LUMBOSACRAL TEXTURE

From Big Medical Encyclopedia

LUMBOSACRAL TEXTURE [plexus lumbosacralis (PNA, JNA, BNA)] — the neuroplex formed by front branches of the 12th chest, all lumbar, sacral and coccygeal spinal nerves.

Anatomy

Fig. 1. Back wall of an abdominal cavity and basin. Topography of a lumbosacral texture (the anterior aspect, sexual and coccygeal textures are not visible): 1 — a locking nerve, 2 — a femoral nerve, 3 — a lateral cutaneous nerve of a hip. 4 — a lumbosacral trunk, 5 — a lumbar texture, 6 — a square muscle of a waist, 7 — a sympathetic trunk, 8 — a subcostal nerve, 9 — an iliohypogastric nerve, io — an ilioinguinal nerve, 11 — connecting branches, 12 — a big lumbar muscle, 13 — a femoral branch of a genitocrural nerve, 14 — an inguinal branch of a genitocrural nerve, 15 — muscular branches to an ileal muscle, 16 — a sacriplex.

The item - to. the page (fig. 1) is divided into four secondary textures: lumbar (plexus lumbalis), sacral (plexus sacralis), sexual (plexus pudendus) and coccygeal (plexus coccygeus).

The lumbar texture consists of three loops formed by front branches of the 12th chest, the 1st, 2nd, 3rd and a part of a front branch of the 4th of lumbar nerves. Depart from the first loop formed by connection of front branches of the 12th chest and the 1st lumbar nerves: 1) an iliohypogastric nerve (n. iliohypogastricus) which, pro-butting a verkhnelateralny piece of a big lumbar muscle, lays down on a front surface of a square muscle of a waist and, being located over an ileal crest, between a cross and internal braid with muscles of a stomach, innervates these muscles, and also skin over a big spit of a femur and skin of inguinal area; 2) an ilioinguinal nerve (item ilioingiui-nalis) which separates or from a front branch of the 1st lumbar nerve, or from an iliohypogastric nerve and, being located below the last, gives branches to muscles of an abdominal wall, takes place in the inguinal channel and on escaping it gives a lateral skin branch, the innervating skin of a medial part of the inguinal area, front scrotal branches at men and the front lip branches at women innervating skin of these areas.

The genitocrural nerve (n. genitofemo-ralis) passing through a big lumbar muscle and in thickness or on a front surface its divided into sexual (r. genitalis) and femoral (of femoralis) branches departs from the second loop formed by connection of front branches of the 1st and 2nd lumbar nerves. The sexual branch in the inguinal channel joins a seed cord and innervates the structures making it and covers of a small egg, and a femoral branch — skin of a hip is lower than an inguinal fold.

The trunk of the second loop connects to a front branch of the 3rd lumbar nerve and forms the third loop. Depart from it: 1) lateral cutaneous nerve of a hip (n. cutaneus femoris lat.), which comes from under lateral edge of a big lumbar muscle to a front surface of an ileal muscle, then medialny an upper front ileal awn, pro-butting a front abdominal wall, comes to a hip and, having passed through a wide fascia, branches in skin of its lateral surface; 2) branches to femoral and locking nerves.

The front branch of the 4th lumbar nerve is divided into three branches: the first unites to branches of the third loop of a lumbar texture and forms femoral nerve (see), coming to a hip through muscle compartment with an iliolumbar muscle (m. iliopsoas); the second unites to branches of the second loop of a lumbar texture, forming a locking nerve (item obturatorius) which, being located behind and medialny a big lumbar muscle (t. psoas major), via the locking channel comes to a hip and is divided into back and front branches. The back branch innervates an outside locking muscle (m. obturatorius ext.) and big adductor (t. adductor magnus); lobby — short and long adductors (mm. adductores brevis et longus), a thin muscle (m. gracilis), partially — edge (m. pectineus) also proceeds in a skin branch (of cutaneus), the innervating skin of lower parts of a medial surface of a hip.

The third branch goes down and connects to a front branch of the 5th lumbar nerve, forming a lumbosacral trunk (truncus lumbosacral is) participating in formation of the sacriplex located in a small basin.

Lumbar spinal nerves have connecting branches with lumbar nodes of sympathetic trunks, contain motive, sensitive and sympathetic nerve fibrils.

Lumbar texture, being located ahead of cross shoots of lumbar vertebrae, between a square muscle of a waist and a big lumbar muscle, gets into its thickness, gives muscular branches (rr. musculares) innervating lateral intercross and a square muscle of a waist, big and small lumbar muscles.

