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Publication numberCN101816588 A
Publication typeApplication
Application numberCN 201010139615
Publication date1 Sep 2010
Filing date18 Feb 2005
Priority date20 Feb 2004
Also published asCA2556102A1, CA2556102C, CA2765204A1, CA2765204C, CN1960680A, CN1960680B, EP1734878A2, EP1734878A4, EP1734878B1, US7235076, US9044252, US20050192575, US20070276397, WO2005081863A2, WO2005081863A3, WO2005081863B1
Publication number201010139615.4, CN 101816588 A, CN 101816588A, CN 201010139615, CN-A-101816588, CN101816588 A, CN101816588A, CN201010139615, CN201010139615.4
Inventors赫克托O帕切科
Applicant赫克托O帕切科
Export CitationBiBTeX, EndNote, RefMan
External Links: SIPO, Espacenet
Piercer with an adjustable hole
CN 101816588 A
Abstract
The invention provides a piercer with an adjustable hole. The hole allows screw or other devices to insert into pediculus arcus vertebrae or other parts of the body. The piercer includes a long sleeve opened on one end and a long piercer body movably mounted inside the sleeve. The piercer body could extend beyond the opening end of the sleeve so as to change the length of the piercer. The piercer also includes a locking device which locks the sleeve at a preselected position. The piercer body is provided with marks for displaying the position relative to the sleeve.
Claims(6)  translated from Chinese
  1. 一种用于开孔的可调整的锥子,该孔供螺钉或其他装置插入椎弓根或身体其他部分,其特征在于:所述锥子包括一端开口的长形外套及活动安装在所述外套内的长形锥子本体,所述锥子本体可以伸长越过所述外套开口端从而改变锥子的长度,所述锥子还包括锁定装置,将所述锥子本体锁定在相对所述外套选定的位置,所述锥子本体上设有标记以显示其相对所述外套的位置。 An adjustable awl for opening the aperture for inserting a pedicle screw or other means, or other body part, characterized in that: said awl comprising elongated outer and activities open end mounted within said housing awl elongate body, the elongate body may awl across the open end of the housing so as to vary the length of the awl, the awl further comprising locking means for locking the awl body in a selected position relative to said housing, the with a mark above awl to display its position relative to the housing.
  2. 2.如权利要求1所述的可调整的锥子,其特征在于:所述外套是射线可穿透的,而所述锥子本体是射线不可穿透的。 2. The adjustable awl of claim 1, characterized in that: the coat is transparent to radiation, but the awl is a ray impenetrable.
  3. 3.如权利要求1所述的可调整的锥子,其特征在于:所述锥子本体上的标记是彩带式的以便于观察。 The adjustable awl 1 according to claim, characterized in that: said tag body awl ribbon on a formula to facilitate observation.
  4. 4.如权利要求1所述的可调整的锥子,其特征在于:所述外套具有可供观察所述锥子本体上的标记的窗口。 The adjustable awl of claim 1, wherein: said housing having a window for viewing the marks on the body of awl.
  5. 5.如权利要求1所述的可调整的锥子,其特征在于:所述外套在其与开口端相对的末端有一个坚固的头部,所述头部构造成适于合适的工具敲打的结构,以在椎弓根或身体其他部位形成孔。 5. The adjustable awl of claim 1, wherein: said housing has a solid head at the end opposite the open end thereof, said head portion adapted suitable tool configured to beat structure to the pedicle or other body parts in a hole.
  6. 6.如权利要求1所述的可调整的锥子,其特征在于:所述锥子本体具有沿中心纵向延伸并贯穿其中的通孔,所述外套之与所述开口端相对的另一端有一中心孔,所述外套中心孔与所述锥子本体通孔纵向对齐,一导线穿过所述锥子本体和外套的通孔和中心孔延伸至所述锥子本体的外端,从而,在锥子移出其所开的孔后,所述导线留在孔中标识该孔,以便螺钉或其他装置的置入。 6. The adjustable awl of claim 1, wherein: the awl having a body extending along a central longitudinal through hole therethrough, said housing open end of said opposite end having a central bore the center hole and the outer body of the awl through holes aligned longitudinally, a wire through the awl and jacket bore extending through-hole and the center to the outer end of the awl, thus, out of which it opened in awl After the hole, leaving the wire in the hole of the identification holes for insertion of screws or other means.
Description  translated from Chinese

一种用于开孔的可调整的锥子 Adjustable awl for opening

[0001] 分案申请说明 [0001] divisional application instructions

[0002] 本专利申请是申请日为2005年2月18日、申请号为200580005451. 3、发明名称为“脊柱外科手术中椎弓根螺钉置入的改进方法”的分案申请。 [0002] This patent application is filed on February 18, 2005, Application No. 200580005451.3, titled "spinal surgery improved method for pedicle screw placement," the divisional application.

技术领域 Technical Field

[0003] 本发明涉及脊柱外科手术技术领域,尤其涉及一种用于开孔的可调整的锥子。 [0003] The present invention relates to the technical field of spinal surgery, and more particularly to an adjustable awl for opening. 背景技术 Background

[0004] 将螺钉置入到人类脊柱是进行大多数脊柱外科手术的共有手术程序,其中典型的是将螺钉置入腰椎和荐椎单节脊椎体的椎弓根。 [0004] The screw placement is carried out most of the human spine spine surgery total surgical procedures, which typically screws into the lumbar and sacral vertebrae pedicle single vertebra. 由于该方法在生物力学效果上胜过其它固定方式,外科医生正不断扩展椎弓根螺钉置入脊柱的范围。 Since the method is better than other fixed manner on the biomechanical effect, surgeons are constantly expand the scope of the spine pedicle screw. 然而,Btt邻脊柱的是大量重要组织和器官,尤其是颈椎和胸椎区域,这些组织和器官对手术创伤的承受力很低,最后可能导致严重的发病率和/或死亡率。 However, Btt adjacent the spine is a lot of important tissues and organs, especially the cervical and thoracic region, these tissues and organs for surgical trauma tolerance is low, may eventually lead to severe morbidity and / or mortality. 因此,大多数专注于椎弓根螺钉置入的研究都以改进保持螺钉在多骨(骨内)环境下的精确度为中心。 Therefore, most focus on research pedicle screw in retaining screw are to improve the accuracy of multi-bone (the bone) under the environment center.

[0005] 图像导航系统不断发展,并愈来愈多地用于帮助医生准确置入螺钉。 [0005] The continuous development of image-guided navigation system, and more and more used to aid in the accurate screw placement. 将椎弓根螺钉置入人体脊柱的关键参数有螺钉的直径、长度、轨线和实际的置入位置。 The key parameters of the human spine pedicle screw has a screw diameter, length, trajectory and the actual placement position. 目前许多图像导航系统都是由人工确定这些参数以提高外科医生的手工置入螺钉的效果。 Many image navigation systems are determined by these parameters to improve the artificial hand-surgeon screws into effect. 到目前为止,还没有系统能为椎弓根螺钉准确置入自动确定椎弓根螺钉理想的直径、长度和轨线。 So far, no system can provide accurate pedicle screw placement automatically determines the ideal pedicle screw diameter, length and trajectory. 本发明提供了这样一种技术,使医生可以利用开方的或经皮的技术将椎弓根螺钉置入,类似于飞行员利用计算机控制的航空技术驾驶飞机。 The present invention provides a technique that can be used prescribing physician or percutaneous pedicle screw technology, similar to pilot the use of computer-controlled aviation technology to fly a plane.

