CN101674781B - 外科器械 - Google Patents

外科器械 Download PDF

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CN101674781B
CN101674781B CN200880014402XA CN200880014402A CN101674781B CN 101674781 B CN101674781 B CN 101674781B CN 200880014402X A CN200880014402X A CN 200880014402XA CN 200880014402 A CN200880014402 A CN 200880014402A CN 101674781 B CN101674781 B CN 101674781B
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surgical instruments
ratchet
end effector
depth stop
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CN101674781A (zh
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K·L·豪瑟
A·M·泽沃林斯基
T·D·洛佩斯
P·玛拉维亚
D·W·普赖斯
L·T·德卢卡
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Ethicon Endo Surgery Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00464—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable for use with different instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477—Coupling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/2833—Locking means
    • A61B2017/2837—Locking means with a locking ratchet
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2924—Translation movement of handle without rotating movement
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320069—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic for ablating tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B2017/320071—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with articulating means for working tip
    • A—HUMAN NECESSITIES
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    • A61B2017/320082—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic for incising tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320089—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic node location
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320094—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw additional movable means performing clamping operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320095—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw with sealing or cauterizing means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/036—Abutting means, stops, e.g. abutting on tissue or skin abutting on tissue or skin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means

Abstract

一种外科器械，可以包括壳体、与壳体接合且能够产生振动的换能器以及与换能器接合的末端执行器。外科器械还可以包括从壳体延伸的可调整的护套，其中护套可以相对于末端执行器的远端移动并且护套的远端和末端执行器的远端之间的距离可以被设置成使得护套可以用作深度止挡。护套能够被调整使得当护套的远端接触正被切开的组织或骨时，外科医生可以确定切口已经到达合适的深度。在其它的实施方式中，末端执行器可以相对于护套移动以调整末端执行器的远端和护套的远端之间的距离。

Description

外科器械
相关申请的交叉引用
本申请与下述共同拥有的与本申请同时提交的美国专利申请相关，下述专利其整体通过引用包含于此：
(1)美国专利申请序列号为11/726,625，题为SURGICALINSTRUMENTS，代理人案件目录编号为060878/END6051USNP；
