JP2008036248A - Vertebral pedicular arch probe navigation system and navigation method - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide the establishment of a simple and accurate insertion/installation method of vertebral pedicular arch screw. <P>SOLUTION: The navigation system of a vertebral pedicular arch probe 11 is a system to navigate the insertion of the vertebral pedicular arch probe 11 in spinal reconstruction surgery, and has a transmission and reception ultrasonic transducer 12 provided at the tip of the vertebral arch pedicle probe 11, a measuring means to measure an ultrasonic echo in the boundary between a spongy bone 2 and a cortical bone 3 by using the ultrasonic transducer 12 when the vertebral pedicular arch probe 11 is inserted into the spongy bone 2 of the vertebral pedicular arch, an analysis means 13 to analyze the signal waveform of the ultrasonic echo measured by the measuring means, and a display means 14 to display the result of the measuring means and/or the result of the analysis means in real-time. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to an intraoperative ultrasound monitoring system and method, such as for spinal pedicle screw placement in spinal reconstruction.

  At present, in spinal column reconstruction, CT (Computed Tomography) MPR (Multi Planer Reconstruction), pedicle diameter, insertion point, insertion angle, etc. Therefore, it is possible to evaluate the site where the pedicle screw can be installed before the operation. However, only with the image information of these MPR images, there is a problem that it is difficult to safely and accurately place the screw on the pedicle in practice.

  That is, in the pedicle screw in spine reconstruction, it is necessary to create a bone hole in the vertebra pedicle in order to insert and install the pedicle screw in the vertebra pedicle. The vertebral pedicle is a bone tissue whose bone structure is mainly divided into external cortical bone and cancellous bone contained therein. When inserting a pedicle screw into the vertebral pedicle, if the pedicle screw inserted from the cancellous bone pierces the surrounding thin cortical bone, it damages important organs such as the spinal cord, vertebral artery and nerve root There is a risk of doing so.

  In particular, the cervical spine is not only small in anatomical size, but also contains the spinal cord, vertebral artery, and nerve roots, and insertion and placement of the pedicle screw always involves the possibility of neurovascular damage . In the cervical spine, once injury such as brainstem infarction or cerebellar infarction due to spinal cord injury or vertebral artery injury, the resulting damage is enormous, and the cervical pedicle screw is the most accurate placement in all spinal fixation procedures A procedure is required.

  On the other hand, in spine reconstruction, the fixation strength of the fixation plate to the spine correlates with the insertion depth of the screw, so that the insertion depth of the pedicle screw into the pedicle is large in order to increase the fixation strength. It is desirable. However, in the pedicle, there is a danger site that the pedicle screw can be inserted only about 4 to 5 mm in diameter even if the cancellous bone and the surrounding cortical bone are combined. Since there is such a dangerous part, in order to increase the insertion depth further, a method for accurately inserting the pedicle screw is required.

  Under these circumstances, in spine reconstruction for unstable cervical vertebral lesions, it is essential to establish a simple and accurate method for inserting and installing a pedicle screw.

In spinal column reconstruction, there are cases where X-ray transmission devices are used during the operation, but it is pointed out that the possibility of erroneous insertion cannot be denied even by skilled spine surgeons with only two-dimensional image information. is there. Even highly skilled spine surgeons have reported about 5% or more false insertions.
That is, in a procedure using a pedicle screw, 4 to 6 pedicle screws are inserted in one operation, and more than 10 pedicle screws are inserted in many cases. Therefore, it can be said that about 5% or more erroneous insertion is a heavy burden on the patient.
Furthermore, it was reported that the accuracy of the installation procedure was expected due to the appearance of advanced medical devices such as a fluoroscopy-based spine navigation system, but the pedicle screw insertion rate was not different from the manual method. ing.
Under such a background, a simple and cost-effective method for inserting and installing a pedicle screw is desired.

