| Section ? Pathogenesis of piriformis syndrome:a Magnetic Resonance Imaging-based comparison studyObjective To assess the morphological parameters of the piriformis muscle(PM)through MR imaging,so as to further elucidate the pathogenesis of piriformis syndrome(PS).Methods From September 2015 to October 2016,35 suspected PS patients and 30 normal controls were enrolled in this study from the Nanfang Hospital,Southern Medical University.The possible causative factors of the PS patients were obtained,and the PS patients were divided into subgroups depending on the anatomic site of the tender regions.The parameters of the maximum thickness(cm),area(cm2)and the volume(cm3)of the piriformis muscle of both groups were measured by MRI,and were statistically analyzed between the pathological side and the healthy side through Paired-Sample t test and via Independent-Sample t test compared both groups,so as to investigate the pathogenesis of injured sciatic nerve.Results Thirty-one patients were diagnosed with PS.18 cases(58.1%)with tenderness located at the suprapiriformis foramen region(SPF,n=18),13 patients(41.9%)with tenderness at the piriformis muscle(PM,n=13).Crossed-legged sitting or/and squatting down was present in 76.9%of the patients in the PM group,unhealthy sitting posture(reclining sitting posture)was present in 16 of 18(88.9%)patients of the SPF group.The thickness(1.65±0.36cm VS.1.68±0.30cm),area(8.83±2.36cm2 VS.8.72±2.00cm2)and volume(15.39±2.77cm3 VS.15.11±2.64cm3)of the PM in the control group between the both sides did not show a significant difference.In the PM group,the thickness(2.22±0.42cm VS.1.67±0.15cm),area(13.56±2.84cm2 VS.8.17±2.36cm2)and volume(23.55±4.40cm3 VS.14.72±2.57cm3)of the PM between the pathological side and the healthy side revealed a significant difference(P<0.001,P<0.001,P<0.001),whereas the thickness(1.65±0.23cm VS.1.62±0.28cm),area(9.011±1.58cm2 VS.8.66±1.73cm2)and volume(14.53±4.87cm3 VS.14.63±2.59cm3)of the PM between the pathological and the healthy sides in the SPF group did not present a difference(P = 0.720,P = 0.468,P?0.932).A significant difference was detected in the thickness(2.22±0.42cm VS.1.66±0.30cm,P<0.001),area(13.56±2.84cm2 VS.8.77±2.12cm2,P<0.001)and volume(23.55±4.40cm3 VS.15.25±2.60cm3,P<0.001)of the pathological side PM in the PM group when compared with the control group,and compared to the SPF group(2.22±0.42cm VS.1.65±0.23cm,P<0.001;13.56±2.84cm2 9.01±1.58cm2,P<0.001;23.55±4.40cm3 VS.14.53±4.87cm3,P<0.001).No significant difference was observed in the thickness,area and volume of the piriformis muscle between the SPF group and the control group(P = 0.906,P = 0.688,P = 0.570).Conclusions Tender region at the buttock indicates the lesion site of the PS patients.The PS patients with tenderness at the suprapiriformis region might originate from another pathogenesis independent of piriformis muscle compression,the injury of the sciatic nerve or its branch may be due to the indirect crush by the soft tissue of the suprapiriformis region under an unhealthy sitting posture.Section ? Effect of "Mannitol plus Vitamins B" in the management of patients with Piriformis SyndromeObjective Piriformis syndrome(PS)is an entrapment of the sciatic nerve by the piriformis muscle.The aim of this study was to investigate the effectiveness of"Mannitol plus Vitamins B" regime in the management of PS.Methods From November 2016 to May 2016,22 patients with PS were included in this study from the Nanfang Hospital,Southern Medical University.All of the 22 patients have received the therapeutic regime of 250 ml of mannitol 20%intravenous infusion for 5 days + Vitamins B(vitamin B1 10 mg + vitamin B2 10 mg+ vitamin B12 50 ?g PO)for 6 weeks in treating PS.Clinical outcomes of the treatment in the patients with PS were assessed systematically by clinical tests(tenderness,FAIR test,Beatty's,Freiberg's and Pace's maneuver),Numeric Rating Scale(NRS),Likert Analogue Scale(LAS),and MRI examination;and were statistically analyzed between baseline point and the evaluation at 1 month,3months and 6 months follow-up.Results The clinical evaluations showed a significant reduction(P<0.05)of tenderness,FAIR test,Beatty's maneuver,Freiberg's maneuver and Pace's maneuver when compared with baseline evaluation during the 3rd and 6th month follow-ups.A statistically significant improvement(P<0.05)of pain was measured by NRS at resting(P<0.001),at night(P<0.001)and during activities(P<0.001)and LAS with prolonged sitting(P<0.001),standing(P<0.001)and lying(P<0.001).Concomitantly,swelling of SN revealed a significant reduction(P = 0.003)from 86.4%to 18.2%.Conclusions Mannitol plus Vitamins B is effective in the management of piriformis syndrome and it could be an alternative regime in treating PS. |
PDF Full Text Request