Suturing and anchoring instrument matched with temporomandibular arthroscope and use method of suturing and anchoring instrument

Abstract

The invention provides a suturing and anchoring instrument matched with a temporomandibular arthroscope and a using method of the suturing and anchoring instrument. The instrument comprises a suturing needle and an anchoring device. The anchoring device comprises a device body part which is in a cylindrical shape with two through ends; the device head part is arranged at one end of the device body part and comprises a porous shell connected to one end of the device body part, and a thin film layer used for wrapping holes in the porous shell is arranged on the porous shell; the porous shell is filled with the temperature-sensitive gel layer, and the temperature-sensitive gel layer can be expanded in a body temperature environment and becomes a colloidal solid state; the movable rod penetrates through the device body part, one end of the movable rod extends into the porous shell, and the other end of the movable rod extends out of the device body part; and the anchoring body wraps the periphery of the porous shell and is provided with a first anchoring line and a second anchoring line. External auditory canal surgical incisions are reduced, minimally invasive surgery can be achieved, and after the anchoring device is screwed into the back slope of the glenoid fossa and solidified, the joint disc can be reset, anchored and fixed only by using a suture needle with a thread to penetrate through the joint disc twice and knotted and fixed.

Description

Technical Field

[0001] The present application relates to the technical field of temporomandibular arthroscopy medical devices, and in particular to a suturing and anchoring device for a temporomandibular arthroscopy and a method of using the same. Background Art

[0002] In the clinical diagnosis and treatment of oral and maxillofacial surgery, disc reduction surgery is more common in the field of temporomandibular joint repair. It mainly refers to restoring the displaced temporomandibular joint disc to its normal physiological position and fixing it to the surrounding tissues of the temporomandibular joint with sutures to achieve the purpose of disc reduction and fixation.

[0003] Disc reduction surgery includes open disc reduction surgery and arthroscopic disc reduction surgery. Currently, open temporomandibular disc reduction, fixation and anchoring surgery are mainly used in clinical practice. On the one hand, open temporomandibular disc reduction surgery mainly refers to directly cutting the affected part of the temporomandibular joint, loosening the displaced anterior disc attachment, resetting the displaced disc tissue to the normal position, and fixing the disc tissue with sutures. The fixation of the disc includes disc anchoring with anchoring nails and soft tissue suture fixation without anchoring nails. On the other hand, the currently common arthroscopic disc reduction surgery is to observe the internal structure of the joint with the help of an arthroscopic imaging system, loosen the anterior disc attachment and reduce the disc through the surgical operation channel, and suture and fix the disc to the external auditory canal cartilage with the help of surgical sutures. In addition to the three arthroscopic channel incisions in the joint area, this method also involves an incision in the external auditory canal.

[0004] Due to the lack of suitable auxiliary anchoring instruments and operation methods for temporomandibular arthroscopic disc anchoring surgery, temporomandibular arthroscopic disc anchoring surgery has not been realized so far. In recent years, minimally invasive maxillofacial surgery has put forward higher requirements on the clinical surgical methods and instruments of oral surgeons. Therefore, those skilled in the art are in urgent need of realizing temporomandibular arthroscopic disc reduction and fixation with less surgical incision, stable fixation and convenient operation. Summary of the invention

[0005] In order to improve the problem of lack of temporomandibular arthroscopic lower disc reduction surgical instruments with fewer surgical incisions, stable fixation and convenient operation, the present application provides a suturing and anchoring instrument for a temporomandibular arthroscopy and a method of using the same.

[0006] In the first aspect, the present application provides a suturing and anchoring instrument for a temporomandibular arthroscopy, which adopts the following technical solution: A suturing and anchoring device for a temporomandibular arthroscopy, comprising a suturing needle and an anchoring device; The anchoring device comprises: The device body is in the shape of a cylinder with two ends connected; The device head is arranged at one end of the device body, and comprises: A porous shell connected to one end of the device body, on which a film layer for covering the holes on the porous shell is provided; A thermosensitive gel layer is filled in the porous shell, and the thermosensitive gel layer can expand and become a gelatinous solid under body temperature; A movable rod is inserted into the device body, one end of which extends into the porous shell and the other end of which extends outside the device body; and The anchor body is wrapped around the outer periphery of the porous shell and has a first anchor line and a second anchor line thereon.

