骨骼肌肉系统疾病和功能障碍的诊断、功能分析以及中医干预：基于ICD-11传统医学分类模块1和ICF的研究

doi:10.3969/j.issn.1006-9771.2025.04.003

摘要/Abstract

摘要：

目的探讨将《国际疾病分类第十一次修订本》(ICD-11)传统医学分类部分(TM1)和《国际功能、残疾和健康分类》(ICF)应用于骨骼肌肉系统疾病和功能障碍的诊断、功能分析和评估的方法，并提出中医康复干预方案。
方法采用ICD-11 TM1和ICF的分类工具对骨骼肌肉系统疾病和功能障碍进行诊断以及功能分析和评估。探讨ICD-11 TM1中骨骼肌肉系统疾病和功能障碍的分类、编码、病因病机、临床表现及中医诊断标准和方法。运用ICF分类分析和评估相关的功能特征，涉及身体功能和活动，明确障碍的评估内容和障碍分级标准，设计中医康复干预方案。
结果在中医康复领域，采用ICD-11 TM1，可实现骨骼肌肉系统疾病主功能障碍的标准化诊断、功能分析和评估。骨骼肌肉系统疾病和功能障碍涉及的身体功能障碍包括关节活动度和肌肉力量，涉及的活动障碍包括行走和穿衣等方面。中医康复干预方案整合了针灸和推拿等多种干预方法，能显著改善患者的身体功能和活动。
结论 ICD-11 TM1与ICF的联合应用，可在中医康复领域建立精细化和标准化的诊断、功能分析和功能评估以及中医综合康复干预方案，不仅可应用于临床康复实践，还可用于临床康复管理和康复质量控制，特别是中医电子病历系统和病历统计。

关键词: 骨骼肌肉系统疾病, 功能, 《国际疾病分类第十一次修订本》传统医学分类模块1, 国际功能、残疾和健康分类, 中医

Abstract:

Objective To apply the International Classification of Diseases, the 11th Revision (ICD-11) Traditional Medicine 1 (TM1) chapter and International Classification of Functioning, Disability, and Health (ICF) in the diagnosis, functional analysis and assessment of musculoskeletal diseases and dysfunctions, and propose traditional Chinese medicine (TCM) rehabilitation intervention programs.
Methods ICD-11 TM1 and ICF were used for diagnosing musculoskeletal diseases and dysfunctions, as well as for functional analysis and assessment. The classification, coding, etiology, pathogenesis, clinical manifestations and diagnostic criteria of musculoskeletal diseases and dysfunctions in ICD-11 TM1 were examined. ICF classification was employed to analyze and assess relevant functional characteristics, including body functions and activity limitations, to clarify assessment content and grading disabilities. TCM rehabilitation intervention programs were designed.
Results The adoption of ICD-11 TM1 enabled standardized diagnosis and coding of the primary functional impairments of musculoskeletal system diseases in the field of TCM rehabilitation. The physical functional impairments involved in musculoskeletal system diseases and functional disorders, including joint range of motion and muscle strength, and the activity limitations involved walking and dressing, etc. The TCM rehabilitation intervention integrated a variety of intervention methods such as acupuncture and Tuina, which can significantly improve the body functions and activities of patients.
Conclusion The combined application of ICD-11 TM1 and ICF can establish a refined and standardized system for diagnosis, functional analysis, and assessment, as well as an integrated TCM rehabilitation intervention program in the field of TCM rehabilitation. This approach is not only applicable to clinical rehabilitation practice but also to clinical rehabilitation management and quality control, particularly in TCM electronic medical records and medical record statistics.

Key words: musculoskeletal diseases, functioning, International Classification of Diseases, the 11th Revision, Traditional Medicine 1, International Classification of Functioning, Disability, and Health, traditional Chinese medicine

中图分类号:

R685

顾忠平, 屠东艳. 骨骼肌肉系统疾病和功能障碍的诊断、功能分析以及中医干预：基于ICD-11传统医学分类模块1和ICF的研究[J]. 《中国康复理论与实践》, 2025, 31(4): 391-397.

