JP6372784B2 - A system that provides the position of creating a screw insertion hole in surgery in real time - Google Patents

Description

  The present invention relates to a system that detects a drilling position, a drilling direction, and a drilling depth in real time when creating a screw insertion hole in a surgical operation, and transmits it to an operator.

  One of the spine operations is a procedure to insert a screw into the spine. Generally, the screw is placed in the pedicle of each vertebra in the lumbar vertebra and cervical vertebra, but the nerve network and ligaments exist around the pedicle, so a screw insertion hole is created. If they are damaged when creating an insertion hole with a device (such as a drill or owl), a serious condition will occur. In addition, if the screw insertion hole is made on an accurate track and the screw cannot be inserted, the screw will escape and the fixing force will decrease. Therefore, advanced techniques and experience are required for surgery.

  In conventional spine surgery, first, CT images of the spine are acquired before surgery, and the optimal screw insertion position is planned based on the CT images. During the operation, a fluoroscopic device is used to display a fluoroscopic image of both the blade tip of the screw insertion hole creation device (drill) and the spine on the screen, and a doctor who refers to the positional relationship and anatomical position of both. This determines the screw insertion position and direction. At this time, since the X-ray fluoroscopic image during surgery is two-dimensional, it is difficult to obtain an accurate screw insertion position and direction during surgery. The adjustment of the perforation direction and the determination of the perforation depth are carried out at the discretion of the doctor with reference to the images obtained with a fluoroscope.

Although it is expensive and difficult to install in many hospitals, there is a navigation system using an infrared camera as a method to solve the above.
In this method, first, a spine-up (back-up) image of the spine is performed by a CT scanner before surgery, and a three-dimensional image of the spine is created on a computer from a detailed two-dimensional tomographic image (in virtual space). The optimal screw placement is planned by looking at the obtained 3D image. Next, we will move on to intraoperative work. First, using a tracking system that recognizes the position of the marker in the real space with a CCD camera using infrared rays, the patient's spine position (real space) and the 3D image created by CT The registration work is done to match the position of the spine (virtual space) and the coordinate system of the real space and the virtual space.
In this work, first, an infrared marker indicating the reference position is attached to the spine, and images of the front, rear, and side are taken with a fluoroscope. Next, while taking a fluoroscopic image, moving the drill with an infrared marker on the bone surface and confirming the positional relationship between the spine and the drill, the preoperative CT image and the intraoperative bone fluoroscopic image And match the position on the image (virtual space) with the actual screw insertion position (real space). In a navigation system using an infrared camera, preoperative CT imaging is performed in the supine position due to structural limitations of the device, but it is prone (prone) during surgery. 3D images in the virtual space become inaccurate because the shape of the spine image and the position of the spine change before and during the operation due to different postures before and during surgery and torsion of the body. In addition, the position of the spine is not constant due to the procedure performed during the operation, resulting in navigation errors. In particular, it is difficult to grasp the screw insertion direction, angle, and depth. The preparation of the screw insertion hole requires repeated confirmation of the drilling direction, angle, and depth. Technology and experience are required.

  In the latest navigation system, a method of performing intraoperative CT imaging (O-arm imaging) is known. In this method, CT images are taken during surgery. During the operation, the spine in the prone position is accurately computed by CT, and a three-dimensional image in the virtual space is constructed. This system is difficult to install in many hospitals due to the large size of the equipment, the time required for intraoperative work, and the high cost.

  Computer navigation is also used to perform arthroscopic anterior cruciate ligament reconstruction for anterior cruciate ligament injury. This is a method of performing CT and MRI imaging before surgery, constructing a three-dimensional image in virtual space, aligning the target joints during surgery, and performing navigation. This enables highly accurate navigation. However, it is necessary to fix the reference frame to the bone and there is a risk of fracture. In addition, it is difficult to install in many hospitals because the navigation device becomes large, time is required for the operation, and it is expensive.

Open osteosynthesis is performed for fractures. At that time, a fluoroscope is used for screw fixation in intramedullary nail insertion and plate fixation. However, there is a risk that a clear image of the fracture cannot be obtained and X-ray irradiation takes a long time and the exposure dose increases.

Special table 2007-52285 gazette JP 2008-229332 A JP 2011-218180 A

In conventional surgical operations, CT images of the spine are acquired before surgery, and the optimal screw insertion position is planned based on the CT image. However, during the operation, the screw is placed in the correct direction and depth at the planned position. It was difficult to create an insertion hole.
The present invention is equipped with sensors in the bone imaging device and screw insertion hole creation device used during surgery, and detects the insertion hole creation position, direction and depth of the pedicle screw in real time, and provides information to the operator. It is intended to provide.

