WO2014176118A1 - Procédé et système de production d'au moins une aide chirurgicale propre à un patient - Google Patents

Procédé et système de production d'au moins une aide chirurgicale propre à un patient Download PDF

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Publication number
WO2014176118A1
WO2014176118A1 PCT/US2014/034578 US2014034578W WO2014176118A1 WO 2014176118 A1 WO2014176118 A1 WO 2014176118A1 US 2014034578 W US2014034578 W US 2014034578W WO 2014176118 A1 WO2014176118 A1 WO 2014176118A1
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WO
WIPO (PCT)
Prior art keywords
patient
specific surgical
surgical aid
interest
patient tissue
Prior art date
Application number
PCT/US2014/034578
Other languages
English (en)
Inventor
Wael K. Barsoum
Joseph P. Iannotti
Jason A. Bryan
Peter D. O'neill
Original Assignee
The Cleveland Clinic Foundation
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
Priority claimed from US13/870,180 external-priority patent/US20130236874A1/en
Application filed by The Cleveland Clinic Foundation filed Critical The Cleveland Clinic Foundation
Publication of WO2014176118A1 publication Critical patent/WO2014176118A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • 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
    • 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
    • A61B17/1778—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the shoulder
    • 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

Definitions

  • the present invention relates to an apparatus and method for producing at least one patient-specific surgical aid and, more particularly, to a method and apparatus for using a physical model of a native patient tissue to help produce at least one patient-specific surgical aid.
  • a glenoid component is implanted into the glenoid vault of the patient's scapula.
  • An obverse surface of the glenoid component is configured for articulating contact with a humeral component carried by the patient's humerus.
  • a reverse surface of the glenoid component is secured to the bone surface of the glenoid vault.
  • the shoulder prosthesis is normally provided to correct a congenital or acquired defect of the native shoulder joint
  • the glenoid vault or joint surface often exhibits a pathologic, nonstandard anatomic configuration.
  • a surgeon must compensate for such pathologic glenoid vault anatomy when implanting the glenoid component in striving to achieve a solid anchoring of the glenoid component into the glenoid vault.
  • Detailed preoperative planning using two- or three-dimensional internal images of the shoulder joint, often assists the surgeon in compensating for the patient's anatomical limitations.
  • an elongated pin may be inserted into the surface of the patient's bone, at a predetermined trajectory and location, to act as a passive landmark or active guiding structure in carrying out the preoperatively planned implantation.
  • This "guide pin” may remain as a portion of the implanted prosthetic joint or may be removed before the surgery is concluded.
  • This type of pin-guided installation may be useful in any joint replacement procedure-indeed, in any type of surgical procedure in which a surgeon-placed fixed landmark is desirable.
  • the guide of this co-pending application is described, in relevant part, as being planned using a computer and generated (e.g., via three-dimensional printing or rapid prototyping) with the landmark-guiding features in place.
  • a user may wish to manufacture or generate a guide without the use of a computer in some situations.
  • a method for producing at least one patient-specific surgical aid is described.
  • a physical model of a native patient tissue is provided.
  • the physical model has at least one surface of interest.
  • a constraining wall is placed in contact with at least a portion of the physical model.
  • a moldable substance is placed into contact with at least a portion of the surface of interest. An impression of the surface of interest is maintained upon the moldable substance.
  • the moldable substance is solidified into a patient-specific surgical aid.
  • the patient-specific surgical aid is removed from the physical model.
  • a system of providing at least one patient-specific surgical aid is provided.
  • a physical model of a native patient tissue is provided.
  • the physical model has at least one surface of interest.
  • a constraining wall for contacting at least a portion of the physical model is provided.
  • a moldable substance for contacting at least a portion of the surface of interest and for maintaining an impression of the surface of interest thereupon is provided.
  • the moldable substance is solidified into a patient-specific surgical aid.
  • the patient- specific surgical aid is removed from the physical model for use.
  • a method for producing at least one patient-specific surgical aid is described.
  • a native patient tissue having at least one patient tissue surface of interest is provided.
  • a moldable substance is placed into contact with at least a portion of the patient tissue surface of interest.
  • An impression of the patient tissue surface of interest is maintained upon the moldable substance.
  • the moldable substance is solidified into a patient-specific surgical aid.
  • the patient-specific surgical aid is removed from the native patient tissue.
  • a system of providing at least one patient-specific surgical aid is described.
  • a moldable substance for contacting at least a portion of a patient tissue surface of interest of a native patient tissue is provided.
  • the moldable substance is configured to maintain an impression of the patient tissue surface of interest thereupon.
  • the moldable substance is solidified into a patient-specific surgical aid when in contact with at least a portion of the patient tissue surface of interest before removal of the patient-specific surgical aid from the native patient tissue.
  • FIGs. 1 -3 are perspective views of one structure of the present invention in a first configuration
  • FIGs. 4-6 are perspective views of the structure of Figs. 1 -3 in a second
  • FIGS. 7 and 9-10 are perspective views of the structure of Figs. 1 -3 in a third configuration;
  • Fig. 8A is a partial cross-sectional view taken along line A-A in Fig. 7;
  • Fig. 8B is a partial cross-sectional view taken along line B-B in Fig. 7;
  • Fig. 8C is a partial cross-sectional view taken along line C-C in Fig. 7;
  • FIGs. 1 1 -13 are perspective views of another structure of the present
  • FIGS. 14A-14F are perspective views depicting an example sequence of operation of the present invention.
