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Article(id=1322924010719289726, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923782029062261, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.06.026, 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=1793339262895, onlineDateStr=2026-10-30, pubDate=1749484800000, pubDateStr=2025-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339262895, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339262895, creator=13701087609, updateTime=1793339262895, updator=13701087609, issue=Issue{id=1322923782029062261, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='6', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1749484800000', pubDateStr='2025-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339208371, creator='13701087609', updateTime=1793340556755, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929437859258468, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923782029062261, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929437859258469, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923782029062261, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=134, endPage=137, ext={EN=ArticleExt(id=1322924010975142271, articleId=1322924010719289726, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Yiqi Huoxue Fuyuan Decoction（益气活血复元汤）Combined with Minimally Invasive Treatment of Calcaneal Fracture on Bone Metabolism and Bone Healing, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To study the effects of Yiqi Huoxue Fuyuan Decoction（益气活血复元汤）combined with minimally invasive surgery on bone metabolism and bone healing of calcaneal fracture.

Methods

Eighty patients diagnosed as calcaneal fracture were selected and divided into two groups according to random number table.Forty patients in the reference group were treated with minimally invasive surgery，and forty patients in the study group were treated with Yiqi Huoxue Fuyuan Decoction combined with minimally invasive surgery.The clinical efficacy，TCM syndrome score，bone metabolism index，bone healing index and imaging index of the two groups were observed and compared.

Results

Compared with that（77.50%）of the reference group，the total effective rate of the study group was97.50%，and the difference was statistically significant（P<0.05）.Compared with that of the reference group，the TCM syndrome score of the study group was lower，and the difference was statistically significant（P<0.05）.Compared with those of the reference group，the levels of osteocalcin（OC）and bone alkaline phosphatase（BALP）in the study group were higher，and the levels of pyridinoline（PYD）and tartrate resistant acid phosphatase（TRAP）were lower，with statistical significance（P<0.05）.Compared with those of the reference group，the levels of alkaline phosphatase（ALP），propeptide of typeⅠprocollagen（PICP），insulin-like growth factor（IGF）and bone morphogenetic protein（BMP）in the study group were higher，and the differences were statistically significant（P<0.05）.Compared with those of the reference group，Bohler Angle，Gissane Angle and calcaneus height in the study group were higher，and calcaneus width was lower，with statistical significance（P<0.05）.

Conclusion

The combination of minimally invasive surgery and Yiqi Huoxue Fuyuan Decoction can effectively improve the clinical symptoms of patients with calcaneal fracture and promote fracture healing，with high clinical application value.

, authors=Zhonghua HUANG, Huiyuan WANG, Xianchao ZHOU, authorsList=Zhonghua HUANG, Huiyuan WANG, Xianchao ZHOU, 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=1322924014150230410, articleId=1322924010719289726, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=益气活血复元汤联合微创手术治疗跟骨骨折对骨代谢和骨愈合的影响研究, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

研究益气活血复元汤联合微创手术治疗跟骨骨折对骨代谢和骨愈合的影响研究。

方法

抽取80例经检查被确诊为跟骨骨折的患者，按随机数字表分为两组，对照组40例予以微创手术治疗，研究组40例予以益气活血复元汤、微创手术联合治疗。观察比较两组患者的临床疗效、中医证候积分、骨代谢指标、骨愈合指标以及影像学指标。

结果

研究组总有效率97.50%，对照组总有效率77.50%，研究组高于对照组，差异有统计学意义（P<0.05）。治疗后，与对照组相对比，研究组中医证候积分更低，差异有统计学意义（P<0.05）。与对照组相对比，研究组骨钙素（osteocalcin，OC）、骨碱性磷酸酶（Bone alkaline phosphatase，BALP）水平显著增高，吡啶啉（Pyridinoline，PYD）、抗酒石酸性磷酸酶（tartrate resistant acid phosphatase，TRAP）水平显著降低，差异有统计学意义（P<0.05）。与对照组相对比，研究组碱性磷酸酶（alkaline phosphatase，ALP）、I型前胶原氨基末端前肽（Propeptide of typeⅠprocollagen，PICP）、胰岛素样生长因子（Insulinlike Growth Factor，IGF）、骨形态发生蛋白（bonemorphogeneticprotein，BMP）水平均更高，差异有统计学意义（P<0.05）。与对照组相对比，研究组Bohler角、Gissane角、跟骨高度水平均显著增高，跟骨宽度显著降低，差异有统计学意义（P<0.05）。

