WO2015185864A1 - Method and device for extramedullary control for performing surgery - Google Patents

Method and device for extramedullary control for performing surgery Download PDF

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Publication number
WO2015185864A1
WO2015185864A1 PCT/FR2015/051475 FR2015051475W WO2015185864A1 WO 2015185864 A1 WO2015185864 A1 WO 2015185864A1 FR 2015051475 W FR2015051475 W FR 2015051475W WO 2015185864 A1 WO2015185864 A1 WO 2015185864A1
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WIPO (PCT)
Prior art keywords
anatomical
intra
light
joint
interposition member
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PCT/FR2015/051475
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French (fr)
Inventor
Christophe Alepee
Thierry GUITON
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One Ortho
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Publication of WO2015185864A1 publication Critical patent/WO2015185864A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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
    • A61B2034/107—Visualisation of planned trajectories or target regions

Definitions

  • the present invention relates to the technical sector of orthopedic surgery, and more particularly relates to a method and an extra-medullary device for the control of the positioning of an intra-articular interposition member with respect to an anatomical reference point of a bone articulation. .
  • the invention also relates to an intra-articular interposition member equipped with such a control device. Every joint is generally composed of an overlying bone at the joint, an underlying bone, and a cartilage situated between the two bones. These two bones are in a relative position defined anatomically by so-called anatomical axes. These axes are well known and defined in anatomy manuals. To stabilize these joints, there is a ligament and capsular environment that allows the position of the two bones forming said joint to be maintained in position.
  • extramedullary control devices are, in general, coupled to an intra-articular interposition member to be positioned between two bones, in particular for example instead of the cartilage of a joint, and comprise a stem.
  • control member extending on either side of said intra-articular interposition member, in a direction substantially parallel to the bones of the joint.
  • This rod allows the surgeon to visually check the alignment of the anatomical axes. Indeed, in practice and when it is a knee operation, the surgeon places one end of the stem at the center of the femoral head, and adjusts the position of the interposition member intra-articular until the other end of the stem is at the center of the ankle.
  • this device allows the visualization of an axis in only one plane, ie for example a frontal plane, while for a good positioning in the space of a bone section during implantation of implants in orthopedic surgery, it is necessary to visualize axes in two orthogonal planes, especially in the sagittal and frontal planes.
  • Another disadvantage also lies in the fact that this solution can be quite restrictive in the operating field, especially in terms of space, and cause inconvenience to the surgeon practitioner.
  • connection plugs it is necessary to place and attach connection plugs to each of the bones of the joint. This operation makes, on the one hand, even more invasive the surgeon's gesture and, on the other hand, may involve risks of fractures initiated bones where said plugs, generally quite rigid, have been fixed to the bone.
  • any solution of the state of the art implementing a computer system has the disadvantage of being difficult to implement, and quite cumbersome because it requires several connections and the use of a computer.
  • One of the aims of the invention is therefore to remedy at least one of the aforementioned drawbacks by proposing a method and a device for extra-medullary control of the positioning of an intra-articular interposition member with respect to a anatomical landmark of a joint, with said intra-articular interposition member being made to measure to stabilize and align two bones of said joint, and which allow a surgeon to perform a visual control of said positioning.
  • Another object of the invention is to provide such a control device which is simple in design, safe and rational, while being easy to implement and very small footprint to not interfere with the surgeon practitioner.
  • the aim of the invention is to make it possible to carry out a visual check of the positioning of an element, in a simple and autonomous manner, by dispensing with the compelling use of a computer.
  • Another object of the invention is to provide such a method and such a control device which are of optimum precision.
  • the method consists in projecting, by means of at least one light source attached to the intra-articular interposition member, at least one light beam according to at least one anatomical reference plane of the anatomical landmark. of the joint.
  • the projection of the light beam according to an anatomical reference plane of the anatomical reference of the joint makes it possible to materialize, through at least one line of light, the intersection of said reference anatomical plane with a member comprising the articulation bone, and allows a visual control of said positioning of the element relative to the anatomical reference of the joint.
  • the intra-articular interposition device to measure, a line of light materializing the theoretical position of at least one anatomical axis of the joint relative to said intra-articular interposition member, so that the surgeon can visualize, on a part of the body of a patient comprising the joint considered, at least one axis to control the positioning of the intra-articular interposition member by checking the correspondence between the projected anatomical axis and the real anatomical axis on the limb.
  • the projected anatomical axis is aligned with the real anatomical axis on the patient, it means that the intra-articular interposition member is positioned correctly to achieve the stabilization and correct alignment of the bones of the joint. It is therefore not a method of guiding a surgical instrument, but a visual control device for the correct positioning of an intra-articular interposition member, for example previously designed to measure.
  • This characteristic makes it possible to visualize the projection of an anatomical reference plane linked to the articulation directly on the limb comprising the joint considered, such as for example the leg when it is a knee operation, and therefore avoid parallax defects and increase the accuracy of the visual check.
  • the method is therefore reliable, easy to implement, repeatable and accurate without requiring the attachment of any object on a bone that could lead to the risk of fractures initiated.
  • the method allows a simple and autonomous visual control directly performed by the surgeon. The control is done without the use of any computer means.
  • two light beams are projected according to the sagittal or frontal anatomical plane of the anatomical landmark of the joint, and on both sides of the transverse anatomical plane of the anatomical landmark of the joint.
  • This characteristic makes it possible to visualize, for example, during a surgical operation of the knee, the intersection of the frontal or sagittal plane of the anatomical reference mark of the joint along the whole leg of a patient, and of part and of other knee.
  • it makes it possible to materialize on the patient's limb the theoretical position of the anatomical axis of the patient's entire leg with respect to said intra-articular interposition organ.
  • the use of two beams also makes it possible to arrange the light source in the sterile surgical field, which is limited in volume.
  • light beams are projected according to at least two anatomical reference planes of the anatomical landmark of the joint, orthogonal to each other.
  • This characteristic therefore makes it possible to increase the accuracy of the positioning control and to visualize the intersection of two anatomical reference planes of the anatomical reference point of the articulation with the member comprising the articulation.
  • light beams are projected along the three anatomical sagittal, frontal, and transverse planes of the anatomical landmark of the joint.
  • the invention also relates to a device for the extra-medullary control of the positioning, in orthopedic surgery, of an element, such as an intra-articular interposition member with respect to an anatomical landmark of a bone joint, said organ Intra-articular interposition being, for example, made to measure to stabilize and re-axis the articulation of a patient.
  • the device comprises at least one light source intended to be fixed on the intra-articular interposition member, by means of fixing means, so as to project, on a member comprising said articulation, to less a light beam according to an anatomical reference plane of the anatomical reference of the joint, to materialize, by means of at least one line of light, the theoretical position of at least one anatomical axis of the joint relative to said intra-articular interposition member, allowing a visual control of the positioning of the intra-articular interposition member by checking the correspondence between the projected anatomical axis and the real anatomical axis on the limb.
  • the device makes it possible to achieve optimum control of the positioning of the intra-articular interposition member, and also makes it possible to implement the extramedullary control method as described above.
  • it is not a device for guiding a surgical instrument, it is a device allowing the visual control of the correct positioning of an intra-articular interposition member, by example made to measure.
  • the device according to the invention is of relatively small size, and does not hinder the practitioner. It allows a simple visual control, autonomous, and precise, without effect of parallax and without the need of computer tool.
  • the invention is described for the positioning of an intra articular interposition member, commonly called “spacer” and well known in the state of the art, but concerns all applications in which it is necessary to check the position of an element with respect to at least one anatomical landmark, in particular by the alignment of anatomical axes.
  • the invention finds an advantageous application when it is necessary to position bone cutting planes during the implantation of a prosthesis in orthopedic surgery.
  • the element can also be a cutting guide for the placement of a prosthesis, or a trial implant.
  • the light source may be of any suitable type, it may for example be of the L.A.S.E.R. or light-emitting diode. It can be envisaged a single light source arranged to project two beams in different directions, for example by means of a reflective element, diffraction, or equivalent. It can also be implemented two light sources each being arranged to project at least one light beam in a plane, the two projection planes being orthogonal to one another.
  • This characteristic therefore makes it possible to increase the accuracy of the positioning control and to visualize two anatomical axes, namely the intersection of two anatomical reference planes of the anatomical reference point of the articulation with the member comprising the articulation.
  • the device comprises three light sources, each being arranged to project at least one light beam in a plane, the three projection planes being orthogonal to each other.
