Sciatic Neuropathy Caused by Focal Myositis: Report of a Case

局部肌炎引起之坐骨神經病變：病例報告

姜周禮(Chou-Li Chiang) ； 謝芳郁(Fang-Yuh Hsieh)

《Formosan Journal of Surgery》 39卷2期 (2006/04) Pp. 89-94

https://doi.org/10.29833/FJS.200604.0006

摘要

我們報告一例因肌肉痙攣導致炎症反應，表現出坐骨神經病變的少見病例。
一名因突發性右下肢劇烈痙攣疼痛的47歲男性患者至急診求醫而入院。理學檢查發現右臀有一壓痛性硬塊。我們在此硬塊之中心點注射局部麻劑xylocaine，數小時之後疼痛逐漸消失。右臀硬塊亦消失。我們再度檢視患者，發現他右腳幾乎喪失活動功能。神經生理檢查顯示臀肌有去神經化之現象，而坐骨神經自坐骨切跡以下有病變之發生。
我們回顧了肌肉痙攣與坐骨神經病變的病理機轉與治療的相關文獻。我們認為神經病變是持續肌肉痙攣導致神經缺血的後遺症。至於神經病變因無進一步惡化，因此採取密切觀察的保守治療法。患者在之後的五個月逐漸恢復其部分神經功能。

並列摘要

We report a case of muscle cramp-induced aseptic inflammatory reaction of gluteal muscles presenting with sciatic neuropathy. A 47-year-old male was admitted from ER for abruptly onset of severe right leg cramping pain. Physical examination revealed an exquisitely tender, localized, and firm mass in the right buttock. Injection of xylocaine was performed at the midpoint of the mass. The pain faded over the next few hours. We re-examed the patient after the pain episode subsided. The firm mass disappeared promptly. He had nearly no foot movement on involved site. Electrophysiological studies disclosed denervated change in gluteal muscles and sciatic neuropathy below the right sciatic notch. A review of the literature in respect of pathogenesis and treatment of muscle cramps and sciatic neuropathy was made. We assumed that the neuropathy was an ischemic sequela after persistent muscle cramps. Where there was no further deterioration in neuropathy, a watch-and-wait policy appeared to be a valid initial therapeutic option. The patient gradually recovered from the insult 5 months later.

並列關鍵字

myositis ； sciatic neuropathy ； muscle cramps