超声引导下局部注射治疗类风湿性关节炎手腕部腱鞘炎  

Ultrasound-guided local injection in treatment of hand and wrist tenosynovitis in patients with rheumatoid arthritis

作　　者：徐华军[1] 陈士芳[2] 张惠美[3] XU Huajun;CHEN Shifang;ZHANG Huimei(Department of Ultrasound, Huzhou Central Hospital, Huzhou 313003, China;Department of Rheumatology and Immunology, Huzhou Central Hospital, Huzhou 313003, China;Department of Radiology, Huzhou Central Hospital, Huzhou 313003, China)

机构地区：[1]湖州市中心医院超声科,浙江湖州313003 [2]湖州市中心医院风湿免疫科,浙江湖州313003 [3]湖州市中心医院放射科,浙江湖州313003

出　　处：《中国医学影像技术》2019年第8期1123-1127,共5页Chinese Journal of Medical Imaging Technology

基　　金：浙江省湖州市公益性应用研究项目(2017GYB25)

摘　　要：目的探讨超声引导下局部注射治疗类风湿性关节炎(RA)手腕部腱鞘炎的临床效果。方法对62例RA手腕部腱鞘炎患者分别给予超声引导下(超声引导组,n=37)及触诊引导下(触诊引导组,n=25)手腕部腱鞘注射复方倍他米松注射液和盐酸利多卡因注射液。对比分析2组治疗过程中不良反应发生率;比较2组治疗前及治疗后2、4及12周疼痛视觉模拟量表(VAS)、28关节疾病活动度(DAS28)、灰阶超声(GSUS)、能量多普勒超声(PDUS)评分及治疗有效率。结果超声引导组治疗过程中不良反应发生率为2.70%(1/37),触诊引导组为20.00%(5/25),差异有统计学意义(P=0.03)。超声引导组治疗后4、12周VAS评分及DAS28评分均低于触诊引导组(P均<0.01);治疗后2、4及12周PDUS评分均低于触诊引导组,治疗后12周GSUS评分低于触诊引导组(P均<0.01);治疗后4、12周治疗有效率均高于触诊引导组(P均<0.05)。结论超声引导下局部注射治疗RA手腕部腱鞘炎的疗效及安全性均较好。Objective To explore the clinical efficacy of ultrasound-guided local injection in treatment of rheumatoid arthritis (RA) patients with hand and wrist tenosynovitis. Methods Totally 62 RA patients with hand and wrist tenosynovitis were randomly divided into ultrasound-guided injection (USGI ) group ( n =37) and conventional blind injection (CBI) group ( n =25 ) and underwent USGI or CBI of betamethasone and lidocaine mixture, respectively. The ratio of adverse effect during the therapeutic process was compared between the two groups. Before treatment and 2, 4 and 12 weeks after treatment, the pain visual analogue scale (VAS), disease activity score in 28 joints (DAS28), gray scale ultrasound (GSUS) and power Doppler ultrasound (PDUS) scores, as well as therapeutic efficiency were compared between the two groups. Results The ratio of adverse effect of USGI group was 2.70%(1/37), lower than that of CBI group (5/20, 20.00%;P =0.03). VAS and DAS28 scores of USGI group 4 and 12 weeks after treatment were lower than those in CBI group (all P <0.01). PDUS scores of USGI group 2, 4 and 12 weeks after treatment were lower than those in CBI group (all P <0.01), respectively, while GSUS score of USGI group was lower than that of CBI group 12 weeks after treatment ( P <0.01). The efficiency of USGI group 4 and 12 weeks after treatment was higher than that in CBI group (both P < 0.05). Conclusion Ultrasound-guided local injection is safe and efficient in treatment of RA patients with hand and wrist tenosynovitis.

关 键 词：关节炎 类风湿 腱鞘炎 超声检查 鞘内注射 

分 类 号：R593.22[医药卫生—内科学] R445.1[医药卫生—临床医学]