Double-incision surgical navigation method and system for acetabulum revision

Abstract

A double-incision surgical navigation method for acetabulum revision comprises a planning process, including digital planning of incisions and tunnels before an operation and planning of a main incision: on a three-dimensional coordinate system of a pelvis, carrying out navigation on the three-dimensional coordinate system of the pelvis, and carrying out navigation on the three-dimensional coordinate system of the pelvis; the method comprises the following steps: simulating a main incision path along a hip large muscle fiber direction and a thighbone axis, ensuring that the path can expose an acetabular margin, a residual acetabular cup and sciatic nerves, marking the walking of the sciatic nerves in a three-dimensional coordinate system of the pelvis as an absolute forbidden zone in an operation, and positioning an auxiliary incision: positioning a gluteus column bullseye, and on the three-dimensional coordinate system of the pelvis, positioning an auxiliary incision on the three-dimensional coordinate system of the pelvis; the method comprises the following steps: defining a gluteus column bone surface area used for fixing a reinforcing block, acquiring a walking model of a suprahip nerve and blood vessel bundle, avoiding an incision and an approach which are positioned at the rear lower part of the suprahip nerve and blood vessel bundle, virtually constructing a subcutaneous tunnel, drawing a smooth 3D curve pointing to the rear upper part of an acetabulum in a main incision from the deep part of an auxiliary incision, according to the size of the winged reinforcing block including the width of the fixed wing, the minimum diameter needed by the tunnel is determined, and it is ensured that the implant can pass through smoothly.

Description

Technical Field

[0001] This invention relates to the field of acetabular reconstruction, and to a double-incision surgical planning method, navigation method, and system for acetabular revision surgery. Background Technology

[0002] Total hip arthroplasty (THA) is one of the most successful surgical procedures of the 20th century. However, with the surge in surgical volume and the increase in patient life expectancy, revision hip surgery due to aseptic loosening of the prosthesis, infection, osteolysis, and other reasons is facing increasingly severe challenges. Among these, Paprosky type III acetabular defects, especially those accompanied by pelvic discontinuity and significant upward displacement of the hip joint rotation center, are considered the "crown jewel" of hip revision surgery and are among the most challenging procedures.

[0003] Such complex defects lead to the following problems: First, loss of structural support: the normal dome structure of the acetabulum is destroyed, failing to provide sufficient bony support for a standard acetabular cup. Second, weak biological fixation: the contact area between the host bone and the implant is severely insufficient, making reliable bone ingrowth difficult with traditional prostheses. Third, deterioration of the biomechanical environment: the upward shift of the center of rotation leads to a shortened abductor lever arm, increased joint load, accelerated prosthesis wear and loosening, creating a vicious cycle.

[0004] Current mainstream solutions all have significant shortcomings. The traditional single posterolateral approach provides insufficient exposure: it cannot directly address high-level bone defects or prepare the critical weight-bearing area above and behind the acetabulum—the gluteal column.

[0005] The risk of neurovascular injury is high. In pursuit of fixation, blindly inserting long screws anterosuperiorly into the acetabulum can easily damage important structures such as the external iliac vessels and obturator nerve. Implant placement relies on experience; for example, the position and angle of the acetabular cup depend on the surgeon's visual estimation and feel, making it difficult to guarantee accuracy and increasing the risk of postoperative dislocation and biomechanical imbalance. Summary of the Invention

[0006] The purpose of this invention is to provide a double-incision surgical navigation method and system for acetabular revision surgery.

[0007] A double-incision surgical navigation method for acetabular revision surgery, comprising a planning process, characterized in that the planning process includes: Based on the collected patient information, a three-dimensional model of the pelvis is generated and a three-dimensional coordinate system of the pelvis is established. The bone defect area, the gluteal column area, and the dangerous structural area including the sciatic nerve, the superior gluteal nerve vascular bundle, and the obturator vessel are identified and mapped into the three-dimensional coordinate system of the pelvis. The placement pose information of the acetabular cup is virtually set in the three-dimensional coordinate system of the pelvis, and a winged reinforcement block is designed. Digital planning of the incision and tunnel before surgery: Planning the main incision: On the pelvic three-dimensional coordinate system, simulate the main incision path along the direction of the gluteus maximus muscle fibers and the femoral axis, ensuring that this path can expose the acetabular rim, the remaining acetabular cup, and the sciatic nerve. Then, mark the course of the sciatic nerve on the pelvic three-dimensional coordinate system as an absolute no-go zone during the operation. Locating the auxiliary incision: Locate the target center of the gluteal column. On the three-dimensional coordinate system of the pelvis, delineate the bone surface area of ​​the gluteal column used to fix the reinforcing block, obtain the course model of the superior gluteal neurovascular bundle, and avoid the incision and approach located posteroinferior to the superior gluteal neurovascular bundle. A subcutaneous tunnel is virtually constructed, and a smooth 3D curve is drawn from the depth of the auxiliary incision to the posterosuperior aspect of the acetabulum within the main incision. Based on the size of the winged reinforcement block, including the width of the fixation wing, the minimum diameter required for the tunnel is determined to ensure that the implant can pass smoothly.

