Tuberculosis of bones – a tuberculosis form, the second for prevalence, after tuberculosis of lungs. Damage of a backbone and bones of extremities is possible. It can be diagnosed at any age. The disease arises under the influence of a number of factors, including – overcoolings, adverse social conditions, hard physical work, decrease in immunity etc., but the crucial role is played by contact with the tubercular patient. The diagnosis is exposed on the basis of a X-ray analysis, a tomography and other researches. At initial stages treatment conservative, at considerable destruction of bones operations are performed.
Tuberculosis of bones
Tuberculosis of bones – the infectious disease caused by tubercular mikobakteriya (Koch's sticks). Strikes sites of spongy substance with plentiful blood supply, is followed by formation of the centers of destruction, abscesses and fistulas. It becomes frequent the reason of deformation of the struck segment, can cause contractures and shortening of an extremity. At backbone tuberculosis perhaps expressed backbone curvature, formation of a hump, and in hard cases – and paralysis of extremities.
More than in half of cases the backbone suffers. The second place on prevalence is taken by tuberculosis of large joints of the lower extremities (knee and coxofemoral). The combination to active pulmonary tuberculosis is observed rather seldom (approximately in 3% of cases), however when carrying out a X-ray analysis of lungs at patients characteristic sites of a kaltsination in lymph nodes or the top shares of lungs come to light (is more often than right). Treatment of this pathology is performed by phthisiatricians.
Reasons of development of tuberculosis of bones
Tuberculosis of bones, as well as other forms of tuberculosis, develops at hit in an organism of sticks of Koch. At the same time infection with mikobakteriya not always leads to development of a disease. The disease arises when the organism of the patient is weakened by overcoolings, too hard physical work, other infectious diseases and adverse vital conditions, and mikobakteriya of tuberculosis are in a ready state to active division or a condition of reproduction (as at active tuberculosis).
The first center arises in lungs, then mikobakteriya extend on lymphatic and blood vessels and get into a bone. Sites of a bone with good blood supply (vertebras, epifizarny departments of femurs, bones of a shin, humeral bones and bones of a forearm) are exposed to the greatest risk. As a result of reproduction of sticks of Koch in a bone small hillocks granulomas appear. At increase in granulomas bone substance collapses, abscesses which in the subsequent can be opened outside, forming fistulas are formed.
In most cases mikobakteriya "settle" in close proximity to a joint therefore at spread of an infection to process intra articulate structures are involved. Allocate three phases of development of tuberculosis of bones. The first – primary osteitis (formation of the center in a bone), the second – secondary arthritis (transition of an infection to a joint), the third – postartritichesky (the residual phenomena, a recurrence etc.). Expressiveness of the residual phenomena depends on time of an initiation of treatment, adequacy of therapy and a condition of an organism of the patient.
Classification of tuberculosis of bones
As tubercular process in most cases takes not only a bone, but also a joint, scientific and practical doctors usually use the term "bone and articulate tuberculosis". Allocate the following forms of this disease:
- Backbone tuberculosis. Can suffer as one vertebra, and a little. In 60% of cases defeat of chest department, in 30% – lumbar department is observed.
- Tuberculosis of a knee joint (drives). The most widespread tubercular damage of joints, comes to light at teenage age more often.
- Tuberculosis of a coxofemoral joint (koksit). Develops at children more often, can become the reason of considerable shortening of an extremity and formation of pathological dislocation of a coxofemoral joint.
- Tuberculosis of an ankle joint and bones of foot. Is followed by education it is long the existing fistulas and cavities. Quite often leads to a joint anchylosis owing to an union of articulate surfaces.
- Tuberculosis of a shoulder joint (omartrit). Comes to light seldom. The current is long, the purulent exudate in a joint usually is absent.
- Tuberculosis of a luchezapyastny joint. One more rare form of a disease. Damage of a joint and bones of a wrist, usually bilateral is observed. It is often combined with tuberculosis of an elbow or knee joint.
- Tuberculosis of an elbow joint (olenit). Usually develops at youthful age. At an overdue initiation of treatment sinter fistulas and abscesses are formed.
- Tuberculosis of a tubular bone without damage of a joint. Meets very seldom, usually comes to light at children, damage of pyastny bones and main phalanxes of a brush is characteristic.
Symptoms of tuberculosis of bones
Tuberculosis of bones begins gradually, gradually. Specific symptoms at early stages are absent. Patients are disturbed by the weakness, irritability, slackness, decrease in working capacity aching or nagging pains in muscles and slight increase of temperature. Some patients after physical activity have not intensive pains in the struck part of a skeleton, quickly disappearing at rest. Children with tuberculosis of bones become scattered, refuse outdoor games. The raised shoulders, a clubfoot, sudden stoop or limping without the previous trauma have to become an occasion to prick up the ears for parents. It is sometimes noticeable that the child protects a leg, tries to step less on it, does not jump on it or podvolakivat after long walking.
