中西医治疗桡骨远端骨折后遗关节僵硬研究进展

Research Progress of Treating Joint Stiffness After Distal Radius Fractures with Integrated Traditional Chinese and Western Medicine

中医治疗桡骨远端骨折后遗关节僵硬的方法主要有中药内服、中药熏洗、针灸治疗、按摩导引等。西医治疗分为保守治疗和手术治疗,保守治疗包括西药治疗、关节活动训练、物理治疗等;手术治疗主要为腕关节松解术、腕关节融合术及腕关节置换术。中西医结合在治疗关节僵硬的同时,降低了手术并发症的发生。目前,中西医治疗桡骨远端骨折后遗关节僵硬存在以下问题:(1)中药内服、熏洗方属于复方药,其作用机制仍不明确,且缺乏循证医学及药理学研究;(2)传统功法练习的动作标准及练习时间没有明确规范;(3)针刺以及灸法取穴的辨证标准不统一;(4)手术治疗对软组织的二次损伤以及关节假体存在的松动、脱位问题仍未解决。今后,应该重视“未病先防”的中医理念,对桡骨远端骨折患者采取合理的治疗,正确指导患者进行积极有效的功能锻炼,尽可能避免关节僵硬的发生。对关节僵硬患者,应在详细检查的基础上,找出其发生机制,依据患者情况采取中西医结合的个体化治疗。

TCM treatments of joint stiffness after distal radius fractures mainly include oral administration of Chinese medicinals,fumigation and washing of Chinese medicinals,acupuncture and moxibustion,massage,conducting exercise,etc.Western medicine treatments are divided into conservative treatments and surgical treatments.The former include Western medicinal treatment,joint activity training,physical treatment,etc.The latter mainly include wrist joint release surgery,wrist joint fusion surgery,and wrist joint replacement surgery.The combination of traditional Chinese and Western medicine reduces the occurrence of surgical complications as well as treating joint stiffness.At present,there are the following problems in the treatment of joint stiffness after distal radius fractures using integrated traditional Chinese medicine and Western medicine:(1)Chinese medicinals for oral administration and fumigation belong to compound drugs,and their mechanism of action is still unclear,and there is a lack of evidence-based medicine and pharmacological research;(2)The action standards and practice time of traditional martial arts practice are not clearly standardized;(3)The differentiation standards for acupuncture and moxibustion acupoint selection are not unified;(4)The secondary damage to soft tissues caused by surgical treatment,as well as the problems of loosening and dislocation of joint prostheses,remain unresolved.In the future,it is necessary to pay attention to the concept of"prevention before disease"of TCM,take reasonable treatment for patients with distal radius fractures,correctly guide patients to carry out active and effective functional exercise,try possible ways to avoid the occurrence of joint stiffness.For patients with joint stiffness,the mechanism of occurrence should be found out based on detailed examination,and individualized treatment of integrated Chinese and Western medicine should be taken according to the patient's situation.