WO2011149106A1 - スクリューガイドテンプレート、スクリューガイドテンプレートシステム、穿孔方法、および脊椎固定手術方法 - Google Patents
スクリューガイドテンプレート、スクリューガイドテンプレートシステム、穿孔方法、および脊椎固定手術方法 Download PDFInfo
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- WO2011149106A1 WO2011149106A1 PCT/JP2011/062405 JP2011062405W WO2011149106A1 WO 2011149106 A1 WO2011149106 A1 WO 2011149106A1 JP 2011062405 W JP2011062405 W JP 2011062405W WO 2011149106 A1 WO2011149106 A1 WO 2011149106A1
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- hole
- screw guide
- guide template
- drilling
- drilled
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—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
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
- A61B17/7076—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—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
- A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00526—Methods of manufacturing
-
- 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
- A61B2017/568—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor produced with shape and dimensions specific for an individual patient
-
- 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
Definitions
- the present invention relates to a screw guide template, a screw guide template system including the screw guide template, and a drilling method and a spinal fixation operation method using the screw guide template.
- the spinal fusion surgery is a surgery in which a titanium implant is inserted into the spine to fix the position of the spine.
- a spinal fixation screw which is a kind of implant, is inserted into the spine.
- Patent Document 1 discloses a technique related to a registration template used for medical navigation system surgery.
- a hole for inserting a fixing member such as a spinal fixation screw into a certain member is used as an accurate planned drilling site
- scheduled drilling site is a surface of a member scheduled to be drilled. This means a portion that becomes an opening portion of a hole scheduled to be drilled by the drilling means (the same applies hereinafter) (the “drilling drilling direction” means a through-direction of a hole scheduled to be drilled by the drilling means). The same shall apply hereinafter). It took a lot of experience to pierce the spine with a hole for inserting the spinal fixation screw into the puncture site in the exact puncture planned position.
- the template described in Patent Document 1 is used only to mark the bone surface, and even with the technique disclosed in Patent Document 1, the above problem cannot be solved.
- the present invention provides a screw guide template capable of drilling a hole in an accurate planned drilling direction at a precise planned drilling position of a member scheduled to be drilled (hereinafter also referred to as a “member to be drilled”). This is the issue.
- a screw guide template system and a member to be drilled that can drill a hole in an accurate planned drilling direction in an accurate planned drilling position even in a narrow place where it is difficult to specify the planned drilling site using a screw guide template
- a drilling method that allows a hole to be drilled in an accurate planned drilling location of the spine, and a spinal fixation screw to be inserted into an accurate planned spinal site (the “scheduled insertion site” Puncture in the correct direction of insertion (“scheduled direction of insertion” means the direction in which the spinal fixation screw is scheduled to be inserted; the same applies hereinafter).
- Another object of the present invention is to provide a spinal fixation operation method that can be entered.
- the first aspect of the present invention is a screw guide template that determines the position and direction of the hole (33) when the member (30) is punched by the punching means, and is a contact surface (11, 21) that is in close contact with the member. , 51, 61) and a through hole (12, 22, 52) having one opening (13, 23a, 53a) in the contact surface, and the contact surface of the screw guide template is to be drilled in the member.
- the shape of the surface (31) including the location (32) and the shape of the male and female are provided, and when the contact surface is brought into close contact with the planned drilling location of the member, the opening of the screw guide template and the member
- a screw guide template (10, 20, 20 ′, 50, 60) which is formed so as to overlap with a hole to be drilled and the through hole is coaxial with the hole to be drilled by the drilling means. It is.
- the “perforating means” is not particularly limited as long as it can perforate the member to be perforated.
- Specific examples of the drilling means include a drill.
- “adhesion” refers to the adhesion surface of a template (the “screw guide template” of the first aspect of the present invention and the “location template” described later may be simply referred to as “template”) on the surface of the member to be drilled.
- template the “screw guide template” of the first aspect of the present invention and the “location template” described later may be simply referred to as “template”
- the contact surface (11, 21, 51, 61) is based on the tomographic information of the member (30) to be drilled. It is preferable that it is formed. By forming the contact surface using the tomographic information of the member to be punched, it becomes easy to form the contact surface in a shape that precisely corresponds to the shape of the surface of the member to be punched.
- the hollow tube (40, 50) communicates with the through hole (22, 52) and extends on the opposite side of the contact surface (21, 51). 54), and the hollow tube preferably has a hollow part into which the punching means can be inserted. With this configuration, as will be described later, it becomes easy to insert the punching means into the through hole.
- the screw guide template (20, 20 ′, 60) of the first aspect of the present invention includes a first piece (20a) having one end (22a) and a close contact surface (21) of the through hole (22), and a through hole.
- the insertion direction of the punching means can be easily determined, and the correct drilling direction of the drilled member is accurately set in the planned drilling position. It becomes easy to make a hole.
- the inner diameter of the through hole (22b) of the second piece is The inner diameter of the through hole (22a) of the first piece is preferably equal to or larger than the inner diameter of the through hole of the first piece.
- one end of the hollow tube is It can be set as the form which communicates with the through-hole (22a) of a 1st piece, and connects the other edge part to the through-hole (22b) of a 2nd piece.
- the hollow tube is coaxial with the through hole (22, 52) and substantially the same. It is preferable to have a large inner diameter.
- the length (x1, x2) of the through hole is at least twice the outer diameter of the drilling means inserted into the through hole. It is preferable that it is 3 times or more.
- “the length of the through hole” means the distance from the opening where the punching means is first inserted to the opening overlapping the planned drilling portion.
- the total length of the hollow tube and the through hole is defined as “the length of the through hole”.
- the length (x1, x2) of the through hole is the length (y) of the hole scheduled to be drilled in the member (30).
- the length (z) of the portion of the punching means that can be inserted into the through hole (12, 22, 52) is preferably determined (zy).
- the inner diameter of the through hole (12, 22, 52, 62) is the outer diameter of the punching means inserted into the through hole.
- the ratio is preferably 1.001 to 1.1 times, and more preferably 1.001 to 1.05 times.
