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Pelvic1ppt课件BonypelvisuComposition:formedbypaired hip bones,sacrum,coccyx,andtheirarticulationsuTwoportions Greater pelvis Lesser pelvisTerminal line(pelvic inlet):formed by promontory of sacrum,arcuate line,pectin of pubis,pubic tubercle,upper border of pubic symphysisPelvic outlet:formed by tip of coccyx,sacrotuberous ligament,ischial tuberosity,ramus of ischium,inferior ramus of pubic symphysis2ppt课件MusclesofpelvicwalluPiriformm.uObturatorinternusm.3ppt课件MusclesoffloorofpelvisandpelivicdiaphragmMusclesoffloorofpelvisLevatorani肛提肌uLevateo prostate前 列 腺 提 肌(pubovaginalis耻骨阴道肌)uPuborectalis耻骨直肠肌uPubococcygeus耻 尾 肌andiliococcygeus髂尾肌Coccygeus尾骨肌4ppt课件Pelivicdiaphragm盆膈uSuperiorfasciaofpelvicdiaphragm盆膈上筋膜uLevatorani肛提肌uCoccygeus尾骨肌uInferiorfasciaofpelvicdiaphragm盆膈下筋膜5ppt课件PelvicfasciaParietalpelvicfasciauAcontinuationofthetransversefascia into the pelvis.It covesthe piriformis and obturatorinternusuAttaches to the arcuate line ofthe pubis and ilium,thickensover the obturator internus toform the arcus tendineus,theoriginofportionsofthelevatoranimuscleuAtthetendinousarchoflevatoraniitsplitstocovebothsuperiorandinferiorsurfacesofthe levator ani as superior andinferiorfasciaofpelvicdiaphragm6ppt课件VisceralpelvicfasciauLiesbetweentheperitoneumandthepelvicviscerauItisacontinuationoftheextraperitonealconnectivetissueuEnsheathesretroperitonealvisceraandformsseptabetweenretroperitonealorgans Rectovesical septum 直肠膀胱隔直肠膀胱隔 Rectovaginal septum 直肠阴道隔直肠阴道隔7ppt课件Retropubicspace耻骨后隙uLiesbetweenpubicsymphysisandurinarybladderPararectalspace直肠周间隙uLiesaroundtherectusuRetrorectalspace直肠后隙8ppt课件Commoniliacartery髂总动脉uCommoniliacarteryuContinuation of abdominalaortaatlevelofL4vertebrauTerminatesinfrontofsacroiliac joint by dividinginto internal and externaliliacarteries9ppt课件Internaliliacartery髂内动脉ParietaliliacarteryuObturatora.闭孔动脉uIliolumbera.髂腰动脉uLateralsacrala.骶外侧动脉uSuperiorgluteala.臀上动脉uInferiorgluteala.臀下动脉10ppt课件VisceralbranchesuUmbilicala.脐动脉superiorvesicala.膀胱上动脉uInferiorvesicala.膀胱下动脉uUterinea.子宫动脉uInferiorrectala.直肠下动脉uInternalpudendala.阴部内动脉11ppt课件12ppt课件uUterinea.子宫动脉about2cmfromneckofuterusitcrossesaboveandinfrontofureter13ppt课件uInternalpudendalartery阴部内动脉 Perineal artery Anal artery Dorsal artery of penis(clitoris)14ppt课件ExternaliliacarteryuInferiorepigastricarteryuDeepiliaccircumflexartery15ppt课件VeinsofpelvisInternaliliacvein髂内静脉uParietaltributaries:accompanywitharteriesuVisceraltributariessuperiorrectalveininferiormesentericv.Rectalvenousplexusinferiorrectalveininternaliliacv.直肠静脉丛 analveininternalpudendalv.Vesicalvenousplexus膀胱静脉丛vesicalv.Uterinevenousplexus子宫静脉丛uterinev.16ppt课件Externaliliacvein髂外静脉accompanythearteryCommoniliacvein髂总静脉 formed by union ofinternal and external iliacveins in front of sacroiliacjoint,end upon L4L5 byuniting each other to forminferiorvenacava17ppt课件ThelymphaticdrainageofpelvisInternaliliaclymphnodeuSurroundinternaliliacvesselsuReceiveafferentsfrompelvicviscera,perineum,buttock andbackofthighExternaliliaclymphnodesuLiealongexternaliliacarteryuReceiveafferentsfromlowerlimbandsomepartsofpelvicvisceraSacrallymphnodeCommoniliaclymphnodeuLiealongcommoniliacarteryuReceive afferents from all theabovenodesuEfferents pass to lumbar lymphnode18ppt课件Sacralplexus骶丛Formation:formedbyanteriorrami of L4 and L5 spinalnerves(thelumbrosacraltrunk)and anterior rami ofsacralandcoccygealnervesPosition:lies in pelvic cavity,anteriortosacrumandpiriformis19ppt课件BranchesuSuperiorglutealuInferiorglutealuPudendaluPosteriorfemoralcutaneouuSciaticCommon20ppt课件Pudendalnerveblock21ppt课件AutonomicplexusesofplevicHypogastricplexusuSuperiorhypogastricplexus上腹下丛:liesinfrontof L5 between commoniliacateriesuInferiorhypogastricplexus下腹下丛(pelvicplexus):lieoneachsideofrectumSacralsympathetictrunkuIs continuos above withtheabdominalpartuHas4or5ganglion22ppt课件RelationshipsofrectusAnteriorlyuInmale Fundus of bladder Seminal vesicle Prostate Ampulla ductus deferentisuInfemale neck of uterus Vagina 23ppt课件PosteriorlyuSacrumandcoccyxuPiriformisuMediansacralvesselsuAnteriorbranchesofsacralandcoccygealnervesuSacralsympathetictrunkLaterallyuPelvicplexusuSuperiorandinferiorrectalvesselsuLevatorani24ppt课件VesselsandlymphaticsofrectumArteriesuSuperiorrectala.uInferiorrectala.uMediansacrala.uLymphaticdraingeLymphatics