摘要
[目的]先天性婴儿型髋内翻象髋脱位一样可有臀纹不对称、下肢缩短、Allis征阳性等体征.X线片显示髋关节内侧间隙增宽,股骨近端上移,股骨颈干角不易测量,容易误诊为小儿先天性髋关节脱位.本文旨在分析探讨先天性婴儿型髋内翻误诊为先天性髋关节脱位的原因.[方法]作者在为54例73髋先天性髋脱位患儿实施诊疗中,由于体格、影像检查时的疏忽,导致6例6髋先天性婴儿型髋内翻误诊为髋脱位,并按照髋脱位进行保守治疗.因治疗效果欠佳,经再次认真体格检查、仔细阅读影像资料、注重保守治疗效果等综合分析之后,发现该6例6髋患儿确系先天性婴儿型髋内翻,而非髋关节脱位.[结果]总结出先天性婴儿型髋内翻有如下特点：股骨大转子肥大上移;股骨颈短宽低平;髋关节内侧间隙增宽;股骨颈与股骨小转子重叠;髋臼指数基本正常;Shenton线连续性尚好;股骨头骺角增大;股骨头骨化中心出现晚,发育差.多合并短股骨、股骨弯曲、锁颅骨发育不全、马蹄足等畸形.[结论]股骨头二次骨化中心在出生后6～9个月时才出现,此前判断其是髋脱位或是髋内翻,确实困难.只有正确了解婴儿型髋内翻的临床与X线表现特征,才能正确早期诊断先天性婴儿型髋内翻,避免误诊误治.
[ Objective] To analyze reason of congenital infantile coxa vara to be misdiagnosed as infantile dislocation of hip joint. [ Method] There were 6 patients （6 hip join） congenital infantile coxa vara being misdiagnosed as infantile dislocation of hip join in 54 patients （73 hip join） and treated by expectant treatment as infantile dislocation of hip join. The curative effect of 6 patients were not good, after serious medical examination, careful reading image data, paying attention to curative effect, 6 patients were confirmed to be diagnosed as infantile dislocation of hip join and not infantile dislocation of hip join. [ Result] The features for diagaosis of congenital infantile coxa vara were： the big greater trochanter of femur and its position moving up, short spacious neck of femur, spacious medial blank in hip joint, superposed neck of femur and lesser trochanter of femur, praeter propter exponent of acetabulum, acceptable succession of Shenton＇s line, enlarged angle of femoral head epiphysis, late center of ossification, incorporated abnormity such as breves femoral bone, bowing of femoral bone, abortive clavicle and bones of cranium, equines. [ Conclusion] The second center of ossification of femoral head is appeared 6 -9 monthes after birth, and it is difficult to discriminate congenital infantile coxa vara and infantile dislocation of hip join before this. Early to realize symptom, physical sign and character of image of congenital infantile coxa vara is significant for correct diagnosis and can avoid misdiagnosis and mistreatment.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2007年第13期976-978,共3页
Orthopedic Journal of China
关键词
婴儿
先天性
髋关节
髋内翻
髋脱位
infant
congenital
hip joint
coxa vara
dislocation of hip joint
