WO2020122063A1 - Dispositif de chirurgie, dispositif de traitement d'informations, système, procédé de traitement d'informations et programme - Google Patents

Dispositif de chirurgie, dispositif de traitement d'informations, système, procédé de traitement d'informations et programme Download PDF

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Publication number
WO2020122063A1
WO2020122063A1 PCT/JP2019/048273 JP2019048273W WO2020122063A1 WO 2020122063 A1 WO2020122063 A1 WO 2020122063A1 JP 2019048273 W JP2019048273 W JP 2019048273W WO 2020122063 A1 WO2020122063 A1 WO 2020122063A1
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WIPO (PCT)
Prior art keywords
bone
model data
drill
shape
information processing
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PCT/JP2019/048273
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English (en)
Japanese (ja)
Inventor
健吾 原藤
武雄 名倉
聡 木山
大造 林田
Original Assignee
学校法人慶應義塾
Jsr株式会社
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Application filed by 学校法人慶應義塾, Jsr株式会社 filed Critical 学校法人慶應義塾
Publication of WO2020122063A1 publication Critical patent/WO2020122063A1/fr

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

Definitions

  • Embodiments of the present invention relate to a surgical device, an information processing apparatus, a system, an information processing method, and a program.
  • the ligament In sports, etc., if a large external force acts on the ligament, it may be damaged.
  • the anterior cruciate ligament has a poor blood flow and is difficult to spontaneously heal. Therefore, if it is damaged, a ligament reconstruction operation is performed.
  • the ligament reconstruction operation the collected tendon is used, but since it is difficult to fix it to the intra-articular ligament attachment part, a bone hole is formed and the reconstructed ligament is guided and fixed to the bone hole.
  • the reconstructed ligament is preferably placed anatomically at the same position as the ligament before rupture with respect to the bone, but it depends on the bone hole preparation position.
  • a drill is used to create a bone hole, but an arthroscopic surgical device that guides the drill to the bone is used to accurately form the bone hole as described above.
  • the device for arthroscopic surgery includes a fixing part that comes into contact with bone and a drill guide part that guides the drill movably in the cutting direction. The doctor cuts the bone with a drill guided by the drill guide to form a bone hole in a state where the fixed portion of the arthroscopic surgery device is in contact with the bone.
  • the arthroscopic surgical device may move with the fixing portion as a base point, that is, the drill guided by the drill guide may move with respect to the bone.
  • the ligament reconstruction operation is an operation with a narrow visual field using an arthroscope because the area where the skin and the muscle are incised is narrow. Therefore, it was technically difficult to make a bone hole at the same anatomical position as the ligament before injury.
  • An object of the present invention is to provide a surgical device, an information processing apparatus, a system, an information processing method, and a program capable of accurately positioning a drill with respect to a bone in ligament reconstruction surgery.
  • the present invention is a surgical device for positioning a drill that forms a bone hole that penetrates a bone of a subject in a ligament reconstruction surgery.
  • a drill guide part connected to one end of the main body part and movably guiding the drill in the cutting direction of the bone by the drill, and connected to the other end part of the main body part, the bone
  • a fixing portion having a portion corresponding to the bone, the fixing portion being attachable to and detachable from the main body portion.
  • the present invention is an information processing apparatus for generating at least model data of a fixed part of a surgical device for positioning a drill for forming a bone hole penetrating a bone of a subject in ligament reconstruction surgery, wherein: Based on image data obtained by imaging a region including the bone of the subject, an acquisition unit that acquires bone shape information including the contour data of the bone, and a portion that is in contact with the bone and corresponds to the bone A generation unit that generates the model data based on the bone shape information.
  • the present invention includes at least an information processing device and a modeling device, and at least models a fixing portion of a surgical device that positions a drill that forms a bone hole that penetrates a bone of a subject in ligament reconstruction surgery.
  • the present invention also provides an information processing method for generating at least model data of a fixed part of a surgical device for positioning a drill that forms a bone hole that penetrates a bone of a subject in ligament reconstruction surgery.
  • a generation step of generating the model data having the above based on the bone shape information is generating the model data having the above based on the bone shape information.
  • the present invention is a program for generating model data of at least a fixed part of a surgical operation device for positioning a drill for forming a bone hole penetrating a bone of a subject in a ligament reconstruction operation, which comprises a computer On the basis of image data obtained by imaging a region including the bone of the subject, an obtaining step of obtaining bone shape information including the outline data of the bone, and contacting the bone, and depending on the bone A generation step of generating the model data having a part based on the bone shape information.
  • a surgical device an information processing apparatus, a system, an information processing method, and a program capable of accurately positioning a drill with respect to a bone in ligament reconstruction surgery.
  • FIG. 1 is a diagram showing an example of a schematic configuration of a system according to an embodiment.
  • FIG. 2 is a diagram illustrating an example of a hardware configuration of the information processing device according to the embodiment.
  • FIG. 3 is a diagram illustrating an example of functions of the information processing apparatus according to the embodiment.
  • FIG. 4 is a diagram showing an example of a screen on which image data of the knee is displayed.
  • FIG. 5 is a diagram for explaining the processing of the acquisition unit.
  • FIG. 6 is a perspective view showing a surgical device.
