骨關節結核病變的X光表現

從民國75年1月至民國78年12月，三軍總醫院共有39位經細菌學或組織學證實為骨關節結核病變者，統計其年齡、性別、發生部位，並就其X光表現作分析報告。病人年齡從11歲到90歲，其中以50-60歲佔最多(11/39)，男女比率為1.3:1。大部分病例為單一病灶，僅2例有一處以上病灶。發生部位以脊椎最多佔23例(58.9%)，其餘髖關節4例(10.5%)，膝關節、踝關節、鑣骨、肩關節各3例(8%)，肱骨、肘關節、薦腸關節、經骨，恥骨聯合各有1例(2.6%)，分析結果，常見的X光表現在脊椎和關節病變為骨糜爛(erosion)或破壞(destruction)，關節腔變小，骨質疏鬆，軟組織腫大或有鈣化。在長骨病變為較不具特異性的溶解性病灶(lytic lesion)合併不同程度的硬化(sclerosis)。此外，共有16位(43%)病人同時有X光可見的肺部病灶，雖然結核病例在過去數十年有減少的趨勢，我們仍然可以看到一些病例侵犯骨關節系統，大部份都因診斷延遲使骨關節嚴重破壞而變形。提高放射線醫師的警覺性與牢記其x光表徵應有助於疾病的早期診斷。

關鍵字

結核病；關節病變

並列摘要

Tuberculous osteoarthropathy is not common, which is reported to comprise 1% of tubercubus patients. However, the disease remains a major cause of bone and joint infection in many developing countries. Thirty-nine cases of tuberculous osteoarthropathy were collected in the past 4 years. All were proved by TB culture, biopsy or operation. The radiologic appearances were analized retrospectively. Among these patients, 23 cases had spinal involvement, mostly in the thoracic and lumbar regions, 14 cases had joint involvements and 2 cases had long bone involvements. Multiple site of involvements were uncommon, which were seen in two cases. The common radiologic features of tuberculous spondylitis and arthropathy were bony erosion or destruction, narrowing of joint or disc space and soft tissue swelling. Periarticular osteoporosis usually occurred at the late stage. Sclerotic bone reaction was unusual, which occasionally occurred in the lumbar region. The long bone lesions showed a non-specific picture of osteomyelitis with marked sclerotic bone reaction and periosteal new bone formation. Soft tissue calcification was not commonly seen, which might be a clue to diagnose osteo-articular tuberculosis, and could be well demonstrated in the CT study. Besides, associated pulmonary tuberculosis was found in about 43% of our patients.

並列關鍵字

tuberculosis ； arthropathy

國際替代計量

骨關節結核病變的X光表現

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