Keilholz L, Seegenschmiedt H, Sauer R
Strahlentherapeutische Klinik und Poliklinik, Universität Erlangen-Nürnberg.
Strahlenther Onkol. 1998 May;174(5):243-50. doi: 10.1007/BF03038716.
Radiotherapy of degenerative joint disorders is almost replaced by other treatments, although its efficacy is well known. Compared to orthopedic studies radiotherapy data are lacking long-term analysis and objective reproducible evaluation criteria.
From 1984 to 1994, 85 patients with painful osteoarthritis were treated. The mean follow-up was 4 (1 to 10) years. Seventy-three patients (103 joints) were available for long-term analysis: 17 patients (27 joints) with omarthrosis, 19 (20 joints) with rhizarthrosis, 31 (49 joints) with osteoarthritis of the knee and 6 patients (7 joints) with osteoarthritis of the hip. All patients were intensively pretreated over long time. Mean symptom duration prior to radiotherapy was 4 (1 to 10) years. Orthovoltage or linac photons were applied using some technical modifications depending upon the joint. Two radiotherapy series (6 x 1 Gy, total dose: 12 Gy, 3 weekly fractions) were prescribed. The interval between the 2 series was 6 weeks. The subjective pain profile was assessed prior to and 6 months after radiotherapy and at last follow-up. The classification and assessment of pain symptoms were performed using the Pannewitz score and 5 pain categories and 3 pain grades. Joint edema and effusion were objective response parameters together with special orthopedic scores for each joint.
Forty-six (63%) patients (64 joints) achieved a reduction of pain symptoms; 16 of those had a "major pain relief" and 14 "complete pain relief". Large joints--knee and hip--responded better (64% each) than the rhizarthrosis (53%). All pain categories and grades and their combined pain score were significantly reduced. The pain reduction was mostly pronounced for the symptom "pain at rest". The orthopedic score correlated well with the subjective response of the patients. The thumb score improved in 11 (57%) joints, the shoulder score of Constant and Murley [5] in 16 (59%), the Japonese knee score of Sasaki et al. [37] in 33 (67%), the hip score of Harris [12] in 5 (71%) joints. Only 9 of 19 patients which were treated to avoid surgery, had to be operated, and 3 of those received a total arthroplasty of the hip or knee. In multivariate analysis for the endpoint "complete" or "major pain relief" only the criterion "symptom duration > or = 2 years prior to radiotherapy" was an independent negative prognostic parameter (p < 0.05).
Radiotherapy for refractory osteoarthritis is a very effective treatment option for pain reduction compared to other conventional methods. Due to the very low risk of side effects and the low costs, radiotherapy provides an excellent alternative to conventional conservative treatment methods and in case of inoperability.
尽管退行性关节疾病的放射治疗效果已为人所知，但它几乎已被其他治疗方法所取代。与骨科研究相比，放射治疗数据缺乏长期分析和客观可重复的评估标准。
1984年至1994年，对85例疼痛性骨关节炎患者进行了治疗。平均随访时间为4（1至10）年。73例患者（103个关节）可进行长期分析：17例患者（27个关节）患有肩关节病，19例（20个关节）患有腕关节病，31例（49个关节）患有膝关节骨关节炎，6例患者（7个关节）患有髋关节骨关节炎。所有患者均经过长时间的强化预处理。放疗前平均症状持续时间为4（1至10）年。根据关节情况采用一些技术改进应用正交电压或直线加速器光子。规定了两个放疗疗程（6×1Gy，总剂量：12Gy，每周3次分割）。两个疗程之间的间隔为6周。在放疗前、放疗后6个月及最后随访时评估主观疼痛情况。使用潘内维茨评分、5种疼痛类别和3种疼痛等级对疼痛症状进行分类和评估。关节水肿和积液是客观反应参数，同时还有每个关节的特殊骨科评分。
46例（63%）患者（64个关节）疼痛症状减轻；其中16例“疼痛明显缓解”，14例“疼痛完全缓解”。大关节——膝关节和髋关节——的反应比腕关节病更好（各为64%）。所有疼痛类别、等级及其综合疼痛评分均显著降低。症状“静息痛”的疼痛减轻最为明显。骨科评分与患者的主观反应相关性良好。拇指评分在11个（57%）关节中有所改善，Constant和Murley[5]的肩关节评分在16个（59%）关节中有所改善，Sasaki等人[37]的日本膝关节评分在33个（67%）关节中有所改善，Harris[12]的髋关节评分在5个（71%）关节中有所改善。为避免手术而接受治疗的19例患者中，只有9例不得不接受手术，其中3例接受了髋关节或膝关节全关节置换术。在对终点“完全”或“主要疼痛缓解”的多变量分析中，只有“放疗前症状持续时间≥2年”这一标准是独立的不良预后参数（p<0.05）。
与其他传统方法相比，难治性骨关节炎的放射治疗是一种非常有效的减轻疼痛的治疗选择。由于副作用风险极低且成本低廉，放射治疗为传统保守治疗方法以及在无法手术的情况下提供了极佳的替代方案。
