US20210275196A1 - Patient-specific cutting guide - Google Patents
Patient-specific cutting guide Download PDFInfo
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- US20210275196A1 US20210275196A1 US17/327,970 US202117327970A US2021275196A1 US 20210275196 A1 US20210275196 A1 US 20210275196A1 US 202117327970 A US202117327970 A US 202117327970A US 2021275196 A1 US2021275196 A1 US 2021275196A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/14—Surgical saws ; Accessories therefor
- A61B17/15—Guides therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1703—Guides or aligning means for drills, mills, pins or wires using imaging means, e.g. by X-rays
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- A—HUMAN NECESSITIES
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- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
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- A61B17/15—Guides therefor
- A61B17/151—Guides therefor for corrective osteotomy
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- A61B17/15—Guides therefor
- A61B17/151—Guides therefor for corrective osteotomy
- A61B17/152—Guides therefor for corrective osteotomy for removing a wedge-shaped piece of bone
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- A—HUMAN NECESSITIES
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- A61B17/14—Surgical saws ; Accessories therefor
- A61B17/15—Guides therefor
- A61B17/154—Guides therefor for preparing bone for knee prosthesis
- A61B17/155—Cutting femur
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- A—HUMAN NECESSITIES
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- A61B17/154—Guides therefor for preparing bone for knee prosthesis
- A61B17/157—Cutting tibia
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- A—HUMAN NECESSITIES
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- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1707—Guides or aligning means for drills, mills, pins or wires using electromagnetic effects, e.g. with magnet and external sensors
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- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1728—Guides or aligning means for drills, mills, pins or wires for holes for bone plates or plate screws
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- A61B17/17—Guides or aligning means for drills, mills, pins or wires
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- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1764—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the knee
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- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B2017/568—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor produced with shape and dimensions specific for an individual patient
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- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
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- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/3983—Reference marker arrangements for use with image guided surgery
Definitions
- the present disclosure relates to patient-specific cutting instruments, and more particularly to systems, devices, and methods of forming custom manufactured instruments that aid in the cutting of bone to precise dimensions.
- a system for a patient-specific bone cutting guide generally comprises two instruments One instrument is a positioner configured to locate at least one fiducial Marker (placed on a patient's bone) and to be secured in three axes to prevent movement.
- the second instrument is a cutting guide configured to cooperate with the positioner and to delineate the cuts to be made in the bone.
- the positioner and the cutting guide are designed from images taken of the patient's bone with one or more markers already in place.
- the marker(s) may or may not be considered part of the system, and the same is true of the imaging technology used to locate the marker(s).
- Such items may be provided separately or as a kit, along with any pegs or anchors.
- a positioner generally comprises at least three targeting apertures configured to locate at least three markers implanted in non-linear order. At least three anchoring apertures are configured to cooperate any necessary anchors.
- the cutting guide comprises top surface contours that guide the depth of the cuts. Also, bottom surface contours that match the contours of the top surface of the bone may be utilized.
- a method of forming a patient-specific bone cutting guide system generally comprises placing at least one marker on a patient's bone, imaging the patient's bone with the at least one marker in place, forming a positioner designed to incorporate the position of the at least one marker (where the positioner is configured to locate the at least one marker and to be anchored in place, and forming a cutting guide configured to be oriented by the positioner and to delineate the cuts to be made in the bone.
- this method comprises placing at least three markers on the bone and forming the positioner with at least three targeting apertures, one of which is on a transverse member, and at least three anchoring apertures. More simply, this method may comprise only the steps of forming and configuring the positioner and the cutting guide horn images taken of the patient's bone with the one or more markers already in place.
- FIG. 1 is a view of a bone having three implanted fiducial markers.
- FIG. 2 is a top view of a silicone located over two markers of FIG. 1 .
- FIG. 3 an illustration of the positioner of FIG. 2 prior to location over the third marker of FIG. 1 .
- FIG. 4 is an illustration of the positioner correctly located in three axes.
- FIG. 5 id top view of the positioner of FIG. 4 secured by anchors.
- FIG. 6 is a perspective vie of the positioner of FIG. 5 secured on the bone.
- FIG. 7 illustrates alternate securing of the positioner of FIG. 6 .
- FIG. 8 illustrates optional features for e positioner.
- FIG. 9 is a perspective view of a cutting guide attached to the positioner.
- FIG. 10 illustrates a cutting guide located on a bone.
- FIG. 11 is a top view of two cutting guides attached to one positioner.
- FIG. 12 is a flow chart showing a method(s) for making and using a cutting guide of the present invention.
- invention within this document is a reference to an embodiment of a family of inventions, with no single embodiment including features that are necessarily included in all embodiments, unless otherwise stated. Furthermore, although there may be references to “advantages” provided by some embodiments, other embodiments may not include those same advantages, or may include different advantages. Any advantages described herein are not to be construed as limiting to any of the claims.
- relational terms such as “first” and “second.” “top” and “bottom,” and the like, maybe used solely to distinguish one entity or element from another entity or element without necessarily requiring or implying any physical or logical relationship or order between such entities or elements.
- Every human bone is unique, and Applicant has leveraged various technologies for 3D and/or 4D scanning and printing to develop novel systems, devices, and methods for making precise cuts in bones based upon attributes that are specific to each patient. There is obvious value to both surgeon and patient when cuts in bones are made precisely and with increased ease.
- the “navigated cutting guide” or patient-specific cutting guide system 100 of FIGS. 1-12 includes a patient-specific cutting guide 160 that is itself a system and/or device that may further include a cutting guide positioner 120 that also may be a system or device.
- a patient-specific cutting guide 160 that is itself a system and/or device that may further include a cutting guide positioner 120 that also may be a system or device.
