Maigne Jean-Yves, Chatellier Gilles, Faou Michel Le, Archambeau Marie
Department of Physical Medicine, Hôpital Hôtel-Dieu, Paris, France.
Spine (Phila Pa 1976). 2006 Aug 15;31(18):E621-7. doi: 10.1097/01.brs.0000231895.72380.64.
Randomized open study.
To evaluate the efficacy of intrarectal manual treatment of chronic coccydynia; and to determine the factors predictive of a good outcome.
In 2 open uncontrolled studies, the success rate of intrarectal manipulation of the coccyx was around 25%.
Patients were randomized into 2 groups of 51 patients each: 1 group received three sessions of coccygeal manipulation, and the other low-power external physiotherapy. The manual treatment was guided by the findings on stress radiographs. Patients were assessed, at 1 month and 6 months, using a VAS and (modified) McGill Pain, Paris (functional coccydynia impact), and (modified) Dallas Pain questionnaires.
At baseline, the 2 groups were similar regarding all parameters. At 1 month, all the median VAS and questionnaire values were modified by -34.7%, -36.0%, -20.0%, and -33.8%, respectively, in the manipulation group, versus -19.1%, -7.7%, 20.0%, and -15.7%, respectively, in the control (physiotherapy) group (P = 0.09 [borderline], 0.03, 0.02, and 0.02, respectively). Good results were twice as frequent in the manipulation group compared with the control group, at 1 month (36% vs. 20%, P = 0.075) and at 6 months (22% vs. 12%, P = 0.18). The main predictors of a good outcome were stable coccyx, shorter duration, traumatic etiology, and lower score in the affective parts of the McGill and Dallas questionnaires.
We found a mild effectiveness of intrarectal manipulation in chronic coccydynia.
随机开放研究。
评估直肠内手法治疗慢性尾骨痛的疗效；并确定预测良好预后的因素。
在两项开放非对照研究中，直肠内尾骨手法操作的成功率约为25%。
将患者随机分为两组，每组51例：一组接受三次尾骨手法治疗，另一组接受低强度外部物理治疗。手法治疗以应力X线片结果为指导。在1个月和6个月时，使用视觉模拟评分法（VAS）、（改良）麦吉尔疼痛问卷、巴黎（功能性尾骨痛影响）问卷和（改良）达拉斯疼痛问卷对患者进行评估。
基线时，两组在所有参数方面相似。1个月时，手法治疗组的VAS中位数和各问卷值分别改善了-34.7%、-36.0%、-20.0%和-33.8%，而对照组（物理治疗组）分别改善了-19.1%、-7.7%、20.0%和-15.7%（P值分别为0.09[临界值]、0.03、0.02和0.02）。1个月时，手法治疗组的良好结果发生率是对照组的两倍（36%对20%，P = 0.075），6个月时为（22%对12%，P = 0.18）。良好预后的主要预测因素是尾骨稳定、病程较短、创伤性病因以及麦吉尔和达拉斯问卷情感部分得分较低。
我们发现直肠内手法治疗慢性尾骨痛有一定疗效。
