WO2009087214A4 - Stereotactic computer assisted surgery based on three-dimensional visualization - Google Patents

Stereotactic computer assisted surgery based on three-dimensional visualization Download PDF

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Publication number
WO2009087214A4
WO2009087214A4 PCT/EP2009/050210 EP2009050210W WO2009087214A4 WO 2009087214 A4 WO2009087214 A4 WO 2009087214A4 EP 2009050210 W EP2009050210 W EP 2009050210W WO 2009087214 A4 WO2009087214 A4 WO 2009087214A4
Authority
WO
WIPO (PCT)
Prior art keywords
region
interest
dimensional
implant
images
Prior art date
Application number
PCT/EP2009/050210
Other languages
French (fr)
Other versions
WO2009087214A1 (en
Inventor
Arno Blau
Original Assignee
Stryker Leibinger Gmbh & Co. Kg
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Stryker Leibinger Gmbh & Co. Kg filed Critical Stryker Leibinger Gmbh & Co. Kg
Priority to US12/812,125 priority Critical patent/US10105168B2/en
Priority to EP09700962A priority patent/EP2173269B1/en
Priority to ES09700962T priority patent/ES2397807T3/en
Publication of WO2009087214A1 publication Critical patent/WO2009087214A1/en
Publication of WO2009087214A4 publication Critical patent/WO2009087214A4/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
    • A61B17/744—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to an intramedullary nail
    • 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
    • A61B17/1703—Guides or aligning means for drills, mills, pins or wires using imaging means, e.g. by X-rays
    • 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
    • A61B17/1721—Guides or aligning means for drills, mills, pins or wires for applying pins along or parallel to the axis of the femoral neck
    • 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
    • A61B17/1725—Guides or aligning means for drills, mills, pins or wires for applying transverse screws or pins through intramedullary nails or pins
    • 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
    • A61B17/1742—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • A61B17/1753—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip for fixing pins through femoral hip prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74—Devices for the head or neck or trochanter of the femur
    • A61B17/742—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
    • A61B17/746—Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck the longitudinal elements coupled to a plate opposite the femoral head
    • 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
    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • 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
    • A61B17/1728—Guides or aligning means for drills, mills, pins or wires for holes for bone plates or plate screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/564—Methods for bone or joint treatment
    • 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
    • A61B2034/107—Visualisation of planned trajectories or target regions
    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B2090/363—Use of fiducial points
    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B2090/364—Correlation of different images or relation of image positions in respect to the body
    • A61B2090/367—Correlation of different images or relation of image positions in respect to the body creating a 3D dataset from 2D images using position information
    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
    • 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

Abstract

A computer assisted surgical system that includes an apparatus (110) for imaging a region of interest of a portion of an anatomy of a subject; a memory containing executable instructions; and a processor programmed using the instructions to receive two or more two-dimensional images of the region of interest taken at different angles from the apparatus and process the two or more two-dimensional images to produce three dimensional information associated with the region of interest.

Claims

AMENDED CLAIMS received by the International Bureau on 24 August 2009 (24.08.2009)
1. A method for operating a computer assisted surgical system for stereotactic surgery, comprising: imaging a region of interest and a medical device associated with a reference body proximate the region of interest of a portion of an anatomy of a subject at two or more angles to obtain a plurality of two-dimensional images; processing the plurality of two-dimensional images tp produce three dimensional information associated with the region of interest; associating, based on the three dimensional information, a virtual medical device with the region of interest in a predetermined relationship relative to the reference body; and displaying the association as an image showing the virtual medical device superimposed on the region of interest.
2. The method of claim 1, further comprising detecting the presence of the reference body based on one or more fiducial markers.
3. The method of claim 1 or 2, wherein imaging comprises acquiring two fluoroscope images of the region of interest at two different angles-
4. The method of any of claims 1 to 3, wherein processing further comprises estimating the contours of the region of interest in at least two dimensions based on the plurality of two-dimensional images.
5. The method of claim 4, wherein processing further comprises forming a three dimensionaj image associated with the region of interest ba.sed on the estimation.
6. The method of claim 4 or 5, wherein the region of interest comprises a femoral head, the plurality of two dimenβional images comprise anterior-to-posterior and axial images of the femoral region and estimating comprises forming an outline of the femoral head on the anterior-to-posterior and axial images.
7. The method of any of claims 1 to 6, further comprising adjusting the position of the medical device and repeating the steps of imaging, processing, associating and displaying.
$. A computer assisted surgical system, comprising: an apparatus for imaging a region of interest of a portion of an, anatomy of a subject; a memory containing executable instructions; and a processor programmed using the instructions to : receive two or more two-dimensional images of the region of interest and an implant positioned in the region of interest taken at different angles from the apparatus, process the two or more two-dimensional images to produce three dimensional information associated with the region of interest and of the implant positioned in the region of interest, superimpose a virtual implant onto the region of interest in a predetermined feed relationship relative to the implant positioned based on the three dimensional information to form an image thus showing the position of the virtual implant relative to the region of interest, and generate a display signal associated with the superimposed image.
9, The system of claim 8, wherein the apparatus comprises a fluoroscope.
10- The system of claim 8 ox 9, further comprising a virtual sub-implant associated with the region of interest and the virtual implant such that the virtual sub-implant provides an estimate of the location of an actual implant and one or more sub-implants within the region of interest.
11. The system of any of claims 8 to 10, wherein the processor processes the one or more two-dimensional images by outlining the contours of the region of interest in two dimensions and creates a three dimensional object representing the region of interest,
12. The system of claim 11, wherein the three dimensional object comprises a sphere.
13, The system of claim 11 or 12, wherein the three dimensional object is derived from a database and based on age and gender of the patient,
14. The system of any of claims 8 to 13, wherein the three dimensional object is determined based on landmarks associated with the region pf interest.
PCT/EP2009/050210 2008-01-09 2009-01-09 Stereotactic computer assisted surgery based on three-dimensional visualization WO2009087214A1 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
US12/812,125 US10105168B2 (en) 2008-01-09 2009-01-09 Stereotactic computer assisted surgery based on three-dimensional visualization
EP09700962A EP2173269B1 (en) 2008-01-09 2009-01-09 Stereotactic computer assisted surgery based on three-dimensional visualization
ES09700962T ES2397807T3 (en) 2008-01-09 2009-01-09 Computer-assisted stereotactic surgery based on three-dimensional visualization

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US1054308P 2008-01-09 2008-01-09
US61/010,543 2008-01-09

Publications (2)

Publication Number Publication Date
WO2009087214A1 WO2009087214A1 (en) 2009-07-16
WO2009087214A4 true WO2009087214A4 (en) 2009-11-12

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PCT/EP2009/050210 WO2009087214A1 (en) 2008-01-09 2009-01-09 Stereotactic computer assisted surgery based on three-dimensional visualization

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US (4) US10105168B2 (en)
EP (2) EP2191783B1 (en)
ES (2) ES2595366T3 (en)
WO (1) WO2009087214A1 (en)

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