Trabecular Plate Loss and Deteriorating Elastic Modulus of Femoral Trabecular Bone in Intertrochanteric Hip Fractures

作     者：Ji Wang Bin Zhou Ian Parkinson C.David L.Thomas John G.Clement Nick Fazzalari X.Edward Guo 

作者机构：Bone Bioengineering LaboratoryDepartment of Biomedical EngineeringColumbia UniversityNew YorkNew York 10027USA Bone and Joint Research LabSA Pathology and Discipline of Anatomy and PathologyUniversity of AdelaideAdelaideAustralia Section of Oral Anatomy and SurgeryThe Melbourne Dental SchoolUniversity of MelbourneVictoria 3010Australia 

出 版 物：《Bone Research》 (骨研究（英文版）)

年 卷 期：2013年第1卷第4期

页      面：346-354页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：This work was partially supported by grants from National Institutes of Health(AR051376 AR058004) 

主　　题：hip fracture intertrochanteric microstructure individual trabecula segmentation finite element 

摘      要：Osteoporotic hip fracture is associated with significant trabecular bone loss, which is typically characterized as low bone density by dual-energy X-ray absorptiometry （DXA） and altered microstructure by micro-computed tomography （pCT）. Emerging morphological analysis techniques, e.g. individual trabecula segmentation （ITS）, can provide additional insights into changes in plate-like and rod-like trabeculae, two major micro- structural types serving different roles in determining bone strength. Using ITS, we evaluated trabecular microstructure of intertrochanteric bone cores obtained from 23 patients undergoing hip replacement surgery for intertrochanteric fracture and 22 cadaveric controls. Micro-finite element （~FE） analyses were performed to further understand how the abnormalities seen by ITS might translate into effects on bone strength. ITS analyses revealed that, near fracture site, plate-like trabeculae were seriously depleted in fracture patients, but trabecular rod volume was maintained. Besides, decreased plate area and rod length were observed in fracture patients. Fracture patients also showed decreased elastic moduli and shear moduli of trabecular bone. These results provided evidence that in intertrochanteric hip fracture, preferential loss of plate-like trabeculae led to more rod-like microstructure and deteriorated mechanical competence adjacent to the fracture site, which increased our understanding of the biomechanical pathogenesis of hip fracture in osteoporosis.