UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

成人髋痛的评估

Author
Bruce C Anderson, MD
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

引言

髋痛是一种常见症状，可能导致该症状的原因有很多[1]。一项针对6596例60岁及60岁以上成人的调查发现，14.3%的成人报告在过去6周的多数时间中出现过严重的髋痛[2]。

转子滑囊炎、臀中肌滑囊炎、骨关节炎以及股骨骨折均是最为常见的累及髋部的疾病。可以通过疼痛的特征及部位、诱发疼痛的运动和姿势，以及对步行的影响将累及软组织的病变与累及髋关节和相邻骨骼的疾病相区分。

本专题将提供对髋痛患者进行评估的一般方法。有关髋部具体疾病诊断和治疗的更深入讨论参见其他专题。儿童髋痛的诊断方法将在别处讨论。 (参见“儿童期髋痛概述”)

解剖学

髋关节是由圆形的股骨头和髋臼咬合而成。后者是由髂骨、坐骨及耻骨共同构成的。髋关节是一个通过骨盆带相对固定于身体的球窝关节。由于这种相对的固定性，髋部或骨盆的原发性病变可导致腰椎或膝的症状，而腰椎或膝的原发性病变则可能引起髋部的继发性病变[3]。

股骨颈长约8-10cm。股骨颈有两处骨性突起，分别为外侧的大转子和内侧的小转子。大转子是髋部外展肌(臀中肌和臀小肌)和外旋肌的附着部位。髋部的主要伸肌为臀大肌和腘绳肌；前者附着于股骨近端，恰好处于大转子远端。小转子是主要的髋屈肌(即髂腰肌)附着部位。

                                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2016-06-24.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Anderson BC. Office Orthopedics for Primary Care: Diagnosis and Treatment, 2nd ed, WB Saunders, Philadelphia 1999.
  2. Christmas C, Crespo CJ, Franckowiak SC, et al. How common is hip pain among older adults? Results from the Third National Health and Nutrition Examination Survey. J Fam Pract 2002; 51:345.
  3. Steinberg GG, Seybold EA. Hip and pelvis. In: Orthopaedics in Primary Care, 3rd, Steinberg GG, Akins CM, Baran DT. (Eds), Lippincott Williams and Wilkins, Baltimore 1999.
  4. Swezey RL, Spiegel TM. Evaluation and treatment of local musculoskeletal disorders in elderly patients. Geriatrics 1979; 34:56.
  5. Altman R, Alarcón G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 1991; 34:505.
  6. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 1995; 77:459.
  7. Zizic TM, Marcoux C, Hungerford DS, Stevens MB. The early diagnosis of ischemic necrosis of bone. Arthritis Rheum 1986; 29:1177.
  8. LaPorte DM, Mont MA, Mohan V, et al. Multifocal osteonecrosis. J Rheumatol 1998; 25:1968.
  9. Moder KG, Hunder GG. Examination. In: Textbook of Rheumatology, 5th, Kelly WN, Harris ED, Ruddy S, et al. (Eds), WB Saunders, Philadelphia 1997. p.364.
  10. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA 1992; 268:760.
  11. Cardinal E, Chhem RK, Beauregard CG. Ultrasound-guided interventional procedures in the musculoskeletal system. Radiol Clin North Am 1998; 36:597.