332例骨关节结核的临床特点分析  

Clinical features of 332 cases of bone and joint tuberculosis

作　　者：马俊[1] 肖和平[1] 尹洪云[1] 

机构地区：[1]同济大学附属上海市肺科医院结核病临床中心上海市结核病(肺)重点实验室,200433

出　　处：《中国防痨杂志》2016年第2期129-132,共4页Chinese Journal of Antituberculosis

摘　　要：目的分析骨关节结核的临床特点。方法选取上海市肺科医院2013年112月收治的骨关节结核患者作为研究对象，共332例。收集并分析研究对象的人口学特征、临床表现、实验室检查结果、影像学检查结果，以及骨关节结核的诊断和类型。结果332例患者中，男208例（62．7％）、女124例（37．3％），平均年龄（47．51±17．64）岁。初治患者224例，占67．5％；复治患者108例，占32．5％。发热74例（22．2％），局部疼痛280例（84．3％），功能受限160例（48．2％），局部肿胀99例（29．8％），出现神经根受压症状110例（33．1％），局部压痛242例（72．9％）。实验室检查结核感染T细胞斑点试验（T-SPOT．TB）阳性228例（68．7％），结核抗体阳性80例（24．1％），血红细胞沉降率（ESR）升高266例（80．1％），C反应蛋白（CRP）升高212例（63．9％）。影像学所见呈骨质破坏合并脓肿形成者197例（59．3％）。主要诊断为脊柱结核248例（74．7％），其中，腰椎结核168例（50．6％），胸椎结核80例（24．1％），骶髂关节结核16例（4．8％）；胸骨结核14例（4．2％），多发骨关节结核32例（9．6％）。骨关节结核合并血行播散性肺结核38例（11．4％），合并继发性肺结核78例（23．5％），合并其他肺外结核54例（16．3％）。结论骨关节结核发病部位以脊柱结核为主，临床表现为局部疼痛及压痛、ESR增快、CRP升高、T-SPOT．TB阳性；联合磁共振等影像学检查有助于诊断，骨质破坏合并脓肿形成是诊断骨关节结核的重要依据，合并肺结核及其他肺外结核是诊断骨关节结核的重要线索。Objective To analyze the clinical features of bone and joint tuberculosis （TB）. Methods A total of 332 bone and joint TB cases were selected from Shanghai Pulmonary Hospital between January and December 2013. The characteristics, clinical features, laboratory test results, mageological examination results and types of bone and joint TB of the cases were analyzed. Results Among 332 cases of patients, 208 were male （62. 7%） and 124 were female （37.3%）, with the average age of （47. 51±17.64） years. Naive patients in 224 cases, accounting for 67.5%; retreatment in 108 cases, accounting for 32.5%. Fever in 74 cases, accounting for 22.2%; local pain in 280 cases, accounting for 84.3%, functional limitation in 160 cases, accounting for 48.2%; local swelling in 99 cases accounting for 29.8%; 110 cases occur peripheral nerve compression symptoms which accounting for 33.1%; local tenderness in 242 cases, accounting for 72. 9%. Laboratory tuberculosis T cell spot test （T-SPOT. TB） positive in 228 cases, accounting for 68.7%; 80 cases of tuberculosis antibody positive, accounting for 24.1%. Eryth-ocyte sedimentation rates （ESR） elevated in 266 cases, accounting for 80.1 %, C-reactive protein （CRP） increased in 212 cases, accounting for 63.9%. Radiographic bone destruction was merged abscess in 197 cases, accounting for 59.3%. The main diagnosis of spinal tuberculosis in 248 cases, accounting for 74.70/00, of whicb 168 cases of spinal tuberculosis, accounting for 50.6%, 80 cases of thoracic tuberculosis, accounting for 24. 10%00, sacroiliac joint tuber- culosis in 16 cases, accounting for 4.8%; sternum tuberculosis in 14 cases, accounting for 4.2%; multiple bone tuberculosis in 32 cases, accounting for 9.6 %. Bone and joint tuberculosis with hematogenous disseminated tuberculosis in 38 cases, accounting for 11.4%, with secondary pulmonary tuberculosis in 78 cases, accounting for 23.5%, combined with other extrapulmonary tuberculosis in 54 cases, accounting for 16.3%. Conclusion Of bone and joint T

关 键 词：结核 骨关节 病理状态 体征和症状 诊断 

分 类 号：R529.2[医药卫生—内科学]