Bone tuberculosis
Introduction
Introduction to bone tuberculosis Most of the bone tuberculosis is secondary to tuberculosis. However, some patients have no history of tuberculosis and are occult infections of tuberculosis. Most of the tuberculosis sclerotia occurs first in the lungs. After the lung infection, the blood can be transmitted to many systems throughout the body, which can lead to skeletal system tuberculosis, urinary system tuberculosis, and digestive system tuberculosis. Therefore, bone tuberculosis is not a simple disease, it is a local manifestation of systemic diseases. basic knowledge The proportion of illness: 0.31% Susceptible people: children of school age who are 3-5 years old Mode of infection: respiratory transmission Complications: muscle atrophy
Cause
Cause of bone tuberculosis
Mycobacterium tuberculosis infection (80%)
Bone tuberculosis is a purulent destructive disease caused by the invasion of bone or joint by Mycobacterium tuberculosis. The motherland medicine is caused by the disease in the bones or joints, which consumes blood and fluid, causing the body to be thin and thin, and the righteousness is fading, and the lingering is difficult. After the disease became pus, it can form a cold abscess elsewhere, and the pus in the pus is accompanied by scum-like sputum, so it is also known as hooligan. The disease is more common in children and adolescents. Most patients are under the age of 30. School age children under the age of 10, especially 3-5 years old, have the highest incidence. Most of the affected parts are bones or joints that are heavy, active, and prone to strain. The onset of the spine is the most prosperous, accounting for about half of all bones, followed by knees, hips, elbows, ankles and other joints. The limbs, sternum, ribs, skull, etc. are rarely affected.
Prevention
Bone tuberculosis prevention
First, the prevention system
Establishing and improving flood control organizations at all levels is the key to prevention and control. The work of the prevention and treatment institutions (health and epidemic prevention stations, tuberculosis prevention and treatment stations) includes: investigating the epidemic situation of tuberculosis, formulating prevention and treatment plans, conducting education on the basis of training, training and prevention of backbones, and assessing the effects of prevention and treatment and exchange of experience.
Second, the treatment site
Reasonable anti-tuberculosis drug treatment can not only cure tuberculosis, but also turn sputum and yang to eliminate the source of infection. Efficient anti-tuberculosis drugs are equally satisfactory at home or in hospitals.
Third, found the patient
The source of infection for tuberculosis is the patient who is sterilized. A smear-positive bacterium can infect 5 to 10 people per year. Healing patients with bactericidal bacteria can help control infectious agents and improve the epidemic. Asymptomatic patients must actively seek. X-ray examination of the collective lung can detect early patients, but most of them are still found after some symptoms are seen. Suspicious people should be further investigated.
Fourth, management of patients
Register patients with tuberculosis and strengthen management. Tuberculosis requires long-term treatment, so it is important to seek a safe, effective, responsive, and economically resistant anti-tuberculosis therapy.
V. BCG vaccination
BCG is a live avirulent bovine tuberculosis vaccine that allows the body to acquire acquired immunity against tuberculosis. It is vaccinated against uninfected newborns, children and adolescents.
Controlling the source of infection, cutting off the route of infection, enhancing immunity, and reducing infection are the basic principles for controlling the spread of tuberculosis.
Complication
Bone tuberculosis complications Complications muscle atrophy
According to the location and development of the lesion can be divided into simple bone tuberculosis, simple synovial tuberculosis and total joint tuberculosis. Joint tuberculosis develops slowly, and early accidental joint pain is gradually aggravated and turns into frequent pain. The pain is aggravated during exercise, and there is tenderness. The pain can be released to other parts. For example, hip joint tuberculosis pain is often released to the knee joint. Because of the pain in the activity, there is tendon, which causes the automatic and passive movement of the joint to be restricted. The persistent tendon can cause the joint to contract or deform, and the affected limb is atrophied due to disuse. In the late stage, due to bone destruction, or the growth of callus, joint deformity, pathological dislocation or limb shortening are formed.
Symptom
Symptoms of bone tuberculosis common symptoms, weight loss, low fever, elbow joint malformation, loss of appetite, job burnout
1. The onset of bone and joint tuberculosis is slower, the systemic symptoms are concealed, and the patient may have low fever, burnout, night sweats, loss of appetite and weight loss. Only a few cases showed an acute attack in addition to the above symptoms, high fever of about 39 degrees, easy to be confused with other acute infections. Past or current tuberculosis, pleurisy, lymphatic tuberculosis or urinary tuberculosis, and close contact with tuberculosis patients or families with tuberculosis patients, will help diagnose.
2. Local symptoms and signs
1) dysfunction
Usually the patient's joint dysfunction occurs earlier than the affected part of the pain. In order to reduce the pain in the affected part, the joints are often forced to be in a special position, such as the shoulder joint sagging position, the elbow joint half flexion position. Hip flexion position, ankle joint foot drop position. Cervical tuberculosis is often used to support the lower jaw, thoracic or lumbar tuberculosis, and the muscles are protective, causing difficulty in bending and careful picking and other unique postures.
