基于CT的股骨有限元模型的建立及髋关节中空多孔假体植入后受力分布的初步研究

利用有限元分析的方法,对髋关节中空多孔假体植入后的受力分布改变进行研究,为改进中空多孔人工关节假体的设计提供依据.建立了股骨和假体三维有限元模型,应用有限元分析软件Ansys5.7模拟单腿负重状态,考察应力分布并进行比较.使用SPSS Statistics 17.0软件进行分析处理,绘制折线图.结果表明:a.开孔后张力侧最大压应力有所减小,开孔部位的应力水平变化不明显.b.与周围骨质形成连接后孔缘局部应力增加,张力侧受力改变不明显.c.短柄假体受力模式仍为远端应力集中;张力侧应力减小,开孔部位应力明显增加.d.下孔受力均大于上孔,受力方向基本一致.     

过盈植入对种植体-骨界面应力分布影响的三维有限元分析（英文）

目的：应用三维有限元分析法研究牙种植体过盈植入对种植体-骨界面接触压力的影响。方法：选择直径为3.3 mm的ITI种植体和成人离体下颌骨,模拟种植体植入下颌骨内,过盈量为0.5 mm,建立三维有限元模型,应用ANSYS软件分析种植体-骨界面的应力分布情况。结果：种植体周围骨最大应力为48.796 MPa,应力分布均匀。种植体所受应力主要集中于颈部,最大应力值为87.832 MPa。结论：过盈量为0.5 mm时,种植体-骨界面所产生的应力值在骨组织所能承受的最大应力值范围内,种植体所受到的应力值远远小于钛的屈服强度,从生物力学角度,周围骨所受应力在骨组织能够承受范围,种植体也不会断裂,过盈联结在临床种植时有其可行性。     

过盈植入对种植体-骨界面应力分布影响的三维有限元分析

目的:应用三维有限元分析法研究牙种植体过盈植入对种植体-骨界面接触压力的影响.方法:选择直径为3.3mm的ITI种植体和成人离体下颌骨,模拟种植体植入下颌骨内,过盈量为0.5mm,建立三维有限元模型,应用ANSYS软件分析种植体-骨界面的应力分布情况.结果:种植体周围骨最大应力为48.796 MPa,应力分布均匀.种植体所受应力主要集中于颈部,最大应力值为87.832 MPa.结论:过盈量为0.5mm时,种植体-骨界面所产生的应力值在骨组织所能承受的最大应力值范围内,种植体所受到的应力值远远小于钛的屈服强度,从生物力学角度,周围骨所受应力在骨组织能够承受范围,种植体也不会断裂,过盈联结在临床种植时有其可行性.     

新型非骨水泥柄设计特征及临床应用效果

目的:探讨一种新型的适合于儿童的非骨水泥固定型股骨柄设计特征,并通过随访获得其临床效果。方法:选取2010年9月~2013年4月在我科植入新型非骨水泥股骨柄的6名儿童患者,其中男1例,女5例;年龄8.5±3.2岁(5~11岁)。病理诊断结果骨肉瘤患者5例,恶性神经鞘瘤患者1例;右股骨下端患者5例,左股骨下端患者1例;其中一例患者术前有病理骨折。6例患者在我科行双动半膝关节置换术,其中股骨下端均采用了新型非骨水泥假体柄。采用Enneking骨肌肉肿瘤置换后下肢功能评定标准对患肢行功能评价,影像学重点评估股骨柄在髓腔放置位置是否得当、股骨柄假体有无松动、有无应力遮挡、骨溶解等现象,并测量术后患者患肢短缩畸形数据。结果:6例患者随访时间32个月(14~54个月),除1例5岁女童术前肢体条件较差在术后14个月行膝关节融合手术,其余无翻修病例,置换关节均无感染、折断等现象。MSTS评分21.33分;射线片示所有患者股骨髓腔内假体柄放置位置满意,股骨侧及胫腓骨侧假体周围未见骨溶解。结论:新型非骨水泥固定型股骨柄设计合理,早期稳定性可,后期可取得满意的生物固定效果。     

