Patient-customized 3D printing surgical guide for cap-type humeral head resection for reverse total shoulder arthroplasty and method for manufacturing same

Abstract

A processing method using a surgical guide, in relation to an example of the present invention, may comprise: a first step of obtaining at least one medical image among a CT image and an MRI image; a second step of pre-processing the at least one medical image and segmenting same into the humerus head of the humerus and other structures; a third step of generating a three-dimensional (3D) digital structure model for a shoulder joint of a patient by using the segmented image; a fourth step of establishing, on the basis of the digital structure model, a virtual plan for determining a resection surface for the humeral head; a fifth step of generating, on the basis of information about the resection surface determined in the virtual plan, design information for manufacturing the surgical guide; and a sixth step of generating the surgical guide by means of 3D printing technology using the design information.

Description

Patient-specific 3D-printed surgical guide and manufacturing method for cap-type humeral head resection for retrograde total shoulder arthroplasty

[0001] The present invention relates to a patient-specific 3D printing surgical guide for cap-type humeral head resection for reverse total shoulder arthroplasty and a manufacturing method thereof. Specifically, the present invention provides a cap-type surgical guide model that performs Boolean processing and standard optimization using the patient's 3D skeletal structure obtained from the patient's CT image and MR image, thereby completing a patient-specific surgical guide. The present invention proposes a flexible manufacturing method so that the size and shape can be somewhat different for each patient, and proposes that after resection, the resection site and the surgical guide are detached together while still attached, so that they are easy to handle during surgery.

[0002] Performing reverse shoulder arthroplasty without a surgical guide can lead to several difficulties and potential problems.

[0003] Without a surgical guide, the precision and accuracy of humeral head resection may be reduced.

[0004] Surgeons may have difficulty determining the optimal resection margin, which may result in uneven or inadequate removal of the humeral head.

[0005] This can affect the stability, range of motion, and overall function of the shoulder joint.

[0006] Without a surgical guide, variability in implant position may occur.

[0007] Surgeons may have to rely on visual estimation and intraoperative judgment, which may lead to inconsistent implant placement and alignment.

[0008] Improper positioning can lead to suboptimal joint mechanics, increased wear, and poor postoperative outcomes. The absence of a surgical guide increases the risk of intraoperative complications.

[0009] Therefore, the need for methods and systems that can solve this problem is increasing.

[0010] The present invention proposes a patient-specific 3D printing surgical guide and manufacturing method for cap-type humeral head resection for retrograde total shoulder arthroplasty that can solve the aforementioned problems.

[0011] The present invention proposes a cap-type form in which a surgical guide is mounted on the humeral head like a hat to facilitate smooth humeral head resection.

[0012] In the case of the cap type, it is a structure that is easy to install on the humeral head when the humeral head is completely removed from the acromion during surgery, and it is designed as an optimal structure for fixation and resection at key points after installation.

[0013] According to the present invention, a patient-tailored surgical guide is completed by performing Boolean processing and specification optimization using the patient's 3D bone structure obtained from the patient's CT image and MR image on a basic cap-type surgical guide model, and a flexible manufacturing method is proposed so that the size and shape can be somewhat different for each patient.

[0014] In addition, in the present invention, after resection, the resection site and the surgical guide are attached together and removed, so that they can be easily handled during surgery.

[0015] The technology proposed by the present invention can be summarized as follows.

[0016] 1) Manufacturing of patient-specific surgical guides based on 3D printing

[0017] 2) Design of a cap-type patient-specific circulatory guide

[0018] Meanwhile, the technical tasks to be achieved in the present invention are not limited to the technical tasks mentioned above, and other technical tasks not mentioned can be clearly understood by a person having ordinary skill in the technical field to which the present invention belongs from the description below.

[0019] A processing method using a surgical guide related to an example of the present invention for realizing the above-described task includes a first step of acquiring at least one medical image among a CT image and an MRI image; a second step of segmenting the humeral head and remaining structures of the humerus by pre-processing the at least one medical image; a third step of generating a three-dimensional (3D) digital structural model for the shoulder joint of the patient using the segmented image; a fourth step of establishing a virtual plan for determining a resection plane for the humeral head based on the digital structural model; a fifth step of generating design information for manufacturing the surgical guide based on resection plane information determined in the virtual plan; and a sixth step of generating the surgical guide using a 3D printing technology using the design information; wherein the surgical guide generated in the sixth step comprises: a cap-shaped guide mechanism that combines the surgical guide in a form that surrounds the humeral head; It may include at least one fixing member for reinforcing the connection between the guide device and the humerus; and at least one entry space for inserting a surgical resection device to perform resection related to the humerus while the guide device is fixed to the humerus.

