University of New Mexico, Albuquerque, NM, USA.
Am Fam Physician. 2021 Jan 15;103(2):81-89.
Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located anteriorly, laterally, or posteriorly. Anterior hip pain includes referred pain from intra-abdominal or intrapelvic causes; extra-articular etiologies, such as hip flexor injuries; and intra-articular etiologies. Intra-articular pain is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults. Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction. Posterior hip pain includes referred pain such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy. In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. Radiography of the hip and pelvis should be the initial imaging test. Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain. Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes.
成年人常因髋部疼痛就诊于家庭医生，明确病因对于制定有效治疗方案非常重要。髋部疼痛通常位于前方、外侧或后方。前方髋部疼痛包括来自腹腔或盆腔内的牵涉痛；髋关节外病因，如髋屈肌损伤；以及髋关节内病因。髋关节内疼痛常由年轻人的盂唇撕裂或股骨髋臼撞击症或老年人的骨关节炎引起。外侧髋部疼痛最常见于大转子疼痛综合征，包括臀中肌肌腱病或撕裂、滑囊炎和阔筋膜张肌摩擦。后方髋部疼痛包括来自腰椎病变的牵涉痛、坐骨神经卡压的深部臀肌综合征、闭孔上缘撞击和腘绳肌腱病。除了病史和体格检查外，可能需要进行放射摄影、超声或磁共振成像以明确诊断。髋关节和骨盆的放射摄影应作为初始影像学检查。超声引导下麻醉注射有助于诊断关节内疼痛的原因。由于股骨髋臼撞击症、盂唇撕裂和臀中肌肌腱撕裂通常具有良好的手术效果，因此先进的影像学检查和/或早期转诊可能会改善患者的预后。
