【目的】 在经筋理论指导下探讨膝骨关节炎（KOA）足阳明经筋病变与X线股胫关节内外侧间隙及比值、股胫关节半脱 位程度和Insll-Salvati指数之间的相关性。【方法】 选取2019年1月至2021年11月在广州中医药大学第三附属医院诊断为KOA 的66例患者为研究对象，根据是否为足阳明经筋循经部位病变分为足阳明经筋组与非足阳明经筋组；行膝关节负重正侧位 X线拍摄，测量 2组 X线影像学指标，再对 2组行疼痛程度视觉模拟量表（VAS）评分及西安大略和麦克马斯特大学骨关节炎 指数（WOMAC）评分，比较2组X线影像学测量指标及相关量表评分之间的差异，分析2组经筋病变在X线相关测量指标上发 生的改变及影响。【结果】（1）非足阳明经筋组在X线正位片上股胫关节内侧间隙、内外侧间隙比值低于足阳明经筋组，股胫 关节半脱位程度高于足阳明经筋组（P < 0.05或P < 0.01）；（2）足阳明经筋组在X线侧位片上的髌韧带长度∶髌骨长度（LT∶LP） 值明显大于非足阳明经筋组（P < 0.01）；（3）非足阳明经筋组的疼痛程度VAS评分及WOMAC关节疼痛评分均明显高于足阳明 经筋组（P < 0.05），而2组患者的WOMAC关节僵硬、生理功能评分及总分比较，差异均无统计学意义（P > 0.05）。【结论】 KOA 足阳明经筋病变可能与X线侧位片上的髌骨相对高位密切相关；非足阳明经筋病变可能与X线正位片上的股胫关节内侧间隙 变窄、内外侧间隙比值增大及半脱位严重程度之间存在密切关系。

Objective Under the guidance of meridian-sinew（jingjin） theory， the correlation between footyangming jingjin lesions and X-ray imaging findings such as medial space and lateral space in femorotibial joint and their ratio，degree of subluxation of femorotibial joint，and the Insll-Salvati index in the patients with knee osteoarthritis（KOA）. Methods From January 2019 to November 2021，a total of 66 patients diagnosed as KOA at the Third Affiliated Hospital of Guangzhou University of Chinese Medicine were selected as the study subjects. The patients were divided into the foot-yangming jingjin group and non-foot-yangming jingjin group according to the presence of foot-yangming jingjin lesions. The X-ray postero-anterior and lateral radiography of the knee joint under weight bearing was performed， and imaging parameters of the two groups were measured. Afterwards the pain Visual Analogue Scale（VAS）scores and Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC）scores in the two groups were evaluated， the differences between the two groups’X-ray imaging findings and scale scores were compared，and the various X-ray imaging findings in the two groups were analyzed. Results（1）Under X-ray postero-anterior radiography of the knee joint，the medial space and lateral space in femorotibial joint and their ratio in non-foot-yangming jingjin group were lower than those in foot-yangming jingjin group，and degree of subluxation of femoro-tibial joint was higher than that of foot-yangming jingjin group（P < 0.05 or P < 0.01）.（2）The ratio of length of patellar tendon to length of patella（LT：LP）under X-ray lateral radiography in foot-yangming jingjin group was significantly greater than that of the non-foot-yangming jingjin group（P < 0.01）.（3）The scores of pain VAS and WOMAC in non-foot-yangming jingjin group were both significantly higher than those in foot-yangming jingjin group（P < 0.05），while the differences of the scores of WOMAC items such as joint stiffness and physiologic function， and the total WOMAC scores between the two groups were not statistically significant（P > 0.05）. Conclusion Foot-yangming jingjin lesions in KOA may be closely related to the relatively high position of patella under X-ray lateral radiography，and non-foot-yangming jingjin lesions may be closely related to the narrowing of the medial femorotibial joint space， the increase of medial-lateral space ratio，and the severity of subluxation under X-ray postero-anterior radiography.

R274.12

广东省中医药局科研项目（编号：20241258）；广州中医药大学第三附属医院科研基金创新项目（编号：sy2018005）