Etiological classification and clinical manifestations of coccygeal pain? The coccyx is composed of 3 ~ 5 vertebrae, which is the residual part of the "tail" in the process of human evolution. Coccygeal pain includes pain in coccyx, lower sacrum and its adjacent soft tissues, which can be caused by various diseases in these parts. Etiology and classification There are many pathogenic factors of coccygeal pain, both directly caused by local factors and caused by neighboring diseases, which are summarized as follows. 1. Strain of sacrococcygeal ligament The sacrococcygeal ligament is located in the lowest position of the spine, which can be caused by falling and sitting on the hip, local shuttle kicking or collision. However, the compression when sitting, the pulling and squeezing when sitting, and even the collision of hard feces during defecation can further damage the damaged ligament and make it develop into chronic strain. Sacrococcygeal joint itself is fragile, often accompanied by coccyx subluxation. The strain of sacrococcygeal ligament can aggravate the instability of sacrococcygeal joint, and also promote the pathological changes of damaged ligament, forming a vicious circle. Fiber breakage, edema, exudation, proliferation and adhesion of sacrococcygeal ligament strain not only cause dysfunction, but also pull and compress adjacent or internal nerve fibers, resulting in tail pain. 2. Degeneration of sacrococcygeal joint Traumatic subluxation or instability of sacrococcygeal joint can narrow joint space, wear, hyperplasia and sclerosis of joint surface, leading to degeneration. Coccyx injury often occurs in women during childbirth, which leads to the fibrosis and stiffness of sacrococcygeal joints. Degeneration of sacrococcygeal joints or osteoarthritis can cause pain when sitting or squeezing the end of coccyx. 3. Fracture or dislocation of coccyx is often caused by hip injury and direct violence when sitting on the ground. The strong contraction of levator ani and coccygeal muscles attached to the distal end of the fracture can move forward. Fresh fracture or dislocation without displacement, just stay in bed. Old fractures, dislocations and poor bone healing often leave symptoms of coccyx pain. 4. The coccyx deformity is mostly long coccyx, and the soft tissue of the tail is compressed by sitting posture, resulting in pain. There are also long and twisted coccyx or acute angle or ankylosis. 5. Pelvic infection The focus of pelvic infection spreads to the pelvic floor muscles, which reflexively causes repeated muscle spasms, thus causing coccygeal pain. 6. coccygeal tumors include chordoma, chondroma, glomus tumor and chondrosarcoma. 7. Tuberculosis or osteomyelitis of coccyx. Lumbosacral diseases Lumbosacral vertebra 5 1 disc herniation, fifth lumbar spondylolisthesis, lumbar spinal stenosis, etc. , can cause tail pain due to compression of dura mater and nerve roots. Clinical manifestations: Tail pain is the main symptom. Most patients have a history of tail trauma. The pain is more obvious when sitting, especially when sitting on a hard bench, and the pain can be alleviated or painless when walking. Patients often sit on a stool with one hip, or use sponges and pillows as cushions to avoid compression of the coccyx. When coughing or defecating, especially constipation, the pain can be aggravated, and patients often have fear of defecation. Physical examination showed tenderness in sacrococcygeal joint, caudal apex and adjacent soft tissues. The anus refers to the diagnosis with food, and the thumb holds the coccyx and shakes it back and forth, which can aggravate the pain. Conventional X-ray plain film examination can only find fracture or dislocation of coccyx and abnormal changes of coccyx, but it is helpful for differential diagnosis. To treat fresh sacrococcygeal joint dislocation or displaced fracture, anal reduction should be done by hand. Stay in bed after reset, get up after 1 ~ 2 weeks, put a balloon or air pillow on the seat to prevent further injury, and give physical therapy. People with strain or degeneration can use massage therapy or local blocking therapy. Before massage, physical therapy can be performed first, and then the spastic muscles attached to the front of sacrococcygeal bone and its left and right sides can be massaged in the anus with the index finger, from light to heavy, 3 ~ 4 times a week. After this treatment, most patients can relieve or disappear the pain. If the symptoms are difficult to control, hydrocortisone acetate or Corning Ke Tong (triamcinolone acetonide suspension) plus procaine or lidocaine can be used to block the pain point. When sealing the tube, the most obvious tenderness should be determined, and the puncture depth should be grasped to prevent the liquid medicine from being injected into the rectum by mistake. All kinds of coccygeal pain can be treated by hot water sitz bath, 1 ~ 2 times a day. Reduce walking to reduce anal tail muscle spasm. It is also important to change the sitting posture. Keeping the weight of ischium and thigh root or using air cushion to help coccyx not be compressed as much as possible is beneficial to the rehabilitation of the disease. However, this sitting habit usually needs to be maintained for 3 ~ 6 months, otherwise the coccyx compression can often restart the course of disease. Analgesics and antibacterial drugs can be used as appropriate. Conservative treatment is effective for most coccygeal pain. Long-term conservative treatment is ineffective, and the pain is serious, which affects normal work and life. Surgical treatment and coccygeal resection can be considered, but it is not easy to use. The operative effect of coccyx tumor, coccyx tuberculosis and ankylosing coccyx is better.