Here, conventionally, as a bone diagnostic device, an ultrasonic transmission unit that transmits pulsed ultrasonic waves that are output to a bone sample having at least cancellous bone and transmits through the cancellous bone, and a path in the cancellous bone, respectively. The ultrasonic wave receiving unit that receives the transmitted first wave and the slow second wave, and the amplitude ratio of the first wave and the second wave are measured to determine the bone mass ratio or the bone mass volume ratio. 2. Description of the Related Art Bone ultrasonic measuring devices including measuring means are known (see, for example, Patent Document 1 and Patent Document 2).
When a pulsed ultrasonic wave is incident on a bone, this device is divided into two pulse waves (a first wave that precedes and a second wave that moves backward) that have passed through a certain path in the cancellous bone. And the second wave uses the fact that the amplitude changes depending on the bone quality ratio in the cancellous bone, and by calculating the ratio, the bone mass ratio is indirectly calculated, and the correlation with the bone strength is searched. Thus, diagnosis of bone condition such as osteoporosis is performed.

On the other hand, as an ultrasonic diagnostic apparatus capable of performing a safe puncture treatment, it is used for monitoring a region in a puncture treatment using a puncture needle inserted into a region from a body surface of a subject to a predetermined site in the body. An ultrasound diagnostic apparatus that transmits ultrasound to a region and receives a reflected wave from a subject, and combines a morphological image including a tissue and a structure image including a blood vessel structure based on the reflected wave Image generating means for generating the synthesized image, marker control means for generating and controlling a puncture needle guide marker indicating the path or puncture needle through which the puncture needle passes when the puncture needle is inserted, the composite image and the puncture Display means for simultaneously displaying the needle guide marker on the screen, and designation means for designating a puncture route where the puncture needle guide marker does not contact the blood vessel in at least the region on the screen of the display means Comprising a marker control means is responsive to designation from the specified unit, the puncture needle guide markers it is possible to move the device is known to the puncture route (Patent Document 3).
According to the above apparatus, a safe puncture route that avoids blood vessels can be determined before insertion of the puncture needle, and the operator can injure blood vessels and the like by inserting the puncture needle so as to pass through the puncture route. Therefore, the puncture feather needle can reach the tumor without causing bleeding and metastasis, and a safe puncture treatment can be realized and the burden on the operator can be reduced.

Japanese Patent No. 2863886 JP 2005-204831 A JP 2004-298476 A

  In the conventional spine reconstruction, the pedicle screw insertion / installation method has a problem that a highly skilled spine surgeon has a risk of erroneous insertion.

  In view of the above problems, an object of the present invention is to provide a simple and accurate insertion / installation method for a pedicle screw.

  In order to achieve the above object, a pedicle probe navigation system according to claim 1 of the present invention is a system for navigating insertion of a pedicle probe in spinal reconstruction, wherein the tip of the pedicle probe is provided. When the pedicle probe is inserted into the cancellous bone of the pedicle, the ultrasonic transducer is used at the boundary between the cancellous bone and the cortical bone. Measuring means for measuring the ultrasonic echo signal, analyzing means for analyzing the signal waveform of the ultrasonic echo measured by the measuring means, and display for displaying the result of the measuring means and / or the result of the analyzing means in real time And a means.

  In order to generate a bony hole for passing a pedicle screw, an ultrasonic transducer for transmission and reception is provided at the tip of the pedicle probe to be inserted, thereby measuring the bone state several millimeters ahead from the tip in real time. Thus, a bone hole can be formed in the pedicle having a diameter of about 4 to 5 mm without damaging important organs such as the spinal cord, vertebral artery, and nerve root, thereby enabling placement of the pedicle screw. .

  Next, a pedicle probe navigation system according to claim 2 of the present invention is a system for navigating insertion of a pedicle probe in spine reconstruction, and is provided at a rear portion of the pedicle probe. When the pedicle probe is inserted into the cancellous bone of the pedicle, the ultrasonic wave transmitted from the transmit / receive ultrasonic transducer is transmitted in the longitudinal direction of the pedicle probe. A measuring means for propagating and transmitting ultrasonic waves from the tip of the pedicle probe, and using the receiving ultrasonic transducer to measure ultrasonic echoes at the boundary between cancellous bone and cortical bone; and the measurement Analyzing means for analyzing the signal waveform of the ultrasonic echo measured by the means, and displaying the result of the measuring means and / or the result of the analyzing means in real time Characterized in that it is configured to include a display unit.

