Surgery – Miscellaneous – Methods
Patent
1990-12-13
1993-03-23
Pellegrino, Stephen C.
Surgery
Miscellaneous
Methods
602 44, 606151, 623 19, A61B 1900, A61F 240
Patent
active
051955423
DESCRIPTION:
BRIEF SUMMARY
BACKGROUND OF THE INVENTION
The present invention relates to the technical sector of surgery of the shoulder and means to provide therapy in particular. In order to understand the objects and advantages of the invention, its environment with regard to degenerative ruptures of rotator cuffs will be briefly discussed.
FIELD OF THE INVENTION The rotator cuff of a shoulder joint is made up by
the distal tendinous portion of four muscles, supraspinatus and subspinatus (1) (2), subscapularis (3) and teres minor (4), (FIGS. 1 and 2). The cuff is attached to the upper, anterior and posterior faces of the trochiter (5) by covering the upper pole of the humeral head. The function of this tendinous cuff, 3 to 4 millimetres thick, depends on the fundamental centering and stabilizing role of the numeral head with respect to sliding action during anterior and lateral lifting and rotation movements of the arm.
The musculotendinous cuff passes under an osteofibrous arch, which is made up from the front to the rear by a portion of the acromion (7), the coracoacromial ligament (8) and the coracoid process (9), (FIG. 3), thereby forming a canal. (6) represents a partial section of the clavicle. A sliding bursa passes is inerted between the musculotendinous cuff and the walls of the osteofibrous arch. Therefore, there is a potential and sometimes detrimental interaction between the musculotendinous cuff and the acromiocoracoidan arch, particularly during lateral and anterior lifting movements of the arm. The repeated rubbing of the cuff against the walls of the osteofibrous arch results in wearing of the tendinous cuff by progressive abrasion. The rubbing can be increased in as much as arthosis lesions with severe osteophytes may thickens the walls of the aforementioned such becoming more aggressive as the cuff gets older. With time, gradual thinning is brought about and a trophic perforation (less than 1 cm.sup.2) of the cuff, particularly in the hypo-vascularized and fragile area where the supraspinatus muscle passes, may occur. A fall may provide a more extensive rupture by retraction of the supraspinatus muscle, with extension towards the front (subscapularis muscle) or the rear (subepinatus muscle). The degenerative rupture of the rotator or musculotendinous cuff may be of a varied size:
--grade 1--perforation (less than 1 cm.sup.2) reaching the supraspinatus muscle
--grade 2--supraspinatus rupture (greater than 1 cm.sup.2)
--grade 2--Massive rupture concerning the supraspinatus, subspinatus, subscaptularis muscles and sometimes the teres minor muscle.
It is possible to carry out surgery to reconstruct the rotator cuff. This is done by recovering the numeral head, giving back the cuff its capturing and stabilizing role and reestablishing establishing a harmonious scapulohumeral rhythem. Reconstruction requires excision of the coracoacromial ligament and cleaning the subacromial space, including suppression of the arthrosis legions and thinning of the anterior portion of the acromion.
Several processes are therefore possible in order to cover the numeral head.
DESCRIPTION OF SURGICAL PROCESSES Certain processes do not use the rotator
cuff, such as when the tendinous cuff has disappeared due to wear or major retraction. It is technically possible to fill in the space corresponding to the cuff by covering the humeral head with a natural or synthetic, inert material. However, it appears preferable, in the case of major ruptures, where the numeral head is uncovered, to carry out plasty by the anterior deltoid muscular flap, which offers the advantage of covering the humeral head and having a lowering effect of the humeral head by active contraction of the flap.
Other surgical processes use the rotator cuff. The rotator cuff is disinserted. The humeral head is uncovered when there is a more or less significant lack of covering (grades 1, 2, 3). The tendons are retracted according to a variable degree, however it is possible to free the adherences in order to bring them to their initial trochiterian insertion area. Just
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Blondel Pierre
Gazielly Dominique
Jackson Gary
Pellegrino Stephen C.
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