WO2001021084A1 - Procede et dispositif de positionnement servant au montage d'un appareil de poursuite - Google Patents

Procede et dispositif de positionnement servant au montage d'un appareil de poursuite Download PDF

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Publication number
WO2001021084A1
WO2001021084A1 PCT/CA2000/001071 CA0001071W WO0121084A1 WO 2001021084 A1 WO2001021084 A1 WO 2001021084A1 CA 0001071 W CA0001071 W CA 0001071W WO 0121084 A1 WO0121084 A1 WO 0121084A1
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WO
WIPO (PCT)
Prior art keywords
contact
rigid
rigid body
layer
tracker
Prior art date
Application number
PCT/CA2000/001071
Other languages
English (en)
Inventor
Antony J. Hodgson
Kevin Bryant Inkpen
Original Assignee
The University Of British Columbia
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by The University Of British Columbia filed Critical The University Of British Columbia
Priority to CA002383096A priority Critical patent/CA2383096A1/fr
Priority to AU73969/00A priority patent/AU7396900A/en
Publication of WO2001021084A1 publication Critical patent/WO2001021084A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • 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
    • A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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
    • A61B2034/2072—Reference field transducer attached to an instrument or patient
    • A—HUMAN NECESSITIES
    • 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
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/061—Measuring instruments not otherwise provided for for measuring dimensions, e.g. length
    • A—HUMAN NECESSITIES
    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B2090/363—Use of fiducial points
    • A—HUMAN NECESSITIES
    • 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
    • A61B2090/3983—Reference marker arrangements for use with image guided surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • 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

Definitions

  • This invention pertains to a method and apparatus for securing one body to another across a soft tissue interface so as to minimize their relative movement, for example, as is required in biomechamcal studies and calibrated surgical interventions
  • RSA loentgen stereophotogrammetry
  • metal spheres typically made of tantalum
  • a mathematical algorithm Kiss J, Murray DW , Turner-Smith AR, Bulstrode CJ Roentgen stereophotogrammet ⁇ c analysis for assessing migration of total hip replacement femoral components, Proceedings of the Institution of Mechanical Engineers, Part H Journal of Engineering in Medicine v 209 n 3 1995, p 169-175
  • optical tracking in which a bone pin is inserted transcutaneously, a marker array mounted to an extension of the bone pin, and an optical measurement device used to identify the location of the marker
  • Marker arrays are typically constructed of either retroreflective markers or of active light- emitting diodes
  • Non-optical tracking systems such as ultrasonic or magnetic systems may also be used in conjunction with bone pins to track the bone Since this technique is invasive, it is undesireable for all but the most critical applications and in more routine applications, less invasive techniques are used For example, it is common in gait laborato ⁇ es to attach optical marker arrays to a sub)ect using elasticized bands wrapped around relevant limb segments Alternatively, retroreflective tape may be applied directly to a subject's skin Unfortunately, since skin can move relative to the underlying bone, any marker mounted to the skin will also move relative to the bone, which introduces inaccuracies into the measurement (Stacoff A Nigg BM, Reinschmidt C, van den Bogert AJ, Lundberg A. Tibiocalcaneal kinematics of barefoot versus shod running. J Biomech. 2000 Nov 1;33(11): 1387-1395).
  • a preoperative scan is made to identify the target for the surgery and the task for the surgeon is to identify this location in the operating room.
  • a common approach is to secure a frame to the patient prior to the preoperative scan (e.g., a stereotactic frame for neurosurgery), leave it intact between taking the scan and performing the surgery, and using it as a reference frame during the surgery to identify the target location.
  • high accuracy is desired (on the order of less than a millimetre), so transcutaneous bone pins are used to provide mounting points for the frame.
  • the present invention relates to a device for indicating the position of a rigid body covered with a layer of soft pliable material, comprising: a rigid element, a plurality of contact surfaces mounted on said rigid element, said contact surfaces being arranged in a pattern wherein each said surface is oriented at a different angle to a reference line of said rigid element so that when the surfaces contact the soft material said contact surfaces apply pressure in different directions relative to said reference line and in a direction normal to an underlying portion of said rigid body, thereby to fix said rigid element substantially immobile relative to said rigid body by a reaction force at each of said contact surfaces acting on said rigid body through said layer of soft pliable material, and a seating means of applying a seating force between said rigid element and said rigid body to force said contact surfaces to apply said pressure and maintained said pressure at each said contact surface during use of the device whereby relative motion between said rigid element and said rigid body due to the soft pliable material sliding tangentially over the body is minimised.
  • At least one of the contact surfaces is adjustable in position relative to said rigid element to accommodate a range of sizes and shapes of said rigid body.
  • a marker array will be fixed to said rigid element.
