A suture and anchor instrument for use with a temporomandibular joint arthroscope and methods of use

Abstract

The application provides a suture and anchoring device matched with a temporomandibular joint arthroscope and a use method thereof. The device comprises a suture needle and an anchoring device. The anchoring device comprises a device body in a through barrel shape, and a device head arranged at one end of the device body. The device head comprises a porous shell connected to one end of the device body, a film layer arranged on the porous shell for wrapping the holes of the porous shell, a temperature-sensitive gel layer filled in the porous shell, the temperature-sensitive gel layer being inflatable and changed into a gel solid state in a body temperature environment, a movable rod arranged in the device body, one end of the movable rod extending into the porous shell and the other end extending out of the device body, and an anchoring body wrapped around the outer periphery of the porous shell, the anchoring body being provided with a first anchoring line and a second anchoring line. The application reduces the surgical incision of the external auditory canal, realizes minimally invasive surgery, and after the anchoring device is screwed into the posterior slope of the joint socket and is coagulated, only two times of passing through the articular disc by the suture needle with a line and knot fixing are needed to complete the articular disc reduction and anchoring fixation.

Description

Technical Field

[0001] The present application relates to the technical field of temporomandibular arthroscopic medical devices, and in particular to a suturing and anchoring device for a temporomandibular arthroscopic device and a method for 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 anterior attachment of the displaced disc, and resetting the displaced disc tissue to its normal position, and using sutures to fix the disc tissue. The fixation of the disc includes disc anchoring with the help of anchoring nails and soft tissue suture fixation without the help of 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, and to loosen the anterior attachment of the disc and reduce the disc through the surgical operation channel, and to 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 surgical methods, temporomandibular arthroscopic disc anchoring surgery has not been possible to date. In recent years, minimally invasive maxillofacial surgery has placed higher demands on the clinical surgical methods and instruments of oral surgeons. Therefore, those skilled in the art are urgently seeking to achieve temporomandibular arthroscopic disc reduction and fixation with minimal surgical incision, stable fixation, and convenient operation. Summary of the Invention

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

[0006] In a first aspect, the present application provides a suturing and anchoring instrument for use with a temporomandibular arthroscopy, which employs the following technical solutions:

[0007] A suturing and anchoring device for a temporomandibular arthroscopy, comprising a suturing needle and an anchoring device;

[0008] The anchoring device comprises:

[0009] The device body is in the shape of a cylinder with two ends connected;

[0010] The device head is provided at one end of the device body and includes:

[0011] A porous shell connected to one end of the device body, provided with a film layer for covering the holes of the porous shell;

[0012] A thermosensitive gel layer is filled in the porous shell, and the thermosensitive gel layer can expand and become a gel-like solid under body temperature;

[0013] a movable rod, which is inserted into the body of the device, with one end of the movable rod extending into the porous shell and the other end extending outside the body of the device; and

[0014] The anchoring body is wrapped around the outer periphery of the porous shell and has a first anchoring line and a second anchoring line.

[0015] Furthermore, the material of the thermosensitive gel layer is a combination of one or more of poloxamers, poly (N-isopropylacrylamide), polyethylene glycol-polyesters, and chitosan / cellulose;

[0016] The temperature-sensitive gel layer is in a gel-like state below 37°C.

[0017] 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.

[0018] 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.

[0019] Furthermore, the anchoring body is an anchoring coil formed by winding absorbable or non-absorbable suture thread.

[0020] Furthermore, the anchoring body is made of chitosan and is a material that can undergo a solid-liquid chemical reaction with the temperature-sensitive gel layer to solidify.

[0021] Furthermore, the anchoring device further comprises:

[0022] a device handle connected to an end of the device body away from the device head;

[0023] The end of the handle is fixedly connected to the end of the movable rod extending outside the device body.

[0024] Furthermore, the suture needle includes a suture needle head, a suture needle body and a suture needle handle which are connected in sequence, and a groove is provided on one side of the suture needle head.

[0025] 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.

[0026] 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:

[0027] S1. After intraoperative anesthesia takes effect, establish three channels for the temporomandibular arthroscopy from front to back: the surgical cannula channel, the irrigation / flushing channel, and the imaging system channel.

[0028] S2. Under imaging observation, use arthroscopic instruments to release the anterior disc attachments and reduce the disc proper.

[0029] S3. Take the electric drilling instrument that comes with the arthroscope and insert it through the surgical cannula. Position the instrument head posteriorly and upwards against the bone on the posterior bevel of the fossa. After mechanically drilling the posterior bevel of the fossa, withdraw the drilling instrument from the surgical cannula. This creates a hole slightly larger than the diameter of the head of the device on the posterior bevel of the fossa.

