CN113171175A - A lumbar vertebral endoscopy fusion technique assisted by electromagnetic navigation - Google Patents
A lumbar vertebral endoscopy fusion technique assisted by electromagnetic navigation Download PDFInfo
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- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
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- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
- A61B2034/2051—Electromagnetic tracking systems
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
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- A61B2034/2065—Tracking using image or pattern recognition
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Abstract
本发明公开了一种电磁导航辅助下的腰椎镜下融合技术，具体涉及腰椎微创手术技术领域，具体步骤如下：步骤一：影像匹配；步骤二：注册开路锥；步骤三：注册穿刺针、导杆和工作通道；步骤四：注册环锯；步骤五：注册镜下器械。本发明通过步骤一到步骤五与电磁导航技术相结合，实现了手术全程的可视化，对手术器械持续跟踪，避免了术中透视，既缩短了手术时间，又减少了患者和医护人员的术中辐射，操作前就对操作路径进行规划，术中可以根据电磁导航系统呈现的全息影像，对器械的角度和位置及时进行调整，实现了手术的精准化，避免了对管道的多次调整、对肌肉的过度牵拉以及对骨性结构不必要的切除，避免了神经损伤，保证了手术效果。The invention discloses a fusion technology of lumbar spine assisted by electromagnetic navigation, and specifically relates to the technical field of minimally invasive lumbar spine surgery. The specific steps are as follows: step 1: image matching; step 2: registering an open-circuit cone; Guide rod and working channel; Step 4: Register the trephine; Step 5: Register the instrument under the microscope. Through the combination of steps 1 to 5 and electromagnetic navigation technology, the present invention realizes the visualization of the whole operation process, continuously tracks the surgical instruments, avoids intraoperative fluoroscopy, shortens the operation time, and reduces the intraoperative time for patients and medical staff. Radiation, the operation path is planned before the operation, and the angle and position of the instrument can be adjusted in time according to the holographic image presented by the electromagnetic navigation system during the operation, which realizes the precision of the operation and avoids multiple adjustments to the pipeline, Excessive stretch of muscles and unnecessary resection of bony structures avoids nerve damage and guarantees surgical results.
Description
Technical Field
The invention relates to the technical field of lumbar minimally invasive surgery, in particular to an electromagnetic navigation-assisted lumbar under-mirror fusion technology.
Background
With the continuous progress of the aging of Chinese population, the lumbar degenerative disease becomes a common disease affecting the health of the elderly, the disability rate is high, and serious people even completely lose normal living ability. Generally, conservative treatment is not effective, and lumbar surgery decompression and fusion are effective means of treating the disease. In the minimally invasive treatment and the precise treatment, the spinal endoscopic surgery has become the most common surgical technique of the spinal surgery at present due to the advantages of small trauma, quick recovery and the like. However, along with the spinal endoscopy, the operator loses the direct visualization of the anatomical structure of the patient in the operation, so the spinal endoscopy operation has steep learning curve and great operation difficulty.
The under-mirror fusion operation not only combines the percutaneous pedicle screw internal fixation technology, but also can be implanted into the interbody fusion cage by means of a working pipeline to reconstruct the lumbar stability of the patient, thereby providing an ideal operation mode for the minimally invasive operation treatment of the patient suffering from lumbar spondylolisthesis. The steps of percutaneous pedicle screw implantation, endoscope working channel placement, endoscopic operation and the like in the traditional endoscopic fusion technology are generally completed by hands by combining self experience under the guidance of perspective of an operator in an operation. The traditional technology can not be directly visualized, so that the positions, the depths and the angles of the screws and the instruments need to be repeatedly confirmed by fluoroscopy, the steps are complicated, the operation time is long, and the risk of nerve root injury exists.
Disclosure of Invention
Therefore, the invention provides a lumbar under-mirror fusion technology under the assistance of electromagnetic navigation, which is combined with the electromagnetic navigation technology to solve the problem that the traditional under-mirror fusion technology in the background technology cannot realize full-range visualization.
In order to achieve the above purpose, the invention provides the following technical scheme: a lumbar under-mirror fusion technology under the assistance of electromagnetic navigation comprises the following specific steps:
(professional name: registration, colloquially, to present a tool on a hologram of a navigation system and to dynamically track it)
The method comprises the following steps: image matching: collecting lumbar vertebra three-dimensional CT (computed tomography) imaging data of a patient before an operation and transmitting the lumbar vertebra three-dimensional CT imaging data to an electromagnetic navigation host; a positioner and a mapping ring are placed in the operation, and the images are matched after perspective so as to carry out the next operation planning;
step two: registering an open-circuit cone: registering the open-circuit cone, planning a percutaneous pedicle screw path through the open-circuit cone, and realizing visualization of pedicle screw bone tunnel drilling;
step three: registering puncture needles, guide rods and working channels: the puncture needle, the guide rod and the working channel are registered, and a puncture path, a guide rod path, a depth and an angle are planned, so that the working channel is accurately placed and continuously tracked;
step four: registering a trepan: planning a path and an angle of the trepan, and continuously tracking the depth and the sawtooth position of the trepan;
step five: registering an under-the-mirror instrument: planning the path and angle of the under-mirror instrument and continuously tracking the head position of the instrument.
