SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : TUBERCULOSIS OF BONES (ТUBERCULOSIS OSSIUM) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Always is the result of hematogenous migration tubercle Bacillus from the primary tumor (lung, lymph nodes, bronchial gland) into the bone.
The development of the pathological process is expressed in the destruction of bone tissue, the formation of granulomas in the bone cavities, followed by sprouting them in the joints or soft tissue. During germination of granulomas inside of the joint is the defeat of the synovial membrane, cartilage surfaces of the joint. During germination of granulomas in the soft tissue are formed sintered abscesses with liquid breakup in the center.
Symptoms. Pain, impaired function, swelling, muscle atrophy, deformity of the joints. Low grade fever, weakness, lethargy, fatigue.
For. Onset is often gradual, imperceptible, mainly affects children. Localization is possible in all the bones and joints, most often observed in the vertebrae and in the large joints (hip, knee). In the long tubular bones are mainly affected epiphyses, short - diaphyse.
The transition process on the soft tissue causes significant compaction of the latter. Atechnique spontaneously opened, forming a fistula through which highlighted small sequestrum and slimy liquid pus. Atechnique may be subject to resorption or stay for several years in the depth of the tissue as a source of repeated outbreaks of the process. When the joints are affected, patients, usually sparing the patient the joint, limiting his movement and giving limb position, limiting the tenderness. Long off the joint leads to the development of contractures or ankylosis. Inaction limbs and neurotrophic disorders leading to progressive muscular atrophy.
Recognition is difficult in the beginning of the disease; with the advent of the main signs (pain, muscular atrophy, deformation of the joints, abscesses, fistulas) the picture becomes clear. Radiographically characterized by osteoporosis articular ends of the bones before the appearance of the lesion in the bone; a clear picture is determined only from the appearance of granulomas.
The detection of tuberculous lesions, timely isolation of healthy children from tuberculous parents. Wide sanitary-educational work among the population to explain the ways of the spread of tuberculosis, the promotion of measures for the prevention of TB infection.
General treatment (see Diseases of the respiratory system tuberculosis of the lungs). Local treatment: rest the injured body, unloading to prevent the development of contractures. With the defeat of the spine: plaster bed, in the subsequent plaster corset. With the defeat of the joints: the corresponding plaster bandage with fixation of higher - and lower joint in a functionally advantageous position of the limb. In the presence of atechnical and abscesses, if the latter does not dissolve shown puncture and lavage of the joint antiseptic liquids (iodoform emulsion). Under special conditions - wide surgical intervention. In the treatment of fistulas need to guard against secondary infection.