ОСТЕОПОРОЗ И ЭНДОПРОТЕЗИРОВАНИЕ
Аннотация
В последние десятилетия количество имплантаций эндопротезных суставов постоянно увеличивается. Многие пациенты пожилого возраста, нуждающиеся в замене суставов, имеют пониженное качество кости из-за остеопороза. У пациентов с эндопротезами и остеопорозом часто наблюдаются следующие осложнения: интраоперационные перипротезные переломы, перипротезный остеолиз, увеличение миграции имплантатов или послеоперационные перипротезные переломы. Таким образом, оценка качества костной ткани является важным этапом в лечении пациентов для обеспечения наилучшего ухода и оптимизации долгосрочных хирургических результатов. При необходимости, пациенты должны получить информацию о возможном дополнительном приеме кальция и витамина D. Кроме того, представляется целесообразным ориентироваться на физиологические уровни витамина D в периоперационном периоде. У женщин в постменопаузе, мужчин старше 70 лет, а также женщин и мужчин с повышенным риском развития остеопороза в течение двух лет после имплантации эндопротеза должны быть выполнены измерения минеральной плотности кости. У пациентов со сниженным качеством кости следует рассматривать лечение бисфосфонатами, Деносумабом или Терипаратидом для улучшения костной интеграции цементных имплантатов, увеличения срока службы имплантатов, а также для уменьшения перипротезных переломов и переломов в целом. В отдельных случаях у пациентов с остеопорозом может потребоваться имплантация с цементной фиксацией протезных компонентов (особенно при замене тазобедренного сустава).
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