小孩跛行之探討

Evaluation of a Child with Limp

沈慶源(Chin-Yuan Shen)

《北市醫學雜誌》 1卷2期 (2004/04) Pp. 134-141

https://doi.org/10.6200/TCMJ.2004.1.2.03

摘要

小孩跛行不但是骨科門診常見的疾患，對骨科醫師而言也是診斷上很大的挑戰。小孩跛行的原因很多，從單純無害的不當支架到嚴重的惡性疾病都有可能。小孩步態受許多因素的影響。如疼痛、肌肉無力、異常的肌肉活動、骨骼及關節的異常、下肢長短不一都會影響。不同的病理狀況產生的跛行特徵也有所不同。所以仔細的觀察步態對小孩跛行的診斷幫助很大。小孩跛行絕不是一種正常的情形，需要盡可能的找出確實的原因。完整病史及周全的理學檢查是找出跛行原因最有助益的工具。臨床醫師應該對這類病患做有順序及系統性的檢查以找出跛行的原因。實驗室檢查、影像學檢查應該取決於病史及理學檢查之後的結果而定。持續性的症狀則提醒臨床醫師應做更進一步的追查。小孩跛行須要做鑑別診跛行須要做鑑別診斷的病因範圍很廣，包括許多下肢與脊椎的病變，如創傷、感染、炎性症病、先天及發育異常、以及腫瘤。一般而言這些病因在不同的年齡層也有所不司，所以年齡層去考慮可能的病因，可以縮小臨醫師所需考慮的範圍以及更有效的去應對診斷上的挑戰。

關鍵字

跛行 ； 步態 ； 肢體疼痛性 ； 站立期 ； 擺盪期

並列摘要

Limp in childhood is a common problem and a serious challenge for orthopedists. The differential diagnosis is wide ranged from benign conitions (e.g., improper bracing )to serious ones (e.g., septic arthritis or malignancy). The conditions generally vary with the patient’s age and include pathologies of the lower extremity and spien, such as truam, infection, inflammation, neoplasia, and developmental and congenital disorders. Numerous factors, such as pain, wkakened muscles, abmoral muscle activity, bone and joint abnormalities , and limb-length discrepancy can affect a child
‘s pattern of gait. Because pathologic states can produce different characterisitic limps, careful observation of a child’s gait is extremely helpful in identifying the cause. Limping is never normal in childhood, and the cause should be established as accurately as possible. Complete history taking and thorough physical exzamination ate the most helpful tools in differentiating the causes, and the findings can direct subsequent laboratory and imaging studies.And persistent symptoms warrant further investigation.A systemic and orderly approach enabeles tehe orthopedist to narrow the differential diagnosis and more defectively address the identificed cause. (Full text in Chinese)

並列關鍵字

limp ； gait antalgic gait ； stance phase ； swing phase