[0020] In addition, after the sixth step, a surgery is performed to apply a reverse total shoulder arthroplasty to the patient, and during the surgery, if the humeral head is completely removed from the acromion and exposed, the cap-shaped guide device is placed on the humeral head, thereby further including a seventh step in which the surgical guide is coupled to the humeral head.

[0021] In addition, after the seventh step, if the surgical resection instrument is inserted and resection related to the humerus is performed, an eighth step may be further included in which the resection site and the surgical guide are attached together and removed to the outside for processing.

[0022] Additionally, in the first step, the at least one medical image may include anatomical information about the patient's shoulder, including the humerus and surrounding structures of the humerus.

[0023] Additionally, in the second step, the bone structure and soft tissue can be distinguished, and the boundary between the humeral head and the remaining region can be identified based on the distinguished region.

[0024] Additionally, in the third step, the anatomical structure of the remaining structures including the humeral head can be reconstructed in three dimensions.

[0025] Additionally, in the fourth step, the resection margin can be determined by considering the patient's anatomical data, pathological data, and the type and placement location of the pre-specified implant structure.

[0026] Additionally, in the fifth step, the design information may include alignment guide information of the surgical guide, cutting guide information through the resection surface, and mechanism information for fixing the surgical guide.

[0027] Meanwhile, a system related to another example of the present invention for realizing the above-described task includes: an acquisition unit for acquiring at least one medical image among CT images and MRI images; a preprocessing unit for segmenting the humeral head and remaining structures of the humerus by preprocessing the at least one medical image; a generation unit for generating a three-dimensional (3D) digital structural model of the shoulder joint of the patient using the segmented image; a control unit for establishing a virtual plan for determining a resection plane for the humeral head based on the digital structural model, and generating design information for manufacturing the surgical guide based on the resection plane information determined in the virtual plan; and a 3D printer unit for generating the surgical guide through 3D printing technology using the design information; wherein the generated surgical guide comprises: a cap-shaped guide mechanism for connecting the surgical guide to surround the humeral head; at least one fixing member for reinforcing the connection between the guide mechanism and the humerus; and at least one entry space for inserting a surgical resection instrument to perform resection related to the humerus while the guide device is fixed to the humerus.

[0028] In addition, when a surgery is performed to apply a reverse total shoulder arthroplasty to the patient, and the humeral head is completely removed from the acromion and exposed during the surgery, the cap-shaped guide device is placed on the humeral head, so that the surgical guide is coupled to the humeral head, and when the surgical resection device is inserted and resection related to the humerus is performed, the resection site and the surgical guide can be detached and processed together while remaining attached to the outside.

[0029] The use of a patient-specific surgical guide as a cap-type tool for humeral head resection in reverse total shoulder arthroplasty of the present invention provides several key advantages and addresses the specific requirements of the surgical procedure.

[0030] The necessity and benefits of utilizing patient-tailored surgical guides are as follows.

[0031] In reverse total shoulder arthroplasty, humeral head resection requires precise and accurate planning and execution.

[0032] Patient-specific surgical guides allow for high-precision resections in predefined planes, minimizing errors and optimizing implant positioning.

[0033] Each patient has different anatomical variations, pathologies, and specific surgical requirements. Patient-specific surgical guides enable a personalized approach tailored to each patient's anatomy. This customization can enhance the accuracy and effectiveness of the surgical procedure, improving surgical outcomes and patient satisfaction.

[0034] Using a surgical guide eliminates the need for intraoperative measurements and adjustments during the resection process. The surgeon can use the guide as a pre-determined reference, reducing surgical time and improving operating room efficiency.

[0035] Surgeons can achieve consistent and reproducible humeral head resections across multiple surgical cases using patient-specific surgical guides. This standardization can improve the reliability and predictability of surgical outcomes.

[0036] Surgical guides provide surgeons with clear visual and tactile references during the resection process. This reduces the need for intraoperative decision-making and allows the surgeon to focus on the operation with greater confidence.

[0037] Patient-specific surgical guides help minimize the risk of damage to critical anatomical structures such as nerves and blood vessels, and these guides can ensure controlled and precise resections, reducing the likelihood of complications and improving patient safety.

