坐骨神经在盆腔出口区的MR成像对梨状肌综合征诊断的临床意义

The Clinical significance of diagnosis of piriformis syndrome about the sciatic nerve MR imaging of Pelvic outlet area

目的探讨坐骨神经在盆腔出口区的MR显像特征及其对梨状肌综合征诊断的临床意义。方法选择2008年6月-2014年12月新疆医科大学第一附属医院骨科中心收住院的34例梨状肌综合征患者及同期在体检中心体检的75例健康志愿者,分别进行双侧盆腔出口区坐骨神经MR扫描,梨状肌综合征患者均进行坐骨神经盆腔出口处探查手术,对正、异常盆腔出口区坐骨神经的MR成像特点进行分析总结。将所有患者术中所见与术前坐骨神经MR成像进行比较。应用BMRC周围神经功能恢复评价系统评定手术疗效。结果 (1)34例梨状肌综合征患者与健康志愿者MRI的对比发现异常坐骨神经的MR成像特点:健康志愿者的正常型占65.3%,异常型占34.7%;梨状肌综合征患者的正常型占11.8%,异常型占88.2%;坐骨神经周围脂肪组织消失;坐骨神经的特征性条纹结构消失或不清楚;坐骨神经与梨状肌之间界限不清楚、模糊。(2)34例患者中术前MRI显示坐骨神经与梨状肌存在变异者30例,坐骨神经周围脂肪组织消失或不清楚者26例,坐骨神经与梨状肌界限不清者25例;术中发现神经、肌肉变异者30例,梨状肌明显变性挛缩者16例,周围组织粘连者20例,神经上血管骑跨者4例。(3)术后疗效:优67.6%,良26.5%,可5.9%,优良率为94.1%。结论坐骨神经MR斜矢状位成像有助于梨状肌综合征的诊断。

Objective To discuss the sciatic nerve MR imaging characteristics of pelvic outlet area and its clinical significance of diagnosis of piriformis syndrome. Methods We chose 75 healthy volunteers and 34 piriformis syndrome patients during June 2008 to December 2015 from Department of orthopedics, the First Affiliated Hospital of Xinjiang Medical University.we scanned the MR of the sciatic nerve in the pelvic area of the pelvis and the patients with the syndrome were carried out exploration operation of the pelvic outlet of the sciatic nerve. Then we analyzed and summarized the MR imaging features of the sciatic nerve in the normal and abnormal for Pelvic outlet area and comparison of MR imaging with the sciatic nerve was performed.Finally, through Peripheral nerve function recovery evaluation system of BMRC to evaluate the surgical curative effect. Results We compared 75 healthy volunteers with 34 piriformis syndrome patients,summarized MR imaging characteristics of abnormal sciatic nerve as follows：There is a variety of variation between the sciatic nerve and the piriformis： Normal type of healthy volunteers accounted for 65.3%,abnormal type accounted for 34.7%;The normal type of the patients with the piriformis syndrome accounted for 11.8%,and the abnormal type accounted for 88.2%; Fatty tissue around the sciatic nerve disappeared; The characteristics of stripe structure of sciatic nerve disappeared or not clear% The boundary between the sciatic nerve and the pear shaped muscle is not clear and fuzzy. In 34 patients,preoperative MRI showed the sciatic nerve and the piriformis muscle mutations in 30 patients,26 cases of fatty tissue around the sciatic nerve disappeared or was not clear, 25 cases of nerve and piriformis muscle boundaried was unclear; 30 cases of nerve and muscle mutation were found in the operation, 16 cases of piriformis degeneration contracture,20 cases of surrounding tissue adhesion,4 cases of nerve on blood vessel ride. The postoperative curative effects were showed as follows： excellent 67.6%,good 26.5%,can 5.9%.The fine rate was 94. 1%. Conclusion The sciatic nerve with oblique sagittal MR imaging is helpful to diagnose piriformis syndrome.