JP2002538884A - 靭帯移植片配置のため造影し、計画する装置 - Google Patents
靭帯移植片配置のため造影し、計画する装置Info
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- JP2002538884A JP2002538884A JP2000604771A JP2000604771A JP2002538884A JP 2002538884 A JP2002538884 A JP 2002538884A JP 2000604771 A JP2000604771 A JP 2000604771A JP 2000604771 A JP2000604771 A JP 2000604771A JP 2002538884 A JP2002538884 A JP 2002538884A
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- 210000003041 ligament Anatomy 0.000 title claims abstract description 30
- 238000003384 imaging method Methods 0.000 title 1
- 210000000689 upper leg Anatomy 0.000 claims abstract description 22
- 210000002303 tibia Anatomy 0.000 claims abstract description 21
- 238000001356 surgical procedure Methods 0.000 claims abstract description 9
- 238000002604 ultrasonography Methods 0.000 claims abstract 5
- 238000000034 method Methods 0.000 claims description 20
- 210000003127 knee Anatomy 0.000 claims description 10
- 238000005553 drilling Methods 0.000 claims description 3
- 210000000988 bone and bone Anatomy 0.000 description 4
- 239000007943 implant Substances 0.000 description 3
- 230000008439 repair process Effects 0.000 description 3
- 210000001264 anterior cruciate ligament Anatomy 0.000 description 2
- 230000008901 benefit Effects 0.000 description 2
- 238000002594 fluoroscopy Methods 0.000 description 2
- 238000011065 in-situ storage Methods 0.000 description 2
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- 102000008186 Collagen Human genes 0.000 description 1
- 108010035532 Collagen Proteins 0.000 description 1
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- 101000777301 Homo sapiens Uteroglobin Proteins 0.000 description 1
- 102100031083 Uteroglobin Human genes 0.000 description 1
- 230000004075 alteration Effects 0.000 description 1
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- 230000008859 change Effects 0.000 description 1
- 238000006243 chemical reaction Methods 0.000 description 1
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- 230000001419 dependent effect Effects 0.000 description 1
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 1
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- 208000014674 injury Diseases 0.000 description 1
- 238000003780 insertion Methods 0.000 description 1
- 230000037431 insertion Effects 0.000 description 1
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- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1714—Guides or aligning means for drills, mills, pins or wires for applying tendons or ligaments
