EP1605853A1 - Procede et dispositif pour determiner un point d'articulation entre deux os - Google Patents

Procede et dispositif pour determiner un point d'articulation entre deux os

Info

Publication number
EP1605853A1
EP1605853A1 EP04713058A EP04713058A EP1605853A1 EP 1605853 A1 EP1605853 A1 EP 1605853A1 EP 04713058 A EP04713058 A EP 04713058A EP 04713058 A EP04713058 A EP 04713058A EP 1605853 A1 EP1605853 A1 EP 1605853A1
Authority
EP
European Patent Office
Prior art keywords
rotation
orientation
bone
scatter
axes
Prior art date
Legal status (The legal status 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 status listed.)
Withdrawn
Application number
EP04713058A
Other languages
German (de)
English (en)
Inventor
Andreas GÖGGELMANN
Josef Kozak
Hanns-Peter TÜMMLER
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.)
Aesculap AG
Original Assignee
Aesculap AG
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 Aesculap AG filed Critical Aesculap AG
Priority claimed from PCT/EP2004/001665 external-priority patent/WO2004084750A1/fr
Publication of EP1605853A1 publication Critical patent/EP1605853A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/45—For evaluating or diagnosing the musculoskeletal system or teeth
    • A61B5/4528—Joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
    • A61B5/1071—Measuring physical dimensions, e.g. size of the entire body or parts thereof measuring angles, e.g. using goniometers
    • A—HUMAN NECESSITIES
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    • A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/11—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb
    • A61B5/1126—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb using a particular sensing technique
    • A61B5/1127—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb using a particular sensing technique using markers
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61B5/6867—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive specially adapted to be attached or implanted in a specific body part
    • A61B5/6878—Bone
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/02—Prostheses implantable into the body
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    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/461—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of knees
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/4668—Measuring instruments used for implanting artificial joints for measuring angles

