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

목적: 종양의 위치, 천장관절의 해부학적 구조와 위치, 관절강직증 유무, 그리고 종양이 형성하는 연부 조직 종괴의 양상에 따라 악성 골반 골종양이 천장 관절로 경관절 침습하는 방식을 알아보고자 하였다. 대상과 방법: 병리학적으로 확진된 골반골에서 발생한 악성 골종양 환자 중, 영상소견에서 천장 관절을 침범하여 상대편 골(opposing bone)의 골 파괴가 있는 11명의 환자를 대상으로 하였다. 골종양의 발생위치와 크기를 알아보았으며, 천장관절의 침범부위를 위치에 따라 상부, 중간, 하부 침습으로 분류하였고, 해부학적 차이에 따라 활막 유리질 연골 부위(synovial hyaline cartilage portion)와 섬유성 연골 인대 부위(fibrous ligamentous portion)침습으로 나누었다. 관절의 강직증 유무에 따라 경관절 침습 양식을 비교하였다. 천장관절로의 경관절 침습 양식은 연골을 파괴하고 직접적으로 관절을 가로질러 넘어가는 직접 침습(direct invasion)과 연부 조직 종괴가 상대편 골피질에 인접하여 관절 주변부와 상대편 골(opposing bone)을 침범하는 간접 침습(indirect invasion)으로 분류하였다. 결과: 종양은 전예에서 천장 관절 근처에서 발생하였고, 장골이 8예, 천골이 3예였다. 천장관절의 간접 침습은 6예, 직접 침습은 5예였다. 천장관절의 간접 침습에서 종양의 크기는 평균191.8 cm2 이었고, 직접 침습에서는 평균 69.6 cm2이었다. 천장관절의 간접침습은 모든 예에서 큰 연부조직 종괴가 천장관절 주변부에서 관절과 접하고 있었다. 상부에서 발생한 간접 침습의 5예는 모두 관절 후방의 섬유성 연골 인대 부위를 침범하였으나 종양과 인접한 활막 유리질 연골은 침범하지 않았다. 하부에서 발생한 1예에서는 활막 유리질 인대를 유지하면서, 관절강을 우회하여 상대편 골(opposing bone)의 골피질을 파괴하였다. 이중 관절강직증은 1예에서 보였다. 직접 침습 역시 비교적 큰 연부 조직 종괴가 관찰되었으며, 관절 상부에서 발생한 2예와 중간부위에서 발생한 1예는 관절 후방의 섬유성 연골 인대를 침습하였다. 관절 강직증을 동반한 2예만 하부의 활막 유리질 연골을 통하여 직접 침습을 하였다.결론: 악성 골반 골종양의 경관절 침습은 대부분이 섬유성 연골 인대부분을 통하여 천장관절 을 침습한다. 관절강직증이 동반된 경우 활막 유리질 연골 파괴를 통한 천장관절 침습이 가 능하다. 또한 골반 골종양은 천장관절을 가로질러 침습하기 보다는 큰 연부 조직 종괴가 천장관절과 접한 후, 관절 주변부(periphery)로부터 관절 또는 상대편 골(opposing bone)로의 파급되는 것으로 생각된다. 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>

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.

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.

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

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

본 연구는 골반변위 여성들에게 천장관절교정술과 짐볼(Gym-Ball)트레이닝의 치료적 효과를 비교, 분석하는 것이다. 이를 위하여, 골반변위 여성 52명을 천장관절교정그룹 28명과 짐볼트레이닝그룹 24명으로 나누어 8주간의 적용 전, 후에 하지길이 차이와 신체동요면적을 측정하였다. 하지길이 변화에서는 천장관절교정그룹과 짐볼트레이닝그룹이 적용 전에 비해 적용 후에 유의하게 감소하였으며(p<.05), 감소효과는 천장관절교정그룹이 더욱 높게 나타났다. 신체동요면적의 변화에서는 눈뜨고 외발서기 좌측의 동요면적에서는 천장관절그룹에서 적용 후 유의한 감소효과가 나타났고(p<.05). 우측의 동요면적에서는 두 그룹 모두에서 적용 후 유의하게 감소하였으며(p<.05), 감소효과는 천장관절교정그룹이 더욱 높게 나타났다. 눈감고 양발서기의 동요면적의 변화에서는 천장관절교정그룹과 짐볼트레이닝그룹이 적용 전에 비해 적용 후에 유의하게 감소하였다(p<.05). 이처럼, 골반변위 여성들을 위한 천장관절교정과 짐볼(Gym-Ball)트레이닝의 치료적 효과 비교에서는 천장관절교정요법의 적용이 하지길이 차이의 감소와 밸런스 향상에 더 도움이 되는 것으로 나타났다. 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.

