Topography and subdivision of the pelvic connective tissue in human fetuses and in the adult

Summary We investigated epoxy resin impregnated sections through the pelves of 9 to 37-week-old fetuses, of newborn infants, and of adults to study the topography and subdivision of the pelvic connective tissue. Fetal and adult preparations show that the pelvic connective tissue can be subdivided into a presacral, a perirectal and a paravisceral compartment. Whereas the presacral and the perirectal compartment contain connective tissue, adipose tissue and supplying structures, the paravisceral compartment is mainly composed of adipose tissue. While only a very thin rectal fascia was found at the border of the perirectal compartment, no further visceral pelvic fascia can be seen in the impregnated sections. Moreover it is shown that the ligaments of the pelvic cavity are only composed of the sacrouterine ligaments and the pubovesical ligaments in the female and the puboprostatic ligaments in the male. Our data show that sectional anatomy provides new insights into the organization of the pelvic connective tissue, that may be of clinical importance.

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Topographie et subdivision du tissu conjonctif pelvien chez le foetus humain et chez l'adulte

Résumé Nous avons examiné des sections de bassins de foetus âgés de 9 à 37 semaines, de nouveaux nés et d'adultes après injection de résine époxy, afin d'étudier la topographie et la subdivision du tissu conjonctif pelvien. Les préparations histologiques foetales et adultes indiquent que le tissu conjonctif pelvien peut être subdivisé en trois compartiments : le compartiment présacré, périrectal et paraviscéral. Les compartiments présacré et périrectal contiennent du tissu conjonctif, du tissu adipeux et des éléments vasculaires tandis que le compartiment paraviscéral est principalement composé de tissu adipeux. On a noté un fascia rectal très mince au bord du compartiment périrectal, mais aucun fascia viscéral pelvien n'a été observé sur les sections imprégnées. De plus, elles indiquent que les ligaments de la cavité pelvienne ne sont composés que de ligaments utéro-sacrés (plis recto-utérins) et pubo-vésicaux chez la femme et de ligaments pubo-prostatiques chez l'homme. Nos résultats indiquent que l'anatomie par sections permet une étude approfondie de l'organisation du tissu conjonctif pelvien qui pourrait être importante sur le plan clinique.

     

Anatomical compartments of the parasellar region: adipose tissue bodies represent intracranial continuations of extracranial spaces

The cavernous sinus is traditionally described as a single anatomical compartment that contains cranial nerves, blood vessels, and connective tissue. A detailed analysis of 45 infant and 4 fetal parasellar regions shows that this view must be modified. The spatial arrangement, the topographic relations, and the expansion of the adipose and connective tissue spaces were analysed and reconstructed 3-dimensionally on a computer. It is shown that 3 different anatomical compartments, which are strictly demarcated by connective tissue, compose the parasellar region of infants. Two represent intracranial continuations of extracranial tissue spaces. The 3rd compartment corresponds to the so-called 'cavernous sinus' of the adult. Each of the 3 compartments contains characteristic adipose tissue bodies. Because the cavernous sinus represents only one compartment of the area, we propose to use the term 'parasellar region' to designate the entire anatomical region on either side of the sella turcica.     

A simplified fascial model of pelvic anatomical surgery: going beyond parametrium-centered surgical anatomy

The classical surgical anatomy of the female pelvis is limited by its gynecological oncological focus on the parametrium and burdened by its modeling based on personal techniques of different surgeons. However, surgical treatment of pelvic diseases, spreading beyond the anatomical area of origin, requires extra-regional procedures and a thorough pelvic anatomical knowledge. This study evaluated the feasibility of a comprehensive and simplified model of pelvic retroperitoneal compartmentalization, based on anatomical rather than surgical anatomical structures. Such a model aims at providing an easier, holistic approach useful for clinical, surgical and educational purposes. Six fresh-frozen female pelves were macroscopically and systematically dissected. Three superficial structures, i.e., the obliterated umbilical artery, the ureter and the sacrouterine ligament, were identified as the landmarks of 3 deeper fascial-ligamentous structures, i.e., the umbilicovesical fascia, the urogenital-hypogastric fascia and the sacropubic ligament. The retroperitoneal areolar tissue was then gently teased away, exposing the compartments delimited by these deep fascial structures. Four compartments were identified as a result of the intrapelvic development of the umbilicovesical fascia along the obliterated umbilical artery, the urogenital-hypogastric fascia along the mesoureter and the sacropubic ligaments. The retroperitoneal compartments were named: parietal, laterally to the umbilicovesical fascia; vascular, between the two fasciae; neural, medially to the urogenital-hypogastric fascia and visceral between the sacropubic ligaments. The study provides the scientific rational for a model of pelvic retroperitoneal anatomy based on identifiable anatomical structures and suitable for surgical planning and training.

