Park Eunsung, Choi Duyoung, Lee Cheol
Department of Neurosurgery, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan-si 54538, Jeonbuk, Republic of Korea.
Department of Pediatrics, Wonkwang University School of Medicine Hospital, 895 Muwang-ro, Iksan-si 54538, Jeonbuk, Republic of Korea.
J Clin Med. 2025 Aug 21;14(16):5908. doi: 10.3390/jcm14165908.
Piriformis syndrome (PS) causes sciatic nerve entrapment and chronic pain. In refractory cases, pulsed radiofrequency (PRF) and endoscopic piriformis release (EPR) are used, but comparative evidence is limited. This retrospective cohort study compared PRF and EPR in patients treated from 2018 to 2024 at a tertiary hospital using propensity score matching (PSM). Patients with PS, unresponsive to conservative treatment (≥3 months), were included. PRF targeted the sciatic nerve under imaging guidance; EPR involved endoscopic decompression. Primary outcomes were Numeric Rating Scale (NRS) scores at 3 and 6 months. Secondary outcomes included patient satisfaction, reintervention rates, complications, and the Oswestry Disability Index (ODI), where available. After PSM, 115 patients were analyzed per cohort. Multivariate regression identified the predictors of pain improvement. From 465 eligible patients (PRF 350; EPR 115), after PSM, 230 patients were analyzed (115 per cohort). The baseline NRS score was 7.4 ± 1.4 (PRF) vs. 7.5 ± 1.3 (EPR). At 3 months, EPR showed a lower NRS score (2.6 ± 1.3) compared to PRF (3.2 ± 1.6; = 0.032). At 6 months, the EPR NRS score was 2.2 ± 1.1 vs. 2.9 ± 1.5 for PRF ( = 0.018). EPR had a higher rate of ≥50% NRS score reduction (78% vs. 65%; = 0.041). EPR patients reported higher satisfaction and fewer reinterventions but more complications. Regression analysis identified EPR (OR = 2.15), higher baseline NRS scores, and shorter symptom duration as predictors of improvement. EPR provided superior pain relief compared to PRF at 3 and 6 months, although with a higher risk of complications. PRF remains a safer initial option.
梨状肌综合征（PS）可导致坐骨神经卡压和慢性疼痛。在难治性病例中，会使用脉冲射频（PRF）和内镜下梨状肌松解术（EPR），但比较性证据有限。这项回顾性队列研究在一家三级医院采用倾向评分匹配（PSM）方法，对2018年至2024年接受治疗的患者中的PRF和EPR进行了比较。纳入了对保守治疗（≥3个月）无反应的PS患者。PRF在影像引导下靶向坐骨神经；EPR包括内镜减压。主要结局指标为3个月和6个月时的数字评定量表（NRS）评分。次要结局指标包括患者满意度、再次干预率、并发症以及（如有）Oswestry功能障碍指数（ODI）。经过PSM后，每组分析115例患者。多变量回归确定了疼痛改善的预测因素。从465例符合条件的患者（PRF组350例；EPR组115例）中，经过PSM后，分析了230例患者（每组115例）。基线NRS评分为7.4±1.4（PRF组）对比7.5±1.3（EPR组）。在3个月时，与PRF组（3.2±1.6）相比，EPR组的NRS评分更低（2.6±1.3；P = 0.032）。在6个月时，EPR组的NRS评分为2.2±1.1，而PRF组为2.9±1.5（P = 0.018）。EPR组NRS评分降低≥50%的比例更高（78%对比65%；P = 0.041）。EPR组患者报告的满意度更高，再次干预更少，但并发症更多。回归分析确定EPR（比值比 = 2.15）、更高的基线NRS评分和更短的症状持续时间是改善的预测因素。与PRF相比，EPR在3个月和6个月时提供了更好的疼痛缓解，尽管并发症风险更高。PRF仍然是更安全的初始选择。
