Tuberculosis of bones and joints

Tuberculosis of bones and joints is a large group of diseases of musculoskeletal system (about 10% of tuberculosis). Osteo-articular tuberculosis occurs on a background of the General hematogenous dissemination mycobacteria from existing in the body of the hearth. First, the disease occurs as an isolated bone lesion, then cover the joints and surrounding tissues, destroy them.
Pathological anatomy. Pathological bone joint tuberculosis is characterized by the formation of TB granulomas, most of which reverses its development, only a few of them are making progress, giving rise to the primary stitu. The initial focus is a conglomeration bumps with caseous necrosis in the center. Around developing area exudation. Bone beams are destroyed in large pockets nekrotizirovanne bone sequestered. With further progression is the destruction of the articular cartilage and the process applied to the joint. First of all affected the synovium. It is covered with tuberculosis granulomas, becomes swollen, formed inflammatory joint effusion in the bag. Pus and the dead mass of bone lesion or joint cavity often erupt into surrounding soft tissue, forming tuberculosis wandering abscess (see Matecznik), which interstitial spaces may travel considerable distance.
Anatomic-physiological features of a children's organism, richly developed vascular network epiphyses of the bone, and the vertebral bodies during their period of rapid growth determine the primary defeat of osteo-articular tuberculosis children. Appearance it is largely dependent on external adverse factors: poor living conditions of incomplete valuable nutrition, acute infectious diseases that weaken the protective forces of the child.
More common tuberculosis of the spine - 40%, hip and knee joints - 20 %. Less common tuberculosis other joints, divisov tubular bones. Spondylitis (see) is usually observed in 2-4 years of age, coxit (see) and drives (see) - 4-7 years, and tuberculous lesions of the joints of the upper extremities in the age of 15-20 years. Multiple foci are rare. The defeat of divisov tubular bones of the hand and foot occurs mainly in children under the age of 3 years. Most often affected more bones at a time.
The clinic. Clinical manifestations of osteoarticular tuberculosis caused by localization and character of pathological process. There are three phases of the disease: 1st phase - predostatochno (primary bone hearth); 2nd phase - arthritic with specific damage to the joint (in this phase, there are three stages of the disease - the beginning, the middle and remission); 3-I phase - postcritically with temporary stabilization of the process, but with the constant threat of aggravation.
The earliest sign of disease is the deterioration of the General condition of the patient. There is increased irritability, fatigue and lethargy of the child, loss of appetite, low-grade fever. This state without the expressed local manifestations of the disease (predostatochno phase) can take several weeks or even months. Biological reaction to the tuberculin (Pirke and Mantoux test), produced at this time, indicate tuberculosis sensitization.
Later joined by local manifestations of the disease: change of gait, lameness, pain, limited mobility, muscular atrophy. They characterize the first (initial) stage arthritic phase.
In the stage of the midst of disease are increasing symptoms of joint: see the swelling and effusion in the joint with increased skin temperature over him, develops contracture, leading to a vicious position of the limb. Along with atrophy of the muscles on the affected limb is developing a thickening of the skin fold is a symptom of Alexandrov. Deteriorating General condition of the patient, the temperature rises to 38-38,5 degrees. Often formed wandering abscesses. The skin above them first is unchanged, then becomes inflamed, formed fistula, which is released through the contents of matecznik - whitish liquid pus fine granulated masses. The accession of secondary infection significantly increase the tuberculosis process.
Stage of remission occurs slowly and gradually: General condition improves, reduces body temperature, normalized blood counts, inflammatory changes in the joints is reduced. The favorable outcome of the disease inflammation ends, and residual effects and deformation characterize posterities phase. With early diagnosis and timely treatment is possible to restore normal function of the affected organ.

  • Diagnosis and treatment of osteo-articular tuberculosis