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成人肌肉骨骼性胸痛的主要病因

Author
Christopher M Wise, MD
Section Editor
Don L Goldenberg, MD
Deputy Editor
Paul L Romain, MD

引言

胸痛初始诊断性评估的重点通常为可能危及生命的心脏和肺部问题，但累及胸壁肌肉骨骼结构的问题也属于胸痛最常见的原因，尤其是常被称为非典型或非心源性胸痛的胸部不适感(表 1)。此外，累及胸廓内和胸廓周围结构并且可能引起胸痛的疾病还包括食管、上腹部和头颈部疾病。对于存在这些问题的患者，早期识别出引发胸痛的肌肉骨骼综合征是对疼痛进行有效特异性治疗的关键[1-6]。

本专题将总结肌肉骨骼性胸痛的主要病因。如何对这类患者进行评估和治疗将单独讨论。 (参见“儿童和青少年非创伤性胸痛的原因”和“儿童胸痛的认识”)

其他将单独详细总结的内容包括：在急诊科中胸痛的评估，胸痛诊断和鉴别诊断的一般方法，以及儿童和青少年非创伤性胸痛的病因、评估和处理。 (参见“成人胸痛的诊断方法”和“急诊科胸痛的评估”和“肌肉骨骼性胸痛的临床评估”和“肌肉骨骼性胸痛的治疗”)

患病率

胸痛患者中有肌肉骨骼方面原因者所占比例根据临床环境而有差异，在急诊科中高达1/4，在非急诊性门诊诊所中占1/3以上。胸壁压痛较常见，但按压胸壁并非总能再现主诉症状，这类压痛甚至偶尔可见于心源性胸痛患者。

●急诊科–在急诊科，成人胸痛中肌肉骨骼性胸痛的发生率估计为10%-50%，具体取决于临床环境和研究设计[7-13]。例如：

                            

