Park Chan-Woo, Jeong Sang Jin, Kim Jae Soon, Lim Seung-Jae, Park Youn-Soo
Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Myongji Hospital, Hanyang University School of Medicine, Goyang, Republic of Korea.
J Bone Joint Surg Am. 2025 Jun 9;107(15):1699-1708. doi: 10.2106/JBJS.24.00737.
Sciatic neuropathy can result from pressure, injury, or inflammation around the sciatic nerve. In rare instances, sciatic neuropathy is caused by an intraneural ganglion cyst (IGC) originating from the hip joint. However, an effective treatment modality for this condition has not yet been established. The purpose of the present study was to evaluate the clinical and radiographic outcomes of hip arthroscopy for the treatment of IGCs involving the sciatic nerve.
We reviewed the records on a consecutive series of hip arthroscopy procedures that had been performed by a single surgeon for the treatment of sciatic IGCs between July 2016 and February 2022. Thirteen Asian patients (13 hips) with symptomatic sciatic neuropathy were included. During arthroscopic surgery, IGCs were decompressed by enlarging their periarticular connection. Magnetic resonance imaging (MRI) and electrodiagnostic evaluation were routinely performed. The visual analog scale (VAS) for pain and modified Harris hip score (mHHS) were used for clinical evaluations. The mean age at the time of surgery was 57 years (range, 23 to 72 years), and the mean duration of follow-up was 41 months (range, 24 to 87 months).
The mean VAS score decreased from 8.3 preoperatively to 1.9 at the latest evaluation (p < 0.001). Satisfactory pain relief was reported by 12 patients (92%), including 9 patients (69%) who had complete remission. Four of the 6 patients with sensory impairment and 3 of the 4 patients with motor weakness reported complete recovery. The mean mHHS improved from 51.5 to 94.1 (p < 0.001). In MRI comparisons, the mean largest diameter and length of IGCs decreased from 2.6 to 0.5 cm (p < 0.001) and from 6.8 to 0.6 cm (p < 0.001), respectively. IGCs completely disappeared on MRI in 9 patients (69%). The latest electrodiagnostic studies confirmed improvement in all 12 patients with preoperative abnormalities. One patient (8%) with symptomatic recurrence was successfully treated with revision arthroscopic decompression.
In patients with sciatic neuropathy, the possibility of IGCs arising from the hip should be considered. Our findings suggest that arthroscopic hip surgery is a less-invasive and more-effective treatment for relieving neuropathic pain and neurological deficits associated with sciatic IGCs.
Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
坐骨神经病变可由坐骨神经周围的压迫、损伤或炎症引起。在罕见情况下，坐骨神经病变由起源于髋关节的神经内腱鞘囊肿（IGC）所致。然而，针对这种情况的有效治疗方式尚未确立。本研究的目的是评估髋关节镜检查治疗累及坐骨神经的IGC的临床和影像学结果。
我们回顾了2016年7月至2022年2月期间由同一位外科医生进行的一系列连续髋关节镜手术记录，这些手术用于治疗坐骨神经IGC。纳入13例有症状性坐骨神经病变的亚洲患者（13髋）。在关节镜手术中，通过扩大IGC的关节周围连接进行减压。常规进行磁共振成像（MRI）和电诊断评估。使用视觉模拟评分法（VAS）评估疼痛，改良Harris髋关节评分（mHHS）进行临床评估。手术时的平均年龄为57岁（范围23至72岁），平均随访时间为41个月（范围24至87个月）。
VAS评分均值从术前的8.3降至最近一次评估时的1.9（p < 0.001）。12例患者（92%）报告疼痛缓解满意，其中9例患者（69%）完全缓解。6例感觉障碍患者中的4例以及4例运动无力患者中的3例报告完全恢复。mHHS均值从51.5提高至94.1（p < 0.001）。在MRI比较中，IGC的平均最大直径和长度分别从2.6 cm降至0.5 cm（p < 0.001）以及从6.8 cm降至0.6 cm（p < 0.001）。9例患者（69%）的IGC在MRI上完全消失。最新的电诊断研究证实，所有12例术前有异常的患者均有改善。1例有症状复发的患者（8%）通过关节镜翻修减压成功治疗。
对于坐骨神经病变患者，应考虑IGC起源于髋关节的可能性。我们的研究结果表明，关节镜下髋关节手术是一种侵入性较小且更有效的治疗方法，可缓解与坐骨神经IGC相关的神经性疼痛和神经功能缺损。
治疗性IV级。有关证据水平的完整描述，请参阅作者须知。
