骶结节韧带和骶棘韧带的解剖定位研究

目的通过测量骶结节和骶棘韧带附着处附近的骨性标志间的距离,获得两条韧带的解剖定位方法及其体表投影位置,为临床相关应用提供解剖学依据。方法 20例(男、女性各10例20侧)正常成人防腐骨盆标本,用游标卡尺测量同侧髂后上棘至坐骨结节、髂后上棘至坐骨棘、髂后上棘至第4骶椎横突结节、髂后上棘至骶角、坐骨结节至坐骨棘、坐骨棘至骶角、坐骨结节至骶角的距离,并进行性别比较。结果男、女性骨盆髂后上棘至坐骨结节距离分别为(12.19±0.49)cm和(11.20±0.39)cm(P0.05);髂后上棘至骶角距离(7.62±0.50)cm和(6.70±0.92)cm(P0.05)。骶结节韧带的体表投影线为同侧髂后上棘至骶角连线中点与坐骨结节的连线;骶棘韧带的体表投影线为同侧髂后上棘至坐骨结节连线的上3/4与下1/4交点(坐骨棘位置,约距髂后上棘8.5cm)与骶角的连线。结论本研究不仅丰富了人类学数据,且提供的体表定位方法,为临床相关应用和康复治疗提供解剖学参考。     

女性骶棘韧带区域应用解剖研究

目的　研究女性尸体标本骶棘韧带（sarospinous ligament,SSL）的解剖特点及其毗邻,为骶棘韧带固定术提供解剖学参考。 方法　对24具女性尸体进行解剖,测量相关参数。 结果　SSL长度右侧为（5.11±0.30）cm,左侧为（5.10±0.36）cm;两侧长度无明显差别。24具尸体阴部管最内侧均为阴部神经,其与坐骨棘距离为右侧（1.51±0.35）cm,左侧（1.61±0.31）cm。SSL薄且坚韧,所有标本的平均厚度约0.2 cm。尾骨肌位于SSL盆腔侧,层厚远大于SSL,且覆盖范围更大,二者联系紧密,重合部分可视为整体。臀下动脉均走行于SSL上缘及以上出骨盆,其中7条经坐骨棘端出骨盆。坐骨神经远离SSL。SSL盆腔面未见重要血管神经束。有少量血管及神经走行于SSL背侧。 结论 行骶棘韧带固定术时应选择离右侧坐骨棘至少1.51 cm、左侧至少1.61 cm处作为悬吊点。     

正常人骨盆骶棘韧带的解剖学及MRI成像研究

目的　明确骶棘韧带MRI最佳扫描平面角度并探讨其临床意义。 方法　（1）正常成人新鲜尸体骨盆标本8具,观察骶棘韧带起止点及其形态特点;（2）利用36例正常人骨盆CT数据,测量骶棘韧带在矢状面上的投影与冠状面的角度;（3）对10名志愿者进行3D MRI扫描,记录骶棘韧带角度并与CT数据对比;比较斜冠状面与常规3个面的显像效果。 结果　（1）骶棘韧带起于骶尾部连接至坐骨棘。（2）骶棘韧带在矢状面上的投影与冠状面的角度CT数据测量结果为（61.32±8.71）°, 在双侧及性别上无统计学差异（P>0.05）;（3）MRI测量结果为（57.53±2.12）°。CT数据与MRI数据比较无统计学差异（P>0.05）;斜冠状面的成像优于常规扫描（P <0.05）。 结论　骶棘韧带MRI扫描在（60.0±5.0）°斜冠状面上显像较好,是常规扫描的重要补充。     

腰椎横突间韧带的解剖学观测及意义

目的　通过对腰椎横突间韧带的解剖学观测,为极外侧型腰椎间盘突出症的手术治疗提供解剖学基础。 方法　15具经防腐固定的成人尸体标本,解剖观测腰椎横突间韧带,用游标卡尺测量其长度、宽度和厚度。 结果　L1~2横突间韧带长度（1.67±0.39）cm,宽度（0.80±0.23）cm,厚度（0.09±0.04）cm;L2~3横突间韧带长度（1.80±0.35）cm,宽度（0.94±0.23）cm,厚度（0.09±0.06）cm;L3~4横突间韧带长度（1.72±0.25）cm,宽度（0.95±0.21）cm,厚度（0.09±0.03）cm;L4~5横突间韧带长度（1.50±0.20）cm,宽度（1.04±0.23）cm,厚度（0.09±0.04）cm。 结论　腰椎横突间韧带为经横突间入路（含内窥镜下）治疗极外侧腰椎间盘突出症的重要解剖学标志,熟悉其解剖形态特点对于此类手术具有重要意义。     

骶棘韧带阴道固定术的临床解剖学

在26侧成人女性盆腔正中矢状剖面标本上,观察测量了骶棘韧带的长度与附着部宽径、骶棘韧带的周围邻接关系,对以骶棘韧带作为悬吊物施行阴道固定术缝合安全区作了解剖学研究,并讨论了临床应用要点.     

