TWI461176B - 手術導航 - Google Patents

手術導航 Download PDF

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TWI461176B
TWI461176B TW097104115A TW97104115A TWI461176B TW I461176 B TWI461176 B TW I461176B TW 097104115 A TW097104115 A TW 097104115A TW 97104115 A TW97104115 A TW 97104115A TW I461176 B TWI461176 B TW I461176B
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drill
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Ravish V Patwardhan
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Interactive Neuroscience Ct Llc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3472—Trocars; Puncturing needles for bones, e.g. intraosseus injections
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1695—Trepans or craniotomes, i.e. specially adapted for drilling thin bones such as the skull
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1703—Guides or aligning means for drills, mills, pins or wires using imaging means, e.g. by X-rays
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1637—Hollow drills or saws producing a curved cut, e.g. cylindrical
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
    • A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
    • A61B2017/349—Trocar with thread on outside
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/107—Visualisation of planned trajectories or target regions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B2090/103—Cranial plugs for access to brain
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/11—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/14—Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins

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  • Orthopedic Medicine & Surgery (AREA)
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Description

手術導航
本發明係關於手術導航。
本發明係關於一種進入腦之手術導航方法，其包括建立經由頭蓋骨進入腦直至靶之軌跡，使用鑽子在頭蓋骨中鑽孔，及使用影像導引在鑽孔期間驗證該所鑽之孔之軌跡。
該態樣之實施例可包括一或多個下列特徵。由鑽子所容納之探針提供影像導引。探針容納於鑽子所界定之內腔中。該方法包括將接取構件置放於鑽孔中，且置放期間驗證接取構件之軌跡。使用鑽子置放接取構件，且使用由鑽子所容納之探針驗證軌跡。
本發明係關於一種手術導航系統，其包括一管狀鑽子、一管狀接取構件及一用於使該接取構件耦合於該鑽子且使鑽子與接取構件之套管維持對準之耦合構件。該接取構件相對於該耦合構件可移動，如此可使接取構件固定於組織，同時耦合構件維持套管之對準。
該態樣之實施例可包括一或多個下列特徵。該系統包括容納於管狀鑽子中之探針。該系統包括鑽頭。
本發明係關於一種手術套組，其包括一管狀鑽子、一管狀接取構件、一使該接取構件耦合於該鑽子之耦合構件及一收納於管狀鑽子內之探針。該態樣之實施例亦可包括一鑽頭、一醫學裝置及/或一機器手臂。
本發明之一或多個實施例之詳情陳述於隨附圖式及以下 描述中。由描述及圖式及申請專利範圍，本發明之其他特徵、目的及優點將顯而易見。