[0008] Preferably, the present invention further includes: Virtual implantation design is performed, and the designed winged reinforcement block model is dynamically collided along the planned subcutaneous tunnel path. Implantability analysis steps: Simulate the process of the reinforcement block passing through the tunnel and rotating into place. If a collision occurs or it cannot be placed, the design of the reinforcement block needs to be optimized or the tunnel path adjusted. Generate surgical navigation plan: Transform the plan into navigation instructions, and set the planned auxiliary incision center point, tunnel direction, gluteal column target area, and safety screw channel as the visual targets and no-go zones in the navigation system.

[0009] Preferably, the present invention further includes: Before surgery, an optical positioning system is used to establish a dynamic reference base for the patient and a dynamic reference base for the instrument, and the data in the instrument coordinate system is converted to the data in the patient coordinate system in real time. The main incision is used for point registration and surface matching; The auxiliary incision allows the navigation pointer to directly touch the bone surface of the gluteal column to acquire additional surface points, thereby improving the local registration accuracy of this key target area and ensuring the fit of the fixation wing and the registration of the screw insertion.

[0010] Preferably, the present invention further includes: Generate a surgical navigation configuration file and export all the planned key information in a format that the navigation system can read, including: the three-dimensional coordinates of the auxiliary incision center point, the ideal axis of the subcutaneous tunnel, the target area of ​​the gluteal column, the safe passage of each planned screw, and the neurovascular danger zone; Output personalized surgical guide design files, design personalized guides that precisely fit the patient's gluteal column bone surface, for intraoperative positioning and drilling assistance, and generate 3D printing files for the guides.

[0011] Preferably, the present invention further includes: using surgical instrument navigation to complete the implantation surgery, and further includes the surgical instrument navigation being configured to perform the following operations: The acetabulum is treated through the main incision, soft tissue, residual prosthesis and bone cement are removed, the bone bed is ground down until bleeding occurs, the gluteal column is exposed through the auxiliary incision, the bone surface is cleaned, and the fitting area of ​​the fixation wing is prepared. Implantation of winged reinforcement blocks: The winged reinforcement block is inserted through the auxiliary incision and pushed towards the main incision through the subcutaneous tunnel, so that its fixation wing can face the gluteal column and its support arm can face the center of the acetabulum. In the main incision, a support block is positioned to guide its insertion into the acetabular region. In the auxiliary incision, a pusher is used to press the fixation wing against the gluteal column, bringing it into contact with the bone surface. The direction of the support arm is adjusted so that the acetabular cup recess at the end of the support arm is at a predetermined abduction and anteversion angle. Through the auxiliary incision, screws are driven into the pre-drilled holes on the fixation wing under direct vision to securely fix the support block to the gluteal column. The acetabular cup is installed through the main incision. A standard hemispherical acetabular cup is inserted into the support arm slot of the reinforcing block, and the liner is installed.

[0012] Preferably, the present invention further includes: Infill block implantation: Through the main incision, the filler block is placed into the cavity between the reinforcing block and the host bone. The filler block is individually designed according to the shape of the remaining cavity. If there are multiple filler blocks, they are implanted sequentially, ensuring that they fit tightly together with each other, the host bone, and the reinforcing block. Some filler blocks may have mortise and tenon structures or screw holes for interconnection or fixation to the host bone.

[0013] A dual-incision surgical navigation system for acetabular revision surgery, comprising: The optical positioning system uses a camera to emit infrared light and capture the reflected light from a reflective sphere mounted on a dynamic reference base on the surgical instruments and the patient. The system then calculates the three-dimensional spatial coordinates of the sphere in real time using triangulation. Navigation workstation: It includes: Patient dynamic reference base, rigid support with reflective sphere.

