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Étude des modifications osseuses de composition et de structure au cours de l’ostéonécrose de tête fémorale et corrélations étiopathogéniques IRM

Abstract : IntroductionThe pathophysiology and structural evolution of the osteonecrosis of the femoral head (ONFH) are poorly understood. The objectives of this thesis were to search for modifications of composition and structure of both the trabecular and the subchondral bone occurring during ONFH.MethodsA preliminary study looked into the potential modifications of bone composition induced by embalmment procedures using Raman spectroscopy in order to determine which controls are the most appropriate for comparisons with pathological bones. Femoral bones from 5 embalmed anatomical subjects were compared to femoral bones from 5 subjects that did not undergo any preservation procedure. The first work on ONFH addressed the potential modifications of trabecular bone mineral and organic physico-chemical parameters using Raman spectroscopy. The study included bone samples from femoral heads of 11 patients affected with ONFH and compared them to samples from 11 fresh anatomical subjects. The second study on ONFH addressed modifications of the subchondral bone. The study included 15 patients suffering from ONFH and 15 patients affected with hip osteoarthritis (OA) requiring joint prosthetic replacement. MRI examination that included standard medical sequences as well as experimental perfusion and DIXON sequences was performed prior to surgery. Once removed, the femoral heads were scanned using a nano-CT and samples of regions of interest were performed and analysed using histology, nano-CT with contrastenhancer marking and Raman spectroscopy.ResultsBone femoral mineral and organic composition was significantly altered in embalmed samples. Trabecular bone composition did not differ in any of the regions of interest inside the group of patients with ONFH nor in comparison with the control group of embalmed subjects after adjustment on age. The volume of the necrotic zone defined by the hypo-T1 MRI signal correlates to the volume including the sclerotic zone measured by nano-CT. Regarding the subchondral bone, preliminary results found differences of mineral and organic composition of the subchondral plate between zones of the ONFH group and with the OA group. Qualitative preliminary results from the study of biopsies analysed with the nano-CT and histology suggest that there are alterations of the subchondral plate and of the subchondral trabecular bone to a lesser extent. MRI examination with the DIXON sequence and nano-CT scans suggest that there is a decrease of the adipose content in the femoral head but an increase in the femoral neck in the ONFH group compared to the OA group.ConclusionThis work adds further evidence advocating that trabecular disorganization during ONFH is a consequence of massive alterations of the subchondral bone.
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Tristan Pascart. Étude des modifications osseuses de composition et de structure au cours de l’ostéonécrose de tête fémorale et corrélations étiopathogéniques IRM. Médecine humaine et pathologie. Université du Droit et de la Santé - Lille II, 2017. Français. ⟨NNT : 2017LIL2S049⟩. ⟨tel-01871949⟩

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