參考圖1，影像導引軌跡系統10包括一用於建立一組至靶位點之軌跡之接取構件12、一管狀鑽子14及一在接取構件12固定於患者頭蓋骨20期間使接取構件12耦合於管狀鑽子14之耦合構件桿16。同時展示於圖1中的為容納於鑽子14中且向下延伸約鑽子14之長度之一半的探針18，例如BrainLab探針(可獲自BrainLab Cranial Navigation System)或Integra探針(可獲自Integra Lifesciences)。探針18耦合於影像導引系統19，例如BrainLab影像導引系統或Integra影像導引系統，其循跡探針18相對於患者之腦之圖像的軌跡。在接取構件12固定於頭蓋骨20期間將探針18容納於管狀鑽子14中確保接取構件12建立至靶位點之想要軌跡。
參考圖2，接取構件12包括一界定內腔24之主體22及一界定與內腔24對準之內腔28之夾緊構件26。主體22具有一具有螺紋區32的遠端部分30，該螺紋區32與頭蓋骨嚙合以將接取構件固定於頭蓋骨20。圍繞遠端部分30為設定接取構件12可***頭蓋骨中之深度之限深器34。主體22具有一具有兩個向外延伸的翼38的近端部分36，該兩個向外延伸的翼可與操作者之手嚙合且轉動以使接取構件12擰入頭蓋骨中
夾緊構件26具有一由主體22之近端部分36容納且相對於主體22可轉動之螺紋延伸部分40。夾緊構件26作用於位於 近端部分36內之夾頭42，如此夾緊構件26之轉動使得夾頭42夾緊及釋放容納於內腔24及28中之桿16(圖3)。
參考圖4，在將接取構件12固定於頭蓋骨20之前，操作者使用管狀鑽子14在頭蓋骨20中鑽導向孔60。使用鑽頭62及容納於鑽子14中之探針18，操作者在影像導引下鑽導向孔60，如此使導向孔60與想要的預定的至安置於腦內之靶之軌跡對準。圍繞鑽頭62的為可移動之限深器64，其設定鑽頭62可***頭蓋骨中之深度。
鑽導向孔後，如圖1中所示，操作者用桿16及連接接取構件12替代鑽頭62。桿16延伸至鑽子14中約3.5cm且延伸至接取構件12中約3.5cm以使鑽子14與接取構件12軸向對準。操作者將接取構件12置放於導向孔60之入口且使用探針18沿至靶位點之想要軌跡對準接取構件12。操作者隨後鬆開夾頭26，如此接取構件12可相對於桿16轉動使接取構件12進入頭蓋骨20中。雖然接取構件12轉動期間桿仍連接於鑽子14且仍在內腔24、28內，但在接取構件桿12前進期間，桿16不必移動，亦即，不轉動。雖然對翼38施加力以使接取構件12擰入頭蓋骨20中，但操作者使用定位於鑽子14內之探針18驗證接取構件12沿軌跡之對準。
操作者隨後自接取構件12移出鑽子14及桿16。參考圖5，接取構件12現建立一組將各種醫學裝置70(例如，腦室造口導管(ventriculostomy catheter)、其他對流療法引導導管(directed catheters for convection therapy)、癲癇症深部電極(epilepsy depth electrode)、熱凝探針(thermocoagulation probe)、病變探針(lesioning probe)、立 體定位針(stereotactic needle)及消融探針(ablative probe))引入靶位點72之軌跡。操作者僅需要控制醫學裝置前進之深度，在許多情況下，該深度可使用導航軟體預先決定。
為進一步增加裝置經由接取構件12置放之準確性，在接取構件固定於頭蓋骨20後，鑽子14可直接固持接取構件，且可使醫學裝置穿過鑽子及接取構件到達靶位點。
管狀鑽子可獲自Stryker(4200 Cordless Driver 2)，且可與用於固持鑽頭62及桿16之降低式卡盤(step down chuck)一起使用。
影像導引軌跡系統10之各種組件可以套組80(圖6)形式出售，一次性的或非一次性，包括系統10之一或多個組件。舉例而言，可將管狀鑽子14、接取構件12、耦合構件16及鑽頭62封裝在一起從而以一次性套組形式出售。或者，可將該四種組件中之一或多種之任何組合封裝在一起從而以一次性套組形式出售，例如可僅將接取構件12、耦合構件16及鑽頭62封裝在一起，可僅將接取構件12及耦合構件16封裝在一起等。探針18亦可包括在上述一次性套組之任何各種組合中，例如一次性套組可包括探針18、鑽子14、接取構件12及耦合構件16。此外，一或多種醫學裝置70可包括在一次性套組(包括具有探針18之套組)之任何各種組合中。所有組件不必為一次性的。各種組件可以具有影像導引系統19之系統形式出售。
參考圖7，管狀鑽子14在由機器手臂82(例如BrainLab機器手臂)使用期間，可加以支撐。可操作機器手臂82以將 管狀鑽子14之位置固定於選定軸中。機器手臂82較佳由用於固定頭部之裝置84、例如Mayfield頭部固持器支撐。機器手臂82可包括在任何上述套組組態中。
在不背離本發明之精神及範疇之情況下，可進行各種修改。因此，其他實施例在下列申請專利範圍之範疇內。
10‧‧‧影像導引軌跡系統
12‧‧‧接取構件
14‧‧‧管狀鑽子
16‧‧‧耦合構件桿/耦合構件/桿
18‧‧‧探針
19‧‧‧影像導引系統
20‧‧‧頭蓋骨
22‧‧‧主體
24‧‧‧內腔
26‧‧‧夾緊構件
28‧‧‧內腔
30‧‧‧遠端部分
32‧‧‧螺紋區
34‧‧‧限深器
36‧‧‧近端部分
38‧‧‧翼
40‧‧‧螺紋延伸部分
42‧‧‧夾頭
60‧‧‧導向孔
62‧‧‧鑽頭
64‧‧‧限深器
70‧‧‧醫學裝置
72‧‧‧靶位點
80‧‧‧套組
82‧‧‧機器手臂
84‧‧‧固定頭部之裝置
圖1說明用於在導航導引下將接取構件置放於頭蓋骨中之管狀鑽子。
圖2為接取構件之部分橫截面視圖。
圖3為使接取構件耦合於管狀鑽子之耦合構件之側視圖。
圖4展示用於在頭蓋骨中鑽孔之管狀鑽子。
圖5展示用於使醫學裝置定位於腦內之靶位點之接取構件。
圖6說明含有系統之組件之例示性一次性套組。
圖7說明支撐管狀鑽子之機器手臂。
10‧‧‧影像導引軌跡系統
12‧‧‧接取構件
14‧‧‧管狀鑽子
16‧‧‧耦合構件桿/耦合構件/桿
18‧‧‧探針
19‧‧‧影像導引系統
20‧‧‧頭蓋骨
26‧‧‧夾緊構件
38‧‧‧翼

