EP3328306A1 - Appareil pour effectuer une réduction de fracture - Google Patents

Appareil pour effectuer une réduction de fracture

Info

Publication number
EP3328306A1
EP3328306A1 EP16747566.4A EP16747566A EP3328306A1 EP 3328306 A1 EP3328306 A1 EP 3328306A1 EP 16747566 A EP16747566 A EP 16747566A EP 3328306 A1 EP3328306 A1 EP 3328306A1
Authority
EP
European Patent Office
Prior art keywords
manipulator
fracture
optical tracking
attachment
bone
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Withdrawn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
EP16747566.4A
Other languages
German (de)
English (en)
Inventor
Sanja DOGRAMADZI
Ioannis GEORGILAS
Giulio DAGNINO
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.)
University of The West of England
Original Assignee
University of The West of England
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 University of The West of England filed Critical University of The West of England
Publication of EP3328306A1 publication Critical patent/EP3328306A1/fr
Withdrawn legal-status Critical Current

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Classifications

    • 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
    • A61B34/30—Surgical robots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical 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
    • A61B17/60—Surgical 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 for external osteosynthesis, e.g. distractors, contractors
    • A61B17/64—Devices extending alongside the bones to be positioned
    • A61B17/6408—Devices not permitting mobility, e.g. fixed to bed, with or without means for traction or reduction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical 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
    • A61B17/60—Surgical 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 for external osteosynthesis, e.g. distractors, contractors
    • A61B17/66—Alignment, compression or distraction mechanisms
    • 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
    • A61B34/30—Surgical robots
    • A61B34/32—Surgical robots operating autonomously
    • 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
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/76—Manipulators having means for providing feel, e.g. force or tactile feedback
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
    • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
    • B25J18/00—Arms
    • B25J18/005—Arms having a curved shape
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
    • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
    • B25J9/00—Programme-controlled manipulators
    • B25J9/003—Programme-controlled manipulators having parallel kinematics
    • B25J9/0063—Programme-controlled manipulators having parallel kinematics with kinematics chains having an universal joint at the base
    • B25J9/0069—Programme-controlled manipulators having parallel kinematics with kinematics chains having an universal joint at the base with kinematics chains of the type universal-prismatic-universal
    • 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
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/102—Modelling of surgical devices, implants or prosthesis
    • 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
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/105—Modelling of the patient, e.g. for ligaments or bones
    • 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
    • A61B2034/2046—Tracking techniques
    • A61B2034/2055—Optical tracking systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A61B2034/304—Surgical robots including a freely orientable platform, e.g. so called 'Stewart platforms'
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, 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
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension
    • A61B2090/066—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension for measuring torque
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B2090/364—Correlation of different images or relation of image positions in respect to the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B2090/364—Correlation of different images or relation of image positions in respect to the body
    • A61B2090/367—Correlation of different images or relation of image positions in respect to the body creating a 3D dataset from 2D images using position information
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
    • A61B2090/3762—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy using computed tomography systems [CT]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, 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
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3937—Visible markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, 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
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3983—Reference marker arrangements for use with image guided surgery

Definitions

  • the present application relates to apparatus and method for performing fracture reduction.
  • anatomical reduction which involves positioning and aligning the fragments of the broken bone to reconstruct the fractured bone as precisely as possible, so that the bone recovers to a form as close as possible to its original form as it heals.
  • This anatomical reduction may be performed by open surgery, in which large incisions are made in flesh around the broken bone and the bone fragments are manipulated by a surgeon to reposition and realign them as precisely as possible.
  • minimally invasive percutaneous procedures have been developed. These techniques involve sequentially fixating and manipulating each bone fragment manually using manipulation pins inserted in the fragments, without making large incisions in the patient' s flesh. Such techniques are associated with a faster recovery and a lower risk of infection compared to open surgery techniques.
