CN104203134A - 使用患者特异性器械的关节盂植入手术 - Google Patents
使用患者特异性器械的关节盂植入手术 Download PDFInfo
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Abstract
用于将销放置在骨骼中的销放置器械包括:具有钩状部的解剖学交界部,所述钩状部在所述器械的侧向上开口以将骨骼接纳于其内规划的位置。钻孔引导件与所述解剖学交界部连接并且在所述器械的纵向上限定至少一个引导槽。在所述钻孔引导件中,所述引导槽在其整个长度上具有侧向开口,以便在放置于所述骨骼中的所述销穿过所述侧向开口的情况下允许在所述侧向上侧向地撤走所述器械。衬套经由所述纵向以规划的配合可移除地放置在所述引导槽中,所述衬套限定通孔,当所述衬套位于所述引导槽中用于进行销放置时,所述通孔与所述引导槽对准并且适于接纳在所述纵向上延伸的所述销。
Description
技术领域
本发明涉及肩关节置换术,更具体地说涉及例如肩关节置换术中的关节盂植入肩关节手术,以及因此使用的患者特异性器械(PSI)。
背景技术
肩关节手术中植体的使用是众所周知的。在这样的肩关节手术中,植体部件被安装在肩胛骨(即肩胛)的关节盂部分上和/或肱骨部上,以复现肩关节。当植体被安装在肩胛骨上时,植体通常被安装在关节腔(也称为关节盂或关节窝)内。关节盂是接纳解剖学肩关节中肱骨的头部的空腔。当植体与关节盂使用时,植体的基部位于关节盂内部,并且可以通过诸如螺钉等紧固件、或者使用粘合剂和/或固定栓或龙骨固定于此。
当在关节盂中安装植体时碰到的一个挑战涉及植体的定位。因为韧带及类似软组织的存在,必须规划植体的定位以尽可能多地复现肱骨相对于肩胛骨的正常生物机械运动。另一个挑战涉及将植体紧固于肩胛骨的紧固件的定位。实际上,肩胛骨是相对薄的并且被软组织包围。为了使植体能够被牢固地紧固于肩胛骨,螺钉必须在骨骼材料内足够深。然而,除非外科医生期望如此,否则螺钉一定不能刺穿骨骼表面,从而不会损坏诸如神经韧带、肌腱等软组织。
患者特异性器械(本文中称为“PSI”)涉及专门为患者制作的器械的制造。PSI通常由使用影像建模骨骼几何形状的数据来制造。因此,PSI具有能够以可预测的方式与骨骼接触的表面,因为这样的接触表面是专门制造的以匹配骨骼的表面。因此,期望的是在肩关节手术中使用PSI技术。
发明内容
因此,本发明的一个目的是提供一种使用患者特异性器械执行关节盂植入手术的方法。
本发明的另一个目的是提供一种用于关节盂植入手术的患者特异性器械。
因此,根据本发明的一个方面,提供一种用于将销放置在骨骼中的销放置器械,包括:解剖学交界部,其具有钩状部,所述钩状部在所述器械的侧向上开口以将骨骼接纳于其内规划的位置;钻孔引导件,其与所述解剖学交界部连接并且在所述器械的纵向上限定至少一个引导槽,在所述钻孔引导件中,所述至少一个引导槽在其整个长度上具有侧向开口,以便在放置于所述骨骼中的所述销穿过所述侧向开口的情况下允许在所述侧向上侧向地撤走所述器械;以及至少一个衬套,其经由所述纵向以规划的配合可移除地放置在所述引导槽中,所述衬套限定通孔,当所述衬套位于所述引导槽中用于进行销放置时,所述通孔与所述引导槽对准并且适于接纳在所述纵向上延伸的所述销。
此外,根据本发明的一个方面,其特征在于,所述钻孔引导件包括两个所述引导槽。
此外,根据本发明的一个方面,两个所述引导槽彼此平行。
此外,根据本发明的一个方面,所述至少一个衬套具有抵接端,所述抵接端用于在所述衬套被放入所述引导槽中时限制衬套在所述纵向上的移动。
