多发性骨髓瘤骨病外科治疗循证医学指南

,诊疗指南多发性骨髓瘤骨病外科治疗循证医学指南【摘要】大部分多发性骨髓瘤患者在病程中会出现骨髓瘤骨病，严重影响忠者的生活质量和生存率。规范的化疗、靶向治疗和双瞬酸盐是治疗多发性骨髓癌骨病的基础和最重要的部分。外科手术在多发性骨髓瘤骨病急性并发症（病理性骨折、脊柱不稳和脊髓压迫症等)的治疗中发挥着重要作用。中国医师协会骨科医师分会骨肿瘤专业委员会依据循证医学方法制定了《多发性骨髓瘤骨病外科治疗循证医学指南》，分别就外科治疗时机、手术指征、不同部位的手术方式及综合治疗等临床问题进行总结，依据文献证据等级给出相应的推荐等级。专业委员会希望本指南能够为骨肿瘤医师的临床诊疗提供最佳的、有效的意见参考，从而使患者达到最佳的治疗效果。而本指南仅为学术性指导意见，具体实施时必须依据忠者的个体医疗情况而定【关键词】多发性骨髓癌骨病：骨肿癌：外科治疗，指南Guideline for evidence-based surgical treatment of multiple myeloma bone diseaseMusculoskeletal Tumor Society,Chinese Association of Orthopaedic SurgeonsGUO Wei,NIU Xiaohui,XIAO Jianru',LI Jianmin',WANG Zhen',SHEN Jingnan,SHAO Zengwu',ZHANG Weibin',YE Zhaoming',WU Sujia",TU Chongqi",LU Jin 2,CHEN Wenming5,DU Xinru4,YANG Yi'(1.Musculoskeletal Tumor Center,Peking University People's Hospital,Beijing 100044;2.Department of Orthopaedic On-cology,JIshuitan Hospital,Beijing 100035;3.Department of Orthopaedics,Shanghai Changzheng Hospital,Shanghai200003:4.Department of Orthopaedics,Qilu Hospital of Shandong University,Ji'nan 250012:5.Department of Orthopae-dics,Xijing Hospital,Air Force Medical University,Xi'an 710032;6.Department of Orthopaedics,The First Affiliated Hos-pital of Sun Yat-sen University,Guangzhou 510080;7.Department of Orthopaedics,Union Hospital,Tongji Medical Col-lege,Huazhong University of Science and Technology,Wuhan 430022;8.Department of Orthopaedics,Shanghai RuijinHospital,Shanghai 200025;9.Department of Orthopaedics,The Second Affiliated Hospital,Zhejiang University School ofMedicine,Hangzhou 310009;10.Department of Orthopaedics,General Hospital of Nanjing Military Region,Nanjing210002;11.Department of Orthopaedics,West China Hospital,Sichuan University,Chengdu 610041;12.Department of He-matology,Peking University People's Hospital,Beijing 100044;13.Department of Hematology,Beijing Chaoyang Hospital,Beijing 100020;Department of Orthopaedics,Beijing Chaoyang Hospital,Beijing 10002 0,China)[Abstract Bone diseases would be developed in most patients with multiple myeloma (MM)during the course of disease,which severely jeopardize the quality of life and survival rates of the patients.Standardized chemotherapy,targeted therapyand bisphosphonates compose the fundamental treatments for MM,while surgical treatments play a critical role in the treat-ment for acute complications of bone diseases (e.g.pathological fracture,spinal instability,spinal cord compression).TheMusculoskeletal Tumor Society from Chinese Association of Orthopaedic Surgeons proposes the "Guideline for evidence.based surgical treatment of multiple myeloma bone disease".This guideline addresses several clinical problems (e.g.timingfor surgical treatments,indications for operations,surgical options for lesions of different locations,and multi-modalitytreatments)and provides recommendations with categories of evidence and consensus.The Society hopes that this guidelinecan provide the most effective references for practitioners of oncological orthopaedics in order to achieve the best outcomesfor patients.Bu