结论

跟骨骨折的患者采取微创手术、益气活血复元汤联合治疗后，治疗效果好，能有效改善患者的临床症状，促进骨折愈合，临床应用价值较高。

, authors=黄中华, 王穗源, 周贤超, authorsList=黄中华, 王穗源, 周贤超, authorCompany=null, correspAuthors=null, authorNote=

黄中华（1982-），男，湖南长沙人，副主任医师，硕士，研究方向：足踝，骨科疾病。

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黄中华（1982-），男，湖南长沙人，副主任医师，硕士，研究方向：足踝，骨科疾病。

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黄中华（1982-），男，湖南长沙人，副主任医师，硕士，研究方向：足踝，骨科疾病。

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Associations between osteocalcin，calciotropic hormones，and energy metabolism in a cohort of chinese postmenopausal women：peking vertebral fracture study［J］. International journal of endocrinology，2021，2021（Pt. 1）：5585018-5585027., articleTitle=Associations between osteocalcin，calciotropic hormones，and energy metabolism in a cohort of chinese postmenopausal women：peking vertebral fracture study, refAbstract=null), Reference(id=1322924022765330897, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, doi=null, pmid=null, pmcid=null, year=2022, volume=111, issue=3, pageStart=288, pageEnd=299, url=null, language=null, rfNumber=［30］, rfOrder=29, authorNames=IVASKA, KAISA K, MCGUIGAN, journalName=Calcified tissue international, refType=null, unstructuredReference=IVASKA，KAISA K，MCGUIGAN，et al. Bone turnover marker profiling and fracturerisk in older women：fracture risk from age75 to90［J］. 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An antibody against Siglec-15 promotes bone formation and fracture healing by increasing TRAP+mononuclear cells and PDGF-BB secretion［J］. 骨研究（英文版），2021，9（4）：582-592., articleTitle=An antibody against Siglec-15 promotes bone formation and fracture healing by increasing TRAP+mononuclear cells and PDGF-BB secretion, refAbstract=null), Reference(id=1322924023209927124, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, doi=null, pmid=null, pmcid=null, year=2022, volume=20, issue=3, pageStart=325, pageEnd=334, url=null, language=null, rfNumber=［33］, rfOrder=32, authorNames=刘嘉, 严宝飞, 孙占东, journalName=生物加工过程, refType=null, unstructuredReference=刘嘉，严宝飞，孙占东，等. 基于网络药理学的当归-红花治疗原发性痛经的作用机制［J］. 生物加工过程，2022，20（3）：325-334., articleTitle=基于网络药理学的当归-红花治疗原发性痛经的作用机制, refAbstract=null), Reference(id=1322924023390282197, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, doi=null, pmid=null, pmcid=null, year=2022, volume=53, issue=14, pageStart=4428, pageEnd=4436, url=null, language=null, rfNumber=［34］, rfOrder=33, authorNames=刘青松, 李微, 张怡, journalName=中草药, refType=null, unstructuredReference=刘青松，李微，张怡，等. 基于数据挖掘探讨“柴胡劫肝阴”的相杀配伍内涵［J］. 中草药，2022，53（14）：4428-4436., articleTitle=基于数据挖掘探讨“柴胡劫肝阴”的相杀配伍内涵, refAbstract=null), Reference(id=1322924023457391062, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, doi=null, pmid=null, pmcid=null, year=2021, volume=28, issue=4, pageStart=47, pageEnd=51, url=null, language=null, rfNumber=［35］, rfOrder=34, authorNames=方坤炎, 吕丽容, 郭超峰, journalName=中国中医药信息杂志, refType=null, unstructuredReference=方坤炎，吕丽容，郭超峰. 基于数据挖掘的小柴胡汤加减治疗热入血室方证关系研究［J］. 中国中医药信息杂志，2021，28（4）：47-51., articleTitle=基于数据挖掘的小柴胡汤加减治疗热入血室方证关系研究, refAbstract=null)], funds=[Fund(id=1322924018373894578, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, awardId=320.6750.17258, language=CN, fundingSource=吴阶平医学基金会临床科研专项资助基金项目(320.6750.17258), fundOrder=null, country=null), Fund(id=1322924018441003443, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, awardId=D202304076930, language=CN, fundingSource=湖南省卫生健康委员会科研计划项目(D202304076930), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322924014385111435, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, xref=null, ext=[AuthorCompanyExt(id=1322924014393500044, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, companyId=1322924014385111435, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=The Fourth Hospital of Changsha，Changsha 410023，Hunan，China), AuthorCompanyExt(id=1322924014401888653, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, companyId=1322924014385111435, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=长沙市第四医院，湖南 长沙 410023)])], figs=[ArticleFig(id=1322924016008307111, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效率
对照组4024（60.00）7（17.50）9（22.50）31（77.50）
研究组4030（75.00）9（22.50）1（2.50）39（97.50）
χ2值---7.314 3
P值---0.006 8
), ArticleFig(id=1322924017606336937, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, language=CN, label=表1, caption=

