目的 采用Meta分析系统评价补肾与活血类中药辅助治疗桡骨远端骨折的临床疗效，并通过网络药理学初步揭示其作用机制。方法 计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国生物医学文献数据库（CBM）、中国知网（CNKI）、万方、维普（VIP）数据库，检索时限为建库至2026年6月，纳入补肾或活血类中药联合西医常规治疗对比单纯西医常规治疗桡骨远端骨折的临床对照研究。采用RevMan 5.4软件进行Meta分析，同时运用网络药理学筛选核心活性成分、预测靶点并进行通路富集分析。结果 共纳入23项研究，合计3 377例患者。Meta分析结果显示，补肾类与活血类中药均可显著提高临床有效率、缩短骨折愈合时间、降低视觉模拟评分（visual analogue scale，VAS）、升高骨钙素水平并改善腕关节功能，两类药物总体疗效无统计学差异（P＞0.05）；活血类中药在腕关节背伸活动度改善方面更优，补肾类中药疗效更稳定、异质性更低。网络药理学筛选出肿瘤蛋白p53（tumor protein p53，TP53）、Src酪氨酸激酶（proto-oncogene tyrosine-protein kinase Src，SRC）、信号转导和转录激活因子3（signal transducer and activator of transcription 3，STAT3）等核心靶点，主要调控磷脂酰肌醇-3-羟激酶（phosphatidylinositol-3-hydroxykinase，PI3K）-蛋白激酶B（protein kinase B，Akt）、丝裂原活化蛋白激酶（mitogen-activated protein kinase，MAPK）、核因子-κB（nuclear factor-κB，NF-κB）等通路；活血类中药主要通过血管内皮生长因子（vascular endothelial growth factor，VEGF）、肿瘤坏死因子（tumor necrosis factor，TNF）、Janus激酶（Janus kinase，JAK）-STAT通路发挥抗炎、改善微循环作用，补肾类中药则通过Wnt//β-连环蛋白（β-catenin）及细胞周期通路促进成骨分化与骨代谢。结论 补肾类与活血类中药辅助治疗桡骨远端骨折，疗效确切、安全性良好，均通过多成分、多靶点、多通路促进骨折愈合；早期宜选用活血类中药消肿止痛，中后期选用补肾类中药强骨促愈。

Objective To systematically evaluate the clinical efficacy of kidney-tonifying and blood-activating traditional Chinese medicines as adjunctive therapies for distal radius fractures using a Meta-analysis, and to preliminarily explore their mechanisms of action through network pharmacology. Methods PubMed, Web of Science, Cochrane Library, Embase, CBM, CNKI, Wanfang, and VIP databases were searched from inception to June 2026 to identify clinical controlled studies comparing traditional Chinese medicine decoctions combined with conventional Western medicine versus conventional Western medicine alone for distal radius fractures. RevMan 5.4 software was used for Meta-analysis, and network pharmacology was employed to screen core active components, predict targets, and conduct pathway enrichment analysis. Results A total of 23 studies involving 3 377 patients were included. The Meta-analysis results showed that both kidney-tonifying and blood-activating traditional Chinese medicines significantly improved the clinical effective rate, shortened fracture healing time, reduced visual analog scale (VAS) pain scores, increased osteocalcin levels, and improved wrist joint function, with no statistically significant difference in overall efficacy between the two categories (all P > 0.05). Blood-activating traditional Chinese medicines showed superior improvements in wrist dorsiflexion range of motion, while kidney-tonifying traditional Chinese medicines exhibited more stable efficacy with lower heterogeneity. Network pharmacology identified core targets such as tumor protein p53 (TP53), proto-oncogene tyrosine-protein kinase Src (SRC), signal transducer and activator of transcription 3 (STAT3), primarily regulating pathways including phosphatidylinositol-3-hydroxykinase (PI3K)-protein kinase B (Akt), mitogen-activated protein kinase (MAPK), nuclear factor-κB (NF-κB). Blood-activating traditional Chinese medicines exerted anti-inflammatory and microcirculation-improving effects mainly through vascular endothelial growth factor (VEGF), tumor necrosis factor (TNF), and Janus kinase (JAK)-STAT pathways, whereas kidney-tonifying traditional Chinese medicines promoted osteogenic differentiation and bone metabolism via the Wnt/β-catenin pathway and cell cycle pathways. Conclusion Kidney-tonifying and blood-activating traditional Chinese medicines are effective and safe as adjunctive therapies for distal radius fractures, both promoting fracture healing through multi-component, multi-target, and multi-pathway mechanisms. Blood-activating traditional Chinese medicines are more suitable for relieving swelling and pain in the early stage, while kidney-tonifying traditional Chinese medicines are better for strengthening bone and promoting healing in the middle and late stages.

R285

天津市卫生健康委员会天津市中医药重点领域科研项目（2026005）；河北省中医药管理局科研计划项目（T2025087）；天津中医药大学教师队伍建设研究项目（Y-202608）；天津中医药大学教师教学发展研究项目（A26JF12）；天津市高等学校研究生教育改革研究计划项目（TJYG25101）