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目的探讨儿童先天性无痛症并发骨关节病理损害的发病机制、临床诊断及外科治疗。方法本组6例患儿以不同程度的骨关节病理损害而入院。年龄3～12岁。股骨远端、胫骨近端各2例,髋关节、足部各1例。其中3例在入院前误诊为骨肉瘤。本组患儿根据病史、临床表现及X线表现确诊。治疗主要采用局部制动及抗炎治疗,同时指导家长做好护理。结果6例患儿均随访2～6个月。2例患儿出院后因看护不当而过早下床,关节损害加重,甚至出现局部感染、关节脱位。另外4例患儿经石膏制动至少观察2个月,关节损害处均有不同程度修复。结论明确先天性无痛症并骨关节病理损害诊断是关键,只要耐心仔细询问病史,认真观察和分析患儿的临床表现及X线表现,是不难作出正确诊断的。
Objective To investigate the pathogenesis, clinical diagnosis and surgical treatment of congenital and painless children complicated with pathological damage of bone and joint. Methods Six children in this group were admitted to the hospital with varying degrees of bone and joint pathology. Age 3 to 12 years old. Distal femur, proximal tibia in 2 cases, hip, foot in 1 case. Three of them were misdiagnosed as osteosarcoma before admission. This group of children diagnosed based on medical history, clinical manifestations and X-ray findings. Treatment mainly uses local braking and anti-inflammatory treatment, at the same time to guide parents to be well nurse. Results 6 cases of children were followed up for 2 to 6 months. 2 patients discharged due to improper care and get out of bed prematurely, joint damage worse, and even local infection, joint dislocation. The other 4 cases of gypsum brake observed at least 2 months, joint damage at different levels of repair. Conclusions A clear diagnosis of congenital painless and bone and joint pathological damage diagnosis is the key, as long as the patience carefully asked history, careful observation and analysis of children with clinical manifestations and X-ray findings is not difficult to make a correct diagnosis.