无尾骨痛成年中国人尾骨CT形态学研究

A CT-based study of coccyx morphology in adult Chinese without symptoms of coccydynia

中文关键词:  无症状  尾骨形态  影像学

英文关键词:Asymptomatic  Coccygeal morphology  Radiographic

中文摘要:

  【摘要】 目的：基于CT扫描研究无尾骨痛症状成年中国人的尾骨形态，为中国人尾骨痛的风险评估提供形态学参考。方法：回顾性分析2018年8月～2023年8月在温州医科大学附属第二医院进行骨盆三维CT扫描的113例无尾骨痛症状患者，其中男67例，女46例，年龄53.5±19.1岁（18~93岁）。在三维重建CT影像上分析骶尾骨的形态学特征：尾骨节段数、尾骨Nathan改良分型、骶尾关节融合、尾骨间关节半脱位、尾骨骶骨化、尾骨尖端侧偏、第五骶骨腹侧弯曲、尾骨针状体；分别测量相关形态学参数：尾骨直线长度、骶骨直线长度、骶尾直线长度、腰骶角、骶尾角、骶尾关节角、尾骨间角、尾1/2间角并进行一致性检验。比较不同性别和不同年龄段（分为年龄＜50岁和年龄≥50岁两组）上述形态学参数的差异。结果：在113例无尾骨痛成年中国人中，88例（77.9%）的尾骨由4节组成，Nathan改良分型Ⅰ型是最常见类型，约占46.9%（53例）。骶尾关节融合、尾骨间关节半脱位、尾骨骶骨化、尾骨尖端侧偏、第五骶骨腹侧弯曲和尾骨针状体的发生率分别为52.2%（59例）、25.7%（29例）、20.4%（23例）、53.1%（60例）、7.1%（8例）和15.0%（17例）。一致性检验表明，观察者间测量数据的一致性良好。中国人的平均尾骨直线长度、骶骨直线长度、骶尾直线长度分别为3.59±0.72cm、10.97±0.92cm、12.68（11.99，13.69）cm，腰骶角、骶尾角、骶尾关节角、尾骨间角和尾1/2间角分别为38.0°±7.3°、110.6°±10.6°、173.1°（164.2°，178.2°）、131.5°±21.5°、152.8°±17.1°。男性的骶尾直线长度和骶尾角大于女性（P＜0.05）。年龄＜50岁人群的尾骨直线长度、腰骶角、骶尾关节角和尾1/2间角小于年龄≥50岁人群（P＜0.05），而年龄＜50岁人群的骶骨直线长度大于年龄≥50岁人群（P＜0.01）。结论：在无尾骨痛症状成年中国人中，最常见的尾骨节段数和类型分别为4节和Ⅰ型尾骨，骶尾关节融合、尾骨针状体、尾骨间关节半脱位、尾骨骶骨化等变异具有较高发生率；男性比女性有更长更直的骶尾骨，年龄＜50岁人群相比年龄≥50岁人群具有更短的尾骨、更长的骶骨以及更小的腰骶角。

英文摘要:

  【Abstract】 Objectives: To investigate the coccygeal morphology in adult Chinese without coccydynia using CT scans, and to provide a morphological reference for assessing the risk of coccydynia in Chinese population. Methods: A retrospective analysis was conducted on 113 patients without coccydynia who underwent pelvic three-dimensional CT scans at the Second Affiliated Hospital of Wenzhou Medical University between August 2018 and August 2023. There were 67 males and 46 females, with a mean age of 53.5±19.1 years(range: 18-93 years). The morphological characteristics of the sacrococcygeal anatomical structures, including coccyx number, coccyx type(modified Nathan classification), sacrococcygeal joint fusion, intercoccygeal joint subluxation, coccygeal sacralization, lateral deviation of coccygeal tip, ventral angulation of S5, and coccygeal bony spicule, were analyzed on the three-dimensional reconstructed CT images; And relevant morphological parameters were measured, such as the coccygeal straight length, sacral straight length, sacrococcygeal straight length, sacrolumbar angle, sacrococcygeal angle, sacrococcygeal joint angle, intercoccygeal angle, and first intercoccygeal joint angle, with consistency tests conducted for the measurements. The differences in morphological parameters were compared between different genders and age groups(<50 years and ≥50 years). Results: Among the 113 asymptomatic adult Chinese subjects, 88 cases(77.9%) had a 4-segment coccyx, and type Ⅰ coccyx(modified Nathan classification) was the most common type(53 cases), accounting for approximately 46.9%. The incidence of sacrococcygeal joint fusion, intercoccygeal joint subluxation, coccygeal sacralization, lateral deviation of the coccygeal tip, ventral angulation of S5, and coccygeal bony spicule were 52.2%(59 cases), 25.7%(29 cases), 20.4%(23 cases), 53.1%(60 cases), 7.1%(8 cases), and 15.0%(17 cases), respectively. The consistency test showed that the consistency of the measurement data among observers was good. In Chinese population, the coccygeal straight length was 3.59±0.72cm, sacral straight length was 10.97±0.92cm, and sacrococcygeal straight length was 12.68(11.99, 13.69)cm. The lumbosacral angle, sacrococcygeal angle, intercoccygeal angle, and first intercoccygeal joint angle were 38.0°±7.3°, 110.6°±10.6°, 173.1°(164.2°, 178.2°), 131.5°±21.5°, and 152.8°±17.1°, respectively. Gender comparisons showed that males had greater sacrococcygeal straight length and sacrococcygeal angle than females(P<0.05). Age group comparisons revealed that subjects <50 years had shorter coccygeal straight length, smaller lumbosacral angle, sacrococcygeal joint angle, and first intercoccygeal joint angle than those ≥50 years(P<0.05), while the sacral straight length was longer in the <50 years group(P<0.01). Conclusions: Among the adult Chinese without coccydynia, 4 coccygeal segments and type Ⅰ(modified Nathan classification) are the most common. Sacrococcygeal joint fusion, coccygeal bony spicules, intercoccygeal joint subluxation, and coccygeal sacralization have relatively high incidences. Males have longer and straighter sacrococcygeal structures than females. Compared with those ≥50 years, subjects <50 years have shorter coccyxes, longer sacra, and smaller lumbosacral angles.