1、Pelvic Bony pelvisuComposition: formed by paired hip bones, sacrum, c o c c y x , a n d t h e i r articulationsuTwo 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 Pelv
2、ic outlet: formed by tip of coccyx, sacrotuberous ligament, ischial tuberosity, ramus of ischium, inferior ramus of pubic symphysisMuscles of pelvic walluPiriform m.uObturator internus m.Muscles of floor of pelvis and pelivic diaphragm Muscles of floor of pelvisLevator ani 肛提肌uLevateo prostate 前列腺提肌
3、(pubovaginalis 耻骨阴道肌)uPuborectalis 耻骨直肠肌uPubococcygeus 耻 尾 肌and iliococcygeus 髂尾肌Coccygeus 尾骨肌Pelivic diaphragm 盆膈uSuperior fascia of pelvic diaphragm 盆膈上筋膜uLevator ani 肛提肌uCoccygeus 尾骨肌uInferior fascia of pelvic diaphragm盆膈下筋膜Pelvic fascia Parietal pelvic fascia uA continuation of the transverse fa
4、scia into the pelvis. It coves the piriformis and obturator internus uAttaches 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 muscleuAt the tendinous arch of levator ani it splits to cove both su
5、perior and inferior surfaces of the levator ani as superior and i n f e r i o r f a s c i a of p e l v i c diaphragm Visceral pelvic fascia uL i e s b e t w e e n t h e peritoneum and the pelvic viscerauIt is a continuation of the extraperitoneal connective tissueuEnsheathes retroperitoneal viscera
6、and forms septa between retroperitoneal organs Rectovesical septum 直肠膀胱隔直肠膀胱隔 Rectovaginal septum 直肠阴道隔直肠阴道隔Retropubic space 耻骨后隙uL i e s b e t w e e n p u b i c symphysis and urinar y bladderPararectal space 直肠周间隙uLies around the rectus uRetrorectal space 直肠后隙Common iliac artery 髂总动脉uCommon iliac a
7、rteryuContinuation of abdominal aorta at level of L4 vertebra uTerminates in front of sacroiliac joint by dividing into internal and external iliac arteries Internal iliac artery 髂内动脉Parietal iliac arteryuObturator a. 闭孔动脉uIliolumber a.髂腰动脉uLateral sacral a. 骶外侧动脉uSuperior gluteal a. 臀上动脉 uInferior
8、gluteal a. 臀下动脉 Visceral branches uUmbilical a.脐动脉 superior vesical a. 膀胱上动脉uInferior vesical a.膀胱下动脉uUterine a.子宫动脉uInferior rectal a.直肠下动脉uInternal pudendal a. 阴部内动脉 uUterine a. 子宫动脉about 2cm from neck of uterus it crosses above and in front of ureteruInternal pudendal artery 阴部内动脉 Perineal artery
9、 Anal artery Dorsal artery of penis (clitoris) External iliac arteryuInferior epigastric arteryuDeep iliac circumflex artery Veins of pelvisInternal iliac vein 髂内静脉uParietal tributaries: accompany with arteriesuVisceral tributaries superior rectal veininferior mesenteric v.Rectal venous plexus infer
10、ior rectal veininternal iliac v.直肠静脉丛 anal veininternal pudendal v. Vesical venous plexus 膀胱静脉丛vesical v.Uterine venous plexus 子宫静脉丛uterine v. External iliac vein 髂外静脉 accompany the arteryCommon iliac vein 髂总静脉 formed by union of internal and external iliac veins in front of sacroiliac joint, end up
11、on L4L5 by uniting each other to form inferior vena cavaThe lymphatic drainage of pelvisInternal iliac lymph nodeuSurround internal iliac vesselsuReceive afferents from pelvic viscera, perineum, buttock and back of thighExternal iliac lymph nodes uLie along external iliac arteryuReceive afferents fr
12、om lower limb and some parts of pelvic visceraSacral lymph nodeCommon iliac lymph node uLie along common iliac arteryuReceive afferents from all the above nodesuEfferents pass to lumbar lymph node Sacral plexus 骶丛Formation: formed by anterior rami of L4 and L5 spinal nerves (the lumbrosacral trunk)
13、and anterior rami of sacral and coccygeal nervesPosition: lies in pelvic cavity, anterior to sacrum and piriformis BranchesuSuperior gluteal uInferior gluteal uPudendaluPosterior femoral cutaneou uSciatic CommonPudendal nerve blockAutonomic plexuses of plevicHypogastric plexus uSuperior hypogastric
14、plexus 上腹下丛: lies in front of L5 between common iliac ateriesuInferior hypogastric plexus下腹下丛 (pelvic plexus): lie on each side of rectumSacral sympathetic trunkuIs continuos above with the abdominal partuHas 4or 5 ganglion Relationships of rectusAnteriorlyuIn male Fundus of bladder Seminal vesicle
15、Prostate Ampulla ductus deferentisuIn female neck of uterus Vagina PosteriorlyuSacrum and coccyxuPiriformisuMedian sacral vesselsuAnterior branches of sacral and coccygeal nervesuSacral sympathetic trunkLaterally uPelvic plexusuSuperior and inferior rectal vesselsuLevator ani Vessels and lymphatics
16、of rectumArteries uSuperior rectal a.uInferior rectal a.uMedian sacral a.uLy m p h a t i c d r a i n g e Lymphatics follow arterial blood supply to following nodes:uSuperior rectal ln.uInferior mesenteric ln. uPararectal ln.uInternal iliac ln.uSacral ln.Perineum山东大学医学院 解剖教研室李振华General featuresuRegio
