Sacroiliac joint tuberculosis

　　Sacroiliac joint tuberculosis (tuberculosis of sacroiliac joint) is relatively common, more common in young and middle-aged adults, slightly more in women, and rare in children. It often invades one side of the sacroiliac joint, and occasionally both sides.

　　The cause of sacroiliac joint tuberculosis is the infection of the respiratory or digestive tract through contaminated air, and then through the blood circulation to the bone infection.

　　Sacroiliac joint tuberculosis is divided into synovial type and bony type, often caused by tuberculosis bacteria through hematogenous infection or secondary infection, leading to joint synovitis and swelling, and the destruction of articular cartilage and underlying bone by tuberculosis granuloma tissue. Initially, it is mostly bony tuberculosis, occurring in the sacrum or ilium, and then spreading to the joint. The joint lesion progresses posteriorly, penetrating the posterior joint capsule or sacrum, causing the abscess to accumulate deep in the gluteus maximus muscle. The lesion progresses forward, penetrating the anterior joint capsule or sacrum, and the pus flows to the space between the psoas major muscle and the iliac muscle, or within the muscle, or to the more posterior part of the iliac muscle. Occasionally, the pus may flow to the inguinal region or above the thigh. There may also be lesions that break through the lower joint capsule, with the abscess flowing along the sacrotuberous ligament or into the vicinity of the greater trochanter via the piriformis muscle. There may also be separate abscesses formed in the front and back, or they may communicate with each other. The abscesses can溃破 to form sinus tracts; in some cases, the pus may penetrate into the abdominal cavity or rectum.

　　Sacroiliac joint tuberculosis often causes severe destruction, with the affected side of the sacrum moving upwards, resulting in pathologic dislocation. Women are more prone to dislocation, and sometimes there is symphysis pubis dislocation, which may be related to the looser pelvis in women.

　　The onset of sacroiliac joint tuberculosis is generally slower than that of vertebral tuberculosis. It often presents with abscesses, pain, and tenderness, and is often delayed in diagnosis due to the reduction of pain after the abscess ruptures and relieves pressure. There may be pain in the lower back and the affected side of the sacroiliac region, and there may also be 'sciatica' or referred pain to the affected hip and lateral thigh. However, it is different from the symptoms of lumbar disc herniation, which does not radiate to the lower leg and foot, with no change in sensation, and pain increases during activity, such as turning over, sitting for a long time, climbing stairs, bending over, etc. When standing, the body usually leans to the healthy side; when walking, one is afraid to take big steps, and it is often painful in the sacroiliac region when lying on the back.

　　Sacroiliac joint tuberculosis is not very common in clinical practice, accounting for about 8% of all bone and joint tuberculosis. As a local manifestation of systemic tuberculosis infection, sacroiliac joint tuberculosis often occurs with other diseases. Relevant studies have shown that 50% of cases of sacroiliac joint tuberculosis are accompanied by tuberculosis in other parts, such as pulmonary tuberculosis, pleurisy, or lymph node tuberculosis, etc. Therefore, in addition to symptomatic treatment for sacroiliac joint tuberculosis, active treatment of tuberculosis infection should be carried out to prevent complications caused by tuberculosis. In addition, sacroiliac joint tuberculosis can also be complicated by pathologic dislocation of the sacroiliac joint.

　　Sacroiliac joint tuberculosis develops slowly, with a long course of disease, with some reaching 15 years, mostly 1-2 years. If there is no other tuberculosis, the general condition of the patient with sacroiliac joint tuberculosis is usually good. In terms of clinical manifestations, there are mainly local pain and abscesses, with occasional limping. Some patients may have pain radiating along the sciatic nerve.

　　Pain is usually limited to the affected side of the buttocks, and it is difficult to wear socks and shoes when sitting cross-legged. Early symptoms are very mild and gradually worsen. After the lesion breaks through the joint capsule, the pus is exuded, the intra-articular pressure decreases, and the pain is relieved. In the late stage, when the joint develops fibrous or bony ankylosis, the pain completely disappears. There may be palpable fluctuation in the iliac fossa or buttocks. The compression and separation test of the pelvis is often positive. Buttock abscesses or sinus tracts may appear at the buttocks, hip fossa, or greater trochanter of the femur.

