Факторы, определяющие развитие посттравматической боли и посттравматического остеоартрита

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.

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