Balaji Gopisankar, Arockiaraj Justin, Roy Alfred Cyril, Ashok Anand
Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry. India.
Department of Orthopaedics Unit 1, Christian Medical college, Vellore. India.
J Orthop Case Rep. 2013 Oct-Dec;3(4):7-11. doi: 10.13107/jocr.2250-0685.122.
Isolated tuberculosis of the scapula is rare. The presentation mimics the tumors of scapula. Hence it is important to know the clinical presentation and when to suspect tubercular osteomyelitis of scapula. Few cases have been described before. We have analyzed all reports with isolated scapular tuberculosis so far and described the varied presentations.
We report two cases of isolated scapular tuberculosis. One patient underwent aspiration and was started on antituberculous drugs (ATT) and the other underwent debridement, drainage of abscess and then was started on ATT. Both had excellent outcomes at the end of one year follow up. We reviewed previous published literature of isolated scapular tuberculosis. The most common presentation of scapular tuberculosis is as follows: age less than 30 years and there is no difference with respect to gender. Swelling and pain are the commonest symptoms. Lytic areas with surrounding sclerosis is the commonest radiological finding. Body of the scapula is affected most commonly. Prognosis is excellent with adequate treatment.
To conclude, clinicians should have high index of suspicion for diagnosing this condition as it mimics tumors. Pain and swelling is the most common presentation of scapular tuberculosis. Radiography shows lytic lesion with marginal sclerosis. The prognosis is excellent with appropriate treatment.
孤立性肩胛骨结核较为罕见。其表现类似肩胛骨肿瘤。因此，了解其临床表现以及何时怀疑肩胛骨结核性骨髓炎很重要。此前仅有少数病例被描述过。我们分析了迄今为止所有孤立性肩胛骨结核的报告，并描述了其多样的表现。
我们报告两例孤立性肩胛骨结核病例。一例患者接受了穿刺抽吸并开始使用抗结核药物（ATT）治疗，另一例患者接受了清创、脓肿引流，随后开始使用ATT治疗。在一年的随访结束时，两例患者均取得了良好的疗效。我们回顾了此前发表的关于孤立性肩胛骨结核的文献。肩胛骨结核最常见的表现如下：年龄小于30岁，性别方面无差异。肿胀和疼痛是最常见的症状。溶骨性区域伴周围硬化是最常见的影像学表现。肩胛骨体最常受累。经过充分治疗，预后良好。
总之，由于其表现类似肿瘤，临床医生在诊断这种疾病时应保持高度怀疑。疼痛和肿胀是肩胛骨结核最常见的表现。X线片显示溶骨性病变伴边缘硬化。经过适当治疗，预后良好。
