The Deformed Hip

髖部畸形

1.1 Introduction 

The spectrum of malformations of the hip in the newborn is wide and ranges from a minor degree of acetabular dysplasia to major deficiency like proximal focal femoral deficiency. Developmental dysplasia of the hip (DDH) is the commonest of hip anomalies; early diagnosis and treatment often results in a satisfactory outcome, while a delay may make treatment more complicated and the outcome less predictable. Some abnormaliies of the hip may not be evident on cursory examination since the hip is a deep-seated joint unlike the knee where minor deformities are easily recognized. The important questions that need to be answered while trying to make a diagnosis of the nature and cause of congenital anomalies of the hip in the newborn are listed below. 

新生兒髖關(guān)節(jié)畸形的范圍很廣,，從輕微的髖臼發(fā)育不良到嚴(yán)重的缺損，如股骨近端局灶性髖臼缺損,。髖關(guān)節(jié)發(fā)育不良（DDH）是最常見(jiàn)的髖關(guān)節(jié)異常,；早期診斷和治療往往會(huì)導(dǎo)致令人滿意的結(jié)果，而延遲可能會(huì)使治療更加復(fù)雜,，結(jié)果難以預(yù)測(cè),。髖關(guān)節(jié)的一些異常在粗略的檢查中可能不明顯，因?yàn)轶y關(guān)節(jié)是一種深層關(guān)節(jié),，不像膝關(guān)節(jié),，輕微的畸形很容易被識(shí)別。在試圖診斷新生兒先天性臀部異常的性質(zhì)和原因時(shí),，需要回答的重要問(wèn)題如下,。

1.2 Questions to Establish a Diagnosis 

Was the baby premature or full term? 

Hip dysplasia is more frequent in full-term infants and it is infrequent in premature babies . 

Is the baby the first born? 

Developmental dysplasia of the hip is more common in first-born babies. 

Is there a history of breech presentation? 

There is a strong association between developmental dysplasia of the hip and breech presentation. 

Is there a family history of hip dysplasia? 

A positive family history may be present in developmental dysplasia of the hip. 

Is there a history of reduced fetal movements during pregnancy? 

Reduced fetal movement during pregnancy (akinesia) is often reported in arthrogryposis. 

Is there a history of maternal illness or substance abuse? 

Ingestion of drugs or maternal illness early in pregnancy can predispose the infant to signifi cant congenital malformations and syndromes. 

Are the joints of the limbs hypermobile or are they stiff? 

Stiff joints are encountered in arthrogryposis while hypermobile joints are seen in Larsen syndrome; in both these conditions, the hip may be dislocated. 

Are there other musculoskeletal deformities? 

Metatarsus adductus and congenital muscular torticollis are often associated with hip dysplasia. Symmetrical joint contractures and dislocations are often associated with arthrogryposis, Larsen syndrome, and myelomeningocele. Infantile scoliosis is often associated with the windswept hip deformity. 

Is there pseudoparalysis or pain with hip examination? 

Neonatal proximal femoral physeal fractures can occur in diffi cult deliveries. 

