DE102010041564B4 - orienting device - Google Patents

orienting device

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Publication number
DE102010041564B4
DE102010041564B4 DE102010041564.2A DE102010041564A DE102010041564B4 DE 102010041564 B4 DE102010041564 B4 DE 102010041564B4 DE 102010041564 A DE102010041564 A DE 102010041564A DE 102010041564 B4 DE102010041564 B4 DE 102010041564B4
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DE
Germany
Prior art keywords
orientation element
surgical object
element
orientation
surgical
Prior art date
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Active
Application number
DE102010041564.2A
Other languages
German (de)
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DE102010041564A1 (en
Inventor
Rainer Graumann
Gerhard Kleinszig
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Siemens Healthcare GmbH
Original Assignee
Siemens Healthcare GmbH
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 Siemens Healthcare GmbH filed Critical Siemens Healthcare GmbH
Priority to DE102010041564.2A priority Critical patent/DE102010041564B4/en
Publication of DE102010041564A1 publication Critical patent/DE102010041564A1/en
Application granted granted Critical
Publication of DE102010041564B4 publication Critical patent/DE102010041564B4/en
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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/80Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58Surgical 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
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7059Cortical plates
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, 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
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477Coupling
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046Tracking techniques
    • A61B2034/2055Optical tracking systems
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, 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
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3966Radiopaque markers visible in an X-ray image
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, 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
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3983Reference marker arrangements for use with image guided surgery

Abstract

Device comprising a surgical object (1, 4) and an orientation element (2), which has at least one first connection element (3a, 3b; 5a, 5b) to the surgical object (1, 4), wherein the orientation element (2) is attached to a surgical object defined position (32, 52) on the surgical object (1, 4) is positionable, wherein the at least one first connecting element (3a, 3b; 5a, 5b) at one end semicircular gripping elements (31, 51) which are formed thereto in that the orientation element (2) can be clipped onto the surgical object (1, 4), corresponding surfaces on an inner side of the gripping elements (31, 51 ) and on the surgical object (1, 4) each have a toothing (311, 511; 322, 522), by means of which the orientation element (2) rotationally symmetrical and angular stable on the surgical object (1, 4) can be aligned raster.

