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    • 专利摘要:
    set of surgical instruments for precision cutting. a method and a set of instruments are disclosed, particularly for carpal tunnel surgeries that allow a precision cut in the transverse ligament of the body (ltc) without direct vision or exposure of the ligament, except its most proximal edge, but with orientation and safety of the cutting knife, eliminating or, at least greatly reducing the probability of cutting lines in the wrong direction and inadvertent (iatrogenic) lesions in the surrounding structures, comprising, in a preferred way: a cannulated guide rod of unique shape, through which it passes a flexible metal guide needle (33) that serves as a guideline for a cutting knife or fasciotome (25) of unique shape that has a cannulated tip shaped like a finger at the bottom edge of the knife blade portion, in addition to, in a second embodiment of the invention, a sphere (32) coupled to the end of the upper blunt tip in the form of a finger present on the upper edge of said blade portion of said knife ; a cutting knife or fasciotome of exclusive shape with a 90 ° curved axis with, in a second embodiment of the invention, a pair of spheres coupled to the end of blunt fingers in the form of a guide cannula with slits (40), optional, of exclusive shape, with a fenestration at its end tip allowing the passage of the flexible metallic needle (33) and, in a second embodiment of the invention, also a restriction metal arch or brake arch (37) close to its distal end and on its back, two ears / handles for correct handling.
    公开号:BR112013003719B1
    申请号:R112013003719-9
    申请日:2010-12-10
    公开日:2020-10-06
    发明作者:José Dinis Carmo
    申请人:José Dinis Carmo；
    IPC主号:
    专利说明:

    Field of the Invention
    This invention concerns a set of surgical instruments for precision cutting, particularly suitable for carpal tunnel release surgeries. The method for carrying out the release is also disclosed.
    The set of surgical instruments developed for use especially, but not exclusively, in carpal tunnel release surgery, comprises a cannulated guide rod, a cutting knife or fasciotome with a 90 ° curved axis and a slotted guide cannula. . The present invention comprises a method for carrying out a release from the transverse carpal tunnel which is designed to be carried out without the need to expose and / or see the entire ligament before cutting, although with totally controlled cutting precision of the release, eliminating or, at least, greatly reducing the likelihood of cutting lines in the wrong direction and inadvertent (iatrogenic) lesions in the surrounding structures. BACKGROUND OF THE INVENTION Description of the Prior Art
    Carpal tunnel syndrome is a complex of symptoms that result from compression of the median nerve in the carpal tunnel. The carpal tunnel is the bone-fibrous passage to the median nerve and flexor tendons, formed by the flexor retinaculum and carpal bones. Carpal bones are the bones of the carpus. The carpus or wrist is the region of the joint between the forearm and the hand, which is made up of eight bones. The flexor retinaculum or transverse carpal ligament is a heavy fibrous band that continues with the distal part of the antebrachial fascia, completing the carpal tunnel. The forearm fascia or fascia (deep) of the forearm is the lining fascia of the forearm. The fascia is a sheet or band of fibrous tissue that lies deeply in relation to the skin or forms an envelope for muscles (and various organs in the body).
    The treatment of carpal tunnel syndrome by releasing the transverse carpal ligament has been used for over 60 years. During this time several methods were developed for the release of the ligament.
    In summary, these can be classified into two main groups: 1) open methods that use an incision in the skin of the volar aspect of the palm over the ligament and 2) endoscopic methods. Endoscopic methods can be further divided into two subgroups: 2) a) one that uses a single incision and 2) b) another that uses two incisions, at least one in the patient's palm. 1) Open methods are all performed basically in the same way, with some variants, related only to the length of the skin incision and / or its exact positioning on the palm. Although very effective in relieving the symptoms of most patients and safe (the safety of the procedure in general varying inversely with the length of the scar) these methods may require a relatively prolonged postoperative recovery for the hand and are often complicated by back sensitivity from the incision site and the so-called "pillar pain", at the base of the tenar and hypotenar eminences, immediately distal to the wrist crease and on each side of the surgical scar. References U.S. PATENT DOCUMENTS 5,387,222 02/1995 Strickland. Carpal Tunnel Tome and Carpal Tunnel Release Surgery 5,413,580 05/1995 Stephenson. Carpal Tunnel Knife 5,908,433 6/1999 Eager. Carpal Tunnel Knife 2) In an attempt to minimize these complications, several endoscopic methods were developed to divide the transverse carpal ligament, receiving considerable popularity during the 1980s and 1990s.
    In general, these techniques employ the passage of a special instrument under the transverse carpal ligament, such as, for example, the method known in Pat. No. 5, 273, 024 to Menon, and then use optical fibers and special cutting devices to observe and divide the ligament. However, these techniques are fraught with problems, including the need for expensive special equipment, requiring specialized training and prolonged learning curves on the part of the surgeon, which is a very time-consuming procedure. These techniques have also been challenged as not always being consistent in their ability to completely split the transverse carpal ligament and there are reports of complications such as iatrogenic injury to the contents of the carpal tunnel, especially the median nerve and its ramifications and tendons within the tunnel of the carpus. In some cases, the instrument was inserted into the wrong passage causing injury to the nerve and ulnar artery.
    Often, during the operation, the vision of the desired structures is significantly impaired by fogging of the tip of the lens of the optical instrument, or by a drop of palmar fat in the working field as the transverse ligament of the carpus is released. If the technique involves the use of a "small" palmar incision, the problem of local and abutment pain can be reduced but is not entirely eliminated.
    In addition to all these reasons, it is the inventor's personal opinion that one of the biggest disadvantages of endoscopic techniques is the need to previously dilate the contents of the carpal tunnel, using a kit of "dilators" to give space to introduce the cutting device. The fundamental reason why carpal tunnel syndrome develops in the first place is because both structures that connect and fill the carpal space are virtually incompressible, so if the contents swell, the median nerve is compressed, triggering the symptoms. "Dilating" the content of the channel increases the problem to be solved, at least temporarily, and is potentially dangerous because the pressure can move structures upwards or in front of the cutting instrument, putting them at serious risk. References U.S. PATENT DOCUMENTS 5,273,024 12/1993 Menon. Method and Apparatus for Performing Endoscopic Surgery 5,334,214 08/1994 Putnam. Apparatus and Method for Dividing Transverse Carpal Ligament
    Thus, what is needed is a simple, safe, effective and economical technique that requires only a single incision in the wrist, in order to avoid or minimize as much complications and surgical loads as possible.
    In summary, the advantages offered by the present invention over the prior art are as follows:
    Regarding 1) Open methods: 1) Avoid any incision in the palm of the hand, thereby eliminating or greatly decreasing the pain of the incision and the "abutment pain" 2) Minor incision on the distal wrist crease 3) Less postoperative pain 4) Better cosmetic result: the said incision becomes (in a few months) for all practical aspects, undetectable.
