Amling M, Pösl M, Ritzel H, Hahn M, Vogel M, Wening V J, Delling G
Department of Bone Pathology, University of Hamburg, Germany.
Arch Orthop Trauma Surg. 1996;115(5):262-9. doi: 10.1007/BF00439050.
The objective of this study was to analyze the structure of cancellous bone and its significance for vertebral fractures. Therefore, the complete spinal column from 40 autopsy cases (18 without diseases affecting the skeleton and 12 osteoporotic) was removed and sectioned in the sagittal plane to a thickness of 1 mm. A surface-stained block grinding technique allowed combined two- and three-dimensional histomorphometric analysis, which included an evaluation of the trabecular bone volume (BV/TV, in %) and the trabecular interconnection (TBPf, in mm). In addition, qualitative investigation of the structure of trabecular bone was done. The distribution of trabecular bone volume within the spinal column of a normal skeleton shows a curve, with the highest values in the cervical spine and a decline in the thoracic and lumbar spine. Osteoporosis presents itself with a pathologically diminished trabecular bone volume, whereas the distribution within the spine is comparable to that of the controls. Osteoporotic patients show an apparently reduced trabecular interconnection. It is important that the measured values for TBPf are not only in general higher, but also more widely dispersed. The age-related decrease of trabecular bone mass is due to the transformation from plates to rods. This is quantitatively indicated by the close correlation of BV/TV and TBPf (P < 0.001, r = 0.85). The bone loss in osteoporosis is a loss of structure and a loss of whole trabeculae, which is caused by perforations. It involves a gradual change from normal bone. However, the polyostic heterogeneity in osteoporosis is immense. These structural differences demonstrate the development of regions of least resistance within the spine, serving as an explanation of osteoporotic fractures. Due to the polyostotic heterogeneity it is impossible to define a threshold mineral content for crash fractures by diagnostic measurements at any reference site.
本研究的目的是分析松质骨的结构及其对椎体骨折的意义。因此，从40例尸检病例（18例无影响骨骼的疾病，12例骨质疏松症患者）中取出完整的脊柱，并在矢状面切成1毫米厚的切片。一种表面染色的块磨技术允许进行二维和三维组织形态计量分析，包括对骨小梁体积（BV/TV，百分比）和骨小梁连接性（TBPf，毫米）的评估。此外，还对骨小梁结构进行了定性研究。正常骨骼脊柱内骨小梁体积的分布呈曲线，颈椎处值最高，胸腰椎处值下降。骨质疏松症表现为骨小梁体积病理性减少，而脊柱内的分布与对照组相当。骨质疏松症患者的骨小梁连接性明显降低。重要的是，TBPf的测量值不仅总体上更高，而且分布更广泛。骨小梁骨量随年龄的减少是由于从板状向杆状的转变。这在定量上由BV/TV和TBPf的密切相关性表示（P < 0.001，r = 0.85）。骨质疏松症中的骨质流失是结构的丧失和整个骨小梁的丧失，这是由穿孔引起的。它涉及从正常骨的逐渐变化。然而，骨质疏松症中的多部位异质性非常大。这些结构差异表明脊柱内阻力最小区域的发展，这可解释骨质疏松性骨折。由于多部位异质性，不可能通过在任何参考部位的诊断测量来定义脆性骨折的阈值矿物质含量。
