膝关节骨性关节炎各期经筋辨证及相关证素研究
|
摘要
膝骨性关节炎(knee osteoarthritis, KOA)是一种以关节软骨变性破坏、骨质增生、髌骨软化、韧带炎症钙化为特征的慢性关节病,该病多发于中老年人,严重影响其生活质量。随着人口老龄化问题的日益严重,其发病率也明显增加。本研究对KOA临床各期的中医证候病机及膝关节局部经筋病变的特点进行研究,探讨其规律,为该病的临床分期、综合治疗提供依据。
目的：在前期研究的基础上,进一步对KOA临床三期的中医证候病机进行研究,并观察病变膝关节的经筋病变特点,探讨证素与经筋病变的关系,以实现局部经筋辨证与整体脏腑辨证的统一,为KOA的分期、综合治理提供依据。
方法：通过临床观察,对符合KOA诊断、临床分期的232例患者进行临床观察。中医证候特征研究主要采用证素辨证的方法,对早、中、晚三期KOA患者的证素进行调查；然后采对常见证素进行聚类分析,以获得KOA常见中医证型；采用频数分析的方法,对KOA患者膝关节的经筋病变特点进行研究,并对各期病变经筋的中医证素分布进行观察,分析经筋病变与中医证素的相关性。根据临床观察结果,结合中医理论,探讨KOA整体脏腑辨证与膝关节局部经筋辨证的临床参考意义。
结果：本研究发现,本研究对所获得证素取其频数在5%以上共10个,包括病位证素、虚证证素、实证证素(肾、肝、脾、气虚、血虚、阳虚、瘀血、湿邪、气滞、痰浊)。结合临床,聚类分析的结果分为8类较为合理,包括四个证型：肾虚兼气滞血瘀、脾肾亏虚兼湿邪下注、肝肾亏虚兼瘀血、肝肾亏虚兼痰瘀阻滞。KOA早期可见肾虚兼气滞血瘀,中期证型可见脾肾亏虚兼湿邪下注、肝肾亏虚兼瘀血；晚期证型以肝肾亏虚兼痰瘀阻滞。385个病变膝关节中,属于单一经筋病变的共有129个,以阳明、少阳为主；二经复合型的病变关节有207个,包括阳明太阳型、阳明少阳型、阳明三阴型、少阳太阳型；三经复合型有49个关节,包括阳明太阳少阳型、阳明太阳三阴型、少阳太阳三阴等。膝关节局部经筋的病变以阳明经筋为主,但早期以单一经筋型为主,中期以二经复合型为主,晚期以三经复合型为主。阳明经筋病变在KOA患者中所占比例最大,该经筋病灶分布也最多。本次研究中尚未发现单一的太阳经筋证型,但是本研究中该经筋常和其它经筋合并出现。KOA三期患者各期均以阳明经筋为主,早期除阳明经筋外,依次分别为少阳、三阴和太阳经筋；中期除阳明经筋病变外分别为太阳、三阴、少阳经筋病变为主；晚期除阳明经筋最多外,其次分别为太阳、三阴、少阳经筋。经筋病变的病灶点在各期并不相同,早期以自觉疼痛、压痛为主,中期以疼痛、压痛、增厚、肿胀、皮色改变、络脉迂曲为主,晚期除疼痛、压痛外,尚有增厚、结节、结块等表现。中医证素在经筋中的分布表明,经筋与相应脏腑并无直接相关性,但在早期、中期,阳明、太阳经筋常见湿邪证素,少阳可见气滞证素,三阴可见气虚、血虚证素,但在晚期,经筋病变与证素之间并无显着联系。各期KOA患者不论在脏腑病变还是在经筋病变上在各期均各有特点,反映了KOA临床各期的特征和演变。
结论：证素和聚类分析的研究表明,KOA是以肾虚为基础,此外还有肝脾亏虚,以及血瘀、痰湿等病理因素；该病是一个渐进的临床过程,在不同临床阶段,则又有不同特征。早期证型可见肾虚兼气滞血瘀,中期证型可见脾肾亏虚兼湿邪下注、肝肾亏虚兼瘀血；晚期证型以肝肾亏虚兼痰瘀阻滞。局部经筋病变的研究表明,膝骨关节炎的经筋病变以阳明经筋为主,早、中、晚期病灶随病程而逐渐加重；KOA病变涉及的经筋随病程而逐渐增加；早期、中期,病变经筋与相应脏腑病机有一定联系,但在晚期表现并不明显,晚期各个经筋病变,整体以肝肾亏虚、痰瘀阻滞为特征,具体到各个病变经筋,则有不同之处,阳明经筋常兼有各个证素；太阳首见瘀血；少阳以常兼血虚；三阴以常兼血虚、阳虚及其它证素。
中医证素病机与其所属经筋的既区别又联系,表明经筋不入脏腑、病变时独立演变的特点,表明了整体的脏腑病机与膝关节局部病变的辩证统一。
Osteoarthritis of knee joint (KOA) is a kind of joint disease with articular cartilage injury.hyperosteogeny chondromalacia patella and inflammatory of ligaments. It often occurs at people over middle age,which badly influences the health and has become the primary reason of people in middle and old age and causing chronic disability.This thesis studied the characteristics of knee osteoarthritis models at different stages by meridian tendons and syndrome elements of TCM.The study will provide reference for clinical therapy for KOA through the research.
Objective:Study the clinical pathological mechanism and the characteristics of syndrome elements and meridian tendons to three stage of KOA On the basis of previous studies in order to realize the local meridian syndrome differentiation and whole organs dialectical unity,and provide reference for clinical therapy for KOA.
Methods:Method232cases that accorded with operational standard of diagnosis to different clinical staging of KOA through clinical observation. Study on characteristics of TCM Syndromes mainly observe the early, metaphase and late stagse through the syndrome element investigation. And classify the element classification through the cluster analysis mathematical of statistics method which get the common TCM Syndromes to KOA. Using frequency analysis method study KOA patients with knee tendons disease research.Study the relevance of meridian tendons and syndrome elements to KOA.
Results:The study on acquired syndrome shows that there have10syndromes which frequency more than5%of a total patients, including the position of disease syndrome factor deficiency syndrome, empirical syndrome (kidney, liver, spleen qi deficiency, blood deficiency, blood stasis, deficiency of Yang, Qi, dampness, phlegm,). A combination of clinical, cluster analysis results into8categories is more reasonable, including four syndromes:kidney deficiency and stagnation of Qi and blood stasis, spleen and kidney deficiency and damp wager, liver and kidney deficiency and blood stasis, liver and kidney deficiency and phlegm stasis block.The KOA patients have different characteristic to every period by visceral syndrome differentiation or meridian tendons. Patients at early stage have kidney deficiency and qi stagnation and blood stasis. Metaphase patients have deficiency of spleen and stomach with pouring of dampness, deficiency of the liver and kidney with blood stasis. The late stagse have deficiency of the liver and kidney with stagnation of phlegm-stasis. In385abnorma knees joint, there have129knees belonging to a single tendon lesions, which Include Yang-ming, Shaoyang; there have207joints belong two compound disease, including Yang sun, Yangming Shaoyang, Yangming three negative, Yangming solar type; three has49joints whicih belong the composite, including the Yangming sun sun sun, Yang Yin type three, type three, Shaoyang sun shade. Pathological changes to early stage of meridian tendons is mainly yang-ming,and metaphase is mainly two meridian tendons, the late stagse is mainly three meridian tendons.Three have no direct correlation to the tendons of syndrome element on meridian tendons.While yang-ming and tai-yang tendons have the distribution of dampness and three yin have the distribution of blood deficiency and qi deficiency.This features Indicate tendons do not enter the Viscera.
Conclusion:Kidney deficiency is the pathological basis with the deficiency of spleen and stomach and qi stagnation and blood stasis, phlegm-dampness to KOA through the research. It is a gradual process which have different characteristic at different periods.It realize the unify of the overall zang-fu differentiation and local meridian tendons differentiation.
