Guillouzouic Aurélie, Andrejak Claire, Peuchant Olivia, Hery-Arnaud Geneviève, Hamdad Farida, Lanotte Philippe, Gaborit Benjamin, Bernard Louis, Bémer Pascale
Department of Bacteriology, Nantes University Hospital, 1 Place Alexis Ricordeau, 44095 Nantes, France.
Respiratory Department, Amiens University Hospital, 80000 Amiens, France.
J Clin Med. 2020 Aug 5;9(8):2529. doi: 10.3390/jcm9082529.
Nine percent of all cases of tuberculosis are bone and joint tuberculosis (BJTB). BJTB occurs in two main forms: spinal (STB) and extraspinal (ESTB). The aim of this study was to compare STB with ESTB in terms of diagnosis, treatment and outcomes.
We collected demographic, clinical, microbiological, treatment duration and outcome data for patients with BJTB in a retrospective multicentre study over a 17-year period.
Of the 116 patients included in the study, 69 (59.5%) had STB and 47 (40.5%) had ESTB. The median age was higher in the ESTB group. There were significantly more foreign-born patients in the STB group. The median time for diagnosis was longer for ESTB (6 months) than STB (4 months) ( = 0.017). Magnetic resonance imaging was highly reliable for the diagnosis. Direct examination and histology allowed the diagnosis to be made in more than 80% of cases. The median treatment duration of 12 months, regardless of the type of BJTB, was longer than recommended. A favourable outcome was achieved in 91.9% of cases.
The management of BJTB remains challenging. An earlier diagnosis should be more effective, reducing the total duration of treatment and leading to better tolerance.
所有结核病病例中有9%为骨与关节结核（BJTB）。BJTB主要有两种形式：脊柱结核（STB）和脊柱外结核（ESTB）。本研究的目的是比较STB和ESTB在诊断、治疗及预后方面的情况。
在一项为期17年的回顾性多中心研究中，我们收集了BJTB患者的人口统计学、临床、微生物学、治疗时长及预后数据。
纳入研究的116例患者中，69例（59.5%）为STB，47例（40.5%）为ESTB。ESTB组的年龄中位数更高。STB组中出生于国外的患者明显更多。ESTB的中位诊断时间（6个月）比STB（4个月）更长（P = 0.017）。磁共振成像对诊断高度可靠。直接检查和组织学检查能在80%以上的病例中确诊。无论BJTB类型如何，12个月的中位治疗时长均长于推荐时长。91.9%的病例取得了良好预后。
BJTB的管理仍然具有挑战性。更早的诊断应该会更有效，减少总治疗时长并带来更好的耐受性。
