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背痛儿童的评估

Author
Peter A Nigrovic, MD
Section Editors
Jan E Drutz, MD
Robert Sundel, MD
William Phillips, MD
Deputy Editor
Mary M Torchia, MD
Translators
关海山, 副主任医师

引言

背痛是儿童中一个不太常见的主诉。虽然其病因通常为良性，但有时也会发现严重的先天性或获得性疾病。对于后者而言，感染性、风湿性和肿瘤性疾病最有可能引发严重问题(表 1)。

本文将总结背痛儿童的评估。儿童和青少年背痛的病因将单独讨论。 (参见“Back pain in children and adolescents: Causes”)

流行病学

虽然患者很少去儿科诊所就诊，但是暂时性背痛是儿童中比较常见的现象，特别是在青春期早期之后[1-6]。一项纳入超过5000例儿童和年轻成人的大型斯堪的纳维亚人调查发现，7%的12岁儿童至少经历过1次腰痛发作，到18岁(女性)和20岁(男性)时，腰痛的累积发病率上升至50%[7](图 1)。研究发现其时点患病率约为：12岁时1%，15岁时5%，20出头时上升至10%(图 2)。大多数背痛儿童都有轻微的非致残性症状，且没有就医。已发现的相关因素包括女性、看电视的时间较长、情感量表负面得分较高及存在背痛家族史[8,9]。

一项贫民区的病例系列研究发现，在儿科急诊室就诊的所有患者中，背痛患者比例不到0.4%[10]。几乎90%的患儿在就诊时的症状持续时间都不到4周。所有年龄组中有约半数的背痛发作是由肌肉骨骼创伤造成，而其余原因包括感染[例如，泌尿道感染(urinary tract infection, UTI)或病毒性疾病](9%)]、特发性疼痛(13%)、镰状细胞疼痛危象(13%)及各种各样的原因(6%)。初级保健机构及一些专科诊所发现，书包过重可能引起儿童背痛，但不是所有的前瞻性研究都确定了这一关联[11-13]。

持续或逐渐恶化的背痛需引起重视。在一项病例系列研究中，61例因背痛而就诊于骨科诊所的儿童中有32例存在严重基础病变，包括9例感染或肿瘤[14]。一个肌肉骨骼疾病转诊组发现的严重基础病变发生率较低，其在265例背痛儿童中发现0例感染和4例肿瘤(良性或恶性)，不过部分患有这些疾病的儿童可能已在初级保健医生处得到诊断，因此没有转诊[15]。在由初级保健医生接诊的迁延性背痛儿童中，目前尚无数据表明诊断的分布情况。但是，一项关于11-14岁学龄儿童的调查发现，有25%的儿童在初步评估时存在背痛，其中多达1/4在1年和4年后的再次评估中仍有疼痛，这表明没有严重器质性病变者也会出现持续疼痛[5]。实际上，在该病例系列研究中，持续性疼痛的预测因素包括同伴问题、身材矮小以及存在延伸至背部外的疼痛。

              

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-01.
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