JP5564003B2 - Computer-assisted surgery system - Google Patents

Description

  The present invention relates to computer-assisted surgery systems and methods for operating computer-assisted surgery systems, and in particular, computer-aided to provide a virtual display of a medical device that results in easier application of a medical device such as an implant or the like. The present invention relates to a surgical system and a method for operating a computer-assisted surgical system.

  For example, femoral neck fractures can be treated by intramedullary nailing. In such treatment, intramedullary nailing nails typically include at least one bore hole for receiving a bone screw. The nail is generally introduced in the longitudinal direction of the femur and when the bone screw is received within the at least one bore hole, the bone screw extends laterally at a specific angle with respect to the neck of the femur. A particular problem for the surgeon is predicting the future or implanted location of such nails or implants or parts thereof. In the past, operators have tried and errored to obtain an optimal position for the implant. However, this leads to a longer period of surgery, which can cause greater stress on the patient. Further, for each trial, at least one x-ray image (eg, a fluoroshot) is generally required to ascertain the current position of the implant in order to evaluate the position of the implant.

  Recently, computer-assisted surgery for dynamic hip screws has been described in Amir Herman et al. This document is a computer-aided method that uses image analysis techniques to measure three-dimensional distances, visualize implant templates, and view trajectories guided in standard fluoroscopy. A surgical system is described. The guidance system combines a set of x-ray non-conductive markers that are incorporated into transparent hardware as a target, positioning and reference device. This device is attached to a guide wire. A fluoroscopic image is acquired by the surgeon and then processed by the image processing engine, which calculates the three-dimensional orientation relative to the C-arm and the drill trajectory in the image.

  Further, Patent Document 1 describes a process for obtaining information intended to insert a locking screw into an orifice of an intramedullary device. This document describes a process for obtaining information intended for inserting a locking screw into the distal locking hole of an intramedullary device. The process described includes taking two images of different orientations of the distal portion of the intramedullary device using a fluoroscope, a reference frame secured to the intramedullary device, and a selective other secured to the fluoroscopic device. To obtain the projection parameters, in particular the position of the X-ray source and the projection plane of each image. The process further includes correcting any distortion of the image, segmenting the distal portion of the intramedullary device in each image, calculating attributes relating to the position of the intramedullary device and the position of the hole, Includes at least the contour of the intramedullary device, its center of gravity, and its principal axis. Further, the process builds a projection cone at the distal portion of the intramedullary device for each image, determines the intersection of the two projection cones, models the intramedullary device based on the intersection, modeling and Including determining the center of the locking hole with the help of the center of gravity of the hole determined on the image, repetitively determining the orientation of the locking orifice, and guiding the drill tool.

The Journal of Medical Robots and Computer Assisted Surgary, Dec. 29, 2008; Volume 5, Pages 45-50 EP1491151B1

  The present invention provides a computer assisted surgical system and a method of operating a computer assisted surgical system that allow simple and rapid positioning of a medical device to be applied, such as, for example, an implant.

  According to one embodiment of the present invention, a method of operating a computer-assisted surgical system is provided, the method comprising positioning a reference body relative to an anatomical structure, the reference body being an anatomical structure Virtual display of the position of the medical device to be applied, and detecting the position of the reference body relative to the anatomical structure, and applying the anatomical structure based on the detected position of the reference body relative to the anatomical structure Including overlaying with a virtual representation of the medical device to be included, including providing rules for the tolerance of applying the medical device to the anatomy, including changing the position of the reference body, To optimize the virtual position of the medical device to be applied to the anatomy to obtain the best fit to the rules for tolerance.

  Thus, by using a virtual representation of the medical device to be applied, the future of a real medical device can be obtained without having to insert this medical device during the stage of determining the final desired position of the medical device. Can be predicted. Thus, the position of the medical device can be virtually optimized before inserting the medical device. This can result in a reduction of patient stress to incisions and x-ray impacts. Optimizing involves looking for the optimal location, orientation, and geometry of the medical device, ie, the implant. This optimization can be performed with the aid of a computer device. The reference body can be a special add-on element as well as a medical tool with a unique geometry that identifies its position during imaging.

  According to another embodiment of the invention, the position of the medical device includes the size, location, and orientation of the medical device.