此外,根据本发明的一个方面,所述钻孔引导件中的插孔适于接纳用于远端操纵的手柄。
此外,根据本发明的一个方面,为每个由所述引导槽和所述衬套构成的组提供至少一个所述销,所述衬套与所述销滑动接合。
此外,根据本发明的一个方面,所述钩状部的表面大致横向于所述纵向。
此外,根据本发明的一个方面,所述钩状部具有基于患者的解剖学模型的至少一个患者特异性表面。
此外,根据本发明的一个方面,患者的解剖学模型是肩胛骨的模型,所述至少一个患者特异性表面与所述肩胛骨的头部和关节盂的颈部之中的至少一者的形状互补。
此外,根据本发明的一个方面,所述至少一个引导槽与下列位置中的一者纵向对准:植体的规划中心、邻近与喙突对准的上盂缘的位置以及喙突的基部。
根据本发明的另一个方面,还提供一种对关节盂修整表面的方法,包括:获得具有至少两个销槽的患者特异性器械;将所述患者特异性器械的销槽安装在固定于肩胛骨的第一销上;将管状扩孔器安装在固定于关节盂的第二销上;将所述患者特异性器械的轴槽安装在管状扩孔器的轴上,以在所述轴槽和所述管状扩孔器的轴之间形成结合部,允许所述管状扩孔器沿着第二销进行平移移动;以及在被所述患者特异性器械和所述销引导的同时,利用所述管状扩孔器对关节盂进行扩孔。
此外,根据本发明的一个方面,获得所述患者特异性器械包括获得如下患者特异性器械,即其轴槽的远离所述关节盂的端部与所述关节盂相距患者特异性距离,还包括一旦所述管状扩孔器的轴上的止动器抵接所述轴槽的端部就停止扩孔。
此外,根据本发明的一个方面,所述方法还包括获得如下管状扩孔器,即所述轴上的止动器位于的患者特异性距离处,所述患者特异性距离是规划扩孔深度的函数。
此外,根据本发明的一个方面,将所述患者特异性器械的轴槽安装在所述管状扩孔器的轴上包括:围绕所述第一销旋转所述患者特异性器械,用于使所述管状扩孔器的轴经由所述轴槽中的侧向开口接纳在所述轴槽中。
根据本发明的另一个方面,提供一种在已修整表面的关节腔中定位植体的方法,包括:获得具有至少一个销槽的患者特异性器械;将所述患者特异性器械的销槽安装在固定于肩胛骨的销上;将冲击器的轴安装在所述患者特异性器械的引导支架中,使得所述轴与已修整表面的关节腔对准,在所述轴和所述引导支架之间形成平移结合部,允许所述轴沿着所述引导支架平移移动;将所述植体安装在所述冲击器的自由端;以及在被所述患者特异性器械和所述销引导的同时,迫使所述植体进入已修整表面的关节腔。
此外,根据本发明的一个方面,获得所述患者特异性器械包括获得所述引导支架的患者特异性取向,使得所述植体中的通孔相对于已修整表面的关节腔的取向与接纳在所述植体的通孔中的螺钉的规划定位有关。
此外,根据本发明的一个方面,所述方法还包括在被迫进入已修整表面的关节腔中的植体中定位钻孔引导件,所述钻孔引导件包括定位为指向所述销的视觉指示器。
此外,根据本发明的一个方面,在被所述患者特异性器械和所述销引导的同时迫使所述植体进入已修整表面的关节腔包括在单一平移自由度中移动所述植体。
附图说明
图1是使用患者特异性器械将关节盂植体紧固于肩胛骨上的方法的流程图;
图2是在虚拟规划中带有关节盂植体的肩胛骨的透视图;
图3是根据本发明实施例的销放置PSI的一对透视图;
图4是在放置销的过程中带有图3的销放置PSI的肩胛骨的透视图;
图5是在移除销放置PSI的过程中图4的肩胛骨的透视图;
图6是根据本发明另一实施例的深度钻孔PSI的透视图;
图7是带有图6的深度钻孔PSI的肩胛骨的透视图;
图8是带有管状扩孔器的肩胛骨和深度钻孔PSI的透视图;
图9是带有扩孔关节盂的肩胛骨的透视图;
