国产日韩欧美一区二区三区三州_亚洲少妇熟女av_久久久久亚洲av国产精品_波多野结衣网站一区二区_亚洲欧美色片在线91_国产亚洲精品精品国产优播av_日本一区二区三区波多野结衣 _久久国产av不卡

?

男性恥骨骨炎23例臨床誤診分析

2017-03-07 03:22程文龍紀(jì)世琪張海建韓志興劉慶軍王建文
臨床誤診誤治 2017年8期
關(guān)鍵詞:觸痛查體恥骨

程文龍,平 浩,紀(jì)世琪,張海建,韓志興,劉慶軍,王建文

·誤診研究:運(yùn)動(dòng)系疾病·

男性恥骨骨炎23例臨床誤診分析

程文龍,平 浩,紀(jì)世琪,張海建,韓志興,劉慶軍,王建文

目的 探討男性恥骨骨炎(osteitis pubis, OP)的臨床特點(diǎn)、誤診原因及防范措施。方法 對(duì)2015年2月—2016年9月首都醫(yī)科大學(xué)附屬北京地壇醫(yī)院門診收治的曾誤診的23例OP的臨床資料進(jìn)行回顧性分析。結(jié)果 本組均為男性,皆以睪丸和腹股溝區(qū)疼痛就診,慢性前列腺炎癥狀指數(shù)(CPSI)評(píng)分總體評(píng)分(18.13±2.69)分,查體骨盆及恥骨中度觸痛17例,重度觸痛6例。當(dāng)恥骨聯(lián)合上方有觸痛時(shí),可誘發(fā)同側(cè)睪丸牽涉痛。23例均曾診斷為慢性前列腺炎/慢性盆腔疼痛綜合征(chronic prostatitis/chronic pelvic pain syndromes, CP/CPPS),給予相應(yīng)治療6個(gè)月以上,癥狀無(wú)明顯改善。后通過(guò)詳細(xì)病史采集、仔細(xì)查體和綜合全面對(duì)患者病情進(jìn)行分析后診斷為OP。給予糾正病因、康復(fù)訓(xùn)練和活血散瘀類中藥治療2周后,19例疼痛等癥狀緩解,隨訪6個(gè)月患者病情無(wú)反復(fù);4例疼痛等癥狀改善不明顯,加用非甾體抗炎藥治療2周,癥狀略緩解,停藥后癥狀反復(fù)。結(jié)論 男性O(shè)P與CP/CPPS臨床表現(xiàn)相似,易誤診。臨床遇及患者主訴睪丸和腹股溝區(qū)疼痛,查體恥骨結(jié)節(jié)區(qū)壓痛,并可以誘發(fā)睪丸牽涉痛時(shí)應(yīng)考慮OP。糾正病因、康復(fù)訓(xùn)練和口服活血散瘀類中藥有利于OP病情緩解。

骨炎;恥骨;男性;誤診;前列腺炎

恥骨骨炎(osteitis pubis, OP)是由于恥骨應(yīng)力損傷導(dǎo)致的一種運(yùn)動(dòng)醫(yī)學(xué)常見疾病,臨床表現(xiàn)為腹股溝及會(huì)陰區(qū)慢性疼痛[1-2],與IIIb型慢性前列腺炎,即慢性前列腺炎/慢性盆腔疼痛綜合征(chronic prostatitis/chronic pelvic pain syndromes, CP/CPPS)的臨床表現(xiàn)相似,易誤診為CP/CPPS[3]。2015年2月—2016年9月首都醫(yī)科大學(xué)附屬北京地壇醫(yī)院門診收治主訴睪丸和腹股溝疼痛,查體恥骨結(jié)節(jié)區(qū)域壓痛,并可誘發(fā)同側(cè)睪丸牽涉痛的男性23例,均曾診斷為CP/CPPS,并進(jìn)行相應(yīng)治療6個(gè)月以上,但臨床癥狀無(wú)改善,后經(jīng)詳細(xì)病史采集、仔細(xì)查體及行相關(guān)醫(yī)技檢查,綜合對(duì)患者病情進(jìn)行分析后診斷為OP,給予糾正病因、康復(fù)訓(xùn)練和口服活血散瘀類中藥治療后獲得滿意效果,現(xiàn)回顧分析其臨床資料報(bào)告如下。