目的：在前期研究的基础上,进一步对KOA临床三期的中医证候病机进行研究,并观察病变膝关节的经筋病变特点,探讨证素与经筋病变的关系,以实现局部经筋辨证与整体脏腑辨证的统一,为KOA的分期、综合治理提供依据。
方法：通过临床观察,对符合KOA诊断、临床分期的232例患者进行临床观察。中医证候特征研究主要采用证素辨证的方法,对早、中、晚三期KOA患者的证素进行调查；然后采对常见证素进行聚类分析,以获得KOA常见中医证型；采用频数分析的方法,对KOA患者膝关节的经筋病变特点进行研究,并对各期病变经筋的中医证素分布进行观察,分析经筋病变与中医证素的相关性。根据临床观察结果,结合中医理论,探讨KOA整体脏腑辨证与膝关节局部经筋辨证的临床参考意义。
结果：本研究发现,本研究对所获得证素取其频数在5%以上共10个,包括病位证素、虚证证素、实证证素(肾、肝、脾、气虚、血虚、阳虚、瘀血、湿邪、气滞、痰浊)。结合临床,聚类分析的结果分为8类较为合理,包括四个证型：肾虚兼气滞血瘀、脾肾亏虚兼湿邪下注、肝肾亏虚兼瘀血、肝肾亏虚兼痰瘀阻滞。KOA早期可见肾虚兼气滞血瘀,中期证型可见脾肾亏虚兼湿邪下注、肝肾亏虚兼瘀血；晚期证型以肝肾亏虚兼痰瘀阻滞。385个病变膝关节中,属于单一经筋病变的共有129个,以阳明、少阳为主；二经复合型的病变关节有207个,包括阳明太阳型、阳明少阳型、阳明三阴型、少阳太阳型；三经复合型有49个关节,包括阳明太阳少阳型、阳明太阳三阴型、少阳太阳三阴等。膝关节局部经筋的病变以阳明经筋为主,但早期以单一经筋型为主,中期以二经复合型为主,晚期以三经复合型为主。阳明经筋病变在KOA患者中所占比例最大,该经筋病灶分布也最多。本次研究中尚未发现单一的太阳经筋证型,但是本研究中该经筋常和其它经筋合并出现。KOA三期患者各期均以阳明经筋为主,早期除阳明经筋外,依次分别为少阳、三阴和太阳经筋；中期除阳明经筋病变外分别为太阳、三阴、少阳经筋病变为主；晚期除阳明经筋最多外,其次分别为太阳、三阴、少阳经筋。经筋病变的病灶点在各期并不相同,早期以自觉疼痛、压痛为主,中期以疼痛、压痛、增厚、肿胀、皮色改变、络脉迂曲为主,晚期除疼痛、压痛外,尚有增厚、结节、结块等表现。中医证素在经筋中的分布表明,经筋与相应脏腑并无直接相关性,但在早期、中期,阳明、太阳经筋常见湿邪证素,少阳可见气滞证素,三阴可见气虚、血虚证素,但在晚期,经筋病变与证素之间并无显着联系。各期KOA患者不论在脏腑病变还是在经筋病变上在各期均各有特点,反映了KOA临床各期的特征和演变。
结论：证素和聚类分析的研究表明,KOA是以肾虚为基础,此外还有肝脾亏虚,以及血瘀、痰湿等病理因素；该病是一个渐进的临床过程,在不同临床阶段,则又有不同特征。早期证型可见肾虚兼气滞血瘀,中期证型可见脾肾亏虚兼湿邪下注、肝肾亏虚兼瘀血；晚期证型以肝肾亏虚兼痰瘀阻滞。局部经筋病变的研究表明,膝骨关节炎的经筋病变以阳明经筋为主,早、中、晚期病灶随病程而逐渐加重；KOA病变涉及的经筋随病程而逐渐增加；早期、中期,病变经筋与相应脏腑病机有一定联系,但在晚期表现并不明显,晚期各个经筋病变,整体以肝肾亏虚、痰瘀阻滞为特征,具体到各个病变经筋,则有不同之处,阳明经筋常兼有各个证素；太阳首见瘀血；少阳以常兼血虚；三阴以常兼血虚、阳虚及其它证素。
中医证素病机与其所属经筋的既区别又联系,表明经筋不入脏腑、病变时独立演变的特点,表明了整体的脏腑病机与膝关节局部病变的辩证统一。
Osteoarthritis of knee joint (KOA) is a kind of joint disease with articular cartilage injury.hyperosteogeny chondromalacia patella and inflammatory of ligaments. It often occurs at people over middle age,which badly influences the health and has become the primary reason of people in middle and old age and causing chronic disability.This thesis studied the characteristics of knee osteoarthritis models at different stages by meridian tendons and syndrome elements of TCM.The study will provide reference for clinical therapy for KOA through the research.
Objective:Study the clinical pathological mechanism and the characteristics of syndrome elements and meridian tendons to three stage of KOA On the basis of previous studies in order to realize the local meridian syndrome differentiation and whole organs dialectical unity,and provide reference for clinical therapy for KOA.
Methods:Method232cases that accorded with operational standard of diagnosis to different clinical staging of KOA through clinical observation. Study on characteristics of TCM Syndromes mainly observe the early, metaphase and late stagse through the syndrome element investigation. And classify the element classification through the cluster analysis mathematical of statistics method which get the common TCM Syndromes to KOA. Using frequency analysis method study KOA patients with knee tendons disease research.Study the relevance of meridian tendons and syndrome elements to KOA.
Results:The study on acquired syndrome shows that there have10syndromes which frequency more than5%of a total patients, including the position of disease syndrome factor deficiency syndrome, empirical syndrome (kidney, liver, spleen qi deficiency, blood deficiency, blood stasis, deficiency of Yang, Qi, dampness, phlegm,). A combination of clinical, cluster analysis results into8categories is more reasonable, including four syndromes:kidney deficiency and stagnation of Qi and blood stasis, spleen and kidney deficiency and damp wager, liver and kidney deficiency and blood stasis, liver and kidney deficiency and phlegm stasis block.The KOA patients have different characteristic to every period by visceral syndrome differentiation or meridian tendons. Patients at early stage have kidney deficiency and qi stagnation and blood stasis. Metaphase patients have deficiency of spleen and stomach with pouring of dampness, deficiency of the liver and kidney with blood stasis. The late stagse have deficiency of the liver and kidney with stagnation of phlegm-stasis. In385abnorma knees joint, there have129knees belonging to a single tendon lesions, which Include Yang-ming, Shaoyang; there have207joints belong two compound disease, including Yang sun, Yangming Shaoyang, Yangming three negative, Yangming solar type; three has49joints whicih belong the composite, including the Yangming sun sun sun, Yang Yin type three, type three, Shaoyang sun shade. Pathological changes to early stage of meridian tendons is mainly yang-ming,and metaphase is mainly two meridian tendons, the late stagse is mainly three meridian tendons.Three have no direct correlation to the tendons of syndrome element on meridian tendons.While yang-ming and tai-yang tendons have the distribution of dampness and three yin have the distribution of blood deficiency and qi deficiency.This features Indicate tendons do not enter the Viscera.
Conclusion:Kidney deficiency is the pathological basis with the deficiency of spleen and stomach and qi stagnation and blood stasis, phlegm-dampness to KOA through the research. It is a gradual process which have different characteristic at different periods.It realize the unify of the overall zang-fu differentiation and local meridian tendons differentiation.
引文
[1]陈灏珠.实用内科学[M].北京：人民卫生出版社,2001：2356-2359.
[2]江艳,李荣亨,曹文富.骨关节炎中药治疗研究进展.实用中医药杂志,2007,23(5)：336-337.
[3]许建荣,柴维敏.膝类风湿性关节炎和骨关节炎的MRI表现特点和比较骨骼肌肉放射学.临床放射学杂志,2001,20(11)：862-864.
[4]陈百成,张静.骨关节炎[M].1版.北京：人民卫生出版社,2004：3-13,18-19.
[5]Felson DT. Epidemiologic of rheumatic disease. In:Arthistis and Allieol conditions:A Textbook of Rhermatology (13th ed), Koopman WJ ed. Baltimor, Williams and Wikins,1998:3-34.
