儿童骨关节结核77例临床分析

Bone and joint tuberculosis in children： A retrospective study of 77 cases

目的进一步了解和掌握儿童骨关节结核临床特征，减少误诊。方法回顾性分析1992年12月至2005年4月我院骨关节结核病患儿病历资料，并对患儿进行随访。结果共有77例骨关节结核。大多因疼痛和／或行走姿态异常就诊。其中脊柱结核28例，受累椎体大多数在2个或2个以上，最多的达9个椎体；伴结核中毒症状19例（19／28，67．9％）；6例伴有不全性截瘫。脊柱外骨关节结核49例，其中髋关节结核最多占32例；45／49例单个关节受累；伴结核中毒症状25例（25／49，51．0％）。41例（41／77，53．2％）无结核接触史。血沉22例（22／30，73．3%）明显增快。8例（8／20，40．0％）血结核抗体（IgG）阳性。经过3至10年随访：完成疗程者共55例,12例失访。其中50例（50／55，90．9％）临床治愈，5例（5／55，9％）肢体功能障碍，余22例中10例自行停药未完成抗痨治疗，关节变形或截瘫，不能行走。结论本组骨关节结核中髋关节受累最多，脊柱结核次之。起病一般较隐匿，半数以上的患儿无明确结核接触史；在脊柱和脊柱外骨关节结核中伴结核中毒症状患儿的比例占一半以上。骨关节结核以骨关节疼痛和／或行走姿态异常为主要表现，诊断主要依靠X线检查、CT或MRI，血沉和血结核抗体IgG检测有助于骨关节结核的诊断。早诊断、早治疗、联合全程用药是改善骨关节结核患儿预后，降低患儿肢体功能障碍发生率的关键。

Objective To retrospectively review 77 cases of bone and joint tuberculosis （BJTB） in our department. Methods Seventy seven cases diagnosed with BJTB between December 1992 and April 2005 in Chongqing Children＇s hospital were reviewed retrospectively. The clinical features, his topathological and radiological results, and outcomes of follow-up were analyzed. Results The 77 cases of BJTB consisted of 47 male and 30 female. Median age at diagnosis was 3. 16 years （range, 3-6 years）. Forty-one （53.2%） patients had no history of tuberculosis contact. Twenty eight patients were diagnosed with vertebral TB and the other 49 were extravertebral BJTB. The common complaints were pains in the affected area and abnormal walking patterns. Among the 28 vertebral TB cases, the number of affected vertebral bodies ranged from 2 to 9, 67. 9% （19/28） patients had tuberculosis poisoning symptoms, and 6 cases suffered incomplete paraplegia. Of the 49 extravertebral BJTB cases, 32 were affected in the hip joints, 7 in the articular genu and synovium of knee joints, 6 in the femurs, 2 in the ankle ioints, 1 in the distal end of sinister-humerus and 1 in the dexter petrosal bone; 45 were affected in single joint. The erythrocyte sedimentation rate （ESR） elevated in 22 （73.3%） out of the 30 tests. TB serological tests were positive in 8 （40. 0%） out of the 20 tests. Seventy seven eases have been followed up for 3 to 10 years. Of the 55 patients completed a standard course of antituberculosis （anti-TB） therapy, 50 （90.9 % ） were cured and the other 5 had lower limb dysfunction. Ten patients who failed to complete a standard anti-TB therapy were disabled for joint deformation and paraplegia. Twelve patients were lost to follow up. Conclusions Hip is the most common BJTB site followed by vertebral body. Early diagnosis and an early standard combined anti-TB therapy are the key points to improve the prognosis and reduce the disabilities of the children with BJTB.