(2)美国专利申请序列号为11/726,760，题为ULTRASONICSURGICAL INSTRUMENTS，代理人案件目录编号为060879/END6052USNP；以及
(3)美国专利申请序列号为11/726,621，题为ULTRASONICSURGICAL INSTRUMENTS AND CARTILAGE BONE SHAPINGBLADES THEREFOR，代理人案件目录编号为060876/END6049USNP。
技术领域
本发明整体涉及超声外科器械，且更特别地涉及，诸如用于切割骨以及用于切割和/或凝结组织的超声刀。
背景技术
超声外科器械可以在很多医学状况下进行安全而有效的治疗。一般来说，超声外科器械可以使用诸如以超声频率传递到外科末端执行器的超声振动(即机械振动)形式的能量来切割和/或凝结器官组织。当以适当的能量水平和使用适合的末端执行器传递到器官组织时，这种超声振动可以被用来切割和/或凝结组织。这种器械可以用于开放式手术或微创手术，例如内窥镜或腹腔镜手术，其中末端执行器通过套管针到达手术部位。
虽然超声外科器械可以很好地执行其预定的功能，这些器械形成大量的能量和振动，如果不能得到妥善的控制，可能无意中导致对手术部位周围的组织和/或骨的损伤。因此，开发了若干安全特征来防止这种损伤或至少减少其出现的可能性。例如，开发了一些包括围绕着至少一部分末端执行器延伸的护套的外科器械。在使用中，这些护套能够防止末端执行器的部分无意中接触手术部位周围的组织和/或骨。但是，这些护套可能例如妨碍外科医生看到手术部位。因此，外科医生可能无法容易地确定切口的深度并对其进行校正性的调整。在上述技术的基础上还需要改进。
发明内容
在本发明的至少一种形式中，外科器械可以包括壳体、与壳体接合且被配置为产生振动的换能器以及与换能器接合的末端执行器。在多种实施方式中，末端执行器可以限定轴线以及远端，其中远端可以通过换能器产生的振动沿着轴线移动。在至少一种实施方式中，外科器械还可以包括从壳体延伸的可调整的护套，其中护套可以相对于末端执行器的远端移动。在这些实施方式中，护套的远端和末端执行器的远端之间的距离可以被设置使得护套可以起深度止挡的作用。更特别地，护套能够被调整使得例如当护套的远端接触正被切开的组织或骨时，外科医生可以容易地确定切口已经到达合适的深度。在其它的实施方式中，末端执行器可以相对于护套移动以调整末端执行器的远端和护套的远端之间的距离。
在本发明的至少一种形式中，外科器械可以包括可去除地连接到外科器械的壳体上的护套。在多种实施方式中，可以提供包括多个护套的套件，每个护套可以具有不同的长度和/或配置。在至少一种实施方式中，套件可以包括第一护套和第二护套，其中当第一护套被装配到壳体时，末端执行器的远端和第一护套的远端限定了它们之间的第一距离，且当第二护套被装配到壳体时，末端执行器的远端和第二护套的远端限定了它们之间与第一距离不同的第二距离。在这些实施方式中，外科医生可以从套件中选择护套使得例如当该护套的远端接触正被切开的组织或骨时，护套允许外科医生容易地确定切口已经到达需要的深度。
在本发明的至少一种形式中，外科器械可以包括壳体、与壳体接合并被配置为产生振动的换能器以及与换能器接合的末端执行器。末端执行器可以包括第一治疗区域、第二治疗区域以及在末端执行器上的被配置为确定例如第一治疗区域的至少一个标记或界线。在至少一个这样的实施方式中，第一治疗区域可以包括被配置为切割组织的切割边缘且第二治疗区域可以包括被配置为烧灼或凝固组织的弓形面，其中至少一个标记或界线可以允许外科医生容易地确定末端执行器的这些部分。类似地，在至少一种实施方式中，至少一个标记或界线可以被配置成指示末端执行器的哪些部分以高强度振动而哪些部分以低强度振动。
在本发明的至少一种形式中，外科器械可以包括壳体、与壳体接合并被配置为产生振动的换能器以及与换能器接合的末端执行器。末端执行器还可以包括具有钳口构件以及枢轴的夹具，其中钳口构件可绕着枢轴相对于末端执行器在打开位置和闭合位置之间转动。此外，夹具可以相对于末端执行器的远端在第一位置和第二位置之间平移。在这些实施方式中，如果需要，钳口构件可以被用于当组织正被切割时相对于末端执行器夹持住组织，或者可选地，夹具可以从末端执行器的远端被移走，使得末端执行器可以在没有夹具的条件下使用。这些特征允许外科医生使用一种器械来执行原来需要多于一种器械来执行同一任务的多种任务。
附图说明
结合附图参照对本发明的实施方式的下述描述，本发明的上述和其它特征和优点以及其获得的方法将变得更加清楚，且发明本身也将得到更好的理解。其中：
图1为可操作地连接到信号发生器的超声外科器械的透视图；
图2为图1的超声外科器械的剖面图；
图3为根据本发明的一种实施方式的外科器械的透视图；
图4为图3的外科器械的部分剖视图，其中，外科器械的护套延伸至覆盖末端执行器；
图5为图3的外科器械的部分剖视图，其中，护套缩回以露出末端执行器的一部分；
图6为图3中的外科器械的分解组装视图；
图7为图3的外科器械的棘轮机构以及护套的透视图；
图8为图7的棘轮机构的部分的分解组装视图；
图9为图7的棘轮机构的棘轮和棘爪的一部分的部分透视图；
图10为图7的棘轮机构的剖视图；
图11为根据本发明的一种可选的实施方式的外科器械的部分剖视图；
图12为图11的外科器械的部分剖视图，其中，末端执行器相对于护套被延伸；
图13为图11的外科器械的分解组装视图；
图14为图11的外科器械的棘轮机构的透视图；
图15为图11的外科器械的护套、末端执行器和换能器的部分分解组装视图，为清晰起见部分元件示出截面；
图16为根据本发明的一种可选的实施方式的外科器械的透视图，其具有手柄和相对可转动的护套；
图17为图16的外科器械的平面图，其中护套处于完全延伸位置；
图18为图16的外科器械的剖视图，其中护套处于完全延伸位置；
图19为图16的外科器械的平面图，其中护套处于部分缩回位置；
图20为图16的外科器械的平面图，其中护套处于缩回位置；
图21为图16的外科器械的剖视图，其中护套处于缩回位置；
图22为根据本发明的一种可选的实施方式的外科器械的平面图，其在护套上具有标记以指示护套的远端和末端执行器的远端之间的距离；
图23为图22的外科器械的部分剖视图；
图24为根据本发明的一种可选的实施方式的医疗器械的透视图，其具有相对伸缩部分；
图25为图24的外科器械处于完全伸展构型的剖视图；
