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。     

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.     

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。     

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。     

膝关节交叉韧带和侧副韧带的断面解剖学研究及其意义

目的研究膝关节交叉韧带和侧副韧带的断面形态特征和变化规律,为诊断膝部韧带病变提供更为详尽的形态学资料。方法利用27例正常成人膝关节标本制作连续断面,其中矢状断面9例,冠状断面12例,横断面6例。通过横、矢、冠状断面标本,观测膝关节韧带的断面形态特征及定量测量。结果矢状面上测量前、后交叉韧带长度分别为(29.66±4.21)mm、(40.26±6.81)mm,厚度分别为(10.03±1.97)mm、(11.24±3.50)mm。冠状面上前、后交叉韧带长径分别为(15.18±3.25)mm、(18.79±3.35)mm,短径分别为(6.37±1.32)mm、(8.03±1.46)mm;胫、腓侧副韧带长度分别为(102.85±19.64)mm、(45.52±14.91)mm,厚度分别为(2.63±0.72)mm、(3.43±1.04)mm。髁间隆起的横断面上胫、腓侧副韧带长径分别为(21.98±11.95)mm、(5.25±1.93)mm,短径分别为(2.03±0.59)mm、(2.87±0.64)mm。结论 (1)观测交叉韧带最好的断面是膝关节正中矢状面,其次是正中旁开1个矢状断面。除厚度外,在矢状面上前后交叉韧带长度、股、胫骨附着区宽度均有明显差异。(2)胫、腓侧副韧带在连续的冠状断面及横断面上均可显示,以冠状断面配合横断面相对为佳。     

盆底补片用于骶棘韧带固定术的临床疗效

目的探讨盆底补片用于骶棘韧带固定术(SSLF)对盆底支持结构的有效性和安全性。方法选取64例中盆腔缺陷患者,采用双盲法随机分为观察组(31例)和对照组(33例)。观察组采用“Y”形补片实施SSLF,对照组采用传统SSLF。比较2组患者围术期相关指标、并发症、手术前后阴道轴向变化、POP-Q分期以及Aa、Ap、Ba、Bp、C指示点位置变化。采用盆底障碍影响简易问卷7(PFIQ-7)、盆底功能障碍问卷简短版20(PFDI-20)、视觉模拟量表(VAS)及POP-Q分期评价疗效。结果所有患者均顺利完成手术。观察组手术时间、术中出血量均短/少于对照组(P<0.05),2组患者并发症、肛门排气时间、尿管留置时间、住院时间比较,差异无统计学意义(P>0.05)。术后6、12个月POP-Q分期以及Aa、Ba、Ap、Bp、C指示点位置组间比较差异均无统计学意义(P>0.05);观察组阴道轴向右侧偏离角度小于对照组,差异有统计学意义(P<0.05);2组患者PFIQ-7和PFDI-20评分较术前均下降(P<0.05),但组间比较差异无统计学意义(P>0.05)。结论SSLF采用补片重建阴道顶端的盆底支持结构,可克服坐骨棘深藏、术野狭窄、操作困难等问题,且具有快捷、微创、治愈率高的特点,对于全身状况欠佳的中盆腔缺陷患者安全、有效。     

颈椎棘上棘间韧带生物力学研究

为明确颈椎棘上、棘间韧带在维持颈椎稳定性中的作用,选用四具新鲜颈椎尸体标本（C2－T1）,建立颈后方棘上、棘间韧带切除生物力学模型,模拟人体颈椎前屈、后伸运动,测量颈椎标本的力学参数变化情况。实验结果表明,切除颈后方韧带结构,使颈椎总体位移加大,轴向刚度减低,倾角增大,C5、C6椎体前缘应变值异常增高,统计学处理差异显著,颈后韧带切除愈多,此趋势愈明显。结论：颈椎棘上、棘间韧带的存在十分重要,它的损伤切除,会使颈椎稳定性能大大降低,可能引发颈椎急、慢性失稳,出现临床症状、畸形。因此,保留颈后棘上、棘间韧带的改良颈椎板成形术较好地解决了此问题。     

