目的：观察针刀松解结筋病灶点联合手穴膝点针刺治疗膝骨关节炎（KOA） 的临床效果。方法：将72 例KOA 患者随机分为治疗组与对照组各36 例，对照组行普通针刺治疗，治疗组行针刀松解结筋病灶点联合手穴膝点针刺治疗，均治疗6 周。比较2 组治疗前后中医证候积分、膝关节疼痛视觉模拟评分法（VAS） 评分、膝关节活动度、膝关节西安大略大学和麦克马斯特大学骨关节炎指数（WOMAC） 评分及血清前列腺素E2（PGE2）、β-内啡肽（β-EP），并比较2 组临床总有效率及不良反应发生率。结果：治疗组总有效率94.12%，高于对照组75.76%（P＜0.05）。与同组治疗前比较，治疗后2 组中医证候积分均降低（P＜0.05）；与对照组治疗后比较，治疗组治疗后中医证候积分较低（P＜0.05）。与同组治疗前比较，治疗3 周、6 周后2 组VAS 评分及疼痛、僵硬、日常活动难度评分、WOMAC 总分均降低（P＜0.05），膝关节活动度均增大（P＜0.05）；与对照组治疗3 周、6 周后比较，治疗组同期VAS 评分及疼痛、僵硬、进行日常活动难度评分、WOMAC 总分均较低（P＜0.05），膝关节活动度均较大（P＜0.05）。与同组治疗前比较，治疗后2 组血清PGE2 水平降低（P＜0.05），β-EP 水平升高（P＜0.05）；与对照组治疗后比较，治疗组治疗后血清PGE2 水平较低（P＜0.05），β-EP 水平较高（P＜0.05）。2 组不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：针刀松解结筋病灶点联合手穴膝点针刺治疗KOA 患者可明显调节PGE2 与β-EP 水平，有效缓解疼痛，增加关节活动度，改善中医证候及膝关节功能，提高临床疗效，且安全性高。
Abstract：Objective：To observe the clinical effect of needle knife loosening tendon lesion combined with Xidian of hand point acupuncture on knee osteoarthritis(KOA). Methods： A total of 72 patients with KOA were randomly divided into the treatment group and the control group， with 36 cases in each group. The control group was treated with routine acupuncture，and the treatment group was treated with needle knife loosening tendon lesion combined with Xidian of hand point acupuncture. Both groups were treated for six weeks. Before and after treatment， the Chinese medicine syndrome scores，scores of Visual Analogue Scale(VAS) for knee joint pain，range of motion of knee joint，scores of Western Ontario and McMaster Universities Arthritis Index(WOMAC)，and levels of serum prostaglandin E2(PGE2) and β-endorphin(β-EP) in the two groups were compared. The clinical effective rates and incidence of adverse reactions in the two groups were compared. Results：The total effective rate was 94.12% in the treatment group，higher than that of 75.76% in the control group(P＜0.05). After treatment，the Chinese medicine syndrome scores in the two groups were decreased when compared with those before treatment(P＜0.05)； the Chinese medicine syndrome score in the treatment was lower than that in the treatment group(P＜0.05). After three weeks and six weeks of treatment，the VAS scores，scores of pain，stiffness，and difficulty of daily activities and total scores of WOMAC in the two groups were decreased when compared with those before treatment(P＜0.05)， and the range of motion of knee joint was larger(P＜0.05)； after three weeks and six weeks of treatment， the VAS score， scores of pain， stiffness and difficulty of daily activities and total score of WOMAC in the treatment group were lower than those in the control group at the same period(P＜0.05)，and the range of motion of knee joint was lager(P＜0.05). After treatment， the levels of serum PGE2 were decreased when compared with those before treatment(P＜0.05)， and the levels of β- EP were increased(P＜0.05)； after treatment， the level of serum PGE2 in the treatment was lower than that in the control group(P＜0.05)， and the level of β- EP was higher(P＜0.05). There was no significant difference being found in the comparison of incidence of adverse reactions between the two groups(P＞0.05). Conclusion： The therapy of needle knife loosening tendon lesion combined with Xidian of hand point acupuncture can significantly regulate the levels of PGE2 and β-EP in patients with KOA，effectively relieve the pain，increase the range of motion of joint and improve the Chinese medicine syndromes，knee joint function and clinical effects，with high safety.