人体脊柱松质骨三维形态学指标的临床应用研究
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摘要
目的：
随着显微成像技术（包括μCT， μMRI）广泛应用于实验研究和临床初期研究，研究者们已经能够获得骨骼的微观三维空间结构。然而，目前关于准确测量松质骨的结构参数和在临床实践中应用结构参数的研究很少。本研究的目的是探讨影响松质骨微观结构测量精确性的四个因素，并将微观结构测量的指标应用于骨水泥定量注射的计算。
方法：
本研究采集了6具人体颈椎椎体松质骨标本，进行显微CT扫描后，应用结构参数测量、显微有限元分析、力学参数计算方法、椎弓根螺钉拔出仿真模拟，研究了感兴趣区域体积、图像分割阈值、感兴趣区域形状、椎体内解剖部位对于结构参数和力学参数测量结果的影响，并结合骨质疏松椎弓根螺钉植入的骨水泥强化过程，应用文献中显微CT测量得到的腰椎松质骨骨体积分数，提出了一种计算腰椎椎弓根螺钉强化时骨水泥注射量的计算方法。
结果：
1.感兴趣区域体积是影响显微CT测量人椎体松质骨结构参数的一个重要因素。基于本研究，我们推荐一个最佳的采样体积为216mm3，当样本满足以下三个标准时，可以采取本采样体积。(1).标本来源为人体颈椎椎体。(2).样本形状为立方体。(3).显微CT扫描分辨率大于42um。
2.图像分割的阈值是影响显微CT测量人椎体松质骨结构参数的一个重要因素。当阈值的改变超过2.9%时，在不同的阈值组和对照组之间，结构参数和力学参数存在显著的差异。
3.感兴趣区域形状的改变（圆柱体Vs.立方体）对于人椎体松质骨显微结构参数的测量没有显著性影响。
4.通过对颈椎椎体松质骨不同部位的结构参数和力学参数的对比研究发现：(1).在颈椎椎体松质骨，头侧和尾侧的结构参数均存在显著差异，其余部位的结构参数无显著差异。(2).在颈椎椎体松质骨，头侧和尾侧的力学参数在主方向上存在显著差异；此外，外侧和内侧的表观弹性模量在非主方向上存在显著差异，在主方向上无显著差异，表观剪切模量无显著差异。
5.对于一个标准的直径为6.5mm的腰椎椎弓根螺钉，在骨质疏松患者椎体内，其有效体积是在螺钉周围的一个圆柱体带，直径为3.4mm，相应的骨水泥注射量为大约2.6ml。
结论：
在显微CT测量和显微有限元计算中，结构参数和力学参数受到感兴趣区域体积、图像分割的阈值、以及椎体内部解剖部位的显著影响；与感兴趣区域形状的关系不大；显微CT对于松质骨显微结构的测量有助于骨质疏松患者椎弓根螺钉植入时的骨水泥注射量的计算。
Objective:
With the development of the micro imaging technology (including μCT andμMRI), scientists could acquire the three-dimensional spatial architecture ofhuman cancellous bone. However, there was few study on the clinicalapplication of the three-dimensional architectural parameters. In the currentstudy, we focused on whether the architectural parameters are sensitive to thevolume of interests, the threshold, ROI shape and anatomical site within thevertebral body. In addition, we proposed an algorithm for the injection volumeof the bone cement during the pedicle screw augmentation based on thearchitectural parameters acquired from μCT.
Methods:
Six human C5body samples were scanned by micro-CT. The measurement ofarchitectural parameters, large-scale finite element analysis, and calculation ofmechanical parameters were performed. We studied whether the architecturalparameters are sensitive to the volume of interests, the threshold, ROI shape andanatomical site within the vertebral body. In addition, we proposed an algorithm for the injection volume of the bone cement during the pedicle screw augmentationbased on the architectural parameters acquired from μCT.
Results:
1. Based on present study, a recommended size of volume interest wasconcluded. The recommended size is216mm3if the sample meet threeconditions:(1). The samples are from human vertebral bodies.(2). Theshape of the sample is cubic.(3). The resolution of micro-CT scanning is80um or higher.
2. The significant difference in architectural parameters and stiffness existedbetween the control group (threshold value determined by Otsu‘s method)and the other threshold groups when the variation of threshold value beyond2.9%.
3. The architectural parameters and stiffness are not sensitive to the ROI shape.
4. The architectural parameters and stiffness are sensitive to the anatomic sitewithin the vertebral body.
5. The RoE and AIC was calculated based on a validated FE model in presentstudy. The results showed RoE was a circular region with a Δr of3.4mmaround the pedicle screw and the proper AIC was about2.6ml for a standard6.5mm pedicle screw augmentation in the osteoporosis patients.
Conclusion：
During the analysis of μCT image and LSFE, the architectural andmechanical parameters are sensitive to the ROI volume, threshold and theanatomical site within the vertebral body; not sensitive to the ROI shape. Thearchitectural parameters are helpful the calculation of AIC for pedicleaugmentation in the osteoporosis patients.
