Kirschner S, Hartmann A, Günther K-P, Hamann C
UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl-Gustav Carus, Technische Universität Dresden AöR, Fetscherstr. 74, 01307, Dresden, Deutschland,
Orthopade. 2014 Apr;43(4):353-64. doi: 10.1007/s00132-013-2167-0.
With increasing life expectancy the prevalence of osteoarthritis is also substantially rising. Patients aged between 65 and 75 years scheduled for total joint arthroplasty suffer from undetected osteoporosis in 20-25% of cases.
How to determine osteoporosis during preoperative workup? Which conclusions can be drawn for the operation treatment and the postoperative course?
The literature dealing with the prevalence of osteoporosis, perioperative complications of total hip arthroplasty, selected register informations, guidelines for diagnostics and treatment of osteoporosis and for the postoperative treatment are summarized and discussed.
The fracture risk is determined according to the guidelines of the Dachverband Osteologie (DVO, Governing Body on Osteology). The implant and the anchorage are selected based on the risk of suffering from osteoporosis. An intraoperative fracture and early aseptic loosening are the main operative risk factors. For the postoperative course in addition to education about arthroplasty, adequate support for prevention of falls is mandatory. Continuous physiotherapy with muscular strengthening is advisable. The long-term medication should be checked for risks in the PRISCUS list of potentially inappropriate medication in the elderly and non-steroidal anti-inflammatory drugs (NSAIDs) should not be prescribed in patients with cardiac comorbidities. Patients with confirmed osteoporosis should be treated with antiresorptive agents.
随着预期寿命的增加，骨关节炎的患病率也在大幅上升。计划进行全关节置换术的65至75岁患者中，有20%至25%的病例存在未被检测出的骨质疏松症。
如何在术前检查中确定骨质疏松症？对于手术治疗和术后病程可以得出哪些结论？
总结并讨论了有关骨质疏松症患病率、全髋关节置换术围手术期并发症、选定的登记信息、骨质疏松症诊断和治疗指南以及术后治疗的文献。
根据德国骨科学会（DVO，骨科学管理机构）的指南确定骨折风险。根据骨质疏松症患病风险选择植入物和固定方式。术中骨折和早期无菌性松动是主要的手术风险因素。对于术后病程，除了进行关节置换术相关教育外，必须提供足够的预防跌倒支持。建议持续进行增强肌肉的物理治疗。应检查长期用药是否存在老年潜在不适当用药PRISCUS列表中的风险，对于有心脏合并症的患者不应开具非甾体抗炎药（NSAIDs）。确诊为骨质疏松症的患者应使用抗吸收药物进行治疗。