  • FIG. 15 is a perspective view of another structure of the invention in a first configuration
  • Figs. 16A-16C are partial cross-sectional views of the structure of Fig. 15;
  • Fig. 17 is a partial cross-sectional view of another structure of the invention.
  • Fig. 18 is a top view of an example use environment for an embodiment of the present invention.
  • Fig. 19 is a top view of the embodiment of Fig. 18 in the example use
  • Fig. 20 is a partial cross-sectional view taken along line 20-20 in Fig. 19;
  • Fig. 21 A is a top view of the embodiment of Fig. 18 in another example use environment
  • Fig. 21 B is a side view of the embodiment of Fig. 18 in the example use
  • Fig. 22A is a top view of the embodiment of Fig. 18 in another example use environment
  • Fig. 22B is a side view of the embodiment of Fig. 18 in the example use
  • Fig. 23 is a top view of the of the embodiment of Fig. 18 in the example use environment of Fig. 18;
  • Fig. 24 is a partial cross-sectional view taken along line 24-24 in Fig. 23.
  • the patient tissue is shown and described herein at least as a scapula and an acetabulum
  • the prosthetic implant component is shown and described herein at least as a glenoid prosthetic shoulder component and an acetabular prosthetic hip component
  • the patient tissue and corresponding prosthetic implant component could be any desired types such as, but not limited to, hip joints, shoulder joints, knee joints, ankle joints, phalangeal joints, metatarsal joints, spinal structures, long bones (e.g., fracture sites), or any other suitable patient tissue use environment for the present invention.
  • long bones e.g., fracture sites
  • FIGs. 1 -3 depict three different components
  • a physical model 100 (sometimes called a "surrogate model") of a native patient tissue-here, the glenoid fossa and surrounding scapular structures.
  • the term "native patient tissue” and variants thereof is used herein to indicate a patient tissue of interest in its condition at the time of surgical preparation, having any included natural or artificial structures of interest, whether congenital or acquired.
  • model is used herein to indicate a replica or copy of a physical item, at any relative scale and represented in any medium, physical or virtual.
  • the patient tissue model may be a total or partial model of a subject patient tissue, and may be created in any suitable manner.
  • the patient tissue model may be a tangible representation of a virtual model generated using computer tomography ("CT") data imported into a computer aided drafting ("CAD") system.
  • CT computer tomography
  • CAD computer aided drafting
  • the patient tissue model may be based upon a virtual model created with the aid of digital or analog radiography, magnetic resonance imaging, or any other suitable imaging means.
  • the patient tissue model will generally be displayed for the user to review and manipulate preoperatively, such as through the use of a physical model or (in the case of a virtual model) the use of a computer or other graphical workstation interface.
  • the patient's name, identification number, surgeon's name, and/or any other desired identifier may be molded into, printed on, attached to, or otherwise
  • the physical model 100 may be made by any suitable method such as, but not limited to, selective laser sintering ("SLS”), fused deposition modeling (“FDM”), stereolithography (“SLA”), laminated object manufacturing (“LOM”), electron beam melting (“EBM”), 3-dimensional printing (“3DP”), contour milling, computer numeric control (“CNC”), other rapid prototyping methods, or any other desired manufacturing process.
  • SLS selective laser sintering
  • FDM fused deposition modeling
  • SLA stereolithography
  • LOM laminated object manufacturing
  • EBM electron beam melting
  • 3DP 3-dimensional printing
  • contour milling computer numeric control
  • CNC computer numeric control
  • the physical model may be directly generated from the native patient tissue using a microscribe three-dimensional scanning/replicating device and/or using a molding system to take an impression of the patient's tissue from which the physical model can be made.
  • the physical model 100 represents a three-dimensional, physically manipulate representation of a particular native patient tissue.
  • the physical model 100 has at least one surface of interest 102 (substantially the glenoid fossa, in the embodiment shown in the Figures).
  • the term "surface of interest” is used herein to indicate a surface of the physical model 100 which the user wishes to replicate and/or reference with the patient-specific surgical aid.
  • a "surface of interest" 102 in most cases will not have clearly defined borders, but that person of ordinary skill in the art will be able to instinctively differentiate between a surface of interest and another patient tissue, which is not a surface of interest, for a particular application of the present invention.
  • the physical model 100 of the Figures depicts a portion of a scapula which will be undergoing a glenoid resurfacing and/or replacement procedure. Therefore, one surface of interest 102 that will be referenced herein is the glenoid fossa surface.
  • at least one landmark 104 may be associated with the physical model 100.
  • two landmarks 104a and 104b are present, with the former being located on the glenoid fossa surface and the latter being located to one side of the glenoid fossa surface, shown here on the glenoid rim at/near the base of the coracoid process.
  • landmark 104 is used herein to indicate any guiding aid which serves as a detectable indicator of a particular position on a "marked" substrate (here, the patient tissue or the physical model 100 representing such).
