【目的】观察筋针联合中药熏洗治疗湿瘀痹阻型膝骨关节炎（KOA）的临床疗效。【方法】选取2024 年3 月至2025 年3月 于深圳市中医院筋伤科病房及门诊收治的80 例明确诊断为KOA 的患者为研究对象，采用随机数字表法将以上受试者随机分 为观察组和对照组，每组各40 例。对照组给予舒筋活络洗剂治疗。观察组在对照组治疗的基础上，给予筋针治疗。连续治 疗4 周。治疗1 个月后，评价2 组临床疗效。观察2 组患者治疗前后西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评 分、疼痛视觉模拟量表（VAS）评分、中医证候积分的变化情况，以及血清白细胞介素（IL）-1β、肿瘤坏死因子（TNF）-α、基 质金属蛋白酶（MMP）-3 的情况。比较2 组患者治疗前后Ⅱ型胶原羧基端肽（CTX- Ⅱ）、软骨寡聚基质蛋白（COMP）和成纤维 细胞生长因子（FGF）-2 水平的变化情况。治疗结束6 个月后，随访2 组患者的复发情况，比较复发率。【结果】（1）研究过程 中，对照组脱落2 例，观察组脱落3 例。最终观察组37 例、对照组38 例纳入疗效统计。（2）治疗后，2 组患者的WOMAC 评 分、VAS 评分、中医证候积分均明显改善（P＜0.05），且观察组在改善WOMAC 评分、VAS 评分、中医证候积分方面明显优 于对照组，差异有统计学意义（P＜0.05）。（3）治疗后，2 组患者的TNF-α、IL-1β、MMP-3 水平明显改善（P＜0.05），且观察 组在改善TNF-α、IL-1β、MMP-3 水平方面明显优于对照组，差异有统计学意义（P＜0.05）。（4）治疗后，2 组患者的CTX-Ⅱ、 COMP、FGF-2 含量明显改善（P＜0.05），且观察组在改善CTX- Ⅱ、COMP、FGF-2 含量方面明显优于对照组，差异有统计 学意义（P＜0.05）。（5）观察组总有效率为86.49%（32/37），对照组为73.68%（28/38）。观察组疗效优于对照组，差异有统计学 意义（P＜0.05）。（6）治疗结束后6 个月随访，观察组复发率为8.33%（3/36），对照组为26.47%（9/34）。观察组复发率明显低于 对照组，差异有统计学意义（P＜0.05）。【结论】筋针联合中药熏洗治疗湿瘀痹阻型KOA，可明显缓解患者的疼痛症状，改善 患者的膝关节功能，调节炎性因子及骨代谢相关指标水平，临床疗效显著且复发率低。

Objective To observe the clinical efficacy of tendon-needling（a tendon-specific acupuncture technique）combined with herbal fumigation and washing in treating knee osteoarthritis（KOA）of dampness-stasis obstruction type. Methods A total of 80 patients definitively diagnosed with KOA and treated in the inpatient wards and outpatient clinics of the Department of Tendon Injury，Shenzhen Traditional Chinese Medicine Hospital from March 2024 to March 2025 were enrolled as study subjects. Using a random number table method，the participants were randomly divided into an observation group and a control group，with 40 cases in each group. The control group received treatment with Shujin Huoxue Lotion（Tendon-Relaxing and Collateral-Activating Lotion）. The observation group received tendon-needling treatment in addition to the treatment given to the control group. Both groups were treated continuously for 4 weeks. After one month of treatment，the clinical efficacy was evaluated in both groups. Changes in the Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）score， Visual Analogue Scale（VAS）score，and traditional Chinese medicine（TCM）syndrome score，as well as serum levels of interleukin（IL）-1β，tumor necrosis factor（TNF）-α，and matrix metalloproteinase（MMP）-3，were observed before and after treatment in both groups. Changes in levels of C-telopeptide of type Ⅱ collagen（CTX-Ⅱ）， cartilage oligomeric matrix protein（COMP），and fibroblast growth factor（FGF）-2 were compared between the two groups before and after treatment. Six months after the completion of treatment，recurrence in both groups was followed up，and recurrence rates were compared. Results（1）During the study，2 cases dropped out from the control group and 3 cases from the observation group. Finally，37 cases in the observation group and 38 cases in the control group were included in the efficacy analysis.（2）After treatment，WOMAC scores，VAS scores，and TCM syndrome scores were significantly improved in both groups（P＜0.05），and the improvements in WOMAC scores，VAS scores，and TCM syndrome scores were significantly greater in the observation group than in the control group，with statistically significant differences（P＜0.05）.（3）After treatment，the levels of TNF-α， IL-1β，and MMP-3 were significantly improved in both groups（P＜0.05），and the improvements in TNF-α， IL-1β，and MMP-3 levels were significantly greater in the observation group than in the control group，with statistically significant differences（P＜0.05）.（4）After treatment，the levels of CTX- Ⅱ，COMP，and FGF-2 were significantly improved in both groups（P＜0.05），and the improvements in CTX- Ⅱ，COMP，and FGF-2 levels were significantly greater in the observation group than in the control group，with statistically significant differences（P＜0.05）.（5）The total effective rate was 86.49%（32/37）in the observation group and 73.68% （28/38）in the control group. The efficacy in the observation group was superior to that in the control group，and the difference was statistically significant（P＜0.05）.（6）At the 6-month follow-up after treatment completion， the recurrence rate was 8.33%（3/36）in the observation group and 26.47%（9/34）in the control group. The recurrence rate in the observation group was significantly lower than that in the control group，with a statistically significant difference（P＜0.05）. Conclusion Tendon-needling combined with herbal fumigation and washing for treating KOA of dampness-stasis obstruction type can significantly alleviate patients’pain symptoms，improve their knee joint function，and regulate levels of inflammatory factors and bone metabolism-related indicators， demonstrating significant clinical efficacy and a low recurrence rate.

R246.9

国家自然科学基金资助项目（编号：81804167）；广东省中医药局科研资助项目（编号：20241280）；深圳市中医院“3030 计划” 中医临床研究项目