WO2010017307A1 - Instrumentation d'exposition du glénoïde - Google Patents

Instrumentation d'exposition du glénoïde Download PDF

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Publication number
WO2010017307A1
WO2010017307A1 PCT/US2009/052869 US2009052869W WO2010017307A1 WO 2010017307 A1 WO2010017307 A1 WO 2010017307A1 US 2009052869 W US2009052869 W US 2009052869W WO 2010017307 A1 WO2010017307 A1 WO 2010017307A1
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WO
WIPO (PCT)
Prior art keywords
humeral
arm
scapular
head
humerus
Prior art date
Application number
PCT/US2009/052869
Other languages
English (en)
Inventor
John M. Fenlin
Brent A. Ponce
Steve Block
Ryan Koepke
Original Assignee
Tornier, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Tornier, Inc. filed Critical Tornier, Inc.
Publication of WO2010017307A1 publication Critical patent/WO2010017307A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/025—Joint distractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/562—Implants for placement in joint gaps without restricting joint motion, e.g. to reduce arthritic pain
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00473—Distal part, e.g. tip or head

Definitions

  • the present invention relates generally to the field of surgical instrumentation for glenoid exposure.
  • the present invention relates to a retraction device and a method of using the retraction device to expose the glenoid area of a patient.
  • a retraction device In surgical operations, it is customary to use a retraction device to properly gain access to bone structures, joints and internal organs. Such devices are designed to hold back anatomy in the immediate area of the operative site to enable a surgeon both an optimal view of the site and a sufficient working area. The less obstructive a retraction device, the more useful it is to surgeons. Additionally, some conventional retractors require that the surgeon use one hand to operate the retractor, which leaves the surgeon with only one hand to perform surgical functions. Often, a surgical assistant must operate the retractor to maintain adequate exposure of a joint in order for the surgeon to view the operation site and to perform the bone work.
  • the guide includes a glenoid contact surface and an anterior scapula contact surface.
  • One form of the apparatus and method includes a guide for positioning a guide pin to facilitate implantation of a glenoid prosthesis so that the guide pin may be anchored in the glenoid and serve as an alignment guide for other devices, such as implants, used to modify the glenoid surface. (See, for example, U.S. Patent 7,294,133). While this device allows the surgeon to accurately target the glenoid cavity, it may not open up the glenoid area enough to introduce large implantation devices.
  • One such surgical retractor design includes a pair of arms with a pivotal connection, a pair of retractor blades in which each blade is detachably connected to an arm by a rotating knee joint allowing the retractor blade to rotate, and a locking mechanism.
  • a rotating knee joint allowing the retractor blade to rotate
  • a locking mechanism See, for example, US Patent 6,663,562. While this design has flexibility in angularity and motion, the retraction portion is limited in the angle at which the two retraction blades move apart from one another, requiring a customized fit for each surgical retraction, including exposure of the glenoid.
  • Another design teaches using an alignment guide comprising a plate for displacing the deltoid muscle and a drill guide slidably movable along the retractor plate to expose the glenoid and assist shoulder implantations.
  • the retractor is designed to move muscle and soft tissues from the glenoid to provide surgical access.
  • the device is not designed to open the glenohumeral joint by extending the humerus.
  • a European design includes a glenoid alignment guide including a retractor plate for displacing the superior and posterior aspect of the deltoid muscle and a drill guide slidably carried on the retractor plate
  • the retractor plate has a curved finger where the tip engages the bone of the glenoid neck to clear the glenoid of muscle and tissue.
  • tissue retractors use fluid-operated expansion or bladder mechanisms.
  • Another design teaches a mechanically expandable retractor for use in arthroscopic surgery.
  • the retractor includes an expanding portion for expanding against sub-surface tissues at its distal end and is controlled by a projecting portion at a proximal end (See, for example, US Patent 5,454,365).
  • Another retractor has a mechanical expanding portion for expanding against sub-surface tissues and has an independently controllable fluid-operated expanding portion for expanding against sub-surface tissues (See, for example, US Patent 5,707,390).
