基于古代文献溯源的骨伤流派外伤后肿胀护理研究进展

Research Progress on Post-Traumatic Swelling Nursing in Orthopedic Schools Based on Ancient Literature Tracing

摘要: 外伤后肿胀是骨伤科创伤及围手术期常见问题，可由局部炎症反应、微循环障碍、静脉与淋巴回流受限、组织损伤及制动等因素共同导致，并可能影响皮肤软组织条件、手术时机、疼痛控制和功能训练。中医骨伤流派在长期实践中形成了以气血津液理论为基础、强调分期辨证和内外兼治的认识体系。本文采用叙述性综述方法，对《黄帝内经》《诸病源候论》《仙授理伤续断秘方》《外科正宗》《外科证治全生集》《医宗金鉴》等古代医籍进行溯源，并结合现代骨科肿胀评估、冷疗、加压、患肢抬高、淋巴引流以及穴位按摩、艾灸、针刺和中药外敷等临床研究，分析古代病机理论向现代护理评估、技术选择和风险管理的转化路径。现有证据提示，外伤后肿胀护理应以排除深静脉血栓、感染、筋膜室综合征及神经血管损害等高危情况为前提，以标准化周径或体积测量、疼痛与皮肤评估为基础，优先采用抬高、适度活动、冷疗及经评估的加压等常规措施；中医护理技术可作为个体化辅助干预，但其参数、适应证和疗效证据仍需进一步规范。未来应加强古籍术语的现代语义映射，开展多中心、标准化、报告充分的临床研究，形成可复制的骨伤流派外伤后肿胀中西医结合护理路径。

Abstract: Post-traumatic swelling is a common issue in orthopedic trauma and perioperative care, arising from multiple factors including local inflammatory responses, microcirculatory disturbances, restricted venous and lymphatic return, tissue injury, and immobilization. It may further affect skin and soft tissue conditions, surgical timing, pain control, and functional rehabilitation. Over long-term practice, traditional Chinese orthopedic schools have developed a conceptual framework grounded in the theory of qi, blood, and body fluids, emphasizing stage-based pattern differentiation and combined internal and external treatment. This article employs a narrative review methodology, tracing ancient medical texts such as the Yellow Emperor’s Inner Canon, Treatise on the Origins and Manifestations of Various Diseases, Secrets of Traumatology, Orthodox Manual of External Medicine, Complete Life-Saving Manual of External Medicine, and Golden Mirror of Medicine, while also incorporating clinical studies on modern orthopedic swelling assessment, cryotherapy, compression, limb elevation, lymphatic drainage, as well as acupoint massage, moxibustion, acupuncture, and external application of Chinese herbal medicines. The review analyzes the translational pathway from ancient etiopathogenetic theories to contemporary nursing assessment, technical selection, and risk management. Existing evidence suggests that nursing care for post-traumatic swelling should be premised on the exclusion of high-risk conditions such as deep vein thrombosis, infection, compartment syndrome, and neurovascular impairment, and should be based on standardized circumferential or volumetric measurements, as well as pain and skin assessments. Routine measures such as elevation, moderate activity, cryotherapy, and evaluated compression should be prioritized; traditional Chinese medicine nursing techniques may serve as individualized adjunctive interventions, but their parameters, indications, and evidence of efficacy still require further standardization. Future efforts should strengthen the modern semantic mapping of ancient medical terminology, conduct multicenter, standardized, and adequately reported clinical studies, and develop reproducible integrated Chinese and Western nursing pathways for post-traumatic swelling within orthopedic schools.