1.2確定診斷的問(wèn)題 

**這個(gè)嬰兒是早產(chǎn)兒還是足月的？

髖關(guān)節(jié)發(fā)育不良在足月嬰兒中更常見(jiàn),，在早產(chǎn)兒中更少見(jiàn),。

**這個(gè)嬰兒是第一個(gè)孩子嗎？

髖關(guān)節(jié)發(fā)育不良在出生嬰兒中更常見(jiàn),。

**有臀位表現(xiàn)的歷史嗎,？

髖關(guān)節(jié)發(fā)育不良與臀位表現(xiàn)之間有很強(qiáng)的相關(guān)性。

**是否有髖關(guān)節(jié)發(fā)育不良的家族病史,？

髖關(guān)節(jié)發(fā)育發(fā)育不良可能存在陽(yáng)性家族史,。

**妊娠期間是否有胎兒運(yùn)動(dòng)減少的歷史？

妊娠期間胎兒運(yùn)動(dòng)減少（運(yùn)動(dòng)障礙）常在關(guān)節(jié)攣縮中被報(bào)道,。

**是否有母親疾病史或藥物濫用史,？

在懷孕早期攝入藥物或母親的疾病可使嬰兒易患嚴(yán)重的先天性畸形和綜合征。

**是四肢的關(guān)節(jié)活動(dòng)過(guò)度還是僵硬,？

關(guān)節(jié)攣縮時(shí)出現(xiàn)僵硬關(guān)節(jié)，而Larsen綜合征出現(xiàn)關(guān)節(jié)過(guò)度活動(dòng),；在這兩種情況下,，髖關(guān)節(jié)都可能脫位。 

**還有其他的肌肉骨骼畸形嗎,？

跖骨內(nèi)收肌和先天性肌弓肌常與髖關(guān)節(jié)發(fā)育不良有關(guān),。對(duì)稱性關(guān)節(jié)攣縮和脫位常與關(guān)節(jié)攣縮、拉爾森綜合征和脊髓脊膜膨出有關(guān),。嬰兒脊柱側(cè)彎常與風(fēng)掠髖關(guān)節(jié)畸形有關(guān),。

**髖關(guān)節(jié)檢查是否有假性麻痹或疼痛？

新生兒股骨近端骨骺骨折可發(fā)生在分娩困難時(shí),。

1.3 Physical Examination 

體格檢查

1.3.1 Look 

Observe if the normal groin crease is present or lost. Note if the gluteal creases are symmetric. Look for deformities of the hip in the sagittal, coronal, and transverse planes. Observe if one limb is short with shortening of the femoral segment (Galeazzi sign). Note if the leg is also short. Look for spontaneous movement of the lower limbs and note if movements are reduced or absent. 

觀察正常的腹股溝皺褶是否存在或丟失,。注意,，如果臀肌皺褶是對(duì)稱的。觀察髖關(guān)節(jié)矢狀面,、冠狀面和橫切面的畸形,。觀察一個(gè)肢體是否短，股骨段縮短（Galeazzi征）,。如果腿也很短,。注意觀察下肢的自主運(yùn)動(dòng)，并注意運(yùn)動(dòng)是否減少或缺失,。

1.3.2 Feel 

Palpate the femoral triangle and see if the normal resistance offered by the femoral head is present. Palpate the femoral pulse and note if the vascular sign of Narath is positive. Palpate the trochanter and see if the normal relationship to the anterior superior iliac spine is maintained. 

觸摸股骨三角,，看看是否存在股骨頭提供的正常阻力。觸摸股骨脈搏,，并注意Narath的血管征象是否為陽(yáng)性,。觸摸大轉(zhuǎn)子，看看是否保持與髂前上棘的正常關(guān)系,。

1.3.3 Move 

Abduct both hips with the hips and knees held in 90° of fl exion, and observe if there is any limitation of abduction (normally in the new born, the thighs may almost touch the couch). Check the ranges of internal and external rotation of the hips. 

髖部和膝關(guān)節(jié)保持在90°的外展中,，觀察是否有外展的限制（通常在新生兒中，大腿幾乎可以接觸到沙發(fā)）,。檢查髖關(guān)節(jié)內(nèi)外旋的范圍,。

1.3.4 Special Tests 

Tests for Neonatal Hip Instability: The Barlow and Ortolani Tests 

The Ortolani test indicates a reduction of a dislocated hip. The Barlow test indicates a dislocation of a reduced hip. These tests should be performed with the baby relaxed and warm and without a diaper (Fig. 1.1 ). 

The Ortolani test is performed with the hip flexed and adducted, and then with the examiner’s fi ngers gently resting on the greater trochanter and slight traction, the hip is gently abducted. Specifi cally for the left hip, the right hand gently holds the left thigh with the middle/ring finger resting on the greater trochanter and the thumb on the medial thigh. The left hand stabilizes the opposite hip. Then with gentle abduction and slight traction, the examiner will feel a clunk as the femoral head reduces into the acetabulum. The opposite positioning of the hands is used on the right hip. Each hip is tested individually. 

