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WO2012020707A1 - Outil de guidage tridimensionnel d'un fil destiné à préparer un trou en vue de l'insertion d'une vis pédiculaire de voûte vertébrale - Google Patents

Outil de guidage tridimensionnel d'un fil destiné à préparer un trou en vue de l'insertion d'une vis pédiculaire de voûte vertébrale Download PDF

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Publication number
WO2012020707A1
WO2012020707A1 PCT/JP2011/067955 JP2011067955W WO2012020707A1 WO 2012020707 A1 WO2012020707 A1 WO 2012020707A1 JP 2011067955 W JP2011067955 W JP 2011067955W WO 2012020707 A1 WO2012020707 A1 WO 2012020707A1
Authority
WO
WIPO (PCT)
Prior art keywords
guide
wire
pedicle screw
dimensional guide
dimensional
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2011/067955
Other languages
English (en)
Japanese (ja)
Inventor
善治 川口
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
University of Toyama NUC
Original Assignee
University of Toyama NUC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by University of Toyama NUC filed Critical University of Toyama NUC
Priority to JP2012528659A priority Critical patent/JP5935218B2/ja
Publication of WO2012020707A1 publication Critical patent/WO2012020707A1/fr
Priority to US13/764,048 priority patent/US20130145812A1/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B21—MECHANICAL METAL-WORKING WITHOUT ESSENTIALLY REMOVING MATERIAL; PUNCHING METAL
    • B21F—WORKING OR PROCESSING OF METAL WIRE
    • B21F1/00—Bending wire other than coiling; Straightening wire
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; 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
    • A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; 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
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/568—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor produced with shape and dimensions specific for an individual patient

