CN114144137A - 基准标记物 - Google Patents
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Abstract
一种医疗标记设备，其包括透射线板，该透射线板具有第一多个不透射线元件和第二多个光学反射器，第一多个不透射线元件以第一预定图案嵌入透射线板，第二多个光学反射器以第二预定图案定位在靠近该板的表面上。该设备还包括S型安装臂，该S型安装臂具有第一端和第二端，第一端连接到透射线板，第二端包含一个或更多个紧固插座。
Description
发明领域
本发明总体上涉及基准标记物(fiducial marker)，且具体地说，涉及可以用于对图像引导式手术中存在的多个参照系的配准的标记物。
发明背景
在用于图像引导式手术的增强现实系统中，该系统应该追踪手术中使用的对象和/或患者的正在接受手术的元素。该追踪需要对在手术期间操作的不同参照系进行配准，包括患者的参照系和对患者成像的透视设施的参照系。配准通常需要基准标记物，并且许多这样的标记物是已知的。下面给出了描述标记物示例的参考文献。
Ben-Haim等人的美国专利6,314,310描述了用于x射线引导式手术的装置。该装置包括放置成与受试者身体接触的参照元件，并且该元件包括多个基准标记。
Jutras等人的美国专利7,107,091描述了一种适于与图像引导式手术系统一起使用的手术设备。该设备便于监测相互依存的可移动骨骼元素。
Teichman等人的美国专利9,179,984描述了一种包括多配置追踪阵列的导航系统。多个追踪设备可以位于多配置追踪阵列上。
Haider等人的美国专利9,498,231描述了利用工具追踪系统的计算机辅助手术。
Doan等人的美国专利9,844,413描述了一种在三维空间中追踪身体的不可见结构的监测系统。追踪器获得对象及其附近器械的图像信息，所有这些都带有至少一个图案片段的3D追踪标记物。
Shoham等人的美国专利9,872,733描述了一种系统，该系统为髓内打钉手术中远侧螺钉钻孔提供了机械导向。利用从x射线透视图像获得的数据，通过机器人相对于远侧锁定钉孔自动地定位钻子导向器。
Yang等人的美国专利10,034,713和美国专利申请2017/0252109描述了一种用于追踪手持工具的位置和定向的系统。支撑构件相对于手持工具的纵向部分固定一个或更多个标记物，并且包含标记物的标记物平面相对于纵向部分的纵向轴线成一定角度定向。
Wilkinson等人的美国专利10,080,616描述了一种访问参照标记物阵列固定到其上的骨骼的图像数据的系统。
Lavallee等人的美国专利10,085,709和美国专利申请2017/0164919描述了将3D图像投影到2D的X射线图像的至少一部分上并调整图像的投影几何数据，该调整包括使用图像对图像的配准技术将图像与初始3D图像的投影进行配准。
McLachlin等人的美国专利10,166,079描述了在医疗程序中执行术中图像配准。向感兴趣的对象提供深度编码的标记物。该标记物可由至少两个成像系统成像，并且该标记物至少在深度维度上具有不对称性。
Roger等人的美国专利10,194,993描述了一种用于辅助对患者进行手术的系统。该系统包括显示设备和存储设备，该存储设备存储患者解剖结构的至少一部分的图像，包括定位在患者身上的一个或更多个手术导航标记物，用于在显示设备上显示。
Stallings等人的美国专利申请2011/0004259描述了一种用于在解剖结构上定位基准标记物的设备。该设备包括基准基座和固定构件。基准基座包括被构造成将基准标记物定位在追踪传感器的视野内的转弯部和延伸部。
Robbins等人的美国专利申请2011/0098553描述了通过将磁共振(MR)可见标记物置于相对于相机追踪系统中可见的标记物的已知位置，在图像引导系统中执行对磁共振图像的自动配准。
Doan等人的美国专利申请2015/0150641描述了一种具有一个或更多个图案标签的位置和定向追踪系统，每个标签包括多个对比部分。存在追踪器和数据库，追踪器用于获得关于图案标签的图像信息，数据库具有描述图案标签上的图案的几何信息。
Cameron等人的美国专利申请2015/0366620描述了一种与基于端口的手术的进入端口一起使用的引导件。该引导件包括可定位在手术开口上的主体和联接到主体的把手，该把手用于将进入端口可移除地接收到手术开口中。
