英汉对照骨科患者指南054：梨状肌综合征

冷面人0311 2017-07-23

展开全文

Piriformis Syndrome

梨状肌综合征

A Patient’s Guide to Piriformis Syndrome

梨状肌综合征患者指南

Introduction

引言

Pain in the buttock that radiates down the leg is commonly called sciatica. The most common cause for sciatica is irritation of the spinal nerves in or near the lumbar spine. Sometimes the nerve irritation is not in the spine but further down the leg. One possible cause of sciatica is piriformis syndrome. Piriformis syndrome can be painful, but it is seldom dangerous and rarely leads to the need for surgery. Most people with this condition can reduce the pain and manage the problem with simple methods, such as physical therapy.　　

　　从臀部放射到腿部的疼痛通常叫做坐骨神经痛。导致坐骨神经痛的原因中，最常见的是脊神经在腰椎里或邻近部位受到激惹。有时候神经受刺激不是发生在脊柱里，而是在靠下的腿部。坐骨神经痛的一种可能的原因就是梨状肌综合征。梨状肌综合征可以导致疼痛，但是很少会有危险，极少需要手术。大多数患有此症的人可以通过简单的方法——比如物理治疗——来减少疼痛，治疗疾病。

This guide will help you understand

　　本指南将帮助你理解

· how the problem develops

· how doctors diagnose the condition

· what treatment options are available

· 为什么会发生这种疾病

· 医生怎么诊断这种疾病

· 可以采取什么治疗措施

Anatomy

解剖

What parts of the body are involved?

　　身体的哪些部位受到影响？

The lower lumbar spinal nerves leave the spine and join to form the sciatic nerve. The sciatic nerve leaves the pelvis through an opening called the sciatic notch.

　　下腰段的脊神经离开脊柱后，合并起来组成了坐骨神经。坐骨神经从骨盆的一个叫做坐骨切迹的开口离开骨盆。

The piriformis muscle begins inside the pelvis. It connects to the sacrum, the triangular shaped bone that sits between the pelvic bones at the base of the spine. The connection of the sacrum to the pelvis bones forms the sacroiliac joint. There is one sacroiliac joint on the left and one on the right of the low back. The other end of the piriformis muscle connects by a tendon to the greater trochanter, the bump of bone on the top side of your hip.

　　梨状肌的起点在骨盆内侧，连着骶骨。骶骨是一块三角形的骨头，在脊柱的最下端，位于盆骨中间。骶骨与盆骨之间的连接构成了骶髂关节。下背部的左右两侧各有一个骶髂关节。梨状肌另一端的肌腱附着于股骨大粗隆，即髋部外侧上端的一个骨性隆起。

The piriformis muscle is one of the external rotators of the hip and leg. This means that as the muscle works, it helps to turn the foot and leg outward. Problems in the piriformis muscle can cause problems with the sciatic nerve. This is because the sciatic nerve runs under (and sometimes through) the piriformis muscle on its way out of the pelvis. The piriformis muscle can squeeze and irritate the sciatic nerve in this area, leading to the symptoms of sciatica.

　　梨状肌属于髋和腿的外展肌群。这就是说这个肌肉发力会让足和腿向外转动。梨状肌的疾患可以引起坐骨神经的问题。这是因为坐骨神经在走出骨盆时，会经由梨状肌下方走行（有时候是穿过）。在这一区域，梨状肌可以挤压和刺激坐骨神经，导致坐骨神经痛的症状。

Related Document: A Patient’s Guide to Lumbar Spine Anatomy

相关阅读：腰椎解剖患者指南（翻译招募中，有意者请留言）

Causes

病因

What causes this problem?

　　什么造成了这个疾病？

The symptoms of sciatica come from irritation of the sciatic nerve. It’s still a mystery why the piriformis muscle sometimes starts to irritate the sciatic nerve. Many doctors think that the condition begins when the piriformis muscle goes into spasm and tightens against the sciatic nerve, squeezing the nerve against the bone of the pelvis.

　　坐骨神经痛的症状来自坐骨神经的刺激。为什么梨状肌有时候会刺激到坐骨神经？这还是个未解之谜。很多医生认为，如果梨状肌发生痉挛，卡紧了坐骨神经，将神经挤压到盆骨的时候，就会产生这个疾病。

In some cases, the muscle may be injured due to a fall onto the buttock. Bleeding in and around the piriformis muscle forms a hematoma. A hematoma describes the blood that has pooled in that area.