  • minimally invasive techniques may involve lower reduction accuracy, and in some cases the reduction accuracy is less than the minimum accuracy (typically ⁇ 1 mm translationally and ⁇ 5 degrees rotationally) required for optimum clinical outcomes. This is mainly due to the poor intra-operative imaging technology currently available. Minimally invasive procedures require multiple plain radiographic images (i.e.
  • fluoroscopic images taken by using a fluoroscope of the patient to be taken during the surgical procedure to ensure that the bone fragments are being correctly positioned and orientated during the procedure.
  • the 2 dimensional nature of this technology does not provide enough information to the surgeon regarding the fracture alignment and rotation, which is actually a three- dimensional problem. This makes the intra-operative assessment of the fracture challenging and, notwithstanding these multiple radiographic images, the reduction remains sub-optimal.
  • the extensive use of the intra-operative fluoroscope exposes both the patient and medical staff to undesirably high levels of radiation.
  • a key element in orthopaedic fracture surgery is manipulation of fracture fragments into their anatomically correct positions for further stabilization and fixation.
  • a surgeon manually moves the fragments using percutaneous pins attached to the fracture fragments.
  • a system for anatomical reduction of bone fractures is known from US patent application publication no. 2014/0379038.
  • This system includes at least first and second manipulators, and preferably a third manipulator.
  • the first manipulator permits rotation and translation of a first fragment of the fracture, for orientation and distraction of the first fragment, whilst the second manipulator (and the third manipulator, where used) permit rotation and translation of other fragments of the fracture, to permit those other fragments to be correctly positioned and oriented for subsequent fixation.
  • apparatus for performing fracture reduction comprising: a first manipulator for performing distraction of a bone section the fracture; a second manipulator for manipulating a first bone fragment of the fracture; wherein the second manipulator is mounted on a moveable platform having multiple degrees of freedom and is configured to manipulate the first bone fragment by means of a percutaneous attachment device attached to the first bone fragment, and wherein the first manipulator comprises a limb support configured for removable attachment to the limb such that distraction of the bone section can be performed without any attachment of the first manipulator to the bone section.
  • the platform permits the second manipulator to be positioned over the surgical field in an optimally selected location to allow manipulation of the fragments.
  • the platform does not impede full access to the operating field, as it is configured to be compatible and complementary with standard operating tables and other equipment such as fluoroscope equipment.
  • the first manipulator is designed to manipulate and distract the limb to align correctly the bone section without requiring any percutaneous attachment of the first manipulator to the bone section, thereby reducing trauma to the patient whilst also not interfering with the surgical field.
  • the present invention provides an improved surgical apparatus that permits enhanced fracture reduction with reduced patient trauma.
  • the moveable platform may be rotatable about a first axis thereof to adjust a position of the second manipulator within a first plane.
  • the moveable platform may be rotatable about a second axis thereof to adjust a position of the second manipulator within a second plane.
  • the moveable platform may be moveable axially along the first axis to adjust an axial position of the second manipulator.
  • the first manipulator may be moveable axially along a longitudinal axis thereof to effect translational movement to adjust an axial position of the bone section.
  • the first manipulator may be rotatable about a longitudinal axis thereof to effect rotary movement to adjust an orientation of the bone section.
  • the first manipulator may be moveable to effect translational movement of the first manipulator along an axis which is transverse to a longitudinal axis of the first manipulator to adjust a position of the bone section.
  • the first manipulator may be rotatable about an axis that is transverse to a longitudinal axis of the first manipulator to effect movement of the bone section.
  • the first manipulator may comprise a force and torque sensor for preventing excessive force and torque from being applied by the first manipulator.
  • the force and torque sensor may comprise a six-axis load cell, for example.
  • the first manipulator may comprise an automated traction table.
  • the apparatus may further comprise a control system configured to receive input from an operator and to control operation of the first and second manipulators in accordance with the received input.
  • the apparatus may further comprise a control system configured to control operation of the first and second manipulators in accordance with a predefined series of movements required to effect reduction of the fracture.
