WordNet

any connection or unifying bond
a sheet or band of tough fibrous tissue connecting bones or cartilages or supporting muscles or organs

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靱帯(じんたい)(骨と骨を結びつてけ関節の動きを調節する)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/07 16:39:16」(JST)

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The sacrotuberous ligament (great or posterior sacrosciatic ligament) is situated at the lower and back part of the pelvis. It is flat, and triangular in form; narrower in the middle than at the ends.

Structure

It runs from the sacrum (the lower transverse sacral tubercles, the inferior margins sacrum and the upper coccyx^[1]) to the tuberosity of the ischium.

The sacrotuberous ligament is attached by its broad base to the posterior superior iliac spine, the posterior sacroiliac ligaments (with which it is partly blended), to the lower transverse sacral tubercles and the lateral margins of the lower sacrum and upper coccyx. Its oblique fibres descend laterally, converging to form a thick, narrow band that widens again below and is attached to the medial margin of the ischial tuberosity. It then spreads along the ischial ramus as the falciform process, whose concave edge blends with the fascial sheath of the internal pudendal vessels and pudendal nerve. The lowest fibres of gluteus maximus are attached to the posterior surface of the ligament; superficial fibres of the lower part of the ligament continue into the tendon of biceps femoris. The ligament is pierced by the coccygeal branches of the inferior gluteal artery, the perforating cutaneous nerve and filaments of the coccygeal plexus.^[2]

Variation

The membranous falciform process of the sacrotuberous ligament was found to be absent in 13% of cadavers. When present it extends towards the ischioanal fossa travelling along the ischial ramus and fusing with the obturator fascia.

The lower border of the ligament was found to be directly continuous with the tendon of origin of the long head of the Biceps femoris in approximately 50% of subjects.^[3] Biceps femoris could therefore act to stabilise the sacroiliac joint via the sacrotuberous ligament.

Function

The sacrotuberous ligament contains the coccygeal branch of the inferior gluteal artery.

Clinical significance

If the pudendal nerve becomes entrapped between this ligament and the sacrospinous ligament causing perineal pain, the sacrotuberous ligament is surgically severed to relieve the pain.

Additional images

Articulations of pelvis. Anterior view.
The superficial branches of the internal pudendal artery.
The posterior aspect of the rectum exposed by removing the lower part of the sacrum and the coccyx.
Nélaton’s line and Bryant’s triangle.

External links

Anatomy figure: 13:03-04 at Human Anatomy Online, SUNY Downstate Medical Center - "Deep muscles of the gluteal region with gluteus medius and maximus muscles removed."
Anatomy figure: 17:02-05 at Human Anatomy Online, SUNY Downstate Medical Center - "Posterior view of the bones and ligaments of the hip joint."
Anatomy photo:41:os-0114 at the SUNY Downstate Medical Center - "The Female Perineum"
Anatomy photo:42:12-0102 at the SUNY Downstate Medical Center - "The Male Perineum and the Penis: Boundaries of the Ischioanal fossa"
Anatomy image:9075 at the SUNY Downstate Medical Center
hip/hip%20ligaments/ligaments7 at the Dartmouth Medical School's Department of Anatomy

References

This article incorporates text in the public domain from the 20th edition of Gray's Anatomy (1918)

^ Marios Loukas,Robert G Louis Jr, Barry Hallner, Ankmalika A Gupta and Dorothy White. (2006) "Anatomical and surgical considerations of the sacrotuberous ligament and its relevance in pudendal nerve entrapment syndrome" Surg Radiol Anat 28(2): 163-169
^ Gray's anatomy, 40 edition.
^ Vleeming, A., R. Stoeckart, et al. (1989). "The sacrotuberous ligament: a conceptual approach to its dynamic role in stabilizing the sacroiliac joint." Clinical Biomechanics 4(4): 200-203.

UpToDate Contents

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English Journal

Locked versus standard unlocked plating of the symphysis pubis in a Type-C pelvic injury: A cadaver biomechanical study.

Moed BR1, O'Boynick CP2, Bledsoe JG3.Author information 1Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Avenue, 7th Floor Desloge Towers, St. Louis 63110, Missouri, United States; Department of Biomedical Engineering, Parks College of Engineering, Aviation and Technology, Saint Louis University, 3450 Lindell Boulevard, St. Louis 63103, Missouri, United States. Electronic address: moedbr@slu.edu.2Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Avenue, 7th Floor Desloge Towers, St. Louis 63110, Missouri, United States.3Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Avenue, 7th Floor Desloge Towers, St. Louis 63110, Missouri, United States; Department of Biomedical Engineering, Parks College of Engineering, Aviation and Technology, Saint Louis University, 3450 Lindell Boulevard, St. Louis 63103, Missouri, United States.AbstractINTRODUCTION: The benefits of locked plating for pubic symphyseal disruption have not been established. The purpose of this biomechanical study was to determine whether locked plating offers any advantage over conventional unlocked plating of the pubic symphysis in the vertically unstable, Type-C pelvic injury.
Injury.Injury.2014 Apr;45(4):748-51. doi: 10.1016/j.injury.2013.11.017. Epub 2013 Nov 22.
INTRODUCTION: The benefits of locked plating for pubic symphyseal disruption have not been established. The purpose of this biomechanical study was to determine whether locked plating offers any advantage over conventional unlocked plating of the pubic symphysis in the vertically unstable, Type-C pe
PMID 24326027

Anatomy and biomechanics of gluteus maximus and the thoracolumbar fascia at the sacroiliac joint.