[0030] S4. Insert the anchoring device through the surgical cannula. Under observation with the imaging system, insert the head of the device in a posterior-superior direction into the hole on the posterior oblique surface of the glenoid fossa, ensuring that the ends of the first and second anchoring lines remain outside the surgical cannula.

[0031] S5. Push the movable rod gradually forward to exert pressure on the thermosensitive gel layer in the head of the device, causing the thin film layer outside the holes of the porous shell to rupture. The thermosensitive gel layer then seeps out of the porous shell and into the anchor body. Under body temperature, the thermosensitive gel layer gradually expands from a liquid state and solidifies to a solid state, securing the anchor body in the hole on the posterior slope of the glenoid fossa. Pulling the first and second anchoring lines outside the surgical cannula channel can determine whether the anchor body has been successfully secured.

[0032] 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 secure it.

[0033] In summary, this application includes at least one of the following beneficial technical effects:

[0034] 1. It can achieve 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;

[0035] 2. The conventional arthroscopic disc reduction and fixation reduces the external ear canal surgical incision, further achieving the purpose of minimally invasive surgery, and at the same time, reducing the external ear canal incision can reduce the risk of postoperative wound infection;

[0036] 3. The operation is relatively simple. After the anchor device is rotated into the posterior slope of the glenoid cavity and coagulated, only two times of passing through the articular disc with a suture needle and fixing the knot can complete the reduction and fixation of the articular disc. Moreover, the anchor body, the first anchor line and the second anchor line can be made of absorbable suture, so that the secondary surgery for removing the anchor body is not needed, the trauma to the patient is smaller, and the patient's recovery is facilitated. BRIEF DESCRIPTION OF DRAWINGS

[0037] In order to more clearly illustrate the technical solutions in the present application or prior art, the following will briefly introduce the drawings needed to be used in the embodiments or prior art description. Obviously, the drawings in the following description are some embodiments of the present application, and other drawings can also be obtained by those skilled in the art without creative labor.

[0038] Figure 1 is a structural schematic diagram of the anchor device of the embodiment of the present application;

[0039] Figure 2 is a structural schematic diagram of the suture needle of the embodiment of the present application;

[0040] Figure 3 is a partial structural schematic diagram of the device head of the anchor device of the embodiment of the present application;

[0041] Figure 4 is a partial structural schematic diagram of the suture needle head of the suture needle of the embodiment of the present application;

[0042] Figure 5 is a schematic diagram after the articular disc is reduced and fixed by the embodiment of the present application.

[0043] Reference signs:

[0044] 11, suture needle head; 12, suture needle body; 13, suture needle handle; 111, front baffle; 112, rear baffle; 113, groove;

[0045] 21, device head; 211, anchor body; 212, temperature-sensitive gel layer; 213, porous shell; 214, first anchor line; 215, second anchor line;

[0046] 22, device body; 221, movable rod;

[0047] 23, device handle; 231, handle end. DETAILED DESCRIPTION

[0048] To make the objectives, technical solutions, and advantages of the present invention more clear, the technical solutions of the present invention will be clearly and completely described below in conjunction with the accompanying drawings. Obviously, the embodiments described are only some embodiments of the present invention, not all embodiments. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field without making creative efforts shall fall within the scope of protection of the present invention.

[0049] 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.

[0050] The anchoring device includes:

[0051] The device body 22 is in the shape of a cylinder with both ends penetrated.

[0052] The device head 21 is provided at one end of the device body 22 and includes:

[0053] The porous shell 213 is connected to one end of the device body 22 and is provided with a thin 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.

[0054] 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 solution temperature of the thermosensitive gel layer 212.

[0055] The movable rod 221 is inserted into the device body 22, with one end extending into the porous shell 213 and the other end extending outside the device body 22.

[0056] 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.

[0057] In a feasible embodiment, the anchor body 211 is an anchoring coil formed by winding absorbable or non-absorbable suture.

[0058] Therefore, when the temporomandibular arthroscopic 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 the anterior attachment of the articular disc is loosened and reduced using arthroscopic auxiliary instruments (such as a low-temperature radiofrequency ablation device, a blunt dissector, surgical scissors, a scalpel, etc.). After the drilling instrument is used to drill a hole, the device head 21 is screwed into the hole on the posterior slope 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 coil. 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 slope of the fossa, thereby realizing the anchoring fixation of the first anchor line 214 and the second anchor line 215. The first anchoring line 214 is passed through the articular disc by the suture needle and thread twice, and the first anchoring line 214 and the second anchoring line 215 are knotted and fixed by the suture needle and clamp, thereby completing the reduction and fixation of the articular disc.