Description

  • The present invention is in the field of medical technology and more particularly relates to an approach for locating surgical objects, including implants, tools and instruments, with respect to their orientation and length in the x-ray image for medical intervention in a two-dimensional x-ray image.
  • From the US Pat. No. 6,226,548 B1 For example, a method and apparatus for subcutaneous registration for computer-assisted surgical navigation is known. In this case, an identification structure is firmly attached to the device.
  • The US 2001/0 034 480 A1 describes a method for localizing objects in interventional radiology. In this case, projections of the object to be localized are simulated and compared with a projection image.
  • From the DE 20 2006 019 649 U1 is a navigated application guide for targeted spinal drug delivery known. In this case, a guide tube fixing device for fixing a guide tube is provided. On the guide tube, a navigation element can be attached.
  • The DE 10 2008 052 680 A1 describes a device for the controlled adjustment of a surgical positioning unit. The positioning unit can be used to align operation guidance means.
  • From the DE 10 2005 022 901 A1 For example, a method and an apparatus for determining the orientation of a portion of an instrument located in an object are known. There are markers on the section that form a marking pattern. The marking pattern can be assigned to previously known patterns.
  • In the field of orthopedics or traumatology, z. As in femoral fractures or hip joint surgery, but also in the field of cardiac surgery, it may be necessary to introduce implants or instruments by means of an X-ray image control in the patient or to position it correctly.
  • At the patient, by means of medical measures, eg. B. performed surgical procedures. In doing so, it is desirable for the executors to obtain navigation support. This means z. B. that both the position and orientation of bone as well as the positions and orientations of instruments, medical aids, medical devices, etc. are determinable in a two- or three-dimensional coordinate system. For this purpose, one or more orientation elements or navigation markers are attached to the objects to be located. On the orientation element several markers are arranged in a geometrically defined arrangement on a support or tripod.
  • The orientation element, which can also be referred to as navigation marker, usually has four marker elements, two of the marker elements define a straight line in space. A third marker element is arranged so that it lies outside this line and thus defines a plane in space together with the first two marker elements. The fourth marker element is again outside this plane. The respective relative spatial position of the marker elements to each other describes their relative arrangement, which may be different, for example, for different navigation markers in order to distinguish each of them from each other in a camera or X-ray image.
  • The use of infrared-reflecting spheres in optical navigation systems or x-ray markers in the use of x-ray systems is known. By means of the markers arranged on the orientation elements, they can be determined with regard to position and orientation in the 2D X-ray image. To determine the length of the instrument, segmentation algorithms had to be used on the objects visible in the X-ray image. Determining the objects with respect to their length can be difficult because overlays with other radiopaque materials, e.g. As implants, instrument tip often occur.
  • The object of the present invention is to specify a further orientation element for instruments and implants.
  • This object is achieved by a device according to claim 1. Advantageous developments of the invention will become apparent from the dependent claims, the following description and the figures.
  • The orientation element is attached to a defined position of a surgical object having at least one first connection thereto, wherein this connection between the surgical object and the orientation element is designed such that the orientation element can be aligned such that it can be flexibly attached.
  • The invention has the advantage that by means of a Anklippmechanismus the orientation element rotationally symmetrical but also angular stable to the surgical object attachable.
  • The invention has the advantage that conclusions can be derived by a location-accurate attachment of an orientation element on an instrument or implant conclusions for the three-dimensional position of the instrument or implant in the coordinate system of the X-ray system.
  • The invention has the advantage that an immediate detection of deviations between the actual and desired length of the surgical object, z. B. caused by Objektverbiegungen, are visualized in the X-ray image.
  • The invention has the advantage that complex shapes of k-wires and / or implants can be displayed.
  • Further advantageous embodiments are given in the dependent claims.
  • For a further description of the invention, reference is made to the exemplary embodiments illustrated in the figures.
  • Show it:
  • 1 an implant with orientation device,
  • 2 a k-wire with orientation device and
  • 3 a detailed view.
  • In this orientation device, an orientation element is so pronounced that it can be arranged at at least one defined position alignable on a surgical object.
