Sinha Rishi, Ellis Henry B, Podeszwa David A, Sucato Daniel J, Morris William Z
Scottish Rite for Children, Dallas, TX, USA.
University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Pediatr Soc North Am. 2024 Apr 6;7:100043. doi: 10.1016/j.jposna.2024.100043. eCollection 2024 May.
The history and physical exam are crucial components of the initial assessment of hip pain in adolescents and young adults to identify the cause of the pain, distinguish between common causes of early degeneration such as femoroacetabular impingement (FAI) and acetabular dysplasia (instability), and guide further workup and management. Different aspects of the history and exam are specific to various common causes of hip pain in this patient population. The purpose of this review is to synthesize these components to provide a comprehensive approach to the history and physical exam for adolescents and young adults presenting with hip pain.
(1)Common signs that suggest a mechanical hip problem, but are not specific for the etiology, include symptoms that worsen with activity, discomfort in a seated position, pain on rising from a seated position, or difficulty with ascending or descending stairs.(2)A Trendelenburg gait is caused by insufficient abductors that are unable to maintain a level pelvis and is commonly associated with hip instability due to the biomechanical disadvantage of the dysplastic hip joint.(3)Obligate external rotation of the hip during hip flexion is concerning for slipped capital femoral epiphysis (SCFE) and warrants an AP pelvis and frog leg lateral view for evaluation.(4)The Prone Apprehension Relocation Test (PART) assesses for anterior undercoverage of the acetabulum, and a positive test has been found to be correlated with radiographic markers of instability.
病史和体格检查是青少年和年轻成年人髋部疼痛初始评估的关键组成部分，用于确定疼痛原因，区分早期退变的常见原因，如股骨髋臼撞击症（FAI）和髋臼发育不良（不稳定），并指导进一步的检查和治疗。病史和检查的不同方面对于该患者群体髋部疼痛的各种常见原因具有特异性。本综述的目的是综合这些组成部分，为出现髋部疼痛的青少年和年轻成年人提供全面的病史和体格检查方法。
（1）提示机械性髋部问题但对病因不具特异性的常见体征包括活动时症状加重、坐位不适、从坐位起身时疼痛或上下楼梯困难。（2）臀中肌步态是由外展肌无力导致无法维持骨盆水平引起的，通常与发育不良髋关节的生物力学劣势导致的髋部不稳定有关。（3）髋关节屈曲时髋关节必然出现的外旋提示股骨头骨骺滑脱（SCFE），需要拍摄骨盆前后位和蛙式侧位片进行评估。（4）俯卧位恐惧复位试验（PART）用于评估髋臼前方覆盖不足，发现阳性试验与不稳定的影像学标志物相关。
