rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2022-299-305rsp-3177Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESПрием нестероидных противовоспалительных препаратов для обезболивания при травмах: есть ли риск нарушения костного метаболизма и несращения переломов костей?Nonsteroidal anti-inflammatory drugs for pain relief in case of injuries: Is there a risk of bone metabolism disorders and nonunion of bone fractures?https://orcid.org/0000-0002-8882-2281КаратеевР. А.KarateevR. A.

101990, Москва, Петроверигский пер., 10, стр. 3 

101990, Moscow, Petroverigsky lane, 10, building 3 

aekarat@yandex.ruhttps://orcid.org/0000-0001-6759-8367НикитинскаяО. А.NikitinskayaO. A.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0003-4739-4302ТоропцоваН. В.ToroptsovaN. V.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-1391-0711КаратеевА. Е.KarateevA. E.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

ФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава РоссииРоссияNational Medical Research Center for Therapy and Preventive MedicineRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation202209072022603299305Copyright © Каратеев Р.А., Никитинская О.А., Торопцова Н.В., Каратеев А.Е., 20222022Каратеев Р.А., Никитинская О.А., Торопцова Н.В., Каратеев А.Е.Karateev R.A., Nikitinskaya O.A., Toroptsova N.V., Karateev A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3177

Согласно экспериментальным исследованиям, нестероидные противовоспалительные препараты (НПВП) могут снижать темпы репаративных процессов и нарушать восстановление костной ткани после переломов. Значение этого эффекта НПВП для реальной клинической практики является предметом дискуссии. Нами был проведен анализ публикаций по проблеме несращения или развития переломов на фоне приема НПВП, представленных в системах PubMed и MEDLINE. С 1976 по 2021 г. было опубликовано 75 работ по данной теме, 19 из которых представляли наблюдательные, когортные и рандомизированные контролируемые исследования и исследования «случай – контроль», 4 – метаанализы. По данным метаанализов, включавших от 6 до 16 исследований, имелась ассоциация между приемом НПВП и несращением костей после переломов или послеоперационной травмы: отношение шансов от 2,07 (95%-й доверительный интервал (95% ДИ): 1,19–3,61) до 5,27 (95% ДИ: 2,34–11,88). Ряд крупных исследований подтверждают повышение риска несращения переломов и развития «маршевых» переломов у пациентов, получавших НПВП. Риск несращения был повышен при использовании НПВП более 2 недель и в высоких дозах. При кратковременном применении НПВП (менее 2 недель) и использовании этих препаратов в педиатрической практике частота нарушений репарации костной ткани не повышалась. 

According to experimental studies, nonsteroidal anti-inflammatory drugs (NSAIDs) can affect the healing of bone tissue after fractures. The significance of this effect of NSAIDs for real clinical practice is the subject of discussion. We analyzed publications on the problem of nonunion or development of fractures against the background of taking NSAIDs presented in the PubMed and MEDLINE system. From 1976 to 2021, 75 papers on this topic were published, of which 19 were observational, cohort and randomized controlled trials, as well as case-control studies, 4 meta-analyses. According to meta-analyses, which included from 6 to 16 studies, there was an association between taking NSAIDs and nonunion of bones after fractures or postoperative trauma: the odds ratio ranged from 2.07 (95% CI: 1.19–3.61) to 5.27 (95% CI: 2.34–11.88). A number of large studies confirm an increased risk of nonunion of fractures and the development of “marching” fractures in patients treated with NSAIDs. The risk of nonunion was increased when using NSAIDs for more than 2 weeks and in high doses. With short-term use of NSAIDs (less than 2 weeks) and the use of these drugs in pediatric practice, the frequency of bone tissue repair disorders did not increase. 

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The authors declare that there are no conflicts of interest present.