結核性脊椎炎回溯性的分析

Pott's disease. A retrospective study of 35 patients

目的：本研究的目的是要來說明在南台灣的醫學中心的結核性脊椎炎的經驗。方法：我們經由病歷回溯性的研究去分析在高雄長庚醫院醫學中心在過去10年期間的35名結核性脊椎炎的患者。結果：其中有24名患者（68.6%）是男性。平均年齡是65.2 ± 9.3歲。其中有8名患者（22.9%）去有肺結核或肺外結核病的病史。患者最常出現的症狀是背痛（94.3%）。25名患者（71.4%）有神經學的症狀表現。胸椎（40%）是最常被感染的部位。其中24名患者的結核性脊椎炎的診斷是經由手術的方式來診斷，而其餘患者是經由針頭穿刺的切片方式來診斷。所有患者都接受抗結核菌的藥物治療，其中有24名患者（68.6%）同時有接受手術的治療。結論：在我們的研究中，男性患者佔多數，胸椎是最常被感染的部位，背痛是最常出現的症狀，而神經學的併發症是病患需要開刀治療的最重要原因。藥物同時加上外科的治療的患者會比單獨只有接受藥物治療的患者預後會比較好。

Objective: The aim of our study was to illustrate the experience of Pott's disease at a medical center in southern Taiwan. Methods: We undertook a retrospective study of 35 adult cases of Pott's disease presenting over a 10-year period to Chang Gung Memorial Hospital-Kaohsiung medical center. Results: Of the subjects recruited, 24 (68.6%) are male. The mean age was 65.2 ± 9.3 years. Eight subjects (22.9%) had a previous history of pulmonary and/or extra-pulmonary tuberculosis. Backache (n = 33, 94.3%) and neurological manifestations (n = 25, 71.4%) were the 2 leading initial presentations. Thoracic spine was the site most frequently involved (n = 14, 40 %). The diagnosis was made by surgical intervention in 24 (68.6%) subjects and computer tomography-guided biopsy in the rest. All subjects received chemotherapy treatment for TB and 24 of the subjects (68.6%) required surgical intervention for diagnosis or refractory neurological involvement. Of all of the subjects who completed a 1-year follow-up period, no mortality was found. Conclusion: In our series of Pott's disease, male is the dominant gender, thoracic spine is the major site involved, backache is the leading initial manifestation, and neurological involvement is the most important cause of surgical intervention. Additional surgery was signifi cantly related to a favorable outcome.