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Literature review current through: 2017-06 . | This topic last updated: 2015-10-17.
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References
Top
  1. Habib PA, Huang GS, Mendiola JA, Yu JS. Anterior chest pain: musculoskeletal considerations. Emerg Radiol 2004; 11:37.
  2. Freeston J, Karim Z, Lindsay K, Gough A. Can early diagnosis and management of costochondritis reduce acute chest pain admissions? J Rheumatol 2004; 31:2269.
  3. Eslick GD. Classification, natural history, epidemiology, and risk factors of noncardiac chest pain. Dis Mon 2008; 54:593.
  4. Stochkendahl MJ, Christensen HW. Chest pain in focal musculoskeletal disorders. Med Clin North Am 2010; 94:259.
  5. Yelland M, Cayley WE Jr, Vach W. An algorithm for the diagnosis and management of chest pain in primary care. Med Clin North Am 2010; 94:349.
  6. Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician 2009; 80:617.
  7. Cilia C, Malatino LS, Puccia G, et al. The prevalence of the cardiac origin of chest pain: the experience of a rural area of southeast Italy. Intern Emerg Med 2010; 5:427.
  8. Disla E, Rhim HR, Reddy A, et al. Costochondritis. A prospective analysis in an emergency department setting. Arch Intern Med 1994; 154:2466.
  9. Spalding L, Reay E, Kelly C. Cause and outcome of atypical chest pain in patients admitted to hospital. J R Soc Med 2003; 96:122.
  10. How J, Volz G, Doe S, et al. The causes of musculoskeletal chest pain in patients admitted to hospital with suspected myocardial infarction. Eur J Intern Med 2005; 16:432.
  11. Cunningham R, Walton MA, Weber JE, et al. One-year medical outcomes and emergency department recidivism after emergency department observation for cocaine-associated chest pain. Ann Emerg Med 2009; 53:310.
  12. Karlson BW, Herlitz J, Pettersson P, et al. Patients admitted to the emergency room with symptoms indicative of acute myocardial infarction. J Intern Med 1991; 230:251.
  13. Roche T, Gardner G, Lewis P. Retrospective observational study of patients who present to Australian rural emergency departments with undifferentiated chest pain. Aust J Rural Health 2014; 22:229.
  14. Klinkman MS, Stevens D, Gorenflo DW. Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network. J Fam Pract 1994; 38:345.
  15. Verdon F, Herzig L, Burnand B, et al. Chest pain in daily practice: occurrence, causes and management. Swiss Med Wkly 2008; 138:340.
  16. Bösner S, Becker A, Hani MA, et al. Chest wall syndrome in primary care patients with chest pain: presentation, associated features and diagnosis. Fam Pract 2010; 27:363.
  17. Brunse MH, Stochkendahl MJ, Vach W, et al. Examination of musculoskeletal chest pain - an inter-observer reliability study. Man Ther 2010; 15:167.
  18. Wolf E, Stern S. Costosternal syndrome: its frequency and importance in differential diagnosis of coronary heart disease. Arch Intern Med 1976; 136:189.
  19. Bechgaard P. Segmental thoracic pain in patients admitted to a medical department and a coronary unit. Acta Med Scand Suppl 1981; 644:87.
  20. Wise CM, Semble EL, Dalton CB. Musculoskeletal chest wall syndromes in patients with noncardiac chest pain: a study of 100 patients. Arch Phys Med Rehabil 1992; 73:147.
  21. Gregory PL, Biswas AC, Batt ME. Musculoskeletal problems of the chest wall in athletes. Sports Med 2002; 32:235.
  22. Fam AG, Smythe HA. Musculoskeletal chest wall pain. CMAJ 1985; 133:379.
  23. Scott EM, Scott BB. Painful rib syndrome--a review of 76 cases. Gut 1993; 34:1006.
  24. Tietze, A. Uber eine eigneartige Haufund von Fallen mit Dystrophie der Rippenknorpel. Berlin Klin Wschr 1921; 58:829.
  25. Aeschlimann A, Kahn MF. Tietze's syndrome: a critical review. Clin Exp Rheumatol 1990; 8:407.
  26. LIPKIN M, FULTON LA, WOLFSON EA. The syndrome of the hypersensitive xiphoid. N Engl J Med 1955; 253:591.
  27. van Holsbeeck M, van Melkebeke J, Dequeker J, Pennes DR. Radiographic findings of spontaneous subluxation of the sternoclavicular joint. Clin Rheumatol 1992; 11:376.
  28. Briggs AM, Bragge P, Smith AJ, et al. Prevalence and associated factors for thoracic spine pain in the adult working population: a literature review. J Occup Health 2009; 51:177.
  29. Kuhne M, Boniquit N, Ghodadra N, et al. The snapping scapula: diagnosis and treatment. Arthroscopy 2009; 25:1298.
  30. Arroyo JF, Jolliet P, Junod AF. Costovertebral joint dysfunction: another misdiagnosed cause of atypical chest pain. Postgrad Med J 1992; 68:655.
  31. Almansa C, Wang B, Achem SR. Noncardiac chest pain and fibromyalgia. Med Clin North Am 2010; 94:275.
