Department of Pediatric Orthopaedics Surgery, University Hospital of Montpellier, Lapeyronie Hospital, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France.
Orthop Traumatol Surg Res. 2012 Oct;98(6 Suppl):S146-53. doi: 10.1016/j.otsr.2012.04.015. Epub 2012 Aug 30.
Orthopaedic surgeons are often the first physicians to evaluate paediatric patients in the event of delayed walking, gait abnormalities, or parental concern about motor abilities. Therefore, orthopaedic surgeons must be thoroughly familiar with the normal neurodevelopmental stages. Neurological disorders are often first recognised during an orthopaedic evaluation. Minimal neurological abnormalities should be taken as warning signs that require additional investigations. Consequently, the evaluation must follow a strict protocol, even in children referred for apparently trivial functional disorders. We have developed an original physical examination protocol in which the largest possible number of signs is sought in each body position to ensure that the examination is both systematic and rapid. About ten minutes are required when all findings are normal. This protocol is extremely helpful for identifying the cause of the problem that motivated the evaluation or for reassuring the child and family. The main causes of paediatric orthopaedic disorders are cerebral palsy, spinal dysraphism, myopathies, peripheral neuropathies, motor neuron diseases, and intraspinal tumours. In some instances, no definitive diagnosis can be established clinically. In this situation, appropriate orthopaedic treatment can be initiated, although considerable caution is in order when establishing the indications. The cause may be detected only much later, when the clinical manifestations become more prominent.
骨科医生通常是在出现行走延迟、步态异常或父母对运动能力担忧的情况下，第一个评估儿科患者的医生。因此，骨科医生必须非常熟悉正常的神经发育阶段。神经障碍通常是在骨科评估中首次发现的。即使是在因明显的功能障碍而转诊的儿童中，也应将最小的神经异常视为需要进一步检查的警告信号。因此，即使是在因明显的功能障碍而转诊的儿童中，评估也必须遵循严格的方案。我们制定了一个原始的体检方案，在每个体位中寻找尽可能多的体征，以确保检查既系统又快速。当所有发现都正常时，大约需要十分钟。当所有发现都正常时，这个方案对于确定评估的原因或让孩子和家人放心非常有帮助。儿科骨科疾病的主要原因是脑瘫、脊柱裂、肌病、周围神经病、运动神经元病和脊髓内肿瘤。在某些情况下，临床上无法明确诊断。在这种情况下，可以开始进行适当的骨科治疗，但在确定适应证时要非常小心。只有在临床表现更加明显时，病因才会被发现。
