Efficacy and mechanism of modified Guizhi Fuling Powder in reducing preoperative swelling of calcaneal fractures

WANG Jinzhong; ZHU Hanjie; JIN Jianmiao

doi:10.13276/j.issn.2097-1656.2025.11.017

Abstract：Objective To evaluate the efficacy of modified Guizhi Fuling Powder in treating preoperative soft tissue swelling in closed calcaneal fractures and to explore its clinical mechanism of action.Methods Seventy patients scheduled for surgical treatment of closed calcaneal fractures were selected and divided into the experimental group and the control group by random number table method,with 35 cases in each group.The control group received conventional preoperative anti-edema and analgesic treatments including elevation of the affected limb,ice application to the affected area,intravenous infusion of mannitol,and lornoxicam for pain relief.The experimental group additionally received oral administration of modified Guizhi Fuling Powder.Following anti-edema treatment,both groups underwent surgical internal fixation with plates via either a lateral L-shaped calcaneal incision or a tarsal sinus incision.Comparisons were made between groups for inflammatory factors(TNF-α,IL-1β,IL-6,and CRP),D-dimer(D-D),ferritin(FER),ankle swelling difference,time to skin crease sign appearance,and postoperative incision-related adverse events before and after 5 d of edema reduction treatment.Results There were no statistically significant differences between the two groups in terms of age,gender,or affected foot(left or right).① Blood test indicators:FER expression differed between the two groups(t=2.231,P=0.029).D-D expression differed between groups based on whether patients received modified Guizhi Fuling Powder(t=-2.960,P=0.005).Intra-group differences in D-D expression were observed before and after treatment with modified Guizhi Fuling Powder(t=-5.153,P＜0.001).Intra-group differences in CRP expression were observed in the control group(t=-2.047,P=0.048),whereas no statistically significant intra-group differences were found in the experimental group(t=0.119,P=0.906).There was no statistically significant difference in CRP expression between the two groups at admission(t=-1.308,P=0.195),but there was a significant inter-group difference in CRP expression before surgery(t=-2.213,P=0.032).There were no statistically significant differences in IL-1β between groups or within the experimental group(experimental group intra-group t=-0.088,P=0.930;inter-group at admission t=-1.785,P=0.081;inter-group preoperatively t=0.685,P=0.496).Intra-group expression differed in the control group(t=2.552,P=0.015).TNF-αlevels showed no significant differences between groups or within groups(control group intra-group t=0.139,P=0.890;experimental group intra-group t=1.271,P=0.212;inter-group at admission t=-0.668,P=0.506;inter-group preoperatively t=-1.743,P=0.087).There were no statistically significant differences in IL-6 levels between groups or within the experimental group(experimental group intra-group Z=-0.098,P=0.922;inter-group at admission Z=-0.670,P=0.503;inter-group preoperatively Z=-1.186,P=0.235).Intra-group expression differed significantly in the control group(Z=-3.251,P=0.001).②Observed indicators:Significant inter-group differences were observed in ankle swelling difference at admission and preoperatively(t=2.930,P=0.005).Inter-group differences were also noted in skin crease reappearance time(t=-3.611,P=0.001).Pearson correlation analysis indicated that FER increased with longer skin crease reappearance time,showing moderate positive correlation(r=0.554,P＜0.001).No flap necrosis or infection was observed in the experimental group postoperatively.Three cases of blistering occurred,with an adverse event rate of 8.57％.The control group reported one case of flap necrosis,one case of infection,and six cases of blistering,yielding an adverse event rate of 22.86％.The experimental group demonstrated lower postoperative incision-related adverse events compared to the control group.Conclusion Modified Guizhi Fuling Powder,due to its diuretic,edema-reducing,and blood-activating effects,helps alleviate preoperative swelling in closed calcaneal fractures and promotes better postoperative wound healing.The clinical research mechanism may be related to iron metabolism and coagulation mechanism.