The Barlow test is performed with the hip flexed and abducted; similar positioning of the hand is used as in the Ortolani test. Then the thigh is gently moved into an adducted position with gentle posterior pressure. The examiner will feel the femoral head exit the posterior aspect of the acetabulum. 

新生兒髖關(guān)節(jié)不穩(wěn)定試驗(yàn)：Barlow試驗(yàn)和Ortolani試驗(yàn)

Ortolani試驗(yàn)表明髖關(guān)節(jié)脫位復(fù)位。Barlow試驗(yàn)顯示髖關(guān)節(jié)脫位,。這些測(cè)試應(yīng)在嬰兒放松,、溫暖、不穿尿布的情況下進(jìn)行（圖1.1）,。 測(cè)試是通過(guò)髖關(guān)節(jié)屈曲和內(nèi)收進(jìn)行的,，然后用檢查者的手指輕輕放在大轉(zhuǎn)子上，輕微牽引,，髖關(guān)節(jié)輕輕外展,。特別是左髖關(guān)節(jié)，右手輕輕握住左大腿,，中環(huán)指放在大轉(zhuǎn)子上,，拇指放在大腿內(nèi)側(cè)。左手穩(wěn)定對(duì)著髖關(guān)節(jié),。然后通過(guò)溫和的外展和輕微的牽引,，當(dāng)股骨頭進(jìn)入髖臼時(shí)，檢查者會(huì)感到叮當(dāng)聲,。手的相反位置用于右髖關(guān)節(jié),。對(duì)每個(gè)髖關(guān)節(jié)進(jìn)行單獨(dú)測(cè)試。 Barlow試驗(yàn)采用髖關(guān)節(jié)屈曲和外展時(shí)進(jìn)行；手的位置與Ortolani試驗(yàn)相似,。然后用輕輕的后壓輕輕移動(dòng)大腿到內(nèi)收位置,。檢查者會(huì)感覺(jué)到股骨頭從髖臼后部脫出。

Thigh of the infant is held with the thumb on the medial aspect of the thigh and the index and middle fingers on the trochanter

用拇指握在嬰兒的大腿內(nèi)側(cè),，食指和中指放在大轉(zhuǎn)子上

1.4 Investigations to Confirm the Diagnosis 

1.4研究確認(rèn)診斷

1.4.1 Radiography

 1.4.1放射學(xué)

Plain radiographs of the pelvis are not indicated in the newborn; the hip is highly cartilaginous and thus diffi cult to interpret. Between birth and age 4 months, ultrasound is the imaging method of choice. After 4 months of age, plain radiographs are used. DDH can range from simple acetabular dysplasia to frank high-riding dislocation. T?nnis describes 4 classes of hip dysplasia. Grade 0 is a normal hip; grade 1 is where the ossifi cation center of the capital femoral epiphysis is medial to Perkin’s line; grade 2 the ossifi cation center is lateral to Perkin’s line but below the superolateral margin of the acetabulum; grade 3 the ossifi cation center is at the level of the superolateral margin of the acetabulum; and grade 4 the ossifi cation center is above the superolateral margin of the acetabulum . 

新生兒骨盆平片不顯示,；髖關(guān)節(jié)軟骨高度難以詮釋。出生至4個(gè)月時(shí),，選擇超聲影像學(xué)方法,。4個(gè)月大以后，使用X線平片,。DDH可以從單純的髖臼發(fā)育不良到明顯的高位脫位,。T?nnis描述了4級(jí)髖關(guān)節(jié)發(fā)育不良。0級(jí)為正常髖關(guān)節(jié),；1級(jí)為股骨骨中心位于Perkin線的內(nèi)側(cè),；2級(jí)骨中心位于Perkin線外側(cè)但位于髖臼上外側(cè)邊緣下方；3級(jí)骨中心位于髖臼上外側(cè)邊緣,；4級(jí)骨中心位于髖臼上外側(cè)邊緣上方,。

