cervical tuberculosis
Introduction
Introduction to cervical tuberculosis Cervical tuberculosis is most common in cervical vertebral inflammatory disease. Spinal tuberculosis ranks first in the incidence of bone and joint tuberculosis, accounting for 40% to 50%. Spinal tuberculosis occurs in cervical spine is relatively rare, accounting for only 2.2% to 6.3%. Cervical tuberculosis can cause spinal cord compression and lead to high paraplegia. The resulting illness is very serious, so attention should be paid to the early diagnosis, treatment and prevention of this disease. The basic trend of the age of onset of spinal tuberculosis is more common in children and adolescents. The higher the age, the less the incidence. It is generally believed that the onset of tuberculosis is related to the body's immunity. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: retropharyngeal abscess dysphagia cervical spondylosis
Cause
Cervical tuberculosis
Mycobacterium tuberculosis infection (45%):
From the primary lesion through the arterial system into the vertebral body, a small number of venous system and lymphatic vessels into the vertebral body. When the body's resistance is reduced, the thrombosis that enters the vertebral body forms a lesion. Most (about 90%) cases have only one vertebral lesion. In a few cases, the lesions are in two or more. The intervertebral disc has no blood running, so there is no primary intervertebral disc tuberculosis, but it is easily destroyed by tuberculosis.
Prevention
Cervical tuberculosis prevention
Prevention of cervical tuberculosis, first of all to completely treat the primary disease, prevent the spread of tuberculosis from the primary site to the cervical vertebrae, or the tuberculosis that has spread to the cervical vertebrae is quickly eliminated, no longer develop into a lesion, for the already formed cervical vertebrae Tuberculosis should be diagnosed early and treated early to shorten the course of treatment, reduce disability and prevent deformity. After the disease is cured, it should also pay attention to nutrition, avoid overwork, prevent the body's resistance from decreasing, and reduce the recurrence rate. Because cervical tuberculosis is a secondary lesion. Most of them are secondary to respiratory and digestive system tuberculosis, so the key to prevention is the prevention of primary disease.
1. Sound prevention and control institutions:
In recent years, the incidence of tuberculosis has shown an upward trend, reminding people that the prevention and treatment of tuberculosis cannot be relaxed. It is necessary to strengthen publicity and education, popularize the prevention and treatment methods of tuberculosis, establish and improve tuberculosis prevention and treatment institutions at all levels, and ensure human and material resources so that tuberculosis can be discovered in time. And standardization and standardized treatment.
2. Strengthen the exercise to protect susceptible people:
Strengthen physical exercise, enhance physical fitness, and actively improve the body's resistance, especially for the elderly, children and various immune-impaired patients. It is also necessary to pay attention to physical exercise to prevent the infection or recurrence of tuberculosis, and carry out the vaccination work of BCG to make the susceptible person change. For people who are resistant.
3. Eliminate the source of infection:
Early detection and thorough treatment of open lung, intestine, bone, joint, kidney or lymphatic tuberculosis patients, these lesions are cured, patients no longer sterilized.
4. Block the infection route:
Strengthen disinfection and isolation, block the infection route, thoroughly disinfect and treat the excretion of tuberculosis patients, do a good job of isolation of tuberculosis patients, and minimize the contact between healthy people and patients.
Complication
Cervical tuberculosis complications Complications, post-pharyngeal abscess, dysphagia, cervical spondylosis
1. Cervical tuberculosis can often form cold abscess, cervical vertebral lesions of tuberculous granulation tissue, inflammatory exudate, necrotic tissue, etc., forming pus through the vertebral cortex and collecting under the periosteum on one side of the vertebral body, forming a limitation Paravertebral abscess, the lesion continues to develop, the pus increases, the pus can break through the anterior periosteum and anterior longitudinal ligament of the vertebral body, and gather in the front of the vertebral periosteum and the posterior aspect of the longus muscle. More than 4 lesions in the neck, abscesses are located in the pharyngeal cavity. The back, therefore also known as the posterior pharyngeal abscess, the lesion below the neck 5, the abscess is mostly located behind the esophagus, a huge posterior pharyngeal abscess, can push the posterior pharyngeal wall forward, close to the base of the tongue, so the patient is very loud during sleep, and even causes breathing and Dysphagia, the pus in the lower cervical spine can sag along the long neck of the neck to the sides of the upper mediastinum, so that the shadow of the upper mediastinum is enlarged, like the appearance of the tumor, the posterior pharyngeal, the abscess after the esophagus can penetrate the pharyngeal cavity or esophagus, forming Internal hemorrhoids, so that the pus, dead bone pieces are swallowed or spit out from the mouth, and the pus on the lateral side of the vertebral body can also form an abscess on both sides of the neck, or along the anterior fascia and the scalene to the supraclavicular Note that the abscess can be directed The sinus is formed by in vitro perforation, and the sinus is often unhealed after it is formed. It is very difficult to treat when there is mixed infection.
