Hermann W
SRO AG Langenthal, St. Urbanstraße 67, 4900, Langenthal, Deutschland.
Nervenarzt. 2020 Feb;91(2):99-106. doi: 10.1007/s00115-020-00866-4.
The piriformis syndrome (PiS) is a possible cause of gluteal pain radiating into the legs. From a pathophysiological anatomical point of view a division into primary and secondary PiS is made. A primary PiS is based on variants of the course of the sciatic nerve with respect to the piriformis muscle. A secondary PiS occurs as a result of hypertrophy, tension and hardening of the piriformis muscle. Muscular hypertrophy causes an impingement syndrome with pressure on the sciatic nerve in the infrapiriform foramen more often than course variants. A tentative diagnosis of PiS can be made based on anamnestic information, clinical signs of strain and the flexion adduction internal rotation (FAIR) test. If asymmetry or hypertrophy exists, the tentative diagnosis is substantiated with the representation of the piriformis muscle in computed tomography (CT). Thus, a CT-supported botulinum injection (BTX) into the piriformis muscle is indicated. This is a pathogenetic treatment approach leading to a reduction in volume. In most cases a single treatment is sufficient. Since there are no adverse consequences, the BTX into the piriformis muscle is also justified from a diagnostic and therapeutic point of view in cases of primary PiS if the clinical indications are clear and other causes can be ruled out. In an in-house case series the tentative diagnosis of PiS could be made for 19 patients and the effectiveness of BTX was confirmed.
梨状肌综合征（PiS）是导致臀部疼痛并放射至腿部的一种可能原因。从病理生理解剖学角度来看，可将其分为原发性和继发性梨状肌综合征。原发性梨状肌综合征基于坐骨神经相对于梨状肌走行的变异。继发性梨状肌综合征是梨状肌肥大、紧张和硬化的结果。肌肉肥大比走行变异更常导致梨状肌下孔处坐骨神经受压的撞击综合征。基于病史信息、劳损的临床体征和屈髋内收内旋（FAIR）试验可作出梨状肌综合征的初步诊断。如果存在不对称或肥大情况，通过计算机断层扫描（CT）显示梨状肌可进一步证实初步诊断。因此，建议对梨状肌进行CT引导下肉毒杆菌毒素注射（BTX）。这是一种导致体积减小的致病治疗方法。在大多数情况下，单次治疗就足够了。由于没有不良后果，在原发性梨状肌综合征病例中，如果临床指征明确且可排除其他原因，从诊断和治疗角度来看，对梨状肌进行肉毒杆菌毒素注射也是合理的。在一组内部病例系列中，对19例患者作出了梨状肌综合征的初步诊断，并证实了肉毒杆菌毒素注射的有效性。