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Abstract
Description
ーター処理により自然位(in situ)でプランニングし、ガイダンスする
装置に係るものであり、そして請求項8の前文に記載の靭帯移植片配置をリアル
タイムでコンピューター処理により自然位(in situ)でプランニングし
、ガイダンスする方法に係るものである。
内視鏡を最小限侵入させて近接させ、自生の移植片で再構成するのがAGLの修
復の標準となっている。これの利点は手術の外傷が最も小さいということである
。
適当に配置されているということであり、これは不幸なことである。このことは
処置の質に深刻な問題をもたらし、適正に行われなければ、結局は膝全体の修復
を必要とすることになる膝構造の時期尚早な変質を招来する。
となり得て、普通の術後のX線写真で見れるように、外科医に靭帯位置の全体観
察をさせない。内視鏡で視認される標識点がこういうことで限られてくるという
ことから経験のある外科医は、手術中位置を確認できる量的手法として蛍光透視
の利用を提唱している。
ン繊維が破断する); d)膝の安定性の回復のための適正な移植片の張力と位置;そして e)良質な骨への移植片の適正な固定
0 603089 CINQUINに開示されている。この既知の方法は、脛
骨の移植片取付け点に対して大腿部の移植片取付け点を決めることについて、膝
の屈伸中それら2つの点の間の距離が変わらないように決めている。この既知の
方法では、基準子とポインターとを使用し、両方ともエネルギーを発する指標を
有し、自然位の3次元座標系内での指標の位置を3次元位置測定装置により、例
えばオプティカル・カスタム・ポジション測定装置(OPTOTRAK、ノーサ
ン・ディジタル、ウオータール、オン)により、求める。この位置測定装置は自
然位の3次元座標系に対する指標の位置を測定する。それを使ってポインターの
先端の位置もコンピューターにより求める。
するポインターの位置を測定する。 3)不変の点が期待される位置の近くで、大腿骨の滑車(trochlea)に
おいて幾つかの点Piにポインターの先端を配置する。 4)点Piのそれぞれと点T1との距離を計算する。 5)脛骨に対して大腿骨を変位させ、点Piのそれぞれと点T1との距離の変動を
計算する。 6)最も不変の距離を示しているP1を点Piの中から選択する。
を求める。 この既知の方法の欠点は、関節の全解剖学的構造に対して移植片の位置を全体
的に見るといったような解剖学的配置状態を確認できないことである。 この点について本発明は救済手段を提供しようとするものである。
剖構造的な、そして(構造的でない)機能的な、両方の基準を支持できる装置を
提供することである。
の配置をリアルタイムでコンピューター処理により自然位でプランニングし、ガ
イダンスする装置であり、本発明の方法は請求項8に記載の特徴を有する靭帯移
植片の配置をリアルタイムでコンピューター処理により自然位でプランニングし
、ガイダンスする方法である。
挿入を許す融通性を持っているということである。
脛骨とに1つずつ基準子を取付けるネジもしくはピン; B)少なくとも3つの指標を有するポインター; C)内視鏡; D)コンピューター; E)指標の位置を求めるためコンピューターに接続された位置計測器; F)手術前もしくは手術中使用されるX線源; G)医療像データを集めるX線レシーバー(この医療データは数字フォーマット
の形で直接コンピューターへ転送されるか、もしくはX線撮影フィルムを走査し
てコンピューターに入力する);そして H)コンピューターへ接続され、そして少なくとも3つの指標を有する超音波装
置 を備えている。
ネルギーを受けもしくは反射する手段であって、例えばエネルギー放出手段とし
ては、 −光源; −発光デバイス(発光ダイオード); −赤外線放出ダイオード(IRED); −音響トランスミッター;もしくは −磁界を発生するためのコイル、 または、エネルギーを受ける手段としては、 −ホトダイオード; −マイクロホーン:もしくは −ホール効果素子 等を設置してもよい。
てもよい。このドリル装置に取付けた指標により、ドリル装置の自然位での位置
、特にドリル先端の位置を求めることができる。このようなドリル先端は、コン
ピューターであらかじめ計画した骨に位置決めされてもよい。ドリルがあけた孔
の進路はコンピューターで制御されてもよく、コンピューターであらかじめ計画
した孔に従ってドリル装置を案内する。これらの孔の位置の計画は医療像を使っ
て行ってもよい。
コンピューターに組み込まれた内視鏡装置として形成されている。 超音波装置は、リアルタイム信号処理を可能とするような、1つの軸に沿って
超音波ビームを放射し、そして受けるAモードの超音波装置である。
めた靭帯の取付け点と取付け点との間の接続を表している3次元表示を呈示する
。さらに、この靭帯取付点を使用して、コンピューターは膝の屈伸中、靭帯を表
示する。
をそれぞれ測定し; D)超音波装置を使って、自然位での3次元座標系内の脛骨と大腿骨の表面の点
をそれぞれ測定し;そして E)前記A、CそしてDで得たデータにより靭帯移植片の配置を解剖構造的に、
そして(構造的でない)機能的に決める。
写真のデータとの間の数学的関係を確立してもよい。 X線写真を手術前もしくは手術中につくり、そして靭帯をどこに置くかを決め
る助けとして使ってもよい。
もよい。 好ましくはX線写真はテンプレートとして準備される。そのテンプレートを操
作することにより、コンピューターで表示された医療像上の解剖学的標識点に対
して、所望の靭帯移植片の配置を直接計画できる。 本発明の方法は脛骨に、大腿骨にそれぞれ起点指標を植え込む段階を含んでも
よい。
またはX線撮影フィルムを走査して取込むかのどちらかで医療像データを転送す