  • the light source or sources are arranged to project at least two light beams in the same plane, and on either side of a plane orthogonal to the projection plane of said light source. In this way, it is possible, as mentioned above, to project a line of light on an entire leg during an operation of the knee, without the need to remove the light source from the sterile surgical field.
  • FIG. 1 is a schematic representation of an extra-medullary control device according to the invention implemented during an operation of the knee, said figure illustrating the visualized axis and materialized on the body part of a patient and in the frontal plane of the anatomical landmark of the joint;
  • Figure 2 is a schematic representation similar to that of Figure 1, said figure illustrating the visualized axis and materialized on the body part of a patient and in the sagittal plane of the anatomical reference of the joint;
  • FIG. 3 is a diagrammatic perspective view illustrating a particular embodiment of the extra-medullary control device according to the invention and implemented during an operation of the knee;
  • FIG. 4 is a diagrammatic perspective view of the extra-medullary control device of FIG. 3, said device comprising three light sources arranged for projecting into the three anatomical reference planes of the anatomical reference point of the articulation;
  • FIGS. 5 and 6 are diagrammatic representations of an extramedullary control device according to the invention implemented during an operation of the shoulder, said figures illustrating the axes visualized and materialized on the part of the body of a patient and in the frontal and sagittal planes of the anatomical mark of the joint.
  • Figures 1 to 4 attached illustrate the use of an extramedullary control device in the case of implantation of a knee prosthesis.
  • the reconstructed knee must fulfill a number of anatomical relationships. For example, among them is the anatomical relationship according to which the mechanical axis of the leg, which extends from the center of the femoral head to the center of the ankle, must pass through the center of the knee joint.
  • the knee prosthesis must therefore be implanted so as to respect said anatomical relationships.
  • the surgeon is particularly required to position an intra-articular interposition and stabilization member that forms a kind of waiting prosthesis.
  • This intra-articular interposition organ must be positioned in such a way as to respect the anatomical relations of the knee joint.
  • the intra-articular interposition member must be positioned so that the axes of the leg are aligned.
  • the extra-medullary control device (1) for implanting a knee prosthesis in orthopedic surgery comprises at least one light source (2), and is adapted to be mounted on an organ intra-articular interposition as an element to be positioned relative to at least one anatomical landmark of the knee joint.
  • the intra-articular interposition member should be positioned relative to an anatomical landmark of the knee joint.
  • the visualization and the materialization of the anatomical reference planes of said anatomical reference mark of the knee joint on the limb comprising said knee joint, namely the leg, would make it easier to place said intra-articular interposition member.
  • control device (1) comprises a light source (2) equipped with fixing means on said intra-articular interposition member.
  • the light source (2) is arranged to project, on the limb comprising the joint, namely the leg, at least one light beam (2a, 2b) according to an anatomical reference plane of the anatomical landmark of the joint.
  • This light projection of the reference anatomical plane makes it possible to materialize, via at least one line of light (3) on the patient's leg, the intersection of said anatomical reference plane of the anatomical landmark of the joint with said leg.
  • This line of light (3) thus allows the surgeon to perform a simple visual control of the correct positioning of the intra-articular interposition member relative to the anatomical landmark of the knee joint.
  • the invention is advantageously implemented with a custom-designed intra-articular interposition member.
  • the intra-articular interposition member comprises in particular an anatomical shape complementary to the shape of the bones of the joint so that when inserted between the two bones of the joint, at the appropriate position, it makes it possible to stabilize said bones and maintaining the correct alignment of said bones.
  • To design the intra-articular interposition device to measure it is for example to reconstruct, from medical imaging, a virtual model in three dimensions of the hinge portion, then to virtually correct the alignment of the articulation so as to define a space between the two bones of said hinge corresponding to a worn part to be replaced by an implant. It is then necessary to conceive virtually intra-articular interposition member so that it is able to fill the space defined between the two bones of the corrected joint.
  • the customary intra-articular interposition member comprises at least one light source projecting at least one light source light beam fixed on the intra-articular interposition member so as to project on a member comprising said articulation, at least one light beam according to an anatomical reference plane of the anatomical landmark of the joint, so as to materialize, through at least one line of light, the intersection of said reference anatomical plane with the limb .
  • the light source is fixed to the intra-articular interposition member so as to project at least one line of light to materialize the theoretical position of at least one anatomical axis of the articulation relative to said intra-articular interposition member, allowing a visual control of the positioning of the intra-articular interposition member by checking the correspondence between the projected anatomical axis and the real anatomical axis on the limb.
  • the surgeon can visualize, on a part of the body of a patient comprising the joint considered, at least one axis enabling him to perform a visual check of the correct positioning of said element according to the anatomical landmarks of the joint.
  • the light source (2) is, for example, coupled to the intra-articular interposition member via an extension rod, preferably aligned with the center of the intra-articular interposition member. .
  • the light source (2) is of the LASER type, and projects two light beams (2a, 2b), in this case two light rays in the form of two lines projected according to the sagittal anatomical plane of the reference mark. anatomical joint, and on both sides of the transverse anatomical plane of the anatomical landmark of the knee joint.
  • the projected light beams (2a, 2b) make it possible to visualize and materialize two anatomical axes defined by the intersection between the sagittal plane of the anatomical landmark of the knee joint and the leg of the patient. This allows the surgeon to visually control the positioning of the intra-articular interposition member with respect to said sagittal plane of the anatomical landmark of the joint.
  • the light source (2) projects two beams (2a, 2b) according to the sagittal plane, and on both sides of the transverse plane to cover the entire length of the leg, and avoid having to remove the light source (2) at the risk of getting out of the sterile surgical field.
  • another device (1) according to the invention, or the same device (1) as that of FIG. 1 may furthermore comprise another light source (2) capable of projecting two light beams (2a, 2b) along the anatomical frontal plane of the anatomical landmark of the knee joint, and on either side of the transverse anatomical plane of the anatomical landmark of the knee joint.
  • another light source (2) capable of projecting two light beams (2a, 2b) along the anatomical frontal plane of the anatomical landmark of the knee joint, and on either side of the transverse anatomical plane of the anatomical landmark of the knee joint.
  • the extra-medullary control device (1) comprises three light sources (2) capable of projecting into the three anatomical planes of references of the anatomical landmark. of the joint.
  • the three light sources (2) are therefore oriented to project in three orthogonal planes to each other.
  • the device is extended by a stud (4) adapted to be fixed on an extension rod (not shown) of the intra-articular interposition member for example.
  • Figure 3 illustrates the positioning of said extramedullary control device relative to the knee of a patient.
  • the projected light beams make it possible to visualize and to materialize the intersection between the sagittal, frontal and transverse planes of the anatomical reference mark of the joint and the patient's leg. This allows the surgeon to visually control the positioning of the intra-articular interposition organ in relation to these anatomical reference planes.
  • the device according to the invention can also be implemented in the case of an operation of the shoulder for example.
  • the device (1) is fixed on an element to be positioned relative to reference anatomical landmarks, such as an intra-articular interposition member.
  • the device (1) comprises a light source (2) projecting two light beams (2a, 2b) to materialize on the patient's arm and light lines (3), the intersection between the frontal and sagittal planes of the anatomical landmark. of the joint and said arm of the patient.
  • This characteristic allows the surgeon to verify the correct positioning of an intra-articular interposition member for example, by means of a simple visual control.
  • the extra-medullary control device (1) provides a visual control system using a LASER beam, a light-emitting diode, or any other light source (2) capable of producing light powerful enough to project lines of light. (3) on a body part of a patient according to each of the selected reference planes of the anatomical landmark of a joint. These lines of light (3) make it possible to visualize and to materialize the intersection of the frontal, sagittal, and transverse anatomical planes of the anatomical landmark of a joint with a limb comprising the joint to be operated. These lines of light (3) thus allow the surgeon to be able to perform a visual check of the positioning of an element by report audit anatomical reference plans, in particular by controlling the correspondence between the projected axes and the real axes on the patient.
  • the extra-medullary control device (1) according to the invention also allows, for example, the introduction of an element in the form of a humeral cutting block, in the context of shoulder surgery, for correctly adjust the alignment to ⁇ forearm.

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Abstract

The invention relates to a method for the extramedullary control of the positioning of an element, in orthopaedic surgery, in relation to an anatomical landmark of a bone joint. According to the invention, the method involves projecting at least one light beam (2a, 2b), by means of at least one light source (2) attached to the element to be positioned, in at least one anatomical reference plane of the anatomical landmark of the joint, in order to form an intersection between said anatomical reference plane and a limb comprising the joint, by means of at least one line of light (3), and to allow visual control of said positioning of the element in relation to the anatomical reference of the joint.

