Surgical tracking system for tracking instruments relative to a reference body - Patent Application 20070122997

Abstract

The present invention relates to surgical guide devices, surgical references, and surgical tracking systems, and in particular to surgical guide devices, surgical references, and surgical tracking systems that enable improved localization of surgical components.

Description

[Technical Field]

[0001] The present invention relates to surgical guide devices, surgical reference bodies, and surgical tracking systems, and in particular to surgical guide devices, surgical reference bodies, and surgical tracking systems that enable improved localization of surgical components, as well as corresponding methods, computer program products, and storage media having computer program products stored thereon. [Background technology]

[0002] Advances in surgical procedures have been made in recent years. Significant improvements have been achieved with support systems for supporting clinicians, particularly surgeons, during surgery. Fractures, in particular, benefit from surgeon support systems that provide surgeons with instruments that allow them to improve the accuracy of repositioning bone segments and positioning implants, such as screws, nails, and bone plates, as well as the precision of tools, targeting devices, and guide devices.

[0003] Because traumatized bones, i.e., fractures, have limited visual accessibility, monitoring is usually based on radiation principles, such as X-ray imaging, or computed tomography (CT) imaging, or magnetic resonance imaging (MRT) imaging. All these principles and methods have at least one drawback: they use a lot of radiation, require large equipment, and take a considerable amount of time. Each monitoring step during surgery extends the duration of the surgery, thus extending the duration of the effects of the anesthetic, increasing costs and radiation effects.

[0004] Therefore, there is a need for surgical guide devices, surgical references, and surgical tracking systems and corresponding methods that reduce imaging efforts, thereby shortening surgical time and reducing radiation effects on the patient, while at the same time maintaining or improving the level of surgical accuracy. Summary of the Invention

[0005] The present invention provides a surgical guide device, a surgical reference and a surgical tracking system that allow for improved localization and positioning of surgical components, as well as corresponding methods, computer program products and storage media storing computer program products according to the subject matter of the independent claims. Further embodiments are incorporated in the dependent claims.

[0006] According to one embodiment of the present invention, there is provided a surgical tracking system for tracking a surgical instrument relative to a surgical reference, the surgical tracking system comprising: an optical imaging device representing a position and orientation of one of the surgical instrument and the surgical reference, the optical imaging device having a predetermined line of sight; a light pattern representing the position and orientation of the other of the surgical instrument and the surgical reference, the light pattern having at least one unique light sub-pattern, thereby enabling determination of the relative position and orientation of the surgical reference to the position and orientation of the surgical instrument; and an optical imaging device, the optical imaging device comprising pattern recognition means adapted to recognize the position and orientation of at least the light sub-pattern of the light pattern relative to the position and viewing direction of the imaging device based on an image captured from the optical imaging device and a stored representation of the light pattern; and visualization means adapted to virtually visualize the surgical instrument represented by either the optical imaging device or the light pattern, and virtually visualize the surgical reference represented by the other of the light pattern and the optical imaging device.

[0007] In this way, the relative position of the optical imaging device and the light pattern can be determined. If the light pattern is known in terms of its structure and size, its image can determine where the image was taken from. It is not necessary to take an image of the entire pattern, as long as the imaged portion of the pattern is unique within the entire pattern. Both the optical imaging device and the light pattern represent either a surgical instrument or a surgical reference. Note that the optical imaging device and the light pattern may also represent other items whose relative positions to one another need to be determined. The entire surgical tracking system can support multiple optical imaging devices and can also support multiple light patterns. The light pattern may be printed on a surgical instrument or a reference. When printed, embedded, or affixed to an item, the pattern enables optical referencing, thereby making the item a reference. When embedded or affixed to an item, the optical imaging device enables optical referencing, thereby making the item a reference. Optically determining relative position and orientation requires that the relative position and relative imaging or line of sight direction of the optical imaging device with respect to the item, as represented by the optical imaging device, be known. Similarly, the light pattern itself needs to be known, as well as its relative position and relative orientation with respect to the items represented by the light pattern. If the relative positions and orientations of the optical imaging device and the light pattern with respect to each other can be determined, and the relative positions and orientations of the items with respect to each other can be determined, and the positions and orientations of the items with respect to each other can be visualized, which can be visualized for surgical instruments and reference bodies attached to the patient's anatomy, when the relative positions and orientations of the optical imaging device and the light pattern with respect to each item that they represent are known.

[0008] According to one embodiment of the present invention, there is provided a surgical tracking system for tracking a first portion of a surgical reference body relative to a second portion of the surgical reference body, the surgical tracking system including: an optical imaging device representing the position and orientation of one of the first portion of the surgical reference body and the second portion of the surgical reference body, the optical imaging device having a predetermined line of sight; a light pattern representing the position and orientation of the other of the first portion of the surgical reference body and the second portion of the surgical reference body, the light pattern having at least one unique light sub-pattern that enables determination of the relative position and orientation of the first portion of the surgical reference body relative to the position and orientation of the second portion of a surgical instrument; and an image processing device including pattern recognition means adapted to recognize the position and orientation of at least the light sub-pattern of the light pattern relative to the position and line of sight of the imaging device based on an image captured from the optical imaging device and a stored representation of the light pattern, and calculation means adapted to determine the relative position and orientation of the first portion of the surgical reference body relative to the position and orientation of the second portion of the surgical instrument.

[0009] In this way, the relative position of the optical imaging device and the light pattern can be determined. If the light pattern is known in terms of its structure and size, its image can determine where it was taken from. It is not necessary to take an image of the entire pattern, as long as the imaged portion of the pattern is unique within the entire pattern. Both the optical imaging device and the light pattern represent either a first portion of the surgical reference body or a second portion of the surgical reference body. To determine the relative spatial position and orientation of three or more portions of the surgical reference body, the entire surgical tracking system can support two or more optical imaging devices and can also support two or more light patterns. The light patterns can be printed on each portion of the surgical reference body. When printed, embedded, or affixed to a portion of the surgical reference body, the pattern enables optical referencing, thereby making the portion of the surgical reference body a reference body. Optically determining the relative position and relative orientation requires that the relative position and relative imaging or line of sight direction of the optical imaging device with respect to the portion of the surgical reference body represented by the optical imaging device be known. Similarly, the light pattern itself must be known, as must its relative position and orientation, as represented by the optical imaging device, relative to the portion of the surgical reference body represented by the light pattern. If the relative positions and orientations of the optical imaging device and the light pattern relative to each other can be determined, and the relative positions and orientations of the optical imaging device and the light pattern relative to the respective portions of the surgical reference body represented by them are known, it is possible to determine the relative positions and orientations of the portions of the surgical reference body relative to each other. This can be applied to extractable surgical reference bodies having at least two portions, one of which is provided with a light pattern and the other of which is provided with an optical imaging device. Two or more portions of the surgical reference body can be used to accommodate patient anatomies that are too large to image in a single radiographic image. The portions can have radio-dense geometries or sub-geometries, each with its own projection in the radiographic image, and can be shown in separate radiographic images.Spatial position and orientation can be performed using an optical imaging device coupled to one portion of the reference body and a light pattern coupled to another portion of the surgical reference body, so that along with optical determination of relative spatial position, the spatial position of radiopaque (sub)geometry can also be determined, including, for example, bony portions of long bones, which are referenced to parts of the surgical reference body. The parts of the surgical reference body can be coupled to each other by a mechanical structure that selectively allows for locking and release of the parts of the surgical reference body relative to each other. This can be done via rails or hinges, each with only one degree of freedom, or by a combination of one or more rails and one or more hinges that allow one or more degrees of freedom. Note that what is discussed below with respect to the surgical instrument and the reference body also applies to the first part of the surgical reference body and the second part of the surgical reference body.

[0010] According to one embodiment, the surgical tracking system further includes an augmentation means adapted to augment a predetermined movement trajectory of the surgical instrument on the virtual visualization of the surgical instrument based on the recognized position and orientation of at least a light sub-pattern of the light pattern relative to the position and line of sight of the imaging device, thereby visualizing the movement path of the surgical instrument relative to the surgical reference body represented by the light pattern.

[0011] In this way, not only can the items represented by the optical imaging device and the light pattern be visualized, but additional information can also be augmented. The surgical instrument's motion path can be the trajectory that an implant or tool can move along when guided by the surgical instrument, whether it is inside the surgical instrument, outside or within the extension of the surgical instrument, or the range and radius of motion of a tool connected to the surgical instrument, or the contour of an implant to be implanted that can be guided by the surgical instrument. Augmentation can also include augmentation of different items, various types of items applied by the surgical instrument, for example, implants of various sizes. The augmentation of types can be performed simultaneously or alternately.

[0012] According to one embodiment, the augmentation means may include a scrolling means that the surgeon may use to selectively scroll through a variety of different items, such as different tools, implant sizes, implant types, etc., until the surgeon identifies the most suitable implant.

[0013] Thus, the appropriate tool can be easily found by scrolling through, for example, implants with different drill diameters, different implant sizes, different implant types or varieties, especially sub-implants. For example, if a bone nail is to be augmented, various types of nails can be augmented, including types with fixation screws, so that if the augmented fixation screws clash with anatomical structures that are not suitable for receiving fixation screws, the surgeon can not only recognize the primary implant, but also determine whether the primary implant is appropriate. By scrolling through the varieties, the surgeon can select the appropriate implant, such as a nail, or a sub-implant, such as a fixation screw, within seconds.

[0014] According to one embodiment, the optical imaging device includes a mechanical interface that couples to a positive fit receptacle on one of the surgical instrument and the surgical reference to form a unit having a reproducible relationship between the geometry of one of the surgical instrument and the surgical reference and the position and line of sight of the optical imaging device.

[0015] This ensures that the relative position and orientation of the optical imaging device to the connected surgical instrument and reference body, respectively, is established. Positive-fit receptacles can also be equipped with coded key and keyhole sections, which allow connection only for specific combinations whose relative position and orientation are known to the system. This avoids unintentional misuse and misunderstandings during operation. Mechanical interfaces allow the unit to be released for selective reuse of components.

[0016] According to one embodiment, the surgical tracking system further includes a surgical instrument, the surgical instrument including a mechanical interface for the mechanical interface of the optical imaging device to form a reproducible relationship between the geometry of the surgical instrument and the position and viewing direction of the optical imaging device.

