加速康复外科理念下老年髋部骨折从动而论辩证思想的研究进展

Research progress on dialectical thinking of hip fracture in the elderly frommoving theory under the concept of enhanced recovery aftersurgery

老年髋部骨折是一种低能量的脆性骨折,随着我国逐渐进入老龄化社会,其发病率也不断升高。然而中医骨折传统辩证思想为3期分治,将骨折愈合总结为“瘀去、新生、骨合”,尤其重视早期以活血化瘀为主。然而,老年髋部骨折患者本身具有肝、脾、肾亏虚的辨证特点,且在加速康复外科理念下,应以促进患者早期下床活动为主。因此,该文探讨了在加速康复外科理念下老年髋部骨折的辨证,提出应从动而论,以筋骨肉为枢,辨证当以补肝脾肾,舒筋活络为主,以补促动,以动促通,以动促愈。

Hip fracture in the elderly is a low-energy fragility fracture,and its incidence rate is increasing as China gradually enters the aging society.However,the traditional dialectical thinking of fracture in traditionalChinesemedicine(TCM)is dividied into three-stage treatment,which summarizes fracture healing as“blood stasis,neogenesis,and osteosynthesis”,with special attention to early promoting blood circulation and removing blood stasis.However,the elderly patients with hip fracture have the dialecticalcharacteristics of deficiency of liver,spleen and kidney,and under the concept of enhanced recovery aftersurgery(ERAS),it is necessary to promote early ambulation of patients.Therefore,this paper discusses the dialectic of hip fracture in the elderly under the concept of ERAS,and proposes that it should be discussed from the movingtheory,with the muscles and bones as the pivot,and the dialectic should be based on tonifying the liver,spleen and kidney,relaxing the tendons and activating the collaterals,in order topromote action by tonifying,promote communication by moving,and promote healing by moving.