CN106214215A - 用于在髋关节外科手术中确定骨钉放置的方法和装置 - Google Patents

用于在髋关节外科手术中确定骨钉放置的方法和装置 Download PDF

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CN106214215A
CN106214215A CN201610682641.9A CN201610682641A CN106214215A CN 106214215 A CN106214215 A CN 106214215A CN 201610682641 A CN201610682641 A CN 201610682641A CN 106214215 A CN106214215 A CN 106214215A
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M·D·罗伯特·J·戴利
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1742—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1742—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip
    • A61B17/175—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the hip for preparing the femur for hip prosthesis insertion
    • 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
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1664—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the hip
    • A61B17/1666—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the hip for the acetabulum
    • 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
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1664—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the hip
    • A61B17/1668—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the hip for the upper femur
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/564—Methods for bone or joint treatment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/568—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor produced with shape and dimensions specific for an individual patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/108—Computer aided selection or customisation of medical implants or cutting guides

Abstract

针对它们的设计和使用的新的装置和方法得以公开，其可用于帮助外科医生在髋关节手术中放置导向骨钉。具体地，公开了一种髋关节外科手术方法，其中可以获取患者股骨的图像并且用于设计和准备模具，所述模具含有用以在期望位置和角度处对钻孔机进行导向的孔。在外科手术中，可以将模具快速且精确地定位在暴露的股骨头上。然后，可以将钻头插入通过所述孔，以及在股骨头中钻出用于骨钉的开口。模具具有适合在单独位置中装配到股骨头的独特的成形表面，这样在独特的所期望的位置形成开口。所述装置和方法便于更快速、更精确地进行外科手术，以及更小的侵入。