[0038] Surgical guides simplify surgical techniques by providing a structured and guided approach. In particular, surgeons with limited experience performing reverse total shoulder arthroplasty can leverage the guidance provided by surgical guides to improve surgical skill and outcomes.

[0039] Meanwhile, the effects that can be obtained from the present invention are not limited to the effects mentioned above, and other effects that are not mentioned can be clearly understood by a person having ordinary skill in the technical field to which the present invention belongs from the description below.

[0040] FIG. 1 illustrates an example of a block diagram of the entire system in relation to the present invention.

[0041] FIG. 2 illustrates an example of a flowchart explaining a processing method using a surgical guide in relation to the present invention.

[0042] FIG. 3 illustrates an example of a method for manufacturing a patient-specific surgical guide in relation to the present invention.

[0043] FIGS. 4 and 5 illustrate an example of a design and structure of a cap-type patient-specific 3D printed surgical guide for humeral head resection during retrograde total shoulder arthroplasty in relation to the present invention.

[0044] FIG. 6 illustrates an example of a 3D printed surgical guide and a form fixed to a humeral head model in relation to the present invention.

[0045] Reverse shoulder arthroplasty is a surgical procedure primarily used to treat certain shoulder conditions, such as severe arthritis and irreparable rotator cuff tears.

[0046] This surgery reverses the anatomical structure of the shoulder joint to improve function and relieve pain.

[0047] A patient-specific surgical guide (commonly known as a PSI) is a personalized surgical tool designed to assist the surgeon during specific surgical procedures.

[0048] It is custom-made according to each patient's unique anatomy and surgical needs.

[0049] PSIs are typically manufactured using advanced imaging technologies, computer-aided design (CAD), and 3D printing technologies.

[0050] It serves as a guide or template for accurate and precise surgical intervention.

[0051] In the present invention, in the case of shoulder surgery such as reverse total shoulder arthroplasty, the patient-tailored surgical guide means a surgical guide specifically designed to assist in resection of the humeral head or in placement of prosthetic components.

[0052] This surgical guide is customized to the patient's anatomy, ensuring optimal humeral head resection and implant positioning and alignment. Features such as a cutting guide, alignment marker, and fixation mechanism assist the surgeon during surgery.

[0053] Performing reverse shoulder arthroplasty without a surgical guide can lead to several difficulties and potential problems.

[0054] Without a surgical guide, the precision and accuracy of humeral head resection can be compromised. Surgeons may struggle to determine the optimal resection margin, potentially resulting in uneven or inappropriate humeral head removal.

[0055] This can affect shoulder joint stability, range of motion, and overall function. Without a surgical guide, implant positioning variability can occur.

[0056] Surgeons may have to rely on visual estimation and intraoperative judgment, which may lead to inconsistent implant placement and alignment.

[0057] Improper positioning can lead to suboptimal joint mechanics, increased wear, and poor postoperative outcomes. The absence of a surgical guide increases the risk of intraoperative complications.

[0058] Without clear guidelines, surgeons may inadvertently damage important anatomical structures, such as nerves or blood vessels, during resection.

[0059] Additionally, improper implant placement can cause instability, impingement, or excessive tension in the soft tissue, which can lead to postoperative complications.

[0060] Additionally, without a surgical guide, the surgical procedure may be longer.

[0061] The surgeon may spend additional time assessing landmarks, determining the resection margin, and making intraoperative adjustments.

[0062] This may increase anesthesia time, surgical exposure time, and overall surgical time, which may affect patient outcomes and surgical efficiency.

[0063] Separately, it becomes difficult to ensure consistency and reproducibility across different surgical cases.

[0064] Surgeons may have difficulty accurately replicating resections, which can lead to variability in outcomes and potential difficulties in evaluating the effectiveness of the procedure.

[0065] Surgery without a surgical guide can increase fatigue and stress levels for the surgeon. The resection process requires constant visualization and decision-making, which can be mentally and physically taxing.

[0066] Surgeon fatigue can impair optimal surgical performance, affecting surgical precision and patient safety.

[0067] Finally, imprecise resection, variability in implant position, and potential complications may affect patient satisfaction.

[0068] Patients may experience suboptimal outcomes, such as limited range of motion, instability, or persistent pain, which may affect their quality of life and overall satisfaction with the surgical procedure.

