Achar Suraj, Yamanaka Jarrod
University of California San Diego School of Medicine, San Diego, CA, USA.
Fairview Sports and Orthopedic Care, Blaine, MN, USA.
Am Fam Physician. 2020 Jul 1;102(1):19-28.
Back pain is a relatively common presenting symptom in children and adolescents. Typical causes include muscle strain or spasm, spinal deformities (e.g., Scheuermann kyphosis, adolescent idiopathic scoliosis), spondylolysis, bulging or herniated intervertebral disks, apophysitis of the iliac crest, and functional pain syndromes such as fibromyalgia. Spondyloarthropathies such as ankylosing spondylitis may present with low back pain and stiffness, which are often worse in the morning. Less common but more serious causes include malignancy and infections. The physical examination should include postural inspection, evaluation for tenderness, range of motion, strength testing, and testing for fractures and nerve impingement. Treatment for patients with muscle strain include relative rest, home-based exercises, physical therapy, and limited use of nonsteroidal anti-inflammatory drugs. If findings from the history and physical examination suggest underlying pathology, radiography and laboratory studies are indicated initially; magnetic resonance imaging, computed tomography, or a bone scan may be needed for further evaluation. It is generally accepted that the following factors warrant immediate evaluation: patient age younger than five years, symptoms persisting beyond four weeks, systemic symptoms, nighttime pain, bowel incontinence/urinary retention, or other neurologic symptoms.
背痛是儿童和青少年中相对常见的症状。典型病因包括肌肉拉伤或痉挛、脊柱畸形（如休门氏驼背、青少年特发性脊柱侧弯）、椎弓根峡部裂、椎间盘膨出或突出、髂嵴骨突炎以及纤维肌痛等功能性疼痛综合征。强直性脊柱炎等脊柱关节病可能表现为腰骶部疼痛和僵硬，通常在早晨加重。较罕见但更严重的病因包括恶性肿瘤和感染。体格检查应包括姿势检查、压痛评估、活动范围、力量测试以及骨折和神经受压检查。肌肉拉伤患者的治疗包括适当休息、家庭锻炼、物理治疗以及有限使用非甾体抗炎药。如果病史和体格检查结果提示存在潜在病变，最初需进行放射学检查和实验室检查；可能需要磁共振成像、计算机断层扫描或骨扫描进行进一步评估。一般认为，以下因素需要立即评估：患者年龄小于5岁、症状持续超过四周、全身症状、夜间疼痛、大便失禁/尿潴留或其他神经症状。