  • One surgical instrument for retracting muscles and other tissues includes a clamp with jaws for attachment around a bone, a blade for retracting muscles and tissues away from the bone, a pivotable mounting member to interact with the blade and a rod for support.
  • the instrument can effectively retract muscle and tissue to expose a bone for surgery; however, it is not ideal for bone retraction because the construction of the instrument cannot easily be used to exert enough force for bone distraction.
  • the instrument is large and obstructive in design, including a large mounting member which limits a surgeon's view of the operative site.
  • FIG. 1 Another patented method for performing surgery on a shoulder joint utilizes a positionable support arm attached to a retractor support apparatus.
  • a retractor where the humerus retractor blade is positioned about the humerus, the humeral ball is dislocated from the glenoid cavity (See, for example, US Patent 6,368,271).
  • Another patent teaches a retraction apparatus for retracting anatomy in which the retractor blade is angularly-adjustable to provide exposure of the surgical area.
  • the apparatus includes a handle rod, a body portion, a retractor blade and a mechanism which allows the retractor blade to be angularly adjusted and secured (See, for example, US Patent 5,902,233).
  • the present invention is a surgical instrument for shoulder joint distraction.
  • the surgical instrument includes a scapular arm having a first end and a second end, a humeral arm having a first end and a second end, and a plate shaped to engage all or part of a head of a humerus.
  • the scapular arm and the humeral arm are articulated relative to one another.
  • the first end of the scapular arm includes means for engaging part of a shoulder scapula and the first end of the humeral arm is mechanically attached to the plate.
  • the present invention is a surgical shoulder joint distraction method.
  • the method includes, in succession, gaining access to a region of a joint between a shoulder scapula glenoid cavity and a head of a humerus in a shoulder, covering at least part of the head of the humerus with a complementing plate, inserting first ends of a scapular arm and a humeral arm between the shoulder scapula glenoid cavity and the head of the humerus, respectively, and parting the first ends of the scapular and humeral arms such that the first end of the scapular arm presses against the glenoid cavity and the first end of the humeral arm collaborates mechanically with the plate to press the plate against the head of the humerus.
  • the present invention is a method of surgical shoulder joint distraction.
  • the method includes, in succession, gaining access to a region of a joint between a shoulder scapula glenoid cavity and a head of a humerus in a shoulder, dislocating the head of the humerus with respect to the shoulder scapula glenoid cavity, partially resecting the head of the humerus, introducing an end of a scapular arm and an end of a humeral arm between a coracoid process of the shoulder scapula and the resected head of the humerus, and parting the ends of the scapular and humeral arms by articulating the arms relative to one another.
  • the scapular and humeral arms are introduced between the coracoid process of the shoulder scapula and the resected head of the humerus until the end of the scapular arm engages against the coracoid process and a plate mechanically attached to the end of the humeral arm engages against the resected head of the humerus.
  • the ends of the scapular and humeral arms are parted such that the plate presses against the resected head of the humerus and moves the resected head of the humerus away from the shoulder scapula by pushing it in a posterio-inferior anatomical direction.
  • FIG. 1 is a perspective view of a first part of a first embodiment of a retraction device in accordance with the present invention.
  • FIG. 2 is a perspective view of a second part of the first embodiment of the retraction device in accordance with the present invention.
  • FIG. 3 is a schematic elevation of the retraction device of FIGS. 1 and 2 in the process of being used in accordance with the first embodiment of the present invention.
  • FIG. 4 is a perspective view of an alternative embodiment of the second part of the first embodiment of the retraction device in accordance with the present invention.
  • FIG. 5 is a perspective view of a retraction device in accordance with a second embodiment of the present invention.
  • FIG. 6 is a schematic view of a first step in a method of retracting a glenoid in accordance with the second embodiment of the present invention.
  • FIG. 7 is a schematic view of a second step in the method of retracting a glenoid in accordance with the second embodiment of the present invention.
  • FIG. 8 is a schematic view of a third step in the method of retracting a glenoid in accordance with the second embodiment of the present invention.
