CAJ | 학술논문

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。
목적：탐토좌골신경재분강출구구적 MR 현상특정급기대리상기종합정진단적림상의의。방법선택2008년6월－2014년12월신강의과대학제일부속의원골과중심수주원적34례리상기종합정환자급동기재체검중심체검적75례건강지원자，분별진행쌍측분강출구구좌골신경 MR 소묘，리상기종합정환자균진행좌골신경분강출구처탐사수술，대정、이상분강출구구좌골신경적 MR 성상특점진행분석총결。장소유환자술중소견여술전좌골신경 MR 성상진행비교。응용 BMRC 주위신경공능회복평개계통평정수술료효。결과（1）34례리상기종합정환자여건강지원자 MRI 적대비발현이상좌골신경적 MR 성상특점：건강지원자적정상형점65．3％，이상형점34．7％；리상기종합정환자적정상형점11．8％，이상형점88．2％；좌골신경주위지방조직소실；좌골신경적특정성조문결구소실혹불청초；좌골신경여리상기지간계한불청초、모호。（2）34례환자중술전 MRI 현시좌골신경여리상기존재변이자30례，좌골신경주위지방조직소실혹불청초자26례，좌골신경여리상기계한불청자25례；술중발현신경、기육변이자30례，리상기명현변성련축자16례，주위조직점련자20례，신경상혈관기과자4례。（3）술후료효：우67．6％，량26．5％，가5．9％，우량솔위94．1％。결론좌골신경 MR 사시상위성상유조우리상기종합정적진단。
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 per-formed.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%,ab-normal 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 con-tracture,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.