JP2008188400A - Artificial hip joint replacement assisting auxiliary member, and manufacturing method - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an acetabular cup component which is used for artificial hip joint replacement surgery, and to provide a member which can display a proper position or direction of a thigh bone component in the operational field. <P>SOLUTION: A three-dimensional model is prepared which is constituted of two of a bone fitting section and an installation information displaying section. In this case, the bone fitting section is prepared by utilizing the three-dimensional shape of an acetabular cup or a thigh bone which becomes an operational area of the artificial hip joint replacement, and a part or the all of which can be fitted on the acetabular cup or the thigh bone. The installation information displaying section provides the information of the proper position or direction of the acetabular cup component and the thigh bone component based on the pre-operational plan for the artificial hip joint replacement. Then, this artificial hip joint replacement assisting member is prepared which has the three-dimensional model prepared by a rapid prototyping technique such as optical molding. Thus, the installation position or direction of the acetabular cup component or the thigh component can directly be checked in a surgical field to perform the surgery. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

The present invention relates to an artificial hip joint that can directly display an appropriate installation position or direction based on a preoperative plan in order to install an acetabular component and a femoral component used for hip replacement. The present invention relates to a replacement operation support auxiliary member and a manufacturing method thereof.

First, hip replacement will be described. Hip replacement is an effective treatment method that can provide pain relief and functional recovery early after surgery for hip joint disease. For the pelvic acetabulum, the acetabular bone is excavated into a hemispherical socket type. The acetabular component is installed, the femur is cut into the femoral neck, which is part of the femur, and the femoral head, which is also part of the femur, is removed, and then the ball and Surgery to install a femoral component consisting of a connecting rod-like stem.

When performing such surgery, it is necessary to fix the acetabular component at an appropriate installation angle. If this installation angle is poor, it may cause complications such as post-operative dislocation. On the other hand, in the case of the femoral component, it is necessary to appropriately cut the femoral neck and to install the femoral component in an appropriate position and direction. If this osteotomy or the placement of the femoral component is improper, it will cause inconsistencies in leg lengths after surgery.

Conventionally, for this hip joint operation, preoperative planning has been performed so that the components of the acetabulum and femur can be installed at appropriate positions using an X-ray image which is a two-dimensional image. However, the preoperative plan based on the two-dimensional image has problems such as that the enlargement rate of the X-ray image cannot be made constant and that the femur changes its shape due to the rotation of the lower limbs. Therefore, a method for preoperative planning by creating an arbitrary cross-sectional image or a three-dimensional image three-dimensionally using a CT (computer tomography) image has been performed. As a result, a three-dimensional preoperative plan for properly installing the acetabular component and the femoral component in three dimensions can be created. There was a problem that it was impossible to grasp where the installation position of the three-dimensional preoperative plan corresponds.

In response to such problems, in recent years, a three-dimensional computer model of bone obtained from CT images and an actual bone, an infrared sensor provided in a surgical site, an optical camera installed in an operating room, etc. The acetabular excavation, the femoral neck osteotomy and the femoral excavation, and the acetabular component or the femoral component Computer navigation techniques have been developed that can guide the practitioner in the direction or position of installation, and some have already been used in clinical practice.

A machine using such a computer navigation technique can display information such as the position of a surgical target site and the position or direction of a surgical instrument on a computer, but has several problems. For one, it is necessary for the practitioner to operate the surgical instrument while looking at the computer display. Therefore, it is difficult to operate the surgical instrument so as to match the position and direction of the displayed surgical instrument. Secondly, it requires expensive equipment that is not necessary for normal surgery, such as the sensor, for performing navigation surgery. In addition, using one machine and using it in several hospitals may cause problems in transportation.

Therefore, the first problem to be solved by the present invention is not to display the installation position or direction of the artificial joint in a place other than the surgical field such as computer navigation surgery, but directly to the installation position or the artificial joint in the surgical field. The second problem is that an expensive instrument required for navigation surgery is not required, and the third problem is that it is easy to carry without specifying a use facility.

In order to solve the above-mentioned problems, the hip replacement assisting auxiliary member according to the present invention is created using a three-dimensional shape of a acetabulum or a femur serving as a surgical site for performing hip replacement. Also used for total hip arthroplasty, which has a bone-fitting part that can be partly or entirely fitted to the femur, and is obtained by preoperative planning based on CT data of the surgical site where hip arthroplasty is performed. It comprises an installation information display unit for providing information including at least one of a position and a direction for installing a acetabular component or a femoral component.

