[1]杨美平,侯宇,林方政,等.膝骨关节炎“髓损”的发病机制与防治[J].中医正骨,2026,38(02):56-59.
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膝骨关节炎“髓损”的发病机制与防治()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第38卷
期数:
2026年02期
页码:
56-59
栏目:
学术探讨
出版日期:
2026-02-20

文章信息/Info

作者:
杨美平1侯宇1林方政2曾小龙1李永津1林定坤1
1.广东省中医院,广东 广州 510120; 2.新黄埔中医药联合创新研究院,广东 广州 510530
关键词:
骨关节炎 髓损 中医病机 治疗学
摘要:
膝骨关节炎(knee osteoarthritis,KOA)是一种常见的慢性筋骨病,其核心病机为筋骨失衡,具体表现为“筋劳”“节错”“骨变”“髓损”4个方面。KOA“髓损”的发生多始于“筋劳—节错—骨变”的递进式损伤,是KOA病变进程的关键环节,可分为“痛觉敏化型髓损”和“运动控制障碍型髓损”,前者主要表现为以膝关节痛觉敏化为主的感觉异常,后者主要表现为以膝周本体感觉受损、肌肉激活异常、步态失调为特征的运动控制异常。本文介绍了“髓损”的概念,对KOA“髓损”的发病机制与防治进行了探讨,为该病的临床诊疗提供了新的思路和参考。

参考文献/References:

