摘要
目的研究骶棘韧带(sacrospinous ligament,SSL)区的血管神经解剖特点,为骶棘韧带固定术(sacrospinous ligament fixation,SSLF)提供解剖学基础。方法对10具(20侧)成人女性尸体的SSL区进行解剖、观查并测量其与周围血管神经的解剖关系。结果 SSL的长度是(52.3±4.2)mm,距离坐骨棘2.5 cm处的宽度为(12.0±2.1)mm。大部分臀下血管(15/20)出骨盆前经过SSL外侧一半的后方或紧邻上缘,且大部分(18/20)在近SSL上缘处发出尾动脉,它在SSL上缘处距离坐骨棘(15.7±5.6)mm。阴部神经在坐骨棘内侧从内上向外下斜行跨越SSL背侧进入坐骨小孔,位于阴部内血管的内侧或内上方,在SSL上、下缘其最内界与坐骨棘的距离分别是(23.4±3.6)mm和(15.7±1.3)mm。15个半骨盆中(15/20)找到肛提肌神经,其跨越SSL上缘处与坐骨棘的距离是(39.6±8.3)mm。结论 SSLF中,选择缝合SSL距离坐骨棘至少2.5 cm处、宽度为韧带靠近下缘的1/2、深度为韧带全层厚度的浅层之1/2,即宽度约5 mm,深度约1 mm,可避免损伤其后方及上缘的血管神经。
Objective： To characterize the neurovascular anatomy of the sacrospinous ligament （SSL） regions and to determine the safe area for sacrospinous ligament fixation （SSLF）. Methods：Detailed dissections and related measurements of the presacral region were performed on 10 Chinese female cadavers （3 unembalmed and 7 embalmed cadavers）. Results： The average length of the SSL was （52. 3±4. 2） mm. The width of the SSL at the point 2.5 cm medial to the ischial spine was （12.0±2. 1） ram. The inferior gluteal vessels left the pelvis by passing behind the lateral half of the SSL in seven hemipelvises （7/20）, or by passing in proximity to the superior border of the SSL in 8 hemipelvises （8/20）. The majority coursed behind the sacral plexus and the pudendal nerve, with a small segment sometimes left uncovered above the top of the SSL. The coccygeal branch of the inferior gluteal artery was found in 18 hemipelvises （18/20）, （15.7±5.6） mm medial to the ischial spine at the level of the superior border of the SSL. The pudendal nerve passed posterior to the SSL and exited the pelvis through the lesser sciatic foramen, medial and superior to the pudendal vessels. The pudendal complex was found to be （23.4±3.6） mm and （15.7±1.3） mm medial to the ischial spine at the upper and lower border of the SSL, respectively. Conclusions： Sutures should be placed through the SSL at least 2.5 cm from the ischial spine and within half of the lower margin and within superficial half of the entire thickness to preserve the nerves and vessels behind and above the SSL during SSLF.
出处
《生殖医学杂志》
CAS
2009年第4期349-353,共5页
Journal of Reproductive Medicine
关键词
骶棘韧带
臀下血管
阴部神经
阴部内动脉
Sacrospinous ligament
Inferior gluteal vessels
Pudendal nerve
Internal pudendalartery
