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1.
Medicine (Baltimore) ; 99(28): e20935, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664091

RESUMO

During ganglion impar block, the needle may approach the presacral space and the sacrum may be penetrated during caudal anesthesia. Because the rectum is in front of the sacrococcyx and is thus at risk for puncture, it is important to determine the distance between the sacrococcyx and rectum, as well as the thickness of the sacrococcyx.Computed tomography was used to measure the distance between the rectum and sacrococcyx, as well as the thickness of the sacrococcyx. The distances between the coccyx and rectum, sacrococcygeal joint and rectum, sacral level 5 ('sacrum 5') and rectum, and 'sacrum 4 to 5 junction' and rectum were measured. The results were compared based on the presence or absence of stools in the rectum. The thickness of the sacrococcyx was measured at the sacrum 4 to 5 junction and sacrococcygeal joint.In total, 1264 patients were included in this study. All distances were less than 1 mm in both males and females, with the exception of the distance between the coccyx and rectum in males. In both males and females, there was no significant difference in distance between the sacrococcyx and rectum according to the presence or absence of feces in the rectum, but there was a difference in the distance between sacrum 5 and the rectum in males (P = .048). Several male and female patients showed thicknesses of less than 5 mm at the sacrococcygeal joint.Some patients have a distance of less than 1 mm between the sacrum and rectum. Practitioners should exercise caution when applying a needle to the presacral space. If the sacrum is accidentally penetrated during caudal block, rectum puncture cannot be ruled out. Excretion of feces does not influence the distance between the sacrococcyx and rectum in females.


Assuntos
Anestesia Caudal/instrumentação , Cóccix/anatomia & histologia , Agulhas , Reto/anatomia & histologia , Reto/lesões , Sacro/anatomia & histologia , Ferimentos Penetrantes/etiologia , Ferimentos Penetrantes/prevenção & controle , Adulto , Idoso , Pesos e Medidas Corporais , Cóccix/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Sacro/diagnóstico por imagem , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 99(6): e18860, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028396

RESUMO

RATIONALE: Coccyx fracture is an injury usually caused by trauma. In most cases, the fractures recover after conservative therapy. For refractory cases that exhibit coccydynia after more than 2 months of conservative treatment, coccygectomy is indicated. However, limited information about the efficacy of this procedure is available, and it is known to have a high complication rate. As such, other therapeutic approaches are needed. Here, we report our experience using another conservative treatment option, low-level laser therapy, to successfully reduce refractory coccydynia in a patient with coccyx fracture. PATIENT CONCERNS: A 23-year-old woman had refractory coccydynia and increased pain after a traffic accident-induced coccyx fracture. DIAGNOSES: Initially, the patient reported transient improvement after conservative treatment with non-steroidal anti-inflammatory drugs. However, the pain increased in severity (numerical rating scale score of 8) soon after she resumed work in her office, and progressed in the following 2 months. Surgical intervention was suggested owing to the prolonged coccydynia following the failure of conservative treatment and difficulties in performing daily life activities. However, she sought other conservative therapy options, because she was concerned about the risks associated with the coccygectomy surgery. INTERVENTIONS: The patient received low-level laser therapy once a week, for 24 weeks. OUTCOMES: After 11 weeks of treatment, the patient reported significant improvements in her symptoms; her pain was reduced to a numerical rating scale score of 2 and bone healing was noted on radiographs. The patient could eventually perform her daily activities satisfactorily, without coccydynia, after 24 weeks of treatment. LESSONS: Laser acupuncture produced analgesic effects in this patient with refractory coccydynia after traumatic coccyx fracture. This is the first case report to apply laser acupuncture for refractory coccydynia after traumatic coccyx fracture. Our findings imply that laser acupuncture may be a good conservative therapy option for coccyx fracture.