[0007] Furthermore, the material of the thermosensitive gel layer is a combination of one or more of poloxamers, poly-N-isopropylacrylamide, polyethylene glycol-polyester, and chitosan / cellulose; The temperature-sensitive gel layer is in a gel state below 37°C.

[0008] Furthermore, the length of the first anchoring line is greater than that of the second anchoring line, and the two are arranged on both sides of the anchor body.

[0009] Furthermore, the holes on the porous shell are opened at the end and the peripheral side thereof, and the anchor body wraps and covers all the holes on the porous shell.

[0010] Furthermore, the anchor body is an anchoring coil formed by winding absorbable or non-absorbable suture thread.

[0011] Furthermore, the anchoring body is made of chitosan and is a material that can undergo a solid-liquid chemical reaction with the thermosensitive gel layer to solidify.

[0012] Furthermore, the anchoring device further comprises: A device handle connected to an end of the device body away from the device head; The end of the handle is fixedly connected to one end of the movable rod extending out of the device body.

[0013] Furthermore, the suture needle comprises a suture needle head, a suture needle body and a suture needle handle which are connected in sequence, and a groove is arranged on one side of the suture needle head.

[0014] Furthermore, the suture needle head is integrally formed with a front baffle and a rear baffle on both side walls of the groove along the length direction of the suture needle, and there is a gap between the front baffle and the rear baffle for the first anchoring line to pass through.

[0015] In a second aspect, the present application provides a method for using a suturing and anchoring device for a temporomandibular arthroscopy, based on the above-mentioned suturing and anchoring device for a temporomandibular arthroscopy, comprising the following steps: S1. After the intraoperative anesthesia takes effect, three channels of the temporomandibular arthroscopy are established from front to back, namely the surgical operation cannula channel, the irrigation-flushing channel, and the imaging system channel; S2. Under the observation of the imaging system, the anterior attachment release of the articular disc and the reduction of the articular disc body are performed using arthroscopic auxiliary instruments; S3. Take the electric drilling instrument that comes with the arthroscope, insert it through the surgical operation sleeve channel, and place the head of the instrument against the bone on the posterior bevel of the fossa. After mechanical drilling on the posterior bevel of the fossa, withdraw the drilling instrument from the surgical operation sleeve channel. At this time, a hole slightly larger than the diameter of the head of the device is formed on the posterior bevel of the fossa. S4. Insert the anchoring device through the surgical operation cannula channel, and insert the head of the device into the hole of the posterior oblique surface of the fossa in the posterior-superior direction under observation by the imaging system, and ensure that the ends of the first anchoring line and the second anchoring line are still located outside the surgical operation cannula channel; S5. Push the movable rod forward gradually to generate pressure on the thermosensitive gel layer in the head of the device, causing the film layer outside the hole of the porous shell to rupture, and the thermosensitive gel layer then seeps out of the porous shell and enters the anchor body; under the body temperature environment, the thermosensitive gel layer gradually expands from a liquid state and solidifies into a solid state, so that the anchor body is fixed in the hole on the posterior slope of the joint socket, and the first anchoring line and the second anchoring line outside the surgical operation sleeve channel are pulled to determine whether the anchor body has been successfully fixed; S6. Use the suture needle to pass the longer first anchoring line through the posterior disc band twice, and tie a knot with the second anchoring line to fix it.

