胫骨近端松质骨不同层面骨密度和生物力学特性研究  

Bone densities and biomechanical properties on different layers of the trabecular bone in the proximal tibia

作　　者：权元元 王海程 李彦霖 丁凯 张一凡 张建志[2,4] 陈伟 Quan Yuanyuan;Wang Haicheng;Li Yanlin;Ding Kai;Zhang Yifan;Zhang Jianzhi;Chen Wei(Department of Medicine,Linfen Vocational and Technical College,Linfen 041000,Shanxi,China;Orthopedic Research Institution of Hebei Province,Key Laboratory of Biomechanics of Hebei Province,Department of Orthopaedic Surgery,The Third Hospital of Hebei Medical University,Shijiazhuang,Hebei 050051,China;Department of Rehabilitation,Tianjin Binhai New Area Hospital of Traditional Chinese Medicine,Tianjin 300450,China;The Second Department of Orthopedics,Hebei Chest Hospital,Shijiazhuang 050041,Hebei,China)

机构地区：[1]临汾职业技术学院医学系,山西临汾041000 [2]河北省骨科研究所,河北省骨科生物力学重点实验室,河北医科大学第三医院创伤急救中心,石家庄050051 [3]天津市滨海新区中医医院康复科,天津300450 [4]河北省胸科医院骨二科,石家庄050041

出　　处：《中华创伤骨科杂志》2024年第8期711-718,共8页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金面上项目(82072447);河北省自然科学基金杰出青年项目(H2021206329)。

摘　　要：目的探讨胫骨近端松质骨不同层面骨密度、生物力学特性以及两者的相关性。方法选取15侧成年男性胫骨标本,采用定量CT扫描,根据测量的胫骨平台松质骨人工破坏层面,随机将15侧标本平均分为3组(n=5):A组(关节软骨下1.5 cm层面的松质骨)、B组(关节软骨下3.0 cm层面的松质骨)和C组(软骨下骨0~3 cm区域的松质骨)。3组标本模拟站立位,连接至生物力学试验机,选取24个位点,施予600 N的垂直负荷,在松质骨破坏前、后分别记录应变值和标本整体位移值。分析A、B两组骨密度与位移值的相关性,比较3组标本松质骨破坏前、后应变值及标本整体形变值。结果A、B两组标本骨密度均与破坏前、后位移值呈负相关(P<0.05)。3组各自组内比较松质骨破坏前、后24个位点的应变值:A组8个位点松质骨破坏前、后应变值差异有统计学意义(P<0.05),其中6个位点应变值增大,主要集中于前交叉韧带止点周围和内侧胫骨平台。B组有3个位点松质骨破坏前、后应变值差异有统计学意义(P<0.05),3个位点应变值均增大,主要集中于破坏平面下方层面后方。C组有10个位点松质骨破坏前、后应变值差异有统计学意义(P<0.05),其中5个位点应变值减小,集中于破坏平面上方;5个位点应变值增大,集中于破坏平面下方。A、B、C组标本整体形变值分别为(0.033±0.003)、(0.015±0.003)、(0.066±0.007)mm,3组间比较差异有统计学意义(P<0.05),两两比较差异均有统计学意义(P<0.05)。结论胫骨近端松质骨骨密度在评估骨强度方面具有一定价值。破坏胫骨近端松质骨显著改变了胫骨近端应变分布,胫骨近端松质骨对应力支撑和负荷传导具有关键作用。ObjectiveTo investigate the correlations between the bone mineral densities and biomechanical properties on different layers of the cancellous bone in the proximal tibia.MethodsQuantitative CT was conducted of the 15 specimens of adult male tibia.Based on the artificial destruction levels at the trabecular bone on the tibial plateau,the 15 specimens were randomly divided into 3 groups(n=5):group A(cancellous bone on the 1.5 cm layer below the articular cartilage),group B(cancellous bone on the 3.0 cm layer under the articular cartilage)and group C(cancellous bone on the 0 to 3 cm range of the subchondral bone).After standing positions were simulated in the 3 sets of specimens,they were connected to a biomechanical testing machine.Twenty-four sites were selected and subjected to a vertical load of 600 N.Strain values and overall displacement values of the specimens were recorded before and after trabecular bone destruction.The correlations were analyzed between bone density and displacement values in groups A and B.The strain values before and after trabecular bone destruction,as well as the overall deformation values of the specimens were compared between the 3 groups.ResultsThe bone densities of specimens in groups A and B were negatively correlated with the displacement values before and after destruction(P<0.05).Comparisons of strain values at the 24 sites before and after trabecular bone destruction within 3 groups:There were statistically significant differences in the strain values at 8 sites between before and after trabecular bone destruction in group A(P<0.05).Of the 8 sites,6 showed increased strains which were mainly concentrated around the insertion point of the anterior cruciate ligament and the medial tibial plateau.There were statistically significant differences in the strain values between before and after trabecular bone destruction at 3 sites in group B(P<0.05).The strains at all the 3 sites increased,mainly concentrated behind the surface below the level of destruction.There were statistically

关 键 词：胫骨 生物力学 骨密度 胫骨近端 松质骨 

分 类 号：R68[医药卫生—骨科学] R318.01[医药卫生—外科学]