图5和6),从而锁定件120和齿312之间的相互作用可防止或者至少部分地抑制端部执行器106围绕轴线116旋转,如下面更具体地描述。
在各种实施方式中,参照图7至9,锁定机构118还可包括致动器122,该致动器122可操作地连接到锁定件120。在至少一种实施方式中,致动器122可包括销124,该销124可容纳在锁定件120的切口121内,使得当致动器122相对于手柄部分102滑动时,销124可抵接切口121的侧壁并且促使锁定件120相对于端部执行器106运动。在至少一种实施方式中,致动器122可被例如向着近侧从端部执行器106拉开,以使锁定件120从端部执行器106脱开。虽然没有示出,但是可以想到其它实施方式,其中为了使锁定件120从端部执行器106脱开,致动器122可向远侧运动或者甚至能旋转。在任何一种情况下,锁定机构118还可包括复位弹簧126(图6),该复位弹簧126在致动器122被释放后可用于使锁定件120朝着端部执行器106例如向着远侧运动,以使锁定件120与端部执行器106接合。在2005年4月7日提交的、序列号为No.11/100,772、题为“SURGICAL INSTRUMENT WITH ARTICUALTING SHAFT WITHSINGLE PIVOT CLOSURE ANDD OUBLE PIVOT FRAMEGROUND”的美国专利申请,2005年9月29日提交的、序列号为No.11/238,358、题为“SURGICAL INSTRUMENT WITHARTICUALTING SHAFT WITH RIGID FIRING BAR SUPPORTS”的美国专利申请,以及2006年7月24日提交的、序列号为No.11/491,626、题为“SURGICAL STAPLING AND CUTTINGDEVICE AND METHOD FOR USING THE DEVICE”的美国专利申请中公开了其它锁定机构,以上专利申请的全部内容因此通过引用接合入本文。
在各种实施方式中,参照图1和2,致动器122可具有适当轮廓,使得外科医生能够抓持致动器122的外表面并且如上所述向近侧拉动致动器122。为了使致动器122运动,在至少一种实施方式中,外科医生例如可将手放在手柄握持件127上并且将其另一只手放在致动器122上,使得外科医生可使致动器122相对于手柄握持件127运动。在其它不同实施方式中,参照图10至13,致动器122’可被构造成使得外科医生可只需一只手操作外科器械。更具体地,在至少一种实施方式中,致动器122’可包括从致动器122’延伸出的钩子或凸起部115,该钩子或凸起部115可允许外科医生用一只手握住手柄握持件127并且从这只手向远侧伸出至少一根手指来抓住至少一个凸起部115并且如上所述向近侧拉动致动器122’。虽然致动器122’如此处所述具有凸起部115,但是致动器122或其它任何适当的致动器也可以包括凸起部115和/或任何其它能够帮助外科医生用一只手操作外科器械100的适当特征部。在至少一种实施方式中,凸起部115可以是至少部分地包括和/或涂有弹性材料或“软接触”材料,这可改善外科医生对凸起部115的抓握并且能够为外科医生提供其它人机工程学上的好处。在各种实施方式中,致动器122’例如可操作地与细长轴组件104接合,使得端部执行器106和细长轴组件104可通过致动器122’围绕纵向轴线旋转。在这些实施方式中,外科医生能够通过如上所述使端部执行器106进行关节运动和/或使端部执行器106旋转就位来将端部执行器106定位在外科部位处。在至少一种实施方式中,外科医生可通过将手指放在其中一个凸起部115上并且在其上施加力来旋转致动器122’。在各种实施方式中,外科医生可通过将手指放在凸起部115上并且防止致动器122’的任何不期望的运动将致动器122’保持就位,相应地将端部执行器106保持就位。
在各种实施方式中,根据本发明的外科器械可包括例如用于将端部执行器106闭合或夹紧在软组织上的系统。在至少一种实施方式中,参照图2、5、8和9,外科器械100可包括闭合扳机128、传动连杆130、驱动器132和闭合管134。在各种实施方式中,随着对闭合扳机128的致动,闭合扳机128能够使传动连杆130、驱动器132和闭合管134向远侧运动。更具体地,在至少一种实施方式中,传动连杆130可包括可枢转地连接到扳机128上的第一端和可枢转地连接到驱动器132的第二端,从而扳机128朝着手柄握持件127的旋转可使传动连杆130向前并且使驱动器132沿着由驱动器引导件136(图8)限定的轴线滑动。在各种实施方式中,驱动器132可包括从驱动器132延伸出的凸起部133,该凸起部133可滑动地容纳在驱动器引导件136的切口137内,使得在驱动器132运动时,切口137可以限定驱动器132的路径。在各种实施方式中,闭合管134与驱动器132可操作地接合,使得当驱动器132如上所述向远侧运动时,闭合管134可接合砧座112并且可使砧座112向下枢转。主要参照图5,闭合管134可被构造成在关节运动接头114上滑动并且使砧座112相对于钉仓110枢转。在至少一种实施方式中,如图9所示,闭合管134可包括近端,该近端具有从该近端延伸出的凸起部135,该凸起部135可容纳在驱动器132的切口131内,使得驱动器132的移动被传递到闭合管134。
在各种实施方式中,如上所述,锁定机构118可防止或至少部分地抑制端部执行器106和轴组件104之间的相对运动。在软组织例如被夹紧在砧座112和钉仓110之间的情况下,端部执行器106和轴组件104之间的相对运动可将剪切力施加在被夹紧在端部执行器106和轴组件104之间的软组织上,该夹紧力可能损伤软组织。在各种实施方式中,参照图10至13,为了防止或至少减少在端部执行器106闭合时端部执行器106和轴组件104之间的相对运动,端部执行器闭合系统可用于接合锁定机构118,以防止致动器122’运动进入其锁定位置中。实际上,在至少一种实施方式中,闭合扳机128不仅可以闭合端部执行器106,而且其还可以防止锁定机构118被解锁。在各种实施方式中,参照图10至13,外科器械100’可包括驱动器132,驱动器132具有适当构造,当驱动器132被扳机128向远侧运动时,驱动器132抵接致动器122’或设置在致动器122’附近,并且由此防止致动器122’如上所述相对于致动器122向近侧运动。更具体地,在扳机132被致动之前,如图10和11所示,致动器122’可向近侧滑动,以使锁定件120相对于端部执行器106滑动并且解锁关节运动接头114。然而,随着对扳机132的致动,参照图13,驱动器132可被构造成抵接致动器122’或邻近致动器122’定位,从而使致动器122’不能向近侧运动以使锁定件120从端部执行器106脱开。因此,端部执行器闭合系统可防止端部执行器106在被闭合后进行关节运动,由此减少了传递到被夹紧在端部执行器106中的软组织的剪切力的可能性。
接着上文,端部执行器闭合系统可给外科医生提供端部执行器已被闭合的反馈,并且为了使外科医生解锁端部执行器并使端部执行器进行关节运动,外科医生在能够使端部执行器进行关节运动之前首先必须至少部分地重新打开端部执行器。更具体地,由于在端部执行器106闭合时驱动器132和致动器122’之间的相互作用,当外科医生尝试向近侧拉动致动器122’以解锁关节运动接头114,驱动器132可基本上防止致动器122’运动,由此给外科医生发出信号,告知端部执行器106已经闭合并且在致动器122’可被运动以及关节运动接头可被解锁之前必须首先打开端部执行器106。在各种实施方式中,这样的端部执行器闭合系统可防止外科医生损坏外科器械和/或损坏被夹紧在端部执行器中或在端部执行器周围的组织。更具体地,在至少一种实施方式中,当闭合管134已被推进以使砧座112如上所述地闭合时,闭合管134可在砧座112上施加力,将砧座112保持在闭合位置,并且在各种情况下,该力可在关节运动接头114内产生摩擦力,该摩擦力可防止或者如果不能防止则可抑制端部执行器106围绕关节运动接头114旋转。在没有如上所述的端部执行器闭合系统的实施方式中,如果外科医生在不首先至少部分地打开端部执行器的情况下试图克服这些摩擦力,那么外科医生可能例如弯曲或折断外科器械的一个或多个组成部件。然而,在本发明的各种实施方式中,驱动器132例如可防止外科医生释放如上所述的关节运动锁定件120,因此,外科医生可能没有机会解锁关节运动接头114,更别提使端部执行器106进行关节运动了。
在各种实施方式中,根据本发明的外科器械可包括端部执行器闭合系统,该闭合系统可将砧座112例如设置在打开位置、闭合位置和部分闭合的位置。在至少一种实施方式中,外科医生可使砧座112运动到部分闭合的位置中并且估计在砧座112被移动至其闭合位置之前是否应当对端部执行器进行重新定位或者使端部执行器进行关节运动。在该实施方式中,在砧座112完全闭合之前,砧座112可相对于定位在砧座112和钉仓110之间的软组织运动,而不会在该软组织上施加剪切力或施加至少很大的剪切力。在至少一种实施方式中,砧座112可具有适当构造,使得砧座112在处于其部分闭合的位置时不会夹紧位于砧座112和钉仓110之间的软组织。替代地,当砧座112进入其闭合位置而施加较大的夹紧力之前,砧座112在其部分闭合的位置时可用于在软组织上施加轻微夹紧力。在至少一种这样的实施方式中,外科器械可包括扳机,该扳机可在第一位置(图11)、第二位置(图12)和第三位置(图13)之间运动,第一位置对应于砧座112的打开位置,第二位置对应于砧座的部分闭合的位置,第三位置对应于砧座的闭合位置。在各种实施方式中,参照图8和9,扳机128可枢转地安装在手柄部分102的壳体103上,使得扳机128可围绕销129在其第一位置、第二位置和第三位置之间转动。在各种实施方式中,参照图8、9、17和18,外科器械100还可包括扳机锁定件148,该扳机锁定件148可用于接合扳机128并且选择性地将扳机128锁定在其上述第一位置、第二位置和第三位置的至少一个位置上。在至少一种实施方式中,扳机128可包括具有凸轮面140的枢转端138,第一槽口142和第二槽口144,其中扳机锁定件148可用于接合第一槽口142和第二槽口144。更具体地,参照图8和9,外科器械100还可包括扳机锁定弹簧150,扳机锁定弹簧150可用于将扳机锁定件148的从动部分149偏压在凸轮面140上,使得当第一槽口142或第二槽口144与从动部分149对齐时,扳机锁定弹簧150可将从动部分149分别推入第一槽口142或第二槽口144中。在至少一种实施方式中,主要参照图8和9,扳机锁定件148可枢转地通过销151安装在手柄部分102的壳体103上。在各种实施方式中,扳机锁定弹簧150可被压缩在扳机锁定件148的按钮部分152和壳体103之间,使得扳机锁定弹簧150能够使扳机锁定件148围绕销151旋转并且将扳机锁定件148向下偏压在扳机128的凸轮面140上。
接着上文,在至少一种实施方式中,当扳机128运动进入其第二位置并且砧座112运动进入其部分闭合的位置中时,第一槽口142可与从动部分149对齐。在各种实施方式中,从动部分149可以被牢固地保持在第一槽口142内,使得在扳机128可运动进入其第三位置和/或回到其第一位置之前,扳机锁定件148可能需要手动地从扳机132脱开。在至少一种实施方式中,参照图8和9,外科医生可以按压扳机锁定件148的按钮部分152,使得扳机锁定件148围绕销151旋转并且从动部分149被向上提升并且脱开与扳机128的接合。在其它各种实施方式中,第一槽口142可具有适当结构,使得在扳机128施加力的过程中,从动部分149可滑出第一槽口142。在任何一种情况下,在从动部分149已与第一槽口142脱开后,外科医生可选择性地使扳机128运动进入其第三位置或者释放扳机128并且允许扳机弹簧例如将扳机128回复到其第一位置。在至少一种替代实施方式中,第一槽口142和从动部分149可被构造成,在扳机128被移动进入其第二位置之后,扳机128在能够回到其第一位置之前必须被移动进入其第三位置。在任何一种情况下,在至少一种实施方式中,当扳机128运动进入其第三位置并且砧座112运动进入其闭合位置时,扳机128的第二槽口144可与从动部分149对齐。与第一槽口142相似,第二槽口144可用于将从动部分149保持在其中,直到扳机锁定件148从扳机128脱开和/或足够的力被施加在扳机128上以使从动部分149从第二槽口144移出。随后,在各种实施方式中,扳机弹簧可使扳机128从其第三位置运动进入其第二位置,在此与以上类似,可能要求外科医生将从动部分149从第一槽口142脱开。在至少一种替代实施方式中,第一槽口142可被构造成,使得从动部分149能滑动越过第一槽口142并且允许扳机128从其第三位置运动到其第一位置,而无需外科医生将从动部分149从第一槽口142移出。
