盛扬 杨珺 彭涛 魏海棠 陶干 张俊雄

【摘 要】目的：觀察股四头肌等速肌力训练联合关节腔注射治疗类风湿关节炎缓解期膝关节炎的临床疗效。方法：将68例类风湿关节炎缓解期膝关节炎患者按照数字双盲法分为治疗组和对照组，每组34例。对照组给予常规药物加关节腔注射治疗，治疗组给予常规药物加股四头肌等速肌力训练及关节腔注射治疗。观察2组治疗前后膝关节疼痛视觉模拟评分法（VAS）评分、Lysholm膝关节功能评分（Lysholm评分）、股四头肌等速肌力，以及睁闭眼静态平衡功能。结果：治疗后，2组VAS评分较治疗前均有改善（P < 0.05）;但2组间比较，差异无统计学意义（P > 0.05）。治疗2周，2组Lysholm评分较治疗前均有明显改善（P < 0.05）;但2组间比较，差异无统计学意义（P > 0.05）。治疗4周，治疗组Lysholm评分较治疗前有改善（P < 0.05）;2组间比较，差异有统计学意义（P < 0.05）。治疗后，治疗组股四头肌肌力较治疗前有改善（P < 0.01）;2组间比较，差异有统计学意义（P < 0.01）。治疗后，2组睁闭眼静态平衡能力较治疗前均有改善

（P < 0.05）;2组间比较，差异有统计学意义（P < 0.05）。结论：股四头肌等速肌力训练、关节腔内注射治疗类风湿关节炎缓解期膝关节炎患者具有协同疗效，股四头肌肌力训练不会加重关节疼痛、增加关节负担，反而能进一步提高患者膝关节稳定性，改善膝关节功能，从而恢复患者日常生活活动能力，值得临床推广。

【关键词】 类风湿关节炎;膝关节炎;等速肌力训练;关节腔注射;缓解期;临床疗效

Clinical Observation of Isokinetic Muscle Strength Training of Quadriceps Femoris Combined with Intra-articular Injection in the Treatment of 34 Cases of Knee Arthritis in Remission Stage of Rheumatoid Arthritis

SHENG Yang，YANG Jun，PENG Tao，WEI Hai-tang，TAO Gan，ZHANG Jun-xiong

【ABSTRACT】Objective：To observe the clinical effect of isokinetic muscle strength training of quadriceps femoris combined with intra-articular injection in the treatment of rheumatoid arthritis in remission stage of knee arthritis.Methods：Sixty-eight patients with rheumatoid arthritis in remission stage were divided into a treatment group and a control group according to digital double-blind method，34 cases in each group.The control group was given conventional drugs and intra-articular injection，while the treatment group was given conventional drugs and quadriceps isokinetic muscle strength training and intra-articular injection.The visual analogue scale（VAS）score of knee pain，Lysholm score of knee function，isokinetic muscle strength of quadriceps femoris and static balance function with eyes closed and open were observed before and after treatment.Results：After treatment，VAS scores of the two groups were improved compared with those before treatment（P < 0.05），but there was no significant difference between the two groups（P > 0.05）.After 2 weeks of treatment，Lysholm scores of the two groups were significantly improved（P < 0.05），but there was no significant difference between the two groups（P > 0.05）;After 4 weeks of treatment，the Lysholm score of the treatment group was improved compared with that before treatment

（P < 0.05），and the difference between the two groups was statistically significant（P < 0.05）.After treatment，the quadriceps muscle strength of the treatment group was improved compared with that before treatment（P < 0.01），and the difference between the two groups was statistically significant（P < 0.01）.After treatment，the static balance ability of the two groups were improved compared with that before treatment（P < 0.05），and the difference between the two groups was statistically significant（P < 0.05）.Conclusion：Quadriceps isokinetic muscle strength training and intra-articular injection in the treatment of patients with rheumatoid arthritis in the remission stage have a synergistic effect.Quadriceps muscle strength training will not aggravate joint pain and increase joint burden，but can further improve the stability of the knee joint，improve knee joint function，so as to restore patients' activities of daily living，which is worthy of clinical promotion.

【Keywords】 rheumatoid arthritis;knee arthritis;isokinetic muscle strength training;intra articular injection;remission period;clinical efficacy

类风湿关节炎（rheumatoid arthritis，RA）是一种以慢性破坏性关节病变为特征的全身性自身免疫病，临床常表现为双手、腕、膝、踝和足关节的对称性多关节炎[1]。RA的基本病理改变是滑膜炎，其炎性细胞浸润导致滑膜、软骨乃至软骨下骨组织的破坏，关节周围支持性肌肉萎缩，造成关节活动受限及关节畸形。RA膝关节炎中股四头肌肌力下降加重膝关节不稳定和功能受限，明显影响患者行走能力及日常生活能力[2]。本研究采用股四头肌等速肌力训练联合复方倍他米松、甲氨蝶呤关节腔注射治疗RA缓解期膝关节炎患者，现总结报道

如下。

1 临床资料

1.1 一般资料 选取2016年4月至2019年10月在武汉市汉口医院风湿科门诊就诊的RA缓解期膝关节炎患者68例，按照数字双盲法随机分为治疗组和对照组，每组34例。……