图10是根据本发明另一实施例的冲击引导PSI的透视图;
图11是带有冲击器引导PSI和冲击工具的肩胛骨的透视图;
图12是根据本发明另一实施例的钻孔引导PSI的透视图;
图13是带有钻孔引导PSI和钻头的肩胛骨的透视图;
图14是关节盂半球形植体的组装图;
图15是带有关节盂植体和转接部的肩胛骨的透视图;以及
图16是肩胛骨上的图4的销放置PSI的侧视图。
具体实施方式
参考附图,特别是参考图1,图中附图标记10示出将关节盂植体紧固于肩胛骨(即肩胛骨)上的方法。为了执行该方法,参考图2至图13,各种患者特异性器械被使用,下面将被称为PSI。作为例子,图2示出在反置式全肩关节手术中在肩胛骨上定位关节盂半球形头植体基部。然而,作为替代,方法10可以如在解剖学全肩关节置换术中所实施的那样用于将杯状植体紧固于关节盂中。
根据图1的步骤11,执行虚拟肩关节手术规划。在该规划步骤中,各种肩关节结构与模型植体及其部件一起被显示为三维模型。这些三维模型典型地是处理术前成像术(例如CT扫描、MRI等)的结果,因此是患者骨骼的精确且准确的表现。
在规划步骤中,操作者可以选择各种类型和尺寸的植体并且交互地规划植体及其部件将定位在肩胛骨和肱骨上的哪里。在关节盂植体的情况下,其位置和取向可以包括将关节盂植体紧固于肩胛骨的螺钉的位置和取向的虚拟表现。由于螺钉的长度和关节盂内侧肩胛骨的厚度,关节盂植体的位置的虚拟规划典型地旨在获得螺钉的取向和深度,使得螺钉不会刺穿骨骼材料。
例如,图2中示出带有一部分植体20(另外如图14所示)的患者肩胛骨A的模型,植体20是球头型(即半球形头部20A)。植体20包括基板21。基板21是由粘合并配合到已修整表面的关节腔C(图9)中的金属制成的类型。例如,可以将梁状医用级金属用于基板21。栓22从基板21的底侧突出并且将容纳于在关节腔B中钻出的孔中。螺钉23也从基板21的底侧突出并且将植体20锚固于肩胛骨A。本体25被紧固于基板21,就如同这些部分是基本上一体的。本体25是植体20与半球形球头之间的交界部,该球头限定与肱骨或其上的植体接触的表面。通孔26因此同时被限定于本体25和基板21中,螺钉23穿过这些通孔26。
方法10的步骤12至17被用来在执行骨骼替换时引导外科医生或操作者,从而复现步骤11的虚拟肩关节手术规划。因此,方法10的步骤12至17被执行以确保关节盂植体基本上与虚拟规划相似地被安装。
根据步骤12,利用从虚拟规划获得的数据制成PSI。PSI将在后面更详细地描述。任何合适的制造方法和材料都可以用于PSI,只要PSI是作为虚拟规划的结果而需要的PSI的精确而准确的表现。利用影像数据在术前进行根据步骤12制成PSI,该影像数据还用于虚拟肩关节手术规划的步骤11。还可以使用术前获得的任何其它解剖学数据源,例如人体骨骼测量结果。可以经由规划步骤获得的另一信息是所需转接部的制成。可能需要在植体与肩胛骨之间使用转接楔B1,规划步骤因此可以限定如图15所示的所需转接部的模型,以及PSI工具,该工具用于将转接楔B1成形为在虚拟规划中计算的预定几何形状。转接楔B1将被定位在植体20和经加工的关节腔C之间。对于受限于浅关节腔C的肩胛骨,即没有完全的扩孔形状的肩胛骨而言可能需要使用转接部。因此,如图15所示,转接楔B1将与腔C同时地形成,植体20施加于转接楔B1的表面上。
步骤13至17在手术进行时被执行。一旦肩关节已经暴露出来并且肱骨已经脱位、切除和/或从肩胛骨A(图2)分离之后,执行这些步骤。
