共识与指南
ENGLISH ABSTRACT
骨质疏松性桡骨远端骨折中西医协同诊疗临床实践指南计划书
李律宇
李川
邢丹
王斌
李宁
颜炎
陈卫衡
徐永清
董玮
作者及单位信息
·
DOI: 10.3760/cma.j.cn501098-20241121-00665
Protocol for clinical practice guideline for the diagnosis and treatment of osteoporotic distal radius fracture through integrated traditional Chinese medicine and Western medicine
Li Lyuyu
Li Chuan
Xing Dan
Wang Bin
Li Ning
Yan Yan
Chen Weiheng
Xu Yongqing
Dong Wei
Authors Info & Affiliations
Li Lyuyu
Third Affiliated Hospital of Yunnan University of Chinese Medicine (Kunming Hospital of Chinese Medicine), Kunming 650500, China
Li Chuan
920th Hospital of the Joint Logistics Support Force of the PLA, Kunming 650032, China
Xing Dan
Peking University People′s Hospital, Beijing 100044, China
Wang Bin
First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
Li Ning
Third Affiliated Hospital of Yunnan University of Chinese Medicine (Kunming Hospital of Chinese Medicine), Kunming 650500, China
Yan Yan
Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100029, China
Chen Weiheng
Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100029, China
Xu Yongqing
920th Hospital of the Joint Logistics Support Force of the PLA, Kunming 650032, China
Dong Wei
Third Affiliated Hospital of Yunnan University of Chinese Medicine (Kunming Hospital of Chinese Medicine), Kunming 650500, China
·
DOI: 10.3760/cma.j.cn501098-20241121-00665
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摘要

骨质疏松性桡骨远端骨折(ODRF)是老年患者常见的一种脆性骨折,因其高发病率与高致残率,严重威胁患者的生命健康。中医和西医均在ODRF的诊断、治疗和康复领域积累了丰富的临床经验。然而,关于如何将2种体系的优势进行协同整合,目前尚缺乏具体指导方案。为了规范ODRF的中西医协同诊疗方式,2024年9月,由云南中医药大学第三附属医院(昆明市中医医院)牵头、全国多家医疗单位参与,共同组建“骨质疏松性桡骨远端骨折中西医协同诊疗临床实践指南”工作组,并撰写《骨质疏松性桡骨远端骨折中西医协同诊疗临床实践指南》计划书,详细介绍指南制订的各个关键环节,并阐述相关流程,旨在促进本指南制订工作规范、有序、透明化地开展。

骨质疏松;桡骨骨折;医学,中国传统;指南
ABSTRACT

Osteoporotic distal radius fracture (ODRF), a common fragility fracture in elderly patients, poses a significant threat to patients′ life and health due to its high incidence and disability rate. Both traditional Chinese medicine and Western medicine have accumulated extensive clinical experience in the diagnosis, treatment and rehabilitation of ODRF. However, there is currently a lack of specific guideline on how to effectively integrate the strengths of the two medical systems. To standardize the collaborative diagnosis and treatment of ODRF using integrated traditional Chinese and Western medicine, the Clinical Practice Guideline Working Group for the clinical practice guideline for the diagnosis and treatment of osteoporotic distal radius fracture through integrated traditional Chinese medicine and Western medicine was established in September 2024, led by the Third Affiliated Hospital of Yunnan University of Chinese medicine (Kunming Hospital of Chinese Medicine) with the participation of many medical institutions across China. Protocol for the guideline was then formulated to detail each key aspect in the development of the guideline and explain the related procedures, aiming to ensure a standardized, orderly and transparent development.

Osteoporosis;Radius fractures;Medicine, Chinese traditional;Guideline
Dong Wei, Email: mocdef.0ab13iewgnoD
Xu Yongqing, Email: tendef.3ab61mkgniqgnoyux
引用本文

李律宇,李川,邢丹,等. 骨质疏松性桡骨远端骨折中西医协同诊疗临床实践指南计划书[J]. 中华创伤杂志,2025,41(03):253-258.

