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目的探讨多发性骨髓瘤(multiple myeloma,MM)椎管内浸润的临床特点、诊断及治疗方法。方法回顾性分析于2011-11/2016-10月在作者医院诊治的8例MM合并椎管内浸润患者的临床特点、核磁共振成像(magnetic resonance imaging,MRI)及电子计算机断层扫描(computed tomography,CT)表现、不同治疗方法及疗效。结果 8例MM合并的椎管内髓外浆细胞瘤(extramedullary plasmacytoma,EMP)均发生在胸椎节段。6例患者从感觉双下肢麻木、腰背部疼痛起,在数小时至3d内进展至截瘫状态。经MRI或CT检查诊断为椎管内硬膜外占位性病变。8例中1例放弃治疗。另7例中,3例接受手术及术后化疗者,1例肌力改善,另2例肌力无变化;单纯接受化疗的2例无效;2例接受放疗者,均恢复行走,其中1例肌力恢复至5级,另1例恢复至4级。7例患者治疗过程中均未出现严重不良反应。结论 MM合并椎管内浸润多发生在胸椎节段,病情进展快。MRI可明确病变部位,尽早进行放疗可以改善患者神经功能,尤其是下肢运动功能。
Objective To investigate the clinical features, diagnosis and treatment of multiple myeloma (MM) infiltration into the spinal canal. Methods The clinical features, magnetic resonance imaging (MRI) and computed tomography (CT) of 8 patients with MM complicated with spinal cord invasion who were treated in the authors’ hospital during 2011-11 / 2016-10 were retrospectively analyzed. CT) performance, different treatment methods and efficacy. Results Eight cases of MM complicated with extramedullary plasmacytoma (EMP) occurred in the thoracic segment. Six patients experienced numbness in both lower extremities and back and back pain, progressing to paraplegia within a few hours to 3d. MRI or CT examination diagnosed as spinal canal epidural lesions. One of eight patients gave up treatment. In the other 7 cases, 3 cases underwent surgery and postoperative chemotherapy, 1 case had improved muscle strength, 2 cases had no change in muscle strength; 2 cases received chemotherapy alone were ineffective; 2 cases received radiotherapy and all recovered; 1 case Muscle strength recovered to 5, the other 1 case recovered to 4. None of the seven patients experienced serious adverse reactions during the course of treatment. Conclusion MM with intramedullary infiltration occurred in the thoracic segment, the disease progressed rapidly. MRI can identify the lesion, early radiotherapy can improve the patient’s neurological function, especially in lower extremity motor function.