Repko M, Chaloupka R, Grosman R, Krbec M, Tichý V, Neubauer J
Ortopedická klinika Lékarské fakulty MU a FN Brno.
Vnitr Lek. 2006 Nov;52 Suppl 2:32-40.
Myeloma of the spine seriously affects the stability of the spine and can lead to compression of nerve structures. Instability of the spine caused by pathological vertebral fracture without compression of the nerve structures can be addressed conservatively using an external orthesis. Surgery is indicated in patients whose survival prognosis is 3-6 months in a situation of existing or imminent spinal collapse or nerve damage. The primary aim of the surgery is to stop the progress, improve or, in ideal cases, prevent damage to the nerves. The surgery renews stability of the spine, and reduces or eliminates the painful symptoms. From a surgical perspective, we distinguish between back, front, and combined procedures. The results are evaluated according to the changes found in the nerve findings based on the Frankel grading system. In our sample of 98 patients with myeloma of the spine who underwent surgery, 37 (38%) showed improved nerve findings, 57 (58%) stayed on the same level, neurologically, and only 4 (4%) showed post-operation deterioration of the nerve findings. Early diagnosis and urgent surgical decompression involving eventual stabilization of the spine can prevent irreversible damage to the nervous system under pressure from the myeloma of the spine.
脊柱骨髓瘤严重影响脊柱稳定性，并可导致神经结构受压。由病理性椎体骨折引起的脊柱不稳定，若未伴有神经结构受压，可采用外部支具进行保守治疗。对于生存期预计为3至6个月、存在或即将发生脊柱塌陷或神经损伤的患者，应考虑手术治疗。手术的主要目的是阻止病情进展，改善或在理想情况下防止神经损伤。手术可恢复脊柱稳定性，并减轻或消除疼痛症状。从手术角度来看，我们分为后路、前路和联合手术。根据基于Frankel分级系统的神经检查结果变化来评估手术效果。在我们对98例接受手术的脊柱骨髓瘤患者的样本中，37例（38%）神经检查结果有所改善，57例（58%）神经功能维持在同一水平，只有4例（4%）术后神经检查结果恶化。早期诊断并进行紧急手术减压，必要时进行脊柱稳定手术，可防止脊柱骨髓瘤压迫导致的神经系统不可逆损伤。
