缺氧是包括骨肉瘤在内的实体肿瘤的普遍特征.缺氧诱导因子是肿瘤细胞在缺氧条件下的重要调节因子.研究缺氧诱导因子在骨肉瘤的相关机制能为骨肉瘤的治疗提供新思路,本文就缺氧诱导因子的结构功能、缺氧诱导因子与骨肉瘤干细胞、缺氧诱导因子与骨肉瘤放疗抵抗、缺氧诱导因子与骨肉瘤多药耐药、缺氧诱导因子的抑制剂等相关研究进行综述.

目的 对比PHILOS锁定钢板和髓内钉内固定手术治疗肱骨近端骨折的临床疗效.方法 回顾性分析2015年1月至2019年1月期间因肱骨近端骨折于本院骨科行手术治疗的患者297例,根据手术方法分为PHILOS组(n=150)和髓内钉组(n=147),收集患者手术时长,住院总时长,平均切口长度,术中输血率,术后6h、12h、24 h、36 h与72 h疼痛视觉模拟评分(VAS),院内感染率等围术期相关参数,统计术后6、12、24个月时的Constant-Murley肩关节功能评分与术后并发症发生情况.结果 在手术时长、住院总时长、平均切口长度、术中输血率、院内感染率、术后6、12 h VAS、术后肩峰撞击症并发症方面,PHILOS组患者明显高于髓内钉组患者(P＜0.05);在术后24、36、72 h VAS、骨折再移位、内固定物断裂、肱骨头坏死并发症、术后6、12、24个月Constant-Murley肩关节功能评分方面,两组患者比较差异均无统计学意义(P＞0.05).结论 PHILOS锁定钢板和髓内钉均能在肱骨近端骨折的内固定手术中取得良好术后疗效,但考虑并发症发生、术中操作损伤程度的因素,髓内钉内固定手术更为合适.

目的 探讨HIF-3α在骨肉瘤侵袭转移中的作用,观察低氧对骨肉瘤MG-63细胞侵袭能力的影响.方法 收集15例骨肉瘤组织和15例骨软骨瘤组织,用免疫组织化学染色方法检测骨肉瘤组织和骨软骨瘤组织中HIF-3α的表达情况;MG-63细胞低氧刺激,用定量RT-PCR和Western Blot方法检测MG-63细胞中HIF-3α的表达情况;用细胞黏附实验、细胞迁移实验及细胞侵袭实验检测MG-63细胞的黏附、迁移及侵袭能力.在MG-63细胞中,敲降HIF-3α或过表达HIF-3α后,检测低氧对细胞的黏附、迁移及侵袭能力的影响.结果 免疫组化结果显示骨肉瘤组织中HIF-3α高表达而骨软骨瘤组织中HIF-3α低表达.与常氧条件相比,低氧促进MG-63细胞中HIF-3αmRNA和HIF-3α蛋白的表达,低氧增强MG-63细胞的黏附、迁移及侵袭能力.MG-63细胞中HIF-3α的敲降减弱了 MG-63细胞的黏附、迁移及侵袭能力而HIF-3α的过表达增强了 MG-63细胞的黏附、迁移及侵袭能力.结论 低氧促进了 MG-63细胞中的HIF-3α的表达,增强了 MG-63细胞的侵袭转移能力,HIF-3α在低氧诱导的MG-63细胞侵袭转移中具有重要作用.

Objective:To investigate the osteogenic effect of exosomes derived by mouse brain microvascular endothelial cell line bEnd.3 on bone marrow mesenchymal stem cells (BMSCs).Methods:Ultracentrifuge was used to extract the exosomes derived by brain-derived endothelial cells.3 (bEnd.3) cells bEnd.3 cells derived exosomes (b-Exo). Transmission electron microscopy (TEM), nanoparticle tracking analysis (NTA) and Western blotting were use to characterize the exosomes. Alizarin red staining was used to detect the osteogenic effects of the exosomes. The relative messenger ribonucleic acid (mRNA) expression of osteogenic-related genes runt-related transcription factor 2 (Runx2), osteopontin and osteocalcin was detected by reverse transcriptase-polymerase chain reaction (RT-PCR).Results:TEM showed that the particles presented a typical vesicle-like shape. NTA manifested the concentration of Exo was 7.5×10 10 particles/ml and the diameter was (100.0±7.3) nm. The b-Exo could enhance the BMSCs matrix mineralization and increase the mRNA expression of osteogenic-related genes Runx2, osteopontin and osteocalcin compared to the controls (8.28±0.34 vs. 3.71±0.40, t=4.974, P<0.01; 9.19±1.91 vs. 4.09±0.88, t=5.562, P<0.01; 10.31±1.67 vs. 5.32±0.31, t=5.432, P<0.01). Conclusion:The b-Exo could promote the osteogenic performance of BMSCs and may be applied to the bone regeneration and the cell-free treatment of osteoporosis in the near future.