[0017] Thus, not only is an optical imaging device provided, but also a surgical instrument to which an optical instrument is releasably coupled via an interface.

[0018] According to one embodiment, the surgical tracking system further includes a surgical reference body, which includes a mechanical interface for the mechanical interface of the optical imaging device to form a reproducible relationship between the geometry of the surgical reference body and the geometry of the position and line of sight of the optical imaging device.

[0019] Thus, not only is an optical imaging device provided, but also a surgical reference to which the optical instrument is releasably coupled. This also demonstrates that the optical imaging device can be coupled to a surgical reference as well as a surgical instrument.

[0020] According to one embodiment, the light pattern includes a mechanical interface that is coupled to a positive-fit mechanical interface of one of the surgical instrument and the surgical reference to form a unit having a reproducible relationship between the geometry of one of the surgical instrument and the surgical reference and the position and orientation of the light pattern.

[0021] This ensures that the relative position and orientation of the light pattern to the connected surgical instrument and reference body, respectively, is established. Positive-fit receptacles can also be equipped with coded key and keyhole sections, which allow connection only to specific combinations whose relative position and orientation are known to the system. This helps to avoid unintentional misuse and misunderstandings during operation.

[0022] According to one embodiment, the surgical tracking system further includes a surgical instrument, the surgical instrument including a mechanical interface for the mechanical interface of the light pattern to form a reproducible relationship between the geometry of the surgical instrument and the position and orientation of the light pattern.

[0023] Thus, not only is an optical imaging device provided, but also a surgical instrument to which a light pattern is releasably coupled via an interface.

[0024] According to one embodiment, the surgical tracking system further includes a surgical reference, which includes a mechanical interface for the mechanical interface of the light pattern to form a reproducible relationship between the geometry of the surgical reference and the position and orientation of the light pattern.

[0025] Thus, not only is a light pattern provided, but also a surgical reference to which the light pattern is releasably coupled, which also demonstrates that light patterns can be coupled to surgical references as well as surgical instruments.

[0026] According to one embodiment, the surgical tracking system further includes a surgical instrument, and the optical imaging device is inseparably connected to the surgical instrument so as to form a reproducible relationship between the geometry of the surgical instrument and the position and orientation of the optical imaging device.

[0027] In this way, it is possible to establish a reliable assignment between an optical imaging device and a surgical instrument without running the risk of connecting the optical imaging device to a surgical instrument for which it is not intended.

[0028] According to one embodiment, the surgical tracking system further includes a surgical reference, and the light pattern is inseparably connected to the surgical reference so as to form a reproducible relationship between the geometry of the surgical reference and the position and orientation of the light pattern.

[0029] In this way, it is possible to establish a reliable assignment between a light pattern and a surgical reference without running the risk of connecting the light pattern to a surgical reference for which it is not intended.

[0030] According to one embodiment, the surgical tracking system further includes a surgical instrument, and the light pattern is inseparably connected to the surgical instrument so as to form a reproducible relationship between the geometry of the surgical instrument and the position and orientation of the light pattern.

[0031] In this way, it is possible to establish a reliable assignment between a light pattern and a surgical instrument without running the risk of connecting the light pattern to a surgical instrument for which it is not intended.

[0032] According to one embodiment, the surgical tracking system further includes a surgical reference, and the optical imaging device is inseparably connected to the surgical reference so as to form a reproducible relationship between the geometry of the surgical reference and the position and orientation of the optical imaging device.

[0033] In this way, it is possible to establish a reliable assignment between an optical imaging device and a surgical reference without running the risk of connecting the optical imaging device to a surgical reference for which it is not intended.

[0034] According to one embodiment, the light pattern consists of geometrically uniform light and dark field rasters, in particular square light and dark field rasters, in particular light and black field rasters.

[0035] This makes it easier to reproduce the orientation and position of the pattern. Furthermore, the printing process is easier to implement and the patterns are easier to calculate. Fields of different colors or shades within the square raster form unique pattern areas. Geometrically uniform means that the dimensions of the fields are geometrically uniform, but each field can have a different color or shade to form a unique pattern area.

[0036] According to one embodiment, the light pattern consists of a raster of geometrically uniform fields of different colors, in particular a raster of square colored fields, in particular a raster of color gradient fields.

[0037] Thus, not only can light and dark fields be used, but different colors can also be used. This allows for color coding, which helps the surgeon select the appropriate light pattern. Furthermore, using three or more colors, i.e., light and dark, instead of two options allows more information to be stored on the same surface area. With two options, for example, two fields of light and dark, four different combinations can be reflected. With four options, for example, two fields of yellow, blue, red, and green, four times as many can be reflected, i.e., 16 different combinations.

[0038] According to one embodiment, the light pattern consists of a honeycomb raster of light and dark fields, in particular a raster of light and dark circles or light and dark hexagons within the honeycomb raster, in particular a raster of light / black circles or light / black hexagons.

[0039] This provides a more compact pattern because each field in a honeycomb raster is closer to a circle than a square raster, resulting in a more densely packed pattern than a square pattern. Fields of different colors or shades within a honeycomb raster form unique pattern regions.

[0040] According to one embodiment, the light pattern is composed of honeycomb rasters of different color fields, in particular colored circle or hexagonal rasters within the honeycomb raster, in particular color gradient circle or hexagonal rasters.

[0041] Thus, not only can light and dark fields be used, but also different colors. This allows for color coding that helps the surgeon select the appropriate light pattern. Furthermore, using three or more colors, i.e., light and dark, instead of two options allows more information to be stored on the same surface area. With two options, for example, two fields of light and dark, four different combinations can be reflected. With four options, two fields of yellow, blue, red, and green, four times as many can be reflected, for example, 16 different combinations.

[0042] According to one embodiment, the surgical instrument is a surgical guide device, the surgical guide device further comprising: a guide body having a longitudinal extension from a proximal end of the surgical guide device to a distal end of the surgical guide device, the guide body adapted to guide at least one of a longitudinal surgical implant and a longitudinal tool, the guide body having a guide track extending therealong and continuing distally along a path of travel of at least one of the surgical implant and surgical tool being inserted and guided; and a radiopaque geometric shape disposed at a predetermined spatial position and orientation relative to the guide body, the radiopaque geometric shape adapted to provide a unique radiographic projection for each proximal-to-distal orientation of the guide body.

[0043] According to one embodiment, the surgical reference body includes a radiopaque geometry fixedly and spatially reproducibly connected to the surgical reference body, and a reference body portion having a surface anatomically adapted to the patient's anatomy, the radiopaque geometry having a unique radiographic projection for each proximal-to-distal orientation of the surgical reference body, thereby enabling the spatial position and orientation of the surgical reference body to be determined based on two-dimensional radiographic projections of at least a portion of the surgical reference body.

[0044] In this way, it is possible not only to determine relative position and orientation based on light pattern recognition and identification, but also to simultaneously monitor the surgical references, whether in the form of integrally formed or attachable references, by radiological monitoring, thus providing both identification options and allowing them to be used simultaneously.

[0045] According to one embodiment, the surgical reference body includes: a radiopaque geometry having a first radiopaque sub-geometry and a second radiopaque sub-geometry, each radiopaque sub-geometry being fixedly and spatially reproducibly connected to the surgical reference body; a first reference body part having a surface anatomically adapted to the patient's anatomy; and a second reference body part having a surface anatomically adapted to the patient's anatomy; wherein the first radiopaque sub-geometry and the second radiopaque sub-geometry are fixedly and spatially reproducibly connected to the surgical reference body. Each of the radiopaque sub-geometry shapes has a unique radiographic projection for each orientation from the base end to the tip end of the surgical reference body, whereby the spatial position and orientation of the surgical reference body can be determined based on two-dimensional radiographic projections of at least a portion of the surgical reference body using only the first radiopaque sub-geometry shape and the second radiopaque sub-geometry shape, and the first radiopaque sub-geometry shape is assigned to a first reference body portion and the second radiopaque sub-geometry shape is assigned to a second reference body portion.

[0046] This reduces the focus on the relevant part of the reference body, especially when using larger reference bodies. The leg structure not only allows coverage of a large surface of the patient's anatomy, but also allows access between the legs. Such a reference body can be used in surgeries in the pelvic region, which require reliable reference with a reference body covering a large area of ​​the pelvis. Depending on the viewing direction during radiography, only a portion of the entire reference body may be visible in the radiographic image. Therefore, it is important to be able to determine the position and orientation even when only a partial view is available. When multiple radiopaque sub-geometries are provided, each of which allows for the determination of spatial position and orientation, it is highly likely that at least one of the radiopaque sub-geometries is within the imaged area, making it possible to determine the position and orientation of the reference body.

[0047] According to one embodiment, the surgical reference body includes: a radiopaque geometry having a first radiopaque sub-geometry, a second radiopaque sub-geometry, and a third radiopaque sub-geometry, each sub-geometry being fixedly and spatially repeatably connected to the surgical reference body; a first leg having an anatomically adapted surface relative to the patient's anatomy; and a second leg having an anatomically adapted surface relative to the patient's anatomy; wherein the first leg having a first end is connected to a first end of the second leg at a leg interface, and the first radiopaque sub-geometry, the second radiopaque sub-geometry, and the third radiopaque sub-geometry are fixedly and spatially repeatably connected to the surgical reference body. Each radiopaque sub-geometry has a unique radiographic projection for each orientation of the surgical reference body from the base end to the tip end, whereby the first radiopaque sub-geometry, the second radiopaque sub-geometry, and the third radiopaque sub-geometry alone can determine the spatial position and orientation of the surgical reference body based on two-dimensional radiographic projections of at least a portion of the surgical reference body, wherein the first radiopaque sub-geometry is assigned to the second end of the first leg, the second radiopaque sub-geometry is assigned to the second end of the second leg, and the third radiopaque sub-geometry is assigned to the leg junction of the first leg and the second leg.

[0048] Thus, the use of three radiopaque sub-geometries allows for a more dispersed arrangement of the radiopaque sub-geometries, which increases the likelihood of finding a projection of the radiopaque sub-geometries in each radiographic image taken, allowing the spatial location and orientation of the imaged area to be determined.

[0049] According to one embodiment, the surgical reference includes at least one apex pin hole.