　　During the examination, there is limited flexibility in the forward bending, backward extension, and lateral bending of the spine in the standing position, with local pain. However, the activity is better in the sitting position. The straight leg raising test in the supine position is limited on the affected side with local pain. Pain occurs when the iliac bone is compressed or separated, and there is tenderness in the affected part of the sacroiliac joint. There may be cold abscesses or sinus tracts. Local tenderness and swelling can sometimes be felt during rectal examination. X-ray film examination is very important for early diagnosis, and it is necessary to take anteroposterior and oblique views (sagittal plane) of the sacroiliac joint, showing bone destruction, sequestra, and空洞 formation, etc.

　　Sacroiliac joint tuberculosis often occurs through hematogenous infection or secondary infection by tuberculosis bacteria, causing congestion and swelling of the joint synovium, destruction of the articular cartilage and underlying bone by tuberculosis granuloma tissue, and concurrent tuberculosis of adjacent lumbar sacral vertebrae or hip joints.

　　This disease is caused by Mycobacterium tuberculosis and is often a local manifestation of systemic tuberculosis infection. Therefore, in terms of prevention, it is necessary to do a good job in the publicity and prevention of infectious diseases, actively treat the infected, and prevent tuberculosis infection from causing this disease is the key.

　　Sacroiliac joint tuberculosis is not common in clinical practice, accounting for about 8% of total bone and joint tuberculosis. The early symptoms and X-ray signs are atypical, and there are many similarities with other diseases of the sacroiliac joint, which are prone to misdiagnosis. The clinical diagnosis of sacroiliac joint tuberculosis mainly depends on the clinical manifestations and the results of auxiliary examinations to avoid misdiagnosis.

　　1.Blood examination:Erythrocyte sedimentation rate is accelerated.

　　2. Auxiliary examination:The auxiliary examination methods for this disease mainly rely on X-ray and CT scans, with the following main manifestations:

　　1. Lesion location:Psoas joint tuberculosis mainly occurs in the anterior inferior one-third of the iliac cancellous bone, and synovial tuberculosis can also penetrate through the articular cartilage to invade the bone tissue, causing destruction of the sacroiliac joint surface and bone tissue.

　　2, Bone destruction:The bone type joint tuberculosis bone destruction area is round or elliptical, the edge of the destruction area can be seen, the sacroiliac joint space is not significantly narrowed, and the synovial type joint tuberculosis shows different degrees of blurring or erosion of the sacroiliac joint surface, with different degrees of narrowing or widening of the space; some show obvious bone destruction, and the joint space is irregularly widened.

　　3, Dead bone:Some scholars believe that tuberculosis can appear large pieces of dead bone, and there is information that the longest diameter of the largest dead bone of tuberculosis can reach more than 2 cm. Regarding small granular or 'sand-like' dead bone, it may be the calcification points of caseous matter, or it may be true 'sand-like' dead bone. The true 'sand-like' dead bone has a lower density than the above calcification points and is often covered by calcified caseous matter. Therefore, the two are sometimes difficult to distinguish or show.

　　4, Ossification and hardening:Sacroiliac joint tuberculosis without fistula formation and without secondary infection can also occur ossification and hardening, the reason lies in the osteoporosis of sacroiliac joint tuberculosis is often not as obvious as other joints, and often shows signs of ossification and hardening.

　　5, Cold abscess and sinus tract formation:Sacroiliac joint tuberculosis is more prone to cold abscess and sinus tract formation, which often occurs in the buttocks, inguinal or pelvic cavity.

　　Early X-ray films show blurred joint edges and widened joint spaces; in the late stage, the joint space can be narrowed or disappeared, and local bone destruction foci are common, and some may show dead bone. Severe joint destruction may show ipsilateral iliac and pubic bones upward dislocation, and long-term mixed infection will cause obvious ossification of the local bone.