[0014] The instrument's dynamic reference base includes a reflective ball support; Navigation equipment: includes: Navigation pointers are used to locate anatomical landmarks in the bone during surgery for registration. Navigation drill bit guide / sleeve: A guide with a tracking reference base to ensure that the drilling path is completely consistent with the pre-operative plan; Implant holder: Used to hold winged reinforcement blocks or filler blocks, and includes a reference base. It can display a virtual model of the implant and its placement angle on the screen in real time. The preoperative planning module is configured as follows: Based on the collected patient information, a three-dimensional model of the pelvis is generated and a three-dimensional coordinate system of the pelvis is established. The bone defect area, the gluteal column area, and the dangerous structural area including the sciatic nerve, the superior gluteal nerve vascular bundle, and the obturator vessel are identified and mapped into the three-dimensional coordinate system of the pelvis. The placement posture information of the acetabular cup is virtually set in the three-dimensional coordinate system of the pelvis, and a winged reinforcement block is designed. Digital planning of the incision and tunnel before surgery: Planning the main incision: On the pelvic three-dimensional coordinate system, simulate the main incision path along the direction of the gluteus maximus muscle fibers and the femoral axis, ensuring that this path can expose the acetabular rim, the remaining acetabular cup, and the sciatic nerve. Then, mark the course of the sciatic nerve on the pelvic three-dimensional coordinate system as an absolute no-go zone during the operation. Locating the auxiliary incision: Locate the target center of the gluteal column. On the three-dimensional coordinate system of the pelvis, delineate the bone surface area of ​​the gluteal column used to fix the reinforcing block, obtain the course model of the superior gluteal neurovascular bundle, and avoid the incision and approach located posteroinferior to the superior gluteal neurovascular bundle. A subcutaneous tunnel is virtually constructed, and a smooth 3D curve is drawn from the depth of the auxiliary incision to the posterosuperior aspect of the acetabulum within the main incision. Based on the size of the winged reinforcement block, including the width of the fixation wing, the minimum diameter required for the tunnel is determined to ensure that the implant can pass smoothly.

[0015] The core innovation of this invention lies in: In terms of concept: it breaks away from the mindset of a single approach and creatively proposes a dual-incision collaborative surgical paradigm of "main incision to treat the acetabulum and auxiliary incision for direct visualization and fixation of the gluteal column".

[0016] In terms of planning: the surgical approach itself (incision location, tunnel establishment) is included in the scope of digital planning, realizing full-path preoperative simulation "from skin to bone".

[0017] In terms of navigation: The dual-incision operation process is deeply integrated with real-time navigation, ensuring the accuracy and repeatability of the operation in a narrow and deep surgical field.

[0018] In terms of system integration: a complete technical closed loop has been built, from preoperative imaging -> personalized design -> access planning -> intraoperative navigation -> precise execution.

[0019] In summary, this invention addresses three major pain points in complex acetabular revision surgery: unreliable fixation, unsafe operation, and unpredictable outcomes. It solves the surgical access problem through a dual-incision approach, the implant matching problem through personalized design, and the execution accuracy problem through precise navigation. These three aspects are indispensable and together constitute a complete, reliable, and efficient solution with significant clinical value and technological foresight. Attached Figure Description

[0020] Figure 1 shows an example of a double-incision surgery for acetabular revision: Figure 1A This is an example image of a bone defect. Figure 1B and Figure 1C These are examples of acetabular revision surgery from different angles. Figure 1D This is a diagram illustrating a surgical incision. Figure 2 This is a flowchart of a two-incision surgical navigation method for acetabular revision surgery. Detailed Implementation

[0021] The applicant has identified a long-standing core problem: in complex and irregular revision pelvises, surgeons lack a clear, reliable, and biomechanically optimal "golden anchor point." Existing techniques (such as reinforcing blocks and Burch-Schneider rings) allow for the placement of fixation screws in multiple locations, including the iliac bone, ischium, and pubis. However, the choice of location often depends on the surgeon's personal experience and intraoperative judgment, lacking a unified anatomical standard, resulting in significant uncertainty and variability in fixation outcomes.

[0022] This proposal focuses on a technological achievement with significant innovative value in the field of orthopedic hip revision surgery. The core of this achievement lies in the rediscovery and application of a relatively obscure anatomical structure—the "gluteal column"—and the design of an implant filling model based on this structure, resulting in a completely new acetabular reconstruction system. This system effectively reconstructs bony defects in the acetabular dome by precisely placing fixation anchors on the strong gluteal column and utilizing a unique L-shaped winged design, thereby solving the industry pain points of traditional revision surgery, such as unstable prosthesis fixation, ambiguous positioning, and poor long-term stability. The applicant has detailed the anatomical basis, design principles, innovative details, and significant advantages of this technology compared to existing technologies, laying a solid foundation for subsequent patent layout and product development.

[0023] The applicant has discovered that the core of this approach has been upgraded from "designing a guiding tool" to "directly manufacturing a permanent implant that integrates with the bone." The following is the digital design process to achieve this goal: First, 3D reconstruction and segmentation are fundamental. The approach involves using a region growing algorithm combined with manual correction to accurately extract the skeletal model, particularly separating the healthy gluteal column region from the bone defect region. The next crucial step is identifying the gluteal column as the "anchor point," requiring the extraction of its complete bone surface curvature as the fitting surface for the fixation wing. Then comes the core implant design phase. The fixation wing design must perfectly fit the gluteal column, like the "negative space" of a 3D scan, which can be ensured using parametric modeling and continuous curvature detection. The screw hole layout must incorporate safety thresholds and mechanical analysis, avoiding blood vessels and nerves while ensuring the screws are placed in the area with the best bone quality. The support bracket design must simultaneously meet two conflicting requirements: stable holding of the standard acetabular cup while adjusting posture according to the patient's anatomy, potentially requiring the use of the multi-parameter combination optimization algorithm from the patent. Finally, all designs must undergo virtual verification, including Boolean operations to check fit and mechanical simulations to test stability—this corresponds precisely to the patent's emphasis on "contact volume ≥ 50%" and "uniform stress distribution." The entire process is closed-loop, from data to design to verification, all completed digitally.