  • the control system may be configured to calculate the predefined series of movements required to effect reduction of the fracture.
  • the apparatus may further comprise a tracking system for tracking the position and orientation of the first bone fragment, the tracking system comprising: an optical tracking tool configured for attachment to the percutaneous attachment device; and an optical tracking device configured to track the position and orientation of the optical tracking tool, wherein the apparatus further comprises a processing system for updating a model of the fracture based on data received from the optical tracking device.
  • a tracking system for tracking the position and orientation of the first bone fragment comprising: an optical tracking tool configured for attachment to the percutaneous attachment device; and an optical tracking device configured to track the position and orientation of the optical tracking tool
  • the apparatus further comprises a processing system for updating a model of the fracture based on data received from the optical tracking device.
  • the processing system may be configured to: receive 3D image data of the fracture; generate a 3D model of the fracture; receive data from the tracking system; and update the 3D model of the fracture in accordance with the data received from the tracking system.
  • the processing system may be configured to receive 2D image data of the first bone fragment with the percutaneous attachment device attached thereto, and to register the 2D image data with the 3D image data to compute a pose of the attachment device with respect to the first bone fragment.
  • the processing system may include a 3D model of the percutaneous attachment device and a 3D model of the optical tracking tool.
  • the optical tracking tool may comprise a plurality of tracking points and an attachment formation for attaching the optical tracking tool to a percutaneous attachment device, the attachment formation being configured to permit attachment of the optical tracking tool to the percutaneous attachment device in one orientation only.
  • the limb support may be of an X-ray transparent material.
  • a manipulator for manipulating a limb containing a first bone section of a fracture comprising a limb support configured for removable attachment to the limb such that distraction of the bone section can be performed without any attachment of the first manipulator to the bone section.
  • the manipulator may be moveable axially along a longitudinal axis thereof to effect translational movement to adjust an axial position of the bone section.
  • the manipulator may be rotatable about a longitudinal axis thereof to effect rotary movement to adjust an orientation of the bone section.
  • the manipulator may be moveable to effect translational movement of the manipulator along an axis which is transverse to a longitudinal axis of the first manipulator to adjust a position of the bone section.
  • the manipulator may be rotatable about an axis that is transverse to a longitudinal axis of the manipulator.
  • the manipulator may comprise a force and torque sensor for preventing excessive force and torque from being applied by the first manipulator.
  • the force and torque sensor may comprise a six-axis load cell, for example.
  • the manipulator may comprise an automated traction table.
  • a moveable platform having multiple degrees of freedom for mounting a manipulator for manipulating a first bone fragment of a fracture.
  • the moveable platform may be rotatable about a first axis thereof to adjust a position of the manipulator within a first plane.
  • the moveable platform may be rotatable about a second axis thereof to adjust a position of the manipulator within a second plane.
  • the moveable platform may be moveable axially along the first axis to adjust an axial position of the manipulator.
  • an imaging system for use in fracture reduction surgery, the imaging system comprising: an optical tracking tool configured for attachment to a percutaneous attachment device which is attachable to a fragment of a fracture for manipulation of the fragment; an optical tracking device configured to track the position and orientation of the optical tracking tool, wherein the imaging system further comprises a processing system for updating a model of the fracture based on data received from the optical tracking device.
  • the processing system may be configured to: receive 3D image data of the fracture; generate a 3D model of the fracture; receive data from the optical tracking device; and update the 3D model of the fracture in accordance with the data received from the optical tracking device.
  • the processing system may be configured to receive 2D image data of the first bone fragment with the percutaneous attachment device attached thereto, and to register the 2D image data with the 3D image data to compute a pose of the attachment device with respect to the first bone fragment.
  • the processing system may include a 3D model of the percutaneous attachment device and a 3D model of the optical tracking tool.