[0050] In this way, the surgical reference can be fixed to the patient's anatomy, thereby establishing and maintaining the spatial position and orientation between the reference and the patient's anatomy. It is noted that multiple apical holes may be provided. It is noted that in addition to one or more apical pin holes, one or more interfaces may be provided for coupling an optical imaging device or light pattern. Such interfaces are typically provided on the surface side opposite the surface side used for adhering to the patient's anatomy.

[0051] According to one embodiment, at least one apical pin hole is located between the first end and the second end of at least one of the first leg and the second leg.

[0052] Thus, when the radiopaque sub-geometry is located at the end of the leg and at the junction of the leg, the apical pin hole can be provided at a certain distance from the radiopaque sub-geometry. It should be noted that instead of using the apical pin hole, the reference body can also be fixed to the patient's anatomy via, for example, a loop for Velcro attachment, a connecting element for a pin, or an additional surgical instrument (e.g., a railed surgical instrument for clamping the Hoffman system).

[0053] According to one embodiment, at least one of the first leg and the second leg includes a first sub-leg and a second sub-leg, a first end of the first sub-leg corresponding to a first end of at least one of the first leg and the second leg, and a second end of the first sub-leg corresponding to a first end of the second sub-leg at the sub-leg junction.

[0054] Thus, the first and second sub-legs allow placement such that the trajectory of the legs follows the patient's anatomy.

[0055] According to one embodiment, the sub-leg interface includes at least one of the at least one apical pin hole.

[0056] Thus, an apical hole can be provided at the junction of the first and second sub-legs, which can correspond to an exposed bone of the patient, the bone being close to the skin, thereby allowing the apical pin hole to be attached to a bone of the patient's anatomy.

[0057] According to one embodiment, the angle between the first leg and the second leg at their junction is less than 90°, in particular less than 60°.

[0058] In this way, a compact leg frame structure can be provided. The leg tracks may be curved, and the curve may be shaped to open up an angle.

[0059] According to one embodiment, the angle between the first and second sub-legs at their junction is less than 90°, in particular less than 60°.

[0060] In this way, a compact leg frame structure can be provided. The leg tracks may be curved, and the curve may be shaped to open up an angle.

[0061] According to one embodiment, one of the first and second legs and the first and second sub-legs of the other of the first and second legs form a W-shape.

[0062] In this way, the entire reference body can be adapted to the patient's anatomy, particularly the pelvic region of the patient's anatomy. The W-shape allows for a stable framework for the legs and sub-legs, provides sufficient open space between the legs at the relevant parts of the patient's anatomy, and can adequately adapt to the patient's pelvic anatomy, particularly where the patient's bones are exposed due to being close to the skin surface, thereby allowing for reliable fixation and positional and orientation referencing between the reference body and the patient's anatomy.

[0063] According to one embodiment, at least a portion of the anatomically compatible surface comprises adhesive means.

[0064] In this way, the reference device can be easily adhered to the patient's anatomy without causing additional damage, although the adhering may be in addition to application to the apical pin.

[0065] According to one embodiment, the adhesive means comprises a portion that is a surface portion coated with an adhesive that is non-irritating to human skin.

[0066] In this way, the reference body can be easily fixed to the patient's anatomy. The adhesive can be activated or deactivated by applying a specific temperature or radiation.

[0067] According to one embodiment, the adhesive means comprises a portion that is part of a touch fastener, the counterpart of which is capable of adhering to human skin.

[0068] In this way, the reference body can be easily fixed to the patient's anatomy and the position of the reference body can be easily corrected if it becomes dislocated.

[0069] According to one embodiment of the present invention, there is provided a method for visualizing the tracking of a surgical instrument relative to a surgical reference, the method comprising the steps of: capturing an optical image, directed in a predetermined line of sight, of a light pattern attached at a predetermined relative position and orientation to the other of the surgical instrument and the surgical reference, using an imaging device attached in a predetermined line of sight to one of the surgical instrument and the surgical reference, the light pattern having at least one unique light sub-pattern, thereby enabling determination of the relative position and orientation of the surgical reference relative to the position and orientation of the surgical instrument; processing the captured optical image of the light pattern by recognizing at least one sub-pattern of the light pattern; comparing the recognized light sub-pattern with a stored representation of the light pattern; and determining the position and orientation of the surgical instrument relative to the orientation and position of the surgical reference from the size, orientation, and distortion of the recognized sub-pattern compared to the stored representation of the light pattern.

[0070] According to one embodiment, the method further includes a step of visualizing the surgical instrument represented by one of the optical imaging device and the light pattern, and a step of visualizing the surgical reference body represented by the other of the optical imaging device and the light pattern.

[0071] According to one embodiment, the method further includes a step of augmenting a predetermined motion trajectory of the surgical instrument onto the virtual visualization of the surgical instrument based on the recognized position and orientation of at least a light sub-pattern of the light pattern relative to the position and line of sight of the imaging device to visualize the motion path of the surgical instrument relative to the surgical reference body represented by the light pattern.

[0072] According to one embodiment of the present invention, there is provided a computer program product which, when executed, performs the method described above.

[0073] According to one embodiment of the present invention, there is provided a data storage medium having stored thereon executable code for the computer program product described above.

[0074] It should be noted that the above-described embodiments may be combined, and in combination provide synergistic technical effects and benefits that are greater than the sum of the individual technical effects and benefits. [Brief explanation of the drawings]

[0075] The present invention will be explained with reference to the following drawings. [Figure 1] FIG. 1 is a side view of an exemplary embodiment of a surgical guide device / surgical instrument / tool. [Figure 2] FIG. 1 is a perspective view of an exemplary embodiment of a surgical guide device / surgical instrument / tool, looking from the proximal end toward the distal end. [Figure 3] FIG. 1 is a perspective view of an exemplary embodiment of a surgical guide device / surgical instrument / tool ​​viewed from the proximal to the distal end in a radiographic image. [Figure 4] FIG. 1 is a radiographic side view of a surgical guide device / surgical instrument / tool ​​applied to a patient's anatomy. [Figure 5] FIG. 10 illustrates the complementary matching of first and second radiopaque sub-geometry shapes. [Figure 6] 1A-1C illustrate an exemplary embodiment of a surgical guide device / surgical instrument / tool ​​attached to an optical imaging device. [Figure 7] 1A-1C illustrate an exemplary embodiment of a surgical reference having a square light pattern. [Figure 8] FIG. 1 shows an exemplary embodiment of a surgical reference having a hexagonal light pattern applied to a patient's anatomy, along with a surgical guide device / surgical instrument / tool ​​attached to an optical imaging device. [Figure 9] 1 is a schematic diagram of an exemplary embodiment of an image processing device; [Figure 10] 1A and 1B show an exemplary embodiment in which an optical imaging device is connected to a surgical tool via a respective interface and a pattern is connected to a reference body connected via a respective interface. [Figure 11] 10A-10C show an exemplary embodiment in which the optical imaging device is connected to a reference body via a respective interface and the pattern is connected to a surgical tool connected via a respective interface. [Figure 12] 10A-10C show an exemplary embodiment of a W-shaped surgical reference body containing unique radiographic projections of different radiopaque sub-geometries. [Figure 13] 10A-10C show an exemplary embodiment of a W-shaped surgical reference with a pointed pin applied in the pointed pin hole. [Figure 14] FIG. 1 illustrates an exemplary embodiment of a method with required and optional method steps. [Figure 15] 1 illustrates an adjustable length reference body according to an exemplary embodiment. [Figure 16] FIG. 1 illustrates a radiological image including a reference body attached to a patient's anatomy, according to an exemplary embodiment. [Figure 17] 1A-1C illustrate a surgical guide tool according to an exemplary embodiment removably attached to a guide body. [Figure 18] FIG. 17 illustrates the reference body of FIG. 16 adhered to a patient's anatomy, according to an exemplary embodiment. [Figure 19] 19 is a diagram showing the situation in FIG. 18 and its radiographic images in a first line of sight direction and a second line of sight direction. [Figure 20] 10A-10C illustrate the general positioning of a reference body, a first guide body, and a second guide body relative to a patient's anatomy. [Figure 21] FIG. 1 shows cut anatomy before and after reconstruction. [Figure 22] 1 illustrates a surgical instrument in the form of an inserter including an optical camera attached to an implant, according to an exemplary embodiment. [Figure 23]

[0023] Figures 1A and 1B are diagrams illustrating different application samples of embodiments of the present invention. Note that the same or similar reference numerals indicate the same or similar components. The exemplary embodiments of the present invention will be described below along these figures. DETAILED DESCRIPTION OF THE INVENTION

[0076] In the case of surgical implants and surgical tools, the distal end is defined as the end that is first inserted into the patient's body, and the proximal end is defined as the opposite end. In the case of drilling tools, the end containing the drilling shape is considered to be the distal end, and the shaft for securing the drilling tool to the drilling drive is considered to be the proximal end.

[0077] A (radial) projection can be thought of as an image of a geometric shape projected onto a two-dimensional array.

[0078] Complementary patterns of first and second radiopaque sub-geometric shapes are considered to be matching patterns and together form a closed common pattern. Such matching patterns may be formed, for example, by concentric circles, polygons, or other shapes with uniform circumferential distance or overlap, or by interleaving segments with uniform distance or overlap, such as segments of circles or polygons or other shapes.

[0079] The centerline of a tool, implant, or part thereof is an imaginary line that follows a path having equal distances to the lateral edges of the respective tool, implant, or part thereof.

[0080] The junction of the two legs is considered to be the point where both centerlines of the two legs intersect each other or the point where the distance is smallest.

[0081] The angle between two legs is considered to be the angle subtended by a line tangent to the centerline of each leg extending through the junction of both centerlines.

[0082] The junction of the two legs is the area where both legs towards the junction are no longer separated, i.e. they share an edge.

[0083] Complementary patterns of first and second radiopaque sub-geometric shapes are considered to be matching patterns and together form a closed common pattern. Such matching patterns may be formed, for example, by concentric circles, polygons, or other shapes having uniform circumferential distance or overlap, or by interleaving segments having uniform distance or overlap, such as segments of circles or polygons or other shapes.