目的 观察经皮空心钉微创治疗APC-Ⅰ型骨盆前环损伤的临床疗效.方法 通过观察2017年6月至2019年8月采用经皮空心钉微创治疗APC-Ⅰ型骨盆骨折前环损伤17例患者的手术时间、手术出血量、术后下地活动时间、骨折愈合时间、骨盆骨折复位Matta影像学标准评价复位质量及Majeed评分系统来评价功能状态和临床疗效.结果 所有患者均获随访,随访时间为8～13个月,平均10.7个月.单侧耻骨支或耻骨联合固定手术时间为28～47 min,平均35 min;出血量4～14mL,平均(7.1±2.4) mL;术后下地活动时间4～11周,平均(6.4±0.7)周,骨折愈合时间4～14周,平均(8.2±2.1)周.Matta复位标准结果,优13例,良4例.所有患者骨折均愈合,无切口感染、无神经血管损伤.末次随访时Majeed功能评分为(85.1±2.4)分,其中优13例,良4例.结论 经皮空心钉微创治疗APC-Ⅰ型骨盆骨折前环损伤能获得良好的临床效果.

目的 探讨血清Ⅰ型胶原羧基端肽β 特殊序列(β-CTX)、胰岛素样生长因子-1(IGF-1)预测老年骨质疏松患者并发髋部骨折的价值.方法 前瞻性研究2018年1月—2019年12月华中科技大学同济医学院附属梨园医院骨科收治的164例老年骨质疏松患者临床资料,其中85例老年骨质疏松并发髋部骨折为骨折组,79例单纯骨质疏松患者为无骨折组,另72例门诊体检正常者为对照组.骨折组男性36例,女性49例;年龄63～78岁,平均70.1岁;跌倒42例,摔伤31例,撞击12例.无骨折组男性29例,女性50例;年龄62～79岁,平均71.2岁.对照组男性31例,女性41例;年龄61～78岁,平均70.5岁.检测受试者血清β-CTX、IGF-1水平以及骨质疏松患者骨密度(BMD).比较三组血清β-CTX、IGF-1水平及临床一般资料,Logistic回归分析老年骨质疏松患者并发髋部骨折的影响因素,受试者工作特征曲线(ROC)分析血清 β-CTX、IGF-1预测老年骨质疏松患者并发髋部骨折的价值.结果 骨折组年龄≥70岁比例、户外运动≥3次/周比例、补充钙剂比例均高于无骨折组(P<0.05),骨质疏松病程长于无骨折组(P<0.05),股骨颈、全髋BMD低于无骨折组(P<0.05).血清β-CTX水平在对照组、无骨折组、骨折组依次升高(P<0.05),IGF-1依次降低(P<0.05),各组间差异有统计学意义(P<0.05).Pearson相关性分析结果显示骨折组血清β-CTX水平与股骨颈、全髋BMD呈负相关(r=-0.561、-0.623,P<0.05),IGF-1与股骨颈、全髋BMD呈正相关(r=0.565、0.642,P<0.05).Logistic多元逐步回归分析结果显示年龄≥70岁、低全髋BMD、户外运动<3次/周、高β-CTX、低IGF-1是老年骨质疏松患者并发髋部骨折的危险因素(P<0.01).ROC分析结果显示β-CTX、IGF-1、β-CTX+IGF-1预测老年骨质疏松患者并发髋部骨折的曲线下面积(AUC)分别为0.734、0.723、0.894,灵敏度分别为74.12％、70.59％、90.59％,特异度分别为81.01％、79.75％、91.14％.结论 老年骨质疏松患者并发髋部骨折患者血清β-CTX水平升高,IGF-1水平降低,β-CTX、IGF-1水平与股骨颈、全髋BMD降低、髋部骨折发生均有关,是评估老年骨折疏松患者骨折风险的有价值指标.

