CN106659537B - 结合机器人手术系统使用的手术器械固持器 - Google Patents
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Abstract
本文描述一种(例如)在脊柱手术期间结合机器人手术系统使用的手术器械固持器。在某些实施例中，所述手术器械固持器是手术期间所使用的机器人臂与手术器械之间的接口。此接口可以稳定方式精确、稳固地固持所述手术器械同时准许外科医生在紧急情况下容易且迅速安装或收回所述器械。
Description
背景技术
已开发机器人辅助的手术系统来改进手术精度且使实施新的手术过程成为可能。举例来说，已开发机器人系统以感测外科医生的手部移动并将其转化成按比例缩小的微移动且针对器官移植、再造及微创手术中的精确显微外科手术技术滤除无意的震颤。其它机器人系统涉及手术工具的遥控操作，使得外科医生不用必须待在手术室中，由此促进远程手术。也已开发反馈控制机器人系统以在手术期间提供比可由无辅助的外科医生实现的对手术工具的操纵更平稳的对手术工具的操纵。
然而，外科医生及医院对机器人系统的广泛接受因为各种原因而受到限制。拥有及维护当前系统较昂贵。所述系统通常在使用之前需要进行周密的术前手术规划，且其延长了手术室中所需的准备时间。所述系统在生理上是侵入性的，从而可能会模糊外科医生视野的部分且阻挡手术台周围的某些区域，使得外科医生及/或手术助手被隔在手术台的一侧。当前系统也可为非直观的或使用起来较麻烦，尤其是对已针对在手术期间执行某些操纵开发出特殊技能或“感觉”及发现不能使用机器人系统来实施此技能的外科医生来说。最后，机器人手术系统可易于发生故障或易受操作员错误影响，尽管具有安全联锁及电源备份。
脊柱手术通常需要精密钻孔及螺钉或其它器具关于脊柱的放置，且在手术期间对椎骨的接近可能会受约束，这使得此类操纵更困难。归因于脊髓与动脉的接近性，灾变性损伤或死亡可起因于在脊柱手术期间对身体的不适当的钻孔或操纵。通常的脊柱手术过程包含用于去除全部或部分椎间盘的椎间盘切除术、用于加宽神经根离开脊柱的开口的椎板切开术、用于去除背部中的椎板或骨刺的椎板切除术及用于将两个椎骨或椎骨段融合在一起以消除由椎骨的移动导致的疼痛的脊柱融合术。
涉及螺钉放置的脊柱手术需要在放置螺钉之前在骨头(例如，椎骨段)中准备孔。在一些实施方案中，在手动执行此类过程的情况中，外科医生基于术前CT扫描判断用于随后螺钉放置的钻孔轨迹。不涉及术前CT扫描的使用的其它手动方法(例如，荧光镜检查、3D荧光镜检查或基于自然地标)可用于确定用于在放置螺钉之前在骨头中准备孔的轨迹。在一些实施方案中，外科医生将钻固持于其手中同时进行钻孔，且获得荧光图像以验证轨迹是否正确。一些手术技术涉及使用不同工具，例如椎弓根定位器或K线。此类过程强烈依赖外科医生的专业知识，且在不同外科医生之间成功率存在显著差异。螺钉误放是此类手术过程中的常见问题。
图像引导脊柱手术需要光学跟踪来协助螺钉放置。然而，当前手动地执行此类过程，且尽管存在虚拟跟踪但手术工具也可能会被不准确地定位。外科医生需要使用在二维屏幕上所显示的图像来协调其在真实世界中对手术工具的手动操纵。此类过程可为不直观的且需要训练，这是因为外科医生的眼睛必须连续扫描手术部位及屏幕两者来确认对准。此外，过程错误可导致图像引导系统的配准不准确性，从而使其无用或甚至具有误导性。因此，需要一种用于使手术器械稳定同时允许容易地对所述器械及器械固持器进行消毒及容易地安装所述器械及器械固持器及从机器人系统去除所述器械及器械固持器而不会使定位精度以及附接刚性降级的系统。
发明内容
本文描述一种(例如)在脊柱手术期间结合机器人手术系统使用的手术器械固持器。在某些实施例中，所述固持器被附接到机器人臂且提供刚性结构，所述刚性结构允许在准备患者情况中通过钻孔、穿刺抽液或其它操纵精确精密准备患者组织(例如，椎弓根的准备)，以及将螺钉精确放置于钻孔中或附加假肢或植入物。
在某些实施例中，所述手术器械固持器是机器人臂与手术期间所使用的手术器械之间的接口。所述手术器械固持器以稳定方式精确、稳固地固持所述手术器械同时准许外科医生在紧急情况中容易且迅速安装或收回所述器械。所述手术器械包含机械地耦合到机器人臂的基座。
