多发性骨髓瘤伴股骨转子间病理性骨折的治疗

Treatment of multiple myeloma with intertrochanteric pathological fracture of the femur

目的探讨多发性骨髓瘤伴股骨转子间病理性骨折的治疗效果。方法根据骨折情况和患者意愿,将9例多发性骨髓瘤伴股骨转子间病理性骨折患者3例采用非手术治疗、6例采用股骨近端防旋髓内钉(PFNA)固定治疗。记录骨折愈合情况及生存情况。结果①3例非手术治疗者:治疗2~3个月后可卧床进行患肢简单活动,但患髋屈曲时疼痛症状明显,骨折部位轴向叩击痛仍存在,局部压痛不明显。2例治疗后4个月因多器官转移等并发症而死亡;1例治疗后12个月(末次随访)患髋存在屈曲疼痛症状,可坐卧,并且可在床旁借助助行器做简单活动。②6例PFNA固定治疗者:术后均未见感染、骨折移位、内固定失效及松动等情况发生。5例术后3周患髋疼痛明显缓解;术后2个月骨折愈合,骨折处可见骨痂形成,可扶拐下床进行一般活动;术后12个月(末次随访)均可弃拐缓步行走。1例因无法耐受疼痛而未进行下床活动,术后6个月时因多器官转移等并发症而死亡。结论对于多发性骨髓瘤伴股骨转子间病理性骨折,需早期明确肿瘤及骨折类型,明确疼痛产生来源,尽快对骨折进行治疗。PFNA固定治疗多发性骨髓瘤伴股骨转子间病理性骨折,患者可早期下床活动,结合进一步的化疗可有效减轻患者痛苦,提高其生存质量,是一种可行的治疗方式。

Objective To investigate the therapeutic effect of multiple myeloma with intertrochanteric pathological fracture of the femur.Methods Nine patients were suffered from the multiple myeloma with intertrochanteric pathological fracture of femur,according to fracture conditions and their wishes,3 cases of whom were treated with non-operative treatment and 6 cases were treated with proximal femoral nail antirotation(PFNA)fixation.Fracture union and survival condition were recorded.Results①Three cases of non-operative patients were confined to bed for simple activities of the affected limb after 2~3 months of treatment,but the pain symptoms were obvious when suffering from hip flexion,axial percussion pain at the fracture site still existed,and local tenderness was not obvious.At 4 months after treatment,2 cases died due to complications such as multiple organ transfer,and the other one was still alive at 12 months after treatment(the last follow-up).After treatment,the affected hip had painful flexion symptoms,and the patient could sit and lie,and did simple activities beside the bed.②No infection,fracture displacement,internal fixation failure and loosening occurred in 6 patients after PFNA fixation.The pain of the hips in 5 patients were significantly relieved at 3 weeks after operation.The fracture healed 2 months after the operation,and callus formation was visible at the fracture site.The paitents could get out of bed for general activities with the crutches help;all patients could walk slowly without crutches at 12 months after operation(the last follow-up).One patient did not get out of bed because of intolerable pain,and died of complications such as multiple organ metastasis at 6 months after operation.Conclusions For the occurrence of intertrochanteric pathological fracture of the femur in multiple myeloma patients,it is necessary to identify the tumor and fracture type,identify the source of pain,and treat the fracture as soon as possible.PFNA internal fixation in the treatment of multiple myeloma with intertrochanteric pathological fracture of the femur can make patients get out of bed early,and combined with further chemotherapy can effectively reduce the pain of patients and improve the quality of life of patients,which is a feasible treatment mode.