鎖骨骨折之徒手整復治療病例報告

本病例為66歲女性，在108／1／3騎車返家途中遭汽車撞擊跌落，隨後送入彰化秀傳醫院急診，當下左側肩膀外觀腫脹變形、按壓疼痛及膝蓋輕微擦傷，疼痛評估為5，muscle power上肢：左2右5；下肢：左5右5，對答、意識並無異常，無眩暈頭痛；經X光檢查顯示：左側中1／3鎖骨及左側3－8肋骨骨折。經住院三天觀察無血胸、氣胸及內臟出血，病人拒絕鎖骨內固定手術便於108／1／5出院，並於108／1／11至坊間國術館作復位及包紮，但因後續X光顯示（108／1／25）鎖骨骨折處恢復仍不理想；平時感到患側無力，臥床起身時需用健側手施力，肩關節活動受限且移動疼痛，脅肋處緊繃伴隨睡覺翻身疼痛，便於108／2／15來中醫門診就診。在經過五個月傷科和針灸處置及中藥治療後，左肩鎖骨骨折處外觀恢復良好，無壓痛，被動活動關節阻力減少，ROM進步。

關鍵字

鎖骨骨折；中醫正骨；徒手復位；叉腰挺胸復位；八字固定；非手術外固定

並列摘要

This is a 66-year-old female patient. She suffered severe injuries from the car accident on the way back home on 108/1/3. She was then sent to the Changhua Show Chwan Memorial Hospital for emergency treatment. Her left shoulder was swollen and deformed, and the knees were slightly bruised. Her pain scale was 5, and muscle power upper limbs: left 2 right 5, lower limbs: left 5 right 5. X-ray examination showed: left 1/3 clavicle and left 3-8 Rib fractures. After three days hospitalization, no hemothorax, no pneumothorax and no visceral hemorrhage were observed. She refused the Open reduction and internal fixation (ORIF) on 108/1/5. Then she accecpted the close reduction by chiropractor in Kung Fu Clinic on 108/1/11. Due to subsequent X-ray display ( 108/1/25) , unsatisfactory recovery of the clavicle fracture, and the weak affected side, she came to our Chinese medicine clinic on 108/2/15 with her restricted shoulder joint ,painful movement, awfully tight left rib. After five months of Manipulative reduction , acupuncture treatment ,and Chinese medicine treatment, the appearance of the left acromioclavicular fracture recovered well, no tenderness, reduced passive joint resistance, and improved ROM.