Surgical Cutting Guide

• US 20080275452A1
• Filed: 06/13/2008
• Published: 11/06/2008
• Est. Priority Date: 05/25/2001
• Status: Active Grant

• Current Assignee: Conformis Incorporated
• Original Assignee: Conformis Incorporated
• Inventors: Lang, Philipp, Steines, Daniel, Bojarski, Raymond A., Fitz, Wolfgang
• Granted Patent: US 8,951,260 B2
• Time in Patent Office: Days
• US Class Current: 606/88
• CPC Class Codes: A61B 17/15 Guides therefor arrangements for guiding straight saw blades in general B23D51/025
• CPC Class Codes: A61B 17/157 Cutting tibia
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 2017/00526 Methods of manufacturing
• CPC Class Codes: A61B 2090/033 Abutting means, stops, e.g. abutting on tissue or skin
• CPC Class Codes: A61B 2090/034 abutting on parts of the device itself
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 5/103 Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes A61B5/08 takes precedence; measuring aids for tailors A41H1/00; measuring instruments specially adapted for dentistry A61C19/04
• CPC Class Codes: A61B 5/4528 Joints A61B5/4533, A61B5/4538 take precedence

Abstract

The present invention is directed to a surgical cutting guide for guiding a surgical instrument along a cutting path located on a biological tissue. The surgical guide includes a contact surface that conforms to a surface associated with the tissue and at least one guide for restricting movement of a surgical instrument in a first direction and for allowing the movement of the surgical instrument in a second direction along a cutting path across the surface of the tissue. The guide further contains a stop for restricting movement of the surgical instrument in the second direction along the cutting path. The stop is based at least, in part, on patient specific information.

Claims

1. A surgical cutting guide for guiding a surgical instrument along a cutting path located on a biological tissue, the cutting guide comprising:

a contact surface that conforms to a surface associated with the tissue;

at least one guide for restricting movement of a surgical instrument in a first direction and for allowing the movement of the surgical instrument in a second direction along a cutting path across the surface of the tissue; and

a stop for restricting movement of the surgical instrument in the second direction along the cutting path, wherein the stop is based at least, in part, on patient specific information.

2. A surgical cutting guide according to claim 1, wherein the guide is a configured to abut the tissue and the abutment of the guide and tissue defines at least part of the cutting path of the surgical instrument.

3. A surgical cutting guide according to claim 1, wherein the stop is configured to abut the tissue.

4. A surgical cutting guide according to claim 1, wherein the stop is configured to contact a cutting surface of the surgical instrument.

5. A surgical guide according to claim 1, wherein at least a portion of the contact surface is a mirror image of an uncut surface of the tissue.

6. A surgical cutting guide according to claim 1, wherein the biological tissue is one of a joint, an articular surface, a spine, a structure adjacent to one of a joint, an articular surface, and a spine.

7. A surgical cutting guide according to claim 1, wherein the contact surface is based at least, in part, on patient specific information.

8. A surgical cutting guide according to claim 1, wherein the patient specific information is based at least, in part, on intra-operative measurement of the tissue.

9. A surgical cutting guide according to claim 1, wherein the patient specific information is based on an image of the tissue.

10. A surgical cutting guide according to claim 9, wherein the image is one of a CT image, a spiral CT image, an MRI image, an ultrasound image, a digital tomosynthesis image, and an optical coherence tomograph.

11. A surgical cutting guide according to claim 1, wherein the guide is one of a slot, an aperture, and a cutting plane.

12. A surgical cutting guide according to claim 1, wherein one of a placement, location, orientation, and shape of the stop is based at least, in part, on patient specific information.

13. A surgical cutting guide according to claim 1, wherein the stop protects at least one of a ligament, a vessel, a nerve, a muscle, a bony structure, and a cartilaginous structure.

14. A surgical cutting guide according to claim 1, wherein the stop protects tibial spines.

15. A surgical cutting guide according to claim 14, wherein the at least one guide guides movement of the surgical instrument towards the tibial spines and wherein the stop prevents the surgical instrument from cutting the tibial spines.

16. A surgical cutting guide according to claim 1, wherein the surgical instrument is one of a blade or a saw.

17. A surgical cutting guide according to claim 1 for use in one of a knee, a hip, an ankle, a foot, a shoulder, an elbow, a wrist, a hand, a spine, a vertebral endplate, a skull, a pedicle, a posterior element, and a spinous process.

18. A surgical cutting guide according to claim 1, wherein the contact surface has a plurality of concavities and a plurality of convexities.