- a plurality of contact surfaces (61a, 61b) are provided at predetermined intervals.
- the screw guide template (10, 20, 20 ′, 50, 60) of the first aspect of the present invention has a hole (33) for inserting a spinal fixation screw for fixing the spine (30). It can be set as a screw guide template used for the above. That is, the member to be drilled is the spine, and the hole drilled in the spine can be a hole for inserting the spinal fixation screw.
- the “vertebral fixation screw” is a kind of implant and means a screw used for fixing the spine.
- a second aspect of the present invention is a screw guide template system for determining the position and direction of a hole when a member is drilled by a punching means, the screw guide template (10, 20, 20 ′ of the first aspect of the present invention). , 50, 60) and a location template (5), and the location template has a close contact surface (1) to be in close contact with the member, and a through hole (2) having one opening (3) in the close contact surface. ), And the close contact surface of the location template has a shape of a relationship between the surface of the member including the planned perforation portion and the male and female, and the close contact surface is in close contact with the planned perforation portion of the member.
- the through hole is formed so that the opening of the location template and the planned drilling portion of the member overlap. That.
- the third aspect of the present invention is a drilling method for perforating a certain member, and the contact surface (11, 21, 51) of the screw guide template (10, 20, 20 ′, 50, 60) of the first aspect of the present invention in advance. , 61) are formed so as to have a male-female relationship with the shape of the surface (31) including the planned drilling location (32) of the member (30), and the contact surface is brought into contact with the surface of the member.
- a fourth aspect of the present invention is a spinal fusion operation method in which a spinal fixation screw is inserted after drilling in the spine, and the screw guide template (10, 20, 20 ′, 50, 60) of the first aspect of the present invention is provided in advance.
- the surface of the spine is brought into contact with the surface of the spine so that the screw guide template is tightly fixed to the surface including the planned insertion site of the spine, and the planned insertion site is specified, and through holes (12, 22, 52, 62) through a perforation means, and a step of perforating a planned puncture site of the spine, and a step of inserting a spinal fixation screw into a hole formed by perforation.
- the screw guide template of the first aspect of the present invention it is possible to make a hole in an accurate drilling direction at an accurate drilling location of the member to be drilled. Further, according to the screw guide template system of the second aspect of the present invention, even in a narrow place where it is difficult to specify the planned drilling location by the screw guide template, the accurate drilling planned direction is set at the correct planned drilling location. A hole can be drilled. Furthermore, according to the drilling method of the third aspect of the present invention, it is possible to make a hole in an accurate planned drilling direction at an accurate planned drilling location of the member to be drilled. Further, according to the spinal fixation operation method of the fourth aspect of the present invention, the spinal fixation screw can be inserted into the accurate planned insertion position of the spine in the correct planned insertion direction.
- FIG. 1 It is a perspective view showing roughly the screw guide template of the present invention concerning the example of the 1st embodiment. It is a perspective view which shows roughly the screw guide template of this invention concerning the example of 2nd Embodiment. It is a figure which shows roughly the cross section of the screw guide template shown in FIG. It is sectional drawing which shows schematically the screw guide template of this invention concerning the example of 3rd Embodiment. It is sectional drawing which shows schematically the screw guide template of this invention concerning the example of 4th Embodiment. It is sectional drawing which shows roughly the screw guide template of this invention concerning the example of 5th Embodiment. It is a perspective view showing a location template concerning one embodiment roughly. FIG.
- FIG. 3 is a perspective view schematically showing a posture in which the screw guide template shown in FIG. 2 is closely attached to a spine.
- FIG. 9 is a diagram schematically showing a part of a section taken along line VIII-VIII shown in FIG. 8. It is a perspective view which shows roughly the spine which bored the hole. It is a flowchart which shows roughly an example of the drilling method of this invention. It is a flowchart which shows roughly about an example of the spinal fusion operation method of this invention.
- FIG. 1 is a perspective view schematically showing a screw guide template 10 of the present invention according to a first embodiment.
- the screw guide template 10 determines the position and direction of the hole when the member to be drilled is drilled.
- the screw guide template 10 includes a contact surface 11 that is in close contact with the member to be drilled, and a through hole 12 that has one opening 13 in the contact surface 11.
- the close contact surface 11 has a shape of a surface and a male-female shape including a planned perforation portion of the member to be perforated.
- the contact surface 11 is used in close contact with the surface of the member to be drilled including the planned drilling location.
- the relative position between the screw guide template 10 and the member to be drilled is fixed.
- a drilling means such as a drill is inserted into the through hole 12, and a hole is drilled in the drilled member.
- the opening 13 and the planned drilling portion of the member to be drilled overlap, and the through hole 12 is formed so as to be coaxial with the planned drilling direction. Holes can be drilled in the exact drilling direction.
- the inner diameter of the through hole is not particularly limited as long as it can be inserted into the perforating means, but is 1.001 to 1.1 times the outer diameter of the perforating means inserted into the through hole.
- the ratio is preferably 1.001 to 1.05 times. If the inner diameter of the through hole is too small, it becomes difficult to insert the punching means. If the inner diameter of the through hole is too large, the insertion position and insertion of the drilling means in the through hole when the drilling means is inserted into the through hole. The direction is likely to shake.
- the length of the through hole is not particularly limited, but from the viewpoint of making the insertion position and the insertion direction of the drilling means difficult to shake when inserting the drilling means into the through hole, It is preferable to have a certain length.
- the thickness of the screw guide template is reduced as much as possible, the screw guide template can be easily used even in a narrow place.
- the screw guide template is too thin, a sufficiently long through hole may not be provided. If the length of the through hole is too short, it is difficult to determine the direction of the hole (insertion direction of the punching means) when the hole is punched in the member to be punched by the punching means.
- the screw guide template of the present invention is easier to ensure the length of the through-hole to some extent in other forms described below than the plate-like body as shown in FIG. preferable.
- the length of the through hole is, for example, preferably twice or more the outer diameter of the punching means, and more preferably three times or more.
- the length of the through hole is the difference (zy) between the length (y) of the hole to be drilled in the member to be drilled and the length (z) of the portion of the drilling means that can be inserted into the through hole.
