WO2022124851A1 - Procédé et appareil de simulation d'arthroplastie totale pour articulations de la hanche - Google Patents

Procédé et appareil de simulation d'arthroplastie totale pour articulations de la hanche Download PDF

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Publication number
WO2022124851A1
WO2022124851A1 PCT/KR2021/018756 KR2021018756W WO2022124851A1 WO 2022124851 A1 WO2022124851 A1 WO 2022124851A1 KR 2021018756 W KR2021018756 W KR 2021018756W WO 2022124851 A1 WO2022124851 A1 WO 2022124851A1
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WIPO (PCT)
Prior art keywords
unit
error
stem
acetabular cup
size
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PCT/KR2021/018756
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English (en)
Korean (ko)
Inventor
채동식
강경일
박성준
Original Assignee
가톨릭관동대학교산학협력단
한국교통대학교산학협력단
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Publication of WO2022124851A1 publication Critical patent/WO2022124851A1/fr

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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
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/32—Joints for the hip
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations 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
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/102—Modelling of surgical devices, implants or prosthesis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/105—Modelling of the patient, e.g. for ligaments or bones
    • 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
    • A61B2034/108—Computer aided selection or customisation of medical implants or cutting guides
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4632—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor using computer-controlled surgery, e.g. robotic surgery
    • A61F2002/4633—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor using computer-controlled surgery, e.g. robotic surgery for selection of endoprosthetic joints or for pre-operative planning