  • the landmarks 104 discussed with respect to the present invention are presumed to be affixed or otherwise rigidly associated with a particular patient tissue so that a user can confidently maintain a sense of physical and/or visual orientation within the operative field.
  • Suitable landmarks 104 may include, but are not limited to, visual "written” marks (e.g., a thin layer of a substance left behind after contact with a crayon, surgical pen, or the like), other written marks outside the visual spectrum (e.g., a UV-fluorescent paint), guide pins, fasteners (e.g., screws, nails, staples, or the like), radioactive tags, bovie cautery burn marks, metallic or nonmetallic devices attached to the desired landmark site (e.g., a rivet, tack, or the like), or even modifications of the patient tissue itself (e.g., notches, inscribed lines, drill holes, or the like, as with the landmarks 104a and 104b shown in the Figures).
  • visual "written” marks e.g., a thin layer of a substance left behind after contact with a crayon, surgical pen, or the like
  • other written marks outside the visual spectrum e.g., a UV-fluorescent paint
  • guide pins e.g., fast
  • each landmark 104 on the physical model 100 may be predetermined by a user before the landmark is associated with the physical model. This predetermination may occur intraoperatively, while the user is able to directly see the condition of the surgical site and associate the landmark(s) 104 with the corresponding physical model 104 accordingly.
  • a predetermination of the desired marking location and desired marking trajectory for each landmark 104 could be accomplished preoperatively, with reference to preoperative imaging of the patient tissue. For example, a system similar to that of co-pending U.S. Patent Application No.
  • virtual landmarks 104 may be virtually placed on a virtual patient tissue model.
  • the physical model 100 may be at least partially custom- manufactured responsive to preoperative imaging of the patient tissue, the physical model 100 having at least one landmark 104 associated therewith as generated.
  • Figs. 4-6 three perspective views are shown of a physical model 100 having landmarks 104a, 104b which are guide pins, protruding from the surface of the physical model.
  • the guide pin landmarks 104a, 104b could either be stock or bespoke guide pins inserted into previously provided bores in the physical model 100, or could be originally formed as protrusions from the physical model.
  • the guide pin landmarks 104a, 104b shown in Figs. 4-6 are three-dimensional and therefore include both a marking location and a marking trajectory.
  • the guide pin landmarks 104a, 104b of Figs. 4-6 are examples of non-native (i.e., non-native patient tissue) structures which are associated with the surface of interest 102 (For certain use environments of the present invention, the glenoid rim guide pin landmark 104b may be considered to be "outside" the surface of interest 102, depending on the metes and bounds of the surgical procedure being planned.).
  • the non-native structure may be an information feature providing clinically useful information to a user.
  • “Clinically useful” information is used herein to indicate any information, other than the structure of the native patient tissue itself, that assists one of ordinary skill in the art with some pre- and/or intra-operative task.
  • An “information feature” is any physical feature or characteristic of the physical model 100 which signifies or communicates the clinically useful information to the user, optionally in combination with a preoperative plan.
  • the information feature may be substantially separated from the surface of interest.
  • Figs. 7-10 illustrate various structures which can assist with providing at least one patient-specific surgical aid using a molding fabrication process according to the present invention.
  • Figs. 7-10 each include at least a portion of a physical model 100 having two guide pin landmarks 104a, 104b protruding therefrom.
  • Figs. 7-10 each also depict at least one constraining wall which may be provided for contacting at least a portion of the physical model 100, such as at least a portion of the surface of interest 102.
  • constraining walls are shown schematically via dotted lines: an outer wall 706 defining at least one perimeter boundary of a patient-specific surgical aid, an inner wall 708 defining at least one inner recess 710 of the patient-specific surgical aid (omitted from Figs. 9-10 for clarity), and two guide bushings 712a and 712b which each are associated with a guide pin landmark 104a and 104b, respectively, to define a guiding aperture (not shown) through a thickness of the patient-specific surgical aid, as will be discussed below.
  • the constraining wall(s) of the present invention when provided, may be of any suitable size, shape, configuration, material, construction, or other physical property, and may be integrally formed in a one-piece manner with the physical model 100 or separately provided by any agent, at any time, and with any degree (or none) of attachment or connection, permanent or temporary, to the physical model 100.
  • the dimensions, construction, material(s), configuration(s), attach ment(s), and other properties of a suitable constraining wall(s) may be readily determined by one of ordinary skill in the art for a particular application of the present invention.
  • each constraining wall is contemplated for use in helping to form a patient-specific surgical guide 814, as shown in the cross-sectional views of Figs. 8A, 8B, and 8C.
  • the patient-specific surgical guide 814 will, for most applications of the present invention, be molded from the physical model 100, optionally with the assistance of one or more constraining walls. That is, a moldable substance 816 will be placed into contact with at least a portion of the surface of interest 102.
  • the moldable substance 816 which makes up the body of the patient-specific surgical guide 814 as denoted by the shaded portions of those Figures, is shown as being slightly separated from adjacent surfaces for clarity of depiction. In reality, the moldable substance 816 can be placed into a mating relationship with those adjacent surfaces, as desired by a user.
  • the moldable substance 816 may be any suitable material, or combination of materials, which is capable of maintaining an impression of the surface of interest 102 thereupon.