随着显微成像技术（包括μCT， μMRI）广泛应用于实验研究和临床初期研究，研究者们已经能够获得骨骼的微观三维空间结构。然而，目前关于准确测量松质骨的结构参数和在临床实践中应用结构参数的研究很少。本研究的目的是探讨影响松质骨微观结构测量精确性的四个因素，并将微观结构测量的指标应用于骨水泥定量注射的计算。
方法：
本研究采集了6具人体颈椎椎体松质骨标本，进行显微CT扫描后，应用结构参数测量、显微有限元分析、力学参数计算方法、椎弓根螺钉拔出仿真模拟，研究了感兴趣区域体积、图像分割阈值、感兴趣区域形状、椎体内解剖部位对于结构参数和力学参数测量结果的影响，并结合骨质疏松椎弓根螺钉植入的骨水泥强化过程，应用文献中显微CT测量得到的腰椎松质骨骨体积分数，提出了一种计算腰椎椎弓根螺钉强化时骨水泥注射量的计算方法。
结果：
1.感兴趣区域体积是影响显微CT测量人椎体松质骨结构参数的一个重要因素。基于本研究，我们推荐一个最佳的采样体积为216mm3，当样本满足以下三个标准时，可以采取本采样体积。(1).标本来源为人体颈椎椎体。(2).样本形状为立方体。(3).显微CT扫描分辨率大于42um。
2.图像分割的阈值是影响显微CT测量人椎体松质骨结构参数的一个重要因素。当阈值的改变超过2.9%时，在不同的阈值组和对照组之间，结构参数和力学参数存在显著的差异。
3.感兴趣区域形状的改变（圆柱体Vs.立方体）对于人椎体松质骨显微结构参数的测量没有显著性影响。
4.通过对颈椎椎体松质骨不同部位的结构参数和力学参数的对比研究发现：(1).在颈椎椎体松质骨，头侧和尾侧的结构参数均存在显著差异，其余部位的结构参数无显著差异。(2).在颈椎椎体松质骨，头侧和尾侧的力学参数在主方向上存在显著差异；此外，外侧和内侧的表观弹性模量在非主方向上存在显著差异，在主方向上无显著差异，表观剪切模量无显著差异。
5.对于一个标准的直径为6.5mm的腰椎椎弓根螺钉，在骨质疏松患者椎体内，其有效体积是在螺钉周围的一个圆柱体带，直径为3.4mm，相应的骨水泥注射量为大约2.6ml。
结论：
在显微CT测量和显微有限元计算中，结构参数和力学参数受到感兴趣区域体积、图像分割的阈值、以及椎体内部解剖部位的显著影响；与感兴趣区域形状的关系不大；显微CT对于松质骨显微结构的测量有助于骨质疏松患者椎弓根螺钉植入时的骨水泥注射量的计算。
Objective:
With the development of the micro imaging technology (including μCT andμMRI), scientists could acquire the three-dimensional spatial architecture ofhuman cancellous bone. However, there was few study on the clinicalapplication of the three-dimensional architectural parameters. In the currentstudy, we focused on whether the architectural parameters are sensitive to thevolume of interests, the threshold, ROI shape and anatomical site within thevertebral body. In addition, we proposed an algorithm for the injection volumeof the bone cement during the pedicle screw augmentation based on thearchitectural parameters acquired from μCT.
Methods:
Six human C5body samples were scanned by micro-CT. The measurement ofarchitectural parameters, large-scale finite element analysis, and calculation ofmechanical parameters were performed. We studied whether the architecturalparameters are sensitive to the volume of interests, the threshold, ROI shape andanatomical site within the vertebral body. In addition, we proposed an algorithm for the injection volume of the bone cement during the pedicle screw augmentationbased on the architectural parameters acquired from μCT.
Results:
1. Based on present study, a recommended size of volume interest wasconcluded. The recommended size is216mm3if the sample meet threeconditions:(1). The samples are from human vertebral bodies.(2). Theshape of the sample is cubic.(3). The resolution of micro-CT scanning is80um or higher.
2. The significant difference in architectural parameters and stiffness existedbetween the control group (threshold value determined by Otsu‘s method)and the other threshold groups when the variation of threshold value beyond2.9%.
3. The architectural parameters and stiffness are not sensitive to the ROI shape.
4. The architectural parameters and stiffness are sensitive to the anatomic sitewithin the vertebral body.
5. The RoE and AIC was calculated based on a validated FE model in presentstudy. The results showed RoE was a circular region with a Δr of3.4mmaround the pedicle screw and the proper AIC was about2.6ml for a standard6.5mm pedicle screw augmentation in the osteoporosis patients.
Conclusion：
During the analysis of μCT image and LSFE, the architectural andmechanical parameters are sensitive to the ROI volume, threshold and theanatomical site within the vertebral body; not sensitive to the ROI shape. Thearchitectural parameters are helpful the calculation of AIC for pedicleaugmentation in the osteoporosis patients.
引文
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