根据步骤13(图1),利用PSI将一对销放在肩胛骨A中。同时参考图3和图4,附图标记30大致地示出销放置PSI。销放置PSI 30包括解剖学交界部31。解剖学交界部31具有侧向开口的钩状形状,以便在内部容纳肩胛骨的头部和/或关节盂B的颈部的两侧。根据PSI,解剖学交界部31具有(一个或多个)接触面32,接触面制造成匹配患者肩胛骨上的对应表面。因此,销放置PSI 30的定位将受接触面32引导,从而找到其在肩胛骨A上的对应匹配表面。
销放置PSI 30还包括钻孔引导件33。钻孔引导件33根据步骤11(图1)的虚拟规划而相对于解剖学交界部31定位。钻孔引导件33具有一对圆柱形的切口或槽34,槽34特别地定位和取向为引导销在关节盂B中的钻入,也就是说,槽34在PSI 30的纵向上延伸。根据一个实施例,侧向开口35允许侧向地触及槽34,使得销可以在侧向上插入槽34中。也可以在钻孔引导件33中限定插孔36或类似的连接件,以便于操纵销放置PSI 30。例如,可以借助于插孔36将细长形的工具连接于销放置PSI 30,用于进行其远端操纵。
如图4和图5同时地显示,销40被钻入肩胛骨A中。销40可以设置有以规划配合(即精确配合)接纳的套筒41(即衬套),由于套筒41具有在槽34中居中的通孔,该配合将确保销40轴向地在槽34中居中。此外,套筒41可以包括抵接端42以控制销40在关节盂中插入的深度。还可以考虑任何合适的方法来控制销40的插入深度,例如以某一比率使销40渐变等。
在操作中,手柄43与插孔36(图3和图4)连接,通过将销放置PSI 30侧向地移动到骨骼上的规划位置,销放置PSI 30被安装在关节盂B上,而解剖学交界部31确保销放置PSI 30被正确地定位在肩胛骨A上。上面带有套筒41的销40经由侧向开口35被插入销放置PSI的槽34中,并且因此可以被钻入关节盂B中,或者可以在将销40旋入之前将套筒/衬套41放在槽34中。一旦销40被适当地插入肩胛骨A中,可以通过将套筒41滑动离开图5所示的销40的端部来撤走套筒41,从而允许通过侧向移动来从肩胛骨A移除销放置PSI 30。解剖学交界部31的钩状部分的表面大致横向于钻孔引导件33的纵向。侧向开口35的存在允许解剖学交界部31的钩状部分之间的良好接触表面,不会由于销40穿过侧向开口35而在侧向撤走PSI30时存在困难。
根据图示实施例,一个销40位于预期的已修整表面关节腔C的中心,另一个销40的位置邻近与喙突对准的上盂缘或位于喙突基部。其它位置也是可以考虑的。出于示例的目的,销放置PSI 30的可想到的位置在图16中相对于肩胛骨A大致地示出。
参考图1,利用销40和合适的PSI执行在关节盂B上的深度钻孔和/或表面扩孔的步骤14。同时参考图6和图7,扩孔PSI大致以附图标记60示出。扩孔PSI 60具有带销槽62的第一管61,销槽62的尺寸设定为使其能够滑动到一个销40上,从而与销40形成圆柱结合部。第一管61的端部限定与肩胛骨A抵接的抵接部63。间隔臂64从第一管61侧向地延伸并且在其自由端具有第二管65。第二管65也包括轴槽66,轴槽66可以经由侧向开口67侧向地触及,侧向开口67被用于旋转扩孔PSI 60使得销40进入轴槽66。由于扩孔PSI 60是患者特异性的,销槽62和轴槽66以预定距离间隔开以匹配销40之间的间距。因此,如图7所示,当第一管61被滑动到一个销40上时,另一个销40可以取向为位于第二管65的轴槽66内。
要指出的是步骤14可以包括验证销40的位置。由于扩孔PSI 60被制造来接纳销40,位于中心的销40应该轴向地在第二管65中居中。任何偏心都指示销40的非正确定位,并且这样的指示可以导致复查步骤13以再次定位销40。