　　有些病人可能因为跌坐而使肌肉受伤。梨状肌内部和周围的出血形成了血肿。血肿这个词的意思是那个区域积集的血液。

The piriformis muscle begins to swell and put pressure on the sciatic nerve. Soon the hematoma dissolves, but the muscle goes into spasm.

　　梨状肌开始肿胀，对坐骨神经造成压力。血肿很快会消散，但是肌肉却发生挛缩。

The sciatic nerve stays irritated and continues to be a problem. Eventually the muscle heals, but some of the muscle fibers inside the piriformis muscle are replaced by scar tissue. Scar tissue is not nearly as flexible and elastic as normal muscle tissue. The piriformis muscle can tighten up and put constant pressure against the sciatic nerve.

　　坐骨神经一直受到刺激，持续产生症状。最终肌肉愈合了，但是梨状肌内的一些肌纤维被疤痕组织所取代。疤痕组织远远不及正常肌肉组织那样柔韧有弹性。梨状肌会紧绷，对坐骨神经造成持续的压力。

Symptoms

症状

What does the condition feel like?

　　得了这个病会有什么感受？

Piriformis syndrome commonly causes pain that radiates down the back of the leg. The pain may be felt only on one side, though it is sometimes felt on both sides. The pain can radiate down the leg all the way to the foot and may be confused for a herniated disc in the lumbar spine. Changes in sensation and weakness in the leg or foot are rare. Some people say they feel a sensation of vague tingling down the leg.

　　梨状肌综合征通常引起放射到腿部后侧的疼痛。这种疼痛可以发生在一侧，但有时也会发生在两侧。疼痛可以沿着腿部一直向下放射到足部，可能会与腰椎间盘突出症相混淆。感觉异常以及腿和足的无力比较少见。有些人描述他们的感受是一种沿着腿部的模糊的刺痛。

Sitting may be difficult. Usually people with piriformis syndrome do not like to sit. When they do sit down, they tend to sit with the sore side buttock tilted up rather than sitting flat in the chair.

　　坐下会比较困难。梨状肌综合征患者往往不喜欢坐下。当他们坐下的时候，会倾向于将酸痛一边的臀部抬起来，而不是在椅子上坐平。

Diagnosis

诊断

How do doctors diagnose the problem?

　　医生怎么诊断这个疾病？

Diagnosis begins with a complete history and physical exam. Your doctor will ask questions about your symptoms and how the pain is affecting your daily activities. Your doctor will also want to know what positions or activities make your symptoms worse or better. You will be asked about any injuries in the past and about any other medical problems you might have such as any arthritis that runs in the family.

　　诊断首先需要完善的病史和查体资料。医生会询问你的症状，以及疼痛如何影响你的日常活动。医生还会想知道什么样的姿势或者活动会让你的症状加重或者改善。你要回答以前受过什么样的创伤，以及任何其他的医学问题比如家族遗传的任何关节炎。

Next the doctor examines you by checking your posture, how you walk, and where your pain is located. Your doctor checks to see which back movements cause pain or other symptoms.

　　然后医生会检查你的姿态，你的行走步态和你疼痛的部位。医生会检查什么样的背部运动能引起疼痛或其他症状。

Your skin sensation, muscle strength, and reflexes are also tested because it is difficult to distinguish pain coming from the sacroiliac joint from pain coming from other spine conditions.

　　你的皮肤感觉、肌肉力量和反射也要受到检查，因为要鉴别疼痛来源于骶髂关节还是其他脊柱疾病并不容易。

If there is any question whether you might have an infection or some type of arthritis affecting multiple joints, laboratory tests may be ordered. You may need to have blood drawn and give a urine sample to send to the laboratory for special tests.

　　如果你可能有感染，或者某种影响到多个关节的关节炎，那么可能要做实验室检查。你可能需要抽血和送尿样到实验室做特殊检查。

X-rays are commonly ordered of both the low back and pelvis. X-rays can give your doctor an idea about how much wear and tear has developed in the sacroiliac joint. X- rays of the lumbar spine and hips are also helpful to rule out problems in these areas that may look and act like sacroiliac joint problems.