图26为图24的外科器械处于部分缩回构型的剖视图；
图27为图24的外科器械处于完全缩回构型的剖视图；
图28为根据本发明的一种可选的实施方式的外科器械的部分平面图；
图29为图28的外科器械的剖视图；
图30为根据本发明的一种可选的实施方式的包括外科器械以及多个可除去地连接的护套的外科套件的简图；
图31为根据本发明的一种可选的实施方式的包括外科器械以及多个可除去地连接的末端执行器的外科套件的简图；
图32为图31的外科器械的末端执行器和换能器之间的互相连接的部分剖视图；
图33为根据本发明的一种可选的实施方式的外科器械的部分透视图，其具有第一治疗区域和第二治疗区域；
图34为根据本发明的一种可选的实施方式的外科器械的部分透视图，其包括可缩回的夹具；
图35为图34的外科器械当夹具处于缩回位置时的部分剖视图；
图36为图34的外科器械当夹具处于延伸位置时的部分剖视图；
图37为图34的外科器械当夹具的钳口构件被移动至打开位置时的部分剖视图；
图38为根据本发明的一种实施方式的被可操作地配置为使图34的外科器械的夹具延伸和缩回的致动器的可选的实施方式的部分剖视图；
图39为被可操作地配置为使图34的外科器械的夹具延伸和缩回的致动器的剖视图；
图40为图34的外科器械的部分正视图，其示出被配置为使外科器械的钳口构件在打开和闭合位置之间移动的第二致动器；
图41为图34的外科器械的剖视图，其示出图40的第二致动器；
图42为图34的外科器械的夹具的分解透视图；
图43为图42的夹具以及图39和图40中的致动器之间的连接的分解透视图；
图44为图43的连接器的部分的分解组装图；
图45为根据本发明的一种可选的外科器械的分解组装图，其具有可去除地连接的钳口构件；
图46为图45的外科器械的透视图；
图47为图45的外科器械的夹具的透视图，其中钳口构件处于打开位置，为清晰起见以截面表示部分组件；
图48为图45的外科器械的夹具处于缩回位置的部分透视图；
图49为图45的钳口构件的透视图；
图50为图45的钳口构件的第二透视图；
图51为根据本发明的一种优选的实施方式的可去除地连接的钳口构件的透视图；以及
图52为图51中的钳口构件的第二透视图。
在各种视图中相应的标记表示相应的部件。这里所述示例以一种形式描述本发明的优选的实施方式，且这些实例不应以任何方式解释为对本发明范围的限制。
具体实施方式
现在将描述一些示例性的实施方式来提供对这里所公开的结构的原理、功能、制造、以及装置和方法的使用的整体理解。附图中示出了一个或多个示例。本领域普通技术人员将理解这里具体描述并在附图中示出的装置和方法是非限制性的示例性的实施方式，且本发明的多种实施方式的范围仅由权利要求书来限定。结合一种示例性的实施方式示出或描述的特征可以与其它实施方式的特征相结合。这些变型和修正应当被包括在本发明的范围内。
如前文所指出，超声外科器械可以例如使用以超声频率传递至外科末端执行器的超声振动(即机械振动)形式的能量来切割、烧灼和/或凝结器官组织。超声外科器械的实例在专利号为5,322,055、5,954,736、6,278,218、6,283,981、6,309,400和6,325,811的美国专利中公开，上述专利整体通过引用包含于此。在多种实施方式中，可以提供产生所需要的电信号并通过缆线连接到外科器械的手持件的超声信号发生器。适合的发生器可作为俄亥俄州辛辛那提市EthiconEndo-Surgery，Inc.的型号GEN04得到。在一种实施方式中，如图1，电信号(即驱动电流)可以从发生器10通过缆线14传递至手持件12。
如图2，手持件12可以包括换能器18，换能器18包括例如能够被配置为将驱动电流转换回机械振动的压电陶瓷元件16。更特别地，驱动电流可以导致元件16的反复位移形式的扰动，从而导致元件16沿着电压梯度、或轴线以连续的方式扩张和收缩，沿着此轴线产生纵向的超声能量波。在多种实施方式中，元件16可以产生与纵向轴线横向或以围绕纵向轴线扭转的方式的振动。压电陶瓷元件16可以以诸如锆-钛酸铅、偏铌酸铅、钛酸铅或其它压电晶体的任何适合的材料制造。在多种实施方式中，元件16可以包括磁致伸缩元件，包括例如铁、钴和包括镍、钒、镝和铽的稀土元素的合金。磁致伸缩是铁磁体金属的一种属性，当金属遭受磁场时会改变形状。在专利号为7,157,058的美国专利中进一步描述了磁致伸缩元件，该专利公开的整体通过引用包含于此。总之，换能器18可以包括能使末端执行器22产生如下文所描述的振动的任何机构或材料。
在使用中，换能器18产生的纵向波可以使波导管20和安置在其上的末端执行器22产生纵向振动。在至少一种实施方式中，驱动电流可以包括由上文描述的元件16的激发所得到的、由基本正弦频率限定的交流电，导致波导管20和末端执行器22以基本正弦的方式纵向振动。在多种实施方式中，换能器18可以被配置为使得波导管20和末端执行器22以预定的共振频率振动。在至少一种这样的实施方式中，压电陶瓷元件16可以以包括在例如约50,000和约60,000周期每秒之间的频率的超声频率被驱动。在其它的实施方式中，元件16可以以大于或等于约20,000周期每秒的频率被驱动。除上述以外，驱动电压的幅值可以决定末端执行器的位移的幅值。
当压电陶瓷元件16被激励时，经由换能器18、波导管20和末端执行器22产生振动驻波。沿着这些组件在任意点的振动的幅值可以取决于振动被测量的位置。例如，在沿着波导管20和末端执行器22的一些位置，振动具有较高的强度或幅值，而在其它位置，具有较低的强度或幅值。在一些位置，振动为零或基本为零。振动驻波中最小或为零的点一般被称为节点(node)，而驻波中最大点或峰值一般被称为反节点(anti-node)。反节点和邻近的节点之间的距离约为驻波频率的波长的四分之一，即λ/4。这些节点位置也相应于系统的相对最大应力位置，而反节点位置相应于相对最小应力位置。
为了将驻波从换能器18传递至波导管20，波导管20必须与换能器18声学耦合，即它们必须以换能器18产生的机械振动传递至波导管20的方式连接。类似地，为了将振动传递至末端执行器22的远端，如果波导管20和末端执行器22被制造为分开的组件，它们就必须声学耦合。在优选的实施方式中，这些耦合被配置为与驻波的反节点基本一致，使得在耦合处具有很少的(如果有的话)振动应力。因此在这些实施方式中，降低了换能器18、波导管20和末端执行器22去耦的可能性。
