椎体成形术联合放疗减轻骨转移癌疼痛的疗效观察

Efficacy of percutaneous vertebroplasty with radiotherapy for bone metastasis pain

目的：比较椎体成形术（percutaneous vertebroplasty,PVP）联合放疗与单纯放疗减轻骨转移癌疼痛的临床疗效。方法：收集2012年1月至2014年6月在天津医科大学肿瘤医院治疗的247例骨转移癌疼痛患者纳入分析,其中放疗组患者158例（放疗组）,PVP联合放疗组患者89例（联合组）,主要观察指标是治疗前后疼痛评分、行为状态以及情绪变化情况,次要观察指标是治疗后的不良反应及并发症,并比较两组患者日常口服背景痛药物总量变化情况。使用SPSS 17.0分析统计软件进行数据分析。计量资料比较应用t检验,计数资料比较采用χ2检验。结果：放疗组VAS评分从治疗前的（8.12±1.45）分下降到（3.06±1.68）分（P〈0.05）,而联合组VAS评分从治疗前的（8.46±1.73）分下降到（2.45±1.47）分（P〈0.05）;联合组起效时间为（1.63±0.81）天,放疗组为（8.56±2.87）天（P〈0.001）;经过治疗,联合组爆发痛发生频率由之前（4.56±1.98）次/日降至（1.57±0.98）次/日（P〈0.05）,放疗组由（4.73±2.24）次/日降至（3.56±1.56）次/日（P〉0.05）。联合组患者治疗后行为状态较放疗组明显改善（χ2=46.587,P〈0.001）。与放疗组相比,联合组患者的抑郁、焦虑情绪有更好的改善。与治疗前比较,放疗组背景痛止痛药物用量增加（P〈0.05）,而联合组的背景痛止痛药物用量减少（P〈0.05）。两组均未出现严重的不良反应及并发症。结论：CT引导下PVP联合放疗可有效减轻骨转移癌疼痛,提高生活质量,值得临床推广。

To compare efficacy of percutaneous vertebroplasty（PVP） with radiotherapy and radiotherapy alone for bone metastasis pain. Methods： A total of 247 bone metastasis patients with pain were analyzed. The radiotherapy group comprised 158 cases,whereas the combination group comprised 89 cases. We mainly observed the effect of pain treatment, behavioral states, and improved emotional condition. The side effects and complications were also investigated. Daily medicine consumption of background pain treatment was observed between the two groups. Analysis was done by SPSS 17.0 statistical software. Numerical variables were analyzed using t test and comparisons between groups used chi-square test. Results： The VAS scores of radiotherapy group decreased from 8.12±1.45 to 3.06±1.68 after treatment（P〈0.05）, and combination group VAS scores from 8.46±1.73 to 2.45±1.47（P〈0.05）. The time to pain relief following PVP and radiotherapy were 1.63±0.81 and 8.56±2.87 days, respectively（P〈0.001）. The breakthrough pain frequency was 4.56±1.98 times/day, which decreased to 1.57±0.98 times/day after PVP（P〈0.05）. By contrast, the breakthrough pain frequency was 4.73±2.24 times/day before treatment, which decreased to 3.56±1.56 times/day after radiotherapy. No serious complications were observed in the two groups. The depression and anxiety mood in the combination group improved after treatment. Daily medicine consumption in radiotherapy group increased after therapy. However, daily medicine consumption in combination group was reduced after therapy. Conclusion： PVP with radiotherapy can effectively relieve bone metastasis pain and improve patients＇ quality of life and it is worthy of promotion in clinical practice.