大龄儿童钳夹型股骨髋臼撞击征误诊分析(附7例报告)  

Analysis of misdiagnosed pincer femoracetabular impingement in elder children:a report of seven cases

作　　者：修承祥 王庆 刘帅 Xiu Chengxiang;Wang Qing;Liu Shuai(Department of Radiology,Wuxi Ninth Hospital,Wuxi 214062,China;Department of Pediatric Orthopedics,Wuxi Ninth Hospital,Wuxi 214062,China)

机构地区：[1]无锡市第九人民医院影像医学科,无锡214062 [2]无锡市第九人民医院小儿骨科,无锡214062

出　　处：《中华小儿外科杂志》2025年第2期150-157,共8页Chinese Journal of Pediatric Surgery

基　　金：无锡市"太湖人才计划"顶尖医学团队课题(编号:WXTTP-2020-06)。

摘　　要：目的探讨钳夹型股骨髋臼撞击征(femoracetabular impingement,FAI)误诊原因及诊断方法。方法回顾分析2020年4月至2022年3月被误诊为其他疾病但在无锡市第九人民医院小儿骨科被确诊为钳夹型FAI的7例患儿的临床资料,其中男5例(9髋),女2例(3髋);右侧2例,双侧5例;患儿年龄为(14±2)岁,年龄范围是12~18岁。7例患儿均进行专科体格检查明确典型症状和体征,行骨盆正位X线片观察髋臼交叉征和坐骨棘征,应用3DCT动态后处理技术观察"撞击"的发生和股髋重叠征。结果7例患儿存在腹股沟区基础性疼痛者4例(5髋),存在腹股沟区压痛者5例(7髋),屈髋内旋受限者6例(8髋),屈髋内旋诱发腹股沟区疼痛者3例(3髋),屈髋内旋使腹股沟区基础性疼痛加重者3例(3髋)。摄骨盆正位X线片,髋臼交叉征(+)7例(11髋),坐骨棘征(+)6例(11髋)。行3DCT动态后处理,7例(12髋)"股髋重叠征"均(+)。结论对临床症状、体征的认识不足是导致临床误诊的重要原因,腹股沟区疼痛或屈髋内旋受限是FAI的典型症状,3DCT动态后处理技术可进行影像解剖学诊断,X线片上髋臼交叉征和坐骨棘征(+)可作为间接诊断依据。ObjectiveTo study the reasons for misdiagnoses and the diagnostic methods of pincer femoracetabular impingement(FAI)in elder children at 12-18 years.MethodsSeven elder children diagnosed as pincer FAI in the Department of Pediatric Orthopedics of Wuxi Ninth Hospital while misdiagnosed as other disease previously from April 2020 to March 2022 were analyzed retrospectively.There were 5 boys(9 hips)and 2 girls(3 hips).Right-sided lesions were detected in 2 cases,and bilateral lesions were found in 5 cases.The average age was 14±2(12-18)years.Physical examination was performed to find out the typical symptoms and signs.Radiological examination of pelvis in anterior-posterior position was used to observe the sign of crossed acetabulum and sciatic spine.Dynamic reprocessing of three-dimensional computed tomography(3DCT)was applied to verify the impingement and observe the overlapped sign of femur and acetabulum.ResultsAmong the 7 children,4 children(5 hips)had pain and 5 children(7 hips)had tenderness in their groins.When the hip was in flexion and internal rotation,activity limitations were observed in 6 cases(8 hips),the pain was elicited in the groin in 3 cases(3 hips)and the pain from the groin was aggravate in 3 cases(3 hips).The sign of crossed acetabulum was observed 7 cases(11 hips)and the sign of sciatic spine in 6 cases(11 hips)in the radiograph of pelvis.The overlapped sign of femur and acetabulum was observed in all the 7 cases(12 hips)on dynamic reprocessing of 3DCT.ConclusionsInsufficient recognition to the clinical symptoms and signs of FAI are the dominant reasons of misdiagnosis.Pain in groin or limited activity of hip in flexion and internal rotation is the typical manifestation of FAI.The dynamic reprocessing of 3DCT can be applied for imaging anatomy diagnose if possible.The signs of crossed acetabulum and of sciatic spine in radiograph are indirect proofs for diagnosing FAI.

关 键 词：股骨髋臼撞击征 误诊 儿童 

分 类 号：R68[医药卫生—骨科学]