    In relation to 2) Endoscopic methods: Much simpler technique, avoiding: 1) The need for special (very) expensive equipment; the technique implies the use of only 4 or 5 simple, economical instruments; 2) The need for specialized training and long learning curves on the part of the surgeon; 3) Fast procedure; 4) There is no need to previously dilate the contents of the carpal tunnel; 5) Reliable and reproducible technique; 6) Able to ensure complete release of the ligament in all cases; 7) Safe technique: in more than 100 cases performed by the inventor, no case of significant complications was detected. DESCRIPTION OF THE PREFERRED EMBODIMENT
    In order to promote an understanding of the principles of the invention, reference will be made to the modality illustrated in the drawings and specific language will be used to describe it. However, it will be understood that no limitation of the scope of the invention is intended, such changes and other modifications to the illustrated devices, and other applications of the principles of the invention as illustrated herein are contemplated as would normally occur to a person skilled in the art to which the invention is intended. relates.
    The present invention relates to a set of surgical instruments particularly suitable, but not exclusively, for carpal tunnel release surgery, and its method of use, which allows an incision to be made in the LTC without direct view of the ligament, except its most proximal edge, but with guidance and safety in handling the knife, eliminating or greatly reducing the likelihood of cutting lines in the wrong direction. This set comprises:
    A cannulated guide rod (28), Fig. 10, with a curved distal end, which guides the passage of a metal guide needle (33) through a selected point on the palm.
    A cutting knife or fasciotome (25), Fig. 12, comprising at least one cannulated tip in the form of a finger (20 or 24) connected to the lower surface of the blade holder (21) located in the head portion of the device, and one or more solid fingers-shaped tips (22; 23) that extend forward above and below the blade, similar to the type of surgical knife found in Pat. No. 5,387,222 published by Strickland.
    Alternatively, the lower end of the blade portion may be flat or rounded at the end, extending below the blade, replacing the lower solid finger-shaped tip (22). Attached to the bottom surface of said solid finger-shaped tip (22) or its replacement surface, there are one or two cannulated finger-shaped tips (20 and 24). The purpose of the cannulated tips in the form of fingers is to allow the flexible metal guide needle (33) to pass, after this needle is placed under the LTC subsurface (106), with the aid of the curved cannulated guide rod (28) ). This needle will guide the advancement of said blade (21) from said distal end of the fasciotome (25) during the cutting action, thereby eliminating the possibility of the device deviating from the intended route into any wrong passage. In the distal part of the axis of the fasciotome (25) there is also a set of holes or fenestrations (26), placed at regular, referenced distances, from the tip of the instrument and with each other in order to determine the length of the device inserted in the palm and, thus, the cut length of the transverse carpal ligament (LTC). The fasciotome also includes a cable (34) connected to the proximal (posterior) end of the axis, in order to make it easier and safer to push the device along the ligament, as illustrated in Fig. 15. At the end of the shaped upper tip There is, in a preferred embodiment, a metal sphere (32) with the preferred size of 2mm, preferably placed eccentrically in order not to decrease the width of the blade. This sphere increases the lack of cut of the finger-shaped tip, virtually eliminating the possibility of the blade deviating from the intended route, that is, downwards, through the transverse carpal ligament (LTC), towards the median nerve and tendons. However, its preferred size does not interfere with the advance of the fasciotome.
    A cutting knife or fasciotome with a curved axis at an angle of 90 ° (41), attached to any type of handle that the surgeon may consider appropriate for its use, and a blade holder with a portion of the blade (21) connected by two solid fingers-shaped tips (22; 23) at the end, extend forward above and below the blade, similar to the type of surgical knife found in Pat. No. 5,387,222 published by Strickland. Alternatively, the lower end of the blade may be flat or rounded at the end, extending below the blade by the same distance, replacing the lower solid tip in the form of a finger (22). At the end of each finger-shaped tip there is preferably a metal sphere (32), with the preferred size of 2mm, preferably placed eccentrically so as not to decrease the width of the blade portion. Said spheres increase the lack of cut of the finger-shaped tip, virtually eliminating the possibility of the blade deviating from the intended route, either superficially, which could result in an incomplete cut or no cut of the distal antebrachial fascia either downward, through of the transverse palmar ligament, towards the median nerve and tendons. However, its preferred size does not interfere with the advance of the fasciotome.
    A slotted guide cannula (40), with a closed but fenestrated distal end, through a central hole (33A), and an open proximal end, the cannula provided with a longitudinal slit (39) extending from a point adjacent to the cannulated distal end to a point adjacent to the open proximal end. The cannula can have a C or D-shaped cross-section with the flat part of the C or D-shape located along the edge of the longitudinal slit.
    The slit guiding the fasciotome and the fenestration at the distal end allows the passage of the flexible guide needle that will lead the fasciotome through the transverse carpal ligament (LTC) (106), placed first under the orientation of the curved cannulated guide rod (28) .
    In its preferred modality, there is also, near the distal end of the cannula, a brake arc (37) that helps: a) repress the final advance of the blade portion (21) of said fasciotome (25), being another element that prevents the blade to deviate forward or upward, towards the palm of the hand, as illustrated in Fig. 14; b) to remove the soft tissues under the LTC, and c) to increase the surgeon's tactile sensation of the surfaces under the LTC. At the open distal end, there are a pair of handles or ears (38) to facilitate their handling, as shown in Fig. 17. DESCRIPTION OF THE DRAWINGS
    Fig. 1 is a schematic view of a human palm and wrist showing some anatomical structures and some of the reference points in addition to the surgical incision used during the procedure described here, in which the numerals represent the following: 104 - Tendon of the Palmar Long Muscle ; 105 - Pisiform bone 106 - Transverse carpal ligament (LTC); 107 - Apophysis of unciform bone; 202 - Line drawn as the continuation of the radial border of the ring finger; 203 - Line drawn as the continuation of the ulnar border of the ring finger; 207 - Kaplan cardinal line; 208 - 4th metacarpal bone; 304 - Distal palmar fold of the wrist; 305 - Surgical incision.
    Fig. 2 is a schematic view of a human palm and wrist showing the surgical incision in the skin, the edges of the skin being retracted by two hooks and a knife making a transverse surgical incision in the fascia of the wrist used during the procedure described here, in that the numerals represent the following: 306 - Palmar distal fold of the wrist; 305 - Surgical incision (skin edge); 401 and 40IA - Hooks; 402 - Knife (surgical blade); 405 - Proximal border of the transverse carpal ligament (LTC); 405A - Distal border of the antebrachial fascia (carpal palmar ligament) (LPC); 406 - Adson forceps; 407 - Surgical incision in the palmar fascia.
    Fig. 3 is a schematic view of a human palm and wrist showing the curved-axis fasciotome at an angle of 90 ° cutting through the distal edge of the antebrachial fascia, during a part of the procedure described here, in which the numerals represent the following: 41 - Axis fasciotome at an angle of 90 °; 106 - Transverse carpal ligament (LTC); 305 - Surgical incision; 405A - Antebraquial fascia (Carpal palmar ligament) (LPC); 501B - Leather; 502B - Proximal cut in the distal antebrachial fascia.
    Fig. 4A is a schematic view of a human palm and wrist showing a blunt probe or obturator being inserted distally below the transverse carpal ligament (LTC) during a part of the procedure described here, where the numerals represent the same than indicated in Fig. 4.C.
