rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2023-377-384rsp-3366Research ArticleРЕВМООРТОПЕДИЯ И РЕАБИЛИТАЦИЯORTHOPEDIC RHEUMATOLOGY AND REHABILITATIONФакторы, определяющие развитие посттравматической боли и посттравматического остеоартритаFactors determining the development of post-traumatic pain and post-traumatic osteoarthritishttps://orcid.org/0000-0002-5256-7346ЧерниковаА. А.ChernikovaA. A.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

nas36839729@yandex.ruhttps://orcid.org/0000-0002-1391-0711КаратеевА. Е.KarateevA. E.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-5626-7404МакаровМ. А.MakarovM. A.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-7938-1536БяликЕ. И.BialikE. I.

115522, Москва, Каширское шоссе, 34а;125993, Москва, ул. Баррикадная, 2/1, стр. 1

115522, Moscow, Kashirskoye Highway, 34A; 125993, Moscow, Barrikadnaya str., 2/1, building 1

https://orcid.org/0000-0001-8563-0631МакаровС. А.MakarovS. A.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-3745-0924БяликВ. Е.BialikV. E.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-7179-8174НестеренкоВ. А.NesterenkoV. A.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-7660-8210ДудниковаП. Е.DudnikovaP. E.

150000, Ярославль, ул. Революционная, 5

150000, Yaroslavl, Revolyutsionnaya str., 5

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияV.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian FederationRussian FederationФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава РоссииРоссияYaroslavl State Medical UniversityRussian Federation202329062023613377384Copyright © Черникова А.А., Каратеев А.Е., Макаров М.А., Бялик Е.И., Макаров С.А., Бялик В.Е., Нестеренко В.А., Дудникова П.Е., 20232023Черникова А.А., Каратеев А.Е., Макаров М.А., Бялик Е.И., Макаров С.А., Бялик В.Е., Нестеренко В.А., Дудникова П.Е.Chernikova A.A., Karateev A.E., Makarov M.A., Bialik E.I., Makarov S.A., Bialik V.E., Nesterenko V.A., Dudnikova P.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/3366

Травмы вызывают системную нейрогуморальную и поведенческую реакцию организма, направленную на восстановление поврежденных тканей и коррекцию нарушений биомеханики. Однако во многих случаях полноценная репарация невозможна: травматическое повреждение, возникающее на его фоне воспаление и дегенеративные процессы (фиброз, неоангиогенез, гетеротопическая оссификация) приводят к тяжелым структурным изменениям и прогрессирующему снижению функциональной способности. К наиболее частым осложнениям травм относятся хроническая посттравматическая (ПТ) боль и ПТ остеоартрит (ОА). Эти осложнения взаимосвязаны: болевые ощущения (сопровождающиеся скованностью и нарушением функции), возникающие у 10–50% лиц, перенесших травму сустава, могут указывать на формирование ранней (дорентгенологической) стадии ПТ ОА. Развитие типичных структурных изменений при ПТ ОА через 10–15 лет отмечается после травмы коленного сустава более чем у 30% пациентов. ПТ ОА крупных суставов протекает более агрессивно, чаще сопровождается синовитом и требует проведения эндопротезирования в среднем на 10–15 лет раньше, чем первичный ОА. Ранняя диагностика ПТ ОА основывается на анализе динамики клинических проявлений (прежде всего ПТ боли), визуализации ранних изменений структуры сустава (магнитно-резонансная томография), а также исследовании уровня биомаркеров воспаления и костно-хрящевой деструкции. В качестве дополнительных факторов риска ПТ ОА рассматривают генетические особенности, определяющие хронизацию воспаления и боли, а также нарушения репарации хрящевой и костной ткани.

Injuries cause a systemic neurohumoral and behavioral response of the body, aimed at restoring damaged tissues and correcting biomechanical disorders. However, in many cases, full-fledged repair is impossible – traumatic injury, inflammation that occurs against its background, and degenerative processes (fibrosis, neoangiogenesis, heterotopic ossification) lead to severe structural changes and a progressive decrease in functional ability. The most common complications of trauma include chronic post-traumatic pain and post-traumatic osteoarthritis (PTOA). These complications are interrelated – pain (accompanied by stiffness and dysfunction) that occurs in 10–50% of people who have suffered a joint injury may indicate the formation of early (pre-radiological) stages of PTOA. The development of typical structural changes in PTOA is observed 10–15 years after a knee injury (in >30% of patients). PTOA of large joints is more aggressive, often accompanied by synovitis, and requires arthroplasty on average 10–15 years earlier than primary osteoarthritis. Early diagnosis of PTOA is based on the analysis of the dynamics of clinical manifestations (primarily post-traumatic pain), visualization of early changes in the structure of the joint (magnetic resonance imaging), as well as the study of the level of biomarkers of inflammation and osteochondral destruction. As additional risk factors for PTOA, genetic features are considered that determine the chronicity of inflammation, pain, and impaired repair of cartilage and bone tissue.

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