CroweⅣ型髋关节脱位儿童髋臼有限元生物力学分析

目的:建立CroweW型发育性髋关节脱位儿童骨盆三维有限元模型,对发育性髋关节脱位儿童真性髋臼及假性髋臼的生物力学进行初步分析.方法:采用单侧发育性髋关节脱位儿童骨盆CT扫描DICOM数据,通过Mimics10.0对图像DICOM数据进行重建,经Geomagic Proe5.0进行网格优化,在Hepermesh 10.0中进行有限元网格划分后输入ANSYS12.0中,在ANSYS中根据解剖部位建立骨盆主要韧带,行单腿站立载荷加载,计算该加载方式下骨盆的应力及位移分布情况.结果:模拟患者单腿(患侧)站立状态下身体重心通过假关节的中心,骨盆极度倾斜约45°,给予生理载荷,应力主要集中在假髋臼和骶髂关节面之间,耻骨上肢内侧是应力集中区但是应力小于骶髂关节周围部分;患侧骨盆位移以髂骨翼前侧向后侧逐渐减弱.结论:建立的有限元模型在静载荷下特征部位的应力及位移能够反映CroweⅣ型髋关节脱位儿童骨盆的力学结构特性,模型的准确性高,可以成为CroweⅣ型髋关节脱位儿童骨生物力学研究的工具,满足临床研究需要.     

二磷酸盐促进假体周围骨溶解后假体翻修骨整合的实验研究

目的:评价阿仑膦酸钠对新西兰大白兔假体周围发生骨溶解后,再进行对新西兰大白兔假体翻修骨整合的影响。方法:选取雄性新西兰大白兔30只,随机分成3组(正常组,实验组,对照组,每组10只)。正常组在胫骨松质骨区域植入钛合金假体,实验组和对照组分别植入钛合金假体和钛颗粒,饲养8周后,三组统一进行假体翻修。实验组用阿仑磷酸钠治疗8周后取材,对照组和正常翻修组也分别进行取材。通过假体推出力学实验、硬组织切片观察,评价阿仑磷酸钠对假体周围翻修后骨整合的影响。结果:假体推出力学实验结果显示,实验组假体最大推出载荷明显大于对照组(P0.01)。硬组织学切片通过苦味酸--品红染色,利用图像分析仪器统计假体周围骨整合的面积实验组假体周围骨量明显优于对照组假体周围骨量(P0.05)。结论:二磷酸盐-阿仑磷酸钠可以提高假体翻修后假体周围骨整合。     

基于新型低弹β钛合金的植入物-骨界面成骨效应研究

为了进一步分析基于新型低弹β钛合金的植入物-骨界面成骨效应研究,进而探究两种不同骨植入物的弹性模量(弹性模量为110 GPa的Ti-6Al-4V与弹性模量为30 GPa的Ti-24Nb-4Zr-7.9Sn)的钛合金界面应力分布情况及对骨形成的影响。选用30只成年的新西兰大白兔,基于Slaets E方法植入不同种弹性模量的钛合金于白兔双侧胫骨内侧近端,右侧为弹性模量110 GPa的Ti-6Al-4V的高弹组,左侧为弹性模量30 GPa的Ti-24Nb-4Zr-7.9Sn的低弹组,术后在4、8、12周分别处死9只实验动物,并分别应用组织学、X线、Micro-CT及生物力学对标本测试结果进行评估。组织学监测指标为:骨形成率(BFR)、骨接触率(BCR),兴趣区为植入物横断面上的半径为0.5 mm的环状区域。Micro-CT检测标准为BVF,BMD,SMI,兴趣区是以植入物为中心的半径为1 mm的管状区域。Micro-CT:在4周时,两组的BVF,BMD,SMI,AS无明显差异(p0.05),在8、12周时高弹组BVF,BMD,SMI,AS均显著低于低弹组(p0.05)。组织学:在4、8、12周,组织学切片研究表明高弹组的BCR显著弱于低弹组,p0.05。在8周、12周时低弹组的BFR相较于高弹组略高(p0.05),在4周时两组的BFR均没有明显差异(p0.05)。生物力学检测结果:在8、12周时低弹组Fmax显著比高弹组高(p0.05),在4周时低弹组的Fmax相较于高弹组没有明显差异(p0.05)。X线检测:在4、8、12周时X线结果均无显著差异(p0.05)。     

