Bony ypelvis. Composition: formed by coccyx, and their articulations Two portions

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1 Pelvis

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4 Bony ypelvis 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: t formed by tip of coccyx, sacrotuberous ligament, ischial tuberosity, ramus of ischium, inferior ramus of pubic symphysis

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8 Anterior wall of the pelvis (posterior view)

9 Posterior wall of the pelvis

10 Lateral wall of the pelvis

11 Inferior wall or floor of the pelvis

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

13 Muscles of floor of pelvis and pelivic diaphragm Muscles of floor of pelvis 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 yg Coccygeus 尾骨肌

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15 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

16 Pelvic fascia Parietal pelvic fascia A continuation of the transverse fascia into the pelvis. It covers 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 cover both superior and inferior surfaces of the levator ani as superior and inferior fascia of pelvic diaphragm

17 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

18 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

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20 Sagittal section of the male pelvis

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26 Sagittal section of the female pelvis

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

32 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

33 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

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

36 Internal pudendal artery 阴部内动脉 Perineal artery Anal artery artery of penis (clitoris)

37 External iliac artery Inferior epigastric artery Deep iliac circumflex artery

38 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.

39 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

40 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

41 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

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43 Branches Superior gluteal Inferior gluteal Pudendal Posterior femoral cutaneou Sciatic Common

44 Pudendal nerve block

45 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 4 or 5 ganglion

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

47 Posteriorly Sacrum and coccyx Piriformisif i Lateral sacral vessels Anterior branches of sacral and coccygeal nerves Sacral sympathetic trunk Laterally Pelvic plexus Superior and inferior rectal vessels Levator ani

48 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 Superior rectal ln. Inferior mesenteric ln. Pararectal ln. Internal iliac ln. Sacral ln.