DEVICE FOR MANIPULATING A BONE OR BONE FRAGMENT OR A SURGICAL INSTRUMENT, TOOL OR IMPLANT AND A METHOD FOR POSITIONING SUCH A DEVICE

• US 20110166447A1
• Filed: 09/02/2009
• Published: 07/07/2011
• Est. Priority Date: 09/03/2008
• Status: Active Grant

• Current Assignee: Synthes GmbH (Johnson & Johnson)
• Original Assignee: AO Technology AG (Johnson & Johnson)
• Inventors: Noetzli, Christoph Martin, Windolf, Markus
• Granted Patent: US 9,119,641 B2
• Time in Patent Office: Days
• US Class Current: 600/426
• CPC Class Codes: A61B 17/17 Guides or aligning means for drills , mills, pins or wires
• CPC Class Codes: A61B 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/1725 for applying transverse screws or pins through intramedullary nails or pins
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 17/8866 for gripping or pushing bones, e.g. approximators joint distractors A61B17/025
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/3966 Radiopaque markers visible in an X-ray image
• CPC Class Codes: A61B 90/10 for stereotaxic surgery, e.g. frame-based stereotaxis
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: G01B 5/0002 Arrangements for supporting, fixing or guiding the measuring instrument or the object to be measured

Abstract

A device and a method for surgically manipulating a bone or bone fragment or a surgical instrument, tool or implant. Said device comprising: A) a rod shaped member (2) with a central axis (6), a rear end (3), a front end (4) and a length L2; B) a first targeting element (7) fixed to said rod shaped member (2) coaxially to said central axis (6) and having a first center (46), wherein said first targeting element (7) is arranged on said rod shaped member (2) with said first centre (46) at a distance A1>0 from said rear end (3); C) a second targeting element (5) with a second center (45), wherein—said second targeting element (5) is fixed to said rod shaped member (2) coaxially to said central axis (6) with said second centre (45) at a distance A2<A1 from said rear end (3); or—said second targeting element (5) is joinable to a surgical instrument or tool which is displaceable parallel to said central axis (6) with respect to said rod shaped member (2) so that said second targeting element (5) remains coaxial to said central axis (6); and wherein D) said first targeting element (7) has a diameter DK measured orthogonal to said central axis (6) of minimum 10 mm.

Claims

1. A device for manipulating a bone or bone fragment or a surgical instrument, tool or implant comprising:

A) a rod shaped member with a central axis, a rear end, a front end and a length L2;

B) a radiopaque first targeting element fixed to said rod shaped member coaxially to said central axis and having a first center, wherein said first targeting element is arranged on said rod shaped member with said first center at a distance A1>

0 from said rear end;

C) a radiopaque second targeting element with a second center, wherein said second targeting element is fixed to said rod shaped member coaxially to said central axis with said second center at a distance A2<

A1 from said rear end;

wherein

D) said first targeting element has a diameter D_K measured orthogonal to said central axis of minimum 10 mm;

E) said second targeting element has an annular form with a circular central line with a diameter D_R>

D_K and lying in a plane perpendicular to said central axis said second targeting element being arranged in such manner that its circular central line is concentrical to said central axis; and

wherein

F) said second targeting element is fixedly attached to said rod shaped member by radiolucent means.

2. The device according to claim 1, wherein said first targeting element has the form of a sphere or a disc or a ring.

3. The device according to claim 2, wherein the cross-sectional area orthogonal to said central axis and containing said first center of said sphere, disc or ring has a circular periphery with said diameter D_K.

4. The device according to claim 1, wherein at least one of said first and second targeting elements has a spherical portion with a radius of curvature R1 directed towards said rear end of said rod shaped member and directed towards said front end a front portion with a radius of curvature R2 which is equal or greater than R1.

5. The device according to claim 1, wherein said device is an aiming device for guiding an instrument, tool or implant with respect to a three-dimensional body and wherein said rod shaped member is a tubular member with an external diameter D_t and a central through bore for guiding an instrument, tool or implant.

6. The device according to claim 1, wherein at least one of said first and second targeting elements has an annular form with a circular central line with a diameter D_R>

D_K and lying in a plane perpendicular to said central axis;

said second targeting element being arranged in such manner that its circular central line is concentrical to said central axis.

7. The device according to claim 1, wherein said device comprises at least two cylindrical or prismatical targets which are arranged parallel to each other and at an identical distance A_Target from said central axis of said rod shaped member.