  • a means of measuring the thickness of the said layer of soft material is incorporated into at least one and more preferably each contact surface to enable the user to correct for any relative motions which may occur, which permits to verify proper attachment of the device, and to monitor any loss of constraint.
  • the present invention also relates to a method of indicating the position of a rigid body when said rigid body is covered with a layer of soft material, comprising the steps of arranging six contact surfaces and fixing them to a common rigid frame, applying said rigid frame so that said surfaces contact the soft material and fully constrain said rigid frame relative to said rigid body by a reaction force at each of the contact surfaces, acting through said layer of soft material substantially normal to the surface of said rigid body in the region of contact, and applying a seating force between said rigid frame and said rigid body such that a reaction force is maintained at each contact surface during use.
  • Fig. 1 (a) shows the frontal aspect of the pelvic region of a typical patient
  • Fig 1 (b) shows the frontal aspect of the pelvic region of a typical patient with an embodiment of the invention as adapted for tracking the pelvis ("hip tracker") applied.
  • Fig. 2 shows the posterior aspect of the patient with the hip tracker applied.
  • Fig. 3 is an exploded view looking on the posterior aspect of the preferred embodiment of the hip tracker.
  • Fig. 4 is a view on the frontal plane of a typical person's pelvic region with the preferred embodiment of the hip tracker applied.
  • Fig. 5 is a modified section view taken on line 4 - 4 of Fig. 4, looking proximally through the pelvic region of the patient with the preferred embodiment of the hip tracker applied.
  • Fig. 6 shows a frontal view on the patient showing the bony outline of the pelvis, reaction forces with substantial components in the frontal plane, the lines of acdon of these reaction forces, and their corresponding contact surfaces on the hip tracker.
  • Fig. 7 shows the head of a typical patient with an embodiment of the invention as adapted for tracking the skull ("head tracker") applied.
  • Fig. 8 is a view looking crainially and posteriorly, parallel to the bridge of the nose, showing the contact point between the patient and the head tracker at the zygomatic arch and at the bridge of the nose over the nasal bones.
  • Fig. 9 is a view on the frontal plane of a typical person's pelvic region with an alternate embodiment of the hip tracker applied.
  • Fig. 10 is a modified section view taken on line 10 - 10 of Fig. 9, looking proximally through the pelvic region of the patient with the alternate embodiment of the hip tracker applied.
  • Fig. 11 shows a frontal view on the patient showing the bony outline of the pelvis, reaction forces with substantial components in the frontal plane, the lines of action of these reaction forces, and their corresponding contact surfaces on the alternate embodiment of the hip tracker.
  • Fig. 12 is a schematic illustration of an contact block of the present invention incorporating an ultrasonic sensor.
  • the present invention takes advantage of the fact that the soft tissues overlying bony structures are often comparatively thin and, once loaded, do not compress significantly more over time. Recognizing that soft tissues are typically mobile parallel to the underlying bony surface, a contact face on an external object is therefore effectively unconstrained except in the normal direction. To achieve full constraint between the external object (rigid element) and the underlying bony structure, then, it is necessary to design a set of six contact faces oriented according to the known principles of fixture design (see, for example, Blanding DL, "Exact Constraint", ASME Press, 1999 for details) so as to prevent relative movement of the two bodies through normal contact forces only.
  • each contact can only sustain compressive forces, means must also be provided for ensuring that each contact is loaded with a bias towards compressive forces to prevent loss of contact and constraint.
  • any system of forces and torques applied to any portion of the above described external object or rigid element can be reduced to a single combination of a force and torque known as a wrench.
  • One means of producing a desired wrench is to apply a set of forces (known as seating forces) equal in number to the number of contact points and oriented substantially collinearly with the normals at the points of contact
  • each applied force affects the contact force only at the one contact point through which it passes
  • it is often inconvenient to apply a force directly through a contact point one may offset the applied force lateral to its direction of application to a more convenient location and apply a countervailing torque to compensate for the added torque produced by the position shift.
  • Forces may be applied to the above described rigid element using a variety of means of reacting against a third body
  • the magnitude and direction of this seating force will therefore be largely insensitive to small motions of the third body relative to the rigid element Since the human arm is compliant, similar to an elastic element, it is possible to provide a desired seating force simply by pushing on the rigid element at the desired point of application of the force on the rigid element in substantially the desired direction.
  • Alternative means of applying the seating force may also be used
  • a mass could be positioned such that the gravitational force acting on this mass acts through the desired point on the rigid element in the desired direction
  • electromagnetic repulsion fields such as are embodied in a solenoid could be used to generate a force between the rigid element and the said third body along a desired line between the two
  • the magnitude of the seating force should be insensitive to small displacements of the the above described rigid element
  • compliant means such as a spring or hand pressure, or other objects which can convert various fields into forces, such as a mass acted on by gravity, a magnet acted upon by a repulsive magnetic field or a solenoid acted upon by an electromagnetic field.
