儿童髋关节疼痛。
Hip Pain in Children.
机构信息
Department of Orthopedics and Trauma Surgery, University Hospital Cologne; Department of Pediatrics, University Hospital Cologne.
出版信息
Dtsch Arztebl Int. 2020 Jan 31;117(5):72-82. doi: 10.3238/arztebl.2020.0072.
BACKGROUND
Atraumatic hip pain in children is one of the most common symptoms with which pediatricians, orthopedists, and general practitioners are confronted, with an incidence of 148 cases per 100 000 persons per year.
METHODS
This article is based on publications up to April 2019 that were retrieved by a selective search in the PubMed data- base, including case reports and reviews.
RESULTS
Infants with fever often have purulent coxitis, which can be diagnosed by blood tests and ultrasonography. Toddlers and older children may suffer from painful restriction of motion of the hip joint, associated with limping (antalgic gait) or even the in- ability to walk. The main elements of the differential diagnosis in children aged 2-10 are coxitis fugax and idiopathic necrosis of the femoral head (Perthes disease). In children aged 10 and up, and in adolescents, slipped capital femoral epiphysis (SCFE) is typical. Bone tumors and rheumatic diseases must always be considered as well. The initial diagnostic steps on presentation of a child with restricted hip movement should be plain x-rays and joint ultrasonography for the detection of an effusion. Suspicion of a tumor is the main indication for tomographic imaging (computed tomography or magnetic resonance imaging).
CONCLUSION
The underlying cause of hip pain in children should be diagnosed early to avoid adverse sequelae.
背景
儿童髋关节无痛性疼痛是儿科医生、骨科医生和全科医生最常见的症状之一，发病率为每 10 万人每年 148 例。
方法
本文基于截至 2019 年 4 月的文献，通过在 PubMed 数据库中进行选择性搜索，包括病例报告和综述，检索到这些文献。
结果
发热的婴儿常患有化脓性髋关节炎，可通过血液检查和超声检查进行诊断。蹒跚学步的儿童和大龄儿童可能会出现髋关节疼痛性运动受限，伴有跛行（疼痛步态）甚至无法行走。2-10 岁儿童的主要鉴别诊断要素是一过性髋关节滑膜炎和特发性股骨头坏死（Perthes 病）。10 岁及以上儿童和青少年中，常见的是股骨头骨骺滑脱（SCFE）。骨肿瘤和风湿性疾病也必须始终考虑在内。对于髋关节运动受限的儿童，初次就诊时应进行平片和关节超声检查，以发现关节积液。怀疑肿瘤是进行断层成像（计算机断层扫描或磁共振成像）的主要指征。
结论
儿童髋关节疼痛的病因应尽早诊断，以避免不良后果。
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