　　X片通常要拍到腰部和骨盆。X片可以给医生提供关于骶髂关节发生了多少损坏和退变的信息。腰椎和髋部的X片也有助于排除这些区域的疾病，其中有些可能看起来或者表现得像是骶髂关节病变。

Other radiological tests may also be useful. A magnetic resonance imaging (MRI) scan can be used to look at the lumbar spine and pelvis in much more detail and rule out other conditions in the area conditions. The MRI scan uses magnetic waves rather than X-rays and shows a very detailed picture of the soft tissues of the body.

　　其他影像学检查可能也有用。磁共振成像（MRI）扫描可以用来更细致地观察腰椎和骨盆，并且排除此区域的其他问题。MRI扫描使用磁力波而不是X线，能显示非常精细的人体软组织图像。

A special type of MRI scan called neurography is being used more frequently to look at nerves. This uses a regular MRI scanner, but the computer settings are set to look for areas of irritation along a nerve. This may change the way doctors use the MRI to diagnose nerve problems such as piriformis syndrome, thoracic outlet syndrome, and carpal tunnel syndrome.

　　一种特殊的MRI扫描叫做神经成像正在被越来越多地应用于观察神经。这个检查使用常规磁共振扫描仪，但是计算机的设置是观察沿神经的受刺激区域。这可能改变医生使用MRI诊断神经病变的方式，例如梨状肌综合征、胸廓出口综合征和腕管综合征。

A bone scan is useful to see how the skeleton is reacting to any type of “stress,” such as an injury, an infection, or inflammation from arthritis. Chemical “tracers” are injected into your blood stream. The tracers then show up on special spine X- rays. The tracers collect in areas where the bone tissue is reacting strongly to some type of stress to the skeleton, such as arthritis and infection of the sacroiliac joint.

　　骨扫描对于观察骨骼如何对任何类型的“应激”起反应是有用的，例如创伤、感染或者源自关节炎的炎症。把化学“示踪剂”注射进你的血流，然后示踪剂会在特殊的脊柱X片上显示。骨骼对于应激反应强烈的部位会引起示踪剂的积聚，例如骶髂关节的关节炎和感染。

The most accurate way to tell if the piriformis muscle is the cause of pain is with a diagnostic injection into the muscle. The muscle is deep inside the buttock, so the injection requires X-ray guidance with a fluoroscope, a CT scanner, or an open MRI machine. Once the needle is placed in the muscle, an anesthetic can be injected into the muscle to paralyze the piriformis muscle. If the pain goes away after the injection, your doctor can be reasonably sure that the pain you are feel is from piriformis syndrome.

　　对于梨状肌是否致痛原因的辨别方法，最准确的是肌内诊断性注射。这块肌肉位于臀部深处，所以注射需要X线透视机、CT机或者开放式MRI仪器的影像引导。一旦针头进入肌肉，就可以把麻醉剂注射入肌肉，来麻痹梨状肌。如果疼痛在注射后消失了，那么医生可以确定你感觉到的疼痛是因梨状肌综合征而起。

Treatment

治疗

What treatment options are available?

　　可以采取什么治疗手段？

Nonsurgical Treatment

非手术治疗

Doctors often begin by prescribing nonsurgical treatment for piriformis syndrome. In some cases, doctors simply monitor their patients’ condition to see if symptoms improve. Anti-inflammatory medications, such as ibuprofen and naproxen, are commonly used to treat the pain and inflammation caused by the irritation on the nerve. Acetaminophen (for example Tylenol®) can be used to treat the pain but will not control the inflammation.

　　医生通常对于梨状肌综合征受限采取非手术治疗。对于某些病例，医生仅仅采取观察的方法，看症状是否会改善。抗炎药物，例如布洛芬和萘普生，普遍用于治疗神经刺激造成的疼痛和炎症。对乙酰氨基酚（例如Tylenol®）可以用于治疗疼痛，但是不能控制炎症。

You’ll probably work with a physical therapist. After evaluating your condition, the therapist uses treatments to ease spasm and pain in the piriformis muscle. Exercises, particularly stretching exercises, are given to try and relieve irritation on the sciatic nerve.