Unlike the configuration of the navigation system for the pedicle probe according to the first aspect, the transmission / reception ultrasonic transducer is arranged at the rear portion of the pedicle probe, not at the tip portion of the pedicle probe. Specifically, an ultrasonic transducer for transmission / reception is provided at the rear part of the pedicle probe, and the shape of the pedicle probe is expanded from the diameter of the posterior part of the pedicle probe to that of the tip part, and a squeezing is applied to the pedicle probe. A transmitting / receiving ultrasonic transducer having a size larger than the insertion size is arranged. When the pedicle probe is inserted into the cancellous bone of the pedicle, the ultrasonic wave transmitted from the transmitting / receiving ultrasonic transducer propagates in the longitudinal direction of the pedicle probe, and the distal end portion of the pedicle probe The ultrasonic wave is transmitted from the transmitter, and ultrasonic echoes at the boundary between the cancellous bone and the cortical bone are measured using the transmission / reception ultrasonic transducer.
Since the transmission / reception ultrasonic transducer is provided at the rear part of the pedicle probe, by devising the shape of the pedicle probe, restrictions such as the size of the transmission / reception ultrasonic transducer are released and the sound wave output increases. This can improve the sensitivity.

  Next, the pedicle probe navigation system according to claim 3 of the present invention is the pedicle probe navigation system analyzing means according to claim 1 or 2, wherein the pedicle probe is a pedicle. When inserted into the cancellous bone of the root, the state in which there is no ultrasonic echo is recognized as the state in which the pedicle probe is progressing in the trabecular bone, and the state in which there is two ultrasonic echoes The root probe recognizes that it is progressing in the cancellous bone toward the cortical bone, and the state where there is one ultrasonic echo is recognized as the state where the pedicle probe is progressing in the cortical bone, and then It is characterized by recognizing a state where there is no ultrasonic echo as a state where the pedicle probe is exposed outside the cortical bone.

  With the above algorithm, the position state of the distal end portion of the pedicle probe can be grasped.

  Next, the pedicle probe navigation system according to claim 4 of the present invention is subjected to spinal reconstruction in the analysis means of the pedicle probe navigation system according to any one of claims 1 to 3. The reception sensitivity of the ultrasonic echo is adjusted with reference to a knowledge database including at least the bone hardness and bone density of the patient.

  With the above configuration, the position state of the distal end portion of the pedicle probe can be grasped with higher accuracy from the bone diagnosis information corresponding to the patient's state.

  Next, a navigation system for a pedicle probe according to claim 5 of the present invention is the display means of the navigation system for a pedicle probe according to any one of claims 1 to 4, wherein the analysis means includes: An alarm is notified when it is recognized that there is no sound echo from a state.

  With the above configuration, the pedicle probe can be inserted safely and accurately.

  A pedicle probe navigation method according to claim 6 of the present invention is a method for navigating insertion of a pedicle probe in spine reconstruction, and is provided at the distal end of the pedicle probe. When the pedicle probe is inserted into the cancellous bone of the pedicle using an ultrasonic transducer for transmission and reception, a step of measuring an ultrasonic echo at the boundary between the cancellous bone and the cortical bone, and measurement A step of analyzing the signal waveform of the ultrasonic echo, and a step of displaying the result of ultrasonic echo signal measurement and / or the analysis result in real time.

  Next, a pedicle probe navigation method according to claim 7 of the present invention is a method for navigating insertion of a pedicle probe in spine reconstruction, which is provided at the distal end of the pedicle probe. When the pedicle probe is inserted into the cancellous bone of the pedicle using the receiving ultrasonic transducer and the transmitting ultrasonic transducer provided at the rear part of the pedicle probe, The ultrasonic wave transmitted from the ultrasonic transducer propagates in the longitudinal direction of the pedicle probe, the ultrasonic wave is transmitted from the distal end portion of the pedicle probe, and the ultrasonic wave for reception at the boundary between the cancellous bone and the cortical bone The steps of measuring the ultrasonic echo signal with a transducer, analyzing the measured ultrasonic echo signal waveform, and measuring the ultrasonic echo signal in real time. And characterized by comprising the steps of displaying / or analysis results.

