Department of Anatomy, University of Otago, Dunedin, New Zealand.
School of Medicine, University of Otago, Dunedin, New Zealand.
Pain Physician. 2019 Jul;22(4):E247-E274.
The sacroiliac joint (SIJ) forms a complex joint and has shown to be underappreciated in its involvement with lower back pain. Research efforts have intensified on SIJ anatomy and biomechanics because of its predisposing position to pain and dysfunction in individuals suffering from lower back discomfort. Previous work has focused on SIJ anatomy including bone and joint structure, innervation, as well as biomechanics and the treatment of SIJ pain. However, to date, no review exists describing the range of 'normal' anatomic features of the SIJ.
To describe the normal appearance of the SIJ and adjacent tissues, as opposed to 'abnormal' conditions involving SIJ morphology. It will also identify key areas that require further study because of lacking information or disagreement.
A systematic literature review.
The research took place at the University of Otago, New Zealand. All published research on 'normal SIJ anatomy' available from MEDLINE, OVID, Scopus, Web of Science, PubMed, and Science Direct were included, available until December 2018, in English, French, and German. Subject areas included bony landmarks, joint type, bone morphology, ligamentous attachments, muscular and fascial relationships, blood supply, fatty infiltration, and morphologic variation.
Articles met the selection criteria if they contained specific information on SIJ anatomy, including bone morphology and architecture, ligaments, muscle attachments, innervation, vasculature, and the presence of fat. Biomechanics and kinematics related keywords were used as the literature often couples these with the anatomy. Keywords of individual articles were named as 'structures of interest.'
A total of 88 primary and 101 secondary articles were identified in the time frame from 1851 to 2018. Primary articles provided quantitative data and detailed anatomic descriptions. Secondary articles did not focus specifically on the anatomy of the SIJ. Although research appeared to be in general agreement on bony landmarks, joint type, myofascial attachments, vasculature, and innervation of the SIJ, there was only part consensus on ligament attachments and cartilage structure. Information regarding bone density of the articulating surfaces of the SIJ is lacking. Despite its potential clinical significance, fatty infiltration within the joint lacks research to date.
Only the given databases were used for the initial search. Keyword combinations used for this review may not have been inclusive of all articles relevant to the SIJ. Work in languages other than the ones listed or work that is not available via the internet may be missing.
This study provides an overview of normal SIJ structures, including all neuromusculoskeletal elements related to the joint. There is a lack of knowledge on the SIJ ligaments warranting further investigation. Furthermore, there are discrepancies in relation to the nomenclature, layers, attachment sites, and on the topographical relationships between ligamentous tissues and nerves. Subsequent studies on the quantification of fat and bone density in the SIJ have been suggested. These could be useful radiologic parameters to assess the condition of the joint clinically. This review may provide insight into the clinical signs and abnormal biomechanical features of the joint for the purposes of treating SIJ pain.
Bone density, bony landmarks, fat infiltration, innervation, ligaments morphology, muscles, sacroiliac joint, vasculature.
骶髂关节 (SIJ) 是一个复杂的关节，其在引起下腰痛方面的作用被低估了。由于个体下背部不适时易出现疼痛和功能障碍，因此人们对 SIJ 解剖结构和生物力学的研究力度有所加大。先前的研究主要集中在 SIJ 解剖结构上，包括骨骼和关节结构、神经支配以及生物力学和 SIJ 疼痛的治疗。但是，迄今为止，尚无关于 SIJ 正常解剖结构的综述。
描述 SIJ 及其相邻组织的正常表现，而非涉及 SIJ 形态的“异常”情况。还将确定需要进一步研究的关键领域，因为这些领域缺乏信息或存在分歧。
系统文献回顾。
这项研究在新西兰奥塔哥大学进行。纳入了从 1851 年至 2018 年期间发表的关于“正常 SIJ 解剖结构”的所有 MEDLINE、OVID、Scopus、Web of Science、PubMed 和 Science Direct 可用的研究，研究语言为英语、法语和德语。研究领域包括骨性标志、关节类型、骨骼形态、韧带附着、肌肉和筋膜关系、血液供应、脂肪浸润和形态变异。
如果文章包含有关 SIJ 解剖结构的具体信息，包括骨骼形态和结构、韧带、肌肉附着、神经支配、血管和脂肪存在，则符合选择标准。生物力学和运动学相关关键词被用作文献中经常与解剖结构结合使用的关键词。文章的关键词被命名为“感兴趣的结构”。
在 1851 年至 2018 年期间，共确定了 88 篇原发性文章和 101 篇继发性文章。原发性文章提供了定量数据和详细的解剖描述。继发性文章并未专门针对 SIJ 的解剖结构进行研究。尽管研究似乎普遍对骨性标志、关节类型、肌筋膜附着、血管和 SIJ 的神经支配达成共识，但对韧带附着和软骨结构的共识仅部分达成。关于 SIJ 关节面骨密度的信息尚缺乏。尽管关节内脂肪浸润具有潜在的临床意义，但目前尚无相关研究。
仅使用了最初搜索的给定数据库。用于此综述的关键词组合可能并未包含与 SIJ 相关的所有文章。可能会遗漏其他语言的研究或无法通过互联网获取的研究。
本研究提供了 SIJ 正常结构的概述，包括与关节相关的所有神经肌肉骨骼元素。对 SIJ 韧带的了解有限，需要进一步研究。此外，在命名、层、附着部位以及韧带组织和神经之间的局部解剖关系方面存在差异。建议进一步研究 SIJ 中脂肪和骨密度的定量。这些可能是评估关节状况的有用影像学参数。本综述可为治疗 SIJ 疼痛时的关节临床体征和异常生物力学特征提供参考。
骨密度、骨性标志、脂肪浸润、神经支配、韧带形态、肌肉、骶髂关节、血管。
