Labat J J, Robert R, Bensignor M, Buzelin J M
Service de Rééducation fonctionnelle, CHU Nantes.
J Urol (Paris). 1990;96(5):239-44.
The anatomic study of the pudendal nerve and its relation allows an approach of the mechanisms of compression likely to engender perineal neuralgia. Two conflictual zones are isolated: the first is linked to the clamp which is produced by the insertion of the sacro-epinous ligament on the ischial spine and the sacro-tuberal ligament; the second is linked to the falciform process of the sacrotuberal which threatens the nerve by its sharp upper edge. This conflict is particularly acute in a sitting position. The relation between the trunk of the nerve, its branches and these zones of conflict may explain the clinical observations. The electrophysiological investigations (detection of neurogenic muscles of the perineal floor. Increased sacral latency, pudendal nerve terminal motor latency) confirm the diagnosis. The anesthetic blocks of the pudendal nerve on the ischial spine only have a complimentary diagnostic value. The peridural blocks may also have an interesting therapeutic action (60% of good results 3 months later). In some persistent cases, the nerve has been decompressed firstly by perineal approach, but latterly by transguteal approach.
对阴部神经及其关系的解剖学研究有助于探讨可能导致会阴神经痛的压迫机制。发现了两个易发生冲突的区域：第一个区域与骶棘韧带附着于坐骨棘和骶结节韧带时形成的卡压有关；第二个区域与骶结节韧带的镰状突有关，其锐利的上缘会压迫神经。这种冲突在坐姿时尤为严重。神经主干、分支与这些冲突区域之间的关系或许可以解释临床观察结果。电生理检查（检测会阴底部的神经源性肌肉、骶部潜伏期延长、阴部神经终末运动潜伏期延长）可确诊。在坐骨棘处进行阴部神经麻醉阻滞仅具有辅助诊断价值。硬膜外阻滞也可能具有有趣的治疗作用（3个月后60%效果良好）。在一些持续性病例中，起初通过会阴途径对神经进行减压，但后来采用经臀途径。