  Next, a pedicle probe navigation method according to claim 8 of the present invention is a step of analyzing a signal waveform of an ultrasonic echo of the pedicle probe navigation method according to claim 6 or 7, When the pedicle probe is inserted into the cancellous bone of the pedicle, the state in which there is no ultrasonic echo is recognized as the state in which the pedicle probe is traveling in the cancellous bone, and the ultrasonic echo is detected. The pedicle probe recognizes that the pedicle probe is traveling through the cancellous bone toward the cortical bone, and the pedicle probe travels through the cortical bone when there is one ultrasonic echo. It is characterized by recognizing that the pedicle probe is exposed to the outside of the cortical bone.

  Next, a pedicle probe navigation method according to claim 9 of the present invention analyzes a signal waveform of an ultrasonic echo of the pedicle probe navigation method according to any of claims 6 to 8. In the step, the reception sensitivity of the ultrasound echo is adjusted with reference to a knowledge database including at least bone hardness and bone density of the patient undergoing spinal reconstruction.

  Next, a pedicle probe navigation method according to claim 10 of the present invention includes a step of displaying an analysis result of the pedicle probe navigation method according to any of claims 6 to 9, wherein: An alarm is notified when it is recognized that there is no sound echo from a state.

Since the pedicle probe navigation system and method according to the present invention can be measured in real time during spine reconstruction surgery, it has the effect of ensuring high safety and accuracy.
In addition, since the present system and method itself use ultrasonic waves, there is also an effect that there is no risk of exposure that occurs when an X-ray transmission device or the like is used. If a conventional X-ray transmission device or the like is used in combination, it can be expected that higher safety can be secured.

  Hereinafter, embodiments of the navigation system and method of the pedicle probe of the present invention will be described in detail with reference to the drawings.

  FIG. 1 shows how a pedicle screw is inserted into a pedicle in cervical vertebra reconstruction using a cervical pedicle screw. The place where the pedicle screw is inserted is a cancellous bone portion of the pedicle, and the cancellous bone is covered with a hard cortical bone. A pedicle screw is inserted into the cancellous bone. In cervical spine reconstruction, as shown in FIG. 1, the insertion angle of the pedicle screw is in a narrow angle range of 15 to 25 degrees, and the narrowest passage portion is a portion indicated by an arrow in the figure. The width is as narrow as 4-5 mm. In addition, a vertebral artery is present in the vicinity of the narrow passage portion, and there is a difficulty in a technique in which serious surgical complications such as brainstem infarction due to vertebral artery damage must be avoided. Therefore, in order to perform such cervical spine reconstruction, even a skilled spine surgeon is required to have the most advanced technology.

FIG. 2 is a schematic diagram illustrating a schematic system configuration of the navigation system for the pedicle probe according to the first embodiment.
The pedicle probe navigation system according to the first embodiment includes a transmission / reception ultrasonic transducer 12 provided at the distal end of a pedicle probe 11 and the pedicle probe 11 inserted into the cancellous bone 2 of the pedicle. In this case, the ultrasonic transducer 12 is used to measure the echo of the ultrasonic wave (schematically shown by the ultrasonic ripple 4 in the figure) at the boundary between the cancellous bone 2 and the cortical bone 3. Means (referring to an unillustrated power supply system and signal system associated with the pedicle probe 11 and the ultrasonic transducer 12 and their signals) and an analysis means 13 for analyzing the signal waveform of the ultrasonic echo measured by the measuring means. Display means 14 for displaying the result of the analysis means in real time.

FIG. 2 shows the pedicle probe 11 being inserted into the cancellous bone 2. The pedicle probe 11 is for forming a bone hole for inserting a pedicle screw (not shown) into the pedicle. The pedicle is a bone tissue that is mainly divided into external cortical bone and cancellous bone contained therein. A bone hole is provided in this cancellous bone portion.
When a pedicle screw inserted from the cancellous bone pierces thin cortical bone, important organs such as the spinal cord, vertebral artery and nerve root may be damaged, which should be avoided. For this reason, in the navigation system for the pedicle probe of the first embodiment, the pedicle probe 11 is connected to the pedicle sponge using the transmitting / receiving ultrasonic transducer 12 provided at the distal end portion of the pedicle probe 11. When inserted into the bone 2, by measuring the ultrasonic echo (reflected wave) at the boundary between the cancellous bone 2 and the cortical bone 3, the path of the pedicle probe 11 straightens the cancellous bone 2. It is decided to judge whether it is.

