ヒトの体幹下肢における感覚分節構造図

抄録

   We have been carrying out basic studies employing rats to clarify the segmental structure of the peripheral nerves, thereby establishing a rat map. In this paper, we present a potential human map of the segmental structure of the sensory nerves that was determined from the rat map and discuss pain sensation areas in lumbar radiculopathy. The somatic tissues innervated by sensory fibers involved in a spinal nerve, provisionally termed as "sensoritomes",could be considered as the space (or surface) extending between the rami of the spinal nerve. Sensoritomes are shaped like a "deformed cone" due to the caudal inclination of spinal nerve rami. The boundary lines of sensoritomes crossed the lumbar spine obliquely. The lines ran cranio-dorsally to caudo-ventrally in the lateral side of the coxal bone, converging toward the pubis symphysis. The boundary surfaces of sensoritomes in the hindlimb were formed by the lateral expansion of the boundary lines in the coxal bone. Pain sensation areas in lumbar radiculopathy, which were identical to sensoritomes, were predicted as follows. L4: ilium - hip joint - femur-knee joint - medial tibia - first digit. L5: Dorsal surface of ilium - gluteus medius muscles - hamstrings - tibia-medial foot. S1: ischii - gluteus maximus - hamstrings - fibula - lateral foot. The sensoritome of S1 was located more caudally and dorsally in the body trunk, more dorsally in the thigh, and more laterally in the leg and foot than that of L5. It was suggested that L5 and S1 radiculopathies could be discriminated and therefore diagnosed by referring pain distribution to the human sensoritome map.