shoulder joint tuberculosis debridement

Surgical treatment of shoulder joint tuberculosis for shoulder joint tuberculosis. The shoulder muscles are rich and the blood supply is good. Although the scope and extent of the activity is large, but the weight is less than the lower limbs, the incidence is lower. At the same time, the central or marginal bone tuberculosis of the humeral head or the humeral large nodules is rich in the shoulder joint muscles, the blood supply is good, and the tuberculosis lesions are easily controlled. If the tuberculosis lesion is not controlled, it can be extended to cause total joint tuberculosis. Early total joint tuberculosis is an indication for the removal of lesions. Surgical treatment can not only cure the lesion quickly, but also preserve some useful joint functions. Treatment of diseases: shoulder joint tuberculosis Indication Shoulder joint tuberculosis resection is applicable to: 1. Early shoulder joint joint tuberculosis. 2. Simple bone tuberculosis such as humeral head and humeral tuberculosis and large tuberosity of the tibia. 3. Total joint tuberculosis in children and old age. 4. Early shoulder joint joint tuberculosis. Contraindications 1. Active tuberculosis, tuberculous meningitis is not cured. 2. Old and frail, combined with other serious diseases such as heart disease, diabetes, liver and kidney. Preoperative preparation Preoperative regular anti-tuberculosis treatment for 2 to 3 weeks, blood sedimentation below 30mm / h. Surgical procedure Incision Starting from the front of the acromioclavicular joint, turning inward along the anterior edge of the outer 1/3 of the clavicle, the leading edge of the deltoid muscle extends to 3 to 4 cm above the stop point of the muscle. 2. Cut the skin and subcutaneous tissue, and find the cephalic vein to protect the inside of the deltoid and pectoralis major. The deltoid leading edge is free, and the deltoid clavicular head is cut transversely and pulled to the outside. In order to fully reveal the medial side of the shoulder, the humerus can be externally rotated, and the pectoralis major muscle that terminates in the outer lip of the internodal groove and the latissimus dorsi muscle that is in contact with the inner lip are cut off and retracted inward. 3. Cut the joint tendon formed by the short head of the biceps and the diaphragm from the condyle 1cm and turn it to the far side. Be careful not to pull the tendon excessively, so as not to hurt the diaphragm. The middle part enters the musculocutaneous nerve of the muscle. Ligation of the anterior circumflex artery. It can reveal the anterior joint capsule covered by the supraspinatus and the subscapularis muscle sleeves, the size of the nodules and the biceps tendon. Incision of the subscapularis muscle reveals the anterior side of the joint capsule. 4. Clear the lesion First observe the swelling of the joint capsule and the presence or absence of rupture, and whether there is tuberculosis granulation tissue in the biceps sulcus. The joint capsule without swelling and swelling is first puncture, understand the contents of the joint, and protect the tissue around the joint capsule with gauze before cutting the sac. Before the scapula, cut the small mouth to attract the pus and then enlarge the incision, carefully observe the synovial membrane. Color, thickness and necrosis in the joints. Use a curette to remove diseased granulation and cheese-like tissue. The humerus is externally contracted to dislodge the humeral head, and the synovial membrane and joint capsule of the lesion are removed. If there is a fistula, the granulation tissue of the wall should be completely scraped off. Pay special attention to the lesions behind the joint capsule, and squeeze the posterior margin of the fistula to see if there is pus out. 5. Close the wound The wound was washed with a large amount of isotonic saline, the humeral head was repositioned, and streptomycin 1 g and isoniazid 200 mg were placed in the joint. The combined tendon of the short head and diaphragm of the biceps muscle is sutured, the subscapularis muscle, part of the pectoralis major and latissimus dorsi and deltoid muscle. Finally, the subcutaneous tissue and skin are sutured in layers.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.