骨结核合并多发骨梗死三例报告  

Multifocal bone infarcts combined with bone tuberculosis:3 cases report

作　　者：余一品[1] 王翀[1] 田征[1] 宋兴华[1] 李文举[1] 

机构地区：[1]新疆医科大学第一附属医院骨肿瘤外科,乌鲁木齐830054

出　　处：《中国骨与关节杂志》2013年第9期531-534,共4页Chinese Journal of Bone and Joint

摘　　要：目的探讨非潜水减压性多发骨结核合并骨梗死的诊断与治疗。方法收治3例多发性骨梗死伴疼痛的患者，1例患有系统性红斑狼疮并服用激素治疗，1例有长期大量饮酒病史，1例患有肾病综合征并服用激素治疗，3例患者术前均出现7个月至2年不等的膝关节及周围疼痛并逐渐加重。MRI显示骨梗死共10处，6处病灶内梗死的信号不典型，考虑合并感染可能。术前胸部X线片皆未发现活动性结核，并行视觉模拟评分法（visualanaloguescale，VAS）评估术前疼痛情况。对疼痛明显、梗死灶信号不典型的病变区域进行手术探查、行病灶清除、常规病理检查，病理诊断骨结核合并骨梗死，术后给予5联抗结核治疗。并观察其疗效。术后行视觉模拟评分法（VAS）评估疼痛情况。结果术后患者切口愈合良好，局部疼痛症状缓解， VAS评分改善为0～1分。随访12～24个月未出现疼痛及复发。结论在结核病高发区，晚期骨梗死患者，疼痛突然加重，MRI提示骨梗死灶内不典型信号，应考虑是否骨结核合并骨梗死。治疗上应按骨与关节结核进行。Objective To probe into the diagnosis and treatment of non decompression bone infarcts combined with bone tuberculosis. Methods 3 patients of multifocal bone infarcts and pain were collected. 1 case was of systemic lupus erythematosus （ SLE ） and treated with steriod. 1 case was of excessive drinking in alcohol. 1 case was of nephrotic syndrome and treated with steroid. Ingravescent pain occurred in all 3 patients from 3 month to 2 years about the knee joint. Active phthisis has not been found in X-ray test. Preoperative pain was evaluated by visual analogue scale （ VAS ）. 10 lesions of bone infarcts were found by magnetic resonance imaging （ MRI ）. 6 lesions might be infected because of some non-typical abnormal signal. The lesions accompanied by pain and non-typical abnormal signal were treated with surgical exploration, debridement, routine pathologic examination. Bone infarcts combined with bone tuberculosis was conifrm by pathologic diagnosis. Routine anti-tuberculosis therapy was used. Effects were observed. Postoperative pain was evaluated by VAS. Results Postoperative incision healing was good, local pain symptom was relieved, VAS scores reduced to 0-1 scale. No pain and recurrence was found in the follow-up ranged from 12 to 24 months. Conclusions Tuberculosis bacterium infection should be considered if pain suddenly aggravated in late bone infarction patients in high-incidence area of tuberculosis and MRI suggests non-typical abnormal signal. Treatment should be performed as what we did in bone and joint tuberculosis.

关 键 词：结核 骨关节 骨梗死 结核 

分 类 号：R687.3[医药卫生—骨科学]