坐骨棘筋膜固定术的临床解剖学研究

目的 探讨坐骨棘筋膜固定术中,将坐骨棘筋膜作为阴道穹隆悬吊点的可行性和安全性.方法 2007年6月-2008年1月,对10具成年女性尸体(包括7具经甲醛固定的尸体和3具新鲜尸体)进行解剖,观察、测量坐骨棘筋膜及其与周围血管和神经的解剖关系,并使用拉力计测定骶棘韧带、坐骨棘筋膜、髂尾肌筋膜及阴道左右侧穹隆的最大拉力.结果 坐骨棘表面附着的肌肉、筋膜形成坐骨棘筋膜,厚约3 mm,其表面无重要的血管及神经走行.骶棘韧带、坐骨棘筋膜、髂尾肌筋膜和阴道侧穹隆的最大拉力分别为(102±26)、(64±15)、(33±8)和(32±6)N.结论 坐骨棘前外侧1 cm处的坐骨棘筋膜牢固有力,表面无重要血管和神经走行,可以作为阴道穹隆手术新的悬吊点.

Clinical anatomic study on ischial spinous fascia fixation

Objective The study was to explore the safety, firmness and convenience of the fascia around the ischial spine as a new fixation site for the vaginal fornix. Methods Between June 2007 and January 2008, detailed dissections and related measurements of the regions around the ischial spine were performed on 10 Chinese female cadavers (3 unembalmed and 7 embalmed cadavers). At the same time, the sacrospinous ligament,the fascia on the ischial spine, the iliococcygeus fascia as well as the vaginal fornix were exposed and the pull-out strength sequentially tested using a digital push-pull force gauge. Results The fascia on the ischial spine was firm and strong, with a thickness of 3 about mm. No major vessels or nerves were observed on the ischial spine. The greatest pullout strengths of the sacrospinous ligament,the fascia on the ischial spine, the iliococcygeus fascia as well as the vaginal fornix were (102±26),(64±15),(33±8)and(32±6)N, respectively. Conclusion The fascia at 1 cm from anterior lateral ischial spine, free of major vessels and nerves, is safe and strong and could be used as a new site for suspension in vaginal prolapse.