目的 探讨髌骨钢板与克氏针张力带内固定治疗髌骨骨折的临床疗效.方法 2015年1月～2020年10月期间收治的髌骨骨折病人60例.按就诊顺序间次分为钢板组与张力带组,每组各30例.钢板组采用髌骨钢板,张力带组采用克氏针钛缆张力带.比较两组病人手术时间、出血量、并发症发病率和术后膝关节的功能等.结果 钢板组和张力带组手术时间分别为(63.53±7.07)分钟和(76.53±4.16)分钟,切口长度分别为(6.28±0.57)cm和(7.73±0.77)cm,术后6个月膝关节活动度分别为(124.07±4.35)°和(118.40±4.55)°,手术出血量分别为(118.42±10.39)ml和(133.77±12.43)ml,两组比较差异有统计学意义(P＜0.05).结论 钢板组与张力带组相比较,手术时间缩短,切口长度短于张力带组;钢板组术后膝关节活动度满意度强于张力带组.髌骨钢板内固定治疗髌骨骨折具有良好的生物力学稳定性,临床疗效优于张力带内固定治疗.

目的 探讨乏氧状态下γ分泌酶抑制剂(γ-secretase inhibitors,DAPT)介导Notchl信号通路对骨肉瘤MG-63细胞系增殖、凋亡、侵袭、转移的影响及相关机制.方法 以骨肉瘤细胞株MG-63为研究对象,分为正常组(NC)、乏氧组(Hypoxia)和含有DAPT的乏氧组作为实验组(Hypoxia+DAPT).采用流式细胞仪检测处理后的细胞周期,CCK-8方法检测细胞的增殖能力,并使用Western Blot检测MG-63细胞株中Notchl、HIF-1α、Hes-1蛋白的表达情况,通过Transwell实验来验证其转移能力.同时探讨DAPT在乏氧环境下对细胞增殖和细胞周期方面的影响,分析其介导的Notch1下调情况及其抑制乏氧对MG-63细胞的促增殖作用.结果 与正常组相比较,乏氧组细胞的增殖能力及侵袭能力均较正常组有显著的提升,差异具有统计学意义(P＜0.05).而实验组与乏氧组相比较,γ泌酶抑制剂(DAPT)能显著降低其增殖及侵袭能力(P＜0.05).Western Blot结果显示,与正常组相比,乏氧组和实验组均可上调Notch1、HIF-1α、Hes-1相关蛋白的表达:但是与乏氧组对比,实验组可显著下调Notch1、HIF-1α、Hes-1蛋白的表达水平(P＜0.05).流式细胞仪结果显示:与正常组相比,乏氧组和实验组均可促进细胞由G1期转向G2期;而与乏氧组对比,实验组可显著抑制细胞由G1期转向G2期,使细胞周期停滞,差异具有统计学意义(P＜0.05).增殖实验结果显示,与正常组相比,乏氧组和实验组均可促进细胞增殖;而与乏氧组对比,实验组可显著抑制细胞增殖,差异具有统计学意义(P＜0.05).结论 γ分泌酶抑制剂可通过下调Notch1通路显著抑制乏氧状态下骨肉瘤细胞株MG-63的增殖与侵袭,阻断Notch1表达可能是潜在的治疗骨肉瘤的机制之一.

目的 探讨临床护理人员科研能力现况以及相关改善策略.方法 将本院228例护理人员纳入研究,分析护理人员的科研能力现况,并探讨相应的改善策略.结果 20～39岁组计算机操作知识得分高于40岁及以上组,P<0.05;但各个年龄组其他各项指标对比无明显差异,P>0.05.本科及以上组各项指标均高于大专组、中专组,P<0.05;大专组各项指标均高于中专组,P<0.05.主管护师组论文写作知识、科研基础知识以及总分高于护师组、护士组,P<0.05;护师组论文写作知识、科研基础知识以及总分高于护士组,P<0.05.结论 临床护理人员科研能力普遍水平较低,临床中应完善相应管理体系,重视对护理人员的培训教育,从而加强护理人员的科研能力,促进护理学的不断发展.

