Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Physical and Rehabilitative Medicine, Antwerp University Hospital, Edegem, Belgium.
Department of ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Orthopaedic Surgery and Traumatology, Antwerp University Hospital, Edegem, Belgium.
Ann Anat. 2022 Oct;244:151959. doi: 10.1016/j.aanat.2022.151959. Epub 2022 May 31.
Collection and meta-analysis of all relevant anatomical studies related to the pubic symphysis to provide a state of the art review of its musculotendinous and ligamentous attachments from 2010 to date.
A systematic search of published literature databases (PubMed, Web of Science and Embase) was conducted according to the PRISMA guidelines from January 2010 up until now. All papers investigating the anatomy of the musculotendinous attachments of the pubis and the pubic ligaments were eligible. Methodological quality was assessed using the Quality Appraisal for Cadaveric Studies (QUACS scale). A narrative analysis approach was adopted to synthesize the findings.
After screening and review of 1313 papers, a total of six studies investigating the anatomy of the pubic ligaments and tendons were included. Of the six articles included in this systematic review, five articles performed a macroscopic anatomical dissection, three articles performed a microscopic (histological) study, and one article combined microscopic examination with an MRI imaging examination. The anatomy of the pubic symphysis was examined in 76 anatomical cadavers (60 embalmed, 16 fresh frozen). In total 44 male cadavers (58%), 28 female cadavers (37%) and four cadavers whose gender was not stated were dissected.
The age-old accepted concept of the fusion of the rectus abdominis with the adductor longus via the aponeurotic plate is outdated. New anatomical concepts like the pyramidalis-anterior pubic ligament-adductor longus complex (PLAC), recto-gracilis tendon, fusion of adductor brevis with gracilis, etc. are recently introduced. The awareness of anatomy and morphology of the pubic ligaments plays a significant role in understanding the diagnosis and treatment of groin pain.
收集并分析截至目前 2010 年以来所有与耻骨联合相关的解剖学研究，对耻骨联合的肌腱和韧带附着进行综述。
根据 PRISMA 指南，对已发表的文献数据库（PubMed、Web of Science 和 Embase）进行系统检索。所有研究耻骨肌腱附着和耻骨韧带解剖结构的论文都符合纳入标准。采用 Cadaveric Studies 质量评估（QUACS 量表）对方法学质量进行评估。采用叙述性分析方法对结果进行综合。
经过筛选和审查 1313 篇论文，共有 6 项研究调查了耻骨韧带和肌腱的解剖结构。在这项系统综述中纳入的 6 篇文章中，有 5 篇进行了宏观解剖学解剖，3 篇进行了微观（组织学）研究，1 篇将微观检查与 MRI 成像检查相结合。共检查了 76 具解剖尸体的耻骨联合（60 具防腐，16 具新鲜冷冻）。共有 44 具男性尸体（58%）、28 具女性尸体（37%）和 4 具未说明性别的尸体进行了解剖。
将腹直肌通过腱膜与内收肌长头融合的古老观念已经过时。新的解剖概念，如耻骨前韧带-内收肌长头复合体（PLAC）、耻骨直肌肌腱、短收肌与长收肌融合等，最近已被引入。了解耻骨韧带的解剖和形态对于理解腹股沟疼痛的诊断和治疗具有重要意义。
