1、TUBERCULOSIS of BONES the quantity of new bone formation of periosteum is determined by the age.,Pathology (Simple Skeletal TB),TB of the metaphysis (干骺端結(jié)核） forming sequestrua (死骨片） (cancellous bone) new bone formation of periosteum （骨膜） (compact bone),Pathology (TB of the Synovial membrane滑膜結(jié)核),Ear

2、ly stage: Hyperaemia 充血 Synovial hypertrophy 腫脹 Exudate increasing 滲出增多 Pannus formation （血管翳） femal20mm/h) Tuberculin skin test: immunocompetent patients: always postive immunocompromised patients: 33% postive,Diagnosis,Lab finding Bacteriologic examination (the tubercle bacillus culture) (36weeks)

3、 or histological examination of pus or biopsy specimen. Positive Rate of Culture for M. tuberculosis on smear pus: 70% granulomas or caseation (or cheesy) necrosis area:43% joint asperation or dead bone:35% Positive Rate of Pathological exam: 70 - 80% (Langerhans giant cells ) MRI and PCR use for ea

4、rly diagnosis,Method of Joint Aspiration for TB,Differential Diagnosis,Rheumatoid Arthritis: 2055歲女性，多關(guān)節(jié)、小關(guān)節(jié)，對稱性。RF因子（+） Ankylosing Spondylitis: 1535歲男性，多發(fā)，（脊柱、髖、膝），對稱性，無膿無死骨，HLAb27（+） Septic arthritis: 關(guān)節(jié)穿刺 Septic Osteomyelitis: 全身中毒癥狀重。細(xì)菌學(xué)和病理檢查 Bone Tumor: 脊柱結(jié)核早期侵犯椎間盤，椎間隙狹窄消失,急性骨髓炎(以破壞和增生為主）X線見骨質(zhì)廣

5、泛破壞，大量死骨及大量骨膜新骨形成,骨結(jié)核（破壞、疏松、萎縮為主）髓腔內(nèi)溶骨性破壞,無死骨；骨干周圍有廣泛新骨形成,慢性骨髓炎 破壞與增生并存; 骨質(zhì)硬化；大量死骨、包殼發(fā)生,骨結(jié)核 以破壞、疏松、萎縮為主; 很少硬化；死骨少、小(沙粒狀）,掌握要點(diǎn),骨與關(guān)節(jié)結(jié)核的診斷要點(diǎn)： 分四步驟： 病史與臨床表現(xiàn) 結(jié)菌素皮膚實(shí)驗(yàn) X線片檢查（胸部和患肢）; MRI 細(xì)菌學(xué)檢查（痰培養(yǎng)、膿腫穿刺液培養(yǎng)） 主要鑒別的疾?。?結(jié)締組織病 骨關(guān)節(jié)感染性疾病 骨腫瘤,Prophylaxis and Treatment,Effective TB Control The WHO-recommended treatme

6、nt strategy for detection and cure of TB is DOTS.,Treatment,Early diagnosis and the use of antituberculous drugs have radically improved the prognosis of tuberculous arthritis. Other measures adopted are rest to the affected joint in functional position, traction when needed and dietary improvement.

7、 Treatment consists of general medical measures, chemotherapy, local conservative orthopedic care, and surgery.,Criterion of Cure 治愈標(biāo)準(zhǔn),全身情況良好，體溫正常，食欲（orexia）良好 局部癥狀消失，無疼痛，竇道閉合 血沉3次結(jié)果正常 X線顯示膿腫縮小乃至消失或鈣化，無死骨，病灶邊緣輪廓清晰 起床活動已達(dá)1年，仍保持上述4項(xiàng)指標(biāo),Indications of operation 手術(shù)適應(yīng)證,骨關(guān)節(jié)結(jié)核有明顯的死骨忽而大膿腫形成 竇道流膿經(jīng)久不愈 脊柱結(jié)核引起脊髓

8、受壓,Spinal Tuberculosis,Clinical Manifestation Cervical: Neck Pain (mild to sever) Numbness of arm due to neural compression Obstructing breathing and swallowing with Postpharyngeal abscess,Tuberculosis of Spine Clinical Manifestation,Thoracic: Back pain Gibbous deformity Lumbar: Special Standing sta

9、nce,Pick-up test (+),Gravitation abscess,Osseous destroy and decrease in one or more disc spaces Cold Abscess: Cervical:,Lumbar,Thoracic,Tuberculosis of Spine Roentgenographic Findings,Principle of Treatment,Cast fixation Surgical treatment Evacuation or excision of soft tissue abscesses （切開排膿） Clea

10、rance of focal lesion （病灶清除術(shù)） Osteotomy, Arthrodesis and arthroplasty. （矯形手術(shù)）,Hip Tuberculosis,Clinical Manifestation Hip pain Limp Abscess of groin PE: Figure 4 test Hip hyperextension test Thomas test,Hip Tuberculosis,Roentgenographic Findings X-ray CT MRI,Hip Tuberculosis,Principle of Treatment C

11、hemotherapy Skin traction to prevention forming contracture hip (bending deformity) then fix with hip spica for 3 months. Simple synovial TB: Intra-articular injection with anti-tubercle medicine Synovectomy or curettage for the cases with intra-articular dropsy to reserve femoral head. (arthroscopy

12、/ local lesion, open/extensive lesion) Tuberculous panarthritis : ( anti-tb drug 1yr. ESR, CRP Normal.) Osteotomy, Arthrodesis and arthroplasty,Case report,74 yrs, female, low back pain, radiate to the rt. leg, 6 months with hip pain limited in bed 2 months progressive weight loss, anorexia, no feve

13、r, Tenderness at the rt. groin of the hip Limited rang of motion of rt. hip, Thomas sign (-) Lab test : Wbc normal, CRP , ESR,Oct. 26, 2019,Feb. 23, 2019,March 2, 2019,March 2, 2019,Hip joint aspiration,Pus-like liquid 5ml Culture (-),Q IL-6, IL8, IL-10, TNF-a),TB- Controversy & tendency,Early diagnosis: the molecular biology technic is still a developmental tendenc