  Thus, the medical device can be virtually displayed in view of all relevant information regarding the patient's anatomy. The location may specifically be the geometry of the medical device from a variety of predetermined medical devices.

  According to yet another embodiment of the present invention, detecting a reference body positioned with respect to an anatomical structure takes two two-dimensional images from different angles, and displays a three-dimensional display based on the two-dimensional image. Generating and determining a spatial position of the reference body relative to the anatomical structure based on the three-dimensional image. The two two-dimensional images can include an anatomical structure that receives the medical device. The position of the medical device relative to the anatomical structure may be based on a three-dimensional display.

  Thus, the anatomy and the virtual implant or virtual medical device to be applied can be displayed in a three-dimensional manner to provide an overview of the correct positioning and sizing of the medical device to be applied.

  According to yet another embodiment of the present invention, changing may include rotating and / or moving the reference body.

  Thus, in order to find an optimized position of the medical device that will be positioned in the future within the provided rules, a reference body displaying the position of the medical device can be virtually positioned with respect to the anatomy, The rules provide a tolerance for applying medical devices to anatomical structures.

  According to yet another embodiment of the present invention, modifying may include selecting a medical device from a predetermined group of various medical devices.

  Thus, to meet the rules for tolerance, the dimensions of the medical device can also be selected from a predetermined group, for example, to find the optimal implant type to be implanted. Different types may have different geometries, such as length, tilt angle, and other geometric characteristics corresponding to different anatomical characteristics.

  According to yet another embodiment of the present invention, a method of operating a computer-assisted surgical system further includes imaging an overlap of an anatomy and a virtual display of a medical device to be inserted.

  Thus, the surgeon can control and monitor the ongoing process of the computer-assisted surgical system in the field, which ultimately determines whether the optimization is sufficient and the immediate finalization by the surgeon. May be relevant when providing confirmation.

  According to yet another embodiment of the invention, the position of the medical device to be applied is remote from the reference body. Preferably, the medical device is an implant. Preferably, the reference body is attachable to a medical tool such as a target tool.

  Thus, the reference body need not be provided in the immediate vicinity of the medical device. Implants that are not immediately adjacent to the reference body may be virtually displayed. This is particularly relevant for implants having a final remote location with respect to the opening location of the incision. Further, when providing the reference body to the target tool, sub-implants, such as bone screws of intramedullary nails, for example, may also be virtually displayed.

  According to yet another embodiment of the present invention, there is provided a program element configured to implement a method of operating a computer assisted surgical system when executed by a processor.

  In accordance with yet another embodiment of the present invention, a computer readable medium for storing inventive program elements is provided.

  Thus, a method for operating a computer-assisted surgery system can be implemented on a computer and a computer program, respectively.

  In accordance with yet another embodiment of the present invention, a computer-assisted surgical system is provided, the computer-assisted surgical system includes a reference body for the anatomical structure, and the reference body is provided to the anatomical structure. Detecting an anatomical structure including a detection device configured to virtually display a position of a medical device to be detected and detecting a position of a reference body with respect to the anatomical structure For predetermined rules for overlaying with a virtual representation of the medical device to be applied based on the output of the device, changing the position of the reference body, and tolerance for applying the medical device to the anatomy In order to obtain the best fit, it includes a computing device configured for optimizing the virtual position of the medical device to be applied to the anatomy.

  Such a computer-aided surgical system does not require a surgeon's trial-and-error approach to meet predetermined rules for tolerances for applying medical devices to anatomical structures, for example, for implants It is possible to predict the future position of the medical device to be applied, the rules for example the required distance to the surface of the bone, for example the longitudinal direction of the femur and the orientation of the femoral neck In the form of a specific inclination angle between and the like.

  According to one embodiment of the invention, the database includes a plurality of data sets for medical devices, the data sets displaying various medical devices.

  Thus, not only the orientation and location of the medical device can be determined, but also the dimensions of the medical device itself, in order to satisfy the predetermined rules for tolerance. This may be particularly relevant, for example, when having a wide range of anatomical structures that require different dimensions with respect to the length, diameter, and specific angle of the intramedullary nail and each bone screw. According to one embodiment of the invention, the medical device is an implant.

  According to yet another embodiment of the present invention, the system further includes a medical tool configured to position the implant, and the reference body can be attached to the medical tool in a predetermined manner.