[0069] Several essential technologies are required to manufacture a cap-type 3D printing-based patient-specific surgical guide for humeral head resection in the reverse total shoulder arthroplasty proposed by the present invention.

[0070] The main steps involved in the process are:

[0071] Medical Imaging: This process begins with obtaining high-quality medical images of the patient's shoulder joint, such as a CT scan or MRI scan. These images provide detailed anatomical information about the patient's shoulder, including the humeral head and surrounding structures.

[0072] Image segmentation: Image processing techniques are used to process medical images to segment and isolate the humeral head and other related structures. This step distinguishes between bone structures and soft tissue and accurately identifies the boundaries of the humeral head.

[0073] 3D Reconstruction: The segmented images are then used to create a three-dimensional (3D) digital model of the patient's shoulder joint. This involves reconstructing the anatomical structures, including the humeral head, into a digital representation.

[0074] Virtual Planning: Using a 3D model of the shoulder joint, virtual planning is performed to determine the optimal resection margin for the humeral head. This involves determining the appropriate level of resection, taking into account factors such as the patient's anatomy, pathology, and desired implant position.

[0075] Cap Design: A customized cap-shaped surgical guide is designed based on a virtual plan. The cap is specially manufactured to fit the resected humeral head and serves as a guide during the surgical resection. This design includes features such as alignment guides, cutting guides, and fixation mechanisms.

[0076] 3D Printing: The designed cap-shaped surgical guide is transformed into a physical object using 3D printing technology. The 3D model of the cap is sent to a 3D printer, which deposits the selected material (typically biocompatible plastic or metal) layer by layer to create the surgical guide.

[0077] The technical points of the present invention are as follows.

[0078] 1) Manufacturing of patient-specific surgical guides based on 3D printing

[0079] 2) Design of a cap-type patient-specific circulatory guide

[0080] In the present invention, a cap-type form that is basically used to mount a surgical guide by covering the humeral head like a hat in order to perform smooth humeral head resection can be adopted.

[0081] In the case of the cap type, it is a structure that is easy to install on the humeral head when the humeral head is completely removed from the acromion during surgery, and it is designed as an optimal structure for fixation and resection at key points after installation.

[0082] A patient-tailored surgical guide is completed by performing Boolean processing and specification optimization using the patient's 3D bone structure obtained from CT and MR images on a basic cap-type surgical guide model. A flexible manufacturing method was adopted so that the size and shape can vary slightly for each patient.

[0083] After resection, the resection site and surgical guide are attached together and removed, making them easy to handle during surgery.

[0084] FIG. 1 illustrates an example of a block diagram of the entire system in relation to the present invention.

[0085] Referring to FIG. 1, the entire system (1) may include an acquisition unit (10), a preprocessing unit (20), a generation unit (30), a control unit (40), and a 3D printing unit (50).

[0086] The acquisition unit (10) can acquire at least one medical image among CT images and MRI images.

[0087] The preprocessing unit (20) can segment the humeral head and remaining structures of the humerus by preprocessing at least one medical image.

[0088] Additionally, the generation unit (30) generates a three-dimensional (3D) digital structural model of the patient's shoulder joint using the segmented image.

[0089] In addition, the control unit (40) can establish a virtual plan for determining a resection plane for the humeral head based on a digital structural model, and generate design information for manufacturing the surgical guide based on the resection plane information determined in the virtual plan.

[0090] Additionally, the 3D printing unit (50) can create the surgical guide using 3D printing technology using design information.

[0091] Meanwhile, the surgical guide (100) produced here may include a cap-shaped guide device (110) that connects the surgical guide to the humeral head in a manner that surrounds it, at least one fixing member (120, 130) for reinforcing the connection between the guide device and the humerus, and at least one entry space (140) for inserting a surgical resection device to perform resection related to the humerus while the guide device is fixed to the humerus.

[0092] Meanwhile, FIG. 2 illustrates an example of a flowchart explaining a processing method using a surgical guide in relation to the present invention.

[0093] Referring to FIG. 2, first, a step (S10) of acquiring at least one medical image among a CT image and an MRI image is performed.

[0094] At step S10, the at least one medical image includes anatomical information about the patient's shoulder, including the humerus and surrounding structures of the humerus.

[0095] Afterwards, a step (S11) of segmenting the humeral head and remaining structures of the humerus is performed by preprocessing at least one medical image.