[6]Felson DT, Nevitt MC. The effects of estrogen on osteoarthritis. Curr Opin Rheumatol,1998; 10:269-272.
[7]Felson DT, Andeson JJ, Naimark A, er al. Obesity and knee osteoarthritis, The Framingham Studv. Ann Intern Med,1988;109:18-24.
[8]Felson DT, Zhang YQ, Marian T, et al. Arthritis Rheum,1997; 40 (4):728-733.
[9]Cicutini FM, Spector T. Baker J. Risk factors for osteoarthritis in the tibiofemoral and patellofemoral joints of the knee. J Rheumatol,1997, 24:1164-1167.
[10]郭世绂.骨关节炎与骨质疏松.骨质疏松和骨矿盐疾病-基础与临床,2002,12：2.
[11]Hart DJ, Mootoosamy I, Doyk DV, e 七 al. Ann Rheum Dis.1994; 53:158-162.
[12]Burger H, Pavlvs LAVD, Odding E, et al. Arthritis Rheum.1996:39 (1):81-86.
[13]Schouteo JSAG, Quwdand VDFA, Volkenburg HA, et al. Br J Rheuma.1993; 32:274-280.
[14]Tew SR. Kwom API et al. The reaistion of articular cartilage to experimental wounding. Arthristis Rhirm.2000,43:215-225.
[15]Felson DT. Preventing knee and hip osteoarthritis. Bull Rheum Dis,1998. 47:1-4.
[16]Lane NE. Ann Rheum Dis,1996; 55 (9):671-673.
[17]Slemenda C, Heilman DK, Brandt KD,et al. Relative to body weight relative to baody weight:a rise factor for knee osteoarthrit is in women Arthritis Rheum, 1998; 41:1951-1959.
[18]Slemenda C, Brandt KD, Heilman D, et al. Quadriceps weakness and osteoarthritis oft the knee. Ann Intern Med,1997;127:97-104.
[19]Hurley MV, Newham DJ. The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early unilateral osteoarthritic knees. Br J Rheumatol,1993:32:127-131.
[20]Jordan J, Luta G, Rener J, et al. Knee pain and knee osteoarthritis severity in self-reported task specific disability:the Johnston County osteoarthritis project. J Rheumatol,1997,24:1344-1349.
[21]王玉泉,守敏,柴举龙蛋白多糖与骨性关节炎的研究[]中医正骨,2005；17(4)：60.
[22]肖经难,谢丹.骨性关节炎的中西医研究进展.湖南中医学院学报,2003,23(2)：62-64.
[14]陈利新,马少云,莫卫海,等.膝骨性关节炎中医证型与炎症介质、神经多肽和免疫细胞因子的关系.中医正骨,2007,19(2)：14-15.
[23]林木南,刘放祥.OA护膝治疗膝骨性关节炎的临床研究.福建中医药,2006,37(6)：16-17.
[24]Pelletier JP, Dibattista JA, Roughley P, et al. ytokines and inflammation in cartilage degradation. Rheum Dis Clin North Am,1993;19:545-568.
[25]Mccord. TM. Free radicas and inflammotion. Science,1994; 185:529-531 Merry P, Grootreld M, Lanec J, et al. Oxidative damage to lipids with the inflamed human provides evidence of radical-mediated hypoxic-reperfusion injury. Am J Clin Nutr,1991; 56:362-369.
[26]YoshiharaY, NakamuraH, ObataK, eta.1 Matrixmetalloprotinases and tissue inhibitors ofmetalloproteinases in synovial fluid from pa-tientswith rheumatoid arthritis or osteoarthritis [J]. Ann Rheum Dis,2000,59:455-461.
[27]陈利新,马少云,莫卫海,等.膝骨性关节炎中医证型与炎症介质、神经多肽和免疫细胞因子的关系.中医正骨,2007,19(2)：14-15.
[28]贺宪,魏春山,蔡智刚,等.膝骨性关节炎的病机和防治机制探讨.山东中医杂志,2005,24(2)：74-75.
[29]Hashimoto S, Setareh M, Roseen F, et al. Fas/Fas ligand expression and induction of apoptosis in chondrocytes · Arthritis Rheum,1997,40(10):1749.
[30]Erlacher L, Maier R, Ullrich R, et al. Differential expression of the protooncogene bcl-2 in normal and osteoarthritic human articular cartilage. J Rheumatol,1995,22 (5):926.
[31]Lotz M, Hashimo S, Kuhn K.Mechanisms of chondmcy teap optosis. Osteoarthritis Cartilage,1999;7 (4):389.
[32]李宏宇,安洪.骨内高压症的研究现状和进展.广西医学,2005,27(1)：87-90.
[33]毛宾尧,刘洪涛.胫、股骨内压与膝关节疼痛关系的研究和治疗方法探讨[J].骨与关节损伤杂志.1992：7(4)：206.
[34]陈清汉,许振华,刘家勇,等.膝部疼痛与骨内压关系的临床研究[J].中华骨科杂志,1996；16(1)：25-27.
[35]何永清,孙仲旎,王坤正.骨内高压与退行性膝关节病关系的临床研究[J].中国骨伤,1999；12(6)：3-4.
[36]郭开今,王业华.静脉回流对膝关节骨内压影响的动态观察.徐州医学院学报,1995;15(4)：389-390.
[37]Blanco F,orol ixferation Lotz M. IL-1 induced nitric oxide inhibits chondrocytes via PGE2. FASEB T:1994:8 (1):365-371.
[38]Francisco JB, Robert L0, Herbert S, et al. Chondrocyte apoptosiss induced by nitric oxide. Am. T Path,1995:146:75-85.
[39]张静,张为.骨关节炎的诊断与治疗进展.现代康复,20015(3)：14-16.
[40]谭文成,查振刚.膝骨性关节炎关节液分析研究进展.现代医院,2006,6(3)：10-13.
[41]Sing H G, Fort J G, Goldstein J L, et al. Celecoxib Versus Naproxen and Diclofeuac in Osteoarthritis Patients:SUCCESS-I Study. Am J Med,2006, 119 (3):255-266.
[42]Chen L C, Ashcroft D M. Risk of Myocardial infarction associated with selective COX-2 Inhibitors:Meta-analysis of Randomised Controlled Trials. Pharmacoepidemiol Drug Saf,2007,16(7):762-772.
[43]施桂英.骨性关节炎的药物治疗进展.中华全科医师杂志,2003,2(6)：341-343.
[44]江湘宝,高李侠.盐酸氨基葡萄糖治疗退行性骨性关节炎的临床观察.中国修复重建外科杂志,2008,22(1)：29.
[45]Reginster J Y, Deroisy R, Rovati L C, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression:a randomized, placebo-controlled clinical trial. Lancet,2001,357:251-256.
[46]施桂英.骨性关节炎的药物治疗进展.中华全科医师杂志,2003,2(6)：341-343.
[47]邓伟.补脾益肾化瘀法治疗膝骨关节炎.中药材.2003,26(7)：535.
[48]Pelletier JP, Yaron M, Harsoui B, et al. Efficacy and safety of diacerelin in osteoarthritis of the knee:a double-blind, placebo-controlled trial. The Discerein Study Group. Arthritis Rheum,2000,43:2339-2348.
[49]陈汝岭,李谦,侯仲军,等.透明质酸钠治疗膝骨性关节炎的临床评价.中国骨与关节损伤杂志,2007,22(9)：752-754.
[50]章军辉,陈永强.透明质酸钠及其衍生物在骨科的应用.国外医学·骨科学分册,2002,23(11)：248.
[51]Gossec L, Dougados M. Intra-articular treatments in osteoarthritis:from the symptomatic to the structure modifying. Ann RheumDis,2004,63 (5):478-482.
[52]Fukuda K. Intra-articular injection of hyaluronan for the treatment of knee osteoarthritis.Clin Calcium,2004,14 (7):104-107.
[53]章权.膝骨性关节炎的药物治疗进展.中国中医骨伤科杂志,2009,17(8)：70-72.
[54]McInnes IB, Liew FY, Gracie JA. Interleukin-18:a therapeutic target in rheumatoid arthritis? Arthritis Res Ther,2005,7(1):38-41.
