CAJ | 학술논문

目的探讨非潜水减压性多发骨结核合并骨梗死的诊断与治疗。方法收治3例多发性骨梗死伴疼痛的患者，1例患有系统性红斑狼疮并服用激素治疗，1例有长期大量饮酒病史，1例患有肾病综合征并服用激素治疗，3例患者术前均出现7个月至2年不等的膝关节及周围疼痛并逐渐加重。MRI显示骨梗死共10处，6处病灶内梗死的信号不典型，考虑合并感染可能。术前胸部X线片皆未发现活动性结核，并行视觉模拟评分法(visualanaloguescale，VAS)评估术前疼痛情况。对疼痛明显、梗死灶信号不典型的病变区域进行手术探查、行病灶清除、常规病理检查，病理诊断骨结核合并骨梗死，术后给予5联抗结核治疗。并观察其疗效。术后行视觉模拟评分法(VAS)评估疼痛情况。结果术后患者切口愈合良好，局部疼痛症状缓解， VAS评分改善为0～1分。随访12～24个月未出现疼痛及复发。结论在结核病高发区，晚期骨梗死患者，疼痛突然加重，MRI提示骨梗死灶内不典型信号，应考虑是否骨结核合并骨梗死。治疗上应按骨与关节结核进行。
목적탐토비잠수감압성다발골결핵합병골경사적진단여치료。방법수치3례다발성골경사반동통적환자，1례환유계통성홍반랑창병복용격소치료，1례유장기대량음주병사，1례환유신병종합정병복용격소치료，3례환자술전균출현7개월지2년불등적슬관절급주위동통병축점가중。MRI현시골경사공10처，6처병조내경사적신호불전형，고필합병감염가능。술전흉부X선편개미발현활동성결핵，병행시각모의평분법(visualanaloguescale，VAS)평고술전동통정황。대동통명현、경사조신호불전형적병변구역진행수술탐사、행병조청제、상규병리검사，병리진단골결핵합병골경사，술후급여5련항결핵치료。병관찰기료효。술후행시각모의평분법(VAS)평고동통정황。결과술후환자절구유합량호，국부동통증상완해， VAS평분개선위0～1분。수방12～24개월미출현동통급복발。결론재결핵병고발구，만기골경사환자，동통돌연가중，MRI제시골경사조내불전형신호，응고필시부골결핵합병골경사。치료상응안골여관절결핵진행。
Objective To probe into the diagnosis and treatment of non decompression bone infarcts combined with bone tuberculosis. Methods 3 patients of multifocal bone infarcts and pain were collected. 1 case was of systemic lupus erythematosus ( SLE ) and treated with steriod. 1 case was of excessive drinking in alcohol. 1 case was of nephrotic syndrome and treated with steroid. Ingravescent pain occurred in all 3 patients from 3 month to 2 years about the knee joint. Active phthisis has not been found in X-ray test. Preoperative pain was evaluated by visual analogue scale ( VAS ). 10 lesions of bone infarcts were found by magnetic resonance imaging ( MRI ). 6 lesions might be infected because of some non-typical abnormal signal. The lesions accompanied by pain and non-typical abnormal signal were treated with surgical exploration, debridement, routine pathologic examination. Bone infarcts combined with bone tuberculosis was conifrm by pathologic diagnosis. Routine anti-tuberculosis therapy was used. Effects were observed. Postoperative pain was evaluated by VAS. Results Postoperative incision healing was good, local pain symptom was relieved, VAS scores reduced to 0-1 scale. No pain and recurrence was found in the follow-up ranged from 12 to 24 months. Conclusions Tuberculosis bacterium infection should be considered if pain suddenly aggravated in late bone infarction patients in high-incidence area of tuberculosis and MRI suggests non-typical abnormal signal. Treatment should be performed as what we did in bone and joint tuberculosis.