在多种实施方式中，换能器18、波导管20和末端执行器22可以包含部件，该部件能够以或接近其共振或自然频率被驱动并放大由换能器18所开始的运动。在所示出的实施方式中，末端执行器22包括与波导管20一体并且由诸如Ti6Al4V(一种包括铝、钒的钛合金)、铝、不锈钢或其它已知材料的适于传递超声能量的材料构建的刀片。可选地，刀片22可以作为分开的组件制造，并且可以通过例如与波导管20不同的材料制成。在这些实施方式中，刀片22和波导管20可以通过短轴、螺纹连接或包括诸如焊接、胶合或其它已知方法的任何适合的方法来联接。在多种实施方式中，至少一部分的波导管、刀片和换能器可以包括连续材料。
为了以有效的方式操作超声外科系统，提供给换能器18的信号的频率可以在一个频率范围上进行扫描，以定位共振频率。在至少一种实施方式中，可以操纵手持件12上的例如开关24的开关来致动信号扫描。一旦找到共振频率，发生器10可以锁定在共振频率上，监视换能器的电流-电压相位角，并且调整驱动电流使其以共振频率或接近共振频率地驱动波导管和刀片部件。在至少一种实施方式中，一旦发生器锁定在共振频率上，例如声频指示器可以与用户通讯以进行指示。一旦确定了系统的共振频率，驱动电流可以被立刻施加到手持件12和/或驱动电流可以通过例如位于手持件上的开关24进行控制。在其它的实施方式中，驱动电流可以由通过电缆28连接到发生器10的脚开关26来控制。
如图3，外科器械50可以包括壳体52、末端执行器54和可调整的护套56。在使用中，当外科医生在例如切割组织或骨时，护套56可以起深度止挡的作用。更特别地，当外科医生将末端执行器54插入组织或骨时，外科医生可以压迫其中的末端执行器54，直至护套56的远端57与组织或骨的表面接触。一旦护套56的远端57接触到组织或骨的表面，外科医生将知道末端执行器54的远端55已经到达其中需要的深度。因此，降低了外科医生将末端执行器54超过需要深度地插入组织或骨的可能性。这一特征在外科医生需要使末端执行器54插入组织或骨中的情况下特别有用。在一种这样的实施方式下，可能需要外科医生在将螺钉插入骨中之前在诸如椎骨体的骨中形成导向孔。在多种实施方式中，护套56也可以基本防止末端执行器65意外地接触到手术部位周围的组织或骨。虽然示出护套56为整体地环绕末端执行器56的周边，可以想到护套56仅部分地环绕末端执行器56的周边的其它实施方式。
在多种实施方式中，如下文将更具体描述的，可以调整护套56的位置来改变末端执行器54的末端55和护套56的末端57之间的距离。在至少一种这样的实施方式中，如图4和图5，护套56可以可操作地接合致动器58使得当致动器58被操作时，护套56的末端57例如远离末端执行器54的末端55地移动。更特别地，如示出本实施方式的图3至图8，外科器械50可以包括棘轮机构60，当被致动器58操作时，棘轮结构60可以将护套56相对于末端执行器54的远端55向近侧移动从而露出末端执行器54的治疗部分。因此，通过设置远端55和远端57之间的距离来使得末端执行器54不会超过需要深度地切割组织或骨，外科医生或例如其它临床医生可以调整护套56的位置以适应特定应用的需要。
主要参考图4至图7，护套56可以通过轴环64被安置在齿条62上。在本实施方式中，护套56可以被固定地保持或压配合在轴环64的槽66中使得护套56和槽66之间基本没有相对移动或转动。更特别地，护套56可以包括被配置为滑入槽66中并将护套56保持在轴环64上的凸缘59。但是在其它实施方式中，护套56和轴环64可以被配置为例如允许两者之间的相对转动。如图6，轴环64可以包括从轴环64延伸的凸起68，凸起68被设置尺寸并被配置为可滑动地保持在壳体52的槽53内。由于凸起68，当齿条62相对于壳体52移动时，如下文将更具体讨论的，槽53可以限定齿条62的路径。在本实施方式中，槽53限定了基本直线的路径使得齿条沿着或平行于由末端执行器54限定的轴线(即轴线51(图5))移动。但是，在其它多种实施方式中，可以想得到包括非直线路径的其它路径。
为了使齿条62相对于壳体52移动，在本实施方式中，致动器58可以与棘轮机构60接合使得当致动器58向手柄60移动时，棘轮机构60将齿条62相对于末端执行器54的末端55向近侧滑动。主要如图7和图8所示，棘轮机构60可以包括棘轮61、棘爪63和驱动齿轮65。在本实施方式中，棘轮61可以包括被配置为接合致动器58的齿轮面70的齿轮面67，使得当致动器58向手柄60移动时，齿轮面67和70绕着轴线69(图8)驱动棘轮61。在至少一种实施方式中，齿轮面67和70可以包括齿，齿被配置为当致动器58如上述向手柄60转动时啮合在一起，但也被配置为当致动器58向反方向转动时阻止两者之间的相对滑动。更特别地，在致动器58已经相对于手柄60紧密对置时，齿轮面67和70可以被配置为使得当致动器58被松开时，弹簧74可以通过在齿轮面67上牵引齿轮面70将致动器58拉回起始位置。当致动器58被弹簧74重新定位后，致动器58可以再一次被拉向手柄70以进一步转动棘轮61。
如图8，棘轮61可以被固定地安置在驱动轴72上使得当致动器58绕轴线69驱动棘轮61转动时，驱动轴72也绕着轴线69转动。驱动齿轮65也可以被固定地安置在驱动轴72上使得当棘轮61转动时，驱动轴72使得驱动齿轮65转动。主要如图6所示，驱动齿轮65可以可操作地与大齿轮71接合使得驱动齿轮65的转动能使大齿轮71转动。大齿轮71可以通过轴75固定地安置在小齿轮73上使得大齿轮71的转动带动小齿轮73转动。如图6，小齿轮73可以可操作地与齿条62接合使得当致动器58被操作时，包括驱动齿轮65、大齿轮71和小齿轮73的齿轮系被操作以使得齿条62如上文所述地向近侧滑动。
如图8和图9，当致动器58如上文所描述地被相对于手柄60紧密对置然后被放开时，棘爪63可以被配置为当致动器58回到起始位置时保持棘轮61就位。更特别地，棘轮61可以包括齿78，齿78被配置为当致动器58向手柄60移动时允许棘爪63在其上滑过，且被配置为当致动器58反向移动时与棘爪63啮合。因此，棘轮61可以被致动器58转动以拉回护套56，而没有来自于棘爪63的干涉，但是，棘爪63可以如上文所描述地在致动器58被重新设定时基本防止棘轮61和护套56移动。一旦护套56的位置被选定，棘爪63也可以当外科器械在手术部位被操作和操纵时保持棘轮61就位。