Siegler等人的美国专利申请2017/0281283描述了包括一个或更多个基准参照标记物的追踪标记物支撑结构，其中追踪标记物支撑结构被构造成可移除地且牢固地附接到患者的骨骼区域。
Kostrzewski的美国专利申请2018/0200002描述了具有内置导航能力的机器人手术系统，用于手术过程中的患者位置追踪和手术器械引导，而不需要单独的导航系统。
McLachlin等人的美国专利申请2018/0318035描述了一种参照结，该参照结在手术过程中固定在脊柱的一部分周围，并且由手术导航系统追踪。
Abhari等人的美国专利申请2019/0015163描述了如何确定与医疗程序的部位相关的导航信息。然后导航信息被映射到公共坐标空间，以相对于手术部位的保存和实时光学图像的视野确定导航信息。
通过引用并入本专利申请的文件被认为是本申请的整体部分，其程度为除了任何术语在这些并入的文件中以与本说明书中明确地或隐含地作出的定义相冲突的方式被定义之外，应仅考虑本说明书中的定义。
发明概述
本发明的实施例提供了一种医疗标记设备，该医疗标记设备包括：
透射线板，其具有第一多个不透射线元件和第二多个光学反射器，第一多个不透射线元件以第一预定图案嵌入透射线板，第二多个光学反射器以第二预定图案定位在靠近该板的表面上；和
S型安装臂，其具有第一端和第二端，第一端连接到透射线板，第二端包含一个或更多个紧固插座(fastening receptacles)。
典型地，S型安装臂是透射线的。
在公开的实施例中，S型安装臂包括通过笔直区段连接到第二弯曲区段的第一弯曲区段。
在另外的公开的实施例中，S型安装臂包括直接连接到第二弯曲区段的第一弯曲区段。
在又一公开的实施例中，第一预定图案和第二预定图案没有对称轴并且没有对称平面。
根据本发明的实施例，还提供了一种装置，该装置包括：
手术夹具，其用于附接到患者的骨骼；
具有第一表面和第二表面的间隔件，间隔件被构造成固定地连接到手术夹具；以及
标记设备，该标记设备包括：
透射线板，其具有多个不透射线元件，该多个不透射线元件以预定图案嵌入透射线板；和
S型安装臂，其具有第一端和第二端，第一端固定地连接到透射线板，第二端被构造成与间隔件的第一表面配合，并且包含一个或更多个紧固插座，紧固插座被构造成用于臂与间隔件的可移除连接。
在替代实施例中，第一表面和间隔件表面之间有固定的距离。
在另一可选实施例中，第一表面包括第一板，并且第二表面包括第二板，该装置还具有可调整机构，可调整机构连接第一板和第二板，可调整机构被构造成调整板之间的间距。
根据本发明的实施例，还提供了一种装置，该装置包括：
手术夹具，其用于附接到患者的骨骼；
夹具调整元件，其被构造成实现所述附接；
支撑结构，其包围夹具调整元件；以及
标记设备，该标记设备包括：
透射线板，其具有多个不透射线元件，该多个不透射线元件以预定图案嵌入透射线板；和
S型安装臂，其具有第一端和第二端，第一端固定地连接到透射线板，第二端包含一个或更多个紧固插座，紧固插座被构造成用于臂与支撑结构的可移除连接。
根据本发明的实施例，还提供了一种方法，该方法包括：
在透射线板中嵌入以第一预定图案布置的第一多个不透射线元件；
将第二多个光学反射器以第二预定图案定位在靠近该板的表面上；和
将S型安装臂的第一端连接到透射线板，该臂具有包含一个或更多个紧固插座的第二端。
根据本发明的实施例，还提供了一种方法，该方法包括：
将手术夹具附接到患者的骨骼；
在透射线板中嵌入以第一预定图案布置的第一多个不透射线元件，并将第二多个光学反射器以第二预定图案定位在靠近该板的表面上；
将S型安装臂的第一端连接到手术夹具，该臂具有固定地连接到透射线板的第二端；
透视地扫描透射线板、S型安装臂和手术夹具，以便形成透视扫描；
光学扫描第二多个光学反射器以形成第一光学扫描；
将S型安装臂的第一端与手术夹具断开连接，并将患者标记物连接到手术夹具，患者标记物具有处于第三预定图案的第三多个反射器；
光学地扫描第三多个光学反射器，以形成第二光学扫描；
从第一光学扫描和第二光学扫描中导出校正向量，校正向量指示透射线板的位置和定向与患者标记物的位置和定向之间的差异；和
