morphoМорфологические ведомостиMorphological newsletter1812-31712686-8741Private Medical University REAVIZ10.20340/mv-mn.2025.33(4).932morpho-932Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯRESEARCH ARTICLESСОВРЕМЕННЫЕ ПРЕДСТАВЛЕНИЯ ОБ АНАТОМИИ БОЛЬШОГО СЕДАЛИЩНОГО ОТВЕРСТИЯMODERN CONCEPTS OF THE ANATOMY OF THE GREATER SCIATIC FORAMENhttps://orcid.org/0009-0006-9684-8250ВасильевРоман СергеевичVasil'evRoman S.

аспирант кафедры анатомии человека

Postgraduate Student, Department of Human Anatomy

vas1lev.anatomy@gmail.comПуталоваИрина НиколаевнаPutalovaIrina N.

доктор медицинских наук, профессор, заведующий кафедрой анатомии человека

Doctor of Medical Sciences, Professor, Head of the Department of Human Anatomy

ДевятириковДмитрий АлексеевичDevyatirikovDmitriy A.

кандидат медицинских наук, доцент кафедры анатомии человека

Candidate of Medical Sciences, Associate Professor, Department of Human Anatomy

devjtirikov@mail.ruСуслоАлександр ПавловичSusloAleksandr P.

кандидат медицинских наук, доцент, доцент кафедры анатомии человека

Candidate of Medical Sciences, Associate Professor, Department of Human Anatomy

alex-su@list.ruГольфманЕкатерина ЮрьевнаGol'fmanEkaterina Yu.

студентка 3 курса лечебного факультета

3-rd year student of the Faculty of Medicine

ekagolfman@mail.ruОмский государственный медицинский университет, ОмскРоссияOmsk State Medical University, OmskRussian Federation202526012026334id-932Copyright © Васильев Р.С., Путалова И.Н., Девятириков Д.А., Сусло А.П., Гольфман Е.Ю., 20262026Васильев Р.С., Путалова И.Н., Девятириков Д.А., Сусло А.П., Гольфман Е.Ю.Vasil'ev R.S., Putalova I.N., Devyatirikov D.A., Suslo A.P., Gol'fman E.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.morpholetter.com/jour/article/view/932

Актуальность. Большое седалищное отверстие является зоной практического интереса широкого круга специалистов в связи с большим количеством проходящих через него нервных стволов, которые могут быть подвержены компрессии в данном месте или повреждены при инвазивных медицинских манипуляциях.Цель исследования: провести анализ источников литературы по анатомии большого седалищного отвер-стия и связанных с ним анатомических структур для выявления недостаточно освещенных вопросов.Материалы и методы. Проведен поиск публикаций в электронных базах данных PubMed, Scopus, Web of Science, eLibrary, а также анализ монографий, имеющихся в фондах научных медицинских библиотек. Критерии включения: публикации на русском и английском языках, содержащие оригинальные данные по анатомии большого седалищного отверстия, грушевидной мышцы, седалищного нерва и тазовых костей. Временной диапазон поиска – 1937–2024 гг.Результаты. Анализ литературы показал, что наиболее изученной структурой большого седалищного отверстия является грушевидная мышца. Предложены различные классификации данной мышцы, учитывающие места её крепления на крестце, длину образующих её брюшков, положение седалищного нерва относительно этой мышцы. Приведённые данные демонстрируют, что вопрос о влиянии морфологии дан-ной мышцы на развитие синдрома грушевидной мышцы остаётся дискуссионным и нерешённым. В то же время костные структуры, формирующие края седалищного отверстия, изучены недостаточно. Большая седалищная вырезка тазовой кости имеет выраженные половые различия в размерах и форме, однако её влияние на параметры отверстия в целом не освещено в литературе.Заключение. Существует необходимость определения размеров и формы большого седалищного отверстия в соотношении с размерами грушевидной мышцы с учётом индивидуальных особенностей организма (пол, возраст, антропометрические и этнические параметры).

Objective

Objective: to demonstrate the existence of various morphological variants of neurovascular relationships in Background. The greater sciatic foramen is a region of practical interest to a wide range of specialists due to the numerous nerve trunks that pass through it, which may be subjected to compression in this area or be damaged during invasive medical procedures.

Aim

Aim. To analyze the sources of literature on the anatomy of the greater sciatic foramen and its related anatomical structures to identify underexplored issues.

