Establishment Of Diagnostic Criteria For Tuberculosis And Brucellosis Spondylitis

Objectives:Tuberculous spondylitis and brucellic spondylitis are common in orthopedic clinical disease,high morbidity.The early diagnosis and differential diagnosis of the occurrence and development of the disease played a very important role.The diagnosis depends mainly on the clinical manifestations,imaging and related laboratory tests to establish,but because of the two clinical manifestations of non-typical imaging and related laboratory tests lack specificity,so the diagnosis and differential diagnosis are still more difficult.Through clinical data collection and statistical analysis,find and establish clinical discriminant that can be applied to the differential diagnosis of tuberculous spondylitis and brucellosis,and reduce the misdiagnosis rate.Materials and methods:Retrospective analysis From July 2014 to July 2017,the first visit to our hospital spine surgery was finally confirmed by blood culture,postoperative pathology and tissue culture as tuberculous spondylitis in 49 cases,brucellosis spondylitis in 14 cases.Using the four grid table x2 or between groups T test analysis of the two groups of patients with the degree of fever,whether big sweat appear,history of exposure to sick animals,VAS,ESR,CRP,WBC,NC%,upper and lower vertebral endplates CT value,Disease vertebral height loss,lesions high loss of intervertebral space,T-SPOT.TB.Results:The degree of fever statistics:There were 5 cases of tuberculous spondylitis with body temperature?38?,44 cases of<38C? 10 cases with Brucellosis spondylitis whose body temperature was ?38?,and 4 cases<38?.?2=22.143,(P=0)<0.05,There was a statistically significant difference in the degree of fever between the two groups.Brucella spondylitis was more feverish than tuberculous spondylitis.Whether there are statistical results of sweating:Tuberculous spondylitis occurred in 1 case with sweating,48 cases without sweating,9 cases with Brucella spondylitis,and 5 cases without profuse sweating.?2=31.092,(P = 0)<0.05,there is a statistical difference between the two in the presence of sweat,Brucella spondylitis is more severe than sweating in tuberculous spondylitis.Epidemiological contact history statistics:There were 10 patients with history of epidemiological contact with tuberculous spondylitis in the past,and no 39 cases.There were 9 patients with epidemic history of brucellosis spondylitis and no 5 cases.?2=9.795,(P=0)<0.05,there was a statistical difference.Brucellosis spondylitis had more obvious epidemiological contact history than tuberculous spondylitis.VAS statistics:The VAS score of tuberculous spondylitis(x±s):4.63± 1.32;VAS score of Brucella spondylitis(x ±s):6.50 ± 1.02.(P=0)>0,05,T=-4.89,statistically significant.ESR,CRP,WBC,NC%statistical results:Tuberculous spondylitis(x±s):33.69±24.96,25.98±25.68,8.83±10.54,59.21±16.36;Brucella spondylitis(x±s):34.14±16.76,32.82±28.60,6.57±1.60 55.61±10.88.There was no statistical difference between the two groups in ESR,CRP,WBC,and NC%,P<0.05.Lesion of the upper and lower endplates of the lesioned vertebral body,loss of the lesioned vertebral body height,and loss of height of the diseased intervertebral space were statistically statistical:Tuberculous spondylitis(x±s):692.41 ±128.67,3.55 ±3.83 mm,5.06 ±2.51 mm brucellosis spondylitis(x±s):304.07 ± 69.64,0.10 ±0.39 mm,2.72±2.56mm.Both the upper and lower vertebral endplate in the CT value,vertebral height loss,loss of disc height lesion P<0.05,statistically significant.When the CT value of the upper and lower endplates of the lesioned vertebral body is greater than 589.75,when the height loss of the vertebral body is higher than 0.156 and the height loss of the intervertebral space is higher than 3.2828 mm,tuberculous spondylitis and brucellosis spondylitis can be distinguished.The sensitivity is 0.854 respectively.The specificities were 0.867,0.929,and 0.786,respectively,and the areas under the curve were 0.902,0.890,and 0.787,respectively.T-SPOT.TB positive rate results:Tuberculous spondylitis:T-SPOT.TB(+)41 cases,T-SPOT.TB(-)patients 8 cases;Brucellosis spondylitis:T-SPOT.TB(+)2 cases,T-SPOT.TB(-)12 cases.?2=21.09,(P=0)<0.05 There was a statistical difference in T-SPOT.TB.Conclusions:By epidemiology,clinical symptoms,imaging studies and laboratory tests can be a comprehensive analysis of tuberculous spondylitis and brucellic spondylitis,reduce the misdiagnosis rate.Specifically,the important indications for distinguishing between the two should include:degree of fever,presence of sweat,VAS,T-SPOT.TB,CT values of the upper and lower endplates of lesioned vertebrae,loss of the height of the lesioned vertebral bodies,and loss of the intervertebral space.