    Fig. 4B is a larger scale view of part of FIG.4.A showing a sagittal view of the blunt probe or obturator inserted distally below the transverse carpal ligament (LTC), where the numerals represent the same than indicated in Fig. 4.C.
    Fig. 4C shows the same sagittal view as FIG. 4.B with the blunt probe or obturator replaced by the cannulated guide rod with curved tip that is part of the invention described here, in which the numerals represent the following: 27 - Cannulated guide rod with curved tip; 106 - Transverse carpal ligament (LTC); 401 - Hooks; 305 - Surgical incision; 405A - Antebraquial fascia (Carpal palmar ligament) (LPC); 501B - Leather; 502B - Subcutaneous fat; 601 - Blunt probe or obturator; 607 - Laser marks of the curved tip cannulated guide rod.
    Fig. 5A is a schematic view of a human palm and wrist showing: 1) a flexible metal guide needle being inserted under the deep surface of the transverse carpal ligament (LTC) through the lumen of the cannulated tipped guide rod curve that is part of the invention described here during the procedure that is the object of it and, 2) The palm of the hand is distant to the referenced line of Kaplan being pressed down with a blunt spatula to facilitate the extrusion of the flexible needle tip, in that the numerals represent the same as indicated in Fig. 5B.
    Fig. 5B is a sagittal view, on a larger scale, of part of Fig. 5A showing the same procedure illustrated in the previous figure, in which the numerals represent the following: 27 - Axis of the cannulated guide rod with curved tip; 33 - Flexible metal guide needle; 106 - Transverse carpal ligament (LTC); 305 - Surgical incision; 405 - Proximal border of the transverse carpal ligament (LTC); 501B - Leather; 502B - Subcutaneous fat; 706- Spatula.
    Fig. 6 is a schematic view of a human palm and wrist showing the cannulated tip in the shape of a finger from the distal end of the fasciotome to the transverse carpal ligament that is part of the invention described here introduced along the flexible metal guide needle placed under the transverse carpal ligament (LTC), during the procedure that is the object of the same, in which the numerals represent the following: 20 - Cannulated tip in the shape of a finger; 21 - Blade (cutting edge of the knife); 25 - Fasciotome; 26 - Fenestrations on the fasciotome axis; 32 - Metal sphere; 33 - Flexible metal guide needle; 106 - Transverse carpal ligament (LTC); 305 - Surgical incision; 405 - Proximal border of the transverse carpal ligament (LTC); 810 - Wire.
    Fig. 7 is a schematic view of a human palm and wrist with the fasciotome for transverse carpal ligament (LTC) that is part of the invention described here being fitted to the proximal edge of the transverse carpal ligament (LTC), riding the ligament, under the orientation of the flexible metal guide needle kept under tension with the help of strong needle carriers (not shown) during the procedure that is the object of the procedure, in which the numerals represent the following: 20 - Cannulated tip shaped finger; 21 - Blade (cutting edge of the knife); 25 - Fasciotome; 26 - Fenestrations on the fasciotome axis; 32 - Metal sphere; 33 - Flexible metal guide needle; 106 - Transverse carpal ligament (LTC); 405 - Proximal border of the transverse carpal ligament (LTC); 405A - Antebraquial fascia (Carpal palmar ligament) (LPC); 810 - Wire.
    Fig. 8A is a schematic view of a human palm and wrist that illustrates the complete division of the transverse carpal ligament (LTC) by advancing the fasciotome to the transverse carpal ligament (LTC), under the guidance of the metal guide needle, along the entire length of the ligament (LTC), where the numerals represent the same as indicated in Fig. 8C.
    Fig. 8B is a larger-scale view of part of Fig. 8A showing a sagittal plan view of the same procedure described, the section of the carpal transverse ligament (LTC), in which the numerals represent the same as indicated in Fig 8C.
    Fig. 8C is a larger-scale view of part of Fig. 8A showing a cross-sectional plan view of the same procedure, the section of the transverse carpal ligament (LTC), in which the numerals represent the following: 25 - Fasciotome; 26 - Fenestrations on the fasciotome axis; 33 - Flexible metal guide needle; 106 - Transverse carpal ligament (LTC); 810 - Wire; 405A - Antebraquial fascia (Carpal palmar ligament) (LPC); 501B- Leather.
    Fig. 9A is a schematic view of a human palm and wrist that illustrates the use of the optional fenestrated tip cannula, with slits, which is part of the invention described here, introduced under the transverse carpal ligament (LTC), under the direction of the flexible metal guide needle inserted through its fenestrated tip, where the numerals represent the same as indicated in Fig. 9D.
    Fig. 9B is a larger-scale view of part of Fig. 9A, illustrating a sagittal view of the same procedure, the total introduction under the carpal transverse ligament (LTC) of the fenestrated tip guide cannula, with slits, until it is prevented from progressing further by the flexible metal guide needle that limits the deep surface of the palmar skin, where the numerals represent the same as indicated in Fig. 9D.
    Fig. 9C illustrates the same plan view as FIG. 9.B, which illustrates the surgical step that follows in the procedure that is its object, consisting of the initial introduction of the fasciotome for transverse carpal ligament (LTC) along the flexible metal guide needle located along the longitudinal slit of the cannula - fenestrated tip guide, with slits, in which the numerals represent the same as indicated in Fig. 9D.
    Fig. 9D illustrates the same plan view as FIG. 9C with the fasciotome for transverse carpal ligament (LTC) fully inserted along the longitudinal slit of the fenestrated tip guide cannula, with slits, along the transverse carpal ligament (LTC), in which the numerals represent the following: 25 - Fasciotome; 33 - Flexible metal guide needle; 40 - Fenestrated Tip Guide Cannula with Slits; 105 - Pisiform bone; 106 - Transverse carpal ligament (LTC); 305 - Surgical incision; 501B- Skin; 502B - Subcutaneous fat.
    Fig. 10 is a 3D view of a preferred embodiment of the cannulated guide rod with a curved tip, which is part of the invention described here, with a "nail" at the end of the shaft coupled to a suitable shape of the rear handle, in which the numerals represent the following: 306 - Cable (from) cannulated guide rod with curved tip; 307 - Cannulated stem axis; 308 - Distal end of the cannulated stem; 309 - Tooth or nail.
    Fig. 11A and B are seen in full-scale 3D of part of Fig. 11, highlighting the tip of the cannulated guide rod with a curved tip, in two of the preferred embodiments, with a "tooth" or "nail" on the its distal end, where the numerals represent the following: 310 - Tooth; 311 - Nail.
    Fig. 12 is a 3D view of one of the preferred modalities of the distal end of the straight-axis fasciotome that is part of the invention described here, in which the numerals represent the following: 312 - Cannulated tip in the shape of a finger; 313 - Blade (cutting edge of the knife); 314 - Lower finger-shaped tip; 315 - Upper tip shaped like a finger; 316 - Metal sphere.
