CT引导下椎体成型术在多发性骨髓瘤胸腰椎压缩性骨折化学治疗前的应用研究

Application of CT guided percutaneous vertebroplasty in the treatment of thoracic and lumbar com-pressive fracture with multiple myeloma before chemotherapy

目的探讨经皮椎体成型术（PVP）在缓解多发性骨髓瘤（MM）胸腰椎压缩性骨折疼痛和改善生活质量的疗效。方法多发性骨髓瘤合并胸、腰椎急性压缩性骨折的患者37例，分为两组。联合组（n=13）先行PVP，后行VAD方案化学治疗；化学治疗组（n=24）单纯行VAD方案化学治疗。化学治疗期间所有患者均给予二膦酸盐（bisphosphonates）护骨治疗。观察患者治疗前及治疗后1个月、3个月和6个月疼痛视觉模拟评分（VAS），治疗6个月后Karnofsky体力状况评分（KPS评分），疼痛下降为轻度疼痛所需治疗日数及治疗相关并发症情况。结果两组患者治疗后疼痛VAS评分均有明显下降。治疗1个月、3个月、6个月时化学治疗组VAS评分分别为（2．50±0．76）、（1．95±0．85）、（1．15±0．38），联合组为（1．31±0．41）、（1．01±0．32）、（0．89±0．10），联合组优于化学治疗组（P〈0．05）。疼痛强度自重度疼痛下降为轻度疼痛所需的治疗日数联合组（7．15±0．59）d短于化学治疗组（20．33±0．87）d（P〈0．01）。治疗后KPS评分改善率，联合组（84．6％）较化学治疗组（45．8％）也有明显优势。结论多发性骨髓瘤患者合并胸、腰椎急性压缩性骨折者应用经皮椎体成型术能迅速缓解骨痛症状，改善其生活质量。

Objective To explore the effect of percutaneous vertebroplasty （PVP） in relieving the pain and improving the quality of life of patients with thoracic and lumbar compressive fracture with multiple myeloma （MM）. Methods Thirty-seven patients with thoracic and lumbar compressive fracture in MM were divided into two groups. The patients in united group （n= 13） were received PVP, then VAD chemotherapy pro- gram, and in the chemotherapy group （n=24） only VAD chemotherapy program. VAS before treatment and at 1 month, 3 months and 6 months after treatment, the Karnofsky physical status score （KPS score） at 6 months af- ter treatment, the days to mild pain and the related complications of treatment were observed. Results VAS was significantly decreased in the two groups after treatment. VAS was （1.31 ± 0.41 ）, （1.01 ± 0.32）, （0.89 ± 0.10） at 1 month, 3 months and 6 months in the united group after the treatment respectively, and the chemo- therapy group was （2.50 ± 0.76）, （1.95 ± 0.85）, （1.15 ± 0.38）. The united group was superior to the chemo- therapy group （P 〈 0.05）. The mean days of the pain intensity from severe pain to the mild pain in the chemo- therapy group needed （20.33 ± 0.87）days, while the days in the united group （7.15 ＋ 0.59） days （P〈 0.01）. KPS score in the united group was also better than that in the chemotherapy group（84.6% vs 45.8%） after treat- ment. Conclusion The PVP could aileviate quickly the symptoms of bone pain and improve the iiving qualityof the patients with thoracic and lumbar compressive fracture in multiple myeloma.