Grob K R, Neuhuber W L, Kissling R O
Anatomisches Institut, Universität, Zürich, Schweiz.
Z Rheumatol. 1995 Mar-Apr;54(2):117-22.
The innervation of the human sacroiliacal joint was investigated on adult cadaveric specimens devoted for routine dissection courses, and on fetuses obtained from therapeutic abortions. Gross anatomical and microscopic dissection, histology of dissected nerves, and histological and immunocytochemical approaches were used. Innervation of the iliosacral joint is provided by fine nerve branches derived exclusively from dorsal rami of spinal nerves S1-S4. No branches could be detected from the plexus sacralis and obturator nerve coursing over the ventral aspect of the joint. Nerves were distributed to superficial and deep dorsal sacroiliac ligaments, and to the sacrotuberous and sacrospinous ligaments. Dorsal spinal rami continued their course laterally, sandwiched between superficial and deep portions of sacroiliac ligaments, piercing the origin of the glutaeus maximus muscle. Histological examination of dissected nerves demonstrated numerous thick myelinated, besides thin myelinated and unmyelinated nerve fibers compatible with a broad repertoire of sensory receptors including encapsulated mechanoreceptors. Histological and immunocytochemical studies on fetal iliosacral joints showed neurofilament positive nerve fibers only in dorsal portions. This innervation pattern may provide explanations for various patterns of pseudoradicular and referred pain in affections of the sacroiliac joint.
在用于常规解剖课程的成年尸体标本以及从治疗性流产获取的胎儿上，对人骶髂关节的神经支配进行了研究。采用大体解剖和显微镜解剖、解剖神经的组织学以及组织学和免疫细胞化学方法。骶髂关节的神经支配由仅来自脊神经S1 - S4背侧支的细小神经分支提供。未检测到来自骶丛和闭孔神经且在关节腹侧走行的分支。神经分布于骶髂背侧浅、深韧带以及骶结节韧带和骶棘韧带。脊神经背侧支继续向外侧走行，夹在骶髂韧带的浅部和深部之间，穿经臀大肌起点。对解剖神经的组织学检查显示，除了与包括被囊化机械感受器在内的多种感觉受体相符的细有髓神经纤维和无髓神经纤维外，还有许多粗有髓神经纤维。对胎儿骶髂关节的组织学和免疫细胞化学研究表明，仅在背侧部分有神经丝阳性神经纤维。这种神经支配模式可能为骶髂关节病变中各种假性神经根性疼痛和牵涉痛模式提供解释。
