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I ēnei rā, tata ki te katoa o ngā tapahi taiaho tika o ngā konganuku me ngā mea kore-konganuku ka mahia mā te whakamahi i ngā taputapu kua rite ki ngā taiaho muka, ki ngā taiaho poto rawa rānei (USP), i ētahi wā e rua rānei. I roto i tēnei tuhinga, ka whakamāramahia e mātou ngā painga rerekē o ngā taiaho e rua, ka tirohia hoki me pēhea te whakamahi a ngā kaihanga e rua i ēnei taiaho. Ko te NPX Medical (Plymouth, MN) he kamupene tukatuka kirimana motuhake e hanga ana i ngā momo taputapu me ngā taputapu whakatinanatanga, pērā i ngā stent, ngā implants, me ngā ngongo ngāwari, mā te whakamahi i ngā mīhini e whakauru ana i ngā taiaho muka. Ka hangaia e Motion Dynamics ngā huihuinga iti, pērā i ngā huihuinga "waea kume" e whakamahia ana i roto i te neurology, mā te whakamahi i tētahi mīhini kei roto ko te taiaho femtosecond USP me tētahi o ngā pūnaha ranu hou tae atu ki ngā taiaho femtosecond me te muka mō te ngāwari me te whānui.
Mō ngā tau maha, ko te nuinga o ngā mahi miihini iti o te laser e whakamahia ana ngā laser nanohekona totoka e kiia nei ko ngā laser DPSS. Heoi, kua tino rerekē tēnei nā te whanaketanga o ngā momo laser e rua e tino rerekē ana, ā, nō reira he tautoko. I whakawhanakehia tuatahitia mō ngā whakawhitiwhiti kōrero, kua pakeke ngā laser muka hei rauemi mahi nui e tukatuka ana i ngā laser i roto i te maha o ngā ahumahi, he maha ngā wā i ngā roangaru tata-infrared. Ko ngā take mō tōna angitu kei roto i tōna hoahoa ngāwari me te tauine mana tika. Ko te hua o tēnei he laser he kiato, he tino pono, he ngāwari ki te whakauru ki ngā mīhini motuhake, ā, he iti ake te utu o te mana i ngā momo laser tawhito. He mea nui mō te miihini iti, ka taea te arotahi i te hihi putanga ki tētahi wāhi iti, ma, he torutoru noa iho ngā micron te whānui, nō reira he pai mō te tapahi, te whakarewa me te keri teitei. He tino ngāwari hoki ā rātou putanga, ā, ka taea te whakahaere, me ngā tere pāorooro mai i te pupuhi kotahi ki te 170 kHz. I te taha o te mana tauine, ka tautokohia e tēnei te tapahi tere me te keri.
Heoi, ko tētahi ngoikoretanga pea o ngā taiaho muka i roto i te miihini iti ko te miihini i ngā āhuatanga iti me/ranei ngā wāhanga angiangi, ngawari. Ko ngā roanga o te pātītī roa (hei tauira, 50 µs) ka hua ake he iti noa te rohe pāngia e te wera (HAZ) pērā i te rauemi hanga anō me te iti o te taratara o te taha, e hiahia ana pea ki ētahi tukatuka muri. He waimarie, ko ngā taiaho hou—ngā taiaho pātītī poto rawa (USP) me ngā pātītī putanga femtosecond—ka whakakore i te raruraru HAZ.
Ki ngā taiaho USP, ko te nuinga o te wera tāpiri e pā ana ki te tapahi, ki te keri rānei ka haria atu i roto i ngā paru i peia i mua i te wā ki te horapa ki roto i ngā rauemi e karapoti ana. Kua roa te whakamahinga o ngā taiaho USP me te putanga picosecond i roto i ngā tono miihini iti e uru ana ki ngā kirihou, ngā semiconductors, ngā uku, me ētahi konganuku (picoseconds = 10-12 hēkona). Engari mō ngā taputapu konganuku he pou te rahi o te makawe tangata, ko te kawe wera teitei o te konganuku me te iti o te rahi e tohu ana kāore ngā taiaho picosecond e whakarato i ngā hua pai ake e tika ai te pikinga o te utu o ngā taiaho USP o mua. Kua rerekē tēnei inaianei me te taenga mai o ngā taiaho femtosecond taumata ahumahi (femtosecond = 10-15 hēkona). Ko tētahi tauira ko te raupapa taiaho Monaco a Coherent Inc.. Pērā i ngā taiaho muka, ko tā rātou putanga he mārama tata-infrared, ko te tikanga ka taea e rātou te tapahi, te keri rānei i ngā konganuku katoa e whakamahia ana i roto i ngā taputapu hauora, tae atu ki te maitai kore waikura, te konupora, te koura, te konupora, te cobalt-chromium, te titanium, me ētahi atu, tae atu ki ngā mea ehara i te konganuku. Ahakoa te whakakotahitanga o te roanga poto o te pao me Mā te iti o te kaha pāorooro ka ārai i te kino wera (HAZ), mā te tere auau teitei (MHz) ka whakarite kia tere te tukunga hua mō te maha o ngā taputapu hauora utu nui.