  • the optical tracking tool may comprise a plurality of tracking points and an attachment formation for attaching the optical tracking tool to the percutaneous attachment device, the attachment formation being configured to permit attachment of the optical tracking tool to the percutaneous attachment device in one orientation only.
  • an optical tracking tool for use in the imaging system of the fourth aspect, wherein the optical tracking tool comprises a plurality of tracking points and an attachment formation for attaching the optical tracking tool to a percutaneous attachment device, the attachment formation being configured to permit attachment of the optical tracking tool to the percutaneous attachment device in one orientation only
  • Figure 1 is a schematic perspective representation of an apparatus for performing fracture reduction
  • Figure 2 is a schematic perspective representation showing a first manipulator of the apparatus of Figure 1 ;
  • Figure 3 is a schematic perspective representation showing in more detail part of the manipulator of Figure 2;
  • Figure 4 is a schematic perspective representation of platform for mounting a second manipulator for use in the apparatus of Figure 1
  • Figure 5 is a schematic representation of a second manipulator for use in the apparatus of Figure 1 ;
  • Figure 6 is a schematic representation of elements of a system for visualisation and realtime position update of bone fractures
  • Figure 7 is a schematic representation of a long-bone fracture that is suitable for reduction using the system of Figure 1 ;
  • Figure 8 is a flow chart illustrating use of the system of Figure 6 in reduction of the fracture of Figure 7;
  • Figure 9 is a schematic representation of an optical tracking tool used in the system of Figure 6.
  • an exemplary system for performing fracture reduction is shown generally at 100, and comprises a first manipulator 200 for performing distraction and manipulation of a fragment of a fractured bone, and a platform 300 having multiple degrees of freedom on which one or more second manipulators 400 can be mounted.
  • the exemplary system 100 described and illustrated herein is particularly suited to reduction of fractures of the femur, but it will be appreciated by those skilled in the art that the principles discussed herein can equally be applied to reduction of other fractures.
  • the system 100 is configured to meet a set of clinical requirements, having a compact overall size that is compatible with the size of a standard operating theatre trolley and can be used in existing operating theatres without unduly restricting movement of surgeons or other medical staff, as its overall geometry is configured for minimal obstruction of the surgical field.
  • the size and configuration of the system 100 also permits inter-operative fluoroscopic imaging of the patient.
  • the overall configuration of the system 100, in particular the platform 300 will be familiar to surgeons, due to its resemblance to conventional fluoroscopic imaging systems.
  • the multiple degrees of freedom of the moveable platform 300 permit precise access to the fracture site, whilst trauma to soft tissue is minimised, as only one bone fragment need be drilled because of the manner in which the patient's limb attaches to the first manipulator 200.
  • FIG. 2 is a more detailed schematic representation of the first manipulator 200.
  • the first manipulator 200 takes the form of an automated traction table, having an X-ray transparent support 202 for supporting a limb or part of a limb containing a section or fragment of a fractured bone.
  • the patient's limb is attached to the support, for example by means of straps or bandages which attach the foot and lower leg to an X-ray transparent foot rest 204 and an X-ray transparent limb splint 206 of the support 202, to secure the limb to the support 202 firmly but without causing damage or trauma to the limb.
  • straps or bandages which attach the foot and lower leg to an X-ray transparent foot rest 204 and an X-ray transparent limb splint 206 of the support 202, to secure the limb to the support 202 firmly but without causing damage or trauma to the limb.
  • the first manipulator 200 relies upon the attachment of the limb to the support 202, and on precise control of the position and orientation of the support 202, to position the section or fragment accurately and to align the limb correctly, as will be described in more detail below.
  • This arrangement also keeps the operating field clear and avoids placing metal parts in an imaging field around the limb, thereby permitting artefact-free intra-operative imaging of the fracture.
  • the support 202 is moveable with four degrees of freedom, namely: translationally along a longitudinal axis of the limb (in the directions indicated by the arrow X in Figure 2); rotationally about the longitudinal axis of the limb; translationally along an axis transverse to the longitudinal axis of the limb to effect movement of the limb in a direction transverse to the longitudinal axis of the limb (in the directions indicated by the arrow Y in Figure 2) and rotationally about this transverse axis.
