Division of Orthopaedic Surgery,Department of Surgical Sciences,Faculty of Medicine and Health Sciences,Stellenbosch University,Francie van Zijl Drive,Parow, 7505,Cape Town,South Africa.
Department of Paediatrics and Child Health,Faculty of Medicine and Health Sciences,Desmond Tutu TB Centre, Stellenbosch University,Francie van Zijl Drive, Parow,7505,Cape Town,South Africa.
Epidemiol Infect. 2018 Dec;146(16):2107-2115. doi: 10.1017/S0950268818002649. Epub 2018 Sep 28.
The aim of this retrospective review was to assess the overall burden and trend in spinal tuberculosis (TB) at tertiary hospitals in the Western Cape Province of South Africa. All spinal TB cases seen at the province's three tertiary hospitals between 2012 and 2015 were identified and clinical records of each case assessed. Cases were subsequently classified as bacteriologically confirmed or clinically diagnosed and reported with accompanying clinical and demographic information. Odds ratios (OR) for severe spinal disease and corrective surgery in child vs. adult cases were calculated. A total of 393 cases were identified (319 adults, 74 children), of which 283 (72%) were bacteriologically confirmed. Adult cases decreased year-on-year (P = 0.04), however there was no clear trend in child cases. Kyphosis was present in 60/74 (81%) children and 243/315 (77%) adults with available imaging. Corrective spinal surgery was performed in 35/74 (47%) children and 80/319 (25%) adults (OR 2.7, 95% confidence interval 1.6-4.5, P = 0.0003). These findings suggest that Western Cape tertiary hospitals have experienced a substantial burden of spinal TB cases in recent years with a high proportion of severe presentation, particularly among children. Spinal TB remains a public health concern with increased vigilance required for earlier diagnosis, especially of child cases.
本回顾性研究旨在评估南非西开普省三级医院中脊柱结核（TB）的总体负担和趋势。在该省的三家三级医院中，确定了 2012 年至 2015 年间所有脊柱 TB 病例，并对每个病例的临床记录进行了评估。随后将病例分为细菌学确诊和临床诊断，并报告了伴随的临床和人口统计学信息。计算了儿童病例与成人病例严重脊柱疾病和矫形手术的比值比（OR）。共确定了 393 例病例（319 例成人，74 例儿童），其中 283 例（72%）为细菌学确诊。成人病例逐年减少（P = 0.04），但儿童病例无明显趋势。有影像学资料的 74 例儿童中有 60 例（81%）存在后凸畸形，315 例成人中有 243 例（77%）存在后凸畸形。74 例儿童中有 35 例（47%）接受了矫形脊柱手术，319 例成人中有 80 例（25%）接受了矫形脊柱手术（OR 2.7，95%置信区间 1.6-4.5，P = 0.0003）。这些发现表明，近年来，西开普省三级医院的脊柱结核病例负担很大，严重病例比例很高，尤其是儿童。脊柱结核仍然是一个公共卫生问题，需要提高警惕，以便及早诊断，尤其是儿童病例。