Ae, kāore rawa he tangata i roto i tā tātou umanga e hiahia ana ki te kotahi noa te taiaho. Engari, me whai mīhini taiaho rātou, ā, he maha ngā mīhini motuhake kua arotauhia mō te tapahi me te keri i ngā taputapu hauora. Hei tauira ko te raupapa StarCut Tube a Coherent, ka taea te whakamahi me ngā taiaho muka, ngā taiaho femtosecond, hei putanga ranu rānei e whakauru ana i ngā momo taiaho e rua.
He aha te tikanga o te tohungatanga taputapu hauora? Ko te nuinga o ēnei taputapu ka hangaia i roto i ngā puranga iti i runga i ngā hoahoa ritenga. Nō reira, ko te ngāwari me te ngāwari o te whakamahi ngā mea matua hei whakaaroaro. Ahakoa he maha ngā taputapu e hangaia ana mai i ngā pireti, me miihini tika ētahi wāhanga mai i ngā pireti papatahi; me whakahaere e te mīhini kotahi ngā mea e rua kia nui ake ai tōna uara. Ko te tikanga ka tutukihia ēnei hiahia mā te whakarato i te nekehanga CNC maha-tuaka (xyz me te hurihuri) me te HMI ngāwari ki te whakamahi mō te hōtaka me te whakahaere ngāwari. Mō te Ngongo StarCut, ka tae mai he kōwhiringa kōwae uta ngongo hou me te maheni uta taha (e kiia nei ko StarFeed) mō ngā ngongo tae atu ki te 3 m te roa me te tātari mō ngā hua tapahi, e taea ai te whakaputa aunoa katoa.
Ka whakarei ake i te ngāwari o te tukanga o ēnei mīhini mā te tautoko i te tapahi mākū me te tapahi maroke, me ngā pūwero tuku ngāwari ki te whakarite mō ngā tukanga e hiahia ana ki te āwhina hau. He mea nui hoki te taumira ā-wāhi mō te miihini i ngā wāhanga tino iti, ko te tikanga ka whakakorea e te pumau werawera ngā pānga o te wiri e kitea pinepine ana i ngā toa mīhini. Ka tutuki i te whānuitanga o ngā Ngongo StarCut tēnei hiahia mā te hanga i te papa tapahi katoa me te maha o ngā huānga karāhe.
He kaihanga kirimana hou a NPX Medical e whakarato ana i ngā ratonga hoahoa, hangarau me te tapahi taiaho tika ki ngā kaihanga taputapu hauora. I whakatūria i te tau 2019, kua hangaia e te kamupene he ingoa rongonui i roto i te umanga mō ngā hua kounga me te urupare, e tautoko ana i te whānuitanga o ngā taputapu tae atu ki ngā stent, ngā implants, ngā stent takirere me ngā ngongo tuku ngāwari mō ngā tikanga pokanga rerekē, tae atu ki te neurovascular, te cardiac, te renal, te spinal, te orthopedic, te gynecological, me te gastrointestinal surgery. Ko tana tapahi taiaho matua ko te StarCut Tube 2+2 me te StarFiber 320FC me te mana toharite o te 200 watts. I whakamārama a Mike Brenzel, tētahi o ngā kaiwhakaū o NPX, "he maha ngā tau o te wheako hoahoa me te hanga taputapu hauora a ngā kaiwhakaū - neke atu i te 90 tau te katoa", me ngā wheako o mua ki ngā mīhini rite ki a StarCut e whakamahi ana i ngā taiaho muka. He nui o ā mātou mahi ko te tapahi Nitinol, ā, e mōhio ana mātou ka taea e ngā taiaho muka te whakarato i te tere me te kounga e hiahiatia ana e mātou. Mō ngā taputapu pēnei i ngā ngongo matotoru me ngā takirere ngakau, me tere mātou, ā, ka taea e te taiaho USP te ... "kia puhoi rawa mō ā mātou hiahia. Haunga ngā ota whakaputa nui - he tohunga mātou ki ngā puranga iti o ngā wāhanga - i waenga i te 5 me te 150 ngā wahi anake - ko tā mātou whāinga he whakaoti i ēnei hurihanga puranga iti i roto i ngā rā torutoru noa iho, tae atu ki te hoahoa, te hōtaka, te tapahi, te hanga, te tukatuka muri me te tirotiro, ki te whakaritea ki ngā wiki i muri i te whakatakotoranga o te ota mō ngā kamupene nunui." Haunga te whakahua i te tere, i whakahuatia e Brenzel te pono o te mīhini hei painga nui, kāore e hiahiatia he waea ratonga kotahi i roto i ngā marama 18 kua pahure ake nei o te mahi tata tonu.
