胸锁关节结核:16例保守治疗病例系列

Sternoclavicular joint tuberculosis: A series of conservatively managed sixteen cases.

作者信息

Kumar Sanjeev, Jain Vijay Kumar

机构信息

Department of Orthopedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, India.

出版信息

J Clin Orthop Trauma. 2020 Jul;11(Suppl 4):S557-S567. doi: 10.1016/j.jcot.2020.04.026. Epub 2020 May 1.

Abstract

INTRODUCTION

Sternoclavicular joint tuberculosis is rare with non-specific signs and symptoms thus making correct clinical diagnosis difficult. Delay in diagnosis results in destruction of osteo-ligamentous structures, spread of abscess to deeper planes as well as bursting through skin resulting in joint instability and scar formation.

MATERIAL AND METHODS

All the cases of sternoclavicular joint tuberculosis presented to the orthopaedic outdoor between 2004 and 2017 were evaluated clinico-radiologically along with cyto-histopathological and/or microbiological tests to ascertain the diagnosis before initiation of treatment.

RESULTS

There were 11 males and 5 females patients aged 11-65 years (mean, 35 years). Aspiration or curettage of the swelling was performed, and the diagnosis was confirmed in 12 cases by cytology, AFB stain, TB polymerase chain reaction, culture or a combination of these. In 4 patients, anti-tubercular treatment was initiated on clinical suspicion.

CONCLUSION

Diagnosing sternoclavicular tuberculosis requires multimodal approach. A strong clinical suspicion is required as the presentation is often atypical. Early detection of disease and with conservative treatment resulted in complete remission and minimal long term disability.

摘要

引言

胸锁关节结核较为罕见,其体征和症状不具特异性,因此临床正确诊断困难。诊断延误可导致骨韧带结构破坏、脓肿向更深层面扩散以及穿透皮肤,从而导致关节不稳定和瘢痕形成。

材料与方法

对2004年至2017年期间到骨科门诊就诊的所有胸锁关节结核病例进行临床放射学评估,并进行细胞组织病理学和/或微生物学检查,以在开始治疗前确定诊断。

结果

共有11例男性和5例女性患者,年龄在11至65岁之间(平均35岁)。对肿胀部位进行了抽吸或刮除术,12例通过细胞学、抗酸杆菌染色、结核聚合酶链反应、培养或这些方法的组合确诊。4例患者因临床怀疑而开始抗结核治疗。

结论

诊断胸锁关节结核需要采用多模式方法。由于表现往往不典型,因此需要高度的临床怀疑。疾病的早期发现并采用保守治疗可实现完全缓解且长期残疾最小化。

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