針藥並用治療股骨幹骨折之病例報告

此案例討論的36歲男性患者，因車禍遭汽車追撞造成右下肢股骨閉鎖性骨折、額頭撕裂傷，右大腿內外側均有大片瘀青，及下肢多處擦傷，無法行走，需藉由枴杖輔助。在經過骨科內固定手術後，隨即積極配合中醫共同治療。股骨幹骨折(Femoral shaft fracture)在臨床上多見於受外力撞擊造成（如：車禍），此案例以Winquist and Hansen classification作分級，已屬Type IV（第0級為正常，第四級為最嚴重）。若不及時施以內固定手術，並妥善治療，其預後可能有併發症或創傷性關節炎之可能。患者於內固定手術九天之後接受中醫針灸及傷科治療，除了針灸、薰洗、推拿、理筋，另搭配科學中藥。患者於每個月皆有至西醫骨科門診密切追蹤。一個月後骨折處骨痂已開始形成。兩個月後，活動角度增加，腫痛程度減輕。三個月後，骨痂形成明顯，大腿除了有輕微痠軟、腫脹，活動度持續進步中。一般股骨幹嚴重骨折，施以內固定手術，多要一年以上方能將釘子取出，而此患者於手術後即配合中醫傷科用藥的輔助治療，整體回復狀況，及股骨癒合的進程相當良好。

關鍵字

股骨幹骨折；內固定手術；針灸；傷科用藥

並列摘要

This is a case about a thirty-six-year-old male, suffered from closed fracture of right femoral shaft, and laceration of forehead after a serious car accident. There were multiple abrasions on his lower limbs and ecchymosis on the medial and lateral side of his right thigh. He could not walk without a walker. The patient actively accepted traditional medicine co-treatments, not long after the internal fixation surgery was done. Femoral shaft fracture is often caused by some high-energy collision (e.g., car accident). The patient in this case can be classified into type IV of Winquist and Hansen classification, which is the most severe grading in femoral shaft fracture (Type IV means segmental comminution of femoral shaft, and type 0 means no comminution of femoral shaft.). Patients may suffer from complications and traumatic arthritis, if proper treatments do not perform in time. The patient received traditional traumatology therapy nine days after internal fixation surgery. Therapy includes acupuncture, herbal fumigation, massage, tendon-soothing maneuver, and went with concentrated herbal medicine. He had regular follow-up in orthopedic clinic every month. After one month of traditional therapy, bone-callus began to form at the periphery of the fracture site. Increased range of motion(ROM), and decreased pain intensity of his right lower leg were observed after two months. In the third month of recovery, feeling of mild soreness, strengthlessness, and swollen of his right thigh were still complained, but obvious callus formation and continuously increasing ROM of his right lower limb were found. In general, it takes at least one year of recovery to remove the femoral screw in severe femoral shaft fracture. The patient in this case report, accepted traditional traumatology therapy nine days after surgery, and had great process on fracture healing.