  • Tightened straps may also be used for this purpose if they are themselves sufficiently compliant or if they are wrapped around a compliant object such as a portion of the subject's body covered with a sufficient amount of soft tissue as is taught hereinbelow
  • a system may also be made for tracking the external object with a motion measurement system
  • a motion measurement system This will typically entail providing a mounting point for a marker array (e g , light-emitting diodes for an optoelectronic system, tantalum balls for an RSA system, a receiving coil for a magnetic localizer, etc )
  • a marker array e g , light-emitting diodes for an optoelectronic system, tantalum balls for an RSA system, a receiving coil for a magnetic localizer, etc
  • Fig. 1 (a) shows the frontal aspect of the pelvic region of a typical patient showing the left anterior superior iliac spine (ASIS) 21, the right ASIS 22, and the pubic tubercle 23, all well known bony landmarks palpable on most patients
  • Fig. 1 (b) shows the patient with the preferred embodiment of the hip tracker 26 applied, contacting the patient at bony landmarks 21, 22, and 23
  • a portion of the hip tracker 26, pubic arch contact rod 34 extends through the crotch area to contact the patient at the inferior ramus of the right pubis
  • Waist strap 27 is fastened around the waist under tension and in this embodiment provide means of applying a seating force between said rigid element (tracker structure) and said rigid body (bone in the body of the patient)
  • FIG. 2 shows the posterior aspect of the patient with the hip tracker 26 applied, showing waist strap 27 fastened under tension around the patent's waist proximal to the posterior superior iliac spines and crotch strap 28 emerging from its attachment to the hip tracker at the posterior end of pubic arch contact rod 34 to join the waist strap 27 at a point to the right of the patient's midline.
  • the lengths of straps 27 and 28 can be adjusted and fixed using buckle/adjuster assemblies 29 and 24 respectively and can also be released and rejoined at buckle/adjuster assemblies 29 and 24 without changing their relaxed lengths.
  • the straps 27 and 28 together apply a seating force to the hip tracker 26 oriented posterior, proximal, and towards the patient's right, passing through the area bounded by the contact points between the hip tacker 26 and the patient at the left ASIS, the right ASIS, and the pubic tubercle (see Fig. la).
  • This seating force is generated by the elasticity of the soft tissues lying under the strap and by elasticity in the strap itself.
  • straps 27 and 28 may be replaced by network of elastic material of fixed relaxed length or an elastic garment enveloping the posterior aspect of the patient's pelvic region and attached to the hip tracker 26 such that a posterior, proximal, and rightward oriented seating force is applied to the hip tracker 26 relative to the patient.
  • the seating force is sufficient to ensure positive contact at the six contact points described below between the hip tracker 26 and the patient under the disturbing forces expected during phases of the procedure where the hip tracker's 26 position is being recorded, for example during articulation of the femur.
  • Fig. 3 is an exploded view looking on the posterior aspect of the preferred embodiment of the hip tracker 26.
  • the hip tracker 26 is formed from a rigid element or frame 30 provided with a plurality of mounting slots 100 and 102 including an upper and lower substantially parallel pair of left mounting slots and a corresponding pair of right mounting slots 104 and 106 respectively.
  • the upper slots 100 and 104 are axially aligned as are the lower slots 102 and 106.
  • Also provided in the frame 30 is a set of three parallel slots 108, 110 and 112 that have their axes substantially perpendicular to the axes of the slots 100 and 102.
  • the slot 110 is position substantially on the vertical center line of the frame 30.
  • Left ASIS contact block 31 is bolted to the hip tracker rigid element 30 or frame 30 via bolts 114 and 116 that pass through the slots 100 and 102 respectively and thread into corresponding threaded holes (not shown) in the block 31.
  • the position of the block 31 relative to the frame 30 may be adjusted by loosing the bolts 114 and 116 and sliding along the slots 100 and 102.
  • the width of the slots 100 and 102 may be made wider than the diameters of the bolts 1 14 and 1 16 to permit limited angular adjustment of the block 31 relative to the frame 30
  • ASIS contact block 32 is attached to frame 30 via bolts 118 and 120 extending through the slots 104 and 106 respectively
  • the structure of the connection of the block 32 to the frame 30 is essentially the same as for block 31 and thus will not be described again in detail
  • a right-left adjustment range of at least 85 mm is provided for each ASIS contact block 31 and 32 to accommodate the greater or 'false' pelvis width (distance between the right and left ASIS) of most patients.
  • Block 31 has substantially perpendicular pressure applying surfaces surfaces 36 and 39 and block 32 substantially perpendicular pressure applying surfaces 37 and 40 which will be described below.