  • suitable reusable or single-use moldable substances include, but are not limited to, modeling clay, gelatins, urethane and silicone rubber, urethane and epoxy casting resins, other epoxies, latexes, adhesives, cements (e.g., bone cement or any other type), glues, foams (e.g., florists' foam, aerosol foams, or any other type), other plastic materials, candy, closely packed
  • the moldable substance 816 has relatively high viscosity and/or is a solid, one or more of the constraining walls discussed herein may be omitted if not needed to constrain a moldable substance that itself has sufficient physical properties to maintain position as desired by the user.
  • the moldable substance 816 should be able to be solidified into a patient- specific surgical aid 814, which can then be removed from the physical model 100 for use.
  • the term “solidify” is used herein to indicate that the moldable substance 816 dries, sets, cures, or otherwise takes on a definite physical form (optionally with the use of an oven, fan, light of a certain wavelength [e.g., ultraviolet], or other "curing" aid) sufficient to substantially maintain the impression of the surface of interest 102 upon removal of the patient-specific surgical aid 814 from the physical model 100.
  • Solidify is also used herein to reference the process, if any, of
  • a moldable substance 816 that is substantially solid in raw material form (e.g., florists' foam) sufficiently for the moldable substance to maintain the format of the patient-specific surgical aid 814, whether or not any phase change from raw to "solidified” form of the moldable substance occurs.
  • a “solidified” patient-specific surgical aid 814 may still be somewhat pliant or supple, or even include portions (e.g., "pockets") of fluid material, and be considered sufficiently “solidified” for a particular application.
  • the "solidified" patient-specific surgical aid 814 may be substantially rigid.
  • a release agent or other intermediate substance e.g., a lubricant, mold release spray or powder, wax, thin film [e.g., plastic wrap], or the like
  • a release agent or other intermediate substance may be placed on at least a portion of the surface of interest 102 before the moldable substance 816 is placed into contact with at least a portion of the surface of interest, for any desired reason including protecting the surface of interest from the moldable substance or vice versa, facilitating removal of the patient-specific surgical aid 814 from the physical model 100, or for any other reason.
  • the contact between the moldable substance 816 and the affected portion(s) of the surface of interest 102 may be indirect.
  • Each constraining wall (e.g., the outer wall 706, inner wall 708, guide bushing 712, or any other constraining wall as desired) may be provided and used to help contain or block flow of the moldable substance 816 before it is solidified, to help define the area of the physical model 100 which is a surface of interest 102, to help insulate or separate portions of the patient-specific surgical aid 814 from each other, and/or for any other desired reason.
  • the moldable substance 816 may come into contact with at least a portion of the constraining wall—this is evident in Figs. 8A-8C, in which a relatively fluid moldable substance has been poured into a mold cavity comprised of the surface of interest 102 and the constraining walls.
  • the physical model 100 may be arranged with a substantial part of the surface of interest 102 being located at a topmost position (if it is not already), and optionally oriented to be substantially level to a local ground plane, before the moldable substance 816 is brought into contact with the surface of interest-in this manner, a suitable amount of the moldable substance may be assisted by gravity in reaching all desired portions of the surface of interest.
  • the constraining wall(s) need not solely provide containment of the moldable substance 816, and other structures (not shown) might also be used to facilitate the molding process.
  • a portion of the moldable substance 816 may be molded without need for containment, due to the viscosity of the moldable substance 816, the orientation of the physical model 100 with respect to the local gravitational field, or for any other reason.
  • At least one constraining wall may be incorporated into, and
  • the affected constraining wall(s) may be detached or otherwise removed from contact with the physical model 100 as the patient-specific surgical aid 814 is removed from the physical model.
  • Fig. 8A depicts a simple cross-section through the thickness of the patient- specific surgical aid 814, wherein the moldable substance 816 has been poured into the outer wall 706.
  • the outer wall 706 may be placed somewhat arbitrarily to provide an outer border for the patient-specific surgical aid 814.
  • at least a portion of the outer wall 706 itself may be an information feature and contain clinically useful information, such as a "cookie cutter" type border indicator showing where the underlying patient tissue should be resected.
  • Fig. 8B depicts a slightly more complex cross-section than in Fig. 8A, with at least one non-native structure (here, the guide pin landmark 104a) bring associated with the physical model 100 in this cross-section.
  • a molded feature incorporated in the patient-specific surgical aid 814 is based upon the guide pin landmark 104a. That is, a bore or aperture 818 protrudes through the patient- specific surgical aid 814 as a negative space where the guide pin landmark 104a has prevented the presence of the moldable substance 816.
  • the guide bushing 712 or at least a portion of another constraining wall may be interposed between at least a portion of the non-native structure and the moldable substance 816.
  • the guide pin landmarks 104 may either go with, and be considered a part of, the patient-specific surgical aid or may be removed therefrom.
  • the guide pin landmarks 104 may assist with creating a drill guide aperture 818 in the patient-specific surgical aid 814, the drill guide aperture having the desired marking location and marking trajectory embodied in the corresponding guide pin landmark.
  • a guide bushing 712 type constraining wall may become an integral part of the patient-specific surgical aid 814 to limit the size of the aperture, resist abrasion (by preventing contact between the drill bit and the moldable substance 816), and/or serve as a guide for the drill bit.
