Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, the Netherlands.
Pain Pract. 2010 Nov-Dec;10(6):554-9. doi: 10.1111/j.1533-2500.2010.00404.x. Epub 2010 Sep 6.
Coccygodynia is painful condition localized in the region of the coccyx. In most cases a traumatic etiology is present. In the idiopathic form other causes such as infections and tumor have to be excluded. Coccygodynia can also be the result of pain referred from visceral structures due to conditions such as disorders of the rectum, the colon sigmoideum, and the urogenital system. In case of a traumatic etiology the diagnosis is made based on the typical medical history whereby the pain is provoked by prolonged sitting and cycling. Lateral images of the coccyx are always indicated. The same is true for manual examination of the coccyx. In case of absence of provocation of the coccygeal pain by prolonged sitting and manual examination neurological causes such as lumbar disc hernias are a possible reason for the coccygodynia. In the acute phase the first choice of treatment are NSAIDs. Treatment for patients with severe pain in the chronic phase consists of manual therapy and/or a local injection of local anesthetic and corticosteroid into the painful segment (2 C+). Other interventional treatments such as intradiscal injections, ganglion impar block, radiofrequency treatment and caudal block are advised only under study conditions (0). Coccygectomy is not recommended because of long-term moderate results and the chance of major complications.
尾痛症是一种疼痛局限于尾骨区域的疾病。在大多数情况下,其病因是创伤性的。在特发性形式中,需要排除感染和肿瘤等其他原因。尾痛症也可能是由于直肠、乙状结肠和泌尿生殖系统等内脏结构的疼痛牵涉所致。在创伤性病因的情况下,基于疼痛由长时间坐着和骑自行车引起的典型病史做出诊断。尾骨的侧位图像总是需要的。手动检查尾骨也是如此。如果长时间坐着和手动检查都没有引发尾骨疼痛,则可能是腰椎间盘突出等神经源性原因导致尾痛症。在急性期,治疗的首选是非甾体抗炎药。对于慢性严重疼痛的患者,治疗包括手法治疗和/或在疼痛部位局部注射局部麻醉剂和皮质类固醇(2C+)。其他介入治疗,如椎间盘内注射、腹神经节阻滞、射频治疗和骶管阻滞,仅在研究条件下建议使用(0)。由于长期效果中等和发生重大并发症的几率较高,不建议进行尾骨切除术。