骶直肠筋膜在轴向腰椎椎间融合术中的应用解剖

目的　观察骶直肠筋膜在轴向腰骶椎椎间融合术中的应用解剖。 方法 10具(20侧)男女骨盆标本,观察骶直肠筋膜的位置,并进行相关解剖学测量。 结果　①骶直肠筋膜起自S3者较多,为44.4%,将骶前间隙分为上下两部分;②男性骶直肠筋膜跨越直肠两侧连于骨盆腔壁腹膜,女性的则两侧跨越直肠后连于直肠子宫襞;③骶直肠筋膜长度（23.14±1.41）mm、厚度（1.25±0.13）mm,距离手术切口（66.10±7.03）mm、距离S1/S2横线中点（23.09±1.87）mm。 结论　①骶直肠筋膜在骶前间隙内普遍存在,术中应对其进行锐性分离以避免骶前静脉丛撕裂伤;②女性骶直肠筋膜可能为子宫骶韧带的一部分。     

子宫骶韧带的应用解剖

目的:为临床开展子宫骶韧带悬吊术治疗子宫脱垂及阴道膨出提供解剖学基础资料。方法:取正常成年女性防腐标本15具,其中10具半侧盆腔标本,观测子宫骶韧带及相邻结构解剖形态。结果:子宫骶韧带大部分与第1~3骶椎相连,与第4骶椎多不相连;子宫骶韧带分颈部、中间部、骶骨部,其分别距离输尿管的长度为(0.8±0.5)cm、(2.4±0.8)cm、(4.0±0.7)cm;输尿管盆部分3段,其长度分别为:壁内段(4.6±0.9)cm,子宫主韧带内段(1.7±0.5)cm,膀胱后间隙内段(2.4±0.6)cm。输尿管膀胱后间隙内段距离坐骨棘的长度为(4.8±2.0)cm。结论:子宫骶韧带及相邻结构的解剖形态对临床开展子宫骶韧带悬吊术治疗子宫脱垂及阴道膨出有重要的指导意义。     

骶髂关节韧带应用解剖学意义

背景：骨盆后部结构中,骶髂后韧带复合体、骶结节韧带和骶棘韧带的完整,对骨盆稳定性有重要作用。 目的：观察骶髂关节周围韧带解剖结构,了解各韧带对关节稳定性的作用。 方法：对20具防腐成年尸体骨盆标本,共40侧依次采用前后方入路,对骶棘韧带,骶结节韧带,耻骨联合及骶髂关节诸韧带结构进行解剖学观察。 结果与结论：骶髂关节周围韧带可分为3组：骶髂前韧带、骶髂骨间韧带和骶髂后韧带。耻骨上下韧带及耻骨前后韧带。骶棘韧带和骶结节韧带。此3组韧带主要有两个功能：连接脊柱和骨盆环;维持骨盆环的稳定。     

骶髂关节未经影像学引导下穿刺的解剖学基础

目的　为临床骶髂关节未经影像学引导下穿刺的可行性和安全性提供解剖学基础。 方法　对3例已固定好的骶髂关节断层标本,4例干燥骨盆(男女各2例),4例防腐骨盆（男3例,女1例）和62例强直性脊柱炎患者（男32例,女30例）骶髂关节CT平扫图及三维重建进行解剖观察和测量,以髂后上棘下的骶髂关节矢状滑膜部为穿刺目标。 结果　男女矢状滑膜部矢状长度分别为（18.40±3.40）mm 和（17.32±3.60）mm（P>0.05）;男女矢状滑膜部到后正中线的距离分别为（41.00±3.30)mm和（42.74±4.00)mm（P<0.05）;男女矢状滑膜部中点与髂后上棘距离分别为（27.66±3.10)mm和（28.76±3.50)mm（P>0.05）。 结论　根据性别,脂肪厚度等不同情况在距离后正中线（41.00±3.50）mm的范围,髂后上棘下（28.00±3.20）　mm这一区域进行未经引导下穿刺可使穿刺较容易进入骶髂关节,使得穿刺成功率提高。     