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)

천장 관절의 Crescent 골절 탈구에 대한 골반 내 전방 금속판 고정술

오광준 ( Kwang Jun Oh ),최진호 ( Jin Ho Choi ) 대한골절학회 2013 대한골절학회지 Vol.26 No.3

목 적: Day 2형 Crescent형 천장 관절 골절-탈구에서 골반 내 전방 접근법을 통한 금속판 고정술 시행 시 정복 정도와 골반 안정성, 임상적 결과를 평가하고자 하였다. 대상 및 방법: 2006년 이후 본원에서 수술적 치료를 받고 최소 1년 이상 추시가 가능했던 10명의 환자를 대상으로 구를 시행하였고 전 예에서 Day Classification상 2에 해당하였다. 수술은 전 예에서 후방 골반환에 대하여 골반 내 전방 접근법을 통해 관혈적 정복술 및 금속판 내고정술을 먼저 시행하였고 4예는 전위가 심한 전방 골반환의 손상에 대한 금속판 고정술도 같이 시행하였다. 이에 방사선학적 평가와 임상적 평가를 시행하였다. 결 과: 모든 환자에게서 유합을 얻었으며, 방사선학적 결과에서 천장 관절의 정복은 준 해부학적 정복 이상이 9예, 회전 전위는 만족할 만한 정복이 9예로 나타났다. 변형 지수 및 수직 전위는 골반 내 전방 고정술을 통한 후방 골반환 고정과 전방 골반환 고정을 동시에 시행한 경우 상대적으로 변화량이 적은 것으로 나타났다. 임상적 결과는 7예에서 보통 이상이었다. 결 론: Day 2형 Crescent형 골절 탈구에 대하여 골반 내 전방 접근법을 통한 금속판 고정술 시행 시 만족스러운 해부학적 정복, 골반환의 안정성 및 임상적 결과를 얻을 수 있을 것으로 판단된다. Purpose: To evaluate the radiological and clinical outcomes of intrapelvic anterior plate fixations for Day Classification Type II crescent fracture-dislocations of sacroiliac joints. Materials and Methods: Ten patients who had undertaken the surgical treatment for the sacroiliac joint from 2006 to 2012 were enrolled in this study. All cases fell into Type II by Day Classification for sacroiliac joint injuries. For surgical treatments, the plate fixation through the intra-pelvic anterior approach was first performed for all cases and anterior ring fixation was performed in 4 cases with more severely displaced anterior pelvic ring injuries. Then, radiological and clinical evaluation was implemented. Results: The bone union was observed from all patients whom performed the surgical fixation. In the radiological results, 9 cases with the anatomic and nearly-anatomic reductions were observed. Out of the 10 cases which performed the rotational displacement analysis, there were 3 excellent cases, 6 good cases and 1 fair case. The 10 cases that performed the deformity index and vertical displacement analysis, less variations were observed in the anterior ring fixations after intra pelvic anterior plate fixation group. According to the clinical results, 4 excellent cases, 3 good cases, and 3 moderate cases were observed. Conclusion: In the Type II crescent fracture-dislocation of sacroiliac joint, the intrapelvic anterior plate fixation achieved satisfactory anatomical reductions, radiological stabilities and clinical results.