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Pelvic 山东大学医学院 解剖教研室 李振华. Bony pelvis Composition: formed by paired hip bones, sacrum, coccyx, and their articulations Two portions  Greater pelvis 

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Presentation on theme: "Pelvic 山东大学医学院 解剖教研室 李振华. Bony pelvis Composition: formed by paired hip bones, sacrum, coccyx, and their articulations Two portions  Greater pelvis "— Presentation transcript:

1 Pelvic 山东大学医学院 解剖教研室 李振华

2 Bony pelvis Composition: formed by paired hip bones, sacrum, coccyx, and their articulations Two portions  Greater pelvis  Lesser pelvis Terminal line ( pelvic inlet): formed by promontory of sacrum, arcuate line, pectin of pubis, pubic tubercle, upper border of pubic symphysis Pelvic outlet: formed by tip of coccyx, sacrotuberous ligament, ischial tuberosity, ramus of ischium, inferior ramus of pubic symphysis

3 Muscles of pelvic wall Piriform m. Obturator internus m.

4 Muscles of floor of pelvis and pelivic diaphragm Muscles of floor of pelvis Levator ani 肛提肌 Levateo prostate 前列腺提肌 (pubovaginalis 耻骨阴道肌 ) Puborectalis 耻骨直肠肌 Pubococcygeus 耻尾肌 and iliococcygeus 髂尾肌 Coccygeus 尾骨肌

5 Pelivic diaphragm 盆膈 Superior fascia of pelvic diaphragm 盆膈上筋膜 Levator ani 肛提肌 Coccygeus 尾骨肌 Inferior fascia of pelvic diaphragm 盆膈下筋膜

6 Pelvic fascia Parietal pelvic fascia A continuation of the transverse fascia into the pelvis. It coves the piriformis and obturator internus Attaches to the arcuate line of the pubis and ilium, thickens over the obturator internus to form the arcus tendineus, the origin of portions of the levator ani muscle At the tendinous arch of levator ani it splits to cove both superior and inferior surfaces of the levator ani as superior and inferior fascia of pelvic diaphragm

7 Visceral pelvic fascia Lies between the peritoneum and the pelvic viscera It is a continuation of the extraperitoneal connective tissue Ensheathes retroperitoneal viscera and forms septa between retroperitoneal organs  Rectovesical septum 直肠膀胱隔  Rectovaginal septum 直肠阴道隔

8 Retropubic space 耻骨后隙 Lies between pubic symphysis and urinary bladder Pararectal space 直肠周间隙 Lies around the rectus Retrorectal space 直肠后隙

9 Common iliac artery 髂总动脉 Common iliac artery Continuation of abdominal aorta at level of L4 vertebra Terminates in front of sacroiliac joint by dividing into internal and external iliac arteries

10 Internal iliac artery 髂内动脉 Parietal iliac artery Obturator a. 闭孔动脉 Iliolumber a. 髂腰动脉 Lateral sacral a. 骶外侧动脉 Superior gluteal a. 臀上动脉 Inferior gluteal a. 臀下动脉

11 Visceral branches Umbilical a. 脐动脉 → superior vesical a. 膀胱上动脉 Inferior vesical a. 膀胱下动脉 Uterine a. 子宫动脉 Inferior rectal a. 直肠下动脉 Internal pudendal a. 阴部内动脉

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13 Uterine a. 子宫动脉 —about 2cm from neck of uterus it crosses above and in front of ureter

14 Internal pudendal artery 阴部内动脉  Perineal artery  Anal artery  Dorsal artery of penis (clitoris)

15 External iliac artery Inferior epigastric artery Deep iliac circumflex artery

16 Veins of pelvis Internal iliac vein 髂内静脉 Parietal tributaries: accompany with arteries Visceral tributaries →superior rectal vein→inferior mesenteric v. ① Rectal venous plexus →inferior rectal vein→internal iliac v. 直肠静脉丛 →anal vein→internal pudendal v. ② Vesical venous plexus 膀胱静脉丛 →vesical v. ③ Uterine venous plexus 子宫静脉丛 →uterine v.

17 External iliac vein 髂外静脉 – accompany the artery Common iliac vein 髂总静脉 – formed by union of internal and external iliac veins in front of sacroiliac joint, end upon L4~L5 by uniting each other to form inferior vena cava

18 The lymphatic drainage of pelvis Internal iliac lymph node Surround internal iliac vessels Receive afferents from pelvic viscera, perineum, buttock and back of thigh External iliac lymph nodes Lie along external iliac artery Receive afferents from lower limb and some parts of pelvic viscera Sacral lymph node Common iliac lymph node Lie along common iliac artery Receive afferents from all the above nodes Efferents pass to lumbar lymph node

19 Sacral plexus 骶丛 Formation: formed by anterior rami of L4 and L5 spinal nerves (the lumbrosacral trunk) and anterior rami of sacral and coccygeal nerves Position: lies in pelvic cavity, anterior to sacrum and piriformis

20 Branches Superior gluteal Inferior gluteal Pudendal Posterior femoral cutaneou Sciatic Common

21 Pudendal nerve block

22 Autonomic plexuses of plevic Hypogastric plexus Superior hypogastric plexus 上腹下丛 : lies in front of L5 between common iliac ateries Inferior hypogastric plexus 下 腹下丛 (pelvic plexus): lie on each side of rectum Sacral sympathetic trunk Is continuos above with the abdominal part Has 4or 5 ganglion

23 Relationships of rectus Anteriorly In male  Fundus of bladder  Seminal vesicle  Prostate  Ampulla ductus deferentis In female  neck of uterus  Vagina

24 Posteriorly Sacrum and coccyx Piriformis Median sacral vessels Anterior branches of sacral and coccygeal nerves Sacral sympathetic trunk Laterally Pelvic plexus Superior and inferior rectal vessels Levator ani

25 Vessels and lymphatics of rectum Arteries Superior rectal a. Inferior rectal a. Median sacral a. Lymphatic drainge Lymphatics follow arterial blood supply to following nodes: Superior rectal ln. Inferior mesenteric ln. Pararectal ln. Internal iliac ln. Sacral ln.