[55]Frisbie NN, Mcwraith CW. Evaluation of gene therapy as atreatment for equine traumatic arthritis and osteoarthritis. Clin Orthop,2000 379 (Suppl):273-287.
[56]吴剑锋,余斌,胡言君,等.臭氧对骨性关节炎的近期疗效.南方医科大学学报,2008,28(5)：905.
[57]湛川,于方,安久力,等.低能量激光照射膝眼穴治疗膝骨性关节炎的疗效.中国激光医学杂志,2007,16(2)：126.
[58]邹远云,张云卫,吴敏.连续滴注冲洗后局部封闭治疗膝关节OA72例.骨与关节损伤杂志,1999,14(1)：69.
[59]敖邦华,姜杉,时广敬,等.OA液加膝关节镜清理治疗骨性关节炎78例.中国骨伤,1998,11(6)：45.
[60]陆庄樵,谭干,宋立坚,等.关节镜冲洗液治疗膝关节骨关节炎.中华骨科杂志,1990,10(4)：281.
[61]Joseph A B, Andrew G C. Lateral elease for patellofemoral arthritis. Arthroscopy,2002,4:399.
[62]Cole BJ, Hamer CD. Degenerative arthritis of the knee in active patients: evaluation and management.J Am Acad Orthop Surg,1999,7:389-402.
[63]Bert JM. Role of abrasion arthroplasty and debridement of osteoarthritis of the knee. Rheum at Dis Clin North America,1993,19:725-730.
[64]胥少汀,葛宝丰,徐印坎.实用骨科学(第三版).北京：人民军医出版社,2005,1340-1343.
[65]Marotii G. The osteocyte as a wiring transmission system. J Musculoskeletal Neuronal Interact,2001,1:133-136.
[66]王韶进,刘琦,戴国峰,等.人工全膝关节置换术治疗严重膝骨关节炎.山东医药,2003,43(3)：1-3.
[67]王庆甫,黄沪.膝关节骨性关节炎的X线影像学分析.中国骨伤,2000,13(6)：348-349.
[68]Superio-Cabuslay E, Ward], Lorig KR. Patient education interventions in osteoarthritis and rheumatoid arthritis:a meta analytic comparison with nonsteroidal anti-inflammatory rug treatment. Arthritis Care Res,1996; 9:292-301.
[69]孙铁铮,吕厚山.骨关节炎的诊治与研究进展.继续医学教育.2005,19(3)：47.
[70]石印玉,徐荣喜,陈友红.养血软坚方治疗膝骨关节炎的临床报告.中国中医骨伤科,1994,2(4)：33-36.
[71]刘玉兰.中药治疗骨性关节炎疼痛136例.江苏中医,1997,18(6)：26.
[72]孙年祥.补肾活血法治疗骨关节炎30例.实用中医药杂志,1997,13,(6)：16.
[73]陈泽文,喻友军.骨痹汤治疗膝关节骨性关节炎82例总结.湖南中医杂志,2002,18(3)：22-23.
[74]陈建鸿.中医中药治疗膝关节骨关节炎54例临床体会.中国中医骨伤科杂志,1995,3(6)：36-38.
[75]范明,员士忠.中医治疗膝关节增生性关节炎的临床体会.辽宁中医杂志,1984,12(12)：22.
[76]刘柏龄.退行性脊椎炎1000例临床分析.辽宁中医杂志,1982,9(3)：40-41.
[77]吴登清.自拟骨质灵治疗骨质增生症628例.国医论坛,1994,9(6)：19-21.
[78]娄玉钤,娄高峰.娄多峰教授治疗老年性膝骨关节炎65例临床总结.国医论坛,1993,8(1)：28.
[79]王春秋.骨痹通治疗膝关系骨性关节炎92例.四川中医,2003,21(4)：67-68.
[80]龙志坚.牛膝通痹汤治疗膝关节骨关节炎疗效观察.中国现代实用医学杂志,2004,3(5)：78-80.
[81]王世彪,郁俊文,张建军等.骨痹威灵丸治疗骨性关节炎临床研究.中国中医骨伤科杂志,2004,12(3)：41-42.
[82]黎立,武文婕,张俊忠.蠲痹合剂治疗骨性关节炎的临床观察.中国中西医结合外科杂志,2004,10(4)：250-251.
[83]刘荣顺,司文顺,沈志刚等.蠲痹通络胶囊治疗膝关节骨性关节炎200例.中医杂志,2004,45(11)：867-868.
[84]江伟达,郑效文,郑清波.中药关节Ⅲ号方治疗家兔膝骨关节炎实验研究[J].中国中医骨伤科,1994,2(1)：1-3.
[85]朱正刚.疗骨丸治疗膝关节增生性关节炎42例临床观察[J].中医杂志,1992,33(11)：38-39.
[86]曹月龙,郑昱新,石印玉等.养血软坚胶囊治疗膝骨关节炎疗效及安全性评价的随机对照试验.中国药物与临床,2004,4(6)：423-424.
[87]刘德玉.李堪印教授治疗骨性关节炎临床经验.陕西中医学院学报,1999,22(1)：19.
[88]陈炳坤.当归四逆汤加减治疗膝关节骨性关节炎85例疗效观察.中医正骨,1995,7(5)：30-31.
[89]刘金陵.补肝汤加减治疗骨性膝关节炎76例.广西中医药,1995,18(2)：10-11.
[90]刘安定,雷波,杨少锋.化瘀软坚法治疗骨性关节炎35例报告.中国中医骨伤科杂志,1998,6(2)：38-39.
[91]陈广祯,李心沁,梁安民.从瘀血痰湿论治膝关节骨性关节炎[J].中医正骨,1998,10(4)：31.
[92]李恒敏.软坚化瘀法治疗骨关节病.中医杂志,1995,36(3)：147-148.
[93]杜秀兰.增生消痛汤治疗增生性膝关节痛55例.山东中医杂志1994,13(1)：14.
[94]邢锋.自制复方风湿康治疗骨关节炎68例临床观察.安徽中医临床杂志,1998,10(6)：371-372.
[95]任峰.益气养血通络法(治血痹法)对小鼠骨关节病的实验研究.上海中医药杂志,1994,28(7)：41-42.
[96]曾淑红.寄生汤加减治疗膝骨关节炎128例.陕西中医,2006,27(8)：946.
[97]陈南星.补气活血法治疗膝部骨关节炎临床应用体会.光明中医.1998,13(3)：48.
[98]杜引平.齐刺治疗老年性膝骨性关节炎50例.湖北中医杂志,2002,24(7)：49.
[99]张金贵.针灸治疗膝关节骨性关节炎60例疗效观察.针灸临床杂志,2003,19(11)：21-22.
[100]陈翔飞.拔河针法治疗退行性膝关节炎38例.针灸临床杂志,1998,4(5)：30-31.
[101]姚志芳,黄晓卿,张炜.温针灸与单纯针刺治疗膝关节骨性关节炎疗效观察比较[J].针灸临床杂志,2003,19(7)：32-33.
[102]谷建林.温针灸加中药治疗膝关节骨性关节炎的体会[J].中医临床医学研究杂志,2003,70(7)：11663-11664.
[103]侯中伟,郑萍.砭石温通法治疗退行性膝关节炎36例临床观察.北京中医药大学学报(中医临床版).2010,17(2)：33-35.
[104]吴际.生电针治疗膝骨关节炎36例.针灸临床杂志,2002；18(4)：27.
[105]李兰敏,张立夫,杨会道.电针治疗中老年骨性关节炎165例.针灸临床杂志,1997,13(10)：27-28.
[106]周光辉.电针疗法缓解膝关节骨关节炎疼痛的疗效.中国临床康复,2004；8(20)：4082.
[107]任宗曲.电针透刺结合推拿治疗退行性膝关节炎68例.湖北民族学院学报·医学版2007Vo.1 24 No.3：70.
[108]张国祥,刘忠文.小针刀治疗膝关节骨性关节炎体会.右江民族医学院学报,1999,(5)：839.
[109]吕桂芬.小针刀与温针灸结合治疗膝骨性关节炎58例.辽宁中医学院学报,2004,6(6)：482.