Bassett韧带的解剖学研究及其临床意义

目的　通过对Bassett韧带的精细解剖,明确其解剖特点,探讨其功能及临床意义。 方法　取10例成人完整踝关节标本,观察韧带的起止点,走行,毗邻关系,并对相应解剖参数进行精细测量(包括它们的长度、宽度和厚度)。 结果　8例踝关节标本存在Bassett韧带,起自胫骨远端前侧止于腓骨外踝前侧,形状呈四方形,走行与下胫腓前韧带平行,长17.86~18.56 mm,宽3.22~3.89 mm,厚0.67~1.47 mm。 结论　Bassett韧带是一正常韧带组织结构,通过模拟此韧带损伤机制可探讨其造成踝关节前外侧胫距撞击综合征机制。     

The sacrotuberous and the sacrospinous ligament – A virtual reconstruction

Little is known about the morphometric properties of the sacrotuberous ligament (ST) and the sacrospinous ligament (SS). The influence of ligaments on pelvic stability and the extent of reconstruction in case of instability are controversially discussed. The ST and the SS of 55 human subjects fixed in alcohol solution and of four fresh cadavers were measured. Both ligaments were defined as geometric figures. The ST was a contorted bifrustum, while the SS was a contorted frustum, both with elliptic planes. In all cases investigated, the ST and the SS fibres were twisted. For men, the ST and the SS had a mean length of 64 and 38 mm. For women, lengths of 70 and 46 mm were measured in the ST and the SS. The ST length, height and cross-sectional area showed gender-specific differences at statistically significant level. The ST and the SS volumes correlated closely, regardless of gender or side. Measurements of fresh ligaments of four unfixed cadavers showed similar results. The data obtained were then used to generate computer-based three-dimensional models of both ligaments, using the Catia^® software. Conclusively, the virtually generated ST and SS are suitable models to be included in pelvic fracture simulation, using the finite element method.     

Anatomical and surgical considerations of the sacrotuberous ligament and its relevance in pudendal nerve entrapment syndrome

In view of the paucity of literature, this study was undertaken to reappraise the gross anatomy of the sacrotuberous ligament (STL), with the objective of providing an accurate anatomical basis for clinical conditions involving the STL. We studied the gross anatomy of the STL in 50 formalin fixed cadavers (100 sides) during the period of 2004–2005. All specimens exhibited an STL with a ligamentous part and (87%) of specimens exhibited a membranous (falciform) segment, which extended towards the ischioanal fossa. The variations of the falciform extensions were classified into three types. In Type I (69%), the falciform process extended towards and along the ischial ramus to terminate at the obturator fascia. In Type II (108%), the falciform process extended along the ischial ramus, fused with the obturator fascia and continued towards the ischioanal fossa. In addition, the medial border of the falciform process descended to fuse with the anococcygeal ligament, forming a continuous membrane. Lastly, in Type III (13%), the falciform process of the STL was absent. The above mentioned data could have an important implication to the understanding of the relationship between the pudendal nerve and the sacrotuberous ligament and their relevance to pudendal nerve entrapment syndrome.     

寰椎的解剖学测量及其临床意义

目的　探讨寰椎因素致椎 基底动脉供血不足的发病机制及手术切开横突孔减压提供解剖学依据。方法　在5 0例中国成年人干燥寰椎标本上 ,对具有临床意义的数据进行解剖学测量。结果　寰椎横突孔与椎动脉沟的成角左侧为(6 7 87± 5 39)°,右侧为 (6 9 84± 4 5 5 )° ;椎动脉沟绕寰椎侧块成角 :左侧为 (6 2 4 6± 4 6 6 )°,右侧为 (6 3 6 1± 2 31)°。寰椎横突孔前壁厚度 :左侧为 (2 96± 0 5 4 )mm ,右侧为 (3 2 1± 0 4 0 )mm。横突孔后壁厚度 :左侧为 (2 2 8± 0 5 7)mm ,右侧为 (2 0 2± 0 2 6 )mm。以上数据左、右侧比较差异无显著性。结论　椎动脉行经在寰椎横突孔与椎动脉沟内时 ,在骨性结构上有明显的两个成角 ,即横突孔与椎动脉沟的成角和椎动脉沟绕过侧块的成角 ,椎动脉的这两个成角增加了血液循环的阻力 ,同时在头颈部旋转运动时 ,椎动脉与骨性成角间更加贴近 ,这两个成角与椎 基底动脉供血不足的发生有关。寰椎横突孔后壁较前壁薄 ,此数据可作炒寰椎横突孔后壁切开减压时手术参考依据     