For example, in the case of FIG. 2, the pedicle probe 11 inserted from the cancellous bone 2 side is thin when the pedicle probe 11 passes through the narrowest portion of the pedicle as shown in the description of FIG. When the cancellous bone 2 that does not pierce the cortical bone 3 is advanced straight (inserted), ultrasonic waves transmitted from the transmitting / receiving ultrasonic transducer 12 provided at the distal end of the pedicle probe 11 are used. The echo is not measured.
However, as shown in FIGS. 3A to 3C, when the pedicle probe 11 passes through the narrowest portion of the pedicle, the pedicle probe 11 inserted from the cancellous bone 2 side is When the needle is inserted at an angle that penetrates the thin cortical bone 3, an echo from the ultrasonic wave transmitted from the transmitting / receiving ultrasonic transducer 12 provided at the distal end of the pedicle probe 11 is measured. Become.

This will be described in more detail below. First, in FIG. 3A, the pedicle probe 11 inserted from the side of the cancellous bone 2 is advanced (inserted) at an angle toward the boundary wall between the cancellous bone 2 and the cortical bone 3, unlike FIG. In this state, the ultrasonic echo has not been captured by the ultrasonic transducer 12 yet. Next, when the state shown in FIG. 3B is reached, the pedicle probe approaches the boundary wall between the cancellous bone 2 and the cortical bone 3, and the ultrasonic transducer 12 is connected to the cancellous bone and the cortical bone surrounding the cancellous bone. Capture echoes (reflected waves) from the boundary.
In the state of FIG. 3C, the distal end portion of the pedicle probe 11 enters the thin cortical bone 3, and the ultrasonic transducer 12 starts from the boundary portion between the cortical bone and the cortical bone. The echo (reflected wave) is captured.

Here, ultrasonic echoes at the boundary between the cancellous bone and the cortical bone include the reflected wave from the boundary portion between the cancellous bone and the cortical bone surrounding it, and the outside of the cortical bone beyond the boundary portion and the cortical bone. There are two types of reflected waves from the boundary part.
The echo captured by the ultrasonic transducer 12 in FIG. 3B is a reflected wave from the boundary between the cancellous bone and the cortical bone surrounding the cancellous bone, and the echo captured by the ultrasonic transducer 12 in FIG. Is a reflected wave from the boundary between the outside of the cortical bone and the cortical bone.

The state of the echo (reflected wave) varies depending on the insertion angle of the pedicle probe 11 and the state of cancellous bone or cortical bone.
Depending on the insertion angle of the pedicle probe 11, the boundary portion between the cancellous bone and the cortical bone surrounding the cancellous bone and the cortical bone surrounding the cancellous bone when the state is close to a perpendicular direction to the interface between the cancellous bone and the cortical bone surrounding the cancellous bone It is possible to measure two types of waves: a reflected wave from the outside and a reflected wave from the boundary between the outside of the cortical bone and the cortical bone beyond the boundary.
Therefore, by analyzing the ultrasonic echo pattern, the position and progress of the pedicle probe 11 can be estimated and grasped.

Next, the analysis means 13 for analyzing the signal waveform of the measured ultrasonic echo will be described.
The analysis means 13 is an arithmetic circuit equipped with a microprocessor, and as its analysis logic, there is no ultrasonic echo when the pedicle probe 11 is inserted into the cancellous bone 2 of the pedicle. It is recognized that the pedicle probe 11 is moving straight through the cancellous bone 2, and a state where there is one or two ultrasonic echoes, the pedicle probe 11 is inside the cancellous bone 2 and the cortical bone 3. A state in which there is one ultrasonic echo, a state in which the pedicle probe 11 is in progress in the cortical bone 3 and there is no subsequent ultrasonic echo Is recognized as a state in which the pedicle probe 11 is exposed outside the cortical bone 3.

