DE202007016245U1 - Surgical referencing unit and surgical navigation system - Google Patents

Abstract

surgical Referencing unit (12) for a surgical navigation system (10), wherein a position and / or Orientation of the referencing unit (12) in space by the navigation system (10) is determinable and which referencing unit (12) at least a marker element (14) whose position in space through the Navigation system (10) is determinable, characterized in that a position change device (130) is provided for positioning the at least one marker element (14) at the referencing unit (12) in a first reference position and in at least a second, different from the first reference position.

Description

The The present invention relates to a surgical referencing unit for a surgical navigation system, having a position and / or orientation the Referenzierungseinheit in space determined by the navigation system and which referencing unit is at least one marker element whose position in space can be determined by the navigation system is.

Further The present invention relates to a surgical navigation system with at least one referencing unit and with at least one detection device for detecting the position and / or orientation of the referencing unit in the room, with the surgical referencing unit at least a marker element comprises its position in space by the navigation system is determinable.

In Surgery, especially in orthopedics, is becoming increasingly navigational-based performed. This referencing units are used, the on a human or animal body and / or on instruments to be ordered. The position and / or orientation of each referencing unit let yourself Use the navigation system to determine which one is appropriate Detection device has. Referencing units are known, which have a rigid geometry. This means that that at least a marker element, in a defined manner on the referencing unit fixed or definable. This will change the size of the referencing unit given and thus indirectly also an accuracy in determining the position and / or orientation of the referencing unit in the room. About that In addition, the number of provided at the referencing unit Fixed marker elements. The consequence of this is that the design the referencing unit, in particular its size and geometry, always only a compromise between the wishes of users and application requirements of the navigation system.

It is therefore an object of the present invention, a surgical Referencing unit and a surgical navigation system of to improve the type described above so that use of the Referencing unit and thus also of the navigation system individually can be adapted to respective requirements.

These Task is the case of a surgical referencing unit The type described above solved according to the invention, that a position change device is provided for positioning the at least one marker element at the referencing unit in a first reference position and in at least a second, different from the first reference position.

By the position change device becomes it is possible the at least one marker element of the referencing unit in such a way differently arrange that a geometry of the referencing unit and thus possibly also a size of the same, is customizable. This can be at unfavorable Operating conditions an accuracy in determining the position and / or improve the orientation of the referencing unit in the room. In particular, the surgical referencing unit may be so be formed such that the at least one marker element in more positions positionable is provided as marker elements. It can, however but also more marker elements can be provided as positions for Positioning of the at least one marker element are provided, it being advantageous in such a case when the marker elements differently formed or trained differently carriers are arranged or held on this. Under a positioning the at least one marker element on the referencing unit in a first and in at least one second reference position is also to be understood that the marker element by a characteristic other is replaced, then in another position the referencing unit is arranged. Further, it is also under to understand the different positioning that at least a marker element in another position on the referencing unit to arrange.

On easy way lets the at least one referencing unit in the form of a kit or a modular system, if they have at least one body has, on which the arranged at least one marker element or can be arranged. This allows it to be optimal for each present operating situation to select appropriate marker elements and with the main body connect to. It leaves form such a referencing individually, where the size and the Geometry and the number of used marker elements optimal coordinated and can be chosen so that accuracy in determining position and / or orientation the referencing unit increases becomes. Of course you can instead of a modular system also from a referencing unit to talk, which is formed in the form of a sentence, a basic body and which comprises at least one marker element.

So that the at least one marker element can be transferred in a simple manner from a first reference position into a reference position, it is favorable if a first coupling device is provided for detachably connecting the at least one marker element and the at least one main body. Thus, the at least one marker element can be connected in the desired manner to the at least one base body. Of course, a plurality of first coupling means may be provided, so that the at least one marker element can be arranged in different positions on at least one base body.

On particularly simple way form the first coupling device, if they at least a first coupling element and at least one second coupling element comprising which engage in a coupling position with each other stand, and if the at least one first coupling element at least a marker element and if the at least one second coupling element at least one basic body is arranged. In particular, it is also conceivable on the main body a To provide plurality of second coupling elements, the different Define reference positions and with the at least one first coupling element the at least one marker element in a coupling position in Intervention can be brought. Thus, for example, the at least one marker element connected to a first second coupling element of the base body and in another reference position with a second or another second coupling element of the main body.

Easy to connect are the at least one marker element and at least a basic body with each other when the at least one first or second coupling element is formed in the form of a coupling receptacle and if the corresponding other coupling element formed in the form of a coupling projection is. In particular, you can the coupling receptacle and the coupling projection formed in such a way be that power and / or form-fitting engage each other in the coupling position. Furthermore are so designed coupling elements easy to clean and, if necessary to sterilize.

Around to prevent the at least one marker element and the at least one main body in unwanted Way can solve each other is it cheap, if at least one securing device is provided for securing a connection of the at least one marker element and the at least a basic body in a coupling position.

The at least one marker element and the at least one main body in secure a coupling position and this possibly anyway to separate again from each other, is advantageously achieved in particular by the fact that the at least one securing device in the form of a latching device is trained. For example, the two can each other engage parts to be connected in the coupling position, So in particular when connecting a marker element with a body automatic go into the backup position.

According to one preferred embodiment of The invention may further be provided that the at least one Securing device at least a first securing element and comprises at least a second securing element, which in a securing position engage with each other, and that at least a first Securing element on at least one marker element and that the at least one second securing element arranged on at least one base body is. The safety device thus makes it possible in a simple way already over a coupling device with each other engaged parts the referencing unit in addition to secure.