- the length of the through hole is a difference (zy) between the length (y) of the hole scheduled to be drilled in the member to be drilled and the length (z) of the portion of the drilling means that can be inserted into the through hole.
- the length is longer, only a shorter hole than planned can be drilled with the screw guide template kept in close contact with the member to be drilled.
- the length of the through hole is the difference (zy) between the length (y) of the hole scheduled to be drilled in the member to be drilled and the length (z) of the portion of the drilling means that can be inserted into the through hole. If it is shorter, there is a possibility that a hole longer than planned is formed by inserting the punching means into the through hole too much.
- FIG. 2 is a perspective view schematically showing the screw guide template 20 of the present invention according to the second embodiment.
- FIG. 3 is a diagram schematically showing a cross section including the central axis of the through hole 22 (the chain line in FIGS. 2 and 3) with respect to the screw guide template 20 shown in FIG. 2.
- the screw guide template 20 shown in FIGS. 2 and 3 includes a first piece 20a provided with one end 22a of the through hole 22 (hereinafter, also referred to as “through hole 22a”) and a contact surface 21; And a second piece 20b provided with the other end 22b of the through hole 22 (hereinafter, also referred to as “through hole 22b”).
- the central axis of the through hole 22 (the chain line shown in FIGS. 2 and 3) is determined by the relative positional relationship between the through hole 22a of the first piece 20a and the through hole 22b of the second piece 20b.
- the through hole 22a and the through hole 22b are formed coaxially. That is, the through hole 22 has one central axis.
- the punching scheduled location of the member to be drilled is determined by the opening 23a in the contact surface 21 of the first piece 20a.
- the screw guide template 20 is used with the contact surface 21 being in close contact with the surface including the planned drilling portion of the member to be drilled.
- the relative position between the screw guide template 20 and the member to be drilled is fixed.
- a drilling means such as a drill is inserted into the through hole 22, and a hole is drilled in the drilled member.
- the opening 23a and the planned drilling location of the member to be drilled overlap, and the through hole 22 is formed so as to be coaxial with the planned drilling direction.
- a hole can be drilled in a predetermined direction.
- the inner diameter of the through hole is not particularly limited as long as it can be inserted into the perforating means, but it is 1.001 to 1 of the outer diameter of the perforating means inserted into the through hole. .Times.1, preferably 1.001 to 1.05 times.
- the inner diameter of the through-hole having an opening on the contact surface is in the above range, and the inner diameters of the other through-holes are It is preferable to make it the same or larger than the inner diameter of the through hole having an opening on the contact surface.
- the inner diameter of the through hole 22a is in the above range, and the inner diameter of the through hole 22b is the same as or larger than the inner diameter of the through hole 22a. If the inner diameter of the through hole 22b is larger than the inner diameter of the through hole 22a, it becomes easy to insert a drilling means and a spinal fixation screw described later into the through hole 22a.
- the length of the through hole is not particularly limited, but is preferably at least twice the outer diameter of the drilling means inserted into the through hole, and at least three times. More preferably.
- the length of the through hole is the difference (zy) between the length (y) of the hole to be drilled in the member to be drilled and the length (z) of the portion of the drilling means that can be inserted into the through hole. It is also preferable to be determined by
- the “length of the through hole” means the distance from the opening where the drilling means is first inserted to the opening overlapping the planned drilling location. That is, when the through-hole 22 is divided into a plurality of pieces like the screw guide template 20, x1 shown in FIGS. 2 and 3 (from the center of the opening 23b, which is the opening into which the first punching means is inserted, The distance to the center of the opening 23a, which is the opening on the side overlapping with the planned drilling location, is the length of the through hole 22.
- FIG. 4 is a cross-sectional view schematically showing the screw guide template 20 ′ of the present invention according to the third embodiment, and corresponds to FIG. Since the screw guide template 20 ′ is the same as the screw guide template 20 except that the screw guide template 20 ′ is provided, the description other than the hollow tube 40 is omitted.
- the hollow tube 40 has one end communicating with the through-hole 22a of the first piece 20a and the other end communicating with the through-hole 22b of the second piece 20b. It has a hollow part into which the means can be inserted. By providing the hollow tube 40, it becomes easy to insert the punching means from the through hole 22b to the through hole 22a.
- the shape of the hollow tube 40 is not particularly limited as long as the punching means can be inserted from the through hole 22b to the through hole 22a when the close contact surface 21 of the screw guide template 20 'is brought into close contact with the member to be drilled. It is a cylinder having an inner diameter approximately the same size as the hole 22, and is preferably coaxial with the through hole 22.
- the inner diameter of the hollow tube 40 is preferably 1.001 to 1.1 times the outer diameter of the punching means, and more preferably 1.001 to 1.05 times. This is because it is possible to prevent the insertion position and the insertion direction of the perforating means from moving in the hollow tube 40 when the perforating means is inserted.
- FIG. 5 is a cross-sectional view schematically showing a screw guide template 50 of the present invention according to a fourth embodiment, and is a view corresponding to FIGS. 3 and 4.
- the screw guide template 50 shown in FIG. 5 includes a contact surface 51, a through hole 52 having one opening 53 in the contact surface 51, and a hollow tube 54.
- the contact surface 51 can be the same as the contact surfaces 11 and 21 of the screw guide templates 10, 20, and 20 ′ described so far, and thus description thereof is omitted.
- the opening 53 of the through hole 52 and the planned drilling portion of the member to be drilled overlap with each other.
- An axis (a chain line in FIG. 5) is formed so as to be coaxial with a hole to be drilled.
- the hollow tube 54 has one end communicating with the through-hole 52 and extending on the opposite side of the contact surface 51, and has a hollow portion into which a punching means used when punching a member to be punched can be inserted. is doing. That is, the hollow tube 54 is provided so as to extend the through hole 52. By providing the hollow tube 54, it is easy to make the screw guide template 50 (excluding the hollow tube 54) thinner and to secure the length of the through hole 52 (including the hollow tube 54). .
- the hollow tube 54 can be formed integrally with the through hole 52, and a separately prepared hollow tube after the through hole 52 is formed can be provided as the hollow tube 54.
