髂腹股沟神经的应用解剖

目的：为临床上阑尾切除术、腹股沟斜疝修补术、剖宫产术等手术作腹壁切口时，弄清髂腹股沟神经和切口的关系提供应用解剖学资料。方法：在33具（66侧）教学用的成人尸体标本上对髂腹股沟神经的行程进行了观察。用游标卡尺测量了该神经在穿出腹横肌、腹内斜肌、腹外斜肌腱膜时距骨性标志点的距离。结果：髂腹股沟神经腹横肌穿出点，位于距髂嵴最高点下方2．5cm处。腹内斜肌穿出点位于髂前上棘内侧3～4cm处，腹外斜肌腱膜穿出点位于距耻骨结节外侧1．5cm处。结论：下腹部的麦氏切口及斜切口等手术，要避开髂腹股沟神经的穿肌点，以免损伤该神经。     

利用腹横筋膜对腹股沟斜疝修补术的改进

利用腹横筋膜及其类同物对传统的腹股沟斜疝（简称斜疝）修补术行以下改进：①在高位结扎疝囊前，预先缝置修补内环口之缝线，将凹间韧带与髂耻束缝在一起。②在内环口至耻骨结节间将腹横筋膜折叠缝合于髂耻束上，对93例斜疝患者的治疗结果表明，改进后的修补方法，能明显减少术后腹股沟斜疝复发的因素，有一定的临床实用价值。     

腹股沟疝修补术的解剖基础

目的探讨腹股沟管的有关解剖结构,为腹股沟疝修补术提供解剖学基础。方法解剖33具(66侧)成人尸体标本,观察腹股沟韧带、腹股沟镰、腹股沟管等结构,并测量了相关数据。结果腹股沟韧带长度,男性约11.9cm,女性约11.4cm;宽度男性约0.7cm,女性约0.6cm;腹股沟管长度,男性约4.9cm,女性约4.5m;腹股沟管后壁可分为两层紧贴的筋膜层,并形成一个卵圆形的区域,其纵径长度男性约2.9cm,女性约2.6cm,横径约1.4cm;腹股沟镰长度,男性约2.4cm,女性约2.0cm。腹股沟镰可分为4种类型;腹内斜肌起始有3种类型,肌腱移行处呈现3种类型;腹横肌起始有两种类型。结论测量值为腹股沟疝修补术提供了解剖学依据     

髂腹下神经的应用解剖及临床意义

目的为临床上阑尾切除术、腹股沟疝修补术、剖宫产术、肾切除术等手术作腹壁切口时,注意髂腹下神经和切口的关系提供应用解剖学资料。方法在33具(66侧)教学用的成人尸体上对髂腹下神经的行程进行了研究。用游标卡尺测量分析了该神经在穿腹横肌、腹内斜肌、腹外斜肌时距一些骨性点的距离。结果髂腹下神经在腰大肌外侧1/3处穿出,经髂嵴最高点与第12肋尖端的中份,穿过腹横肌腱膜,距髂前上棘内侧4cm处,在腹横肌与腹内斜肌之间穿腹内斜肌,最后在腹股沟韧带上方2.5cm处与腹股沟韧带平行走行,并被腹外斜肌腱膜覆盖,在距耻骨联合上缘5cm处,它的终末皮支穿过腹外斜肌腱膜。结论在阑尾切除术时为了避免切断髂腹下神经,切口应选择在距髂前上棘至少4cm处;在作低位的旁正中切口时切口应在距腹股沟韧带3.5cm处进行;在作肾切除术时,在腰大肌外侧缘上1/3处易找到髂腹下神经。     

疝修补术后网状填塞物移动导致小肠功能障碍

自1996年Lichtenstein连续报道了300例非紧张性腹股沟疝修补术后,对待疝修补手术的意见尚不一致。该报告介绍了使用人工材料修复腹股沟管底部而不需缝合腹横肌、腹内斜肌和腹股沟韧带的概念。这项叫做无紧张性疝修补术的术后复发率为零,并且手术较简单。随后,Ratkow根据他使用网状物进行填塞的经验提出了一种方法,即用一块包有金箔的网状物     

