急性下背痛的陷阱：腰大肌膿瘍

腰大肌膿瘍臨床表現相當多樣性，但僅有不到30% 的病人會出現典型的三病徵（triad：發燒、腰窩疼痛、髖關節活動因疼痛受限）。因此誤診和延遲診斷並不少見。腰大肌膿瘍可分為：（1）原發性：身體有一潛在的病源，可能是外傷性血腫，經由血路傳播而引起，90%為金黃色葡萄球菌。（2）續發性：由腰大肌鄰近構造直接散播而來，常見的病因為庫隆氏病（Crohn’s disease）、盲腸炎、憩室炎、椎間盤感染及脊椎炎。治療上除抗生素外，需積極的排膿處理（穿刺引流或手術），並探查及處理可能隱藏的病因，以防復發。本文的病例提醒臨床醫生，面對急性下背痛的病人求診時，要當心是否伴有發炎的症狀。對於帶有感染病徵的下背痛病人，應留意腰大肌膿瘍的可能性，以免錯失治療的先機。

關鍵字

腰大肌；膿瘍；急性下背痛

並列摘要

The clinical presentation of psoas abscess is variable and nonspecific. The triad of fever, flank pain, and limitation of hip movement, which is specific for psoas abscess, is present in only less than 30% of the cases. Therefore, delayed diagnosis or misdiagnosis, resulting in the high mortality and morbidity, is not uncommon. A primary psoas abscess has no obvious focus of infection. It is believed that hematogeneous spread occurs from an occult source, analogous to acute osteomyelitis. Hematoma due to trauma may be the pathogenesis. The most common pathogen is staphylococcus. Secondary psoas abscess is defined as occurring by direct spread from contiguous structures. Several causes are described, including Crohn’s disease, appendicitis, diverticulitis, disc infection and spondylitis. Percutaneous or open drainage of psoas abscess combined with appropriate antibiotic therapy is highly successful treatment. In cases of secondary psoas abscess, further investigation for the underlying disease and subsequent surgery is necessary for the prevention of the recurrence. Here what we discuss remind clinicians, the approach with acute low back pain patient who presents the classical triad of psoas abscess, requiring high index of suspicion. Therefore, the patient could be diagnosed and managed as early as possible.

並列關鍵字

psoas muscle ； abscess ； acute low back pain

國際替代計量

急性下背痛的陷阱：腰大肌膿瘍

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