目的 探讨上臂前外侧入路双锁定钢板治疗肱骨干术后骨不连的临床疗效.方法 回顾2015年2月至2018年6月在我科行上臂前外侧入路双钢板治疗肱骨干骨折术后骨不连患者并随访获得完整资料的患者13例.其中,男8例,女5例;左侧4例,右侧9例;年龄21～75岁,平均50.2岁;肱骨干上1/3段骨折3例,中1/3段骨折8例,下1/3段骨折2例;10例患者钢板断裂失效,3例钢板完好.增生性骨不连9例,缺血性骨不连3例,萎缩性骨不连1例.记录患者基本信息和随访结果,肩关节Constant-Murley评分、肘关节Mayo评分、患侧上肢DASH评分来评定临床疗效.结果 13例患者随访获得完整随访资料,平均随访10.7个月(9～14个月),所有患者均获得骨性愈合,平均愈合时间6.2个月(4～11个月),1例出现术后一过性桡神经麻痹,该患者术后2个月恢复正常,并发症发生率为7.69％.患者肩关节Constant-Murley评分(术前67.2±5.7、术后末次随访81.2±4.4),肘关节Mayo评分(术前74.2±5.4、术后末次随访80.2±3.2),患侧上肢DASH评分(术前8.9±2.7、术后末次随访7.97±2.3).该三项评分术后末次随访较术前改善,与术前比较差异有统计学意义(P＜0.05).结论 上臂前外侧双锁定钢板治疗肱骨干骨折骨不连效果满意.

目的 探讨应用微创接骨板内固定技术(minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗老年肱骨近端不稳定型骨折的临床疗效.方法 选取2015年7月至2017年8月本院采用微创接骨板内固定技术手术治疗并成功随访的34例肱骨近端不稳定型骨折老年患者,其中男12例,女22例;年龄69.2～81.5岁,平均年龄为73.5岁;右侧20例,左侧14例.骨折按Neer分型:二、三、四部分骨折分别为10例、17例、7例.受伤到手术时间3～7 d,本组患者均获得完整随访资料,分别记录手术时间、手术出血量、术中透视次数、骨折愈合时间、术后并发症发生率及术后12个月时肩关节功能Neer评分分析该手术方法的临床疗效.结果 所有患者均获随访,随访时间12～18个月,平均16个月.手术时间52.6～135.4 min,平均78.5 min;术中出血量45.6～135.4mL,平均75 mL;术中透视7～18次,平均9.7次;骨折愈合时间2.3～5个月,平均愈合时间3个月.2例出现内固定松动,经治疗后骨折均一期愈合.术后12个月时肩关节功能Neer评分:优22例,良8例,可3例,差1例,总体优良率88.2％.结论 微创接骨板内固定技术是治疗肱骨近端骨折的有效方法,创伤小、骨折愈合快,临床疗效满意.

目的探讨微创接骨板内固定技术(minimally invasive percutaneous plate osteosynthesis,MIPPO)结合锁定接骨板治疗肱骨近端Neer Ⅱ、Ⅲ型骨折的疗效。方法回顾性分析2013年6月~2015年6月在我科运用MIPPO技术结合锁定接骨板治疗的肱骨近端骨折44例患者,根据NEER分型,属于二部分骨折30例,属于三部分骨折14例。围手术期预防使用抗生素,术后肩关节功能采用NEER评分评估。结果全部病例获得随访,平均16个月。骨折均愈合,末次随访时肩关节功能NEER评分:优24例,良14例,可6例,总优良率86.4%。结论微创经皮锁定接骨板内固定是治疗肱骨近端骨折的有效方法,尤其Neer Ⅱ、Ⅲ型骨折能提供足够坚强固定,并发症少、疗效满意。

Objective To investigate the clinical effect of internal heat needle combined with ossotide in treatment of knee osteoarthritis. Methods 94 Patients with knee osteoarthritis were randomly divided into control groups(47 cases) and treatment groups(47 cases) according to different treatment plans. The patients in control groups were intra-articular injected with ossotide injection, the patients in treatment groups were treatment with internal heat needle on the basis of control groups. After treatment of 4 weeks, the clinical efficacies and VAS between two groups were evaluated, the change of erythrocyte sedimentation rate and C-reaction protein and the levels of blood IL-1β, TNF-α, MMP-3 in two groups before and after treatment were detected. Results After treatment, the total effective rate in the control groups and treatment groups were respectively 76.6% and 93.6%, there were diff erences between two groups(P < 0.05). The vas score in the treatment group was significantly lower than that in the control group(P < 0.05). After treatment, the levels of ESR, CRP and IL-1β, TNF-α, MMP-3 in the two groups were significantly lower than those in the control group(P < 0.05), but lower in the treatment group than in the control group(P < 0.05). Conclusion The internal heat needle combined with ossotide has a good clinical efficacy than only injected with ossotide injection.