1 臨床資料

1.1 一般資料 本組23例,均為男性;年齡18~45(28.96±7.41)歲。病程6個(gè)月~3年。既往身體健康,未合并其他疾病。5例有快速變換方向運(yùn)動(dòng),包括4例足球、籃球愛好者和1例廚師;其余患者均有長(zhǎng)期坐位工作史,游戲和棋牌愛好者7例,司機(jī)4例,辦公室職員4例,美術(shù)學(xué)生、畫家和裝修工人各1例,且每天連續(xù)坐位2 h以上。

1.2 臨床表現(xiàn) 23例皆以睪丸及腹股溝區(qū)疼痛就診。右側(cè)疼痛14例,左側(cè)疼痛6例,雙側(cè)疼痛3例。疼痛在坐位時(shí)可誘發(fā)或加重,平臥或收小腹時(shí)緩解;睡前疼痛較重并影響睡眠,晨起癥狀較輕;寒冷或注意力集中時(shí)癥狀可以加重。23例治療前均進(jìn)行慢性前列腺炎癥狀指數(shù)(CPSI)評(píng)分,其中疼痛和不適癥狀評(píng)分(12.57±1.75)分,排尿評(píng)分(2.09±1.00)分,癥狀對(duì)生活質(zhì)量影響評(píng)分(3.48±0.80)分,總體評(píng)分(18.13±2.69)分。骨盆及恥骨查體采用右手食、中和環(huán)指按壓,中度觸痛定義為手指力量在3500 g左右時(shí)才能誘發(fā)難以忍受的疼痛;重度觸痛定義為手指力量在1500 g左右時(shí)即可誘發(fā)難以忍受的疼痛[4]。本組骨盆及恥骨中度觸痛17例,重度觸痛6例;觸痛分布于恥骨聯(lián)合右上區(qū)(恥骨結(jié)節(jié))17例,右下緣3例,左上區(qū)9例,左下緣2例,其中雙側(cè)4例,上、下均有觸痛3例。當(dāng)恥骨聯(lián)合上方(恥骨結(jié)節(jié)處)有觸痛時(shí),可誘發(fā)同側(cè)睪丸牽涉痛。本組陰囊查體睪丸、附睪無(wú)異常,無(wú)觸痛,不合并精索靜脈曲張;直腸指診提示前列腺大小、質(zhì)地正常,無(wú)觸痛,無(wú)結(jié)節(jié)。尿常規(guī)和前列腺液檢查無(wú)異常。11例行骨盆前后位X線檢查,2例行骨盆CT檢查,均未發(fā)現(xiàn)骨折及腫瘤,3例有恥骨聯(lián)合間隙增寬(>10 mm),4例恥骨緣不規(guī)則,余無(wú)特異性影像學(xué)表現(xiàn)。

1.3 誤診情況 本組均曾診斷為CP/CPPS,18例為外院誤診,5例為本院誤診,其中曾在2家以上醫(yī)療機(jī)構(gòu)就診16例。23例按CP/CPPS進(jìn)行相應(yīng)治療(口服藥物、直腸給藥、坐浴及尿道內(nèi)微波治療等)6個(gè)月以上[(19±10)個(gè)月],癥狀無(wú)明顯改善。

