Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, 710049, China.
Department of Orthopedics, Xi'an Daxing Hospital, Xi'an, 710000, China.
Calcif Tissue Int. 2024 Feb;114(2):119-128. doi: 10.1007/s00223-023-01153-5. Epub 2023 Nov 30.
The study was aimed to investigate microarchitecture of osteochondral junction in patients with osteonecrosis of the femoral head (ONFH). We hypothesis that there were microarchitecture alternations in osteochondral junction and regional differences between the necrotic region (NR) and adjacent non-necrotic region(ANR) in patients with ONFH. Femoral heads with ONFH or femoral neck fracture were included in ONFH group (n = 11) and control group (n = 11). Cylindrical specimens were drilled on the NR/ANR of femoral heads in ONFH group and matched positions in control group (CO.NR/ CO.ANR). Histology, micro-CT, and scanning electron microscope were used to investigate microarchitecture of osteochondral junction. Layered analysis of subchondral bone plate was underwent. Mankin scores on NR were higher than that on ANR or CO.NR, respectively (P < 0.001, P < 0.001). Calcified cartilage zone on the NR and ANR was thinner than that on the CO.NR and CO.ANR, respectively (P = 0.002, P = 0.002). Tidemark roughness on the NR was larger than that on the ANR (P = 0.002). Subchondral bone plate of NR and ANR was thicker than that on the CON.NR and CON.ANR, respectively (P = 0.002, P = 0.009). Bone volume fraction of subchondral bone plate on the NR was significantly decreasing compared to ANR and CON.NR, respectively (P = 0.015, P = 0.002). Subchondral bone plate on the NR had larger area percentages and more numbers of micropores than ANR and CON.NR (P = 0.002/0.002, P = 0.002/0.002). Layered analysis showed that bone mass loss and hypomineralization were mainly on the cartilage side of subchondral bone plate in ONFH. There were microarchitecture alternations of osteochondral junction in ONFH, including thinned calcified cartilage zone, thickened subchondral bone plate, decreased bone mass, altered micropores, and hypomineralization of subchondral bone plate. Regional differences in microarchitecture of osteochondral junction were found between necrotic regions and adjacent non-necrotic regions. Subchondral bone plate in ONFH had uneven distribution of bone volume fraction and bone mineral density, which might aggravate cartilage degeneration by affecting the transmission of mechanical stresses.
本研究旨在探讨股骨头坏死（ONFH）患者的骨软骨连接的微观结构。我们假设在 ONFH 患者的骨软骨连接中存在微观结构改变，并且在坏死区域（NR）和相邻非坏死区域（ANR）之间存在区域差异。ONFH 组（n=11）和对照组（n=11）分别纳入了 ONFH 或股骨颈骨折患者的股骨头 NR/ANR 处的圆柱形标本。通过组织学、微 CT 和扫描电子显微镜观察骨软骨连接的微观结构。对软骨下骨板进行分层分析。NR 的 Mankin 评分高于 ANR 或 CO.NR（P<0.001，P<0.001）。NR 和 ANR 的钙化软骨层比 CO.NR 和 CO.ANR 薄（P=0.002，P=0.002）。NR 的潮标粗糙度大于 ANR（P=0.002）。NR 和 ANR 的软骨下骨板比 CON.NR 和 CON.ANR 厚（P=0.002，P=0.009）。与 ANR 和 CON.NR 相比，NR 的软骨下骨板骨体积分数明显降低（P=0.015，P=0.002）。NR 的软骨下骨板的面积百分比和微孔数量大于 ANR 和 CON.NR（P=0.002/0.002，P=0.002/0.002）。分层分析表明，ONFH 患者软骨下骨板的骨量丢失和矿化不足主要发生在软骨侧。ONFH 患者的骨软骨连接存在微观结构改变，包括钙化软骨层变薄、软骨下骨板增厚、骨量减少、微孔改变和软骨下骨板矿化不足。在坏死区域和相邻非坏死区域之间发现了骨软骨连接微观结构的区域差异。ONFH 的软骨下骨板的骨体积分数和骨矿物质密度分布不均匀，这可能通过影响机械应力的传递而加重软骨退变。