目的 探讨经外侧"L"型切口锁定接骨板内固定术治疗SandersⅢ～Ⅳ型跟骨骨折的临床效果.方法 选取华中科技大学同济医学院附属梨园医院2014年6月—2015年12月收治的SandersⅢ～Ⅳ型粉碎性跟骨骨折患者40例(45足),均采用经外侧"L"型切口锁定接骨板内固定术治疗.随访12～24个月,观察患者患足愈合情况(愈合率、切口愈合时间),并比较术前及术后即刻、12个月患足B?hler's角、Gissane's角及跟骨后部高度.结果 术后,患者骨折均一期愈合,术后1周出现皮缘部分变紫2足,及时给予局部创口间断拆线和换药处理后愈合;采用同体异种骨植骨12足中出现3足排异反应,放置负压引流管后换药好转.切口愈合时间为(16.21±4.33)d.术后即刻及术后12个月,患者患足B?hler's角、Gissane's角大于术前,跟骨后部高度高于术前(P<0.05).结论 经外侧"L"型切口锁定接骨板内固定术治疗SandersⅢ～Ⅳ型跟骨骨折的临床效果明显,可有效改善患者患足B?hler's角、Gissane's角及跟骨后部高度,促进骨折愈合.

Objective:To evaluate the difference of continuous brachial plexus anesthesia techniques pine solution and rehabilitation training in the treatment of periarthritis of shoulder with manipulation release and rehabilitation training in the treatment of periarthritis of shoulder.Method:A total of 114 patients with periarthritis of shoulder were randomly selected from November 2011 to May 2015.According to the wishes of the patients, they were divided into two groups:the experimental group(n=57) and the control group(n=57).The experimental group received manual release and rehabilitation training during continuous brachial plexus block,the control group received manual relaxation and rehabilitation training,the test group received continuous brachial plexus block analgesia, manual release,and the control group received brachial plexus anesthesia within 4 hours.Rehabilitation training was performed after operation.Result:After treatment, the curative effect,VAS score and shoulder joint activity score of the experimental group were better than those of the control group,and the differences were statistically significant(P<0.01).Conclusion:Continuous brachial plexus anesthesia technique loose solution and rehabilitation training in the treatment of periarthritis of shoulder,effectively and improve the limb function,improve the ability of daily life,reduce the pain of patients is a safe and effective treatment.

Objective: To study the related risk factors of premature ventricular cardiomyopathy and the feasibility of radiofrequency catheter ablation treatment. Method: 192 cases of functional frequent premature ventricular contractions were given ventricular tachycardia radiofrequency ablation therapy,including 141 cases of simple ventricular premature group and51 cases of premature ventricular cardiomyopathy group. Gender,age,course of disease,weight,the amount and sources of premature ventricular contractions and concomitant ventricular tachycardia were analyzed and compared. Results: The percentage of males were significantly higher( P < 0. 01),the body mass index was significantly higher( P < 0. 01),the total burden of premature ventricular contractions was significantly greater( P < 0. 05),and the rate of concomitant ventricular tachycardia was significantly higher( P < 0. 01) in premature ventricular cardiomyopathy group than in simple ventricular premature group. Conclusion: In patients with frequent ventricular premature without organic heart diseases,male,high body mass index and ventricular tachycardia may be the high risk factors of cardiomyopathy. Radiofrequency catheter ablation for premature ventricular cardiomyopathy is safe and effective.

目的:探究Ⅰ导联正向向量在定位左室流出道室性早搏中的作用。方法:回顾性分析21例成功行射频消融术治疗左室流出道室早患者的体表心电图特征。根据最终消融成功靶点与主动脉瓣的关系,分为瓣上组(10例)和瓣下组(11例)。统计2组患者的基本信息和相关体表心电图参数。结果:瓣上组患者的Ⅰ导联正向向量为(0. 17±0. 48) mV,瓣下组为(-0. 31±0. 30) mV,差异具有显著统计学意义(P <0. 05);以Ⅰ导联正向向量>0. 15 mV为瓣上组,<0. 15 mV为瓣下组时,敏感性为70. 0%,特异性为90. 9%。结论:Ⅰ导联正向向量对判断左室流出道室早起源于主动脉瓣上或瓣下具有重要的意义。