  • This movement of the support 202 is effected by a series of actuators, as will now be described.
  • Rotation of the support 202 about the axis transverse to the longitudinal axis of the limb is effected by a movement mechanism 208 driven by an actuation mechanism 210.
  • the actuation mechanism 210 comprises an electric motor, whilst the movement mechanism 208 includes a worm gear reducer driven by the electric motor and a pair of transmission gears.
  • Translation of the support 202 in the directions indicated by the arrow Y in Figure 2 is effected by a lead-screw mechanism 212 driven by an actuation mechanism 214 comprising an electric motor and a worm gear.
  • Translation of the support 202 along the axis of the limb in the directions indicated by the arrow X is effected by a lead-screw mechanism 216 driven by an actuation mechanism 218 comprising an electric motor and a worm gear.
  • Rotation of the support 202 about the axis of the limb is effected by a movement mechanism 220 driven by an actuation mechanism 222 comprising an electric motor, a worm gear and a set of transmission gears.
  • a force and torque sensing system is disposed between the movement mechanism 220 and the support 202, as will now be described with reference to Figure 3.
  • the force and torque sensing system is shown generally at 230, and, in the example illustrated in Figure 3, comprises a mounting plate 232 and a six-axis load cell 234.
  • the force and torque sensing system 230 ensures that the amount of force and torque applied to the patient's limb by the first manipulator 200 does not exceed a safe limit. This safe limit is determined based upon empirical data established through clinical trials.
  • Figure 4 is a schematic representation of the moveable platform 300 on which can be mounted one or more second manipulators.
  • the moveable platform 300 comprises a base 302, which in the illustrated example is of aluminium, having a double rail 304 and a single rail 306. In use of the system 100, the base 302 is positioned beneath the patient's limb, such that a longitudinal axis of the base 302 is aligned with and parallel to the longitudinal axis of the limb.
  • a first linear carriage 308 and a second linear carriage 310 are coupled to the first and second rails 304, 306, and carry an actuation system 312 comprising a motor, a worm gear and a shaft carrying a pinion that meshes with a rack of the single rail 306.
  • the actuation system 312 effects translational movement of the first and second linear carriages 308, 310 (and the other components of the moveable platform 300), along the rails in the directions indicated by the arrow X in Figure 4, such that the first and second linear carriages 308, 310 and the other components of the moveable platform 300 are moveable translationally along an axis parallel to the longitudinal axis of the limb.
  • the first and second linear carriages 308, 310 also carry a support structure 314 comprising generally parallel first and second arcuate curved guides 316, 318, each of which is provided with a machined rack extending, in the illustrated example, along its outer curved surface.
  • First and second rotary carriages 320, 322 are coupled to the first and second guides 316, 318 respectively.
  • One of the rotary carriages 320, 322 (in this example the second rotary carriage 322) is provided with an actuation system 324 comprising a motor, a worm gear and a shaft carrying one or more pinions that mesh with the machined racks of the guides 316, 318, to effect movement of the first and second rotary carriages 320, 322 along the guides 316, 318.
  • the first and second rotary carriages 320, 322 move in an arc about an axis that is perpendicular to the longitudinal axis of the platform 300.
  • First and second brackets 324, 326 are mounted on the first and second rotary carriages 320, 322. Between the brackets is mounted a generally C-shaped arm 340 comprising first and second generally parallel spaced arcuate rails 328, 330, each of which is provided with a rack extending, in the illustrated example, along its outer curved surface.
  • One or more second manipulators can be mounted towards a distal end 332 of the generally C-shaped arm 340 formed of the first and second generally parallel spaced arcuate rails 328, 330.
  • An actuation system 334 is mounted on one of the first and second brackets 324, 326.
