Overview: wrist joint tuberculosis in the upper ranks third in total body bone joint tb 0.43/100. More common in adults. Like the other limb joints, and other patients at the same time many parts of tuberculosis.[Cause]
mycobacterium tuberculosis is generally not a direct violation of the bone and joints, so it is most of the bone and joint tuberculosis changes are secondary, about 95% of secondary lesions in the lungs, lymph nodes into the blood by mycobacterium tuberculosis, and then spread throughout the body. As the large amount of wrist activity, when the deterioration in health, malnutrition, chronic fatigue or accumulated damage and to promote the formation of tuberculosis.
(B) the pathogenesis
wrist complex, proximal radius, ulna and triangular cartilage bottom, middle for the eight carpal bones, distal metacarpal base. Carpal articular surface is characterized by multiple, poor blood supply, not the muscles around the wrist cover, only a number of tendons, nerves and blood vessels through, it is easily found in the wrist joint swelling, abscess, sinus formation and easy ulceration. In addition, the sheath worn occasionally abscess, caused by secondary tendon sheath tuberculosis. Wrist joint synovial less, while a larger proportion of spongy bone, therefore, in the wrist joint tuberculosis should be simple bone tuberculosis bone tuberculosis or from the majority of total joint tuberculosis.
wrist tuberculosis, pure and simple synovial tuberculosis bone tuberculosis is very rare. This is less because of a wrist joint synovium, synovial tuberculosis incidence rate is low. Carpal and metacarpal base size is very small, small amount of bone lesions near joints and often quickly become invasive total joint tuberculosis, only the radius, ulna bottom of the larger, and can still see the simple bones.
into center-and edge of the lesion type, and has the characteristics of various types. These features in the radial, ulnar easier to see the bottom, in the carpal and metacarpal base, because of their size is very small, center-and edge-type is not easy to distinguish, often quickly develop full joint tuberculosis.
in the composition of the various bones in the wrist, the distal radius, skull, and the highest incidence of bone hook, large and small trapezoid second, triangular bone and metacarpal base at least. Pisiform bone tuberculosis is extremely rare.
late lesions, gradually forearm pronation, wrist sag and ulnar deviation deformity, joint stiffness gradually. Radius, ulna growth plate in the bottom radius, ulna account for the development of a very important position. Therefore, if the child's distal radius growth plate damage was tuberculosis, in the future will be shortened radius, resulting in radial deviation of wrist deformity.[Sign]
wrist What are the early symptoms of tuberculosis?
1. pain and tenderness at the beginning of a slight pain, as the lesion, the pain gradually increase, when the disease by the simple development of synovial or bone tuberculosis total joint tuberculosis, the pain is obvious. Simple bone tuberculosis tenderness limited to the site where the bone lesions, total joint synovial tuberculosis and tuberculosis have tenderness around the joint is full.
3. dysfunction, dysfunction of bone tuberculosis alone light, the whole joint tuberculosis is more obvious. As radio-ulnar joint was involved, the limited forearm rotation. Severe wrist damage, not because of the long-term activities of the fingers, finger stiffness, such as flexion and extension refers to the tendon is damaged, or the occurrence of adhesions, the finger function was limited.
4. abscess or sinus abscess is usually located in the dorsal or volar wrist, palpable fluctuations. abscess formed after rupture of the sinus, sinus is a first. Mixing of sinus infection can become more, sinus closure scar.
based on symptoms, signs, x-ray examination findings, diagnosis is not difficult. Simple synovial tuberculosis x-ray showed only soft tissue swelling and local osteoporosis. The lower end of radius and ulna x-ray findings of tuberculosis can be divided into central type and edge type. The former often sequestrum formation, after the death of bone resorption cavities; and the latter more common osteolytic destruction. tuberculosis of the carpal and metacarpal base although the center-and edge-type, but easily penetrated into the whole articular surface and joint tuberculosis, while the performance of carpal sparse. Early joint total joint tuberculosis still see the edge of destruction. Late shows a significant number of carpal destruction, blood flow is blocked, the formation of sequestrum. Began to increase when the joint space, after the narrow or disappear. As the positive performance of the x-ray examination appeared later, so there are symptoms, signs and blood cell sedimentation rate increased faster cases should be done early CT or MRI, tests on suspected cases of anti-TB treatment and should be plaster fixed 2 months, such as responded well to treatment, tuberculosis treatment, and wrist should be closely followed.[Aftertreat]
wrist should be how to prevent tuberculosis?
aggressive treatment of tb disease, to prevent the spread of TB, is the key to prevention and treatment of this disease. Also need to actively prevent recurrence after surgery, in principle, the complete removal of disease, based on the norms and adequate combination chemotherapy, not less than 1 to 1.5 years. For joint stability is poor, remove excess bone disease, should be implemented arthrodesis, restriction of joint activities, and better nutrition, health, enhancing the body resistance, to avoid over exertion and early weight-bearing.[Treat]
for no apparent sequestrum of bone tuberculosis alone, synovial tuberculosis or not suitable for surgical treatment can be old and weak non-surgical therapy. Content and non-surgical therapy and elbow tuberculosis treatment are the same. However, non-surgical treatment of serious damage to the efficacy of total joint tuberculosis is slow, often have more than a year.
this period will be available within a short plaster wrist dorsiflexion fixed in 30 ° position, the wrist in a functional position tonic, non-surgical treatment fails, surgery may be considered . Because of the anatomical characteristics of the wrist, dorsal approach to better.