接着上文,虽然没有示出,但是当闭合扳机128在其第一位置时,锁定件148的按钮部分152可例如凹进外科器械壳体103内。在替代实施方式中,按钮部分152可设置成与壳体103齐平或者按钮部分152可稍微从壳体103伸出。在任何一种情况下,在至少一种实施方式中,当闭合扳机128运动进入其第二位置时,按钮部分152可相对于壳体103向外运动。这样的运动可给外科医生提供视觉反馈,告知外科器械的砧座处于其部分闭合的位置中。另外,按钮部分152的运动还可以通过听觉反馈和/或触觉反馈完成。在任何一种情况下,在按钮部分152被向外运动后,外科医生可接近按钮部分152,使得锁定件148可如上所述从扳机128脱开。在各种实施方式中,当扳机128从其第二位置运动到其第三位置时,按钮部分152可进一步向外运动。与上述相似,这样的运动可为外科医生提供砧座现在处于其闭合位置的视觉提示,并且这可以通过听觉反馈和/或触觉反馈完成,如上所述。虽然按钮部分152如上所述在扳机128在其第一位置和第三位置之间渐进时会朝外运动,但是本发明并不限于此。相反,按钮部分152或者任何其它适当的指示器可被设置用于以任何适当的方式给外科医生提供反馈。
在替代实施方式中,虽然没有示出,但是砧座112可被保持或保留在比上述三个位置即其打开位置、闭合位置和部分闭合的位置更多的位置中。在至少一种实施方式中,砧座112被保持在打开位置、闭合位置和两个或更多个中间位置中。在这样的实施方式中,砧座112可渐进通过这些中间位置并且在砧座112朝着其闭合位置运动的过程中在被捕获在端部执行器106中的软组织上施加逐渐增大的力。在至少一种实施方式中,与以上相似,扳机128可包括与砧座112的各中间位置对应的多个槽口。在各种替代实施方式中,虽然没有示出,但是端部执行器闭合系统可包括棘轮组件,该棘轮组件可允许将扳机128和相应地将砧座112保持在多个位置中。在这样的实施方式中,砧座112和扳机128可通过棘爪保持就位,该棘爪可枢转地与棘轮接合,棘轮可操作地与扳机128接合。
在各种实施方式中,参照图10至13,如上所述,致动器122’和手柄部分102’之间的相对运动可被限制,以便控制锁定件120可以移动通过的范围。更具体地,参照图10和11,致动器122’的远侧部分可包括从致动器122’延伸出的凸起部123,该凸起部123可容纳在腔125中,在此致动器122’的位移可受到腔125的近侧壁117和远侧壁119限制。在至少一种实施方式中,当扳机128在其第一位置时,如图10和11所示,致动器122’可从如图10所示的远侧位置运动到如图11所示的较近侧的位置中,在远侧位置中凸起部123可抵靠在远侧壁119上,在较近侧的位置中凸起部123与远侧壁119不抵接。如上所述,在该较近侧的位置中,如上所述,锁定件120可从端部执行器106脱开并且端部执行器106可相对于轴组件104旋转。当扳机128在其第二位置时,参照图12,驱动器132可限制致动器122’的运动范围,使得凸起部123不能被定位成靠在近侧壁117上。然而,在至少一种实施方式中,致动器122’可向近侧运动一段距离,该距离足以以使锁定件120从端部执行器106脱开。在这些情况下,外科医生可重新定位端部执行器106,尽管砧座112例如可被部分地闭合在软组织上。当扳机128在其第三位置中时,如图13所示,驱动器132可向远侧迫压致动器122’,使得凸起部132与远侧壁119抵接或者被定位在远侧壁119附近,并且致动器122’能够充分运动以解锁关节运动接头114。
在各种实施方式中,根据本发明的外科器械可包括击发驱动装置,该击发驱动装置用于在如上所述的端部执行器内推进切割件和/或钉驱动器。在至少一种实施方式中,参照图8、9和19-25,外科器械100的击发驱动装置可包括击发扳机160、第一击发连杆162、第二击发连杆164和击发件166。在各种实施方式中,击发扳机160可操作地与击发件166和击发连杆162、164中的至少一个接合,以便在细长轴组件104内推进刀杆168。在至少一种实施方式中,刀杆168可操作地与端部执行器106中的切割件(未示出)和钉驱动器(未示出)接合,其中切割件可用于例如切割组织,并且钉驱动器可用于将钉从钉仓110中展开。在美国专利No.6,905,057和No.7,044,352中很好地公开了切割件和钉驱动器,上述美国专利之前已经通过引用结合入本申请中,因此,这些装置在此不再详细描述。其它切割件和钉驱动器在2006年9月29日提交的、序列号为No.11/541,123、题为“SURGICAL STAPLES HAVING COMPRES SIBLE ORCRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN ANDSTAPLING INSTYRUMENTS FOR DEPLOYING THE SAME”的美国专利申请,2007年1月11日提交的、系列号为No.11/652,169、题为“SURGICAL STAPLING DEVICE WITH CURVED CUTTINGMEMBER”的美国专利申请中公开,上述专利申请的整体内容由此通过引用结合入本文。
在各种实施方式中,主要参照图19和20,击发扳机160可以通过销161可枢转地连接到外科器械的壳体103(图8和9)。在使用中,在至少一种实施方式中,击发扳机160可围绕销161枢转,以便向远侧推进击发件166和击发连杆162、164。在各种实施方式中,第一扳机160可包括切口159、其中切口159可用于容纳击发销172。在各种实施方式中,当击发扳机160被从其如图2所示的位置致动或转动至与手柄握持件127邻近的位置时,切口159的侧壁可用于与击发销172接合并且向远侧推进击发销172。在至少一种实施方式中,参照图23,击发驱动装置还可包括棘爪170、其中棘爪170可包括孔171。在各种实施方式中,孔171可被用于容纳击发销172的至少一部分,使得当击发销172被扳机160向远侧推进时,击发销172同样可向远侧推进棘爪170。在各种实施方式中,参照图24,棘爪170可包括齿174,并且击发件166可包括凹槽167,其中凹槽167可用于容纳齿174。在使用中,当棘爪170被击发销172向远侧推进并且齿174与凹槽167的侧壁接合时,棘爪170也可向远侧推进击发件166。在各种实施方式中,棘爪170可被击发销172沿着基本线性的路径推进。在这样的实施方式中,切口159可包括弧形型面,该弧形型面能与击发销172协作,将击发扳机160的旋转运动转化成棘爪170的移动。在至少一种实施方式中,施加在棘爪170上的力可大致指向远侧方向,如果不是完全指向远侧方向的话。在这样的实施方式中,因此可以减少棘爪170被束缚或卡在钉合器机架184上的可能性。
在各种实施方式中,棘爪170可在第一位置和第二位置之间枢转,在第一位置中棘爪170可操作地从击发件166脱开,在第二位置中(参照图19和20)棘爪170可操作地与击发件166接合。主要参照图21至25,击发驱动装置还可以包括倾斜机构178,该倾斜机构178可用于使棘爪170在其第一位置和第二位置之间枢转。在使用中,当击发扳机160被致动时,棘爪170可以至少初始地相对于倾斜机构178运动,使得棘爪170的至少一部分可抵接倾斜机构178并且使棘爪170向上枢转进入与击发件166的操作接合。在至少一种实施方式中,主要参照图23,棘爪170可包括槽175,该槽175可用于容纳从倾斜机构178的中央部分延伸出的凸起部179(图25)。在至少一种实施方式中,当棘爪170向远侧行进时,槽175的近侧壁176可接触凸起部179上的凸轮面,并且由于通过枢转销172施加在棘爪170上的力,棘爪170可被向上枢转或旋转,使得齿174可如上所述被定位在击发件166的凹槽167中。在棘爪170被枢轴后,当棘爪170被朝着端部执行器106推进时,棘爪170可向远侧拖动倾斜机构178。更具体地,在至少一种实施方式中,倾斜机构178可包括可变形件180,该可变形件可容纳在钉合器机架184的切口182内,使得可变形件180和钉合器机架184之间的相互作用至少部分地抑制倾斜机构178相对于钉合器机架184的运动。换句话说,由于可变形件180和切口182的侧壁之间的静摩擦力,在倾斜机构178可被相对于钉合器机架184“拖动”之前必须在倾斜机构178上施加足以克服这些摩擦力的力。
在击发扳机160已被致动并且击发件166已被推进之后,扳机160可被释放并且回复到其如图2所示的未致动的位置,并且棘爪170可从击发件166脱开并且回缩到其如图19所示的起始位置。更具体地,在至少一种实施方式中,外科器械100还可包括扳机弹簧(未示出),该扳机弹簧例如可操作地与扳机160和壳体103接合,其中在棘爪170已从击发件166脱开后,扳机弹簧可用于使扳机160围绕销161旋转并且向近侧驱动击发销172。在各种实施方式中,在棘爪170如上所述通过倾斜机构178从其如图24所示的第二位置枢转进入其第一位置时,棘爪170可从击发件166脱开。在这样的实施方式中,棘爪170可被至少部分地相对于倾斜机构178移动,使得槽175的远侧壁177可接触凸起部179上的第二凸轮面,并且由于扳机160或复位弹簧186施加在击发销172上的力而可以使棘爪170向下旋转,使得棘爪170的齿174可从击发件166的凹槽167脱开。随后,扳机160和/或复位弹簧186可相对于击发件166拉动或回缩棘爪170。在各种实施方式中,与以上相似,棘爪170可用于在切口182内向近侧拖动倾斜机构178。上述结果是,棘爪170不需要被偏压在其第一位置或第二位置中。在各种情况下,棘爪170可在其第一位置和第二位置之间自由地旋转,无需克服由偏压弹簧施加在棘爪170上的力。实际上,在各种实施方式中,使棘爪170在其第一位置和第二位置之间运动的力只需要克服棘爪170的重力以及在棘爪170与外科器械的周围组成部件之间的任何摩擦力。
一旦棘爪170已被回复到其初始位置,在至少一种实施方式中,棘爪170的齿174可以无需再与击发件166中的凹槽167对齐。相反,总体参照图19和20,棘爪170的齿174可与第一击发连杆162中的凹槽163对齐。更具体地,第一击发连杆162可枢转地连接到击发件166,使得当击发件166被向远侧推进时,如上所述,击发件166可将第一击发连杆162拉入击发件166先前占据的位置中。因此,随着击发扳机160的第二次致动,棘爪170可从其第一位置枢转到其第二位置,使得齿174可操作地与凹槽163接合并且棘爪170可向远侧推进击发连杆162。在至少一种实施方式中,击发连杆162可向远侧推动击发件166和刀杆168,并且相应地在端部执行器106内向远侧推进切割件和钉驱动器。随后,棘爪170可再次从其第二位置枢转到其第一位置,并且被相对于第一击发连杆162回缩。一旦棘爪170第二次回到其初始位置,棘爪170的齿174可以无需再与第一击发连杆162的凹槽163对齐。相反,与以上相似,齿174可与第二击发连杆164的凹槽165对齐,并且上述过程可被重复。
虽然没有示出,但是根据本发明的外科器械可包括多于两个或少于两个击发连杆,以便在端部执行器106内将切割件和钉驱动器推进到它们的所需位置。在各种实施方式中,如以下更具体地描述,击发件166可包括多于一个凹槽167,使得棘爪170可直接朝着端部执行器106多次推进击发件166。在至少一种这样的实施方式中,棘爪170在向远侧推进击发件166后可被回缩,如上所述,使得当棘爪170被再次向上倾斜时,棘爪170可接合击发件166中的另一凹槽167,并且朝着端部执行器106再次推进击发件166。因此,在至少一种实施方式中,可以不需要击发连杆162和击发连杆164。
