Liquid-guided laser arthroscopic surgery device and use method thereof

Abstract

A liquid guided laser arthroscopic surgery device comprises a laser (1), a central control system (2), a handheld scalpel pen (12), a high-pressure liquid supply system (11), a low-pressure liquid supply system (13), a liquid pumping device (4), an optical fiber (3), a liquid pipeline (14), a liquid supply small hole (17), a liquid supply hose (18) and a joint cavity (23). A coupling cavity (7) is formed in the handheld scalpel pen (12), and a nozzle (9) is arranged at the front end of the handheld scalpel pen (12); and laser emitted by the laser (1) passes through the focusing mirror (5) and the transmitting mirror (6) and forms a coaxially-coupled laser liquid beam (10) with the isotonic normal saline in the coupling cavity (7) in the coupling cavity (7). The invention also claims to protect a method of use of the liquid guided laser arthroscopic surgical device. The operation is intelligent, safe and controllable; the operation application range is wide, and the biological action is accurate; the device is suitable for a non-contact operation mode, the operation process is simplified, the cost is low and the efficiency is high; and the comprehensive technical effect is excellent.

Description

TECHNICAL FIELD

[0001] The present application relates to the field of structural design and application technology of orthopedic minimally invasive surgical instruments, in particular to a liquid-guided laser arthroscopic surgical device mainly suitable for precise resection and ablation of various tissues in arthroscopic surgery of knee joints, shoulder joints and ankle joints and a use method thereof. BACKGROUND

[0002] US 5,902,499A patent granted on May 11, 1999 has clearly described the complete nozzle-focusing light path structure, which is the basic document of liquid-guided laser. The traditional liquid-guided laser arthroscope generally has the following technical defects: 1. Poor tissue selectivity: water beam absorption rate ≈ 0, but the difference in absorption of 1.06 μm by cartilage, tendon and fat is small, resulting in "cutting cartilage also cuts tendon", which is difficult to do hierarchical ablation like radio frequency.

[0003] 2. Heat damage cannot be ignored: although it is called "cold cutting", a heat spot of >55 ℃ can be formed on the target surface within 0.1 s of water beam interruption; animal experiments show that the depth of cartilage cell necrosis is 150-300 μm, which is not much different from traditional side-firing optical fibers.

[0004] 3. Poor water beam stability: pressure fluctuations in the joint cavity (suction blockage, patient position change) make the laminar flow become turbulent instantaneously, the energy density drops sharply, and two extremes of "cutting not moving" or "sudden deepening" appear.

[0005] 4. View obstruction and bubble interference: a large number of microbubbles are generated by pulsed laser instantaneous vaporization of liquid, and if the negative pressure suction is not timely, the lens will be white screen immediately; it needs to be repeatedly removed and wiped, prolonging the operation time.

[0006] 5. Low instrument integration: the existing system needs external laser host, high-pressure pump and negative pressure station, with pipe winding and occupying operating room space; the nozzle is a one-time sapphire with a price of 1500-2000 yuan per set, with a cost much higher than that of radio frequency head.

[0007] Liquid-guided laser arthroscope provides a new energy platform based on the concept of "water beam guidance + coaxial cooling", but is limited by problems such as insufficient tissue selectivity, poor heat-mechanical control precision, and expensive equipment-consumables, and is still at the stage of "high-end supplementary tool", and has not yet formed a dominant alternative to radio frequency and power systems. In summary, the existing arthroscopic surgical instruments have single function, and usually need frequent switching during operation, and the control and processing functions of heat damage and other measures are relatively simple, and the function is insufficient.

[0008] It is urgent to obtain a liquid-guided laser arthroscopic surgery device and its use method which is excellent in technical effect and suitable for precise resection and ablation operation of various tissues in arthroscopic surgery of knee joint, shoulder joint and ankle joint. SUMMARY

[0009] The application provides a liquid-guided laser arthroscopic surgery device and its use method which are mainly suitable for precise resection and ablation operation of various tissues in arthroscopic surgery of knee joint, shoulder joint and ankle joint.

[0010] The technical scheme of the application is as follows: a liquid-guided laser arthroscopic surgery device comprises a laser 1, a central control system 2, a handheld surgical pen 12, a high-pressure liquid supply system 11, a low-pressure liquid supply system 13, a liquid pumping device 4, an optical fiber 3 and a liquid pipeline 14. The handheld surgical pen 12 as the main pipe body of the operator end of the surgery device meets the following requirements: the diameter is 4 mm; the inside is provided with a focusing mirror 5, a transmission mirror 6 and a coupling cavity 7; the front end is provided with a replaceable nozzle 9; the replaceable nozzle 9 is arranged at the liquid outflow outlet of the front part of the coupling cavity 7. The high-pressure liquid supply system 11 is connected with the coupling cavity 7 through the liquid pipeline 14. The laser 1 is fixedly arranged at the end of the handheld surgical pen 12; the laser emitted by the laser 1 is transmitted into the coupling cavity 7 through the optical fiber 3; the laser emitted by the laser 1 and the isotonic physiological saline in the coupling cavity 7 form a coaxial coupling laser liquid beam 10 in the coupling cavity 7; then the laser continues to be emitted to the liquid emission direction through the nozzle 9; then the laser occurs total reflection in the cylindrical liquid water column emitted by the nozzle 9; the laser and the liquid flow are combined into a processing laser liquid beam 10. The liquid in the high-pressure liquid supply system 11 is one of the following or a combination thereof: pure water, physiological saline and bacteriostatic liquid; the liquid pressure emitted by the nozzle 9 is 0.5-3 MPa; the liquid in the low-pressure liquid supply system 13 is one of the following or a combination thereof: pure water, physiological saline and bacteriostatic liquid; the low-pressure liquid supply system 13 is communicated with the handheld surgical pen 12 through a liquid supply hose 18; the liquid supply small hole pressure is 0.1-0.2 MPa; the physiological saline provided by the low-pressure liquid supply system 13 is sprayed into the joint cavity through the liquid supply small hole.

