Department of Orthopaedic Surgery, Indiana University Health, Indianapolis, Indiana, U.S.A.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
Arthroscopy. 2019 Aug;35(8):2358-2364. doi: 10.1016/j.arthro.2019.02.043.
To characterize the 3-dimensional muscular, musculotendinous, and neurovascular anatomy about the pubic symphysis relevant to core muscle injury (CMI).
Ten cadaveric hips were dissected to characterize the musculotendinous insertion of the rectus abdominis and inguinal ligament, origins of the adductor longus and adductor brevis, and the pubic cartilage plate. A 3-dimensional coordinate measuring system and data acquisition software were used to calculate structure cross-sectional area, and the landmark anatomical relationships to 1 another and relevant neurovascular structures.
All specimens were male with an average age of 62 ± 2 years. The mean footprints of the rectus abdominis, inguinal ligament, adductor longus, and adductor brevis were 8.4 ± 3.1, 1.2 ± 0.5, 3.8 ± 1.6, and 2.9 ± 1.3 cm, respectively. The mean pectineus and gracilis footprints were 6.3 ± 2.4 and 3.4 ± 0.9 cm, respectively. The mean cross-sectional area of the cartilage plate was 24.8 ± 5.6 cm. The adductor longus was an average 1.5 ± 0.25 cm from the adductor brevis and 0.69 ± 0.52 cm from the rectus abdominis. The genital branch of the genitofemoral nerve was an average of 4.3 cm (range, 2.8-6.4) lateral to the insertion of the inguinal ligament. The femoral vein and artery were 3.0 cm (range, 2.5-3.6) and 3.7 cm (range, 2.5-5.9) lateral to the inguinal ligament footprint. The obturator nerve was 2.5 cm (range, 1.6-3.4) lateral to the adductor longus.
Familiarity with the anatomy of the pubic symphysis is essential for surgeons treating patients with CMI. We have shown that this relatively small area is the site of many muscular, musculotendinous, and neurovascular structures with various sized footprints and described the 3-dimensional anatomy of the anterior pubic symphysis. The origin of the adductor longus lies in close proximity to other structures, such as the adductor brevis, the insertion of the rectus abdominis, and the obturator nerve. These findings should be considered when operating in this region and treating patients with chronic groin pain.
The anatomy of the pelvic region and pubic symphysis has not been well characterized. Intimate knowledge of relevant anatomy is essential to treating CMI, also known as athletic pubalgia or sports hernia.
描述与核心肌肉损伤（CMI）相关的耻骨联合的三维肌肉、肌肉肌腱和神经血管解剖结构。
对 10 具尸体髋关节进行解剖，以描述腹直肌和腹股沟韧带、长收肌和短收肌的肌腱止点、耻骨软骨板的起源。使用三维坐标测量系统和数据采集软件来计算结构的横截面积，以及与其他结构和相关神经血管结构的标志解剖关系。
所有标本均为男性，平均年龄为 62±2 岁。腹直肌、腹股沟韧带、长收肌和短收肌的平均足迹分别为 8.4±3.1cm、1.2±0.5cm、3.8±1.6cm 和 2.9±1.3cm。耻骨肌和髂腰肌的平均足迹分别为 6.3±2.4cm 和 3.4±0.9cm。软骨板的平均横截面积为 24.8±5.6cm。长收肌平均距离短收肌 1.5±0.25cm，距离腹直肌 0.69±0.52cm。生殖股神经的生殖支平均距离腹股沟韧带插入处 4.3cm（范围为 2.8-6.4cm）。股静脉和股动脉分别距离腹股沟韧带足迹 3.0cm（范围为 2.5-3.6cm）和 3.7cm（范围为 2.5-5.9cm）。闭孔神经距离长收肌 2.5cm（范围为 1.6-3.4cm）。
熟悉耻骨联合的解剖结构对于治疗 CMI 的外科医生至关重要。我们已经表明，这个相对较小的区域是许多肌肉、肌肉肌腱和神经血管结构的所在地，这些结构具有不同大小的足迹，并描述了前耻骨联合的三维解剖结构。长收肌的起点与短收肌、腹直肌止点和闭孔神经等其他结构非常接近。在该区域进行手术和治疗慢性腹股沟疼痛的患者时，应考虑这些发现。
骨盆区域和耻骨联合的解剖结构尚未得到很好的描述。了解相关解剖结构对于治疗 CMI 至关重要，CMI 也称为运动性耻骨炎或运动疝。