[0016] In summary, the present application includes at least one of the following beneficial technical effects: 1. It can realize the temporomandibular arthroscopic disc reduction and anchoring, which is more stable than the fixation of sutures to the external auditory canal cartilage tissue in conventional arthroscopic disc reduction and fixation, and can effectively reduce the recurrence rate of anterior disc displacement after surgery; 2. Compared with conventional arthroscopic disc reduction and fixation, the surgical incision of the external auditory canal is reduced, which further achieves the purpose of minimally invasive surgery. At the same time, reducing the incision of the external auditory canal can reduce the chance of postoperative wound infection; 3. The operation is relatively simple. After the anchoring device is screwed into the posterior bevel of the articular fossa and solidified, the articular disc can be repositioned and anchored by passing the suture needle and thread through the articular disc twice and tying a knot to fix it. The anchor body, the first anchor line and the second anchor line can be made of absorbable suture lines. There is no need for a second operation to remove the anchor body after the operation, which causes less trauma to the patient and is beneficial to the patient's recovery. BRIEF DESCRIPTION OF THE DRAWINGS

[0017] In order to more clearly illustrate the technical solutions in the present invention or the prior art, the drawings required for use in the embodiments or the description of the prior art will be briefly introduced below. Obviously, the drawings described below are some embodiments of the present invention. For ordinary technicians in this field, other drawings can be obtained based on these drawings without paying creative work.

[0018] Figure 1 is a schematic structural diagram of an anchoring device according to an embodiment of the present application; Figure 2 is a schematic structural diagram of a suture needle according to an embodiment of the present application; Figure 3 It is a schematic diagram of the partial structure of the head of the anchoring device of an embodiment of the present application; Figure 4 It is a schematic diagram of the partial structure of the suture needle head of the suture needle of the embodiment of the present application; Figure 5 It is a schematic diagram of the articular disc being repositioned and fixed using the embodiment of the present application.

[0019] Reference numerals: 11. sewing needle head; 12. sewing needle body; 13. sewing needle handle; 111. front baffle; 112. rear baffle; 113. groove; 21. Device head; 211. Anchor body; 212. Thermosensitive gel layer; 213. Porous shell; 214. First anchor line; 215. Second anchor line; 22. Device body; 221. Movable rod; 23. Device handle; 231. End of the handle. DETAILED DESCRIPTION

[0020] In order to make the purpose, technical solution and advantages of the present invention clearer, the technical solution of the present invention will be clearly and completely described below in conjunction with the drawings of the present invention. Obviously, the described embodiments are part of the embodiments of the present invention, not all of the embodiments. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without creative work are within the scope of protection of the present invention.

[0021] Reference Figure 1 , Figure 2 and Figure 3 The embodiment of the present application discloses a suturing and anchoring instrument for a temporomandibular arthroscopy, which includes a suturing needle and an anchoring device.

[0022] The anchoring device includes: The device body 22 is in the shape of a tube with both ends penetrated.

[0023] The device head 21 is disposed at one end of the device body 22 and includes: The porous shell 213 is connected to one end of the device body 22, and is provided with a film layer (not shown in the figure) for wrapping the holes on the porous shell 213; the holes on the porous shell 213 are opened at its end and surrounding sides, and the anchor body 211 wraps and covers all the holes on the porous shell 213.

[0024] The thermosensitive gel layer 212 is filled in the porous shell 213. The thermosensitive gel layer 212 can expand and become a gel-like solid under body temperature. The material of the thermosensitive gel layer 212 is a combination of one or more of poloxamers, poly (N-isopropylacrylamide), polyethylene glycol-polyesters, and chitosan / cellulose. The thermosensitive gel layer 212 is in a gel-like state below 37°C. In specific settings, 37°C can be used as the lower critical dissolution temperature of the thermosensitive gel layer 212.

[0025] The movable rod 221 is inserted into the device body 22, one end of which extends into the porous shell 213 and the other end of which extends to the outside of the device body 22. The anchor body 211 is wrapped around the outer periphery of the porous shell 213, and has a first anchor line 214 and a second anchor line 215 thereon, wherein the first anchor line 214 is longer than the second anchor line 215, and the two are arranged on both sides of the anchor body 211, and the anchor body 211 should have pores that can allow the gel-like thermosensitive gel in the thermosensitive gel layer 212 to penetrate, and the outer peripheral size of the anchor body 211 is larger than the outer peripheral size of the device body 22.

