骨科首诊原发性甲状旁腺功能亢进症的临床特征分析

Clinical features of primary hyperparathyroidism diagnosed in orthopedic department

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 explore the clinical features of primary hyperparathyroidism （PHPT） diagnosed in orthopedic department, and improve our competence in diagnosis. Methods The clinical data （including radiological and pathological） of 32 cases of PHPT who were diagnosed in orthopedic department and confirmed by histological test was retrospectively analyzed. Results All patients were confirmed to have parathyroid adenoma and underwent adanoma resection. The X-ray images of all patients＇ bones were present with extensive reduced bone mineral density and osteolytic changes of different degrees. 15 patients （46.88%） also sustained pathological fracture and underwent surgery. Lab results revealed that blood calcium, alkaline phosphatase （ALP）, osteoealcin （BGP） and parathyroid hormone （PTH） were significantly higher than normal, while phosphorus was significantly lower than normal. The first day after the resection, the patient＇s blood calcium returned to normal, and PTH was also back to normal 7 days after surgery. Long-term follow-up of 12 patients showed a good recovery of bones. Conclusions For patients with PHPT who were diagnosed in orthopedic department, if doctors can recognize the bone damage correctly, timely surgical treatment to the parathyroid glands can result in good recovery.