- Each of these systems and devices arc nog el in their own right and have associated methods that are also novel.
- related system, device, and method terminology may often be used interchangeably unless specified otherwise.
- the first option is burdensome and involves using an external computer-aided navigation apparatus to confirm correct location of the surgical instruments relative to the bone,
- the second prior art option is to design and manufacture a patient-specific cutting guide (also known as a patient specific instrument, or “PSI”) utilizing cross-sectional imaging of the bone and additive manufacturing (3D printing).
- the surface of the cutting guide to be placed against the bone is made to match the surface contours of the bone, and the cutting guide incorporates one or more slots to precisely guide a cutting instrument.
- there is a risk of inaccurate cuts due to improper location of the cutting guide on the bone during surgery, even with the contour match. Risk is greatest in two instances.
- One potential for missing the intended location of the cutting guide occurs with a tubular bone, such as the femur or tibia, where the surface is relatively devoid of surface irregularities, thus fading to ensure an identical match of the cutting guide to its location.
- Another potential positioning error occurs due to soft tissue covering the bone (for example, extraosseous extension of a tumor) and preventing contact between the cutting guide and the underlying bone.
- a bone 1 (which may include soft tissue) is prepared for surgery by placement of at least three small fiducial markers 111 , 115 firmly in or on the bone 1 or adjacent tissues to serve as reference points for proper placement of a cutting guide 160 , which will be described later.
- fiducial markers 111 , 115 are small, typically radio-opaque metal (for example, stainless steel or gold) cylinders or pins that allow pinpoint guidance for medical treatment.
- markers 111 , 115 are not limited to metal or specific types of metal or to specific shapes (for example, markers may be spheres, coils, or other shapes), and may include devices that emit electromagnetic or other energy for purposes of localization, provided the markers 111 , 115 provide the functionality described herein.
- Markers 111 , 115 may be seen via any number of scanning or imaging technologies 7 generally referred to as x-ray imaging, which may include fluoroscopy, computed tomography (CT), and radiography via live moving and/or still images.
- An imager or imaging system/technology 7 represents these and other current or future imaging technologies that allow markers to be seen in or on a patient's body. Said imaging technology 7 is understood to be used even if not illustrated in each Figure.
- the first two markers 111 are implanted on the closest bone surface 2 to the surgeon during the planned procedure. These two markers 111 are necessarily linear and lie on at least a first plane 112 (see FIG. 6 ) that runs through the markers 111 to the closest portion of the floor below the patient.
- the third fiducial 115 cannot be co-linear (as denoted by axis and/or plane 116 , which may be orthogonal to plane 112 ) but may be placed anywhere else on the bone, preferably on a not-too-distant bone surface 3 . In other words, regardless of their positions, three or more markers 111 , 115 allow triangulation 110 for placing a cutting guide positioner 120 as shown in FIG. 2 .
- Fiducials are implanted with a minor procedure before obtaining CT (or other) images used for designing any patient-specific instrument.
- the location of the markers 111 , 115 on the bone 1 . as visualized on the CT scan is then incorporated into the design of the positioner 120 and cutting guide 160 .
- These parts are then printed of medical grade materials, including plastic, carbon, composites, or a wide variety of suitable materials that are generally inflexible in order to maintain position. Scanning produces data that is then used (and may be manipulated) for printing patient-specific parts. Scanning, manipulating data, and printing may or may not be included in the methods related to these systems and devices, and manufacturing is not limited to printing.
- FIG. 2 is a view of the positioner 120 placed over the bone 1 .
- markers 111 are visualized.
- the “c-arm” would be positioned in the anterior-posterior (AP) plane.
- AP anterior-posterior
- FIG. 3 is a view at this time of the bone 1 and positioner 120 with the c-arm in the lateral position. Initially, the (transverse) third marker 115 is not correctly located within the aperture 145 of the transverse targeting ring 144 .
- the positioner 120 is rotated and transverse member 140 oriented such that he third marker 115 is accurately visualized within the transverse targeting aperture 145 of the transverse targeting ring 144 .
- Anchors 139 are preferably driven through two locking rings 136 . These anchors 139 are slightly oblique to the first two anchors 139 in the anchoring apertures 130 .
- the positioner 120 is now correctly located and firmly locked or secured in three axes.
- FIG. 6 is a perspective view of the positioner 120 secured on the bone 1 using four wires or anchors 139 .
- FIG. 7 is the same view with alternative anchoring.
- the three anchors 139 are secured through the targeting apertures 135 , 145 at the markers 111 , 115 .
- the markers 111 , 115 may be hollo and accept the anchors 139 as they pass into the bone 1 .
- Anchoring is not limited to wires, but may include other parts that provide similar locking functionality, such as screws.
- the markers 111 , 115 , anchors 139 and/or coacting parts of the positioner 120 may be magnetic, threaded, snap-like, or otherwise designed to provide comparable functionality.
- FIG. 8 illustrates the basics of the positioner 120 structure and functionality.
- the positioner 120 has been illustrated as a triangular body 121 and rings 130 , 134 , and 136 with outer surface 123 (also called the side or exterior surface), plus transverse member 140 having ring 144 .
- the positioner 120 is not limited to a triangular shape, nor to rings 130 , 134 , 136 , 144 .
- body 121 may range from a “V” shape to an oval or rectangle, or a combination thereof, with rounded or sharp corners
- the overall shape of the positioner 120 may range from a “Y” shape to a “J” shape to other shapes having a transverse member 140 .
- the chosen structure must maintain apertures (selected from among 131 , 135 , 137 ) for locating and anchoring the positioner 120 to bone 1 .
- the positioner 120 may have some curvature, particularly at transverse member 140 .