Definitions

  • the present invention relates to an insertion guide for an insertion hole producing wire for a pedicle screw suitable for inserting a pedicle screw used in spinal surgery into an anatomically appropriate site, and a method for manufacturing the same. About.
  • the spine bone not only allows movement in any direction, but also serves to protect many veins, arteries, nerves, and the like in the body.
  • the spine consists of more than 20 separate bones that are interconnected via a posterior intervertebral joint located between adjacent vertebrae and a cartilage disc (disc).
  • the bones of the spine are anatomically classified into four parts and are called cervical vertebrae, thoracic vertebrae, lumbar vertebrae and sacral vertebrae. These areas also form unique curvatures and are known as cervical lordosis, thoracic kyphosis, lumbar lordosis and sacral kyphosis.
  • a pedicle screw may be used to obtain a therapeutic effect by fixing the spine.
  • the shape of the spine varies greatly from person to person, especially in the case of scoliosis, etc., and large deformation has occurred, and death due to limb paralysis due to spinal cord injury or vertebral artery damage during pedicle screw insertion Have been reported to cause serious complications. Therefore, in Non-Patent Document 1, the CT image was developed at the same magnification, the position and angle for inserting the pedicle screw were directly drawn on the CT film, and the line was cut to include the contour of the vertebral dorsal side. A CT cutout method using a CT film has been proposed. However, this technique was uneasy about the stability of the insertion direction even if the insertion position was obtained accurately.
  • the present invention relates to a three-dimensional guide device for a wire used for making an insertion hole for inserting a pedicle screw when inserting the pedicle screw into an anatomically appropriate position, and its manufacture.
  • the purpose is to provide a method.
  • a three-dimensional guide device is a three-dimensional guide device for a pedicle screw insertion hole manufacturing wire manufactured based on a CT image obtained by imaging a spine. It has a contact surface portion that abuts and contacts the bone form surface in a planar manner, and a guide block portion erected from the contact surface portion, and the guide block portion has a guide hole that regulates the insertion direction of the insertion hole forming wire. It is characterized by having. In order to insert the pedicle screw into the pedicle, an insertion hole of the pedicle screw needs to be made in the pedicle in advance in an anatomically appropriate direction and depth.
  • a K-wire is inserted into the pedicle, and then a pilot hole is created in the pedicle using a drill having a hollow center based on the K-wire inserted into the pedicle.
  • a drill having a hollow center based on the K-wire inserted into the pedicle.
  • the present invention is characterized by providing a three-dimensional guide that contributes to stabilization of the insertion position and insertion direction of the K wire.
  • the spinal vertebral arch has lateral processes, spinous processes, articular processes, etc., so that the abutting surface portion is pierced so that the position of the three-dimensional guide is easily stabilized during surgery.
  • the length of the guide hole is 15 mm to 30 mm. The degree is preferred. If the length of the guide hole is less than 15 mm, the direction of insertion becomes unstable. If the length of the guide hole exceeds 30 mm, the insertion direction becomes stable, but the standing height of the guide block increases.
  • a method of manufacturing such a three-dimensional guide device there are a step of taking a spine as a CT image, a step of extracting a site for inserting a pedicle screw based on the CT image, and a step of extracting the inserted site of insertion. It is possible to form a block-shaped plan having a contact surface portion that matches the bone form surface, to produce a mold based on the plan, and to mold based on the mold.
  • the three-dimensional guide device for the pedicle screw insertion hole producing wire has a contact surface portion so as to coincide with the morphological surface of the bone, and three-dimensionally guides the insertion direction of the wire. Since it has a guide hole, it can be safely and stably inserted into an appropriate place in any part of the spine.
  • FIG. 1 An example of a bone model of a cervical vertebra is shown, and an example of a three-dimensional guide device manufactured so as to abut and come into contact with the morphological surface of the bone is shown.
  • a state in which the cervical vertebra is viewed from the side is shown, and an example in which the insertion direction of the K wire is determined by the guide hole 13 so as not to damage the vertebral artery 3 is shown.
  • (A) is before applying a three-dimensional guide tool to a cervical spine
  • (b) shows the subsequent.
  • the positional relationship between the pedicle and the three-dimensional guide is shown using a cross-sectional view of the pedicle.
  • (A) is before the three-dimensional guide device is applied to the pedicle
  • (b) is a state in which the concave projection contact surface 14a formed on the three-dimensional guide device is in contact with the bone projection 2.
  • (C) shows the figure which looked at the three-dimensional guide tool from the bottom. The front view which applies a three-dimensional guide implement to a pedicle is shown.
  • (A) is a partial cross-sectional view of the state before applying and (b) is applied.
  • the state which inserts K wire along the guide hole formed in the three-dimensional guide tool is shown.
  • (A) shows before insertion of K wire, and (b) shows the state of insertion.
  • (C) shows the state which removes a three-dimensional guide tool from K wire.
  • An example of drilling K-wires on the pedicle using a hollow drill is shown.
  • (A) shows a state through a hollow portion of the drill K wire, state, a state (c) is the formation of the prepared hole P 1 (b) is obtained by drilling.
  • An example will be shown in which a K wire is tapped using a hollow tap on the inner periphery of the prepared hole.
  • (A) shows the state where the tap is passed through the K wire
  • (b) shows the tapped state
  • (c) shows the state where the insertion screw hole of the pedicle screw is formed.
  • An example is shown in which a pedicle screw is inserted into an insertion screw hole formed in the pedicle using a dedicated screwdriver.
  • (A) shows the state before insertion of the pedicle screw
  • (b) shows the inserted state
  • (c) shows the state where the driver is removed. The example which connected the some pedicle screw with the rod is shown.
  • the three-dimensional guide device according to the present invention can be applied to any part of the spine, and will be described below using the cervical spine as an example.
  • the bone shape of the surgical site is captured and captured as a CT image, and a bone model A shown as an example in FIG. Since the bone has a complex shape in which the vertebra is connected via the intervertebral disc, the anatomically appropriate insertion direction and depth of the pedicle screw are planned from this bone model A and CT images. To do.
  • the spine bone (vertebral arch) 1 has processes 2 such as a transverse process, a spinous process, and an articular process, and the surface of the bone has a complicated uneven shape. Further, as shown in FIGS. 3 and 4, the vertebral artery 3 is running. When these are taken into consideration and the insertion site and the insertion direction are determined anatomically, the shapes (plans) of a plurality of, for example, three three-dimensional guides 10, 10A, 10B in FIG. To set up.
  • the sizes of the contact surface portions 11, 11A, and 11B that are in contact with each other in a surface contact state along the shape of the unevenness of the bone at the insertion site And it is necessary to set the shape and size of the guide block parts 12, 12A, 12B.
  • the description will be given by using the three-dimensional guide tool 10, and the other parts are denoted by corresponding reference numerals and the description thereof is omitted.
  • the abutment surface portion is provided with a protrusion abutting portion 14 that abuts also on the protrusion (spinous process) 2 of the vertebral arch so that the three-dimensional guide device 10 can be positioned simply by abutting on the vertebra.
  • the shape of the contact surface consisting of a gentle uneven surface of the bone at the insertion site and the projection contact portion consisting of a sharp slope
  • the position of the three-dimensional guide 10 is inevitably accurately determined by the shape and does not shift.
  • the projection contact portion 14 is formed with a recess-shaped projection contact surface 14 a that matches the shape of the spinous process 2, but the projection contact portion 14 may be an effective projection portion for positioning the three-dimensional guide 10. It is not limited to this.
  • the shape of the guide block portion 12 is to guide and guide the insertion direction of the K wire 20 by forming guide holes 13 along the guide block portion 12.
  • the shape (plan) of the three-dimensional guide tool 10 is determined, a mold having this plan is manufactured. A resin or the like is injected into the mold to produce a three-dimensional guide having a predetermined shape.
  • the three-dimensional guide 10 manufactured in this manner can accurately determine the insertion position and direction of the K wire simply by being applied to the insertion site of the spine.
  • FIG. 2 is a view from the back of the cervical spine
  • FIG. 3 is a view from the side. 4 shows a cross-sectional view of the pedicle
  • FIG. 5 shows an enlarged view of the spinous process 2 portion.
  • a three-dimensional guide 10 manufactured in advance based on a CT image has a protrusion contact surface 14a formed with a recess-shaped protrusion contact surface 14a that matches the protrusion shape of the spinous process 2.
  • abutment surface portion 11 that makes contact with the surface along the morphological surface of the bone from the spinous process 2 to the insertion site of the pedicle screw 50, and a guide block portion 12 in which a guide hole 13 is formed.
  • the abutment surface portion 11 is intended to contact the surface substantially along the morphological surface of the bone, and does not necessarily need to be in contact with the entire surface of the abutment surface portion 11.
  • the concave-shaped protrusion abutting surface 14a matches the shape of the spinous process 2 of the bone, and guides from the spinous process 2 Positioning is performed when the uneven surface shape of the surface contact portion up to the hole 13 matches the uneven surface shape of the bone, and the insertion direction of the K wire 20 is the guide hole as shown in FIG. It is accurately determined by the direction of 13 through holes.
  • the K wire is a wire having a diameter of 1 to 2 mm, and the guide hole 13 preferably has an inner diameter slightly larger than the outer diameter of the K wire, and its length is preferably 15 mm or more.
  • the longer guide hole 13 improves the stability in the insertion direction, but may be 30 mm or less in consideration of insertion workability and manufacturability of the guide block portion 12.
  • the artery 3 and the like are not damaged.
  • the K wire 20 is inserted into the pedicle as shown in FIG. 6B, the three-dimensional guide 10 is removed from the K wire 20 as shown in FIG. 6C.
  • a drill 30 having a hollow center portion is inserted into the pedicle while rotating through the K wire 20, thereby forming a pilot hole P 1 as shown in FIG. 7C. .
  • the male screw portion 50 a of the pedicle screw 50 is screwed in using a dedicated driver 60.
  • the bone 1 is fixed by adjusting the angle of the head 50b of the pedicle screw 50 inserted in this way and connecting with the rod 70 as shown in FIG.
  • the external diameter of the male screw portion of the pedicle screw 50 is generally 3.5 to 4 mm.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Dentistry (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Mechanical Engineering (AREA)
  • Surgical Instruments (AREA)
  • Prostheses (AREA)

