Ritzel H, Amling M, Vogel M, Pösl M, Hahn M, Werner M, Delling G
Abteilung Osteopathologie, Pathologisches Institut der Universität, Hamburg.
Pathologe. 1996 Jan;17(1):68-77. doi: 10.1007/s002920050137.
Osteoporosis is the most frequent generalized bone disease. The clinical expression of postmenopausal osteoporosis is characterized by spontaneous fractures of the vertebral bodies which affect mainly the trabecular bone structure. Thus the morphological bone transformation in osteoporosis is of clinical relevance. The object of this study was to analyze quantitatively and qualitatively the distribution of three-dimensional structure of cancellous bone in the human spine in osteoporosis. Therefore the complete anterior column of the spine and bone biopsies of the iliac crest of 11 autopsy cases with proven osteoporosis and 26 autopsy cases without primary or secondary bone disease were removed. A 1-mm-thick prepared sagittal section through the center of all vertebral bodies was embedded undecalcified in plastic and stained on the surface using a modification of the von Kossa method. This technique allowed combined two- and three-dimensional measurements simultaneously; these included evaluation of trabecular bone volume, trabecular interconnection, trabecular thickness, and trabecular number. The quantitative spine deformity index and qualitative analysis of the trabecular bone structure completed the investigation. The bone loss in osteoporosis is a loss of structure and the loss of whole trabeculae caused by perforations. The age-related decrease of trabecular bone mass is due to the transformation from plates to rods. Patient with osteoporosis show pathologically diminished trabecular bone volume and apparently reduced trabecular interconnection, while trabecular thickness and trabecular number show age-dependent change. The polyostotic heterogeneity in osteoporosis is immense. Neighboring vertebral bodies show differences of up to 100% in bone volume and bone structure. Due to this fact it is impossible to define a threshold for osteoporotic fractures. At the moment the transformation and loss of trabecular bone structure in osteoporosis is assumed to be irreversible; therefore, early prophylaxis is necessary to prevent clinical manifestations of these changes of bone.
骨质疏松症是最常见的全身性骨病。绝经后骨质疏松症的临床表现以椎体自发性骨折为特征，主要影响松质骨结构。因此，骨质疏松症中骨的形态学改变具有临床意义。本研究的目的是对骨质疏松症患者脊柱松质骨三维结构的分布进行定量和定性分析。为此，从11例经证实患有骨质疏松症的尸检病例和26例无原发性或继发性骨病的尸检病例中取出脊柱的完整前柱和髂嵴骨活检标本。通过所有椎体中心制作的1毫米厚矢状切片未经脱钙嵌入塑料中，并使用改良的冯·科萨法对表面进行染色。该技术允许同时进行二维和三维测量；这些测量包括评估松质骨体积、小梁连接性、小梁厚度和小梁数量。定量脊柱畸形指数和松质骨结构的定性分析完成了这项研究。骨质疏松症中的骨质流失是结构的丧失以及由于穿孔导致的整个小梁的丧失。与年龄相关的小梁骨量减少是由于从板状向杆状的转变。骨质疏松症患者的小梁骨体积在病理上减少，小梁连接性明显降低，而小梁厚度和小梁数量呈现年龄依赖性变化。骨质疏松症中多骨的异质性很大。相邻椎体的骨体积和骨结构差异高达100%。由于这一事实，不可能确定骨质疏松性骨折的阈值。目前，骨质疏松症中小梁骨结构的转变和丧失被认为是不可逆的；因此，早期预防对于防止这些骨变化的临床表现是必要的。