女性盆底子宫骶主韧带MRI的观察研究

目的通过MRI不同序列对健康女性盆底扫描,比较两种扫描序列对子宫骶主韧带的显示图像特点和清晰度,选择优化MRI扫描序列进一步三维建模研究女性盆底功能障碍。方法选择无盆底功能障碍性疾病的健康女性10例,分别采用质子密度加权自旋回波序列和TSE T2WI序列行盆底薄层MR成像,获得连续薄层断面的图像集,在横断面分别观察骶主韧带起源及终止点,观察每层的显示情况,辨认盆底器官与子宫骶主韧带解剖位置及与周围器官的关系,通过同一检查者相同的每一层辨认评分,比较两种扫描序列对子宫骶主韧带的显示图像辨认率和清晰度。结果质子密度加权自旋回波序列对子宫骶主韧带的显示优于TSE T2WI,有显著性差异（P〈0.05）,能更清楚地显示骶主韧带边界。10例检查者中骶韧带起自骶骨2例（20%）、尾骨肌/骶棘韧带复合体6例（60%）、坐骨棘2例（20%）;插入宫颈3例（30%）、阴道1例（10%）、宫颈和阴道6例（60%）;主韧带起自同侧骨盆侧壁坐骨大孔,解剖末端7例（70%）至宫颈,1例（10%）至阴道,2例（20%）至宫颈和阴道。结论采用MRI质子密度加权自旋回波脉冲序列对女性盆底成像,可清楚显示盆底器官与子宫骶主韧带解剖位置及与周围器官关系,活体骶主韧带解剖起止点、走行方向,与临床解剖对子宫骶主韧带观察一致,为探讨子宫脱垂患者的骶主韧带解剖改变与功能障碍关系奠定了研究基础。     

骶韧带耻骨阴道肌筋膜交叉缝合术联合骶棘韧带悬吊术治疗盆腔器官脱垂

目的探讨骶韧带耻骨阴道肌筋膜交叉缝合术联合骶棘韧带悬吊术治疗中、重度盆腔器官脱垂的临床应用价值。方法回顾分析我院应用骶韧带耻骨阴道肌筋膜交叉缝合术联合骶棘韧带悬吊术治疗32例中、重度盆腔器官脱垂患者的临床资料。结果 32例盆腔器官脱垂患者均以中盆腔、前盆腔缺陷为主,子宫脱垂程度均为Ⅲ度以上,都合并不同程度的阴道前后壁脱垂。行经阴道全子宫切除术+阴道前后壁修补术+骶棘韧带悬吊术+骶韧带耻骨阴道肌筋膜交叉缝合术(有压力性尿失禁患者加行尿道后韧带折叠术)。手术时间60~120 min,失血量100~300 m L,无严重并发症发生。32例术后无1例复发。结论骶韧带耻骨阴道肌筋膜交叉缝合术可显著减少骶棘韧带悬吊术治疗盆腔器官脱垂术后前盆腔缺陷复发概率,可显著加固前盆腔,且简单、安全、有效,值得在临床推广运用。     

Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament

The pudendal nerve (S3-S5) is a major branch of the sacral plexus. After branching from the sacral plexus, the pudendal nerve travels through three main regions: the gluteal region, the pudendal canal, and the perineum. In the gluteal region, the pudendal nerve lies posterior to the sacrospinous ligament. The relationship of the pudendal nerve to the sacrospinous ligament has important clinical ramifications, but there is a lack of literature examining the variations in pudendal nerve anatomy in the gluteal region. This study investigates the pudendal nerve trunking in relation to the sacrospinous ligament in 37 cadavers (73 sides of pelves) of 21 males and 16 females, ranging from 18-83 years of age. Pudendal nerve trunking could be grouped into five types: Type I is defined as one-trunked (41/73; 56.2%), Type II is two-trunked (8/73; 11%), Type III is two-trunked with one trunk as an inferior rectal nerve piercing through the sacrospinous ligament (8/73; 11%), Type IV is two-trunked with one as an inferior rectal nerve not piercing through the sacrospinous ligament (7/73; 9.5%), and Type V is three-trunked (9/73; 12.3%). In summary, 56.2% of pudendal nerves adjacent to the sacrospinous ligament were one-trunked, 31.5% were two-trunked and 12.3% were three-trunked. Fifteen inferior rectal nerves originated independently from the S4 root and never joined the main pudendal nerve. Eight of fifteen inferior rectal nerves pierced through the sacrospinous ligament, perhaps making it prone for entrapment. We measured the average diameter of the main trunk of the pudendal nerve to be 4.67 +/- 1.17 mm. We also measured the average length of the pudendal nerve trunks before terminal branching to be 25.14 +/- 10.29 mm. There was no significant statistical difference in the average length, average diameter, number of trunks, and pudendal nerve variations between male and female or right or left sides of the pelves. A detailed study of pudendal nerve trunking in relationship to the sacrospinous ligament would be useful for instruction in basic anatomy courses and in relevant clinical settings as well.     