Description

PROCEDE ET DISPOSITIF DE CONTROLE EXTRA-MEDULLAIRE POUR LA PRATIQUE CHIRURGICALE  EXTRA-MEDALLIC CONTROL METHOD AND DEVICE FOR SURGICAL PRACTICE
La présente invention se rapporte au secteur technique de la chirurgie orthopédique, et concerne plus particulièrement un procédé et un dispositif de contrôle extra-médullaire du positionnement d'un organe d'interposition intra-articulaire par rapport à un repère anatomique d'une articulation osseuse. L'invention concerne également un organe d'interposition intra-articulaire équipé d'un tel dispositif de contrôle. Toute articulation est composée, d'une manière générale, d'un os sus-jacent à l'articulation, d'un os sous-jacent, et d'un cartilage situé entre lesdits deux os. Ces deux os sont dans une position relative définie anatomiquement par des axes dits anatomiques. Ces axes sont bien connus et définis dans les manuels d'anatomie. Pour stabiliser ces articulations, il existe un environnement ligamentaire et capsulaire qui permet le maintien en position des deux os formant ladite articulation. The present invention relates to the technical sector of orthopedic surgery, and more particularly relates to a method and an extra-medullary device for the control of the positioning of an intra-articular interposition member with respect to an anatomical reference point of a bone articulation. . The invention also relates to an intra-articular interposition member equipped with such a control device. Every joint is generally composed of an overlying bone at the joint, an underlying bone, and a cartilage situated between the two bones. These two bones are in a relative position defined anatomically by so-called anatomical axes. These axes are well known and defined in anatomy manuals. To stabilize these joints, there is a ligament and capsular environment that allows the position of the two bones forming said joint to be maintained in position.
Pour implanter une prothèse en chirurgie orthopédique, il est nécessaire de veiller à ce que le ou les axes du membre qui contient l'articulation soient correctement alignés, que les coupes des os soient correctement réalisées et positionnées par rapport auxdits axes, et que la balance ligamentaire soit parfaitement ajustée entre les deux coupes pour permettre la stabilité de la prothèse, et la mise en tension stable des ligaments et de la capsule articulaire. Pour aider à la mise en place d'une telle prothèse, il est connu des dispositifs de contrôle extra-médullaire. Ces dispositifs permettent notamment de réaliser un contrôle visuel de l'alignement des axes anatomiques lors de l'implantation de la prothèse. To implant a prosthesis in orthopedic surgery, it is necessary to ensure that the axis or axes of the limb that contains the joint are properly aligned, that the cuts of the bones are correctly made and positioned relative to said axes, and that the balance the ligament is perfectly adjusted between the two sections to allow the stability of the prosthesis, and the stable tension of the ligaments and the articular capsule. To help in the establishment of such a prosthesis, it is known devices for extra-medullary control. These devices make it possible in particular to carry out a visual check of the alignment of the anatomical axes during the implantation of the prosthesis.
Ces dispositifs de contrôle extra-médullaire sont, d'une manière générale, accouplés à un organe d'interposition intra-articulaire devant être positionné entre deux os, notamment par exemple en lieu et place du cartilage d'une articulation, et comprennent une tige de contrôle s'étendant de part et d'autre dudit organe d'interposition intra-articulaire, dans une direction sensiblement parallèle aux os de l'articulation. Cette tige permet au chirurgien d'effectuer un contrôle visuel de l'alignement des axes anatomiques. En effet, en pratique et lorsqu'il s'agit d'une opération du genou, le chirurgien place l'une des extrémités de la tige au niveau du centre de la tête fémorale, et ajuste la position de l'organe d'interposition intra-articulaire jusqu'à ce que l'autre extrémité de la tige soit au niveau du centre de la cheville. Lorsque c'est le cas, cela signifie que l'axe du fémur est correctement aligné avec l'axe du tibia et que l'organe d'interposition intra-articulaire est bien positionné. La tige permet alors de restituer et de visualiser l'axe anatomique de la jambe. Cependant, un tel dispositif de contrôle extra-médullaire présente quelques inconvénients inhérents à sa structure. En effet, en pratique il est assez difficile d'apprécier correctement la position dans l'espace de l'axe défini par la tige, notamment du fait du défaut de parallaxe lié à la distance entre les os de l'articulation et ladite tige. De plus, ce dispositif ne permet la visualisation d'un axe que dans un seul plan, à savoir par exemple un plan frontal, alors que pour un bon positionnement dans l'espace d'une coupe osseuse lors de l'implantation d'implants dans la chirurgie orthopédique, il est nécessaire de visualiser des axes dans deux plans orthogonaux, notamment dans les plans sagittal et frontal. Un autre inconvénient réside également dans le fait que cette solution peut être assez contraignante sur le champ opératoire, notamment en termes d'encombrement, et occasionner de fait une gêne pour le praticien chirurgien. These extramedullary control devices are, in general, coupled to an intra-articular interposition member to be positioned between two bones, in particular for example instead of the cartilage of a joint, and comprise a stem. control member extending on either side of said intra-articular interposition member, in a direction substantially parallel to the bones of the joint. This rod allows the surgeon to visually check the alignment of the anatomical axes. Indeed, in practice and when it is a knee operation, the surgeon places one end of the stem at the center of the femoral head, and adjusts the position of the interposition member intra-articular until the other end of the stem is at the center of the ankle. When this is the case, this means that the axis of the femur is correctly aligned with the axis of the tibia and that the intra-articular interposition member is well positioned. The stem then makes it possible to restore and visualize the anatomical axis of the leg. However, such an extramedullary control device has some disadvantages inherent in its structure. Indeed, in practice it is quite difficult to correctly assess the position in the space of the axis defined by the rod, in particular because of the parallax defect related to the distance between the bones of the joint and said rod. In addition, this device allows the visualization of an axis in only one plane, ie for example a frontal plane, while for a good positioning in the space of a bone section during implantation of implants in orthopedic surgery, it is necessary to visualize axes in two orthogonal planes, especially in the sagittal and frontal planes. Another disadvantage also lies in the fact that this solution can be quite restrictive in the operating field, especially in terms of space, and cause inconvenience to the surgeon practitioner.
Il est connu de l'état de la technique une autre solution, beaucoup plus précise, mais beaucoup plus complexe et contraignante. En effet, il est connu d'utiliser un dispositif de contrôle extra-médullaire par assistance par ordinateur. It is known from the state of the art another solution, much more precise, but much more complex and constraining. Indeed, it is known to use an extra-medullary control device by computer assistance.
Dans cette solution assistée par ordinateur, il est nécessaire de placer et de fixer des fiches de connexion sur chacun des os de l'articulation. Cette opération rend, d'une part, encore plus invasif le geste du chirurgien et, d'autre part, peut entraîner des risques de fractures amorcées des os à l'endroit où lesdites fiches, généralement assez rigides, ont été fixées à l'os. In this computer-assisted solution, it is necessary to place and attach connection plugs to each of the bones of the joint. This operation makes, on the one hand, even more invasive the surgeon's gesture and, on the other hand, may involve risks of fractures initiated bones where said plugs, generally quite rigid, have been fixed to the bone.
De plus, toute solution de l'état de la technique mettant en œuvre un système informatique présente l'inconvénient d'être peu facile à mettre en œuvre, et assez encombrante du fait qu'elle nécessite plusieurs branchements et l'utilisation d'un ordinateur. L'un des buts de l'invention est donc de remédier au moins à l'un des inconvénients précités en proposant un procédé et un dispositif de contrôle extra-médullaire du positionnement d'un organe d'interposition intra-articulaire par rapport à un repère anatomique d'une articulation, avec ledit organe d'interposition intra-articulaire étant réalisé sur mesure pour stabiliser et aligner deux os de ladite articulation, et qui permettent à un chirurgien d'effectuer un contrôle visuel dudit positionnement. In addition, any solution of the state of the art implementing a computer system has the disadvantage of being difficult to implement, and quite cumbersome because it requires several connections and the use of a computer. One of the aims of the invention is therefore to remedy at least one of the aforementioned drawbacks by proposing a method and a device for extra-medullary control of the positioning of an intra-articular interposition member with respect to a anatomical landmark of a joint, with said intra-articular interposition member being made to measure to stabilize and align two bones of said joint, and which allow a surgeon to perform a visual control of said positioning.
Un autre objectif de l'invention est de fournir un tel dispositif de contrôle qui soit de conception simple, sûre et rationnelle, tout en étant facile à mettre en œuvre et d'encombrement très réduit pour ne pas gêner le praticien chirurgien. Another object of the invention is to provide such a control device which is simple in design, safe and rational, while being easy to implement and very small footprint to not interfere with the surgeon practitioner.