Especially simply the structure of the at least one safety device, if the at least one first or second securing element in shape a fuse holder is formed and if the corresponding formed other fuse element in the form of a securing projection is.

The Handling of the surgical referencing unit can continue be improved by the securing projection in shape a movably mounted latching projection is formed. The locking projection It can easily turn into a backup capture altogether or partially in, so that the securing device then takes her backup position.

One Safe locking and easy release is advantageous then possible when the movably mounted latching projection formed in the form of a ball pressure piece is.

A connection between the at least one marker element and the at least one base body can be secured in a simple manner by a movement direction of the at least one first and / or second securing element being transverse or substantially transverse to a longitudinal axis defined by the first and / or second coupling element. The coupling elements can thus, for example, be moved towards one another in a direction and be brought into engagement with one another, whereas the direction of movement of the at least one first and / or second securing element transversely to this coupling direction runs.

Cheap is it, if one of the securing elements on at least a first Coupling element is arranged and if a corresponding Secured element arranged on at least one second coupling element is. In this way, the securing device can be compact in the respective coupling device are integrated, which is a minimum Size of the referencing unit allows.

Preferably the first coupling device comprises two, three, four, five or more second coupling elements. This means in particular that at least one basic body said number or a plurality of coupling elements provided could be, which can be equipped with marker elements or the like. In particular, then if more second coupling elements are provided on the base body as marker elements for disposal can stand a position change of Marker elements can be achieved in a simple manner that they are engaged with other coupling elements on the body.

On In a simple way, referencing units can be different form arranged marker elements when the two or more Clutch elements define differently oriented longitudinal axes.

Basically, any Shapes for forming the at least one base body conceivable. Advantageously, however, it is in the form of a sphere or in shape a disk-shaped Plate formed. On balls and plates can be easily Set way marker elements. Furthermore, such a referencing unit be formed with high symmetry.

In order to the referencing unit in a simple and secure way with a surgical instrument or a fastener for fixing can be connected to a human or animal body, it is advantageous if the at least one first base body at least a connecting element of a connecting device for connecting of the basic body having an instrument and / or a fastener.

Especially just lets form the connecting device, if the at least one Connecting element in the form of a connecting projection or in the form a connection receptacle is formed.

Around make sure that the connection device is also permanent takes a connection position and so the referencing unit securely held on an instrument or a fastener can be, it is advantageous if the at least one first body at least one connection backup element to secure a connection the at least one first base body on an instrument and / or having a fastening element.

A good assurance of at least one first body an instrument and / or a fastener can be in particular achieve that the at least one connecting element is formed in the form of a movably mounted latching projection.

On simple way to connect and solve the connection securing element, when the locking projection in shape formed of a ball pressure piece which is preferably in a direction transverse to that of the connecting element defined longitudinal axis runs.

Advantageous it may also be, if the position changing means at least comprises two relatively movable position change members. For example can the two position change links together form a variable segment of the modular system to a Marker element with the main body connect to. Furthermore, so by relative movement of at least two position change links a marker element which is arranged on one of the two position change members or held, from a first reference position to a second Reference position be transferred.

conveniently, are the at least two position change members relative to each other pivotable and / or rotatable and / or slidably arranged. As a result, a at one of the at least two position change members arranged marker element by pivoting, twisting or moving the at least two position change members relative to each other from a first reference position to a second one Reference position be transferred.

advantageously, the at least two position change members are pivotable about a pivot axis which are transversely or substantially transversely to one of at least one of the at least two position change members defined longitudinal axis runs. Optionally, such a pivoting movement only in discrete Steps allows be, for example, by corresponding and at least partially interlocking teeth of the two relative to each other pivotable position change members.

Around for example, a length one formed by the at least two position change members Unit, for example a variable segment of the surgical Referencing unit, change to be able to it is advantageous if the at least two position change members in a direction parallel to one of at least one of the at least two position change links defined longitudinal axis are displaceable relative to each other.

On a particularly simple way can be the position change members move relative to each other, if one of them a piston portion and another of the position change members having a corresponding cylinder portion. The cylinder section can be moved in the piston. Preferably still can Arrangements are made to prevent unintentional release of the to prevent relatively movable position change members, for example in the form of safety devices. Furthermore is it is also conceivable, the position change members such form that only a discrete positioning of the parts relative possible to each other is, for example, by appropriate latches or gears.

Cheap is it, if the at least two position change members non-positively and / or positively in the first and / or second reference position held together are. So it can be ensured that the at least two position change members relative to each other, the adjusted position during a surgical procedure maintained or at least until a user has a relative position the at least two position change members deliberately changes again.

Especially simple and compact is the structure of the referencing unit, when the at least two position change members are supported against each other are.

According to one preferred embodiment of Invention may be provided that a distance and / or a relative Orientation of the at least two position change members in the first Reference position are different than in the second reference position. So lets in a simple way in a defined form a referencing unit change in their characteristic composition. The referencing unit let yourself so for example, given by an operating room boundary conditions adjust to optimal and possible exact position and orientation determination of the referencing unit to allow in the room. A In particular, the referencing unit can be changed so that it does not identical to another homing unit used at the same time is constructed, and thus clearly identified in space can.

conveniently, is at least one position change element provided, which is the at least two position change members includes. A position change element is thus preferably a variable segment which allows Orientation and / or distance between two position change members, in particular be connected or stored together, targeted to change. In particular, it is conceivable that the at least one position change element a basic body and connects a marker element together. So it is possible that Marker element relative to the main body to be set in different positions, for example in discrete positions or in any, not discrete positions.