1.4.2 Ultrasound 

1.4.2 超聲

Ultrasound of the hip is very useful to assist in the diagnosis of hip dysplasia as well as monitoring treatment. There are two methods (Weintroub and Grill 2000 ) commonly used: the static method of Graf ( 1984 ) and the dynamic method of Harcke ( 1995 , 2005 ). The method of Graf assesses the morphology of the hip using angular measurement (α and β angles) and the percentage of femoral head coverage (Fig. 1.2 ). The dynamic method of Harcke assesses the stability of the hip with the Ortolani and Barlow maneuvers. 

髖關(guān)節(jié)超聲對(duì)輔助診斷髖關(guān)節(jié)發(fā)育不良和監(jiān)測(cè)治療是非常有用的。有兩種方法（Weintroub和Grill2000）：Graf的靜態(tài)方法（1984）和Harcke的動(dòng)態(tài)方法（1995,2005）,。Graf的方法采用角度測(cè)量（α和β角）和股骨頭覆蓋度的百分比（圖1.2）來(lái)評(píng)估髖關(guān)節(jié)的形態(tài),。哈克的動(dòng)態(tài)方法評(píng)估 使用Ortolani和Barlow動(dòng)作的髖關(guān)節(jié)穩(wěn)定性。

 Fig. 1.2 Hip ultrasounds in DDH. ( a ) A representative longitudinal ultrasound image of a normal neonatal hip. The ilium is marked by the solid black arrow , the bony acetabular roof by the white arrow , the abductor muscles by the white asterisk , and the femoral head by the white circle . ( b ) Measurement of the alpha (α) and beta (β) angles on ultrasound establish the Graf class. The baseline is fi rst drawn and is the line along the ilium as it intersects the bony and cartilaginous portions of the acetabulum (line 1, solid yellow line ). Line 2 ( solid white line ) is from the acetabular edge to the triradiate cartilage; line 3 ( dashed white line ) is from the acetabular edge to the lateral cartilaginous roof. The α angle is the angle between the baseline line 2; the β angle is the angle between the baseline line 3. A normal α angle is > 60°. ( c ) The percentage of femoral coverage is calculated as (d/D) × 100. D is the entire diameter of the femoral head and d is the portion covered by the bony acetabular roof. In this example, the percentage of femoral coverage is 65%. ( d ) A complete hip dislocation; note there is no contact between the femoral head and the acetabulum. ( e ) Mild acetabular dysplasia in an infant born breech. The α Graf angle is 51 ( a ) degrees and the femoral head coverage is 42.9 % ( b )

圖 1.2 DDH 中的髖關(guān)節(jié)超聲,。（ a ）正常新生兒髖關(guān)節(jié)的代表性縱向超聲圖像,。髂骨以黑色實(shí)心箭頭為標(biāo)志，骨髖臼頂以白色箭頭為標(biāo)志,，外展肌以白色星號(hào)為標(biāo)志,，股骨頭以白色圓圈為標(biāo)志。（ b ）超聲測(cè)量α角（α）和β角（β）建立了 Graf 等級(jí),?；€是首先繪制的，是沿髂骨與髖臼的骨和軟骨部分相交的線（線 1,，黃色實(shí)線）,。線2（白色實(shí)線）是從髖臼邊緣到三放射軟骨;線3（白色虛線）是從髖臼邊緣到外側(cè)軟骨頂。α角是基線線 2 之間的角度;β角是基線線 3 之間的角度,。法α角為 > 60°。（c） 股骨覆蓋率的計(jì)算方法是 （d/D） × 100,。D是股骨頭的整個(gè)直徑,，d是骨髖臼頂覆蓋的部分。在此示例中,，股骨覆蓋率為 65%,。（ d ） 完全髖關(guān)節(jié)脫位;注意股骨頭和髖臼之間沒(méi)有接觸,。（ e ） 嬰兒出生后臀位的輕度髖臼發(fā)育不良。α格拉夫角為51（a）度,，股骨頭覆蓋率為42.9%（b）