19. A surgical cutting guide according to claim 1, wherein the stop is perpendicular to a cut plane defined by the at least one guide.

20. A method for guiding a surgical instrument, the method comprising:

providing a surgical cutting guide having a contact surface that conforms to a surface associated with a tissue and at least one guide for restricting movement of a surgical instrument in a first direction and for allowing the movement of the surgical instrument in a second direction along the cutting path across the surface of the tissue, wherein providing the surgical guide includes;

ascertaining patient specific information associated with the tissue; and

incorporating a stop into the guide for restricting movement of the surgical instrument in the second direction along the cutting path, wherein the stop is based at least, in part, on patient specific information.

21. A method according to claim 20, further comprising securing the cutting guide to the tissue.

23. A method according to claim 20, further comprising configuring the at least one guide to abut the surface of the tissue.

24. A method according to claim 20, further comprising configuring the stop to abut the surface of the tissue.

26. A method according to claim 20, further comprising configuring the contact surface so that at least a portion of the contact surface is a mirror image of an uncut surface of the tissue.

27. A method according to claim 20, wherein the tissue is one of a joint, an articular surface, a spine, and a structure adjacent to one of a joint, an articular surface, and a spine.

28. A method according to claim 20, further comprising configuring the contact surface, based at least, in part, on patient specific information.

29. A method according to claim 20, further comprising configuring one of a placement, location, orientation, and shape of the stop based at least, in part, on patient specific information.

30. A method according to claim 20, further comprising intra-operative measuring of the tissue in order to ascertain patient specific information.

31. A method according to claim 20, further comprising imaging the tissue in order to ascertain patient specific information.

32. A method according to claim 31, wherein the imaging is one of CT imaging, CT spiral imaging, MRI imaging, ultrasound imaging, digital tomosynthesis, and optical coherence tomography.

33. A method according to claim 20, further comprising configuring the guide into one of a slot, an aperture, and a cutting plane.

35. A method according to claim 20 for use in one of a knee, a hip, an ankle, a foot, a shoulder, an elbow, a wrist, a hand, a spine, a vertebral endplate, a skull, a pedicle, a posterior element, and a spinous process.

36. A method according to claim 20, further comprising configuring the contact surface with a plurality of concavities and a plurality of convexities.

37. A method according to claim 20, further comprising configuring the stop to be perpendicular to a cut plane defined by the at least one guide.

38. A method according to claim 20, the cutting guide is secured to the tissue using anchoring screws.

22. A method according to claim 22, further comprising cutting the tissue by using the cutting guide to guide the surgical instrument along the cutting path.

25. A method according to claim 22, further comprising cutting the tissue so that a cutting surface of the surgical instrument contacts the stop.

34. A method according to claim 22, further comprising using one of a blade and a saw to cut the tissue.

39. A surgical cutting guide comprising:

a surface that is a mirror image of at least one of a joint, an articular surface, a spine, and a structure adjacent to one of a joint, an articular surface, and a spine;

at least one of a guide and a guide aperture for directing movement of a surgical instrument along a predetermined path; and

a stop that prevents the surgical instrument from deviating from the predetermined path, wherein location of the stop is based at least, in part, on patient specific information.

40. A surgical tool comprising:

a portion that is a mirror image of at least one of a joint, an articular surface, a spine, and a structure adjacent to one of a joint, an articular surface, and a spine;

at least one of a guide and a guide aperture for directing movement of a surgical instrument along a predetermined path; and

a stop for inhibiting the surgical instrument from deviating from the predetermined path.

41. A surgical tool for a knee joint, the surgical tool comprising:

a portion that is a mirror image of one of a joint, an articular surface, a spine, and a structure adjacent to a joint, an articular surface, or a spine;

at least one of a guide and a guide aperture for directing movement of a surgical instrument along a predetermined path; and

a stop that prevents the surgical instrument from deviating from the predetermined path, wherein the stop protects a tibial spine.

42. The surgical tool of claim 41, wherein the surgical tool is used for a total knee arthroplasty.

43. The surgical tool of claim 41, wherein the surgical tool is used for a partial knee arthroplasty.

44. The surgical tool according to claim 41, wherein the position of the stop is based at least, in part, on patient specific information.

45. A cutting guide comprising:

a portion that is a mirror image of one of a joint, an articular surface, a spine, and a structure adjacent to a joint, an articular surface, or a spine;

at least one of a guide and a guide aperture for directing movement of a surgical instrument along a predetermined path; and

a stop that prevents a surgical instrument from deviating from the predetermined path, wherein the stop protects at least one of a ligament, a vessel, a nerve, a muscle, a bony structure, and a cartilaginous structure.