1. simple synovial tuberculosis the first non-surgical therapy 1 to 2 courses of treatment, no response can be used for wrist synovectomy. Dorsal swelling of the dorsal approach may be obvious method of surgical dorsal synovectomy. palm side of the swelling can be significant for another vertical incision in the palm side of the synovial membrane removed. Fixed with plaster after wrist 3 to 4 weeks after removal of plaster, exercise wrist function.
2. simply no sequestrum of bone tuberculosis can be treated non-surgical therapy. Either surgical therapy ineffective, or have significant sequestrum should prompt surgical removal of disease. according to the lesion revealed a different incision. lesions on the lower end of radius and ulna, can be used for vertical incision; of the carpal metacarpal base and tuberculosis, can be used for the dorsal transverse wrist incision. After debridement and plaster the wrist with a fixed 3 to 4 weeks later to care for functional training.
4. late total joint tuberculosis in addition to frail elderly persons with non-surgical therapy, the dorsal approach should be used for debridement surgery. Carpal serious spoilers, resectable carpal row or two rows, if necessary, while removal of the bottom radius and ulna and metacarpal base. For the wrist caused by defects after resection of two treatment methods. If there is no mixed infection, and lesions cleared completely, free iliac bone defect filling, and with two kirschner wire through the lower end of radius and ulna, and metacarpal bone graft to be fixed base; also be filled without any bone, only a short plaster immobilization suffering from wrist in functional position, to be local fiber adhesion formation, bone-side close to each other and then to plaster practice activities. In both treatment methods, the latter is simple, but better; while the former, although the length may be retained, but the operative trouble, they need a long time after external fixation, functional results are poor.
such lesions have been stable, the joint occurrence of bony or fibrous ankylosis, but there are significant vertical wrist deformity, or forearm rotation was limited, should be cut distal radius bone surgery to correct vertical wrist deformity. In order to restore forearm rotation, resectable ulnar head, fixed with plaster after 3 to 4 weeks, then go to child care practice function.
(b) the prognosis
1. Some patients may have increased erythrocyte sedimentation rate is faster.
2.X-ray examination of the early cases, only osteoporosis and soft tissue swelling. development to the whole joint tuberculosis, there intercarpal and radiocarpal joint space gap to narrow, and the edge of the bone erosion. bone damage to the radial position of the head and hook-shaped bone bone is most common. Latter case the joint structure completely destroyed, the occurrence of carpal bone fusion between the not rare, but few see the radial wrist bone fusion.
3.CT can see the edge of the early detection of bone destruction, and found sequestrum.
this disease and these diseases were identified:
1. rheumatoid arthritis is the rheumatic wrist joint predilection sites of inflammation. Can be displayed, osteoporosis, joint edge of a small cystic defects, joint space narrowing, pathological subluxation, or bony ankylosis, but it often symmetrically involving multi-joint, the symptoms of intermittent seizures, bone surface erosion or small capsule was state absorption, no abscess, sinus or sequestrum formation. Patients often around the age of 40 women, mostly bilateral, often coexist with other joint diseases. The single is not easy to identify with synovial tuberculosis. Be diagnosed by biopsy and bacteriological examination.
2. lunate necrosis more common in young men, were often manual. Complained of chronic wrist pain and swelling, more than a history of trauma. x-ray film can be seen on the bone is relatively dense early and late changes on the bone flat, jagged. erythrocyte sedimentation rate in patients with slow, other carpal normal.
3.Brodie bone abscess can be seen even distal radius bone Brodie abscess. x-ray film can be seen distal radius limitations osteolytic destruction, generally no sequestrum, bone wall slightly hardened. Often difficult to type with the center bone tuberculosis differentiated. Have to rely on surgical exploration, bacterial culture and histological examination.
4. ganglion tuberculosis was gourd-shaped swelling of the tendon sheath involvement, limited finger function. The point is to identify x-ray negative, swelling and tenderness only one side of the wrist or palm.
5. wrist tumor distal radius is the primary bone tumor of location, giant cell tumor, reticulocyte cell sarcoma could be seen, the tumor is small and centered to be differentiated from tuberculosis of the bone cavity, the former Department of osteolytic destruction, which are reactive dense cavity wall.
6.Sudeck's bone atrophy: the early x-ray wrist joint tuberculosis were similar. The former mainly involving the spongy bone, resorption phenomenon was most spots, finishing its cortex is sharp, not destroyed, no change in joint space.[Disease]
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