中西醫合治成人鎖骨骨折病例報告

Integrative Chinese and Western Medicine in Treating Clavicle Fractures: A Case Report

10.6516/TJTCM.201909_22(2).0011

謝嘉娟(Chia-Chuan Hsieh)；陳旺全(Wang-Chuan Chen)

成人鎖骨骨折 ； 中西醫合治 ； 非手術治療 ； Clavicle fracture ； integrative Chinese and Western medicine ； non-operative management

中醫藥研究論叢

22卷2期（2019 / 09 / 30）

107 - 113

繁體中文

一壯年男性於2018年01月05日因交通意外，身體左傾著地，致左肩疼痛、肢體數處表淺性損傷，起初自行使用成藥，2018年01月15日因局部逐漸腫脹、疼痛加劇無法入睡至急診，經X光診斷為左側鎖骨中段骨折，會診骨科醫師診視，鎖骨閉鎖性骨折併部分位移採取非手術治療為原則，以八字肩帶與三角巾懸臂吊帶回復生理結構與功能，並控制疼痛與均衡營養。2018年01月27日因腋下紅疹、左手痠麻腫脹等症狀回診，門診X光複查無明顯進展，醫師建議繼續以八字肩帶固定、加強營養補充及戒除咖啡，表示西藥功效有限，可考慮尋求第二意見；病人與親友討論後，決定接受中西醫整合非手術治療。2018年01月30日中醫舌診舌質隱青有瘀斑，脈沉弦，由於骨斷筋傷、瘀血停滯、經絡不通、局部腫脹疼痛，治宜活血化瘀為主，選用活血疏肝湯治之。2018年02月26日回診追蹤，骨折處無壓痛，X光複查骨痂形成良好，逕移除八字肩帶，回復日常活動（碰撞性運動除外），並開始積極鍛鍊肌力。2018年04月28日追蹤，病人自述患處無疼痛、活動功能正常，搬運重物輕鬆自如。2018年12月22日健檢X光顯示左側鎖骨中段骨折癒合良好。中西醫相輔相成，本案例中西醫合治成人鎖骨骨折的經驗，可作為中西醫整合醫學應用的參考。

The middle-aged man fell down on the road in a traffic accident, which caused left shoulder pain and several superficial injuries over the limbs. Despite self medication with over-the-counter drugs for days, painful disability of left shoulder was gradually exacerbated, which bothered his sleep. He visited our emergency room, where the X-ray disclosed fracture of the left clavicle, middle-third. The orthopedist was then consulted, that non-operative management is the first choice of closed midshaft clavicle fractures. The goals of treatment are to restore normal anatomy, limit pain and promote a quick return to activity. A figure-of- eight dressing and a triangular bandage were used for immobilization. However, some skin rashes over the axilla were noted days later. He visited our clinic, where the X-ray revealed no obvious interval change. Continuation of figure-of-eight dressing, more nutritional supplement and cessation of coffee consumption were recommended. Seeking a second opinion may be considered. Adoption of integrative Chinese and Western medicine in treating a clavicle fracture is an option. Six weeks after diagnosis, there was no tenderness at the injury site. The follow-up X-ray showed callus formation at fracture site. The figure-of-eight dressing was then removed; return to noncontact sports and full daily activities were suggested. Fourteen weeks after diagnosis, he returned to contact activities without discomfort, which solid bony union was presumed. Integrative Chinese and Western medicine is the trend of the future. The experience of treating a clavicle fracture with comprehensive non-operative management in an adult is an example of applying integrative Chinese and Western medicine.

1. Hill, JM,McGuire, MH,Crosby, LA(1997).Closed treatment of displaced middle-third fractures of the clavicle gives poor results.J Bone Joint Surg Br,79,537-539.
2. Holgersson, M,Larsson, S(2004).Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up.J Shoulder Elbow Surg,13,479-486.
3. Housner, JA,Kuhn, JE(2003).Clavicle fractures.Phys Sports Med,31,30-36.
4. Kim, W,McKee, MD(2008).Management of acute clavicle fractures.Orthop Clin North Am.,39(4),491-505.
5. McKee, MD,Pedersen, EM,Jones, C,Stephen, DJ,Kreder, HJ,Schemitsch, EH,Wild, LM,Potter, J(2006).Deficits following nonoperative treatment of displaced midshaft clavicular fractures.J Bone Joint Surg Am,88,35-40.
6. Pecci, M,Kreher, JB(2008).Clavicle fractures.Am Fam Physician,77(1),65-70.
7. Postacchini, F,Gumina, S,De Santis, P,Albo, F(2002).Epidemiology of clavicle fractures.J Shoulder Elbow Surg,11,452-456.
8. Robinson, CM(1998).Fractures of the clavicle in the adult. Epidemiology and classification.J Bone Joint Surg Br,80,476-484.
9. Robinson, CM,Court-Brown, CM,McQueen, MM,Wakefield, AE.(2004).Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture.J Bone Joint Surg Am,86(A),1359-1365.
10. Wiesel, B,Nagda, S,Mehta, S,Churchill, R(2018).Management of midshaft clavicle fractures in adults.J Am Acad Orthop Surg.,26,e468-e476.
11. 孫孝洪(1992).中醫治療學原理.成都:四川科學技術出版社.
12. 郭蘭忠(2000).新編中醫內科臨床手冊.江西科學技術出版社.
13. 賈河先(1996).中醫方庫.北京:科學技術文獻出版社.
14. 戴新民(1979).中醫臨床各科治療學.台北:啟業書局.