Piriformis syndrome.

Julian K Lo, Lawrence R Robinson
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引用次数: 0

Abstract

Piriformis syndrome is a condition that is proposed to result from compression of the sciatic nerve, either in whole or in part, in the deep gluteal space by the piriformis muscle. The prevalence of piriformis syndrome depends upon the diagnostic criteria being used and the population studied but is estimated by some to be 5%-6% in all cases of low back, buttock, and leg pain and up to 17% of patients with chronic low back pain. While the sciatic nerve may pierce the piriformis muscle in about 16% of healthy individuals, this frequency is no different in those with the syndrome; thus, the relationship to this anatomic finding is unclear. The most common symptoms are buttock pain, external tenderness over the greater sciatic notch, and aggravation of the pain through sitting. Many clinical signs are reported for piriformis syndrome, but the sensitivity and specificity are unclear, in part because of the lack of a uniformly accepted case definition. In the majority of cases in the literature, it appears that the diagnosis is more ascribed to a myofascial condition rather than a focal neuropathy. Electrodiagnostic studies can be useful to exclude other causes of symptoms, but there is no well-accepted test to confirm the presence of piriformis syndrome. Ultrasound imaging may show thickening of the piriformis muscle, but further research is required to confirm that this is correlated with the clinical diagnosis. Magnetic resonance imaging and neurography may hold promise in the future, but there are not yet sufficient data to support adopting these methods as a standard diagnostic tool. The initial treatment of piriformis syndrome is typically conservative management with the general rehabilitation principles similar to other soft tissue musculoskeletal conditions. Local anesthetic, botulinum toxin, and/or corticosteroid injections have been reported by some to be beneficial for diagnostic or treatment purposes. Surgical interventions have also been used with variable success.

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腓肠肌综合征
梨状肌综合征是指坐骨神经在臀深部间隙受到梨状肌的全部或部分压迫而引起的一种病症。梨状肌综合症的发病率取决于所使用的诊断标准和所研究的人群,但据一些人估计,在所有腰痛、臀痛和腿痛病例中,梨状肌综合症的发病率为 5%-6%,而在慢性腰痛患者中,梨状肌综合症的发病率高达 17%。虽然约有 16% 的健康人坐骨神经可能会刺穿梨状肌,但这一频率在患有该综合症的人中并无不同;因此,与这一解剖发现的关系尚不清楚。最常见的症状是臀部疼痛、坐骨大切迹外侧触痛以及久坐后疼痛加剧。有许多关于梨状肌综合征临床表现的报道,但其敏感性和特异性并不明确,部分原因是缺乏统一公认的病例定义。文献中的大多数病例似乎更倾向于诊断为肌筋膜病变而非局灶性神经病变。电诊断检查有助于排除引起症状的其他原因,但目前还没有公认的检查方法来确诊是否存在梨状肌综合征。超声波成像可能会显示梨状肌增厚,但这与临床诊断是否相关还需要进一步研究。磁共振成像和神经影像学将来可能会有前景,但目前还没有足够的数据支持将这些方法作为标准诊断工具。对梨状肌综合征的初步治疗通常是保守治疗,其一般康复原则与其他软组织肌肉骨骼疾病相似。据报道,局部麻醉剂、肉毒杆菌毒素和/或皮质类固醇注射有利于诊断或治疗目的。手术干预的效果也不尽相同。
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来源期刊
Handbook of clinical neurology
Handbook of clinical neurology Medicine-Neurology (clinical)
CiteScore
4.10
自引率
0.00%
发文量
302
期刊介绍: The Handbook of Clinical Neurology (HCN) was originally conceived and edited by Pierre Vinken and George Bruyn as a prestigious, multivolume reference work that would cover all the disorders encountered by clinicians and researchers engaged in neurology and allied fields. The first series of the Handbook (Volumes 1-44) was published between 1968 and 1982 and was followed by a second series (Volumes 45-78), guided by the same editors, which concluded in 2002. By that time, the Handbook had come to represent one of the largest scientific works ever published. In 2002, Professors Michael J. Aminoff, François Boller, and Dick F. Swaab took on the responsibility of supervising the third (current) series, the first volumes of which published in 2003. They have designed this series to encompass both clinical neurology and also the basic and clinical neurosciences that are its underpinning. Given the enormity and complexity of the accumulating literature, it is almost impossible to keep abreast of developments in the field, thus providing the raison d''être for the series. The series will thus appeal to clinicians and investigators alike, providing to each an added dimension. Now, more than 140 volumes after it began, the Handbook of Clinical Neurology series has an unparalleled reputation for providing the latest information on fundamental research on the operation of the nervous system in health and disease, comprehensive clinical information on neurological and related disorders, and up-to-date treatment protocols.
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