Meknas Khaled, Christensen Anders, Johansen Oddmund
Department of Orthopaedics, University Hospital North Norway, N-9038, Tromso, Norway.
Pain. 2003 Jul;104(1-2):375-80. doi: 10.1016/s0304-3959(03)00045-9.
Six patients suspected to have piriformis syndrome were operated in the hip region in an attempt to relieve pressure on the sciatic nerve. The piriformis muscle and tendon as well as their relationship to the sciatic nerve were found to be normal. However, the internal obturator muscle was found to be very tense, slightly hyperaemic and pressing the sciatic nerve. During Lasegue's testing on the operating table the internal obturator and not the piriformis muscle impinged on the nerve at an early stage in the hip flexion movement. A sectioning of the tendon to the internal obturator muscle near its insertion at the trochanter was performed. Median pain score was found to be reduced from the preoperative value (8.5) to that at 6 weeks (3.5) (P<0.05) and 3 (3.5) (P<0.05) and 6 months (5.5) (N.S.) postoperatively. No significant reduction of pain was found in a control group of six patients followed during the same period. Three patients who needed opioids preoperatively managed without such drugs 6 months after the operation. Two patients in the operated group were at work 50 and 100% after having been out of work for 3 and 10 years, respectively.
对6例疑似患有梨状肌综合征的患者在髋部进行手术，试图减轻坐骨神经所受压力。结果发现梨状肌及其肌腱以及它们与坐骨神经的关系均正常。然而，发现闭孔内肌非常紧张，稍有充血，并压迫坐骨神经。在手术台上进行直腿抬高试验时，在髋关节屈曲运动早期，是闭孔内肌而非梨状肌压迫神经。在闭孔内肌靠近转子附着处对其肌腱进行了切断。发现疼痛中位数评分从术前的8.5降至术后6周时的3.5（P<0.05）、3个月时的3.5（P<0.05）和6个月时的5.5（无统计学意义）。在同期随访的6例对照组患者中未发现疼痛有明显减轻。3例术前需要使用阿片类药物的患者在术后6个月无需此类药物。手术组中有2例患者，在分别失业3年和10年后，术后50%和100%恢复了工作。
