CN104869919A - Surgical perforation guide - Google Patents
Surgical perforation guide Download PDFInfo
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- CN104869919A CN104869919A CN201480002607.1A CN201480002607A CN104869919A CN 104869919 A CN104869919 A CN 104869919A CN 201480002607 A CN201480002607 A CN 201480002607A CN 104869919 A CN104869919 A CN 104869919A
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- Prior art keywords
- guide member
- surgical operation
- drill
- bone
- perforation guide
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/14—Surgical saws ; Accessories therefor
- A61B17/15—Guides therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/14—Surgical saws ; Accessories therefor
- A61B17/15—Guides therefor
- A61B17/151—Guides therefor for corrective osteotomy
- A61B17/152—Guides therefor for corrective osteotomy for removing a wedge-shaped piece of bone
Abstract
The present application relates to a surgical perforation guide (200) to be fixated against a target bone. Said surgical perforation guide (200) comprises at least one first elongated slot (201) or at least one protrusion (250) defining a first osteotomy plane (A) and multiple drill guiding bores (202a - 202z). The multiple drill guiding bores (202a - 202z) have a diameter and a central axis (X), the central axes (X) of the drill guiding bores (202a - 202z) lying parallel to said first osteotomy plane (A). The diameter of the multiple drill guiding bores (202a - 202z) intersects the osteotomy plane (A).; Each of the multiple drill guiding bores (202a - 202z) comprises a drill seat (203a - 203z) providing a stop surface for a drill (400), said drill seat (203a - 203z) limiting the drilling depth to a specific required drilling depth (312) for each of the multiple drill guiding bores (202a - 202z).
Description
Technical field
The present invention relates to a kind of surgical operation perforation guide member, it opens cuneiform osteotomy and closed wedgeshaped osteotomy specifically for carrying out knee.
Background technology
Knee osteotomy is the surgical method of Micoud Leech line (Mikulicz-line) of large joint, i.e. buttocks for aiming at lower limb, knee and ankle.Under the normal axial alignment case of limbs, the center of the center of buttocks, the intercondylar eminence of tibial plateau and ankle arthrosis at a line, i.e. so-called Mikulicz line, the namely axial alignment of lower limb.Such as due to joint (arthritic) damage on knee side, congenital dislocation or traumatic lesion, this aims at may be disturbed and cause the excessive wear of knee cartilage.This is sick also referred to as knee endoprosthesis.
The object of knee osteotomy surgical technic is by the region of the power in knee from the affected area rebalancing of knee to contrary health.This allows the power produced by the body weight on patient knees joint and muscle that distributes better.There is the technology that two kinds common in clinical practice, namely open cuneiform osteotomy and closed cuneiform osteotomy.The object of these two kinds of technology is partly or wholly to build above-mentioned Mikulicz line again.
When carrying out closed cuneiform osteotomy, under tibial plateau, remove sphenoid.Wound plate and screw is used to fix drop-down for tibial plateau with closed gap subsequently.
When carrying out opening wedged-shaped technique, under tibial plateau about 80% surface on carry out horizontal bone and cut.Then wedge-like pad is inserted.Therefore, tibial plateau is forced in side and improves to correct leg axis.Wedge-like pad can by the material of nature bone, artificial bone or other biological perhaps Integrated implant (osteointegrative) mutually.Pad is fixed to bone by plate and screw usually.Writing this osteotomy for patient provides significant benefit, because it contributed to the time retardation of whole for possible replacing knee up to 10 years.
In order to help surgeon to carry out wedgeshaped osteotomy, known several guide member in the prior art.Such as, US 7,185,645 (Hudson Surgical Design Inc.) discloses as the plane cutting instruments such as such as oscillating bone saw provide the device of guiding face.Described cutting tool thus guided by the tangential face of multiple pin members of the inside being positioned at bone to be corrected.Two or more described pin members define the predetermined plane in the excision face that will be generated by cutting tool.
US 2008/0262500 A1 (Howmedica Osteonics Corp.) describes a kind of cutting guidance part of the osteotomy operation for carrying out bone, it has the first arm and the second arm, described first arm has the first guiding face be formed at wherein, and described second arm has the second guiding face be formed at wherein.First arm is connected each other pivotly with the second arm.In addition, cutting guidance face can comprise circular groove, and this circular groove defines drill guide part, thus allows to guide drill bit to enter in bone when described two arms are in the close position.
US 5,021,056 (Intermedics Orthopedics Inc.) discloses a kind of method and apparatus for carrying out osteotomy.Described device comprises the first guide set piece installing, and this first guide set piece installing has the mirror image jig arm assembly comprising clamping plate for a pair separately.Jig arm can be free to slide along the first guide set piece installing.The feature of each clamping plate is multiple bore hole and the guide groove for cutting tool.Under the help of the first guide set piece installing, form the first otch by guide groove in bone, therefore clamping plate are stablized by the bone securing member be inserted in described multiple bore hole.Then, remove the first guide set piece installing, and on described bone, arrange the second guide set piece installing, wherein in the otch of bone, insert flat sword element.Second guide set piece installing comprises several guide grooves, thus allows to form the otch becoming different angles with described first otch, to create suitable wedge in described bone.