The display means 14 transmits the ultrasonic echo analysis result to the surgeon, and in the simplest form, displays it with three display lamps of normal, caution, and danger. Here, “normal” refers to a state in which there is no ultrasonic echo (a state in which the pedicle probe is proceeding straight through the cancellous bone), and “caution” refers to one or two ultrasonic echoes. State (state in which the pedicle probe is moving in the cancellous bone toward the cortical bone, or state in which the pedicle probe is moving in the cortical bone), and the danger is one ultrasonic echo This represents a state where there is no ultrasound echo after a certain state (a state where the pedicle probe is exposed outside the cortical bone).
Moreover, it is displayed as a measurement signal graph image of ultrasonic echoes, and further, an imaging display using a CT (Computed Tomography) MPR (Multi Planer Reconstruction) image. It may be.

As an example of the above-mentioned ultrasound echo, using a bovine bone, the reflected wave from the boundary between the cancellous bone and the cortical bone surrounding the cancellous bone, and beyond the boundary, the outside of the cortical bone and the cortical bone Basic data indicating that the reflected wave can be separated from the boundary portion will be described below.
FIG. 4 is a diagram schematically showing a state in which ultrasonic flaw detection is performed from the inner cancellous bone to the outer cortical bone by dividing the bovine bone.
FIG. 5 is a graph showing ultrasonic echoes obtained when ultrasonic flaw detection is performed from the inner cancellous bone to the outer cortical bone by dividing the bovine bone.
The horizontal axis of the graph of FIG. 5 is time, and the vertical axis is sensitivity (ratio of the amplitude of the ultrasonic echo to the amplitude of the transmitted ultrasonic wave). The parameters on the right side of the graph of FIG. 5 will be described. RANGE is the distance of one scale, and MTLEBEL is the sound speed of the target medium. D-DELAY means a gap from the transmission waveform.

Here, as the ultrasonic probe, a 1-3 composite 5 MHz 10Φ spherical probe (model number: USM25S, manufacturer: GE Inspection Technologies) was used.
In the graph of FIG. 5, a portion indicated by an arrow (A) is a reflected wave from a boundary portion between the cancellous bone and the cortical bone surrounding the periphery (in FIG. 4, reflection from the surface of the cortical bone 3 obtained through the cancellous bone 2. A portion indicated by an arrow (B) is a reflected wave from a boundary portion between the cortical bone and the cortical bone (a reflected wave from the bottom surface of the cortical bone 3 in FIG. 4).
Here, since one scale is 5 mm, the reflected waves from the surface and the bottom surface of the cortical bone having a thickness of about 2 mm are separated.
The bone used in the experiment was a bone of a specific part of the cow, which is different from the bone of the human pedicle, but from the graph of FIG. 5, the separation of ultrasonic reflected waves from cancellous bone and cortical bone in the bone part. It will be understood that this is possible.

  In the graph of FIG. 5, peaks other than those indicated by arrows (A) and (B) are considered measurement noise. For these measurement noises, an appropriate noise cut filter can be provided by creating a knowledge database of the characteristics of the ultrasonic wave reflected by the bone material. By providing the noise cut filter, the separation of ultrasonic reflected waves from cancellous bone and cortical bone can be measured more clearly.

FIG. 6 shows, with reference to a knowledge database (knowledge DB) including at least bone hardness and bone density of a patient undergoing spinal reconstruction, the analysis means 13 receives ultrasonic echoes and analyzes parameters (distance to vertebral artery). FIG. 6 schematically shows how the thickness of cortical bone, the hardness of a substance in the vicinity of the pedicle probe, and the like are adjusted.
The trabecular bone and cortical bone characteristic parameters (hardness, density, sound velocity, etc.) are many parameters such as patient gender, age, height, weight, nationality, medical history, exercise history, lifestyle, etc. (these are referred to as reference information) And are expected to be interrelated. Therefore, unless the characteristic parameters optimum for the target patient are used, it is impossible to provide appropriate information (distance to the calcaneous artery or the like, the hardness of the substance in the vicinity of the pedicle probe). Therefore, by building a knowledge DB that stores a certain number of these interrelationships, it is possible to infer appropriate feature parameters from the above reference information for new patients and to provide appropriate information using them. It is what.