  Thus, the reference body is used to display the correct location of the intramedullary nail as well as the correct location of the future implanted bone screw prior to insertion into the intramedullary nail. Can do. However, the intramedullary nail can be considered a reference body. This is because the intramedullary nail can have a unique configuration that also indicates the future location of the bone screw to be inserted. Thus, when an intramedullary nail attached to a medical tool is inserted, the future location of the bone screw, ie, location, size, and orientation, can be determined from the geometry of the intramedullary nail. For example, it should be noted that an intramedullary nail can be used as a reference body for indicating the future position of the bone screw. However, for example, a separate reference can be used to display the intramedullary nail, in which case such a reference can be used to display and predict the future position of the intramedullary nail. Can be secured to a medical tool or nail in place. When knowing the geometry and orientation of the intramedullary nail, the future position of the bone screw can also be predicted by evaluating a reference body attached to the medical tool.

  It should be noted that the above-described embodiments of the present invention also apply to a method for operating a computer-assisted surgical system, a computer-assisted surgical system, a program element, and a computer-readable medium.

  It should also be noted that the above features can be combined. Combinations of the above features can also cause synergistic effects, even if not specified in detail.

  These and other features of the invention will be clearly elucidated with reference to the embodiments described below.

  The present invention will be better understood after reading the following detailed description of its non-limiting embodiments and after examining the accompanying drawings.

It is the schematic which shows a computer-assisted surgery system. FIG. 5 is a side view showing a medical tool having a reference body fixed thereon and an implant including an intramedullary nail and a bone screw. FIG. 3 is a side view showing the implant separated from the medical tool shown in FIG. 2. It is a front view which shows the reference | standard body shown by FIG. FIG. 4 is an end view showing the reference body shown in FIG. 3. It is a side view which shows the virtual display of an implant. It is a side view which shows the actual position of an implant. It is a side view which shows the virtual position of a bone screw, and the actual position of a nail. It is a side view which shows the virtual display of a bone screw and a nail. FIG. 6 is a side view showing the bias in a first direction of a virtual nail and a virtual screw as indicated by the provided arrows. FIG. 6 is a side view showing a bias in a second direction of a virtual nail and a virtual screw as indicated by the provided arrows. It is a side view which shows the correct position of a virtual nail and a virtual screw. It is a side view which shows the final position of a virtual nail and a virtual screw. FIG. 6 is a side view showing the bias in the first direction of a real nail and virtual screw as indicated by the provided arrows. FIG. 7 is a side view showing the bias in the second direction of the real nail and virtual screw as indicated by the provided arrows. It is a side view which shows the correct position of an actual nail and a virtual screw | thread. It is a side view which shows the final position of an actual nail and an imaginary screw. FIG. 5 is a side view showing a virtual representation of various different geometries, i.e., the angle of inclination of a screw relative to a nail. FIG. 5 is a side view showing a virtual representation of various different geometries, i.e., the angle of inclination of a screw relative to a nail. FIG. 6 is a side view showing a virtual representation of various different geometries, i.e., screw lengths for real nails. FIG. 3 is a flow diagram schematically illustrating a method of operating a computer-assisted surgery system.

  FIG. 1 illustrates a computer-assisted surgery system 1. For example, the patient 2 may be positioned in or on a computer assisted surgical system so as to assist in providing a medical device to be applied, such as an implant. The computer-assisted surgery system of FIG. 1 illustrates a structure for implantation of an intramedullary nail into the femur of a patient 2. For this purpose, an imaging device 3 is provided for sending an image from the location of the anatomy where the implant application is intended. The computer-assisted surgical system further includes a display device 4 and a computing device 5 so that the correct position of the medical device and the implant can be calculated and displayed on the display device, respectively. Thus, the surgeon is assisted in providing an intramedullary nail and respective bone screw so that the total incision time can be reduced and the position of the implant can be improved.

