sacroiliac joint tuberculosis
Introduction
Ankle joint tuberculosis Ankle joint tuberculosis is rare in clinical practice, accounting for 8% of total body and joint tuberculosis. Early symptoms and X-ray signs are atypical, and there are many similarities in other diseases of the ankle joint, which are prone to misdiagnosis. Ankle joint tuberculosis, as a local manifestation of systemic tuberculosis infection, has gradually gained attention in recent years. The ankle joint is often severely damaged, the affected tibia is moved up, pathological dislocation occurs, female patients have more dislocation, and sometimes the pubic symphysis is dislocated, which may be related to the loosening of the female pelvis. basic knowledge The proportion of illness: 0.21% Susceptible people: no specific population Mode of infection: respiratory transmission Complications: tuberculosis, pleurisy, lymphatic tuberculosis
Cause
Ankle joint tuberculosis
Infection (30%):
The contaminated air of Mycobacterium tuberculosis infects the respiratory tract or digestive tract, and then causes bloody infection through the blood circulation. The ankle joint tuberculosis is divided into synovial type and bone type.
Pathogenesis:
The ankle joint is often severely damaged, the affected tibia is moved up, pathological dislocation occurs, female patients have more dislocation, and sometimes the pubic symphysis is dislocated, which may be related to the loosening of the female pelvis.
The joint lesion develops backward, and the posterior joint capsule or humerus is worn through, so that the abscess gathers in the deep layer of the gluteus maximus. The lesion develops forward and will pierce the anterior joint capsule or tibia. The pus flows between the psoas muscle and the diaphragm. More common in the muscle or under the diaphragm than in the posterior, occasionally flow to the groin or upper thigh, there are lesions break through the lower joint capsule, abscess along the sacral nodular ligament or piriformis flow near the big trochanter, or before and after alone Abscesses form, or communicate with each other, the abscess collapses outward to form the sinus; in some cases, the pus can be worn through the abdominal cavity or rectum.
Prevention
Ankle joint tuberculosis prevention
This disease is caused by Mycobacterium tuberculosis, and it is often used as a local manifestation of systemic tuberculosis infection. Therefore, in the prevention of this disease, it is necessary to do a good job in the promotion and prevention of infectious diseases, actively treat infected people, and prevent tuberculosis infection from causing this disease.
Tuberculosis is a general term for tuberculosis infecting human body and causing clinical symptoms. Tuberculosis can form tuberculosis in almost all human organs and tissues after infection, but the most common is in the lungs, called tuberculosis, accounting for more than 80% of tuberculosis. Therefore, people often refer to tuberculosis as tuberculosis, but don't forget that there may be tuberculosis in other human organs and tissues. Tuberculous pleurisy, meningitis, pericarditis, lymphatic tuberculosis, endobronchial tuberculosis, and intestines are more common. Tuberculosis, peritoneal tuberculosis, bone and joint tuberculosis, kidney tuberculosis and skin tuberculosis.
To prevent the spread of tuberculosis, the primary task is to control the source of infection, that is, to promptly discover and completely cure patients with infectious tuberculosis. The second is to protect susceptible populations, to inoculate BCG vaccine for all newborns, to receive tuberculosis-related tests for close contacts, and to take preventive treatment for high-risk groups of people infected with tuberculosis. In addition, good living hygiene habits should be developed to reduce the possibility of transmission, such as not spitting, paying attention to ventilation and sanitation in densely populated areas, and exercising to enhance physical fitness.
Complication
Ankle joint tuberculosis complications Complications, tuberculosis, pleurisy, lymphatic tuberculosis
Ankle joint tuberculosis as a local manifestation of systemic tuberculosis infection, combined with its disease, studies have shown that 50% of cases of ankle joint tuberculosis are accompanied by other parts of tuberculosis, such as tuberculosis, pleurisy or lymphatic tuberculosis, so the disease In addition to symptomatic treatment, it should also actively treat tuberculosis infection, prevent other complications caused by tuberculosis, and may also be complicated by pathological dislocation of the ankle joint.
Symptom
Ankle joint tuberculosis symptoms Common symptoms Osteoporosis, night sweats, dead bones, neuralgia, low fever, ankle pain, spondylolisthesis, severe pain
The incidence of this disease is generally slower than spinal tuberculosis, often found first abscess, pain and tenderness, but often due to abscess decompression, pain relief and delay diagnosis, there are lower back and affected side of the ankle pain, there may also be "sciatica "Transfer pain to the affected side of the buttocks and the lateral side of the femur, but different from the symptoms of lumbar disc herniation, do not release to the calf and the foot, no change in feeling, increased pain during activities, such as turning over, sitting for a long time, going up and down the stairs, bending over, down, etc., when standing, the general body leans toward the healthy side; when walking, dare not step across the stride, and the supine position often feels pain in the ankle.