A systematic review of the morphology and function of the sacrotuberous ligament

The sacrotuberous ligament (STL) has been linked to conditions such as pelvic girdle pain and pudendal nerve entrapment, yet its contribution to pelvic stability is debated. The purpose of this review was to explore the current understanding of the STL and highlight any gaps in knowledge regarding its anatomy and function. A systematic search of the literature was conducted, focussing on the morphology and attachments of the STL, the relationship of the STL with surrounding structures, and its neurovascular supply and function. A total of 67 papers and four textbooks were obtained. The attachment sites of the STL are largely consistent; however, the extent of its connections with the long head of biceps femoris, gluteus maximus, piriformis, the posterior layer of the thoracolumbar fascia, and sacrospinous ligament are unclear. Morphometric parameters, such as mean STL length (6.4–9.4 cm), depth (0.3–0.4 cm), and width (1.8–3.5 cm, at its mid‐point) are variable within and between studies, and little is known about potential side‐, age‐, or sex‐related differences. The STL is pierced in several sites by the inferior and superior gluteal arteries, but information on its innervation pattern is sparse. Functionally, the STL may limit sacral nutation but it appears to have a limited contribution to pelvic stability. Some morphological aspects of the STL warrant further investigation, particularly its connections with surrounding structures, innervation pattern and function. Knowledge of the detailed anatomy and function of this ligament is important to better understanding its role in clinical conditions. Clin. Anat. 32:396–407, 2019. © 2018 Wiley Periodicals, Inc.     

新鲜标本的下胫腓联合韧带解剖特点及临床意义

目的： 研究新鲜标本下胫腓联合韧带的解剖学特点,为下胫腓联合韧带相关损伤及韧带重建提供解剖学依 据。方法： 选取新鲜胫腓下联合标本,剥离新鲜标本的下胫腓联合的肌、血管及筋膜组织,对下胫腓联合前、后、 横韧带进行解剖学测量,包括胫腓下联合前、后、横韧带的近端长度、远端长度、平均宽度、与水平面的夹角、 冠状面的夹角等相关解剖学数据。结果： 下胫腓联合前韧带近、远端平均长度为（8.51±0.70）mm、（19.03±1.35） mm,平均宽度（15.98±1.17） mm,与水平面、冠状面夹角分别为（42.27±3.43）°、（20.50±4.69）° ;下胫腓联 合后韧带近、远端平均长度为（9.32±0.62）mm、（16.92±1.76）mm,平均宽度（14.36±0.88）mm,与水平 面、冠状面夹角分别为（40.96±3.16）°、（13.10±1.99）°;下胫腓联合横韧带近、远端平均长度为（18.46±2.48） mm、（21.87±2.52）mm,平均宽度（4.56±0.17）mm,与水平面、冠状面夹角分别为（30.60±3.65）°、（13.48±1.60）°。 对左右、男女的下胫腓联合前、后、横韧带的解剖学数据进行对比,差异均无统计学意义。结论： 了解下胫腓联 合韧带各解剖结构及其特点,有助于指导下胫腓联合韧带损伤的修复和重建,帮助外科医生制定手术方案,改善 预后。     