两组跟骨骨折患者临床疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效率
对照组4024（60.00）7（17.50）9（22.50）31（77.50）
研究组4030（75.00）9（22.50）1（2.50）39（97.50）
χ2值---7.314 3
P值---0.006 8
), ArticleFig(id=1322924017690223018, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间疼痛僵硬皮下瘀斑口渴便秘
对照组40治疗前5.58±0.315.48±0.275.59±0.212.35±0.542.53±0.45
治疗后4.75±0.334.89±0.353.74±0.241.31±0.501.21±0.37
t值11.593 98.441 536.689 58.937 714.330 1
P值0.000 00.000 00.000 00.000 00.000 0
研究组40治疗前5.49±0.295.39±0.285.55±0.232.29±0.562.55±0.39
治疗后2.25±0.151.91±0.181.75±0.200.57±0.140.78±0.25
t值62.761 966.121 078.850 718.845 424.165 1
P值0.000 00.000 00.000 00.000 00.000 0
治疗前t值1.340 91.463 40.812 30.487 80.212 4
治疗前P值0.183 80.147 40.419 10.627 10.832 3
治疗后t值43.618 747.887 340.286 49.013 76.090 3
治疗后P值0.000 00.000 00.000 00.000 00.000 0
), ArticleFig(id=1322924017765720491, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, language=CN, label=表2, caption=

两组跟骨骨折患者中医证候积分的比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间疼痛僵硬皮下瘀斑口渴便秘
对照组40治疗前5.58±0.315.48±0.275.59±0.212.35±0.542.53±0.45
治疗后4.75±0.334.89±0.353.74±0.241.31±0.501.21±0.37
t值11.593 98.441 536.689 58.937 714.330 1
P值0.000 00.000 00.000 00.000 00.000 0
研究组40治疗前5.49±0.295.39±0.285.55±0.232.29±0.562.55±0.39
治疗后2.25±0.151.91±0.181.75±0.200.57±0.140.78±0.25
t值62.761 966.121 078.850 718.845 424.165 1
P值0.000 00.000 00.000 00.000 00.000 0
治疗前t值1.340 91.463 40.812 30.487 80.212 4
治疗前P值0.183 80.147 40.419 10.627 10.832 3
治疗后t值43.618 747.887 340.286 49.013 76.090 3
治疗后P值0.000 00.000 00.000 00.000 00.000 0
), ArticleFig(id=1322924017837023660, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间BALP/（U/L）OC/（μg/L）PYD/（U/L）TRAP/（U/L）
对照组40治疗前28.34±2.542.59±0.2239.89±3.238.24±1.11
治疗后65.88±5.714.64±1.3530.14±2.164.22±0.94
t值37.991 19.478 915.869 717.479 5
P值0.000 00.000 00.000 00.000 0
研究组40治疗前29.06±2.582.55±0.2140.26±3.198.31±1.04
治疗后77.73±6.696.36±1.5225.75±1.793.25±0.52
t值42.929 615.703 825.088 027.522 8
P值0.000 00.000 00.000 00.000 0
治疗前t值1.257 70.831 80.515 50.291 1
治疗前P值0.212 20.408 10.607 70.771 8
治疗后t值8.521 05.351 09.897 35.710 8
治疗后P值0.000 00.000 00.000 00.000 0
), ArticleFig(id=1322924017912521133, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, language=CN, label=表3, caption=

