肩関節結核の臨床的検討

治療上の問題点について

抄録

Although the incidence of new cases of tuberculosis of all types has decreased dramatically, tuberculosis is still a major cause of infections. The rarity of bone and joint tuberculosis has lowered the index of suspicion in the medical field, which often results in unfortunate delays in diagnosis. Shoulder joints are not common sites of articular tuberculoses. We reviewed a series of 9 cases with histologically-proven tuberculosis of gleno-humeral joints.
There were 3 females and 6 males. The right shoulder was affected in 5 cases, an d left side was affected in 4 cases. All patients were treated surgically. The age at the time of operation ranged from 21 years old to 67 years old. Associated tuberculous lesions were present in 6 patients. The lung was involved in 6 cases, and 2 had other joint lesions. The time between onset of symptom and diagnosis was from 6 months to 23 years. Six patients had not been diagnosed properly on their first visit, and three patients had not been diagnosed properly on their first visit, and three patients had steroidal injections. All patients had painful swelling and stiffness of the affected joints. Four patients had fistulas. Radiography revealed advanced stages of joint destruction in all patients, who had been diagnosed late. Curettage alone was performed in 4 cases, but 5 cases required arthrodesis after curettage. A drug regimen of 3 drugs continued for one year postoperatively. The average postoperative follow-up period was 4.5 years. Five cases with arthrodesis gained solid fusion. Considerably good active motion was preserved in two patients with great tuberosity left after curettage. There have been no local recurrences.
We emphasize the importance of early d iagnosis and adequate local and general treatment.