[0096] At step S11, the bone structure and soft tissue can be distinguished, and the boundary between the humeral head and the remaining region can be identified based on the distinguished region.

[0097] Additionally, a step (S12) of creating a three-dimensional (3D) digital structural model of the patient's shoulder joint using the segmented image is performed.

[0098] Here, the anatomical structure of the remaining structures, including the humeral head, can be reconstructed in three dimensions.

[0099] Additionally, a step (S13) of establishing a virtual plan for determining a resection plane for the humeral head based on a digital structural model is performed.

[0100] Here, the resection margin can be determined by considering the patient's anatomical data, pathological data, and the type and placement location of the pre-specified implant structure.

[0101] Additionally, a step (S14) is performed in which design information for producing a surgical guide is generated based on the resection surface information determined in the virtual plan.

[0102] Here, the design information may include alignment guide information of the surgical guide, cutting guide information through the resection surface, and mechanism information for fixing the surgical guide.

[0103] Afterwards, a step (S15) is performed in which a surgical guide is created using 3D printing technology using design information, and a step (S16) is performed in which surgery is performed to apply reverse shoulder joint replacement to the patient.

[0104] At this time, if the humeral head is completely removed from the acromion and exposed during the surgical procedure, a cap-shaped guide device is placed on the humeral head, and a step (S17) in which the surgical guide is coupled to the humeral head is performed.

[0105] Afterwards, when a surgical resection instrument is inserted and resection related to the humerus is performed, a step (S18) is performed in which the resection site and the surgical guide are attached together and removed externally.

[0106] Meanwhile, FIG. 3 illustrates an example of a method for manufacturing a patient-specific surgical guide in relation to the present invention.

[0107] Through steps S1 to S21 and steps S22 to S14 of FIG. 3, specific steps are shown for changing the previously stored basic PSI size using the cutting level determined from deep learning, performing 2D Boolean to fit the patient's skeleton, and reconstructing it in 3D.

[0108] This illustrates an example of the design algorithm process that is automatically applied for PSI.

[0109] In addition, FIGS. 4 and 5 illustrate an example of a design and structure of a cap-type patient-specific 3D printed surgical guide for humeral head resection during retrograde total shoulder arthroplasty in relation to the present invention.

[0110] Referring to FIG. 4, the surgical guide (100) may include a cap-shaped guide device (110) that connects the surgical guide to surround the humeral head (300), at least one fixing member (120, 130) for reinforcing the connection between the guide device and the humerus, and at least one entry space (140a, 140b) for inserting a surgical resection device to perform resection related to the humerus while the guide device is fixed to the humerus.

[0111] Referring to FIG. 5, a virtual resection plane (300) is illustrated through which a surgical saw is applied and resected through the entry space (140a, 140b).

[0112] In addition, FIG. 6 illustrates an example of a 3D printed surgical guide (100K) and a form fixed to a humeral head model (200K) in relation to the present invention.

[0113] When applying the system and method of the present invention described above, the use of a patient-specific surgical guide as a cap-type tool for humeral head resection in reverse total shoulder arthroplasty provides several key advantages and addresses the specific requirements of the surgical procedure.

[0114] The necessity and benefits of utilizing patient-tailored surgical guides are as follows.

[0115] In reverse total shoulder arthroplasty, humeral head resection requires precise and accurate planning and execution.

[0116] Patient-specific surgical guides allow for high-precision resections in predefined planes, minimizing errors and optimizing implant positioning.

[0117] Each patient has different anatomical variations, pathologies, and specific surgical requirements. Patient-specific surgical guides enable a personalized approach tailored to each patient's anatomy. This customization can enhance the accuracy and effectiveness of the surgical procedure, improving surgical outcomes and patient satisfaction.

[0118] Using a surgical guide eliminates the need for intraoperative measurements and adjustments during the resection process. The surgeon can use the guide as a pre-determined reference, reducing surgical time and improving operating room efficiency.

[0119] Surgeons can achieve consistent and reproducible humeral head resections across multiple surgical cases using patient-specific surgical guides. This standardization can improve the reliability and predictability of surgical outcomes.

[0120] Surgical guides provide surgeons with clear visual and tactile references during the resection process. This reduces the need for intraoperative decision-making and allows the surgeon to focus on the operation with greater confidence.

[0121] Patient-specific surgical guides help minimize the risk of damage to critical anatomical structures such as nerves and blood vessels, and these guides can ensure controlled and precise resections, reducing the likelihood of complications and improving patient safety.

