摘要
目的探讨原发性甲状旁腺功能亢进(PHPT)性病理性骨折的早期诊断及治疗效果。方法回顾2013年6月至2016年6月山东省立医院骨肿瘤科以病理性骨折首诊的5例PHPT患者临床资料,分析其临床诊断特征并进行文献复习。结果 5例病理性骨折患者影像学检查均发现骨折部位呈膨胀性骨质破坏,其中2例分别为骨囊肿和动脉瘤样骨囊肿并病理性骨折。4例术前化验指标存在典型高血钙、低血磷,碱性磷酸酶及甲状旁腺激素(PTH)水平明显高于正常。颈部B超示甲状旁腺囊性占位,99m锝-甲氧基异丁基异腈(99mTc-MIBI)双时相显像示甲状旁腺异常放射性浓聚,确诊为PHPT。其中,3例行甲状旁腺手术,术后均证实为甲状旁腺腺瘤,余2例行保守对症治疗。经随访6~24个月,所有患者骨质均得以不同程度的修复,骨折处均有连续性骨痂生长。结论血钙及PTH的同步升高是诊断PHPT的重要依据,早期检测血钙、血磷及PTH,行甲状旁腺彩超及99mTc-MIBI显像检查,能够早期确诊,提高治愈率。
Objective To explore the early diagnosis and improve the treatment of primaryhyperparathyroidism.Methods Five patients of pathological fracture caused by primary hyperparathyroidism（PHPT）,who admitted to Shandong Provincial Hospital in recent 3 years were enrolled in this study.ResultsDistensible bone destruction was found by imageological examination in 5 patients,the other 2 cases werebone cyst and aneurysmal bone cyst respectively. Four patients with preoperative test indicators of typicalhypercalcemia, hypophosphatemia, and the levels of alkaline phosphatase and PTH were significantlyincreased.The diagnosis of PHPT was further diagnosed by neck ultrasonography and parathyroid 99mTc-MIBIexamination.Parathyroid gland surgery was performed in 3 cases, postoperative pathology was parathyroidadenoma,and 2 cases were transferred to the department of endocrinology for symptomatic treatment. Fivepatients were followed up for 6 to 24 months,and sclerotin of all patients had been repaired with differentdegree,callus growth was continuous.Conclusions The simultaneous increase of serum calcium and PTH isan important basis for the diagnosis of PHPT. Early detection of serum calcium, phosphorus and PTH,parathyroid ultrasonography and 99mTc-MIBI can diagnose PHPT early and can improve the cure rate.
出处
《中华诊断学电子杂志》
2017年第4期277-280,共4页
Chinese Journal of Diagnostics(Electronic Edition)
