Investigation Of The Classification And Therapeutic Schedule Of Acute Traumatic Coccygodynia

Objective: This paper is to classify acute traumatic coccygodynia (ATC) according to clinical manifestation and imageology and figure out a scientific therapeutic schedule based on the analysis of curative effects of applying comprehensive conservation treatment and coccygectomy respectively, then provide orthopedic surgeons with scientific evidence to choose suitable treatment for ATC.Methods: 159 patients of ATC in the clinics or hospitals from July 2006 to October 2008 were randomly selected to take a X-ray check on the sacroiliac. Six types of ATC were displayed on the X-ray images including Typeâ… , without fracture or dislocation, Typeâ…¡, mild fracture and subluxation, Typeâ…¢, instability of coccygeal vertebrae, Typeâ…£, severe fracture displacement, Typeâ…¤, dislocation only, and Typeâ…¥, multiple fracture and/or dislocation. And furthermore, all cases in the study were classified into six groups according to the above types. For group 1 only comprehensive conservation treatment was offered, and for group 2 to 6 both comprehensive conservation treatment and coccygectomy were randomly applied as comparison. The comprehensive conservation treatments included general treatment, massage, medication and local injection for hormonal blocking. And the coccygectomy included total or partial coccygectomy. The curative effects within two weeks, a month, three months and six months after applying treatment were assessed by the Wong-Banker facial pain scale and the Oswestry low back pain Disability Index (ODI) questionnaire. All data were analyzed by software SAS 8.0.Results: The changes of Wong-Banker facial pain scale and ODI indicated the patients in ATC cases of group 1 who were conservatively treated recovered well. Their pains were obviously relieved and they could go back to routine life and work within two weeks. Patients in group2 treated with comprehensive conservation had the same good results as the ones treated with coccygectomy(P> 0.05).The results of group3, group4, group5, and group6 treated with coccygectomy were significantly superior to the ones with comprehensive conservation(P<0.05). Of the 69 cases studied, six had postoperative complications, such as superficial wound infection (2), deep-wound infection (1), acute urinary retention (2), and rectum irritation (1). The postoperative incidence was up to 8.70%.Conclusions: The ATC classification method, which is prompt, reliable and easy to apply, may contribute to guiding efficient treatment according to clinical manifestation and imaging examination proposed in the study. Generally speaking, better results can be witnessed on these ATC cases with either comprehensive conservation treatment or coccygectomy. Meanwhile, we recommend orthopedic surgeons offering comprehensive conservation treatment to ATC patients without fracture and dislocation or with mild fracture and coccygectomy to those with instability of coccygeal vertebrae, serious fracture displacement, dislocation only, and multiple fracture and/or dislocation.