Objective To explore the clinical effect and biochemical index changes of bortezomib combined with dexamethasone in multiple myeloma bone disease.Methods A total of 40 cases of multiple myeloma patients were randomly divided into experimental group (20 cases) and control group (20 cases), two groups of patients were treated with zoledronic acid, the experiment group adopted the bortezomib and dexamethasone treatment scheme, control group received dexamethasone+vincristine+epirubicin scheme.After 3 courses of treatment,compared the pain relieving degree,clinical efficacy and adverse reactions incidence, and analysed serum calcium, phosphorus, DDK1, RANKL, TRACP-5b and ALP levels of two groups.Results After the end of chemotherapy,bone pain in two groups was significantly relieved,and the pain relieving degree experimental group was significantly better than the control group (P<0.05).Total effective rate in experimental group was 95.0%, significantly higher than that in control group 65.0%(χ2 =5.625,P=0.018).The adverse reaction rate had no significant difference between two groups.The of calcium, phosphorus after chemotherapy, DDK1, RANKL, TRACP-5b levels in experimental group were significantly lower than those in control group, ALP was significantly higher than that of control group (P<0.05).Conclusion Bortezomib in combination with dexamethasone can significantly improve the curative effect of multiple myeloma,and its mechanism may regulate DDK1, RANKL, TRACP-5b levels,and balance the osteolytic and osteoblastic process.

BACKGROUND:Vertebral metastatic tumor often occurs in the thoracolumbar segment, and it is difficult for internal fixation due to the complex anatomical position. OBJECTIVE:To evaluate the stability of lumbar vertebra in the patients with single thoracolumbar vertebral metastases after treated with artificial vertebral placement and internal fixation. METHODS:Sixteen patients (9 male and 7 female) with single thoracolumbar vertebral metastases treated in the Department of Orthopedics, the Fourth Hospital of Hebei Medical University from January 2006 to January 2009 were selected, and the age ranged 40-74 years, averaged 52 years. Before treatment, al the patients were evaluated according to Frankel classification:A grade in two cases, B grade in three cases, C grade in three cases, D grade in five cases, and E grade in three cases. And the vertebral state of patients was detected with X-ray plain film examination, systemic radionuclide bone scanning, CT and MRI. The T11 vertebral metastases were treated with chest approach artificial vertebral placement and internal fixation, and T12-L2 vertebral metastases were treated with artificial vertebral placement and internal fixation via extrapleural and extraperitoneal space approach. RESULTS AND CONCLUSION:Al the 16 patients were fol owed up for 4-32 months, and the average survival time after treatment was 12 months. After treatment, Frankel classification was C grade in three cases, D grade in five cases and E grade in eight cases. The visual analog scale score was decreased from (6.22±1.31) before treatment to (3.25±0.94) after treatment, and there was significant difference between two groups (P<0.05). The artificial vertebral placement and internal fixation can restore the stability of lumbar vertebra in the patients with spinal metastases, and thus improving the symptoms and quality of life.