Barker PJ1, Hapuarachchi KS, Ross JA, Sambaiew E, Ranger TA, Briggs CA.Author information 1Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, 3800, Australia.AbstractBiomechanical models predict that recruitment of gluteus maximus (GMax) will exert a compressive force across the sacroiliac joint (SIJ), yet this muscle requires morphologic assessment. The aims of this study were to document GMax's proximal attachments and assess their capacity to generate forces including compressive force at the SIJ. In 11 embalmed cadaver limbs, attachments of GMax crossing the SIJ were dissected and their fascicle orientation, length and attachment volume documented. The physiological cross-sectional area (PCSA) of each attachment was calculated along with its estimated maximum force at the SIJ and lumbar spine. GMax fascicles originated from the gluteus medius fascia, ilium, thoracolumbar fascia, erector spinae aponeurosis, sacrum, coccyx, dorsal sacroiliac and sacrotuberous ligaments in all specimens. Their mean fascicle orientation ranged from 32 to 45° below horizontal and mean length from 11 to 18 cm. The mean total PCSA of GMax was 26 cm(2) (range 16-36), of which 70% crossed the SIJ. The average maximum force predicted to be generated by GMax's total attachments crossing each SIJ was 891 N (range 572-1,215), of which 70% (702 N: range 450-1,009) could act perpendicular to the plane of the SIJ. The capacity of GMax to generate an extensor moment at lower lumbar segments was estimated at 4 Nm (range 2-9.5). GMax may generate compressive forces at the SIJ through its bony and fibrous attachments. These may assist effective load transfer between lower limbs and trunk. Clin. Anat. 27:234-240, 2014. © 2013 Wiley Periodicals, Inc.
Clinical anatomy (New York, N.Y.).Clin Anat.2014 Mar;27(2):234-40. doi: 10.1002/ca.22233. Epub 2013 Aug 20.
Biomechanical models predict that recruitment of gluteus maximus (GMax) will exert a compressive force across the sacroiliac joint (SIJ), yet this muscle requires morphologic assessment. The aims of this study were to document GMax's proximal attachments and assess their capacity to generate forces
PMID 23959791

Laparoscopic pudendal nerve decompression and transposition combined with omental flap protection of the nerve (Istanbul technique): technical description and feasibility analysis.

Erdogru T1, Avci E, Akand M.Author information 1Department of Urology, Minimally Invasive and Robotic Surgery Center, Memorial Istanbul Atasehir Hospital, Vedat Gunyol Street, Nr:30-31, Istanbul, Turkey, dr@tibeterdogru.com.AbstractBACKGROUND: We aimed in this study to investigate the efficacy of laparoscopic pudendal nerve decompression and transposition (LaPNDT) in the treatment of chronic pelvic pain due to pudendal neuralgia. Pudendal nerve entrapment (PNE) between the sacrospinous and sacrotuberous ligaments is the most frequent etiology. We describe the technical details, feasibility, and advantages of a laparoscopic approach in patients with PNE.
Surgical endoscopy.Surg Endosc.2014 Mar;28(3):925-32. doi: 10.1007/s00464-013-3248-1. Epub 2013 Oct 23.
BACKGROUND: We aimed in this study to investigate the efficacy of laparoscopic pudendal nerve decompression and transposition (LaPNDT) in the treatment of chronic pelvic pain due to pudendal neuralgia. Pudendal nerve entrapment (PNE) between the sacrospinous and sacrotuberous ligaments is the most f
PMID 24149853

Japanese Journal

経会陰的に修復を行った腹会陰式直腸切断術後会陰ヘルニアの2例

日本臨床外科学会雑誌 76(5), 1221-1226, 2015
NAID 130005110818

Myositis Ossificans Circumscripta of the Sacrotuberous Ligament : A Case Report and Review of the Literature

Journal of orthopaedic trauma 16(9), 672-674, 2002-10-01
NAID 10016118838

First Cutaneous Branch of the Internal Pudendal Artery: An Anatomical Basis for the So-called Gluteal Fold Flap

Okajimas Folia Anatomica Japonica 78(1), 23-30, 2001
NAID 130004650564

「仙結節靭帯」

Sacrotuberous ligament
	Articulations of pelvis, anterior view, with greater sciatic foramen (labeled in red) and its boundaries.
	Articulations of pelvis. Posterior view.
Details
Latin	ligamentum sacrotuberale
From	sacrum
To	tuberosity of the ischium
Identifiers
Gray's	p.309
TA	A03.6.03.005
FMA	21479
	Anatomical terminology

　　[★]

英: sacrotuberous ligament (M,K)
ラ: ligamentum sacrotuberale
関: 陰部神経管、仙骨、坐骨結節

[1] Marios Loukas,Robert G Louis Jr, Barry Hallner, Ankmalika A Gupta and Dorothy White. (2006) "Anatomical and surgical considerations of the sacrotuberous ligament and its relevance in pudendal nerve entrapment syndrome" Surg Radiol Anat 28(2): 163-169

[2] Gray's anatomy, 40 edition.

[3] Vleeming, A., R. Stoeckart, et al. (1989). "The sacrotuberous ligament: a conceptual approach to its dynamic role in stabilizing the sacroiliac joint." Clinical Biomechanics 4(4): 200-203.

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案内

sacrotuberous ligament