Otcenasek Michal, Baca Vaclav, Krofta Ladislav, Feyereisl Jaroslav
Institute for the Care of Mother and Child (UPMD), Department of Obstetrics and Gynecology, Prague, Czech Republic.
Obstet Gynecol. 2008 Mar;111(3):622-30. doi: 10.1097/AOG.0b013e3181649e5c.
The endopelvic fascia is a confluent suspensory apparatus of the female pelvic organs. The aim of the study was to construct a three-dimensional model of the endopelvic fascia, defining its shape and its connections to the surrounding parietal structures.
We created a three-dimensional multiple-source computer model to simultaneously visualize and analyze all the structures within the female pelvic floor. This model integrates data from magnetic resonance imaging of 15 nulliparas under age 30 with no symptoms of pelvic floor dysfunction. The model also includes data from direct observation in the dissection laboratory and in surgical rooms, together with the relevant scientific literature.
The endopelvic fascia has the shape of a semifrontally oriented septum, which surrounds the vagina and part of the uterine cervix and divides the pelvic floor into the anterior and posterior compartments. This confluent septum has specific connections to the pubic bone, anterior perineal membrane, perineal body, and superior fascia of the levator ani muscle. Additionally, the uterosacral part of the septum has three subdivisions- the "vascular part," the "neural part," and the true uterosacral ligament. Each of these subdivisions has a different physical link to the parietal structures. Three-dimensional illustrations and schemes were created to facilitate the understanding of the anatomy of these complex structures.
Connecting descriptions of the geometry of the organs visible by magnetic resonance imaging with descriptions of their individual connections to the endopelvic fascia gave us unique information about the three-dimensional representation of the anatomy of the female lesser pelvis. The endopelvic fascia divides the lesser pelvis in a manner that is similar to the way the urorectal septum divides the embryonic cloaca.
盆内筋膜是女性盆腔器官的一个融合性悬吊装置。本研究的目的是构建盆内筋膜的三维模型，明确其形状及其与周围壁层结构的连接。
我们创建了一个三维多源计算机模型，以同时可视化和分析女性盆底内的所有结构。该模型整合了15名年龄在30岁以下、无盆底功能障碍症状的未育女性的磁共振成像数据。该模型还包括在解剖实验室和手术室的直接观察数据，以及相关的科学文献。
盆内筋膜呈半额状隔膜的形状，围绕阴道和部分宫颈，将盆底分为前后两部分。这个融合的隔膜与耻骨、会阴前膜、会阴体和肛提肌上筋膜有特定的连接。此外，隔膜的子宫骶骨部分有三个细分部分——“血管部分”、“神经部分”和真正的子宫骶骨韧带。这些细分部分中的每一个与壁层结构都有不同的物理连接。创建了三维插图和示意图，以促进对这些复杂结构解剖学的理解。
将磁共振成像可见器官的几何形状描述与其与盆内筋膜的个体连接描述相结合，为我们提供了有关女性小骨盆解剖结构三维呈现的独特信息。盆内筋膜对小骨盆的划分方式类似于尿直肠隔对胚胎泄殖腔的划分方式。
