骨质疏松症骨折愈合的扫描电镜观察

A Scanning Electron Microscopy Study of the Osteoporotic Fracture Healing

为了解骨质疏松症骨折愈合过程,通过对30例骨质疏松症患者股骨粗隆间骨折愈合过程进行扫描电镜观察,结果发现骨质疏松症骨折后两周左右时:骨折骨小梁表面及周围有大量大小不等的卵圆形细胞增殖,骨吸收陷窝内有胶原纤维形成,但比较稀疏、紊乱。在骨折塑形改造期,破骨细胞性骨吸收活动显得异常活跃,而成骨细胞性骨形成显得异常微弱,骨形成滞留于骨吸收向骨形成转换期,称为Cement line现象,致使骨质疏松症骨折愈合塑形改建期,松质骨小梁变细、穿孔、离断,骨强度明显进一步下降。认为骨质疏松症骨折的治疗,不但要使骨折良好复位,坚强固定,而且在骨折塑形改造期,更应该促进成骨细胞的活性,使骨形成加快,抑制破骨细胞的活性,使骨吸收减少。扫描电镜是研究骨质疏松症骨折骨组织形态学、成骨细胞和破骨细胞的形态学变化、骨动力、骨细胞功能和骨细胞活动的一种高精度灵活性强的有效工具。

The processes of fracture healing in thirty osteoporotic patients with fracture of the proximal part of the femur were investigated with the scanning electron microscopy (SEM). The results showed that in the early stage of the frac-ture healing in the osleoporotic patients , on the surface and around the femoral trabecular, there were a large number of cells with varying sizes, there were collagen fibers covering resorplion cavities, but collagen fibers were thin without any obvious orientation. In the remodelling stage , the osteoclastic resorption seemed more aggressive, with deeper lacunae, while no osteoblaslic forming seemed to follow bone resorplion, and the remodelling process appeared delayed in an ab-sorptive reversal phase (this is interpreted as the Cement line ). It resulted in that the cancellous trabecular became thin、perforation、disconnected in the remodelling stage in the osteoporotic patients, the intensity of which decreased signifi-cantly. We also found that the scanning electron microscopy (SEM) can be recognized as a highly refined and very flexi-ble tool for the description of the bone dynamics of bone cells, and bone cell activity in the histomorphometic studies on the fracture healing in the osteoporosis.