WO2005048852A1 - Outil intelligent a commande automatique destine au fraisage d'os - Google Patents

Outil intelligent a commande automatique destine au fraisage d'os Download PDF

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Publication number
WO2005048852A1
WO2005048852A1 PCT/EP2004/013079 EP2004013079W WO2005048852A1 WO 2005048852 A1 WO2005048852 A1 WO 2005048852A1 EP 2004013079 W EP2004013079 W EP 2004013079W WO 2005048852 A1 WO2005048852 A1 WO 2005048852A1
Authority
WO
WIPO (PCT)
Prior art keywords
path
wheels
movement
predetermined
control
Prior art date
Application number
PCT/EP2004/013079
Other languages
German (de)
English (en)
Inventor
Werner Korb
Stefan Hassfeld
Jörg Raczkowsky
Helge Peters
Dirk Engel
Original Assignee
Universität Heidelberg
Universität Karlsruhe
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 Universität Heidelberg, Universität Karlsruhe filed Critical Universität Heidelberg
Publication of WO2005048852A1 publication Critical patent/WO2005048852A1/fr

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Classifications

    • 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
    • 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
    • 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
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/75—Manipulators having means for prevention or compensation of hand tremors
    • 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
    • A61B17/1695—Trepans or craniotomes, i.e. specially adapted for drilling thin bones such as the skull
    • 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
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • 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
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0801—Prevention of accidental cutting or pricking
    • A61B2090/08021—Prevention of accidental cutting or pricking of the patient or his organs
    • 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
    • A61B34/30—Surgical robots

