激素性股骨头坏死与股骨颈骨折患者股骨头内骨小梁形态学对比研究

Morphological comparison of trabeculae bone in femoral head in patients with steroid-induced osteonecrosis of the femeral head and fracture of femoral neck bone

目的利用微计算机断层扫描技术(Micro-CT)对比分析激素性股骨头坏死与股骨颈骨折患者的股骨头内骨小梁的结构特点。方法选取2016年9月至2017年9月因股骨颈骨折与激素性股骨头坏死于大连大学附属中山医院行人工全髋关节置换术的患者,分别设为骨折组与坏死组,每组各20例(20髋),术中完整取出股骨头作为研究材料。应用计算机对股骨头进行三维重建,利用x、y、z轴各2个相互平行的平面将股骨头分割成27个区域,27个区域的编号规则:分为内侧、中间、外侧3个区,每组按照由前向后、由上向下的顺序编为1~9号。内侧区编号为m1、m2……m9;中间区编号为c1、c2……c9;外侧区编号为l1、l2……l9。对样本进行Micro-CT断层扫描,获取股骨头样本的计算机三维图像。手工选取兴趣区,采用骨体积分数、骨小梁厚度、骨小梁数量、骨小梁间隙等三维空间参数分别对2组股骨头内骨小梁进行评价。数据比较采用t检验和单因素方差分析。结果在骨折组中,将股骨头按矢状面分割为内侧区、中间区、外侧区进行对比,中间区表现为骨体积分数均值最大、厚度均值最大、数量均值最大、间隙均值最小的优势骨小梁区域,差异均有统计学意义(F=36.59、73.50、38.60、48.50,P值均小于0.05);将股骨头按冠状面分割为前区、中间区、后区进行对比,前区表现为骨体积分数均值最大、厚度均值最大、数量均值最大、间隙均值最小,差异均有统计学意义(F=69.50、43.92、85.40、36.00,P值均小于0.05);将股骨头按水平面分割为上区、中间区、下区进行对比,上区表现为骨体积分数均值最大、厚度均值最大、数量均值最大、间隙均值最小,差异均有统计学意义(F=37.03、29.47、255.50、45.50,P值均小于0.05)。对比坏死组股骨头不同部位骨小梁微结构参数,如果将股骨头分为内侧区、中间区、外侧区,中间区表现为骨体积分数均值最大、厚度均值最大、数量均值最大、间隙均值最小的优势骨小梁区域,差异均有统计学意义(F=41.42、26.60、400.00、36.00,P值均小于0.05);如果将股骨头分为上区、中间区、下区,上区表现为骨体积分数均值最大、厚度均值最大、数量均值最大、间隙均值最小,差异均有统计学意义(F=52.99、25.33、28.50、37.33,P值均小于0.05);如果将股骨头分为前区、中间区、后区,前区表现为骨体积分数均值最大、厚度均值最大、数量均值最大、间隙均值最小,差异均有统计学意义(F=2567.17、57.29、42.11、41.17,P值均小于0.05)。与坏死组相比,骨折组骨小梁骨体积分数均值更大,差异有统计学意义(t=4.90,P=0.01)、骨小梁厚度均值更大,差异有统计学意义(t=-4.17,P=0.01)、骨小梁数量均值更大,差异有统计学意义(t=-31.37,P=0.01),骨小梁间隙均值更小,差异有统计学意义(t=-7.12,P=0.01)。结论激素对于坏死股骨头的影响不仅仅是坏死区,包括硬化区、正常骨小梁区,即对于整个股骨头都产生了影响。

Objective Micro computed tomography(Micro-CT)was used to analyze the structural characteristics of trabecular bone in the femoral head in patients with steroid-induced osteonecrosis of femeral head and femoral neck fracture.Methods From September 2016 to September 2017,patients who underwent artificial total hip arthroplasty due to femoral neck fracture and steroid-induced osteonecrosis of femeral head at Affiliated Zhongshan Hospital of Dalian University,the fracture group and necrotic group were set respectively,20 cases each(20 hips).Each femoral head was removed as research material.Using a computer to do three-dimensional reconstruction of the femoral head,the femoral head was divided into 27 parts by 2 parallel planes of x,y and z axes,the numbering rules of the 27 areas were:divided into inner,middle and outer areas,each area was numbered 1-9 in the order from front to back and from top to bottom.The inner area numbers were m1,m2……,m9;the intermediate area numbers were c1,c2,……,c9;the outer area numbers were l1,l2,……,l9.A Micro-CT tomography scan of the sample was performed to obtain a three-dimensional computer image of the femoral head sample.Manually selected the area of interest,subsequently,three-dimensional spatial parameters such as bone volume fraction,trabecular thickness,trabecular bone number and trabecular space were used to evaluate the trabecular bone in femoral head for steroid-induced osteonecrosis of femeral head and femoral neck fracture.Data were compared with t test and one-way analysis.Results In the fracture group,the femoral head was divided into the innor,medial,and lateral regions according to the sagittal plane for comparison.The median region showed the largest average bone volume fraction,the largest average thickness,the largest trabecular number and the smallest mean gap,the differences were statistically significant(F=36.59,73.50,38.60,48.50;with P values below 0.05).The femoral head was divided into anterior,middle,and posterior regions according to the coronal plane for comparison.The anterior region showed the largest average bone volume fraction,the largest average thickness,the largest trabecular number and the smallest mean gap,the differences were statistically significant(F=69.50,43.92,85.40,36.00;with P values below 0.05).According to the horizontal plane,it was divided into upper zone,middle zone and lower zone for comparison.The upper zone showed the highest average bone volume fraction,the largest average thickness,the largest trabecular number and the minimum mean gap,the differences were statistically significant(F=37.03,29.47,255.50,45.50;with P values below 0.05).The microstructural parameters of the trabecular bone of different parts of the femoral head in the femoral head necrosis group were compared,if the femoral head was divided into the medial area,the intermediate area,and the lateral area,the median zone exhibits the largest average bone volume fraction,the largest average thickness,the largest number average,and the smallest gap mean of the dominant trabecular bone area,the differences are statistically significant(F=41.42,26.60,400.00,36.00;with P values below 0.05).If the femoral head was divided into an upper zone,a middle zone,and an inferior zone,the superior zone exhibits the largest average bone volume fraction,the largest average thickness,the largest number average,and the smallest gap mean of the dominant trabecular bone area,the differences are statistically significant(F=52.99,25.33,28.50,37.33;with P values below 0.05).If the femoral head was divided into anterior,intermediate,and posterior areas,the anterior area exhibits the largest average bone volume fraction,the largest average thickness,the largest number average,and the smallest gap mean of the dominant trabecular bone area,the differences are statistically significant(F=2567.17,57.29,42.11,41.17;with P values below 0.05).Compared with the necrosis group,the average value of trabecular bone volume fraction in each area of the fracture group was larger(t=4.90,P=0.01),the average value of trabecular bone thickness was greater(t=-4.17,P=0.01),the number of trabecular bone was larger(t=-31.37,P=0.01),and the mean value of trabecular bone gap was smaller(t=-7.12,P=0.01).Conclusion The effect of hormones on the necrotic femoral head is not only the necrotic area,including the sclerotic area and normal trabecular area,it affects the entire femoral head.