Device for identifying biological tissue of epidural space of spinal canal

FIELD: medical engineering.

SUBSTANCE: device has optically connected optical radiation source, light division unit, light guide and photodetector. Photodetector output is connected to video monitor, light guide end for transmitting optical radiation is removably set in medical needle pavilion. Polished light guide end is combined with needle end and manufactured at an angle of α determined from relation of arc sin (1/n2)< α < arc sin (n1/n2), where n2 is the light guide material refraction coefficient value and n1 is the epidural space tissue refraction coefficient value.

EFFECT: high accuracy of examination.

2 dwg

 

The invention relates to medical equipment and is intended to define the time of occurrence of the end of the needle of the syringe into the fabric of the epidural space of the spinal canal, for example, when performing epidural anesthesia.

Definition of the moment of occurrence of the end of the medical needle in biological tissue epidural space when performing epidural anesthesia is usually based on the tactile sensations of the fingers of the hand of the doctor to the resistance when passing through the biological tissue of the end of the needle and the pressure on the plunger of the syringe (see training manual for doctors: Morgan Jr. DE, Maged S. Michael. Clinical anesthesiology - M/SPb., Binom /Nevsky dialect, 1998 (s-304). The disadvantage of this method is the subjectivity of the perception of the physician, leading to errors of determination of the moment of occurrence of the end of the needle of the syringe into the epidural space and possible perforation (damage) of the Dura mater of the spinal cord, causing danger and complications associated with epidural analgesia (see Svetlov V.A., Kozlov S. p. Dangers and complications of Central segmental analgesia. Anesthesiology and resuscitation. 2000, No. 5, p.86).

It is also known Device for identifying the position of the needle in the epidural space” (a utility model certificate No. 25390 from 10.10.2002, bull. No. 28), which with the help of photoelectric conversion on the indicators and reference springs are measured effort on the housing and the plunger of the syringe, with the transfer of their values on the video monitor, which reduces the subjective feelings of the doctor and increases his confidence during anesthesia. A disadvantage of this device is the lack of reliability and the accuracy of determining the time of occurrence of the end of the needle in the desired tissue epidural space due to the variability of the relationship between the measured force and form of biological tissue in which the needle tip when the needle is obturated (the hole in the needle is clogged).

The closest in technical essence is U.S. patent No. 5172685, R.J. IMS 7-14-94 “Endoscope with a laser camera, selected as a prototype. The device includes a source of optical radiation, the optical fiber having a working end which is inserted into the endoscopic probe, a beam splitter mounted on the optical path formed by the second end of the light guide for illumination of biological tissue and direction reflected from her radiation on the photosensor, the output of which is connected to the monitor.

The disadvantages of this device is the lack of accuracy of determining the location of the working end of the tip with respect to the desired biological tissue, because the location of the working end of the fiber relative to rabochego the end of the probe and the biological tissue is not sufficiently certain. In addition e is Oh, the device does not allow you to use instead of the standard probe disposable needles, as the working end of the fiber permanently installed in the endoscopic probe. In the prototype for image transfer fabric you want to use the so-called “picturing” of the fiber (with regular stacking of individual fibers), the cost of which is much higher than the cost of a light guide that transmits only radiation.

The present invention solves the problem of increasing the accuracy of determining the moment of entering the working end of the needle into the fabric of the epidural space by combining the polished end face of the working end of the fiber with the working end of the needle allows the use of standard medical needle, due to the installation of the working end of the fiber into the pavilion of the needle with the possibility of removal from it, allows the use of cheaper neizobrazimo (transmit only optical radiation)fiber with irregular laying lived or solid by performing working end of the fiber at a certain angle.

Device for identifying tissue epidural space of the spinal canal that contains optically connected to the optical radiation source, a beam splitter, an optical fiber, a photodetector, the output of which is connected to the monitor, wherein the working end of the fiber for preaciption radiation to the target tissue is installed in the pavilion of the medical needle can remove it, the polished end face of the working end of the fiber is combined with the working end of the needle and the end of the working end of the fiber angled αdetermined by the ratio of arcsin(1/n2)<α<arcsin(n1/n2), where n2is the refractive index of the material of the fiber, n1the refractive index of the tissue epidural space.

The essence of the invention lies in the fact that the definition of the moment of entering the working end of the needle into the fabric of the epidural space with the introduction of the needle with a built in her pavilion fiber, polished end face which are aligned with the working end of the needle, which is transmitted optical radiation to the tissue adjacent to the working end of the needle and the working end face of the fiber is determined by the degree of violation of the angle of total internal reflection from the polished end of the fiber, measured by the level of the signal from the photosensor.

The angle of total internal reflection ω0determined to falling on the working face of the light guide optical radiation known relation: sin ω0=n1/n2where n1is the refractive index of the external environment, n2is the refractive index of the material of the light guide.

For the case when the working face of the light guide is in the air n1=1, for example, optical fibers made of quartz glass (n2=1,45843), the angle is olego internal reflection If the working face of the optical fiber to perform under this or a slightly greater angle, a significant portion of the transmitted radiation after multiple reflections from the end and sides of the light guide back and photosensor will yield the maximum signal.

Biological tissue (substrate)in the epidural space has a jelly consistency with the refractive index in the rangetherefore, fiber, made for example of quartz glass (n2=1,45843), the angle of total internal reflection is in the range

Biological tissue during needle in front of the epidural space (muscle, nedostacha, Marostica, yellow ligament), has a denser consistency, to a lesser extent wets the polished end of the fiber is effectively opaque to visible wavelengths of light (not transmitting, reflecting and absorbing radiation), so the portion of the reflected radiation is reduced compared with the case where the end of the needle is in the air (but still significant) and the amplitude of the signal from the photosensor is reduced.