Objective To investigate the correlation between the production of NO, iNOS and the expressions of TNF-α、IL-1β 、IL-6 and IL-17 in the articular cartilage of rabbits with traumatic osteoarthritis(OA), and to explore the influence of Sodium hyaluronate(SH) on cartilage degeneration in traumatic OA. Methods 48 New Zealand rabbits underwent anterior cruciateligament transaction(ACLT) of the right knee and then were divided into three groups. The animals in the SH-treatment group were injected with SH(0.3 mg) in the knees 4 week after operation, once a week for 4 weeks.Rabbits in the model group were treated with normal saline under the same condition and the control group does nothing.All rabbits were sacrificed after the last treatment. Cartilagineus changes of the medial femoral condyles were grossly checked and OA severity was evaluated under light-microscope. The concentration of NO and iNOS in joint fluid, serum and the expressions of TNF-α、IL-1β 、IL-6 and IL-17 in joint fluid were assessed ELISA kit. Results The results of HE staining and pathological score show that cartilage degeneration in the SH-treatment group was significantly slighter than that in the model group. The concentration of NO and iNOS in joint fluid, serum and the expressions of TNF-α、IL-1β 、IL-6 and IL-17 in joint fluid were significantly lower than those in the model group( <0.01) after SH treatment. Conclusion The expression of NO was positively correlated with inflammatory Cytokines in the early stages of OA. And SH may protect articular cartilage by inhibiting synthesis of NO.

AIM To evaluate the preventive effect of early enteral nutrition combined with omeprazole on stress ulcer in patients with cerebral apoplexy.METHODS Fifty-two patients with cerebral apoplexy treated at our hospital from June 2013 to June 2016 were selected and randomly divided into a treatment group and a control group.The control group was given early enteral nutrition alone,and the treatment group was given early enteral nutrition combined with omeprazole.Gastric pH at 1 wk after treatment,length of hospital stay,bleeding time,stress ulcer incidence,mortality,and adverse reactions were compared between the two groups.RESULTS Compared with the control group,mean nocturnal gastric pH and 24-h mean gastric pH were significantly increased and the incidence rates of nocturnal gastric pH ＜ 4.0 and pH ＜ 4.0 significantly decreased (P ＜ 0.05);the length of hospital stay was significantly shorter;bleeding was significantly postponed;the incidence rates of stress ulcer and mortality were significantly decreased (P ＜ 0.05);and the percentages of patients with fecal occult blood and gastric occult blood were significantly decreased (P ＜ 0.05) in the observation group.There was no significant difference in the incidence of insomnia,headache,or abnormal liver function between the two groups (P ＞0.05).Before treatment,there was no significant difference in SAS score between the two groups (P ＞ 0.05);however,after treatment,SAS score was significantly lower in the observation group than in the control group (P ＜ 0.05).CONCLUSION Early enteral nutrition combined with omeprazole can effectively reduce the incidence of stress ulcer in patients with cerebral apoplexy.

目的探讨中药外敷联合口服美洛昔康治疗类风湿性关节炎的临床效果。方法选取2014年1月至2016年1月在华中科技大学同济医学院附属梨园医院骨科住院治疗的类风湿性关节炎患者96例,根据入院先后顺序分为观察组和对照组,每组48例。对照组口服美洛昔康,观察组在口服美洛昔康的同时患处使用中药外敷。连续治疗1个月后,观察两组患者的临床疗效,比较两组患者治疗前后的西大略湖和麦克马斯特大学(WOMAC)骨关节炎指数评分、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)、炎性因子白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)以及免疫球蛋白Ig G、Ig M、Ig A的变化情况。结果观察组的治疗总有效率为95.8%,明显高于对照组的68.7%,差异具有统计学意义(P<0.05);治疗后两组患者的WOMAC评分(疼痛评分、日常活动评分、关节僵硬评分、综合评分)与治疗前比较均明显降低,且观察组患者WOMAC评分下降较对照组更明显,差异均有统计学意义(P<0.05);治疗后两组患者血清中RF、ESR、CRP水平、炎性因子IL-6、IL-1β、TNF-α以及血清中免疫球蛋白Ig G、Ig M、Ig A的含量与治疗前比较均明显下降(P<0.05),且观察组下降较对照组更明显,差异均有统计学意义(P<0.05)。结论中药外敷联合美洛昔康治疗类风湿性关节炎可明显改善患者的病情,其疗效明显优于单独口服美洛昔康,值得临床推广应用。