  FIG. 2 illustrates a medical application tool 10 in the form of a target tool. The target tool includes a knob 11 and a coupling part 15 for coupling the medical device 200 to be applied. This medical device in FIG. 2 is an intramedullary nail 200. The intramedullary nail has an upper portion 201, and the upper portion 201 also includes a coupling portion 205 for coupling the intramedullary nail to the coupling portion 15 of the medical tool 10. In the embodiment shown in FIG. 2, the intramedullary nail 200 includes an orifice 202 provided in the upper shaft portion 201 of the intramedullary nail. The orifice 202 serves to receive the bone screw 210. The intramedullary nail 200 further includes a lower shaft portion 203 that includes a further orifice 204 for receiving a distal fixation screw 220. Bone screw 210 is designed to extend into the neck of the femur. For this purpose, the bone screw 210 comprises a gear shaft 211 for fixation in the bone material. Further, the bone screw 210 includes a fixation configuration 216 so that the bone screw can be secured within the intramedullary nail 200. This fixation can be done by internal screws along the longitudinal extension of the intramedullary nail in the upper shaft portion 201 to fix the position of the bone screw 210 relative to the intramedullary nail 200. Further, the bone screw 210 may include a receiving portion 215 for receiving a respective tool, eg, a screwdriver, for rotating the bone screw 210 into a bone, eg, the femoral neck.

  In FIG. 2, the reference body 100 is fixed on the medical tool 10 by a predetermined method. The reference body includes a knob 101 for easier fixing and positioning of the reference body. The reference body further includes a plurality of reference markers 102. These markers are applied to the reference body in a predetermined manner that provides a unique display in every two-dimensional projection so that a single fluoroshot image may be sufficient to determine the unique three-dimensional position of the reference body 100. It is arranged over. Since the reference body 100 is fixed to the medical tool 10 in a predetermined manner and is also fixed to the intramedullary nail 200, the known orientation, location, and generally position of the reference body 100 is determined by the marrow. The position of the inner nail 200 is displayed simultaneously. If the geometry of the intramedullary nail 200 is known, the positions of the bone screw 210 and the distal locking screw 220 are also predetermined for at least the direction of their longitudinal extension. Thus, the positioning of the medical tool 10 along with the reference body 100, for example, the position of the intramedullary nail 200, and at least the bone screw 210 and the distal locking screw, regardless of the visibility of the intramedullary nail in the fluoroshot image. 220 makes it possible to determine the longitudinal extension direction. In order to determine whether the reference body 10 is correctly positioned relative to the medical tool 10, the correct position of the reference body relative to the medical tool 10 can be determined by evaluating a single fluoroshot image. The medical tool 10 can also include a plurality of fiducial markers 12.

  FIG. 3 illustrates a single element implant and the tool shown in FIG. FIG. 3 illustrates the intramedullary nail 200 in a released state with respect to the medical tool 10. The medical tool 10 includes a coupling portion 15 having a unique alignment pattern 16 in the form of a nose for receiving the counterpart of each of the intramedullary nails 206, 205, for example. Thus, a unique alignment position of the intramedullary nail 200 relative to the medical tool 10 may be provided to ensure that the reference body 10 can be used to clearly display the intramedullary nail 200 in advance.

  FIG. 3 a illustrates a front view of the reference body 100. The fiducial markers 202 are arranged in a predetermined but irregular manner on the fiducial body 100 so that a single fluoro shot allows a unique determination of the spatial position of the fiducial. FIG. 3 b illustrates a side view of the reference body separated from the medical tool 10.

  When the position of the intramedullary nail 200 with respect to the reference body is known, even if the intramedullary nail is not attached to the medical tool 10, the variation in the position of the reference body attached to the medical tool 10 will be described here. Can be used to determine future positions. This can be seen from FIG. 4 a, which illustrates an anatomical structure 300 in the form of a femur having a femoral head 330, a femoral neck 320, and a femoral shaft 310. When positioning the medical tool 10 with the reference body 100 mounted thereon, the future position of the intramedullary nail can be determined by visualizing a virtual representation of the intramedullary nail 200 '. For purposes of the following description, a reference number with an apostrophe indication indicates the virtual position of the medical device to be provided, e.g., an implant, and a reference number without an apostrophe represents an actual medical device, and the applied medical device It must be noted that it also represents the device.

  When positioning the medical tool 10 on the top of the femur, the correction of the position of the medical tool, along with the reference body 100, determines a virtual representation of the medical device to be applied later. As shown in FIG. 4a, when the correct position of the medical device to be implanted is found, each guide wire 400 can be applied to the femur to fix the entry point, Belongs to the optimal position of the medical device to be done. The medical tool 10 can then be removed while maintaining the guide wire 400 on the femur 300. Thus, the entry points are fixed to provide a drilling device or awl to open each entry point in the femur. After drilling, the actual intramedullary nail 200 can be coupled to the medical tool 10 for insertion into the femur 300, specifically the femoral shaft 310, as can be seen in FIG. 4b.

