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儿童跛行的诊断方法

Author
Mark C Clark, MD, FAAEM, FAAP, FACEP
Section Editors
Gary R Fleisher, MD
Jan E Drutz, MD
William Phillips, MD
Deputy Editor
James F Wiley, II, MD, MPH
Translators
陈峰, 主治医师

引言

跛行是一种偏斜、不平稳或费力的步态，常由疼痛、肌无力或畸形造成[1]。跛行是儿童期的常见症状，在一间儿科急诊室中，每1000例就诊中有4例跛行[2]。良性病因或危及生命的疾病均可引起跛行(表 1)；治疗方法取决于病因，从解释安抚到需行大手术不等[2,3]。

跛行的原因常可通过详细的病史询问和体格检查确定。此类患者通常需要放射影像学检查来确定临床怀疑，但极少需要进行诊断性操作。虽然大多数跛行都是由创伤或良性自限性疾病引起，但必须迅速诊断出危及生命或危及肢体功能的疾病(表 2) [4,5]。

本文将总结跛行儿童的评估。儿童跛行的具体原因将在其他专题中概述。 (参见“儿童跛行的病因概述”)

流行病学

在急诊科或初级医疗保健诊所中，轻微创伤是跛行的主要病因。而观察性研究在就诊于三级医疗中心或骨科诊所且无明确外伤史的儿童中发现，病因往往是严重感染性疾病，如骨髓炎或化脓性关节炎[2,3,6,7]。一项前瞻性研究评估了243例因跛行而就诊于儿科急诊的14岁以下儿童，患者均无创伤史，结果如下[4]：

●男孩多于女孩，比例接近2:1。

                                

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-17.
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