  • FIG. 7 is a plan view showing the fixing portion of the surgical operation device.
  • FIG. 8 is a side view showing the fixing portion of the surgical operation device.
  • FIG. 9 is a flowchart showing an operation example of the information processing apparatus of this embodiment.
  • FIG. 10 is a diagram for explaining a ligament reconstruction operation according to the embodiment.
  • FIG. 11 is a diagram for explaining a ligament construction operation according to the embodiment.
  • FIG. 12 is a diagram for explaining the ligament construction surgery according to the embodiment.
  • FIG. 13 is a figure which shows the modification of the fixing part of a surgical device.
  • FIG. 14 is a figure which shows the modification of the fixing
  • FIG. 15 is a figure which shows the modification of the fixing
  • This embodiment is for inserting a reconstructed ligament in a ligament reconstruction operation for replacing the damaged anterior cruciate ligament with a reconstructed ligament when the anterior cruciate ligament between the femur and the tibia as the bone of the subject is damaged.
  • the present invention provides a surgical device for positioning a drill with respect to a femur when forming a bone hole.
  • FIG. 1 is a diagram showing an example of a schematic configuration of a system according to an embodiment.
  • the system 1 according to the embodiment includes a medical image diagnostic apparatus 10, an information processing apparatus 20, and a modeling apparatus 30.
  • Each device illustrated in FIG. 1 is in a state of being able to communicate with each other directly or indirectly through a network such as a LAN (Local Area Network) or a WAN (Wide Area Network).
  • a network such as a LAN (Local Area Network) or a WAN (Wide Area Network).
  • the medical image diagnostic device 10 is a device that does not damage the human body and generates image data that is an image of a portion that is not normally visible.
  • the medical image diagnostic apparatus 10 shown in FIG. 1 can generate three-dimensional image data (volume data) in which at least the contour of the body surface of the imaging region of the subject and the bone present in the imaging region are depicted. It is a device.
  • the medical image diagnostic apparatus 10 is an X-ray CT (Computed Tomography) apparatus, an MRI (Magnetic Resonance Imaging) apparatus, or the like. Note that any known medical image diagnostic apparatus may be applied as the medical image diagnostic apparatus 10. Imaging (imaging) performed by the X-ray CT apparatus, which is an example of the medical image diagnostic apparatus 10, will be briefly described below.
  • the X-ray CT apparatus uses a gantry device having a rotatable frame that supports an X-ray tube that irradiates X-rays and an X-ray detector that detects X-rays that have passed through a subject at opposing positions. Take a picture.
  • the X-ray CT apparatus collects projection data by rotating the rotating frame while irradiating X-rays from the X-ray tube, and reconstructs X-ray CT image data from the projection data.
  • the X-ray CT image data is, for example, a tomographic image (two-dimensional X-ray CT image data) on the rotation surface (axial surface) of the X-ray tube and the X-ray detector.
  • the X-ray detector has a plurality of detection element rows, which are X-ray detection elements arranged in the channel direction, arranged along the rotation axis direction of the rotating frame.
  • an X-ray CT apparatus having an X-ray detector in which 16 detection element rows are arranged has a plurality of pieces (in a body axis direction of a subject, based on projection data collected by one rotation of a rotating frame). For example, 16 tomographic images are reconstructed.
  • the X-ray CT apparatus reconstructs, for example, 500 tomographic images covering the entire heart as three-dimensional X-ray CT image data by rotating the rotating frame and performing a helical scan to move the subject or the gantry device. Can be configured.
  • the X-ray CT apparatus as the medical image diagnostic apparatus 10 shown in FIG. 1 is an apparatus capable of imaging a subject in a standing, sitting or lying position.
  • Such an X-ray CT apparatus for example, images a subject sitting on a chair made of a material having high X-ray transparency and generates three-dimensional X-ray CT image data.
  • the MRI apparatus uses an MR (Magnetic Resonance) signal acquired by changing the gradient magnetic field for phase encoding, the gradient magnetic field for slice selection, and the gradient magnetic field for frequency encoding to acquire MR image data of any one cross section or any MR image data.
  • MR image data (volume data) of a plurality of cross sections can be reconstructed.
  • the medical image diagnostic apparatus 10 generates, as image data, three-dimensional X-ray CT image data (or MR image data) obtained by imaging a region including the knee of the subject. Then, the medical image diagnostic apparatus 10 transmits the generated image data to the information processing apparatus 20.
  • the medical image diagnostic apparatus 10 converts the image data into DICOM data in a format conforming to the DICOM (Digital Imaging and Communications in Medicine) standard and transmits it to the information processing apparatus 20.
  • the medical image diagnostic apparatus 10 creates DICOM data in which incidental information is added to the image data.
  • the incidental information includes a patient ID that can be uniquely identified, patient information (name, sex, age, etc.), type of examination in which an image was taken, examination site (imaging site), This includes information such as the patient's posture at the time of shooting and image size.
  • the information about the image size is used as information for converting the length in the image space into the length in the real space.
  • the medical image diagnostic apparatus 10 images three-dimensional X-ray CT image data (or MR image data) captured including the knee portion of the subject in the standing, sitting or lying position. It is applicable even when it is transmitted to the information processing device 20 as data.
