Scott E M, Scott B B
Department of Medicine, County Hospital, Lincoln.
Gut. 1993 Jul;34(7):1006-8. doi: 10.1136/gut.34.7.1006.
The painful rib syndrome consists of three features: pain in the lower chest or upper abdomen, a tender spot on the costal margin, and reproduction of the pain on pressing the tender spot. This is a common cause for referral to a general medical/gastroenterology clinic, accounting for 3% of new referrals in Lincoln. Seventy six consecutive patients were studied. The mean age was 48 years and 70% were women. Forty three per cent had been investigated, often extensively, before referral, and eight had had a non-curative cholecystectomy. The case notes from all patients were reviewed and a follow up questionnaire was sent after a mean period of four years to those 72 still alive, of which 56 replied. Thirty nine (70%) still had the pain although all except three had learnt to live with it. Despite a firm diagnosis being given, 25 (33%) patients were referred again to hospital by their general practitioner. All further investigations were negative apart from the finding of gall stones in three patients. The four patients who died had died from unrelated causes. The painful rib syndrome is common but underdiagnosed. It is a safe, clinical diagnosis requiring no investigation. Systematic firm palpation of the costal margin in recommended in all patients presenting with pain in the lower chest or upper abdomen.
下胸部或上腹部疼痛、肋缘有压痛点、按压压痛点时疼痛再现。这是转诊至普通内科/胃肠病科门诊的常见原因，在林肯市新转诊患者中占3%。对76例连续患者进行了研究。平均年龄为48岁，70%为女性。43%的患者在转诊前曾接受过检查，且往往检查范围广泛，8例患者接受过非根治性胆囊切除术。对所有患者的病历进行了回顾，并在平均四年后向72例仍在世的患者发送了随访问卷，其中56例进行了回复。39例（70%）患者仍有疼痛，尽管除3例患者外，其他患者都已学会忍受。尽管已作出明确诊断，但仍有25例（33%）患者被其全科医生再次转诊至医院。除3例患者发现胆结石外，所有进一步检查均为阴性。4例死亡患者死于无关原因。疼痛性肋骨综合征很常见但诊断不足。这是一种无需检查即可作出的安全临床诊断。建议对所有出现下胸部或上腹部疼痛的患者系统地用力触诊肋缘。