- the transverse member 140 may unibody with or attachable to the body 121 .
- the drawings do not label every element of symmetrical parts, as that symmetry is understood, but the present invention is not limited to symmetrical design.
- Anchoring aperture 131 may be slotted and may have an interior beveled, recessed surface 132 to allow some adjustment of the positioner's 120 orientation relative to the anchors 139 .
- “Slotted” may be oval, diamond-shaped, or other shapes and is intended broadly to describe an aperture 131 functional to hold the positioner 120 in two axes on relative markers 111 while allowing adjustability to reach proper orientation in the third axis.
- the body 121 , any rings, and/or the transverse member 140 may share a top surface 122 / 142 and/or outer surface 123 / 143 .
- Pegs 138 see FIG.
- Attachment aperture 125 having inner surface 127 is illustrated at the center of the positioner 120 , although it, is not limited to that location, and is used for connecting one or more cutting guides 160 to the positioner 120 .
- Attachment aperture 125 may be a small hole for accepting a screw pin, or other fastener or may be relatively large for accepting a plug 175 or similar fastener (see FIG. 9 ), and the inner surface 127 may hold via friction at a minimum.
- use of at least two locking apertures 137 is preferred, at times only one may be used and may be centrally located on the positioner 120 (see FIG. 8 ).
- the transverse member 140 may extend from the positioner body 121 at angles different from ninety degrees and from points other that the tip of a triangle.
- FIG. 9 view a patient-specific cutting guide system 100 .
- the cutting guide 160 is attached to the positioner 120 , in this illustration via plug 175 pushed firmly into attachment aperture 125 , wherein the plug 175 is connected to the wall 161 of the cutting guide 160 by inflexible arm 174 .
- the plug 175 , arm 174 and guide 160 may be printed or otherwise formed as one piece or may be formed separately and assembled.
- the cutting guide 160 may be attached to any part of the positioner 120 , not being limited to its center, and at times the arm 174 may be omitted, in which case the wall 161 of the guide 160 will contact the positioner 120 .
- This illustration omits anchors for simplicity.
- the cutting guide 160 itself may also be anchored to the bone 1 .
- the positioner 120 and guide 160 may be one piece or multiple pieces.
- Cutting slot(s) 163 running through the wall 161 of the guide 160 are designed to guide a cutting mechanism 190 such as a saw. Phrased another way, the wall top 161 with cutting slot 163 resembles a rail on which the cutting mechanism rides.
- the guide 160 may have interior walls 167 , exterior walls 168 , and bends 164 in the wall 161 and may have one or more stops or end walls 165 to impede a saws progress.
- the cutting guide 160 is not limited to saws and linear slot shapes, as it is contemplated that other cutting mechanisms 190 (including drills) and cutting patterns may utilize a variety of guiding shapes inside or outside of the cutting guide 160 .
- FIGS. 9-10 show a preferred embodiment of the cutting guide 160 wherein the top 162 of the wall 161 has contours 162 ′ such that the thickness or height of the wall 161 varies in dimension in proportion to the dimensions (surface contours) of the bone 1 at that location, thus allowing for accurate cutting depth.
- the contours 162 ′ are a negative of the back of the bone 1 .
- cutting device 190 for example, an oscillating saw having blade 192 with cutting edge 193 , as well as an attachment opening 191 ) comprising a rounded head 195 is constrained by the wall's 161 top surface contours 162 ′ as the top surface 162 helps the cutting device 190 navigate the guide 160 .
- This design and method of navigation are novel.
- Pegs 169 may be used and modified (whether added or removed in part or in whole) between the bone 1 and the bottom surface 166 of the cutting guide 160 at the time of surgery.
- the cutting guide 160 may be formed with a bottom surface contour 166 ′ that matches the top surface 2 contour of the bone 1 on which the guide 160 rests.
- a cutting guide 160 having bottom surface contour 166 ′ is designed and placed with the aid of at least one marker 113 ( FIG. 9 ).
- the marker 113 acts in similar fashion to transverse marker 115 because bottom surface contours 166 ′ themselves are not sufficient to confirm accurate guide 160 placement.
- a positioner 120 would need to target and anchor With reference to the at least one marker 113 .
- the positioner 120 and arm 174 are not shown in FIG. 10 , but their use has been discussed.
- FIG. 11 illustrates that one positioner 120 may be used to make additional cuts on the same bone 1 by attaching a second cutting guide 160 , or more.
- the portion of bone 1 to which the positioner 120 is attached may even be separated from the remaining skeleton, and the accuracy of further cuts would remain, which would not be the case with currently available patient-specific instruments.
- This invention can also be used in craniomaxillofacial or veterinary applications. In addition to improved precision, this invention also circumvents the challenges incurred when there is soft tissue overlying the bone 1 to be cut. As the placement of the cutting guide 160 does not depend solely on matching the bone 1 surface anatomy, the potential for error due to overlying soft tissue is eliminated.
- FIG. 12 is a floss chart that shows the basic steps of the method(s) of forming and using a patient-specific cutting guide 200 , including the positioner 120 and cutting guide 160 instruments.
- Methods of producing and/or using those instruments 205 , 220 may include placing markers on bone 210 , scanning or imaging the bone with markers 207 , manipulating images and designing a patient-specific positioner and/or cutting guide 208 (including any manipulation and transfer of data), printing or otherwise forming one or both of those patient-specific tools 215 , and correctly locating/orienting 230 and anchoring 239 the positioner 120 on the bone 1 as described above.
- the cutting guide is attached 260 to the positioner 120 .
- a cutting instrument placed in the guide 290 , and the bone 1 may be divided by making navigated cuts 262 .