　　The CT examination of sacroiliac joint tuberculosis has obvious advantages, which can show the location, scope, and degree of destruction of the sacroiliac joint, especially the location and size of the abscess, which provides a reliable basis for formulating the correct surgical plan.

　　Sacroiliac joint tuberculosis can cause joint synovial congestion and swelling, and the destruction of the granuloma tissue of tuberculosis can destroy the articular cartilage and the underlying bone, so that the patient's attention to diet adjustment is helpful for the treatment of the disease.

　　What should be eaten to be good for the body with sacroiliac joint tuberculosis?

　　1, Vitamins and inorganic salts have a great promoting effect on the recovery of tuberculosis. Among them, vitamin A has the effect of enhancing the body's resistance to diseases; vitamins B and C can improve various metabolic processes in the body, increase appetite, and improve the function of tissues such as the lungs and blood vessels; for patients with recurrent hemoptysis, iron supply should be increased, and more green leafy vegetables, fruits, and coarse grains should be eaten to supplement various vitamins and minerals.

　　2, Tuberculous patients of bone and joint can also eat more seafood, such as seaweed, deep-sea fish, and prawns, etc. The nutritional value of marine organisms is very high. Detection shows that every 100 grams of shrimp meat contains 20.6 grams of protein, and also contains fat, ash, and calcium, phosphorus, iron, vitamins, and riboflavin, etc. The body also contains myosin and actin, so it is not only a delicacy but also has the functions of kidney-nourishing and Yang-tonifying, nourishing Yin and strengthening bones, and calming. It can be used to treat various diseases such as tetany, skin ulcers, chickenpox, muscle and bone pain, and bone tuberculosis.

　　骶髂关节结核最好不要吃哪些食物?

　　What foods should be avoided for sacroiliac joint tuberculosis?

　　1. Eggplant: Eggplant is easy to cause an allergic reaction in patients with sacroiliac joint tuberculosis during anti-tuberculosis treatment.

　　2. Milk: When taking rifampicin at the same time as milk, the absorption of the drug is very little one hour later. However, when taken on an empty stomach, the drug concentration in the blood can reach a peak one hour later. Therefore, during the period of taking rifampicin and rifapentine, milk and other beverages should not be consumed at the same time to prevent a decrease in drug absorption. Isoniazid should not be taken with lactose or sugary foods because lactose can completely block the absorption of isoniazid in the human body, preventing it from exerting its pharmacological effect.

　　Sacroiliac joint tuberculosis is not very common in clinical practice, accounting for about 8% of total skeletal tuberculosis. Sacroiliac joint tuberculosis often complicates tuberculosis in other parts of the body, so it should be treated as soon as possible.

　　To shorten the course of treatment, debridement of the focus and arthrodesis are often used, and in the early stage of the disease without dead bone or abscess formation, only arthrodesis (from the posterior part of the joint) can be performed, and a prefabricated plaster bed should be prepared before surgery. If there are abscesses both anteriorly and posteriorly, debridement can be performed in stages, first dealing with the anterior part, and then dealing with the posterior part about 1-2 months later, and performing arthrodesis.

　　1. Systemic Treatment

　　This disease often complicates tuberculosis in other parts of the body, and systemic treatment should not be ignored. Patients generally have poor general condition, and elderly patients should receive internal medicine support therapy before surgery. For patients with secondary infection of sinus tract, sensitive antibacterial therapy should be given before surgery. Patients with large abscesses or dead bones, or sinus tracts that are not cured for a long time, can be treated with surgery, otherwise, simple drug treatment can be used.

　　2. Surgery

　　The location of the abscess and sinus tract determines the approach, which can be from the anterior or posterior route. If the abscess is located in the iliac fossa, it can reach the focus through the pus cavity via the retroperitoneal route from the anterior side, attention should be paid not to damage the sciatic nerve and blood vessels. The posterior route should be adopted as much as possible, as the surgical field is wide and it is convenient to deal with the focus.