| disease | Bone and Joint Tuberculosis |
Bone and joint subcutaneous nodes have the highest incidence in children and adolescents, but they can also occur in adults. About 50% occur in the spine, with weight-bearing joints such as the hip, knee, and ankle being more common, while upper limb joints like the shoulder, elbow, and wrist are less frequent.
bubble_chart Diagnosis
It often occurs secondary to pulmonary or intestinal tuberculosis. The bacilli from the primary lesion invade the joints or bones through the bloodstream and, when the body's resistance is reduced, can proliferate to form lesions and cause clinical symptoms.
Based on the location and progression of the lesion, it can be classified into simple bone tuberculosis, simple synovial tuberculosis, and total joint tuberculosis.
1. Systemic symptoms: Vary in severity, usually presenting as a chronic onset with symptoms such as low-grade fever and weight loss. If complicated by infection, there may be high fever and purulent discharge from wounds. The erythrocyte sedimentation rate is often accelerated.
2. Local symptoms: Progress slowly, with early symptoms often being occasional joint pain that gradually worsens and becomes persistent. Pain increases during activity and is accompanied by tenderness, which may radiate to other areas, such as hip joint tuberculosis pain often radiating to the knee joint. Muscle spasms due to pain during movement can restrict both active and passive joint motion. Persistent muscle spasms may lead to joint contractures or deformities, and disuse atrophy of the affected limb. In the advanced stage, joint deformities, pathological dislocation, or limb shortening may occur due to bone destruction or epiphyseal growth disturbances. In spinal tuberculosis, spinal cord compression may lead to paraplegia due to vertebral collapse, abscess formation, or granulation tissue. Spinal tuberculosis and other joint tuberculosis often present with cold abscesses, which, if ruptured, may complicate infection, exacerbate symptoms, and result in chronic sinus wounds that fail to heal.
bubble_chart Treatment Measures(1) Systemic treatment: Mainly includes systemic supportive therapy and drug therapy. Supportive therapy involves improving nutrition, fresh air, appropriate sunlight, and psychological comfort for the patient. Drug therapy primarily involves the appropriate combined use of anti-subcutaneous node medications, which can enhance efficacy and reduce bacterial resistance to medicinal properties.
(2) Local treatment: The application of traction and fixation to prevent and correct limb deformities, maintaining joints in functional positions, typically requiring 4–6 months.
(3) Surgical treatment.
Under the control of systemic supportive therapy and anti-subcutaneous node medications, timely and thorough surgical treatment can shorten the course of therapy, prevent or correct deformities, and reduce disability and recurrence.
1. Lesion debridement: This procedure involves direct access to the lesion, completely or nearly completely removing the diseased tissue.
2. Joint fusion.
3. Management of cold abscesses: To prevent spontaneous rupture leading to secondary infection or organ compression, repeated aspiration can be employed. For larger cold abscesses (formed during the Great Cold, the 24th solar term), surgical treatment is necessary.
4. Correction of deformities: If joint subcutaneous node healing results in bony ankylosis with severe deformity, osteotomy should be considered to correct the deformity.
1. Diagnosis is based on medical history, exposure to subcutaneous nodes, and the aforementioned systemic and local symptoms. Due to the slow progression of the disease, early confirmation is crucial.
2. X-ray examination: Early X-ray images may show no significant changes, followed by osteoporosis, narrowing of joint spaces, as well as bone destruction and cold abscesses.3. Laboratory tests: The erythrocyte sedimentation rate is often increased. In children with suspected cases, a subcutaneous node bacillus test can be performed. When joint effusion is present, aspiration and laboratory tests can be conducted to detect subcutaneous node bacilli; sometimes culture and animal inoculation are required, and a biopsy may be necessary when indicated.
