目的 系统比较小针刀、局部浸润麻醉及两者联合疗法治疗腰椎间盘突出症（LDH）的临床疗效。方法 采用前瞻性随机对照设计，选取2023年1月—2025年1月收治的120例保守治疗无效的LDH患者，随机分为小针刀组（A组，n=40）、局部浸润麻醉组（B组，n=40）和联合治疗组（C组，n=40）。A组实施标准化小针刀松解术，采用“三点九刀”布点法松解粘连组织；B组采用超声引导下椎间孔外口及关节突关节囊周围利多卡因联合曲安奈德浸润麻醉；C组实施“麻醉-松解序贯疗法”（即先B组方案，后A组方案）。比较三组治疗前后视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、腰椎活动度（ROM）、表面肌电图（sEMG）、疼痛压力阈值（PPT）及改良Macnab优良率。结果 治疗后，三组VAS、ODI评分均较治疗前下降（P＜0.001）。组间比较显示，C组VAS（2.08±0.90分）、ODI（14.65±3.70分）改善显著优于A组（3.80±1.20分，21.00±4.25分）和B组（3.93±1.15分，22.10±4.65分）（均P＜0.05），A、B两组间无统计学差异（P＞0.05）。C组在腰椎前屈ROM（67.78±9.18°）、竖脊肌静息sEMG比值（0.19±0.05）、腰椎旁PPT（4.60±0.91 kg/cm²）上亦显著优于A、B两组（均P＜0.05）。改良Macnab评价显示C组优良率达85.00%（34/40），高于A组的52.50%（21/40）和B组的55.00%（22/40）（P＜0.05）。结论 小针刀与局部浸润麻醉单一疗法对LDH均有效，但联合应用可产生多模式协同效应，通过阻断疼痛传导、调节炎性微环境和改善生物力学失衡，在缓解疼痛、促进功能恢复及改善客观生理指标方面均展现出显著优势，为中西医结合治疗LDH提供了更优化的创新性方案，具有重要临床推广价值。

      Objective To systematically evaluate and compare the clinical effectiveness and mechanistic actions of acupotomy，local infiltration anesthesia，and their combination in treating lumbar disc herniation（LDH）．Methods This prospective，randomized controlled trial included 120 LDH patients unresponsive to conservative management，admitted between January 2023 and January 2025．Participants were randomly allocated to three groups：the Acupotomy Group（Group A，n=40）receiving standardized acupotomy release with a “three-point nine-needle” technique to address adhesions；the Local Infiltration Anesthesia Group（Group B，n=40）receiving ultrasound-guided infiltration of lidocaine combined with triamcinolone acetonide around the extraforaminal outlet and facet joint capsule；and the Combined Therapy Group（Group C，n=40）undergoing a sequential “anesthesia-release” protocol（first applied Group B therapy then Group A therapy）．Assessments conducted before and after treatment included the Visual Analog Scale（VAS），Oswestry Disability Index（ODI），lumbar range of motion（ROM），surface electromyography（sEMG），pain pressure threshold（PPT），and the modified Macnab criteria．Results Following treatment，significant reductions from baseline were observed in VAS and ODI scores across all three groups（P＜0.001）．Between-group comparisons indicated that Group C achieved significantly greater improvement in VAS（2.08±0.90）and ODI scores（14.65±3.70）compared to Group A（3.80±1.20；21.00±4.25）and Group B（3.93±1.15；22.10±4.65）（all P＜0.05），with no significant difference between Groups A and B（P＞0.05）．Group C also showed superior outcomes in lumbar flexion ROM（67.78±9.18°），the resting sEMG amplitude ratio of the erector spinae muscles（0.19±0.05），and paravertebral PPT（4.60±0.91 kg/cm²）compared to the other two groups（all P＜0.05）．Based on the modified Macnab criteria，the excellent-good rate was 85.00%（34/40）in Group C，significantly higher than the rates of 52.50%（21/40）in Group A and 55.00%（22/40）in Group B（P＜0.05）．Conclusions While both acupotomy and local infiltration anesthesia as standalone treatments are effective for LDH，their combined application produces a multimodal synergistic effect．This integrated strategy，which concurrently interrupts pain signaling，modulates the local inflammatory milieu，and ameliorates biomechanical dysfunction，demonstrates significant advantages in pain relief，functional recovery，and normalization of objective physiological measures．The findings present an optimized and novel integrative approach for LDH management，highlighting its considerable potential for broader clinical adoption．