RU2763648C1 - Tenotome - Google Patents

Abstract

FIELD: medical technology.

SUBSTANCE: invention relates to medical technology, namely to traumatology and orthopedics, and can be used for the release or disinsection of tendons, for example, the tendons of the radial extensor of the wrist and the radial flexor of the wrist, during surgical interventions on the water of lateral or medial epicondylitis of the humerus. Tenotome includes a handle and a working part with a cutting element at the end. The handle is made in the form of a leaf spring, the ends of which smoothly pass at right angles into the upper and lower webs of the working part, which fit tightly to each other. The upper blade ends with a cutting edge, and the lower blade ends with a hook protruding from under the upper blade. The cutting edge of the lower blade is located on the underside of the hook. The cutting edges are made of a complementary configuration and have counter-sharpening. A through groove is located on the upper web along its longitudinal axis, and on the lower one there is a stop that enters the groove without protruding beyond the surface of the upper web.

EFFECT: use of the invention provides the implementation of a one-stage minimally invasive peri-rest tenotomy of degeneratively changed tendons in the places of their attachment to the bones while minimizing trauma, which ultimately improves the functional results of surgical treatment.

1 cl, 10 dwg

Description

The invention relates to medical equipment, namely to traumatology and orthopedics, and can be used for the release or dissipation of tendons, for example, the tendons of the radial extensor of the wrist and the radial flexor of the wrist during surgical interventions for lateral or medial epicondylitis of the humerus.

Epicondylitis of the humerus is a fairly common disease in the general population, with an incidence of 1-4% of the population. The main symptom of epicondylitis is pain in the area of attachment of the tendon groups of the forearm to the epicondyles of the humerus, aggravated by the resistance of the wrist [1].

If the course of conservative therapy is ineffective, patients with persistent pain and dysfunction of the limb against the background of complex conservative therapy, carried out for six months, require surgical treatment [2].

In the surgical treatment of patients with both lateral and medial epicondylitis of the humerus, the most effective method is the release of degeneratively altered tendon muscle groups of the forearm [3, 4, 5].

Therefore, this pathology is an illustrative example of the possibility of clinical application of tenotomes of various designs.

A known device is a basket puncher from Acufex [6], which consists of a working cutting part and a handle. The disadvantages of this device are the difficulty of manipulating it in the joint cavity, as well as the impossibility to perform tenotomy of the tendon periosteally. The disadvantage of this device is also a large area of the tenotomy zone, due to the large area of the cutting part of the puncher, which leads to the formation of a hernial orifice in the postoperative period.

Known devices, the so-called strippers for harvesting a transplant from the quadriceps femoris. The closest in terms of technical characteristics is the Quad tendon stripper/cutter from Arthrex [7], designed to harvest the tendon part of the quadriceps femoris. The hybrid cutting-stripping device consists of a handle, a hollow graduated rod with a cutting part at its end. The cutting part is made on the distal part of the tool and consists of a mobile blade located on a circularly closed tendon stripper. To prevent premature cutting of the graft during harvesting, the handle of the instrument is equipped with a locking locking mechanism designed to lock and unlock the cutting part of the stripper. The mechanism of the known device is designed to take a graft with a round cross section, and during release, even the correct mechanism of action does not provide the desired result due to the discrepancy between the shape of the working part and the shape of the epicondyles of the humerus and the tendons attached to them. The closed cutting ring does not allow the release of the modified tendon, keeping its attachment sites intact.

The technical problem is to develop a device for the release or dissipation of the tendons of various muscles at the sites of their attachment to the bones, devoid of the above disadvantages.

The technical result of the invention is to ensure the implementation of one-stage minimally invasive periosteal tenotomy of degeneratively changed tendons at the sites of their attachment to the bones while minimizing trauma, which ultimately improves the functional results of surgical treatment.