Claims (15)

  1. 一種導引系統(10)，其包括：一接取構件(12)，其藉由固定於一組織而建立至一靶位點之一軌跡；一管狀鑽子(14)，其具有一長度；一耦合構件(16)，其用於在該接取構件(12)的固定期間，將該接取構件(12)耦合於該鑽子(14)；及一探針(18)，其設於該管狀鑽子(14)內，且延伸約該管狀鑽子(14)之長度之一半；其中該探針(18)導引該接取構件(12)至該靶位點之軌跡的對準。
  2. 如請求項1之導引系統，其中該耦合構件(16)維持該管狀鑽子(14)與該接取構件(12)之內腔之對準。
  3. 如請求項1或2之導引系統，進一步包括一鑽頭(62)，該鑽頭連接於該管狀鑽子(14)。
  4. 如請求項1或2之導引系統，其中該接取構件(12)包括一夾緊構件(26)，用以夾緊至容納於一內腔(28)內之一裝置。
  5. 如請求項1或2之導引系統，其中該接取構件(12)包括一主體(22)，該主體具有一近端部分(36)，其具有兩向外延伸之翼(38)，可助於該接取構件(12)進入該靶位點中。
  6. 如請求項1或2之導引系統，進一步包括一醫學裝置(70)，以藉由該接取構件(12)引入一靶位點。
  7. 如請求項6之導引系統，進一步包括一導航軟體，可決定該醫學裝置(70)的進入深度。
  8. 如請求項7之導引系統，其中該醫學裝置(70)包括一腦室造口導管、對流療法導管、癲癇症深部電極、熱凝探針、病變探針、立體定位針及消融探針。
  9. 如請求項1或2之導引系統，其中該探針(18)耦合於一影像導引系統(19)。
  10. 如請求項9之導引系統，其中該影像導引系統(19)循跡探針(18)相對於一患者之圖像的軌跡。
  11. 如請求項4之導引系統，其中該接取構件(12)包括一主體(22)，該主體具有一近端部分(36)，其具有兩向外延伸之翼(38)，可助於該接取構件(12)進入該靶位點中，且其中該夾緊構件(26)包括一螺紋延伸部分(40)，其由主體(22)之近端部分(36)容納且相對於該主體(22)可轉動。
  12. 如請求項3之導引系統，其中該鑽頭(62)可用來鑽一導向孔於該組織內。
  13. 如請求項1或2之導引系統，進一步包括一機器手臂(82)以支持該管狀鑽子(14)。
  14. 如請求項1或2之導引系統，進一步包括一機器手臂(82)以將該管狀鑽子(14)之位置固定於一選定軸中。
  15. 如請求項11之導引系統，其中該主體(22)具有一遠端部分(30)，該遠端部分被一限深器(34)圍繞，該限深器(34)可設定該接取構件(12)***該靶位點的深度。
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