Schoolmeesters Bram J A, van den Hout Joost A A M, Joosten A J P, Terra Maaike P, Elmans-Reuvers Miranda J C M, van Bergen Christiaan J A
Amphia Ziekenhuis, Afd. Kinderorthopedie, Breda.
Contact: B.J.A. Schoolmeesters (
Ned Tijdschr Geneeskd. 2019 Oct 24;163:D3786.
A limping gait pattern in a child is a red flag for every physician until proven otherwise. Among the most common causes are coxitis fugax, infection (septic arthritis, osteomyelitis), Perthes disease, and slipped capital femoral epiphysis, depending on the age of the patient. A high index of suspicion is required because clinical findings are often subtle, and the diagnosis may be present even if initial radiographs are negative. A missed or delayed diagnosis may have devastating consequences. Therefore, this paper describes the main characteristics of different causes of a limping child, based on four typical cases. Tools are provided to recognize each diagnosis. Early referral to a paediatric orthopaedic surgeon is recommended.
对每位医生来说,儿童跛行步态都是一个危险信号,除非能排除其他病因。根据患者年龄,最常见的病因包括暂时性滑膜炎、感染(化脓性关节炎、骨髓炎)、佩吉特氏病和股骨头骨骺滑脱。由于临床表现往往不明显,即使最初的X光片呈阴性也可能存在诊断情况,因此需要高度怀疑。漏诊或误诊可能会带来灾难性后果。所以,本文基于四个典型病例描述了儿童跛行不同病因的主要特征。提供了用于识别每种诊断的方法。建议尽早转诊至小儿骨科医生处。