多发性骨髓瘤合并股骨颈骨折的治疗.pdfVIP

多发性骨髓瘤合并股骨颈骨折的治疗 刘红艳 肖运祥 郭静明 王海燕 叶松 [摘要]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MPT(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。 多发性骨髓瘤；股骨颈骨折；全髋置换术； 药物疗法 Treatmentofmultiplemyelomacomplicatingfemoralneckfracture LIUHong-yan XIAOYun- xiangGUOJing-ming WANGHai-yan YESong DepartmentofOrthopaedics,theFirstCollegeof ClinicalMedicineScienceofThreeGorgesUniversity,YichangCentralPeoplesHospital,HubeiYichang 443003,China [Abstract] Objective Toevaluatetheeffectontreatmentofmultiplemyelomacomplicatingfemoral neckfracturebysurgicalinterventioncombinedwithdrugs.Methods Twelvepatientswithmultiple myelomacomplicatingfemoralneckfractureweretreatedbycementedtotalhiparthroplastyfemoralhead shank.Allofpatientswerereceivedzoledronicacidtreatment,atthesametime,7casesofthemtreatedby MPTregimen (melphalan, methylprednisoloneandthalidomide),3bybortezomibcombinedwith dexamethasone,and1byautologousperipheralbloodstemcelltransplantation.Results Twelvepatients couldtoleratesurgery,postoperativepainwassignificantlyreduced.AssessedbyusingHarrishipfunction scoreafter6monthsoperation,2caseswereexcellent,7casesweregood,3caseswerecommon,excellent andgoodratewas75％ (9/12).Allpatientswerefollowedupfor8monthsto3years,1caseoflocal recurrenceafter13months.1-yearoverallsurvivalratewas100％,2-yearoverallsurvivalratewas83％ ,and 3-yearoverallsurvivalratewas67％.Conclusions Multiplemyelomacomplicatingfemoralneckfracture, usingbonecementintotalhiparthroplastyfemoralheadshanktoclearthelocaltumorlesions,receive reconstructioncapability,rapidpostoperativerecovery,painrelief,andopportunitiesforfurthercomprehe