Although open wedge shape and closed cuneiform osteotomy provides advantage, this technology is often relevant to complication, and this may cause patient not feel well between convalescence, or makes surgical operation therapy itself complicated.Such as, one of challenge larger in surgical operation operation process is that bone is only cut to certain depth, then when not making tibial plateau fracture or depart from (so-called iatrogenic fracture) to be risen on deep place by Proximal Tibial Plateau.
Summary of the invention
The object of the invention is to create the perforation guide member relating to the technical field mentioned at first, it contributes to the carrying out of opening cuneiform osteotomy and closed cuneiform osteotomy, and reduces the risk of iatrogenic fracture in operation process.The solution of the present invention described in detail by the feature of claim 1.According to the present invention, described surgical operation perforation guide member is intended to lean on targeted bone to be fixed, and comprises at least one first elongated slot or at least one outthrust of defining the first deep plane.In addition, described surgical operation perforation guide member comprises multiple drill guide bore hole, described drill guide bore hole has diameter and central axis separately, the centerline axis parallel of wherein said multiple drill guide bore hole is in described first deep plane, and the diameter of each bore hole in described multiple drill guide bore hole and described first deep Plane intersects.In addition, each bore hole in described multiple drill guide bore hole comprises drill headstock, this drill headstock provides stop surface for drill bit, and wherein drilling depth is limited to the specific required drilling depth for each bore hole in described multiple drill guide bore hole by each described stop surface.By providing drill headstock, likely avoid, by surgeon, drill bit was advanced the far soft tissue injury of the opposite side of the bone caused.In addition, drill headstock also allows the degree of depth accurately controlling the hole pierced in bone, makes bone can by local weakness fully to increase its pliability, avoids the generation of iatrogenic fracture when to be opened by wedge with convenient surgeon or close.
Surgical operation perforation guide member preferably includes rigid bodies, it is more preferably configured to biocompatible materials block, described biocompatible materials is such as rustless steel, titanium or biocompatible polymer, such as polyether-ether-ketone (PEEK) or polylactic acid (PLA).Described rigid bodies is preferably shaped as cubic form generally, and this cube has the face that being suitable for contacts to earth with targeted bone places, and such as, has suitable curvature, and the length of wherein said bone contact surface roughly corresponds to the size of lateral of tibia.At least one first elongated slot described is that plane cutting instrument (such as the saw blade of reciprocating bone saw) provides two guiding faces.Therefore, at least one first elongated slot described allows accurately along described first deep plane guide plane cutting tool.Preferably, select the thickness of at least one elongated slot described to mate the thickness of saw blade.Or surgical operation perforation guide member can comprise at least one outthrust, and wherein said outthrust is preferably suitable for being inserted in the otch of bone.Therefore, described at least one outthrust guide member that allows surgical operation to bore a hole accurately is registered in the otch such as formed by bone saw.
Due to diameter and the first deep Plane intersects of multiple drill guide bore hole, therefore each described drill guide bore hole comprises described first deep plane.Preferably, multiple drill guide bore hole is arranged on described surgical operation perforation guide member, is in described first deep plane to make its axis.Or the axis of described multiple drill guide bore hole from described first deep planar offset, but can also be no more than the half of its diameter.In this application, " skew " mean the distance with described first deep plane on the direction perpendicular to the first deep plane.
Preferably, the axis of all described drill guide bore holes is not only parallel to described first deep plane, but also all parallel to each other.Or at least one bore hole in described drill guide bore hole can have the angled axis of axis with all the other bore holes in described drill guide bore hole.Preferably, all axis of described drill guide bore hole are all from the distance that described first deep planar offset is identical.Or the distance that at least one bore hole in described drill guide bore hole can offset is less than or greater than the distance of axis from described first deep planar offset of all the other drill guide bore holes.
Preferably, all multiple drill guide bore holes are evenly distributed in the length of bone contact surface, that is, all multiple drill guide bore holes are spaced apart from each other identical distance.Or the distance between two adjacent drill guide bore holes can change along the length of bone contact surface.
Term " multiple " is understood to include any number being greater than.Preferably, surgical operation perforation guide member comprises 2 to 20 drill guide bore holes, more preferably 4 to 10 drill guide bore holes.
Drill guide bore hole preferably has the diameter of scope from 1.2mm to 4.0mm.Correspondingly, to have with existing surgical operation any drill bit that guide member uses relatively of boring a hole the diameter mated.
Drill headstock is preferably configured to the surface that the stop-motion seat corresponding on drill bit matches, thus stops physically by the further propelling of surgeon to drill bit.The specific required drilling depth of each drill guide bore hole according to carry out wherein osteotomy targeted bone area and change.Usually, for the drill guide bore hole be positioned at towards surgery surgical punch guide member side, required drilling depth is less, this is because these bore holes will be arranged in the both sides of targeted bone simultaneously; And for being positioned at the drill guide hole at center of surgical operation perforation guide member, required drilling depth is larger.It will be recognized by those skilled in the art, the required drilling depth of multiple drill guide bore hole depends on the type of targeted bone and the position of osteotomy, such as, and proximal tibia, distal femur, near end of thighbone etc.In addition, the build of patient to be dealt with and the Individual Size of therefore she or he bone also can affect the required drilling depth of each bore hole in multiple drill guide bore hole.
Preferably, each drill headstock is arranged on described perforation guide member, to limit drilling depth according to patient specific data.More preferably, the required drilling depth of each bore hole in described multiple drill guide bore hole corresponds to the distance of the cortex of the bone on the fixation side opposite being positioned at described surgical operation perforation guide member.