响应于校正向量和透视扫描，确定患者和手术夹具之间的空间变换，以便将患者的参照系与手术夹具的参照系配准。
典型地，该方法包括，响应于对参照系的配准，向为患者执行手术的专业人员呈现与患者对准的、存储的患者图像。
根据结合附图进行的本公开的实施例的以下详细描述，本公开将被更完全地理解，在附图中：
附图简述
图1是示出根据本发明实施例的、在医疗程序的准备阶段使用的医疗标记设备的示意图；
图2是根据本发明实施例的与夹具分离的设备的示意图；
图3是根据本发明实施例的、该设备的示意性分解图。
图4是根据本发明实施例的，在程序的准备阶段和后续阶段两个阶段执行的步骤的流程图；
图5是根据本发明实施例的、程序的后续阶段的示意图；以及
图6、图7和图8是根据本发明替代实施例的、医疗标记设备的示意图。
具体实施方式
概述
本发明的实施例提供了一种基准标记物，该基准标记物用于对在患者的图像引导式手术中存在的不同参照系进行配准。图像引导式手术可以由佩戴增强现实头戴式显示器的医学专业人员来执行，并且为了使显示器正确操作，呈现给专业人员的患者图像应该与实际患者对准。由基准标记物提供的配准确保了必要的图像对准。
在公开的实施例中，标记物连接到夹具，该夹具在对患者执行的程序的准备阶段已经附接到患者的一个或更多个棘突。为了适应患者之间的身体差异，本发明的实施例提供了用于将基准标记物附接到夹具的可选系统，该可选系统包括将标记物连接到夹具的固定宽度间隔件和可变宽度间隔件。
基准标记物包括以预定图案布置的不透射线元件，使得标记物和患者的计算机断层扫描(CT)图像能够在准备阶段将患者解剖结构的参照系和夹具的参照系进行配准。
在该程序的后续阶段，基准标记物被患者标记物替代。在本发明的一些实施例中，基准标记物还包括光学反射器，并且这些反射器的图像可以用于适应患者标记物的不同位置。
在准备阶段获得的配准被用于该程序的后续阶段，从而患者标记物的图像被用于追踪患者，并确保呈现给专业人员的图像是被正确对准的。
该CT设施典型地包括具有狭窄视野的术中CT扫描仪，因此为了成功配准，基准标记物和椎体(vertebral body)的不透射线元件应该是靠近的。本发明的实施例通过使基准标记物处于“台阶”的形式来实现这种紧密接近，其中台阶的一部分包括含有不透射线元件的板，基准标记物的台阶状形式使得板能够靠近椎体定位。台阶的第二部分附接在夹具，并且在这两个部分之间存在已知的机械偏移。
在本发明的实施例中，该板是透射线的，并且具有以预定图案嵌入其中的、上文提到的多个不透射线元件。为了实现上述台阶状形式，S型安装臂的第一端固定地连接到透射线板。此外，S型安装臂具有包含一个或更多个紧固插座的第二端，紧固插座被构造成用于将臂可移除地连接到附接于棘突的夹具。
在公开的实施例中，透射线板、S型安装臂和手术夹具被透视地扫描以形成透视扫描。响应于透视扫描和预定的机械偏移，确定患者和手术夹具之间的空间变换，以便将患者的参照系与手术夹具的参照系进行配准。
典型地，响应于参照系的配准，与患者对准的、存储的患者图像呈现给对患者执行手术的专业人员。
系统描述
在下文中，所有方向参照(例如，上、下、向上、向下、左、右、顶、底、之上、之下、竖直和水平)仅用于识别目的，以帮助读者理解本发明，并且不产生限制，特别是不产生对于本发明实施例的位置、定向或使用的限制。
现在参考图1，图1是示出根据本发明实施例的、在对患者20的医疗程序的准备阶段期间使用的医疗标记设备10的示意图。本文所指的程序假定包括准备阶段和后续阶段，并且如下文更详细描述的，设备10可以在准备阶段期间使用。设备10在本文也被称为基准标记物10。此外，如下所述，医学专业人员在程序的后续阶段使用增强现实系统。
增强现实系统对患者20的各元素的虚拟图像进行投影，以供医学专业人员观察。图像投影与专业人员观察实际患者同时进行，因此投影图像应与患者对准。为了使增强现实系统中的投影图像与患者对准，在准备阶段，使用标记设备10将患者的参照系和附接到患者骨骼的夹具的参照系进行配准。在使用增强现实系统的后续阶段，在准备阶段计算的夹具配准被用于正确地对准由系统产生的图像。
