Almanac of Clinical MedicineAlmanac of Clinical MedicineАльманах клинической медицины2072-05052587-9294Moscow Regional Research and Clinical Institute (MONIKI)51910.18786/2072-0505-2017-45-2-79-79INVITED ARTICLEПРИГЛАШЕННАЯ СТАТЬЯСurrent concepts in physiological and reparative osteogenesisСовременные концепции процессов физиологического и репаративного остеогенезаOnoprienkoG. A.ОноприенкоГ. А.
Russian Federation

Onoprienko Gennadiy A. – MD, PhD, Professor, Corresponding Member of Russian Academy of Sciences, Professor of Chair of Traumatology and Orthopaedics, Postgraduate Training Faculty 

22–118 B. Gruzinskaya ul., Moscow, 123242

Оноприенко Геннадий Алексеевич – д-р мед. наук, профессор, член-корр. РАН, профессор кафедры травматологии и ортопедии факультета усовершенствования врачей

123242, г. Москва, ул. Б. Грузинская, 22–118

gao-1537@mail.ruVoloshinV. P.ВолошинВ. П.
Russian Federation

Voloshin Viktor P. – MD, PhD, Professor; Head of Department of Traumatology and Orthopaedics, Head of Chair of Traumatology and Orthopaedics, Postgraduate Training Faculty

61/2 Shchepkina ul., Moscow, 129110

Волошин Виктор Парфентьевич – д-р мед. наук, профессор, заведующий отделением травматологии и ортопедии, заведующий кафедрой травматологии и ортопедии факультета усовершенствования врачей

129110, г. Москва, ул. Щепкина, 61/2

Moscow Regional Research and Clinical Institute (MONIKI)ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»1503201745279790605201706052017Copyright ©; 2017, Onoprienko G.A., Voloshin V.P.Copyright ©; 2017, Оноприенко Г.А., Волошин В.П.2017Onoprienko G.A., Voloshin V.P.Оноприенко Г.А., Волошин В.П.https://creativecommons.org/licenses/by/4.0https://almclinmed.ru/jour/article/view/519

Studies conducted in the recent years by biologists strongly suggest that physiological and reparative osteogenesis, as well as of the functional, adaptive, and post-traumatic reconstruction of bone tissues are based on common and stereotypical molecular and cellular mechanisms. Our experimental studies have shown that all stages of the bone microstructure morphogenesis are synchronously and continuously associated with focal and stereotypical angiogenesis (capillarogenesis). A powerful factor in the implementation of reparative osteogenesis is the osteoinductive interaction of the ends of the damaged bone segments, which positively shows itself even in cases of large diastasis between the fragments (provided that the fragments are steadily fixed). After any kind of stable osteosynthesis, by ensuring the stability of the bone fragments for the entire period of consolidation, an endosteal cortical bone regeneration by direct osteogenesis (i.e. without fibro-cartilaginous tissue) is observed in the minimum amount at the shortest time period. Periosteal bone formation in this case is actually a reserve source of bone formation, which becomes effective during insufficiently stable conditions. The instability of the bone damage area particularly that of the metal implants results in the most severe destructive consequences. 

Исследования последних лет, выполненные биологами, убедительно свидетельствуют, что в  основе физиологического и  репаративного остеогенеза, а  также функционально-адаптивной и  посттравматической перестройки костной ткани лежат единые и стереотипные молекулярно-клеточные механизмы. Собственные экспериментальные исследования авторов показали: все этапы морфогенеза костных микроструктур синхронно обеспечиваются и  непрерывно сопровождаются очаговым и стереотипным ангиогенезом (капиллярогенезом). Мощным фактором реализации репаративного остеогенеза выступает остеоиндуцирующее взаимодействие концов поврежденного костного сегмента, которое положительно проявляется даже в  случаях значительных диастазов между отломками (но стабильно фиксированных). При обеспечении стабильности зоны костного повреждения на весь период консолидации после любого вида стабильного остеосинтеза формируется эндостально-кортикальный костный регенерат за счет прямого остеогенеза (то есть без фиброзно-хрящевой ткани) минимального объема и  в кратчайшие сроки. Периостальный остеогенез при этом фактически становится резервным источником костеобразования, который проявляется в  недостаточно стабильных условиях. Нестабильность зоны костного повреждения и особенно металлического имплантата чревата самыми тяжелыми деструктивными последствиями. 

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