[0024] Please see Figures 1A-1D This is an example of a double-incision surgery for acetabular revision. Figure 1A This is an example of a bone defect. Figure 1B and Figure 1C Examples of acetabular revision at different angles are shown in the diagram. The filling block 21 secures the acetabular cup 6 to the gluteal column region 5 through several screw holes 15 and screw holes (not shown in the diagram). The cup rim 61 of the acetabular cup 6 fits perfectly with the retaining edge 211 of the filling block 21, facilitating secure fastening. Figure 1D This is a similar diagram to the surgical procedure. Example diagrams of the main incision and auxiliary incisions.

[0025] Please see Figure 2 This invention provides a flowchart of a two-incision surgical navigation method for acetabular revision surgery. It includes a planning process, which comprises: S110: Generate a three-dimensional model of the pelvis based on the collected patient information and establish a three-dimensional coordinate system for the pelvis. Identify areas of bone defects, gluteal column areas, and dangerous structural areas including the sciatic nerve, superior gluteal nerve vascular bundle, and obturator vessels, and map them into the three-dimensional coordinate system of the pelvis. S120: The placement posture information of the acetabular cup is virtually set in the three-dimensional coordinate system of the pelvis, and a winged reinforcement block is designed. S130: Digital planning of incision and tunnel before surgery: Planning the main incision: On the pelvic three-dimensional coordinate system, simulate the main incision path along the direction of the gluteus maximus muscle fibers and the femoral axis, ensuring that this path can expose the acetabular rim, the remaining acetabular cup, and the sciatic nerve. Then, mark the course of the sciatic nerve on the pelvic three-dimensional coordinate system as an absolute no-go zone during the operation. Locating the auxiliary incision: Locate the target center of the gluteal column. On the three-dimensional coordinate system of the pelvis, delineate the bone surface area of ​​the gluteal column used to fix the reinforcing block, obtain the course model of the superior gluteal neurovascular bundle, and avoid the incision and approach located posteroinferior to the superior gluteal neurovascular bundle. A subcutaneous tunnel is virtually constructed, and a smooth 3D curve is drawn from the depth of the auxiliary incision to the posterosuperior aspect of the acetabulum within the main incision. Based on the size of the winged reinforcement block, including the width of the fixation wing, the minimum diameter required for the tunnel is determined to ensure that the implant can pass smoothly.

[0026] This article details an innovative dual-incision surgical navigation method that combines a posterolateral main incision and an auxiliary incision above the buttock to safely prepare and fix the gluteal column under direct vision, providing a precise and safe implantation path for personalized implants. This method integrates advanced preoperative planning, intraoperative navigation, and specialized instruments, aiming to reduce surgical risks and improve long-term implant survival rates.

[0027] Specific steps for preoperative planning: Step 1: Data Acquisition and 3D Reconstruction High-precision CT scans (S) can employ thin-slice (≤1mm) scanning to acquire DICOM data of the pelvis. This data is then imported into specialized software (such as Mimics) to generate precise 3D models of the pelvis, bone defects, and important blood vessels and nerves through threshold segmentation and region growing. Key structures such as the gluteal column, bone defect area (V_defect), and acetabular rim are precisely segmented and labeled to prepare for subsequent design.

[0028] Step 2: Define the reference point and coordinate system Establish a pelvic coordinate system: Using the healthy side's teardrop shape as the origin, establish a unified three-dimensional coordinate system. Mirror the healthy side's acetabulum to the affected side and calculate the healthy hip joint rotation center C_normal. This is the gold standard reference for evaluating reconstruction results and planning the acetabular cup position.

[0029] Step 3: Virtual Implant Design and Optimization Quantitative optimization of acetabular cup position: In a computer, a virtual hemispherical acetabular cup is placed thousands of times within a reasonable range (abduction angle 35°-55°, anteversion angle 10°-25°, and positional movement of approximately 10mm in all directions). For each position, two key indicators are calculated simultaneously: contact volume ratio (η): η = (V_contact / V_defect) * 100%. The contact volume between the acetabular cup and the host bone is automatically calculated using Boolean intersection operations. Target: η ≥ 50%. Rotation center offset (D_offset): D_offset = ‖ C_implant - C_normal ‖. Target: D_offset ≤ 8mm. The computer automatically filters out positions that simultaneously meet the above two threshold conditions and selects the position with the largest contact volume and the smallest offset as the optimal solution. This process transforms the doctor's "gut feeling" experience into measurable and repeatable scientific decision-making.