在一些实施方案中，需(例如，在高压灭菌器中)对所述器械固持器进行消毒。可容易地安装将所揭示的器械固持器及容易地将其从机器人系统去除而不会使定位精度以及附接刚性降级。通过(例如)被插入到基座中的定位销实现定位精度。所述销可接触被精确固持于机器人臂上的较薄定位板中的长椭圆形开口。使用接触所述定位板中的长椭圆形开口的销将所述器械固持器的基座定位于所述机器人臂上。螺钉可被直接紧固到机器人中以将所述器械固持器的基座刚性附接到所述机器人。
手术器械滑动到器械固持器的基座中的通道中。夹具可定位成使器械位于基座与所述夹具之间，使得当抵靠所述夹具拧紧螺母(例如，抵靠所述器械推挤所述夹具)时所述器械被牢固地固持于所述基座与所述夹具之间。导航标志也可被固定于所述基座与所述夹具之间。所述夹具接触所述螺母的表面(而非整个表面)可经弧形化使得形成水平接触线。此水平接触线允许所述夹具稍微倾斜以适应尺寸变化。
在某些实施例中，所揭示的技术包含一种结合机器人手术系统使用的手术器械固持器。在某些实施例中，所述手术器械固持器包含：基座，其经配置以机械耦合到所述机器人手术系统的机器人臂。所述基座可包含：第一通道，其具有经设定大小及塑形以容纳紧固螺钉的内部表面，所述紧固螺钉经配置以将所述基座直接或间接牢固地附接到所述机器人手术系统的机器人臂；第二通道，其具有带有锥形圆柱体形状的内部表面，所述内部表面经设定大小以容纳通过其的手术器械，使得所述手术器械的移动在除沿着由所述第二通道表面所界定的轴外的全部方向上被约束；第一锥形弯曲表面，其沿着所述第二通道的所述轴延伸，所述第一锥形弯曲表面经配置以在所述手术器械被固定于所述第二通道中时由手术器械啮合，其中第一通道与所述第二通道相交；及一或多个销，其被插入到所述基座中，使得所述一或多个销(例如，三个销)在将所述基座机械耦合到所述机器人臂之后啮合(例如，所述机器人臂的定位板中的)工具支撑件中的一或多个开口(例如，一或多个长椭圆形开口)，由此相对于所述机器人臂精确定位所述手术器械固持器(例如，其中所述一或多个开口宽于所述一或多个销，且所述一或多个开口沿着其长度逐渐变细)。
在某些实施例中，所述手术器械固持器包含：夹具，其经配置以在通过所述第二通道放置手术器械时啮合所述手术器械使得所述手术器械在螺母紧固之后被牢固地固持于所述夹具与所述基座之间。所述夹具可包含：第三通道，其具有经塑形及设定大小以容纳滑动通过其的所述第一通道的内部表面；第二锥形弯曲表面，其经配置以在所述手术器械被固定于所述第二通道中时由手术器械啮合；及一或多个狭缝，其经配置以允许所述夹具的主体在所述螺母的紧固之后弹性变形，其中所述螺母经配置以啮合所述第一通道的外部表面上及所述夹具的弧形表面上的螺纹。所述器械固持器经配置使得在将导航标志放置于所述夹具与所述基座之间且紧固所述螺母之后所述导航标志被牢固地固持于所述夹具所述基座之间。在某些实施例中，由导航摄像机使用所述导航标志来跟踪所述手术器械。
所述第一通道的外部表面可经螺纹化以牢固地容纳所述螺母，使得在将手术器械放置于所述第二通道中且拧紧所述螺母之后所述手术器械被牢固地固持于所述夹具所述基座之间。在某些实施例中，所述手术器械是经配置以接纳通过其的第二手术器械的器械引导器(例如，钻孔引导器)，所述第二手术器械是钻头、丝锥、螺丝刀或锥子。
在某些实施例中，所述基座包含具有内部表面的螺纹衬套。在某些实施例中，所述第一通道穿过所述螺纹衬套的内部表面，且所述螺纹衬套的所述内部表面经螺纹化，使得当通过所述螺纹衬套插入所述紧固螺钉时，所述紧固螺钉上的所述螺纹啮合所述螺纹衬套上的所述螺纹。在某些实施例中，所述紧固螺钉包含螺钉主体的近端上的尖端；所述螺钉主体的远端上的头部；及沿着所述螺钉主体的部分的螺纹。在某些实施例中，沿着所述螺钉主体的所述部分的所述螺纹沿着所述螺钉主体的最靠近所述紧固螺钉的尖端的部分。在某些实施例中，所述螺钉主体的最靠近所述头部的部分是平滑的，使得在所述紧固螺钉被完全插入到所述螺纹衬套中时所述紧固螺钉由所述螺纹衬套松弛地固持于适当位置中。