Definitions

  • the present invention relates to a method and an apparatus for material-removing processing of tissue on the human or animal body, such as, for example, milling or drilling on bones.
  • ITD Intelligent Tool Drive
  • the goal of the project is a small 5-DOF manipulator based on parallel kinematics, which enables the automatic alignment and stabilization of a drill in medical applications (pedicle screwing). External disturbances such as involuntary transient movements of the operator and the hand tremor are to be compensated for and the drill tip stabilized.
  • the handheld surgical robot ITD is intended to combine the possibilities of robotics (high precision) with those of navigation (simplified orientation to the patient) and the experience of the surgeon.
  • the tremor of the hand is intended to compensate for a tremor movement, which is individually around 4-5 and 8-12 Hz, in order to guide the drill or instrument tip smoothly.
  • the system has a limited working space due to its kinematics. Areas of application are in the pre-drilling of pedicle screws in the spine. The system cannot easily mill trajectories.
  • robots in surgery for bone processing have so far mostly been used to place boreholes or when milling shafts to place hip prostheses.
  • former industrial robots for surgery were usually upgraded to comply with the safety regulations.
  • Commercialized, well-known robots are, for example, "Robodoc” (Davies, USA), “Caspar” (Schwerin, DE), “Neuromate” (Davies, USA), “Otto” (Berlin, DE) and “Pathfinder” (England, UK)
  • the inventors developed a robot system for milling trajectories, but the use of a robot suffers from the disadvantage that it requires a great deal of logistical and technical effort in sterilization and in ensuring the required safety.
  • the object of the invention is therefore to provide a device and a method for material-removing processing of a tissue on the human or animal body, which can precisely adhere to a given processing path, is easy to operate and avoids the disadvantages of the prior art.
  • This object is achieved with a device for path control of a medical instrument with the features according to claims 1 and 15 and with a method with the features according to claim 8.
  • Advantageous developments of the invention are set out in the dependent claims.
  • a device for path regulation of a medical instrument the path of which is regulated relative to a tissue on the human or animal body and which has the following components: one or more wheels or sliding or rolling elements for supporting the device on the treating body; and one or more actuators for moving the device or influencing the movement of the device along a predetermined or predeterminable path on the basis of movement signals fed into the device, the path of movement of the device in particular by means of a locating system that can be attached to it for detecting the position of the device is detectable.
  • Robots with wheels and without kinematics to be used in human surgery The coupling with the navigation allows local, precise
  • the actuators can be designed as brakes which influence the predetermined movement path of the device by means of a corresponding signal from the control unit for braking at least one of the wheels.
  • the surgeon's hand can be corrected so that the predetermined path is essentially achieved.
  • the wheels can alternatively be driven and a drive signal from the control unit can be issued so that the
  • Movement of the device is affected. Instead of braking one wheel or in addition to this, the opposite wheel is driven in order to carry out the previously described path correction.
  • This construction the so-called active variant
  • the brakes as actuators
  • the device is activated by a sliding shoe on the tissue part to be processed, i.e. clamped or guided on the skull so that the device is supported on one side by the wheels and on the other side by the slide shoe.
  • This provides secure support or guidance of the device, so that an unintentional injury to adjacent tissue parts, such as the brain skin, can advantageously be avoided.
  • the device can be provided with a deviation control device for preoperatively setting permissible deviations from the specified movement path.
  • a deviation control device for preoperatively setting permissible deviations from the specified movement path.
  • the object is achieved according to the invention by a method for path control of a medical device relative to a tissue human or animal body solved with the following steps: setting a predetermined trajectory of the device; Supporting the path control device on the body to be treated by means of one or more wheels; Detecting the trajectory of the device; and controlling actuators of the device for influencing the path of the device on the basis of a comparison of the predetermined movement path with the detected movement path.
  • the individual elements such as wheels for support on the fabric part to be machined, sliding shoe or shoes, brakes and / or
  • FIG 1 shows an inventive device for material-removing processing of tissue on the human body.
  • FIG. 2 shows an exploded view of the device from FIG. 1.
  • Fig. 3 shows the use of the device as a craniotome for sawing out a bone flap.
  • Fig. 4 shows a block diagram of the individual components of the control or regulation of the device.
  • the device has a drive and driving system for traveling along a predetermined path, which essentially consists of a frame 2 and one or more wheels or sliding or rolling elements 4.
  • the device is intended to follow a predetermined path on the body of a human or animal to be treated. This path is determined preoperatively from computer tomographic data, for example.
  • the device with the wheels 4 is placed on the patient's body by means of a handle or handpiece 1.
  • a localization system 9 which can be attached to the device and / or by a separate localization system 9 (for example with one or more cameras) certainly.
  • a localization system 9 is sufficiently known in the relevant art and are therefore not to be described in more detail here. These systems are based on mechanical, optical, electromagnetic or other principles or a combination of the same.
  • the localization system 9 sends a signal in accordance with the respective position of the tool 6 or from corresponding reference points thereof to a control unit 8, which has access to the image or planning data of the operation.
  • the control unit 8 is now able to determine the actual path of the machining from the received position data with respect to the position of the tool 6 and to compare this with the preoperatively determined or definable target path.
  • control unit 8 can determine a path correction and send a corresponding signal to one or more actuators 10 of the device, which have one or more brakes 3a, 3b (in the "passive variant") or one or more Motors or drives (in the "active variant").
  • the surgeon preferably moves the device manually using the handle 1 along the predetermined path, with the brakes 3a, 3b through the
  • Control unit 8 are controlled with signals so that the device maintains the predetermined path.
  • the device is moved forward and guided (manually) by the surgeon, but the device corrects the hand of the surgeon in such a way that the predetermined path is essentially fulfilled or that the device essentially follows this predetermined path.
  • the brakes 3a, 3b are preferably controlled electrically and act mechanically on the wheels 4 via a brake block 3c.
