Amling M, Grote H J, Pösl M, Hahn M, Delling G
Department of Bone Pathology, University of Hamburg, Germany.
Bone Miner. 1994 Dec;27(3):193-208. doi: 10.1016/s0169-6009(08)80193-6.
It was the aim of this study to record quantitatively and qualitatively the distribution of the three-dimensional microarchitecture throughout the human spine in osteoporosis. Bone biopsies of the iliac crest and the complete spine of 26 autopsy cases without skeletal disease and 11 female patients with proven osteoporosis were removed. Grindings of all vertebrae by a technique which we developed allowed two- and three-dimensional measurements simultaneously. The analysis included an evaluation of trabecular bone volume, trabecular interconnection, and trabecular thickness, as well as a qualitative investigation of the structure of cancellous bone. The bone loss in osteoporosis is a loss of structure. The relative loss of the trabecular microarchitecture is greater in the iliac crest than in the lumbar spine. It is a gradual change from normal bone to osteoporosis. Transformation from plates to rods and the loss of whole trabeculae are caused by perforations. The polyostotic heterogeneity in osteoporosis is remarkable. Adjacent vertebrae may show differences of up to 100% in bone structure and bone volume. This explains the difficulties in early diagnosis of osteoporosis. Due to the polyostotic heterogeneity it is impossible to define a threshold mineral content for osteoporotic fractures.
本研究的目的是定量和定性记录骨质疏松症患者整个人类脊柱三维微结构的分布情况。获取了26例无骨骼疾病的尸检病例的髂嵴和整个脊柱以及11例经证实患有骨质疏松症的女性患者的骨活检样本。采用我们开发的技术对所有椎骨进行研磨，可同时进行二维和三维测量。分析包括对小梁骨体积、小梁连接性和小梁厚度的评估，以及对松质骨结构的定性研究。骨质疏松症中的骨质流失是结构的丧失。髂嵴中小梁微结构的相对丧失比腰椎更严重。这是从正常骨到骨质疏松症的逐渐变化。从骨板到骨棒的转变以及整个小梁的丧失是由穿孔引起的。骨质疏松症中的多骨异质性很显著。相邻椎骨的骨结构和骨体积差异可能高达100%。这解释了骨质疏松症早期诊断的困难。由于多骨异质性，不可能为骨质疏松性骨折定义一个阈值矿物质含量。
