University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Am Fam Physician. 2023 May;107(5):474-485.
A limp is a deviation from normal gait pattern, with pain as the presenting feature in about 80% of cases. The differential diagnosis is broad and includes congenital/developmental, infectious, inflammatory, traumatic (including nonaccidental), and, less commonly, neoplastic etiologies. Transient synovitis of the hip is the cause of a limp in the absence of trauma in 80% to 85% of children. It can be differentiated from septic arthritis of the hip by the absence of fever or ill-appearance and with laboratory testing that shows normal or only mildly elevated inflammatory markers and white blood cell count. If septic arthritis is suspected, joint aspiration should be performed urgently with ultrasound guidance and the aspirated fluid sent for Gram staining, culture, and cell count. Patient history, such as breech presentation at birth, and a leg-length discrepancy on physical examination may suggest developmental dysplasia of the hip. Pain reported primarily at night can occur with neoplasms. Hip pain in an adolescent who is overweight or has obesity may suggest slipped capital femoral epiphysis. Knee pain in an active adolescent may suggest Osgood-Schlatter disease. Radiography shows the degenerative femoral head changes in Legg-Calvé-Perthes disease. Abnormalities in bone marrow shown on magnetic resonance imaging indicate septic arthritis. A complete blood count with differential, erythrocyte sedimentation rate, and C-reactive protein should be obtained if infection or malignancy is suspected.
跛行是一种步态模式的偏离，约 80%的病例以疼痛为主要表现。鉴别诊断范围广泛，包括先天性/发育性、感染性、炎症性、外伤性（包括非外伤性）和较少见的肿瘤性病因。80%至 85%的儿童在无创伤的情况下出现跛行，其病因是一过性髋关节滑膜炎。通过无发热或不适外观以及实验室检查显示正常或仅轻度升高的炎症标志物和白细胞计数，可以将其与髋关节化脓性关节炎区分开来。如果怀疑化脓性关节炎，应在超声引导下紧急进行关节抽吸，并将抽出的液体送去进行革兰氏染色、培养和细胞计数。患者病史，如出生时臀位，以及体格检查时的下肢长度差异，可能提示髋关节发育不良。主要在夜间出现的疼痛可能与肿瘤有关。超重或肥胖的青少年髋关节疼痛可能提示股骨颈滑脱。活动过度的青少年膝关节疼痛可能提示 Osgood-Schlatter 病。放射摄影显示出 Legg-Calvé-Perthes 病中退行性股骨头变化。磁共振成像上骨髓的异常表明存在化脓性关节炎。如果怀疑感染或恶性肿瘤，应进行全血细胞计数、分类计数、红细胞沉降率和 C 反应蛋白检查。
