WO2010116359A1 - Ensemble d'imagerie ultrasonore osseuse - Google Patents

Ensemble d'imagerie ultrasonore osseuse Download PDF

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Publication number
WO2010116359A1
WO2010116359A1 PCT/IL2010/000255 IL2010000255W WO2010116359A1 WO 2010116359 A1 WO2010116359 A1 WO 2010116359A1 IL 2010000255 W IL2010000255 W IL 2010000255W WO 2010116359 A1 WO2010116359 A1 WO 2010116359A1
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WO
WIPO (PCT)
Prior art keywords
bone
ultrasound
intramedullary nail
screw hole
locking screw
Prior art date
Application number
PCT/IL2010/000255
Other languages
English (en)
Inventor
Zvi Laster
Ilan Weissberg
Adi Eldar
Avraham Levy
David Elkaim
Original Assignee
Zvi Laster
Ilan Weissberg
Adi Eldar
Avraham Levy
David Elkaim
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 Zvi Laster, Ilan Weissberg, Adi Eldar, Avraham Levy, David Elkaim filed Critical Zvi Laster
Publication of WO2010116359A1 publication Critical patent/WO2010116359A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
    • A61B8/0875—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of bone
    • 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
    • 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
    • A61B17/1725—Guides or aligning means for drills, mills, pins or wires for applying transverse screws or pins through intramedullary nails or pins
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
    • A61B8/0833—Detecting organic movements or changes, e.g. tumours, cysts, swellings involving detecting or locating foreign bodies or organic structures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/42—Details of probe positioning or probe attachment to the patient
    • A61B8/4209—Details of probe positioning or probe attachment to the patient by using holders, e.g. positioning frames
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like for external osteosynthesis, e.g. distractors, contractors
    • A61B17/62—Ring frames, i.e. devices extending around the bones to be positioned

Definitions

  • the present invention generally relates to ultrasound bone imaging devices and, more particularly, but not exclusively, to an ultrasound bone imaging assembly for use in conjunction with fracture fixation.
  • a C-arm X-ray includes an X-ray source configured to be positioned on one side of a body portion of a subject and a detector configured to be positioned on a second side of the body portion.
  • the C-arm is swiveled around the body portion in multiple axes to produce transillumination X-ray images.
  • fracture fixation may require using an intramedullary (IM) rod, alternatively referred to as an IM nail.
  • IM rod fixation of the femur C-arm X-ray transillumination may be used to image the fractured bone portions during reduction and in guiding the IM nail through the medulla of the fractured long bone to maintain alignment.
  • some IM rods include locking holes through which locking screws are placed.
  • an IM jig having drill guides corresponding to the locking holes in the implanted IM rod, is externally aligned with the internally implanted IM rod, and secured in place.
  • the skin is incised at a given drill guide and a bore is drilled using a drill guide in the IM jig to guide the drill bit through the locking hole, thereby creating a bore through the bone and locking hole of an appropriate diameter to receive a locking screw.
  • the locking screw is then screwed through the locking hole and positioned so that screw shaft extends on either side of the IM rod.
  • One or two locking screws are typically placed in the proximal portion of the IM rod as well as the distal portion of the IM rod, thereby preventing the above-noted torsion and/or misalignment between the fractured bone portions.
  • the above-noted C-arm X-ray transillumination is often used to locate the position of each locking hole and/or properly aim the locking screw into the locking hole.
  • the resulting extended use of the C-arm increases the exposure time of the patient to harmful ionizing radiation which can jeopardize patient health.
  • X-ray transillumination presents a health risk to the physician, whose hands must function under the X-ray beam during fracture alignment, reduction, IM nail placement, drilling locking holes, and placement of locking screws.
  • the many X- ray transillumination operations that a physician may perform throughout a lifetime collectively accumulate adverse ionizing radiation effects, putting the physician at a much higher risk than each individual patient.
  • C-arm X-ray assemblies cannot be sterilized, thereby creating difficulty in maintaining the necessary sterile field during fracture reduction surgery.
  • a C-arm X-ray is a large, expensive assembly and, as a result, only one C-arm X-ray assembly exists in a small rural hospital, making it impossible to rapidly attend to multiple injured patients, for example following a local multiple vehicle road accident.