Further, the scope instruments in step five include, but are not limited to, nucleus pulposus pincers, square chisels, reamers, curettes, and the like.
The invention has the following advantages:
1. through the arrangement of the third step, the fourth step and the fifth step, compared with the prior art, the visualization of the whole operation process is realized, the operation instrument is continuously tracked, the perspective during the operation is avoided, the operation time is shortened, and the radiation of a patient and medical staff during the operation is reduced;
2. according to the invention, through the arrangement of the step one, compared with the prior art, the operation path is planned before the operation, the angle and the position of the instrument can be timely adjusted in the operation according to the holographic image presented by the electromagnetic navigation system, the precision of the operation is realized, the multiple adjustment of the pipeline, the excessive traction of the muscle and the unnecessary excision of the bony structure are avoided, the nerve injury is avoided, and the operation effect is ensured;
3. compared with the prior art, the invention has the advantages that through the arrangement of the step two, the screw path is individually designed, the hand feeling of a surgeon in the traditional screw placing step is kept, the screw placing step is perfected, and the repeated screw placing is avoided. Therefore, the postoperative wound of the patient is small, the recovery is fast, the life quality is high, and the complication is few.
Drawings
In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below. It should be apparent that the drawings in the following description are merely exemplary, and that other embodiments can be derived from the drawings provided by those of ordinary skill in the art without inventive effort.
The structures, ratios, sizes, and the like shown in the present specification are only used for matching with the contents disclosed in the specification, so as to be understood and read by those skilled in the art, and are not used to limit the conditions that the present invention can be implemented, so that the present invention has no technical significance, and any structural modifications, changes in the ratio relationship, or adjustments of the sizes, without affecting the effects and the achievable by the present invention, should still fall within the range that the technical contents disclosed in the present invention can cover.
FIG. 1 is a diagram of a placement locator and mapping ring of the present invention;
FIGS. 2 and 3 are image matching diagrams according to the present invention;
FIG. 4 is a schematic representation of the implantation path planning and real-time navigation of the percutaneous pedicle screw of the present invention;
FIG. 5 is a diagram of the path planning and real-time navigation of the needle and guide of the present invention;
FIG. 6 is a working channel path planning and continuous navigation diagram of the present invention;
FIG. 7 is an under-mirror trepan path planning and continuing navigation view of the present invention;
fig. 8 is a view of the endoscopic instrument path planning and continuous navigation of the present invention.
Detailed Description
The present invention is described in terms of particular embodiments, other advantages and features of the invention will become apparent to those skilled in the art from the following disclosure, and it is to be understood that the described embodiments are merely exemplary of the invention and that it is not intended to limit the invention to the particular embodiments disclosed. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
Referring to the attached fig. 1-8 of the specification, the lumbar under-mirror fusion technology with the electromagnetic navigation assistance of the embodiment specifically comprises the following steps:
(professional name: registration, colloquially, to present a tool on a hologram of a navigation system and to dynamically track it)
The method comprises the following steps: image matching: collecting lumbar vertebra three-dimensional CT (computed tomography) imaging data of a patient before an operation and transmitting the lumbar vertebra three-dimensional CT imaging data to an electromagnetic navigation host; a positioner and a mapping ring are placed in the operation, and the images are matched after perspective so as to carry out the next operation planning;
step two: registering an open-circuit cone: registering the open-circuit cone, planning a percutaneous pedicle screw path through the open-circuit cone, and realizing visualization of pedicle screw bone tunnel drilling;
step three: registering puncture needles, guide rods and working channels: the puncture needle, the guide rod and the working channel are registered, and a puncture path, a guide rod path, a depth and an angle are planned, so that the working channel is accurately placed and continuously tracked;
step four: registering a trepan: planning a path and an angle of the trepan, and continuously tracking the depth and the sawtooth position of the trepan;
step five: registering an under-the-mirror instrument: planning the placement path and angle of the under-the-mirror instruments, such as chisels, reamers, curettes, etc., and continuously tracking the instrument head position.