[110]胡平安,张利萍.小针刀治疗膝关节骨性关节炎68例.中国中医药科技,2003,10(3)：135
[111]李宁,吴滨,张永铃.艾灸配合运动疗法治疗膝关节骨性关节炎疗效观察[J].中国针灸,2002,22(11)：729-730.
[112]张建平.电针加温和灸治疗退行性膝关节炎67例疗效观察.针灸临床杂志.2003,19(10)：31-32.
[113]倪凌.手法治疗膝骨关节病58例[J].中国骨伤,1994,7(2),27-28.
[114]谢利民.张涛研究员治疗膝关节软骨退行性疾病的手法特点.中医正骨,1999,11(5),51.
[115]谢利民,张涛.张氏推拿法治疗膝关节软骨退行性疾病的临床疗效评价.中医正骨,2000,12(4),8-10.
[116]于福军.按摩治疗增生性膝关节炎12例临床体会.按摩与导引.2002,18(3)：47-48.
[117]王铂欣,赵登芳等.熏洗液治疗骨性膝关节炎185例.中国骨伤1994,7(5)：37-38.
[118]李申影,韩颖萍,李玉彦.麻沸通痹散外敷治疗骨关节病230例报告.中医正骨,1999,11(3)：26.
[119]王峰.中药外用治疗膝关节骨性关节炎的临床观察.安徽中医学院学报,2004,23(5)：8-9.
[120]卢勇,吕发明,孟庆才.天龙镇痛浴液治疗关节骨性关节炎356例报告.中医正骨,1996,8(5)：26.
[121]卢勇,吕发明,孟庆才.天龙镇痛浴液治疗膝关节骨性关节炎356例报告.中医正骨,1996,8(5)：26.
[122]姜洪洋,薛剑冰,程云峰中药熏洗治疗膝关节骨性关节炎例报告中医正骨,2004；16(7)：50.
[123]刘访文.中药熏洗治疗膝关节骨关节炎.江苏中医.2000；21(11)：37.
[124]周启慧.通痹止痛膏治疗原发性骨性关节炎120例总结.湖南中医杂志,2002,18(1)：13-14.
[125]吴建民,宋贵杰.自拟二乌南星散酒炒外敷治疗膝关节骨关节病.中医正骨,2000； 12(1)：47.
[126]魏会东.乌鸡膏治疗膝关节骨性关节炎260例.山东中医杂志,2001；20(2)：94-95.
[127]刁维珍,毕鸿雁,伊长松.中药离子导入治疗退行性膝骨关节炎1000例疗效分析.东中医药大学学报.2003,27(3)：199-200.
[128]陈利新,马少云,莫卫海.中药离子导入治疗膝关节骨性关节炎例临床报告.医学理论与实践.2003；16(5)：557-558.
[129]尹东利.郑丽敏.余莹.江必明.电脑中频中药透入治疗老年慢性疼痛的疗效观察.中国老年学杂志.2005(1)：99.
[130]陈日兰.针灸结合药物治疗膝骨性关节炎86例[J].医学文选,2004,23(6)：758.
[131]刘霞.针刺配合中药热敷治疗膝骨性关节炎36例[J].江苏中医药,2005,26(2)：35-36.
[132]蒋戈利,肖蕾,李坚将等.四步针药疗法治疗膝骨性关节炎疗效分析[J].上海针灸杂志,2005,24(3)：12-13.
[133]张文柱,霍禹痴.增生性膝关节炎的临床治疗观察.天津中医,1993,(2)：27.
[134]朱文锋.中医主症鉴别诊断学[M].长沙：湖南科学技术出版社,2000：316-331.
[135]李灿东,甘慧娟,朱文锋.腑病等病位证素特征症的提取[J].福建中医药,2008,39(2)：1-3.
[136]李水健,方肇勤,邸若虹.聚类分析在中医药研究中的应用与思考.中国中医药信息杂态,2001,8(6)：8.
[137]孟庆刚,郭书文.如何将数学方法应用于现代中医药研究[J].中国中医药信息杂志,2000,7(8)：21.
[138]邓晋丰,钟广玲.骨伤科专病中医临床诊治.[M].北京：人民卫生出版社,2000,第一版：231.
[135]黄国良,孙材江.正确认识和对待“骨质增生”问题[J].中国现代实用医学杂志.2004,3(3)：4344.
[136]马建兵,刘德玉,李湛印,等.中药对家兔实验性膝关节骨性关节炎氧化自由基代谢的影响[J].中医正骨,2000；12(1)：8.
[137]汪青春,沈培芝,徐宇.不同方药治疗膝骨关节炎的组织形态学对比研究[J].中国中医骨伤科,1998；6(2)：1.
[138]周尊谦,谢林,孙达武.丹紫康膝冲剂治疗膝关节退行性骨关节病临床研究.中医骨伤,1999；12(2)：49.
[139]王文瑞,刘宏泽,卫小春,等.川芎素防治膝关节软骨退变的实验研究.中国骨伤,2004：17(2)：80-82.
[140]郑秀媛等.现代运动生物力学.第1版.北京.国防工业出版社.2002：398-407.
[141]薛立功,张海荣.经筋理论与临床疼痛诊疗学].第1版.北京.中国中医药出版社.2002：8-14,45-46,523-536.
[142]Moskowitz等着,王学谦等译.骨关节炎诊断与治疗[M].第1版.天津：天津科技翻译出版公司.2005：3,87,296.
[143]徐卫东,吴岳嵩等.骨关节炎的诊断与治疗.第2版.上海.第二军医大学出版社.2004：1,4,8-20,63-64.
[144]刘金洪.肩凝症从经筋论治60例.南京中医药大学学报,1995,11(5)：28-29.
[145]徐辉.经筋刺动态针法治疗急性软组织损伤.中国临床康复,2005,9(2)：41.
[146]韦英才,梁树勇.经筋疗法治疗肱骨外上髁炎84例.辽宁中医杂志,2001,21(3)：155-157.
[147]黄敬伟.经筋疗法治疗怪病“肋端综合征”96例[J].中国民间疗法,1994,4：19.
[148]甘衍昌.经筋疗法治疗腰腹腿三联征128例.中国民族民间医药杂志,1996,19：19-21.
[149]田辉.经筋理论与腰椎间盘突出症发病机理探析.辽宁中医学院学报,2005,7(3)：209-210.
[150]岳增辉.经筋刺法治疗脑卒中后痉挛状态及疗效评价研究.中国中医药信息杂志,2001,8(4)：85-87.
[151]王以进,王介麟.骨科生物力学[M]1989,10.北京,人民军医出版社.296-297.
[152]柏树令.系统解剖学[M].2004.7.北京,人民卫生出版社.100-111.
[153]林建华,Shin DW, Athanasiou KA等.实验关节软骨生物力学性质随深度变化.中华骨科杂志,1998,18(8)：488.
[154]黄涛,黄昌林.运动对兔膝制动后血氧自由基的影响.中国运动医学杂志,2000,19(3)：317-319.
[155]杨红梅,罗颂椒.应力对体外培养软骨细胞影响的研究.国外医学·口腔医学分册,1999,26(4)：215-218.
[156]王亦璁编.膝关节外科的基础和临床.第1版.北京.人民卫生出版社.1999：40,364.
[157]周士枋,丁伯坦主编.运动学.第1版.北京.华夏出版社.2005：235-236.
[158]朱汉章着.针刀医学原理.第1版.北京.人民卫生出版社.2002：130-133,152-161.
[159]吴文豹等.颈肩腰腿痛推拿疗法.第1版.上海.同济大学出版社.1991：171-177.
[160]孟和,顾志华主编.骨伤科生物力学.第2版.北京.人民卫生出版社.1999：159-160.
[2]江艳,李荣亨,曹文富.骨关节炎中药治疗研究进展.实用中医药杂志,2007,23(5)：336-337.
[3]许建荣,柴维敏.膝类风湿性关节炎和骨关节炎的MRI表现特点和比较骨骼肌肉放射学.临床放射学杂志,2001,20(11)：862-864.
[4]陈百成,张静.骨关节炎[M].1版.北京：人民卫生出版社,2004：3-13,18-19.