  • Pubic tubercle contact block 33 is bolted to the hip tracker frame 30 via bolt 122 passing through the central slot 110 and threading into the block 33 such that the user can move the contact block 33 proximally or distally to lie over the patient's pubic tubercle and then fix it rigidly to frame 30 by tightening the bolt 122
  • Pubic arch contact rod 34 is bolted to the hip tracker frame 30 via bolts 124 and 126 passing through the slot 112 (in the illustrated version, but could be positioned on the opposite side and the bolts 122 and 124 fed through the slot 108) and engaged in threaded connection with the mounting plate 128 fixed at one end of he rod 34 such that the rod 34 can be adjusted proximally or distally as required to contact the right inferior pubic ramus and then fixed rigidly to frame 30 by tightening the bolts 124 and 126.
  • Pubic arch contact rod 34 is oriented such that in the pubic arch region of the typical patient its cylindrical axis lies approximately perpendicular to the axis of the right inferior pubic ramus.
  • the strap 27 is connected at its opposite ends to the frame 30 as indicated by the belt passing through the slots 130 and 132 respectively.
  • the strap 28 is connected at one end to the free end of the rod 34 remote from the plate 128 and at its other end to the strap 27 in a position to apply the required forces to the rod 34 in the required direction.
  • Marker array 35 for locating the hip tracker 26 in space is rigidly attached to the hip tracker frame 30.
  • the attachment means may incoporate features that allow the marker array 35 to be removed and reattached in the same position relative to hip tracker frame 30 with high precision for example iteh illustrated arrangement the shaft 134 of the array is threaded into the hole 136 in the frame 30..
  • Crotch strap 28 is shown with buckle/adjuster 24 fastened, and waist strap 27 is shown with buckle/adjuster 29 released.
  • Fig. 4 is a view on the frontal plane of a typical person's pelvic region with the preferred embodiment of the hip tracker 26 applied The outline of the patient's pelvis is shown in dashed lines (lying underneath the skin and soft tissues)
  • Fig. 5 is a modified section view taken from Fig 4. looking proximally through the pelvic region of the patient with the hip tracker applied
  • the posterior component 41 of the total seating force applied by straps 27 and 28 is reacted by three contact forces acting anteriorly, all approximately normal to the frontal plane of the patient, as follows:
  • a second contact force at surface 37 of right ASIS contact block 32 which is directed anteriorly and is substantially normal to the underlying bony structure of the right ASIS 22, and
  • a third contact force at surface 38 of pubic tubercle contact block 33 which is directed anteriorly and is substantially normal to the underlying bony structure of the pubic tubercle 23.
  • contact surfaces 36, 37, and 38 could be made of compliant materials (such as rubber or gel padding) to improve comfort, at the cost of reduced effectiveness when the net posterior acting seating forces vary or move during use.
  • the posterior component 41 of the seating forces must pass through the area bounded by the three contact points at surfaces 36, 37, and 38 in order to maintain contact and reaction forces at all three points and thereby constrain the hip tracker to a plane.
  • Left ASIS contact block 31 also incorporates left ASIS lateral contact surface 39, which is planar and adducted approximately 20° relative to the sagittal plane and approximately parallel to the AP direction.
  • the reaction force at contact surface 39 due to proximal and rightward seating force components has substantial leftward and distal components.
  • Right ASIS contact block 32 also incorporates right ASIS lateral contact surface 40 and is the mirror image of left ASIS contact block 31 about the sagittal plane.
  • the reaction force at contact surface 40 due to the proximal seating force component has substantial rightward and distal components.
  • Pubic arch contact rod 34 is shown passing through the right side of the crotch, contacting the patient at the skin surface over the right inferior pubic ramus 25.
  • This contact arrangement at the pubic arch may offer improved accuracy in procedures where the left leg is manipulated.
  • pubic arch contact can be mirrored about the sagittal plane and applied to the left side instead (with a corresponding change in the seating forces from rightward to leftward) if desired.
  • Fig. 6 shows a frontal view on the patient showing the bony outline of the pelvis, reaction forces with substantial components in the frontal plane, the lines of action of these reaction forces, and their corresponding contact surfaces on the hip tracker 26.
  • the outline of the hip tracker 26 is shown in phantom lines. This view is provided to more clearly illustrate the forces constraining the hip tracker 26 in the frontal plane (as defined by the frontal plane contact surfaces described in Fig. 5).
  • the proximal component of the seating forces 42 is reacted by the distal components of the reaction forces 44 and 45 acting on surfaces 39 and 40 and the distal component of reaction force 46 acting on pubic arch contact rod 34, preventing proximal-distal translation of the hip tracker 26 relative to the patient.
