多发性骨髓瘤脊柱稳定性评分系统的建立及临床意义的探讨

Preliminary establishment of a spinal stability scoring system for multiple myeloma and its clinical applicability

目的利用现有的最佳文献和专家意见,使用循证医学证据建立多发性骨髓瘤(multiple myeloma,MM)脊柱稳定性评分系统,用于评估MM脊柱稳定性。通过与脊柱肿瘤不稳定评分(SINS)的比较,评价MM稳定性评分的临床适用性。方法通过德尔菲法创建专家共识并建立一个MM脊柱稳定性评分系统。回顾我院收治72例MM脊柱受累患者的临床资料,分别应用SINS评分及MM脊柱稳定性评分进行评价,比较两者在评价MM脊柱稳定中各项指标的分值趋势,并结合相关文献,对两种评分系统指标的临床适用性进行分析。结果对15位骨科、MM领域专家进行两轮问卷调查,结果显示专家意见趋于一致。依据专家意见,初步建立MM脊柱稳定性评分系统,该评分系统包括6个一级指标和29个二级指标,其中一级指标包括:脊柱病变部位、疼痛、节段数目、生理曲度、合并病变以及神经功能,二级指标不在此详述。根据各项指标相对重要性赋予不同的分值,总分为24分,其中评分0~10分为稳定;11~17分为潜在不稳定;18~24分为不稳定。MM脊柱稳定性评分系统与SINS评分系统的临床对比结果表明,MM评分系统与SINS评分系统对同一MM人群的脊柱稳定性评价结果不一致,其主要差异在于对脊柱潜在不稳定性的评估(McNemar-Bowker 38.105;P=0.000);MM评分显示"稳定"组和"潜在不稳定"组在疼痛、节段数目、生理曲度和合并病变,差异有统计学意义(P<0.05)。结论该评分系统基于MM患者的疾病特点、典型症状及脊柱影像学表现,以指导临床医生评估MM患者脊柱稳定性,及时发现由MM引起的脊柱不稳定,为MM患者选择保护性干预措施提供依据。MM脊柱稳定性评分系统在评估MM脊柱受累患者方面具有良好的临床适用性。

Objective A spinal stability scoring system for multiple myeloma (MM) was established via evidence-based literature and expert advice,which was used to evaluate spinal stability in MM patients.To evaluate the clinical applicability of MM stability score by comparing it with Spinal Instability Neoplastic Score (SINS).Methods Delphi method was used to establish an expert consensus and a spinal stability scoring system for MM.Clinical data of 72 MM patients were retrospectively reviewed.Clinical applicabilities of SINS and MM stability scores were evaluated.Results The grading system included 6 first-class indicators and 29 second-class indicators.Six first-class indicators:position of spinal lesion;degree of pain;involved segment;physiological curvature;complication;neurological function.Score assignment (24 in total):0-10,stable;11-17,potentially unstable;18-24,unstable.Results of the MM scoring system were inconsistent with those of the SINS,and the main difference lay in the evaluation of potential instability of the spine (McNemar-Bowker 38.105;P=0.000);MM scores showed that there were significant differences in pain,involved segment,physiological curvature and complication between the stable and potentially unstable groups (P < 0.05).Conclusions The MM scoring system based on the disease characteristics,typical symptoms and spinal imaging manifestations provides references for the evaluation and early diagnosis of spinal stability of MM patients.