“人类尾巴"”：儿童尾骨后置病例报告

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详细

论证。“人类尾巴”是一种罕见的先天性畸形，表现为腰部、骶尾部或肛门旁背侧隆起。

临床观察。本文旨在展示三个罕见的儿童尾骨延长的临床病例，这些病例的尾骨突出成尾部肿块。患者因坐位疼痛和日常不适前来就诊，因为除了尾椎外，该肿块几乎没有其他组织。患者没有神经系统缺陷，也没有盆腔器官功能障碍。根据所有病例的放射诊断方法和磁共振成像数据，确定了尾骨后置，且没有典型的前方成角。其中1例病例的尾骨由4个拉长的椎骨组成，但椎骨在尾部方向的尺寸没有典型的缩小。在2个病例中，CoIII水平的尾骨出现角度畸形，尾骨间的角度值分别为138°和140°。

讨论。根据A.H. Dao和M.G. Netsky（1984年）的分类法，在我们描述的案例中，尾部形态可被称为“假尾”，而根据S. Tojima和S. Yamada（2020年）的分类法，则可被称为“人尾”。

结论。尾椎发育不良最重要的特征是与潜在的脊柱发育不良有关。因此，应对每个病例进行全面的术前检查（神经系统检查、放射诊断方法和磁共振成像）。粗心大意的手术消融会导致严重后果，严重影响患者的生活质量。

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作者简介

Svetlana I. Trofimova

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: trofimova_sv2012@mail.ru
ORCID iD: 0000-0003-2690-7842
SPIN 代码: 5833-6770
Scopus 作者 ID: 57193275907

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Dmitry S. Buklaev

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: dima@buklaev.com
ORCID iD: 0000-0003-1868-3703
SPIN 代码: 4640-6856

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Tatiana V. Murashko

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: popova332@mail.ru
ORCID iD: 0000-0002-0596-3741
SPIN 代码: 9295-6453

MD, radiologist

俄罗斯联邦, Saint Petersburg

参考

  1. Dao AH, Netsky MG. Human tails and pseudotails. Hum Pathol. 1984;15(5):449–453. doi: 10.1016/s0046-8177(84)80079-9
  2. Giri PJ, Chavan VS. Human tail: a benign condition hidden out of social stigma and shame in young adult – a case report and review. Asian J Neurosurg. 2019;14(1):1–4. doi: 10.4103/ajns.AJNS_209_17
  3. Hamoud K, Abbas J. A tale of pseudo tail. Spine. 2011;36(19):E1281–E12814. doi: 10.1097/BRS.0b013e31820a3dd9
  4. Lin PJ, Chang YT, Tseng HI, et al. Human tail and myelomeningocele. Pediatr Neurosurg. 2007;43(4):334–337. doi: 10.1159/000103318
  5. Cai C, Shi O, Shen C. Surgical treatment of a patient with human tail and multiple abnormalities of the spinal cord and column. Adv Orthop. 2011;2011. doi: 10.4061/2011/153797
  6. Tojima S, Yamada S. Classification of the “human tail”: Correlation between position, associated anomalies, and causes. Clin Anat. 2020;33(6):929–942. doi: 10.1002/ca.23609
  7. Katsuno S, Horisawa M. A case of perianal human tail. J Jpn Soc Pediatr Surg. 2008;44:808–813.
  8. Saka R, Hasegawa T, Sonobe H. A case of perianal human tail. Journal of Japanese College of Surgeons. 2010;35:85–88.
  9. Falzoni P, Boldorini R, Zilioli M, et al. The human tail. Report of a case of coccygeal retroposition in childhood. Minerva Pediatr. 1995;47(11):489–491.
  10. Mohammad Bashir, Davlicarov MA, Cybin AA, et al. Istinnyj hvost s distal’nym udvoeniem u novorozhdennogo. Detskaya hirurgiya. 2015;19(4):53–54. (In Russ.)
  11. Wilkinson CC, Boylan AJ. Proposed caudal appendage classification system; spinal cord tethering associated with sacrococcygeal eversion. Childs Nerv Syst. 2017;33(1):69–89. doi: 10.1007/s00381-016-3208-x
  12. Ersahin Y, Gezen F, BedÜk AB. Neuroectodermal appendage: a case report and review. Turkish Neurosurgery. 1993;3:25–27.
  13. Iqbal Z, Cejudo-Martin P, de Brouwer A, et al. Disruption of the podosome adaptor protein TKS4 (SH3PXD2B) causes the skeletal dysplasia, eye, and cardiac abnormalities of Frank-Ter Haar syndrome. Am J Hum Genet. 2010;86(2):254–261. doi: 10.1016/j.ajhg.2010.01.009
  14. Sirmaci A, Walsh T, Akay H, et al. MASP1 mutations in patients with facial, umbilical, coccygeal, and auditory findings of Carnevale, Malpuech, OSA, and Michels syndromes. Am J Hum Genet. 2010;87(5):679–686. doi: 10.1016/j.ajhg.2010.09.018

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2. Fig. 1. Appearance of the tail-like formation

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3. Fig. 2. X-ray imaging of the sacrococcygeal spine in the lateral view: atypical position of the caudal spine (coccyx retroposition)

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4. Fig. 3. Comparison of the vertebrae of the sacrococcygeal spine of the patient (a, c) with the “age norm” (b, d) on the midsagittal image using volume imaging. Elongation of vertebrae SIV, SV, CoI, CoII, and CoIII, and absence of a typical gently-sloping kyphosis of the posterior vertebral line at the level of the sacrum from the SIV level

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5. Fig. 4. Computed tomography. Reconstruction of the sacrococcygeal spine, sagittal view: posterior angulation of the coccyx, intercoccygeal angle of 138°

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6. Fig. 5. Computed tomography. Reconstruction of the sacrococcygeal spine, sagittal view (a), axial view (b), and volume imaging (c). Additional bone fragment of the prevertebral region at the CoI–II level

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7. Fig. 6. Tail formation

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8. Fig. 7. X-ray imaging of the sacrococcygeal spine in the lateral view. The sacrococcygeal angle is 150°, and the angle is open anteriorly. The coccyx is retropositioned and straightened and is represented by atypical IV vertebrae with elongation without size reduction in the caudal direction. Plus-tissue symptom was noted

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9. Fig. 8. X-ray imaging of the sacrococcygeal spine in the lateral view after coccyx removal

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10. Fig. 9. View of the tail formation

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11. Fig. 10. X-ray imaging of the sacrococcygeal spine in the lateral view (a). Computed tomography. Reconstruction of the sacrococcygeal spine, volumetric imaging (b), and sagittal view (c): atypical position of the coccyx (retroposition, posterior angulation, and intercoccygeal angle of 140°)

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12. Fig. 11. Magnetic resonance (MR) imaging in the T2-weighted imaging mode. Sagittal image (a): angular deformity of the coccyx with posterior displacement of CoIV. Axial images in fat suppression mode (b): hyperintense MR signal at the level of the caudal vertebrae from the posteriorly displaced CoIV vertebra (trabecular edema of the adjacent soft tissues on the left)

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13. Fig. 12. X-ray imaging of the sacrococcygeal spine in the lateral view after coccyx removal (a) and gross specimen of the coccyx in the posterior view (b)

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