Tuberculosis of bones - Causes, Symptoms and Treatment .MF .
Bone tuberculosis is the most common form of tuberculosis after pulmonary tuberculosis.The disease can occur at any age, but most often affects adults.Tuberculosis is found in various parts of the musculoskeletal system, but as a rule, most of the pathological process develops in the spine.
Causes of bone tuberculosis
development of the disease contributes to increased physical activity, trauma, recurring diseases, including infections, hypothermia, poor living and working conditions.
crucial prior contact with TB patients.The disease occurs when the penetration of infection - Mycobacterium tuberculosis from a tuberculous focus in the lungs through the blood and lymphatic vessels in the bone.Therefore risk are bone structures having a good blood supply, such as the humerus, femur, the body of the vertebrae, the bones of the lower leg and forearm.
During the multiplication of mycobacteria form specific tubercles-granulomas, which are then destroyed.When Pumping granulomas dissolves bone substance fo
In tuberculosis of the spine disease usually begins in one vertebra.In the development of granulomas is destroyed vertebral bone, the inflammatory process proceeds to neighboring sections.The spine is deformed.With the defeat of the thoracic spine is often due to compression of the spinal cord, forming paresis, paralysis.
Symptoms of bone tuberculosis
In beginning diseases typical symptoms of TB may be poorly expressed or absent.Patients concerned moderate increase in temperature to 37 ° C, seldom higher.Children become lethargic, drowsy, adults complain expressed general weakness, irritability, nagging, aching pain in the muscles, reduced working capacity.In some patients, after exercise or at the end of the working day appear weak pain in the spine, without a clear position.After a rest they are fully tested.
Thus, at the beginning of the disease all the manifestations of non-specific, so most patients do not seek medical attention, explaining the symptoms banal fatigue.
is necessary to remember the following rule.If the pain does not pass after taking anti-inflammatory or pain medications, or the effect of the drugs is insufficient or short-term, these pains are a sign of a serious disease, with whom you yourself probably can not handle.
When tubercular process goes beyond the vertebra (in the case of tuberculosis of the spine), begins the second phase of tuberculosis pzvonochnika .Weakness, lethargy, weakness intensified, high body temperature is maintained.However, there is severe pain or other spine.Because of the pain the patient is trying to move less, formed by a violation of gait and posture.At rest, the pain intensity or reduced, or they are completely gone.The muscles along the spine, are constantly on our toes, vybuhayut, painful at palpation.
In the third phase of spinal tuberculosis inflammatory process proceeds to the neighboring vertebrae.The general condition of patients with severe.They significantly lose weight, the body temperature rises to 39-40 degrees, severe weakness persists.Intense pain in the spine, often unbearable at rest, their intensity decreases somewhat.Because of the constant stay in a tone the muscles along the spine atrophy, movement in the spine dramatically difficult or impossible.
After treatment patients are spinal deformity, atrophy of the muscles of the back and limited mobility.
spinal deformity with bone tuberculosis
Sandro Botticelli's "Birth of Venus", detail, XV century.It is known that of models with which Venus is written, died at age 22 of tuberculosis.The painting draws attention sharply lowered his left shoulder.It is believed that the girl holds tuberculosis of the spine or the shoulder joint.
Some patients are saved complaints sense of instability in the spine, pain in the affected vertebrae.
Development tuberculosis of bones of the upper and lower extremities goes through the same stages as tuberculosis of the spine.Inflammation causes pain, redness and swelling of the development of the affected area.Because bone destruction occur deformation of limbs, gait disturbance, up to lameness, decreased disability.
Diagnostics of bone tuberculosis
All patients with suspected bone tuberculosis produced X-ray imaging or the affected organ in two projections.It identifies pockets of bone destruction, sequesters, sometimes the shadows of the sinter abscesses.
X-ray of the lumbar spine.The red circle shows a typical bone damage in spinal tuberculosis.
the presence of abscesses or fistulas to determine their extent is performed fistulography or abstsessografiya.The cavity of an abscess or fistula is filled with contrast medium stroke, then performed a series of shots.It is very important for diagnosis is microbiological research areas of dead bone, the contents of an abscess or fistula motion.In favor of bone tuberculosis says the discovery of Mycobacterium tuberculosis.The blood test identifies all the signs of an infectious inflammation:. Increase in the number of white blood cells, accelerated erythrocyte sedimentation rate, the appearance of C-reactive protein and others to confirm the diagnosis are also used provocative tuberculin test.
