特发性和激素性股骨头坏死塌陷前骨小梁形态学研究

Morphological study of bone trabecula of the femoral head after osteonecrosis with different causes

目的比较不同诱因导致的股骨头坏死后骨小梁形态学与骨折后无股骨头坏死的骨小梁差别。方法收集我院2011年4月至2014年3月行全髋关节置换术的股骨头标本18例,其中激素性股骨头坏死标本6例(FicatⅡ期,激素组)、特发性股骨头坏死标本6例(FicatⅡ期,特发组),股骨颈骨折无股骨头坏死标本6例(骨折组)。所有标本统一切取相同部位进行显微CT扫描,通过DateView软件进行三维重建分析,比较各组骨小梁形态差异,以及整体和局部分段骨计量学参数,包括骨体积分数(BV/TV)、结构模型指数(SMI)、骨小梁数目(Tb.N)、骨小梁厚度(Tb.Th)、骨小梁间隙(Tb.Sp)、各向异性程度(DA)。结果显微CT显示,骨折组骨小梁形态规则、方向统一,特发组和激素组骨小梁形态破坏、结构混乱,激素组较特发组形态更为紊乱且Tb.Sp更大。整体骨计量学结果中,特发组(34.72%±5.13%)和激素组(35%±5.35%)BV/TV显著低于骨折组(43.41%±3.99%,P=0.008),同时特发组(0.17±0.49)和激素组(-0.3±0.74)SMI也显著低于骨折组(1.51±0.81,P=0.001)。局部分段比较中,骨折组各段BV/TV和SMI均分别高于激素组和特发组相应各段;骨折组各段Tb.N和Tb.Th较为接近,而激素组和特发组各段Tb.N和Tb.Th波动较大且低于骨折组;骨折组各段Tb.Sp及DA均较为一致,而激素组和特发组Tb.Sp及DA一致性较差且高于骨折组。结论特发性和激素性股骨头坏死后骨小梁结构紊乱、骨量丢失,且激素性股骨头坏死者更为严重。

Objective To study the bone trabecula morphology of the femoral head after osteonecrosis with different causes .Methods Twelve specimens of femoral head with osteonecrosis（Ficat Ⅱ ,6 cases were steroid‐induced and 6 cases were idiopathic） and 6 specimens of femoral neck fracture were collected after total hip arthroplasty perfomed from April 2011 to March 2014 .Morphological parameters of all the bone trabecula specimens were gathered with micro‐CT .Results Trabecular bone volume fraction （BV/TV） and structure model index （SMI） of fracture group was significantly higher than that of the osteonecrosis group（P〈0 .05） .In the fracture group ,no difference of trabecular spacing （Tb .Sp） and degree of anisotropy （DA ） existed in various regions ;in the steroid‐induced and idiopathic osteonecrosis groups ,difference of Tb .Sp and DA existed in various regions and all of them were higher than in the fracture group .Conclusion Bone trabecula structure disorder and bone mass loss occured after avascular necrosis of the femoral head .