Surgical and clinical anatomy of the interclavicular ligament

Dislocation of the sternoclavicular joint can be associated with life-threatening complications; therefore, a thorough knowledge of the ligaments contributing to sternoclavicular joint stability is essential for the clinician dealing with this anatomical area. The aim of our study was to examine the anatomy of the interclavicular ligament. We examined 50 human cadavers. The interclavicular ligament was identified in 90% of the specimens. The interclavicular ligament was located at the base of the sternal notch in 50% of the cases and connected the superior portions of the capsule of the sternoclavicular joints of each side. The interclavicular ligament connected with the posterior superior aspect of each medial end of the clavicle and with the fibers of the posterior and anterior interclavicular ligaments forming a continuous ligamentous layer. The mean length of this ligament was 2.1 cm, the mean width was 0.72 cm and the mean thickness was 0.36 cm. With the elevation of the shoulder joint and the abduction of the humerus, the interclavicular ligament remained lax. With the depression of the shoulder joint and the adduction of the humerus, this ligament became fully taut. As a result, the interclavicular ligament prevented the upward displacement of the clavicle during forceful depression of the humerus and the shoulder. The tensile force necessary for failure was >53.7 N/cm² in all the specimens. These data may be useful to surgeons for instituting techniques for surgical procedures that reconstruct the sternoclavicular joint. Moreover, a future study aimed at evaluating the long-term consequences of surgical transection of this ligament may be in order.     

膝关节前外侧韧带测量及其临床意义

目的 测量膝关节前外侧韧带（ALL)的相关解剖学参数及即其出现率、形态和解剖关系。 方法 选择国人成人尸体下肢标本40例,解剖膝关节前外侧区域,分离前外侧韧带,观察其与邻近组织的位置关系,并测量膝关节屈曲90°时其长度,关节线水平的宽度以及厚度。 结果 膝关节屈曲90°时,前外侧韧带的长度为（38.04±6.14）mm,关节线水平的宽度为（5.39±2.80）mm,厚度为（0.93±0.52）mm。 结论 前外侧韧带作为膝关节前外侧一个独特的、确切存在的韧带,对维持人体膝关节稳定性具有重要意义。     

膝关节前交叉韧带的解剖学观测

在50侧尸体膝关节上,对前交叉韧带的股骨附着区、胫骨附着区、长度、方向和宽度进行了形态学测量,提供了详细的数据。股骨附着区呈椭圆形,胫骨附着区似三角形。前交叉韧带本身呈50°扭曲状态,随屈膝程度的增加,其扭曲程度也增加,这种变化的幅度,在韧带表面的纤维较中心部位者为大,这与前交叉韧带两附着区的形态有密切关系,尤其是股骨附着区。     

膝关节腓侧副韧带的解剖学观察及其临床意义

目的 对国人膝关节腓侧副韧带进行解剖观察,以积累国人体质资料和为临床腓侧副韧带修复与重建提供解剖学依据.方法 对61侧成人膝关节标本进行解剖,观察与测量腓侧副韧带形态及与周围结构关系.结果 腓侧副韧带恒定出现,长(61.41±6.21)mm,中点宽(4.14±0.74)mm,厚(1.96±0.37)mm.腓侧副韧带与腘...     

Lateral collateral ligament and anterolateral ligament of the knee – A morphological analysis with orthopedic significance

BackgroundThe lateral collateral ligament (LCL) is the chief stabilizer of the lateral aspect of the knee to varus forces. Studies have confirmed the function of the anterolateral ligament (ALL), which improves the lateral knee stability by preventing excessive internal tibial rotation. Clinically, a persistent instability following anterior cruciate ligament reconstruction may be due to damage to the anterolateral structures. The finding has created a novel interest in anterolateral extra-articular operations.MethodsThis observational, cross-sectional study involved 42 dissected adult knees. The variations in morphology and morphometry of the LCL were identified and classified. The prevalence and the variabilities in the ALL were also noted.ResultsThe variations in the shape of the LCL were classified into four types: (1) cord, (2) band, (3) mixed, and (4) inverted Y shaped, with a frequency of 69.04, 26.20, 2.38, and 2.38% of specimens, respectively. The cord type measured 50.4 ± 2.7 mm in length and 5 ± 0.9 mm in width. In comparison, the band type measured 50.1 ± 4.2 mm in length and 9 ± 1.6 mm in width. The ALL was identified in four (9%) of the specimens with a mean length of 35 ± 0.9 mm. Two types of ALL were observed, membranous wideband and distinct cord-like ALL.ConclusionThe anatomy of the lateral structures of the knee is inconsistent. The study has attempted to classify the different shapes of the LCL along with the frequency and prevalence of the ALL. Orthopedic surgeons and radiologists must note the LCL morphology and prevalence of the ALL due to their clinical implications.