     

Clinical anatomy of the subserous layer: An amalgamation of gross and clinical anatomy

The 1998 edition of Terminologia Anatomica introduced some currently used clinical anatomical terms for the pelvic connective tissue or subserous layer. These innovations persuaded the present author to consider a format in which the clinical anatomical terms could be reconciled with those of gross anatomy and incorporated into a single anatomical glossary without contradiction or ambiguity. Specific studies on the subserous layer were undertaken on 79 Japanese women who had undergone surgery for uterine cervical cancer, and on 26 female cadavers that were dissected, 17 being formalin‐fixed and 9 fresh. The results were as follows: (a) the subserous layer could be segmentalized by surgical dissection in the perpendicular, horizontal and sagittal planes; (b) the segmentalized subserous layer corresponded to 12 cubes, or ligaments, of minimal dimension that enabled the pelvic organs to be extirpated; (c) each ligament had a three‐dimensional (3D) structure comprising craniocaudal, mediolateral, and dorsoventral directions vis‐á‐vis the pelvic axis; (d) these 3D‐structured ligaments were encoded morphologically in order of decreasing length; and (e) using these codes, all the surgical procedures for 19th century to present‐day radical hysterectomy could be expressed symbolically. The establishment of clinical anatomical terms, represented symbolically through coding as demonstrated in this article, could provide common ground for amalgamating clinical anatomy with gross anatomy. Consequently, terms in clinical anatomy and gross anatomy could be reconciled and compiled into a single anatomical glossary. Clin. Anat. 29:508–515, 2016. © 2015 Wiley Periodicals, Inc.     

The human lumbar anterior epidural space: morphological comparison in adult and fetal specimens

To increase our understanding of the clinical anatomy of the epidural space, the human lumbar anterior epidural space was studied morphologically and developmentally. Histological transverse sections of human lumbar spines were taken at the level of the intervertebral disc and the vertebral body in adult specimens and in fetuses aged 13, 15, 21, 32 and 39 weeks (menstrual age). At 13 weeks, connective tissue filled the epidural space. The dura mater was attached anteriorly to the posterior longitudinal ligament (PLL). The PLL was attached to the vertebral body beside the midline, whereas it adhered to the posterior edge of intervertebral disc. The anterior internal vertebral venous plexus was located anterolaterally and anteromedially. The vertebral canal was lined with connective tissue that differentiated in a periosteum in contact with the ossification centers. At 15 weeks, the PLL was composed of deep and superficial layers. At 21 weeks, the attachment between the dura mater and PLL was ligament-like at the level of the vertebral body. At 32 weeks, the dura mater was adherent to the superficial layer of PLL. At 39 weeks, groups of adipocytes were identified, and the dura mater was attached to the PLL by some ligaments. There were many more similarities between the adult and the 39-week fetus. In conclusion, some differences in the anatomy of the epidural space exist at each fetal stage studied. The structures of the epidural space are already formed in the fetus of 13 weeks, but they differentiate progressively within the connective tissue.     

The connective tissue sheath of uterus and vagina in the human female fetus.

