Fanucci Ezio, Masala Salvatore, Squillaci Ettore, Sodani Giulio, Varrucciu Viviana, Ursone Antonio, Simonetti Giovanni
Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, Università di Roma Tor Vergata, Rome, Italy.
Radiol Med. 2003 Jan-Feb;105(1-2):69-75.
The aim of our study was to evaluate the diagnostic capabilities of computed tomography (CT) and magnetic resonance (MR) imaging in pyriformis syndrome (PS) and the long-term outcomes of CT-guided percutaneous treatment with botulinum. PS is a cause of sciatica and disability. The pain is usually increased by muscular contraction, palpation or prolonged sitting.
Thirty-four patients suffering from PS, suspected on the basis of clinical and electrophysiological criteria and after imaging examinations had excluded other causes of sciatic pain, had positive lidocaine tests and were treated by intramuscular injection of botulinum toxin type A (BTX-A) under CT guidance. MR sequences was performed in nine patients before treatment and after three months to evaluate the extent of muscle denervation.
In 30 cases relief of symptoms was obtained after 5-7 days. In four patients insufficient pain relief warranted a second percutaneous treatment which proved clinically successful. No complications or side effects were recorded after BTX-A injection. The MR examination demonstrated a change in signal intensity of the muscle in seven patients due to denervation, whereas in the remaining two cases only atrophy was detected. Larger series are necessary to confirm these preliminary results.
CT-guided BTX-A injection in the pyriformis muscle is an emergent and feasible technique that appears to yield excellent local therapeutic effects without the risk of imprecise injection.
我们研究的目的是评估计算机断层扫描（CT）和磁共振成像（MR）在梨状肌综合征（PS）中的诊断能力，以及CT引导下肉毒杆菌毒素经皮治疗的长期效果。PS是坐骨神经痛和残疾的一个病因。疼痛通常在肌肉收缩、触诊或长时间坐着时加重。
34例PS患者，根据临床和电生理标准怀疑患有该病，经影像学检查排除坐骨神经痛的其他病因，利多卡因试验阳性，在CT引导下接受A型肉毒杆菌毒素（BTX-A）肌肉注射治疗。9例患者在治疗前和治疗3个月后进行了MR序列检查，以评估肌肉去神经支配的程度。
30例患者在5-7天后症状缓解。4例患者疼痛缓解不足，需要进行第二次经皮治疗，临床证明治疗成功。注射BTX-A后未记录到并发症或副作用。MR检查显示7例患者因去神经支配导致肌肉信号强度改变，而其余2例仅检测到萎缩。需要更大规模的系列研究来证实这些初步结果。
CT引导下在梨状肌中注射BTX-A是一种紧急且可行的技术，似乎能产生优异的局部治疗效果，且无注射不准确的风险。
