CN105431102B - System for the processing of the amount of plan of body part - Google Patents
System for the processing of the amount of plan of body part Download PDFInfo
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- CN105431102B CN105431102B CN201480033673.5A CN201480033673A CN105431102B CN 105431102 B CN105431102 B CN 105431102B CN 201480033673 A CN201480033673 A CN 201480033673A CN 105431102 B CN105431102 B CN 105431102B
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- A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
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- A—HUMAN NECESSITIES
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- 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
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- A61B34/70—Manipulators specially adapted for use in surgery
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- B—PERFORMING OPERATIONS; TRANSPORTING
- B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
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- B25J15/0019—End effectors other than grippers
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Abstract
The present invention relates to a kind of surgery systems, including：(i) hand-held device (100), (ii) tracing unit (200), (iii) control unit (300), (iv) user interface (400), the hand-held device (100) include：Base (1)；For installing operation tool or instrument guide rail end effector (2)；Driver element (4), the driver element (4) are connected to the base (1) and the end effector (2)；And support unit (5), the support unit (5) is designed to contact with the pending part or adjacent region, to provide local mechanical connection between the base (1) or the end effector (2) and the pending part, described control unit (300) is configured to：(a) optimal path of the end effector is calculated in real time, (b) whether the path of the calculating of detection instrument or end effector can be implemented in the case where not changing the posture of base, and if it can not realize, then determine possible repositioning of the base relative to pending part, (c) driver element is configured to make the end effector be moved according to the path of the calculating, and (d) repeat step (a) arrives (c), untill amount of plan has been processed.
Description
Technical field
The present invention relates to a kind of system of the processing of the amount of plan of the body part for patient.
Background technology
Robot device is used in surgical operation since the later stage in the 1980's, this robot device starts from
It is programmed for instrument guide rail being positioned close to the serial kinematic construction industry robot [Kwoh 1988] of the specific location on head
[Lavall é e 1989].During generation nineteen ninety, have robot doctor system (ISS, USA) and CASPAR (U.R.S.,
Germany robot) is introduced in plastic surgery operations, for hip and knee surgery [Bargar 1998,
Prymka 2006].However, these self-contained systems are not only without being presented the advantage more lasting than routine techniques, and these
The longer operating time is also presented in self-contained system and that increases loses blood [Bach 2002].One in the shortcomings that these systems
It is the entirely autonomous process that rigidly fixes and away from surgeon take control of the bone to robot.Because the shape of tissue
It can change in cutting or pushing or due to the breathing of patient, so autonomous robot is not well suited for operation on soft tissue.
Also have been incorporated into the master slave control robot [Maeso fed back via console and far field vision to control
2010].Leonardo da Vinci's system (da Vinci system) has been used in minimally invasive laparoscopic abdominal operations, wherein, surgeon's control
Up to four mechanical arms, and the motion of surgical hand can be filtered out shaking and in proportion changing can carry out precision
Instrument small movements.
With surgeon using remote console from Leonardo da Vinci's method of distant place control machine people compared with, have been introduced into machine
Device people is for collaborative work.These systems position instrument guide rail and surgeon's self-priming instrument [Liebermann
2006, Plaskos 2005], or surgeon guides tactile controlled hand and robot prevents from entering prohibited area.
The concept of the tactile controlled hand of " operative constraint " or " virtual clamp " is used to pass through gymnastic robot system first
System (Acrobot system) [Davies 2007, Yen 2010] is implemented and then by MAKO Surgical Incs RIO
System is implemented, for single knee replacements (UKA) and replacement of total hip (THA) [US 2006/0142657A1
(Quaid et al.), Lonner 2010, Dorr 2011].The randomized prospective research of gymnastic robot system presents：Pass through
Prepared by the robot bone in UKA, shin stock is aligned within the scope of 2 ° of planning location, and only 40% at 2 ° in control group
[Cobb 2006] below.
Similar but without using megamachine people's system method is to use " intelligence " high speed bone drill (burr), and " intelligence " is high
Fast bone drill can enable and disable in pre-polarizing region Program.In view of Navigation Control (Navigated Control) is general
Read the rotating speed [Strauss 2005] of control bone drill, the hand-held cutting element (Precision Freehand Sculptor) of precision
Including the bone drill [Brisson 2004, WO 2011/133927A2 (Nikou et al.)] at the rear for being retracted into protection device.
US 2005/0171553 (Schwarz et al.) discloses a kind of hand-held device for being used to handle body part, described
Hand-held device includes base, instrument and driver element, and instrument can move relative to base, and driver element is used to make instrument pre-
Determine the precalculated position being moved in working space on pending part.The device is by detecting the position of instrument and pending
Partial position, by considering base by the position compared with target position and by correspondingly adjusting driver element and treating
The motion of the part of processing.US 2012/0143084 (Shoham) discloses a kind of hand-held device for being used to handle body part,
The hand-held device includes handle, instrument and robot, and instrument can move relative to handle, and robot is used to make instrument pre-
Determine the precalculated position being moved in working space on pending part.The device can detect instrument relative to stagnant zone
Position, and if user moves handle so that instrument to be taken to the amount of the prohibited area, then the device can change machine
The posture of device people.The shortcomings that these manual guidance instruments is：Abrasion path needs to be controlled by surgeon in itself, and this can cause not
Bone excision, inaccurate lapped face and the undesirable heat radiation worked.In addition, it is necessary to the plenty of time is reasonable to obtain
Overall accuracy.It is that local lapped face always swells or irregular, and in order to compensate this protrusion, lapped face and
Adhesive, rather than generally preferable non-glued implant are usually required between implant.Even if there is adhesive, this process
Final result can also reduce overall accuracy.
For not allowing the application (for example, operation on retina) of vibration, the hand-held manipulation not trembled is had been introduced into
Device [Mitchell 2007, Uneri 2010] and hand-held active stabilization micro device [Becker 2011, MacLachlan
2012]。
US 2011/0208196 (Radermacher et al.) discloses a kind of for producing constraint and being applied to constraint
The hand-held reaction equation device of user, the hand-held reaction equation device include handle, instrument and support component, and instrument can be relative
Moved in handle, support component is connected to handle, and handle is sustainable on bodily surfaces using support component.Support component passes through
It may move by driver element, according to the sensing data obtained during processing, driver element is by the way that support component displacement is made
Instrument can reposition relative to body surface.However, constraint is applied to user by the device according to the material of work, and
And in view of the amount of plan of processing body, the device can not optimization tool paths on one's own initiative.
Still suffer to enabling tool path to optimize and can compensate for surgical smaller motion to minimize vibration
And optimize the needs of the light-weight handheld surgery device of accuracy.
The content of the invention
Therefore, the invention provides a kind of surgery systems, the surgery systems to include：
(i) hand-held device, the hand-held device include：
- the base for being designed to be maintained in the hand of user,
- end effector, the end effector are used to install operation tool or are used to guide operation tool for installing
Guide rail 20, the operation tool be designed to handle patient body part amount of plan,
- driver element, the driver element are connected to the base and the end effector, to make the operation
Instrument or the instrument guide rail relative to base movement to handle the amount of plan,
- support unit, the support unit are connected to base or the end effector, and the support unit includes quilt
At least one element contacted with the region adjacent with pending part of the body of pending part or patient is designed to,
To provide local mechanical connection between base or end effector and pending part,
(ii) tracing unit, the tracing unit are configured to determine in real time in instrument, end effector and base
At least one posture relative to pending part,
(iii) control unit, described control unit are configured to：
(a) the optimal road of posture based on the measurement come calculating instrument in real time or end effector relative to base
Footpath,
(b) path of the calculating of detection instrument or end effector in the case where not changing the posture of base whether
Can be implemented, and if it does not, then determine base relative to pending part possible repositioning,
(c) driver element is configured to make the end effector be moved according to the path of the calculating, and
(d) repeat step (a) arrives (c), untill amount of plan has been processed,
(iv) user interface, the user interface are configured to feedback information being indicated to user.
Advantageously, the feedback information provided by user interface may include the path of the calculating do not change base and/or
Support unit relative to pending part posture in the case of whether the instruction that can be realized, it is and if irrealizable
Words, then include the instruction of the possible repositioning of the base and/or support unit that are determined by control unit.
