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Abstract：
Phosphaturic mesenchymal tumors (PMT) are rare and distinctive tumors that typically result in paraneoplastic syndrome known as tumor-induced osteomalacia (TIO). We report a case of bilateral osteoporotic femoral neck fracture caused by PMT. PMT was surgically resected, followed by sequential treatment of bilateral femoral neck fractures with total hip arthroplasty (THA). A 49-year-old perimenopausal woman experienced consistent bone pain with limb weakness persisting for over 2 years. Initially, she was diagnosed with early osteonecrosis of the femoral head and received nonsurgical treatment. However, from 2020 to 2022, her pain extended to the bilateral shoulders and knees with increased intensity. She had no positive family history or any other genetic diseases, and her menstrual cycles were regular. Physical examination revealed tenderness at the midpoints of the bilateral groin and restricted bilateral hip range of motion, with grade 3/5 muscle strength in both lower extremities. Laboratory findings revealed moderate anemia (hemoglobin 66 g/L), leukopenia (2.70 × 109/L), neutropenia (1.28 × 109/L), hypophosphatemia (0.36 mmol/L), high alkaline phosphatase activity (308.00 U/L), and normal serum calcium (2.22 mmol/L). After surgery, additional examinations were performed to explore the cause of hypophosphatemic osteomalacia. After definitive diagnosis, the patient underwent tumor resection via T11 laminectomy on August 6, 2022. Six months after the second THA, the patient regained normal gait with satisfactory hip movement function without recurrence of PMT-associated osteomalacia or prosthesis loosening. By providing detailed clinical data and a diagnostic and treatment approach, we aimed to improve the clinical understanding of femoral neck fractures caused by TIO.
摘要：
磷酸间充质肿瘤（PMT）是罕见且独特的肿瘤，通常会导致副肿瘤综合征，称为肿瘤诱导的骨软化症（TIO）。我们报告一例由PMT引起的双侧骨质疏松性股骨颈骨折。手术切除了PMT,然后通过全髋关节置换术（THA）序贯治疗双侧股骨颈骨折。一名49岁的围绝经期妇女经历了持续的骨痛，肢体无力持续超过2年。最初，她被诊断为早期股骨头坏死，并接受非手术治疗。然而,从2020年到2022年，她的疼痛延伸到双侧肩膀和膝盖，强度增加。她没有积极的家族史或任何其他遗传疾病，她的月经周期是有规律的。体格检查显示双侧腹股沟中点有压痛，双侧髋关节活动范围受限，下肢有3/5级肌肉力量。实验室发现中度贫血（血红蛋白66g/L），白细胞减少症（2.70×109/L），中性粒细胞减少症（1.28×109/L），低磷血症（0.36mmol/L），碱性磷酸酶活性高（308.00U/L），血清钙正常(2.22mmol/L)。手术后,我们进行了额外的检查以探讨低磷酸盐血症性骨软化症的原因.明确诊断后,患者于2022年8月6日通过T11椎板切除术进行了肿瘤切除术.第二次THA六个月后，患者步态恢复正常,髋关节运动功能满意,无PMT相关骨软化症或假体松动复发.通过提供详细的临床数据和诊断和治疗方法，旨在提高临床对TIO所致股骨颈骨折的认识。