- Dashed boxes 208 , 290 in FIG. 12 serve to indicate that the present invention is novel regardless of the specifics of data manipulation and types of cutting instruments and that a variety of configurations related to those specifies are contemplated herein.
- steps are not limited by their expression in FIG. 12 , but include intermediate and/or alternative steps as described throughout the specification. The steps themselves may be subdivided, grouped, added to, or otherwise reordered provided that he resultant method provides comparable functionality.
- a system for a patient-specific bone cutting guide comprises at least two instruments.
- One is a positioner configured to locate at least one fiducial marker (placed on or near a patient's bone) and to be secured in three axes to prevent movement of the positioner on the bone.
- the second is a cutting guide configured to cooperate with the positioner and to delineate the cuts to be made in the bone.
- the positioner and the cutting guide are designed, formed, and configured from images taken of the patient's bone with one or more markers already in place.
- the marker(s) may or may not be considered part of the system, and the same is true of the imaging technology used to locate the marker(s).
- Such items may be provided separately or as a kit, along with any pegs or anchors.
- the positioner may comprise at least three targeting apertures configured to locate at least three markers implanted in non-linear order. At least three anchoring apertures are configured to cooperate with any necessary anchors.
- the cutting guide comprises op surface contours that guide the depth of the cuts. Also, bottom surface contours that match the contours of the top surface of the bone may be utilized.
- a method of forming a patient-specific bone cutting guide system comprises placing at least one marker on a patient's bone, imaging the patient's bone with the at least one marker in place, forming a positioner designed to incorporate the position of the at least one marker (where the positioner is configured to locate the at least one marker and to be anchored in place), and forming a cutting guide configured to he oriented by the positioner and to delineate the cuts to be made in the bone.
- This method may comprise placing at least three markers on the bone and forming the positioner with at least three targeting apertures, one of which is on a transverse member, and at least three anchoring apertures. Also, this method may simply comprise forming and configuring the positioner and the cutting guide from images taken of the patient's bone with at one or more markers already in place.
Abstract
A patient-specific cutting guide system comprises at least two instruments. One is a positioner configured to locate a fiducial marker on a patient's bone and to be secured in three axes. The second is a cutting guide that cooperates with the positioner and delineates cuts to be made. The instruments are designed from images of the bone with the marker already in place. Preferably, a positioner comprises at least three targeting apertures configured to locate at least three non-linear markets. The cutting guide comprises top surface contours that guide the depth of the cuts. A method of forming this system comprises placing at least one marker (preferably three) on a patient's bone, then imaging the bone, forming a positioner designed to incorporate the marker position, and forming a cutting guide configured to be oriented and anchored by the positioner.
Description
- This application is a continuation of U.S. patent application Ser. No. 15/896,284 entitled “Patient-Specific Cutting Guide” filed Feb. 14, 2018, which claims the benefit of and herein incorporates by reference U.S. Provisional Patent Application No. 62/541,701, filed on Aug. 5. 2017, entitled “Patient Specific Instrument Augmented with Radiologic Imaging, for Use in Precisely Cutting Bones in a Variety of Settings,” and also claims the benefit of U.S. Provisional Patent Application No. 62/514,952, filed on Jun. 4, 2017, entitled “Navigated Patient Specific Instrument, for Use in Precisely Cutting Bones in a Variety of Settings,” which is also incorporated by reference.
- The present disclosure relates to patient-specific cutting instruments, and more particularly to systems, devices, and methods of forming custom manufactured instruments that aid in the cutting of bone to precise dimensions.
- This section provides background information related to the present disclosure which is not necessarily prior art.
- It is often necessary in orthopedic surgery to divide a bone accurately into two or more portions. When bones are divided for the removal of a tumor, the location of these cuts is of paramount importance. Current methods for ensuring the precision of the cuts are either burdensome or subject to inaccuracy due to improper location on the bone.
- There is need in the art for a system, device, and method for locating cuts so that they are made in the intended location.
- This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features.
- A system for a patient-specific bone cutting guide generally comprises two instruments One instrument is a positioner configured to locate at least one fiducial Marker (placed on a patient's bone) and to be secured in three axes to prevent movement. The second instrument is a cutting guide configured to cooperate with the positioner and to delineate the cuts to be made in the bone. The positioner and the cutting guide are designed from images taken of the patient's bone with one or more markers already in place. The marker(s) may or may not be considered part of the system, and the same is true of the imaging technology used to locate the marker(s). Such items may be provided separately or as a kit, along with any pegs or anchors.
- In a preferred embodiment, a positioner generally comprises at least three targeting apertures configured to locate at least three markers implanted in non-linear order. At least three anchoring apertures are configured to cooperate any necessary anchors. The cutting guide comprises top surface contours that guide the depth of the cuts. Also, bottom surface contours that match the contours of the top surface of the bone may be utilized.
- A method of forming a patient-specific bone cutting guide system generally comprises placing at least one marker on a patient's bone, imaging the patient's bone with the at least one marker in place, forming a positioner designed to incorporate the position of the at least one marker (where the positioner is configured to locate the at least one marker and to be anchored in place, and forming a cutting guide configured to be oriented by the positioner and to delineate the cuts to be made in the bone. In a preferred embodiment, this method comprises placing at least three markers on the bone and forming the positioner with at least three targeting apertures, one of which is on a transverse member, and at least three anchoring apertures. More simply, this method may comprise only the steps of forming and configuring the positioner and the cutting guide horn images taken of the patient's bone with the one or more markers already in place.
- Further areas of applicability will become apparent from the description provided herein. The description and specific examples in this summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.
- A more complete understanding of these embodiments, and the attendant advantages and features thereof, will be more readily understood by reference to the following detailed description when considered in conjunction with the accompanying drawings. The drawings described herein may not be to scale, are for illustrative purposes only of selected embodiments and not all possible implementations, and are not intended to limit the scope of the present disclosure.