在各种实施方式中,外科器械可包括一个或多个弹簧件,用于将棘爪170运动进入其第一位置和第二位置的至少一个中。在至少一种实施方式中,参照图27和28,击发驱动装置可包括棘爪170’、击发销172和倾斜机构178’,其中与以上相似,当棘爪170’被向远侧推进时,倾斜机构178’可用于使棘爪170’向上枢转。击发驱动装置还可包括枢转弹簧188,该枢转弹簧188可操作地连接到棘爪170’,使得当棘爪170’向上枢转进入其如图27所示的第二位置时,棘爪170’可使枢转弹簧188挠曲或者弹性弯曲。在棘爪170’已被推进之后,棘爪170’可通过枢转弹簧188向下枢转进入其如图28所示的第一位置。更具体地,由于在枢转弹簧188挠曲时存储在枢转弹簧188中的势能,一旦棘爪170’不再被倾斜机构178’和击发销172保持在其第二位置,枢转弹簧188就可向下运动棘爪170’。随后,如上所述,棘爪170’可相对于击发件166和/或击发连杆162和164回缩。在各种实施方式中,倾斜机构178’可以不包括用于将棘爪170枢转进入其第一位置的第二凸轮面。在这样的实施方式中,如上所述,棘爪170’可通过施加在击发销172上的力回缩。在各种替代实施方式中,虽然未示出,但是倾斜机构178’和棘爪170’也可包括协作特征部,用于使棘爪170’向下枢转进入其第一位置中。
在各种实施方式中,参照图19和20,外科器械100还可包括带190,该带190可用于使击发件166和击发连杆162、164相对于端部执行器106运动。在至少一种实施方式中,带190的第一端例如可连接到击发件166上,使得当击发件166被向远侧推进时,带190也可被拉向远侧。在各种替代实施方式中,带190可连接到第一击发连杆162和/或第二击发连杆164上。在至少一种实施方式中,带190可围绕卷轴或卷盘192的至少一部分设置,使得当带190被击发件166拉动时,带190可被从卷轴192展开或松开。在至少一种实施方式中,带190的第二端可被连接到卷轴192上,使得带190在外科器械100的正常操作条件下不能轻易地从卷轴192脱开。在任何一种情况下,当带190被击发件166拉动时,卷轴192可沿着顺时针方向或逆时针方向旋转,这取决于带190围绕卷轴192设置的方式。为了回缩击发件166,卷轴192可被沿着相反方向旋转,以使击发件166和击发连杆162、164向近侧运动并且将带190卷绕在卷轴192上。
在各种实施方式中,带190可围绕卷轴192卷绕,使得带190围绕卷轴192的大致圆柱形表面缠绕。在至少一种实施方式中,卷轴192的旋转轴线和圆柱形表面之间的距离围绕卷轴192的周长基本上等距。在这些实施方式中,在如上所述向近侧拉动带190时,卷轴192的机械利益可保持基本不变,并且卷轴192在带190上施加拉力的能力可保持基本相同。然而,在替代实施方式中,卷轴192可用于提供变化的机械利益。在至少一种实施方式中,卷轴192可包括非圆柱形的表面,带190可缠绕在该非圆柱形的表面上,使得卷轴192的旋转轴线和非圆柱形的表面之间的距离围绕卷轴192的周长不是等距离的。因此,在这些实施方式中,卷轴192在带190上施加拉力的能力可以在带190被缠绕在卷轴192上时改变。在至少一种实施方式中,在带190最初回缩时,即在例如使切割件回缩的力可为最大时,卷轴190用作凸轮并且可包括能优化用于在带190上提供附加力的形状。
在各种实施方式中,参照图29-42,击发扳机160可选择性地与外科器械100的复位机构接合。在至少一种实施方式中,当击发扳机160经由棘爪170与击发件166可操作地接合,如上所述,对击发扳机160的致动可向远侧推进击发件166,并且当击发扳机160经由带190与击发件166可操作地接合时,对击发扳机160的致动可向近侧回缩击发件166。在各种实施方式中,复位机构可被手动地致动,以将击发扳机160从击发件166脱开并且将击发扳机160与卷轴192可操作地接合。在至少一种实施方式中,复位机构可包括复位滑架194,复位滑架194能被可枢转地安装在外科器械的壳体103上,使得复位滑架194可在如图29所示的第一位置或未致动的位置和如图32所示的第二位置或致动位置之间枢转。在至少一种实施方式中,复位滑架194可包括按钮部分195,当在按钮部分195上施加力时,按钮部分195可用于将复位滑架194从其未致动位置运动至其致动位置。
当复位滑架194被定位在其如图29至31所示的未致动位置时,击发扳机160可被用于如上所述地推进击发件166,并且扳机160的齿轮部分158与扳机齿轮196可操作地接合。在各种实施方式中,齿轮部分158和扳机齿轮196能够可操作地接合,使得扳机160围绕销161的旋转可驱动扳机齿轮196围绕由复位销198限定的轴线运动。在至少一种实施方式中,当复位滑架194在其未致动的位置时,扳机齿轮196可用于围绕复位销198自由旋转,使得扳机齿轮196的旋转不被传递到或至少没有被大部分传递到复位销198。更具体地,参照图30,复位销198的键199可被偏压成与扳机齿轮196脱开接合,使得扳机齿轮196的旋转不会被传递到键齿轮206和卷轴192。因此,当复位滑架194在其未致动位置时,扳机齿轮196的致动不会使或者至少不会明显使卷轴192旋转。
在切割件和钉驱动器已在端部执行器106内被推进之后,复位滑架194可运动进入其致动位置。在各种实施方式中,参照图30,卷轴192可包括从其延伸出的凸轮件202,该凸轮件202可接触复位滑架194并且使复位滑架194向下旋转。在至少一种实施方式中,凸轮件202可在扳机160的最终致动过程中接触复位滑架194,扳机160在端部执行器106内推进切割件和钉驱动器。在至少一种这样的实施方式中,凸轮件202在致动扳机160的第三次致动后可接触复位滑架194。在各种实施方式中,参照图32至35,当复位滑架194运动进入其致动位置时,复位滑架194可用于使扳机齿轮196与卷轴192可操作地接合。在至少一种实施方式中,参照图33和35,复位滑架194可包括偏压弹簧200,其中当复位滑架194在其未致动位置时,弹簧200可定位在如图33所示的位置中,并且当复位滑架194运动进入其如图35所示的致动位置时,弹簧200可接触复位销198并且朝着扳机齿轮196偏压复位销198。在至少一种实施方式中,参照图31,扳机齿轮196中可包括D形的腔197,在以下解释的某些情况下,所述腔197内可容纳从复位销198延伸出的键199并且能使扳机齿轮196与键齿轮206和卷轴192可操作地接合。在各种实施方式中,复位滑架194进入其致动位置的运动可通过听觉反馈和/或触觉反馈完成,所述反馈告知外科医生,外科器械的复位机构已经与扳机160接合。
接着上文,当复位销198朝着扳机齿轮196滑动时,D形腔197可被定位成,使得键199不会立即进入腔197内。相反,参照图31,弹簧200可偏压复位销198,使得键199初始地抵靠在扳机齿轮196的面204上。然而,在扳机160被释放并且回复到其未致动的位置时,D形腔197可被旋转并且与键199对齐,使得弹簧200可将键199偏压入腔197中,如图36所示。在至少一种实施方式中,参照图31,当复位销198朝着扳机齿轮196滑动时,复位销198的一端可被容纳在复位滑架194的切口193中,如图32所示。在键199被插入腔197中之后,对扳机160的下一次致动可使D形腔197的驱动面210抵接键199并且使复位销198旋转至如图37和38所示的位置。实际上,在至少一种实施方式中,对扳机160的致动可使键199大约旋转半转,使得初始时基本向下延伸的键199(图36)可被旋动成基本向上延伸(图37)。此后,扳机160可被释放并且扳机齿轮196可相对于键199旋转,其中键199可保持如图39至41所示的基本向上的定向。
在各种实施方式中,主要参照图38,键齿轮206能够可操作地与复位销198接合,使得复位销198的旋转可被传递到键齿轮206。在至少一种实施方式中,键齿轮206可包括键形孔212,该孔212能用于可滑动地容纳复位销198的键199。在至少一种实施方式中,当复位销198与扳机齿轮196接合时,键199能可操作地与扳机齿轮196的凹槽197和键齿轮206的孔212接合。在各种替代实施方式中,键齿轮206可被固定地安装在复位销198上。在这样的实施方式中,当复位销198相对于扳机齿轮196滑动时,键齿轮206也可相对于扳机齿轮196滑动。在各种实施方式中,总体参照图38,卷轴192可包括安装在其上的正齿轮216,其中正齿轮216能够可操作地与键齿轮206接合,使得键齿轮206的旋转可被传递到卷轴192。在至少一种实施方式中,当键齿轮206朝着扳机齿轮196滑动时,键齿轮206可被滑动进入与卷轴192的操作性接合。在替代实施方式中,正齿轮216可具有适当构造,使得键齿轮206与正齿轮216处于操作性接合,而与键齿轮206是否被偏压向扳机齿轮196无关。
由于上述情况,当复位滑架194被定位在其如图32所示的致动位置时,扳机160的致动可使卷轴192旋转并且将带190围绕所述卷轴192的至少一部分缠绕。如果当复位滑架194被致动时,键199不能与扳机齿轮196可操作地接合,那么卷轴192可被手动地旋转以回缩带190。在至少一种这样的实施方式中,参照图33和37,螺栓或紧固件218能与卷轴192可操作地接合,使得螺栓218的旋转能影响卷轴192的旋转。在各种实施方式中,外科医生可将螺栓218插入穿过外科器械的壳体103中的开口并且使螺栓218与卷轴192接合。在至少一种实施方式中,外科器械100还可包括计数机构(未示出),该计数机构可对扳机160的致动进行计数,并且在至少一种实施方式中,螺栓218例如能够可操作地与计数机构接合,以旋转卷轴192。因此,在各种实施方式中,外科器械可包括用于卷轴192的第一致动器或主致动器和第二致动器,该第二致动器可用于代替第一致动器来卷绕卷轴192。
在各种实施方式中,如上所述,卷轴192可被用于向近侧拉动带190并且向近侧回缩击发件166和击发连杆162、164。更具体地,如上所述,击发件166和击发连杆162、164可被相对于棘爪170回缩,以便将击发件166和击发连杆162、164重新定位在它们的起始位置中。在这样的实施方式中,尤其是在如上所述棘爪170能够枢转的实施方式中,外科器械100的复位机构还可用于保持棘爪170脱开与击发件166以及击发连杆162、164的操作性接合,同时它们可相对于棘爪170运动。更具体地,当复位滑架194运动进入其如图35所示的致动位置时,复位滑架194可用于接触击发销172的一端并且使击发销172朝着棘爪170滑动,使得击发销172与棘爪170接合并且防止棘爪170向上枢转。更具体地,参照图34,击发销172可包括第一端220,该第一端例如可包括圆锥面和/或圆面,其中,当复位滑架194接触第一端220时,复位滑架194可朝着棘爪170推动击发销172。在至少一种实施方式中,棘爪170可包括凹槽173,当击发销172朝着棘爪170运动时,该凹槽173可用于容纳从击发销172延伸出的键222。当键222和凹槽173操作性地接合时,击发销172可防止棘爪170向上枢转进入与击发件166和击发连杆162、164的接合。
