Forst Stacy L, Wheeler Michael T, Fortin Joseph D, Vilensky Joel A
Spine Technology and Rehabilitation & Indiana University School of Medicine Fort Wayne, Indiana, USA.
Pain Physician. 2006 Jan;9(1):61-7.
The sacroiliac joint (SIJ) is a putative source of low back pain. The objective of this article is to provide clinicians with a concise review of SIJ structure and function, diagnostic indicators of SIJ-mediated pain, and therapeutic considerations. The SIJ is a true diarthrodial joint with unique characteristics not typically found in other diarthrodial joints. The joint differs with others in that it has fibrocartilage in addition to hyaline cartilage, there is discontinuity of the posterior capsule, and articular surfaces have many ridges and depressions. The sacroiliac joint is well innervated. Histological analysis of the sacroiliac joint has verified the presence of nerve fibers within the joint capsule and adjoining ligaments. It has been variously described that the sacroiliac joint receives its innervation from the ventral rami of L4 and L5, the superior gluteal nerve, and the dorsal rami of L5, S1, and S2, or that it is almost exclusively derived from the sacral dorsal rami. Even though the sacroiliac joint is a known putative source of low back and lower extremity pain, there are few findings that are pathognomonic of sacroiliac joint pain. The controlled diagnostic blocks utilizing the International Association for the Study of Pain (IASP) criteria demonstrated the prevalence of pain of sacroiliac joint origin in 19% to 30% of the patients suspected to have sacroiliac joint pain. Conservative management includes manual medicine techniques, pelvic stabilization exercises to allow dynamic postural control, and muscle balancing of the trunk and lower extremities. Interventional treatments include sacroiliac joint, intra-articular joint injections, radiofrequency neurotomy, prolotherapy, cryotherapy, and surgical treatment. The evidence for intra-articular injections and radiofrequency neurotomy has been shown to be limited in managing sacroiliac joint pain.
骶髂关节（SIJ）被认为是下腰痛的一个潜在源头。本文旨在为临床医生提供有关骶髂关节结构与功能、骶髂关节介导性疼痛的诊断指标以及治疗考量因素的简要综述。骶髂关节是一个真正的动关节，具有一些在其他动关节中不常见的独特特征。该关节与其他关节的不同之处在于，除了透明软骨外，它还有纤维软骨，后关节囊不连续，且关节面有许多嵴和凹陷。骶髂关节有丰富的神经支配。对骶髂关节的组织学分析已证实关节囊和相邻韧带内存在神经纤维。关于骶髂关节的神经支配有多种描述，有人认为它接受来自L4和L5腹侧支、臀上神经以及L5、S1和S2背侧支的神经支配，也有人认为它几乎完全源自骶神经背侧支。尽管骶髂关节是已知的下腰和下肢疼痛的潜在源头，但几乎没有什么发现是骶髂关节疼痛所特有的。采用国际疼痛研究协会（IASP）标准进行的对照诊断性阻滞显示，在疑似骶髂关节疼痛的患者中，骶髂关节源性疼痛的发生率为19%至30%。保守治疗包括手法治疗技术、进行骨盆稳定练习以实现动态姿势控制，以及对躯干和下肢进行肌肉平衡训练。介入治疗包括骶髂关节内关节注射、射频神经切断术、注射增殖疗法、冷冻疗法以及手术治疗。关节内注射和射频神经切断术在治疗骶髂关节疼痛方面的证据已表明是有限的。
