自發性骨折－某護理之家二病例報告

護理之家的住民多為慢性病、長期臥床、日常生活完全依賴的個案，本文提出兩位長期臥床之年長女性，無跌倒、外力撞擊或虐待的情況下，卻在癱瘓的肢體發生骨折的案例。發生骨折的部位，在外觀上並沒有傷口，只見到局部紅、腫、熱、痛等創傷反應，以及肢體活動度受限，屬於自發性骨折。自發性骨折發生後，個案可能因後續的治療或發生併發症而住院，造成醫療費用的增加；也可能因為病人為長期臥床者卻在機構內發生骨折，家屬難以接受，而衍生醫療糾紛。相關研究報告指出此類骨折的發生可能與骨質疏鬆有關。已知女性、年長者、長期臥床、使用抗癲癇、類固醇等藥物為骨質疏鬆的危險因子。護理之家除了需要提高對住民的骨質疏鬆進行評估與治療以外，照顧服務員在幫住民翻身、移位或移動肢體時，需更小心，勿使力量超過肢體所能承受的範圍，以免發生自發性骨折。

關鍵字

微創傷性骨折；移位性骨折；自發性骨折；護理之家

並列摘要

Most nursing home residents are bedridden for suffering multiple chronic diseases and loss of independence. The study reports the cases of two patients with fractures that occurred without known trauma or physical abuse. They are both old women and bedridden for a long time, and the fractures occurred on the limbs which were paralytic. And there was no obvious wound while only local redness, swelling, heat, tenderness, and limitation in range of motion were noted. Patients suffering fractures are likely to face rise in medical cost, morbidity, and even mortality. Often leading to medical-legal problems, unexplained fractures in particular are found in several studies to be related to osteoporosis. Women, elders, status of non-weight bearing, medication such as steroid and anticonvulsant are all risk factors of osteoporosis. Osteoporosis should be evaluated and treated. Moreover, it should be kept in mind that fractures can occur even during common nursing procedures for positioning, transferring, or turning if the external force exceeds the fragility of bones.

並列關鍵字

minimal trauma fracture ； transfer fracture ； spontaneous fracture ； nursing home

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自發性骨折－某護理之家二病例報告

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