Naranje Sameer, Kelly Derek M, Sawyer Jeffrey R
Forrest City Medical Center, Forrest City, AR, USA.
University of Tennessee-Campbell Clinic, Memphis, TN, USA.
Am Fam Physician. 2015 Nov 15;92(10):908-16.
A limp is defined as a deviation from a normal age-appropriate gait pattern resulting in an uneven, jerky, or laborious gait. It can be caused by pain, weakness, or deformity as a result of a variety of conditions. Transient synovitis is the most common diagnosis. Other causes of acute limp include contusion, foreign body in the foot, fracture, osteomyelitis, septic arthritis, reactive arthritis, and Lyme arthritis. Causes of chronic limp include rheumatic disease, dermatomyositis, acute rheumatic fever, inflammatory bowel disease, and systemic lupus erythematosus. Evaluation of a limping child should begin with a history focused on identifying pain, trauma, and associated systemic symptoms. For a limping child with focal findings on physical examination, initial imaging includes anteroposterior and lateral radiography of the involved site. If there are no focal findings on physical examination, radiography of both lower extremities should be performed. Laboratory testing is guided by history and physical examination findings. Septic arthritis of the hip should be suspected in a child with an oral temperature more than 101.3°F (38.5°C), refusal to bear weight, erythrocyte sedimentation rate more than 40 mm per hour, peripheral white blood cell count more than 12,000 per mm3 (12 × 109 per L), or C-reactive protein level more than 20 mg per L (180.96 nmol per L).
跛行被定义为偏离正常的、与年龄相符的步态模式，导致步态不均匀、不平稳或费力。它可能由多种情况引起的疼痛、虚弱或畸形导致。暂时性滑膜炎是最常见的诊断结果。急性跛行的其他原因包括挫伤、足部异物、骨折、骨髓炎、化脓性关节炎、反应性关节炎和莱姆关节炎。慢性跛行的原因包括风湿性疾病、皮肌炎、急性风湿热、炎症性肠病和系统性红斑狼疮。对跛行儿童的评估应从病史开始，重点是确定疼痛、创伤和相关的全身症状。对于体检有局部体征的跛行儿童，初始影像学检查包括受累部位的前后位和侧位X线片。如果体检没有局部体征，则应进行双下肢X线检查。实验室检查以病史和体检结果为指导。对于口腔温度超过101.3°F（38.5°C）、拒绝负重、红细胞沉降率超过每小时40毫米、外周白细胞计数超过每立方毫米12,000（每升12×10⁹）或C反应蛋白水平超过每升20毫克（每升180.96纳摩尔）的儿童，应怀疑有髋关节化脓性关节炎。
