多发性骨髓瘤骨病的外科治疗及预后因素  

Surgical Treatment and Prognosis of Multiple Myeloma Bone Disease

作　　者：刘巍峰[1] 王涛[1] 李远[1] 李斌[1] 郝林[1] 牛晓辉[1] Liu Weifeng;Wang Tao;Li Yuan;Li Bin;ttao Lin;Niu Xiaohui(Department of Orthopaedic Oncology Surgery,Beijing Ji Shui Tan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院骨肿瘤科,100035

出　　处：《中华骨科杂志》2018年第14期841-850,共10页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（61372179）

摘　　要：目的评价多发性骨髓瘤手术治疗对于疼痛和生活质量的改善并分析预后影响因素。方法回顾性分析1992年6月至2016年6月我科手术治疗非脊柱部位骨髓瘤且资料完整的43例患者，其中男性28例，女性15例，明确诊断时平均年龄56．8岁，中位年龄57岁（28-81岁）。病灶位于上肢13例，下肢26例，骨盆3例，躯干2例，其中1例具有肱骨和股骨两处手术病灶。患者主要症状包括疼痛35例（81．4％），病理性骨折22例（51．2％），其中上肢和下肢各11例。手术方式包括：长骨病灶刮除内固定22例，长骨瘤段截除＋关节置换l1例，长骨瘤段截除＋大段异体骨半关节置换1例，长骨闭合复位内固定3例，肢体肿瘤局部切除2例。骨盆部位3例分别为病灶刮除内固定1例，病灶切除＋髂股融合1例，病灶切除＋髋臼重建＋全髋置换1例。躯干病灶为肩胛骨切除1例，肋骨切除1例。其中手术前后的视觉模拟量表（visual ananlogue scale，VAS）评分及美国东部肿瘤协作组（Eastern Cooperative Oncology Group，EcOG）一般状况评分采用配对设计的两样本秩和检验，美国肌骨胳肿瘤协会（Musculoskeletal Tumor Society，MSTS）评分采用配对设计t检验，Kaplan-Meier方法计算生存曲线，复发率的比较采用卡方检验，单因素和多因素分析采用Cox回归模型。结果本组平均手术时间164min（40-290min），出血量883ml（50-7000m1）。肢体肿瘤患者Mirels评分平均为9．97分，中位10分（8-12分）。术后与术前的ECOG评分比较（Z=-5．622，P=0．000）、VAS评分（Z=-5．671，P=0．000）、MSTS评分（t=-18．520，P=0．000）均较术前有显著改善。4例局部复发（4／43，9．3％），其中股骨远端1例，肱骨3例，病灶切除组与病灶刮除组的复发率比较的差异无统计学意义（χ^2＝3．175，P=0．127）。4例出现术后并发症（4／43，9．3％），内固定失效2例，关�Objective To evaluate the effect of surgical treatment for pain relief, quality of life, survival status of pa- tients and analyze prognostic factors with multiple myeloma bone disease. Methods Retrospective analyzed 43 consecutive pa- tients from June 1992 to June 2016 who underwent surgery in our department. Twenty five males and 15 females were enrolled with average age of 56.8 （ranged： 28-81 years）. Lesions location distribution： upper limb in 13 cases, lower extremity in 26 cases, pelvic 3 cases and trunk 2 cases. One patient had two lesions in humerus and femur. The main symptoms manifested 35 cases of pain （81.4%） and 22 cases （51.2%） of pathological fractures, including 11 cases of upper and lower limbs. Limbs surgical included curettage and fixation in 22 cases, segment resection and prosthesis replacement in 11 cases, allograft replacement in 1 case, inter- nal fixation without removal the tumor in 3 cases and resection without reconstruction in 2 cases. Pelvic surgical included 1 curet- tage, 1 resection with Iliofemoral fusion and 1 resection with acetabular reconstruction of total hip replacement. Trunk surgery in- cluded scapulectomy 1 case and rib resection 1 case. The postoperative pain relief, via visual analogue scale （VAS） and Eastern Cooperative Oncology Group （ECOG） score were analyzed by Wilcoxon. MSTS score was analyzed by paired-samples t-test. Surviv- al rate and local recurrence were analyzed by Kaplan-Meier and Chi-square respectively. We collected gender, age, number of lesions, laboratory test （HB, CRP, ALB,Cre, LDH）, chemotherapy and surgical marginal for multivariate analysis with Cox regression model Results The average time and blood loss were 164 rains （40-290 mins） and 883ml （50-7 000 ml） respectively. The Mire- ls score for limb tumor patients averaged 9.97 and the median score was 10 （8-12）. The quality of life ECOG （Z=-5.622, P= 0.000）, pain relief VAS （Z=-5.671, P=0.000） and MSTS score （t=-18.520, P=0.000） were improved sig

关 键 词：多发性骨髓瘤 骨折 预后 治疗结果 

分 类 号：R733.3[医药卫生—肿瘤]