骨质疏松髋部骨折区骨微结构变化研究

Variations in bone microarchitecture in the osteoporotic hip fracture area

目的分析骨质疏松髋部骨折区张力侧骨小梁微结构的变化。方法实验组选择16例低能量创伤致股骨颈骨折需要行髋关节置换的老年患者,术前行健侧髋部骨密度检测。因活体取材困难,故选取5根青年同种异体股骨为对照组。在实验组与对照组股骨颈张力侧骨小梁中,切取5 mm×5 mm×10 mm的松质骨,行Micro-CT扫描分析微结构参数。分析两组之间微结构参数的差异及实验组患者微结构参数与骨密度之间关系。结果实验组微结构:骨体积分数(BV/TV)0.0645±0.0259,骨小梁数量(Tb.N)(0.8078±0.2212)mm-1,骨小梁厚度(Tb.Th)(0.0836±0.0212)mm,骨小梁距离(Tb.Sp)(1.2197±0.4492)mm,连接密度(Conn.D)1.8577±1.0217,结构模型指数(SMI)1.7780±0.5168。对照组微结构:BV/TV0.1470±0.0633,Tb.N(1.2692±0.1376)mm-1,Tb.Th(0.1201±0.0414)mm,Tb.Sp(0.6810±0.1129)mm,Conn.D 3.3585±1.7851,SMI 0.8781±0.6665。与对照组相比,实验组髋部张力侧松质骨小梁显著破坏,各微结构指标均有明显的改变,差异有统计学意义(P<0.05)。实验组微结构参数与骨密度之间无相关性(P>0.05)。结论骨质疏松髋部骨折区张力侧骨小梁明显破坏,这可能是髋部骨折发生的重要原因之一。

Objective To evaluate the changes of trabeculae microstructure in the tensional side of the hip fracture area.Methods Sixteen elderly patients with low-energy femoral neck fractures and undergone arthroplasty were selected in the experimental group.Bone mineral density of the healthy side of the hip was examined before the operation.Five femurs in control group were obtained from 5 young cadavers due to difficult sample collection.Trabecular specimens of 5 mm × 5 mm × 10 mm were obtained from the tensional side of femoral neck trabeculae in both experiment and control group.The difference of microstructure between the 2 groups and the correlation between microstructure parameters and BMD of patients in experiment group were analyzed.Results Microstructure in the experimental gourp：Bone volume / tissue volume（BV /TV） 0.0645 ± 0.0259,trabecular number（Tb.N）（0.8078 ±0.2212） mm-1,trabecular thickness（Tb.Th）（0.0836 ±0.0212） mm,trabecular spacing（Tb.Sp）（1.2197± 0.4492） mm,connect density（Conn.D） 1.8577 ± 1.0217,structure mode index（SMI） 1.778 ± 0.5168.Microstructure in the control group ：BV /TV 0.1470 ± 0.0633,Tb.N（1.2692 ± 0.1376） mm-1,Tb.Th（0.1201 ±0.0414） mm,Tb.Sp（0.6810 ±0.1129） mm,Conn.D 3.3585 ± 1.7851,SMI 0.8781 ± 0.6665.Comparing to control group,the trabecular of the tensional side in experiment group was obviously destroyed.All the microstructure parameters were altered obviously,and the changes were statistically significant（P 0.05）.No correlation was found between microstructure parameters and BMD in experiment group（P 0.05）.Conclusion The microstructure of the trabecular in the tensional side of the hip is deteriorated in patients with osteoporosis.This may be one of the important causes of the hip fracture.