follow arterialbloodsupplytofollowingnodes:uSuperiorrectalln.uInferiormesentericln.uPararectalln.uInternaliliacln.uSacralln.25ppt课件Perineum山东大学医学院解剖教研室李振华26ppt课件GeneralfeaturesuRegion of below pelvicdiaphragmuA diamond-shape spacewhose boundaries arethoseofthepelvicoutlet Lower border of symphysis pubis Rami of pubis and ischium Ischial tuberosities Sacrotuberous ligament The coccyx27ppt课件TwotrianglesAnimaginarylinedrawnbetweenthetwoischialtuberosities divides perineuminto anterior and posteriortrianglesuUrogenital region尿 生 殖 区(anterior)differsinmaleandfemaleuAnalregion肛区(posterior)similarinbothsexes28ppt课件Analregion肛区Analsphincters肛门括约肌uInternal Smooth muscle(thickened circular muscle coat)Surrounds upper two-thirds of anal canal Autonomic nerve supplyuExternal Striated muscle Surrounds lower two-thirds of anal canal Three partssubcutaneous,superficial and deep Innervation by anal nerves of pudendal nerve and branches of S429ppt课件Ischioanalfossa坐骨肛门窝BoundariesuApexconjunctive area ofinferiorfasciaofpelvicdiaphragmandfasciacoveringtheobturatorinternusuBaseskinofanalregionuMedialsphincteraniexternus,levatorani,coccygeusandinferiorfasciaofpelvicdiaphragmuLateral ischial tuberosity,obturatorinternusandfasciaPaired,wedge-shaped,fat-filled spaces on either side of anal canal30ppt课件uAnterior Posterior border of urogenital diaphragm 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 31ppt课件ContentsuFatuInternalpudendalarteryandveinandtheirrectalbranchesuPudendalnerveanditsinferiorrectalbranch 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 region32ppt课件BranchesuSuperiorglutealuInferiorglutealuPudendaluPosteriorfemoralcutaneouuSciaticCommon33ppt课件Pudendalnerveblock34ppt课件Urogenitalregion尿生殖区SuperficialfasciahastwolayersuThesuperficialorfattylayeruThe deep or membranouslayer(superficial fascia ofperineum会阴浅筋膜orCollesfascia)Anteriorlyitiscontinuouswith:Dartos of the scrotum Fascia of the penis Membranous layer of superficial fascia of the abdominal wall known as the fascia of ScarpaDeepfasciahastwolayersuSuperior fascia of urogenitaldiaphragm尿生殖隔上筋膜uInferior fascia of urogenitaldiaphragm尿生殖隔下筋膜35ppt课件Campers fasciaPosition of penisScarpas fasciaFascia laterLine of fusionPosition of scrotum36ppt课件Superior 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）37ppt课件Superficialperinealspace会阴浅隙BoundariesuLiesbetweeninferiorfasciaofurogenitaldiaphragmandsuperficialfasciaofperineumuSpace open anteriorly(Inruptureofcavernouspartofurethra,urinecanextravasate from scrotumupwardinfrontofsymphysispubisintoanterior abdominal walldeeptomembranousfasciaofScarpa)38ppt课件ContentsuPosteriorpartsuperficialtransverseperinealmuscleuLateral partcrus penis(male),crus of clitoris(female)andischiocavernoususcoveringthemuCentralpartbulbofurethra(male),bulbofvestibule(female)andbulbocavernoususcoveringthemuBranchesofpudendalnervesandinternalpudendalvessels39ppt课件40ppt课件Deepperinealspace会阴深隙uLies between superior and inferior fascia of urogenitaldiaphragmuContents Deep transverse perineal muscle Bulbourethral gland(male)Sphincter 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 nerves41ppt课件Urogenitaldiaphragm尿生殖隔uTriangularinshapeuAttachedlaterallytoischiopubicramiandischialtuberositiesuFormedbysphincterofurethra,deeptransverseperinealmuscle,superiorandinferiorfasciaofurogenitaldiaphragm42ppt课件Perinealcentraltendon会阴中心腱uWedge-shapefibromuscularmassuInfemale,betweenanalcanalandlowerendofvagina,uInmale,betweenanalcanalandrootofpenisuItislargerinthefemalethaninthemaleandfivesupporttotheposteriorwallofthevagina43ppt课件uOriginorinsertionofseveralsmall muscles and insertionofpartofpalvicdiaphragmuThesemusclesare:Sphincter ani externus Levator ani Superficial transverse muscle perineum Deep transverse muscles perineum Bulbocavernousus Sphincter of urethra(male)or urethrovaginal sphincter(female)44ppt课件Sphincter ani externusLevator ani Superficial transverse muscle perineum Bulbocavernousus Deep transverse muscles perineum Sphincter of urethra(male)or urethrovaginal sphincter(female)45ppt课件46ppt课件
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