WO2009109669A1 - Système pour la résection du plateau tibial et/ou des condyles fémoraux pour implanter une prothèse - Google Patents

Système pour la résection du plateau tibial et/ou des condyles fémoraux pour implanter une prothèse Download PDF

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Publication number
WO2009109669A1
WO2009109669A1 PCT/ES2008/000127 ES2008000127W WO2009109669A1 WO 2009109669 A1 WO2009109669 A1 WO 2009109669A1 ES 2008000127 W ES2008000127 W ES 2008000127W WO 2009109669 A1 WO2009109669 A1 WO 2009109669A1
Authority
WO
WIPO (PCT)
Prior art keywords
femur
resection
cutting
tibia
support
Prior art date
Application number
PCT/ES2008/000127
Other languages
English (en)
Spanish (es)
Inventor
Luis Marquez Alvarez
Original Assignee
Traiber, S.L.
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 Traiber, S.L. filed Critical Traiber, S.L.
Priority to ES201090061A priority Critical patent/ES2406607B1/es
Priority to PCT/ES2008/000127 priority patent/WO2009109669A1/fr
Publication of WO2009109669A1 publication Critical patent/WO2009109669A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • A61B17/155—Cutting femur
    • 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
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • 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
    • A61B17/154—Guides therefor for preparing bone for knee prosthesis
    • A61B17/157—Cutting tibia
    • 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
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1675—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the knee
    • 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
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • 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
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/102—Modelling of surgical devices, implants or prosthesis
    • 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
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/105—Modelling of the patient, e.g. for ligaments or bones

