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椎骨形成術と前弯術は多発性骨髄腫脊髄転移患者のQOLにどのような影響を与えるか？
How do vertebroplasty and kyphoplasty affect the quality of life of patients with multiple myeloma spinal metastasis?
PMID: 32591912 DOI: 10.1007/s00590-020-02721-3.
抄録
背景:
転移性脊髄病変は、生活の質を損なう病気であり、早期の診断と治療が必要です。脊椎転移患者の数は日に日に増加しています。平均寿命の延長に伴い、がんの罹患率が上昇し、転移が観察されやすくなっています。本研究の目的は、多発性骨髄腫の脊髄転移による椎体骨折で椎骨形成術と前頭骨形成術を受けている患者群において、生活の質にどのような影響があるかを調べることであった。
BACKGROUND: Metastatic spinal lesions are diseases that impair the quality of life and require early diagnosis and treatment. The count of spinal metastasis patients rises day by day. Increased life expectancy has increased the incidence of cancer, making metastases more observable. The aim of our study was to investigate how the quality of life is affected in the patient group with vertebral fracture due to spinal metastases of multiple myeloma and undergoing vertebroplasty and kyphoplasty.
材料および方法:
2011年から2018年までの間に脊椎転移による骨折があり、十分な経過観察を行った患者42例を対象とした。患者は、原発性悪性腫瘍と転移の有無に応じてリストアップした。術前・術後のVASとOswestry Disability Indexスコアを評価することで、椎骨形成術と前頭骨形成術の効果を検討した。全患者のレントゲン上の前弯角度、圧迫比、ウェッジング指数を術前と術後に算出した。
MATERIALS AND METHODS: Forty-two patients with fracture due to spinal metastasis and adequate follow-up between the years of 2011 and 2018 were included in the study. Patients were listed according to their primary malignancy and metastases. The effect of vertebroplasty and kyphoplasty was investigated by evaluating preoperative and postoperative VAS and Oswestry Disability Index scores. All patients' radiographic kyphosis angle, compression ratio and wedging index were calculated before operation and after operation.
結果:
42人の患者で合計76個の椎体が手術された。脊椎転移後に椎骨形成術、前頭骨形成術、両方の手術を受けた患者の術前と術後のQOLをVASとOswestry Disability Indexスコアで比較したところ、有意差が認められた（VAS：p=0.0001、ODI：p=0.002/0.0001）。術前の局所前弯角、圧迫率、楔状指数、術後の局所前弯角、圧迫率、楔状指数には統計学的に有意な差が認められた（p=0.001）。
RESULTS: A total of 76 vertebrae were operated in 42 patients. Significant differences were found in the comparison of preoperative and postoperative quality of life according to VAS and Oswestry Disability Index scores in the patients undergoing vertebroplasty, kyphoplasty or both procedures after spinal metastases (VAS; p = 0.0001, ODI; p = 0.002/0.0001). There were statistically significant differences in preoperative local kyphosis angle, compression ratio and wedging index and post-op local kyphosis angle, compression ratio and wedging index (p = 0.001).
結論:
脊椎転移後に行われる低侵襲な手術である椎骨形成術とキフ形成術は、患者さんのQOLを向上させます。
CONCLUSION: Vertebroplasty and kyphoplasty, minimally invasive procedures performed after spinal metastases, improve the quality of life of the patients.