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Article(id=1322922765942137111, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.02.009, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793338966117, onlineDateStr=2026-10-30, pubDate=1739116800000, pubDateStr=2025-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793338966117, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793338966117, creator=13701087609, updateTime=1793338966117, updator=13701087609, issue=Issue{id=1322922680609014711, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='2', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1739116800000', pubDateStr='2025-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793338945772, creator='13701087609', updateTime=1793340618065, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929694785536732, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929694785536733, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322922680609014711, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=41, endPage=44, ext={EN=ArticleExt(id=1322922766135075096, articleId=1322922765942137111, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Xixi Guzhe Prescription（西溪骨折方）on Prognosis and Serum β-CTX and Crosslaps of Patients with Tibiofibular Fracture after Operation, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the influence of Xixi Guzhe Prescription（西溪骨折方）on the prognosis of patients with tibiofibular fracture after operation and the serum type I collagen carboxy terminal peptideβspecial sequence（β-CTX）and collagen Crosslaps.

Methods

One hundred and ten patients with tibia and fibula fractures admitted to the hospital from June 2016 to March 2021 were randomly divided into the combined group（55 cases）and the control group（55 cases）. Both groups were treated with open reduction and internal fixation，and the combined group was treated with Xixi Guzhe Prescription. The changes of pain score，tenderness，swelling degree，serumβ-CTX and Crosslaps before and 7 days after operation，and the changes of knee joint function score and knee joint range of motion（ROM）in American Special Surgery Hospital（HSS）at 7 days and 4 weeks after operation were evaluated. The fracture healing time of the two groups was compared，and the prognosis of the two groups was evaluated by Johner-Wruh tibial shaft fracture evaluation standard at 4 weeks after operation.

Results

The pain score，tenderness and swelling degree of the two groups decreased after 7 days，while the serumβ-CTX and Crosslaps increased. The pain score，tenderness and swelling degree of the combined group were lower than those of the control group after 7 days，while the serumβ-CTX and Crosslaps were higher than those of the control group（P<0.05）. The HSSscore and ROM of the two groups were higher than those of the control group at 4 weeks after operation，while those of the combined group were higher than those of the con-trol group at 4 weeks after operation（P<0.05）. The fracture healing time in the combined group was（15.14±2.63）weeks，which was lower than that in the control group（16.88±3.15）weeks（t＝3.145，P=0.002）. The excellent and good recovery rate in the combined group was 94.55%（52/55）after 4 weeks，which was higher than that in the control group（81.82%，45/55）（P<0.05）. The incidence of postoperative complications in the combined group and the control group were 7.27%（4/55）and 10.91%（6/55）respectively，and there was no statistical difference between the two groups（P>0.05）.

Conclusion

On the basis of open reduction and internal fixation，the addition of Xixi Guzhe Prescription can relieve patients'pain，improve bone metabolism and play a positive role in promoting the early rehabilitation of patients'knee joint function，and will not lead to an increase in the risk of postoperative complications.

, authors=Xuezi YU, Long ZHANG, Yinhong WANG, Bingbing YE, Yuan XU, authorsList=Xuezi YU, Long ZHANG, Yinhong WANG, Bingbing YE, Yuan XU, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322922767326257443, articleId=1322922765942137111, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=西溪骨折方对胫腓骨骨折术后患者预后及血清β-CTX、Crosslaps的影响, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

分析西溪骨折方对胫腓骨骨折术后患者预后及血清Ⅰ型胶原羧基端肽β特殊序列（Type I collagen carboxy terminal peptide β special sequence，β-CTX）、骨胶原交联（Crosslaps）的影响。

方法

纳入2016年6月—2021年3月收治的110例胫腓骨骨折患者，使用简单随机法分为联合组和对照组各55例，两组均接受切开复位内固定治疗，联合组加用西溪骨折方。评估两组术前、术后7 d疼痛评分、压痛、肿胀度以及血清β-CTX、Crosslaps变化，和术后7 d、术后4周美国特种外科医院（Hospital for special surgery，HSS）膝关节功能评分、膝关节活动度（Range of motion，ROM）变化，比较两组骨折愈合时间，并于术后4周使用Johner-Wruh胫骨干骨折评估标准评估两组预后。

