老年骨质疏松性骨折骨量与骨质量关系的探讨

Studies of relation between bone quantity and bone quality in the elder with osteoporotic fracture

目的:探讨老年股骨颈骨折患者的骨量与骨质量两者的关系与规律。方法:取老年股骨颈骨折患者股骨头和正常青年股骨头,行骨密度测量后,进行扫描电镜观察和形态计量学检测。结果:86.5%病例符合WHO骨质疏松症诊断标准,43.2%病例股骨颈骨密度在骨折阈值之上。扫描电镜下观察发现:骨折患者骨小梁发生明显变化。形态计量学显示:老年组骨小梁游离末端数(FET)、平均骨小梁间距(MTPS)较青年组明显升高(P<0.01),小梁间连接点数(Tb.n)、松质骨体积(TBV)、平均骨小梁密度(MTPD)、平均骨小梁厚度(MTPT)明显减少(P<0.01)。结论:术后股骨头标本行扫描电镜观察和形态计量学分析是一种简便而准确的诊断骨量与骨质量下降的方法。

AIM:To investigate interrelationship and regular rule between bone quality and bone quantity in the elder with femoral neck fractures.METHODS:Femoral heads from 37 aged patients, 18 men and 19 women, with femoral neck fracture were obtained after total hip replacement. The bone mineral density of all patients and all specimens of the femoral head were measured with DEXA.Cancellous bone samples were obtained from the femoral head. All samples were observed with scanning electron microscopy, and then the histomorphometric analysis was done. RESULTS:86.5%cases accorded with the diagnostic standard of osteoporosis(WHO).The proximal femural BMD in 43.2%cases were over the threshold value of fracture.As compared with the young adults,the old people presented obvious microstructural changes under electron microscopy. The result of histomorphometry showed: free end trabecular(FET) and mean trabecular plate separation (MTPS) were remarkably increased(P< 0.01). Intertrabecular node(Tb.n), trabecular bone volume(TBV), mean trabeculaar plate thickness(MTPT) and mean trabecular plate density(MTPD) decreased(P< 0.01)in the old people. CONCLUSION:Scanning electron microscopy and histomorphometry, adopted at femoral head from osteoporotic fracture,is a simple and accurate method for assessing the quantity and the quality of bone.