摘要
目的 探讨儿童化脓性髋关节炎的误诊原因及防范措施。方法 回顾性分析我院2015年1月—2018年1月收治的误诊为其他疾病的儿童化脓性髋关节炎4例的临床资料。结果 本组均因患侧下肢不愿负重或跛行来我院就诊,其中伴有发热、髋关节周围压痛各3例;4例患侧髋关节伸直活动受限,下肢末梢循环及感觉均无明显异常;2例“滚木试验”阳性。本组误诊时间2~7d,平均4.3d,其中3例误诊为髋关节一过性滑膜炎,1例误诊为髋关节扭伤,均予相应处理症状未见好转。为进一步诊治,3例行髋关节MRI,1例复查X线及行髋关节穿刺,均确诊为化脓性髋关节炎。1例予以保守治疗后症状好转;3例行髋关节切开引流术,术后予抗感染治疗后好转出院。随访12个月,3例关节功能恢复良好,1例出现患侧髋关节病理性脱位,行手术治疗后好转。结论 儿童化脓性髋关节炎早期缺乏特异性表现,提示临床医生加强相关知识的学习、及时行髋关节MRI等检查是减少或避免误诊误治的关键。
Objective To investigate causes of misdiagnosis of septic arthritis of the hip in children and to provide preventive measures. Methods Clinical data of four patients with septic arthritis of the hip misdiagnosed as other diseases who were admitted to our hospital between January 2015 to January 2018 were analyzed retrospectively. Results In this group, all patients presented to our department for inability to bear weight on the affected limb or limp, of whom 3 patients got fever and 3 had tenderness around the hip joint. In 4 cases, hip-joint extension was limited, and peripheral circulation and sensation of the lower limbs were normal. Rollingwood Test results were positive. The duration of misdiagnosis was 2-7 d, with a mean duration of 4.3 d. Three patients were misdiagnosed as transient synovitis of the hip, and one patient was misdiagnosed as hip sprain. No improvement was observed after symptomatic treatment. For further diagnosis and treatment, MRI scanning of the hip confirmed septic arthritis in three patients, and X-ray examination and aspiration of the hip joint confirmed septic arthritis in one patient. One patient underwent conservative treatment and the symptoms were improved. Three patients underwent hip incision and drainage, and then were discharged after anti-infective treatment. After one-year follow-up, three patients got favorable prognosis, and one patient got a pathological dislocation of the hip, but recovered after a surgical intervention. Conclusion Due to lack of specific manifestations in early stage of septic arthritis of the hip in children, clinicians should develop relevant knowledge and perform timely MRI scan of the hip joint, which are the key to reducing or avoiding misdiagnosis and mistreatment.
作者
李论
潘辰
LI Lun;PAN Chen(Department of Orthopedics, Kunming Children's Hospital, Kunming 650000, China;Department of Ultrasonography, Kunming Children's Hospital, Kunming 650000, China)
出处
《临床误诊误治》
2019年第9期11-13,共3页
Clinical Misdiagnosis & Mistherapy
关键词
骨关节炎
髋
化脓
误诊
滑膜炎
儿童
Osteoarthritis, hip
Suppuration
Misdiagnosis
Synovitis
Child
