ankle tuberculosis
Introduction
Ankle joint tuberculosis There are few soft tissues around the ankle joint. The ankle abscess is easy to wear through the skin and form a sinus. Long-term mixed infection can occur. The sinus can be multiple, with the anterior and lateral sides being the most. Foot ptosis and varus deformity can be seen in the late stage. Because the ankle joint is connected to the subtalar joint. Therefore, ankle joint tuberculosis often coincides with talar joint tuberculosis. Ankle joint tuberculosis accounts for 3.4% of the body's bone tuberculosis, and the lowest incidence among the three major joints of the lower extremities. Ankle joint synovial tuberculosis is more common, and it is easier to transform into total joint tuberculosis than bone tuberculosis, especially talus tuberculosis and lower tibia tuberculosis. basic knowledge The proportion of illness: 0.045% Susceptible people: good for young adults Mode of infection: non-infectious Complications: neuromuscular rigidity
Cause
Ankle joint tuberculosis
(1) Causes of the disease
The pathogen of tuberculosis is Mycobacterium tuberculosis, which generally cannot directly invade bones and joints. Therefore, most bone and joint diseases are secondary.
(two) pathogenesis
Pathological changes show the following aspects:
Bone tuberculosis
According to the degree of compactness of bone, it can be divided into cancellous bone (or sponge bone) and dense bone (or cortical bone). Cancellous bone tuberculosis can be divided into two types: central type and marginal type. Central type tuberculosis is infiltrated and necrotic. Mainly, the necrotic bone tissue is free to form a dead bone, and the residual bone remains after the bone is absorbed; the marginal tuberculosis is not easy to form a large dead bone, and the smaller dead bone is often absorbed or discharged, forming a localized bone defect, dense bone. Tuberculosis starts from the medullary cavity and is mainly caused by localized bone destruction. Generally, no dead bone is formed. The pus can be collected under the periosteum along the Volkmann tube, the periosteum is picked up, and the periosteum is stimulated to form new bone. The periosteal new bone has an onion-like appearance, and the tubular end-to-side tuberculosis is characterized by two types of tuberculosis: cancellous bone and dense bone.
2. Synovial tuberculosis
The synovial membrane is distributed on the inner surface of the joint, the tendon sheath and the bursa. The synovial membrane is swollen and congested after infection with tuberculosis, the inflammatory cells infiltrate, the exudate increases, and the late synovial membrane thickens.
3. Total joint tuberculosis
The joint is mainly composed of cancellous bone, articular cartilage and synovium. The earliest joint tuberculosis is simple bone tuberculosis or simple synovial tuberculosis. The further development of simple tuberculosis is that the granulation tissue invades below the edge of the cartilage surface, and The septic destruction is performed under the cartilage surface, and finally the entire cartilage surface and its attached bone tissue are separated, the cartilage surface is necrotic and shedding, and the pus of the cancellous bone tuberculosis can penetrate the cartilage surface and enter the joint cavity to cause the cartilage. And the synovial lesions, at this time, the three tissues that make up the joints have been infected with tuberculosis, so it is called total joint tuberculosis. This stage of the disease is called the whole joint tuberculosis stage, the cartilage surface damage is less, and the lesions no longer develop; Active functional exercise, most of the joint function can return to normal, this stage of lesions can be called early total joint tuberculosis stage, if most of the cartilage surface is destroyed, joint function will be seriously lost, and even fibrous rigidity or bony rigidity, This stage is called the late total joint tuberculosis stage.
Prevention
Ankle joint tuberculosis prevention
1. Control the source of infection: The main source of infection for tuberculosis is tuberculosis patients, especially those with positive tuberculosis, who receive reasonable chemotherapy in the early stage. The tuberculosis in the tuberculosis is reduced in the short term, and even disappears. Almost 100% can be cured, so early detection Patients, especially those with positive bacteria, and timely administration of reasonable chemotherapy are the central links of modern flood control work.