  • Fig. 8C depicts a cross-section in which the inner recess 710 has been left free of moldable substance 816 for some reason.
  • the inner recess 710 may provide material cost and/or weight savings for the patient-specific surgical aid 814, the inner recess 710 may mark a desired cutting plane for a step in the surgical procedure, the inner recess may be configured to accept a handle or other auxiliary tool structure, a portion of the patient tissue within the inner recess may be pressure-sensitive, or the inner recess may have been provided for any other reason.
  • the inner recess 710 When the patient-specific surgical aid 814 is removed from the physical model 100, the inner recess 710 will remain "open", and the inner wall 708 may be incorporated into the patient-specific surgical aid to maintain integrity (e.g., size and/or shape) of the inner recess. However, the inner recess 710 is omitted from successive Figures for clarity of depiction.
  • Figs. 9-10 illustrate the manner in which the constraining walls (i.e., the outer wall 706 and guide bushings 712a and 712b) relate to the physical model 100 before and during the molding process for the patient-specific surgical aid 814.
  • the constraining walls i.e., the outer wall 706 and guide bushings 712a and 712b
  • Figs. 1 1 -13 depict various perspective views of the completed patient-specific surgical aid 814 after having been solidified and removed from a physical model 100, such as the physical model 100 shown in Figs. 9-10. As can be seen from the substantially bottom view of Fig. 1 1 , the bottom surface 1 120 substantially
  • the patient-specific surgical aid 814 produced using the above-described process should substantially mate with a native patient tissue (corresponding to the physical model 100) when placed upon the appropriate native patient tissue and aid the user in positively transferring landmark 104 marking locations and/or marking trajectories, or any other clinically useful information embodied in the patient-specific surgical aid to the native patient tissue.
  • the patient-specific surgical aid 814 may be used similarly to the devices disclosed in co-pending U.S. Patent Application No. 13/282,509, filed 27 October 201 1 and titled "System and Method for Association of a Guiding Aid with a Patient Tissue", the entire contents of which are incorporated herein by reference.
  • the patient-specific surgical aid 814 such as to guide a drill bit or guide pin into the underlying native patient tissue at a specified location and trajectory. Because the patient-specific surgical aid 814 is contemplated to only mate securely with the native patient tissue in a single relative orientation, the user has a reasonably high degree of confidence that the drill bit or guide pin is being guided into the underlying native patient tissue in the desired location and/or trajectory.
  • the patient-specific surgical aid 814 is a patient- specific, single-use, bespoke component suited only for use at a surgical site corresponding to the surface of interest 102, though one of ordinary skill in the art could create a guide (not shown) which uses a patient-specific "disposable” structure (which may be substantially limited to the surface of interest) connected to a stock, generic "reusable" carrier (which may help the user in manipulating, stabilizing, securing, or otherwise interacting with the "disposable” structure as desired.
  • Figs. 14A-14F depict an example sequence of operation of the present
  • Fig. 14A includes two physical models 100a (on the left, in the orientation of Fig. 14A) and 100b (on the right, in the orientation of Fig. 14A).
  • Physical model 100a is bare, with no landmarks included.
  • Physical model 100b includes landmarks 104a and 104b, which are each guide pins as previously described.
  • guide bushings 712 serving as constraining walls, have been placed around each of the landmarks 104a and 104b.
  • Fig. 14C depicts the physical model 100b with the inserted landmarks 104a and 104b and the surrounding guide bushings 712.
  • a moldable substance 816 has been placed into contact with at least a portion of the surface of interest 102.
  • Figs. 14E-14F depict different views of the patient-specific surgical aid 814 placed in a use position atop the bare physical model 100a, which includes no landmarks 104. (This bare physical model 100a is used in Figs. 14E-14F as an easily viewed proxy for the patient tissue upon which that physical model was based, for the sake of the present discussion.) As can be seen in Figs.
  • the guide bushings 712 are each held by the patient-specific surgical aid 814 at a location and trajectory that will direct a guide pin inserted therethrough into an insertion location and trajectory that substantially replicates the landmarks 104a and 104b present on the physical model 100b which was used to create the patient-specific surgical aid.
  • Figs. 15-16C illustrate a second embodiment of the present invention for use with a second physical model 100'.
  • the embodiment of Figs. 15-16C is similar to the embodiment of Figs. 1 -14F and therefore, structures of Figs. 15-16C that are the same as or similar to those described with reference to Figs. 1 -14F have the same reference numbers with the addition of a "prime" mark. Description of common elements and operation similar to those in the previously described embodiments will not be repeated with respect to the second embodiment.
  • the physical model 100' of the patient tissue embodies a hip and an acetabulum, as opposed to the scapula and glenoid of Figs. 1 -14F.
  • two landmark 104' guide pins have been placed, with one landmark 104'a being located inside the acetabulum and a second landmark 104'b being located outside the rim of the acetabulum.
  • the user will probably want to avoid creating a single patient-specific surgical aid 814' which includes both of the landmarks 104'a and 104'b in the positions depicted in Fig. 15, at least because it would take a relatively large quantity of moldable substance 816' to fill the acetabulum and also come into molding contact with the area of the pelvis near the second landmark 104'b. That large quantity of moldable substance 816' may be expensive, difficult to obtain, difficult to work with (e.g., does not solidify well), or may otherwise be undesirable to use.
