目的 检测股骨颈骨折绝经女性股骨头骨铁含量,结合骨密度、血清铁蛋白和血清骨代谢指标,探讨骨组织铁含量与绝经女性骨质疏松的关系.方法 10例绝经后女性脆性股骨颈骨折患者(行走跌倒6例、扭伤跌倒4例)为绝经组,年龄56～87岁,平均72.6岁；6例年轻女性暴力性股骨颈骨折患者(车祸伤4例、骑车摔倒1例、高处坠落1例)为对照组,年龄19 ～ 43岁,平均31岁.2组患者均为住院、单发、非开放性骨折,入院检查无炎性反应,既往无病理性铁过载史.2组人院后均检测血清铁代谢和骨代谢指标,术中留取骨组织行骨铁含量测定和骨组织铁染色,术后均行腰椎和髋部(健侧)骨密度检查.结果 绝经组髋部和L1-4 BMD值、铁蛋白(FER)、25羟基维生素D(25-OH)均大于参考值范围；对照组各项指标均在正常范围内；绝经组骨铁含量均值为(88.9±47.2)μg/g,血清FER均值为(234.3±91.70) ng/mL,Ⅰ型胶原C端肽β降解产物(β-CTX)均值为(643.4±284.3)pg/mL,抗酒石酸酸性磷酸酶5b(TRAP5b)均值为(3.4±0.73) U/L,均明显高于对照组的(32.5 ±12.7) μg/g,(69.6±42.5)ng/mL,(254.3 ±129.9) pg/mL,(2.3±0.45) U/L,差异有统计学意义(P＜0.05).绝经组髋部BMD均值为(0.63±0.11) g/cm2、L1-4 BMD均值为(0.87 ±0.10) g/cm2,均低于对照组的(0.88±0.67) g/cm2和(1.06±0.18) g/cm2,差异有统计学意义(P＜0.05).骨组织普鲁士蓝+ HE染色后可见条絮状骨小梁结构,绝经组骨小梁区可见特异性铁元素沉积,对照组骨小梁区未见明显铁元素沉积；2组骨小梁之外区域均有散在特异性铁元素沉积.绝经组骨铁含量与血清FER呈正相关(r=0.966),与髋部BMD值呈负相关(r=-0.820).结论 绝经后女性易发生铁代谢及骨代谢异常,骨铁水平升高、骨量减少和骨铁含量增加可能是导致绝经后女性骨质疏松症发生的潜在危险因素.%Objective Detecting the femoral head bone iron contents of femoral neck fracture patients (postm-enopausal women) , and further contacting of bone mineral density ( BMD) , serum ferritin ( FER) and serum bone metabolic markers to explore the potential values of the iron contents of bone tissue in osteoporosis patients. Methods 10 elderly women aged 56 ~ 87 years old (an average of 72. 6 years old) as the older age group with the brittle femoral neck fracture ( 6 cases with walking falls, while 4 cases with sprains fell) ; Meanwhile 6 cases of young female violence femoral neck fracture (traffic accidents in 4 cases, rider fell 1 cases, falls 1 case) as the control group aged 19~43 years with mean 31 years; Both cases were hospitalized, single, non-open fracture with no inflammation abnormal indicators and no previous pathological history of iron overload. The serum specimens were measured for iron metabolism and bone metabolic markers were detected, the biopsy specimens were performed in both groups by a special require to detect the bone iron contents and bone iron were stained after operation and BMD considered of lumbar vertebras and hips were undertook after surgeries. Results Hip and L1-L4 BMD values, FER and 25-OH-VD, of elderly women were outside the reference range; while the control group were within it. The bone iron contents, FER, β-CTX and TRAP5b of postmenopausal group were significantly higher than those of the control group (88.9 ±47.2 μg/g vs 32.5 ± 12.7 μg/g, 234.3 ± 91. 70 ng/Ml vs 69. 6 ± 42. 5 ng/Ml, 643. 4 ± 284. 3 pg/Ml vs 254. 3 ± 129. 9 pg/Ml, 3. 4 ±0. 73 U/L vs 2. 3 ± 0. 45 U/L; P <0. 05) , while hip and L1-4 BMD values were less than the control group (0. 63 ±0. 11 g/cm2 vs 0. 88 ± 0. 67 g/cm , 0. 87 ± 0. 10 g/cm vs 1. 06 ± 0. 18 g/cm ; P < 0. 05 ) . HE staining covered by Prussian showed iron was seen as blue-staining lines at the bone trabecular structures in old age group, and no obvious blue staining structures of control group were appeared; Specific iron deposition (blue staining areas) also could be showed outside of the trabecular bone structures in both groups. A significant phenomenon was found that bone iron contents and FER showed a positive correlation ( r = 0. 966 ) , and were negatively correlated with hip BMD values ( r = - 0. 820) among postmenopausal women. Conclusion Postmenopausal women often had abnormal iron and bone metabolism. When bone iron contents increased, bone mass reduced. Iron contents of bone tissue may be a potential risk factor for osteoporosis in postmenopausal women.
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