旋股外侧动脉旋髂浅动脉和旋髂深动脉起始变异1例

笔者在解剖一具成年男性尸体时,发现其右侧旋股外侧动脉、旋髂浅动脉和旋髂深动脉的起始变异,为积累资料和为临床提供参考,现报道如下：1.右旋股外侧动脉起于股动脉,起始处外径3.8 mm,距股深动脉起始处2.42cm发出,发出后行向外侧0.85 cm后继而行向下,分支分布于缝匠肌、股直肌、股外侧肌。2.右旋髂浅动脉起于旋股外侧动脉,距股动脉0.85 cm发出,起始处外径1.8mm,发出后行向外上,分布于缝匠肌、阔筋膜张肌。3.正常情况下：旋髂深动脉在距髂前上棘附近分为髂嵴支和腹壁肌支(升之),前者分布至髂嵴及附近肌及皮肤,后者分布至肌。本例右旋髂深动脉起于股动脉,起始处外径为3.0 mm,距腹股沟韧带1.22 cm,以短干发出后分为上、下两支,起始处外径分别为2.4 mm、2.2 mm。上支向上穿腹股沟韧带后行向外上,分布于髂肌和腹横肌的下份内面,上支起始段还发出两较大分支,分布于耻骨肌;下支行向外上于腹股沟深面入腹内斜肌和腹横肌之间,分布于此二肌的下份。     

腹股沟区的应用解剖学

对100侧腹股沟区进行了解剖观察。腹股沟韧带平均长12cm,宽0.6cm;腹股沟管平均长4.7cm;腹股沟镰有四种类型:(1)联合腱型占66%;(2)肌一腱膜混合型占15%;(3)结合肌型占14%;(4)腹横肌腱膜型占5%。有10%的腹壁下动脉行程异常,其中 S 形(高位弯曲)和 L 形(低位弯曲)各5例。腹股沟后壁可分为两层紧贴的筋膜层,并成一个“梨状窝”,其平均纵径为2.9cm,横径1.4cm。加强和重建后壁,现已被认为是腹股沟疝手术成败的关键。     

腹股沟区的应用解剖学研究

目的为临床腹股沟疝修补术提供解剖学资料。方法选取经甲醛防腐固定的40具成人尸体(男30具,女10具),逐层解剖并用三角板、游标卡尺、量角器对其进行测量。结果腹股沟韧带长(12.0±0.5)cm,宽0.6 cm;腹股沟管长(4.7±0.6)cm;腹股沟镰长(2.2±0.8)cm。腹股沟镰表现为四种类型:联合腱型55侧、结合型12侧、腹横肌腱膜型4侧、肌-腱膜混合型9侧。腹壁下动脉的行程异常占11.3%。腹股沟管后壁可分为两层紧贴的筋膜层,并形成一个卵圆形的区域,其纵径长(2.9±0.7)cm,横径(1.4±0.38)cm。结论腹横筋膜深层较浅层薄弱,加强和重建腹股沟管后壁是腹股沟疝手术成败的关键。     

多血管神经蒂腹内斜肌瓣修复面瘫的应用解剖

目的：为了探索晚期面瘫动力性修复中多神经支配的供区，提供多血管神经蒂腹内斜肌瓣的应用解剖学基础。方法：在２２侧红色乳胶灌注的成人尸体上，测量观察了腹内斜肌的神经支配及血供情况。结果：腹内斜肌主要接受第１１肋间神经和肋下神经支配的占９０．９％，接受第１０、１１肋间神经和肋下神经支配的占９．１％。第１１肋间神经入肌处至腋后线的平均长度为１２．７ｃｍ，肋下神经入肌处至腋后线的平均长度为１２．９ｃｍ，血供主要来源于第１１肋间动脉、肋下动脉和旋髂深动脉的腹壁肌支，在腹内斜肌和腹横肌筋膜之间有丰富的血管吻合。结论：可利用腹内斜肌多血管神经支配的特点，设计超长吻合多血管神经蒂的腹内斜肌瓣跨面移植治疗晚期面瘫的新术式。     

阑尾McBurney切口处的局部形态学的研究

目的研究髂腹下神经及髂腹股沟神经与阑尾切除术切口位置的解剖关系,为临床提供参考。方法在福尔马林固定的教学38具(男性21具,女性17具)成人尸体标本上,观察和测量髂腹下神经及髂腹沟神经。结果髂腹下神经在腹内斜肌与腹横肌之间经过者占63.2%(24例),在腹外斜肌腱膜与腹内斜肌之间经过者占10.5%(4例),在腹内斜肌肌层内经过者占26.3%(10例),髂腹下神经距髂前上棘内侧1~40mm的范围内通过脐-右髂前上棘连线的占97.7%;距麦氏点外侧11~50mm的范围内通过脐-右髂前上棘连线的也占到97.7%;髂腹下神经与脐-右髂前上棘连线的向外上的夹角约为83.45°±6.23°(66°~89°),近乎垂直。结论选择阑尾切口时,应在脐-右髂前上棘连线上距髂前上棘不低于40 mm外进行,或选在麦氏点外侧1 cm以内;在分离时也应注意不要扰及距髂前上棘内侧1~40 mm的范围;切口应与脐-右髂前上棘连线垂直,且作切口时不易向下延长超过两髂前上棘连线。     

