脊髓损伤后骨代谢形态改变的髂骨形态计量学研究  

Morphometric study of flank bone with osteoporosis after spinal cord injury

作　　者：李全义[1] 刘时璋[1] 罗振群[1] 弓立群[1] 王茁[1] 马战胜[1] 徐洪海[1] 凌鸣[1] 

机构地区：[1]陕西省人民医院骨科,陕西西安710068

出　　处：《第四军医大学学报》2007年第15期1421-1424,共4页Journal of the Fourth Military Medical University

基　　金：陕西省科技攻关项目(2000年)

摘　　要：目的:观察和分析脊髓损伤引起骨质疏松患者骨组织形态计量学(骨结构与骨转换)参数特征,进一步探明发生骨质疏松的机制.方法:选择脊髓损伤截瘫患者30(男19,女11)例;颈脊髓伤16例,胸脊髓损伤14例.伤后24h内取髂骨标本设为对照组,伤后1,6,12mo取髂骨标本设为实验组.每位患者均采用自制微创活检器于同一部位获取2cm长的髂骨组织,进行骨组织形态计量学观察与分析.结果:实验组患者髂骨结构参数中骨小梁密度(Tb.N),骨小梁厚度(Tb.Th),结点末端比(NTR)均低于对照组(P<0.05),而骨小梁间距(Tb.Sp)则高于对照组(P<0.05);骨转换参数中平均类骨质宽度(Os.Th),类骨质体积(OV/BV),平均骨壁厚度(W.Th)均较对照组低,其中两组间比较骨壁厚度(W.Th)差异有统计学意义(P<0.05);骨吸收表面(ES/BS)则高于对照组.结论:脊髓损伤后患者由于神经功能缺失和废用因素,引起骨转换出现特异性改变,呈高转换率状态,骨形成与骨吸收严重失衡,导致髂骨代谢显微结构发生明显退变,骨组织力学性能下降,是发生骨质疏松的重要因素.AIM： To observe and analyze the morphometric fea tures of the bone tissue of the patients with osteoporosis caused by spinal cord injury so as to further explore the mechanism of osteo poresis. METHODS： Thirty cases （19 males, 11 females） with paraplegia caused by spinal cord injury （cervical spinal cord injury in 16, thoracic spinal cord injury in 14） were enrolled into the study. The 2 cm flank bone specimens were taken with a self made biopsy instrument 24 h after injury （as control group） and 1, 6, 12 months after injury （as experimental groups） to observe and analyze their morphometric parameters. RESULTS： The bone structure parameters such as Tb. N, Tb. Th, NTR were lower in experimental groups than in control group （ P 〈 0.05 ） , but Tb. Sp was higher in experimental groups （ P 〈 0.05 ） ; the bone turn over parameters such as Os. Th, OV/BV and W. Th were lower in experimental groups than in control group, but the differences were not significant statistically but W. Th （ P 〈 0.05）, and ES/ BS was higher in experimental groups than in control group. CONCLUSION： Since the nerve dysfunction caused by spinal cord injury results in high bone turnover rate, the balance of bone formation and bone absorption is impaired severely, the bone metabolism degenerates obviously and the bone mechanical functions reduce, all which contribute to the osteoporosis following spinal cord injury.

关 键 词：脊髓损伤 骨和骨组织/代谢 骨组织形态计量学 

分 类 号：R651.2[医药卫生—外科学]