[0006] 于2004年12月2日公开的美国专利申请早期公开第2004/0240715 Al号涉及到了脊柱外科手术中确定椎弓根螺钉置入的方法和计算机系统,该方法中,首先确定最小的椎弓根直径,以确定最佳的椎弓根螺钉轨线以及利用最佳轨线确定每个椎弓根螺钉的最大直径和长度。 [0006] US patent in December 2, 2004 Application Laid-open Publication No. 2004/0240715 Al relates to spinal surgery method and a computer system to determine the pedicle screw placement, the method, first determine the smallest pedicle diameter, to determine the best use of pedicle screw trajectory and determine the optimal trajectories of each pedicle screw diameter and length of the maximum. 二维横向切片数据堆叠形成三维数据点,通过线性最小二乘解确定符合这些数据的最佳轨线,要求最小二乘解能够通过所有最小横向椎弓根宽度。 Dimensional transverse slices stacked to form a three-dimensional data point data by linear least-squares solution to determine the best trajectory of these data, the requirements of the least squares solution through all minimum transverse pedicle width. 这一方法的不足之处在于它包括了偏离轨线的确定,尤其是歪曲的椎弓根剖析,使得确定的螺钉最大直径和长度都减小,导致了生物力学结构上的不足。 The inadequacy of this method is that it includes determining trajectory deviation, especially distorted pedicle analysis, making maximum screw diameter and length are determined decreases, resulting in a lack of biomechanical structure. 与此相反的,本发明中改进了的新方法可通过最佳轨线的确定将轨线总是集中通过椎弓根,该最佳轨线是利用最小横截面区域(峡部) 的中心点及用计算机在相反方向上画出该限制区域的法线的方法确定的,在下文中将进行更详细的描述。 In contrast, the new method of the invention can be improved by determining the optimal trajectory of the rail line is always centralized through the pedicle, the optimal trajectory is to use the smallest cross-sectional area (isthmus) and the center point computer drawn in the opposite direction normal to the restricted area of the method of determination, will hereinafter be described in more detail. 本发明的方法可以确定骨内置入的最大螺钉直径和长度。 The method of the present invention can determine bone built into the largest screw diameter and length.

发明内容 DISCLOSURE

[0007] 本发明利用三维图象和计算机或类似装置生成一表格,该表格提供了最大允许椎弓根螺钉的直径、长度、轨线的主要数据,还生成阐释各椎弓根的数据的示意图。 Schematic invention uses three-dimensional images to a computer or similar device to generate a table that provides the maximum allowable primary data pedicle screw diameter, length, trajectory, and also generate data that explain each pedicle [0007] The present . 医生利用这些数据通过以下方式之一进行实际骨内椎弓根螺钉的置入:1.按医生优选的方法进行手工椎弓根螺钉置入;2.椎弓根基部圆周轮廓法并结合外科手术中的荧光透视法;3.自动椎弓根螺钉置入;或4.任何商业可用的配准软件(例如计算机断层摄影术/荧光透视法 Doctors use the data in one of the following ways within the actual bone of the pedicle screw placement: 1 by the doctor preferred method for manual pedicle screw; 2 pedicle base circumference outline method combined with surgery. The fluoroscopy; 3. automatic pedicle screw; or 4. Any commercially available registration software (such as computer tomography / fluoroscopy

寸乂O Inch Yi in O

[0008] 如果外科医生希望,本发明还可基于轨线进行骨外或椎弓根外进行椎弓根螺钉置入,该轨线始于前皮层附近相同的起点,但与外科医生期望的优选在切向上有一距离或角度。 [0008] If the surgeon hope that the present invention may also be based on rail lines outside bone or pedicle screw pedicle performed, the rail line starts near the beginning of the same premotor cortex, but expectation and the surgeon's preferred In the tangential direction at a distance or angle.

[0009] 本发明通过经椎弓根或在椎弓根周围法使进入脊锥体安全可靠,如锥体成形术、 锥体后凸成形术或者锥体活组织检查。 [0009] The present invention pedicle pedicle around the law or entering ridge cone safe and reliable, such as angioplasty cone, cone kyphoplasty or cone biopsy.

[0010] 此外,本发明还形成了一种新的研究工具,该工具可以提供适于所有脊柱的较小、 较大直径或者普通尺寸的椎弓根螺钉。 [0010] Further, the present invention also formed a new research tool that can provide suitable for all spine smaller or larger diameter pedicle screw normal size.

[0011] 本发明的方法包括以下步骤: [0011] The method of the present invention comprises the following steps:

[0012] 1.首先取得所选的脊柱区域的计算机断层扫描(CT)、磁共振成像(MRI)、CT荧光透视或类似的二维成像法形成的二维图像。 [0012] 1. First, get computed tomography of the selected region of the spine (CT), magnetic resonance imaging (MRI), CT fluoroscopy or similar two-dimensional image formed by two-dimensional imaging method.

[0013] 2.通过CT、MRI或其它方法,或用任何其它适合的方法生成脊柱的真实尺寸的三维计算机图像。 [0013] 2. by CT, MRI or other methods, or to generate a three-dimensional computer image of the true size of the spine by any other suitable method.

[0014] 3.计算机形成单个脊椎体的三维图像,然后用计算机或其它装置将其挖空,类似于一次经椎弓根锥体次切除,将其成为医生期望的规格,例如剩余的锥体皮层或椎根壁的皮层壁厚度。 [0014] 3. The three-dimensional computer image of a single vertebra, and then use a computer or other device to be hollowed out, like a cone times pedicle resection, which was expected to become a doctor specifications, such as the rest of the cone vertebral cortex or cortical wall thickness end wall. 单节脊椎体被形象化为一种去芯的或被挖空的结构,使剩余的脊椎体全部壁通电的或照亮。 Individual vertebra to be visualized as a core or hollowed structure, all of the remaining vertebral body wall powered or illuminated.

[0015] 4.然后计算机根据外科医生优选的椎弓根皮层壁的直径确定任意给定椎弓根的最窄直径或横截区域(峡部)X,自动确定被置入螺钉的最大允许直径。 [0015] 4. Then the computer according to the surgeon preferred to determine the diameter of the pedicle cortical wall at any given pedicle narrowest diameter or cross-sectional area (isthmus) X, the screw is placed automatically determines the maximum allowable diameter.

[0016] 5.然后计算机生成一个从峡部X中心开始沿直线伸长的圆柱,该圆柱确定了理想的轴/轨线,并向例如垂直于椎弓根峡部所在平面的两相反方向延伸,这样就能尽可能地将该圆柱集中设置在椎弓根内部而不接触到通电的或照亮的皮层。 [0016] 5. The computer then generates a start from the center of the isthmus along the line X elongated cylinder, the cylinder to determine the ideal shaft / rail lines, such as perpendicular to the pedicle isthmus where the two planes extend in opposite directions, so You will be able to focus as much as possible the cylinder disposed inside the pedicle without touching the skin energized or illuminated. 所述的直线可以刺穿背部或后椎弓根皮层,这样就能延伸到病人的皮肤外至任意所期望的长度。 The post may be straight or pedicle skin piercing the back, so that we can extend to the outer skin of a patient to any desired length. 所述直线在锥体内部延伸至与预先确定的前内部皮层壁为预定的距离时停止,该距离由外科医生选择,这样它就不会刺穿前外部皮层。 The straight line extending to the inside of the cone at a predetermined distance before stopping the internal cortical wall pre-determined by the surgeon to select the distance, so it does not pierce the front outer skins.

[0017] 6.然后计算机以直线为中心在半径方向上扩展其至最终的最大直径,所述直径不超过根据外科医生优选的皮层壁厚度的定义的最窄椎弓根直径。 [0017] 6. The computer then extended in a straight line as the center thereof to a final maximum diameter not exceeding the diameter of the narrowest according to the surgeon pedicle cortical wall thickness is preferably defined by a diameter in the radial direction. 这种同轴扩展最后形成一个明显的圆柱,当该圆柱外表面上任意一点都与除后侧椎弓根皮层外的通电的或照亮的内侧皮层壁接触时停止构建。 This coaxial extension and finally form a clear cylinder, stops the building when any point on the outer surface of the cylinder are in contact with the skin in addition to the rear side of the pedicle outside energized or illuminated wall inside the cortex. 然而,这种方法不能应用于毗邻已经存在的从峡部产生的直轨迹线的前皮层。 However, this method can not be applied to the anterior cortex adjacent to the existing isthmus generated from straight-line trajectory.

[0018] 7.然后计算机通过测量圆柱的长度确定螺钉的长度,该圆柱始于预定的前内皮层,到其与背/后皮层的交叉点为止。 [0018] 7. A computer then determined by measuring the length of the cylinder length of the screw, the cylinder begins within the first predetermined cortex, to its intersection with the back / rear cortex so far. 为了使螺钉的置入更容易,圆柱可以延长到超过其与背/后皮层的交叉点。 To make it easier to screw placement, it can be extended to the intersection of the cylinder over it with the back / rear cortex.

[0019] 8.然后计算机提供一个数据汇总表和一个理想化的示意图,所述数据汇总表显示了每个单个椎弓根的理想椎弓根螺钉的直径、长度和轨线。 [0019] 8. A computer then provides a data summary table and schematic diagram of an idealized, the data summary table shows each individual pedicle ideal pedicle screw diameter, length and trajectory.