" pending amount " is context means that the one-dimensional 1D amounts extended along the line (are handled in part for example, working as
During drilling), along two-dimentional 2D amounts part described in processing is sawing (for example, when) of plane extension or three-dimensional 3D amounts (for example, ought
Processing is to cut off scheduled volume to cooperate perfectly with implant or be to cut off registering with work coordinate system when handling
During the exact part limited on image).
" local mechanical connection " refers to the mechanical attachment between at least two parts, wherein, at least two part
Relative motion along at least one free degree is possible.The term excludes " complete " mechanical attachment, i.e. does not allow between part
(base will be rigidly attached to wait to locate by the example of this complete mechanical connection by least one screw for the connection of relative motion
The part (for example, bone) of reason).
As described in detail further below, the local mechanical being arranged between base and the body part of patient
Connection can be direct (meaning that support unit contacts in itself with pending part) or indirectly (mean support unit
The part adjacent with body the and pending part of patient contacts).The adjacent part can by belong to it is pending
The bone in part identical joint or the soft tissue composition for surrounding pending part.Indirect local mechanical connection can also be
Support unit obtains when being kept by the hand of user, and the hand leans against pending part or soft tissue and surrounded pending
On partial skin.
Design according to the part contacted with support unit and according to support unit in itself, the local mechanical connection can
To be rigid or damp.
Described device can compensate for the attitude error (for example, small motion due to user) of specified rate.
" posture " is context means that instrument orients along up to the 3D positions of six-freedom degree and 3D.It should be noted that basis
Using, it may be unnecessary to determine all six-freedom degrees, but only determine one in six-freedom degree or some.
" path " refers to the instrument posture group for enabling amount of plan to be processed.
If the posture group is calculated based on device and the current relative attitude of remaining pending part, road
Footpath is " optimal ", at least one in list below to minimize：
The number that-the repositioning to device necessary to realization processing acts；
Time required for-processing plan amount；
- as caused by instrument heat；
The surface roughness and accuracy of-the part being processed；
- instrument (or cutting edge of milling tool) is relative to the orientation of bone surface；
(list is nonrestrictive).
According to the favourable but optional embodiment (alone or in combination) of the present invention：
- instrument guide rail is installed on end effector, and support unit includes instrument guide rail；
- support unit includes being used at least one sensor for detecting the power being applied to by user in local mechanical connection,
And control unit is configured to check for whether the power is more than threshold value so that support unit has minimum damping parameter；
- support unit includes at least one damping element so that base or end effector and pending part it
Between caused local mechanical connection can absorb the reaction force being applied to by processed part on instrument.
The damping characteristic of-at least one damping element is adjustable；
- support unit includes with least one rigid free degree or damped at least one pin of the free degree；
- support unit is designed to second handle, and the local mechanical between patient and executor couples via surgery
Second hand of the gripping second handle of doctor is established；
- support unit includes at least one pad, and at least one pad has features designed to adhere to and pending part
Surface on adjacent soft patient tissues；
- support unit includes Part I and Part II, and Part I is connected to base or end effector, and second
Part is intended to be fixed to pending part or the part adjacent with pending part of patient；
Connection between the Part I and Part II of-support unit includes loop fasteners or magnetic fastener；
- support unit includes the handle that can be gripped by the another hand of user；
- support unit is hinged relative to base；
- operation tool is hinged relative to end effector；
- control unit is configured to：If described control unit detects that the current pose of instrument is located at the outer of amount of plan
Portion, then stop driver element and/or instrument；
- support unit includes retaining arm, and the retaining arm is connected to the base of hand-held device and suitable for being connected to
The mechanical support of such as operating table；
- support unit includes from spring pulley extending and being connected to the cable of the base of hand-held device, and the spring is slided
Wheel is suitable to be connected to fixed or movable cart the mechanical support such as on the top plate of operating table, room, floor；
- the system includes planning system, the planning system be configured to determine the amount for the treatment of to be handled by instrument and
At least one processing parameter of instrument is determined in the case of appropriate；
Drilling tool guide rail or saw blade guide rail are included in-end effector or in support unit, and can be or may not be
The instrument of a part for device is the drilling tool or saw blade for being intended to move in the axis of the guide rail or plane；
- operation tool includes saw blade, drilling tool, mill, scraper or bone drill；
- tracing unit includes at least one transmitter and at least one sensor, and at least one transmitter is mounted
On base or on end effector；
At least one sensor of-tracing unit is suitable for being installed on pending part.
According to one embodiment, the base of hand-held device is by the cable support that extends from spring pulley.
Above-mentioned system can operate according to process described below.
Hand-held device is provided to user, and the hand-held device includes：
- the base being adapted to remain in the hand of user,
- it is used for the end effector for installing operation tool or the guide rail for guiding operation tool, the operation tool quilt
It is designed to handle the amount of plan of the body part of patient,
- driver element, the driver element are connected to the base and the end effector, to make the operation
Instrument and/or instrument guide rail relative to base movement to handle the amount of plan,
- support unit, the support unit are connected to base or end effector, the support unit include being suitable to
At least one element that pending part or the region adjacent with pending part of the body of patient contact, so as to the bottom of at
Local mechanical connection is provided between seat or end effector and pending part.
Before start to process, a possibility is to calculate optimal beginning posture first.Starting posture can be on subscript
It is accurate optimised：
The maximum of-pending amount reaches part；
- pending amount to the limit of robot working space ultimate range (if entirely measured in accessibility machine
Within people's working space).Distance is important, so as to maximum space, wherein, robot can compensate for robot pose
Motion；
- instrument relative to bone surface orientation
(list is nonrestrictive).
Then user is guided so that robot base is positioned at into optimum attitude by user interface.Therefore, it can use not
Same common schematic diagram, for example, line, horizontal line (bars), cross hairs (crosses) or 3D schematic diagrames.
It is adjacent with pending part with the body of pending part or patient for support unit to be positioned to
Region contacts, to provide local mechanical connection between base or end effector and pending part.
At least one posture relative to pending part in instrument, end effector and base passes through tracing unit
Determined in real time.
Control unit implements procedure below：
(a) posture based on the measurement calculates optimal path of the end effector relative to base in real time,
(b) path of the calculating of detection instrument or end effector in the case where not changing the posture of base whether
Can be implemented, and if negative situation, it is determined that base relative to pending part possible repositioning
(new optimal starting position),
(c) driver element is configured to move the end effector according to the path of the calculating, and
(d) repeat step (a) arrives (c), untill amount of plan has been processed.
During the operation of instrument, feedback information is supplied to user by user interface；Specifically, in advantageous embodiment
In, user interface instruction in the case where not changing base and/or support unit relative to the posture of pending part whether
The instruction in the path of the calculating can be realized, and if it is irrealizable, it indicates that the base determined by control unit
And/or the possible repositioning of support unit.
When repositioning is necessary, repositioning can be on starting position so that robot and instrument are stopped
And user is directed, untill he reaches optimal location and restarting systems, or it can be continuous to reposition
Process so that during the direction of new optimal location is repositioned onto, the process will not be stopped.
Brief description of the drawings
It will be clear that further feature, embodiment and the advantage of the present invention from reference to the accompanying drawings described further below, in accompanying drawing
In：
- Fig. 1 shows total view of the surgery systems according to the present invention；
- Fig. 2 shows the plan detail that can be shown on the screen for be connected to control unit；
- Fig. 3 A to Fig. 3 L show the example of the embodiment of hand-held device and support unit；
- Fig. 4 A to Fig. 4 D show the different devices implemented with tracing unit；
- Fig. 5 A to Fig. 5 C show the different embodiments of user interface；
- Fig. 6 is the flow chart for showing to implement the mode of the system according to the present invention；
- Fig. 7 A and Fig. 7 B show the embodiment of the hand-held device suitable for single knee replacements；
- Fig. 8 A to Fig. 8 C show the embodiment of the hand-held device suitable for total knee arthroplasty；
- Fig. 9 A and Fig. 9 B show the embodiment of the hand-held device suitable for processing femur acetabular bone Impingement Syndrome；
- Figure 10 shows another embodiment, wherein, hand-held device is supported by retaining arm.