LISS钢板治疗股骨远端骨折有限元建模及分析

目的建立LISS-DF治疗股骨远端骨折近端螺钉不同单双皮质固定的三维有限元模型,并进行初步生物力学分析。方法提取CT图片相关数据,利用自行编写程序生成命令流文件,建立完整股骨以及16个不同LISS-DF治疗股骨远端AO分型33-A3型骨折的实体模型（钢板和股骨不接触、螺钉分别固定于钢板和股骨）,进行网格划分。分析不同载荷作用下完整股骨和LISS钢板近端螺钉全双皮质固定治疗骨折的模型受力状况。结果建立了相关的有限元模型。不同载荷作用下,LISS钢板近端螺钉全双皮质固定模型和完整股骨的应力集中均位于股骨颈内侧和股骨干外侧中下1/3处。相同载荷作用下,LISS钢板近端螺钉全双皮质固定模型的股骨颈部最大等效应力值略减小,股骨干最大等效应力值明显减小。结论研究建立的三维有限元模型,为应用LISS治疗股骨骨折的生物力学分析提供了良好的实验平台和基础。从生物力学角度而言,LISS-DF近端螺钉全双皮质固定为治疗股骨远端复杂骨折的有效方法。     

人体股骨弹性模量与骨矿含量的关系

选取正常男性成人股骨18段,制成5-20mm测试块202个,用Ⅱ型γ线骨矿分析仪测得骨矿含量面密度分别为1.324-1.901g/cm2,再用WE-10(A)型液压式万能试验机和千分表测得测试块受纵向压应力时所承受的压力及相应的高度变化并计算其弹性模量。结果显示：骨矿含量在1.802g/cm2以下时,弹性模量及力学性能与骨矿含量呈正相关关系,但超出此范围后,骨矿含量的增加可能会使骨的力学性能下降。     

人工半骨盆假体置换联合腰椎椎弓根螺钉固定术后生物力学的有限元分析

目的:建立人工半骨盆假体置换与联合腰椎椎弓根螺钉固定后的三维有限元模型,评价腰骶段生物力学改变后半骨盆假体力学结构的特点。方法:采用CT薄层扫描采集原始数据,分别建立正常骨盆、半骨盆假体置换术后以及半骨盆假体置换联合腰椎椎弓根螺钉固定术后骨盆的三维有限元模型,分别在第4腰椎上终板平面施以500 N的垂直纵向载荷,分析不同骨盆模型的应力分布特点。结果:与正常骨盆有限元模型相比,半骨盆假体置换术后健侧骨盆应力分布以骶髂关节、髋臼窝及耻骨为主,置换侧半骨盆假体以耻骨连接棒、髋臼杯及髂骨座为主,最大应力出现在耻骨连接棒,应力峰值为65.62 MPa。联合腰椎椎弓根螺钉固定后健侧应力相对减小,置换侧髂骨固定座与骶骨固定处应力相对减小,应力分布以腰椎椎弓根钉棒、耻骨连接棒及髋臼杯为主,最大应力出现在椎弓根螺钉,应力峰值为107 MPa。结论:半骨盆假体置换联合腰椎椎弓根螺钉固定后钉棒分担了半骨盆置换后健侧骨盆及置换侧髂骨固定座与骶骨固定处附近的部分应力,缓解应力集中现象,降低术后骨盆破坏风险,一定程度上增加了半骨盆置换后骨盆的稳定性。     

Influence of resin cement rigidity on the stress distribution of resin-bonded fixed partial dentures

The mechanical properties of the adhesive cement used in resin-bonded fixed partial dentures (RBFPD) can modify the clinical performance of the rehabilitation. The goal of this study was to evaluate the influence of the elastic modulus of different cements on the stress distribution in RBFPD using finite element analysis. For that an anterior 3-unit prosthesis was modeled based in a stereolithography file. The model was meshed with tetrahedral elements and materials considered isotropic, linearly elastic and homogeneous. The force applied to the palatal area of the lateral incisor (pontic) at 45° was 100?N. The cements used presented 7 different elastic modulus (E): 2, 6, 10, 14, 18, 22 or 26?GPa. The total deformation, von-Mises stress and maximum principal stress criteria were used to calculate the results. The lower tensile stress occurred in the cement layer with E?=?2?GPa [25.6 (canine) and 16.32?MPa (incisor)]. For the prosthesis, the model with the lower tensile stress [287 (canine) and 248?MPa (incisor)] occurred when the cement presented E?=?26?GPa.

