Iliac dense osteitis is a non-specific inflammatory disease characterized by osteosclerosis, with highly dense osteosclerosis, especially in the lower 2/3 of the ilium, but no change in the joint space. It is also called “sacroiliac joint dense osteitis” because it is located in the sacroiliac joint and has significant symptoms in this joint. Iliac dense osteitis is a disease of increased bone density that occurs in the olecranon part of the iliac joint. The cause is unknown, but may be related to pregnancy, mechanical strain, or focal inflammation.
The disease occurs in women of childbearing age between 20 and 35 years, and occasionally in men. The disease is seen in more than 90% of middle-aged women and is more common in late pregnancy, especially after childbirth, and also after chronic infection of the urinary tract or female adnexa, or other infections in the pelvis. In addition, trauma to the hip-sacral area can also trigger or cause the disease. Pregnancy, childbirth and trauma can cause tearing of the ligaments of the sacroiliac joint, which can easily block the local blood supply.
As a result, early local congestion, edema and increased exudation appear, and gradually local proliferation and degenerative reactions appear, evolving to sclerosis with the densification of collagen fibers; blood vessels form thick-walled vessels, which are easily occluded and cause ischemia and hypoxia at the auricular surface of the iliac bone, and the bone shows sclerotic changes, resulting in less local bleeding during surgery. The sacroiliac joint capsule wall shows fibrous hyperplasia, reduced elasticity and loosening-like changes.
Similar pathological changes are seen secondary to inflammatory disease in the pelvis, probably due to bacterial endotoxin action. Iliac dense osteitis is a nonspecific inflammatory disease characterized by osteosclerosis, with highly dense osteosclerosis, especially in the lower 2/3 of the ilium, but no alteration of the joint space. It is also called “sacroiliac joint dense osteitis” because it is located in the sacroiliac joint and has significant symptoms in this joint.
Dense osteoarthritis of the iliac joint occurs in women, and is more common in middle-aged women between the ages of 20 and 40. It has recurrent lower back pain, sometimes radiating down to the buttocks and thighs on both sides, but not radicular pain, which can be aggravated by lower back activity.
Etiology and pathology
1.Aetiology
The disease is more than 90% in middle-aged women, and is more common in late pregnancy, especially after childbirth. It can also be seen after chronic infection of the urinary tract or female adnexa, or other infections in the pelvis. In addition, trauma to the hip-sacral area can also trigger or cause this disease.
2.Pathology
Pregnancy, childbirth and trauma can cause tearing of sacroiliac joint ligaments and easily block the local blood supply. Therefore, early local congestion, edema and exudation increase, and gradually local hyperplasia and degenerative reactions appear, and evolve to sclerosis with the densification of collagen fibers; blood vessels form thick-walled vessels, which are easily occluded and cause ischemia and hypoxia at the auricular surface of the iliac bone, and the bone shows sclerotic changes, resulting in less local bleeding during surgery. The sacroiliac joint capsule wall shows fibrous hyperplasia, reduced elasticity and loosening-like changes. Similar pathological changes were also seen in those secondary to inflammation in the pelvis, which might be caused by the action of bacterial endotoxin.
3.Clinical manifestations and imaging diagnosis
The diagnosis of this disease is mainly based on: past history: most of them have a history of pregnancy, trauma and pelvic infection. Complaint: sacroiliac pain, 80% of which is one-sided, especially acute with walking, standing and weight-bearing, but mostly tolerable. Signs: percussion pain and pressure pain in the sacroiliac joint. The pelvic separation and compression test, “4” test and Gay’s test are positive. (X-ray plain film: no change in the early stage, later stage shows sclerosis of the iliac surface but no bone destruction. Sclerotic changes of the iliac bone adjacent to the sacroiliac joint, often involving the distal 1/2 of the joint, and sometimes both sides at the same time. It may be a bony response to the secretion of relaxin acting on the pelvic joint before delivery.
4.Differential diagnosis
The disease is mainly distinguished from osteoarthritis, sacroiliac joint tuberculosis, early ankylosing spondylitis and septic sacroiliac arthritis. The latter two are mostly involved in one side of the joint, and both sides are extremely rare.
Clinical manifestations and signs
Patients have lumbosacral pain, mostly chronic, intermittent soreness and vague pain, which may spread to one or both buttocks and posterior thighs, but does not radiate in the direction of sciatic nerve, aggravated by walking, standing, weight bearing and exertion, and the pain cannot be significantly aggravated by coughing and sneezing, and the symptoms are alleviated after rest. The patient’s lumbosacral angle increased, with local pressure pain and muscle tension, positive pelvic separation and squeeze test, positive “4” test, and laboratory tests were mostly within normal range. x-ray examination, the sacroiliac joint gap was neat and clear, and the bone density of the iliac auricular joint part near the sacroiliac joint surface was increased, showing a dense zone of bone with uniformly dense white and clear edges. The bone trabeculae disappeared, and there was no bone destruction.
Treatment principles
1, the mild: to tight pants, more can be healed or improved.
2, heavy: refers to affect walking and workers, feasible sacroiliac joint fusion. Generally, only the upper joint fusion is needed, do not need the whole joint fusion, so as not to accidentally injure the superior gluteal artery and cause serious consequences.
3.A variety of non-surgical treatments, such as traditional Chinese medicine, physical therapy, massage, acupuncture, fire cupping and non-steroidal anti-inflammatory drugs, can be used.