The present inventors have devised a system for accurately creating a screw insertion hole in a surgical operation. The present invention provides the following means.
[1] Bone imaging device (1) used before surgery;
A bone imaging device (2) used during surgery;
A screw insertion hole creation device (3);
A bone position reference device (4);
Computer (5),
A display device (6);
In a system for surgery constituted by
The system
Bone imaging device (2) equipped with at least one of the sensors that detect the imaging position, imaging direction, and imaging angle (10), and the drilling position, drilling direction, drilling distance, drilling trajectory, A screw insertion hole creation device (3) equipped with at least one of the sensors for detecting (12),
With
Store the detected information in the computer,
This system is characterized in that one or more information among the drilling position, drilling direction, drilling distance, drilling trajectory, etc., is transmitted to the operator in real time when creating a screw insertion hole for bone.
[2] A system according to the system described in item 1 above, wherein a screw insertion hole creating device including a display device (14, 18, 26) is used.
[3] In the system according to item 1, the bone imaging device (1) used before the operation, the bone imaging device (2) used during the operation, the screw insertion hole creating device (3), and the bone position A system characterized in that at least two or more of a reference device (4), a computer (5), and a display device (6) are linked in a wireless or wired manner.
[4] The system according to the above item 1, comprising a function (7, 8, 9, 11) for communicating with an external device outside the system or a network.
[5] In the system described in item 1 above, images taken before surgery, images taken during surgery, proper screw placement planned before surgery, and drilling by a bone screw insertion hole creation device detected in real time A system characterized in that information is transmitted to the surgeon by displaying (27, 28) at least one of the position, direction, and trajectory on the screen.
[6] In the system according to claim 1, an image taken before the operation, an image taken during the operation, an appropriate screw arrangement planned before the operation, and a screw insertion hole creation device for the bone detected in real time. A system characterized by transmitting at least one of position, direction, and trajectory to a surgeon by sound or voice.
[7] In the system described in the preceding item 1, an electronic device having at least one of a communication function, a storage function, a calculation function, a voice recognition function, and an image display function is used instead of a computer. system.
[8] The system according to item 1 above, further comprising a bone position reference device (4) used during the operation, equipped with at least one of the sensors for detecting the fixed position, the fixed direction, and the fixed angle, and is more accurate. A system that can be enhanced.

The method of the present invention can detect the position of the pedicle screw insertion hole in real time and transmit information to the operator. This makes it possible to accurately create the screw insertion hole according to the screw insertion position, direction and depth planned before surgery. Since accurate pedicle screw insertion is possible, it is possible to avoid the deviation of the screw from the pedicle, thereby reducing the fixation force, and avoiding paralysis due to the screw contacting or compressing the spinal cord. It minimizes the amount of radiation exposure of patients and shortens the operation time. In addition, the system can be built at low cost, so it is expected to spread.

It is a system diagram of an example of the best mode for carrying out the present invention. In order to carry out the present invention, an example of a system using a pre-operative imaging device equipped with a sensor and a screw insertion hole creating device (drill) equipped with a sensor and a device in which the device and the device are linked by a communication device. It is a figure of. It is a figure of one form of the screw insertion hole creation apparatus (drill) equipped with the display apparatus and sensor for implementing this invention. It is a conceptual diagram of the spine shape. It is an example of a conceptual diagram of insertion position detection when creating a pedicle screw insertion hole. It is an example of a conceptual diagram for creating a pedicle screw insertion hole. It is an example of the screen of the display device equipped in the screw insertion hole creation device (drill).

  Hereinafter, exemplary embodiments of the present invention will be described in detail, but the present invention is not limited to the exemplary embodiments.

  FIG. 1 shows one of the best modes for carrying out the present invention. In a surgical operation for creating a pedicle screw insertion hole, in one embodiment, a bone imaging device used before surgery, a bone imaging device used during surgery, a screw insertion hole creation device, preoperative and The system consists of a computer that stores images taken during surgery and a display device as the main components.

