Pelvic
山东大学医学院 解剖教研室李振华
Bony pelvis Composition: formed by paire
d 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
Muscles of pelvic wall
Piriform m. Obturator internus m.
Muscles of floor of pelvis and pelivic diaphragm
Muscles of floor of pelvisLevator ani 肛提肌 Levateo prostate 前列腺提肌 (pubov
aginalis 耻骨阴道肌 ) Puborectalis 耻骨直肠肌 Pubococcygeus 耻尾肌 and iliococ
cygeus 髂尾肌
Coccygeus 尾骨肌
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
Pelvic fascia
Parietal pelvic fascia A continuation of the transverse f
ascia 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
Visceral pelvic fascia Lies between the peritoneu
m and the pelvic viscera It is a continuation of the ext
raperitoneal 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
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
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
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
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
Uterine a. 子宫动脉— about 2cm from neck of uterus it crosses above and in front of ureter
Internal pudendal artery 阴部内动脉 Perineal artery Anal artery Dorsal artery of penis (cli
toris)
External iliac artery
Inferior epigastric artery Deep iliac circumflex art
ery
Veins of pelvis
Internal iliac vein 髂内静脉 Parietal tributaries: accompany with arteries Visceral tributaries
→superior rectal vein→inferior mesenteric
v.
①Rectal venous plexus →inferior rectal vein→internal iliac v.
直肠静脉丛 → anal vein→internal pudendal v.
②Vesical venous plexus 膀胱静脉丛→ vesical v.
③Uterine venous plexus 子宫静脉丛→ uterine v.
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
The lymphatic drainage of pelvisInternal iliac lymph node Surround internal iliac vessels Receive afferents from pelvic viscera,
perineum, buttock and back of thighExternal iliac lymph nodes Lie along external iliac artery Receive afferents from lower limb an
d some parts of pelvic visceraSacral lymph nodeCommon iliac lymph node Lie along common iliac artery Receive afferents from all the above
nodes Efferents pass to lumbar lymph node
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
Branches Superior gluteal Inferior gluteal Pudendal Posterior femoral cuta
neou Sciatic Common
Pudendal nerve block
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 a
bdominal part Has 4or 5 ganglion
Relationships of rectusAnteriorly In male
Fundus of bladder Seminal vesicle Prostate Ampulla ductus deferentis
In female neck of uterus Vagina
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 v
essels Levator ani
Vessels and lymphatics of rectumArteries Superior rectal a. Inferior rectal a. Median sacral a. Lymphatic drainge Lymphati
cs follow arterial blood supply to following nodes:
Superior rectal ln. Inferior mesenteric ln. Pararectal ln. Internal iliac ln. Sacral ln.
Perineum
山东大学医学院 解剖教研室李振华
General features Region of below pelvic dia
phragm A diamond-shape space
whose boundaries are those of the pelvic outlet Lower border of symph
ysis pubis Rami of pubis and ischi
um Ischial tuberosities Sacrotuberous ligament The coccyx
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
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 a
nal canal Three parts - subcutaneous, s
uperficial and deep Innervation by anal nerves of p
udendal nerve and branches of S4
Ischioanal fossa 坐骨肛门窝
Boundaries Apex - conjunctive area of inf
erior fascia of pelvic diaphragm and fascia covering the obturator internus
Base - skin of anal region Medial - sphincter ani extern
us, 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
Anterior Posterior border of urogenital diaphragm Forward projection of anterior recess of fossa between pelvic dia
phragm above and urogenital diaphragm below Posterior
backward projection of posterior recess of fossa between gluteus maximus, sacrotuberous ligament and coccyx
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
Branches Superior gluteal Inferior gluteal Pudendal Posterior femoral cutaneou Sciatic Common
Pudendal nerve block
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 f
ascia of the abdominal wall known as the fascia of Scarpa
Deep fascia has two layers Superior fascia of urogenital dia
phragm 尿生殖隔上筋膜 Inferior fascia of urogenital diap
hragm 尿生殖隔下筋膜
Camper’s fascia
Position of penis
Scarpa’s fascia
Fascia later
Line of fusion
Position of scrotum
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)
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)
Contents Posterior part - superficial transverse perineal muscle Lateral part - crus penis (male), crus of clitoris (female) and ischioca
vernousus covering them Central part - bulb of urethra (male), bulb of vestibule (female) and b
ulbocavernousus covering them Branches of pudendal nerves and internal pudendal vessels
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
Urogenital diaphragm 尿生殖隔 Triangular in shape Attached laterally to isc
hiopubic rami and ischial tuberosities
Formed by sphincter of urethra, deep transverse perineal muscle, superior and inferior fascia of urogenital diaphragm
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 post
erior wall of the vagina
Origin or insertion of several small muscles and insertion of part of palvic diaphragm
These muscles are: Sphincter ani externus Levator ani Superficial transverse mu
scle perineum Deep transverse muscles
perineum Bulbocavernousus Sphincter of urethra (mal
e) or urethrovaginal sphincter (female)
Sphincter ani externus
Levator ani
Superficial transverse muscle perineum
Bulbocavernousus
Deep transverse muscles perineum
Sphincter of urethra (male) or urethrovaginal sphincter (female)