外科学教学课件：骨关节结核（Eng）

1/27TuberculosisBoneAndJoint

KeyfactsTuberculosis–OldDiseaseMayhaveevolvedfromMbovis;acquiredbyhumansfromdomesticatedanimals~15,000yearsagoEndemicinhumanswhenstablenetworksof200-440peopleestablished(villages)~10,000yearsago;EpidemicinEuropeafter1600(cities)2/27KeyfactsTuberculosis(TB)isaninfectiousdiseasethatspreadsthroughtheair.OnlypeoplewhoaresickwithTBintheirlungs(pulmonaryTB)areinfectious.354-322BC-Aristotle（亚里士多德）–“Whenonecomesnearconsumptives…onedoescontracttheirdisease…Onetakesthediseasebecauseinthisairthereissomethingdiseaseproducing.”3/27KeyfactsWheninfectiouspeoplecough,sneeze,talkorspit,theypropelTBgerms(bacilli),intotheair.4/27TB:AirborneTransmissionTBInvades/InfectstheLungEffectiveimmuneresponseInfectionlimitedtosmallareaoflungImmuneresponseinsufficientAMulti-systemInfectionKeyfactsOnethirdoftheworld'spopulationiscurrentlyinfectedwiththeTBbacillus,butonly5%-10%ofpeopleinfectedwillbecomesickwiththediseaseintheirlifetime.6/27NaturalHistoryofTBInfectionExposuretoTBNoinfection(70-90%)Infection(10-30%)LatentTB(90%)ActiveTB(10%)UntreatedDiewithin2yearsSurviveTreatedDieCuredNeverdevelopActivediseaseTBInfection&Disease

Thereare2CategoriesofTB:Latent&ActiveTBinfectionofthelungscanfallinto2categoriesofdisease:LatentTBorActiveTB.LatentTBmeansapersonisinfectedbyTBbacteria,butcannotinfectothers,andisnotcoughingorappearingsick.LatentTBmeansthebody’simmunesystemhascontainedtheinfection.KeyfactsTuberculosismostlyaffectsyoungadultsintheirmostproductiveyears.发病年龄：好发于儿童和青少年，30岁以下的占80%9/27KeyfactsTheimmunesystem“wallsoff”theTBbacilliwhich,protectedbyathickwaxycoat,canliedormant（冬眠）

inthebodyforyears.Whensomeone'simmunesystemisweakened,thechancesofbecomingsickaregreater.Leftuntreated,eachpersonwithactiveTBdiseasewillinfectonaverageofbetween10and15peopleeveryyear.PeoplewithHIVaremuchmorelikelytodevelopTBafterinfectionduetotheirweakenedimmunesystems.发病诱因是机体抵抗力下降：外伤、营养不良、过度疲劳10/27Tuberculosis

BoneAndJointAlthoughskeletaltuberculosishasbeenreportedtooccurineverylocation,thespineismostfrequentlyaffected(50%),especiallythelumbarspine,followedbythehipsandkneesTuberculosis

ClinicalFeaturescontactwithTBpain,swelling,lossofweightjointswellingdecreaseROMankylosis（关节强直）deformity13/27臀部脓肿髋关节结核，男，34岁多发瘘孔（箭头所示）·髋关节内收·屈曲·内旋·下肢短缩10cm。Tuberculosis

Pathologyprimarycomplex(inthelungorthegut)secondaryspreadtuberculousgranulomaTuberculosis

Spinallittlepainpresentwithabscessorkyphosis（驼背）Tuberculosis

DiagnosislonghistoryinvolvementofsinglejointmarkedthickeningofthesynoviummarkedmusclewastingMtuberculosisascausative

agentfortuberculosis1886RobertKochTuberculosis

laboratoryfindingsFBC（全血计数）

,ESR（血沉）,TestMantoux（结核菌素试验，也称为芒图试验、PPD试验）Xray：

softtissueswelling periarticularosteoporosis（关节周围骨质疏松） jointappearwashedout articularspacenarrowing19/2720/2721/27第4,5腰椎结核22/27MRI显示L4,5椎体破坏，椎间隙变窄CT显示椎体破坏和腰大肌脓肿形成Tuberculosis

differentialdiagnosistransientsynovitis（一过性滑膜炎）monoarticularRA（单关节风湿性关节炎）haemorhagicarthritis（血友病性关节炎）pyogenicarthritis（化脓性关节炎）24/271.SupportivetherapyRestSunshine，freshair

andnutritionTreatment:

chemotherapyrifampicin（利福平）

isoniazid（异烟肼）12weeksethambutol（乙胺丁醇）streptomycin（链霉素）

Pyrazinamide

（吡嗪酰胺）rifampicinandisoniazid6-12month2.Chemotherapy26/27Localtreatment：splintageoperativedrainage：rarelynecessary27/27indicationsofoperation①

alargesequestrum②

abigabscesswhichcannotbeabsor