How to treat coccyx dislocation, two methods are effective

There are many reasons for coccyx dislocation, some due to falls, some due to illness. For treatment, both non-surgical and surgical methods can be used. From a clinical point of view, the treatment effect is very good, allowing many patients to stay away from pain and have a healthy life.

1. Non-surgical treatment

(1) Acute phase: Rest in bed for 3 to 5 days and then gradually get out of bed and move around, using an inflatable or sponge pad when sitting. For those with displaced fractures, manual reduction is performed through digital rectal examination under local anesthesia (sliding up and down and applying pressure to return the distal fracture end to its original position), and repeated once after 3 days. Due to the pulling effect of the perianal and anal levator muscles, it is often difficult to obtain an ideal reduction.

(2) Chronic stage: Physical therapy, sitz bath and other therapies can be used, and care should be taken not to apply excessive pressure to the local area. For seriously ill patients, sacral canal blockade therapy can be performed once a week, with 3 to 4 times as a course of treatment. For patients with persistent symptoms, coccygeal resection may be performed as appropriate.

2. Surgical treatment mainly includes coccygectomy.

(1) Surgical case selection: mainly cases with long-term pain after coccyx injury that cannot be relieved. The exact cause is unclear, but it may be due to compression of the coccygeal nerve by scar tissue. Sacral tumors, inflammation, and lumbar disc herniation should be excluded before surgery.

(2) Preoperative preparation: Perform a cleansing enema 1 to 2 days before surgery, empty the bowels on the morning of surgery, and take oral antibiotics to prevent gastrointestinal infections.

(3) Surgical steps:

① Body position: The patient takes the chest-knee position, lateral position or prone position, and uses 2 to 3 pillows to raise the pelvis (Figure 2).

②Anesthesia: Epidural anesthesia or general anesthesia is often used.

③Incision: Make a longitudinal or "S"-shaped incision centered on the sacrococcygeal joint, about 5 cm long (Figure 3).

④ Expose the surgical field and retract the coccyx: first expose the sacrococcygeal joint and sacrococcygeal ligament (Figure 4), then incise the joint capsule and retract the coccyx posteriorly and inferiorly.

⑤ Resection of the coccyx: Dissect from the upper end of the coccyx to the tip of the coccyx, use a sharp knife to cut off the levator ani muscles attached to both sides of the coccyx, and completely remove the coccyx (Figures 5, 6).

⑥ Suture the muscle group: After cleaning the surgical field, suture the levator ani muscles one by one and suture the incisions in layers.

(4) Postoperative care: Follow routine postoperative care for anorectal surgery, mainly to prevent wound contamination and infection, and pay attention to diet control.