Ihara K, Toyoda K, Ofuji A, Kawai S
Department of Orthopaedic Surgery, Yamaguchi University School of Medicine, 1144 Kogushi, Ube, Yamaguchi 755, Japan.
J Orthop Sci. 1998;3(2):120-4. doi: 10.1007/s007760050031.
A patient with tuberculous bursitis of the greater trochanter is reported. A 37-year-old woman had experienced persistent dull hip pain and noticed diffuse swelling over the greater trochanteric region. Plain radiograph revealed unremarkable osteopenic changes in the greater trochanter and faint mineralization in the vicinity of the trochanter. Computed tomogram showed erosion of the trochanter and a large soft tissue mass. Magnetic resonance imaging demonstrated a large multicystic mass. Histology of the cyst wall, showing chronic granulomatous tissue, and a positive culture of Mycobacterium tuberculosis confirmed the diagnosis of musculoskeletal tuberculosis. Complete excision of the lesion, followed by 6 months of antituberculous chemotherapy with rifampicin and isoniazid, cured the disease. There has been no sign of recurrent disease in 30 months of follow-up. Correct diagnosis was difficult because of its rarity, but modern imaging technology, magnetic resonance imaging, in particular, was extremely useful for showing the extent of the disease. Tuberculous infection should be considered as a differential diagnosis in patients with persistent hip pain.
本文报告了一例患有大转子结核性滑囊炎的患者。一名37岁女性持续感到髋部钝痛，并注意到转子区弥漫性肿胀。X线平片显示大转子骨质减少变化不明显，转子附近有模糊的矿化影。计算机断层扫描显示转子侵蚀和一个大的软组织肿块。磁共振成像显示一个大的多囊性肿块。囊肿壁组织学检查显示为慢性肉芽肿组织，结核分枝杆菌培养阳性，确诊为肌肉骨骼结核。病变完整切除，随后用利福平和异烟肼进行6个月的抗结核化疗，治愈了该病。随访30个月无疾病复发迹象。由于该病罕见，正确诊断困难，但现代成像技术，尤其是磁共振成像，对于显示疾病范围极为有用。对于持续髋部疼痛的患者，应考虑结核感染作为鉴别诊断。
