目的 探討硼替佐米輔助治療老年骨腫瘤對(duì)患者血清腫瘤壞死因子-α（TNF-α）水平的影響。方法 采用回顧性、抽樣調(diào)查研究方法，2014年3月—2017年1月選擇在重慶市開州區(qū)人民醫(yī)院診治的老年膝關(guān)節(jié)周圍骨腫瘤患者118例作為研究對(duì)象，所有患者都給予人工假體置換治療，對(duì)照組給予地塞米松和環(huán)磷酰胺輔助治療，環(huán)磷酰胺200 mg/m²在治療的第1~4 d靜脈推注；地塞米松20 mg/d，在術(shù)后第1~2、4~5、8~9、11~12 d靜脈滴注；觀察組在對(duì)照組治療的基礎(chǔ)上輔助硼替佐米治療，劑量為1.3 mg/m²，在治療第1、4、8、11 d靜脈推注，其他治療方法同對(duì)照組。在術(shù)前與術(shù)后6個(gè)月進(jìn)行膝關(guān)節(jié)主動(dòng)屈曲活動(dòng)度的評(píng)定，觀察與記錄關(guān)節(jié)退變、囊性變、關(guān)節(jié)面塌陷、壞死等并發(fā)癥發(fā)生情況；在術(shù)前與術(shù)后6個(gè)月檢測(cè)TNF-α的濃度；隨訪至今，對(duì)比兩組的無(wú)進(jìn)展生存時(shí)間。結(jié)果 觀察組與對(duì)照組術(shù)后6個(gè)月膝關(guān)節(jié)主動(dòng)屈曲活動(dòng)度都顯著高于術(shù)前（P<0.05），觀察組也顯著高于對(duì)照組（P<0.05）。觀察組術(shù)后6個(gè)月的關(guān)節(jié)退變、囊性變、關(guān)節(jié)面塌陷、壞死等并發(fā)癥發(fā)生率顯著低于對(duì)照組（P<0.05）。觀察組與對(duì)照組術(shù)后6個(gè)月的血清TNF-α值都顯著低于術(shù)前（P<0.05），術(shù)后6個(gè)月觀察組的血清TNF-α值也顯著低于對(duì)照組（P<0.05）。隨訪至今，觀察組與對(duì)照組的無(wú)進(jìn)展生存時(shí)間（15.77±2.14）個(gè)月和（10.87±3.14）個(gè)月，觀察組顯著長(zhǎng)于對(duì)照組（P<0.05）。結(jié)論 硼替佐米輔助治療老年膝關(guān)節(jié)周圍骨腫瘤能有效降低患者的血清TNF水平，促進(jìn)膝關(guān)節(jié)功能的恢復(fù)，減少術(shù)后并發(fā)癥的發(fā)生，從而延長(zhǎng)患者的生存時(shí)間。

Objective To investigate the effects of bortezomib on bone tumor necrosis factor (TNF) level in elderly patients with bone tumor.Methods Used a retrospective, sampling and survey research methods, From March 2014 to January 2017, 118 elderly cases of bone tumor around the knee joint patients in our hospital diagnosis and treatment were seas the research object, all patients were given prosthetic replacement treatment, all patients were given prosthetic replacement treatment, the control group was treated with dexamethasone and cyclophosphamide treatment, the observation group was treated with bortezomib plus dexamethasone and cyclophosphamide therapy. Results The active flexion of the knee joint in the observation group and the control group was significantly higher than that before the operation (P<0.05), and the observation group was also significantly higher than the control group at 6 months after operation (P<0.05). The incidence of complications, such as joint degeneration, cystic degeneration, articular surface collapse and necrosis, was significantly lower in the observation group than the control group at 6 months after operation (P<0.05). The serum TNF-α values of the observation group and the control group at 6 months after operation were (8.36 ±4.25) ng/mL and (14.63 ±4.59) ng/mL, respectively, which were significantly lower than those before operation of (23.57 ±5.62) ng/mL and (23.66 ±4.12) ng/mL (P<0.05), and the observation group was also lower than that of the control group (P<0.05). Up to now, the progression free survival time of the observation group and the control group was (15.77 ±2.14) months and (10.87 ±3.14) months, and the observation group was more than that of the control group (t=8.284, P<0.05).Conclusion The bortezomib can effectively reduce the serum TNF-α level in the treatment of knee joint bone tumors, it can promote the recovery of knee function, reduce postoperative complications and prolong the survival time of elderly patients with knee joint bone tumors.