Bone and joint tuberculosis debridement

Bone and joint tuberculosis are secondary to tuberculosis and digestive system tuberculosis. It is still more common in rural areas and mountain areas. The basic treatment for bone and joint tuberculosis is rest, increased nutrition and local restricted activity. The implementation of lesion removal on the basis of anti-tuberculosis drug treatment can greatly improve the efficacy and shorten the course of treatment. The lesion removal surgery directly enters the tuberculosis by surgical methods, and removes cold abscess, dead bone, tuberculous granulation tissue, necrotic tissue and hypertrophic synovial tissue as much as possible. However, although bone and joint tuberculosis lesion removal therapy has many advantages, not all patients with bone and joint tuberculosis need to perform surgery. Only some patients who have indications and general conditions are allowed to undergo surgery. Modern non-surgical treatments have also made a lot of progress, such as early diagnosis, early non-surgical treatment (including rest, nutrition, drug treatment and topical injection), some bone and joint tuberculosis can be cured, especially for infants. The ability to repair is strong, and more non-surgical treatment should be used first. Although the removal of lesions is an important part of the treatment of certain bone and joint tuberculosis, it is not the only link, and it can not replace other therapies. The bone and joint tuberculosis is a local manifestation of systemic tuberculosis, which can only be based on systemic and drug treatment. Perform a lesion removal procedure. Treatment of diseases: bone tuberculosis knee joint tuberculosis wrist joint tuberculosis hip tuberculosis ankle joint tuberculosis shoulder tuberculosis Indication 1. Simple bone tuberculosis in the extremities, with clear dead space, dead bone or sinus. 2. Non-surgical treatment of simple synovial tuberculosis in the extremities was not effective. 3. The joint part is deep, the puncture injection treatment is difficult, and the non-surgical treatment effect is not obvious (such as hip joint tuberculosis). 4. All-articular tuberculosis of the extremities, obvious destruction of articular cartilage, dead bone or complicated sinus, deformity. 5. Spinal tuberculosis with cold abscess, dead bone, paraplegia long-term unhealed sinus and more pus discharge. Contraindications 1. Active tuberculosis (such as invasive tuberculosis, tuberculous meningitis, etc.) in other parts of the body should be considered as surgical contraindications (eg, after reasonable treatment, stable or cured lesions, lesion removal can still be considered). 2. Systemic multiple tuberculosis, generally poor. 3. Spinal tuberculosis complicated with paraplegia, there have been a wide range of hemorrhoids, severe urinary tract infections, anemia, edema and other general maladies, should be actively treated, after surgery to fight for surgery. 4. After treatment with streptomycin and other anti-tuberculosis drugs, there was no significant improvement in systemic poisoning symptoms. 5. The elderly have poor tolerance to surgery, and the ability of infants to repair is strong. All non-surgical treatments should be used first. Preoperative preparation Bone and joint tuberculosis is a chronic wasting disease, and most patients have poor general condition. In order to ensure that the patient can perform the operation safely and the surgery receives good results, adequate preoperative preparation must be made, and surgery should be avoided in case of insufficient preparation. In addition to preoperative preparation for general surgery, bone and joint tuberculosis must be prepared as follows. 1. Acquired patient cooperation Bone and joint tuberculosis is a chronic disease with a long course of treatment and a certain degree of dysfunction after treatment. Therefore, most patients have irritable emotions and ideological burden. Before the operation, we must thoroughly explain the work, and truthfully seek the treatment plan and consequences (including the number of operations, external fixation and bed time, medication time and possible dysfunction) to the patient and their families to obtain cooperation. 2. Perform necessary examinations Before the operation, careful physical examination and chest fluoroscopy should be performed to find out if there are other tuberculosis in the body. For patients with long disease period and many sinus secretions, liver and kidney function should be checked. X-ray examination should be performed on the lesions. If necessary, spinal tuberculosis and paraplegia should be performed by CT examination to understand the lesions for surgical design. 3. Improve the general condition. Immediately after admission, you should rest in bed and perform bed defecation training to avoid difficulty in defecation due to unaccustomed postoperative. In general, TB patients have poor appetite and should seek to improve their appetite before surgery. Strengthen nutrition as much as possible to improve the general condition. 4. Drug treatment The application of anti-tuberculosis drugs is an important part of preoperative preparation, mainly to prevent the spread of lesions. Once the diagnosis is confirmed. Anti-tuberculosis drugs should be applied. Single drug treatment is not effective, and it is easy to cause bacterial resistance. In general, streptomycin is used in combination with isoniazid. The amount of streptomycin varies depending on the age, 0.25g per day for children under 5 years old, 0.33g for 5 to 10 years old, 0.5 to 1.0g for adults, and intramuscular injection once or twice. Isoniazid is taken daily for 5 to 10 mg/kg, orally or in three divided doses. After 1 week of anti-tuberculosis drugs, the symptoms of tuberculosis poisoning can begin to improve; in about 2 weeks, most patients have improved symptoms and can be operated on. Sodium salicylate is easy to cause gastrointestinal symptoms, affect appetite, and is less clinically applicable. However, when the efficacy of streptomycin or isoniazid is not good, sodium salicylate can be added in an amount of 8 to 10 g per day, orally or intravenously. For patients with drug resistance, kanamycin can be applied twice daily, 0.5g intramuscular injection; rifampicin orally, adult 450-600mg daily, 1 time or 3 times, ethambutol The alcohol was taken daily at 25 mg/kg, and the subsequent reduction was 15 mg/kg per day. If combined with streptomycin and isoniazid, the effect is better. Patients with bone and joint tuberculosis and sinus, need to use penicillin or other antibiotics before surgery to control suppurative infection and prevent postoperative wound infection. 5. Locally braked spinal tuberculosis patients should be placed in a hard bed or plaster bed, limbs tuberculosis, especially due to severe pain or muscle spasm caused by joint deformity, should be external fixation or traction to relieve pain, paralysis, patients can rest adequately It can prevent pathological dislocation or gradually correct deformity and reduce the difficulty of surgical operation. 6. Spine tuberculosis and hip tuberculosis lesions are more traumatic and should be matched with blood.