The result of the invention is achieved due to the fact that the handle continuously passes into the webs of the working part, at the end of which cutting edges are made, and the upper web of the working part ends directly with the cutting edge, and the lower web ends with a hook protruding from under the upper web, containing a cutting edge on the underwear (inner edge) of the hook. The cutting edges are made of a complementary configuration and have a counter sharpening. A long groove is located on the upper canvas along its axis, and on the lower one there is a limiter that enters the groove of the upper canvas, allowing the canvases to move along the longitudinal axis relative to each other when the handle is compressed.

The execution of the tenotome handle in the form of a leaf spring (spring circuit), which smoothly at a right angle passes into the upper and lower webs of the working part, allows you to compress the handle. When the compression is released, the handle is unclenched under the action of elastic forces and the device returns to its original position.

The upper web contains a through longitudinal straight groove, and the lower one - a limiter that enters the groove of the upper web, allowing the webs to move along the longitudinal axis relative to each other when the handle is compressed. Moreover, in a static position, the limiter rests against the leading edge (stop) of the groove. When the handle is squeezed after crossing the tendon, the limiter rests against the rear edge (stop) of the groove, which makes it possible to cut or cut only the selected tendon and not injure the surrounding tissues.

The cutting edges of the upper and lower blades of the working part are made in a complementary (corresponding) configuration and have counter sharpening like "scissors" (the cutting edge of the upper blade has a sharpening from above, and the cutting edge of the lower blade has a sharpening from below). When the handle is squeezed, the lower and upper blades move relative to each other and their cutting edges, respectively, move towards each other, which makes it possible to cut off or cross the tendon at the same time.

On the inner edge, as mentioned above, the hook of the lower blade contains a cutting edge that complementarily matches the cutting edge of the upper blade in configuration, and the rest of its edges and end (sting) are rounded, which allows you to enter the tenotome into the area of interest without injuring the surrounding tissues .

The hook configuration allows you to grab (pry) the selected part of the tendon and cut or cut off only it.

The illustrations show:

Fig. 1, (side view), tenotome, where: 1 - handle; 2 - working part; 3 - bottom canvas; 4 - upper canvas; 7 - hook of the lower canvas; 8 - cutting edge of the lower web;

Fig. 2, tenotome (front view ¾ turn), where: 1 - handle; 2 - working part; 3 - bottom canvas; 4 - upper canvas; 5 - guide groove; 6 - limiter; 7 - hook of the lower web; 8 - cutting edge of the lower web; 9 - prying the hook; 10 - cutting edge of the upper web; 11 - front edge of the guide groove; 12 - rear edge of the guide groove;

Fig. 3, tenotome (front view), where: 1 - handle; 2 - working part; 4 - upper canvas; 7 - hook of the lower canvas; 8 - cutting edge of the lower web; 9 - prying the hook;

Fig. 4 Tenotome (front view ¾ turn, the handle is compressed, the canvases are brought together), where: 2 - working part; 3 - bottom canvas; 4 - upper canvas; 5 - guide groove; 6 - limiter; 10 - cutting edge of the upper web; 12 - rear edge of the guide groove;

Fig. 5. The position of the patient with lateral epicondylitis on the operating table.

Fig. 6. Optics installed in the proximal medial approach.

Fig. Fig. 7. Stages of formation of the anterolateral (instrumental) access, where: a - visualization of the glenohumeral joint; b - marking access with a needle; c - obturator installed in the formed anterolateral access, external view; d - obturator installed in the formed anterolateral approach, inside view.

Fig. 8. Stage of detection of the tendon of the short radial extensor of the wrist.

Fig. 9. Tenotome installed in the joint through the anterolateral approach, where: a - external view; b - view from the inside of the joint, tenotome in the initial position, ready for work; c - the handle of the tenotome is compressed, the work is done.

Fig. 10. Image of the performed tenotomy of the short radial extensor of the wrist.

The tenotome is made of a material approved for use in traumatology and orthopedics, and consists of a handle 1 and a working part 2 (Fig. 1, 2, 3, 4). The handle 1 is made in the form of a leaf spring (spring circuit), the ends of which at a right angle smoothly pass into the blades 3 and 4 of the working part 2.