[0020] 9.然后根据最大椎弓根螺钉直径和长度,利用列表的数据确定椎弓根螺钉的生存能力,同样利用列表的数据按外科医生优选的方法进行椎弓根螺钉的置入。 [0020] 9. The pedicle screw and then according to the maximum diameter and length, the use of a list of data to determine the viability of the pedicle screw, the same data by use of a list of preferred methods surgeon pedicle screw placement. 附图说明 Brief Description

[0021] 图Ia和Ib分别是三维计算机图像的侧面和后面,该图像是通过对所选脊柱区域的脊椎体进行CT、MRI或其它研究方式而形成。 [0021] FIG. Ia and Ib, respectively side and rear three-dimensional computer image, the image is formed by the selected region of the spine vertebral bodies were CT, MRI, or other research methods.

[0022] 图2是从如图Ia和Ib所示的脊柱区域经人工切除后的单节脊椎体的三维计算机图像。 [0022] FIG. 2 is a region of the spine shown in Figure Ia and Ib by three-dimensional computer image of artificial removal after a single vertebra.

[0023] 图3是一个挖空的单节脊椎体的计算机图像,显示了椎弓根内最窄直径或横截面区域(峡部)。 [0023] FIG. 3 is a computer image of a hollowed out individual vertebra, showing the pedicle narrowest diameter or cross-sectional area (isthmus).

[0024] 图4是一个挖空的单节脊椎体的计算机图像,显示了穿过峡部中心并沿相反方向延伸穿过后椎弓根皮层及前内皮层的直线。 [0024] FIG. 4 is a computer image of a hollowed out individual vertebra, showing the isthmus through the center and extending in opposite directions through the straight-line after pedicle cortex and frontal cortex of.

[0025] 图5是圆柱形成的示意图,该圆柱以穿过峡部中心的直线为中心轴,在半径方向上扩展而成。 [0025] FIG. 5 is a schematic view of a cylindrical form, the cylinder to a straight line passing through the center of the isthmus to the central axis, extend in the radial direction is made.

[0026] 图6a和6b分别是挖空的对称和不规则形状的单节脊椎体的示意图。 [0026] Figures 6a and 6b are schematic hollowed out individual vertebra of symmetry and irregularly shaped.

[0027] 图7a和7b分别是直的和弯曲的椎弓根的峡部的示意图。 [0027] Figures 7a and 7b are schematic isthmus straight and curved pedicle.

[0028] 图8是挖空的脊椎体的示意图,显示了用于确定椎弓根螺钉长度的圆柱的长度。 [0028] FIG. 8 is a schematic view of a hollowed out vertebra showing the means for determining the length of the cylinder of the pedicle screw length.

[0029] 图9是单节脊椎体的侧视图,显示了外科医生为椎弓根螺钉的安装而标记的单节脊椎体。 [0029] FIG. 9 is a side view of a single vertebra, showing the individual vertebra surgeon pedicle screw installation marks.

[0030] 图IOa是一个由计算机生成的数据汇总表,该表包括最大椎弓根螺钉直径和长度,还包括椎弓根螺钉相对于矢状面和横截面的轨线角度。 [0030] FIG IOa is a summary table of data generated by the computer, the table contains the maximum pedicle screw diameter and length, but also with respect to the sagittal pedicle screw and the angle of the cross-section of the rail line.

[0031] 图IOb是一个脊椎体的侧视图,显示了矢状面及图IOa中轨线角度的性质。 [0031] FIG IOb is a side view of a vertebra showing the sagittal plane and FIG IOa rail line angle properties.

[0032] 图IOc是一个脊椎体的平面示意图,显示了横截面及图IOa中轨线角度的性质。 [0032] FIG IOc is a schematic plan view of a vertebral body, it shows a cross section and FIG IOa rail line angle properties.

[0033] 图IOd是一个脊椎体的后视图,显示了冠状面及图IOa中轨线角度的性质。 [0033] FIG IOd is a rear view of a vertebra showing the coronal plane and FIG IOa rail line angle properties.

[0034] 图11是计算机根据图IOa中数据汇总表定义的理想椎弓根螺钉置入生成的示意图表,并展示置入面的冠状面轨线。 [0034] FIG. 11 is a schematic diagram of a computer-generated list placed according to FIG IOa data tables define ideal pedicle screw and the rail line to show the coronal plane into faces.

[0035] 图12是最大可利用螺钉尺寸参数表,该表的数据与图IOa中的数据汇总表的数据相对应,还包括椎弓根基部圆周轮廓线(冠状面)和椎弓根点A到点B的距离。 [0035] FIG. 12 is the maximum size parameter table with screws, data summary table of data in the table in Fig IOa data corresponds, including pedicle base circumference contour (frontal plane) and pedicle point A B's point distance.

[0036] 图13是计算机根据图12表中的数据生成的螺钉置入的示意图表。 [0036] FIG. 13 is a computer based on the data generated in the table in Figure 12 screws into a schematic form.

[0037] 图14a是一个脊椎体的侧视图,显示了峡部和椎弓根基部圆周。 [0037] Figure 14a is a side view of a vertebra showing the isthmus and the pedicle base circumference.

[0038] 图14b是一个脊椎体的平面示意图,显示了由计算机生成的在横截面和冠状面穿过椎弓根基部圆周的圆柱。 [0038] FIG. 14b is a schematic plan view of a vertebra showing in cross-section and coronal plane through the pedicle base circumference of the cylinder generated by the computer.

[0039] 图14c、14d和14e分别是腰椎、胸椎和颈椎区域的脊椎体的平面图,显示了每个脊椎体中峡部和椎弓根基部圆周的关系。 [0039] FIG. 14c, 14d and 14e are plan lumbar, thoracic and cervical vertebral body area, showing the relationship between each vertebra in the isthmus and the pedicle base circumference.

[0040] 图14f和14g是一个脊椎体的后视图,显示了用于在脊椎体中产生椎弓根螺钉定位孔的锥子的定位。 [0040] FIG. 14f and 14g is a rear view of a vertebra showing the positioning of pedicle screws used to generate awl positioning holes in the vertebral body of the.

[0041] 图14h显示了一个脊椎体两个对齐的后视图,并显示一个人工确定的通过椎弓根基部圆周中心的椎弓根螺钉方向线。 [0041] Figure 14h shows a two vertebra aligned rear view, and display is determined by an artificial pedicle screw pedicle base circumference direction of the center line.

[0042] 图15a、15c和15e显示了一个脊椎体在不同方位的后视图,并显示一计算机生成的通过其椎弓根基部圆周的椎弓根螺钉圆柱。 [0042] FIG. 15a, 15c and 15e shows a rear view of the vertebral body in different directions, and displays a computer generated pedicle base circumference through which the pedicle screw cylinder.

[0043] 图15b、15d和15f分别显示了图15a、15c和15e所示脊椎体的侧视图。 [0043] FIG. 15b, 15d and 15f show the 15a, 15c and 15e vertebral body shown in side view.

[0044] 图16是通过椎弓根T1、T2、T4和T5中心的CT轴视图,显示了与每个脊椎体在手术中的前后位荧光透视成像结合后的椎弓根形态、峡部和椎弓根定位孔进入点的确定。 [0044] FIG. 16 is a pedicle T1, CT isometric view T2, T4 and T5 center, showing the pedicle morphology anteroposterior fluoroscopic imaging in conjunction with each of the vertebral body after surgery, and vertebral isthmus pedicle positioning holes into the determined points.

[0045] 图17a和17b是本发明中可调整锥子的不同实施例的侧视图。 [0045] Figures 17a and 17b is a side view of the present invention, various embodiments of the adjustable awl.

[0046] 图18a是单节脊椎体和椎弓根基部圆周在手术中前后位荧光透视成像的示意图。 [0046] FIG. 18a is a schematic view individual vertebra and pedicle base circumference during surgery anteroposterior fluoroscopic imaging.

[0047] 图18b是计算机生成的脊椎体的三维图像的示意图,并显示了由计算机置入的椎弓根圆柱和椎弓根基部圆周。 [0047] FIG. 18b is a schematic diagram of a three-dimensional image of the vertebral body computer generated and displayed by a computer into a cylindrical pedicle and pedicle base circumference.

[0048] 图18c是图18a和图18b的配准图象示意图。 [0048] FIG. 18a and FIG. 18c is a schematic diagram of the registration image and 18b.

[0049] 图19a是本发明的双环椎弓根螺钉排列装置的侧视图。 [0049] Figure 19a is a side view bicyclic pedicle screw aligning apparatus of the present invention.

