桡骨远端和髂嵴的骨结构与骨转换：一项组织形态计量学研究。

Bone structure and turnover in the distal radius and iliac crest: a histomorphometric study.

作者信息

Schnitzler C M, Biddulph S L, Mesquita J M, Gear K A

机构信息

MRC Mineral Metabolism Research Unit, University of the Witwatersrand, Johannesburg, South Africa.

出版信息

J Bone Miner Res. 1996 Nov;11(11):1761-8. doi: 10.1002/jbmr.5650111120.

DOI:10.1002/jbmr.5650111120

PMID:8915784

Abstract

In bone grafting procedures of the wrist, the distal radius would be a more convenient graft donor site than the conventionally used iliac crest. We compared tetracycline-labeled bone biopsies from these two sites in 18 white patients (12 males, 6 females, aged 26-66 years) undergoing bone grafting procedures of the wrist. Fourteen had had previous trauma, 1 osteonecrosis of the lunate, 2 mild rheumatoid arthritis, and 1 a brachial plexus palsy. The specimens were processed undecalcified and examined by routine histomorphometry for bone structure, static and dynamic bone turnover variables, and marrow cellularity. We found that bone from the distal radius had thinner cortices (p = 0.0001), lower bone volume (p = 0.01), thinner trabeculae (p = 0.029), greater trabecular separation (p = 0.015), and lower wall thickness (p = 0.0001), marrow cellularity (p = 0.0001), osteoid volume (p = 0.01), osteoid surface (p = 0.02), osteoid thickness (p = 0.0002), osteoblast surface (p = 0.001), eroded surface (p = 0.01), osteoclast surface (p = 0.012), mineral apposition rate (p = 0.0002), double-labeled surface (p = 0.0005), single-labeled surface (p = 0.006), bone formation rate (p = 0.0005), adjusted apposition rate (p = 0.0001), longer mineralization lag time (p = 0.012), and greater activation frequency (p = 0.003). Prolonged mineralization lag time in the radius was associated with thin osteoid seams and low adjusted apposition rates and was therefore attributable to a low level of osteoblast activity rather than to osteomalacia. We conclude that bone from the distal radius was structurally inferior to and had lower turnover than the iliac crest bone. We suggest that where a graft has to provide immediate structural integrity, the iliac crest is the preferred donor site. However, where bone graft is to be compacted into a small cavitary defect, distal radial bone may be an adequate alternative. A clinical study is needed to confirm this assumption.

摘要

在腕部骨移植手术中，桡骨远端作为供骨部位比传统使用的髂嵴更方便。我们比较了18例接受腕部骨移植手术的白人患者（12例男性，6例女性，年龄26 - 66岁）这两个部位的四环素标记骨活检标本。其中14例曾有过外伤史，1例月骨坏死，2例轻度类风湿性关节炎，1例臂丛神经麻痹。标本经不脱钙处理，通过常规组织形态计量学检查骨结构、静态和动态骨转换变量以及骨髓细胞成分。我们发现，桡骨远端的骨皮质更薄（p = 0.0001），骨体积更低（p = 0.01），骨小梁更薄（p = 0.029），骨小梁间距更大（p = 0.015），壁厚度更低（p = 0.0001），骨髓细胞成分更低（p = 0.0001），类骨质体积更低（p = 0.01），类骨质表面更低（p = 0.02），类骨质厚度更低（p = 0.0002），成骨细胞表面更低（p = 0.001），侵蚀表面更低（p = 0.01），破骨细胞表面更低（p = 0.012），矿物质沉积率更低（p = 0.0002），双标记表面更低（p = 0.0005），单标记表面更低（p = 0.006），骨形成率更低（p = 0.0005），调整后沉积率更低（p = 0.0001），矿化延迟时间更长（p = 0.012），激活频率更高（p = 0.003）。桡骨矿化延迟时间延长与类骨质缝薄和调整后沉积率低有关，因此归因于成骨细胞活性水平低而非骨软化。我们得出结论，桡骨远端的骨结构不如髂嵴骨，且骨转换率更低。我们建议，若移植骨必须立即提供结构完整性，髂嵴是首选的供骨部位。然而，若将骨移植填充到小的腔隙性缺损中，桡骨远端骨可能是一种合适的替代选择。需要进行临床研究来证实这一假设。