[0084] The virtual visualization of the surgical guide device or surgical instrument may include a complete visualization of the surgical guide device and surgical instrument, respectively, but may additionally or alternatively include visualization of the axis of the surgical guide device and surgical instrument, respectively, and / or a characteristic geometric shape, which may be a representative scale and / or outline thereof. The virtual visualization of the surgical guide device or surgical instrument may also include visualization of various available implants, etc., particularly visualization of three different available bone screws in combination with the patient's anatomy to which the screws are intended to be applied, thereby allowing the surgeon to recognize and identify the appropriate screw from among the various screws through the virtual visualization. Note that this is not limited to the number three, and is not limited to screws, but may also include nails, particularly nails with various radii of curvature, and other implants and surgical instruments, such as K-wires.

[0085] The inherent projection of any intended use orientation of a surgical guide device or surgical instrument does not preclude two or more different orientations from being identical, so long as the system and / or surgeon recognizes that each additional orientation with the second and identical projection is outside the intended or reasonable use range. In this regard, repeated pattern projections may be acceptable if it is always ensured that an orientation within the intended or reasonable use range can be determined based on the inherent projection. A surgical guide device or surgical instrument may be considered outside the intended or reasonable use range if it is upside down or oriented in a certain way, but this is not likely to cause significant injury during surgery.

[0086] The correspondence between the reference body and the patient's anatomy can be established by providing multiple (two or more) images from different positions / orientations (e.g., ML, AP, or other different directions) with the reference body attached to the patient's anatomy. Based on these multiple views, the relationship between the reference body and the patient's anatomy is realized through image augmentation. The known geometry of the reference body can determine the scaling of the reference body and the instrument / tool / anatomical structure in the image plane. Different imaging views can be referenced to each other. Furthermore, automatic or manual 2D image segmentation can be performed to establish various reference bodies in relation to the patient's anatomy. This can be supported by a database containing commonly known bone geometries or individually known bone geometries, such as those obtained by postoperative CT.

[0087] 1 and 2 illustrate a surgical guide system 1 for computer-assisted surgical CAS. The surgical guide system 1 includes a surgical guide device 10, shown here as an awl. The surgical guide device 10 includes a guide body 15 having a longitudinal extension from a proximal end 11 of the surgical guide device to a distal end 12 of the surgical guide device 10. The guide body has a hollow shaft 15a and is adapted to guide at least one of a longitudinal surgical implant and a longitudinal tool. The surgical implant may be, for example, a screw, a nail, or a wire. The tool may be a K-wire, a drill, a needle, or the like. The hollow shaft 15a includes a guide channel 15b that extends along the guide body and follows a guide trajectory 16 that continues distally along a path of travel 46 of the surgical implant or surgical tool being inserted and guided. The guide trajectory may be straight, bent, or curved. A straight trajectory can be used to insert straight implants or tolls, such as drills or screws. A curved trajectory can be used to insert bent or curved implants or tools, such as bent nails or bent wires. A guide trajectory should be understood as a trajectory within or on the guide body 15 or hollow shaft. A travel path 46 should be understood as a path extending distally through the guide trajectory 16, i.e., toward the patient. The travel path typically has a curvature similar to that of the guide trajectory 16. If the guide trajectory 16 is straight, the travel path 46 is also straight. If the guide trajectory is curved, the travel path along which a curved implant or tool travels is typically also curved. The travel path defines the path that the guided implant or tool travels during insertion after exiting the distal hollow shaft 15a, here shown as the tool tip 18. The awl shown here has a handle or knob 17, which is used to handle the awl, particularly for applying a blade to the distal end 12 of the awl. The blade leaves an opening through which a tool or implant can be guided through the hollow shaft and distal opening toward the patient.

[0088] 1 and 2 show an awl, it should be understood that the guide device 10 may also be a targeting device for positioning a nail or screw.

[0089] FIG. 2 shows the radiopaque geometry 20 on the knob 17. The radiopaque geometry 20 is positioned at a predetermined spatial location and orientation relative to the guide body 15. The radiopaque geometry 20 provides a unique radiographic projection 25 for any proximal-to-distal orientation of the guide body in the intended orientation of the surgical guide device 10. Because the unique projection determines the orientation of the guide device 10, and thus the guide body 15 and hollow shaft 15a, the unique projection can be used to determine the guide trajectory 16 and the path of travel 46 that a tool or implant will follow when guided by the hollow shaft 15a. Note that the hollow shaft may also have a transverse slit (not shown here) for lateral insertion of an implant or instrument. This slit may be closed by a cover to form a closed hollow shaft 15a. The guide body 15 includes a hollow shaft 15a with a guide channel 15b that follows the guide trajectory 16.

[0090] The radiopaque geometry 20 may have a first radiopaque sub-geometry 21 and a second radiopaque sub-geometry 22. In this illustration, the first and second radiopaque sub-geometry 21, 22 are located on the knob 17, but may be located anywhere on the guide device 10. Any of the radiopaque geometries 20 or sub-geometry 21, 22, 23 may also be provided as releasably attached geometries, for example, with a clip connection. The sub-geometry 21, 22 may be formed together into a clip. By matching key / keyhole elements of the guide device and the radiopaque geometry 20 or radiopaque sub-geometry 21 / 22 / 23, a predetermined orientation and position of the radiopaque geometry 20 / sub-geometry 21, 22, 23 relative to the guide device can be established. The key / keyhole elements may also be used to allow only the radiopaque geometry 20 / sub-geometry 21, 22, 23 intended for use with the guide device 10 to be clipped onto the guide device. The radiopaque geometry may have a unique three-dimensional shape and / or may be composed of sub-geometry shapes that together form a unique projection.

[0091] As shown in FIG. 2, the first radiopaque sub-geometry 21 and the second radiopaque sub-geometry 22 can be realized by two circular rings of radiopaque material arranged concentrically, but in parallel planes rather than in the same plane. When viewed straight from the proximal to distal end, both rings in the projection appear as concentric circles. In this viewing direction, both rings, one first radiopaque sub-geometry 21 and one second radiopaque sub-geometry 22, can form a complementary pattern—here, two concentric rings that fit together. When a slightly tilted view is applied from a slightly lateral position, the rings appear as ellipses and are no longer concentric. The concentric shift measurements, the elliptical deformation measurements, and the relative sizes of both rings can provide a basis for calculating not only the lateral viewing angle but also the viewing distance. Because the geometry of the guide device is known, its guide trajectory 16 is also known, and thus, the travel path 46 is also known. This applies not only to straight guide tracks but also to curved guide tracks 16. As shown in Figure 5, the radiographic projection 26 of the first radiopaque sub-geometry 21 and the radiographic projection 27 of the second radiopaque sub-geometry 22 can both have a complementary pattern 29 in a given viewing direction (which can be towards a straight longitudinal extension). This complementary pattern 29 can be formed, for example, by both concentric rings. Other complementary patterns may also be formed by any key / keyhole shapes that match each other when viewed in the complementary viewing direction.

[0092] As shown in FIG. 2, the guide device may further include a third radiopaque sub-geometry 23. While the first and second radiopaque sub-geometry 21 and 22 in the illustrated embodiment are located at the proximal end 11, including the knob 17, the third radiopaque sub-geometry 23 is located near the distal end 12 and tip 18. As shown in FIG. 4, the third radiopaque sub-geometry 23 may include a fiducial marker 24. The third radiopaque sub-geometry 23 may also be located at the proximal end 11 and may spatially overlap the first and second radiopaque sub-geometry 21 and 22. The fiducial marker 24 may be a radiopaque sphere or other geometric shape, spatially positioned to provide a common, unique projection for any viewing direction. The concentric circles of the first and second radiopaque sub-geometry 21 and 22 allow for very accurate determination of the exact direction from proximal to distal end, and the fiducial marker 24 allows for accurate lateral determination of the spatial orientation.

[0093] 3 shows the visualization of the first radiopaque sub-geometry 21, including its unique radiographic projection 26. The radiopaque geometries 20, 21, 22, 23 allow a more accurate determination of the guide device's contour, especially when the contour of the guide device does not have high contrast. Based on the position, size, and shape of both rings of the first radiopaque sub-geometry 21, it is possible to determine the orientation of the guide device 10 and to augment and visualize the guide trajectory 16 and the path of travel 46.

[0094] The visualization and augmentation can be performed by an image processing device 30, which can be a computer or any other computing power. The image processing device here has visualization means 36 adapted to perform a virtual visualization 19 of the orientation of the guide body 15 relative to the patient's anatomy 100 based on a unique radiographic projection 25 of the radiopaque geometry 20 of the third radiopaque sub-geometry 23 including its fiducial markers 24, as shown in FIG. 4 . The unique radiographic projection 27 of the third radiopaque sub-geometry 23, in particular the pattern of the fiducial markers 24, allows for the determination of the position and orientation of the guide device. This allows for the virtual visualization 19 of the orientation of the guide body 15. The image processing device 30 further has augmentation means 38 for augmenting the guide trajectory 16 on the virtual visualization 19 of the orientation of the guide body 15 in order to visualize a movement path 46 of at least one of the surgical implant or surgical tool 45 to be implanted.

[0095] To simplify the surgeon's orientation, the augmentation means 38 can augment a reproducible scale 39 along the augmented guide trajectory 16. This scale 39 can give the surgeon an idea of ​​where the implant tip or tool tip will end up when inserted along the guide trajectory 16. This scale can also help the surgeon select the correct implant / tool ​​length. Image recognition, combined with anatomical structure identification, can suggest to the surgeon which tool or implant to use. The augmentation means can also augment the geometry associated with the implant to be implanted relative to the patient's anatomy 100 based on the unique radiographic projections 25 of the radiopaque geometry 20, and in particular the unique radiographic projections 27 of the fiducial markers 24 of the third radiopaque sub-geometry 23, as shown in FIG. 4 .

[0096] 6 and 7 show a surgical tracking system for tracking a surgical instrument 10 relative to a surgical reference 50. The surgical tracking system 2 includes an optical imaging device 70 and a light pattern 80. The imaging device 70 captures an image of the pattern 80, and since the pattern 80 has its own unique portion, size, and distortion, the relative positions of the optical imaging device 70 and the pattern 80 can be determined by recognizing the unique pattern portion. The imaging device 70 may be a camera or any other image capturing device. The imaging device may be coupled to either the surgical tool 10 or the reference 50, which is attached to the patient's anatomy. The pattern 80 may be coupled to the other of the reference 50 and the optical imaging device 70. FIG. 5 shows the optical imaging device 70 coupled to the surgical tool / instrument 10. FIG. 6 shows the light pattern 80 coupled to the reference 50. Here, the pattern 80 is printed directly on the reference 50. It should be noted that the pattern may be provided on the surgical instrument / tool ​​10, or the optical imaging device 70 may be provided on the reference 50. Both the pattern 80 and the optical imaging device 70 may be fixedly or removably coupled to the respective instrument 10 and reference body 50. The pattern 80 may be non-removably printed on the reference body 10 and discarded after use, although the optical imaging device 70 may be removably coupled to the surgical instrument 10 to reuse valuable camera equipment.