[0011] The liquid-guided laser arthroscopic surgery device provided by the application preferably requires protection of the following technical content: The liquid-guided laser arthroscopic surgery device also meets one of the following requirements or a combination thereof: Firstly, two groups of sealing rings 16 are arranged in the liquid-guided laser arthroscopic surgery device, one group is arranged at the connection between the transmission mirror 6 and the coupling cavity 7, and the other group is arranged at the connection between the coupling cavity 7 and the nozzle 9. Secondly, the liquid-guided laser arthroscopic surgical device is also equipped with a suction device 4 that is compatible with the high-pressure fluid supply system 11 and the low-pressure fluid supply system 13; the high-pressure fluid supply system 11 provides the coupling fluid required for the laser liquid beam, and the low-pressure fluid supply system 13 provides isotonic physiological fluid filling the joint cavity 23; the suction device 4 removes the supplied fluid to maintain the stable fluid pressure in the joint cavity 23; the fluid-filled suction device 4 and the low-pressure fluid supply system 13 are respectively connected to the joint cavity 23; (the joint cavity is the joint part of the human body, in...) Figure 4 This is reflected in the text;) Third, the nozzle 9 has a cylindrical structure with a through hole coaxial with the outer surface arranged in its inner cavity. The diameter of the through hole is 1~2mm. The nozzle 9 is made of one or a combination of the following materials: stainless steel, Peek material, and titanium alloy. Fourth, laser 1 is one of the following: a Ho laser with a wavelength of 2.1 μm; an infrared laser with a wavelength of 1064 nm; or a thulium laser with a wavelength of 1904 nm. Fifth, the central control system 2 has one of the following tissue-specific working modes: soft tissue fine cutting mode, meniscus cartilage resection mode, hyperplastic synovial soft tissue ablation mode, and bone ablation mode.

[0012] The liquid-guided laser arthroscopic surgical device operates in a tissue-specific working mode, which is preset with corresponding laser power parameters, pulse frequency parameters, and isotonic fluid flow rate parameters; it meets one of the following requirements: Firstly, when the liquid-guided laser arthroscopic surgical device is operating in the soft tissue fine incision mode, a 1064nm infrared laser is used with a low power of 5~10W and a water pressure of 0.5MPa to achieve precise and low-damage ablation of the joint skin and muscles, thus establishing a channel for arthroscopic entry. Secondly, when the liquid-guided laser arthroscopic surgical device is operating in the meniscus cartilage resection mode, a 2.1µm Ho laser is used with a medium power of 20~40W, precise pulse, and water pressure of 1~2MPa to achieve precise resection of meniscus cartilage and treat meniscus injury, a major arthroscopic disease. Third, when the liquid-guided laser arthroscopic surgical device is operating in the bone ablation mode, a 2.1μm Ho laser is used with a high power of 40~60W, precise pulses, and a water pressure of 2~3MPa to achieve precise bone cortex ablation and establish a bone tunnel, providing tunnel support for the reconstruction of the anterior cruciate ligament. Fourth, when the liquid-guided laser arthroscopic surgical device is operating in the soft tissue ablation mode of hyperplastic synovium, a 1904nm thulium laser is used with a low power of 5~10W and a water pressure of 1MPa. It is suitable for removing hyperplastic synovium, fat and other soft tissues, as well as laser ablation of synovial bleeding points. The liquid guide laser arthroscopic surgical device, the outer diameter of the handheld surgical pen 12 is less than or equal to 4 mm, The low-pressure liquid supply system 13 is connected with the outer liquid supply hose 18 and the liquid suction hose 19 corresponding to the liquid suction device 4, and the distance between the two and the nozzle 120 is 180 mm, and the handheld surgical pen 12 forms a cross structure, which controls the length of the surgical device entering the joint cavity 23, facilitates the holding and control of the surgical device, and prevents accidental injury caused by the deepening of the surgical device into the joint cavity 23 due to body position changes during the operation.