- For clarity and in order to emphasize certain features, not all of the drawings depict all of the features that might be included with the depicted embodiment. The invention also encompasses embodiments that combine features illustrated in multiple different drawings; embodiments that omit, modify, or replace some of the features depicted; and embodiments that include features not illustrated in the drawings. Therefore, it should be understood that there is no restrictive one-to-one correspondence between any given embodiment of the invention and any of the drawings.
-
FIG. 1 is a view of a bone having three implanted fiducial markers. -
FIG. 2 is a top view of a silicone located over two markers ofFIG. 1 . -
FIG. 3 an illustration of the positioner ofFIG. 2 prior to location over the third marker ofFIG. 1 . Rd -
FIG. 4 is an illustration of the positioner correctly located in three axes. -
FIG. 5 id top view of the positioner ofFIG. 4 secured by anchors. -
FIG. 6 is a perspective vie of the positioner ofFIG. 5 secured on the bone. -
FIG. 7 illustrates alternate securing of the positioner ofFIG. 6 . -
FIG. 8 illustrates optional features for e positioner. -
FIG. 9 is a perspective view of a cutting guide attached to the positioner. -
FIG. 10 illustrates a cutting guide located on a bone. -
FIG. 11 is a top view of two cutting guides attached to one positioner. -
FIG. 12 is a flow chart showing a method(s) for making and using a cutting guide of the present invention. - Corresponding reference numerals indicate corresponding parts throughout.
- Any reference to “invention” within this document is a reference to an embodiment of a family of inventions, with no single embodiment including features that are necessarily included in all embodiments, unless otherwise stated. Furthermore, although there may be references to “advantages” provided by some embodiments, other embodiments may not include those same advantages, or may include different advantages. Any advantages described herein are not to be construed as limiting to any of the claims.
- As used herein, relational terms, such as “first” and “second.” “top” and “bottom,” and the like, maybe used solely to distinguish one entity or element from another entity or element without necessarily requiring or implying any physical or logical relationship or order between such entities or elements.
- Specific quantities, dimensions, spatial characteristics, compositional characteristics and performance characteristics may be used explicitly or implicitly herein, but such specific quantities are presented as examples only and are approximate values unless otherwise indicated. Discussions and depictions pertaining to these, if present, are presented as examples only and do not limit the applicability of other characteristics, unless otherwise indicated.
- In describing preferred and alternate embodiments of the technology described herein, specific terminology is employed for the sake of clarity. The technology described herein, however, is not intended to be limited to the specific terminology so selected, and it is to be understood that each specific element includes all technical equivalents that operate in a similar manner to accomplish similar functions.
- Example embodiments will now be described more fully with reference to the accompanying drawings. Specific details are set forth such as examples of specific components and methods to provide a thorough understanding of embodiments of the present disclosure. It will be apparent to those skilled m the art that specific details need not be employed, that example embodiments may be embodied in many different forms, and that neither should be construed to limit the scope of the disclosure. In some example embodiments, well-known device structures are not described in detail.
- Introduction
- Every human bone is unique, and Applicant has leveraged various technologies for 3D and/or 4D scanning and printing to develop novel systems, devices, and methods for making precise cuts in bones based upon attributes that are specific to each patient. There is obvious value to both surgeon and patient when cuts in bones are made precisely and with increased ease.
- In this specification, the “navigated cutting guide” or patient-specific
cutting guide system 100 ofFIGS. 1-12 includes a patient-specific cutting guide 160 that is itself a system and/or device that may further include acutting guide positioner 120 that also may be a system or device. Each of these systems and devices arc nog el in their own right and have associated methods that are also novel. One of skill in the art will understand that related system, device, and method terminology may often be used interchangeably unless specified otherwise. - Two prior art methods are currently used to ensure the precision of cuts. The first option is burdensome and involves using an external computer-aided navigation apparatus to confirm correct location of the surgical instruments relative to the bone,
- The second prior art option is to design and manufacture a patient-specific cutting guide (also known as a patient specific instrument, or “PSI”) utilizing cross-sectional imaging of the bone and additive manufacturing (3D printing). The surface of the cutting guide to be placed against the bone is made to match the surface contours of the bone, and the cutting guide incorporates one or more slots to precisely guide a cutting instrument. However, there is a risk of inaccurate cuts due to improper location of the cutting guide on the bone during surgery, even with the contour match. Risk is greatest in two instances. One potential for missing the intended location of the cutting guide occurs with a tubular bone, such as the femur or tibia, where the surface is relatively devoid of surface irregularities, thus fading to ensure an identical match of the cutting guide to its location. Another potential positioning error occurs due to soft tissue covering the bone (for example, extraosseous extension of a tumor) and preventing contact between the cutting guide and the underlying bone.