Pikitia 2. He maha ngā kōwhiringa tukatuka-muri e tukuna ana e te NPX. Ko te rauemi e whakaaturia ana i konei he kowiri tira T316 me te OD 5mm me te matotoru pakitara 0.254mm. Ka tapahia/ka moroitihia te taha maui, ā, ka orohia te taha matau ki te hiko.
Haunga ngā wāhanga nitinol, ka whakamahia nuitia hoki e te kamupene ngā koranu cobalt-chromium, ngā koranu tantalum, ngā koranu titanium me ngā momo rino kowiri tira hauora. E whakamārama ana a Jeff Hansen, Kaiwhakahaere Tukatuka Taiaho: "Ko te ngāwari o te mīhini tētahi atu taonga nui, e āhei ai mātou ki te tautoko i te tapahi i te whānuitanga o ngā rauemi, tae atu ki te ngongo me te papatahi. Ka taea e mātou te arotahi i te hihi ki raro ki te wāhi 20-micron, he mea whai hua mō ngā ngongo angiangi ake. Ko ētahi o ēnei ngongo he 0.012″ ID noa iho, ā, ko te ōwehenga teitei o te mana tihi ki te mana toharite o ngā taiaho muka hou ka whakanui ake i tō mātou tere tapahi me te whakarato tonu i te kounga mata e hiahiatia ana. Me tino hiahia mātou ki te tere o ngā hua nui ake me te diameter o waho tae atu ki te 1 inihi."
Haunga te tapahi tika me te urupare tere, kei te tuku hoki a NPX i te whānuitanga katoa o ngā hangarau tukatuka-muri, me ngā ratonga hoahoa whānui e whakamahi ana i tōna wheako whānui i roto i te umanga. Kei roto i ēnei tikanga ko te whakakanapa hiko, te pupuhi onepu, te tango pīkara, te whakarewa laser, te whakatakoto wera, te hanga, te whakakorekore, te whakamātautau pāmahana Af, me te whakamātautau ngenge, he mea nui katoa ēnei ki te hanganga taputapu Nitinol. Mā te whakamahi i te tukatuka-muri hei whakahaere i te whakaotinga taha, e ai ki a Brenzel, "ko te tikanga ka whakawhirinaki ki te mea kei te kōrero tātou mō te tono ngenge nui, ngenge iti rānei. Hei tauira, ko te wāhanga ngenge nui pērā i te takirere ngākau ka piko pea i te piriona ngā wā i roto i tōna oranga hei tukatuka-muri. Hei taahiraa, he mea nui te whakamahi i te pupuhi onepu hei whakanui ake i te radius o ngā taha katoa. Engari ko ngā wāhanga ngenge iti pērā i ngā pūnaha tuku, i ngā waea arataki rānei, he maha ngā wā kāore e hiahiatia he tukatuka-muri whānui." Mō te tohungatanga hoahoa, e ai ki tā Brenzel, e toru hauwhā o ngā kiritaki e whakamahi ana i ā rātou ratonga hoahoa hei whakamahi i te āwhina me ngā pūkenga a NPX ki te whiwhi whakaaetanga a te FDA. He tino pai te kamupene ki te huri i te ariā "tātuhi napkin" hei hua i tōna āhua whakamutunga i roto i te wā poto.
Ko Motion Dynamics (Fruitport, MI) he kaihanga o ngā puna iti ritenga, ngā koiri hauora me ngā huihuinga waea, ko tā rātou kaupapa matua he whakaoti rapanga a te kiritaki, ahakoa te uaua, te āhua kore rānei, i roto i te wā poto rawa. I roto i ngā taputapu hauora, ko te kaupapa matua ko te arotahi ki ngā huihuinga uaua mō te pokanga neurovascular, tae atu ki te hoahoa, te whakaputa, me te huihuinga o ngā huihuinga waea kounga teitei mō ngā tono pēnei i ngā taputapu catheter ka taea te urungi, tae atu ki ngā huihuinga "waea kume".
