続発性上皮小体機能亢進症に対する上皮小体摘除術後の骨病変の変化の検討

Abstract

1)自覚症状のうち骨関節痛は23例全例に存在しており, 手術後は再発例を除く87%に改善を見た。2)骨単純X線所見では, 手術前は手指骨と頭蓋骨の骨変化の程度が大きく, 手術後これらの約90%が改善した。一方, 椎骨と歯槽骨の改善率は低かった。3)SPA法とDIP法による手術後の骨塩量の改善率はそれぞれ75%, 83%で, 同性同年代の正常者と対比した%骨塩量も手術後は有意に増加した。4)手術後の骨塩量の変化は5つのパターンを示し, その分析により移植腺機能の把握に有用である可能性が示唆された。5)上皮小体摘除術後の骨所見は, 直接的には手術の効果を表わすが, 間接的には移植腺の機能をも反映するものと考えられた

We evaluated the changes of the bone lesions and their relative bone findings before and after parathyroidectomy in 23 patients with secondary hyperparathyroidism. Before the operation, all patients had bone and/or joint pain. In radiographic findings, subperiosteal bone resorption of the hand and a salt and pepper coloration of the skull were observed in all patients. Rugger jersey spine and the disappearance of the lamina dura were observed in about 90% of the patients. The bone mineral contents measured by single photon absorptiometry and digital image processing method had decreased in all of the patients compared with the mean values in sex- and age-matched controls. After the operation, the bone and/or joint pain had disappeared excluding three patients with recurrent hyperparathyroidism. The bone changes of the hand and the skull had improved in about 90% of the patients. However, the improvement rate was low in the vertebral and dental bone changes. The bone mineral contents increased significantly compared with the preoperative values. In recurrent cases, transient increase of the bone mineral contents was observed postoperatively. However, their values, were decreased gradually with the elevation of parathyroid hormone level. The evaluation of the bone lesions before and after parathyroidectomy not only indicates the effectiveness of the operation but also illustrates the function of the autotransplanted parathyroid tissues. We conclude that regular examination of the bone lesions after parathyroidectomy, paying attention to recurrent hyperparathyroidism and/or graft function, is mandatory.