emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университетemcardio-263Research ArticleОбзоры и лекцииReviews and lecturesРоль сосудистых и метаболических факторов в патогенезе нетравматического асептического некроза костной тканиThe role of vascular and metabolic factors in the pathogenesis of nontraumatic avascular necrosis of bone tissueМартусевичН. А.MartusevichN. A.ГудкевичЕ. В.GudkevichE. V.МурзичА. Э.MurzichA. E.Белорусский государственный медицинский университетBelarusian State Medical UniversityУчреждение здравоохранения «6-я городская клиническая больница г. Минска»Minsk City Clinical Hospital № 6Государственное учреждение «РНПЦ травматологии и ортопедии»State Institution «Republican Scientific and Practical Centre for Traumatology and Orthopedics»20181311202522427431Copyright © Мартусевич Н.А., Гудкевич Е.В., Мурзич А.Э., 20252025Мартусевич Н.А., Гудкевич Е.В., Мурзич А.Э.Martusevich N.A., Gudkevich E.V., Murzich A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/263

Асептический некроз представляет собой заболевание, которое встречается в основном среди мужчин трудоспособного возраста. Актуальность его обусловлена высокой инвалидизацией, связанной с поражением в большинстве случаев тазобедренного сустава, высокой частотой двустороннего вовлечения суставов и исходом во вторичный остеоартрит. Целью данного обзора является анализ и обсуждение различных патофизиологических механизмов развития асептического некроза как с позиции метаболического синдрома, так и костного обмена. Асептический некроз возникает вследствие значительного снижения кровотока в участке костной ткани, что реализуется за счет двух основных моментов: а) окклюзии просвета сосудов тромбом, эмболом, спазмом либо б) компрессии сосудов вследствие повышения внутрикостного давления. Особое внимание в данном обзоре уделено звеньям патогенеза метаболического синдрома, при котором могут реализоваться оба вышеописанных механизма развития асептического некроза. На возникновение асептического некроза при метаболическом синдроме влияют эндотелиальная дисфункция, дислипидемия, повышение внутрикостного давления, развитие остеопороза. Cвязь костного метаболизма и сосудистой патологии может быть реализована с помощью системы OPG/RANK/RANKL, что несомненно представляет интерес для понимания патогенеза асептического некроза.

Avascular necrosis of bone is a disease affecting predominantly men of working age. It steadily progresses to secondary osteoarthritis. The rate of disability is high because hip joint is most commonly affected by avascular necrosis; moreover, the rate of bilateral hip joint involvement is also high. The aim of the present review is to analyze and discuss several pathophysiological mechanisms of avascular necrosis in the context of metabolic syndrome and bone turnover. Avascular necrosis occurs due to critically decreased blood flow to the bone, which results from a) vascular occlusion with local thrombi, emboli, vasospasm or b) extrinsic compression of intraosseous vessels due to increased pressure within the bone. It is important to discuss the components of metabolic syndrome pathogenesis, which may possibly lead to avascular necrosis due to both aforementioned mechanisms. Particularly, in patients with metabolic syndrome avascular necrosis may be caused by endothelial dysfunction, dyslipidemia, increased intraosseous pressure and development of osteoporosis. The recent findings demonstrate that in avascular necrosis there is a possible interaction between bone turnover and vascular pathology, which occurs through OPG/RANK/RANKL axis. This fact represents a new concept of understanding avascular necrosis pathways.

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