Dislocated tail bone 1/2 gap line odd nerve section puncture block treatment will be a case of pain 1 case

The pain is a common disease ofclinicalpain physicians, with female patients as common, the ratio of men and women is about 1:3 to 1:2, of which 40 to 60 years of age patients are common, the course of the disease is mainly chronic for 1 to 3 yearsAt present, its treatment methods are: drug treatment, psychotherapy, surgical treatment, nerve block treatment, traditional medical treatment, but there are high cost, low cure rate and other problemsodd nerve node is located in the front of the transctor behind the cranial joint, composed of the lower end of the double-sided palate dry, is the end of the vertebral intersympathetic nerve chain, responsible for the distribution of the pelvis orreproductiveorgans of the sympathetic nerve fibers, dominate the vulva, rectum end, anus, urethra tail end, scrotum and vaginal end 1/3 painOdd neurosection blockist is used to relieve some of the ineffective by conservative treatment, but by chichi neurojunction blocking effective will pussy stubborn pain,clinicalmainly used for cancer surgery will be pussy pain treatmentThe puncture-in path used in odd nerve blocking is different, and the traditional entrance route includes puncture through the tail joint, puncture through the tail bone, puncture through endoscociate ligament and mid-line puncture through the side sideThis case of patients due to the gap of the tibia joint is too narrow and the second tail vertebrae forward dislocation caused by excessive forward movement of the tail bone tip, resulting in the above puncture path is difficult to complete the operation, and finally through the dislocated tail bone 1/2 gap puncture operation, to achieve the clinical effect of strange nerve blocking, is reported as follows:1General informationcases, male, 67 years old, patientself complaint circumsculity, scros) Persistent blunt pain, can be radiated to the two-sided groin area, to the left side as heavy, walking and standing symptoms are obvious, check body: no obvious numbness in the, the anus and scrotum area shallow feeling normal, and scrotum tenderness, visual simulation score (visual analogue scale, VAS) score attack 8 points, rest time 3 points; Previously, there is a history ofdiabetes , after admission to the patient's tibia vertebrae side piece shows the defection joint mutation, the tail bone is not clear, again observed the lumbar vertebral MRI tablet, determine the tail joint, found that the MRI image on the tail joint showed that dislocation in the tail bone 1/2 vertebrae (see Figure 1,2) Figure 1 Preoperative tibia joint X--
Figure 2 Preoperative tail MRI tablets 2 Diagnosis and treatment to improve the corresponding examination after admission, after the elimination of surgical contraindications, in the bureau to give the patient odd nerve blocktreatment treatment The patient resides, with 1% Lidoca in 1 ml of local immersion anesthesia, after the completion of anesthesia puncture needle in the C-shaped arm guide vertical injection needle pierced cruciate ligament, positive side guide, determine the puncture position, inject 1 ml contrast agent, contrast agent dispersion is not ideal, finally choose the tail bone 1/2 gap into the needle The puncture needle is tilted upward, after repeatedadjustment of the angle under the C-arm guidance, after repeatedly adjusting the angle of the needle, after breaking the cruciate ligament, to reach the ideal position (see Figure 3), injectthed with the contrast agent, the contrast agent dispersed in the front edge of the tibia is a disclaimer (see Figure 4), slowly injected with waterless alcohol 1 ml, slowly out of the needle Figure 3 Punctured C-arm shown Figure 4 3.Results the first day after surgery when the patient's pain VAS score strikes 4 minutes, rest time 2 minutes; HAMA score 10 points No obvious abdominal pain, bloating, the saddle shallow feeling of decline and other symptoms, size is normal After surgery, the patient consciously alleviated the symptoms, required discharge, after discharge 1 week, January, March, respectively, telephone follow-up, symptoms did not appear obvious recurrence 4 Discussion the vulva nerve sending to the front corner neurons of the spinal cord, often referred to as Onufrowicz's nuclei, in the inner and tail side of the sciatic nerve, through the pear-shaped muscle hole through the sciatica hole into the hip area Generally there are 3 nerves blood vessels beams from the tube together: the anal nerve, the vulva nerve and the clitoris back nerve The anal nerve dominates the area around the anus, and the vulva branch of the femur nerve is connected, and the end branch is the large labia nerve The vulva nerve has a motor branch and two shallow sensory branches (inner and outer branch of the nerve behind the labia), dominates the vulva and the later side sensation of the large labia on the same side, and also dominates the movement of the vulva, shallow transverse muscle, cystic sponge muscle, urethocyte sponge muscle, urethr sphincter and anal muscle This branch originates from the back of the pussy tube also known as the Walther Nerve Section, lmpar Nerve Section or Tail Nerve Section; it is responsible for the transmission of genital damaging sensations and sympathetic nerve pain signals, the pain source of the pain of the vulva may come from the odd nerve section, at least in part related to the odd nerve section Therefore, blocking the chioculinity, can block the transmission of genital pain signals, effectively relieve pain, reduce or eliminate the adverse effects of pain on the human body, at the same time, can also expand the dominant area of the blood vessels , improve local circulation, accelerate the repair of damaged nerves, as well as ease the tension of sympathetic nerves, reduce the body's response stress, regulate plant nerve function Its main applicable to: will have asomal pain, pain, post-traumatic and icharacteristic tail bone pain It is generally believed that the odd nerve joint is located at the front of the tail joint behind the rectum, and the safety block should choose the tail joint as the puncture into the road some scholars have proposed the horizontal distance between the odd nerve joint and the rectum, from the tip of the tail bone to the tail joint, the distance between the two is constantly shortened The closest distance between the chichi nerve section and the rectum is at the chichi nerve water-saving plane (average 4.25mm) Therefore, the risk of puncture is mainly: puncture dysenteria leading to sepsis, anaesthetic into the blood vessels lead to toxic reactions of drugs and so on Some scholars have also proposed the use of casing needles for punctures Tailbone dislocation is a multiple morbidity in clinical practice, common in riding injuries, falling on the back, and even riding too bumpy can be caused Because its pain is not severe, activity is limited, often does not attract the attention of patients, so some patients appear after the failure to find out in time Such patients often appear narrow and oblique gaps in the tail joint, soft tissue flexing in front of the tail joint, potential cavity loss, blocking and so on Can affect the operation of odd nerve section block the patient's tail bone dislocation after the appearance of the gap between the tibia joint narrow, resulting in the puncture needle difficult to enter the gap, and into the front of the soft tissue blocking, affecting the spread of waterless alcohol, so the result is not ideal The puncture caused by the piercing caused by the forward dislocation of the tail bone tip through the tailbone is also difficult to complete Therefore, after comprehensive analysis, the dislocated tail bone 1/2 vertebral gap and its formation angle can provide a possible path for puncture, because the pre-inclination after dislocation increases, so that the needle tip after the puncture in place is closer to the anatomical position of the odd nerve section, thus achieving satisfactory clinical results After the above 1 case, experience as follows: (1) preoperative shooting lumbar tail film to eliminate lumbar vertebral lumbar or lumbar lumbarization, the tail side piece requires the patient to stand in the correct position, the operation requires the C-shaped arm positive position film to show the shame bone joint and the positive mid-line connection vertical in a straight line, the side piece can make The two-sided femoral bone is concentric circle distribution, clear the size of the gap between the tibia joint and the morphological structure, (2) preoperative measurement of the depth of the needle, (3) clear needle entry point, the tibia joint due to special circumstances is not suitable, you can choose other needle points; (4) the tail joint gap is not perpendicular to the skin, so it is necessary to clearly tilt direction, angle