- Figure 11 shows another embodiment, wherein, hand-held device is by the cable support that extends from spring pulley.
Embodiment
Explanation focuses on specific processing femur acetabular bone Impingement Syndrome (femoro-acetabular below
Impingement, FAI), single knee replacements (uni knee arthroplasty, UKA) and total knee arthroplasty
In the operation on hip joint or knee surgery of (total knee arthroplasty, TKA).
Pending part is such as bone of pelvis, femur and/or shin bone, and handles the plan for being to cut off bone
Amount.
However, the present invention is not limited to these application-specifics.
Specifically, pending part may not be bone, and the processing for being applied to the part may not mean that and cut
Except a certain amount of part.
For example, device can be used for：Any kind of orthopedic of polytype implant is accurately placed performing
(knee, hip, ankle, foot, wrist, shoulder etc.) and bone is bored in the radio-frequency ablation procedure of laser surgey or soft tissue in surgical operation
Hole, sawing, grinding, sawing and bone is ground in cranial and facial surgery, tooth is carried out in dentistry orthopedic with inlay or filling up
Thing coordinates, and drills to place dental implant, is inserted the screws into for traumatology in bone, passage is drilled out for ligament reconstructive,
One or more planes or cheese osteotomy is performed, adhesive is cut off during revision, bone fragments are accurate
Ground is placed into together, is got within vertebra root, cuts off cartilage defect, obtains the health part of bone or cartilage to be moved
Plant, inlay, implant or graft are inserted into accurate location, pin is accurately placed during interventional radiology processing, etc..
As will be discussed in further detail below, described device uses under background below：The amount of pending part
It is planned before operation intervenes.
Use 3D data (examples in preoperative image (for example, CT, MRI, ultrasonoscopy, 3D X-rays, PET etc.) or operation
Such as, CT in operation, X-ray image in MRI, ultrasonoscopy, 2D or 3D operations in operation, by localizing system provided and carried
For 3D points, 3D point cloud, the geometric data on surface etc. rebuild by 3D point cloud) or both perform the plan of pending amount.
Multiple computer assisted surgery methods are used to the amount of being intended to and matched somebody with somebody with being attached to the coordinate system of pending part
It is accurate.
Typically, image or data are used to preoperative image being attached to the unique of pending part in operation
In coordinate system registration and generally shown (optical, magnetic etc.) by tracker.
As will be described below in detail, the result of any one in these conventional computer assisted surgery methods is used
It is：Pending amount has known geometric representation in the coordinate system for being attached to pending part and its motion is by chasing after
Track unit is followed the trail of in real time.
As described above, the amount can be 1D amounts, 2D amounts or 3D amounts according to application.
The usual explanation of surgery systems
Fig. 1 shows total view of the surgery systems according to the present invention.
For example, in view of single knee replacements (single knee replacements, UKA), patient P is lain on operating table 500.
Therefore, the instrument 3 being intended to from shin bone and distal femoral resection 3D amounts is supported by hand-held device 100, hand-held device 100 is by outer
Section's doctor's (not shown) manipulates.
Hand-held device 100 is connected to control unit 300.
Described control unit typically comprises power supply, AC/DC converters, is provided with power to the AC/DC motors of driver element
Motion controller, fuse, real-time control system interface circuit.
System also includes tracing unit 200 so that the posture of device and/or pending bone followed the trail of in real time and
Shared between real-time control system and planning system.
At least one coordinate system 201 is affixed to pending part, and at least one coordinate system 202 is affixed to instrument
And/or hand-held device.
Tracing unit measures the relative motion between two coordinate systems 201,202 in high frequency.
The data obtained by tracing unit are via any suitable connector by wire or wirelessly (not shown) transmission
To control unit 300.
Real-time control system can perform proposed real time control algorithms under at a relatively high frequency.
Actual posture according to amount to be cut off and the amount cut off in advance and device relative to pending bone, in real time
Control system calculates optimal tool path.
Robotics optimizes with the geological information for the similar dualization based on amount to be cut off in mechanics be present
Abrasion path generation many well-known algorithms, or exist from digital control processing etc. parameter path generating algorithm.
In the figure, connector is represented by electric wire 301, but if hand-held device is battery powered, then connector can be anti-
But wireless.
Control unit and tracing unit can be disposed in the trolley 302 that can be moved in situations in the surgery room.
System also includes user interface 400, and user interface 400 is intended to feedback information being shown to surgeon and made outer
Section doctor can carry out system configuration.
Advantageously, the user interface 400 may include to be located at and the identical hand push where control unit and tracing unit
Screen on car 302.
In addition to the screen or the screen is replaced, user interface may include indicator, and indicator is disposed in hand
Hold with device sheet to provide information to surgeon.
If embedded unit will not hinder user to device by the sufficient battery powered of energy and its size and weight
Manipulation, then surgery systems during control unit, tracing unit and/or user interface are embedded into hand-held device in itself will be at this
In the range of invention.
The usual explanation of the operation of surgery systems
Before operation intervenes, user is based on operation consent medical image and/or operation traditional Chinese medicine image and data are being planned
Plan intervention in system.
The plan step is conventional and will not described in detail herein.
The plan step is specific to each application.
For example, in the case of TKA, the plan of the knee-joint prosthesis on femur needs five cuttings of restriction on femur flat
Face.In the case of FAI, the plan of the amount to be cut off on femoral head and neck needs to limit complicated shape to be cut off, with
Just the shape (for example, spherical femoral head) with normal geometric parameter is recovered.
Planning system can form a part for the surgery systems according to the present invention；Otherwise, technological system can be separately provided
And it is connected to control unit.
During performing the operation and intervening, user can be used together Pre-operation data/image or directly with method for registering in operation
Use data/image in operation.
In both cases, the result of plan is waited to cut off by being made up of instrument at least one continuous quantity to be cut off
The posture of the amount be determined in the coordinate system of pending part.
The amount is then passed to control unit.
Control unit initializes its subsystem and device can be used.
Before the processing can start, support unit must be connected to pending part or adjacent body part, with
Local mechanical connection is provided between device and pending part.
Once user has begun to handle, state and tracked information are continuously fed back to planning system by control unit, with
For recalculating and visualizing purpose.
Fig. 2 is shown can be by the example of the plan detail of screen display.
Part p1 shows the amount handled, and part p2 shows residue with pending amount.The surplus energy
Enough by the Boolean lattice computing (boolean mesh operation) of pending amount and the amount handled or by subtracting
Voxel amount is gone to calculate.
The working space of dotted line p3 instruction devices, i.e. instrument can be used to the space safely operated.
Because the working space of device is limited, it may be impossible to from handling and treat relative to the single posture of target amount from device
The full amount of reason.From which in order to notify the pending amount of user safely can partly come from current robot pose
Reason, user interface can highlight the part for the amount that can be handled.The part of the safe handling of amount can pass through pending residue
The Boolean lattice computing (or voxel amount subtraction) of amount and robot working space calculate.It is in order to ensure the part of amount
Can " safety " excision, the calculating can also be completed by the more limited amount of the size of device, even in allowing robot bottom
Boundary in the case of the little deviation of the posture of seat in pending amount is also such.
The limited working space can in Descartes's working space (by i.e. with a few micrometers and several times reach work
Make the skew of spatial margins or (a certain amount of coding step with the limit for reaching each axis) is counted in axial space
Calculate.
Part p4 is the instrument posture relative to pending bone, and instrument posture is measured by tracing unit and/or by reality
When control unit calculate.
During use hand-held device, user is provided with the information of the pending repositioning on device, to incite somebody to action
Instrument is maintained in predetermined work space.
According to the present invention, user's on the one hand freely manipulating and on the other hand from control unit from the base of hand-held device
Automated tool path optimization be benefited.
The local mechanical connection provided by support unit enables surgeons to do not adding patient the feelings of intrusion action
Small motion is made under condition so that device to be repositioned.
In addition, the information relevant with the ability in the processing plan region under current setting position is supplied to by user interface
User, and provide in the appropriate case how the instruction for suitably repositioning device.
As control unit stops instrument, if instrument Departure Plan working region, system ensures to intervene security.Separately
Outside, the working space very little of device, so as to provide intrinsic security.
