微创针刀镜联合关节腔注射复方倍他米松治疗类风湿关节炎难治性膝关节炎34例临床观察

Clinical Observation of Minimally Invasive Acupotomy Combined with Intra-articular Injection of Compound Betamethasone in the Treatment of 34 Cases of Refractory Rheumatoid Arthritis

目的:观察微创针刀镜联合复方倍他米松关节腔注射治疗类风湿关节炎难治性膝关节炎的临床疗效及安全性。方法:选取2017年12月至2020年6月在重庆市中医院风湿病科住院的类风湿关节炎患者68例,随机分为治疗组和对照组,每组34例,治疗期间均反复出现膝关节肿痛。2组均联合口服甲氨蝶呤加来氟米特,治疗组给予微创针刀镜联合复方倍他米松关节腔注射,对照组给予复方倍他米松关节腔注射。评估2组患者治疗1个月、3个月后的Lysholm膝关节功能评分(Lysholm评分)、关节疼痛视觉模拟评分法(VAS)评分、28个关节的疾病活动度评分(DAS28评分)、关节压痛数、关节肿胀数、红细胞沉降率(ESR)、C反应蛋白(CRP)、D-二聚体(DD)、血小板(PLT)、纤维蛋白原(Fib),并观察治疗期间的不良反应。结果:治疗1个月、3个月后,2组Lysholm评分、VAS评分、DAS28评分、关节压痛数、关节肿胀数、ESR、CRP、DD、PLT、Fib较治疗前均有显著改善,差异有统计学意义(P<0.05)。治疗3个月后,治疗组Lysholm评分、VAS评分、DAS28评分、关节压痛数、关节肿胀数、ESR、CRP均优于对照组,差异有统计学意义(P<0.05)。结论:微创针刀镜联合复方倍他米松膝关节腔注射是类风湿关节炎难治性膝关节炎的一种有效、安全的治疗方法。

Objective:To observe the clinical efficacy and safety of minimally invasive acupotomy combined with compound betamethasone intra-articular injection in the treatment of refractory rheumatoid arthritis.Methods:Sixty-eight patients with rheumatoid arthritis were selected,treated in the Department of Rheumatology,Chongqing Traditional Chinese Medicine Hospital from December 2017 to June 2020.During the treatment,they all had knee joint swelling and pain repeatedly.They were divided into a treatment group and a control group,34 cases in each group.Both groups were given methotrexate and leflunomide.In addition,the treatment group was given minimally invasive acupotomy combined with compound betamethasone intra-articular injection,while the control group was given compound betamethasone intra-articular injection only.Lysholm knee function score(Lysholm score),visual analogue scale(VAS)of joint pain,DAS28 score,joint tenderness,joint swelling,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),D-Dimer(DD),platelet(PLT),fibrinogen(Fib)were evaluated respectively after one and three months of treatment.The adverse reactions during the treatment were observed.Results:One and three months after treatment,Lysh-olm score,VAS,DAS28 score,number of joint tenderness,number of joint swelling,ESR,CRP,DD,PLT and Fib of the two groups were significantly improved compared with those before treatment(P<0.05).After three months of treatment,Lysholm score,VAS,DAS28 score,number of joint tenderness,number of joint swelling,ESR and CRP in the treatment group were better than those in the control group(P<0.05).Conclusion:Minimally invasive acupotomy combined with compound betamethasone intra-articular injection is an effective and safe way of treating refractory rheumatoid arthritis.