在击发件166以及击发连杆162、164已被回缩之后,新的钉仓110可被固定在端部执行器106上,并且外科器械100可被复位,使得其可被再次用于切割并钉合软组织。在各种实施方式中,参照图39至42,复位滑架194可从其如图32所示的致动位置运动至其如图40所示的未致动位置。在至少一种实施方式中,当在按钮部分195上施加力时,复位滑架194可被向上旋转或枢转。替代地,参照图29,当扳机锁定件148如上所述被向上旋转以使从动部分149从闭合扳机128脱开来重新打开端部执行器106时,复位滑架194可被向上运动。更具体地,当对扳机锁定件148的按钮部分152施加力时,扳机锁定件148可向上旋转,使得从扳机锁定件148延伸出的突起部147可接触复位滑架194并且也使复位滑架194向上运动。在任何一种情况下,参照图42,当复位滑架194向上运动进入其未致动位置时,复位滑架194可将击发销172从棘爪170脱开,此外可使复位销198从扳机齿轮196脱开。更具体地,复位滑架194可用于抵接击发销172的带圆锥面或圆形的端221,使得当复位滑架194被向上旋转时,复位滑架194可使击发销172远离棘爪170滑动并且使键222从凹槽173脱开。同样,当复位滑架194向上运动时,切口193的侧壁可用于接触复位销198并且使复位销198远离扳机齿轮196运动以使键199从D形腔197脱开。简而言之,在至少所示的实施方式中,当锁定件148的按钮部分152被压下并且复位滑架194被向上运动时,外科器械可被复位并且可被再次重新使用。
虽然上述的外科器械在切割件和钉驱动器在端部执行器106内已被完全推进后可被复位,复位滑架194的按钮部分195例如在切割件和钉驱动器在端部执行器106内仅被部分地推进时可被压下。在各种实施方式中,复位滑架194还可包括在复位滑架194的相对两侧之间延伸的引导销191。在至少一种这样的实施方式中,引导销191能被可滑动地容纳在机架184的引导切口185(图31)内,使得切口185和销191可限定复位滑架194的路径。在各种实施方式中,当复位滑架194如上所述从其致动位置运动至其未致动位置时,引导销191和引导切口185可用于确保复位滑架194接合击发销172和复位销198并且复位外科器械。
在各种实施方式中,外科器械100还可包括制动器,该制动器用于防止或至少部分地抑制击发驱动装置例如在端部执行器106内推进和/或回缩切割件和钉驱动器。在至少一种实施方式中,参照图43,机架184可包括制动面187,其中制动面187可用于将制动力施加在带190上。更具体地,当带190如上所述被拉向近侧和/或远侧时,机架184可具有适当构造,使得带190在制动面187上滑动并且在带190和制动面187之间产生摩擦力。在各种实施方式中,参照图44,制动面187’可具有适当构造,使得带190在击发件166和卷轴192之间的路径被制动面187’打断并且可在带190上施加很大的法向力。
在至少一种实施方式中,当带190处于静止状态时,带190可与制动面187’接合,使得当在带190上施加拉力时,带190和制动面187’之间的静态摩擦力可至少初始地防止带190相对于制动面187’运动。当施加在带190上的拉力超过静态摩擦力时,带190可相对于制动面187’运动。当扳机160被多次致动以在端部执行器106内推进切割件和/或钉驱动器时,这样的实施方式可能特别有用。更具体地,在扳机160的致动之后,棘爪170可如上所述相对于扳机件166回缩,并且在各种实施方式中,当棘爪170被回缩时,带190和制动面187’之间的摩擦力可防止或至少部分地抑制击发件166和击发连杆162、164向近侧运动和/或向远侧运动。由于上述原因,当棘爪170相对于击发件166和击发连杆162、164运动时,棘爪170的齿174和击发件166的凹槽以及击发连杆162、164之间的对齐可被保持。
同样,在至少一种实施方式中,带190的刚度也可帮助将击发件166和击发连杆162、164保持就位。更具体地,为了使击发件166“反向运动”或者向近侧运动,击发件166必须向近侧推动带190,并且实际上将带190卷绕在卷轴192上。在各种实施方式中,带190的刚度可以使得需要在很大的力将带190卷绕在卷轴192上,因此,击发件166可被保持就位。为了进一步增加用于使带190围绕卷轴192卷绕所需的力,参照图44,带190的路径可被控制,使得带190不会沿着相切方向卷绕在卷轴192上。更具体地,如果带190的路径是沿着非相切方向卷绕在卷轴192上,那么通过带190传递的力的一部分将会损失掉,导致用于卷绕卷轴192的差的机械利益。
在各种实施方式中,外科器械100可包括制动器,其可与卷轴192或者击发驱动装置的任何其他适当组成部分接合,以防止击发件166和/或击发连杆162、164例如被意外地回缩。在至少一种实施方式中,虽然没有示出,但是制动器可在第一位置和第二位置之间运动,其中,当制动器在第一位置时,制动器例如可将第一制动力施加到带190上。在至少一种这样的实施方式中,当制动器在第二位置时,制动器例如可将第二制动力施加到带190上,第二制动力可大于或者小于第一制动力。在各种替代实施方式中,当制动器在第二位置时,制动器可以不与带190接合或者不与击发驱动装置的任何其他部分接合。在各种实施方式中,虽然没有示出,但是外科器械100可包括制动机构,该制动机构能将制动力施加到卷轴192和/或带190上。在至少一种这样的实施方式中,制动机构可包括球形制动件和弹簧件,该弹簧件用于将球形制动件偏压抵靠在卷轴192和/或带190上。
在各种实施方式中,外科器械100可包括棘轮机构,该棘轮机构可以允许卷轴192沿着第一方向回转,但是能够在各种情况下防止卷轴192沿着与第一方向相反的方向回转。在至少一种实施方式中,参照图45至49,外科器械100可包括棘轮组件230,在此棘轮组件230可包括棘轮232和棘爪234。在各种实施方式中,主要参照图47和48,除了棘轮232可包括棘齿236之外,棘轮232能以与上述的键齿轮206基本相同的方式工作,由于棘齿236与棘爪234的齿合,棘齿236防止了例如当复位滑架194’在其未致动的位置(图47)中时棘轮232沿着顺时针方向回转。更具体地,每个棘齿236可包括平面240,其中,参照图48,至少其中一个平面240可抵接棘爪234的边缘235,由此防止棘轮232沿着顺时针方向旋转。
每个棘齿236还可包括斜面238,在此,当棘轮232沿着逆时针方向回转时,斜面238能够滑动到棘爪234下面。由于上述情况,至少当复位滑架194’在其未致动的位置中时,棘轮组件230可允许例如通过击发件166向远侧拉动带190,但是防止或者至少基本抑制带190向近侧运动。当复位滑架194’向下枢转到其致动位置中时,如以上关于复位滑架194’的描述,棘轮232可朝着扳机齿轮196’滑动并且脱开与棘爪234的操作性接合。因此,在这之后,棘轮232可沿着顺时针和逆时针方向中的任何一个方向旋转,而没有来自棘爪234的干扰或至少没有实质干扰。在棘轮232不向着扳机齿轮196’滑动的各种替代实施方式中,当复位滑架194’运动进入其致动位置时,棘爪234可向下运动并且脱开与棘齿236的操作性接合。在任何一种情况下,当复位滑架194’在其致动位置时,扳机齿轮196’可转动棘轮232和凸轮192’以回缩带190和击发件166。
在各种实施方式中,参照图68至86,外科器械400可包括用于闭合端部执行器的砧座的闭合系统,用于在端部执行器内推进击发杆、切割件和/或钉驱动器的击发驱动装置,以及用于相对于端部执行器回缩击发杆、切割件和/或钉驱动器中的至少一个的齿轮驱动反向驱动装置。在至少一种实施方式中,参照图68,闭合系统可包括闭合扳机428、传动连杆130和驱动器132,其中与以上类似,当闭合扳机428从其如图68所示的未致动位置运动到其如图69所示的致动位置时,闭合扳机428可用于移动传动连杆130和驱动器132。在各种实施方式中,闭合扳机428的致动可解锁击发驱动装置。在至少一种实施方式中,击发驱动装置可包括击发扳机460,该击发扳机在闭合扳机428朝着手柄427旋转时可在如图68所示的锁定位置和如图69所示的解锁位置之间运动。在至少一种这样的实施方式中,闭合扳机428可包括切口或槽128a,该切口或槽可容纳销或者突起部160a,该销或突起部160a从击发扳机460延伸出,其中当闭合扳机428在其未致动位置时(图68),切口128a的侧壁可用于防止销160a和击发扳机460相对于闭合扳机428运动或者至少明显运动。当闭合扳机428被致动或闭合时,切口128a的侧壁可抵接销160a并且使击发扳机460在其如图68所示的锁定位置和如图69所示的解锁位置之间运动。在这样的解锁位置中,切口128a可被定向成允许销160a在切口128a内运动,由此允许击发扳机460相对于闭合扳机428运动并且推进击发驱动装置,如以下更详细地描述。
在各种实施方式中,参照图68,击发驱动装置可包括击发扳机460、击发销172和棘爪170,其中击发扳机460能够经由棘爪170和击发销172可操作地与击发杆或击发件466接合,以便在端部执行器内推进切割件和钉驱动器。在至少一种这样的实施方式中,与以上相似,棘爪170可向上枢转进入与击发件466的接合,使得当击发扳机460被致动时,参照图70,击发扳机460可向远侧推进击发销172、棘爪170和击发件466。此后,参照图101,棘爪170可被向下枢转,脱开与击发件466的接合,使得当击发扳机460被释放或回复到其如图72所示的未致动且解锁的位置中时,棘爪170可相对于击发件466向近侧回缩。通过比较图69和图72,容易看出,击发驱动装置的第一循环使击发件466向远侧运动并且还对棘爪170、击发销172和击发扳机460进行重新定位,使得击发扳机460可被第二次致动以进一步推进击发件466。在这样的情况下,参照图102,通过再次致动击发扳机460,棘爪170可被向上枢转成进入与击发件466的操作性接合并且被向远侧推进。
在各种实施方式中,参照图101和102,击发件466可包括多个凹槽467,每个凹槽467可容纳棘爪170的至少一部分,使得棘爪170可依次接合凹槽467,以便如上所述多次推进击发件466。更具体地,在至少一种实施方式中,击发件466可包括三个凹槽467,这三个凹槽467可允许凹槽467被扳机460推进至少三次。通过举例,图73示出了在扳机460的第二次致动时的击发驱动装置,图74示出了在扳机460在其第二次致动后回到其未致动位置之后的击发驱动装置,图75示出了在扳机460的第三次致动时的击发驱动装置,并且图82示出了在扳机460在其第三次致动后回到其未致动位置之后的击发驱动装置。在此,如以下更具体地描述,击发驱动装置可从击发件466脱开并且反向驱动装置能够与击发件466可操作地接合,使得在各种实施方式中,击发件466可相对于端部执行器回缩并且外科器械可被复位。虽然击发扳机460在所示的示例性的实施方式中被致动了三次以便完全推进击发件466,但是可以想到其他可采用多于或少于三次击发扳机冲程或致动的实施方式。
在各种实施方式中,如上所述的,外科器械400还可包括齿轮驱动的反向驱动装置或机构,其可用于相对于外科器械的端部执行器回缩击发件466、切割件和/或钉驱动器。在至少一种实施方式中,反向机构能够与击发件466或者击发驱动装置的任何其他适当的部分可操作地接合,以使击发件466向近侧运动。在至少一种实施方式中,参照图71,反向驱动装置包括齿轮组,该齿轮组例如包括扳机齿轮496、键齿轮406、小齿轮401、中间齿轮403和正齿轮416。在各种实施方式中,参照图84,反向驱动装置还可包括从击发扳机460延伸出的齿轮部分158,该齿轮部分158可具有适当构造,使得当击发扳机460以类似于以上方式围绕销161旋转时,齿轮部分158可使扳机齿轮496围绕复位销498限定的轴线旋转。在至少一种实施方式中,齿轮部分158和扳机齿轮496可包括齿和/或凹槽,该齿和/或凹槽可被构造成协同动作并且在齿轮158和扳机齿轮496之间传递旋转运动。
参照图77,同样与以上相似,扳机齿轮496和复位销498可具有适当构造,使得它们可有选择地彼此接合和脱开。在至少一种这样的实施方式中,当击发件466被击发驱动装置推进时,扳机齿轮496能够可操作地与复位销498脱开。换句话说,当击发件466如上所述被击发驱动装置推进时,扳机齿轮496可被构造成使得其不将或至少不实质上将旋转运动传递到复位销498。而且,在至少一种实施方式中,参照图77和79,复位销498可包括从复位销498延伸出的键499,其中该键499可保持与扳机齿轮496中的D形腔497脱开操作性的接合,直到所述反向驱动装置与击发件466可操作地接合(如下面更详细描述的)。为了保持键499不与扳机齿轮496操作性地接合,参照图84,复位销498可包括端部498a,该端部498a可被复位滑架494移动和/或保持就位,使得键499被定位在D形腔497外面。
