原发性甲状旁腺功能亢进症合并股骨头骨骺滑脱1例

Case report of slipped capital femoral epiphysis combined with primary hyperparathyroidism

对2022年5月苏州大学附属儿童医院收治的1例股骨头骨骺滑脱(SCFE)合并原发性甲状旁腺功能亢进症(PHPT)患儿临床资料进行回顾性分析。患儿,女,13岁5个月,双下肢跛行1.5年,加重1个月。髋关节X线检查示双侧股骨头骨骺滑脱,考虑患儿体重指数为18.2 kg/m^(2),无明显外伤史,不符合典型的SCFE特点,遂入院进一步完善甲状旁腺超声检查发现合并甲状旁腺腺瘤,考虑为甲状旁腺腺瘤导致PHPT进而引发的SCFE。手术切除甲状旁腺肿瘤后,患儿双侧股骨头、颈融合,髋关节功能明显改善,遂未行SCFE固定术。结合本例患儿诊疗经验,发现对于SCFE合并PHPT患儿,在甲状旁腺腺瘤切除后,若股骨头与股骨颈已融合,髋关节功能改善,疼痛好转,可不使用内固定治疗骨骺滑脱。对于SCFE合并PHPT的患儿,甲状旁腺功能亢进的管理优先于SCFE的治疗。急性股骨头滑脱和慢性滑脱急性发作者,无论有无PHPT引起的高钙血症,应先行SCFE固定术,尽快或同时进行甲状旁腺肿瘤切除术。对于慢性滑脱,有轻、中度高钙血症及1种或多个相关症状,则应先行甲状旁腺切除术,待甲状旁腺激素和血钙稳定后再考虑SCFE固定术。

Clinical data of a teenager with slipped capital femoral epiphysis(SCFE)combined with primary hyperparathyroidism(PHPT)treated in the Children′s Hospital of Soochow University in May 2022 were retrospectively analyzed.A girl,aged 13 years and 5 months,had claudication of both lower limbs for 1.5 years,and the symptom was aggravated for 1 month.X-ray examination of the hip joint showed bilateral SCFE.However,the patient had a body mass index of 18.2 kg/m^(2) and no trauma,which did not meet the typical characteristics of SCFE.Further ultrasound examination of the parathyroid gland shows parathyroid adenoma.And parathyroid adenoma was considered to cause PHPT,which in turn triggered SCFE.After surgical resection of the PHPT,the patient had a better fusion of the femoral head and femoral neck and improved hip joint function.Therefore,SCFE fixation was not performed.The diagnosis and treatment of this patient indicated that for similar patients with SCFE and PHPT,SCFE may not be treated with internal fixation,if the femoral head and femoral neck have been fused,the hip joint function has improved,and the pain has been relieved after resection of PHPT.In patients with SCFE and PHPT,the management of hyperparathyroidism takes precedence over the treatment of SCFE.Acute and acute-on-chronic slip,with or without PHPT-induced hypercalcemia,should be treated first by SCFE fixation,and excising parathyroid adenoma should be performed simultaneously or as soon as possible.For chronic slip patients who have mild to moderate hypercalcemia and one or more related symptoms,parathyroidectomy should be performed firstly,and then the SCFE fixation should be considered after parathyroid hormone and blood calcium levels become stable.