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目的探讨甲状旁腺功能亢进(hyperparathyroidism,PHPT)导致骨病的诊疗策略。方法回顾本中心诊治的26例PHPT骨病患者的临床资料,其中男6例,女20例,年龄13~83岁,平均50岁。26例症状均有骨痛,其中6例合并活动障碍,5例合并乏力。结果术前,本组26例中23例血钙均高于正常,为2.65~l4.28 mmol/L,平均3.00 mmol/L。26例中,16例血磷正常,10例均低于正常(0.53~0.77 mmol/L,平均0.61 mmol/L)。26例甲状旁腺素(PTH)均高于正常(105~2361 ng/L,平均651.88 ng/L),15例行X线平片检查,3例无明显异常;12例呈骨密度减低,5例出现骨皮质吸收。所有患者均转入普外科行甲状旁腺腺瘤切除术,1例术后行刮除植骨内固定术,1例术后骨折行切开复位内固定。术后随访半年至2年,1例术后发生骨折,其余25例均无骨折发生,25例骨痛明显改善,VAS评分均<3分,骨痛明显改善所需时间为3天至1年半。结论对骨痛、病理性骨折的患者,应加以怀疑PHPT的可能,完善并密切关注血钙及PTH检查结果,结合甲状旁腺超声及骨骼相关的影像学检查,可确诊此病。经普外科切除甲状旁腺腺瘤后,长期随访此病预后较好,并发症少。
Objective To investigate the diagnosis and treatment strategy of bone disease caused by hyperparathyroidism (PHPT). Methods The clinical data of 26 cases of PHPT patients diagnosed and treated by our center were retrospectively reviewed. There were 6 males and 20 females, aged 13-83 years (average 50 years). Twenty-six patients had bone pain, of which 6 were complicated by mobility disorder and 5 were weak. Results Before operation, 23 of the 26 patients in our study had elevated serum calcium levels from 2.65 to 14.28 mmol / L with an average of 3.00 mmol / L. Of the 26 patients, 16 had normal serum phosphorus, and 10 were lower than normal (0.53-0.77 mmol / L, mean 0.61 mmol / L). 26 cases of PTH were higher than the normal (105 ~ 2361 ng / L, an average of 651.88 ng / L), 15 cases of X-ray examination, 3 cases without obvious abnormalities; 12 cases showed decreased bone mineral density, 5 cases of cortical bone absorption. All patients were transferred to general surgery parathyroid adenoma resection, 1 case of curettage and bone grafting and internal fixation, 1 case of postoperative fractures open reduction and internal fixation. All patients were followed up for 6 months to 2 years. One patient had fractures postoperatively, the other 25 patients had no fractures. The pain scores in 25 patients were significantly improved, VAS score <3, and bone pain significantly improved from 3 days to 1 year half. Conclusion For patients with bone pain and pathological fracture, the possibility of PHPT should be questioned. The calcium and PTH test results should be improved and closely monitored. Combined with parathyroid ultrasound and bone-related imaging examination, the disease can be diagnosed. After general surgery resection of parathyroid adenoma, the long-term follow-up of the disease better prognosis, fewer complications.