Eich G F, Superti-Furga A, Umbricht F S, Willi U V
Division of Diagnostic Radiology, The University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland.
Eur J Pediatr. 1999 Nov;158(11):923-8. doi: 10.1007/s004310051243.
Children with a painful hip present a diagnostic challenge since clinical differentiation between septic arthritis, transient synovitis and Perthes disease may be difficult. Septic arthritis, a potentially life-threatening and debilitating medical emergency, requires early recognition for successful treatment, while transient synovitis and Perthes disease may be managed conservatively. An "ideal" single test for discrimination between these conditions is currently not available. We assessed the value of clinical examination and simple laboratory tests together with radiography and hip ultrasound in differentiating septic arthritis from transient synovitis and Perthes disease by analyzing the records of 89 children treated at our institution for hip pain. Ultrasound, radiographs, laboratory, clinical, and follow-up data were available for all the children. Diagnoses were made according to established criteria. Transient synovitis was present in 64 patients, septic arthritis in 8 (of whom 2 had additional osteomyelitis), and Perthes disease in 4. All children with septic arthritis had hip effusion shown by ultrasound and at least two of the following criteria: fever, elevation of erythrocyte sedimentation rate (ESR) and of C-reactive protein (CRP). None of the children without effusion on ultrasound or who lacked two or all criteria had septic arthritis. Radiographs had no significant impact on the decision-making in primary evaluation of acute hip pain.
We conclude that investigation of painful hips in children, based on hip ultrasound, body temperature, ESR and CRP, may allow cases for hip joint aspiration to be selected efficiently and may reduce the number of radiographs and hospital admissions.
患有髋关节疼痛的儿童面临诊断挑战，因为化脓性关节炎、暂时性滑膜炎和佩特兹病之间的临床鉴别可能很困难。化脓性关节炎是一种潜在的危及生命且使人衰弱的医疗急症，需要早期识别以成功治疗，而暂时性滑膜炎和佩特兹病可以保守治疗。目前尚无用于区分这些病症的“理想”单一检测方法。我们通过分析在我们机构接受治疗的89例髋关节疼痛儿童的记录，评估了临床检查、简单实验室检查以及X线摄影和髋关节超声在区分化脓性关节炎与暂时性滑膜炎和佩特兹病方面的价值。所有儿童均有超声、X线片、实验室检查、临床及随访数据。诊断依据既定标准做出。64例患者患有暂时性滑膜炎，8例患有化脓性关节炎（其中2例合并骨髓炎），4例患有佩特兹病。所有化脓性关节炎患儿超声均显示髋关节积液，且至少具备以下两项标准：发热、红细胞沉降率（ESR）升高和C反应蛋白（CRP）升高。超声检查无积液或不具备两项或全部标准的儿童均无化脓性关节炎。X线片对急性髋关节疼痛的初步评估决策没有显著影响。
我们得出结论，基于髋关节超声、体温、ESR和CRP对儿童髋关节疼痛进行检查，可能有助于有效选择需要进行髋关节穿刺的病例，并可能减少X线片检查次数和住院人数。