[0013] The liquid guide laser arthroscopic surgical device, the output diameter and angle of the nozzle 9 meet one of the following requirements to match the arthroscopic operation in a narrow space: First, for shoulder arthroscopic surgery, a small-diameter nozzle 1.0-1.2 mm is used, and the nozzle 9 with a straight head (i.e. 0° head) is combined with the nozzle 9 with a 30° bent head to adapt to the narrow and complex anatomical structure of the shoulder joint gap, such as the glenoid lip and rotator cuff. The straight head nozzle is suitable for glenoid lip trimming or synovial ablation in relatively open areas such as the anterior glenoid and humeral head, and the 30° bent nozzle is crucial for treating lesions in the blind area of the posterior and lower joint cavity, or for precise ablation of the rotator cuff attachment point by bypassing the humeral head, greatly expanding the range of operation; Second, for knee arthroscopic surgery, the recommended nozzle 9 diameter is 1.2-1.5 mm, the nozzle 9 with a straight head (i.e. 0° head), the nozzle 9 with a 30° bent head, and the nozzle 9 with a 70° bent head are combined. The knee joint cavity space is relatively large, but it needs to handle multiple structures such as meniscus, anterior and posterior cruciate ligament, and intercondylar fossa; the straight head nozzle is a general choice, suitable for most meniscus shaping, intercondylar fossa shaping, and anterior cruciate ligament stump cleaning; the 30° bent nozzle 9 is useful for handling corner areas such as the posterior corner of the meniscus; and the 70° bent (or lateral bent) nozzle 9 is specifically used for handling synovial folds hidden behind the femoral condyle or for synovial cleaning in the posterior compartment, avoiding excessive traction for exposure of the surgical field. Third, for ankle arthroscopic surgery, the recommended nozzle diameter is 1.2 mm, and the nozzle 9 with a straight head (i.e. 0° head) is combined with the nozzle 9 with a 15-45° bent head. The ankle joint space is tight and the bony structure is complex, requiring high precision of the instrument; the straight head nozzle 9 is suitable for osteophyte grinding or cartilage shaping in major areas such as the anterior compartment of the ankle joint and the talofibular joint; the 15-45° bent nozzle 9 is crucial for handling impact bone spurs behind the tibiotalar joint or cartilage damage in the posterior part of the talar dome, effectively solving the problem of difficult exposure of the posterior compartment of the ankle joint.

[0014] The method for using the liquid-guided laser arthroscopic surgery device is mainly used for guiding doctors or other medical practitioners to practice the operation on a human model or a dummy; and the method for using the liquid-guided laser arthroscopic surgery device comprises the following steps and contents in sequence: Step 1: preparation before use and device setting; connect and initialize each component of the liquid-guided laser arthroscopic surgery device; Step 2: establish an arthroscopic working channel; after the surgical area is routinely disinfected and laid with a drape, the soft tissue fine incision mode is adopted: 1064 nm infrared laser is selected, the power is set to 5-10 W, the water pressure is set to 0.5 MPa, and the handheld surgical pen 12 is used to sequentially perform the following operations: incise the skin, subcutaneous tissue and joint capsule, and establish an arthroscopic access channel; in this process, the liquid-guided laser energy beam simultaneously completes tissue incision and hemostasis; Step 3: maintain the operation environment of the joint cavity; the low-pressure liquid supply system 13 continuously perfuses isotonic saline into the joint cavity 23 to fully expand the joint cavity 23; at the same time, the suction device 4 is started to maintain the dynamic balance of the liquid pressure in the joint cavity 23, thereby providing a clear and stable visual field environment for the operation; Step 4: lesion treatment and operation; according to the type of the lesion tissue found during the operation, the corresponding working mode is selected on the central control system 2 for treatment; Step 5: real-time adjustment and monitoring during the operation; during the operation, the laser power, pulse frequency and water flow pressure parameters are adjusted in real time through the central control system 2 according to the tissue reaction and the progress of the operation; at the same time, the suction device 4 timely removes tissue debris and bubbles to keep the operation field clear; Step 6: end of the operation and device shutdown.

[0015] The method for using the liquid-guided laser arthroscopic surgery device preferably comprises the following contents: Step 4 further satisfies the following requirements: In Step 4, according to the objective requirements (for example, the type of the lesion tissue found during the operation), the corresponding working mode is selected on the central control system 2 for the following treatment: Firstly, when treating a meniscus injury, the meniscus cartilage shaping and resection mode is selected: 2.1 μm Ho laser is used, the power is set to 20-40 W, and the water pressure is set to 1-2 MPa, so as to accurately shape and resect the torn meniscus; Secondly, when anterior cruciate ligament reconstruction is needed, the hard bone ablation mode is selected: 2.1 μm Ho laser is used, the power is set to 40-60 W, and the water pressure is set to 2-3 MPa, so as to accurately establish a bone tunnel at a predetermined position; Thirdly, when treating synovial membrane hyperplasia, the hyperplastic synovial membrane soft tissue ablation mode is selected: a 1904nm thulium laser is used, the power is 5-10W, the water pressure is 1MPa, the hyperplastic synovial membrane tissue is accurately ablated, and the bleeding points are coagulated and hemostasia.

[0016] The method for using the liquid-guided laser arthroscopic surgery device preferably further satisfies the following requirements: Step 1, preparation before use and device setting; the components of the liquid-guided laser arthroscopic surgery device are connected and initialized, specifically: the handheld surgical pen 12 is connected with the laser 1 through the optical fiber 3, the inner cavity of the handheld surgical pen 12, i.e., the coupling cavity 7, is connected with the high-pressure liquid supply system 11 through the liquid pipeline 14, the liquid suction small hole 8 is connected with the suction device 4 through the liquid suction hose 19, and the liquid supply small hole 17 is connected with the low-pressure liquid supply system 13 through the liquid supply hose 18; the tissue-specific working mode and the corresponding laser parameters and liquid pressure parameters are preset in the central control system 2; the sealing performance of the sealing ring 16 is checked, and a suitable replaceable nozzle 9 is installed; Step 6: specific requirements for closing the device after the operation is completed: After all the surgical operations are completed, the device is closed in the following order: first, the laser 1 is turned off, and the laser output is stopped; then, the high-pressure liquid supply system 11 is turned off, and the coupling liquid supply is stopped; the low-pressure liquid supply system 13 and the suction device 4 are kept running for a while, the joint cavity 23 is flushed, and it is confirmed that there is no active bleeding; finally, all the systems are completely turned off, and the handheld surgical pen 12 is slowly withdrawn.