Assuntos
Cóccix/lesões , Dor Lombar/terapia , Fraturas da Coluna Vertebral/complicações , Terapia por Acupuntura , Feminino , Humanos , Dor Lombar/etiologia , Terapia com Luz de Baixa Intensidade , Medição da Dor , Resultado do Tratamento , Adulto Jovem
3.
Proc Natl Acad Sci U S A ; 117(6): 3034-3044, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-31988131

RESUMO

Developmental novelties often underlie the evolutionary origins of key metazoan features. The anuran urostyle, which evolved nearly 200 MYA, is one such structure. It forms as the tail regresses during metamorphosis, when locomotion changes from an axial-driven mode in larvae to a limb-driven one in adult frogs. The urostyle comprises of a coccyx and a hypochord. The coccyx forms by fusion of caudal vertebrae and has evolved repeatedly across vertebrates. However, the contribution of an ossifying hypochord to the coccyx in anurans is unique among vertebrates and remains a developmental enigma. Here, we focus on the developmental changes that lead to the anuran urostyle, with an emphasis on understanding the ossifying hypochord. We find that the coccyx and hypochord have two different developmental histories: First, the development of the coccyx initiates before metamorphic climax whereas the ossifying hypochord undergoes rapid ossification and hypertrophy; second, thyroid hormone directly affects hypochord formation and appears to have a secondary effect on the coccygeal portion of the urostyle. The embryonic hypochord is known to play a significant role in the positioning of the dorsal aorta (DA), but the reason for hypochordal ossification remains obscure. Our results suggest that the ossifying hypochord plays a role in remodeling the DA in the newly forming adult body by partially occluding the DA in the tail. We propose that the ossifying hypochord-induced loss of the tail during metamorphosis has enabled the evolution of the unique anuran bauplan.


Assuntos
Anuros , Evolução Biológica , Cóccix , Metamorfose Biológica/fisiologia , Animais , Anuros/anatomia & histologia , Anuros/embriologia , Anuros/crescimento & desenvolvimento , Cóccix/anatomia & histologia , Cóccix/embriologia , Cóccix/crescimento & desenvolvimento , Larva/anatomia & histologia , Larva/crescimento & desenvolvimento , Notocorda/anatomia & histologia , Notocorda/embriologia , Notocorda/crescimento & desenvolvimento
4.
World Neurosurg ; 135: e567-e572, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863883

RESUMO

OBJECTIVE: The sacral dorsal rami form the posterior sacrococcygeal plexus (PSCP), which has been scantly studied. This study's goal was to clarify the PSCP s detailed anatomy and discuss its clinical relevance. METHODS: Ten sides of 5 fresh-frozen cadavers were dissected for this research. After the muscles covering the sacrum were removed, the PSCP was identified and traced under the operating microscope until the entire plexus was exposed. The contributions to this plexus and its relations to surrounding anatomic structures were recorded. RESULTS: The PSCP was found on all sides and was composed of a medial trunk (MT), communicating branches, and a lateral trunk. Each sacral dorsal ramus's MT formed a series of loops created by adjacent sacral dorsal rami placed between the transverse tubercles and the posterior sacral foramina. The MT, communicating branches, and lateral trunk demonstrated potential entrapment sites. CONCLUSIONS: To our knowledge, this is the first anatomic study that provides detailed images that indicate 3 potential sites where surrounding structures could entrap the PSCP. Knowledge of its detailed anatomy might help in better understanding low-back pain, targeting pain sources and guide spine surgeons for avoiding injury to these nerves.


