女性盆腔解剖课件.ppt

* 盆腔的肌肉有闭孔内肌、梨状肌和肛提肌。前二肌属髋肌，肛提肌为盆底肌。 1、闭孔内肌：起于闭孔膜内面和周围骨面，肌束向后绕坐骨小切迹，出坐骨小孔转折外行，止于大转子内面。 2、梨状肌：起于骶骨前面，外行经坐骨大孔出骨盆，止于大转子尖。经坐骨大孔时并形成梨状肌上孔和梨状肌下孔，其间有血管神经通过。 3、肛提肌：分为耻骨尾骨肌、髂骨尾骨肌、耻骨直肠肌。为一薄而宽的扁肌，起自骨盆侧壁的肛提肌腱弓（自耻骨联合后方2厘米，沿闭孔内肌筋膜向后延伸，达坐骨棘），纤维斜向后下，止于直肠壁下部（女性还止于阴道下部）。两侧肛提肌下端在前方没有会合，形成被尿道、阴道及直肠所通过的裂隙（泌尿生殖裂），在后方的肛门和尾骨之间，两侧肛提肌在中线融合成一肌板。肛提肌上层的纤维（朝向盆腔面）起自耻骨联合，向后呈“U”形绕过直肠肛管上方，肛提肌这部分纤维称耻骨直肠肌，此肌在功能上对直肠和阴道有重要的括约作用，肛门周围手术时，切勿损伤该肌环。整个肛提肌对于承托盆腔内脏、排便及分娩等具有重要作用。肛提肌如因某些原因扩张、松弛或断裂，都可引起子宫脱垂及直肠脱垂。 * This is a superior view of the pelvis. Be sure to orient yourself in terms of the sacrum, pubis, and left and right os coxae. Also notice the openings for the urethra, vagina, and anal canal. The vessel anterior to the urethra is the deep dorsal vein of the clitoris. The pelvis not only has an anterior, posterior, and lateral boundaries, it also has a floor. The floor of the pelvis is comprised of pelvic floor muscles. Looking down into the pelvis you can see the various pelvic floor muscles. The majority of the pelvic floor is comprised of the levator ani muscle. The levator ani muscle is divided into three areas: puborectalis, pubococcygeus, and iliococcygeus. These muscles are located between the pubis anteriorly, the coccyx posteriorly, and the left and right pelvic walls laterally. It functions to support and raise the pelvic floor. Now go back to the language of medicine and break these terms down into root words, prefixes, and suffixes. For example, pubo- means pubic bone and rect- means rectum. Therefore, the muscle fibers of the puborectalis travel from the pubic bone to the rectum. Apply this same concept to the words pubococcygeus and iliococcygeus. The muscle fibers of the pubococcygeus travel from the pubic bone to the coccyx. The muscle fibers of the iliococcygeus travel from the ilium to the coccyx. Levator = raises, Ani = anus, Pubo = pubis, Coccygeus = coccyx, Ilio = ilium * This is a superior view of the pelvis. Again, orient yourself in terms of the sacrum, pubis