参考图8,管状扩孔器80因此可以被安装在位于轴槽66内部的销40上,从而被销40同轴地平移引导。扩孔器80具有扩孔器端部81,该扩孔器端部被选择为执行关节盂B中的规划直径的表面修整。扩孔器端部81位于轴82的端部。轴82的尺寸设定为其能够接纳在扩孔PSI 60的轴槽66中,以形成平移结合部。此外,扩孔器端部81还可以将孔钻至通过抵接扩孔PSI60而限定的深度,孔的直径使其内部足以接纳植体20的栓22(图2)。作为替代,钻栓孔的步骤也可以单独地执行。因此,管状扩孔器80中的销40以及轴82与轴槽66之间的协作这样的组合确保关节盂B特别地在期望的部位被扩孔至期望的深度。轴82通过滑到或咬扣到轴槽66中而进入轴槽66。仍然参考图8,止动器83可以安装在轴82的端部上。止动器83与扩孔PSI 60协作以限制扩孔器80在关节盂B中的穿入深度,从而确保表面扩孔和可选的深度钻入(如果为图2的栓22单独执行的话)具有规划的深度。
可以观察到,两个销40被用来支撑扩孔PSI 60和引导管状扩孔器80的移动。利用两个销40,与单一销40相比提高了销40/PSI 60组件的结构完整性。然而,可以考虑任何其它的构造与管状扩孔器80一起使用对关节盂B进行扩孔,例如使用单一销40与管状扩孔器80一起。
如图9所示,一旦关节盂B已经被扩孔而限定具有栓孔D的已修整表面的关节腔C,可以与销40一起移除深度钻孔PSI 60。尽管没有示出,但是期望的是,如下面更详细地解释,保留不位于已修整表面的关节腔C中的销40。在使用转接楔B1(图15)的情况下,转接楔B1邻近已修整表面的关节腔C地被安装在关节盂B上的适当位置上。喙突上的销40可以被用来在使转接楔B1正确地取向中引导操作者。转接楔B1可以被融合到关节盂B上,并且螺钉23将植体20和转接楔B1这两者紧固于关节盂B。
参考图1,利用其中一个销和用于使植体20正确地取向的PSI执行冲击植体20的步骤15。更具体地说,植体20的取向将对螺钉23(图2)的定位具有影响。因此,为了复现步骤11的虚拟规划,植体20必须被正确地取向从而使得通孔26与螺钉23的规划插入位置对准。
同时参考图10和图11,冲击引导PSI大致地以附图标记100示出。冲击引导PSI 100包括带有销槽102的管101。销槽102的尺寸设定为使其内部接纳留下的销40并且与销形成圆柱结合部。管的抵接端(具有任何合适的形状/几何形状)103可以具有患者特异性接触表面,该接触表面成形为当管101抵接骨骼时靠在周围的骨骼表面上并因此阻止PSI 100旋转。臂104从管101侧向地突出。引导支架105位于臂104的自由端并且被用来引导冲击工具110的移动。更具体地说,引导支架105具有侧向开口,该开口用于在内部接纳冲击工具110的轴111以便与轴111形成滑动结合部。
冲击工具110可以是常规的冲击工具,具有一对间隔开的、将接纳在植体20(图2)的通孔26中的栓。引导支架105特别地与这些栓位于冲击工具110的轴111端部处的位置相关地取向,以根据虚拟规划步骤11(图1)控制植体20的通孔26的定位。
因此,利用图11的组件,植体20可以被插入已修整表面的关节腔C中。植体20与已修整表面的关节腔C的匹配形状可以使得在冲击过程中植体20自居中(因此不需要在抵接端103处设置患者特异性表面来执行对准)。然而,PSI 100和冲击工具110基本上确保植体20被完全地插入已修整表面的关节腔C中,并且通孔26位于规划的位置。此时,PSI 100可以与冲击工具110一起被移除,而将植体20留在已修整表面的关节腔C中。
