Orthopaedic, Trauma Surgery and Plastic Surgery Clinic, Leipzig University Clinics, Germany.
Anatomical Institute, Leipzig University, Germany.
Z Orthop Unfall. 2022 Oct;160(5):507-516. doi: 10.1055/a-1398-6055. Epub 2021 May 3.
In recent years, the sacroiliac joint has become increasingly important as a generator of low back pain with and without pseudo-radicular pain in the legs. Up to 27% of reported back pain is generated by disorders in the sacroiliac joint.
This review is based on a selective literature search of the sacroiliac joint (SIJ) as a possible pain generator. It also considers the anatomical structures and innervation of the sacroiliac joint.
The SIJ is a complex joint in the region of the posterior pelvis and is formed by the sacrum and the ilium bones. The SIJ is very limited in movement in all three planes. Joint stability is ensured by the shape and especially by strong interosseous and extraosseous ligaments. Different anatomical variants of the sacroiliac joint, such as additional extra-articular secondary joints or ossification centres, can be regularly observed in CT scans. There is still controversy in the literature regarding innervation. However, there is agreement on dorsal innervation of the sacroiliac joint from lateral branches of the dorsal rami of the spinal nerves S I-S III with proportions of L III and L IV as well S IV. Nerve fibres and mechanoreceptors can also be detected in the surrounding ligaments.
A closer look at the anatomy and innervation of the SIJ shows that the SIJ is more than a simple joint. The complex interaction of the SIJ with its surrounding structures opens the possibility that pain arises from this area. The SIJ and its surrounding structures should be included in the diagnosis and treatment of back and leg pain. Published literature include a number of plausible models for the sacroiliac joint as pain generator. The knowledge of the special anatomy, the complex innervation as well as the special and sometimes very individual functionality of this joint, enhance our understanding of associated pathologies and complaints.
近年来，骶髂关节作为产生腰痛（伴或不伴下肢假性神经根痛）的原因变得越来越重要。据报道，高达 27%的腰痛是由骶髂关节紊乱引起的。
这篇综述是基于对骶髂关节（SIJ）作为可能的疼痛发生器的选择性文献检索。它还考虑了骶髂关节的解剖结构和神经支配。
SIJ 是骨盆后部的一个复杂关节，由骶骨和髂骨组成。SIJ 在所有三个平面上的活动都非常有限。关节稳定性由形状特别是由强大的骨间和骨外韧带来保证。在 CT 扫描中可以经常观察到骶髂关节的不同解剖变异，例如额外的关节外副关节或骨化中心。关于神经支配，文献中仍存在争议。然而，对于来自脊神经 S I-S III 的背侧支的骶髂关节的背侧神经支配有共识，L III 和 L IV 以及 S IV 的比例也相同。神经纤维和机械感受器也可以在周围的韧带中检测到。
仔细观察 SIJ 的解剖和神经支配，表明 SIJ 不仅仅是一个简单的关节。SIJ 与其周围结构的复杂相互作用使该区域产生疼痛成为可能。SIJ 及其周围结构应纳入腰痛和腿痛的诊断和治疗中。已发表的文献包括许多关于骶髂关节作为疼痛发生器的合理模型。对特殊解剖结构、复杂神经支配以及该关节的特殊且有时非常个体化功能的了解，增强了我们对相关病理和症状的理解。