[0050] 图19b是图19a所示装置的主视图。 [0050] Figure 19b is a front view of the device shown in FIG. 19a.

[0051] 图19c和19d单节脊椎体的平面视图,分别显示了经皮环境和开放的外科手术环境中双环椎弓根螺钉排列装置的使用。 [0051] FIG. 19c and 19d plan view of a single vertebra, show the environment using percutaneous and open surgical environment bicyclic pedicle screw arrangement device.

[0052] 图20是本发明的双环椎弓根螺钉排列装置另一实施例的主视图。 [0052] FIG. 20 is a front view of the bicyclic pedicle screw aligning apparatus of the present invention to another embodiment.

[0053] 图21a和21b是分别本发明钻孔套管部分第一实施例的尾部的侧视图和主视图, 该套管部分用于图19a和19b所示的双环椎弓根螺钉排列装置。 [0053] Figures 21a and 21b are respectively a side view of the present invention and a front view of the embodiment of the rear portion of the first embodiment of the sleeve bore, the sleeve portion 19a to FIG bicyclic pedicle screw aligning apparatus shown and 19b.

[0054] 图22a和22b是本发明钻孔套管部分第二实施例的尾部的侧视图和前视图,该套管部分用于图19a和19b所示的双环椎弓根螺钉排列装置。 [0054] Figures 22a and 22b are side and front views borehole casing portion of the second embodiment of the present invention, the tail, the sleeve portion for pedicle screw arrangement bicyclic Figures 19a and 19b and the device shown.

[0055] 图23a是一个槽形外套管的立体图,该外套管与图19a和19b中双环椎弓根螺钉排列装置配套使用。 [0055] Figure 23a is a perspective view of a channel-shaped outer tube, the outer tube 19a and 19b in FIG bicyclic supporting the use of pedicle screw aligning apparatus.

[0056] 图23b是图23a所示的槽形外套管的主视图,双环椎弓根螺钉排列装置中的一个排列环置入其中。 [0056] FIG. 23b is a front view of the grooved outer tube shown in Fig. 23a, bi- pedicle screw arrangement means an arrangement into which ring.

[0057] 图24是一个挖空的脊椎体的示意图,显示了不同的椎弓根螺钉轨线,其一具有中心的或理想的轨线,另一具有骨外或椎弓根外轨线,骨外或椎弓根外轨线偏离中心轨线。 [0057] FIG. 24 is a schematic diagram of a hollowed vertebral body, pedicle screws show different trajectories, one with a center or desired trajectory, the other with a bone or pedicle rail line, bone or pedicle rail line from the center rail lines.

[0058] 图25是一个脊椎体的平面示意图,显示了依照本发明方法进行的椎弓根螺钉的安装。 [0058] FIG. 25 is a schematic plan view of a vertebral body showing the method according to the present invention pedicle screw mounting.

具体实施方式 DETAILED DESCRIPTION

[0059] 本发明确定椎弓根螺钉的尺寸和置入位置的方法将在下文中进行详细描述。 [0059] The present invention determines the size and placement of pedicle screw position method will be described in detail below.

[0060]步骤 1 [0060] Step 1

[0061] 首先取得选择的脊柱区域的计算机断层扫描(CT)、磁共振成像(MRI)、CT荧光透视法或类似的二维成像方法形成的二维图象。 Two-dimensional image [0061] First, computed tomography of the spine to achieve the selected region (CT), magnetic resonance imaging (MRI), CT fluoroscopy or similar two-dimensional imaging method of formation. 为了增加准确性和详细度,优选薄分割区段。 In order to increase the accuracy and detail, preferably thin dividing sections.

[0062]步骤 2 [0062] Step 2

[0063],根据步骤1的CT、MRI或其它任何适当的方法取得的图象制得如图Ia和图Ib所示脊柱的具有真实尺寸的三维计算机图像。 [0063] The image prepared in step 1 of CT, MRI or any other suitable method was obtained as shown with a life-size three-dimensional computer image of the spine and Fig. Ia Ib.

[0064]步骤 3 [0064] Step 3

[0065] 如图2所示的三维单节脊椎体然后用计算机挖空成外科医生期望的规格(例如剩余的椎体皮层或椎弓根壁的皮层壁的厚度),类似于一次经椎弓根锥体次切除(eggshell transpedicular vertebral corpectomy)。 [0065] three-dimensional individual vertebra shown in Figure 2 and then use the computer to a surgeon hollowed desired size (for example, skin or the rest of the vertebral pedicle cortical wall thickness of the wall), similar to a through arch root cone times resection (eggshell transpedicular vertebral corpectomy). 这些规格允许不对称的厚度,例如,前椎体皮层可能厚五毫米,侧椎体壁厚七毫米,而椎弓根壁只有一毫米厚;或者椎体皮层壁一律五毫米厚,而椎弓根壁只有一毫米厚或者与此类似。 These specifications allow asymmetrical thickness, for example, before the vertebral cortex may be five millimeters thick, the side wall thickness vertebral seven millimeters, while the pedicle walls only one millimeter thick; or cortical wall of the vertebral body will be five millimeters thick, while the arch only one millimeter thick root wall or similar. 该单节脊椎体可以被形象化为一种去芯的或被挖空的结构,使剩下的脊椎体可以一种合适的方式将其全部锥体壁通电(electrified)或照亮(highlighted)。 The individual vertebra can be visualized as a knockout or go the core structure, so that the rest of the vertebral body may be an appropriate way to electrify the entire cone wall (electrified) or illuminated (highlighted) .

[0066]步骤 4 [0066] Step 4

[0067] 然后,计算机通过测量根据外科医生对椎弓根皮层壁的直径参数选择选定的椎弓根的最窄直径或横截区域(峡部)x,自动确定被置入螺钉的最大允许直径,如图3所示。 [0067] Then, the computer pedicle cortical wall diameter parameter selection pedicle selected narrowest diameter or cross-sectional area (isthmus) x, automatically determine the placement of the screw diameter by measuring the maximum allowed according to the surgeon , as shown in Fig.

[0068]步骤 5 [0068] Step 5

[0069] 然后计算机生成一个从峡部X中心开始沿如图4所示直线10伸长的圆柱,该圆柱确定了理想的轴/轨线,并向例如垂直于椎弓根峡部所在平面的两相反方向延伸,这样就能尽可能地将该圆柱集中设置在椎弓根内部而不接触到剩下的皮层,在峡部中心形成支点。 [0069] The computer then generates a start in the direction from the center of the isthmus X 10 as shown in Figure 4 straight elongated cylinder, the cylinder to determine the ideal shaft / rail lines, such as perpendicular to the pedicle isthmus where two opposite plane extending, as much as possible so that we can collectively set the cylinder internal pedicle without touching the rest of the cortex, in the center of the isthmus forming the fulcrum. 所述的直线可以刺穿背部或后椎弓根皮层,这样就能延伸到病人的皮肤外至任意所期望的长度。 The post may be straight or pedicle skin piercing the back, so that we can extend to the outer skin of a patient to any desired length. 所述直线在锥体内部延伸至与预先确定的前内部皮层壁为预定的距离(例如5 毫米)时停止,该距离由外科医生选择,这样它就不会刺穿前外部皮层并且还可以最大化螺钉直径,详后述。 The straight line extending to the interior of the cone and the front wall of the internal cortex predetermined predetermined distance (for example 5 mm) is stopped, the distance from the surgeon to select, so that it will not pierce the outer cortex before and also the maximum of the screw diameter, described in detail later.

[0070]步骤 6 [0070] Step 6

[0071] 如图5所示,然后计算机以直线10为中心在半径方向上扩展至其最终的最大直径,所述直径不超过基于外科医生优选的皮层壁厚度确定的最窄椎弓根直径。 [0071] As shown in Figure 5, and then the computer 10 as the center of a straight line extended to its final maximum diameter in the radial direction, the narrowest diameter less than the diameter of pedicle cortical wall thickness is preferably determined based on the surgeon. 这种同轴扩展最后形成一个可见的圆柱12,当该圆柱外表面上任意一点都与除后侧椎弓根皮层外的内侧皮层壁接触时停止构建。 This coaxial extension and finally form a visible cylinder 12 stops the building when any point on the outer surface of the cylinder are in contact with the outer skin layer in addition to the rear side of the pedicle medial cortical wall. 形成的圆柱中心有起始直线10,该起始直线10可以用与圆柱12不同的颜色或模式来鉴别。 Formed in the center of the cylinder 10 has a starting straight line, the straight line 10 starting with the cylinder 12 may be a different color or pattern to identify. 如下文所述,圆柱12可以越过其与背/后皮层的交点,以便按下文所述的一种自动化方法将螺钉置入。 As described below, the cylinder 12 may be past its intersection with the back / rear cortex, in order to press an automated method will be described screw placement.