Patient specific data is preferably such as by means of X ray computer tomoscan (CT scan), nuclear magnetic resonance (MRI scanning) or 3D x-ray imaging, the imaging data collected before surgery Surgery Surgery.According to the concrete imaging data of this patient, drilling depth needed for the best can determining each bore hole in described multiple drill guide bore hole.Preferably, surgical operation perforation guide member according to the present invention is that each patient is customized.This allows the convenient adaptation of the position of the drill headstock of each bore hole in described multiple drill guide bore hole.
There is provided required drilling depth to match the distance of the cortical bone being positioned at the surgical operation perforation fixation side of guide member or the opposite side of fixed area can allow to weaken described cortex fully, make it at the closed of wedge subsequently or open in process and can not break.This considerably reduce the generation of iatrogenic fracture.
Preferably, described surgical operation perforation guide member also comprises the face for contact target bone, and described bone contact surface has the shape matched with the external shape of described targeted bone.This contributes to the surgical operation placement of perforation guide member in described targeted bone and attachment.
Again, preferably adaptive described shape is carried out according to patient specific data, the preferential imaging data according to collecting before surgery Surgery Surgery.To it will be understood to those of skill in the art that or described bone contact surface is machined into have correct shape, or described surgical operation perforation guide member is for every patient is customized.
Described surgical operation perforation guide member preferably includes at least one elongated slot and provides guiding face to limit the exterior face of the excision degree of depth of described saw blade in described bone for saw blade.
Thus described exterior face is arranged in the side relative with described bone contact surface, and is arranged to the stop surface serving as the saw blade seat be positioned on saw blade.Thus described shape is selected to give best geometry to the otch formed in described targeted bone with saw blade.Preferably, described exterior face is concave surface.Such geometry of exterior face creates saw blade depth of cut more shallow and darker towards the center of bone towards the both sides of bone in targeted bone.
Preferably, the shape of described exterior face is arranged so that the excision degree of depth preferably changes along at least one elongated slot described according to patient specific data.Preferably, the shape of described exterior face is arranged so that the geometry of the otch formed by bone saw sheet is by with described the coordinating of saw blade seat of bone saw sheet and the targeted bone for patient is optimized.Therefore, the shape of described exterior face most preferably based on patient specific data, be preferably the concrete imaging data of patient and determine.Surgical operation perforation guide member preferably includes the first elongated slot and the second elongated slot, described second elongated slot defines the second deep plane, this second deep horizontal layout is angled with described first elongated slot, wherein configures the second elongated slot to make described second deep plane crossing in described bone with described first deep plane.There is provided the second elongated slot can allow along described second deep plane to the clean cut of targeted bone, thus produce with two of wedge-shaped arrangement otch.Preferably, the described angle of described second elongated slot and the position of described second elongated slot on described surgical operation perforation guide member is selected according to patient specific data, the preferably concrete imaging data of patient, can allow the clean cut to wedge, this will cause once remove the best that namely described wedge obtain Mikulicz line and again aim at.
Preferably, surgical operation perforation guide member comprises multiple outthrust, and the size and shape of described outthrust is configured to for being inserted in the excision otch of described targeted bone.When carrying out closed cuneiform osteotomy, such configuration of the guide member that can make surgically to bore a hole, accurately aims at this is because described multiple outthrust to be placed in otch the guide member that can allow surgical operation to bore a hole with described otch.Therefore, by using such surgical operation perforation guide member, boring can accurately be placed in targeted bone, this is because drill guide bore hole also will be precisely placed in correct position by surgeon.
Surgical operation perforation guide member preferably also comprises at least one fastener receiver hole.By bone securing member, such as bone screw being inserted at least one fastener receiver hole described, guide member of surgical operation can being bored a hole is attached to targeted bone securely.
The application also relates to and comprises at least one has the drill bit of stop-motion seat external member according to surgical operation perforation guide member of the present invention and at least one.
The stop-motion seat of configuration drill bit is to match with the drill headstock of described drill guide bore hole.Thus stop-motion seat is arranged in the fixed range place apart from bit point of the drill.Preferably, described external member can comprise several drill bits, and each drill bit has the stop-motion seat be arranged in apart from bit point of the drill different distance place.Or replace stop-motion seat, at least one drill bit described can comprise at least one and be arranged in the labelling limiting distance apart from bit point of the drill.In this case, once described labelling and described drill headstock are superimposed, surgeon just can determine whether to reach specific required drilling depth.
Preferably, described external member also comprises at least one saw blade, and this saw blade has the outthrust defining saw blade seat.Especially relevant to guide member of boring a hole with the surgical operation with the exterior face limiting shape, saw blade seat and the cooperation of described exterior face shape produce the otch having and define the main geometry corresponding with the shape of the exterior face in the first deep plane.The application also relates to the method for the production of guide member of preferably boring a hole according to surgical operation of the present invention.In a first step, the position of each drill guide bores in multiple drill guide hole and required drilling depth is limited according to patient specific data.Described patient specific data is preferably the concrete imaging data of patient.In the second step, the position of the drill headstock of each bore hole in described multiple drill guide bore hole is determined according to required drilling depth.In third step, produce surgical operation perforation guide member.Produce and carry out preferably by machining or increasing material manufacturing technology (additive manufacturing technique).Those skilled in the art know suitable Machining Technology, such as milling, to be produced surgical operation perforation guide member by a block of material, such as metal.Increase material manufacturing technology and comprise selective laser sintering, direct metal sintering, selective laser consolidation, selective thermal sintering, electron beam Non-mould shaping and fusion sediment modeling, and other technologies.
