1. Pelvic
山东大学医学院 解剖教研室
李振华

2. Bony pelvis
Composition: formed by paired hip bones, sacrum, coccyx, and their articulations
Two portions
Greater pelvis
Lesser pelvis
Terminal line ( pelvic inlet): formed by promontory of sacrum, arcuate line, pectin of pubis, pubic tubercle, upper border of pubic symphysis
Pelvic outlet: formed by tip of coccyx, sacrotuberous ligament, ischial tuberosity, ramus of ischium, inferior ramus of pubic symphysis

3. Muscles of pelvic wall
Piriform m.
Obturator internus m.

4. Muscles of floor of pelvis and pelivic diaphragm
Levator ani 肛提肌
Levateo prostate 前列腺提肌(pubovaginalis 耻骨阴道肌)
Puborectalis 耻骨直肠肌
Pubococcygeus 耻尾肌and iliococcygeus 髂尾肌
Coccygeus 尾骨肌

5. Pelivic diaphragm 盆膈 Superior fascia of pelvic diaphragm 盆膈上筋膜
Levator ani 肛提肌
Coccygeus 尾骨肌
Inferior fascia of pelvic diaphragm盆膈下筋膜

6. Pelvic fascia Parietal pelvic fascia
A continuation of the transverse fascia into the pelvis. It coves the piriformis and obturator internus
Attaches to the arcuate line of the pubis and ilium, thickens over the obturator internus to form the arcus tendineus, the origin of portions of the levator ani muscle
At the tendinous arch of levator ani it splits to cove both superior and inferior surfaces of the levator ani as superior and inferior fascia of pelvic diaphragm

7. Visceral pelvic fascia
Lies between the peritoneum and the pelvic viscera
It is a continuation of the extraperitoneal connective tissue
Ensheathes retroperitoneal viscera and forms septa between retroperitoneal organs
Rectovesical septum 直肠膀胱隔
Rectovaginal septum 直肠阴道隔

8. Retropubic space 耻骨后隙
Lies between pubic symphysis and urinary bladder
Pararectal space
直肠周间隙
Lies around the rectus
Retrorectal space 直肠后隙

9. Common iliac artery 髂总动脉
Continuation of abdominal aorta at level of L4 vertebra
Terminates in front of sacroiliac joint by dividing into internal and external iliac arteries

10. Internal iliac artery 髂内动脉
Parietal iliac artery
Obturator a. 闭孔动脉
Iliolumber a.髂腰动脉
Lateral sacral a 骶外侧动脉
Superior gluteal a 臀上动脉
Inferior gluteal a 臀下动脉

11. Visceral branches Umbilical a.脐动脉→ superior vesical a. 膀胱上动脉
Inferior vesical a.膀胱下动脉
Uterine a.子宫动脉
Inferior rectal a.直肠下动脉
Internal pudendal a 阴部内动脉

13. Uterine a. 子宫动脉—about 2cm from neck of uterus it crosses above and in front of ureter

14. Internal pudendal artery 阴部内动脉
Perineal artery
Anal artery
Dorsal artery of penis (clitoris)

15. External iliac artery Inferior epigastric artery
Deep iliac circumflex artery

16. →superior rectal vein→inferior mesenteric v.
Veins of pelvis
Internal iliac vein 髂内静脉
Parietal tributaries: accompany with arteries
Visceral tributaries
→superior rectal vein→inferior mesenteric v.
①Rectal venous plexus →inferior rectal vein→internal iliac v.
直肠静脉丛 →anal vein→internal pudendal v.
②Vesical venous plexus 膀胱静脉丛→vesical v.
③Uterine venous plexus 子宫静脉丛→uterine v.

17. External iliac vein 髂外静脉– accompany the artery
Common iliac vein 髂总静脉– formed by union of internal and external iliac veins in front of sacroiliac joint, end upon L4~L5 by uniting each other to form inferior vena cava

18. The lymphatic drainage of pelvis
Internal iliac lymph node
Surround internal iliac vessels
Receive afferents from pelvic viscera, perineum, buttock and back of thigh
External iliac lymph nodes
Lie along external iliac artery
Receive afferents from lower limb and some parts of pelvic viscera
Sacral lymph node
Common iliac lymph node
Lie along common iliac artery
Receive afferents from all the above nodes
Efferents pass to lumbar lymph node

19. Sacral plexus 骶丛
Formation: formed by anterior rami of L4 and L5 spinal nerves (the lumbrosacral trunk) and anterior rami of sacral and coccygeal nerves
Position: lies in pelvic cavity, anterior to sacrum and piriformis

20. Branches Superior gluteal Inferior gluteal Pudendal
Posterior femoral cutaneou
Sciatic Common

21. Pudendal nerve block

22. Autonomic plexuses of plevic
Hypogastric plexus
Superior hypogastric plexus 上腹下丛: lies in front of L5 between common iliac ateries
Inferior hypogastric plexus下腹下丛 (pelvic plexus): lie on each side of rectum
Sacral sympathetic trunk
Is continuos above with the abdominal part
Has 4or 5 ganglion

23. Relationships of rectus
Anteriorly
In male
Fundus of bladder
Seminal vesicle
Prostate
Ampulla ductus deferentis
In female
neck of uterus
Vagina

24. Posteriorly
Sacrum and coccyx
Piriformis
Median sacral vessels
Anterior branches of sacral and coccygeal nerves
Sacral sympathetic trunk
Laterally
Pelvic plexus
Superior and inferior rectal vessels
Levator ani

25. Vessels and lymphatics of rectum
Arteries
Superior rectal a.
Inferior rectal a.
Median sacral a.
Lymphatic drainge Lymphatics follow arterial blood supply to following nodes:
Superior rectal ln.
Inferior mesenteric ln.
Pararectal ln.
Internal iliac ln.
Sacral ln.

