不同骨密度骨质疏松性椎体压缩骨折骨组织形态与骨代谢标志物分析  

Analysis of bone histomorphometry and metabolic markers in osteoporotic vertebral fracture patients with different bone mineral density

作　　者：张芸 张业峰 王磊[3] 李志超[3] 王文波[3] 薛景才 ZHANG Yun;ZHANG Yefeng;WANG Lei;LI Zhichao;WANG Wenbo;XUE Jingcai(College of Chinese Medicine,Shandong University of Traditional Chinese Medicine,Ji’nan 250012;Shandong Provincial Hospital Affiliated to Shandong University,Ji’nan 250012;Department of Spine,the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Ji’nan 250012,China)

机构地区：[1]山东中医药大学中医学院,山东济南250012 [2]山东大学附属省立医院,山东济南250012 [3]山东中医药大学第二附属医院骨外科,山东济南250012

出　　处：《中国骨质疏松杂志》2022年第1期56-61,共6页Chinese Journal of Osteoporosis

基　　金：山东省医药卫生科技发展计划项目(2018WS094)。

摘　　要：目的观察不同骨密度骨质疏松椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)骨组织形态学特征及骨代谢标志物变化规律。方法将136例OVCF患者按不同骨密度(T值)分为3组:I组,-3.5<T值≤-2.5;Ⅱ组,-4.5<T值≤-3.5;Ⅲ组,T值≤-4.5。所有病例常规行骨代谢标志物检测,椎体成形术过程中获取骨活检标本,采用骨组织形态学标准进行定义。结果所有病例中,Ⅰ组66例(48.5%),Ⅱ组49例(36%),Ⅲ组21例(15.4%)。骨组织形态学示,随骨质疏松程度的加重,BV/TV逐渐下降,并在Ⅲ组降至最低[(9.5±3.6)%],而NBV/TV则在Ⅲ组达到峰值[(15.52±2.15)%]。EBV/TV和FV/TV在Ⅰ组达到峰值[(7.28±0.52)%,(11.33±0.45)%],之后被编织骨所取代。LBV/TV作为矿化骨组织后期,在Ⅱ组达到峰值[(13.93±3.28)%]。骨代谢指标示,成骨及破骨活性均在Ⅱ组达到峰值,其中OST峰值为(24.42±3.74)ng/mL;β-CTX峰值为(0.90±0.17)ng/mL;PINP峰值为(76.10±6.33)ng/mL。结论骨质疏松严重者,其骨折椎体内常伴随大量坏死骨组织及纤维组织,骨代谢活性在-4.5<T值≤-3.5时处于峰值。Objective To observe the morphological characteristics of bone tissue and the changes of bone metabolic markers in patients with osteoporotic vertebral compression fracture(OVCF).Methods One hundred and thirty-six OVCF patients were divided into 3 groups according to their bone mineral density(T values),group Ⅰ-2.5≥T value>-3.5;Group Ⅱ-3.5≥T value>-4.5;and group Ⅲ T value≤-4.5.Bone metabolic markers were routinely examined in all cases.Bone biopsy specimens were obtained during vertebroplasty,which were defined according to bone histomorphometry criteria.Results Among all the cases,there were 66 cases in Group Ⅰ(48.5%),49 cases in Group Ⅱ(36%),and 21 cases in Group Ⅲ(15.4%).Bone histomorphometry result showed that BV/TV decreased gradually with the aggravation of osteoporosis.The decrease was the lowest(9.5±3.6%)in group Ⅲ,and NBV/TV reached the peak(15.52±2.15%)in group Ⅲ.EBV/TV and FV/TV reached the peak value in group Ⅰ(7.28±0.52%,11.33±0.45%,respectively),and then they were replaced by trabecular bone.LBV/TV,as the later stage of mineralized bone tissue,reached the peak in group Ⅱ(13.93±3.28%).Bone metabolic indexes showed that both osteogenic and osteoclast activities reached their peak values in group Ⅱ.The peak values of OST,β-CTX,and PINP were 24.42±3.74 ng/mL,0.90±0.17 ng/mL,and 76.10±6.33 ng/mL,respectively.Conclusion In severe cases of osteoporosis,a large amount of necrotic bone tissue and fibrous tissue are often present in the fractured vertebrae.The peak value of bone metabolic activity is at-3.5≥T value>-4.5.

关 键 词：骨质疏松椎体压缩骨折 骨密度 骨组织形态学 骨代谢标志物 

分 类 号：R683.2[医药卫生—骨科学]