L'invention vise à permettre d'effectuer un contrôle visuel du positionnement d'un élément, d'une manière simple et autonome en s 'affranchissant de l'utilisation contraignante d'un ordinateur. The aim of the invention is to make it possible to carry out a visual check of the positioning of an element, in a simple and autonomous manner, by dispensing with the compelling use of a computer.
Un autre objectif de l'invention est de fournir un tel procédé et un tel dispositif de contrôle qui soient d'une précision optimale. Another object of the invention is to provide such a method and such a control device which are of optimum precision.
A cet effet il a été mis au point un procédé de contrôle extra-médullaire du positionnement, en chirurgie orthopédique, d'un élément, tel qu'un organe d'interposition intra-articulaire, par rapport à un repère anatomique d'une articulation osseuse. Ledit organe d'interposition intra-articulaire a, par exemple, été préalablement conçu sur mesure pour stabiliser et réaxer l'articulation d'un patient. Selon l'invention, le procédé consiste à projeter, par l'intermédiaire d'au moins une source lumineuse fixée à l'organe d'interposition intra-articulaire, au moins un faisceau lumineux selon au moins un plan anatomique de référence du repère anatomique de l'articulation. La projection du faisceau lumineux selon un plan anatomique de référence du repère anatomique de l'articulation permet de matérialiser, par l'intermédiaire d'au moins une ligne de lumière, l'intersection dudit plan anatomique de référence avec un membre comprenant l'articulation osseuse, et permet un contrôle visuel dudit positionnement de l'élément par rapport au repère anatomique de l'articulation. For this purpose it has been developed a method of extra-medullary control of the positioning, in orthopedic surgery, of an element, such as an intra-articular interposition member, with respect to an anatomical reference point of an articulation. bone. Said intra-articular interposition member has, for example, been custom designed to measure and stabilize the articulation of a patient. According to the invention, the method consists in projecting, by means of at least one light source attached to the intra-articular interposition member, at least one light beam according to at least one anatomical reference plane of the anatomical landmark. of the joint. The projection of the light beam according to an anatomical reference plane of the anatomical reference of the joint makes it possible to materialize, through at least one line of light, the intersection of said reference anatomical plane with a member comprising the articulation bone, and allows a visual control of said positioning of the element relative to the anatomical reference of the joint.
En d'autres termes, il s'agit de projeter par l'intermédiaire d'une source lumineuse liée à l'organe d'interposition intra-articulaire sur mesure, une ligne de lumière matérialisant la position théorique d'au moins un axe anatomique de l'articulation par rapport audit organe d'interposition intra-articulaire, de sorte que le chirurgien puisse visualiser, sur une partie du corps d'un patient comprenant l'articulation considérée, au moins un axe lui permettant de contrôler le positionnement de l'organe d'interposition intra-articulaire en vérifiant la correspondance entre l'axe anatomique projeté et l'axe anatomique réel sur le membre. En effet, si l'axe anatomique projeté est aligné avec l'axe anatomique réel sur le patient, cela signifie que l'organe d'interposition intra-articulaire est positionné correctement pour réaliser la stabilisation et l'alignement correct des os de l'articulation. II ne s'agit donc pas d'un procédé de guidage d'un instrument chirurgical, mais d'un dispositif de contrôle visuel du positionnement correct d'un organe d'interposition intra- articulaire, par exemple préalablement conçu sur mesure. In other words, it is to project through a light source linked to the intra-articular interposition device to measure, a line of light materializing the theoretical position of at least one anatomical axis of the joint relative to said intra-articular interposition member, so that the surgeon can visualize, on a part of the body of a patient comprising the joint considered, at least one axis to control the positioning of the intra-articular interposition member by checking the correspondence between the projected anatomical axis and the real anatomical axis on the limb. Indeed, if the projected anatomical axis is aligned with the real anatomical axis on the patient, it means that the intra-articular interposition member is positioned correctly to achieve the stabilization and correct alignment of the bones of the joint. It is therefore not a method of guiding a surgical instrument, but a visual control device for the correct positioning of an intra-articular interposition member, for example previously designed to measure.
Cette caractéristique permet de visualiser la projection d'un plan anatomique de référence liée à l'articulation directement sur le membre comprenant l'articulation considérée, tel que par exemple la jambe lorsqu'il s'agit d'une opération du genou, et donc d'éviter les défauts de parallaxe et d'augmenter la précision du contrôle visuel. Le procédé est donc fiable, facile à mettre en œuvre, répétable et précis, sans nécessiter la fixation d'un objet quelconque sur un os qui pourrait entraîner des risques de fractures amorcées. Le procédé permet un contrôle visuel simple et autonome directement réalisé par le chirurgien. Le contrôle se fait sans l'utilisation d'un quelconque moyen informatique. This characteristic makes it possible to visualize the projection of an anatomical reference plane linked to the articulation directly on the limb comprising the joint considered, such as for example the leg when it is a knee operation, and therefore avoid parallax defects and increase the accuracy of the visual check. The method is therefore reliable, easy to implement, repeatable and accurate without requiring the attachment of any object on a bone that could lead to the risk of fractures initiated. The method allows a simple and autonomous visual control directly performed by the surgeon. The control is done without the use of any computer means.
Avantageusement, deux faisceaux lumineux sont projetés selon le plan anatomique sagittal ou frontal du repère anatomique de l'articulation, et de part et d'autre du plan anatomique transversal du repère anatomique de l'articulation. Advantageously, two light beams are projected according to the sagittal or frontal anatomical plane of the anatomical landmark of the joint, and on both sides of the transverse anatomical plane of the anatomical landmark of the joint.
Cette caractéristique permet de visualiser, par exemple, lors d'une opération chirurgicale du genou, l'intersection du plan frontal ou sagittal du repère anatomique de l'articulation le long de toute la jambe d'un patient, et de part et d'autre du genou. Ainsi, cela permet de matérialiser sur le membre du patient la position théorique de l'axe anatomique de toute la jambe du patient par rapport audit organe d'interposition intra-articulaire. L'utilisation de deux faisceaux permet également de pouvoir agencer la source lumineuse dans le champ opératoire stérile, lequel est limité en volume. En effet, pour visualiser l'intersection du plan sagittal ou frontal du repère anatomique de l'articulation sur toute la jambe et au moyen d'un seul faisceau lumineux, il faut nécessairement éloigner la source lumineuse de la jambe au risque de sortir du champ opératoire stérile. This characteristic makes it possible to visualize, for example, during a surgical operation of the knee, the intersection of the frontal or sagittal plane of the anatomical reference mark of the joint along the whole leg of a patient, and of part and of other knee. Thus, it makes it possible to materialize on the patient's limb the theoretical position of the anatomical axis of the patient's entire leg with respect to said intra-articular interposition organ. The use of two beams also makes it possible to arrange the light source in the sterile surgical field, which is limited in volume. Indeed, to visualize the intersection of the sagittal or frontal plane of the anatomical reference of the joint on the whole leg and the by means of a single light beam, it is necessary to move the light source away from the leg at the risk of leaving the sterile surgical field.
Avantageusement, des faisceaux lumineux sont projetés selon au moins deux plans anatomiques de référence du repère anatomique de l'articulation, orthogonaux l'un par rapport à l'autre. Cette caractéristique permet donc d'augmenter la précision du contrôle du positionnement et de visualiser l'intersection de deux plans anatomiques de référence du repère anatomique de l'articulation avec le membre comprenant l'articulation. Pour augmenter davantage la précision du contrôle visuel, des faisceaux lumineux sont projetés selon les trois plans anatomiques sagittal, frontal, et transversal du repère anatomique de l'articulation. Advantageously, light beams are projected according to at least two anatomical reference planes of the anatomical landmark of the joint, orthogonal to each other. This characteristic therefore makes it possible to increase the accuracy of the positioning control and to visualize the intersection of two anatomical reference planes of the anatomical reference point of the articulation with the member comprising the articulation. To further increase the accuracy of visual control, light beams are projected along the three anatomical sagittal, frontal, and transverse planes of the anatomical landmark of the joint.
