CN104083204A - Tibia tunnel locating device and method based on personalized navigation template - Google Patents
Tibia tunnel locating device and method based on personalized navigation template Download PDFInfo
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- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
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- 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
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/90—Guides therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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Abstract
The invention relates to a tibia tunnel locating device and method based on a personalized navigation template and belongs to cruciate ligament reconstruction surgery. The method comprises the steps that firstly, CT data and MRI data of a patient are collected, a data model is processed, and three-dimensional reestablishment is conducted on the data model; secondly, according to the three-dimensional model, the position of a tunnel is measured and determined, a bone surface needed by locating is obtained through partition, and a navigation template model is established; thirdly, the navigation template is manufactured through the rapid forming technology; finally, locating and verification are conducted through the navigation template and a locating device of a guider, and then a Kirschner wire is inserted through drilling. According to the tibia tunnel locating device and method based on the personalized navigation template, the navigation template is easy to locate and easy to operate, due to the auxiliary locating calibration of the guider, it is avoided that the error of the Kirschner wire inserted into the inner opening of the tunnel through drilling is amplified due to navigation template catheter small-angle swing deviation caused by soft tissues residues and other factors, the locating precision can be effectively guaranteed, and the surgical effect is more reliable.
Description
Technical field
The invention belongs to computer aided medicine surgical technic field, tibial tunnel location and navigation technology in art while relating to Cruciate ligament reconstruction, a kind of tibial tunnel positioner and method thereof based on Personalized Navigation template in art while being specifically related to Cruciate ligament reconstruction.
Background technology
Along with the development of transport science and techonologies and the raising of sports level, high-energy damages and causes the situation that cruciate ligaments of knee joint is torn constantly to increase.Cruciate ligaments of knee is most important to maintaining motion of knee joint stability, if can not get effective reparation, may cause meniscus injury, cartilage wearing and tearing, accelerate the serious consequences such as knee joint degeneration and osteoarthritis, yet because of biotic environment and the reason such as blood supply feature of himself, cruciate ligaments of knee self-healing ability extreme difference, therefore operative reconstruction becomes Main Means and the method for repairing Knee injuries, according to survey data, show, the U.S. approximately has the capable ligament reconstruction of 100,000 routine Knee injuries every year.
Under arthroscope, cruciate ligaments of knee reconstruction technique is because tissue injury in its art is little and infection rate is low, postoperative without significant complications and the advantage such as rehabilitation speed is fast and become the most popular modus operandi, but showing its success rate of operation, document only has 65%～90%, revision rate is up to 10%～20%, and incorrect tunnel location is the one of the main reasons that causes operative failure rate high.
The method of tunnel placement while mainly containing following several auxiliary cruciate ligaments of knee joint reconstruction in prior art:
1, license notification number is the forward and backward ligamentaum cruciatum femur of knee joint side tunnel locator described in CN101919720A, this guider under arthroscope according to bone mark, ligament stump and linked groups's structure for determining tunnel location and hole with reference to rough.Due to individuation difference, the anatomical position of everyone skeletal form size and ligament has larger difference, there is larger difference in knee joint organizational structure form and the practical situation under the arthroscope visual field simultaneously, so the accuracy of this tunnel placement method mainly relies on the Rhizoma Atractylodis Macrocephalae traditional Chinese medical science raw experience and operation, tunnel placement precision and direction are uncontrollable.
2, license notification number is a kind of method that improves spinal surgery computer navigation system precision described in CN101518447A, on spinal column, operation tool apparatus and the intelligent apparatus that navigates, tracer is installed, after registration, be navigated system identification and establish the position between them, by video camera, obtain the position in corrective surgery region, in preoperative or art, obtain the digitized video of operative region and import navigation system and carry out image registration, navigation system real-time tracking operation process simultaneous display are come liaison tunnel location.This navigation system equipment is complicated and expensive, and equipment connection and registration process are consuming time, and learning curve is long, operating time is long, before video camera and operative region, can not block, and affects operation technique, there is the phenomenons such as image " drift " simultaneously, operation precision is caused to error.