  • reaction forces 44 and 45 (generated by the proximal seating force 42 and the adducted angles of contact surfaces 39 and 40) define the right-left position and prevent right-left translation of the hip tracker 26.
  • the hip tracker 26 can rotate in the frontal plane about pivot point 50, which is the intersection of the lines of action of forces 44 and 45.
  • the rightward component 43 of the seating force applied to the pubic arch contact rod 34 applies a clockwise moment to the hip tracker 26 when looking on the frontal aspect of the patient, generating reaction force 46 normal to the right inferior pubic ramus 25 where it contacts pubic arch contact rod 34.
  • Rotation of the hip tracker 26 about pivot point 50 is prevented by the moment arm distance 47 between the line of action of reaction force 46 and pivot point 50.
  • rotation about pivot point 51 is prevented by moment arm 48
  • rotation about pivot point 52 is prevented by moment arm 49.
  • Fig. 7 shows the head of a typical patient with an embodiment of the invention as adapted for tracking the skull ("head tracker" 53) applied.
  • a caudal-posterior seating force is applied through three contact blocks or elements 57, 58, and 59 fixed to the rigid element or frame 60 which is biased into position on the head via posterior head strap 55 and chin strap 56.
  • the frame 60 is formed with a main section 60a that is curves and extends from front to rear of the head and a curved branch section 60b that forms a Y shape with the main section and extends laterally thereof.
  • a laterally projecting section curved 60c is rigid with the rest of the frame 60 and projects laterally from the forward end of the main section 60a
  • the head strap 55 passes through a slot 55a in the main section 60a and in a location adjacent the front of the frame 60 to apply a pressure rearward relative to the head.
  • the strap 56 has one end connected to the free end of the branch 60b via slot 56a and at its opposite end to the slot 56b formed in the frame 60 adjacent to the intersection of the sections 60a and 60b.
  • Three contact elements 57, 58, and 59 are each bolted to the rigid element or frame 60 in the illustrated arrangement by suitable bolts 200, 202 and 204 respectively.
  • the bolts pass through their respective slots 200a, 202a and 204a in the frame 60 and 200b, 202b and 204b the pressure element such that they can be moved to the desired position and then fixed rigidly to frame 60.
  • This mounting system provides for adjustment in two mutually perpendicular directions and for rotation about the axis of the respective bolts.
  • the slots 200a and 204a are provided in the main section 60a and the slot 202a in the branch section 60b so three contact elements 57, 58, and 59 may contact an approximately spherical portion of the skull such that the lines of action of each of the three reaction forces normal to the skull are substantially non-collinear. In this example, they will approximately intersect at the nominal centre point of the spherical portion of the skull.
  • a fourth contact element 61 (zygomatic arch contact element 61) is mounted adjacent to a free end of section 60c via a bolt 206 passing through slot 206a in the frame 60 and 206b in the element 62 to permit the same types of relative adjustment between the frame 60 and element 61 as can be attained with the other elements 57, 58 and 59
  • the fourth element 61 forms a fourth constraint applied by zygomatic arch contact element 61 with a line of action normal to the underlying bone of the zygomatic arch which will not pass through the spherical centre defined by the intersection of the lines of action normal to the skull at the three contact elements 57, 58, and 59
  • Nasal bone contact element 62 is mounted on the forward part of the frame section 60a (forward of the slot 55a via a bolt 208 passing through slot 208a in the frame 60 and 208b in the element 62 to permit the same types of relative adjustment between the frame 60 and element 62 as can be attained with the other elements 57, 58 and 59
  • the fifth element 62 provides the fifth and sixth constraints by contacting the skin over the left and right nasal bones via cylindrical shaped contact pads 62a and 62b (see Figure 8)
  • the lines of action normal to the two nasal bones passing through the contact points will intersect at a pivot point located in the nasal passage, a substantial distance from a spherical centre defined by the intersection of the three lines of action normal to the skull passing through the three contact points 57, 58, and 59
  • Marker array 54 for locating the head tracker 53 in space is rigidly attached to the head tracker frame 60 by any suitable means
  • the attachment means may incoporate features that allow the marker array 54 to be removed and reattached in the same position relative to head tracker frame 60 with high precision
  • Fig. 8 is a view looking crainially and posteriorly, parallel to the bridge of the nose, showing the contact point between the patient and the zygomatic arch contact element 61 and the two contact points at nasal bone contact with pads 62a and 62b of element 62.
  • the two cylindrical surfaces of nasal bone contact pads 62a and 62b of element 62 give point contact to a variety of included angles between the nasal bones ('flat' or 'sharp' noses).
  • This additional embodiment of the invention as adapted for tracking the pelvis is described to illustrate that different arrangements of constraints can be used for a particular bony structure. These different arrangements may be desirable to maximize constraint, avoid particular contact points, allow access to certain areas of the patient, or other design or utility reasons.