The upper web 4 is located above the lower web 3 and tightly adjoins 4 to it 3. The web 4 contains a through longitudinal guide groove 5 for the location of the limiter 6, which 6 is rigidly fixed on the upper surface of the lower web 3. The limiter 6 does not protrude beyond the surface of the upper web 4.

The top blade 4 ends with a cutting edge 10.

The lower web 3 ends with a hook 7, which is 7 made in the plane of the web 3 and equal in width to the web. The hook 7 protrudes from under the upper blade 4. The cutting edge 8 of the lower blade 3 is located on the underwear 9 of the hook 7, and the cutting edges 8 and 10 are made in a complementary (corresponding) configuration and have opposite sharpening.

In the initial position of the tenotome, the limiter 6 is in contact with the front edge 11 of the guide groove 5 (the front stop for the extreme position of the limiter 6). When the handle 1 is compressed, the outer edge of the hook 7 reaches the level of the cutting edge 10 of the upper blade 4, while the limiter 6 abuts against the rear edge 12 of the guide groove 5 (back stop for the extreme position of the limiter 6).

Next, we present the work and illustrative examples of the clinical application of the proposed device.

During the operation of tendon release of the short radial extensor of the wrist (in the treatment of a patient with lateral epicondylitis), the device works as follows: the patient is positioned on a healthy side, the injured upper limb is fixed with a shoulder stop, after installing a 30° 4 mm arthroscopic optic in the proximal medial approach, the brachioradial is visualized. joint. Then, using a needle, the topography of the anterolateral (instrumental) access is identified, through which the joint capsule is resected with a high-frequency ablator and a shaver, after which the tendon of the short radial extensor carpi (CLRC) or the radial flexor of the wrist (FRC) is visualized. Further, holding the device by the handle 1, the working part 2 leads it into the joint cavity, the tendon is captured by underwear 9 of the hook 7 located on the bottom sheet 3. In this case, the limiter 6 contacts the front edge 11 of the guide groove 5.

Next, squeeze the handle 1 to the stop. At the same time, the blades 3, 4, moving relative to each other, and the limiter 6 along the guide groove 5, close the cutting edges 8 and 10 with the latter overlapping each other, which cross or cut off the selected tendon. In this case, the outer edge of the hook 7 reaches the level of the cutting edge 10 of the upper blade 4, and the limiter 6 rests against the rear edge of the guide groove 12.

During the operation of the release of the radial flexor of the wrist (on the example of the treatment of a patient with medial epicondylitis), the device works as follows: in the position of the patient on a healthy side, the injured upper limb is fixed with a shoulder stop, after the installation of arthroscopic optics 30° 4 mm in the anterolateral approach, the glenohumeral joint is visualized . The medial surface of the joint capsule is visualized in the region of the medial epicondyle of the humerus. Next, using a needle, the topography of the proximal medial (instrumental) access is identified, through which the joint capsule is resected with a high-frequency ablator and a shaver, after which the flexor carpi radialis tendon (FRC) is visualized. Next, holding the handle 1 with the tenot, the working part 2 is inserted into the joint cavity, the tendon of the LSZ is captured by underwear 9 of the hook 7 located on the lower canvas 3. In this case, the limiter 6 contacts the front edge 11 of the guide groove 5.

Next, squeeze the handle 1 to the stop. At the same time, the blades 3, 4, moving relative to each other, and the limiter 6 along the guide groove 5, close the cutting edges 8 and 10 with the latter overlapping each other, which cross or cut off the selected tendon. In this case, the outer edge of the hook 7 reaches the level of the cutting edge 10 of the upper blade 4, and the limiter 6 rests against the rear edge of the guide groove 12.

Clinical case #1

1. Patient A, 40 years old, with lateral epicondylitis of the left humerus. Clinically: Welsh, Thomsen tests are positive, carpal dynamometry: 30daN - injured limb; 40daN - healthy limb. MRI of the elbow joint - signs of lateral epicondylitis of the humerus.

