从分离到融合：骨科与康复医学结合的研究进展与实践路径

From Separation to Integration: Research Progress and Practical Pathways for the Integration of Orthopedics and Rehabilitation Medicine

摘要: 骨科治疗的传统优势在于纠正畸形、固定骨折和重建关节结构，康复医学则强调活动、参与和生活质量。随着加速康复外科、老年骨折协同管理、数字健康及智能设备的发展，单纯以手术完成为终点的模式正转向以功能结局为核心的全周期管理。本文围绕骨科–康复一体化的理论基础、围手术期路径、关节置换康复、数字技术、物理因子及中西医结合进行综述。现有证据支持多学科、标准化且可个体化的路径，并提示预康复、早期活动、疼痛与营养管理、出院后延续服务是关键环节。远程康复、可穿戴设备、人工智能、虚拟现实和康复机器人可提高服务可及性与评估客观性，但其效果受患者筛选、数字素养、算法透明度和成本影响。未来应建立共同功能结局驱动的跨学科团队，形成医院–社区–居家闭环，实现从结构修复向功能重建和社会参与恢复的转变。在组织实施层面，本文进一步从跨学科沟通与决策、信息系统支撑以及与医保政策相适应的支付机制三个维度提出实施建议，并强调对证据边界和真实世界可实施性的批判性评价。

Abstract: The traditional strengths of orthopedic treatment lie in deformity correction, fracture fixation, and reconstruction of joint structures, whereas rehabilitation medicine emphasizes activity, participation, and quality of life. With the development of enhanced recovery after surgery (ERAS), co-management of geriatric fractures, digital health, and intelligent devices, the conventional model that regards completion of surgery as the endpoint is shifting toward full-cycle management centered on functional outcomes. This review summarizes the theoretical foundations of orthopedic–rehabilitation integration, perioperative pathways, rehabilitation after joint arthroplasty, digital technologies, physical modalities, and integrative Chinese and Western medicine. Current evidence supports multidisciplinary, standardized, yet individualized care pathways and highlights prehabilitation, early mobilization, pain and nutritional management, and continuity of post-discharge services as key components. Telerehabilitation, wearable devices, artificial intelligence, virtual reality, and rehabilitation robotics may improve service accessibility and the objectivity of functional assessment; however, their effectiveness is influenced by patient selection, digital literacy, algorithmic transparency, and cost. Future efforts should focus on establishing interdisciplinary teams driven by shared functional outcomes and creating a closed-loop continuum of care linking hospitals, communities, and patients’ homes, thereby facilitating a transition from structural repair to functional reconstruction and restoration of social participation. At the organizational and implementation level, this review further proposes practical strategies from three perspectives: interdisciplinary communication and decision-making, information-system support, and payment mechanisms compatible with health insurance policies. It also emphasizes the critical appraisal of evidence boundaries and real-world implementability.