Agarwal Anil, Khan Shariq Azam, Qureshi Nadeem Akhtar
Department of Orthopaedics, CNBC, Geeta Colony, Delhi, India.
J Orthop Surg (Hong Kong). 2011 Dec;19(3):336-40. doi: 10.1177/230949901101900315.
To review records of 16 children with multifocal osteoarticular tuberculosis.
Records of 7 girls and 9 boys aged one to 14 (mean, 6) years with multifocal osteoarticular tuberculosis were reviewed. Haematological tests and radiographs of the chest, whole spine, pelvis, knees, elbows, hands, and feet were taken. The diagnosis was confirmed histologically. Patients were treated with standard 4-drug antitubercular chemotherapy (isoniazid, rifampicin, ethambutol, pyrazinamide) for 2 months, followed by a 2-drug regimen (isoniazid and rifampicin) for 10 months. Supportive treatment (deworming and nutritional advice) was also provided.
All 16 patients were immunocompetent. Pain and swelling around the lesions were the main symptoms; fever was not common (2 cases only). No patient reported weight loss or night sweats. The mean number of bony lesions was 3.4 (range, 2-15) per patient. Appendicular (hands and feet) involvement was more common than axial (spinal) involvement. Radiological appearances of the lesions were cystic, irregular, lytic, and with or without sequestrum/ periosteal reaction. Some lesions were asymptomatic and detected incidentally on radiographs. Only one patient had active chest lesions. Five patients had spinal involvement but no neurological deficit. No patient underwent any surgical intervention, except for diagnostic biopsy. The mean follow-up period was 18 (range, 6-24) months. All patients showed complete healing within one year of chemotherapy. There were residual deformities and restriction of joint movement in patients with advanced articular and axial osteoarticular involvement.
Children with multifocal osteoarticular tuberculosis were usually immunocompetent. Appendicular involvement was common, but concomitant chest involvement was uncommon. Standard multidrug antitubercular therapy and nutritional supplementation achieved good outcome.
回顾16例儿童多灶性骨关节结核的病例记录。
回顾7例女孩和9例男孩的病例记录，年龄1至14岁（平均6岁），均患有多灶性骨关节结核。进行了血液学检查以及胸部、全脊柱、骨盆、膝盖、肘部、手部和足部的X光检查。诊断通过组织学确诊。患者接受标准的四联抗结核化疗（异烟肼、利福平、乙胺丁醇、吡嗪酰胺）2个月，随后接受二联方案（异烟肼和利福平）治疗10个月。还提供了支持性治疗（驱虫和营养建议）。
所有16例患者免疫功能正常。病变周围的疼痛和肿胀是主要症状；发热并不常见（仅2例）。没有患者报告体重减轻或盗汗。每位患者的骨病变平均数量为3.4个（范围为2至15个）。四肢（手和脚）受累比轴向（脊柱）受累更常见。病变的放射学表现为囊性、不规则、溶骨性，有或无死骨/骨膜反应。一些病变无症状，在X光检查时偶然发现。只有1例患者有活动性胸部病变。5例患者有脊柱受累但无神经功能缺损。除诊断性活检外，没有患者接受任何手术干预。平均随访期为18个月（范围为6至24个月）。所有患者在化疗1年内均显示完全愈合。晚期关节和轴向骨关节受累的患者存在残留畸形和关节活动受限。
多灶性骨关节结核患儿通常免疫功能正常。四肢受累常见，但合并胸部受累不常见。标准的多药抗结核治疗和营养补充取得了良好的效果。