  • the brakes can have an electromagnetic design or an electrostrictive design.
  • the brakes 3a, 3b can act by frictional engagement, positive locking or magnetically, for example by eddy current.
  • Materials of the components of the brakes 3a, 3b and the wheels 4 are selected such that abrasion is minimal and, at the same time, a quick and reliably constant response behavior of the brakes 3a, 3b is ensured. In addition, their sterilization is simple and inexpensive to carry out.
  • Suitable materials are, for example, plastics, in particular based on carbon, metals, in particular titanium or aluminum alloys, ceramics, composite materials and the like. However, all other suitable materials can also be used.
  • the device is actively driven by the wheels 4, i.e. the wheels 4 are equipped with motors (not shown) with encoders, which essentially move the device along the predetermined path on the basis of the signals from the control unit 8, either the brakes 3a, 3b can be omitted or the device can alternatively also be used the brakes 3a, 3b.
  • the encoders allow redundant monitoring and control in addition to the localization system 9.
  • the drive of the wheels 4 is triggered by a slight pressure on the handle 1 by the surgeon. In other words, the device only starts moving when the surgeon exerts a slight pressure on the device in the direction of the predetermined path. The device can be stopped at any time by applying slight pressure against the direction of movement.
  • the control or regulation of the brakes 3a, 3b or the motors is designed so that certain deviations from the predetermined path are permitted.
  • these deviations are less than approximately 0.6 mm, preferably less than approximately 0.3 mm.
  • the deviation from the planned path should be less than approximately 1 mm, preferably less than approximately 0.5 mm.
  • the deviation from the planned path is less than approximately 1 mm, preferably less than approximately 0.5 mm.
  • the cutting error is below approximately 1.5 mm, preferably below approximately 1 mm.
  • the device can also be designed in such a way that higher or lower deviations than those described above are permitted.
  • the device can alternatively be designed such that the permissible deviation can be determined preoperatively via an input unit of a computer or the like.
  • the device is preferably used in oral, maxillofacial or facial surgery or for skull operations. However, it can also be used in orthopedics, for example for screwing pedicle screws. For additional guidance of the device, this can also be done with a
  • Be equipped sliding shoe 7, which, as shown in Fig. 1 and 2, is formed substantially in an L-shape.
  • This slide shoe 7 essentially has a web 7a running parallel to a tool and a guide plate or element 7b which is inclined, preferably essentially perpendicular, to it.
  • the body tissue to be processed such as a bone, is at least temporarily clamped or arranged between the guide plate 7b on one side and the wheels 4 on the other side.
  • a thickness compensation of the body tissue is preferably made possible by a spring 5, which allows a longitudinal displacement of the slide shoe 7, preferably essentially along the longitudinal extent of the web 7a.
  • the slide shoe 7 enables the device to be clamped to the skull cap by the guide plate 7b of the sliding shoe 7 slides along the inside of the cranium while the wheels 4 roll on the outside thereof. This prevents the tool from penetrating too deeply into the patient's skull.
  • an incision path is determined preoperatively on the skull.
  • a plurality of boreholes 21 are formed using a so-called trepan 26.
  • the dura mater (brain skin) is released from the bone with these differently curved detachment elements (so-called raspatories) 22, 23.
  • the tool 6 clamped in the device can now be inserted into the skull through one of the drilled holes 21 and the predetermined or precalculated milling path 25 can essentially be traversed in order to separate or mill out the bone cover 24. Damage to the brain is avoided in that the depth of penetration of the
  • Tool 6 into the skull is advantageously limited by the previously described sliding block 7.
  • the feed force of the device can also be applied entirely or partially by driving the wheels 4 by means of the motors.
  • the feed is switched on by the motors either by a separate switch or by "pushing" the device, i.e. by pushing the device placed on the patient's body, the wheels 4 are rotated.
  • a signal is generated in the motor or in a separate rotation angle or speed sensor (not shown), which is sent to the control unit 8.
  • the control unit 8 now starts driving the wheels 4 in response to this signal input.
  • the stopping of the device can in turn be triggered either by a separate switch or by braking the device by introducing a force at least partially opposite the direction of movement of the device via the handle 1.
  • the speed sensors or the motors now in turn transmit a corresponding signal to the control unit 8, whereupon the latter switches off the motors or activates the brakes 3a, 3b.
  • the device is not limited to the construction described here and both exemplary embodiments can be combined as desired.
  • the device can also be equipped with more than two wheels, Braked wheels as well as driven wheels and free-running wheels can be used.
  • the sliding block 7 can also be provided with small wheels at its tip, so that it rolls instead of sliding on the tissue part to be supported or on a tissue part to be protected from the processing tool, for example the dura mater.
  • the brakes are not only mechanically in the manner described here, but also electrically, hydraulically etc.
  • the motors integrated in the wheels 4 described here which are preferably electrically driven motors, but not on them are limited. These can also be arranged separately from the wheels 4 and drive the wheels 4 via appropriate gear means.
  • the tool 6 described here is not limited to a cutting tool such as a milling cutter or drill. It is also possible, for example, to clamp or use a laser in the device according to the invention. In addition, it would also be conceivable to use a diagnostic device as the medical instrument, such as ultrasound, X-ray, computed tomography, in connection with the device according to the invention.
  • a diagnostic device such as ultrasound, X-ray, computed tomography
  • the device can be used in all those applications where precise path control relative to a tissue on the human or animal body is important.
  • the device according to the invention can (in the passive variant) also be used in connection with a robot, whereby it is held by a robot arm instead of by the hand of a surgeon and is operated by remote control.
  • the robot arm follows (equipped with a force torque sensor) Specifications of the device according to the invention and redundantly monitors the movements.
  • the robot can then also be used as a localization system 9 in its capacity as a measuring system.
  • the device described here can also be used to shutdown predetermined
  • Lanes 25 can also be used to drive over open spaces.
  • a permissible and an impermissible area (which includes, for example, risk structures to be protected) is defined in the planning.
  • the brakes 3a, 3b and / or actuators in interaction with the localization system 9 restrict the movements to the permissible area.
  • Handpiece frame a, b brake c brake pad wheels spring tool slide shoe a web guide plate control unit localization system0 actuator1 borehole2 raspatory3 raspatory4 bone lid5 predetermined path6 trepan