在某些实施例中，所揭示的技术包含一种结合机器人手术系统使用的手术器械固持器，所述手术器械固持器包含：基座，其经配置以机械耦合到所述机器人手术系统的机器人臂，所述基座包括：第一通道，其具有经设定大小及塑形以容纳紧固螺钉的内部表面，所述紧固螺钉经配置以将所述基座直接或间接牢固地附接到所述机器人手术系统的机器人臂；第二通道，其具有带有锥形圆柱体形状的内部表面，所述内部表面经设定大小以容纳通过其的手术器械，使得所述手术器械的移动在除沿着由所述第二通道表面所界定的轴外的全部方向上被约束；第一锥形弯曲表面，其沿着所述第二通道的所述轴延伸，所述第一锥形弯曲表面经配置以在所述手术器械被固定于所述第二通道中时由手术器械啮合，其中第一通道与所述第二通道相交；及一或多个销，其被插入到所述基座中，使得所述一或多个销在将所述基座机械耦合到所述机器人臂之后啮合工具支撑件中的一或多个开口，由此相对于所述机器人臂精确定位所述手术器械固持器；及夹具，其经配置以在通过所述第二通道放置手术器械时啮合所述手术器械使得所述手术器械在螺母拧紧之后被牢固地固持于所述夹具与所述基座之间。
在某些实施例中，所述基座包含具有内部表面的螺纹衬套。
在某些实施例中，所述第一通道穿过所述螺纹衬套的内部表面，且所述螺纹衬套的所述内部表面经螺纹化，使得当通过所述螺纹衬套插入所述紧固螺钉时所述紧固螺钉上的所述螺纹啮合所述螺纹衬套上的所述螺纹。
在某些实施例中，所述紧固螺钉包含：螺钉主体的近端上的尖端；所述螺钉主体的远端上的头部；及沿着所述螺钉主体的部分的螺纹。
在某些实施例中，沿着所述螺钉主体的所述部分的所述螺纹沿着所述螺钉主体的最靠近所述紧固螺钉的尖端的部分。
在某些实施例中，所述螺钉主体的最靠近所述头部的部分是平滑的，使得在所述紧固螺钉被完全插入到所述螺纹衬套中时所述紧固螺钉由所述螺纹衬套松弛地固持于适当位置中。
在某些实施例中，所述夹具包含：第三通道，其具有经塑形及设定大小以容纳滑动通过其的所述第一通道的内部表面；第二锥形弯曲表面，其经配置以在所述手术器械被固定于所述第二通道中时由手术器械啮合；及一或多个狭缝，其经配置以允许所述夹具的主体在所述螺母的拧紧之后弹性变形，其中所述螺母经配置以啮合所述第一通道的外部表面及所述夹具的弧形表面上的螺纹。
在某些实施例中，所述一或多个开口是一或多个长椭圆形开口。
在某些实施例中，所述一或多个销包括三个销。
在某些实施例中，所述手术器械是经配置以接纳通过其的第二手术器械的器械引导器，所述第二手术器械包括从以下各物组成的群组中选出的构件：钻头、丝锥、螺丝刀及锥子。
在某些实施例中，所述器械引导器是钻孔引导器。
在某些实施例中，所述机器人手术系统用于脊柱手术中。
在某些实施例中，器械固持器经配置使得在将导航标志放置于所述夹具与所述基座之间且拧紧所述螺母之后所述导航标志被牢固地固持于所述夹具所述基座之间。
在某些实施例中，由导航摄像机使用所述导航标志来跟踪所述手术器械。
在某些实施例中，所述工具支撑件是所述机器人臂的定位板。
在某些实施例中，所述一或多个开口宽于所述一或多个销，且所述一或多个开口沿着其长度逐渐变细。
在某些实施例中，所述第一通道的外部表面经螺纹化以牢固地容纳所述螺母，使得在将手术器械放置于所述第二通道中且拧紧所述螺母之后所述手术器械被牢固地固持于所述夹具所述基座之间。
附图说明
通过参考结合附图进行的以下描述，将更加明白且更好地理解本发明的前述及其它目标、方面、特征及优点，其中：
图1是处于手术室中的实例机器人手术系统的说明；
图2是实例钻孔引导器及两个钻头的说明；
图3A是处于其相对于机器人臂固持的位置中的钻孔引导器的说明；
图3B是由实例器械固持器固持的钻孔引导器的说明；
图4是其中固持有钻孔引导器的实例器械固持器的横截面图的说明；
图5A到B是手术器械固持器的实例基座的说明。
图6A是在安装夹具之前的实例手术器械固持器的说明；
图6B是具有抵靠器械所插入及定位的夹具的实例手术器械固持器的说明；
图7是从夹具的引导器侧观察的实例夹具的说明；
图8是实例手术器械的说明；
图9A到B是实例器械固持器的说明，所述器械固持器具有器械及用于将所述器械固定于所述固持器中的螺母；
图10A到B是用于将器械固持器固定于机器人臂上的系统的说明；
图11是器械固持器的实例基座的说明；
图12A是根据本发明的实施例的夹具基座及转矩螺钉的说明；
