Ekere A U, Yellowe B E, Echem R C
Orthopadic Unit, Department of Surgery, University of Port Harcourt Teaching Hospital, Nigeria.
Niger J Med. 2005 Oct-Dec;14(4):386-9.
Tuberculous spondylitis is a significant health burden in the Third world. Tuberculosis and its complications are on the increase because of the HIV/AIDS challenge. The aim of this study was to review the patients managed for tuberculous spondylitis at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
This was a retrospective study of patients seen at the University of Port Harcourt Teaching Hospital between January 1999 and December 2002 with tuberculosis of the spine. Patients case notes were reviewed after collating out-and-in-patient records. Analysis was done using multiway frequency tables.
There were 16 males and 18 females, with a ratio of 1:1.1. Their ages ranged from 3.3 to 82 years with an average of 31.1. Peak ages of occurrence were the 3rd and 4th decades. Eighteen patients (52.9%) presented within the first 6 months of symptoms. The most frequent presenting symptoms were back pain, weight loss, difficulty with walking, low grade fever, and night sweats. The most frequent signs were gibbus and lower limb paralysis. The most common association was pulmonary tuberculous (32.4%). The thoracic spine was mostly affected, followed by the lumbar spine. Wedge collapse of the vertebrae was the common radiological finding. Twenty two patients had multilevel affection. Twenty patients (71%) had a lymphocyte differential of more than 45%, 87% had erythrocyte sedimentation rate of over 20 mm/hr. Westergren, and Mantoux test was positive in 55 percent of the patients. Twelve patients had outpatient treatment and 22 had in-patient treatment. Duration of hospital stay ranged from 7 to 157 days with an average of 62.6 days. All the patients had standard combination antituberculosis therapy. No patient had surgery for tuberculous spondylitis. Outcome of treatment was good (68.2%). Follow up was poor with a high default rate. There were 3 mortalities (8.8%).
Diagnostic delays partly due to lack of experience makes a high index of suspicion necessary to make a diagnosis. Outcome utilizing conservative methods of treatment is good.
结核性脊柱炎在第三世界是一项重大的健康负担。由于艾滋病毒/艾滋病的挑战，结核病及其并发症正在增加。本研究的目的是回顾在尼日利亚哈科特港大学教学医院接受结核性脊柱炎治疗的患者情况。
这是一项对1999年1月至2002年12月期间在哈科特港大学教学医院就诊的脊柱结核患者的回顾性研究。在整理门诊和住院记录后，对患者的病历进行了审查。使用多维频率表进行分析。
有16名男性和18名女性，比例为1:1.1。他们的年龄从3.3岁到82岁不等，平均年龄为31.1岁。发病的高峰年龄在第三和第四个十年。18名患者（52.9%）在症状出现的前6个月内就诊。最常见的症状是背痛、体重减轻、行走困难、低热和盗汗。最常见的体征是脊柱后凸和下肢瘫痪。最常见的关联疾病是肺结核（32.4%）。胸椎受累最常见，其次是腰椎。椎体楔形塌陷是常见的放射学表现。22名患者有多个节段受累。20名患者（71%）的淋巴细胞分类超过45%，87%的患者红细胞沉降率超过20mm/小时（韦斯特格伦法）。55%的患者结核菌素试验呈阳性。12名患者接受门诊治疗，22名患者接受住院治疗。住院时间从7天到157天不等，平均为62.6天。所有患者均接受标准的联合抗结核治疗。没有患者因结核性脊柱炎接受手术治疗。治疗效果良好（68.2%）。随访情况不佳，失访率高。有3例死亡（8.8%）。
部分由于缺乏经验导致的诊断延迟使得高度怀疑指数对于做出诊断很有必要。采用保守治疗方法的治疗效果良好。
