Analysis of trabecular bone microstructure in osteoporotic femoral heads in human patients: in vivo study using multidetector row computed tomography.
Analysis of trabecular bone microstructure in osteoporotic femoral heads in human patients: in vivo study using multidetector row computed tomography.
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DOI：
10.1186/s12891-015-0848-z
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发表时间：
2016-01-12
影响因子：
2.3
通讯作者：
Tanaka Y
中科院分区：
文献类型：
--
作者：
Munemoto M;Kido A;Sakamoto Y;Inoue K;Yokoi K;Shinohara Y;Tanaka Y
拉力螺钉位置在股骨粗隆间骨折治疗中非常重要，以防止螺钉切出等并发症。目前的研究建议在前后位片上将拉力螺钉置于中心或下方，在侧位片上将拉力螺钉置于中心。这些报告基于影像学评价，但很少有研究调查拉力螺钉放置部位骨质的重要性。在这项研究中，我们使用多排螺旋CT（MDCT）对股骨转子间骨折患者的股骨头的骨微结构进行体内评价。本研究已获得Okanami General Hospital伦理委员会的批准。我们收集了10例股骨粗隆间骨折患者的MDCT图像。纳入了需要计算机断层扫描以确认骨折形态的患者。我们定义了六个区域作为感兴趣区域（ROI）：ROI 1-3被定义为股骨头尖区，ROI 4-6被定义为股骨颈区。采用骨分析软件（TRI/3D-BON）评价骨小梁微结构参数，包括平均骨体积/总体积（BV/TV）、骨小梁厚度（Tb.Th）、骨小梁间距（Tb.Sp）和结构模型指数（SMI）。使用EZR软件进行统计学分析;通过方差分析（ANOVA）和Tukey检验对ROI中的每个参数进行统计学评价。在p < 0.05时建立统计学显著性。在根尖区，所有参数均表明ROI 1（上级）的骨质量最高，ROI 2（中央）的骨质量高于ROI 3（下级）。在股骨颈中，所有参数均表明ROI 6（下部）的骨质显著高于ROI 5（中部）。我们可以在活体内用临床MDCT评价骨质量。股骨头顶端中心区的骨质量大于下方区，股骨颈下方区的骨质量大于中心区。认识到股骨头的哪个区域具有更好的骨质，可能会导致更好的治疗股骨粗隆间骨折的临床效果。
Lag screw position is very important in the treatment of intertrochanteric femoral fracture to prevent complications such as screw cut-out. Current studies recommend central or inferior placement of the lag screw on the anteroposterior radiograph, and central placement on the lateral radiographs. These reports are based on radiographic evaluation, but few studies have investigated the importance of bone quality at the site of lag screw placement. In this study, we used multidetector row computed tomography (MDCT) to perform in vivo evaluation of the bone microstructure of the femoral head in patients with intertrochanteric femoral fractures. This study was approved by the Ethics Committee of Okanami General Hospital. MDCT images were obtained in our hospital from ten patients who had sustained intertrochanteric femoral fracture. Patients who needed computed tomography to confirm fracture morphology were included. We defined six areas as regions of interest (ROI): ROI 1–3 were defined as the femoral head apex area, and ROI 4–6 were defined as the femoral neck area. Trabecular microstructure parameters, including mean bone volume to total volume (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), and structure model index (SMI), were evaluated with bone analysis software (TRI/3D-BON). Statistical analyses were performed using EZR software; each parameter among the ROIs was statistically evaluated by analysis of variance (ANOVA) and Tukey’s test. Statistical significance was established at p < 0.05. In the apical area, all parameters indicated that ROI 1 (superior) had the highest bone quality and ROI 2 (central) was higher in bone quality than ROI 3 (inferior). In the femoral neck, all parameters indicated that bone quality was significantly greater in ROI 6 (inferior) than ROI 5 (central). We could evaluate bone quality with clinical MDCT in vivo. Bone quality in the central area of the femoral head apical was greater than in the inferior area, and bone quality in the inferior area of the femoral neck was greater than in the central area. Recognizing which area of femoral head has greater bone quality may lead to a better clinical result in treating intertrochanteric femoral fracture.