In order to the at least one position change element connected in a simple way with the at least one marker element can be, it is advantageous if at least one second coupling device to the detachable Connecting the at least one marker element and the at least one Position change element is provided. For example, a referencing unit be structured differently so that a first directly with the main body connected marker element separated from the body and with this again over a position change element connected which makes it possible a distance and / or orientation of the marker element relative to body to change and thus the at least one marker element from a first into a to transfer the second reference position.

Especially the structure of the at least one second coupling device becomes simple, if these at least one first coupling element and at least a third coupling element comprises, which in a coupling position engage with each other, and if the at least one first coupling element on at least one marker element and if the at least one third Coupling arranged on at least one position changing element is. So lets Quasi the position change ele- ment between a marker element and a base body or another position change element interpose.

The structure of the at least one second coupling device further simplifies if the at least one first or third coupling element is designed in the form of a coupling receptacle and if the corresponding other coupling element is designed in the form of a coupling projection. The mutually engageable coupling elements can be so stuck, for example, by one another, bayonet-like connection or screw them together.

Around the at least one position change member connect in a simple way with the at least one body to be able to it is advantageous if at least one third coupling device to the detachable Connecting the at least one base body and the at least one Position change element is provided.

Of the Structure of the available in particular in the form of a modular system Referencing unit leaves be further simplified if the at least one third coupling device at least one second coupling element and at least one fourth Coupling element comprises, which in a coupling position with each other in Engage and if the at least one second coupling element at least one basic body and if the at least one fourth coupling element on at least a position change element is arranged. So can in particular a fourth coupling element on a position change element and any second coupling elements on at least one main body or another position change element in the desired Way and in principle completely arbitrarily combined and brought into engagement.

One a particularly simple construction of the referencing unit becomes possible if the at least one second or fourth coupling element in the form a coupling receptacle is formed and if the corresponding other coupling element formed in the form of a coupling projection is. So in particular a complete compatibility also be achieved to the first and third coupling elements, so that body, position change elements and connect marker elements in any way and combine to referencing units.

In order to the referencing unit targeted to, for example by a Operating room predetermined boundary conditions can be adjusted is it cheap if a distance and / or a relative orientation of the at least a third and the at least one fourth coupling element are different in the first reference position than in the second reference position.

Preferably the surgical referencing unit comprises at least one passive one Marker element. This has the advantage of no power supply for the Marker element is required.

Cheap is it if an outer surface of the passive marker element an electromagnetic radiation or ultrasound reflective surface is. Thus, the referencing unit in conjunction with known, electromagnetic radiation or ultrasound emitting and detecting Navigation systems are used.

alternative or additionally It is advantageous if the surgical referencing unit comprises at least one active marker element. Such marker elements are particularly suitable when the risk of contamination the marker elements is particularly large or a direct visual connection to the navigation system or a detection device of the same always given.

Preferably the active marker element comprises a transmitting unit for transmission electromagnetic radiation or ultrasound. This can be signals and in particular data from the marker element to a detection device of a navigation system become.

Especially simply the structure of the surgical referencing unit, if the at least one marker element in the form of a sphere or is formed in the form of a flat circular disk. It can be so easy to manufacture and can, especially in passive Marker elements, electromagnetic radiation and / or ultrasound reflect in an optimal and defined way.

In principle, it would be conceivable the at least one marker element directly with the at least one body or a position change element connect to. To the variability the referencing unit continues to increase, it is beneficial if that at least one marker element is arranged on a marker element carrier or a marker element carrier includes. In particular, the marker element can be detachably connected to the marker element carrier be. So can individual marker elements if required, without a supporting structure to be exchanged with the referencing unit, For example, if a reflective surface or a transmitting unit damaged by a marker element or destroyed.

Around the marker element carrier in a simple way with a base body or a position change element to be able to connect is it cheap if on the marker element carrier at least one first coupling element of the at least one first Coupling device is arranged.

Advantageous it may also be, if the marker element carrier in the form of a position change member is trained. this makes possible it to hold a marker element directly to the position change member and thus optionally on a position change element.

Of the Structure of the referencing unit can be further simplified if the marker element carrier a longitudinal axis Are defined. So can in particular an orientation and also a Position of the respective marker element in the desired and defined manner be specified.

Especially It is easy to make a marker element carrier if it has at least one Cylinder section includes. In particular, at one end of the cylinder portion a marker element to be held, preferably rotationally symmetrical to the longitudinal axis arranged, and at the other end of the cylinder portion a first Coupling element, preferably oriented coaxially to the longitudinal axis.

Preferably is the main body arranged on an instrument or a fastening device. In other words, this means that the fastening device or the instrument each comprise one or more basic bodies can. So can easily use the referencing unit to position and / or orientation of an instrument or an example attached to a human or animal body fastening device be determined with the navigation system.

Especially economical can be made the surgical referencing unit, if the at least one Marker element is made of a plastic.

The Manufacture and the cost of this can be further simplified or reduced, if the at least one position change member made of a plastic is made. In particular, you can made of plastic parts of the referencing as Disposable articles are formed.

Advantageous it is also when the at least one base body is made of a plastic. Also the basic body lets it go easy and inexpensive manufacture and form as a disposable product.