Definitions

  • the present invention belongs to the field of knee prostheses and more specifically proposes a method and system for carrying out the resection of the tibial plateau and / or the condyles of the femur for the implantation of the prosthesis.
  • the object of the invention consists of a system by means of which a preoperative study is carried out that models the tibia and the femur of the patient in 3D to define the ideal cutting plane and models the position of the instruments to cut the bone, and then, in The stage of surgery, translates and redefines on the tibia and the patient's femur the data of the position and real orientation of the instruments to practice the resection according to said cutting plane.
  • Another object of the invention relates to the program that executes the described modeling method.
  • An intervention of total knee replacement consists in the implantation of a prosthesis that acts as a prosthesis.
  • the intervention consists first of all in cutting the lower end of the femur and the upper end of the tibia to leave a surface where the elements of the prosthesis can be implanted. Then, between these two elements, a separation of polyethylene is placed that allows rotation and compensation of the tibial cut.
  • the spatial orientation refers to the orientation of the cutting plane of the tibia and / or the femur.
  • the surgeon has to resect the tibia and / or the femur in a plane with a spatial orientation defined by two angles with respect to an imaginary axis that passes through the mechanical axis thereof.
  • This imaginary axis is mentally constructed by the surgeon from direct visual information or images of X-ray fluoroscopy. Since it is a qualitative estimate, sometimes the prosthesis cannot be placed in the desired alignment. Thus, the difficulty of this process is to transport in the most precise way possible the orientation of the cutting plane with respect to the mechanical axis of the bone, decided from the preoperative images, to the "patient coordinates" during the surgical intervention.
  • the solutions used during the intervention include the use of surgery, the use of navigators or robotic systems.
  • Another solution includes the use of commercial browsers consisting of computer vision systems based on a stereoscopic pair of infrared cameras. Once the cameras are calibrated, it is possible to determine by triangulation the 3D coordinates of a visible point by two cameras at the same time.
  • the surgeon creates an individual anatomical map for each patient.
  • markers Prior to the intervention, markers are fixed to the bone (tibia and / or femur) of the patient.
  • diodes LEDs that emit infrared light are fixed so that they are easily visible by the cameras.
  • the computer can deduce the 3D (patient) coordinates of the markers from the 2D coordinates of the diodes captured in each camera.
  • the emitting diodes are fixed to the patient, it does not matter if the leg moves as its position is recalculated constantly. In this way, movements and reference points can be recorded and, from these data, the navigation system shows the position of the instruments in relation to the available information of the patient on the computer screen. In this way, the surgeon is assisted in the alignment of the instruments during the intervention to ensure the correct implantation of the prosthesis.
  • Another solution consists in the use of robotic arms, commanded by computer, which can perform bone resection automatically with the help of a navigator and / or preoperative images. Therefore they turn out to be even more complex systems than those of browsers.
  • the preoperative study tries to obtain all the geometric data of the tibia and / or the femur by means of exploration that can consist of devices designed to perform scanning operations, MRI, radiography or computed tomography, for example.
  • the instruments used for resection include a support that is embedded in the bone, a guide holder that is mounted on the support that at its end has the positioning support of the cutting guide and a cutting guide.
  • the set consisting of virtual support, virtual guide and virtual cutting guide is fixed, establishing the position and orientation of the virtual support on the bone, so that the plane of the groove of the The cutting guide coincides with the ideal cutting plane selected by the surgeon.
  • the phases described are performed in the preoperative study, then, in the stage of surgery, the support is placed in the tibia or in the patient's femur at a point and in a position approximately coincident with those obtained for virtual support.
  • a plaque is mounted on it reference that is preferably formed by translucent material to an x-ray and opaque radio elements.
  • scanning means are applied on the reference plate, preferably approximately orthogonal fluoroscopies are performed, which are loaded to the program, where a second virtual model is obtained in which the upper profile of the tibia or the femur, the support is appreciated and the reference plate.
  • the position and orientation of the virtual model can be compared with the position and orientation of the real model, and as a result the program presents the correction data.
  • the position of the guide holder is made relative to the place of the guide holder that is fixed to the support.
  • the guide holder configuration is adjusted, it is positioned on the support and the cutting guide in the guide, then proceeding to introduce the cutting tool through the groove to perform bone resection.
  • the execution of the cut or resection is carried out according to this modeling method oriented to the tibia and / or femur of the patient to be treated and without the need to use intra or extramedullary guides.
  • Figure 1. Shows a schematic representation of the system for the resection of the tibial plateau.
  • Figure 2.- Shows a perspective view of the support.
  • Figure 3. Shows a perspective view from below of the reference plate.