In this way, the stress concentration may have its magnitude modified depending on the stiffness of the cement. Since more flexible cements concentrate less tensile stress in its structure, but allow an increased displacement of the prosthesis, which is friable and rigid and ends up concentrating more tensile stress at its connector. In that way the clinician should avoid the use of adhesive cement with lower elastic modulus due to it increases the stress concentration in the ceramic.     

Polymer-based composite hip prostheses

A composite hip prosthesis (CHP) made from poly(ether-imide) reinforced with carbon and glass fibres was manufactured and characterized. The main objective of the study was to evaluate the effect of fibre organization on the mechanical properties of the composite femoral implant and compare with the bone. A stacking sequence of drop-off plies of carbon/glass fibres reinforcing poly(ether-imide) (PEI) constitutes a symmetrical and balanced CHP. The hip was manufactured according to the finite element modelling (FEM) design and using the compression moulding and water-jet technologies. The measured stress-strain data according to tensile, flexural and torsional tests showed agreement with the numerical calculation. Young's modulus and the strength in tension are uniform along the stem axis (40 GPa and 600 MPa, respectively) while the elastic modulus in bending varies from 10 to 60 GPa in the tip-head direction. The composite stem showed a linear load-displacement relation up to 4500 N without breaking. Mechanical behaviour of the CHP is compared to that of a canine femur. Comparison with metal prostheses has also been undertaken. CHPs control stress-strain distributions, and hence the mechanical signals to bone, through a material-structure design.     

Rapid prototyping of scaphoid and lunate bones

In this study, a novel rapid prototyping technology was used to fabricate scaphoid and lunate bone prostheses, two carpal bones that are prone to avascular necrosis. Carpal prostheses were fabricated with an Envisiontec Perfactory® SXGA stereolithography system using Envisiontec eShell 200 photocurable polymer. Fabrication was guided using 3-D models, which were generated using Mimics software (Materialise NV, Leuven, Belgium) from patient computer tomography data. The prostheses were fabricated in a layer-by-layer manner; ∼ 50-μm thick layers were observed in the prostheses. Hardness and Young's modulus values of polymerized eShell 200 material were 93.8 ± 7.25 MPa and 3050 ± 90 MPa, respectively. The minimum compressive force required for fracture was 1360 N for the scaphoid prosthesis and 1248 N for the lunate prosthesis. Polymerized Envisiontec eShell material exhibited high human neonatal epidermal keratinocyte cell viability rate in an MTT assay. The results of this study indicate that small bone prostheses fabricated by stereolithography using eShell 200 polymer may have suitable geometry, mechanical properties, and cytocompatibility properties for in vivo use.     

Influence of the stiffness of bone defect implants on the mechanical conditions at the interface--a finite element analysis with contact

The study focused on the influence of the implant material stiffness on stress distribution and micromotion at the interface of bone defect implants. We hypothesized that a low-stiffness implant with a modulus closer to that of the surrounding trabecular bone would yield a more homogeneous stress distribution and less micromotion at the interface with the bony bed. To prove this hypothesis we generated a three-dimensional, non-linear, anisotropic finite element (FE) model. The FE model corresponded to a previously developed animal model in sheep. A prismatic implant filled a standardized defect in the load-bearing area of the trabecular bone beneath the tibial plateau. The interface was described by face-to-face contact elements, which allow press fits, friction, sliding, and gapping. We assumed a physiological load condition and calculated contact pressures, shear stresses, and shear movements at the interface for two implants of different stiffness (titanium: E=110GPa; composite: E=2.2GPa). The FE model showed that the stress distribution was more homogeneous for the low-stiffness implant. The maximum pressure for the composite implant (2.1 MPa) was lower than for the titanium implant (5.6 MPa). Contrary to our hypothesis, we found more micromotion for the composite (up to 6 microm) than for the titanium implant (up to 4.5 microm). However, for both implants peak stresses and micromotion were in a range that predicts adequate conditions for the osseointegration. This was confirmed by the histological results from the animal studies.     

The relationship of mechanical properties to morphology in patellar tendon autografts after posterior cruciate ligament replacement in sheep.