With this configuration, the artificial hip joint replacement assisting auxiliary member can be applied to the acetabulum or the femur, which is a surgical site where any of the acetabular component or the femoral component is installed. In addition, the artificial hip joint replacement assisting auxiliary member provides the installation information display unit that provides at least one of the position and direction for installing any of the acetabular component or the femoral component planned before the operation. Therefore, if the artificial hip joint replacement support assisting member is fitted to the acetabulum or femur, which is the surgical site, it is simultaneously positioned and oriented to install any of the previously planned components. At least one of the information can be displayed in the operative field.

An example will be described. The artificial hip joint replacement assisting auxiliary member for installing the acetabular component on the acetabulum, which is a surgical site, in the direction obtained from the three-dimensional preoperative plan includes the acetabular component installation direction and three-dimensional In parallel, the portion having a hole through which a Kirschner wire or Hoffman pin, which is a steel wire, can be inserted, that is, the installation information display section that provides information on the direction in which the acetabular component is installed, and at the same time, the acetabulum Since it has the bone fitting portion to be fitted to the acetabulum, it is possible to directly display the installation direction of the acetabular component in the operative field by fitting the acetabulum in the operative field during the operation. Further, whether or not the hip replacement support assisting member functions can be confirmed by looking at the fitting portion of the hip replacement support assisting member and the acetabulum.

Another example will be described. The artificial hip joint replacement assisting auxiliary member for installing the femoral component on the femur which is a surgical site in the position or direction obtained by the three-dimensional preoperative plan is a bone saw or the like. The above-mentioned installation information display section such as a slit section for performing in an appropriate position or direction with the saw tool and a straight section having one of a convex portion and a concave portion for indicating the insertion direction of the femoral component. Further, since the artificial hip joint replacement assisting auxiliary member for installing the femoral component has the bone fitting portion that fits into the femur, when the artificial hip joint replacement assisting auxiliary member fits into the femur At the same time, the femoral neck osteotomy position and direction and the femoral component installation direction can be displayed in the surgical field. Further, whether or not the hip replacement replacement assisting auxiliary member functions can be confirmed by looking at the fitting portion of the hip replacement replacement assisting member and the femur.

Information for setting the hip prosthesis in an appropriate position or direction is only possible by fitting the hip replacement replacement assisting member to the acetabulum or the femur, It is possible to support the installation of an artificial joint without requiring an expensive instrument such as the navigation. Moreover, since this member is within 10 cm in size, it is convenient for transportation.

Hereinafter, exemplary embodiments of the present invention will be described in detail with reference to the drawings. However, the constituent elements described in this embodiment are merely examples, and are not intended to limit the scope of the present invention only to them.

The artificial hip joint replacement assisting auxiliary member according to the present embodiment mainly includes an artificial hip joint replacement assisting auxiliary member a8 used when displaying the installation direction in the acetabular component installation, and the femoral component specifying the femoral component installation position. There is a hip replacement assisting assisting member b20 that displays the position or direction of the osteotomy line of the head and the insertion direction of the femoral component.

The artificial hip joint replacement assisting auxiliary member a8 for installing the acetabular component is made by creating a three-dimensional model (for acetabulum) 7 for creating an artificial hip joint replacement assisting member on a computer. The three-dimensional model (for acetabulum) 7 for creating the artificial hip joint replacement assisting auxiliary member is created through the following steps.
1. As shown in FIG. 1, medical image data of a pelvis including a acetabulum, which is one of surgical sites when an artificial hip joint is installed, is acquired in advance by CT (tomographic imaging) or the like. By importing the medical image data into the computer, the acetabulum and pelvis, which are one of the surgical sites when the artificial hip joint is installed, are respectively referred to as the acetabular three-dimensional model 2 and the pelvis three-dimensional model 1 on the computer. Can be created.
2. Next, in FIG. 1, a method for creating a three-dimensional model 7 for creating an artificial hip joint replacement assisting auxiliary member is shown. An arbitrary three-dimensional three-dimensional model (for acetabular surgery) 3 is created at a position overlapping the acetabular three-dimensional model 2 on the computer.
3. Subsequently, in FIG. 1, a difference calculation for removing the overlapping portion of the three-dimensional 3D model (for acetabular surgery) 3 and the acetabular three-dimensional model 2 from the three-dimensional 3D model (for acetabular surgery) 3. As a result, a three-dimensional model with a bone fitting portion (for acetabulum) having a bone fitting portion (not shown in FIG. 1, indicated by reference numeral 6 in FIG. 2) to be fitted to the acetabulum is created.
4). Further, in FIG. 1, an installation information display unit that can provide information on an appropriate installation direction of the acetabular component obtained in the three-dimensional preoperative plan, for example, a steel wire parallel to the installation direction as shown in FIG. An installation information display unit three-dimensional model (for acetabulum) 4 having an installation information display unit having an insertable hole 5 is created.
5. As shown in FIG. 2, the hip joint replacement is a combination of the bone fitting portion-attached three-dimensional model (for acetabulum) and the installation information display portion three-dimensional model (for acetabulum) 4 by a sum operation. This is a three-dimensional model (for acetabulum) 7 for creating support auxiliary members. A member created by rapid prototyping such as stereolithography of the three-dimensional model (for acetabulum) 7 for creating the artificial hip joint replacement support auxiliary member is an artificial hip joint replacement support auxiliary member a8 that can be provided by the present invention.