  • Figure 4. Shows a perspective view from above of the reference plate.
  • Figure 5. Shows a perspective view from below of the guide.
  • Figure 6. Shows a perspective view from the top of the guide.
  • Figure 7.- Shows a view of the guide holder according to section A-A practiced in Figure 6.
  • Figure 8.- Shows a previous perspective view of the cutting guide.
  • Figure 9.- Shows a rear perspective view of the cutting guide.
  • Figure 10.- Shows a perspective view of the calibration tool.
  • the system for resection of the tibial plateau proposed by this invention is based on the basic incorporation of:
  • the system additionally comprises the following elements:
  • a removable reference plate (7) that is mounted on the fixing support (1) to, through the scanning means (5), send images of the position and orientation of the fixing support (1) to the computer ( 6), in which they are compared with the virtual positions of the instruments to redefine the cutting plane and consequently the relative position of the cutting instruments (1, 2, 3),
  • the fixing support (1) comprises a nail (5), a cylindrical central section (6) and a quasi-cylindrical upper section (37) topped by a vertical plane, inside the which is a longitudinal drill (8).
  • the reference plate (7) as seen in Figures 3 and 4, consists of a central body (9) provided with a cavity (10) of configuration adaptable to the upper section (37) of the fixing support ( 1), a transparent body to the radiographs (11) that surrounds the central body (9) and opaque radio spheres (12) integrated in the transparent body to the radiographs (11).
  • a screw (13) can be penetrated, which screws into the longitudinal hole (8) of the fixing support (1), linking the reference plate (7) with said fixing support (1).
  • the guide (2) incorporates a positioning support of the cutting guide (14) in which a groove (24) is defined to receive the cutting guide (3), represented in Figure 8.
  • the positioning support of the cutting guide (14) is integral with parallel shafts (15) connected in turn by their opposite ends, on which a carriage (16) is constituted consisting of two plates ( 17), upper and lower, joined together by thymes (18), which slide with respect to the axes (15), and have corresponding central openings (19), as shown in Figures 6 and 7 , in which a ball joint (20) is located with respect to which the carriage (16) can rotate in the horizontal plane and in the vertical plane.
  • a carriage (16) is constituted consisting of two plates ( 17), upper and lower, joined together by thymes (18), which slide with respect to the axes (15), and have corresponding central openings (19), as shown in Figures 6 and 7 , in which a ball joint (20) is located with respect to which the carriage (16) can rotate in the horizontal plane and in the vertical plane.
  • the relative position of the guide of cutting (3), or rather of the guide holder (2) that at its end has the positioning support of the cutting guide (14) in which the cutting guide (3) is housed, with respect to the fixing support ( 1) it will be adjusted by means of the calibration tool (8), represented in figure 10-
  • the calibration tool (8) By means of the calibration tool (8) the distance between the positioning support of the cutting guide (14) and the center of The ball joint (20) by displacement of the assembly formed by said positioning support of the cutting guide (14) and axes (15) with respect to the carriage (16).
  • the assembly formed by the positioning support of the cutting guide (14), carriage (16) and axles (15) can rotate with respect to the ball joint (20) in the horizontal and vertical plane, establishing the fixing of this set with respect to the kneecap (20) by means of a fixing screw (22), as seen in figures 6 and 7, which hugs the plates (17) against the ball joint (20) and against one of the axes (15 ) leaving all the elements of the carrier (2) in solidarity.
  • the cutting guide (3) which is mounted the positioning support of the cutting guide (14) of the guide (2), is oriented so that the plane of its groove (4) coincides with the ideal plane cutting
  • the cutting guide (3) represented in figures 8 and 9, consists of a flat body (23) in which the aforementioned groove (4) is defined, finished at its ends in some lateral stops (26), counting in one of the faces of the flat body (23) with a circular headland (27) that fits into the groove (24) of the positioning support of the cutting guide (14) during the assembly of the cutting guide (3) on the guide holder (2). Positioned the cutting guide (3) is fixed to the tibia by using pins that are inserted through the holes (36).
  • the calibration tool (8) fundamentally incorporates a coupling shaft (28) of the same shape and dimensions as the upper section (7) of the fixed support (1), on which the Ia ball joint (20) of the guide holder (2) and a support (29) distant from the axis of coupling (28) on which the guide support positioning bracket (14) fits.
  • This support (29) is mounted on a first block (30) provided with linear displacement with respect to the coupling shaft (28), in order to adjust the distance between the positioning support of the cutting guide (14) and the ball joint ( 20), as seen in Figure 1, operation that is performed with a first command (31).
  • the coupling shaft (28) of the calibration tool (8) is linked to a second block (32) that moves with rotational movement in the vertical plane with respect to a third block (33) to adjust the relative inclination, in this vertical plane of the positioning support of the cutting guide (14), with respect to the kneecap (20), operation that is performed with a second command (34).
  • the third block (33) is provided with rotating movement in the horizontal plane to adjust the angular position of the positioning support of the cutting guide (14) with respect to the ball joint (20), an operation that is performed with a third control (35 ).