L'invention concerne également un dispositif de contrôle extra-médullaire du positionnement, en chirurgie orthopédique, d'un élément, tel qu'un organe d'interposition intra-articulaire par rapport à un repère anatomique d'une articulation osseuse, ledit organe d'interposition intra-articulaire étant, par exemple, réalisé sur mesure pour stabiliser et réaxer l'articulation d'un patient. Selon l'invention, le dispositif comprend au moins une source lumineuse destinée à être fixée sur l'organe d'interposition intra-articulaire, par l'intermédiaire de moyens de fixation, de manière à projeter, sur un membre comprenant ladite articulation, au moins un faisceau lumineux selon un plan anatomique de référence du repère anatomique de l'articulation, pour matérialiser, par l'intermédiaire d'au moins une ligne de lumière, la position théorique d'au moins un axe anatomique de l'articulation par rapport audit organe d'interposition intra-articulaire, permettant un contrôle visuel du positionnement de l'organe d'interposition intra-articulaire par une vérification de la correspondance entre l'axe anatomique projeté et l'axe anatomique réel sur le membre. Ainsi, le dispositif permet de réaliser un contrôle optimal du positionnement de l'organe d'interposition intra-articulaire, et permet aussi de mettre en œuvre le procédé de contrôle extra-médullaire tel que décrit ci-avant. De la même manière, il ne s'agit pas d'un dispositif de guidage d'un instrument chirurgical, il s'agit d'un dispositif permettant le contrôle visuel du positionnement correct d'un organe d'interposition intra-articulaire, par exemple réalisé sur mesure. Le dispositif selon l'invention est d'encombrement relativement réduit, et ne gêne pas le praticien. Il permet un contrôle visuel simple, autonome, et précis, sans effet de parallaxe et sans nécessiter d'outil informatique. The invention also relates to a device for the extra-medullary control of the positioning, in orthopedic surgery, of an element, such as an intra-articular interposition member with respect to an anatomical landmark of a bone joint, said organ Intra-articular interposition being, for example, made to measure to stabilize and re-axis the articulation of a patient. According to the invention, the device comprises at least one light source intended to be fixed on the intra-articular interposition member, by means of fixing means, so as to project, on a member comprising said articulation, to less a light beam according to an anatomical reference plane of the anatomical reference of the joint, to materialize, by means of at least one line of light, the theoretical position of at least one anatomical axis of the joint relative to said intra-articular interposition member, allowing a visual control of the positioning of the intra-articular interposition member by checking the correspondence between the projected anatomical axis and the real anatomical axis on the limb. Thus, the device makes it possible to achieve optimum control of the positioning of the intra-articular interposition member, and also makes it possible to implement the extramedullary control method as described above. In the same way, it is not a device for guiding a surgical instrument, it is a device allowing the visual control of the correct positioning of an intra-articular interposition member, by example made to measure. The device according to the invention is of relatively small size, and does not hinder the practitioner. It allows a simple visual control, autonomous, and precise, without effect of parallax and without the need of computer tool.
L'invention est décrite pour le positionnement d'un organe d'interposition intra articulaire, couramment appelé « spacer » et bien connu de l'état de la technique, mais concerne toutes les applications dans lesquelles il est nécessaire de vérifier la position d'un élément par rapport à au moins un repère anatomique, notamment par l'alignement d'axes anatomiques. L'invention trouve une application avantageuse lorsqu'il est nécessaire de positionner des plans de coupes des os lors de l'implantation d'une prothèse en chirurgie orthopédique. The invention is described for the positioning of an intra articular interposition member, commonly called "spacer" and well known in the state of the art, but concerns all applications in which it is necessary to check the position of an element with respect to at least one anatomical landmark, in particular by the alignment of anatomical axes. The invention finds an advantageous application when it is necessary to position bone cutting planes during the implantation of a prosthesis in orthopedic surgery.
L'élément peut également être un guide de coupe pour la mise en place d'une prothèse, ou bien un implant d'essai. The element can also be a cutting guide for the placement of a prosthesis, or a trial implant.
La source lumineuse peut être de tout type approprié, elle peut par exemple être du type à L.A.S.E.R. ou bien à diode électroluminescente. II peut être envisagé une seule source lumineuse agencée pour projeter deux faisceaux dans des directions différentes, par exemple par l'intermédiaire d'un élément réflecteur, de diffraction, ou équivalent. Il peut également être mis en œuvre deux sources lumineuses chacune étant agencée pour projeter au moins un faisceau lumineux selon un plan, les deux plans de projection étant orthogonaux l'un à l'autre. The light source may be of any suitable type, it may for example be of the L.A.S.E.R. or light-emitting diode. It can be envisaged a single light source arranged to project two beams in different directions, for example by means of a reflective element, diffraction, or equivalent. It can also be implemented two light sources each being arranged to project at least one light beam in a plane, the two projection planes being orthogonal to one another.
Cette caractéristique permet donc d'augmenter la précision du contrôle du positionnement et de visualiser deux axes anatomiques, à savoir l'intersection de deux plans anatomiques de référence du repère anatomique de l'articulation avec le membre comprenant l'articulation. This characteristic therefore makes it possible to increase the accuracy of the positioning control and to visualize two anatomical axes, namely the intersection of two anatomical reference planes of the anatomical reference point of the articulation with the member comprising the articulation.
Pour augmenter davantage la précision du contrôle extra-médullaire, le dispositif comprend trois sources lumineuses, chacune étant agencée pour projeter au moins un faisceau lumineux selon un plan, les trois plans de projection étant orthogonaux les uns aux autres. D'une manière avantageuse, la ou les sources lumineuses sont agencée pour projeter au moins deux faisceaux lumineux selon un même plan, et de part et d'autre d'un plan orthogonal au plan de projection de ladite source lumineuse. De cette manière, il est possible, comme évoqué ci-avant, de projeter une ligne de lumière sur toute une jambe lors d'une opération du genou, sans nécessiter de sortir la source lumineuse du champ opératoire stérile. To further increase the accuracy of the extramedullary control, the device comprises three light sources, each being arranged to project at least one light beam in a plane, the three projection planes being orthogonal to each other. Advantageously, the light source or sources are arranged to project at least two light beams in the same plane, and on either side of a plane orthogonal to the projection plane of said light source. In this way, it is possible, as mentioned above, to project a line of light on an entire leg during an operation of the knee, without the need to remove the light source from the sterile surgical field.
D'autres caractéristiques et avantages de l'invention ressortiront clairement de la description qui en est réalisée ci-après, à titre indicatif et nullement limitatif, en référence aux figures annexées dans lesquelles : Other characteristics and advantages of the invention will emerge clearly from the description which is given hereinafter, by way of indication and in no way limiting, with reference to the appended figures in which:
- la figure 1 est une représentation schématique d'un dispositif de contrôle extra-médullaire selon l'invention mis en œuvre lors d'une opération du genou, ladite figure illustrant l'axe visualisé et matérialisé sur la partie du corps d'un patient et dans le plan frontal du repère anatomique de l'articulation ; - Figure 1 is a schematic representation of an extra-medullary control device according to the invention implemented during an operation of the knee, said figure illustrating the visualized axis and materialized on the body part of a patient and in the frontal plane of the anatomical landmark of the joint;
- la figure 2 est une représentation schématique similaire à celle de la figure 1 , ladite figure illustrant l'axe visualisé et matérialisé sur la partie du corps d'un patient et dans le plan sagittal du repère anatomique de l'articulation ; - Figure 2 is a schematic representation similar to that of Figure 1, said figure illustrating the visualized axis and materialized on the body part of a patient and in the sagittal plane of the anatomical reference of the joint;
- la figure 3 est une représentation schématique en perspective illustrant une forme de réalisation particulière du dispositif de contrôle extra-médullaire selon l'invention et mis en œuvre lors d'une opération du genou ; FIG. 3 is a diagrammatic perspective view illustrating a particular embodiment of the extra-medullary control device according to the invention and implemented during an operation of the knee;
- la figure 4 est une représentation schématique en perspective du dispositif de contrôle extra-médullaire de la figure 3, ledit dispositif comprenant trois sources lumineuses agencées pour projeter dans les trois plans anatomiques de références du repère anatomique de l'articulation ; FIG. 4 is a diagrammatic perspective view of the extra-medullary control device of FIG. 3, said device comprising three light sources arranged for projecting into the three anatomical reference planes of the anatomical reference point of the articulation;
- les figures 5 et 6 sont des représentations schématiques d'un dispositif de contrôle extramédullaire selon l'invention mis en œuvre lors d'une opération de l'épaule, lesdites figures illustrant les axes visualisés et matérialisés sur la partie du corps d'un patient et dans les plans frontal et sagittal du repère anatomique de l'articulation. FIGS. 5 and 6 are diagrammatic representations of an extramedullary control device according to the invention implemented during an operation of the shoulder, said figures illustrating the axes visualized and materialized on the part of the body of a patient and in the frontal and sagittal planes of the anatomical mark of the joint.