Materials and Methods

Materials and Methods. A literature search was conducted in electronic databases (PubMed, Scopus, Web of Science, eLibrary) and monographs available in scientific medical libraries. Inclusion criteria: publications in Russian and English containing original data on the anatomy of the greater sciatic foramen, piriformis muscle, sciatic nerve, and pelvic bones. Search period – 1937–2024.

Results

Results. The literature analysis showed that the most studied structure of the greater sciatic foramen is the piriformis muscle. Various classifications of this muscle have been proposed, taking into account the sites of its attachment to the sacrum, the length of its muscle bellies, and the position of the sciatic nerve relative to this muscle. The data presented demonstrate that the question of the influence of the morphology of this muscle on the development of piriformis syndrome remains a topic of discussion and is unresolved. At the same time, the bony structures forming the edges of the sciatic foramen are insufficiently studied. The greater sciatic notch of the pelvic bone shows pronounced sexual dimorphism in size and shape; however, its influence on the parameters of the foramen as a whole is not covered in the literature.

Conclusion

Conclusion. There is a need to determine the sizes and shapes of the greater sciatic foramen in relation to the sizes of the piriformis muscle, taking into account individual characteristics of the body (sex, age, anthropometric and ethnic parameters).

большое седалищное отверстиевариантная анатомияgreater sciatic foramenvariant anatomyReferencesProbst D, Stout A, Hunt D. Piriformis Syndrome: A Narrative Review of the Anatomy, Diagnosis, and Treatment. PM R. 2019;11(1):54-63. https://doi.org/10.1002/pmrj.12189Probst D, Stout A, Hunt D. Piriformis Syndrome: A Narrative Review of the Anatomy, Diagnosis, and Treatment. PM R. 2019;11(1):54-63. https://doi.org/10.1002/pmrj.12189Kurushina OV, Barulin AE. Novye vozmozhnosti terapii sindroma grushevidnoy myshtsy. Zhurnal nevrologii i psikhiatrii im. S.S. Kor-sakova. 2021;121(9):116‑120. https://doi.org/10.17116/jnevro2021121091116. In RussianKurushina OV, Barulin AE. Novye vozmozhnosti terapii sindroma grushevidnoy myshtsy. Zhurnal nevrologii i psikhiatrii im. S.S. Kor-sakova. 2021;121(9):116‑120. https://doi.org/10.17116/jnevro2021121091116. In RussianBelash VO, Petrova EA. Sindrom grushevidnoy myshtsy. Rossiyskiy osteopaticheskiy zhurnal. 2022;3:131-156. https://doi.org/10.32885/2220-0975-2022-3-131-156 In RussianBelash VO, Petrova EA. Sindrom grushevidnoy myshtsy. Rossiyskiy osteopaticheskiy zhurnal. 2022;3:131-156. https://doi.org/10.32885/2220-0975-2022-3-131-156 In RussianCorey S, Adrienne LKLi, Gustavo L et al. Intrapelvic entrapment of sacral nerve roots by abnormal bundles of the piriformis muscle: description of an extra-spinal cause of sciatica and pudendal neuralgia. J Hip Preserv Surg. 2021;8(1):132-138. https://doi.org/10.1093/jhps/hnab041Corey S, Adrienne LKLi, Gustavo L et al. Intrapelvic entrapment of sacral nerve roots by abnormal bundles of the piriformis muscle: description of an extra-spinal cause of sciatica and pudendal neuralgia. J Hip Preserv Surg. 2021;8(1):132-138. https://doi.org/10.1093/jhps/hnab041Larionov A, Yotovski P, Filgueira L. Novel anatomical findings with implications on the etiology of the piriformis syndrome. Surg Ra-diol Anat. 2022;44(10):1397-1407. https://doi.org/10.1007/s00276-022-03023-5Larionov A, Yotovski P, Filgueira L. Novel anatomical findings with implications on the etiology of the piriformis syndrome. Surg Ra-diol Anat. 2022;44(10):1397-1407. https://doi.org/10.1007/s00276-022-03023-5Pokorný D, Jahoda D, Veigl D et al. Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty. Surg Radiol Anat. 2006;28(1):88-91. https://doi.org/10.1007/s00276-005-0056-xPokorný D, Jahoda D, Veigl D et al. Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty. Surg Radiol Anat. 2006;28(1):88-91. https://doi.org/10.1007/s00276-005-0056-xGomes BA, Ramos MR, Fiorelli RK et al. Topographic anatomical study of the sciatic nerve relationship to the posterior portal in hip arthroscopy. Rev Col Bras Cir. 2014;41(6):440-444. https://doi.org/10.1590/0100-69912014006010Gomes BA, Ramos MR, Fiorelli RK et al. Topographic anatomical study of the sciatic nerve relationship to the posterior portal in hip arthroscopy. Rev Col Bras Cir. 2014;41(6):440-444. https://doi.org/10.1590/0100-69912014006010Khabib'yanov RYa, Galeev IG. Intraoperatsionnaya profilaktika sindroma grushevidnoy myshtsy pri lechenii zastarelykh perelomov zadney kolonny vertluzhnoy vpadiny. Prakticheskaya meditsina. 2018;16(7-1):71-73. https://doi.org/10.32000/2072-1757-2018-16-7-71-73. In RussianKhabib'yanov RYa, Galeev IG. Intraoperatsionnaya profilaktika sindroma grushevidnoy myshtsy pri lechenii zastarelykh perelomov zadney kolonny vertluzhnoy vpadiny. Prakticheskaya meditsina. 2018;16(7-1):71-73. https://doi.org/10.32000/2072-1757-2018-16-7-71-73. In RussianYudin AL, Shomakhov MA, Yumatova EA i dr. Sindrom grushevidnoy myshtsy. Lechenie pod kontrolem KT-skopii. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2020;120(10):85–90. https://doi.org/10.17116/jnevro202012010185. In RussianYudin AL, Shomakhov MA, Yumatova EA i dr. Sindrom grushevidnoy myshtsy. Lechenie pod kontrolem KT-skopii. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2020;120(10):85–90. https://doi.org/10.17116/jnevro202012010185. In RussianAdibatti M, Sangeetha V. Study on Variant Anatomy of Sciatic Nerve. J Clin Diagn Res. 2014;8(8):AC07-9. https://doi.org/10.7860/JCDR/2014/9116.4725Adibatti M, Sangeetha V. Study on Variant Anatomy of Sciatic Nerve. J Clin Diagn Res. 2014;8(8):AC07-9. https://doi.org/10.7860/JCDR/2014/9116.4725Beaton LE, Anson BJ. The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. Anat Rec. 2005;70:1-5. https://doi.org/10.1002/ar.1090700102Beaton LE, Anson BJ. The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. Anat Rec. 2005;70:1-5. https://doi.org/10.1002/ar.1090700102Krzysztof A. Tomaszewski, Matthew J. Graves, Brandon Michael et al. Surgical Anatomy of the Sciatic Nerve: A Meta-Analysis. J Or-thop Res. 2016;34(10):1820-1827. https://doi.org/10.1002/jor.23186Krzysztof A. Tomaszewski, Matthew J. Graves, Brandon Michael et al. Surgical Anatomy of the Sciatic Nerve: A Meta-Analysis. J Or-thop Res. 2016;34(10):1820-1827. https://doi.org/10.1002/jor.23186Poutoglidou F, Piagkou M, Totlis T et al. Sciatic Nerve Variants and the Piriformis Muscle: A Systematic Review and Meta-Analysis. Cureus. 2020;12(11):e11531. https://doi.org/10.7759/cureus.11531Poutoglidou F, Piagkou M, Totlis T et al. Sciatic Nerve Variants and the Piriformis Muscle: A Systematic Review and Meta-Analysis. Cureus. 2020;12(11):e11531. https://doi.org/10.7759/cureus.11531Bartret AL, Beaulieu CF, Lutz AM. Is it painful to be different? Sciatic nerve anatomical variants on MRI and their relationship to piriformis syndrome. Eur Radiol. 2018;28(11):4681-4686. https://doi.org/10.1007/s00330-018-5447-6Bartret AL, Beaulieu CF, Lutz AM. Is it painful to be different? Sciatic nerve anatomical variants on MRI and their relationship to piriformis syndrome. Eur Radiol. 2018;28(11):4681-4686. https://doi.org/10.1007/s00330-018-5447-6Bharadwaj UU, Varenika V, Carson W et al. Variant Sciatic Nerve Anatomy in Relation to the Piriformis Muscle on Magnetic Reso-nance Neurography: A Potential Etiology for Extraspinal Sciatica. Tomography. 2023;9(2):475-484. https://doi.org/10.3390/tomography9020039Bharadwaj UU, Varenika V, Carson W et al. Variant Sciatic Nerve Anatomy in Relation to the Piriformis Muscle on Magnetic Reso-nance Neurography: A Potential Etiology for Extraspinal Sciatica. Tomography. 