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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)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Dentistry (AREA)
  • Transplantation (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Robotics (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)
  • Cardiology (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Vascular Medicine (AREA)
  • Biophysics (AREA)

Abstract

Selon le mode de réalisation décrit dans l'invention, le système permet d'effectuer un examen pré-opératoire qui consiste à modéliser en trois dimensions le tibia et/ou le fémur dans un ordinateur (6), à définir le plan de coupe idéal et à modéliser la position de l'instrument de résection (1, 2, 3) pour couper l'os. De plus, selon le mode de réalisation de l'invention, le système permet de redéfinir le plan de coupe idéal ainsi que le positionnement et l'orientation de l'instrument de résection (1, 2, 3) sur le tibia et/ou le fémur, de telle sorte que le plan de la rainure (4) du guide de coupe (3) permettant l'introduction de l'outil de coupe coïncide avec le plan de coupe idéal.
PCT/ES2008/000127 2008-03-07 2008-03-07 Système pour la résection du plateau tibial et/ou des condyles fémoraux pour implanter une prothèse WO2009109669A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
ES201090061A ES2406607B1 (es) 2008-03-07 2008-03-07 Sistema para la resección de la meseta tibial y/o de los cóndilos del fémur para implantar una prótesis
PCT/ES2008/000127 WO2009109669A1 (fr) 2008-03-07 2008-03-07 Système pour la résection du plateau tibial et/ou des condyles fémoraux pour implanter une prothèse

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/ES2008/000127 WO2009109669A1 (fr) 2008-03-07 2008-03-07 Système pour la résection du plateau tibial et/ou des condyles fémoraux pour implanter une prothèse

Publications (1)

Publication Number Publication Date
WO2009109669A1 true WO2009109669A1 (fr) 2009-09-11

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/ES2008/000127 WO2009109669A1 (fr) 2008-03-07 2008-03-07 Système pour la résection du plateau tibial et/ou des condyles fémoraux pour implanter une prothèse

Country Status (2)

Country Link
ES (1) ES2406607B1 (fr)
WO (1) WO2009109669A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2014197987A1 (fr) * 2013-06-13 2014-12-18 Laboratoires Bodycad Inc. Outil de validation de coupe chirurgicale et procede

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6205411B1 (en) * 1997-02-21 2001-03-20 Carnegie Mellon University Computer-assisted surgery planner and intra-operative guidance system
WO2002037935A2 (fr) * 2000-10-23 2002-05-16 Krause Norman M Chirurgie orthopedique assistee par ordinateur
US6514259B2 (en) * 2001-02-02 2003-02-04 Carnegie Mellon University Probe and associated system and method for facilitating planar osteotomy during arthoplasty
EP1430842A1 (fr) * 2002-12-20 2004-06-23 Zimmer Technology, Inc. Instrument chirurgical et methode de positionnement
EP1442712A1 (fr) * 2003-01-31 2004-08-04 Howmedica Osteonics Corp. Guide d'alignement universel
US20060217733A1 (en) * 2005-02-15 2006-09-28 Norman Plassky User guidance in adjusting bone incision blocks

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6205411B1 (en) * 1997-02-21 2001-03-20 Carnegie Mellon University Computer-assisted surgery planner and intra-operative guidance system
WO2002037935A2 (fr) * 2000-10-23 2002-05-16 Krause Norman M Chirurgie orthopedique assistee par ordinateur
US6514259B2 (en) * 2001-02-02 2003-02-04 Carnegie Mellon University Probe and associated system and method for facilitating planar osteotomy during arthoplasty
EP1430842A1 (fr) * 2002-12-20 2004-06-23 Zimmer Technology, Inc. Instrument chirurgical et methode de positionnement
EP1442712A1 (fr) * 2003-01-31 2004-08-04 Howmedica Osteonics Corp. Guide d'alignement universel
US20060217733A1 (en) * 2005-02-15 2006-09-28 Norman Plassky User guidance in adjusting bone incision blocks

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2014197987A1 (fr) * 2013-06-13 2014-12-18 Laboratoires Bodycad Inc. Outil de validation de coupe chirurgicale et procede
US10456273B2 (en) 2013-06-13 2019-10-29 Laboratoires Bodycad Inc. Surgical cut validation tool and method

Also Published As

Publication number Publication date
ES2406607A1 (es) 2013-06-07
ES2406607B1 (es) 2014-04-14

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