  • In 1 is an implant 1 , For example, a femur LCP plate, shown schematically. On this implant 1 is at a defined position P1, P2 an orientation element 2 arranged. The positions of P1, P2 are exactly determinable. Thus, P1, P2 can be determined by the distance from the tip or the end of the femur plate with respect to a central axis MA and the respective distance, optionally with an angle, from the central axis MA. The orientation element 2 can at the time of insertion of the implant 1 be attached to this or be. The attachment can be achieved, for example, by clipping on at least one of the exact predetermined points P1, P2 on the implant 1 respectively. The attachment means may be detachably formed from the surgical object. The connection can by means of a first, second connecting element 3a . 3b respectively. On the orientation element 2 a plurality of X-ray and / or infrared detectable marker points are integrated. The number of marker points may vary from orientation element to orientation element. The arrangement of the marking elements is designed individually for each orientation element. Helpful in determining the orientation can be the shape of the orientation element 2 be. The marking elements can be introduced through holes on an elongate orientation element. Data regarding orientation and placement of the orientation element 2 can be taken from a 2D / 3D X-ray image or, if available, the registration procedure. The outer edges of the orientation element 2 can be faded in the X-ray image. The implant 1 stored data with respect to its geometry are superimposed taking into account the orientation of the orientation element in the 2D / 3D X-ray image. By means of on the orientation element 2 arranged markers and markings and the positions P1, P2 of the attachment to the surgical object 1 . 4 can affect the orientation of the surgical object 1 . 4 and its length or the distance to other objects can be determined. About the on the orientation element 2 arranged markers 7 and their position on the object can be determined from the X-ray image of the complete geometry of the object without further Segmentierungsprozeduren in a not reproduced here arithmetic unit and visualized on a screen unit. By means of a cross-fade unit in the arithmetic unit not explicitly shown here, fade-ins and blends of model data of both surgical objects and orientation elements in the 2D / 3D X-ray images are undertaken. This can be immediately closed, for example, on the length or correct orientation of the objects in the X-ray image.
  • In 2 is an orientation element 2 on a Kirschner wire 4 arranged. The arrangement of the orientation element 2 takes place at a defined location 5a . 5b of the k-wire 4 , Due to the exact and known position of the orientation element 2 on the k-wire 4 by stored model data of the respective k-wire 4 the position as well as a distance to other objects in the environment in the 2D or 3D X-ray image is visualized. The model data may be retrieved, for example, by the manufacturer or recorded after or during a sterilization process by means of a scanning device. After determining the orientation of the orientation element, the model data can be superimposed on the 2D / 3D X-ray image. If differences in the length and orientation of the k-wire or the surgical object to the actual image in the x-ray images are visible, the surgeon can advantageously be immediately notified of this change to the surgical object used via a monitor unit. By means of the k-wire 4 incorporated cuts 8th this can be the orientation unit 2 Record defined.
  • In addition, stored dimensions or the object data as well as the data of the orientation element can be calculated and superimposed into the 2D and / or 3D X-ray images. This has the advantage that segmentation procedures do not have to be performed. Another advantage is the possibility of a review of the surgical object z. B. with respect to deformations. In the case of the device of an orientation element presented here, the desired position of a surgical object in the 2D / 3D X-ray image can be overlaid with the current representation. Deviations are recognized immediately, measures such as replacement or re-calibration of the surgical object can be initiated.
  • In 3 are part of the orientation element 2 as well as a part of the surgical object 1 . 4 displayed. The orientation element 2 is at a defined position P1, P2 of the surgical object 1 . 4 arranged. The recess in or on the surgical object 1 . 4 is fitting to the first or second connecting element 3a . 3b . 5a . 5b educated. The connection between the connecting element and the surgical object is detachable. The attachment of the orientation element 2 can via first and / or second connecting elements 3a . 5a ; 3b . 5b respectively. The connecting element is, for example, rigid with the orientation element at its first end 2 connected. At the second end of the connecting element 2 are semicircular gripping elements 31 . 51 formed for example of resilient material. These gripping elements 31 . 51 are then designed so that these form-accurate characteristics 32 . 52 on the surgical object 1 . 4 include. An enclosing or a circular expression can be designed so that the gripping element 31 . 51 is rigidly attached to this fixable or rotationally symmetrical. The corresponding surfaces between the inside of the semicircular gripping element 31 . 51 and the surface of the expression 32 . 52 on the surgical object 1 . 4 can also be designed such that a parallel orientation of the orientation element 2 to the surgical object 1 . 4 can be grid-shaped. A defined, for example, parallel adjustment or alignment of the orientation element to the surgical object can be achieved by means of toothing 311 . 511 ; 322 . 522 the mutually aligned surfaces can be achieved. The clamping action of the gripping element 31 . 51 fixes the orientation element 2 defined on the surgical object. The same device can also be used if instead of the x-ray marker on the orientation element 2 optical markers are arranged. In the case of optical markers, the position determination or alignment z. B. with a single navigation "CAMC" done. Required for this is the use of at least four non-in-plane markers.
  • LIST OF REFERENCE NUMBERS
  • 1
    Implant / femoral LCP plate
    2
    Orientation element / Navigation markers
    P1
    first positioning
    P2
    second positioning
    3a
    first connecting element
    3b
    second connecting element
    4
    k-wire
    5a
    first connecting element
    5b
    second connecting element
    7
    Marker elements / X-ray markers / optical markers
    8th
    defined notches
    31, 51
    gripping element
    32, 52
    Expression on the surgical object
    311, 511
    Characteristic on the inside of the gripping element
    322, 522
    Corresponding expression on the outside of the expression on the surgical object
    MA
    central axis