[0072]步骤 7 [0072] Step 7

[0073] 对于那些有不规则剖面的椎弓根,如图6b所示,或如图7b所示的弯曲的椎弓根或类似的畸形,允许的最大螺钉直径实际上小于最窄直径方法确定的直径,从而避免了椎弓根皮层壁破裂。 [0073] For those who have irregular cross-sectional pedicle, pedicle curved as shown, or, as shown in Fig. 6b, 7b or the like deformity, the maximum allowable screw diameter substantially less than the diameter of the narrowest method for determining diameter, thus avoiding the pedicle cortical wall rupture.

[0074]步骤 8 [0074] Step 8

[0075] 然后计算机通过测量圆柱12的长度确定椎弓根螺钉的长度,参阅图8,所述圆柱的长度是从靠近预定的前内侧皮层的点D到其与背/后皮层的交点A之间的距离。 [0075] The computer then by measuring the length of the cylinder 12 determines the length of the pedicle screw, see Figure 8, the cylinder near a predetermined length from the medial cortex and back to its point D / A of the intersection after the cortex the distance between.

[0076]步骤 9 [0076] Step 9

[0077] 然后计算机产生一个数据汇总表,如图IOa所示,该表显示了每个单节脊椎体椎弓根的理想椎弓根螺钉的直径、长度和轨线(如图IOb和IOc所示,以相应的上端面20为参考面,轨线是通过测量横截面和矢状面相对参考面的角度而得),还提供了图11所示的理想示意图。 [0077] The computer then generates a data summary table, IOa As shown, the table shows each individual vertebra pedicle ideal pedicle screw diameter, length and trajectory (Figure IOb and IOc the shows, on a corresponding end surface 20 of the reference plane, relative to the reference trajectory is a cross-sectional plane, and by measuring the sagittal angle derived), also provides an ideal schematic diagram 11 shown in FIG. 参阅图9,经医生鉴定的特殊的脊椎体被加上标签,然后计算机用医生确认的精确脊椎体标签自动标记剩下的脊椎体。 Referring to Figure 9, the doctors identified special vertebral body is labeled, then the computer with a doctor to confirm the exact vertebral body tags automatically mark the rest of the vertebral body.

[0078]步骤 10 [0078] Step 10

[0079] 然后利用表格中的数据确定使用基于如图12所示的最大直径和长度的椎弓根螺钉的生存能力,所述数据同样被用来按外科医生的优选方法确定螺钉的置入。 [0079] and then use the data in the table to determine the maximum use of pedicle screw diameter and length as shown in Fig. 12 based on the viability of the data is also used to determine the screw placement by the surgeon's preferred method. 图12还提供了单节椎弓根基部从点A到B的圆周轮廓线(冠状轨线)及它们各自的长度。 Figure 12 also provides a single pedicle base from point A to B of the circumferential contour (coronal trajectory) and their respective lengths. 实际使用的螺钉尺寸是基于外科医生选用的商业上可用的螺钉。 Screw the actual size is chosen based on the surgeon commercially available screw. 一旦外科医生在所选椎弓根螺钉系统内提供可用螺钉的尺寸范围,计算机就能自动确定并产生所述表格,同时产生一个理想化的前后位示意图(冠状)、带有图13所示数据的侧面和横截面图。 Once the surgeon screws available within a selected size range pedicle screw system, the computer can automatically determine and generate the table, while producing an idealized schematic anteroposterior (coronal), with the data shown in FIG. 13 side and cross-sectional view. 此外,这个系统还为外科医生提供一种基本能力,即根据单节脊椎体基部选择不同于最大可用直径的直径,并且将这些变化并入到数据汇总表和图中。 In addition, this system also provides the surgeon a basic capacity, i.e. the maximum usable choose a different diameter according to the diameter of the base of individual vertebra, and these changes are incorporated into the data summary table and FIG.

[0080] 步骤11-手工椎弓根螺钉置入 [0080] Step 11 Hand pedicle screw

[0081] 然后,外科医生按他或她优选的方法,并利用理想化的示意图和汇总的数据完成椎弓根螺钉的置入。 [0081] Then, the surgeon according to his or her preferred method, and the use of idealized schematic and summarized data to complete the pedicle screw placement.

[0082] 步骤12a_椎弓根基部圆周轮廓法_人工确定 [0082] Step 12a_ pedicle base circumference outline method _ artificial OK

[0083] 这种方法利用解剖学中意义重大的X光照相技术拍摄的脊椎体图像来匹配如图IOd和11所示的冠状面理想的椎弓根螺钉轨线。 [0083] This method utilizes anatomical significance of the X-ray photography captured image to match the vertebral body as shown IOd and coronal ideal pedicle screw trajectory 11 shown in FIG. 特别地,在标准的X光照片或荧光透视成像所看到的放射线密度圆周线与椎弓根基部圆周相符。 In particular, in the standard X-ray or fluoroscopic imaging radiation density seen circumference and pedicle base circumference match. 椎弓根基部圆周B被定义为椎弓根壁和它过渡到脊椎体的皮层接合点。 Pedicle base circumference B is defined as the pedicle wall and its transition to the cortical junction vertebral body. 所述椎弓根基部圆周显然不同于椎弓根峡部,但是对于单节脊椎体而言,在某些情况下它们是同一个或非常接近,在图14a到14e中可以看到。 The pedicle base circumference is clearly different from the pedicle isthmus, but for a single vertebra, in some cases they are the same or very close, can be seen in FIG. 14a to 14e are.

[0084] 对于椎弓根基部圆周技术的人工利用,参阅图14b,首先利用相应的穿过椎弓根的横截面X光图像人工确定通过椎弓根峡部X的理想轨线。 [0084] For use artificial pedicle base circumference technology, see Figure 14b, first through the pedicle using the corresponding cross-sectional X-ray images manually determined by the desired trajectory of the pedicle isthmus X. 然后测量椎弓根峡部X,从而确定最大直径的椎弓根螺钉,轨线被用来确定椎弓根螺钉的最大长度。 Then measuring the pedicle isthmus X, to determine the maximum diameter of the pedicle screw, the rail line is used to determine the maximum length of the pedicle screw. 然后,如图14b所示, 通过鉴别椎弓根壁到脊椎体的过渡确定椎弓根基部圆周B。 Then, as shown in FIG. 14b, by identifying the pedicle wall transition vertebral body to determine the pedicle base circumference B. 最后,测量A到B的长度,并利用该长度校准合适的工具,例如下文所述的长度可变的锥子,所述A到B的长度对应于后皮层A上的起点到与椎弓根基部圆周B的交点之间的长度。 Finally, measure the length A to B, and use the proper length calibration tools, such as variable length awl described below, the starting point of the A to B corresponds to a length of the upper skin layer A and pedicle base the length of the intersection between the circumference B. 如图14h所示,点A和点B应该关于椎弓根基部圆周从椎弓根基部圆周的顶部(头部)和底部(尾部)边缘集中。 As shown in Figure 14h, point A and point B should be on the top of the pedicle base circumference pedicle base circumference (head) and bottom (trailing) edge set. 然后结合理想轨线和椎弓根基部圆周确定点A关于椎弓根基部圆周前后方向上的位置和点B在椎弓根基部圆周内部的位置。 And then combined with the ideal trajectory and pedicle base circumference to determine the point A on the front and rear of the pedicle base circumference direction position and the position of the point B in the interior of the pedicle base circumference. 所述椎弓根基部圆周轮廓线具有类似于每个单节脊椎体的前后位X光图像的圆形外形。 The pedicle base circumference having a similar outline to each individual vertebra in the anteroposterior X-ray image of a circular shape.

