Beware of low back pain and bone tuberculosis.
CCTV International on June 9, 2004 15:38
1 Professor Wang, director of the Department of Orthopaedics, Affiliated Hospital of Ningxia Medical College, has made in-depth research on the treatment of spinal tuberculosis, and has designed partial resection of diseased vertebral body, iliac bone grafting and anterior-posterior internal fixation to treat spinal tuberculosis. Under short-term or ultra-short-term chemotherapy, the excellent and good rate is over 95%. (Left)
2. Professor Dang Gengzhen, chief physician, doctoral supervisor, former chairman of the Orthopedic Society of Chinese Medical Association, has been engaged in the clinical work of spinal surgery, focusing on the clinical research of cervical spondylosis, cervical trauma and other diseases. (right)
Moderator: Hello, audience friends! This is CCTV's live program "The Road to Health". Today we are going to talk about bone tuberculosis.
Guoqiao Town, Lingwu District, Ningxia is a relatively poor area in Ningxia Autonomous Region. People work here all the year round, but the per capita annual income is still less than that of 200 yuan. It is here that we met an unfortunate man named Yang Yuejiang.
Patient: I had low back pain and chest pain as soon as I got sick. I can't shoot anything when I go to the hospital for filming.
Narrator: Back pain forced Yang Yuejiang, a migrant worker, to go home and open a small shop to make a living.
Patient: At the end of February 2003, my condition began to deteriorate.
Narrator: Severe low back pain slowly spread to the whole body. Yang Yuejiang gradually felt numb in his legs, weak in his limbs and finally unable to leave the ground. As the illness worsened, the situation at home gradually declined. We also saw many patients like Yang Yuejiang who gradually developed from low back pain to bedridden in the orthopedic ward of the Affiliated Hospital of Ningxia Medical College.
Patient (Ms. Lin, 28 years old): Anyway, my back always hurts when I am confined. I think I may be tired with my baby in my arms and think I can have a good rest, but my low back pain continues and gradually develops into a large area of pain and numbness in my chest, back and legs until I can't walk by myself.
Patient (Ms. Wang, 30 years old): A year ago, low back pain was thought to be a gynecological disease. Later, the symptoms worsened and I saw it in a small hospital. The doctor there said it might be caused by gynecological diseases, but it became more and more serious after treatment according to gynecological diseases.
Narrator: The inevitable situation finally appeared. Because of low back pain, Ms. Wang had to stay in bed and was unable to move. The doctor told us that the disease of these patients is called bone tuberculosis, which is an orthopedic disease caused by the erosion of human bones by mycobacterium tuberculosis.
Moderator: Which bone was invaded by the patient's bone tuberculosis, which caused him to be unable to take care of himself?
Danggeng Town: The bone infection of these patients is mainly the bones of the spine. Tuberculosis first occurs in the lungs. At a very young age, lung infection can spread to many systems in the whole body through blood, which may lead to tuberculosis in the skeletal system, urinary system and digestive system. After the bacteria spread to other parts, they can be destroyed in most parts due to the enhancement of resistance, but tuberculosis bacteria in some parts may form a small focus locally. If the body has strong resistance, it may lurk there. When the body's resistance is weakened, these latent lesions will develop and lead to bone tuberculosis. Therefore, bone tuberculosis is a secondary lesion.
Moderator: Why do people with bone tuberculosis cause paralysis?
Wang: Some bone tuberculosis can paralyze patients. This is due to the erosion of bones by tuberculosis. As we all know, the spinal cord is behind the spine, as shown in the figure. This is a comparison of CT findings between normal spine and spinal tuberculosis. Once the spinal cord is compressed or pulled by injury, there will be problems in conveying instructions and the patient will be paralyzed. The human body will get tuberculosis from cervical vertebra, thoracic vertebra to lumbar vertebra. The higher the position, the greater the harm. If the cervical vertebra has tuberculosis, you can't move below the upper limbs. If the thoracic vertebra has tuberculosis, it will not move below the chest. If the lumbar spine gets tuberculosis, it will mainly be the problem of the lower limbs.
Compere: Is it possible to get tuberculosis in limbs?