Definitions

  • the invention relates to a method for determining a joint point of two bones connected by a joint which are pivotably connected relative to one another about at least two axes of rotation which are not parallel to one another, in which the two bones are moved relative to one another, the movement of a point of a bone in one Reference system of the other bone records measured values, determines from these measured values for several parts of the path or for one of several successively recorded paths an axis of rotation describing the movement as rotation.
  • the position of anatomical articulation points can be determined under certain conditions by moving the bones articulated at these articulation points against each other and by analyzing the movement, for example by means of a navigation system, the position of the articulation point is calculated from the recorded trajectory. This is easily possible, for example, for joints that are equipped as ball joints, as is the case with the hip joint. Such a process is i.a. described in EP 0 969 780 Bl.
  • hinge joints or hinge-like joints in the body of mammals are designed so that they can not only be pivoted about a single axis of rotation, but that - at least to a limited extent - pivoting about a second axis of rotation is also possible.
  • About the longitudinal axis of the tibia this can be pivoted to a small extent in addition to the normal pivoting movement about the transverse axis, so there are essentially two axes of rotation perpendicular to one another. These axes of rotation together determine a point of articulation for the knee, around which every movement takes place, even if it is formed from the rotations around the two axes of rotation described as a superimposed movement.
  • an articulation point can be determined, but it is necessary to actually pivot the two bones against each other about these two axes of rotation in order to be able to determine this articulation point.
  • a pivoting movement alone around one of the two axes of rotation would not be sufficient, since the determination of an axis of rotation alone does not yet determine a pivot point along this axis of rotation.
  • This object is achieved according to the invention in a method of the type described at the outset by calculating the scatter in the orientation for the differently oriented axes of rotation determined in this way and only calculating an articulation point from the differently oriented axes of rotation if the scatter in the orientation of the axes of rotation unites exceeds a certain value.
  • the invention is thus based on the knowledge that all actually determined axes of rotation are formed by superimposing the joint's own axes of rotation, in the case of the knee, for example, as a superposition of the flexion axis of the knee on the one hand and the tibial longitudinal axis as the second axis of rotation on the other.
  • the spread of this orientation is a measure of how strongly the shares of these two main axes of rotation are represented in the differently oriented axes of rotation. If the joint is only moved so that all axes of rotation are substantially parallel, then it is impossible to determine a joint point. The more the differently oriented axes of rotation differ in their orientation, the more precisely they define the point of articulation sought through their intersection.
  • the momentary orientation of one bone in the reference system of the other bone is determined during a movement of the two bones relative to one another in different relative positions, and a momentary axis of rotation is calculated for this momentary orientation, which is a rotation of the bone from an assumed reference orientation corresponds to this momentary orientation, and that the scatter in the orientation is determined by the scatter of the momentary axes of rotation.
  • the position of the one bone relative to the other is tracked using a navigation system and a marking element is attached to one of the bones. If you hold the other bone firmly during the relative movement of the two bones, the trajectory curve of one bone relative to the other can then easily be recorded.
  • the determination of the other bone can be omitted if one also fixes a marking element on the other bone.
  • the method can be carried out particularly advantageously on the knee joint by moving the tibia relative to the femur.
  • the invention further relates to a device for carrying out the method described with a navigation system, at least one marking element of the navigation system which can be fixed on the bone and with one of the measured values recorded for a part of the path or for one of several successively recorded paths Data processing system determining movement as rotation describing axis of rotation.
  • the data processing system calculate the scatter in the orientation for the differently oriented axes of rotation determined in this way and only then from the differently oriented axes of rotation calculates a pivot point if the scatter in the orientation of the axes of rotation exceeds a certain value.
  • the data processing system determines the instantaneous orientation of one bone in the reference system of the other bone during a movement of the two bones relative to one another in different relative positions, and calculates a momentary axis of rotation for this momentary orientation, which rotates the bone from an assumed reference orientation into it Current orientation corresponds, and that the data processing system determines the scatter in the orientation by the scatter of the current axes of rotation.
  • the data processing system is assigned a display on which the scatter of the orientation of the movement carried out is shown.
  • the data processing system blocks the determination of an articulation point as long as the specific value of the scatter of the orientation has not been reached.
  • the navigation system can be assigned a marking element on one and on the other bone.
  • Figure 1 an overall view of a device for determining the knee joint point of a patient with a navigation system and a data processing system;
  • Figure 2 is a schematic representation of the main axes of rotation of a tibia relative to a femur;
  • Figure 3 is a schematic representation of the knee joint with a bundle of differently oriented knee pivot axes
  • Figure 4 a schematic representation of the inclusion of different
  • a patient 2 is lying on an operating table 1, with whom the joint point of the knee joint 3 is to be determined.
  • a marking element 6 or 7 is fixed on both the femur 4 and the tibia 5, which interacts in a manner known per se with a navigation system 8 set up in the operating room.
  • the marking elements 6, 7 each carry three reference bodies 9 at a distance from one another, which either emit electromagnetic radiation themselves or reflect electromagnetic radiation incident on them, for example infrared radiation. This radiation is received by three receivers 10 of the navigation system 8 arranged at a distance from one another, and in this way the exact position and orientation of the marking elements 6, 7 in the room can be determined by the navigation system.
  • Data sets corresponding to the respective position are fed by the navigation system 8 to a data processing system 11, which can display these data and data derived therefrom on a display 12.
  • FIG. 2 shows which movements the tibia 5 can perform relative to the femur 4.
  • This movement is essentially a hinge-like pivoting movement about a flexion axis 13 running transversely to the longitudinal direction of the femur and tibia and next to it a rotation about the longitudinal axis 14 of the tibia 5.
  • This rotation about the longitudinal axis 14 is limited and only possible over a relatively small angular range
  • pivoting about the flexion axis 13 can sweep an angle of well over 90 °.
  • the point of articulation 15 of the knee joint 3 can be determined from the intersection of the flexion axis 13 and the longitudinal axis 14. If the two axes do not intersect exactly, but only run very close together, can this point can also be defined as a point between the two axes and as close as possible to this point.
  • the tibia 5 is moved relative to the femur 4 in such a way that this movement does not only consist of a pure bending of the knee, but also a part of a rotary movement about the Includes longitudinal axis 14, ie The two bones move as irregularly as possible against one another, the practitioner not having to pay attention to how this movement proceeds.
  • the data processing system can use the movement of the marking element 6 on the femur 4 and the marking element 7 on the tibia 5 to perform the relative movement Determine the tibia and femur and thus the respective position of the marking element 7 and thus the tibia 5 in a femur's own reference system.
  • the rotation axes of this movement can be determined from the movement curves of the marking element 7 in the femur's own reference system using algorithms known per se, i.e. averaged rotation axes are determined from the trajectory curves, for example by averaging different positions and orientations of the marking element 7, which counteract the movements of the tibia in successive movements the femur will usually be different depending on how the tibia has been moved relative to the femur.
  • these axes of rotation will normally not deviate too much from the flexion axis 13, since the movement around this flexion axis axis can cover a much larger angular range than the rotation about the longitudinal axis 14.
  • the axes of rotation determined in this way then lie, for example, in a double cone 16, the longitudinal axis of which coincides with the flexion axis and the tip of which marks the hinge point 15 sought.
  • This articulation point 15 can only be determined very imprecisely if the opening angle of the double cone 16 is very small, that is to say if the deviation of the axes of rotation determined in this way is small from one another, if the angle of the double cone 16 becomes larger, on the other hand, a more precise determination of the exact
  • the position of the hinge point 15 ensures that the larger angle of the double cone 16 corresponds to a greater dispersion of the orientation of the axes of rotation determined in this way.
  • the data processing system 11 determines the deviation or scatter of the orientation values from one another from the individual orientations of the axes of rotation and compares them with a predetermined reference value. If the scatter lies below this reference value, the measured values are not used to calculate a joint point, since the scatter is then too small in accordance with the angle of the double cone 16 and only imprecise information about the joint point 15 can be obtained. The articulation point is only calculated in the manner described when the predetermined value of the scatter is exceeded.
  • the value of the scatter can be shown on the display 12 so that it can be read at any time whether the movement of the tibia relative to the femur has taken the two pivoting options sufficiently into account, that is, was irregular enough. If the scatter threshold has not yet been reached, the practitioner merely has to ensure that the following movements of the tibia relative to the femur deviate as much as possible from a pure pivoting movement in a single plane.
  • the orientation of the marking element 7 of the tibia 5 in the femur's own reference system is determined in different positions during the course of movement, this is symbolized in FIG. 4 by a large number of axis crosses, each of which indicates the position of this marking element 7, in relation to a reference orientation R, which can be calculated, for example, from the mean of all individual orientations.
  • the data processing system For each position of the marking element 7 during the movement sequence, the data processing system now calculates a momentary axis of rotation, which is selected such that the axis cross corresponding to a certain position passes into the axis cross of the reference system solely by rotation about this momentary axis of rotation. In other words, it is determined about which axis the marking element 7 has to be rotated in order to reach the reference position corresponding to the axis cross R. This is carried out in this way for all positions of the marking element 7 determined along the path curve and leads to a number of differently oriented instantaneous axes of rotation.