It is also understood that the production of surgical operation perforation guide member can use several different technologies to carry out.Such as, production rigid bodies can be carried out by increasing material manufacturing technology, and make it to stand mechanical processing technique in subsequently, such as to produce described drill guide bore hole or at least one first elongated slot described.
Preferably, described method is further comprising the steps of: before described production stage, by the shape of the predetermined contact area by patient's concrete imaging data determination targeted bone, is defined for the shape in the face of contact target bone.
Preferably, described method is further comprising the steps of: before described production stage, according to necessity excision degree of depth from the concrete imaging data of patient, limits the shape of exterior face.
Following detailed description of the invention and whole claim disclose other Advantageous embodiments and characteristics combination.
Accompanying drawing explanation
Below with reference to the accompanying drawings specific embodiment is explained, in the accompanying drawings:
The closed cuneiform osteotomy of Fig. 1 a, 1b knee;
Fig. 2 a, 2b knee open cuneiform osteotomy;
The example of the iatrogenic fracture of Fig. 3 a, 3b;
Fig. 4 a-4c is according to the different views of the first embodiment of surgical operation perforation guide member of the present invention;
Fig. 5 and Design and manufacture surgical operation are bored a hole the surface of bone of the relevant tibia of guide member;
Fig. 6 a, 6b will to bore a hole the Alternate embodiments of drill bit that guide member uses relatively with surgical operation according to the present invention;
Fig. 7 a, 7b will to bore a hole the Alternate embodiments of saw blade that guide member uses relatively with surgical operation according to the present invention;
Fig. 8 is used for according to the design of surgical operation perforation guide member of the present invention and the relevant anatomy gauge point of size setting;
Fig. 9 a-9c is used for the operating procedure of the surgical operation perforation guide member according to Fig. 4 a;
Figure 10 a-10c uses the drill process according to surgical operation perforation guide member of the present invention;
The sectional view of Figure 11 boring;
Figure 12 a-12b uses the sawing step according to surgical operation perforation guide member of the present invention;
The cross-sectional view of Figure 13 sawing;
Figure 14 is according to the second embodiment of surgical operation perforation guide member of the present invention;
Figure 15 a, 15b are according to the 3rd embodiment of surgical operation perforation guide member of the present invention;
The Alternate embodiments of Figure 16 a, 16b surgical operation perforation guide member.
In the accompanying drawings, identical parts use identical label.
Detailed description of the invention
Fig. 1 a and Fig. 1 b shows for kneed closed cuneiform osteotomy.Femur 100 and tibia 101 interact at knee joint 102 place.At the excision plane place limited through on the cross-sectional area of the about 60-90% of proximal tibia, under joint 102, form the first plane excision 104.Then formation and the first plane are excised 104 angled second planes and are excised 107.Described first plane excision 104 and described both second plane excisions 107 limit wedge 103.Remove this this wedge 103 subsequently and under push away the far-end of Proximal Tibial Plateau to rebuild axial alignment 106 (Mikulicz line) and such as to fix this Proximal Tibial Plateau with plate and screw (not shown).
Fig. 2 a and Fig. 2 b depicts and opens cuneiform osteotomy.Form the first plane excision 104.Then bone wedge 105 is inserted in the first plane excision 104.Bone wedge 105 will promote tibial plateau in inner side and rebuild correct axial alignment 106 (Mikulicz line).Such as use plate or screw (not shown) by bone wedge 105 fix in position.Ideally, not cut cortex makes self to be adapted to reorientating of tibial plateau by natural pliability such as elastic deformation and moulding deformation.If the pliable and tough not and hypertonia be applied thereto of not cut cortex, then tibial plateau may break.
With reference to figure 3a and Fig. 3 b, there is shown the example of contingent iatrogenic fracture 107 in osteotomy process.Iatrogenic fracture 107 like this may be the result of lifting or drop-down Proximal Tibial Plateau.As mentioned before, not enough in the pliability that not cut bone in region 108 owing to caused by the material character (elastic modelling quantity and elasticity) of bone material of so iatrogenic fracture 107.In addition, if the excision degree of depth 110 of described first plane excision 104 is too short and cause the remaining region 108 that do not cut bone to show stronger resilience to any bending force, so iatrogenic fracture 107 may also be caused.Fig. 4 a shows the illustrative embodiments according to surgical operation perforation guide member 200 of the present invention.Surgical operation perforation guide member 200 comprises rigid bodies 210, and this rigid bodies 210 has cubic shaped generally.This rigid bodies has bone contact surface 204, for contact target bone.Described bone contact surface 204 preferably presents the shape corresponding with the external shape will carrying out the region of the targeted bone of osteotomy wherein.On the opposite of described bone contact surface 204, surgical operation perforation guide member 200 comprises exterior face 205.Exterior face 205 is that surgical operation bores a hole guide member 200 in operation process towards surgical side.Elongated first groove 201 is across to described bone contact surface 204 from described exterior face 205, and provides two guiding faces for the saw blade of plane cutting instrument such as reciprocating bone saw.In addition, surgical operation perforation guide member 200 comprises seven drill guide bore hole 202a-202z.For the application, indication numbers a to z for identifying multiple entities of same feature, and does not imply that the number for described entity has any concrete restriction.Each described drill guide bore hole 202a – 202z has central axis X, and this central axis X is parallel to the first deep plane A limited by described first elongated slot 201.For the sake of simplicity, illustrate only a central axis X.The central axis X of each described drill guide bore hole 202a – 202z is parallel to described first deep plane A.In addition, in the present embodiment, the central axis X of all drill guide bore hole 202a – 202z and described first deep plane A are superimposed.In addition, each described drill guide bore hole 202a – 202z comprises the drill headstock 203a-203z caved in from described exterior face 205.Drill headstock 203a – 203z provides stop surface for the drill bit be inserted in described drill guide bore hole 202a – 202z.By changing the position of each described drill headstock 203a – 203z, specific drilling depth can be limited for each bore hole in multiple drill guide bore hole 202a – 202z.In addition, surgical operation perforation guide member comprises two fastener receiver holes 221a, 221b.Fastener receiver hole 221a, 221b are arranged to and receive bone securing member so that described surgical operation perforation guide member 200 is attached to targeted bone.
