人股骨头坏死标本不同区域骨小梁的显微结构特征及病理学表现

目的 对股骨头坏死标本不同区域的骨小梁进行量化分析。 方法 收集我院2011 - 2013 年非创伤性股骨头坏死病人行全髋关节置换术后的股骨头标本10 个以及病人病历和临床影像学资料（ 男性6 例，女性4 例）。对标本进行显微CT 断层扫描，根据图像结果将标本分为健康区、硬化区和坏死区，分别进行骨计量学分析。分析指标有骨矿密度（bone mineral density，BMD）、骨矿容量（bone mineral content，BMC）、骨表面积与骨骼体积比（bone surface to bone volume ratio，BS/BV） ；体积分数（bone volume fraction，BVF）、结构模型指数（structure model index，SMI）、骨小梁数目（trabecular plate number，Tb.N）、骨小梁厚度（trabecular plate thickness，Tb.Th）、骨小梁间隙（trabecular spacing，Tb.Sp）。扫描后将标本作病理学处理。 结果 晚期股骨头坏死区和硬化区的骨小梁空间结构明显改变。与健康区相比，硬化区骨小梁明显增厚，BVF 显著增加，两组间BMD、Tb.Th、BMC、BS/BV 差异有统计学意义（P ＜ 0.05），而Tb.Sp 差异无统计学意义（P ＞ 0.05） ；与健康区相比，坏死区的BMD、BMC、BVF、Tb.N 明显减少，Tb.Sp 较硬化区显著增宽，两组差异有统计学意义（P ＜ 0.05），而Tb.Th、BS/BV 差异无统计学意义（P ＞ 0.05）。 结论 晚期股骨头坏死标本坏死区的骨小梁连续性破坏，结构散乱；硬化区的骨小梁结构增厚，数目增多，间隙变窄；正常区域骨小梁结构完整，厚度分布均匀。

Microstructure features and pathology of trabecula in different regions of femoral head necrosis

Objective To analyze the microstructure of trabecula in different regions of femoral head necrosis. Methods Clinical and imaging data about 10 patients （6 males and 4 females） with non-traumatic femoral head necrosis who underwent total hip arthroplasty in our hospital from 2011 to 2013 were retrospectively analyzed. Samples were taken from the healthy, sclerotic and necrosed regions of the patients. The following parameters were analyzed, including the bone mineral density （BMD）, bone mineral content （BMC）, bone surface/ bone volume （BS/BV） ratio, bone volume fraction（BVF）, structure model index （SMI）, number of trabecular plates, thickness of trabecular plate, and trabecular space. Results The spatial structure of trabecula was significantly changed in necrosed and sclerotic regions of femoral head. The trabecula was significantly thicker and the BVF was significantly higher in necrosed region than in healthy region （P 〈 0.05）. No significant difference was found in the BMD, the number of trabecular plates, the thickness of trabecular plate, and the BS/BV ratio between the two groups （P 〉 0.05）. The BMD and BMC, the BVF, and the thickness of trabecular plate were significantly lower while the trabecular space was significantly wider in necrosed region than in healthy region （P 〈 0.05）. No significant difference was found in the thickness of trabecular plate and the BS/BV ratio between the two groups （P 〉 0.05）. Conclusion The spatial structure and pathological features of trabecula are different in different necrosis regions of femoral head. The continuity of trabecula in necrosed region is disrupted, with its structure disarranged and thickened, the number of trabecular plates increased, and the trabecular space narrowed. However, the structure of trabecula is intact and its thickness is even in the healthy region.