JP2023053980A - 股関節交換ナビゲーションシステムおよび方法 - Google Patents
股関節交換ナビゲーションシステムおよび方法 Download PDFInfo
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Abstract
Description
2017年3月14日に出願された米国仮出願第62/471,185号、および、2017年6月16日に出願された米国仮出願第62/521,097号明細書を含む、外国のまたは国内の優先権主張が本出願とともに提出された出願データシートの中に識別されている任意のおよびすべての出願は、それぞれ、37 CFR 1.57の下で、その全体が参照により本明細書に組み込まれている。
1.股関節ナビゲーションシステム
図1は、解剖学上のランドマークを参照して股関節手技をナビゲートするように適合された股関節ナビゲーションシステム600を示している。システム600は、図1の中の骨盤の上に装着されて示されており、図1の中の骨盤は、簡単にするためにボックスとして示されている。システム600は、本明細書で説明されているように、後方アプローチのために骨盤の上に装着され得る。システム600は、本明細書で説明されているように、前方アプローチのために骨盤の上に装着され得る。
いくつかの使用の方法において、システム600は、図6Aに示されている光学コンポーネント174を含む。いくつかの実施形態では、光学コンポーネント174は、外科的配向デバイスに一体化されている。いくつかの実施形態では、光学コンポーネント174は、外科的配向デバイス172とは別個のコンポーネントであることが可能である。光学コンポーネント174は、患者と連結されることになる固定具に隣接して、たとえば、患者の骨盤のより近くに、外科的配向デバイス172の下方に位置し得る。光学コンポーネント174は、外科的配向デバイス172のそばに、または、外科的配向デバイス172に隣接して、または、外科的配向デバイス172の上方に位置し得る。外科的配向デバイス172のディスプレイは、光学コンポーネント174を使用する方法に関する取扱説明を含むことが可能である。
図7は、股関節ナビゲーションシステム700を図示している。図8A~図8Bは、図7のシステム700の固定ベース702の実施形態を図示している。図9は、図7のシステム700の第1のアセンブリ704の実施形態を図示している。図10A~図10Dは、図7のシステム700の第2のアセンブリ706の実施形態を図示している。
1.後方アプローチのための方法
図1~図10Dは、後方アプローチからの股関節手技をナビゲートするように適合された股関節ナビゲーションシステム600、700を図示している。方法は、システム700に関して説明されているが、本明細書または以下の公報において説明されている任意のシステムが利用され得る:2015年3月10日に出願された米国特許出願公開第2016/0242934号明細書;2013年3月13日に出願された米国特許出願公開第2014/0052149号明細書;2009年9月10日に出願された米国特許出願公開第2010/0137871号明細書、それらのすべては、その全体が参照により組み込まれている。
1.前方アプローチに関する方法
図1~図5Cは、前方アプローチからの股関節手技をナビゲートするように適合された股関節ナビゲーションシステム600を図示している。図7~図10Dは、前方アプローチから股関節手技をナビゲートするように適合された股関節ナビゲーションシステム700を図示している。方法は、システム600に関連して説明されているが、本明細書または以下の公報に説明されている任意のシステムが利用され得る:2015年3月10日に出願された米国特許出願公開第2016/0242934号明細書;2013年3月13日に出願された米国特許出願公開第2014/0052149号明細書;2009年9月10日に出願された米国特許出願公開第2010/0137871号明細書、それらのすべては、その全体が参照により組み込まれている。股関節交換に対する前方アプローチは、有利には、後方アプローチよりも低侵襲性であることが可能である。とりわけ、前方アプローチは、より小さい切開、より少ない軟部組織解離、および、より短い患者の回復時間を可能にすることができる。
図28Aは、前骨盤平面の側面図を図示している。前骨盤平面は、本明細書で説明されているように、ASIS間ラインを含む。図28Bは、前骨盤平面と調節された平面との間の比較を図示している。図28A-1および図28B-1は、ASISが整合されているシステムの別の側面図を図示している。図28Bは、前骨盤平面および調節された平面の側面図を図示している。図28Cは、前骨盤平面および調節された平面の上面図を図示している。本明細書で説明されているように、前骨盤平面および調節された平面は、両方ともASIS間ラインを含有している。また、前骨盤平面は、平面を画定するためにポイント3を含有している。調節された平面は、平面を画定するために重力の方向を利用する。いくつかの実施形態では、前骨盤平面および調節された平面は、図28Bおよび図28B-1に示されているように、ASIS間ラインの周りに同軸になっている。調節された平面は、ASIS間ラインの周りの前骨盤平面の回転である。調節された平面および前骨盤平面は、図28Bおよび図28B-1に示されているように、角度アルファを形成することが可能である。角度アルファは、骨盤の傾きの測定であることが可能である。角度アルファは、前骨盤平面からの水平方向に対する差を測定することが可能である。角度アルファは、前骨盤平面を調節することが可能であり、カップ角度が、手術後のX線に示されているものとより密接にマッチするようになっている。いくつかの実施形態では、調節された平面は、傾きに関して調節する。いくつかの実施形態では、調節された平面は、ASIS間ラインに対する恥骨の傾きに関して調節する。
