The dissertation is devoted to the development of a minimally invasive technology
for hanging the shoulder to the acromial process of the scapula at optimal points for agerelated patients with a high degree of operational risk.
There were investigated in this research the prevalent types of traumatism and
gender/age features of the recurrent shoulder dislocation. It has been analyzed the
dependence between degree of shoulder articular elements deterioration and the number of dislocations in the anamnesis. The diagnostic value of tests was studied during clinical and functional research. The results of X-ray, arthrosonography and electromyography (EMG) have been analyzed. Surgical treatment was performed by hanging the shoulder to the acromial process of the scapula at optimal points. It was established that the first place in the structure of injuries is trauma after
falling on the abducted arm (12 cases, 33.3%), the second place - the falling on the
shoulder joint (8 cases, 22.2%). In the vast majority of cases (29 patients, 80.6%) there
was an indirect mechanism of injury. A greater proportion of right-sided pathology
(58.3%) was established, compared to the left-hand side (38.9%). Important clinical and diagnostic features were the presences of specific clinical symptoms – Jobe`s test (72.2%), symptom of Leclerc (63.9%),the symptom of Hitrov F.M. (13.9%), symptom of deltoid muscle retraction (36.1%), symptom of Drobotun V.Ya. (5.6%), hypotrophy of the shoulder joint area (52.8%), symptom of Babich B.K. (36.1%), symptom of Weinstein V.G. (50.0%), symptom of Golyakhovsky Yu.V. (16.7%) symptom
of "relative elongation of the limb", proposed by Stutin A.Ya. (52.8%), the second
symptom of Stutin A.Ya. "reduction of the resistance to adduction" (50.0%).
According to the goniometry of the shoulder joint, it was verified that the amplitude
of movements on the side of the recurrent shoulder dislocation is lower than normal
(p<0.05). Radiographic signs of the recurrent shoulder dislocation were characterized by the presence of impressed fracture of the anterior part of the scapula articular process (47.2%), regional sclerosis of the anterior part of the scapula articular process (61.1%), incongruity of the articular surfaces (36.1%) and damage of Hill-Sachs (38.9%). During arthrosonography, it was found that the most probable indirect sonographic signs of the recurrent shoulder dislocation are hypotrophy and visual defect of the rotator cuff muscles (47.2%), thinning of the tendon and decreasing of thickness of the rotator cuff muscles (58.3%), the presence of scars in the structure of rotator cuff muscles (66.7%).
It was established that on comparative electromyograms of the affected and healthy
upper extremities there was a significant decrease in the amplitude and frequency of the M-response on the side of the damage (p<0.05).
It was suggested a minimally invasive method of treatment of the recurrent shoulder
dislocation for the patients of older age groups in the way of hanging the humerus to the acromial process of the scapula.
It was carried out an experimental research about strength of anchor screw fixation
in the head of the humerus by an end-element method. It is proved that the optimal angle of anchor insertion is an angle 60°, in which a pair bone-screw can withstand a load of 44N.
It was developed a computer-navigational system based on the Arduino controller
with the ATmega328P chip and software written in the C++ programming language using ARToolKit, Visualization Toolkit and OpenGL package libraries. The complex is used for determination the correct position of the upper limb during the proposed method of treatment.