  • a method for reducing a fracture and detecting a locking hole of an intramedullary nail inserted within a medullary cavity includes the steps of scanning an ultrasonic wave signal in a direction perpendicular to an axis of the bone, ultrasonically detecting a fracture based on an echo of the ultrasonic wave signal reflected from the bone, reducing the fracture, and confirming fracture reduction using the ultrasonic wave signal.
  • the method further includes the steps of introducing an intramedullary nail having locking screw holes through the medulla of the bone, to span the fracture, slidably supporting an ultrasonic probe at a location of a locking screw hole of the intramedullary nail, and detecting the locking screw hole based on shape of the echo of the ultrasonic wave signal reflected from the intramedullary nail.
  • the method includes drilling a bore through the bone and through the locking screw hole.
  • the method includes rotating a locking screw through the bone and through the locking screw hole.
  • an assembly for detecting the orientation and position of a locking screw hole of an intramedullary nail positioned within a medullary canal of a bone is provided.
  • the assembly includes an ultrasonic transducer assembly having one or more transducers arranged to emit and detect ultrasonic signals, and an ultrasound imager operatively associated with the one or more transducers.
  • the ultrasound imager is configured for providing one or more images that indicate that the one or more transducers are at least one of: perpendicular to an intramedullary nail axis; and centered over a locking hole; of an intramedullary nail positioned within a medullary canal of a bone.
  • the ultrasound imager is additionally configured to provide one or more images that indicate at least one of: an orientation, a position, and drill bit image, during drilling of the locking screw hole of the intramedullary nail.
  • the assembly includes at least one elongate positioning bar, and at least one bone connector extending from the elongate positioning bar.
  • the connector is configured to connect the elongate positioning bar to at least one portion of a bone of a human subject.
  • the assembly further includes one or more ultrasound slidable transducer guides configured to slide along the at least one elongate positioning bar during the emission and detection of the ultrasonic signals.
  • the assembly includes at least one elongate positioning bar slidably mounted on at least one curved member having at least one bone connector configured to connect to at least one portion of a bone of a human subject.
  • the at least one curved member includes at least two curved members, a first curved member configured to connect to a first portion, and a second curved member configured to connect to a second portion, of the human subject.
  • the assembly includes an intramedullary rod connector configured to connect to the intramedullary rod in vivo and extend ex vivo.
  • the assembly further includes an elongate measuring bar configured to connect to the intramedullary rod connector, the elongate measuring bar including markings corresponding to the position of at least one locking screw hole, and an ultrasound transducer guide including the one or more transducers arranged to emit and detect ultrasonic signals and including a central bore configured for receiving a drill bit for drilling the bone through the at least one locking screw hole.
  • the assembly includes a central channel configured for receiving a drill bit for drilling the bone through at least one locking screw hole in an intramedullary nail inserted within a medullary cavity of a bone, and one or more ultrasound transducers that emit and detect ultrasonic signals, the one or more ultrasound transducers being arranged around the central channel.
  • the one or more ultrasound transducers are operatively associated with an ultrasound beam imager configured for determining that one or more ultrasonic signals emitted and detected by the one or more ultrasonic transducers are at least one of: perpendicular to an axis of the intramedullary nail, and centered over a locking hole.
  • the present invention provides a method and assembly for facilitating reduction of bone fractures using ultrasound imaging as well as locking the distal holes of an intramedullary nail.
  • This stage requires very accurate positioning of the C-arm, perpendicular to the distal nail longitudinal axis, until a perfect circle (representing the hole) is seen. Once the hole in the nail is identified, the surgeon must be accurate and steady in drilling through a convex surface of the femur, a task which can be difficult to achieve especially for less experienced surgeons. As a result, surgeons oftentimes repeat the drilling step thereby enlarging the bone hole and potentially weakening the bone.
  • the ultrasound signal Due to the relatively long path that the ultrasound wave passes up to the bone and back (twice the thickness of the thigh, more than 10cm) the ultrasound signal is severely attenuated in the soft tissue; in addition, the density differences between the soft tissues and the bone causes most of the ultrasound energy to be reflected back and not penetrating the bone to reach the IM nail at all.
  • a high power ultrasound signal is needed, and this causes a patient safety issue as it can potentially damage surrounding tissues (heating and causing cavitation).
