医学常见的女性盆腔解剖.pptVIP

* This is a medial view of the left hip bone. The space within the obturator internus fascia lining the lateral wall of the ischioanal fossa that transmits the pudendal vessels and nerves is the Alcock’s canal (Pudendal canal). This fibrous tunnel is formed by splitting of the obturator fascia and is found on the lateral wall of the ischioanal fossa. It transmits the internal pudendal artery and vein as well as the pudendal nerve. The internal pudendal artery passes inferolaterally, anterior to the piriformis muscle and sacral plexus. It then leaves the pelvis between the piriformis and coccygeus muscles by passing through the inferior part of the greater sciatic foramen. It then enters the perineum through the lesser sciatic foramen and passes through Alcock’s canal. The pudendal nerve arises from S2, S3, and S4. It leaves the pelvis through the greater sciatic foramen between the piriformis and coccygeus muscles. It then hooks around the sacrospinous ligament to enter the perineum through the lesser sciatic foramen. It then enters Alcock’s canal along with the internal pudendal artery and vein. It gives rise to the inferior rectal nerve and perineal nerve and terminates as the dorsal nerve of the clitoris (or penis). The inferior rectal nerve innervates the external anal sphincter. * * 盆腔的肌肉有闭孔内肌、梨状肌和肛提肌。前二肌属髋肌，肛提肌为盆底肌。 1、闭孔内肌：起于闭孔膜内面和周围骨面，肌束向后绕坐骨小切迹，出坐骨小孔转折外行，止于大转子内面。 2、梨状肌：起于骶骨前面，外行经坐骨大孔出骨盆，止于大转子尖。经坐骨大孔时并形成梨状肌上孔和梨状肌下孔，其间有血管神经通过。 3、肛提肌：分为耻骨尾骨肌、髂骨尾骨肌、耻骨直肠肌。为一薄而宽的扁肌，起自骨盆侧壁的肛提肌腱弓（自耻骨联合后方2厘米，沿闭孔内肌筋膜向后延伸，达坐骨棘），纤维斜向后下，止于直肠壁下部（女性还止于阴道下部）。两侧肛提肌下端在前方没有会合，形成被尿道、阴道及直肠所通过的裂隙（泌尿生殖裂），在后方的肛门和尾骨之间，两侧肛提肌在中线融合成一肌板。肛提肌上层的纤维（朝向盆腔面）起自耻骨联合，向后呈“U”形绕过直肠肛管上方，肛提肌这部分纤维称耻骨直肠肌，此肌在功能上对直肠和阴道有重要的括约作用，肛门周围手术时，切勿损伤该肌环。整个肛提肌对于承托盆腔内脏、排便及分娩等具有重要作用。肛提肌如因某些原因扩张、松弛或断裂，都可引起子宫脱垂及直肠脱垂。 * This is a superior view of the pelvis. Be sure to orient yourself in terms of the sacrum, pubis, and left and right os coxae. Also notice the openings for the urethra, vagina, and anal canal. The vessel a