摘要目的 寻找治疗成人前臂创伤性骨弯曲的最佳方案.方法 收治1例左前臂创伤性骨弯曲患者,男性,21岁;前臂旋后65°,旋前受限.按照循证实践证据检索原则,以获取当前能获得的最佳临床证据.计算机检索Cochrane图书馆(2007年第4期)、MEDLINE(1976年至2009年10月)、ACP Joumal Club(1991年1月至2009年10月)和中国生物医学文献数据库(1979年至2009年1月),查找相关的系统评价、随机对照试验(RCT)和临床回顾性研究、综述、病例报告等,并对所获证据进行质量评价.从而指导本例患者的治疗.结果 未检索到关于手法复位与切开复位比较的系统评价和大样本RCT,因此选择了与临床问题密切相关的5篇回顾性临床研究和1篇病例报告.证据显示对于成人前臂创伤性骨弯曲早期适合手法复位,而晚期及复位困难患者宜行切开复位"楔形"截骨内固定.对本例患者选择切开复位"楔形"截骨内固定治疗,术后7个月随访,左前臂无明显畸形,功能恢复旋前约85°,旋后约75°.结论 本病例的成功治疗得益于循证医学的方法,但尚需大样本、高质量RCT支持.

abstractsObjective To find the best therapy plan for an adult patient with forearm traumatic bowing who sought medical help in our department. Methods We searched Cochrane Library(Issue 4,2007),MEDLINE(1976 to October 2009),ACP Journal Club(1991 to October 2008),and CBMDisc (1979 to January 2009)for meta analyses,systematic reviews,randomized controlled trials (RCTs),casecontrol studies.reviews and case reports concerning adult forearm traumatic bowing.The quality of the included studies was assessed. Results We did not find any systematic reviews or large-scale RCTs involving a comparison between manipulative reduction and open reduction and internal fixation in the treatment of traumatic bowing.Five clinical retrospective studies and one case report closely related to our clinical questions were found and assessed.These studies concluded that manipulative reduction of the forearm with the patient under general anesthesia was the preferred method for early treatment,and osteotomy misht have to be performed at a late stage to regain appropriate limb function.Since the patient Was at a late stage,we performed osteotomy conscquently and the patient regained appropriate functions. Conclusion The present successful treatment of a rare cage benefits from the evidence-based medicine approach,but high quality large-scale randomized controlled trials are still required to support a good treatment.