  • the present invention utilizes a device which is configured for: (i) aligning a cutting path for a cutting device using an ultrasound probe; and (ii) positioning the ultrasound probe in a manner which enables bone and nail imaging without having to transmit the ultrasound signal through soft tissues.
  • a device for setting a cutting path which is aligned with a locking feature (e.g. hole) of an intramedullary nail.
  • the device of the present invention includes a device body having a cutting path for a cutting tool and a holder for at least one ultrasound probe.
  • cutting when made in reference to bone refers to drilling, boring and the like using any suitable device, including, but not limited to, rotary cutters (e.g.
  • the transducers are located either on top of the bone looking via the bone for the IM nail, or inside the nail hole looking via the bone outside for the drill, but in both cases the ultrasound wave doesn't pass via soft tissue of the thigh (or shin or forearm).
  • Some of the configurations utilize a jig that is attached to the bone, stabilizes the transducers and enable locking them in place, while other configurations utilize hand held trocar that contains the transducers for navigation in a standard free hand technique.
  • Implementation of the method and/or system of embodiments of the invention can involve performing or completing selected tasks manually, automatically, or a combination thereof. Moreover, according to actual instrumentation and equipment of embodiments of the method and/or system of the invention, several selected tasks could be implemented by hardware, by software or by firmware, or by a combination thereof using an operating system.
  • hardware for performing selected tasks according to embodiments of the invention could be implemented as a chip or a circuit.
  • selected tasks according to embodiments of the invention could be implemented as a plurality of software instructions being executed by a computer using any suitable operating system.
  • one or more tasks according to embodiments of method and/or system as described herein may be performed by a data processor, such as a computing platform for executing a plurality of instructions.
  • the data processor includes a volatile memory for storing instructions and/or data and/or a non-volatile storage, for example, a magnetic hard-disk and/or removable media, for storing instructions and/or data.
  • a network connection is provided as well.
  • a display and/or a user input device such as a keyboard or mouse are optionally provided as well.
  • Figures 1-3 show flow charts for fracture reduction and fixation using ultrasound, according to some embodiments of the invention.
  • Figures 4-5 show an ultrasound assembly for fracture reduction and fixation, according to some embodiments of the invention.
  • Figure 6 shows an alternative embodiment for fracture fixation shown in Figures 4-5, according to some embodiments of the invention
  • Figure 7-8 show ultrasound hand held assemblies for fracture reduction and fixation, according to some embodiments of the invention
  • FIGS 9-10 show details of the handheld assemblies shown in Figure 8, according to some embodiments of the invention.
  • Figure 11 shows another option for the hand held assembly, alternative to figure 8.
  • the present invention generally relates to ultrasound bone imaging assemblies and, more particularly, but not exclusively, to an ultrasound bone imaging assembly for use in conjunction with a fracture fixation system.
  • Figure 1 shows an intramedullary nailing flow chart 200 wherein at a stage 210 a fracture reduction jig is attached proximate to the fractured bone and two fracture ultrasound transducers are placed in sliding jig holes. Alternatively, at a stage 211 , when using a handheld fracture unit, two transducers are placed in the transducer frame.
  • the transducers are moved to either side of the fracture site.
  • the two transducers are moved 180° around the thigh to view contour of the fracture fragments.
  • each portion of the fracture is visualized using the ultrasound images produced by the transducers, with the image being constructed using integration of data from different projections that is known in the art.
  • the constructed images are merged at a stage 218, and produce two semicircles, corresponding to the edges of the bone shell (cortex) of the fracture fragments.
  • Overlap in the two semicircles of the bone shell images signifies that the fracture has been properly reduced at a stage 230.
  • the image is analyzed in two dimensions and it is determined if there is overlap in the bone fragments, signifying the above-noted fracture reduction.
  • stage 224 is accessed to determine the required vector for reduction of the fracture.
  • the fracture is aligned and reduced at a stage 226.
  • transducers are again utilized in stage 214 through stage 220 to ensure that the fracture has been reduced at stage 230.
  • Figure 4 shows a fracture jig 100 used in this figure for fracture reduction.
  • the jig has positioning spikes 152 that pass through thigh tissue 105 and secure into a femur 104, alternatively referred to as thigh bone 104.
