CN101610731A - 用于双间室膝关节置换的计算机辅助外科手术方法和系统 - Google Patents

用于双间室膝关节置换的计算机辅助外科手术方法和系统 Download PDF

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CN101610731A
CN101610731A CNA2008800050766A CN200880005076A CN101610731A CN 101610731 A CN101610731 A CN 101610731A CN A2008800050766 A CNA2008800050766 A CN A2008800050766A CN 200880005076 A CN200880005076 A CN 200880005076A CN 101610731 A CN101610731 A CN 101610731A
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詹森·乔丹
C·卡森
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • A61B17/155—Cutting femur
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/25—User interfaces for surgical systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/11—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints

Abstract

本发明提供了一种为双间室假体切除股骨远端部分的远前部的方法。该方法包括生成股骨远端部分的几何表示。计算预定深度的虚拟前切除平面，并使其相对于股骨定向为预定角度。该方法标识出虚拟前切除平面的侧向部分的最远点和AP线。计算内翻/外翻角和前－后距离。根据由该方法计算的参数来导航前切除引导件和远端切除引导件。

Description

用于双间室膝关节置换的计算机辅助外科手术方法和系统
相关申请引用
[0001]本申请要求2007年2月14日提交的美国临时申请60/889,876的权益。
技术领域
[0002]本发明涉及计算机辅助外科手术。更具体地，本发明涉及用于局部膝关节假体的计算机辅助外科手术。
背景技术
[0003]用于全膝置换的计算机辅助外科手术系统和单髁系统是已知的。全膝置换，也被称作“三间室膝关节置换”对股骨上的内髁和外髁以及髌骨接触股骨的股骨髁内区，也称作滑槽进行置换。在该全膝置换系统中髌骨也可以被置换。在全膝置换的外科手术过程中，在移植之前通常要对膝关节韧带切口，使得外科医生可以接近膝关节。单髁膝关节置换系统置换髁骨中的任意一个(单髁假体)或者滑槽(髌股假体)。
[0004]对髁骨中的任一个以及滑槽进行置换的双间室膝关节置换外科手术可以在手术过程中使解剖髁突之一保持完整。此外，双间室置换可以是全膝置换的一种替换方式，可减少韧带损伤。用于双间室膝关节置换的外科手术方法使用附连并定位到股骨和胫骨的夹具和引导件以便通过股骨和胫骨的髓内管。与使用计算机辅助外科手术的外科手术过程相比，就相对于骨头对切割夹具进行定位而言，介入髓内管的引导件介入程度更大，并且可能引起栓塞的危险。
发明内容
[0005]在一个实施例中提供了一种切除股骨远端部分的远前部的方法。该方法包括生成股骨远端部分的几何表示。另一步骤在股骨远端部分的几何表示中创建股骨远端的前部上预定深度的虚拟前切除平面。该虚拟前切除平面相对于股骨在内/外旋转方向被定向成一预定角度。该方法选择所述虚拟前切除平面的侧向部分的最远点。另一步骤在股骨远端部分的几何表示上标识出(或称识别)AP线。该方法计算垂直于股骨机械轴线的平面和通过侧向部分的最远点和所述AP线的平面之间的内翻/外翻角。一步骤测量股骨髁突的后部和相交点之间的前-后距离。另一步骤在股骨髁突的后部和相交点之间的前-后距离确定的深度垂直于所述AP线导航前切除引导件。该方法包括根据所述内翻/外翻角，导航被定位的远端切除引导件。
[0006]在一个替代性实施例中，股骨的髁突可以是内髁。
[0007]在该方法的一个替代性实施例中，可以由点云(point cloud)计算几何表示。
[0008]替代性地，可以由MRI计算所述几何表示。
[0009]另一替代性实施例包括一种方法，其中根据屈曲-伸展平衡进一步调节远端切除深度。
