Bitsadze M. Improving surgical treatment of patients with unstable shoulder joint capsule with combined injuries and Hill-Sachs lesion

Object: instability of the shoulder joint in a violation of the congruence of the articular surfaces. Purpose: develop the algorithm and scheme for choice of surgical approach in patients with unstable shoulder joint and combined injuries capsule and Hill-Sachs lesion (based on the study of the mechanism of realization of habitual dislocation of the shoulder in violation of congruency of the articular surface of the humerus and scapula). Methods: information and analytical, clinical, computer modeling of values impression defect of the articular surface of the humeral head, mathematical modeling of the shoulder joint stabilization and mechanism for the implementation of recurrent shoulder dislocation, statistical. As a result of mathematical modeling it was proved that the defect of the humeral head involving the articular edge of the scapula is the key mechanism for the implementation of the humerus dislocation. For the first time it was found that the main conditions for the implementation of this mechanism is the angle of inclination of the defect of the humerus head and this defect area. The angle of defect inclination over 60? and defect area smaller ? area of the scapula articular surface are critical values at which the shoulder joint stability will be kept. Based on the results of modeling the methodology of preoperative planning of surgical treatment of patients with shoulder joint instability and combined injuries of the capsule and Hill-Sachs lesions has been developed. For the first time on the basis of mathematical and computer modeling biomechanically grounded mathematical algorithm to choice of tactics of surgical treatment of shoulder joint instability, depending on the characteristics of the defect of the humeral head articular surface has been proposed. It was proved that the type and extent of surgery depend on the ratio of the area of the humerus head defects to the articular surface of the scapula and, accordingly, the angle of inclination of the humeral head defect. The method of computer modeling and calculation of geometrical parameters of the humeral head defect developed. This method makes it possible to perform high-quality preoperative planning, which implies an individual approach to patients with defects of the humeral head. This eventually allowed increase the effectiveness of surgical treatment of patients with shoulder joint instability in case of combined injuries of the capsule and Hill-Sachs damages, as well as exclude relapses shoulder joint instability after surgery. Based on the results of studies of the implementation mechanism of dislocations of the humerus, which are accompanied by Hill-Sachs damages, practical recommendations to the determination of surgical intervention tactics in case of the Hill-Sachs lesions of the humeral head have been formulated. The proposed treatment strategy made it possible to get a good functional outcome and restore the ability of patients as soon as possible, and completely to exclude relapses of dislocation. The results of the research are introduced into clinical practice is SI "Sytenko Institute of Spine and Joints Pathology of National Academy of Medical Sciences of Ukraine", KU "Odessa Regional Clinical Hospital", KUZ " Kharkiv Multidisciplinary Hospital № 18". Traumatology and Orthopaedics.