lumbar tuberculosis
Introduction
Introduction to lumbar tuberculosis Lumbar tuberculosis, commonly known as "sakyback", has a high incidence rate and is the first tuberculosis of the whole body. Most of them are vertebral tuberculosis, and lamina, spinous processes, articular processes and transverse tuberculosis are rare. basic knowledge The proportion of illness: 0.012% Susceptible people: no specific population Mode of infection: respiratory transmission Complications: Arthritis
Cause
Lumbar spinal tuberculosis
Cause
Lumbar tuberculosis and other parts of the tuberculosis are mostly caused by tuberculosis. Tuberculosis is transmitted to the bone tissue with the blood. Most tuberculosis bacteria are eliminated. The cause of lumbar tuberculosis is only a small number of tuberculosis bacteria escaping anti-tuberculosis drugs, hidden in the body, when the body is immune When the force drops, the infection is colonized, causing bone destruction to develop into bone tuberculosis.
Tuberculosis likes to grow in a place rich in blood. The vertebrae are mainly cancellous bones. Its nourishing artery is the terminal artery. The venous blood flows slowly here, and the tuberculosis easily stays in the vertebral body. The lumbar spine activity is the largest in the entire spine, so the incidence of lumbar vertebrae is the highest in bone and joint tuberculosis.
Pathophysiology
Lumbar tuberculosis is more common in adults. The lesion is confined to the upper and lower edges of the vertebral body and quickly invades the intervertebral disc and adjacent vertebral bodies. Intervertebral disc destruction is a feature of this disease, and thus the intervertebral space is very narrow.
Cold abscesses formed after vertebral destruction can have two manifestations: 1 paraspinal abscess: pus is collected in the vertebral body, can be in front, rear or both sides. It is more common to accumulate on both sides and in front. The pus picks up the periosteum and can also spread up and down along the ligament gap, causing bone erosion on the edges of several vertebral bodies. It can also enter the spinal canal to the rear, compressing the spinal cord and nerve roots. 2 flow abscess: after the paravertebral abscess accumulates to a certain amount, the pressure increases, will penetrate the periosteum, flow down the muscle fascia gap, and abscess appears in the area away from the lesion. The paraspinal abscess caused by lumbar vertebrae penetrates the periosteum and accumulates in the sheath of the psoas muscle to form a psoas abscess. The superficial psoas abscess can pass through the lumbar fascia to the lumbar triangle and become a lumbar deltoid abscess. The lumbar triangle is a potential gap, the edge of which is the trailing edge of the iliac crest, the outer edge of the iliac spine muscle and the posterior edge of the intra-abdominal oblique muscle. The psoas muscle abscess can also flow along the psoas muscle to the small trochanter of the femur, becoming a deep abscess in the groin. It also bypasses the back of the upper end of the femur, appears on the outside of the thigh, and even flows down the fascia to the knee.
Prevention
Lumbar 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
Lumbar tuberculosis complications Complications
Can cause osteoarthritis.
Symptom
Lumbar spinal tuberculosis symptoms Common symptoms Low back pain, persistent pain, joint swelling, motor dysfunction, joint deformity
Low back pain is the most common symptom of lumbar tuberculosis. The nature of the pain is dull or sore, accompanied by tenderness and snoring pain. The pain is aggravated during exertion, coughing and bedtime. Upper lumbar tuberculosis may have thigh pain, lower lumbar tuberculosis may have sciatica, which is due to tuberculous abscess, granulation tissue and necrotic intervertebral disc or dead bone protruding into the spinal canal, causing spinal cord or nerve root to be compressed or stimulated, Radiation pain. The specific performance is as follows:
pain
Initial local pain is not obvious, until the lesion develops to stimulate or oppress the adjacent nerve roots, such as intercostal neuralgia in thoracic 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.
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.
disfunction
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 special positions, such as shoulder joint sagging, elbow joint flexion, hip flexion, and ankle joint. Cervical tuberculosis is commonly used in two hands, the lower jaw, thoracic or lumbar tuberculosis, muscle protection, sputum, resulting in difficult bending and careful picking up and other unique posture.
deformity
With the development of lesions, bone and joint or vertebral bone destruction, the above-mentioned unique posture remains unchanged and further develops, joint activities are further restricted and deformed, and spinal tuberculosis often has angulated kyphosis.
Examine
Lumbar tuberculosis examination
1, X-ray film on the performance of bone destruction and intervertebral space stenosis. Bone destruction is concentrated on the upper or lower edge of the vertebral body and quickly invades the intervertebral disc, manifesting as destruction of the vertebral endplate and progressive intervertebral space stenosis, involving two adjacent vertebral bodies.
2, cold abscess performance: in the lumbar vertebrae anterior piece, the psoas muscle abscess is characterized by one side of the psoas muscle shadow, or the waist muscles widened, full or limited bulge. Chronic cases can be seen with a large number of calcification shadows.
3, CT examination can clearly show the location of the lesion, with or without cavity and dead bone formation. Even a small paraspinal abscess can be found on CT. CT examination has unique value for psoas abscess.
4, MRI has the value of early diagnosis, abnormal signal can be displayed in the inflammatory infiltration stage, but it is mainly used to observe the compression and degeneration of the spinal cord.
Diagnosis
Diagnosis and diagnosis of lumbar spinal tuberculosis
diagnosis
According to the symptoms, signs and imaging findings, the diagnosis of typical cases is not difficult.
Differential diagnosis
1. Ankylosing spondylitis This disease has ankle inflammation. There is no symptoms of systemic poisoning. X-ray examination can not see bone destruction and dead bone. After chest traction, there will be clinical manifestations such as limited thoracic expansion.
2, the incidence of suppurative spondylitis is acute, with high fever and obvious pain, rapid progress, early blood culture can detect pathogenic bacteria. X-ray performance is progressing rapidly, and its characteristic X-ray findings can be identified.
3, lumbar disc herniation without systemic symptoms, lower extremity nerve root compression symptoms, blood sedimentation is not fast. There is no bone destruction on the X-ray film, and a prominent nucleus pulposus can be found by CT examination.
4, spinal tumors are more common in the elderly, the pain is increasing day by day, X-ray film shows bone destruction involving the pedicle, the intervertebral space is normal, generally no paravertebral soft tissue block.
5. Degenerative spondyloarthropathy is an senile disease. The general intervertebral space is narrowed. The upper and lower margins of the adjacent vertebral body are hardened and white, and there is a bone bridge. There is no bone destruction and systemic symptoms.