[0122] Surgical guides simplify surgical techniques by providing a structured and guided approach. In particular, surgeons with limited experience performing reverse total shoulder arthroplasty can leverage the guidance provided by surgical guides to improve surgical skill and outcomes.

[0123] Meanwhile, the effects that can be obtained from the present invention are not limited to the effects mentioned above, and other effects that are not mentioned can be clearly understood by a person having ordinary skill in the technical field to which the present invention belongs from the description below.

[0124] In addition, the system and its control method described above are not limited to the configuration and method of the embodiments described above, and the embodiments may be configured by selectively combining all or part of each embodiment so that various modifications can be made.

Claims

1. A first step of acquiring at least one medical imaging image among CT images and MRI images; A second step of segmenting the humeral head and remaining structures of the humerus by pre-processing at least one of the above medical image; A third step of creating a three-dimensional (3D) digital structural model of the patient's shoulder joint using the segmented image; A fourth step of establishing a virtual plan for determining a resection plane for the humeral head based on the digital structural model; A fifth step in which design information for manufacturing the surgical guide is generated based on the resection surface information determined in the above virtual plan; and A sixth step of generating the surgical guide using 3D printing technology using the above design information; The surgical guide generated in the above 6th step is A cap-shaped guide device that combines the above surgical guide in a manner that surrounds the humeral head; At least one fixture for reinforcing the connection between the guide device and the humerus; and A treatment method using a surgical guide, comprising at least one entry space for inserting a surgical resection instrument to perform resection related to the humerus while the guide device is fixed to the humerus.

2. In paragraph 1, After step 6 above, A treatment method using a surgical guide, further comprising a seventh step in which, when a surgery is performed to apply a reverse total shoulder arthroplasty to the patient and the humeral head is completely removed from the acromion and exposed during the surgery, the cap-shaped guide device is placed on the humeral head, thereby coupling the surgical guide to the humeral head.

3. In paragraph 2, After step 7 above, A method of treating using a surgical guide, further comprising an 8th step in which, when the surgical resection instrument is inserted and resection related to the humerus is performed, the resection site and the surgical guide are attached together and removed to the outside for treatment.

4. In paragraph 3, A method of processing at least one medical image in the first step using a surgical guide including anatomical information about the patient's shoulder, including the humerus and surrounding structures of the humerus.

5. In paragraph 4, In the second step, a surgical guide-based treatment method is used to distinguish between bone structure and soft tissue, and identify the boundary between the humeral head and the remaining region based on the distinguished region.

6. In paragraph 5, A treatment method using a surgical guide in which the anatomical structure of the remaining structures including the humeral head is reconstructed in three dimensions in the third step.

7. In paragraph 6, A treatment method using a surgical guide in which the resection surface is determined in the fourth step by considering the patient's anatomical data, pathological data, and the type and placement location of the pre-specified implant structure.

8. In paragraph 7, A processing method using a surgical guide, wherein the design information in the fifth step includes alignment guide information of the surgical guide, cutting guide information through the resection surface, and mechanism information for fixing the surgical guide.

9. An acquisition unit for acquiring at least one medical image among CT images and MRI images; A preprocessing unit for segmenting the humeral head and remaining structures of the humerus by preprocessing at least one of the above medical image images; A generation unit for generating a three-dimensional (3D) digital structural model of the patient's shoulder joint using the segmented image; A control unit that establishes a virtual plan for determining a resection plane for the humeral head based on the digital structural model, and generates design information for manufacturing the surgical guide based on the resection plane information determined in the virtual plan; and A 3D printer unit that generates the surgical guide using 3D printing technology using the above design information; The surgical guide generated above is: A cap-shaped guide device that combines the above surgical guide in a manner that surrounds the humeral head; At least one fixture for reinforcing the connection between the guide device and the humerus; and A system comprising at least one entry space for inserting a surgical resection instrument to perform resection related to the humerus while the guide device is fixed to the humerus.

10. In paragraph 9, When a surgery is performed to apply a reverse total shoulder arthroplasty to the patient, and the humeral head is completely removed from the acromion and exposed during the surgery, the cap-shaped guide device is placed on the humeral head, thereby combining the surgical guide with the humeral head. A system in which, when the above surgical resection instrument is inserted and resection related to the humerus is performed, the resection site and the above surgical guide are attached together and removed externally.

Images