根据图1的步骤16,可以如规划那样在关节盂中钻锚固孔,用于接下来插入螺钉23。参考图12和图13,钻孔引导PSI 120具有本体121,本体121的尺寸设定为使其被接纳在植体本体25中的对应空腔中。一对钻引导孔122被限定于钻孔引导PSI 120的本体121中。钻引导孔122特别地定位和取向为在植体20(图2)中的通孔26的轴向延伸上具有引导圆柱体122A。此外,引导圆柱体122A的直径大致为渐缩的,以便使钻头123在其内部居中,以减少钻头123与钻引导孔122之间的任何可能的间隙。用于钻孔引导PSI 120的本体121的材料还可以选择为不受钻头123损坏。如图13所示,止动器124可以设置在钻头123上以控制钻孔深度到达锚固孔的规划深度。也可以考虑替代的方法,例如以某一比率使钻头123渐缩,以控制深度。一旦已经钻出锚固孔,可以移除钻孔引导PSI 120。如图12所示,钻孔引导PSI 120还可以包括视觉指示器125。视觉指示器125可以患者特异性地形成于钻孔引导PSI 120中以指向留下的销。因此,这表示附加的验证步骤以确保在期望的位置钻出孔。
根据图1的步骤17,螺钉23(或类似的紧固件)可以将植体20紧固于肩胛骨A,从而复现图1的虚拟规划。然后执行常规步骤来完成肩关节手术。
这里指出,方法10可以包括制作图15的转接部B1的步骤。方法10的步骤还可以包括提供用于例如从肱骨移除骨骼材料的PSI工具,这是因为肱骨必须被修整表面。然而,从肱骨或其它骨骼移除的转接部B1可以简单地具有圆柱形状,并且因此可以使用具有适当直径的标准圆柱形扩孔器。由于转接部B1在图15中显示为具有楔形,因此可以制作合适的PSI工具来加工转接部B1的斜面。
虽然上面已经结合以特定顺序执行的特定步骤描述和显示了上述方法和系统,但是在不脱离本发明的教导的情况下这些步骤可以进行组合、分割或重新排序以形成等同方法。因此,步骤的顺序和组合不受限于本公开。
Claims (18)
1.一种用于将销放置在骨骼中的销放置器械,包括:
解剖学交界部,其具有钩状部,所述钩状部在所述器械的侧向上开口以将骨骼接纳于其内规划的位置;
钻孔引导件,其与所述解剖学交界部连接并且在所述器械的纵向上限定至少一个引导槽,在所述钻孔引导件中,所述至少一个引导槽在其整个长度上具有侧向开口,以便在放置于所述骨骼中的所述销穿过所述侧向开口的情况下允许在所述侧向上侧向地撤走所述器械;以及
至少一个衬套,其经由所述纵向以规划的配合可移除地放置在所述引导槽中,所述衬套限定通孔,当所述衬套位于所述引导槽中用于进行销放置时,所述通孔与所述引导槽对准并且适于接纳在所述纵向上延伸的所述销。
2.根据权利要求1所述的销放置器械,其中,所述钻孔引导件包括两个所述引导槽。
3.根据权利要求2所述的销放置器械,其中,两个所述引导槽彼此平行。
4.根据权利要求1至3中任一项所述的销放置器械,其中,所述至少一个衬套具有抵接端,所述抵接端用于在所述衬套被放入所述引导槽中时限制衬套在所述纵向上的移动。
5.根据权利要求1至4中任一项所述的销放置器械,还包括所述钻孔引导件中的插孔,所述插孔适于接纳用于远端操纵的手柄。
6.根据权利要求1至5中任一项所述的销放置器械,还包括用于每个由所述引导槽和所述衬套构成的组的至少一个所述销,所述衬套与所述销滑动接合。
7.根据权利要求1至6中任一项所述的销放置器械,其中,所述钩状部的表面大致横向于所述纵向。
8.根据权利要求1至7中任一项所述的销放置器械,其中,所述钩状部具有基于患者的解剖学模型的至少一个患者特异性表面。