[0017] In the method for using the liquid-guided laser arthroscopic surgery device, preferably, the following requirements are further met: step 7 is further provided after step 6; and the content requirement is: Step 7: postoperative treatment; the surgical incision is routinely closed, and the post-treatment of the necessary use operation is performed; the replaceable nozzle 9 of the handheld surgical pen 12 is cleaned and disinfected or replaced, so as to be ready for the next use.

[0018] The beneficial effects of the present application are: The present application also provides a liquid-guided laser arthroscopic use operation method using the above device, which comprises the following steps: establishing an arthroscopic working channel; maintaining the liquid balance in the joint cavity through the low-pressure liquid supply system and the liquid suction device; selecting the corresponding working mode for accurate ablation according to the type of lesion tissue; adjusting the parameters in real time and removing the debris during the use operation; and closing the systems in order and treating the incision after the use operation.

[0019] The application proposes a kind of arthroscopic surgery device based on liquid guide laser technology, which can realize precise resection and ablation of various tissues in joint by the synergistic effect of laser energy and isotonic liquid beam.The operation process is free of mechanical contact, which not only avoids the pulling damage of traditional instruments to healthy tissues, but also significantly reduces the risk of thermal damage through the synchronous cooling effect of liquid flow.In addition, the liquid jet coaxial with the laser not only guides the energy to be accurately delivered to the target tissue, but also flushes the surgical field in time to maintain a clear field of view, while having good hemostatic effect;The overall operation precision is high, the trauma is small, and the comprehensive technical effect is excellent.

[0020] The application successfully integrates liquid guide laser technology into arthroscopic surgery scene, proposes a highly integrated function, and a special device suitable for narrow space and a matching operation method;For the first time, physiological saline is used as a flow guide medium in arthroscopic laser operation, which not only guarantees the transmission efficiency of laser, but also fully matches the physiological environment of the object being operated;The system is equipped with a multi-mode central control system 2, which can automatically match laser and fluid parameters according to different tissue types, and the operation is intelligent, safe and controllable.

[0021] Compared with the prior art, the application has the following advantages: 1、The application adopts multi-wavelength laser configuration (including 2.1 μm Ho:YAG laser, 1064 nm infrared laser and 1904 nm thulium laser), which can realize selective ablation of different tissues (such as cartilage, synovial membrane and bone) in joint cavity, and has wide application range and precise biological effect; 2、The liquid flow and laser are output in coaxial composite form, which not only improves the energy transmission efficiency, but also realizes real-time cooling and debris removal of the action area, effectively controls heat diffusion, and protects the surrounding important tissues; 3、The device is used in a non-contact mode, without mechanical vibration and torque, so the operation process is more stable, the reaction of the object being operated is light, and the recovery is fast, especially suitable for sports medicine and elderly patients; 4、The device can replace traditional surgical knives, planers, plasma knives and other instruments, significantly reduce the number of instrument changes during operation, simplify the operation process, reduce the cost of consumables, and improve the efficiency. BRIEF DESCRIPTION OF DRAWINGS

[0022] Figure 1 is a schematic diagram of the principle of the liquid guide laser arthroscopic surgery device described in embodiment 1; Figure 2 is a schematic diagram of the appearance of the liquid guide laser arthroscopic surgery device described in embodiment 1; Figure 3 is a working principle flow chart of the liquid guide laser arthroscopic surgery device; Figure 4is one of flow chart of using liquid-guided laser arthroscopic surgical device of example 3; Figure 5 is two of flow chart of using liquid-guided laser arthroscopic surgical device of example 3; Figure 6 is three of flow chart of using liquid-guided laser arthroscopic surgical device of example 3; Figure 7 is four of flow chart of using liquid-guided laser arthroscopic surgical device of example 3; Figure 8 is the photo of skin under optical microscope after operation of liquid-guided laser arthroscopic surgical device; Figure 9 is the photo of cartilage under optical microscope after operation of liquid-guided laser arthroscopic surgical device; Figure 10 is the photo of bone under optical microscope after operation of liquid-guided laser arthroscopic surgical device. DETAILED DESCRIPTION

[0023] The application is further described below in conjunction with examples and the attached drawings, but is not limited thereto.

[0024] The meaning of each figure mark: laser 1, central control system 2, optical fiber 3, liquid suction device 4, focusing lens 5, transmission lens 6, coupling cavity 7, liquid suction hole 8, nozzle 9, laser liquid beam 10, high-pressure liquid supply system 11, handheld surgical pen 12, low-pressure liquid supply system 13, liquid pipeline 14, laser light path 15, sealing ring 16, liquid supply hole 17, liquid supply hose 18, liquid suction hose 19, liquid-guided laser arthroscopic surgical device 20, skin incision 21, arthroscope 22, joint cavity 23.

