男性耻骨骨炎23例临床误诊分析

摘要

目的 探讨男性耻骨骨炎(osteitis pubis,OP)的临床特点、误诊原因及防范措施.方法 对2015年2月-2016年9月首都医科大学附属北京地坛医院门诊收治的曾误诊的23例OP的临床资料进行回顾性分析.结果 本组均为男性，皆以睾丸和腹股沟区疼痛就诊,慢性前列腺炎症状指数(CPSI)评分总体评分(18.13±2.69)分,查体骨盆及耻骨中度触痛17例,重度触痛6例.当耻骨联合上方有触痛时,可诱发同侧睾丸牵涉痛.23例均曾诊断为慢性前列腺炎/慢性盆腔疼痛综合征(chronic prostatitis/chronic pelvic pain syndromes,CP/CPPS),给予相应治疗6个月以上,症状无明显改善.后通过详细病史采集、仔细查体和综合全面对患者病情进行分析后诊断为OP.给予纠正病因、康复训练和活血散瘀类中药治疗2周后,19例疼痛等症状缓解,随访6个月患者病情无反复;4例疼痛等症状改善不明显,加用非甾体抗炎药治疗2周,症状略缓解,停药后症状反复.结论 男性OP与CP/CPPS临床表现相似,易误诊.临床遇及患者主诉睾丸和腹股沟区疼痛,查体耻骨结节区压痛,并可以诱发睾丸牵涉痛时应考虑OP.纠正病因、康复训练和口服活血散瘀类中药有利于OP病情缓解.%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.