發(fā)布時間：2018-12-18 11:36

【摘要】：目的:研究閉膜管的管徑和長度;閉孔神經(jīng)在閉膜管外的分支長度、寬度和厚度及終支數(shù),為臨床上診斷和治療盆腔出口綜合癥提供解剖學(xué)基礎(chǔ)。 材料與方法:解剖清理12具(共24例)尸體標(biāo)本,年齡不詳。其中男性8具,女性4具,盆部外觀無破損,且排除盆內(nèi)病變。暴露研究區(qū)域,測量閉膜管的內(nèi)徑和長度,并對閉孔神經(jīng)分支及其肌支進行相關(guān)測量,并使用統(tǒng)計軟件對數(shù)據(jù)進行處理。 結(jié)果: (1)閉膜管是閉孔神經(jīng)由盆腔至股部通過的骨纖維管,其上方是恥骨的閉孔溝,下方是閉孔膜、閉孔內(nèi)肌和閉孔外肌之上緣。管的走向與腹股溝管相似,由外側(cè)向前內(nèi)下方。外口的橫徑為(4.22±8.8)mm,長度為(1.45±2.3 )mm。 (2)閉孔神經(jīng)前支、后支分叉處多在閉膜管內(nèi),也存在盆內(nèi)分支與管外分支的情況。在盆內(nèi)分支的共有2例,分支點距離閉膜管外口的平均長度為(28.22±3.42)mm,最大值45.42mm,最小值24.26mm。在閉膜管內(nèi)分支的共有19例,分支點距離閉膜管外口的平均長度為(20.13±3.32)mm,最大值37.43 mm ,最小值7.87mm。在盆外分支的共有3例,分支點距離閉膜管外口的平均長度為(13.62±2.34)mm,最大值21.81 mm,最小值12.34mm。 (3)閉孔神經(jīng)前支的寬度為(5.13±0.42)mm ,厚度為( 0.56±0.12)mm。后支的寬度為(3.04±0.64)mm,厚度為(0.51±0.14)mm。 (4)閉孔神經(jīng)的各肌支:長收肌支,都來自前支,長度為(80.31±6.42)mm,寬度為(8.65±2.13)mm,厚度為(1.95±0.34)mm,終支數(shù)為4.2;短收肌支,多來自前支,少數(shù)來自后支,長度為(59.54±2.45)mm,寬度為(3.06±1.22)mm,厚度為(0.26±0.05)mm,終支數(shù)為2.3;股薄肌支,都來自前支,長度為(118.27±5.76)mm,寬度為(2.53±1.46)mm,厚度為(0.47±0.03)mm,終支數(shù)為4.8;恥骨肌支,多來自后支,少數(shù)來自神經(jīng)干,長度為(16.02±2.45)mm,寬度為(1.85±0.39)mm,厚度為(0.28±0.02)mm,終支數(shù)為1.1;大收肌支,都來自后支,長度為(133.27±9.43)mm,寬度為(5.23±2.53)mm,厚度為(0.59±0.09)mm,終支數(shù)為5.6。 結(jié)論: (1)封閉法治療盆腔出口綜合癥(實施骨盆外閉孔神經(jīng)阻滯麻醉)進針部位應(yīng)為以長收肌外緣與腹股溝韌帶下緣交點處(即恥骨結(jié)的外下方1-2cm處。 (2)手術(shù)治療盆腔出口綜合癥時,從恥骨支向股內(nèi)下方弧形切口,在長收肌止點處切斷該肌,翻起后,尋找閉孔神經(jīng)前后支,沿神經(jīng)尋找其交匯處。 (3)閉孔神經(jīng)離斷術(shù)時,尋找到前后支后,選擇在閉膜管外口處切斷閉孔神經(jīng)前后支或閉孔神經(jīng)主干。
[Abstract]:Objective: to study the diameter and length of the obturator canal, the length, width and thickness of the obturator nerve branch outside the obturator canal, and to provide anatomic basis for the clinical diagnosis and treatment of pelvic outlet syndrome. Materials and methods: 12 cadavers (24 cases) with unknown age were dissected. There were 8 males and 4 females. The appearance of the pelvis was not damaged, and the pelvic lesions were excluded. The inner diameter and length of obturator tube were measured, and the branch of obturator nerve and its muscle branch were measured. The data were processed by statistical software. Results: (1) the obturator canal is the osseous fibrous canal of obturator nerve from pelvic cavity to femoral part, which is superior to obturator sulcus of pubis and superior edge of obturator membrane, internal obturator muscle and external obturator muscle. The direction of the tube is similar to that of the inguinal canal, from the lateral front to the inside. The transverse diameter of the external orifice is (4.22 鹵8.8) mm, and the length is (1.45 鹵2.3) mm.. (2) the branches of the anterior branch and posterior branch of obturator nerve are mostly in the obturator tube, and there are also the branches in the basin and outside the canal. There were 2 cases of intrapelvic branches. The average length of the branch point was (28.22 鹵3.42) mm, and the minimum value was 24.26mm. In 19 cases, the average length of the branch point was (20.13 鹵3.32) mm, the maximum value was 37.43 mm, and the minimum value was 7.87 mm. There were 3 cases of extrapelvic branches. The average length of the branch point to the outer orifice of the closed membrane tube was (13.62 鹵2.34) mm, the maximum value was 21.81 mm, the minimum value was 12.34 mm. (3) the width of the anterior branch of obturator nerve was (5.13 鹵0.42) mm,) and (0.56 鹵0.12) mm.. The width of the posterior branch is (3.04 鹵0.64) mm, and the thickness is (0.51 鹵0.14) mm.. (4) the muscular branches of obturator nerve: the long adductor muscle branches came from the anterior branch, the length was (80.31 鹵6.42) mm, width was (8.65 鹵2.13) mm, thickness was (1.95 鹵0.34) mm, terminal branch was 4.2; The short adductor muscle branch, mostly from the anterior branch, and a few from the posterior branch, the length was (59.54 鹵2.45) mm, the width was (3.06 鹵1.22) mm, the thickness was (0.26 鹵0. 05) mm, terminal branch was 2.3; The length was (118.27 鹵5.76) mm, the width was (2.53 鹵1.46) mm, the thickness was (0.47 鹵0.03) mm, terminal branch was 4.8; Most of the Rami pubis came from the posterior branch, and a few came from the nerve trunk, the length was (16.02 鹵2.45) mm, the width was (1.85 鹵0.39) mm, the thickness was (0.28 鹵0.02) mm, terminal branch was 1.1; The length of adductor Magnus was (133.27 鹵9.43) mm, the width was (5.23 鹵2.53) mm, the thickness was (0.59 鹵0.09) mm, final branch was 5.6. Conclusion: (1) in the treatment of pelvic outlet syndrome (to carry out external obturator nerve block anesthesia), the needling position should be at the point of intersection between the external edge of adductor longus and the inferior edge of inguinal ligament (that is, 1-2cm below the pubic junction). (2) in the surgical treatment of pelvic outlet syndrome, an arc incision was made from the pubic branch to the lower part of the medial femoris, the adductor muscle was cut off at the point where the adductor muscle was stopped, and the anterior and posterior branches of the obturator nerve were searched for the intersection along the nerve. (3) after the anterior and posterior branches of obturator nerve were found, the anterior and posterior branches of obturator nerve or the main trunk of obturator nerve were cut off at the external orifice of obturator canal.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R322.85

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