[0025] Example 1 A liquid-guided laser arthroscopic surgical device, comprising a laser 1, a central control system 2, a handheld surgical pen 12, a high-pressure liquid supply system 11, a low-pressure liquid supply system 13, and a liquid suction device 4; The handheld surgical pen 12 is the main body of the operator end of the surgical device, with a diameter of 4 mm, and has a focusing lens 5, a transmission lens 6, and a coupling cavity 7 inside, and a replaceable nozzle 9 at the front end, arranged at the liquid outflow outlet of the coupling cavity; The high-pressure liquid supply system 11 is connected to the coupling cavity 7 through the liquid pipeline 14, and the laser and the isotonic physiological saline form a coaxial coupled laser liquid beam 10 in the coupling cavity 7; The laser 1 fixes the end of the handheld scalpel pen 12, the laser emitted by the laser 1 is transmitted into the coupling cavity 7 through the optical fiber 3, and then continues to be emitted in the liquid ejection direction through the nozzle 9; then the laser is totally reflected in the cylindrical liquid water column ejected by the nozzle 9; the laser and the liquid flow are combined into a liquid-guided laser energy beam for processing; The liquid in the high-pressure liquid supply system 11 is one of the following or a combination thereof: pure water, physiological saline, bacteriostatic liquid, and the liquid ejection pressure of the nozzle 9 is 0.5-3 MPa; the liquid in the low-pressure liquid supply system is one of the following or a combination thereof: pure water, physiological saline, bacteriostatic liquid, and the liquid supply orifice pressure is 0.1-0.2 MPa; The wavelength of the laser 1 is 2.1um Ho laser, 1064nm infrared laser, and 1904nm thulium laser.

[0026] Embodiment 2 The liquid-guided laser arthroscopic surgical device according to embodiment 1 further satisfies one of the following requirements or a combination thereof: One of them, the liquid-guided laser arthroscopic surgical device is provided with two sets of sealing rings 16, one set is arranged at the connection between the transmitting lens 6 and the coupling cavity 7, and the other set is arranged at the connection between the coupling cavity 7 and the nozzle 9; Secondly, the high-pressure liquid supply system 11, the low-pressure liquid supply system 13 and the suction device 4 in the liquid-guided laser arthroscopic surgical device, the high-pressure liquid supply system 11 provides the coupling liquid required by the laser liquid beam, the low-pressure liquid supply system 13 provides the isotonic physiological liquid that fills the joint cavity, and the suction device 4 sucks away the liquid to maintain the stability of the liquid pressure in the joint cavity.

[0027] Thirdly, the nozzle 9 is a cylindrical structure, coaxially arranged with a through hole, the diameter of the through hole is 1-2mm, and the material of the nozzle is one of the following or a combination thereof: stainless steel, Peek material, titanium alloy; Fourthly, the wavelength of the laser 1 is one of the following: 2.1um Ho laser, 1064nm infrared laser, and 1904nm thulium laser; the laser emitted by the laser 1 is transmitted into the coupling cavity through the optical fiber 3; Fifthly, the central control system 2 is built-in with tissue-specific working modes, including but not limited to soft tissue fine incision mode, meniscus cartilage shaping and resection mode, and hyperplastic synovial tissue ablation mode, and hard bone ablation mode.

[0028] Embodiment 3 The liquid-guided laser arthroscopic surgical device according to embodiment 2, the tissue-specific working mode is preset with corresponding laser power parameters, pulse frequency parameters and isotonic liquid flow rate parameters.