在本文的描述中，程序被假定包括对患者20的脊柱进行操作，并且为了在操作之前以及在该程序的准备阶段执行上述配准，医学专业人员将手术骨骼夹具24插入患者20。夹具的插入部位28靠近患者脊柱的部位32、但与患者脊柱的部位32分开，在程序的后续阶段对该部位32进行操作。专业夹具24夹住患者的一段脊柱，典型地夹住患者的一个或更多个棘突，并且夹具具有支撑结构36，标记物10紧固到该支撑结构36。美国专利申请16/120,480中描述了一种类似于夹具24的夹具，该美国专利申请通过引用并入本文。
图2是与夹具24分离的设备10的示意图，并且图3是根据本发明实施例的设备10的示意性分解图。设备10包括透射线板50，其典型地由诸如聚酰亚胺的生物相容性塑料形成。多个基本上相似的不透射线元件54嵌入板50内，本文假设这些元件包括球体。元件54以预定图案嵌入板50内，本文假设该图案包括矩形的边上的点。然而，可以使用任何其他方便的预定图案。在一些实施例中，预定图案没有对称轴或对称平面。典型地，板50由盖52保护。
典型地由与板50相同的生物相容性塑料形成的透射线S型安装臂58通过臂的第一端62连接到板的边缘66。臂的第二端70包含一个或更多个紧固插座74，紧固插座74使得臂能够以预定的定向牢固地且固定地紧固到支撑结构36。在本发明的实施例中，支撑结构36包围用于夹具24的调整元件102，调整元件实现夹具的钳口与患者20的骨骼的附接。在本发明的实施例中，支撑结构具有不同的深度d。
第二端70具有与支撑结构36的上表面82连接的下平面表面78。在公开的实施例中，插座74包括系留螺钉86和孔92，螺钉和孔分别与上表面82中的螺纹孔96和立柱100配合。
从图中可以明显看出，臂58的长度决定了板50与臂的第二端的下表面78的间距。本发明的实施例包括多组设备10，组中的每个构件大致如本文所述，但是具有不同于其他组构件的已知臂58长度。臂58由被笔直区段120分开的两个弯曲区段112、116形成，并且通过改变笔直区段120的长度来形成不同长度的臂。在本发明的实施例中，笔直区段120的长度从0(零)一直变化到大约7cm，尽管大于7cm的值是可能的。应当理解，当区段120的长度为0时，两个弯曲区段连接在一起，没有中间的笔直区段。
组中的每个构件包括以台阶状布置连接到相应S型安装臂58的相应板50，典型地通过注射成型，可以形成为单件。应当理解，该组中的每个构件都具有已知的尺寸，从而在板50和臂的第二端(包括臂的第二端的下表面78)之间存在已知的机械偏移。
典型地，对于一组设备10的每个构件，不透射线元件54的预定图案被构造成与已知的机械偏移具有一一对应关系。在这种情况下，对图案的识别提供了机械偏移的唯一且明确的值，并且提供该对应关系使得本发明的实施例能够支持基本上任何偏移。如下所述，该对应关系可以存储在计算机存储器中，并且可以访问该存储器，从而可以根据该构件的元件图案来确定给定组的构件的机械偏移的唯一值。
除了上述设备10的组之外，本发明的实施例还包括夹具24的组，其中支撑结构36具有不同的深度d。应当理解，对于任何给定的臂长58，支撑结构26的深度d决定了板50与选自夹具24的组的给定夹具的间距。
回到图1，设备10典型地选自设备10的组，并且夹具24典型地选自夹具24的组，使得当设备附接到支撑结构36的上表面82时，设备的板50尽可能靠近部位32，即，靠近将在程序的后续阶段中执行操作的部位。一旦选定的设备10已经附接到表面82，就对该设备和患者的脊柱执行计算机断层(CT)扫描。可以通过将患者20嵌入到CT扫描设施中来执行扫描，该CT扫描设施典型地是手术中的CT扫描仪。该嵌入可以通过将CT扫描设施带向患者20，或者通过将患者运送到该设施来实施。
包括联接到存储器114的计算机处理器108的处理系统104接收设备10和患者脊柱的扫描，并将扫描作为图像118存储在存储器中。上面提到的一对一对应关系也可以作为对应关系122存储在存储器114中。处理系统被构造成分析存储的图像，以便识别由不透射线元件54形成的图案，并且从识别的图案将设备10的参照系与患者解剖结构的参照系进行配准，并且因此将所附接的夹具24与患者解剖结构的参照系进行配准。
图4是根据本发明的实施例，在程序的准备阶段和后续阶段两个阶段中执行的步骤的流程图。在准备阶段的初始步骤150和附接步骤152中，夹具24被插入患者20体内，并且使用调整元件102夹住患者的一个或更多个棘突，并且基准标记物10被附接到夹具的支撑结构36，如上面参考图1所述。