- the shape of the hollow tube 54 is not particularly limited as long as the perforating means can be guided to the planned drilling site when the contact surface 51 is brought into close contact with the surface including the planned drilling site of the member to be drilled. It is a cylinder having an inner diameter of substantially the same size, and is preferably coaxial with the through hole 52. As described above, in the screw guide template of the present invention, the inner diameter of the through hole is not particularly limited as long as it can be inserted into the perforating means, but it is 1.001 to 1 of the outer diameter of the perforating means inserted into the through hole. .Times.1, preferably 1.001 to 1.05 times.
- the inner diameter of the hollow tube 54 is also preferably 1.001 to 1.1 times the outer diameter of the punching means, and more preferably 1.001 to 1.05 times. This is because, when the perforating means is inserted, it is possible to prevent the insertion position and the insertion direction of the perforating means from shifting in the hollow tube 54.
- the length of the through hole is not particularly limited, but is preferably twice or more the outer diameter of the punching means, and more preferably three times or more.
- the length of the through hole is the difference (zy) between the length (y) of the hole to be drilled in the member to be drilled and the length (z) of the portion of the drilling means that can be inserted into the through hole. It is also preferable to be determined by
- the “length of the through hole” means the length of the hollow tube and the length of the through hole in the form in which the hollow tube is provided so as to extend the through hole as in the form shown in FIG. Means the sum of That is, in the template 50, x2 (total length of the hollow tube 54 and the through hole 52) shown in FIG. 5 is the length of the through hole.
- FIG. 6 is a cross-sectional view schematically showing a screw guide template 60 of the present invention according to a fifth embodiment, and is a view corresponding to FIGS.
- the screw guide template 60 shown in FIG. 6 includes a contact surface 61, and the contact surface 61 includes a first contact surface 61a and a second contact surface 61b.
- the screw guide template 60 includes a first piece 60a having one end 22a (through hole 22a) of the through hole 22 and a first contact surface 61a, and a second piece having a second contact surface 61b. 60 b and the other end 22 b (through hole 22 b) of the through hole 22, and a third piece 60 c that connects the first piece 60 a and the second piece 60 b.
- the screw guide template can be firmly fixed to the surface of the member to be drilled by providing a plurality of contact surfaces of the screw guide template with a predetermined interval.
- FIG. 6 illustrates a form in which two contact surfaces are provided, the screw guide template of the present invention is not limited to such a form. That is, the close contact surface may be divided into three or more.
- the screw guide template system of the present invention includes the above-described screw guide template of the present invention and a location template.
- the screw guide template system uses a location template described below to first mark a planned drilling location even in a narrow location where it is difficult to identify the planned drilling location by closely contacting the screw guide template. And then drilled using a screw guide template as described above. Therefore, according to the screw guide template system of the present invention, even in a narrow place where it is difficult to specify the planned drilling location using the screw guide template, a hole is drilled in the correct planned drilling location in the correct planned drilling location. be able to.
- FIG. 7 is a perspective view schematically showing a location template 5 according to one embodiment.
- the screw guide template determines the direction in addition to the position of the hole when the member to be drilled is punched by the punching means.
- the location template 5 is used for specifying the position of the hole when the member to be drilled is drilled. Therefore, the location template 5 does not need to be as thick as the screw guide template. From the viewpoint of installing in a narrow place, the location template 5 is preferably as thin as possible.
- the location template 5 includes a close contact surface 1 to be in close contact with the member to be drilled, and a through hole 2 having one opening 3 on the close contact surface 1.
- the close contact surface 1 has a shape of a surface and a male-female shape including a planned perforation portion of the member to be perforated.
- the through-hole 2 is formed so that the opening 3 of the through-hole 2 and the planned drilling location overlap when the contact surface 1 is brought into close contact with the surface including the planned drilling location of the member to be drilled. Yes.
- the contact surface 1 When using the location template 5, the contact surface 1 is used in close contact with the surface of the member to be drilled including the planned drilling location. By bringing the contact surface 1 into close contact with the surface of the member to be drilled, the relative position between the location template 5 and the member to be drilled is fixed. In this state, a marker is inserted into the through hole 2 to mark the member to be drilled. At this time, as described above, since the opening 3 and the scheduled drilling portion of the member to be drilled overlap, it is possible to mark the exact scheduled drilling location.
- the inner diameter of the through hole is not particularly limited as long as the marker can be inserted, but is preferably 1.001 to 1.1 times the outer diameter of the marker inserted into the through hole. More preferably, the ratio is 001 to 1.05 times. If the inner diameter of the through hole is too small, it becomes difficult to insert the marker. If the inner diameter of the through hole is too large, the insertion position of the marker is likely to be blurred in the through hole when the marker is inserted into the through hole.
- the marker that can be used in the present invention is not particularly limited as long as it can mark the perforated member.
- a member to be drilled using the screw guide template or the screw guide template system of the present invention is not particularly limited.
- the screw guide template or screw guide template system of the present invention can be used when a member to be drilled is a spine and a hole for inserting a spinal fixation screw is inserted into the spine.
- FIG. 8 is a perspective view schematically showing a posture in which the screw guide template 20 is brought into close contact with the spine 30.
- FIG. 9 is a diagram schematically showing a part of a section taken along line VIII-VIII shown in FIG.
- FIG. 10 is a perspective view schematically showing a spine 30 having a hole 33 drilled using the screw guide template 20.
- the contact surface 21 of the screw guide template 20 is brought into close contact with the surface 31 of the spine 30 including the planned drilling site (scheduled site for inserting the spinal fixation screw) 32.
- the opening 23a of the screw guide template 20 and the planned drilling portion 32 of the spine 30 overlap, and the through hole 22 is coaxial with the planned drilling direction.
- a drilling means such as a drill is inserted into the through hole 22, and a hole 33 for inserting a spinal fixation screw into the spine 30 is drilled (see FIG. 10).