  Unlike the first embodiment, the navigation system for the pedicle probe of the second embodiment does not integrate the ultrasonic transducers for transmission and reception, but separates the ultrasonic transducer for transmission and the ultrasonic transducer for reception. In addition, since the transmitting ultrasonic transducer is provided in the rear part of the pedicle probe, there is no restriction on the size and the sound wave output can be increased, thereby improving the sensitivity.

  FIG. 7 shows a schematic system configuration diagram of the navigation system for the pedicle probe of the second embodiment. As shown in FIG. 7, when the transmitting / receiving ultrasonic transducer 21 provided in the rear part of the pedicle probe 11 and the pedicle probe 11 are inserted into the cancellous bone 2 of the pedicle, transmission / reception is performed. The ultrasonic wave transmitted from the ultrasonic transducer 21 propagates in the longitudinal direction of the pedicle probe 11, the ultrasonic wave is transmitted from the distal end portion of the pedicle probe 11, and the transmission / reception ultrasonic transducer 21 is used to set the sponge. An ultrasonic echo at the boundary between the bone 2 and the cortical bone 3 is signal-measured. And the analysis means 13 which analyzes the signal waveform of the measured ultrasonic echo, and the display means 14 which displays the result of an analysis means in real time are provided.

  The transmitting ultrasonic transducer 21 does not enter the body, is not limited in size, and can increase the sound wave output. Thereby, the output power of the ultrasonic wave is increased, and the sensitivity of the ultrasonic echo at the boundary between the cancellous bone 2 and the cortical bone 3 can be improved.

  The analysis means 13 for analyzing the signal waveform of the measured ultrasonic echo and the display means 14 for displaying the result of the analysis means in real time are the same as in the first embodiment.

In the case of the present embodiment, the ultrasonic wave propagates through the pedicle probe 11 from the transmission / reception transducer 21 arranged behind the pedicle probe and enters the target object from the tip. When there is a reflected wave from any object, the transmission / reception transducer 21 arranged at the rear part of the pedicle probe 11 receives the ultrasonic echo propagated from the tip of the pedicle probe 11.
Here, the transmission / reception transducer 21 does not need to be an integral type, and the transmission / reception transducer can be made by simply making the inside rectangular and having two transmission / reception areas or two concentric transmission / reception areas. It is also possible to separate transmission and reception.

  The pedicle probe navigation system and method of the present invention can be used as a diagnostic measurement system and a diagnostic measurement method in spinal column reconstruction.

In the cervical vertebra reconstruction using a cervical pedicle screw, the pedicle screw is inserted into the pedicle. The pedicle probe is shown inserted into the cancellous bone. When the pedicle probe passes through the narrowest part of the pedicle, the pedicle probe inserted from the cancellous bone side is inserted at an angle that pierces the thin cortical bone. It is the figure which showed typically a mode when a bone of a cow was cut | disconnected and ultrasonic flaw detection was performed toward the outer cortical bone from the inner cancellous bone. The graph shows ultrasonic echoes when a bone is cut and ultrasonic flaw detection is performed from the inner cancellous bone to the outer cortical bone. The manner in which analysis parameters and the like are adjusted with reference to the knowledge database in the analysis means is schematically shown. The schematic system block diagram of the navigation system of the pedicle probe of Example 2 is shown.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Navigation system of pedicle probe 2 Cancellous bone 3 Cortical bone 4 Ultrasonic wave ripple 11 Pedicle probe 12 Ultrasonic transducer for transmission / reception 13 Analysis device 14 Display device 21 Ultrasonic transducer for transmission / reception

Claims (10)

