Abstract：
BACKGROUND: Coccydynia is pain in the coccyx that typically occurs idiopathically or from trauma. Most forms are self-limiting. However, if symptoms persist, nonsurgical treatment options can include offloading, NSAIDs, physical therapy, and steroid injections. If all treatment options fail, a growing body of evidence supports a coccygectomy for symptomatic relief. The standard approach for a coccygectomy involves a midline incision cephalad to the anus along the gluteal cleft. Historically, this method has had high rates of infection.
OBJECTIVE: To improve healing and decrease infection rate, we propose the paramedian approach to a coccygectomy. This approach has the benefit of distancing the surgical site from the anus, diminishing the crevice effect of the incision, and increasing the dermal and subdermal thickness for improved surgical closure.
METHODS: We present a case series study of 41 patients who underwent the paramedian approach coccygectomy using a 4 to 6 cm incision, approximately 0.5 to 1.5 cm lateral to the midline, for coccyx removal. These patients were evaluated postoperatively to determine infection rate and various outcome measures.
METHODS: Forty-one patients suffering from refractory coccydynia had a coccygectomy via the paramedian approach between 2011 and 2022 by the senior author.
METHODS: Outcome measures included self-reported measures (Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) pain scale and satisfaction with procedure), physiologic measures (presence of infection and treatment provided) and functional measures (return to vocation/avocation).
METHODS: Data was compiled and transferred to Microsoft Excel and analyzed. Two-tailed T-tests were used to compare the patient improvement in VAS and ODI as appropriate for statistical analysis.
RESULTS: The patients\' average age was 45.8 years. Patients\' average body mass index was 27.9, with 71% of patients overweight or obese. A total of 68% of patients were female. Trauma was the most common precipitating factor (75.6%). Five patients presented with postoperative complications (12.1%), one requiring an incision and drainage, and four others were treated with antibiotics for wound erythema. Postoperative evaluations showed continual improvement, with the most significant improvement reported greater than 1-year postoperatively. The Visual Analogue Scale for pain dropped from 7.5 to 2.3 (p<.001), and the Oswestry Disability Index improved from 30.1 to 9.6 (p<.001). A total of 86.7% of patients reported either a good or excellent result.
CONCLUSIONS: Coccygectomies via the midline approach have a variable infection rate, likely due to proximity of the incision to the anus and due to the crevice effect of the gluteal cleft in terms of aeration. These contributing factors are overcome in the paramedian approach, making it an effective option for treating refractory coccydynia that is nonresponsive to conservative management.
OBJECTIVE: To improve healing and decrease infection rate, we propose the paramedian approach to a coccygectomy. This approach has the benefit of distancing the surgical site from the anus, diminishing the crevice effect of the incision, and increasing the dermal and subdermal thickness for improved surgical closure.
METHODS: We present a case series study of 41 patients who underwent the paramedian approach coccygectomy using a 4 to 6 cm incision, approximately 0.5 to 1.5 cm lateral to the midline, for coccyx removal. These patients were evaluated postoperatively to determine infection rate and various outcome measures.
METHODS: Forty-one patients suffering from refractory coccydynia had a coccygectomy via the paramedian approach between 2011 and 2022 by the senior author.
METHODS: Outcome measures included self-reported measures (Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) pain scale and satisfaction with procedure), physiologic measures (presence of infection and treatment provided) and functional measures (return to vocation/avocation).
METHODS: Data was compiled and transferred to Microsoft Excel and analyzed. Two-tailed T-tests were used to compare the patient improvement in VAS and ODI as appropriate for statistical analysis.
RESULTS: The patients\' average age was 45.8 years. Patients\' average body mass index was 27.9, with 71% of patients overweight or obese. A total of 68% of patients were female. Trauma was the most common precipitating factor (75.6%). Five patients presented with postoperative complications (12.1%), one requiring an incision and drainage, and four others were treated with antibiotics for wound erythema. Postoperative evaluations showed continual improvement, with the most significant improvement reported greater than 1-year postoperatively. The Visual Analogue Scale for pain dropped from 7.5 to 2.3 (p<.001), and the Oswestry Disability Index improved from 30.1 to 9.6 (p<.001). A total of 86.7% of patients reported either a good or excellent result.