- Positioner for a Cutting Guide
- The present invention eliminates the above described potential for inaccuracy. Beginning with
FIG. 1 , a bone 1 (which may include soft tissue) is prepared for surgery by placement of at least three smallfiducial markers bone 1 or adjacent tissues to serve as reference points for proper placement of a cuttingguide 160, which will be described later. One of skill in the art will understand that in this specification references to “on the bone” includes the meanings of “or in the bone” and “or adjacent the surface of the bone” and “or proximate the bone.” Fiducials, fiducial markers, ormarkers markers markers -
Markers imaging technologies 7 generally referred to as x-ray imaging, which may include fluoroscopy, computed tomography (CT), and radiography via live moving and/or still images. An imager or imaging system/technology 7 represents these and other current or future imaging technologies that allow markers to be seen in or on a patient's body. Saidimaging technology 7 is understood to be used even if not illustrated in each Figure. - To simplify the procedure, the first two
markers 111 are implanted on theclosest bone surface 2 to the surgeon during the planned procedure. These twomarkers 111 are necessarily linear and lie on at least a first plane 112 (seeFIG. 6 ) that runs through themarkers 111 to the closest portion of the floor below the patient. The third fiducial 115 cannot be co-linear (as denoted by axis and/orplane 116, which may be orthogonal to plane 112) but may be placed anywhere else on the bone, preferably on a not-too-distant bone surface 3. In other words, regardless of their positions, three ormore markers triangulation 110 for placing a cuttingguide positioner 120 as shown inFIG. 2 . - Fiducials are implanted with a minor procedure before obtaining CT (or other) images used for designing any patient-specific instrument. The location of the
markers bone 1. as visualized on the CT scan is then incorporated into the design of thepositioner 120 and cuttingguide 160. These parts are then printed of medical grade materials, including plastic, carbon, composites, or a wide variety of suitable materials that are generally inflexible in order to maintain position. Scanning produces data that is then used (and may be manipulated) for printing patient-specific parts. Scanning, manipulating data, and printing may or may not be included in the methods related to these systems and devices, and manufacturing is not limited to printing. - During a later surgery,
FIG. 2 is a view of thepositioner 120 placed over thebone 1. Usingimaging technology 7,markers 111 are visualized. For example, with radiologic imaging such as intraoperative fluoroscopy, the “c-arm” would be positioned in the anterior-posterior (AP) plane. Once the first twofiducial markers 111 are visualized within the targetingapertures 135 of two targetingrings 134, two fixation wires or anchors 139 are driven through the anchoringapertures 131 of anchor rings 130 and into thebone 1. These twoanchors 139 constrain thepositioner 120 in two axes. -
FIG. 3 is a view at this time of thebone 1 andpositioner 120 with the c-arm in the lateral position. Initially, the (transverse)third marker 115 is not correctly located within theaperture 145 of thetransverse targeting ring 144. - In
FIG. 4 , thepositioner 120 is rotated andtransverse member 140 oriented such that hethird marker 115 is accurately visualized within the transverse targetingaperture 145 of thetransverse targeting ring 144. - At that time, as shop
FIG. 5 . and with the c-arm returned to the AP position, at least oneadditional anchor 139 is driven through the lockingaperture 137 of thelocking ring 136 and into thebone 1.Anchors 139 are preferably driven through two locking rings 136. Theseanchors 139 are slightly oblique to the first twoanchors 139 in the anchoringapertures 130. Thepositioner 120 is now correctly located and firmly locked or secured in three axes. -
FIG. 6 is a perspective view of thepositioner 120 secured on thebone 1 using four wires or anchors 139.FIG. 7 is the same view with alternative anchoring. In this case, the threeanchors 139 are secured through the targetingapertures markers markers anchors 139 as they pass into thebone 1. Anchoring is not limited to wires, but may include other parts that provide similar locking functionality, such as screws. Alternatively, themarkers positioner 120 may be magnetic, threaded, snap-like, or otherwise designed to provide comparable functionality. -
FIG. 8 illustrates the basics of thepositioner 120 structure and functionality. To this point, thepositioner 120 has been illustrated as atriangular body 121 and rings 130, 134, and 136 with outer surface 123 (also called the side or exterior surface), plustransverse member 140 havingring 144. However, thepositioner 120 is not limited to a triangular shape, nor torings body 121 may range from a “V” shape to an oval or rectangle, or a combination thereof, with rounded or sharp corners, and the overall shape of thepositioner 120 may range from a “Y” shape to a “J” shape to other shapes having atransverse member 140. The chosen structure must maintain apertures (selected from among 131, 135, 137) for locating and anchoring thepositioner 120 tobone 1. Thepositioner 120 may have some curvature, particularly attransverse member 140. Thetransverse member 140 may unibody with or attachable to thebody 121. For simplicity, the drawings do not label every element of symmetrical parts, as that symmetry is understood, but the present invention is not limited to symmetrical design. -
FIGS. 1-7 provide insight into several other details and alternatives. Anchoringaperture 131 may be slotted and may have an interior beveled, recessedsurface 132 to allow some adjustment of the positioner's 120 orientation relative to theanchors 139. “Slotted” may be oval, diamond-shaped, or other shapes and is intended broadly to describe anaperture 131 functional to hold thepositioner 120 in two axes onrelative markers 111 while allowing adjustability to reach proper orientation in the third axis. Thebody 121, any rings, and/or thetransverse member 140 may share atop surface 122/142 and/orouter surface 123/143. Pegs 138 (seeFIG. 4 ) or similarly functional surface features will usually be placed between the bone and thebottom surface 124 of thepositioner 120 to aid orientation and anchoring.Attachment aperture 125 havinginner surface 127 is illustrated at the center of thepositioner 120, although it, is not limited to that location, and is used for connecting one or more cutting guides 160 to thepositioner 120.Attachment aperture 125 may be a small hole for accepting a screw pin, or other fastener or may be relatively large for accepting aplug 175 or similar fastener (seeFIG. 9 ), and theinner surface 127 may hold via friction at a minimum. Although use of at least two lockingapertures 137 is preferred, at times only one may be used and may be centrally located on the positioner 120 (seeFIG. 8 ). Finally, thetransverse member 140 may extend from thepositioner body 121 at angles different from ninety degrees and from points other that the tip of a triangle. - Cutting Guide
- Having fully described the
