1例维生素D缺乏伴继发性甲状旁腺功能亢进股骨头缺血性坏死患者的医疗管理和康复

C. Diaconu, R. Cipăian, M. Iliescu, V. Ciortea, Laszlo Irsay, R. Ungur, C. Diaconu
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引用次数: 0

摘要

维生素D对骨骼和肌肉健康至关重要。维生素D缺乏(VDD)会导致继发性甲状旁腺功能亢进,骨质和骨量下降,矿化效应和骨折,肌病和跌倒。股骨头缺血性坏死(AVN)的病理生理尚不清楚,可认为是一种血管性骨病。我们的论文旨在评估一个年轻的男性双侧股骨-口腔颈部损伤,需要双侧关节置换术的AVN的病因。方法:我们报告一例46岁男性患者,因股骨头AVN继发骨性关节炎而行双侧全髋关节置换术。在完成激素、生物学和影像学评估后,原发性甲状旁腺功能亢进的诊断不被支持;治疗8个月后维生素D缺乏症的改善明确了诊断:继发于维生素D缺乏症的甲状旁腺功能亢进。结果:补充4000 IU维生素D可改善患者对特定康复方法的反应。结论:严重维生素D缺乏可通过继发性甲状旁腺功能亢进继发影响股骨头结构,产生AVN,但DXA评价仅表现为骨质减少。VDD可能是AVN发生的重要病因,对其进行纠正可以改善疾病的发展,提高患者的康复能力。关键词:缺血性坏死,继发性甲状旁腺功能亢进,维生素D缺乏,康复
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Medical management and rehabilitation in a patient with avascular necrosis of the femoral head in the context of vitamin D deficiency and secondary hyperparathyroidism – case report
Vitamin D is essential in determining bone and muscle health. Vitamin D deficiency (VDD) produces secondary hyperparathyroidism, loss of bone quality and mass, mineral-ization effects and fractures, myopathy, and falls. The avascular necrosis (AVN) of the femoral head pathophysiology is still unclear and can be considered a vascular bone dis-ease. Our paper aimed to evaluate the etiology of AVN in a young male with bilateral fem-oral neck damage who required bilateral arthroplasty. Method: We present the case of a 46-year-old male patient with VDD and bilateral total hip arthroplasty for osteoarthritis secondary to AVN of the femoral head. After complete hormonal, biological, and imaging evaluations, the diagnosis of primary hyperparathyroidism was not supported; the im-provement of vitamin D deficiency after eight months of treatment clarified the diagnosis: hyperparathyroidism secondary to vitamin D deficiency. Results: Supplementation with 4000 IU of vitamin D improved the patient’s response to specific rehabilitation methods. Conclusions: Severe vitamin D deficiency can secondarily affect the structure of the femoral head through secondary hyperparathyroidism, producing AVN, but only osteopenia was obtained on DXA evaluation. VDD can be an important etiological factor in the occur-rence of AVN, and its correction can improve the evolution of the disease, improving the reabilitation of these patients. Keywords: avascular necrosis, secondary hyperparathyroidism, vitamin D deficiency, rehabilitation
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