Bone and joint tuberculosis
Introduction
Introduction to bone and joint tuberculosis Bone and joint tuberculosis has the highest incidence in children and adolescents, but can also occur in adults. About 50% of the spine occurs, weight-bearing joints such as hip joints, knee joints, ankle joints, etc. are also more, upper limbs such as shoulders, elbows and wrist joints are less. The onset is slow, there may be low fever in the afternoon, pain, tenderness, cramps and muscle spasms in the affected area, and joint activity is limited. Late in the formation of not red, not hot abscess, known as cold abscess; after rupture, the formation of sinus, secondary mixed infection can occur joint stiffness. The erythrocyte sedimentation rate increases during the active period of the lesion, and the lymphocytes increase in the classification of white blood cells; tubercle bacilli may be found in the pus, and pathological examination may help to confirm the diagnosis. X-ray examination showed osteoporosis and bone destruction, vertebral space or joint space stenosis and abscess shadow. The key to treatment is early diagnosis and treatment, including rest and local braking, increased nutrition and application of anti-tuberculosis drugs, abscess puncture and injection of anti-tuberculosis drugs; if necessary, debridement, arthroplasty, arthrodesis and spinal fusion . basic knowledge Sickness ratio: 2-3% Susceptible people: good for children and adolescents Mode of infection: non-infectious Complications: tuberculosis, intestinal tuberculosis
Cause
Bone and joint tuberculosis
The disease is often secondary to lung or intestinal tuberculosis. Mycobacterium tuberculosis invades the joint or bone through the blood from the primary lesion. When the body's resistance is reduced, it can reproduce and form a lesion, and clinical symptoms appear.
According to the location and development of the lesion can be divided into simple bone tuberculosis, simple synovial tuberculosis and total joint tuberculosis.
Prevention
Bone and joint tuberculosis prevention
Bone and joint tuberculosis is a kind of secondary tuberculosis, which occurs in children and adolescents. It has obvious influence on children's growth and development, adult labor and quality of life. For tuberculosis and digestive tract tuberculosis, it should be regular, and anti-tuberculosis should be applied throughout. Improve the living and sanitation conditions; the health and medical departments should form a strong monitoring system, do a good job of prevention and isolation, pay more attention to the vast rural areas, increase the census, prevention and treatment, only early diagnosis and early treatment of patients with bone and joint tuberculosis In order to obtain the best results, it can not only cure tuberculosis, but also maintain normal or near-normal joint function, and ensure the normal development of the affected limb in children.
Complication
Bone and joint tuberculosis complications Complications tuberculosis intestinal tuberculosis
According to the development of the disease, the disease can be complicated with various injuries:
1. Bone and joint tuberculosis is basically secondary. The primary lesion is often tuberculosis and intestinal tuberculosis. If the body has certain resistance during the primary disease, the treatment can be appropriate to avoid tuberculosis of bone and joint.
2, improper treatment can lead to the stage of simple tuberculosis (including simple bone tuberculosis, synovial tuberculosis) has a certain resistance during the disease, appropriate treatment, and can retain normal or near normal joint function,
3. If the condition continues to develop and enters the stage of total joint tuberculosis, improper treatment may result in loss of joint function in patients. In severe cases, amputation is required to cause permanent disability.
Symptom
Bone and joint tuberculosis symptoms Common symptoms Joint pain Low heat Muscle atrophy Weight loss Bone destruction Joint deformity Joint contracture Hyperthermia Spinal cord compression paraplegia
Symptoms of the disease mainly include systemic symptoms and local symptoms:
1. Systemic symptoms: light and heavy, generally chronic pathogenesis, mostly low fever, weight loss and other symptoms, such as co-infection, may have high fever, wound pus, etc., red blood cell sedimentation rate increased.
2. Local symptoms: slow development, early accidental joint pain, gradually worsening and turning into frequent pain, increased pain during exercise, tenderness, pain can be released to other parts, such as hip joint tuberculosis pain often released to the knee joint, There is tendon due to pain during activity, resulting in limited automatic and passive movement of the joint. Persistent tendon can cause joint contracture or deformation, muscle atrophy due to disuse, and bone destruction in the late stage due to bone destruction , the formation of joint deformity, pathological dislocation or limb shortening, in the spinal tuberculosis due to bone destruction of the vertebral body collapse and abscess, granulation tissue formation, spinal cord compression and paraplegia, spinal tuberculosis and other joint tuberculosis often cold abscess If worn out can be combined with infection to make the symptoms worse, the formation of sinus wounds will not heal for a long time.
