梨状肌的扫查技巧及其声像图研究

Study of ultrasonic scanning techniques and ultrasonographic characteristics of piriformis

目的探讨梨状肌的扫查技巧及正常与异常梨状肌的声像图特点。方法对40例临床诊断为单侧梨状肌综合征的患者行超声检查，总结梨状肌的超声扫查技巧并对比分析正常与异常梨状肌轮廓、厚度、肌外膜及内部肌纹理的回声。本研究获浙江中医药大学附属第三医院伦理委员会批准（批件号：ZSLL—JS-2016—18）。结果以髂骨回声中断为声像图标志可快速、准确地寻找梨状肌；梨状肌综合征患者患侧异常梨状肌轮廓欠清，并且厚于健侧，差异有统计学意义[x2=9．899，P=0．002；（25．81±0．30）mm对（22．29±0．27）mm，t=13．604，P=0．000]，两侧梨状肌的肌外膜及内部肌纹理的回声比较，差异亦有统计学意义（X2=23．226，P=0．000；x2=54．848，P=0．000）。结论髂骨回声中断是寻找梨状肌的重要标志，超声能清晰显示梨状肌并准确区分正常与异常梨状肌的图像，可为临床诊断梨状肌综合征提供影像学依据。

Objective To explore the scanning techniques of piriformis and different ultrasonographic characteristics of normal and abnormal piriformis. Methods A total of 40 cases diagnosed with unilateral piriformis syndrome underwent ultrasonic examination. Then ultrasonic scanning techniques of piriformis were summarized. Contours, thickness and smoothness of epimysium and ultrasonic echo of internal muscle texture of piriformis were compared between the normal and abnormal piriformis. The study was approved by the Third Affiliated Hospital Ethics Committee of Zhejiang Chinese Medical University （Approval no. ZSLL-JS-2016-18）. Results Interruption of ultrasonic echo of ilium could be considered as ultrasonographic signs for locating piriformis quickly and accurately. Abnormal piriformis in suffering side of patients with piriformis syndrome showed obscure contours and being thicker than the other side [x2 = 9.899, P = 0.002;（25.81 ±0.30） mm vs （22.29 ± 0.27） mm, t = 13.604, P = 0.000]. Moreover, there were significant differences in comparing smoothness of epimysium and ultrasonic echo of internal muscle texture of piriformis between the two sides （ X2 = 23. 226, P = 0. 000 ; X2 = 54. 848, P = 0. 000）. Conclusions Interruption of ultrasonic echo of ilium may be an important sign for locating piriformis. Ultrasound can display piriformis clearly and distinguish ultrasonographic images of normal piriformis accurately from abnormal piriformis, which can be taken as an basis imaging for clinical diagnosis of piriformis syndrome.