46. The cutting guide of claim 45, wherein the surgical tool is used for a total knee arthroplasty.

47. The cutting guide of claim 45, wherein the surgical tool is used for a partial knee arthroplasty.

48. A cutting guide comprising:

a portion that is a mirror image of at least one of a joint, an articular surface, a spine, and a structure adjacent to one of a joint, an articular surface, and a spine;

at least one of a guide and a guide aperture for directing movement of a surgical instrument along a predetermined path; and

a stop for preventing the surgical instrument from deviating from the predetermined path, wherein the stop is integrated into the cutting guide.

49. A cutting guide comprising:

a portion that is a mirror image of at least one of a joint, an articular surface, a spine, and a structure adjacent to one of a joint, an articular surface, and a spine;

at least one of a guide and a guide aperture for directing movement of a surgical instrument along a predetermined path; and

a stop for preventing the surgical instrument from deviating from the predetermined path, wherein the stop is attached to the cutting guide.

50. The cutting guide according to claim 49, wherein the attachment is via a block.

51. The cutting guide according to claim 49, wherein the attachment of the stop is via a linkage.

52. A cutting guide comprising:

a portion that is a mirror image of at least one of a joint, an articular surface, a spine, and a structure adjacent to one of a joint, an articular surface, and a spine;

at least one of a guide and a guide aperture for directing movement of a surgical instrument along a predetermined path;

a stop for preventing the surgical instrument from deviating from the predetermined path, wherein one of a position or orientation or shape of the stop is derived using patient specific information.

53. The cutting guide according to claim 52, wherein one of a position or orientation or shape of the stop allows for intra-operative adjustments.

54. A surgical tool comprising:

a template that includes at least one guide for directing movement of a surgical instrument along a predetermined path; and

at least one insert attached to the at least one of a guide and a guide aperture, the at least one insert for protecting the template from the surgical instrument.

55. The surgical tool according to claim 54, wherein the template is made of plastic, and wherein the insert is made of metal.

56. The surgical tool according to claim 54, wherein the template includes a mold.

57. The surgical tool according to claim 54, wherein the template is a rapid prototype.

58. The surgical tool according to claim 54, wherein the insert is removably attached to the template.

59. The surgical tool according to claim 54, wherein the insert snaps onto the template.

60. A surgical cutting guide comprising:

a surface that is a mirror image of at least one of a joint, an articular surface, a spine, and a structure adjacent to one of a joint, an articular surface, and a spine;

at least one of a guide and a guide aperture for directing movement of a surgical instrument along a predetermined path, wherein the position or shape or orientation of the at least one of a guide and a guide aperture is based on patient specific information and provides for at least one of a predetermined cut angulation and a predetermined cut height.

61. The surgical tool according to claim 60, further including a stop for inhibiting the surgical instrument from deviating from the predetermined path.

62. The surgical tool according to claim 60, wherein the position of the stop is based at least, in part, on patient specific information.

63. A surgical cutting guide comprising:

a surface that is a mirror image of at least one of a joint, an articular surface, a spine, and a structure adjacent to one of a joint, an articular surface, and a spine;

at least one of a guide and a guide aperture for directing movement of a surgical instrument along a predetermined path; and

a stop that prevents the surgical instrument from deviating from the predetermined path, wherein at least one of the shape, location, and orientation of the stop is based at least, in part, on an image that includes a tissue structure to be preserved, such that the stop prevents the surgical from damaging the tissue structure.

64. A surgical cutting guide for guiding a surgical instrument along a cutting path located on a biological tissue, the cutting guide comprising:

a contact surface that conforms to a surface associated with the tissue;

at least one guide for restricting movement of a surgical instrument in a first direction and for allowing the movement of the surgical instrument in a fifth direction along a cutting path into the tissue; and

a stop for restricting movement of the surgical instrument in a second direction, wherein the stop is based at least, in part, on patient specific information.

65. A method for guiding a surgical instrument, the method comprising:

providing a surgical cutting guide having a contact surface that conforms to a surface associated with a tissue and at least one guide for restricting movement of a surgical instrument in a first direction and for allowing the movement of the surgical instrument in a fifth direction along the cutting path into the tissue, wherein providing the surgical guide includes;

ascertaining patient specific information associated with the tissue; and

incorporating a stop into the guide for restricting movement of the surgical instrument in the second direction, wherein the stop is based at least, in part, on patient specific information.