Description

用于在髋关节外科手术中确定骨钉放置的方法和装置
分案申请
本申请为分案申请，原申请的申请号为200880024069.0，申请日为2008年7月10日，发明名称为“用于在髋关节外科手术中确定骨钉放置的方法和装置”。
技术领域
本申请通常涉及用于髋关节外科手术的装置和方法。
背景技术
在对患者髋关节中的股骨头的表面置换（resurfacing）中，用表面置换装置在股骨头上安装新的表面可能需要针对钻孔机的导向件，所述钻孔机安装在患者股骨头/股骨颈的合适轴线上。在进行外科手术之前由外科医生通过分析股骨的X射线图像或其它图像，来确定钻孔导向件的轴线。在植入新的表面装置之前，典型地将股骨头机加工成具有中心轴线的合适形状。由钻孔导向件来确定该轴线。外科手术的成功，很重要一部分是取决于钻孔导向件的位置。已知的，在本领域中精确地定位钻孔导向件的问题由来已久，因此表面置换装置自身随后可以精确地加以装配。
发明内容
针对它们的设计和使用的新的装置和方法得以公开，其可用于帮助外科医生在髋关节手术中更快且更精确地放置导向骨钉。具体地，髋关节外科手术方法得以公开，其中可以获取患者股骨的图像并且将其用于设计和准备模具，所述模具含有用以在期望位置和角度处对钻孔机进行导向的孔。在外科手术中，可以将模具快速且精确地定位在暴露的股骨头上。然后，可以将钻头插入通过所述孔，以及将用于骨钉的开口钻入到股骨头中。模具可具有适合在单独位置中装配到股骨头的唯一的成形表面。所述装置和方法便利了更快速、更精确地外科手术，以及更小的侵入。
附图说明
在此对其它的特征和优点进行描述，并且它们通过随后的具体描述和附图将变得更加清楚。
图1是定位成插入到示例性块状校准模具中的股骨头的透视图；
图2是定位成插入到示例性块状校准模具中的股骨头的另一幅透视图；
图3是定位成插入到示例性块状校准模具中的股骨头的横截面视图；
图4是定位成插入到示例性锥形校准模具中的股骨头的透视图；
图5是用于在髋关节外科手术中确定骨钉放置的示例性方法的流程图。
具体实施方式
公开了一种用于股骨头的模具，其部分地由适于接触股骨头表面的成形表面来限定。模具还限定了可以作为用于钻头的导向件使用的孔，在股骨表面置换过程中，所述钻头可以用于在股骨头中钻出开口来用以容纳骨钉，诸如导向骨钉。
模具可以由任何抗磨损的硬材料制成，其多数都是已知的，在髋关节外科手术中可以用于引导钻头。可以理解的是，合适的材料将能够承受杀菌过程，从而它们可以用于外科手术中并且对外科医生或患者不会产生毒性。合适的材料包括金属和塑料，尤其是热固性塑料。
转向图1和图2，在外科手术之前，使用诸如X-射线机、磁共振成像(MRI)装置、和/或计算机断层成像(CT)扫描器以及类似的扫描器对患者的股骨100进行测量。然后，外科医生可以用图像来确定用于将骨钉插入股骨头的所期望位置和角度。然后，来自扫描器的数据以及外科医生的选择就可以用于创建出装配到股骨头104上的模具102。例如，可以将MRI数据传输至具有软件的公司，所述软件估算出与股骨相关联的临界角和几何结构，以及使用计算机辅助设计/计算机辅助制造(CAD/CAM)系统来生成模具102。在优选方法中，将模具102设计成具有唯一的成形表面106，其适于与股骨头104表面的独特部分紧密配合。在外科手术中，这种设计便利了模具102在股骨头104上的定位，从而孔112能够引导钻头进入到最佳位置中用以放置骨钉。在这样的位置，孔112限定了在股骨头104中的轴线，其基本上是与股骨头104中的同股骨颈114排成一行的轴线相一致的。然后，模具102被装运到医院并且准备用于外科手术。
在一些外科手术过程中，诸如已知的切骨术中，在股骨头104中设置切口也是所期望的。为了便于制作合适的切口，狭槽或导向件116可以被包括在模具102中。狭槽116可以被包括在模具102中，从而使得当将模具102定位在股骨头104上时，该狭槽限定着用于在股骨头104内所作的这种切割的角度、位置和/或深度。
在某些实施例中，模具102可被设计成包含一个或多个用于锚定骨钉108的骨钉放置孔110。然后，可将模具102放置在股骨100上，以及通过骨钉放置孔110将锚定骨钉108插入到股骨头104中以牢固地将模具102固定到股骨头104上，当在外科手术中使用模具102时。
图3示出了与股骨头104接触的模具102并且还示出了与股骨头104的独特轮廓相接触的模具102的唯一成形接触面106。在图3的实施例中可以看出，当固定到股骨头104上时，模具102的孔112基本上可与股骨头104的轴线对准，所述股骨头104的轴线与股骨颈114排成一行。图3还示出了延伸通过骨钉放置孔110并且进入到股骨头104中的骨钉108，以将模具102固定地保持在股骨头104上。
模具102可以具有任何合适的形状，只要孔112能够被精确地定位在股骨头104之上。如图4所示意的，例如，模具102可具有圆锥形状并且仍旧保留用于钻孔导向件和用于锚定骨钉108的孔112，以及用于切骨术的导向狭槽116。本领域任一技术人员可以理解的是，其它形状也是可能的。
还公开了一种髋关节外科手术方法，其中使用诸如X-射线、磁共振成像或其它技术之类的方法来获取患者股骨的图像。然后，将图像用于设计和准备模具，所述模具包含合适尺寸的孔，用以在期望的位置和角度处引导钻孔机。这可以通过使用CAD/CAM设备最便利地实现。用于在髋关节外科手术中确定骨钉放置的示例性方法的流程图在图5中进行了示意。
在外科手术中，在首先暴露患者髋关节和股骨头104之后使用实施例。将模具102定位在股骨头104上。图3示意了如下实施例，其中根据模具102内侧的唯一成形表面106，模具102只可以在单独位置中装配到股骨头104上，所述模具102内侧的唯一成形表面106与股骨头104的独特成形表面相匹配。可将小型锚定骨钉108插入而通过模具102侧部中的骨钉放置孔110，以将模具102固定在合适位置。一旦模具102固定，可将较大的骨钉、钻孔机、和/或导向线插入通过模具102的主孔112并且进入到患者股骨100的头104和/或颈114中。主骨钉(或其它装置)一旦处于合适位置，则可以将模具102优选地移走。
在实施例中，模具102将股骨头104装配到一个位置，通过模具102的主孔112来确定准确的骨钉定位(即骨钉进入到股骨头104的进入点以及骨钉相对于股骨颈114的轴线)。此外，由模具102的主孔112的尺寸可以确定骨钉的尺寸。结果，本技术较之之前的技术更快速、更精确并且更小侵入。
骨钉可以作为用于切割设备的导向件而使用，其用以对股骨头104进行表面置换。可以将表面置换工具的中心孔定位在骨钉上，以及所述工具可被用来移走股骨头104表面的一部分以在股骨头104的周边上形成新表面。可以将股骨头104重新成形为任何形状，其可以接纳着产生新股骨头表面的表面置换装置。合适的形状例如包括圆锥形、锥形或圆锥形。
一旦股骨头104重新成形，表面置换工具可以被移走。骨钉也可以被移走。然后可以将承受新股骨头表面的表面置换装置定位在股骨头104上。表面置换装置可以具有适合于与股骨头104重新成形表面匹配的部分。而且，表面置换装置可以具有适合于装配到股骨头104中心轴线中的开口内的突出骨钉。
在手术过程中，现在外科医生还可以使用狭槽116，当其存在时被用来切开股骨头104(如股骨头的切骨术)以准备股骨头104从而接收股骨头组件。当模具102只装配到股骨头104上一个位置时，可以由模具102的狭槽116精确确定切割的准确定位和角度。可以这样使用狭槽116，即将切割装置定位在狭槽116中以及使用狭槽116作为导向而在股骨中进行切割。
可以理解的是，对在此描述的本优选实施例的各种变化和修改对本领域技术人员来说都是显而易见的。在不偏离本发明的精神和范围以及在没有减少其预计的优点的情况下可以进行这样的变化和修改。由此，这样的变化和修改也将属于所附权利要求书限定的范围内。

