中西医结合治疗髌股关节炎的研究进展

Research Progress on Integrated Traditional Chinese and Western Medicine Treatment of Patellofemoral Arthritis

摘要: 髌股关节炎(PFOA)作为膝骨关节炎(KOA)的重要亚型，是影响中老年人群生活质量的常见关节退行性疾病。西医学认为生物力学失衡是PFOA的核心病理机制，伴随促炎因子驱动的软骨退变，其治疗遵循阶梯化原则，从运动康复、药物保守治疗到关节镜、力线纠正、软骨修复乃至关节置换等手术逐层递进。中医将PFOA归属于“膝痹”范畴，认为其病机以肝肾亏虚为本、风寒湿邪痹阻及气滞血瘀为标，治疗上强调辨证论治与整体调节，以中药内服外用、针灸、针刀、推拿等为特色手段。本文主要对中医、西医及两者结合治疗PFOA的现有的研究成果与临床实践进行综述，从现代医学视角解读“补肝肾”“活血化瘀”等中医病机和治法的分子机制，简要探讨不同结合模式的协同机制。

Abstract: Patellofemoral Osteoarthritis (PFOA), an important subtype of Knee Osteoarthritis (KOA), is a common degenerative joint disease affecting the quality of life of middle-aged and elderly populations. Western medicine considers biomechanical imbalance as the core pathological mechanism of PFOA, accompanied by cartilage degeneration driven by pro-inflammatory factors. Its treatment follows a stepwise principle, progressively advancing from exercise rehabilitation and drug conservative therapy to arthroscopy, alignment correction, cartilage repair, and even joint replacement surgeries. Traditional Chinese Medicine (TCM) classifies PFOA under the category of “Xibì” (knee obstruction). It holds that the pathogenesis is rooted in deficiency of liver and kidney, with wind-cold-damp pathogenic factors blocking the meridians and qi stagnation with blood stasis as the manifestations. In treatment, TCM emphasizes syndrome differentiation and overall regulation, employing characteristic methods such as internal and external use of Chinese herbal medicines, acupuncture, needling knife, and tuina. This article primarily reviews existing research findings and clinical practices on the treatment of PFOA by TCM, Western medicine, and their integration. From a modern medical perspective, it interprets the molecular mechanisms of TCM pathogenesis and therapeutic approaches such as ‘nourishing liver and kidney’ and ‘activating blood and resolving stasis,’ and briefly explores the synergistic mechanisms of different integration models.