CAJ | 학술논문

目的：总结对多发性骨髓瘤骨病患者采用骨水泥成形术的适应证、方法、疗效和预后。方法选择2005年7月至2014年5月北京大学第一医院收治的经骨水泥成形术治疗的多发性骨髓瘤骨病患者35例，其中男19例，女16例；年龄49～78岁，中位年龄62岁；包括胸椎85个椎体、腰椎34个椎体、骶椎5个椎体，髂骨6处，胸骨3处。每次1～5处病变，胸椎每个椎体注入骨水泥2～4 ml，腰椎每个椎体注入骨水泥2～6 ml，骶椎2～4 ml，胸骨3～5 ml，髂骨2～4 ml。对患者术后第1天、第3天和1个月后的VAS评分进行分析。结果患者在术后疼痛均有不同程度缓解，其中28例由重度疼痛缓解为轻度疼痛，6例由中度疼痛缓解为轻度疼痛，1例由重度疼痛缓解为中度疼痛，无严重手术并发症。术后33例接受化疗，随访3～76个月，有1例于术后3个月内死于化疗并发症，5例1年内死于肿瘤并发症，1年生存率65.7%，末次随访中位生存时间29个月。椎体成形术后，无出现脊髓压迫需再次行开放手术者，但有5例因其他椎体出现病理骨折而再次行椎体成形术，其中有2例因其他椎体骨折行第3次骨水泥成形术。结论对于有明显椎体破坏伴有疼痛或有病理骨折的脊柱骨髓瘤患者，椎体成形术可以明显缓解疼痛，并预防椎体压缩加重而出现脊髓压迫症状。对于有明显疼痛的非承重部位的胸骨和髂骨翼的病变，行骨水泥成形术也可明显缓解疼痛，提高患者生活质量。
목적：총결대다발성골수류골병환자채용골수니성형술적괄응증、방법、료효화예후。방법선택2005년7월지2014년5월북경대학제일의원수치적경골수니성형술치료적다발성골수류골병환자35례，기중남19례，녀16례；년령49～78세，중위년령62세；포괄흉추85개추체、요추34개추체、저추5개추체，가골6처，흉골3처。매차1～5처병변，흉추매개추체주입골수니2～4 ml，요추매개추체주입골수니2～6 ml，저추2～4 ml，흉골3～5 ml，가골2～4 ml。대환자술후제1천、제3천화1개월후적VAS평분진행분석。결과환자재술후동통균유불동정도완해，기중28례유중도동통완해위경도동통，6례유중도동통완해위경도동통，1례유중도동통완해위중도동통，무엄중수술병발증。술후33례접수화료，수방3～76개월，유1례우술후3개월내사우화료병발증，5례1년내사우종류병발증，1년생존솔65.7%，말차수방중위생존시간29개월。추체성형술후，무출현척수압박수재차행개방수술자，단유5례인기타추체출현병리골절이재차행추체성형술，기중유2례인기타추체골절행제3차골수니성형술。결론대우유명현추체파배반유동통혹유병리골절적척주골수류환자，추체성형술가이명현완해동통，병예방추체압축가중이출현척수압박증상。대우유명현동통적비승중부위적흉골화가골익적병변，행골수니성형술야가명현완해동통，제고환자생활질량。
Objective To investigate the indications, methods, efficacy of cementoplasty and the prognosis for bone disease in patients with multiple myeloma. Methods July 2005 to May 2014, 35 cases of bone disease in patients with multiple myeloma were treated with cementoplasty, 19 males and 16 females, aged from 49 to 78 years, mean 62 years, including thoracic vertebrae 85, lumbar vertebrae 34, sacral vertebrae 5, iliac 6 , sternum 3 . Every patient, 1-5 lesions were operated. In thoracic vertebra, cement was injected about 2~4ml, in lumbar vertebra, bone cement was injected about 2~6ml, sacral 2~4ml, sternum 3~5ml, ilium 2~4ml. For postoperative 1 day, 3 days,1 month and 3 month, VAS were analyzed. Results Pain relief was obtained in all cases in varying degrees postoperatively, including 28 cases of a severe pain alleviated by a mild pain, six cases of moderate pain relieve to mild pain, and one case with the severe pain was eased to moderate pain. The VAS score decreased from 8.6(5 ~ 10) preoperatively to 3.7(2~6) day 1, 3.2(1~5) day 3, 2.4(1~3) 1 month and 2.1(1~3) 3 month postoperatively. No serious surgical complications occur. All cases were followed up for 3 to 76 months after surgery, 33 cases received chemotherapy, one patient died of complications of chemotherapy 3 months postoperatively, 5 cases died of tumor progression in a year , 1 year survival rate was 65.7%, medium overall survival time is 29 months at last follow up.After vertebroplasty,no spinal cord compression occurs requiring underwent open surgery, but there are five cases operated with cementoplasty again due pathological vertebral fractures of other vertebrae, two cases obtained vertebroplasy the third time due to other vertebral fracture. Conclusion For myeloma patients, vertebroplasty can significantly relieve pain, prevent the aggravation of vertebral compression and spinal cord compression, there is significant pain relief for non- load-bearing parts of sternum and iliac wing with cementoplasty, improve quality of life, but the final prognosis depends on the initial severity at presentation, tumor progression rate and the effect of chemotherapy. Patients with renal failure and advanced age could not tolerate chemotherapy have poor prognosis.