Around being able to use the referencing unit multiple times is It is advantageous if it is at least partially made of a steam sterilizable Material is made. In particular, bearing parts, for example Basic body, Position change link and marker element carriers, also of a stainless metal, such as a tool steel or the like.

According to one preferred embodiment of Invention more marker elements are provided as connectable to the body are. Preferably, more position change elements are provided as with the main body are connectable. Overall leaves build up such a modular system from particular primitives, marker elements with and without marker element carrier and optionally also position change links, in the desired Way to be mounted or changed to a referencing unit can.

advantageously, the first and second reference positions are clearly defined Reference positions. This is especially useful with a navigation system Position and / or orientation required for a referencing unit be firmly determined, clearly an instrument or a fastening device, which can be arranged, for example, on a human or animal body is, assign.

Around a clear determination of position and / or orientation of a To obtain referencing unit in the room, it is convenient if the referencing unit has three or more surgical marker elements includes.

The The object initially posed is further in a surgical navigation system The type described above solved according to the invention, that a position change device is provided for positioning the at least one marker element at the at least one referencing unit in a first reference position and in at least a second, different from the first reference position. Such a navigation system makes it possible to connect the above with the inventively proposed Referencing units described benefits to be able to use is called in particular the adaptation of a referencing unit to constraints in a room or for distinguishing instruments and for example a fastening device fixed to a human or animal body.

conveniently, The surgical navigation system includes one of those described above Referenzierungseinheiten. Accordingly, the navigation system also those mentioned above in connection with the invention Referencing units described advantages.

The following description of preferred embodiments of the invention used in conjunction with the drawings for further explanation. Show it:

1 a schematic representation of a surgical navigation system with associated homing units;

2 : a partially openwork and ge sectional perspective view of a surgical referencing unit;

3 : an enlarged view of area A off 2 ;

4 a partially cutaway perspective view of a position change member with marker element;

5 : A further, partially cutaway perspective view of a further embodiment of a referencing unit.

In 1 is an example by a reference numeral 10 equipped navigation system shown. It includes several referencing units 12 which preferably have at least three marker elements in the exemplary embodiments illustrated in the figures 14 include. The marker elements 14 may be provided in the form of active, that is to say electromagnetic radiation and / or ultrasound emitting, or in the form of passive marker elements which can reflect electromagnetic radiation and / or ultrasound.

The navigation system 10 includes a transmitting and receiving unit 16 for emitting and receiving electromagnetic radiation and / or ultrasound. It comprises a bar-shaped carrier 18 , at which three transceivers 20 are arranged with which electromagnetic radiation or ultrasound emitted and / or can be received. Basically, only two transceivers could 20 be provided. For accuracy in determining the position of the referencing units 12 can also improve three or more such transceivers 20 be provided. Furthermore, the navigation system includes 10 a data processing system 22 , which at the in 1 illustrated embodiment, three interconnected computer 24 , a display device in the form of a monitor 26 and an input device in the form of a keyboard 28 includes. With the data processing system 22 can from the sending and receiving unit 16 generated and / or received signals are processed to a position and / or orientation of a referencing unit 12 to be determined in the room.

Some of the referencing units 12 may in particular be designed such that they with corresponding adapters 30 For example, in the form of fasteners such as bone screws, for example on a patient 32 can be determined. In particular, so can joint positions and joint centers of the patient 32 be determined, for example, by a body part, for example, a femur 34 of the patient 32 to which a first reference element 12 is fixed, relative to another body part, for example, a pelvic bone 36 of the patient 32 , is moved, on which a further fastening unit 12 is fixed. Alternatively, a referencing unit 12 also on a surgical instrument 38 or a tool, for example using a suitable holding device 40 ,

For example, referencing units 12 a cross-shaped carrier 42 comprising, which four substantially mutually perpendicular support arms 44 has, in particular, may have different lengths. Each arm 44 carries at the in 1 illustrated embodiment, a spherical, passive marker element 14 ,

Alternatively, a referencing unit 12 also active marker elements 14 include, for example, a total of six active marker elements 14 , The active marker elements are preferably designed such that they can emit electromagnetic radiation and / or ultrasound signals emitted by the transmitting and receiving unit 16 of the navigation system 10 can be detected. With the data processing system 22 can the navigation system 10 from the received signals, a position and / or an orientation of the referencing unit 12 and thus indirectly also an instrument 38 or a femur 34 in the room, for example in an operating room.

The referencing unit 12 , which on the instrument 38 is arranged, is preferably composed of individual elements of a modular system for forming Referenzierungseinheiten. The referencing unit 12 comprises a spherical base body 46 of which a round rod-shaped connecting element 48 protrudes, which is part of a connection device 50 forms, by means of which the basic body 46 on the holding device 40 can be arranged. The holding device 40 preferably has one to the free end of the connecting element 48 corresponding recording in which the end 52 can be introduced. In the area of the free end 52 is on the connecting element 48 Further, a connection securing element 54 provided, preferably in the form of a ball pressure piece, which is designed such that spherical ends transverse to a longitudinal axis of the connecting element 48 moved and over an outer surface of the connecting element 48 something can project, so they with corresponding shots of the recording on the holding device 40 can be engaged when the connecting element 48 in defi nated manner on the holding device 40 is stored. The connection protection element 54 prevents in particular a movement coaxial with the longitudinal axis of the connecting element 48 and optionally a rotation of the connecting element 48 around its longitudinal axis. The connecting element 48 can be solvable or insoluble with the main body 46 be connected.