    Fig. 13 is a 3D view of another preferred embodiment of the end of the distal axis of the fasciotome for transverse carpal ligament (LTC) that is part of the invention described here, emitting two tips in the form of parallel cannulated fingers, in which the numerals represent the following: 317 - Cannulated tip shaped like a finger; 318 - Blade (cutting edge of the knife); 319 - Lower finger-shaped tip; 320 - Upper finger-shaped tip; 321 - Cannulated tip in the shape of a finger; 322 - Fasciotome; 323 - Fenestrations on the fasciotome axis; 324 - Metal sphere.
    Fig. 14 is a 3D view, distal to proximal, of the assembly consisting of the flexible metal guide needle in the procedure that is its object, the fenestrated guide cannula with slits and the cutting knife or fasciotome for transverse tunnel of the carpus, in a preferred embodiment, with a metal sphere at the end of the upper distal tip in the form of a finger in the portion of the head of the fasciotome which are both part of the invention described here, in which the numerals represent the following: 25 - Fasciotome; 32 - Metal sphere; 33 - Flexible metal guide needle; 37 - Restraining arc or brake arc; 40 - Fenestrated Tip Guide Cannula with Slits.
    Fig. 15 is the same 3D view, proximal to the distal, of the assembly illustrated in Fig. 14, which illustrates the preferred modality of the posterior handle of the cutting knife or fasciotome for straight-axis carpal tunnel, which is part of the invention. described here, in which the numerals represent the following: 41 - Fasciotome; 42 - Rear cable; 43 - Fenestrated Guide Cannula with Slits.
    Fig. 16 is a 3D view, distal to proximal, of the 90 ° curved fasciotome that is part of the invention described here, coupled to a suitable form of posterior cable, in which the numerals represent the following: 44 - Axis fasciotome at an angle of 90 °; 45 - Metal sphere.
    Fig. 17 is a 3D view, distal to proximal, of the assembly consisting of the flexible metal guide needle used in the procedure that is its object, placed along the fenestrated tip cannula with slits, which is part of the invention described here, with its tip protruding through the closed distal end of the cannula. The metallic arch of restraint on the distal dorsal axis of the cannula is also illustrated. The numerals represent the following: 46 - Flexible metal guide needle; 47 - Restriction arc or brake arc; 48 - Ears / Handles; 49 - Longitudinal crack; 50 - Guide cannula of fenestrated tip with slits.
    Fig. 18 is a 3D view on a larger scale, proximal to the distal, of the distal end assembly consisting of the flexible metal guide needle used in the procedure that is its object, placed along the longitudinal slit of a preferred embodiment of the guide cannula with fenestrated tip with slits, which is part of the invention described here with its tip projecting through the closed distal end of the cannula. The metallic arch of restraint on the distal dorsal axis of the cannula is also illustrated. The numbers represent the following: 51 - Flexible metal guide needle; 52 A - Frontal orifice of the Guide cannula with fenestrated tip with Slits; 53 - Restriction arc or brake arc; 54 - Longitudinal crack.
    Fig. 19 is a 3D view, distal to proximal, of the assembly of instruments that are part of the invention described here, that is, from left to right: the cannulated guide rod, the cutting knife or fasciotome for transverse ligament the carpus over the slit of the guide cannula with a fenestrated tip with slits and the cutting or fasciotome knife with a 90 ° curved axis, in which the numerals represent the following: 55 - Fasciotome; 56 - Cable (from) cannulated guide rod with curved tip; 57 - Flexible metal guide needle; 58 - Restriction arc or brake arc; 59 - Ears / Handles; 60 - Fenestrated Tip Guide Cannula with Slits; 61 - Axis fasciotome at an angle of 90 °. DETAILED DESCRIPTION OF THE INVENTION
    The present invention discloses a set of surgical instruments particularly, but not exclusively suitable for cutting the transverse carpal ligament (LTC) during carpal tunnel surgery and its method of use, comprising:
    A cannulated guide rod (28) which preferably has a cylindrical section and two open ends, with a curved distal end (29). Its lumen allows the introduction of a flexible metal guide needle (33), the guide for the blade portion of the cutting knife or fasciotome (25) of the carpal ligament. The instrument is characterized by having an appropriate size and shape to optimize its introduction into the palm, under the subsurface of the transverse carpal ligament (LTC), through a minimal surgical incision, and also leading to the introduction of the referred needle ( 33) to a selected point on the palm.
    Furthermore, said rod (28) is characterized by having, at about 1 cm from its distal end, a curvature (29) with an angle of about 25 ° to 30 °, in order to: facilitate its introduction by under the LTC subsurface; push the LTC subsurface upwards with its tip; increase the tactile sensation of the surgeon of that ligament and its distal edge and taking the tip of the flexible guide needle (33) upwards towards the surface of the palm of the hand, so that the tip of the needle will extrude at one point of the palm near the tip of said rod.
    In a preferred embodiment, said rod (28) is further characterized by having attached to the tip of the most distal edge of its curved end, on the side of the convexity, a protuberance such as a tooth (30) or nail (31) of at least , 1 mm high as shown in Fig.ll-A and 11-B, facilitating and increasing the tactile sensation of the surgeon of the LTC subsurface, in addition to inducing a sensation of a jolt when the distal edge of the ligament is exceeded. As part of the measures designed to prevent a complete cut of the LTC, on the upper distal surface of the axis (28), considered to be the side of its concavity, a metric scale (607) can be engraved by one of several means known in the art. ) with the dual purpose of referring at all times in which direction the tip of the nail is pointing and to determine the length of the device inserted in the palm, as shown in Fig. 10.
    Said rod must be manufactured by one of several means known in the art, with biocompatible material, such as surgical stainless steel or iron-based, titanium-based, cobalt-based or any other suitable alloy with the following preferred dimensions, which can be changed for manufacturing purposes or to adjust to the surgeon's ergonomic conditions:. Length: 50 to 100mm. Outside diameter: 3-5mm. Inner diameter: 2-3mm
    This cannulated guide rod (28) can be coupled with any type of cable as it may be convenient for manufacturing and for the surgeon to control and maneuver the instrument. Said cable can be manufactured, by one of several means known in the art, preferably with a metal alloy of the same type as the rod or a biocompatible material resistant to high temperatures, for example, high density polyethylene or another one of the plastics family.
    In any case, it is critical that the proximal end of the stem (28) is always visible and permeable on the side of the handle to allow the insertion of the flexible metal guide needle (33) into the lumen of the instrument.
    The proposed set of this invention also included a cutting knife or fasciotome (25) comprising at least one tubular, cannulated finger-shaped tip (20 or 24) that can be coupled to a solid finger-shaped tip (22) present on the lower surface of the cutting blade (21) or, alternatively, it can even replace it, if the lower end of the blade holder, in a preferred embodiment, is manufactured flat or with a flattened shape, rounded at its tip, allowing the direct fixation to said cannulated tubular tip (20). The purpose of said cannulated tip (20) in the form of a finger is to guide the passage of the flexible metal guide needle (33) after it has been brought into position with the aid of the cannulated guide rod (28). This needle will guide the advance of the blade portion (21) of said knife or fasciotome, during the cutting action, eliminating the possibility of the device deviating from the intended route for a wrong passage.
