以彎針自肛門－－尾骨間注射，以治療尾骨疼痛──病例報告

Anococcygeal Approach for Coccydynia by a Bent Needle

尾骨疼痛，曾有報告使用Impar神經節阻斷術來治療。施打的方法，大致是兩種方式.（1）經薦骨尾骨關節，（2）經肛門尾骨韌帶。我們報告兩位典型尾骨疼痛案例，他們都曾接受一般的口服消炎止痛劑，也都曾接受復健物理治療，但仍無法獲得緩解。他們的疼痛都有共同的特徵──最末尾骨關節的腹側有壓痛點。雖然診斷是韌帶炎，但是無法以直針注射到關節腹側。為了能在尾骨腹側注射，我們用彎針以P1ancarte的經肛門尾骨韌帶進針法。在兩案例都成功地將彎針放到末節尾骨腹側的壓痛點，大約只越過尾骨末梢1公分，並能誘發與患者本來相似的尾骨疼痛。我們對兩例都予以注射 triamcinolone 5 mg in 0.25% bupivacaine 0.5ml。兩例的尾骨疼痛都立刻能緩解，並在追蹤三個月內不再復發疼痛。依照我們注射的部位與劑量，並非真正的Impar神經節阻斷術，也非為了解決會陰部交感神經相關的疼痛。我們只是利用Plancarte的經肛門尾骨韌帶進針法，治療尾骨末節腹側韌帶炎的頑固疼痛。

Coccydynia has been currently treated by Ganglion Impar Block with some successes. It is usually approached through sacrococcygeal joint (SCJ) or anococcygeal ligment. Two cases with typical coccydynia are reported. Their pain was refractory to current medical and rehabitational therapy. They both showed the most painful complaint over the ventral side of the last coccygeal joint. Ligmentitis were impressed but direct injection by a regular straight needle was impossible. A 23 G long needle was then made bent to facilitate anococcygeal approach as modified from Plancarte's method. In both cases, the needle was advanced shortly (less than 1 cm) and triggered similar pain that was complained of by patients. At the very target, triamcinolone 5 mg in 0.25% bupivacaine 0.5ml was injected. Coccydynia was successfully relieved in both cases instantly and did not recur after following up for 3 months at least. Concerning about injection sites and volume, our approach should not be truely classical Ganglion Impar Block which may relieve sympathetic nerve mediated perineal pain. We only use Plancarte's ventral approach for intractable pain over last coccygeal joint.