结果

两组术后7 d疼痛评分、压痛、肿胀度均较术前下降，血清β-CTX、Crosslaps均较术前升高，联合组术后7 d疼痛评分、压痛、肿胀度均低于对照组，血清β-CTX、Crosslaps均高于对照组（P<0.05）。两组术后4周HSS评分、ROM均较术后7 d升高，联合组术后4周HSS评分、ROM均高于对照组（P<0.05）。联合组骨折愈合时间为（15.14±2.63）周，低于对照组的（16.88±3.15）周（t＝3.145，P=0.002）。联合组术后4周恢复优良率为94.55%（52/55），较对照组的81.82%（45/55）更高（P<0.05）。联合组、对照组术后并发症发生率分别为7.27%（4/55）、10.91%（6/55），组间比较差异无统计学意义（P>0.05）。

结论

在切开复位内固定治疗的基础上，加用西溪骨折方能够减轻患者疼痛、改善骨代谢，对于促进患者膝关节功能早期康复具有积极作用，且不会导致术后并发症风险上升。

, authors=俞学子, 张龙, 王殷红, 叶冰兵, 许远, authorsList=俞学子, 张龙, 王殷红, 叶冰兵, 许远, authorCompany=null, correspAuthors=null, authorNote=

俞学子（1984-），男，浙江杭州人，副主任医师，学士，研究方向：四肢与关节周围骨折、关节运动损伤的修复及功能康复锻炼、老年骨质疏松性骨折的微创化治疗等。

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俞学子（1984-），男，浙江杭州人，副主任医师，学士，研究方向：四肢与关节周围骨折、关节运动损伤的修复及功能康复锻炼、老年骨质疏松性骨折的微创化治疗等。

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俞学子（1984-），男，浙江杭州人，副主任医师，学士，研究方向：四肢与关节周围骨折、关节运动损伤的修复及功能康复锻炼、老年骨质疏松性骨折的微创化治疗等。

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journalName=中国中医药现代远程教育, refType=null, unstructuredReference=胡雨珠，万小萍，尹红波. 自制治伤三黄酊湿敷联合冷疗治疗胫腓骨骨折早期肿胀临床观察［J］. 中国中医药现代远程教育，2022，20（8）：88-90., articleTitle=自制治伤三黄酊湿敷联合冷疗治疗胫腓骨骨折早期肿胀临床观察, refAbstract=null), Reference(id=1322922775681311086, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922765942137111, doi=null, pmid=null, pmcid=null, year=2022, volume=44, issue=4, pageStart=569, pageEnd=573, url=null, language=null, rfNumber=［26］, rfOrder=25, authorNames=齐冰冰, 李国梁, journalName=河北中医, refType=null, unstructuredReference=齐冰冰，李国梁. 马骨续筋胶囊联合中医手法复位孟氏架治疗胫腓骨骨折的临床研究［J］. 河北中医，2022，44（4）：569-573., articleTitle=马骨续筋胶囊联合中医手法复位孟氏架治疗胫腓骨骨折的临床研究, refAbstract=null)], funds=[Fund(id=1322922773877760340, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922765942137111, awardId=国中医药人教函〔2021〕228号, language=CN, fundingSource=国家中医药管理局项目(国中医药人教函〔2021〕228号), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322922767548555556, 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组别例数年龄/（岁）性别/［例/（%）］骨折分型/［例/（%）］骨折性质/［例/（%）］
男女A~B型C型闭合性开放性
联合组5545.71±6.0839（70.91）16（29.09）26（47.27）29（52.73）30（54.55）25（45.45）
对照组5545.42±5.7942（76.36）13（23.64）28（50.91）27（49.09）33（60.00）22（40.00）
t/χ2值-0.2560.4210.1460.334
P值-0.7980.5160.7030.563
), ArticleFig(id=1322922771356983625, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922765942137111, language=CN, label=表1, caption=

两组胫腓骨骨折患者一般临床资料比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数年龄/（岁）性别/［例/（%）］骨折分型/［例/（%）］骨折性质/［例/（%）］
男女A~B型C型闭合性开放性
联合组5545.71±6.0839（70.91）16（29.09）26（47.27）29（52.73）30（54.55）25（45.45）
对照组5545.42±5.7942（76.36）13（23.64）28（50.91）27（49.09）33（60.00）22（40.00）
t/χ2值-0.2560.4210.1460.334
P值-0.7980.5160.7030.563
), ArticleFig(id=1322922771436675402, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922765942137111, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时期VAS评分/（分）压痛/（分）肿胀度/（%）
联合组55术前5.25±0.695.87±1.197.83±0.69
术后7 d2.25±0.31*2.76±0.63*2.97±0.38*
对照组55术前5.36±0.655.91±1.037.66±0.75
术后7 d2.71±0.26*#3.58±0.71*#4.19±0.42*#
), ArticleFig(id=1322922771528950091, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922765942137111, language=CN, label=表2, caption=