In a sheep model the posterior cruciate ligament (PCL) was replaced by a patellar tendon autograft (PTAG) using the central one-third of the ipsilateral patellar tendon (PT). The sheep were sacrificed at 16, 26, 52 and 104 weeks postoperation. The PTAG, and, as controls, the contralateral PCL and PT were harvested. These were examined using biomechanical testing as well as light and transmission electron microscopy, including immunohistological techniques. The material properties (maximum stress, elastic modulus) were compared to the morphological features. The cellular distribution, the distribution of glycosaminoglycans (GAGs), the collagen fibril diameter and the occurrence of Type III collagen were studied. Prior to transplantation, the PTAG was shown to be superior in maximum stress (57.2 +/- 5.5 MPa vs 41.3 +/- 1.9 MPa) and elastic modulus (368.8 +/- 49.3 MPa vs 172.3 +/- 14.6 MPa) to the PCL. The early decline in material properties of the PTAG (maximum stress 22% and elastic modulus 42% of the control) after free grafting paralleled a cell- and capillary-rich PTAG tissue with remnants of necrosis and a poorly organized extracellular matrix. Two years after implantation, with progressive alignment of the tissue matrix, maximum stress and elastic modulus acquired approximately 60 and 70% of the control, respectively. However, there was also an evidence of degenerative changes characterized by acellular areas, loss of the normal bundling pattern of collagen fibers and abnormal accumulation of GAGs. Ultrastructurally, there was a predominant shift to thin collagen fibrils in the PTAG compared to PCL and PT, both consisting of thick and thin collagen fibrils. Thin fibrils were demonstrated to be, in part, split thick fibrils as well as newly formed fibrils. Most of these thin fibrils revealed a positive reaction with antibodies to Type III collagen.     

Topological optimization in hip prosthesis design

With particular interest on total hip arthroplasty (THA), optimization of orthopedic prostheses is employed in this work to minimize the probability of implant failure or maximize prosthesis reliability. This goal is often identified with the reduction of stress concentrations at the interface between bone and these devices. However, aseptic loosening of the implant is mainly influenced by bone resorption phenomena revealed in some regions of the femur when a prosthesis is introduced. As a consequence, bone resorption appears due to stress shielding, that is to say the decrease of the stress level in the implanted femur caused by the significant load carrying of the prosthesis due to its higher stiffness. A maximum stiffness topological optimization-based (TO) strategy is utilized for non-linear static finite element (FE) analyses of the femur–implant assembly, with the goal of reducing stress shielding in the femur and to furnish guidelines for re-designing hip prostheses. This is accomplished by employing an extreme accuracy for both the three-dimensional reconstruction of the femur geometry and the material properties maps assigned as explicit functions of the local densities.     

The construction of the scoliosis 3D finite element model and the biomechanical analysis of PVCR orthopaedy

ObjectiveThe objective is to investigate the biomechanical conditions of the Posterior Vertebral Column Resection (PVCR) of the constructed scoliosis 3D finite element model.MethodsA patient with scoliosis was selected; before the PVCR orthopaedy, the patient was submitted to the radiography of normal and lateral full-length vertebral column scans and the total magnetic resonance imaging (MRI) scans; then, the idiopathic scoliosis model was constructed by the 3D finite element method, and the 3D finite element software utilized in the process of model construction included Mimics software, Geomagic Studio 12 software, and Unigraphic 8.0 (UG 8.0) software; in addition, PVCR orthopaedy was utilized to correct the scoliosis of the patient, and the biomechanical parameters, such as orthodontic force, vertebral body displacement, orthopedic rod stress, stress on the pin-bone interface of the vertebral body surface, and the stress on the intervertebral disc, were studied.ResultsThe 3D effective finite element model of scoliosis was successfully constructed by the Mimics software, the Geomagic Studio 12 software, and the UG 8.0 software, and the effectiveness was tested. PVCR orthopaedy could effectively solve the problem of scoliosis. The magnitude of the orthodontic force that a patient needed depended on the physical conditions and the personal orthodontic requirements of the patient. The maximum vertebral body displacement on the X-axis was the vertebral body L1, the maximum displacement on the Y-axis was the vertebral body T3, the maximum displacement on the Z-axis was the vertebral body T1, and the rang of orthopedic rod stress was 0.0050214e⁷ MPa to 0.045217e⁷ MPa, in which the maximum stress of 2 vertebral bodies in, above, and below the osteotomy area reached 0.045217e⁷ MPa, the stress on the pin-bone interface of the T10 vertebral body surface reached 11.83 MPa, and the stress of T8/T9 intervertebral disc reached 13.84 MPa.ConclusionThe 3D finite element model based on 3D finite element software was highly efficient, and its numerical simulation was accurate, which was important for the subsequent biomechanical analysis of PVCR orthopaedy. In addition, the vertebral stress of PVCR orthopaedy was different in each body part, which was mainly affected by the applied orthodontic force and the sites of the orthodontic area.     

