Department of Anatomy, University of Otago, Dunedin, New Zealand; Department of Orthopaedic and Trauma Surgery, University of Leipzig, Leipzig, Germany; Fraunhofer IWU, Dresden, Germany.
Institute of Legal Medicine, Medical Faculty University of Leipzig, Leipzig, Germany.
Pain Physician. 2019 Nov;22(6):E615-E625.
The sacroiliac joint (SIJ) is a common source of low back pain. SIJ pain has shown to have negative impact on patients' quality of life. Although clinically there is an increasing interest to treat SIJ-related pain both conservatively and surgically, the underlying mechanisms related to pathology in that region are poorly understood. One hypothesis is that the SIJ ligaments are structurally altered in SIJ pain.
The given study investigated patient cases with different pain durations undergoing posterior distraction arthrodesis of the SIJ, with subsequent micro- and ultrastructural assessment of the interosseous and posterior SIJ ligaments compared with autopsy controls without known history of low back pain.
Case-control study. Morphologic-pathological analysis of tissue samples obtained during surgery with controls from legal medicine.
Rural hospital setting in Halberstadt, Germany.
SIJ ligaments were removed from 6 patients undergoing SIJ arthrodesis for histological and ultrastructural assessment in scanning and transmission electron microscopy, and compared with 6 controls without known history of SIJ pathology.
A number of alterations were observed in the ligaments of patients with SIJ, namely ligament disruption, collagen loosening and coiling, vascularization, and hemorrhage. In some areas, these changes were observed in proximity to healthy (structurally unaltered and intact tissues), indicative of a potential disease progression. Comparison to controls yielded a significant correlation between SIJ pathology and the level of collagen degeneration (Phi >/= 0.82; P < 0.001).
Small sample size, method of tissue removal from patients may have influenced tissue integrity.
The combined clinical, histological, and ultrastructural analysis provided, to our knowledge, first-time evidence of morphologic SIJ ligament alteration of a nontraumatic and noninflammatory cause. Further research is necessary to elucidate these structural changes and to substantiate pain duration and patient-history-dependent changes at the ligaments of the posterior pelvis.
Collagen, electron microscopy, histological and ultrastructural assessment, interosseous sacroiliac ligament, low back pain, sacroiliac joint.
骶髂关节（SIJ）是腰痛的常见原因。SIJ 疼痛已被证明对患者的生活质量有负面影响。尽管临床上越来越有兴趣对 SIJ 相关疼痛进行保守和手术治疗，但该区域相关病理学的潜在机制仍知之甚少。一种假设是，SIJ 韧带在 SIJ 疼痛中结构发生改变。
本研究调查了不同疼痛持续时间的患者病例，这些患者接受了 SIJ 后路牵开融合术，随后对骨间和 SIJ 后韧带进行微观和超微结构评估，并与无已知腰痛病史的尸检对照进行比较。
病例对照研究。对手术中获得的组织样本进行组织病理学分析，并与无已知 SIJ 病史的尸检对照进行比较。
德国哈尔伯施塔特的农村医院。
从 6 例接受 SIJ 融合术的患者中取出 SIJ 韧带，进行扫描和透射电子显微镜下的组织病理学和超微结构评估，并与 6 例无已知 SIJ 病理史的对照进行比较。
在 SIJ 患者的韧带中观察到多种改变，包括韧带断裂、胶原松解和缠绕、血管化和出血。在某些区域，这些变化与健康（结构未改变和完整的组织）相邻，表明潜在的疾病进展。与对照组相比，SIJ 病理学与胶原变性水平之间存在显著相关性（Phi >/= 0.82；P < 0.001）。
样本量小，从患者中取出组织的方法可能影响组织完整性。
综合临床、组织学和超微结构分析首次提供了非创伤性和非炎症性原因导致的形态学 SIJ 韧带改变的证据。需要进一步研究来阐明这些结构变化，并证实与疼痛持续时间和患者病史相关的后骨盆韧带变化。
胶原、电子显微镜、组织学和超微结构评估、骨间骶髂韧带、下腰痛、骶髂关节。
