Hollingworth P
Department of Rheumatology, Southmead Hospital, Westbury-on-Trym, Bristol.
Br J Rheumatol. 1995 Jan;34(1):78-82. doi: 10.1093/rheumatology/34.1.78.
Hip pain in children is always potentially serious. Different specialists see a different spectrum of hip diseases. Acute hip pain is usually referred to the surgeons, and the principal concern is to distinguish sepsis of the hip joint or pelvic bones from irritable hip: untreated sepsis can destroy the hip within days, but its presentation may be atypical or mild and investigations misleading. A reliable protocol for the management of acute hip pain in children is now available. Perthe's disease and slipped capital femoral epiphysis is usually evident on the initial radiograph. Hip disorders with a subacute or chronic presentation are usually referred to the paediatrician or rheumatologist. If examination shows restriction of hip movement or there are radiographic abnormalities, many will have a serious disorder requiring long-term management. The diagnosis is often apparent on the initial radiographs, although special imaging techniques may be needed. In a monoarticular presentation of juvenile arthritis, the hip radiograph will be normal but the diagnosis evident from other clinical features or blood investigations. Recognition of non-organic syndromes presenting with hip pain requires the exclusion of organic causes and an alertness to the incongruity of the physical signs.
儿童髋关节疼痛总是具有潜在的严重性。不同专科医生所见到的髋关节疾病范围有所不同。急性髋关节疼痛通常会转诊给外科医生，主要关注点在于区分髋关节或骨盆骨的败血症与易激惹髋关节：未经治疗的败血症可在数天内破坏髋关节，但其表现可能不典型或轻微，检查结果也可能具有误导性。现在已有一套可靠的儿童急性髋关节疼痛管理方案。佩特兹病和股骨头骨骺滑脱通常在初次X线片上即可明显显示。表现为亚急性或慢性的髋关节疾病通常会转诊给儿科医生或风湿病学家。如果检查显示髋关节活动受限或存在影像学异常，许多患者会患有需要长期治疗的严重疾病。虽然可能需要特殊的成像技术，但诊断通常在初次X线片上就很明显。在幼年型关节炎的单关节表现中，髋关节X线片可能正常，但可从其他临床特征或血液检查中明确诊断。识别表现为髋关节疼痛的非器质性综合征需要排除器质性病因，并警惕体征的不一致性。
