Serhiienko R. Prevention, diagnosis and treatment of osteoarthrosis of the shoulder joint

The dissertation is concerned with the issues of improving treatment outcomes for patients with osteoarthrosis of the shoulder joint on the ground of a pathogenetically based approach to prevention, diagnosis and differentiated treatment. The paper is based on the analysis of the examination findings and treatment outcomes of 1362 patients with various injuries of the shoulder joint area and their sequalae, aging from 17 till 79 years (mean age – 46,6±18,1). 830 (60,93%) were men, 532 (39,07%) - were women. We divide our patients on two groups: group 1 – 995 (73,05 %) and group 2 – 367 (26,95 %) of patients. Group 1 includes patients with different soft tissue pathology and proximal humerus fractures without X-Ray sighns of ostheoarthritis. Group 2 consist from the patients with different soft tissue pathology and proximal humerus fractures with X-Ray sighns of ostheoarthritis. The experimental part was performed on 24 5-month-old Guinea pigs (Cavia porcellus) weighting 380-420 grams. In the course of modelling adductor contracture of the shoulder joint, in the Guinea pigs, structural disturbances of the articular surface of the humeral head and glenoid cavity of the scapula were revealed, as well as changes in the contour of the subchondral bone tissue and proliferative changes in the articular capsule. Impaired mobility and an altered load area caused a loss of 48% (p<0.01) of the cartilaginous articular surface thickness of the humerus and 14% (p<0.01) of the cartilaginous articular surface of the glenoid. The findings of the study have confirmed the statement that the impaired mechanics of movements in the shoulder joint is one of the monopathogenetic factors of osteoarthrosis. The greatest number of post-traumatic osteoarthrosis in case of conservative treatment was found in patients with A1 fractures – 10.9% and A2 fractures – 14.6%; in case of surgical treatment, post-traumatic osteoarthrosis develops in patients with type C3 and A3 fractures, 12.6% and 14.6%, respectively (p>0.05). The main cause of post-traumatic osteoarthrosis is aseptic necrosis of the humeral head – 61.8% (p<0.05), which are more common in patients with AO type B and C fractures according. It has been established that arthroplasty of the shoulder joint provides a significant improvement of the function in patients over 50 years of age with osteoarthritis (p<0.01). A differentiated approach to shoulder arthroplasty has been developed. In case of osteonecrosis of a humeral head the most effective is unipolar prosthesis of a shoulder joint (p <0,05). In the treatment of the consequences of injuries of the shoulder joint with damage to the articular surfaces of the shoulder head and the scapula, it is necessary to perform total anatomical prosthetics. Total reverse prosthetics is optimal for rotator arthropathy. Daifferrential approach in rehabilitation for patients with daifferent types of soft tissue shoulder patholoigy was designed. Usage of different forms of rehabilitation protocol depending on kind of operative treatment give opportunity to receive good and satisfactory results of the treatment and delay arthritic formation.