Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 52, 22529, Hamburg, Germany.
Clin Orthop Relat Res. 2013 Nov;471(11):3663-71. doi: 10.1007/s11999-013-3195-0. Epub 2013 Jul 27.
Fractures of the talus in the elderly are rare and usually result from high-impact injuries, suggesting only minor age-related bone structure changes. However, total ankle replacement failures with age often result from talar subsidence, suggesting age-related bone loss in the talus. Despite a number of histological analyses of talar microarchitecture, the effects of age and sex on talar microarchitecture changes remain poorly defined.
QUESTIONS/PURPOSES: The aim of this study was to analyze changes or differences in the trabecular microarchitecture of the talus with regard to (1) age and (2) sex.
Sixty human tali were harvested from 30 patients at autopsy of three different age groups (20-40, 41-60, 61-80 years). The specimens were analyzed by radiography, micro-CT, and histological analysis. Given that there was no difference between the left and right talus, static histomorphometric parameters were assessed in three regions of interest of the right talus only (body, neck, head; n = 30).
The talar body, neck, and head were affected differently by age-related changes. The greatest loss of bone volume with age was seen in the talar body (estimate: -0.239; 95% confidence interval [CI], -0.365 to -0.114; p < 0.001). In the talar neck (estimate: -0.165; 95% CI, -0.307 to -0.023; p = 0.025), bone loss was only moderate and primarily was the result of reduction in trabecular thickness (estimate: -1.288; 95% CI, -2.449 to -0.127; p = 0.031) instead of number (estimate: -0.001; 95% CI, -0.005 to -0.003; p = 0.593). Bone structure changes were independent of sex.
Age-related bone structure changes predominantly occur in the talar body, which poses a potential risk factor for total ankle replacement loosening. The moderate changes in the talar neck might explain the persistent low incidence of talar neck fractures with age.
Our findings suggest that before total ankle replacement implantation, careful patient selection with dual-energy xray absorptiometry evaluation may be necessary to reduce the risk of talar implant subsidence.
老年人的距骨骨折很少见，通常是由高能量损伤引起的，这表明只有轻微的与年龄相关的骨骼结构变化。然而，随着年龄的增长，全踝关节置换失败通常是由于距骨下沉引起的，这表明距骨存在与年龄相关的骨质流失。尽管对距骨微结构进行了许多组织学分析，但年龄和性别对距骨微结构变化的影响仍未得到明确界定。
问题/目的：本研究旨在分析年龄和性别对距骨小梁微结构的变化或差异。
从 30 名尸检患者的 60 个距骨中，我们获得了三个不同年龄组（20-40 岁、41-60 岁、61-80 岁）的样本。对标本进行放射学、微 CT 和组织学分析。由于左右距骨无差异，因此仅对右侧距骨的三个感兴趣区域（体部、颈部、头部）进行了静态组织形态计量学参数评估（n=30）。
年龄相关变化对距骨体部、颈部和头部的影响不同。随着年龄的增长，骨量的最大损失发生在距骨体部（估计值：-0.239；95%置信区间[CI]，-0.365 至-0.114；p<0.001）。在距骨颈部（估计值：-0.165；95%CI，-0.307 至-0.023；p=0.025），骨丢失仅为中度，主要是由于小梁厚度的减少（估计值：-1.288；95%CI，-2.449 至-0.127；p=0.031）而不是数量（估计值：-0.001；95%CI，-0.005 至-0.003；p=0.593）。骨结构变化与性别无关。
与年龄相关的骨骼结构变化主要发生在距骨体部，这可能是全踝关节置换松动的潜在危险因素。距骨颈部的中度变化可能解释了随着年龄的增长，距骨颈部骨折发生率持续较低的原因。
我们的研究结果表明，在进行全踝关节置换植入之前，可能需要通过双能 X 射线吸收法评估来进行仔细的患者选择，以降低距骨植入物下沉的风险。