[0059] 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.

[0060] 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.

[0061] In this way, when the film layer ruptures, 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 fossa, and can also be used for the reduction and fixation of the articular disc.

[0062] In addition, refer to Figure 1 , the anchoring device also includes:

[0063] The device handle 23 is connected to the end of the device body 22 away from the device head 21;

[0064] The handle end 231 is fixed to the end of the movable rod 221 extending outside the device body 22 .

[0065] Thus, the movable rod 221 can be stably and conveniently controlled by holding the handle 23 of the device and pushing or rotating the handle end 231, making the intraoperative operation simpler.

[0066] And, refer to Figure 2 and Figure 4The suture needle includes a needle head 11, a needle body 12, and a needle handle 13 connected in sequence. A groove 113 is provided on one side of the needle head 11. A front baffle 111 and a rear baffle 112 are integrally formed on both side walls of the groove 113 along the length of the suture needle. A gap is provided between the front baffle 111 and the rear baffle 112 for the first anchoring line 214 to pass through. The needle handle 13 and the needle head 11 form a bend of approximately 10 degrees, the groove 113 is provided on the inner arc side, and the suture needle length is 8 to 15 cm.

[0067] Therefore, by arranging the front baffle 111 and the rear baffle 112 on the groove 113 of the needle head 11, the first anchoring line 214 can be conveniently hooked to perform operations such as puncture, suturing, and knotting.

[0068] 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 , adopt the following technical solutions:

[0069] A method for using a suturing and anchoring device for a temporomandibular arthroscopy comprises the following steps:

[0070] S1. After intraoperative anesthesia takes effect, three channels for the temporomandibular arthroscopy are established from front to back: 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.

[0071] S2. Under the observation of the imaging system, use arthroscopic auxiliary instruments to release the anterior attachment of the articular disc and reduce the articular disc body.

[0072] S3. Take the electric drilling instrument that comes with the arthroscope, insert it through the surgical operating sleeve channel, and place the instrument head against the bone on the posterior slope of the fossa toward the posterior and upper part. After mechanically drilling a hole in the posterior slope of the fossa, withdraw the drilling instrument from the surgical operating sleeve channel. At this time, a hole slightly larger than the diameter of the device head 21 is created on the posterior slope of the fossa.

[0073] S4. Insert the anchoring device through the surgical operation sleeve channel, and under the observation of the imaging system, insert the device head 21 in the posterior and superior direction into the hole on the posterior slope of the joint socket, and make sure that the ends of the first anchoring line 214 and the second anchoring line 215 are still outside the surgical operation sleeve channel.

[0074] S5. Push the movable rod 221 forward gradually 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 liquid and solidifies into a solid state, so that the anchor body 211 is fixed in the hole on the posterior oblique 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.

[0075] S6. The first 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;

[0076] 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 into the surgical operation cannula 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 beak of the clamp is used to clamp the first anchoring line 214 passing through the inside of the articular disc and tighten it. At this time, the first anchoring line 214 is still located in the groove 113 of the suture needle; by retracting the suture needle, the front baffle 111 of the suture needle is used to hook the first anchoring line 214, and the clamp of the arthroscope is used to clamp the second anchoring line 215. The clamp and the suture needle cooperate to tie and fix under the observation of the imaging system, and then the excess anchoring line ends are cut off to finally achieve the reduction and fixation of the articular disc.

[0077] S7. Gradually withdraw the arthroscopic instruments and suture the three-port arthroscopic incision to complete the temporomandibular arthroscopic lower disc reduction and anchoring surgery.

[0078] 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 various embodiments of the present invention.

Claims

1. A suturing and anchoring instrument for 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 provided at one end of the device body and includes: A porous shell connected to one end of the device body, provided with a film layer for covering the holes of the porous shell; A thermosensitive gel layer is filled in the porous shell, and the thermosensitive gel layer can expand and become a gel-like solid under body temperature; a movable rod, which is inserted into the body of the device, with one end of the movable rod extending into the porous shell and the other end extending outside the body of the device; and The anchoring body is wrapped around the outer periphery of the porous shell and has a first anchoring line and a second anchoring line.

2. The suturing and anchoring instrument for 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-polyesters, and chitosan / cellulose; The thermosensitive gel layer is in gel form below 37°C.

3. The suturing and anchoring instrument 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 instrument 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 instrument for 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 instrument for 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 instrument for temporomandibular arthroscopy according to claim 1, characterized in that: 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 the end of the movable rod extending outside the device body.

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

9. The suturing and anchoring instrument for temporomandibular arthroscopy according to claim 8, 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.

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