Muscles and fascias of the pelvic fascia pelvis
: connective tissue that occupies the space between the membranous peritoneum and pelvic muscle walls and the floor is not occupied by the pelvic viscera, is then Fascia of endoabdominal which is situated between the abdominal wall muscles and the peritoneum superiorly. Pelvic fascia has been described in parietal and visceral. Fascia
membranous pelvic
is divided into parietal and visceral.
- parietal pelvic fascia, membranous layer that lines the inside of the muscles that form the walls and pelvic floor. Covers the inner surfaces of the muscles, internal shutters, pear, coccygeal, levator ani, and part of the urethral sphincter muscles. Parties are called fascia overlying muscle, is continued upward with the transversalis fascia and iliopsoas.
- visceral pelvic fascia, which lines the way their bodies and adventitia. The parietal and visceral fascia become continuous where the bodies penetrate the soil pélvico. La Fascia parietal se espesa y forma el arco tendinoso de la Fascia pélvica, una banda bilateral que va desde el pubis hasta el sacro a lo largo del suelo pélvico, Anterior se conforma por el ligamento puboprostático en el hombre que une la próstata al pubis o pubo vesical en la mujer donde une la vejiga al pubis, la parte más posterior de este arco tendinoso se extiende como ligamentos sacrogenitales, desde el sacro a los alrededores del recto hasta la próstata en el hombre o hasta la vagina en la mujer.
Fascia endopélvica:
Tejido conectivo entre las capas parietal y visceral, se considera como Fascia pélvica subperitoneal la cual se continua con ambas fascias: parietal y visceral. Es una Fascia fill, composed of areolar connective tissue or fat. Limit the retropubic space and retrorectal. There may be condensation of this fascia and the hypogastric sheath such that leads to the vessels and nerves that pass from the side wall of the pelvis to the pelvic viscera, along with the ureters and the man with the vas deferens. Hypogastric sheath is divided into three layers that pass between the pelvic organs and neurovascular structures are, for this function are called ligaments, most previous film called the lateral ligament of the bladder and bladder vessels are superior and the lamina carries more posterior superior rectal vessels. In man the middle lamella forms a fascial division, rectovesical septum between the posterior surface of the bladder and prostate in the front and the back straight. In women, the middle lamella forms the transverse cervical ligament in its upper portion at the base of the broad ligament peritoneum, the uterine artery.
To understand the muscles of the pelvis is necessary to understand the walls and floor of the pelvis, which is divided into a wall above a rear wall and two side ground, the front wall is formed by the bodies and branches of pubic bones and pubic symphysis, the side walls formed by the innominate bones and the shutter hole that is closed by the obturator membrane, the internal obturator muscles lining the side wall are located medially obturator vessels and nerves and other branches of internal iliac vessels, each internal obturator muscle is a journey back from the pelvis through lesser sciatic hole and rotates in the lateral plane to fit into the greater trochanter of the femur, the surface of these muscles is covered by obturator fascia thickened in the center and the tendinous arch which gives attachment to the pelvic diaphragm, the muscle insertion in a split upper pelvic portion and a lower portion of perineal pelvic portions of these muscles are obturator nerve. The back wall is formed by the sacrum and coccyx and posterolateral walls consist of muscle ligament ligaments associated with the sacroiliac joint and piriformis muscles, medial sacral plexus is located, form a bed "muscle" for this. The pelvic floor consists of the pelvic diaphragm, coccygeal muscle, levator ani, and fascias that cover the top and bottom. Separates the pelvic cavity of the perineum into the pelvis. The levator ani muscle has different portions depending on the direction and insertion of the fibers, up almost the entire floor of the pelvis and divides into three parts:
- Pubococcygeus, the main portion of the levator ani muscle, was born in the back of the pubic body and goes almost horizontal to the rear.
- puborectalis muscle: consists of the medial portion of the pubococcygeus muscle, binds to heterolateral to form a U-shaped loop that goes back to the anorectal junction.
- iliococcygeus: back of the levator ani muscle.
The levator ani muscle supports the pelvic viscera, resists the elevations of intraabdominal pressure, helps maintain the gut pelvic in position. When acting together the parts of this muscle helps to elevate the pelvic floor and helps anterolateral abdominal muscles to increase intra-abdominal pressure, action should be forced expiration, coughing, sneezing, depositions, urination, fecal continence. According
Latarjet Muscles of the pelvic girdle are divided into three groups:
1. Pelvitrocantéricos Muscles:, join the hip bone to the greater trochanter of the femur, are ten and are subdivided in:
gluteal muscles: the more medium and smaller tensor fascia lata. Muscles
pelvitrocantericos themselves: piriformis obturator internus, obturator externus, superior twin, twin lower femoral square.
2. Iliopsoas muscle group, joins the coxal femur through the iliac spine and through the psoas.
3. Adductor muscles of thigh muscle pectineus, adductor magnus, adductor longus, adductor brevis, adductor and gracilis minimum.
pelvic walls are made up (according to moore's anatomy):
lateral pelvic wall: obturator internus
:
Insertion proximal sides of the ilium and pelvic ischium, obturator membrane insertion
Distal femoral trochanter
Nerve: nerve to obturator internus (L5, S1 and S2)
Action: laterally rotates the thigh helps hold the femoral head within the acetabulum
Relationships: has two parts: one part where her face deep intrapelvic the obturator membrane lining the perimeter of the obturator foramen and the quadrilateral surface of the hip bone. His face is covered by fascia superficial obturator, thick, which gives insertion into the middle fibers of the levator ani muscle, the insertion divides the muscle in an upper part of the side wall of the pelvis and lower limiting ischioanal fossa laterally, from which the levator ani muscle forms the medial wall, the muscle leaves the pelvis through the lesser sciatic foramen. Extrapelvic portion: the internal obturator tendon lies between the two twins, upper and lower part of the deep level of the gluteal region, between the piriformis quadratus femoris superiorly and inferiorly, the hip joint above the posterior gluteus maximus, which is separated by the sciatic and posterior femoral cutaneous and inferior gluteal vessels.
rear wall: piriformis muscle
Insertion proximal pelvic side 2 to 4 sacral segments, the upper edge of the greater sciatic notch and ligament insertion sacrotuberous
Distal femoral trochanter
Nerve: ventral rami of S1 and S2
Action: laterally rotates the thigh, between the thigh, helps to hold the head of the femur to the acetabulum.
Relations: is a portion intrapelvic: where the muscle covers the anterior sacral back is covered by a fascia which separates it from the other front and side items, such as the rectum, ureter, internal iliac vessels and branches, is closely related with the sacral plexus. Extrapelvic portion, after passing through the greater sciatic notch, leaving the pelvis and reaches the gluteal region, this portion is covered later by the gluteus maximus, its anterior surface is applied to the hip joint. Is in contact with the gluteus minimus superiorly and inferiorly to the superior twin.
pelvic floor muscle levator ani (pubococcygeus, puborectalis, iliococcygeal)
proximal Insertion: body of pubis, tendinous arch of obturator fascia, ischial spine
Insertion of distal perineal body, rump anococcygeal ligament, walls of a prostate or vagina, rectum and anal canal.
Nerve: nerve to the levator ani muscle (branches of S4), inferior anal nerve, coccygeal plexus
Action: holding the pelvic viscera and resist increases in abdominal pressure
isquiococcígeo
muscle: proximal insertion
:
ischial spine insertion of distal lower end of the sacrum
Innervation: branches of S4 and S5
Action: form a small part of the diaphragm of the pelvis and supports the pelvic viscera and flexes the coccyx.
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