- the hole 33 for inserting the spinal fixation screw into the accurate planned insertion site 32 can be formed along the accurate planned insertion direction. Therefore, by using the screw guide template of the present invention, it is possible to accurately guide the spinal fixation screw for fixing the spine to the planned insertion place without requiring an expensive machine such as a navigation system, and to accurately insert the insertion direction. It is easy to insert along.
- the spinal fixation screw can be easily inserted with higher accuracy than before.
- the screw guide template of the present invention When the screw guide template of the present invention is used when a hole for inserting a spinal fixation screw is made in the spine, the screw guide template of the present invention corresponds to each position to be operated on the spine as described later. It is possible to make it. Therefore, it is possible to prevent the contact surface of the template from being brought into close contact with the wrong position of the spine. Therefore, by using the screw guide template of the present invention as described above, it is possible to guide the spinal fixation screw with high accuracy.
- Template production method is not particularly limited, but for example, it is preferable that the contact surface is formed based on tomographic information of the member to be drilled.
- tomographic information When drilling using a template, it is necessary that the contact surface has a relationship between the surface shape of the member to be drilled and the male and female. From the tomographic information, as described later, it is possible to reproduce the surface shape of the member to be drilled with high accuracy (error of 0.1 mm or less). Therefore, by using the tomographic information, it is possible to easily form a contact surface having a shape that closely contacts the surface of the member to be drilled.
- a method for producing a template will be described with a specific example.
- the tomography information is obtained by fluoroscopic measurement by using any one or two or more of known methods such as X-ray CT (X-ray-Computer-Tomography), MRI (Magnetic-Resonance-Imaging), and ultrasonic imaging in combination. Or it can obtain by measuring an external shape.
- X-ray CT X-ray-Computer-Tomography
- MRI Magnetic-Resonance-Imaging
- ultrasonic imaging in combination. Or it can obtain by measuring an external shape.
- the tomographic information obtained as described above is three-dimensionalized to obtain three-dimensional three-dimensional surface image data of the drilled member.
- general-purpose software “Mimics” can be used.
- Three-dimensional image processing and editing can be performed by reading tomographic information into a computer using “Mimics”.
- “Mimics” it is possible to read an X-ray CT or MRI slice image, extract a region of interest, and create three-dimensional three-dimensional surface image data.
- a three-dimensional image of the appearance and internal structure of the member to be drilled when viewed from an arbitrary angle can be displayed on the display.
- DICOM Digital Imaging and Communication in Medicine
- a standard format called “DICOM (Digital Imaging and Communication in Medicine) data” can be used for the image processing.
- DIOM data it is possible to extract a region of interest, which is a part to be three-dimensionalized, from the tomographic information by using various thresholding functions and various segmentation functions of “Mimics”.
- the obtained tomographic information is applied to, for example, a powder sintering additive manufacturing method and an optical modeling method, which will be described later, by converting it into two-dimensional DICOM data once and further converting it into surface type STL format data. can do.
- a full-scale model of the member to be drilled is produced using the three-dimensional three-dimensional surface image data of the member to be drilled.
- the model can be produced by, for example, an optical modeling method, an inkjet modeling method, a powder fixing modeling method, a paper lamination method, a powder sintering lamination modeling method, or the like.
- the above model is a full-scale model of a member to be drilled, and by using the model, it is possible to confirm the contact position, contact state, contact accuracy, etc. of the template when drilling. Therefore, the model can be effectively used for prior examination of drilling procedures or drilling practice before drilling. From the viewpoint of using this model for simulation of drilling or the like, it is preferable to manufacture the model with a material close to the actual drilled member. For example, when the member to be perforated is a spine, it is preferable to prepare a model by a powder sintering additive manufacturing method using a thermoplastic resin powder mixed with an inorganic material (see Japanese Patent No. 3927487). This is because it is possible to accurately and accurately reproduce the three-dimensional model of the solid shape close to the spine and the internal structure of the bone.
- the surface of the model at a predetermined position (the surface including the drilled portion) is pressed against a mold of a predetermined size (for example, a plaster mold, etc.) to change the shape of the model surface.
- a mold of a predetermined size for example, a plaster mold, etc.
- a portion to which the shape of the surface of the model is transferred can be used as a close contact surface of the template.
- the template also includes a through hole for inserting the punching means.
- the through hole can be formed with a drill or the like in a predetermined position and direction after producing a template that does not include the through hole as described above.
- a through hole for inserting the punching means can be made separately. That is, after a template having no through hole is prepared, a hole is formed in the template, a through hole forming hollow tube is inserted into the hole, and a through hole forming hollow tube is inserted into the hole. It is also possible to use a through-hole.
- the hollow tube communicating with the through hole as in the third embodiment and the fourth embodiment, it is possible to attach the hollow tube after providing the through hole in the template. It is also possible to provide the hollow tube and the through hole forming hollow tube integrally.
- the number of through holes provided in one template is not particularly limited, and an appropriate number of through holes can be formed according to the number of holes to be drilled.
- the material of the template is not particularly limited as long as it has an appropriate hardness.
- the material of the template needs to be biocompatible. Examples of those having biocompatibility include synthetic resins, rubbers, inorganic materials, inorganic powders, and composite materials thereof.
- the template is sterilized.
- the method of sterilization is not particularly limited, and examples thereof include gas sterilization and coating.
- stereoscopic surface image data of the surface (surface including the planned drilling portion) of the model at a predetermined position is obtained by a non-contact type laser scanning apparatus or the like. Thereafter, a template contact surface can be formed based on the three-dimensional surface image data of the surface of the model, and a template having the contact surface can be manufactured.
- the method for producing the template based on the three-dimensional surface image data is not particularly limited, and various molding techniques can be used. For example, production methods such as an optical modeling method, an inkjet modeling method, a powder modeling method, a powder sintering method, a paper lamination method, and a powder sintering lamination modeling method can be suitably used.
- production methods such as an optical modeling method, an inkjet modeling method, a powder modeling method, a powder sintering method, a paper lamination method, and a powder sintering lamination modeling method can be suitably used.
- a through-hole and a hollow tube can be provided later as described above.
- Data processing for adding through hole data to the target surface image data can be performed, and a template having through holes can be produced from the data.