1.5 Differential Diagnosis 

1.5鑒別診斷

1.5.1 Developmental Dysplasia of the Hip 

1.5.1髖關(guān)節(jié)發(fā)育不良

Neonatal Hip Instability 

This is diagnosed by a positive Barlow sign or feeling some subluxation without complete dislocation. A complete dislocation may or may not be reducible with the Ortolani maneuver. Dynamic and static ultrasound will confirm the diagnosis. 

新生兒髖關(guān)節(jié)不穩(wěn)定

通過(guò)Barlow陽(yáng)性征或感覺(jué)一些半脫位而沒(méi)有完全脫位得出診斷,。完全脫位可以使用Ortolani復(fù)位，或不能復(fù)位,。動(dòng)態(tài)超聲和靜態(tài)超聲將會(huì)合并診斷,。

Acetabular Dysplasia with or Without Instability 

This is simply a shallow acetabulum. If there is no instability, no abnormality will be felt upon the Barlow maneuver. It can be diagnosed only with either ultrasound (where the α angle will be less than normal) or by a plain radiograph (where the acetabular index will be higher than normal) . 

髖臼發(fā)育不良，伴有或不伴有不穩(wěn)定

這只是一個(gè)淺的髖臼,。如果沒(méi)有不穩(wěn)定,，在Barlow試驗(yàn)上就不會(huì)感覺(jué)到異常。它只能通過(guò)使用超聲波（α角小于正常值）或x線平片診斷出來(lái)（髖臼指數(shù)高于正常值）,。

1.5.2 Teratogenic Hip Dislocation 

1.5.2致畸性髖關(guān)節(jié)脫位

Hip Dislocation in Arthrogryposis 

髖關(guān)節(jié)攣縮癥患者的髖關(guān)節(jié)脫位

The hip is frequently involved in children with arthrogryposis and can range from a mild contracture to complete dislocation. Physical examination often demonstrates a flexion and adduction contracture of the hip. When there is a dislocation, it is usually very rigid and high riding such that the Ortolani sign is negative; ultrasound will clearly demonstrate the dislocation in the newborn; plain radiography will also demonstrate the dislocation (Fig. 1.3 ). 

髖關(guān)節(jié)常發(fā)生于兒童關(guān)節(jié)攣縮中,，可從輕度攣縮到完全脫位。體格檢查經(jīng)常顯示髖關(guān)節(jié)外伸和內(nèi)收攣縮,。當(dāng)出現(xiàn)脫位時(shí),，它通常是非常堅(jiān)硬和高騎術(shù)，因此Ortolani征為陰性,；超聲可以清楚地顯示新生兒的脫位,；平片也會(huì)顯示脫位（圖1.3 )。

Hip Dislocation in Spina Bifida

脊柱裂髖關(guān)節(jié)脫位

Children with spina bifida often either are born with a hip dislocation or develop it later in life . They are often associated with flexion and adduction contractures. Those born with a hip dislocation have the teratologic type. In children with higher levels of spina bifida, the hip adductors and flexors are strong while the hip abductors and extensors are weak (e.g. L3 and L4); this can lead to a dislocation (Fig. 1.4 ). 