[0029] First, the soft tissue fine incision mode uses 1064nm infrared laser, low power 5~10W, water pressure 0.5MPa to realize precise low-damage ablation of joint epidermis muscle, and establish the channel for arthroscopic entry, such as Figure 4 In knee arthroscopic surgery, the front-lateral and front-medial approaches of the knee joint are taken, and the laser beam generated by the liquid-guided laser arthroscopic surgical device 20 is used to ablate epidermis muscle fascia, etc., to establish the access channel skin incision 21 into the joint cavity 23; Second, the meniscus cartilage shaping and resection mode uses 2.1um Ho laser, medium power (20~40W), precise pulse, water pressure 1~2MPa, to realize precise resection of meniscus cartilage, and treat the main arthroscopic disease of meniscus injury, such as Figure 5 The liquid-guided laser arthroscopic surgical device 20 enters from the front-medial approach, ablates and resects the lateral meniscus, and the arthroscope 22 enters from the front-lateral approach to provide illumination and real-time image for the joint cavity; Third, the hard bone ablation mode uses 2.1um Ho laser, high power (40~60W), precise pulse, water pressure 2~3MPa, to realize precise bone cortex ablation and establish bone tunnel, providing tunnel support for anterior cruciate ligament reconstruction, such as Figure 6 The liquid-guided laser arthroscopic surgical device 20 enters from the front-lateral approach to ablate the femur and establish the femoral tunnel, and the arthroscope 22 enters from the front-medial approach to provide illumination and real-time image for the joint cavity; Fourth, the proliferative synovial membrane soft tissue ablation mode uses 1904nm thulium laser, low power 5~10W, water pressure 1MPa, to realize removal of proliferative synovial membrane, fat and other soft tissues, and laser condensation of synovial membrane bleeding points, such as Figure 7 The liquid-guided laser arthroscopic surgical device 20 enters from the front-lateral approach to ablate proliferative synovial membrane, fat and other soft tissues, and condenses the bleeding points, and the arthroscope 22 enters from the front-medial approach to provide illumination and real-time image for the joint cavity; According to the liquid-guided laser arthroscopic surgical device of embodiment 1, the outer diameter of the handheld surgical pen 12 is not greater than 4mm, the length is 120~180mm, an ergonomic holding shape is adopted, the low-pressure liquid supply system 13 and the liquid tube cavity of the liquid extraction device 4 are perpendicular to the main body of the handheld surgical pen 12, which is convenient for holding and controlling the depth of entering the joint, and prevents accidental injury; In the liquid-guided laser arthroscopic surgical device, the replaceable nozzle 9 provides multiple output diameters and angle configurations to match the arthroscopic operation in narrow space; Embodiment 4 A liquid-guided laser arthroscopic surgical device and a method of using the device, the steps and contents of which are as follows: Step 1: Preoperative preparation and device setup, connect and initialize the components of the liquid-guided laser arthroscopic surgery device: connect the handheld scalpel pen 12 to the laser 1 through the optical fiber 3, connect the high-pressure liquid supply system 11 through the liquid pipeline 14, connect the suction device 4 through the suction hose 19, and connect the low-pressure liquid supply system 13 through the liquid supply hose 18; preset the tissue-specific working mode and its corresponding laser parameters and liquid pressure parameters in the central control system 2; check the sealing of the sealing ring 16, and install the appropriate replaceable nozzle 9; Step 2: Establish the arthroscopic working channel, after the surgical area is routinely disinfected and draped, use the soft tissue fine incision mode: select 1064nm infrared laser, set the power to 5~10W, and the water pressure to 0.5MPa, use the handheld scalpel pen 12 to sequentially incise the skin, subcutaneous tissue, and joint capsule, and establish the arthroscopic access channel; in this process, the liquid-guided laser energy beam simultaneously completes tissue incision and hemostasis, such as Figure 8 Skin after ablation by the liquid-guided laser arthroscopic surgery device; Step 3: Maintain the operating environment of the joint cavity; continuously perfuse isotonic saline into the joint cavity through the low-pressure liquid supply system 13 to fully expand the joint cavity; at the same time, start the suction device 4 to maintain the dynamic balance of the liquid pressure in the joint cavity, and provide a clear and stable visual environment for surgical operation; Step 4: Lesion treatment and surgical operation, according to the type of lesion tissue found during the operation, select the corresponding working mode on the central control system 2 for treatment, when treating meniscus injury, select the meniscus cartilage shaping and resection mode: use 2.1μm Ho laser, power 20~40W, water pressure 1~2MPa, to accurately shape and trim the torn meniscus, such as Figure 9 Meniscus cartilage after ablation by the liquid-guided laser arthroscopic surgery device; when anterior cruciate ligament reconstruction is needed, select the hard bone ablation mode: use 2.1μm Ho laser, power 40~60W, water pressure 2~3MPa, to accurately create a bone tunnel at the predetermined position, such as Figure 10 Femur after ablation by the liquid-guided laser arthroscopic surgery device; when treating synovial hyperplasia, select the hyperplastic synovial soft tissue ablation mode: use 1904nm thulium laser, power 5~10W, water pressure 1MPa, to accurately ablate the hyperplastic synovial tissue and coagulate and stop bleeding at the bleeding points; Step 5: Real-time adjustment and monitoring during operation, during the operation, adjust the laser power, pulse frequency, and water flow pressure parameters in real time through the central control system 2 according to the tissue response and the progress of the operation; at the same time, timely remove tissue debris and bubbles through the suction device 4 to keep the surgical field clear; Step 6: End of procedure and device shut down, after all surgical procedures have been completed, the device is shut down in the following order: First, the laser 1 is turned off, stopping the laser output; then the high pressure fluid supply system 11 is turned off, stopping the coupling fluid supply; the low pressure fluid supply system 13 and the suction device 4 are kept running for a short while, flushing the joint cavity and confirming that there is no active bleeding; finally, all systems are turned off completely and the handheld surgical pen 12 is slowly withdrawn; Step 7: Post procedure, the surgical incision is closed conventionally and the necessary post procedure treatment is performed; the replaceable nozzle 9 of the handheld surgical pen 12 is cleaned and disinfected or replaced, ready for the next use.

Claims

1. A liquid-guided laser arthroscopic surgical device, characterized in that: The liquid-guided laser arthroscopic surgical device includes a laser (1), a central control system (2), a handheld surgical scalpel (12), a high-pressure fluid supply system (11), a low-pressure fluid supply system (13), a fluid aspiration device (4), an optical fiber (3), a fluid pipeline (14), a fluid supply orifice (17), a fluid supply hose (18), and a joint cavity (23); wherein: The handheld scalpel pen (12), which serves as the main body of the surgical device at the surgeon's end, meets the following requirements: it is equipped with a focusing lens (5), a transmission lens (6) and a coupling cavity (7) inside, and a replaceable nozzle (9) is provided at its front end. The replaceable nozzle (9) is arranged at the liquid outlet at the front of the coupling cavity (7). The high-pressure liquid supply system (11) is connected to the coupling cavity (7) through the liquid pipeline (14); A laser (1) is fixedly arranged at the end of a handheld surgical scalpel pen (12). The laser emitted by the laser (1) is transmitted to the coupling cavity (7) through an optical fiber (3). The laser emitted by the laser (1) and the isotonic saline solution in the coupling cavity (7) form a coaxially coupled laser liquid beam (10) in the coupling cavity (7). Then the laser continues to be emitted in the direction of liquid ejection through the nozzle (9). Then the laser undergoes total reflection in the cylindrical liquid column ejected from the nozzle (9). The laser and the liquid flow are combined to form a laser liquid beam (10) for processing. The liquid in the high-pressure fluid supply system (11) is one of the following or a combination thereof: purified water, physiological saline, antibacterial solution; the pressure of the liquid sprayed from the nozzle (9) is 0.5~3MPa; the liquid in the low-pressure fluid supply system (13) is one of the following or a combination thereof: purified water, physiological saline, antibacterial solution; the low-pressure fluid supply system (13) is connected to the handheld surgical scalpel pen (12) through the fluid supply hose (18), and the pressure of the fluid supply hole (17) is 0.1~0.2MPa; the physiological saline provided by the low-pressure fluid supply system (13) is sprayed into the joint cavity (23) through the fluid supply hole (17).