Thus, if the working face of the optical fiber to perform at an angle (α) in the range, a large angle of total internal reflection, when he is titsa in the air, and the smaller the angle of total internal reflection when he is in the tissue of the epidural space (i.e.due to violations of the angle of total internal reflection at the time of entry of the working end of the needle (fiber) into the fabric of the epidural space, a significant portion of the light will be distributed in this fabric, the portion of the reflected radiation is sharply reduced and the amplitude of the signal from the photo-sensor drops to the minimum value.

The essence of the invention illustrated by figure 1 and figure 2.

Figure 1 explains the phenomenon of violation of the angle of total internal reflection, figure 2 - schematic diagram of a device.

Figure 1 shows the environment (tissue epidural space) 1 with a refractive index of n1; fiber 2 having a refractive index of n2; medical needle 3 is inserted in its pavilion working end of the light guide 2, fabric yellow and megastate ligaments 4.

While the working end of the needle is in the yellow fabrics and megastate ligaments, the light beam AB is incident on the end face of the optical fiber, angled α, undergoes total internal reflection, is deflected in the direction of the sun and then part of it after multiple reflections from the walls and an end face of the light guide back. When the working end of the needle enters the epidural space, the ray AB rotten is aetsa on the boundary of two media, extends in the direction VD and absorbed.

Measurement of the degree of violation of the angle of total internal reflection exercise on the amplitude of the signal from the photodetector, working with reflected from the working end of the fiber and the adjacent tissue by radiation. A sharp drop in signal amplitude (minimum signal) will correspond to the case when the working face of the fiber, and hence the working end of the needle enters the fabric of the epidural space. Since there is no need to acquire images of the object of observation, the light guide is used neizobrazimo (monovacancy or without regular stacking of individual fibers).

The proposed device is presented in figure 2.

Here the working end of the fiber 2 is inserted into the pavilion medical needle 3, the polished end face of the working end of the fiber 2 angled α and combined with the working end of the needle 3, the device 5 for attaching and fixing the polished end face of the working end of the fiber with the working end of the needle.

The second end of the fiber is located in the housing 6, which are optically coupled to the beam splitter 7, the radiation source 8, the photo sensor 9, the output of which is connected to the monitor 10 of the computer.

A beam splitter 7 can be performed, for example, in the form of a splitter to two of the loom, one of which produce illumination from the source of radiation is placed 8 (for example, LEDs with optimal length of the radiation), and the other reflected from the working end of the fiber and fabric of the radiation supplied to the photosensor 9, made for example in the form of a photodiode, the output of which is connected to the video monitor 10 computer located at a convenient distance from the doctor.

The device operates as follows.

Inserted into the cavity of a standard needle 3 working end of the fiber 2, combine it polished the working face with the working end of the needle 3 and fix them relative to each other by the device 5. Include the radiation source 8 and see the level of signal amplitude of the video monitor 10 of the computer. Introduce the needle into the skin tissue of the patient and then promote it in the tissues, watching the video monitor changes in the amplitude of the signal produced by the photosensor 9 optical radiation reflected from the working end of the fiber and the corresponding biological tissue.

A sharp decrease in the amplitude of the signal will correspond to the moment of entering the working end of the needle into the fabric of the epidural space.

After determining the position of the end of the needle into the tissue epidural channel light guide is removed from the pavilion of the needle to the needle to connect the syringe or set cater etc. This allows you to use disposable needles. The light guide 2 can also be disposable.

The light guide 2 may be a compound and have the connector 11 to the portion that is inserted into the needle (i.e. the working end), could be made of different diameter, as the standard needles have different lumen diameter.

The device 5 for attaching and fixing the position of the polished end face of the working end of the fiber with the working end of the needle may be made in the form of a collet clamp or removable ring having a slot for clamping screw (see Reference constructor accurate instrumentation Ed. by Volodymyr Lytvyn FL, M-L, engineering, 1964, str-416). The proposed device is compared with the prototype allows to increase the accuracy of determining the time of occurrence of the end of the medical needle into the fabric of the epidural space because the working end of the needle combined with a polished end face of the working end of the fiber in contact with the desired tissue optical properties which influence the magnitude of the reflected optical radiation and the magnitude of the amplitude signal that uniquely identifies this moment, which reduces (eliminates) the possibility of puncture of the Dura mater of the spinal cord, causing danger and complications associated with epidural anesthesia. The possibility of removing the working end of the fiber from the pavilion needle after identification of the epidural tissue space allows the use od Gazovye standard medical needle, that reduces the potential infection and also increases the quality of treatment. The implementation of the polished end face of the working end of the fiber at an angle greater than the angle of total internal reflection, when the end face of the fiber is in the air, and the smaller this angle, when it is in the fabric of the epidural space allows you to use neizobrazimo fiber, which significantly reduces the cost of the device.

Device for identification of biological tissue epidural space of the spinal canal that contains optically connected to the optical radiation source, a beam splitter, an optical fiber, a photodetector, the output of which is connected to the video monitor, wherein, the end of optical fiber to transmit optical radiation installed in the pavilion of the medical needle can remove it, its polished end face aligned with the end of the needle and is made at an angle determined by the ratio

arc sin (1/n2)<α<arc sin (n1/n2),

where n2is the refractive index of the material of the light guide;

n1the refractive index of the tissue epidural space.



 

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