- a synthetic resin powder when a template is produced by a powder sintering additive manufacturing method, a synthetic resin powder can be used as a material.
- the synthetic resin powder is not particularly limited.
- nylon, polycarbonate, polyester, polyacetal, polyethylene, polypropylene, polyvinyl chloride, polystyrene, polybutylene, ABS resin, cellulosic resin, acrylic resin, epoxy resin, fluororesin powder, etc. can be used.
- nylon can be preferably used, and nylon 12 can be particularly preferably used.
- a photocurable resin can be used as a material.
- the photocurable resin is not particularly limited, and for example, a known photocurable resin such as an acrylate type or an epoxy type can be used.
- a transparent template can be produced by using a material such as a transparent resin as a raw material.
- a transparent template is preferable in terms of operation because the surface of the perforated member to be adhered can be directly visually confirmed when the template is adhered to the perforated member.
- a template can also be produced by the method described below.
- the three-dimensional surface image data of the spine is copied and moved by a certain amount (the thickness of the template to be produced) in the direction opposite to the contact surface, and the moved copy data and the original three-dimensional surface image data are copied.
- a certain amount the thickness of the template to be produced
- the moved copy data and the original three-dimensional surface image data are copied.
- the templates can be produced by various molding techniques as described above.
- a manufacturing method that does not use a model is effective when it is not necessary to use a full-scale model of a member to be drilled for prior examination because a template can be directly produced without producing a model. Moreover, these methods are preferable at a point with a simple manufacturing process. Further, when a surface having the same shape as the close contact surface is formed on the surface opposite to the close contact surface, it is easy to determine the position where the template is closely attached when the template is closely attached to the surface of the perforated member. Has the advantage.
- FIG. 11 is a flowchart schematically showing an example of the drilling method of the present invention.
- the punching method of the present invention includes a contact surface forming step S1, a punching location specifying step S2, and a punching step S3.
- a contact surface forming step S1 As shown in FIG. 11, the punching method of the present invention includes a contact surface forming step S1, a punching location specifying step S2, and a punching step S3.
- these steps will be described.
- the contact surface forming step S1 is a step in which the contact surface of the screw guide template is formed so as to have a male-female relationship with the surface shape including the planned drilling portion of the member to be drilled.
- the method for forming the contact surface has been described when the template manufacturing method is described, and thus the description thereof is omitted here.
- the contact surface of the location template is also formed in this step S1 so that the surface shape including the planned drilling portion of the member to be drilled has a male-female relationship.
- the screw guide template is brought into close contact with the surface of the drilled member including the planned drilling location by contacting the contact surface of the screw guide template with the surface of the drilled member, and the planned drilling location is specified. It is a process to do. As described above, the screw guide template is formed so that the opening portion of the screw guide template and the scheduled drilling portion of the drilled member overlap when the contact surface is brought into close contact with the scheduled drilling location of the drilled member. . Therefore, it is possible to specify the planned drilling location by bringing the contact surface of the screw guide template into contact with the surface of the member to be drilled and searching for a place where the contact surface of the screw guide template and the surface of the member to be drilled are closely fixed. it can.
- the location template is brought into close contact with the surface of the member to be drilled including the planned drilling site by bringing the contact surface of the location template into contact with the surface of the member to be drilled in this step S2, and drilling is performed. Mark the planned location. Then, the contact surface of the screw guide template is brought into contact with the surface of the member to be drilled, and the contact surface of the screw guide template and the surface of the member to be drilled are contacted and fixed.
- the perforating step S3 is a step of perforating at a planned perforation portion of the member to be perforated through the perforating means through the through hole of the screw guide template that is closely fixed to the surface of the perforated member as described above.
- the through hole of the screw guide template is formed so as to be coaxial with the planned drilling direction. Therefore, by inserting a drilling means such as a drill into the through hole of the screw guide template and drilling by the drilling means, a hole can be drilled in the exact planned drilling location along the planned drilling direction.
- FIG. 12 is a flowchart schematically showing an example of the spinal fusion operation method of the present invention.
- the spinal fusion surgery method of the present invention is a spinal fusion surgery method in which a spinal fixation screw is inserted after being drilled into the spine.
- the spinal fixation operation method of the present invention includes a contact surface forming step S11, a piercing site specifying step S12, a perforating step S13, and a piercing step S14.
- these steps will be described.
- the contact surface forming step S11 is a step of forming the contact surface of the screw guide template so as to have a male-female relationship with the shape of the surface including the planned insertion site of the spine.
- the insertion location specifying step S12 is a step of closely fixing the screw guide template to the surface including the planned insertion site of the spine by bringing the contact surface of the screw guide template into contact with the surface of the spine and specifying the planned insertion site. It is.
- the drilling step S13 is a step of drilling at a puncture planned site of the spine through the drilling means through the through hole of the screw guide template.
- the planned insertion site is substantially the same as the planned drilling site.
- the contact surface forming step S11 is the same as the contact surface forming step S1 except that the member to be perforated is the spine, and the insertion site specifying step S12 is the same as the punching site specifying step S2, and the drilling step S13. Since this is the same as the drilling step S3, detailed description of these steps will be omitted.
- the insertion step S14 is a step of inserting a spinal fixation screw into the hole formed by drilling in the drilling step S13.
- the hole formed in the drilling step S13 (drilling step S3) is formed along the exact planned drilling direction at the exact planned drilling location of the spine (member to be drilled). Accordingly, the member to be perforated is the spine, and the spinal fixation screw is inserted into the hole formed in the perforation step S13, so that the spinal fixation screw is inserted into the accurate planned insertion position of the spine in the correct planned insertion direction. can do.