Claims (17)

1.一种进行髋关节外科手术的一部分的方法，所述方法包括：
获取表示股骨头形状的数据；
准备好限定出第一孔的模具，基于所获取的数据将所述模具成形为能装配到股骨头上；
将模具定位在股骨头上；
将钻头插入通过第一孔；以及
在股骨头中钻出开口。
2.如权利要求1所述的方法，其还包括将骨钉放置到股骨头中的开口内。
3.如权利要求2所述的方法，其还包括将表面置换工具的中心孔定位在骨钉上，以及将股骨头的表面部分移走以在股骨头的周边上形成新表面。
4.如权利要求3所述的方法，其中所述新表面包括圆柱形表面。
5.如权利要求3所述的方法，其还包括移走表面置换工具和骨钉并且将表面置换装置固定到股骨头上。
6.如权利要求5所述的方法，其中所述表面置换装置具有适合与股骨头的新表面相匹配的部分。
7.如权利要求5所述的方法，其中所述表面置换装置具有适合装配到股骨头中的开口内的突出骨钉。
8.如权利要求1所述的方法，其中所述模具限定用于定位骨钉的第二孔，并且通过所述第二孔将所述定位骨钉放置到股骨头中。
9.如权利要求1所述的方法，其中所述模具限定了用于引导切割装置的狭槽。
10.如权利要求9所述的方法，其还包括将切割装置定位到狭槽中以及使用狭槽作为导向件而在股骨头内进行切割。
11.一种用于在股骨头中确定骨钉放置的装置，所述装置包括：
根据表示股骨头形状的数据形成的模具，所述模具包括用于接触股骨头的成形接触表面，所述模具限定第一孔。
12.如权利要求11所述的装置，其中所述成形接触表面适于在唯一位置装配到股骨头的暴露部分上。
13.如权利要求11所述的装置，其中成形接触表面适于在唯一位置装配到暴露的股骨头上，这样第一孔基本上与股骨头中的轴线对准，所述股骨头中的轴线与股骨颈排成一行。
14.如权利要求11所述的装置，其中所述模具限定用于切割装置的导向件，所述导向件与股骨头对准从而限定用于在股骨头内切割的角度和位置。
15.如权利要求11所述的装置，其还限定用于定位第一骨钉的第二孔，以将模具固定到股骨头上。
16.如权利要求12所述的装置，其还限定用于定位第二骨钉的第三孔，以将模具固定到股骨头上。
17.如权利要求11所述的装置，其中所述模具至少部分由塑料制成。
CN201610682641.9A 2007-07-11 2008-07-10 用于在髋关节外科手术中确定骨钉放置的方法和装置 Pending CN106214215A (zh)

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