Clinical, radiological, pathological and bacteriological study of bone and joint tuberculosis
With the advancement of antituberculous chemotherapy, surgery has been applied more and more vigorously against bone and joint tuberculosis.
Thus it has become easier to obtain pathological materials directly from the lesion.
Clinical, radiological, pathological and bacteriological study was performed in 110 cases of bone and joint tuberculosis who received operation in our department from October 1962 to August 1964.
The purpose of this study was to find tuberculous bacilli from the lesions for sensitivity tests, and determine the most effective drugs for chemotherapy.
The cases were divided into three groups for the study according to X-ray finding; Active stage (68.2%), Non-active stage (23.6%) and Healing stage (8.2%).
They were also divided into five groups by gross operative pathological findings according to the main material from the focus; (1) Pus (20.8%), (2) Granulation (40.0%), (3) Degenerated capsule (7.1%), (4) Caseous material(26.3%) and Sequestrum (27.2%).
Bacteriological investigation was performed with direct concentration smear (Ziehl-Neelsen's method), cluture on Ogawa media and sensitivity test.
Tuberculous bacilli were found in 6.3% on direct concentration smear and 28.2% on culture.
Correlation of positive culture and other factors were as follows;
1) Mixed infection with draining sinus showed a lower percentage (10.5%) than unmixed infection cases (31.8%).
2) Cases receiving chemotherapy before admission showed 18.% compared with 33.3% in untreated cases.
3) On the basis of pathological materials from the focus, a higher percentage of positives were found in granulation (40%) than in other materials.
4) In the three stages on X-ray findings, there was noted 90.3% in the active state, 9.7% in non-active stage and none in the healing stage.
One the sensitivity tests, PAS., INH. and SM. drugs gave less resistance although they were the drugs mainly used before admission.