Innervation of the female levator ani muscles

被引:122
作者
Barber, MD
Bremer, RE
Thor, KB
Dolber, PC
Kuehl, TJ
Coates, KW
机构
[1] Duke Univ, Med Ctr, Div Gynecol Specialties, Dept Obstet & Gynecol, Durham, NC 27706 USA
[2] Duke Univ, Med Ctr, Div Urol, Dept Surg, Durham, NC 27706 USA
[3] Durham Vet Adm Med Ctr, Durham, NC USA
关键词
levator ani muscle; pelvic floor; pudendal nerve;
D O I
10.1067/mob.2002.124844
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: The objective of this study was to characterize the innervation of the human female levator ani muscles. STUDY DESIGN: Detailed dissections of the peripheral innervation of the iliococcygeal, pubococcygeal, puborectal, and coccygeal muscles were performed in 12 fresh-frozen female cadavers (aged, 32-100 years) with the use of transabdominal, gluteal, and perineal approaches. Both the pudendal nerve and the sacral nerve roots that enter the pelvis from the cephalic side were followed from their origin at the sacral foramina to their termination. Pelvic floor innervation was described with reference to fixed bony landmarks, particularly the coccyx, the ischial spine and the inferior pubis. Photographs were taken, and nerve biopsies were performed to confirm the gross findings histologically. Biopsy specimens were stained with Masson's trichrome. RESULTS: In each dissection, a nerve originated from the S3 to S5 foramina (S4 alone, 30%; from S3 and S4, 40%; from S4 and S5, 30%), crossed the superior surface of the coccygeal muscle (3.0 +/- 1.4 cm medial to the ischial spine [range, 1.0-4.2 cm]), traveled on the superior surface of the iliococcygeal muscle innervating it at its approximate midpoint, and continued on to innervate both the pubococcygeal and puborectal muscles at their approximate midpoint. The pudendal nerve originated from the S2 to S4 foramina, exited the pelvis through the greater sciatic foramen, traversed Alcock's canal, and branched to innervate the external anal sphincter, the external urethral sphincter, the perineal musculature, the clitoris, and the skin. Despite specific attempts to locate pudendal branches to the levator ani, none could be demonstrated, Nerve biopsy specimens that were obtained at gross dissection were confirmed histologically. CONCLUSION: Gross dissections suggest that the female levator ani muscle is not innervated by the pudendal nerve but rather by innervation that originates the sacral nerve roots (S3-S5) that travels on the superior surface of the pelvic floor (levator ani nerve). Because definitive studies (eg, nerve transection or neurotracer studies) cannot be performed in humans, further studies that will use appropriate animal models are necessary to confirm and extend our findings.
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页码:64 / 71
页数:8
相关论文
共 34 条
[1]   PELVIC FLOOR DAMAGE AND CHILDBIRTH - A NEUROPHYSIOLOGICAL STUDY [J].
ALLEN, RE ;
HOSKER, GL ;
SMITH, ARB ;
WARRELL, DW .
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 1990, 97 (09) :770-779
[2]   DENERVATION AND RE-INNERVATION OF THE URETHRAL SPHINCTER IN THE ETIOLOGY OF GENUINE STRESS-INCONTINENCE - AN ELECTROMYOGRAPHIC STUDY [J].
BARNICK, CGW ;
CARDOZO, LD .
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 1993, 100 (08) :750-753
[3]   Continence mechanism of the isolated female urethra: An anatomical study of the intrapelvic somatic nerves [J].
Borirakchanyavat, S ;
Aboseif, SR ;
Carroll, PR ;
Tanagho, EA ;
Lue, TF .
JOURNAL OF UROLOGY, 1997, 158 (03) :822-826
[4]   Epidemiology and natural history of pelvic floor dysfunction [J].
Bump, RC ;
Norton, PA .
OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA, 1998, 25 (04) :723-+
[5]   THE SQUIRREL-MONKEY - AN ANIMAL-MODEL OF PELVIC RELAXATION [J].
COATES, KW ;
GALAN, HL ;
SHULL, BL ;
KUEHL, TJ .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1995, 172 (02) :588-593
[6]   The squirrel monkey as an animal model of pelvic relaxation: An evaluation of a large breeding colony [J].
Coates, KW ;
Gibson, S ;
Williams, LE ;
Brady, A ;
Abee, CR ;
Shull, BL ;
Kuehl, TJ .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 1995, 173 (06) :1664-1670
[7]  
De Lancey John O. L., 1997, P63
[8]   The female pelvic floor: A dome - Not a basin [J].
Hjartardottir, S ;
Nilsson, J ;
Petersen, C ;
Lingman, G .
ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, 1997, 76 (06) :567-571
[9]  
JUENEMANN KP, 1988, J UROLOGY, V139, P74
[10]  
LAWSON JON, 1974, ANN ROY COLL SURG, V54, P244