  • the information processing apparatus 20 acquires the image data of the subject from the medical image diagnostic apparatus 10. For example, the operator (doctor or the like) of the information processing device 20 performs a search using the patient ID of the subject. As a result, the information processing apparatus 20 acquires from the medical image diagnostic apparatus 10 three-dimensional X-ray CT image data (or MR image data) captured including the knee of the subject.
  • the information processing apparatus 20 uses various information acquired from the image data of the subject to generate model data that is a basis for modeling the surgical device with the modeling apparatus 30.
  • the processing content for generating model data will be described later.
  • the information processing device 20 sends the generated model data to the modeling device 30.
  • the modeling apparatus 30 is an apparatus that models at least the fixed portion of the surgical operation device based on the model data received from the information processing apparatus 20.
  • the modeling apparatus 30 includes a modeling unit 31 for modeling the fixed unit.
  • the configuration of the modeling unit 31 for providing the function of the three-dimensional printer can be realized by various known configurations.
  • the modeling unit 31 has a nozzle for discharging a material heated and melted to a desired temperature and pressure, a moving mechanism for moving the nozzle in a three-dimensional direction, and a material having a desired shape depending on the material discharged from the nozzle. It includes a modeling stage on which a pattern layer is formed, a control unit that controls each unit, and the like.
  • the modeling unit 31 uses a powder sintering method, and a laser for sintering the material, a moving mechanism for moving the laser in the plane direction, and a pattern layer having a desired shape are formed by the stacked materials.
  • the molding stage a moving mechanism for moving the molding stage in a direction orthogonal to the plane direction, a control unit for controlling each unit, and the like may be included.
  • the modeling unit 31 models the three-dimensional structure corresponding to the model data by repeatedly stacking the pattern layers based on the model data.
  • one pattern layer is formed based on one tomographic image corresponding to the same position as the one pattern layer among a plurality of tomographic images forming the model data.
  • FIG. 2 is a diagram illustrating an example of a hardware configuration of the information processing device 20 according to the embodiment.
  • the information processing device 20 includes a CPU (Central Processing Unit) 21, a ROM (Read Only Memory) 22, a RAM (Random Access Memory) 23, an auxiliary storage device 24, and an input device 25.
  • a display device 26 and an external I/F (Interface) 27 are provided.
  • the CPU 21 is a processor (processing circuit) that centrally controls the operation of the information processing device 20 by executing a program and realizes various functions of the information processing device 20. Various functions of the information processing device 20 will be described later.
  • the ROM 22 is a non-volatile memory, and stores various data (information written at the manufacturing stage of the information processing device 20) including a program for starting the information processing device 20.
  • the RAM 23 is a volatile memory having a work area for the CPU 21.
  • the auxiliary storage device 24 stores various data such as programs executed by the CPU 21.
  • the auxiliary storage device 24 is composed of, for example, an HDD (Hard Disc Drive), an SSD (Solid State Drive), and the like.
  • the input device 25 is a device for an operator who uses the information processing device 20 to perform various operations.
  • the input device 25 is composed of, for example, a mouse, a keyboard, a touch panel, or a hardware key.
  • the operator corresponds to a medical person such as a doctor or a physical therapist, for example.
  • the display device 26 displays various information.
  • the display device 26 displays image data, model data, a GUI (Graphical User Interface) for receiving various operations from an operator, medical images, and the like.
  • the display device 26 is composed of, for example, a liquid crystal display, an organic EL (Electro Luminescence) display, or a CRT display.
  • the input device 25 and the display device 26 may be integrally configured in the form of a touch panel, for example.
  • the external I/F 27 is an interface for connecting (communicating) with an external device such as the medical image diagnostic device 10 and the modeling device 30.
  • FIG. 3 is a diagram illustrating an example of functions of the information processing device 20 according to the embodiment. Note that the example of FIG. 3 illustrates only the functions related to the present embodiment, but the functions of the information processing device 20 are not limited to these.
  • the information processing device 20 includes a storage unit 201, a user interface unit 202, an acquisition unit 203, a generation unit 204, and an output unit 205.
  • the function of the storage unit 201 is realized, for example, by the auxiliary storage device 24 (for example, HDD) shown in FIG.
  • the function of the user interface unit 202 is realized by, for example, the input device 25 and the display device 26.
  • Each function of the acquisition unit 203, the generation unit 204, and the output unit 205 is realized by, for example, the CPU 21 that reads out a program for causing a computer to execute the processes of the acquisition unit 203, the generation unit 204, and the output unit 205. ..
  • the storage unit 201 stores various information used for generating model data, programs, and the like.
  • the storage unit 201 can also store image data (DICOM data) captured by the medical image diagnostic apparatus 10.
  • DICOM data image data
  • the user interface unit 202 is a display unit and a reception unit, and has a function of receiving an operator's input and a function of outputting various information.
  • the user interface unit 202 receives an input operation performed by the operator via the input device 25, converts the received input operation into an electric signal, and sends the electric signal to each unit in the information processing apparatus 20.
  • the user interface unit 202 receives various kinds of information from each unit in the information processing device 20, stores the received information in the storage unit 201, or causes the display device 26 to display the received information. Further, the user interface unit 202 sends the information designated by the operator to the external device via the external I/F 27.
