Elsawy Ahmed Gamal Salah, Ameer Abdulnasir Hussin, Gazar Yasser A, Allam Abdallah El-Sayed, Chan Shun-Ming, Chen Se-Yi, Hou Jin-De, Tai Yu-Ting, Lin Jui-An, Galluccio Felice, Nada Doaa Waseem, Esmat Ahmed
Anesthesia and Intensive Care Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt.
Clinical Neurophysiology, Department of Physiology, College of Medicine, Baghdad University, Baghdad 61224, Iraq.
Healthcare (Basel). 2022 Dec 28;11(1):95. doi: 10.3390/healthcare11010095.
Background: Piriformis syndrome (PS) is a painful musculoskeletal condition characterized by a deep gluteal pain that may radiate to the posterior thigh and leg. This study was designed to compare the effectiveness of ozone and BTX to lidocaine injection in treating piriformis syndrome that was resistant to medication and/or physical therapy. Study design: Between November 2018 and August 2019, we involved eighty-four subjects diagnosed with piriformis syndrome in a double-blinded, prospective, randomized comparative study to receive an ultrasound-guided injection of lidocaine (control group), botulinum toxin A, or local ozone (28 patients each group) in the belly of the piriformis muscle. Pain condition evaluated by the visual analog score (VAS) was used as a primary outcome, and the Oswestry Disability Index (ODI) as a secondary outcome, before, at one month, two months, three months, and six months following the injection. Results: The majority (58.3%) of patients were male, while (41.7%) were female. At one month, a highly significant decrease occurred in VAS and ODI in the lidocaine and ozone groups compared to the botulinum toxin group (p < 0.001). At six months, there was a highly significant decrease in VAS and ODI in the botulinum toxin group compared to the lidocaine and ozone groups (p < 0.001). Conclusion: Botulinum toxin may assist in the medium- and long-term management of piriformis syndrome, while lidocaine injection and ozone therapy may help short-term treatment in patients not responding to conservative treatment and physiotherapy.
梨状肌综合征（PS）是一种疼痛性肌肉骨骼疾病，其特征为深部臀肌疼痛，可放射至大腿后部和小腿。本研究旨在比较臭氧和肉毒杆菌毒素与利多卡因注射治疗对药物和/或物理治疗耐药的梨状肌综合征的有效性。研究设计：在2018年11月至2019年8月期间，我们将84名被诊断为梨状肌综合征的受试者纳入一项双盲、前瞻性、随机对照研究，在梨状肌肌腹接受超声引导下注射利多卡因（对照组）、A型肉毒杆菌毒素或局部臭氧（每组28例患者）。注射前、注射后1个月、2个月、3个月和6个月，以视觉模拟评分（VAS）评估的疼痛状况作为主要结局，以Oswestry功能障碍指数（ODI）作为次要结局。结果：大多数（58.3%）患者为男性，而（41.7%）为女性。在1个月时，与肉毒杆菌毒素组相比，利多卡因组和臭氧组的VAS和ODI显著降低（p < 0.001）。在6个月时，与利多卡因组和臭氧组相比，肉毒杆菌毒素组的VAS和ODI显著降低（p < 0.001）。结论：肉毒杆菌毒素可能有助于梨状肌综合征的中长期管理；而利多卡因注射和臭氧治疗可能有助于对保守治疗和物理治疗无反应患者的短期治疗。