[5]Felson DT. Epidemiologic of rheumatic disease. In:Arthistis and Allieol conditions:A Textbook of Rhermatology (13th ed), Koopman WJ ed. Baltimor, Williams and Wikins,1998:3-34.
[6]Felson DT, Nevitt MC. The effects of estrogen on osteoarthritis. Curr Opin Rheumatol,1998; 10:269-272.
[7]Felson DT, Andeson JJ, Naimark A, er al. Obesity and knee osteoarthritis, The Framingham Studv. Ann Intern Med,1988;109:18-24.
[8]Felson DT, Zhang YQ, Marian T, et al. Arthritis Rheum,1997; 40 (4):728-733.
[9]Cicutini FM, Spector T. Baker J. Risk factors for osteoarthritis in the tibiofemoral and patellofemoral joints of the knee. J Rheumatol,1997, 24:1164-1167.
[10]郭世绂.骨关节炎与骨质疏松.骨质疏松和骨矿盐疾病-基础与临床,2002,12：2.
[11]Hart DJ, Mootoosamy I, Doyk DV, e 七 al. Ann Rheum Dis.1994; 53:158-162.
[12]Burger H, Pavlvs LAVD, Odding E, et al. Arthritis Rheum.1996:39 (1):81-86.
[13]Schouteo JSAG, Quwdand VDFA, Volkenburg HA, et al. Br J Rheuma.1993; 32:274-280.
[14]Tew SR. Kwom API et al. The reaistion of articular cartilage to experimental wounding. Arthristis Rhirm.2000,43:215-225.
[15]Felson DT. Preventing knee and hip osteoarthritis. Bull Rheum Dis,1998. 47:1-4.
[16]Lane NE. Ann Rheum Dis,1996; 55 (9):671-673.
[17]Slemenda C, Heilman DK, Brandt KD,et al. Relative to body weight relative to baody weight:a rise factor for knee osteoarthrit is in women Arthritis Rheum, 1998; 41:1951-1959.
[18]Slemenda C, Brandt KD, Heilman D, et al. Quadriceps weakness and osteoarthritis oft the knee. Ann Intern Med,1997;127:97-104.
[19]Hurley MV, Newham DJ. The influence of arthrogenous muscle inhibition on quadriceps rehabilitation of patients with early unilateral osteoarthritic knees. Br J Rheumatol,1993:32:127-131.
[20]Jordan J, Luta G, Rener J, et al. Knee pain and knee osteoarthritis severity in self-reported task specific disability:the Johnston County osteoarthritis project. J Rheumatol,1997,24:1344-1349.
[21]王玉泉,守敏,柴举龙蛋白多糖与骨性关节炎的研究[]中医正骨,2005；17(4)：60.
[22]肖经难,谢丹.骨性关节炎的中西医研究进展.湖南中医学院学报,2003,23(2)：62-64.
[14]陈利新,马少云,莫卫海,等.膝骨性关节炎中医证型与炎症介质、神经多肽和免疫细胞因子的关系.中医正骨,2007,19(2)：14-15.
[23]林木南,刘放祥.OA护膝治疗膝骨性关节炎的临床研究.福建中医药,2006,37(6)：16-17.
[24]Pelletier JP, Dibattista JA, Roughley P, et al. ytokines and inflammation in cartilage degradation. Rheum Dis Clin North Am,1993;19:545-568.
[25]Mccord. TM. Free radicas and inflammotion. Science,1994; 185:529-531 Merry P, Grootreld M, Lanec J, et al. Oxidative damage to lipids with the inflamed human provides evidence of radical-mediated hypoxic-reperfusion injury. Am J Clin Nutr,1991; 56:362-369.
[26]YoshiharaY, NakamuraH, ObataK, eta.1 Matrixmetalloprotinases and tissue inhibitors ofmetalloproteinases in synovial fluid from pa-tientswith rheumatoid arthritis or osteoarthritis [J]. Ann Rheum Dis,2000,59:455-461.
[27]陈利新,马少云,莫卫海,等.膝骨性关节炎中医证型与炎症介质、神经多肽和免疫细胞因子的关系.中医正骨,2007,19(2)：14-15.
[28]贺宪,魏春山,蔡智刚,等.膝骨性关节炎的病机和防治机制探讨.山东中医杂志,2005,24(2)：74-75.
[29]Hashimoto S, Setareh M, Roseen F, et al. Fas/Fas ligand expression and induction of apoptosis in chondrocytes · Arthritis Rheum,1997,40(10):1749.
[30]Erlacher L, Maier R, Ullrich R, et al. Differential expression of the protooncogene bcl-2 in normal and osteoarthritic human articular cartilage. J Rheumatol,1995,22 (5):926.
[31]Lotz M, Hashimo S, Kuhn K.Mechanisms of chondmcy teap optosis. Osteoarthritis Cartilage,1999;7 (4):389.
[32]李宏宇,安洪.骨内高压症的研究现状和进展.广西医学,2005,27(1)：87-90.
[33]毛宾尧,刘洪涛.胫、股骨内压与膝关节疼痛关系的研究和治疗方法探讨[J].骨与关节损伤杂志.1992：7(4)：206.
[34]陈清汉,许振华,刘家勇,等.膝部疼痛与骨内压关系的临床研究[J].中华骨科杂志,1996；16(1)：25-27.
[35]何永清,孙仲旎,王坤正.骨内高压与退行性膝关节病关系的临床研究[J].中国骨伤,1999；12(6)：3-4.
[36]郭开今,王业华.静脉回流对膝关节骨内压影响的动态观察.徐州医学院学报,1995;15(4)：389-390.
[37]Blanco F,orol ixferation Lotz M. IL-1 induced nitric oxide inhibits chondrocytes via PGE2. FASEB T:1994:8 (1):365-371.
[38]Francisco JB, Robert L0, Herbert S, et al. Chondrocyte apoptosiss induced by nitric oxide. Am. T Path,1995:146:75-85.
[39]张静,张为.骨关节炎的诊断与治疗进展.现代康复,20015(3)：14-16.
[40]谭文成,查振刚.膝骨性关节炎关节液分析研究进展.现代医院,2006,6(3)：10-13.
[41]Sing H G, Fort J G, Goldstein J L, et al. Celecoxib Versus Naproxen and Diclofeuac in Osteoarthritis Patients:SUCCESS-I Study. Am J Med,2006, 119 (3):255-266.
[42]Chen L C, Ashcroft D M. Risk of Myocardial infarction associated with selective COX-2 Inhibitors:Meta-analysis of Randomised Controlled Trials. Pharmacoepidemiol Drug Saf,2007,16(7):762-772.
[43]施桂英.骨性关节炎的药物治疗进展.中华全科医师杂志,2003,2(6)：341-343.
[44]江湘宝,高李侠.盐酸氨基葡萄糖治疗退行性骨性关节炎的临床观察.中国修复重建外科杂志,2008,22(1)：29.
[45]Reginster J Y, Deroisy R, Rovati L C, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression:a randomized, placebo-controlled clinical trial. Lancet,2001,357:251-256.
[46]施桂英.骨性关节炎的药物治疗进展.中华全科医师杂志,2003,2(6)：341-343.
[47]邓伟.补脾益肾化瘀法治疗膝骨关节炎.中药材.2003,26(7)：535.
[48]Pelletier JP, Yaron M, Harsoui B, et al. Efficacy and safety of diacerelin in osteoarthritis of the knee:a double-blind, placebo-controlled trial. The Discerein Study Group. Arthritis Rheum,2000,43:2339-2348.
[49]陈汝岭,李谦,侯仲军,等.透明质酸钠治疗膝骨性关节炎的临床评价.中国骨与关节损伤杂志,2007,22(9)：752-754.
[50]章军辉,陈永强.透明质酸钠及其衍生物在骨科的应用.国外医学·骨科学分册,2002,23(11)：248.
[51]Gossec L, Dougados M. Intra-articular treatments in osteoarthritis:from the symptomatic to the structure modifying. Ann RheumDis,2004,63 (5):478-482.
