Mohammed Yusif, Qazi Zain N, Shuler Franklin D, Garabekyan Tigran
W V Med J. 2016 Sep-Oct;112(5):48-53.
Adolescents and young adults (less than 30 years of age) with pre-arthritic hip pain constitute a diagnostic dilemma for the primary care physician. The most common underlying diagnoses range from benign muscle strains/joint sprains to stress reactions, insufficiency fractures, and tears involving the articular cartilage/labrum in the setting of femoroacetabular impingement, a hip shape abnormality that is present in up to 90% of this age group. Undetected or left untreated these seemingly innocuous disorders can result in significant loss of function and, in some cases, irreversible joint damage. Despite sharing common predisposing factors, many of the above diagnoses can be identified with a focused history and physical examination. Conservative management may be safely initiated without advanced imaging, reserving orthopaedic consultation for refractory cases or more serious diagnoses. The presented focused hip clinical examination has 98% sensitivity in localizing intra-articular hip pathology and will be helpful to direct appropriate referrals. This article will serve as a guide for primary care physicians undertaking the difficult task of evaluating and treating a young patient with hip pain.
患有髋部关节炎前期疼痛的青少年及青年（年龄小于30岁）患者，给初级保健医生带来了诊断难题。最常见的潜在诊断范围从良性肌肉拉伤/关节扭伤到应力反应、不全骨折，以及在股骨髋臼撞击症（一种在该年龄组中高达90%的人存在的髋部形状异常）情况下涉及关节软骨/盂唇的撕裂。这些看似无害的病症若未被发现或未得到治疗，可能会导致严重的功能丧失，在某些情况下还会造成不可逆转的关节损伤。尽管有共同的易感因素，但通过详细的病史询问和体格检查，上述许多诊断都可以确定。在没有先进影像学检查的情况下，可以安全地开始保守治疗，对于难治性病例或更严重的诊断则安排骨科会诊。所介绍的髋部重点临床检查在定位髋关节内病变方面具有98%的敏感性，将有助于指导进行适当的转诊。本文将为承担评估和治疗髋部疼痛年轻患者这项艰巨任务的初级保健医生提供指导。
