Öz
Amaç: Türkiye popülasyonunda bilgisayarlı tomografide yapılan ölçümler ile normal koksigeal
morfoloji ve morfometriyi araştırmayı amaçladık.
Gereç ve Yöntem: Kasım 2020-Nisan 2021 tarihleri arasında merkezimizde alt batın bilgisayarlı
tomografi veya pelvik bilgisayarlı tomografi çekilen 428 hastaya ait görüntüler retrospektif olarak
değerlendirildi. Sakral ya da koksigeal patolojisi ya da kırığı olan hastalar çalışma dışı bırakıldı. Sagital
plan reformatlardan koksiks segment sayıları, koksiks tipleri; morfometrik olarak parametreler olarak
sakral ve koksigeal dik uzunluk, sakral ve koksigeal kavisli uzunluk, sakral ve koksigeal eğrilik indeksi,
sakrokoksigeal ve interkoksigeal açılar ölçüldü. Bu parametrelerin yaş ve cinsiyetle ilişkileri ve
farklılıkları analiz edildi.
Bulgular: Tip 1 koksiks (%45,8) en sık saptanan koksiks tipi olup 2 hastada (%0,5) Tip 0 koksiks
saptandı. Hastaların 234’ünde (%54,6) koksiks 4 segmentten oluşmaktaydı ve en sık görülen
varyasyondu. Sakrum ve koksiksin ortalama dik uzunluğu 110,2 mm ve 33,1 mm olarak; kavisli
uzunlukları sırasıyla 124,5 mm ve 41,6 mm olarak saptandı. Ortalama sakral ve koksigeal eğrilik
indeksi 90,4 ve 86,3 olarak ölçüldü. Ortalama sakrokoksigeal ve interkoksigeal açılar ise 109,2° ve
43,3° derece olarak saptandı. Sakrokoksigeal açı ile cinsiyet arasında anlamlı farklılık tespit edildi
(p=0,001).
Sonuç: Koksigeal morfoloji ve morfometri ülkemizde yapılmış diğer araştırmalarla karşılaştırıldığında
daha heterojen olarak saptanmıştır. Tip 0 koksiks literatürde yeni tanımlanmış, sadece Türk
popülasyonunda tariflenmiş bir morfolojik tip olup radyolojik sınıflamaya eklenmesi faydalı olacaktır.
Özellikle asemptomatik hastalarda olağan vertebral anatominin bilinmesi koksidinialı hastalarda
gereksiz cerrahiyi önleyebilir.
Anahtar Kelimeler
Koksiks sakrum sakrokoksigeal eklem sakrokoksigeal açı interkoksigeal açı
Kaynakça
- Duncan G. Painful coccyx. Arch Surg 1937;34(6):1088-104.
- Lirette LS, Chaiban G, Tolba R vd. An overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J 2014;14(1):84-7.
- Karadimas EJ, Trypsiannis G, Giannoudis PV. Surgical treatment of coccygodynia: an analytic review of the literatüre. Eur Spine J 2011;20(5):698-705.
- Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine 2000;25(23):3072-9.
- Ballain B, Eisenstein M, Alo G. Coccygectomy for coccydynia: case series and review of literature. Spine (Phila Pa 1976) 2006 ;31(13):E414-20.
- Wray C, Easom S, Hoskinson J. Coccydynia: aetiology and treatment. J Bone Joint Surg Br 1991;73(2):335-8.
- Postacchini F, Massobrio M. Idiopathic coccygodynia: analysis of fifty-one operative cases and a radiographic study of the normal coccyx. J Bone Joint Surg Am 1983;65(8):1116-24.
- Hekimoglu A, Ergun O. Morphological evaluation of the coccyx with multidetector computed tomography. Surg Radiol Anat 2019;41(12):1519-24.
- Przybylski P, Pankowicz M, Boćkowska A, vd. Evaluation of coccygeal bone variability, intercoccygeal and lumbo-sacral angles in asymptomatic patients in multislice computed tomography. Anat Sci Int 2013;88(4):204-11.
- Yoon MG, Moon MS, Park BK, vd. Analysis of Sacrococcygeal Morphology in Koreans Using Computed Tomography. Clin Orthop Surg. 2016;8(4):412-9.
- Kerimoglu U, Dagoglu MG, Ergen FB. Intercoccygeal angle and type of coccyx in asymptomatic patients. Surg Radiol Anat 2007;29(8):683-7.
- Guneri B, Gungor G. Morphological Features of the Coccyx in the Turkish Population and Interrelationships Among the Parameters: A Computerized Tomography-Based Analysis. Cureus 2021;13(11):e19687.
- Marwan YA, Al-Saeed OM, Esmaeel AA, vd. Computed tomography-based morphologic and morphometric features of the coccyx among Arab adults. Spine (Phila Pa 1976) 2014;39(20):E1210-9.
- Woon JT, Maigne JY, Perumal V, vd. Magnetic resonance imaging morphology and morphometry of the coccyx in coccydynia. Spine (Phila Pa 1976) 2013;38(23):E1437-45.
- Karayol S. S., Karayol K.C., Sen Dokumacı D. Anatomic and morphometric evaluation of the coccyx in the adult population. Harran Üniversitesi Tıp Fakültesi Dergisi 2019;16(2):221-6.
- Indiran V, Sivakumar V, Maduraimuthu P. Coccygeal Morphology on Multislice Computed Tomography in a Tertiary Hospital in India. Asian Spine J 2017;11(5):694-9.