  • FIG. 9 is a schematic view of a fourth step in the method of retracting a glenoid in accordance with the second embodiment of the present invention.
  • FIG. 10 is a side view of the fourth step in the method of retracting a glenoid in accordance with the second embodiment of the present invention.
  • FIG. 11 is a schematic view of a fifth step in the method of retracting a glenoid in accordance with the second embodiment of the present invention.
  • FIG. 1 depicts a schematic view of a first embodiment of a retraction device 10 of the present invention for distracting a shoulder joint.
  • the retraction device 10 includes distraction forceps 12 having a scapular arm 14 pivotally connected to a humeral arm 16 about an axis Z-Z by an articulation means 18. Oftentimes, surgeons have difficulty exposing the glenoid joint area for accurate alignment purposes.
  • the retraction device 10 helps the surgeon to efficiently gain access to the glenoid joint area by positioning the scapular arm 14 against a scapula S and the humeral arm 16 against a humerus H and pushing a humeral head T of the humerus H posterior-inferiorly to distract the glenoid joint.
  • FIG. 3 shows the bones of the shoulder exposed using the retraction device 10.
  • the glenoid joint includes a shoulder scapula S, including a coracoid process C, and a humerus H. When exposed, an upper epiphysis of the humerus H is articulated at its head T against the glenoid cavity G of the shoulder scapula S. Because the retraction device 10 is compact, the retraction device 10 provides the surgeon with an unobstructed view of the surgical site while performing a surgery or implantation procedure. A method of using the retraction device 10 to expose the glenoid joint area is also provided.
  • Each of the scapular and humeral arms 14 and 16 is in the form of an elongate rigid bar having a width and thickness substantially smaller than its length.
  • the scapular arm 14 includes a distal end 20 and a proximal end 22 and the humeral arm 16 includes a distal end 24 and a proximal end 26.
  • the scapular and humeral arms 14 and 16 extend along one another and are articulated to one another at the articulation means 18 so as to be able to pivot relative to one another about the axis of articulation Z-Z.
  • the surgeon manipulates the proximal ends 22 and 26, respectively, of the scapular and humeral arms 14 and 16 in such a way as to separate them or to bring them closer together.
  • FIG. 1 depicts the scapular and humeral arms 14 and 16 articulated to one another substantially mid-way between the distal ends 20 and 24 and the proximal ends 22 and 26, the scapular and humeral arms 14 and 16 may be articulated substantially anywhere between the distal ends 20 and 24 and the proximal ends 22 and 26 without departing from the intended scope of the present invention.
  • Each of the scapular and humeral arms 14 and 16 has a distal longitudinal part 28 and 30 and a proximal longitudinal part 32 and 34 which, in use, face respectively towards the user of the forceps 12 and towards the shoulder that is to be distracted.
  • the distal parts 28 and 30 of the scapular and humeral arms 14 and 16 run substantially parallel to one another, substantially contiguously, while the proximal parts 32 and 34 are spaced from one another with a relative separation that increases along the length of the scapular and humeral arms 14 and 16 from the articulation means 18 to the proximal ends 22 and 26 of the scapular and humeral arms 14 and 16.
  • the forceps 12 also include a locking mechanism 36 that locks the relative pivoted position of the scapular and humeral arms 14 and 16. In the embodiment shown in FIG.
  • the locking mechanism 36 includes a bar 38 that is articulated to the proximal end 26 of the humeral arm 16 and a set of teeth 40 that face towards the humeral arm 16.
  • the proximal end 22 of the scapular arm 14 is shaped to engage the set of teeth 40.
  • the locking mechanism 36 also includes a lever 42 pivotally mounted on the proximal end 22 of the scapular arm 14 so that when the lever 42 is engaged around the bar 38, as shown in FIG. 1, the lever 42 firmly holds the proximal end 22 of the scapular arm 14 in the bottom of one of the dedenda of the set of teeth 40, thus immobilizing the relative pivoted configuration of the scapular and humeral arms 14 and 16.