  • Fig. 9 is a view looking posteriorly on the frontal aspect of the patient's pelvic region with the alternate embodiment of the hip tracker 92 applied. Seating forces are applied by waist strap 96 and crotch strap 97 (see Fig. 10) and act in a posterior, proximal, and leftward direction.
  • Fig. 10 is a modified sectional view taken on line 10 10 of Fig. 9, looking proximally through the pelvic region of the patient with the alternate embodiment of the hip tracker applied.
  • the construction is essentially the same and uses slots, bolts in the rigid frame member 300 to secure the various blocks equivalent to blocks 30, 31 and 32 namely blocks 75, 76 and 33 respectively to the frame 300.
  • the posterior component 80 of the total seating force is reacted by three contact forces acting anteriorly, all approximately normal to the frontal plane of the patient, at surfaces 93, 94, and 95 on the soft tissue over left ASIS 21, right ASIS 22, and pubic tubercle 23.
  • These three contact points define the plane in which the hip tracker 92 lies relative to the patient and prevent orientation changes of the hip tracker relative to the patient, to the degree that the contact surface materials and the soft tissue lying over the bone at the contact points are incompressible.
  • alternate strap 96 (connected at opposite ends to the frame member 300) applies a posterior, proximal leftward seating force and crotch strap 97 applies a substantially posterior and proximal seating force to the hip tracker.
  • Alternate left ASIS contact block 75 does not have a lateral contact surface, and generates no substantial reaction forces not perpendicular to the frontal plane.
  • Alternate right ASIS contact block 76 also incorporates right ASIS lateral contact surface 79 which is substantially parallel to the sagittal plane
  • the reaction force at right ASIS lateral contact surface 79 has a substantial rightward component but no substantial distal component.
  • Pubic arch contact element 77 is different from that of Figure 3 and is in effect U shaped with opposite ends bolted to the frame 300 in a similar manner to the manner in which the plate 128 is fixed to the frame 30
  • the element 77 passes through the right and left sides of the crotch, contacting the patient at the skin surface over the right inferior pubic ramus 25 and left inferior pubic ramus 78.
  • the plane defined by contact at surfaces 93, 94, and 95 will be referred to as the frontal plane in the remaining description of this embodiment.
  • Fig. 11 shows a frontal view on the patient showing the bony outline of the pelvis, reaction forces with substantial components in the frontal plane, the lines of action of these reaction forces, and their corresponding contact surfaces on the hip tracker 92.
  • the outline of the hip tracker 92 is shown in phantom lines This view is provided to more clearly illustrate the forces constraining the hip tracker 92 in the frontal plane (as defined by the frontal plane contact surfaces described in Fig 10)
  • the proximal component of the seating forces 81 is reacted by the distal components of the reaction forces 84 and 85 acting on pubic arch contact element 77 preventing proximal-distal translation of the hip tracker 92 relative to the patient.
  • the opposing medially directed components of reaction forces 84 and 85 (generated by the proximal seating force 81 and the angles of the pubic arch) define the right-left position and prevent right-left translation of the hip tracker 92.
  • the leftward component 82 of the seating forces applies a leftward force to the hip tracker 92 when looking on the frontal aspect of the patient, generating reaction force 83 normal to the right ASIS lateral contact surface 79 and a portion of the leftward component of left pubic arch reaction force 84
  • the hip tracker 92 can rotate in the frontal plane about pivot point 89, which is the intersection of the lines of action of forces 84 and 85.
  • the leftward component 82 of the seating forces applies a clockwise moment to the hip tracker 92 about pivot point 89 when looking on the frontal aspect of the patient, reacted primarily by right ASIS lateral reaction force 83
  • the minimum length of distances 86, 87 and 88 must be such that the torques resisting rotation (computed as sums of cross products between relevant moment arms and reaction force vectors) are greater than the maximum torque expected to be applied to the object In practice the minimum length of the moment arms 86, 87 or 88 will not be less than 5 cm.
  • crotch strap 28 attaches to waist strap 27 on the same side of the patient as the side of the pubic arch chosen for contact to pubic arch contact rod 34 (in the illustration the right side) and adjust the length of crotch strap 28 using adjuster/buckle 24 such that when adjuster/buckle 24 is fastened, crotch strap 28 is under tension sufficient to maintain firm contact at the right inferior pubic ramus 25 (see Fig. 5) under the expected forces and movements during the position recording procedure.
  • hip tracker 26 can be removed and if no subsequent adjustments are made, hip tracker 26 can be reinstalled on the patient in substantially the same position by reapplying straps 27 and 28 (or providing similar seating forces, for example holding the tracker to the patient) and ensuring that firm contact is made at all six contact points between the patient's skin and contact surfaces 36, 37, 38, 39, and 40 as well as pubic arch contact rod 34.