Definitions

  • the present invention relates to a method and apparatus for simulating total hip arthroplasty, and more particularly, to a method and apparatus capable of assisting in determining the physical size and position of an implant to be inserted in total hip arthroplasty.
  • the hip joint implant shown in FIGS. 1 and 2 may be used for hip replacement surgery.
  • the hip joint implant includes a head 110 , a stem 120 , and a neck 123 , and the acetabular cup 150 is fixed to the pelvic joint bone.
  • the head 110 is accommodated in the shell 155 with a liner interposed therebetween and rotates within a predetermined angle to replace the hip joint.
  • the total hip arthroplasty is performed accordingly.
  • the size of the cap can be determined using the template of FIG. 3, and the position of the cap of the corresponding size can be determined on the x-ray photograph.
  • the size of the stem, the neck, and the head can be determined using the templates of FIGS. 4 and 5, etc. Determine the offset and the rotation center of the joint.
  • the present invention is to break away from the method of determining the size and angle of a femur insert while randomly or sequentially overlapping femur templates provided for each two-dimensional (planar) size.
  • Provided are a method and a device according to which data can be selected by providing data on implants of suitable physical specifications.
  • the present invention provides a method and apparatus for predicting the result after surgery in order to provide information on an implant to be selected or through a simulation result by an implant of a selected standard and location.
  • the present invention provides a simulation method and apparatus capable of quickly taking follow-up measures in response to errors that may occur during a surgical procedure.
  • the apparatus for simulating total hip arthroplasty includes: a photographing unit that takes an X-ray photograph of a patient; an image processing unit for storing the photo data taken by the photo taking unit as a first layer, extracting a femur image corresponding to the affected part from the first layer, and dividing the image into a second layer; Using the image data captured by the photographing unit, the patient's abnormal state is analyzed from the physical dimensions and angles of the affected hip joint and the normal hip joint, and motions such as physical dimensions and range of motion predicted from the normal hip joint state an image analysis unit for identifying characteristics; and a template recommendation unit selected by providing images according to a plurality of standards of implants to be inserted into the affected hip joint to the doctor in charge of the patient.
  • It may also include; a simulation unit that calculates joint characteristics and motion characteristics according to physical size and angle by simulating the post-operative state of the affected area according to the specifications of the acetabular cup, head and stem selected through the template recommendation unit.
  • the simulation unit, the joint characteristics and movement characteristics of the affected part may be evaluated by comparing the joint characteristics and movement characteristics of the normal side.
  • an error response prediction unit that provides data on the type of error that can occur when surgery is performed according to the physical size and location of the implant selected through the template recommendation unit and the standard variation data according to the type of error value; includes; can do.
  • the standard variation value data may be a data table including a plurality of data pairs of variation values corresponding to error values.
  • the error type may be at least one of a stem size error, a stem insertion depth error, an acetabular cup inner insertion depth error, an acetabular cup size error, and an acetabular cup insertion angle error.
  • the corresponding value according to the type of error may be a variation value of at least one of a receiving groove depth in the head of the implant, an offset of the implant, a stem length of the implant, and a stem size of the implant.
  • the template recommendation unit may provide an acetabular cup image of the implant according to a plurality of standards to determine the size of the acetabular cup, the positioning of the acetabular cup, and the rotational center of the acetabular cup on the third layer from the doctor.
  • the template recommendation unit may mark the rotation center of the acetabular cup determined by the doctor.
  • the template recommendation unit provides the head and stem images of the implant according to a plurality of standards, so that the size, position and receiving groove depth of the head and the offset, length and size of the stem can be selected from the doctor on the fourth layer. have.
  • the template recommendation unit may be positioned so that the rotational center of the acetabular cup coincides with the rotational center of the head.
  • an X-ray photograph suitable for a surgeon who operates by breaking away from the method of determining the size and angle of a femoral implant while randomly or sequentially overlapping the existing two-dimensional (planar) size-specific femur templates
  • comparison of the surgical result can be performed in various ways.
  • the present invention can prevent delays during surgery by promptly taking follow-up measures in response to errors that may occur during the surgical procedure.
  • FIG. 1 and 2 are photographs showing an example of an implant used in total hip arthroplasty.
  • 3 to 5 are photographs illustrating a template for selecting an acetabular cup and a stem according to an exemplary embodiment.
  • FIG. 6 is a block diagram illustrating an apparatus for simulating total hip arthroplasty according to an embodiment.
  • FIG. 7 is a schematic diagram for explaining a physical specification of a stem according to an embodiment.
  • FIG. 8 is a flowchart illustrating a method for simulating total hip arthroplasty according to an embodiment.
  • 10 to 11 are images illustrating a process of selecting an implant by using each layer.
  • the apparatus for simulating total hip arthroplasty includes: a photographing unit that takes an X-ray photograph of a patient; an image processing unit for storing the photo data taken by the photo taking unit as a first layer, extracting a femur image corresponding to the affected part from the first layer, and dividing the image into a second layer; Using the image data captured by the photographing unit, the patient's abnormal state is analyzed from the physical dimensions and angles of the affected hip joint and the normal hip joint, and motions such as physical dimensions and range of motion predicted from the normal hip joint state an image analysis unit for identifying characteristics; and a template recommendation unit selected by providing images according to a plurality of standards of implants to be inserted into the affected hip joint to the doctor in charge of the patient.
  • FIGS. 6 and 7 A total hip arthroplasty simulation apparatus 200 according to an embodiment will be described with reference to FIGS. 6 and 7 .
  • 6 is a block diagram illustrating an apparatus for simulating total hip arthroplasty according to an embodiment
  • FIG. 7 is a schematic diagram for explaining the specifications of an artificial joint implant.
  • the artificial joint simulation apparatus 200 includes a photo capturing unit 210 , an image processing unit 220 , an image analysis unit 230 , a simulation unit 240 , and an error response prediction unit 250 .
  • the photographic unit 210 obtains basic data by taking an MRI or CT photograph, including an X-ray photograph including a pelvic bone and a femur, for a specific patient.
  • the photo taking unit 210 allows to calculate the length between specific points in the photographed image by using the photographing by placing markers at regular intervals.
  • the image processing unit 220 stores the photographed photo data as a first layer, extracts an image of the femur therefrom, and divides the image into a separate layer, that is, a second layer.
  • the image analysis unit 230 calculates the angle of commitment from the physical dimensions and angles of the normal affected hip joint and the contralateral hip joint, such as the femur head, the acetabulum, and the femoral neck, using the image data captured by the photographing unit 210, valgus Analyze the patient's condition, such as high and varus elevation, and identify motion characteristics such as physical dimensions and range of motion predicted from the normal hip joint condition.
  • the template recommendation unit 240 displays an acetabular cup image on the third layer that can be layered in various sizes to determine the acetabular cup size, positioning, and head depth (center of rotation) so that the doctor can select it. let it be Also, the template recommendation unit 240 may provide a head and stem image for selecting a head and a stem on the fourth layer.
