patmedfarПациентоориентированная медицина и фармацияPatient-Oriented Medicine and Pharmacy2949-1924LLC Izdatelstvo OKI10.37489/2949-1924-0030patmedfar-54Research ArticleРЕВМАТОЛОГИЯRHEUMATOLOGYОтёк костного мозга при остеоартрите коленного суставаBone marrow edema in osteoarthritis of the knee jointhttps://orcid.org/0000-0003-3456-9409НосковС. М.NoskovS. M.

Носков Сергей Михайлович — д. м. н., проф., зав. кафедрой госпитальной терапии с профпатологией 

Ярославль

РИНЦ Author ID: 575502

Sergey M. Noskov — Doctor of Medical Sciences, Prof., head of the department of hospital therapy with professional pathology

Yaroslavl

Elibrary Author ID: 575502

noskov03@gmail.comhttps://orcid.org/0000-0002-3163-102XСнигиреваА. В.SnigirevaА. V.

Снигирева Анна Владимировна — к. м. н., доцент кафедры госпитальной терапии с профпатологией

Ярославль

РИНЦ Author ID: 439168

Anna V. Snigireva — Candidate of Medical Sciences, Associate Professor of the department of hospital therapy with professional pathology

Yaroslavl

Elibrary Author ID: 439168

n0613@yandex.ruhttps://orcid.org/0009-0007-3655-2172ПаруляО. М.ParulyaО. М.

Паруля Олеся Михайловна — к. м. н., ассистент кафедры госпитальной терапии с профпатологией

Ярославль

РИНЦ Author ID: 575503

Olesya M. Parulya — Candidate of Medical Sciences, Assistant of the department of hospital therapy with professional pathology

Yaroslavl

Elibrary Author ID: 575503

karabaska1@yandex.ruhttps://orcid.org/0000-0002-6623-6230ШепеляеваЛ. С.ShepelyaevaL. S.

Шепеляева Людмила Сергеевна — ассистент кафедры поликлинической терапии, клинической лабораторной диагностики и медицинской биохимии 

Ярославль

РИНЦ Author ID: 1106852

Lyudmila S. Shepelyaeva — assistant department of polyclinic therapy, clinical laboratory diagnostics and medical biochemistry

Yaroslavl

Elibrary Author ID: 1106852

shepel17511751@gmail.comhttps://orcid.org/0009-0009-5503-1131МикрюковА. А.MikryukovА. А.

Микрюков Андрей Александрович — врач-рентгенолог

Ярославль

Andrey A. Mikryukov — radiologist

Yaroslavl

andmikryukov@gmail.comФГБОУ ВО «Ярославский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияYaroslavl State Medical University, Ministry of Health of the Russian FederationRussian FederationЦентр лучевой диагностики «Мед Арт»Россия"Med Art" radiodiagnostic centerRussian Federation202324012024142942Copyright © Носков С.М., Снигирева А.В., Паруля О.М., Шепеляева Л.С., Микрюков А.А., 20242024Носков С.М., Снигирева А.В., Паруля О.М., Шепеляева Л.С., Микрюков А.А.Noskov S.M., Snigireva А.V., Parulya О.М., Shepelyaeva L.S., Mikryukov А.А.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pomph.ru/jour/article/view/54

Термин «отёк (повреждение) костного мозга» при МРТ-исследовании коленного сустава принят для описания зон снижения интенсивности сигнала на T1-взвешенных изображениях или повышения интенсивности сигнала на T2-взвешенных изображениях в субхондральной кости. Отёк костного мозга (ОКМ) классифицируется как ишемический (остеонекрозы), механический (травмы) и реактивный (артриты) типы. В обзоре рассмотрены причины и различия ОКМ при спонтанном и вторичном остеонекрозе, дана характеристика синдрома преходящего ОКМ. ОКМ при травмах и ушибах обычно обратим и проходит примерно через 2–4 месяца, если сопровождает кортикальный перелом — через 6–12 месяцев. Усталостный перелом развивается вследствие многократной перегрузки нормальных костных структур, тогда как переломы в зонах субхондральной костной недостаточности возникают спонтанно в патологически изменённых костных тканях (например, остеопоретические кости), без каких-либо травм или перегрузок. Гистологическое исследование повреждённой субхондральной кости при ишемическом и механическом ОКМ выявляет кровоизлияния, микроразрушения костных трабекул и сосудистые аномалии, и практически полное отсутствие непосредственно отёка в зонах МРТ-позитивных по увеличению содержания внеклеточной жидкости, что частично может быть объяснено методологическими сложностями выявления увеличения внеклеточной жидкости гистопатологическими методами. Для консервативной терапии ишемического и механического ОКМ предложены простациклин и бисфософонаты.

При остеоартрите коленных суставов (ОА) ОКМ рассматривается в качестве маркера быстрого прогрессирования. Представлены данные о влиянии ожирения, лечебной физкультуры и диеты, использования трости на ОКМ. Анализ эффективности консервативной терапии доказал слабоположительный ответ на применение бисфосфонатов. Ингибиторы фактора роста нервов (NGF) — моноклональные антитела к NGF (танезумаб и фулранумаб) — снижали выраженность боли, но приводили к увеличению частоты остеонекрозов и эндопротезирования. В двух исследованиях продемонстрировано снижение интенсивности ОКМ при пероральном приёме хондроитин сульфата. Внимание ортопедов сосредоточено на субхондропластике фосфатами кальция. Субхондральное пломбирование, укрепляя кость и замещая утраченную барьерную функцию хряща, оказывает симптоматическое действие и эффективно противодействует развитию ОКМ, хотя отдалённые результаты нуждаются в изучении.

The term "bone marrow edema" (BME) in MRI examination of the knee joint is used to describe areas of decreased signal intensity on T1-weighted images or increased signal intensity on T2-weighted images in the subchondral bone. BME is classified into ischemic (osteonecrosis), mechanical (trauma), and reactive (arthritis) types. In this review, the causes and differences in BME with spontaneous and secondary osteonecrosis and other characteristics of BME transitioning to a syndrome are considered. BME with injuries and bruises is usually reversible and passes after approximately 2–4 months, if accompanied by a cortical fracture, after 6–12 months. A fatigue fracture develops as a result of repeated overloading of normal bone structures, whereas fractures in zones of subchondral bone insufficiency spontaneously occur in pathologically changed bone tissues (for example, osteoporotic bones) without any trauma or overloading. Histological examination of the damaged subchondral bone in ischemic and mechanical BME revealed hemorrhages, microdestruction of bone trabeculae and vascular anomalies, and almost complete absence of direct edema in MRI-positive zones due to increased extracellular fluid content, which can be partially explained by methodological difficulties in detecting increased extracellular fluid by histopathological methods. Prostacyclin and bisphosphonate have been proposed as conservative therapies for ischemic and mechanical BME.

In osteoarthritis (OA) of the knee joints, BME is considered a marker of rapid progression. Data on the influence of obesity, therapeutic exercise and diet, and the use of a cane on BME are presented. Analysis of the effectiveness of conservative therapy revealed a weakly positive response to bisphosphonates. Inhibitors of nerve growth factor (NGF) — monoclonal antibodies to nerve growth factor (like tanezumab and fulranumab) — reduced the severity of pain but led to an increase in the frequency of osteonecrosis and endoprosthesis. Two studies have shown a decrease in the intensity of BME with oral chondroitin sulfate. The attention of orthopedists is focused on subchondroplasty using calcium phosphates. Subchondral filling, which strengthens the bone and replaces the lost barrier function of cartilage, has a symptomatic effect and effectively counteracts the development of BME, although the long-term results need to be studied.

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