研究背景與動機
前臂骨骨折案例之治療方法並無定論，尤其在台灣有一部分是以中醫療法介入的，此為其他國家地區資料庫所沒有的，國際上發表的研究還沒有關於中醫藥干預前臂骨折再骨折風險趨勢和死亡率的報導。也沒有完整的大數據報告來比較台灣中醫治療或西醫治療的報告。在台灣即將邁入超高齡社會之際，中高齡前臂骨折病患是否會因有無中醫治療併用而有所差異，值得研究。
研究目的
探討中高齡族群在治療前臂骨折各類中西醫合併就醫模式中，所呈現的再骨折率及死亡率等醫療現況，俾助台灣衞福醫界在制定健保政策或醫病間討論選擇治療策略時有所酌參之處，此乃本篇論文所瞄準的研究目的。
研究方法
採用世代研究系列法(Series of Cohort Studies)，分2階段進行。
首先，本研究先經由社區居民雙世代資料庫串聯台灣地區全民健保庫，針對前臂骨折患者出院後的再骨折率及死亡率進行初探，了解有無中醫合併治療是否有差異；然後再用全民健保巨型資料庫觀察【中西醫併用組】、【僅用西醫組】、【僅用中醫組】及【後續無治療紀錄組】四個就醫模式間的再骨折及死亡率進行更廣大的真實世界實證之世代研究，以辨明其差異性。
之後，本篇論文另有一探討，就是中高齡族群發生前臂骨折後進行中西醫合併治療時，我們藉由人因工程分析概念來得知其合併治療的時間點，在何時會較好的保護效益(降低5年內死亡率)。
結果
前臂骨折的住院患者，出院後30日中西醫合併治療再追蹤所出現的五年內死亡率，會顯著優於後續無治療紀錄組與其他分組有所差異。中西醫合併治療的時間點在3個月內就開始者會有降低5年內死亡率接近6成的保護效益，且達統計顯著；6個月~1年內開始者則降低4成、一年後才開始合併中西醫治療者就只降低不到2成。
結論
在台灣全民健保制度所提供的醫療資源下，中高齡族群發生了前臂骨折，在急性處理後，民眾可以依其意願尋求中醫、西醫、中西醫合併或無治療等後續就醫型態。研究發現，以中西醫合併治療者為基準來做比較，無治療者其5年內死亡率及3年內再骨折率風險最高。與僅用西醫或僅用中醫比較都有風險上的差異出現，在統計上5年內死亡率達顯著差異，但在3年內再骨折率風險則尚未顯著。而中醫介入時間點，在3個月內最好。

This research paper addresses the treatment methods for forearm fractures, particularly in Taiwan, where traditional Chinese medicine (TCM) therapy is often utilized. The study highlights the lack of international research on the risks, trends, and mortality rates associated with TCM intervention for forearm fractures. Additionally, there is a dearth of comprehensive big data reports comparing TCM and Western medicine treatments in Taiwan. Given Taiwan's impending super-aged society, the paper aims to examine whether middle-aged and elderly patients with forearm fractures differ based on the combination of TCM treatment. The research utilizes a series of cohort studies, analyzing data from the national health insurance database in Taiwan to investigate re-fracture rates and mortality among different treatment modes. The findings will inform health insurance policies and facilitate discussions between doctors about treatment strategies.