A morphological study concerning the development and arrangement of the connective tissue surrounding uterus and vagina was performed by investigating epoxy resin impregnated sections through the pelves of 9-37-week-old female fetuses, of newborn children and a three-year-old child. In order to study the histology of the connective tissue in detail paraffin, semithin and ultrathin sections were used. The organization of the pelvic connective tissue in female fetuses can best be studied in middle-aged fetuses (19-28 weeks of gestation). We here report that no supportive ligaments of the uterus are found in fetuses of that age group, but that the connective tissue covering uterus and vagina is part of the connective tissue sheaths of neighbouring structures. The fetal uterus is interposed between dense subperitoneal connective tissue circularly covering the vesico- and rectouterine pouch. Dorsally the subperitoneal tissue of the rectouterine pouch joins the circularly arranged connective tissue of the rectal adventitia. A triangularly-shaped plate of dense connective tissue is situated at each lateral border of the cervix uteri. Dorsally it is continuous with the circularly running fibres of the rectouterine pouch. Whereas the dorsal wall of the vagina is loosely connected with the rectal adventitia, fibrous connective tissue intimately fuses the muscular wall of the vagina with that of the neck of the bladder and of the urethra. No evidence is provided for the existence of smooth muscle cells and elastic material within the connective tissue covering the fetal uterus.     

Synovial remodeling process induced by type V collagen immunization in rabbits

The pathogenesis of diffuse connective tissue diseases is still unknown despite studies of the autoimmunity aspects related to extracellular matrix elements, mainly the collagens. Articulations are frequently affected by the synovitis process in these diseases. The objective of the present study was to verify the morphologic aspects of the synovial membrane of rabbits immunized with type V collagen, which has some particular characteristics 75 days after the first antigen inoculation and when compared to control animals. The synovial membrane of the animals sacrificed after 75 days of immunization presented an intense remodeling phenomenon along the connective tissue screen and interlobular septa of the adipose-muscle tissue screen compartment. The remodeling process determined type I and III collagen fiber depositions in the vascular and connective tissue compartments of the synovial membrane. The nutrient vessels of the adipose-muscle compartment showed a similar remodeling process, which resulted in small vessel occlusion. Few residual inflammatory foci consisting of monocytes and eosinophils were observed. Thus, our experimental model reproduces morphologic changes in different tissues, characterized by an extracellular matrix remodeling process similar to those observed in many diffuse connective tissue diseases such as systemic lupus erytematosus and scleroderma. Therefore, this model could be useful in understanding the pathogenesis and the treatment of these diseases.     

Use of the extensor retinaculum as a donor site for bone-ligament-bone grafts

Abstract The recent introduction of bone-ligament-bone grafts for ligament reconstruction in hand surgery has led to a search for suitable graft donor sites. The extensor retinaculum had been suggested, but harvesting details were still lacking. We therefore studied the anatomy of the extensor retinaculum, with radiography and morphometric measurements. Ten cadaver wrists were dissected the thick portion of the retinaculum and its insertions on the radius in the different extensor compartments were studied. The compartments were wire-marked, and AP radiographs taken of each specimen. The retinaculum spanning the first three compartments was removed with the bony ridges it inserted on, and the inter-ridge retinaculum length was measured. A comparison of our dissections with the radiographs showed that only the radial compartments 1, 2 and 3 had constant bony insertions on both ridges, making them suitable for bone-ligament-bone grafting. The mean compartment length was 11.7 mm (compartment 1), 17 mm (compartment 2) and 7.3 mm (compartment 3) respectively. Thus, the extensor retinaculum can be relied upon to provide bone-ligament-bone grafts from the first three compartments, for possible use in ligament reconstructions in the hand and wrist.     

Compartmental anatomy of the superficial fibular nerve with an emphasis on fascial release operations of the leg

Compartment syndrome is a common cause of lower extremity pain via an increased intra-compartmental pressure. Fasciotomy is currently the mainstay for surgical treatment. Fasciotomy can be performed either with classical open or minimally invasive techniques including endoscopically assisted or semi blind subcutaneous releases. Incompletely released fascial compartments, soft tissue damage, and neurovascular injury, which includes superficial fibular nerve injury are common complications. The aim of this study was to investigate the localization of the superficial fibular nerve (SFN) in the lateral and the anterior compartments. Thirty-eight legs of 20 cadavers fixed in 10% formaldehyde were dissected and the compartmental anatomy of the SFN investigated. Three particular types in the course of SFN were determined. In 71% of the cases, the SFN coursed entirely within the lateral compartment of the leg (Type I). In 23.7%, the SFN penetrated the anterior intermuscular septum, 12.7 cm inferior to the apex of the head of fibula and coursed in the anterior compartment (Type II). In the remaining 5.3% of the specimens the SFN had branches both in the anterior and lateral compartments (Type III). Knowledge of variations of the SFN with reference to compartmental anatomy of the leg may be useful in fascial release operations.     