两组胫腓骨骨折患者疼痛评分、压痛、肿胀度变化比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时期VAS评分/（分）压痛/（分）肿胀度/（%）
联合组55术前5.25±0.695.87±1.197.83±0.69
术后7 d2.25±0.31*2.76±0.63*2.97±0.38*
对照组55术前5.36±0.655.91±1.037.66±0.75
术后7 d2.71±0.26*#3.58±0.71*#4.19±0.42*#
), ArticleFig(id=1322922771612836172, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922765942137111, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时期β-CTXCrosslaps
联合组55术前385.86±69.7661.69±9.71
术后7 d552.59±87.61*79.36±12.65*
对照组55术前388.83±70.1261.88±9.52
术后7 d510.59±80.34*#72.71±11.83*#
), ArticleFig(id=1322922771696722253, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922765942137111, language=CN, label=表3, caption=

两组胫腓骨骨折患者血清β-CTX、Crosslaps变化比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时期β-CTXCrosslaps
联合组55术前385.86±69.7661.69±9.71
术后7 d552.59±87.61*79.36±12.65*
对照组55术前388.83±70.1261.88±9.52
术后7 d510.59±80.34*#72.71±11.83*#
), ArticleFig(id=1322922771780608334, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922765942137111, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时期HSS评分/（分）ROM/（°）
联合组55术后7 d58.31±6.6260.65±7.19
术后4周80.75±9.59*98.32±11.08*
对照组55术后7 d58.66±6.7560.33±7.26
术后4周75.63±9.21*#91.44±10.57*#
), ArticleFig(id=1322922771864494415, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922765942137111, language=CN, label=表4, caption=

两组胫腓骨骨折患者HSS评分、ROM变化比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时期HSS评分/（分）ROM/（°）
联合组55术后7 d58.31±6.6260.65±7.19
术后4周80.75±9.59*98.32±11.08*
对照组55术后7 d58.66±6.7560.33±7.26
术后4周75.63±9.21*#91.44±10.57*#
), ArticleFig(id=1322922771944186192, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922765942137111, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数优良可差优良率
联合组5525（45.45）27（49.09）2（3.64）1（1.82）52（94.55）
对照组5511（20.00）34（61.82）7（12.73）3（5.45）45（81.82）
χ2值-----4.274
P值-----0.039
), ArticleFig(id=1322922772036460881, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922765942137111, language=CN, label=表5, caption=

两组胫腓骨骨折患者术后4周恢复优良率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数优良可差优良率
联合组5525（45.45）27（49.09）2（3.64）1（1.82）52（94.55）
对照组5511（20.00）34（61.82）7（12.73）3（5.45）45（81.82）
χ2值-----4.274
P值-----0.039
), ArticleFig(id=1322922772090986834, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922765942137111, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数感染畸形愈合骨不连功能障碍合计
联合组552（3.64）01（1.82）1（1.82）4（7.27）
对照组553（5.45）1（1.82）1（1.82）1（1.82）6（10.91）
χ2值-----0.440
P值-----0.507
), ArticleFig(id=1322922773751931219, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322922765942137111, language=CN, label=表6, caption=

两组胫腓骨骨折患者术后并发症发生率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数感染畸形愈合骨不连功能障碍合计
联合组552（3.64）01（1.82）1（1.82）4（7.27）
对照组553（5.45）1（1.82）1（1.82）1（1.82）6（10.91）
χ2值-----0.440
P值-----0.507
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西溪骨折方对胫腓骨骨折术后患者预后及血清β-CTX、Crosslaps的影响
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俞学子 , 张龙 , 王殷红 , 叶冰兵 , 许远
中华中医药学刊 | 国家项目点击 2025,43(2): 41-44
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中华中医药学刊 |国家项目点击 2025 , 43 (2) : 41 -44
西溪骨折方对胫腓骨骨折术后患者预后及血清β-CTX、Crosslaps的影响
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俞学子（1984-），男，浙江杭州人，副主任医师，学士，研究方向：四肢与关节周围骨折、关节运动损伤的修复及功能康复锻炼、老年骨质疏松性骨折的微创化治疗等。

