基于中医三期辨证治疗桡骨远端骨折的临床疗效及对骨折愈合质量的研究进展

Research Progress on Clinical Efficacy of TCM Three-Phase Syndrome Differentiation in the Treatment of Distal Radius Fractures and Its Influence on Fracture Healing Quality

摘要: 桡骨远端骨折作为上肢骨折中发病率居首的疾病类型，是临床骨伤科门诊接诊频次最高的骨折病症之一，相关流行病学研究显示其发病率约占全身各类骨折的18%，多见于中老年人群及青壮年意外损伤者。中医古籍无“桡骨远端骨折”之明确病名，根据其损伤部位、临床证候及发病特点，将其归属于“桡骨下端骨折”“辅骨下端骨折”“腕折”等范畴，其发病机理契合中医“肢体损于外，气血伤于内，营卫有所不贯，脏腑有所不和”的核心认知。中医三期辨证疗法根植于中医骨伤科数千年的经典传承，以“瘀去、新生、骨合”为核心治则纲领，层层递进、辨证施术，其治疗思路与桡骨远端骨折后血肿机化、骨痂形成、骨痂重塑的病理生理愈合进程高度契合，既兼顾局部损伤的辨证调理，又重视整体脏腑气血的调和养护，是中医骨伤科治疗本病的核心学术思想与规范化治疗体系，更是中医“筋骨并重、动静结合、内外兼治”诊疗理念在肢体外伤骨折中的具体践行。本文结合近年来国内外相关临床研究及经典古籍论述，从中医三期辨证治疗桡骨远端骨折的理论渊源、临床应用规范、疗效研究佐证及对骨折愈合质量的调控作用、当前研究领域存在的不足及未来发展展望等多个维度进行系统综述，旨在梳理本病三期辨证的治疗规律，凝练学术成果，为临床进一步推广该疗法、优化辨证用药方案及开展更深层次的机制研究提供坚实的理论参考与临床依据。

Abstract: Distal radius fracture (DRF) is the most prevalent type of upper extremity fracture and one of the most frequently encountered fracture diseases in clinical orthopedics and traumatology outpatient clinics. Relevant epidemiological studies have shown that its incidence accounts for approximately 18% of all fractures in the whole body, mostly occurring in middle-aged and elderly people as well as young and middle-aged adults with accidental injuries. There is no clear terminology for “distal radius fracture” in ancient TCM literature. According to its injured site, clinical syndromes and onset characteristics, it is classified into the categories of “distal radius fracture”, “distal accessorial bone fracture” and “wrist fracture” in traditional Chinese medicine (TCM). Its pathogenesis is consistent with the core TCM cognition that “external injury to the limbs leads to internal damage to qi and blood, disharmony of nutrient and defensive qi, and imbalance of zang-fu organs”. The TCM three-phase syndrome differentiation therapy is rooted in thousands of years of classic inheritance of TCM orthopedics and traumatology, with “removing blood stasis, promoting tissue regeneration and achieving bone union” as the core therapeutic principle. It adopts a progressive and syndrome differentiation-based treatment approach, whose therapeutic idea is highly consistent with the pathophysiological healing process of distal radius fracture, including hematoma organization, callus formation and callus remodeling. This therapy not only focuses on the syndrome differentiation and regulation of local injuries, but also attaches importance to the harmonization and nourishment of the overall zang-fu organs, qi and blood. It is the core academic thought and standardized treatment system for treating this disease in TCM orthopedics and traumatology, and also a specific practice of the TCM diagnostic and therapeutic concepts of “valuing both bones and tendons, combining motion and immobility, and treating both internally and externally” in external traumatic fractures of the limbs. Combining relevant domestic and foreign clinical studies and classic ancient TCM literatures in recent years, this paper systematically reviews the theoretical origin, clinical application standards, clinical efficacy evidence, regulatory effect on fracture healing quality, existing deficiencies in the current research field and future development prospects of TCM three-phase syndrome differentiation in the treatment of distal radius fractures. The purpose of this review is to sort out the therapeutic rules of three-phase syndrome differentiation for this disease, condense academic achievements, and provide a solid theoretical reference and clinical basis for further promoting this therapy in clinical practice, optimizing syndrome differentiation-based medication regimens and carrying out in-depth mechanism research.