  The reference body can also be attached to the awl or drilling tool or to the target tool for displaying the awl. When the awl has a reference body, the future position of the nail can be predicted based on the trajectory of the awl. Thus, for example, when generating a bore hole with an awl or drilling tool, the future position of the nail may be determined. In other words, when drilling holes for nails, it is possible to determine the location of future nails in the field.

  Due to the known geometry of the intramedullary nail and the predetermined coupling of the intramedullary nail 200 to the medical tool 10 via the predetermined coupling configurations 205, 206, 15, 16, the direction of the bone screw 210 is also the distal locking screw. Defined with 220 directions.

  FIG. 5 illustrates a virtual representation of bone screw 210 'and locking screw 220', starting with FIG. 4b with a real intramedullary nail 200 inserted. Although the exact location of the bone screw and the locking screw can vary, their longitudinal direction and orientation are predetermined by the orifices 202, 204 of the intramedullary nail 200. Thus, when inserting an intramedullary nail, a virtual representation of the bone screw 210 'can be used to determine the correct position of the intramedullary nail with respect to longitudinal translation and rotation relative to the longitudinal axis of the intramedullary nail. It should also be understood that the intramedullary nail 200 may have a unique geometry that allows for a predetermined determination of the location of the intramedullary nail, ie, its location, size, and orientation. In other words, when using an actual intramedullary nail 200 as a reference body, the additional reference body 100 on the top of the medical tool may be omitted. This is because in that case the intramedullary nail can serve as a reference for the bone screw 210 'to be applied and the distal locking screw 220' to be applied.

  FIG. 6 illustrates a virtual representation of the intramedullary nail 200 'along with a virtual representation of the bone screw 210' and the distal locking screw 220 '. Since the position of the bone screw 210 'is determined by its orientation relative to the intramedullary nail 200', the position of the medical tool can be used to find the correct position of the intramedullary nail and bone screw. The virtual display of the intramedullary nail 200 ′ along with the bone screw 210 ′ varies depending on the position change of the medical tool, so that not only the correct position of the intramedullary nail but also the correct position of the bone screw can be determined. This is the correct axial orientation of the virtual intramedullary nail 200 ′, for example, to find the correct position of the virtual bone screw 210 ′ to maintain a specific distance between the bone screw and the bone surface of the femoral neck 320. Makes it possible to determine the displacement. This will be described in more detail in connection with subsequent figures.

  FIG. 7 a illustrates the virtual position of the intramedullary nail 200 with a virtual representation of the bone screw 210. However, virtual representations of implants, intramedullary nails, and bone screws illustrate locations that are not sufficient for final insertion of intramedullary nails and bone screws. This is because the distance of the intramedullary nail to the surface of the femoral shaft 310 and the distance of the bone screw to the surface of the femoral neck 320 are too small (see arrows). Thus, in order to look for better positioning, the position of the medical tool 10 must be changed.

  However, FIG. 7b illustrates that this position is also not suitable for the final insertion of the implant. This is because the virtual representation of the intramedullary nail 200 ′ and the virtual representation of the bone screw 210 ′ are still too narrow for the respective surfaces of the femoral shaft 310 and the femoral neck 320. After further positioning according to FIG. 7c, the correct position of the virtual representation of the virtual intramedullary nail 200 ′ and the bone screw 210 ′ is achieved, so that the correct position is fixed, for example by applying a guide wire 400. obtain. After fixing the correct entry point, the entire real implant, i.e., intramedullary nail 200 and bone screw 210, can be applied to the femur 300 in a previously determined location. In accordance with the unique indication of the reference body 100, the unique indication of the intramedullary nail and bone screw direction, no further fluoro shots are required between FIGS. 7a and 7c. As illustrated in FIG. 7d, other fluoro shots may be taken if it is desirable to control the final implant position to confirm its successful implantation.

