배벽과 샅굴 (The Abdominal wall & Inguinal canal)

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배벽과샅굴 (The Abdominal wall & Inguinal canal) 배 (Abdomen) 와배안 (Abdominal Cavity) 배 : 가슴과골반사이 배안 (abdominal cavity): 장기 (viscera) 들이들어있는배속공간 천장 : 가로막 (diaphragm) 바닥 : 골반강 (pelvic cavity) 배안을둘러싸고있는벽

1 배벽과샅굴 (The Abdominal wall & Inguinal canal) 배 (Abdomen) 와배안 (Abdominal Cavity) 배 : 가슴과골반사이 배안 (abdominal cavity): 장기 (viscera) 들이들어있는배속공간 천장 : 가로막 (diaphragm) 바닥 : 골반강 (pelvic cavity) 배안을둘러싸고있는벽 (wall) : 앞가쪽배벽 (anterolateral abdominal wall) 뒤배벽 (posterior abdominal wall) 가로막 (diaphragm) 골반가장자리 (pelvic brim) 엉치뼈곶 (promontory of sacrum) 분계선 (linea terminalis) 엉덩뼈속면의활꼴선 (arcuate line) 두덩뼈빗 (pectineal line) 과두덩뼈능선 (pubic crest) 1

2 Pelvic inlet Nine regions of the abdominal cavity - subcostal and transtubercular planes) - midclavicular planes) Transtubercular plane - passing through the iliac tubercles and the body of L5 vertebra - tubercles - approx 5 cm post to the ASIS Four regions - transumbilical plane - median plane 2

transpyloric plane ( 날문가로면 ) jugular notch 와 pubic

선자세에서는날문은더낮은쪽에위치한다. * Trasnpyloric plane 을지나는구조물 1.

Neck of the pancreas 4. Origins of SMA 5.

3 transpyloric plane ( 날문가로면 ) jugular notch 와 pubic symphysis 의가운데 또는 9 th costal cartilages and L1 & interspinous plane : ASIS - 보통 L1 높이중간에위치하는날문가로면은환자가눕거나엎드린자세에서날문 (pylorus) 을가로지른다. 선자세에서는날문은더낮은쪽에위치한다. * Trasnpyloric plane 을지나는구조물 1. L1 2. The fundus of the gall bladder 3. Neck of the pancreas 4. Origins of SMA 5. Hepatic portal vein 6. Root of the transverse mesocolon 7. Duodenojejunal junction 8. Rt, Lt. hilum of the kidney 3

4 편의상앞벽가쪽벽뒤벽으로나누나앞쪽과가쪽의경계는불분명하고몇몇근육이나피부신경의경우앞과가쪽모두에존재하기때문에앞가쪽배벽 (anterolateral abdominal wall) 이라는용어를사용한다 4

superficial fascia (or subcutaneous tissue) a fatty layer (superficial layer) a membranous layer (deep layer) 3. external oblique m 4.

5 Anterolateral Abdominal Wall - The anterolateral abdominal wall extends from the thoracic cage to the pelvis. The major part of the wall is musculotendinous. Layers of the abdominal wall 1. skin (epidermis & dermis) 2. superficial fascia (or subcutaneous tissue) a fatty layer (superficial layer) a membranous layer (deep layer) 3. external oblique m 4. internal oblique m 5. transversus abdominis m 6. fascia transversalis 7. extraperitoneal fatty tissue 8. peritoneum (parietal peritoneum) 층 배바깥빗근 : 등허리근막에서기원하지않고가장뒤쪽에있는섬유는자유모서리형태로존재 5

All three flat muscles end anteriorly in a strong, sheetlike aponeurosis.

6 - 서로반대편의배바깥빗근과배속빗근이함께공통된중심널힘줄 (central tendon) 을공유함으로써하나의운동단위로작용하는두힘살근 (digastric muscle) 은형성한다. - 예를들어오른배바깥빗근과왼배속빗근은몸통회전운동 (torsional movement of trunk) 을할때굽힘과돌림운동작용에함께작용한다. All three flat muscles end anteriorly in a strong, sheetlike aponeurosis. The aponeuroses of these muscles interlace at the linea alba with their fellows of the opposite side to form the tough, aponeurotic, tendinous sheath of the rectus muscle - the rectus sheath. The decussation and interweaving of the aponeuroses in the rectus sheath is not only from side to side but also from superficial to deep. 6

7 배바깥빗근 : 등허리근막에서기원하지않고가장뒤쪽에있는섬유는자유모서리형태로존재 7

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9 근육 신경 9

a&v (from external iliac a&v) - superficial circumflex iliac a&v (from femoral a &

