Metikala Sreenivasulu, Sharma Vivek
Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA.
Cureus. 2022 Mar 14;14(3):e23153. doi: 10.7759/cureus.23153. eCollection 2022 Mar.
Deep gluteal syndrome (DGS) is an underdiagnosed condition caused by an extra-spinal entrapment of the sciatic nerve in the deep gluteal space. Symptomatic patients who fail conservative treatment require surgical decompression of the nerve either by an open or endoscopic approach. In recent times, there has been an increasing trend towards minimally invasive surgery performed with endoscopic techniques. This systematic review aimed to assess the effectiveness of endoscopic sciatic nerve decompression in the management of DGS. A comprehensive search of the PubMed, Web of Science, Cumulated Index to Nursing and Allied Health Literature (CINAHL), and SPORTDiscus databases were performed on January 3, 2022. All English-language clinical studies on DGS treated with endoscopic surgical decompression were included. The initial search criteria identified 145 articles, of which four studies were available for the final review. There was one level III evidence, while the remaining three were level IV, comprising 144 patients with a mean age of 46 years. The Coleman methodology score (CMS) was utilized to assess the quality of the studies and the mean score was 62 (range, 52 to 71). The presence of fibrovascular bands and bursal tissue was the most common cause of DGS, followed by musculotendinous structures. The average follow-up of the included studies was 26.3 months (range, 12 to 32 months). Less favorable outcomes were seen in patients with major traumatic sciatic neuropathies after fractures or open reconstructive hip surgeries. Conversion to formal open surgery was recorded in one case of DGS caused by sciatic nerve schwannoma due to poor endoscopic access. One patient developed postoperative recurrent sciatic nerve entrapment due to a foreign body reaction requiring an open decompression. Overall, the available studies reported a high degree of clinical success with a low rate of complications, albeit no high-quality studies could be identified.
深部臀肌综合征（DGS）是一种诊断不足的疾病，由坐骨神经在深部臀肌间隙的椎管外卡压引起。保守治疗失败的有症状患者需要通过开放或内镜手术对神经进行减压。近年来，采用内镜技术进行微创手术的趋势日益增加。本系统评价旨在评估内镜下坐骨神经减压治疗DGS的有效性。2022年1月3日对PubMed、科学网、护理及联合健康文献累积索引（CINAHL）和体育科学数据库进行了全面检索。纳入所有采用内镜手术减压治疗DGS的英文临床研究。初步检索标准确定了145篇文章，其中4项研究可供最终综述。有1项III级证据，其余3项为IV级证据，包括144例患者，平均年龄46岁。采用科尔曼方法学评分（CMS）评估研究质量，平均评分为62分（范围为52至71分）。纤维血管束和滑囊组织的存在是DGS最常见的原因，其次是肌腱结构。纳入研究的平均随访时间为26.3个月（范围为12至32个月）。骨折或开放性髋关节重建手术后发生严重创伤性坐骨神经病变的患者预后较差。1例由坐骨神经鞘瘤引起的DGS因内镜操作困难而转为正式开放手术。1例患者因异物反应导致术后复发性坐骨神经卡压，需要进行开放减压。总体而言，现有研究报告了较高的临床成功率和较低的并发症发生率，尽管未发现高质量研究。