患有脊柱裂的兒童通常在出生時(shí)伴有髖關(guān)節(jié)脫位,，要么在以后的生活中發(fā)展,。它們通常與屈曲和內(nèi)收攣縮有關(guān)。先天性髖關(guān)節(jié)脫位的人屬于畸形類型,。在脊柱裂兒童中有較高的發(fā)病率,，髖關(guān)節(jié)內(nèi)收肌和屈肌較強(qiáng)，而髖關(guān)節(jié)外展肌和伸肌較弱（例如 L3 和 L4）;這可能導(dǎo)致脫位（圖 1.4）,。

Hip Dislocation in Skeletal Dysplasias and Generalized Syndromes 

One form of skeletal dysplasia that is associated with congenital hip and knee dislocation is spondyloepiphyseal dysplasia with congenital joint dislocation . In addition to the dislocations, short stature and progressive kyphosis are characteristic features of the condition. The dysplasia is caused by a CHST3 mutation. Larsen syndrome is a constellation of multiple joint dislocations (hip, elbow, knee), severe foot deformities , and dysmorphic facies. It can often be diagnosed prenatally with ultrasound . Congenital dislocation of the knee commonly occurs in association with Larsen syndrome .

骨骼發(fā)育不良和全身綜合征中的髖關(guān)節(jié)脫位

與先天性髖關(guān)節(jié)和膝關(guān)節(jié)脫位相關(guān)的一種骨骼發(fā)育不良形式是伴有先天性關(guān)節(jié)脫位的脊柱骨骺發(fā)育不良,。除脫位外，身材矮小和進(jìn)行性脊柱后凸是該病的特征,。異型增生是由 CHST3 突變引起的,。Larsen綜合征是多發(fā)關(guān)節(jié)脫位（髖關(guān)節(jié)、肘關(guān)節(jié),、膝關(guān)節(jié)）,、嚴(yán)重足部畸形和畸形面容的一系列癥狀。它通?？梢酝ㄟ^(guò)超聲波在產(chǎn)前診斷,。先天性膝關(guān)節(jié)脫位通常與 Larsen 綜合征有關(guān)。

1.5.3 Congenital Coxa Vara 

Congenital coxa vara is defined as a neck-shaft angle of the proximal femur less than normal. It is also associated with a classic inferior metaphyseal triangular fragment. It is frequently unilateral and often associated with a short femur. Physical examination will not demonstrate any instability, but there will be decreased internal rotation of the hip, and in the severe case with a significantly short femur, there will be a positive Galeazzi sign. It is often not diagnosed until the infant begins to walk, at which point a Trendelenburg limp is noted. Radiographs demonstrate the reduced neck-shaft angle, a more vertical proximal femoral physis, inferior displacement of the epiphysis, and the triangular inferior metaphyseal fragment (Fig. 1.5 ).

1.5.3 先天性髖內(nèi)翻

先天性髖骨內(nèi)翻定義為股骨近端的頸干角小于正常值。它還與經(jīng)典的下干骺端三角形碎片有關(guān),。它通常是單側(cè)的,，通常與股骨短有關(guān)。體格檢查不會(huì)顯示任何不穩(wěn)定,，但髖關(guān)節(jié)內(nèi)旋會(huì)減少,，在股骨明顯短的嚴(yán)重情況下，會(huì)出現(xiàn)陽(yáng)性的Galeazzi征,。通常直到嬰兒開始走路時(shí)才被診斷出來(lái),，此時(shí)注意到Trendelenburg跛行。X線片顯示頸干角減小,，股骨近端骨骺更垂直,，骨骺下移位，三角形下干骺端碎片（圖1.5）,。

1.5.4 Proximal Focal Femoral Deficiency 

Proximal femoral focal deficiency (PFFD) is part of the wide spectrum of congenital femoral deformity which can range from congenital coxa vara and congenital short femur to almost complete absence of the femur. There are numerous different classifi cation systems. Clinically the thigh is shorter than the opposite side (unless bilateral) and with the hip and knee in fl exion. There is often associated external rotation of the thigh. Ortolani and Barlow tests are negative. Plain radiographs will confi rm the diagnosis. 