Abstract
Description
また、第2の本発明のスクリューガイドテンプレートシステムによれば、スクリューガイドテンプレートによって穿孔予定箇所の特定をすることが困難な狭い場所であっても、正確な穿孔予定箇所に正確な穿孔予定方向で孔を穿つことができる。
さらに、第3の本発明の穿孔方法によれば、被穿孔部材の正確な穿孔予定箇所に正確な穿孔予定方向で孔を穿つことができる。
さらに、第4の本発明の脊椎固定手術方法によれば、脊椎固定スクリューを脊椎の正確な刺入予定箇所に正確な刺入予定方向で刺入することができる。
1.1.第1実施形態
図1は、第1実施形態例にかかる本発明のスクリューガイドテンプレート10を概略的に示す斜視図である。
本発明のスクリューガイドテンプレートは、上記のような密着面と貫通孔を備えていればよく、図1に示したような板状体に限定されない。図2は、第2実施形態例にかかる本発明のスクリューガイドテンプレート20を概略的に示す斜視図である。図3は、図2に示したスクリューガイドテンプレート20について、貫通孔22の中心軸(図2及び図3中の一点鎖線)を含む断面を概略的に示す図である。
さらに他の実施形態を例示して、本発明のスクリューガイドテンプレートについて説明する。図4は、第3実施形態例にかかる本発明のスクリューガイドテンプレート20’を概略的に示す断面であり、図3に相当する図である。スクリューガイドテンプレート20’は、中空管40を備える以外はスクリューガイドテンプレート20と同様であるため、中空管40以外の説明は省略する。
さらに他の実施形態を例示して、本発明のスクリューガイドテンプレートについて説明する。図5は、第4実施形態例にかかる本発明のスクリューガイドテンプレート50を概略的に示す断面であり、図3及び図4に相当する図である。
さらに他の実施形態を例示して、本発明のスクリューガイドテンプレートについて説明する。図6は、第5実施形態例にかかる本発明のスクリューガイドテンプレート60を概略的に示す断面であり、図3~図5に相当する図である。
次に、本発明のスクリューガイドテンプレートシステムについて説明する。本発明のスクリューガイドテンプレートシステムは、上述した本発明のスクリューガイドテンプレートと、ロケーションテンプレートとを備えている。
本発明のスクリューガイドテンプレートまたはスクリューガイドテンプレートシステムを用いて孔を穿つ対象は特に限定されない。例えば、被穿孔部材を脊椎とし、該脊椎に脊椎固定スクリューを刺入するための孔を穿つ際に本発明のスクリューガイドテンプレートまたはスクリューガイドテンプレートシステムを用いることができる。
テンプレートの作製方法は特に限定されないが、例えば、被穿孔部材の断層撮影情報に基づいて密着面が形成されることが好ましい。テンプレートを用いて穿孔する際には、密着面が被穿孔部材の表面形状と雄雌の関係の形状を備えている必要がある。断層撮影情報からは、後に説明するようにして、高精度(誤差0.1mm以下)に被穿孔部材の表面形状を再現することが可能である。したがって、断層撮影情報を用いることによって、被穿孔部材の表面に正確に密着する形状の密着面を容易に形成することができる。以下に、テンプレートの作製方法について、具体例を挙げて説明する。
次に、図面を参照しつつ、本発明の穿孔方法について説明する。図11は、本発明の穿孔方法の一例について概略的に示すフローチャートである。
次に、図面を参照しつつ、本発明の脊椎固定手術方法について説明する。図12は、本発明の脊椎固定手術方法の一例について概略的に示すフローチャートである。
2 貫通孔
3 開口部
5 ロケーションテンプレート
10 スクリューガイドテンプレート
11 密着面
12 貫通孔
13 開口部
20 スクリューガイドテンプレート
20’ スクリューガイドテンプレート
20a 第一片
20b 第二片
21 密着面
22 貫通孔
22a、22b 貫通孔(貫通孔22の端部)
23a 開口部
30 脊椎
31 脊椎の表面
32 穿孔予定箇所
40 中空管
50 スクリューガイドテンプレート
51 密着面
52 貫通孔
53 開口部
54 中空管
60 スクリューガイドテンプレート
60a 第一片
60b 第二片
60c 第三片
61 密着面
61a 第一の密着面
61b 第二の密着面
Claims (17)
- 穿孔手段によって部材に穿孔する際に、該孔の位置および方向を決めるスクリューガイドテンプレートであって、
前記部材に密着させる密着面と、該密着面に一方の開口部を有する貫通孔とを備え、
前記スクリューガイドテンプレートの密着面が、前記部材の穿孔予定箇所を含む表面の形状と雄雌の関係の形状を備えており、該密着面を前記部材の穿孔予定箇所に密着させた際に、前記スクリューガイドテンプレートの開口部と前記部材の穿孔予定箇所とが重なり、前記貫通孔が、前記穿孔手段によって穿つ予定の孔と同軸になるように形成されている、スクリューガイドテンプレート。 - 前記密着面が、前記部材の断層撮影情報に基づいて形成されたものである、請求項1に記載のスクリューガイドテンプレート。
- 前記貫通孔に連通するとともに、前記密着面とは反対側に延在する中空管を有し、
前記中空管が、前記穿孔手段を挿入可能な中空部を有する、請求項1または2に記載のスクリューガイドテンプレート。 - 前記貫通孔の一方の端部および前記密着面を備えた第一片と、前記貫通孔の他方の端部を備えた第二片とを備えて構成され、
前記第一片の貫通孔および前記第二片の貫通孔の相対的な位置関係により、貫通孔の軸が決定され、前記第一片の前記密着面における前記開口部により、前記穿孔予定箇所の位置が決定される、請求項1~3のいずれかに記載のスクリューガイドテンプレート。 - 前記第二片の貫通孔の内径が、前記第一片の貫通孔の内径と同一若しくは前記第一片の貫通孔の内径より大きい、請求項4に記載のスクリューガイドテンプレート。
- 一方の端部が前記第一片の貫通孔に連通するとともに他方の端部が前記第二片の貫通孔に連通し、かつ、前記穿孔手段を挿入可能な中空部を有する中空管を備える、請求項5に記載のスクリューガイドテンプレート。
- 前記中空管が、前記貫通孔と同軸であるとともに略同一の大きさの内径を有する、請求項3または6に記載のスクリューガイドテンプレート。
- 前記貫通孔の長さが、前記穿孔手段の外径の2倍以上である請求項1~7のいずれかに記載のスクリューガイドテンプレート。
- 前記貫通孔の長さが、前記穿孔手段の外径の3倍以上である請求項8に記載のスクリューガイドテンプレート。
- 前記貫通孔の長さが、前記部材に穿つ予定の孔の長さ(y)と、前記穿孔手段のうち、前記貫通孔に挿入できる部分の長さ(z)との差(z-y)によって決定される、請求項1~9のいずれかに記載のスクリューガイドテンプレート。
- 前記貫通孔の内径が、前記穿孔手段の外径の1.001~1.1倍である請求項1~10のいずれかに記載のスクリューガイドテンプレート。