Les figures 1 à 4 annexées illustrent l'utilisation d'un dispositif de contrôle extramédullaire dans le cas d'une implantation d'une prothèse de genou. Dans le cas d'une articulation du genou, le genou reconstruit doit remplir un certain nombre de rapports anatomiques. Par exemple, parmi eux on retrouve le rapport anatomique selon lequel l'axe mécanique de la jambe, qui s'étend depuis le centre de la tête fémorale vers le centre de la cheville, doit passer par le centre de l'articulation du genou. Figures 1 to 4 attached illustrate the use of an extramedullary control device in the case of implantation of a knee prosthesis. In the case of a knee joint, the reconstructed knee must fulfill a number of anatomical relationships. For example, among them is the anatomical relationship according to which the mechanical axis of the leg, which extends from the center of the femoral head to the center of the ankle, must pass through the center of the knee joint.
La prothèse de genou doit donc être implantée de manière à respecter lesdits rapports anatomiques. Ainsi, pendant l'opération le chirurgien est notamment amené à positionner un organe d'interposition et de stabilisation intra-articulaire qui forme une sorte de prothèse d'attente. Cet organe d'interposition intra-articulaire doit être positionné d'une telle sorte à respecter les rapports anatomiques de l'articulation du genou. Par exemple l'organe d'interposition intra-articulaire doit être positionné de manière à ce que les axes de la jambe soient bien alignés. En référence aux figures 1 et 2, le dispositif de contrôle extra-médullaire (1) pour l'implantation d'une prothèse du genou en chirurgie orthopédique comprend au moins une source lumineuse (2), et est adapté pour être monté sur un organe d'interposition intra- articulaire en tant qu'élément à positionner par rapport à au moins un repère anatomique de l'articulation du genou. The knee prosthesis must therefore be implanted so as to respect said anatomical relationships. Thus, during the operation, the surgeon is particularly required to position an intra-articular interposition and stabilization member that forms a kind of waiting prosthesis. This intra-articular interposition organ must be positioned in such a way as to respect the anatomical relations of the knee joint. For example the intra-articular interposition member must be positioned so that the axes of the leg are aligned. With reference to FIGS. 1 and 2, the extra-medullary control device (1) for implanting a knee prosthesis in orthopedic surgery comprises at least one light source (2), and is adapted to be mounted on an organ intra-articular interposition as an element to be positioned relative to at least one anatomical landmark of the knee joint.
L'organe d'interposition intra-articulaire doit être positionné par rapport à un repère anatomique de l'articulation du genou. Ainsi, la visualisation et la matérialisation des plans anatomiques de référence dudit repère anatomique de l'articulation du genou sur le membre comprenant ladite articulation du genou, à savoir la jambe, permettrait de faciliter la mise en place dudit organe d'interposition intra-articulaire. The intra-articular interposition member should be positioned relative to an anatomical landmark of the knee joint. Thus, the visualization and the materialization of the anatomical reference planes of said anatomical reference mark of the knee joint on the limb comprising said knee joint, namely the leg, would make it easier to place said intra-articular interposition member. .
A cet effet, le dispositif de contrôle (1) comprend une source lumineuse (2) équipée de moyens de fixation sur ledit organe d'interposition intra-articulaire. La source lumineuse (2) est agencée pour projeter, sur le membre comprenant l'articulation, à savoir la jambe, au moins un faisceau lumineux (2a, 2b) selon un plan anatomique de référence du repère anatomique de l'articulation. For this purpose, the control device (1) comprises a light source (2) equipped with fixing means on said intra-articular interposition member. The light source (2) is arranged to project, on the limb comprising the joint, namely the leg, at least one light beam (2a, 2b) according to an anatomical reference plane of the anatomical landmark of the joint.
Cette projection lumineuse du plan anatomique de référence permet de matérialiser, par l'intermédiaire d'au moins une ligne de lumière (3) sur la jambe du patient, l'intersection dudit plan anatomique de référence du repère anatomique de l'articulation avec ladite jambe. This light projection of the reference anatomical plane makes it possible to materialize, via at least one line of light (3) on the patient's leg, the intersection of said anatomical reference plane of the anatomical landmark of the joint with said leg.
Cette ligne de lumière (3) permet ainsi au chirurgien de réaliser un simple contrôle visuel du positionnement correct de l'organe d'interposition intra-articulaire par rapport au repère anatomique de l'articulation du genou. This line of light (3) thus allows the surgeon to perform a simple visual control of the correct positioning of the intra-articular interposition member relative to the anatomical landmark of the knee joint.
L'invention est avantageusement mise en œuvre avec un organe d'interposition intra- articulaire conçu sur mesure. L'organe d'interposition intra-articulaire comprend notamment une forme anatomique complémentaire à la forme des os de l'articulation de sorte que lorsqu'il est inséré entre les deux os de l'articulation, à la position adéquate, il permet de stabiliser lesdits os et maintien l'alignement correct desdits os. Pour concevoir l'organe d'interposition intra-articulaire sur mesure, il convient par exemple de reconstruire, à partir d'imageries médicales, un modèle virtuel en trois dimensions de la portion d'articulation, puis de corriger virtuellement l'alignement de l'articulation de sorte à définir un espace entre les deux os de ladite articulation correspondant à une partie usée à remplacer par un implant. Il faut ensuite concevoir virtuellement l'organe d'interposition intra-articulaire de manière à ce qu'il soit apte à remplir l'espace défini entre les deux os de l'articulation corrigée. The invention is advantageously implemented with a custom-designed intra-articular interposition member. The intra-articular interposition member comprises in particular an anatomical shape complementary to the shape of the bones of the joint so that when inserted between the two bones of the joint, at the appropriate position, it makes it possible to stabilize said bones and maintaining the correct alignment of said bones. To design the intra-articular interposition device to measure, it is for example to reconstruct, from medical imaging, a virtual model in three dimensions of the hinge portion, then to virtually correct the alignment of the articulation so as to define a space between the two bones of said hinge corresponding to a worn part to be replaced by an implant. It is then necessary to conceive virtually intra-articular interposition member so that it is able to fill the space defined between the two bones of the corrected joint.
Dans cette configuration, l'organe d'interposition intra-articulaire sur mesure comprend au moins une source lumineuse projetant au moins un faisceau lumineux source lumineuse fixée sur l'organe d'interposition intra-articulaire de manière à projeter, sur un membre comprenant ladite articulation, au moins un faisceau lumineux selon un plan anatomique de référence du repère anatomique de l'articulation, de manière à matérialiser, par l'intermédiaire d'au moins une ligne de lumière, l'intersection dudit plan anatomique de référence avec le membre. In this configuration, the customary intra-articular interposition member comprises at least one light source projecting at least one light source light beam fixed on the intra-articular interposition member so as to project on a member comprising said articulation, at least one light beam according to an anatomical reference plane of the anatomical landmark of the joint, so as to materialize, through at least one line of light, the intersection of said reference anatomical plane with the limb .
En d'autres termes, la source lumineuse est fixée à l'organe d'interposition intra-articulaire de sorte à projeter au moins une ligne de lumière pour matérialiser la position théorique d'au moins un axe anatomique de l'articulation par rapport audit organe d'interposition intra-articulaire, permettant un contrôle visuel du positionnement de l'organe d'interposition intra-articulaire par une vérification de la correspondance entre l'axe anatomique projeté et l'axe anatomique réel sur le membre. Ainsi, le chirurgien peut visualiser, sur une partie du corps d'un patient comprenant l'articulation considérée, au moins un axe lui permettant de réaliser un contrôle visuel du positionnement correct dudit élément selon les repères anatomiques de l'articulation. En effet, si l'axe anatomique de l'articulation projeté est aligné avec l'axe anatomique réel sur le patient, cela signifie que l'organe d'interposition intra-articulaire est positionné correctement pour réaliser la stabilisation et l'alignement correct des os de l'articulation. Le positionnement correct de l'organe d'interposition intra-articulaire est contrôlé visuellement par le chirurgien. La source lumineuse (2) est, par exemple, accouplée à l'organe d'interposition intra- articulaire par l'intermédiaire d'une tige d'extension, de préférence alignée avec le centre de l'organe d'interposition intra-articulaire. En référence à la figure 1, la source lumineuse (2) est du type à L.A.S.E.R., et projette deux faisceaux lumineux (2a, 2b), en l'occurrence deux rayons lumineux sous forme de deux lignes projetées selon le plan anatomique sagittal du repère anatomique de l'articulation, et de part et d'autre du plan anatomique transversal du repère anatomique de l'articulation du genou. In other words, the light source is fixed to the intra-articular interposition member so as to project at least one line of light to materialize the theoretical position of at least one anatomical axis of the articulation relative to said intra-articular interposition member, allowing a visual control of the positioning of the intra-articular interposition member by checking the correspondence between the projected anatomical axis and the real anatomical axis on the limb. Thus, the surgeon can visualize, on a part of the body of a patient comprising the joint considered, at least one axis enabling him to perform a visual check of the correct positioning of said element according to the anatomical landmarks of the joint. Indeed, if the anatomical axis of the projected joint is aligned with the real anatomical axis on the patient, it means that the intra-articular interposition member is positioned correctly to achieve the stabilization and correct alignment of the bone of the joint. The correct positioning of the intra-articular interposition member is visually controlled by the surgeon. The light source (2) is, for example, coupled to the intra-articular interposition member via an extension rod, preferably aligned with the center of the intra-articular interposition member. . With reference to FIG. 1, the light source (2) is of the LASER type, and projects two light beams (2a, 2b), in this case two light rays in the form of two lines projected according to the sagittal anatomical plane of the reference mark. anatomical joint, and on both sides of the transverse anatomical plane of the anatomical landmark of the knee joint.