8. The device according to claim 1, wherein said second targeting element comprises a radiolucent means.

9. A method for positioning the device according to claim 1 in a desired position with respect to a three-dimensional body after having determined the position of at least one cylindrical or prismatical target in said three-dimensional body, wherein said target has a different density than the surrounding material of said three-dimensional body, a longitudinal axis, a height h and a center;

said method comprising the steps of;

a) acquiring one single image by means of an image acquisition device with a projection of said target into a projection plane of said image acquisition device; and

b) determining the position and angular orientation of said target with respect to a global system of coordinates fixed to said image acquisition device by means of a numerical procedure using said single image and by using a computer with a display;

c) establishing a virtual geometrical representation of the device in the desired position with respect to said target or three-dimensional body by means of said computer;

d) depicting a first target curve on said display by means of said computer;

wherein said first target curve represents a virtual projection of said first targeting element of said virtual geometrical representation of said device on said projection plane;

e) depicting a second target curve on said display by means of said computer;

wherein said second target curve represents a virtual projection of said second targeting element of said virtual geometrical representation of said device on said projection plane;

f) positioning said device by aligning said first targeting element with said first target curve and by aligning said second targeting element with said second target curve using an image acquisition device.

10. The method according to claim 9, wherein said positioning of said device is performed manually.

11. The method according to claim 9, wherein said positioning of said device is performed by firstly aligning said first targeting element with said first targeting curve by translational movement of said device and by secondly aligning said second targeting element with said second targeting curve by rotational movement of said device.

12. The method according to claim 9, wherein said image acquisition device includes an energy emitting source allowing an approximation as a punctiform energy source and with a central ray at a known position with regard to said image and wherein said target is circular cylindrical and that upon acquiring said single image the angulation range between the central ray and the longitudinal axis of said target is restricted in a way that a lens-shaped projection of said target is visible on said image.

13. The method according to claim 12, wherein said numerical procedure essentially comprises the steps of:

i) automatic detection of a lens-shaped projection of said target in said image and determination of the two points of intersection and the first and second apex of said lens-shaped projection of said target;

ii) generating a virtual geometric representation of said target with said diameter d, said longitudinal axis, said center and said height h;

iii) determining the virtual projection points representing said two points of intersection and said first and second apex using said virtual geometric representation of said target; and

iv) iterative determination of the position and orientation of said target by matching said virtual projection points of said virtual geometric representation of said target with said two points of intersection and said first and second apex.

14. The method according to claim 9, wherein comprising the step of:

determining the position of at least two cylindrical targets in said three-dimensional body, wherein said targets are arranged with known position and orientation relative to each other; and

determining the position and angular orientation of said three-dimensional body with respect to a fixed system of coordinates using said position and angular orientation of said at least two cylindrical targets by means of said computer.

15. The method according to claim 9 including the additional steps of:

I) fixing at least one target in or on each object which is relevant for said surgical operation;

II) establishing a 3D representation of a relevant body portion of a patient by using a standard medical acquisition means;

III) planning of the surgical procedure to be performed at said relevant body portion by using a computer and said 3D representation of the relevant body portion;

IV) acquiring one single image with a projection of said at least one target by means of an image acquisition device with a projection plane;

V) performing steps b) to f) according to claim 9; and

VI) performing the planned surgical procedure by using said device and said computer, wherein said step of;

fixing at least one target in or on each object which is relevant for said surgical operation can be performed before step IV) instead of before performing steps II) to III).

16. The method according to claim 15, wherein step IV) comprises:

IV) acquiring one single image with a projection of all targets of at least one of said objects by means of an image acquisition device with a projection plane; and

if not all targets of all objects are visible in said single image;

repeat step IV) for further objects until the projection of all targets of each object are visible in one of said images.

17. The method according to claim 15, further comprising the step of:

positioning at least one virtual target in or on each virtual anatomical object of a body portion of a patient which is relevant for said surgical operation and at each relevant instrument, tool or implant used during performing the planned surgical procedure by using said computer, said 3D representation of a relevant body portion of a patient and each a 3D representation of said relevant instrument, tool or implant.

18. The method according to claim 17, further comprising the step of:

determining the position and orientation of each said virtual anatomical objects of a body portion of a patient which is relevant for said surgical operation and of each relevant instrument, tool or implant used during performing the planned surgical procedure according to the planning of the surgical procedure performed under step III) by using said computer.

19. The method according to claim 18, further comprising the step of:

determining the position and orientation of each object of a body portion of a patient which is relevant for said surgical operation and of each relevant instrument, tool or implant used during performing the planned surgical procedure with regard to the orientations of said targets according to step b) by using said computer.

20. The method according to claim 9, wherein the device is used for aligning a tool or instrument to the target in the three-dimensional body.

21. The method according to claim 9, wherein the device is used for non-destructive measurement and determination of a desired position of a bore hole to be drilled into the three-dimensional body coaxially to a desired hole axis by aligning said device to said hole axis.

22. The method according to claim 9, wherein the device is used for location and treatment of an implanted cardiac pacemaker.

23. The method according to claim 9, wherein the device is used for treatment of multilayer printed circuit boards.

24. The method according to claim 9, wherein the device is used for spatial manipulating the three-dimensional body including at least one target by means of a manipulating device.

25. The method according to claim 9, wherein the device is used for inserting screws or guide-wires into a bone or other objects.

26. The method according to claim 9, wherein the device is used for repositioning of bone fragments according to surgical planning.

27. The method according to claim 9, wherein the device is used for achieving an anatomical reconstruction after correction osteotomies according to surgical planning.