Examine
Ankle joint tuberculosis examination
Blood test: Erythrocyte sedimentation rate increases.
Auxiliary examination: The auxiliary examination method of this disease mainly relies on X-ray and CT examination, and its performance mainly has the following aspects:
1. Lesion: The bone joint tuberculosis is mainly in the anterior and inferior tibia of the ankle joint. The synovial tuberculosis can also break through the articular cartilage and invade the bone tissue, causing damage to the ankle joint surface and bone tissue.
2. Bone destruction: The bone destruction zone of bone joints is round or elliptical, the edge of the destruction zone is visible, the ankle joint space is not obviously narrow, and the synovial joint tuberculosis is characterized by different degrees of blur or erosion of the ankle surface. The gap is narrowed or widened to varying degrees; some show significant destruction of the bone and irregular widening of the joint space.
3, dead bone: Some scholars believe that tuberculosis can appear large dead bones, there are data showing that the largest dead bone diameter of tuberculosis can reach more than 2cm, about fine granular or "sand-like" dead bone, may be the calcification of cheese material, It may also be a true sand-like dead bone. The true sand-like dead bone density is lower than the above-mentioned calcification point and is often masked by the calcified cheese substance. Therefore, it is sometimes difficult to distinguish or display.
4, bone hyperplasia: ankle joint tuberculosis without fistula formation, no secondary infection can also occur bone hyperplasia, the reason is that the ankle joint tuberculosis osteoporosis is often not as obvious as other joints, but often shows bone Symptoms of hyperplasia of hyperplasia.
5, cold abscess and sinus formation: ankle joint tuberculosis is more likely to occur cold abscess and sinus formation, mostly in the buttocks and groin or pelvis.
In the early X-ray films, the joint edges were blurred and the joint space was widened. In the late stage, the joint space was narrowed or disappeared. The local bone destruction was common. Some bones were visible. The joint destruction was severe. The ipsilateral humerus and pubic bone were dislocated upward. Long-term mixing Infection, the local bone is significantly hardened.
CT examination of ankle joint tuberculosis has obvious advantages, which can show the location, extent and extent of ankle joint destruction, especially the location of the abscess, which can be clearly displayed, providing a reliable basis for the development of a correct surgical plan.
Diagnosis
Diagnosis and diagnosis of ankle joint tuberculosis
diagnosis
The diagnosis is mainly based on the results of its clinical manifestations and auxiliary examinations, mainly X-ray examination.
During the examination, the anterior curvature of the spine was limited, and the extension and lateral curvature were limited, and there was local pain, but the activity was better when sitting, the straight leg raising test in the lying position, the affected side was limited and there was local pain, crushing or When the humerus is separated, the affected part is painful. There is tenderness in the affected part of the ankle joint. There may be a cold abscess or sinus. The anal finger examination sometimes touches the local abscess and tenderness.
X-ray examination is very important for early diagnosis. It is necessary to take the ankle joint and the oblique position (sagittal plane of the joint), showing bone destruction, dead bone and cavity formation.
Differential diagnosis
1. Ankylosing spondylitis:
Ankle joint tuberculosis can occur at any age, with unilateral morbidity, often occurring in the lower third of the ankle joint, and ankylosing spondylitis is common in young men, mostly bilateral symmetric disease, performance Irregularity of the joint space is narrowed or accompanied by osteopetal joints. The edge may have a small cystic defect. The lesion is easy to invade and the upper part of the ankle joint is often accompanied by blurring, narrowing or disappearance of the lumbar facet joint.
2. Dense osteitis:
Bone-type ankle joint tuberculosis occurs in the cancellous cane, which is a circular or elliptical localized destruction zone, which can affect the ankle joint. The dense otitis media is more common in adult women, often symmetry violation of the ankle joint. The lower 2/3 part of the humerus is characterized by a triangular shape, a crescent-shaped or pear-shaped dense shadow, and the trabecular fusion disappears without involving the joint.
3. Loss of bone caused by external pulsation of the external iliac artery:
Localized ankle joint tuberculosis in the proximal iliac artery area sometimes needs to be differentiated from bone destruction or loss caused by pulsation of the external iliac artery. Although the bone destruction area caused by the former is relatively limited, the bone destruction is extensive, and the edge of the destruction area is not Clear, no sclerosis; and long-term pulsation of the external iliac artery can cause obvious and deep depression of the lower edge of the humerus, and the edge of the sag can be seen clearly, without signs of hardening.
In addition, the disease also needs to pay attention to sputum strain, disc herniation, lumbar tuberculosis and hip inflammation, rheumatoid arthritis, septic arthritis and tumor identification, lumbosacral tuberculosis and ankle joint tuberculosis symptoms, signs, Abscesses and sinus are very similar, the two are easy to be confused, such as the two in the same patient, to determine which lesion from the abscess and sinus, sometimes difficult, only by surgery or sinus angiography to identify .
