以超音波導引類固醇注射治療梨狀肌症候群：單一醫學中心經驗

Treating piriformis syndrome with sono-guided corticosteroid local injection: a single-center experience

目的：治療梨狀肌症候群，目前主要的方法包括復健、症狀緩解治療、及局部類固醇或肉毒桿菌注射。有些人使用盲目注射，而其他人則使用電腦斷層或肌電圖作為導引之注射技術。我們報告本院以超音波導引方式，注射類固醇的治療經驗。方法：本研究收案了29位患有梨狀肌症候群，症狀在接受初步藥物治療後並未緩解的的患者。他們接受了超音波導引的局部類固醇和lidocaine注射。我們並未使用傳統的解剖構造定位的注射方法。取而代之的是，我們使用超音波定位，直接目視梨狀肌，施行超音波導引的注射。治療的結果使用Likert pain scale來評估。每位患者治療前的疼痛評分都有紀錄，而在為期六個月的追蹤當中，我們以曾經達到的最低疼痛分數，來當作治療後的疼痛程度，接著使用Wilcoxon rank sum test來評估治療前後疼痛的差異。結果：在29名梨狀肌症候群患者中，12位為男性（41.4%），17位為女性（58.6%）。患者的年齡都介在 22 到 89 歲之間，平均年齡是59.1歲。治療前的平均疼痛程度為7.7 ± 1.7分，而治療後平均降為3.1 ± 2.8分，有統計上的顯著差異（p<0.001）。整體來說，共有65.5%的患者有50%以上的疼痛緩解。在這29名患者中，沒有人在治療後發生併發症。結論：超音波導引的局部類固醇注射治療，對於梨狀肌症候群來說，是安全有效的治療方法。

Objective: The current treatment strategy for piriformis syndrome includes rehabilitation, symptomatic relief and local injection with either corticosteroid or botulinum toxin. Blind injection is sometimes used, as are CT-guided or electromyography-guided injection techniques. We report our local experience in treating piriformis syndrome with sono-guided corticosteroid injection. Methods: We enrolled 29 patients with piriformis syndrome whose initial symptoms were not relieved after medical treatment. They then received sono-guided local corticosteroid and lidocaine injection. Instead of traditional localization using anatomical landmarks, we used ultrasound to directly visualize the piriformis muscle and perform sono-guided local injection. The outcome was measured using a Likert pain scale. The pre-treatment pain score was recorded for every patient. During the six-month follow-up, the minimal pain score achieved was recorded for each patient as the post-treatment pain score. The Wilcoxon rank sum test was used to evaluate the difference between pre-treatment and post-treatment Likert pain scales. Results: Of the 29 patients with piriformis syndrome, 12 were male (41.4%), and 17 were female (58.6%). The ages of the patients ranged from 22 to 89 years, and the mean age was 59.1. The average pre-treatment and post-treatment pain scores were 7.7 ± 1.7 and 1 ± 2.8, respectively, which showed a statistically significant improvement (p<0.001). In all, 65.5% of the patients had more than 50% reduction of pain. None of the 29 patients had complications after the treatment. Conclusion: Local corticosteroid injection guided by ultrasound is a safe and effective treatment modality for piriformis syndrome.