Abstract

[PROBLÈME] La présente invention concerne la réalisation d'un outil de guidage tridimensionnel d'un fil destiné à préparer un trou en vue de l'insertion d'une vis pédiculaire de voûte vertébrale au moment de l'insertion de la vis pédiculaire de voûte vertébrale au niveau d'un site anatomique approprié, et un procédé de fabrication de celui-ci. [SOLUTION] L'invention concerne un outil de guidage tridimensionnel pour un fil destiné à préparer un trou en vue de l'insertion d'une vis pédiculaire de voûte vertébrale préparée sur base d'une image de tomodensitométrie de la colonne vertébrale, outil de guidage tridimensionnel qui comprend une partie de surface de contact qui vient en butée contre et vient en contact de manière plane avec une surface de type osseuse du site d'insertion, et une section de bloc de guidage conçue pour se tenir à l'écart de cette partie de surface de contact, la section de bloc de guidage comportant un trou de guidage qui limite le sens d'insertion du fil destiné à préparer le trou d'insertion.
PCT/JP2011/067955 2010-08-12 2011-08-05 Outil de guidage tridimensionnel d'un fil destiné à préparer un trou en vue de l'insertion d'une vis pédiculaire de voûte vertébrale Ceased WO2012020707A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
JP2012528659A JP5935218B2 (ja) 2010-08-12 2011-08-05 椎弓根スクリュー用挿入穴作製ワイヤーの三次元ガイド具
US13/764,048 US20130145812A1 (en) 2010-08-12 2013-02-11 Three-dimensional guide for wire for forming pedicle screw insertion hole and method of producing the same