[0030] The design of the winged reinforcement block is customized. The fixed wing surface generation process includes offsetting the labeled gluteal column bone surface inward by 0.2-0.5mm using a surface offset algorithm to generate a fixed wing inner surface that perfectly fits the bone surface. Topology optimization of the support arm involves establishing a connecting block between the fixed wing and the optimal acetabular cup center. Joint reaction forces during the gait cycle (e.g., 2.5 times body weight) are applied, with the objective of "minimizing compliance (i.e., maximizing stiffness)" and the constraint of "reducing volume by 50%), and the topology optimization algorithm is run. The algorithm automatically generates a lightweight support arm structure with optimal material distribution, resembling tree roots, ensuring sufficient material along the force path while hollowing out non-load-bearing areas.

[0031] The design of the filler block generation and fixation mechanism involves executing V_filler = V_defect - V_augment to automatically calculate the precise shape of the filler block, or allowing the doctor to directly select one or more areas as the generation region for the filler block. A collision detection algorithm simulates the implantation path of the filler block. If it cannot be implanted as a whole, it is automatically or manually divided into multiple assemblable parts, and a tenon-and-mortise structure is designed for connection.

[0032] Screw path safety planning. In three-dimensional space, the sciatic nerve, superior gluteal vessels, etc. are pre-defined as "danger zones". A path is planned for each screw hole on the fixation wing to maximize the screw's holding length within the bone, and to ensure that its safety boundary is more than 5mm away from all danger zones.

[0033] Step 4: Generate surgical plan and navigation data, outputting a "surgical blueprint": including the final 3D model of the implant, the optimal acetabular cup pose matrix, and safe screw channel coordinates. Generate navigation plan file: export the planned data for use by the intraoperative navigation system.

[0034] Intraoperative registration—a "bridge" connecting the virtual and the real world. Intraoperative registration is the core technology and the bottleneck to precision in the entire navigation surgery. Its goal is to find a mathematical transformation that allows every point on the preoperative 3D model to correspond precisely with the patient's actual anatomical position during surgery.

[0035] No matter how perfect the preoperative planning is, it's all in vain if it can't be accurately mapped onto the patient. Target Registration Error (TRE) will directly translate into errors in surgical execution.

[0036] The specific process of registration Step 1: Establish a tracking baseline. Install the patient's dynamic reference base: After the surgery begins and the bones are exposed, a reference base with a reflective ball is securely fixed to the iliac crest on the affected side using a fixation pin. From this point onward, the navigation system will use this reference base as the origin to track all movements of the patient's pelvis.

[0037] Step 2: Perform the registration operation Paired point registration involves matching a set of corresponding points that can be accurately identified in both the preoperative model and intraoperative anatomy to calculate a preliminary coordinate transformation matrix. The surgeon uses a navigation pointer (whose position is tracked in real-time by the system) to sequentially touch pre-selected bony landmarks, such as the anterior superior iliac spine, posterior superior iliac spine, pubic symphysis, and the center of the femoral head. The system matches the acquired set of real points with the virtual set to calculate the preliminary registration error (FRE).

[0038] Paired-point registration may introduce errors between individual points. Surface matching, by acquiring a large number of unrelated bone surface points (point clouds), achieves higher overall registration accuracy across the entire bone surface. The surgeon uses a navigation pointer to randomly but extensively acquire 30-50 or more surface points around the acetabulum, iliac wing, ischium, and other areas. The system runs an iterative nearest-point algorithm, continuously optimizing the transformation matrix to minimize the overall distance error between the virtual model surface and the actually acquired surface point cloud. This is the most effective step in reducing TRE (Transmission Error Reduction).

[0039] Step 3: Registration verification involves using a navigation pointer to touch several bony landmarks not used during the registration process (such as the ischial tuberosity, the teardrop shape in the acetabulum). Observe on the navigation screen whether the virtual tip of the pointer precisely coincides with the corresponding point on the virtual model. If the error is within an acceptable range (usually <1.5mm), the registration is successful. If the error is significant, re-registration is necessary; never take chances.

[0040] Preoperative selection of registration points: On the virtual 3D model of the navigation workstation, select 4-6 bony landmarks that are easy to access intraoperatively and are relatively far apart from each other. Commonly used points include: anterior superior iliac spine, posterior superior iliac spine, pubic symphysis (exposed by touch or small incision), femoral head center (fitted by rotating the femur), ischial tuberosity (exposed through a posterior incision), and tip of the greater trochanter. During the procedure, corresponding points are acquired. Using a calibrated navigation pointer, under aseptic conditions, the corresponding real bony landmarks on the patient's pelvis are sequentially and precisely touched. Each time a point is touched, the foot pedal is depressed, and the system records the point's true coordinates in the patient's coordinate system. The transformation matrix is ​​calculated by matching the acquired set of real points with the corresponding set of points on the virtual model using navigation software. Mathematical algorithms such as the "iterative nearest point algorithm" are employed to calculate an optimal spatial transformation matrix (including rotation and translation) that minimizes the error between the virtual and real point sets. The system displays a registration error (e.g., FRE, Fiducial Registration Error), typically required to be less than 1.0 mm. If the error is too large, points need to be reacquired.