  • the set of teeth 40 can be disengaged from the proximal end 22 of the scapular arm 14 so that the humeral arm 16 can be moved freely with respect to the scapular arm 14 about the axis Z-Z.
  • the above-described locking mechanism 36 may be reversed with respect to the scapular and humeral arms 14 and 16 such that the bar 38 is articulated to the proximal end 22 of the scapular arm 14 while the proximal end 26 of the humeral arm 16 is designed to engage the set of teeth 40.
  • the locking mechanism 36 aimed at immobilizing the articulation between the scapular and humeral arms 14 and 16 so as to maintain a fixed separation between their proximal ends 22 and 26 and therefore between their distal ends 20 and 24 may be used without departing from the intended scope of the present invention.
  • the distal parts 28 and 30 of the scapular and humeral arms 14 and 16 have a curved longitudinal profile and are each respectively rigidly equipped with a peg 44, 46 which projects out from the main plane face of one of the scapular and humeral arms 14 and 16, opposite the other arm 14, 16, as can be seen in FIG. 3.
  • Each peg 44, 46 is centered on an axis X 44 , X 46 transverse to the scapular and humeral arm 14 and 16 which extends orthoradially with respect to the axis of articulation Z-Z, as shown in FIG. 1.
  • each projecting peg 44, 46 has the exterior form of a cylinder on a circular base, centered on the axis X 44 , X 46 , equipped at its free end with a blunted point.
  • the retraction device 10 also includes a plate 48, depicted in FIG 2.
  • the plate 48 has the specific feature of not being flat but, by contrast, of being domed, and having a substantially constant thickness.
  • the plate 48 thus has a convex face 48A and a concave face 48B.
  • the convex face 48A faces the forceps 12, as explained in detail below.
  • the concave face 48B is dimensioned so that, in application, the concave face 48B covers in a substantially complementary manner part of the convex joint face of the head T of the humerus H.
  • the concave face 48B of the plate 48 is provided with a plurality of small spikes or teeth in order to facilitate the adhesion between the concave face 48B and the head T of the humerus H.
  • the small spikes or teeth prevent the concave face 48B from sliding against the head of the humerus H.
  • the plate 48 has a plurality of cavities 50 passing through its thickness. Each of the cavities 50 extends through the convex and concave faces 48 A and 48B of the plate 48 and is designed to accept the peg 46 of the humeral arm 16 to mechanically attach the plate 48 to the humeral arm 16. After the plate 48 is attached to the humeral arm 16, the plate 48 presses against the head T of the humerus H such that when the humeral arm 16 is pivoted with respect to the scapular arm 14, the distal ends 20 and 24 of the scapular and humeral arms 14 and 16 move apart.
  • each cavity 50 is in the form of a cylinder on a circular base that is smaller than that of the cylindrical exterior face of the peg 46 so that only part of the free end of the peg 46 of the humeral arm 16can fit into the cavities 50, where they open onto the convex face 48A.
  • the cavities 50 do not have to extend through the concave face 48B of the plate 48. In other words, the cavities 50 may be blind cavities.
  • the peg 46 of the humeral arm 16 is accommodated completely inside the cavities 50, provided that the axial dimension of the peg 46 of the humeral arm 16 is shorter than the depth of the cavities 50, or the thickness of the plate 48, so that the main face of the humeral arm 16 from which the peg 46 extends presses against the convex face 48A of the plate 48 without the free end of the peg 46 protruding from the concave face 48B.
  • the transverse profile of the cavities 50 is tailored to the exterior transverse profile of the peg 46 so that the peg 46 can be accommodated in the cavities 50 without any transverse clearance.
  • the plate 48 has a hole 52 that differs functionally from the cavities 50, passing through the entire thickness of the plate 48.
  • the hole 52 differentiates from the cavities 50 in part because the hole 52 has a transverse dimension slightly greater than that of the cavities 50.
  • the hole 52 is sized to accommodate a pin 54 passing through the exterior transverse profile.
