中醫治療骨盆多處骨折術後病例報告

Traditional Chinese Medicine in Post-operative Pelvic Multiple Fractures Therapy: A Case Report

許家祥(Chia-Hsiang Hsu) ； 洪裕強(Yu-Chiang Hung) ； 胡文龍(Wen-Long Hu)

《臺灣中醫科學雜誌》 4卷2期 (2010/02) Pp. 51-58

https://doi.org/10.29810/SJTTCM.201002.0007

摘要

目的：本篇報告一例外傷性骨盆多處骨折，經手術後施行針藥併用配合復健得到良好療效之病例。 臨床表現：這位47歲電焊工，工作中從二樓摔落，經送本院急診檢查後發現左側骨盆變形，診斷為左側骨盆多處骨折。翌日發生上消化道出血。住院第4 日施行鋼釘內固定手術，術中患者發生嚴重出血，在完成髖臼骨折鋼釘內固定後即結束手術。在骨科病房主要的治療有質子泵抑制劑、輸血、骨骼牽引、皮膚牽引、抗生素使用及床邊復健。住院第44日轉入中醫病房，當時症狀為左髖部以下腫脹痛甚，活動受限，須服西藥止痛藥及鎮定劑方能入睡。 治療過程與結果：我們給予電針、雷射針灸、藥熏，配合骨折3 期治療用藥，停用西藥亦能入眠。此時為骨折中期，治宜調和氣血、接骨續筋，方選接骨沒藥散加減；及至後期，治宜補氣血、益肝腎，方選壯筋續骨丹合龜鹿二仙膠。住院第58日能使用助行器行走，第82日病情改善出院。門診治療包括電針、內服龜鹿二仙膠合六味地黃丸；1個月後改持拐杖行走，再3個月後則行動自如。由於我們的介入，使其復原時間比骨科醫師預期縮短一半。 結論：治療骨盆多處骨折，於手術後早期結合中醫與復健治療可縮短復原時間。

關鍵字

骨盆骨折 ； 電針 ； 雷射針灸 ； 中藥

並列摘要

Objective: This report of one case illustrates good curative effect of traditional Chinese medicine combined with rehabilitation for pelvic multiple fractures status post surgery.
Clinical features: This 47 years old male fell from the second floor while working. He was sent to our ER by ambulance. Initial survey revealed left iliac wing and acetabular fracture for him. He suffered from upper gastrointestinal bleeding the next day. The open reduction and internal fixation for just his acetabular fracture owing to the episode of massive bleeding during the operation on the 4(superscript th) admission day. He received the treatments including administration of proton pump inhibitor, blood transfusion, skeletal traction, skin traction, administration of antibiotics and bedside rehabilitation during his admission to orthopedic ward. He was admitted to our ward with the chief complaints of pain, swelling and limited range of motion of left lower extremity on the 44(superscript th) admission day.
Interventions and outcome: We treated him with electroacupuncture, laser acupuncture, herb steam and three-staged herbal medication for fracture healing. At the mean time, he ceased taking orthopedic medications. We prescribed modified Jiegu Mo Yao San to harmonize qi and blood for healing of fracture and soft tissue in the middle stage (3-7 weeks post fracture). Zhuangjin Xugu Dan and Guilu Erxian Decoction were prescribed to tonify qi and replenish blood, enrich the kidney and nourish the liver in the late stage (8 weeks later post fracture). He had been able to walk with walker since the 58th admission day, and discharged on the 82(superscript nd) admission day. We treated him with electroacupuncture, Guilu Erxian Decoction and Liu Wei Ti Huang Wan at our out-patient department. He could walk with cane 1 month later, and his independent ambulating was developed after another 3 months of treatments. The healing period was shortened to half a year in this case due to our intervention; otherwise it would take more than 1 year under the orthopedist's estimation.
Conclusion: The early interventions of traditional Chinese medicine and rehabilitation for post-operative pelvic multiple fractures can shorten the recovery period.

並列關鍵字

Pelvic fracture ； Electroacupuncture ； Laser acupuncture ； Chinese herbal medicine