肱骨近端骨折之中醫傷科治療病例報告

Proximal Humerus Fracture Well-recovered Under Traditional Chinese Orthopedic Treatment: A Case Report

肱骨外科頸位於解剖頸下2～3公分，相當於大小結節下緣跟肱骨幹的交界處，又為疏鬆骨質和緻密骨質交界處，易發生骨折。靠近肱骨外科頸內側有腋神經向後進入三角肌內、臂神經叢、腋下動靜脈通過腋窩。肱骨近端骨折完全復原時間通常需6～12週，早期的骨癒傷組織（early callus formation）約於損傷後4～6週生成。目前骨科治療一般認為增加肩部活動範圍之復健運動（range of motion exercises）應於受傷後2週時開始進行，但是否應提前於2週之前開始復健仍有爭議。肱骨近端骨折主要的併發症為喪失肩部的活動度，而肩部活動度的降低與滑囊炎造成的沾黏（俗稱「冰凍肩」）密切相關，嚴重者會造成肩部活動困難及疼痛，而這些併發症尤以未能在恢復期適時進行復健運動者為高風險族群。肱骨近端骨折在臨床上，是一個中西醫都需重視的課題。本病例報告一例老年女性肱骨近端骨折的醫案，討論肱骨骨折移位後的中西醫治療和預後，並且整理了現有的傷科肱骨復位手法，期望能為無法接受手術或手術併發症存在高風險的患者族群，提供有效的治療選擇，並能有良好預後和更好的生活品質。 The constriction 2~3 cm below the true anatomical neck of humerus, in which the greater and lesser tubercles of the humerus junction with humerus shaft, is referred to as its surgical neck due to its nature of being the border of compact bone and cancellous bone (spongy bone), thus the tendency to fracture. The axillary nerve runs posterior into the deltoid muscle through medial side of the surgical neck at the proximal end of humerus, while the brachial plexus, axillary artery and vein run through the axilla. The complete recovery time of the proximal humerus fracture usually takes 6 to 12 weeks, and early callus formation takes place about 4 to 6 weeks after injury. At present, orthopedic treatment which aiming to increase the range of movement of the shoulder is generally considered should begin in 2 weeks after the injury. However, whether to start the rehabilitation ahead of 2 weeks is still controversial. The main complication of the proximal humerus fracture is the loss of shoulder activity, and the reduction in shoulder mobility is closely related to adhesive capsulitis (commonly known as ＂frozen shoulder＂.) Shoulder movement difficulties and pain can happen in severe cases, with those who fail to receive rehabilitation in time being the high-risk groups of these complications. Proximal humerus fracture is a critical subject that calls for attention both in Chinese and Western medicine. We discussed a senior woman who suffered from proximal humerus fracture and have been recovered well under traditional Chinese orthopedic treatment, as well as the comparison between prognosis of Chinese and Western medicine treatments in this case report. We gratefully hope this case report helps to provide an effective treatment option, better prognosis and better quality of life for those with contradictions or at high risk to receive surgery managements.

The constriction 2~3 cm below the true anatomical neck of humerus, in which the greater and lesser tubercles of the humerus junction with humerus shaft, is referred to as its surgical neck due to its nature of being the border of compact bone and cancellous bone (spongy bone), thus the tendency to fracture. The axillary nerve runs posterior into the deltoid muscle through medial side of the surgical neck at the proximal end of humerus, while the brachial plexus, axillary artery and vein run through the axilla. The complete recovery time of the proximal humerus fracture usually takes 6 to 12 weeks, and early callus formation takes place about 4 to 6 weeks after injury. At present, orthopedic treatment which aiming to increase the range of movement of the shoulder is generally considered should begin in 2 weeks after the injury. However, whether to start the rehabilitation ahead of 2 weeks is still controversial. The main complication of the proximal humerus fracture is the loss of shoulder activity, and the reduction in shoulder mobility is closely related to adhesive capsulitis (commonly known as ＂frozen shoulder＂.) Shoulder movement difficulties and pain can happen in severe cases, with those who fail to receive rehabilitation in time being the high-risk groups of these complications. Proximal humerus fracture is a critical subject that calls for attention both in Chinese and Western medicine. We discussed a senior woman who suffered from proximal humerus fracture and have been recovered well under traditional Chinese orthopedic treatment, as well as the comparison between prognosis of Chinese and Western medicine treatments in this case report. We gratefully hope this case report helps to provide an effective treatment option, better prognosis and better quality of life for those with contradictions or at high risk to receive surgery managements.