PVP与放疗联合唑来膦酸治疗多节段胸腰椎转移瘤的疗效分析

The Clinical Efficacy of Percutaneous Vertebroplasty and Radiotherapy combined with Zoledronie Acid for the Treatment of Multiple Thoracolumbar Metastases

目的：回顾性分析经皮椎体成形术与放疗联合唑来膦酸治疗多节段胸腰椎转移瘤的临床疗效。方法：随访自2011年6月～2016年6月我院因椎体转移瘤接受经PVP或放疗并联合唑来膦酸治疗的患者共104例，按照治疗方案，分为PVP组：PVP＋唑来膦酸，共54例；放疗组：放疗＋唑来膦酸，共50例，比较2组患者治疗前后症状改善情况、椎体形态及不良反应发生率。结果：治疗后3天PVP组VAS、EORTC评分较治疗前明显下降（P〈0．05），优于放疗组（P〈0．05）。6个月时2组疗效有显着差异（P〈0．05）。PVP组治疗后各时间点椎体相对高度与术前比较差异无统计学意义（P〉0．05），而放疗组6个月复查时见患椎高度明显丢失（P〈0．05）。2组不良反应症状均较轻，经对症治疗后均消失。结论：PVP与放疗联合唑来膦酸治疗多节段转移瘤，均可有效缓解疼痛，提高生活质量；PVP较放疗起效快，有效维持患椎高度，但需注意骨水泥渗漏压迫神经及穿刺风险；放疗则费用低，更方便，直接杀灭肿瘤细胞，但副反应较常见。

Objectiv：To review and analyze the clinical efficacy of pereutaneous vertebroplasty and radiotherapy combined with zole- dronie acid for the treatment of multiple thoracolumbar metastases. Methods：Follow - up 104 patients suffering from multiple thoracolum- bar metastases that were treated with percutaneous vertebroplasty or radiotherapy combined with zoledronie acid in our hospital From Jun 2011 to Jun 2016. According to the treatment, all patients were divided into two groups, PVP group had 54 patients and radiotherapy group had 50 patients. All patients＇pain scale, quality of life, morphology change of vertebral and complication were observed. Processed the gained data in a statistical way and analyzed the clinical efficacy of different groups. Results： Compared with preoperative score, the scores of VAS and EORTC of PVP group were significantly decreased after operation 3 days （ P 〈 0.05 ）, and was better than radiotherapy group（P 〈0.05）. Each time after treatment, he score of life quality and pain of two groups were significantly lower than those before treatment. And 6 months after the treatment, the efficacy between two groups had significant difference（ P 〈 0.05 ）. And the height of the vertebral body（ anterior,median and posterior） in PVP group had no obvious change too（ P 〉0.05 ）. However, after treatment 6 months, the height in radiotherapy had lost significantly compared with preoperative time and PVP group （ P 〈 0.05 ） . Tow groups also have letter complication, all disappeared after treatment. Conclusion： Percutaneous vertebroplasty and radiotherapy combined with zoledronie acid are also safe and effective treatment in improving the quality of life and pain relief. PVPg efficacy is faster and its ability of height maintain is better than radiotherapy. However, it needs to prevent nerve damage which caused by puncture and bone cement leakage. Radiotherapy is more convenient and cheaper; It can also kill tumor cells. But it has many side reactions.