Fig. 4 b shows the surgical operation perforation guide member 200 according to Fig. 4 a from another visual angle, and Fig. 4 c shows surgical operation perforation guide member 200 from bone contact surface 204.Make following description for Fig. 5 to Figure 15 about opening cuneiform osteotomy, described in open cuneiform osteotomy and mean to carry out Partial Resection toward the outer side from tibial medial.Thus excision guide member is fixed to inside before proximal tibia, and by the perforation of the lateral cortex of tibia to weaken cortical bone, so that the lifting of tibial plateau can be allowed.
For closed wedged-shaped technique, inner side must be read as outside, and outside must be read as inner side, forces upwards must be read as to force downwards.
Fig. 5 shows the surface of bone region of tibia 300, and itself and the Design and manufacture surgical operation such as shown in Fig. 4 a to Fig. 4 c guide member 200 of boring a hole is relevant.As being hereafter described in more detail, the shape of exterior face 205 defines the excision degree of depth 110.The related data of surface of bone can be collected by CT scan, MRI scanning or 3D x-ray imaging.The shape of bone contact surface 204 is configured to the negative-appearing image of the front inner side 301 of tibia 300, and therefore closely cooperates with the shape on the surface of described front inner side 301.As skilled in the art to understand, bone contact surface 204 this moulding permission based on preoperative plan and patient specific data in surgery Surgery Surgery process to the definite location of surgery surgical punch guide member 200.
The outside of record tibia 300, to limit drilling depth needed for each drill guide bore hole 202a – 202z, to bore a hole the lateral cortex 303 of the opposite side of tibia 300.Described perforation is ideally issued to and runs through lateral cortex 303, but is not deeper than outer cortex.Darker penetrating may cause damage to soft tissue structure, and for example, described soft tissue structure is such as the muscle on lateral cortex 303 side, tremulous pulse or nerve.
See Fig. 6 a, there is shown and will to bore a hole the preferred implementation of drill bit 400 that guide member 200 uses relatively with surgical operation according to the present invention.Described drill bit 400 has the drillable length 401 of calibration, and this drillable length 401 limited by stop-motion seat 402.When the bores are being drilled, stop-motion seat 402 will meet the drill headstock 203a-203z that drill bit 400 is inserted in drill guide bore hole 202a – 202z wherein, thus stop drill bit 400 to any further propelling in bone, therefore physically possible drilling depth is limited to the specific required drilling depth of described drill guide bore hole 202a – 202z.
Fig. 6 b illustrates the Alternate embodiments of drill bit 400, and it has the drillable length 401 of the calibration limited by labelling 403.When using the drill bit 400 according to this Alternate embodiments, surgeon must determine when to stop boring by vision.
Fig. 7 a shows and will to bore a hole the preferred implementation of saw blade 500 that guide member 200 uses relatively with creationary surgical operation.Described saw blade 500 has the sawing length 501 of calibration, and this sawing length 501 limited by stationary saw bar 502.In operation, saw blade seat 502 encounter surgical operation perforation guide member 200 exterior face 205, therefore limit physically surgeon can saw in bone into the degree of depth.Saw blade 500 has thickness 503, and this thickness 503 corresponds to the thickness of the first elongated slot 201.In addition, saw blade 500 has the sawtooth 504 being positioned at one end and the coupled structure 505 being positioned at opposite end.Coupled structure 505 allows saw blade 500 to be attached to bone saw.
Fig. 7 b shows the Alternate embodiments of saw blade 500.In the present embodiment, saw blade 500 comprises labelling 503, and this labelling 503 defines the sawing length 501 of calibration.When using saw blade 500 according to the present embodiment, surgeon must determine when to stop sawing by vision.
Fig. 8 shows the relevant anatomy gauge point for the surgical operation perforation design of guide member 200 and size setting.Partial Resection 316 in planning tibia 300, to correct axial alignment 106 as in fig. la and lb.For all dissection variablees of correct plane of qualifying part excision 316 and the interpretation of gauge point be carry out these surgeon institutes intervened receive an education with obtain the part of experience, therefore do not belong to the part of this description.