正常足部软组织的MRI解剖研究

目的研究正常足部的MRI解剖及MRI对足部软组织结构的显示能力，为足部软组织损伤的MRI诊断提供断层解剖学依据。方法选择40例正常足部MRI图像资料，参考足部断层解剖文献，确定各肌肉、肌腱、韧带以及软骨的MRI解剖表现。结果所有肌肉、肌腱在各MRI序列都能清楚分辨。跗部韧带大多能确切辨认。跗部少量短而薄的韧带及跖、趾部大多数韧带难以辨认。结论MRI是目前显示足部软组织活体断面解剖最好的手段，但对于细小结构的满意显示尚有待于技术和方法的改进。     

正常踝关节内、外侧韧带的解剖及其影像学表现

目的:探讨正常踝关节内、外侧韧带的解剖形态及其MRI和CT表现。方法:6例正常人踝关节新鲜标本MRI扫描,解剖显示内、外侧韧带后,CT断层扫描与MRI对照观察踝关节内、外侧韧带的影像学表现;在30例正常志愿者踝关节的MRI上测量内、外韧带的宽度及厚度。结果:MRI横断面及冠状面可充分显示踝关节内、外侧韧带及其周围组织的解剖结构;踝关节内、外侧韧带在冠状面及横断面上所测的宽、厚度,男女间存在一定的差异。结论:MRI能清晰地显示踝关节的解剖结构,所测量的正常踝关节内、外侧韧带的宽、厚度数据,为临床诊断踝关节内、外侧韧带的病变提供了形态学依据。     

Topography of the pelvic autonomic nerves in human fetuses between 21-29 weeks of gestation

Summary A topographical study concerning the autonomic nerves in the pelvis of human fetuses was performed by investigating 300–600 m thick sections through fetal pelves, impregnated with the epoxy resin E 12 and cut with a diamond wire-saw. In addition the inferior hypogastric plexus of a 26-week old male fetus was dissected by lateral approach. In 21–29-week old fetuses the pelvic autonomic nerves are relatively thick. Thus the nerves stand out well against surrounding structures and their topographical relationships can exactly be determined. The inferior hypogastric plexus of 21–29-week old fetuses is situated on a curved line between the rectum and the ventrally adjacent structure. It constitutes a rectangular plate, which cannot be subdivided into individual plexuses for the different pelvic organs. The fetal plexus is heavily ganglionated. Large ganglia, forming the so-called ganglion of Frankenhaeuser, are found in the female as well as in the male fetus. In the fetal pelvis the connective tissue compartments are still clearly arranged, because adipose tissue is not yet abundant. The greater part of the inferior hypogastric plexus is situated exactly at the border between a dense visceral tissue medially and a loose parietal tissue laterally. The plexus does not share a common connective tissue cover with the pelvic blood vessels. In fetuses the inferior hypogastric plexus lies in close vicinity to serveral organs, but the pelvic floor is the only region where the nerves can hardly be separated from the surrounding structures.     

Details of fibroligamentous structures in the cervical unco-vertebral region: an obscure corner

Vertebral bone, joints and ligaments on the cervical spine are structures that maintain the stability of the spine and protect the neurovascular structures. Determining the detailed anatomical location of the intervertebral foramen and unco-vertebral (UV) region with respect to the vertebral bone, joint and ligaments is critical when choosing the safest surgical approach to the cervical spine. We studied the microscopic detailed anatomy of the dural covering and posterior longitudinal ligament (PLL) in eight cadaver specimens and the relevance of these structures in the UV region from C4 to C7. The uncinate process (UP) and its covering ligaments are mechanical barriers that prevent the nerve root and the vertebral artery against unintentional surgical damage. Dissection at the posterolateral surface of the UP revealed a separate perivascular fibroligamentous tissue (PVFLT) that originates from the PLL. The recognition of the PVFLT may provide for safe surgery by protecting the neural and vascular structures during decompression in the UV region.     