  • the template recommendation unit 240 can provide data by simply removing from the list the acetabular cup, head, and stem of unapplicable sizes from the data analyzed by the image analysis unit 230 and displaying it, and more actively A method of recommending implant components of an appropriate standard analyzed from the image is also possible. Finally, by applying the images from the presented list to the corresponding layers in turn, the doctor selects the acetabular cup, head, and stem of the appropriate size, and selects the location of the corresponding configuration.
  • the simulation unit 250 predicts the joint characteristics of the post-operatively affected area through the specifications of the acetabular cup, head, and stem finally selected through the template recommendation unit 240, and uses the predicted post-operative state image. Simulations such as comparison of leg lengths and comparison of conditions with the normal side are performed, and the results are displayed to the doctor. At this time, it is also possible to display the expected problems with respect to the physical movement state.
  • the simulation unit 250 may perform a simulation for each standard of the acetabular cup, head, and stem to be recommended through the template recommendation unit 240 and present the results together with a recommendation list. That is, the simulation unit 250 may provide a result value to the doctor by simulating the implant before and after determining the size and position for surgery.
  • the simulation results for each case may be displayed together, and the suitability of the selected standards and positions in the simulation may be evaluated.
  • the error response prediction unit 260 provides a database of errors that may actually occur when surgery is performed according to the selected physical standard and location. It provides data so that doctors can respond quickly without having to leave the operating room and go through separate calculations and tasks.
  • the types of errors that can occur and corresponding figures according to changes in the corresponding physical specifications are provided in advance, in addition to the implants of the determined physical specifications, the surgery is performed in response to the errors quickly by preparing the implants of the preliminary specifications in advance and performing the operation. can make it go ahead. That is, the type of error, a list of possible standard changes for that type of error, the amount of change in motion characteristics for each list item, or comparison data between the changed motion characteristics and the normal motion characteristics analysis value are presented to promptly respond to the error and perform surgery. make it possible to proceed
  • the stem goes into the femur by 1 mm less or more, an error has occurred compared to the planned situation.
  • an ad hoc response was taken, such as leaving the operating room, recalculating it, replacing it with a stem or head of a standard suitable for the calculated items, and resuming the operation in the operating room, or inserting a stem by grinding bones with the eye.
  • the error response prediction unit 260 in preparation for possible errors, the stem and head specifications according to the follow-up measures are presented in the form of a list for each data in advance so that the error can be quickly responded to.
  • the error response predicting unit 260 provides a data set or data table with a classification for each type of generated error, a changed countermeasure according to the error size, and the corresponding standard of the stem and head, thereby eliminating the need for separate calculation.
  • the size determined before surgery can be changed simply by inserting a stem of a different size and selecting an appropriate one.
  • the stem size before surgery was determined to be 3 and applied in the actual operation. If there is room for the bone inside the proximal femur where the implant is inserted, increase the size and apply the size lower.
  • the depth of the receiving groove of the head change the depth of the receiving groove of the head or change the offset of the stem.
  • the stem goes in less and sometimes more.
  • adjust the depth of the receiving groove of the head to match the length of the leg (almost similar to the opposite leg). If the leg is longer than the normal side, select the one with a deep head and insert the stem to expose the neck relatively short. If the leg is shorter than the normal side, select the one with the deep head.
  • the stem length (A), the offset (B), the leg adjustment length (C), has the characteristics of the main physical specifications such as the neck length (D).
  • the configuration inserted into the thigh of the stem and the distance to the head correspond to the stem length (A) and the leg adjustment length (C).
  • the rotation center is changed and the offset is also changed.
  • the leg length adjustment and the maintenance of stability can be maximized. can do.
  • the depth of the head receiving groove or the offset of the stem is changed, or the length of the stem is adjusted.
  • the center of rotation may move toward the acetabulum and the length of the leg may be shortened.
  • the length of the legs is adjusted by selecting the shallow depth of the receiving groove of the head so that the neck is exposed relatively long from the head.
  • the leg length can be lengthened on the contrary.
  • the offset may increase or decrease due to a change in the leg adjustment length C, data can be provided to ensure maximum stability along with the adjustment of the leg length through adjustment of these values.
  • the size of the acetabular cup is re-determined in consideration of the degree of exposure or burial of the contact surface of the acetabular cup and the acetabulum and the upper end.
  • the angle of the acetabular cup is such that the lower surface of the hemisphere (receiving side of the head) forms an angle of 45 to 50 degrees with respect to the central axis of the body.
  • the leg length is different than expected, but also various deformations of the leg may occur due to the change of the angle of focus. Even in this case, it is possible to evaluate the balance, stability, and movement characteristics after surgery through simulation and provide the appropriate change standard in the form of a data table to the doctor in the form of a data table, etc.
  • FIGS. 8 to 11 A method of simulating total hip arthroplasty according to an embodiment will be described with reference to FIGS. 8 to 11 .
  • 8 is a flowchart illustrating a method for simulating total hip arthroplasty according to an embodiment
  • FIGS. 10 to 11 are images illustrating a process of selecting an implant using each layer.
  • a first layer After taking an X-ray picture, it is prepared as a first layer, and the femur is recognized from the X-ray picture and separated into a second layer (S100). At this time, an X-ray picture is taken in an anatomical position, and a marker at a predetermined interval (eg, 10 cm) is placed and taken during imaging, and the size of the implant and calibration can be performed using this.
  • a marker at a predetermined interval eg, 10 cm
  • the acetabular cup size, positioning, and head depth (rotation center) are determined on the third layer (S200).
  • images of the acetabular cup are provided on the third layer for various sizes so that the size and position of the acetabular cup can be determined.
  • the appropriate size of the acetabular cup and the position of the rotation center of the artificial joint are determined in consideration of the femoral antevesion on the first layer.
  • the size is determined by referring to the internal margin, and the rotation center may be marked on the third layer in consideration of the optimal position and bone contact.
  • the determined center of rotation is involved in determining the depth of the stem receiving groove of the head.
  • a head and a stem are selected on the fourth layer (S300).
  • the insertion size, offset, and head depth of the implant head (ball) are determined. Since the head is provided for each depth of the receiving groove for accommodating the stem (especially the neck), the length of the neck exposed from the head is changed when the depth of the receiving groove is changed, and accordingly, the position of the rotation center of the stem is changed.
  • the stem is selected. Choose a stem size suitable for the proximal femur and equal to the length of the leg. Stem images are available with standard offset or high offset options for all stem sizes. Match the cup's center of rotation to the desired center of rotation to determine the option to restore the appropriate offset.
  • a simulation is performed with respect to the dimensions and positions of the selected acetabular cup, head, and stem (S400).
  • the simulation can also be performed for a plurality of selections, and even when data of implant components for a plurality of standards and positions are provided to a doctor for selection, data for comparative analysis can be obtained through this. can be provided together.
  • a method of calculating the leg length difference by comparing the vertical lengths from the lower ends of both sides of the pelvis to the greater or lesser trochanter of the femur may be considered.