[0085] 对于椎弓根螺钉的人工置入,可以利用标准荧光透视单元排列各个单节脊椎体的上端面,使其平行于所述荧光透视图像。 [0085] For artificial pedicle screw placement, using standard fluoroscopy unit arranged on the end face of each individual vertebra to be parallel to the fluoroscopic image. 此外,当具有头部脊椎体的脊椎体上端面用对称圆盘空间荧光透视形象化时,及当脊椎体通过椎弓根基部圆周轮廓在荧光透视前后位图像上可以明显识别其距每个椎弓根的距离相等时,脊椎体居中放置。 Further, when the vertebral body having a head end surface of the vertebral bodies with symmetrical fluoroscopic visualization of the disc space and vertebral body through the pedicle base circumference outline can be clearly identified on the anteroposterior fluoroscopic images of each vertebra when their distance It is equal to the distance pedicle, vertebral body centered. 当每个脊椎体有不同的两个椎弓根时,例如天生畸形、瘤、骨折等,该居中放置依然可以进行。 When each vertebra has two different pedicle, for example a natural deformity, tumors, fractures, which can still be centered. 然后在荧光透视成像下,将一经适当校准的长度可变的锥子或其他合适的工具T从椎弓根定位孔的起点A插入相应的脊椎体的后皮层,并向椎弓根内推进至点B,参阅图14f和14g。 Then under fluoroscopic imaging, will a properly calibrated variable length awl or other suitable tool T inserted cortex corresponding vertebral body pedicle positioning holes starting from A, to advance to the point pedicle B, see Fig. 14f and 14g. 这种置入在荧光透视下确定,并在与理想轨线对齐的直线上绘出A和B两点。 Such placement under fluoroscopy to determine and draw two points A and B on the ideal trajectory aligned straight. 工具T被重新调长,更进一步向脊椎体内部推进至点D或改用其他椎弓根探测锥或相似的工具。 Tool T is re-adjusted long, vertebral body to further advance the inside to the point D or switch to other pedicle awl or similar tool to detect. 然后探测椎弓根内骨质的完整性,打开定位孔,具有适当直径和长度的椎弓根螺钉置入到脊椎体。 Then probe pedicle bone integrity, open the positioning holes with appropriate diameter and length of pedicle screw into the vertebral body.

[0086] 根据步骤12a,穿过椎弓根Tl、T2、T4、T5中心的CT轴视图,如图16所示,结合在手术中每个脊椎体的前后荧光透视成像,展示了椎弓根形态、峡部和椎弓根定位孔进入点的人工确定。 [0086] According to step 12a, through the pedicle Tl, T2, T4, T5 center CT isometric view, shown in Figure 16, the front and rear binding fluoroscopic imaging during surgery each vertebral body, pedicle shows shape, isthmus and the pedicle positioning holes into the manually determined points. 椎弓根螺钉的长度、直径和轨线已经确定。 Pedicle screw length, diameter and rail lines have been identified. 椎弓根基部圆周轮廓线由右下角圆代表,并被用来作为识别椎弓根定位孔进入点的一致性手术标记。 Pedicle base circumference of the circle represents the contour line from the bottom right corner, and is used as an identification pedicle positioning holes into the consistency of operation marked point. 例如,椎弓根Tl和Τ2 的起点A分别是大约2个和1. 25个椎弓根基部圆周,如在手术中的前后位荧光透视成像上所见(圆内部用圆点显示)。 For example, the starting point A Τ2 pedicle Tl and were about 2 and 1.25 pedicle base circumference, as in surgery anteroposterior fluoroscopy saw (circular internal display dots) imaging. 椎弓根Τ4和Τ5的定位孔分别是0. 9和0. 8个椎弓根基部圆周。 Pedicle Τ4 and positioning holes Τ5 were 0.9 and 0.8 pedicle base circumference.

[0087] 步骤12b_椎弓根基部圆周轮廓法_半自动[0088] 这种方法类似于步骤12a,除了点A和B与椎弓根基部圆周轮廓是由计算机在构建了椎弓根圆柱后确定的。 [0087] Step 12b_ pedicle base circumference outline law _ semiautomatic [0088] This method is similar step 12a, in addition to points A and B and pedicle base circumference outline is constructed by a computer pedicle cylinder Determine a. 然后这些数据汇总进图12。 The data is then aggregated into 12. 所述数据还包括矢向和横向轨线与上端面和中线的夹角度数。 The data also include the number of folders angle sagittal and transverse rail line and the center line of the upper end face. 长度可变的锥子或其它工具,例如,可以适当调整到图12中的特定椎弓根距离AB,并按照步骤12a中描述的方法在标准荧光透视图像下将螺钉置入。 Variable length awl or other tool, for example, can be appropriately adjusted to the 12 specific pedicle distance AB, and in accordance with the method described in Step 12a standard fluoroscopic image under the screw placement.

[0089] 步骤12c-椎弓根基部圆周轮廓法_全自动 [0089] Step 12c- pedicle base circumference outline law _ Automatic

[0090] 这种方法进一步扩展了本技术,可以实时成像和多个脊椎体形象化,呈现椎弓根螺钉置入情况。 [0090] This approach further expansion of this technology, real-time imaging and visualization of multiple vertebral body, showing pedicle screw cases. 产生的数据与图12中的一样,除了椎弓根基部圆周轮廓和标识点A和B是动态的,也不要求如步骤12a和12b中要求的脊椎体居中放置或上端面平行于荧光透视成像。 12 as data generated map, in addition to the pedicle base circumference outline and identify the points A and B is dynamic and does not require such steps 12a and 12b in the vertebral body requirements centered on the end face or parallel to the fluoroscopic imaging . 荧光透视成像的脊椎体通过任何适当的方法登记在计算机上,形成带有相应的计算机生成的椎弓根圆柱的脊椎体。 Fluoroscopic imaging of the vertebral body by any suitable method registered on the computer, with the formation of vertebral body pedicle corresponding computer-generated cylinder. 然后点A和B被显现出来,如图15a、15c和15e中所示,显示了按图12更新的实时图像。 Then A and B are apparent, as 15a, 15c and 15e shown in Figure 12 shows the updated real-time images. 长度可变的锥子或其它工具,例如,可以调整到大约适合每个单个脊椎体从点A开始推进到点B的长度。 Variable length awl or other tool, for example, can be adjusted to suit each individual vertebra about from point A to point B began to advance length. 注意,任意合适的工具,如不可调整的锥子,可以按本发明方法不同于可调整的锥子使用。 Note that any suitable tools, such as non-adjustable awl, may be different according to the method of the present invention to use an adjustable awl.

[0091] 步骤13-可调整的可变长度的锥子 [0091] Step 13- adjustable variable length awl

[0092] 点A到点B的距离(图14b),即后皮层到与椎弓根基部圆周的交点的距离,被用来设置可调整的长度可变的锥子的长度A到B,所述锥子用来在荧光透视成像下开设椎弓根定位孔。 [0092] from point A to point B (FIG. 14b), i.e., after the point of intersection with the distance from the cortex to the pedicle base circumference, is used to set the variable length awl adjustable length A to B, the awl to open the pedicle positioning hole under fluoroscopic imaging. 在椎弓根螺钉置入的一系列步骤中,形成该椎弓根定位孔是第一步,从计算机指出的识别起点A开始,一旦它完全固定,就产生椎弓根圆柱并将其推进到点B。 Pedicle screw in a series of steps, the formation of the pedicle positioning hole is the first step to start from the computer pointed to identify a starting point A, once it is fully seated, it creates a cylindrical pedicle and advance to Point B.

[0093] 参阅图17a,锥子100包括一个用来插入锥子本体的射线可穿透的外套102,其末端开口,用来移动地支持射线不可穿透的锥子本体104。 [0093] Referring to Figure 17a, awl 100 includes an insert awl rays penetrate the coat to 102, its open-ended, for moving the support ray impenetrable awl 104. 所述锥子100完全可以调整到与A 到B的长度一致的长度,也可以设置以防止锥子进一步推进超过图14b和其它图中可见的任何距离A到B。 The awl 100 can be adjusted to coincide with the A to B in the length may be provided in order to prevent further advance the awl over Fig. 14b and other figures seen in any distance A to B.

[0094] 一旦A到B的距离在X光线成像中被确定,外科医生可以调整所述锥子点A到点D 的任意长度,即图14b中最后的螺钉长度。 [0094] Once the A to B is determined from the X-ray imaging, the surgeon can adjust the length of any awl point A to point D, i.e., in Figure 14b the last length of the screw. 这种锥子100最好具有能承受用槌棒或类似物敲打的结构,而其直径也足够窄用来穿透皮肤。 This awl 100 preferably has to withstand beat with a mallet or similar structure, and its diameter narrow enough to penetrate the skin. 为了便于显示深度,锥子本体104可以按固定的增量106用颜色或其他方式标记,如5毫米或10毫米。 For ease of display depth, awl member 104 can be fixed by increments of 106 color or otherwise marked, such as 5 mm or 10 mm.