Use of a Digital Image Correlation Technique for Measuring the Material Properties of Beetle Wing

Beetle wings are very specialized flight organs consisting of the veins and membranes.Therefore it is necessary from abionic view to investigate the material properties of a beetle wing experimentally.In the present study,we have used a DigitalImage Correlation (DIC) technique to measure the elastic modulus of a beetle wing membrane.Specimens were prepared bycarefully cutting a beetle hind wing into 3.0 mm by 7.0 mm segments (the gage length was 5 mm).We used a scanning electronmicroscope for a precise measurement of the thickness of the beetle wing membrane.The specimen was attached to a designedfixture to induce a uniform displacement by means of a micromanipulator.We used an ARAMISTM system based on the digitalimage correlation technique to measure the corresponding displacement of a specimen.The thickness of the beetle wing variedat different points of the membrane.The elastic modulus differed in relation to the membrane arrangement showing a structuralanisotropy;the elastic modulus in the chordwise direction is approximately 2.65 GPa,which is three times larger than the elasticmodulus in the spanwise direction of 0.84 GPa.As a result,the digital image correlation-based ARAMIS system was suc-cessfully used to measure the elastic modulus of a beetle wing.In addition to membrane’s elastic modulus,we considered thePoisson’s ratio of the membrane and measured the elastic modulus of a vein using an Instron universal tensile machine.Theresult reveals the Poisson’s ratio is nearly zero and the elastic modulus of a vein is about 11 GPa.     

Elastic moduli, yield stress, and ultimate stress of cancellous bone in the canine proximal femur

Elastic moduli, yield stress and ultimate compressive stress were determined for cancellous bone from the femoral head and neck regions of the canine femur. Unconfined compression tests were performed on 5 mm cubic samples which were cut from two femurs. Elastic moduli were measured in three orthogonal directions, and the yield stress and ultimate stress were measured along the proximal-distal axis. The results from this investigation support previous assumptions that the mechanical behavior of canine cancellous bone is qualitatively similar to human cancellous bone. The canine cancellous bone was observed to be anisotropic in elastic modulus. For two thirds of the cubic specimens tested, the elastic modulus was largest in the load-bearing, proximal-distal direction. A linear relationship between yield stress and elastic modulus was observed for canine bone, as is typical of human bone. A similar linear relationship between ultimate stress and elastic modulus was observed. Thus, for canine bone as well as for human bone, failure appears to be governed by a strain level which is position independent. The yield strain of 0.0259 and ultimate strain of 0.0288 for canine bone were both less than the yield strain of 0.0395 reported for human bone.     

Elastic modulus and hardness of cortical and trabecular bone lamellae measured by nanoindentation in the human femur.

The mechanical properties of bone tissue are determined by composition as well as structural, microstructural and nanostructural organization. The aim of this study was to quantify the elastic properties of bone at the lamellar level and compare these properties among osteonal, interstitial and trabecular microstructures from the diaphysis and the neck of the human femur. A nanoindentation technique with a custom irrigation system was used for simultaneously measuring force and displacement of a diamond tip pressed 500 nm into the moist bone tissue. An isotropic elastic modulus was calculated from the unloading curve with an assumed Poisson ratio of 0.3, while hardness was defined as the maximal force divided by the corresponding contact area. The elastic moduli ranged from 6.9 +/- 4.3 GPa in trabecular tissue from the femoral neck of a 74 yr old female up to 25.0 +/- 4.3 GPa in interstitial tissue from the diaphyseal cortex of a 69 yr old female. The mean elastic modulus was found to be significantly influenced by the type of lamella (p < 10(-6)) and by donor (p < 10(-6)). The interaction between the type of lamella and the donor was also highly significant (p < 10(-6)). Hardness followed a similar distribution as elastic modulus among types of lamellae and donor, but with lower statistical contrast. It is concluded that the nanostructure of bone tissue must differ substantially among lamellar types, anatomical sites and individuals and suggests that tissue heterogeneity is of potential importance in bone fragility and adaptation.