wrist tuberculosis
Introduction
Introduction to wrist tuberculosis Wrist tuberculosis ranks the third in the upper limb joints and accounts for 0.43/100 of the patients with tuberculosis of the whole body. It is more common in adults. Like other limb joints, the patient has multiple tuberculosis lesions at the same time. basic knowledge Sickness ratio: 0.0001% Susceptible people: more common in adults Mode of infection: non-infectious Complications: swelling
Cause
Wrist tuberculosis
(1) Causes of the disease
Mycobacterium tuberculosis generally cannot directly invade bones and joints, so a large part of bone and joint tuberculosis lesions are secondary, about 95% secondary to lung lesions, tubercle bacilli enter the blood through lymph nodes, and then spread to the whole body, due to the wrist joint The amount of activity is large, and when the constitution declines, malnutrition, chronic strain or accumulated damage promotes the formation of tuberculosis.
(two) pathogenesis
The structure of the wrist joint is complex, the proximal end is sacral, the lower end of the ulna and the triangular cartilage, the middle is 8 carpal bones, the distal end is the base of the metacarpal bone. The carpal bone is characterized by many articular surfaces, poor blood supply, no muscle coverage around the wrist joint, only many tendons The nerves and blood vessels pass, so the swelling of the wrist joint is easy to be found, and the abscess is easy to collapse to form the sinus. In addition, the abscess occasionally wears the tendon sheath, causing secondary tendon sheath tuberculosis, and the wrist joint synovium is less, while the bone cancellous component is more Many, therefore, in the wrist joint tuberculosis, should be the majority of bone tuberculosis or total joint tuberculosis from bone tuberculosis.
Among the wrist tuberculosis, simple synovial tuberculosis and simple bone tuberculosis are rare, because the synovial membrane of the wrist is less, the incidence of synovial tuberculosis is low, the volume of the carpal bone and metacarpal base is small, and the bone mass is small. The lesion often invades the adjacent joint and becomes a whole joint tuberculosis. Only the sputum and the lower end of the ulna are large in volume, and only simple bone tuberculosis can be seen.
The lesions are divided into central and marginal types, and have various characteristics. These features are easy to see at the lower end of the ulna, and at the base of the carpal and metacarpal bones. Because of their small size, the central and marginal types are difficult to distinguish, often very fast. The development of the whole joint tuberculosis.
Among the bones that make up the wrist joint, the lower end of the humerus, the skull and the hook bone have the highest incidence, the large and small polygonal bones are the second, the triangular bone and the metacarpal base are the least, and the pea bone tuberculosis is extremely rare.
In the late stage of the disease, the forearm pronation, wrist sagging and ulnar deformity gradually occur, and the joints are gradually stiffened. The iliac crest and the lower end of the ulna occupy an important position in the development of the ulna and the ulna. Therefore, the humerus at the lower end of the humerus is Tuberculosis is destroyed, and the tibia will be shortened in the future, resulting in a wrist deformity.
Prevention
Wrist tuberculosis prevention
Active treatment of tuberculosis and prevention of tuberculosis spread is the key to the prevention and treatment of this disease. In addition, it is necessary to actively prevent recurrence after surgery. In principle, on the basis of thorough elimination of the lesion, standard and sufficient amount of combined chemotherapy, no less than 1 to 1.5 years, for joint stability is poor, remove excessive bone disease, joint fusion should be performed to limit joint activities, and strengthen nutrition, enhance physical fitness, improve body resistance, avoid overwork and premature weight bearing.
Complication
Wrist joint tuberculosis complications Complications swelling
The clinical symptoms of wrist joint tuberculosis can initially cause swelling of the affected part, which can lead to bone changes and joint effusion. In the late stage of the disease, sinus formation may also occur. Malformation due to pathological dislocation or subluxation, severe cases in the late stage, wrist The joints can be stiff.
Symptom
Wrist joint tuberculosis symptoms Common symptoms Osteoporosis bone pain Long wrist spur low heat wrist back or volar side... Wrist drooping soft tissue swollen dead bone
1. Pain and tenderness: The pain is slight at the beginning. As the lesion develops, the pain gradually worsens. When the lesion develops from simple synovial membrane or bone tuberculosis to total joint tuberculosis, the pain is obvious. The simple bone tuberculosis is limited to bone. At the site of the lesion, synovial tuberculosis and total joint tuberculosis have tenderness around the joint.
2. Swelling: Because there are few soft tissues around the wrist joint, swelling is easy to be found, especially on the dorsal side. Fingers are reduced in activity, venous return is blocked, and there is often mild edema.