Assuntos
Cóccix/inervação , Dor Lombar/etiologia , Plexo Lombossacral/anatomia & histologia , Sacro/inervação , Nervos Espinhais/anatomia & histologia , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino
5.
J Med Case Rep ; 13(1): 339, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31747964

RESUMO

BACKGROUND: This case series describes, for the first time, to the author's knowledge, a novel treatment for coccydynia. Tarsal tunnel block with lignocaine only brought relief of chronic coccydynia lasting more than 6 months in three patients. The author adopts the theory that the myelin sheath of the posterior tibial nerve will convey the lipid-soluble lignocaine upward toward the dorsal root ganglia and the nerve roots of the lumbar spine through the uninterrupted myelin sheath, which is itself mainly formed of lipids. The author thinks that most coccyx pain is actually a radiating pain from the lumbar spine, which is not always apparent on magnetic resonance imaging of the lumbar spine. Certainly, the author acknowledges that large-scale studies need to be done to prove the efficacy of this new technique and to prove that the myelin sheath can convey the lignocaine chemical upward. CASE PRESENTATION: Three Arab patients presented with chronic coccydynia of more than 6 months' duration in whom conservative management had failed to control their symptoms. They had no past medical history of significance and no history of trauma. The results of physical examination of all of the patients were normal apart from tenderness on palpation of the coccyx. They all received local coccyx injection with steroids on two occasions, which failed to relieve their pain. One patient underwent manipulation under anesthesia, and one underwent coccygectomy with no pain relief. Magnetic resonance imaging results were reported to be normal in two of them, whereas the other one had a prolapsed disc at the L4/L5 level. The three patients described pain relief 30 minutes after tarsal tunnel block with lignocaine only lasting more than 6 months. All patients had heel anesthesia 15 minutes after the tarsal tunnel injection, which lasted only 1 hour. CONCLUSIONS: Tarsal tunnel block with lignocaine can relieve coccyx pain for a long time. Tarsal tunnel block can be done to achieve heel anesthesia before injection of lignocaine into the plantar fascia in patients with plantar fasciitis.


Assuntos
Anestésicos Locais , Cóccix/patologia , Lidocaína , Dor Lombar/tratamento farmacológico , Bloqueio Nervoso , Nervo Tibial/efeitos dos fármacos , Adulto , Anestésicos Locais/administração & dosagem , Doença Crônica , Humanos , Lidocaína/administração & dosagem , Dor Lombar/etiologia , Dor Lombar/fisiopatologia , Masculino , Nervo Tibial/fisiopatologia , Resultado do Tratamento
6.
Artigo em Inglês | MEDLINE | ID: mdl-31700690

RESUMO

Introduction: Ganglion impar block (GIB) is a well-recognised treatment for chronic coccydynia. Several side effects have previously been described with this procedure, including transient motor dysfunction, bowel, bladder, and sexual dysfunction, neuritis, rectal perforation, impingement of the sciatic nerve, cauda equina syndrome, and infection. Case presentation: We describe the first report of imaging-documented conus infarction after an unguided-GIB performed in theatre using particulate steroids for a 17-year-old patient with coccydynia. Immediately post-GIB, patient developed transient neurological deficits in her lower limbs of inability to mobilise her legs that lasted for 24 h. These include back and leg pain, decreased power and movement, increased tone, brisk reflexes, reduced light touch sensation and proprioception of legs up to the T10 level. Urgent MRI spine showed intramedullary hyperintense signal within the conus and mild restricted diffusion on the distal cord and conus, suggestive of an acute conus infarction. On follow-up, the GIB did not result in symptom improvement of coccydynia and there was persistent altered sensation of her legs. Discussion: Various approaches of ganglion impar block have been described and performed in the past with different imaging techniques and injectants. A few cases of unusual neurological complications have been reported with the use of epidural steroid injections and ganglion impar block. Clinicians should be aware of the possible neurological complications following ganglion impar blocks and the risk of inadvertent intravascular injection of particulate steroids can potentially to be minimised by using imaging guidance.