Examine
Examination of bone and joint tuberculosis
Laboratory tests and imaging examinations are conducive to the diagnosis of this disease:
1. X-ray examination: early X-ray photos can be no significant changes, followed by osteoporosis, narrow joint space, and bone destruction and cold abscess.
2. CT examination: typical CT findings of bone and joint tuberculosis are characteristic, manifested as multiple bone destruction, edge around the bone hardening margin, cold abscess formation, calcification on the edge of some abscess, enhanced edge margin enhancement (called "edge" "Recovery"; calcification and dead bone form in soft tissue.
3. Laboratory tests: the rate of red blood cell sedimentation rate increases, can be used for tuberculin test when children are suspicious, can be used for puncture test when there is joint effusion, check tuberculosis; sometimes need to be cultured and animal inoculated, if necessary, live Organizational inspection.
Diagnosis
Diagnosis of bone and joint tuberculosis
diagnosis:
According to the history, the history of tuberculosis exposure and the above systemic and local symptoms for diagnosis, due to the slow course of the disease, attention should be paid to early diagnosis.
Diagnostic points
1. Have a history of tuberculosis exposure, or have a tuberculosis pathogen.
2. Spinal tuberculosis is mostly radioactive pain, stiffness, deformity, or spinal compression. Local tenderness or snoring, positive test results have diagnostic significance. Tuberculosis of the hips and knees can be seen in lameness, intermittent leg pain or joint swelling, and limited activity.
3. The onset is slow, and there may be symptoms of tuberculosis poisoning such as low fever, fatigue, anorexia, and general malaise.
4. Anemia, white blood cells rise slightly, and blood sedimentation speeds up. Positive PPD or OT test.
5. Abscess fluid or joint cavity puncture smear, culture, PPD-IgG, PCR-TB-DNA positive for diagnosis.
6. X-ray examination shows that the joint space is narrowed, as well as osteoporosis, destruction and other diseases.
Differential diagnosis
1, the identification of suppurative discitis: suppurative discitis clinically can have low back pain, fever, white blood cells and other infections, the incidence is more acute, CT on the early stage of the intervertebral space stenosis, visible bone hardening around the X-ray The plain film can be seen to be hardened and absorbed by suppurative lesions. The abscess is mostly confined to both sides of the vertebral body, and the calcification is less. The spinal tuberculosis generally has a long-term and occult disease course, and the hardening changes are less and less severe than those of the discitis.
2, with the differentiation of spinal metastases: spinal metastases are more common in the elderly, generally with primary lesions, lesions of vertebral body destruction often jump, attachments are more involved, the intervertebral space is basically normal, no parastomal parasites, dead bone formation, The paravertebral soft tissue mass is more limited. CT has certain difficulties in the identification of cheese-like calcification and residual bone and dead bone. The CT value of tuberculosis calcification is higher than that of residual bone and dead bone. Will help.
3, the identification of spinal fungal infection: fungal infection of the vertebral body and intervertebral disc may invade the adjacent rib head, often prompted diagnosis, cryptococcal osteomyelitis rarely occurs in the spine, and bone marrow cavity spread and abscess are rarely shown, In the vertebral osteolysis area, a "soap bubble"-like change can be seen. The paraspinal abscess can occur under the posterior longitudinal ligament, which is smaller than the abscess formed by tuberculosis. The spinous process and rib head are also susceptible, and the hunchback deformity is rare.
4, identification with other diseases: bone and joint tuberculosis also need to be differentiated from rheumatoid arthritis and rare tumors, rheumatoid arthritis occurs in the hands, foot joints, joint involvement is often symmetrical and multiple, clinical manifestations and Different lesions are helpful for identification. Single joint invasion and occult pathogenesis should be suspected of tuberculosis. For atypical cases, if imaging is difficult, the lesion biopsy should be selected as early as possible to achieve early diagnosis and early treatment. .
