多发性骨髓瘤初始诊断患者中椎体压缩骨折和脊柱不稳的发生率

The incidence of vertebral compression fractures and spinal instability in newly diagnosed patients with multiple myeloma

目的探讨多发性骨髓瘤(MM)初始诊断患者中,椎体压缩骨折(VCF)和脊柱不稳的发生率及其相关影响因素。方法选择2020年1月至2021年12月在该院初始诊断为MM的患者126例作为研究对象,记录患者的VCF、脊柱不稳肿瘤评分(SINS)、MM的国际分期(ISS),观察VCF与临床资料的关系。结果126例中,共有64例在确诊MM时出现一处或多处VCF,发生率为50.79%,共有114个椎体发生VCF。其中31例为单个椎骨VCF;33例出现≥2个椎骨VCF,其中2节段VCF 15例,3节段VCF 12例,≥4节段VCF 6例。VCF最常见节段为T_(11)、T_(1)2、L_(1)和L 2,T1至T4发生率较低。VCF患者和非VCF患者的性别、年龄、吸烟、ISS、背痛、中位生存时间相比较,差异存在统计学意义(P<0.05)。SINS评分与BMI不存在相关性(P>0.05),SINS与性别、年龄、吸烟、ISS、背痛存在显著正相关(P<0.05),SINS与生存时间存在显著负相关(P<0.05)。VCF不是影响生存时间的独立风险因素(P>0.05),年龄、性别、ISS等是影响生存时间的独立风险因素(P<0.05)。结论MM初始诊断患者VCF发生率50.79%。VCF患者中超过50%为≥2个椎体VCF,VCF患者潜在不稳42.19%,脊柱不稳20.31%。VCF与疾病分期相关,与生存期无独立相关性。

Objective To investigate the incidence of vertebral compression fracture(VCF)and spinal instability in patients with initial diagnosis of multiple myeloma(MM)and the related influencing factors.Method 126 patients initially diagnosed with MM in our hospital from January 2020 to December 2021 were selected as the study objects.The VCF,the spinal instability neoplastic score(SINS)and the international Staging system(ISS)of MM were recorded.The relationship between VCF and clinical data was observed.Results The total of 64 patients in 126 cases developed one or more VCFs at the time of diagnosis of MM,with an incidence rate of 50.79%.A total of 114 vertebral bodies developed VCFs.Among them,31 patients had a single vertebral VCF,and 33 patients had≥2 vertebral VCFs,including 15 cases of 2-segment VCF,12 cases of 3-segment VCF,and 8 case of≥4-segment VCF.The most common segments of VCF are T_(11),T_(1)2,L_(1),and L 2,with a lower incidence of T1 to T4.There were statistically significant differences in gender,age,smoking,ISS,back pain,and median survival time between VCF patients and non VCF patients(P<0.05).There was no correlation between SINS score and BMI(P>0.05),while SINS was significantly positively correlated with gender,age,smoking,ISS,and back pain(P<0.05),and significantly negatively correlated with survival time(P<0.05).VCF was not an independent risk factor affecting survival time(P>0.05),while age,gender,ISS,etc.were independent risk factors affecting survival time(P<0.05).Conclusions The incidence of VCF in patients initially diagnosed with MM was 50.79%.More than 50%of patients with VCF had≥2 vertebral VCF,42.19%of patients with VCF had potential instability,and 20.31%had spinal instability.VCF was correlated with disease stage,but not with survival.