  If the correct entry location is determined, as shown in FIG. 7 c, the intramedullary nail 200 can be coupled to the medical tool 10 and then inserted into the femoral shaft 310. To virtually display the bone screw 210 ′ and the distal locking screw 220 ′, either the intramedullary nail 200 or the reference body 100 or both the reference body 100 and the intramedullary nail 200 are used as the reference body 100. obtain. By repositioning the medical tool 10 with the intramedullary nail 200, the correct further position of the bone screw 210 'can be determined.

  FIGS. 8a-8d illustrate the virtual display arrangement of the bone screw 210 'when the actual nail 200 is positioned. FIG. 8 a illustrates an inadequate position (arrow) for the low distance between the virtual bone screw 210 ′ and the femoral neck 320, whereas FIG. Illustrates the poorly positioned (arrow) positioned oppositely with respect to the sides. FIG. 8c illustrates a better position of the intramedullary nail 200 relative to the virtual representation of the bone screw 210 'so that a real bone screw 210 can be inserted as shown in FIG. 8d. For example, to provide a bore hole in the root of the femoral neck 320 so that the correct position of the drilling machine can be monitored during the drilling process without requiring a single fluoro-shot image during the drilling process. It should also be noted that the reference body 100 can be used to present a drilling tool. The reference body may also display the nail 200 'when drilling the bore hole so that the correct positioning of the nail can be monitored when drilling a hole for receiving the nail later. This monitoring of the drilling process is similar to the illustration of FIGS. 8a-8c, in which case the intramedullary nail 200 is replaced by the drilling machine, while the bone screw 210 is used to ensure the correct position of the bone screw 210. You can maintain a virtual display of '.

  It should be noted that the computer assisted surgical system also helps to find a better position or orientation of the reference body 100,200. This can happen by giving detailed instructions to the surgeon. In that case, the target tool direction must be moved to find the correct position. For example, tactile feedback can be provided to the target tool handle so that the surgeon can directly recognize in which direction the target tool should be moved. For this purpose, each actor can be arranged on a handle or grip.

  FIG. 9 a illustrates the visualization of a virtual display of an intramedullary nail having different geometric orifices 202. By selecting each virtual intramedullary nail 200 ', the slope of the bone screw 210' can be changed to a steeper position 210a 'or a less inclined position 210b'. Thus, the correct type of intramedullary nail is achieved in order to achieve correct positioning of the bone screw 210 to be implanted later by virtually displaying the various possible intramedullary nails that allow different tilt angles of the bone screw 210 '. Can be selected. This selection may be performed by a computer-aided surgical system when examining the optimal geometry in the database and proposing each type of implant.

  In practice, stereotaxic with intraoperative X-ray imaging is used, in which case, as illustrated in FIG. 9b, an awl 9 with a reference body 100 is used to drill a bore hole for a nail. Can be used. The system can detect the reference body 100 of the awl 9 and thus know the axis of the implant 200 ', for example the axis of the gamma nail / intramedullary nail in three-dimensional space. When the bone is advanced over a certain distance, the trajectory of the awl 9 is substantially determined. However, depending on the depth of the awl, a slight correction can be made. By generating two two-dimensional images, for example one two-dimensional image in the AP direction and one two-dimensional image in the ML direction, the anatomical structure can be visualized along with the already entered awl. In the ML view, the system segments the femoral head, thus knowing the center of the femoral head and thus calculating the correct rotation of the implant in the ML view. For AP views, the system overlays the implant with the correct axis rotation as calculated in the ML, performs automatic segmentation of the femoral head, and thus calculates the center (or apex) of the femoral head. The virtual representation of the nail allows the reference body to be rotated and / or translated to look for an optimized position of the nail. The system then virtually inserts an implant, eg, a nail, along the trajectory corresponding to the nail axis to the trajectory of the bone screw over the 125 ° inclination angle between the nail 200 and the bone screw 210 as an initial value. It is movable and passes through the center (or apex) of the femoral head and displays all other available types of implants in addition to the default type. This can be done by a software tool. Since the computing device can automatically determine the optimal nail position and optimal nail type based on the available data set in the database, the surgeon can determine the nail position and nail type and the corresponding bone screw and A suggestion regarding the distal locking screw may be received. Optionally, the user can interact with the system to employ the nail penetration depth. Optionally, the system may present a 3D reconstruction of the entire scene. Already introduced awls provide a stable position in the bone and may provide a future position for the intramedullary nail. Furthermore, the rigid position of the awl makes it possible to maintain its position during the surgical process. In other words, when using a computer-assisted surgical system, the entire surgical workflow is not hindered. It should be noted that the illustrations of FIGS. 2 to 10 are illustrations in the AP direction, and that corresponding illustrations can also be obtained in the ML direction to be supplied by the computing device 5.