positioner 120, we now turn toFIG. 9 to view a patient-specificcutting guide system 100. The cuttingguide 160 is attached to thepositioner 120, in this illustration viaplug 175 pushed firmly intoattachment aperture 125, wherein theplug 175 is connected to thewall 161 of the cuttingguide 160 byinflexible arm 174. Theplug 175,arm 174 and guide 160 may be printed or otherwise formed as one piece or may be formed separately and assembled. The cuttingguide 160 may be attached to any part of thepositioner 120, not being limited to its center, and at times thearm 174 may be omitted, in which case thewall 161 of theguide 160 will contact thepositioner 120. This illustration omits anchors for simplicity. The cuttingguide 160 itself may also be anchored to thebone 1. Thepositioner 120 and guide 160 may be one piece or multiple pieces. - Cutting slot(s) 163 running through the
wall 161 of theguide 160 are designed to guide acutting mechanism 190 such as a saw. Phrased another way, thewall top 161 with cuttingslot 163 resembles a rail on which the cutting mechanism rides. Theguide 160 may haveinterior walls 167,exterior walls 168, and bends 164 in thewall 161 and may have one or more stops or endwalls 165 to impede a saws progress. The cuttingguide 160 is not limited to saws and linear slot shapes, as it is contemplated that other cutting mechanisms 190 (including drills) and cutting patterns may utilize a variety of guiding shapes inside or outside of the cuttingguide 160. -
FIGS. 9-10 show a preferred embodiment of the cuttingguide 160 wherein the top 162 of thewall 161 hascontours 162′ such that the thickness or height of thewall 161 varies in dimension in proportion to the dimensions (surface contours) of thebone 1 at that location, thus allowing for accurate cutting depth. In other words, thecontours 162′ are a negative of the back of thebone 1. InFIG. 10 , cutting device 190 (for example, an oscillating saw havingblade 192 with cuttingedge 193, as well as an attachment opening 191) comprising arounded head 195 is constrained by the wall's 161top surface contours 162′ as thetop surface 162 helps thecutting device 190 navigate theguide 160. This design and method of navigation are novel.Pegs 169 may be used and modified (whether added or removed in part or in whole) between thebone 1 and thebottom surface 166 of the cuttingguide 160 at the time of surgery. Alternatively, the cuttingguide 160 may be formed with abottom surface contour 166′ that matches thetop surface 2 contour of thebone 1 on which theguide 160 rests. - In an alternative and novel method, a cutting
guide 160 havingbottom surface contour 166′ is designed and placed with the aid of at least one marker 113 (FIG. 9 ). Themarker 113 acts in similar fashion totransverse marker 115 becausebottom surface contours 166′ themselves are not sufficient to confirmaccurate guide 160 placement. Thus, apositioner 120 would need to target and anchor With reference to the at least onemarker 113. Thepositioner 120 andarm 174 are not shown inFIG. 10 , but their use has been discussed. -
FIG. 11 illustrates that onepositioner 120 may be used to make additional cuts on thesame bone 1 by attaching asecond cutting guide 160, or more. The portion ofbone 1 to which thepositioner 120 is attached may even be separated from the remaining skeleton, and the accuracy of further cuts would remain, which would not be the case with currently available patient-specific instruments. This invention can also be used in craniomaxillofacial or veterinary applications. In addition to improved precision, this invention also circumvents the challenges incurred when there is soft tissue overlying thebone 1 to be cut. As the placement of the cuttingguide 160 does not depend solely on matching thebone 1 surface anatomy, the potential for error due to overlying soft tissue is eliminated. -
FIG. 12 is a floss chart that shows the basic steps of the method(s) of forming and using a patient-specific cutting guide 200, including thepositioner 120 and cuttingguide 160 instruments. Methods of producing and/or using thoseinstruments bone 210, scanning or imaging the bone withmarkers 207, manipulating images and designing a patient-specific positioner and/or cutting guide 208 (including any manipulation and transfer of data), printing or otherwise forming one or both of those patient-specific tools 215, and correctly locating/orienting 230 and anchoring 239 thepositioner 120 on thebone 1 as described above. Once the positioner's 120 position is confirmed usingimaging 7, the cutting guide is attached 260 to thepositioner 120. A cutting instrument placed in theguide 290, and thebone 1 may be divided by making navigatedcuts 262. Dashedboxes FIG. 12 serve to indicate that the present invention is novel regardless of the specifics of data manipulation and types of cutting instruments and that a variety of configurations related to those specifies are contemplated herein. One of skill in the art understand that these steps are not limited by their expression inFIG. 12 , but include intermediate and/or alternative steps as described throughout the specification. The steps themselves may be subdivided, grouped, added to, or otherwise reordered provided that he resultant method provides comparable functionality. - In general, a system for a patient-specific bone cutting guide comprises at least two instruments. One is a positioner configured to locate at least one fiducial marker (placed on or near a patient's bone) and to be secured in three axes to prevent movement of the positioner on the bone. The second is a cutting guide configured to cooperate with the positioner and to delineate the cuts to be made in the bone. The positioner and the cutting guide are designed, formed, and configured from images taken of the patient's bone with one or more markers already in place. The marker(s) may or may not be considered part of the system, and the same is true of the imaging technology used to locate the marker(s). Such items may be provided separately or as a kit, along with any pegs or anchors.
- The positioner may comprise at least three targeting apertures configured to locate at least three markers implanted in non-linear order. At least three anchoring apertures are configured to cooperate with any necessary anchors. The cutting guide comprises op surface contours that guide the depth of the cuts. Also, bottom surface contours that match the contours of the top surface of the bone may be utilized.
- A method of forming a patient-specific bone cutting guide system comprises placing at least one marker on a patient's bone, imaging the patient's bone with the at least one marker in place, forming a positioner designed to incorporate the position of the at least one marker (where the positioner is configured to locate the at least one marker and to be anchored in place), and forming a cutting guide configured to he oriented by the positioner and to delineate the cuts to be made in the bone. This method may comprise placing at least three markers on the bone and forming the positioner with at least three targeting apertures, one of which is on a transverse member, and at least three anchoring apertures. Also, this method may simply comprise forming and configuring the positioner and the cutting guide from images taken of the patient's bone with at one or more markers already in place.