1.4 診斷及治療 臨床上OP診斷主要基于病史和臨床表現(xiàn)[5]。本組通過(guò)詳細(xì)病史采集、仔細(xì)查體和綜合全面對(duì)患者病情進(jìn)行分析后診斷為OP。本組確診后均給予糾正病因、康復(fù)訓(xùn)練和口服活血散瘀類中藥治療。①根據(jù)病史和查體情況進(jìn)行發(fā)病機(jī)制分析,向患者解釋病情及可能發(fā)病原因,讓患者理解如何減少誘發(fā)和加重因素,糾正不正確運(yùn)動(dòng)方式或步態(tài),避免久坐,適當(dāng)收小腹減小下腹張力和避免骨盆前傾。②指導(dǎo)患者進(jìn)行康復(fù)訓(xùn)練和局部手法治療(按摩和捏拿),改善下腹肌肌力,促進(jìn)局部血液循環(huán),緩解疼痛癥狀。增強(qiáng)力量薄弱的下腹肌群訓(xùn)練對(duì)于OP的治療和預(yù)防復(fù)發(fā)具有重要意義,評(píng)估腹部和背部肌群的肌力是關(guān)鍵步驟,對(duì)不平衡的拮抗肌群有效正確訓(xùn)練是治療OP的一部分,正確的旋轉(zhuǎn)和偏心訓(xùn)練是OP康復(fù)的關(guān)鍵[1,6]。③活血散瘀類中藥能有效降低組織水腫,改善局部微循環(huán),抗炎止痛,其中云南白藥對(duì)炎性物質(zhì)的釋放有抑制作用,且在改善微循環(huán)及改變血管通透性等方面都有效果[7]。本組均給予云南白藥膠囊0.5 g每日4次口服。

1.5 預(yù)后 本組經(jīng)綜合治療2周后,19例疼痛等癥狀緩解[CPSI評(píng)分:疼痛和不適癥狀評(píng)分(4.65±2.31)分,排尿評(píng)分(2.09±0.92)分,癥狀對(duì)生活質(zhì)量影響評(píng)分(1.26±1.28)分,總體評(píng)分(7.17±3.85)分],繼續(xù)服用云南白藥膠囊2周后停藥,糾正病因及康復(fù)訓(xùn)練等治療方案不變,隨訪6個(gè)月,患者病情無(wú)反復(fù);4例疼痛等癥狀改善不明顯(CPSI評(píng)分:疼痛和不適癥狀評(píng)分>9分或總體評(píng)分>14分),加用非甾體抗炎藥治療2周,癥狀略緩解,停藥后癥狀反復(fù)。

2 討論

2.1 臨床特點(diǎn) OP是包括恥骨、恥骨聯(lián)合以及相鄰組織的無(wú)菌性炎癥反應(yīng)導(dǎo)致的疼痛。其發(fā)病與職業(yè)相關(guān),足球、曲棍球以及網(wǎng)球等職業(yè),因常具有過(guò)度扭曲和快速轉(zhuǎn)體性運(yùn)動(dòng)損傷,發(fā)病率為5%~13%[8]。OP發(fā)病初期表現(xiàn)為股收肌、腹部和恥骨聯(lián)合區(qū)疼痛,查體可發(fā)現(xiàn)恥骨上下緣、恥骨聯(lián)合區(qū)觸痛,股收肌和腹部肌肉對(duì)抗拉力時(shí)可誘發(fā)疼痛。OP常規(guī)X線檢查沒有特異性表現(xiàn),診斷意義不大,恥骨聯(lián)合間隙造影和MRI檢查有助于診斷[9-10]。臨床上OP保守治療方法包括休息、非甾體抗炎鎮(zhèn)痛藥、局部封閉及康復(fù)訓(xùn)練等[1,11-16];保守治療無(wú)效時(shí),需手術(shù)治療,包括恥骨聯(lián)合融合術(shù)、關(guān)節(jié)盤刮除術(shù)以及相關(guān)肌腱再固定術(shù)等,可通過(guò)關(guān)節(jié)鏡或開放手術(shù)進(jìn)行[17]。