Fig. 2. Sagittal cut of a basin, topography of a sacriplex: 1 — a lumbosacral trunk, 2 — a front branch of the 1st sacral nerve, 3 — a sacriplex, 4 — a front branch of the 2nd sacral nerve, 5 — a front branch of the 3rd sacral nerve, 6 — a coccygeal nerve, 7 — a sexual texture, 8 — a sexual nerve.

The sacriplex is formed by a lumbosacral trunk and front branches of the 1st, 2nd and partially the 3rd sacral nerves (fig. 2); it through connecting branches is connected with nodes of a sympathetic trunk. Length and thickness of the front branches forming a texture decreases in the caudal direction. The lumbosacral trunk goes down in a small pelvis and about a big sciatic opening connects to front branches 1 — the 3rd sacral nerves, located on an inner surface of a pear-shaped muscle, forming triangular shape the sacriplex, top to-rogo proceeds in a sciatic nerve (item ischiadicus). The sacriplex is covered with a plate of a pelvic fascia, knutr from a cut the parietal layer of a peritoneum is located. Short and long branches depart from a sacriplex.

Treat short branches: 1) pear-shaped nerve, internal locking nerve, nerve of a square muscle of a hip; 2) upper buttock nerve (n. gluteus sup.), leaving a small pelvis through over - piriform opening (foramen suprapiriforme), innervating small, average gluteuses and-pryagatel on a wide fascia of a hip; 3) lower buttock nerve (n. gluteus inf.), leaving through under - piriform opening (foramen infrapiriforme), innervating a big gluteus (m. gluteus max.), the capsule of a hip joint and sometimes giving branches to internal locking, to twin muscles and a square muscle of a hip.

Treat long branches: 1) back cutaneous nerve of a hip (n. cutaneus femoris post.), leaving behind a sciatic nerve through subpiriform opening and the branches innervating skin of a buttock, a crotch, a back surface of a hip, a popliteal space and partially back surface of a shin; 2) a sciatic nerve (n. ischiadicus), all front branches of the 1st, 2nd and partially the 3rd sacral nerves participate in education to-rogo (see. Sciatic nerve ).

The bottom of a sacriplex formed by connection of a part of a front branch of the 3rd with a front branch of the 4th of sacral nerves and located on a front surface of a coccygeal muscle (m. coccygeus) nek-ry clinical physicians is called a sexual texture (plexus pudendus). By means of connecting branches it is connected with a vegetative lower hypogastric (pelvic) texture. The sexual texture shares on: 1) muscular branches, the innervating muscle lifting an anus (m. levator ani) and a coccygeal muscle (m. coccygeus); 2) pelvic splanchnic nerves (nn. splanchnici pelvini), entering a pelvic texture; 3) the sexual nerve (n. pudendus) which, leaving a basin through subpiriform opening, bends around spina ischiadica through foramen ischiadicum minus enters a pryamokishechno-sciatic pole (fossa ischiorectalis) and is divided into the branches participating in an innervation of external genitals, muscles and skin of a crotch.

The coccygeal texture (plexus coccygeus) is formed by front branches of the 5th sacral and the 1st coccygeal nerves and located on a coccygeal muscle (m. coccygeus). It is connected through the 4th sacral nerve with a sexual texture and an unpaired node of a sympathetic trunk. Muscular branches to the coccygeal muscle and a muscle lifting an anus, and also thin zadneprokhodno-coccygeal nerves depart from it (nn. anococcygei) in number of 3 — 5, distributed in skin between an anus and a tailbone.

Fig. 3. Diagrammatic representation of types of a lumbar texture: and — loose type — the concentrated type.
Fig. 4. Diagrammatic representation of types of a sacriplex (sagittal cut of a basin): and — loose type — the concentrated type.

Situation P. - to. the page can be displaced on one vertebra kranialno or caudally. It is observed in cases lumbalizations (see) or sacralization (see) is also followed by the shift of the corresponding front branches of spinal nerves. Lumbar and sacral textures can be constructed according to concentrated, loose (fig. 3 and 4) and mixed to types.

Pathology

the Most frequent reason of defeat of P. - to. pages are injuries (gunshot wounds or other damages), a prelum splinters of a bone (at spinal fractures, pelvic bones, tumors, coming from haunch bones or abdominal organs, aneurisms of nearby arteries, a head of a fruit at difficult delivery. Diseases of ovaries, uterine tubes, a worm-shaped shoot, the inflammatory processes arising in pelvic cellulose or a peritoneum quite often cause secondary lumbosacral plexitis (see). Infections, intoxications and exchange disturbances can also be a cause of illness more often not than all texture, but its branches. Usually P.'s defeat - to. the page happens unilateral, but at injuries of a backbone and nek-ry infectious diseases (flu, a brucellosis, tuberculosis, etc.) it can be and bilateral.

