Recovery pattern of patients with osteitis fibrosa cystica in primary hyperparathyroidism after successful parathyroidectomy
Recovery pattern of patients with osteitis fibrosa cystica in primary hyperparathyroidism after successful parathyroidectomy
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DOI：
10.1067/msy.2002.128484
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发表时间：
2002-12-01
期刊：
影响因子：
3.8
通讯作者：
Mithal, A
中科院分区：
文献类型：
--
作者：
Agarwal, G;Mishra, SK;Mithal, A
背景甲状旁腺切除术后，恢复纤维性囊性骨炎，这仍然是主要介绍原发性甲状旁腺功能亢进症在印度尚未被客观记录。我们随访了51例原发性甲状旁腺功能亢进和囊性纤维性骨炎患者的临床恢复情况、骨转换生化标志物、骨密度和骨骼放射学，共9年。至124个月（中位数，32个月）。甲状旁腺切除术后，46例患者发生低钙血症。术后第1周，71%的患者骨痛改善。3个月内，33例患者骨折全部愈合，7例卧床患者中有6例可以行走。在不同部位观察到的平均骨密度增量（变化百分比/年）。1周、3、6和12个月时，前臂远端-37，28，23，21;腰椎165，104，101，106;全髋关节-168，157，166，133。随访X线片显示虽然无序再矿化但迅速恢复。棕色肿瘤和骨折在3个月内显示高密度。6个月后，27例患者中有6例棕色肿瘤部分消退。甲状旁腺切除术后，原发性甲状旁腺功能亢进患者的囊性纤维性骨炎有早期、显著和持续的恢复。早期（1周）骨矿物质密度增量>100%/y提示骨骼有能力迅速恢复自身。松质骨（腰椎）的密度恢复迅速，但皮质骨（前臂）的密度恢复不迅速。轮廓缺陷和骨肿瘤持续存在，可能需要矫正截骨术。
Background. After parathyroidectomy, recovery of osteitis fibrosa cystica, which continues to dominate presentation of primary hyperparathyroidism in India has not been documented objectively.Methods. We followed up clinical recovery, biochemic markers of bone turnover, bone mineral density, and skeletal radiology in 51 patients with primary hyperparathyroidism and osteitis fibrosa cystica for 9. to 124 months (median, 32 months).Results. After parathyroidectomy, 46 patients had hypocalcemia. During postoperative week 1, bone pain improved in 71%. During 3 months, appendicular fractures healed in all 33 such patients, and 6 of 7 patients who were bedridden could walk. Mean bone mineral density increments (percent change/y) seen at various sites at. 1 week, 3, 6, and 12 months were distal forearm -37, 28, 23, 21; lumbar spine 165, 104, 101, 106; and total hip -168, 157, 166, 133. Follow-up radiographs demonstrated prompt recovery though disorderly remineralization. Brown tumors and fractures showed hyperdensities within 3 months. Brown tumors regressed partially in 6 of 2 7 patients after 6 months.Conclusions. After parathyroidectomy, patients with primary hyperparathyroidism have early, marked, and sustained recovery of osteitis fibrosa cystica. Early (1 week) bone mineral density increments of >100%/y hint at the skeleton's ability to promptly restore itself Densitometric recovery is prompt at cancellous (lumbar spine), but not at cortical (forearm) bone sites. Contour defects and bony tumors persist, and may need corrective osteotomies.