26. Perineum
山东大学医学院 解剖教研室
李振华

27. General features Region of below pelvic diaphragm
A diamond-shape space whose boundaries are those of the pelvic outlet
Lower border of symphysis pubis
Rami of pubis and ischium
Ischial tuberosities
Sacrotuberous ligament
The coccyx

28. Two triangles
An imaginary line drawn between the two ischial tuberosities divides perineum into anterior and posterior triangles
Urogenital region尿生殖区 (anterior)－differs in male and female
Anal region 肛区 (posterior)－similar in both sexes

29. Anal region 肛区 Anal sphincters 肛门括约肌 Internal External
Smooth muscle (thickened circular muscle coat)
Surrounds upper two-thirds of anal canal
Autonomic nerve supply
External
Striated muscle
Surrounds lower two-thirds of anal canal
Three parts－subcutaneous, superficial and deep
Innervation by anal nerves of pudendal nerve and branches of S4

30. Ischioanal fossa 坐骨肛门窝
Paired, wedge-shaped, fat-filled spaces on either side of anal canal
Boundaries
Apex－conjunctive area of inferior fascia of pelvic diaphragm and fascia covering the obturator internus
Base－skin of anal region
Medial－sphincter ani externus, levator ani, coccygeus and inferior fascia of pelvic diaphragm
Lateral－ischial tuberosity, obturator internus and fascia

31. Anterior
Posterior border of urogenital diaphragm
Forward projection of anterior recess of fossa between pelvic diaphragm above and urogenital diaphragm below
Posterior
backward projection of posterior recess of fossa between gluteus maximus, sacrotuberous ligament and coccyx

32. Contents
Fat
Internal pudendal artery and vein and their rectal branches
Pudendal nerve and its inferior rectal branch
Vessels and nerves enter from gluteal region, through lesser sciatic
foramen, travel on a fascial canal－the pudental canal 阴部管 (Alcock’s)
－on the lateral wall of fossa, and extend forward into urogenital region

33. Branches Superior gluteal Inferior gluteal Pudendal
Posterior femoral cutaneou
Sciatic Common

34. Pudendal nerve block

35. Urogenital region 尿生殖区
Superficial fascia has two layers
The superficial or fatty layer
The deep or membranous layer (superficial fascia of perineum 会阴浅筋膜 or Colles fascia)
Anteriorly－ it is continuous with:
Dartos of the scrotum
Fascia of the penis
Membranous layer of superficial fascia of the abdominal wall known as the fascia of Scarpa
Deep fascia has two layers
Superior fascia of urogenital diaphragm 尿生殖隔上筋膜
Inferior fascia of urogenital diaphragm 尿生殖隔下筋膜

36. Scarpa’s fascia
Camper’s fascia
Line of fusion
Position of penis
Fascia later
Position of scrotum

37. Superficial perineal space
Superior fascia of urogenital diaphragm
Deep perineal space
Inferior fascia of urogenital diaphragm
Superficial perineal space
Fascia of Scarpa
superficial fascia of perineum
Fascia of the penis
Dartos of the scrotum
会阴深隙：上、下两层膜，中间夹着肉，四周均封闭，尿殖管穿过（如座垫）
会阴浅隙：上、下两层膜，中间东西多，三边都封闭，前上方敞着（如口袋）

38. Superficial perineal space 会阴浅隙
Boundaries
Lies between inferior fascia of urogenital diaphragm and superficial fascia of perineum
Space open anteriorly (In rupture of cavernous part of urethra, urine can extravasate from scrotum upward in front of symphysis pubis into anterior abdominal wall deep to membranous fascia of Scarpa)

39. Contents Posterior part－superficial transverse perineal muscle
Lateral part－crus penis (male), crus of clitoris (female) and ischiocavernousus covering them
Central part－bulb of urethra (male), bulb of vestibule (female) and bulbocavernousus covering them
Branches of pudendal nerves and internal pudendal vessels

41. Deep perineal space 会阴深隙
Lies between superior and inferior fascia of urogenital diaphragm
Contents
Deep transverse perineal muscle
Bulbourethral gland (male)
Sphincter of urethra尿道括约肌 (male)，urethrovaginal sphincter尿道阴道括约肌
Ateries, veins and nerves

42. Urogenital diaphragm 尿生殖隔
Triangular in shape
Attached laterally to ischiopubic rami and ischial tuberosities
Formed by sphincter of urethra, deep transverse perineal muscle, superior and inferior fascia of urogenital diaphragm

43. Perineal central tendon 会阴中心腱
Wedge-shape fibromuscular mass
In female, between anal canal and lower end of vagina,
In male, between anal canal and root of penis
It is larger in the female than in the male and five support to the posterior wall of the vagina

44. Origin or insertion of several small muscles and insertion of part of palvic diaphragm
These muscles are:
Sphincter ani externus
Levator ani
Superficial transverse muscle perineum
Deep transverse muscles perineum
Bulbocavernousus
Sphincter of urethra (male) or urethrovaginal sphincter (female)

45. Sphincter of urethra (male) or
urethrovaginal sphincter (female)
Bulbocavernousus
Deep transverse muscles perineum
Sphincter ani externus
Superficial transverse muscle perineum
Levator ani