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Similar a TB of Bone and Joint: Causes, Symptoms, and Treatment
Similar a TB of Bone and Joint: Causes, Symptoms, and Treatment (20)
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TB of Bone and Joint: Causes, Symptoms, and Treatment
- 1. Tuberculosis of Bone and Joint Li Qiang The Second Clinical College Hainan Medical College
- 2. 1 Tuberculosis of Bone and Joint General Considerations • Tuberculosis of bone and joint is a secondary not primary disease • Tubercle bacillus may reproduce rapidly while the whole condition of human body becomes poor • Tuberculosis of bone and joint occurs in the young people and teenagers • Spine is the commonest site,next to it is Knee,Hip ,and Elbow Joint
- 3. 2 Tuberculosis of Bone and Joint Pathology • Isolated bone tuberculosis a.Cancellous bone tuberculosis Formation of sequestrum b.Cortical tuberculosis New bone formation c.Metaphyseal tuberculosis Formation of sequestrum and new bone
- 4. 3 Tuberculosis of Bone and Joint Pathology • Isolated synovial tuberculosis a.Commonly occurs in knee,next to it is in the hip b.Focus at the site of synovial membrane c.Synovial membrane becomes thick,edema,hyperaemia.Inflammatory infiltration and fluid exudate increases
- 5. 4 Tuberculosis of Bone and Joint Pathology • Total Joint tuberculosis Come from isolated bone tuberculosis and isolated synovial tuberculosis
- 6. 5 Tuberculosis of Bone and Joint Pathology • Complications of total joint tuberculosis at late stage a,Gravity abscess(cold abscess) b,Sinus formation c,Pathological dislocation or subdislocation d,Stiffness or deformity of joint e,Shortage of limb f,Paraplegia
- 7. 6 Tuberculosis of Bone and Joint Treatment • The principles of treatment a,The treatment should be at early stage b,Systemic treatment should be combined with local treatment c,Indication for surgical treatment should be taken in to consideration
- 8. 7 Tuberculosis of Bone and Joint Treatment • Systemic treatment RDC Rest Dietetic treatment Chemotherapy
- 9. 8 Tuberculosis of Bone and Joint Treatment • Systemic treatment RDC Rest take proper rest Absolutely rest is not necessary,proper action,exercise should be encouraged
- 10. 9 Tuberculosis of Bone and Joint Treatment • Systemic treatment RDC Dietetic treatment High protein,high vitamini C diet should be given
- 11. 10 Tuberculosis of Bone and Joint Treatment • Systemic treatment RDC Chemotherapy • Total bactericide Isonicotinylhydrazide(INH) (rimifon),Rifampicin • Semi bactericide Streptomycini( mild basic) pyrazinamide(mild acid) • Bacteriostatic agent Ethambutol p-aminosalicylic acid(PAS) thiosemicarbazone
- 12. 11 Tuberculosis of Bone and Joint Treatment • Systemic treatment Principles of chemotherapy a, Combination in order to reduce drug resistance or anti-drug effect Streptomycin 0.75/day intramuscular injection Rimifon 300-400mg/day orally Rifampicin 600mg/day orally b,One time administration
- 13. Tuberculosis of Bone and Joint Treatment • Local treatment Two purposes Local drug administration Removing exudated fluid
- 14. 13 Tuberculosis of Bone and Joint Treatment • Surgical Treatment Once chemotherapy has been taken for 2-3 weeks(at least 2 weeks),operation can be considered
- 16. 15 Tuberculosis of Spine • General Consideration a,The highest incidence among the cases of tuberculosis of bone and joint b,Occurs commonly in children aged less than 10 years old c,Skipping spinal tuberculosis is very rare in clinic d,Site Vertebral body (lumbar>thoracic>thoracolumbar>lumb osacrum>cervical)
- 17. 16 Tuberculosis of Spine • General Consideration Reasons for easy occurring site a,Cancellous bone b,High gravity-bearing c,Affected easily by fatigue d,Poor blood supply e,Less muscular attachment
- 18. 17 Tuberculosis of Spine • Pathological types a,Central type commonly in children in thoracic Erosion of the whole vertebral body and disc b,Marginal type commonly in adult in lumbar The damage of intervertebral disc
- 19. Tuberculosis of Spine • Pathology Formation of cold abscess a,Paravertebral abscess It may occur at the anterior or posterior part of vertebral body,sometimes bilaterally b,Gravity abscess Cold abscess can travel along the musculo- fascial compartment to a distant area
- 20. 19 Tuberculosis of Spine • Examples of Gravity abscess a,Cervical Retropharyngeal abscess Retroesophageal abscess b,Cervicothoracic Mediastinal tumor like abscess c,Thoracic Paravertebral abscess d,Thoracico-lumbar Paravertebral abscess Great psoas muscle abscess e,Lumbar Knee and hip are often affected f,Lumbo-sacranal Rectus and collon g,Sacrum Presacral abscess
- 21. 20 Tuberculosis of Spine • Clinical Findings • General symptoms of tuberculosis Toxic symptoms of tuberculosis lassitude poor appetite loss of weight night sweats thin pale malar flush aching pain
- 22. 21 Tuberculosis of Spine • Clinical Findings • Local symptoms and signs a,Pain The first symptom after the onset Backache,lumbar pain are usually mild,often only a dull pain,worsen after activity,which means pain is not very severe b,Tenderness and percussing pain at the affected spinous process may happen