[0097] When attached to the surgical instrument 10, the imaging device 70 represents the position and orientation of the surgical instrument 10 relative to a predetermined line of sight direction 71 of the optical imaging device 70; similarly, the light pattern 80 represents the position and orientation of the surgical reference 50 relative to the unique light sub-pattern 80a. Thus, by acquiring an image from the pattern 80, the relative position and orientation of the surgical reference 50 to the position and orientation of the surgical instrument 10 can be determined. To this end, as shown in Figure 9, the system is provided with an image processing device 30 including pattern recognition means 32 and visualization means 38. Furthermore, the image processing device 30 may comprise augmentation means 36.

[0098] The image processing device 30 comprises a pattern recognition means 32 for recognizing the position and orientation of at least a light sub-pattern 80a of the light pattern 80 relative to the position of the imaging device 70 and the line of sight direction 71 based on the image captured from the imaging device 70 and the stored representation of the light pattern. Furthermore, the image processing device 30 comprises a visualization means 38 for virtually visualizing the surgical instrument 10 represented by the optical imaging device 70 and the surgical reference body 50 represented by the light pattern 80. Alternatively, the visualization means 38 virtually visualizes the surgical instrument 10 represented by the light pattern 80 and the surgical reference body 50 represented by the optical imaging device 70, depending on whether the imaging device 70 and the pattern 80 are attached to the instrument 10 or the reference body 50. If augmentation means 36 are provided, the augmentation means can augment the visualization with the instrument, the scale, and even the movement axis or trajectory of the virtual instrument or virtual implant. The augmentation items may be provided from a conversion process that converts at least two two-dimensional images into a three-dimensional image, or from virtually stored items in a database. Furthermore, additional information such as quantitative measures, implant characteristics, or identifiers may be augmented, which may help the surgeon identify the correct measurements and items. Based on the recognized position and orientation of at least the light sub-pattern 80a of the light pattern 80 relative to the position of the imaging device 70 and the line of sight direction 71, the augmentation means can augment the predetermined movement trajectory 16, 46 of the surgical instrument 10 onto the virtual visualization of the surgical instrument 10 to visualize the movement path 46 of the surgical instrument 10 relative to the surgical reference body 50 represented by the light pattern 80. This augmentation may be performed on a screen or even on an augmentation eyeglass screen worn by the surgeon during surgery.

[0099] 10 and 11 show that the optical imaging device 70 can have a mechanical interface 77a that couples to a positive-fit receptacle 17a, 57a of one of the surgical instrument 10 and the surgical reference body 50 to form a unit having a repeatable relationship between the geometry of one of the surgical instrument 10 and the surgical reference body 50 and the position and line of sight 71 of the optical imaging device 70. Similarly, the light pattern 80 can include a mechanical interface 87a that couples to a positive-fit mechanical interface 17a, 57a of one of the surgical instrument 10 and the surgical reference body 50 to form a unit having a repeatable relationship between the geometry of one of the surgical instrument 10 and the surgical reference body 50 and the position and orientation of the light pattern 80. Instead of providing a removable receptacle, the optical imaging device 70 may be fixedly connected to one of the surgical instrument 10 and the surgical reference body 50 to form a unit having a repeatable relationship between the geometry of one of the surgical instrument 10 and the surgical reference body 50 and the position and line of sight 71 of the optical imaging device 70. Similarly, the light pattern 80 may be fixedly attached to the other of the surgical instrument 10 and the surgical reference body 50 to form a unit having a repeatable relationship between the geometry of the other of the surgical instrument 10 and the surgical reference body 50 and the position and orientation of the light pattern 80.

[0100] As shown in FIG. 7 , the light pattern 80 is composed of a geometrically uniform raster 82 of light and dark fields. The fields may be square or circular, or may have a shape that somewhat fits a rectangular raster. The raster field colors can be any different colors, including printing dark or black fields on a light, white, or metallic surface (e.g., an anodized surface of an implant, tool, or reference body). In particular, square light and dark field rasters, especially light and black field rasters, can be used similarly to QR codes. Specific anchor patterns can be used to request defined subpatterns. Instead of light and dark fields or black and white fields, fields of different colors, such as red and green, yellow and blue, or yellow and black, can also be used. Alternatively, as shown in FIG. 8 , the light pattern 80 can be composed of a honeycomb raster 83 of light and dark fields. The fields may be hexagonal or circular, or may have a shape that somewhat fits a honeycomb raster. The color of the honeycomb raster field can be any different color, including printing dark or black fields on a light, white, or metallic surface (anodized surface of an implant, tool, or reference body, etc.), in particular a raster of square light and dark fields. Instead of light and dark or black and white fields, fields of different colors can also be used, for example red and green, yellow and blue, or yellow and black.

[0101] FIG. 12 illustrates the shape of a surgical reference 50 that may be aligned to a patient's anatomy 100 as shown in FIG.

[0102] The surgical reference 50 is intended for radiation-based identification as a radiopaque geometry 60 having a first radiopaque sub-geometry 61 and a second radiopaque sub-geometry 62, each sub-geometry being fixedly and spatially reproducibly connected to the surgical reference 50. The reference 50 (whose general shape is not shown here) has a first leg 51 and a second leg 52, each having an anatomically-matched surface 59 relative to the patient's anatomy 100. The anatomically-matched surfaces are shown in FIG. 13. The first leg 51, which includes a first end 51 a, is connected to a first end 52 a of the second leg 52 at a leg connection 53. Each of the first radiopaque sub-geometry 61 and the second radiopaque sub-geometry 62 has a unique radiographic projection 66, 67 for each proximal-to-distal orientation of the surgical reference body 50, thereby allowing the spatial position and orientation of the surgical reference body 50 to be determined solely from the first radiopaque sub-geometry 61 and the second radiopaque sub-geometry 62, respectively, based on two-dimensional radiographic projections of at least a portion of the surgical reference body. The radiopaque geometries may be formed by a set of fiducial markers 24, as described with respect to FIGS. 1-4, particularly FIG. 4. The radiopaque geometries of the sub-geometry 61, 62 may also be provided by a pattern 80, where, for example, the dark field of the pattern is made of a radiopaque material or paint. A first radiopaque sub-geometry 61 is assigned to the first leg 51 and a second radiopaque sub-geometry 62 is assigned to the second leg 52. In certain embodiments, the first radiopaque sub-geometry 61 is assigned to the second end 52b of the first leg 51 and the second radiopaque sub-geometry 62 is assigned to the second end 52b of the second leg 52.

[0103] FIG. 12 shows a surgical reference body 50 for referencing a patient's anatomy during surgery. The surgical reference body 50 has a radiopaque geometry 60 having a first radiopaque sub-geometry 61, a second radiopaque sub-geometry 62, and a third radiopaque sub-geometry 63. Each of the sub-geometry is fixedly and spatially repeatably connected to the surgical reference body 50. As shown in FIG. 4, the radiopaque sub-geometry can be provided as a set of fiducial markers, but can also be provided as a raster, as shown in FIG. 2 or 3, where, for example, the dark fields are made of radiopaque material and the light fields are not covered with radiopaque material. The first and second legs 51, 52 have surfaces 59 anatomically adapted to the patient's anatomy 100, as shown in FIGS. 8 and 13. First leg 51, including first end 51a, is connected to first end 52a of second leg 52 at leg interface 53. First radiopaque sub-geometry 61, second radiopaque sub-geometry 62, and third radiopaque sub-geometry 63 each have unique radiographic projections 66, 67, 68 for each proximal-to-distal orientation of surgical reference body 50, thereby allowing the spatial position and orientation of surgical reference body 50 to be determined solely from first radiopaque sub-geometry 61, second radiopaque sub-geometry 62, and third radiopaque sub-geometry 63, respectively, based on two-dimensional radiographic projections of at least a portion of the surgical reference body. A first radiopaque sub-geometry 61 is assigned to the second end 51b of the first leg 51, a second radiopaque sub-geometry 62 is assigned to the second end 52b of the second leg 52, and a third radiopaque sub-geometry is assigned to the leg junction 53 of the first leg 51 and the second leg 52.

[0104] FIG. 12 shows that the surgical reference 50 includes an apical pin hole 57. The reference 50 may also have an additional apical hole, not shown. The apical pin hole 57 here is located between the first end 52a and the second end 52b of the second leg 52. As shown in FIG. 12, at least one of the first leg 51 and the second leg 52, here the second leg 52 in FIG. 12, is composed of a first subleg 54 and a second subleg 55, with the first end 54a of the first subleg 54 corresponding to the first end 52a of the second leg 52, and the second end 54b of the first subleg 54 corresponding to the first end 55a of the second subleg 55 at the subleg interface 56. In this illustrated embodiment, the subleg interface 56 includes the apical pin hole 57. As shown in FIG. 13, the apical pin hole 57 can receive an apical pin hole. The illustrated reference body 50 may have a W-shape, with the first sub-leg 54 and second sub-leg 55 of the second leg forming the W-shape with the first leg 51. To fix the reference body 50 to the patient's anatomy, the reference body 50 may have adhesive means 58 on at least a portion of the anatomically compatible surface 59. The adhesive means may be a surface portion coated with an adhesive that is non-irritating to human skin. Alternatively, or in another surface portion, the adhesive means 58 may include a portion that is part of a touch fastener, the counterpart of which can adhere to human skin.

[0105] 14 shows a method for assisting in locating the application position of an implant / tool ​​relative to a patient's anatomy. The method includes an image processing step S30, which may include a step S32 of recognizing a pattern and a step S33 of comparing the recognized (sub)pattern with a predetermined pattern. Further, the image processing step S30 may include a step S34 of determining the position and orientation of the (sub)pattern, a step S36 of visualizing the item, and a step S38 of augmenting, for example, a guide trajectory, an outline or an illustration of the implant / tool / instrument. To provide the relative position and orientation of the optical imaging device and the light pattern, the method may include a step S70 of acquiring an optical image of the pattern using the imaging device.

