Shen Jiangtao, Du Xinru, Zhao Lingxiu, Luo Hui, Xu Ziyu
Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing 101100, P.R. China.
Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, P.R. China.
Oncol Lett. 2018 Jun;15(6):10017-10025. doi: 10.3892/ol.2018.8559. Epub 2018 Apr 24.
The present retrospective study was designed to compare the pain relief, surgery duration, life quality, survival time and relative prognostic factors in multiple myeloma (MM) bone disease patients with different surgical sites. A total of 65 cases were enrolled and divided into two groups. Group A included patients with lesions located in the spine, while Group B included patients with lesions located in the long bone or soft tissue. Pain relief was measured by the visual analogue scale (VAS), neurological impairment was determined according to Frankel classification, and survival was assessed by the Kaplan-Meier method. Cox regression analysis was also used to estimate the effect of factors on the prediction of survival. The hospitalization time, preoperative duration of symptoms, method of surgery, complications, recurrence and survival time were evaluated and compared retrospectively. Pain relief and improvement of life quality were observed in all the patients in groups A and B. No significant differences were detected for the majority of parameters compared between groups A and B, with the exception of the surgery duration, as well as the postoperative VAS score at 1 and 6 months after surgery. The multivariate Cox regression analysis revealed several risk factors significantly associated with survival, including the preoperative VAS score, postoperative chemotherapy, prothrombin time activity (PTA), albumin, lactate dehydrogenase and urine protein level. In conclusion, surgical treatment was an effective therapeutic method in patients with MM. Postoperative analgesic use should be individualized according to the different surgical sites and postoperative periods. Furthermore, preoperative pain, PTA, albumin, urine protein level and postoperative chemotherapy are associated with prognosis.
本回顾性研究旨在比较不同手术部位的多发性骨髓瘤（MM）骨病患者的疼痛缓解情况、手术时长、生活质量、生存时间及相关预后因素。共纳入65例患者并分为两组。A组包括病变位于脊柱的患者，而B组包括病变位于长骨或软组织的患者。采用视觉模拟量表（VAS）测量疼痛缓解情况，根据Frankel分级确定神经功能障碍，并用Kaplan-Meier法评估生存情况。还采用Cox回归分析来估计各因素对生存预测的影响。回顾性评估并比较两组患者的住院时间、术前症状持续时间、手术方式、并发症、复发情况及生存时间。A组和B组所有患者均观察到疼痛缓解及生活质量改善。A组和B组相比，除手术时长以及术后1个月和6个月的VAS评分外，大多数参数未检测到显著差异。多因素Cox回归分析显示，有几个危险因素与生存显著相关，包括术前VAS评分、术后化疗、凝血酶原时间活动度（PTA）、白蛋白、乳酸脱氢酶及尿蛋白水平。总之，手术治疗是MM患者的一种有效治疗方法。术后镇痛应根据不同手术部位和术后时期进行个体化。此外，术前疼痛、PTA、白蛋白、尿蛋白水平及术后化疗与预后相关。
