多发性骨髓瘤合并股骨颈骨折的治疗

Treatment of multiple myeloma complicating femoral neck fracture

目的探讨外科手术干预联合药物治疗多发性骨髓瘤合并股骨颈骨折的疗效。方法多发性骨髓瘤合并股骨颈骨折12例患者，采用骨水泥型长柄股骨头全髋关节置换术，术后所有患者接受唑来膦酸治疗及针对原发病治疗，其中7例行MTT（美法仑、甲泼尼龙、沙利度胺）方案化疗，3例采用硼替佐米联合地塞米松治疗，1例行自体外周血造血干细胞移植。结果12例患者均能耐受手术，术后疼痛明显减轻。术后6个月Harris评分优2例，良7例，一般3例，优良率为75％（9／12）。术后随访8个月至3年，1例13个月后局部复发，1年总生存率100％，2年总生存率83％，3年总生存率67％。结论多发性骨髓瘤合并股骨颈骨折患者采用骨水泥型长柄股骨头全髋关节置换术可清除局部肿瘤病灶，重建功能，术后恢复快，缓解疼痛，为进一步综合治疗争取机会。术后接受双膦酸盐治疗可促进新骨形成，预防再次骨折发生;外科手术干预局部处理的同时应标本兼治，针对原发病多发性骨髓瘤积极治疗，降低肿瘤细胞负荷，提高患者生活质量，延长生存时间。

Objective To evaluate the effect on treatment of multiple myeloma complicating femoral neck fracture by surgical intervention combined with drugs. Methods Twelve patients with multiple myeloma complicating femoral neck fracture were treated by cemented total hip arthroplasty femoral head shank. All of patients were received zoledronic acid treatment, at the same time, 7 cases of them treated by MPT regimen （melphalan, methylprednisolone and thabdomide）,3 by bortezomib combined with dexamethasone,and 1 by autologous peripheral blood stem cell transplantation. Results Twelve patients could tolerate surgery, postoperative pain was significantly reduced. Assessed by using Harris hip function score after 6 months operation, 2 cases were excellent, 7 cases were good , 3 cases were common, excellent and good rate was 75% （9/12） . All patients were followed up for 8 months to 3 years, 1 case of local recurrence after 13 months. 1-year overall survival rate was 100%, 2-year overall survival rate was 83% ,and 3-year overall survival rate was 67%. Conclusions Muhiple myeloma complicating femoral neck fracture, using bone cement in total hip arthroplasty femoral head shank to clear the local tumor lesions, receive reconstruction capability, rapid postoperative recovery, pain relief, and opportunities for further comprehensive treatments. The bisphosphonate can promote new bone formation and prevent further fractures. The surgical intervention combined with chemotherapy could relieve the symptoms, reduce tumor cell burden, improve quality of life and prolong survival time.