  FIG. 10 illustrates a similar method of selecting the correct bone screw 210 from the various bone screws so that the required distance of the bone screw to the surface of the femoral head 330 can be maintained. FIG. 10 illustrates two possible lengths of bone screws 210 'and 210c', and a system based on tolerance rules must select a position 210 '. This is because the longer bone screw 210 c does not maintain the required distance to the surface of the femoral head 330.

  FIG. 11 illustrates a method of operating a computer-assisted surgery system. The method includes positioning S10 of the reference body 100, 200 relative to the anatomical structure 300, wherein the reference body virtually displays the position of the medical device 200, 210, 220 to be applied to the anatomical structure 300. ing. The method further includes detecting a position of the reference body relative to the anatomical structure 300 S20, based on the detected position of the reference body relative to the anatomical structure, the virtual display 200 of the medical device to which the anatomical structure is to be applied. , 210, 220 and S30, providing rules relating to tolerances for applying medical devices to anatomical structures S40, changing the position of the reference body S50, and rules relating to tolerances In order to obtain the best fit with respect to, including S60, optimizing the virtual position of the medical device to be applied to the anatomy. Detecting the reference body 100; 200 positioned relative to the anatomical structure S20, taking two two-dimensional images from different angles S21, generating a three-dimensional display based on the two two-dimensional images S22 And determining a spatial position of the reference body relative to the anatomical structure based on the three-dimensional display. Changing S50 may include rotating S51 and / or moving S52 of the reference body 100; 200, and selecting S53 of the medical device 200; 210; 220 from a predetermined group of various medical devices. .

  In another embodiment of the present invention there is provided a computer program or computer program element configured to perform the method steps of the method according to one of the preceding embodiments on a suitable system. Is done.

  Accordingly, computer program elements may be stored on a computing device that may also be part of an embodiment of the present invention. The computing device may be configured to perform or cause execution of the method steps described above. Moreover, the computing device can be configured to operate the components of the device described above. The computing device may be configured to automatically activate and / or execute a user command. The computer program can be loaded into the working memory of the data processor. Thus, the data processor can be equipped to carry out the method of the invention.

  This embodiment of the invention covers both computer programs that use the invention immediately from the start and computer programs that use updates to convert existing programs to programs that use the invention.

  Further, the computer program element may provide all necessary steps that satisfy the procedure of the method embodiment as described above.

  According to a further embodiment of the present invention, a computer readable medium such as a CD-ROM is presented, the computer readable medium having computer program elements stored thereon, the computer program elements Is described in the preceding part.

  However, the computer program can also be presented on a network such as the World Wide Web and downloaded from such a network into the working memory of the data processor. According to a further embodiment of the present invention, there is also provided a medium for enabling download of a computer program element, which performs the method according to one of the aforementioned embodiments of the present invention. Arranged so that.

  It should be noted that embodiments of the invention are described with reference to different subject matters. In particular, some embodiments are described with reference to method type claims, while other embodiments are described with reference to apparatus type claims. However, those skilled in the art will recognize that, unless otherwise specified, in addition to any combination of features belonging to one type of subject matter, any combination between features on different subject matter is considered to be disclosed in this application. And will be inferred from the following description. However, all features can be combined to produce more synergies than a simple sum of those features.

  It should be noted that embodiments of the invention are described with reference to different subject matters. In particular, some embodiments are described with reference to apparatus type claims, whereas some embodiments are described with reference to method type claims. However, unless otherwise indicated, those skilled in the art will recognize, in addition to any combination of features belonging to one type of subject matter, between features on different subject matters, in particular the features and methods of the device type claims. It will be inferred from the above and the following description that any combination between the features of the claims of this type is considered to be disclosed in this application.

  In the claims, the term “comprising” does not exclude other elements or steps, and the use of the indefinite article does not exclude a plurality. A single processor or other device may fulfill the functions of several items recited in the claims. The mere fact that certain measures are recited in mutually different dependent claims does not indicate that a combination of these measured cannot be used to advantage.