[0026] In a feasible embodiment, the anchor body 211 is an anchoring coil formed by winding absorbable or non-absorbable suture.

[0027] Therefore, when the temporomandibular arthroscopy imaging device passes through the imaging system channel to the affected area during the operation, the anchoring device can pass through the operating sleeve channel to the affected area, and use arthroscopic auxiliary instruments (such as low-temperature radiofrequency ablators, blunt strippers, surgical scissors, scalpels, etc.) to loosen and reposition the anterior attachment of the articular disc. After the drilling instrument is used to drill a hole, the device head 21 is screwed into the hole on the posterior inclined surface of the fossa, and then the movable rod 221 is pushed so that one end of the movable rod 221 located in the porous shell 213 squeezes the thermosensitive gel layer 212, so that the gel in the thermosensitive gel layer 212 breaks through the thin film layer and penetrates into the anchor body 211 composed of the anchoring wire balls. This part of the gel expands and becomes a gel-like solid under the action of the patient's body temperature, so that the anchor body 211 expands and is clamped in the hole on the posterior inclined surface of the fossa, thereby realizing the anchoring fixation of the first anchor line 214 and the second anchor line 215. The suture needle is used to bring the thread twice to allow the first anchoring line 214 to pass through the articular disc, and the suture needle and clamp are used to tie and fix the first anchoring line 214 and the second anchoring line 215, thereby completing the reduction and fixation of the articular disc.

[0028] Among them, since the anchor body 211, the first anchor line 214 and the second anchor line 215 can be made of absorbable sutures, there is no need for a second operation to remove the anchor body 211 after the operation, which causes less trauma to the patient and is beneficial to the patient's recovery.

[0029] In another feasible embodiment, the anchoring body 211 is made of a chitosan-based material that can undergo a solid-liquid chemical reaction with the thermosensitive gel layer 212 to solidify.

[0030] In this way, when the film layer is broken, the gel seeping out of the thermosensitive gel layer 212 can undergo a solid-liquid chemical reaction with the anchor body 211 and solidify, which can also achieve the effect of fixing the anchor body 211 in the hole on the posterior slope of the articular socket, and can also be used for the reduction and fixation of the articular disc.

[0031] In addition, refer to Figure 1 , the anchoring device also includes: The device handle 23 is connected to the end of the device body 22 away from the device head 21; The handle end 231 is fixedly connected to one end of the movable rod 221 extending outside the device body 22 .

[0032] Therefore, the movable rod 221 can be stably and conveniently controlled by holding the handle 23 of the handheld device and pushing or rotating the handle end 231, making the intraoperative operation simpler.

[0033] And, refer to Figure 2 and Figure 4 The suture needle comprises a suture needle head 11, a suture needle body 12 and a suture needle handle 13 which are connected in sequence. A groove 113 is provided on one side of the suture needle head 11. The suture needle head 11 is formed with a front baffle 111 and a rear baffle 112 on both side walls of the groove 113 along the length direction of the suture needle, respectively. There is a gap between the front baffle 111 and the rear baffle 112 for the first anchoring line 214 to pass through. The suture needle handle 13 and the suture needle head 11 form a bend of about 10°, the groove 113 is provided on the inner arc side, and the length of the suture needle is 8 to 15 cm.

[0034] Therefore, by arranging the front baffle 111 and the rear baffle 112 on the groove 113 of the suture needle head 11, the first anchoring line 214 can be conveniently hooked to perform operations such as puncture, suturing, and knotting.

[0035] The present application also discloses a method for using a suturing and anchoring device for a temporomandibular arthroscopy. Based on the above-mentioned suturing and anchoring device for a temporomandibular arthroscopy, referring to Figure 1 , Figure 2 and Figure 5 , using the following technical solutions: A method for using a suturing and anchoring device matched with a temporomandibular arthroscopy comprises the following steps: S1. After intraoperative anesthesia takes effect, three channels of the temporomandibular arthroscopy are established from front to back, namely the surgical operation cannula channel, the irrigation-flushing channel, and the imaging system channel. The positions of the three channels can be adjusted during the operation.

