Выпуск 5-21, 2022
Особенности биомеханики и реабилитации плечевого сустава после реверсивного эндопротезирования: обзор
1 Чугреев И.А., 1 Фесюн А.Д., 1 Рожкова Е.А.
1 Национальный медицинский исследовательский центр реабилитации и курортологии, Москва, Россия
РЕЗЮМЕ
Реверсивное эндопротезирование является одним из методов хирургического лечения заболеваний плечевого сустава. Показаниями для проведения данного вида операции являются: клинически выраженный артроз, в том числе дефект артропатия, ревматоидный артрит, много фрагментарный перелом и переломовывих головки плечевой кости, онкопатология плечевого сустава, аваскулярный некроз, массивный разрыв вращательной манжеты и дисфункция ранее установленного протеза. На сегодняшний день в клинической практике применяют различные модели реверсивных эндопротезов, основанных на принципах P. Grammont. Наблюдается рост частоты проведения реверсивной артропластики плечевого сустава во всем мире. Ожидается увеличение количества операций эндопротезирования плечевого сустава к 2025 г. более, чем на 200%. Особенностью реверсивного протеза является смена полярности суставных поверхностей. Конструкция протезного импланта вносит существенные изменения в биомеханику плечевого сустава. Различные вариации параметров конструкции оказывают влияние на функционирование сустава, поэтому для достижения оптимального объема движения необходим тщательный подбор таких характеристик, как: диаметр гленоидальной сферы, смещение лопаточного компонента, смещение центра ротации и изменение угла наклона шейки плечевого компонента. Понимание биомеханических особенностей плечевого сустава после реверсивного эндопротезирования позволяет определить оптимальный подход к восстановительному лечению пациентов после операции. Главными целями реабилитации после реверсивного эндопротезирования являются: обезболивание и обеспечение заживления послеоперационных ран, профилактика послеоперационных осложнений (вывихи и перипротезные переломы), разработка объема движений в суставе, увеличение силы и выносливости мышц плечевого пояса, в особенности дельтовидной мышцы. Несмотря на наличие стандартных протоколов, существуют разногласия во многих вопросах послеоперационного ведения пациентов. Данная тема нуждается в дальнейшей разработке.
КЛЮЧЕВЫЕ СЛОВА: обратная артропластика плечевого сустава, гленосфера, плечевой компонент, дефект артропатии, плечевой сустав, биомеханика, реабилитация, физиотерапия, мышечная сила, мышечная выносливость, диапазон движения
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