Wu Xiaowei, Yan Linglan, Wu Tianran, Tu Shaochen, Lin Yanbin
Department of Orthopaedics, Fuzhou Second General Hospital, Fujian Medical University, Fuzhou, 350007, China.
Quanzhou Orthopedic-Traumatological Hospital, Quanzhou, 362000, China.
J Orthop Surg Res. 2024 Dec 26;19(1):876. doi: 10.1186/s13018-024-05379-3.
Chinese herbal medicine (CHM) is extensively utilized in managing hidden bleeding following an intertrochanteric femur fracture (IFF). Despite its widespread use, the most effective CHM approach for addressing hidden bleeding post-IFF remains unclear. A Bayesian network meta-analysis was conducted to identify a CHM that both effectively reduces hidden bleeding and stabilizes blood volume after IFF.
Comprehensive electronic searches were performed on databases in both Chinese and English, including the Chinese National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform (Wanfang), China Science and Technology Journal Database (VIP), PubMed, Web of Science, and Cochrane Library. All randomized controlled trials (RCTs) employing CHM to address hidden bleeding post-IFF, up to December 31, 2023, were thoroughly reviewed. The analysis utilized Stata17.0 and Review Manager 5.4 software, tailored to the frequentist framework.
Thirty-one articles were included, encompassing 17 interventions and 2076 patients. The systematic analysis revealed that: For improving postoperative haemoglobin (HB), the top three interventions were conventional treatment combined with Yiqi Buxue decoction, Yangxue Rougan decoction, and Sanqi powder; For reducing hidden bleeding post-surgery, the leading interventions were conventional treatment combined with Siwu decoction, Yangxue Rougan decoction, and Qitian Keli prescription; For enhancing the Harris score, the top interventions were conventional treatment combined with Bazhen decoction, Danggui Buxue decoction, and Sanqi powder; Descriptive analysis indicated minimal adverse reactions and enhanced safety overall.
CHM presents a viable method for treating hidden blood loss after IFF. Yangxue Rougan decoction notably excels in reducing hidden bleeding and stabilizing HB levels, making it a preferred option. Nevertheless, further rigorous RCT studies are essential to compare various CHM treatments to establish the most effective options for clinicians. PROSPERO registration number CRD42023489292.
中药广泛应用于股骨粗隆间骨折（IFF）后隐性出血的治疗。尽管其应用广泛，但治疗IFF后隐性出血最有效的中药方法仍不明确。进行了一项贝叶斯网络荟萃分析，以确定一种既能有效减少隐性出血又能稳定IFF后血容量的中药。
对中英文数据库进行全面电子检索，包括中国知网、万方数据知识服务平台（万方）、维普中文科技期刊数据库（维普）、PubMed、Web of Science和Cochrane图书馆。对截至2023年12月31日所有采用中药治疗IFF后隐性出血的随机对照试验（RCT）进行了全面回顾。分析使用了针对频率主义框架定制的Stata17.0和Review Manager 5.4软件。
纳入31篇文章，涵盖17种干预措施和2076例患者。系统分析显示：对于提高术后血红蛋白（HB），前三位的干预措施是常规治疗联合益气补血汤、养血柔肝汤和三七散；对于减少术后隐性出血，主要干预措施是常规治疗联合四物汤、养血柔肝汤和芪天颗粒方；对于提高Harris评分，前几位的干预措施是常规治疗联合八珍汤、当归补血汤和三七散；描述性分析表明不良反应极小，总体安全性提高。
中药是治疗IFF后隐性失血的可行方法。养血柔肝汤在减少隐性出血和稳定HB水平方面表现尤为突出，是首选。然而，进一步严格的RCT研究对于比较各种中药治疗方法以确定临床医生最有效的选择至关重要。PROSPERO注册号CRD42023489292。
