Abstract：
OBJECTIVE: Parathyroidectomy is beneficial in tertiary hyperparathyroidism (THPT) consequent to chronic renal failure. The craniofacial morphology of patients who undergo total parathyroidectomy and autologous transplantation (tPTX + AT) has not been widely studied. This study assessed the efficacy of tPTX + AT in THPT and evaluated possible improvements in craniofacial features.
METHODS: This retrospective analysis included patients who were diagnosed with medically refractory THPT and had undergone tPTX + AT between September 2013 and May 2021. The VAS was used to evaluate improvements in various symptoms including bone pain and pruritus. Changes in serum calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone (iPTH) levels were also assessed. The impact of the procedure was assessed by comparing two-photon X-ray bone mineral density measurements obtained 1 year before and after surgery.
RESULTS: The VAS of pain and pruritus decreased significantly on the first postoperative day (P < 0.05). Calcium levels changed significantly (from 2.50 ± 0.22 mmol/L to 2.10 ± 0.26 mmol/L) on postoperative day 1 (P = 0.0000); iPTH levels also declined substantially on this day, reducing from 211.00 (122.10, 252.80) to 5.04 (2.96, 9.40) pmol/L. Bone mineral density increased significantly across various regions including the greater trochanter of the femur, intertrochanteric area, total hip, and third lumbar vertebra (P < 0.05). The angles between the upper incisor and mandibular plane and the lower lip and Ricketts E line (drawn from the tip of the nose to the soft tissue area) also improved (P = 0.043, P = 0.001).
CONCLUSIONS: Total parathyroidectomy and autologous transplantation can rapidly alleviate bone pain and skin itching in THPT. It may also improve bone density and facial soft tissue.
METHODS: This retrospective analysis included patients who were diagnosed with medically refractory THPT and had undergone tPTX + AT between September 2013 and May 2021. The VAS was used to evaluate improvements in various symptoms including bone pain and pruritus. Changes in serum calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone (iPTH) levels were also assessed. The impact of the procedure was assessed by comparing two-photon X-ray bone mineral density measurements obtained 1 year before and after surgery.
RESULTS: The VAS of pain and pruritus decreased significantly on the first postoperative day (P < 0.05). Calcium levels changed significantly (from 2.50 ± 0.22 mmol/L to 2.10 ± 0.26 mmol/L) on postoperative day 1 (P = 0.0000); iPTH levels also declined substantially on this day, reducing from 211.00 (122.10, 252.80) to 5.04 (2.96, 9.40) pmol/L. Bone mineral density increased significantly across various regions including the greater trochanter of the femur, intertrochanteric area, total hip, and third lumbar vertebra (P < 0.05). The angles between the upper incisor and mandibular plane and the lower lip and Ricketts E line (drawn from the tip of the nose to the soft tissue area) also improved (P = 0.043, P = 0.001).
CONCLUSIONS: Total parathyroidectomy and autologous transplantation can rapidly alleviate bone pain and skin itching in THPT. It may also improve bone density and facial soft tissue.
摘要：
目的：甲状旁腺切除术对慢性肾功能衰竭后的三级甲状旁腺功能亢进症（THPT）有益。接受全甲状旁腺切除术和自体移植（tPTXAT）的患者的颅面形态尚未得到广泛研究。这项研究评估了tPTX+AT在THPT中的疗效，并评估了颅面特征的可能改善。
方法：本回顾性分析包括2013年9月至2021年5月期间诊断为医学难治性THPT并接受过tPTX+AT的患者。VAS用于评估各种症状(包括骨痛和瘙痒)的改善。血清钙的变化，磷，碱性磷酸酶,还评估了完整的甲状旁腺激素（iPTH）水平。通过比较手术前后1年获得的双光子X射线骨密度测量结果来评估手术的影响。
结果：术后第一天疼痛和瘙痒的VAS评分明显下降（P<0.05）。术后第1天，钙水平发生显著变化（从2.50±0.22mmol/L至2.10±0.26mmol/L）（P=0.0000）；iPTH水平也在这一天大幅下降，从211.00(122.10,252.80)降低到5.04(2.96,9.40)pmol/L骨矿物质密度在不同地区显着增加，包括股骨的大转子，转子间区域,全髋关节,和第三腰椎（P<0.05）。上切牙和下颌平面与下唇和RickettsE线（从鼻尖到软组织区域绘制）之间的角度也有所改善（P=0.043，P=0.001）。
结论：甲状旁腺全切除和自体移植可迅速缓解THPT患者骨痛和皮肤瘙痒。它还可以改善骨密度和面部软组织。
方法：本回顾性分析包括2013年9月至2021年5月期间诊断为医学难治性THPT并接受过tPTX+AT的患者。VAS用于评估各种症状(包括骨痛和瘙痒)的改善。血清钙的变化，磷，碱性磷酸酶,还评估了完整的甲状旁腺激素（iPTH）水平。通过比较手术前后1年获得的双光子X射线骨密度测量结果来评估手术的影响。
结果：术后第一天疼痛和瘙痒的VAS评分明显下降（P<0.05）。术后第1天，钙水平发生显著变化（从2.50±0.22mmol/L至2.10±0.26mmol/L）（P=0.0000）；iPTH水平也在这一天大幅下降，从211.00(122.10,252.80)降低到5.04(2.96,9.40)pmol/L骨矿物质密度在不同地区显着增加，包括股骨的大转子，转子间区域,全髋关节,和第三腰椎（P<0.05）。上切牙和下颌平面与下唇和RickettsE线（从鼻尖到软组织区域绘制）之间的角度也有所改善（P=0.043，P=0.001）。
结论：甲状旁腺全切除和自体移植可迅速缓解THPT患者骨痛和皮肤瘙痒。它还可以改善骨密度和面部软组织。