两组跟骨骨折患者骨代谢指标比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间BALP/（U/L）OC/（μg/L）PYD/（U/L）TRAP/（U/L）
对照组40治疗前28.34±2.542.59±0.2239.89±3.238.24±1.11
治疗后65.88±5.714.64±1.3530.14±2.164.22±0.94
t值37.991 19.478 915.869 717.479 5
P值0.000 00.000 00.000 00.000 0
研究组40治疗前29.06±2.582.55±0.2140.26±3.198.31±1.04
治疗后77.73±6.696.36±1.5225.75±1.793.25±0.52
t值42.929 615.703 825.088 027.522 8
P值0.000 00.000 00.000 00.000 0
治疗前t值1.257 70.831 80.515 50.291 1
治疗前P值0.212 20.408 10.607 70.771 8
治疗后t值8.521 05.351 09.897 35.710 8
治疗后P值0.000 00.000 00.000 00.000 0
), ArticleFig(id=1322924017979629998, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间ALP/（%）PICP/（mg/L）IGF/（μg/L）BMP/（ng/L）
对照组40治疗前3.34±0.6189.13±4.543.20±0.5158.41±3.25
治疗后4.78±0.85128.25±5.496.32±1.1467.74±4.54
t值8.704 934.729 915.800 310.568 5
P值0.000 00.000 00.000 00.000 0
研究组40治疗前3.35±0.5989.21±4.483.27±0.5058.34±3.22
治疗后5.41±0.92145.33±6.418.45±1.3573.21±4.98
t值11.920 845.385 722.756 915.858 5
P值0.000 00.000 00.000 00.000 0
治疗前t值0.074 50.079 30.619 90.096 8
治疗前P值0.940 80.937 00.537 20.923 2
治疗后t值3.181 112.799 57.624 15.133 7
治疗后P值0.002 10.000 00.000 00.000 0
), ArticleFig(id=1322924018109653423, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, language=CN, label=表4, caption=

两组跟骨骨折患者骨愈合指标比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间ALP/（%）PICP/（mg/L）IGF/（μg/L）BMP/（ng/L）
对照组40治疗前3.34±0.6189.13±4.543.20±0.5158.41±3.25
治疗后4.78±0.85128.25±5.496.32±1.1467.74±4.54
t值8.704 934.729 915.800 310.568 5
P值0.000 00.000 00.000 00.000 0
研究组40治疗前3.35±0.5989.21±4.483.27±0.5058.34±3.22
治疗后5.41±0.92145.33±6.418.45±1.3573.21±4.98
t值11.920 845.385 722.756 915.858 5
P值0.000 00.000 00.000 00.000 0
治疗前t值0.074 50.079 30.619 90.096 8
治疗前P值0.940 80.937 00.537 20.923 2
治疗后t值3.181 112.799 57.624 15.133 7
治疗后P值0.002 10.000 00.000 00.000 0
), ArticleFig(id=1322924018197733808, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间Bohler角/（°）Gissane角/（°）跟骨宽度/（mm）跟骨高度/（mm）
对照组40治疗前15.53±2.54106.23±8.5137.33±2.7239.30±3.21
治疗后21.81±2.75111.31±7.5335.67±1.8743.25±3.54
t值10.609 82.827 53.180 75.227 8
P值0.000 00.006 00.002 10.000 0
研究组40治疗前15.51±2.52105.27±8.4837.35±2.7039.20±3.23
治疗后25.41±2.89118.56±7.4533.42±1.5548.68±3.64
t值16.329 47.446 47.983 712.320 4
P值0.000 00.000 00.000 00.000 0
治疗前t值0.035 40.505 40.033 00.138 9
治疗前P值0.971 90.614 70.973 80.889 9
治疗后t值5.707 44.328 85.858 86.763 6
治疗后P值0.000 00.000 00.000 00.000 0
), ArticleFig(id=1322924018269036977, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322924010719289726, language=CN, label=表5, caption=

两组跟骨骨折患者影像学指标比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间Bohler角/（°）Gissane角/（°）跟骨宽度/（mm）跟骨高度/（mm）
对照组40治疗前15.53±2.54106.23±8.5137.33±2.7239.30±3.21
治疗后21.81±2.75111.31±7.5335.67±1.8743.25±3.54
t值10.609 82.827 53.180 75.227 8
P值0.000 00.006 00.002 10.000 0
研究组40治疗前15.51±2.52105.27±8.4837.35±2.7039.20±3.23
治疗后25.41±2.89118.56±7.4533.42±1.5548.68±3.64
t值16.329 47.446 47.983 712.320 4
P值0.000 00.000 00.000 00.000 0
治疗前t值0.035 40.505 40.033 00.138 9
治疗前P值0.971 90.614 70.973 80.889 9
治疗后t值5.707 44.328 85.858 86.763 6
治疗后P值0.000 00.000 00.000 00.000 0
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益气活血复元汤联合微创手术治疗跟骨骨折对骨代谢和骨愈合的影响研究
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黄中华 , 王穗源 , 周贤超
中华中医药学刊 | 国家项目点击 2025,43(6): 134-137
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中华中医药学刊 |国家项目点击 2025 , 43 (6) : 134 -137
益气活血复元汤联合微创手术治疗跟骨骨折对骨代谢和骨愈合的影响研究
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黄中华, 王穗源, 周贤超
作者信息
  • 长沙市第四医院，湖南 长沙 410023
作者简介:

