内科学教学课件：Tuberculosis of bone and joint.pptVIP

Stage II(Arthritis) The destructive process spreads to the articular surfaces. Cold abscesses appear and may point either on the lateral aspect or anteriorly. StageIII (Pathological Dislocation)  The destruction spreads in the acetabulum and pathological dislocation of the hip joint occurs The cold abscess bursts and there are sinuses discharging thin pus. Stage I No bony focus will be seen. The joint space appears widened due to the effusion. Stage II Erosion of the articular surface and narrowing of the joint space. Stage III Destruction of the head of the femur Travelling acetabulum with dislocation of the hip A break in the Shentons line. Conservative Management The patient is put to bed and the hip joint immobilised. Indications for early surgery: When the disease is stabilised, the presence of a well localised cavity in the neck of the femur or the acetabulum is an indication for surgical curettage. The End Thank You! * Conservative Treatment Complete rest in bed and improve his general health Antituberculous chemotherapy Periodically assessed. When the lesion is quiescent, the patient is given a spinal brace and made ambulant.? The chemotherapy is continued upto a total period of 9 months. Surgical Treatment The indications for surgery in paraplegia are as follows; 1. No sign of recovery after 3-4 weeks of conservative treatment. 2. Paraplegia getting worse in spite of conservative treatment. 3. Spastic paraplegia with severe and uncontrollable spasms of the legs. Anterior decompression and spinal fusion: (Hongkong operation). Through a standard thorocotomy, the abscess is evacuated and debridement done. The diseased vertebral bodies are excised (vertebrectomy) and the cord de-compressed. Autologous bone grafts? are placed between the vertebral bodies to promote anterior spinal fusion. Case 1 Pathology examination Case 2 Case 3 Case 4 Case 5 Kyphosis TUBERCULOSIS OF THE HIP JOINT Next to the spine, t