  A system for navigating insertion of a pedicle probe in spinal reconstruction, wherein the transmitting / receiving ultrasonic transducer is provided at the distal end of the pedicle probe, and the pedicle probe is a cancellous bone of the pedicle. A measuring means for measuring an ultrasonic echo at the boundary between cancellous bone and cortical bone using the ultrasonic transducer, and a signal waveform of the ultrasonic echo measured by the measuring means A pedicle probe navigation system comprising: an analysis unit for analyzing; and a display unit for displaying the result of the measurement unit and / or the result of the analysis unit in real time.   A system for navigating insertion of a pedicle probe in spinal reconstruction, wherein a transmitting / receiving ultrasonic transducer provided at a rear part of the pedicle probe includes a pedicle probe in the cancellous bone of the pedicle. Ultrasonic waves transmitted from the transmitting / receiving ultrasonic transducer propagate in the longitudinal direction of the pedicle probe, and ultrasonic waves are transmitted from the distal end of the pedicle probe. Measuring means for measuring an ultrasonic echo at the boundary between cancellous bone and cortical bone using an ultrasonic transducer, an analyzing means for analyzing a signal waveform of the ultrasonic echo measured by the measuring means, and the real time A navigation system for a pedicle probe, comprising: display means for displaying the result of the measuring means and / or the result of the analyzing means Beam.   In the analyzing means, when the pedicle probe is inserted into the cancellous bone of the pedicle, the state in which there is no ultrasonic echo is recognized as a state in which the pedicle probe is traveling in the cancellous bone. The state in which there is one or two ultrasonic echoes is recognized as the state in which the pedicle probe is progressing in the cancellous bone toward the cortical bone, and the state in which there is one ultrasonic echo is the pedicle. The probe recognizes that the probe is progressing in the cortical bone, and then recognizes the state where there is no ultrasonic echo as a state where the pedicle probe is exposed to the outside of the cortical bone. 3. A navigation system for a pedicle probe according to 2.   4. The ultrasonic echo reception sensitivity is adjusted by referring to a knowledge database including at least bone hardness and bone density of a patient undergoing spinal reconstruction in the analysis means. A pedicle probe navigation system as described.   The pedicle probe navigation according to any one of claims 1 to 4, wherein in the display means, when the analyzing means recognizes that there is no ultrasonic echo, the alarm is notified. system.   A method of navigating insertion of a pedicle probe in spinal reconstruction, wherein the pedicle probe is inserted into the pedicle using an ultrasonic transducer for transmission and reception provided at a distal end portion of the pedicle probe. When inserted into the cancellous bone, the step of measuring the ultrasonic echo at the boundary between the cancellous bone and the cortical bone, the step of analyzing the signal waveform of the measured ultrasonic echo, and the real-time ultrasonic echo A pedicle probe navigation method, comprising: a step of displaying a signal measurement result and / or an analysis result.   A method for navigating insertion of a pedicle probe in spinal reconstruction, wherein the pedicle probe is connected to a sponge of a pedicle using an ultrasonic transducer for transmission / reception provided at a rear portion of the pedicle probe. When inserted into the bone, the ultrasonic wave transmitted from the transmitting / receiving ultrasonic transducer propagates in the longitudinal direction of the pedicle probe, and the ultrasonic wave is transmitted from the distal end of the pedicle probe. A step of measuring an ultrasonic echo signal at the boundary between bone and cortical bone with the ultrasonic transducer for transmission / reception, a step of analyzing a signal waveform of the measured ultrasonic echo, and a result of ultrasonic echo signal measurement in real time And / or a step of displaying an analysis result.   In the step of analyzing the signal waveform of the ultrasonic echo, when the pedicle probe is inserted into the cancellous bone of the pedicle, the pedicle probe shows no state in the cancellous bone. Recognizing that the state is advancing, the state where the ultrasonic echo is once or twice is recognized as the state where the pedicle probe is proceeding through the cancellous bone toward the cortical bone, and the ultrasonic echo is 1 The pedicle probe is recognized as a state in which the pedicle probe is progressing in the cortical bone, and the state in which there is no ultrasonic echo is recognized as a state in which the pedicle probe is exposed outside the cortical bone. The pedicle probe navigation method according to claim 6 or 7, wherein:   The step of analyzing the signal waveform of the ultrasonic echo adjusts the reception sensitivity of the ultrasonic echo with reference to a knowledge database including at least bone hardness and bone density of a patient undergoing spinal reconstruction. Item 9. A pedicle probe navigation method according to any one of Items 6 to 8. The pedicle probe navigation method according to any one of claims 6 to 9, wherein in the step of displaying the analysis result, an alarm is notified when it is recognized that there is no ultrasonic echo from a state where there is no ultrasonic echo. .