2023;9(2):475-484. https://doi.org/10.3390/tomography9020039Varenika V, Lutz AM, Beaulieu CF et al. Detection and prevalence of variant sciatic nerve anatomy in relation to the piriformis mus-cle on MRI. Skeletal Radiol. 2017;46(6):751-757. https://doi.org/10.1007/s00256-017-2597-6Varenika V, Lutz AM, Beaulieu CF et al. Detection and prevalence of variant sciatic nerve anatomy in relation to the piriformis mus-cle on MRI. Skeletal Radiol. 2017;46(6):751-757. https://doi.org/10.1007/s00256-017-2597-6Eastlack J, Tenorio L, Wadhwa V et al. Sciatic neuromuscular variants on MR neurography: frequency study and interobserver per-formance. Br J Radiol. 2017;90(1079):20170116. https://doi.org/10.1259/bjr.20170116Eastlack J, Tenorio L, Wadhwa V et al. Sciatic neuromuscular variants on MR neurography: frequency study and interobserver per-formance. Br J Radiol. 2017;90(1079):20170116. https://doi.org/10.1259/bjr.20170116Tukhbatullin MG, Akhmedova GM, Sharafutdinov BM. Luchevaya diagnostika neyropatiy pri sindrome grushevidnoy myshtsy. Prak-ticheskaya meditsina. 2013;1(66):85-91. In RussianTukhbatullin MG, Akhmedova GM, Sharafutdinov BM. Luchevaya diagnostika neyropatiy pri sindrome grushevidnoy myshtsy. Prak-ticheskaya meditsina. 2013;1(66):85-91. In RussianMichel F, Decavel P, Toussirot E et al. The piriformis muscle syndrome: An exploration of anatomical context, pathophysiological hypotheses and diagnostic criteria. Ann Phys Rehabil Med. 2013;56(4):300-311. https://doi.org/10.1016/j.rehab.2013.03.006Michel F, Decavel P, Toussirot E et al. The piriformis muscle syndrome: An exploration of anatomical context, pathophysiological hypotheses and diagnostic criteria. Ann Phys Rehabil Med. 2013;56(4):300-311. https://doi.org/10.1016/j.rehab.2013.03.006Windisch G, Braun EM, Anderhuber F. Piriformis muscle: clinical anatomy and consideration of the piriformis syndrome. Surg Radiol Anat. 2007;29(1):37-45. https://doi.org/10.1007/s00276-006-0169-xWindisch G, Braun EM, Anderhuber F. Piriformis muscle: clinical anatomy and consideration of the piriformis syndrome. Surg Radiol Anat. 2007;29(1):37-45. https://doi.org/10.1007/s00276-006-0169-xKoh E, Webster D, Boyle J. Case report and review of the potential role of the Type A piriformis muscle in dynamic sciatic nerve entrapment variant of piriformis syndrome. Surg Radiol Anat. 2020;42(10):1237-1242. https://doi.org/10.1007/s00276-020-02440-8Koh E, Webster D, Boyle J. Case report and review of the potential role of the Type A piriformis muscle in dynamic sciatic nerve entrapment variant of piriformis syndrome. Surg Radiol Anat. 2020;42(10):1237-1242. https://doi.org/10.1007/s00276-020-02440-8Bemnet TG, Lidet GA. Piriformis syndrome secondary to accessory belly of the piriformis muscle: A rare case report with MRI diag-nosis. Radiol Case Rep. 2024;19(4):1503-1505. https://doi.org/10.1016/j.radcr.2024.01.009Bemnet TG, Lidet GA. Piriformis syndrome secondary to accessory belly of the piriformis muscle: A rare case report with MRI diag-nosis. Radiol Case Rep. 2024;19(4):1503-1505. https://doi.org/10.1016/j.radcr.2024.01.009Matheus CL, João GA, Eduardo HB et al. The absence of piriformis muscle, combined muscular fusion, and neurovascular variation in the gluteal region. Autops Case Rep. 2021;11:e2020239. https://doi.org/10.4322/acr.2020.239Matheus CL, João GA, Eduardo HB et al. The absence of piriformis muscle, combined muscular fusion, and neurovascular variation in the gluteal region. Autops Case Rep. 2021;11:e2020239. https://doi.org/10.4322/acr.2020.239Massimiliano T, Elia S, Adriana C et al. Case report: absence of the right piriformis muscle in a woman. Surg Radiol Anat. 2019;41(7):845-848. https://doi.org/10.1007/s00276-018-02176-6Massimiliano T, Elia S, Adriana C et al. Case report: absence of the right piriformis muscle in a woman. Surg Radiol Anat. 2019;41(7):845-848. https://doi.org/10.1007/s00276-018-02176-6Kozioł T, Chaba W, Janda P et al. A three-headed piriformis muscle: an anatomical case study and narrative review of literature. Folia Morphol (Warsz). 