骨结核:一项回顾性研究中的临床和放射性概况,管理和结果
Vinay Kumar Si1, Akash Hosthota2, Vinutha D3
1Orthopedics, Subbaiah Institute of Medical Sciences, Shivamogga, IND.
Cureus
|December 29, 2025
概括
根据印度国家结核病消除计划 (NTEP) 的骨结核病诊断和治疗显示出显著的疼痛减轻和成功的结果. 早期的MRI和活检对于及时诊断和尽量减少骨关节结核病的残疾至关重要.
科学领域:
- 整形外科 整形外科 整形外科
- 传染性疾病 传染性疾病
- 放射学 放射学是一门学科.
- 公共卫生 公共卫生
背景情况:
- 骨结核病 (TB) 是一种肺外结核病 (EPTB) 的形式,具有诊断上的挑战,占所有结核病例的1-3%.
- 有效的骨关节结核病 (OAT) 管理策略对于改善患者的治疗结果和减少长期残疾至关重要.
- 印度的国家结核病消除计划 (NTEP) 提供了一个管理结核病病例的框架,包括EPTB.
研究的目的:
- 评估根据NTEP管理的骨结核病患者的临床表现,诊断方法和治疗结果.
- 评估综合诊断方法的有效性,包括MRI,组织病理学和GeneXpert MTB/RIF,用于骨结核病.
- 分析标准化抗结核疗法 (ATT) 和选择性手术干预后的功能性结果和治疗成功率.
主要方法:
- 在2022年1月至2025年1月期间在第三级护理中心接受NTEP治疗的20名骨结核病患者的回顾性评估.
- 诊断整合了临床特征,MRI,组织病理学 (死核性颗粒状炎症) 和微生物学测试 (GeneXpert MTB/RIF).
- 使用视觉模拟尺度 (VAS) 评估疼痛的功能性结果,使用弗兰克尔分级对脊柱病例进行分级,以及使用关节特异性得分对脊柱外病例进行分级.
主要成果:
- 脊椎结核病影响了70%的患者 (14/20),腰椎是最常见的;脊外结核病涉及30% (6/20) 的各种关节.
- 平均VAS疼痛评分从治疗前的7.35显著改善到一年后的2.40 (p < 0.001);功能评分从相当到优秀不等.
- 所有患者都完成了NTEP指导的治疗,并获得了临床放射治疗,包括那些患有并发症和艾滋病毒的患者,没有被GeneXpert检测到的抗利芬素抵抗.
结论:
- 以NTEP为指导的复合诊断,结合成像,活检和分子检测,加上选择性手术和标准化的ATT,在骨结核病中产生了有利的结果.
- 早期利用MRI和活检对于准确和及时的诊断至关重要,大大减少了患者的残疾.
- 在NTEP框架有效地管理骨结核病,证明成功完成治疗和显著的疼痛缓解,即使在复杂的情况下.
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