[0010]一个替代性实施例提供了一种用于切除股骨远端部分的远前部的系统。该系统包括所述股骨远端部分的几何表示。在所述股骨远端部分的几何表示中，提供股骨远端的前部上预定深度的虚拟前切除平面。该虚拟前切除平面相对于股骨在内/外旋转方向被定向成一预定角度。所述虚拟前切除平面包括在股骨远端部分的几何表示中所述虚拟前切除平面的侧向部分的最远点以及AP线。所述几何表示在股骨髁突的后部和相交点之间具有前-后距离。计算机代码可以被配置成计算垂直于股骨机械轴线的平面和通过侧向部分的最远点和所述AP线的平面之间的内翻/外翻角。前切除引导件可以在由股骨髁突的后部和相交点之间的前-后距离确定的深度垂直于所述AP线而被导航。远端切除引导件可以根据所述内翻/外翻角而被导航。
[0011]一种替代性系统可以提供：股骨的髁突可以是内髁。
[0012]在另一实施例中，所述几何表示是由点云计算的。
[0013]在另一实施例中，所述几何表示是由MRI计算的。
[0014]替代性地，远端切除深度是根据屈曲-伸展平衡被进一步调节的。
[0015]在又一实施例中，提供附着到所述前切除引导件和远端切除引导件的基准件和附着到所述股骨的基准件。
附图说明
[0016]并入说明书并形成说明书一部分的附图对本发明的实施例进行了图解说明，而且与说明书的文字部分一起用来解释本发明的原理、特性和特征。附图中：
[0017]图1是双间室膝关节假体的一个例子；
[0018]图2是股骨的前切除引导件的一个例子；
[0019]图3是股骨的远端切除引导件的一个例子；以及
[0020]图4是根据本发明一个方面的用来切割股骨的步骤的流程图。
具体实施方式
[0021]以下对优选实施例的说明本质上只是示例性的，决不打算用来限定本发明及其应用或用途。
[0022]现在参见附图，图1是双间室膝关节假体10的一个例子。假体10包括股骨部件12和胫骨部件14。股骨部件12包括髁突部16和滑槽部18。胫骨部件14包括接合面20和胫骨盘22。
[0023]股骨部件12被配置成遮盖股骨髁突和滑槽。尽管示出的图1的假体10是内髁双间室假体，但外髁双间室假体也类似地遮盖一个股骨髁突和滑槽。内髁双间室假体的形状可以与外髁双间室假体的形状不同。在任一实施例中，股骨假体10被配置成通常近似于股骨的自然形状。
[0024]胫骨部件14包括接合面20和胫骨盘22。胫骨盘22被配置成附连到胫骨并支持接合面20。接合面20的形状通常与股骨部件12的髁突部16的轮廓相符。接合面20可以由例如聚乙烯材料制成，这可以促使接合面20和股骨部件12之间的摩擦干扰最小。接合面20可以使股骨部件12相对于胫骨部件14旋转，同时提供将力分量从股骨部件12传送到胫骨部件14的表面。
[0025]为了使股骨部件12和胫骨部件14置于人本身的股骨和胫骨上，必须从股骨和胫骨上拿掉骨头。当拿掉骨头时，股骨部件12和胫骨部件14可以凹陷到与组件12和14周围的人本身的骨头齐平。骨头的几何形状非常复杂，因人而异。当切割远离股骨和胫骨的骨头时，必须考虑诸如切割深度、切割角度(所有方向上的)和切割长度之类的变量。如图2和图3中所示的切除引导件，在计算机辅助外科手术系统中实现时，对这些切割变量进行设置。
[0026]现在来看图2，图2是股骨32的前切除引导件30的一个例子。诸如钉子34和桨状物(paddle)36之类的保持部件使前切除引导件30相对于股骨32定位、放置。远端的钉子38还可以使切除引导件相对于股骨32定位和放置。定位放置部件34-38被配置成将前切除引导件30定位在刀状引导件40被定位为从股骨32的前表面上取出股骨32的凹陷部42的位置处。定位放置部件34-38对前部切割的角度方向进行设置。附着到40的深度量规44对前部切割的深度进行设置。
[0027]现在来看图3，图3是股骨32的远端切除引导件50的一个例子。由计算机辅助外科手术系统定义的过渡点52是开始进行远端切割的点。抵靠前部切口的桨状物54使远端切除引导件50相对于前部切口定向。外翻筒夹(valgus collet)56关于远端切除引导件50的对齐引导件60对由方向58定义的角位移进行定向。远端切除引导件50被定位成以距离过渡点52的某一角度来切割股骨32的远端部，在由前表面到后表面进行切割时过渡点向内延伸。外翻筒夹56对切口的外翻对齐进行定向。前切除和远端切除一起确定假体和人本身的骨头之间的过渡区。
