闭孔神经在闭膜管外的解剖学研究
发布时间：2018-12-18 11:36
【摘要】：目的:研究闭膜管的管径和长度;闭孔神经在闭膜管外的分支长度、宽度和厚度及终支数,为临床上诊断和治疗盆腔出口综合症提供解剖学基础。 材料与方法:解剖清理12具(共24例)尸体标本,年龄不详。其中男性8具,女性4具,盆部外观无破损,且排除盆内病变。暴露研究区域,测量闭膜管的内径和长度,并对闭孔神经分支及其肌支进行相关测量,并使用统计软件对数据进行处理。 结果: (1)闭膜管是闭孔神经由盆腔至股部通过的骨纤维管,其上方是耻骨的闭孔沟,下方是闭孔膜、闭孔内肌和闭孔外肌之上缘。管的走向与腹股沟管相似,由外侧向前内下方。外口的横径为(4.22±8.8)mm,长度为(1.45±2.3 )mm。 (2)闭孔神经前支、后支分叉处多在闭膜管内,也存在盆内分支与管外分支的情况。在盆内分支的共有2例,分支点距离闭膜管外口的平均长度为(28.22±3.42)mm,最大值45.42mm,最小值24.26mm。在闭膜管内分支的共有19例,分支点距离闭膜管外口的平均长度为(20.13±3.32)mm,最大值37.43 mm ,最小值7.87mm。在盆外分支的共有3例,分支点距离闭膜管外口的平均长度为(13.62±2.34)mm,最大值21.81 mm,最小值12.34mm。 (3)闭孔神经前支的宽度为(5.13±0.42)mm ,厚度为( 0.56±0.12)mm。后支的宽度为(3.04±0.64)mm,厚度为(0.51±0.14)mm。 (4)闭孔神经的各肌支:长收肌支,都来自前支,长度为(80.31±6.42)mm,宽度为(8.65±2.13)mm,厚度为(1.95±0.34)mm,终支数为4.2;短收肌支,多来自前支,少数来自后支,长度为(59.54±2.45)mm,宽度为(3.06±1.22)mm,厚度为(0.26±0.05)mm,终支数为2.3;股薄肌支,都来自前支,长度为(118.27±5.76)mm,宽度为(2.53±1.46)mm,厚度为(0.47±0.03)mm,终支数为4.8;耻骨肌支,多来自后支,少数来自神经干,长度为(16.02±2.45)mm,宽度为(1.85±0.39)mm,厚度为(0.28±0.02)mm,终支数为1.1;大收肌支,都来自后支,长度为(133.27±9.43)mm,宽度为(5.23±2.53)mm,厚度为(0.59±0.09)mm,终支数为5.6。 结论: (1)封闭法治疗盆腔出口综合症(实施骨盆外闭孔神经阻滞麻醉)进针部位应为以长收肌外缘与腹股沟韧带下缘交点处(即耻骨结的外下方1-2cm处。 (2)手术治疗盆腔出口综合症时,从耻骨支向股内下方弧形切口,在长收肌止点处切断该肌,翻起后,寻找闭孔神经前后支,沿神经寻找其交汇处。 (3)闭孔神经离断术时,寻找到前后支后,选择在闭膜管外口处切断闭孔神经前后支或闭孔神经主干。
[Abstract]:Objective: to study the diameter and length of the obturator canal, the length, width and thickness of the obturator nerve branch outside the obturator canal, and to provide anatomic basis for the clinical diagnosis and treatment of pelvic outlet syndrome. Materials and methods: 12 cadavers (24 cases) with unknown age were dissected. There were 8 males and 4 females. The appearance of the pelvis was not damaged, and the pelvic lesions were excluded. The inner diameter and length of obturator tube were measured, and the branch of obturator nerve and its muscle branch were measured. The data were processed by statistical software. Results: (1) the obturator canal is the osseous fibrous canal of obturator nerve from pelvic cavity to femoral part, which is superior to obturator sulcus of pubis and superior edge of obturator membrane, internal obturator muscle and external obturator muscle. The direction of the tube is similar to that of the inguinal canal, from the lateral front to the inside. The transverse diameter of the external orifice is (4.22 卤8.8) mm, and the length is (1.45 卤2.3) mm.. (2) the branches of the anterior branch and posterior branch of obturator nerve are mostly in the obturator tube, and there are also the branches in the basin and outside the canal. There were 2 cases of intrapelvic branches. The average length of the branch point was (28.22 卤3.42) mm, and the minimum value was 24.26mm. In 19 cases, the average length of the branch point was (20.13 卤3.32) mm, the maximum value was 37.43 mm, and the minimum value was 7.87 mm. There were 3 cases of extrapelvic branches. The average length of the branch point to the outer orifice of the closed membrane tube was (13.62 卤2.34) mm, the maximum value was 21.81 mm, the minimum value was 12.34 mm. (3) the width of the anterior branch of obturator nerve was (5.13 卤0.42) mm,) and (0.56 卤0.12) mm.. The width of the posterior branch is (3.04 卤0.64) mm, and the thickness is (0.51 卤0.14) mm.. (4) the muscular branches of obturator nerve: the long adductor muscle branches came from the anterior branch, the length was (80.31 卤6.42) mm, width was (8.65 卤2.13) mm, thickness was (1.95 卤0.34) mm, terminal branch was 4.2; The short adductor muscle branch, mostly from the anterior branch, and a few from the posterior branch, the length was (59.54 卤2.45) mm, the width was (3.06 卤1.22) mm, the thickness was (0.26 卤0. 05) mm, terminal branch was 2.3; The length was (118.27 卤5.76) mm, the width was (2.53 卤1.46) mm, the thickness was (0.47 卤0.03) mm, terminal branch was 4.8; Most of the Rami pubis came from the posterior branch, and a few came from the nerve trunk, the length was (16.02 卤2.45) mm, the width was (1.85 卤0.39) mm, the thickness was (0.28 卤0.02) mm, terminal branch was 1.1; The length of adductor Magnus was (133.27 卤9.43) mm, the width was (5.23 卤2.53) mm, the thickness was (0.59 卤0.09) mm, final branch was 5.6. Conclusion: (1) in the treatment of pelvic outlet syndrome (to carry out external obturator nerve block anesthesia), the needling position should be at the point of intersection between the external edge of adductor longus and the inferior edge of inguinal ligament (that is, 1-2cm below the pubic junction). (2) in the surgical treatment of pelvic outlet syndrome, an arc incision was made from the pubic branch to the lower part of the medial femoris, the adductor muscle was cut off at the point where the adductor muscle was stopped, and the anterior and posterior branches of the obturator nerve were searched for the intersection along the nerve. (3) after the anterior and posterior branches of obturator nerve were found, the anterior and posterior branches of obturator nerve or the main trunk of obturator nerve were cut off at the external orifice of obturator canal.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R322.85