In the 2 shown referencing unit 12 includes four identical marker elements 14 that by means of first coupling devices 56 with the main body 46 can be connected. Each marker element 14 comprises a cylindrical marker element carrier which has a longitudinal axis 60 Are defined. Coaxial to the longitudinal axis 60 stands at one of the two free ends 62 and 64 a smaller outer diameter than the marker element carrier 58 exhibiting coupling pin from which a first coupling element 66 the first coupling device 56 forms.

A second coupling element 68 the first coupling device 56 is formed by a blind hole-like recess on the base body 46 , which may for example be oriented so that its longitudinal axis is a center of the body 46 cuts. The two coupling elements 66 and 68 are coordinated so that they can be positively interlocked with each other. To a relative movement of the marker element 14 and the basic body 46 to prevent is a safety device 70 provided, which comprises mutually corresponding first and second securing elements, such as in 3 shown. The security elements 72 and 74 are formed in the form of annular grooves or hemispherical securing receptacles and spherical securing projections, which by means of a coil spring 76 in a direction transverse to the longitudinal axis 60 be pressed apart and partially over an outer surface of the first coupling element 66 protrude so they fit into the first fuse element 72 can intervene in a backup position. The second security elements 74 as well as the coil spring 76 make up a total of a ball pressure piece 78 out, which in a transverse to the longitudinal axis 60 on the first coupling element 66 trained and transverse to the longitudinal axis 60 oriented drilling 80 is held. The ball pressure piece 78 thus comprises two movably mounted latching projections in the form of the second securing elements 74 , Through the security device 70 are the marker element 14 and the main body 46 In addition, also secured to each other in a positive engagement in a coupling position. Instead of a safety device 70 comprising a ball pressure piece 78 provide all kinds of latching or snap-in connections come into question, which allow a simple defined positioning of the two coupling elements to be joined together, which are also separated by a defined application of force again.

On the other end 64 of the marker element carrier 58 is also coaxial with the longitudinal axis 60 a short cylindrical pin 82 from, which has an even smaller diameter than the first coupling element 66 , Attached to this is a marker ball 84 with an electromagnetic radiation and / or ultrasound reflecting outer surface 86 , The marker ball 84 Can be permanent or detachable with the pin 82 be connected. A detachable connectivity of the marker ball 84 with the pin 82 allows dirty or damaged marker balls 84 replace if necessary. Optionally, on the pin 82 to a defined positioning of the marker ball 84 relative to the marker element carrier 58 on the cone 82 to ensure a locking connection, not shown, may be provided, for example in the form of a ball pressure piece. It would also be possible to tap 82 to provide an annular groove in which a in a pin receiving on the marker ball 84 forming annular groove inserted snap ring can engage in a coupling position.

The marker elements 14 the in 2 shown referencing unit 12 are all identical. In total, four second coupling elements 68 at the base body 46 provided, the longitudinal axes are all in one plane and each rotated by 90 ° relative to each other. This allows a total of four marker elements in such a way with the main body 46 connect that to a cross-shaped structure of the referencing unit 12 can be trained. Optionally, however, more than four second coupling elements 68 at the base body 46 be provided, the arrangement of the longitudinal axes can be arbitrary in principle. The more second coupling elements 68 at the base body 46 are provided, the more marker elements 14 can with the main body 46 which results in an accuracy in the determination of the position and / or orientation of the referencing unit 12 can be improved in the room. Of course, the marker elements 14 also be shaped slightly differently. In particular, they may be in the embodiment of the marker element carrier 58 differ. These may have a different length and also optionally be angled, preferably with a fixed angle of deflection. It would also be conceivable to use the marker element carrier 58 similar to the main body 46 spherical form and provide further recordings for the formation of coupling elements, in which in turn one or more marker elements 14 can be arranged.

Another part of the referencing unit 12 forming modular system is in 3 exemplified. It is a total with the reference numeral 88 provided position change element. It includes, as in 3 shown, three position change members 90 . 92 and 94 , The position change links 90 and 92 are relative to each other about a pivot axis 96 pivoted, which are perpendicular to the longitudinal axes 98 and 100 the first and second position change member 90 respectively 92 runs. The position change member 90 is substantially cylindrical and has adjacent a free end 102 a coupler pocket 104 on, in the construction of the second coupling element 68 equivalent. This allows a marker element 14 , especially as related to 2 described by inserting the first coupling element 66 in the coupler pocket 104 latching to connect and so secure. The coupler holder 104 forms a third coupling element. The third coupling element in conjunction with a first coupling element 66 form a total with the reference numeral 103 provided second coupling means. It should be noted that one of the coupling receptacle 104 defined longitudinal axis 106 perpendicular to the longitudinal axis 98 is oriented. It would also be possible, however, the coupling receptacle 104 starting from the free end 102 provide, in which case the longitudinal axis 106 coaxial to the longitudinal axis 98 would be aligned. The other end 108 the position change member 90 is plate-shaped in the shape of a cuboid 110 formed and provided with a bearing bore, not shown, which the pivot axis 96 Are defined.