As for the remainder of the plane for Partial Resection 316, the profile 313 of tibia 300 is noted down.Necessity excision degree of depth 110, the drillable length 401 of calibration of drill bit 400 and the sawing length 501 of the calibration of saw blade 500 of the Partial Resection 316 of preoperative planning define the design of surgical operation perforation guide member 200, specifically, define the placement of the seat 203a-203z for controlling required drilling depth, for control excise the degree of depth exterior face 205 shape and for helping the shape of the bone contact surface 204 of expliciting the position.
Opening in the operation of wedge shape surgical operation, the surgical operation operating procedure of the use of the osteotomy external member of surgery surgical punch guide member and/or correspondence may be summarized to be:
1. guide member of being bored a hole by surgical operation is positioned on the target area of targeted bone; 2., in order to stable, be fixed with bone fixation element;
3. holed by all drill guide bore holes, bore a hole with the cortex of the opposite side by bone;
4., in order to Partial Resection, carry out sawing by elongated slot;
5. remove surgical operation perforation guide member.
Ensuing surgical operation operating procedure is:
6. bending with flared section cut-away area;
7. insert bone wedge;
8. be fixed by the such as implant such as plate and screw and stablize;
9. close soft tissue and skin.
Step 3 and step 4 can also perform in reverse order.Step 1 and step 2 is depicted in Fig. 9 a to Fig. 9 c.
As shown in Figure 9 a, inner side 301 before tibia 300 is placed into by surgeon's guide member 200 of being bored a hole by surgical operation.Bone contact surface 204 has the shape with the mating shapes of described front inner side 301.Therefore, the shape of bone contact surface 204 preferably uses patient specific data to be formed.Thus as shown in Figure 9 b, the shape of bone contact surface 204 and the front inner side 301 of tibia 300 external shape mate the guide member 200 that contributes to surgical operation to bore a hole correctly be positioned over before inner side 301.
Then as shown in Fig. 9 c, two bone fixation elements 220a, 220b are inserted through two fastener receiver holes 221a, 221b, and by it in the bone material being screwed into tibia 300, so that guide member 200 of being bored a hole by surgical operation as shown in Fig. 9 d is solidly anchored on tibia 300.In the next step, as illustrated in fig. 10 a, surgeon uses the drill bit 400 with effective drillable length 401, and is undertaken holing until the stop-motion seat 402 of drill bit 400 collides with corresponding drill headstock 203a-203z by drill guide bore hole 202a-202z, as shown in fig. 10b.By making guide member 200 of surgically boring a hole, when drill headstock 203a-203z being arranged according to patient specific data especially wherein in described surgical operation perforation guide member 200, lateral cortex 303 run through by boring 310a-310z, but but suffers damage without any the soft tissue adjacent to described lateral cortex 303.As shown in fig. 10 c, by means of described boring 310a-310z, lateral cortex 303 is run through, and therefore weakened, which increase its pliability.The pliability increased reduces the risk of the iatrogenic fracture when surgeon forces wedge to open.
In order to the number preventing the perforation needed for iatrogenic fracture depends primarily on following variable: the size of bone mass, tibial plateau, the excision degree of depth 110, the diameter of drill bit 400 and the correct amount of axial alignment 106.Figure 11 shows the situation according to Figure 10 c with sectional view.Can see, drill headstock 203a-203z is all differently positioned in described surgical operation perforation guide member, thus produces the relative to each other slightly stepped layout of drill headstock 203a-203z, as in Figure 11 by thicker line emphasized.In addition, the specific required the drilling depth 312 how stop-motion seat 402 that can identify drill bit 400 matches with drill headstock 203a-203z drilling depth to be limited to each bore hole in multiple drill guide bore hole 202a-202z.Can see, described restriction avoids any infringement to soft tissue, this is because drill bit 400 can not be advanced further by surgeon.In the drawings, illustrate only the specific required drilling depth 312 of a bore hole in multiple drill guide bore hole 202a-202z.Drill process is the boring 310a-310z that each drill guide bore hole 202z-202z produces through tibia 300.
Figure 12 a shows next step, is wherein inserted in elongated slot 201 by saw blade 500.As shown in figure 12b, by means of saw blade 500, surgeon can saw into otch 311 in tibia 300.Bored a hole by saw blade seat 502 and surgical operation the coordinating of exterior face 205 of guide member, the degree of depth of otch 311 is remained on the greatest hope degree of depth in the tibia 300 of preoperative restriction.
Figure 13 shows and represents according to the cross section of the situation of Figure 12 b.Thus cross section is positioned at the first deep plane.In detail in this figure, can identify that the shape how degree of depth of otch 311 is subject to exterior face 205 affected, this exterior face 205 interacts with saw blade seat 502.The geometry of the otch 311 in tibia 300 corresponds essentially to the shape of exterior face 205, this is because the sawtooth 504 of saw blade 500 deeper can not insert in tibia 300 than the sawing length 501 of calibration.
Figure 14 shows another embodiment according to surgical operation perforation guide member 200 of the present invention.Except the feature of embodiment as shown in Figure 4, surgical operation perforation guide member according to the present embodiment also comprises the second elongated slot 240, and this second elongated slot 240 defines the second deep plane B.The axis X of drill guide bore hole 202a-202z is parallel to described first deep plane A, and the second deep plane B is arranged to described first deep plane A angled.Deep plane A, deep plane B intersect at line 315, and this line 315 is positioned at targeted bone in surgical procedures.Use such surgical operation perforation guide member, surgeon very accurately can cut out wedge in targeted bone, particularly particularly like this when carrying out closed cuneiform osteotomy.