黄中华（1982-），男，湖南长沙人，副主任医师，硕士，研究方向：足踝，骨科疾病。

Effect of Yiqi Huoxue Fuyuan Decoction（益气活血复元汤）Combined with Minimally Invasive Treatment of Calcaneal Fracture on Bone Metabolism and Bone Healing
Zhonghua HUANG, Huiyuan WANG, Xianchao ZHOU
Affiliations
  • The Fourth Hospital of Changsha，Changsha 410023，Hunan，China
出版时间: 2025-06-10 doi: 10.13193/j.issn.1673-7717.2025.06.026
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摘要
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目的

研究益气活血复元汤联合微创手术治疗跟骨骨折对骨代谢和骨愈合的影响研究。

方法

抽取80例经检查被确诊为跟骨骨折的患者，按随机数字表分为两组，对照组40例予以微创手术治疗，研究组40例予以益气活血复元汤、微创手术联合治疗。观察比较两组患者的临床疗效、中医证候积分、骨代谢指标、骨愈合指标以及影像学指标。

结果

研究组总有效率97.50%，对照组总有效率77.50%，研究组高于对照组，差异有统计学意义（P<0.05）。治疗后，与对照组相对比，研究组中医证候积分更低，差异有统计学意义（P<0.05）。与对照组相对比，研究组骨钙素（osteocalcin，OC）、骨碱性磷酸酶（Bone alkaline phosphatase，BALP）水平显著增高，吡啶啉（Pyridinoline，PYD）、抗酒石酸性磷酸酶（tartrate resistant acid phosphatase，TRAP）水平显著降低，差异有统计学意义（P<0.05）。与对照组相对比，研究组碱性磷酸酶（alkaline phosphatase，ALP）、I型前胶原氨基末端前肽（Propeptide of typeⅠprocollagen，PICP）、胰岛素样生长因子（Insulinlike Growth Factor，IGF）、骨形态发生蛋白（bonemorphogeneticprotein，BMP）水平均更高，差异有统计学意义（P<0.05）。与对照组相对比，研究组Bohler角、Gissane角、跟骨高度水平均显著增高，跟骨宽度显著降低，差异有统计学意义（P<0.05）。

结论

跟骨骨折的患者采取微创手术、益气活血复元汤联合治疗后，治疗效果好，能有效改善患者的临床症状，促进骨折愈合，临床应用价值较高。

跟骨骨折  /  微创手术治疗  /  益气活血复元汤  /  骨代谢  /  骨愈合
Objective

To study the effects of Yiqi Huoxue Fuyuan Decoction（益气活血复元汤）combined with minimally invasive surgery on bone metabolism and bone healing of calcaneal fracture.

Methods

Eighty patients diagnosed as calcaneal fracture were selected and divided into two groups according to random number table.Forty patients in the reference group were treated with minimally invasive surgery，and forty patients in the study group were treated with Yiqi Huoxue Fuyuan Decoction combined with minimally invasive surgery.The clinical efficacy，TCM syndrome score，bone metabolism index，bone healing index and imaging index of the two groups were observed and compared.

Results

Compared with that（77.50%）of the reference group，the total effective rate of the study group was97.50%，and the difference was statistically significant（P<0.05）.Compared with that of the reference group，the TCM syndrome score of the study group was lower，and the difference was statistically significant（P<0.05）.Compared with those of the reference group，the levels of osteocalcin（OC）and bone alkaline phosphatase（BALP）in the study group were higher，and the levels of pyridinoline（PYD）and tartrate resistant acid phosphatase（TRAP）were lower，with statistical significance（P<0.05）.Compared with those of the reference group，the levels of alkaline phosphatase（ALP），propeptide of typeⅠprocollagen（PICP），insulin-like growth factor（IGF）and bone morphogenetic protein（BMP）in the study group were higher，and the differences were statistically significant（P<0.05）.Compared with those of the reference group，Bohler Angle，Gissane Angle and calcaneus height in the study group were higher，and calcaneus width was lower，with statistical significance（P<0.05）.