图12B是根据本发明的实施例的夹具基座及转矩螺钉的说明；及
图12C是根据本发明的实施例的夹具基座及螺丝刀的说明。
将从下文结合图式进行阐述的详细描述更加明白本发明的特征及优点，其中相似的参考字符始终识别对应元件。在图式中，相似的参考数字通常指示相同、在功能上类似以及/或在结构上类似的元件。
具体实施方式
图1说明处于手术室100中的实例机器人手术系统。在一些实施方案中，一或多个外科医生、手术助手、外科技师以及/或其它技术人员(106a到c)使用机器人辅助手术系统对患者104执行手术。在手术室中，可由机器人系统引导外科医生准确地执行手术。这可通过手术工具的机器人引导来实现，所述机器人引导包含确保工具(例如，钻或螺钉)的适当轨迹。在一些实施方案中，外科医生使用极少术前规划或不使用术前规划界定手术过程中的轨迹。系统允许外科医生物理操纵工具固持器以安全实现工具的适当对准以用于执行手术过程的关键步骤。外科医生(或其它操作者)以力控制模式对机器人臂进行的操作准许工具以忽视外科医生的意外、微小移动的经测量、均匀方式移动。外科医生移动工具固持器以在操作工具或将工具插入到患者中之前实现工具(例如，钻或螺钉)的适当轨迹。一旦机器人臂处于所期望的位置中，就固定所述臂以维持所期望的轨迹。工具固持器用作稳定的牢固引导器，工具可以准确的角度移动或滑动通过所述引导器。因此，所揭示的技术向外科医生提供可靠的器械及技术来成功地执行其手术。
在一些实施方案中，手术可为脊柱手术，例如椎间盘切除术、椎间孔切开术、椎板切除术或脊柱融合术。在一些实施方案中，手术机器人系统包含移动推车上的手术机器人102。手术机器人102可接近于手术台112定位而无需附接到手术台，由此围绕手术台为外科医生提供最大手术区域及移动性且减少手术台上的杂乱。在替代实施例中，手术机器人(或推车)可被固定到手术台。在某些实施例中，手术台及推车两者都被固定到共同的基座以防止推车或手术台相对于彼此的任何移动，即使在地颤的情况下也如此。
移动推车可准许用户(操作者)106a(例如，技术人员、护士、外科医生或手术室中的任何其它医务人员)在手术过程之前、期间及/或之后将手术机器人102移动到不同位置。移动推车使能够容易地将手术机器人102运到手术室100及运出手术室100。举例来说，用户106a可将手术机器人从存储位置移动到手术室中。在一些实施方案中，移动推车可包含车轮、跟踪系统(例如，连续跟踪推进系统)或用于推车的移位的其它类似移动系统。移动推车可包含附接或嵌入式把手以供操作者移动移动推车。
出于安全原因，移动推车可具备在使用手术机器人执行手术过程期间可使用的稳定系统。所述稳定机构增加移动推车相对于地板的整体刚度，以便确保手术过程的准确性。在一些实施方案中，车轮包含防止推车移动的锁定机构。可在机器开启时激活稳定、制动及/或锁定机构。在一些实施方案中，移动推车包含多个稳定、制动及/或锁定机构。在一些实施方案中，稳定机构是具有电子激活的机电稳定机构。稳定、制动及/或锁定机构可为完全机械的。可以电子方式激活及取消激活稳定、制动及/或锁定机构。
在一些实施方案中，手术机器人102包含安装于移动推车上的机器人臂。致动器可移动机器人臂。机器人臂可包含经配置以固持手术工具的力控制末端执行器。机器人可经配置以使用至少四个自由度(例如，六个自由度：三个平移及三个旋转)控制及/或允许末端执行器的定位及/或移动。
在一些实施方案中，机器人臂经配置以可释放地固持手术工具，从而允许手术工具被去除及以第二手术工具取代。系统可允许手术工具在无需重新配准末端执行器的位置的情况下或在自动或半自动重新配准末端执行器的位置的情况下被调换。
在一些实施方案中，手术系统包含手术机器人102、跟踪检测器108(其捕获患者及手术机器人102的不同组件的位置)及显示器屏幕110(其显示(例如)实时患者数据及/或实时手术机器人轨迹)。
