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多发性骨髓瘤的椎体成形术:大型患者系列的结果

Vertebroplasty in multiple myeloma: outcomes in a large patient series.

作者信息

McDonald R J, Trout A T, Gray L A, Dispenzieri A, Thielen K R, Kallmes D F

机构信息

Medical Scientist Training Program, Mayo Clinic, Rochester, MN 55905, USA.

出版信息

AJNR Am J Neuroradiol. 2008 Apr;29(4):642-8. doi: 10.3174/ajnr.A0918. Epub 2008 Jan 17.

Abstract

BACKGROUND AND PURPOSE

Despite the literature supporting the efficacy of vertebroplasty for treatment of osteoporotic vertebral compression fractures, few reports exist documenting its use in the treatment of compression fractures in multiple myeloma patients. Accordingly, we sought to characterize the imaging characteristics, clinical course, and outcomes in myeloma patients treated with vertebroplasty.

MATERIALS AND METHODS

We performed a retrospective review of clinical outcome data from 67 multiple myeloma patients treated with vertebroplasty since October 2000. Quantitative outcome data including the Roland Morris Disability Questionnaire (RDQ) and Visual Analog Scales for pain and qualitative outcome data (self-reported pain, mobility, and narcotic use) were collected preoperatively, immediately after vertebroplasty, and at 1 week, 1 month, 6 months, and 1 year after treatment.

RESULTS

Significant improvements in all of the outcome measures were observed postoperatively and throughout the duration of follow-up. Quantitative outcome measures (RDQ, analog pain scale 0-10, with rest and activity) improved by 11.0 (48%; P < .0001), 2.7 (25%; P < .001), and 5.3 (48%; P < .0001) points, respectively, with persistent improvement at 1 year (P < .01; P < .03; P < .001). Eighty-two percent and 89% of patients experienced a significant improvement in subjective rest pain and activity pain, respectively. Subjective scores achieved durable improvements, with 65% of patients requiring fewer narcotics after vertebroplasty and 70% having improved mobility.

CONCLUSION

Vertebroplasty provides significant and durable pain relief for patients with intractable spinal pain secondary to compression fractures resulting from multiple myeloma.

摘要

背景与目的

尽管有文献支持椎体成形术治疗骨质疏松性椎体压缩骨折的疗效,但关于其用于治疗多发性骨髓瘤患者压缩骨折的报道却很少。因此,我们试图描述接受椎体成形术治疗的骨髓瘤患者的影像学特征、临床过程及预后。

材料与方法

我们对自2000年10月以来接受椎体成形术治疗的67例多发性骨髓瘤患者的临床结局数据进行了回顾性分析。收集术前、椎体成形术后即刻、治疗后1周、1个月、6个月和1年的定量结局数据,包括罗兰·莫里斯残疾问卷(RDQ)和疼痛视觉模拟量表,以及定性结局数据(自我报告的疼痛、活动能力和麻醉药物使用情况)。

结果

术后及整个随访期间,所有结局指标均有显著改善。定量结局指标(RDQ、静息和活动时的0-10分模拟疼痛量表)分别改善了11.0分(48%;P <.0001)、2.7分(25%;P <.001)和5.3分(48%;P <.0001),1年时仍持续改善(P <.01;P <.03;P <.001)。分别有82%和89%的患者静息时主观疼痛和活动时疼痛有显著改善。主观评分实现了持久改善,65%的患者椎体成形术后所需麻醉药物减少,70%的患者活动能力改善。

结论

椎体成形术为因多发性骨髓瘤导致压缩骨折而引起顽固性脊柱疼痛的患者提供了显著且持久的疼痛缓解。

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