Kodumuri P, Raghuvanshi S, Bommireddy R, Klezl Z
Royal Derby Hospital , Derby , UK.
Haywood Hospital , Burslem , UK.
Ann R Coll Surg Engl. 2018 Jan;100(1):12-15. doi: 10.1308/rcsann.2017.0089. Epub 2017 Sep 15.
Introduction The aetiology of coccydynia can be multifactorial, with several associated factors such as obesity, female gender and low mood. The long-term results of operative interventions, such as manipulation under anaesthesia and coccygectomy are variable, ranging from 63-90%. Materials and methods Our aim was to identify whether age, trauma and body mass index (BMI) were independent prognostic factors in coccydynia treatment. All patients who presented to the Royal Derby Hospital with a primary diagnosis of coccydynia between January 2011 and January 2015 who had injections, manipulation under anaesthesia or coccygectomy were included. We used patient-reported satisfaction score as the primary outcome measure. We hypothesised that patients with preceding history of trauma and with high BMI (> 25) would be less satisfied. We divided patient BMI into four groups, following World Health Organization guidelines: group A (18.5-24.9), group B (25-29.9), group C (30-39.9) and group D (> 40). Results A total of 748 patients were diagnosed with coccydynia. Of these, 201 patients had 381 injections, 40 had 98 manipulations under anaesthesia and 9 had coccygectomy. Mean age was 46.4 years; 26% of patients had trauma to the coccyx. The mean time to follow-up was 7.3 months. We found a statistically significant difference (P = 0.03) between satisfaction scores in groups B and D. Patients who had trauma improved significantly (P = 0.04). The odds ratio calculation of coccygectomy and BMI revealed a higher risk of coccygectomy in Group A. Discussion This is the first study to establish BMI and trauma as independent prognostic factors for coccydynia treatment. Our hypothesis that patients with higher BMI would have lower satisfaction levels has been proven true.
引言
尾骨痛的病因可能是多因素的，与肥胖、女性性别和情绪低落等多种相关因素有关。手术干预的长期效果，如麻醉下手法复位和尾骨切除术，各不相同，范围在63%至90%之间。
材料与方法
我们的目的是确定年龄、创伤和体重指数（BMI）是否为尾骨痛治疗中的独立预后因素。纳入2011年1月至2015年1月期间在皇家德比医院初诊为尾骨痛且接受过注射、麻醉下手法复位或尾骨切除术的所有患者。我们将患者报告的满意度评分作为主要结局指标。我们假设既往有创伤史且BMI较高（>25）的患者满意度较低。我们按照世界卫生组织的指南将患者BMI分为四组：A组（18.5 - 24.9）、B组（25 - 29.9）、C组（30 - 39.9）和D组（>40）。
结果
共有748例患者被诊断为尾骨痛。其中，201例患者接受了381次注射，40例患者接受了98次麻醉下手法复位，9例患者接受了尾骨切除术。平均年龄为46.4岁；26%的患者尾骨受过创伤。平均随访时间为7.3个月。我们发现B组和D组的满意度评分存在统计学显著差异（P = 0.03）。有创伤的患者改善显著（P = 0.04）。尾骨切除术和BMI的比值比计算显示A组尾骨切除术风险较高。
讨论
这是第一项将BMI和创伤确立为尾骨痛治疗独立预后因素的研究。我们关于BMI较高的患者满意度较低的假设已被证实。