中文文獻
王亮懿, 吳芷螢, 陳榮陞, & 游麗惠. (2018). 臺灣 [健康餘命計算與解構資料庫]之建置介紹. 健康科技期刊, 33-49. . Retrieved from https://www.airitilibrary.com/Publication/alDetailedMesh?docid=P20140106002-201812-201812260002-201812260002-33-49
王光旭, 葉謹䌀, 劉宜君, 陳敦源, & 林昭吟. (2021).全民健康保險委員會決策參與影響因素之探析: 社會網絡分析的觀點.行政暨政策學報, (72), 67-114.)。Retrieved from https://www.airitilibrary.com/Publication/alDetailedMesh?docid=17286425-202106-202106280006-202106280006-67-114
中華民國勞動部，勞基法 Retrieved from http://laws.mol.gov.tw/Chi/FLAW/FLAWDAT0201.asp
內政部、衛生福利部、OECD Retrieved from網址:www.stst.gov.tw
江昭皚, 張文典, & 吳季樺. (2008). 低能量雷射治療手部骨折病例報告. 中西整合醫學雜誌, 10(1), 21-28 Retrieved from. https://www.airitilibrary.com/Publication/alDetailedMesh?docid=02119153-200806-10-1-21-28-a
沈.,Ruei-Rung　Shen.(2016).「老年」定義與退休規劃之閩客比較. Retrieved from http://ir.lib.ncu.edu.tw:88/thesis/view_etd.asp?URN=101756026101756026
李長平, & 胡良平. (2019). 非配對設計二值資料一水平多重 Logistic 回歸分析. 四川精神衛生, 32(4), 297-303. Retrieved from http://www.psychjm.net.cn/scjswszz/ch/reader/founder_html.aspx?journal_id=scjswszz&file_no=20190502&html_url=scjswszz/article/html/20190502
李傳, & 劉建惠. (2019). 創伤性骨折術後創面感染不愈合的穿支皮瓣修復術. 2019 楚天骨科高峰論壇暨第二十六届中國中西醫结合骨傷科学術年會論文集
周玟琪. (2007). 中高齡者與老年人年齡層界定問題之探討. Retrieved from http://ir.lib.ncu.edu.tw:88/thesis/view_etd.asp?URN=101756026
季新強, & 劉志民. (2006). Delphi 法及其在醫學研究和決策中的應用. 中國藥物依賴性雜誌, 15(6), 422-426 Retrieved from http://www.chinadoi.cn/portal/mr.action?doi=10.3969/j.issn.1007-9718.2006.06.003
洪錦墩, 黃昱瞳, 李卓倫, 何清治, & 李淑芬. (2009). 台灣地區中醫師人力現況分析及未來需求之推估. 臺灣中醫醫學雜誌, 8(2), 1-9. Retrieved from https://www.airitilibrary.com/Publication/alDetailedMesh?docid=16841166-200911-201001140010-201001140010-1-9
徐慶玶. (2016). 健保限縮骨質疏鬆藥物給付, 是否影響醫師開立骨鬆藥? Retrieved from https://www.airitilibrary.com/Publication/alDetailedMesh1?DocID=U0001-0302201603590500
郭霞珍. (2012). 《 黄帝内經》“五臟應時” 說與天人相應觀. 中華中醫藥雜誌， 27(5)，1223-1226.《 黄帝内經原文》)(“五體五臟” Retrieved from http://seirouoosone.web.fc2.com/KouteiNaikeiGennbunn.pdf
郭卜瑄. (2012). 社區中老年人骨骼肌減少症盛行率與相關危險因子探討Retrieved from https://hdl.handle.net/11296/3zy8h6
許仲博(2022) Advisers 財務顧問雜誌.2022/02/01 Retrieved from https://www.advisers.com.tw/?p=12595
骨質疏鬆症治療藥物(100/1/1) (發文日期：中華民國 99 年 12 月 15 日,發文字號：健保審字第 0990082312 號) (發文日期：中華民國 99 年 11 月 22 日,發文字號：健保審字第 0990082152 號) Retrieved from https://www.kln.mohw.gov.tw/public/news/d49b292d929b0e0fb0ea47f1358484f5.pdf
黒木登志夫. (2007). 健康・老化・寿命. Retrieved from https://www.jahbs.info/journal/pdf/vol28_1/vol28_1_1_1.pdf
陳無擇. (2006). 陳無擇醫學全書․ 三因極一病證方論. 北京. 中國中醫藥出版社, 79. Retrieved from https://jicheng.tw/tcm/book/%E4%B8%89%E5%9B%A0%E6%A5%B5%E4%B8%80%E7%97%85%E8%AD%89
陳嘉宏. (2020). 台灣嘉義地區骨質疏鬆症風險因子研究. 臺灣醫事放射期刊, 8(2), 1-6. Retrieved from https://www.airitilibrary.com/Publication/alDetailedMesh?docid=P20170608002-202012-202101200003-202101200003-1-6
齊士格, 王志會, 王麗敏, 張梅. 2013年中國老年居民跌倒傷害流行狀況分析. 中華流行病學雜誌, 2018, 39(4): 439-442 Retrieved from http://html.rhhz.net/zhlxbx/20180410.htm
黃蕙棻, 中醫學, & 馮逸卿. (2007). 中醫傷科診斷基準之科學化指標研究. 行政院衛生署中醫藥委員會.) Retrieved from https://www.mohw.gov.tw/dl-28061-16fb2f5b-adf9-4ba8-af4d-f6479587bbec.html
黃蕙棻, & 游智勝. (2007). 如意金黃散與接骨散在骨折癒合過程中的病理研究. 中醫骨傷科醫學雜誌, (6), 32-38. Retrieved from https://www.airitilibrary.com/Publication/alDetailedMesh?docid=a0000153-200712-x-6-32-38-a
黃立恒等,臺灣老年醫學暨老年學雜誌 2013；8(4)：273-289 Retrieved from https://www.tagg.org.tw/upload/nFile/8-4-4%E5%8E%9F%E8%91%97-%E9%BB%83%E7%AB%8B_p273-289-1.pdf
楊文山. (1996). 台灣地區人口平均餘命與死因別變化趨勢之研究. In 人口變遷, 國民健康與社會安全 (台北市: 中央研究院中山人文社會科學研究所). 中央研究院中山人文社會科學研究所.) Retrieved from https://ir.sinica.edu.tw/handle/201000000A/65746
趙育箴, 陳全裕, 吳俊鋒, 張秦松, 郭柏秀, 張軒睿, ... & 吳至行. (2010). 偏遠社區老年女性骨質疏鬆症盛行率與相關危險因子之研究. 台灣家庭醫學雜誌, 20(2), 64-73. Retrieved from https://www.tagg.org.tw/upload/nFile/8-4-4%E5%8E%9F%E8%91%97-%E9%BB%83%E7%AB%8B_p273-289-1.pdf
鄭秝丞，2010 ISO 609中醫利用降低骨鬆性骨折風險Retrieved from https://ndltd.ncl.edu.tw/cgibin/gs32/gsweb.cgi/login?o=dnclcdr&s=id=%22108NCKU5201008%22.&searchmode=basic
盧文瑞. (2011). 老年性腕部骨折: 二病例報告. 中醫骨傷科醫學雜誌, (10), 63-75. Retrieved from https://www.airitilibrary.com/Publication/alDetailedMesh?docid=a0000153-201112-201202140006-201202140006-65-77
 