[0095] 锥子100外部末端具有用于敲打的坚固的头部108,还有合适的锁定装置110,如螺钉锁定装置,用来在相对于外套102的期望的位置锁定锥子本体104。 [0095] awl outer end 100 has a head 108 of the beat of the solid, as well as suitable locking means 110, such as a screw locking means for the housing 102 with respect to the desired position of the lock body 104 awl. 所述锥子还有一个窗口112或其它标记,用来显示锥子本体104的位置或长度。 There is also a window 112 of the awl or other mark used to show the position of the body 104 awl or length. 图14f和14g显示了一个正在推进椎弓根内部开设螺钉定位孔的锥子。 Figure 14f and 14g show is promoting a pedicle screw internal positioning holes opened awl.

[0096] 图17b揭露了一个改进的可调整的锥子300,包括可插导管的或空的锥子本体304 和一个具有中心孔309的头部308,这样一个导线311可以穿过头部和锥子本体304延伸至其内端。 [0096] Figure 17b uncovered an improved adjustable awl 300, includes a catheter or empty awl 304 and a head 309 having a center hole 308, so the head can pass through a wire 311 and awl 304 extending to its inner end. 在定位孔用锥子300打通后,导线311可以留在定位孔中适当的位置,从而在后面的步骤中方便用它的位置为椎弓根螺钉的置入导航。 After positioning holes 300 opened with an awl, wire 311 may remain in the positioning holes in the appropriate location, making it easy to use its position as a pedicle screw placement navigation in a later step.

[0097] 步骤14-双环排列装置 [0097] Step 14- bicyclic arrangement device

[0098] 对于在手术中自动置入椎弓根螺钉的方法,有用到具有真实尺寸的三维脊柱模型,该模型中具有计算机自动置入的椎弓根螺钉圆柱,所述圆柱定义了椎弓根螺钉的长度、 直径和轨线。 [0098] For the automatic operation of the pedicle screw method, useful for the three-dimensional model of the spine with the real dimensions of the computer model with automatic placement of pedicle screw cylinder, the cylinder defines a pedicle screw length, diameter and rail lines. 另外,还用到椎弓根基部圆周轮廓数据,以利手术中成像的记录。 In addition, the pedicle base circumference outline data used to facilitate surgical imaging records.

[0099] 手术中实时进行荧光透视检查,以准确记录单节脊椎体基部的三维模型。 [0099] intraoperative fluoroscopy performed in real time, in order to accurately record the three-dimensional model of a single vertebra base. 这种荧光透视的脊椎体成像被集中在监控器上,并由外科医生鉴别出特别的脊椎体(例如T2,T3 等)。 This fluoroscopic imaging of vertebral bodies is concentrated on the monitor by the surgeon identify the particular vertebral body (e.g., T2, T3, etc.). 相应的具有真实尺寸的三维单节脊椎体模型与荧光透视图像配准,如图18a、18b和18c所示。 The corresponding three-dimensional individual vertebra model with fluorescent perspective with realistic size image registration, as 18a, 18b and 18c in FIG. 上述步骤可以在如外科手术般的暴露的脊柱上进行或经由皮肤进行。 The above steps can be carried out on the skin or via a surgically exposed spine.

[0100] 该配准是利用内部脊椎体骨性标记进行,这些标记是荧光透视成像中所见的椎弓根基部圆周,该圆周起于椎弓根皮层壁连接脊椎体的汇合处。 [0100] This registration is the use of internal vertebral body bone markers, these markers are seen fluoroscopic imaging pedicle base circumference of the circumferential wall connections from the cortex to the pedicle vertebral body meet. 如前文所述,这些椎弓根基部圆周形成圆形或是椭圆形,基于脊椎体相对于荧光透视成像中的旋转,可以改变其外形和平方面积。 As mentioned above, the pedicle base circumference to form a circular or oval shape, based on the vertebral bodies relative to the rotation of fluoroscopic imaging, and can change its shape square area.

[0101] 然后,手术中的荧光透视图像和计算机生成的椎弓根基部圆周轮廓进行配准,通过确保轮廓线重叠和测量的平方面积相等及确保椎弓根间距离相等来获得配准的精确度。 [0101] Then, the operation of fluoroscopic images and computer generated pedicle base circumference outlines registration, and ensure equal square area by ensuring that overlap and contour measurement equal to the distance between the pedicle to get accurate registration degrees. 这种配准方法消除了将X光线成像标记锚定在病人骨骼上的要求,这种要求特别不利于经皮置入的应用。 This registration method eliminates the X-ray imaging markers anchored in the bone of the patient requirements that do not particularly conducive to the percutaneous implantation of applications. 这种方法还允许一个脊椎体自由独立地向另一个脊椎体移动,来展示计算机产生的模型的符合性,所述方法在不稳定脊柱中尤其有用。 This method also allows a free and independent vertebral body to vertebral body moves to another to demonstrate compliance of a computer-generated model, the method is particularly useful in an unstable spine. 外科医生在手术中确认椎弓根基部圆周的配准充分,以进行椎弓根螺钉的置入。 The surgeon confirmed during surgery pedicle base circumference of full registration, for pedicle screw placement. 所述方法允许计算机生成的模型增大或减小,以匹配手术中的荧光透视成像。 The method allows a computer generated model to increase or decrease to match the operation of the fluoroscopic imaging.

[0102] 现在包括计算机生成的椎弓根基部圆周和椎弓根圆柱的完整的三维图像接着被投射到手术中的荧光透视成像上。 [0102] Now a complete three-dimensional computer-generated images include the pedicle base circumference and pedicle cylinder is then projected onto the surgery fluoroscopic imaging. 如图19a和19b所示,计算机生成的椎弓根螺钉圆柱200 穿过后皮层并凸出到病人体外,并被两个分离的同线环202、204截取及延伸穿过该同线环202、204。 As shown in Fig. 19a and 19b, the computer generated pedicle screw cylinder 200 protrude through the skin and into the patient's body, and with the line separating the two rings 202,204 interception and extends through the same line ring 202, 204. 该环安装在一个配套的锚定在病床或其他支持物上(未显示)的支架206上, 环的尺寸允许截取计算机圆柱图像和将锥子套管插入。 The ring is mounted on a supporting anchor in bed or other support (not shown) of the bracket 206, the size of the ring to allow the interception of computer graphics and will awl cylindrical casing inserted. 第一个环202在靠近后皮层区域208或刚好在体外截取计算机椎弓根螺钉圆柱,而第二个环204在距第一个环202任意期望的距离处截取计算机椎弓根螺钉圆柱。 The first ring 202 in the region 208 near the cortex in vitro or just intercept computer pedicle screw cylinder, and the second ring interception computer pedicle screw cylinder 204 away from the first ring 202 in any desired distance. 两个环之间的距离越大,螺钉的置入就越准确。 The greater the distance between the two rings, screw placement more accurate. 环202、204对计算机椎弓根圆柱的截取在计算机监控器上显示,展示环相对计算机椎弓根圆柱200移动。 Ring 202 to intercept computer pedicle cylinder display on a computer monitor, showing ring opposite the computer pedicle cylinder 200 moves.

[0103] 图19c和19d分别显示了经皮环境和开放的外科手术环境中从脊椎体VB伸出并穿过环202、204的计算机生成的圆柱200和直线210。 [0103] FIG. 19c and 19d show the environment percutaneous and open surgical environment extends from the vertebral body VB and through the loop 202, 204 computer-generated column 200 and line 210.