3, license notification number is a kind of manufacture method that can be used for the navigation template of pedicle of vertebral arch location described in CN101390773A, this navigation template utilizes CT or MRI to gather initial data and imports sets up vertebra threedimensional model in computer, pedicle of vertebral arch is entered to follow closely passage and carry out oppositely setting up after three dimensional analysis and virtually enter to follow closely guiding die plate, and utilize rapid shaping to make.This navigation template only relies on the surface anatomy form of vertebra to position, lack the corresponding appraisal agency of locating, positioning precision is low, manual the pressing of fixing dependence of template, the vibrations that enter electric drill in nail process may cause Template Location deviation, are only applicable to pedicle of vertebral arch location.
4, license notification number is manufacture method and the former thereof of a kind of navigation template of human bone surgery described in CN101816590A, the method gathers the bone initial data of corrective surgery and imports sets up bone threedimensional model in computer, set screw locating rod and extract near the bone curved surface in screw location, set up reverse navigation template model by former three dimensional model printing out, biomaterial is filled into and in former, prepares the navigation template with biocompatibility.For entering to follow closely navigation template, it is biological less demanding, the navigation template complex procedures of tool biocompatibility prepared by the method and prepare somewhat expensive, and practicality is not enough.
In sum, when traditional arthroscope is rebuild in conjunction with the auxiliary cruciate ligaments of knee joint of guider, tunnel placement reckons without skeleton individuation difference, doctor's experience and operation depended in the success or failure of operation, and the equipment of image navigation technology costliness and complicated operation have increased the cost of operation, learning curve and operating time, images " drift " etc. will cause certain influence to operation precision, existing navigation template Intraoperative position precision cannot be assessed, its stability and safety are not enough, therefore, the current a kind of auxiliary ligamentaum cruciatum tibial tunnel positioner of personalization and the method thereof that proposes quick high accuracy of needing badly.
Summary of the invention
In situation based on above-mentioned, the invention provides the tool and method of the auxiliary anterior cruciate ligament tunnel placement of personalization that a kind of cost is low, precision is high, simple and easy to use, to solve the problem of personalized tunnel dissection location difficulty in currently available technology.
For solving the problems of the technologies described above, the technical solution used in the present invention is: a kind of tibial tunnel positioner based on Personalized Navigation template, comprise navigation template and guider,
Described navigation template comprises a pedestal that inner surface is consistent with the anatomic form of the bone surface of contact, is designed with the guide pipe corresponding to collar extension center, tunnel on pedestal, and the centrage of guide pipe is coaxial with tunnel centrage, and quantity is consistent with reconstruction tunnel number; In guide pipe, be provided with female thread; On pedestal, have some through holes, for checking the location of navigation template and fixing navigation template;
Described guider comprises interior bar, outer bar, metal catheter and dip stick; Interior bar one end is location hook, and the other end is that cross section is the arc registration arm of keyway shape, is provided with the scale that shows guider subtended angle in registration arm; The upper end of outer bar and the registration arm of interior bar adapt, and are that a cross section is the arc chute of keyway shape, by the first lock-screw, are connected with registration arm; Outer bar lower end is connected to sleeve middle part one side of a hollow; Metal catheter one end is provided with and the corresponding external screw thread of guide pipe female thread, and metal catheter is connected with guide pipe through after sleeve, and sleeve is fixed metal catheter by the second lock-screw; Dip stick is that one end is pointed Metallic rod, is provided with the scale to distance between two tips corresponding to location hook in Metallic rod, for measuring the distance in tunnel.
The first described lock-screw is arranged on the platform of inner side, outer bar upper end, and the second lock-screw is arranged on the platform of lower cartridge.
Described pedestal wall thickness is 2～3mm, and the nominal diameter of guide pipe female thread is 4mm, and hollow sleeve internal diameter is 4mm, and length is 30mm, and the externally threaded nominal diameter of metal catheter is 4mm, and metal catheter internal diameter is 2mm, and wall thickness is 1mm, and dip stick diameter is 3.4mm.