Assuntos
Cóccix/irrigação sanguínea , Cóccix/diagnóstico por imagem , Gânglios Espinais/diagnóstico por imagem , Glucocorticoides/efeitos adversos , Infarto/diagnóstico por imagem , Bloqueio Nervoso/efeitos adversos , Adolescente , Doença Crônica , Cóccix/efeitos dos fármacos , Feminino , Gânglios Espinais/efeitos dos fármacos , Glucocorticoides/administração & dosagem , Humanos , Infarto/etiologia , Esteroides/administração & dosagem , Esteroides/efeitos adversos , Triancinolona Acetonida/administração & dosagem , Triancinolona Acetonida/efeitos adversos
7.
Turk J Med Sci ; 49(5): 1555-1559, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31652036

RESUMO

Background/aim: Ganglion impar blockis used for the treatment of chronic coccygodynia. Pulsed radiofrequency (PRF) of the ganglion impar is a promising novel technique. The aim of this study was to determine and compare the efficacy of the blockade and PRF of the ganglion impar. Materials and methods: Thirty-nine consecutive patients diagnosed with coccygodynia and treated with a blockade or PRF of the ganglion impar were included in this retrospective study. We compared the ganglion impar block (GIB) group (n = 25) with the ganglion impar pulsed radiofrequency (GIPRF) group (n = 14) in terms of pain intensity and patient satisfaction. We applied a numeric pain rating scale (NPRS) and a Likert scale (LS). Results: The NPRS scores in both groups had improved significantly from baseline at 3 weeks and at 3 and 6 months. However, in the sixth month, pain levels in the GIPRF group remained good, but they had returned to almost initial levels in the GIB group. Correspondingly, there were significant differences between groups in NPRS and patient satisfaction scores at 6 months (P ˂ 0.05). Conclusion: PRF neuromodulation provides significantly longer pain relief and reduces the risk of recurrence of pain in chronic coccygodynia as compared with blockade of the impar ganglion.


Assuntos
Gânglios Simpáticos , Dor Lombar/terapia , Bloqueio Nervoso , Tratamento por Radiofrequência Pulsada , Adulto , Cóccix , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Região Sacrococcígea , Resultado do Tratamento
8.
Forensic Sci Int ; 303: 109955, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31541936

RESUMO

Sex estimation is an essential step in the process of the identification of the skeletal remains in forensic anthropology since it reduces the number of possible matches by half. In this study, sex estimation with 21 sacral and coccygeal metric parameters obtained from Computerized Tomography images of a Turkish population which consists of 480 patients that are equalized according to their sexes and ages, is performed. Univariate discriminant analysis, linear discriminant function analysis, stepwise discriminant function analysis, and multilayer perceptron neural networks are used in this study. A maximum of 67.1% accuracy for univariate discriminant analysis, 82.5% for linear discriminant function analysis, 78.8% for stepwise discriminant function analysis, and 86.3% for multilayer perceptron neural networks, were achieved. Although it does not reach an acceptable accuracy rate of 95% or more for sacrum and coccyx, sex estimation with neural networks is a promising field of research in corpses where identification is otherwise not possible, and further studies with other bones and with new techniques might give useful information.


Assuntos
Cóccix/diagnóstico por imagem , Análise Discriminante , Redes Neurais de Computação , Sacro/diagnóstico por imagem , Determinação do Sexo pelo Esqueleto/métodos , Tomografia Computadorizada por Raios X , Adulto , Idoso , Feminino , Antropologia Forense , Humanos , Masculino , Pessoa de Meia-Idade , Turquia , Adulto Jovem
9.
Surg Radiol Anat ; 41(12): 1519-1524, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493008