2.2 診斷與鑒別診斷 OP診斷主要基于病史和臨床表現(xiàn)[5]。臨床上OP需與CP/CPPS進(jìn)行鑒別診斷。CP/CPPS是前列腺炎中最常見的類型,占慢性前列腺炎的90%以上[18],表現(xiàn)為長(zhǎng)期、反復(fù)的骨盆區(qū)域疼痛或不適,持續(xù)時(shí)間超過(guò)3個(gè)月,可伴有不同程度排尿困難和性功能障礙,嚴(yán)重影響患者生活質(zhì)量,發(fā)病機(jī)制和病理學(xué)改變目前還不清楚[19]。CP/CPPS缺乏客觀性和特異性診斷依據(jù),主要依據(jù)臨床癥狀和查體進(jìn)行診斷,臨床上易與OP混淆[18]。OP導(dǎo)致的腹股溝、下腹及恥骨區(qū)域疼痛與CP/CPPS相似,但OP臨床表現(xiàn)仍具有特殊性,疼痛主要是由于突然或長(zhǎng)期慢性牽拉薄弱的拮抗肌產(chǎn)生損傷導(dǎo)致的,可與CP/CPPS相鑒別。腹肌拮抗力減弱會(huì)使附著于恥骨的肌肉和筋膜受到損傷。損傷部位包括全部或部分的腹直肌起點(diǎn)、腹橫筋膜、聯(lián)合腱和腹外斜肌腱膜。損傷機(jī)制并非是腹直肌的自主收縮,而是由于拮抗肌群的反復(fù)過(guò)快、過(guò)強(qiáng)收縮,對(duì)肌力薄弱的腹肌被動(dòng)牽拉,導(dǎo)致其起點(diǎn)附著處產(chǎn)生了反復(fù)微損傷[20-21]。坐位時(shí),下腹部肌肉張力增加,下腹部肌肉受被動(dòng)牽拉作用而對(duì)恥骨聯(lián)合上緣形成牽拉損傷,疼痛加重。平臥位時(shí),這種被動(dòng)張力最小,故而疼痛緩解。坐位時(shí)通過(guò)保持下腹部肌肉適當(dāng)收縮(收小腹)可以減輕對(duì)恥骨聯(lián)合上緣腱膜的被動(dòng)牽張因而有助于緩解疼痛。當(dāng)恥骨結(jié)節(jié)區(qū)疼痛時(shí),多伴有睪丸牽涉痛(睪丸抽搐感),觸診時(shí)可誘發(fā),與提睪肌和下腹部肌肉的同源性有關(guān)。恥骨下方(股收肌腱附著處)由于收肌腱和恥骨間的牽拉和抗?fàn)坷饔每梢栽斐蓳p傷,其中主要是股長(zhǎng)收肌腱對(duì)附著于恥骨下方的股薄肌聯(lián)合腱的牽拉損傷,查體時(shí)恥骨下緣收肌聯(lián)合腱處壓痛,與經(jīng)常性大腿內(nèi)收有關(guān)。本組具有OP臨床表現(xiàn),且符合其發(fā)病機(jī)制,故可診斷OP。本組骨盆及恥骨中度觸痛17例,重度觸痛6例;觸痛分布于恥骨聯(lián)合右上區(qū)(恥骨結(jié)節(jié))17例,右下緣3例,左上區(qū)9例,左下緣2例,其中雙側(cè)4例,上、下均有觸痛3例。