3 to 5 are schematic views showing the acetabulum 10 and the hip replacement replacement assisting member a8 in the surgical field during the hip replacement surgery. Below, the usage method of the said hip replacement replacement assistance member a8 is demonstrated.

FIG. 3 shows a state before the acetabulum 10 and the bone fitting portion (for acetabulum) 9 to be fitted to the acetabulum 10 of the artificial hip joint replacement assisting auxiliary member a8. FIG. 4 shows a state where the artificial hip joint replacement assisting auxiliary member a8 is fitted to the acetabulum 10. Since the bone fitting part (for acetabulum) 9 and the acetabulum 10 fitted to the bone fitting part (for acetabulum) 9 can be directly seen in the operative field, fitting is performed appropriately. Can be confirmed. The position of the fitted artificial hip joint replacement assisting auxiliary member a8 with respect to the acetabulum 10 is relative to the acetabular three-dimensional model 2 of the three-dimensional model 7 for creating an artificial hip joint replacement assisting auxiliary member created on a computer. It will match the position. The matching means that the installation information display part (for acetabulum) 11 is a part for providing information necessary for the installation of the acetabular component of the artificial hip joint replacement assisting auxiliary member a8. The direction to install is displayed.

In FIG. 4, for example, when the installation information display unit (for mortar) 11 includes a hole 13 into which the steel wire 12 can be inserted in parallel to the installation direction, the steel wire 12 is inserted into the hole 13 and the mortar is left as it is. A steel wire can be pierced and fixed to the lid 10. That is, the direction of the steel wire 12 exactly matches the direction in which the acetabular component is installed.

FIG. 5 shows a state in which the hip replacement replacement assisting member a8 is removed from the acetabulum 10, and the acetabular component is installed while directly viewing the direction of the steel wire 12 fixed first in the operative field. Surgery is possible.

The artificial joint placement assisting member b20 for placing the femoral component is created by creating a three-dimensional model (for femur) 18 for creating an artificial hip joint replacement assisting assist member on a computer. The three-dimensional model (for femur) 18 for creating an artificial hip joint replacement assisting auxiliary member is created through the following steps.
1. As shown in FIG. 6, medical image data of the femur, which is one of the surgical sites when an artificial hip joint is installed, is acquired in advance by CT (tomographic imaging) or the like. By fetching the medical image data into a computer, the femur, which is one of the surgical sites when the artificial hip joint is installed, can be created as a femoral three-dimensional model 14 on the computer.
2. Next, in FIG. 6, an arbitrary 3D model (for the femur) (not shown in FIG. 6) is created at a position overlapping with the 3D femur 3D model 14 on the computer.
3. Subsequently, in FIG. 6, an overlapping portion of the three-dimensional three-dimensional model (for femur) (not shown in FIG. 6) and the three-dimensional femoral three-dimensional model 14 is extracted from the three-dimensional three-dimensional model (for femur). A three-dimensional model with a bone fitting portion having a bone fitting portion (for femur) 19 (not shown in FIG. 6; shown in FIG. 7) fitted to the three-dimensional femur three-dimensional model 14 by the difference calculation to be removed. (For femur) 15 is created.
4). Further, in FIG. 6, an installation information display unit that can provide information on an appropriate installation direction of the femoral component obtained from the three-dimensional preoperative plan, for example, one of a convex part and a concave part parallel to the installation direction The installation information display unit 16 (shown by a concave groove structure in the figure) is created in the three-dimensional model with bone fitting portion (for femur) 15. In this work, for example, a cylindrical three-dimensional model showing a straight portion is created, and a portion where the cylindrical three-dimensional model and a three-dimensional model with a bone fitting portion (for femur) 15 overlap each other has a bone fitting portion. It can be obtained by a difference calculation that is removed from the three-dimensional three-dimensional model (for femur) 15.
5. Furthermore, in FIG. 6, an installation information display unit that can provide a position or direction for performing osteotomy of the femoral neck necessary for installing the femoral component at an appropriate position, obtained from the three-dimensional preoperative plan, For example, the installation information display unit 17 having a slit structure along the osteotomy surface is created in the three-dimensional model (for femur) 15 having a bone fitting portion. In this work, in order to create the shape of the slit structure, for example, a rectangular parallelepiped model is created, and the overlapping portion of the rectangular parallelepiped model and the three-dimensional model with bone fitting portion (for femur) 15 is replaced with a bone fitting portion. It can be obtained by a difference calculation that is removed from the three-dimensional three-dimensional model (for femur) 15.
6). Through the above-described steps, an installation information display unit that can provide information on an appropriate installation direction of the femoral component as shown in FIG. 7, for example, one straight line of a convex part and a concave part parallel to the installation direction The femoral bone includes either or both of an installation information display unit 16 which is a structure and an installation information display unit 17 having a slit structure indicating the position or direction of the osteotomy line for cutting the femoral neck. A member produced by rapid prototyping such as stereolithography of a three-dimensional model (for femur) 18 for creating an artificial hip joint replacement assisting auxiliary member having a bone fitting portion (for femur) 19 to be fitted to 14. It is the artificial hip joint replacement assisting auxiliary member b20 that can be provided in the above.

