Сучасний погляд на діагностику токсичного некрозу щелепних кісток у наркозалежних пацієнтів

Abstract

У статті проаналізовані наукові публікації, присвячені діагностиці токсичного некрозу щелепних кісток. Інтерес до цієї проблеми викликаний стрімким зростанням останнім часом випадків дифузних уражень щелеп, викликаних вживанням саморобної наркотичної речовини - первитину. Авторами розглядаються різні концептуальні підходи до з’ясування основних механізмів патогенезу цього захворювання, узагальнюються виявлені дослідниками особливості його клінічної картини та результати клінічних і лабораторних обстежень пацієнтів; В статье проанализированы научные публикации, посвященные диагностике токсического некроза челюстных костей. Интерес к данной проблеме вызван стремительным ростом в последнее время случаев диффузных поражений челюстей, вызванных употреблением самодельного наркотического вещества - первитина. Авторами рассматриваются различные концептуальные подходы к выяснению основных механизмов патогенеза этого заболевания, обобщаются выявленные исследователями особенности его клинической картины, а также результаты клинических и лабораторных обследований пациентов; Drug addiction itself is a serious disease. However, the need for constant struggle with it is dictated by the fact that with a drug addiction the number of other diseases related to it increase. One of them is toxic osteonecrosis of the jaws. The purpose of this paper is to analyze and summarize scientific publications devoted to the clarifying of features, course and diagnostics of toxic necrosis of the jawbone caused by drug addiction. The fulfilled research allowed scientists to reach a consensus that the development of necrosis of the jaw bone in drug addicted patients is a consequence of the use of so called “pervitin” . However, in the question of the pathological mechanisms of action of this drug positions of author's differ. Most researchers tend to see in red phosphorus main cause of devastating impact of "screw" on the human body. Other scientists associated pathological effects of “pervitin” with the action of ephedrine, which is found in large numbers in that drug. Despite the differences in the views of different authors on the main cause of necrotic process in the jaw bone in drug dependent patients, all researchers emphasize the special importance for the development of disease mitigation of nonspecific and specific immune reactivity. Important place in the study on the necrosis of the jaws in drug addicts is given to the study of clinical manifestation of disease. Scientists have identified the most essential features of clinical manifestations of the disease. It is characterized by a difficult and atypical course of the pathological process that encompasses sev areas of the jaw; hypoergic type of general reaction with slow clinical course, the emergence of new foci of osteomyelitis and recurrence even after radical surgery. Data on total blood, presented in the literature, indicate the presence in all patients with necrosis of the jaw bones anaemia with decreased red blood cells and haemoglobin. Thus, there is a significant increase of white blood cells, high level of SSE, a significant raise of thrombocytes levels, and inhibition of fibrinolysis and fibrinogen hyperproduction. Results of immunological studies, presented in scientific publications, indicate that the development of toxic necrosis of the jaw bone in patients with drug addiction occurs in a background of significant inhibition of T-cell immunity. Among additional research scientists specify radiography which allows examining the localization of destructive changes of bone tissue. On the basis of X-ray analysis scientists have identified a number of characteristics of the X-ray picture of jaw in patients with toxic osteonecrosis: propagation of lesions on large areas of jaw bone; the presence of several independent sites with possible localized in different anatomical areas; chaotic alternating of areas with osteosclerosis and areas with osteoporosis with the prevalence of the last, the lack of the marked demarcation zone on the edges of the process. So much attention is given by researchers to reveal mechanisms of pathogenesis of toxic necrosis and detailed study of its clinical manifestations. However, a substantial number of problems require its further development. In particular, it is necessary to investigate thoroughly the impact of various components of the drug substance on bone metabolism, in addition, special attention should be paid also to improve methods of examination of patients, including their immune system.