The position of the patient on a healthy side, the injured upper limb was fixed with a shoulder rest (Fig. 5), after the installation of arthroscopic optics 30° 4 mm in the proximal medial approach (Fig. 6), the glenohumeral joint was visualized. Next, using a needle, the topography of the anterolateral (instrumental) access was determined (Fig. 7). Next, a resection of the joint capsule was performed with a high-frequency ablator and a shaver, and the tendon of the short radial extensor carpi (CLRC) was identified (Fig. 8). After that, the tenotome was brought into the joint through the anterolateral approach (Fig. 9), then the trapped tendon was released (Fig. 10). As a result, it was possible to perform a minimally invasive periosteal release of the damaged tendon, which made it possible to exclude the preservation of the degeneratively altered tendon tissue of the central stump. Thus, already a month after the operation, clinical results were obtained, which can be used to draw a conclusion about the effectiveness of the use of the claimed device: Welsh and Thomsen clinical tests are negative, carpal dynamometry: 40daN - injured limb; 40daN - healthy limb.

Clinical case #2

1. Patient C, 45 years old, with medial epicondylitis of the right humerus. Clinically: the reverse Cosen test is positive, carpal dynamometry: 30daN - injured limb; 40daN - healthy limb. MRI of the elbow joint - signs of medial epicondylitis of the humerus.

The position of the patient on a healthy side, the injured upper limb was fixed with a shoulder rest, after the installation of arthroscopic optics 30° 4 mm in the anterolateral approach, the medial surface of the joint capsule was visualized in the region of the medial epicondyle of the humerus. Next, using a needle, the topography of the proximal medial (instrumental) access was determined. Then, a resection of the joint capsule was performed using a high-frequency ablator and a shaver, and the tendon of the radial flexor of the wrist (FRC) was identified. After that, the tenotome was brought into the joint through the proximal medial approach. The LSZ tendon was grasped periosteally with a hook. After that, by bringing the handles of the tenotome handle together, the captured tendon was released. As a result, it was possible to perform a minimally invasive periosteal release of the damaged tendon, which made it possible to exclude the preservation of the degeneratively altered tendon tissue of the central stump. Thus, already a month after the operation, clinical results were obtained, according to which it is possible to conclude that the claimed device is effective: the reverse Cosen clinical test is negative, carpal dynamometry: 40daN - injured limb; 40daN - healthy limb.

Bibliography

1. Smidt N, van der Windt DA. Tennis elbow in primary care. BMJ 2006; 333:927-928.

2. Ahmad Z, Siddiqui N, Malik SS, et al. Lateral epicondylitis: a review of pathology and management. Bone Joint J [Br] 2013;95-B:1158-1164.

3. Rose NE, Forman SK, Dellon AL. Denervation of the lateral humeral epicondyle for treatment of chronic lateral epicondylitis. J Hand Surg Am. 2013;38(2):344-9.

4. Lattermann C, Romeo AA, Anbari A, et al. Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis. J Shoulder Elbow Surg. 2010;19(5):651-656. doi: 10.1016/j.jse.2010.02.008.

5. Berry N, Neumeister MW, Russell RC, Dellon AL. Epicondylectomy versus denervation for lateral humeral epicondylitis. Hand (N Y). 2011;6(2):174-8.

6. Basket cutters Scoop 012030 1.3 working part is bent up. Catalog of hand tools ACUFEX. Smith&nephew 2012. p. 7

7. Application No. US2014277020-A1/03/12/2013. Google David C (Us), Ingwer Zachary A (Us), Jolly Jacob A (Us). Quadriceps tendon stripper/cutter

Claims (1)

Tenotome, which includes a handle and a working part with a cutting element at the end, characterized in that the handle is made in the form of a leaf spring, the ends of which smoothly pass at a right angle into the upper and lower webs of the working part, which fit snugly against each other; the upper web ends with a cutting edge, and the lower one ends with a hook protruding from under the upper web; the cutting edge of the lower web is located on the underside of the hook; cutting edges are made of complementary configuration and have opposite sharpening; on the upper sheet along its longitudinal axis there is a through groove, and on the lower sheet there is a limiter that enters the groove without protruding beyond the surface of the upper sheet.

Images