Figure 15 a and Figure 15 b shows the further embodiment according to surgical operation perforation guide member 200 of the present invention.In the present embodiment, surgical operation perforation guide member 200 does not comprise elongated slot 201, the substitute is the multiple outthrust 250 be arranged on bone contact surface 204.Outthrust 250 is arranged parallel to each other, and defines the first deep plane A.Again, multiple drill guide bore hole 202a-202z is arranged so that its axis being parallel is in described first deep plane A.Select the thickness 251 of outthrust 250 can be inserted in excision otch 311 to make outthrust 250.The axis being parallel of drill guide bore hole 202a-202z is aimed at described otch 311 by this permission.
Figure 16 a and Figure 16 b shows the Alternate embodiments of surgical operation perforation guide member 200, and it is not a part of the present invention.In the present embodiment, as seen in Figure 16 a, the elongated slot 201 defining the first deep plane A is capable with the axis X irrelevancy of drill guide bore hole 202a-202z (illustrate only one of them drill guide bore hole 202).But axis X and elongated slot 201 are arranged such that they intersect at line 315, this line 315 is positioned at targeted bone in surgery Surgery Surgery process.In addition, in the present embodiment, surgical operation perforation guide member 200 also comprises the second elongated slot 240, and this second elongated slot 240 defines the second deep plane B.Second elongated slot 240 is arranged so that the second deep plane B and the first deep plane A intersects at line 315.Therefore, the second deep plane B also intersects at line 315 with the axis X of drill guide bore hole 202a-202z.
Figure 16 b shows the surgical operation perforation guide member 200 according to embodiment as shown in figure 16 a from bone contact surface 204.Can identify in detail in this figure, drill guide bore hole 202a-202z (illustrate only one of them drill guide bore hole 202) is all arranged on single line, this line and the first elongated slot 201 and the second elongated slot 240 spaced apart.In addition, the position of two fastener receiver holes 221a, 221b can also be identified in detail in this figure easily.Such surgical operation perforation guide member is particularly suitable for closed cuneiform osteotomy, this is because its permission cuts out two otch inclined towards each other in targeted bone, described otch defines will at the wedge of the bone removed from targeted bone subsequently.
Claims (13)
1. a guide member (200) of will boring a hole against the surgical operation that targeted bone is fixing, comprise at least one the first elongated slot (201) or at least one outthrust (250) that define the first deep plane (A), and there are multiple drill guide bore holes (202a-202z) of diameter and central axis (X), the central axis (X) of described drill guide bore hole (202a-202z) is parallel to described first deep plane (A), the diameter of wherein said multiple drill guide bore hole (202a-202z) is crossing with described deep plane (A), it is characterized in that, each bore hole in described multiple drill guide bore hole (202a-202z) comprises for drill bit (400) provides the drill headstock (203a-203z) of stop surface, drilling depth is limited to the specific required drilling depth (312) of each bore hole in described multiple drill guide bore hole (202a-202z) by described drill headstock (203a-203z).
2. surgical operation perforation guide member (200) according to claim 1, it is characterized in that, each described drill headstock (203a-203z) is arranged on described surgical operation perforation guide member (200), to limit described drilling depth according to patient specific data, thus preferably producing specific required drilling depth (312), this specific required drilling depth (312) corresponds to the distance of the relative cortical bone of the fixation side that is positioned at described surgical operation perforation guide member (200).
3. surgical operation perforation guide member (200) any one of claim 1 or 2, it is characterized in that, described surgical operation perforation guide member (200) also comprises the bone contact surface (204) for contacting described targeted bone, and described bone contact surface (204) has the shape matched with the external shape of described targeted bone.
4. surgical operation perforation guide member (200) as claimed in one of claims 1-3, it is characterized in that, described surgical operation perforation guide member (200) comprises at least one elongated slot (201) and exterior face (205), and described at least one elongated slot (201) and exterior face (205) provide guiding face to limit the excision degree of depth (110) of described saw blade (500) in described targeted bone for saw blade (500).
5. surgical operation perforation guide member (200) according to claim 4, it is characterized in that, the shape of described exterior face (205) is configured to described depth of cut (110) is preferably changed along described at least one elongated slot (201) according to patient specific data.
6. surgical operation perforation guide member (200) as claimed in one of claims 1-5, it is characterized in that, described surgical operation perforation guide member (200) comprises the first elongated slot (201) and the second elongated slot (240), described second elongated slot (240) defines the second deep plane (B), this second deep plane (B) is arranged as with described first deep plane (A) angled, wherein said second elongated slot (240) is configured to make described second deep plane (B) crossing in described targeted bone with described first deep plane (A).
7. surgical operation perforation guide member (200) as claimed in one of claims 1-3, it is characterized in that, described surgical operation perforation guide member (200) comprises multiple outthrust (250), and the size and shape of described outthrust (250) is configured to for being inserted in the excision otch (311) of described targeted bone.
8. surgical operation perforation guide member (200) as claimed in one of claims 1-7, is characterized in that, described surgical operation perforation guide member (200) also comprises at least one fastener receiver hole (221a, 221b).
9. an external member, comprises at least one surgical operation as claimed in one of claims 1-8 perforation guide member (200) and has at least one drill bit (400) of stop-motion seat (402).
