Modern approaches to the treatment of tuberculosis spondylitis
In today’s epidemiological situation incidence of osteoarticular tuberculosis takes the first place in the structure and morbidity of extrapulmonary tuberculosis in our country, and tuberculosis of the spine has the first place among the bones and joints affection.
Purpose: to attract the attention of practitioners to the problem of tuberculosis spondylitis treatment (TS) and improving its efficiency.
Methods: The survey data reports and medical records of 175 patients diagnosed for the first time TC. The patients were divided into two groups: I — 93 (53.1 %) subjects underwent surgery on the affected vertebrae by specific destructive process, II — 82 (46.9 %) patients after the conservative treatment. Patients in group I by neurological disorders degree as follows: Type A — 8, B — 12, C — 16, D — 40, E — 17. Patients with uncomplicated disease, as well as with the indication to surgical treatment, but with significant risk of decompensation due to comorbidities continued conservative treatment. In group II patients with severe neurological were less: Type A — 0, B — 0, C — 3, D — 7, E — 72. Chemotherapy was conducted according to internationally accepted protocols and standards Tuberculosis (Order No 620, 2014 , Ministry of Health of Ukraine).
Results: long-term results of TS treatment (2 to 10 years) were studied in 85 (91.4 %) patients in group I and in 76 (92.7 %) — II. Clinical, radiological, neurological surveys, as well as in the case shown, the computer tomography revealed no recurrence of the disease. Excellent results were obtained in 46 (54.2 %) patients in group I and in 65 (85,6 %) — II, good — in 21 (24.7 %) and 9 (11.8 %), respectively, satisfactory — 14 (16.4 %) and 2 (2.6 %). Unsatisfactory results were observed in 4 (4.7 %) patients in group I.Conclusions: The analysis of the long-term results in the treatment of patients showed that the use of combination therapy, and surgical treatment of TS allows to achieve high efficiency of treatment.
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