[1] 王凯,昝树杰,徐家淳,等.中医“脑髓”的现代生物学基础探讨[J].中华中医药杂志,2024,39(2):566-570.
[2] BONDI D,ROBAZZA C,LANGE-KÜTTNER C,et al.Fine motor skills and motor control networking in developmental age[J].Am J Hum Biol,2022,34(8):e23758.
[3] GAO Z,PANG Z,CHEN Y,et al.Restoring after central nervous system injuries:neural mechanisms and translational applications of motor recovery[J].Neurosci Bull,2022,38(12):1569-1587.
[4] SROKOVA S,AKTAS A N Z,KOEN J D,et al.Dissociative effects of age on neural differentiation at the category and item levels[J].J Neurosci,2024,44(4):e0959232023.
[5] JONES R,RATNAKUMAR N,AKBAS K,et al.Delayed center of mass feedback in elderly humans leads to greater muscle co-contraction and altered balance strategy under perturbed balance:a predictive musculoskeletal simulation study[J].PLoS One,2024,19(5):e0296548.
[6] 林方政,陈树东,林定坤,等.基于筋骨失衡论慢性筋骨病的辨证分型理念及治疗[J].上海中医药杂志,2021,55(12):6-11.
[7] 林方政,林定坤,陈树东,等.基于“筋伤、节错、骨病”辨证探讨膝骨关节炎的治疗策略[J].中华中医药杂志,2022,37(10):5832-5836.
[8] TANG Y L,WANG Z Y,CAO J,et al.Bone-brain crosstalk in osteoarthritis:pathophysiology and interventions[J].Trends Mol Med,2025,31(3):281-295.
[9] RANKIN J,RUDY-FROESE B,HOYT C,et al.Quantitative sensory testing protocols to evaluate central and peripheral sensitization in knee OA:a scoping review[J].Pain Med,2022,23(3):526-557.
[10] HUNTER D J,BIERMA-ZEINSTRA S.Osteoarthritis[J].Lancet,2019,393(10182):1745-1759.
[11] 郑义,康凯,王智杰,等.中枢敏化及其对膝关节骨关节炎临床治疗的影响[J].中华老年骨科与康复电子杂志,2020,6(4):243-247.
[12] YAO Q,WU X,TAO C,et al.Osteoarthritis:pathogenic signaling pathways and therapeutic targets[J].Signal Transduct Target Ther,2023,8(1):56.
[13] CUNHA J E,BARBOSA G M,DE CASTRO P A T S,et al.Knee osteoarthritis induces atrophy and neuromuscular junction remodeling in the quadriceps and tibialis anterior muscles of rats[J].Sci Rep,2019,9(1):6366.
[14] TAYFUR B,CHARUPHONGSA C,MORRISSEY D,et al.Neuromuscular joint function in knee osteoarthritis:a systematic review and meta-analysis[J].Ann Phys Rehabil Med,2023,66(2):101662.
[15] PUROHIT R,BHATT T.Mobile brain imaging to examine task-related cortical correlates of reactive balance:a systematic review[J].Brain Sci,2022,12(11):1487.
[16] 杨扬,万凤,侯晓梦,等.熟地黄中促神经干细胞增殖活性的成分研究[J].中南药学,2024,22(5):1201-1206.
[17] 孙梦璐.何首乌对衰老和神经退行性疾病的干预作用及机制研究[D].上海:同济大学,2022.
[18] 王瀚泽.菟丝子促神经干细胞增殖的活性成分研究[D].北京:北京中医药大学,2021.
[19] VINTS W A J,LEVIN O,FUJIYAMA H,et al.Exerkines and long-term synaptic potentiation:mechanisms of exercise-induced neuroplasticity[J].Front Neuroendocrinol,2022,66:100993.
[20] HWANG E,PORTILLO B,GROSE K,et al.Exercise-induced hypothalamic neuroplasticity:implications for energy and glucose metabolism[J].Mol Metab,2023,73:101745.
[21] YUAN X C,WANG Q,SU W,et al.Electroacupuncture potentiates peripheral CB2 receptor-inhibited chronic pain in a mouse model of knee osteoarthritis[J].J Pain Res,2018,11:2797-2808.
[22] 杨昆吾,袁普卫,董博,等.电针对膝骨性关节炎大鼠痛行为及脊髓背角和背根神经节中疼痛相关因子含量的影响[J].针刺研究,2020,45(10):818-822.
[23] LYU Z,GUO Y,GONG Y,et al.The role of neuroglial crosstalk and synaptic plasticity-mediated central sensitization in acupuncture analgesia[J].Neural Plast,2021,2021:8881557.
[24] GAO N,SHI H,HU S,et al.Acupuncture enhances dorsal raphe functional connectivity in knee osteoarthritis with chronic pain[J].Front Neurol,2022,12:813723.
[25] 秦丽.基于背根神经节PKC-P2X3通路探讨推拿干预神经病理性疼痛的外周镇痛机制研究[D].福州:福建中医药大学,2020.
[26] 马安琪.“以痛为腧”按压法对臂丛神经损伤大鼠的镇痛作用及脑内机制研究[D].上海:上海中医药大学,2019.
[27] 何天翔,孔令军,周鑫,等.基于静息态功能磁共振探析腰痛中医推拿镇痛起效机制[J].中华中医药杂志,2023,38(8):3887-3890.
[28] STENBÄCK V,LEHTONEN I,MÄKELÄ K A,et al.Effect of single session of Swedish massage on circulating levels of interleukin-6 and insulin-like growth factor 1[J].Int J Mol Sci,2024,25(17):9135.
[29] MONTI E,TAGLIAFERRI S,ZAMPIERI S,et al.Effects of a 2-year exercise training on neuromuscular system health in older individuals with low muscle function[J].J Cachexia Sarcopenia Muscle,2023,14(2):794-804.
[30] HUERTAS A M,MORTON A B,HINKEY J M,et al.Modification of neuromuscular junction protein expression by exercise and doxorubicin[J].Med Sci Sports Exerc,2020,52(7):1477-1484.
[31] TIBURCIO F C,LEITE A P S,MULLER K S,et al.Effects of nandrolone decanoate on skeletal muscle and neuromuscular junction of sedentary and exercised rats[J].Medicina(Kaunas),2023,59(11):1940.

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备注/Memo

备注/Memo:
基金项目:2021年岐黄学者支持项目(国中医药人教函〔2022〕6号); 林定坤广东省名中医传承工作室建设项目(0103030912); 广东省中医院“岭南骨伤科流派传承工作室”建设项目(中医二院〔2013〕233号); 广东省中医院青年项目(YN2023QN17)
通信作者:侯宇 E-mail:houyu@gzucm.edu.cn
(收稿日期:2025-03-14 本文编辑:杨雅)
更新日期/Last Update: 2026-02-20