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Аваскулярный некроз головки бедренной кости

https://doi.org/ 10.17238/PmJ1609-1175.2017.1.27-35

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Аннотация

Аваскулярный некроз головки бедренной кости - мультифакториальное заболевание с прогрессирующим развитием тяжелого вторичного коксартроза. Различают вторичный и идиопатический остеонекроз. Патогенез болезни связан с местным нарушением кровообращения, коагулопатиями и ослаблением регенерации костной ткани. Гистологически пораженная кость характеризуется образованием пустых лакун с васкуляризированной фиброзной тканью вокруг, в субхондральной зоне и зоне некроза возрастает активность остеокластов, в то время как в зоне склероза усиливается активность остеобластов. Среди лабораторных показателей определяется значительное повышение уровней ингибитора-1 активатора плазминогена, фактора Виллебранда, ингибитора-1 активатора плазминогена, С-реактивного белка, интерлейкина-33, снижение уровней грелина, остеопротегерина, перекрестно-связанного N-концевого телопептида, С-концевого пептида проколлагена-1, фактора некроза опухоли-а, miR-17-5p. При генетических исследованиях выявляются мутации в гене COL2A1 и протромбина, ассоциации полиморфных локусов в генах фактора V Лейдена, метилентетрагидрофолатредуктазы, тканеспецифического активатора плазминогена, ингибитора-1 активатора плазминогена. Лечение включает оперативные вмешательства и коррекцию цитоактивности. Имеются данные о способности бисфосфонатов предотвращать коллапс головки бедра.

Об авторах

Р. Н. Мустафин
Башкирский государственный университет
Россия


Э. К. Хуснутдинова
Башкирский государственный университет; Институт биохимии и генетики Уфимского научного центра РАН
Россия


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Для цитирования:


Мустафин Р.Н., Хуснутдинова Э.К. Аваскулярный некроз головки бедренной кости. Тихоокеанский медицинский журнал. 2017;(1):27-35. https://doi.org/ 10.17238/PmJ1609-1175.2017.1.27-35

For citation:


Mustafin R.N., Khusnutdinova E.K. Avascular necrosis of the femoral head. Pacific Medical Journal. 2017;(1):27-35. (In Russ.) https://doi.org/ 10.17238/PmJ1609-1175.2017.1.27-35

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