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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 is a common complication of chronic kidney disease and can significantly increase the risk of fractures. In this paper, a case of bone pain, fracture nonunion and limited mobility as the main performance of older men, detailed etiological inquiries, the results found that patients with elevated serum creatinine, a serious lack of vitamin D, metabolic acidosis, secondary Hyperparathyroidism and biochemical markers of bone turnover increased, leading to distal fracture of the left tibiofibula nonunion, imaging studies suggest osteoporosis and osteomalacia. Given calcium, active vitamin D treatment and sodium bicarbonate to correct metabolic acidosis, patients with bone pain relief, fracture healing, activity was significantly improved. Diagnosis and treatment of patients with this case prompted renal osteodystrophy can cause increased fracture risk and nonunion, clinicians should pay attention to the diagnosis and treatment of renal osteodystrophy.