FIG. 2 shows a preoperative bone imaging device equipped with a sensor and a screw insertion hole creating device (drill) equipped with a sensor and a sensor, in which the device and the device are linked by a communication device in order to carry out the present invention. It is an example of the system used.
In the present invention, a CT image photographing device as a bone image photographing device used before surgery, a X-ray fluoroscopic device as a bone image device used during surgery, a drill as a screw insertion hole creating device, and a bone position reference device 4. , And computers 5 and 6 equipped with display devices.

  In the present invention, among the sensors for detecting the imaging position, imaging direction, and imaging angle, the X-ray fluoroscopic apparatus 2 equipped with at least one sensor 10 used during the operation, the drilling position, the drilling direction, the drilling distance, and the drilling trajectory The drill 3 equipped with at least one sensor 12 is used.

  In the present invention, the constituent devices 1, 2, 3, 4, 5, and 6 are linked wirelessly by the communication devices 7, 8, 9, 11, and 13. In the wireless cooperation here, it is preferable to use an electromagnetic wave of 1 GHz to 3 THz, but an electromagnetic wave of 3 THz to 400 THz, or 400 THz or more may be used.

  In the present invention, the cooperation between the component devices 1, 2, 3, 4, 5, 6 is preferably a wireless method, but may be a wired method. In the wired cooperation here, at least one of optical fiber cable, coaxial cable, and twisted pair cable is used.

The combination of each component device 1, 2, 3, 4, 5, 6 may be a method combining wireless and wired.
Further, the devices 7, 8, 9, 11, and 13 that perform communication may have a function of communicating with devices other than the system shown in FIG. 2 or with an external network.
By providing linkage or external communication functions, the information on the proper insertion position of the screw planned before surgery and the physical quantity detected by the sensor during the procedure can be compared in real time, or from an external database. The information necessary to perform proper surgery can be provided to the surgeon.

  Information detected by the fluoroscope 2 and the drill 3 is transmitted to and stored in the computer 5. The computer compares the proper arrangement of the screw planned and memorized before the operation with the current drilling position, drilling direction, drilling distance, drilling trajectory detected by the sensor, and advances the drilling, for example. Calculate the drilling direction to be corrected and the remaining distance to the end of drilling.

  In the present invention, the drill 3 having the display device 14 is used so that information can be easily transmitted to the operator. Information calculated by the computer is displayed on the display devices 6 and 14 in real time.

  As one embodiment of the present invention, it is preferable to use a CT imaging device and an X-ray fluoroscopy device as a bone imaging device. As the bone imaging device, a nuclear magnetic resonance imaging device (MRI), a CT cable fluoroscopy Devices, ultrasound imaging devices, or similar 2D or 3D bone imaging devices can be selected.

  In the system of the present invention, in addition to the storage function, an electronic device or portable terminal provided with at least one of a communication function, a storage function, a voice generation function, a voice recognition function, and an image display function is replaced with a computer. May be used.

  In the system of the present invention, an electronic device or portable terminal provided with at least one of a communication function, a sound generation function, and a voice recognition function in addition to a storage function and an image display function is replaced with a computer and a display device. May be used.

  In the present invention, the sensor equipped in the intraoperative X-ray fluoroscope 2 is preferably one or more of an acceleration sensor, a magnetic orientation sensor, a global positioning system receiver, an infrared camera, and a visible light camera. , Sensors based on other principles may be equipped. More preferably, the sensor and camera are multi-axis and multi-eye, but uni-axis and monocular may be selected.

  In the present invention, when a global positioning system receiver is used, several position information distribution devices according to the global positioning system may be installed in the operating room.

FIG. 3 is a diagram of one embodiment of a screw insertion hole creating apparatus for carrying out the present invention.
In the present invention, a screw insertion hole creating device provided with a display device 18 is used so that information can be easily transmitted to the operator. The display device 18 is preferably a small monitor integrated with the screw insertion hole creating device, but information can be transmitted and received between the screw insertion hole creating device and the display device by wireless or wired communication. If you can get, it does not have to be integrated.

  In the present invention, the sensor 17 provided in the screw insertion hole creating device includes an acceleration sensor, a magnetic orientation sensor, a gyro sensor, a laser distance sensor, a differential transformer type displacement sensor, an ultrasonic sensor, a global positioning system receiver, One or a plurality of infrared cameras and visible light cameras are preferable, but sensors based on other principles may be provided. More preferably, the sensor and camera are multi-axis and multi-eye, but single-axis and monocular may be selected.

  The pedicle screw fixation is performed using the system example as described above.