  • Ultrasound transducers for fracture reduction 160 are placed into transducer bases 128 along a longitudinal rail 124 on either side of a fracture 107. To determine the above-noted bone contour and fracture alignment, the fracture reduction transducers 160 are moved in directions 164 along longitudinal rail 124 and positioned above the two bone fragments on either side of the fracture, as close as possible to the fracture.
  • transducer bases 128 are locked in position with transducer locks 129, and longitudinal rail 124 is rotated in directions 162 along semicircular rails 148 after releasing rail stops 140. Based on the accumulated transducers' data during rotation in directions 162, an integrated echo image is generated on imaging display 166.
  • surgeon manipulates femur 104 in order to align fracture 107 in preparation for driving an intramedullary nail through femur 104.
  • Alignment of fracture 107 is confirmed on an imaging display 166, when two shells 177, alternatively two semi circles 177, representing the proximate bone cortex of the two bone fragments, appear partially aligned and/or overlapping.
  • Figure 7 shows a handheld ultrasound assembly 240 for fracture reduction in which fracture reduction transducers 160 are placed into horizontal transducer holders
  • Horizontal transducer holders 139 are moved laterally in directions 164, using a handle 182, to the optimal position on either side of fracture 107 and rotated in direction 162 to define the above-noted bone contour.
  • Fracture 107 is manipulated as noted above, until semi-circles 177 partially overlap and/or align as noted above.
  • a stage 310 is accessed, as seen in Figure 2, in which a drill guide is attached to the fracture jig, in a drilling alignment hole corresponding to a locking hole in the IM nail.
  • a stage 350 is accessed and a ruler is used to mark the incision area into which the locking screw is to be placed.
  • an incision is made where the bore for the screw will be drilled.
  • a drill guide equipped with one or more ultrasound transducers is pressed up against the bone in a stage 314 through the incision made at stage 312.
  • the ultrasound echo image is reviewed in a stage 318 in order to ensure precise alignment and/or angulation between the drill guide and the locking hole of the IM nail.
  • a stage 320 is accessed and the transducers are slid laterally to view the nail edge and/or hole image.
  • the echo image is reviewed and checked to determine if part of the screw hole is visible in the form of an arc shape.
  • stage 340 the transducer and drill guide are moved until aligned with the center of the hole.
  • the echo image does not display any part of the screw hole, for example an arc shape is not visible, misalignment is indicated; and a stage 324 is accessed.
  • the transducers are slid longitudinally along with the hole-drilling guide until such time that a portion or all of a locking hole is visible and aligned,
  • sliding may be performed either manually or using a power source comprising, inter alia, a motor, a magnet propelled positioning palette, or a pressurized hydraulic system.
  • a power source comprising, inter alia, a motor, a magnet propelled positioning palette, or a pressurized hydraulic system.
  • the many options for sliding transducers along an IM positioning jig are well known to those familiar with the art.
  • the present invention can be used in conjunction with a phased array transducers.
  • a drilling process 400 is accessed as seen in Figure 3.
  • a stage 410 is initially accessed, wherein the echo ultrasound image is reviewed. At a stage 412, it is determined whether the hole is a circle or an ellipse. Additionally, the ultrasound echo is analyzed to determine if the echo is from the distant bone or from the walls of the nail hole.
  • a circle, or ellipse, in the ultrasound image is generated by the edges of the locking hole. If alignment is correct, an ultrasound echo is received from the distant bone cortex through the locking hole. In such cases, the analyzed ultrasound echo will demonstrate signal delay consistent with the distance to the distant bone cortex.
  • the received ultrasound echo will be generated from one or more portions of the vertical walls of the nail hole.
  • the determination of potential drilling misalignment occurs when the analyzed ultrasound echo demonstrates a short signal delay that signifies that the ultrasound echo is being reflected from a proximate structure, rather than the distant bone cortex.
  • a stage 414 is accessed.
  • the locking of the drill guide in position over the locking hole takes place.
  • the drill guide is held in place with the operator's hand.
  • stage 416 is accessed, wherein the transducer and drill guide are rolled, possibly in two orthogonal angles, until the image produced by the ultrasound is sharp, and shows a circle with an ultrasound echo from the distant bone, as opposed to an ultrasound echo from the walls of the nail locking hole.
  • stage 414 is accessed and, as noted above, the drill guide is locked (or held) in place.
  • the echo of the ultrasound is used to calculate the required drilling depth.
  • the transducer is removed from the drill guide.
