急性和亚急性骨质疏松椎体骨折不同愈合时期骨组织形态学分析

Bone histomorphologic analysis at different healing stages of sub and acute osteoporotic vertebral fracture

目的观察急性和亚急性骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)发生后,不同愈合时期椎体内骨组织病理特点。方法将119例(OVCF)患者按发病时间分为四期:Ⅰ期(0~15 d);Ⅱ期(15~30 d);Ⅲ期(30~60 d);Ⅳ期(60~90 d)。常规行椎体内骨折区活检骨组织取出,制备脱钙活检标本,运用光镜观察并骨组织形态计量学分析。结果共获得活检标本119例,其中Ⅰ期67例(56.3%)、Ⅱ期28例(23.5%)、Ⅲ期12例(10.8%)、Ⅳ期13例(10.9%)。所有病理标本均未发现肿瘤或结核。骨折时间与骨组织形态学改变呈显著正相关,镜下表现为骨折区域的修复变化:从早期血肿和炎性浸润到肉芽期织和纤维组织的增生,进一步软骨成骨、钙盐沉积,最终形成新的编织骨。骨组织形态学测量结果显示Ⅰ期、Ⅱ期FV/TV(%)显著增高(P<0.000 1,r=0.488 2),Ⅲ期OS/BS(%)显著增高(P<0.000 1,r=-0.572 7),Ⅳ期WBV/TV(%)显著增高(P<0.000 1,r=-0.583 6)。结论骨折时间是骨折愈合分期重要的预测因素,发病时间不同,其椎体内部的病理变化也不尽相同。

Objective To observe the bone pathologic characteristics of sub and acute osteoporotic vertebral compression fracture( OVCF) at different healing stages. Methods According to the time since fracture,119 patients were divided into four stages:Stage Ⅰ( 0 to 15 days),Stage Ⅱ( 15 days to 30 days),Stage Ⅲ( 30 days to 60 days),Stage Ⅳ( 60 days to 90 days). Decalcified biopsy specimen was obtained from the cancellous bone core in the fractured vertebral body. The histomorphometry study were analyzed by light microscopy using grid analysis and defined using bone histomorphometry criteria. Results 119 biopsy specimens were obtained,67( 56. 3%) patients in Stage Ⅰ,28( 23. 5%) in Stage Ⅱ,12( 10. 8%) in Stage Ⅲ and 1( 10. 9%) in Stage Ⅳ.No tumor or tuberculosis was found in all pathological specimens. There was a significant positive correlation between fracture time and bone histomorphometry. Microscopically,the changes were observed: From early hematoma and inflammatory infiltration to granulation weave and fibrous tissue proliferation,further cartilage osteogenesis,calcium salt deposition,and eventually the formation of new woven bone. Bone histomorphometry showed that FV/TV( %) in stage Ⅰ and Ⅱ increased significantly( P<0. 000 1,r = 0. 488 2),OS/BS( %) in stage Ⅲ increased significantly( P< 0. 000 1,r =-0. 572 7),and WBV/TV( %) in stage Ⅳ increased significantly( P<0. 000 1,r =-0. 583 6). Conclusion The fracture time is an important predictor of healing stage. The pathological changes inside the vertebral body were also different with the onset time.