结核性脊柱炎ppt课件.ppt

1 Casereport Patientinformation JingXianLiuFemale78yNo p733876leftureteralcalculicombinedwithleftkidneyhydronephrosis 肾积水 结核性脊柱炎 TuberculousSpondylitis PottDisease 4 4 Epidemiology 80 under30y OsteoarticularTB 90 secondarytopulmonaryTB L T C adults T C L kids 骨关节结核 spine hip knee elbowjoint vertebraappendixaloneinvolvedisrare 5 5 Pathology Mycobacteriumtuberculosisspreadhematogenouslytoparavertebralvenousplexus 椎间静脉丛 anteriorpartofvertebralbodiesareprimaryinfected thenspreadbeneaththeanteriorspinalligament involvingadjacentvertebra Inadults diskdiseaseissecondarytothespreadofinfectionfromthevertebralbody Inchildren thedisk becauseitisvascularized canbetheprimarysite 6 6 Pathology Progressivebonedestructionleadstovertebralcollapseandkyphosis 驼背 Thespinalcanalcanbenarrowedbyabscesses granulation 粗糙 tissue ordirectduralinvasion 硬膜侵犯 leadingtospinalcordcompressionandneurologicdeficits Acoldabscesscanoccuriftheinfectionextendstoadjacentligamentsandsofttissues 7 7 Clinicalpresentation Commonsymptoms malaise 不适 lossofappetite weightlossandnightsweats Neurologicaldeficits spinestiff painfulwithmovement backmusclespasms 肌痉挛 localizedhumpback 驼背 Thesymptomsareofteninsidious 隐匿 evenduringtheactivestage 8 8 Radiographicfeatures bonedestructionsequestrum 死骨 narrow disapearofintervertebralspacekyphosisdeformity 后凸畸形 paravertebralabscess 9 9 Radiographicfeatures osteoporosis 骨质疏松 ofvertebralbodyirregularityoftheanteriorvertebralmarginofmultiplelevelsreductioninvertebralheight Ivory 象牙 vertebraeahumpbackdeformityvertebraplana 扁平椎 paravertebralabscess Plainradiograph chestfilmisneccessary 10 sensitivietocalcificationbetterexpressionofsequestrum 死骨 formation Radiographicfeatures CT Cross sectionalimaging 11 epidural 硬膜 cordcompressionmarrowoedema abnormalenhancementT1 hypointensemarrowinadjacentvertebrae T2 hyperintensemarrow disc softtissueinfectionT1C Gd marrow subligamentous 韧带下 discal meningesenhancement Radiographicfeatures MRI paraspinalcollectionswellcircumscribedwithenhancingmargins 12 12 PyogenicSpondylitis 化脓性脊柱炎 differentialdiagnosis 13 differentialdiagnosis 14 differentialdiagnosis 15 differentialdiagnosis 16 Manegement Prognosis primarygoal eradicate 消除 theinfectionSecondarygoals maintainstabilityofaffectedspinalsegmentscorrectingthespinaldeformitiespreventparalysismaintainpulmonaryfunctionTreatment supportivecarechemotherapysurgeryearlystages generalsupportivecareandchemotherapyadvancedcases Surgeryisindicatedonlyfordisease relat