在扳机齿轮496和复位销498如上所述可操作地接合时,参照图71,反向驱动装置的小齿轮401能够可操作地与击发件466的齿条部分405接合,使得当击发件466如上所述被击发驱动装置向远侧推进时,齿条部分405可使小齿轮401绕由轴407限定的轴线旋转。在各种实施方式中,齿条部分405可包括多个齿和/或槽,该齿和/槽可用于将击发件466的平移运动转化成小齿轮401的旋转运动。在各种实施方式中,中间齿轮403可被安装在小齿轮401上或与小齿轮401一体形成,使得击发件466的平移也可以旋转中间齿轮403。在至少一种实施方式中,中间齿轮403和键齿轮406可包括能够用于协调和传递它们之间的旋转运动的齿和/或凹槽。同样,正齿轮416可包括能够与键齿轮406的齿和/或凹槽协同动作并且在正齿轮416和键齿轮406之间传递旋转运动的齿和/或凹槽。因此,考虑到以上内容,击发件466的推进可旋转齿轮组的齿轮401、403、406和416。
在至少一种实施方式中,参照图71和84,正齿轮416可被安装在指示器齿轮492上或与指示器齿轮492一体形成,使得当正齿轮416如上所述通过键齿轮406旋转时,指示器齿轮492可被正齿轮416旋转。因此,在至少一种这样的实施方式中,击发件466的向前推进可使指示器齿轮492绕由孔407限定的轴线旋转。在各种实施方式中,指示器齿轮492上可包括至少一个标记,例如字母、数字和/或任何其他适当的符号,用于显示击发扳机460已被致动的次数。在至少一种这样的实施方式中,外科器械的壳体中可包括窗口或孔,其中在击发扳机460的第一次致动之后指示器齿轮492上的例如数字“1”可与窗口对齐。同样,在击发扳机460的第二次致动之后指示器齿轮492上的例如数字“2”可与窗口对齐,并且相应地,在第三次致动之后例如数字“3”可与窗口对齐。替代地,在至少一种实施方式中,指示器齿轮492上可包括标记,该标记可对应于为了相对于端部执行器完全推进击发件466、切割件和/或钉驱动器所必须的剩余致动次数。
在击发件466相对于端部执行器完全推进或至少适当地推进后,复位滑架494可向下旋转,参照图76和82,以使反向驱动装置、击发扳机460和击发件466可操作地联接。在各种实施方式中,复位滑架494可围绕销494a旋转,使得复位滑架494不再接触或至少基本接触复位销498。此后,参照图77和78,弹簧400可使复位销498朝着扳机齿轮496滑动或移动,并且将键499的至少一部分定位在腔497内。在至少一种这样的实施方式中,参照图78,弹簧400可被定位在机架484和复位销498的键499中间,使得当复位滑架494不再接触端部498a时,弹簧400可扩张并且使键499移动进入腔497中。在各种实施方式中,参照图80,当复位滑架494如上所述向下旋转时,复位滑架494也可操作地使击发驱动装置从击发件466脱开。更具体地,参照图81,复位滑架494可接触击发销172的端部220,使得击发销172可朝着棘爪170滑动,并且还如上所述的,击发销172可包括从击发销172延伸出的键222,该键222可接合棘爪170的凹槽173,从而防止棘爪170向上枢转至与击发件466接合。因此,当棘爪170被防止与击发件466可操作地接合时,击发驱动装置可以不再接合击发件466,并且反向驱动装置可在没有来自击发驱动装置的干扰的情况下回缩击发件466。
接着上文,在各种实施方式中,复位滑架494可例如由外科医生或由其他临床医生手动地向下旋转。在各种实施方式中,总体参照图68和82,外科医生可向按钮部分495施加力,使得复位滑架494能围绕由销494a限定的轴线向下枢转。这样的力可在击发扳机的预定次数的致动后施加,但是在不同实施方式中,这样的力可在达到击发扳机的预定次数的致动之前施加。除了以上情况或者替代以上情况,反向机构的至少一个齿轮可被构造成在击发扳机460的预定次数的致动后接触复位滑架494。在各种实施方式中,参照图76,指示器齿轮492可包括凸轮402,该凸轮402可用于接触复位滑架494的一部分并且随着击发扳机460的第三次致动而向复位滑架494施加力。在至少一种这样的实施方式中,击发件466的推进可使指示器齿轮492随着击发扳机460的每次致动旋转预定的量,使得凸轮402可在扳机460的第三次或最后一次冲程时接触复位滑架494,击发扳机460推进击发件466。实际上,指示器齿轮492或者反向机构的任何其他适当的齿轮可被构造成在将外科器械从“推进”工作模式切换到“反向”工作模式之前旋转预定的量。
如果复位销498已与扳机齿轮496可操作地接合并且击发销172已与棘爪170接合,以防止棘爪170如上所述与击发件466可操作地接合,那么击发扳机460可被再次致动,以回缩击发件466。在至少一种这样的实施方式中,击发扳机460的后续致动可使扳机齿轮492旋转,并且由于扳机齿轮492和复位销498之间的操作性接合,扳机齿轮492可旋转键齿轮406。更具体地,参照图71、77和78,复位销的键499除了与键齿轮406内的腔406a的侧壁操作性地接合,还可与扳机齿轮492的驱动面410操作性地接合,使得扳机齿轮496的旋转被经由复位销498传递到键齿轮406。在各种实施方式中,参照图71,键齿轮406的旋转可使中间齿轮403和小齿轮401旋转,以便向近侧驱动或回缩击发件466。实际上,当扳机460与反向驱动装置可操作地接合时,小齿轮401可沿着一方向旋转,该方向与小齿轮401在击发扳机460与击发驱动装置可操作地接合时旋转的方向相反。在各种实施方式中,例如齿轮401、403、406、492、496以及扳机齿轮460的齿轮部分158的尺寸或节圆半径可适当选取,使得击发件466可通过扳机460的一次致动而复位,但是其他使用多于或少于扳机460的一次致动的实施方式是可想到的。
在击发件466被回缩之后,复位滑架494可向上枢转进入其未致动位置,以复位外科器械。在各种实施方式中,参照图85和86,外科医生或临床医生可在扳机锁定件448的按钮部分452上施加力,使得扳机锁定件448可向上旋转并且抵接复位滑架494。在这样的情况下,扳机锁定件448同样可向上旋转复位滑架494并且将复位滑架494定位在其未致动位置中。在这样做时,复位滑架494可接合击发销172的端部221,以使击发销172从棘爪170滑离并且使键222从棘爪170的凹槽173脱开,由此允许棘爪170在击发扳机460的下一次致动时重新接合击发件466。当复位滑架494向上旋转时,复位滑架494也可接合复位销498的端部498a,以便使键499从扳机齿轮496滑离,由此使复位销498从扳机齿轮496可操作地脱开,相应地使反向驱动装置从击发件466可操作地脱开。随后,用尽的钉仓可从外科器械拆下并且更换成新的钉仓,使得外科器械可被再次使用。
在各种替代实施方式中,外科器械可包括离合器,该离合器用于使反向驱动装置与击发件可操作地接合和脱开。在至少一种实施方式中,参照图87至94,外科器械500(与外科器械400相似)可包括击发扳机560,该击发扳机560可用于驱动例如击发驱动装置的击发销和棘爪,从而相对于端部执行器推进击发件566、切割件和/或钉驱动器。在各种实施方式中,也与以上相似,外科器械还可包括反向驱动装置,该反向驱动装置包括小齿轮501、中间齿轮503、键齿轮506和正齿轮516。在至少一种这样的实施方式中,由于击发件496的齿条部分505和小齿轮501之间的操作性接合,击发件466的推进可旋转齿轮501、503、506和516,如下面更详细地描述。在各种实施方式中,复位销或键销598可安装在键齿轮506上或者与键齿轮506一体形成,使得旋转动作在销598和键齿轮506之间传递。在至少一种这样的实施方式中,参照图89,复位销598的至少一部分可包括例如具有平整部分598b的非圆形横截面,参照图92,所述部分可滑动地容纳在键齿轮506的相应形状的孔506b内。同样与以上相似,击发扳机560可包括齿轮部分558,该齿轮部分558可与扳机齿轮596可操作地接合,使得齿轮部分558可使扳机齿轮596围绕由键销598限定的轴线旋转,如下面更详细地描述。
在使用中,随着击发扳机560的第一次致动,击发扳机560可与以上相似地使扳机齿轮596围绕键销598旋转,而不会经由扳机齿轮596直接将旋转运动传递到键销598。参照图88,击发扳机560的第一次致动可使扳机齿轮596沿着箭头“A”所指的方向旋转,也就是顺时针方向(为了便于讨论)。同样随着对击发扳机560的第一次致动,击发件566可沿着箭头“B”所指的方向旋转小齿轮501和中间齿轮503,沿着箭头“C”所指的方向旋转键齿轮506,沿着箭头“D”所指的方向旋转正齿轮516和指示器齿轮592。在各种实施方式中,如图88所示,扳机齿轮596和键齿轮506在扳机560的第一次致动过程中可沿着相反方向旋转并且能够彼此可操作地接合,直到扳机560的第一次致动之后,如下面更具体地描述。当扳机560在其第一次致动后被释放或回到其未致动位置时,击发驱动装置的棘爪例如可从击发件566脱开,使得当扳机560回到其初始位置或未致动位置时,小齿轮501和键齿轮506例如不旋转或至少基本上不旋转。然而,当击发扳机560回到其未致动位置时,扳机齿轮596可被击发扳机560旋转,因此,扳机齿轮596可被相对于键齿轮506旋转,如图89所示。当扳机560回到其未致动位置时,如上所述,扳机齿轮596的斜面509可接触键销598的离合止动器(clutch dog)599,并且使键销598从扳机齿轮596移动开,如图90所示。随后,扳机齿轮596可被击发扳机590进一步旋转,直到斜面509被离合止动器599完全超过并且弹簧500可将离合止动器599偏压到驱动面510后面的位置中,如图91所示。在此处,击发扳机560可处于其未致动位置中。
在击发扳机560的第二次致动时,击发驱动装置的棘爪可保持从击发件566脱开,但是击发扳机560的第二次致动可再次沿着箭头A所指的方向旋转扳机齿轮596,参照图92。由于止动器599的位置在扳机齿轮596的驱动面510后面,扳机齿轮596的旋转可引起键销598和键齿轮506沿着如箭头A所指的顺时针方向旋转,也就是沿着与箭头C所指方向相反的方向旋转。相应地,键齿轮506可沿着箭头E所指的方向(也就是与箭头B方向相反的方向)旋转小齿轮501和中间齿轮503,并且可沿着箭头F所指的方向(也就是与箭头D方向相反的方向)旋转指示器齿轮592。由于小齿轮501在扳机560的第二次致动过程中沿着相反方向旋转,小齿轮501可相对于端部执行器回缩击发件566并且将击发件566重新定位或至少基本上重新定位在其起始或未致动的位置中。此后,击发扳机566可被释放和回复到其未致动的位置中。在这种情况下,扳机齿轮596的驱动面510仍然能够从击发件566操作性地脱开,键销598和键齿轮596可保持就位。为了复位外科器械,击发驱动装置的棘爪可被释放,使得该棘爪在扳机560的下一次致动时可重新接合击发件566。在这样的实施方式中,用尽的钉仓可被更换,使得外科器械可被再次使用。
在各种实施方式中,参照图94,外科器械500还可包括扳机锁定件548,其与上述的扳机锁定件148相似,可用于将闭合扳机保持就位。在至少一种实施方式中,扳机锁定件548可在致动位置和未致动位置之间旋转以例如分别锁定和解锁诸如闭合扳机428(图68)的闭合扳机。在至少一种这样的实施方式中,当扳机锁定件548在其未致动位置时,扳机锁定件548的部分548a可被定位在指示器齿轮592的凹槽592a内,以防止或至少基本上防止齿轮组和击发件566被无意地启动。换句话说,当部分548a被定位在凹槽592a内时,上述的击发驱动装置和反向驱动装置基本上不能进行操作,并且因此击发件566也基本上不能运动。当扳机锁定件548运动进入其致动位置以保持或锁定闭合扳机就位时,扳机锁定件548的部分548a可被移动或旋转出凹槽592a,使得上述的击发驱动装置和反向驱动装置可被操作。
