髋关节置换术的挑战——骨质疏松与股骨几何形态的影响

Challenges of Hip Arthroplasty—Impact of Osteoporosis and Proximal Femoral Geometry

摘要: 随着全球老龄化加速及骨质疏松发病率上升，髋部骨折已成为重大公共卫生问题，尤其绝经后女性更易发生骨密度下降和骨结构退化，从而增加髋部骨折风险。骨质疏松引起股骨近端皮质变薄和髓腔扩张，不利于假体固定，易导致术后无菌性松动和假体周围骨折。全髋关节置换术通过重建髋关节功能及改善负荷分布，在提升患者生活质量方面具有明显优势，但在骨质疏松患者中，初次置换及翻修手术均面临固定不稳、骨缺损及生物力学失衡等挑战。综述回顾了假体设计、固定技术的发展，强调术前个体化评估骨质及股骨形态，选择适宜的假体柄及固定方式，对于提高手术成功率和降低并发症风险至关重要。本综述旨在探讨老年骨质疏松患者髋关节置换术的挑战及翻修策略。

Abstract: With accelerating global aging and rising osteoporosis prevalence, hip fractures have emerged as a major public health crisis. Postmenopausal women are particularly susceptible to decreased bone density and degeneration of bone structure, which increases their risk of hip fractures. Osteoporosisinduced thinning of the proximal femoral cortex and expansion of the medullary canal undermine prosthetic fixation, predisposing to aseptic loosening and periprosthetic fracture. Total hip arthroplasty (THA) has obvious advantages in improving patients’ quality of life by reconstructing hip joint function and optimizing load distribution. However, in patients with osteoporosis, both primary and revision surgeries face challenges such as unstable fixation, bone defects, and biomechanical imbalance. This review looks back at the development of prosthesis design and fixation techniques, emphasizing the importance of individualized preoperative assessment of bone quality and femoral morphology. Selecting appropriate prosthesis stems and fixation methods is crucial for improving surgical success rates and reducing the risk of complications. This review aims to explore the challenges and revision strategies of hip arthroplasty in elderly patients with osteoporosis.