  • the actuation system 334 is mounted on the first bracket 324.
  • the actuation system comprises an electric motor and a worm gear which drive a shaft on which is mounted one or more pinions which mesh with the racks of the first and second generally parallel arcuate rails 328, 330 to effect rotary movement of the generally C-shaped arm 340 about a longitudinal axis thereof that is parallel to the longitudinal axis of the platform.
  • the longitudinal axis of the generally C- shaped arm 340 formed by the first and second generally parallel spaced arcuate rails 328, 330 coincides with the longitudinal axis of the limb.
  • This alignment of the longitudinal axis of the generally C-shaped arm 340 with that of the limb permits the generally C-shaped arm 340 to be rotated in a first plane perpendicular to the longitudinal axis of the limb such that the second manipulator(s) mounted on the generally C-shaped arm 340 positioned anywhere within an envelope defined by the generally C-shaped arm 340.
  • the parallel alignment of the longitudinal axis of the platform 300 with the longitudinal axis of the limb permits the second manipulator(s) mounted on the generally C-shaped arm 340 to be positioned anywhere along the axis of the limb.
  • the moveable platform 300 gives rise to a part-cylindrical workspace around the limb, a longitudinal axis of which coincides with that of the limb.
  • first and second rotary carriages 320, 322 along the generally parallel first and second arcuate curved guides 316, 318 permits the second manipulator(s) mounted on the generally C-shaped arm 340 to be rotated in a second plane that is parallel to the longitudinal axis of the limb such that the second manipulator(s) can be positioned at any angle with respect to the longitudinal aspect of the limb within a range defined by the generally parallel first and second arcuate curved guides 316, 318.
  • FIG. 1 - 5 includes only one generally C-shaped arm 340 for mounting second manipulators, it will be appreciated that a fracture reduction system could include two such generally C-shaped arm 340s, either mounted on the same pair of rails, or 304, 306, or else mounted on different pairs of rails.
  • the use of two generally C-shaped arm 340s in this way increases the size of the workspace that is accessible, as the generally C-shaped arm 340s can be oriented in opposite directions, thereby permitting a fully cylindrical accessible workspace within which the second manipulators can operate.
  • the second manipulator(s) are mounted on one or more generally C-shaped arms 340, it is to be appreciated that alternative arrangements could equally be employed for mounting the second manipulator(s).
  • one or more articulated or fixed arm(s) may be used in place of the generally C-shaped arm(s) of, for example, an invented L-shaped configuration, may be used in place of the generally C-shaped arm(s) 340 for mounting the second manipulator(s).
  • Figure 5 is a schematic representation of a second manipulator which can be mounted on the generally C-shaped arm 340.
  • the second manipulator shown generally at 400 in Figure 5, is a lightweight parallel manipulator, and is configured to manipulate a fragment of bone in and around the fracture site by effecting rotational and translational movement of the bone fragment so as to achieve the correct position and orientation for a successful reduction of the fracture, that is to say reconstruction of the fractured bone with the fragments in the correct position and orientation.
  • the second manipulator 400 takes the form of a hexapod robot, having a platform 402 on which an end effecter (not shown) is mounted.
  • the platform 402 is connected to a fixed annular or partially annular base 404 by means of six linear actuators 406 (hence the term "hexapod robot").
  • This arrangement permits precise movement of the end effecter with up to six degrees of freedom.
  • the end effecter itself is mounted for rotation about its longitudinal axis.
  • the second manipulator(s) 400 permit manipulation of bone fragments of a limb fracture, whilst the first manipulator 200 permits minimally traumatic distraction and manipulation of the fracture.
  • Control of the first and second manipulators 200, 400 may be via any suitable control mechanism including, for example, a computer-implemented control system which receives manual input from an operator such as a surgeon and controls the first and second manipulators 200, 400 to effect manipulation of the fracture in accordance with the operator's control inputs.
