| There were two aims in this study, one was to summarize the original thoughts and theories of fracture fixation and exercise therapeutics in Chinese Orthpaedics and Traumatology, the other was to observe the changing trend of axial movement range of rabbit tibial fracture ends in healing process.The signification of this study is demonstrate that the therapeutics of fracture fixation and exercise in Chinese Orthpaedics and Traumatology are guided by credible basic theories about human body in Huangdi Neijing. So, followed these theories and principals we designed and fulfilled animal experiment. The outcome can provide later researching such as assessing treating factors and mathematic modeling with basic data.Part I theoretic researching.Fixation is a key section in fracture treatment. The motion and immobilization of fracture ends are crucial issues in fracture healing which raised clinician's attention persistently from early time. For now, although there is a agreement with suitable axial micromovement of the fracture fragments promoting callus formation, some aspects such as the opportunity, amplitude and frequency of this axial micromovement are still the subjects of widespread controversy. Furthermore, the effects of shear motion and rotation of fracture ends are not clear yet. So, it is very significant to observing and exploring the most optimal micromovement of fragments for fracture healing research.Bandage-splint fixation and exercises for functional rehabilitation has been used from antiquity to the present day in China, which are characteristics of Orthpaedics and Traumatology of Chinese Medicine in treating fractures. Chinese osteosynthesis has been proved a proper measure in treating fractures for its following the principles below:keep the fracture ends in a relatively state to reach secondary healing; blood supply of fracture site is not be compromised when applying fixation; maintaining the articular function all the while in healing process. The therapeutic principles of Chinese osteosynthesis are originated from the basic theory of Traditional Chinese Medicine. The fundamental classic of basic theories in Traditional Chinese Medicine is Huangdi Neijing, which has a comprehensive knowledge on the nourishment and function about human bones. Gu Shu flexing and Xi Gu belonging to bone are two primary theories among them. Gu Shu and Xi Gu are both anatomical structural conceptions which attach to bone, but Xi Gu are widespread over a body while Gu Shu are mainly distributed at articular ends of bones. Xi Gu are located at fascicles' converging points through which Qi and blood are irrigating bones, and Gu Shu can accelerate this procedure by their flexing movement. The theory of Gu Shu flexing shows the relationship between joint motion outside and nourishment spreading inside. Meanwhile, the theory of Xi Gu belonging to bone provide former with detail evidence in anatomy.Part II animal experiment.Body kinematics is drive from muscular force transmission in skeleton. These transmission will produce stress concentration and callus strain when they pass through fracture site. Then callus strain is expressed in the form of fragmentary movement. Therefore the interfragmentary motion can reflect the stress-strain state of fracture site.To observe the changing regularity of axial movement range of fracture ends in healing process, a rabbit experiment was designed and performed following the therapeutic theories of fracture in Orthpaedics and Traumatology of Chinese Medicine.34 adult healthy rabbits were used to create tibial diaphysial transection fracture model, and stabilized with sliding external fixator frame. The axial movement range of fracture ends were measured by displacement transducer which was installed on the slide bar. Data were recorded in computer while rabbit moving naturally every 3 days and fracture site X-rayed every 2 weeks from osteotomy.Finally,27 rabbits accomplished observation on schedule. X-ray evidence showed that laminal callus has formed around the fracture site and clinical union has been achieved at 4 weeks after osteotomy. There is 2 peak values in the changing trend of axial fragmentary motion, one is at 4 day and the other is at 21 day after osteotomy. Since 3 weeks after modeling the motion range became decrease to a low level. The statistic of measurement data is 69.52±86.91μm(M±Q), the minimum value is 14.07μm while the maximum is 825.68μm, which is consistent with literature. The curve based on experimental dara demonstrated that the axial fragmentary movement range of rabbit fracture model chanded from little to large, then became little again and stabilized in a small range. There are two peak value in this curve, one appeared at 4 days after operation showed that rabbit increased its activity due to disappearing of pain, the other appeared at 21 days after operation showed that the strength of wounded muscles was recovering. The curve decreased to a small range from the second peak value which indicated the fracture site has arrived at a state of stabilization.In conclusion, the theoretic researching results suggest that the basic theories on human bones and exercises, especially the theories of Gu Shu flexing and Xi Gu belonging, in Huangdi Neijing are the original thoughts and theoretic guidance of fracture fixation and exercise therapeutics in Orthpaedics and Traumatology of Chinese Medicine. the experimental results suggested that there is regular trend relative to time going in axial movement range of fracture ends while rabbit model acting physical motion. The regular trend support the method that take gradual tolerance of exercise intensity by healing phases in fracture treatment in Orthpaedics and Traumatology of Chinese Medicine. It can provide comprehensive assessing the effect of interfragmentary micromovement in healing process with a available way and a fundmental thoughts, and it is of great clinical significance in technical improvement and innovation to treat fractures. |
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