FIG. 4 is a conceptual diagram of the spine, FIG. 5 is an example of a conceptual diagram for detecting an insertion position when creating a pedicle screw insertion hole, and FIG. 6 is an example of a conceptual diagram for creating a pedicle screw insertion hole. .
Preoperative CT images of the spine and the screw arrangement planned based on them are stored in the computer.

The insertion hole creation proper position 21 is detected by seeing through both the spine 20 and the cutting edge 22 of the drill using an X-ray fluoroscope and confirming the positional relationship between them.
Alternatively, X-ray fluoroscopic images taken during surgery by synchronizing the X-ray fluoroscopic images taken during surgery with the spinal CT images taken before surgery on a computer and using existing image recognition technology The screw proper insertion position 21 is detected.

  The detection of the insertion hole creation position 21 may be performed using a navigation system when registration using the bone position reference device 4 which is an infrared navigation system can be used.

  After detecting the screw insertion hole creation position 21, the process proceeds to drilling with a drill. In the present invention, one or more of the position of the drill tip, the drilling direction, the drilling distance, and the drilling trajectory are detected by a sensor equipped on the drill. Is always detected.

  The detected information is stored in a computer and, together with the screw placement plan information stored before surgery, necessary calculations are performed to transmit appropriate information to the display device. Here, for example, the calculation necessary to simultaneously display information on the position of the cutting edge, drilling direction, drilling distance, and drilling trajectory on the spine image is performed.

  Figure 7 shows an example of the screen of the display device equipped on the drill. In the present invention, the current drill tip coordinates and angle, proper drilling start coordinates, proper angle, and proper drilling distance are displayed as characters 27, and information necessary for the operation is provided to the operator.

In the present invention, an appropriate perforation trajectory 30 planned before the operation and an image 28 are simultaneously displayed together with the fluoroscopic images of the spine 29 and the drill blade 31 by the X-ray fluoroscopic apparatus. At this time, the image of the spine may be a three-dimensional spine image acquired by a CT imaging device before surgery.
The surgeon can perform perforation while confirming the information provided, and can perform safe and accurate surgery.

  The information providing method by the display device is performed by one or more of characters, moving images, still images, and sounds.

  The information provided by the display device can be switched by key operations on the computer terminal or touching images and characters on the display device. It is more preferable to equip the drill with a microphone, recognize the surgeon's voice, and switch the display information.

  One example is shown below. The present invention is not limited to the examples.

  Before the operation, CT imaging device 1 is used to perform spinal tomography to construct a 3D image.

Two-dimensional images of the spine are taken from multiple directions using the fluoroscopic device 2 during the operation.
The X-ray fluoroscope 2 is equipped with a magnetic azimuth sensor and an acceleration sensor, detects the imaging direction and angle of the image, and matches both the pre-operative 3D spine image and the intraoperative 2D spine image on the computer. .

  The X-ray fluoroscope 2 is fixed at the finally matched imaging position. The captured spine image is displayed in detail in three dimensions and the direction in space is determined.

  The doctor places the tip of the screw insertion hole creation device (drill) 3 on the spine while seeing the spine through the fixed fluoroscope 2. This image information is transmitted to the computer and displayed on the 3D spine image. The drill is equipped with a magnetic orientation sensor and an acceleration sensor, and the information is sent to the computer at the same time.

  The computer 5 calculates the relative angle between the image direction and the drilling direction of the drill, and displays the drill tip position and the drilling direction on the three-dimensional spine image on the computer monitor 6 and the small monitor 14 of the drill. The doctor drills the drill at an appropriate position with reference to this information.

  Before the operation, CT imaging device 1 is used to perform spinal tomography to construct a 3D image. The proper arrangement of the screw is planned based on the 3D image.

  Two-dimensional images of the spine are taken from multiple directions using the fluoroscopic device 2 during the operation. The X-ray fluoroscopy device 2 is equipped with a magnetic azimuth sensor and an acceleration sensor 10 to detect the imaging direction and angle of the image.

The computer matches the 3D spine image before surgery and the 2D spine image during surgery. The X-ray fluoroscope 2 is fixed at the finally matched imaging position.
The appropriate arrangement of the screw planned before the operation is displayed on the two-dimensional spine image captured by the fluoroscope 2 during the operation. A monitor 6 on a computer is used as a display device.

  The doctor places the tip of the screw insertion hole creation device (Owl) 3 against the spine while looking through the spine with the X-ray fluoroscope 2. The doctor determines the perforation start position 21 of the screw insertion hole while comparing the optimal arrangement 30 of the screw displayed on the two-dimensional spinal fluoroscopy image and the position 31 of the owl tip on the spine on the image. .