[52]Fukuda K. Intra-articular injection of hyaluronan for the treatment of knee osteoarthritis.Clin Calcium,2004,14 (7):104-107.
[53]章权.膝骨性关节炎的药物治疗进展.中国中医骨伤科杂志,2009,17(8)：70-72.
[54]McInnes IB, Liew FY, Gracie JA. Interleukin-18:a therapeutic target in rheumatoid arthritis? Arthritis Res Ther,2005,7(1):38-41.
[55]Frisbie NN, Mcwraith CW. Evaluation of gene therapy as atreatment for equine traumatic arthritis and osteoarthritis. Clin Orthop,2000 379 (Suppl):273-287.
[56]吴剑锋,余斌,胡言君,等.臭氧对骨性关节炎的近期疗效.南方医科大学学报,2008,28(5)：905.
[57]湛川,于方,安久力,等.低能量激光照射膝眼穴治疗膝骨性关节炎的疗效.中国激光医学杂志,2007,16(2)：126.
[58]邹远云,张云卫,吴敏.连续滴注冲洗后局部封闭治疗膝关节OA72例.骨与关节损伤杂志,1999,14(1)：69.
[59]敖邦华,姜杉,时广敬,等.OA液加膝关节镜清理治疗骨性关节炎78例.中国骨伤,1998,11(6)：45.
[60]陆庄樵,谭干,宋立坚,等.关节镜冲洗液治疗膝关节骨关节炎.中华骨科杂志,1990,10(4)：281.
[61]Joseph A B, Andrew G C. Lateral elease for patellofemoral arthritis. Arthroscopy,2002,4:399.
[62]Cole BJ, Hamer CD. Degenerative arthritis of the knee in active patients: evaluation and management.J Am Acad Orthop Surg,1999,7:389-402.
[63]Bert JM. Role of abrasion arthroplasty and debridement of osteoarthritis of the knee. Rheum at Dis Clin North America,1993,19:725-730.
[64]胥少汀,葛宝丰,徐印坎.实用骨科学(第三版).北京：人民军医出版社,2005,1340-1343.
[65]Marotii G. The osteocyte as a wiring transmission system. J Musculoskeletal Neuronal Interact,2001,1:133-136.
[66]王韶进,刘琦,戴国峰,等.人工全膝关节置换术治疗严重膝骨关节炎.山东医药,2003,43(3)：1-3.
[67]王庆甫,黄沪.膝关节骨性关节炎的X线影像学分析.中国骨伤,2000,13(6)：348-349.
[68]Superio-Cabuslay E, Ward], Lorig KR. Patient education interventions in osteoarthritis and rheumatoid arthritis:a meta analytic comparison with nonsteroidal anti-inflammatory rug treatment. Arthritis Care Res,1996; 9:292-301.
[69]孙铁铮,吕厚山.骨关节炎的诊治与研究进展.继续医学教育.2005,19(3)：47.
[70]石印玉,徐荣喜,陈友红.养血软坚方治疗膝骨关节炎的临床报告.中国中医骨伤科,1994,2(4)：33-36.
[71]刘玉兰.中药治疗骨性关节炎疼痛136例.江苏中医,1997,18(6)：26.
[72]孙年祥.补肾活血法治疗骨关节炎30例.实用中医药杂志,1997,13,(6)：16.
[73]陈泽文,喻友军.骨痹汤治疗膝关节骨性关节炎82例总结.湖南中医杂志,2002,18(3)：22-23.
[74]陈建鸿.中医中药治疗膝关节骨关节炎54例临床体会.中国中医骨伤科杂志,1995,3(6)：36-38.
[75]范明,员士忠.中医治疗膝关节增生性关节炎的临床体会.辽宁中医杂志,1984,12(12)：22.
[76]刘柏龄.退行性脊椎炎1000例临床分析.辽宁中医杂志,1982,9(3)：40-41.
[77]吴登清.自拟骨质灵治疗骨质增生症628例.国医论坛,1994,9(6)：19-21.
[78]娄玉钤,娄高峰.娄多峰教授治疗老年性膝骨关节炎65例临床总结.国医论坛,1993,8(1)：28.
[79]王春秋.骨痹通治疗膝关系骨性关节炎92例.四川中医,2003,21(4)：67-68.
[80]龙志坚.牛膝通痹汤治疗膝关节骨关节炎疗效观察.中国现代实用医学杂志,2004,3(5)：78-80.
[81]王世彪,郁俊文,张建军等.骨痹威灵丸治疗骨性关节炎临床研究.中国中医骨伤科杂志,2004,12(3)：41-42.
[82]黎立,武文婕,张俊忠.蠲痹合剂治疗骨性关节炎的临床观察.中国中西医结合外科杂志,2004,10(4)：250-251.
[83]刘荣顺,司文顺,沈志刚等.蠲痹通络胶囊治疗膝关节骨性关节炎200例.中医杂志,2004,45(11)：867-868.
[84]江伟达,郑效文,郑清波.中药关节Ⅲ号方治疗家兔膝骨关节炎实验研究[J].中国中医骨伤科,1994,2(1)：1-3.
[85]朱正刚.疗骨丸治疗膝关节增生性关节炎42例临床观察[J].中医杂志,1992,33(11)：38-39.
[86]曹月龙,郑昱新,石印玉等.养血软坚胶囊治疗膝骨关节炎疗效及安全性评价的随机对照试验.中国药物与临床,2004,4(6)：423-424.
[87]刘德玉.李堪印教授治疗骨性关节炎临床经验.陕西中医学院学报,1999,22(1)：19.
[88]陈炳坤.当归四逆汤加减治疗膝关节骨性关节炎85例疗效观察.中医正骨,1995,7(5)：30-31.
[89]刘金陵.补肝汤加减治疗骨性膝关节炎76例.广西中医药,1995,18(2)：10-11.
[90]刘安定,雷波,杨少锋.化瘀软坚法治疗骨性关节炎35例报告.中国中医骨伤科杂志,1998,6(2)：38-39.
[91]陈广祯,李心沁,梁安民.从瘀血痰湿论治膝关节骨性关节炎[J].中医正骨,1998,10(4)：31.
[92]李恒敏.软坚化瘀法治疗骨关节病.中医杂志,1995,36(3)：147-148.
[93]杜秀兰.增生消痛汤治疗增生性膝关节痛55例.山东中医杂志1994,13(1)：14.
[94]邢锋.自制复方风湿康治疗骨关节炎68例临床观察.安徽中医临床杂志,1998,10(6)：371-372.
[95]任峰.益气养血通络法(治血痹法)对小鼠骨关节病的实验研究.上海中医药杂志,1994,28(7)：41-42.
[96]曾淑红.寄生汤加减治疗膝骨关节炎128例.陕西中医,2006,27(8)：946.
[97]陈南星.补气活血法治疗膝部骨关节炎临床应用体会.光明中医.1998,13(3)：48.
[98]杜引平.齐刺治疗老年性膝骨性关节炎50例.湖北中医杂志,2002,24(7)：49.
[99]张金贵.针灸治疗膝关节骨性关节炎60例疗效观察.针灸临床杂志,2003,19(11)：21-22.
[100]陈翔飞.拔河针法治疗退行性膝关节炎38例.针灸临床杂志,1998,4(5)：30-31.
[101]姚志芳,黄晓卿,张炜.温针灸与单纯针刺治疗膝关节骨性关节炎疗效观察比较[J].针灸临床杂志,2003,19(7)：32-33.
[102]谷建林.温针灸加中药治疗膝关节骨性关节炎的体会[J].中医临床医学研究杂志,2003,70(7)：11663-11664.
[103]侯中伟,郑萍.砭石温通法治疗退行性膝关节炎36例临床观察.北京中医药大学学报(中医临床版).2010,17(2)：33-35.
[104]吴际.生电针治疗膝骨关节炎36例.针灸临床杂志,2002；18(4)：27.
[105]李兰敏,张立夫,杨会道.电针治疗中老年骨性关节炎165例.针灸临床杂志,1997,13(10)：27-28.
[106]周光辉.电针疗法缓解膝关节骨关节炎疼痛的疗效.中国临床康复,2004；8(20)：4082.
