【作者】 刘欣；

【导师】 柏树令；

【作者基本信息】 中国医科大学 ， 人体解剖与组织胚胎学， 2006， 硕士

【摘要】 腰椎骨质疏松形态学变化研究 骨质疏松（OP）是一种危害性较大的老年性疾病。定义为骨量减少的同时骨的微细结构衰变而致骨的脆性增大,进而导致骨折危险性增大的一种疾病。本研究通过取材不同性别年龄的腰椎尸体标本（L₁-L₄）为样本,对其进行影像学、骨密度、扫描电镜、骨形态计量学等观察,探讨腰椎骨质疏松的发病特点,以及对脊柱的影响。 材料与方法 取16具不同性别年龄的腰椎尸体标本（L₁-L₄）,共计64个椎体,年龄25～75岁,平均59.2岁。在相同条件下摄腰椎正侧位片,根据第三腰椎侧位片上骨小梁数目变化,分为正常组、疏松组,进行如下研究:①测量腰椎体平均矢状径,前、中、后高度,计算其变形指数及椎体高度比,判定椎体变形程度。②测量腰椎正、侧位骨密度,探讨附件对骨密度的影响。③腰椎标本取材进行扫描电镜观察,探讨其超微结构变化特点。④腰椎标本部分取材,切片染色,观察其骨微形态变化,研究骨质疏松骨形态计量参数和软骨板形态变化特点。 结果 与正常组相比,①疏松组椎体高度下降,多为楔形变。②侧位骨密度下降显著,而正位骨密度下降不显著。③扫描电镜下观察,椎体骨小梁变细、变尖、穿孔、断裂、小梁间隙增大。④组织切片显示骨组织形态计量参数与正常对照组差别显著;软骨板变薄,钙化层疏松,软骨细胞稀疏排列不整,呈退变表现。更多还原

【Abstract】 Osteoporosis is one of the senile diseases which is mainly harmful to the elderly. It is well known that osteoporosis is defined as a disease characterized by low bone mass and bone microarchitectural deterioration which makes the bone more fragile, consequently increases the risk of fractures. In this study we employed conventional radiography, bone mineral density （ BMD） , scanning e-lectron microscopy （SEM） and bone histomorphometry analysis of to 16 human lumbar specimens with different sex and age to investigate the characteristic of osteoporosis lumbar vertebrae and the influence to the spine.Material and MethodsSixteen human lumbar specimens （ L₁ - L₄ ） aged from 25 to 75 years （mean 59. 2 years） were studied. Each lumbar vertebrae specimen was taken anteroposterior and lateral X — ray examination under equal circumstances. They were divided into two groups including normal group （ NG） and osteoporosis group （OG） according to the change of numbers of trabecular network in the third lumbar vertebrae. Following observations were taken :（l）The average segit-tal diameter and the height （ha. hm. hp） of the vertebral body were measured. The deformation degree of the lumbar vertebral body was obtained from the deformation index and the ratio of height. （2） PA - BMD and L - BMD of the L₁ -L₄ lumbar vertebrae of all subjects with dual - energy X - ray absorptiometry （DEXA） （IQ Lunar, U. S. A. ） were measured to investigate the influence of appendix to the bone mineral density. （3）The ultrastractural changes of the trabecular area of lumbar vertebrae were observed with JSM - 840 SEM. （4） The specimen of cancellous bone and end - plate in lumbar vertebrae were sliced andstained with pollak and HE staining. Bone histomorphometry observations were made and the influence of osteoporosis to the end - plate was investigated.ResultsThe OG was compared with the NG. （l）The height of the vertebral body decreased and the body is mainly wedge - deformed. （2）The measurements of L -BMD decreased significantly while that of PA - BMD does not. ?Under the SEM, the trabecular in lumbar vertebrae is thinner and sharper than NG and perforates and disrupts with a wider intertrabecular distance. （J）Histological observation shows that bone histomorphometry in NG were significantly higher than those in OG, the end - plate is thinner, the calcificated - layer increased and loosen, the chondrocytes loosen and degenerate.Conclusion1. Biomechnical strength of vertebrae in osteoporosis cases reduce and is apt to compressed deformation.2. The measurement of L — BMD is more accurate than that of PA — BMD because the latter are easy to be affected by appendix.3. The abnormal reconstruction of bone trabecular ultimatly results in bone absorption, decrease of the strength of structure and high risk of fracture.4. Bone structural and morphological change in OG is one reason for decrease in mechanical strength leading to spine disease. The change of loading on osteoporotic vertebrae induce the and plate degenerated and further destruction of the intervertebral disc. Osteoporosis is one of inducing factors of intervetebral disc degeneration.更多还原