多发骨与关节结核病一例诊治分析及文献复习  

A Case Analysis of Tuberculosis of Multiple Bones and Joints ：Diagnosis and Treatment with Literature Review

作　　者：屈满英[1] 蒋之[1] 万轲[1] 

机构地区：[1]湖南省长沙市中心医院肺科二病室,湖南长沙410007

出　　处：《医学临床研究》2015年第9期1710-1713,共4页Journal of Clinical Research

摘　　要：【目的】探讨多发骨与关节结核的临床特征、诊治过程。【方法】回顾性分析1例多发骨与关节结核患者的临床资料并结合文献复习。【结果】患者左侧颧骨处脓肿穿刺液分枝杆菌快培阳性，细菌分型为结核分枝杆菌复合群，联合药敏发现对异烟肼、利福平、利福喷丁均低耐，系耐多药颧骨结核。全身多部位出现结核病灶（颧骨、颈椎、胸椎及横突、肘关节、心包），明确诊断为多发骨与关节结核病（双侧颧骨结核并脓肿形成、右侧肘关节结核、C7～T3结核并椎旁脓肿形成、T9～10右侧横突骨结核、结核性心包炎）。经积极规律全身及局部抗结核治疗，预后良好。【结论】耐多药颧骨结核临床少见，多发骨与关节结核易被误诊及漏诊。诊断需结合病史、体征、影像学检查，确诊依靠抗酸染色（AFB）、结核分枝杆菌核酸（TB-DNA）和脓液分枝杆菌培养，以及病变骨关节组织活检病理诊断。规范抗结核对预防耐药骨与关节结核病具有重要意义。[Objective]To study the clinical feature of multiple bone and joint tuberculosis, the diagnosis and treatment process. [MethodslA retrospective analysis of the clinical data of one special patient with multiple bones and joints tuberculosis was discussed with additional review of literature.[Results] Fast culture of abscess puncture fluid from left zygomatic of the patient shows that mycobacterium was positive, and bacterial classification indicates a composite group of mycobacterium tuberculosis. Joint drug susceptibility found isonia- zid, rifampicin and rifampicin spray butyl were all low resistant, which meant multi-drug resistant TB zygomatic. Tuberculosis lesions （cheekbones, cervical, thoracic and transverse process, elbow, pericardium） were found in many areas of the body. Clear diagnosis was ensured multiple bone and joint tuberculosis （double side cheek bone tuberculosis and abscess formation, the right elbow tuberculosis, plus the C7 ~T3 vertebral tuber- culosis and tuberculosis abscess formation, T9-10 right-side transverse process bone tuberculosis, tuberculous pericarditis）. After positive regular systemic and local anti-tuberculosis treatment, the prognosis was fairly good. [ConclusionlMultidrug-resistant zygomatic tuberculosis is rare clinically, and multiple bone and joint tuberculosis are susceptible to misdiagnosis and missed diagnosis. Diagnosis should be combined with the history, signs, imaging examination, diagnosis relies on acid-fast stain （AFB）, TB - DNA and pus mycobacterium culture, as well as the joint biopsy pathologic diagnosis. Standardizing anti-TB to prevent drug resistance of bone and joint tuberculosis （TB） is of great significance.

关 键 词：结核 骨关节/诊断 结核 骨关节/治疗 穿刺术 回顾性研究 

分 类 号：R529.2[医药卫生—内科学]