骨质疏松患者股骨头不同区域骨结构与生物力学分析

Analysis on microstructure and biomechanical properties in different regions of osteoporotic femoral head

目的探讨老年股骨颈骨折病人的股骨头样本各个区域的结构和生物力学性能差异,研究不同区域显微结构和生物力学特征及其对内固定物的影响。方法收集20个老年股骨颈骨折病人关节置换术后股骨头标本,以股骨头表面解剖标志点为参照,将股骨头按平分方法分为外侧、内侧、中间三部分。确定环钻的位置和钻取方向,用环钻于不同区域钻取直径10 mm、高10 mm圆柱形松质骨柱。通过Micro-CT系统扫描分析,分析不同区域内松质骨柱数据,包括骨体积分数(BVF)、骨小梁间隙(Tb.Sp)、骨小梁厚度(Tb.Th)、骨小梁数目(Tb.N)、骨表面积体积比(BS/BV)、结构模型指数(SMI)。应用微有限元计算不同区域骨组织的力学差异。结果老年股骨头颈内骨质含量下降,显微结构和生物力学性能区域变化明显,中间区域的骨结构和力学性能明显优于内侧和外侧。结论股骨头中间部位骨骼结构和力学强度明显优于内侧和外侧,在临床治疗骨质疏松股骨颈骨折的时候需要充分考虑内固定的部位。

Objective To investigate the structure and biomechanical property differences in different regions of the femoral head for elderly patients with femoral neck fractures, and to study its influence on internal fixation for fracture. Methods Twenty femoral head specimens were collected from elderly patients with femoral neck fracture after joint replacement. The femoral head was divided into 3 parts （lateral, inferior and medial region） with reference to anatomical markers on surface of the femoral head. After the position and drilling direction of the ring drill were determined, a circular drill was used to obtain the cylindrical cancellous bone columns with 10 mm in diameter and 10 mm in height. The data of cancellous bone columns in different regions were analyzed by Micro-CT scanning system, including bone volume fraction （BVF）, trabecular space （Tb.Sp）, trabecular thickness （Tb.Th）, the number of trabecular number （Tb.N）, the bone surface volume ratio （bone surface/bone volume, BS/BV）, structural model index （SMI）. Mechanical property differences of bone tissues in different regions were calculated by micro-finite element analysis. ResultsBone mass in the elderly osteoporotic femoral head decreased, and there were significant differences in bone microstructure and mechanical properties in different regions of the femoral head. Bone microstructure and mechanical properties in medial region were obviously superior to those in lateral and interior region. Conclusions The bone structure and mechanical strength in medial region of the femoral head are obvious superior to those in lateral and inferior regions. The position for internal fixation should be fully considered during treatment of osteoporotic femoral neck fracture in clinic.