악성 골반 골종양에 의한 천장관절의 경관절 침습

허진도,조길호,김성민,조영덕,Heo, Jin-Do,Jo, Gil-Ho,Kim, Seong-Min,Jo, Yeong-Deok 대한영상의학회 2002 대한영상의학회지 Vol.46 No.3

Purpose: To describe modes of transarticular invasion, with reference to the size and location of a tumor, the anatomic characteristics of invaded cartilage, and the existence of ankylosis in SI joint. Materials and Methods: Eleven histologically confirmed malignant pelvic bone tumors involving transarticular invasion of sacroiliac joints, were retrospectively analysed. Transarticular invasion of a joint was defined as involvement of its opposing bones. The anatomic site and size of the tumors were analysed, and invaded sacroiliac joint was divided into upper, middle and lower parts on the basis of the anatomic characteristics of the intervening cartilage: synovial hyaline or fibrous ligamentous. The existence of ankylosis was determined, and transarticular invasion directly across a joint was classified as direct invasion. Extension of tumors around a joint from its periphery to the opposing bone were considered as indirect invasion. Results: All tumors were located near the sacroiliac joint, eight at the ilium and three at the sacrum. Six invasions were indirect and five were direct. Average tumor area was larger in indirect cases than in direct: 191.8 cm2 vs. 69.6 cm2. In all indirect invasions, a huge soft tissue mass abutted onto the peripheral portion of the sacroiliac joint. In five of six cases of indirect transarticular invasion, the upper part of the joint posteriorly located fibrous ligamentous cartilage. In the other, the lower part was invaded, and this involved a detour around the joint space, avoiding the invasion of intervening cartilage. Ankylosis occurred in one of the indirect cases. Among the five cases of direct invasion, there was invasion of the posteriorly located ligamentous fibrous cartilage in three without ankylosis. In the other two cases, involving ankylosis, the synovial hyaline cartilage was invaded directly at the lower part of the joint. Conclusion: Transarticular invasions of sacroiliac joint via fibrous cartilage are most common. Ankylosis of the sacroiliac joint facilitates hyaline cartilage invasion. We consider that in transarticular invasion of malignant pelvic bone tumors, indirect invasion is more common than direct.

사체를 이용한 이상근 주사 위치에 대한 해부학적 지표

민지혜,최은석,이원일,김고운,이베나 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.1

Objective: To identify the optimal site for piriformis muscle injection, using easily detectable sacroiliac joint as a landmark, under fluoroscopic guidance. Method: We examined the anatomic relationships of the sciatic nerve, piriformis muscle and sacroiliac joint in 18 buttocks from 9 cadavers. The distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve, and the width of the sciatic nerve at that point were measured. We assessed the depth of the piriformis muscle and the sciatic nerve using ultrasonography in asymptomatic controls. Results: The mean distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve was 15.7±3.4 (12∼22) mm laterally and 16.5±4.1 (10∼25) mm caudally. The mean width of the sciatic nerve at that point was 15.4±3.7 (12∼22) mm. Ultrasonographic findings revealed the mean distance as 4.48±0.49 cm from the skin to the surface of the piriformis muscle and as 5.68±0.62 from the skin to the surface of the sciatic nerve. Conclusion: The most optimal injection site for piriformis syndrome was located 15.6±3.4 (12∼22) mm laterally and 16.5±4.1 (10∼25) mm caudally from the inferior margin of the sacroiliac joint. Objective: To identify the optimal site for piriformis muscle injection, using easily detectable sacroiliac joint as a landmark, under fluoroscopic guidance. Method: We examined the anatomic relationships of the sciatic nerve, piriformis muscle and sacroiliac joint in 18 buttocks from 9 cadavers. The distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve, and the width of the sciatic nerve at that point were measured. We assessed the depth of the piriformis muscle and the sciatic nerve using ultrasonography in asymptomatic controls. Results: The mean distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve was 15.7±3.4 (12∼22) mm laterally and 16.5±4.1 (10∼25) mm caudally. The mean width of the sciatic nerve at that point was 15.4±3.7 (12∼22) mm. Ultrasonographic findings revealed the mean distance as 4.48±0.49 cm from the skin to the surface of the piriformis muscle and as 5.68±0.62 from the skin to the surface of the sciatic nerve. Conclusion: The most optimal injection site for piriformis syndrome was located 15.6±3.4 (12∼22) mm laterally and 16.5±4.1 (10∼25) mm caudally from the inferior margin of the sacroiliac joint.

