Sponseller P D
Johns Hopkins Hospital, Baltimore, Maryland, USA.
Am Fam Physician. 1996 Nov 1;54(6):1933-41.
The most common causes of serious low back pain in children include spondylolysis, Scheuermann disease and musculoligamentous injury. Questions should be asked about the mechanism of onset and exacerbating factors, and the frequency, duration and severity of the pain. The examination should check gait and alignment, flexibility, strength and reflexes, and localize and evaluate the pain. Warning signs of serious problems include constant pain in a child younger than 11 years of age that lasts for several weeks or occurs spontaneously at night, repeatedly interferes with school, play or sports, or is associated with marked stiffness and limitation of motion, fever or neurologic abnormalities. Pain at the lumbosacral junction may suggest spondylolysis or spondylolisthesis. Scheuermann disease is diagnosed by the observance of wedging, irregularity or growth disturbance of three successive vertebrae. Musculoligamentous pain may result from injury to or overuse of muscles or joints of the back. Rare causes include discitis, tuberculosis, bone or spinal cord tumor, pyelonephritis and retroperitoneal infection.
儿童严重腰痛的最常见原因包括椎弓根峡部裂、休门氏病和肌肉韧带损伤。应询问发病机制、加重因素，以及疼痛的频率、持续时间和严重程度。检查应包括步态和姿势、柔韧性、力量和反射，并对疼痛进行定位和评估。严重问题的警示信号包括11岁以下儿童持续数周的疼痛、夜间自发出现的疼痛、反复影响上学、玩耍或运动的疼痛，或伴有明显僵硬和活动受限、发热或神经异常的疼痛。腰骶部交界处的疼痛可能提示椎弓根峡部裂或椎体滑脱。休门氏病通过观察连续三个椎体的楔形变、不规则或生长紊乱来诊断。肌肉韧带疼痛可能由背部肌肉或关节的损伤或过度使用引起。罕见原因包括椎间盘炎、结核病、骨或脊髓肿瘤、肾盂肾炎和腹膜后感染。