  • the user interface unit 202 when the user interface unit 202 receives an operation for calling the image data of the subject for which the surgical operation device is to be created, the user interface unit 202 reads out the image data designated by the operation from the storage unit 201. The control for displaying on the display device 26 is performed.
  • FIG. 4 is a diagram showing an example of a screen on which image data of the knee is displayed.
  • FIG. 4 shows the three-dimensional X-ray CT image data displayed on the screen of the display device 26.
  • the three-dimensional X-ray CT image data shown in FIG. 4 is the body surface of the knee of the subject and the outlines of various bones forming the knee, which are rendered by surface rendering processing.
  • the user interface unit 202 When displaying the three-dimensional image data on the two-dimensional screen (for example, the display device 26), the user interface unit 202 performs various rendering processes on the three-dimensional image data.
  • rendering processing include volume rendering processing, surface rendering processing, and cross-section reconstruction method (MPR: Multi Planar Reconstruction).
  • volume rendering process a two-dimensional image that reflects the three-dimensional information of volume data can be generated.
  • surface rendering process surface information of an arbitrary part (body surface, bone, etc.) can be extracted from the volume data to generate a two-dimensional image.
  • MPR an MPR image of an arbitrary cross section can be reconstructed from volume data.
  • the acquisition unit 203 acquires various data required for designing a surgical device. For example, when the user interface unit 202 receives an acquisition request for image data including a patient ID, the acquisition unit 203 transmits a transmission request for image data corresponding to the patient ID to the medical image diagnostic apparatus 10 via the external I/F 27. To do.
  • the external I/F 27 stores the image data received from the medical image diagnostic apparatus 10 in the storage unit 201. Then, the acquisition unit 203 acquires the image data from the storage unit 201.
  • the acquisition unit 203 acquires the bone shape information including the outline data of the bone of the subject based on the image data.
  • the acquisition unit 203 performs known image processing such as edge detection processing on the three-dimensional X-ray CT image data to extract the contour (bone surface) of the mandible.
  • the acquisition unit 203 acquires, from the image data, the outer shape data that three-dimensionally represents the surface shape of the bone of the subject.
  • FIG. 5 is a diagram for explaining the processing of the acquisition unit 203.
  • FIG. 5 illustrates a case where the image 40 of the femur TB is displayed on the display device 26.
  • the generation request is sent to the acquisition unit 203.
  • the model data generation request includes, for example, identification information (patient ID or the like) for identifying a patient (subject) having an anterior cruciate ligament injury.
  • the acquisition unit 203 receives image data of the subject identified by the patient ID (three-dimensional X-ray CT image data or MR) from among various information stored in the storage unit 201. Image data). Then, the read image data is subjected to various rendering processes (surface rendering process in the example of FIG. 4) by the user interface unit 202 and displayed on the display device 26.
  • the acquisition unit 203 refers to the database in which the bone type, the bone shape, and the bone position information are stored in association with each other, and the bone type and the bone shape from the three-dimensional X-ray CT image data. Acquiring knee bone data including information regarding bone position and location.
  • the acquisition unit 203 performs known segmentation processing on the three-dimensional X-ray CT image data to extract a three-dimensional region (three-dimensional bone region) corresponding to bone.
  • the acquisition unit 203 extracts the three-dimensional bone region by binarizing and extracting the voxels corresponding to the CT value of the bone with a predetermined threshold value.
  • the acquisition unit 203 refers to the database and specifies the shape, type, and position of each of the plurality of bones included in the extracted three-dimensional bone region.
  • the above database is stored in the storage unit 201.
  • the template is a template for detecting various bones forming the knee by pattern matching.
  • the template represents the shape of various bones that make up the knee.
  • an anatomical name indicating the type of bone is associated with each bone of the template.
  • the database stores that, when the knee is viewed from the front, the femur and the tibia are sequentially arranged from the top to the bottom.
  • the database is that, when the femur is viewed from the front, the lower end of the femur is the lateral femoral condyle and the femoral medial condyle that are separated in the width direction, the lateral femoral condyle and the femoral medial condyle. I remember that the space between and was the femoral intercondylar fossa.
  • the database also stores Resident's ridges on the surface of the lateral femoral condyle on the medial femoral condyle side when the lateral femoral condyle is viewed from the front.
  • the Resident's ridge is a projection on the surface of the medial condyle of the femur and projects into the intercondylar space of the femur.
  • the shape of Resident's ridge differs depending on the subject and the position of the lateral femoral condyle on the surface of the medial femoral condyle side.
  • the acquisition unit 203 performs pattern matching between the template and the three-dimensional bone region extracted from the three-dimensional X-ray CT image data by the segmentation process to obtain information on the bone type, the bone shape, and the bone position, and the thigh.
  • Acquire knee bone data including Resident's ridge position information, which is information about the position of the Resident's ridge on the surface of the lateral condyle of the femur on the medial side of the femur.
  • Examples of the pattern matching method include template matching that determines whether or not they match with predetermined template data, and multivariate analysis that determines based on a feature amount related to bone type, bone shape, and bone position. ..
  • the database stores templates representing standard knees for each gender and age, such as the template for “male, 8 to 10 years old” and the template for “female, 20 to 30 years old”. You can do it.