17、n of below pelvic diaphragmuA 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 coccyxTwo triangles An imaginary line drawn between the two ischial tuberosities divides perineu
18、m into anterior and posterior trianglesuUrogenital region尿生殖区 (anterior)differs in male and femaleuAnal region 肛区 (posterior)similar in both sexes Anal region 肛区Anal sphincters 肛门括约肌uInternal Smooth muscle (thickened circular muscle coat) Surrounds upper two-thirds of anal canal Autonomic nerve supp
19、lyuExternal Striated muscle Surrounds lower two-thirds of anal canal Three partssubcutaneous, superficial and deep Innervation by anal nerves of pudendal nerve and branches of S4 Ischioanal fossa 坐骨肛门窝 BoundariesuApexconjunctive area of inferior fascia of pelvic diaphragm and fascia covering the obt
20、urator internusuBaseskin of anal regionuMedialsphincter ani externus, levator ani, coccygeus and inferior fascia of pelvic diaphragmuLateralischial tuberosity, obturator internus and fasciaPaired, wedge-shaped, fat-filled spaces on either side of anal canaluAnterior Posterior border of urogenital di
21、aphragm Forward projection of anterior recess of fossa between pelvic diaphragm above and urogenital diaphragm belowuPosterior backward projection of posterior recess of fossa between gluteus maximus, sacrotuberous ligament and coccyx ContentsuFatuInternal pudendal artery and vein and their rectal b
22、ranchesuPudendal nerve and its inferior rectal branch Vessels and nerves enter from gluteal region, through lesser sciatic foramen, travel on a fascial canalthe pudental canal 阴部管阴部管 (Alcocks)on the lateral wall of fossa, and extend forward into urogenital regionBranchesuSuperior gluteal uInferior g
23、luteal uPudendaluP o s t e r i o r f e m o r a l cutaneou uSciatic CommonPudendal nerve blockUrogenital region 尿生殖区Superficial fascia has two layersuThe superficial or fatty layeruThe deep or membranous layer (superficial fascia of perineum 会阴浅筋膜 or Colles fascia) Anteriorly it is continuous with: D
24、artos of the scrotum Fascia of the penis Membranous layer of superficial fascia of the abdominal wall known as the fascia of ScarpaDeep fascia has two layersuSuperior fascia of urogenital diaphragm 尿生殖隔上筋膜uInferior fascia of urogenital diaphragm 尿生殖隔下筋膜Campers fasciaPosition of penisScarpas fasciaFa
25、scia laterLine of fusionPosition of scrotumSuperior fascia of urogenital diaphragmInferior fascia of urogenital diaphragmsuperficial fascia of perineumDeep perineal space Superficial perineal space Fascia of the penisFascia of ScarpaDartos of the scrotum会阴深隙会阴深隙：上、下两层膜，中间夹着肉，四周均封闭，尿殖管穿过（如座垫）上、下两层膜，中
26、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）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BoundariesuLies between inferior fascia of urogenital diaphragm and superficial fascia of perineumuSpace open anteriorly (In rupture of cavernous part of urethra, urine can extrava
27、sate from scrotum u p w a r d i n f r o n t o f symphysis pubis into anterior abdominal wall deep to membranous fascia of Scarpa)ContentsuPosterior partsuperficial transverse perineal muscleuLateral partcrus penis (male), crus of clitoris (female) and ischiocavernousus covering themuCentral partbulb
28、 of urethra (male), bulb of vestibule (female) and bulbocavernousus covering themuBranches of pudendal nerves and internal pudendal vesselsDeep perineal space 会阴深隙uLies between superior and inferior fascia of urogenital diaphragmuContents Deep transverse perineal muscle Bulbourethral gland (male) Sp
29、hincter of urethra尿道括约肌尿道括约肌 (male)，urethrovaginal sphincter尿道阴道尿道阴道括约肌括约肌 Ateries, veins and nervesUrogenital diaphragm 尿生殖隔uTriangular in shapeuAtt a c h e d l a te r a l l y to ischiopubic rami and ischial tuberositiesuFormed by sphincter of urethra, deep transverse perineal muscle, superior and
30、inferior fascia of urogenital diaphragmPerineal central tendon 会阴中心腱uWedge-shape fibromuscular massuIn female, between anal canal and lower end of vagina, uIn male, between anal canal and root of penisuIt is larger in the female than in the male and five support to the posterior wall of the vaginauO
31、rigin or insertion of several small muscles and insertion of part of palvic diaphragmuThese muscles are: Sphincter ani externus Levator ani Superficial transverse muscle perineum Deep transverse muscles perineum Bulbocavernousus Sphincter of urethra (male) or urethrovaginal sphincter (female)Sphincter ani externusLevator ani Superficial transverse muscle perineum Bulbocavernousus Deep transverse muscles perineum Sphincter of urethra (male) or urethrovaginal sphincter (female)
