Huang Z F, Yang D S, Shi Z J, Xiao J
Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Zhonghua Yi Xue Za Zhi. 2018 Jan 2;98(1):42-45. doi: 10.3760/cma.j.issn.0376-2491.2018.01.009.
To assess the morphological parameters of the piriformis muscle through magnetic resonance imaging(MRI) so as to further elucidate the pathogenesis of piriformis syndrome (PS). From September 2015 to October 2016, 30 suspected PS patients and 30 normal controls were enrolled in this study from the Nanfang Hospital, Southern Medical University. The possible causative factors of the PS in the patients were obtained, and the PS patients were divided into subgroups according to the anatomic site of the tender regions. The parameters of the maximum thickness (cm), area (cm(2)) and the volume (cm(3)) of the piriformis muscle of both groups were measured by MRI and were statistically compared between the groups with the independent-sample test so as to investigate the pathogenesis of injured sciatic nerve. Twenty-six patients were verified with PS, unhealthy sitting postures presented in 16 patients (61.5%) and no trauma history was recorded in these patients. Fifteen cases (57.7%) with tenderness located at the suprapiriformis foramen region (SPF group, =15), 11 patients (42.3%) with tenderness at the piriformis muscle (PM group, =11). The thickness, area and volume of the pathological side piriformis muscle in the PM group were all significantly higher than the corresponding indexes in the control group[(2.24±0.46) vs (1.66±0.30) cm, (14.4±2.2) vs (8.8±2.1) cm(2,) (23.9±3.8) vs (15.2±2.6) cm(3,) respectively, =4.699, 7.437, 8.291, all <0.05]and were all higher remarkably than those in the SPF group[(1.62±0.20) cm, (8.7±1.6) cm(2,) (14.1±4.8) cm(3,) respectively, =4.640, 7.631, 5.589, all <0.05]. No significant difference was observed in the up-mentioned indexes between the SPF and the control group (=-0.439, -0.102, -1.083, all >0.05). Tender region at the buttock indicates the lesion site in the PS patients. The PS patients with tenderness at the suprapiriformis region might originate from another pathogenesis independent of piriformis muscle compression, the injury of the sciatic nerve or its branch maybe due to the indirect crush by the soft tissue of the suprapiriformis region under an unhealthy sitting posture.
通过磁共振成像（MRI）评估梨状肌的形态学参数，以进一步阐明梨状肌综合征（PS）的发病机制。2015年9月至2016年10月，从南方医科大学南方医院招募了30例疑似PS患者和30例正常对照。获取患者中PS可能的致病因素，并根据压痛区域的解剖部位将PS患者分为亚组。通过MRI测量两组梨状肌的最大厚度（cm）、面积（cm²）和体积（cm³）参数，并采用独立样本检验进行组间统计学比较，以研究坐骨神经损伤的发病机制。26例患者被确诊为PS，16例患者（61.5%）存在不良坐姿，且这些患者均无创伤史。15例（57.7%）压痛位于梨状肌上孔区域（SPF组，n = 15），11例患者（42.3%）压痛位于梨状肌（PM组，n = 11）。PM组患侧梨状肌的厚度、面积和体积均显著高于对照组相应指标[分别为（2.24±0.46）cm vs（1.66±0.30）cm，（14.4±2.2）cm² vs（8.8±2.1）cm²，（23.9±3.8）cm³ vs（15.2±2.6）cm³，t = 4.699、7.437、8.291，均P < 0.05]，且均显著高于SPF组[分别为（1.62±0.20）cm，（8.7±1.6）cm²，（14.1±4.8）cm³，t = 4.640、7.631、5.589，均P < 0.05]。SPF组与对照组上述指标差异无统计学意义（t = -0.439、-0.102、-1.083，均P > 0.05）。臀部压痛区域提示PS患者的病变部位。梨状肌上区域压痛的PS患者可能源于独立于梨状肌压迫的另一种发病机制，坐骨神经或其分支损伤可能是由于不良坐姿下梨状肌上区域软组织的间接挤压所致。