The direction and angle information of the owl is transmitted to the computer by the magnetic azimuth sensor and acceleration sensor installed in the owl 3, and the proper angle and relative angle of the screw displayed on the 2D spinal vertebra image are calculated. It is done.
As a result, the angle direction to be corrected is displayed to the doctor on the monitor, and the doctor determines the proper perforation direction and the proper perforation angle, and starts perforation treatment with Owl.

  When drilling the spine, the direction angle of the owl is detected by the magnetic direction sensor and acceleration sensor installed on the owl at any time, and the correction angle and direction are displayed on the computer monitor accordingly. Drill holes.

  The drilling depth can be detected in real time by installing a differential transformer type small displacement sensor in Oulu.

DESCRIPTION OF SYMBOLS 1 Image taking device before operation 2 Image taking device during operation 3 Screw insertion hole making device 4 Bone position reference device 5 Computer 6 Display device 7 Communication device equipped in image taking device before operation 8 Equipped in image taking device during operation Communicated equipment 9 Communicated equipment 10 equipped with computers 10 Sensors equipped with imaging devices during operation 11 Communicated equipment equipped with screw insertion hole creating devices 12 Sensors equipped with screw insertion hole creating devices 13 Bone position reference Sensor 14 equipped with the device Display device 15 equipped with the screw insertion hole creating device 15 Screw insertion hole creating device 16 Communication device 17 equipped with the screw insertion hole creating device Sensor 18 equipped with the screw insertion hole creating device Screw insertion Display 19 equipped with a hole making device 19 Spine 20 Pedicle and bone X-ray fluoroscopic image 21 of a lill cutting edge 21 Appropriate position for screw hole creation 22 Drill cutting edge 23 Pedicle 24 Screw insertion hole creating device 25 for forming a hole for setting a pedicle screw Setting a pedicle screw The hole 26 formed to display the display device 27 installed in the screw insertion hole creation device 27 Information provided by characters on the display device equipped in the screw insertion hole creation device 28 The display device equipped in the screw insertion hole creation device Information provided by image 29 X-ray fluoroscopic image of spine 30 Proper perforation trajectory planned before operation provided on X-ray fluoroscopic image of spine 31 X-ray fluoroscopic image of cutting edge of drill

Claims (7)

A bone imaging device that images bone before surgery;
A bone imaging device for use during surgery, comprising a sensor for detecting the imaging direction, and a bone imaging device for imaging the bone while fixing the imaging direction during surgery
A screw insertion hole creating device including at least a sensor for detecting a drilling direction among sensors for detecting a drilling direction, a drilling distance, and a drilling trajectory;
A computer that performs 3D bone image construction from bone images taken before surgery, and performs information processing to determine the appropriate screw placement in virtual space based on the screw placement plan before surgery;
In a system for surgery comprising a computer-displayed device and a device for displaying information ,
The system
Along with the information of the screw arrangement plan planned before the operation, the planned proper drilling position, drilling direction, drilling distance, drilling trajectory are displayed during the operation, and the drilling position and drilling of the screw insertion hole creation device during the operation The system is characterized in that at least the drilling direction among the direction, drilling distance and drilling trajectory is simultaneously displayed in real time on the bone image and transmitted to the operator. 2. The system according to claim 1, wherein the screw insertion hole creating device includes a display device .   2. The system according to claim 1, wherein at least two of a bone imaging device used before surgery, a bone imaging device used during surgery, a screw insertion hole creating device, a display device, and a computer. A system characterized by linking the above wirelessly or wiredly.   The system according to claim 1, comprising a function of communicating with an external device other than the system or a network.   The system according to claim 1, wherein an image taken before surgery, an image taken during surgery, an appropriate screw arrangement planned before surgery, a position of a bone screw insertion hole creation device detected in real time, A system that transmits information to the surgeon by displaying at least one of the direction and the trajectory on the screen.   The system according to claim 1, wherein an image taken before surgery, an image taken during surgery, an appropriate screw arrangement planned before surgery, a position of a bone screw insertion hole creation device detected in real time, A system characterized in that at least one information of direction and trajectory is transmitted to the operator by sound or voice.   2. The system according to claim 1, wherein an electronic device or a portable terminal having at least one of a communication function, a storage function, a calculation function, a voice recognition function, and an image display function is used instead of a computer. System.

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