Katrikh Aaron Z, Ettarh Rajuno, Kahn Margie A
Departments of Structural and Cellular Biology, Obstetrics and Gynecology, and Urology, Tulane University School of Medicine, New Orleans, Louisiana; and the Department of Medical Education, California University of Science and Medicine, Colton, California.
Obstet Gynecol. 2017 Nov;130(5):1033-1038. doi: 10.1097/AOG.0000000000002324.
To simulate sacrospinous ligament fixation on cadaveric specimens, describe the surrounding retroperitoneal anatomy, and estimate the risk to nerves and arteries for the purposes of optimizing safe suture placement.
Sacrospinous ligament fixation was performed on eight fresh-tissue female cadavers using a Capio ligature capture device. Distances from placed sutures to the following structures were measured: ischial spine; fourth sacral root; pudendal nerve; the nerve to coccygeus muscle; the nerve to levator ani muscle; inferior gluteal artery; and internal pudendal artery. Periligamentous anatomy was examined in an additional 17 embalmed cadaver dissections.
Sacrospinous ligament length was not seen to differ significantly between sides. The fourth sacral spinal nerve was seen most commonly associated with the medial third of the ligament, whereas the pudendal nerve and the nerves to coccygeus and levator ani muscles were associated with the lateral third. The inferior gluteal artery was seen leaving the greater sciatic foramen a median 15.8 mm (range 1.8-48.0, CI 14.9-22.3) above the ligament, whereas the internal pudendal artery exited just above the ischial spine. The two sets of sutures were placed 20.5 mm (range 9.2-34.4, CI 19.7-24.7) and 24.8 mm (range 12.4-46.2, CI 24.0-30.0) medial to the ischial spine, respectively. No structures were directly damaged by placed sutures. The nerves to coccygeus and levator ani were closest and arteries farthest from the placed sutures.
The middle segment of the sacrospinous ligament has the lowest incidence of nerves and arteries associated with it. This study confirms that the nerves supplying the pelvic floor muscles are at a higher risk from entrapment than the pudendal nerve.
在尸体标本上模拟骶棘韧带固定术，描述周围的腹膜后解剖结构，并评估神经和动脉的风险，以优化安全缝线放置。
使用Capio结扎捕获装置对八具新鲜组织女性尸体进行骶棘韧带固定术。测量放置的缝线与以下结构的距离：坐骨棘；骶神经根；阴部神经；尾骨肌神经；肛提肌神经；臀下动脉；和阴部内动脉。在另外17例防腐尸体解剖中检查韧带周围解剖结构。
两侧骶棘韧带长度未见明显差异。骶神经根最常与韧带内侧三分之一相关，而阴部神经以及尾骨肌和肛提肌的神经与外侧三分之一相关。臀下动脉从坐骨大孔穿出，位于韧带上方中位数为15.8毫米（范围1.8 - 48.0，可信区间14.9 - 22.3），而阴部内动脉恰好在坐骨棘上方穿出。两组缝线分别置于坐骨棘内侧20.5毫米（范围9.2 - 34.4，可信区间19.7 - 24.7）和24.8毫米（范围12.4 - 46.2，可信区间24.0 - 30.0）处。放置的缝线未直接损伤任何结构。尾骨肌和肛提肌的神经距离缝线最近，动脉距离最远。
骶棘韧带中段与神经和动脉相关的发生率最低。本研究证实，供应盆底肌肉的神经比阴部神经更容易受到卡压。
