Guzik Grzegorz
Orthopedic Oncology Department of the Podkarpacki Oncology Hospital, Bielawskiego 18, 36-200, Brzozów, Poland.
, Dworska 77a, 38-420, Korczyna, Poland.
BMC Surg. 2017 Aug 23;17(1):92. doi: 10.1186/s12893-017-0288-9.
In nearly 30% of patients with myeloma, pathological fractures are found to occur in the spine. If the patients are not treated promptly and satisfactorily, the quality of their lives diminishes. Currently, the standard treatment for metastatic lesions of the spine is radiotherapy, but surgical intervention is becoming more frequent. It is very important to quickly identify metastases and implement surgical treatment before any fracture/s occur.
Over the period of 2010-2014 in our department, a total of 129 patients were treated for metastatic spinal myeloma. 73 patients underwent vertebroplasty and 56 patients were operated on through various methods. Indications for the surgery, its course, technique and outcome were subsequently evaluated. The majority of patients (76%) admitted for treatment, exhibited vertebral fractures. Most lesions were multiplace and involved the vertebral bodies. In 42% of the patients, radiological examinations showed symptoms of compression of the nervous structures, while clinical signs were observed in only 16% of the patients. The functional status of the patients was assessed using the Karnofsky scale, while pain intensity was measured in a VAS score, before and after the surgery. The oncological results were assessed as a survival rate and local recurrence rate.
The average follow-up was conducted within 31 months (min 18, max 48). The patients after vertebroplasty survived 42 months, and the patients after surgery 23 months. Local recurrence of the disease was observed in 12 patients. In 10 patients, among a group of 21 with paresis, their neurological conditions improved. The average results of both their VAS score and Karnofsky performance score in patients after surgery was seen to have improved. Only sporadic postoperative complications after vertebroplasty and surgery were reported.
Early diagnosis of myeloma spine metastasis is essential to achieve the desired results of treatment. Vertebroplasty, as advised, should be performed as early as possible. Both the functional and oncological results after vertebroplasty are beneficial and the complication rates are low. Three relevant factors were found in our study: patient's age over 65 years, initial diagnosis over 3 years and stage III of disease were related, significantly and statistically to survival.
在近30%的骨髓瘤患者中，发现病理性骨折发生在脊柱。如果患者得不到及时、满意的治疗，其生活质量会下降。目前，脊柱转移性病变的标准治疗方法是放射治疗，但手术干预正变得越来越频繁。在任何骨折发生之前快速识别转移灶并实施手术治疗非常重要。
2010年至2014年期间，我们科室共治疗了129例转移性脊柱骨髓瘤患者。73例患者接受了椎体成形术，56例患者通过各种方法进行了手术。随后对手术适应症、手术过程、技术和结果进行了评估。大多数接受治疗的患者（76%）出现了椎体骨折。大多数病变为多部位，累及椎体。42%的患者影像学检查显示有神经结构受压症状，而只有16%的患者有临床体征。术前和术后使用卡诺夫斯基量表评估患者的功能状态，使用视觉模拟评分法（VAS）测量疼痛强度。肿瘤学结果通过生存率和局部复发率进行评估。
平均随访时间为31个月（最短18个月，最长48个月）。椎体成形术后的患者存活42个月，手术后的患者存活23个月。12例患者出现疾病局部复发。在21例有轻瘫的患者中，10例患者的神经状况得到改善。术后患者的VAS评分和卡诺夫斯基表现评分的平均结果均有所改善。椎体成形术和手术后仅报告了散发性术后并发症。
骨髓瘤脊柱转移的早期诊断对于取得理想的治疗效果至关重要。建议尽早进行椎体成形术。椎体成形术后的功能和肿瘤学结果均有益，且并发症发生率低。我们的研究发现了三个相关因素：患者年龄超过65岁、初始诊断超过3年以及疾病III期与生存率显著相关且具有统计学意义。
