合并骨折的白血病患者外科治疗的临床分析  

Clinical Analysis of Surgical Treatment for Leukemia Patients with Fracture

作　　者：唐一仑[1] 徐燕[2] 王剑利[2] 何爱丽[2] 张王刚[2] 宋金辉[1] 王坤正[1] 杨佩[1] Tang Yilun;Xu Yan;Wang Jianli;He Aili;Zhang Wanggang;Song Jinhui;Wang Kunzheng;Yang Pei(Department of Orthopaedics,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Hematology,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第二附属医院骨关节外科,陕西西安710061 [2]西安交通大学第二附属医院血液科,陕西西安710061

出　　处：《实用骨科杂志》2023年第2期110-115,共6页Journal of Practical Orthopaedics

摘　　要：目的 回顾性分析合并骨折的白血病患者外科手术治疗的临床疗效及可行性。方法 收集2012年1月至2021年12月就诊于西安交通大学第二附属医院合并骨折行外科手术治疗的白血病患者共21例,其中男性13例,女性8例;年龄15~77岁,平均年龄(55±15)岁;急性髓系白血病9例,急性淋巴细胞白血病9例,慢性髓系白血病1例,慢性淋巴细胞白血病2例;骨折部位:腰椎骨折6例,胸椎骨折1例,胸腰椎骨折2例,股骨颈骨折4例,股骨干骨折1例,股骨转子间骨折2例,股骨远端骨折1例,胫骨干骨折1例,胫骨近端骨折1例,肱骨骨折1例,股骨合并髌骨骨折1例;其中15例是外伤、车祸、高处坠落等原因导致,6例无明显外伤史。4例发生白血病细胞浸润骨组织。患者术前、术后1个月均行疼痛视觉模拟评分(visual analogue scale,VAS)及美国东部肿瘤协作组(eastern cooperative oncology group,ECOG)一般状况评分、骨与软组织肿瘤协会(musculoskeletal tumor society,MSTS)肢体功能评分。结果 手术均顺利完成,术后局部疼痛症状均得到明显缓解,肢体功能得到较快恢复,患者对于手术的满意度高,日常生活能够自理,后期能继续接受内科化疗。无一例围手术期死亡。术后随访时间3~43个月,平均(18±13)个月,随访期间内白血病复发11例,9例死亡,中位生存时间为6个月(3~29个月)。无一例因骨折而长期卧床,无一例患者发生二次骨折。所有患者术后VAS评分为(3.57±1.08)分,低于术前的(8.14±1.15)分,差异有统计学意义(P=0.022);一般状况ECOG评分术后(1.43±0.60)分,较术前(3.38±0.59)分明显改善,差异有统计学意义(P=0.001)。MSTS评分术后(22.32±3.25)分,较术前(11.24±2.82)分明显改善,差异有统计学意义(P=0.015)。结论 采用外科手术治疗合并骨折的白血病患者,可明显减轻患者的疼痛症状,恢复肢体功能,改善患者的生活质量,安全性高,利于后期白血病的继续治疗。Objective To retrospectively analyze the clinical efficacy and feasibility of surgical treatment for leukemia patients with fracture.Methods There were 9cases of acute myeloid leukemia,9cases of acute lymphoblastic leukemia,1case of chronic myeloid leukemia and 2cases of chronic lymphocytic leukemia.The median age was(55±15)years(range,15~77years).There were 6cases of lumbar vertebra,1cases of thoracic vertebra,2cases of thoracic and lumbar vertebrae,4cases of femoral neck,2cases of femoral intertrochanteric,1case of femoral shaft,1case of distal femur,1case of tibia shaft,1case of proximal tibia,1case of proximal humeral,1cases of femoral and patellar.Among them,there were 15cases with traumatic cause and 6cases of spontaneous fracture.Leukemic cells infiltrated bone tissue in 4cases.Preoperative and postoperative visual analogue scale(VAS)were used for pain evaluation,eastern cooperative oncology group(ECOG)for general condition score,and Musculoskeletal Tumor Society(MSTS)for functional scores.Results Procedures were successfully performed in all the patients.The local pain symptoms were significantly relieved after operation.The function recovery was fast.The satisfaction with the operation was high.The patients could take care of their daily life,and continue to receive medical chemotherapy in the later period.There was no perioperative death.The follow-up time was 3~43months(mean,18±13months).During the follow-up period,11cases of leukemia had recurrence,9cases died,and the median survival time was 6months(3~29months).No patient was bedridden for a long time due to fracture,and no patient had secondary fracture.The postoperative VAS score of all patients was(3.57±1.08),which was lower than(8.14±1.15)before operation,and the results were significantly different(P=0.022).The general ECOG score of(1.43±0.60)after operation was significantly improved compared with(3.38±0.59)before operation,and the results were significantly different(P =0.001).The MSTS functional scores after operation was(22.32±3.25),s

关 键 词：白血病 病理骨折 外科手术 疼痛 

分 类 号：R683[医药卫生—骨科学]