Abstract:

Objective　To analyze the clinical effect of ultrasound-guided acupotomy combined with Qinxitong in the treatment of rheumatoid shoulder arthritis. Methods　This study was a randomized controlled trial. A total of 120 patients with rheumatoid shoulder arthritis treated in Xi'an Fifth Hospital from September 2021 to March 2023 were selected and were divided into group A, B, and C by the random number table method, with 40 cases in each group. Group A included 8 males and 32 females, aged (52.43±11.77) years, with a course of disease of (55.40±33.89） months. Group B included 11 males and 29 females， aged （51.48±11.91） years， with a course of disease of (56.25±40.41) months. Group C included 10 males and 30 females, aged (53.18±10.47) years, with a course of disease of (55.88±41.52) months. All the three groups took methotrexate tablet 10.0-12.5 mg/time, once a week, and leflunomide tablet 10-20 mg/time, once a day. Group A was treated with ultrasound-guided acupotomy once a week for 3 consecutive weeks. Group B took Qinxitong orally, 1.08-1.80 g/time, twice a day. Group C was treated with ultrasound-guided acupotomy combined with Qinxitong, and the treatment plan was consistent with group A and B. All the three groups were treated for 12 weeks. The Visual Analogue Scale (VAS) score, Constant-Murley Shoulder Joint Function Score (CMS), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), 28 joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR), and 28 joint disease activity score-C reactive protein (DAS28-CRP) were compared among the three groups before treatment, 4 weeks after treatment, and 12 weeks after treatment, as well as clinical efficacy and adverse effects. χ² test, analysis of variance, and generalized estimation equation were used for statistical analysis. Results　The effective rate of group C was 97.50% (39/40), higher than those of group A [77.50% (31/40)] and B [77.50% (31/40)], with a statistically significant difference (χ²=8.004, P=0.018). After 4 weeks and 12 weeks of treatment, the VAS, ESR, CRP, DAS28-ESR, and DAS28-CRP of the three groups showed a decreasing trend compared to before treatment, and those in group C were lower than those in group A and B; the CMS showed an upward trend, and that in group C was higher than those in group A and B (all P<0.05). The incidences of adverse reactions in group A, B, and C were 12.50% (5/40), 17.50% (7/40), and 20.00% (8/40), respectively, with no statistically significant difference (P>0.05). Conclusion　The combination of ultrasound-guided acupotomy and Qinxitong in the treatment of rheumatoid arthritis can relieve shoulder joint pain, improve shoulder joint function, reduce inflammation level and disease activity, and improve clinical efficacy, with relatively high safety in clinical application.

Key words:

Rheumatoid shoulder arthritis, Ultrasound-guided acupotomy, Qinxitong, Clinical efficacy

摘要：

目的　分析超声引导针刀联合秦息痛治疗类风湿性肩关节炎的临床疗效。方法　本研究为随机对照试验。选取2021年9月至2023年3月西安市第五医院诊治的120例类风湿性肩关节炎患者，采用随机数字表法分为A、B、C 3组，每组40例。A组男、女各8、32例；年龄（52.43±11.77）岁；病程（55.40±33.89）个月。B组男、女各11、29例；年龄（51.48±11.91）岁；病程（56.25±40.41）个月。C组男、女各10、30例；年龄（53.18±10.47）岁；病程（55.88±41.52）个月。3组均口服甲氨蝶呤片10.0～12.5 mg/次，每周一次；来氟米特片10～20 mg/次，每日一次。A组采取超声引导针刀治疗，每周一次，连续3周。B组采取秦息痛口服，1.08～1.80 g/次，每日两次。C组采取超声引导针刀联合秦息痛治疗，治疗方案与A、B组一致。3组均治疗12周。比较3组患者治疗前、治疗4周后、治疗12周后的视觉模拟评分法（VAS）评分、Constant-Murley肩关节功能评分（CMS）、红细胞沉降率（ESR）、C反应蛋白（CRP）、28个关节疾病活动度-红细胞沉降率（DAS28-ESR）、28个关节疾病活动度-C反应蛋白（DAS28-CRP），临床疗效及不良反应。采用χ²检验、方差分析、广义估计方程进行统计学分析。结果　C组治疗有效率为97.50%（39/40），高于A组的77.50%（31/40）及B组的77.50%（31/40），差异有统计学意义（χ²=8.004，P=0.018）。治疗4周、12周后，3组患者的VAS、ESR、CRP、DAS28-ESR、DAS28-CRP均呈下降趋势，且C组低于A、B组；CMS呈上升趋势，且C组高于A、B组（均P<0.05）。A、B、C组的不良反应发生率分别为12.50%（5/40）、17.50%（7/40）、20.00%（8/40），差异无统计学意义（P>0.05）。结论　超声引导针刀联合秦息痛治疗类风湿性肩关节炎能缓解肩关节疼痛，改善肩关节功能，降低炎症水平及疾病活动度，提升临床疗效，且临床应用安全性较高。

关键词:

类风湿性肩关节炎, 超声引导针刀, 秦息痛, 临床疗效