2.3 誤診原因分析 ①對(duì)OP缺乏認(rèn)識(shí):OP作為一種運(yùn)動(dòng)醫(yī)學(xué)范疇的慢性疾病,發(fā)病與職業(yè)有關(guān),與過(guò)度扭曲和快速轉(zhuǎn)體性運(yùn)動(dòng)損傷相關(guān),臨床表現(xiàn)與CP/CPPS相似,多于泌尿外科就診。CP/CPPS則為泌尿生殖系統(tǒng)疾病,“2014中國(guó)泌尿外科疾病診斷治療指南”將前列腺炎定義為一組疾病,并指出CP/CPPS缺乏客觀性和特異性診斷依據(jù),主要依據(jù)臨床癥狀和體征進(jìn)行診斷,導(dǎo)致骨盆區(qū)域疼痛的疾病易誤診為CP/CPPS[18]。但指南中沒有明確列出應(yīng)著重鑒別的疾病,加之OP并不為泌尿外科醫(yī)生所熟悉,故易誤診。②OP與CP/CPPS臨床表現(xiàn)相似:OP最初臨床表現(xiàn)為股收肌、腹部和恥骨聯(lián)合區(qū)疼痛;而CP/CPPS則為長(zhǎng)期、反復(fù)的骨盆區(qū)域疼痛或不適,持續(xù)時(shí)間超過(guò)3個(gè)月。OP的疼痛部位包含在CP/CPPS的疼痛范圍之內(nèi),容易導(dǎo)致誤診。③患者就診科室不當(dāng):OP為運(yùn)動(dòng)創(chuàng)傷引起的恥骨、恥骨聯(lián)合以及相鄰組織的無(wú)菌性炎癥。臨床上OP患者首次多因睪丸和腹股溝疼痛就診,其病變雖然不在睪丸,而疼痛卻放射到睪丸,故常首先就診于泌尿外科,而泌尿外科醫(yī)生往往不會(huì)將OP與CP/CPPS進(jìn)行鑒別,亦易造成誤診。④病史采集及查體不細(xì)致:OP的病因和臨床表現(xiàn)有其獨(dú)特之處,但是若接診醫(yī)師沒有詳細(xì)采集病史和仔細(xì)查體,加之臨床經(jīng)驗(yàn)不足,就無(wú)法將其與CP/CPPS鑒別開來(lái)。⑤缺乏分析總結(jié):本組就診初期接診醫(yī)生將患者主訴的OP疼痛部位誤認(rèn)為骨盆區(qū)域疼痛,從而誤診成CP/CPPS,當(dāng)按CP/CPPS治療效果不理想時(shí)[18],又未能認(rèn)真對(duì)患者病情進(jìn)行總結(jié)分析,認(rèn)為療效差是理所當(dāng)然的事,放棄進(jìn)一步的分析鑒別,從而導(dǎo)致誤診誤治。⑥缺乏特異性診斷措施:OP常規(guī)X線檢查無(wú)特異性表現(xiàn),診斷意義不大。MRI或恥骨聯(lián)合間隙造影檢查雖然有助于OP診斷[9-10],但由于MRI或恥骨聯(lián)合間隙造影檢查成本較高或具有損傷性,臨床在類似本文患者中很少應(yīng)用。

2.4 防范誤診措施 通過(guò)對(duì)本文病例誤診原因進(jìn)行分析,我們認(rèn)為以下措施有助于防范OP誤診誤治:①臨床醫(yī)生應(yīng)增加對(duì)OP了解,加強(qiáng)OP與CP/CPPS的鑒別診斷。②臨床遇及類似本文患者要詳細(xì)病史采集、仔細(xì)查體,以得到充分的臨床信息,并對(duì)患者病情進(jìn)行綜合分析,查找病因、闡明發(fā)病機(jī)制,從而將OP與CP/CPPS鑒別開來(lái)。③對(duì)類似本文患者當(dāng)按CP/CPPS治療臨床效果不理想時(shí),要認(rèn)真分析總結(jié),查找深層次不愈因素,還可借助影像學(xué)檢查,如MRI或恥骨聯(lián)合間隙造影檢查等進(jìn)行鑒別,必要時(shí)請(qǐng)骨科、運(yùn)動(dòng)創(chuàng)傷醫(yī)學(xué)科醫(yī)師會(huì)診協(xié)助診斷和治療。

總之,男性O(shè)P與CP/CPPS臨床表現(xiàn)相似,易誤診,但OP有特定的發(fā)病機(jī)制,可以通過(guò)詳細(xì)病史采集、仔細(xì)查體得到診斷。臨床遇及患者主訴睪丸和腹股溝區(qū)疼痛,查體恥骨結(jié)節(jié)區(qū)壓痛,并可以誘發(fā)睪丸牽涉痛時(shí)應(yīng)考慮OP。糾正病因、康復(fù)訓(xùn)練和口服活血散瘀類中藥有利于OP病情緩解。另外,需注意的是,由于MRI或恥骨聯(lián)合間隙造影檢查成本較高或具有損傷性,本研究中缺乏相關(guān)數(shù)據(jù),故本組治療前后客觀評(píng)估依據(jù)有限,需要進(jìn)一步研究加以補(bǔ)充。

