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患者男,29岁,既往有口渴、多饮、多尿、消瘦、食欲差、便秘伴四肢乏力、酸痛、跛行的病史半年。今因转身突发左大腿肿痛、畸形,活动障碍1d人院。查体:消瘦,右侧甲状腺旁触及花生米和黄豆大小的肿物各一,质硬,无压痛,表面光滑,随甲状腺活动。右上臂及双大腿肿胀、畸形,压痛,并触及骨擦感及反常活动。X线示:右肱骨、双股骨粉碎性骨折(病理性),骨质普遍疏松,皮质变薄,部分呈穿凿样缺损,髓腔内有不规则骨间隔形成,呈囊肿样变。初步诊断为甲状旁腺瘤致多发性病理性骨折。即行手法整复,小夹板外固定,双下肢牵引,在局麻下行右侧甲状旁腺瘤摘除术,术后第3d出现手足搐搦,即给予静脉补钙,口服维生素D,搐搦消失,口渴、多饮、多尿渐消失,食欲增加,肌力渐增强。
The patient was a 29-year-old man with a history of thirst, excessive drinking, polyuria, weight loss, poor appetite, constipation with limb weakness, soreness, and lameness. Due to the sudden turn of the left thigh swelling and pain, deformity, activity disorder 1d hospital. Physical examination: weight loss, the right side of the thyroid gland touches peanuts and soy-sized tumors, each of which is hard, has no tenderness, and has a smooth surface and is accompanied by thyroid activity. The right upper arm and the thighs are swollen, deformed, tender, and touched with bruising and abnormal activity. X-rays showed: comminuted fractures of the right sacrum and double femurs (pathological), loose osteoporosis, thinning of the cortex, and partial puncture-like defects, irregular septal formation within the medullary cavity, and cystic degeneration. The primary diagnosis is multiple pathological fractures caused by parathyroid tumors. Immediately after manipulation, small splints were externally fixed, and lower limbs were towed. Right hepatic parathyroid adenomas were removed under local anesthesia. Hand-foot-plantar fistula developed on the 3rd day after surgery. The patients were given intravenous calcium, oral vitamin D, phlegm, and thirst. , More drink, more urine gradually disappeared, increased appetite, muscle strength gradually increased.