  • Adjust nasal bone contact element 62 to contact the skin over the left and right nasal bones (as shown in Fig. 8) and fix rigidly to frame 60.
  • Adjust zygomatic arch contact element 61 on frame 60 such that it contacts the skin over the zygomatic arch (as shown in Fig. 8) and fix rigidly to frame 60.
  • the head tracker 53 can be removed and if no subsequent adjustments are made, head tracker 53 can be reinstalled on the patient in substantially the same position by reapplying straps 55 and 56 (or providing similar seating forces, for example holding the tracker to the head) and ensuring that firm contact is made at all six contact points between the patient's skin and elements 57, 58, and 59, nasal bone contact element 62, and zygomatic arch contact element 61.
  • FIG. 9 and Fig. 10 adjust left ASIS contact block 75, right ASIS contact block 76, and pubic tubercle contact block 33 such that frontal plane contact surfaces 93, 94, and 95 contact the skin over the most prominent portion of the left ASIS 21, right ASIS 22, and pubic tubercle 23 (shown in Fig la).
  • crotch strap 97 attaches to waist strap 96 roughly at the midline of the patient such that when adjusted and fastened under tension, crotch strap 97 maintains a proximal pull on the hip tracker 92 sufficient to maintain firm contact betwenn pubic arch contact element 77 and the skin over the right inferior pubic ramus 25 and the left inferior pubic ramus 78 (see Fig. 10) under the expected forces and movements during the position recording procedure.
  • the contact block 500 has a pressure contacting surface 502, which could be any of the contacting surfaces described for the various embodiments of the invention shown in the other drawings, and which incorporates an ultrasound transducer 504 that delivers a signal to the signal processor 506 as indicated by the line 508.
  • the signal processor 506 determines the distance between the contact surface 502 and the bone (not shown) against which it presses based on the signal from the transducer 504. This information may be used in any suitable manner.
  • a warning or display device 512 may show the actual or the change in spacing and/or send a warning if the distance between any one of the contacting surfaces 502 and the bone exceeds a preset limit. It will be apparent to one skilled in the art that variations of this method in which additional normal constraints are applied through adjustable means may effectively convert a force- closed constraint to a form-closed constraint which may in selected cases improve the resistance of the system to dislodgement without affecting the degree of relative movement or repeatability during remounting.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Medical Informatics (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Neurosurgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Pathology (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Orthopedics, Nursing, And Contraception (AREA)

Abstract

L'invention concerne un procédé consistant à apposer un corps sur un autre, à travers une interface de tissu mou, de manière à minimiser le déplacement relatif entre les deux corps au moyen de contraintes normales, afin d'atténuer les altérations cutanées dues aux mouvements. Des appareils selon l'invention comprennent plusieurs surfaces de contact ainsi que des moyens d'application de forces de repos, de même qu'ils peuvent comporter des mécanismes de réglage permettant leur adaptation sur différentes tailles de corps, ainsi que, le cas échéant, des moyens de détection permettant de compenser les petits mouvements et de surveiller le bon fonctionnement du système.
PCT/CA2000/001071 1999-09-17 2000-09-15 Procede et dispositif de positionnement servant au montage d'un appareil de poursuite WO2001021084A1 (fr)

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CA002383096A CA2383096A1 (fr) 1999-09-17 2000-09-15 Procede et dispositif de positionnement servant au montage d'un appareil de poursuite
AU73969/00A AU7396900A (en) 1999-09-17 2000-09-15 Positioning method and apparatus for mounting a tracker

Applications Claiming Priority (2)

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US60/154,367 1999-09-17

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FR2814668A1 (fr) * 2000-09-29 2002-04-05 Bertrand Lombard Dispositif porte-bloc emetteur et procede et dispositif de navigation chirurgicale associes