Conclusion

The combination of minimally invasive surgery and Yiqi Huoxue Fuyuan Decoction can effectively improve the clinical symptoms of patients with calcaneal fracture and promote fracture healing，with high clinical application value.

calcaneal fracture  /  minimally invasive surgery  /  Yiqi Huoxue Fuyuan Decoction（益气活血复元汤）  /  bone metabolism  /  osseous union
黄中华, 王穗源, 周贤超. 益气活血复元汤联合微创手术治疗跟骨骨折对骨代谢和骨愈合的影响研究. 中华中医药学刊, 2025 , 43 (6) : 134 -137 . DOI: 10.13193/j.issn.1673-7717.2025.06.026
Zhonghua HUANG, Huiyuan WANG, Xianchao ZHOU. Effect of Yiqi Huoxue Fuyuan Decoction（益气活血复元汤）Combined with Minimally Invasive Treatment of Calcaneal Fracture on Bone Metabolism and Bone Healing[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (6) : 134 -137 . DOI: 10.13193/j.issn.1673-7717.2025.06.026
正文
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跟骨骨折属于临床上较为常见且复杂的后足跟骨折。该病大多由于高处的坠落、意外、交通致伤等暴力导致[1]。目前，临床上治疗移位明显的跟骨骨折多采取手术治疗。随着微创技术的不断发展，采取微创手术治疗跟骨骨折已逐渐深入临床，并熟练运用。通过微创治疗可有效减少手术带来的创伤，较好稳定跟距关节[2]。但是由于足部的血供较为特殊，即使是微创手术治疗，因跗骨窦小切口的存在，也会影响局部软组织血供及回流，下肢的血液回流变慢，进而导致足部肿胀。从中医的角度上看，跟骨骨折属于“折疡”的范畴。中医认为，跟骨骨折以后，血脉受到损伤，血溢到脉外，进而形成瘀，不通则痛，因此骨折后极易出现肿胀、疼痛等症状[3]。因此，治疗时应以活血化瘀、行气通络为主。益气活血复元汤对治疗血瘀、跌打损伤具有较好疗效，可有效调和气血，疏通经络[4]。基于此，为探讨微创手术、益气活血复元汤联合治疗给跟骨骨折患者带来的临床效果，选取我院80例经检查被确诊为跟骨骨折的患者作为研究对象，现报道如下。
1　临床资料
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1.1　一般资料
抽中2019年4月—2023年10月在我院收入治疗的跟骨骨折患者80例作为研究对象，按随机数字表法划分组别，各40例。研究组男20例，女20例；年龄30～55岁，平均（43.44±10.22）岁；Sanders分期：SandersⅡ期21例，SandersⅢ期19例。对照组男18例，女22例；年龄31～57岁，平均（43.32±10.60）岁；Sanders分期：SandersⅡ期20例，SandersⅢ期20例。两组比较差异无统计学意义（P>0.05）。
1.2　诊断标准
①符合《骨与关节损伤和疾病的诊断分类及功能评定标准》[5]中对跟骨骨折的诊断标准；②足跟部有明确的外伤史，伴疼痛、肿胀，活动受限；③影像学检查示Bohler角、Gissane角异常，且跟骨的宽度和高度异常变化。
1.3　中医辨证标准
参考《中医病证诊断疗效标准》[6]中对该病的辨证；伴疼痛、肿胀，皮下有瘀斑，舌质红或有瘀点，苔黄，脉弦紧。
1.4　纳入标准
①符合跟骨骨折的诊断标准；②根据Sanders分期，患者均属于SandersⅡ期、SandersⅢ期；③符合微创手术指征；④患者对该研究知情，签署相关文件参与。
1.5　排除标准
①陈旧性骨折；②合并可能影响骨愈合的代谢性疾病；③合并心脑血管、肝肾功能不全等疾病的患者；④不能耐受研究治疗的患者；⑤近半年内服用过影响骨折愈合的药物。
2　治疗方法
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2.1　对照组
