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KMID : 0378019800230100087
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New Medical Journal
1980 Volume.23 No. 10 p.87 ~ p.96
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A Study of Skeletal Tuberculosis
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Abstract
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The incidence of skeletal tuberculosis has been reduced recently because of improvement of hygine and economic status. However this disease still has a high morbidity in Korea.
The outcome of skeletal tuberculosis, without an early diagnosis and treatment, is permanent deformity or death.
For the period of 7 years from June 1972 to May 1979, two hundred cases of skeletal tuberculosis"at Wonju Christian Hospital were evaluated and the results of the study are as follows.
1. The frequency of this disease has been declining.
2. The sex ratio was 3:2 (male: female)´and the most prevalent age was 11 to 20 years (25%).
3. The most prevalent signs on admission were skeletal deformity in 52 cases (26%) and draing sinus in 48 cases (24%).
4. The most commonly affected site was the spine in 93 cases (47%) and among these the predominent site was the lumbar spine in 39 cases (20%). The other affected sites in order of frequency were the hip, knee and ankle joints.
5. Other combined tuberculous lesions were found in 80 cases (40%) and pulmonary tuberculosis was observed in 62 (78%) cases.
6. In laboratory findings, ESR was 37 mm/hr in average on admission but shifted to normal range of 10-20mm/hr after treatent. However the value of ESR was not correlated to the degree of healing.
7. The degree of bony destructive changes in X-ray findings was determined as minimal, moderate and severe. Lesions were classed as minimal in 97 cases (49%), moderate in 60 cases (30°0) and severe in 43 cases (21%).
8. The number of patients with recurrence was 29 cases after conservative treatment and 27 cases after operative tieatment.
9. Pathologic examinations were done in 118 cases and AFB stain and culture were done in 132 cases each. Tuberculosisis was diagnosed in 102 cases on histopathology, and a positive results was obtained in 65 cases on AFB stain and in 50 cases on AFB culture.
10. In all cases except spinal tuberculosis, conservative treatment was done in 13 cases (12%) and operative treatment in 94 cases (88%).
11. In cases of spinal tuberculosis, the management consisted of conservative treatment in 10 cases (11%) and operative treatment in 83 cases (89%). In the operative treatment, anterior spinal fusion was performed in 34 cases (37%), posterior spinal fusion in 21 cases (22%), and both in 5 cases (6%), pus drainage in 12 cases (13%), costotransversectomy in 4 cases (5%) and curettage in 6 cases (6%).
12. Of two hundred cases of skeletal tuberculosis, excellent or good results were obtained in 12 cases (50%) with . conservative treatment and in 139 cases (78%) with operative treatment. A better result was obtained in cases with short duration of disease. In the cases of spinal tuberculosis, neurologic complications were found in 18 cases (20%) and among these, 11 cases were improved by operative treatment.
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