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • Public Health (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Veterinary Medicine (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Robotics (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Dentistry (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Manipulator (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un dispositif et un procédé de régulation de la trajectoire d'un instrument médical par rapport à un tissu d'un corps humain ou animal, comportant des roues (4) destinées à l'appui du dispositif sur le corps à traiter, et des actionneurs destinés à influencer le mouvement du dispositif manipulé par un chirurgien. La trajectoire du dispositif est enregistrée par un système de localisation (9) interne ou externe et comparée à une trajectoire prédéfinie. Sur la base de cette comparaison, une unité de régulation (8) émet des signaux correspondants de correction de trajectoire aux actionneurs conçus en tant que freins (3a, 3b) et/ou moteurs. De cette manière, il est possible de suivre précisément une trajectoire au moyen d'un dispositif d'utilisation simple.
PCT/EP2004/013079 2003-11-18 2004-11-18 Outil intelligent a commande automatique destine au fraisage d'os WO2005048852A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE10353700A DE10353700B4 (de) 2003-11-18 2003-11-18 Gerät zur Bahnregelung eines medizinischen Instruments und Regelungseinheit dafür
DE10353700.7 2003-11-18

Publications (1)

Publication Number Publication Date
WO2005048852A1 true WO2005048852A1 (fr) 2005-06-02

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Application Number Title Priority Date Filing Date
PCT/EP2004/013079 WO2005048852A1 (fr) 2003-11-18 2004-11-18 Outil intelligent a commande automatique destine au fraisage d'os

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DE (1) DE10353700B4 (fr)
WO (1) WO2005048852A1 (fr)

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
AT503933B1 (de) * 2006-12-12 2008-02-15 Strehl Bernhard Dr Instrument zur anfertigung von öffnungen in knochen in form eines knochendeckels
WO2009049863A1 (fr) * 2007-10-17 2009-04-23 Rheinisch-Westfälische Technische Hochschule Aachen Dispositif et procédé de traitement de matériaux
US8876830B2 (en) 2009-08-13 2014-11-04 Zimmer, Inc. Virtual implant placement in the OR
US9345552B2 (en) 2011-09-02 2016-05-24 Stryker Corporation Method of performing a minimally invasive procedure on a hip joint of a patient to relieve femoral acetabular impingement
US10368878B2 (en) 2013-06-11 2019-08-06 Orthotaxy System for positioning a surgical device
CN110974420A (zh) * 2019-11-29 2020-04-10 上海交通大学 一种用于开颅手术的机械臂末端稳定装置