予以微创手术治疗，采取微创复位通道螺钉内固定术，操作如下：患者侧卧位，常规麻醉后在其患侧外踝前下方作一跗骨窦切口，并充分暴露其跟距关节面、显露关节间隙。使用剥离器、克氏针复位距下关节面即跟骨总体形态力线后，通过C型壁X线机的辅助，经皮从跟骨外侧向载距突，跟骨后结节向跟骰关节方向，依据骨折具体情况，置入适量导针，骨块固定的同时，拧入空心钉。止血以后，逐层将切口关闭，术后予以预防感染、消肿等对症治疗。
2.2　研究组
在对照组基础上予以益气活血复元汤，方药如下：柴胡15 g，当归10 g，瓜蒌根10 g，红花10 g，穿山甲（炮）6 g，酒大黄12 g，桃仁10 g，甘草6 g。水煎服，1剂日2次，早晚温服。术后第3天开始服用，连续服用两周。
3　观察指标与统计学方法
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3.1　观察指标
（1）临床疗效。参考《中医病证诊断疗效标准》[6]制定，若患者足跟的外形无畸形，对位准确，骨折线消失，可正常行走，足部功能基本恢复，即为显效；若患者足跟仅伴有轻度畸形，骨折对位良好，足弓伴轻度变平，行走时有轻微疼痛，足部功能轻度受限，即为有效；若患者疼痛明显，足跟部畸形较为明显，足弓已塌陷，行走困难，即为无效。治疗总有效率为显效率与有效率总和。
（2）中医证候积分。主要症状包括疼痛、肿胀和皮下瘀斑，分值0～6分。次要症状口渴、便秘，分值0～3分。患者症状的严重程度和中医证候积分成正比。
（3）血液指标。①骨代谢指标：取患者治疗前、治疗两周后清晨空腹静脉血，测定骨碱性磷酸酶（Bone alkaline phosphatase，BALP）、骨钙素（osteocalcin，OC）、吡啶啉（Pyridinoline，PYD）、抗酒石酸性磷酸酶（tartrate resistant acid phosphatase，TRAP）；②骨愈合指标：取患者治疗前、治疗两周后清晨空腹静脉血，测定碱性磷酸酶（alkaline phosphatase，ALP）、Ⅰ型前胶原氨基末端前肽（Propeptide of typeⅠprocollagen，PICP）、胰岛素样生长因子（Insulin-like Growth Factor，IGF）、骨形态发生蛋白（bonemorphogeneticprotein，BMP）。
（4）影像学指标。治疗前后，通过影像学检查测定Bohler角、Gissane角，以及跟骨的宽度和高度。
3.2　统计学方法
采用SPSS 22.0统计学软件分析数据。计量资料以（）表示，采用t检验；计数资料以率（%）表示，采用χ2检验。P<0.05表示差异有统计学意义。
4　结果
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4.1　临床疗效
研究组总有效率与对照组相比，97.50%高于77.50%，差异有统计学意义（P<0.05）。详见表1。
4.2　两组中医证候积分比较
治疗前，两组患者中医证候积分比较无差异（P>0.05）；治疗后，与对照组相对比，研究组中医证候积分显著降低，差异有统计学意义（P<0.05）。详见表2。
4.3　两组骨代谢比较
治疗前，两组患者BALP、OC、PYD、TRAP水平比较无差异（P>0.05）；治疗后，与对照组相对比，研究组OC、BALP水平显著增高，PYD、TRAP水平显著降低，差异有统计学意义（P<0.05）。详见表3。
4.4　两组骨愈合指标比较
治疗前，两组患者ALP、PICP、IGF、BMP比较无差异（P>0.05）；治疗后，与对照组相对比，研究组ALP、PICP、IGF、BMP水平均显著增高，差异有统计学意义（P<0.05）。详见表4。
4.5　两组影像学指标比较
治疗前，两组患者ALP、PICP、IGF、BMP比较无差异（P>0.05）；治疗后，与对照组相对比，研究组Bohler角、Gissane角、跟骨高度水平均显著增高，跟骨宽度更低，差异有统计学意义（P<0.05）。详见表5。
5　讨论
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跟骨骨折约占跗骨骨折的60%，且约75%属于关节内骨折[7]。当患者出现跟骨骨折后，会伴有患处的疼痛、肿胀等临床症状。患者骨折后，大多会出现跟骨距下关节面移位、跟骨力线的丢失，进而出现距下关节的创伤性关节炎，行走或是负重时产生疼痛，给患者日常生活带来影响[8]。若处理不当，就会导致患者跟骨愈合后畸形，甚至合并感染，导致残疾。目前，临床上治疗跟骨骨折最有效的方式是手术治疗患者受损的部位以及功能，进而提高患者距下关节的稳定性，恢复其关节功能、跟骨形态。传统的开放手术[9]，视野虽然清晰，但是创伤较大，术后极易出现感染、软组织损伤等并发症，疗效并不理想。随着微创手术的不断发展和更新，采取微创治疗跟骨骨折的方式已成熟运用到临床当中。微创手术治疗能够有效缩小骨膜的大面积剥离，减少对患者局部软组织的损伤，保护跟骨的血液运行，减少术后并发症，疗效更好[10-12]。但是单一采取微创治疗难以有效促进患者的骨折愈合，术后由于骨折本身和手术治疗带来的创伤，常导致局部出现组织出血、渗出等情况，出现静脉、淋巴管的淤积，导致回流受阻。长此以往，就会导致组织水肿。此外，即使是微创手术，同样可导致患者患处的血运受损，还会影响骨折的愈合程度。因此，术后需要及时加以有效干预。
