目的 探讨髋-膝-踝主、被动相结合运动疗法对早、中期膝骨关节炎（KOA）患者的临床疗效。 方法 纳入2023年3月至2024年3月来自河北中医药大学第一附属医院的早、中期KOA患者180例。采用计算机生成随机序列分为主动组、被动组、结合组、对照组各45例。主动组对其采用髋-膝-踝主动运动疗法（每日进行，持续至随访结束），被动组采用髋膝踝被动运动疗法（每周3次，共2周），结合组采用主动组+被动组的组合疗法，对照组采用口服塞来昔布胶囊（200 mg，每天1次，共2周）。比较4组患者治疗前，治疗后2、14周关节功能情况，主要结局指标为WOMAC子项关节功能积分，次要结局指标为WOMAC子项疼痛、僵硬积分以及生活质量评分（SF-12）。 结果 最终完成试验者共160例，其中主动组39例、被动组42例，结合组40例，对照组39例，各组基线信息差异无统计学意义（P > 0.05）。组内比较方面，与基线相比，治疗后2、14周被动组、结合组、对照组患者WOMAC功能、疼痛、僵硬积分均较治疗前下降（P < 0.05），SF-12积分较治疗前升高（P < 0.05）；与治疗后2周相比，治疗后14周主动组、结合组WOMAC功能、疼痛、僵硬积分均下降（P < 0.05），SF-12积分升高（P < 0.05）。组间比较方面，与对照组相比，治疗后2周被动组、组合组WOMAC功能积分显著下降（P < 0.05），但被动组与组合组差异无统计学意义（P > 0.05）；治疗后14周主动组、结合组WOMAC功能积分显著下降（P < 0.05），且结合组较主动组降低（P < 0.05）。 结论 4组疗法在对早、中期KOA患者关节功能等方面均有一定疗效，但被动组短期疗效更好，主动组长期疗效较好。结合组在无论短期、长期疗效中均优势突出，但短期疗效并不优于被动组。建议在有胃肠道及心血管基础疾病的早、中期KOA人群中可选择应用。

Objective To evaluate the clinical efficacy of hip?knee?ankle active and passive exercise therapy in patients with early? to mid?stage knee osteoarthritis （KOA）. Methods A total of 180 patients with early to mid?stage knee osteoarthritis （KOA） were recruited from the First Affiliated Hospital of Hebei University of Traditional Chinese Medicine between March 2023 and March 2024. Patients were randomly assigned to one of four groups： active movement group， passive movement group， combined movement group， and control group， with 45 patients in each group. The active movement group received hip?knee?ankle active movement therapy daily until the end of follow?up. The passive movement group underwent hip?knee?ankle passive movement therapy three times per week for two weeks. The combined movement group received both active and passive therapies. The control group was administered oral celecoxib capsules （200 mg once daily for two weeks）. Joint function was assessed in all four groups before treatment， at two weeks post?treatment， and at 14 weeks post?treatment. The primary outcome measure was the WOMAC joint function score， while secondary outcomes included the WOMAC pain score， stiffness score， and quality of life score （SF?12）. Results A total of 160 patients completed the trial， with 39 in the active group， 42 in the passive group， 40 in the combined group， and 39 in the control group. There were no significant differences in baseline characteristics among the groups （P > 0.05）. Compared to baseline， the WOMAC scores for function， pain， and stiffness in the passive， combined， and control groups decreased significantly at both 2 and 14 weeks post?treatment （P < 0.05）， while the SF?12 scores increased significantly （P < 0.05）. Between 2 and 14 weeks post?treatment， the active and combined groups showed further significant decreases in WOMAC function， pain， and stiffness scores （P < 0.05） and increases in SF?12 scores （P < 0.05）. At 2 weeks post?treatment， compared to the control group， the passive and combined groups exhibited significantly lower WOMAC function scores （P < 0.05）， with no significant difference between the passive and combined groups （P > 0.05）. By 14 weeks post?treatment， the active and combined groups demonstrated significantly lower WOMAC function scores （P < 0.05）， with the combined group showing a significantly lower score than the active group （P < 0.05）. Conclusion The four therapeutic approaches demonstrate a certain degree of efficacy in improving joint function for patients with early and mid?stage KOA. The passive therapy group exhibits superior short?term outcomes， while the active therapy group shows better long?term benefits. The combined therapy group presents notable advantages in both short?term and long?term efficacy， although its short?term effectiveness does not surpass that of the passive therapy group. It is recommended for patients with early and mid?stage KOA who have underlying gastrointestinal and cardiovascular conditions.