[0106] Wedge osteotomy is a common treatment for midfoot deformities (such as flatfoot or Charcot foot). The current approach is to use freehand osteotomy under fluoroscopic guidance using a C-arm. Even if an appropriate plan based on CT data is used, a major challenge is executing the plan during surgery. This often results in a difficult procedure, inaccurate correction, and insufficient fixation strength. The solution described here is an extension to the pattern recognition described above, where a camera can determine its position in space relative to the light pattern of another device, as well as stereotactic techniques, where the relationship between the position of the radiographic image and the instrument within the radiographic image can be calculated and augmented with additional information, such as trajectories, measurements, and other 3D information. The embodiment described below combines a fluoroscopic reference body 50 with a camera 70 attached to a target instrument, such as a cutting guide, plate inserter, or drill sleeve. The reference body 50 is a rigid structure fixed to the patient's anatomy 100, e.g., the foot via adhesive or pins, allowing all fluoroscopic images of interest to be correlated. The reference body also includes the optical reference pattern 80, as described above. The camera 70 attached to the targeting device can then determine its position relative to the reference body 50. In this way, the current trajectory / plane / position of the targeting instrument 10, 15 can be shown on all previously acquired images in which the reference body 50 is in view. This allows the planning performed on the 3D CT data in the first step to be registered to the X-ray or radiographic images. This also allows the planned wedge to be displayed as a reference on all X-ray or radiographic images taken during surgery. In a next step, this information can be used to help the surgeon align the guide body 15, 15a, 15b as the cutting guide by using an incremental approach based on a stereotactic approach using the radiopaque markers 20, 24 in the cutting guide visualized on the X-ray or radiographic images, thereby allowing the system to indicate the current position of the cutting plane 16, 16a, 16b based on the current tool position in the radiographic images relative to the planned cuts 101a, 101b.This approach can also provide this information without taking additional radiological images in all required planes at once. Once the cutting guide 15, 15a, 15b is positioned according to the plan and the cut is made, the system also allows for verification of the actual repositioning by comparing it to the initial plan. To place implants such as plates 45 or nails, an insertion tool can be used in combination with the camera 70, providing live feedback on implant placement. A similar principle can be used with drill guides to place screws using a stereotactic optical image-based approach, providing additional information such as trajectory, length, and diameter. This can be enhanced by collision warnings or screw length suggestions from the system based on the underlying anatomy. Compared to standard radiological or fluoroscopic navigation, this solution requires significantly less hardware, trackers, and references, as explained with reference to the following figures, and minimizes field-of-view issues to only one camera requiring a reference object in its field of view, providing highly comparable functionality with significantly reduced complexity.

[0107] FIG. 15 shows an adjustable-length reference body 50, which may be a radiolucent object having a radio-dense or radio-opaque geometry with a unique radiographic projection, as described above, and the radio-opaque geometry has a marking pattern that appears on an X-ray image. The reference body 50 may be composed of two parts, a first leg 51 and a second leg 52, which can be removed from each other. Both legs 51, 52 may have separate radio-opaque sub-patterns, as described above but are not shown here. The reference body 50 and / or each leg 51, 52 may have individual light patterns 80, as described above. Note that the relative positions of both parts of the reference body as shown in FIG. 15 may be determined by connecting an optical imaging device to one of the parts of the surgical reference body, and spatial determination functions as described above for the surgical tools and surgical reference devices.

[0108] FIG. 16 shows a radiographic or X-ray image including a reference body 50 attached to a patient's anatomy 100 and having a radiopaque geometry 60, where each of the legs 51, 52 may have a separate radiopaque sub-geometry 61, 62.

[0109] 17 shows, for example, a surgical guide tool 10 removably mounted at the distal end of a guide body 15. The proximal end, including the knob 17, is fitted with an optical imaging device 70, such as the camera described above. The guide body 15 has a cutting guide track 16 along which a cutting tool, not shown here, can be guided. The cutting guide track may be formed by a slit in the body 15. The guide body 16 has radiopaque geometry formed therein, here in the form of a number of fiducial markers 24, which have unique radiographic projections that allow the orientation and position of the object 15 to be determined from projected images of the fiducial markers.

[0110] 18 shows the reference body 50 of FIG. 16 adhered to a patient's anatomy 100. The reference body 50 has a light pattern attached to it that allows the position and orientation of the reference body 50 to be determined from images taken by the optical imaging device 70. Light pattern recognition allows the relative position and orientation of the guide body 15 to be determined with respect to the reference body 50. The radiopaque geometry of the reference body 50 allows the relative position and orientation of the reference body 50 to be determined with respect to the patient's anatomy 100. The combined use of optical and radiographic discrimination allows the relative position and orientation of the guide body 15 and the patient's anatomy 100 to be determined.

[0111] FIG. 19 shows the situation shown in FIG. 18 on the left side. The center of FIG. 19 shows a radiographic image of the situation shown on the left side from a first viewing direction. From the radiographic image, a reference body 50 can be obtained, including the patient's anatomical structure 100 and its radiopaque geometry 20. The augmentation means can augment the cutting guide trajectory 16 corresponding to the radiopaque geometry 20 of the body 15. When using a first guide body 15a and a second guide body 15b, the augmentation means can similarly augment the first cutting guide trajectory 16a and the second cutting guide trajectory 16b. Additionally, the wedge defined by the first intended cutting plane 101a and the second intended cutting plane 101b can be augmented; as shown in FIG. 21, these intended cutting planes 101a, 101b may result from a planning procedure requiring osteotomy cuts to be made to reposition bone fragments. Figure 19 on the right shows the same situation as the left view, but from a different viewing direction of the radiographic image than that of the central view of Figure 19. The guide trajectory 16 is aligned with the intended planes 101a, 101b by repositioning the surgical instrument 10 attached to the guide body 15, and its unique projection 20 is used to augment the guide trajectory 16, 16a, 16b. There are two ways to align the guide body 15 with the planned wedges, i.e., the intended planes 101a, 101b. One method is an incremental approach based on stereotactic imaging. Additional alignment information is augmented based on the system's recognized position in the X-ray image. The illustration in Figure 19 shows that proper alignment has not been achieved. The closer the augmented frame of the guide trajectory 16 matches the planes 101a, 101b of the wedges, the better the subsequent cut will be. The other method is live tracking based on tracking via an optical imaging device 70, e.g., an optical camera. The difference from the stereotactic approach is that there is no need to repeatedly take radiographic images, and live feedback can be obtained while moving the guide body 15.

[0112] FIG. 20 shows the schematic positioning of the reference body 50, the first guide body 15a, and the second guide body 15b relative to the patient's anatomy. In the case of a wedge osteotomy, two cutting guides or guide bodies 15a, 15b are positioned according to the plan. The guide bodies 15, 15a, 15b themselves can be removed from the surgical instrument or handle and fixed to the bone with K-wires. After the two cuts, the anatomy can be repositioned as shown in FIG. 21 (top: Cutting; bottom: Repositioning). The planned results can also be verified with the reference body 50 still in the radiographic image, as shown at the bottom of FIG. 21. In the top diagram, FIG. 21 shows the planned portion of the wedge based on 3D CT data. The wedge is formed by a first intended cutting plane 101a on the patient's anatomy 100 and a second intended cutting plane 100b on the patient's anatomy 100. The 3D dataset is then manually or automatically matched to intraoperatively acquired radiological images of the patient's anatomy, allowing the planned wedges to be transferred to those images, as shown with wedges in the center and right of Figure 19.

[0113] 22 shows a surgical instrument 10 in the form of an inserter including an optical camera 70 attached to an implant 45 in the form of a plate or nail. This inserter can be used for minimally invasive placement, as the system provides live feedback on previously taken radiographic images, where the position and orientation of the implant is determined relative to the anatomical structure 100. A similar approach can be used for screw planning and placement by using the camera 70 or based on a stereotactic approach. Markers or radiopaque geometries 60, 65 can be added, or the camera 70 can be attached to, for example, the drill guide 10, 15, providing information about length and trajectory. [Explanation of symbols]

[0114] 1 Surgical guide system for computer-assisted surgery (CAS) 2. Surgical Tracking System 10. Surgical guide devices / surgical instruments 11 Surgical guide device / proximal end of surgical instrument 12 Surgical guide device / tip of surgical instrument 15 Guide body 15a Hollow shaft guide body 15b Guide channel in guide body 16 Guide trajectory of the guide body / Cutting plane trajectory / Operation trajectory of surgical instruments 16a: the trajectory of the first cutting surface of the guide body of the surgical instrument 16b Trajectory of the second cutting surface of the guide body of the surgical instrument 17 Knob / Handle of Surgical Guide Device 17a Mechanical interfaces of surgical instruments for optical imaging devices or patterns 18 Surgical guide device tip 18a Surgical guide device tip blade / tool 19 Virtual visualization of the guide body / guide body orientation 20 Radiopaque Geometry of Surgical Guide Devices 21 First radiopaque sub-geometry of surgical guide device 22 Second Radiopaque Sub-Geometry of the Surgical Guide Device 23 Third Radiopaque Sub-Geometry of Surgical Guide Device 24 fiducial markers 25 Radiographic projection of the radiopaque geometry of surgical guide devices 26 Radiation projection of the first sub-geometry of the surgical guide device 27 Radiation projection of the second sub-geometry of the surgical guide device 28. Intrinsic radiographic projection of the third sub-geometry of the surgical guide device 29 Complementary patterns of the first / second sub-geometry projections 30 Image processing device 32 Recognition tools for pattern recognition 36 Visualization Tools 38 Augmentation means for augmenting the guideway 39 Reproducible scale along the augmented guideway 45 Surgical Implants / Surgical Tools 46 Inserted and guided surgical implants / Trajectory of surgical instruments / Extended trajectory of surgical instruments 50 Surgical reference body 51 First leg of surgical reference body 51a First end of first leg 51b Second end of first leg 51c Centerline of first leg 52 Second leg of surgical reference body 52a: First end of second leg 52b Second end of second leg 52c Centerline of second leg 53 Junction of the first and second legs of the surgical reference body 53c Junction of the centerlines of the first and second legs 54 First sub-leg of surgical reference body 54a First end of first sub-leg 54b: second end of first sub-leg 54c Centerline of first sub-leg 55 Second sub-leg of surgical reference body 55a: First end of second sub-leg 55b Second end of second sub-leg 55c Centerline of second sub-leg 56 Junction of the first and second sub-legs of the surgical reference body 56c Junction of centerlines of first and second sub-legs 57 Fixation hole / apical pin hole of surgical reference body 57a Mechanical interfaces of surgical reference bodies for optical imaging devices or patterns 58 Adhesion means for surgical reference body / surgical guide body 59 Anatomically adapted surfaces of the first / second (sub)legs 60 Radiopaque Geometry of Surgical Reference Bodies 61 First radiopaque sub-geometry of surgical reference body 62 Second radiopaque sub-geometry of surgical reference body 63 Third radiopaque sub-geometry of surgical reference body 64 fiducial markers 65 Intrinsic radiographic projections of the radiopaque geometry of surgical reference bodies 66 Specific radiographic projection of the first sub-geometry of the surgical reference body 67 Specific radiographic projection of the second sub-geometry of the surgical reference body 68 Unique radiographic projection of the third sub-geometry of the surgical reference body 70 Optical imaging device 71 Line of sight direction of optical imaging device 77a Mechanical interfaces of optical imaging devices for instruments or reference bodies 80 Light Patterns 80a Optical Subpattern 82 Uniform light pattern raster 83 Light Pattern Honeycomb Luster 87a Mechanical interfaces of optical imaging devices for instruments or reference bodies 100 Patient Anatomy 101 Intended cut plane in the patient's anatomy 101a First intended cut plane in the patient's anatomy 101b Second intended cut plane in the patient's anatomy S30 Image Processing S32 Pattern Recognition S33 Compare the recognized (sub)pattern with the given pattern S34 Determining the position and orientation of (sub)patterns S36 Visualization S38 Augmentation to increase guideway S70 Optical Image Capture