  • a drill bit is placed in the drill guide and the bore is created to the required depth through the bone.
  • drilling process 400 is repeated until all locking screws have been drilled into place.
  • the jig is removed from the bone.
  • use of the present drill guide provides two advantages: it enables correct alignment between the proposed cutting path through the bone and the hole in the nail while it also stabilizes the cutting tool throughout the bone cutting procedure thereby preventing the cutting tool from slipping off the convex bone surface or straying during cutting.
  • FIG. 5 shows an intramedullary nail 102 having been passed through the intramedullary canal.
  • An intramedullary nail connector 112 has been attached to intramedullary nail 102 and secured with a connector trimmer to jig 100.
  • ultrasound transducers 136 are placed through a guide sleeve 130 in guide holes 180 in transducer bases 128.
  • Transducer base(s) 128 is moved in directions 164 and transducer 136 is used to locate a locking hole 106 in intramedullary nail 102.
  • display 166 Upon locating locking hole 106, display 166 shows an IM rod image 167 with symmetrical IM locking hole 169 with the highest contrast corresponding to one of the locking holes 106.
  • transducer 136 is removed from guide sleeves
  • a locking screw 108 is then screwed into femur 104 via guide sleeve 130 through locking hole 106. Following introduction of proximal and distal locking screws 108, spikes 152 are removed from femur 104 and jig 100 is removed from thigh 105.
  • Figure 6 shows an alternative embodiment of the jig assembly 100 that attaches directly to intramedullary nail 102 with connector 112 and only one set of positioning spikes 152 attached to the distal portion of femur 104.
  • Figure 8 shows a handheld ultrasound assembly for locating the IM nail holes and drilling.
  • An IM nail 102 attached to intramedullary nail connector 112 and passed through femur 104 using standard surgical IM nailing technique.
  • a measuring rod 184 is placed so that a connector end 185 is in contact with, and/or connected to intramedullary nail connector 112 and positioned parallel to IM nail 102.
  • Measuring rod 184 includes markings 187 corresponding to the position of locking holes 106 and thigh 105 is incised to form an incision 131 at the approximate position of each locking hole, optionally following marking thigh 105 with a skin marker.
  • Guide sleeve 130 on a handle 186 is placed into incision 131 to contact femur 104 and swiveled along the X and Y axes in directions 164 and 162 until a symmetrical locking hole 169 with the highest contrast is visualized on imaging display 166.
  • Drill bit 134 is then passed through drill guide to bore across femur 104 through locking hole 106, following which screw 108 is rotated into place through locking hole 106.
  • FIG 9 shows details of an integrated drill guide assembly 250, in cross section, passing through a cross section of femur 104 and IM nail; and
  • Figure 10 shows an aerial view of integrated drill guide assembly 250.
  • Integrated drill guide assembly 250 incorporates three ultrasound transducers 136 in a transducer jacket assembly 201 that slides within guide sleeve 130.
  • guide assembly 250 is configured such that when a distal end portion thereof is positioned against the bone, transducers 136 contact the surface of the imaged bone directly or through an ultrasound conductive material (e.g. ultrasound gel).
  • an ultrasound conductive material e.g. ultrasound gel
  • transducer 136 disposed within sleeve 130 and displaced (several cm) from the surface of the imaged bone via an ultrasound gel.
  • transducer jacket assembly 201 and guide sleeve 130 Prior to drilling femur 104, transducer jacket assembly 201 and guide sleeve 130 are passed, through incision 131 and against femur 104, proximate to locking hole 106. Guide sleeve 130 is manipulated in the above-noted manner in directions 162 and 164, until locking hole 106 is imaged on the above-noted ultrasound imager.
  • Transducer jacket assembly 201 includes a central drill bore 213 through which drill bit 134 is passed, and femur 104 is drilled in the above-noted manner.
  • an ultrasound image is optionally used to image drill bit 134 during passage through femur 104.
  • guide sleeve 130 is additionally configured to receive and guide screw 108 following drilling and the ultrasound image is used to image screw 108 during passage through femur 104.
  • FIG 11 is similar to Figure 8, where the only difference is the usage of a different type of transducer 136.
  • the transducer is composed of two distinct parts: a transmitter and a receiver (a.k.a. a transducer pair).