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俞学子（1984-），男，浙江杭州人，副主任医师，学士，研究方向：四肢与关节周围骨折、关节运动损伤的修复及功能康复锻炼、老年骨质疏松性骨折的微创化治疗等。

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俞学子, 张龙, 王殷红, 叶冰兵, 许远
作者信息
  • 杭州市西溪医院，浙江 杭州 310022
作者简介:

俞学子（1984-），男，浙江杭州人，副主任医师，学士，研究方向：四肢与关节周围骨折、关节运动损伤的修复及功能康复锻炼、老年骨质疏松性骨折的微创化治疗等。

Effect of Xixi Guzhe Prescription（西溪骨折方）on Prognosis and Serum β-CTX and Crosslaps of Patients with Tibiofibular Fracture after Operation
Xuezi YU, Long ZHANG, Yinhong WANG, Bingbing YE, Yuan XU
Affiliations
  • Hangzhou Xixi Hospital，Hangzhou 310022，Zhejiang，China
出版时间: 2025-02-10 doi: 10.13193/j.issn.1673-7717.2025.02.009
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摘要
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目的

分析西溪骨折方对胫腓骨骨折术后患者预后及血清Ⅰ型胶原羧基端肽β特殊序列（Type I collagen carboxy terminal peptide β special sequence，β-CTX）、骨胶原交联（Crosslaps）的影响。

方法

纳入2016年6月—2021年3月收治的110例胫腓骨骨折患者，使用简单随机法分为联合组和对照组各55例，两组均接受切开复位内固定治疗，联合组加用西溪骨折方。评估两组术前、术后7 d疼痛评分、压痛、肿胀度以及血清β-CTX、Crosslaps变化，和术后7 d、术后4周美国特种外科医院（Hospital for special surgery，HSS）膝关节功能评分、膝关节活动度（Range of motion，ROM）变化，比较两组骨折愈合时间，并于术后4周使用Johner-Wruh胫骨干骨折评估标准评估两组预后。

结果

两组术后7 d疼痛评分、压痛、肿胀度均较术前下降，血清β-CTX、Crosslaps均较术前升高，联合组术后7 d疼痛评分、压痛、肿胀度均低于对照组，血清β-CTX、Crosslaps均高于对照组（P<0.05）。两组术后4周HSS评分、ROM均较术后7 d升高，联合组术后4周HSS评分、ROM均高于对照组（P<0.05）。联合组骨折愈合时间为（15.14±2.63）周，低于对照组的（16.88±3.15）周（t＝3.145，P=0.002）。联合组术后4周恢复优良率为94.55%（52/55），较对照组的81.82%（45/55）更高（P<0.05）。联合组、对照组术后并发症发生率分别为7.27%（4/55）、10.91%（6/55），组间比较差异无统计学意义（P>0.05）。

结论

在切开复位内固定治疗的基础上，加用西溪骨折方能够减轻患者疼痛、改善骨代谢，对于促进患者膝关节功能早期康复具有积极作用，且不会导致术后并发症风险上升。

西溪骨折方  /  胫腓骨骨折  /  Ⅰ型胶原羧基端肽β特殊序列  /  骨胶原交联
Objective

To analyze the influence of Xixi Guzhe Prescription（西溪骨折方）on the prognosis of patients with tibiofibular fracture after operation and the serum type I collagen carboxy terminal peptideβspecial sequence（β-CTX）and collagen Crosslaps.

Methods

One hundred and ten patients with tibia and fibula fractures admitted to the hospital from June 2016 to March 2021 were randomly divided into the combined group（55 cases）and the control group（55 cases）. Both groups were treated with open reduction and internal fixation，and the combined group was treated with Xixi Guzhe Prescription. The changes of pain score，tenderness，swelling degree，serumβ-CTX and Crosslaps before and 7 days after operation，and the changes of knee joint function score and knee joint range of motion（ROM）in American Special Surgery Hospital（HSS）at 7 days and 4 weeks after operation were evaluated. The fracture healing time of the two groups was compared，and the prognosis of the two groups was evaluated by Johner-Wruh tibial shaft fracture evaluation standard at 4 weeks after operation.