In the second phase of tuberculosis of bones process extends out of limits of a bone or vertebra, symptoms become brighter. Body temperature increases even more, weakness, slackness and weakness amplify. There are intensive pains in the field of defeat. At localization of the center in a vertebra violation of a bearing is formed, okolopozvonochny muscles inflame, vybukhat and become painful at a palpation. At damage of an extremity the joint reddens and swells, there is a progressing deformation, violations of gait and lameness are noted.
At further progressing of tuberculosis of bones the condition of the patient is even more aggravated. The expressed general weakness, temperature increase of a body to 39-40 degrees and loss of weight is observed. Intensity of pains increases, the pain syndrome becomes intolerable. Deformations amplify, the movements are even more limited. Mobility restriction, an atrophy of muscles of a back, deformation of a backbone, deformation and shortening of an extremity, a contracture or an anchylosis of a joint can become an outcome, depending on weight and prevalence of process.
Diagnosis of tuberculosis of bones
For confirmation of the diagnosis appoint a thorax X-ray analysis, a X-ray analysis of the struck segment and MRT of the struck segment. In pictures of a thorax of the patients having tuberculosis of bones the calcinated primary tubercular centers in the top departments of lungs and intra chest lymph nodes come to light. On roentgenograms of a backbone or the affected bones of extremities the centers of destruction and sequesters are visible. In certain cases it is possible to notice shadows of sinter abscesses.
Carry out tuberkulinovy tests, sometimes conduct a microbiological research of contents of fistula or abscess for identification of sticks of Koch. At fistulas or abscesses carry out an abstsessografiya or a fistulografiya. During the research the cavity is filled with contrast substance then do a series of the pictures allowing to estimate the sizes and a configuration of abscesses and the svishchevy courses. This technique has great practical value by preparation of the plan of surgery.
Treatment of tuberculosis of bones
Treatment of tuberculosis of bones complex, includes a diet, the all-strengthening actions and medicamentous therapy. Patients are sent to the specialized centers, clinics and sanatoria. In an active phase appoint a bed rest, in the subsequent recommend to happen more in the fresh air and to acquire a tan, apply massage and physiotherapy exercises.
In an active phase in an organism of the patient there is a strengthened disintegration of proteins therefore to it increase amount of food on 1/3 in comparison with norm and appoint the digestible diet with the high content of protein including eggs, boiled fish, mincemeat dishes, soups on fish and meat broth. During recovery increase amount of dairy products, during performing antibiotic treatment recommend to use a large number of fresh vegetables and fruit.
To patients with tuberculosis of bones appoint antibacterial therapy: , pyrazinamide, isoniazid, rifampicin and other medicines. If necessary carry out surgical interventions. The volume of operation depends on absence or existence of fistulas and abscesses, and also on extent of destruction of a bone. Sequesters excise, the svishchevy courses and cavities of abscesses wash out solutions of antibiotics and anti-septic tanks. At a favorable current of a cavity are closed over time, at adverse – are excised by the surgeon.
At emergence of rough defects and serious anatomic violations in the late period perform corrective and reconstructive operations. At the final stage carry out the rehabilitation actions directed to restoration of function of the struck segment and return of the patient to normal life. In the course of rehabilitation of patients with tuberculosis of bones apply physiotherapeutic procedures, massage and physiotherapy exercises, carry out social and professional rehabilitation.
Forecast and prevention of tuberculosis of bones
The forecast for life at tuberculosis of bones favorable. Use of the combined methods of treatment and modern antibacterial medicines allowed to bring a lethality almost to naught. However in the remote period at many patients deformations of an affected segment of this or that degree of expressiveness are observed. A half of patients with tuberculosis of a backbone reaches disability. At patients with the centers in bones of extremities lameness, shortening and deformation of an extremity, and also a contracture of various degree of expressiveness often remains.
Prevention of a disease consists in minimization of contacts with patients with active tuberculosis, the prevention of intoxications, injuries and overcoolings. An essential role is played by improvement of the general standard of living and ensuring social wellbeing. To parents recommend not to refuse conducting planned tuberkulinovy tests to children. It is necessary to treat seriously nonspecific symptoms (to weakness, weakness, slight increase of temperature) if they remain within several weeks. It is necessary to see a doctor at emergence of constant pains in bones and muscles even if these pains are poorly expressed.