China
Africa
Explore chapters and articles related to this topic
Arthroscopic resection of the superomedial scapula and scapulothoracic bursectomy
Published in Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss, Atlas of Advanced Shoulder Arthroscopy, 2017
Numerous muscles participate in the scapulothoracic motion, and their origins on the scapula body separate off various spaces that are occupied by bursa. The levator scapulae and romboids originate from the axial spine and insert onto the medial border of the scapula. The serratus anterior originates from the chest wall and inserts on the undersurface of the entire medial edge of the scapula. The subscapularis muscle also originates from the undersurface of the scapula. Two spaces are created as a result of these two muscles—the scapulothoracic space or serratus anterior space and the subscapuarlis space.4 The scapulothoracic space is formed between the chest wall and the serratus anterior and is the location of the scapulothoracic or infraserratus bursa.4 This bursa is typically involved with snapping scapula syndrome and is removed during surgical bursectomy. The subscapularis space is formed between the subscapularis and the serratus anterior and is the location of the subscapularis or supraserratus bursa.4 This location is not typically involved with snapping scapula syndrome and should be avoided during surgery because it is not the location of the pathologic bursa and it is also the location of the neurovascular bundle (Figure 43.1).
Arthritis and Common Musculoskeletal Conditions
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Jennifer H. Paul, Katarzyna Iwan, Claudia Ramirez
Surgery is indicated for severe refractory cases. Surgical management may involve lengthening/release of the ITB and fascia lata (proximal Z-plasty, proximal longitudinal release, and distal Z-plasty). For others, treatment may involve a bursectomy or trochanteric reduction osteotomy. Repairing tears of gluteus medius and gluteus minimus have been shown to improve pain.69
Gluteus medius tears of the hip: a comprehensive approach
Published in The Physician and Sportsmedicine, 2019
Collin LaPorte, Marci Vasaris, Leland Gossett, Robert Boykin, Travis Menge
Arthroscopic repair is accomplished through standard hip arthroscopy portals, including the anterolateral (AL) and mid-anterior (MAP) portals, with accessory portals placed as needed. An arthroscopic bursectomy is then performed until it is possible to visualize the gluteus maximus proximally, vastus lateralis medially, and the gluteus medius lateral footprint of the greater trochanter and gluteus minimus insertion anteriorly. After identifying the tear, the gluteus medius footprint is debrided to bleeding bone (Figure 2). Sutures are passed independently through the torn tendon (in a manner similar to rotator cuff repair in the shoulder) and tied, completing the repair. The hip is taken through passive motion to evaluate the stability of the repair. For large or retracted tears, a double row repair can be performed to improve the biomechanical construct and help establish improved contact with the footprint. Additional anchors can be used in a single or double row construction, depending upon the extent of the gluteus medius disruption [18]. Arthroscopic repairs offer the advantage of being much less invasive than open repairs, although require specialized training and have a steep learning curve.
Oncologic Effectiveness and Safety of Bursectomy in Patients with Advanced Gastric Cancer: A Systematic Review and Updated Meta-Analysis
Published in Journal of Investigative Surgery, 2018
Luigi Marano, Karol Polom, Alberto Bartoli, Alessandro Spaziani, Raffaele De Luca, Laura Lorenzon, Natale Di Martino, Daniele Marrelli, Franco Roviello, Giampaolo Castagnoli
Results from our meta-analysis clearly show that there is not statistically significant prognostic difference, in terms of OS, between the bursectomy versus nonbursectomy groups. Conversely, the resection of bursa omentalis is associated with better overall survival than nonbursectomy surgery in serosa positive gastric cancer patients. The omental bursa (or lesser peritoneal sac) represents a posterior peritoneal space between the liver, stomach and omentum, anteriorly, and the pancreas, left adrenal gland and kidney, posteriorly. Since it is connected with the main peritoneal cavity only through the foramen of Winslow, it is considered an anatomical barrier against the spillage of cancer cells adhering at the posterior gastric wall [24, 25]. According to this anatomical as well as oncological consideration, the bursectomy (mainly defined as a dissection of the peritoneal lining covering the pancreas and the anterior plane of the transverse mesocolon with an omentectomy [24, 30]) represents a procedure performed to: (1) eliminate cancer cells and/or micrometastasis trapped in the lesser sac of peritoneal cavity; (2) improve the resection of the subpyloric and peripancreatic lymph nodes [24, 25, 44–47]. Interestingly, this surgical technique has been recommended as part of complete radical gastrectomy since the 1960s in Japan exclusively based on traditional acceptance. However, recent changes of Japanese Gastric Cancer Treatment Guidelines recommended bursectomy only for tumors with invasion of the serosa of posterior gastric wall [7, 28]. Nevertheless, the therapeutic efficacy of bursectomy is still controversial because the survival benefit is uncertain. The unique randomized controlled trial on 210 patients with cT2–3 gastric adenocarcinoma indicated the bursectomy as an independent prognostic factor of good OS [20]. The five-year OS resulted in 77.5% for the bursectomy group and 71.3% for the non bursectomy group, while the subgroup analysis showed a trend toward improved survival after bursectomy for tumors in the middle or lower third of the stomach and for pathologically serosa-positive tumors [20]. Similar results were reported in the retrospective study by Zhang et al. [29]. Converesely, other studies showed totally opposite results, finding no survival benefits of bursectomy when compared with nonbursectomy surgery [21, 33, 43]. Furthermore, a recent meta-analysis by Shen et al. [33] concluded that there was no statistically significant survival benefits for the bursectomy when compared with nonbursectomy surgery for gastric cancer patients and for subgroup of serosa-positive patients as well. These results, however, may be unreliable since the study by Shen et al. [33] was affected by selecting bias due to the inclusion of the paper by Hasegawa et al. [42], investigating the impact of greater omentum resection rather than bursectomy for advanced gastric cancer patients.