Orthopaedic and Traumatology Unit, Vicenza General Hospital, Vicenza, Italy.
J Orthop Traumatol. 2009 Jun;10(2):105-10. doi: 10.1007/s10195-009-0053-7. Epub 2009 May 26.
In newborns physeal separations and septic osteomyelitis or arthritis are unusual, representing a problem in diagnosis and treatment. Therapy needs to be carried out soon in order to prevent anatomical and functional consequences. Association between septic event and physeal separation is rare. We report a 28-day-old female, admitted for elevated temperature, who underwent three nonorthopaedic surgical procedures before, and orthopaedic evaluation 8 days after admission. After an X-ray and an ultrasonography a septic arthritis with consequent hip dislocation was supposed. Only at the time of surgery a separation between the epiphysio-trochanteric nuclei complex and the femoral shaft was observed, with clear hip joint. The interest in this case consists in the difficulty of the differential diagnosis at the first evaluation, the orthopaedic misdiagnosis based on the lack of complete preoperative imaging, and finally the long-term excellent result after a prompt surgical treatment.
在新生儿中，骺板分离和脓毒性骨髓炎或关节炎并不常见，这在诊断和治疗上构成了难题。为了防止发生解剖和功能方面的后果，需要尽快进行治疗。脓毒性事件与骺板分离之间的关联较为罕见。我们报告了一例 28 日龄女性，因发热而入院，在入院前接受了 3 次非矫形外科手术，入院 8 天后接受了矫形外科评估。在进行 X 光和超声检查后，推测存在化脓性关节炎伴随后续的髋关节脱位。只有在手术时，才观察到骺-转子核复合体与股骨干之间的分离，髋关节清晰可见。本病例的意义在于初次评估时鉴别诊断的难度、基于不完整术前影像学的矫形外科误诊，以及及时手术治疗后的长期良好结果。
