Article
The diagnosis and treatment for extra-pulmonary tuberculosis in the wrist and hand
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Authors
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Rui Zhao
- Xijing Hospital affiliated Airforce Medical University, Xi'an Shaanxi Province, China
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Analysis the status and regional distribution of tuberculosis in China. Introduce our experiences on the diagnosis and treatment of extra-pulmonary tuberculosis in wrist and hand.
Methods: Tuberculosis is an old and infectious disease. According to the 2018 global tuberculosis report of WHO, the number of new cases was 889,000 and the incidence rate of TB was 63/100,000 in China in 2017. Though the global incidence rate in China has decreased, but a lot of cases of extra-pulmonary tuberculosis in the wrist and hand still could be seen in the northwest China. From 2012 to 2018, 25 patients were diagnosed extra-pulmonary tuberculosis in the wrist and hand in our department and debridement of focal lesion and/or proximal row carpectomy and external fixation were conducted for the treatments according to the degree of lesion. Chemotherapy was recommended for patients including rifampicin, isoniazid, pyrazinamide and ethambutol for three months and rifampicin together with isoniazid for another nine months. First of all, we focused on the relapse of TB in wrist and hand. Then we evaluated the motion of the wrist and joints of hand. And we also measured the VAS score of wrist and hand for assessment the degree of pain.
Results and Conclusions: 25 patients were all followed up. All of patients finished the chemotherapy. The incisions of all cases were primary healing. 3 cases relapsed after 3 months for the first operation. Then they were cured after second debridement for distal row carpectomy. The histopathological examination of tissue showed chronic inflammatory cells with evidence of granuloma with giant cells and central caseation. The range of motion of wrist was obviously limited owing to joint fusion or scar adhesion in the patients with severe erosion in their wrists. The average VAS score of wrist pain decreased from 8.3 to 1.7.
Completely debridement of the lesion synovial tissues and bones eroded by mycobacterium tuberculosis combined with early, united, regular, moderate and whole course chemotherapy could be an option for the treatment for the severe extra-pulmonary tuberculosis in wrist and hand.
