目的 采用前瞻性随机对照试验探讨囊液抽吸加关节腔内注射醋酸曲安奈德及玻璃酸钠对贝克氏囊肿的疗效及对血清炎症因子和骨代谢指标的影响。方法 选择联勤保障部队第九〇〇医院2018年5月-2020年6月收治的120例贝克氏囊肿患者作为研究对象进行前瞻性随机对照试验（RCT），患者随机分为对照组和试验组，每组各60例。对照组患者给予传统开放手术治疗，进行S形切口，将囊肿从根部切除。试验组患者给予囊液抽吸加关节腔内注射醋酸曲安奈德及玻璃酸钠治疗，利多卡因浸润麻醉下选择最浅表的囊肿一端进行穿刺，将囊液抽取出来，采用0.9%氯化钠溶液对其囊腔进行清洗，直至冲洗液体变清亮。针头不拔出，向关节腔内注射20 mg的醋酸曲安奈德注射液及2 mL的1%玻璃酸钠注射液，包扎固定膝关节，保持制动48 h。每周1次，连续进行5周的治疗。比较两组临床疗效，比较两组患者治疗前后视觉模拟（VAS）评分、膝关节Lysholm评分、血清炎症因子、骨代谢指标变化，记录两组患者并发症发生情况。结果 试验组的治疗总有效率（95%）显著高于对照组（75%），两组间比较差异具有统计学意义（P<0.05）。与治疗前相比，治疗后两组患者VAS评分均明显降低（P<0.05），Lysholm评分明显升高（P<0.05），且试验组评分改善更为显著（P<0.05）；与治疗前相比，治疗后两组患者血清肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）、白细胞介素1β（IL-1β）水平均明显降低（P<0.05），且试验组患者各项炎症因子水平降低更为显著（P<0.05）；与治疗前相比，治疗后两组患者血清β胶原降解产物（β-CTX）、核转录因子κB受体活化因子配基（RANKL）水平均明显降低（P<0.05），血清骨保护素（OPG）、胰岛素样生长因子-1（IGF-1）水平明显升高（P<0.05），且试验组患者上述指标改善更为显著（P<0.05）。两组患者随访期间均没有出现神经及血管损伤、膝关节感染、皮瓣坏死、切口开裂等并发症。结论 囊液抽吸加关节腔内注射醋酸曲安奈德及玻璃酸钠治疗贝克氏囊肿，可以有效改善膝关节功能，缓解疼痛症状，减轻炎症反应，疗效显著，具有一定的临床应用价值。

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

福建省莆田市科技计划项目（2018SJ3003）