From the *Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario; †Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Alberta; and ‡Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada.
Reg Anesth Pain Med. 2014 Nov-Dec;39(6):456-64. doi: 10.1097/AAP.0000000000000156.
Optimization of clinical outcomes of lateral branch radiofrequency ablation or blocks for sacroiliac joint (SIJ) pain requires precise nerve localization; however, there is a lack of comprehensive morphological studies. The objectives of this cadaveric study were to document SIJ innervation relative to bony landmarks in 3 dimensions and to identify reference points visible under ultrasound and fluoroscopy for optimal needle placement.
In 25 cadaveric hemipelves, L5-S4 lateral branches were exposed, digitized, and modeled in 3 dimensions. The models were used to compare innervation patterns between specimens and to quantify the distances of the nerves innervating the SIJ relative to the transverse sacral tubercles (TSTs) and posterior sacral foramina. Quadrants of origin of the nerves were recorded.
The SIJ was innervated by the posterior sacral network: S1-S2 contributed in all specimens, S3 in 88%, L5 in 8%, and S4 in 4%. Most frequently, the lateral branch(es) emerged from the inferolateral S1, superolateral and inferolateral S2, and superolateral S3 quadrants. All TSTs were easily identifiable elevations that were used to landmark the nerves innervating the SIJ. The majority of branches of the posterior sacral network crossed the lateral sacral crest between TST1-3, with the greatest concentration between TST2-3. Only 3 specimens had a branch superior or inferior to these landmarks.
Based on the innervation pattern and using bony landmarks identifiable under ultrasound and fluoroscopy, 2 radiofrequency ablation techniques were proposed. Further research is required to determine the accuracy and reliability of needle placement and to evaluate clinical outcomes.
为了优化射频消融或阻滞治疗骶髂关节（SIJ）疼痛的临床效果，需要对神经进行精确定位；然而，目前缺乏全面的形态学研究。本尸体研究的目的是记录 SIJ 神经支配与 3 维骨性标志的关系，并确定在超声和透视下可见的参考点，以实现最佳的针置放。
在 25 个尸体半骨盆中，暴露 L5-S4 外侧支，对其进行数字化并进行 3 维建模。使用这些模型来比较标本之间的神经支配模式，并量化支配 SIJ 的神经与横突骶骨结节（TST）和骶后孔的距离。记录神经起源的象限。
SIJ 由骶后神经网支配：S1-S2 在所有标本中均有贡献，S3 在 88%的标本中，L5 在 8%的标本中，S4 在 4%的标本中。最常见的是，外侧支从 S1 的后外侧、S2 的超外侧和后外侧以及 S3 的超外侧象限出现。所有 TST 都是容易识别的隆起，可用于定位支配 SIJ 的神经。大多数骶后神经网的分支在 TST1-3 之间穿过侧骶嵴，在 TST2-3 之间最集中。仅有 3 个标本的分支位于这些标志之上或之下。
根据神经支配模式，并使用在超声和透视下可识别的骨性标志，提出了 2 种射频消融技术。需要进一步研究来确定针置放的准确性和可靠性，并评估临床效果。
