Hopayian Kevork, Danielyan Armine
Centre for Primary Care and Population Health, University of Nicosia, Makedonitissas Avenue, 1700, Nicosia, Cyprus.
Family Medicine Department, Yerevan State Medical University, Koryun Street, Yerevan, Armenia.
Eur J Orthop Surg Traumatol. 2018 Feb;28(2):155-164. doi: 10.1007/s00590-017-2031-8. Epub 2017 Aug 23.
To update the evidence on the clinical features of the piriformis syndrome since the first systematic review published in 2010.
A systematic review of all case, cross-sectional and prevalence studies.
The commonest features reported were: buttock pain, pain aggravated on sitting, external tenderness near the greater sciatic notch and pain on any maneuver that increases piriformis muscle tension, and limitation of straight leg raising. The quality of case reports since the previous review has not improved with considerable under-reporting of presumed negative tests. Three recent cross-sectional and prevalence studies have been reported, but the two larger studies are at high risk of bias.
Piriformis syndrome can be defined by a quartet of symptoms and signs. Many physical tests have been described, but the accuracy of these tests and the symptoms cannot be concluded from studies to date. Straight leg raising does not rule out the diagnosis. Piriformis syndrome is at a stage previously encountered with herniated intervertebral disc: that piriformis muscle pathology can cause sciatica has been demonstrated, but its prevalence among low back pain and sciatica sufferers and the diagnostic accuracy of clinical features requires cross-sectional studies free of incorporation and verification biases. One small cross-sectional study provides an encouraging example of how such studies could be conducted but would need replication in a broader population and better reporting.
自2010年发表首篇系统评价以来，更新梨状肌综合征临床特征的证据。
对所有病例、横断面和患病率研究进行系统评价。
报告的最常见特征为：臀部疼痛、坐位时疼痛加重、坐骨大切迹附近外侧压痛、增加梨状肌张力的任何动作时疼痛以及直腿抬高受限。自上次评价以来，病例报告的质量没有提高，假定阴性试验的报告严重不足。最近报告了三项横断面和患病率研究，但两项较大的研究存在较高的偏倚风险。
梨状肌综合征可由一组症状和体征来定义。已经描述了许多体格检查，但从目前的研究中无法得出这些检查和症状的准确性。直腿抬高不能排除诊断。梨状肌综合征正处于此前椎间盘突出症所经历的阶段：梨状肌病变可导致坐骨神经痛已得到证实，但其在腰痛和坐骨神经痛患者中的患病率以及临床特征的诊断准确性需要无纳入和验证偏倚的横断面研究。一项小型横断面研究提供了一个令人鼓舞的范例，展示了如何进行此类研究，但需要在更广泛的人群中重复进行并更好地报告。