WO2004089192A2 (fr) 2003-04-02 2004-10-21 Kinamed, Inc. Localisateur de plan pelvien et dispositif de positionnement pour patient
EP1482853A1 (fr) * 2002-02-13 2004-12-08 Kinamed, Inc. Systeme de navigation sans imagerie assiste par ordinateur concu pour des operations chirurgicales de remplacement de la hanche
EP1569576A2 (fr) * 2002-08-09 2005-09-07 Kinamed, Inc. Outils de localisation sans imagerie et procede chirurgical de remplacement de hanche
EP1632193A1 (fr) * 2004-09-02 2006-03-08 BrainLAB AG Système de recalage de hanche
WO2011029934A1 (fr) * 2009-09-11 2011-03-17 Materialise N.V. Outil chirurgical, thérapeutique, ou diagnostique
EP2368530A1 (fr) * 2010-03-25 2011-09-28 In Novation B.V. Système de navigation pour chirurgie orthopédique
US8712503B2 (en) 2006-09-21 2014-04-29 Brainlab Ag Pelvic registration device for medical navigation
WO2015150185A1 (fr) * 2014-04-03 2015-10-08 Aesculap Ag Système médical de fixation ainsi que dispositif de repérage et jeu d'instruments médicaux
JP2019513474A (ja) * 2016-04-15 2019-05-30 ザクト ロボティクス リミテッド 医療機器を対象に取り付けるための装置及び方法

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US5423832A (en) * 1993-09-30 1995-06-13 Gildenberg; Philip L. Method and apparatus for interrelating the positions of a stereotactic Headring and stereoadapter apparatus
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Cited By (25)

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Publication number Priority date Publication date Assignee Title
FR2814668A1 (fr) * 2000-09-29 2002-04-05 Bertrand Lombard Dispositif porte-bloc emetteur et procede et dispositif de navigation chirurgicale associes
EP1482853A1 (fr) * 2002-02-13 2004-12-08 Kinamed, Inc. Systeme de navigation sans imagerie assiste par ordinateur concu pour des operations chirurgicales de remplacement de la hanche
EP1482853A4 (fr) * 2002-02-13 2010-10-27 Kinamed Inc Systeme de navigation sans imagerie assiste par ordinateur concu pour des operations chirurgicales de remplacement de la hanche
EP1569576A4 (fr) * 2002-08-09 2009-04-08 Kinamed Inc Outils de localisation sans imagerie et procede chirurgical de remplacement de hanche
US8271066B2 (en) 2002-08-09 2012-09-18 Kinamed, Inc. Non-imaging tracking tools and method for hip replacement surgery
EP1569576A2 (fr) * 2002-08-09 2005-09-07 Kinamed, Inc. Outils de localisation sans imagerie et procede chirurgical de remplacement de hanche
US8002772B2 (en) 2002-08-09 2011-08-23 Kinamed, Inc. Non-imaging tracking tools and method for hip replacement surgery
JP2006521896A (ja) * 2003-04-02 2006-09-28 キナメッド・インコーポレーテッド 骨盤平面位置特定器及び患者位置決め器
WO2004089192A2 (fr) 2003-04-02 2004-10-21 Kinamed, Inc. Localisateur de plan pelvien et dispositif de positionnement pour patient
US8657830B2 (en) 2003-04-02 2014-02-25 Kinamed, Inc. Pelvic plane locator and patient positioner
EP1610705A4 (fr) * 2003-04-02 2010-05-05 Kinamed Inc Localisateur de plan pelvien et dispositif de positionnement pour patient
JP2011050786A (ja) * 2003-04-02 2011-03-17 Kinamed Inc 骨盤平面位置特定器及び患者位置決め器
EP1610705A2 (fr) * 2003-04-02 2006-01-04 Kinamed, Inc. Localisateur de plan pelvien et dispositif de positionnement pour patient
JP4777878B2 (ja) * 2003-04-02 2011-09-21 キナメッド・インコーポレーテッド 骨盤平面位置特定器及び患者位置決め器
US8162955B2 (en) 2004-09-02 2012-04-24 Brainlab Ag Registering intraoperative scans
EP1632193A1 (fr) * 2004-09-02 2006-03-08 BrainLAB AG Système de recalage de hanche
US8712503B2 (en) 2006-09-21 2014-04-29 Brainlab Ag Pelvic registration device for medical navigation
WO2011029934A1 (fr) * 2009-09-11 2011-03-17 Materialise N.V. Outil chirurgical, thérapeutique, ou diagnostique
EP2368530A1 (fr) * 2010-03-25 2011-09-28 In Novation B.V. Système de navigation pour chirurgie orthopédique
US8568419B2 (en) 2010-03-25 2013-10-29 Hipsecure B.V. Navigation system for orthopaedic surgery
WO2015150185A1 (fr) * 2014-04-03 2015-10-08 Aesculap Ag Système médical de fixation ainsi que dispositif de repérage et jeu d'instruments médicaux
JP2017509428A (ja) * 2014-04-03 2017-04-06 アエスキュラップ アーゲー 医療用緊締装置及び参照装置、並びに医療機器
US10507062B2 (en) 2014-04-03 2019-12-17 Aesculap Ag Medical fastening device and referencing device and medical instrumentation
JP2019513474A (ja) * 2016-04-15 2019-05-30 ザクト ロボティクス リミテッド 医療機器を対象に取り付けるための装置及び方法
US11103277B2 (en) 2016-04-15 2021-08-31 Xact Robotics Ltd. Devices and methods for attaching a medical device to a subject

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CA2383096A1 (fr) 2001-03-29
AU7396900A (en) 2001-04-24

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