骨痛-骨折不愈合-血肌酐升高  

Bone pain,nonunion of bone fracture,elevated serum creatinine

作　　者：徐晓杰[1] 吕芳[1] 宋玉文[1] 王建一[1] 姜艳[1] 王鸥[1] 夏维波[1] 李玉秀[1] 邢小平[1] 李梅[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院内分泌科国家卫生和计划生育委员会内分泌重点实验室,北京100730

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2016年第4期402-408,共7页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：国家自然科学基金面上项目(81100623;81570802);国家临床重点专科课题(WBYZ2011-873)

摘　　要：肾性骨病是慢性肾脏疾病的常见并发症,可显著增加骨折风险。本文对1例以骨痛、骨折不愈合和活动受限为主要表现的老年男性,进行细致病因查询,结果发现患者存在血肌酐水平升高、维生素D严重缺乏、代谢性酸中毒、继发性甲状旁腺功能亢进及骨转换生化指标升高,导致左胫腓骨远端骨折不愈合,影像学检查提示骨质疏松和骨软化。给予钙剂、活性维生素D治疗以及碳酸氢钠纠正代谢性酸中毒后,患者骨痛缓解、骨折愈合,活动能力显著提高。本例患者诊治经验提示肾性骨病可以引起骨折风险增加及骨折不愈合,临床医生应重视对肾性骨病的诊断及治疗。Renal osteodystrophy （ROD） is a common bone disorder that occurs in patients with chronic kidney disease （CKD） , which significantly increases the risks of bone fracture. We reported an old male patient who presented with chronic bone pain, nonunion of fracture and restricted mobility. The intensive etiology screening revealed elevated serum creatinine, severe vitamin D deficiency, metabolic acidosis, secondary hyperparathyroidism and elevated bone turnover biomarkers, all of which might result in the nonunion of fracture at the lower limb. Radiographs demonstrated os- teoporosis and osteomalacia. Calcium and active vitamin D were administered in conjunction with acidosis modification. During the treatment, bone pain was relieved and healing of the fracture was confirmed by radiology, with improvement in his activity ability. This case indicated that ROD may lead to increased fracture risk and nonunion of bone fractures, and the doctors should pay attention to the diagnosis and management of ROD.

关 键 词：慢性肾功能不全 肾性骨病 骨折不愈合 

分 类 号：R681[医药卫生—骨科学]