  32. Rodríguez-Henríquez P, Solano C, Peña A, et al. Sternoclavicular joint involvement in rheumatoid arthritis: clinical and ultrasound findings of a neglected joint. Arthritis Care Res (Hoboken) 2013; 65:1177.
  33. Ramonda R, Lorenzin M, Lo Nigro A, et al. Anterior chest wall involvement in early stages of spondyloarthritis: advanced diagnostic tools. J Rheumatol 2012; 39:1844.
  34. Wendling D, Prati C, Demattei C, et al. Anterior chest wall pain in recent inflammatory back pain suggestive of spondyloarthritis. data from the DESIR cohort. J Rheumatol 2013; 40:1148.
  35. Jurik AG. Seronegative anterior chest wall syndromes. A study of the findings and course at radiography. Acta Radiol Suppl 1992; 381:1.
  36. Guglielmi G, Cascavilla A, Scalzo G, et al. Imaging of sternocostoclavicular joint in spondyloarthropaties and other rheumatic conditions. Clin Exp Rheumatol 2009; 27:402.
  37. Saghafi M, Henderson MJ, Buchanan WW. Sternocostoclavicular hyperostosis. Semin Arthritis Rheum 1993; 22:215.
  38. Magrey M, Khan MA. New insights into synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Curr Rheumatol Rep 2009; 11:329.
  39. Colina M, Govoni M, Orzincolo C, Trotta F. Clinical and radiologic evolution of synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: a single center study of a cohort of 71 subjects. Arthritis Rheum 2009; 61:813.
  40. Carneiro S, Sampaio-Barros PD. SAPHO syndrome. Rheum Dis Clin North Am 2013; 39:401.
  41. Benhamou CL, Chamot AM, Kahn MF. Synovitis-acne-pustulosis hyperostosis-osteomyelitis syndrome (SAPHO). A new syndrome among the spondyloarthropathies? Clin Exp Rheumatol 1988; 6:109.
  42. Ferguson PJ, Sandu M. Current understanding of the pathogenesis and management of chronic recurrent multifocal osteomyelitis. Curr Rheumatol Rep 2012; 14:130.
  43. Richette P, Molto A, Viguier M, et al. Hidradenitis suppurativa associated with spondyloarthritis -- results from a multicenter national prospective study. J Rheumatol 2014; 41:490.
  44. Aljuhani F, Tournadre A, Tatar Z, et al. The SAPHO syndrome: a single-center study of 41 adult patients. J Rheumatol 2015; 42:329.
  45. Jurik AG. Anterior chest wall involvement in patients with pustulosis palmoplantaris. Skeletal Radiol 1990; 19:271.
  46. Earwaker JW, Cotten A. SAPHO: syndrome or concept? Imaging findings. Skeletal Radiol 2003; 32:311.
  47. Sallés M, Olivé A, Perez-Andres R, et al. The SAPHO syndrome: a clinical and imaging study. Clin Rheumatol 2011; 30:245.
  48. Vittecoq O, Said LA, Michot C, et al. Evolution of chronic recurrent multifocal osteitis toward spondylarthropathy over the long term. Arthritis Rheum 2000; 43:109.
  49. Kotilainen P, Merilahti-Palo R, Lehtonen OP, et al. Propionibacterium acnes isolated from sternal osteitis in a patient with SAPHO syndrome. J Rheumatol 1996; 23:1302.
  50. Hurtado-Nedelec M, Chollet-Martin S, Nicaise-Roland P, et al. Characterization of the immune response in the synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome. Rheumatology (Oxford) 2008; 47:1160.
  51. Govoni M, Colina M, Massara A, Trotta F. "SAPHO syndrome and infections". Autoimmun Rev 2009; 8:256.
  52. Stern SM, Ferguson PJ. Autoinflammatory bone diseases. Rheum Dis Clin North Am 2013; 39:735.
  53. Nguyen MT, Borchers A, Selmi C, et al. The SAPHO syndrome. Semin Arthritis Rheum 2012; 42:254.
  54. Naik HB, Cowen EW. Autoinflammatory pustular neutrophilic diseases. Dermatol Clin 2013; 31:405.
  55. Witt M, Meier J, Hammitzsch A, et al. Disease burden, disease manifestations and current treatment regimen of the SAPHO syndrome in Germany: results from a nationwide patient survey. Semin Arthritis Rheum 2014; 43:745.
  56. Wohlgethan JR, Newberg AH, Reed JI. The risk of abscess from sternoclavicular septic arthritis. J Rheumatol 1988; 15:1302.
  57. Ross JJ, Shamsuddin H. Sternoclavicular septic arthritis: review of 180 cases. Medicine (Baltimore) 2004; 83:139.
  58. Pollack MS. Staphylococcal mediastinitis due to sternoclavicular pyarthrosis: CT appearance. J Comput Assist Tomogr 1990; 14:924.
  59. Chopra R, Chaudhary N, Kay J. Relapsing polychondritis. Rheum Dis Clin North Am 2013; 39:263.
  60. Fam AG, Shuckett R, McGillivray DC, Little AH. Stress fractures in rheumatoid arthritis. J Rheumatol 1983; 10:722.
  61. Fortier M, Mayo JR, Swensen SJ, et al. MR imaging of chest wall lesions. Radiographics 1994; 14:597.
  62. Rucknagel DL, Kalinyak KA, Gelfand MJ. Rib infarcts and acute chest syndrome in sickle cell diseases. Lancet 1991; 337:831.
  63. Serjeant GR, Ceulaer CD, Lethbridge R, et al. The painful crisis of homozygous sickle cell disease: clinical features. Br J Haematol 1994; 87:586.