  • FIGS. 16A-16C depict, schematically and sequentially, the creation of two spaced-apart surgical aids 814'a and 814'b, which is contemplated as being a more likely scenario for most users of the present invention.
  • Fig. 16A is a cross- sectional view of the physical model 100' including both landmarks 104'a and 104'b.
  • guide bushings 712'a and 712'b have been placed around the
  • Fig. 16C shows the landmarks 104'a and 104'b, the guide bushings 712'a and 712'b, and two outer walls 706'a and 706'b, with each outer wall substantially surrounding one landmark-guide bushing pair.
  • Fig. 16C also shows moldable substance 816'a and 816'b, which has been provided within the outer walls 706'a and 706'b, respectively.
  • the moldable substance 816'a and 816'b may be the same at each location, or may differ, as desired by the user.
  • Fig. 17 illustrates an alternate patient-specific surgical aid 814' in an example use environment corresponding to the second physical model 100'. As shown in Fig.
  • a landmark 104' can be located at a position, such as the depicted acetabular rim, with a constraining wall having a guide bushing 712' which is supported by a remote locator 1722.
  • An anchor end 1724 of the remote locator 1722 is located adjacent, and optionally contacting, the physical model 100' at a location which is provided with a moldable substance 816'.
  • the moldable substance 816' is constrained by an outer wall 706', to reduce the volume of moldable substance needed to replicate the surface of interest 102' (here, the acetabular fovea) while securing the anchor end 1724 of the remote locator 1722 sufficiently to memorialize the location and/or trajectory of the landmark 104' in the patient-specific surgical aid 814' for transference to the native patient tissue.
  • the remote locator 1722 may be at least partially patient-specific (e.g., designed and/or produced with the aid of pre-operative images of the native patient tissue), or may be a generic/stock component.
  • the body of the remote locator 1722 could be configured to mate with, or follow closely along a contour of, a native patient tissue, or could instead have no particular relationship with the native patient tissue save that needed to span the distance between the landmark 104' or other desired remote endpoint and the location at which the moldable substance 816' is applied to create the patient-specific surgical aid 814'.
  • FIGs. 18-24 illustrate a third embodiment of the present invention for use with a native patient tissue 1822.
  • the embodiment of Figs. 18-24 is similar to the embodiments of Figs. 1 -16C and therefore, structures of Figs. 18-24 that are the same as or similar to those described with reference to Figs. 1 -16C have the same reference numbers with the addition of a double "prime" mark. Description of common elements and operation similar to those in the previously described embodiments will not be repeated with respect to the third embodiment.
  • a native patient tissue 1822 (here, a glenoid of a scapula) is shown in situ, exposed via a surgical wound 1824.
  • the native patient tissue 1822 has at least one patient tissue surface of interest 1826.
  • the patient tissue surface of interest 1826 may be in a congenital or acquired "natural" state (i.e., a state as encountered at the time the surgical wound 1824 is made) and/or may have been at least partially altered during the instant surgical procedure, optionally according to a preoperative surgical plan.
  • a moldable substance 816" is placed into contact with at least a portion of the patient tissue surface of interest 1826.
  • An impression of the patient tissue surface of interest 1826 is maintained, in any suitable manner and at any desired resolution, upon the moldable substance 816".
  • bone cement may be placed upon the patient tissue surface of interest 1826 (optionally constrained by a constraining wall, not shown) and then at least partially solidified to "hold" a negative, molded contour replicating the patient tissue surface of interest on a bottom surface of the resulting pile of bone cement.
  • a release agent or other intermediate substance e.g., a lubricant, mold release spray or powder, wax, thin film [e.g., plastic wrap], or the like
  • a release agent or other intermediate substance may be placed on at least a portion of the patient tissue surface of interest 1826 before the moldable substance 816" is placed into contact with at least a portion of the patient tissue surface of interest.
  • the patient-specific surgical aid can be removed from the native patient tissue 1822 as desired by the user.
  • a cross-sectional view of the completed patient-specific surgical aid 814" is shown in Fig. 20.
  • the patient-specific surgical aid 814" of the third embodiment could be intentionally less- solidified when removed from the native patient tissue 1822 than a corresponding patient-specific surgical aid of the first and/or second embodiments is when removed from the corresponding physical model for any desired reason, including, but not limited to, avoiding damage to the native patient tissue, facilitating structural changes to the patient-specific surgical aid 814", limiting contact time between the moldable substance 816" and the native patient tissue, or the like.
  • the surgical aid 814" of the third embodiment can be manually and/or automatically physically altered as desired by the user.
  • the patient-specific surgical aid 814" could be drilled, cut, reformed, or otherwise re-structured or re-shaped according to a preoperative plan and/or spontaneously as desired by a user (e.g., "eyeballed” or “dead reckoned"), though it is contemplated that at least the portion of the patient-specific surgical aid upon which the impression of the patient tissue surface of interest 1826 is maintained will remain in its as-molded condition, for reasons which will become apparent below.