Considering the secondary nature of the disease, with suspected tuberculosis of bones is always necessary to perform radiography of the chest, and in the presence of specific complaints, to conduct a survey and other organs.
Treatment of tuberculosis of bones
Treatment of bone tuberculosis should be directed to the rapid elimination of infection, prevention of bone loss, as well as conducting nonspecific restorative treatment.
Diet for bone tuberculosis
The active phase of inflammation in patients with tuberculosis observed enhanced protein breakdown.Therefore, to accelerate the healing necessary to increase the consumption of foods rich in protein.The amount of food consumed should be increased by 1/3.Daily caloric during active inflammatory averages 3100-3500 kcal per day.This sverhusilennoe food leads to an overload of the body with unnecessary carbohydrates, obesity, is therefore inadmissible.
The day a patient with tuberculosis should consume an average of 100-120 grams of protein.At high temperature, protein intake body is reduced to 70 grams per day.Recommended: soups on meat or fish broth, the meat in the form of cutlets, paste, boiled fish, a variety of egg dishes.
In tuberculosis in the period of recovery in the diet should be increased content of milk and milk products as a valuable source of calcium for the damaged bone.When inflammation, as well as during treatment with antibiotics is recommended the consumption of large amounts of fresh fruits and vegetables, as well as pharmaceutical preparations containing a complex of vitamins.
Features lifestyle in the treatment of bone tuberculosis
At active inflammatory process is recommended bed rest.In the process of healing can be used physiotherapy, massage.The patient necessarily how much time should be carried out in the fresh air, have a good effect sunbathing.Typically, treatment and rehabilitation of patients is carried out in specialized clinics and nursing homes, where this mode of the day and the rest followed.
medical and surgical treatment of bone tuberculosis
most effective treatment of bone tuberculosis is a combination antibiotic therapy and surgical methods.Antibacterials applied both before and after surgery.It's drugs such as rifampicin, isoniazid, pyrazinamide, ethambutol, and others.Typically, these drugs are used together, it is long in a certain pattern.
volume surgery depends on the degree of bone destruction, and the presence of abscesses, fistulas.Surgically removed sequesters, oral abscesses and sinus tracts are washed with an antiseptic solution, antibiotic.Such cavities when adequate treatment with the passage of time are closing on their own or are eliminated by the surgeon.
much more complex operations are conducted in the late period of the disease with the development of gross anatomical abnormalities, major defects.Such operations do not eliminate the disability of patients, but they can significantly reduce its severity.
Rehabilitation after recovery should be gradual.Its main task is to complete restoration of function of the affected organ and the patient's return to normal life.At the same time apply therapeutic exercise, massage, physiotherapy treatments, as well as various methods of vocational and social rehabilitation.
Possible complications of bone tuberculosis
Possible complications include bone tuberculosis:
• curvature of the spine.
Severe spinal curvature with bone tuberculosis
On the site of the lesion of the vertebrae often formed hump.It is often combined with secondary deformity of the chest.This forms the compression of the chest.When spinal deformity in all patients develop more or less pronounced disorders of the nervous system, ranging from easy improve muscle tone or involuntary movements, ending with paresis and paralysis.
• abscess with tuberculosis of the spine are located next to the affected vertebrae.There may be a greater extent.The only method of treatment - surgery.
• fistulas arise on exit of inflammation on the skin surface.Currently rare.
Forecast of development of bone tuberculosis
Currently, mortality from tuberculosis of the bone is close to zero.But the disease is characterized by very severe with the development of irreversible deformation of the bones, which leads to permanent disability.It was found that patients become disabled in half of the cases of tuberculosis of the spine.Treatment long, many drugs are toxic, but only a timely appeal for medical help, and strict adherence to prescribing will prevent irreversible changes.
Prevention of bone tuberculosis
General preventive measures include actions aimed at reducing the probability of meeting with TB patients, as well as hypothermia prevention, injury, intoxication.
children and adolescents is recommended not to abandon the plan of tuberculin tests, as this may help to identify latent forms of the disease.Seeking medical attention if pain occurs in the bones, muscles contributes to the recognition of the disease in the early and effective treatment.
therapists Sirotkin EV