在各种替代的实施方式中,外科器械可包括棘轮机构,该棘轮机构用于使反向驱动装置与击发件接合和脱开。在至少一种实施方式中,参照图95至100,外科器械600可包括击发扳机660,该击发扳机660可用于驱动例如击发驱动装置的击发销和棘爪,以相对于端部执行器推进击发件666、切割件和/或钉驱动器,与以上相似。在各种实施方式中,同样与以上相似,外科器械还可包括反向机构,该反向机构包括小齿轮601、键齿轮606和正齿轮616,其中,由于击发件666的齿条部分605和小齿轮601之间的操作性接合,击发件666的推进可使齿轮601、606和616旋转。在各种实施方式中,复位销或键销698可被安装在键齿轮606上或与键齿轮606一体形成,使得旋转动作可在销698和键齿轮606之间传递。同样与以上相似,击发扳机660可包括齿轮部分658,该齿轮部分658可与扳机齿轮696操作性地接合,从而齿轮部分658可使扳机齿轮696围绕由键销698限定的轴线旋转。
在使用中,随着击发扳机660的第一次致动,击发扳机660可使扳机齿轮696围绕键销698旋转,而不会将旋转运动直接传递给键销698和键齿轮606。更具体地,参照图97,扳机齿轮696可包括孔696a,该孔696a可被构造成使得在键销698和孔696a的侧壁之间存在间隙配合,因此,键销698可在孔696a内旋转。而且,参照图96,键齿轮606可包括棘齿面606c并且扳机齿轮696可包括棘齿面696c,当击发扳机666被击发驱动装置推进时,键齿轮606和扳机齿轮696可彼此脱开或分开,从而在键齿轮606和扳机齿轮696之间也不能传递旋转运动。在击发件666被完全推进后,与以上相似,复位滑架694可被例如围绕销694a向下旋转,使得复位滑架694可从复位销698的端部698a脱开,参照图99。在这样的情况下,如下面更具体地描述,复位销698可与扳机齿轮696操作性地接合并且击发件666可被回缩。
接着上文,在各种实施方式中,复位滑架694可被手动地在其如图95所示的未致动位置和其如图99所示的致动位置之间移动,与复位滑架494相似。除了或替代以上情况,齿轮组中的至少一个齿轮(例如指示器齿轮692)可包括凸轮(例如凸轮602),在击发扳机660的预定程度的致动之后,该凸轮接触复位滑架694并且使复位滑架694向下旋转。此后,在任何一种情况下,键齿轮606可通过弹簧600朝着扳机齿轮696滑动。更具体地,按照图100,弹簧600可被定位或压缩在例如外科器械的键齿轮606和机架之间,使得一旦复位滑架694已从复位销698的端部698a脱开,那么弹簧600可扩张以使键齿轮606朝着扳机齿轮696滑动。而且,在至少一种实施方式中,复位销698可被安装在键齿轮606上或与键齿轮606一体形成,从而复位销698可与键齿轮606一起朝着扳机齿轮696滑动。在至少一种实施方式中,参照图97,复位销698可包括凸缘698b,键齿轮606可抵接该凸缘698b并且将复位销698推向扳机齿轮696。
在各种实施方式中,由于上述原因,当复位滑架695向下旋转进入其如图100所示的致动位置时,棘齿面606c和696c可通过弹簧600定位成彼此抵靠。在至少一种实施方式中,参照图97,棘齿面606c和696c每个都可包括从其延伸出的齿,该齿能协同动作以在棘齿面606c和696c之间传递旋转运动。在使用中,随着击发扳机660的下一次致动,击发扳机660可沿着箭头A所指的顺时针方向旋转扳机齿轮696和键齿轮606,参照图99,其中键齿轮606可沿着箭头E所指的方向旋转小齿轮601。由于例如小齿轮601和击发件666的齿条部分605之间的操作性接合,小齿轮601可相对于端部执行器回缩击发件666、切割件和/或钉驱动器,与以上相似。在至少一种实施方式中,齿轮601、606和696以及齿轮部分658可被构造成使得击发件666可通过扳机660的一次致动而完全回缩。
随后,击发扳机660可被释放或回复到其未致动位置。在至少一种这样的实施方式中,棘齿面606c和696c可包括圆锥面,当扳机被回复到其未致动位置时,该圆锥面可允许棘齿面606c和696c相对于彼此旋转。在这样的情况下,扳机齿轮696可沿着逆时针方向旋转,也就是沿着箭头A所示的方向相反的方向旋转。在至少一种实施方式中,棘齿面606c和696c可相对于彼此旋转,甚至在棘齿面彼此接触时仍然如此。随后,复位滑架694可被向上旋转,使得其可接触到复位销698的端部698a并且使复位销698和键齿轮606从扳机齿轮696滑开。因此,在这样的情况下,棘齿面606c可从棘齿面696c脱开,从而它们不再彼此可操作地接合。在至少一种这样的实施方式中,复位滑架694可将力施加到复位销698的端部698a上,其中,力可被经由凸缘698b传递到键齿轮606,以使键齿轮606从扳机齿轮696移动开。
如上所述,根据本发明的外科器械可包括击发驱动装置,该击发驱动装置包括棘爪,该棘爪可用于相对于端部执行器推进击发件。在各种实施方式中,如上所述,棘爪170可向上枢转以接合例如击发件466中的凹槽467并且向远侧推进击发件466。随后,参照图101和102,棘爪170可被向下枢转并且相对于击发件466向近侧回缩以重新定位棘爪170,使得棘爪170可被再次向上枢转以接合另一个凹槽467并且进一步推进击发件466。但是,在不同情况下,当棘爪170被如图103所示向上枢转时,棘爪170可能不能接合凹槽467。当击发扳机466例如被通过外科器械的各种机构传递的力或能量和/或存储在外科器械的各种机构内的力或能量无意地移动时,可能会产生这种情况。如果棘爪不能够重新接合击发件,那么外科器械可能变得不能工作,因此,外科器械可能必须手动地复位。为了改善该条件,根据本发明的各种实施方式的外科器械可包括防反向机构,该防反向机构能保持或基本保持击发件就位。
在各种实施方式中,参照图104,防反向机构例如可用于将击发驱动装置和/或反向驱动装置的至少一部分保持就位,同时棘爪170被相对于击发件466回缩。在至少一种实施方式中,防反向机构可包括索引机构或索引板711,如上所述,当击发件466被推进时,该索引机构或索引板可用于允许复位销798沿着由箭头B所指的逆时针方向旋转,但是抑制或至少基本上抑制复位销798沿着顺时针方向(即与箭头B的方向相反的方向)旋转。实际上,当复位销798与键齿轮406可旋转地接合并且键齿轮406通过中间齿轮403和小齿轮401与击发件466可操作地接合时,索引机构711也可防止或至少基本上防止击发件466向近侧回缩。而且,如下面更详细地描述,索引机构711同样也可抑制击发件466被无意地向远侧推进。
为了如上所述防止复位销798无意地旋转,索引机构711可包括一个或多个凹槽和/或孔,用于将复位销798保持就位。在各种实施方式中,参照图104、107和111,索引机构711可包括片簧,该片簧包括夹紧端711a,该夹紧端711a可被保持在机架784的凹槽784a内,使得索引机构711可相对于机架784的支轴784b挠曲和/或旋转。在至少一种实施方式中,参照图105和106,复位销798可包括从复位销798延伸出的键799,其中键799可用于接合索引机构711。更具体地,在至少一种这样的实施方式中,索引机构711可包括多个凹槽或孔713a-b,参照图107和108,每个凹槽或孔可用于容纳从键799延伸出的凸起部799a,由此将复位销798保持就位,如下面更详细地描述。
在使用中,外科器械的端部执行器例如可闭合到患者的软组织上,并且随后如上所述,外科器械的击发件可被击发驱动装置推进。在推进击发件之前,如图110a所示,复位销798的凸起部799a可被容纳在索引机构711的第一孔713内。在各种实施方式中,参照图106和109,键799还可包括倾斜面或斜面799b,该倾斜面或斜面可使得,当复位销798随着扳机460的第一次致动被击发件466、小齿轮401、中间齿轮403和键齿轮406沿着箭头B所指的方向旋转时,斜面799b可接触孔713a的边缘并且使索引机构711向下偏转和/或旋转,如图110b所示。注意,可能需要一定大小的力来使索引机构711偏转和/或旋转,这样,复位销798被无意地从凹槽713移出的可能性被减少。更具体地,在例如不向击发件766施加大的拉力的情况下,索引机构711中的凹槽可具有将复位销798的键799保持在该凹槽中的能力,相应地,击发件466可被无意地推进的可能性被减少。
在击发扳机460的第一次致动结束之时,键799可被定位在索引机构711的第二孔713b内,如图110c所示。在这样的位置中,由于止挡面799c的存在,能够防止键799向后运动进入孔713a中。更具体地,参照图108,键799还可包括止挡面799c,该止挡面799c可被构造成例如抵接孔713b的周界,并且由于止挡面799c的构造,孔713b和止挡面799c可用于防止键799在凹槽715内向下偏转或旋转索引机构711(图111)并且允许复位销798沿着与箭头B的方向相反的方向旋转。在至少一种这样的实施方式中,止挡面799c和孔713b的周界可包括彼此平行的表面。在其它各种实施方式中,抵接面可包括至少部分倾斜的部分,该部分被构造成使得当止挡面799c被迫压在孔713b的周界上时,键799可进一步被拉入孔713b中,而不是被从孔713b中提升出来。因此,在任何一种情况下,例如当棘爪170被相对于击发件466回缩时,棘爪170可被相对于击发件466内的凹槽467不重合的可能性可被减少。
随着击发扳机460的第二次致动时,击发件466可再次旋转齿轮401、403和406,使得复位销798沿着箭头B所指的方向旋转。因此,在各种实施方式中,斜面799b可接触第二孔713b的边缘并且向下偏转和/或旋转索引机构711,如图110d所示。在击发扳机460的第二次致动结束时,键799可被定位在索引机构711的第三孔713c内,如图110e所示。在这样的位置中,与以上相似,由于止挡面799c的存在,能够防止键799向下运动进入第二孔713b中。而且,随着击发扳机460的第三次致动,击发件466可再次使复位销798沿着箭头B所指的方向旋转,因此,斜面799b可接触第三孔713c的边缘并且向下偏转和/或旋转索引机构711,如图110f所示。在击发扳机460的第三次致动结束时,键799可被定位在索引机构711的第四孔713d内,如图110g所示。在这样的位置中,与以上相似,由于止挡面799c的存在,能够防止键799向下运动进入第三孔713c中。
在此时,与以上相似,为了使反向驱动装置与击发件可操作地接合,复位销798和键799可朝着扳机齿轮496旋转,以使键齿轮406与扳机齿轮496可操作地接合。因此,在各种实施方式中,凸起部799a可运动离开索引机构711并且离开第四孔713d。此后,随着击发扳机460的复位冲程,击发件466可被回缩并且复位销798可被沿着顺时针方向(即与箭头B相反的方向)旋转。在此时,击发件466和棘爪170将双双回到它们的起始位置,复位销798将被旋转,使得复位销798与第一孔713a重新对齐,并且复位销798可从扳机齿轮486脱开,使得键799滑动进入与第一孔713a的接合。因此,随后外科器械可被再次使用。
在各种实施方式中,参照图112和113,防反向机构可包括索引元件或索引板811,该索引元件或索引板811被可旋转地安装在机架884的凹槽884a中,使得铰链端811a可旋转地安装到销部分884b。在至少一种实施方式中,类似上述的,索引元件811可相对于销部分884b旋转和/或偏转。在各种实施方式中,防反向机构还在凹槽815内包括至少一个弹簧元件或复位弹簧811b,该弹簧元件或复位弹簧811b可用于将索引元件811偏压进入如图112和113所示的位置中。同样,复位弹簧811b可进一步被用于在索引元件如上所述被键799偏转之后将索引元件恢复到这样的位置中。在各种实施方式中,所述至少一个复位弹簧例如可被定位在索引元件811和凹槽815的侧壁中间。在各种替代实施方式中,参照图114,防反向机构可包括索引元件911,该索引元件911与上面相似可安装在机架984的凹槽984a内。在至少一种这样的实施方式中,机架984还可包括安装凸起部984b,该安装凸起部984b可构造成压配合在索引元件911的孔911a内,使得索引元件911可被相对于机架984挠曲和/或旋转。
