目的 采用前瞻性隨機(jī)對(duì)照試驗(yàn)探討囊液抽吸加關(guān)節(jié)腔內(nèi)注射醋酸曲安奈德及玻璃酸鈉對(duì)貝克氏囊腫的療效及對(duì)血清炎癥因子和骨代謝指標(biāo)的影響。方法 選擇聯(lián)勤保障部隊(duì)第九〇〇醫(yī)院2018年5月-2020年6月收治的120例貝克氏囊腫患者作為研究對(duì)象進(jìn)行前瞻性隨機(jī)對(duì)照試驗(yàn)（RCT），患者隨機(jī)分為對(duì)照組和試驗(yàn)組，每組各60例。對(duì)照組患者給予傳統(tǒng)開放手術(shù)治療，進(jìn)行S形切口，將囊腫從根部切除。試驗(yàn)組患者給予囊液抽吸加關(guān)節(jié)腔內(nèi)注射醋酸曲安奈德及玻璃酸鈉治療，利多卡因浸潤麻醉下選擇最淺表的囊腫一端進(jìn)行穿刺，將囊液抽取出來，采用0.9%氯化鈉溶液對(duì)其囊腔進(jìn)行清洗，直至沖洗液體變清亮。針頭不拔出，向關(guān)節(jié)腔內(nèi)注射20 mg的醋酸曲安奈德注射液及2 mL的1%玻璃酸鈉注射液，包扎固定膝關(guān)節(jié)，保持制動(dòng)48 h。每周1次，連續(xù)進(jìn)行5周的治療。比較兩組臨床療效，比較兩組患者治療前后視覺模擬（VAS）評(píng)分、膝關(guān)節(jié)Lysholm評(píng)分、血清炎癥因子、骨代謝指標(biāo)變化，記錄兩組患者并發(fā)癥發(fā)生情況。結(jié)果 試驗(yàn)組的治療總有效率（95%）顯著高于對(duì)照組（75%），兩組間比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。與治療前相比，治療后兩組患者VAS評(píng)分均明顯降低（P<0.05），Lysholm評(píng)分明顯升高（P<0.05），且試驗(yàn)組評(píng)分改善更為顯著（P<0.05）；與治療前相比，治療后兩組患者血清腫瘤壞死因子α（TNF-α）、白細(xì)胞介素6（IL-6）、白細(xì)胞介素1β（IL-1β）水平均明顯降低（P<0.05），且試驗(yàn)組患者各項(xiàng)炎癥因子水平降低更為顯著（P<0.05）；與治療前相比，治療后兩組患者血清β膠原降解產(chǎn)物（β-CTX）、核轉(zhuǎn)錄因子κB受體活化因子配基（RANKL）水平均明顯降低（P<0.05），血清骨保護(hù)素（OPG）、胰島素樣生長因子-1（IGF-1）水平明顯升高（P<0.05），且試驗(yàn)組患者上述指標(biāo)改善更為顯著（P<0.05）。兩組患者隨訪期間均沒有出現(xiàn)神經(jīng)及血管損傷、膝關(guān)節(jié)感染、皮瓣壞死、切口開裂等并發(fā)癥。結(jié)論 囊液抽吸加關(guān)節(jié)腔內(nèi)注射醋酸曲安奈德及玻璃酸鈉治療貝克氏囊腫，可以有效改善膝關(guān)節(jié)功能，緩解疼痛癥狀，減輕炎癥反應(yīng)，療效顯著，具有一定的臨床應(yīng)用價(jià)值。

Objective To investigate the clinical effect and prognosis of cystic fluid aspiration plus intra-articular injection of triamcinolone acetonide acetate and sodium hyaluronate on Becker's cyst, and to investigate effects on serum inflammatory factors and bone metabolism of patients with Becker's cyst. Methods A total of 120 patients with Becker's cyst treated in the 900th Hospital of the Joint Logistics Support Force PLA from May 2018 to June 2020 were selected as the research objects for prospective randomized control trial (RCT), the patients were randomly divided into control group and experimental group, with 60 cases in each group. The patients in the control group were treated with traditional open surgery, with S-line incision to remove the cyst fromthe root. The patients in the experimental group were treated with cystic fluid aspiration and intra-articular injection of triamcinolone acetonide acetate and sodium hyaluronate. Under lidocaine infiltration anesthesia, one end of the shallowest cyst was selected for puncture and the cyst fluid was removed. Extract it and clean the cystic cavity with 0.9% sodium chloride solution until the flushing liquid becomes clear. Without pulling out the needle, inject 20 mg triamcinolone acetonide acetate injection and 2 mL 1% sodium hyaluronate injection into the articular cavity, bind and fix the knee joint and keep braking for 48 hours. Once a week for five weeks. The clinical efficacy and recurrence rate of the two groups were compared. The changes of visual analog (VAS) score, Lysholm score of knee joint, serum inflammatory factors and bone metabolism indexes were compared between the two groups before and after treatment, and the complications of the two groups were recorded. Results The total effective rate of the experimental group (95.0%) was significantly higher than that of the control group (75.0%), the difference between the two groups was statistically significant (P < 0.05). Compared with before treatment, the VAS score of the two groups decreased significantly (P < 0.05), the Lysholm score increased significantly (P < 0.05), and the score of the experimental group improved more significantly (P < 0.05). Compared with before treatment, the serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1β (IL-1β) of the two groups after treatment were decreased significantly (P < 0.05), and the levels of inflammatory factors in the experimental group decreased more significantly (P < 0.05). Compared with before treatment, the levels of β collagen degradation products (β-CTX), nuclear transcription factor κB receptor activating factor ligand (RANKL) of the two groups after treatment were decreased significantly (P < 0.05), and the levels of serum osteoprotegerin (OPG) and insulin-like growth factor-1 (IGF-1) were increased significantly (P < 0.05), and the improvement of the above indexes in the experimental group was more significant (P < 0.05). There were no complications such as nerve and vascular injury, knee infection, flap necrosis and incision cracking in both groups during follow-up. Conclusion Cystic fluid aspiration plus intra-articular injection of triamcinolone acetonide acetate and sodium hyaluronate in the treatment of Becker's cyst can effectively improve knee function, relieve pain symptoms and reduce inflammatory reaction. The curative effect is significant, and it has certain clinical application value.

R969.4

福建省莆田市科技計(jì)劃項(xiàng)目（2018SJ3003）