    Said fasciotome is also characterized by having, in a preferred embodiment, connected to the end of the solid finger-shaped tip (23) a metal sphere (32), with the preferred size of 2mm, preferably placed eccentrically in order not to decrease the width of the blade portion (21). This sphere (32) also increases security, increasing the lack of cut of said solid finger-shaped tip (23), virtually eliminating the possibility of the blade (21) deviating from the intended route for any wrong passage, that is, downwards , through the transverse carpal ligament (LTC), towards the median nerve and tendons. However, its preferred size does not interfere with the advance of the fasciotome. Said fasciotome also presents, in a preferred embodiment, on the distal part of the axis of the fasciotome (25) on at least two of its sides or edges, a group of fenestrations (26), placed at regular distances, referenced from each other and the tip of the instrument, forming a scale that the surgeon can use to check the length of the device that has advanced into the hand and, thus, the length of the cut made in the LTC (106).
    Said fasciotome also includes a handle (34), Fig. 15, for the purpose of making it easier to push the instrument through the ligament. This cutting knife or fasciotome (25) can be manufactured, by one of several means known in the art, with biocompatible material, in two different ways: "disposable" and "non-disposable" or "permanent", in the preferred modality: 1) The "disposable" fasciotome consists of a portion of the front or distal blade made of stainless steel or any other high-strength biocompatible metal alloy coupled with a disposable shaft and rear handle, manufactured by one of several means known in the art, with a biocompatible material resistant to high temperatures, for example, high density polyethylene or other from the plastics family. 2) The permanent or "non-disposable" fasciotome is made, by one of several means known in the art, as an entirely metallic piece, made of surgical stainless steel, or any other biocompatible, high-strength metal alloy, as described for the cannulated guide rod (28).
    The remaining structural parts of the cutting knife / fasciotome (25) and respective preferred dimensions, which can be changed for reasons of convenience of industrial manufacture or to adjust to the surgeon's ergonomic characteristics, without meaning that we are facing a new instrument, follow : BACK CABLE
    Trapezoidal cable, with a main longitudinal axis, concave-convex, with the concavity on the face opposite the axis, and a set of indentations (notches or slits) along its entire width. Recommended dimensions:. Length: 29mm. Width: 10mm. Thickness: 5mm. Indentations on the concave surface of the cable away from the stem: Imm of depth (bas relief). • CONNECTION TO THE AXLE OR ROD - Mounted perpendicular to it, at the rear end of the said axis, so that its lower transverse side does not protrude more than approximately 5 mm below the bottom surface of the said axis and this configuration allows to achieve the following objectives : 1) Provide a comfortable and functional thumb support surface to push the fasciotome (25) along the LTC during the cutting action. 2) Have an ergonomic configuration adapting to the convexity of the palm of the thumb. 3) Indentations contribute to the stability of the instrument by increasing the adhesion / friction between the device and the gloved thumb during surgery. 4) The detail of the cable being attached to the stem in the manner described, eccentrically upwards, prevents the cable from pressing on the palmar surface of the patient's forearm while pushing the fasciotome (25) forward, towards the hand, therefore, without disturbing the advance of the instrument during the process of cutting the LTC. • AXLE OR ROD PROXIMAL END (BACK)
    In a preferred mode, with a square section, with the following recommended lateral dimensions: 6mm. DIAPHYSIS
    In its preferred modality, with a square proximal section, in continuity with the proximal (posterior) end approximately 100 mm from the posterior end, the diaphysis tapers progressively towards its distal end and assuming a preferentially flat shape on the transverse axis, with height greater than width (diaphysis only):. Length: 130-140mm. Proximal width up to 100mm away from the rear end: 6mm, with a preferably square configuration. Progressive tapering of the stem from this point until it reaches the dimensions of 4mm in the longitudinal direction at the level of the stem neck, 140mm away from the posterior end of the device and 25mm proximal to the tip of the device. . Progressive narrowing of the stem from the same point up to 2mm on the transverse axis at the level of the stem neck, 140mm away from the posterior end of the device and 25mm proximal to the tip of the device.
    The shank is fenestrated vertically, horizontally or both through a preferred number of 5 holes, arranged at regular distances between them, preferably 5mm, starting at 30mm from the cutting edge of the blade of the distal end and ending at 50mm . In a preferred embodiment, a numerical scale can be engraved next to the holes (26), in the form of laser marks or any other form known in the art. DISTAL END (FRONT) (BLADE PORTION; BLADE)
    This end comprises a head portion consisting of: 1) A trapezoidal blade, welded to the opposite end of the head portion, with the distal cutting edge preferably concave or "V-shaped" ("fish mouth") ), with the following recommended dimensions:. Maximum length: 14mm
    Length at concavity level (most posterior point): 10mm. Height: 4mm. Width: Imm It is recommended that the distal cutting edge be moderately but not excessively sharp, in order to easily cut the LTC (106), but with a certain degree of resistance, increasing the tactile perception of the cutting surgeon being performed. 2) A solid, blunt, finger - shaped tip, attached to the upper edge of the blade, in continuity with the neck of the shaft with the following preferred dimensions:. Maximum length: 10mm. Diameter: Imm
    The tip of this finger-shaped tip should preferably extend beyond the apex of the blade concavity by at least 4mm. In its preferred embodiment, a metal sphere (32) approximately 2mm in diameter is attached to its tip, preferably placed eccentrically outward, in order not to decrease the width of the blade portion. 3) A solid, blunt, finger - shaped tip, attached to the lower edge of the blade, in continuity with the neck of the shaft with the following preferred dimensions:. Maximum length: 13mm. Diameter: Imm
    This tip, preferably, should extend beyond the apex of the blade concavity of about 6mm, therefore being more advanced than its similar. 4) A cannulated tip in the shape of a finger, connected to the said solid, blunt, lower point in the shape of a finger, or, alternatively, totally replacing it, directly connected to the lower surface of the blade, with the same dimensions and positional characteristics of the cylinder solid in continuity with the neck of the shaft, and, in a preferred embodiment, also with a distal beveled end, with the bevel oriented from top to bottom and facing back and with the following preferred dimensions:. Maximum length: 13mm. Outside Diameter: 2mm. Internal Diameter: Imm. Distal end preferably beveled.