  • the acquisition unit 203 acquires the sex and age of the subject from the supplementary information of the DICOM data, reads the template corresponding to the acquired sex and age from the database, and acquires the bone data of the knee.
  • the operator has found the anterior cruciate ligament ruptured site as a lesion site from the image displayed on the display device 26, and the ruptured anterior cruciate ligament was in contact with the ruptured anterior cruciate ligament via the input device 25.
  • Select a bone for example, femur TB.
  • the femur TB is selected, only the femur TB is displayed on the display device 26, as shown in FIG.
  • a lateral femoral condyle TBO, a medial femoral condyle TBI, a Resident's ridge TBT, etc. are displayed.
  • the operator further sets the bone hole TBH from the image of the femur TB displayed on the display device 26.
  • the bone hole TBH is a hole that penetrates from the side of the femoral medial condyle TBI of the lateral femoral condyle TBO, that is, from the body surface side surface TBS1 to the femoral medial condyle side surface TBS2, and the reconstruction ligament described later is used. It is inserted.
  • the acquisition unit 203 extracts bone shape information including Resident's ridge position information and bone hole information corresponding to the set bone hole TBH. Then, the acquisition unit 203 sends the acquired bone shape information to the generation unit 204.
  • the generation unit 204 generates model data of the fixed portion of the surgical device having at least outer shape data corresponding to the bone based on the bone shape information. For example, the generation unit 204 is based on the bone shape information acquired by the acquisition unit 203, when forming a bone hole TBH penetrating the femur TB, a surgical device that positions a drill with respect to the femur TB. Generate model data for the fixed part.
  • FIG. 6 is a diagram for explaining the processing of the generation unit 204.
  • FIG. 6 shows an example of a surgical device including a fixing portion shaped based on model data generated based on bone shape information.
  • FIG. 7 and FIG. 8 show an example of a fixed portion formed based on model data generated based on shape information.
  • the generation unit 204 generates model data for shaping the fixed portion of the surgical operation device according to the bone based on the outer shape data corresponding to the bone, the bone hole data, and the Resident's ridge position data included in the bone shape information. To do.
  • This model data is information that defines at least the shape of the fixed portion of the surgical device that is modeled based on the model data.
  • the surgical device 100 includes a main body 110, a drill guide 120, a fixing portion 130, and a screw 140.
  • the surgical operation device 100 is a material that does not affect the biological tissue even if it temporarily comes into contact with the biological tissue, a material that can be sterilized, and a strength that does not deform during surgery by the surgical operation device 100 by a doctor. Is composed of a material having
  • the main body section 110 is connected to the drill guide section 120 and the fixed section 130.
  • the main body 110 has a drill guide 120 connected to one end 111 and a fixed part 130 connected to the other end 112.
  • the main body 110 in the present embodiment is made of metal or synthetic resin, is formed in a substantially U shape, and has a rectangular cross-sectional shape orthogonal to the longitudinal direction.
  • the drill guide section 120 guides the drill 200 movably in the bone cutting direction A by the drill 200.
  • the drill guide part 120 is made of synthetic resin or metal, and has a grip part 121, a drill guide hole 122, and a slide hole 123.
  • the grasping portion 121 is a portion that a doctor grasps by hand during a ligament reconstruction operation, and is formed in a curved shape in consideration of ease of grasping.
  • the drill guide hole 122 guides the inserted drill 200 movably in the cutting direction A.
  • the drill 200 in the present embodiment forms a bone hole TBH penetrating the femur TB, and as long as it can cut the femur TB, the shape, configuration, and cutting method of the drill It is not particularly limited.
  • the one end portion 111 of the main body 110 is inserted into the slide hole 123.
  • the slide hole 123 is formed such that one end 111 is movable in the insertion direction and the opposite direction. That is, the drill guide portion 120 is connected to the one end portion 111 by the slide hole 123, and is connected to the main body portion 110 so as to be movable relative to the main body portion 110. Therefore, in the surgical device 100, the distance between the fixed part 130 and the drill guide part 120 can be changed.
  • the surgical device 100 has a holding portion that holds the relative position of the drill guide 120 with respect to the main body 110.
  • the holding portion is, for example, a screw that is screwed into a screw hole that communicates with the slide hole 123.
  • the drill guide part 120 has graduations formed at regular intervals on the outer surface facing the slide hole 123. The doctor can easily recognize the relative position of the drill guide part 120 with respect to the main body part 110, that is, the distance between the fixing part 130 and the drill guide part 120 by visually observing the scale.
  • the fixing portion 130 contacts the bone.
  • the fixing portion 130 in the present embodiment is in contact with the femoral lateral condyle TBO of the femur TB, particularly, at least the Resident's ridge TBR.
  • the fixed part 130 faces the drill guide part 200 in the cutting direction A in a state of being connected to the main body part 110.
  • the fixing portion 130 is made of synthetic resin or metal and has a contact surface 131, an insertion hole 132, a screw hole 133, and a notch 134.
  • the fixing portion 130 in this embodiment has an elliptical shape when viewed from the cutting direction A. That is, when viewed from the cutting direction A, the fixed portion 130 has an elliptical outer periphery.