RESUMO

PURPOSE: This study aims to evaluate the morphology of the coccyx in adults with multidetector computed tomography and to contribute to the classification of the coccyx using intercoccygeal and sacrococcygeal angle measurements. METHODS: The pelvic computed tomography images of 224 patients were retrospectively evaluated. The multiplanar reconstruction and 3D volume rendering images of the coccyx were obtained from all patients at sagittal and coronal planes. The morphology of the coccyx, number of bone segments, the presence of scoliosis, and presence of sacrococcygeal and intercoccygeal fusion were evaluated. After the measurement of coccygeal length, width, and thickness, intercoccygeal and sacrococcygeal angles were also calculated in all patients. RESULTS: The morphological classification showed that 136 patients (60.7%) had type 1, 65 patients (29%) had type 2, and 17 patients (7.6%) had type 3 coccyx. The intercoccygeal angle was zero degree in five patients (type 0) and one patient had retroverted coccyx (type 5). The coccyx had four segments in 155 patients (69.2%), three segments in 52 patients (23.2%), five segments in 15 patients (6.7%), two segments in one patient (0.4%), and one segment in one patient (0.4%). CONCLUSION: We determined patients with an intercoccygeal angle of zero degree, which is not mentioned in the literature before, and we propose to use the term "type 0" for these patients in the classification of coccyx. The coccygeal measurements and classification will be instructive for the radiologists and have a guiding role for the future studies.


Assuntos
Cóccix/anatomia & histologia , Imageamento Tridimensional , Tomografia Computadorizada Multidetectores , Sacro/anatomia & histologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cóccix/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Adulto Jovem
10.
JBJS Case Connect ; 9(3): e0346, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31390334

RESUMO

CASE: We present a 26-year-old active duty man who sustained a coccygeal fracture and gluteus maximus hematoma after a fall from height during training. The patient returned 3 weeks postinjury with symptoms and physical examination findings concerning for gluteal compartment syndrome. An expanding gluteal hematoma was confirmed on imaging and the patient was taken to the operating room for emergent evacuation and endovascular hemostasis. CONCLUSIONS: This case of gluteal compartment syndrome is a unique contribution to the literature with respect to the specific vascular injury observed and the delayed presentation of gluteal compartment syndrome.


Assuntos
Falso Aneurisma/complicações , Artérias/lesões , Nádegas/irrigação sanguínea , Síndromes Compartimentais/etiologia , Hematoma/complicações , Adulto , Falso Aneurisma/cirurgia , Nádegas/diagnóstico por imagem , Cóccix/lesões , Síndromes Compartimentais/diagnóstico por imagem , Síndromes Compartimentais/cirurgia , Fraturas Ósseas/complicações , Hematoma/cirurgia , Humanos , Masculino , Ruptura/complicações
11.
Enferm. clín. (Ed. impr.) ; 29(4): 245-247, jul.-ago. 2019.
Artigo em Espanhol | IBECS | ID: ibc-182919

RESUMO

El cóccix es un hueso con morfología y movilidad propia y puede presentar dolor por causas traumáticas como el parto dificultoso o con terminación instrumental. Sufrir coccidinia puede imposibilitar la realización de las actividades de la vida diaria y afectar desde la esfera física hasta el área psicosocial, dando gran morbilidad a la puérpera. El presente artículo resalta los factores que predisponen a la puérpera a sufrir coccigodinia y qué acciones realizar para su alivio y mejora. La coccidinia posparto es el dolor que aparece tan pronto se adopta posición sentada tras el parto. Son factores de riesgo la morfología del cóccix, el índice de masa corporal, el parto vaginal, el parto instrumental, multiparidad, sexo femenino, edad madura y con periné corto en mujer con parto difícil. Entre las actividades para mejorar el dolor se encuentran los analgésicos y coadyuvantes, la rehabilitación y el masaje del suelo pélvico, las infiltraciones, la psicoterapia y, por último, la cirugía


The coccyx is a bone with its own morphology and mobility and pain can occur due to trauma such as a difficult or instrumental delivery. Coccydynia can make it impossible to carry out the activities of daily life, its affects can be both physical and psychosocial, and causes great maternal morbidity. This article highlights the factors that predispose women to coccydynia and actions to relieve and improve it. Postpartum coccydynia is pain that appears as soon as a sitting position is adopted after delivery. Coccyx morphology, body mass index, vaginal delivery, instrumental delivery, multiparity, female sex, mature age and short perineum in women with difficult delivery are risk factors. The activities to improve pain begin with analgesia and coadjuvants, rehabilitation and pelvic floor massage, infiltrations, psychotherapy or, finally, surgery