Next, FIGS. 8 to 9 are schematic views showing the femur 21 and the hip replacement replacement assisting member b20 in the surgical field during the hip replacement surgery. A method of using the artificial hip joint replacement assisting auxiliary member b20 will be described.

FIG. 8 shows a state before the bone fitting portion (femur) 22 fitted to the femur 21 of the artificial hip joint replacement assisting auxiliary member b <b> 20 is fitted to the femur 21.

FIG. 9 shows a state in which the artificial hip joint replacement assisting auxiliary member b <b> 20 is fitted to the femur 21. At this time, since the bone fitting portion (femur) 22 and the femur 21 fitted to the bone fitting portion (femur) 22 can be directly seen in the operative field, fitting is performed appropriately. Can be confirmed. The position of the fitted hip replacement support assisting member b20 with respect to the femur 21 is a three-dimensional model for creating a hip replacement assisting member for creating a hip replacement assisting member created on a computer ( (For the femur) 18 matches the position of the three-dimensional model of the femur. The matching means that the hip replacement replacement assisting auxiliary member b20 has an installation information display section which is information necessary for the installation of the femoral component, so that the position or direction necessary for installing the femoral component can be determined. It can be displayed. That is, the artificial hip joint replacement assisting auxiliary member b20 is provided with an installation information display unit 23 having a slit structure for displaying a position or direction for performing osteotomy of the femoral neck, and for installing the femoral component. Since it has either or both of an installation information display unit 24 having a linear structure of either one of a convex part and a concave part parallel to the installation direction for displaying an appropriate installation direction, osteotomy of the femoral neck is performed. Either or both of the indication of the position or direction to perform and the indication of the appropriate orientation of the femoral component can be made directly in the operative field.

It is a figure for demonstrating the creation method of the three-dimensional model (for acetabulum) 7 for artificial hip joint replacement assistance auxiliary member creation for producing the artificial hip joint replacement assistance auxiliary member 8 based on Example 1 of this invention. is there. FIG. 6 is a perspective view of a three-dimensional model 7 for creating a hip replacement replacement assisting member for creating a hip replacement replacement assisting member a8. It is a figure for demonstrating the usage method of the artificial hip joint replacement assistance auxiliary member a8. It is a figure for demonstrating the usage method of the artificial hip joint replacement assistance auxiliary member a8. It is a figure for demonstrating the usage method of the artificial hip joint replacement assistance auxiliary member a8. It is a figure for demonstrating the production method of the three-dimensional model (for femur) 18 for artificial hip joint replacement assistance auxiliary member creation for producing the artificial hip joint replacement assistance auxiliary member b20 based on Example 2 of this invention. is there. FIG. 11 is a perspective view of a three-dimensional model (for femur) 18 for creating an artificial hip joint replacement assisting auxiliary member. It is a figure for demonstrating the usage method of the artificial hip joint replacement assistance auxiliary member b20. It is a figure for demonstrating the usage method of the artificial hip joint replacement assistance auxiliary member b20.