  • the contact surface 131 is a part corresponding to the bone.
  • the contact surface 131 is formed corresponding to, ie, following, the shape of the surface TBS (including TBS1 and TBS2) of the femoral lateral condyle TBO of the femur TB.
  • the contact surface 131 in this embodiment is formed corresponding to, ie, following, the shape of the surface including at least a region corresponding to the Resident's ridge TBT in the medial femoral condyle surface TBS2 that is the surface TBS of the lateral femoral condyle TBO. ing.
  • the other end 112 of the main body 110 is inserted into the insertion hole 132.
  • the insertion hole 132 has a rectangular space shape in a plane orthogonal to the insertion direction.
  • the other end 112 of the main body 110 and the insertion hole 132 of the fixed portion 130 form a rotation restriction structure RRS.
  • the insertion hole 132 is formed in a rectangular space shape, and the other end 112 is formed in a rectangular cross-sectional shape, so that the fixed portion is fixed to the main body 110. 130 is restricted from rotating around the extending direction of the main body 110.
  • the screw hole 133 communicates with the insertion hole 132, and the screw 140 is screwed into the screw hole 133.
  • the screw holes 133 in the present embodiment are formed at a plurality of positions in the fixing portion 130 in the extending direction of the insertion hole 132, and are formed so as to penetrate to the outer surface and the inner surface forming the insertion hole 132.
  • the notch 134 is for inserting the drill 200. After the drill 200 guided by the drill guide portion 120 moves in the cutting direction A to form the bone hole TBH in the state where the fixed portion 130 is connected to the other end portion 112 of the main body portion 110, the notch 134 is formed. A drill 200 protruding in the cutting direction A is inserted from the bone hole TBH.
  • the notch 134 is open on the outer surface of the fixed portion 134 in a direction orthogonal to the cutting direction. That is, the fixing part 130 is in contact with the femur TB by the doctor operating the surgical device 100 with the drill 200 guided by the drill guide part 120 and inserted into the bone hole TBH. In some cases, it can be separated from the femur TB.
  • the screw 140 fixes the fixing unit 130 to the main body 110.
  • the screw 140 corresponds to each screw hole 133, and is formed in such a length that the tip portion thereof protrudes into the insertion hole 132 in a state of being screwed into the screw hole 133.
  • the screw 140 is screwed into the screw hole 133, and the tip portion thereof comes into contact with the other end portion 112 of the main body 110 inserted into the insertion hole 132. That is, the fixing portion 130 is connected to the other end portion 112 by fixing the other end portion 112 to the fixing portion 130 in the insertion hole 132 with the screw 140. Further, the fixing portion 130 is disconnected from the other end 112 by loosening the screw 140. Therefore, the fixed portion 130 is attachable to and detachable from the main body 110 (detachable).
  • the generation unit 204 determines model data based on the outline data according to the bone.
  • the generation unit 204 in this embodiment determines model data based on the outer shape data, bone hole data, and Resident's ridge position data corresponding to the bone.
  • the generation unit 204 uses the contact surface data corresponding to the contact surface 131 in the model data, based on the outer shape data and the Resident's ridge position data corresponding to the bone, to determine that the contact surface 131 is at least the resident's medial condyle surface TBS2.
  • the data is determined to have a shape in which the surface including the area corresponding to the ridge TBT is transferred.
  • the generation unit 204 connects the model data to the other end 112 of the main body 110, the drill guide 120 to one end 111 of the main body 110, and the fixed unit 130. It is determined so as to face the drill guide 120 in the cutting direction A.
  • the generation unit 204 determines the cutout data based on the bone hole data.
  • the generation unit 204 determines that the drill 200 protruding from the bone hole TBH can be inserted into the fixing unit 130 without contact.
  • the generation unit 204 generates information including the outer shape data of the fixed unit 130 of the surgical device 100 as model data.
  • the generation unit 204 sends the generated model data to the output unit 205.
  • the generation unit 204 also accepts an operation for modifying the model data on the screen on which the model data and the image data are displayed at the same time, and modifies the model data according to the accepted operation.
  • the output unit 205 displays the model data and the image data at the same time.
  • the output unit 205 displays the model data corresponding to the fixed unit 130 of the surgical device 100 shown in FIG. 6 on the image 40 shown in FIG.
  • the operator refers to the model data and the image data displayed on the display device 26 and performs an operation of correcting the model data using the input device 25.
  • the user interface unit 202 receives an operation of correcting model data from the operator, the user interface unit 202 notifies the generation unit 204 of the received operation.
  • the generation unit 204 corrects the model data according to the operation received by the user interface unit 202. Thereby, the operator can correct the model data while confirming the shape of the surface TBS of the lateral femoral condyle TBO on the screen.
  • the output unit 205 outputs the model data generated by the generation unit 204.
  • the output unit 205 stores the model data generated by the generation unit 204 in the storage unit 201.
  • the output unit 205 also outputs the model data to the modeling apparatus 30.
  • the output unit 205 outputs the model data generated by the generation unit 204 to the modeling apparatus 30.
  • the output unit 205 outputs the model data corrected by the generation unit 204 according to the instruction operation of the operator to the modeling apparatus 30.