[0041] Optimize registration accuracy, especially in large areas between paired points. Intraoperatively, acquire surface point clouds using a navigation pointer, randomly but extensively touching 30-50 points on the pelvic bone surface (especially around the acetabulum, gluteal column region, and the inner and outer plates of the iliac wing). These points do not need to be specific anatomical landmarks; any bone surface is acceptable, forming a "point cloud." The system then performs an optimal fit between the acquired real surface point cloud and the virtual model surface. The algorithm further optimizes the transformation matrix to minimize the overall target registration error (TRE) between the virtual model surface and the real bone surface. TRE is the gold standard for measuring final accuracy and directly affects the reliability of intraoperative navigation.

[0042] In other words, this method also includes: Virtual implantation design is performed, and the designed winged reinforcement block model is dynamically collided along the planned subcutaneous tunnel path. Implantability analysis steps: Simulate the process of the reinforcement block passing through the tunnel and rotating into place. If a collision occurs or it cannot be placed, the design of the reinforcement block needs to be optimized or the tunnel path adjusted. Generate surgical navigation plan: Transform the plan into navigation instructions, and set the planned auxiliary incision center point, tunnel direction, gluteal column target area, and safety screw channel as the visual targets and no-go zones in the navigation system.

[0043] This method also includes: Before surgery, an optical positioning system is used to establish a dynamic reference base for the patient and a dynamic reference base for the instrument, and the data in the instrument coordinate system is converted to the data in the patient coordinate system in real time. The main incision is used for point registration and surface matching; The auxiliary incision allows the navigation pointer to directly touch the bone surface of the gluteal column to acquire additional surface points, thereby improving the local registration accuracy of this key target area and ensuring the fit of the fixation wing and the registration of the screw insertion.

[0044] This invention can also generate surgical navigation configuration files, exporting all planned key information in a format readable by the navigation system, including: the three-dimensional coordinates of the auxiliary incision center point, the ideal axis of the subcutaneous tunnel, the target area of ​​the gluteal column, the safe passage of each planned screw, and the neurovascular danger zone; Output personalized surgical guide design files, design personalized guides that precisely fit the patient's gluteal column bone surface, for intraoperative positioning and drilling assistance, and generate 3D printing files for the guides.

[0045] This method also includes using surgical instrument navigation to complete the implantation procedure, and further includes the surgical instrument navigation being configured to perform the following operations: The acetabulum is treated through the main incision, soft tissue, residual prosthesis and bone cement are removed, the bone bed is ground down until bleeding occurs, the gluteal column is exposed through the auxiliary incision, the bone surface is cleaned, and the fitting area of ​​the fixation wing is prepared. Implantation of winged reinforcement blocks: The winged reinforcement block is inserted through the auxiliary incision and pushed towards the main incision through the subcutaneous tunnel, so that its fixation wing can face the gluteal column and its support arm can face the center of the acetabulum. In the main incision, a support block is positioned to guide its insertion into the acetabular region. In the auxiliary incision, a pusher is used to press the fixation wing against the gluteal column, bringing it into contact with the bone surface. The direction of the support arm is adjusted so that the acetabular cup recess at the end of the support arm is at a predetermined abduction and anteversion angle. Through the auxiliary incision, screws are driven into the pre-drilled holes on the fixation wing under direct vision to securely fix the support block to the gluteal column. The acetabular cup is installed through the main incision. A standard hemispherical acetabular cup is inserted into the support arm slot of the reinforcing block, and the liner is installed.

[0046] The specific process also includes the implantation of filler blocks: through the main incision, the filler blocks are placed into the cavity between the reinforcing block and the host bone. The filler blocks are individually designed according to the shape of the remaining cavity. If there are multiple filler blocks, they are implanted in sequence, ensuring that they fit tightly together with each other and with the host bone and the reinforcing block. Some filler blocks may have mortise and tenon structures or screw holes for interconnection or fixation to the host bone.

[0047] A dual-incision surgical navigation system for acetabular revision surgery, comprising: The optical positioning system uses a camera to emit infrared light and capture the reflected light from a reflective sphere mounted on a dynamic reference base on the surgical instruments and the patient. The system then calculates the three-dimensional spatial coordinates of the sphere in real time using triangulation. Navigation workstation: It includes: Patient dynamic reference base, rigid support with reflective sphere.