  • the pin 54 is partially driven into the head T, as depicted partially by the dotted lines in FIG. 3.
  • the pin 54 may correspond to an already existing alignment pin, supplied as part of the retraction device 10 for resurfacing the head T, such as the resurfacing instrumentation associated with the Aequalis (registered trade name) prostheses marketed by the TORNIER company (France).
  • the pin 54 may be embodied in other ways which may or may not be specific to the remainder of the retraction device 10.
  • the plate 48 is then placed on the head T of the humerus H by slipping the hole 52 around the pin 54 until the concave face 48B is brought into contact with the joint face of the head T, as depicted in FIG. 3.
  • the plate 48 is seated by impaction against the joint face of the head T.
  • a fluted impactor that comes with the resurfacing instrumentation associated with the Aequalis prostheses mentioned above may be used.
  • the forceps 12 are then manipulated via the proximal ends 22 and 26 of the scapular and humeral arms 14 and 16 so as to insert the distal ends 20 and 24 of the scapular and humeral arms 14 and 16 between the glenoid cavity G of the shoulder scapula S and the head T of the humerus H.
  • the introduction of the distal ends 20 and 24 is formed while the forceps 12 are in the configuration in which they are depicted in FIG. 1, with the distal parts 28 and 30 of the scapular and humeral arms 14 and 16 substantially contiguous in order to make them easier to insert into the region of the joint.
  • the surgeon determines that the distal ends 20 and 24 have been inserted a sufficient depth between the glenoid cavity G and the head T, the surgeon moves the proximal ends 22 and 26 of the scapular and humeral arms 14 and 16 closer together. If necessary, the locking mechanism 36 is first unlocked. By relative pivoting of the scapular and humeral arms 14 and 16 about the axis Z-Z, the distal ends 20 and 24 move apart, as indicated by the arrow Fi in FIG. 3.
  • the peg 44 of the scapular arm 14 then presses against the glenoid cavity G, while the peg 46 of the humeral arm 16 engages in one of the cavities 50 of the plate 48 so that the proximal end 24 of the humeral arm 16 presses the plate 48 firmly against the head T of the humerus H.
  • the cavity 50 used is chosen by the surgeon during the course of the procedure, thus making the retraction device 10 easier to use for different depths of insertion of the forceps 12 and for different surgical approach routes at greater or lesser angles.
  • the surgeon gradually separates the glenoid cavity G and the head T from one another in a direction substantially ortho-radial with respect to the axis Z-Z.
  • the plate 48 is fixedly pressed against the head T, particularly under the action of the spikes or teeth provided on its concave face 48B.
  • the axillary pocket is exposed by symmetric distraction of the shoulder joint. This being the case, the soft tissues around the axillary pocket are moved clear very precisely.
  • the surgeon determines that the relative separation between the glenoid cavity G and the head T is sufficient, the surgeon locks the pivoted configuration of the scapular and humeral arms 14 and 16 using the locking mechanism 36, as explained above. The surgeon can then release the forceps 12 and use both hands to continue the surgical procedure, for example to prepare the glenoid cavity G and/or the head T for the implanting a partial or total shoulder prosthesis.
  • the shoulder joint distraction is stable because of the locking mechanism 36 and the plate 48, which is immobilized against the head T under the action of the concave face 48B and of the pin 54.
  • the plate 48 protects the head T, particularly against other ancillary instruments that might be introduced between the glenoid cavity and the head T during the surgical procedure without impeding the surgeon because of the small thickness of the plate 48 and the fact that it is shaped to complement the head T.
  • the peg 44 of the scapular arm 14 is substantially identical to the peg 46 of the humeral arm 16, as far as their dimensions and their positioning relative to their associated arm 14 and 16 are concerned, the scapular and humeral arms 14 and 16 can be used with equal preference to act either on the shoulder scapula S or on the humerus H.
  • different embodiments of pressing means for the peg 44 may be used, particularly through complementing shapes, to improve the bearing contact between the proximal end 20 of the scapular arm 14 and the glenoid cavity G, which may already have a prosthesis.
