System and method for assisting with arrangement of a stock instrument with respect to a patient tissue

• US 10,512,496 B2
• Filed: 12/15/2015
• Issued: 12/24/2019
• Est. Priority Date: 10/29/2010
• Status: Active Grant

• Current Assignee: Cleveland Clinic Foundation
• Original Assignee: Cleveland Clinic Foundation
• Inventors: Iannotti, Joseph P., Barsoum, Wael K., Bryan, Jason A.
• Primary Examiner(s): Hanna, Samuel S
• Application Number:
  US14/969,964
• Publication Number:
  US 20160095608A1
• Time in Patent Office: 1,470 Days
• Field of Search: None
• CPC Class Codes: A61B 17/1739 specially adapted for particular parts of the body
• CPC Class Codes: A61B 17/1778 for the shoulder
• CPC Class Codes: A61B 17/88 Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices A61B17/7074 takes precedence
• CPC Class Codes: A61B 17/8872 Instruments for putting said fixation devices against or away from the bone A61B17/7074, A61B17/808 take precedence
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/108 Computer aided selection or customisation of medical implants or cutting guides
• CPC Class Codes: A61B 2090/3916 Bone tissue
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations

Abstract

A stock instrument includes at least one guide interacting feature. A lower instrument surface of the stock instrument is placed into contact with the patient tissue. A guide has a lower guide surface contoured to substantially mate with at least a portion of an upper instrument surface of the stock instrument. A predetermined instrument orientation upon the patient tissue is defined, which is preselected responsive to preoperative imaging of the patient tissue. The guide and instrument are mated in a predetermined relative guide/instrument orientation wherein at least one guide interacting feature of the instrument is placed into engagement with at least one instrument guiding feature of the guide. The guide is moved into a predetermined guide orientation with respect to the patient tissue and concurrently the instrument is moved into a predetermined instrument orientation with respect to the patient tissue.

Claims

1. A method of arranging a stock instrument with respect to a patient tissue, the stock instrument including at least one guide interacting feature, the method comprising the steps of:

providing a guide having a lower guide surface contoured to substantially mate with at least a portion of an upper instrument surface of the stock instrument, an upper guide surface spaced longitudinally apart from the lower guide surface by a guide body, and at least one instrument guiding feature at a predetermined feature location with respect to the guide body;

placing a lower instrument surface of the stock instrument into contact with the patient tissue without using the guide;

defining a predetermined instrument orientation upon the patient tissue, the predetermined instrument orientation being preselected responsive to preoperative imaging of the patient tissue;

placing the lower guide surface of the guide into mating contact with at least a portion of the upper instrument surface in a predetermined relative orientation of the guide and the instrument wherein the at least one guide interacting feature of the instrument is placed into engagement with the at least one instrument guiding feature of the guide; and

moving the guide into a predetermined guide orientation with respect to the patient tissue while the lower instrument surface of the instrument remains in contact with the patient tissue to concurrently move the instrument into the predetermined instrument orientation with respect to the patient tissue.

2. The method of claim 1, further comprising securing the instrument in the predetermined instrument orientation upon the patient tissue before removing the guide from engagement with the instrument.

3. The method of claim 2, wherein the step of securing the instrument in the predetermined instrument orientation includes the step of placing at least one guide pin through a corresponding securing feature in the instrument.

4. The method of claim 1, wherein the step of moving the guide into a predetermined guide orientation with respect to the patient tissue includes the steps of:

providing an orienting feature to the guide; and

repositioning the guide to bring the orienting feature into a predetermined orienting relationship with a previously placed landmark on the patient tissue.

5. The method of claim 4, further comprising affixing the previously placed landmark to the patient tissue at a location spaced from a location of the stock instrument.

6. The method of claim 4, wherein the step of repositioning the guide to bring the orienting feature into a predetermined orienting relationship with a previously placed landmark on the patient tissue includes the steps of:

providing an orienting indicator to the orienting feature; and

repositioning the guide to bring the orienting indicator into a predetermined signaling relationship with the landmark.

7. The method of claim 1, wherein a chosen one of the guide interacting feature and the instrument guiding feature is a protrusion and the other one of the guide interacting feature and the instrument guiding feature is a cavity, and the protrusion enters the cavity to engage the guide and the instrument in the mating contact.