[0048] The instrument's dynamic reference base includes a reflective ball support; Navigation equipment: includes: Navigation pointers are used to locate anatomical landmarks in the bone during surgery for registration. Navigation drill bit guide / sleeve: A guide with a tracking reference base to ensure that the drilling path is completely consistent with the pre-operative plan; Implant holder: Used to hold winged reinforcement blocks or filler blocks, and includes a reference base. It can display a virtual model of the implant and its placement angle on the screen in real time. The preoperative planning module is configured as follows: Based on the collected patient information, a three-dimensional model of the pelvis is generated and a three-dimensional coordinate system of the pelvis is established. The bone defect area, the gluteal column area, and the dangerous structural area including the sciatic nerve, the superior gluteal nerve vascular bundle, and the obturator vessel are identified and mapped into the three-dimensional coordinate system of the pelvis. The placement posture information of the acetabular cup is virtually set in the three-dimensional coordinate system of the pelvis, and a winged reinforcement block is designed. Digital planning of the incision and tunnel before surgery: Planning the main incision: On the pelvic three-dimensional coordinate system, simulate the main incision path along the direction of the gluteus maximus muscle fibers and the femoral axis, ensuring that this path can expose the acetabular rim, the remaining acetabular cup, and the sciatic nerve. Then, mark the course of the sciatic nerve on the pelvic three-dimensional coordinate system as an absolute no-go zone during the operation. Locating the auxiliary incision: Locate the target center of the gluteal column. On the three-dimensional coordinate system of the pelvis, delineate the bone surface area of ​​the gluteal column used to fix the reinforcing block, obtain the course model of the superior gluteal neurovascular bundle, and avoid the incision and approach located posteroinferior to the superior gluteal neurovascular bundle. A subcutaneous tunnel is virtually constructed, and a smooth 3D curve is drawn from the depth of the auxiliary incision to the posterosuperior aspect of the acetabulum within the main incision. Based on the size of the winged reinforcement block, including the width of the fixation wing, the minimum diameter required for the tunnel is determined to ensure that the implant can pass smoothly.

Claims

1. A dual incision surgical navigation method for acetabular revision for acetabular revision, comprising a planning process, characterized in that, The planning process comprises: According to the collected patient information, a three-dimensional model of the pelvis is generated and a three-dimensional coordinate system of the pelvis is established, the bone defect area, the gluteal muscle column area, the dangerous structure area containing the sciatic nerve, the superior gluteal nerve and blood vessel bundle, and the obturator blood vessel are identified and mapped into the three-dimensional coordinate system of the pelvis; The virtual setting of the cup placement pose information in the three-dimensional coordinate system of the pelvis is designed with a winged reinforcing block; The digital planning of the incision and tunnel before surgery is configured to: Planning the main incision: in the three-dimensional coordinate system of the pelvis, simulate the main incision path along the direction of the gluteus maximus muscle fiber and the femoral axis, and ensure that the path can expose the acetabular rim, the remaining acetabular cup and the sciatic nerve, and then mark the running of the sciatic nerve in the three-dimensional coordinate system of the pelvis as an absolute forbidden area during the operation, Positioning the auxiliary incision: positioning the target of the gluteal muscle column, defining the gluteal muscle column bone surface area for fixing the reinforcing block in the three-dimensional coordinate system of the pelvis, obtaining the running model of the superior gluteal nerve and blood vessel bundle, and avoiding the incision and approach to be located below the superior gluteal nerve and blood vessel bundle, Virtual construction of a subcutaneous tunnel, drawing a smooth 3D curve from the deep part of the auxiliary incision to the upper posterior of the acetabulum in the main incision, determining the minimum diameter required for the tunnel according to the size of the winged reinforcing block including the width of the fixing wing, and ensuring that the implant can pass through smoothly.

2. The method of claim 1, wherein, It also includes: Virtual implant design: the designed winged reinforcing block model is subjected to dynamic collision detection along the planned subcutaneous tunnel path; Implantability analysis step: simulate the process of the reinforcing block passing through the tunnel and rotating into place, if collision occurs or the reinforcing block cannot be placed, the design of the reinforcing block needs to be optimized or the tunnel path needs to be adjusted, Generating a surgical navigation plan: converting the planning into navigation instructions, setting the planned center point of the auxiliary incision, the direction of the tunnel, the target area of the gluteal muscle column, and the safe screw channel as visualized targets and forbidden areas in the navigation system.

3. The method of claim 1 or 2, wherein, It also includes: Before surgery, a dynamic reference base of the patient and a dynamic reference base of the instrument are established using an optical positioning system, and data in the instrument coordinate system are converted to data in the patient coordinate system in real time; Point registration and surface matching are performed on the main incision; The auxiliary incision directly touches the bone surface of the gluteal muscle column with a navigation pointer through the incision, additional surface point collection is performed to improve the local registration accuracy of the key target area of the gluteal muscle column, and the fitting of the fixing wing and the registration of screw insertion are ensured.