  • additional moldable substance 816" may be provided to the patient-specific surgical aid after removal from the native patient tissue 1822.
  • at least one non-native structure e.g., a landmark 104" or a remote locator, not shown
  • additional moldable substance 816" could be "potted” on or otherwise added to the arrangement to physically link the non-native structure and the patient-specific surgical aid.
  • the non-native structure could be an information feature providing clinically useful information to a user.
  • one or more constraining walls such as, but not limited to, an outer wall, an inner wall, and a guide bushing could be added to, or otherwise associated with, the patient-specific surgical aid 814" before or after the patient-specific surgical aid is removed from the native patient tissue 1822.
  • both a constraining wall and a non-native structure are provided to the patient-specific surgical aid 814"
  • at least a portion of the constraining wall could be interposed between at least a portion of the non-native structure and the moldable substance 816".
  • the moldable substance 816" could be formed upon the patient tissue surface of interest 1826, optionally with the assistance of an inner wall-type constraining wall, into a toroidally shaped patient-specific surgical aid 814" having a central aperture allowing access to the underlying patient tissue surface of interest therethrough.
  • toroidally shaped patient-specific surgical aid 814" has been at least partially solidified and removed from the native patient tissue 1822, the user can place a guide bushing 712 into the central aperture at a desired location and trajectory, and then "fill" the central aperture around the guide bushing with the same, or a different, moldable substance 816" to hold the guide bushing at the desired location and trajectory.
  • a moldable substance 816" is added to the patient-specific surgical aid 814" after the patient-specific surgical aid has been removed from the native patient tissue 1822, it is contemplated that the added moldable substance might be prevented from extending below the bottom (surface of interest impression-holding) side of the patient-specific surgical aid, so as not to protrude therefrom and prevent the patient-specific surgical aid from being re- mated with the patient tissue surface of interest 1826.
  • a location/trajectory "memorialization” or “capture” of any other physical
  • a moldable substance 816" and/or a non-moldable substance could be provided to any surface of the patient-specific surgical aid 814" to assist with holding a guide bushing, guiding a surgical tool, or otherwise indicating clinically useful information to a user.
  • any physical alteration(s) to the patient-specific surgical aid will result in the production of an altered patient-specific surgical aid.
  • FIGs. 21 A-22B depict the use of a physical model 100" to help physically alter a patient-specific surgical aid 814".
  • FIGs. 21 A-21 B depict top and side views, respectively, of a physical model 100" at least partially corresponding to the native patient tissue 1822.
  • at least one physical alteration of the native patient tissue 1822 could be also embodied in the physical model 100". This physical alteration, when present, could be at least the result of a preoperative surgical planning process.
  • the physical model 100 when not reflective of a pre-surgical condition of the native patient tissue 1822, could be a predictive model (preoperatively created with anticipation of the effect that at least one surgical task [e.g., reaming, drilling] would have on the native patient tissue during the surgery if performed as planned) and/or could be a reactive model (created during the surgical procedure, such as via intraoperative scanning and manufacture, with actual knowledge of the effect that the performed surgical task(s) had on the native patient tissue).
  • a predictive model preoperatively created with anticipation of the effect that at least one surgical task [e.g., reaming, drilling] would have on the native patient tissue during the surgery if performed as planned
  • a reactive model created during the surgical procedure, such as via intraoperative scanning and manufacture, with actual knowledge of the effect that the performed surgical task(s) had on the native patient tissue.
  • the surface of interest 102" of the physical model reflects or replicates the actual condition of the patient tissue surface of interest 1826 with sufficient resolution/fidelity for the patient-specific surgical aid 814" (having been removed from the native patient tissue 1822) to be placed into contact with the surface of interest of the physical model (optionally mated therewith) in a position that approximates the position in which the patient-specific surface of interest was created upon the patient tissue surface of interest, as shown in the top and side views of Figs. 21 A-21 B.
  • the patient-specific surgical aid 814" is located in the desired orientation with respect to the physical model 100"
  • at least one physical alteration may be made to the patient-specific surgical aid to create an altered patient-specific surgical aid 2228.
  • a landmark 104" could be inserted into the (unaltered) patient-specific surgical aid 814" at a desired location and trajectory that the altered patient-specific surgical aid 2228 could then
  • the moldable substance 816" forming the patient-specific surgical aid 814" could be chosen and/or manipulated in any suitable manner to facilitate the physical alteration--e.g., the moldable substance 816"could be associated with the physical model 100" when only partially solidified so that a landmark 104" can be inserted and/or manipulated/oriented therethrough more easily.
  • the patient-specific surgical aid 814" will be sufficiently "set” in most use environments of the present invention to maintain the impression of the patient tissue surface of interest 1826 without substantial alteration of that impression by the surface of interest 102" of the physical model 100"
  • the location, orientation, and other physical properties of the landmark 104", non-native structure, constraining wall, and/or other physical alteration of the patient- specific surgical aid 814" could be preplanned (e.g., using preoperative planning software and/or preoperative physical rehearsals/tests) and/or spontaneous (e.g., "eyeballed” or “dead reckoned") and may be provided in any suitable manner, including by being at least partially embodied in the physical model 100" before alteration of the patient-specific surgical aid.