Explanation of symbols

1. 1. Pelvic solid model on computer 2. Three-dimensional model of acetabular solid on computer 3D model on computer (for acetabular surgery)
4). Installation information display unit three-dimensional model having a hole 5 that allows a steel wire to be inserted parallel to the acetabular component installation direction of the three-dimensional model 7 for creating an artificial hip joint replacement assisting auxiliary member shown on a computer (For acetabulum)
5. 5. A hole, which is shown on a computer, and which allows the insertion of a steel wire parallel to the acetabular component installation direction of the three-dimensional model 7 for creating an artificial hip joint replacement assisting auxiliary member. 6. Bone fitting portion 7 that can be fitted to the acetabular three-dimensional model 2 of the three-dimensional model 7 for creating an artificial hip joint replacement assisting auxiliary member shown on the computer. Three-dimensional model (for acetabulum) for creating assistive hip replacement support members shown on a computer
8). Auxiliary hip replacement assisting member a
9. Bone fitting part (for acetabulum) in artificial hip joint replacement assisting auxiliary member a8
10. Acetabulum 11. An installation information display unit (for acetabulum) having a hole 13 that allows the steel wire 12 to be inserted parallel to the acetabular component installation direction of the artificial hip joint replacement assisting auxiliary member a8.
12 Steel wire 13. 13. Hole 14 for enabling insertion of steel wire 12 parallel to the acetabular component installation direction of artificial hip joint replacement assisting auxiliary member a8. 15. Femoral solid three-dimensional model shown on a computer; Three-dimensional model with bone-fitting part shown on computer (for femur)
16. An installation information display unit 17, which is a linear structure parallel to the installation direction of the femoral component of the three-dimensional model (for femur) 18 for creating an artificial hip joint replacement assisting auxiliary member shown on the computer. An installation information display unit 18, which is a slit structure for performing femoral neck osteotomy of a three-dimensional model (for femur) 18 for creating an artificial hip joint replacement assisting auxiliary member shown on a computer. Three-dimensional model (for femur) for creating artificial hip joint replacement assisting auxiliary members shown on a computer
19. Bone fitting part (for femur) of a three-dimensional model (for femur) 18 for creating an artificial hip joint replacement assisting member shown on a computer and fitting with the three-dimensional model 14 of the femur three-dimensional model 14
20. Artificial hip replacement support assisting member b
21. Femur 22. Bone fitting portion 23 of the hip replacement replacement assisting member b20 fitting with the femur 21. Installation information display section 24. which is a slit structure for displaying a position or direction for performing femoral neck osteotomy of the hip replacement replacement assisting member b20. An installation information display unit having a linear structure parallel to the installation direction for proper installation of the femoral component of the artificial hip joint replacement assisting auxiliary member b20

Claims (8)

Using a three-dimensional shape of the acetabulum or femur, which is the surgical site for hip replacement, it has a bone fitting part that can be fitted to the acetabulum or femur, and is used for hip replacement In order to install the acetabular component or femoral component, which is an artificial joint, in the appropriate position and orientation, the appropriate placement position or orientation based on the preoperative plan of the acetabular component or femoral component is confirmed in the operative field. An artificial hip joint replacement assisting member with an installation information display section. The artificial hip joint replacement assisting auxiliary member according to claim 1, wherein it is possible to confirm whether or not the bone fitting portion has been properly fitted to the acetabulum. The said installation information display part is equipped with at least one hole which can penetrate a steel wire, in order to confirm the direction which installs the acetabular component in the acetabulum. Item 3. An artificial hip joint replacement assisting auxiliary member according to Item 2. The artificial hip joint replacement assisting auxiliary member according to claim 1, wherein it is possible to confirm whether the bone fitting portion has been properly fitted to the femur. The installation information display unit can display the position and direction of the osteotomy for osteotomy of the femoral neck necessary for installing the femoral component on the femur, The artificial hip joint replacement assisting auxiliary member according to claim 1 or 4. The artificial hip joint replacement assisting member according to claim 1, wherein the installation information display unit can display a direction for installing the femoral component on the femur. The assisting member for assisting hip replacement according to claim 1, which is convenient to carry without being limited to a specific facility. A method for manufacturing an artificial hip joint replacement assisting auxiliary member as defined in claim 1, wherein a three-dimensional shape of an acetabulum or femur, which is a surgical site, is used to determine the shape of an arbitrary object and the acetabulum or the thigh. A first step of creating the bone fitting portion by a difference calculation for cutting an overlapping portion of the three-dimensional shape of the bone from the shape of the object; and the acetabular component or the femoral component in an appropriate position and direction Hip replacement support including a second step of creating the installation information display unit indicating an appropriate installation position or direction based on a preoperative plan of the acetabular component or the femoral component for installation A manufacturing method of the auxiliary member.

Images