2023;82(4):969-974. https://doi.org/10.5603/FM.a2022.0108Kozioł T, Chaba W, Janda P et al. A three-headed piriformis muscle: an anatomical case study and narrative review of literature. Folia Morphol (Warsz). 2023;82(4):969-974. https://doi.org/10.5603/FM.a2022.0108Akamefula RA, Chaiyamoon A, Anadkat S, et al. A Three-Headed Piriformis Muscle with Splitting of the Common Fibular Nerve. Cureus. 2023;15(2):e35302. https://doi.org/10.7759/cureus.35302Akamefula RA, Chaiyamoon A, Anadkat S, et al. A Three-Headed Piriformis Muscle with Splitting of the Common Fibular Nerve. Cureus. 2023;15(2):e35302. https://doi.org/10.7759/cureus.35302Gómez-Valdés JA, Quinto-Sánchez M, Menéndez Garmendia A et al. Comparison of methods to determine sex by evaluating the greater sciatic notch: Visual, angular and geometric morphometrics. Forensic Sci Int. 2012;221(1-3):156.e1-7. https://doi.org/10.1016/j.forsciint.2012.04.027Gómez-Valdés JA, Quinto-Sánchez M, Menéndez Garmendia A et al. Comparison of methods to determine sex by evaluating the greater sciatic notch: Visual, angular and geometric morphometrics. Forensic Sci Int. 2012;221(1-3):156.e1-7. https://doi.org/10.1016/j.forsciint.2012.04.027Kim DH, Lee SH, Lee SS, et al. Comprehensive evaluation of the greater sciatic notch for sexual estimation through three-dimensional metric analysis using computed tomography-based models. Leg Med (Tokyo). 2018;35:1-8. https://doi.org/10.1016/j.legalmed.2018.09.006Kim DH, Lee SH, Lee SS, et al. Comprehensive evaluation of the greater sciatic notch for sexual estimation through three-dimensional metric analysis using computed tomography-based models. Leg Med (Tokyo). 2018;35:1-8. https://doi.org/10.1016/j.legalmed.2018.09.006Katie K, Heather G. Outline analysis of sex and population variation in greater sciatic notch and obturator foramen morphology with implications for sex estimation. Forensic Sci Int. 2020;314:110346. https://doi.org/10.1016/j.forsciint.2020.110346Katie K, Heather G. Outline analysis of sex and population variation in greater sciatic notch and obturator foramen morphology with implications for sex estimation. Forensic Sci Int. 2020;314:110346. https://doi.org/10.1016/j.forsciint.2020.110346Knecht S, Nogueira L, Servant M et al. Sex estimation from the greater sciatic notch: a comparison of classical statistical models and machine learning algorithms. Int J Legal Med. 2021;135(6):2603-2613. https://doi.org/10.1007/s00414-021-02700-1Knecht S, Nogueira L, Servant M et al. Sex estimation from the greater sciatic notch: a comparison of classical statistical models and machine learning algorithms. Int J Legal Med. 2021;135(6):2603-2613. https://doi.org/10.1007/s00414-021-02700-1Lanzieri CF, Hilal SK. Computed tomography of the sacral plexus and sciatic nerve in the greater sciatic foramen. AJR Am J Roent-genol. 1984;143(1):165-8. https://doi.org/10.2214/ajr.143.1.165Lanzieri CF, Hilal SK. Computed tomography of the sacral plexus and sciatic nerve in the greater sciatic foramen. AJR Am J Roent-genol. 1984;143(1):165-8. https://doi.org/10.2214/ajr.143.1.165Cai ZJ, Salem AE, Wagner-Bartak NA et al. Sciatic foramen anatomy and common pathologies: a pictorial review. Abdom Radiol (NY). 2022;47(1):378-398. https://doi.org/10.1007/s00261-021-03265-8Cai ZJ, Salem AE, Wagner-Bartak NA et al. Sciatic foramen anatomy and common pathologies: a pictorial review. Abdom Radiol (NY). 2022;47(1):378-398. https://doi.org/10.1007/s00261-021-03265-8

The authors declare that there are no conflicts of interest present.