Сравнительная оценка эффективности биофизических методов стимуляции остеогенеза: обзор литературы

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Аннотация

Актуальность. Стимуляция остеогенеза (СО) биофизическими методами широко применяется для ускорения заживления или стимуляции сращения переломов при несращениях, начиная с середины XIX в. СО может проводиться прямым методом с помощью электростимуляции постоянным током или непрямым — при помощи низкоинтенсивного импульсного ультразвука, стимуляции емкостной электрической связью и стимуляции импульсным электромагнитным полем. СО имитирует естественные физиологические процессы: в случае с электрической стимуляцией изменяет электромагнитный потенциал поврежденных тканей клеток схожим с процессами нормального заживления образом или в случае с низкоинтенсивным импульсным ультразвуком производит слабые механические воздействия на область перелома. СО увеличивает экспрессию факторов и сигнальных путей, ответственных за регенерацию тканей и минерализацию кости и в конечном итоге ускоряет сращение кости.

Целью данного обзора являлось представление наиболее современных данных лабораторных и клинических исследований эффективности СО.

Материал и методы. Проведен обзор результатов лабораторных исследований и конечных результатов метаанализов статей для каждого из четырех методов СО, опубликованных с 1959 по 2020 г. в базах данных PubMed, EMBASE и eLIBRARY.

Результаты и заключение. Использование СО эффективно стимулирует заживление переломов при правильном расположении датчиков, соблюдении интенсивности и времени воздействия, а также сроков применения при определенных видах переломов. При несращениях или замедлении сращения переломов, спондилодезе, артродезе следует отдавать предпочтение неинвазивным методам СО. Инвазивная стимуляция постоянным током может быть полезна при несращении длинных костей, спондилодезе с риском развития псевдоартроза.

Об авторах

В. Ю. Емельянов

ФГБУ «Федеральный центр травматологии, ортопедии и эндопротезирования» Минздрава России; ФГБОУ ВО «Чувашский государственный университет им. И.Н. Ульянова»

Автор, ответственный за переписку.
Email: vemelianov@mail.ru
ORCID iD: 0000-0003-1720-1741

Емельянов Владимир Юрьевич — врач-методист; доцент кафедры фармакологии, клинической фармакологии и биохимии

г. Чебоксары

Россия

Е. В. Преображенская

ФГБУ «Федеральный центр травматологии, ортопедии и эндопротезирования» Минздрава России

Email: alenka_22@bk.ru
ORCID iD: 0000-0003-3556-145X

Преображенская Елена Васильевна — начальник научно-образовательного отдела, врач-методист

г. Чебоксары

Н. С. Николаев

ФГБУ «Федеральный центр травматологии, ортопедии и эндопротезирования» Минздрава России; ФГБОУ ВО «Чувашский государственный университет им. И.Н. Ульянова»

Email: nikolaevns@mail.ru
ORCID iD: 0000-0002-1560-470X

Николаев Николай Станиславович — д-р мед. наук, профессор, главный врач; заведующий кафедрой травматологии, ортопедии и экстремальной медицины

г. Чебоксары

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