随着中医药技术的不断发展，采取中医治疗跟骨骨折的方式已逐渐运用到临床当中。中医认为[13-15]，跟骨骨折的患者主要是由于外部暴力，伤及筋骨和脉络，导致气血运行失常，血液外溢到脉外，进而形成瘀血，出现疼痛、肿胀、皮下瘀斑等临床症状。因此，治疗时应以活血化瘀为主。益气活血复元汤[16-20]具有活血化瘀、疏经通络、调和气血的效果，可以促进骨折处血液的循环，降低局部水肿症状，同时调和机体正气，增强自我修复能力，促进骨折的愈合。方中柴胡[21]具有疏肝理气、升举阳气的功效；当归[22]具有活血调经、止痛、补血的作用；瓜蒌根[23]清热泻火、消肿排脓、散瘀；红花[24]能活血通经、散瘀止痛；穿山甲[25]活血化瘀、软坚散结、疏通气血；酒大黄[26]活血化瘀、凉血止血；桃仁[27]活血化瘀；甘草[28]调和诸药，达到缓急止痛的目的。诸药合用，可有效起到疏通经络、祛瘀、调和气血的作用。在本研究中，研究组总有效率更高，中医证候积分更低，影像学指标更优（P<0.05）。说明采取微创治疗、益气活血复元汤联合治疗后，可有效提高临床效果，减轻患者的临床症状，维持治疗后的Bohler角、Gissane角，促进患者骨折预后恢复，恢复其足部的功能。OC[29]、BALP[30]属于骨生成的相关指标，会促进骨的正常矿化。血清中含量越高，越有利于患者骨折的愈合。PYD[31]、TRAP[32]属于骨吸收的标志物，含量越低说明足部骨折部位的破骨活性越低，骨形成的趋势越好。与对照组相对比，研究组OC、BALP水平更高，PYD、TRAP水平更低，差异有统计学意义（P<0.05）。ALP、PICP、IGF、BMP属于骨折愈合相关指标，与对照组相对比，研究组ALP、PICP、IGF、BMP水平均更高（P<0.05）。说明联合治疗后可以促进患者骨折后重塑，使骨代谢能够重新回到稳态，促进患者局部血运的重建，促进血管的生成，达到骨愈合的目的。从现代药理学的角度上看[33-35]，柴胡具有抗炎、镇痛、促进免疫功能的作用；当归可以抗血栓形成，改善局部的血液循环；红花可以改善微循环、抗凝血、抗血栓，使血浆复钙的时间延长。通过经络的吸收，调节气血运行，进而加速骨折的愈合程度。
综上所述，跟骨骨折患者通过微创手术治疗后，加以益气活血复元汤，可有效减轻患者的临床症状，促进骨代谢和骨折愈合。
基金
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  • 吴阶平医学基金会临床科研专项资助基金项目(320.6750.17258)
  • 湖南省卫生健康委员会科研计划项目(D202304076930)
文献
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2025年第43卷第6期
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doi: 10.13193/j.issn.1673-7717.2025.06.026
  • 首发时间：2026-10-30
  • 出版时间：2025-06-10
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吴阶平医学基金会临床科研专项资助基金项目(320.6750.17258)
湖南省卫生健康委员会科研计划项目(D202304076930)
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    长沙市第四医院，湖南 长沙 410023
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2种不同金属材料的力学参数
科
Family		 属数
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
species (%)
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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