基于经筋理论的肩周炎中西医结合诊疗研究进展

Research Progress on Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Shoulder Periarthritis Based on the Meridian Sinew Theory

摘要: 肩关节周围炎是临床常见的慢性筋骨疾病，以肩部疼痛和进行性活动受限为主要特征。经筋理论作为中医经络学说的重要组成部分，为肩周炎的诊疗提供了独特的理论视角。近年来，随着肌骨超声等现代影像技术的引入以及肌筋膜链、生物力学等现代医学理论的交叉融合，基于经筋理论的肩周炎中西医结合诊疗取得了显著进展。本文以经筋理论为理论基石，以中西医结合诊疗为组织主线，从病机认识的中西医融合、诊断方法的结合、治疗策略的结合模式以及疗效评价的客观化四个维度，系统梳理该领域的研究进展。研究发现，经筋理论与肌筋膜链理论存在高度对应关系，肌骨超声使“筋结”定位从触诊经验走向影像客观化；治疗上形成了经筋手法联合关节松动术、经筋针法联合西药、针刀联合现代微创技术、经筋功法联合康复训练等多种结合模式；“可视化经筋解结”假说为疗效机制阐释提供了新框架。然而，当前仍存在经筋结点定位标准不统一、高质量随机对照试验匮乏、疗效评价体系不完善等问题。未来应深化多学科交叉研究，推进多中心大样本临床试验，加强超声多模态成像与人工智能辅助评估等新技术的应用，建立统一的经筋结点定位标准和疗效评价体系，促进中西医结合诊疗方案的规范化推广。

Abstract: Shoulder periarthritis is a common chronic musculoskeletal disease characterized by shoulder pain and progressive limitation of motion. As an important component of the meridian theory in traditional Chinese medicine, the meridian sinew theory provides a unique theoretical perspective for the diagnosis and treatment of shoulder periarthritis. In recent years, with the introduction of modern imaging techniques such as musculoskeletal ultrasound and the cross-integration of modern medical theories including myofascial chains and biomechanics, significant progress has been made in the integrated traditional Chinese and Western medicine diagnosis and treatment of shoulder periarthritis based on the meridian sinew theory. Taking the meridian sinew theory as the theoretical foundation and the integrated traditional Chinese and Western medicine diagnosis and treatment as the organizing thread, this paper systematically reviews the research progress in this field from four dimensions: the integration of pathogenesis understanding, the combination of diagnostic methods, the integrated treatment strategies, and the objectification of efficacy evaluation. The study finds that the meridian sinew theory is highly correlated with the myofascial chain theory, and musculoskeletal ultrasound has enabled the localization of “sinew knots” to shift from palpation experience to imaging objectification. In terms of treatment, various integrated modes have been formed, including meridian sinew manipulation combined with joint mobilization, meridian sinew acupuncture combined with Western medicine, acupotomy combined with modern minimally invasive techniques, and meridian sinew exercises combined with rehabilitation training. The hypothesis of “visualized sinew knot release” provides a new framework for explaining the therapeutic mechanism. However, problems remain, such as inconsistent localization standards for meridian sinew knots, lack of high-quality randomized controlled trials, and an imperfect efficacy evaluation system. Future efforts should deepen multidisciplinary cross-research, promote multi-center large-sample clinical trials, strengthen the application of new technologies such as multimodal musculoskeletal ultrasound and artificial intelligence-assisted assessment, establish unified localization standards and efficacy evaluation systems for meridian sinew knots, and promote the standardized application of integrated traditional Chinese and Western medicine diagnosis and treatment protocols.