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目的探讨骨科首诊原发性甲状旁腺功能亢进症(PHPT)患者的临床特征,提高对此类患者的诊断水平。方法回顾性分析骨科首诊并经组织学证实的32例PHPT患者的临床、影像、病理资料。结果所有患者均证实患有甲状旁腺腺瘤并行腺瘤切除术。所有患者骨骼X线片均表现为广泛性骨密度减低,不同程度的局灶性溶骨性改变,15例(46.88%)合并病理性骨折并经手术治疗。实验室检查显示所有患者血钙、碱性磷酸酶(ALP)、骨钙素(BGP)和甲状旁腺激素(PTH)明显高于正常,血磷明显低于正常。患者甲状旁腺腺瘤切除术后第一天血钙即恢复正常,术后7d内PTH恢复正常。长期随诊12例患者骨骼状况恢复良好。结论部分以骨科症状首诊的PHPT患者,如能正确认识PHPT造成的骨损害,及时行甲状旁腺外科治疗可治愈此病。
Objective To investigate the clinical features of patients with primary hyperparathyroidism (PHPT) diagnosed by orthopedics and to improve the diagnosis of these patients. Methods The clinical, imaging and pathological data of 32 patients with PHPT confirmed by histology were retrospectively analyzed. Results All patients were confirmed with parathyroid adenoma and adenoma resection. All patients’ skeletal X-ray showed extensive bone mineral density reduction, varying degrees of focal osteolytic changes, 15 cases (46.88%) with pathological fracture and surgical treatment. Laboratory tests showed that all patients had significantly higher levels of serum calcium, alkaline phosphatase (ALP), BGP and PTH than normal, and their serum phosphorus levels were significantly lower than normal. The level of serum calcium returned to normal on the first day after resection of parathyroid adenoma, and returned to normal within 7 days after operation. Long-term follow-up of 12 patients recovered well. Conclusions Some patients with PHPT who are diagnosed with orthopedic symptoms can correctly treat the bone damage caused by PHPT and get timely parathyroid surgery to cure the disease.