Development and growth of the human fetal sacroiliac joint revisited: a comparison with the temporomandibular joint

Ji Hyun Kim,Zhe Wu Jin,Shogo Hayashi,Gen Murakami,Hiroshi Abe,José Francisco Rodríguez Vázquez 대한해부학회 2023 Anatomy & Cell Biology Vol.56 No.2

The human fetal sacroiliac joint (SIJ) is characterized by unequal development of the paired bones and delayedcavitation. Thus, during the long in utero period, the bony ilium becomes adjacent to the cartilaginous sacrum. This mor­phology may be analogous to that of the temporomandibular joint (TMJ). We examined horizontal histological sections of 24 fetuses at 10–30 weeks and compared the timing and sequences of joint cartilage development, cavitation, and ossification of the ilium. We also examined histological sections of the TMJ and humeroradial joint, because these also contain a disk or disk-like structure. In the ilium, endochondral ossification started in the anterior side of the SIJ, extended posteriorly and reached the joint at 12 weeks GA, and then extended over the joint at 15 weeks GA. Likewise, the joint cartilage appeared at the anterior end of the future SIJ at 12 weeks GA, and extended along the bony ilium posteriorly to cover the entire SIJ at 26 weeks GA. The cavitation started at 15 weeks GA. Therefore, joint cartilage development seemed to follow the ossification of the ilium by extending along the SIJ, and cavitation then occurred. This sequence “ossification, followed by joint cartilage formation, and then cavitation” did not occur in the TMJ or humeroradial joint. The TMJ had a periosteum-like membrane that covered the joint surface, but the humeroradial joint did not. After muscle contraction starts, it is likely that the mechanical stress from the bony ilium induces development of joint cartilage.

Effects of individual strengthening exercises for the stabilization muscles on the nutation torque of the sacroiliac joint in a sedentary worker with nonspecific sacroiliac joint pain

The Society of Physical Therapy Science 2015 JOURNAL OF PHYSICAL THERAPY SCIENCE Vol.27 No.1

<P>[Purpose] We investigated the effects of individual strengthening exercises for the stabilization muscles on the nutation torque of the sacroiliac joint in a sedentary worker with nonspecific sacroiliac joint pain. [Subject] A 36-year-old female complained of pain in the sacroiliac joints. [Methods] The subject performed individual strengthening exercises for the stabilization muscles for nutation torque of the sacroiliac joint for 3 weeks. Pain-provocation tests and visual analog scale (VAS) scores were evaluated before and after the exercises. [Results] After performing the individual strengthening exercises for the erector spinae, rectus abdominis, and biceps femoris muscles for 3 weeks, the subject displayed no pain in the pain provocation tests, and the VAS score was 2/10. [Conclusion] The individual strengthening exercises for the stabilization muscles of the sacroiliac joint performed in the present study appear to be effective for sedentary workers with sacroiliac joint pain.</P>

자연과학편 : 골반변위 여성들을 위한 천장관절교정술과 짐볼(gymnastic-ball) 트레이닝의 치료적 효과 비교

주성범(SungBumJu),박기덕(GiDukPark) 한국체육학회 2007 한국체육학회지 Vol.46 No.4

The purpose of this study was to compare the therapeutic effectiveness between sacroiliac-joint adjustment and gymnastic-ball training in women of pelvic misalignment. Subjects were divided in to 2 group(Sacroiliac-joint adjustment group, gymnastic-ball training group) from 52 women of pelvic misalignment. The each group were treated with Sacroiliac-joint adjustment or gymnastic-ball training for 8 weeks and the effects on leg length and body balance have been evaluated. The Sacroiliac-joint adjustment group and gymnastic-ball training group were significantly decreased legs length and body balance as compared with pre-test. Especially, the Sacroiliac-joint adjustment group was significantly decreased leg length and body balance as compared with the gymnastic-ball training group. To conclude, Applying of Sacroiliac-joint adjustment for women of pelvic misalignment will be effectively appeared to improvement of body balance and decreasing of leg length compare with gym-ball training.

