尾骨痛的磁共振成像形态学和形态测量学研究。
Magnetic resonance imaging morphology and morphometry of the coccyx in coccydynia.
机构信息
*Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand †Service de Médecine Physique, Hôpital Hôtel-Dieu, Paris Cedex, France.
出版信息
Spine (Phila Pa 1976). 2013 Nov 1;38(23):E1437-45. doi: 10.1097/BRS.0b013e3182a45e07.
STUDY DESIGN
Retrospective case-control study.
OBJECTIVE
To determine if differences exists between the bony anatomy of the coccyx in patients with coccydynia and that in subjects with no known coccygeal pathology.
SUMMARY OF BACKGROUND DATA
Numerous bony characteristics of the coccyx have been described in patients with coccydynia but their significance is uncertain. This study aimed to evaluate these in patients with coccydynia and compare them with normal coccyges.
METHODS
Magnetic resonance scans of the coccyx from 107 adults (mean age, 43 ± 12 yr; 84 females) with clinically diagnosed coccydynia were retrospectively analyzed and compared with 112 computed tomographic scans from sex-matched adults with normal coccyges. The following were assessed: coccygeal segmentation; sacrococcygeal and intercoccygeal joint fusion, angles, and curvature; bony spicule formation; and subluxation.
RESULTS
Compared with normal, females with coccydynia had a more ventrally curved coccyx (curvature index, 85 ± 7 vs. 90 ± 5; P< 0.01), a lower prevalence of sacrococcygeal joint fusion (27% vs. 58%, P< 0.01), and a higher frequency of bony spicule formation (44% vs. 19%, P< 0.01). Males with coccydynia showed a trend toward a more ventrally curved coccyx (curvature index: 86 ± 6 vs. 89 ± 5, P< 0.08), and a lower prevalence of sacrococcygeal (27% vs. 60%, P< 0.02) and intercoccygeal (0% vs. 22%, P< 0.02) joint fusion. Combining statistically significant coccygeal parameters in a logistic regression model yielded sensitivity, specificity, and positive predictive values of 72%, 71%, and 73%, respectively in females and 52%, 92%, and 73%, respectively in males.
CONCLUSION
This is the most detailed comparison of coccygeal morphology and morphometry in adults with and without coccydynia investigated using cross-sectional imaging. Anatomical differences in joint fusion and coccygeal curvature may either predispose to the development of coccydynia or arise as a result of this condition.
研究设计
回顾性病例对照研究。
目的
确定尾痛患者的尾骨解剖结构与无已知尾骨病变的受试者之间是否存在差异。
背景资料概要
许多尾痛患者的尾骨存在多种骨特征，但这些特征的意义尚不确定。本研究旨在评估尾痛患者的这些特征，并将其与正常尾骨进行比较。
方法
对 107 例临床诊断为尾痛的成年人（平均年龄 43 ± 12 岁；84 例女性）的尾骨磁共振扫描进行回顾性分析，并与 112 例性别匹配的正常尾骨成年人的计算机断层扫描进行比较。评估内容包括：尾骨分段；骶尾关节和尾间关节融合、角度和曲率；骨刺形成；以及半脱位。
结果
与正常相比，女性尾痛患者的尾骨更向腹侧弯曲（曲率指数：85 ± 7 对 90 ± 5；P<0.01），骶尾关节融合的发生率较低（27%对 58%，P<0.01），骨刺形成的频率较高（44%对 19%，P<0.01）。男性尾痛患者的尾骨向腹侧弯曲的趋势更为明显（曲率指数：86 ± 6 对 89 ± 5，P<0.08），骶尾关节（27%对 60%，P<0.02）和尾间关节（0%对 22%，P<0.02）融合的发生率较低。将统计学上显著的尾骨参数纳入逻辑回归模型，在女性中得出敏感性、特异性和阳性预测值分别为 72%、71%和 73%，在男性中分别为 52%、92%和 73%。
结论
这是使用横断面成像对有和无尾痛的成年人的尾骨形态和形态测量学进行的最详细比较。关节融合和尾骨曲率的解剖差异可能导致尾痛的发生，也可能是尾痛的结果。
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