Kummell病不同时期骨组织形态与骨代谢标志物变化

Changes of bone tissue morphology and bone metabolic markers in different stages of Kummell’s disease

目的观察不同时期Kummell病骨组织形态学特征及骨代谢标志物变化规律。方法共纳入82例Kummell病患者,采集空腹血液样本检测骨代谢标志物水平。经椎弓根骨入路活检以收集骨活检标本,制备脱钙活检标本,运用光镜观察并进行骨组织形态计量学分析,参照Li分期法将患者分为三期。结果所有患者均顺利完成手术,Ⅰ期19例(23.2%),Ⅱ期39例(47.5%),Ⅲ期24例(29.3%)。发病时间Ⅰ期为5.2个月,Ⅱ期10.4个月,Ⅲ期18.5个月,差异有统计学意义(P<0.05)。骨组织形态学分析显示,软骨内骨(endochondral bone volume/tissue volume,EBV/TV)和肉芽组织(granulation or fibrous tissue volume/tissue volume,FV/TV)在Ⅰ期达到峰值(8.87%±0.25%和54.63%±3.52%),后逐渐被坏死骨组织(necrotic bone volume/tissue volume,NBV/TV)所取代,NBV/TV在Ⅰ期仅少量存在(4.81%±2.61%),但在Ⅲ期达到峰值(18.50%±2.77%)。骨代谢指标水平显示,骨钙素(osteocalcin,OC)在骨折后持续上升,在Ⅲ期达到峰值(38.15±3.84)μg/L;Ⅰ型胶原交联C-末端肽(β-isomerized C-terminal telopeptide,β-CTX)骨折后快速上升,在Ⅲ期继续上升至最高水平(1.31±0.16)μg/L;骨折后Ⅰ型原胶原N-端前肽(N-terminal propeptide of type I collagen,P1NP)下降,Ⅲ期达到谷值(38.57±7.25)μg/L。结论Kummell病不同时期组织形态特征以及骨转换标志物浓度各不相同。Ⅰ期骨形成能力较为活跃,有一定愈合可能;Ⅲ期对骨组织破坏程度最为严重,坏死骨组织含量显著升高。

Objective To observe the histomorphological characteristics of bone tissue and the changes of bone metabolic markers in different periods in patients with Kummell’s disease.Methods A total of 82 patients with Kummell’s disease were included in this study,and fasting blood samples were collected to detect the level of bone metabolic markers.During vertebroplasty,pedicle bone biopsy was performed to collect bone biopsy specimens,and decalcified biopsy specimens were prepared.Light microscopy was used to observe and bone tissue morphometric analysis was performed.The patients were divided into three stages according to the Li staging method.Results All patients underwent operation smoothly,including 19 patients in stageⅠ(23.2%),39 patients in stageⅡ(47.5%),and 24 patients in stageⅢ(29.3%).The course disease was 5.2 months for stageⅠ,10.4 months for stageⅡ,and 18.5 months for stageⅢ,with statistically significant differences(P<0.05).Bone histomorphological analysis showed that endochondral bone fraction(EBV/TV)and granulation or fibrous tissue volume/tissue volume(FV/TV)reached a peak value(8.87%±0.25%,54.63%±3.52%)at stageⅠ,which was gradually replaced by necrotic bone tissue(NBV/TV).NBV/TV only existed in a small amount(4.81%±2.61%)at StageⅠ,but reached a peak value(18.50%±2.77%)at stageⅢ.Oosteocalcin(OC)continued to rise after fracture,reaching a peak value of(38.15±3.84)μg/L in stageⅢ.The level of serumβ-isomerized C-terminal telopeptide(β-CTX)increased rapidly after fracture continue to rise to the peak in phaseⅢ,which was(1.31±0.16)μg/L.The level of serum typeⅠtropocollagen N-terminal propeptide(P1 NP)was declined after fracture.Which fell to the lowest level of(38.57±7.25)μg/L in paseⅢ.Conclusions The histological characteristics and bone turnover marker concentration of Kummell’s disease vary in different stages.The bone formation ability in stageⅠis relatively active,which indicate a possibility of healing.In stageⅢ,the degree of bone tissue destruction is more severe than that in typeⅠ,and the content of necrotic bone tissue is significantly increased.