1、Boney pelvis、anterior abdominal wall and soft tissues of the pelvis,Bony pelvis 骨盆,Composition: formed by paired innominate bones, sacrum, coccyx, and their articulations Two portions: false pelvis true pelvis Terminal line: formed by promontory of sacrum, arcuate line, pecten of pubis, pubic tuberc

2、le, upper border of pubic symphysis,Innominate bone,Formed by the fusion of the iliac, ischial ,and pubic ossification centers at the acetabulum . Palpable landmarks: Iliac crest 髂嵴 Anterior superior iliac spine 髂前上棘 Posterior superior iliac spine 髂后上棘 Anterior inferior iliac spine 髂前下棘 Posterior in

3、ferior iliac spine 髂后下棘 pubic tubercle 恥骨結(jié)節(jié) ischial tuberosity 坐骨結(jié)節(jié),Bony pelvis,Sacrospinous ligament Sacrotuberous ligament,Anterior abdominal wall,Layers ( from superficial to deep) Skin Superficial fascia muscles Transverse fascia Extraperitoneal fascia Parietal peritoneum,Langer lines,To minimiz

4、e scarring,incisions of the anterior abdominal wall and flank should follow langer lines of cleavage. These lines parallel dermal collagen fibers and are oriented along lines of stress. They correspond to the segmental thoracic and lumber nerves.,Langer line,History: The lines were first discovered

5、in 1861 by Austrian anatomist Karl Langer (1819-1887),123 though he cited the surgeon Baron Dupuytren as being the first to recognise the phenomenon. Langer punctured numerous holes at short distances from each other into the skin of a cadaver with a tool that had a circular-shaped tip, similar to a

6、n ice pick. He noticed that the resultant punctures in the skin had ellipsoidal shapes. From this testing he observed patterns and was able to determine line directions by the longer axes of the ellipsoidal holes and lines .,Subcutaneous fasciae,Superficial fascia Fatty layer (Campers fascia) contin

7、uous with the superficial fascia over the rest of the body. The superficial circumflex iliac, external pudendal, and superficial inferior epigastric vessels run in this layer. Membranous layer (Scarpas fascia) passes over the inguinal ligament to fuse the deep fascia of the thigh (fascia lata) appro

8、ximately one fingerbreadth below the inguinal ligament. Medially, it is continuous with Colles fascia of the perineum.,Anterolateral Muscles,Obliquus externus abdominis 腹外斜肌 Obliquus internus abdominis 腹內(nèi)斜肌 Transversus abdominis 腹橫肌 Rectus abdominis 腹直肌,These muscles terminate on the anterior abdomi

9、nal wall as broad,tough aponeurotic sheets that fuse in the midline(linea alba) and form the rectus sheath.,Sheath of rectus abdominis 腹直肌鞘,Encloses rectus abdominis Above arcuate line Anterior layer:Formed by fusion of aponeurosis of obliquus externus abdominis and anterior leaf of obliquus internu

10、s abdominis Posterior layer Formed by fusion of posterior leaf of aponeurosis of obliquus internus abdominis and transversus aponeurosis,Sheath of rectus abdominis 腹直肌鞘,Below the arcuate line Anterior layer: formed by aponeuroses of all three muscles Posterior layer: absent,Inguinal canal 腹股溝管,Posit

11、ion: oblique passage, 4cm long, located 1.5cm above medial half of inguinal ligament,Inguinal canal 腹股溝管,Boundaries Anterior wall Aponeurosis of obliquus externus abdominis Obliquus internus abdominis (lateral third of wall) Posterior wall Transverse fascia Inguinal falx medially Roof arching fibers

12、 of obliquus internus and transversus abdominis Flooringuinal ligament,Inguinal canal 腹股溝管,Boundaries Two openings Superficial inguinal ring a triangular-shaped defect in the aponeurosis of the obliquus externus abdominis lies immediately above and lateral to the pubic tubercle Deep inguinal ring an

13、 oval opening in transverse fascia lies approximately 1.5cm above midpoint of inguinal ligament,Structures passing through inguinal canal,In males In females Spermatic cord Round ligament of uterus Ilioinguinal nerve Ilioinguinal nerve,Mechanics of the inguinal canal,The inguinal canal is a site of

14、potential weakness in both sexes. On coughing and straining (as in micturition, defecation, and parturition), the arching lowers fibers of the obliquus internus and transversus abdominis contract and flatten the arch. In turn, this lowers the roof of the canal toward the floor and virtually closes t

15、he canal.,Internal surface of the anterior abdominal wall,Approached laparoscopically, three elevations of the peritoneum, refered to as the median, medial, and lateral umbilical folds, are visible on the anterior abdominal wall below the umbilicus.,Muscles of pelvic wall 盆壁肌,Piriformis Obturator in

16、ternus Tendinous arc of the levator ani serves as the original of the muscles of the pelvic diaphragm.,Muscles of floor of pelvis 盆底肌,Levator ani Coccygeus,Levator prostate,Puborectalis,Pubococcygeus,Iliococcygeus,Coccygeus,It is important to recognize that the pelvic diaphragm is not flat or bowl s

17、haped, as it is frequently depicted.,Pelvic fascia 盆筋膜,Parietal pelvic fascia 盆壁筋膜 Lines the pelvic walls and is regionally named according to the muscle it overlies. Above the pelvic inlet, it is continuous with the fascia lining the abdominal walls. Superior fascia of pelvic diaphragm 盆膈上筋膜 Inferi

18、or fascia of pelvic diaphragm 盆膈下筋膜,Pelivic diaphragm 盆膈,Formed by Superior fascia of pelvic diaphragm Levator ani and coccygeus Inferior fascia of pelvic diaphragm Hiatus of pelvic diaphragm,Visceral pelvic fascia 盆臟筋膜 A layer of loose connective tissue that covers and supports all the pelvic visce

19、ra Ensheathes retroperitoneal viscera and forms septa between retroperitoneal organs Rectovesical septum 直腸膀胱隔 Rectovaginal septum 直腸陰道隔 Vesicovaginal septum 膀胱陰道隔,Spaces of pelvic fascia 筋膜間隙,Retropubic space 恥骨后隙 Lies between pubic symphysis and urinary bladder Pararectal space 直腸周間隙 Lies around the rectum Retrorectal space 直腸后隙,Components of Pelvic fasciae,The pelvic fasciae have three important components: anteriorly, the puboprostatic ligaments in male and pubourethral ligaments in female.,Components of Pelvic fasciae,Laterally, the arcus tendineus fascia pelvis, In the fem