8. The method of claim 1, wherein the step of providing a guide includes one of:

custom-manufacturing the guide responsive to at least one of preoperative imaging of the patient tissue and preoperative selection of the stock instrument; and

modifying a stock guide responsive to at least one of preoperative imaging of the patient tissue and preoperative selection of the stock instrument.

9. The method of claim 8, wherein the step of moving the guide into a predetermined guide orientation with respect to the patient tissue includes the steps of:

providing an orienting feature to the guide; and

repositioning the guide to bring the orienting feature into a predetermined orienting relationship with a previously placed landmark on the patient tissue; and

wherein the step of modifying the stock guide includes the step of providing a custom-manufactured orienting feature to the stock guide.

10. The method of claim 1, including the steps of:

affixing at least one landmark to the patient tissue at a predetermined landmark location chosen responsive to preoperative imaging of the patient tissue; and

using the at least one landmark to assist with at least one of the steps of placing a lower instrument surface of the stock instrument into contact with the patient tissue in any orientation, placing the lower guide surface into mating contact with at least a portion of the upper instrument surface in a predetermined relative guide/instrument orientation, and

moving the guide into a predetermined guide orientation with respect to the patient tissue to concurrently move the instrument into a predetermined instrument orientation with respect to the patient tissue.

11. A method of arranging a stock instrument with respect to a patient tissue, the stock instrument including at least one guide interacting feature, the method comprising the steps of:

providing a guide having a lower guide surface contoured to substantially mate with at least a portion of an upper instrument surface of the stock instrument, an upper guide surface spaced longitudinally apart from the lower guide surface by a guide body, and at least one instrument guiding feature at a predetermined feature location with respect to the guide body;

placing a lower instrument surface of the stock instrument into contact with the patient tissue without using the guide;

defining a predetermined orientation of the stock instrument upon the patient tissue, the predetermined orientation being preselected responsive to preoperative imaging of the patient tissue;

placing the lower guide surface of the guide into mating contact with at least a portion of the upper instrument surface and engaging the guide and the stock instrument together to form a guide assembly wherein relative rotation between the guide and the stock instrument is prevented; and

moving the guide assembly until the stock instrument is disposed in the predetermined orientation while the lower instrument surface of the instrument remains in contact with the patient tissue.

12. The method as defined in claim 11, wherein the guide includes an orienting feature, and moving the guide assembly further comprises rotating the guide assembly until the orienting feature is disposed in a predetermined orienting relationship with at least one landmark on the patient tissue.

13. The method of claim 12, wherein rotating the guide assembly further comprises rotating the guide assembly to bring an orienting indicator of the orienting feature into a predetermined signaling relationship with the landmark.

14. The method of claim 13, further comprising affixing the landmark to the patient tissue at a location spaced from a location of the stock instrument, and wherein bringing the orienting feature into said predetermined orienting relationship further comprises abutting the orienting indicator of the orienting feature against the landmark.

15. The method of claim 14, wherein the landmark includes a pin and the orienting indicator includes a corresponding notch formed in the orienting feature.

16. The method as defined in claim 11, wherein engaging the guide and the stock instrument together further comprises placing the at least one instrument guiding feature of the guide into engagement with the at least one guide interacting feature of the stock instrument.

17. The method of claim 16, wherein a chosen one of the guide interacting feature and the instrument guiding feature is a protrusion and the other one of the guide interacting feature and the instrument guiding feature is a cavity, and the protrusion enters the cavity to engage the guide and the instrument in the mating contact.

18. The method of claim 11, further comprising custom-manufacturing the guide responsive to at least one of preoperative imaging of the patient tissue and preoperative selection of the stock instrument, the guide thereby being patient-specific.

19. The method of claim 11, further comprising modifying a stock guide responsive to at least one of preoperative imaging of the patient tissue and preoperative selection of the stock instrument.

20. The method of claim 19, further comprising providing a custom-manufactured orienting feature to the stock guide.

21. The method of claim 11, further comprising:

affixing at least one landmark to the patient tissue at a predetermined landmark location chosen responsive to preoperative imaging of the patient tissue; and

using the at least one landmark to assist with at least one of the steps of placing the lower instrument surface of the stock instrument into contact with the patient tissue in any orientation, placing the lower guide surface into mating contact with the at least a portion of the upper instrument surface, and moving the guide assembly into the predetermined guide orientation with respect to the patient tissue.