  • the control system may be operative to control the operation of the first and second manipulators 200, 400 automatically, based on a series of movements (e.g. translations and rotations) defined by a surgeon or operator or calculated by the control system itself that are required to effect reduction of the fracture.
  • the system 100 can be used in conjunction with an imaging system that permits visualisation and real-time position updating of fragments of a bone fracture, as will now be described with reference to Figure 6.
  • the imaging system is shown in schematic form at 500 in Figure 6, and comprises an optical tracking system comprising an optical tracking tool 600 mounted on a manipulation pin 502 which is inserted into a bone fragment to be manipulated.
  • the optical tracking tool 600 will be described in more detail later.
  • the optical tracking system of the imaging system 500 also includes an optical tracking device 504, which in this example is an optical infra-red laser measurement device.
  • the optical tracking device 604 is operative to track the movement of the optical tracking tool attached to the manipulation pin 502, thereby permitting real-time updating of a 3D model of the fracture as the fragments of the fracture are manipulated by a surgeon using the system 100, as will be described in detail below.
  • the imaging system 500 also includes an image processing system 506.
  • the image processing system 506 includes a 3D model of the manipulation pin 502.
  • a CT (computer tomography) scanner 508 is also provided, for obtaining pre-operative 3D CT image data, along with a fluoroscope 510, for obtaining intra-operative 2D image data. These image data are used in conjunction with the 3D model of the manipulation pin 502 to generate a 3D model of the fracture with the manipulation pin 502 attached thereto, as will be explained below.
  • Figure 7 is a schematic representation of a long-bone fracture that is suitable for reduction using the system of Figure 1.
  • the fracture is a fracture of the femur, in which the femur is fractured into first and second bone fragments Fl, F2 and a large bone section F3.
  • the procedure 700 commences at step 702, and its first step 704 is a pre-operative CT scan of the fracture, to generate 3D image data of the fracture, for the purpose of diagnosing the patient's injury. From this scan a surgeon can identify fragments of fractured bone. To assist with this identification of the fragments, the 3D image data can be digitally segmented.
  • the image processing system 506 is used to perform segmentation on the 3D image data to identify fracture surfaces of the bone fragments. The results of this segmentation can be used by a medical engineer, using the image processing system 506, to generate a separate 3D model for each of the bone fragments Fl, F2, F3.
  • the 3D models of the bone fragments are displayed on a display screen of the image processing system 506.
  • manipulation pins 502 are inserted into each of the identified bone fragments of by a surgeon, to permit manipulation of each of the bone fragments.
  • the manipulation pins 502 are attached to the second manipulators 400 of the system 100, to permit precise manipulation of the fragments by the surgeon.
  • the manipulation pins have known geometries and corresponding 3D virtual models, which, as indicated above, are included in or imported into the image processing system 506.
  • intra-operative 2D fluoroscopic images are taken from three different angles (90 degrees, 45 degrees and -45 degrees), and the 2D image data from these images is received by the image processing system 506.
  • the image processing system 506 registers the 3D models from the pre-operative CT scan and the 2D image data from the fluoroscopic images to compute the pose of the manipulation pins 502 with respect to the bone fragments.
  • the 3D models of the manipulation pins 502 and the optical tracking tools 600 are imported into the image processing system 506 and merged with the 3D models of the respective bone fragments to generate new 3D models of the bone fragments with the manipulation pins 506 inserted.
  • the optical tracking tools 600 are physically attached to the manipulation pins 502.
  • the connection between the pins 502 and the optical tracking tools is unique, so the relative pose of each optical tracking tool 600 with respect to the corresponding pin 502 is known and is represented in the corresponding 3D model.
  • the optical tracking device 504 is enabled and commences tracking the optical tracking tools 600 that are rigidly attached to the manipulation pins 502 connected to the bone fragments.
  • the surgeon manipulates the bone fragments using the manipulation pins 502 attached to each fragment, by controlling rotation and translation operations performed by the second manipulators 400 of the system 100, which are attached to the manipulation pins 502.