1.5.4 股骨近端局灶性缺陷

股骨近端局灶性缺陷 （PFFD） 是先天性股骨畸形廣譜的一部分,，其范圍從先天性股骨內(nèi)翻和先天性股骨短到幾乎完全沒(méi)有股骨。有許多不同的分類系統(tǒng),。臨床上,，大腿比另一側(cè)短（除非是雙側(cè)），并且髖關(guān)節(jié)和膝關(guān)節(jié)呈外傾狀態(tài),。通常伴有大腿外旋,。Ortolani 和 Barlow 試驗(yàn)呈陰性。X線平片可以診斷,。

1.5.5 Rare Conditions 

The Hip in Exstrophy of the Bladder 

Due to widening of the symphysis in children with bladder/cloacal exstrophy, the hips are externally rotated and acetabular retroversion (Fig. 1.6 ). This will lead to an increased external rotation gait when the child becomes of walking age.

1.5.5 罕見(jiàn)情況

膀胱外翻中的髖關(guān)節(jié)由于膀胱/泄殖腔外翻患兒的聯(lián)合擴(kuò)大,，髖關(guān)節(jié)外旋和髖臼后傾（圖 1.6）。當(dāng)孩子達(dá)到行走年齡時(shí),，這將導(dǎo)致外旋步態(tài)增加,。 

Hip Dysplasia Associated with Abduction Contracture of the Contralateral Hip 

Hip dysplasia can be seen in children with an abduction contracture. The dysplastic hip is the one opposite the side of the contracture. Physical examination will demonstrate asymmetric gluteal folds and an apparent leg length discrepancy . 

與對(duì)側(cè)髖關(guān)節(jié)外展攣縮相關(guān)的髖關(guān)節(jié)發(fā)育不良

髖關(guān)節(jié)發(fā)育不良可見(jiàn)于外展攣縮的兒童。發(fā)育不良的髖關(guān)節(jié)是攣縮側(cè)對(duì)面的髖關(guān)節(jié),。體格檢查將顯示不對(duì)稱的臀部褶皺和明顯的腿長(zhǎng)差異,。

Neonatal Proximal Femoral Physeal Fracture 

A new born can sustain such a fracture during birth; the limb will be held in a position of external rotation and pseudoparalysis will be present . Radiographs will demonstrate proximal and lateral migration of the proximal femoral metaphysis, mimicking a dislocation. Ultrasonography will demonstrate the presence of the proximal femoral epiphysis in the acetabulum. 

新生兒股骨近端骨骺骨折

新生兒在出生時(shí)可能會(huì)遭受這種骨折;肢體將保持在外旋位置，并且會(huì)出現(xiàn)假性癱瘓,。X 線片將顯示股骨近端干骺端的近端和側(cè)向遷移,，類似于脫位。超聲檢查將顯示髖臼中存在股骨近端骨骺,。

Septic Conditions 

Septic arthritis of the hip in the infant with or without concomitant osteomyelitis and iliopsoas abscess will result in a position of fl exion and often abduction of the involved hip. The infant will be very irritable but may or may not be febrile. The hip will demonstrate marked irritability with passive motion, and a pseudoparalysis is often present. Appropriate imaging using ultrasound and MRI will point to the diagnosis. 

膿毒癥狀況

伴或不伴有骨髓炎和髂腰肌膿腫的嬰兒髖關(guān)節(jié)化膿性關(guān)節(jié)炎將導(dǎo)致髖關(guān)節(jié)外脫和經(jīng)常外展,。嬰兒會(huì)非常煩躁，但可能會(huì)發(fā)熱,，也可能沒(méi)有發(fā)熱,。髖關(guān)節(jié)在被動(dòng)運(yùn)動(dòng)時(shí)會(huì)表現(xiàn)出明顯的易激惹,，并且經(jīng)常出現(xiàn)假性麻痹。使用超聲和 MRI 進(jìn)行適當(dāng)?shù)挠跋駥W(xué)檢查將提示診斷,。

1.6 Establishing the Diagnosis 

 An outline of the approach to establishing a diagnosis is shown in Table 1.1

1.6建立診斷建立診斷方法的概述見(jiàn)表1.1。

Table 1.1 Establishing the diagnosis of the cause of a malformed hip in the newborn

表1.1確定新生兒髖關(guān)節(jié)畸形原因的診斷