  • the output unit 205 performs output processing to the modeling apparatus 30 after receiving an output request for the model data generated by the generation unit 204 and the model data corrected by the generation unit 204 from the operator.
  • the modeling unit 31 of the modeling apparatus 30 models the surgical operation device 100 using the model data received from the information processing apparatus 20.
  • the shape of the surgical device 100 shaped by the modeling apparatus 30 is corrected by the operator as necessary.
  • FIG. 9 is a flowchart showing an operation example of the information processing apparatus 20 of this embodiment. Since the specific contents of each step are as described above, detailed description will be appropriately omitted.
  • the user interface unit 202 receives an image data acquisition request (step S101).
  • the acquisition unit 203 acquires image data (step S102).
  • the acquisition unit 203 refers to the database and acquires the bone outline information from the image data (step S103).
  • the generation unit 204 executes model data generation processing based on the bone outer shape information acquired by the acquisition unit 203 (step S104).
  • step S105 the display device 26 displays the model data under the control of the user interface unit 202 (step S105).
  • step S105 the display device 26 displays the image data (including the bone outline information) together with the model data.
  • the user interface unit 202 determines whether or not a model data output request has been received (step S106).
  • the output unit 205 receives the request to output the model data (Yes in step S106)
  • the output unit 205 outputs the model data to the modeling apparatus 30 (step S107) and ends the process.
  • step S106 When the model data output request is not accepted (step S106, No), the user interface unit 202 determines whether or not the model data correction request is accepted (step S108). Next, when the generation unit 204 receives the model data correction request (Yes in step S108), the generation unit 204 corrects the model data according to the model data correction request (step S109).
  • step S108 If the model data correction request is not accepted (No in step S108) or after step S109, the process returns to step S106 to determine whether or not the model data output request is accepted. .. Next, when the output unit 205 receives the model data output request in step S106 after step S109 (Yes in step S106), the output unit 205 outputs the corrected model data to the modeling apparatus 30 (step S107), and the processing is performed. To finish.
  • processing procedure shown in FIG. 9 is merely an example, and can be executed by appropriately changing the order as long as the processing content does not conflict. Further, each processing procedure does not necessarily have to be executed.
  • the information processing apparatus 20 acquires the bone shape information including the bone outer shape data from the image data in which the region including the bone of the subject is imaged. Further, the information processing apparatus 20 generates model data of the fixing unit 130 of the surgical device 100 having at least outer shape data corresponding to the bone based on the bone shape information. In the ligament reconstruction operation, the information processing apparatus 20 according to the embodiment can accurately position the drill with respect to the bone by using the surgical device 100 including the fixing unit 130 corresponding to the generated model data. ..
  • the modeling apparatus 30 models the fixing unit 130 of the surgical device 100 based on the model data generated by the generating unit 204.
  • the fixing portion 130 of the surgical device 100 has a shape corresponding to the bone of the subject.
  • the shape of the fixed part 130 of the surgical operation device 100 is determined based on at least the shape of the bone of the subject.
  • FIG. 10 to 12 are views for explaining a ligament reconstruction operation according to the embodiment.
  • FIG. 10 illustrates the case of fixing the surgical device to the femur.
  • FIG. 11 illustrates a case of cutting a bone hole.
  • FIG. 12 illustrates the case of inserting the reconstructed ligament into the bone hole.
  • the fixing portion 130 having a shape corresponding to the bone of the subject is connected to the other end 112 of the main body 110, and the drill guide 120 is connected to the one end 111 of the main body 110. Connect to. Further, in the present embodiment, the drill 200 is inserted into the drill guide hole 122 of the drill guide part 200 in advance.
  • the doctor incises the epidermis and muscles of the knee of the subject to expose at least a part of the femoral lateral condyle TBO of the femur TB.
  • the doctor presses the fixing portion 130 against the femoral lateral condyle TBO to bring it into contact.
  • the contact surface 131 of the fixing portion 130 contacts the surface of the medial femoral condyle surface TBS2 including at least a region corresponding to the Resident's ridge TBT.
  • the contact surface 131 follows the shape of the surface including at least the region corresponding to the Resident's ridge TBT, it surely contacts the surface including at least the region corresponding to the Resident's ridge TBT.
  • the doctor moves the drill 200 in the cutting direction A while maintaining the contact state where the fixing portion 130 is in contact with the femoral lateral condyle TBO.
  • the drill 200 reaches the body surface side surface TBS1 of the femoral lateral condyle TBO, cutting of the femur TB is started.
  • the drill 200 moves in the cutting direction A and the drill 200 reaches the femoral medial condyle surface TBS2 of the femoral lateral condyle TBO, as shown in FIG. 11, a bone hole TBH is formed in the femur TB. ..
  • the doctor takes out the fixing portion 130 from the incision site to the outside with the drill 200 inserted in the bone hole TBH.
  • the doctor fixes the reconstructed ligament 300 to the tip of the drill 200, moves the drill 200 in the direction opposite to the cutting direction with respect to the drill guide section 120, and moves the drill 200 to the bone hole TBH. From the body surface side to the surface TBS1 side.
  • the reconstructed ligament 300 is fixed to the tip of the drill 200, the reconstructed ligament 300 is inserted into the bone hole TBH from the medial condyle surface TBS2 side of the femur.