[0036] S2. Under the observation of the imaging system, use arthroscopic auxiliary instruments to release the anterior attachment of the articular disc and reduce the main part of the articular disc.

[0037] S3. Take the electric drilling instrument that comes with the arthroscopy, insert it through the surgical operation sleeve channel, and place the instrument head against the bone on the posterior inclined surface of the fossa toward the posterior and upper sides. After mechanical drilling on the posterior inclined surface of the fossa, withdraw the drilling instrument from the surgical operation sleeve channel. At this time, a hole slightly larger than the diameter of the device head 21 is created on the posterior inclined surface of the fossa.

[0038] S4. Insert the anchoring device through the surgical operation sleeve channel, and under the observation of the imaging system, insert the device head 21 into the hole on the posterior inclined surface of the joint socket in the posterior-superior direction, and ensure that the ends of the first anchoring line 214 and the second anchoring line 215 are still outside the surgical operation sleeve channel.

[0039] S5. Push the movable rod 221 gradually forward to generate pressure on the thermosensitive gel layer 212 in the device head 21, causing the thin film layer outside the holes of the porous shell 213 to rupture, and the thermosensitive gel layer 212 then seeps out of the porous shell 213 and enters the anchor body 211; under the body temperature environment of 37°C, the thermosensitive gel layer 212 gradually expands from a liquid state and solidifies into a solid state, so that the anchor body 211 is fixed in the hole on the posterior inclined surface of the joint socket, and the first anchor line 214 and the second anchor line 215 outside the surgical operation sleeve channel are pulled to determine whether the anchor body 211 has been successfully fixed.

[0040] S6. The first longer anchor line 214 is passed through the posterior disc band twice with a suture needle and is tied and fixed with the second anchor line 215; Specifically, the rear baffle 112 on the suture needle head 11 is hooked with the thread end of the first anchoring line 214 outside the body, and the suture needle head 11 is inserted from the surgical operation sleeve channel; by pushing the suture needle handle 13 forward, the suture needle head 11 is inserted from the outside of the posterior band of the articular disc and out from the inside; the clamp of the arthroscope is inserted into the irrigation-flushing system channel, and the first anchoring line 214 passing through the inside of the articular disc is clamped with the beak of the clamp and tightened, at which time the first anchoring line 214 is still located in the groove 113 of the suture needle; the suture needle is retracted, the first anchoring line 214 is hooked with the front baffle 111 of the suture needle, and the second anchoring line 215 is clamped with the clamp of the arthroscope, and the clamp and the suture needle cooperate to tie a knot and fix them under the observation of the imaging system, and then the excess anchoring line ends are cut off, and finally the articular disc is repositioned and fixed.

[0041] S7. Gradually withdraw the arthroscopic instruments and suture the arthroscopic three-channel incision to complete the temporomandibular arthroscopic lower disc reduction and anchoring surgery.

[0042] Finally, it should be noted that the above embodiments are only used to illustrate the technical solutions of the present invention, rather than to limit it. Although the present invention has been described in detail with reference to the aforementioned embodiments, those skilled in the art should understand that they can still modify the technical solutions described in the aforementioned embodiments, or make equivalent replacements for some of the technical features therein. However, these modifications or replacements do not deviate the essence of the corresponding technical solutions from the spirit and scope of the technical solutions of the embodiments of the present invention.

Claims

1. A suturing and anchoring device for a temporomandibular arthroscopy, characterized in that: including a suture needle and an anchoring device; The anchoring device comprises: The device body is in the shape of a cylinder with two ends connected; The device head is arranged at one end of the device body, and comprises: A porous shell connected to one end of the device body, on which a film layer for covering the holes on the porous shell is provided; A thermosensitive gel layer is filled in the porous shell, and the thermosensitive gel layer can expand and become a gelatinous solid under body temperature; A movable rod is inserted into the device body, one end of which extends into the porous shell and the other end of which extends outside the device body; and The anchor body is wrapped around the outer periphery of the porous shell and has a first anchor line and a second anchor line thereon.