図29は、外科的配向デバイス172の対話型ユーザインターフェースの1つの実施形態によって発生される股関節方法に関するスクリーンディスプレイを示している。配向センシングデバイス204が、インパクタ300Aに取り付けられるか、または、ユニバーサルインパクタアダプタ350、352に連結されている任意の他のインパクタに取り付けられると、外科的配向デバイス172は、基準平面に対するインパクタのレントゲン写真上の外転角度および前捻角度を表示することが可能である。基準平面は、前面骨盤平面、前骨盤平面、テーブル平面、調節された平面などを含む任意の平面であることが可能である。外科的配向デバイス172は、2つ以上の平面に対する外転角度および前捻角度を表示することが可能である。図示されている実施形態では、外科的配向デバイス172は、前骨盤平面に対するレントゲン写真上の外転角度および前捻角度を表示することが可能である。外科的配向デバイス172は、前骨盤平面に対する「骨盤」角度を表示する。前骨盤平面は、解剖学的ランドマークからの入力に基づいている。図示されている実施形態では、外科的配向デバイス172は、調節された平面に対するレントゲン写真上の外転角度および前捻角度を表示することが可能である。外科的配向デバイス172は、調節された平面に対する「調節された」角度を表示する。調節された平面は、基準平面であり、そこでは、前骨盤平面が、その上位下位軸線が平らなテーブルに対して平行になるまで、ASIS間軸線の周りに回転される。これは、骨盤の傾きに関して効果的に調節する。「調節された」角度は、水平方向の平面を使用する手術後のX線と相関することが可能である。
18b ターゲットプローブ
18c ターゲットプローブ
18d ターゲットプローブ
18e ターゲットプローブ
106 細長い部材
107 解剖学的接触部分
108 ターゲット部分
109 インサイズドレープ
110 ターゲット形状
172 外科的配向デバイス
174 光学コンポーネント
176 ブラケット
178 調節機構
180 光
182 大腿部
184 カメラ
190 装着機構
192 装着機構
194 光学コンポーネント
196 磁石
198 磁石
202 第1の表面
204 第2の表面、配向センシングデバイス
300A インパクタ
300B インパクタ
312A シェル
340 スプリング部材
342 第4のカプラ
344 スプリング部材
348 先端部コンポーネント
350 ユニバーサルインパクタアダプタ
352 ユニバーサルインパクタアダプタ
354 磁石
356 クランプ
358 凹部
600 股関節ナビゲーションシステム
602 固定ベース
604 第1のアセンブリ
606 第2のアセンブリ
610 固定ピン
612 固定ピン
620 プラットフォーム
622 サポート
624 固定デバイス
630 ディボット
632 第1のカプラ
634 スロット
635 細長いポスト
636 テーパ付き表面
638 骨盤ブラケット
640 ロックレバー
642 ディテント
644 エクステンション
646 マウント
648 第2のカプラ
652 プローブブラケット
654 ロックレバー
656 ディテント
658 マウント
660 枢動ピン
662 ドック
664 貫通ルーメン
668 第3のカプラ
670 エクステンション
672 マウント
676 プローブインレイ
678 プローブ
680 遠位端部
682 マーキング
700 システム
702 固定ベース
704 第1のアセンブリ
706 第2のアセンブリ
710 固定ピン
712 固定ピン
720 プラットフォーム
722 サポート
724 固定デバイス
726 関節接合部
727 ロック
728 ヘッド
729 接触表面
730 ディボット
732 第1のカプラ
734 スロット
735 細長いポスト
736 テーパ付き表面
738 ブラケット
740 ロックレバー
742 ディテント
744 エクステンション
746 マウント
748 第2のカプラ
752 プローブブラケット
754 ロックレバー
756 ディテント
758 マウント
760 枢動ピン
762 ドック
764 貫通ルーメン
766 ロック
768 第3のカプラ
770 エクステンション
772 マウント
776 プローブインレイ
778 プローブ
780 遠位端部
782 マーキング
784 トラッカー
790 キャリブレーション固定具
792 ドライバ
Fm マーク
Claims (1)
- 明細書において説明され、かつ、図面に図示された方法およびシステム。
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