为了将护套56向远侧朝向末端执行器54的远端55移动，棘轮机构60可以包括将棘爪63从棘轮61脱离的释放机构。更特别地，如图5至图9以及主要如图10，外科器械50还可以包括柱塞80，其从致动器58延伸并且与棘轮61接合，使得当柱塞80被压下时，棘轮61远离棘爪63地移动。如图10，棘爪63可以包括倾斜面81，倾斜面81被配置为允许棘爪63在棘轮61的顶部上滑动并且允许棘爪63与齿78脱离。一旦棘爪63与齿78脱离，护套56可以被自由操纵，没有来自于棘轮机构60的干涉。因此，外科医生可以移动护套56使得其覆盖末端执行器54的远端55或至任何其它位置。在本发明中，外科器械50可以包括返回弹簧84(图4至图7)，其可以当柱塞80被压下后自动地将护套56重新定位在远端54之上。护套56被重新定位之后，外科医生可以松开柱塞80并且允许柱塞返回弹簧86将柱塞80重新设置，且从而允许棘爪63重新与棘轮61接合。
如上文所描述的，外科医生可以使用护套56的远端57作为深度止挡。在使用中，外科医生可以选择护套56的远端57与末端执行器54的远端55之间的距离使得远端55和远端57之间的距离等于外科医生希望切割组织或骨的深度。为了辅助外科医生确定远端55和远端57之间的距离，外科器械50可以包括深度指示器88。更特别地，如图3至图5，深度指示器88可以被安置在齿条62上使得当齿条62以及相应的护套56相对于末端执行器54的远端55移动时，深度指示器88与壳体52上的标记89协作，以显示护套56的远端57和末端执行器54的远端55之间的距离。在多种实施方式中，由于制造误差，此距离可能是近似的；但是如本领域已知那样，可以注意通过对这些误差进行控制和核算来减少其影响。
在本实施方式中，换能器90可以如本领域公知那样被安置在壳体52上。在可选的实施方式中，如图11至图15中所示的外科器械150，换能器90可以被安置在齿条162上使得换能器90可以相对于壳体152移动。在这些实施方式中，末端执行器54的远端55和护套56的远端57之间的距离可以通过将末端执行器54和换能器90相对于护套56移动来进行调整。在这种实施方式中，如图13，护套56可以通过凸缘59和槽166被安置在壳体152上，且换能器90可以被安置在轴环164的孔191内。外科器械150也可以包括用于将末端执行器54相对于远端57或护套56移动的棘轮结构160。值得注意的是，主要如图14所示，棘轮机构160的齿轮系比棘轮机构60多包括一个齿轮，即齿轮177，且因此致动器58的操作导致齿条162向远侧前进而不是如前述实施方式中所述地向近侧后退。此外，外科器械150可以包括被配置为将齿条162和末端执行器54拉回的返回弹簧184。在本实施方式中，返回弹簧184包括柔性带185，柔性带185连接到齿条162且被弹性地偏压使得返回弹簧184被配置为将柔性带185拉回且盘绕于其中。
在本发明的多种实施方式中，外科器械可以包括相对于外科器械的壳体可转动地延伸和/或缩回的护套。如图16至图21，外科器械200可以包括壳体252、末端执行器254和护套256。壳体252和护套256可以分别包括螺纹292和螺纹293，其螺纹292和293通过螺纹接合使得壳体252和护套256中的一个可以相对于另一个转动以使护套256的远端257相对于末端执行器254的远端255延伸或缩回。在多种实施方式中，螺纹292和螺纹293可以包括壳体252和护套256的相对位置保持在基本固定位置上的密距螺纹。但是，在多种实施方式中，虽然没有示出，外科器械200可以包括更加可靠地固定壳体252和护套256的相对位置的特征。在至少一种这样的实施方式中，外科器械200可以包括旋在壳体252和护套256的至少一部分上的轴环，以便将其固定地保持就位。
在多种实施方式中，如图22和图23所示，外科器械可以包括标记389和深度计388，其与上述类似地可以被外科医生用来对护套356的远端357和末端执行器354的远端355之间的距离进行估值。更特别地，在本实施方式中，壳体352的远侧边缘(即深度计388)可以被外科医生用作对标记389进行估值的基准。如上文所描述地，一旦远端355和远端357之间的距离被设定，末端执行器354可以被插入例如组织或骨中，直至护套356的远端357接触到组织或骨。在多种实施方式中，远端357可以包括喇叭形或钟形的末端，其可以被配置为将例如手术部位周围的组织从末端执行器352推开以防止对其造成意外伤害。
在本发明的多种实施方式中，外科器械可以包括护套，护套包括两个或更多的伸缩部分。如图24至图27，外科器械400可以包括壳体452、末端执行器454以及护套456。在至少一种实施方式中，壳体452可以包括外部，且护套456可以包括中部494和内部495。如上述类似，中部494可以与壳体452螺纹接合且相对于壳体转动，而内部495可以与中部494螺纹接合且相对于中部转动以将护套456的远端457相对于末端执行器454的远端455延伸或缩回。在多种实施方式中，中部494和内部495可以包括限制它们之间相对运动的远侧和/或近侧限位。在至少一种实施方式中，外科器械400可以包括密封壳体452、中部494和外部495之间的间隙的诸如橡胶O形环的密封件496。
在本发明的多种实施方式中，外科器械可以包括至少两个套爪形的可相对滑动的部分以及例如用于固定地将可滑动部分固定在一起的轴环。更特别地，如图28和图29，外科器械500可以包括壳体552、护套556和轴环597。在使用中，外科医生可以使护套556在壳体552内滑动，以与上文类似地将护套556的远端相对于末端执行器的远端定位。然后，外科医生可以将轴环597旋到壳体552的螺纹末端上以将壳体552压靠定位在壳体中的护套556的外表面。由于这种压靠，壳体552和护套556的相对位置可以基本固定并且防止互相相对滑动。在至少一种实施方式中，如图28，壳体552的螺纹末端可以包括狭缝579，狭缝579将壳体552的螺纹末端划分成更容易地被轴环597移位的独立的可挠曲的部分。在多种实施方式中，虽然没有示出，壳体552可以被配置为在护套556内滑动，且轴环597可以被配置为将护套556向壳体552压靠。