- 23. 22 Tuberculosis of Spine • Clinical Findings • Local symptoms and signs c,Limited movement of spine mainly due to muscular spasm(often sacrospinal muscle) In children A Pick-up test can be positive Let a child pick up anything,if he picks up the thing by bending the knee not by the bending of the spine Night cry mainly due to a sudden relaxation
- 24. 23 Tuberculosis of Spine • Clinical Findings • Local symptoms and signs d,Deformity Angulated deformity may occur(kyphosis),because of vertebral body destruction,vertebral body can be compressed into a wedge shape e,Gravity abscess Features of it demonstrate fluctuation and slight warmth,not tenderness,redness. It is different from pyogenic inflammation abscess
- 25. 24 Tuberculosis of Spine • Clinical Findings • Local symptoms and signs f,Paraplegia Early stage abscess,cheesy material,disc materials sequestra,granulation can cause active paraplegia which can achieve good result after operation of decompression
- 26. 25 Tuberculosis of Spine • Clinical Findings • Local symptoms and signs f,Paraplegia Late stage Thickness of dura mater,fibrosis of intravertebral canal granulation ,ring compression of reproduction of fibrous tissues on spinal cord, deformity, pathological dislocation can cause stationary paraplegia which can not achieve good result after operation of decompression
- 27. 26 Tuberculosis of Spine • Clinical Findings • Lab Test ESR may increase • X-ray Vertebral body may be eroded or destroyed at the margin or in the central part. Space between the vertebral body may become narrow.Sequestra and abscess shadow may be seen
- 28. 27 Tuberculosis of Spine • Treatment • General treatment • Chemotherapy • Operation Indications: a,Obvious sequestra b,Huge abscess c,Uncured sinus d, Paraplegia
- 29. 28 Tuberculosis of Spine • Differential Diagnosis • Bone tumor can destroy the vertebral bodies but in general speaking,tumor has normal spinal space on the X-ray check
- 30. 29 Tuberculosis of the Hip
- 31. 30 Tuberculosis of the Hip General considerations • Tuberculosis of the hip also is a common disease thirdly in the tuberculosis of bone and joint,the first one is the tuberculosis of spine, the second one is the tuberculosis of knee • Most cases are found in children(less than 10 years of age) • Most cases involve one side of the hip
- 32. 31 Tuberculosis of the Hip Pathology • Isolated synovial membrane tuberculosis a,most commonly seen b,less abscess formed c,sinus formation accounts for a tiny minority
- 33. 32 Tuberculosis of the Hip Pathology • Isolated skeletal tuberculosis a,Lesions above acetabulum start the course.Secondly involved site is femoral head or neck.The third site is the whole joint of the hip b,Skeletal destruction,sequestra,dead cavity can be easily seen c,Abscess,pathological dislocation can occur if the femoral head has been destroyed
- 34. 33 Tuberculosis of the Hip Pathology • Isolated skeletal tuberculosis d,When abscess in buttock or in the intrapelvic cavity is found,taking care of whether the tuberculosis of the hip occurs e,When the lesion is healed-limb shortening and deformity can form
- 35. 34 Tuberculosis of the Hip Clinical Findings • Toxic symtoms of tuberculosis Lassitude poor appetite loss of weight night sweat thin pale malar flush aching pain lower fever afternoon lower grade fever
- 36. 35 Tuberculosis of the Hip Clinical Findings • Local symptoms and signs a, Slight stiffness or claudication b, Continuos claudication and pain of the hip c, Night cry in children d, tenderness and percusing pain e, Loss of function of any direction f, Deformity • ESR may increase
- 37. 36 Tuberculosis of the Hip Clinical Findings • X-ray • Isolated synovial membrane tuberculosis osteoporosis thinness of trabecula swollen of joint capsule widen of joint space • Isolated skeletal tuberculosis skeletal destruction formation of sequestrum or sinus • Total joint tuberculosis pathological dislocation joint stiffness skeletal sclerosis
- 39. 37 Tuberculosis of the Hip Treatment • General treatment RDC • Surgical treatment Synovectomy and curettage(debridment) Arthrodesis Orthomorphia
- 40. Fig. 18-6 Osseous ankylosis after excision of hip for tuberculosis complicated by pyogenic infection.
- 41. 38 Tuberculosis of the Hip differential Diagnosis • acute pyogenic osteomyelitis or pyogenic arthritis • chronic pyogenic arthritis with lower toxin pathogens • reumatoid arthritis • transient synovitis of the hip • Legg-Calve’-Perthes disease (osteochondritis of femoral head)
- 43. 40 Tuberculosis of knee • Clinical findings • The cardinal symptoms are minimal in early stage,may be worsen by activity • Swelling around the knee is the local sign Floating Patella Test may be positive,if fluid accumulated in joint with middle amount,you can feel fluctuation over the knee
- 45. 41 Tuberculosis of knee • Differential Diagnosis • Rheumatoid arthritis(Peripheral type) • Pyogenic arthritis • Traumatic arthritis • Pigmented villonodular synovitis
- 46. 42 Tuberculosis of knee • Treatment • General treatment RDC • Local treatment Aspirating and injecting antituberculotics • Synovectomy through arthroscope • Joint fusion
- 47. Thank you for your attention