The iliopubic tract: an important anatomical landmark in surgery

A band of fascial thickening, termed the iliopubic tract, lies on the posterior aspect of the inguinal region and has been described in the surgical literature as playing an important role during herniorraphy. This study was undertaken to examine the gross and microscopic anatomy of the iliopubic tract in 12 cadavers. The results confirmed that the iliopubic tract can be readily identified as a thickening of the transversalis fascia running deep and parallel to the inguinal ligament. It attaches to the superomedial part of the pubic bone medially, but laterally its fibres fan out within the fascia transversalis and fascia iliaca without bony attachment to the iliac spines. In contrast to the inguinal ligament, the histological analysis of the iliopubic tract shows a high elastin to collagen ratio. The functional signficance of this structure merits further study, but there is no doubt that it is important in many approaches to inguinal herniorraphy. For this reason it is considered that the iliopubic tract deserves greater emphasis in the anatomy teaching of the inguinal region.     

腹腔镜腹股沟疝修补术肌耻骨孔的活体解剖学观察及临床意义

目的　探讨腹膜前间隙的解剖学特点,为腹腔镜腹股沟疝修补术的提供手术解剖依据。 方法　对我院30例腹股沟疝患者行LIHR时进行术中解剖观察及术后回顾分析手术视频,通过解剖学绘图描述LIHR手术入路、解剖层次及技术要点。 结果　腹膜前间隙由Retzius间隙和Bogros间隙组成,其间有间隔分开。腹横筋膜由深浅两层结构组成,腹膜与腹横筋膜的深层之间为无血管区域。 腹横筋膜在腹股沟韧带深面增厚形成髂耻束,参与构成股管的内侧壁及腹股沟管的下壁,生殖股神经股支及股外侧皮神经在髂耻束下方通过。 结论　熟悉腹膜前间隙肌耻骨孔区域解剖标志点,是LIHR手术的前提,具有重要临床意义。     

多血管神经蒂腹内斜肌瓣修复面瘫的解剖学基础

目的：为多血管神经蒂腹内斜肌瓣修复晚期面瘫提供解剖学基础。方法：在３６侧成尸标本上,对腹内斜肌的形态、血供及神经支配进行解剖观测。结果：腹内斜肌中部上１／２肌腹主要由第１１肋间神经支配,下１／２肌腹主要由肋下神经支配。上１／２肌腹的血供６６．７％来自第１１肋间后动脉,３３．３％来自旋髂深动脉的髂嵴支;下１／２肌腹的血供主要来自旋髂深动脉的腹壁肌支。第１１肋间神经、肋下神经在腋后线横径分别为２．２ｍｍ和２．４ｍｍ,入肌点距腋后线长分别为１３．３ｃｍ和１３．８ｃｍ。第１１肋间后动脉在腋后线外径为１．７ｍｍ,入肌点距腋后线长为１３．１ｃｍ;旋髂深动脉腹壁肌支和髂嵴支的起始外径分别为１．３ｍｍ和１．８ｍｍ,入肌点至起点长分别为５．１ｃｍ和８．６ｃｍ。结论：吻合多血管神经腹内斜肌瓣移植可全面修复晚期面瘫     

Anatomical basis of neuropathies and damage to the ilioinguinal nerve during repairs of groin hernias. (about 100 dissections)

Surgical access to the inguinal region, notably during hernia repairs, exposes the ilioinguinal nerve to the risk of damage at the origin of the neuralgia. The incidence of these post-operative neuropathies and their medicolegal consequences justify this study about the anatomical variations of the ilioinguinal nerve. With the aim of preventing its damage during repairs of groin hernias and identifying the factors of onset of chronic spontaneous neuropathy of the ilioinguinal nerve, we dissected 100 inguinal regions of 51 fresh adult corpses. The nerve was absent in seven cases and double in one case. Out of the 94 ilioinguinal nerves observed, we analyzed the path in relation to the inguinal ligament and the connections with the walls of the inguinal canal and its content. The ilioinguinal nerve travels along the superficial surface of the internal oblique muscle, passing on average 1.015 cm from the inguinal ligament. In one case, the fibers of the internal oblique muscle spanned it in several places. The nerve was antero-funicular in 78.72% of cases and perforated the fascia of the external oblique in 28.72% of cases. The terminal division took place in the inguinal canal in 86% of cases, with terminal branches that sometimes perforated the fascia of the external oblique. These results enabled us to better understand the etiopathogenic aspects of certain neuropathies of the groin and to propose techniques useful for the protection of the nerve during repairs of groin hernias.     