And the localization method that the described tibial tunnel positioner based on Personalized Navigation template adapts, comprises the following steps:
Step 1: gather patient's knee joint and stretch a CT data, extract tibia and the femur point data of clear-cut and derive;
Step 2: gather patient's knee joint and stretch a MRI data, extract the some data that comprise tibia, femur, meniscus, cartilage and ligamentaum cruciatum and derive;
Step 3: impurity point, noise reduction and fairing processing are sampled, deleted to the data to step 1 and step 2 acquisition, carries out respectively obtaining femur and the tibial knee model with meniscus, cartilage and ligamentaum cruciatum organizational structure by registration after three-dimensional reconstruction;
Step 4: if patient left and right knee joint organizational structure is undistorted and symmetry is good, according to strong side knee joint threedimensional model, determine that being good for side ligamentaum cruciatum depends on an anatomical position and measure, and then determines tibial tunnel internal orifice position, Ipsilateral joint in conjunction with measurement data and the Ipsilateral threedimensional model of strong side; Otherwise directly according to Ipsilateral knee joint threedimensional model and in conjunction with empirical data, determine tibial tunnel internal orifice position;
Step 5: according to internal orifice position, the determined tunnel of step 4, carry out virtual channel three dimensional design and analysis, and be partitioned into the needed bone surface in location, and in industrial Three-dimensional CAD Software, set up navigation template model, then by rapid shaping technique, process and prepare;
Step 6: the auxiliary guider of navigation template location, by the dip stick check navigation template positioning precision of guider, fine-tuning navigation template is until meet requirements of operation if error exceeds standard simultaneously.
In described step 4, tibia ligamentaum cruciatum is depended on point measurement method for adopt tibia ligamentaum cruciatum to depend on a little the method that the distance of tibia leading edge and inside edge accounts for respectively the percentage ratio of tibia edge, front and back and the total distance of outer edge at electronic 3-D model cross-sectional direction;
In described step 5, virtual channel three dimensional design and analyze is mainly included in and in computer, sets up virtual channel, whether then become the internal orifice position, tunnel of some different angles post analysis design can cause ligament to rebuild from stretching a flexing knee joint based on motion of knee joint, occur to clash into and " rain brush effect " and " rubber band effect ", whether length and the direction in measurement tunnel be reasonable; Described rapid shaping technique is fusion sediment molding or Stereolithography or selective laser sintering.
Described step 6 comprises following concrete steps:
(i) use navigation template to fit in bone surface, the geometric shape Primary Location based on skeleton;
(ii) navigation template is fixedly connected with by screw thread with metal catheter, and outer bar is connected at sleeve place with metal catheter, the location hook Primary Location of guider in guiding knee joint, and the position of joint Microscopic observation location hook, fine-tuning template makes location hook reach ideal position;
(iii) keep the invariant position of location hook in step (ii), unload metal catheter, by dip stick, measure respectively on tunnel collar extension central point and pedestal at least four differences of some through hole central points to the distance of location hook, and itself and computer measurement value are contrasted, navigation template accurate positioning is described if be consistent;
(iv) use short Kirschner wire to squeeze on pedestal fixedly navigation template of through hole, while avoiding Kirschner wire to pierce tibia, shake causes a deviation;
(v) take off dip stick, again install metal catheter guiding and pierce Kirschner wire.
Also claimed described positioner application in tibial tunnel location in front and back ligamentaum cruciatum list bundle or two-beam reconstruction operations of the present invention.
A kind of tibial tunnel positioner and method thereof based on Personalized Navigation template that the present invention proposes, combine computer generated image reconfiguration technique and rapid shaping technique, take full advantage of the imaging advantage of CT and MRI, can obtain with the tibia of meniscus, cartilage, ligamentaum cruciatum organizational structure and clear-cut, the complete knee joint model of femur, for virtual channel is accurately measured and location provides reliable reference.Based on skeleton dissection form and preoperative tunnel Virtual Analysis, complete personalized stencil design, preoperatively by rapid shaping technique, create, make to locate simple to operation, can effectively improve the success rate of operation and shorten operating time.Add the auxiliary positioning calibration of upper guide, prevented the guiding die plate conduit small angle oscillation deviation that factor causes because soft tissue is residual etc. and cause Kirschner wire to be drilled in tunnel internal orifice error to be exaggerated situation, effectively guarantee positioning precision, make surgical effect more reliable.
Accompanying drawing explanation
Fig. 1 is navigation template preparation technology flow chart of the present invention.
Fig. 2 is positioner overall schematic of the present invention.
Fig. 3 is navigation template schematic diagram of the present invention.
Fig. 4 is guider assembling schematic diagram of the present invention.
Fig. 5 is bar schematic diagram in guider of the present invention.
Fig. 6 is the first schematic diagram of the outer bar of guider of the present invention.
Fig. 7 is the second schematic diagram of the outer bar of guider of the present invention.
Fig. 8 is interior bar registration arm sectional view of the present invention.
Fig. 9 is metal catheter schematic diagram of the present invention.
Figure 10 is dip stick schematic diagram of the present invention.