2. Cut off the route of infection: Tuberculosis is mainly transmitted through the respiratory tract.
Complication
Ankle joint tuberculosis complications Complications , neuromuscular rigidity
Long-term can lead to osteoarticular fibrosis and skeletal rigidity: if the joint trauma is improperly treated, the fixation time is too long, which can cause joint adhesion, even fiber rigidity, which seriously affects the function of the knee joint and even causes disability, so the knee joint is straight. The treatment is of great significance. Due to long-term fixation of the lower limbs, knee joint function training, intra-articular vein and lymphatic drainage disorder, tissue edema, and exudation increased. Intra-articular hemorrhage is difficult to absorb, gradually fibrosis, and scar formation causes intra-articular adhesion.
Symptom
Ankle joint tuberculosis symptoms Common symptoms Joint swelling joint migration pain, swelling sprain in the infraorbital area pain swelling osteoporosis bone destruction
1. Symptoms and signs
Common in young adults, males are slightly more than females, the incidence is relatively slow, often has a history of sprains, mainly manifested as swelling of the ankle, pain and lameness, the initial pain of bone tuberculosis is not obvious, rest is light, tired is heavy, turned into Pain is severe in all joint tuberculosis, and the pain will be alleviated or disappeared when the joint is fibrotic or skeletal.
During the examination, simple bone tuberculosis swelling is often limited to the vicinity of bone lesions. Synovial tuberculosis and total joint tuberculosis swelling can be seen around the ankle joint. The ankle joint function is limited, mainly in the aspect of back extension and plantar flexion, such as involving the joint and the joint. The valgus movement is reduced or disappeared. The lameness is proportional to the degree of pain and deformity. The pain and deformity are severe, and the limp is significant; sometimes it is necessary to walk.
X-ray findings, simple synovial tuberculosis showed osteoporosis and joint capsule swelling, in the lateral position of the ankle joint, the normal fat translucent area was pushed open, compression narrowed or disappeared; when there was a lot of fluid in the joint, the joint space was widened. .
Simple bone tuberculosis can be seen locally with osteolytic destruction, frosted glass-like changes or dead bone formation.
From simple synovial membrane to total joint tuberculosis, it can be seen that the subchondral bone plate is blurred or the edge bone is destroyed, and the joint damage is severe in the late stage, and deformity or rigidity occurs.
Examine
Ankle joint tuberculosis examination
During the active period of the disease, the erythrocyte sedimentation rate increases rapidly, the white blood cells are normal or slightly more, and there is often mild anemia. The pus culture is untreated, the positive rate of tuberculosis is about 70%, and the positive rate of synovial culture is about 40%. The positive rate of M. tuberculosis culture in the specimen has been improved with the improvement of the method. The application of polymerase chain reaction (PCR) technology is very helpful for the diagnosis of bone and joint tuberculosis. Pathological examination often finds typical lesions.
X-ray inspection
Simple synovial tuberculosis on the X-ray film showed osteoporosis and soft tissue swelling shadow, simple bone tuberculosis showed cystic osteolytic changes or ground-glass changes, during which the dead bone is rare, developed to the whole joint tuberculosis At the time, the progressive joint space is narrowed and asymmetrical, and the marginal bone destruction can be seen. As the lesion progresses, the bone destruction is intensified, the subchondral cortical bone disappears, and in the later stage, the ankle joint is obviously damaged, but rarely occurs. Bony stiffness, unless there is a secondary infection, there is generally no manifestation of osteosclerosis.
2. CT examination
In simple synovial tuberculosis, fluid in the joint cavity can be seen. The effusion is mostly in front of the ankle joint and the posterior achilles tendon; simple bone tuberculosis can have osteolytic changes in the corresponding parts, dead bone formation and lesions. A cold abscess nearby.
3. MRI examination
Lesions can be detected early, manifested as abnormal shadows of inflammatory canal infiltration, usually with similar changes at the bone ends of both sides of the joint.
Diagnosis
Diagnosis and diagnosis of ankle joint tuberculosis
According to the patient's medical history, age, symptoms, signs, X-ray and laboratory findings, the diagnosis is generally not difficult, but simple synovial tuberculosis, sometimes need to be synovial biopsy and joint fluid bacterial culture for further diagnosis.
The disease should be differentiated from rheumatoid arthritis, pigmented villonodular synovitis, sprained ankle, chronic osteomyelitis and Kashin-Beck disease.
