现代中医治疗肩袖损伤研究进展

Research Progress of Modern Traditional Chinese Medicine in the Treatment of Rotator Cuff Injury

摘要: 肩袖损伤是临床高发骨科疾病，以肩关节疼痛、肌力下降、活动功能受限为典型表现。对于小范围撕裂、退行性肩袖损伤及术后康复人群，中医各类保守疗法疗效确切、优势突出，梳理其研究进展具备重要临床参考价值。本文整合近年中医治疗肩袖损伤的研究，从中医病因病机理论、外治法、内治法、综合联合疗法层面系统梳理现代中医诊疗肩袖损伤的研究现状，总结当前研究存在的不足并展望未来发展方向，旨在为肩袖损伤规范化辨证施治、围手术期康复及相关科研工作提供理论依据与文献参考。基于近年基础实验与分子机制研究，本文整合炎症因子、生长因子、信号通路等生物标志物证据，构建中医内外治法作用机制理论模型，打通“活血化瘀、补肾续筋”传统病机与神经–免疫–内分泌、肌腱干细胞调控的现代分子通路关联；同时依托现有文献系统评价，设计5组标准化PICO临床研究问题，为后续高质量循证研究提供可落地方案框架。

Abstract: Rotator cuff injury is a common orthopedic disease in clinical practice, which is mainly manifested as shoulder joint pain, decreased muscle strength and limited motor function. For patients with small-area tears, degenerative rotator cuff injuries and those in postoperative rehabilitation, various conservative traditional Chinese medicine (TCM) therapies have definite curative effects and prominent unique advantages, so sorting out the relevant research progress is of important clinical reference value. This paper integrates recent studies on TCM intervention for rotator cuff injury, systematically summarizes the current research status of modern TCM in the diagnosis and treatment of rotator cuff injury from the aspects of TCM etiology and pathogenesis theory, external therapy, internal therapy and comprehensive combined therapy, and concludes the existing research deficiencies and future development directions. It aims to provide theoretical basis and literature reference for standardized TCM syndrome differentiation and treatment, perioperative rehabilitation and related scientific research of rotator cuff injury. Based on recent basic experiments and molecular mechanism studies, this paper integrates the evidence of biomarkers including inflammatory factors, growth factors and signal pathways, constructs a theoretical model for the action mechanism of internal and external TCM therapies, and clarifies the correlation between the traditional TCM pathogenesis of “promoting blood circulation and removing blood stasis, tonifying kidney and repairing tendons” and modern molecular pathways such as neuro-immune-endocrine regulation and tendon stem cell regulation. Meanwhile, based on the systematic evaluation of existing literature, five groups of standardized PICO clinical research questions are designed to provide an implementable scheme framework for subsequent high-quality evidence-based medical research.