复元活血汤对复杂胫骨平台骨折术前软组织肿胀消退及血清炎性因子的影响：一项回顾性对照研究

Effect of Fuyuan Huoxue Decoction on Preoperative Resolution of Soft-Tissue Swelling and Serum Inflammatory Factors in Complex Tibial Plateau Fractures: A Retrospective Controlled Study

摘要: 目的：回顾性分析复元活血汤联合常规处理对复杂胫骨平台骨折术前软组织肿胀消退的影响，并从血清学层面探讨其可能机制。方法：选择内江市中医院创伤骨科自2023年1月~2024年12月收治的复杂胫骨平台骨折患者80例，按照治疗方式不同分为复元活血汤组和对照组。两组均给予常规抬高患肢、冷疗、弹力绷带包扎等基础治疗，治疗组在基础治疗上加用复元活血汤。分析两组入院及术前的临床与实验室资料，以入院到达到手术软组织条件的时间、患肢与健侧周径差的变化、疼痛视觉模拟评分(VAS)的为临床观察指标，以C反应蛋白(CRP)、白细胞介素-6 (IL-6)为血清炎性指标；检测D-二聚体为血栓形成指标。同时评价肝肾功能及不良事件记录，分析复元活血汤的安全性。结果：与对照组比较，复元活血汤组从入院到满足手术指征的时间明显缩短，术前患肢周径差较入院时的下降幅度更大，VAS评分降低更为显著(P < 0.05)。两组入院时血清CRP、IL-6水平相近，术前上述炎性因子在两组内均较入院时下降，但复元活血汤组下降幅度更大，D-二聚体的改善更为明显(P < 0.05)。两组肝肾功能指标变化均在正常范围内，不良事件发生率差异无统计学意义(P > 0.05)。结论：在常规术前软组织处理基础上，加用复元活血汤有助于加速复杂胫骨平台骨折患者术前软组织肿胀消退，缩短等待手术时间，并可能通过降低炎性因子水平、改善血液流变学状态及高凝倾向发挥作用。复元活血汤安全性较好，可为复杂胫骨平台骨折术前软组织管理提供一种具有中西医结合特色的治疗方案。

Abstract: Objective: To retrospectively analyze the effect of Fuyuan Huoxue Decoction combined with conventional management on preoperative resolution of soft-tissue swelling in patients with complex tibial plateau fractures, and to explore its potential mechanisms from a serological perspective. Methods: A total of 80 patients with complex tibial plateau fractures admitted to the Department of Traumatology and Orthopaedics of Neijiang Municipal Hospital of Traditional Chinese Medicine between January 2023 and December 2024 were included. According to the treatment regimen, patients were divided into a Fuyuan Huoxue Decoction group and a control group. Both groups received standard preoperative care including limb elevation, cryotherapy, and elastic bandage compression. On this basis, the treatment group additionally received Fuyuan Huoxue Decoction. Clinical and laboratory data at admission and before surgery were collected. Clinical outcomes included the time from admission to achievement of acceptable soft-tissue conditions for surgery, changes in limb circumference difference between the affected and contralateral healthy side, and visual analogue scale (VAS) scores for pain. Serum C-reactive protein (CRP) and interleukin-6 (IL-6) were used as inflammatory markers, and D-dimer was measured as an index of thrombosis. Liver and kidney function indices and adverse events were recorded to evaluate the safety of Fuyuan Huoxue Decoction. Results: Compared with the control group, the Fuyuan Huoxue Decoction group had a significantly shorter time from admission to meeting the soft-tissue criteria for surgery. The reduction in limb circumference difference of the affected extremity from admission to the preoperative assessment was greater, and VAS scores decreased more markedly (P < 0.05). Baseline serum CRP, IL-6 and hemorheological parameters were comparable between the two groups at admission. Prior to surgery, inflammatory marker levels in both groups were lower than at admission, but the decreases in CRP, IL-6 and the improvements in hemorheological indices were more pronounced in the Fuyuan Huoxue Decoction group (P < 0.05). Changes in liver and renal function indices in both groups remained within the normal range, and the incidence of adverse events did not differ significantly between groups (P > 0.05). Conclusion: On the basis of conventional preoperative soft-tissue management, adjunctive use of Fuyuan Huoxue Decoction helps accelerate the resolution of soft-tissue swelling, shorten preoperative waiting time, and may exert its effects by reducing inflammatory factor levels, improving hemorheological status, and attenuating hypercoagulability in patients with complex tibial plateau fractures. Fuyuan Huoxue Decoction shows a favorable safety profile and offers a preoperative soft-tissue management strategy with integrated traditional Chinese and Western medicine characteristics for complex tibial plateau fractures.