[1] Sayed Mohammad W, Ragaa Abdelraouf O, Abdel aziem A A. Concentric and eccentric strength of trunk muscles in osteitis pubis soccer players[J].J Back Musculoskelet Rehabil, 2014,27(2):147-152.

[2] Weir A, Brukner P, Delahunt E,etal. Doha agreement meeting on terminology and definitions in groin pain in athletes[J].Br J Sports Med, 2015,49(12):768-774.

[3] Nickel J C. Lower urinary tract symptoms associated with prostatitis[J].Can Urol Assoc J, 2012,6(5):133-135.

[4] Berger R E, Ciol M A, Rothman I,etal. Pelvic tenderness is not limited to the prostate in chronic prostatitis/ chronic pelvic pain syndrome (cpps) type iiia and iiib: comparison of men with and without cp/cpps[J].BMC Urol, 2007,7(7):17.

[5] Paajanen H, Hermunen H, Karonen J. Pubic magnetic resonance imaging findings in surgically and conservatively treated athletes with osteitis pubis compared to asymptomatic athletes during heavy training[J].Am J Sports Med, 2008,36(1):117-121.

[6] Quinn A. Hip and groin pain:physiotherapy and rehabilitation issues[J].The Open Sports Medicine J, 2010,4:93-107.

[7] 王婷安,禹正楊.云南白藥臨床應(yīng)用新進(jìn)展[J].現(xiàn)代醫(yī)藥衛(wèi)生,2012,28(9):1358-1359.

[8] Ekstrand J, Ringborg S. Surgery versus conservative treatment in soccer players with chronic groin pain:a prospective randomized study in soccer players[J].Eur J Sports Traumatol, 2001,23(4):141-145.

[9] Daigeler A, Belyaev O, Pennekamp W H,etal. MRI findings do not correlate with outcome in athletes with chronic groin pain[J].J Sports Sci Med, 2007,6(1):71-76.

[10]Brennan D, O'Connell M J, Ryan M,etal. Secondary cleft sign as a marker of injury in athletes with groin pain: mr image appearance and interpretation[J].Radiology, 2005,235(1):162-167.

[11]Holmich P, Uhrskou P, Ulnits L,etal. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial[J].Lancet, 1999,353(9151):439-443.

[12]Choi H, Mc Cartney M, Best T M. Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review[J].Br J Sports Med, 2011,45(1):57-64.

[13]Cunningham P M, Brennan D, O'Connell M,etal. Patterns of bone and soft-tissue injury at the symphysis pubis in soccer players: observations at MRI[J].AJR Am J Roentgenol, 2007,188(3):291-216.

[14]Kavroudakis E, Karampinas P K, Evangelopoulos D S,etal. Treatment of osteitis pubis in non-athlete female patients[J].Open Orthop J, 2011,5:331-334.

[15]Tyler T F, Nicholas S J, Campbell R J,etal. The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players[J].Am J Sports Med, 2002,30(5):680-683.

[16]Garvey J F, Hazard H. Sports hernia or groin disruption injury? Chronic athletic groin pain: a retrospective study of 100 patients with long-term follow-up[J].Hernia, 2014,18(6):815-823.

[17]Hopp S J, Culemann U, Kelm J,etal. Osteitis pubis and adductor tendinopathy in athletes: a novel arthroscopic pubic symphysis curettage and adductor reattachment[J].Arch Orthop Trauma Surg, 2013,133(7):1003-1009.

[18]那彥群,葉章群,孫穎浩,等.中國(guó)泌尿外科疾病診斷治療指南手冊(cè)[M].2014版.北京:人民衛(wèi)生出版社,2014:435-454.

