Врожденный псевдоартроз большеберцовой кости: Современные стратегии лечения и результаты. Обзор литературы
DOI:
https://doi.org/10.52889/1684-9280-2025-76-6-jto032Ключевые слова:
врожденный ложный сустав большеберцовой кости, аппарат Илизарова, интрамедуллярный стерженьАннотация
Врожденный ложный сустав большеберцовой кости представляет собой редкое, но клинически значимое заболевание, приводящее к прогрессирующей деформации нижней конечности, нарушению костной регенерации, повторным переломам и выраженным долгосрочным функциональным ограничениям у детей. Несмотря на то, что это заболевание описано более ста лет назад, его патогенез остаются неполностью изученными, а современные данные указывают на сложное взаимодействие генетических, молекулярных и биомеханических факторов, способствующих формированию фиброзного несращения. Для лечения предложен широкий спектр терапевтических подходов, включая внутрикостную фиксацию, круговую внешнюю фиксацию с использованием техники Илизарова, васкуляризованные костные трансплантаты, комбинированные хирургические методы и современные процедуры, направленные на создание стабильного тибиофибулярного костного блока. Несмотря на значительный прогресс в хирургическом лечении, сохраняются высокий риск стойкого несращения, рецидивирующей деформации и повторных переломов. Наряду с хирургическими методами активно изучаются биологические и фармакологические методы, направленные на усиление костного заживления, такие как костные морфогенетические белки, бисфосфонаты, обогащенную тромбоцитами плазма, клеточные технологии и инженерные остеогенные конструкции, хотя имеющиеся клинические данные остаются неоднородными. Учитывая вариабельность лечебных протоколов и ограниченное количество качественных сравнительных исследований, комплексный анализ доступных данных необходим для определения наиболее эффективных подходов и направлений будущих исследований. Данный обзор обобщает современные сведения о патогенезе, клинических проявлениях и методах лечения врожденного ложного сустава большеберцовой кости и подчеркивает необходимость стандартизации протоколов и проведения многоцентровых исследований для улучшения долгосрочных результатов.
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