[0028]切除引导件30和切除引导件50一起对前切除和远端切除进行定位和定向。这些切除形成用于放置假体的基本切口。引导件30和50的尺寸使得从移植表面到股骨32的人本身骨头的过渡大致是连续的。为了使假体大致连续，必须根据股骨32的几何形状放置切除引导件。几何形状可以由通过CT扫描、MRI或其它扫描技术生成的表面的点云表示来确定。几何形状还可以由引用来自CT扫描、MRI或其它扫描技术的具体参考点来表示。当所计算的几何形状在计算机辅助外科手术系统内被分立并通过例如附着到股骨的物理几何形状、附着到引导件30和远端切除引导件50的基准件被传送到股骨的物理几何形状时，可以适当放置切除引导件，产生股骨32的适当切除。可以在计算机辅助外科手术中记录基准件，以便使切除引导件30和50相对于股骨适当定向和定位。在去掉被切除的骨头的前部远端部时，可以使用股骨切割块来进行另外切割，使骨头的轮廓符合假体10的内部。
[0029]现在来看图4，图4是根据本发明的一个方面用于切割股骨的流程图步骤。在步骤70，方法开始。在步骤72，创建虚拟前切除平面。步骤74确定远端相交点。在步骤76，创建AP线。在步骤78，生成通过相交点和AP线的平面。步骤80报告相交点和后参考系之间的距离。步骤82报告移动效果。通过步骤72-82的计算，在步骤84中引导前切除和远端切除。在步骤86，完成股骨准备。在步骤88，方法结束。
[0030]在步骤72，创建与前皮层正切的虚拟前切除平面。该平面用来确定前切除与股骨表面相交的表面点。在步骤74，从步骤72的虚拟前切除平面和由股骨几何形状计算的接合点云计算相交点，以确定接合点云和虚拟前切除平面的最远切除点。在步骤76，还由点云计AP线。计算在最近点正切于滑槽的AP线。
[0031]在步骤78，相交点和AP线一起用来定义平面。报告该表面和机械轴线之间的角度。该平面可以用来确定外翻角，并且可以用来确定相对于髁突远端的点云参考系确定的远点的角度，该远点在远端点云的最远点。该远端参考系用来确定距离相交点的前-后距离。在步骤82，报告在外翻角上的向前或向后的移动效果和远端切除。所有计算都用来定位和放置前切除引导件和远端切除引导件，以便进行切除。在步骤84，导航引导件，使得在移植物和股骨的外侧远端软骨之间有光滑的过渡区。在步骤86，完成股骨切割块在前切除和后部切除上的切口，完成股骨准备。在步骤88，方法结束。
[0032]以上所述的方法和装置能够在不需要使用可能会增加脂肪栓塞的IM杆的情况下完成股骨准备。由于在进行任一切除前会对切除进行计算，所以可以增加前切除和远端切除的设置准确度。这也可以在骨头和移植物之间的过渡区中适当放置装置，以及适当计算过渡点。
[0033]尽管已经关于股骨组件描述了所述的系统和方法，但类似地，所述方法和系统可以用来计算胫骨切除，并且可以计算相对于股骨准备的胫骨切除。此外，诸如超声之类的附加成像方法可以用来执行对切除的几何形状的计算。
[0034]例如，股骨准备可以包括生成股骨远端部分的几何表示。另一步骤在股骨远端部分的几何表示中，在股骨远端的前部上的预定深度创建虚拟前切除平面。该虚拟前切除平面相对于股骨在内/外旋转方向被定向成一预定角度。该方法选择虚拟前切除平面的侧向部分的最远点。另一步骤在股骨远端部分的几何表示上标识出AP线。该方法计算垂直于股骨机械轴线的平面和通过侧向部分的最远点和AP线的平面之间的内翻/外翻角。一个步骤测量股骨髁突的后部和相交点之间的前-后距离。另一步骤在由股骨髁突的后部和相交点之间的前-后距离确定的深度垂直于AP线导航前切除引导件。该方法包括根据内翻/外翻角，导航被定位的远端切除引导件。
[0035]在一种具体实施例中，股骨的髁突可以是内髁，可以由点云或MRI来计算几何表示。可以根据屈曲-伸展平衡来进一步调节远端切除深度。
[0036]一种替代性实施例提供一种用于切除股骨远端部分的远前部的系统。该系统包括股骨远端部分的几何表示。在股骨远端部分的几何表示中，提供股骨远端的前部上预定深度的虚拟前切除平面。该虚拟前切除平面相对于股骨在内/外旋转方向被定位成一预定角度。该虚拟前切除平面包括在股骨远端部分的几何表示上的虚拟前切除平面的侧向部分的最远点以及AP线。该几何表示在股骨髁突的后部和相交点之间具有前-后距离。计算机代码可以被配置成计算垂直于股骨机械轴线的平面和通过侧向部分的最远点和AP线的平面之间的内翻/外翻角。前切除引导件可以在由股骨髁突的后部和相交点之间的前-后距离确定的深度上垂直于AP线而被导航。远端切除引导件可以根据内翻/外翻角而被导航。
[0037]一种具体实施例可以提供：股骨的髁突可以是内髁。可以由点云或MRI来计算几何表示。可以根据屈曲-伸展平衡来进一步调节远端切除深度。基准件可以被附着到所述前切除引导件和远端切除引导件，基准件可以被附着到股骨。
[0038]在不偏离本发明范围的前提下，可以对以上参考相应图示说明描述的示例性实施例进行各种变型，前述说明书中包含的附图中显示的所有资料应被解释为示例性的，而不是限制性的。因此，本发明的广度和范围不应被上述的示例性实施例限制，应该仅根据所附权利要求来定义本发明的宽窄和范围。