GU Zhongping, TU Dongyan. Diagnosis, functional analysis and traditional Chinese medicine intervention for musculoskeletal diseases and functioning based on ICD-11 Traditional Medicine Module I and ICF[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(4): 391-397.

图/表 2

表1

基于ICD-11 TM1骨骼肌肉系统疾病和功能障碍的诊断和编码"

TM1编码	疾病/证候	病因与机理	临床表现	常见的疾病与症状表现	中医诊断方法
TM1-SC50、TM1-SC51、TM1-SC52、TM1-SC5Y、TM1-SC5Z	痹证	风寒湿邪侵袭、气血不足、痰瘀阻络	关节疼痛、僵硬、肿胀、运动受限	风湿性关节炎、类风湿关节炎、骨关节炎	望闻问切，辨寒湿、气血瘀滞，查舌脉
TM1-SC60	转筋	外力损伤、气血瘀滞	局部疼痛、肿胀、筋脉活动不利	软组织损伤、韧带拉伤、肌肉劳损	望局部红肿，触诊压痛，辨瘀滞程度
TM1-SC61	腰痛	肾虚、寒湿侵袭、劳损、气滞血瘀	腰部酸痛、活动受限、久坐加重	腰椎间盘突出、腰肌劳损、腰椎骨质增生	查腰部活动度，辨寒湿或肾虚，观舌脉
TM1-SC62	麻木	气血不足、痰湿阻络、寒湿侵袭、瘀血内阻、肝风内动	气血不足型：麻木多见于四肢末端，伴乏力、面色苍白、舌淡苔白、脉细弱痰湿阻络型：麻木伴肢体沉重、胸闷、舌苔厚腻、脉滑寒湿侵袭型：麻木遇寒加重，伴关节冷痛、舌淡苔白、脉沉紧瘀血内阻型：麻木固定不移，伴局部刺痛、舌质紫暗、脉涩肝风内动型：麻木伴头晕、头痛、肢体震颤、舌红苔少、脉弦细	痹证：如寒湿痹、痰瘀痹中风：如缺血性脑卒中、出血性脑卒中、短暂性脑缺血发作痿证：如气血亏虚型痿证血痹：如《金匮要略》中所述血痹	四诊合参：望诊，观察患者面色、舌象、肢体活动情况；闻诊，听患者描述症状特点；问诊，询问病史、伴随症状、饮食起居；切诊，脉诊及局部触诊辨证分型经络辨证辅助诊断：舌诊仪、脉诊仪、经络检测仪
TM1-SC63	痿证	久病体虚、气血不足、肝肾亏虚	肌肉无力、萎缩、四肢运动障碍	肌无力症、多发性硬化症、脊髓病变	问病史，查肌肉萎缩程度，辨肝肾亏虚

表1

表2

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ICF编码	功能/活动	评估内容	限定值
b710	关节活动功能	测量关节屈曲、伸展、内旋、外旋等活动范围	0(无)~4(完全障碍)
b715	关节稳定功能	评估关节在运动中的稳定性和支撑能力	0(无)~4(完全不稳定)
b730	肌力功能	评估肌肉收缩产生的力量，如徒手肌力测试	0(正常)~4(完全无力)
b735	肌张力	评估肌肉紧张程度，如痉挛、松弛	0(正常)~4(严重异常)
d410	改变身体的基本姿势	评估从坐到站、从卧到坐等姿势转换能力	0(无困难)~4(完全不能)
d450	步行	评估平地行走、上下楼梯、长距离步行能力	0(无困难)~4(完全不能)
d455	四处移动	评估爬行、攀爬、奔跑等移动能力	0(无困难)~4(完全不能)
d540	穿着	评估独立完成穿衣、脱衣的能力	0(无困难)~4(完全不能)