在扫描步骤154中，对如上所述附接的标记物10执行CT扫描，并且该扫描的图像118存储在存储器114中。在分析步骤156中，处理系统分析存储的图像，并根据分析将标记物10的参照系与患者解剖结构的参照系配准，并且因此将所附接的夹具24与患者解剖结构的参照系配准。
应当理解，步骤156中的配准利用了板50与下表面78的已知机械偏移，以提供夹具的上表面82相对于患者解剖结构的参照系的位置和定向。在上面提到的一对一对应关系作为对应关系122而存储在存储器114中的情况下，在分析步骤156中，处理系统可以使用该存储的对应关系，通过分析所识别的图案来确定机械偏移。
分析步骤156还确定患者和手术夹具之间的空间变换，并且这与机械偏移一起用于计算两个参照系之间的配准。
在准备阶段的结束步骤158中，基准标记物10从夹具24移除，留下暴露的上表面82。
图5是根据本发明的实施例的、程序的后续阶段的示意图。在后续阶段中，执行患者标记物附接步骤160和对准步骤162，并且这些步骤在下面被进一步描述。在后续阶段中，医学专业人员180对患者实施操作。专业人员180佩戴增强现实头戴式显示器(HMD)184，其被构造成向专业人员呈现与患者对准的、存储的图像。为了操作，HMD 184联接到系统104的处理器108，并且存储的图像可以存储在存储器114中。可选地，HMD 184具有其自己的专用处理器，该处理器执行与处理器108执行的功能相似的功能。美国专利9,928,629描述了一种类似于HMD 184的头戴式显示器，该美国专利通过引用并入本文。
为了执行HMD 184的对准，在附接步骤160中，具有已知预设尺寸的患者标记物190附接到夹具24的支撑结构36的上表面82。标记物190包括紧固插座198，基本上类似于插座74，因此在上文提到的上述公开的实施例中，插座198包括系留螺钉202和孔206，螺钉和孔分别与夹具24的上表面82中的螺纹孔96和立柱100配合。在PCT专利申请PCT/IB2019/053524中描述了一种类似于标记物190的患者标记物，该PCT专利申请通过引用并入本文。
标记物190包括结合到患者标记物的表面的光学反射器194，并且反射器以预定图案布置，使得可以分析反射器的图像，从而提供对标记物的位置和定向的明确测量。
在对准步骤162中，HMD向患者标记物190投射可见光或不可见光，并获取标记物的反射器194的图像。根据所采集的图像，HMD处理器确定患者标记物的位置和定向。由于患者标记物具有已知的尺寸，并且附接到上表面82，所以处理器应用在步骤156中得到的配准(在基准标记物10的参照系和患者的解剖结构的参照系之间)，以确保由HMD投影的图像与患者20的解剖结构对准。
以上描述提供了基准标记物10和患者标记物190可以如何通过夹具24附接成尽可能靠近部位32(即，在患者20上执行的手术部位)的细节。以下描述提供了本发明的实施例的进一步细节，可替换地或附加地，这些细节可以被使用，使得患者标记物和基准标记物尽可能靠近操作部位。
图6是根据本发明的替代实施例的、与夹具24分离的医疗标记设备250的示意图。除了下面描述的差异之外，设备250的操作大致类似于设备10(图1-5)的操作，并且在设备250和10两个设备中由相同参考标记指示的元件在结构和操作上大致类似。设备250在本文也被称为基准标记物250。
与设备10(其中S型臂的第二端70被构造成直接连接到支撑结构36的上表面82)相反，在设备250中，在S型臂的第二端和表面82之间存在中间间隔件254。间隔件254形成为具有一对相对的平行表面，即上间隔件表面258和下间隔件表面262，上间隔件表面258和下间隔件表面262分开预设的固定距离h。当组装时，下表面262与支撑结构36的上表面82固定地配合，并且S型臂的下表面78与间隔件254的上表面258可移除地配合。
为了使下间隔件表面262可以与支撑结构的表面82固定地配合，下间隔件表面具有进入下间隔件表面的两个盲孔266，这两个盲孔266与立柱100对准并与之装配。此外，间隔件254包括位于间隔件的孔274中的系留螺钉270。系留螺钉被构造成使得当它被拧入螺纹孔96时，它将间隔件固定地紧固到支撑结构36，同时螺钉270的头部在孔274内并且在间隔件的上表面258下方。系留螺钉270和盲孔266用作间隔件的下表面紧固插座290。