Another advantage of small working space is due to less means and makes accuracy higher.
The usual explanation of hand-held device
Fig. 3 A to Fig. 3 C show the example of the embodiment of hand-held device.
Although the present invention can be implemented according to multiple embodiments, Fig. 3 A to Fig. 3 C are intended to provide the usual of hand-held device
Explanation.
The explanation that some relevant specific embodiments are applied with particular procedure will be described below.
Base
Hand-held device includes base 1, and base 1 is intended to be held by surgeon.
Therefore, particular handle can be arranged on base, or base is designed to provide ergonomic shape in itself.
Instrument/end effector
Hand-held device further comprises end effector 2, is exclusively used in the operation tool 3 of expected processing and can be installed in end
(referring to Fig. 3 A- Fig. 3 B) on portion's actuator 2.
According to one embodiment, instrument 3 can be installed on end effector 2 by factory；Otherwise, end effector may include
For attachment system (for example, clip mechanism) so that instrument to be fixed, the instrument can be the conventional instrument being separately provided.The implementation
Example has advantages below：It is easily compatible with the sterile drop cloth to cover driving unit and end effector.
Therefore, instrument 3 be probably or may not be device a part.
According to another embodiment (referring to Fig. 3 C), end effector supports the guide rail 20 for instrument, for leading for instrument
Rail 20 is exclusively used in being expected processing.
When instrument is saw blade, instrument guide rail is the cutting guide rail for limiting cutting plane (2D amounts to be cut off).
When instrument is bone drill, instrument guide rail is the drilling tool guide rail for limiting abrasive wire (1D amounts to be cut off).
Instrument guide rail 20 can be installed on end effector 2 by factory；Otherwise, end effector may include attachment system
(for example, clip mechanism) with by routine guide rail fix.
Instrument guide rail can be fixed or movable relative to end effector (for example, slidably and/or rotatable).
Driver element
As shown in Fig. 3 A to Fig. 3 C, end effector 2 is connected to base 1 by driver element 4, to move instrument 3
Move or instrument guide rail 20 is moved relative to hand-held base in the appropriate case, to handle amount of plan.
Driver element is according to the free degree of the application with given quantity.
Driver element 4 includes motor, gear (alternatively) and sensor, and motor, gear (alternatively) and sensor are connected
It is connected to together to form kinematic structure.
As will be described in greater detail below, driver element 4 is controlled by control unit 300.
According to one embodiment, instrument 3 can be spherical bone drill or scraper, and amount to be cut off is modeled as having
With the healing of bone drill or the spheroid of scraper identical diameter.
In this case, driver element 4 is designed to so as to three degree of freedom (one except driving bone drill rotation
Beyond the individual free degree).
Another optimization may include five frees degree to adjust orientation of the cutting edge of instrument relative to pending part.
In another embodiment, instrument can be the bone drill or scraper of cylinder, and amount to be cut off is modeled as having
There is a possible healing of the cylindrical section with bone drill or scraper identical diameter.
In this case, driver element is designed to have five frees degree.
Amount to be cut off can also by voxel, triangle meshes data, plane coordinate (cutting pattern for saw blade),
Point, direction and depth (being used to drill) represent.Driver element designs the type that will be suitable for pending amount.
It is the sterile components being sterilized that driver element can be made before each intervention.But in a preferred embodiment
In, driver element and its cable are covered by the sterile drop cloth of expendable transparent plastic.The additional part of system can also be in nothing
Cap is planted and protected.But instrument is all sterilized as any conventional tool in itself.Typically, make before each intervention
Instrument is carried out disinfection with autoclave.Different types of mechanical adapter can be set between sterile drop cloth and instrument.
If instrument includes tracking element, this adapter does not need point-device renewable fixation, and this is advantageous to global system
Design and use.
Support unit
Hand-held device further comprises support unit 5, support unit 5 be connected to base 1 (referring to Fig. 3 A to Fig. 3 B) or
End effector 2 (referring to Fig. 3 C).
The support unit 5 is adjacent with pending part with the body of pending part or patient including being intended to
At least one element of region contact, so as in base 1 (or end effector 2 as shown in Fig. 3 C) and pending part
Between provide local mechanical connection.User is trained so that pressure is applied into support unit always, to ensure and pending portion
The abundant contact divided.
Support unit 5 is usually sterile components.If driver element is covered with its base and end effector by sterile drop cloth
Lid, the then connection between support function and base or end effector can be established on sterile drop cloth.Or if base or end
Portion's actuator is sterile, then the connection is directly established.
Support unit 5 is the key element of hand-held device, and support unit 5 serves as stabilizer.
The support unit can be rigid, damping (for example, spring-loaded) and/or provide adjustable damping
Characteristic.
Contact between support unit 5 and body part can be by one or several points or at least one surface are formed.
In the embodiment shown in Fig. 3 A and Fig. 3 C, support unit 5 includes the rigidity contacted with pending part P1
Pin.
According to an alternative embodiment (referring to Fig. 3 B), support unit 5 include with patient body with it is pending
The damping pin of part P2 contacts adjacent part P1.
According to one embodiment, when end effector 2 supports instrument guide rail 20, support unit 5 may include that instrument is led
Rail 20 itself (referring to Fig. 3 C).
In varied situations, because support unit 5 directly contacts or via patient body in itself with pending part P1
The region P2 mediate contact adjacent with part P1 the fact, support unit 5 have the function that local mechanical connection, local mechanical
The motion of user is limited when being connected in operation described device, and motion, the cutting for the user that also decays in example is advantageously carried out
The vibration of instrument and the reaction force as caused by the motion of driver element.
In addition, because support unit only provides local mechanical connection, support unit does not need any intrusion to act.
In the case of no restriction effect, it will have to lead to relative to all user movements of pending part
Over-drive unit compensates in real time, and this is extremely hard to realize by existing robot technology.
User must be relative to the microscopic motion of pending part or macroscopic motion (including slow motion and fast motion)
Compensated in the margin of tolerance of the accuracy of device for limiting.
Typically, for bone surgery application, motion in the range of 1/tens millimeters need to be compensated with
Obtain sufficient accuracy；This compensation need ultrafast motion detection and measurement and the calculating of compensation campaign to be applied and
The execution of desired compensation campaign.Non- compensation campaign causes protuberance or irregular surface.
For dental applications, required accuracy even more high, typically in the range of more than one percent millimeters.
In the absence of can realize the sensor of above-described performance, computer, motor, controller, low inertial mechanism or
It is developed and manufactured extremely expensive.
By limitation and preferably convergent mode of motion, support unit can be used existing robot technology required to obtain
Accuracy.
Local mechanical is connected in also critically important when pending part is processed.
Support unit enables the short power of the closing ring of the power applied during processing to return to support unit place via device
Part.
The only small amounts of power applied during processing needs to be compensated by user, and result is that accuracy is higher.
According to the type of support unit, a part for the power of application will be decayed by closing power ring.
Such as when prong is used as support member, the power in both direction can be attenuated parallel to the surface where pin.
For example, local mechanical connection can be realized by one or more prongs, when device is pressed against bone by surgeon
When on bone, one or more of prongs can be lunged in bone.
This prong is with reference to 50 in figure 3D.
This prong 50 produces the local connection for including three degree of freedom.
When using two prongs, only allow the one degree of freedom through two needle tips around axis.
Local mechanical couples can also be realized by one or more pins with rounded tip, when said device is used,
The rounded tip can be pressed on bone (referring to the reference 51 in Fig. 3 D) by user.
The tip of pin, which can also have, to be attached to thereon to provide the silicones pan portion (not shown) of damping effect.
According to another embodiment, support unit may include at least one wheel for being provided with several pointed tooths, and the wheel can be along extremely
Slided on bone and optionally allow for the rotation around wheel shaft in a few direction (referring to the reference 52 in Fig. 3 D).
According to another embodiment, support unit includes attachment arrangement, and attachment arrangement has the body part for being attached to patient
Or the surface at least contacted with the body part of patient, to make the part and the attachment arrangement to be connected into base or hand
Hold the form fit of at least one pin of the end effector of device.Advantageously, attachment arrangement prevents pin end relative to patient's
Body slides.Connection between pin and attachment arrangement is preferably reversible and any kind of connection can be used (mechanical
, magnetic etc.).For example, connection may include for exampleLoop fasteners, magnetic fastener (e.g., including metal
Attachment arrangement and pin end including magnet) or mechanical hinge.