The specific embodiment
Below in conjunction with embodiment and accompanying drawing thereof, describe a kind of tibial tunnel positioner and method thereof based on Personalized Navigation template of the present invention in detail, but protection scope of the present invention is not limited to following embodiment.
As shown in Figure 1, concrete preparation technology's flow process of navigation template of the present invention is carried out according to the direction of arrow.
As shown in Figure 2, auxiliary guider 2 internal orifice position, the tunnel Primary Location of navigation template 1 of the present invention, in the accurate location of joint Microscopic observation location situation fine setting, metal guide 5 guiding Kirschner wires pierce, and effectively prevent collar extension guide pipe 12 small angle error and cause the larger deviation in internal orifice position.
As shown in Figure 3, two-beam rebuilding anterior cruciate ligament tibial tunnel location navigation template 1 of the present invention, comprises the inner surface pedestal consistent with bone surface geometric shape 11, guide pipe 12 and some through holes 14 corresponding to collar extension center, tunnel with female thread 13.
As shown in Figure 4, guider 2 of the present invention, comprises interior bar 3, outer bar 4, metal catheter 5, the first lock-screw 7 and the second lock-screw 8.
As shown in Figure 5, the interior bar 3 of guider 2 of the present invention, comprises arc registration arm 32 and scale 33 thereof that location hook 31, cross sectional shape are key-way shape.
As shown in Figure 6 and Figure 7, the outer bar 4 of guider 2 of the present invention, comprises that one end is that cross section is that arc chute 41, chute 41 inner top side platforms 42, the other end of keyway shape is hollow sleeve 43, sleeve 43 lower platform 44.
As shown in Figure 8, the profile of the registration arm 32 of bar 3 in the present invention.
As shown in Figure 9, metal catheter 5 of the present invention, one end is that nominal diameter is the thread, external thread 51 of 4mm.
As shown in figure 10, dip stick 6 of the present invention for one end be pointed 61, the Metallic rod that diameter is 3.4mm, is provided with the Measurement scales 62 to distance between two tips corresponding to location hook on bar, can be used for measuring the distance in tunnel.
Embodiment mono-
The apparatus and method step of the auxiliary anterior cruciate ligament Single bundle reconstruction tibial tunnel of the present invention location is as follows:
Step 1: gather patient's knee joint and stretch a CT data, adopt mimics software extract tibia and the femur point data of clear-cut and derive.
Step 2: gather patient's knee joint and stretch a MRI data, employing mimics software extracts the some data that comprise tibia, femur, meniscus, cartilage and ligamentaum cruciatum and derives.
Step 3: utilize imageware to sample, delete impurity point, noise reduction and fairing processing to the data of step 1 and step 2 acquisition, carry out respectively obtaining femur and the tibial knee model with meniscus, cartilage, ligamentaum cruciatum organizational structure by registration after three-dimensional reconstruction.
Step 4: at electronic 3-D model cross-sectional direction, the distance that adopts tibia ligamentaum cruciatum to depend on a little tibia leading edge and inside edge accounts for respectively before and after tibia the method measurement of the percentage ratio at edge and the total distance of outer edge and is good for side ligamentaum cruciatum and depends on an anatomical position.Ligament depend on a distance apart from tibia leading edge and inside edge be respectively longitudinal separation 42.8% and inside and outside distance 45.7%.Measurement data and Ipsilateral threedimensional model in conjunction with strong side are determined tibial tunnel internal orifice position, Ipsilateral joint.
Step 5: according to the determined tunnel location of step 4, virtual design tunnel in computer, and from stretching a flexing knee joint, become internal orifice position, tunnel some different angles processes not occur to clash into and " rain brush effect " and " rubber band effect " after can not causing ligament to rebuild based on motion of knee joint, the length in tunnel is 35mm, is respectively 52 ° with the angle of tibial plateau.Be partitioned into the needed bone surface in location, in industrial PRO-E software, set up three-dimensional reverse navigation template 1 model, by the processing of selective laser sintering rapid forming technology, prepare.
Step 6: the auxiliary guider of navigation template 12 location, by dip stick 6 checks of guider 2, check navigation template 1 location simultaneously.
