Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz, Bochum, Germany.
Wagner College, Staten Island, New York and Division of Anatomy, Department of Radiology, Weill Cornell Medicine, New York, NY, United States.
Folia Morphol (Warsz). 2023;82(1):96-101. doi: 10.5603/FM.a2022.0009. Epub 2022 Feb 3.
Sacroiliac joint (SIJ) pain is often difficult to diagnose. Moreover, while its anatomical characteristics have been well studied, its innervation and the contributions of particular nerves remain controversial, especially in relation to posterior joint innervation. To our knowledge, previous studies have not investigated the presence of nociceptive fibres in the nerves innervating the anterior SIJ.
Eight adult cadaveric sides underwent dissection of the anterior SIJ. Adjacent anterior rami were examined for branches to the anterior SIJ. Any branches contributing to the anterior SIJ were measured and then resected. These samples were fixed in formalin and substance P was identified immunohistologically.
On all sides, 1-2 small branches (mean diameter of 0.33 mm) arose from the posterior aspect of the L4 anterior ramus (12.5%), the L5 anterior ramus (62.5%), or simultaneously from both the L4 and L5 anterior rami (25%). These branches had a mean length of 13.5 mm. All histological samples contained nerve tissue. All samples of nerve fibres traveling to the anterior SIJ were positive for diffuse substance P reactivity. There were no histological differences between sides or sex. Each of the branches identified as travelling to the SIJ exhibited similar positivity for substance P.
This cadaveric study demonstrates that the anterior SIJ nerve fibres carry pain fibres. This new knowledge has application to patients with SIJ syndrome and to its various treatments including interventional approaches to SIJ pain.
骶髂关节 (SIJ) 疼痛通常难以诊断。此外，尽管其解剖学特征已经得到很好的研究，但神经支配及其特定神经的作用仍存在争议，尤其是在后关节神经支配方面。据我们所知，以前的研究尚未调查支配前 SIJ 的神经中是否存在伤害感受纤维。
8 具成人尸体侧进行了前 SIJ 解剖。检查相邻前支向前 SIJ 的分支。测量并切除任何有助于前 SIJ 的分支。这些样本用福尔马林固定，并通过免疫组织化学鉴定 P 物质。
在所有侧，1-2 个小分支（平均直径 0.33 毫米）从前 L4 前支的后侧面（12.5%）、L5 前支（62.5%）或同时从前 L4 和 L5 前支（25%）发出。这些分支的平均长度为 13.5 毫米。所有组织学样本均含有神经组织。所有前往前 SIJ 的神经纤维样本均对弥散性 P 物质反应呈阳性。侧别和性别之间没有组织学差异。被确定为前往 SIJ 的每个分支对 P 物质的反应均相似。
这项尸体研究表明，前 SIJ 神经纤维携带疼痛纤维。这一新知识适用于患有 SIJ 综合征的患者及其各种治疗方法，包括针对 SIJ 疼痛的介入方法。