Claims (11)

1.一种切除股骨远端部分的远前部的方法，包括以下步骤：
生成股骨远端部分的几何表示；
在股骨远端部分的几何表示中创建股骨远端的前部上预定深度的虚拟前切除平面，该虚拟前切除平面相对于股骨被定向成在内/外旋转方向一预定角度；
选择所述虚拟前切除平面的侧向部分的最远点；
在股骨远端部分的几何表示上标识出AP线；
计算垂直于股骨机械轴线的平面和通过侧向部分的最远点和所述AP线的平面之间的内翻/外翻角；
测量股骨髁突的后部和相交点之间的前-后距离；
以由股骨髁突的后部和相交点之间的前-后距离确定的深度垂直于所述AP线导航前切除引导件；以及
根据所述内翻/外翻角对被定向的远端切除引导件进行导航。
2.根据权利要求1所述的方法，其中股骨髁突是内髁。
3.根据上述权利要求中任一项所述的方法，其中所述几何表示是由点云计算的。
4.根据上述权利要求中任一项所述的方法，其中所述几何表示是由MRI计算的。
5.根据上述权利要求中任一项所述的方法，其中根据屈曲-伸展平衡进一步调节远端切除深度。
6.一种用于切除股骨远端部分的远前部的系统，包括：
所述股骨远端部分的几何表示；
在所述股骨远端部分的几何表示中股骨远端的前部上预定深度的虚拟前切除平面，该虚拟前切除平面相对于股骨在内/外旋转方向被定向成一预定角度；其中所述虚拟前切除平面包括在股骨远端部分的几何表示中所述虚拟前切除平面的侧向部分的最远点以及AP线，所述几何表示在股骨髁突的后部和相交点之间具有前-后距离；
计算机代码，其被配置成计算垂直于股骨机械轴线的平面和通过侧向部分的最远点和所述AP线的平面之间的内翻/外翻角；
前切除引导件，其在由股骨髁突的后部和相交点之间的前-后距离确定的深度处垂直于所述AP线被导航；以及
远端切除引导件，其根据所述内翻/外翻角被导航。
7.根据权利要求6所述的系统，其中股骨髁突是内髁。
8.根据权利要求6或7所述的系统，其中所述几何表示是由点云计算的。
9.根据权利要求6-8中任一项所述的系统，其中所述几何表示是由MRI计算的。
10.根据权利要求6-9中任一项所述的系统，其中远端切除深度是根据屈曲-伸展平衡被进一步调节的。
11.根据权利要求6-10中任一项所述的系统，进一步包括附着到所述前切除引导件和远端切除引导件的基准件和附着到所述股骨的基准件。
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