Wang: Actually, bones in any part of the human body may get tuberculosis, and spinal tuberculosis accounts for about 50%. Other joints such as knee joint and hip joint can also get tuberculosis.
Moderator: Many other diseases can cause symptoms such as low back pain and numbness. What are the characteristics of bone tuberculosis, lumbago and numbness?
Danggeng Town: The earliest symptom of spinal tuberculosis, especially lumbar tuberculosis, is often low back pain, but many other diseases can also cause low back pain, such as intervertebral disc disease and lumbar strain. There are some differences between low back pain caused by tuberculosis and other diseases. Low back pain caused by tuberculosis is persistent low back pain, especially after falling asleep at night. Children or young people often wake up in pain, and the pain will not be improved by rest and taking medicine. This is a lasting pain. Clinicians believe that the difference between spinal tuberculosis and pain caused by other diseases is that patients with pain caused by spinal tuberculosis have stiff waist and it is difficult to bend down on their own, which is a very important difference.
Moderator: It used to be said that tuberculosis is a disease of the poor, because people with malnutrition are more likely to get it. Why is there a resurgence of tuberculosis after the improvement of people's living standards?
Danggeng Town: There are many reasons. For example, according to some research reports, tuberculosis itself has variation, and the tuberculosis bacteria infected now and before have variation, and are not sensitive to many commonly used anti-tuberculosis drugs. On the other hand, it is also a very important reason. Most urban people neglect the prevention of tuberculosis, that is to say, the incidence of tuberculosis has decreased recently, which leads people to neglect the prevention of tuberculosis. In addition, the pain of lumbar disc herniation often gets better after lying in bed for a period of time, while the pain of lumbar disc herniation is often a limited nerve part, which can be easily distinguished by doctor's examination. Lumbar intervertebral disc pain will not last long and can be relieved after treatment.
Moderator: Why are the initial diagnoses of these patients not very accurate?
Wang: Because tuberculosis was well controlled in the 1970s and 1980s, everyone relaxed their vigilance later. In addition to patients' own problems, there are also some problems such as doctors. In fact, more than 95% of spinal tuberculosis can only be diagnosed after clinical consultation, X-ray and MRI examination. The key is to attract enough attention.
Moderator: What methods are there for the treatment of bone tuberculosis?
Danggeng Town: Bone tuberculosis, including spinal tuberculosis, has its general principles of tuberculosis treatment. The first is supportive therapy, with adequate nutrition such as protein and vitamins, sufficient calories and adequate rest. The other is anti-tuberculosis treatment, which is chemotherapy. It takes a long time to give all kinds of anti-tuberculosis drugs. However, some diseases, such as spinal tuberculosis mentioned above, have developed to a very serious degree, with serious injuries, abscesses and paralysis. , will need surgery.
Wang: The operation should clean up the bones damaged by tuberculosis. The operation we do may be more thorough than the traditional operation, and the amount of resection is also relatively large. After resection, it should basically reach the level close to normal bones. On the basis of basic resection, bones in other parts, such as ilium, are implanted in order to make the implanted bones grow together with the original normal bones and blend into one. On the other hand, surgery requires temporary fixation, and the implanted bones have fused after half a year. Then add medicine.
Moderator: Let's take a look at the operation process of patient Yang Yuejiang (April 2004):
Narrator: The operation was performed at 9: 40 on April 2, 2004.
Wang (Surgeon): The pathological changes of this patient can be seen from this model. Seven upper cervical vertebrae, twelve middle thoracic vertebrae and five lower lumbar vertebrae were eroded by tuberculosis.
Narrator: It is the core of this operation to remove the diseased part of the lumbar spine eroded by tuberculosis.
Wang: The first step of the operation is posterior fixation. The second step is to do anterior lesion resection and iliac bone transplantation. A defect will be formed after resection. We need to take out some large ilium from these two sides and insert it into the patient's defect.
Narrator: The long wait of six hours finally came, and the operation was over.
Wang: The operation went smoothly. I still need medication in the future, and I will recover slowly.
Moderator: Some netizens asked if the risk of surgery was high. Is paraplegia possible?
