Isolated Coccygeal Tuberculosis

Isolated tuberculosis of the coccyx is extremely rare. A 35-year-old man presented with a 3-month history of coccygeal and gluteal pain. Computed tomography and magnetic resonance imaging revealed osseous destruction and a large enhancing mass involving the coccyx with anterior and posterior extension. Pathologic examination of the surgical specimen revealed necrosis, chronic granulomatous inflammation, and multinucleated giant cells consistent with tuberculosis. This case highlights the importance of considering tuberculosis as a diagnosis even though unusual sites are involved.     

Coccygectomy for stubborn coccydynia

Objective: To evaluate the preliminary clinical outcomes of coccygectomy in patients with coccydynia after a failure of conservative treatment.Methods: From May 2002 to January 2010, 31 patients with coccydynia were treated by coccygectomy in our department after conservative measures had failed to produce significant relief. A questionnaire, which included the extent of relief in the painful area, improvement in quality of life, intensity of pain in the sitting position, and pain score during daily activities, was used to evaluate the results.Results: All patients were followed up for 1 to 6 years (mean 3.3 years). The results were excellent in 20 patients (64.5%), good in 7 patients (22.6%), moderate in 3 patients (9.7%) and poor in 1 patient (3.2%). The excellent and good rates amounted to 87.1%. All patients except one had complete resolution of their symptoms and were subjectively highly satisfied with the outcomes of the surgery. Only 2cases of superficial infection were observed postoperatively.Conclusion: Coccygectomy is a feasible management option for patients with coccygodynia that has no response to conservative treatments.     

人体骶尾骨的动脉供应——骨内部分

用解剖、透明、腐蚀铸型和X线摄片等方法,研究了68具不同年龄新鲜尸体骶尾骨的骨内动脉供应。骶骨椎体的营养动脉由椎体腹侧面、背侧面和两外侧面进入。中央支支数恒定,是骶椎体的主要营养动脉。周围支支数不恒定,主要分布于椎体周围部。骶椎体动脉的配布可分为腹侧优势型、背侧优势型和均衡型。腹侧优势型多见于S_4和S_5;背侧优势型多见于S_1～S_3。成人以腹侧优势型多见,胎儿则以背侧优势型多见。均衡型在不同年龄组均较少见。腹侧和背侧营养动脉主要分布于椎体中央,外侧营养动脉分布于椎间孔附近的骨质。椎体内动脉大多吻合成网状。骶骨外侧部的营养动脉分别由腹侧、背侧和内侧面进入。背侧营养动脉管径粗,是外侧部的主要营养动脉。尾骨血液供应较差,营养动脉主要由腹侧面进入。     

Multicentric tuberculosis at two rare sites in an immunocompetent adult

The case of a 20-year-old female who presented with refractory coccydynia and sternal pain is described. She was immunocompetent, and had no systemic features. She was diagnosed with tuberculosis of the sternal and coccygeal regions based on magnetic resonance imaging and histopathology of biopsy specimens. Conservative management with oral multidrug antituberculous therapy completely cured the patient, and she had not suffered any recurrence after three years of follow-up. This case highlights the possibility of the multicentric presentation of tuberculosis at two rare sites in the same immunocompetent patient, even though the differential diagnosis was coccydynia.     

大鼠尾椎椎间盘退变静态压力模型的构建

目的采用静态压力构建稳定的大鼠尾椎椎间盘退变模型。方法将40只12周龄大鼠随机分为静态压力组和针刺组,每组20只。静态压力组:在尾椎C_(4~7)椎体上安装静态压力环形外固定支架,压缩的4根弹簧施加的压强均为10 kPa,维持8周。针刺组:采用16 G针头刺入尾椎C_4/C_5/C_6/C_7椎间盘,限制损伤深度5 mm、朝向椎间盘中心,损伤后留置10 s。分别于术后8周进行组织病理学切片观察,采用秩和检验比较2组Thompson椎间盘退变病理分级。结果对2组大鼠尾椎共120个椎间盘髓核组织标本进行病理分级,统计结果显示静态压力组退变级别明显高于针刺组,差异有统计学意义(P0.05)。结论采用静态压力构建的椎间盘退变模型稳定可靠,较传统针刺模型具有优势,可为临床椎间盘退变研究提供可靠的动物模型。     

PKH26荧光标记牛尾髓核细胞的实验研究

【摘要】 目的 探讨PKH26荧光标记在牛尾髓核细胞的应用研究。方法 从牛尾椎间盘中分离髓核组织,通过酶消化法获取原代细胞,倒置显微镜下观察,P1代髓核细胞进行番红O、甲苯胺蓝和Ⅱ型胶原免疫细胞化学染色,对P1代髓核细胞进行PKH26荧光染料标记,并对标记后细胞的活性、荧光强度（0、14、28d）及增殖特性进行评估。结果 分离得到的髓核细胞数为1.56±0.35×106/g,倒置显微镜下,原代细胞4d开始贴壁,细胞成群生长,13d铺满瓶底,原代细胞、 P1代细胞均呈类软骨样细胞形态;P1代髓核细胞甲苯胺蓝染色异染、番红O染色和Ⅱ型胶原免疫细胞化学染色阳性;PKH26标记前后细胞活性均在95%以上,0d、14d、28d呈递减趋势,但28d时细胞仍可以检测出较强的荧光,标记后的细胞生长曲线与标记前的细胞生长曲线差异无统计学意义（P＞0.05)。结论 牛尾髓核组织中可以分离出数量满意的髓核细胞,而且具有软骨样细胞的表型,可以用作种子细胞;PKH26标记后的髓核细胞无生物学特性的变化,可以用作髓核细胞体内研究的示踪染料。     

尾骨切除术治疗慢性尾骨痛27例

目的：评价尾骨全切术治疗慢性尾骨痛的疗效。方法：2006年3月~2010年1月采用尾骨全切术治疗慢性尾骨痛27例。结果：随访6~24个月,平均12个月。术后有3例出现中度骶尾部疼痛,1例切口浅表皮肤感染,无1例出现主要血管神经损伤、直肠刺激症状等并发症。27例病人,治疗成功率88.9%。结论：利用尾骨全切术治疗慢性尾骨痛是一种合理有效的方法,能有效地治疗慢性尾骨痛并避免患者长期非手术治疗带来的痛苦,从而提高患者生活质量。     

Extracorporeal shock wave therapy relieved pain in patients with coccydynia: a report of two cases

Background contextExtracorporeal shock wave therapy (ECSWT) has been used widely for musculoskeletal conditions; however, no reports are available about its use for coccydynia.PurposeStudy the effect of ECSWT in relieving pain of coccydynia.Study designCase report.MethodsExtracorporeal shock wave therapy was used for two male patients, Patients 1 and 2, who failed to respond completely to other conservative management of coccydynia. Numerical pain scale (NPS) and visual analogue scale (VAS) were used to assess the pain. Consent to publish the data was obtained from both the patients.ResultsBefore starting ECSWT, Patient 1 reported a pain intensity of 6/10 and 5.1/10 on NPS and VAS, respectively, whereas the intensity of pain in Patient 2 was 7/10 and 6.9/10 on NPS and VAS, respectively. Four weeks after ECSWT, Patient 1 reported complete relief of pain on NPS and VAS, whereas Patient 2 reported a pain intensity of 1/10 and 0.8/10 on NPS and VAS, respectively. The same intensity of pain was reported by both patients after 12 months of follow-up.ConclusionsExtracorporeal shock wave therapy relieved pain of coccydynia in our patients.