刘建民　刘晶

[摘要] 根据古代文献对经筋的论述和阐释，本文深入分析膝骨性关节炎与经筋理论的关系，认识到膝部经筋弓弦力学特性维系了膝关节的正常生理功能。当经筋受损，会在其循行线路尤其是经筋“结”“聚”部位出现结节病灶，导致病变部位的疼痛和功能障碍。基于经筋弓弦力学特点，结合现代医学及生物力学对膝骨性关节炎认识的启示，本文探索针刀治疗膝骨性关节炎的优势和机制，认为膝关节经筋弓弦特性指导针刀治疗膝骨性关节炎，能够体现中医整体观和筋骨并重，一方面丰富了中医学治疗膝骨性关节炎的理论，另一方面为提高针刀治疗膝骨性关节炎的临床效果提供了新思路。

[关键词] 经筋理论；膝骨性关节炎；针刀疗法；弓弦力学

[中图分类号] R684.3 [文献标识码] A [文章编号] 1673-7210（2017）09（c）-0161-04

[Abstract] According to the discourse and interpretation of ancient classics for aponeurotic system， this paper analyzes the relationship of knee osteoarthritis and aponeurotic system theory deeply， and realizes that the characteristics of aponeurotic system and bowstring mechanics of knee maintain the normal physiological function of knee joint. When the aponeurotic system is damaged， nodular lesions will be appeared in the following lines， especially in the "knot" and "conglobulation" parts of aponeurotic system， which leads to the pain and dysfunction of lesion site. Based on the characteristics of aponeurotic system and bowstring mechanics， combining with the revelation of the understanding of modern medicine and biomechanics for knee osteoarthritis， this paper explores the advantage and mechanism of acupotomy in the treatment of knee osteoarthritis， it is considered that acupotomy in the treatment of knee osteoarthritis guided by the characteristics of aponeurotic system and bowstring of knee joint can reflect the holism concept of Chinese medicine and equal importance of muscles and bones. On the one hand， it enriches the theory of traditional Chinese medicine in the treatment of knee osteoarthritis， on the other hand， it provides a new idea for improving the clinical effect of acupotomy in the treatment of knee osteoarthritis.

[Key words] Aponeurotic system theory； Knee osteoarthritis； Acupotomy therapy； Bowstring mechanics

膝骨性关节炎（KOA）是中年以后最常见的慢性、退行性关节疾病，临床主要表现为膝关节疼痛、肿胀、功能障碍，甚至引起关节严重畸形导致丧失行走能力，给患者带来了严重的不良后果[1]。随着我国社会人口老龄化，KOA患者人群日益增加，有流行病学调查显示，我国60岁以上老年人群体中KOA患病率达18%[2]，按當前我国老年2.2亿人口计算，全国老年人KOA患者竟达4千万，由此产生的医疗负担和社会经济负担对我国当前医疗提出了严峻挑战。结合现代医学对于KOA的防治认识，如何发挥祖国传统医学优势应对KOA疾病成为当前医学研究热点，笔者从中医学经筋理论和经筋弓弦特性出发，分析针刀疗法治疗KOA的优势，以期为临床提供有效借鉴。……