    Another three main characteristics of the fasciotome head portion (25) are as follows: 1) the width between the bottom surface of the two solid finger-shaped tips (22; 24), connected to each side of the blade (21), is around 4mm because we found that the thickness of the transverse carpal ligament can exceed 3mm in adults. The 4mm gap, therefore, avoids the pressure of the said points on the ligament, which could hinder the knife's unimpeded advance through the ligament during the cutting process. Another, 2) is that the length of the upper solid finger-shaped tip (23) does not need to extend more than approximately 4mm in relation to the most distal edge of the blade (21) because, especially if a metal sphere (32) is coupled to the tip end, as recommended in a preferred embodiment, this is sufficient to prevent any device orientation error. 3) Likewise, the length of the lower cannulated tip in the form of a finger (20; 24) does not need to extend more than approximately 6mm in relation to the most distal edge of the said blade (21) because, during the process of cutting the ligament Transverse carpal plane (LTC) (106), the instrument is oriented along the entire length of the cut by the flexible metal guide needle (33) inserted in the cannulated tip in the form of a finger and not by the tip itself. The short length of the projection of the tips helps to avoid any possible obstruction of the head portion of the instrument against the tissues. CUTTING KNIFE or FASCIOTTO WITH A 90 ° CURVED AXLE (41) (Fig. 16)
    This cutting knife or fasciotome (41) can be manufactured by one of several means known in the art, with biocompatible material, in two different ways: "disposable" and "non-disposable" or "permanent". 1) The "disposable" fasciotome consists of 1) a portion of the front or distal blade made of surgical stainless steel or any other high-strength biocompatible metal alloy as described for the cannulated guide rod (28) manufactured by one of several means known in the art, without this meaning that we are facing a new instrument, connected to 2) a disposable posterior cable and / or posterior axis, manufactured by one of several means known in the art, with a biocompatible material resistant to high temperatures, for example, high density polyethylene or other from the plastics family. The posterior cable can be of any size or shape that adapts to the surgeon's ergonomic characteristics and / or to the convenience of industrial manufacture, without this meaning that we are facing a new instrument. 2) The permanent or "non-disposable" fasciotome can be manufactured, by one of several means known in the art, 1) as an entirely metallic piece, made of surgical stainless steel, or another biocompatible, high-strength metal alloy, such as described for the cannulated guide rod (28) or 2) have the same characteristics as those described for the disposable fasciotome, with the difference that biocompatible, plastic or other non-metallic material must be able to withstand high temperatures repeatedly, as it happens during repeated sterilization processes. Structural Parts and Preferred Dimensions:
    The remaining structural parts of the cutting knife / fasciotome (41) and their preferred dimensions, which can be changed for reasons of convenience of industrial manufacture or to adjust to the surgeon's ergonomic conditions without this meaning that we are facing a new instrument: AXLE OR ROD
    With a bend of approximately 90 °, it can be coupled to any suitable type of cable, as described above, with the following dimensions and preferred morphological characteristics:
    Curvature angle: parallelepiped and quadrangular section and the following preferred dimensions:. Length: 30 to 60 mm. Height and width: 5 mm
    After the angle of curvature: pyramidal in shape and quadrangular proximal section, in continuity with the preceding portion of the stem, tapering towards its distal end, assuming a pyramidal shape, flattened on the transverse axis, with height greater than width, with the following Preferred dimensions: Total length: 30 to 50mm Height: at the angle of curvature: 3 to 5mm; at the distal end: 2-3mm Width: at the angle of curvature: 3 to 5mm; at the distal end: 1-2mm. DISTAL END (HEAD; FRONT) / (BLADE PORTION; BLADE)
    This end consists of: 1) A blade holder with two solid finger-shaped tips (22; 23) at the end, which extends forward above and below the blade, symmetrically, for a distance, in a preferred mode, from approximately 6mm in relation to the most distal edge of the blade. Alternatively, the lower end of the blade may be flat or rounded at the end, extending below the blade by the same distance. 2) A trapezoidal blade (Fig. 12) connected to the opposite end of the head portion, contained between the two ends mentioned above, with the distal cutting edge sharp, preferably concave or in the shape of a "V" ("fish mouth") "), with the following recommended dimensions:. Maximum length: 14mm. Length in the concavity (most posterior point): 10mm. Height: 2 - 2mm. Width: 1 - 2.5mm
    It is recommended that the distal sharp cutting edge be moderately but not excessively sharp, in order to cut easily through the antebrachial fascia (405 A), but with a certain degree of resistance, helping the surgeon to feel the cut that is doing. 3) At the end of each of the two finger-shaped tips, a metal sphere (42) with the preferred size of approximately 2mm is placed, preferably eccentrically, outwards, in order to do not decrease the width of the blade portion. Alternatively, the spheres can be centrally connected at the tip end, as long as the space between them is at least 2mm. This width is not as critical as in the case of the transverse carpal fasciotome with a straight axis (25) because the purpose of this knife is to cut blindly through the distal antebrachial fascia, which is no more than imm thick in adults. Thus, a blade width of 2 to 3 mm is suitable for this instrument.
    The purpose of these spheres is to increase the lack of cut at the end of the tips that surround the blade, making it virtually impossible for the instrument to cut through the fascia in any direction other than that planned (vertically upwards, parallel to the longitudinal axis of the forearm). GUIDE CANNula (40) (Fig. 17)
    A guide cannula (40) with a fenestrated distal end and an open proximal end, the cannula provided with a longitudinal slit (39) extending from a point adjacent to the cannulated distal end to a point adjacent to the open proximal end. The cannula may have an internal cross-section in the shape of C or D with the flat part of the shape of the C or D being located along the edge of the longitudinal slit.
    This tip-tipped cannula-guide with a slit is a modification of a slit-tube cannula, as described below: a) Includes a fenestration - circular hole (33A) at the front end of the cannula in the preferred embodiment, with approximately 1.5-2mm in diameter in order to allow the passage of the flexible metallic needle (33) already mentioned here. b) In a preferred embodiment, there is also a metal restraining arc or brake arc (37) that extends approximately 2mm above the level of the inner edge of the cannula and with a diameter of approximately Imm, and connected approximately 3mm proximal to the inner edge distal end of said cannula. This brake arc helps to remove soft tissues below the transverse carpal ligament (106) during insertion of said cannula (40) and increases the surgeon's manual sensitivity to the subsurface of said ligament (106). It helps to restrict the final advancement of the blade (21) of said fasciotome (25), being another element that prevents the blade from undesirable deviations towards the palm. c) At the open distal end of said cannula (40), a pair of handles (38) is attached, each with the general shape of a semicircle folded in half at an angle of 90 °, forming two L-shaped sheets , of which the horizontal is connected to said axis of said cannula, with the preferred dimensions of approximately 25mm in height and 25mm in width and, in a preferred embodiment, fenestrated with multiple round holes, like a net. The L-shaped configuration allows the instrument to be grasped comfortably and safely, with either hand of the operator. The "network" morphology significantly reduces the weight of the part; multiple fenestrations make the instrument lighter. Surgical procedure
    An explanation of the operative technique, including aspects of the invention of the method and devices disclosed herein, is achieved by describing the steps of the method with reference to the drawings and instruments.
    After the patient has been anesthetized and the extremity is properly prepared and the surgical fields are placed, first, several landmarks are identified and marked as illustrated in Fig. 1, that is: 1) the pisiform bone (105) (where the proximal ulnar connection is located) the transverse carpal ligament (LTC)); 2) from the distal tendon of the Palmar Longo muscle (104) at the level of the distal palmar fold of the wrist; 3) the Kaplan cardinal line (207) and; 4) two lines (202; 203) as a continuation, respectively, of the radial and ulnar edges of the ring finger. The Kaplan cardinal line is drawn, as described in a classic way, from the apex of the interdigital space between the thumb and the index finger, towards the ulnar side of the hand, parallel to the proximal palmar fold. The intersection of this line (207) with the continuation line of the ulnar border of the ring finger (203) corresponds to the apophysis of the unciform bone (that is, the distal ulnar connection of the LTC). The area between the two continuation lines of the ring finger (202) and (203) is considered to be a "safety zone" where the transverse carpal ligament (LTC) can be divided with minimal risk to the underlying structures.