Results

The pain score，tenderness and swelling degree of the two groups decreased after 7 days，while the serumβ-CTX and Crosslaps increased. The pain score，tenderness and swelling degree of the combined group were lower than those of the control group after 7 days，while the serumβ-CTX and Crosslaps were higher than those of the control group（P<0.05）. The HSSscore and ROM of the two groups were higher than those of the control group at 4 weeks after operation，while those of the combined group were higher than those of the con-trol group at 4 weeks after operation（P<0.05）. The fracture healing time in the combined group was（15.14±2.63）weeks，which was lower than that in the control group（16.88±3.15）weeks（t＝3.145，P=0.002）. The excellent and good recovery rate in the combined group was 94.55%（52/55）after 4 weeks，which was higher than that in the control group（81.82%，45/55）（P<0.05）. The incidence of postoperative complications in the combined group and the control group were 7.27%（4/55）and 10.91%（6/55）respectively，and there was no statistical difference between the two groups（P>0.05）.

Conclusion

On the basis of open reduction and internal fixation，the addition of Xixi Guzhe Prescription can relieve patients'pain，improve bone metabolism and play a positive role in promoting the early rehabilitation of patients'knee joint function，and will not lead to an increase in the risk of postoperative complications.

Xixi Guzhe Prescription（西溪骨折方）  /  fracture of tibia and fibula  /  special sequence of carboxy-terminal peptideβof type I collagen  /  collagen Crosslinking
俞学子, 张龙, 王殷红, 叶冰兵, 许远. 西溪骨折方对胫腓骨骨折术后患者预后及血清β-CTX、Crosslaps的影响. 中华中医药学刊, 2025 , 43 (2) : 41 -44 . DOI: 10.13193/j.issn.1673-7717.2025.02.009
Xuezi YU, Long ZHANG, Yinhong WANG, Bingbing YE, Yuan XU. Effect of Xixi Guzhe Prescription（西溪骨折方）on Prognosis and Serum β-CTX and Crosslaps of Patients with Tibiofibular Fracture after Operation[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (2) : 41 -44 . DOI: 10.13193/j.issn.1673-7717.2025.02.009
正文