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  • Robotics (AREA)
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  • Cardiology (AREA)
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  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
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  • Prostheses (AREA)

Abstract

L'invention concerne un procédé de détermination d'un point d'articulation entre deux os reliés par une articulation de façon à pouvoir pivoter l'un par rapport à l'autre autour d'au moins deux axes de pivotement non parallèles. Selon ledit procédé : on déplace les deux os l'un par rapport à l'autre et des valeurs de mesure décrivant le déplacement d'un point d'un os dans un système de référence de l'autre os sont enregistrés ; et, à partir de ces valeurs de mesure, un axe de rotation définissant le déplacement en tant que rotation est déterminé pour plusieurs parties de la trajectoire ou pour respectivement une trajectoire parmi la pluralité de trajectoires enregistrées l'une après l'autre. L'objectif de l'invention est d'augmenter la précision de la détermination du point d'articulation. A cet effet, il est proposé que pour les axes de pivotement d'orientation différente déterminés de cette façon soit calculée la dispersion d'orientation et que, à partir des axes de pivotement d'orientation différente un point d'articulation ne soit calculé que si la dispersion d'orientation des axes de pivotement dépasse une valeur prédéterminée.
EP04713058A 2003-03-27 2004-02-20 Procede et dispositif pour determiner un point d'articulation entre deux os Withdrawn EP1605853A1 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
DE10313747 2003-03-27
DE10313747A DE10313747A1 (de) 2003-03-27 2003-03-27 Verfahren und Vorrichtung zur Bestimmung eines Gelenkpunktes von zwei Knochen
PCT/EP2004/001665 WO2004084750A1 (fr) 2003-03-27 2004-02-20 Procede et dispositif pour determiner un point d'articulation entre deux os

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EP1605853A1 true EP1605853A1 (fr) 2005-12-21

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EP (1) EP1605853A1 (fr)
JP (1) JP2006523477A (fr)
DE (1) DE10313747A1 (fr)

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DE502007004068D1 (de) * 2007-01-19 2010-07-22 Brainlab Ag Registrierung und Stabilitätstest eines Knies durch Aufnahme zweier Punkte an dem Knie
WO2009016478A2 (fr) * 2007-07-30 2009-02-05 Scuola Superiore Di Studi Universitari S.Anna Dispositif mécatronique portable
EP2103259B1 (fr) * 2008-03-19 2012-01-25 BrainLAB AG Procédé et système pour la détermination d'un degré de difformité d'une articulation anatomique
GB0806813D0 (en) * 2008-04-15 2008-05-14 Smith & Nephew Orthopaedics Ag Medical navigation method and system
WO2010082157A1 (fr) * 2009-01-16 2010-07-22 Koninklijke Philips Electronics N.V. Procédé de détermination de l'axe de rotation d'une articulation et dispositif de surveillance des mouvements d'au moins une partie du corps
JP2014117409A (ja) * 2012-12-14 2014-06-30 Kawasaki Heavy Ind Ltd 身体関節位置の計測方法および装置
AU2021369677A1 (en) 2020-10-30 2023-06-15 Mako Surgical Corp. Robotic surgical system with recovery alignment

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JP2006523477A (ja) 2006-10-19
US20060064043A1 (en) 2006-03-23
DE10313747A1 (de) 2004-10-28

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