前交叉韧带重建术后中医骨科护理的应用进展与展望

Application Progress and Prospects of Traditional Chinese Medicine Orthopedic Nursing after Anterior Cruciate Ligament Reconstruction

摘要: 前交叉韧带重建术(Anterior Cruciate Ligament Reconstruction, ACLR)后疼痛、肿胀、关节源性肌肉抑制、本体感觉下降及恐动等问题可延缓功能恢复。本文将“中医骨科护理”限定为护士在执业注册、培训考核、岗位授权及医嘱或护理方案范围内实施的中医护理评估、情志与起居调护、耳穴压豆、穴位按揉、灸法及中药外治等护理活动；针刺、电针、温针灸、针刀和中药处方等医师主导治疗仅作为医护协作背景讨论。在回顾近5年50篇核心中英文研究的基础上，本文将“筋伤–瘀阻–筋骨失养”的分期认识与标准导向康复的功能里程碑进行对位，系统梳理相关技术的潜在作用、证据局限与实施边界，并重点讨论阿司匹林、低分子肝素等药物性血栓预防背景下的出血、血肿、皮损、烫伤、感染及血栓漏诊风险。现有证据提示，中医护理联合标准康复可能缓解疼痛与肿胀，并改善活动度、股四头肌功能、本体感觉和平衡能力，但研究多为单中心、小样本和短期观察，干预参数、操作主体、对照条件及安全结局报告不一致。中医骨科护理应定位为标准康复基础上的辅助增效措施，并以执业边界、分期路径、抗凝风险分层、不良事件登记和多中心长期随访保障其可复制性与安全性。

Abstract: Pain, swelling, arthrogenic muscle inhibition, impaired proprioception, and fear of movement may delay recovery after anterior cruciate ligament reconstruction (ACLR). In this review, traditional Chinese medicine (TCM) orthopedic nursing is restricted to nursing assessment and TCM nursing interventions performed by registered nurses within documented training, institutional authorization, and medical orders or approved nursing protocols. Physician-led interventions, including acupuncture, electroacupuncture, warm-needle acupuncture, acupotomy, and herbal prescribing, are discussed only within a physician-nurse collaborative model. Drawing on 50 core Chinese and international studies from the past five years, the review aligns the TCM sequence of tendon injury, blood stasis, and insufficient nourishment of tendons and bones with criterion-based rehabilitation milestones. It also examines bleeding, hematoma, skin injury, burns, infection, and missed venous thromboembolism in patients receiving pharmacological thromboprophylaxis such as aspirin or low-molecular-weight heparin. Current evidence suggests that TCM nursing added to standard rehabilitation may reduce pain and swelling and improve range of motion, quadriceps function, proprioception, and balance. However, most studies are single-center, small-sample, and short-term, with heterogeneous protocols, unclear practitioner roles, inadequate controls, and limited safety reporting. TCM orthopedic nursing should remain an adjunct to standard rehabilitation and be governed by explicit scope-of-practice boundaries, stage-specific pathways, antithrombotic risk stratification, adverse-event surveillance, multicenter trials, and long-term follow-up.