- 前記貫通孔の内径が、前記穿孔手段の外径の1.001~1.05倍である請求項11に記載のスクリューガイドテンプレート。
- 前記密着面が所定の間隔を設けて複数備えられている、請求項1~12のいずれかに記載のスクリューガイドテンプレート。
- 脊椎を固定する脊椎固定スクリューを刺入するための孔を、該脊椎に穿つときに用いるスクリューガイドテンプレートであって、
前記部材が前記脊椎であるとともに、前記孔が前記脊椎固定スクリューを刺入するための孔である、請求項1~13のいずれかに記載のスクリューガイドテンプレート。 - 穿孔手段によって部材に穿孔する際に、該孔の位置および方向を決めるスクリューガイドテンプレートシステムであって、
請求項1~14のいずれかに記載のスクリューガイドテンプレートと、ロケーションテンプレートとを備え、
前記ロケーションテンプレートが、前記部材に密着させる密着面と、該密着面に一方の開口部を有する貫通孔とを備え、
前記ロケーションテンプレートの密着面が、前記部材の穿孔予定箇所を含む表面の形状と雄雌の関係の形状を備えており、
該密着面を前記部材の穿孔予定箇所に密着させた際に、前記ロケーションテンプレートの開口部と前記部材の穿孔予定箇所とが重なるように前記貫通孔が形成されている、スクリューガイドテンプレートシステム。 - 部材に穿孔する穿孔方法であって、
あらかじめ、請求項1~13のいずれかに記載のスクリューガイドテンプレートの密着面を、前記部材の穿孔予定箇所を含む表面の形状と雄雌の関係になるように形成する工程と、
該密着面を前記部材の表面に接触させることで、前記部材の穿孔予定箇所を含む表面に前記スクリューガイドテンプレートを密着固定させ、前記穿孔予定箇所を特定する工程と、
前記スクリューガイドテンプレートの貫通孔に穿孔手段を通して、前記部材の穿孔予定箇所に、穿孔する工程と、
を備えた穿孔方法。 - 脊椎に穿孔して脊椎固定スクリューを刺入する脊椎固定手術方法であって、
あらかじめ、請求項14に記載のスクリューガイドテンプレートの密着面を、前記脊椎の刺入予定箇所を含む表面の形状と雄雌の関係になるように形成する工程と、
該密着面を前記脊椎の表面に接触させることで、前記脊椎の刺入予定箇所を含む表面に前記スクリューガイドテンプレートを密着固定させ、前記刺入予定箇所を特定する工程と、
前記スクリューガイドテンプレートの貫通孔に穿孔手段を通して、前記脊椎の刺入予定箇所に穿孔する工程と、
穿孔して形成された孔に脊椎固定スクリューを刺入する工程と
を備えた脊椎固定手術方法。
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WO2014002284A1 (ja) * | 2012-06-25 | 2014-01-03 | 株式会社大野興業 | 骨固定スクリュー用テンプレート及びその製造方法 |
WO2014192586A1 (ja) * | 2013-05-29 | 2014-12-04 | 株式会社大野興業 | 手術冶具及び確認冶具並びにこれらの冶具を製造する方法 |
JP2018202182A (ja) * | 2012-12-12 | 2018-12-27 | オベエル エス.アー.Obl S.A. | インプラントおよびガイド |
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CN106236256B (zh) * | 2015-10-30 | 2018-07-06 | 自贡市第四人民医院 | 一种个性化胸腰椎矢状曲度模棒的制作方法 |
JP2018015306A (ja) * | 2016-07-28 | 2018-02-01 | 株式会社ニューロデザイン | ドリルガイド、スクリューガイドシステム、穿孔方法、及び脊椎固定手術方法 |
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WO2014002284A1 (ja) * | 2012-06-25 | 2014-01-03 | 株式会社大野興業 | 骨固定スクリュー用テンプレート及びその製造方法 |
US10085784B2 (en) | 2012-06-25 | 2018-10-02 | Ono & Co., Ltd. | Bone fixing screw template and method for producing same |
JP2018202182A (ja) * | 2012-12-12 | 2018-12-27 | オベエル エス.アー.Obl S.A. | インプラントおよびガイド |
US10869705B2 (en) | 2012-12-12 | 2020-12-22 | Obl S.A. | Implant and guide |
US11759244B2 (en) | 2012-12-12 | 2023-09-19 | Materialise Nv | Implant and guide |
WO2014192586A1 (ja) * | 2013-05-29 | 2014-12-04 | 株式会社大野興業 | 手術冶具及び確認冶具並びにこれらの冶具を製造する方法 |
JP2014230635A (ja) * | 2013-05-29 | 2014-12-11 | 株式会社大野興業 | 手術冶具及び確認冶具並びにこれらの冶具を製造する方法 |
CN105407820A (zh) * | 2013-05-29 | 2016-03-16 | 株式会社大野兴业 | 手术器械、校验器械和制造这些器械的方法 |
AU2014272088B2 (en) * | 2013-05-29 | 2018-12-06 | Nozomu Matsumoto | Surgical jig, verification jig, and methods for producing these jigs |
US10327788B2 (en) | 2013-05-29 | 2019-06-25 | Ono & Co., Ltd. | Surgical jig, verification jig, and methods for producing these jigs |
Also Published As
Publication number | Publication date |
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JPWO2011149106A1 (ja) | 2013-07-25 |
US20130116700A1 (en) | 2013-05-09 |
US9125693B2 (en) | 2015-09-08 |
JP5849299B2 (ja) | 2016-01-27 |
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