The working principle is as follows: referring to the drawings of the specification 1-8:
(professional name: registration, colloquially, to present a tool on a hologram of a navigation system and to dynamically track it)
FIG. 1, FIG. 2, and FIG. 3 show: image matching: collecting lumbar vertebra three-dimensional CT (computed tomography) imaging data of a patient before an operation and transmitting the lumbar vertebra three-dimensional CT imaging data to an electromagnetic navigation host; a positioner and a mapping ring are placed in the operation, and the images are matched after perspective so as to carry out the next operation planning;
FIG. 4 shows: registering an open-circuit cone, planning the implantation path of the percutaneous pedicle screw and navigating in real time. The open-circuit awl is registered, and the percutaneous pedicle screw path is planned through the open-circuit awl, so that the visualization of drilling of the pedicle screw bone tunnel is realized, the repeated adjustment of a bony channel is avoided, the repeated nail placement in the operation is avoided, and the loosening of the screw after the operation is also avoided;
FIGS. 5 and 6 show: and registering a puncture needle, a guide rod and a working channel, planning the path of the puncture needle and the guide rod and navigating in real time. The puncture needle, the guide rod and the working channel are registered, and the puncture path, the guide rod path, the depth and the angle are planned, so that the accurate skin puncture point, the target point of the working pipeline, the implantation angle and the implantation depth are obtained. The three steps of puncture by a puncture needle, expansion of a guide rod and placement of a working channel are completed in sequence, and each step corrects errors under navigation, so that the accurate placement of the working channel is realized, the working channel is continuously tracked, and a foundation is laid for the subsequent under-microscope operation;
FIG. 7 shows: registration of the trepan, endoscopic trepan path planning and continuous navigation. Planning the path and the angle of the trepan and continuously tracking the position of the sawteeth of the trepan, so that the implantation depth of the trepan can be accurately controlled when the articular process is cut off, and the damage to nerves is avoided;
FIG. 8 shows: registration of the sub-scope instruments (square chisels, reamers, curettes, etc.), path planning of the sub-scope instruments and continuous navigation. Planning the path and angle of the under-mirror instrument, and continuously tracking the position of the head end of the instrument to avoid excessive or insufficient treatment of intervertebral discs and intervertebral spaces;
the embodiment specifically solves the problems that in the prior art, due to the fact that the traditional operation technology cannot be used for direct-vision operation, the positions, the depths and the angles of the screws and the instruments need to be determined through repeated perspective, the steps are complex, the operation time is long, and the risk of nerve root injury in the operation exists.
Although the invention has been described in detail above with reference to a general description and specific examples, it will be apparent to one skilled in the art that modifications or improvements may be made thereto based on the invention. Accordingly, such modifications and improvements are intended to be within the scope of the invention as claimed.
Claims (2)
1. The utility model provides a lumbar vertebrae mirror fusion technique under supplementary of electromagnetic navigation which characterized in that: the method comprises the following specific steps:
(professional name: registration, colloquially, to present a tool on a hologram of a navigation system and to dynamically track it)
The method comprises the following steps: image matching: collecting lumbar vertebra three-dimensional CT (computed tomography) imaging data of a patient before an operation and transmitting the lumbar vertebra three-dimensional CT imaging data to an electromagnetic navigation host; a positioner and a mapping ring are placed in the operation, and the images are matched after perspective so as to carry out the next operation planning;
step two: registering an open-circuit cone: registering the open-circuit cone, planning a percutaneous pedicle screw path through the open-circuit cone, and realizing visualization of pedicle screw bone tunnel drilling;
step three: registering puncture needles, guide rods and working channels: the puncture needle, the guide rod and the working channel are registered, and a puncture path, a guide rod path, a depth and an angle are planned, so that the working channel is accurately placed and continuously tracked;
step four: registering a trepan: planning a path and an angle of the trepan, and continuously tracking the depth and the sawtooth position of the trepan;
step five: registering an under-the-mirror instrument: planning the path and angle of the under-mirror instrument and continuously tracking the head position of the instrument.
2. The electromagnetic navigation-assisted lumbar under-mirror fusion technique of claim 1, wherein: the scope instruments in step five include, but are not limited to, nucleus pulposus pincers, square chisels, reamers, curettes, and the like.
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN114288018A (en) * | 2022-01-04 | 2022-04-08 | 青岛大学附属医院 | A robot-assisted microscopic fusion technology method |
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Patent Citations (5)
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| CN101518447A (en) * | 2009-03-02 | 2009-09-02 | 北京积水潭医院 | Precision improving method for spinal surgery computer navigation system |
| CN103976779A (en) * | 2014-05-30 | 2014-08-13 | 上海市东方医院 | Intervertebral foramen mirror puncturing system |
| US20170156816A1 (en) * | 2015-12-04 | 2017-06-08 | Zaki G. Ibrahim | Methods for performing minimally invasive transforaminal lumbar interbody fusion using guidance |
| CN107811684A (en) * | 2017-11-23 | 2018-03-20 | 中山大学附属第三医院 | Visualize foramen intervertebrale lens auxiliary navigation method and ultrasonic navigation system supplymentary instrument |
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