一种新型水刀清创设备的研究

【作者】 郭新；

【导师】 张西正；

【作者基本信息】 中国人民解放军军事医学科学院 ， 军事预防医学， 2009， 博士

【摘要】 随着现代社会的迅速发展,创伤的发病率逐年增加,创伤医学的地位显得日益重要。研究资料表明,创伤死亡在青壮年中是首位死因。尤其遇到如汶川大地震等紧急突发性事件,会造成巨大的人员伤亡,此时大量伤员都需要进行及时的伤口处理,否则会造成严重的后果。因此,创伤急救水平的提高是当前创伤医学中的一个重要课题。清创术是创伤外科最常用的基本技术之一,它包括切开伤道、扩大伤口、切除失活组织、清除异物、止血、引流及固定等一系列操作,而创面清洗是清创术中的首要任务。日常生活中交通事故伤、坠落伤、烧伤、冲击伤、穿刺伤、慢性溃疡、脓肿腔、各种体外伤等经常发生,其中许多伤口创面大、污染严重,直接威胁伤员的生命。因此,对创面进行及时清创,将异物、细菌彻底清除、冲净,可以减少伤口感染,降低伤残、死亡率,提高救治效果。本文研制了一种新型的水刀清创设备,这种新型的装置能够同时完成清创术和水刀切割手术,并融合无线内窥镜技术做到微创。首先对设备进行结构分析和机械设计,确定主要部件如电动机、变频器、液压泵、蓄能器、融合无线内窥镜技术的喷嘴、高压软管以及各种阀门等性能指标和匹配参数。根据硬件设计,研究了设备的控制系统,主要以变频器闭环控制电机为核心,使喷嘴射出稳定、恒压的水流,并实时显示当前的水射流压力。其次,设计了针型结构的水射流喷嘴,将无线内窥镜技术融合在喷嘴中;为了采集原始图像信号并无线传输图像,研究了SONY3142、CXD2096和ICX405摄像系统,设计了以ADSP-BF561处理器为核心的图像处理模块,以解决手术中由于少量毛细血管的破裂所造成的手术区污染变红现象,和水雾反喷到物镜镜面上,引起局部光照不均匀、视野偏暗的不清晰现象;在医用冷光源设计上,采用无线高亮度LED灯电池照明的设计方案。然后对水刀切割材料机理进行了的初步研究,得出了水射流的初始段用于组织切割,基本段和消散段用于伤口清创的结论;应用瞬态动力学仿真软件MSC.DYTRAN模拟了水射流冲击肝脏组织的过程,以不同速度冲击不同部位厚度的猪肝脏材料,并对其进行了分析,仿真结果表明:总可以找到一个合适的水射流速度准确的切割组织,而且不会对附近的其他组织或器官造成损伤。最后,应用新型水刀清创设备对日本大耳白兔子进行了活体肝脏切割实验,手术效果良好,术后兔子能够很快恢复。更多还原

【Abstract】 With the rapid development of modern society,the incidence of trauma has been increasing each year.Therefore,traumatic medicine is becoming daily more important.The results from the present investigation suggest that the death of wounds take the first place in young adults.Especially, when emergency cases such as the massive earthquake in Wenchuan happen that cause great damage and loss of life,prompt dressing wounds is needed. Otherwise,it will cause serious consequences.As a result,the improve of the first-aid level of trauma is very important in modern traumatic medicine.Debridement is the basic skill of traumatology department, including incision into wound tract、widen of wound、cut of devitalized tissue、removal of a foreign object、hemostasis、abteilung etc.The clean of wound surface is the foremost task in the debridement.In daily life, it often happens such as traffic accident injury、injury by falling、bums、blast injury、puncture injury,chronic ulcer,abscess cavity and so on.A lot of large and heavily polluted injuries directly threat the wounded life.Consequently,the debridment of surface wound and clean of bacteria or other foreign bodies can reduce bleeding and infection and decrease disabled and mortality rate,and enhance treatment effect.A new kind of water-jet debridment equipment is studied in this paper, which can implement debridment and cut surgery of water-jet at the same time.Moreover,the equipment can carry out minimally invasive surgery because of wireless endoscopy technology.Firstly,structure analysis and machine design are conducted.Performance index and matching parameter of main units such as motor,transducer,hydraulic pump、accumulator,nozzle integrated wireless endoscopy technology, high-pressure hose and various valve are confirmed.According to hardware design,control system of equipment is studied which transducer closed-loop control is at the core.The equipment can eject stable and isopiestic pressure water jet,and display the current pressure of water jet real time.Secondly,needle-shape structure water-jet nozzle is designed,and wireless endoscopy technology is intergrated.Image pick-up system of SONY3142,CXD2096 and ICX405 is studied,which can collect and wirelessly transmit origin picture.In order to acquire clear image when water-jet is used,a medical image processing system based on ADSP-BF561 is designed.The system can remove partial red color effects(noise) brought by ruptured blood capillary.In addition,it can process the foggy and uneven illumination image clearly during the water jet in operation.The equipment takes wireless intensely bright LED battery as medical cold light source.Then,preliminary study on the mechanism of cutting materials is conducted.Study shows that initial section of water-jet can be used in tissue cut,and base and dissipative section can be used in deridment.MSC.DYTRAN,a dynamic contact emulate analysis software,is used to simulate the course of water-jet attacking pig liver. Simulation results investgate that a properly water-jet velocity can be attained in operation,and has no harm to other tissues or organs nearby. At last,the water-jet debridment equipment is applied in living liver dissection experiment on Japanese White Rabbit.The operation is well, and the rabbit make a quick recovery.更多还原