Pelvis

苏州大学医学院 解剖教研室王晓春

Bony pelvis Composition: formed by paire

d hip bones, sacrum, coccyx, and their articulations

Two 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

Pelvic outlet: formed by tip of coccyx, sacrotuberous ligament, ischial tuberosity, ramus of ischium, inferior ramus of pubic symphysis

Muscles of pelvic wall

Piriform m. Obturator internus m.

Muscles of floor of pelvis and pelivic diaphragm

Muscles of floor of pelvisLevator ani 肛提肌 Levateo prostate 前列腺提肌 (pubov

aginalis 耻骨阴道肌 ) Puborectalis 耻骨直肠肌 Pubococcygeus 耻尾肌 and iliococ

cygeus 髂尾肌

Coccygeus 尾骨肌

Pelivic diaphragm 盆膈 Superior fascia of pelvic diaphragm 盆膈上筋膜 Levator ani 肛提肌 Coccygeus 尾骨肌 Inferior fascia of pelvic diaphragm 盆膈下筋膜

Pelvic fascia

Parietal pelvic fascia A continuation of the transverse f

ascia into the pelvis. It coves the piriformis and obturator internus

Attaches 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 muscle

At the tendinous arch of levator ani it splits to cove both superior and inferior surfaces of the levator ani as superior and inferior fascia of pelvic diaphragm

Visceral pelvic fascia Lies between the peritoneu

m and the pelvic viscera It is a continuation of the ext

raperitoneal connective tissue

Ensheathes retroperitoneal viscera and forms septa between retroperitoneal organs Rectovesical septum

直肠膀胱隔 Rectovaginal septum

直肠阴道隔

Retropubic space 耻骨后隙

Lies between pubic symphysis and urinary bladder

Pararectal space

直肠周间隙 Lies around the rectus Retrorectal space

直肠后隙

Common iliac artery 髂总动脉

Common iliac artery Continuation of

abdominal aorta at level of L4 vertebra

Terminates in front of sacroiliac joint by dividing into internal and external iliac arteries

Internal iliac artery 髂内动脉

Parietal iliac artery Obturator a. 闭孔动脉 Iliolumber a. 髂腰动脉 Lateral sacral a.

骶外侧动脉 Superior gluteal a.

臀上动脉 Inferior gluteal a.

臀下动脉

Visceral branches Umbilical a. 脐动脉→ superior

vesical a. 膀胱上动脉 Inferior vesical a. 膀胱下动脉 Uterine a. 子宫动脉 Inferior rectal a. 直肠下动脉 Internal pudendal a.

阴部内动脉

Uterine a. 子宫动脉— about 2cm from neck of uterus it crosses above and in front of ureter

Internal pudendal artery 阴部内动脉 Perineal artery Anal artery Dorsal artery of penis (cli

toris)

External iliac artery

Inferior epigastric artery Deep iliac circumflex art

ery

Veins of pelvis

Internal iliac vein 髂内静脉 Parietal tributaries: accompany with arteries Visceral tributaries

→superior rectal vein→inferior mesenteric

v.

①Rectal venous plexus →inferior rectal vein→internal iliac v.

直肠静脉丛 → anal vein→internal pudendal v.

②Vesical venous plexus 膀胱静脉丛→ vesical v.

③Uterine venous plexus 子宫静脉丛→ uterine v.

External iliac vein

髂外静脉– accompany the artery

Common iliac vein 髂总静脉– formed by union of internal and external iliac veins in front of sacroiliac joint, end upon L4~L5 by uniting each other to form inferior vena cava

The lymphatic drainage of pelvisInternal iliac lymph node Surround internal iliac vessels Receive afferents from pelvic viscera,

perineum, buttock and back of thighExternal iliac lymph nodes Lie along external iliac artery Receive afferents from lower limb an

d some parts of pelvic visceraSacral lymph nodeCommon iliac lymph node Lie along common iliac artery Receive afferents from all the above

nodes Efferents pass to lumbar lymph node

Sacral plexus 骶丛

Formation: formed by anterior rami of L4 and L5 spinal nerves (the lumbrosacral trunk) and anterior rami of sacral and coccygeal nerves

Position: lies in pelvic cavity, anterior to sacrum and piriformis

Branches Superior gluteal Inferior gluteal Pudendal Posterior femoral cuta

neou Sciatic Common

Pudendal nerve block

Autonomic plexuses of plevic

Hypogastric plexus Superior hypogastric plexus

上腹下丛 : lies in front of L5 between common iliac ateries

Inferior hypogastric plexus 下腹下丛 (pelvic plexus): lie on each side of rectum

Sacral sympathetic trunk Is continuos above with the a

bdominal part Has 4or 5 ganglion

Relationships of rectusAnteriorly In male

Fundus of bladder Seminal vesicle Prostate Ampulla ductus deferentis

In female neck of uterus Vagina

Posteriorly Sacrum and coccyx Piriformis Median sacral vessels Anterior branches of sacral

and coccygeal nerves Sacral sympathetic trunk

Laterally Pelvic plexus Superior and inferior rectal v

essels Levator ani

Vessels and lymphatics of rectumArteries Superior rectal a. Inferior rectal a. Median sacral a. Lymphatic drainge Lymphati

cs follow arterial blood supply to following nodes:

Superior rectal ln. Inferior mesenteric ln. Pararectal ln. Internal iliac ln. Sacral ln.

