来源：风湿病与关节炎,2024,13（2）:12-16,22.

基于经筋理论的膝骨关节炎患者“筋结点”超声解剖学特征分析与针刀治疗的疗效评价研究（临床研究）

阚丽丽¹，张　倩²，郝小路²，周　娜²，王海东¹

　　【摘　要】目的：借助可视化肌骨超声深入剖析膝骨关节炎患者膝关节局部经筋病灶点的病理特征，并综合评价弓弦平衡针刀法与常规针刺法治疗膝骨关节炎的疗效差异，为今后针刀精准辨位定点及安全入路研究提供客观参考依据。方法：将120例膝骨关节炎患者随机分为针刀治疗组和针刺对照组，每组60例。针刀治疗组进行弓弦平衡针刀法治疗，每周2次；针刺对照组选取犊鼻、内膝眼、阳陵泉、梁丘、鹤顶，及局部阿是穴进行针刺，同时根据不同的证型进行配穴加减，每周3次。2组均以3周为1个疗程，治疗3个疗程。根据肌骨超声下“筋结点”的精确定位、层次解剖、回声特点深入剖析经筋病灶点的超声影像学特征，采用股直肌羽状角、肌纤维横断面积、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分、白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）综合评价2组疗效差异。结果：治疗后，2组患者WOMAC评分、股直肌羽状角、平均肌纤维厚度、弹性应变率、IL-1β、TNF-α水平，及膝关节疼痛程度、僵硬、日常活动能力方面较治疗前均显著改善（P < 0.05）；其中，针刀治疗组在提升股直肌羽状角、增加肌纤维厚度、降低弹性应变率、降低致炎致痛因子水平方面优于针刺对照组，差异有统计学意义（P < 0.05）；与正常膝关节超声解剖结构相比，患者膝关节各针刀松解点（筋结点）处呈现出不同程度回声增强，同时伴有滑膜增厚、增生、关节腔积液、滑囊积液等典型超声影像学特征。结论：肌骨超声能够精准呈现膝骨关节炎患者膝关节经筋病灶点的解剖位置、解剖层次等超声病变特征，证实弓弦平衡针刀法的安全性和有效性，为针刀医学的标准化、规范化研究提供重要参考依据。

　　【关键词】　膝骨关节炎；经筋理论；弓弦平衡针刀法；小针刀；超声解剖学；肌骨超声

Analysis of Ultrasound Anatomical Characteristics of Muscle Nodes in Patients with Knee Osteoarthritis Based on Meridian Theory and Evaluation of Therapeutic Effects of Needle-knife Therapy

KAN Li-li,ZHANG Qian,HAO Xiao-lu,ZHOU Na,WANG Hai-dong

　　【ABSTRACT】Objective:To use visual musculoskeletal ultrasound to deeply analyze the pathological characteristics of local tendon lesions in patients with knee osteoarthritis,and comprehensively evaluate the difference in therapeutic effects between bowstring balance needle knife method and conventional acupuncture method for treating knee osteoarthritis,providing objective reference for future research on precise positioning and safe entry of needle knife.Methods:One hundred and twenty patients with knee osteoarthritis were randomly divided into a needle knife treatment group and an acupuncture control group,with 60 cases in each group.The needle knife treatment group received bow string balance needle knife treatment,twice a week.The acupuncture control group selected Dubi,Waixiyan,Yanglingquan,Liangqiu,Heding,and local Ashi acupoints for acupuncture,while adjusting acupoints according to different syndrome types,three times a week.Both groups were treated for 3 weeks as a course of treatment.By utilizing precise localization,hierarchical anatomy,and echogenicity of the “tendon node” under musculoskeletal ultrasound,in-depth analysis of the ultrasound imaging characteristics of the tendon lesion site was conducted.The rectus femoris pinnate angle,cross-sectional area,WOMAC score,IL-1β,TNF-α were used to make a comprehensive evaluation of the difference in therapeutic effects between the two groups.Results:After treatment,the WOMAC score,rectus femoris pinnate angle,mean muscle fiber thickness,elastic strain rate,the levels of IL-1β and TNF-α,and pain,stiffness,and daily activity of knee joint were significantly improved compared to before treatment（P < 0.05）.Among them,the needle knife treatment group was superior to the acupuncture control group in improving the rectus femoris pinnate angle,increasing muscle fiber thickness,reducing elastic strain rate,and lowering the level of inflammatory and pain factors,with statistical significance（P < 0.05）.Compared with the normal ultrasound anatomical structure of the knee joint,the patient’s knee joint showed varying degrees of echo enhancement at each needle knife release point（tendon node）,accompanied by typical ultrasound imaging features such as synovial thickening,hyperplasia,joint cavity effusion,and synovial sac effusion.Conclusion:Musculoskeletal ultrasound ultrasound can accurately present the anatomical position,anatomical level,and other ultrasound lesion characteristics of the tendon lesion points in patients with knee osteoarthritis,confirming the safety and effectiveness of the bowstring balance needle knife method,and providing important reference for the standardization and standardized research of needle knife therapy.

　　【Keywords】 knee osteoarthritis;meridian theory;bowstring balance needle knife method;needle knife;ultrasound anatomy;musculoskeletal ultrasound