The position change member 92 is also substantially cylindrical, wherein the position change member 90 facing the end 112 with a storage slot 114 is provided, in which the rounded cuboid 110 can intervene. Through the storage slot 114 become two mirror-symmetrical bearing arms 116 each defined by another hole coaxial with the pivot axis 96 is formed, interspersed. For pivotable mounting of the position change member 90 and the position change member 92 a bearing pin serves each other 118 or a locking screw whose longitudinal axes are also identical to the pivot axis 96 are, and the pivoting of the position change members 90 and 92 allow each other in an angular range of slightly more than 180 °. From the pivot axis 96 pointing away, joins the through the bearing arms 116 defined storage area a hollow cylindrical section 120 which is up to one of the pivot axis 96 wayward free end 112 the position change member 92 extends. Positive fit in the section 120 is the piston-shaped position change member 94 guided and slidably mounted. A fourth coupling element 124 which is identical to the first coupling element 66 is formed forms one of the pivot axis 96 wegweisende end of the position change member 94 , The fourth coupling element 124 forms in conjunction with a second coupling element 68 or a third coupling element, for example in the form of the coupling receptacle 104 , a total by the reference numeral 123 provided third coupling device.

By the displaceable mounting of the position change members 92 and 94 to each other, a distance between the fourth coupling element 124 and the pivot axis 96 in a section constituting the length of the cylinder 120 predetermined range are adjusted. It is conceivable, the positioning of the position change members 92 and 94 to make discrete relative to each other, for example, by training appropriate teeth with engaging in these locking members. It would be conceivable, in particular, at the section 120 to provide a plurality of annular grooves in the piston-shaped portion of the position change member 94 engage trained ball pressure pieces.

A not shown in the figures modified embodiment of a position change element 88 provides only two position change members, so either only the position change members 90 and 92 , which are pivotally mounted to each other, in which case the end 122 in the form of the fourth coupling element 124 would be formed, or two position change members 92 and 94 , which are displaceable relative to each other, in which case instead of the bearing slot 114 a coupling element defining a third coupling element 104 at the end 112 the position change member 92 can be provided. Such position change elements then allow adjustment of free ends of the two connected to each other and movably mounted position change members either only by pivoting or only by relative displacement. Optionally, of course, it would also be conceivable to provide more than three position change members, wherein then any pivotally and slidably mounted to each other position change members, as exemplified in connection with the in 4 shown position change element 88 described can be provided.

A pivoting of the position change members 90 and 92 relative to one another can optionally also take place in discrete steps, for example in discrete angular steps of 2 °, 5 ° or 10 °. In this way, discrete settings, ie reference positions, of the marker elements can be achieved 14 the referencing unit 12 realize. A Such discrete positioning of the position change members pivotable relative to each other 90 and 92 can be achieved for example by interlocking teeth or by forming grooves in which ball thrust pieces can engage in defined positions detent.

In 5 is another variant of a referencing unit 12 exemplified, which is a spherical body 46 comprises, on which three second coupling elements 68 are formed, in the first coupling elements 66 of marker elements 14 or fourth coupling elements 124 of position change elements 88 introduced and secured.

longitudinal axes 60 the second coupling elements 68 Although cut the center of the spherical body 46 and lie in a plane, but are not arranged symmetrically, that is, a first angle 126 between longitudinal axes of two adjacent second coupling elements has a value in a range between 70 ° and 85 °, another angle 128 between the longitudinal axis of the one of the two second coupling elements 68 and the third second coupling element 68 a value in a range of 120 ° to 160 °. So are the three longitudinal axes 60 offset relative to each other by angles, all of which are not identical. This allows a clearly defined referencing unit 12 form.

With the above related to the 1 to 5 described parts of the modular system for the formation of homing units 12 , as in particular are marker elements 14 which optional marker element carrier 58 have, basic body 46 and position change elements 88 can be referencing units 12 form in almost any configuration. The connectable parts of the referencing unit 12 as a whole define a position change device 130 that makes it possible to use the referencing unit 12 If necessary, redesign in the desired manner, that is, in particular positions of the marker elements 14 , in particular of their marker spheres 84 or other elements that can reflect or emit either electromagnetic and / or ultrasonic radiation, and thus define first and second reference positions. It can thus be referencing units 12 training, which can be adapted individually to the instruments used. This results in particular in a homogeneous behavior of the reference transmitter, particularly stable axes when used with long instruments. Furthermore, accuracy can be achieved by additional arrangement of marker elements 14 on a base body 46 be increased or by increasing the distances between marker elements 14 ,

In particular, the individual parts of the referencing unit can be inexpensively produced from a plastic, which is optionally also steam sterilizable, and a reuse of the referencing unit 12 allows. Alternatively, it is of course also possible to use the parts of the referencing unit 12 essentially form of a steam sterilizable metal.

The parts of the referencing unit described in connection with the figures 12 are purely exemplary. They can be in shape and size, especially in the length of the marker element carrier 58 be different. Furthermore, a total of more marker elements 14 and position change elements 88 be provided as a body 46 second coupling elements 68 having. So can the structure of the referencing unit 12 in a simple way by exchanging non-identical marker elements 14 or non-identical position change elements 88 be changed to position the at least one marker element 14 the referencing unit 12 in a first reference position and in at least one second reference position deviating from the first reference position.