3. Dysfunction: The dysfunction of simple bone tuberculosis is light, and the total joint tuberculosis is more obvious. If the ulnar and ankle joints are involved, the forearm rotation function is limited. If the wrist joint is severely damaged, the fingers are not active for a long time, and the fingers are stiff. When the tendon is broken or the adhesion occurs, the function of the finger is obviously limited.
4. Abscess or sinus: Abscess is often located on the dorsal or volar side of the wrist, and can be fluctuated. The sinus is formed after the abscess is broken. The initial sinus is one. After the mixed infection, the sinus can be changed into multiple, and the sinus is closed. Form a scar.
5. Malformation: common forearm pronation, wrist drooping and hand deviation or deviation.
Examine
Wrist tuberculosis examination
1. Some patients may have increased erythrocyte sedimentation rate.
2. X-ray examination: In early cases, only osteoporosis and soft tissue swelling, when developing to total joint tuberculosis, there was progressive stenosis of the intercarpal space and the interphalangeal joint space, as well as marginal bone corrosion, the location of bone destruction was humerus, head Bone and hook bones are the most common, and the joint structure of the later cases is completely destroyed. It is not uncommon to have bone fusion between the wrists, but it is rare to see the bone fusion of the ankle joint.
3. CT examination: edge bone destruction can be seen in the early stage, and dead bone can be found.
4. MRI examination: early detection of intra-articular fluid and abnormal signs of inflammatory infiltration in the bone.
5 Arthroscopy: The synovial membrane is taken for biopsy under wrist arthroscopy to help diagnose synovial tuberculosis in the wrist.
Diagnosis
Diagnosis of wrist joint tuberculosis
diagnosis
According to the symptoms, signs, X-ray examination, the diagnosis is not difficult, the simple synovial tuberculosis X-ray film only shows soft tissue swelling and local osteoporosis, X-ray film of tuberculosis at the lower end of the radius can be divided into central and marginal The former often has dead bone formation, and the dead bone absorbs to form a cavity; while the latter is more common in osteolytic destruction. Although the carpal and metacarpal tuberculosis has central and marginal types, it is easy to invade the articular surface and become full joint tuberculosis. For the carpal bone sparse, the early total joint tuberculosis still sees the marginal destruction of the joint. In the late stage, several carpal bones are obviously damaged, the blood flow is blocked, and the dead bone is formed. At the beginning, the joint space is enlarged, and then narrows or disappears, due to X. The positive performance of the line examination appears later, so patients with symptoms, signs and blood cell sedimentation rate should be diagnosed early by CT or MRI. For suspected cases, experimental anti-tuberculosis treatment and plaster support should be fixed for 2 months, such as patients. The treatment response was good and should be treated according to the wrist joint tuberculosis and followed closely.
Differential diagnosis
1. Rheumatoid arthritis: The wrist joint is a predilection site for rheumatoid arthritis, which can show osteoporosis, small cystic defect at the joint edge, narrow joint space, pathological subluxation, or bony rigidity, but it Often symmetry involves multiple joints, intermittent symptoms, erosion of the surface of the bone or small cystic absorption, no abscess, sinus or dead bone formation, patients often 40 years old women, mostly bilateral, Often associated with other joint lesions, single-shot is not easy to distinguish from synovial tuberculosis, the diagnosis must rely on biopsy and bacteriological examination.
2. Osteonecrosis of the moon: more common in young men, the patient is often a manual worker, complaining of chronic swelling and pain in the wrist, and more traumatic history. The X-ray film shows that the lunate bone is relatively dense at the beginning, the late lunar bone is flat, and the edges are not neat. The patient's blood is not fast, and the other carpal bones are normal.
3. Brodie bone abscess: Brodie bone abscess can be seen at the lower end of the humerus. X-ray film can be seen at the lower end of the humerus with localized osteolytic destruction. Generally, there is no dead bone, the bone wall is slightly hardened, and it is often difficult to distinguish it from central bone tuberculosis. Surgery, bacterial culture and pathological examination are required.
4. Tendon sheath tuberculosis: The affected tendon sheath is swollen with gourd shape, and the function of the finger is limited. The identification point is negative for X-ray film, and the swelling and tenderness are limited to one side of the wrist or palm.
5. Wrist tumor: the lower end of the humerus is the predilection site of the primary bone tumor, giant cell tumor, reticulocyte sarcoma can be seen. When the tumor is small, it needs to be distinguished from the central cavity of the tuberculosis. The former is osteolytic. Destruction, the latter cavity is reactive and dense.
6.Sudeck: bone atrophy: similar to the early X-ray findings of wrist joint tuberculosis, the former mainly involves bone cancellous, which is mostly spotted bone absorption phenomenon, and its cortex is smooth and undisturbed, and there is no change in joint space.
