股骨头坏死与髋骨下骨不全骨折的外侧塌陷病变的微观结构特征的差异。
Differences in the microarchitectural features of the lateral collapsed lesion between osteonecrosis and subchondral insufficiency fracture of the femoral head.
机构信息
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
出版信息
Bone. 2020 Dec;141:115585. doi: 10.1016/j.bone.2020.115585. Epub 2020 Aug 12.
BACKGROUND
Like osteonecrosis of the femoral head (ONFH), subchondral insufficiency fracture of the femoral head (SIF) causes femoral head collapse. However, little is known about the differences between the two diseases regarding the morphological features of the collapsed lesion. We tested the hypothesis that the morphological features of the lateral collapsed lesion would differ between ONFH and SIF.
METHODS
Twenty femoral heads histopathologically diagnosed as ONFH (n = 10) or SIF (n = 10) were used in this study. In the lateral collapsed lesion of each femoral head, cubic regions of interest (ROIs) were selected within the collapsed subchondral area and the nearby non-collapsed subchondral area. Micro-CT-based microarchitectural parameters were compared between the ROIs in each disease. Additionally, correlations between histopathological and microarchitectural features were evaluated.
RESULTS
In ONFH, bone volume fraction, trabecular thickness, and bone mineral density in the collapsed area were all significantly lower than those in the nearby non-collapsed area where thickened bone trabeculae accompanied by appositional bone formation were invariably seen. On the other hand, in SIF there were no significant differences between the ROIs in any of these microarchitectural parameters. Histopathologically, varying degrees of callus formation overlying the fracture of the subchondral plate were seen around the lateral collapsed lesion.
CONCLUSION
The morphological features of the lateral collapsed lesion were inconsistent between ONFH and SIF, suggesting different pathomechanisms of femoral head collapse.
背景
与股骨头坏死（ONFH）一样，股骨头的软骨下骨不全骨折（SIF）也会导致股骨头塌陷。然而，对于这两种疾病在塌陷病变的形态特征方面的差异，人们知之甚少。我们验证了这样一个假设，即 ONFH 和 SIF 的外侧塌陷病变的形态特征会有所不同。
方法
本研究使用了 20 个经组织病理学诊断为 ONFH（n=10）或 SIF（n=10）的股骨头。在每个股骨头的外侧塌陷病变中，在塌陷的软骨下区域和附近未塌陷的软骨下区域内选择立方感兴趣区域（ROI）。比较了两种疾病中每个 ROI 的基于微 CT 的微观结构参数。此外，还评估了组织病理学和微观结构特征之间的相关性。
结果
在 ONFH 中，塌陷区域的骨体积分数、骨小梁厚度和骨矿物质密度均明显低于附近的非塌陷区域，在非塌陷区域中始终可见骨小梁增厚并伴有新骨形成。另一方面，在 SIF 中，这些微观结构参数在任何 ROI 之间均无显著差异。组织病理学上，在外侧塌陷病变周围的软骨下板骨折处可见不同程度的骨痂形成。
结论
ONFH 和 SIF 的外侧塌陷病变的形态特征不一致，表明股骨头塌陷的发病机制不同。
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