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},
"code": "M87",
"name": "Остеонекроз",
"icd_name": "Остеонекроз",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
1
],
"periodicity": 1,
"slug": "m87_osteonekroz",
"lead": "Нарушение здоровья, относящееся к группе другие остеопатии",
"description": "Остеонекроз – поражение различных отделов кости множественной этиологии, возникающее в ответ на нарушение в ней кровообращения и приводящее к гибели костного мозга и трабекулярной кости.",
"etiology": "<p>Наиболее распространенные причины остеонекроза следующие:</p>\r\n<ul>\r\n<li>Серьезная травма, которая нарушила нормальное кровоснабжение кости.</li>\r\n<li>Прием кортикостероидных препаратов (преднизолон, метилпреднизолон), особенно в больших дозах и длительными курсами, которые назначаются при хронических заболеваниях.</li>\r\n<li>Злоупотребление алкоголем и табакокурение.</li>\r\n</ul>\r\n<p>Другие, редкие причины остеонекроза:</p>\r\n<ul>\r\n<li>Системная красная волчанка (СКВ).</li>\r\n<li>Декомпрессионная болезнь (дисбарический остеонекроз).</li>\r\n<li>Заболевания крови, такие как серповидноклеточная анемия.</li>\r\n<li>Синдром приобретенного иммунодефицита (СПИД).</li>\r\n<li>Лучевая терапия при онкозаболеваниях.</li>\r\n<li>Прием бифосфонатов, которые связаны с некрозом челюсти. </li>\r\n</ul>",
"pathogenesis": "<p>Остеонекроз связан с гибелью клеток костной ткани (остеоцитов) и костного мозга.</p>\r\n<p>Развитие нетравматического остеонекроза может быть обусловлено эмболией сгустками крови или каплями жира, внутрисосудистым тромбозом и внесосудистой компрессией. После сосудистого эпизода развивается репаративный процесс, направленный на удаление некротизированной кости и костного мозга и замещение их живой тканью. Если зона инфаркта невелика и не подвергается значительной нагрузке, этот процесс может быть успешным. В 80% случаев он оказывается неэффективным и зона инфаркта подвергается компрессии. Так как остеонекроз обычно поражает дистальные участки длинных костей, суставная поверхность становится уплощенной и неровной, что сопровождается усилением болей и приводит к развитию остеоартрита.</p>",
"diagnostics": "<p>На начальном этапе проводится рентгенологическое исследование. Ранние рентгенологические признаки включают локализованные очаги склероза и просветления. Позднее может появиться субхондральный симптом полулуния. Затем развивается коллапс кости и уплощение суставной поверхности с последующим развитием дегенеративных изменений.</p>\r\n<p>МРТ – является более чувствительным и специфичным методом.</p>\r\n<p>Сцинтиграфия костей менее чувствительна и менее специфична, чем МРТ, и в настоящее время выполняется редко.</p>\r\n<p>КТ требуется редко, хотя иногда она может быть полезна для выявления сдавления сустава, который не определяется на обычной рентгенограмме, а иногда не виден даже на МРТ.</p>",
"treatment": "<p>Симптоматическая терапия включает покой, ЛФК, назначение нестероидных противовоспалительных препаратов.</p>\r\n<p>Хирургическое вмешательство направлено также на то, чтобы сохранить кость и не прибегнуть к протезированию. Существует несколько направлений:</p>\r\n<p>Декомпрессия, при которой в повреждённой кости делают отверстие, оно уменьшает давление внутри кости, не позволяет возникновению сдавления. Остеотомия – удаление участка некротизированной костной ткани. Аутотрансплантация – пересадка собственной здоровой костной ткани.</p>\r\n<p>При невозможности применения вышеуказанных методов и восстановления костной ткани прибегают к эндопротезированию суставов.</p>\r\n<p> </p>",
"prevention": "<p>Основными профилактическими мероприятиями являются:</p>\r\n<ul>\r\n<li>Отказ от вредных привычек – курения и употребления алкоголя</li>\r\n<li>Подбор минимальных эффективных доз кортикостероидов</li>\r\n<li>Соблюдение правил гигиены при уходе за ротовой полостью для предупреждения разрушения челюсти</li>\r\n<li>Прекращение приема бисфосфонатов за 2 месяца до инвазивной стоматологической манипуляции. </li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p>Заболевание может долгое время протекать бессимптомно. Затем постепенно развивается боль, но она может возникнуть и остро. По мере прогрессирования сдавления сустава боль нарастает, усиливается при физической нагрузке.</p>\r\n<p>В развернутой стадии отмечаются боли и ограничение подвижности, при этом пассивные движения ограничиваются в меньшей степени, чем активные. Возможен клинически выраженный синовиальный выпот, особенно в коленном суставе; жидкость при этом имеет невоспалительный характер.</p>",
"image": null,
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"standard_type": 3,
"danger": 1,
"published": 2,
"parent": null,
"block_rubric": 144,
"standards": [
5194,
5331
]
}
]
}
