老年骨质疏松合并颈椎病患者颈椎椎体骨吸收的扫描电镜观察

Bone resorption of trabeculae in osteoporotic cervical vertebral associated with cervical spondylosis: A scanning electron microscopic study

目的 对老年骨质疏松患者颈椎椎体骨小梁经制备行扫描电镜检查 ,观察骨小梁的骨吸收发生机制 .方法 收集 8例因老年骨质疏松合并颈椎病而行颈前路椎体钻洞减压植骨手术老年患者 (平均年龄 5 5岁 )的颈椎椎体 ,同年轻成年人的颈椎椎体骨小梁相比 .结果 老年骨质疏松患者的柱状骨小梁相继发生明显的骨吸收 ,表现为骨小梁的变细、穿孔 .骨小梁间的空隙因此明显增大 .高倍镜下 ,可见骨小梁上卵圆形、狭长卵圆形或梭形的吸收陷窝 .陷窝的大小、深浅及内容物都不一致 .陷窝四周原来具完整胶原纤维层的静止骨面也先后出现骨吸收 .骨吸收过程中 ,无机盐可以先吸收 ,残剩粗糙不规则的胶原纤丝 .骨形成现象较少见到 ,说明在老年骨质疏松患者骨转换处于负平衡状态 .结论 颈椎椎体骨小梁异常改建是以不断增多的吸收陷窝导致骨小梁穿孔、变细、吸收甚至消失完成的 。

AIM To study bone resorption patterns in osteo porotic cervical vertebral associated with cervical spondylosis by scanning electron microscopy. METHODS The trabeculae of cervical vertebral were collected from 8 cases of aged cervical spondylosis patients associated with osteoporosis at an average age of 55 years, who underwent operation for the cervical spondylosis from the anterior surgical approache. Cervical vertebral trabeculae from 4 young paraplegia adu1ts injuryed in accident served as contro1. RESULTS The trabeculae of the cervical vertebral formed round or roundish arch structure. The columnar trabecu1ae of the cervical vertebral in the aged osteoporosis showed overt osteoclastic resorption,manifesting thinning,tapeting and perfortion. As a result, the inter trabecular space en1arged markedly. Under high magnification, on the trabeculae could be discerned oval, narrow oval or spindle shaped Howship lacunae, which were different in size, depth and content. Around the lacunae the col1agen fibril lamella normally convering the quiscient bone surface became resorbed sooner or 1ater. During bone resorption, the inorganic components of the bone matrix were first dissolved and resorbed leaving behind rough and irregular collagen fibrils. Then emerged in the Howship lacunae and surrounding area newly formed co1lagen fibrils and bone tissuse, signifying reversal and new bone formation phases following the the bone resorption phase. In the aged osteoporotic patients, however, this phenomenon was rather infrequently encountered, thereby leaving the bone turnover always in a negative balance state. CONCLUSION The abnormal reconstruction of bone trabeculae in cervical vertebral body should be accomplished by means of increased Howship's lacunae resulting in perforation thinning, absorption, even obliteration of trabeculae and is the major cause of the deformation of cervical vertebral body.