中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2014年
7期
501-506
,共6页
多发性骨髓瘤%骨肿瘤%肿瘤,继发原发性%治疗结果
多髮性骨髓瘤%骨腫瘤%腫瘤,繼髮原髮性%治療結果
다발성골수류%골종류%종류,계발원발성%치료결과
Multiple myeloma%Bone neoplasms%Neoplasms,second primary%Treatment outcome
目的：总结32例经手术治疗的多发性骨髓瘤(multiplemyeloma，MM)骨相关事件患者的术后效果，并进行术后生存分析。方法2004年11月至2010年11月，手术治疗32例(手术共计40次)多发性骨髓瘤患者：脊柱手术24例次；长骨及骨盆手术11例次；软组织肿物切除术4例次；颅骨手术1例。术后平均随访14.0个月，术后应用VAS评分评价患者疼痛缓解情况，采用( Kaplan-Meier，K-M )法进行生存评估，采用单因素Cox模型分析预后风险因素。结果术前26例以疼痛为主的患者术后24例缓解(92.3%，24/26)，术前、术后1个月与术后6个月VAS平均评分分别为7.2、3.4、0.8；19例脊髓神经功能受损的患者，术后12例好转(63.2%，12/19)，具体为5例由Frankel C至D，2例由Frankel B至D，2例由Frankel B至C，A至B、A至C、D至E各1例。K-M法估计术后中位生存期为22个月，估计术后1、3年的总体生存率分别为70%和38%。单因素Cox模型分析显示术前病程≥12个月( RR 11.199，P＝0.023)、手术次数一次(RR5.273，P＝0.045)及贫血(RR5.171，P＝0.034)是具有意义的术后生存危险因素。结论手术干预是缓解多发性骨髓瘤骨相关事件症状的有效措施之一。术前病程、手术次数及贫血可能是具有意义的术后生存危险因素，对此仍需进一步研究。
目的：總結32例經手術治療的多髮性骨髓瘤(multiplemyeloma，MM)骨相關事件患者的術後效果，併進行術後生存分析。方法2004年11月至2010年11月，手術治療32例(手術共計40次)多髮性骨髓瘤患者：脊柱手術24例次；長骨及骨盆手術11例次；軟組織腫物切除術4例次；顱骨手術1例。術後平均隨訪14.0箇月，術後應用VAS評分評價患者疼痛緩解情況，採用( Kaplan-Meier，K-M )法進行生存評估，採用單因素Cox模型分析預後風險因素。結果術前26例以疼痛為主的患者術後24例緩解(92.3%，24/26)，術前、術後1箇月與術後6箇月VAS平均評分分彆為7.2、3.4、0.8；19例脊髓神經功能受損的患者，術後12例好轉(63.2%，12/19)，具體為5例由Frankel C至D，2例由Frankel B至D，2例由Frankel B至C，A至B、A至C、D至E各1例。K-M法估計術後中位生存期為22箇月，估計術後1、3年的總體生存率分彆為70%和38%。單因素Cox模型分析顯示術前病程≥12箇月( RR 11.199，P＝0.023)、手術次數一次(RR5.273，P＝0.045)及貧血(RR5.171，P＝0.034)是具有意義的術後生存危險因素。結論手術榦預是緩解多髮性骨髓瘤骨相關事件癥狀的有效措施之一。術前病程、手術次數及貧血可能是具有意義的術後生存危險因素，對此仍需進一步研究。
목적：총결32례경수술치료적다발성골수류(multiplemyeloma，MM)골상관사건환자적술후효과，병진행술후생존분석。방법2004년11월지2010년11월，수술치료32례(수술공계40차)다발성골수류환자：척주수술24례차；장골급골분수술11례차；연조직종물절제술4례차；로골수술1례。술후평균수방14.0개월，술후응용VAS평분평개환자동통완해정황，채용( Kaplan-Meier，K-M )법진행생존평고，채용단인소Cox모형분석예후풍험인소。결과술전26례이동통위주적환자술후24례완해(92.3%，24/26)，술전、술후1개월여술후6개월VAS평균평분분별위7.2、3.4、0.8；19례척수신경공능수손적환자，술후12례호전(63.2%，12/19)，구체위5례유Frankel C지D，2례유Frankel B지D，2례유Frankel B지C，A지B、A지C、D지E각1례。K-M법고계술후중위생존기위22개월，고계술후1、3년적총체생존솔분별위70%화38%。단인소Cox모형분석현시술전병정≥12개월( RR 11.199，P＝0.023)、수술차수일차(RR5.273，P＝0.045)급빈혈(RR5.171，P＝0.034)시구유의의적술후생존위험인소。결론수술간예시완해다발성골수류골상관사건증상적유효조시지일。술전병정、수술차수급빈혈가능시구유의의적술후생존위험인소，대차잉수진일보연구。
Objective To summarize the clinical outcomes of 32 patients receiving surgical treatment for multiple myeloma ( MM ) and skeletal-related events, and to analyze the postoperative survival status.Methods From November 2004 to November 2010, 40 operations were performed on 32 patients with MM, including 24 cases in the spine, 11 cases in the long bone and pelvis, 4 cases of soft tissue tumor resection and 1 case in the skull. The mean follow-up period was 14.0 months. The pain was evaluated according to the Visual Analogue Scale ( VAS ) scores. The survival was estimated by the Kaplan-Meier ( K-M ) method. The Cox regression analysis was used to estimate the prognostic risk factors.Results Pain relief was evident in 24 patients ( 92.3% ) among 26 patients whose main symptom was pain before the surgery. The VAS scores were 7.2 points before the surgery, 3.4 points at 1 month after the surgery and 0.8 points at 6 months after the surgery. Twelve out of 19 patients with neurological deifcits got improved ( 63.2% ). The neurological status was improved from Frankel C to D in 5 cases, from Frankel B to D in 2 cases, from Frankel B to C in 2 cases, from Frankel A to B, A to C and D to E each in 1 case. The median postoperative survival time was 22 months by the K-M method. The postoperative 1- and 3- year overall survival rates were 70%and 38% respectively. The univariate Cox regression analysis revealed signiifcant survival risk factors, including the preoperative course≥12 months ( relative risk [ RR ] 11.199,P=0.023 ), single operation ( RR 5.273,P=0.045 ) and anemia ( RR 5.171,P=0.034 ).Conclusions Surgical intervention seems to be 1 of the effective methods for MM and skeletal-related events. The preoperative course, number of operations and anemia may be the signiifcant predictors of mortality, which need to be further studied.