2. The pus, granulation, cheese-like substance, dead bone and necrotic intervertebral disc produced by cervical tuberculosis can protrude into the spinal canal, compress the nerve root and spinal cord, and the dislocation or subluxation of the diseased vertebral body can also compress the spinal cord. There may be defamatory defects.
Symptom
Symptoms of cervical tuberculosis Common symptoms Deciding spinal cord compression, dysuria, urgency, urinary frequency, sensory disturbance, swallowing difficulties, night sweats, high fever
Systemic symptoms
Patients often have general malaise, fatigue, loss of appetite, body weight loss, low fever in the afternoon, night sweats, pulse rate, flustered palpitations and irregular menstruation, such as mild poisoning and autonomic dysfunction, such as mixed infection of abscess High fever, children's patients may have more fever, often have temperament, do not like to play, crying and night screaming, most patients have malnutrition and anemia, patients with tuberculosis, cough, cough, hemoptysis Or difficulty breathing, combined with urinary system tuberculosis, frequent urination, urgency, dysuria and hematuria.
Local symptoms
The neck is slightly persistent and dull, the extension is intensified, the weight is increased after exertion, the bed rest can be relieved, the nighttime pain is not obvious, and the patient can sleep well. This is different from the malignant tumor. The lesion aggravates the pain after stimulating or compressing the nerve root. It can be radiated to the shoulders, upper limbs or back of the pillow. The spinous processes of the affected part are tender and suffocating.
The neck is stiff and the movements in all directions are restricted. The bowing of the head and the torso are rotated together, which is caused by the protective spasm of the muscles around the diseased vertebrae. Some patients often have torticollis deformities; some patients lean forward. The neck is shortened, and the lower jaw is held by both hands to avoid aggravating the pain in the action. This is also called the Rust sign. The atlantoaxial joint is responsible for the head rotation. After the joint is involved, the head rotation function mostly disappears. The kyphosis is not obvious, and the physiological curvature is flattened.
Some patients have pre-neck abscess formation, pharyngeal discomfort, tone changes, loud snoring during sleep, severe breathing and dysphagia, a small number of patients spit pus from the mouth, dead bone tablets and cheese-like substances, pharynx After abscess or post-esophageal abscess rupture into the pharyngeal cavity or esophagus, physical examination can see and touch the abscess in the posterior pharynx and neck, undulating abscess in the posterior triangle of the neck, more suggestive of cold abscess, but Must be differentiated from lymph node tuberculosis.
Cervical tuberculosis occurs when the spinal cord is compressed, the patient may have spastic paralysis, and those with less compression may have incomplete paraplegia, that is, only movement disorders, combined with sensory disturbances and sphincter disorders, and severe compression may result in complete paraplegia. There is a clear plane of sensory disturbance, the limbs are hyperreflexia, and pathological reflexes such as the Babinski sign are mostly positive.
Examine
Cervical tuberculosis examination
1. routine inspection
Including blood routine, urine routine, fecal routine and liver and kidney function tests, hemoglobin is low, white blood cells are generally not high, and other bacterial infections are significantly increased, the proportion of lymphocytes is generally higher than normal, urine manure routine examination can understand Urinary system and intestinal tract with tuberculosis infection, liver function and mild damage, generally hypoproteinemia, white ball than inverted, serum electrophoresis examination found: when the lesion tends to be chronic, albumin decreased and alpha and gamma globulin Both can be elevated, and the use of anticonvulsant drugs can change this condition, but it is not effective for drug-resistant people.