    As usual, a transverse incision of one centimeter (305) is made over the distal palmar fold of the wrist, starting one or two millimeters radial to the medial edge of the Long Palmar tendon (104), whenever present, extending in the ulnar direction . Only the skin is cut with a sharp instrument. This avoids causing any iatrogenic injury to the underlying structures, that is, to the superficial palmar branch of the median nerve radially and medially to the ulnar vessels and nerve. The skin is retracted with hooks as shown in Fig. 2 (401; 401A) and further dissection is performed bluntly with thin dissecting scissors (not shown). Some subcutaneous fat and superficial fibers of the antebrachial fascia are present. These are split and retracted (not shown). Any deeper fat that appears in the operative field is cut and removed to the point necessary for a clear view of the deep antebrachial fascia or carpal ligament (not shown). Otherwise, the fat is simply retracted proximally and distally into the palm.
    With the wrist slightly extended, the area that corresponds to the junction of the distal edge of the carpal ligament (405A) and the proximal edge of the transverse carpal ligament (405) is raised with a pair of fine forceps (406) and is sectioned transversely. and, optionally, also vertically, creating a diamond-shaped defect, with an extension similar to that made on the skin.
    A blunt curved dissector, for example, of the MacDonald type (not shown) is first passed proximally under the antebrachial fascia (405A) to separate any adhesions, specifically, from the median nerve to that fascia, followed by a blunt nail with a diameter of 4mm, cannula inserter or round plug (not shown) to further verify that a clear passage has been established. As soon as it is found that the instruments mentioned above can pass freely into the proximal forearm, the curved-axis fasciotome at an angle of 90 ° (41) is brought to the surgical field and its cutting edge is positioned so that it rides the distal palmar ligament of the carpus. The ligament is bluntly cut by the length of about two centimeters, pushing the knife proximally, parallel to the main axis of the forearm as illustrated in Fig. 3. There is no need for visual control of the cut since the two spheres (32) in the the tip of the finger-shaped tips (best seen in Fig. 16) prevent the knife from coming off the ligament.
    Then, the same maneuver is repeated distally. The blunt curved dissector and blunt stem (601) are passed under the LTC after the distal edge of the ligament, as shown in Fig. 4A and B, as can be seen by the surgeon's manual feeling of the position of the tip of the instrument under the ligament , in addition to the protrusion of the same blunt tip in the palm area distal to the marked Kaplan cardinal line (207). This sensation can be reinforced by the digital pressure by the contralateral finger against the palm over the protruding instrument area (not shown).
    Once the surgeon is sure that the passage under the LTC (106) is free of adhesions, the curved tip cannulated guide rod (27) is passed in the same way under the deep surface of the said ligament in the "safety area" "between the two referred lines extending proximally from the edges of the ring finger, to a point, more or less, 5mm after the distal edge of the ligament, as illustrated in Fig. 4A and C. This is to compensate for the distance between the ends from the tips of the fasciotome to the transverse ligament of the straight-axis carpus (25) and its cutting edge.
    The depth of penetration of the guide rod (27) can be calculated objectively using the laser marks on the concave surface of the rod (607) (best seen in Fig. 4C). The surgeon should check which laser mark is closest to the distal edge of the surgical incision (305). These marks are also useful to indicate, at all times, in which direction the tip of the nail is pointing.
    Once again, manual digital sensation should be used. A blunt trowel (706) is placed on the skin of the palm, pressing immediately distal to the felt tip of the curved tip cannulated guide rod (27) and, with the help of an assistant, a flexible metallic needle (33) (CONMED / Linvatec: Doubled Armed Suture Needle, REF 8535), is advanced through the lumen of the stem until its sharp point protrudes through the skin of the palm, as shown in Fig. 5A and B. The surgeon should note that the tip of the the needle is, in fact, positioned in the "safety zone", in line with the ring finger and less than 10mm distal from the marked Kaplan cardinal line. Otherwise, the surgeon must remove the needle, reposition the cannulated guide rod with a curved tip and try again.
    As soon as the surgeon is satisfied with the position of the needle, the said guide rod (27) is removed and the fasciotome for the transverse ligament of the straight carpus (25) comes into action as illustrated in Fig. 6. The surgeon can start by placing the flat fasciotome on top of the palm, so that the cutting edge of the blade (21) is in close proximity to the flexible metal guide wire (33) at the exact point where it protrudes through the skin (not illustrated). Fenestration on the fasciotome axis that is closest to the distal edge of the surgical incision (305) will also provide the surgeon with an estimate of the fasciotome length that must be introduced through the LTC (106) to obtain a complete cut. Through this fenestration, the surgeon can introduce a metal device, such as a piece of wire (810) or simply a thin hypodermic needle, for example 23G, loosely bent around the axis of the fasciotome, as shown in Figures 6 and 7. This will serve as a guide for the surgeon not to introduce the fasciotome into the palm beyond the marked point, as illustrated in Fig. 8A, B and C, thereby avoiding iatrogenic injuries to any hand structures distal to the distal edge of the LTC (106), specifically the superficial arterial palmar arch (not shown).
    The next step is to feed the flexible metal guide needle through the lumen of the finger-shaped cannulated tip (20) as shown in Fig. 6. Then, the tips are oriented so that the edge of the fasciotome blade rides proximal edge of the ligament as shown in Fig. 7. The upper tip with its sphere at the end (32) must be placed, precisely, under direct view, on top of the proximal edge of the ligament; the lower part of the blade end should also be placed precisely, under direct view, under the ligament subsurface. This is a critical step in the surgical technique.
    As soon as the surgeon is absolutely sure of the position of the fasciotome's blade in relation to the edge of the LTC, the flexible metal guide needle (33) must be put under tension, with the aid of an assistant, pulling it in opposite directions with , for example, strong needle clamps (not shown). At this point, it is also useful if the surgeon slightly raises the needle to push it against the ligament subsurface. By this maneuver the hand is placed in a neutral and slightly extended position. The fasciotome (25), under the direction of said needle (33) is then pushed all the way through the ligament, cutting it, until its distal tip contacts the deep surface of the palmar skin as shown in Fig. 8A, B and C. In addition, at the end of this maneuver, the thread marker should be at the level of the proximal edge of the LTC, as shown in Fig.8-A.
    Optionally, before introducing the knife (25), the cannulated-tipped cannula with slits (40) can be advanced first along the flexible metal guide needle (33) into the palm of the hand, until the its end contacts the subsurface of the skin, at the point where the needle passes through the skin of the palm, from the bottom to the surface. The rationale for this alternative is to increase safety more, the cannula protecting the tissues below the LTC (106). After the slotted cannula (40) is in position, the fasciotome (25) under the direction of the flexible metal guide needle (33) fed through its lower cannulated finger-shaped tip (20), as described above, is slid over the longitudinal slit of the cannula, as shown in Fig. 9-C, along the entire length through the LTC as shown in Fig. 9-D.