Claims

1. A surgical tracking system for tracking a surgical instrument relative to a surgical reference, the surgical tracking system (2) comprising: an optical imaging device (70) representing the position and orientation of one of the surgical instrument (10) and the surgical reference (50), the optical imaging device (70) having a predetermined line of sight (71); a light pattern (80) representing the position and orientation of the other of the surgical instrument (10) and the surgical reference (50), the light pattern (80) having at least one unique light sub-pattern (80a) thereby enabling determination of the relative position and orientation of the surgical reference (50) with respect to the position and orientation of the surgical instrument (10); an image processing device (30); The image processing device (30) pattern recognition means (32) adapted to recognize the position and orientation of at least the light sub-patterns (80a) of the light pattern (80) relative to the position and line of sight (71) of the optical imaging device (70) based on an image acquired from the optical imaging device (70) and a stored representation of the light pattern; a visualization means (38) adapted to virtually visualize the surgical instrument (10) represented by one of the optical imaging device (70) and the light pattern (80), and to virtually visualize the surgical reference (50) represented by the other of the light pattern (80) and the optical imaging device (70), the optical imaging device (70) includes a mechanical interface (77a) coupled to a positive-fit receptacle (17a, 57a) of one of the surgical instrument (10) and the surgical reference (50) to form a unit having a repeatable relationship between the geometric shape of the one of the surgical instrument (10) and the surgical reference (50) and the position and line of sight direction (71) of the optical imaging device (70); the surgical tracking system further includes a surgical reference (50), the surgical reference (50) including a mechanical interface (57a) for the mechanical interface (77a) of the optical imaging device (70) to form a reproducible relationship between the geometric shape of the surgical reference (50) and the position and line of sight direction (71) of the optical imaging device (70); The surgical reference (50) a radiopaque geometry (60) having a first radiopaque sub-geometry (61) and a second radiopaque sub-geometry (62), each radiopaque sub-geometry being fixedly and spatially repeatably connected to the surgical reference (50); a first reference body part (51) having a surface (59) that is anatomically matched to the patient's anatomy (100); a second reference body part (52) having a surface (59) that is anatomically matched to the patient's anatomy (100); each of the first radiopaque sub-geometry (61) and the second radiopaque sub-geometry (62) having a unique radiographic projection (66, 67, 68) for each proximal-to-distal orientation of the surgical reference (50), thereby allowing the spatial position and orientation of the surgical reference (50) to be determined solely from the first radiopaque sub-geometry (61) and the second radiopaque sub-geometry (62), respectively, based on two-dimensional radiographic projections of at least a portion of the surgical reference; the first radiopaque sub-geometry (61) is assigned to the first reference body portion (51) and the second radiopaque sub-geometry (62) is assigned to the second reference body portion (52); Surgery tracking system.

2. The image processing device (30) 2. The surgical tracking system of claim 1, further comprising an augmentation means adapted to augment a predetermined movement trajectory (16, 46) of the surgical instrument (10) onto a virtual visualization of the surgical instrument (10) based on the recognized position and orientation of at least the light sub-pattern (80a) of the light pattern (80) relative to the position and line of sight (71) of the optical imaging device (70) to visualize the movement path (46) of the surgical instrument (10) relative to a surgical reference body (50) represented by the light pattern (80).

3. 2. The surgical tracking system of claim 1, further comprising a surgical instrument (10) including a mechanical interface (57a) for the mechanical interface (77a) of the optical imaging device (70) to form a reproducible relationship between the geometric shape of the surgical instrument (10) and the position and line of sight direction of the optical imaging device (70).

4. 4. The surgical tracking system of claim 1, wherein the light pattern is coupled to a positive-fit mechanical interface of one of the surgical instrument and the surgical reference body to form a unit having a reproducible relationship between the geometric shape of the one of the surgical instrument and the surgical reference body and the position and orientation of the light pattern.

5. 5. The surgical tracking system of claim 4, further comprising a surgical instrument (10), the surgical instrument (10) comprising a mechanical interface (17a) for the mechanical interface (87a) of the light pattern (80) so as to form a reproducible relationship between the geometric shape of the surgical instrument (10) and the position and orientation of the light pattern (80).

6. 5. The surgical tracking system of claim 4, further comprising a surgical reference body (50), the surgical reference body (50) including a mechanical interface (57a) for the mechanical interface (87a) of the light pattern (80) so as to form a reproducible relationship between the geometric shape of the surgical reference body (50) and the position and orientation of the light pattern (80).

7. 3. The surgical tracking system of claim 1, further comprising a surgical instrument (10), wherein the optical imaging device (70) is inseparably connected to the surgical instrument (10) so as to form a reproducible relationship between the geometric shape of the surgical instrument (10) and the position and orientation of the optical imaging device (70).

8. 8. The surgical tracking system of claim 7, further comprising a surgical reference (50), wherein the light pattern (80) is inseparably connected to the surgical reference (50) so as to form a reproducible relationship between the geometric shape of the surgical reference (50) and the position and orientation of the light pattern (80).

9. 3. The surgical tracking system of claim 1, further comprising a surgical instrument (10), wherein the light pattern (80) is inseparably connected to the surgical instrument (10) so as to form a reproducible relationship between the geometric shape of the surgical instrument (10) and the position and orientation of the light pattern (80).

10. 10. The surgical tracking system of claim 9, further comprising a surgical reference body (50), wherein the optical imaging device (70) is inseparably connected to the surgical reference body (50) so as to form a reproducible relationship between the geometric shape of the surgical reference body (50) and the position and orientation of the optical imaging device (70).

11. 11. The surgical tracking system of claim 1, wherein the light pattern (80) is composed of a geometrically uniform raster of light and dark fields (82), in particular a square raster of light and dark fields, in particular a raster of light and black fields.

12. 11. The surgical tracking system of claim 1, wherein the light pattern (80) is composed of a raster (82) of geometrically uniform fields of different colors, in particular a raster of square colored fields, in particular a raster of square color gradient fields.

13. 11. The surgical tracking system of claim 1, wherein the light pattern (80) is composed of a honeycomb raster (83) of light and dark fields, in particular a raster (83) of light and dark circles or light and dark hexagons within a honeycomb raster, in particular a raster of light and black circles or light and black hexagons.

14. 11. The surgical tracking system of claim 1, wherein the light pattern (80) is composed of a honeycomb raster (83) of different color fields, in particular a raster of colored circles or hexagons (83) within a honeycomb raster, in particular a color gradient circle or hexagon raster.

15. The surgical instrument (10) is a surgical guide device, and the surgical guide device further comprises: a guide body (15) having a longitudinal extension from a proximal end (11) of the surgical guide device to a distal end (12) of the surgical guide device, the guide body (15) being adapted to guide at least one of a longitudinal surgical implant and a longitudinal tool, the guide body (15) having a guide track (16) extending therealong and continuing distally along a path of travel (46) of at least one of the surgical implant and the surgical tool being inserted and guided; and a radiopaque geometric shape (20) arranged at a predetermined spatial position and orientation relative to the guide body (15) and adapted to provide a unique radiographic projection (25) for each proximal-to-distal orientation of the guide body.

16. The surgical reference (50) a radiopaque geometric shape (60) fixedly and spatially reproducibly connected to said surgical reference (50); a reference body part (51) having a surface (59) that is anatomically matched to the patient's anatomy (100); 16. The surgical tracking system of claim 1, wherein the radiopaque geometry (60) has unique radiographic projections (66, 67, 68) for each proximal-to-distal orientation of the surgical reference body (50), thereby enabling the determination of the spatial position and orientation of the surgical reference body (50) based on two-dimensional radiographic projections of at least a portion of the surgical reference body.

