Haba Daijiro, Emura Kenji, Watanabe Yuko, Kageyama Ikuo, Kikkawa Satoshi, Uemura Mamoru, Arakawa Takamitsu
Department of Rehabilitation of Sciences, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan.
Faculty of Health Care Sciences, Himeji Dokkyo University, 7-2-1 Kami-ono, Himeji, 670- 8524, Japan.
Anat Sci Int. 2018 Sep;93(4):405-413. doi: 10.1007/s12565-018-0428-z. Epub 2018 Jan 18.
Twenty-one sides of 11 adult Japanese cadavers were investigated, and 2 of 21 sides exhibited absence of the pyramidalis. We observed that all of the nerves to the pyramidalis included the sensory nerve branch, which distributed to the aponeurotic tissue in the upper area of the pubic ramus. To investigate the clinical relevance and developmental process of the pyramidalis, detailed innervation patterns of the pyramidalis and the lumber plexus were examined and compared with the case of absent pyramidalis. The nerves to the pyramidalis could be classified into five types by the derivative nerves and two subtypes by their courses associated with the funiculus spermaticus. In the cases of absent pyramidalis, similar sensory branches distributed close to the upper area of the pubic ramus. We deduced that the sensory branch extended along with the muscular branch to the pyramidalis after development of the pyramidalis and that only the sensory branch remained in cases in which the pyramidalis disappeared. The two subtypes might associate with descensus testis. Surgeons performing inguinal hernia repair using a mesh and tension-free surgical technique should preserve the nerves around the funiculus spermaticus to avoid diminished proprioception in the lower abdominal wall.
对11具成年日本尸体的21侧进行了研究，21侧中有2侧耻骨肌缺失。我们观察到，所有支配耻骨肌的神经均包含感觉神经分支，该分支分布于耻骨支上部的腱膜组织。为了研究耻骨肌的临床相关性和发育过程，对耻骨肌和腰丛的详细神经支配模式进行了检查，并与耻骨肌缺失的病例进行了比较。支配耻骨肌的神经根据其衍生神经可分为五种类型，根据其与精索的走行可分为两个亚型。在耻骨肌缺失的病例中，类似的感觉分支分布在耻骨支上部附近。我们推测，感觉分支在耻骨肌发育后与肌肉分支一起延伸至耻骨肌，在耻骨肌消失的情况下仅保留感觉分支。这两个亚型可能与睾丸下降有关。使用补片和无张力手术技术进行腹股沟疝修补的外科医生应保留精索周围的神经，以避免下腹壁本体感觉减退。
