Agarwal Anil, Kant Kumar Shashi, Kumar Anubrat, Shaharyar Abbas, Verma Indreshwar, Suri Tarun
Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalya, Geeta Colony, Delhi-31, India.
Hand Surg. 2014;19(3):369-74. doi: 10.1142/S0218810414500294.
We report the presentation, management, and outcome in five children with osteoarticular tuberculosis of distal radius.
PATIENTS were recruited in a prospective study. All patients underwent an open biopsy, curettage and diagnosis confirmed by histopathological/microbiological examination. In cavitary lytic lesions, bone grafting was also undertaken. The multidrug anti-tubercular chemotherapy was given for one year.
Five patients were included in the study. The average follow-up post-completion chemotherapy was 34.8 months. Bony lesions presented as a poorly defined radiolucent lytic area in metaphysis, cavitary lytic lesions with or without sequestrum or spanned the physeal plate. At final follow-up, except for one case, a full pain free range of movements was achieved in all cases. Fibular graft was used in two cases with cavitary lesions and incorporated well in both cases.
Tuberculosis can involve the adjacent physis and can be multifocal. The presentation is usually lytic with minimal sclerosis. For smaller ill defined lesions, curettage and multidrug anti-tubercular chemotherapy results in excellent outcome. Cavitary lytic lesions should be bone grafted as there is a risk of pathological fractures.
我们报告了5例桡骨远端骨与关节结核患儿的临床表现、治疗及预后情况。
患者纳入一项前瞻性研究。所有患者均接受了开放性活检、刮除术，并通过组织病理学/微生物学检查确诊。对于有空洞性溶骨性病变的患者，还进行了植骨。给予多药抗结核化疗一年。
5例患者纳入本研究。化疗结束后的平均随访时间为34.8个月。骨病变表现为干骺端边界不清的透光性溶骨区、有空洞的溶骨性病变，伴有或不伴有死骨，或跨越骨骺板。在末次随访时，除1例患者外，所有患者均实现了完全无痛的活动范围。2例有空洞性病变的患者使用了腓骨移植，两者均融合良好。
结核可累及相邻骨骺，且可为多灶性。表现通常为溶骨性，硬化轻微。对于较小的边界不清的病变，刮除术和多药抗结核化疗可取得良好预后。有空洞的溶骨性病变应进行植骨，因为存在病理性骨折的风险。