在本发明的多种实施方式中，外科器械可以包括可拆卸的护套。更特别地，在至少一种实施方式中，如图30，可以给外科医生提供套件，套件包含具有壳体652和末端执行器654的外科器械600以及多个例如具有不同长度和/或配置的护套。在示出的实施方式中，套件可以包括护套656a、656b、656c和656d，其中每个护套具有不同的长度。在使用中，外科医生可以从套件中选择一个护套656，其在末端执行器654的远端655和所选中的护套656的远端657之间提供需要的距离。因此，外科医生可以通过例如选择合适的套筒656来控制末端执行器654插入组织或骨的深度。为了帮助将选中的护套656连接到壳体652，每个护套656可以包括至少一个槽683，槽的尺寸和配置适于接收从壳体652延伸的凸起687并在其上保持护套。在多种实施方式中，每个槽683可以被配置为例如以压配合的接合方式接收凸起687以保证它们之间的固定配合。在示出的实施方式中，槽683为L形使得护套656可以“扭转锁定(twist-lock)”在壳体652上。虽然没有示出，护套可以包括从其延伸出的凸起，且壳体652可以包括被配置为接收凸起或其任何组合的槽。此外，虽然没有示出，护套可以包括几个部分。在至少一种这样的实施方式中，护套可以包括连接壳体的适配器，其中适配器被配置为可去除地接收几个不同的末端部分中的一个。在多种实施方式中，护套可以包括选择性地接合在一起以调整护套整体长度的几个部分。
在本发明的多种实施方式中，外科器械可以包括可拆卸的末端执行器。更特别地，在至少一种实施方式中，如图31，可以给外科医生提供套件，套件包含具有壳体752和护套756的外科器械700以及多个例如具有不同长度和/或配置的末端执行器。在示出的实施方式中，套件可以包括末端执行器756a、756b、756c和756d，其中每个末端执行器具有不同的长度。在使用中，外科医生可以从套件中选择一个末端执行器756，其在护套756的远端757和所选中的末端执行器754的远端755之间提供需要的距离。因此，外科医生可以通过例如选择合适的末端执行器754来控制末端执行器754插入组织或骨的深度。为了帮助将选中的末端执行754连接到换能器790，如图32，每个末端执行器754可以包括螺纹凹口，螺纹凹口被配置为接收换能器790的螺纹部分或从其延伸的螺纹紧固件799。
在本发明的多种实施方式中，外科器械可以包括具有至少一个标记或界线的末端执行器，标记或界线被配置为确定末端执行器的治疗区域。更特别地，如图33，末端执行器可以包括例如可以被外科医生用来治疗组织的第一和第二治疗区域。在至少一种实施方式中，末端执行器854可以包括第一治疗区域830和第二治疗区域831，其中第一治疗区域830包括用于例如切割组织的切割边缘，且第二治疗区域831包括用于例如烧灼或凝结组织的弓形表面。如图33，第二治疗区域831的表面833可以包括允许医生更容易地确定第二治疗区域831以及反之的第一治疗区域830的标记或界线。在可选的实施方式中，第一治疗区域830可以包括与确定第二治疗区域831的标记或界线不同的至少一个标记或界线。
在多种实施方式中，标记可以包括涂层表面。这种涂层可以通过包括例如阳极氧化的传统方法施加。在第一治疗区域830和第二治疗区域831都被涂层的实施方式中，涂层可以具有不同的颜色、材质、厚度和/或包含例如不同的材料。在多种实施方式中，一个治疗区域可以被染色使其具有与另一个治疗区域不同的颜色。在至少一种实施方式中，具有切割边缘或表面的治疗区域可以用诸如红色、橙色或黄色的明亮颜色的材料涂层或染色。类似地，具有用于烧灼或凝固组织的治疗区域可用具有诸如绿色、蓝色或靛青的暗淡颜色的材料涂层或染色。在多种实施方式中，第一治疗区域830和第二治疗区域831的表面中的至少一个可以具有变化的表面处理层。在至少一种这样的实施方式中，至少一部分表面可以被例如浸蚀或喷丸处理以形成有纹理的表面处理层。在两个治疗表面都被例如浸蚀的实施方式中，浸蚀的程度可以不同以允许外科医生更容易地区分治疗区域。在至少一种实施方式中，标记可以包括印刷其上或雕刻其中的数字、字母或符号。
在多种实施方式中，界线可以包括在末端执行器的表面的可以提供治疗区域之间的轮廓的至少一个凹槽。在至少一种实施方式中，治疗区域的整个表面可以包括多个凹槽，多个凹槽在多种实施方式中可以被以例如阴影线的有序图案排列。在至少一种实施方式中，第一和第二治疗区域都可以包括凹槽或其它界线，其中第一治疗区域中的凹槽或界线的密度可以与第二治疗区域中的不同。在多种实施方式中，界线的密度可以包括渐变，渐变可以被配置为指示沿着末端执行器的长度的例如振动的强度或幅值的变化。由于界线的这些变化，外科医生可以容易地辨别以最大和最小强度以及两者之间的强度进行振动的末端执行器的部分。在至少一种这样的实施方式中，末端执行器上例如染色的浓度可以在例如节点处或反节点处最大，并且随着离开节点或反节点的距离增加而逐渐递减。在多种实施方式中，例如染色浓度的变化率可以为线性的，或者在其它的实施方式中可以为几何级数的。在至少部分实施方式中，具有几何级数变化率的界线的实施方式可以更准确地表现出由正弦驻波导致的振动强度的变化。虽然上面列出的实施方式已经被描述为具有第一和第二治疗区域，本发明并不仅限于此。相反，末端执行器可以包括具有至少一个标记和/或界线或没有标记或界线的多于两个治疗区域。
此外，在多种实施方式中，可以使用至少一个标记或界线来确定例如具有高或低的振动强度或幅值的末端执行器的部分。更特别地，如上文所描述地，外科器械的换能器可以在末端执行器中产生驻波，驻波沿着末端执行器的长度形成节点和反节点。这些节点和反节点分别表示外科医生能够使用的末端执行器的振动强度高和低的区域。例如，末端执行器的高强度区域可以被用于例如切割或烧灼组织，而末端执行器的低强度区域可以被用于安全地接触手术部位周围的组织。因为外科医生一般无法分辨这些节点和反节点，可以在末端执行器上提供标记或界线来允许外科医生容易地辨别末端执行器的这些区域。
在本发明的多种实施方式中，外科器械可以包括被配置为抵靠外科器械的末端执行器保持例如一部分骨或组织的可缩回的夹具。在至少一种实施方式中，当夹具延伸时，夹具可以被配置用作例如骨钳或咬骨钳，所述骨钳或咬骨钳被配置为抵靠末端执行器保持至少一部分骨以去除骨的小的部分。当夹具至少部分地缩回时，夹具可以允许末端执行器被作为超声刮除器(cobb)或刮器使用，以例如解剖组织或将组织从骨剥离。此外，当夹具至少部分地缩回时，末端执行器可以被作为切骨刀使用并且可以在不使用超声能量情况下用于凿开或割除。
