Windisch Gunther, Braun Eva Maria, Anderhuber Friedrich
Institute of Anatomy, Medical University Graz, Harrachgasse 21, 8010, Graz, Austria.
Surg Radiol Anat. 2007 Feb;29(1):37-45. doi: 10.1007/s00276-006-0169-x. Epub 2007 Jan 10.
Patients with lumbosacral and buttock pain provide tacit support for recognizing the piriformis muscle as a contributing factor to the pain (piriformis syndrome). One hundred and twelve cadaveric specimens were observed to elucidate the anatomical variations of the piriformis muscle referred to the diagnostic and treatment of the piriformis syndrome. The distance between the musculotendinous junction and the insertion was measured and the piriformis categorized into three types: Type A (71, 63.39%): long upper and short lower muscle belly; Type B (40, 35.71%): short upper and long lower muscle belly; Type C (1, 0.9%): fusion of both muscle bellies at the same level. The diameter of the piriformis tendon at the level of the musculotendinous junction ranged from 3 to 9 mm (mean: 6.3 mm). The piriformis showed the following possible fusions with adjacent tendons. In type one (60, 53.57%) a rounded tendon of the piriformis reached the upper border of the greater trochanter. In type two (33, 29.46%) it first joined into the gemellus superior tendon and at last both fused with the obturator internus tendon and inserted into the medial surface of the greater trochanter. A fusion of the piriformis, obturator internus and gluteus medius tendon with the same insertion area as above was observed in type three (15, 13.39%) and finally in type four (4, 3.57%) the tendon fused with the gluteus medius to reach the upper surface of the greater trochanter. Based on this survey anatomical causes for the piriformis syndrome are rare and a more precise workup is necessary to rule out more common diagnosis.
腰骶部和臀部疼痛的患者为将梨状肌视为疼痛的一个促成因素（梨状肌综合征）提供了隐性支持。观察了112个尸体标本，以阐明梨状肌的解剖变异，这些变异与梨状肌综合征的诊断和治疗相关。测量了肌腱结合部与止点之间的距离，并将梨状肌分为三种类型：A型（71例，63.39%）：上肌腹长而下肌腹短；B型（40例，35.71%）：上肌腹短而下肌腹长；C型（1例，0.9%）：两个肌腹在同一水平融合。梨状肌腱在肌腱结合部水平的直径为3至9毫米（平均：6.3毫米）。梨状肌与相邻肌腱存在以下几种可能的融合情况。在第一种类型（60例，53.57%）中，梨状肌的圆形肌腱到达大转子的上缘。在第二种类型（33例，29.46%）中，它首先与上孖肌肌腱相连，最后两者与闭孔内肌肌腱融合，并插入大转子的内表面。在第三种类型（15例，13.39%）中，观察到梨状肌、闭孔内肌和臀中肌肌腱在与上述相同的止点区域融合，最后在第四种类型（4例，3.57%）中，肌腱与臀中肌融合，到达大转子的上表面。基于这项调查，梨状肌综合征的解剖学原因很少见，需要进行更精确的检查以排除更常见的诊断。
