Sakroiliak Eklem ve Biyomekaniği: Anatomik, Klinik ve Tedavi Açısından Değerlendirme
Özet
Sakroiliak eklem (SİE), sakrum ve ileum arasında yer alan, hem stabilite sağlayan hem de sınırlı fakat fonksiyonel hareket kabiliyeti sunan karmaşık bir sinoviyal eklemdir. Anatomik olarak derin yerleşimli olup, güçlü bağ yapıları (anterior, interosseöz, posterior sakroiliak, iliolumbal, sakrotüberöz ve sakrospinöz bağlar) ve çevre kas-fasya sistemleri ile desteklenmektedir. SİE, omurgadan alt ekstremitelere yük aktarımında kritik bir rol üstlenir. Yürüme sırasında ekleme binen yük normalin üç katına kadar çıkabilir. Hareket aralığı minimal olmasına rağmen, pelvik kinematik denge açısından oldukça önemlidir. Ekleme ait rotasyon genellikle 2 dereceden, yer değiştirme ise 1.6 mm’den azdır. Klinik olarak bel ağrısının önemli bir nedenidir; sırt ağrısıyla başvuran hastaların yaklaşık %30’unda köken SİE olabilir. Dejeneratif, romatizmal, enfeksiyöz ve travmatik etkenler başlıca patoloji sebepleridir. Tanı ve tedavi süreci karmaşıktır. Tedavi; konservatif yöntemlerden fizik tedavi ve enjeksiyonlara, invaziv seçeneklerden radyofrekans ablasyon ve artrodeze kadar uzanır. Konservatif tedaviye yanıt alınamayan hastalarda radyofrekans ablasyon veya artrodez gibi cerrahi seçenekler uygulanabilir. Ancak sakrumun düşük kemik dansitesi, cerrahi fiksasyon başarısını etkileyebilir. Bu nedenle hasta bazlı değerlendirme yapılarak, stabilite ile hareket arasında optimal denge hedeflenmelidir.
The sacroiliac joint (SIJ) is a complex synovial joint located between the sacrum and ilium, providing both stability and limited yet functional mobility. Anatomically deep-seated, it is supported by robust ligamentous structures—including the anterior, interosseous, posterior sacroiliac, iliolumbar, sacrotuberous, and sacrospinous ligaments—and surrounding muscular and fascial systems. The SIJ plays a critical role in transferring axial loads from the spine to the lower extremities. During gait, forces across the joint can reach up to three times body weight. Despite its minimal range of motion, the SIJ is vital for pelvic kinematic balance, with rotation typically under 2 degrees and translation less than 1.6 mm. Clinically, the SIJ is a major source of low back pain; up to 30% of patients with lumbosacral discomfort may have SIJ-related pathology. Degenerative, rheumatologic, infectious, and traumatic causes are common etiologies. Diagnosis and management are often challenging. Treatment options range from conservative methods, such as physical therapy and injections, to interventional approaches like radiofrequency ablation and arthrodesis. In patients unresponsive to conservative care, surgical fixation may be needed. However, low sacral bone density can affect fixation outcomes. Therefore, individualized assessment is essential to balance joint stability with motion preservation.
Referanslar
Ashby K, Yilmaz E, Mathkour M, Olewnik Ł, Hage D, Iwanaga J, Loukas M, et al. Ligaments stabilizing the sacrum and sacroiliac joint: a comprehensive review. Neurosurg Rev 2022;45: 357-64. https://doi.org/10.1007/s10143-021-01625-y
Cardwell MC, Meinerz CM, Martin JM, Beck CJ, Wang M, Schmeling GJ. Systematic review of sacroiliac joint motion and the effect of screw fixation. Clin Biomech (Bristol) 2021;85: 105368. https://doi.org/10.1016/j.clinbiomech.2021.105368
Phillips AT, Pankaj P, Howie CR, Usmani AS, Simpson AH. Finite element modelling of the pelvis: inclusion of muscular and ligamentous boundary conditions. Med Eng Phys 2007;29: 739-48. https://doi.org/10.1016/j.medengphy.2006.08.010
DonTigny RL. Anterior dysfunction of the sacroiliac joint as a major factor in the etiology of idiopathic low back pain syndrome. Phys Ther 1990;70: 250-65; discussion 62-5. https://doi.org/10.1093/ptj/70.4.250
Kemper AR, McNally C, Duma SM. Dynamic compressive response of the human pelvis axial loading of the sacroiliac joint. Biomed Sci Instrum 2008;44: 171-6.
