香砂六君子湯治療脛骨骨幹粉碎性骨折手術後癒合不良之病例報告

Case report of Xiangsha Liujunzi Decoction for treatment of comminuted fracture of tibial shaft after operation

莊凱雯(Kai-Wen Chuang)；張淵雅(Yuan-Ya Chang)；林廉証(Lien-Cheng Lin)

脛骨骨幹骨折 ； 脾虛濕困 ； 香砂六君子湯 ； fracture of the tibial shaft ； dampness stagnancy due to spleen deficiency ； Xiangsha Liujunzi decoction

中西整合醫學雜誌

22卷2期（2020 / 12 / 31）

35 - 47

繁體中文

這位22歲女性，在2018年9月2日左側脛骨骨幹閉鎖性粉碎性骨折，經過骨折開放性復位及內固定（Open reduction of internal fixation, ORIF），五個多月後患部外觀仍腫脹，X光下骨折癒合情況不理想，且病人常感左側小腿抽痛、麻痛、觸電感，夜眠也時常因左小腿抽痛而中斷。綜合上述困擾的症狀，病人於2019年2月14日初次中醫門診就醫，經中醫辨證屬於脾虛濕困型，先予主方香砂六君子湯袪濕補脾胃調理本質，輔以續斷、骨碎補、杜仲補益肝腎、強筋壯骨，臨證加減，服用中藥約四十天後左側脛骨X光下新骨長成，治療兩個多月後左側小腿抽痛、麻痛、觸電感大幅減輕，追蹤X光影像學左側脛骨骨折癒合恢復良好且持續長出新骨。

Complications of fractures are common orthopedic problems, and will cause many medical burdens. This 22-year-old woman had a closed comminuted fracture of the left tibial shaft on September 2, 2018. After open reduction and internal fixation of the fracture, the appearance of the affected part was still swollen after more than five months, and the fracture healing was not ideal under X-rays. And patients often feel pain, numbness, and touch in the left calf, and sleep at night is often interrupted by pain in the left calf. Based on the symptoms mentioned above, the patient went to the Chinese medicine clinic for the first time on February 14, 2019. The syndrome of Chinese medicine is of spleen deficiency and dampness type. The main prescription is Xiangsha Liujunzi Decoction for dampness of the spleen and stomach. Gusuibu, Eucommia tonic liver and kidney, strong muscles and strong bones, clinical card addition and subtraction, after taking Chinese medicine for about 40 days, new bones grow on the left tibia X-ray, after treatment for more than two months left leg calf pain, numbness, touch inductance Substantially reduced, follow-up X-ray imaging of left tibia fracture healing and recovery and new bone continued to grow.

1. Bell, A,Templeman, D,Weinlein, JC(2016).Nonunion of the Femur and Tibia: An Update.Orthop Clin North Am,47(2),365-375.
2. Christiano, AV,Goch, AM,Leucht, P,Konda, SR,Egol, KA(2019).Radiographic union score for tibia fractures predicts success with operative treatment of tibial nonunion.J Clin Orthop Trauma,10(4),650-654.
3. Ekegren, CL,Edwards, ER,de Steiger, R,Gabbe, BJ.(2018).Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture.Int J Environ Res Public Health,15(12)
4. Houben, IB,Raaben, M,Van Basten Batenburg, M,Blokhuis, TJ(2018).Delay in weight bearing in surgically treated tibial shaft fractures is associated with impaired healing: a cohort analysis of 166 tibial fractures.Eur J Orthop Surg Traumatol,28(7),1429-1436.
5. Märdian, S,Schwabe, P,Schaser, KD(2015).Fractures of the tibial shaft.Z Orthop Unfall,153(1),99-117+8-9.
6. Milner, SA,Davis, TR,Muir, KR,Greenwood, DC,Doherty, M(2002).Long-term outcome after tibial shaft fracture: is malunion important?.J Bone Joint Surg Am,84(6),971-980.
7. O'Halloran, K,Coale, M,Costales, T,Zerhusen, T, Jr.,Castillo, RC,Nascone, JW(2016).Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables.Clin Orthop Relat Res,474(6),1385-1395.
8. Pennock, AT,Bastrom, TP,Upasani, VV(2017).Elastic Intramedullary Nailing Versus Open Reduction Internal Fixation of Pediatric Tibial Shaft Fractures.J Pediatr Orthop,37(7),e403-e408.
9. Ross, KA,O'Halloran, K,Castillo, RC,Coale, M,Fowler, J,Nascone, JW(2018).Prediction of tibial nonunion at the 6-week time point.Injury,49(11),2075-2082.
10. Schmidt, AH,Finkemeier, CG,Tornetta, P, 3rd(2003).Treatment of closed tibial fractures.Instr Course Lect,52,607-622.
11. Vallier, HA,Cureton, BA,Patterson, BM(2012).Factors influencing functional outcomes after distal tibia shaft fractures.J Orthop Trauma,26(3),178-183.
12. 王洪圖,王長宇(2013).王洪圖內經講稿.人民衛生出版社.
13. 朱文鋒(2008).朱文鋒中醫診法學講課實錄.中國中醫藥出版社.
14. 朱世增(2008).石筱山論骨傷科.上海中醫藥大學出版社.
15. 岑澤波,吳誠德(2005).中醫傷科學.知音出版社.
16. 肖存,張寶田,宋軍峰,張明亮(2017)。補腎斷續湯結合髓內釘固定植骨術治療脛骨中下段骨折不癒合。吉林中醫藥，37(2)，151-154。
17. 武春發,張安楨,吳誠德,岑澤波,時光達,郭維淮,劉柏齡(1998).中醫骨傷科學.
18. 侯情,王勁松(2010)。杜仲提取物對去卵巢大鼠骨折力和骨壓碎力的影響。陝西中醫學院學報，33(5)，83-84。
19. 孫洽熙(2006).黃元毓醫學全書.中國中醫藥出版社.
20. 馬建中(2012).中醫診斷學.正中書局.
21. 焦志成,苗立新,王善好(2016)。手術配合中藥治療骨折不癒合 15 例。實用中醫藥雜誌，32(4)，331-332。
22. 程士德（編）(2004).內經.知音出版社.
23. 溫建民,徐穎鵬,孫永生,雷仲民,徐海斌,桑志成,胡海威,成永忠,佟雲,孫衛東,韓鳳岳,李莉(2006)。中醫骨折分期治療對骨折癒合作用的 X 線與組織學研究。中國骨傷，19(10)，604-607。
24. 魏威,顧軍,陸男杰,王建三(2004)。中西醫結合治療脛骨骨折內固定術後感染性骨不連。中國基層醫藥，6，716。
25. 羅秀夏(2006)。淺談臟腑氣血辨證在治療骨折遲緩癒合中的優勢。山西中醫學院學報，7(1)，36-37。