JP5560195B2 - 臼蓋コンポーネントの位置決めを決定するための方法および装置 - Google Patents
臼蓋コンポーネントの位置決めを決定するための方法および装置 Download PDFInfo
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Description
股関節形成術中での臼蓋コンポーネントの位置異常は、脱臼、衝突(impingement)、摩耗、及びこれらの問題の全てに対する再手術につながる可能性がある。股関節形成術中での臼蓋コンポーネントの適切な位置決めは、当該コンポーネントが患者の骨盤に対して適切な位置に挿入され得るように、その外科医が外科手術中に患者の骨盤の位置を知っている必要がある。残念ながら、患者の骨盤の位置は、外科手術中に、及び患者によって大幅に異なる。この結果、側臥位であろうと仰臥位であろうと、患者の骨盤が手術台と直角に位置決めされていると外科医が想定する場合、コンポーネントの位置決めに大きな誤差が生じる。例えば、ある研究によれば、患者の骨盤は、中央側方軸を中心に33度、縦軸を中心として47度、及び前後軸を中心として17度の範囲にわたって位置異常を生じたことが明らかにされている(Chow JC、Eckman K、Jaramaz B、Murphy S著、「Evaluation of Intraoperative pelvic position during hip arthroplasty using computer tomography /radiography matching」、International Society for Computer Assisted Orthopedic Surgery、2008年)。
局所的な生体構造の関係が骨盤自体(前骨盤平面のような)及び脊柱−骨盤複合体の全体的な幾何学的配置に対してわかっている場合に、人工臼蓋コンポーネントの位置づけを決定するために、局所的な寛骨臼の生体構造(骨格)を使用することができる。逆に、その関係がわかっていない場合、局所的な寛骨臼の生体構造は、人工臼蓋コンポーネントの位置を決定する際に信頼できるように使用されることができない。本出願人は、局所的な寛骨臼の生体構造ではなくて同側の半骨盤の生体構造が、人工臼蓋コンポーネントの位置決めを案内するために使用されるべきであるという結論を出した。
図1は、問題になっている3つの点を示す右骨盤の略図である。距離d1−2は、第1の点P1(寛骨臼の後壁と交わるような坐骨上に位置する点)と第2の点P2(上前腸骨棘に直接隣接して腸骨翼の外側面に位置する点)との間の距離である。距離d1−3は、第1の点P1と第3の点P3(腸骨上)との間の距離であり、距離d2−3は、第2の点P2と第3の点P3との間の距離である。距離d1−2は、基線であり、距離d1−3とd2−3は、基線の距離の70%〜100%、好適には約80〜90%の距離に設定される。図1において、それらは、基線の距離の約80〜85%であるように示される。図1において、距離d1−3とd2−3は、ほぼ等しい長さであるように示されるが、上述したように、それらは必ずしもそうである必要はない。これら3つの点P1、P2、及びP3は同側の平面を画定する。
1.全患者の全体的な平均;
2.同じ性別、身長、体重、診断結果の全患者の全体的な平均;
3.治療されるべき患者の拡大訂正した単純X線写真からの測定値から統計的に予測される場合、これらのX線写真をCT、MR、又は三次元モデルを導出する他の方法を受けた類似の患者のX線写真および三次元復元物と統計的にマッチングさせる。この方法は、2Dから3Dの統計的モデリングと呼ばれる;又は
4.外科手術においてP1とP2との間の距離を直接的に測定し、それは器具自体を用いてさえも実施され得る。
Claims (14)
- 特定の被術者に対して同側の半骨盤基準面を確立することにより手術器具を正しい方向に置くための装置であって、
フレームと、
前記フレームに装着され、先端部で末端をなす3つのレグと、
前記同側の半骨盤基準面に対して空間における前記手術器具の基準軸を画定するために前記フレーム上に配置可能なガイドとを含み、
前記3つのレグが、第1のレグ、第2のレグ、及び第3のレグからなり、前記フレームが中央ハブにおいて互いに接続された第1及び第2のアームを含み、前記第1及び第2のレグがそれぞれ、前記ハブから離れて前記第1及び第2のアームのそれぞれに配置されており、前記第3のレグが前記ハブに配置されており、
前記レグの少なくとも2つの先端部間の距離が調整可能であり、
第1の対のレグと第2の対のレグとの間の角度方向が調整可能であり、
前記装置が前記特定の被術者の骨盤に結合される際に前記レグの1つの先端部が外科医による識別のための触診可能な目印を備えいていない点において特定の被術者の骨盤の腸骨部分に接触し、且つ前記装置が特定の被術者に対して前記半骨盤基準面を画定するように、前記レグの先端部間の間隔は、前記特定の被術者の骨盤に前記装置を結合する前に決定される、装置。 - 前記角度方向が、前記ハブを中心として互いに対して前記第1及び第2のアームを角度的に回転させることにより調整される、請求項1に記載の装置。
- 前記第1及び第2のアームの長さ、及び前記第1のレグと前記ハブとの間の間隔、並びに前記第2のレグと前記ハブとの間の間隔が、調整可能である、請求項1又は2に記載の装置。
- 前記ガイドは、前記フレーム上に装着可能であり、前記フレームのレグにより画定された平面に対して角度方向に調整可能である、請求項1〜3の何れかに記載の装置。
- 前記ガイドが、中空管からなる、請求項1〜4の何れかに記載の装置。
- 前記ガイドに平行な中空管を含み、前記中空管が、外科医により決定された場所に前記管を通じて前記特定の被術者に挿入可能な細長いピンを受け入れる、請求項5に記載の装置。
- 前記ガイドが、前記管を通じて前記特定の被術者に挿入可能な細長いピンを受け入れる、請求項5に記載の装置。
- 前記装置のレグは、前記レグの第1のレグが前記特定の被術者の後下寛骨臼の領域に配置され、前記レグの第2のレグが前記特定の被術者の上前腸骨棘の領域に配置されることによって、前記手術器具が正しい方向に置かれ得る基準としての平面を画定するように、調整可能である、請求項1に記載の装置。
- 前記レグは、前記レグの少なくとも一対のレグの先端部間の距離が前記レグの別の対のレグの先端部間の距離のある割合であるように調整可能であるように、調整可能である、請求項8に記載の装置。
- 前記割合が、約70%〜100%である、請求項9に記載の装置。
- 前記割合が約90%である、請求項9に記載の装置。
- 前記割合が、CTスキャンから得られた被術者特有のデータに従って決定される、請求項9に記載の装置。
- 前記割合が、X線写真から得られた被術者特有のデータに従って決定される、請求項9に記載の装置。
- 前記割合が、X線写真から得られた被術者特有のデータと、寛骨臼と坐骨上の場所との間の距離関係を画定する統計データとの組み合わせに従って決定される、請求項9に記載の装置。
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