The consistent pedestal 11 of anatomic form that described navigation template 1 comprises an inner surface and the bone surface of contact, its wall thickness is 2mm; On pedestal 11, be designed with the guide pipe 12 corresponding to collar extension center, tunnel, its centrage is coaxial with tunnel centrage, and quantity is consistent with reconstruction tunnel number; In guide pipe 12, having nominal diameter is the female thread 13 of 4mm; On pedestal 11, have some through holes 14, for checking the location of navigation template 1 and fixing navigation template 1.
Guider 2 is comprised of interior bar 3, outer bar 4, metal catheter 5 and dip stick 6.Interior bar 3 one end are location hook 31, and the other end is that cross section is the arc registration arm 32 of keyway shape, and registration arm 32 subtended angles are 50 °, and location hook 31 is connected by round bar with registration arm 32.Outer bar 4 one end are that cross section is the arc chute 41 of keyway shape, in chute 41 inner top side, there is a platform 42 that the first lock-screw 7 is installed, the other end is that hollow sleeve 43 is symmetrically distributed in chute 41 centrage both sides, internal diameter is 4mm, length is 30mm, and sleeve 43 bottoms have a platform 44 that two the second lock-screws 8 are installed.It is the external screw thread 51 of 4mm that there is nominal diameter metal catheter 5 one end, and metal catheter 5 internal diameters are 2mm, and wall thickness is 1mm.Dip stick 6 for one end be pointed 61, the Metallic rod that diameter is 3.4mm, is provided with the Measurement scales 62 to distance between two tips corresponding to location hook 31 on bar, can be used for measuring the distance in tunnel.
The concrete using method of step 6 is:
(i) use navigation template 1 to fit in bone surface, the geometric shape Primary Location based on skeleton.
(ii) navigation template 1 is fixedly connected with external screw thread 51 by female thread 13 with metal catheter 5, outer bar 4 sleeves 43 are coaxially connected with metal catheter 5, location hook 31 Primary Location of guider 2 in guiding knee joint, the position of joint Microscopic observation location hook 31, fine-tuning template makes location hook 31 reach ideal position.
(iii) keep the invariant position of location hook 31 in step (ii), unload metal catheter 5, by dip stick 6, measure respectively on tunnel collar extension central point and navigation template 1 at least four differences of some through hole 14 central points to location hook 31 distance between two tips, and its computer measurement value is contrasted, navigation template 1 accurate positioning is described if be consistent.
(iv) use short Kirschner wire to squeeze into fixedly navigation template 1 of pedestal 11 through holes 14, while avoiding Kirschner wire to pierce tibia, shake causes a deviation.
(v) take off dip stick 6, again install metal catheter 5 guiding and pierce Kirschner wire.
Embodiment bis-
The apparatus and method step of the auxiliary anterior cruciate ligament double bundle reconstruction tibia tunnel placement of the present invention is as follows:
Step 1: gather patient's knee joint and stretch a CT data, adopt mimics software extract tibia and the femur point data of clear-cut and derive.
Step 2: gather patient's knee joint and stretch a MRI data, employing mimics software extracts the some data that comprise tibia, femur, meniscus, cartilage and ligamentaum cruciatum and derives.
Step 3: utilize geomagic studio to sample, delete impurity point, noise reduction and fairing processing to the data of step 1 and step 2 acquisition, carry out respectively obtaining femur and the tibial knee model with meniscus, cartilage, ligamentaum cruciatum organizational structure by registration after three-dimensional reconstruction.
Step 4: at electronic 3-D model cross-sectional direction, the distance that adopts tibia ligamentaum cruciatum to depend on a little tibia leading edge and inside edge accounts for respectively before and after tibia the method measurement of the percentage ratio at edge and the total distance of outer edge and is good for side ligamentaum cruciatum and depends on an anatomical position.Front medial cord depend on a distance apart from tibia leading edge and inside edge be respectively longitudinal separation 37.3% and inside and outside distance 46.2%, rear lateral cord depend on a distance apart from tibia leading edge and inside edge be respectively longitudinal separation 50.4% and inside and outside distance 51.1%.Measurement data and Ipsilateral threedimensional model in conjunction with strong side are determined tibial tunnel internal orifice position, Ipsilateral joint.
Step 5: according to the determined tunnel location of step 4, virtual design tunnel in computer, and from stretching a flexing knee joint, become internal orifice position, tunnel some different angles processes not occur to clash into and " rain brush effect " and " rubber band effect " after can not causing ligament to rebuild based on motion of knee joint, the length in front medial cord and rear lateral cord tunnel is respectively 38mm and 31mm, is respectively 56 ° and 45 ° with the angle of tibial plateau.Be partitioned into the needed bone surface in location, in industrial NX-UG software, set up three-dimensional reverse navigation template 1 model, by the processing of circulation deposition rapid forming technology, prepare.
