Pubic Symphysis Tuberculosis

　　耻骨结核是全身骨关节结核的一种，多发于女性，可能与分娩时耻骨联合损伤有关。而结核杆菌感染是引起耻骨结核的直接因素。

　　一般发病缓慢，局部疼痛轻微，骨质破坏较重常有跛行。耻骨结核若病变部位在耻骨体后方（盆腔面），病变可在膀胱和耻骨间形成脓肿。寒性脓肿常破溃形成窦道。

　　Pubic tuberculosis is common in women of childbearing age, and those without tuberculosis in other parts usually have no systemic symptoms. The onset is usually slow, with mild local pain and severe bone destruction often leading to limping. Swelling and tenderness are common locally, and when seeking medical attention, there are often abscesses or sinus tracts. On the affected side, the hip joint has slight limitation of abduction, but no functional impairment.

　　Pubic tuberculosis is a type of systemic bone and joint tuberculosis caused by Mycobacterium tuberculosis. Therefore, it is important to carry out publicity and education on communicable diseases, and to prevent the occurrence and development of the disease by cutting off the source of infection and transmission. At the same time, attention should be paid to exercise to increase the body's resistance.

　　The examination of pubic tuberculosis includes laboratory tests and imaging tests, and the specific methods are described as follows.

　　1. Blood routine

　　Patients often have mild anemia, and those with multiple foci or long-term secondary infections may have severe anemia. In 10% of cases, the white blood cell count can increase, and in mixed infections, the white blood cell count can significantly increase.

　　2. Erythrocyte sedimentation rate

　　During the active phase of the lesion, the erythrocyte sedimentation rate (ESR) usually accelerates, but it can also be normal. The ESR of those with a stationary or cured lesion will gradually tend to normal, which is significant for follow-up, but this test is not specific, and other inflammatory diseases or malignant tumors can also accelerate the ESR.

　　3. Tuberculin test

　　Children under 15 years of age who have not been vaccinated with BCG, if the tuberculin test changes from negative to positive, it indicates that they have recently been infected with tuberculosis. It can also be positive due to atypical acid-fast bacilli infection, but the reaction is usually mild. False negatives can be seen in the early stage of the disease or in severe cases without allergic reactions. The change from positive to negative can also occur. There are reports that 14% of cases of bone and joint tuberculosis are negative in this test, so when the test is negative, it cannot be completely ruled out that active tuberculosis, including bone and joint tuberculosis, is not present.

　　4. Tuberculosis culture

　　It takes about 3 to 8 weeks to culture using the improved Rocha medium, with a positive rate of about 50%. Bactec rapid growth takes an average of 9 days. Polymerase chain reaction (PCR) detection can obtain results after 48 hours, and this method needs to be further improved.

　　5. Pathological tissue examination

　　When taking pathological tissue specimens, it has been reported that granulation tissue should be taken from the synovium. Tuberculosis culture and pathological histological examination should be performed simultaneously, complementing and verifying each other, which can increase the diagnostic rate by 70% to 90%.

　　6. Imaging examination

　　To date, routine X-ray radiography is still one of the preferred imaging diagnostic methods, but a few cases may require CT, CTM, MRI, or ECT examinations to improve the diagnostic level. X-ray radiography can show localized bone destruction in the pubic bone, commonly with dead bone, the lesion involving the pubic symphysis, and the pubic symphysis widening or dislocation.

　　Patients with pubic bone tuberculosis should eat more vegetables and fruits, and some coarse grains; eat more legumes and dairy products, and use some meat appropriately. Patients should not eat刺激性 food, such as sour, spicy, and fishy foods.

　　In the treatment of pubic bone tuberculosis, it is divided into surgical treatment and non-surgical treatment, and the specific methods are described as follows.

　　For patients without dead bone and without sinus tracts, anti-tuberculosis drug treatment alone can be curative.

　　For patients who have not responded to non-surgical treatment, focus resection therapy should be adopted.

　　1. Pubic bone focus resection

　　(1) Anesthesia Local anesthesia, epidural block, or general anesthesia.

　　(2) Position The patient lies on their back with the buttocks slightly elevated, the legs apart, a catheter placed before the operation to clarify the position of the urethra, and to avoid injury to the urethra during the operation.

　　(3) Exposure of the focus Female patients should turn the mons pubis and the labia majora downward, and male patients should pull the spermatic cord to the sides. Incise the periosteum and ligaments of the pubic bone, perform subperiosteal dissection, and expose the focus for resection. During the operation on the pelvic surface, attention should be paid to avoid injury to the urethra and bladder.

　　Proper hemostasis should be performed to avoid extensive swelling in the perineum after surgery. After lying in bed for 1 to 2 months after surgery, gradually get up and exercise.

　　2. Ischiorectal (bursal) tuberculosis病灶清除术

　　(1) Anesthesia Continuous epidural anesthesia or general anesthesia.

　　(2) Position The patient lies on their side, with the trunk at a 60° angle with the operating table surface, maintained by sandbags. The affected hip and knee joints are flexed at 45°, and the healthy lower limb is extended, with the position maintained by a restraint belt.