    After the LTC is cut, we remove the instruments and do a routine check to certify and document that the ligament has been completely divided. To this end, we lift the palmar skin and its underlying fat pad with a lift (not shown) and insert an endoscope with a 0 ° viewing angle into the wound (not shown). If there is any doubt about any remaining fibers in the distal part of the ligament then we insert (not shown) under direct view of the endoscope, a Stephenson knife and cut those more distal fibers. Otherwise, only one photo is taken for documentation purposes. The palmar skin is closed with two or three absorbable stitches (not shown) and the hand is bandaged appropriately.
    权利要求:
    Claims (15)
    [0001]
    1. Set of surgical instruments for precision cutting, comprising at least one fasciotome (25) comprising a portion of the blade, included in the axis, with the blade (21) protected at its ends by blunt fingers (22, 23), an upper or an upper and a lower that protrude out of the blade, in such a way that the flexible guidewire needle (33) is suitable to guide the blade portion of the fasciotome (25) during the process cutting and characterized by the fact that it comprises an elongated axis in which the distal-front end has at least one cannulated tip in the shape of a finger (20, 24), at the lower distal end of the fasciotome (25), adapted to allow the passage a flexible metal guide needle (33).
    [0002]
    2. Set of surgical instruments according to claim 1, characterized by the fact that it also includes a cannulated guide rod (27) that has means (28, 29, 30, 31) to allow the passage and guide the wire needle flexible guide (33) that will guide the portion of the fasciotome blade (25) during the cutting process.
    [0003]
    3. Set of surgical instruments according to claim 1 or 2, characterized by the fact that the fasciotome (25) comprises a blunt upper tip in the form of a finger (23) projected less distally than its similar (22) and, at least At least one metal sphere (32) is connected to the end of the upper blunt finger-shaped tip (23).
    [0004]
    4. Set of surgical instruments according to any one of claims 1, 2 or 3, characterized in that the cannulated tip in the shape of a finger (20, 24) of the fasciotome (25) is connected to the right or left side of the lower end distal part of the fasciotome (25).
    [0005]
    5. Set of surgical instruments according to any one of claims 1, 2, 3 or 4, characterized in that the fasciotome (25) has two cannulated, parallel, finger-shaped tips (20; 24) and a solid tip , central, blunt, finger-shaped (22).
    [0006]
    6. Set of surgical instruments according to any one of claims 1, 2, 3 or 4, characterized in that the fasciotome (25) comprises guide holes (26) in the axis on at least two of its edges or faces, located at an equal distance from each other, and at a known distance from the distal end of the fasciotome (25).
    [0007]
    7. Set of surgical instruments according to any one of claims 1, 2, 3, 4, 5 or 6, characterized in that the fasciotome (25) comprises a proximal handle (34) with a longitudinal axis and a concavity facing outside the axis, connected to it so that it does not protrude below the bottom surface of said axis.
    [0008]
    Surgical instrument set according to any one of claims 1, 2, 3, 4, 5, 6 or 7, characterized in that the fasciotome (25) comprises spheres (32) up to the upper blunt point in the form of a finger (23) at the distal end with a portion of the blade (21).
    [0009]
    Surgical instrument set according to any one of claims 1, 2, 3, 4, 5, 6, 7 or 8, characterized in that it comprises a fasciotome (41) with a main axis bent at an angle of 90 ° , with blunt top and bottom fingers in the form of fingers (42), in their preferred modality, having a metal sphere connected to the end with a diameter of at least 2mm.
    [0010]
    10. Set of surgical instruments according to any one of claims 1, 2, 3, 4, 5, 6, 7, 8 or 9, characterized by the fact that it also includes a guide cannula (40) which has means (37, 39) to allow passage and guide a flexible guidewire needle (33) to guide the portion of the fasciotome blade (25) during the cutting process.
    [0011]
    11. Set of surgical instruments according to the previous claim, characterized in that the guide cannula (40) is a straight, elongated cannula, having a closed distal end and an open proximal end, and a longitudinal slit (39) capable to accommodate a flexible guidewire needle (33) and guide the fasciotome (25), where said open proximal end of said cannula has at least two handles on the end side (38), and said distal end of said cannula it is fenestrated, through a hole (33A) that allows the passage of the flexible metal guide needle (33).
    [0012]
    12. Set of surgical instruments according to claim 11, characterized by the fact that the guide cannula (40) has a semicircular restriction metal arch or brake arch (37).
    [0013]
    13. Set of surgical instruments according to claim 10, characterized in that the guide cannula (40) has a longitudinal slot (39) to accommodate the flexible metal guide needle (33) and has handles (38) on the lateral end to hold the cannula (40).
    [0014]
    14. Set of surgical instruments according to any one of claims 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 or 13, characterized in that the cannulated guide rod 5 (27) comprise a cannulated cylindrical rod (28) with two open ends, of which the distal end is curved (29).
    [0015]
    15. Set of surgical instruments according to any of claims 2, 3, 4, 5, 6, 7, 8, 9, 10 10, 11, 12, 13 or 14, characterized by the fact that the cannulated guide rod ( 27) understand, at the most distal edge, a curved tip with a protuberance, like a tooth or nail (30; 31) and on the axis, on the side of the concave of the curve, an engraved metric scale (28).
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    同族专利:
    公开号 | 公开日
    CN103153215A|2013-06-12|
    JP2013534166A|2013-09-02|
    CN103153215B|2016-11-23|
    CA2808480A1|2012-02-23|
    US9782192B2|2017-10-10|
    PT2605714T|2017-09-12|
    IL224712A|2016-11-30|
    MX352235B|2017-11-15|
    AU2010359164B2|2016-05-12|
    WO2012023006A1|2012-02-23|
    JP5768130B2|2015-08-26|
    BR112013003719A2|2016-08-23|
    DK2605714T3|2017-09-18|
    KR101756773B1|2017-07-12|
    MX2013001920A|2013-06-05|
    ES2641489T3|2017-11-10|
    KR20130099031A|2013-09-05|
    EP2605714B1|2017-06-28|
    CA2808480C|2017-10-24|
    EP2605714A1|2013-06-26|
    PT105255A|2012-02-20|
    US20130144318A1|2013-06-06|
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    法律状态:
    2019-01-08| B06F| Objections, documents and/or translations needed after an examination request according art. 34 industrial property law|
    2019-07-23| B06U| Preliminary requirement: requests with searches performed by other patent offices: suspension of the patent application procedure|
    2020-01-21| B06A| Notification to applicant to reply to the report for non-patentability or inadequacy of the application according art. 36 industrial patent law|
    2020-05-19| B09A| Decision: intention to grant|
    2020-10-06| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 10/12/2010, OBSERVADAS AS CONDICOES LEGAIS. |
    优先权:
    申请号 | 申请日 | 专利标题
    PT105255A|PT105255A|2010-08-18|2010-08-18|SURGICAL CUTTING INSTRUMENT FOR PRECISION CUTTING|
    PT105255|2010-08-18|
    PCT/IB2010/055721|WO2012023006A1|2010-08-18|2010-12-10|Surgical set of instruments for precision cutting|
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