As shown in FIGURE 3 E, support unit 5 may also include pressure blood band 53, and support pin end is connected to pressure blood band 53 and presses blood band
53 serve as the band of the soft tissue around compression bone, so as to produce rigid and be accepted extensively for other purposes non-firm
Property connection.Herein, term pressure blood band is used for the band that restriction is attached at around soft tissue (skin), and the band has only
Blood function or without hemostatic function.Connection between pin end and pressure blood band bears shearing force and therefore prevents pin in soft tissue
Upper slip.As described above, bindiny mechanism may be designed to loop fasteners or magnetic fastener.
Alternative embodiment may include that adhesive patch 55 rather than pressure blood band, adhesive patch 55 are attached to the skin of patient
Skin and it is connected to pin end (Fig. 3 F).Advantageously, the outer surface of paster prevents the slip at pin end.
Alternatively, attachment arrangement can be by the way that moldable material be applied on the body part of patient to be formed.For example,
By using heat forming technology, the pastel used in dentistry can rapidly be moulded simultaneously in a manner of being aided in by heater
And harden, without producing any injury to patient.The device being molded therefore formation and the form fit of the body of patient
Template.
According to another embodiment shown in Fig. 3 G, support unit 5 may include pin 54a, and pin 54a one end is connected to bottom
Seat 1, and the pin 54a other end is connected to deformable bumper pad 54b (similar with sandbag), deformable bumper pad 54b provides resistance
The support function of Buddhist nun.
This cushion pad is intended to be placed on the skin of patient in the entrance of instrument.
Alternatively, this deformable bumper pad 54b can be fixed by vacuum to provide more rigid support.
In the similar embodiment shown in Fig. 9 A/9B, pin 54a end can be the dish type made of such as plastics
Part 54c, dish 54c have the surface for being intended to contact with the body of patient.The pin end can be coated with the material (example of flexible type
Such as, silicones or foam) to be preferably adhered to the skin of patient.Pin is generally made up of metal (for example, steel).
Connection between pin 54a and cushion pad 54b or dish 54c can use the form of ball-and-socket joint (not shown).
Ball is advantageously located at pin 54a end and is made of metal, and nest and cushion pad 54b or dish 54c into
One and it is made of plastics.
Therefore ball-and-socket joint can easily be connected and separated by the elastic deformation of nest.
Therefore, cushion pad 54b or dish 54c can be arranged on the appropriate location on the body of patient by user first, so
After pick up hand-held device 100 and via ball-and-socket joint by pin 54a be connected to cushion pad 54b or dish 54c with will support it is single
Member 5 assembles.
On the contrary, when user stops using hand-held device 100, user can be by pin 54a and cushion pad 54b or dish
54c is separated and then mobile cushioning pad 54b or dish 54c or the body shifting by cushion pad 54b or dish 54c from patient
Remove.
Advantageously, support unit 5 can provide damping so that the caused part between base and pending part
Mechanical attachment can absorb the reaction force being applied to by processed part on instrument.
The damping characteristic can provide by spring loaded component or by pneumatically or hydraulically damper.
Advantageously, the damping characteristic of support unit can be adjustable.
Damping presents the advantage that：When user need not compensate reaction force, accuracy is higher.
In another embodiment shown in Fig. 3 I, support unit includes at least one pin 56, and pin 56, which has, possesses circle
The V-arrangement end of cross section, pin 56 provide a unstable free degree between base and patient.
The free degree can be by using two (Fig. 3 H) in these pins 56 or by using with being formed as and angular support
The pin 57 (Fig. 3 J) of the similar end of seat hinders.The pin end of V-arrangement provide the template for being aligned with lineae aspera and because
This provides the possibility of the coarse localization for support unit and hand-held device.
The embodiment is particularly advantageous in UKA because support unit provides the position of limited quantity, this make it possible to
The arrival of quick and intuitive way stays in two regions ground on shin bone and on femur.
More generally, support unit can be designed to have predetermined shape, the predetermined shape and patient anatomies
Outer surface coordinates so that and robot base will be positioned in a region immediately, in this region, corresponding robot working space
It will match with the amount of pending part.
Alternatively, as shown in figure 3h, (can pass through with above-mentioned pressure blood band 53 or adhesive patch 55Or magnetic is tight
Gu mechanism) combine, to prevent V-arrangement pin end from being slided relative to femur ridge.
According to the embodiment shown in Fig. 3 K, support unit 5 includes the attachment arrangement 58 for being attached to the body part of patient,
For example, pressure blood band, adhesive patch or template as described above (here, P2 indicates femur ridge).Installation elements 59 are fixed to
Attachment arrangement 58.The base of hand-held device (is transported by the connecting elements being slidably engaged with installation elements 59 along the translation of femur ridge
Dynamic T) it is connected to attachment arrangement.Advantageously, connecting elements includes the joint for enabling base to rotate R1.If end effector or
Instrument can also be pivoted (rotation R2) relative to driver element 4, then instrument can reach all or several of the body of patient
All necessary different pieces, without moving the base of hand-held device.
According to the embodiment shown in Fig. 3 L, support unit 5 is designed to the second handle for user (except base
Normally by user grip part outside).For example, in Fig. 3 K, the handle is designed to be held in the of user
Spheroid in two hands, first hand grip base.Then, local mechanical connection the leaning against by user between patient and device
Second hand on patient body provides, and this can stablize and the relative motion that decays.
According to one embodiment (not shown), support unit may also include is applied to local mechanical connection for detecting by user
At least one sensor of the power connected；Therefore, control unit check that whether the power is more than threshold value so that support unit
Damping parameter with minimum.Which ensure that for example prong may not slide on bone.
Otherwise, control unit can issue the user with warning or device is automatically stopped.
According to application, above-described embodiment of support unit can be combined is fitted with being provided between hand-held device and patient body
The local mechanical connection of conjunction.
Preferably, support unit 5 is designed to so as to separable from hand-held device 100, specifically for providing support function
Element sterilization and/or replacing.
For example, but without limitation, ball-and-socket joint can be used to that support unit easily is connected into base or end
Actuator easily separates support unit with base or end effector.
If support unit 5 is connected to base 1, it, which is only produced, will prevent for instrument 3 to be placed on into large space
The global restriction of any position, but it will not be to reaching any amount or target generation any restrictions near it.
Driver element 4 will continue that the relative motion between base 1 and pending part 100 is worked and mended
Repay, simultaneously continuously optimize abrasion path.
Support unit 5 is intended to help the complex control and dynamics for solving system, but is not intended to add geometrical constraint
Into local neighborhood.
In some cases, support unit 5, which can produce, needs what user moved base and/or support unit contact area
Global restriction.
Tracing unit
System also includes tracing unit 200, and tracing unit 200 is configured to determine instrument 3, end effector 2 in real time
With at least one posture relative to pending part 100 in base 1.
Instrument 3 relative to the posture of end effector 2 can be known and mechanically determine or not mechanically
It is determined that.
In view of being based on dynamic (dynamical) redundant computation, instrument posture can be useful relative to the knowledge of end effector.
Tracing unit can typically comprise tracing system known per se.
In computer assisted surgery usually used tracing system use can be used separately or in combination it is a variety of not
Same technology (passive optical, active optics, electromagnetism, the inertia with gyro to measure, ultrasonic wave etc.).
Tracing unit measurement refers to the second target equipped with the first target of tracker relative to the another of tracker is also equipped with
Posture.
In some cases, it is that a tracker of the tracing unit and only on the first target in itself is necessary with reference to the second target
's.
Tracker can be transmitter or sensor (also known as receiver).
In all cases, tracing unit is between the posture and instrument of pending part and/or the posture of device
Transformation matrix is provided.
The typical frequencies of tracing unit are in the range of 50Hz to 1000Hz or even more high.
In the accompanying drawings, transmitter 210 is by triangular representation, and sensor 220 is represented by square.
Transmitter and sensor can be increased the accuracy of attitude measurement by redundancy.