在多种实施方式中，主要如图34至图44，外科器械900可以包括末端执行器954和可缩回的夹具935。主要如图35至图37，可缩回的夹具935可以包括钳口构件937和枢轴937，其中枢轴937提供钳口构件936可以绕其转动的轴线。可缩回的夹具935可以被连接至内部构件938，如下文将更具体描述地，内部构件938可以可操作地与第一致动器接合。在使用中，第一致动器可以被配置为将夹具935在如图35所示的缩回位置和图36所示的延伸位置之间移动。一旦延伸，钳口构件936可以如图37所示地绕着枢轴937转动，使得钳口构件936可以被放置在骨或组织的一侧而末端执行器954被放置在骨或组织的相对侧。然后钳口构件936可以被闭合到骨或组织上，且从换能器传递至末端执行器954的超声能量可以被用于切割或密封它们之间的骨或组织。如下文将更具体讨论的，钳口构件936也可以通过驱动销940与外部构件939接合，其中外部构件939和驱动销940可以被配合使钳口构件936绕着枢轴937转动。
在多种实施方式中，如图39，医疗器械900还可以包括第一致动器941。如前文所指出的，第一致动器941可以可操作地与外部构件938接合并且可以被配置为使得夹具935延伸或缩回。更特别地，如图39，第一致动器941可以包括柱塞942，柱塞942可以被弹簧943偏压至与壳体942接合以将外部构件938保持在几个预定位置中的一个位置上。例如，当柱塞942与壳体952中的凹口944接触并保持时，夹具935可以如图35所示地处于其延伸位置。为了将夹具935移动至至少部分延伸位置，柱塞942可以被压下以使其与凹口944脱离并且允许外部构件938和夹具935向远侧移动。如上述类似，当柱塞942与壳体952的其它凹口接合时，夹具935可以被夹持和保持在包括如图35所示的完全延伸位置的位置上。虽然图39仅示出几组凹口，如图38所示的多组凹口或其它保持特征可以被用于将外部构件938和夹具935保持就位。为了将外部构件938和夹具935缩回，柱塞942可以被压下并向近侧移动。
在多种实施方式中，如图40和图41，外科器械900还可以包括第二致动器945。第二致动器945可以可操作地与内部构件937接合并且可以被配置为使得钳口构件936如上文所描述地绕着枢轴937移动或转动。更特别地，第二致动器945可以包括可操作地连接杠杆946和内部构件939的杠杆946和连杆947。在使用中，参考图41，杠杆946可运动离开打开位置(即图41虚线所示的位置)和闭合位置(即实线所示的位置)。在打开位置时，杠杆946和连杆947被配置为将钳口构件936保持在打开位置(即如图37所示的位置)。当杠杆946被移动至闭合位置时，连杆947被配置为将内部构件939缩回并闭合钳口构件936，即使其相对于末端执行器954的远端955紧密对置。为了重新打开钳口构件936，杠杆946被移动至上述的打开位置。
在多种实施方式中，如图42至图44，夹具935可以被从外科器械900拆下。更特别地，在至少一种实施方式中，外部构件938和内部构件939均可以包含可以被分开使得夹具935可以被移除的两个部分。如图42和图43，外部构件938可以包括远侧部分938a和近侧部分938b，如图44，远侧部分和近侧部分可以包括连接器部分以在其之间形成卡扣连接。类似地，内部构件939可以包括远侧部分939a和近侧部分939b，其也可以包括连接器部分以在其之间形成卡扣连接。因此，为了将夹具935连接至外科器械900，内部构件939和外部构件938的各自部分被对准，然后转动以使他们固定在一起。相应地，要去除夹具935，夹具935被转动，使得远侧部分938a和939a从近侧部分938b和939b脱离。
在多种实施方式中，如图45至图50，外科器械的可缩回的夹具可以包括可拆下的钳口构件。更特别地，外科器械1100可以包括可缩回的夹具1154，其包括枢轴1137、钳口连接器1148以及可拆卸的钳口构件1136。钳口构件1136可以包括例如可挠曲的腿1149，其被配置为由钳口连接器1148的凹口1127接收。在使用中，在可挠曲的腿1149被插入凹口1127之前，可挠曲的腿1149可以被挤压到一起，然后被松开以允许腿1139向外弹起并将脚1129定位在凹口1127的壁后。在至少一种实施方式中，脚1129可以包括倾斜面，当腿被插入凹口中时，倾斜面可以与凹口1127的壁协作以将腿1149向内侧弯曲。此外，在多种实施方式中，脚1129还可以包括平的表面或其它轮廓表面，一旦脚1129被定位在凹口1127的壁后，该表面与凹口1127协作以将可拆卸的钳口构件1146保持在钳口连接器1148上。
在使用中，可以给外科医生提供包括外科器械1100以及多个钳口构件的套件。外科医生可以从多个钳口构件中选择需要的钳口构件并且如上文所描述地将选中的钳口构件连接到外科器械1100。然后，如果需要，外科医生可以使用带有诸如图51和52所示钳口构件1236的不同钳口构件的同一外科器械1100。要拆下钳口构件1136，外科医生可以将腿1149挤压到一起以将脚1129从凹口1127中脱离，使得腿1149可以穿过凹口1127且钳口构件1136可以从中移除。虽然没有示出，也可以使用诸如压配合连接或紧固件的其它连接方式以将钳口构件保持在钳口连接器处。
如上文所描述的，具有可缩回夹具的外科器械可以用于至少三种目的。第一个目的可以是使用夹具来抵靠住末端执行器保持组织或骨，其中施加在末端执行器上的超声能量可以被用于切割其中的组织或骨。第二个目的可以是至少部分地缩回夹具使得末端执行器可以通过被施加到末端执行器的超声能量来例如从骨上切割或剥离组织。第三个目的可以是至少部分地缩回夹具使得末端执行器可以在没有施加其上的超声能量的情况下使用。在这些情况下，末端执行器可以通过例如使用锤子敲打医疗器械的末端来凿开骨。在多种实施方式中，被配置为使用超声能量来切开组织的末端执行器可能不适于敲击骨，因此，这种末端执行器可以被例如更类似于凿的末端的末端执行器替换。
虽然已经描述了本发明的若干实施方式，但是，应当清楚本领域技术人员可以想到实现本发明部分或全部优点的这些实施方式的多种变型、改型和变化。例如，根据多种实施方式，单个组件可以被多个组件替换，例如多个组件可以由单个组件替换，以执行给定的功能。因此在不脱离由后附的权利要求书所限定的本发明的范围和精神的条件下，本申请意于覆盖所有这些变型、改型和变化。