Assuntos
Humanos , Feminino , Cóccix , Manejo da Dor , Dor/complicações , Pelve , Fatores de Risco , Período Pós-Parto , Enfermeiras Obstétricas
13.
Schmerz ; 33(6): 549-554, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31286239

RESUMO

This article presents the case of a 46-year-old woman with fibromyalgia with an undetected fracture of the coccyx. The heterogeneity of the symptoms of patients suffering from fibromyalgia including chronic widespread pain, vegetative and functional disorders, mental and physical exhaustion as well as sleep disorders can cause accidentally undetected comorbidities, especially if these are rare and predominantly present with pain as the main symptom. In the present case the reason for symptoms was detected only after 14 months of ineffective therapies and diagnostic procedures. The coccygeal pain was eliminated through a coccygectomy as ultima ratio. It should be nevertheless emphasized that patients with fibromyalgia suffer from a central pain-processing disorder. Indications for operative treatment must be very carefully considered. Surgery should only be considered in consultation with the patient and after failed conservative therapy.


Assuntos
Cóccix/lesões , Fibromialgia , Dor Lombar , Fraturas da Coluna Vertebral , Cóccix/cirurgia , Diagnóstico Diferencial , Feminino , Fibromialgia/fisiopatologia , Humanos , Dor Lombar/etiologia , Dor Lombar/cirurgia , Pessoa de Meia-Idade , Dor Musculoesquelética , Fraturas da Coluna Vertebral/diagnóstico
16.
Am J Case Rep ; 20: 773-775, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31152144

RESUMO

BACKGROUND Chordoma is a primary bone tumor that most commonly arises in the sacrococcygeal vertebrae and the spheno-occipital areas. Chordoma is a malignant tumor that should be distinguished from benign notochordal cell tumor (BNCT) of the spine. This report is of a rare case of axial chordoma and describes the challenging approach to diagnosis and management. CASE REPORT A 50-year-old woman presented with a one-year history of a slowly growing swelling in the sacral region. She complained of numbness and progressive weakness in both lower limbs, and urinary incontinence. Computed tomography (CT) imaging showed a large destructive lesion involving the sacrum and coccyx with cranial extension to level S2 and invasion of the right and left S2-S3 neural foramina, sacral nerves, left gluteus maximums muscle, and adjacent subcutaneous tissue. The management approach included the early involvement of a multidisciplinary clinical team. En bloc resection of the tumor through an anterior and posterior approach was performed, and the defect was reconstructed later using bilateral rotational gluteal fascial flaps. CONCLUSIONS Axial chordoma is a very rare, locally aggressive, and highly recurrent primary tumor of bone. The clinical management is challenging and requires early involvement of a multidisciplinary team. Following surgical resection, careful selection from limited available reconstructive surgical options is necessary to ensure that the surgical defect is repaired.


Assuntos
Cordoma/diagnóstico , Cóccix , Sacro , Neoplasias da Coluna Vertebral/diagnóstico , Cordoma/complicações , Cordoma/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X
17.
J Am Osteopath Assoc ; 119(6): 395-400, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31135868

RESUMO

A 21-year-old man with atypical coccydynia that radiated bilaterally to his thigh and lower back came for treatment 10 years after coccyx trauma. Pertinent review of systems showed unintentional weight loss of 20 lb over the past 1 to 3 years, a body mass index of 14.94, significant depression, and poor concentration. In addition to treating his pain, we addressed the weight loss and depression that he was experiencing by advising a balanced diet, discovering the origins of what the patient believed caused his depression, and using osteopathic manipulative treatment. The patient was treated with osteopathic manipulative treatment to alleviate somatic dysfunctions diagnosed in the head, cervical, thoracic, lumbar, and sacral regions. At follow-up visits, the patient described a reduction in his pain symptoms from an initial 5 out of 10 to 3 out of 10 on his third visit. This case report outlines the importance of using a holistic approach when treating patients and advocates for using osteopathic manipulative treatment as a viable treatment option for patients with coccydynia.