9.根据权利要求8所述的销放置器械,其中,患者的解剖学模型是肩胛骨的模型,所述至少一个患者特异性表面与所述肩胛骨的头部和关节盂的颈部之中的至少一者的形状互补。
10.根据权利要求9所述的销放置器械,其中,所述至少一个引导槽与下列位置中的至少一者纵向对准:植体的规划中心、邻近与喙突对准的上盂缘的位置、以及喙突的基部。
11.一种对关节盂修整表面的方法,包括:
获得具有至少两个销槽的患者特异性器械;
将所述患者特异性器械的销槽安装在固定于肩胛骨的第一销上;
将管状扩孔器安装在固定于关节盂的第二销上;
将所述患者特异性器械的轴槽安装在管状扩孔器的轴上,以在所述轴槽和所述管状扩孔器的轴之间形成结合部,允许所述管状扩孔器沿着第二销进行平移移动;以及
在被所述患者特异性器械和所述销引导的同时,利用所述管状扩孔器对关节盂进行扩孔。
12.根据权利要求11所述的方法,其中,获得所述患者特异性器械包括获得如下患者特异性器械,即其轴槽的远离所述关节盂的端部与所述关节盂相距患者特异性距离,还包括一旦所述管状扩孔器的轴上的止动器抵接所述轴槽的端部就停止扩孔。
13.根据权利要求12所述的方法,还包括获得如下管状扩孔器,即所述轴上的止动器位于患者特异性距离处,所述患者特异性距离是规划扩孔深度的函数。
14.根据权利要求12和13中任一项所述的方法,其中,将所述患者特异性器械的轴槽安装在所述管状扩孔器的轴上包括:围绕所述第一销旋转所述患者特异性器械,使所述管状扩孔器的轴经由所述轴槽中的侧向开口接纳在所述轴槽中。
15.一种在已修整表面的关节腔中定位植体的方法,包括:
获得具有至少一个销槽的患者特异性器械;
将所述患者特异性器械的销槽安装在固定于肩胛骨的销上;
将冲击器的轴安装在所述患者特异性器械的引导支架中,使得所述轴与已修整表面的关节腔对准,在所述轴和所述引导支架之间形成平移结合部,允许所述轴沿着所述引导支架平移移动;
将所述植体安装在所述冲击器的自由端;以及
在被所述患者特异性器械和所述销引导的同时,迫使所述植体进入已修整表面的关节腔。
16.根据权利要求15所述的方法,其中,获得所述患者特异性器械包括获得所述引导支架的患者特异性取向,使得所述植体中的通孔相对于已修整表面的关节腔的取向与接纳在所述植体的通孔中的螺钉的规划定位有关。
17.根据权利要求15和16中任一项所述的方法,还包括在被迫进入已修整表面的关节腔中的植体中定位钻孔引导件,所述钻孔引导件包括定位为指向所述销的视觉指示器。
18.根据权利要求15至17中任一项所述的方法,其中,在被所述患者特异性器械和所述销引导的同时迫使所述植体进入已修整表面的关节腔包括在单一平移自由度中移动所述植体。
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US11432934B2 (en) | 2022-09-06 |
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CA3072716C (en) | 2022-03-22 |
CA2866395A1 (en) | 2013-10-03 |
WO2013142998A1 (en) | 2013-10-03 |
ES2637823T3 (es) | 2017-10-17 |
CA3072704A1 (en) | 2013-10-03 |
CA2866395C (en) | 2020-11-10 |
JP6483758B2 (ja) | 2019-03-13 |
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