10. external member according to claim 9, also comprises at least one saw blade (500), and this saw blade (500) has the outthrust defining saw blade seat (502).
11. 1 kinds, for the production of the method for preferably surgical operation as claimed in one of claims 1-8 perforation guide member (200), comprise the following steps:
A) by patient specific data, the preferably concrete imaging data of patient, the position of multiple drill guide hole (202a-202z) and required drilling depth is limited;
B) position of the drill headstock (203a-203z) in each hole in described drill guide hole (202a-202z) is determined according to the required drilling depth (312) in each drill guide hole in described drill guide hole (202a-202z);
C) described surgical operation perforation guide member (200) is produced preferably by machining or by increasing material manufacturing technology.
12. methods according to claim 11, further comprising the steps of: before described production stage, by being determined the shape of the predetermined contact area of described targeted bone by the concrete imaging data of patient, be defined for the shape of the bone contact surface (204) contacting described targeted bone.
13. methods as requested any one of 11-12, further comprising the steps of: before described production stage, according to the necessity excision degree of depth (110) from the concrete imaging data of patient, limit the shape of the exterior face (205) of described surgical operation perforation guide member (200).
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CH12512013 | 2013-07-12 | ||
| CH1251/13 | 2013-07-12 | ||
| PCT/CH2014/000102 WO2015003284A2 (en) | 2013-07-12 | 2014-07-11 | Surgical perforation guide |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CN104869919A true CN104869919A (en) | 2015-08-26 |
Family
ID=51220357
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201480002607.1A Pending CN104869919A (en) | 2013-07-12 | 2014-07-11 | Surgical perforation guide |
Country Status (4)
| Country | Link |
|---|---|
| JP (1) | JP6095800B2 (en) |
| KR (1) | KR101714285B1 (en) |
| CN (1) | CN104869919A (en) |
| WO (1) | WO2015003284A2 (en) |
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| CN106667544A (en) * | 2017-02-21 | 2017-05-17 | 吴霜 | Minimally-invasive perforation surgical tool and machining method thereof |
| CN110477997A (en) * | 2019-09-17 | 2019-11-22 | 上海交通大学医学院附属第九人民医院 | A kind of 3D printing guide plate of the controllable osteotomy depth for fibular flap moulding operation |
| CN111246790A (en) * | 2017-10-06 | 2020-06-05 | Med-El电气医疗器械有限公司 | Drilling platform tool for surgical operations |
| CN109805980B (en) * | 2017-11-22 | 2021-04-30 | 爱派司生技股份有限公司 | Universal osteotomy instrument |
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| AU2016216179B2 (en) * | 2015-02-05 | 2018-10-25 | Ossability Limited | A surgical guide |
| US10039559B2 (en) | 2015-09-02 | 2018-08-07 | Wright Medical Technology, Inc. | Method and cut guide for biplanar wedge osteotomy |
| US10485561B2 (en) | 2017-08-24 | 2019-11-26 | Limacorporate S.P.A. | Ankle arthroplasty system and methods |
| TWI686166B (en) * | 2018-03-19 | 2020-03-01 | 愛派司生技股份有限公司 | Location constrain apparatus for osteotomy surgery |
| WO2020037423A1 (en) | 2018-08-24 | 2020-02-27 | Laboratoires Bodycad Inc. | Patient-specific fixation plate with spacing elements for knee osteotomies |
| GB2591364B (en) | 2018-08-24 | 2023-01-04 | Laboratoires Bodycad Inc | Patient-specific fixation plate with wedge member |
| GB2591885B (en) | 2018-08-24 | 2023-05-31 | Laboratoires Bodycad Inc | Surgical guide assembly for performing a knee osteotomy procedure |
| WO2020037425A1 (en) | 2018-08-24 | 2020-02-27 | Laboratoires Bodycad Inc. | Predrilling guide for knee osteotomy fixation plate |
| US11857206B2 (en) | 2018-08-24 | 2024-01-02 | Laboratoires Bodycad Inc. | Patient-specific surgical tools |
| WO2020037420A1 (en) | 2018-08-24 | 2020-02-27 | Laboratoires Bodycad Inc. | Surgical kit for knee osteotomies and corresponding preoperative planning method |
| CN110353760B (en) * | 2019-07-26 | 2023-12-22 | 中国人民解放军西部战区总医院 | Guide plate for bone carrying tibia osteotomy |
| AU2020344704A1 (en) | 2019-09-13 | 2022-04-14 | Treace Medical Concepts, Inc. | Patient-specific surgical methods and instrumentation |
| USD948719S1 (en) | 2019-10-21 | 2022-04-12 | Laboratoires Bodycad Inc. | Posterior stabilizer for an osteotomy plate |
| USD943100S1 (en) | 2020-02-18 | 2022-02-08 | Laboratoires Bodycad Inc. | Osteotomy plate |
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Also Published As
| Publication number | Publication date |
|---|---|
| WO2015003284A2 (en) | 2015-01-15 |
| KR20150068432A (en) | 2015-06-19 |
| WO2015003284A3 (en) | 2015-04-09 |
| JP2016501644A (en) | 2016-01-21 |
| JP6095800B2 (en) | 2017-03-15 |
| KR101714285B1 (en) | 2017-03-08 |
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Application publication date: 20150826 |