Sagoo Navraj S, Haider Ali S, Palmisciano Paolo, Vannabouathong Christopher, Gonzalez Roberto, Chen Andrew L, Lokesh Nidhish, Sharma Neha, Larsen Kylan, Singh Ravinderjit, Mulpuri Neha, Rezzadeh Kevin, Caldwell Christie, Tappen Lori A, Gill Kevin, Vira Shaleen
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA.
Deparment of Neurosurgery, MD Anderson Cancer Center, Houston, TX, USA.
Eur Spine J. 2022 Jan;31(1):176-189. doi: 10.1007/s00586-021-07041-6. Epub 2021 Oct 25.
We sought to systematically assess and summarize the available literature on outcomes following coccygectomy for refractory coccygodynia.
PubMed, Scopus, and Cochrane Library databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data concerning patient demographics, validated patient reported outcome measures (PROMs) for pain relief, disability outcomes, complications, and reoperation rates were extracted and analyzed.
A total of 21 studies (18 retrospective and 3 prospective) were included in the quantitative analysis. A total of 826 patients (females = 75%) received coccygectomy (720 total and 106 partial) for refractory coccygodynia. Trauma was reported as the most common etiology of coccygodynia (56%; n = 375), followed by idiopathic causes (33%; n = 221). The pooled mean difference (MD) in pain scores from baseline on a 0-10 scale was 5.03 (95% confidence interval [CI]: 4.35 to 6.86) at a 6-12 month follow-up (FU); 5.02 (95% CI: 3.47 to 6.57) at > 12-36 months FU; and 5.41 (95% CI: 4.33 to 6.48) at > 36 months FU. The MCID threshold for pain relief was surpassed at each follow-up. Oswestry Disability Index scores significantly improved postoperatively, with a pooled MD from baseline of - 23.49 (95% CI: - 31.51 to - 15.46), surpassing the MCID threshold. The pooled incidence of complications following coccygectomy was 8% (95% CI: 5% to 12%), the most frequent of which were surgical site infections and wound dehiscence. The pooled incidence of reoperations was 3% (95% CI: 1% to 5%).
Coccygectomy represents a viable treatment option in patients with refractory coccygodynia.
我们试图系统地评估和总结有关难治性尾骨痛行尾骨切除术后结局的现有文献。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南，对PubMed、Scopus和Cochrane图书馆数据库进行系统检索。提取并分析有关患者人口统计学数据、用于疼痛缓解的经过验证的患者报告结局指标（PROMs）、功能障碍结局、并发症和再次手术率的数据。
定量分析共纳入21项研究（18项回顾性研究和3项前瞻性研究）。共有826例患者（女性占75%）因难治性尾骨痛接受了尾骨切除术（全切除720例，部分切除106例）。据报告，创伤是尾骨痛最常见的病因（56%；n = 375），其次是特发性病因（33%；n = 221）。在6至12个月的随访（FU）中，0至10分制疼痛评分较基线的合并平均差（MD）为5.03（95%置信区间[CI]：4.35至6.86）；在超过12至36个月的随访中为5.02（95% CI：3.47至6.57）；在超过36个月的随访中为5.41（95% CI：4.33至6.48）。每次随访时均超过了疼痛缓解的最小临床重要差异（MCID）阈值。Oswestry功能障碍指数评分术后显著改善，较基线的合并MD为 - 23.49（95% CI： - 31.51至 - 15.46），超过了MCID阈值。尾骨切除术后并发症的合并发生率为8%（95% CI：5%至12%），其中最常见的是手术部位感染和伤口裂开。再次手术的合并发生率为3%（95% CI：1%至5%）。
对于难治性尾骨痛患者，尾骨切除术是一种可行的治疗选择。