Claims (57)

Surgical referencing unit ( 12 ) for a surgical navigation system ( 10 ), wherein a position and / or orientation of the referencing unit ( 12 ) in the room by the navigation system ( 10 ) and which referencing unit ( 12 ) at least one marker element ( 14 ) whose position in space is determined by the navigation system ( 10 ), characterized in that a position changing device ( 130 ) is provided for positioning the at least one marker element ( 14 ) at the referencing unit ( 12 ) in a first reference position and in at least a second, different from the first reference position. Surgical referencing unit according to claim 1, characterized in that the referencing unit ( 12 ) at least one basic body ( 46 ), on which the at least one marker element ( 14 ) is arranged or can be arranged. Surgical referencing unit according to claim 2, characterized in that a first coupling device ( 56 ) for detachably connecting the at least one marker element ( 14 ) and the at least one basic body ( 46 ) is provided. Surgical referencing unit according to claim 3, characterized in that the first coupling device ( 56 ) at least one first coupling element ( 66 ) and at least one second coupling element ( 68 ), which in one Coupling position engage with each other, and that the at least one first coupling element ( 66 ) on at least one marker element ( 14 ) and that the at least one second coupling element ( 68 ) on at least one base body ( 46 ) is arranged. Surgical referencing unit according to claim 4, characterized in that the at least one first or second coupling element ( 66 . 68 ) in the form of a coupling receptacle ( 68 ) is formed and that the corresponding other coupling element in the form of a coupling projection ( 66 ) is trained. Surgical referencing unit according to one of claims 2 to 5, characterized in that at least one safety device ( 70 ) is provided for securing a connection of the at least one marker element ( 14 ) and the at least one basic body ( 46 ) in a coupling position. Surgical referencing unit according to claim 6, characterized in that the at least one securing device ( 70 ) in the form of a latching device ( 70 ) is trained. Surgical referencing unit according to claim 6 or 7, characterized in that the at least one securing device ( 70 ) at least one first securing element ( 72 ) and at least one second security element ( 74 ) which engage with each other in a securing position, and in that the at least one first securing element (16) 72 ) on at least one marker element ( 14 ) and that the at least one second security element ( 74 ) on at least one base body ( 46 ) is arranged. Surgical referencing unit according to claim 8, characterized in that the at least one first or second securing element ( 72 . 74 ) in the form of a fuse holder ( 74 ) is formed and that the corresponding other securing element in the form of a securing projection ( 72 ) is trained. Surgical referencing unit according to claim 9, characterized in that the securing projection ( 72 ) in the form of a movably mounted locking projection ( 72 ) is trained. Surgical referencing unit according to claim 10, characterized in that the movably mounted latching projection in the form of a ball pressure piece ( 78 ) is trained. Surgical referencing unit according to one of claims 8 to 11, characterized in that a direction of movement of the at least one first and / or second securing element ( 72 ) transversely or substantially transversely to one of the first and / or second coupling element ( 66 . 68 ) defined longitudinal axis ( 60 ) runs. Surgical referencing unit according to one of claims 8 to 12, characterized in that one of the securing elements ( 72 ) on at least one first coupling element ( 66 ) and that a corresponding securing element ( 74 ) on at least one second coupling element ( 68 ) is arranged. Surgical referencing unit according to one of claims 3 to 13, characterized in that the first coupling device ( 56 ) two, three, four, five or more second coupling elements ( 68 ). Surgical referencing unit according to claim 14, characterized in that the two or more second coupling elements ( 68 ) differently oriented longitudinal axes ( 60 ) define. Surgical referencing unit according to one of claims 2 to 15, characterized in that the at least one first basic body ( 46 ) is formed in the form of a sphere or in the form of a disk-shaped plate. Surgical referencing unit according to one of claims 2 to 16, characterized in that the at least one first basic body ( 46 ) at least one connecting element ( 48 ) a connection device ( 50 ) for connecting the basic body ( 46 ) with an instrument ( 38 ) and / or a fastener ( 30 ) having. Surgical referencing unit according to claim 17, characterized in that the at least one connecting element ( 48 ) in the form of a connection projection ( 48 ) or in the form of a connection receptacle is formed. Surgical referencing unit according to one of claims 2 to 18, characterized in that the at least one first basic body ( 46 ) at least one connection fuse element ( 54 ) for securing a connection of the at least one first basic body ( 46 ) on an instrument ( 38 ) and / or a fastener ( 30 ) having. Surgical referencing unit according to claim 19, characterized in that the at least one connection securing element ( 54 ) in the form of a movably mounted locking projection ( 54 ) is trained. Surgical referencing unit according to claim 20, characterized in that the latching projection ( 54 ) in the form of a ball pressure piece ( 54 ) is trained. Surgical referencing unit according to one of the preceding claims, characterized in that the position changing device ( 130 ) at least two relatively movable position change members ( 90 . 92 . 94 ). Surgical referencing unit according to claim 22, characterized in that the at least two position change members ( 90 . 92 . 94 ) are pivotable relative to each other and / or arranged rotatable and / or displaceable. Surgical referencing unit according to claim 23, characterized in that the at least two position change members ( 90 . 92 ) about a pivot axis ( 96 ) are mounted pivotably, which transversely or substantially transversely to one of at least one of the at least two position change members ( 90 . 92 ) defined longitudinal axis ( 98 . 100 ) runs. Surgical referencing unit according to claim 23, characterized in that the at least two position change members ( 92 . 94 ) in a direction parallel to one of at least one of the at least two position changing members ( 92 . 94 ) defined longitudinal axis ( 100 ) are displaceable relative to each other. Surgical referencing unit according to one of Claims 22 to 25, characterized in that one of the position-changing members ( 94 ) a piston portion and another of the position change members ( 92 ) a corresponding cylinder section ( 120 ) having. Surgical referencing unit according to one of claims 22 to 26, characterized in that the at least two position change members ( 90 . 