In with for the example of transmitter and the electromagnetism tracing system of several possible configurations of sensor, we recognize
For：The first target is fully determined being attached to the transmitter of the first target and being attached to the measurement that is obtained between the sensor of the second target
Relative to the relative attitude of the second target.The vector that the posture is generally translated by the matrix and expression 3D that represent 3D rotations is come table
Show.
If sensor is attached to the 3rd target, the basic combination of matrix determines the 3rd target relative to the relative of the second target
Posture (i.e. between two sensors).
As shown in Fig. 4 A to Fig. 4 E, a variety of arrangements of transmitter and sensor are feasible.
Preferably, the distance between sensor and transmitter are minimized to the distortion by being induced around metal object
Possibility minimize.
According to a preferred embodiment, transmitter is installed in device sheet, is more specifically installed in bottom
On seat or on end effector.
A sensor being installed only on pending part is just enough.
This has advantages below：Reduce the quantity that necessary coordinate system table changes and therefore reduce error incidence and increase
Accuracy.
In some cases, for example, when instrument is scraper or minor diameter bone drill, its not enough rigidity based on end to be performed
The posture of device carries out tool tip posture determination, and additional sensor can be installed on tool tip (or close to instrument
Tip).
In Figure 4 A, tracing unit includes the transmitter 210 on end effector 2 and the biography on patient body
Sensor 220 (here, on the part P2 adjacent with pending part P1).
In figure 4b, tracing unit includes the transmitter 210 on instrument 3 and the sensor on patient body
220 (here, on the part P2 adjacent with pending part P1).
In this particular example, support unit 5 and instrument guide rail 20 are connected to end effector 2 and added by spring
Carry so that under progradation, instrument 3 (saw blade) can skid off from guide rail 20.
In figure 4 c, tracing unit includes the sensor 220 being located on tool tip and on pending part P1
Transmitter 210.
In fig. 4d, tracing unit includes the transmitter 210 and two sensors 220 being located in operating room：End performs
Another sensor on a sensor and pending part P1 on device 2.
In Fig. 4 E, tracing unit includes the transmitter 210 on the base 1 of device and the biography on patient body
Sensor 220.
Also, it should be mentioned that driver element dynamics and the geometric knowledge of end effector may be additionally used for determining base
Transformation matrix between posture and instrument posture.If transmitter or sensor are attached to base and sensor is attached to
Instrument, people are obtained for the redundant measurement completely with optimization purpose.
Certainly, the above embodiments are merely illustrative, and technical staff can in the case of without departing from the scope of the present invention
Sensor and transmitter are arranged in different ways or combine some in these embodiments.
User interface
As it was previously stated, user interface is defined so as to which safety device position is presented into user.
As a rule, essential safety is realized when the space of instrument is less than pending amount.This also results in small dress
Put size and therefore cause light-duty and compact hand-held device.
User interface can provide information to user, and with guiding, device is continuously positioned at optimum attitude by him or she.
The user interface can be tactile, vision and/or the sense of hearing.
According to one embodiment, user interface 400 may include the screen 410 for being connected to control unit, for example, showing in Fig. 1
The screen gone out.
As shown in Figure 5A, for example show in form of arrows must to the continuous processing for keeping whole amount for the screen 410
The adjustment wanted.
The adjustment information can also visualize (for example, in FAI processing) on endoscopic images.
During using described device, control system checks whether pending amount can be safely handled in real time.
If robot base is moved into so that the border of working space (means no too many space closer to pending amount
For error compensation), it can then change the information for being supplied to user, for example, arrow changes its color or produces acoustic feedback.
According to another embodiment (referring to Fig. 5 B), user interface includes such as LED optical indicator 420, optics instruction
Device 420 is supported by supporting plate 421, and supporting plate 421 is fixed to device 100.
The indicator 420 is connected to control unit 300 and is placed with mobile with true so as to which device is had to
The direction and/or orientation for protecting not interrupt processing are presented to user.
LED can be polychrome or flash at different frequencies how many and/or more to indicate to correct along the direction pointed out
It is necessary long.
Because indicator 420 is disposed in 100, device, surgeon receives the attitude information in the original location,
This is conveniently for him or she.
The another way for providing information to user is directly to be repositioned onto information on the skin or bone of patient
Optical projection.
For example, as shown in Figure 5 C, information can use the form of the arrow 430 projected by laser bar (not shown), laser bar
It is arranged on the device 100 and is controlled by control unit 300.
Control unit
System further comprises control unit, and control unit is intended to control tool path optically, to handle meter
Draw amount.
The operation of control unit is described in more detail below.
Fig. 6 is the synoptic diagram of the possible operation for the system that shows.Method described herein is suitable for UKA and FAI processing.So
And technical staff can make methods described be suitable to other surgical procedures.
Programming phase is performed before system operatio.
In the step s 100, user starts to operate above-mentioned device.
In step S101, tool tip is measured relative to the posture of pending part by tracing unit.
In step s 102, control unit updates the surplus of pending part, and surplus is to treat when process starts
The whole amount of plan of excision.
In step s 103, control unit determines posture of the end effector relative to base.
Control unit determines pending surplus (step S105) based on pending amount of plan (input I104), and
And the part (step S106) that can be safely handled of the amount is determined relative to the posture of base based on end effector.
Safety means：In any opening position of complete resection of amount, device can compensate the motion induced by user
Caused error.This may mean that：Device can make instrument to determine speed or necessarily be limited it is determined that being moved in the time
The millimeter of amount makes instrument rotation transmit the angle for moving limited amount.For that purpose it is necessary to known end effector is with the every of workload
Dynamic behaviour under individual posture.
In step C107, whether control unit checking tool tip is within amount of plan.
If it is not, then control unit makes instrument and device stop immediately and produces message (step for user
S109)。
Advantageously, position data can filter to avoid stopping device when obtaining exceptional value in advance.
If user accepts the warning (step C110), then method is again since step 101.
Therefore, user has to be repositioned to and can indicate that (described above is the user interface by user interface device
Preferred embodiment).
If tool tip, within amount of plan, whether the safe handling part of control unit inspection amount is higher than given threshold
It is worth (step C108).
Threshold value can be implemented in different ways.One embodiment can be：The size of surplus, which is less than, limits size.
Another embodiment can be：Distance to the border of safe resection is less than limit value.
If it is not, then control unit 300 indicates via user interface 400：User should will fill along calculated direction
Put and reposition (step 115).The repositioning may include the position for changing support unit, or can not change support unit
Made in the case of position (for example, by making base be moved along the free free degree of support unit).For example, user circle
Face, which may indicate that, makes the base of device support tip to pivot around fixed along assigned direction and pivot specified rate, until its reached by
The posture of the new son amount of pending part can be reached, the sub- measurer has the size higher than predetermined threshold.Then, method
Repeated again from step 101.
If the safe handling part of amount is higher than the given threshold value, seat of the control unit calculating instrument tip in device
Optimal path (step 111) in mark system.Optimal path can not only include the posture under special time step, and may also include
Tool parameters, for example, changing the rotating speed of lapping device according to instrument posture.In other words, optimal path may include according to six
Processing parameter under the posture of the free degree and each time step.
If user enables process to carry out (step C111b) via hand switch or floor push, then control unit
Driver element is adjusted to make end effector according to the path of the calculating to move (step 112).As path is waiting to locate
It is limited on the part of reason in the coordinate of sensor and control unit is by tool tip and the meter under each time step
The distance between current pose in path of calculation minimizes, and device will be independent of user and be applied to the motion of device and follow described
Path.
Control unit checks whether pending surplus is less than given threshold value (step C113).
The given threshold value can be defined as the limitation suitable with desired treating capacity by user, though treating capacity not exclusively and
Amount of plan is identical and such.
In the yes case, method terminates (step S114).
If it is not, method repeats from step S101 again.
It is described fully to be performed under high frequency (for example, 1000kHz).
In the case of TKA, method and above-mentioned method are slightly different.
For the intervention, there are two kinds of possibilities：
- first, instrument (saw blade) is different from device and is grasped in first hand of user (or assistant), and device
It is grasped in (user or assistant) second hand (for example, see Fig. 4 E),
- secondly, instrument is a part for device, and by the way that device is shifted onto on bone, instrument is skidded off from guide rail and gone forward side by side
Enter in bone (as shown in Figure 4 B).