Assuntos
Cóccix/lesões , Manipulação Osteopática/métodos , Dor Musculoesquelética/terapia , Humanos , Masculino , Medição da Dor , Adulto Jovem
19.
Adv Skin Wound Care ; 32(6): 264-271, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30958412

RESUMO

OBJECTIVE: To visually assess and report the influence of supine positioning and sacrum and coccyx anatomy on tissue deformation. METHODS: A convenience sample of three participants was scanned using MRI. All participants were scanned in a supine position with a rig oriented in a flat or horizontal position and with the torso portion of the rig elevated to 30° to simulate head-of-bed elevation. Representative images were identified to visualize and depict (1) the differences in tissue thickness and deformation in response to changes in supine positioning (0° and 30°), (2) the relative displacement of the skeleton relative to the skin during 30° incline, and (3) differences in sacrococcygeal morphology. RESULTS: The tissue thickness under the sacrum stayed the same or increased when torsos were elevated. Skeletons were displaced relative to the skin when the rig was elevated regardless of the pelvis location. Further, in the elevated position, coccyges flexed when pelvises were placed on the elevated segment but did not flex when pelvises were placed on the horizontal segment. CONCLUSIONS: This case series is useful in defining new areas of research that can (1) identify the deformation induced by normal and frictional forces resulting from different positions of the bed chassis, (2) assess the impact of positioning the pelvis on elevated versus horizontal segments of the bed chassis, and (3) define the association between sacral and coccyx morphology and pressure ulcer occurrence in hospitalized patients.


Assuntos
Cóccix/diagnóstico por imagem , Posicionamento do Paciente , Lesão por Pressão/prevenção & controle , Decúbito Dorsal , Adulto , Feminino , Humanos , Masculino , Sacro/diagnóstico por imagem , Estresse Mecânico
20.
Sensors (Basel) ; 19(6)2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-30917555

RESUMO

Relative humidity (RH) at the body-seat interface is considered an important factor in both sitting comfort and generation of health concerns such as skin lesions. Technical difficulties appear to have limited research aimed at the detailed and simultaneous exploration of RH and temperature changes at the body-seat interface; using RH sensors without the capability to record temperature where RH is recorded. To explore the causes of a spike in RH consistently produced on first contact between body and seat surface, we report data from the first use of dual temperature and RH (HTU21D) sensors in this interface. Following evaluation of sensor performance, the effect of local thermal changes on RH was investigated. The expected strong negative correlation between temperature and RH (R² = -0.94) supported the importance of considering both parameters when studying impact of sitting on skin health. The influence of sensor movement speed (higher velocity approach: 0.32 cm/s ± 0.01 cm/s; lower velocity approach: 0.17 cm/s ± 0.01 cm/s) into a static RH region associated with a higher local temperature were compared with data gathered by altering the rate of a person sitting. In all cases, the faster sitting down (or equivalent) generated larger RH outcomes: e.g., in human sitting 53.7% ± 3.3% RH (left mid-thigh), 56.4% ± 5.1% RH (right mid-thigh) and 53.2% ± 2.7% RH (Coccyx). Differences in size of RH change were seen across the measurement locations used to study the body-seat interface. The initial sitting contact induces a transient RH response (duration ≤ 40 s) that does not accurately reflect the microenvironment at the body-seat interface. It is likely that any movement during sitting would result in similar artefact formation. As a result, caution should be taken when investigating RH performance at any enclosed interface when the surfaces may have different temperatures and movement may occur.


Assuntos
Umidade , Cóccix , Humanos , Masculino , Movimento , Temperatura , Adulto Jovem
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