E ai ki te kōrero i mua ake nei, ko te whiriwhiri i te muka, i te USP rānei he mea e pā ana ki te hiahia hangarau me te momo taputapu me ngā tukanga e tautokona ana. I whakamārama a Chris Witham, te Perehitini o Motion Dynamics: "I runga i te tauira pakihi e aro nui ana ki ngā hua neurovascular, ka taea e mātou te whakaputa hua rerekē i roto i te hoahoa, te whakatinanatanga me te ratonga. Ka whakamahia e mātou te tapahi laser hei whakaputa i ngā wāhanga e whakamahia ana e mātou i roto i te whare. , hei hanga i ngā wāhanga "uaua" nui te uara kua riro hei tohungatanga me te ingoa rongonui mā mātou; kāore mātou e tuku tapahi laser hei ratonga kirimana. Kua kitea e mātou ko te nuinga o ngā tapahi laser e mahia ana e mātou he pai ake te mahi me ngā laser USP, ā, mō ngā tau maha kua whakamahia e au he Ngongo StarCut me tētahi o ēnei laser. Nā te kaha o te tono mō ā mātou hua, e rua ā mātou nekehanga 8 hāora ia rā, i ētahi wā e toru ngā nekehanga, ā, i te tau 2019 me hoko e mātou tētahi atu Ngongo StarCut hei tautoko i tēnei Tipu. Engari i tēnei wā, i whakatau mātou ki te haere me tētahi o ngā tauira ranu hou o ngā laser USP femtosecond me ngā laser muka. I honoa hoki e mātou ki te utaina/tango StarFeed. kia taea ai e mātou te mahi aunoa i te tapahi – ka maka noa e te kaiwhakahaere te mea takoto kau. Ka utaina te ngongo ki te whāngai, ā, ka tīmata te hōtaka whakahaere pūmanawa mō te hua.
Pikitia 3. Kua tapahia tēnei ngongo tuku maitai kore waikura ngāwari (e whakaaturia ana i te taha o tētahi ūkui pene) ki tētahi taiaho femtosecond Monaco.
E kī ana a Witham, ahakoa e whakamahia ana e rātou te mīhini mō te tapahi papatahi i ētahi wā, neke atu i te 95 ōrau o tō rātou wā e pau ana ki te hanga, ki te whakarerekē rānei i ngā hua porotaka mō ā rātou huihuinga catheter ka taea te urungi, arā, ngā hypotubes, ngā coils me ngā sprinkles, tae atu ki te tapahi i ngā pito kua tohua me ngā kōhao tapahi. Ko ēnei wāhanga ka whakamahia i roto i ngā tikanga pēnei i te whakatika aneurysm me te tango thrombus. Me whakamahi tēnei i ngā tapahi laser ki runga i ngā momo konganuku tae atu ki te kowiri tira, te koura parakore, te platinum me te nitinol.
Pikitia 4. E whakamahia whānuitia ana hoki e Motion Dynamics te whakarewatanga taiaho. I runga ake nei, kua whakarewahia te koiri ki te ngongo tapahi taiaho.
He aha ngā kōwhiringa taiaho? I whakamārama a Witham he mea nui te kounga taha pai me te iti o ngā kerf mō te nuinga o ā rātou wāhanga, nō reira i te tīmatanga i pai ake ai rātou ki ngā taiaho USP. Hei tāpiri, kāore e taea te tapahi i tētahi o ngā rauemi e whakamahia ana e te kamupene e tētahi o ēnei taiaho, tae atu ki ngā wāhanga koura iti e whakamahia ana hei tohu radiopaque i roto i ētahi o āna hua. Engari i tāpiri atu ia ko ngā kōwhiringa ranu hou, tae atu ki ngā taiaho muka me ngā USP, ka hoatu ki a rātou he ngāwari ake ki te arotau i ngā take tere/kounga taha. "Kāore e kore ka taea e ngā muka whatu te whakarato i ngā tere teitei ake," ko tana kī. "Engari nā te arotahi o tā mātou tono, ko te tikanga o tēnei he momo tukatuka-muri, pērā i te horoi matū me te horoi ultrasonic, te whakakanapa hiko rānei. Nō reira, mā te whai mīhini ranu ka taea e mātou te whiriwhiri ko tēhea tukanga whānui - USP anake, te whakahaere muka me te tukatuka-muri rānei - te mea tino pai mō ia wāhanga. Ka taea e mātou te tūhura i te āheinga o te miihini ranu o te wāhanga kotahi, inā koa he nui ake ngā diameter me ngā matotoru pakitara e uru ana: tae atu ki te tapahi tere me ngā taiaho muka, kātahi ka whakamahia he taiaho femtosecond mō te tapahi pai." E matapaetia ana ko te USP laser te mea tuatahi hei whiriwhiri mā rātou nā te mea ko te nuinga o ā rātou tapahi laser he matotoru pakitara kei waenganui i te 4 me te 6 mano, ahakoa he matotoru pakitara kei waenganui i te 1-20 mano. Ko ngā paipa kowiri tira kei waenganui i te mano.
Hei whakamutunga, ko te tapahi me te keri taiaho he tukanga matua i roto i te hanga o ngā momo taputapu hauora. I ēnei rā, nā te whanaketanga o te hangarau taiaho matua me ngā mīhini tino arotau kua whirihorahia mō ngā hiahia motuhake o te umanga, he māmā ake te whakamahi i ēnei tukanga, ā, he pai ake ngā hua i mua.