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of hip department of pulmonary medicine髋关节结核肺科课件

of hip department of pulmonary medicine髋关节结核肺科课件

ID：19783967

大小：4.40 MB

页数：63页

时间：2018-10-06

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1、SkeletalTuberculosis(Part-2)Dr.SunilAroraJuniorResidentDeptt.ofChest&TBGovt.MedicalCollege,Patiala.11IntroductionSkeletalTBaccountsfor10to35%ofcasesofextrapulmonarytuberculosis.Althoughspineisthecommonestsite(constitutingabout50%)ofskeletalTB.Theotherbonesandjointsc

2、analsobeinvolved.SkeletalTBgenerallyoccursduetohaematogenousspreadfromaprimaryfocus.2ClassificationTUBERCULARARTHRITIS-30%HIPJOINTKNEEWRISTJOINTSACROILIACJOINTANKLEJOINTANDFOOTSHOULDERJOINTTUBERCULAROSTEOMYELITIS-19%LONGTUBULARBONESSHORTTUBULARBONESFLATBONES-RIBS,ST

3、ERNUM,SCAPULA,PELVISTENOSYNOVITIS/BURSITIS-1%3PathogenesisItproducessimilarresponseasinlungsi.e.Chronicgranulomatousinflammation.Thediseaseprocesscanstarteitherinboneorinthesynovialmembrane.Activefocusformsinthemetaphysis(inchildren)orepiphysis(inadults)andtheinflam

4、mationextendsperipherallyalongtheshafttoreachthesubperiostealspace.Theinflammatoryexudatemayextendoutwardthroughthesofttissuetoformcoldabscessandsinuses.Theaffectedbonemayundergofracture.4Metaphysealinfectionreachesthejointthroughsubperiostealspacebypenetratingtheca

5、psularattachment.Inadults,theinflammationcanspreaduptothesubchondralareaandenterthejointattheperipherywheresynoviumjoinsthecartilagewhichleadstothelooseningtheattachmentofarticularcartilageandjointdisplacement.5Sometimesthesynoviumisinfectedfirstandtheboneisinfected

6、secondarily.Itisusuallyintheformoflow-gradesynovitiswiththickeningofthesynovialmembraneandleadingtotheformationofpannus.Eventually,thearticularcartilageisdestroyed,jointgetsdistendedwithpus,whichmayburstouttoformacoldabscessordischargingsinus.Thejointmayalsogetsublu

7、xatedduetothelaxityofthejointcapsuleandligaments.Fibrousankylosisisacommonoutcomeofhealedtuberculosisofthejointsexceptinspinewherebonyankylosisfollowsmoreoften.6TypesTwoclassicalformsofdiseasehavebeenseen;granularandandexudative(caseous)thatinvolvetheboneandsynovium

8、.BoththepatternshavebeenobservedinpatientsofskeletalTB,oneformmaypredominate.1.Osseousgranulartype:--oftenfollowstrauma-insidiousonset,con

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