　　你可能要接受物理治疗师的指导。治疗师评估了你的病情后，会使用治疗手段来缓解梨状肌的痉挛和疼痛，指导你采取特别是拉伸练习的锻炼方式，来尝试解除对坐骨神经的刺激。

If you still have pain after trying these treatments, your doctor may suggest injections.The main use of injections is to see if your pain is from piriformis syndrome. An injection of local anesthetic such as lidocaine can be injected into the muscle to temporarily relax it. This loosens up the muscle and reduces the irritation on the sciatic nerve. Other medications have also been injected into the piriformis muscle. Cortisone, for example, may be mixed with the anesthetic medication to reduce the inflammation on the sciatic nerve. Cortisone is a potent anti-inflammatory medication that is commonly used both in pill form and in injections to treat inflammation.

　　如果尝试过这些治疗手段以后，你还有疼痛，那么你的医生可能会建议注射疗法。注射疗法的主要用途是来检查你的疼痛是否来自梨状肌综合征。将局部麻醉剂（例如利多卡因）注射入肌肉，使其暂时地松弛。这放松了肌肉，减少对于坐骨神经的刺激。也有其他一些药物用于梨状肌的注射。例如可的松，可以与麻醉药物混合，来减轻坐骨神经的炎症。可的松是一种常用的强力抗炎药物，有片剂和注射剂两种剂型。

Related Document: A Patient’s Guide to Piriformis Muscle Injections相关阅读：梨状肌注射患者指南（翻译招募中，有意者请留言）

Botulism injection therapy (also known as Botox® injections) can be used to actually paralyze the piriformis muscle. This makes the muscle relax, which helps take pressure off the sciatic nerve. The effect of the Botox® injection isn’t permanent; it generally only lasts a few months. In the meantime, however, it is hoped that a stretching program can be used to fix the problem. In other words, when the injection wears off, the muscle may have been stretched enough so that the symptoms do not return.

　　肉毒杆菌注射治疗（也叫做Botox®注射）可以用来让梨状肌瘫痪。这可以放松肌肉，有助于消除坐骨神经的压力。Botox®注射的效果不是永久的；通常持续几个月。但同时开展拉伸锻炼有望解除这个病症。就是说，当注射剂失效的时候，肌肉可能已经被足够地拉伸了，从而症状不会再复发。

Surgery

手术

Surgery may be considered but usually only as a last resort. There are two procedures in use. The first is to cut the piriformis tendon where it attaches on the greater trochanter (the bump on the side of your hip). The other method is to cut through the piriformis muscle to take pressure off the sciatic nerve.

　　手术也是可以考虑的，但是只能作为最后的选择。目前采用的有2种方法。第一种是在大粗隆（你髋部外侧的隆起部位）切断梨状肌的肌腱止点。另一种方法是直接切断梨状肌来减轻坐骨神经的压力。

These procedures are usually done on an outpatient basis, meaning that you will be able to go home the same day as the surgery. In some cases, you may need to stay in the hospital for one night. Both procedures can be done under general anesthesia or under a spinal type of anesthetic.

　　这些治疗往往是在门诊施行的，这意味着在手术结束后当天可以回家。有些患者可能需要在医院观察一个晚上。两种方法都可以在基础麻醉下或者在脊神经麻醉下施行。

The surgeon begins by making a small incision, usually about three inches long, in the buttock. The fibers of the gluteus maximus, the largest buttock muscle, are split. This gives the surgeon a way to see deep into the buttock and locate the piriformis muscle. When the piriformis muscle and tendon can be seen, the surgeon then cuts (releases) the tendon where it connects to the greater trochanter.

　　医生会在臀部切一个小口子，通常3英寸长。臀部最大的肌肉臀大肌的肌纤维被分开。这样医生就可以通过这个通道看到臀部的深处，找到梨状肌。当梨状肌与其肌腱被看到了，医生会切断（松解）肌腱在大粗隆的止点。

If more room is needed to release the pressure on the nerve, a portion of the piriformis muscle may be removed.

　　如果需要进一步松解神经，那么可能会切除一部分梨状肌。

This usually doesn’t cause problems with strength because there are several much stronger muscles that help turn the leg outward.这

　　通常不会造成力量的问题，因为还有其他几条更强的肌肉能让腿外旋。

Rehabilitation

康复

What should I expect as I recover?

　　康复期间我将要做什么？

Nonsurgical Rehabilitation

非手术治疗的康复

Most patients with piriformis syndrome work with a physical therapist. Plan to attend physical therapy sessions two to three times each week for six to eight weeks.

