【目的】 观察经筋理论下针刀松解治疗股骨头坏死的临床疗效。【方法】 选取 2020年 5月至 2023年 5月北京市和平里医 院收治且行保髋治疗的82例明确诊断为股骨头坏死的患者为研究对象。按随机数字表将患者随机分为观察组和对照组，每 组各41例。对照组给予髋关节康复训练联合经筋推拿手法治疗，观察组在对照组治疗的基础上，给予经筋理论下针刀松解 治疗。治疗6个月。观察2组患者治疗前后疼痛视觉模拟量表（VAS）评分的变化情况，以及髋关节活动度和Harris评分的情 况。比较2组患者治疗前后血清5-羟色胺（5-HT）、P物质（SP）、降钙素基因相关肽（CGRP）、神经肽Y（NPY）水平的变化情 况。【结果】（1）治疗后，2组患者的VAS评分明显改善（P＜0.05），且观察组在改善VAS评分方面明显优于对照组，差异有统 计学意义（P＜0.05）。（2）治疗后，2组患者的髋关节活动度明显改善（P＜0.05），且观察组在改善髋关节活动度方面明显优于 对照组，差异有统计学意义（P＜0.05）。（3）治疗后，观察组髋关节功能优良率为95.12%（39/41），对照组为78.05（32/41），观 察组髋关节功能优良率优于对照组，差异有统计学意义（P＜0.05）。（4）治疗后，2组患者的 5-HT、SP、CGRP、NPY 含量明 显改善（P＜0.05），且观察组在改善5-HT、SP、CGRP、NPY含量方面明显优于对照组，差异有统计学意义（P＜0.05）。【结论】 经筋理论下针刀松解治疗股骨头坏死，能够明显缓解患者的疼痛症状，改善患者的髋关节功能，其镇痛机制可能与神经递 质因子水平调节及其平衡状态恢复有关。

Objective To observe the clinical efficacy of acupotomy release therapy under the theory of sinew channels in the treatment of femoral head necrosis. Methods A total of 82 patients diagnosed with femoral head necrosis who underwent hip-preserving treatment at Beijing Hepingli Hospital from May 2020 to May 2023 were selected as the study subjects. The patients were randomly divided into an observation group and a control group using a random number table，with 41 patients in each group. The control group received hip joint rehabilitation training combined with sinew channel massage therapy，while the observation group received acupotomy release therapy under the theory of sinew channels in addition to the treatment given to the control group. for 6 months of treatment. Changes in the Visual Analogue Scale （VAS） scores of pain，hip joint range of motion，and Harris scores were observed before and after treatment. Additionally， serum levels of 5-hydroxytryptamine （5-HT）， substance P （SP），calcitonin gene-related peptide （CGRP），and neuropeptide Y （NPY） were compared between the two groups before and after treatment. Results （1） After treatment， the VAS scores of both groups were significantly improved （P＜0.05）， and the observation group showed significantly better improvement in VAS scores compared to the control group，with a statistically significant difference （P＜0.05）.（2） After treatment， the hip joint range of motion improved significantly in both groups （P＜0.05），and the observation group showed significantly better improvement in hip joint range of motion compared to the control group， with a statistically significant difference（P＜0.05）.（3） After treatment， the excellent and good rate of hip joint function in the observation group was 95.12%（39/41），while it was 78.05%（32/41） in the control group. The observation group had a significantly higher excellent and good rate of hip joint function compared to the control group， with a statistically significant difference（P＜0.05）.（4） After treatment，the levels of 5-HT，SP，CGRP，and NPY improved significantly in both groups（P＜0.05）， and the observation group showed significantly better improvement in these levels compared to the control group，with a statistically significant difference（P＜0.05）. Conclusion Acupotomy release therapy under the theory of sinew channels in the treatment of femoral head necrosis can significantly alleviate pain symptoms and improve hip joint function in patients. Its analgesic mechanism may be related to the regulation of neurotransmitter levels and the restoration of their balance.

R246.9

国家自然科学基金资助项目（编号：81873322）