천장관절 증후군에 박동성 전기자장 치료와 병행한 침치료의 효과 연구

황형주 ( Hyung Joo Hwang ),금동호 ( Young Hoi Park ),박영회 ( Dong Ho Keum ) 한방재활의학과학회 2010 한방재활의학과학회지 Vol.20 No.3

Objectives: Although the controversy surrounding the biomechanics of the sacroiliac joint remains unresolved at this time, the clinical importance of this joint in the cause of back pain has been established since 1930`s. Recently, there has been renewed interest in the sacroiliac joint. This study was performed to evaluate the effects of pulsed electromagnetic therapy(PEMT) with acupuncture therapy for patients, who were suffering from sacroiliac joint syndrome, and to conduct more researches in the usage of acupuncture therapy for treating sacroiliac joint syndrome. Methods :25 patients, who were diagnosed as sacroiliac joint syndrome were selected. They were treated twice a week during 3 weeks. They were measured after all the treatment and first week and fourth week after termination of treatment by using visual analogue scale(VAS) and Roland Morris disability index(RMDI). The VAS and RMDI patterns were analyzed by using `pared T-test` and `Kruskal-Wallis` test. Results :1. Each times of PEMT with acupuncture therapy, there were statistical significance in improvement of VAS(p<0.05) and each times of therapy except 1st one, there were statistical significance in improvement of RMDI(p<0.05). 2. After 4th therapy, there were most significant improvement of VAS with RMDI(p<0.001), when we compared the change in VAS and RMDI before and after the each therapy. 3. There was no statistical significance in VAS and RMDI by onset, sex and age. Conclusions :The results indicate that pulsed electromagnetic therapy and acupuncture therapy had good effect on sacroiliac joint syndrome.

Sacroiliac Joint Fusion: Fusion Rates and Clinical Improvement Using Minimally Invasive Approach and Intraoperative Navigation and Robotic Guidance

Sarkar Mehul,Maalouly Joseph,Ruparel Sameer,Choi John 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.6

Study Design: This study adopted a retrospective study design.Purpose: This study was designed to describe the fusion rate and technique and patient subjective improvement after sacroiliac (SI) joint fusion using a minimally invasive surgical (MIS) approach.Overview of Literature: The SI joint can mimic radicular or discogenic pain localized to the lower back, gluteal region, or sacral region, posing a challenge in the diagnosis and treatment. This study determines the radiological fusion rate and patient reported subjective clinical outcomes of SI joint fusion using an MIS approach, comparing the use of the Rialto SI joint fusion system (Medtronic, Minneapolis, MN, USA) with the help of the Stealth Navigation System with the use of ExcelsiusGPS Robotic Navigation Platform (Globus Medical Inc., Audubon, PA, USA) using SI-LOK screws (Globus Medical Inc.).Methods: In this retrospective study, 43 consecutive patients who underwent SI joint fusion between August 2017 and February 2020 were enrolled; 60 SI joints were fused. The patients’ fusion was documented on computed tomography or X-rays, and Visual Analog Scale (VAS) scores were used to determine patient subjective clinical outcomes.Results: A total of 60 joints were fused, including 26 joints fused using robotic guidance and 34 joints fused using the Stealth Navigation System. Student <i>t</i>-test was used to compare the mean preoperative VAS score (7.52±1.3) with the mean postoperative VAS score at the 12-month follow-up (1.43±1.22) (<i>p</i><0.05). The SI joint fusion rate using this technique was 61% at 6 months, 96.4% at 12 months, and 100% at 18 months.Conclusions: The use of navigation guidance or robotic assistance enables accurate percutaneous screw placement across the SI joint. The use of bone morphogenetic protein in the screw bore hastens fusion across the joint, improving patient-perceived pain.

