Sirasanagandla Srinivasa Rao, Nayak Satheesha B, Bhat Kumar Mr, Surendran Sudarshan, Regunathan Deepthinath, Kumar Naveen, Shetty Surekha D, Patil Jyothsna
Department of Anatomy, Melaka Manipal Medical College, Manipal University, Madhav Nagar, Manipal, Karnataka, India.
Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
J Can Chiropr Assoc. 2014 Mar;58(1):39-44.
The lumbar part of the diaphragm arises from the lumbar vertebrae by right and left crura. The duplication of crura of the diaphragm is rarely reported in the past. During regular dissection classes to the medical students, we came across a case of duplicated right crus of the diaphragm. The right crus of the diaphragm was duplicated completely and presented two separate crura; medial right crus & lateral right crus. The medial right crus was attached to the anterolateral surfaces of the superior three lumbar vertebral bodies and intervertebral discs and merged with the anterior longitudinal ligament. The lateral right crus attached only to the intervertebral disc between the third and fourth lumbar vertebrae. These two crura bordered a retrocrural space in the inferior posterior mediastinum. The greater and lesser splanchnic nerves entered the abdomen by passing through this space. No duplication was observed in the left crus. The muscle fibres of medial right crus contributed to the formation of the esophageal opening. Knowledge of variations in the diaphragmatic crural anatomy is useful in the diagnosis of disease processes in the retrocrural space and also might help while performing the surgical repair of gastroesophageal reflux disease.
膈的腰部通过左右膈脚起自腰椎。过去很少报道膈脚重复的情况。在给医学生上常规解剖课时，我们遇到了一例右侧膈脚重复的病例。右侧膈脚完全重复，呈现出两个独立的膈脚，即右侧内侧膈脚和右侧外侧膈脚。右侧内侧膈脚附着于上三个腰椎椎体和椎间盘的前外侧表面，并与前纵韧带融合。右侧外侧膈脚仅附着于第三和第四腰椎之间的椎间盘。这两个膈脚在纵隔后下部界定了一个膈脚后间隙。内脏大神经和内脏小神经通过这个间隙进入腹腔。左侧膈脚未观察到重复。右侧内侧膈脚的肌纤维参与了食管裂孔的形成。了解膈脚解剖结构的变异对于膈脚后间隙疾病的诊断有用，在进行胃食管反流病的手术修复时也可能有帮助。
