Bernstein Robert M, Cozen Harold
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Am Fam Physician. 2007 Dec 1;76(11):1669-76.
Back pain is fairly prevalent in healthy children and adolescents. When children or adolescents seek medical care for back pain, it is highly likely that underlying pathology will be identified. Common causes of back pain include nonspecific pain or muscle strain, herniated disk, spondylolysis, scoliosis, and Scheuermann's kyphosis. Less common causes include tumor, infection, and sickle cell crisis. If nonspecific back pain is suspected, treatment may include home-based exercise, physical therapy, or nonsteroidal anti-inflammatory drugs. If the history and physical examination suggest underlying pathology, radiography, complete blood count, erythrocyte sedimentation rate, and a C-reactive protein measurement should be performed. Follow-up magnetic resonance imaging, computed tomography, or bone scanning may be needed depending on the suspected cause. It is generally accepted that the following factors warrant immediate evaluation: patient age younger than four years, persistent symptoms, self-imposed activity limitations, systemic symptoms, increasing discomfort, persistent night-time pain, and neurologic symptoms.
背痛在健康儿童和青少年中相当普遍。当儿童或青少年因背痛寻求医疗护理时，很有可能发现潜在的病理状况。背痛的常见原因包括非特异性疼痛或肌肉拉伤、椎间盘突出、椎弓根峡部裂、脊柱侧弯和休门氏驼背。不太常见的原因包括肿瘤、感染和镰状细胞危象。如果怀疑是非特异性背痛，治疗可能包括家庭锻炼、物理治疗或非甾体抗炎药。如果病史和体格检查提示有潜在的病理状况，则应进行X光检查、全血细胞计数、红细胞沉降率和C反应蛋白测量。根据怀疑的病因，可能需要进行后续的磁共振成像、计算机断层扫描或骨扫描。一般认为，以下因素需要立即评估：患者年龄小于4岁、症状持续、自我限制活动、全身症状、不适加重、持续夜间疼痛和神经症状。
