В условиях современной эпидемиологической обстановки туберкулез костей занимает четвертое место в структуре заболеваемости внелегочным туберкулезом.
Туберкулез костей характеристика заболевания
Каждый десятый больной туберкулезом имеет костную форму болезни. Костный туберкулез начинается с попадания туберкулезной палочки в костный мозг. Она приносится из первичного очага туберкулеза с кровью. Начинается воспаление кости, приводящее к творожистому расплавлению кости. Далее часть погибающей от туберкулеза кости отделяется от основной кости — это называется секвестром. Потом палочка туберкулеза захватывает суставы.
Если туберкулезная инфекция затрагивает позвоночник и костные суставы, то человеку ставит диагноз туберкулез костей. Это заболевание переносится гематогенным путем из первичного очага поражения и чаще всего появляется у детей до десяти лет. В большинстве случаев туберкулез костей развивается в эпифизе суставного конца кости, где собственно и формируется очаг заражения. Затем инфекция переходит на синовиальную оболочку и суставные хрящи.
Отметим, что заболевание поражает различные части сустава, поэтому специалисты выделяют синовиальный и костный туберкулез костей.
Характерные особенности каждой формы:
Синовиальный туберкулез костей приводит к гиперемии и появлению множества бугорков, наполненных серозным эскудатом. Если лечение начато вовремя, то инфекционный процесс почти сразу же затихает с одновременным заживлением пораженных участков. Туберкулез костей, лечение которого не проводилось или проводилось неправильно, приводит к разрушению связочного аппарата и, в конце концов, полной дисфункции суставных концов костей.
Костный туберкулез протекает различно. Начинается болезнь либо с расплавления костного вещества кости, либо с омертвения значительных участков кожи, причем этот процесс со временем начинает распространяться на все большую и большую площадь. Независимо от первоначальных проявлений, костный туберкулез костей и суставов вызывает образование гнойного свища или полости, открывающейся наружу. Заметим, спустя несколько недель воспалительный процесс может стабилизироваться и у больного наступает стойкая ремиссия.
Фазы туберкулеза костей
Туберкулез костей имеет три фазы:
1 фаза — преартритическая: формирование очага деструкции в эпифизе;
2 фаза — артритическая: переход воспаления с кости на остальные ткани сустава с развитием вторичного артрита;
3 фаза — постартритическая: фаза последствий перенесённого остеомиелита;
Туберкулез костей симптомы
Наиболее характерные симптомы туберкулеза костей – это припухлость в области пораженного сустава, атрофия мягких тканей, скопление серозного или серозно — фибринозного экссудата, мышечная контрактура и ограничение подвижности суставной части. При рентгенологическом исследовании выявляются: ограниченные полости в кости, разрежение костного вещества и расширение или сужение суставной щели (зависит от наличия экссудата).
Этот вид туберкулеза характеризуется ощущениями боли в пораженных участках, а также нестабильностью, ограничением движения, патологическими переломами. Для этого вида туберкулеза очень важно своевременно отличить симптомы туберкулеза костей от других похожих болезней, связанных с опорно — двигательным аппаратом.
Сначала больные туберкулезом жалуются на постоянную, хотя и небольшую, температуру, утомляемость. Затем костный туберкулез вызывает боли при наклонах, движении. Часто страдает мускулатура — например, заметное истощение мышц одной ноги. На рентгеновских снимках при костно-суставном туберкулезе в концах костей видны светлые участки, похожие на сахар, тающий в воде. Это начальная стадия секвестров, еще не имеющих ясных границ. Признаков остеопороза нет. Щель между суставными поверхностями сначала увеличивается, а затем сокращается, поверхность хрящей в суставе неровная. Для костного туберкулеза характерно заражение от больного с открытой формой туберкулеза и медленное течение процесса. Кроме того, костный туберкулез сопровождается симптомами токсикоза, характерного для ранних стадий туберкулеза. Костному туберкулезу присуще образование гнойников, истощение мышц и укорочение одной из конечностей.
Костный туберкулез отличается от других воспалений костей и суставов положительной пробой Манту, палочка туберкулеза обнаруживается при посевах гнойного содержимого абсцессов, в периферической крови резко увеличено количество лимфоцитов.
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