17. A surgical tracking system for tracking a surgical instrument relative to a surgical reference, the surgical tracking system (2) comprising: an optical imaging device (70) representing the position and orientation of one of the surgical instrument (10) and the surgical reference (50), the optical imaging device (70) having a predetermined line of sight (71); a light pattern (80) representing the position and orientation of the other of the surgical instrument (10) and the surgical reference (50), the light pattern (80) having at least one unique light sub-pattern (80a) thereby enabling determination of the relative position and orientation of the surgical reference (50) with respect to the position and orientation of the surgical instrument (10); an image processing device (30); The image processing device (30) pattern recognition means (32) adapted to recognize the position and orientation of at least the light sub-patterns (80a) of the light pattern (80) relative to the position and line of sight (71) of the optical imaging device (70) based on an image acquired from the optical imaging device (70) and a stored representation of the light pattern; a visualization means (38) adapted to virtually visualize the surgical instrument (10) represented by one of the optical imaging device (70) and the light pattern (80), and to virtually visualize the surgical reference (50) represented by the other of the light pattern (80) and the optical imaging device (70), the optical imaging device (70) includes a mechanical interface (77a) coupled to a positive-fit receptacle (17a, 57a) of one of the surgical instrument (10) and the surgical reference (50) to form a unit having a repeatable relationship between the geometric shape of the one of the surgical instrument (10) and the surgical reference (50) and the position and line of sight direction (71) of the optical imaging device (70); The surgical tracking system further includes a surgical reference (50), the surgical reference (50) including a mechanical interface (57a) for the mechanical interface (77a) of the optical imaging device (70) to form a reproducible relationship between the geometric shape of the surgical reference (50) and the position and line of sight direction (71) of the optical imaging device (70); The surgical reference (50) a radiopaque geometry (60) having a first radiopaque sub-geometry (61), a second radiopaque sub-geometry (62), and a third radiopaque sub-geometry (63), each radiopaque sub-geometry being fixedly and spatially repeatably connected to the surgical reference (50); a first leg (51) having a surface (59) that is anatomically adapted to the patient's anatomy (100); a second leg (52) having a surface (59) that is anatomically conforming to the patient's anatomy (100); The first leg (51) having a first end (51a) is connected to a first end (52a) of the second leg (52) at a leg joint (53); each of the first radiopaque sub-geometry (61), the second radiopaque sub-geometry (62), and the third radiopaque sub-geometry (63) having a unique radiographic projection (66, 67, 68) for each proximal-to-distal orientation of the surgical reference (50), such that the spatial position and orientation of the surgical reference (50) can be determined solely from each of the first radiopaque sub-geometry (61), the second radiopaque sub-geometry (62), and the third radiopaque sub-geometry (63), based on two-dimensional radiographic projections of at least a portion of the surgical reference; A surgical tracking system, wherein the first radiopaque sub-geometry (61) is assigned to a second end (51b) of the first leg (51), the second radiopaque sub-geometry (62) is assigned to a second end (52b) of the second leg (52), and the third radiopaque sub-geometry (63) is assigned to the leg junction (53) of the first leg (51) and the second leg (52).

18. 18. The surgical tracking system of any one of claims 1, 16 and 17, wherein the surgical reference (50) includes at least one apical pin hole (57).

19. 19. The surgical tracking system of claim 18, wherein the at least one apical pin hole (57) is located between a first end (51a / 52a) and a second end (51b / 52b) of at least one of the first leg (51) and the second leg (52).

20. 20. The surgical tracking system of claim 18 or 19, wherein at least one of the first leg (51) and the second leg (52) includes a first sub-leg (54) and a second sub-leg (55), a first end (54a) of the first sub-leg (54) corresponds to the first end (51a / 52a) of at least one of the first leg (51) and the second leg (52), and a second end (54b) of the first sub-leg (54) corresponds to the first end (55a) of the second sub-leg (55) at a sub-leg junction (56).

21. 21. The surgical tracking system of claim 20, wherein the sub-leg interface (56) includes at least one of the at least one apical pin hole (57).

22. 22. A surgical tracking system according to claim 1, wherein the angle between the first leg (51) and the second leg (52) at their junction (53c) is less than 90°, in particular less than 60°.

23. 23. A surgical tracking system according to any one of claims 20 to 22, wherein the angle between the first sub-leg (54) and the second sub-leg (55) at their junction (56c) is less than 90°, in particular less than 60°.

24. 24. The surgical tracking system of any one of claims 20 to 23, wherein a first sub-leg (54) and a second sub-leg (55) of one of the first leg (51) and the second leg and the other of the first leg (52) and the second leg form a W-shape.

25. 25. The surgical tracking system of any one of claims 20 to 24, wherein at least a portion of said anatomically compatible surface (59) comprises adhesive means (58).

26. 26. The surgical tracking system of any one of claims 20 to 25, wherein the adhesive means (58) comprises a surface portion coated with an adhesive that is non-irritating to human skin.

27. 27. The surgical tracking system of any one of claims 20 to 26, wherein the adhesive means (58) comprises a portion that is part of a touch fastener, the counterpart of which is adhesive to human skin.

28. The surgical instrument (10) is a surgical cutting guide device, the surgical cutting guide device further comprising: a guide body (15) having a planar cutting extension from a proximal end (11) of the surgical cutting guide device to a distal end (12) of the surgical cutting guide device and adapted to guide a surgical cutting tool, the guide body (15) having a cutting surface track (16) extending therealong and continuing distally along a path of travel (46) of the surgical cutting tool being inserted and guided; a radiopaque geometric shape (20) disposed at a predetermined spatial position and orientation relative to the guide body (15), the radiopaque geometric shape (20) adapted to provide a unique radiographic projection (25) for each proximal-to-distal orientation of the guide body; The surgical reference (50) a radiopaque geometric shape (60) fixedly and spatially reproducibly connected to said surgical reference (50); a reference body part (51) having a surface (59) that is anatomically matched to the patient's anatomy (100); 28. The surgical tracking system of claim 1, wherein the radiopaque geometry (60) has unique radiographic projections (66, 67, 68) for each proximal-to-distal orientation of the surgical reference (50), thereby enabling the spatial position and orientation of the surgical reference (50) to be determined based on two-dimensional radiographic projections of at least a portion of the surgical reference (50).

29. 29. The surgical tracking system of claim 28, wherein the guide body (15) is removably attached to the surgical cutting guide device and includes adhesive means (58) for adhering the guide body (15) to the patient's anatomy (100), whereby the cutting plane trajectory (16) extending along the guide body and continuing distally along a path of travel (46) of an inserted and guided surgical cutting tool aligns with an intended cutting plane (101) in the patient's anatomy (100).

30. the guide body (15) is a first guide body (15a) detachable from the surgical cutting guide device and includes an adhesive means (58) for adhesively attaching the first guide body (15a) to the patient's anatomy (100), whereby a first cutting plane trajectory (16a) extending along the first guide body (15a) and continuing distally along a path of travel (46) of a surgical cutting tool being inserted and guided is aligned with a first intended cutting plane (101a) in the patient's anatomy (100); 29. The surgical tracking system of claim 28, wherein the surgical cutting guide device further comprises a second guide body (15b) detachable from the surgical cutting guide device and includes adhesive means (58) for adhesively adhering the second guide body (15b) to the patient's anatomy (100), whereby a second cutting plane trajectory (16b) extending along the second guide body (15b) and continuing distally along a path of travel (46) of an inserted and guided surgical cutting tool is aligned with a second intended cutting plane (101b) in the patient's anatomy (100), the second cutting plane trajectory (16b) being oblique with respect to the first cutting plane trajectory (16a).

31. 31. The surgical tracking system of claim 28, further comprising an augmentation means for augmenting at least one of a first cutting plane trajectory (16a) and a second cutting plane trajectory (16b) with respect to at least one of a first intended cutting plane (100a) and a second intended cutting plane (100b) in the patient's anatomy (100) based on at least one of the light pattern (80) and a radiopaque geometric shape (20, 60) having a unique radiographic projection (25, 65) provided on each of the surgical reference body (50), the first guide body (15a), and the second guide body (15b).

32. 32. The surgical tracking system of any one of claims 28 to 31, further adapted to instruct the surgeon how to align at least one of the first cutting plane trajectory (16a) and the second cutting plane trajectory (16b) with respect to at least one of the first intended cutting plane (100a) and the second intended cutting plane (100b).

33. 1. A method for visualizing tracking of a surgical instrument (10) relative to a surgical reference (50), the method comprising: capturing an optical image (S70) directed in a predetermined line of sight (71) of a light pattern (80) attached in a predetermined relative position and orientation to the other of the surgical instrument (10) and the surgical reference body (50) by an optical imaging device (70) attached in a predetermined line of sight (71) to one of the surgical instrument (10) and the surgical reference body (50), the light pattern (80) including at least one unique light sub-pattern (80a) enabling determination of the relative position and orientation of the surgical reference body (50) with respect to the position and orientation of the surgical instrument (10); and processing (S30) the captured optical image of the light pattern (80) by recognizing (S32) at least one of the sub-patterns (80a) of the light pattern (80), comparing (S33) the recognized light sub-pattern (80a) with a stored representation of the light pattern (80), and determining (S34) the position and orientation of the surgical instrument (10) relative to the orientation and position of the surgical reference (50) from the size, orientation, and distortion of the recognized sub-pattern (80a) compared to the stored representation of the light pattern (80), The surgical reference (50) a radiopaque geometry (60) having a first radiopaque sub-geometry (61) and a second radiopaque sub-geometry (62), each radiopaque sub-geometry being fixedly and spatially repeatably connected to the surgical reference (50); a first reference body part (51) having a surface (59) that is anatomically matched to the patient's anatomy (100); a second reference body part (52) having a surface (59) that is anatomically matched to the patient's anatomy (100); each of the first radiopaque sub-geometry (61) and the second radiopaque sub-geometry (62) having a unique radiographic projection (66, 67, 68) for each proximal-to-distal orientation of the surgical reference (50), thereby allowing the spatial position and orientation of the surgical reference (50) to be determined solely from the first radiopaque sub-geometry (61) and the second radiopaque sub-geometry (62), respectively, based on two-dimensional radiographic projections of at least a portion of the surgical reference; the first radiopaque sub-geometry (61) is assigned to the first reference body portion (51) and the second radiopaque sub-geometry (62) is assigned to the second reference body portion (52); method.

34. 34. The method of claim 33, further comprising the steps of: visualizing (S38) a surgical instrument (10) represented by one of the optical imaging device (70) and the light pattern (80); and visualizing (S38) a surgical reference (50) represented by the other of the optical imaging device (70) and the light pattern (80).

35. 35. The method of claim 34, further comprising a step (S36) of augmenting a predetermined motion trajectory (16) of the surgical instrument (10) onto a virtual visualization (19) of the surgical instrument (10) based on the recognized position and orientation of at least the light sub-pattern (80a) of the light pattern (80) relative to the position and line of sight of the optical imaging device (70) to visualize a motion path (46) of the surgical instrument (10) relative to a surgical reference body (50) represented by the light pattern (80).

36. A computer program which, when executed, performs the method of any one of claims 33 to 35.

37. 37. A data storage medium having stored thereon the executable code of the computer program of claim 36.

Images