[Abstract]:Objective: to study the diameter and length of the obturator canal, the length, width and thickness of the obturator nerve branch outside the obturator canal, and to provide anatomic basis for the clinical diagnosis and treatment of pelvic outlet syndrome. Materials and methods: 12 cadavers (24 cases) with unknown age were dissected. There were 8 males and 4 females. The appearance of the pelvis was not damaged, and the pelvic lesions were excluded. The inner diameter and length of obturator tube were measured, and the branch of obturator nerve and its muscle branch were measured. The data were processed by statistical software. Results: (1) the obturator canal is the osseous fibrous canal of obturator nerve from pelvic cavity to femoral part, which is superior to obturator sulcus of pubis and superior edge of obturator membrane, internal obturator muscle and external obturator muscle. The direction of the tube is similar to that of the inguinal canal, from the lateral front to the inside. The transverse diameter of the external orifice is (4.22 卤8.8) mm, and the length is (1.45 卤2.3) mm.. (2) the branches of the anterior branch and posterior branch of obturator nerve are mostly in the obturator tube, and there are also the branches in the basin and outside the canal. There were 2 cases of intrapelvic branches. The average length of the branch point was (28.22 卤3.42) mm, and the minimum value was 24.26mm. In 19 cases, the average length of the branch point was (20.13 卤3.32) mm, the maximum value was 37.43 mm, and the minimum value was 7.87 mm. There were 3 cases of extrapelvic branches. The average length of the branch point to the outer orifice of the closed membrane tube was (13.62 卤2.34) mm, the maximum value was 21.81 mm, the minimum value was 12.34 mm. (3) the width of the anterior branch of obturator nerve was (5.13 卤0.42) mm,) and (0.56 卤0.12) mm.. The width of the posterior branch is (3.04 卤0.64) mm, and the thickness is (0.51 卤0.14) mm.. (4) the muscular branches of obturator nerve: the long adductor muscle branches came from the anterior branch, the length was (80.31 卤6.42) mm, width was (8.65 卤2.13) mm, thickness was (1.95 卤0.34) mm, terminal branch was 4.2; The short adductor muscle branch, mostly from the anterior branch, and a few from the posterior branch, the length was (59.54 卤2.45) mm, the width was (3.06 卤1.22) mm, the thickness was (0.26 卤0. 05) mm, terminal branch was 2.3; The length was (118.27 卤5.76) mm, the width was (2.53 卤1.46) mm, the thickness was (0.47 卤0.03) mm, terminal branch was 4.8; Most of the Rami pubis came from the posterior branch, and a few came from the nerve trunk, the length was (16.02 卤2.45) mm, the width was (1.85 卤0.39) mm, the thickness was (0.28 卤0.02) mm, terminal branch was 1.1; The length of adductor Magnus was (133.27 卤9.43) mm, the width was (5.23 卤2.53) mm, the thickness was (0.59 卤0.09) mm, final branch was 5.6. Conclusion: (1) in the treatment of pelvic outlet syndrome (to carry out external obturator nerve block anesthesia), the needling position should be at the point of intersection between the external edge of adductor longus and the inferior edge of inguinal ligament (that is, 1-2cm below the pubic junction). (2) in the surgical treatment of pelvic outlet syndrome, an arc incision was made from the pubic branch to the lower part of the medial femoris, the adductor muscle was cut off at the point where the adductor muscle was stopped, and the anterior and posterior branches of the obturator nerve were searched for the intersection along the nerve. (3) after the anterior and posterior branches of obturator nerve were found, the anterior and posterior branches of obturator nerve or the main trunk of obturator nerve were cut off at the external orifice of obturator canal.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R322.85
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