  • One end of the reconstructed ligament 300 projects from the body surface side surface TBS1.
  • the doctor fixes the reconstructed ligament 300 protruding from the bone hole TBH on the body surface side surface TBS1 of the lateral femoral condyle TBO.
  • the doctor similarly forms a bone hole in the tibia with the drill 200, fixes the other end of the reconstructed ligament 300 to the tip of the drill 200, extracts the drill 200 from the bone hole, and The ends are projected from the body surface side surface of the tibia.
  • the doctor fixes the reconstructed ligament 300 protruding from the bone hole of the tibia on the body surface side surface of the tibia.
  • the doctor repairs the epidermis and muscles of the subject's knee with the reconstructed ligament 300 fixed to the femur TB and tibia, and completes the ligament reconstruction operation.
  • the fixing portion 130 of the surgical device 100 has an elliptical shape when viewed from the cutting direction A, but is not limited to this. At least the end of the fixing portion 130, which is opposite to the end to which the other end 112 of the main body 110 is connected, is formed of a curved surface. 13 to 15 are views showing modified examples of the fixing portion of the surgical operation device.
  • the fixing portion 130 may have a rugby ball shape when viewed from the cutting direction as shown in FIG. 13, or may have an egg shape when viewed from the cutting direction as shown in FIG. Of course, as shown in FIG. 15, it may have a shell shape when viewed from the cutting direction.
  • the program executed by the information processing apparatus 20 of the above-described embodiment is a file in an installable format or an executable format, which is a CD-ROM, a flexible disk (FD), a CD-R, a DVD, a USB (Universal Serial). It may be configured to be provided by being recorded in a computer-readable recording medium such as Bus), or may be provided or distributed via a network such as the Internet. Further, various programs may be configured to be provided by being incorporated in advance in a non-volatile storage medium such as a ROM.
  • the surgical device 100 has been described with respect to the case where one bone hole TBH penetrating the femur TB is formed, a plurality of bone holes TBH penetrating the femur TB may be formed.
  • the fixing portion 130 of the surgical device 100 is in contact with the femur TB, but may be in contact with the tibia, the humerus, or the ulna.
  • the contact surface 131 of the fixing portion 130 is formed corresponding to, ie, following the shape of the surface of the tibia, humerus or ulna.
  • the rotation restricting structure RRS of the surgical device 100 is realized based on the shapes of the other end 112 and the insertion hole 132, but is not limited to this. For example, when the tip of the screw 140 is a flat surface and the screw 140 is screwed into the screw hole 133 and comes into contact with the flat surface of the other end 112 when it comes into contact with the other end 112, the rotation restriction structure RRS is realized. You may. Further, when the screw 140 is screwed into the screw hole 133 and comes into contact with the other end 112, the screw 140 comes into contact with the other end 112 while being inserted into the screw insertion hole formed at the other end. Thus, the rotation restriction structure RRS may be realized.
  • model data in the present embodiment corresponds to only the fixed part 130, but is not limited to this, and may correspond to the main body part 110, the drill guide part 120 and the fixed part 130.

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  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (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)
  • Orthopedic Medicine & Surgery (AREA)
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  • Oral & Maxillofacial Surgery (AREA)
  • Robotics (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un dispositif (100) destiné à une chirurgie, qui est pourvu d'une partie de fixation (130) qui positionne un foret (200) destiné à former un trou dans un os, qui pénètre dans un os d'un patient pendant une chirurgie de reconstruction de ligament. La partie de fixation (130) est reliée à une autre partie d'extrémité (112) d'une partie de corps (110). La partie de fixation (130) vient en contact avec l'os de la cuisse et comporte une surface de contact (131) qui est une partie qui correspond à l'os de la cuisse, la partie de fixation (130) pouvant être attachée à la partie de corps (110) et détachée de cette dernière.
PCT/JP2019/048273 2018-12-14 2019-12-10 Dispositif de chirurgie, dispositif de traitement d'informations, système, procédé de traitement d'informations et programme WO2020122063A1 (fr)

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JP2018-234857 2018-12-14
JP2018234857A JP2022031995A (ja) 2018-12-14 2018-12-14 外科手術用デバイス、情報処理装置、システム、情報処理方法、およびプログラム

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2012523897A (ja) * 2009-04-16 2012-10-11 コンフォーミス・インコーポレイテッド 靭帯修復のための患者固有の関節置換術の装置
US20130030442A1 (en) * 2011-07-26 2013-01-31 Howmedica Osteonics Corp. Pcl guides for drilling tibial and femoral tunnels
JP2014525770A (ja) * 2011-06-27 2014-10-02 スミス アンド ネフュー インコーポレーテッド 解剖学的大腿骨ドリルガイド

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2012523897A (ja) * 2009-04-16 2012-10-11 コンフォーミス・インコーポレイテッド 靭帯修復のための患者固有の関節置換術の装置
JP2014525770A (ja) * 2011-06-27 2014-10-02 スミス アンド ネフュー インコーポレーテッド 解剖学的大腿骨ドリルガイド
US20130030442A1 (en) * 2011-07-26 2013-01-31 Howmedica Osteonics Corp. Pcl guides for drilling tibial and femoral tunnels

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