一旦间隔件254被固定到支撑结构36，S型臂的下表面78可以与间隔件的上表面可移除地配合。间隔件的上表面包括两个与孔92对准的螺纹孔278。为了可移除地将S型臂的下表面与间隔件配合，一对固位螺钉282穿过孔92，并拧入螺纹孔278。螺钉282和螺纹孔278用作间隔件的上表面紧固插座294。
典型地，间隔件254是一组这样的间隔件的一部分。在一个实施例中，该组间隔件所具有的h值在1cm-5cm的范围内，但是在其他实施例中，该组间隔件具有不同的h值范围。间隔件254用于将板50升高到夹具24上方，同时保持板尽可能靠近患者的脊柱，并且选定间隔件的h值可以根据患者的特征进行选择。应当理解，具有一组具有不同h值的间隔件254替代了或补充了上面提到的对于一组设备10的不同长度的臂58的要求。
在使用标记物250的程序中，如上所述，在标记物250附接到间隔件254的上表面之后，可以对其进行透视地扫描，然后可以将其从间隔件的上表面移除。如图6所示，在移除之后，患者标记物190则可以附接到间隔件的上表面。患者标记物的附接由螺钉302实现，螺钉302基本上类似于螺钉282，穿过孔206并拧入螺纹孔278。螺钉302和螺纹孔278用作患者标记物的紧固插座298，插座298基本上类似于插座294。
返回参考图4的流程图，当标记物250被用来代替标记物10时，上面针对流程图的每个步骤描述的动作基本上是相似的，除了如下。
在步骤152中，首先将间隔件254固定地附接到支撑结构36，然后将基准标记物250可移除地附接到间隔件，如上所述。
如上所述，在步骤158中，基准标记物250从间隔件移除，并且在步骤160中，患者标记物190附接到间隔件。
应当理解，因为基准标记物250和患者标记物190附接在相同的位置，即间隔件的上表面，所以在步骤156中建立的配准可以在对准步骤162中使用。
图7是根据本发明的替代实施例的、与夹具24分离的医疗标记设备350的示意图。除了下面描述的差异之外，设备350的操作大致类似于设备250(图1-6)的操作，并且在设备250和350两个设备中由相同参考标记指示的元件在结构和操作上大致类似。设备350在本文也被称为基准标记物350。
与使用间隔件254(其中该间隔件的上表面和下表面之间具有预设的固定距离)的设备250相比，设备350使用间隔件354，本文也称为可调整间隔件354，可调整间隔件354在上可调整间隔件板358和下可调整间隔件板362之间具有可调整距离。可调整间隔件354的两个板中的元件对应于固定间隔件254的两个表面中的相应元件。因此，在上板358中，螺纹孔378和孔374基本上类似于孔278和274，使得孔374允许系留螺钉270通过。螺钉282和螺纹孔378用作上可调整间隔件板的紧固插座394。
在下板362中，孔366的直径和位置与盲孔266基本相似，尽管孔366不一定是盲孔。下板362还包括孔374A，其与孔374对准，并且被设定尺寸成保持螺钉270。系留螺钉270和孔366用作下可调整间隔件板的紧固插座390。
可调整间隔件354包括可调整机构400，其连接可调整间隔件354的下板和上板。机构400保持上板彼此基本上平行，同时操作该机构来调整板的间距。
在一个实施例中，如图7所示，机构400包括具有顺时针和逆时针螺纹的杆404，并且螺纹被构造成与滑动地附接到上板358的相应螺母308、412配合。机构400还包括两个杠杆416、420，它们的支点联接到下板362，并且它们的端点附接到相应的螺母。机构400的杆404的旋转增加或减少了螺母间距，并且相应地减少或增加了可调整间隔件354的上板和下板之间的间距。
对于本领域普通技术人员来说，用于连接间隔件354的上板和下板的其他机构将是明显的，这些机构在提供可调整的板间距的同时保持板基本上彼此平行。所有这些机制都被认为包含在本发明的范围内。
返回参考图4的流程图，当标记物350被用来代替标记物10时，上面针对流程图的每个步骤描述的动作基本上是相似的，除了如下。
在步骤152中，首先将下板362固定地附接到支撑结构36，然后将基准标记物350可移除地附接到上板358，如上所述。
如上所述，在步骤158中，基准标记物350从间隔件的上板358移除，并且在步骤160中，患者标记物190附接到间隔件的上板。