- Tetiker H, Koşar MI, Çullu N, vd. MRI-based detailed evaluation of the anatomy of the human coccyx among Turkish adults. Niger J Clin Pract 2017;20(2):136-42.
- Kim NH, Suk KS. Clinical and radiological differences between traumatic and idiopathic coccygodynia. Yonsei Med J 1999;40(3):215-20.
Öz
Aim: We aimed to detect the normal coccygeal morphology and morphometry in the Turkish
population using computed tomography.
Materials and Methods: Lower abdominal computed tomography or pelvic computed tomography
images of 428 patients obtained between November 2020 and April 2021 were evaluated
retrospectively. Patients with sacral or coccygeal pathology or fracture were excluded from the study.
Coccyx segment numbers from sagittal plane reformats, coccyx types; Sacral and coccygeal vertical
length, sacral and coccygeal curved length, sacral and coccygeal curvature index, sacrococcygeal and
intercoccygeal angles were measured as morphometric parameters. The relationships and differences
of these parameters with age and gender were analyzed.
Results: Type 1 coccyx (45.8%), was the most common type of coccyx and Type 0 coccyx was
detected in 2 patients (0.5%). The coccyx consisted of 4 segments in 234 (54.6%) patients and was
the most common variation. Mean vertical length of sacrum and coccyx was 110.2 mm and 33.1 mm;
curved lengths were found to be 124.5 mm and 41.6 mm, respectively. The mean sacral and
coccygeal curvature indexes were measured as 90.4 and 86.3. The mean sacrococcygeal and
intercoccygeal angles were 109.2° and 43.3°. There was a statistically significant correlation between
the sacrococcygeal angle and gender (p=0.001).
Conclusion: The coccygeal morphology and morphometry show more heterogeneity when compared
with other studies made in our population. Type 0 coccyx is a newly defined morphological type in the
literature. It is detected only in the Turkish population, and it would be useful to add it to the radiologic
classification. Knowing the usual vertebral anatomy, especially in asymptomatic patients, may prevent
unnecessary surgery in patients with coccidynia.
Anahtar Kelimeler
Coccyx sacrum sacrococcygeal joint sacrococcygeal angle ıntercoccygeal angle
Kaynakça
- Duncan G. Painful coccyx. Arch Surg 1937;34(6):1088-104.
- Lirette LS, Chaiban G, Tolba R vd. An overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J 2014;14(1):84-7.
- Karadimas EJ, Trypsiannis G, Giannoudis PV. Surgical treatment of coccygodynia: an analytic review of the literatüre. Eur Spine J 2011;20(5):698-705.
- Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine 2000;25(23):3072-9.
- Ballain B, Eisenstein M, Alo G. Coccygectomy for coccydynia: case series and review of literature. Spine (Phila Pa 1976) 2006 ;31(13):E414-20.
- Wray C, Easom S, Hoskinson J. Coccydynia: aetiology and treatment. J Bone Joint Surg Br 1991;73(2):335-8.
- Postacchini F, Massobrio M. Idiopathic coccygodynia: analysis of fifty-one operative cases and a radiographic study of the normal coccyx. J Bone Joint Surg Am 1983;65(8):1116-24.
- Hekimoglu A, Ergun O. Morphological evaluation of the coccyx with multidetector computed tomography. Surg Radiol Anat 2019;41(12):1519-24.
- Przybylski P, Pankowicz M, Boćkowska A, vd. Evaluation of coccygeal bone variability, intercoccygeal and lumbo-sacral angles in asymptomatic patients in multislice computed tomography. Anat Sci Int 2013;88(4):204-11.
- Yoon MG, Moon MS, Park BK, vd. Analysis of Sacrococcygeal Morphology in Koreans Using Computed Tomography. Clin Orthop Surg. 2016;8(4):412-9.
- Kerimoglu U, Dagoglu MG, Ergen FB. Intercoccygeal angle and type of coccyx in asymptomatic patients. Surg Radiol Anat 2007;29(8):683-7.
- Guneri B, Gungor G. Morphological Features of the Coccyx in the Turkish Population and Interrelationships Among the Parameters: A Computerized Tomography-Based Analysis. Cureus 2021;13(11):e19687.
- Marwan YA, Al-Saeed OM, Esmaeel AA, vd. Computed tomography-based morphologic and morphometric features of the coccyx among Arab adults. Spine (Phila Pa 1976) 2014;39(20):E1210-9.
- Woon JT, Maigne JY, Perumal V, vd. Magnetic resonance imaging morphology and morphometry of the coccyx in coccydynia. Spine (Phila Pa 1976) 2013;38(23):E1437-45.
- Karayol S. S., Karayol K.C., Sen Dokumacı D. Anatomic and morphometric evaluation of the coccyx in the adult population. Harran Üniversitesi Tıp Fakültesi Dergisi 2019;16(2):221-6.
- Indiran V, Sivakumar V, Maduraimuthu P. Coccygeal Morphology on Multislice Computed Tomography in a Tertiary Hospital in India. Asian Spine J 2017;11(5):694-9.
- Tetiker H, Koşar MI, Çullu N, vd. MRI-based detailed evaluation of the anatomy of the human coccyx among Turkish adults. Niger J Clin Pract 2017;20(2):136-42.
- Kim NH, Suk KS. Clinical and radiological differences between traumatic and idiopathic coccygodynia. Yonsei Med J 1999;40(3):215-20.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Radyoloji ve Organ Görüntüleme |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Haziran 2023 |
| Gönderilme Tarihi | 1 Ocak 2023 |
| Yayımlandığı Sayı | Yıl 2023 |