这里公开的装置可以被设计为在单次使用之后丢弃，或者可以被设计为可多次使用的。但是，在任何一种情况下，在至少一次使用后装置可以通过修整以重新使用。修正可以包括下述步骤的组合：分解装置、然后是对特定元件进行清洁或替换、然后是重新组装。特别地，装置可以被重新组装，且装置的任意数量的特定元件或组件可以以任意组合被选择性地替换或去除。在修正设施或者医疗组在手术前立即对特定元件进行清洁或替换之后，装置可以被重新组装以备下次使用。本领域普通技术人员将理解，装置的修整可以使用多种不同的技术来进行分解、清洁/替换以及重新组装。这些技术的应用，以及得到的被修整的装置，都落在本发明的范围内。
优选地，这里所描述的发明将在手术之前进行处理。首先，获取一个新的或用过的器械，并且如果有必要的话进行清洁。然后将器械除菌。在一种除菌技术中，器械被放置在诸如塑料或高密度聚乙烯合成(TYVEK
Figure G200880014402XD00211
)纸袋的闭合密封的容器内。然后将容器和器械放置在能够穿透容器的辐射场中，例如伽马射线、x射线或高能量电子。辐射杀死器械上和容器内的细菌。然后无菌的器械可以被储存在无菌的容器内。密封容器可保持器械无菌直至其在医疗设施中被打开。
通过引用包含于此的任何专利、出版物或其它公开材料其部分或整体仅仅在所包含的材料与现有定义、声明或本公开中所陈述的其它公开材料不冲突的程度上包含于此。这样，在必要的程度上，这里明确陈述的公开取代通过引用包含于此得的任何冲突材料。通过引用包含于此、但是与现有的任何材料或定义、声明或所陈述的其部分冲突的任何材料或其部分仅仅在所包含的材料与现有公开材料之间没有产生不冲突的程度上包含于此。

Claims (12)

1.一种外科器械，包括：
手柄；
换能器，其能够产生振动；
末端执行器，其与所述换能器接合，其中所述末端执行器限定轴线和远端，且其中所述远端能够通过所述换能器产生的振动来相对于所述轴线移动；
可调整的深度止挡，其相对于所述末端执行器可移动地支承，其中所述深度止挡包括远端，且其中所述深度止挡的所述远端能够相对于所述末端执行器的所述远端移动；
致动器，所述致动器从壳体延伸，其中所述致动器能够相对于所述手柄相对移动；以及
驱动机构，其中所述深度止挡与所述驱动机构可操作地接合，且其中所述致动器可操作地与所述驱动机构接合使得当所述致动器相对于所述手柄移动时，所述深度止挡的所述远端相对于所述末端执行器的所述远端移动；
其中所述驱动机构还包括：
棘轮机构，其中所述深度止挡从所述棘轮机构延伸，且所述棘轮机构包括：
齿条，其中所述深度止挡与所述齿条接合；
弹簧，其与所述齿条接合；
棘轮，其与所述致动器接合；以及
棘爪，其能够选择性地与所述棘轮接合，其中当所述棘爪与所述棘轮接合时，所述棘爪与所述棘轮能够使所述齿条和所述深度止挡的所述远端相对于所述末端执行器的所述远端移动，且其中，当所述棘爪与所述棘轮脱离时，所述弹簧能够将所述齿条与所述深度止挡相对于所述末端执行器的所述远端重新定位。
2.如权利要求1所述的外科器械，其中所述深度止挡包括将所述末端执行器至少部分地围绕的护套。
3.如权利要求1所述的外科器械，其中所述振动包括平行于所述轴线的振动、垂直于所述轴线的振动以及围绕所述轴线扭转的振动中的至少一种。
4.如权利要求1所述的外科器械，其中所述深度止挡还包括能够指示所述末端执行器的所述远端和所述深度止挡的所述远端之间的距离的标记。
5.一种用于处理外科手术器械的方法，该方法包括：
获取如权利要求1所述的外科器械；
将所述深度止挡从所述外科器械分离；以及
执行下列动作中的一个：
改变所述深度止挡的至少一部分，将所述深度止挡重新除菌，以及将所述深度止挡重新连接到外科器械；或
将不同的所述深度止挡连接到外科器械。
6.一种外科器械，包括：
手柄，所述手柄包括：
壳体；以及
致动器，所述致动器能够在未致动位置和致动位置之间移动；
换能器，其中所述换能器能够产生振动；
末端执行器，其与所述换能器接合，其中所述末端执行器限定轴线和远端，且其中所述远端能够通过所述换能器产生的振动来相对于所述轴线移动；以及
深度止挡，其从所述壳体延伸，其中所述深度止挡与所述致动器可操作地接合，所述深度止挡包括远端，且其中所述末端执行器的所述远端和所述深度止挡的所述远端之间的距离能够通过所述致动器的致动来调整；
其中所述外科器械，还包括：
棘轮机构，包括：
齿条，其中所述末端执行器与所述齿条接合；
弹簧，其与所述齿条接合；
棘轮，其与所述致动器接合；以及
棘爪，其能够选择性地与所述棘轮接合，其中当所述棘爪与所述棘轮接合时，所述棘爪与所述棘轮能够将所述齿条和所述末端执行器的所述远端相对于所述深度止挡的所述远端推进，且其中，当所述棘爪与所述棘轮脱离时，所述弹簧能够将所述齿条与所述末端执行器相对于所述深度止挡的所述远端拉回。
7.如权利要求6所述的外科器械，其中所述深度止挡包括至少部分地围绕所述末端执行器的护套。
8.如权利要求6所述的外科器械，其中所述振动包括平行于所述轴线的振动、垂直于所述轴线的振动以及围绕所述轴线扭转的振动中的至少一种。
9.如权利要求6所述的外科器械，还包括：
棘轮机构，其中所述末端执行器与所述棘轮机构连接，其中所述致动器可操作地与所述棘轮机构接合，使得当所述致动器相对于所述手柄移动时，所述末端执行器的所述远端相对于所述深度止挡的所述远端移动。
10.如权利要求6所述的外科器械，其中所述换能器与所述齿条接合。
11.如权利要求6所述的外科器械，其中所述深度止挡包括第一部分和第二部分，其中，所述第二部分可去除地与所述第一部分连接，且其中所述第二部分能够从所述第一部分分开以调整所述深度止挡的长度。
12.一种用于处理外科手术器械的方法，该方法包括：
获取如权利要求6所述的外科器械；
将所述深度止挡从所述外科器械分离；以及
执行下列动作中的一个：
改变所述深度止挡的至少一部分，将所述深度止挡重新除菌，以及将所述深度止挡重新连接到外科器械；或
将不同的所述深度止挡连接到外科器械。
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US20080234708A1 (en) 2008-09-25
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