英文文獻
Avenell, Alison; Mak, Jenson C. S.; O'Connell, Dianne. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. The Cochrane Database of Systematic Reviews.2014-04-14,(4):CD000227. ISSN 1469-493X. PMC 7032685  . PMID 24729336. doi:10.1002/14651858.CD000227.pub4.)Retrieved from https://zh.wikipedia.org/zh-tw/%E9%AA%A8%E6%8A%98
BUSH, L. F., LOVE, W., EISEMAN, P., & FERLAND, J. J. (1959). Forearm Fractures. AMA Archives of Surgery, 79(6), 889-899. Retrieved from Charlson, M. E., Carrozzino, D., Guidi, J., & Patierno, C. (2022). Charlson comorbidity index: a critical review of clinimetric properties. Psychotherapy and psychosomatics, 91(1), 8-35. Retrieved fromhttps://pubmed.ncbi.nlm.nih.gov/34991091/
Charlson, M. E., Carrozzino, D., Guidi, J., & Patierno, C. (2022). Retrieved from https://pubmed.ncbi.nlm.nih.gov/34991091/
Caruso, G., Caldari, E., Sturla, F. D., Caldaria, A., Re, D. L., & Pagetti, P. Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature. Musculoskelet Surg. 2021; 105 (3): 225–234. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33058085/
Chen, Y. P., Lan, Y. S., Hu, W. L., & Hung, Y. C. (2018). Nonoperative manipulative reduction with Chinese herbs for the treatment of a displaced olecranon fracture: A case report. Medicine, 97(21). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6392946/
Essex-Lopresti, P (May 1951). "Fractures of the radial head with distal radio-ulnar dislocation: report of two cases". J Bone Joint Surg Br. 33B (2): 244–7. Retrieved from https://pubmed.ncbi.nlm.nih.gov/14832324/
Griffin, XL; Parsons, N; Costa, ML; Metcalfe, D. Ultrasound and shockwave therapy for acute fractures in adults. The Cochrane Database of Systematic Reviews. 23 June 2014, (6): CD008579. PMID 24956457. doi:10.1002/14651858.CD008579.pub3. Retrieved from https://town-pt.com/shockwave-therapy/?gclid=EAIaIQobChMIuq-juN7hgAMV1wx7Bx045QWKEAAYASAAEgKmavD_BwE
HUME AC (August 1957). "Anterior dislocation of the head of the radius associated with undisplaced fracture of the olecranon in children". J Bone Joint Surg Br. 39-B (3): 508–512. Retrieved from https://pubmed.ncbi.nlm.nih.gov/13463039/
JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 29(12), 518-525. Retrieved from https://journals.lww.com/jaaos/toc/2021/06150
J Hand Surg Am. 2014;39(7):1384e1394. Copyright 2014 by the American Society for Surgery of the Hand.) Retrieved from https://pubmed.ncbi.nlm.nih.gov/25194773
Kim S, Ward JP, Rettig ME. Galeazzi fracture with volar dislocation of the distal radioulnar joint. Am J Orthop (Belle Mead NJ) 2012;41:E152-4 Retrieved from https://pubmed.ncbi.nlm.nih.gov/23431520/
Kupperman, E. S., Kupperman, A. I., & Mitchell, S. A. (2018). Treatment of radial head fractures and need for revision procedures at 1 and 2 years. The Journal of Hand Surgery, 43(3), 241-247. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29169720/
Leighton, R.; Watson, J.T; Giannudis, P.; Papakostidis, C.; Harrison, A.; Steen, R.G. Healing of fracture nonunions treated with low-intensity pulsed ultrasound (LIPUS): A systematic review and meta-analysis. Injury. May 2017, 48 (7): 1339–)1347. PMID 28532896. doi:10.1016/j.injury.2017.05.016[16]。Retrieved from https://pubmed.ncbi.nlm.nih.gov/28532896
Li, Q., Ke, C., Han, S., Xu, X., Cong, Y. X., Shang, K., ... & Zhang, B. F. (2020). Nonoperative treatment versus volar locking plate fixation for elderly patients with distal radial fracture: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 15(1), 1-9. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32665000/
Manheimer, E., & Berman, B. (2003). NCCAM support for the Cochrane Collaboration CAM Field. Complementary Therapies in Medicine, 11(4), 268-271.)； Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0965229903001286
Martel, José; Bueno, Angel (2008). "Fractures with names". In Pope, Thomas; Bloem, Hans L.; Beltran, Javier; Morrison, William B.; John, David (eds.).