In step S101, end effector or support unit are determined relative to the posture of bone.
In step C113, user determines whether to be intended to the excision of 2D amounts.
According to application, base can need (typically, three times or four times, but up to 100 times sometimes) for several times again fixed
Position.However, largely repositioning action if necessary, the discrete location of base ought be not necessarily required.Base on the contrary can continuously and
Slowly move to cover necessary complete working space.For pending complicated shape, user can be requested with for
The given position of support unit continuously moves base, and support unit then is moved into another fixed position, and then
Base is continuously moved near the position and repeats this process, until the complete amount handled.
The repositioning of base or support unit can be guided by user interface, to reach new position, not become newly
Maximum can be cut off in the case of change from new position.This minimizes the quantity of necessary repositioning step.
As described above, optimal path may include the processing parameter (for example, tool velocity) at posture and each time step.
Retaining arm
According to the one embodiment shown in Figure 10, the gripping of hand-held device 100 can be aided in by retaining arm 510, be kept
The base 1 and retaining arm 510 of the supporting hand-held device 100 of arm 510 are connected to mechanical support.
Retaining arm 510 is hinged to have several frees degree, and switchs and be used to make its distance braking or motionless (gas
Swing arm, hydraulic arm, mechanical arm, the arm etc. with brake).In addition, retaining arm can have to compensate the hand-held dress of its delivery
The mechanism (such as by using passive or active balancing weight) for the weight put.
In this case, retaining arm is considered as another possible embodiment of previously described support unit.
Another modification is to use the part in addition to retaining arm similar with the embodiment of previously described support unit
Support component.
Retaining arm 510 is hinged to allow users to hand-held device 100 being positioned at desired locations.
Retaining arm 510 can compensate for the weight of hand-held device 100 and make user's minimum fatigue (especially surgical procedure
When taking a long time).
Preferably, the mechanical support contacts with patient body.
Mechanical support additionally aids produces local mechanical connection between pending part and hand-held device.
Preferably, mechanical support is operating table 500 or is generally used for the support component (example that patient is positioned and kept
Such as, leg retainer, pelvis retainer, operation important actor etc.).
Additional local support can by support component being merged on above-mentioned end effector 2 or base 1 to realize,
Compensated by with less riding chain in a manner of according to less vibration.If the mechanical support of retaining arm is only to move
Formula stroller is lifted, then the embodiment is particularly useful.
Keep cable
According to another embodiment shown in Figure 11, gripping for hand-held device 100 can be by the line that extends from spring pulley 511
Cable aids in, and the base 1 and the cable of the cable support hand-held device 100 be connected to mechanical support 511a.
Cable 511 is kept to allow all frees degree of hand-held device in all usage times.
In addition, keep cable can have to compensate its delivery hand-held device weight mechanism (for example, by for
The weight of back-moving spring adjustment is so that cable accelerates), to minimize human fatigue (especially if surgical procedure cost is very long
Time).In this manner it is achieved that when hand-held device 100 is released, it is maintained at its position or somewhat fallen back.
Mechanical support 511a can by room top plate 512, by lean against fixed or movable cart 513 on floor or
Supported by operating table.
Local mechanical connection is provided on above-mentioned end effector 2 or base 1 by support unit (not shown).
Using the mono- knee replacements of example 1- (UKA)
In UKA, instrument is used to prepare the shin bone and femur fixed for the implant at planning location and orientation
Bone.Wait the amount cut off and implant at which in its final position when negative shape it is consistent.
Used grinding strategy can also be used for all other applications, wherein, it has to resection cavity works as use
When bone surface have to reshape the specific implant for patient.
In this regard, (3D) amount of bone at femur and at tibial side must be removed, to insert implant component.
Therefore, used instrument is typically mill and scraper.
Fig. 7 A to Fig. 7 B show the specific embodiment of suitable hand-held device 100.
Instrument 3 is attached to the mill of end effector 2.
Driver element and end effector be broken down into anterior driver element 4a and corresponding end effector 2a and after
Portion driver element 4b and corresponding end effector 2b.
Hand-held device 100 provides three degree of freedom：
- two frees degree provide (driver element includes planar five-bar mechanism) by anterior driver element 4a,
- one degree of freedom (feed motion for leaving pivoting point) is provided by rear transfer unit 4b.
Support unit 5 includes a prong 50 for being connected to base 1.
Prong 50 be intended to and the adjacent bone-contact of pending bone.
In use, user shifts support unit 5 onto on the bone adjacent with pending bone, to produce local machine
Tool couples.
Using example 2- total knee arthroplastys (TKA)
In TKA, instrument is used to prepare the shin bone and femur fixed for the implant at planning location and orientation
Bone.
The instrument generally used in this intervention is saw blade and drilling tool.
Typically, five flush cuts have been carried out at femur and a flush cut has been carried out at shin bone.
According to first embodiment, instrument is held by user and instrument guide rail be fixed to hand-held device end perform
Device.
In this manner it is achieved that instrument is freely manipulated in one hand by user in itself, but instrument is by instrument rail guidance,
The posture of instrument guide rail is limited by rights by the system according to the present invention, and hand-held device is maintained at the another of user
Kept in hand or by assistant.
Fig. 8 A to Fig. 8 B show the specific embodiment of suitable hand-held device.
Here be saw blade guide rail instrument guide rail 20 (but if when instrument is drilling tool, it is drilling tool guide rail certainly) it is attached
It is connected to end effector 2.
According to an alternative embodiment, instrument 3 is fixed to end effector in itself.
Instrument guide rail is in this case not necessarily.
Fig. 8 C show the specific embodiment of this hand-held device.
In this case, instrument 3 is the saw blade for the end for being arranged in end effector.
Hand-held device provides six-freedom degree, and six-freedom degree is indicated by arrow：
- two frees degree (X/Y plane) are supplied to the distal part of end effector by driver element,
- two frees degree (X/Y plane) are supplied to the portions of proximal of end effector by driver element,
- one degree of freedom (being translated along z axis) is provided by end effector,
- one degree of freedom (line rotation about the z axis) is provided by end effector.
The framework can be such that saw blade is moved along institute direction in need to perform total knee arthroplasty.
In example shown here, support unit includes two prongs 50 for being connected to base 1, and two prongs 50 are intended to
With pending bone-contact.
In use, user shifts support unit onto on pending bone, to produce local mechanical connection.
Using example 3- femur acetabular bone Impingement Syndromes (FAI)
Fig. 9 A to Fig. 9 B show hand-held device according to the third embodiment of the invention.
Although being not limited to the application-specific, described device is suitable for FAI processing.
In FAI processing, the overall situation is that the irregular shape at femoral head neck abutment and/or limbus of acetabulum (looks like
Spur) arthroscope excision.Currently, CT/MRI data are used for pre-surgery assessment (determination of amount of plan to be cut off), and
X-ray and arthroscope image be used to orient in operation.One in principal risk in FAI operations is that (this will for excessive excision
Cause hip joint shakiness) or very few excision (this is the reason for revisional operation is most frequent).Generally, using each centimetre of three otch
Arthroscopy Methods used.Pending amount is approached by arthroscopic portal.Surgeon is necessary during instrument moves
The injury to hip joint blood supply, cartilage and/or capsular ligament is avoided via robot system：Therefore for the benefit of planning system
Repay and limit safety zone.
The realization of device has identical reference with the part of device described above identical function.
Therefore, in addition to its special characteristic, will not be described in detail again.
The hand-held device shown in Fig. 9 A to Fig. 9 B includes the end effector 2 of delivery vehicle 3；Here, instrument 3 is to scrape
Knife.
Certainly, user can use another instrument.
Specifically, the operation tool routinely used in FAI processing is the mill and scraper of high speed.
The hand-held device provides three degree of freedom：
- two frees degree are provided by driver element 4：In embodiment shown here, driver element is spherical including two
Five-rod, two spherical five-rods synchronously move by two motor gear units.People can also use plane
Linkage, rather than spherical five-rod.
- one degree of freedom (feed motion (z- translations) of scraper) is provided by end effector 2.