る); −それぞれが4つの指標を有する2つの剛性の基準子4,5と、大腿骨8と脛骨
9とに基準子4,5を取付けるネジ7もしくはピン; −12の指標6を有するポインター10; −ディスプレイ12を有する内視鏡11; −コンピューター3へ接続され、そして4つの指標6を有するAモード超音波装
置13; −指標6の位置を求めるためにコンピューター3に接続された位置計測器14;
そして −4つの指標6を有するドリル装置15 を備えている。
ってもよい。手術前にX線写真を撮影すると、数字フォーマットもしくはX線撮
影フィルムとして利用することができる。数字フォーマットで利用するなら、こ
のX線写真はコンピューターに直接転送され、そうでなければ、X線フィルムは
走査されてコンピューター3に取込まれる。もし手術中にX線写真を撮影するな
ら、X線源1とX線レシーバー2を使って蛍光透視を行う。X線写真は標準配向
で、例えば前方−後方そして中央−側方から撮るべきであり、そしてX線を透過
しない指標を有する定規を膝の側に配置して撮るべきである。定規の上のX線を
透過しない指標は像に現れ、そしてコンピューター3内でディジタル化されて像
の倍率を決定する。このX線写真はテンプレートとして用意される。解剖学的標
識点、例えば中間と横の丸い隆起もしくは滑車に対して所望の靭帯配置を、テン
プレートの操作によりコンピューター3に表示される医療像の上で直接計画でき
る。
、位置測定装置14により行われる。本発明の装置の好ましい実施例では、位置
測定装置14はオプトエレクトロニクス・ナビゲーション・システム(オプトト
ラク3020、ノーザン・ディジタル、キャン.)である。指標6は赤外線放出
ダイオード(IRED)であり、位置測定装置14で検出され、それにより基準
子4,5、ポインターの先端16、ドリルの先端17そして超音波装置13のヘ
ッド18の位置を計算できる。
大腿骨8の構造をそれぞれディジタル化できる。本発明の装置の好ましい実施例
において、ポインター10に内視鏡11が一体化したように、ポインター10は
コンピューターに統合された内視鏡的触接フックとなる。
ィジタル化によっては得にくい。このため本発明の装置は指標6を付けたAモー
ド超音波装置13を取込んでいる。この超音波装置13とコンピューター3とに
より骨表面と超音波ビームとの交差点と超音波装置13のヘッド18との間の距
離を計算できる。自然位での3次元座標20内での超音波ビームの方向と超音波
ヘッド18の位置とが位置測定装置14により求められるので、交差点19の位
置は、コンピューター3による座標変換によって自然位で3次元座標系20内で
求めてもよい。
て患者の手術中の位置と医療像のデータとの間の関係を確立してもよい。医療像
の上でのそのような座標変換はコンピューターで自然位で3次元座標系20に取
込んでもよく、それにより移植片の配置の解剖学的な、そして機能的な考察を可
能とする。
Claims (14)
- 【請求項1】 A)それぞれが少なくとも3つの指標(6)を有する2つの
剛性の基準子(4,5)と、大腿骨(8)と脛骨(9)とに1つずつ基準子(4
,5)を取付けるネジ(7)もしくはピン; B)少なくとも3つの指標(6)を有するポインター(10); C)内視鏡(11); D)コンピューター(3);そして E)指標(6)の位置を求めるためコンピューター(3)に接続された位置計測
器(14)を備えた靭帯移植片の配置をリアルタイムでコンピューターで処理し
て自然位でプランニングし、ガイダンスする装置において、 F)手術前もしくは手術中使用されるX線源(1); G)数字フォーマットの形で直接コンピューター(3)へ転送されるか、もしく
はX線撮影フィルムを走査してコンピューター(3)に入力する、医療像データ
を集めるX線レシーバー(2);そして H)コンピューター(3)へ接続され、そして少なくとも3つの指標(6)を有
する超音波装置(13) をさらに備えていることを特徴とする靭帯移植片の配置をリアルタイムでコンピ
ューターで処理してプランニングし、ガイダンスする装置。 - 【請求項2】 少なくとも3つの指標(6)を有するドリル装置(15)を
備えていることを特徴とする請求項1に記載の装置。 - 【請求項3】 ポインター(10)と内視鏡(11)とが一体化して、コン
ピューターに取込まれた内視鏡装置となっていることを特徴とする請求項1もし
くは2に記載の装置。 - 【請求項4】 超音波装置(13)はAモード超音波装置であることを特徴
とする請求項1ないし3の何れか1項に記載の装置。 - 【請求項5】 コンピューター(3)が、ポインター(10)によりあらか
じめ求められている靭帯取付点間の接続を3次元で表すことができることを特徴
とする請求項1ないし4の何れか1項に記載の装置。 - 【請求項6】 靭帯取付点を使ってコンピューター(3)が膝の屈伸中の靭
帯を表示することができることを特徴とする請求項5に記載の装置。 - 【請求項7】 X線源(1)とX線レシーバー(2)とが蛍光透視鏡として
構成されていることを特徴とする請求項1ないし6の何れか1項に記載の装置。 - 【請求項8】 請求項1ないし7の何れか1項に記載の装置を使用して、靭
帯移植片の配置をリアルタイムでコンピューター処理で、自然位でプランニング
し、ガイダンスする方法において、 A)医療像として大腿骨(8)と脛骨(9)の膝部分の少なくとも1つのX線写
真をつくり; B)その医療像をコンピューター(3)に転送し; C)ポインター(10)を使って、自然位での3次元座標系(20)内の脛骨(
9)と大腿骨(8)の表面の点をそれぞれ測定し; D)超音波装置(13)を使って、自然位での3次元座標系(20)内の脛骨(
9)と大腿骨(8)の表面の点をそれぞれ測定し; E)前記C及び/又はDで測定された脛骨(9)と大腿骨(8)の表面の点を使
って患者の手術中の位置と医療像のデータとの間の数学的関係を確立し;そして