在一些实施方案中，跟踪检测器108监测患者104及手术机器人102的位置。所述跟踪检测器可为摄像机、视频摄像机、红外检测器、场发生器及用于电磁跟踪的传感器或任何其它运动检测设备。在一些实施方案中，基于患者及机器人位置，显示器屏幕显示机器人102的机器人臂从其当前位置到患者手术部位的投射轨迹及/或推荐轨迹。通过使用跟踪检测器108连续监测患者及机器人臂位置，手术系统可计算更新轨迹且在显示器屏幕110上在视觉上显示这些轨迹以通知及引导手术室中使用手术机器人的外科医生及/或技术人员。另外，在某些实施例中，手术机器人102也可改变其位置且基于从使用跟踪检测器108捕获的实时患者及机器人臂位置所计算的轨迹自动定位其本身。例如，考虑到在患者的椎体或其它部位在手术过程期间的移动，可实时自动调整末端执行器的轨迹。
图2是实例钻孔引导器及两个钻头的说明。在一些实施方案中，由器械固持器固持的手术器械是经配置以接纳通过其的第二手术器械的器械引导器(例如，钻孔引导器)。第二手术器械可为钻头、丝锥、螺丝刀或锥子。
在一些实施方案中，器械固持器是机器人臂与手术期间所使用的手术器械之间的接口。所述器械固持器可经配置以以稳定方式精确、稳固地固持手术器械同时准许外科医生在紧急情况中容易且迅速安装或收回所述手术器械。所述手术器械可为器械引导器，例如图2中所展示的钻孔引导器202。在此实例中，钻孔引导器202包含在在一端处具有加固件206的中空管204。把手208及/或导航标志210可被(可拆卸地或永久地)附接到加固件206。所述导航标志可为(例如)导航跟踪器，例如来自明尼苏达州明尼阿波利斯市的美敦力公司(Medtronic,Inc.of Minneapolis,MN)的专用NavLockTM跟踪器。可结合钻孔引导器202使用钻头212a到b执行操作，例如在椎骨中准备孔。
图3A是处于其相对于工具固持器的主体304固持的位置中的钻孔引导器302的说明。工具固持器304被附接到机器人臂306。在一些实施方案中，术语工具固持器是用于指定附接到机器人臂的尖端的整个装置的通用术语。图3B是由包含(除其它事物以外)基座310的实例器械固持器固持的钻孔引导器的说明。
图4是其中固持有钻孔引导器的实例器械固持器的横截面图的说明。在一些实施方案中，器械固持器包含基座402、夹具404、螺母406、定位销408(例如，三个定位销)及紧固螺钉410。基座402经配置以经由插入于基座402的通道中的螺钉410机械耦合到机器人臂。基座402包含第二通道，可通过所述第二通道放置手术器械(例如，钻孔引导器)。螺母406可经拧紧以将手术器械牢固地固持于夹具404与基座402之间。
图5A到B是手术器械固持器的实例基座500的说明。基座可包含允许精确地且以稳定方式定位器械引导器的两个表面(502a到b)(例如，其形成在图5A中的蓝图中所展示的大“V”)。表面502a及502b可为平坦的或弯曲的表面。基座的上部(例如，表面502a到b)中的大“V”可接纳引导器的圆柱形加固部分(例如，图2中的206)，而另一小“V”(由502c到d所展示)接纳引导器的外部圆柱形管部分(例如，图2中的204)。表面504可界定器械引导器的轴向位置。表面506a及/或506b可接触导航标志的附接机构以在组装时防止器械沿着其轴旋转。在一些实施方案中，基座及手术器械经配置使得在手术器械插入于基座中时仅表面502、504及506接触所述手术器械。这可允许手术器械在空间上被完全约束。
基座500可包含第一通道510，其具有经设定大小及塑形以容纳紧固螺钉的内部表面，所述紧固螺钉经配置以(例如，经由工具固持器)将基座500直接或间接牢固地附接到机器人手术系统的机器人臂。所述紧固螺钉可被放置于第一通道510内，且延伸通过基座的相对侧，在所述相对侧处所述紧固螺钉啮合机器人臂(例如，螺合)。
基座500可包含第二通道508，其具有带有锥形圆柱体形状的内部表面，所述内部表面经设定大小以容纳通过其的手术器械，使得所述手术器械的移动在除沿着由第二通道表面508所界定的轴外的全部方向上被约束。第一通道510与第二通道508可相交。
图6A是安装夹具之前的实例手术器械固持器的说明。图6B是具有抵靠器械所插入及定位的夹具的实例手术器械固持器的说明。夹具604可经配置以在通过第二通道放置手术器械606时啮合手术器械606及/或导航标志608，使得在拧紧螺母(例如，如图9A中所展示的螺母906)之后手术器械被牢固地固持于夹具604与基座602之间。夹具604可包含具有经塑形及设定大小以容纳滑动通过其的第一通道610的内部表面的通道。