26 Perineum 山东大学医学院 解剖教研室 李振华

27 General features Region of below pelvic diaphragm A diamond-shape space whose boundaries are those of the pelvic outlet  Lower border of symphysis pubis  Rami of pubis and ischium  Ischial tuberosities  Sacrotuberous ligament  The coccyx

28 Two triangles An imaginary line drawn between the two ischial tuberosities divides perineum into anterior and posterior triangles Urogenital region 尿生殖区 (anterior) - differs in male and female Anal region 肛区 (posterior) - similar in both sexes

29 Anal region 肛区 Anal sphincters 肛门括约肌 Internal  Smooth muscle (thickened circular muscle coat)  Surrounds upper two-thirds of anal canal  Autonomic nerve supply External  Striated muscle  Surrounds lower two-thirds of anal canal  Three parts - subcutaneous, superficial and deep  Innervation by anal nerves of pudendal nerve and branches of S4

30 Ischioanal fossa 坐骨肛门窝 Boundaries Apex - conjunctive area of inferior fascia of pelvic diaphragm and fascia covering the obturator internus Base - skin of anal region Medial - sphincter ani externus, levator ani, coccygeus and inferior fascia of pelvic diaphragm Lateral - ischial tuberosity, obturator internus and fascia Paired, wedge-shaped, fat-filled spaces on either side of anal canal

31 Anterior  Posterior border of urogenital diaphragm  Forward projection of anterior recess of fossa between pelvic diaphragm above and urogenital diaphragm below Posterior  backward projection of posterior recess of fossa between gluteus maximus, sacrotuberous ligament and coccyx

32 Contents Fat Internal pudendal artery and vein and their rectal branches Pudendal nerve and its inferior rectal branch Vessels and nerves enter from gluteal region, through lesser sciatic foramen, travel on a fascial canal - the pudental canal 阴部管 (Alcock’s) - on the lateral wall of fossa, and extend forward into urogenital region

33 Branches Superior gluteal Inferior gluteal Pudendal Posterior femoral cutaneou Sciatic Common

34 Pudendal nerve block

35 Urogenital region 尿生殖区 Superficial fascia has two layers The superficial or fatty layer The deep or membranous layer (superficial fascia of perineum 会阴浅筋膜 or Colles fascia) Anteriorly - it is continuous with:  Dartos of the scrotum  Fascia of the penis  Membranous layer of superficial fascia of the abdominal wall known as the fascia of Scarpa Deep fascia has two layers Superior fascia of urogenital diaphragm 尿生殖隔上筋膜 Inferior fascia of urogenital diaphragm 尿生殖隔下筋膜

36 Camper’s fascia Position of penis Scarpa’s fascia Fascia later Line of fusion Position of scrotum

37 Superior fascia of urogenital diaphragm Inferior fascia of urogenital diaphragm superficial fascia of perineum Deep perineal space Superficial perineal space Fascia of the penis Fascia of Scarpa Dartos of the scrotum 会阴深隙:上、下两层膜,中间夹着肉,四周均封闭,尿殖管穿过(如座垫) 会阴浅隙:上、下两层膜,中间东西多,三边都封闭,前上方敞着(如口袋)

38 Superficial perineal space 会阴浅隙 Boundaries Lies between inferior fascia of urogenital diaphragm and superficial fascia of perineum Space open anteriorly (In rupture of cavernous part of urethra, urine can extravasate from scrotum upward in front of symphysis pubis into anterior abdominal wall deep to membranous fascia of Scarpa)

39 Contents Posterior part - superficial transverse perineal muscle Lateral part - crus penis (male), crus of clitoris (female) and ischiocavernousus covering them Central part - bulb of urethra (male), bulb of vestibule (female) and bulbocavernousus covering them Branches of pudendal nerves and internal pudendal vessels

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41 Deep perineal space 会阴深隙 Lies between superior and inferior fascia of urogenital diaphragm Contents  Deep transverse perineal muscle  Bulbourethral gland (male)  Sphincter of urethra 尿道括约肌 (male) , urethrovaginal sphincter 尿道阴道括 约肌  Ateries, veins and nerves

42 Urogenital diaphragm 尿生殖隔 Triangular in shape Attached laterally to ischiopubic rami and ischial tuberosities Formed by sphincter of urethra, deep transverse perineal muscle, superior and inferior fascia of urogenital diaphragm

43 Perineal central tendon 会阴中心腱 Wedge-shape fibromuscular mass In female, between anal canal and lower end of vagina, In male, between anal canal and root of penis It is larger in the female than in the male and five support to the posterior wall of the vagina

44 Origin or insertion of several small muscles and insertion of part of palvic diaphragm These muscles are:  Sphincter ani externus  Levator ani  Superficial transverse muscle perineum  Deep transverse muscles perineum  Bulbocavernousus  Sphincter of urethra (male) or urethrovaginal sphincter (female)

45 Sphincter ani externus Levator ani Superficial transverse muscle perineum Bulbocavernousus Deep transverse muscles perineum Sphincter of urethra (male) or urethrovaginal sphincter (female)

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