2) Swelling
Local swelling of the joints of the extremities is easy to find, and the skin color usually shows normal, and the skin is slightly warm. The swelling of the joints gradually increases, the muscles of the limbs shrink, and the affected joints are mostly fusiform. Spinal tuberculosis due to anatomical relationship, early body surface can be found without abnormality, with the development of lesions, paraspinal abscess increases and moves along the muscle space to the surface, cold abscess can appear in the neck, back, waist triangle, concave and concave The roots of the legs, etc. If the abscess migrates to the body surface, the skin is affected, the epidermis is flushed, the local temperature can also be increased, and some even wear the skin to form the sinus. At the same time, patients often have low fever and local pain is aggravated. Cold abscesses contribute to the diagnosis of bone and joint tuberculosis.
3) Pain
Initial local pain is not obvious, until the lesion develops to stimulate or oppress the adjacent nerve roots, such as intercostal neuralgia in lumbar tuberculosis; lumbar tuberculosis stimulates or oppresses lumbar plexus nerve causes lumbar and leg pain; simple bone tuberculosis or synovial tuberculosis Pain is aggravated for total joint tuberculosis, which often causes the patient's attention. In order to relieve the pain, the muscles of the affected part are always in a state of paralysis, thereby providing protection. When the patient's position changes, especially when sleeping at night to lose muscle muscle protection, the pain is more obvious, and children often show nightingale.
4) Malformation
With the development of lesions, bone and joint and vertebral bone destruction, the above-mentioned unique postures continue to develop and further develop, joint activities are further restricted and deformed, and spinal tuberculosis often has angulated kyphosis.
Examine
Examination of bone tuberculosis
Blood routine
Patients often have mild anemia (less than 10 grams), multiple lesions or long-term combined with secondary infection, may have more severe anemia. In 10% of cases, the white blood cell count can be increased, and the white blood cell count of the mixed infected person is significantly increased.
ESR
During the active period of the lesion, the general erythrocyte sedimentation rate is accelerated, but it can also be normal. The erythrocyte sedimentation rate will gradually become normal after the lesion is still or cured. This is meaningful for follow-up, but this test is non-specific, and other inflammation or malignant tumors can also accelerate the erythrocyte sedimentation rate. .
3. Tuberculin test
Children under the age of 15 who have not been vaccinated with BCG, the tuberculin test from negative to positive, indicating that recently infected with tuberculosis, can also be positive by atypical acid-fast bacilli, but the response is lighter. False negative can be seen in the initial stage, or in severe cases without allergies. And from positive to negative. It has been reported that 14% of cases of bone and joint tuberculosis are negative in this test, so active tuberculosis including bone and joint tuberculosis cannot be completely excluded when the test is negative.
4. Tuberculosis culture
It takes about 3 to 8 weeks to culture with modified Roche culture medium, and the positive rate is about 50%. Bactec grew rapidly for an average of 9 days. The results of polymerase chain reaction (PCR) detection over 48 hours, this method needs further improvement.
5. Pathological examination
When taking pathological specimens, it was reported that granulation tissue was taken on the synovial membrane, and the living tissue was taken on the x-ray film at the cystic lesion, and the positive rate was high. Tuberculosis culture and histopathological examinations are performed at the same time, and complement each other can improve the diagnosis rate by 70% to 90%.
Film degree exam
X-ray conventional radiography is still one of the preferred imaging diagnostic methods, but a few cases require CT, CTM, MRI or ECT examination to improve the diagnostic level.
The imaging of bone and joint tuberculosis has the following performance:
1. Basic x-ray manifestations of bone and joint tuberculosis: bone destruction, narrow joint space, and swelling of surrounding soft tissue. In addition to infection and repair, bone sclerosis is rare.
2, typical CT findings of bone and joint tuberculosis: multiple bone destruction, edge around the edge of bone hardening, cold abscess formation, calcification at the edge of some abscess, enhanced marginal ring enhancement (called "edge" sign); calcification in soft tissue And dead bones.
3, typical MRI manifestations of spinal tuberculosis: vertebral bone destruction and vertebral osteitis, intervertebral space destruction, fissure-like enhancement, paravertebral and epidural abscess, enhanced abscess wall ring enhancement, posterior longitudinal ligament line-like enhancement .
Diagnosis
Diagnosis and diagnosis of bone tuberculosis
diagnosis
Early diagnosis of bone tuberculosis is difficult, and should be comprehensively analyzed and diagnosed based on medical history, physical signs, imaging, tuberculosis culture, pathological tissue, blood test, epidemiology and other data.
Differential diagnosis
The earliest symptoms of spinal tuberculosis, especially lumbar vertebrae, are often low back pain, but many other diseases can cause back pain, such as disc disease, waist strain, etc. can cause back pain. There is still some difference between the back pain caused by tuberculosis and the back pain caused by other diseases. The back pain of tuberculosis is a kind of persistent back pain, especially after falling asleep at night. Children or young people often wake up, and the pain will not be caused by rest and eating. The medicine has improved. In the eyes of clinicians, the difference between pain caused by spinal tuberculosis and other diseases is that the waist of patients suffering from spinal tuberculosis is stiff and it is difficult to bend over. This is an important difference.
