Dizdarevic Ismar, Bishop Meghan, Sgromolo Nicole, Hammoud Sommer, Atanda Alfred
a 1 Mount Sinai Roosevelt Hospital Center , NY, USA.
b 2 Thomas Jefferson University , Philadelphia, PA, USA.
Phys Sportsmed. 2015 Nov;43(4):421-31. doi: 10.1080/00913847.2015.1093668. Epub 2015 Oct 29.
Back pain in a pediatric patient can present a worrisome and challenging diagnostic dilemma for any physician. Although most back pain can be attributed to muscle strains and poor mechanics, it is necessary to appreciate the full differential of etiologies causing back pain in the pediatric population. The physician must recognize areas of mechanical weakness in the skeletally immature spine and the sport specific forces that can predispose a patient to injury. A comprehensive history involves determining the onset, chronicity, and location of the pain. A focused physical exam includes a neurological exam as well as provocative testing. The combination of a thorough history and focused physical exam should guide appropriate imaging. Radiographic tests are instrumental in narrowing the differential, making a diagnosis, and uncovering associated pathology. Treatment modalities such as activity modification, heat/cold compresses, and NSAIDs can provide pain relief and allow for effective physical therapy. In most cases nonoperative methods are successful in providing a safe and quick return to activities. Failure of conservative measures requires referral to an orthopedic surgeon, as surgical intervention may be warranted.
对于任何医生来说，儿科患者的背痛都可能是一个令人担忧且具有挑战性的诊断难题。尽管大多数背痛可归因于肌肉拉伤和不良力学因素，但有必要全面了解导致儿科人群背痛的各种病因。医生必须认识到骨骼未成熟脊柱中的力学薄弱区域以及可能使患者易受伤的特定运动力量。全面的病史包括确定疼痛的发作、慢性程度和部位。重点体格检查包括神经学检查以及激发试验。全面的病史和重点体格检查相结合应指导进行适当的影像学检查。放射学检查有助于缩小鉴别诊断范围、做出诊断并发现相关病理情况。诸如调整活动、热敷/冷敷和使用非甾体抗炎药等治疗方式可缓解疼痛并有利于进行有效的物理治疗。在大多数情况下，非手术方法能成功实现安全且快速地恢复活动。保守治疗措施失败则需要转诊给骨科医生，因为可能需要进行手术干预。