图7是从夹具700的引导器侧观察的实例夹具700的说明。夹具700可包含一或多个锥形弯曲表面(例如，702及704)，所述表面经配置以在手术器械被固定于第二通道(例如，如图5A中所展示的508)中时由手术器械啮合。所述锥形弯曲表面可包含四个表面702a到b及704a到b(例如，四个平坦表面)，其形成当手术器械被插入于第二通道(例如，如图5A中所展示的508)中时接触手术器械的两个“V”形状(阴影)。表面706a及/或706b可接触导航标志的附接件，以将其固持于夹具700与基座(例如，图5A中的500)之间。在一些实施方案中，导航标志可被安装于两个不同定向上，当手术器械被插入于第二通道中时其在一个定向上接触表面706a且在另一定向上接触表面706b。夹具700可包含一或多个狭缝708，其经配置以允许夹具的主体在拧紧螺母之后弹性变形。这可补偿被插入于手术器械固持器中的手术工具的(除其它事物之外)尺寸变化。
图8是实例手术器械800的说明。在图8中展示接触手术器械固持器的手术器械的表面。在一些实施方案中，手术器械的表面802在手术器械固持器被插入于第二通道(例如，图5A中的508)中时接触如图5A中所展示的手术器械固持器500的表面504。在一些实施方案中，手术器械的表面806a到b在手术器械固持器被插入于第二通道(例如，图5A中的508)中时接触如图5A中所展示的手术器械固持器500的表面502a到b。在一些实施方案中，手术器械的表面804a到b在手术器械固持器被插入于第二通道(例如，图5A中的508)中时接触如图5A中所展示的手术器械固持器500的表面502c到d。此配置可允许将器械十分稳定地固持于固持器中。另外，此配置可防止用户以相对于基座的错误定向插入夹具(例如，鉴于夹具接触器械的表面804及806的大小及/或形状差异)。
图9A到B是具有器械902及用于将器械902固定于固持器中的螺母906的实例器械固持器的说明。器械902可被固定于基座908与夹具904之间。在一些实施方案中，导航标志910被固定于基座908与夹具904之间。可抵靠夹具904拧紧螺母906以将器械902(及/或导航标志910)牢固地按压于夹具904与基座908之间。螺母906可经配置以啮合第一通道(例如，如图5A中所展示的510)的外部表面及夹具的弧形表面上的螺纹。
为使如图9B中所说明的底部反作用力Rb与顶部反作用力Rt之间的螺母906的拧紧力Ft平衡，在一些实施方案中，螺母906接触夹具904上的弧形表面(而非整个表面)从而仅形成水平接触线。此水平接触线可允许夹具904稍微倾斜以适应尺寸变化。此均衡设计可允许减小内部力且因此优化紧固力Rt及Rd。
导航标志可为(例如)导航跟踪器，例如来自明尼苏达州明尼阿波利斯市的美敦力公司的专用NavLockTM跟踪器。可由导航摄像机使用导航标志来跟踪手术器械。在一些实施方案中，机器人手术系统的计算系统(例如)使用跟踪模块跟踪患者及手术工具的位置。计算系统从跟踪检测器接收患者的图像、手术工具位置及末端执行器位置。在一些实施方案中，从数字3D扫描仪接收患者的图像。举例来说，跟踪模块可实时计算手术工具及患者的位置。在实施方案中，跟踪模块可跟踪手术工具及患者在自由空间中的位置。在另一实施方案中，跟踪模块可跟踪手术工具及患者相对于彼此的位置。在实施方案中，跟踪模块可根据从跟踪检测器接收到的图像识别患者待手术的部位及手术工具并跟踪这些经识别的对象。在另一实施方案中，跟踪模块可跟踪标志(例如，附接到患者待手术的部位及手术工具的导航标志)。跟踪模块可根据从跟踪检测器接收到的图像识别所述标志，并识别到这些标志被附接到患者及手术工具，且因此跟踪患者位置及手术工具位置。
