Yiou R, Costa P, Haab F, Delmas V
Département d'Anatomie, Université Val-de-Marne Paris-12, 8 rue du Général-Sarrail, 94000 Créteil, France.
Prog Urol. 2009 Dec;19(13):916-25. doi: 10.1016/j.purol.2009.09.002. Epub 2009 Nov 6.
The pelvic floor is the support of the pelvic visceras. The levator ani muscle (LA) with its two bundles (pubo- and ilio-coccygeus) is the major component of this pelvic floor. LA is formed essentially by type I fibers (with high oxidative capability and presence of slow myosin) as in postural muscles. The aerobic metabolism makes LA susceptible to injury caused by excentric contraction and mitochondrial dysfunction. The innervation of the pelvic floor comes from the 2nd, 3rd, 4th anterior sacral roots; denervation affects pelvic dynamism. Perineum includes the musculofascial structures under the LA: ventrally the striated urethral sphincter and the ischio-cavernous and bulbospongious, caudally the fatty tissue filling the ischioanal fossa. Pelvic fascia covers the muscles; it presents reinforcements: the uterosacral and cardinal ligaments, the arcus tendineus fascia pelvis (ATFP) and the arcus tendineus levator ani (ATLA). The pelvis statics is supported by the combined action of all this anatomical structures anteriorly forming the perineal "hammock", medially the uterosacral and cardinal ligaments, posteriorly the rectovaginal fascia and the perineal body. The angles formed by the pelvic visceras with their evacuation ducts participate to the pelvic statics. During the pelvic dynamics the modification of these angles expresses the action of the musculofascial structures.
盆底是盆腔脏器的支撑结构。肛提肌（LA）及其两个肌束（耻骨尾骨肌和髂尾骨肌）是盆底的主要组成部分。LA主要由I型纤维构成（具有高氧化能力且存在慢肌球蛋白），如同姿势肌。有氧代谢使LA易受离心收缩和线粒体功能障碍所导致的损伤。盆底的神经支配来自骶前2、3、4神经根；去神经支配会影响盆腔动力。会阴包括LA下方的肌筋膜结构：腹侧为横纹肌性尿道括约肌以及坐骨海绵体肌和球海绵体肌，尾侧为填充坐骨肛门窝的脂肪组织。盆腔筋膜覆盖肌肉；它有加强结构：子宫骶韧带和主韧带、盆筋膜腱弓（ATFP）和肛提肌腱弓（ATLA）。盆腔静力由所有这些解剖结构的联合作用来支撑，前方形成会阴“吊床”，中间是子宫骶韧带和主韧带，后方是直肠阴道筋膜和会阴体。盆腔脏器与其排泄管道形成的角度参与盆腔静力。在盆腔动力过程中，这些角度的改变体现了肌筋膜结构的作用。