De cette manière, les faisceaux lumineux projetés (2a, 2b) permettent de visualiser et de matérialiser deux axes anatomiques définis par l'intersection entre le plan sagittal du repère anatomique de l'articulation du genou et la jambe du patient. Cela permet au chirurgien de pouvoir contrôler visuellement le positionnement de l'organe d'interposition intra- articulaire par rapport audit plan sagittal du repère anatomique de l'articulation. In this way, the projected light beams (2a, 2b) make it possible to visualize and materialize two anatomical axes defined by the intersection between the sagittal plane of the anatomical landmark of the knee joint and the leg of the patient. This allows the surgeon to visually control the positioning of the intra-articular interposition member with respect to said sagittal plane of the anatomical landmark of the joint.
La source lumineuse (2) projette deux faisceaux (2a, 2b) selon le plan sagittal, et de part et d'autre du plan transversal pour pouvoir couvrir toute la longueur de la jambe, et éviter de devoir éloigner la source lumineuse (2) au risque de sortir du champ opératoire stérile. The light source (2) projects two beams (2a, 2b) according to the sagittal plane, and on both sides of the transverse plane to cover the entire length of the leg, and avoid having to remove the light source (2) at the risk of getting out of the sterile surgical field.
De la même manière, et en référence à la figure 2, un autre dispositif (1) selon l'invention, ou bien le même dispositif (1) que celui de la figure 1 peut en outre comprendre une autre source lumineuse (2) apte à projeter deux faisceaux lumineux (2a, 2b) selon le plan anatomique frontal du repère anatomique de l'articulation du genou, et de part et d'autre du plan anatomique transversal du repère anatomique de l'articulation du genou. In the same way, and with reference to FIG. 2, another device (1) according to the invention, or the same device (1) as that of FIG. 1, may furthermore comprise another light source (2) capable of projecting two light beams (2a, 2b) along the anatomical frontal plane of the anatomical landmark of the knee joint, and on either side of the transverse anatomical plane of the anatomical landmark of the knee joint.
Cela permet au chirurgien de pouvoir contrôler visuellement le positionnement de l'organe d'interposition intra-articulaire par rapport audit plan frontal. Dans une forme de réalisation préférée de l'invention, et en référence aux figures 3 et 4, le dispositif de contrôle extra-médullaire (1) comprend trois sources lumineuses (2) aptes à projeter dans les trois plans anatomiques de références du repère anatomique de l'articulation. Les trois sources lumineuses (2) sont donc orientées pour projeter selon trois plans orthogonaux les uns aux autres. Le dispositif est prolongé par un plot (4) apte à se fixer sur une tige d'extension (non représentée) de l'organe d'interposition intra-articulaire par exemple. La figure 3 illustre le positionnement dudit dispositif de contrôle extramédullaire par rapport au genou d'un patient. This allows the surgeon to visually control the positioning of the intra-articular interposition member with respect to said frontal plane. In a preferred embodiment of the invention, and with reference to FIGS. 3 and 4, the extra-medullary control device (1) comprises three light sources (2) capable of projecting into the three anatomical planes of references of the anatomical landmark. of the joint. The three light sources (2) are therefore oriented to project in three orthogonal planes to each other. The device is extended by a stud (4) adapted to be fixed on an extension rod (not shown) of the intra-articular interposition member for example. Figure 3 illustrates the positioning of said extramedullary control device relative to the knee of a patient.
De cette manière, les faisceaux lumineux projetés permettent de visualiser et de matérialiser l'intersection entre les plans sagittal, frontal et transversal du repère anatomique de l'articulation et la jambe du patient. Cela permet au chirurgien de pouvoir contrôler visuellement le positionnement de l'organe d'interposition intra-articulaire par rapport audits plans anatomiques de références. In this way, the projected light beams make it possible to visualize and to materialize the intersection between the sagittal, frontal and transverse planes of the anatomical reference mark of the joint and the patient's leg. This allows the surgeon to visually control the positioning of the intra-articular interposition organ in relation to these anatomical reference planes.
En référence aux figures 5 et 6, le dispositif selon l'invention peut également être mis en œuvre ans le cas d'une opération de l'épaule par exemple. De la même manière, le dispositif (1) est fixé sur un élément devant être positionné par rapport à des repères anatomiques de références, tel qu'un organe d'interposition intra-articulaire. Le dispositif (1) comprend une source lumineuse (2) projetant deux faisceaux lumineux (2a, 2b) pour matérialiser sur le bras du patient et par des lignes de lumière (3), l'intersection entre les plans frontal et sagittal du repère anatomique de l'articulation et ledit bras du patient. Cette caractéristique permet au chirurgien de vérifier le positionnement correct d'un organe d'interposition intra-articulaire par exemple, au moyen d'un simple contrôle visuel. With reference to FIGS. 5 and 6, the device according to the invention can also be implemented in the case of an operation of the shoulder for example. In the same way, the device (1) is fixed on an element to be positioned relative to reference anatomical landmarks, such as an intra-articular interposition member. The device (1) comprises a light source (2) projecting two light beams (2a, 2b) to materialize on the patient's arm and light lines (3), the intersection between the frontal and sagittal planes of the anatomical landmark. of the joint and said arm of the patient. This characteristic allows the surgeon to verify the correct positioning of an intra-articular interposition member for example, by means of a simple visual control.
Le dispositif de contrôle extra-médullaire (1) selon l'invention fournit un système de contrôle visuel utilisant un rayon L.A.S.E.R., une diode électroluminescente, ou toute autre source lumineuse (2) capable de produire une lumière assez puissante pour projeter des lignes de lumières (3) sur une partie du corps d'un patient selon chacun des plans de références choisis du repère anatomique d'une articulation. Ces lignes de lumières (3) permettent de visualiser et de matérialiser l'intersection des plans anatomiques frontal, sagittal, et transversal du repère anatomique d'une articulation avec un membre comprenant l'articulation à opérer. Ces lignes de lumières (3) permettent ainsi au chirurgien de pouvoir effectuer un contrôle visuel du positionnement d'un élément par rapport audits plans anatomiques de référence, notamment par le contrôle de la correspondance entre les axes projetés et les axes réels sur le patient. The extra-medullary control device (1) according to the invention provides a visual control system using a LASER beam, a light-emitting diode, or any other light source (2) capable of producing light powerful enough to project lines of light. (3) on a body part of a patient according to each of the selected reference planes of the anatomical landmark of a joint. These lines of light (3) make it possible to visualize and to materialize the intersection of the frontal, sagittal, and transverse anatomical planes of the anatomical landmark of a joint with a limb comprising the joint to be operated. These lines of light (3) thus allow the surgeon to be able to perform a visual check of the positioning of an element by report audit anatomical reference plans, in particular by controlling the correspondence between the projected axes and the real axes on the patient.
Ces lignes de lumières (3) permettent de visualiser et matérialiser des axes directement sur une partie du corps d'un patient comprenant l'articulation osseuse considérée et d'éviter les effets de parallaxe, tout en ayant un système (1) peu encombrant, fiable, facile à mettre en œuvre, précis et répétable. These lines of lights (3) make it possible to visualize and materialize axes directly on a part of the body of a patient including the bone joint considered and to avoid the effects of parallax, while having a system (1) compact, reliable, easy to implement, accurate and repeatable.
