老年髋部骨折患者骨组织形态计量分析

A histomorphometric analysis of the iliac bone biopsy of the old patients with hip fracture

目的通过骨组织形态计量对老年髋部骨折患者的骨量和骨结构异常进行研究。方法 25例患者均接受髂骨活检。 A组 14例，为老年髋部骨折组，其中男 6例 (A1组 )，年龄 (75.01± 7.15)岁；女 8例 (A2组 )，年龄 (69.85± 11.58)岁。 B组 11例，为对照组，其中男 5例，女 6例；年龄 (41.44± 3.87)岁。所取标本经甲基丙烯酸甲酯包埋、硬组织切片、甲苯胺蓝染色后行组织形态计量分析。结果 (1)A组的骨小梁体积、皮质骨宽度、骨小梁密度、骨小梁厚度、结点末端比显著低于对照组 (P< 0.01),而骨小梁间距则明显高于对照组 (P< 0.01)。 (2)A组中 2例女性患者的病理改变较为特殊，其骨量参数与对照组相近；结点末端比在对照组 95％可信度区间之外，而与本组其他患者相似。结论 (1)骨小梁连续性显著下降，而非骨量降低是部分骨转换增高的绝经后女性髋部骨折的重要内因。 (2)按骨量、骨结构 (骨小梁连续性 )和骨转换状况，老年髋部骨折患者的骨组织病理改变可以分为三型。

Objective To elucidate the abnormality of the bone mass and bone structure of the old patients with hip fracture. Methods Histomorphometric analysis of bone structure in iliac bone biopsies was performed in 14 elderly patients with hip fractures(group A)and 11 control subjects(group B). The former include six males (age 75.01± 7.15)and eight females (age 69.85± 11.58). The latter include five males and six females(age 41.44± 3.87 altogether). Results 1) The trabecular bone volume, cortical width, mean trabecular plate density, mean trabecular plate thickness and node-terminus ratio (NTR) of group A were significantly lower than those of the group B(P< 0.01), while the mean trabecular plate separation was higher than that of the group B significantly (P< 0.01). 2) The pathologic changes of two women in group A were special. Their parameters, which accounted for bone mass, were similar to those of group B, while their NTR was beyond the 95％ credibility interval of group B, which was similar to that of group A. Conclusion 1)The bone mass does not decrease significantly in some postmenopausal women with increased bone turnover, but the trabecular connectivity declines significantly; 2) The abnormalities of bone histology of the patients with osteoporotic hip fractures can be divided into three types.