10 Vessels of the anterolateral abdominal wall - superior epigastric a&v (from internal thoracic a&v) - inferior epigastric a&v (from external iliac a&v) - deep circumflex iliac a&v (from external iliac a&v) - superficial circumflex iliac a&v (from femoral a & saphenous v) - superficial epigastric a&v (from femoral a & saphenous v) - intercostal a&v - lumbar a&v 혈관 10

11 ** Caput medusae, Moore Fig. B2-29 portal hypertension 위대정맥또는아래대정맥에서정맥의흐름이막혔을때, 가슴배벽정맥 (thoracoepigastric vein) 과같은몸순환정맥의지류들사이에서폐쇄된부위를우회하여심장으로피가되돌아갈수있는정맥의곁순환이일어난다. 11

12 Inguinal region ( 샅굴부위 ) Inguinal lig. - 배바깥널힘줄의가장아래부분 - 인대의대부분은두덩뼈결절로가지만일부는 1. 가쪽의두덩뼈위가지 lacunar lig. pectineal lig. 2. 두덩뼈결절을지나반대쪽배바깥널힘줄과합쳐진다 reflected inguinal lig. ( 반회샅고랑인대 ) 12

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14 엉덩두덩띠 (iliopubic tract): 배가로근막의아래모서리가두꺼워진것으로, 샅고랑인대의뒤쪽으로평행하게달리는섬유성띠 근육두덩빗구멍 (myopectineal orifice): 샅고랑인대와엉덩두덩띠기덮고있는샅부위. 배벽을가로지르는구조물과관련되어발생하는이러한약한부위에서샅부위탈장의장소가됨. 샅굴 14

2/3이상 <Indirect hernia> <Direct hernia> 이탈빈도 남성 여성 샅굴이탈 (Inguinal

15 < 샅굴이탈 : Inguinal hernia> 직접샅굴이탈 (Direct inguinal hernia) : 30대이후빈번함 간접샅굴이탈 (Indirect inguinal hernia) : 30대이전빈번함 ( 주로우측 ) 전체의 2/3이상 <Indirect hernia> <Direct hernia> 이탈빈도 남성 여성 샅굴이탈 (Inguinal hernia) 97% 50% 넙다리이탈 (Femoral hernia) 2% 34% 배꼽이탈 (Umbilical hernia) 1% 16% 15

16 1. 2. 안쪽 2. 가쪽 평행 3. 정삭안 16

enters the scrotum Direct (acquired) inguinal hernia - leaves the abdominal cavity medial to the inferior epigastric vessels -

17 Indirect (congenital) inguinal hernia - the most common - leaves the abdominal cavity lateral to the inferior epigastric vessels and enters the deep inguinal ring - traverses the entire inguinal canal - exits through the superficial inguinal ring - commonly enters the scrotum Direct (acquired) inguinal hernia - leaves the abdominal cavity medial to the inferior epigastric vessels - protrudes through an area of relative weakness in the posterior wall of the inguinal canal - protrudes through the inguinal triangle Hernia 17

18 성인의경우깊은샅굴구멍과얕은샅굴구멍의경로가비스듬하기때문에복압이증가할경우샅굴의뒤벽이앞벽쪽으로밀면서벽을튼튼하기만들기때문에이러한효과를넘어서는압력이가해지지않는한탈장이생기지않는다. 18

19 고환올림근 : 배속빗근 바깥정삭근막 : 배바깥빗근 속정삭근막 : 배가로근막 정삭의구조물 1. 정관 2. 고환동맥, 정맥얼기 3. 정관동맥 (ductus deferens) 4. 고환올림근동맥 from inf epigastric a 5. 동맥에분포하는교감신경섬유와정관에분포하는교감부교감신경섬유 6. Genital branch of genitofemoral nerve. 7. 림프관 8. 고환집돌기의흔적 19

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제13강: 척추와 갈비우리의 개요 2

제13강: 척추와 갈비우리의 개요 2 제 13 강 척추와갈비우리 2 SPORT & LEISURE STUDIES LEE CHAE SAN 반가시근, 뭇갈래근, 돌림근의위치 가로돌기가시근육群 (transversospinalis) 은깊고, 가로돌기와가시돌기사이의척수곁고랑 (laminar groove) 을채우는근육덩어리 가로돌기가시근육群은세가지하위군 (sub group) 으로나뉠수있는데, 표층에서부터심층순으로가시근