在各种替代实施方式中,根据本发明的至少一种实施方式的防反向机构可包括棘轮机构,用于防止或者至少限制击发件和/或齿轮组的不期望的运动。在各种实施方式中,参照图115至118,棘轮机构可包括棘爪,该棘爪被构造成允许齿轮组的齿轮(例如指示器齿轮492和正齿轮416)在它们被击发件(例如击发件466)驱动时沿着第一方向旋转,但是当击发驱动装置的棘爪(例如棘爪170)相对于击发件回缩时防止或至少限制齿轮沿着相反方向旋转。在至少一种实施方式中,参照图116,棘轮机构可包括片簧或棘爪1011,其可限制正齿轮416的旋转,如以下更详细地描述。
接着上文,当击发件466例如被击发扳机460推进时,由于如上所述小齿轮401、中间齿轮403、键齿轮406和正齿轮416的操作性接合,击发件466可使正齿轮416沿着箭头D所指的方向旋转(图116)。在至少一种实施方式中,当正齿轮416沿着D方向旋转时,齿轮416的轮齿416a可被用于接触和偏转棘爪1011,使得轮齿416a可从棘爪1011通过。然而,如果击发件466被无意地回缩时和/或正齿轮416被沿着箭头H所指的方向旋转时,棘爪1011可被构造成使得棘爪1011的至少一部分可被定位在两个相邻的轮齿416a中间,并且防止或至少限制正齿轮416沿着H方向旋转。在各种实施方式中,参照图116,棘爪1011的至少一部分可楔入轮齿416a之间或“咬入”齿轮416中,使得齿轮416基本上不能沿着H方向旋转,至少直到外科器械的反向驱动装置与击发件可操作地接合,如下面更具体地描述。
在各种实施方式中,外科器械可包括复位滑架,复位滑架可在如图115和116所示的未致动位置和如图117和118所示的致动位置之间运动,以使外科器械进入其反向或回缩工作模式。与复位滑架494相似,在至少一种实施方式中,复位滑架1094可围绕销1094a相对于机架484旋转。在各种实施方式中,参照图118,棘爪1011可被安装在复位滑架1094上,使得当复位滑架1094被向下旋转进入其致动位置时,棘爪1011可运动脱开与正齿轮416的操作性接合。在这样的情况下,当外科器械进入其反向模式时,正齿轮416可被允许沿着箭头H所指的方向旋转。当正齿轮416被允许沿着H方向旋转时,齿轮组可被允许不受防反向机构的干扰或者至少没有实质干扰地旋转,使得击发件可如上所述地被回缩。在击发件被充分地回缩之后,复位滑架1094可被向上旋转进入其未致动位置中并且棘爪1011能够与正齿轮416可操作地重新接合。
在各种情况下,可防止外科器械的反向驱动装置与外科器械的击发件适当地接合。在至少一种实施方式中,反向驱动装置的复位滑架(例如复位滑架494和1094)例如可能无法适当地接触并且启动击发销172和/或复位销498。更具体地,复位滑架可能无法适当地移动击发销172和/或复位销498,使得键齿轮406与扳机496可操作地接合,而且防止棘爪170与击发件466可操作地接合。在各种实施方式中,如上所述,复位滑架可包括按钮部分,该按钮部分在被施加向下的力时可用于手动地使复位滑架向下旋转。然而,在各种情况下,该力可能没有足够大的影响来使复位滑架运动,尤其是在复位滑架和/或其中一个销172和498例如被卡在位置上时。
在本发明的各种实施方式中,外科器械可包括开关,该开关可更好地用于手动地使外科器械的反向驱动装置与击发件接合。在至少一种实施方式中,参照图119,开关可包括第一部分和第二部分,其中第一部分1194例如能够被相对于机架1184可运动地连接,并且第二部分1118也能够被相对于机架1184可运动地连接。在各种实施方式中,开关的第一部分1194能够被可枢转地连接到机架1184,使得当开关的第一部分1194被例如类似于凸轮402的凸轮向下枢转时,第一部分1194可用于从复位销498脱开并且允许复位销498的键部分499与扳机齿轮496接合,如上所述。在各种实施方式中,虽然没有在图119中示出,但是复位滑架1194可包括从复位滑架1194延伸出的臂1194d,该臂1194d可运动离开复位销498的端部498a,使得例如弹簧可将复位销498偏压入与扳机齿轮496的操作性接合。
除了上述情况,开关的第一部分1194在向下枢转时可被用于接触击发销172和使击发销172的键222与棘爪170可操作地接合,使得棘爪170不能向下枢转,同样如以上所述。实际上,在至少一种这样的实施方式中,开关的第一部分1194可包括凸轮,该凸轮可被致动以使击发驱动装置从击发件可操作地脱开或者使反向驱动装置与击发件可操作地接合。在各种情况下,为了使外科器械在其推进工作模式和反向工作模式之间切换,可能只有第一部分1194的操作是需要的。然而,在反向驱动装置的凸轮(例如凸轮402)不能适当地定位或致动开关的第一部分1194时,开关的第二部分1118就可以用来致动开关的第一部分1194,如以下更详细地描述。
接着上文,开关的第二部分1118可被致动,以便致动开关的第一部分1194。在各种实施方式中,参照图119,开关的第二部分1118可包括手柄1118b,该手柄1118b可构造成例如由外科医生握持,使得外科医生能够在手柄1118b上施加力并且使开关的第二部分1118围绕枢轴1118a旋转。在至少一种实施方式中,开关的第二部分1118可被构造成用于接触开关的第一部分1194并且使开关的第一部分1194在其如图119所示的未致动位置和其如上所述的致动位置之间运动。在各种实施方式中,实际上,开关的第二部分1118可包括凸轮,该凸轮可接触开关的第一部分1194并且向下驱动开关的第一部分1194,使得开关的第一部分1194接触击发销172和复位销498。在至少一种这样的实施方式中,参照图119,开关的第二部分1118可包括接触面1118c,该接触面1118c可被构造成与开关的第一部分1194的接触面1194c接触。在各种实施方式中,接触面1118c可被直接定位在接触面1194c上面,使得接触面1118c和1194c可被对齐,并且开关的第二部分1118和开关的第一部分1194不接触的可能性可被减少。
接着上文,在各种实施方式中,接触面1118c和1194c可被定位和布置成使得施加在手柄1118b上的力F2具有足够的机械利益以使开关的第一部分1194运动进入其致动位置中。在至少一种实施方式中,手柄力F2可通过开关的第二部分1118的主体经由接触面1118c和1194c作为传递力F3传递到开关的第一部分1194。注意,在各种实施方式中,传递力F3可不同于手柄力F2。进一步讲,参照图119,为了使开关的第一部分1194初始地运动,与手柄力F2和传递力F3相关的扭矩可以基本相同,即距离Da和力F2的乘积可基本上等于距离Db和力F3的乘积,其中,距离Da可表示枢轴1118a和力F2的施加点之间的距离,并且距离Db可表示枢轴1118a和力F3的传递点之间的距离。因此,当距离Da小于距离Db时,如图119所示,力F2可大于力F3。相应地,为了使力F2基本等于力F3,当力F2被施加在手柄1118b上时,手柄1118b必须基本上被定位在表面1118c和1194c上面。
接着上文,在各种实施方式中,传递力F3可通过开关的第一部分1194的主体作为移动力F1传递到击发销172。与以上相似,移动力F1可不同于传递力F3。进一步讲,再次参照图119,为了使击发销172朝着棘爪170初始地移动,如上所述,与移动力F1和传递力F3相关的扭矩可以基本相同,即距离Dc和力F1的乘积可基本上等于距离Dd和力F3的乘积,其中,距离Dc可表示枢轴1194a和力F1的施加点之间的距离,并且距离Dd可表示枢轴1194a和力F3的传递点之间的距离。因此,当距离Dc小于距离Dd时,如图119所示,力F1可大于力F3。实际上,根据对距离Da、Db、Dc和Dd的选择,较小的传递力F3可被用来向击发销172施加较大的移动力F1。因此,在各种实施方式中,开关的第一部分和第二部分可被构造成使得例如由外科医生提供的力F2可足以手动将开关的第一部分1194通过开关的第二部分定位在其致动位置中,由此将外科器械从推进工作模式操控至反向工作模式,如以上进一步所述。为了使外科器械回到其推进工作模式,开关的第一部分1194例如可被向上旋转,使得开关的第二部分1118也可向上旋转,由此使开关组件复位。
在另一种示例性的实施方式中,参照图120至122,外科器械可包括开关组件,该开关组件包括第一部分1294,另外包括第二部分1218,该第一部分1294能够围绕销1294a可枢转地安装到机架1284上,该第二部分1218能够绕枢轴1218a可枢转地安装到机架1284上。虽然开关的第一部分和第二部分能够可枢转地安装到机架1284上,但是开关部分也能够可枢转地安装到外科器械的任何其它合适的部分上。在各种实施方式中,与以上相似,开关的第一部分1294可被操作地使外科器械在推进工作模式和反向工作模式之间切换。在至少一种实施方式中,开关的第一部分1294可在如图120所示的未致动位置和如图121所示的致动位置之间旋转。与以上相似,开关的第二部分1218可通过向手柄1218b施加力来向下运动,以便使第一部分1294向下运动进入其致动位置。
在各种实施方式中,例如开关的第二部分1218和外科器械的击发扳机(例如击发扳机460)可被构造成使得可防止或至少基本上防止第二部分1218向下旋转,除非击发扳机在其未致动位置中。通过在允许开关被操作之前要求击发扳机在其未致动位置中,反向机构的开关的第一部分1294在第一部分1294向下旋转时可被适当地与击发驱动装置的击发销(例如击发销172)对齐。在各种实施方式中,外科器械可被构造成使得击发销被定位在预定范围内,从而击发销可被开关的第一部分1294接触到并且滑动进入与击发驱动装置的棘爪(例如棘爪170)的接合。
在各种实施方式中,参照图50,外科器械100可包括端部执行器106和细长轴组件104,在此端部执行器106和细长轴组件104能够被关节运动接头114可枢转地连接。如上所述,关节运动接头114可允许端部执行器106围绕轴线116相对于轴组件104移动或进行关节运动。在各种实施方式中,外科医生可使端部执行器106进行关节运动到更容易接近患者体内的手术部位。更具体地,外科医生可将端部执行器106和轴组件104插入穿过至少部分地被插入患者体内的套管,并且一旦端部执行器106已经穿过套管,端部执行器106就可被枢转或进行关节运动,以便例如相对于软组织将端部执行器106定位在待钉合和/或切割的手术部位。一旦端部执行器106被定位好,端部执行器106和轴组件104之间的相对关系就可通过锁定机构固定或锁定,如下面更详细地描述。
在至少一种实施方式中,参照图51和52,关节运动接头114可包括端部执行器锁定件300和枢轴302。在各种实施方式中,参照图53至56,端部执行器锁定件300可包括连接器部分320,该连接器部分320可将锁定件300固定到端部执行器106上,并且参照图52,轴组件104可包括枢转连接器342,在此枢转连接器342可包括从其延伸出的枢轴302。在各种实施方式中,锁定件300可包括孔301,该孔301可具有适当尺寸和构造,以在其中容纳枢轴302的至少一部分。在至少一种实施方式中,枢轴302和孔301可被构造成使得端部执行器106可围绕轴线116自由地旋转。在各种其它实施方式中,枢轴302和孔301可被构造成使得枢轴302和孔301之间的摩擦能够抵抗(虽然允许)端部执行器106和轴组件104之间的相对运动。虽然没有示出,但是关节运动接头114可包括多于一根轴线或枢轴,端部执行器106可围绕这些轴线或枢轴旋转。