  • the optical tracking device 504 continually tracks movement of optical tracking tools 600, and continuously updates the pose of the optical tracking tools 600 to the image processing system 506 (step 720). Since the rigid chain comprising an optical tracking tool 600, the manipulation pin 502 to which the optical tracking tool 600 is attached and the bone fragment to which the manipulation pin 502 is attached has a known geometry corresponding to one of the 3D models used by the image processing system 506, the pose of the bone fragment 3D models displayed on the display screen of the image processing system 506 is updated accordingly (step 722). Thus, the surgeon can continuously assess the reduction accuracy through the real-time imaging system 500 intra-operatively (step 724).
  • a further intraoperative fluoroscope image is taken at step 726, to ensure that the fracture reduction has been achieved to the required accuracy. If so, the surgical procedure can end, whereas if not further manipulation of the fragments can be performed by the surgeon by controlling rotation and translation operations performed by the second manipulators 400 of the system 100.
  • Figure 9 is a schematic representation of the optical tracking tool 600 used in the system 600, mounted on a manipulation pin 502.
  • the optical tracking tool 600 comprises a first arm 602 and a second arm 604 in a cruciform configuration, with the first arm 602 being perpendicular to the second arm 604.
  • the first arm 602 is divided (by its intersection with the second arm 604) into first and second portions 606, 608, which in this example are of generally equal length.
  • the second arm 604 is divided (by its intersection with the first arm 602) into first second portions 610, 612, with the first portion 610 of the second arm 604 being longer than the second portion 612 of the second arm 604.
  • a spherical tracking point 614 is mounted on each end of both the first arm 602 and the second arm 604, and it is these tracking points that are recognised and tracked by the optical tracking device 504.
  • the optical tracking tool 600 further comprises an attachment formation 616 by means of which it can be attached to the manipulation pin 502 in a known position and orientation.
  • the attachment formation 616 comprises a female socket formation of a generally rectangular shape with one rounded end into which a complementary male formation of the manipulation pin 502 can be inserted. Because of the particular shape of the attachment formation 616, the manipulation pin 502 can only be attached to it in a single orientation, which permits accurate reproduction in the 3D model generated by the image processing system 506 tracking of movement of the optical tracking tool 600 and the manipulation pin 502 and bone fragment to which it is attached. It will be appreciated that other configurations attachment formations could be used to attach the optical tracking tool 600 to the manipulation pin 502 in only a single orientation.
  • the combination of the system 100 for performing fracture reduction and the imaging system 500 permits highly accurate reduction of bone fractures, with greatly reduced trauma to patients.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Robotics (AREA)
  • Mechanical Engineering (AREA)
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Abstract

La présente invention concerne un appareil permettant d'effectuer une réduction de fracture, l'appareil comprenant : un premier manipulateur (200) pour effectuer la distraction d'une section osseuse de la fracture ; un second manipulateur (400) pour manipuler un premier fragment osseux de la fracture ; dans lequel le second manipulateur (400) est monté sur une plate-forme mobile (300) ayant de multiples degrés de liberté et est conçu pour manipuler le premier fragment osseux au moyen d'un dispositif de fixation percutanée (502) fixé sur le premier fragment osseux, et dans lequel le premier manipulateur (200) comprend un support de membre (202) configuré pour une fixation amovible au membre de telle sorte que la distraction de la section osseuse peut être effectuée sans fixation du premier manipulateur (200) à la section osseuse.
EP16747566.4A 2015-07-30 2016-07-27 Appareil pour effectuer une réduction de fracture Withdrawn EP3328306A1 (fr)

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GB1513436.4A GB2541177A (en) 2015-07-30 2015-07-30 Apparatus for performing fracture reduction
PCT/GB2016/052294 WO2017017443A1 (fr) 2015-07-30 2016-07-27 Appareil pour effectuer une réduction de fracture

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GB201513436D0 (en) 2015-09-16
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