Claims (5)

  1. Device with a surgical object ( 1 . 4 ) and an orientation element ( 2 ), the at least one first connecting element ( 3a . 3b ; 5a . 5b ) to the surgical object ( 1 . 4 ), wherein the orientation element ( 2 ) at a defined position ( 32 . 52 ) on the surgical object ( 1 . 4 ) is positionable, wherein the at least one first connecting element ( 3a . 3b ; 5a . 5b ) at one end semicircular gripping elements ( 31 . 51 ), which are designed to form precise expressions ( 32 . 52 ) on the surgical object ( 1 . 4 ), whereby the orientation element ( 2 ) on the surgical object ( 1 . 4 ) is clipped, with corresponding surfaces on an inner side of the gripping elements ( 31 . 51 ) and on the surgical object ( 1 . 4 ) each a toothing ( 311 . 511 ; 322 . 522 ), by means of which the orientation element ( 2 ) rotationally symmetrical and angular stable on the surgical object ( 1 . 4 ) is raster alignable.
  2. Device according to one of the preceding claims, characterized in that the orientation element ( 2 ) can be visualized in the X-ray image, wherein each orientation element ( 2 ) are formed on a longitudinally distinct orientation element unique recesses.
  3. Device according to one of the preceding claims, characterized in that on the orientation element ( 2 ) X-ray marker balls are arranged.
  4. Device according to one of the preceding claims, characterized in that on the orientation element ( 2 ) Both x-ray markers, as well as optical markers are arranged.
  5. Device according to one of the preceding claims, characterized in that a cross-fade unit is formed such that the images ( 1 . 2 . 4 ) in the X-ray images or the X-ray image, the associated model data of the orientation element ( 2 ) and / or the surgical objects ( 1 . 4 ) are superimposed congruent.
DE102010041564.2A 2010-09-28 2010-09-28 orienting device Active DE102010041564B4 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
DE102010041564.2A DE102010041564B4 (en) 2010-09-28 2010-09-28 orienting device

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Application Number Priority Date Filing Date Title
DE102010041564.2A DE102010041564B4 (en) 2010-09-28 2010-09-28 orienting device

Publications (2)

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DE102010041564A1 DE102010041564A1 (en) 2012-03-29
DE102010041564B4 true DE102010041564B4 (en) 2017-09-14

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Families Citing this family (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102012207261A1 (en) 2012-05-02 2013-11-07 Siemens Aktiengesellschaft Surgical tool
US20150297315A1 (en) 2012-11-06 2015-10-22 Brainlab Ag Two-part tracking reference structure
DE102013104887A1 (en) * 2013-05-13 2014-11-13 Aap Implantate Ag Osteosynthesis plate and system for osteosynthesis
EP3019109A1 (en) * 2013-07-08 2016-05-18 Brainlab AG Single-marker navigation
LU93104B1 (en) * 2016-06-13 2018-01-23 Scopis Gmbh Attachment of tracking elements to surgical instruments

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6226548B1 (en) * 1997-09-24 2001-05-01 Surgical Navigation Technologies, Inc. Percutaneous registration apparatus and method for use in computer-assisted surgical navigation
US20010034480A1 (en) * 2000-02-26 2001-10-25 Volker Rasche Method of localizing objects in interventional radiology
DE102005022901A1 (en) * 2005-05-18 2006-11-23 Siemens Ag Instrumentation section orientation procedure takes two dimensional image of object area and recognises marking pattern
DE202006019649U1 (en) * 2006-12-22 2007-08-16 Brainlab Ag Guiding tube -fixing device for attaching or fixing guiding tube at structure for supplying substance, has mounting element, fixed joint in fastening element and fixed holding device on joint
DE102008052680A1 (en) * 2008-10-22 2010-04-29 Surgitaix Ag Device for the controlled adjustment of a surgical positioning unit

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6226548B1 (en) * 1997-09-24 2001-05-01 Surgical Navigation Technologies, Inc. Percutaneous registration apparatus and method for use in computer-assisted surgical navigation
US20010034480A1 (en) * 2000-02-26 2001-10-25 Volker Rasche Method of localizing objects in interventional radiology
DE102005022901A1 (en) * 2005-05-18 2006-11-23 Siemens Ag Instrumentation section orientation procedure takes two dimensional image of object area and recognises marking pattern
DE202006019649U1 (en) * 2006-12-22 2007-08-16 Brainlab Ag Guiding tube -fixing device for attaching or fixing guiding tube at structure for supplying substance, has mounting element, fixed joint in fastening element and fixed holding device on joint
DE102008052680A1 (en) * 2008-10-22 2010-04-29 Surgitaix Ag Device for the controlled adjustment of a surgical positioning unit

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Publication number Publication date
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