Division of Pediatric Orthopaedics, Department of Orthopaedics, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
Texas A&M Health Science Center, School of Medicine, Temple, Texas.
J Orthop Res. 2019 Aug;37(8):1784-1789. doi: 10.1002/jor.24311. Epub 2019 Apr 25.
Legg-Calve-Perthes disease is characterized by the capital femoral epiphyseal collapse, which occurs more reliably in the anterior quadrant than the more weight-bearing lateral quadrant. The purpose of this study was to determine whether there is a vascular or microstructural predisposition for anterior femoral epiphyseal collapse in Perthes disease. Thirty-two cadaveric proximal femoral epiphyses from 17 subjects (age 4-14 years old) underwent micro-computed tomography at 10-μm resolution. Each quadrant was analyzed for four markers of trabecular architecture: bone volume fraction (BV/TV), trabecular thickness, trabecular separation (TbSp), and trabecular number (TbN). Vascular channels were then mapped in each quadrant, identified by correlating surface topography with cross-sectional imaging. One-way analysis of variance revealed an overall difference between quadrants (p < 0.001) in BV/TV, TbN, and TbSp. However, post hoc analysis revealed there was no significant difference between the anterior and lateral quadrants for any of the four markers of trabecular architecture. Vascular channel mapping illustrated a predominance of vessels in the posterior half of the epiphysis compared to the anterior half (8.7 ± 4.0 vs. 3.4 ± 3.1 vascular channels, p < 0.001). The lack of microstructural differences between the anterior and lateral quadrants, and the predominance of vascular channels in the posterior half of the epiphysis with posteriorly-based medial femoral circumflex and ligamentum teres vessels suggests that the anterior femoral epiphysis may be a relative vascular watershed region, which predisposes it to collapse after the vascular insult of Perthes disease. Clinical significance: Improved understanding of the pathophysiology of anterior femoral epiphyseal collapse may inform future treatments aimed at revascularization. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1784-1789, 2019.
佩特氏病的特点是股骨头骨骺的塌陷，这种塌陷在前象限比更承重的外侧象限更可靠。本研究的目的是确定佩特氏病中前股骨头骨骺塌陷是否存在血管或微观结构倾向。 从 17 个受试者（年龄 4-14 岁）的 32 个尸体股骨近端骨骺中进行了 10-μm 分辨率的微计算机断层扫描。每个象限都分析了四个小梁结构的标志物：骨体积分数（BV/TV）、小梁厚度、小梁分离（TbSp）和小梁数量（TbN）。然后在每个象限中绘制血管通道，通过将表面地形与横截面成像相关联来识别。单向方差分析显示，在 BV/TV、TbN 和 TbSp 方面，象限之间存在总体差异（p < 0.001）。然而，事后分析显示，在前象限和外侧象限之间，四个小梁结构标志物之间没有显著差异。血管通道映射说明了与前半部分相比，骨骺后半部分的血管优势（8.7±4.0 比 3.4±3.1 个血管通道，p < 0.001）。前象限和外侧象限之间没有微观结构差异，以及后内侧股骨旋肌和韧带的血管优势在后半部分骨骺，表明前股骨头骨骺可能是一个相对的血管分水岭区域，这使其容易在前佩特氏病的血管损伤后塌陷。临床意义：对前股骨头骨骺塌陷的病理生理学的理解的提高可能为旨在再血管化的未来治疗提供信息。©2019 骨科研究协会。由 Wiley 期刊出版公司出版。J Orthop Res 37：1784-1789，2019。