[107]任宗曲.电针透刺结合推拿治疗退行性膝关节炎68例.湖北民族学院学报·医学版2007Vo.1 24 No.3：70.
[108]张国祥,刘忠文.小针刀治疗膝关节骨性关节炎体会.右江民族医学院学报,1999,(5)：839.
[109]吕桂芬.小针刀与温针灸结合治疗膝骨性关节炎58例.辽宁中医学院学报,2004,6(6)：482.
[110]胡平安,张利萍.小针刀治疗膝关节骨性关节炎68例.中国中医药科技,2003,10(3)：135
[111]李宁,吴滨,张永铃.艾灸配合运动疗法治疗膝关节骨性关节炎疗效观察[J].中国针灸,2002,22(11)：729-730.
[112]张建平.电针加温和灸治疗退行性膝关节炎67例疗效观察.针灸临床杂志.2003,19(10)：31-32.
[113]倪凌.手法治疗膝骨关节病58例[J].中国骨伤,1994,7(2),27-28.
[114]谢利民.张涛研究员治疗膝关节软骨退行性疾病的手法特点.中医正骨,1999,11(5),51.
[115]谢利民,张涛.张氏推拿法治疗膝关节软骨退行性疾病的临床疗效评价.中医正骨,2000,12(4),8-10.
[116]于福军.按摩治疗增生性膝关节炎12例临床体会.按摩与导引.2002,18(3)：47-48.
[117]王铂欣,赵登芳等.熏洗液治疗骨性膝关节炎185例.中国骨伤1994,7(5)：37-38.
[118]李申影,韩颖萍,李玉彦.麻沸通痹散外敷治疗骨关节病230例报告.中医正骨,1999,11(3)：26.
[119]王峰.中药外用治疗膝关节骨性关节炎的临床观察.安徽中医学院学报,2004,23(5)：8-9.
[120]卢勇,吕发明,孟庆才.天龙镇痛浴液治疗关节骨性关节炎356例报告.中医正骨,1996,8(5)：26.
[121]卢勇,吕发明,孟庆才.天龙镇痛浴液治疗膝关节骨性关节炎356例报告.中医正骨,1996,8(5)：26.
[122]姜洪洋,薛剑冰,程云峰中药熏洗治疗膝关节骨性关节炎例报告中医正骨,2004；16(7)：50.
[123]刘访文.中药熏洗治疗膝关节骨关节炎.江苏中医.2000；21(11)：37.
[124]周启慧.通痹止痛膏治疗原发性骨性关节炎120例总结.湖南中医杂志,2002,18(1)：13-14.
[125]吴建民,宋贵杰.自拟二乌南星散酒炒外敷治疗膝关节骨关节病.中医正骨,2000； 12(1)：47.
[126]魏会东.乌鸡膏治疗膝关节骨性关节炎260例.山东中医杂志,2001；20(2)：94-95.
[127]刁维珍,毕鸿雁,伊长松.中药离子导入治疗退行性膝骨关节炎1000例疗效分析.东中医药大学学报.2003,27(3)：199-200.
[128]陈利新,马少云,莫卫海.中药离子导入治疗膝关节骨性关节炎例临床报告.医学理论与实践.2003；16(5)：557-558.
[129]尹东利.郑丽敏.余莹.江必明.电脑中频中药透入治疗老年慢性疼痛的疗效观察.中国老年学杂志.2005(1)：99.
[130]陈日兰.针灸结合药物治疗膝骨性关节炎86例[J].医学文选,2004,23(6)：758.
[131]刘霞.针刺配合中药热敷治疗膝骨性关节炎36例[J].江苏中医药,2005,26(2)：35-36.
[132]蒋戈利,肖蕾,李坚将等.四步针药疗法治疗膝骨性关节炎疗效分析[J].上海针灸杂志,2005,24(3)：12-13.
[133]张文柱,霍禹痴.增生性膝关节炎的临床治疗观察.天津中医,1993,(2)：27.
[134]朱文锋.中医主症鉴别诊断学[M].长沙：湖南科学技术出版社,2000：316-331.
[135]李灿东,甘慧娟,朱文锋.腑病等病位证素特征症的提取[J].福建中医药,2008,39(2)：1-3.
[136]李水健,方肇勤,邸若虹.聚类分析在中医药研究中的应用与思考.中国中医药信息杂态,2001,8(6)：8.
[137]孟庆刚,郭书文.如何将数学方法应用于现代中医药研究[J].中国中医药信息杂志,2000,7(8)：21.
[138]邓晋丰,钟广玲.骨伤科专病中医临床诊治.[M].北京：人民卫生出版社,2000,第一版：231.
[135]黄国良,孙材江.正确认识和对待“骨质增生”问题[J].中国现代实用医学杂志.2004,3(3)：4344.
[136]马建兵,刘德玉,李湛印,等.中药对家兔实验性膝关节骨性关节炎氧化自由基代谢的影响[J].中医正骨,2000；12(1)：8.
[137]汪青春,沈培芝,徐宇.不同方药治疗膝骨关节炎的组织形态学对比研究[J].中国中医骨伤科,1998；6(2)：1.
[138]周尊谦,谢林,孙达武.丹紫康膝冲剂治疗膝关节退行性骨关节病临床研究.中医骨伤,1999；12(2)：49.
[139]王文瑞,刘宏泽,卫小春,等.川芎素防治膝关节软骨退变的实验研究.中国骨伤,2004：17(2)：80-82.
[140]郑秀媛等.现代运动生物力学.第1版.北京.国防工业出版社.2002：398-407.
[141]薛立功,张海荣.经筋理论与临床疼痛诊疗学].第1版.北京.中国中医药出版社.2002：8-14,45-46,523-536.
[142]Moskowitz等着,王学谦等译.骨关节炎诊断与治疗[M].第1版.天津：天津科技翻译出版公司.2005：3,87,296.
[143]徐卫东,吴岳嵩等.骨关节炎的诊断与治疗.第2版.上海.第二军医大学出版社.2004：1,4,8-20,63-64.
[144]刘金洪.肩凝症从经筋论治60例.南京中医药大学学报,1995,11(5)：28-29.
[145]徐辉.经筋刺动态针法治疗急性软组织损伤.中国临床康复,2005,9(2)：41.
[146]韦英才,梁树勇.经筋疗法治疗肱骨外上髁炎84例.辽宁中医杂志,2001,21(3)：155-157.
[147]黄敬伟.经筋疗法治疗怪病“肋端综合征”96例[J].中国民间疗法,1994,4：19.
[148]甘衍昌.经筋疗法治疗腰腹腿三联征128例.中国民族民间医药杂志,1996,19：19-21.
[149]田辉.经筋理论与腰椎间盘突出症发病机理探析.辽宁中医学院学报,2005,7(3)：209-210.
[150]岳增辉.经筋刺法治疗脑卒中后痉挛状态及疗效评价研究.中国中医药信息杂志,2001,8(4)：85-87.
[151]王以进,王介麟.骨科生物力学[M]1989,10.北京,人民军医出版社.296-297.
[152]柏树令.系统解剖学[M].2004.7.北京,人民卫生出版社.100-111.
[153]林建华,Shin DW, Athanasiou KA等.实验关节软骨生物力学性质随深度变化.中华骨科杂志,1998,18(8)：488.
[154]黄涛,黄昌林.运动对兔膝制动后血氧自由基的影响.中国运动医学杂志,2000,19(3)：317-319.
[155]杨红梅,罗颂椒.应力对体外培养软骨细胞影响的研究.国外医学·口腔医学分册,1999,26(4)：215-218.
[156]王亦璁编.膝关节外科的基础和临床.第1版.北京.人民卫生出版社.1999：40,364.
[157]周士枋,丁伯坦主编.运动学.第1版.北京.华夏出版社.2005：235-236.
[158]朱汉章着.针刀医学原理.第1版.北京.人民卫生出版社.2002：130-133,152-161.
[159]吴文豹等.颈肩腰腿痛推拿疗法.第1版.上海.同济大学出版社.1991：171-177.
[160]孟和,顾志华主编.骨伤科生物力学.第2版.北京.人民卫生出版社.1999：159-160.