不明原因股骨头骨骺分离的识别和处理：病例报告

摘要(中文译文)

股骨头骨骺滑脱（SCFE）是指股骨近端骨骺通过骨骺板在股骨颈上发生滑移。该病通常见于青春期生长突增期的男性肥胖患者，有时可伴有内分泌疾病。尽管其在儿科人群中发病率较高，但诊断常被延误，从而导致预后显著恶化。我们报告一例因一系列混杂因素导致诊断延误的SCFE病例。患者为一名16岁男孩，因持续跛行数月来到我院风湿病中心就诊。此前为排除骨科、感染性或炎症性疾病所进行的检查 apparently 未发现明显异常，因此被转诊进行风湿病学评估。经进一步检查，发现SCFE，并采用改良Dunn手术进行手术治疗。此外，在评估过程中还发现了胰岛素抵抗和青春期延迟等内分泌疾病。本病例表明，即使存在提示性的病史和临床表现，像SCFE这样的常见诊断仍可能被延误。该诊断的延误与患者临床病情恶化及需要更侵入性治疗相关。因此，对于开始出现跛行或下肢疼痛（即使定位不清）的青春期男孩，应始终考虑SCFE，尤其是因为通过骨盆X线片可快速作出诊断。此外，始终重要的是要记住，像SCFE这样的疾病可能伴有内分泌合并症。

Abstract

Slipped capital femoral epiphysis (SCFE) is the slippage of the proximal femoral epiphysis on the femoral neck through the epiphyseal plate. This condition is generally observed in male, obese patients during pubertal growth spurts, and it can sometimes be associated with endocrine disorders. Despite its significant incidence in the paediatric population, the diagnosis is frequently delayed which leads to significant worsening of the prognosis. We present a case of SCFE in which the diagnosis was delayed due to a series of confounding factors. We present a case of a 16-year-old boy who came to our rheumatology centre due to persistent limp for several months. Previous investigations aimed to exclude orthopaedic, infectious or inflammatory conditions, apparently revealed nothing significant, so he was referred for a rheumatological evaluation. Upon further investigation, a SCFE was identified and treated surgically with the modified Dunn procedure. Additionally, during the evaluation, endocrinological conditions such as insulin resistance and delayed puberty were discovered. This case shows that, even in the presence of a suggestive medical history and clinical picture, a common diagnosis such as SCFE can be delayed. The delay in this diagnosis is correlated with clinical worsening of the patient and the need for more invasive management. Therefore, SCFE should always be considered in an adolescent boy who starts experiencing a limp or pain in the lower limbs, even if poorly localized, especially because the diagnosis can be quickly made with a pelvic x-ray. Furthermore, it is always important to remember that conditions such as SCFE, can be associated with endocrinological comorbidities.

如何引用

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