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1、 梨状肌综合症梨状肌综合症存在吗存在吗 解剖与临床解剖与临床首都医科大学附属北京朝阳医院骨科 杜心如 梨状肌综合症梨状肌综合症 临床表现与腰椎间盘突出症相似临床表现与腰椎间盘突出症相似特点臀部疼痛坐骨神经痛常被忽略正常情况下 坐骨神经自梨状肌下孔穿出但存在各种但存在各种变变异异变异何时引起坐骨神经痛变异何时引起坐骨神经痛l梨状肌肥大、炎症等病变l梨状肌痉挛或持续收缩l有异常血管束带跨越l卡压坐骨神经l引起坐骨神经痛临床真的有梨状肌综合征吗？临床真的有梨状肌综合征吗？l存在争议l中医报道很多，多为临床推断，证据少l西医少有临床报道l现报道几个病例Report Case1 Male 70ys Re
2、port Case1 Male 70ys lButton pain 1 weeklsciatic pain lHe could not sleep because its painlVAS 9 score lLocal injection with lidocaine hydrochloride have the pain relief immediately but cannot 男男 7070岁岁 剧烈坐骨神经痛剧烈坐骨神经痛 髋关节正常髋关节正常 未见肿物未见肿物lMRIX ray of lumbar spine X ray of lumbar spine lDegenerativech
3、anges椎间盘退变但无腰痛椎间盘退变但无腰痛Operation Operation lThe piriformis muscle compress the sciatic nerve lresecting the part of the musckle Buttock pain Buttock pain sciatic pain sciatic pain but no low back painbut no low back painCase2 M 57 ys X ray filmX ray filmNo disc protrusionNo disc protrusionMRI MRI op
4、erationoperationThe gluteal muscle fat mass坐骨神经穿经梨状肌并被腱性组织卡压坐骨神经穿经梨状肌并被腱性组织卡压Sciatic nervePiriformis muscleResecting the part of the Resecting the part of the musclemuscleSciatic nervePiriformis muscle Release the sciatic nerveRelease the sciatic nerveOperation of the decompressiomn of Operation of
5、the decompressiomn of the iplateral common peroneal nervethe iplateral common peroneal nerveFemale 52ys button pain VAS 7Female 52ys button pain VAS 7lNo low back painlSciatic pain sedomoperationoperationVascular bandSciatic nervePirifims muscleCase 4 F 62 ys first operation Case 4 F 62 ys first ope
6、ration lVery pain on the button lPain relief after operation Congested vein in operation Operation agaginOperation agaginDegenerative muscle fibers No obvious fat massNo obvious fat massAnomalous Fiber BandsAnomalous Fiber BandslSciatic nerve The case The case lThe congested vein lThe anomalous fibe
7、r bandlThe pain relief after operation讨论梨状肌综合征客观存在但确诊需手术证实临床为排除性诊断我们的病例手术所见我们的病例手术所见l但不象报道的常见l对于顽固病例手术有效症状症状 SymptomsSymptomsl臀痛 剧烈和明显，VAS评分在5分以上l坐骨神经痛，但没有出现足下垂者l无腰痛及腰部活动受限 l劳累、受凉及潮湿症状加重，热敷后可缓 解症状 l平卧时病痛多不能缓解，部分病例行走可 缓解症状。l下蹲、排便或咳嗽时可以加重臀部疼痛症 状，但多不会引起坐骨神经痛l严重病例，深吸气也可使疼痛加重体征体征 梨状肌压痛梨状肌压痛体检体检l直腿抬高试验阴性，
8、可疑阳性l梨状肌紧张试验阳性l梨状肌处利多卡因封闭或阻滞l可以使症状缓解或减轻X X线线 CT MRICT MRIl可以显示腰椎l骨盆正常l无腰椎椎间盘突出症l无股骨头坏死l无骶骼关节炎l无臀部肿物梨状肌综合症梨状肌综合症l腰椎正侧位片l腰椎CT l腰椎MRIl髋关节及骨盆l可以有退变表现l可以见突出但不能解 释症状l无阳性所见disc protrusion anddisc protrusion andpiriformis syndrome piriformis syndromeBoth? First to treat disc protrusion Second to diagnose piriformis syndrome Becausesymptom of piriformis be a part of disc protrusion Thanks for your attentionThanks for your