DOI:10.3760/cma.j.cn501098-20241121-00665

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骨质疏松性桡骨远端骨折(osteoporotic distal radius fracture,ODRF)是在骨质流失、骨微结构损害的基础上,受到低能量外力冲击(例如跌倒、运动或搬运等)致使桡骨远端关节面以上3 cm以内发生的脆性骨折。ODRF是骨质疏松性骨折中常见的骨折类型之一,也是老年人中第二位常见的骨折类型 1 , 2。鉴于ODRF出现的时间较其他类型骨折更早,常被视为脆性骨折的预警信号 3 , 4,为预防和诊治更高发病率的髋部和脊柱脆性骨折提供了诊断基础。有研究结果表明,ODRF在老年全身骨折中占比约为18%,仅次于脊柱和髋部骨折 5 , 6;而女性在绝经后因雌激素水平骤降,其骨质疏松程度比男性更为严重,故ODRF的发病率也明显高于男性,但男性患者的病死率是女性患者的2倍以上,且ODRF老年患者在1年内继发髋部骨折的风险是正常老年人的5倍 7 , 8,严重威胁患者的生命健康。ODRF往往伴随关节面下沉、骨缺损、骨坏死等多种并发症,这些风险因素的存在一方面加重局部废用性骨质疏松,另一方面可能会延长骨折部位的康复时间,增加骨质疏松性骨折的再骨折率和致残率 9 , 10,给临床治疗带来巨大挑战。
ODRF的确定性治疗一直存在争论,既涉及骨科管理,又涉及基础代谢疾病的管理,且老年骨质疏松症患者的皮质骨薄弱,很难与闭合复位保持对齐,给非手术和手术治疗均提出挑战 4。ODRF患者作为中西医协同诊疗的常见优势群体,中医的传统手法复位结合辨证施治可有效改善其整体情况并促进骨折愈合 11 , 12 , 13 , 14,针灸、外用熏洗中药及经典康复功法可缓解患肢肿痛、促进肢体功能恢复 15 , 16。西医在ODRF的诊治方面也取得良好效果,借助现代影像学技术实现ODRF的精准诊断,并通过手术实现有效固定,还可利用抗骨质疏松药物增加骨量、预防再骨折发生 17 , 18 , 19。中西医在ODRF的诊断、治疗和康复等方面各有优势,如能良好互补,疗效将远优于单纯中医或西医治疗 20。然而,中西医在疾病诊疗理论和防治策略上存在差异,中西医协同诊疗的方案具有太多不确定性,且缺乏足够的指导来实现优势互补。因此,确定中西医对ODRF的最佳协同诊疗方式与干预措施十分关键。但目前尚无关于ODRF中西医协同诊疗的临床实践指南。为了给ODRF的中西医协同诊疗提供指导依据,2024年9月,由云南中医药大学第三附属医院(昆明市中医医院)牵头、全国多家医疗单位参与,共同组建“骨质疏松性桡骨远端骨折中西医协同诊疗临床实践指南”工作组。为更好地指导指南的编订工作,工作组撰写《骨质疏松性桡骨远端骨折中西医协同诊疗临床实践指南》计划书,主要介绍指南制订的各个关键环节,并阐述相关流程,以便规范、有序、透明化地开展指南制订工作。
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备注信息
A

李律宇、李川、邢丹、王斌:研究方案设计、推荐意见讨论;李宁、颜炎:资料收集、指南计划书撰写;陈卫衡、徐永清、董玮:指南计划书修改及审定

B
董玮,Email: mocdef.0ab13iewgnoD
C
徐永清,Email: tendef.3ab61mkgniqgnoyux
D
李律宇, 李川, 邢丹, 等. 骨质疏松性桡骨远端骨折中西医协同诊疗临床实践指南计划书[J]. 中华创伤杂志, 2025, 41(3): 253-258. DOI: 10.3760/cma.j.cn501098-20241121-00665.
E
所有作者声明不存在利益冲突
F
国家中医骨伤优势专科项目
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