- The foregoing description of the embodiments has been provided for purposes of illustration and description. It is not intended to be exhaustive or to limit the disclosure. Individual elements or features of a particular embodiment arc generally not limited to that particular embodiment, but, where applicable, are interchangeable and can he used in a selected embodiment, even if not specifically shown or described. The same may also be varied in many ways. Such variations are not to be regarded as a departure from the disclosure, and all such Modifications are intended to be included Within the scope of the disclosure.
Claims (20)
1. A cutting guide system comprising:
(a) a positioner configured to locate at least one marker on or near a patient's bone and to be anchored to prevent movement; and
(b) a cutting guide configured to cooperate with the positioner and to delineate the cuts to be made in the bone;
wherein the positioner and the cutting guide are configured from images taken of the patient's bone with the at least one marker already in place.
2. The system of claim 1 , further comprising at east one marker configured to be placed on the patient's bone.
3. The system of claim 1 , the positioner comprising at least three targeting apertures configured to locate at least three markers.
4. The system of claim 3 , comprising at least three markers.
5. The system of claim 1 the positioner further comprising a transverse member.
6. The system of claim 1 , the positioner further comprising at least three anchoring apertures.
7. The system of claim 1 , further comprising anchors.
8. The system of claim 1 , the cutting guide comprising top surface contours that guide the depth of the cuts.
9. The system of claim 1 , the cutting guide comprising bottom surface contours that match the contours of the top surface of the bone.
10. The system of claim 1 , further comprising an imaging technology configured to locate one or more markers during surgery.
11. The system of claim 1 , further comprising a cutting instrument configured to cooperate with the cutting guide.
12. A cutting guide system comprising:
(a) a positioner configured to locate at least three markers on or near a patient's bone and to be anchored to prevent movement, the positioner comprising:
(i) at least three targeting apertures; and
(ii) at least three anchoring apertures; and
(b) a cutting guide configured to be attached to the positioner and to delineate the cuts to be made in the bone and comprising top surface contours that guide the depth of the cuts;
wherein the positioner and the cutting guide are configured from images taken of the patient's bone with the at least three markers already in place.
13. The system of claim 12 , the positioner further comprising a transverse member having a targeting aperture.
14. The system of claim 12 , comprising at least three markers.
15. The system of clam 12, further comprising anchors.
16. The system of claim 12 , the cutting guide comprising bottom surface contours that match the contours of the top surface of the bone.
17. A method of forming a cutting guide system, the method comprising:
(a) forming a positioner designed to incorporate the position of at least one marker on or near a patient's bone, therein the positioner is configured to locate the at least one marker and to be anchored to prevent movement; and
(b) forming a cutting guide configured to be oriented by the positioner and to delineate the cuts to be made in the bone;
wherein the positioner and the cutting guide are formed and configured from images taken of the patient's bone with the at least one marker already in place.
18. The method of claim 17 , comprising incorporating the position of at least three markers on the patient's bone.
19. The method of claim 17 , the positioner comprising at least three anchoring apertures.
20. The method of claim 17 , the positioner comprising a transverse member.
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US11931106B2 (en) | 2019-09-13 | 2024-03-19 | Treace Medical Concepts, Inc. | Patient-specific surgical methods and instrumentation |
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DE102014107481A1 (en) * | 2014-05-27 | 2015-12-03 | Aesculap Ag | Medical system |
WO2018158962A1 (en) * | 2017-03-03 | 2018-09-07 | 誠 五島 | Attachment position confirmation member, osteotomy assistance kit, and position detection program |
US11819278B2 (en) * | 2018-08-24 | 2023-11-21 | Laboratoires Bodycad Inc. | Surgical kit for knee osteotomies and corresponding preoperative planning method |
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US6711432B1 (en) * | 2000-10-23 | 2004-03-23 | Carnegie Mellon University | Computer-aided orthopedic surgery |
EP1691692B1 (en) | 2003-11-14 | 2011-01-19 | Smith & Nephew, Inc. | Adjustable surgical cutting systems |
US20050234465A1 (en) | 2004-03-31 | 2005-10-20 | Mccombs Daniel L | Guided saw with pins |
US7744600B2 (en) | 2006-01-10 | 2010-06-29 | Zimmer Technology, Inc. | Bone resection guide and method |
US8591516B2 (en) | 2006-02-27 | 2013-11-26 | Biomet Manufacturing, Llc | Patient-specific orthopedic instruments |
EP2957243A1 (en) * | 2007-09-30 | 2015-12-23 | DePuy Products, Inc. | Customized patient-specific orthopaedic surgical instrumentation |
US20100168799A1 (en) * | 2008-12-29 | 2010-07-01 | Schumer Evan D | Ulnar osteotomy plate including increased compression |
US8764760B2 (en) | 2011-07-01 | 2014-07-01 | Biomet Manufacturing, Llc | Patient-specific bone-cutting guidance instruments and methods |
JP6258299B2 (en) * | 2012-05-03 | 2018-01-10 | シンセス・ゲーエムベーハーSynthes GmbH | Surgical guide with cut resistant insert |
JP6934861B2 (en) | 2015-11-24 | 2021-09-15 | シンク サージカル, インコーポレイテッド | Active robot pin placement in total knee osteoarthritis |
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US11931106B2 (en) | 2019-09-13 | 2024-03-19 | Treace Medical Concepts, Inc. | Patient-specific surgical methods and instrumentation |
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