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胫腓骨骨折约占全身骨折的13.7%，多由高能量损伤所致，除疼痛、肢体肿胀外，患者往往伴有严重软组织损伤及多种合并伤，是导致治疗难度增加、恢复速度缓慢的主要原因，严重者可能发生感染、筋膜室间隔综合征甚至需截肢[1]。因此，在切开复位内固定治疗的基础上，积极消肿、改善微循环，对于避免严重不良后果、促进肢体恢复有着重要意义。中医认为，在骨断筋伤、血溢脉外基础上，局部气血运行受限是导致疼痛、肿胀、关节活动受限的主要原因，故治疗当以消肿止痛、活血化瘀为主要原则[2]。最新研究显示，Ⅰ型胶原羧基端肽β特殊序列（Type I collagen carboxy terminal peptideβspecial sequence，β-CTX）、骨胶原交联（Crosslaps）与人体骨代谢存在密切关联，且与骨折患者恢复质量相关[3]。基于既往观点及研究结论，此次研究尝试将西溪骨折方应用于胫腓骨骨折术后中医药干预，现将其应用效果及对患者血清β-CTX、Crosslaps变化的影响报道如下。
1　资料与方法
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1.1　一般资料
纳入我院2016年6月—2021年3月收治的110例胫腓骨骨折患者，开展前瞻性对照研究。本研究经本院伦理委员会批准。纳入标准：（1）参照《临床骨科学（第3版）》，经影像学检查、病史调查明确胫腓骨骨折诊断[4]；（2）符合切开复位内固定治疗适应证，拟于我院接受外科治疗；（3）X线检查可见清晰骨折线；（4）具备参与研究的意愿和配合研究的能力。排除标准：（1）合并其他类型骨折，以及骨质疏松性、病理性骨折；（2）合并心、肺等重要脏器严重病变；（3）合并急慢性感染、免疫系统疾病或精神疾病；（4）既往有膝关节功能障碍。征得患者及家属知情同意后，使用简单随机法将110例患者分为联合组55例、对照组55例。两组年龄、骨折分型等基线资料对比，差异未见统计学意义（P>0.05），本临床研究具有可比性。见表1。
1.2　治疗方案
两组均接受切开复位内固定治疗，手术均由同组医护人员完成。患者取仰卧、外展位，将骨折部位皮肤、皮下组织及深筋膜切开，钝性分离组织，充分暴露骨折断端，复位骨折部位并使用克氏针临时固定。而后选择长度合适的钢板，置入钢板并以锁定螺钉固定，C型臂X线机透视下明确内固定良好后，充分冲洗、消毒，留置引流管，结束手术。术后行常规消肿、止痛、引流、预防感染治疗，待患者恢复稳定后嘱其早期开展功能锻炼，包括股四头肌收缩训练、踝泵训练等，逐渐过渡至膝关节、踝关节屈伸训练，术后1～2周每日训练2次，每次30 min；术后2周后增加直腿抬高等训练，适当增加训练频次、提高训练强度，鼓励患者早期行床旁训练或床下训练。
在上述治疗及干预方案的基础上，联合组加用西溪骨折方治疗。西溪骨折方组方：当归15 g，川芎10 g，苏木10 g，红花10 g，炒地鳖虫10 g，赤芍10 g，伸筋草10 g，扯根菜10 g，生地黄10 g，醋延胡索10 g，陈皮6 g，甘草6 g。加水1000 mL，煎至400 mL，1剂/d，早晚各服用200 mL，于术后1 d起开始服用，持续12周。
1.3　观察指标
分别于术前、术后7 d，使用疼痛视觉模拟量表（Visual analogue scale，VAS）评估患者躯体疼痛及局部压痛，VAS量表总分0～10分，评分越高则疼痛越明显[5]；评估两组患侧较健侧肿胀情况，以（患侧周径-健侧周径）/健侧周径×100%计；同时，检测两组血清β-CTX、Crosslaps变化，均使用电化学发光免疫法进行检测，检测操作均严格参照试剂盒使用说明书。其次，分别于术后7 d、术后4周，评估两组美国特种外科医院（Hospital for special surgery，HSS）膝关节功能评分、膝关节活动度（Range of motion，ROM），HSS量表包括疼痛、功能、活动度、肌力、屈膝畸形、稳定性等共计7个项目，总分0～100分，评分越高则功能越佳[6]。此外，记录两组骨折愈合时间，即X线示骨折线消失时间，并于术后4周使用Johner-Wruh胫骨干骨折评估标准评估两组预后。Johner-Wruh胫骨干骨折评估标准包括不愈合或感染、神经血管损伤、畸形、关节活动度等共8个项目，未见骨不连、骨髓炎，膝关节活动度、步态恢复正常判定为优；轻度血管、神经受损，内外翻畸形2°～5°，偶发疼痛，判定为良；内外翻畸形6°～10°、前后畸形10°～20°、旋转畸形10°～20°，或短缩11～20 mm、轻度跛行步态，判定为可；未达上述标准判定为差；优良率以（优+良）/总例数×100%计[7]。另外，记录两组术后软组织感染、骨不连等并发症发生情况。
1.4　统计学分析
使用SPSS22.0统计学软件分析本研究相关数据，骨折分型、骨折性质等计数资料以（例数/%）表示，并采用卡方检验（χ2检验），VAS评分、HSS评分等计量资料均符合正态分布，以（平均数±标准差）即（）表示，采用双侧t检验，当P<0.05时，认为差异存在统计学意义。
2　结果
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2.1　疼痛评分、压痛、肿胀度变化
两组术后7 d疼痛评分、压痛、肿胀度均较术前下降，联合组术后7 d疼痛评分、压痛、肿胀度均低于对照组（P<0.05）。见表2。
2.2　血清β-CTX、Crosslaps变化
两组术后7 d血清β-CTX、Crosslaps均较术前升高，联合组术后7 d血清β-CTX、Crosslaps均高于对照组（P<0.05）。见表3。
2.3　HSS评分、ROM变化
两组术后4周HSS评分、ROM均较术后7 d升高，联合组术后4周HSS评分、ROM均高于对照组（P<0.05）。见表4。