Families Citing this family (2)

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Publication number Priority date Publication date Assignee Title
DE102006031356B4 (de) * 2006-07-06 2012-02-16 Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. Vorrichtung zum lokalen Abtrag von menschlichem oder tierischem Knochenmaterial
DE102013201783B4 (de) * 2013-02-04 2019-03-07 Leica Microsystems (Schweiz) Ag Lageausgleichsvorrichtung für Stative für medizinische Geräte

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US6285902B1 (en) * 1999-02-10 2001-09-04 Surgical Insights, Inc. Computer assisted targeting device for use in orthopaedic surgery

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US4676780A (en) * 1986-02-21 1987-06-30 Hans Lee Surgical apparatus for performing suction lipectomy
US6368332B1 (en) * 1999-03-08 2002-04-09 Septimiu Edmund Salcudean Motion tracking platform for relative motion cancellation for surgery
JP3268357B2 (ja) * 2000-01-13 2002-03-25 独立行政法人産業技術総合研究所 位置と方向を規定するリンク機構
US6837892B2 (en) * 2000-07-24 2005-01-04 Mazor Surgical Technologies Ltd. Miniature bone-mounted surgical robot
DE10055293A1 (de) * 2000-11-03 2002-05-29 Storz Karl Gmbh & Co Kg Vorrichtung zum Halten und Positionieren eines endoskopischen Instruments

Patent Citations (1)

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Publication number Priority date Publication date Assignee Title
US6285902B1 (en) * 1999-02-10 2001-09-04 Surgical Insights, Inc. Computer assisted targeting device for use in orthopaedic surgery

Cited By (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
AT503933B1 (de) * 2006-12-12 2008-02-15 Strehl Bernhard Dr Instrument zur anfertigung von öffnungen in knochen in form eines knochendeckels
WO2009049863A1 (fr) * 2007-10-17 2009-04-23 Rheinisch-Westfälische Technische Hochschule Aachen Dispositif et procédé de traitement de matériaux
US20110208196A1 (en) * 2007-10-17 2011-08-25 Klaus Radermacher Device and method for working material
DE102007050017B4 (de) 2007-10-17 2021-07-29 Orthotaxy Sas Vorrichtung zur Materialbearbeitung
US9463031B2 (en) 2007-10-17 2016-10-11 Minmaxmedical Device and method for working material
US8876830B2 (en) 2009-08-13 2014-11-04 Zimmer, Inc. Virtual implant placement in the OR
US9622823B2 (en) 2011-09-02 2017-04-18 Stryker Corporation Method for repairing focal defects in tissue of a patient
US9707043B2 (en) 2011-09-02 2017-07-18 Stryker Corporation Surgical instrument including housing, a cutting accessory that extends from the housing and actuators that establish the position of the cutting accessory relative to the housing
US10813697B2 (en) 2011-09-02 2020-10-27 Stryker Corporation Methods of preparing tissue of a patient to receive an implant
US9345552B2 (en) 2011-09-02 2016-05-24 Stryker Corporation Method of performing a minimally invasive procedure on a hip joint of a patient to relieve femoral acetabular impingement
US11135014B2 (en) 2011-09-02 2021-10-05 Stryker Corporation Surgical instrument including housing, a cutting accessory that extends from the housing and actuators that establish the position of the cutting accessory relative to the housing
US11896314B2 (en) 2011-09-02 2024-02-13 Stryker Corporation Surgical instrument including housing, a cutting accessory that extends from the housing and actuators that establish the position of the cutting accessory relative to the housing
US10368878B2 (en) 2013-06-11 2019-08-06 Orthotaxy System for positioning a surgical device
US10441294B2 (en) 2013-06-11 2019-10-15 Depuy Ireland Unlimited Company System for the treatment of a planned volume of a body part
CN110974420A (zh) * 2019-11-29 2020-04-10 上海交通大学 一种用于开颅手术的机械臂末端稳定装置

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Publication number Publication date
DE10353700B4 (de) 2008-04-03
DE10353700A1 (de) 2005-06-23

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