Support unit 5 includes cushion pad 54c, cushion pad 54c provide with the soft tissue of patient body (more properly, with hip
Skin) contact area.
Contact area is as large as possible, to reduce the pressure for being applied to soft tissue, to keep cushion pad 54c and tissue
Between contact.
Cushion pad 54c can have disc-like shape and be placed on the part of the flat of patient body.
Cushion pad can have annular shape on the contrary, so that it can be placed at around surgical portal.
Cushion pad by band or can pass through any other device (for example, by suction effect, adhesive or adhesive tape)
It is fixed to body.
In this case, the soft tissue of patient provides certain decay of local mechanical connection.
Decay can be provided further by the damping implemented on support unit or spring performance.
Another possibility is (in addition to using pad or vacuum pad to provide contact between support unit and soft tissue)
Support unit is connected to trochar, trochar can be used to close to joint.
Although the fixation for being advantageous in that its to patient body of this cushion pad is not intrusion, soft group is contacted
Knit another possibility (except or be not) be for example via at least one pin as described by the operation for other species come
The contact with the bone near pending part is provided.
At least one pin can be via entrance (instrument can be introduced into by the entrance) or via another entrance
It is inserted into the body of patient.
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Claims (22)
1. surgery systems, including：
(i) hand-held device (100), the hand-held device (100) include：
- the base (1) for being designed to be held in the hand of user,
- end effector (2), the end effector (2) are used to install operation tool or are used to guide operation work for installing
Has the instrument guide rail (20) of (3), the operation tool is designed to handle the meter of the pending part (P1) of the body of patient
Draw amount,
- driver element (4), the driver element (4) is connected to the base (1) and the end effector (2), to make
The operation tool (3) or the instrument guide rail (20) are mobile to handle the amount of plan relative to the base (1),
- support unit (5), the support unit (5) are connected to the base (1) or the end effector (2), the branch
Support unit (5) includes being designed to and the body of the pending part (P1) or patient and the pending part phase
At least one element of adjacent region contact, so as between the base (1) and the pending part (P1) or in institute
State and local mechanical connection be provided between end effector (2) and the pending part (P1),
(ii) tracing unit (200), the tracing unit (200) are configured to determine the operation tool (3), described in real time
At least one posture relative to the pending part in end effector (2) and the base (1),
(iii) control unit (300), described control unit (300) are configured to：
(a) performed based on the posture determined by the tracing unit to calculate the operation tool or the end in real time
Device (2) relative to the base (1) optimal path,
(b) detect the optimal path of the calculating of the operation tool (3) or the end effector (2) do not change it is described
Whether can be implemented in the case of the posture of base (1), and if it does not, then determine the base (1) relative to
The possible repositioning of the pending part (P1),
(c) driver element (4) is configured to make the end effector (2) be moved according to the optimal path of the calculating,
And
(d) repeat step (a) arrives (c), untill the amount of plan has been processed,
(iv) user interface (400), the user interface (400) are configured to feedback information being indicated to user.
2. surgery systems according to claim 1, wherein, instrument guide rail (20) is installed in the end effector (2)
On, and the support unit (5) includes the instrument guide rail (20).
3. surgery systems according to any one of claim 1 to 2, wherein, the support unit include being used for detecting by
User is applied at least one sensor of the power in the local mechanical connection, and wherein, described control unit is configured
Whether it is more than threshold value into the inspection power so that the support unit has minimum damping parameter.
4. surgery systems according to claim 1 or 2, wherein, the support unit includes at least one damping element, makes
Obtain the caused local machine between the base (1) or the end effector (2) and the pending part (P1)
Tool connection can absorb the reaction force being applied to by processed part (P1) on the operation tool (3).
5. surgery systems according to claim 4, wherein, the damping characteristic of at least one damping element is adjustable
's.
6. surgery systems according to claim 1 or 2, wherein, the support unit includes having at least one rigidity certainly
By at least one pin for spending or damping the free degree.
7. surgery systems according to claim 1 or 2, wherein, the support unit includes at least one pad, it is described at least
One pad has features designed to the surface adhered on the soft patient tissues adjacent with the pending part.
8. surgery systems according to claim 1 or 2, wherein, the support unit (5) include Part I (54a) and
Part II (53,54b, 54c, 55,56,57,58), the Part I (54a) are connected to the base (1) or the end
Portion's actuator (2), the Part II (53,54b, 54c, 55,56,57,58) be intended to the pending part (P1) or
The part (P2) adjacent with the pending part of patient coordinate and/or be fixed to the pending part (P1) or
The part (P2) adjacent with the pending part of patient.
9. surgery systems according to claim 8, wherein, the Part I of the support unit and described second
/ connection include loop fasteners or magnetic fastener.
10. surgery systems according to claim 1 or 2, wherein, the support unit (5) includes can be by the another of user
The handle that one hand grips.
11. surgery systems according to claim 1 or 2, wherein, the support unit (5) is cut with scissors relative to the base (1)
Connect.
12. surgery systems according to claim 1 or 2, wherein, the operation tool (3) performs relative to the end
Device (2) is be hinged.
13. surgery systems according to claim 1 or 2, wherein, described control unit (300) is configured to：It is if described
Control unit (300) detects that the current pose of the operation tool is located at the outside of the amount of plan, then makes the driving single
First (4) and/or the operation tool (3) stop.
14. surgery systems according to claim 1 or 2, wherein, the support unit includes retaining arm, the retaining arm
It is connected to the base of the hand-held device and suitable for being connected to mechanical support.
15. surgery systems according to claim 1 or 2, wherein, the surgery systems include planning system, the plan
System is configured to determine the amount for treating to be handled by the operation tool and determines the operation tool in the appropriate case extremely
A few processing parameter.
16. surgery systems according to claim 1 or 2, wherein, the end effector (2) or the support unit (5)
In include drilling tool guide rail or saw blade guide rail, and the operation tool is to be intended to move in the axis of the guide rail or plane
Drilling tool or saw blade.
17. surgery systems according to claim 1 or 2, wherein, the operation tool (3) includes saw blade, drilling tool, grinding
Device, scraper.
18. surgery systems according to claim 1 or 2, wherein, the tracing unit is including at least one transmitter and extremely
A few sensor, at least one transmitter is installed on the base (1) or the end effector (2) and institute
At least one sensor is stated to be suitable to be installed on the pending part (P1).
19. surgery systems according to claim 1 or 2, wherein, the feedback information provided by the user interface includes institute
The optimal path for stating calculating is not changing the base (1) and/or the support unit (5) relative to the pending part
(P1) in the case of posture whether the instruction that can be realized, and if it is irrealizable, then include single by the control
The instruction of the possible repositioning of the base (1) and/or the support unit (5) that first (300) determine.
20. surgery systems according to claim 1 or 2, in addition to the cable from spring pulley (511) extension, the line
Cable supports the base (1) of the hand-held device (100).
21. surgery systems according to claim 14, wherein, the mechanical support is operating table.
22. surgery systems according to claim 1 or 2, wherein, the operation tool (3) includes bone drill.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| EP13171546 | 2013-06-11 | ||
| EP13171546.8 | 2013-06-11 | ||
| PCT/EP2014/062150 WO2014198784A1 (en) | 2013-06-11 | 2014-06-11 | System for the treatment of a planned volume of a body part |
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| CN105431102A CN105431102A (en) | 2016-03-23 |
| CN105431102B true CN105431102B (en) | 2018-01-30 |
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| CN201480033673.5A Active CN105431102B (en) | 2013-06-11 | 2014-06-11 | System for the processing of the amount of plan of body part |
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| EP (2) | EP3007636B1 (en) |
| JP (1) | JP6368906B2 (en) |
| CN (1) | CN105431102B (en) |
| WO (2) | WO2014198784A1 (en) |
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| JP6368906B2 (en) | 2018-08-08 |
| EP3007637A1 (en) | 2016-04-20 |
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| US20160113720A1 (en) | 2016-04-28 |
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| EP3007636A1 (en) | 2016-04-20 |
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| US10368878B2 (en) | 2019-08-06 |
| US10441294B2 (en) | 2019-10-15 |
| EP3007636B1 (en) | 2017-09-27 |
| EP3007637B1 (en) | 2017-11-08 |
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