Maigne J Y, Doursounian L, Chatellier G
Department of Physical Medicine, Hotel-Dieu University Hospital, the Paris, France.
Spine (Phila Pa 1976). 2000 Dec 1;25(23):3072-9. doi: 10.1097/00007632-200012010-00015.
A total of 208 consecutive coccydynia patients were examined with the same clinical and radiologic protocol.
To study radiographic coccygeal lesions in the sitting position, to elucidate the influence of body mass index on the different lesions, and to establish the effect of coccygeal trauma.
A protocol comparing standing radiographs and radiographs subsequently taken in the painful sitting position in coccydynia patients and in controls has shown two culprit lesions: posterior luxation and hypermobility. Obesity and a history of trauma have been identified as risk factors for luxation.
Dynamic radiographs were obtained. The body mass index was compared with the coccygeal angle of incidence, sagittal rotation of the pelvis when sitting down, and the presence and time of previous trauma. The patients with the newly described lesions were examined after an anesthetic block under fluoroscopic guidance.
Two new coccygeal lesions are described (anterior luxation and spicules). Obesity was found to be a risk factor. The body mass index determines the way a subject sits down, and lesion patterns were different in obese, normal-weight, and thin patients (posterior luxation: 51%, 15.2%, 3.7%; hypermobility: 26.5%, 30.3%, 14.8%; spicules: 2%, 15.9%, 29.6%; normal: 16.3%, 32.6%, 48.1%, respectively; P < 0.0001). Trauma affected the type of lesion only if it was recent (<1 month before the onset of coccydynia), in which case the instability rate increased from 55.6% to 77.1%. Backward-moving coccyges were at greatest risk of trauma.
This protocol allows identification of the culprit lesion in 69.2% of cases. The body mass index determines the causative lesion, as does trauma sustained within the month preceding the onset of the pain.
采用相同的临床和放射学方案对208例连续的尾骨痛患者进行检查。
研究坐位时尾骨的放射学病变，阐明体重指数对不同病变的影响，并确定尾骨创伤的作用。
一项比较尾骨痛患者和对照组站立位X线片及随后疼痛坐位X线片的方案显示了两个罪魁祸首病变：后脱位和活动过度。肥胖和创伤史已被确定为脱位的危险因素。
获取动态X线片。将体重指数与尾骨入射角、坐下时骨盆的矢状旋转以及既往创伤的存在和时间进行比较。对新描述病变的患者在荧光透视引导下进行麻醉阻滞检查。
描述了两种新的尾骨病变（前脱位和骨针）。发现肥胖是一个危险因素。体重指数决定了受试者坐下的方式，肥胖、正常体重和消瘦患者的病变模式不同（后脱位：分别为51%、15.2%、3.7%；活动过度：26.5%、30.3%、14.8%；骨针：2%、15.9%、29.6%；正常：16.3%、32.6%、48.1%；P<0.0001）。创伤仅在近期（尾骨痛发作前<1个月）时影响病变类型，在这种情况下，不稳定率从55.6%增加到77.1%。向后移位的尾骨受创伤的风险最大。
该方案在69.2%的病例中可识别出罪魁祸首病变。体重指数决定致病病变，疼痛发作前1个月内遭受的创伤也如此。
