Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO.
Department of Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO.
J Pediatr. 2019 Mar;206:184-189.e1. doi: 10.1016/j.jpeds.2018.10.050. Epub 2018 Nov 16.
To prospectively characterize pain locations in slipped capital femoral epiphysis (SCFE) and evaluate pain locations as predictors of a delay in diagnosis.
This was an institutional review board approved prospective study of 110 children who underwent surgery for SCFE at a tertiary children's hospital between 2009 and 2015. Standardized pain diagrams were completed by 107 children. Pain zones were designated via a composite diagram. Hips without hip pain were categorized as atypical; hips with hip pain were typical.
In total, 122 hips were eligible for pain zone analysis. Seventy hips (57.4%) had hip pain. Atypical pain was present in 52 hips (42.6%), which included groin pain in 17 hips (13.9%), thigh/leg pain in 43 (35.2%), knee pain in 32 (26.2%), and posterolateral pain of the hip and leg in 13 (10.7%). A combination of pain zones was present in 48 hips (39.3%). Forty-nine percent of patients had more than 1 visit until diagnosis. The three most common pain locations for typical hips were hip, hip/thigh, and hip/knee pain (77.2% of typical hips). The 3 most common pain locations for atypical hips were isolated thigh, knee, and groin (65.4% of atypical hips). The least common pain presentations had a longer duration of symptoms (P = .04) and more healthcare visits before diagnosis (P = .04).
A combination of pain locations is common in SCFE. Less frequent pain presentations may delay diagnosis. Delays in diagnosis continue despite education efforts.
前瞻性描述股骨颈滑脱（SCFE）的疼痛部位，并评估疼痛部位作为诊断延迟的预测因素。
这是一项在 2009 年至 2015 年间在一家三级儿童医院接受 SCFE 手术的 110 名儿童的机构审查委员会批准的前瞻性研究。107 名儿童完成了标准化疼痛图。疼痛区通过组合图指定。无髋关节疼痛的髋关节被归类为非典型；有髋关节疼痛的髋关节为典型。
共有 122 个髋关节有资格进行疼痛区分析。70 个髋关节（57.4%）有髋关节疼痛。52 个髋关节（42.6%）存在非典型疼痛，其中包括 17 个髋关节（13.9%）腹股沟疼痛、43 个髋关节（35.2%）大腿/腿部疼痛、32 个髋关节（26.2%）膝关节疼痛和 13 个髋关节（10.7%）和下肢后外侧疼痛。48 个髋关节（39.3%）存在疼痛区的组合。49%的患者在诊断前需要就诊超过 1 次。典型髋关节最常见的三个疼痛部位是髋关节、髋关节/大腿和髋关节/膝关节疼痛（77.2%的典型髋关节）。非典型髋关节最常见的三个疼痛部位是孤立的大腿、膝盖和腹股沟（65.4%的非典型髋关节）。症状持续时间最长（P=0.04）和诊断前就诊次数最多（P=0.04）的疼痛表现最少。
SCFE 中常见疼痛部位的组合。较少见的疼痛表现可能会延迟诊断。尽管进行了教育，但诊断延迟仍在继续。