Wang: The risk of spinal tuberculosis surgery should be considered from several aspects. First of all, it depends on the severity of the patient's condition, the technical strength of the hospital, especially the surgeon and anesthesia, and finally the equipment. At present, the insurance factor of tuberculosis surgery in China is still relatively high.
Compere: Does taking out a part of ilium affect ilium itself?
Dang Geng Zhen: After the ilium is taken out, it has no effect on the function of ilium. This method is also very common, and it is also a last resort.
Compere: Can the injured ilium not undergo supplementary surgery?
Danggeng Town: Yes. At present, some substitute materials (artificial bone) such as allogenic bone and bone transplantation are used, but these materials are still not as good as autogenous iliac bone.
Moderator: Do you still need to cooperate with anti-tuberculosis treatment after operation?
Wang: Anti-tuberculosis treatment is one of the basic principles of tuberculosis. However, our anti-tuberculosis time is less than that of traditional methods. We call it ultra-short-course chemotherapy, which lasts for 3-6 months. Anti-tuberculosis treatment can be performed before and after operation.
Moderator: Let's take a look at the situation of patient Yang Yuejiang 26 days after surgery:
Yang Yuejiang: Don't hold it now. You can walk slowly.
Family members: I used to need someone to serve me every day, but now I can walk without crutches.
Yang Yuejiang: Much better than before. I used to have backache and numbness in my legs. Now I can stand up and recover slowly.
Narrator: Director Wang told us that Yang Yuejiang could live like a normal person after two months of recovery.
Wang: In the past, people usually stayed in bed for more than half a year after spinal tuberculosis surgery. Our method is that patients can go to the fields 3-4 weeks after operation. When they first go to the fields, they must learn to walk with the help of medical staff, and then walk slowly by themselves. We treated 70 cases with this method, including the same surgical methods, three kinds of chemotherapy methods, more than 30 cases for ultra-short-term treatment, and others including short-term and standard chemotherapy. Through our review, it is found that there is no difference in the treatment effect of these patients, and the effect is very good in the average follow-up time of three years.
Moderator: Let's look at the story of an old lady Kong:
Narrator: It was May 65438+May 2002, in the orthopedic ward of the Affiliated Hospital of Ningxia Medical College. Mrs. Kong is 65 years old. Kong Lao had to stay in bed for a long time because of low back pain. Flowers and birthday wishes can't hide the anxiety of the elderly and their children, because recently MRI suspected that the low back pain of the elderly was caused by bone cancer. In the continuing examination, the doctor found that the culprit leading to lumbar degeneration and necrosis in the elderly was not cancer, but mycobacterium tuberculosis. At this point, Kong Lao's body is already very weak.
Family members: The condition is getting worse day by day these days. At first, I still felt at the lesion, but later I lost consciousness. By mid-May, the urine will not be discharged. He entered the operating room at 7: 00 on July 24, 2002 and left the operating room at about 6: 30 pm.
Narrator: The operation brought new life to the old man. After this ordeal, Kong Lao decided to commemorate July 24th every year as the beginning of a new life. On July 24, 2003, the children of the elderly invited orthopedic surgeons to celebrate this new birthday for the elderly.
Moderator: Yu Xiansheng is 34 years old. My nephew is 24 years old and suffers from bone tuberculosis. I recovered well after the operation last April, but now I have no strength to work. What is this?
Wang: Generally speaking, one year after the operation, the treatment should be over. Next, you need to go to the hospital for a review to see if tuberculosis itself has been cured. If tuberculosis has been cured, you should exercise during the recovery period.
Moderator: Mr. Liu from Beijing is 70 years old this year. My wife has bone tuberculosis. Twenty years ago, both thoracic and lumbar vertebrae were operated, and the postoperative effect was very good. Back pain has started again this year. Has it relapsed?
Danggeng Town: There are many reasons for low back pain in the elderly, especially those who have undergone spinal surgery. Not necessarily the operation itself, tuberculosis recurred. First, check whether tuberculosis has recurred. If there is no recurrence, but low back pain caused by other parts, targeted treatment is needed.
Moderator: The clinic hours are Monday and Wednesday afternoons in Danggeng Town, and Wang Tuesday afternoons; The telephone number of the hospital is (095 1)409 1488 to 3242.