Kosukegawa Ima, Yoshimoto Mitsunori, Isogai Satoshi, Nonaka Shinsuke, Yamashita Toshihiko
Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
Spine (Phila Pa 1976). 2006 Aug 15;31(18):E664-6. doi: 10.1097/01.brs.0000231877.34800.71.
Case report.
We report a rare case of piriformis syndrome accompanying anatomic variation in the piriformis muscle and sciatic nerve.
Beaton classified anatomic variation in the piriformis muscle and sciatic nerve into 6 types based on cadaver studies. There has been no report in the English literature of surgical treatment for a case of piriformis syndrome accompanying Beaton type d anatomic variation.
A patient with sciatica showing no nerve root compression in lumbar MRI underwent pelvic MRI and perineurography of the sciatic nerve followed by CT. The findings in these images suggested piriformis syndrome accompanying anatomic variation of the piriformis muscle and sciatic nerve. Surgical treatment was performed.
Surgical exploration of the piriformis muscle revealed Beaton type d anatomic variation. Both anterior and posterior lobes of the piriformis muscle were resected. The pain in the leg had completely disappeared after surgery.
This is a very rare case of surgically treated piriformis syndrome resulting from type d anatomic variation in Beaton's classification. Pelvic MRI and perineurography of the sciatic nerve were useful for diagnosis in this case.
病例报告。
我们报告一例伴有梨状肌和坐骨神经解剖变异的梨状肌综合征罕见病例。
比顿根据尸体研究将梨状肌和坐骨神经的解剖变异分为6种类型。英文文献中尚无关于伴有比顿d型解剖变异的梨状肌综合征病例手术治疗的报道。
一名坐骨神经痛患者腰椎MRI未显示神经根受压，随后接受了盆腔MRI、坐骨神经神经造影及CT检查。这些影像检查结果提示为伴有梨状肌和坐骨神经解剖变异的梨状肌综合征，并进行了手术治疗。
梨状肌手术探查发现为比顿d型解剖变异。切除了梨状肌的前叶和后叶。术后腿部疼痛完全消失。
这是一例因比顿分类中的d型解剖变异导致的经手术治疗的极为罕见的梨状肌综合征病例。盆腔MRI和坐骨神经神经造影对该病例的诊断很有用。
