臨床用 CT を用いた上腕骨大結節部の骨梁微細構造解析

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Background: Preoperative evaluation of bone microstructure is of utmost importance because, especially in elderly patients, osteoporotic change causes anchor pullout problem, which results in failure of rotator cuff (RC) repair. In this study, using Multi-Detector row CT (MDCT), we have successfully performed in vivo evaluation of bone microarchitecture of the tuberosities of the humeral head in patients with RC tears. Methods: Fifteen cases with RC tears were examined. The region of interest (ROI) was defined in six quadrants (medial and lateral rows of anterior, middle, and posterior quadrant) within the greater tuberosity (GT) of the humerus. Each quadrant had an identical cylindrical shape with a diameter of 5.0 mm and a depth of 15 mm, and was placed at a 45° angle to the GT. Morphometric parameters including mean bone volume to total volume (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), and structure model index (SMI) were measured using a bone analysis software and statistically assessed. Results: The value of BV/TV of the posteromedial quadrant was the highest among the values of all other quadrants.The value of SMI was the lowest among those of the other quadrants. Conclusion: Based on the values of BV/TV and SMI, we found that bone quality of the posteromedial portion was the highest within the GT of our patients. Since the bone quality may correlate to the pullout strength of suture anchors, our method can be useful to determine the best position to implant suture anchors in patients with RC tears.

臨床用 CT を用いた上腕骨大結節部の骨梁微細構造解析

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