  • FIG. 4 depicts another embodiment of the plate 48, plate 48', which differs from the plate 48 in that its overall shape is a hemispherical cap.
  • the plate 48' is used similarly to the plate 48 and is provided with cavities 50' and a through-hole 52' which are functionally analogous to the cavities 50 and the hole 52 of plate 48.
  • the hemispherical cap shape allows the plate 48' to be used as a prosthetic humeral trial, particularly during a trial reduction of a shoulder joint being operated on with a view to implanting a total or partial shoulder prosthesis.
  • the through-hole 52' of the plate 48' is substantially more extensive than the cavities 50' and the hole 52' in order to delimit a window 54' through which the head T can be observed.
  • the plate 48' covers the head T and presses against the latter under the action of the forceps 12 in order to distract the shoulder, the surgeon can easily observe the surface condition of the head T through the window 54'.
  • FIG. 5 shows a schematic view of a second embodiment of a retraction device 100 of the present invention including a scapular arm 102 pivotally connected to a humeral arm 104 about an axis Z-Z by an articulation means 106.
  • the retraction device 100 also includes a plate 108.
  • the retraction device 100 exposes the glenoid joint area by positioning the scapular arm 102 on the base of the coracoid process and the humeral arm 104 on the humerus H and pushing the humeral head T of the humerus H posterior- inferior Iy, distracting the glenoid joint.
  • each of the scapular and humeral arms 102 and 104 of the retraction device 100 is in the form of an elongate rigid bar having a width and thickness substantially smaller than its length.
  • the scapular arm 102 includes a proximal end 110, a distal end 112 and a flange 114 at the distal end 112.
  • the humeral arm 104 includes a proximal end 116, a distal end 118 and a tubular member 120 at the distal end 118.
  • the scapular arm 102 and humeral arm 104 of the retraction device 100 cross one another at the articulation means 106 so as to be able to pivot relative to one another about the axis of articulation Z-Z substantially perpendicular to their longitudinal direction.
  • the surgeon manipulates the proximal ends 110 and 116, respectively, of the scapular and humeral arms 102 and 104 in such a way as to separate them or to bring them closer together.
  • the distal end 112 of the scapular arm 102 is equipped with the flange 114 in order to catch the coracoid process C of the shoulder scapula S, and more specifically on the bony base of the process C.
  • the flange 114 is formed in a shape of a "C" of which the central axis of symmetry X c is substantially parallel to the axis of articulation Z-Z and is secured to the distal end 112 of the scapular arm 102.
  • the distal end 118 of the humeral arm 104 is shaped as a tubular member
  • the plate 108 includes a rod 122 and a flat plate 124.
  • the rod 122 is sized to engage the tubular member 120 and projects from one of the edges of the flat plate 124, with the central axis of the rod 122 being parallel to the flat plate 124.
  • the flat plate 124 thus has two flat main faces 124 A and 124B (not shown). In application, the face 124 A faces the distal end 112 of the scapular arm 102 when the rod 122 is received in the tubular member 120, as shown in FIGS. 10 and 11.
  • the retraction device 100 may also include a locking mechanism that locks the relative pivoted position of the scapular and humeral arms 102 and 104.
  • the retraction device 100 distracting the shoulder scapula S and the humeral head T of a humerus H relative to one another, follows.
  • the retraction device 100 securely attaches to the base of a bone, such as the coracoid process in the shoulder, by the flange 114.
  • the surgeon holds and controls the retraction device 100 through the scapular arm 102.
  • the humeral arm 104 is connected to the plate 108 to engage the humerus.
  • the plate 108 is shown and described as including a rod 122 and a flat plate 124, the plate 108 may take various forms.
  • the plate 108 can be made having various sizes and shapes to correspond with varying patient sizes.
  • the plate 108 is a paddle to push the bone.
  • the plate 108 is a connector to a head protector flat plate.
  • the locking mechanism may secure the retraction device 100 to the bone once the retraction device 100 is in place.