  • the transmitter part 136 is positioned in the guide sleeve 130 as in Figure 8, while the receiver part 601 is inserted into a cannulated IM nail 102 using an insertion device 600.
  • the insertion device 600 is comprised from a rigid or flexible wire, with a handle 603 on one end and the receiver 601 on the other end.
  • the receiver 601 should be inserted into the cannulated IM rod 102 along axis 605 such that its position would be in the middle of the required locking hole 106.
  • the receiver 601 can be achieved by longitudinal and angular measuring marks on the wire 600 that can be aligned with a reference mark on the nail connector 112.
  • the receiver active surface 602 should be perpendicular to the locking hole 106, this can be achieved by rotating the device 600 in directions 604 so the angular mark on the wire 600 is aligned with the reference mark.
  • Additional option referring to the same figure 11, is that part 601 comprised of the full transducer (transmitter & receiver) and in this configuration the previous transmitter part 136 is not needed at all. In this case the transducer 601 will transmit the ultrasound wave from the IM nail hole, in a perpendicular direction, via the bone and it could image the drill once the drill is on top of the bone in the correct location.
  • Ultrasound bone alignment assembly It is expected that during the life of a patent maturing from this application many relevant Ultrasound bone alignment assemblies will be developed and the scope of the term "Ultrasound bone alignment assembly" is intended to include all such new technologies a priori.
  • compositions comprising, “comprising”, “includes”, “including”, “having” and their conjugates mean “including but not limited to”. This term encompasses the terms “consisting of and “consisting essentially of.
  • Consisting essentially of means that the composition or method may include additional ingredients and/or steps, but only if the additional ingredients and/or steps do not materially alter the basic and novel characteristics of the claimed composition or method.
  • the singular form “a”, “an” and “the” include plural references unless the context clearly dictates otherwise.
  • the term “a compound” or “at least one compound” may include a plurality of compounds, including mixtures thereof.
  • range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the invention. Accordingly, the description of a range should be considered to have specifically disclosed all the possible subranges as well as individual numerical values within that range. For example, description of a range such as from 1 to 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1 , 2, 3, 4, 5, and 6. This applies regardless of the breadth of the range.
  • a numerical range is indicated herein, it is meant to include any cited numeral (fractional or integral) within the indicated range.
  • the phrases "ranging/ranges between” a first indicate number and a second indicate number and “ranging/ranges from” a first indicate number “to” a second indicate number are used herein interchangeably and are meant to include the first and second indicated numbers and all the fractional and integral numerals therebetween.
  • the term “method” refers to manners, means, techniques and procedures for accomplishing a given task including, but not limited to, those manners, means, techniques and procedures eithe ⁇ known to, or readily developed from known manners, means, techniques and procedures by practitioners of the chemical, pharmacological, biological, biochemical, and medical arts.
  • the term “treating” includes abrogating, substantially inhibiting, slowing or reversing the progression of a condition, substantially ameliorating clinical or aesthetical symptoms of a condition or substantially preventing the appearance of clinical or aesthetical symptoms of a condition.

Abstract

L'invention porte sur un dispositif pour orienter un outil de découpe d'os par rapport à un trou de vis de blocage d'un clou intramédullaire inséré dans un os. Le dispositif comprend un corps de dispositif qui est configuré avec un trajet de découpe pour un dispositif de découpe et une partie d'extrémité distale qui est apte à être positionnée contre une surface de l'os. Le dispositif comprend également un système de maintien de sonde ultrasonore qui sert à aligner le trajet de découpe avec l'élément de blocage de vis à l'aide d'au moins un signal ultrasonore d'au moins une sonde ultrasonore fixée au dispositif.
PCT/IL2010/000255 2009-04-05 2010-03-25 Ensemble d'imagerie ultrasonore osseuse WO2010116359A1 (fr)

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US61/166,746 2009-04-05

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WO2013050787A3 (fr) * 2011-10-07 2013-06-13 Levant Orthopaedics Limited Dispositif de ciblage pour élément de verrouillage distal
CN104905817A (zh) * 2015-06-10 2015-09-16 中国人民解放军第二军医大学 一种髓内钉固定术中的超声定位系统
CN110801299A (zh) * 2019-12-09 2020-02-18 华中科技大学同济医学院附属协和医院 一种确定深度的颅骨缺损模型造模设备及其方法

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