Perineum

苏州大学医学院 解剖教研室王晓春

General features Region of below pelvic dia

phragm A diamond-shape space

whose boundaries are those of the pelvic outlet Lower border of symph

ysis pubis Rami of pubis and ischi

um Ischial tuberosities Sacrotuberous ligament The coccyx

Two triangles An imaginary line drawn between

the two ischial tuberosities divides perineum into anterior and posterior triangles

Urogenital region 尿生殖区 (anterior) － differs in male and female

Anal region 肛区 (posterior) － similar in both sexes

Anal region 肛区Anal sphincters 肛门括约肌 Internal

Smooth muscle (thickened circular muscle coat)

Surrounds upper two-thirds of anal canal

Autonomic nerve supply External

Striated muscle Surrounds lower two-thirds of a

nal canal Three parts － subcutaneous, s

uperficial and deep Innervation by anal nerves of p

udendal nerve and branches of S4

Ischioanal fossa 坐骨肛门窝

Boundaries Apex － conjunctive area of inf

erior fascia of pelvic diaphragm and fascia covering the obturator internus

Base － skin of anal region Medial － sphincter ani extern

us, levator ani, coccygeus and inferior fascia of pelvic diaphragm

Lateral － ischial tuberosity, obturator internus and fascia

Paired, wedge-shaped, fat-filled spaces on either side of anal canal

Anterior Posterior border of urogenital diaphragm Forward projection of anterior recess of fossa between pelvic dia

phragm above and urogenital diaphragm below Posterior

backward projection of posterior recess of fossa between gluteus maximus, sacrotuberous ligament and coccyx

Contents Fat Internal pudendal artery and vein and their rectal branches Pudendal nerve and its inferior rectal branch

Vessels and nerves enter from gluteal region, through lesser sciatic foramen, travel on a fascial canal － the pudental canal 阴部管 (Alcock’s)－ on the lateral wall of fossa, and extend forward into urogenital region

Branches Superior gluteal Inferior gluteal Pudendal Posterior femoral cutaneou Sciatic Common

Pudendal nerve block

Urogenital region 尿生殖区Superficial fascia has two layers The superficial or fatty layer The deep or membranous layer

(superficial fascia of perineum 会阴浅筋膜 or Colles fascia)

Anteriorly － it is continuous with: Dartos of the scrotum Fascia of the penis Membranous layer of superficial f

ascia of the abdominal wall known as the fascia of Scarpa

Deep fascia has two layers Superior fascia of urogenital dia

phragm 尿生殖隔上筋膜 Inferior fascia of urogenital diap

hragm 尿生殖隔下筋膜

Camper’s fascia

Position of penis

Scarpa’s fascia

Fascia later

Line of fusion

Position of scrotum

Superior fascia of urogenital diaphragm

Inferior fascia of urogenital diaphragm

superficial fascia of perineum

Deep perineal space

Superficial perineal space

Fascia of the penis

Fascia of Scarpa

Dartos of the scrotum

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）

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Boundaries Lies between inferior fascia

of urogenital diaphragm and superficial fascia of perineum

Space open anteriorly (In rupture of cavernous part of urethra, urine can extravasate from scrotum upward in front of symphysis pubis into anterior abdominal wall deep to membranous fascia of Scarpa)

Contents Posterior part － superficial transverse perineal muscle Lateral part － crus penis (male), crus of clitoris (female) and ischioca

vernousus covering them Central part － bulb of urethra (male), bulb of vestibule (female) and b

ulbocavernousus covering them Branches of pudendal nerves and internal pudendal vessels

Deep perineal space 会阴深隙 Lies between superior and inferior fascia of urogenital diaphragm Contents

Deep transverse perineal muscle Bulbourethral gland (male) Sphincter of urethra 尿道括约肌 (male) ， urethrovaginal sphincter 尿道阴道

括约肌 Ateries, veins and nerves

Urogenital diaphragm 尿生殖隔 Triangular in shape Attached laterally to isc

hiopubic rami and ischial tuberosities

Formed by sphincter of urethra, deep transverse perineal muscle, superior and inferior fascia of urogenital diaphragm

Perineal central tendon 会阴中心腱 Wedge-shape fibromuscular mass In female, between anal canal and lower end of vagina, In male, between anal canal and root of penis It is larger in the female than in the male and five support to the post

erior wall of the vagina

Origin or insertion of several small muscles and insertion of part of palvic diaphragm

These muscles are: Sphincter ani externus Levator ani Superficial transverse mu

scle perineum Deep transverse muscles

perineum Bulbocavernousus Sphincter of urethra (mal

e) or urethrovaginal sphincter (female)

Sphincter ani externus

Levator ani

Superficial transverse muscle perineum

Bulbocavernousus

Deep transverse muscles perineum

Sphincter of urethra (male) or urethrovaginal sphincter (female)