2. A suturing and anchoring device for a temporomandibular arthroscopy according to claim 1, characterized in that: The material of the thermosensitive gel layer is a combination of one or more of poloxamers, poly-N-isopropylacrylamide, polyethylene glycol-polyester, and chitosan / cellulose; The thermosensitive gel layer is in a gel state below 37°C.

3. The suturing and anchoring device for temporomandibular arthroscopy according to claim 1, characterized in that: The length of the first anchoring line is greater than that of the second anchoring line, and the two are arranged on both sides of the anchor body.

4. The suturing and anchoring device for temporomandibular arthroscopy according to claim 1, characterized in that: The holes on the porous shell are opened at the end and the peripheral side thereof, and the anchor body wraps and covers all the holes on the porous shell.

5. A suturing and anchoring device for a temporomandibular arthroscopy according to any one of claims 1 to 4, characterized in that: The anchoring body is an anchoring coil formed by winding absorbable or non-absorbable suture thread.

6. A suturing and anchoring device for a temporomandibular arthroscopy according to any one of claims 1 to 4, characterized in that: The anchoring body is made of chitosan and can undergo solid-liquid chemical reaction with the temperature-sensitive gel layer to solidify.

7. The suturing and anchoring device for temporomandibular arthroscopy according to claim 1, characterized in that: The anchoring device also includes: A device handle connected to an end of the device body away from the device head; The end of the handle is fixedly connected to one end of the movable rod extending out of the device body.

8. The suturing and anchoring device for temporomandibular arthroscopy according to claim 1, characterized in that: The suture needle comprises a suture needle head, a suture needle body and a suture needle handle which are connected in sequence, and a groove is arranged on one side of the suture needle head.

9. The suturing and anchoring device for temporomandibular arthroscopy according to claim 1, characterized in that: The suture needle head is integrally formed with a front baffle and a rear baffle on both side walls of the groove along the length direction of the suture needle, and a gap is provided between the front baffle and the rear baffle for the first anchoring line to pass through.

10. A method for using a suturing and anchoring device for a temporomandibular arthroscopy, based on the suturing and anchoring device for a temporomandibular arthroscopy as claimed in any one of claims 1 to 9, characterized in that: The following steps are involved: S1. After the intraoperative anesthesia takes effect, three channels of the temporomandibular arthroscopy are established from front to back, namely the surgical operation cannula channel, the irrigation-flushing channel, and the imaging system channel; S2. Under the observation of the imaging system, the anterior attachment release of the articular disc and the reduction of the articular disc body are performed using arthroscopic auxiliary instruments; S3. Take the electric drilling instrument that comes with the arthroscope, insert it through the surgical operation sleeve channel, and place the head of the instrument against the bone on the posterior bevel of the fossa. After mechanical drilling on the posterior bevel of the fossa, withdraw the drilling instrument from the surgical operation sleeve channel. At this time, a hole slightly larger than the diameter of the head of the device is formed on the posterior bevel of the fossa. S4. Insert the anchoring device through the surgical operation cannula channel, and insert the head of the device into the hole of the posterior oblique surface of the fossa in the posterior-superior direction under observation by the imaging system, and ensure that the ends of the first anchoring line and the second anchoring line are still located outside the surgical operation cannula channel; S5. Pushing the movable rod forward gradually to generate pressure on the thermosensitive gel layer in the head of the device, causing the film layer outside the holes of the porous shell to rupture, and the thermosensitive gel layer then seeps out of the porous shell and enters the anchor body; Under body temperature, the thermosensitive gel layer gradually expands from liquid to solid, so that the anchor is fixed in the hole on the posterior slope of the joint socket. The first anchor line and the second anchor line outside the surgical operation sleeve channel are pulled to determine whether the anchor has been successfully fixed. S6. Use the suture needle to pass the longer first anchoring line through the posterior disc band twice, and tie a knot with the second anchoring line to fix it.

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