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A&R：骨关节炎患者的松质骨抗疲劳损伤性能优于骨质疏松症患者

2012-12-27 Arthritis & Rheumatism 网络 蛰虫

Arthritis&Rheumatism骨关节炎骨质疏松
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髋关节骨关节炎（OA）和骨质疏松症（OP）很少发生在同一个患者身上，故OA和OP的软骨下松质骨可能存在较大差别。因此，来自上海交通大学的李展春博士等人进行了一项研究，研究结果发表于2012年12月的《关节炎与风湿病》（ARTHRITIS & RHEUMATISM）杂志上。作者发现因骨量和骨结构不同，OA和OP的松质骨机械性能存在明显差异。 此研究目的在于确定这两种情况是否与软骨下松质骨的


髋关节骨关节炎（OA）和骨质疏松症（OP）很少发生在同一个患者身上，故OA和OP的软骨下松质骨可能存在较大差别。因此，来自上海交通大学的李展春博士等人进行了一项研究，研究结果发表于2012年12月的《关节炎与风湿病》（ARTHRITIS & RHEUMATISM）杂志上。作者发现因骨量和骨结构不同，OA和OP的松质骨机械性能存在明显差异。
此研究目的在于确定这两种情况是否与软骨下松质骨的数量和质量的差别相关。软骨下松质骨样本来自60位接受髋关节置换术的绝经后妇女的股骨头，30例为骨关节炎，30例为骨质疏松症。每组中10例样本有压缩性拉伸疲劳，而其他20例没有。每例样本均进行压缩力学检测、电脑断层扫描和荧光显微镜检查及纳米压痕技术检测。
研究结果表明，OA患者的松质骨的最大应力和弹性系数均明显高于OP患者（P < 0.05）。与OP患者的松质骨相比，OA患者的骨体积分数和骨小梁厚度明显增加，但骨基质明显降低（P < 0.05 ，每次比对）；不考虑疲劳负荷，OP的松质骨的微裂纹密度明显高于OA（P < 0.001）。而疲劳负荷可使OA和OP的松质骨微裂纹密度明显增加（P < 0.001）。不论是否存在骨拉伸疲劳，纳米压痕弹性系数及硬度在OA和OP患者的松质骨无明显区别。
该研究发现，因骨量和骨结构不同，OA和OP的松质骨机械性能存在差异。因骨结构减少，OP的松质骨易出现疲劳损伤，而OA松质骨的骨量增加和板状结构使其可以更好的抵抗疲劳损伤。
Objective
Osteoarthritis (OA) and osteoporosis (OP) of the hip rarely occur in the same patient. The purpose of this study was to determine whether this difference might be attributable to the different quantity and quality of subchondral cancellous bone in the two conditions.
Methods
Subchondral cancellous bone from the femoral head was obtained at the time of hip arthroplasty from 60 postmenopausal women, 30 with OA and 30 with OP. In each group, 10 specimens were subjected to compressive fatigue loading and 20 were left nonloaded. Specimens were examined by compressive mechanical testing, micro–computed tomography scanning, fluorescence microscopy, and nanoindentation techniques.
Results
Both the ultimate stress and the elastic modulus of cancellous bone from OA patients were significantly higher than those of cancellous bone from OP patients (P < 0.05). Compared to cancellous bone from OP patients, the bone volume fraction and trabecular thickness were significantly increased, but bone matrix mineralization was significantly decreased, in cancellous bone from OA patients (P < 0.05 for each comparison). The microcrack density was significantly higher in OP cancellous bone than in OA cancellous bone (P < 0.001), irrespective of fatigue loading. In addition, fatigue loading resulted in a significant increase in microcrack density in both OA and OP cancellous bone (P < 0.001). There was no significant difference in nanoindentation elastic modulus and hardness between cancellous bone from OA and OP patients, as well as between bones with and without fatigue loading.
Conclusion
The difference in mechanical properties between OA and OP cancellous bone is attributed to different bone mass and bone structure. OP cancellous bone is susceptible to fatigue damage due to insufficient structure. However, increased bone volume and plate-like structure provide OA cancellous bone a superior capacity to resist fatigue damage.

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    2013-07-03 lisa438

    #骨关节#

    0

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    2012-12-29 tamgche

    #疲劳#

    0

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    2012-12-29 lmm397

    #关节炎#

    0

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    2012-12-29 智者为医08

    #损伤#

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    2012-12-29 Eleven17

    #骨质#

    0