92 . 94 ) are positively and / or positively held in the first and / or second reference position to each other. Surgical referencing unit according to one of claims 22 to 27, characterized in that the at least two position change members ( 90 . 92 . 94 ) are stored together. Surgical referencing unit according to one of claims 22 to 28, characterized in that a distance and / or a relative orientation of the at least two position change members ( 90 . 92 . 94 ) are different in the first reference position than in the second reference position. Surgical referencing unit according to one of claims 22 to 29, characterized in that at least one position change element ( 88 ) is provided, which the at least two position change members ( 90 . 92 . 94 ). Surgical referencing unit according to claim 30, characterized in that at least one second coupling device ( 103 ) for detachably connecting the at least one marker element ( 14 ) and the at least one position change element ( 88 ) is provided. Surgical referencing unit according to claim 31, characterized in that the at least one second coupling device ( 103 ) at least one first coupling element ( 66 ) and at least one third coupling element ( 104 ), which engage in a coupling position with each other, and that the at least one first coupling element ( 66 ) on at least one marker element ( 14 ) and that the at least one third coupling element ( 104 ) on at least one position change element ( 88 ) is arranged. Surgical referencing unit according to claim 32, characterized in that the at least one first or third coupling element ( 66 . 104 ) in the form of a coupling receptacle ( 104 ) is formed and that the corresponding other coupling element ( 66 ) in the form of a coupling projection ( 66 ) is trained. Surgical referencing unit according to claim 32 or 33, characterized in that at least one third coupling device ( 123 ) for detachably connecting the at least one main body ( 46 ) and the at least one position change element ( 88 ) is provided. Surgical referencing unit according to claim 34, characterized in that the at least one third coupling device ( 123 ) at least one second coupling element ( 68 ) and at least one fourth coupling element ( 124 ) which are engaged with each other in a coupling position, and that the at least one second coupling element ( 68 ) on at least one base body ( 46 ) and that the at least one fourth coupling element ( 124 ) on at least one position change element ( 88 ) is arranged. Surgical referencing unit according to claim 35, characterized in that the at least one second or fourth coupling element ( 68 . 124 ) in the form of a coupling receptacle ( 68 ) is formed and that the corresponding other coupling element ( 124 ) in the form of a coupling projection ( 124 ) is trained. Surgical referencing unit according to claim 35 or 36, characterized in that a distance and / or a relative orientation of the at least one second and the at least one fourth coupling element ( 68 . 124 ) are different in the first reference position than in the second reference position. Surgical referencing unit according to one of the preceding claims, characterized by at least one passive marker element ( 14 ). Surgical referencing unit according to claim 38, characterized in that an outer surface ( 86 ) of the passive marker element ( 14 ) an electromagnetic radiation or ultrasound reflecting surface ( 86 ). Surgical referencing unit according to one of the preceding claims, characterized by at least one active marker element ( 14 ). Surgical referencing unit according to claim 40, characterized in that the active marker element ( 14 ) comprises a transmitting unit for emitting electromagnetic radiation or ultrasound. Surgical referencing unit according to one of the preceding claims, characterized in that the at least one marker element ( 14 ) in the form of a sphere ( 84 ) or in the form of a flat circular disk. Surgical referencing unit according to one of the preceding claims, characterized in that the at least one marker element ( 14 ) on a marker element carrier ( 58 ) or a marker element carrier ( 58 ). Surgical referencing unit according to claim 43, characterized in that on the marker element carrier ( 58 ) at least one first coupling element ( 66 ) of the at least one first coupling device ( 56 ) is arranged. Surgical referencing unit according to claim 43 or 44, characterized in that the marker element carrier ( 58 ) in the form of a position change member ( 90 . 92 . 94 ) is trained. Surgical referencing unit according to one of claims 43 to 45, characterized in that the marker element carrier ( 58 ) a longitudinal axis ( 60 ) Are defined. Surgical referencing unit according to one of Claims 43 to 46, characterized in that the marker element carrier ( 58 ) comprises at least one cylinder section. Surgical referencing unit according to one of claims 2 to 47, characterized in that the basic body ( 46 ) on an instrument ( 38 ) or a fastening device ( 30 ) is arranged. Surgical referencing unit according to one of the preceding claims, characterized in that the at least one marker element ( 14 ) is made of a plastic. Surgical referencing unit according to one of claims 22 to 49, characterized in that the at least one position change member ( 90 . 92 . 94 ) is made of a plastic. Surgical referencing unit according to one of claims 2 to 50, characterized in that the at least one basic body ( 46 ) is made of a plastic. Surgical referencing unit according to one of preceding claims, characterized in that it at least partially from a steam sterilizable material is made. Surgical referencing unit according to one of claims 2 to 52, characterized in that more marker elements ( 14 ) are provided as with the main body ( 46 ) are connectable. Surgical referencing unit according to one of preceding claims, characterized in that the first and second reference positions clearly defined reference positions. Surgical referencing unit according to one of the preceding claims, characterized by three or more surgical marker elements ( 14 ). Surgical navigation system ( 10 ) with at least one referencing unit ( 12 ) and with at least one detection device ( 16 ) for detecting the position and / or orientation of the referencing unit ( 12 ) in the room, the surgical referencing unit ( 12 ) at least one marker element ( 14 ) whose position in space is determined by the navigation system ( 10 ), characterized in that a position changing device ( 130 ) is provided for positioning the at least one marker element ( 14 ) at the at least one referencing unit ( 12 ) in a first reference position and in at least a second, deviating from the first Refe ence position. Surgical navigation system according to claim 56, characterized by at least one surgical referencing unit ( 12 ) according to one of claims 2 to 55.