  • the glenoid joint Prior to actually using the retraction device 100, the glenoid joint is adjusted so that the glenoid and the humeral head T is exposed.
  • the surgeon gains access to the region of the joint between the glenoid cavity G of the shoulder scapula S and the head T of the humerus H by moving aside the soft parts that cover this joint region, as depicted in FIG. 6.
  • the surgeon then dislocates the humeral head T from the glenoid cavity G, as depicted in FIG. 7, so as to arrange the joint face of the humeral head T outside of the glenoid cavity G, transversely with respect to the latter.
  • the humeral head T is thus dislocated in such a way that its joint face faces towards the coracoid process C of the shoulder scapula S.
  • the humeral head T is then resected such that part of the upper epiphysis of the humerus is removed and separated from the remainder of the humeral head T by a flat cut, thus creating a flat resection face on the humeral head T, as clearly visible in FIG. 8.
  • the retraction device 100 is inserted into the glenoid joint area.
  • the distal ends 112 and 118 of the scapular and humeral arms 102 and 104 of the retraction device 100 are introduced between the coracoid process C of the shoulder scapula S and the resected humeral head T, as depicted in FIGS. 9 and 10.
  • the plate 108 is engaged with the humeral arm 104 of the retraction device 100 by sliding the rod 122 of the expander through the tubular member 120 of the humeral arm 104.
  • the flange 114 of the scapular arm 102 is then engaged around the base of the coracoid process C while the face 124B of the flat plate 124 is brought into planar contact with the resected face of the humeral head T.
  • the angular position of the flat plate 124 with respect to the tubular member 120 of the humeral arm 104 is adjusted by rotating the rod 122 about the axis X T - In this configuration, the flat plate 124 can be positioned in planar contact with the resected humeral head T. Likewise, the axial position of the flat plate 124 is adjusted along the axis X T , particularly with a view to maximizing the interface for contact between the face 124B and the resected humeral head T. [0057] The surgeon then moves the proximal end 116 of the humeral arm 104 away from the proximal end 110 of the scapular arm 102, as indicated by the arrow F 2 in FIG.
  • the tubular member 120 accordingly mechanically drives the flat plate 124 in order to distract the humeral head T with respect to the shoulder scapula S.
  • the final position is shown in FIG. 11.
  • the angular and/or axial position of the flat plate 124 with respect to the axis X T can be adjusted by the surgeon through a small movement of the rod 122 inside the tubular member 120 in order to maintain planar and extensive contact between the face 124B of the plate and the resected face of the humeral head T.
  • the pivoted configuration of the scapular and humeral arms 102 and 104 is immobilized under the action of the locking mechanism.
  • ancillaries can then be used by the surgeon to act on the shoulder, for example, with a view to fitting a total or partial prosthesis, while the flat plate 124 protects the humeral head T against these other ancillaries without in any way thereby impeding the view and use of these ancillaries given the small thickness of this plate.

Abstract

L'invention concerne un procédé de distraction chirurgicale de l'articulation de l'épaule qui inclut successivement l'accès à une partie d'une articulation située entre la cavité glénoïde de l'omoplate et la tête de l'humérus dans l'épaule, le déplacement de la tête de l'humérus par rapport à l'omoplate, la résection partielle de la tête de l'humérus, l'introduction d'extrémités d'un bras scapulaire et huméral entre un procès coracoïde de l'omoplate et la tête de l'humérus résectée et la séparation des extrémités des bras en articulant les bras. Les bras sont placés de telle sorte que l'extrémité du bras scapulaire entre en prise avec le procès coracoïde et en ce qu'une plaque fixée mécaniquement à l'extrémité du bras huméral entre en prise avec la tête humérale résectée. Les extrémités des bras sont séparées de telle sorte que la plaque appuie contre la tête humérale résectée et écarte la tête humérale résectée de l'omoplate en la repoussant dans une direction anatomique postério-inférieure.
