“筋骨并重”理论在踝关节骨折治疗中的应用

Application of the theory of“equal emphasis on muscles and bones”in the treatment of ankle fracture

踝关节骨折是最常见的关节内骨折,绝大多数伴有韧带损伤,常规治疗后并发症和后遗症发生率仍很高。临床常见有踝关节僵硬、踝关节不稳定、创伤性踝关节炎等,严重者影响患者的生活质量和劳动能力。一方面踝关节的解剖特性导致其损伤发生率高,另一方面患者对快速康复的需求提高,以致当前踝关节骨折的后遗症高发生率、预后满意度普遍欠佳,是临床上亟待解决的问题。国内外在踝关节骨折的治疗理念、疗效评估等方面皆有大量文献研究,但针对中医学中“筋骨并重”理论临床应用的综述较少。中西医结合治疗踝关节骨折将中医学理念与现代医学治疗相结合,基于“筋骨并重”理论,在临床诊疗康复全过程中强调“骨正筋柔”,即要求对“筋”与“骨”的同等重视,在骨折复位的基础上注重对“筋”的手法整复、固定制动、主被动运动锻炼及功能康复,从而在减轻患者疼痛、恢复踝关节功能、改善预后等方面皆取得了较好的疗效。文章从中西医结合角度阐述“筋骨并重”理论在踝关节骨折治疗中的应用,综合国内外文献总结各学者基于“筋骨并重”理论治疗踝关节骨折的临床经验及研究成果,就“筋骨并重”理论在踝关节骨折治疗中的应用现状及其指导意义进行综述。

Ankle fracture is the most common intraarticular fracture,most of which is accompanied by ligament injury,and the incidence of complications and sequelae is still high after conventional treatment.The common clinical symptoms include ankle stiffness,ankle instability,traumatic ankle arthritis,etc.In severe cases,the quality of life and working ability of patients are affected.On the one hand,the anatomic characteristics of ankle joint lead to a high incidence of injury;on the other hand,patients’demand for rapid rehabilitation is higher than before,so that the current high incidence of sequelae of ankle fracture and generally poor satisfaction with prognosis are urgent problems to be solved clinically.Domestic and foreign scholars have conducted extensive literature research on the treatment concept and efficacy evaluation of ankle joint fractures,but there is a lack of review on the clinical application of the theory of“equal emphasis on muscles and bones”in Chinese medicine.The combination of traditional Chinese medicine and Western medicine in the treatment of ankle fracture combines the Chinese medical concept with modern medical treatment.Based on the theory of“equal emphasis on muscles and bones”,in the whole process of clinical diagnosis and rehabilitation,the emphasis is placed on“solid skeleton and pliable tendons”,that is,it requires equal attention to“tendons”and“bones”,and pays attention to the manipulation of“tendons”,fixed braking,active and passive exercise and functional rehabilitation on the basis of fracture reduction.Therefore,it has achieved good curative effects in alleviating pain,restoring ankle joint function and improving prognosis.This paper expounds the application of the theory of“equal emphasis on muscles and bones”in the treatment of ankle fracture from the perspective of integrated Chinese medicine and Western medicine,summarizes the clinical experience and research results of scholars based on the theory of“equal emphasis on muscles and bones”in the treatment of ankle fracture,and summarizes the application status and guiding significance of the theory of“equal emphasis on muscles and bones”in the treatment of ankle fracture.