应当理解，因为基准标记物350和患者标记物190附接在相同的位置，即间隔件的上板的上表面，所以在步骤156中建立的配准可以在对准步骤162中使用。
图8是根据本发明的替代实施例的、与夹具24分离的医疗标记设备450的示意图。除了下面描述的差异之外，设备450的操作大致类似于设备250的操作(图1-6)，并且在设备250和450两个设备中由相同附图标记指示的元件在结构和操作上大致类似。设备450在本文也被称为基准标记物450。
与设备250相比，多个光学反射器454位于板50的盖52的表面458上。在一个实施例中，反射器454以预定图案布置在表面上，典型地没有旋转对称轴(除了旋转360°的普通对称轴)并且没有对称的镜面。预定图案被构造成使得反射器的图像可以被分析，从而提供对板50的位置和定向的明确测量。反射器454的成像和图像的分析基本上与上面针对患者标记物190的反射器194所描述的相同。
设备450典型地与间隔件254和/或间隔件354一起使用，如上参考图6和图7所述。当所用的设备450与这些间隔件之一一起使用时，患者标记物190可以如上所述相对于间隔件定位。然而，由于反射器454的存在，患者标记物190可以替代地定位在任何其他方便的位置，如下面参考图4的流程图中的改变所解释的。
为了清楚起见，在以下对流程图的改变的描述中，假设设备450与间隔件254一起使用。如果设备450与间隔件354或任何其他有效地将板50与支撑结构36分开的间隔件一起使用，本领域的普通技术人员将能够通过必要的修改调整本描述。
在流程图的步骤152中，首先使用螺钉270将间隔件254附接到支撑结构36，然后使用螺钉282将基准标记物450附接到间隔件，如上所述。
步骤154和156如上面参考图4所描述的那样执行，以便将标记物450的参照系与患者解剖结构的参照系配准，以及因此将所附接的夹具24的参照系与患者解剖结构的参考系配准。
在步骤158中，在从间隔件移除基准标记物450之前，标记物的反射器454被光学地扫描并使用HMD 184成像。与HMD 184相关联的处理器分析该图像以在HMD参照系中找到反射器的位置和定向，从而找到板50的位置和定向。标记物450然后可以从间隔件254移除，并且间隔件可以从支撑结构36移除。
步骤160和162大致如上所述实施，使得在步骤160中，患者标记物190附接到支撑结构36的上表面82。
在步骤162中，患者标记物190被光学地扫描和追踪，并且HMD的处理器能够使用在步骤158中建立的板50的位置和定向来生成板的位置和患者标记物的位置之间的校正向量。校正向量针对基准标记物和患者标记物附接在不同位置(即间隔件和支撑结构)的事实进行校正。在步骤162中，HMD处理器应用该校正向量来确保由HMD投影的图像与患者20的解剖结构对准。
以上描述是针对患者标记物190和基准标记物450附接到与夹具24相关的不同元件的特定情况。本领域的普通技术人员将能够针对其他不同的附接情况进行必要的修改，并且所有这些情况都被认为包括在本发明的范围内。
应认识到，以上描述的实施例是通过示例的方式列举的，并且本发明不限于上文中已经特别示出和描述的那些。更确切地，本发明的范围包括在上文中所述的各种特征的组合和子组合，以及本领域中的技术人员在阅读了前述描述时将想到的且在现有技术中未公开的其变形和修改。
Claims (24)
1.一种医疗标记设备，包括：
透射线板，其包括第一多个不透射线元件和第二多个光学反射器，所述第一多个不透射线元件以第一预定图案嵌入所述透射线板，所述第二多个光学反射器以第二预定图案定位在靠近所述板的表面上；和
S型安装臂，其具有第一端和第二端，所述第一端连接到所述透射线板，所述第二端包含一个或更多个紧固插座。
2.根据权利要求1所述的设备，其中，所述S型安装臂是透射线的。
3.根据权利要求1所述的设备，其中，所述S型安装臂包括第一弯曲区段，所述第一弯曲区段通过笔直区段连接到第二弯曲区段。
4.根据权利要求1所述的设备，其中，所述S型安装臂包括第一弯曲区段，所述第一弯曲区段直接连接到第二弯曲区段。
5.根据权利要求1所述的设备，其中，所述第一预定图案和所述第二预定图案没有对称轴并且没有对称平面。
6.一种装置，包括：
手术夹具，其用于附接到患者的骨骼；