2.4　骨折愈合时间
联合组骨折愈合时间为（15.14±2.63）周，低于对照组的（16.88±3.15）周（t＝3.145，P=0.002）。
2.5　预后评估
联合组术后4周恢复优良率为94.55%，较对照组的81.82%更高（P<0.05）。见表5。
2.6　术后并发症
联合组、对照组术后并发症发生率分别为7.27%、10.91%，组间比较差异无统计学意义（P>0.05）。见表6。
3　讨论
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胫腓骨、肌间隔、骨间膜和小腿固有筋膜共同组成了骨-纤维鞘-筋膜间室，筋膜间室内肌肉丰富、筋膜张力高且容积有限，胫腓骨骨折发生时，骨折断端及肌肉组织出血、渗血难以扩散至周围组织，是导致局部神经、肌肉组织持续受压的主要原因，而长期缺血缺氧可能引发组织坏死甚至全身酸中毒，乃至休克等严重并发症[8]。因此，在积极开展外科手术的基础上，尽快减轻组织水肿对于促进患者早期康复、预防并发症发生至关重要。
鉴于传统引流、消肿方式在减轻组织水肿方面存在一定局限性，此次研究尝试将中医药应用于胫腓骨骨折患者术后干预。胫腓骨骨折属于传统医学“骨折病”范畴，《诸病源候论》指出，“若因坠落损伤，则血行失度，随伤损之处即停积……集聚不散，皆成瘀血”；《圣济总录·伤折恶血不散》也强调，“筋骨损伤，血气磋跌，或留积成瘀，掀肿疼痛，宜速治之”[9-10]。因此，针对胫腓骨骨折的中医药治疗，应以解除气血凝滞不通为首要目标和重要原则。
西溪骨折方是在中医骨折治疗妙方经验的基础上汇总而来的新型方剂，方中当归为君，有补血、活血之功，其疏肝理气、活血行气之效可攻瘀散滞、生新祛瘀，古代中医学家即将当归之功效总结为“不补血而祛瘀，瘀又安能尽去哉”；现代医学研究显示，当归具有扩张毛细血管、降低血液循环阻力的药理学作用，且能够降低全血黏度、改善血流动力学，且当归挥发油也有镇静、镇痛之效[11-12]。红花为臣，有活血祛瘀、消肿止痛之功，被《本草汇言》列为“调血之药”；药理学研究表明，红花可抑制血小板聚集、促进纤溶功能，是改善血液循环的有效药物[13]。川芎、苏木、炒地鳖虫、伸筋草、扯根菜、生地黄、醋延胡索为佐，有散结消肿、清热生津之功，其中，川芎“既可行散、又能入里”，不仅有活血化瘀之效，也有祛风止痛、行气散寒之功，被称为血中之行气药，药理学研究显示，川芎内有效成分以阿魏酸、川芎嗪为主，在降低细胞兴奋性、抑制血小板聚集、改善血液流变方面效果显著[14-15]。陈皮、甘草为使，有健脾益气、运化水湿之效，能够在减轻局部瘀血的同时改善肢体肿胀[16]。数药共用，符合祛瘀而生新原则，可达消肿生肌、祛瘀生骨之功[17]。得益于这一优势，本研究联合组术后7 d疼痛评分、压痛、肿胀度均低于对照组，印证了西溪骨折方在缓解疼痛、减轻肢体肿胀方面的重要作用，也表明该方有助于局部软组织损伤的修复。
除疼痛及肿胀减轻外，联合组术后7 d血清β-CTX、Crosslaps均高于对照组，前者与骨吸收能力相关，其水平升高意味着骨折愈合速度加快，而Crosslaps的升高则表明骨量增加，与再骨折风险下降有关[18-20]。得益于骨代谢状态的好转，联合组骨折愈合时间较对照组显著缩短，且术后4周膝关节功能、活动度及功能恢复优良率均优于对照组，意味着西溪骨折方在促进骨折恢复、改善患者预后方面效果显著[21-23]。与此同时，西溪骨折方并未导致患者术后并发症发生率上升，说明该治疗方案的安全性良好。在今后的研究中，进一步拓展样本量以明确西溪骨折方在预防术后并发症方面的积极作用，有望为该方剂的进一步推广提供更为坚实的证据支持，值得进一步关注[24-26]。
综上所述，在切开复位内固定治疗的基础上，加用西溪骨折方能够减轻患者疼痛、改善骨代谢，对于促进患者膝关节功能早期康复具有积极作用，且不会导致术后并发症风险上升，值得临床广泛推广应用。
基金
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  • 国家中医药管理局项目(国中医药人教函〔2021〕228号)
文献
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2025年第43卷第2期
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doi: 10.13193/j.issn.1673-7717.2025.02.009
  • 首发时间：2026-10-30
  • 出版时间：2025-02-10
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国家中医药管理局项目(国中医药人教函〔2021〕228号)
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    杭州市西溪医院，浙江 杭州 310022
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Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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