  The computer program may be stored and / or located on a suitable medium such as an optical storage medium or solid state medium supplied with or as part of other hardware, but may also be internet or other wired or wireless communication Other forms such as through a system may also be arranged.

1 Computer assisted surgery system
surgery system)
2 patients
3 Imaging device
4 display unit
5. Computation unit
9 Awl
10 Medical tool
11 finger grip
15 coupling portion
16 matching pattern
100 reference body
101 finger grip
102 fiducial marker
200 intramedullary nail
200 'virtual intramedullary nail
201 upper shaft portion
202 orifice
203 lower shaft portion
204 Orifice
205 intramedullary nail
206 intramedullary nail
210 bone screw
210 'virtual bone screw
211 gear shaft
215 Receptacle
216 fixation arrangement
220 Distal locking screw
220 'virtual distal locking screw
screw)
300 femur
310 femur shaft
320 femur neck
330 femur head
400 guide wire

Claims (10)

A program element that, when executed by a processor, causes the processor to perform the following steps:
The step includes
Detecting a position of a reference body relative to the femur as an anatomical structure, wherein the reference body virtually determines a position of an intramedullary nail to be applied to the femur and a bone screw of the intramedullary nail Displayed on the
Superimposing the femur with a virtual representation of the intramedullary nail and the bone screw to be applied based on the detected position of the reference body relative to the femur;
Providing rules for the tolerance to apply the intramedullary nail and its bone screw to the femur;
To optimize the virtual position of the intramedullary nail and its bone screw to be applied to the femur to obtain the best fit to the rules for the tolerance, the position of the reference body A step of virtually changing
The virtually changing step includes selecting the intramedullary nail and its bone screw from a predetermined group of various intramedullary nails and bone screws, the intramedullary nail comprising the intramedullary nail and its bone as the selection of the screw to allow different tilt angles of the bone screw, having an orifice with a certain inclination with respect to the longitudinal axis of the front Kizui nail for receiving the bone screw,
Program element.   The program element of claim 1, wherein the virtual position of the intramedullary nail and its bone screw includes the size, location, and orientation of the intramedullary nail and its bone screw. Detecting the position of the reference body relative to the femur;
Taking two two-dimensional images from different angles;
Generating a three-dimensional display based on the two-dimensional image;
Determining a spatial position of the reference body relative to the femur based on the three-dimensional image.
The program element according to claim 1 or 2.   4. The method according to claim 1, wherein the step of virtually changing the position of the reference body includes a step of virtually rotating and / or moving the reference body. 5. Program element.   The program element according to claim 1, further comprising the step of imaging an overlap of the femur with the intramedullary nail to be inserted and the virtual representation of the bone screw.   6. The program element according to claim 1, wherein the position of the intramedullary nail and its bone screw to be applied is away from the reference body.   The program element according to any one of claims 1 to 6, wherein the reference body is attachable to a medical tool.   A computer readable medium storing the program element according to any one of claims 1 to 7. A reference body for the femur;
A detection device configured to detect a position of the reference body relative to the femur;
A database,
Including a computing device,
A computer-assisted surgery system,
The reference body virtually displays the position of the intramedullary nail to be applied to the femur and its bone screw;
The database includes a plurality of data sets of virtual intramedullary nails and bone screws, and rules for tolerance to apply one intramedullary nail and bone screws to the femur, the data set Displays various intramedullary nails and bone screws, each of the intramedullary nails having an orifice with a specific inclination with respect to the longitudinal axis of the intramedullary nail for receiving one of the bone screws. Have
The computing device is configured to superimpose the femur with a virtual representation of the intramedullary nail and its bone screw to be applied based on the output of the detection device, and the intramedullary to the femur Optimize the virtual position of the intramedullary nail and its bone screw to be applied to the femur to obtain the best fit for a given rule for the tolerance to apply the nail and its bone screw Therefore, the position of the reference body is configured to be changed, the change being made from the database so that the selection of the intramedullary nail and its bone screw allows different tilt angles of the bone screw. And selecting the bone screw,
Computer-assisted surgery system. The computer-aided surgical system of claim 9, further comprising a medical tool configured to position the intramedullary bone, wherein the reference body is attachable to the medical tool in a predetermined manner.

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