具有第一表面和第二表面的间隔件，所述间隔件被构造成固定地连接到所述手术夹具；以及
标记设备，所述标记设备包括：
透射线板，其包括多个不透射线元件，所述多个不透射线元件以预定图案嵌入所述透射线板；和
S型安装臂，其具有第一端和第二端，所述第一端固定地连接到所述透射线板，所述第二端被构造成与所述间隔件的所述第一表面配合，并且包含一个或更多个紧固插座，所述紧固插座被构造成用于所述臂与所述间隔件的可移除连接。
7.根据权利要求6所述的装置，其中，所述S型安装臂是透射线的。
8.根据权利要求6所述的装置，其中，所述S型安装臂包括第一弯曲区段，所述第一弯曲区段通过笔直区段连接到第二弯曲区段。
9.根据权利要求6所述的装置，其中，所述S型安装臂包括第一弯曲区段，所述第一弯曲区段直接连接到第二弯曲区段。
10.根据权利要求6所述的装置，其中，所述预定图案没有对称轴并且没有对称平面。
11.根据权利要求6所述的装置，其中，在所述第一表面和间隔件表面之间存在固定距离。
12.根据权利要求6所述的装置，其中，所述第一表面包括第一板，并且所述第二表面包括第二板，所述装置还包括可调整机构，所述可调整机构连接所述第一板和所述第二板，所述可调整机构被构造成调整所述板之间的间距。
13.一种装置，包括：
手术夹具，其用于附接到患者的骨骼；
夹具调整元件，其被构造成实现所述附接；
支撑结构，其包围所述夹具调整元件；以及
标记设备，所述标记设备包括：
透射线板，其包括多个不透射线元件，所述多个不透射线元件以预定图案嵌入所述透射线板；和
S型安装臂，其具有第一端和第二端，所述第一端固定地连接到所述透射线板，所述第二端包含一个或更多个紧固插座，所述紧固插座被构造成用于所述臂与所述支撑结构的可移除连接。
14.一种方法，包括：
在透射线板中嵌入以第一预定图案布置的第一多个不透射线元件；
将第二多个光学反射器以第二预定图案定位在靠近所述板的表面上；和
将S型安装臂的第一端连接到所述透射线板，所述臂具有包含一个或更多个紧固插座的第二端。
15.根据权利要求14所述的方法，其中，所述S型安装臂是透射线的。
16.根据权利要求14所述的方法，其中，所述S型安装臂包括第一弯曲区段，所述第一弯曲区段通过笔直区段连接到第二弯曲区段。
17.根据权利要求11所述的方法，其中，所述S型安装臂包括第一弯曲区段，所述第一弯曲区段直接连接到第二弯曲区段。
18.根据权利要求11所述的方法，其中，所述第一预定图案和所述第二预定图案没有对称轴并且没有对称平面。
19.一种方法，包括：
将手术夹具附接到患者的骨骼；
在透射线板中嵌入以第一预定图案布置的第一多个不透射线元件，并将第二多个光学反射器以第二预定图案定位在靠近所述板的表面上；
将S型安装臂的第一端连接到所述手术夹具，所述臂具有固定地连接到所述透射线板的第二端；
透视地扫描所述透射线板、所述S型安装臂和所述手术夹具，以便形成透视扫描；
光学地扫描所述第二多个光学反射器以形成第一光学扫描；
将所述S型安装臂的所述第一端与所述手术夹具断开连接，并将患者标记物连接到所述手术夹具，所述患者标记物具有处于第三预定图案的第三多个反射器；
光学地扫描所述第三多个光学反射器，以形成第二光学扫描；
从所述第一光学扫描和所述第二光学扫描中导出校正向量，所述校正向量指示所述透射线板的位置和定向与所述患者标记物的位置和定向之间的差异；和
响应于所述校正向量和所述透视扫描，确定所述患者和所述手术夹具之间的空间变换，以便将所述患者的参照系与所述手术夹具的参照系配准。
20.根据权利要求19所述的方法，其中，所述S型安装臂是透射线的。
21.根据权利要求19所述的方法，其中，所述S型安装臂包括第一弯曲区段，所述第一弯曲区段通过笔直区段连接到第二弯曲区段。
22.根据权利要求19所述的方法，其中，所述S型安装臂包括第一弯曲区段，所述第一弯曲区段直接连接到第二弯曲区段。
23.根据权利要求19所述的方法，其中，所述第一预定图案、所述第二预定图案和所述第三预定图案没有对称轴并且没有对称平面。
24.根据权利要求19所述的方法，包括响应于对所述参照系的配准，向为所述患者执行手术的专业人员呈现与所述患者对准的、存储的患者图像。
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