手术治疗脊柱骨髓瘤的疗效及预后分析

Surgical efficacy and prognosis analysis of spinal myeloma

中文关键词:  脊柱骨髓瘤  手术治疗  疼痛  神经压迫  疗效  生存分析  预后

英文关键词:Spinal myeloma  Surgical treatment  Pain  Nerve compression  Therapeutic effect  Survival analysis  Prognosis

中文摘要:

  【摘要】 目的：评价手术治疗脊柱骨髓瘤（spinal myeloma，SM）对改善患者疼痛、恢复神经功能、提高生活质量的意义，并分析影响患者术后生存时间的因素。方法：回顾性分析2010年1月～2022年12月之间进行手术治疗、临床资料完整且获得随访的49例SM患者。其中男28例，女21例，年龄36～90岁，平均64.3±11.3岁。平均手术时间148.7±106.4min，平均出血量792.1±1091.2mL。随访时间1～158个月，平均52.9±37.7个月。病灶位于颈椎者4例，位于胸椎者20例，位于腰骶椎者18例，同时侵犯胸椎及腰椎者8例，全脊柱病变4例。主诉以疼痛为主者24例，以神经症状为主者11例，同时出现者14例。前路手术3例，后路手术46例。比较手术前后患者疼痛视觉模拟量表评分（visual analogue scale，VAS）、脊髓损伤Frankel分级、美国东部肿瘤协作组（Eastern Cooperative Oncology Group，ECOG）评分，并对患者进行生存分析。结果：本组患者术后中位VAS评分、中位ECOG评分分别为1分和1分，比术前（分别为7分和2分）明显降低（均P<0.001）；中位Frankel分级为E级，较术前的D级明显改善（P<0.001）。术后出现脊柱内置物相关并发症1例，新发脊柱外病灶2例，手术部位随访未见复发；死亡12例，均为骨髓瘤病情进展导致。全组患者1年、5年和10年生存率分别为89.8％、79.5％及75.5%。单因素分析显示，术前血红蛋白、血肌酐、术后综合治疗是影响患者预后的危险因素（P<0.1）。Cox多因素回归分析显示术后综合治疗能显著提高患者的生存时间（P<0.01）。结论：手术治疗脊柱骨髓瘤能有效改善患者脊柱不稳、疼痛及神经压迫症状，显著改善患者生活质量。术后行化疗、免疫或靶向治疗等综合治疗是提高患者生存率的独立影响因素。

英文摘要:

  【Abstract】 Objectives: To assess the efficacy of surgical intervention in the management of spinal myeloma(SM) with regards to pain relief, restoration of neurological function, and enhancement of quality of life, as well as to examine the variables influencing the postoperative survival duration of patients. Methods: A retrospective analysis was conducted on the 49 patients with SM who underwent surgical treatment at the Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University and Central Hospital of Xuhui District from January 2010 to December 2022, with complete clinical and follow-up data. Among the patients, there were 28 males and 21 females, with an average age of 64.3±11.3 years, ranging from 36 to 90 years. The average operative time was 148.7±106.4mins, and the average bleeding volume was 792.1±1091.2mL. The follow-up time was 1-158 months, with an average of 52.9±37.7 months. There were 4 cases of lesions located alone in the cervical vertebrae, 20 cases in the thoracic vertebrae, 18 cases in the lumbosacral vertebrae, 4 cases in the entire spine, and 8 cases of simultaneous invasion of the thoracic and lumbar vertebrae. There were 24 cases with pain as the main complaint, 11 cases with neurological impairment, and 14 cases with concurrent symptoms. Three cases underwent anterior surgery and 46 cases underwent posterior surgery. The visual analogue scale(VAS) score, Frankel grade of spinal cord injury, and Eastern Cooperative Oncology Group(ECOG) score of patients before and after surgery were compared, and survival analysis of the patients was conducted. Results: The median VAS score and median ECOG score of the patients were 1 and 1 points respectively after surgery, which were significantly lower than before surgery(7 and 2 points respectively, both P<0.001). The median Frankel grade was E, which was significantly improved compared to preoperative D grade(P<0.001). One case of spinal implant related complications and two cases of new extraspinal lesions occurred after surgery, and no recurrence was observed during follow-up at the surgical site. 12 deaths were caused by the progression of myeloma. The 1-year, 5-year, and 10-year survival rates of the patients were 89.8%, 79.5%, and 75.5%, respectively. Univariate analysis showed that preoperative hemoglobin, blood creatinine, and postoperative comprehensive treatment were the risk factors affecting patient prognosis(P<0.1). Cox multiple regression analysis showed that postoperative comprehensive treatment can significantly improve the survival time of patients(P<0.01). Conclusions: Surgical treatment for SM can effectively alleviate spinal instability, pain and nerve compression symptoms in patients, and significantly improve their qualities of life. Postoperative comprehensive treatments such as chemotherapy, immunotherapy, or targeted therapy are independent influencing factors for improving patient survival.