Tuberculosis of the greater trochanter of the femur

　　Femoral head tuberculosis is a destructive lesion caused by the invasion of tuberculosis bacilli into the bone. The greater trochanter is located on the surface of the body and is prone to chronic trauma. Because there is a lot of cancellous bone locally, femoral head tuberculosis is relatively common, accounting for 1.59% of systemic bone and joint tuberculosis. It is more common in young and middle-aged people aged 20 to 40, and it is extremely rare in children under 10 years old.

　　The complications of femoral head tuberculosis are rarely reported. The activity of the hip joint on the affected side is usually unimpaired, and tapping the heel does not cause hip pain. Local swelling, abscess, or sinus tracts are common. If the lesion develops and breaks through the skin to form a sinus tract, it is easy to develop secondary infection. In some cases, this disease can also spread to the surrounding bone joint capsules, causing corresponding joint lesions.

　　The synovial type of femoral head tuberculosis is only characterized by synovial swelling. The early bone destruction in the osseous type is mild, and the thickness of the greater trochanter bone is relatively thin. If high-quality imaging is used, the focus is difficult to be found. For patients suspected of having this disease, soft tissue imaging should be performed, using multiple different angles of tangential projection or tomography to observe the swelling of the synovium and the condition of bone destruction, which can avoid misdiagnosis. The early symptoms of this disease are mild, and local signs are not obvious. If the patient has a history of tuberculosis, local pain, and normal hip joint activity, active imaging examinations should be performed, and local puncture or biopsy may be necessary to confirm the diagnosis. Now CT is widely used in clinical practice, and for atypical patients, if CT examination can be performed, it will be possible to make an earlier diagnosis.

　　Femoral head tuberculosis is caused by the invasion of tuberculosis bacteria and is a complication of systemic tuberculosis. Therefore, actively treating tuberculosis and preventing the spread of the pathogen is the key to preventing this disease.

　　The X-ray examination of femoral head tuberculosis shows that the central type of bone tuberculosis can be seen with dead bone, and after the absorption of dead bone, a cavity is formed. The marginal type of tuberculosis is mainly characterized by osteolytic destruction, and the synovial type of tuberculosis only shows soft tissue swelling and local bone decalcification.

　　Local puncture or biopsy may be necessary to confirm the diagnosis, and now CT is widely used in clinical practice. For atypical patients, if CT examination can be performed, it will be possible to make an earlier diagnosis.

　　Vitamins and inorganic salts play a significant role in the rehabilitation of femoral head tuberculosis. Vitamin A has the function 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杂粮 should be eaten to supplement various vitamins and minerals.

　　骨结核病人的食欲特别不好，为增加食欲，可在烹调上下功夫，做到品种多样化，色、香、味、形好。有条件的除每日三次正餐外，可另加两次点心。应忌食刺激性食物及辛燥生痰之食物。因结核病是一种消耗性疾病，在药治和饮食调治并用的同时，还应注意充分休息及适当的户外活动。

　　The common method of Western medicine for treating tuberculosis of the greater trochanter of the femur

　　Firstly, for patients with a larger age and a small abscess, non-surgical treatment can be considered. A reasonable chemotherapy regimen can be used for treatment, and local puncture aspiration and medication can be cured.

　　Secondly, for patients with a large amount of dead bone in the lesion or sinus tract, surgery can be performed to remove the lesion.

　　1. Anesthesia:General anesthesia or epidural block anesthesia.

　　2. Positioning:Lateral decubitus position, the affected side is above, the patient is slightly elevated and slightly abducted, so that the iliotibial band and the aponeurosis of the tensor fascia lata are relaxed, which is convenient for exposing the lesion.

　　3. Incision:Lateral incision on the lateral side of the greater trochanter, an oblique incision for patients with cold abscess flowing to the lower part of the thigh, another small incision can be made. Cut the deep fascia and the aponeurosis of the tensor fascia lata along the direction of the incision, pull the gluteus maximus forward, and pull the gluteus medius and minimus backward. To fully expose the lesion above the greater trochanter, part of the gluteus medius and minimus can be cut, the lateral vastus muscle can be stripped off the periosteum, and pulled downward to expose the lesion below. Carefully investigate to determine which bursa is involved, pay attention to the color, size, and range of the bursa, and whether adjacent bone is involved; conversely, when checking the bone lesion of the greater trochanter, pay attention to whether the bursa is involved. If there is a cold abscess, pay attention to its range and whether it communicates with the pelvic cavity.

　　4. Lesion removal:Completely remove the affected bursa, scrape the bone lesions, but do not remove too much bone to avoid postoperative changes affecting the hip joint. After washing the local area, suture the iliotibial band and the gluteus maximus fascicle, and then suture the incision layer by layer.

　　If there is a preoperative sinus tract, a drain tube can be placed locally, and it should be removed 48 to 72 hours after surgery.