The Clinical Usefulness of Multidetector Computed Tomography of the Sacroiliac Joint for Evaluating Spondyloarthropathies

( You Hyun Lee ),( Ji Young Hwang ),( Sun Wha Lee ),( Ji Soo Lee ) 대한내과학회 2007 The Korean Journal of Internal Medicine Vol.22 No.3

Backgrounds: Due to the low sensitivity of plain radiography, the diagnosis of early stage ankylosing spondylitis (AS) is often difficult since many patients do not meet the radiographic criteria. The objective of our study was to investigate the diagnostic value of performing multidetector computed tomography (MDCT) of the sacroiliac (SI) joint in the evaluation of AS patients. Methods: Thirty seven patients with definite or probable AS were evaluated. Plain radiography and MDCT imaging of the pelvis were performed for evaluating the SI joints. Two radiologists analyzed the images, and they graded the sacroiliitis on a scale of 0-4 according to the modified NY criteria. The clinical variables we analyzed included the disease duration, the treatment duration, the prescribed drugs, peripheral joint involvement, enthesopathy, the functional limitations and the BASDAI. Results: MDCT detected more bilateral sacroiliitis as compared to the plain radiography (86.5% vs. 75.7%, respectively), and MDCT yielded a higher grade of disease in 32.4% (right SI joint) and 24.3% (left SI joint) of the patients. More patients satisfied the modified NY criteria with using MDCT as compared with that when using the plain radiography (81.1% vs. 54.1%, respectively, p=0.002). Conclusions: Visualization of the sacroiliac joint by MDCT provided a better diagnosis of AS, and especially during the early stage of the disease.

Brief Report : Pulsed Radiofrequency Application for the Treatment of Pain Secondary to Sacroiliac Joint Metastases

( Yu Ri Yi ),( Na Rea Lee ),( Young Suk Kwon ),( Ji Su Jang ),( So Young Lim ) 대한통증학회 2016 The Korean Journal of Pain Vol.29 No.1

Sacroiliac (SI) joint pain can result from degeneration, infection, malignancy, and trauma. Patients with metastatic bone pain who do not respond to conventional treatment may need more aggressive neuroinvasive approaches. Recently, pulsed radiofrequency (PRF) neuromodulation has emerged as a promising treatment alternative for refractory cases of SI joint pain. Nevertheless, there is no report on the treatment of pain arising from SI joint metastases with PRF. We are reporting about a 63-year-old woman suffering from buttock pain due to breast cancer metastases in the SI joint. We treated this patient with PRF neuromodulation of the L4-S3 primary dorsal rami and lateral branches using a rotating curved needle technique. The patient tolerated the procedures well, without any complications. She experienced about 70% reduction in pain, and pain relief was sustained for 10 months. This result suggests that PRF neuromodulation is a safe, effective treatment for pain from SI joint metastases. (Korean J Pain 2016; 29: 53-56)

Fixation of the Sacroiliac Joint: A Cadaver-Based Concurrent-Controlled Biomechanical Comparison of Posterior Interposition and Posterolateral Transosseous Techniques

Oluwatodimu Richard Raji,Jason E. Pope,Steven M. Falowski,Michael Stoffman,Jeremi M. Leasure 대한척추신경외과학회 2025 Neurospine Vol.22 No.1

Objective: Our study aimed to compare the posterior interposition technique against the posterolateral transosseous technique in the same cadaver specimens. Methods: Computer and cadaver models of 2 fixation techniques were developed. The com puter model was constructed to analyze bone volume removed during implant placement and the bony surface area available for fusion. The cadaver model included quasi-static mul tidirectional bending flexibility and dynamic fatigue loading. Relative motions between the sacrum and ilium were measured intact, after joint destabilization, after fixation with direct posterior and posterolateral techniques, and after 18,500 cycles of fatigue loading. Relative positions between each implant and the sacrum and ilium were measured after fixation and fatigue loading to ascertain the quality of the bone-implant interface. The 2 techniques were randomized to the left and right sacroiliac joints of the same cadavers. Results: The posterior interposition technique removed less bone volume and facilitated a larger surface area available for bony fusion. Posterior interposition significantly reduced the nutation/counternutation motion of the sacroiliac joint (42% ± 8%) and reduced it more than the posterolateral transosseous technique (14% ± 4%). Upon fatigue loading, the pos terior interposition implant maintained the bone-implant interface across all specimens, while the posterolateral transosseous implant migrated or subsided in 20%–50% of specimens. Conclusion: Posterior interposition fixation of the sacroiliac joint reduces joint motion. The amount of fixation from the posterior technique is superior and more durable than the amount of fixation achieved by the posterolateral technique.