Musculoskeletal Imaging (2nd ed.). Philadelphia: Elsevier. p. 1232.e2. ISBN 978-1-4557-0813-0. Retrieved from https://www.leaderbook.com.tw/book.php?cat=30&id=12496
Matsuura Y, et al. (2017). "Smith's fracture generally occurs after falling on the palm of the hand". Journal of Orthopaedic Research. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28262985/
McQueen, M. M., Gaston, P., & Court-Brown, C. M. (2000). Acute compartment syndrome: who is at risk?. The Journal of bone and joint surgery. British volume, 82(2), 200-203. Retrieved from https://pubmed.ncbi.nlm.nih.gov/10755426/
McRae, Ronald; Esser, Max (2008). Practical Fracture Treatment (5th ed.). Elsevier Health Sciences. p. 187. ISBN 978-0-443-06876-8. Retrieved from https://shop.elsevier.com/books/practical-fracture-treatment/mcrae/978-0-443-06876-8
Moss, J. P., & Bynum, D. K. (2007). Diaphyseal fractures of the radius and ulna in adults. Hand clinics, 23(2), 143-151. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17548006/
Mubarak, S. J., & Hargens, A. R. (1983). Acute compartment syndromes. Journal of Pediatric Orthopaedics, 3(5), 636-638. Retrieved from https://pubmed.ncbi.nlm.nih.gov/6346542/
Ochen, Y., Peek, J., van der Velde, D., Beeres, F. J., van Heijl, M., Groenwold, R. H., ... & Heng, M. (2020). Operative vs nonoperative treatment of distal radius fractures in adults: a systematic review and meta-analysis. JAMA network open, 3(4), e203497-e203497. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32324239/
Orthoinfo.aaos.org. March 2013. Archived from the original on 2 July 2017. Retrieved 12 October 2017. Retrieved from https://orthoinfo.aaos.org/
Potteiger, J. A., Carper, M. J., Randall, J. C., Magee, L. J., Jacobsen, D. J., & Hulver, M. W. (2002). Changes in lower leg anterior compartment pressure before, during, and after creatine supplementation. Journal of Athletic Training, 37(2), 157. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164339/
Ranganathan, P., & Aggarwal, R. (2018). Study designs: Part 1–An overview and classification. Perspectives in clinical research, 9(4), 184. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176693/
Sidener, J. (2004). Everyone's encyclopedia. The San Diego Union-Tribune, 6, 12. Retrieved from https://www.sandiegouniontribune.com/
Srinivasan, R. C., Shrouder-Henry, J. J., Richard, M. J., & Ruch, D. S. (2021). Open and Arthroscopic Triangular Fibrocartilage Complex (TFCC) Repair. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34078841/
Southern, S., & Sloan, J. (2010). Soft tissue injuries: chapter 8 forearm, hand and wrist. Emergency Medicine Journal, 27(2), 133-140. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20156869/
Solarz, M. K., Thoder, J. J., & Rehman, S. (2016). Management of major traumatic upper extremity amputations. Orthopedic Clinics, 47(1), 127-136. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26614927/
The American Society of Health-System Pharmacists. [2011-04-03]. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15364632/
Yao, C. K., Lin, K. C., Tarng, Y. W., Chang, W. N., & Renn, J. H. (2014). Removal of forearm plate leads to a high risk of refracture: decision regarding implant removal after fixation of the forearm and analysis of risk factors of refracture. Archives of orthopaedic and trauma surgery, 134(12), 1691-1697. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25168787/