足舟狀骨骨折病例報告一例兼評相似病例之醫療爭議與司法判決

Navicular Fracture: A Case Study; and Annex the Comments of Medical Arguments and Judicial Verdicts in a Similarity Case

王國成(Kuo-Cheng Wang) ； 張晉賢(Ching-Hsien Chang) ； 黃澤宏(Tse-Hung Huang) ； 韓豐隆(Fong-Long Han) ； 戴承杰(Chen-Jie Tai)

《台灣中醫臨床醫學雜誌》 16卷1期 (2010/03) Pp. 1-20

https://doi.org/10.6968/TJCCM.201003.0001

摘要

一例車禍右足受卡車輾傷病患，當日立即送往他院急診，診斷爲右足挫傷無骨折，但患部持續腫脹疼痛活動受限；於9日後來診時檢查發現爲右足舟狀骨內側撕裂性骨折，經傳統中醫骨折損傷分期辨證屬骨傷初期氣滯血瘀、經絡阻滯，治以活血行氣、疏通經絡兼以消腫定痛，治療後症狀獲得良好改善。
部份足舟狀骨骨折臨床上不易早期診斷，常致延誤治療。本文以實例探討其成因、診斷與治療原則，希望提供相關經驗以求拋磚引玉；並兼以法律觀點評論及分析相似病例之醫療爭議與司法判決，以彰顯相關醫療法令之缺失與應修正之方向。

關鍵字

足舟狀骨 ； 撕裂性骨折 ； 氣滯血瘀 ； 司法判決 ； 醫療法規

並列摘要

A patient who Suffered from right foot crushing injury by a truck was transferred to the other emergency hospital at once, and right foot trauma injury without any bony fracture was diagnosed. However, persistent swelling, tenderness, spasm with limited movement of his right foot was noted since then. So he visited our department for further evaluation and management nine days later, and avulsion fracture over medial aspect of right navicular was noted by recheck.
We applied syndrome differentiation stages of the bony injury by traditional Chinese medical science, and concluded the diagnosis as first stage: qi stagnation and blood stasis; stagnant blockade of channels and collaterals. The treatment principle is to activate blood in order to promote qi flow; to dredge channels and collaterals; and to remove swelling and settle pain. Symptoms of his right foot were nice improved after regular treatment.
Partial cases of navicular fracture could not diagnose accurately in the early stage at the OPD, and that often delayed the practice of clinical treatment. This paper investigated and studied the causes, diagnoses and clinical treatments of navicular fracture by a real clinical case in order to offer useful experience for all Chinese herb doctors, and that could throw a brick and to get a piece of jade in return. Aside from this, it also disscussed the arguments about medical treatments and the judicial verdicts of a similarity case by lawful opinions. Therefore, it manifested general terms of medicine for laws and regulations which were defective and guided the suggestions for reforming in future.

並列關鍵字

navicular bone ； avulsion fracture ； qi stagnation and blood stasis ； judicial verdict ； general terms of medicine for laws and regulations