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目的分析骨质疏松髋部骨折区骨微结构参数与影像学参数之间的相关性,为影像学间接评估髋部松质骨微结构变化提供依据。方法以2012年6月-2013年1月收治的16例低能量创伤致股骨颈骨折并行人工髋关节置换的老年患者作为试验组;以同期5例骨盆骨折青年患者作为对照组。对照组行髋部薄层CT扫描,Mimics10.01软件分析股骨近端松质骨体积/髓腔体积(cancellous bone volume/marrow cavity volume,CV/MV);试验组行健侧髋部薄层CT扫描及骨密度检测,并于置换术中切取股骨颈张力侧松质骨,行Micro-CT扫描分析微结构参数,包括骨体积分数(bone volume fraction,BV/TV)、骨小梁数量(trabecular number,Tb.N)、骨小梁距离(trabecular spacing,Tb.Sp)、骨小梁厚度(trabecular thickness,Tb.Th)、连接密度(connect density,Conn.D)、结构模型指数(structure model index,SMI)。分析影像学参数及骨微结构参数间的相关性。结果试验组骨密度值为0.491~0.698 g/cm2,平均0.601 g/cm2;根据世界卫生组织(WHO)推荐的骨质疏松诊断标准,其中10例为骨质疏松,6例为骨量减少。试验组髋部CV/MV为0.670 1±0.102 0,显著低于对照组的0.885 0±0.089 1(t=—4.567,P=0.000)。试验组CV/MV与骨微结构参数BV/TV、Tb.Th、SMI相关(P<0.05),与Tb.N、Tb.Sp、Conn.D不相关(P>0.05);BV/TV与Tb.Th、Tb.N、Tb.Sp、SMI相关(P<0.05),与Conn.D不相关(P=0.075);骨密度值与各骨微结构参数之间均无相关性(P>0.05)。结论骨质疏松患者股骨近端CT参数CV/MV明显降低,并且与松质骨的BV/TV、Tb.Th、SMI存在相关性,该指标能一定程度上反映骨微结构变化;而股骨颈骨密度与骨微结构参数间无相关性。
OBJECTIVE: To analyze the correlation between the microstructure parameters and imaging parameters of osteoporosis hip fracture area, and to provide a basis for indirect assessment of microstructure changes of hip cancellous bone. Methods Sixteen elderly patients with femoral neck fractures treated by low energy trauma and hip arthroplasty were enrolled in this study from June 2012 to January 2013 as the experimental group. Five young patients with pelvic fracture during the same period were selected as the control group. The control group was performed thin layer CT scan of the hip, the cancellous bone volume / marrow cavity volume (CV / MV) was analyzed by Mimics 10.01 software; the thin layer CT Scanning and bone mineral density measurement were performed. The cancellous bone in the tension side of femoral neck was excised and the microstructure parameters including bone volume fraction (BV / TV), trabecular number number, Tb.N), trabecular spacing (Tb.Sp), trabecular thickness (Tb.Th), connect density (Conn.D), structure model index, SMI). Analysis of imaging parameters and the relationship between the parameters of bone microstructure. Results The BMD of the experimental group was 0.491-0.698 g / cm2 with an average of 0.601 g / cm2. According to the diagnostic criteria of osteoporosis recommended by the World Health Organization (WHO), 10 cases were osteoporosis and 6 cases were osteopenia. The CV / MV of the hip in the experimental group was 0.670 1 ± 0.102 0, which was significantly lower than that in the control group (0.885 ± 0.089 1, t = -4.567, P = 0.000). BV / TV, Tb.Th, SMI (P <0.05), but not Tb.N, Tb.Sp, Conn.D (P> 0.05) Tb.Th, Tb.N, Tb.Sp and SMI (P <0.05), but not with Conn.D (P = 0.075). There was no correlation between BMD and microstructure parameters of each bone (P> 0.05). Conclusions The CV / MV of proximal femur in patients with osteoporosis was significantly lower than that in control group, and correlated with BV / TV, Tb.Th and SMI in cancellous bone. This index could reflect the changes of bone microarchitecture to a certain extent. The femoral neck There was no correlation between BMD and bone microstructure parameters.