图10A到B是用于将器械固持器固定于机器人臂上的系统的说明。在一些实施方案中，需(例如，在高压灭菌器中)对仪器固持器进行消毒。可容易地安装所揭示的器械固持器且容易地将其从机器人系统去除而不会使定位精度以及附接刚性劣化。可由(例如)插入到基座中的三个定位销1002实现定位精度。可使用不同数目个定位销1002(例如，1到5个销)。销1002可接触被精确固持于机器人臂1008(例如，其被固持于工具固持器的主体1010上)上的较薄定位板1006中的长椭圆形开口1004。可使用接触被精确固持于机器人1008上的定位板1006中的长椭圆形开口1004的销1002将器械固持器的基座1012定位于机器人臂1008(例如，其被固持于工具固持器的主体1010上)上。螺钉1014可直接被紧固到机器人1008中以将器械固持器的基座1012刚性附接到机器人1008。图10B说明实例定位板1006的前视图。一或多个销1002可经插入到基座中，使得一或多个销1002在将基座机械耦合到机器人臂之后啮合机器人臂1008中的一或多个开口1004(例如，在机器人臂1008的定位板1006中)，由此相对于机器人臂1008精确定位手术器械固持器(例如，一或多个开口1004可宽于所述一或多个销，且所述一或多个开口可沿着其长度逐渐变细)。
图11是器械固持器的实例基座1102的说明，其中销1104a到c插入到基座1102中。基座1102可经配置以机械耦合到机器人手术系统的机器人臂。基座1102可包含一或多个销1104(例如，三个销1104a到c)，其被插入到基座1102中使得一或多个销1104在将基座1102机械耦合到机器人臂之后啮合工具支撑件中的一或多个开口(例如，在机器人臂的定位板中)，由此相对于机器人臂精确定位手术器械固持器。
图12A是夹具基座1202及转矩螺钉1204的说明。在一些实施方案中，螺纹衬套1206被压配合到夹具基座1202中。转矩螺钉1204由金属制成，使得其提供到机器人的强附接，且满足清理及消毒要求。转矩螺钉1204上的螺纹啮合被压配合到夹具基座1202中的螺纹衬套1206。随着转矩螺钉1204被拧紧，转矩螺钉1204上的螺纹穿过螺纹衬套1206使得最靠近转矩螺钉头部(即，具有更小直径且不具有螺纹的部分)的转矩螺钉1204的端(例如，因为不存在螺纹而稍微松弛地)驻存于螺纹衬套1206中。在此处，优点是转矩螺钉1204及夹具基座组合件1202可接着被安装于机器人上而无在组装期间丢失转矩螺钉1204的风险，这是因为转矩螺钉1204不能滑出螺纹衬套1206，因为转矩螺钉1204上的螺纹将接触螺纹衬套1206(即，由此防止转矩螺钉1204从衬套1206滑出而无需将转矩螺钉1204从衬套1206旋出)。在此实例中，夹具基座1202包含三个定位销1210a到c，如上文所描述。
图12B是具有完全被插入到螺纹衬套1206中的转矩螺钉1204的夹具基座1202的说明。转矩螺钉1204的端具有更小直径，以便允许将其紧固于工具固持器主体上以及在转矩螺钉1204与夹具基座1202之间提供用于清理的间隙。
图12C是夹具基座1202及螺丝刀1208的说明。为紧固转矩螺钉1204，螺丝刀1208被设计有接近夹具基座1202的内直径的轴直径。因此，一旦螺丝刀1208被插入到夹具基座1202中，螺丝刀1208就由夹具基座1202引导，且这简化了将螺丝刀1208的尖端配合于螺钉1204的头部上。
鉴于本文所描述的系统及方法的结构、功能及设备，在一些实施方案中，提供一种用于结合机器人手术系统执行手术的系统及方法。已所描述用于支持机器人手术系统的方法及设备的某些实施方案，所属领域的技术人员现将明白可使用并入本发明的概念的其它实施方案。因此，本发明不应限于某些实施方案，而是应仅由所附权利要求书的精神及范围限制。
贯穿描述，在设备及系统被描述为具有、包含或包括特定组件的情况下，或在过程及方法被描述为具有、包含或包括特定步骤的情况下，应预期，另外存在基本上由或由所述组件组成的所揭示的技术的设备及系统，且存在基本上由或由所述处理步骤组成的根据所揭示的技术的过程及方法。
应理解，只要所揭示的技术保持可操作，那么步骤的顺序或用于执行某一动作的顺序是不重要的。此外，可同时进行两个或两个以上步骤或动作。
Claims (18)
1.一种结合机器人手术系统使用的手术器械固持器，所述手术器械固持器包括：
基座，其经配置以机械耦合到所述机器人手术系统的机器人臂，所述基座包括：
第一通道，其具有经设定大小及塑形以容纳紧固螺钉的内部表面，所述紧固螺钉经配置以将所述基座直接或间接牢固地附接到所述机器人手术系统的机器人臂，