在各种实施方式中,外科医生可例如通过将端部执行器106推到手术部位附近的腔侧壁上并且向轴组件104施加力使端部执行器106相对于轴组件104进行关节运动,从而使端部执行器106围绕轴线116枢转。此后,如果外科医生希望端部执行器106回到中心位置,即将端部执行器106和轴组件104沿着一条线定向,那么外科医生可以例如将端部执行器106再次贴靠在腔侧壁上并且向轴组件104施加力,如上所述。在各种实施方式中,参照图51和52,外科器械100可包括定中机构,该定中机构可自动地相对于轴组件104使端部执行器106重新定中或至少基本上重新定中。在各种实施方式中,端部执行器锁定件300可包括定中面316,并且细长轴组件104可包括定中轴328和偏压件330,在此,偏压件330可用于将定中轴328偏压在定中面316上。在至少一种这样的实施方式中,定中面316可被设置在轴线116的基本相对的侧上,使得定中轴328可将基本相等的扭矩或力矩施加到锁定件300上,并且在没有附加启动力的情况下将端部执行器106保持在基本被定中的位置中。当端部执行器106通过这样的启动力而进行关节运动时,如上所述,锁定件300可用于向近侧移动其中一个定中轴328并且挤压与该定中轴328可操作地接合的偏压件330。更具体地,偏压件330可被定位在引导件331和从定中轴328延伸出的至少一个凸起部329之间,使得当凸起部329通过轴328向近侧运动时,偏压件330被挤压在引导件331和凸起部329之间。在去掉启动力后,被挤压的偏压件330可扩张,并且使锁定件300通过定中轴328旋转到其定中位置或者一通过偏压件330施加的扭矩基本上被平衡的位置。虽然偏压件330显示为螺旋弹簧,但是偏压件330可包括任何适当的弹性件。
在各种实施方式中,锁定机构可被用于将端部执行器106保持在其关节运动后的位置中,甚至在启动力已被去除之后仍然如此。在至少一种实施方式中,参照图53至56,端部执行器锁定件300可包括具有的第一面308的第一部分、具有第二面304的第二部分、齿312、以及限定在齿312之间的凹槽314,其中,如下面更具体地描述,齿312和凹槽314可用于与轴组件锁定件可操作地接合,以便固定或锁定端部执行器106和轴组件104之间的相对关系。在各种实施方式中,齿312和凹槽314可被定位在的第一面308和第二面304中间。在至少一种实施方式中,第一面308可从孔301延伸到第一周界310,第二面304可从孔301延伸到第二周界306。在各种实施方式中,第一周界310可限定第一平面并且第二周界306可限定第二平面,其中第一齿312和凹槽314可设置在第一平面和第二平面中间。在第一周界310不同于第二周界306的实施方式中,齿312可在第一平面310和第二平面306之间成角度地或倾斜地延伸。在各种实施方式中,齿312可在比齿312与第二周界306相交的点更远离轴线116的点处与第一周界310相交。在至少一种实施方式中,齿312的至少一个可限定第一轴线313,第一轴线313可在第一面308和第二面304之间沿着不与第一面308和/或旋转轴线116垂直的方向延伸。在这样的实施方式中,齿312可例如在定位于关节运动接头114周围的软组织上滑动。换句话说,由于齿112的倾斜面或斜面,当端部执行器106进行关节运动时,齿112抓住或撞击关节运动接头114周围软组织的可能性可被减少。在至少一种实施方式中,齿312不可以延伸超过第一周界310,从而例如在第一周界310的至少一部分与软组织接触时,第一周界310和齿312可如上所述相对于软组织轻易滑动。
接着上文,与以前的外科器械相比,本发明的实施方式可提供显著优点。更具体地,参照图57,以前的端部执行器的关节运动接头可包括锁定件(例如锁定件299),该锁定件包括从锁定件的周界向外延伸出的齿298。因此,当端部执行器相对于外科器械的轴组件进行关节运动时,齿298可抓住或撞击周围的软组织并且可能引起软组织的损伤。在各种情况下,组织可能被捕获在相邻的齿298之间,使得当端部执行器进行关节运动时,软组织可被拉入关节运动接头中并且可通过接头的相对运动的部件夹紧。在锁定件的齿成角度或倾斜的本发明实施方式中(如图58所示和以上所述),软组织可更容易地在齿上流动并且减少了软组织可能被拉入关节运动接头中的可能性。
如上所述,参照图59至62,外科器械100还可包括锁定件120,该锁定件120可相对于端部执行器106滑动并且可与端部执行器106可操作地接合,以防止和至少限制轴组件104和端部执行器106之间的相对运动。在至少一种实施方式中,锁定件120可用于接合齿312的至少一个,使得可以防止端部执行器106相对于锁定件120运动。更具体地,锁定件120可包括端部部分338和轴部分120。其中端部部分338可包括凹槽336,该凹槽336可用于以紧配合或甚至过盈配合的方式容纳锁定件300的齿312。在各种替代实施方式中,锁定部分338可以类似于以上的紧配合或过盈配合的方式容纳在凹槽314的至少一个中。在任何一种情况下,外科器械100还可包括弹簧126,该弹簧126可用于将锁定件120偏压成与端部执行器锁定件300接合。在至少一种实施方式中,如果凹槽336没有与齿312对齐,那么由弹簧126施加在锁定件120上的偏压力可引起锁定件120接触端部执行器锁定件300并且使端部执行器锁定件300围绕轴线116旋转,直到齿312的其中一个与凹槽336对齐。在各种实施方式中,弹簧126可包括任何适当的偏压件,包括螺旋弹簧、片簧或其它偏压材料。
在各种替代实施方式中,参照图63至67,外科器械可包括端部执行器锁定件350,该锁定件350包括孔301、具有第一面358的第一部分、具有第二面354的第二部分(图67)以及连接器部分320。端部执行器锁定件350还可包括齿362和限定在齿362之间的凹槽364,其中在至少一种实施方式中,齿362和凹槽364可被定位在第一面358和第二面354中间。在各种实施方式中,参照图65至67,齿362不可以延伸超过第一面358的第一周界357和/或第二面354的第二周界353。在至少一种实施方式中,齿362可被完全定位或容纳在第一面358和第二面354之间。在至少一种替代实施方式中,齿362可从第一周界357和/或第二周界353部分地延伸。在各种实施方式中,第一周界357和第二周界353可在它们之间限定外表面,其中凹槽364可被限定在该外表面中。由于上述特征,端部执行器锁定件350可相对于被定位在关节运动接头周围的软组织滑动,而不撞击到软组织。在各种实施方式中,齿362可被钝化或圆化以进一步促进上述相对滑动。在至少一种实施方式中,参照图63至65,锁定机构可用于使齿362的至少一个与凹槽364接合并且可包括锁定件382,该锁定件382包括端部部分388和轴部分390。在至少一种实施方式中,与以上相似,端部部分338可包括凹槽394,该凹槽394可用于接合例如齿362的至少一个。
本文所述的装置可设计成在使用一次后废弃,或者可设计成多次使用。但是,在任何一种情况下,装置在使用至少一次后可被修复以供再次使用。修复可包括装置的拆卸、接着清洁或更换特定件以及随后组装的步骤的任何组合。具体地,装置可被拆卸,并且装置的任何数目的特定件或部件可以任何组合的方式被选择性地更换或拆除。随着清洁和/或更换特定部件,装置可在修复设施处被重新组装或者由外科团队在即将进行外科手术前重新组装,以便随后使用。本领域技术人员将理解,装置的修复可利用各种组装技术、清洁/更换技术和重新组装技术。这些技术的使用以及得到的修复后的装置都在本申请的范围内。
优选地,本文所述的发明将在外科手术前进行。首先,获取新的或使用过的器械,在需要时进行清洁。然后,可对器械进行消毒。在一种消毒技术中,器械被放置在封闭且密封的容器(例如塑料袋或高密度聚乙烯合成纸袋)中。随后,容器和器械可放置在能够穿透容器的放射(例如伽马放射、x射线或高能电子)区域中。放射会杀死器械上和容器中的细菌。经消毒的器械随后可被存放在无菌容器中。密封容器将保持器械无菌,直到密封容器在医疗设施中被打开为止。
虽然本发明被描述成具有示意性的设计,但是本发明还可在本发明的公开范围和主旨内进一步被修改。该申请因此应当覆盖本发明的使用本发明一般原理的任何变型、使用方式或适配方式。另外,该申请应当覆盖那些虽然从本发明偏离但是能从有关本发明的现有技术的公知常识或惯用手段中得到内容。
Claims (10)
1.一种外科器械,包括:
端部执行器;
击发件;
扳机;
击发驱动装置,该击发驱动装置能选择性地与所述击发件接合,其中,所述击发驱动装置包括齿条,该齿条在所述扳机致动时用于相对于所述端部执行器推进所述击发件;
反向驱动装置,该反向驱动装置能选择性地与所述齿条接合,其中,所述反向驱动装置包括齿轮,该齿轮在所述扳机随后致动时用于相对于所述端部执行器回缩所述齿条和所述击发件;
2.根据权利要求1所述的外科器械,其中,所述齿轮包括第一齿轮,所述扳机包括齿轮部分,并且所述反向驱动装置还包括:
第二齿轮,该第二齿轮与所述第一齿轮可操作地接合;
第三齿轮,该第三齿轮与所述扳机的齿轮部分可操作地接合,其中所述第二齿轮能与所述第三齿轮选择性地接合。
3.根据权利要求2所述的外科器械,其中,当所述击发驱动装置与所述击发件接合时,所述第二齿轮不与所述第三齿轮可操作地接合。
4.根据权利要求2所述的外科器械,其中,所述第三齿轮包括棘齿面,该棘齿面用于接合所述第二齿轮,当所述第三齿轮沿着第一方向旋转时,所述棘齿面能够相对于所述第二齿轮滑动,当所述第三齿轮沿着相反方向旋转时,所述棘齿面用于驱动所述第二齿轮。
5.根据权利要求2所述的外科器械,其中,所述第二齿轮能与所述第三齿轮可操作地接合,使得所述扳机的所述随后致动能够使所述第三齿轮、所述第二齿轮和所述第一齿轮旋转并且回缩所述击发件。
6.根据权利要求5所述的外科器械,其中,所述反向驱动装置还包括:
键销,该键销能选择性地在第一位置和第二位置之间运动,其中当所述键销在所述第一位置中时,所述键销不与所述第三齿轮可操作地接合,并且当所述键销在所述第二位置中时,所述键销与所述第二齿轮可操作地接合;和
弹簧,该弹簧用于将所述键销偏压到所述第二位置中。
7.根据权利要求6所述的外科器械,其中,所述反向驱动装置还包括致动器,当所述击发驱动装置与所述击发件可操作地接合时,该致动器能够将所述键销定位在所述第一位置中,并且所述致动器能运动进入致动位置中,以允许所述弹簧将所述键销偏压到所述第二位置中,并且由此使所述反向驱动装置与所述击发件可操作地接合。
8.根据权利要求7所述的外科器械,其中,当所述致动器运动进入所述致动位置中时,所述致动器还用于使所述击发驱动装置从所述击发件脱开。
9.根据权利要求2所述的外科器械,其中,所述反向驱动装置还包括离合器,该离合器用于可操作地接合和脱开所述第二齿轮和所述第三齿轮。
10.根据权利要求9所述的外科器械,其中,所述离合器包括键销和止动件,该键销与所述第二齿轮可操作地接合,该止动件从所述第三齿轮延伸出,并且所述止动件用于允许所述键销相对于所述第三齿轮沿着第一方向旋转,并且所述止动件能够沿着与所述第一方向相反的方向旋转所述键销。
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US12/008,303 US7658311B2 (en) | 2007-06-22 | 2008-01-10 | Surgical stapling instrument with a geared return mechanism |
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CN106535782B (zh) * | 2014-07-04 | 2019-06-04 | 柯惠有限合伙公司 | 用于内窥镜程序的外科紧固件施加装置和方法 |
CN107809965A (zh) * | 2015-06-26 | 2018-03-16 | 伊西康有限责任公司 | 具有可逆马达的外科缝合器 |
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CN111374728A (zh) * | 2018-12-29 | 2020-07-07 | 江苏风和医疗器材股份有限公司 | 一种传动机构的控制方法 |
CN111374728B (zh) * | 2018-12-29 | 2021-12-07 | 江苏风和医疗器材股份有限公司 | 一种传动机构的控制方法 |
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