继发于甲状旁腺功能亢进的骨病损的临床特点（附8例报告）

目的探讨继发于甲状旁腺功能亢进症（PHPT）的骨病损的临床特点。方法回顾总结8例PHPT患者的临床资料，男3例，女5例，平均年龄38岁（21-54岁）。所有患者均有骨痛和骨质疏松，病理性骨折6例（75％），纤维囊性骨炎7例（87.5％），大部分患者多骨受累。实验室检查显示高钙血症、高尿钙、低磷血症、甲状旁腺素增高，血碱性磷酸酶升高。骨关节X线主要表现为骨质稀疏、骨膜下骨质吸收、纤维囊样骨炎、颅盖骨磨砂玻璃样变等。1例患者接受左肱骨近端骨巨细胞瘤肿瘤切除＋人工肩关节置换之后接受甲状旁腺瘤切除术，其余患者均转入外科接受甲状旁腺腺瘤摘除术。结果术后1例患者死于呼吸衰竭，余患者骨痛症状完全缓解，术后血钙均恢复正常，8例患者病理回报均为甲状旁腺瘤。随访6-30个月，平均15.8个月，6例骨科病损大部分好转。结论PHPT早期诊断最有效的方法是血钙常规筛查，对于高血钙者进一步检测PTH并结合骨关节x线特征以明确诊断，早期手术治疗效果良好，能明显减轻患者症状，并发症较少。

The clinical characteristics of secondary bone diseases caused by primary hyperparathyroidism

Objective To study the clinical characteristics of secondary bone diseases caused by primary hyperparathyroidism （PTPH）. Methods The clinical data of 8 patients with PTPH in Tianjin Orthopaedic Hospital between Decenember 1997 to Decemember 2007 were reviewed. Three men and five women were involved. Their mean age was 38 （ranged from 21-54）. All patients presented with diffuse bone pain and osteoporosis. Six patients sustained pathological fracture; 7 sustained fibrocystic ostitis. Most patients sustained multiple bone involvement. Laboratory tests results showed hypercalcemia, hypercalnuria, hypophosphatemia, increasing parathyrin, and increasing serum alkaline phosphatasemia, X-ray images demonstrated osteoporosis, subperiosteal bone absorption, fibroeystic ostitis and ground glass appearance of cranium, After undergoing giant cell tumor resection and shoulder arthroplasty, 1 patient underwent parathyroidectomy. Other patients all underwent parathyroideetomy. Results After surgery, 1 patient died from respirtory failure. Other patients reported complete pain relief. The serum calculus level returned to normal. Eight patients were confirmed parathyroid adenoma by pathological tests. The follow-up ranged from 6 to 30 months（15.8 months in average）. The bone conditions of 6 patients improved. Conclusions The most effective procedure for early diagnosis of PHPT could be the serum calcium screening which is a routine chemical test of serum samples with additive PTH assay in hypercalcemia. Early surgery is effective for PHPT. It can improve the symptoms significantly with few complications.