Dhillon M S, Sharma S, Gill S S, Nagi O N
Department of Orthopaedics, PGIMER, Chandigarh, India.
Foot Ankle. 1993 Nov-Dec;14(9):505-13. doi: 10.1177/107110079301400904.
Skeletal tuberculosis constitutes 1% to 3% of extrapulmonary cases and involvement of foot bones is rare. Lack of awareness and a confusing clinical and radiological picture often lead to a delay in diagnosis. We reviewed 23 feet seen over a 3.5-year period. Most cases were children or young adults less than 40 years of age; isolated bony involvement was seen in 10 feet, with the calcaneus being involved in five cases. Articular involvement at presentation was seen in 13 cases and these cases had significantly higher delays in diagnosis. Twenty cases responded to antitubercular therapy alone while one case had to be operated (there was one fatal outcome). Complete resolution of sequestra was seen with antitubercular therapy alone. The results were better in cases with isolated bony involvement, while cases with joint involvement had residual sequelae in the form of stiffness or pain. Two patients were advised arthrodesis. Early diagnosis and antitubercular therapy is essential to prevent joint involvement from periarticular bony lesions; surgical intervention is rarely needed. A high index of suspicion has to be maintained in high risk groups like Asian immigrants. Concomitant extraskeletal lesions may not always be present.
骨结核占肺外结核病例的1%至3%，足部骨骼受累情况罕见。认识不足以及临床和影像学表现复杂往往导致诊断延误。我们回顾了3.5年间所见的23例足部病例。大多数病例为儿童或40岁以下的年轻人；10例足部为孤立性骨受累，其中5例跟骨受累。初诊时关节受累的有13例，这些病例的诊断延误明显更长。20例仅对抗结核治疗有反应，1例需手术治疗（有1例死亡）。仅用抗结核治疗即可使死骨完全溶解。孤立性骨受累病例的结果较好，而关节受累病例则遗留僵硬或疼痛等后遗症。2例患者被建议行关节融合术。早期诊断和抗结核治疗对于预防关节受累于关节周围骨病变至关重要；很少需要手术干预。对于亚洲移民等高风险人群必须保持高度警惕。可能并非总是存在骨骼外合并病变。