CONCLUSIONS: Coccygectomies via the midline approach have a variable infection rate, likely due to proximity of the incision to the anus and due to the crevice effect of the gluteal cleft in terms of aeration. These contributing factors are overcome in the paramedian approach, making it an effective option for treating refractory coccydynia that is nonresponsive to conservative management.
摘要：
背景：尾骨痛是指尾骨疼痛，通常由病理性或外伤引起。大多数形式是自我限制的。然而,如果症状持续存在，非手术治疗方案可以包括卸载，NSAIDs,物理治疗,和类固醇注射。如果所有的治疗方案都失败了,越来越多的证据支持尾骨切除术缓解症状。尾骨切除术的标准方法包括沿臀裂向肛门的中线切口。历史上,这种方法感染率很高。
目的：为了改善愈合，降低感染率，我们建议采用辅助方法进行尾骨切除术。这种方法的好处是使手术部位与肛门保持距离，减少切口的缝隙效应，并增加真皮和皮下厚度以改善手术闭合。
方法：我们提供了一项病例系列研究，其中41例患者接受了4-6厘米切口的旁正中入路尾骨切除术，大约0.5-1.5厘米横向中线，尾骨去除。术后对这些患者进行评估，以确定感染率和各种结局指标。
方法：资深作者在2011年至2022年期间，41例难治性尾骨痛患者通过旁正中入路进行了尾骨切除术。
方法：结果指标包括自我报告指标（Oswestry残疾指数（ODI），视觉模拟评分（VAS）疼痛量表和对手术的满意度），生理措施(是否存在感染和提供治疗)和功能措施(返回职业/职业康复)方法:数据被汇编并转移到MicrosoftExcel并进行分析.使用双尾T检验来比较患者在VAS和ODI方面的改善,以适用于统计学分析。
结果：患者平均年龄为45.8岁。患者的平均体重指数为27.9，其中71％的患者超重或肥胖。68%的患者为女性。创伤是最常见的诱发因素(75.6%)。5例患者出现术后并发症（12.1%），一个需要切开和引流的人，另外四人接受抗生素治疗伤口红斑。术后评估显示持续改善，最显著的改善报告超过术后一年。疼痛的视觉模拟评分从7.5降至2.3（P<0.001）。Oswestry残疾指数从30.1提高到9.6(P<0.001)。86.7%的患者报告良好或优异的结果。
结论：经中线入路的眼球切除术有不同的感染率，可能是由于切口靠近肛门以及臀裂在通气方面的缝隙作用。这些促成因素在参数方法中被克服，使其成为治疗对保守治疗无反应的难治性尾骨痛的有效选择。
目的：为了改善愈合，降低感染率，我们建议采用辅助方法进行尾骨切除术。这种方法的好处是使手术部位与肛门保持距离，减少切口的缝隙效应，并增加真皮和皮下厚度以改善手术闭合。
方法：我们提供了一项病例系列研究，其中41例患者接受了4-6厘米切口的旁正中入路尾骨切除术，大约0.5-1.5厘米横向中线，尾骨去除。术后对这些患者进行评估，以确定感染率和各种结局指标。
方法：资深作者在2011年至2022年期间，41例难治性尾骨痛患者通过旁正中入路进行了尾骨切除术。
方法：结果指标包括自我报告指标（Oswestry残疾指数（ODI），视觉模拟评分（VAS）疼痛量表和对手术的满意度），生理措施(是否存在感染和提供治疗)和功能措施(返回职业/职业康复)方法:数据被汇编并转移到MicrosoftExcel并进行分析.使用双尾T检验来比较患者在VAS和ODI方面的改善,以适用于统计学分析。
结果：患者平均年龄为45.8岁。患者的平均体重指数为27.9，其中71％的患者超重或肥胖。68%的患者为女性。创伤是最常见的诱发因素(75.6%)。5例患者出现术后并发症（12.1%），一个需要切开和引流的人，另外四人接受抗生素治疗伤口红斑。术后评估显示持续改善，最显著的改善报告超过术后一年。疼痛的视觉模拟评分从7.5降至2.3（P<0.001）。Oswestry残疾指数从30.1提高到9.6(P<0.001)。86.7%的患者报告良好或优异的结果。
结论：经中线入路的眼球切除术有不同的感染率，可能是由于切口靠近肛门以及臀裂在通气方面的缝隙作用。这些促成因素在参数方法中被克服，使其成为治疗对保守治疗无反应的难治性尾骨痛的有效选择。