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2010181119 2010-08-12
JP2010-181119 2010-08-12

Related Child Applications (1)

Application Number Title Priority Date Filing Date
US13/764,048 Continuation US20130145812A1 (en) 2010-08-12 2013-02-11 Three-dimensional guide for wire for forming pedicle screw insertion hole and method of producing the same

Publications (1)

Publication Number Publication Date
WO2012020707A1 true WO2012020707A1 (fr) 2012-02-16

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PCT/JP2011/067955 Ceased WO2012020707A1 (fr) 2010-08-12 2011-08-05 Outil de guidage tridimensionnel d'un fil destiné à préparer un trou en vue de l'insertion d'une vis pédiculaire de voûte vertébrale

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US (1) US20130145812A1 (fr)
JP (1) JP5935218B2 (fr)
WO (1) WO2012020707A1 (fr)

Cited By (6)

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WO2012169642A1 (fr) * 2011-06-06 2012-12-13 株式会社大野興業 Procédé de fabrication d'une matrice d'enregistrement
CN105534588A (zh) * 2016-02-15 2016-05-04 自贡市第四人民医院 一种拆卸式双侧型经皮个体化椎弓根螺钉导航模板
CN105748142A (zh) * 2016-02-15 2016-07-13 自贡市第四人民医院 一种拆卸式双侧型经皮个体化椎弓根螺钉导航模板装置
CN105852956A (zh) * 2016-04-15 2016-08-17 上海瑞博医疗科技有限公司 一种颈椎椎弓根螺钉进钉导向模板及制备方法
JP2016524506A (ja) * 2013-06-07 2016-08-18 フライ, ジョージFREY, George 外科処置を行うための患者適合器具及び方法
CN106037921A (zh) * 2016-06-29 2016-10-26 自贡市第四人民医院 透视辅助的皮外个体化微创椎弓根螺钉导航模板装置

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CN106175908B (zh) * 2016-06-29 2017-10-27 自贡市第四人民医院 一种透视辅助的皮外个体化微创椎弓根螺钉导航模板
KR101750913B1 (ko) * 2017-01-09 2017-06-26 원유건 척추 고정 장치
US12121245B2 (en) * 2017-09-14 2024-10-22 Mahmoud Alm EL Din HAFEZ Patient-specific templates for pedical screw insertion in corrective scoliosis surgeries
US11737742B2 (en) 2021-02-06 2023-08-29 Spine Craft, LLC Devices, apparatus and methods for patient-specific MIS procedures
US11534183B2 (en) 2021-02-06 2022-12-27 Spinecraft, LLC Devices, apparatus and methods for patient-specific MIS procedures
US20220354511A1 (en) * 2021-05-07 2022-11-10 Mazor Robotics Ltd. Three-dimensional (3d) bone-protecting drill guide device and systems and methods of manufacturing and using device

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JP2009061132A (ja) * 2007-09-07 2009-03-26 Ono Kogyo:Kk 医療用ナビゲーションシステムにおけるレジストレーション用テンプレートの製造方法

Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2012169642A1 (fr) * 2011-06-06 2012-12-13 株式会社大野興業 Procédé de fabrication d'une matrice d'enregistrement
JPWO2012169642A1 (ja) * 2011-06-06 2015-02-23 希 松本 レジストレーション用テンプレートの製造方法
JP2016524506A (ja) * 2013-06-07 2016-08-18 フライ, ジョージFREY, George 外科処置を行うための患者適合器具及び方法
CN105534588A (zh) * 2016-02-15 2016-05-04 自贡市第四人民医院 一种拆卸式双侧型经皮个体化椎弓根螺钉导航模板
CN105748142A (zh) * 2016-02-15 2016-07-13 自贡市第四人民医院 一种拆卸式双侧型经皮个体化椎弓根螺钉导航模板装置
CN105852956A (zh) * 2016-04-15 2016-08-17 上海瑞博医疗科技有限公司 一种颈椎椎弓根螺钉进钉导向模板及制备方法
CN106037921A (zh) * 2016-06-29 2016-10-26 自贡市第四人民医院 透视辅助的皮外个体化微创椎弓根螺钉导航模板装置

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US20130145812A1 (en) 2013-06-13
JPWO2012020707A1 (ja) 2013-10-28
JP5935218B2 (ja) 2016-06-15

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