Le dispositif de contrôle extra-médullaire (1) selon l'invention permet également, par exemple, la mise en place d'un élément sous forme d'un bloc de coupe huméral, dans le cadre de la chirurgie de l'épaule, pour régler correctement l'alignement par rapport à Γ avant-bras. The extra-medullary control device (1) according to the invention also allows, for example, the introduction of an element in the form of a humeral cutting block, in the context of shoulder surgery, for correctly adjust the alignment to Γ forearm.

Claims

REVENDICATIONS
Procédé de contrôle extra-médullaire du positionnement d'un organe d'interposition intra-articulaire par rapport à un repère anatomique d'une articulation, ledit organe d'interposition intra-articulaire étant réalisé sur mesure pour stabiliser et aligner deux os de ladite articulation, caractérisé en ce qu'il consiste à : A method of extramedullary control of the positioning of an intra-articular interposition member with respect to an anatomical mark of a joint, said intra-articular interposition member being made to measure to stabilize and align two bones of said articulation , characterized in that it consists of:
- projeter, par l'intermédiaire d'au moins une source lumineuse (2) fixée à l'organe d'interposition intra-articulaire, au moins un faisceau lumineux (2a, 2b) selon au moins un plan anatomique de référence du repère anatomique de l'articulation, pour matérialiser par l'intermédiaire d'au moins une ligne de lumière (3) sur un membre comprenant l'articulation, la position théorique d'au moins un axe anatomique de l'articulation par rapport audit organe d'interposition intra-articulaire ;  projecting, by means of at least one light source (2) fixed to the intra-articular interposition member, at least one light beam (2a, 2b) according to at least one anatomical reference plane of the anatomical landmark of the articulation, to materialize by means of at least one line of light (3) on a limb comprising the articulation, the theoretical position of at least one anatomical axis of the articulation with respect to said organ of intra-articular interposition;
- contrôler visuellement le positionnement de l'organe d'interposition intra- articulaire en vérifiant la correspondance entre l'axe anatomique projeté et l'axe anatomique réel sur le membre.  - visually control the positioning of the intra-articular interposition member by checking the correspondence between the projected anatomical axis and the real anatomical axis on the limb.
Procédé de contrôle extra-médullaire selon la revendication 1 , caractérisé en ce que deux faisceaux lumineux (2a, 2b) sont projetés selon le plan anatomique sagittal ou frontal, et de part et d'autre du plan anatomique transversal du repère anatomique de l'articulation. Method for extra-medullary control according to claim 1, characterized in that two light beams (2a, 2b) are projected according to the sagittal or frontal anatomical plane, and on either side of the transverse anatomical plane of the anatomical reference mark of the joint.
Procédé de contrôle extra-médullaire selon l'une quelconque des revendications précédentes, caractérisé en ce que des faisceaux lumineux (2a, 2b) sont projetés selon au moins deux plans anatomiques de référence, orthogonaux l'un par rapport à l'autre. Extra-medullary control method according to any one of the preceding claims, characterized in that light beams (2a, 2b) are projected in at least two reference anatomical planes orthogonal to one another.
Procédé de contrôle extra-médullaire selon l'une quelconques des revendications 1 à 2, caractérisé en ce que des faisceaux lumineux (2a, 2b) sont projetés selon les trois plans anatomiques sagittal, frontal, et transversal. An extra-medullary control method according to any one of claims 1 to 2, characterized in that light beams (2a, 2b) are projected along the three anatomical sagittal, frontal, and transverse planes.
Dispositif de contrôle extra-médullaire (1) du positionnement d'un organe d'interposition intra-articulaire par rapport à un repère anatomique d'une articulation, ledit organe d'interposition intra-articulaire étant réalisé sur mesure pour stabiliser et aligner deux os de ladite articulation, caractérisé en ce qu'il comprend au moins une source lumineuse (2) destinée à être fixée sur l'organe d'interposition intra- articulaire, par l'intermédiaire de moyens de fixation (4), de manière à projeter, sur un membre comprenant ladite articulation, au moins un faisceau lumineux (2a, 2b) selon un plan anatomique de référence du repère anatomique de l'articulation, pour matérialiser, par l'intermédiaire d'au moins une ligne de lumière (3), la position théorique d'au moins un axe anatomique de l'articulation par rapport audit organe d'interposition intra-articulaire, permettant un contrôle visuel du positionnement de l'organe d'interposition intra-articulaire par une vérification de la correspondance entre l'axe anatomique projeté et l'axe anatomique réel sur le membre. Device for the extra-medullary control (1) of the positioning of an intra-articular interposition member with respect to an anatomical reference of a joint, said intra-articular interposition member being made to measure to stabilize and align two bones of said articulation, characterized in that it comprises at least one light source (2) intended to be fixed on the intra-articular interposition member, by means of fixing means (4), so as to project on a limb comprising said articulation, at least one light beam (2a, 2b) according to an anatomical reference plane of the anatomical landmark of the joint, to materialize, via at least one line of light (3) , the position theoretical of at least one anatomical axis of the articulation relative to said intra-articular interposition member, allowing a visual control of the positioning of the intra-articular interposition member by checking the correspondence between the anatomical axis projected and the actual anatomical axis on the limb.
Dispositif de contrôle extra-médullaire (1) selon la revendication 5, caractérisé en ce que la ou les sources lumineuses (2) sont du type à L.A.S.E.R Extramedullary control device (1) according to claim 5, characterized in that the light source (s) (2) are of the L.A.S.E.R type.
Dispositif de contrôle extra-médullaire (1) selon la revendication 5, caractérisé en ce que la ou les sources lumineuses (2) sont du type à diode électroluminescente. Extra-medullary control device (1) according to claim 5, characterized in that the light source (s) (2) are of the light-emitting diode type.
Dispositif de contrôle extra-médullaire (1) selon l'une quelconque des revendications précédentes, caractérisé en ce qu'il comprend deux sources lumineuses (2), chacune agencée pour projeter au moins un faisceau lumineux (2a, 2b) selon un plan, les deux plans de projection étant orthogonaux l'un à l'autre. Extramedullary control device (1) according to any one of the preceding claims, characterized in that it comprises two light sources (2), each arranged to project at least one light beam (2a, 2b) in a plane, the two projection planes being orthogonal to each other.
Dispositif de contrôle extra-médullaire (1) selon l'une quelconque des revendications 5 à 7, caractérisé en ce qu'il comprend trois sources lumineuses (2), chacune agencée pour projeter au moins un faisceau lumineux (2a, 2b) selon un plan, les trois plans de projection étant orthogonaux les uns aux autres. Extramedullary control device (1) according to any one of claims 5 to 7, characterized in that it comprises three light sources (2), each arranged to project at least one light beam (2a, 2b) according to a plane, the three projection planes being orthogonal to each other.
Dispositif de contrôle extra-médullaire (1) selon l'une quelconque des revendications précédentes, caractérisé en ce que la ou les sources lumineuses (2) sont agencée pour projeter au moins deux faisceaux lumineux (2a, 2b) selon un même plan, et de part et d'autre d'un plan orthogonal au plan de projection de ladite source lumineuse. Extramedullary control device (1) according to any one of the preceding claims, characterized in that the light source (s) (2) are arranged to project at least two light beams (2a, 2b) in the same plane, and on either side of a plane orthogonal to the projection plane of said light source.
Organe d'interposition intra-articulaire réalisé sur mesure pour stabiliser et aligner deux os d'une articulation, caractérisé en ce qu'il comprend au moins une source lumineuse fixée de sorte à pouvoir projeter sur un membre comprenant ladite articulation, au moins un faisceau lumineux (2a, 2b) selon un plan anatomique de référence du repère anatomique de l'articulation, pour matérialiser, par l'intermédiaire d'au moins une ligne de lumière (3), la position théorique d'au moins un axe anatomique de l'articulation par rapport audit organe d'interposition intra- articulaire, permettant un contrôle visuel du positionnement de l'organe d'interposition intra-articulaire par une vérification de la correspondance entre l'axe anatomique projeté et l'axe anatomique réel sur le membre. Intra-articular interposition member made to measure to stabilize and align two bones of a joint, characterized in that it comprises at least one light source fixed so as to be able to project on a member comprising said articulation, at least one beam light (2a, 2b) according to an anatomical reference plane of the anatomical reference of the joint, to materialize, by means of at least one line of light (3), the theoretical position of at least one anatomical axis of the articulation relative to said intra-articular interposition member, allowing a visual control of the positioning of the intra-articular interposition member by checking the correspondence between the projected anatomical axis and the real anatomical axis on the member.
PCT/FR2015/051475 2014-06-05 2015-06-04 Method and device for extramedullary control for performing surgery WO2015185864A1 (en)

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