Step 6: the auxiliary guider of navigation template 12 location, by dip stick 6 checks of guider 2, check navigation template 1 location simultaneously.
The consistent pedestal 11 of anatomic form that described navigation template 1 comprises an inner surface and the bone surface of contact, its wall thickness is 2.5mm; On pedestal 11, be designed with the guide pipe 12 corresponding to collar extension center, tunnel, its centrage is coaxial with tunnel centrage, and quantity is consistent with reconstruction tunnel number; In guide pipe 12, having nominal diameter is the female thread 13 of 4mm; On pedestal 11, have some through holes 14, for checking the location of navigation template 1 and fixing navigation template 1.
Guider 2 is comprised of interior bar 3, outer bar 4, metal catheter 5 and dip stick 6.Interior bar 3 one end are location hook 31, and the other end is that cross section is the arc registration arm 32 of keyway shape, and registration arm 32 subtended angles are 45 °, and location hook 31 is connected by round bar with registration arm 32.Outer bar 4 one end are that cross section is the arc chute 41 of keyway shape, in chute 41 inner top side, there is a platform 42 that the first lock-screw 7 is installed, the other end is that hollow sleeve 43 is symmetrically distributed in chute 41 centrage both sides, internal diameter is 4mm, length is 30mm, and sleeve 43 bottoms have a platform 44 that two the second lock-screws 8 are installed.It is the external screw thread 51 of 4mm that there is nominal diameter metal catheter 5 one end, and metal catheter 5 internal diameters are 2mm, and wall thickness is 1mm.Dip stick 6 for one end be pointed 61, the Metallic rod that diameter is 3.4mm, is provided with the scale 62 to distance between two tips corresponding to location hook 31 on bar, can be used for measuring the distance in tunnel.
The concrete using method of step 6 is:
(i) use navigation template 1 to fit in bone surface, the geometric shape Primary Location based on skeleton.
(ii) navigation template 1 is fixedly connected with external screw thread 51 by female thread 13 with metal catheter 5, outer bar 4 sleeves 43 are coaxially connected with metal catheter 5, location hook 31 Primary Location of guider 2 in guiding knee joint, the position of joint Microscopic observation location hook 31, fine-tuning template makes location hook 31 reach ideal position.
(iii) keep the invariant position of location hook 31 in step (ii), unload metal catheter 5, by dip stick 6, measure respectively on tunnel collar extension central point and navigation template 1 at least four differences of some through hole 14 central points to location hook 31 distance between two tips, and its computer measurement value is contrasted, navigation template 1 accurate positioning is described if be consistent.
(iv) use short Kirschner wire to squeeze into fixedly navigation template 1 of pedestal 11 through holes 14, while avoiding Kirschner wire to pierce tibia, shake causes a deviation.
(v) take off dip stick 6, again install metal catheter 5 guiding and pierce Kirschner wire.
Claims (8)
1. the tibial tunnel positioner based on Personalized Navigation template, is characterized in that, comprises navigation template and guider;
Described navigation template comprises a pedestal that inner surface is consistent with the anatomic form of the bone surface of contact, is designed with the guide pipe corresponding to collar extension center, tunnel on pedestal, and the centrage of guide pipe is coaxial with tunnel centrage, and quantity is consistent with reconstruction tunnel number; In guide pipe, be provided with female thread; On pedestal, have some through holes, for checking the location of navigation template and fixing navigation template;
Described guider comprises interior bar, outer bar, metal catheter and dip stick; Interior bar one end is location hook, and the other end is that cross section is the arc registration arm of keyway shape, is provided with the scale that shows guider subtended angle in registration arm; The upper end of outer bar and the registration arm of interior bar adapt, and are that a cross section is the arc chute of keyway shape, by the first lock-screw, are connected with registration arm; Outer bar lower end is connected to sleeve middle part one side of a hollow; Metal catheter one end is provided with and the corresponding external screw thread of guide pipe female thread, and metal catheter is connected with guide pipe through after sleeve, and sleeve is fixed metal catheter by the second lock-screw; Dip stick is that one end is pointed Metallic rod, is provided with the scale to distance between two tips corresponding to location hook in Metallic rod, for measuring the distance in tunnel.