第二通道，其具有带有锥形圆柱体形状的内部表面，所述内部表面经设定大小以容纳通过其的手术器械，使得所述手术器械的移动在除沿着由所述第二通道表面所界定的轴外的所有方向上被约束，
第一锥形弯曲表面，其沿着所述第二通道的所述轴延伸，所述第一锥形弯曲表面经配置以在手术器械被固定于所述第二通道中时由所述手术器械啮合，其中第一通道及所述第二通道相交，以及
一或多个销，其被插入到所述基座中，使得所述一或多个销在将所述基座机械耦合到所述机器人臂之后啮合工具支撑件中的一或多个开口，由此相对于所述机器人臂精确定位所述手术器械固持器；以及
夹具，其经配置以在通过所述第二通道放置所述手术器械时啮合所述手术器械，使得所述手术器械在螺母拧紧之后被牢固地固持于所述夹具与所述基座之间。
2.根据权利要求1所述的手术器械固持器，其中所述基座包括具有内部表面的螺纹衬套。
3.根据权利要求2所述的手术器械固持器，其中所述第一通道穿过所述螺纹衬套的内部表面，且所述螺纹衬套的所述内部表面经螺纹化使得当通过所述螺纹衬套插入所述紧固螺钉时所述紧固螺钉上的所述螺纹啮合所述螺纹衬套上的所述螺纹。
4.根据权利要求1到3中任一权利要求所述的手术器械固持器，其中所述紧固螺钉包括：
螺钉主体的近端上的尖端；
所述螺钉主体的远端上的头部；以及
沿着所述螺钉主体的部分的螺纹。
5.根据权利要求4所述的手术器械固持器，其中沿着所述螺钉主体的所述部分的所述螺纹沿着所述螺钉主体的最靠近所述紧固螺钉的所述尖端的部分。
6.根据权利要求5所述的手术器械固持器，其中所述螺钉主体最靠近所述头部的所述部分是平滑的，使得在所述紧固螺钉被完全插入到所述螺纹衬套中时所述紧固螺钉由所述螺纹衬套松弛地固持于适当位置中。
7.根据权利要求1到3中任一权利要求所述的手术器械固持器，所述夹具包括：
第三通道，其具有经塑形及设定大小以容纳滑动通过其的所述第一通道的内部表面；
第二锥形弯曲表面，其经配置以在手术器械被固定于所述第二通道中时由所述手术器械啮合；以及
一或多个狭缝，其经配置以允许所述夹具的主体在所述螺母的拧紧之后弹性变形，其中所述螺母经配置以啮合所述第一通道的外部表面上及所述夹具的弧形表面上的螺纹。
8.根据权利要求1到3中任一权利要求所述的手术器械固持器，其中所述一或多个开口是一或多个长椭圆形开口。
9.根据权利要求1到3中任一权利要求所述的手术器械固持器，其中所述一或多个销包括三个销。
10.根据权利要求1到3中任一权利要求所述的手术器械固持器，其中所述手术器械是经配置以接纳通过其的第二手术器械的器械引导器，所述第二手术器械包括从由以下各者组成的群组中选出的构件：钻头、螺丝刀以及锥子。
11.根据权利要求10所述的手术器械固持器，其中所述器械引导器是钻孔引导器。
12.根据权利要求1到3中任一权利要求所述的手术器械固持器，其中所述手术器械是经配置以接纳通过其的第二手术器械的器械引导器，所述第二手术器械包括丝锥。
13.根据权利要求1到3中任一权利要求所述的手术器械固持器，其中所述机器人手术系统用于脊柱手术中。
14.根据权利要求1到3中任一权利要求所述的手术器械固持器，其中器械固持器经配置使得在将导航标志放置于所述夹具与所述基座之间且拧紧所述螺母之后，所述导航标志被牢固地固持于所述夹具所述基座之间。
15.根据权利要求14所述的手术器械固持器，其中由导航摄像机使用所述导航标志以跟踪所述手术器械。
16.根据权利要求1到3中任一权利要求所述的手术器械固持器，其中所述工具支撑件是所述机器人臂的定位板。
17.根据权利要求1到3中任一权利要求所述的手术器械固持器，其中所述一或多个开口宽于所述一或多个销，且所述一或多个开口沿着其长度逐渐变细。
18.根据权利要求1到3中任一权利要求所述的手术器械固持器，其中所述第一通道的外部表面经螺纹化以牢固地容纳所述螺母，使得在将手术器械放置于所述第二通道中且紧固所述螺母之后所述手术器械被牢固地固持于所述夹具与所述基座之间。
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| US10292778B2 (en) | 2019-05-21 |
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