曹春辉 张莹

【摘 要】目的：觀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。

【关键词】 类风湿关节炎;膝关节炎;微创针刀镜;复方倍他米松;临床疗效

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

CAO Chun-hui，ZHANG Ying

【ABSTRACT】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），fibrino-

gen（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.

【Keywords】 rheumatoid arthritis;knee arthritis;minimally invasive acupotomy;compound betamethasone;

clinical efficacy

类风湿关节炎（rheumatoid arthritis，RA）是以关节滑膜炎为特征的全身性自身免疫性疾病[1]。常规治疗药物为非甾体抗炎药（NSAIDs）、改善病情抗风湿药（DMARDs）、小剂量激素，以及肿瘤坏死因子（TNF）拮抗剂等，部分患者虽坚持长期规范治疗，但仍遗留部分关节滑膜炎迁延不愈，持續的炎症致关节软骨及骨的破坏，最终出现关节功能丧失。为更好地控制炎症而单纯加大用药剂量，不仅增加了不良反应，而且加重了患者的经济负担，所以，关节腔局部治疗具有显著优势。……