Assil-Ramin Alimy, Maximilian Lenard Thiessen, André Strahl, Christoph Kolja Boese, Simon von Kroge, Frank Timo Beil, Tim Rolvien, Christian Ries
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Additionally, matrix mineralization and osteocyte lacunar morphology were evaluated using quantitative backscattered electron imaging. Our analysis revealed that DXA-derived T-scores correlated with trabecular microstructure. Furthermore, radiographic indices and body mass index correlated differentially with aspects of bone quality in women and men. Contrary to previous observations, no correlation was found between serum vitamin D levels and osteoid indices, nor between clinical parameters and matrix mineralization. Age was strongly associated with the number of mineralized osteocyte lacunae, a factor that appeared to be independent of sex. Taken together, our study demonstrates that no single preoperatively available parameter exhibits a strong and consistent association with femoral bone quality. However, DXA remains a reliable preoperative measure for determining the trabecular microstructure of the femoral neck. 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引用次数: 0
摘要
骨质差是导致全髋关节置换术(THA)后并发症风险增加的关键因素。然而,对于术前评估骨质量指标,目前还没有一致的建议。因此,目前仍不清楚哪些术前可用且容易获得的参数与股骨头质量最密切相关。在此,我们从 50 名接受 THA 的患者身上获取了股骨颈标本。对术前双能 X 射线吸收测量(DXA)扫描、骨盆X光片和实验室参数进行了分析。在获得的标本中,使用显微 CT 和组织形态学评估了骨的微观结构。此外,还使用定量反向散射电子成像技术对基质矿化和骨细胞裂隙形态进行了评估。我们的分析表明,DXA得出的T值与骨小梁微结构相关。此外,放射指数和体重指数与女性和男性骨质的相关性也不同。与之前的观察结果相反,血清维生素 D 水平与骨质指数之间以及临床参数与基质矿化之间均未发现相关性。年龄与矿化骨细胞裂隙的数量密切相关,这一因素似乎与性别无关。综上所述,我们的研究表明,没有一个术前可用的参数与股骨头质量有强烈而一致的关联。然而,DXA仍然是确定股骨颈骨小梁微结构的可靠术前指标。在临床实践中,外科医生应采用个体化的术前评估方法,考虑年龄、性别、体重指数和影像学指标,以提高他们对股骨头质量的洞察力,尤其是在无法使用DXA的情况下。
Sex-Specific Association of Clinical Parameters and Components of Femoral Bone Quality in Patients Undergoing Total Hip Arthroplasty
Poor bone quality is a critical factor associated with an increased risk of complications after total hip arthroplasty (THA). However, no consistent recommendations have yet been established for assessing indicators of bone quality preoperatively. Thus, it remains unclear which preoperatively available and readily accessible parameters are most closely associated with femoral bone quality. Here, we obtained femoral neck specimens from 50 patients undergoing THA. Preoperative Dual-energy X-ray absorptiometry (DXA) scans, pelvic radiographs, and laboratory parameters were analyzed. In the obtained specimens, bone microstructure was assessed using micro-CT and histomorphometry. Additionally, matrix mineralization and osteocyte lacunar morphology were evaluated using quantitative backscattered electron imaging. Our analysis revealed that DXA-derived T-scores correlated with trabecular microstructure. Furthermore, radiographic indices and body mass index correlated differentially with aspects of bone quality in women and men. Contrary to previous observations, no correlation was found between serum vitamin D levels and osteoid indices, nor between clinical parameters and matrix mineralization. Age was strongly associated with the number of mineralized osteocyte lacunae, a factor that appeared to be independent of sex. Taken together, our study demonstrates that no single preoperatively available parameter exhibits a strong and consistent association with femoral bone quality. However, DXA remains a reliable preoperative measure for determining the trabecular microstructure of the femoral neck. In clinical practice, surgeons should adopt an individualized approach to preoperative assessments by considering age, sex, BMI, and radiographic indices to enhance their insight into femoral bone quality, particularly when DXA is unavailable.