PCT/US2009/052869 2008-08-05 2009-08-05 Instrumentation d'exposition du glénoïde WO2010017307A1 (fr)

Applications Claiming Priority (8)

Application Number Priority Date Filing Date Title
US8640008P 2008-08-05 2008-08-05
US61/086,400 2008-08-05
US11761808P 2008-11-25 2008-11-25
US61/117,618 2008-11-25
FR0953200A FR2945436A1 (fr) 2009-05-14 2009-05-14 Instrumentation chirurgicale de distraction osseuse de l'epaule
FR0953200 2009-05-14
US18218509P 2009-05-29 2009-05-29
US61/182,185 2009-05-29

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PCT/US2009/063272 WO2010065233A1 (fr) 2008-11-25 2009-11-04 Dispositif d'exposition d'articulation
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US20110282158A1 (en) * 2010-05-17 2011-11-17 Depuy Products, Inc. Spreading retractor
WO2012021241A2 (fr) * 2010-08-12 2012-02-16 Smith & Nephew, Inc. Procédés et dispositifs pour installer des implants d'épaule standards et inversés
WO2022053519A1 (fr) * 2020-09-10 2022-03-17 Limacorporate S.P.A. Dispositif d'espacement chirurgical pour une articulation

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WO2000019911A2 (fr) * 1998-10-02 2000-04-13 Synthes Ag Chur Ecarteur de l'espace intervertebral
WO2001045595A2 (fr) * 1999-12-17 2001-06-28 Cartificial A/S Dispositif prothetique
WO2003099146A2 (fr) * 2002-05-21 2003-12-04 Sdgi Holdings, Inc. Instruments et techniques pour la separation de structures osseuses
US20040199252A1 (en) * 2003-04-03 2004-10-07 William Sears Apparatus and method for supporting vertebral bodies
WO2005122910A1 (fr) * 2004-06-22 2005-12-29 Waldemar Link Gmbh & Co. Kg Ecarteur chirurgical
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US3750652A (en) * 1971-03-05 1973-08-07 J Sherwin Knee retractor
GB2080113A (en) * 1980-07-11 1982-02-03 Hardinge Kevin Surgical tool
WO2000019911A2 (fr) * 1998-10-02 2000-04-13 Synthes Ag Chur Ecarteur de l'espace intervertebral
WO2001045595A2 (fr) * 1999-12-17 2001-06-28 Cartificial A/S Dispositif prothetique
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US20110282158A1 (en) * 2010-05-17 2011-11-17 Depuy Products, Inc. Spreading retractor
US8529445B2 (en) * 2010-05-17 2013-09-10 DePuy Synthes Products, LLC Spreading retractor
US20130317313A1 (en) * 2010-05-17 2013-11-28 DePuy Synthes Products, LLC Spreading retractor
US9107629B2 (en) 2010-05-17 2015-08-18 DePuy Synthes Products, Inc. Spreading retractor
WO2012021241A2 (fr) * 2010-08-12 2012-02-16 Smith & Nephew, Inc. Procédés et dispositifs pour installer des implants d'épaule standards et inversés
WO2012021241A3 (fr) * 2010-08-12 2012-05-10 Smith & Nephew, Inc. Procédés et dispositifs pour installer des implants d'épaule standards et inversés
US20140012266A1 (en) * 2010-08-12 2014-01-09 Smith & Nephew, Inc. Methods and devices for installing standard and reverse shoulder implants
US9232955B2 (en) * 2010-08-12 2016-01-12 Smith & Nephew, Inc. Methods and devices for installing standard and reverse shoulder implants
US10426495B2 (en) 2010-08-12 2019-10-01 Smith & Nephew, Inc. Methods and devices for installing standard and reverse shoulder implants
US10842512B2 (en) 2010-08-12 2020-11-24 Smith & Nephew, Inc. Methods and devices for installing standard and reverse shoulder implants
WO2022053519A1 (fr) * 2020-09-10 2022-03-17 Limacorporate S.P.A. Dispositif d'espacement chirurgical pour une articulation

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WO2010053994A1 (fr) 2010-05-14
WO2010065233A1 (fr) 2010-06-10

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