骨质疏松压缩椎体骨折时的骨密度与病理对照

Bone mineral density and pathologic study of osteoporotic vertebral compression fracture

背景:骨密度作为骨质疏松判断标准的一个条件已被广泛应用于临床疾病诊断中,但其体现椎体骨折自身病理改变特点的价值很少得到体现。目的:观察骨质疏松性椎体压缩骨折在不同时期的骨密度范围及病理学特征,验证骨密度变化与病理特点的一致性。方法:对45例影像学表现为骨质疏松性椎体压缩骨折的病例按年龄进行分组,术前均行股骨颈及腰椎骨密度(T值)检测,同时常规行影像学检查,之后给予经皮穿刺椎体成形术,术中常规行活组织取出进行病理切片观察。结果与结论:术前骨密度测定可见骨密度值随年龄增加而逐渐减低;病理学表现:骨小梁随骨密度的丢失而变细、稀疏、数量减少,同时骨小梁之间间隔增宽,排列随着压缩程度的不同呈不规则或断裂、紊乱、甚至出现坏死,周围可见纤维增生,后期有反应性新生骨的形成。骨密度下降的趋势与骨折病理表现的过程有一致的相关性。结果表明骨质疏松性椎体骨折的骨质破坏分期是一个渐进性的病理发展过程,而骨密度的下降可反映椎体的压缩破坏程度。

BACKGROUND： Bone mineral density, as the osteoporosis criteria, has been widely used in clinical disease diagnosis, but its value of reflecting the changes of pathological characteristics of vertebral body fracture has not been explored. OBJECTIVE： To observe the bone mineral density range and pathological features in different periods of osteoporotic vertebral compression fractures, and to verify the consistency of bone mineral density and pathology.METHODS： Forty-five cases of osteoporotic vertebral compression fractures in imaging findings were divided into groups according to age, femoral neck and lumbar vertebral bone mineral density （T value） tests were performed before surgery, as well as the routine imaging test. Then, all the patients received percutaneous kyphoplasty, and the living tissues were obtained for the pathological section observation. RESULTS AND CONCLUSION： Preoperative bone mineral density range tests showed that the bone mineral density was decreased with the increasing age; the pathological findings showed that with the reducing bone mineral density, the trabecular became thining and sparse, and the number was reduced, the space between trabeculars was widened; the arrangement was irregular with broken, disorder, or even necrosis, and fibrous tissue proliferation could be seen around the trabecular, and reactive new bone formation could be seen later. There was consistency between the bone mineral density decreasing trend and the pathological manifestations. The results indicate that the bone destruction staging of osteoporotic vertebral fractures is a progressive pathological process, while the decrease in bone mineral density may reflect the extent of vertebral compression damage.