F)前記A、CそしてDで得たデータにより靭帯移植片の配置を解剖構造的に、
そして機能的に求める ことを特徴とする靭帯の移植片の配置をリアルタイムでコンピューター処理で、
自然位でプランニングし、ガイダンスする方法。 - 【請求項9】 少なくとも1つのX線写真を手術前につくり、そして靭帯を
どこに置くかを決める助けとして使うことを特徴とする請求項8に記載の方法。 - 【請求項10】 少なくとも1つのX線写真を手術中につくり、そして靭帯
をどこに置くかを決める助けとして使うことを特徴とする請求項8に記載の方法
。 - 【請求項11】 コンピューター(3)により拡大像を決める段階を含むこ
とを特徴とする請求項8ないし10の何れか1項に記載の方法。 - 【請求項12】 少なくとも1つのX線写真をテンプレートとして準備する
ことを特徴とする請求項8ないし10の何れか1項に記載の方法。 - 【請求項13】 テンプレートを操作することによりコンピューター(3)
で表示された医療像上の解剖学的標識点に対して所望の靭帯移植片の配置を直接
計画することを特徴とする請求項12に記載の方法。 - 【請求項14】 脛骨(9)に、大腿骨(8)にそれぞれ起点指標を植え込
む段階を含んでいることを特徴とする請求項8ないし13の何れか1項に記載の
方法。
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PCT/EP1999/001778 WO2000054687A1 (en) | 1999-03-17 | 1999-03-17 | Imaging and planning device for ligament graft placement |
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US (1) | US6725082B2 (ja) |
EP (1) | EP1161194B1 (ja) |
JP (1) | JP4612196B2 (ja) |
AU (1) | AU748703B2 (ja) |
CA (1) | CA2367271C (ja) |
DE (1) | DE69931074T2 (ja) |
ES (1) | ES2260901T3 (ja) |
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JPH0928711A (ja) * | 1995-07-18 | 1997-02-04 | Shimadzu Corp | 超音波像観察装置 |
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JP2004500958A (ja) * | 2000-06-28 | 2004-01-15 | デピュイ インターナショナル リミテッド | 外科手術用器具を位置決めするための装置 |
JP2007518540A (ja) * | 2004-01-22 | 2007-07-12 | スミス アンド ネフュー インコーポレーテッド | 患者に対して取り付けられた外科手術ナビゲーションセンサを提供するための方法およびシステムおよび装置 |
JP2008520275A (ja) * | 2004-11-10 | 2008-06-19 | ウォーソー・オーソペディック・インコーポレーテッド | 患者を探知し処置するエキスパートシステムのための方法および装置 |
JP2007181694A (ja) * | 2005-12-30 | 2007-07-19 | Depuy Products Inc | コンピュータ支援整形外科手術システムを用いて患者の骨を登録するシステムおよび方法 |
JP2007215993A (ja) * | 2005-12-30 | 2007-08-30 | Depuy Products Inc | コンピュータ支援整形外科手術システムを用いて患者の骨を登録する装置および方法 |
US8862200B2 (en) | 2005-12-30 | 2014-10-14 | DePuy Synthes Products, LLC | Method for determining a position of a magnetic source |
JP2009273521A (ja) * | 2008-05-12 | 2009-11-26 | Niigata Univ | 関節鏡手術ナビゲーションシステム |
Also Published As
Publication number | Publication date |
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AU2837299A (en) | 2000-10-04 |
CA2367271A1 (en) | 2000-09-21 |
CA2367271C (en) | 2008-12-16 |
EP1161194B1 (en) | 2006-04-26 |
DE69931074D1 (de) | 2006-06-01 |
AU748703B2 (en) | 2002-06-13 |
JP4612196B2 (ja) | 2011-01-12 |
US20020055679A1 (en) | 2002-05-09 |
DE69931074T2 (de) | 2006-11-16 |
WO2000054687A1 (en) | 2000-09-21 |
EP1161194A1 (en) | 2001-12-12 |
ES2260901T3 (es) | 2006-11-01 |
NZ513919A (en) | 2001-09-28 |
US6725082B2 (en) | 2004-04-20 |
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