  • the altered patient-specific surgical aid 2228 can then be used to facilitate at least one surgical task. As shown in this Figure, for example, an aperture 818" embodying the location and trajectory of the landmark 104" with respect to the physical model 100" has been incorporated into the altered patient-specific surgical aid 2228.
  • a surgical task of drilling into the patient tissue surface of interest 1826 at the desired location and/or trajectory of the landmark can be facilitated by the altered patient-specific surgical aid 2228.
  • Any other information feature, providing clinically useful information to a user, may similarly be provided by the altered patient-specific surgical aid 2228, and one of ordinary skill in the art can readily provide an appropriate altered patient- specific surgical aid 2228 for a particular use environment of the present invention.
  • any of the described structures and components could be integrally formed as a single piece or made up of separate sub-components, with either of these formations involving any suitable stock or bespoke components and/or any suitable material or combinations of materials; however, the chosen material(s) should be biocompatible for most applications of the present invention.
  • the mating relationships formed between the described structures need not keep the entirety of each of the "mating" surfaces in direct contact with each other but could include spacers or holdaways for partial direct contact, a liner or other intermediate member for indirect contact, or could even be approximated with intervening space remaining therebetween and no contact.
  • the system is described herein as being used to plan and/or simulate a surgical procedure of implanting one or more prosthetic structures into a patient's body, but also or instead could be used to plan and/or simulate any surgical procedure, regardless of whether a non-native component is left in the patient's body after the procedure.
  • One or more moldable substance(s) 816 could be applied and/or solidified in a laminated/layered manner to provide desired material properties to the patient-specific surgical aid 814 during and/or after initial fabrication. At least a portion of the patient-specific surgical aid 814 could be pre-fabricated, optionally with the aid of preoperative planning software, for combination with the moldable substance 816.
  • a device or method incorporating any of these features should be understood to fall under the scope of the present invention as determined based upon the claims below and any equivalents thereof.

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

Abstract

Un mode de réalisation de la présente invention concerne un procédé de production d'au moins une aide chirurgicale propre à un patient. Un tissu natif du patient comporte au moins une face tissulaire présentant un intérêt. Une substance moulable est placée en contact avec au moins une partie de la face tissulaire présentant un intérêt. Une impression de la face tissulaire présentant un intérêt est maintenue sur la substance moulable. La substance moulable se solidifie afin de former une aide chirurgicale propre au patient. L'aide chirurgicale propre au patient est retirée du tissu natif du patient. La présente invention concerne un système de production d'au moins une aide chirurgicale propre à un patient.
PCT/US2014/034578 2013-04-25 2014-04-18 Procédé et système de production d'au moins une aide chirurgicale propre à un patient WO2014176118A1 (fr)

Applications Claiming Priority (2)

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US13/870,180 US20130236874A1 (en) 2011-09-20 2013-04-25 Method and system for producing at least one patient-specific surgical aid
US13/870,180 2013-04-25

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2016115109A1 (fr) * 2015-01-12 2016-07-21 Biomet Manufacturing, Llc Cavité glénoïde augmentée et procédé de préparation
EP3215029A4 (fr) * 2014-11-09 2018-08-22 Senso Medical Labs Ltd. Formation personnalisée en trois dimensions de guides chirurgicaux

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4654989A (en) 1983-08-30 1987-04-07 Ward Fleming Vertical three-dimensional image screen
US20050234461A1 (en) * 2001-05-25 2005-10-20 Burdulis Albert G Jr Surgical tools facilitating increased accuracy, speed and simplicity in performing joint arthroplasty
US20100217336A1 (en) * 2006-08-31 2010-08-26 Catholic Healthcare West (Chw) Computerized Planning Tool For Spine Surgery and Method and Device for Creating a Customized Guide for Implantations
WO2013043640A1 (fr) * 2011-09-20 2013-03-28 The Cleveland Clinic Foundation Procédé et système pour produire au moins une aide chirurgicale spécifique de patient

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4654989A (en) 1983-08-30 1987-04-07 Ward Fleming Vertical three-dimensional image screen
US20050234461A1 (en) * 2001-05-25 2005-10-20 Burdulis Albert G Jr Surgical tools facilitating increased accuracy, speed and simplicity in performing joint arthroplasty
US20100217336A1 (en) * 2006-08-31 2010-08-26 Catholic Healthcare West (Chw) Computerized Planning Tool For Spine Surgery and Method and Device for Creating a Customized Guide for Implantations
WO2013043640A1 (fr) * 2011-09-20 2013-03-28 The Cleveland Clinic Foundation Procédé et système pour produire au moins une aide chirurgicale spécifique de patient

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3215029A4 (fr) * 2014-11-09 2018-08-22 Senso Medical Labs Ltd. Formation personnalisée en trois dimensions de guides chirurgicaux
US10952807B2 (en) 2014-11-09 2021-03-23 Senso Medical Labs Ltd. Custom three dimensional forming of surgical guides
WO2016115109A1 (fr) * 2015-01-12 2016-07-21 Biomet Manufacturing, Llc Cavité glénoïde augmentée et procédé de préparation
US9955984B2 (en) 2015-01-12 2018-05-01 Biomet Manufacturing, Llc Augmented glenoid and method for preparation

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