2. the tibial tunnel positioner based on Personalized Navigation template according to claim 1, is characterized in that, the first described lock-screw is arranged on the platform of inner side, outer bar upper end, and the second lock-screw is arranged on the platform of lower cartridge.
3. the tibial tunnel positioner based on Personalized Navigation template according to claim 1, it is characterized in that, described pedestal wall thickness is 2～3mm, the nominal diameter of guide pipe female thread is 4mm, and hollow sleeve internal diameter is 4mm, and length is 30mm, the externally threaded nominal diameter of metal catheter is 4mm, metal catheter internal diameter is 2mm, and wall thickness is 1mm, and dip stick diameter is 3.4mm.
With claim 1-3 in the localization method that adapts of the tibial tunnel positioner based on Personalized Navigation template described in any one, it is characterized in that, comprise the following steps:
Step 1: gather patient's knee joint and stretch a CT data, extract tibia and the femur point data of clear-cut and derive;
Step 2: gather patient's knee joint and stretch a MRI data, extract the some data that comprise tibia, femur, meniscus, cartilage and ligamentaum cruciatum and derive;
Step 3: impurity point, noise reduction and fairing processing are sampled, deleted to the data to step 1 and step 2 acquisition, carries out respectively obtaining femur and the tibial knee model with meniscus, cartilage and ligamentaum cruciatum organizational structure by registration after three-dimensional reconstruction;
Step 4: if patient left and right knee joint organizational structure is undistorted and symmetry is good, according to strong side knee joint threedimensional model, determine that being good for side ligamentaum cruciatum depends on an anatomical position and measure, and then determines tibial tunnel internal orifice position, Ipsilateral joint in conjunction with measurement data and the Ipsilateral threedimensional model of strong side; Otherwise directly according to Ipsilateral knee joint threedimensional model and in conjunction with empirical data, determine tibial tunnel internal orifice position;
Step 5: according to internal orifice position, the determined tunnel of step 4, carry out virtual channel three dimensional design and analysis, and be partitioned into the needed bone surface in location, and in industrial Three-dimensional CAD Software, set up navigation template model, then by rapid shaping technique, process and prepare;
Step 6: the auxiliary guider of navigation template location, by the dip stick check navigation template positioning precision of guider, fine-tuning navigation template is until meet requirements of operation if error exceeds standard simultaneously.
5. localization method according to claim 4, it is characterized in that, in described step 4, tibia ligamentaum cruciatum is depended on point measurement method for adopt tibia ligamentaum cruciatum to depend on a little the method that the distance of tibia leading edge and inside edge accounts for respectively the percentage ratio of tibia edge, front and back and the total distance of outer edge at electronic 3-D model cross-sectional direction.
6. localization method according to claim 4, it is characterized in that, in described step 5, virtual channel three dimensional design and analyze is mainly included in and in computer, sets up virtual channel, whether then become the internal orifice position, tunnel of some different angles post analysis design can cause ligament to rebuild from stretching a flexing knee joint based on motion of knee joint, occur to clash into and " rain brush effect " and " rubber band effect ", whether length and the direction in measurement tunnel be reasonable; Described rapid shaping technique is fusion sediment molding or Stereolithography or selective laser sintering.
7. localization method according to claim 4, is characterized in that, described step 6 comprises following concrete steps:
(i) use navigation template to fit in bone surface, the geometric shape Primary Location based on skeleton;
(ii) navigation template is fixedly connected with by screw thread with metal catheter, and outer bar is connected at sleeve place with metal catheter, the location hook Primary Location of guider in guiding knee joint, and the position of joint Microscopic observation location hook, fine-tuning template makes location hook reach ideal position;
(iii) keep the invariant position of location hook in step (ii), unload metal catheter, by dip stick, measure respectively on tunnel collar extension central point and pedestal at least four differences of some through hole central points to the distance of location hook, and itself and computer measurement value are contrasted, navigation template accurate positioning is described if be consistent;
(iv) use short Kirschner wire to squeeze on pedestal fixedly navigation template of through hole, while avoiding Kirschner wire to pierce tibia, shake causes a deviation;
(v) take off dip stick, again install metal catheter guiding and pierce Kirschner wire.
8. the application in tibial tunnel location in front and back ligamentaum cruciatum list bundle or two-beam reconstruction operations of the positioner described in any one in claim 1-3.
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