人体腕骨显微骨硬度分布特征的研究

目的探讨人体腕骨显微骨硬度的分布特征及其临床意义。方法纳入3具新鲜冰冻成人尸体标本(62岁男性、58岁男性、45岁女性),将右侧腕骨软组织剥离后,用慢速锯分别在舟骨、月骨、头状骨、钩骨、大多角骨和小多角骨切取厚3 mm的骨组织标本。舟骨选取舟骨结节、腰部内外侧和舟骨体部,月骨选取腕关节面、掌侧面、背侧面和远端,头状骨、钩骨、大多角骨和小多角骨选取外层皮质不同区域,应用德国KB-5型显微维氏硬度仪测试标本不同区域的硬度值,采用50 gf力加载50 s、维持12 s的标准操作方法进行硬度值测定,每个区域选取5个有效值,全体有效值的平均值作为该部位的骨硬度值。观察不同骨骼间及骨骼内部不同区域的骨硬度值差异。结果3具标本中共取得舟骨、月骨、头状骨、钩骨、大多角骨和小多角骨标本切片18片,测量位点255个。腕骨不同骨骼骨硬度从高到低依次为钩状骨(39.04±5.79)HV、头状骨(38.98±6.17)HV、舟骨(37.72±5.85)HV、大多角骨(35.89±4.75)HV、月骨(33.65±5.42)HV及小多角骨(31.82±5.54)HV,不同骨骼间总体骨硬度差异有统计学意义(F=10.783,P<0.01)。舟骨、月骨内部不同区域骨硬度分布近似,舟骨结节、腰部外侧、腰部内侧和舟骨体部骨硬度分别为(37.07±5.77)、(37.51±6.39)、(40.00±5.64)、(36.31±5.47)HV,其中腰部内侧骨硬度最大,舟骨体部骨硬度最小,4部位间骨硬度比较差异无统计学意义(F=1.129,P>0.05)。月骨腕关节面、掌侧面、背侧面和远端骨硬度分别为(33.57±3.61)、(34.58±6.04)、(35.47±5.24)、(30.97±5.88)HV,其中背侧骨硬度最大,远端骨硬度最小,4个部位间骨硬度比较差异无统计学意义(F=2.040,P>0.05)。结论健康人腕骨不同骨骼间硬度各有不同,舟骨和月骨内部各部位骨硬度分布均匀一致。测量腕骨显微骨硬度值,了解其分布特征,有助于了解腕骨微观生物力学性能,亦可指导腕骨骨折内固定方法的选择,设计制作更加符合人体生理状态下的腕部骨骼假体及建立腕部肌骨组织的有限元模型。临床试验注册中国临床试验注册中心,注册号为ChiCTR-BPR-17010818。

Distribution of human carpal bone microhardness

Objective To explore the distribution and significance of microhardness of human carpal bones.Methods Three fresh frozen bodies with age > 40 years old, good health and no chronic history were selected and right limbs were used. These carpal bones (navicular bone, lunate bone, capitate bone, hamate bone, trapezium and trapezoid bone) were cut into 3 mm thick slices with a low-speed saw. A microindenter tted with a Vickers indenter point was used to measure the Vickers hardness in the cortical region in the bone slices of navicular bone, lunate bone, capitate bone, hamate bone, trapezium and trapezoid bone. In this series of studies, the standard operating method of 50 gf force loading 50 s and maintaining 12 s was used to determine the hardness values. Five effective region values were selected in the same area, and the average value of all the effective values was taken as the hardness value of the part. Vickers hardness values of different regions were recorded and analyzed.Results Totally, 18 specimens and 255 indentations at different bones and anatomic sites were involved in our result. Among all carpal bones, the hamate bone (39.04±5.79) HV represented the largest hardness, followed by the capitate bone (38.98±6.17) HV, scaphoid bone (37.72±5.85) HV, trapezium bone (35.89±4.75) HV, lunate bone (33.65±5.42) HV and trapezoid bone (31.82±5.54) HV. There were statistically significant differences in hardness among different bones (F=10.783, P<0.01).The highest hardness value existed in the medial of scaphoid waist (40.00 HV) and the lowest hardness existed in the scaphoid body (36.31 HV). The tubercle of scaphoid bone, medial and lateral of scaphoid waist and scaphoid body were measured and analyzed. No significant differences were found among the four sites(F=1.129, P>0.05). The Vickers hardness were similar in the metacarpal site, metacarpal, dorsal and distal site of the lunate bone(F=2.040, P＞0.05).Conclusions Vickers hardness in different bones of healthy person wrist bones are different, whereas the hardness distribution of all parts of scaphoid and lunate bone is consistent. Measuring the microhardness value of wrist bone and understanding its distribution characteristics can help to understand the microbiomechanical properties of wrist bone, and also guide the selection of internal fixation methods for wrist bone fracture, so as to design and make wrist bone prosthesis more in line with human physiology and establish the finite element model of wrist muscule-bone tissue. Trial Registation Chinese Clinical Trail Registry, ChiCTR-TNC-17010818.