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

Abstract

Un appareil de simulation d'arthroplastie totale pour articulations de la hanche, selon la présente invention, comprend : une unité de capture d'images qui capture des images radiologiques d'un patient ; une unité de traitement d'images qui stocke, en tant que première couche, les données d'images obtenues à partir des images capturées par l'unité de capture d'images, extrait de la première couche une image du fémur correspondant à une partie touchée, et divise l'image du fémur en une seconde couche ; une unité d'analyse d'images qui analyse l'état anormal du patient à partir des dimensions physiques et des angles d'une articulation de la hanche sur le côté touché et d'une articulation de la hanche normale à l'aide des données d'images obtenues à partir des images capturées par l'unité de capture d'images, et identifie des caractéristiques de mouvement telles que des dimensions physiques et une amplitude de mouvement prédite à partir de l'état de l'articulation de la hanche normale ; et une unité de recommandation de modèle qui fournit à un médecin responsable du patient des images selon une pluralité de normes d'un implant à insérer dans l'articulation de la hanche sur le côté touché, et reçoit une sélection.
PCT/KR2021/018756 2020-12-11 2021-12-10 Procédé et appareil de simulation d'arthroplastie totale pour articulations de la hanche WO2022124851A1 (fr)

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KR1020200173531A KR102467242B1 (ko) 2020-12-11 2020-12-11 고관절 인공관절 전치환술 시뮬레이션 방법 및 장치

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US20150257846A1 (en) * 2013-02-18 2015-09-17 Orthogrid Systems, Inc. Alignment plate apparatus and system and method of use
KR101696842B1 (ko) * 2015-09-24 2017-01-17 서강대학교산학협력단 고관절 전치환술을 위한 인공기관의 넥 설계방법 및 상기 설계방법에 의해서 제작되는 인공기관
JP6492075B2 (ja) * 2013-07-25 2019-03-27 スミス アンド ネフュー インコーポレイテッド 骨の病理学的変形を治療するために外科的切除計画を作成する方法
US20200214843A1 (en) * 2013-03-15 2020-07-09 Conformis, Inc. Kinematic and Parameterized Modeling for Patient-Adapted Implants, Tools, and Surgical Procedures
JP2020535925A (ja) * 2017-10-06 2020-12-10 インテリジョイント サージカル インク． 人工股関節全置換術の術前計画システムおよび方法

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Publication number Priority date Publication date Assignee Title
JP6253990B2 (ja) * 2011-02-25 2017-12-27 コリン リミテッドＣｏｒｉｎ Ｌｉｍｉｔｅｄ 患者の関節用の整形外科インプラントの位置合わせのための位置合わせ情報データを提供するコンピュータ実行方法、コンピュータ装置、およびコンピュータ読み取り可能な記録媒体

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20150257846A1 (en) * 2013-02-18 2015-09-17 Orthogrid Systems, Inc. Alignment plate apparatus and system and method of use
US20200214843A1 (en) * 2013-03-15 2020-07-09 Conformis, Inc. Kinematic and Parameterized Modeling for Patient-Adapted Implants, Tools, and Surgical Procedures
JP6492075B2 (ja) * 2013-07-25 2019-03-27 スミス アンド ネフュー インコーポレイテッド 骨の病理学的変形を治療するために外科的切除計画を作成する方法
KR101696842B1 (ko) * 2015-09-24 2017-01-17 서강대학교산학협력단 고관절 전치환술을 위한 인공기관의 넥 설계방법 및 상기 설계방법에 의해서 제작되는 인공기관
JP2020535925A (ja) * 2017-10-06 2020-12-10 インテリジョイント サージカル インク． 人工股関節全置換術の術前計画システムおよび方法

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