2. Tuberculin test
As a diagnostic method, there is only a certain reference value. It is helpful for early diagnosis of children under 5 years old who are not vaccinated with BCG. Negative indicates that they are not infected with tuberculosis, and positive indicates that they have been infected with tuberculosis, such as from negative to positive, indicating Tuberculosis infection occurs shortly. As for children over 5 years old and adults, most of them are positive. Doing this test is not helpful for diagnosis, but it should be given enough attention when there is a strong positive reaction.
3. Tuberculosis culture
It takes a long time, and the general positive rate is 50% to 60%. Therefore, the diagnosis rate of cervical tuberculosis is not high by relying on pus culture.
4. Animal inoculation test
The positive rate is high, which is helpful for diagnosis, but the procedure is complicated, it takes a long time, the cost is relatively consistent, it is necessary, and it can be used when there are conditions.
5. Pathological biopsy
For the determination of diagnosis is of great value, puncture needle biopsy and surgical exploration can be used to take biopsy. Puncture needle biopsy often has less difficulty in diagnosis. If surgical examination reveals pus or cheese-like substance, it can often be diagnosed as tuberculosis. There is suspicion that the pathological diagnosis is decided.
Diagnosis
Diagnosis and diagnosis of cervical tuberculosis
diagnosis
The onset of the disease is insidious, the progress of the disease is slow, some patients have a history of tuberculosis or tuberculosis, early symptoms are mild, not easy to find, adult patients are often misdiagnosed as rheumatism, strain and anti-rheumatic or other symptomatic treatment, children's Mild symptoms are more easily overlooked. Some patients have no symptoms in the early stage. They can be found by chance when they are examined. In some cases, until a cold abscess, cervical deformity and paraplegia are found, only a small number of patients have a rapid onset, and the systemic and local symptoms are obvious. .
Differential diagnosis
When the early bone destruction is not obvious, or the symptoms are not typical, the diagnosis often has certain difficulties, and should be identified with the following diseases.
1. Cervical suppurative osteomyelitis :
More rapid onset, rapid rise in body temperature, obvious symptoms of poisoning, white blood cells can be increased to 10 ~ 20 × 109 / L or more, neck pain, limited mobility, local swelling and tenderness are often more obvious, but more subacute and chronic No high fever, it is difficult to identify with tuberculosis. X-ray film shows that the formation of dead bone is earlier, and the late vertebral body can be seen with obvious bone hyperplasia and sclerosis. The thick bone bridge can often be formed between the vertebral bodies, and the new bone formation of cervical tuberculosis is less. The spread of abscess on MRI images is different. The abscess of this disease has no regular boundary, and it is easy to destroy paravertebral ligaments, small joints, etc., and the abscess of cervical tuberculosis shows more smooth borders, and there is no invasion of ligaments.
2. Cervical tumor:
Vertebral tumors are often malignant, less benign, and metastasis is the most common in malignant tumors. It occurs mostly in middle-aged and elderly patients. The neck pain is more obvious, and it is aggravated at night. The paravertebral shadow is mostly round, and the intervertebral disc is not invaded. After the break, the anti-tuberculosis treatment did not improve, and gradually increased, and sometimes the primary cancer was found.
3. Spontaneous atlantoaxial joint dislocation
Most of the patients are children under the age of 10, often secondary to pharyngeal inflammation, the child holds the lower jaw, has a torticollis, limited neck activity, easily misdiagnosed as atlantoaxial joint tuberculosis, X-ray film shows the atlas Dislocation, odontoid displacement to the lateral and posterior, but no bone destruction, no soft tissue before the vertebrae.
4. Cervical spondylosis :
Caused by degeneration of the cervical intervertebral disc and its secondary changes, mostly after 30 years of age, may have neck or neck and shoulder pain, neck activity is limited, there are fashionable nerve root and spinal cord compression symptoms, patients generally no Hyperthermia, night sweats, neck kyphosis and other symptoms, X-ray plain film has intervertebral space stenosis and vertebral body bone hyperplasia, but no bone destruction and thickening of the anterior soft tissue, MRI examination showed disc kyphosis, signal reduction More cold abscesses were found.