[19]Zhang R, Sutcliffe S, Giovannucci E,etal. Lifestyle and risk of chronic prostatitis/chronic pelvic pain syndrome in a cohort of united states male health professionals[J].J Urol, 2015,194(5):1295-1300.

[20]Meeuwisse W H. Assessing causation in sport injury: A multifactorial model[J].Clin J Sport Med, 1994,4:166-170.

[21]Pizzari T, Coburn P T, Crow J F. Prevention and management of osteitis pubis in the australian football league: a qualitative analysis[J].Phys Ther Sport, 2008,9(3):117-125.

Misdiagnosis Analysis of 23 Males with Osteitis Pubis

CHENG Wen-long1, PING Hao2, JI Shi-qi1, ZHANG Hai-jian1, HAN Zhi-xing1, LIU Qing-jun1, WANG Jian-wen2

(1. Department of Urology, Beijing Ditan Hospital Affiliated to Capital Medical University, Beijing 100015, China; 2. Department of Urology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100014, China)

Objective To investigate clinical characteristics, misdiagnosed causes and preventative measures of males with osteitis pubis (OP). Methods Clinical data of 23 male misdiagnosed patients with OP admitted during February 2015 and September 2016 was retrospectively analyzed. Results All patients visited doctors for testicular and inguinal pains. The total score of chronic prostatitis symptom index (CPSI) was 18.13 ± 2.69, and physical examination showed 17 patients with medium pain and 16 patients with severe pain in pelvis and pubis. Homopleural testis was induced referred pain when above area of pubic symphysis had tenderness. All patients had been diagnosed as having chronic prostatitis/chronic pelvic pain syndromes (CP/CPPS), but patients' symptoms did not be improved after corresponding treatment for more than six months. OP was confirmed after detailed history collection, carefully physical examinations and compositive conditions analysis, and they were diagnosed as osteitis pubis clinically. After treatments of correcting etiology, rehabilitation training and oral administration of activating blood flow and removing blood stasis for two weeks, symptoms were relieved in 19 patients. With 6 months of follow-up, no recurrence was found in patients; 4 patients' symptoms such as pains were not obviously improved, and antiinflammatory agents were given for two weeks, and the symptoms were slightly improved, but the symptoms were relapsed after withdrawal. Conclusion Clinical symptoms of male OP and CP/CPPS are similar, and it is easily be misdiagnosed. Clinicians should suspect OP for patients have testicular and inguinal pains and tenderness in pubic tubercle area, and it can induce testicular referred pain. Correcting etiology, rehabilitation training and oral activating blood flow and removing blood stasis of traditional Chinese medicine is conducive to improving symptoms.

Osteitis; Pubic bone; Male; Misdiagnosis; Prostatitis

北京市優(yōu)秀人才基金(3101-03-36-10)

100015 北京,首都醫(yī)科大學(xué)附屬北京地壇醫(yī)院泌尿外科(程文龍、紀(jì)世琪、張海建、韓志興、劉慶軍);100014 北京,首都醫(yī)科大學(xué)附屬北京朝陽(yáng)醫(yī)院泌尿外科(平浩、王建文)

R681.2

A

1002-3429(2017)08-0024-04

10.3969/j.issn.1002-3429.2017.08.008

2017-05-04 修回時(shí)間:2017-06-03)

猜你喜歡
觸痛查體恥骨
錐狀肌及恥骨前韌帶的解剖學(xué)觀測(cè)
正常妊娠期恥骨聯(lián)合間隙寬度變化臨床觀察
健康查體中以人為本服務(wù)的應(yīng)用
健康查體中護(hù)理健康教育的作用
膝部滑囊炎病灶注射方法的選擇與療效分析
論健康查體中護(hù)理健康教育的作用
我坐在夜寒里
穴貼恥骨聯(lián)合痛點(diǎn)治腰痛
100例晚期妊娠婦女正常恥骨間距超聲測(cè)量
冬天,有一只鳥