4. The method of claim 1 or 2, further comprising: Generating a surgical navigation configuration file, exporting all the key information planned into a format readable by the navigation system, including: the three-dimensional coordinates of the center point of the auxiliary incision, the ideal axis of the subcutaneous tunnel, the target area of the gluteal muscle column, the safe channel of each planned screw, and the nerve and blood vessel danger area; Outputting a personalized surgical guide design file, designing a personalized guide plate that accurately fits the bone surface of the patient's gluteal muscle column for intraoperative positioning and drilling, and generating a 3D printing file of the guide plate.

5. The method of claim 1 or 2, further comprising: It also includes completing the implantation surgery using surgical instrument navigation, which further includes the following operations completed by the surgical instrument navigation: Through the main incision, the acetabulum is treated, the soft tissue, the remaining prosthesis and the bone cement are removed, the bone bed is ground to bleeding, the gluteal muscle column is exposed through the auxiliary incision, the bone surface is cleaned, and the fitting area of the fixing wing is prepared; Implantation of the winged reinforcing block: The winged reinforcement block is put in from the auxiliary incision, pushed to the main incision through a subcutaneous tunnel, so that the fixed wing can face the gluteal muscle column and the support arm can face the center of the acetabulum; In the main incision, the configuration is used to guide the reinforcement block into the acetabular area; in the auxiliary incision, the configuration is used to press the fixed wing against the gluteal muscle column with a push rod, so that it is in close contact with the bone surface, and the direction of the support arm is adjusted so that the acetabular cup clamping groove at the end of the support arm is at a predetermined abduction angle and anteversion angle, through the auxiliary incision, a screw is punched into the preset screw hole on the fixed wing under direct vision, and the reinforcement block is firmly fixed on the gluteal muscle column, Through the main incision, the acetabular cup is installed, and a standard hemispherical acetabular cup is implanted in the clamping groove of the support arm of the reinforcement block, and the liner is installed.

6. The method of claim 5, wherein, Also includes: Implantation of filling blocks: Through the main incision, the filling block is placed in the cavity between the reinforcement block and the host bone, and the filling block is individually designed according to the shape of the remaining cavity. If the filling block is in multiple pieces, they are implanted in sequence, and it is ensured that they are in close contact with each other and with the host bone and the reinforcement block. Some filling blocks may have mortise and tenon structures or screw holes for mutual connection or fixation to the host bone.

7. A dual incision surgical navigation system for acetabular revision, characterized in that, It includes: Optical positioning system: the camera emits infrared light and captures the reflected light of the reflective ball installed on the dynamic reference base of the surgical instrument and the patient, and calculates its three-dimensional spatial coordinates in real time by triangulation method; Navigation workstation: it contains: Patient dynamic reference base, rigid support with reflective ball; Instrument dynamic reference base, containing reflective ball support; Navigation instrument: contains: Navigation pointer for intraoperative registration by contacting bone anatomical landmark points; Navigation drill guide / sleeve: a guide with a tracking reference base ensures that the drilling path is completely consistent with the preoperative plan; Implant holder: used to hold the winged reinforcement block or filling block, and with a reference base, the virtual model of the implant and the placement angle can be displayed in real time on the screen, Preoperative planning module, configured to: Generate a three-dimensional model of the pelvis and establish a three-dimensional coordinate system of the pelvis according to the collected patient information, identify the bone defect area, gluteal muscle column area, and dangerous structure area including the sciatic nerve, superior gluteal nerve and blood vessel bundle, and map them to the three-dimensional coordinate system of the pelvis; virtually set the acetabular cup placement pose information in the three-dimensional coordinate system of the pelvis, and design the winged reinforcement block; Digital planning of incisions and tunnels before surgery: Planning the main incision: in the three-dimensional coordinate system of the pelvis, simulate the main incision path along the direction of the gluteus maximus muscle fibers and the femoral axis, and ensure that the path can expose the acetabular rim, the remaining acetabular cup and the sciatic nerve, and then mark the course of the sciatic nerve in the three-dimensional coordinate system of the pelvis as an absolute forbidden area during the operation, Positioning the auxiliary incision: positioning the gluteal muscle column target, in the three-dimensional coordinate system of the pelvis, circumscribing the gluteal muscle column bone surface area for fixing the reinforcement block, obtaining the running model of the superior gluteal nerve and blood vessel bundle, and avoiding the incision and approach to be located below the posterior of the superior gluteal nerve and blood vessel bundle, Virtual construction of subcutaneous tunnel, draw a smooth 3D curve from the deep part of the auxiliary incision to the upper posterior of the acetabulum in the main incision, according to the size of the winged reinforcement block including the width of the fixed wing, determine the minimum diameter required for the tunnel, and ensure that the implant can pass through smoothly.

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