Emergence and course of the ilioinguinal nerve of the groin

The aim of our study was to find a way of preserving the ilioinguinal nerve during surgical procedures for the repair of inguinal hernias. 40 inguinal regions were dissected, 37 ilio-inguinal nerves studied. The emergence of the nerve was at 4.21 cm of the anterior superior iliac spine, at 0.78 cm of the inguinal ligament on average. Its course was parallel to the inguinal ligament, always lay under the aponevrosis of the external oblique abdominal muscle, it passed through the superficial abdominal ring in 67.56% before proceeding on anterior side of spermatic cord. This result allowed us to examine the possibility of the nerve course variation's, of anastomosis with iliohypogastric nerve and particularly the best way to identify it when surgical procedures are performed in the lower portion of the abdomen.     

Anatomical characteristics of the iliopubic tract: Implications for repair of inguinal hernias

The high recurrence rate of inguinal hernias following primary repair has prompted us to re-examine the anatomy of the inguinal region with particular emphasis on the iliopubic tract (IPT). The IPT is described as an aponeurotic band forming the inferior margin of the transversus abdominis lamina. We documented the presence and degree of development of the IPT in dissections of 151 embalmed inguinal regions and in serial sagittal sections of four body halves. The iliopubic tract was identified in all specimens. It stretched between the anterior superior iliac spine laterally and the pubic tubercle and the pubic tubercle and pectineal line medially. The intervening arch formed a discrete structure of variable thickness and was substantial in 63 specimens. Histological sections demonstrated that the IPT is connected to the inguinal ligament, fascia lata, and anterior femoral sheath and is composed primarily of collagenous fibers with a minor elastic component. These data indicate that the iliopubic tract is a consistent and easily identified structure in the inguinal regions. These results suggest that dissection of the iliopubic tract, like the inguinal ligament, should become an integral part of the assessment of groin anatomy during hernia repair. © 1992 Wiley-Liss, Inc.     

The fascial connections of the pectineal ligament

In clinical settings, the pectineal ligament forms a basic landmark for surgical approaches. However, to date, the detailed fascial topography of this ligament is not well understood. The aim of this study was to describe the morphology of the pectineal ligament including its fascial connections to surrounding structures. The spatial–topographical relations of 10 fresh and embalmed specimens were dissected, stained, slice plastinated, and analyzed macroscopically, and in three cases histological approaches were also used. The pectineal ligament is attached ventrally and superiorly to the pectineus muscle, connected to the inguinal ligament by the lacunar ligament and to the tendinous origin of rectus abdominis muscle and the iliopubic tract. It forms a site of origin for the internal obturator muscle, and throughout its curved course, the ligament attaches to both the fasciae of iliopsoas and the internal obturator muscle. However, dorsally, these fasciae pass free from the bone, while the pectineal ligament itself is adhered to it. The organ fasciae are seen apart from the pectineal ligament and its connections. The pectineal ligament seems to form a connective tissue junction between the anterior and medial compartment of the thigh. This ligament, however, is free to other compartments arisen from the embryonal gut and to the urogenital ridge. These features of the pectineal ligament are important to consider during orthopedic and trauma surgical approaches, in gynecology, hernia and incontinence surgery, and in operations for pelvic floor and neovaginal reconstructions. Clin. Anat. 32:961–969, 2019. © 2019 Wiley Periodicals, Inc.     

A simulation finite element model for the mechanics of the internal oblique muscle: A defense mechanism against inguinal hernia formation?

Simulation of the human muscular system has multiple applications in biomechanics, biomedicine and in the study of motion in general. Mechanical alterations of the normal functioning in the inguinal area (“inguinal shutter”) seems to be involved in the genesis of hernias in adults, but the role of this anatomical mechanisms is poorly understood. A finite element model for the mechanics of the internal oblique muscle allowed creating a dynamic model of the inguinal region applicable to the study of the shutter mechanism as a defence mechanism of contention of the abdominal viscera against development of an inguinal hernia.