　　大多数梨状肌综合征患者需要物理治疗师的指导，制订计划参加物理治疗的疗程，每周2到3次，持续6到8周。

Your therapist begins by evaluating your condition. This includes attention to the low back, as well as the sacroiliac and hip joints.

　　治疗师一开始会评估你的病情，关注你的下背部，同时也关注骶髂关节和髋关节。

Physical therapy treatments for piriformis syndrome often begin with heat applications. Heat is used to help the piriformis muscle relax, easing spasm and pain. Your physical therapist may place a hot pack over your buttocks muscle.

　　梨状肌综合征的物理治疗常常以热疗开始。热疗可以帮助梨状肌放松，缓解痉挛和疼痛。理疗师可能会在你臀部肌肉上放置一个热的垫子。

Ultrasound is another treatment choice that can be set for deep heating in the buttock area. Ultrasound uses high frequency sound waves that are directed through the skin. The deep heating effect of ultrasound is ideal for preparing the piriformis muscle for hands-on forms of treatment and for getting the muscle to stretch out.

　　超声波是用来加热臀部区域的另一种治疗选择。超声波使用高频的声波直接穿过皮肤，其深部加热效应十分理想，可以帮助梨状肌准备好接受手法治疗，以及做肌肉拉伸练习。

Hands-on treatments such as deep massage and specialized forms of soft-tissue mobilization may be used initially. Your therapist may also position your hip and leg in a way that helps to relax nerve signals to the piriformis.

　　手法治疗中可能首先采用的有深部按摩和特殊形式的软组织松动术。治疗师可能会将你的髋关节和腿部摆放在可以帮助放松梨状肌神经信号的位置。

The keystone treatment for piriformis treatment is stretching. Stretching is especially effective following heat and hands on treatments. Your therapist will position you in ways that help you get a good stretch on the piriformis muscle. Along with the stretches you’ll do in the clinic, you’ll be shown several ways to stretch the muscle on your own. You need to do your stretches every few hours. Be gentle and cautious as you stretch to avoid overdoing it.

　　梨状肌治疗的重点措施是拉伸。在热疗和手法治疗后进行拉伸尤其有效。治疗师会将你的体位摆放到可以很好地拉伸梨状肌的位置。你在医院接受拉伸治疗的同时，也会学习到如何自己进行拉伸的若干种方法。你需要每隔几个小时就做拉伸。要轻柔小心，预防拉伸过度。

As your symptoms ease, your therapist will gradually advance your program to include posture training, muscle strengthening, and general conditioning.

　　随着你的症状缓解，治疗师会逐步推进你的训练计划，包括姿态训练、肌力训练和一般情况的调整。

After Surgery

术后康复

Your surgeon may prescribe physical therapy after surgery for piriformis syndrome. You’ll probably only need to attend sessions for four to six weeks. Expect full recovery to take up to three months.

　　你的医生可能会嘱咐你在梨状肌综合征术后接受物理治疗。你可能仅需要参加4到6周的疗程。完全康复需要3个月。

During therapy after surgery, your therapist may use treatments such as heat or ice, electrical stimulation, massage, and ultrasound to help calm pain and muscle spasm. Then you’ll begin learning how to move safely with the least strain on the healing area.

　　在术后康复期间，治疗师可能采用热疗或冰敷、电刺激、按摩和超声波等治疗方法来帮助缓解疼痛和肌肉痉挛。然后你将开始学习怎样活动才安全，同时对愈合中的区域造成的影响最小。

As the rehabilitation program evolves, you’ll begin doing more challenging exercises. The goal is to safely advance strength and function.

　　随着康复计划的进展，你将进行更有挑战性的练习。目的是安全地增强力量，改善功能。

As the therapy sessions come to an end, your therapist helps you get back to the activities you enjoy. Ideally, you’ll be able to resume normal activities. You may need guidance on which activities are safe or how to change the way they go about their activities.

　　当疗程结束，治疗师会帮助你重新回到你喜欢的运动。理想的情况下，你将能够恢复正常活动。你可能需要指导，来了解哪些活动是安全的，如何调整进行这些活动的方式。

When treatment is well under way, regular visits to your therapist’s office will end. Your therapist will continue to be a resource. But you’ll be in charge of doing your exercises as part of an ongoing home program.

　　当治疗开展顺利时，就不需要再定期去看你的治疗师了。治疗师还是你的资源，但是你将开始自己安排在家的训练计划。