Goode A, Hegedus EJ, Sizer P, Brismee JM, Linberg A, Cook CE. Three-dimensional movements of the sacroiliac joint: a systematic review of the literature and assessment of clinical utility. J Man Manip Ther 2008;16: 25-38. https://doi.org/10.1179/106698108790818639
Hammer N, Scholze M, Kibsgård T, Klima S, Schleifenbaum S, Seidel T, Werner M, et al. Physiological in vitro sacroiliac joint motion: a study on three-dimensional posterior pelvic ring kinematics. J Anat 2019;234: 346-58. https://doi.org/10.1111/joa.12924
Vleeming A, Stoeckart R. The role of the pelvic girdle in coupling the spine and the legs: A clinical-anatomical perspective on pelvic stability. Movement, Stability & Lumbopelvic Pain 2007;10.1016/B978-044310178-6.50010-4113-37. https://doi.org/10.1016/B978-044310178-6.50010-4
Kiapour A, Abdelgawad AA, Goel VK, Souccar A, Terai T, Ebraheim NA. Relationship between limb length discrepancy and load distribution across the sacroiliac joint--a finite element study. J Orthop Res 2012;30: 1577-80. https://doi.org/10.1002/jor.22119
Zheng N, Watson LG, Yong-Hing K. Biomechanical modelling of the human sacroiliac joint. Med Biol Eng Comput 1997;35: 77-82. https://doi.org/10.1007/bf02534134
Cher D, Polly D, Berven S. Sacroiliac joint pain: burden of disease. Med Devices (Auckl) 2014;7: 73-81. https://doi.org/10.2147/mder.S59437
Adhia DB, Milosavljevic S, Tumilty S, Bussey MD. Innominate movement patterns, rotation trends and range of motion in individuals with low back pain of sacroiliac joint origin. Man Ther 2016;21: 100-8. https://doi.org/10.1016/j.math.2015.06.004
Pantè S, Bufalo M, Aprato A, Nardi M, Giai Via R, Bosco F, Rollero L, et al. Surgical management and outcomes of pure sacroiliac joint dislocations: A systematic review. J Orthop 2025;66: 14-20. https://doi.org/10.1016/j.jor.2025.01.005
Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine (Phila Pa 1976) 1995;20: 31-7. https://doi.org/10.1097/00007632-199501000-00007
Rashbaum RF, Ohnmeiss DD, Lindley EM, Kitchel SH, Patel VV. Sacroiliac Joint Pain and Its Treatment. Clin Spine Surg 2016;29: 42-8. https://doi.org/10.1097/bsd.0000000000000359
Buchowski JM, Kebaish KM, Sinkov V, Cohen DB, Sieber AN, Kostuik JP. Functional and radiographic outcome of sacroiliac arthrodesis for the disorders of the sacroiliac joint. Spine J 2005;5: 520-8; discussion 29. https://doi.org/10.1016/j.spinee.2005.02.022
Wise CL, Dall BE. Minimally invasive sacroiliac arthrodesis: outcomes of a new technique. J Spinal Disord Tech 2008;21: 579-84. https://doi.org/10.1097/BSD.0b013e31815ecc4b
Joukar A, Shah A, Kiapour A, Vosoughi AS, Duhon B, Agarwal AK, Elgafy H, et al. Sex Specific Sacroiliac Joint Biomechanics During Standing Upright: A Finite Element Study. Spine (Phila Pa 1976) 2018;43: E1053-e60. https://doi.org/10.1097/brs.0000000000002623
Shen FH, Mason JR, Shimer AL, Arlet VM. Pelvic fixation for adult scoliosis. Eur Spine J 2013;22 Suppl 2: S265-75. https://doi.org/10.1007/s00586-012-2525-3