2. The liquid-guided laser arthroscopic surgical device according to claim 1, characterized in that: The liquid-guided laser arthroscopic surgical device also meets one or a combination of the following requirements: Firstly, the liquid-guided laser arthroscopic surgical device is provided with two sets of sealing rings (16), one set is arranged at the connection between the transmission mirror (6) and the coupling cavity (7), and the other set is arranged at the connection between the coupling cavity (7) and the nozzle (9); Secondly, the liquid-guided laser arthroscopic surgical device is also equipped with a suction device (4) that is matched with the high-pressure fluid supply system (11) and the low-pressure fluid supply system (13); the high-pressure fluid supply system (11) provides the coupling fluid required for the laser liquid beam, the low-pressure fluid supply system (13) provides isotonic physiological fluid that fills the joint cavity (23), and the suction device (4) removes the supplied fluid to maintain the stability of the joint cavity fluid pressure; Thirdly, the nozzle (9) is a cylindrical structure with a through hole coaxial with the outer surface arranged in its inner cavity. The diameter of the through hole is 1~2mm. The material of the nozzle (9) is one of the following or a combination thereof: stainless steel, Peek material, titanium alloy. Fourth, the laser (1) is one of the following: a Ho laser with a wavelength of 2.1 μm; an infrared laser with a wavelength of 1064 nm; or a thulium laser with a wavelength of 1904 nm. Fifth, the central control system (2) has one of the following tissue-specific working modes: soft tissue fine cutting mode, meniscus cartilage shaping and resection mode, hyperplastic synovial soft tissue ablation mode, and bone ablation mode.

3. The liquid-guided laser arthroscopic surgical device according to claim 2, characterized in that: The liquid-guided laser arthroscopic surgical device operates in a tissue-specific working mode, which is preset with corresponding laser power parameters, pulse frequency parameters, and isotonic fluid flow rate parameters; it meets one of the following requirements: Firstly, when the liquid-guided laser arthroscopic surgical device is operating in the soft tissue fine incision mode, a 1064nm infrared laser is used with a low power of 5~10W and a water pressure of 0.5MPa to achieve precise and low-damage ablation of the joint skin and muscles, thus establishing a channel for arthroscopic entry. Secondly, when the liquid-guided laser arthroscopic surgical device is operating in the meniscus cartilage resection mode, a 2.1µm Ho laser is used with a medium power of 20~40W, precise pulse, and water pressure of 1~2MPa to achieve precise resection of meniscus cartilage and treat meniscus injury, a major arthroscopic disease. Third, when the liquid-guided laser arthroscopic surgical device is operating in the bone ablation mode, a 2.1μm Ho laser is used with a high power of 40~60W, precise pulses, and a water pressure of 2~3MPa to achieve precise bone cortex ablation and establish a bone tunnel, providing tunnel support for the reconstruction of the anterior cruciate ligament. Fourth, when the liquid-guided laser arthroscopic surgical device is operating in the soft tissue ablation mode of hyperplastic synovium, a 1904nm thulium laser is used with a low power of 5~10W and a water pressure of 1MPa. It is suitable for removing hyperplastic synovium, fat and other soft tissues, as well as laser ablation of synovial bleeding points.

4. The liquid-guided laser arthroscopic surgical device according to claim 2, characterized in that: In the liquid-guided laser arthroscopic surgical device, the outer diameter of the handheld surgical scalpel pen (12) is ≤4mm. The external supply hose (18) and suction hose (19) corresponding to the low-pressure supply system (13) and the suction device (4) are 120~180mm away from the nozzle and form a cross structure with the handheld surgical scalpel pen (12). The cross structure controls the length of the surgical device entering the joint cavity (23), which facilitates the gripping and control of the surgical device and the depth of entry into the joint, and prevents the surgical device from entering the joint cavity (23) too deeply due to changes in body position during the operation, causing accidental damage.

