传统方剂现代转化：桃红四物汤辅助治疗股骨转子间骨折术后康复效果的Meta分析

Modern Transformation of Traditional Prescriptions: Meta-Analysis of Postoperative Rehabilitation Effect of Taohong Siwu Decoction in Adjuvant Treatment of Intertrochanteric Fracture of Femur

摘要: 目的：以Meta分析方法对桃红四物汤联合西医治疗股骨转子间骨折术后疗效进行评价；方法：利用计算机从2015年1月至2025年1月检索了包括CNKI、万方数据库、维普、谷歌学术和PubMed在内的多个数据库。筛选出股骨转子间骨折术后应用桃红四物汤的随机对照试验的文献。在纳入的研究中，行西医治疗(常规术后抗感染、止血、止痛)的患者为对照组，在此基础上联合口服桃红四物汤的患者作为实验组。采用了Cochrane评估文献质量，用Revman 5.3软件进行分析，以确保数据的准确性和分析的可靠性；结果：共纳入19篇文献，涉及1463例样本(实验组n = 732；对照组n = 731)，Meta分析结果如下：相较于对照组(单纯西医治疗)，实验组(联合桃红四物汤口服)能明显缩短患者术后2周骨折愈合时间[MD = −1.55, 95% CI (−1.75, −1.36), Z = 15.57, P < 0.00001]，改善全血高切粘度(High Blood Viscosity, HBV)浓度[MD = −0.55, 95% CI (−0.69, −0.42), Z = 8.16, P < 0.00001]，降低术后2周疼痛程度[MD = −0.67, 95% CI (−0.91, −0.43), Z = 5.48, P < 0.00001]，加快术后2周消肿时间[MD = −2.59, 95% CI (−3.11, −2.06), Z = 9.73, P < 0.00001]，降低术后2周凝血指标[MD = −1.55, 95% CI (−2.02, −1.09), Z = 6.52, P < 0.00001]，提高术后2周Harris评分[MD = 0.76, 95% CI (0.39, 1.12), Z = 4.07, P < 0.0001]，术后4周Harris评分[MD = 6.04, 95% CI (5.24, 6.84), Z = 14.77, P < 0.00001]，术后3月Harris评分[MD = 5.25, 95% CI (3.24, 7.25), Z = 5.12, P < 0.00001]；结论：在股骨转子间骨折术后患者的治疗中，口服桃红四物汤在多个短期指标上表现出改善趋势。然而，受限于纳入研究的质量不高及显著的异质性，当前证据强度有限(GRADE评级：低至中等)。建议未来开展更多高质量、大样本的随机对照试验，以进一步验证其疗效。

Abstract: Objective: To evaluate the efficacy of Taohong Siwu decoction combined with western medicine in the treatment of femoral intertrochanteric fracture by Meta-analysis. Methods: Several databases, including China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, Google Scholar and PubMed, were searched by computer from January 2015 to January 2025. Randomized controlled trials on the application of Taohong Siwu decoction after femoral intertrochanteric fracture surgery were screened. In the included studies, the patients treated with Western medicine were the control group, and the patients treated with Taohong Siwu decoction combined with Western medicine were the experimental group. RevMan 5.3 software was used to ensure the accuracy of data and reliability of analysis. Results: A total of 19 articles were included, involving 1463 samples (experimental group n = 732; control group n = 731). The results of Meta-analysis were as follows: Compared with the control group (simple western medicine treatment), the experimental group (combined with oral Taohong Siwu decoction) could significantly shorten the fracture healing time [MD = −1.55, 95% CI (−1.75, −1.36), Z = 15.57, P < 0.00001] and improve (High Blood Viscosity, HBV) concentration [MD = −0.55, 95% CI (−0.69, −0.42), Z = 8.16, P < 0.00001], reduce the degree of pain at 2 weeks after surgery [MD = −0.67, 95% CI (−0.91, −0.43), Z = 5.48, P < 0.00001], and accelerate the time of swelling at 2 weeks after surgery [MD = −2.59, 95% CI (−3.11, −2.06), Z = 9.73, P < 0.00001], decrease blood coagulation index at 2 weeks after operation [MD = −1.55, 95% CI (−2.02, −1.09), Z = 6.52, P < 0.00001], and increase Harris score at 2 weeks after operation [MD = 0.76, 95% CI (0.39, 1.12), Z = 4.07, P < 0.0001], Harris score at 4 weeks after surgery [MD = 6.04, 95% CI (5.24, 6.84), Z = 14.77, P < 0.00001], and Harris score at 3 months after surgery [MD = 5.25, 95% CI (3.24, 7.25), Z = 5.12, P < 0.00001]. Conclusion: Oral Taohong Siwu decoction showed potential improvement in multiple short-term outcomes for patients after intertrochanteric fracture surgery. However, due to the generally low quality and significant heterogeneity of the included studies, the strength of evidence is limited (GRADE: low to moderate). More high-quality, large-sample RCTs are needed to further validate these findings.