高频超声对梨状肌综合征的诊断价值研究  

Diagnostic value of high frequency ultrasound in piriformis syndrome

作　　者：郑杰 谈伟[1] 魏欣[1] 崔宝俊 彭章林 Zheng Jie;Tan Wei;Wei Xin;Cui Baojun;Peng Zhanglin(Department of Functional Detection,Sichuan Province Orthopedic Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院功检科,成都610041

出　　处：《北京医学》2025年第1期27-32,共6页Beijing Medical Journal

基　　金：四川省中医药管理局科研课题(2020JC0097)。

摘　　要：目的分析高频超声对梨状肌综合征(piriformis syndrome,PS)的诊断价值。方法选取2022年8月至2023年11月四川省骨科医院高度可疑PS患者128例,根据临床诊断结果分为PS组(确诊PS)和对照组(非PS)。患者均接受高频超声检查,超声探头频率10~15 MHz。观察两组高频超声图像特点,比较两组一般资料、梨状肌厚度和坐骨神经直径。采用多因素非条件logistic回归方程分析发生PS的影响因素,采用ROC曲线AUC评价高频超声参数诊断PS的准确性。结果128例PS患者中,男42例、女86例;年龄27~84岁,平均(50.2±7.2)岁;确诊PS 98例,其中左侧48例、右侧50例,非PS 30例[椎间盘突出症引起的坐骨神经痛11例、臀上皮神经卡压综合征所致疼痛7例、泌尿系和(或)妇科炎症引起骨盆肌群周围疼痛7例、马尾神经瘤2例、无明显病因或病因不明3例]。高频超声图像提示PS组患侧梨状肌和坐骨神经形态、内部回声发生明显改变。与对照组相比,PS组两侧梨状肌厚度差值较大[(2.73±0.85)mm比(1.68±0.49)mm],坐骨神经直径差值较大[(1.15±0.36)mm比(0.74±0.23)mm],差异有统计学意义(P<0.05)。多因素回归分析结果显示,患侧和健侧的梨状肌厚度差值≥2 mm(OR=2.347,95%CI:1.314~4.192,P=0.004)和坐骨神经直径差值≥0.8 mm(OR=2.307,95%CI:1.346~3.955,P=0.003)的患者更容易发生PS。患侧和健侧的梨状肌厚度差值和坐骨神经直径差值联合诊断PS的灵敏度为76.53%,特异性为100.00%,ROC曲线的AUC为0.943(95%CI:0.887~0.976,P<0.05)。结论高频超声可清晰显示PS患者梨状肌与坐骨神经改变,患侧和健侧的梨状肌厚度差值和坐骨神经直径差值联合检测可提高PS的诊断效能。Objective To analyze the diagnostic value of high frequency ultrasound in piriformis syndrome(PS).Methods A total of 128 patients with highly suspicious PS in Sichuan Province Orthopedic Hospital from August 2022 to November 2023 were selected,and were divided into PS group(confirmed PS)and control group(non-PS)according to the clinical diagnosis results.All the patients were examined by high frequency ultrasound,with a transducer frequency of 10-15 MHz.The characteristics of high frequency ultrasound images of the two groups were observed,and the general data,piriformis thickness and sciatic nerve diameter of the two groups were compared.Multivariate unconditional logistic regression equation was used to analyze the influencing factors of PS,and AUC of ROC curve was used to evaluate the accuracy of high frequency ultrasound parameters in diagnosing PS.Results Among the 128 patients,there were 42 males and 86 females,aged from 27 to 84 years,and the average age was(50.2±7.2)years.98 patients diagnosed with PS(48 cases on the left and 50 cases on the right)and 30 patients without PS(11 cases of sciatica caused by intervertebral disc herniation,seven cases of pain caused by superior gluteal nerve entrapment syndrome,seven cases of pain around pelvic muscles caused by urinary and/or gynecological inflammation,two cases of cauda equina neuroma,and three cases with no obvious cause or unknown cause).High-frequency ultrasound images showed significant changes in the morphology and internal echo of piriformis and sciatic nerve on the affected side of PS group.Compared with the control group,the thickness of piriformis muscle[(2.73±0.85)mm vs.(1.68±0.49)mm]and the diameter of sciatic nerve in the PS group were bigger[(1.15±0.36)mm vs.(0.74±0.23)mm],and the differences were statistically significant(P<0.05).Multivariate regression analysis results showed that patients with thickness difference of piriformis muscle between the affected side and healthy side≥2 mm(OR=2.347,95%CI:1.314-4.192,P=0.004)and diameter differ

关 键 词：高频超声 梨状肌综合征 诊断价值 声像图 梨状肌厚度 坐骨神经 

分 类 号：R445.1[医药卫生—影像医学与核医学] R685[医药卫生—诊断学]