[0104] 椎弓根圆柱的截取发生在两个层面上。 [0104] pedicle cylinder taken place on two levels. 计算机椎弓根圆柱200中心线210及其外围圆柱组成,首先,环202、204需要被置于中心线210和椎弓根圆柱200中心。 Computer pedicle cylinder centerline 200 210 and its peripheral cylindrical composition, first ring 202, 204 and 210 need to be placed in the center line of the pedicle cylinder 200 centers. 第二,环与脊椎体配准以便在计算机监控器上跟踪其移动,例如通过LED装置。 Second, the ring vertebral body registration in order to track its movement on a computer monitor, for example, by LED devices. 第三,环的内部直径与计算机生成的椎弓根圆柱200的直径匹配。 Third, the matching diameter of the inner diameter of the computer generated pedicle cylindrical ring 200. 有多种具有不同直径的移动环可供外科医生期望的椎弓根螺钉系统利用。 There are a variety of mobile ring having different diameters desirable for the surgeon pedicle screw system uses. 第四,为了与计算机生成的椎弓根圆柱的直径相匹配,环被构造成可以以任意合适的方式改变其直径,如图20所示,环202由可移动连接的部分212制成, 该可移动连接的部分212可以旋转来改变环的直径的。 Fourth, to the diameter of the cylinder and the computer generated pedicle match ring can be configured in any suitable manner to change its diameter, as shown, the ring 202 is made of a portion 212 of the movable connection 20, the movable connection portion 212 can be rotated to change the diameter of the ring. 计算机椎弓根圆柱与环的配准是在计算机监控器上被鉴别和确定的。 Computer pedicle cylinder and ring registration is to identify and determine on a computer monitor.

[0105] 所述同线环202、204现在形成了一个用来放置钻孔套管214的通道(图21a和21b),该钻孔套管也被固定在支架206上。 [0105] The ring line 202 is now formed with a passage bore 214 to place the cannula (FIG. 21a and 21b), the borehole casing is also fixed to the bracket 206. 在钻孔套管214内设有一个坚固的套管元件216 (图21a和图21b)或一个特别的内部套管元件218 (图22a和22b),该特别的套管元件内具有多个窄小的可移动的纵向平行的金属杆220,其中心开口可以放置锥子。 In borehole casing 214 features a rugged casing element 216 (Fig. 21a and 21b) or a special inner sleeve member 218 (Fig. 22a and 22b), especially within the sleeve member having a plurality of narrow small movable parallel to the longitudinal metal rod 220, the central opening can be placed awl. 这些金属杆220可以让内部套管元件218平稳地放置在不平坦的表面上。 The metal rod 220 can make a smooth inner sleeve member 218 is placed on an uneven surface. 这种特征在后皮层钻孔区域提供了额外的稳定性以避免钻子被拴牢。 This feature in the cortex drilling area provides additional stability to prevent the drill is tied firmly. 另外,特别的内部套管元件218允许这些金属杆缩回,从而荧光透视可以清楚的呈现椎弓根内部的钻孔过程。 In addition, the special inner sleeve member 218 is retracted to allow these metal rods, which can be clearly presented fluoroscopy internal pedicle drilling process. 外科医生可以使用任一种方式。 The surgeon can use either way.

[0106] 然后椎弓根被钻孔至所期望的预先校准的深度,不会超过预定的椎弓根螺钉的长度。 [0106] pedicle then be drilled to the desired depth of the pre-calibrated, does not exceed a predetermined length of the pedicle screw. 然后用椎弓根探测器探测椎弓根以确保骨质的完整性。 Then probe the pedicle with pedicle probe to ensure the integrity of the bone.

[0107] 实际的螺钉置入中,一种特别的槽形外套管230(图23a和23b)被置于与同线环202、204同一条直线上。 [0107] The actual screw placement, a special grooved outer tube 230 (FIG. 23a and 23b) are placed on the same line with the same 202,204 loops. 这种槽形外套管230也连接在支架206或其他锚定装置上。 This grooved outer casing 230 is also connected to the bracket 206 or other anchoring device. 然后旋转所述环大约90度(未显示)并从槽形外套管230上收回。 Then rotating the ring about 90 degrees (not shown) and to recover from the trough outer tube 230. 槽形外套管的可调整的内部直径足以容纳任意具有螺纹和变化的头部的椎弓根螺钉。 Adjustable inner diameter of the outer sleeve groove sufficient to accommodate any changes in the head with a thread and pedicle screws. 适当的椎弓根螺钉(未显示) 被放入承载它的螺丝起子,置入槽形外套管,然后置入各自的椎弓根。 Appropriate pedicle screws (not shown) is placed in its carrying screwdriver, slotted into the outer sleeve, and then placed in their respective pedicle.

[0108] 对于改进的可调整的并列环,如图20所示,图23a中的槽形外套管230可以选择使用,环202、204可以留在一定的位置并被调整至一个完全开放的位置从而让螺丝起子可以插入并通过。 [0108] for an improved adjustable parallel loop, shown in Figure 20, in Figure 23a slotted outer sleeve 230 may choose to use, ring 202, 204 can stay in position and adjusted to a fully open position so that a screwdriver can be inserted through.

[0109]步骤 15 [0109] Step 15

[0110] 现在有商业可利用的软件包能够将病人手术前的三维脊椎图像与手术中荧光透视图像在手术中配准。 [0110] There are commercially available software packages can take advantage of three-dimensional images of the spine in patients before surgery and intraoperative fluoroscopic image registration during surgery. 这种功能与本发明的方法相结合,可以提供汇总的数据资料和理想化的图表。 This feature and the method of the present invention in combination, can provide data and idealized graph summary. 后面的信息将为实际椎弓根螺钉的置入提供基础,这如前文所述或根据医生的优先选择。 Behind the actual information will provide the basis for pedicle screw placement, which as previously described, or according to the doctor's preference.

[0111]步骤 16 [0111] Step 16

[0112] 有些外科医生宁愿从骨外或椎弓根外置入螺钉,那是因为椎弓根螺钉的尺寸太小,难以提供可以利用的螺钉尺寸,对于这些医生来说,计划用奇怪的螺钉置入大的椎弓根或计划用与剖面轴相对的直头螺钉植入,也可以用本发明的方法。 [0112] Some surgeons prefer placement of pedicle screws from the bone or outside, it is because of the pedicle screw size is too small, it is difficult to provide screw sizes can be utilized for these doctors, plans to use a strange screw into large pedicle or plans to use the cross-sectional axis relative to the straight-head screws implanted, it can also use the method of the present invention. 本发明是这样实现:获取所有理想化的数据,然后由外科医生偏移椎弓根定位孔进入口,该偏移是从理想轨线的正切方向偏移任意期望的距离,也就是说,前螺钉位置在枢轴点D,计算机椎弓根圆柱12从该点产生,如图24所示。 The present invention is achieved by: Get all idealized data, and offset by the surgeon pedicle positioning hole into the mouth, the offset is the offset distance from any desired ideal trajectory tangential direction, that is, before screw position at pivot points D, computer pedicle cylinder 12 generated from that point, as shown in Fig. 此外,这些变化将被自动记载,并结合这些变化产生新的理想化的前后视图、侧视图和轴视图。 In addition, these changes will be automatically recorded and produced in conjunction with these changes before the new idealized view, side view and isometric view. 不管是用椎弓根基部圆周方法,还是用自动排列方法,还是用商业上可用的CT/荧光透视配准法,都可以用这些数据进行螺钉的置入。 Whether using pedicle base circumference method, or with automatic alignment method, or with a commercially available CT / fluoroscopy registration method, you can use these data screw placement. 对于椎弓根基部圆周方法,定位孔的长度被定为可以让合适长度的锥子或其他工具置入。 For the pedicle base circumference method, the length of the positioning hole is set to be able to make proper length awl or other tool placement.

[0113] 作为一个实施例,图25显示了用螺丝起子22或类似工具安装椎弓根螺钉20的示意图,椎弓根螺钉穿过峡部X中心。 [0113] As an example, Figure 25 shows a schematic of a screwdriver or similar tool to install 22 pedicle screws 20, the pedicle screws through the isthmus X Center.

[0114] 所述的本发明的方法的许多步骤都是计算机产生的,值得注意的是,任何合适的设备或装置都可以用来实现本发明方法的这些步骤。 [0114] a number of steps of the method of the present invention is a computer-generated, it is worth noting that any suitable device or devices may be used to implement the method of the present invention, these steps.

[0115] 以上所揭露的仅为本发明的较佳实施例而已,当然不能以此来限定本发明之权利范围,因此依本发明申请专利范围所作的等同变化,仍属本发明所涵盖的范围。 [0115] disclosed above is only a preferred embodiment of the present invention only, of course, can not be used to limit the scope of the claimed invention, therefore equivalent to the change under this patent scope of the invention made, it is still covered by the scope of the invention .

Classifications
International ClassificationA61B17/17, A61B19/00, A61B17/88, A61B17/16, A61F2/30
Cooperative ClassificationA61B34/10, A61B2090/376, A61B17/1671, A61B17/1615, A61B17/1604, A61B17/1757
European ClassificationA61B17/16S4, A61B17/17S4
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