5. The liquid-guided laser arthroscopic surgical device according to claim 2 or 3, characterized in that: In the liquid-guided laser arthroscopic surgical device, the output diameter and angle configuration of the nozzle (9) meet one of the following requirements in order to match arthroscopic operations in confined spaces: Firstly, for shoulder arthroscopic surgery, a small-diameter nozzle of 1.0~1.2 mm is used, with a combination of a straight tip and a 30° curved tip, which is suitable for the narrow and complex anatomical structure of the shoulder joint space; the straight tip nozzle (9) is suitable for labral repair or synovial ablation in relatively open areas; the 30° curved tip nozzle (9) is crucial for treating lesions in blind spots such as the posteroinferior region of the glenoid, or for precise ablation of the rotator cuff attachment point around the humeral head, which greatly expands the surgical range; Secondly, for knee arthroscopy, the recommended nozzle diameter is 1.2 ~ 1.5 mm, with a combination of straight, 30° curved and 70° curved nozzles. The knee joint cavity space is relatively large, but it is necessary to deal with various structures such as the meniscus, anterior and posterior cruciate ligaments, and intercondylar fossa. The straight nozzle (9) is a general choice and is suitable for most meniscectomy, intercondylar fossa repair and anterior cruciate ligament remnant cleaning. The 30° curved nozzle (9) is beneficial for dealing with corner areas such as the posterior horn of the meniscus. The 70° curved nozzle (9) is specifically used to deal with synovial folds hidden behind the femoral condyle or to perform synovial cleaning of the posterior compartment, avoiding excessive traction to expose the surgical field. Thirdly, for the configuration of ankle arthroscopy, the recommended nozzle diameter is 1.2mm. The combination of a straight nozzle (9) and a 15~45° curved nozzle (9) is used. The ankle joint cavity is tight and the bony structure is complex, which requires a high degree of precision in the instruments. The straight nozzle (9) is suitable for osteophyte grinding or cartilage shaping in the main area. The 15~45° curved nozzle (9) is crucial for treating impingement osteophytes behind the tibiotalar joint or cartilage damage in the posterior part of the talar dome, and can effectively solve the problem of difficult exposure of the posterior compartment of the ankle joint.

6. The method of using the liquid-guided laser arthroscopic surgical device according to claim 1, characterized in that: The method of using the liquid-guided laser arthroscopic surgical device includes the following steps and contents: Step 1: Preparation and device setup before use; connect and initialize the components of the liquid-guided laser arthroscopic surgical device; preset the tissue-specific working mode and its corresponding laser parameters and liquid pressure parameters in the central control system (2); check the sealing performance of the sealing ring (16) and install the appropriate nozzle (9); Step 2: Establish the arthroscopic working channel; adopt the soft tissue fine cutting mode: select 1064nm infrared laser, set the power to 5-10W, water pressure to 0.5MPa, and operate sequentially with a handheld scalpel pen (12) to establish the arthroscopic access channel; during this process, the laser liquid beam (10) simultaneously completes the cutting. Step 3: Maintain the operating environment of the joint cavity; continuously infuse isotonic saline into the joint cavity (23) through the low-pressure fluid supply system (13) to fully expand the joint cavity (23); at the same time, start the suction device (4) to maintain the dynamic balance of fluid pressure in the joint cavity (23) and provide a clear and stable visual environment for the operation; Step 4: Processing and Operation; Based on the organization type, select the appropriate working mode on the central control system (2) for processing; Step 5: Real-time adjustment and monitoring; Based on the tissue response and progress, adjust the laser power, pulse frequency and water pressure parameters in real time through the central control system (2); At the same time, remove debris and air bubbles in a timely manner through the suction device (4) to keep the surgical field clear; Step 6: The device is turned off.

7. The method of using the liquid-guided laser arthroscopic surgical device according to claim 5, characterized in that: In the method of using the liquid-guided laser arthroscopic surgical device, step 4 also meets the following requirements: In step 4, based on objective needs, the appropriate working mode is selected on the central control system (2) for processing: Firstly, the meniscus cartilage resection method: using a 2.1μm Ho laser with a power of 20-40W and a water pressure of 1-2MPa, the torn meniscus is precisely reshaped. Secondly, the bone ablation mode: using a 2.1μm Ho laser with a power of 40-60W and a water pressure of 2-3MPa, a bone tunnel is precisely established at a predetermined location; Third, the ablation mode for hyperplastic synovial soft tissue: using a 1904nm thulium laser with a power of 5~10W and a water pressure of 1MPa to precisely ablate the hyperplastic synovial tissue.

8. The method of using the liquid-guided laser arthroscopic surgical device according to claim 5 or 6, characterized in that: The method of using the liquid-guided laser arthroscopic surgical device also meets the following requirements: Step 1, Pre-use preparation and device setup; Connect and initialize the components of the liquid-guided laser arthroscopic surgical device: Connect the handheld scalpel pen (12) to the laser (1) via optical fiber (3), connect the high-pressure liquid supply system (11) via liquid pipeline (14), connect the suction hole (8) to the suction device (4) via suction hose (19), and connect the supply hole (17) to the low-pressure liquid supply system (13) via supply hose (18); Preset the tissue-specific working mode and its corresponding laser parameters and liquid pressure parameters in the central control system (2); Check the sealing performance of the sealing ring (16) and install the appropriate nozzle (9); Step 6: Operation completed and device shut down; After completing all operations, shut down the device in the following order: First, turn off the laser (1) and stop the laser output; then turn off the high-pressure fluid supply system (11) and stop the coupling fluid supply; keep the low-pressure fluid supply system (13) and the suction device (4) running for a while, rinse the joint cavity (23) and confirm that there is no active bleeding; finally, completely shut down all systems and slowly withdraw the handheld scalpel pen (12).

9. The method of using the liquid-guided laser arthroscopic surgical device according to claim 5 or 6, characterized in that: The method of using the liquid-guided laser arthroscopic surgical device also meets the following requirements: After step 6, there is a seventh step, the contents of which are as follows: Step 7: Post-processing; Perform necessary post-processing; Clean, disinfect or replace the nozzle (9) of the handheld scalpel pen (12) to prepare for the next use.

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