Tarsus and surrounding joint tuberculosis
Introduction
Introduction of tibia and peripheral joint tuberculosis Clinically, the incidence of tuberculosis between the humerus, the humerus and the intercondylar tuberculosis is not rarer than that of the ankle joint tuberculosis. Among them, there are more cases of the scaphoid joint and adjacent bones, including the talus, humerus and cuneiform bone. basic knowledge The proportion of illness: 0.004% Susceptible people: no special people Mode of infection: non-infectious Complications: neuromuscular rigidity, bone tumor
Cause
Causes of tuberculosis and surrounding joint tuberculosis
Simple bone tuberculosis (20%):
Because there are fewer synoviums between the humerus and surrounding joints, simple synovial tuberculosis is rare. In the clinical, there are many bone tuberculosis and total joint tuberculosis in the middle and late stages. The calcaneus tuberculosis is mostly central, with dead bone. Occasionally, the marginal type, the pus mostly gathers on the outside of the calcaneal nodules, and forms a sinus after rupture, which can be cured for a long time; such cases can often be found in rural and remote areas, and the lesions in front of the calcaneus can be invaded. With the joints and the scaphoid joints, it is also easy to invade the ankle joints.
Because other interphalangeal joints are connected to each other, they are often characterized by total joint type tuberculosis after the onset, and can affect the adjacent humerus or most of the intercondylar joints at the same time. At this time, the pus penetrates into the tendon sheath to produce tendon sheath tuberculosis.
Total tuberculosis (20%):
In the advanced stage of the disease, the sacral tuberculosis lesions may involve all the tibia and interphalangeal joints. In this case, it is called full-foot tuberculosis. The affected foot may have several sinus tracts, and often it will not heal for a long time. It has become cancerous and has to be amputated.
Infection (30%):
Invasion of blood circulation caused by tuberculosis.
Prevention
Tibial and peripheral joint tuberculosis prevention
Mental state is essential for relieving joint pain. Don't be impatient and relaxed, it will help you to relieve pain.
Complication
Complications of tibia and peripheral joint tuberculosis Complications , neuromuscular tonic bone tumor
Late stage can be combined with fibrous ankylosis.
Symptom
Symptoms of tuberculosis and peripheral joint tuberculosis Common symptoms Low heat and thin osteoporosis
1. Symptoms and signs
Patients with sacral tuberculosis often have lungs or other tuberculosis, so there are systemic symptoms such as weight loss, anemia, and hypothermia. Local symptoms are mainly pain and lameness. Simple bone tuberculosis is mild, while total joint tuberculosis is heavier.
Signs for local abscesses, tenderness and limited joint function, accompanied by sinus.
2. X-ray performance
X-ray film performance is consistent with the development of general osteoporosis tuberculosis. The early calcaneus center tuberculosis showed frosted glass-like changes, and the dead bones were separated afterwards; the dead bones formed after the bones were absorbed, and the bone wall was denser. The calcaneus has obvious hardening.
The X-ray films of other sacral tuberculosis are similar to the calcaneus tuberculosis, but soon enter the adjacent joints or affect the adjacent tibia. The late tibia can be extensively damaged and relatively dense, and the unaffected foot bones have obvious bone. Loose, some only have the contour of the cortex, like a circle of charcoal painting.
Examine
Examination of tibia and surrounding joint tuberculosis
If the whole joint is tuberculosis, the erythrocyte sedimentation rate can be increased.
Mainly for the X-ray film, the calcaneus center tuberculosis showed a frosted glass-like change on the X-ray film in the early stage, and the calcaneus appeared in the cloud; but as the disease progressed, the local dead bone separated and absorbed to form a cavity. When the bone wall is dense, if there is mixed infection, the calcaneus can be accompanied by sclerosing changes, and the sinus tract is not cured for a long time. Other sacral tuberculosis and calcaneus tuberculosis have similar X-ray findings, which easily spread to other tibia and Interphalangeal joints, extensive destruction of the tibia in the late stage, other bones of the foot that are not involved are highly osteoporotic due to disuse, showing a carbonized appearance, and it seems that only the appearance of the cortical contour remains.
CT and MRI examinations are only suitable for cases with unknown early diagnosis and are generally not required.
Diagnosis
Diagnostic diagnosis of tibia and peripheral joint tuberculosis
The diagnosis of this disease is generally no difficulty, mainly based on medical history and systemic and local clinical symptoms, signs and X-ray findings.
Differential diagnosis
Flat foot
More common young people, symmetry, complaining of foot pain, more walking or standing for a long time, the standing position can be seen that the arch of the foot disappears, the foot is more than everted, the lower part of the heel is tilted outward, and the X-ray film sees the arch of the foot, but The bones are normal.
2. Rheumatoid arthritis and calcaneus
Rheumatoid arthritis often invades the interphalangeal joints, local swelling and pain, limited activity, X-ray films only see osteoporosis and soft tissue swelling, but no sacral destruction or densification, can be distinguished from sacral tuberculosis, rheumatoid Osteitis is more common in young men aged 10 to 20 years. The lesions are mostly limited to calcaneal nodules. The nodular hyperplasia is seen, especially in the posterior superior and inferior nodules. There is tenderness and mild soft tissue swelling around the calcaneal nodules. X-ray films showed irregular hyperplasia and compaction of calcaneus nodules, small cystic destruction in the proliferative zone, hyperplasia of the tendon and tendon fascia, and a chicken-like appearance, mostly bilateral. Often associated with other rheumatoid lesions.
3. Aseptic necrosis of the scaphoid
Also known as Köhler disease, X-ray film shows dense scaphoid bone, the scaphoid bone shrinks and deforms, the patient has no tuberculosis symptoms, and the erythrocyte sedimentation rate is normal.
4. Calcaneal tumor
Giant cell tumor of bone, chondroblastoma, fibrosarcoma, etc. must be distinguished from tuberculous bone cavity. The esculent Ewing sarcoma should also be differentiated from tuberculous frosted glass.