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.     

弹簧韧带的解剖观测和MRI分析研究

目的　通过解剖学研究了解弹簧韧带的解剖特点并探讨其功能作用,同时应用MR观察弹簧韧带,分析其在MRI上的显示情况。  方法　解剖并观察弹簧韧带,了解其起止、走形及形态特征等情况,测量相关数据。同时对弹簧韧带不同扫描平面的MRI进行分析研究。  结果　弹簧韧带起于跟骨的载距突,由上内跟舟韧带,内下斜行跟舟韧带和下跟舟韧带3部分组成,分别止于舟骨的上内侧面,舟骨粗隆下和舟骨喙突。MR可以清楚的显示弹簧韧带的各部分结构,在T1及T2加权图像上呈中低信号表现,以矢状面和横断面显示较佳。  结论　弹簧韧带是足底部承载距骨头的一重要韧带复合体结构,对足纵弓的维持具有重要意义,MR可作为弹簧韧带损伤时的诊断工具。     

Anatomical structures at risk using different approaches for sacrospinous ligament fixation

For 50 years now, sacrospinous ligament fixation (SSLF) has been used to treat pelvic organ prolapse consequent on altered integrity of the pelvic myofascial structures. It is usually performed vaginally, but it has recently been performed laparoscopically through either an anterior or a posterior approach, with the broad ligament as a landmark to differentiate the two. In the present study, these two laparoscopic approaches were assessed using Thiel-embalmed cadavers. The anterior and posterior approaches were compared in terms of the closest distance to anatomical structures at risk, including pelvic viscera, the obturator nerve, and vascular structures. The posterior approach was more often closer to the investigated vessels and the rectum. The obturator nerve and the ureter were close to both the anterior and posterior approaches. The urinary bladder was closer using the anterior approach. From an anatomical standpoint, therefore, the anterior laparoscopic approach for SSLF is more likely to cause injury to the urinary bladder, whereas the posterior approach is more prone to causing rectal and vessel injuries. This study illustrates, from a basic science perspective, the importance of combining fascia research, novel endoscopic or minimally invasive surgical exposures informed by anatomy, and contemporary trends in gynecology in order to improve patient outcomes. Clin. Anat. 33:522–529, 2020. © 2019 Wiley Periodicals, Inc.     

腰椎间孔韧带的解剖观测及其临床意义

目的:观察腰椎间孔韧带的形态及特点,以探讨其在腰腿痛发病机制中的作用。方法:取正常人体腰椎防腐标本,解剖椎间孔区,对椎间孔韧带的起止点、形态特征和分布特点等进行观测。结果:所有标本均含有椎间孔韧带,８０%椎间孔存在韧带组织,韧带以上腰椎多见,左右椎间孔韧带分布无对称性。椎间孔韧带平均厚度(０．３６ ± ０．４４)ｍｍ,以带状韧带为主。椎间孔垂直径、神经根孔垂直径和神经根直径分别为(１７．０９±２．９２)ｍｍ、(１１．１９±３．０６)ｍｍ、(４．３７±１．０８)ｍｍ。横孔韧带多分布在上位椎间孔,体横韧带多见于Ｌ５Ｓ１椎间孔处。结论:①腰椎间孔韧带形态变异较大,分布广泛而有一定的规律,应为正常的组织结构;②当椎间孔周围组织出现退变时,椎间孔韧带的存在可能会增加血管和神经根遭遇受挤压的危险性。