基于“从筋论治”理论的针刺联合高频电刀松解术治疗髌股疼痛综合征的疗效研究

Acupuncture Combined with High-Frequency Electrosurgical Dissection for Patellofemoral Pain Syndrome Based on the Theory of “Treating from Tendons”

摘要: 目的：探讨基于“从筋论治”理论的针刺联合肌骨超声引导下高频电刀定点松解术治疗髌股疼痛综合征(Patellofemoral Pain Syndrome, PFPS)的临床疗效及安全性。方法：采用随机对照临床试验设计，选取2024年3月~2025年9月在眉山市中医医院骨伤·康复医学中心就诊的PFPS患者90例，采用随机数字表法分为针刺联合高频电刀组、运动治疗组及等待治疗组，每组30例。针刺联合高频电刀组给予针刺联合肌骨超声引导下高频电刀定点松解术治疗；运动治疗组给予关节功能训练；等待治疗组不进行干预。比较三组治疗前及治疗后6周西安大略与麦克马斯特大学骨关节炎指数(WOMAC)、视觉模拟疼痛评分(VAS)、Lysholm膝关节功能评分、三维步态分析指标及健康生活质量量表(SF-36)评分变化，同时观察不良反应情况。结果：治疗后6周，三组患者WOMAC评分、VAS评分均较治疗前明显下降(P < 0.05)，Lysholm评分及SF-36评分明显提高(P < 0.05)，其中针刺联合高频电刀组改善程度显著优于运动治疗组及等待治疗组(P < 0.05)。三维步态分析显示针刺联合高频电刀组膝关节运动学参数较治疗前明显改善。各组均未出现严重不良事件。结论：基于“从筋论治”理论的针刺联合肌骨超声引导下高频电刀定点松解术能够显著改善PFPS患者膝关节疼痛及功能障碍，提高生活质量，且安全性良好，为PFPS临床治疗提供了一种新的有效治疗方案。

Abstract: Objective: To explore the clinical efficacy and safety of acupuncture combined with high-frequency electrosurgical dissection under ultrasound guidance for the treatment of patellofemoral pain syndrome (PFPS) based on the theory of “treating from tendons”. Methods: A randomized controlled clinical trial design was adopted. From March 2024 to September 2025, 90 patients with PFPS who visited the Department of Orthopedics and Rehabilitation Medicine Center of Meishan Traditional Chinese Medicine Hospital were selected. They were divided into the acupuncture combined with high-frequency electrosurgical dissection group, the exercise therapy group, and the waiting treatment group by random number table method, with 30 cases in each group. The acupuncture combined with high-frequency electrosurgical dissection group was treated with acupuncture combined with high-frequency electrosurgical dissection under ultrasound guidance; the exercise therapy group received joint function training; the waiting treatment group did not receive any intervention. The changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale for Pain (VAS), Lysholm knee joint function score, three-dimensional gait analysis indicators, and Health-related Quality of Life Scale (SF-36) scores before treatment and 6 weeks after treatment were compared among the three groups. Meanwhile, adverse reactions were observed. Results: After 6 weeks of treatment, the WOMAC score and VAS score of all three groups decreased significantly compared with those before treatment (P < 0.05), and the Lysholm score and SF-36 score improved significantly (P < 0.05). The improvement degree of the acupuncture combined with high-frequency electrosurgical dissection group was significantly better than that of the exercise therapy group and the waiting treatment group (P < 0.05). The three-dimensional gait analysis showed that the kinematic parameters of the knee joint in the acupuncture combined with high-frequency electrosurgical dissection group improved significantly compared with those before treatment. No serious adverse events occurred in all groups. Conclusion: Based on the theory of “treating from tendons”, acupuncture combined with high-frequency electrosurgical dissection under ultrasound guidance can significantly improve knee joint pain and functional impairment in patients with PFPS, improve quality of life, and has good safety. It provides a new and effective treatment option for the clinical treatment of PFPS.