Tomographical anatomy of the pelvis,pelvic floor,and related structures

The sectional anatomy of the pelvic floor was studied in plastinated sections of adult pelves by computed tomography and by magnetic resonance imaging. In sectional anatomy, the levator ani is composed of three portions that can be clearly distinguished by their planes of cleavage and by the course of their fiber bundles. No muscular connections are found between the levator ani portions and the pelvic organs. The fascia of the levator ani is always interposed between the muscle and the pelvic organs. The sectional anatomy of the sphincter ani externus reveals a subdivision into a subcutaneous and a deep portion. Although the puborectalis portion of the levator ani and the deep portion of the sphincter ani externus are more or less continuous, in sectional anatomy they can be distinguished due to their different origins and attachments. Clin. Anat. 10:223–230, 1997. © 1997 Wiley-Liss Inc.     

Compartments of the foot: topographic anatomy

Recent publications have renewed the debate regarding the number of foot compartments. There is also no consensus regarding allocation of individual muscles and communication between compartments. The current study examines the anatomic topography of the foot compartments anew using 32 injections of epoxy-resin and subsequent sheet plastination in 12 cadaveric foot specimens. Six compartments were identified: dorsal, medial, lateral, superficial central, deep forefoot, and deep hindfoot compartments. Communication was evident between the deep hindfoot compartment and the superficial central and deep central forefoot compartments. In the hindfoot, the neurovascular bundles were located in separate tissue sheaths between the central hindfoot compartment and the medial compartment. In the forefoot, the medial and lateral bundles entered the deep central forefoot compartment. The deep central hindfoot compartment housed the quadratus plantae muscle, and after calcaneus fracture could develop an isolated compartment syndrome.     

Tricompartmental resurfacing arthroplasty with a follow-up of more than 30 years

BackgroundUnicompartmental and patellofemoral joint replacements are proven solutions for arthritis limited to one compartment of the knee. Bicompartmental replacement has been considered lately as an alternative for combined medial and patellofemoral arthritis. The main idea behind these resurfacing solutions is tissue preservation with conservation of bone stock and both cruciate ligaments. Tricompartmental replacement with selective resurfacing of all three compartments with different modular implants is exceptional.MethodsThe authors present a case with more than thirty year follow-up both clinically and radiographically.ResultsExcellent function and patient satisfaction are observed at 30 year follow-up. Radiographs show no osteolysis or loosening of components.ConclusionsConservation of both anterior and posterior cruciate ligaments seems to protect against polyethylene wear at long-term follow-up.Level of evidenceIV.     

Matrix compartments in the growth plate of the proximal tibia of rats

The cartilaginous matrix in the growth plate of the proximal tibia of rats is subdivided into various compartments according to criteria established by electron microscopic examination. In conventionally fixed specimens, the arrangement of collagen fibrils was analyzed by transmission and scanning electron microscopy. Distribution of proteoglycans and relations between matrix and cells were studied after fixation in media containing cationic dyes. Matrix compartments are best characterized by the density and arrangement of their collagen fibrils. On the other hand, proteoglycans are distributed almost homogenously all over the matrix. Each chondrocyte is surrounded by a thin envelope of proteoglycans, the pericellular matrix. Adjacent to this is a layer dominated by the content and order of its collagen fibrils, the territorial matrix. Its inner part covers the pericellular matrix with a thin net of intersecting fibrils. The outer part unites the cells of each column by a sheath of tightly packed longitudinal fibrils. This distinction is only possible in the longitudinal parts of the territorial matrix, whereas in the transverse septa both layers fuse into a common network. The interterritorial matrix is interposed between the columnar units and thus represents the central part of the longitudinal septa. Mineralization is restricted to the interterritorial matrix and matrix vesicles are coincidentally found in the same compartment. During growth, this structural organization undergoes a permanent and relatively fast remodeling, a process that is discussed in view of possible cell matrix interactions.