Causes, symptoms, diagnosis and treatment of tuberculosis of bones and joints

osteoarticular tuberculosis is carried out with three groups of diseases:

• nonspecific lesions (rheumatoid, infectious, traumatic);
• dystrophic lesions of bones and joints (arthritis of different etiology);

• tumors (hemangioma, chondroblastoma, osteoblastoclastoma, eosinophilic granuloma, sarcoma , etc.).

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Treatment of tuberculosis of bones

The treatment of the disease is long, complex and takes from 1.5 to 3 years. In determining the therapeutic tactics takes into account the phase of the disease, the body's response to infection, internal organs etc. of a Complex therapy consists of restorative measures aimed at strengthening the resilience of the body, and specific means aimed at the destruction of the infectious agent.

For effective treatment is very important a comfortable life, including good nutrition, frequent and prolonged exposure to fresh air and mental peace. Shown Spa treatment with a well-established routine and nutrition.

Local orthopedic treatment

Local orthopedic treatment is the unloading and immobilization of the affected organs. In tuberculosis of the spine and the hip joint the patient is placed in a plaster bed. When spondylitis cot follows the shape of the back, grabs his head and comes to vertiujeni depressions the hip joints, the hip septic arthritis plaster bandage may cover only the affected limb. The patient remains in bed throughout the active phase of the disease. It is necessary to constantly monitor the correct position of the pelvis and legs. When chase and lesions of the ankle superimposed plaster booths.

In the decaying phase of the process in the presence of deformities, disorders of the ratio of the surfaces of the joints or vertebral bodies is shown wearing a corset, a removable dental apparatus.

Antibiotic therapy

Antibiotic therapy is most effective in the initial phase of the disease, it inhibits the growth of pathogenic microorganisms, developing relieves inflammation, prevents the development of complications, promotes rapid decay of tuberculosis. Of antibacterialtools are Streptomycin, Kanamycin, Viomycin, Rifampicin, and Cycloserine.

TB chemotherapy drugs are divided into 3 groups:

1. the hydrazide of isonicotinic acid, its derivatives and analogues (tubazid, ftivazid, megasid, etc.;

2. derivatives paraaminosalicilovaya acid: para-aminosalicylate sodium (PAS), and ethionamide, propionamide, terizidone, pyrazinamide;

3. reactions solyutizon, ataxic (rarely used).

Streptomycin is used in intramuscular injection in combination with oral intake of PAS and Ftivazide. Treatment is always carried out comprehensively, two in special cases – of three drugs at the same time, with the maximum dosage. The average duration of treatment is 12-18 months.

When using these medications in 95% of cases the tuberculosis process successfully stops and there is complete cure. The 2 groups of drugs are used, when the drugs of the 1st group do not bring to the therapeutic effect.

To improve the General condition, decrease in local inflammation, resorption of scars in the articular capsule, as well as when poor tolerability of antibiotics can be prescribed hormones. Their choice is determined by the status of the adrenal cortex. Applied cortisone, for intra-articular injection hydrocortisone. Hormonal therapy requires ongoing clinical observations and blood and urine tests.

Surgical methods

Apply the lack of effectiveness of conservative treatment of acute and progressive course of the disease. They reduce the duration of treatment, completely eliminate the pathological process in the tissues, and to restore the necessary motor function.

Surgical treatment can be applied at all stages and phases of the disease, regardless of the depth and extent of the pathological process, including when complications such as contractures, fistula and abscesses. Contraindications for it is the presence of severe concomitant somatic diseases.

Types of surgical intervention are divided into three groups:

• Radical (removal of focus);
• Restorative (corrective);
• Reconstructive.

Surgery can be selected depending on the location and extent of damage. One of its advantages is the opportunity to explore remote tissue thathelps to clarify diagnosis and to develop a more efficient and rational therapeutic program.

When radical surgery (resection, necrectomy), which completely removes the affected tissue affected by the disease of bones and joints (foci of bone destruction). This helps to prevent the spread of infection and the formation of new lesions.

During recovery operations (alloplasty) eliminated the effects of the tuberculous process – restores the anatomical structure is destroyed or resected bones and joints with artificial materials. For example, when deformation as a result of coxitis is corrective osteotomy, in which the limb is shown in functional position by cutting the bone of the distal part of the leg.

Reconstructive surgery (joint replacement) are used for larger destructions of bones and joints and require replacement of the bone or the entire artificial joint prosthesis.

After stabilization and the attenuation process can be a smooth transition of the patient to a normal lifestyle, with the obligatory adherence of the day and rest and the absence of excessive physical exertion.

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Physiotherapy

Mandatory and important part of the complex therapy is physiotherapy. In the active phase is obschegigienicheskih procedure, the purpose of which is to prevent muscle atrophy, prevention of secondary deformities and improve overall health. The affected part of the body, fixed in a cast, remains stationary.

In the stage of reducing the activity performed exercises involving movement of the affected organ, a massage of the lower extremities, gluteal muscles and paravertebral muscles of the back. On the affected joints massage not covered. Active movement in the affected joint when possible osteth, arthritis with surface destruction, but in the absence of caseous necrotic lesions and abscesses.

When remission and stabilization, the patient gradually passes from classes in the supine position exercises performed in a standing position, aimed at developing a proper posture and learning the proper walk. In addition to physical therapy can be used salt-coniferous baths for faster recovery of range of motion and motor activity.

akarova Evgeniya Vladimirovna, doctor-pulmonologist