小儿急性淋巴细胞性白血病是儿童期最常见的白血病。典型的白血病诊断不难,但当白血病浸润骨关节,临床首先以骨、关节疼痛为主要表现时,会给诊断带来困难而贻误治疗。今将我们见到的三例报告如下。例1 女,3岁,入院前3个月起右膝关节反复出现疼痛,初8～10天痛一次,以后逐渐发展为2～3天一次,每次持续时间半小时至数小时,自行缓解。关节始终无红、肿、热,但活动稍受限。病后按类风湿性关节炎治疗,用青霉素及阿斯匹林无效,转来我院,门诊拟类风湿病(单关节型)收住院。体查:体温36.8℃,皮肤、粘膜苍白,无出血点。颌下、右腋及腹股沟淋巴结如花全米大,质软,活动,无触痛。心肺听诊正常。肝肋下1.5cm,质软,无压痛。脾肋下未扪及。右膝关节无红、肿、热及压痛, Pediatric acute lymphoblastic leukemia is the most common leukemia in childhood. A typical diagnosis of leukemia is not difficult, but when leukemia infiltration of bone and joint, the first clinical bone, joint pain as the main performance, it will give the diagnosis of difficult and delaying treatment. The three cases we have seen so far are as follows. Case 1 female, 3 years old, 3 months before admission right knee recurring pain, the first 8 to 10 days a pain, and later gradually developed to 2 to 3 days time, each duration of half an hour to several hours, relieve itself . Joints are always red, swollen, hot, but activity is limited. After treatment by rheumatoid arthritis, with penicillin and aspirin invalid, transferred to our hospital, outpatient draining rheumatoid arthritis (single joint type) admitted to hospital. Physical examination: body temperature 36.8 ℃, skin, mucous membrane pale, no bleeding point. Submandibular, right axillary and inguinal lymph nodes such as large flowers, soft, activity, no tenderness. Cardiopulmonary auscultation normal. Liver ribs 1.5cm, soft, no tenderness. Spleen ribs not palpable. Right knee without redness, swelling, heat and tenderness,