Elzeiny Ahmed, Giai Via Riccardo, Donis Andrea, Erdmenger Stephan, Giachino Matteo, Aprato Alessandro, Massè Alessandro
, kefr el sheikh, Egypt.
University of Turin, Turin, Italy.
Eur J Orthop Surg Traumatol. 2025 May 31;35(1):223. doi: 10.1007/s00590-025-04349-7.
Deep gluteal syndrome (DGS) involves pain in the buttocks due to entrapment of the sciatic nerve (SN) in the deep gluteal space. This condition can be caused by various structures within this space, such as muscles and fibrous bands, which often cause significant pain and mobility problems. Diagnosis is based on clinical evaluation, diagnostic imaging and nerve conduction studies. At the same time, treatment ranges from physical therapy to surgery, with endoscopic treatment gaining popularity due to its reduced invasiveness and fewer side effects.
The systematic review was conducted in accordance with the guidelines established by the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The review involved an extensive search of five major databases: PubMed, Scopus, Embase, Medline and Cochrane. Articles that met the eligibility criteria were carefully evaluated according to predefined levels of evidence (LoE). Retrospective studies were specifically assessed using the Coleman Methodology Score (mCMS). This review was registered with the International Prospective Registry of Systematic Reviews (PROSPERO), ensuring the rigor and reliability of the study.
The review identified 7 studies involving 312 patients (316 hips) with a mean age of 46.8 years and a mean follow-up of 25.1 months. The diagnosis was based on clinical, radiological and injection test results. Initial conservative treatment failed in all cases, necessitating surgery. Endoscopic sciatic nerve release showed success rates between 70 and 100%. Complications were minimal, with a recurrence rate of 2.5%, and revision surgery was required in 1.6% of cases. Postoperative results indicated a significant improvement in pain and function.
Endoscopic treatment of sciatic nerve entrapment in DGS is effective and safe when physical therapy has failed. Surgery offers significant pain relief and improved function with low complication rates. Despite limitations such as the predominance of retrospective studies and variability in patient management, the results support using this minimally invasive approach. Further high-quality research is needed to validate these results and optimize treatment protocols.
深部臀肌综合征（DGS）是由于坐骨神经（SN）在深部臀肌间隙受压而导致臀部疼痛。这种情况可由该间隙内的各种结构引起，如肌肉和纤维带，常导致严重疼痛和活动问题。诊断基于临床评估、诊断性影像学检查和神经传导研究。同时，治疗方法从物理治疗到手术不等，内镜治疗因其侵入性小、副作用少而越来越受欢迎。
本系统评价按照系统评价和Meta分析的首选报告项目（PRISMA）制定的指南进行。该评价对五个主要数据库进行了广泛检索：PubMed、Scopus、Embase、Medline和Cochrane。根据预先定义的证据水平（LoE）对符合纳入标准的文章进行仔细评估。使用科尔曼方法评分（mCMS）对回顾性研究进行专门评估。本评价已在国际系统评价前瞻性注册库（PROSPERO）注册，确保了研究的严谨性和可靠性。
该评价确定了7项研究，涉及312例患者（316髋），平均年龄46.8岁，平均随访25.1个月。诊断基于临床、影像学和注射试验结果。所有病例初始保守治疗均失败，需要手术治疗。内镜下坐骨神经松解术的成功率在70%至100%之间。并发症极少，复发率为2.5%，1.6%的病例需要翻修手术。术后结果表明疼痛和功能有显著改善。
当物理治疗失败时，内镜治疗DGS中的坐骨神经受压是有效且安全的。手术可显著缓解疼痛并改善功能，并发症发生率低。尽管存在回顾性研究占主导和患者管理存在差异等局限性，但结果支持使用这种微创方法。需要进一步的高质量研究来验证这些结果并优化治疗方案。