A wedge, a picture of defeat of P. - to. the page is characterized by morbidity during the pressing on a stomach, a rump with irradiation of pain in a waist and in the zones innervated femoral, sciatic and locking by nerves; also spontaneous pains are observed. At a rectal research morbidity during the pressing is defined on a front wall of a sacrum. At total defeat of P. - to. the page develops a sluggish flaccid paralysis or paresis of muscles of a belt and a free lower extremity with an areflexia, disorders of sensitivity and a trophicity in the zone innervated by branches of a texture. Function of pelvic bodies is sometimes broken (see. Paralyses, paresis ).

At partial defeat of P. - to. the wedge, a picture varies page depending on localization patol, process. So, at damage of upper trunks of a lumbar texture function only of nek-ry muscles of a waist and stomach is broken and disorder of sensitivity in a buttock, on a lobby and partly an outer surface of a hip is observed. Defeat of the lower trunks of a lumbar texture, the innervating front, internal and partially back muscles of a hip and a muscle of a shin (including a front tibial muscle), is followed by disturbance of bending and reduction of a hip, extension of a shin; standing and walking are at a loss, sensitivity on a front surface of a hip, an inner surface of a shin and foot falls apart, there is no knee jerk.

The isolated defeat of separate branches of a lumbar texture is shown by signs radiculitis (see), is more rare than neuritis of a femoral nerve (see) and other nerves. At a disease of iliohypogastric and ilioinguinal nerves sensitivity in lower parts of a front abdominal wall is broken and unsharp weakness of her muscles appears. Defeat of a lateral cutaneous nerve of a hip is followed by anesthesia on an outer surface of a hip, and his irritation leads to a peculiar neuralgia — meralgia paraesthetica (see. Roth disease ). During the involvement in patol, process of a genitocrural nerve is also observed only disorder of sensitivity, a thicket in the form of a painful hyperesthesia (hyperaesthe-sia dolorosa) in the field of an upper part of a hip and a scrotum. Causes damage of a locking nerve incomplete paralysis or paresis of adductors of a hip and their atrophy. Clinically it is shown by the fact that the patient during the walking brings a sore leg of a knaruzha and cannot put it over a healthy leg; also the turn of a sore leg of a knaruzha is complicated; disorder of sensitivity on the lower half of an inner surface of a hip is noted. The isolated injury of this nerve is observed seldom since its short trunk is protected by bones and muscles of a basin.

Defeat of a sacriplex is clinically shown by dysfunction of all nerves departing from it, but hl. obr. sciatic nerve (see). Damage of the lower buttock nerve is caused by paralysis of a big gluteus that complicates extension of a hip, and during the standing in the situation bent forward — straightening of a trunk. Paralysis of this muscle comes to light at run, jumps, rise on a ladder or the inclined plane; during the walking her paralysis is almost not noticeable by the level ground. Loss of function of an upper buttock nerve complicates assignment and rotation of a hip; at bilateral damage of this nerve there is «duck» gait (see). Involvement in patol, process of a back cutaneous nerve of a hip is characterized by a hypesthesia or anesthesia in lower parts of a buttock and a back surface of a hip; the irritation of this nerve causes pain and a hyperesthesia in these areas.

Defeat of sexual and coccygeal textures is followed by dysfunction of sphincters of a bladder and rectum that also the calla, paralysis of a bladder and muscles of a crotch, anesthesia of a rectum, bladder, skin on an internal half of a buttock, area of a crotch and an anus, a back surface of generative organs is shown by an incontience of urine. The irritation of these textures causes neuralgia in the field of a sacrum (see. Coccyalgia ) that is observed more often at women.

At a neuralgic form of a disease of P. - to. pages the leading sign are pain on the course of the nervous trunks leaving a texture.

Establishment of the diagnosis in the presence of characteristic a wedge, pictures does not represent big difficulties. Differential diagnosis is carried out with median or paramedian loss of lumbar intervertebral disks (see. Diskosis ), disturbance of blood circulation in the pool of radicular and spinal arteries of lumbar department, radicular painful or reflex spondilogenny syndromes (see. Osteochondrosis , Osteochondropathy ), poliomyelitis (see), sacroileitis (see), psoitis (see).

Treatment of defeats of P. - to. page complex. It is carried out using medicamentous means, fizio-and balneoterapiya, LFK, massage. According to indications operational treatment is performed. Importance in recovery of the broken functions P. - to. the page has a dignity. - hens. treatment.




Bibliography: Atlas of peripheral nervous and venous systems, sost. A.S. Vishnevsky and A. N. Maksimenkov, page 129, L., 1949; Bogolepov N. K., etc. Nervous diseases, page 193, M., 1956; B au-gorodinsky D. K., etc. Spon-dilogenny lumbosacral radiculitis, Chisinau, 1975; Kovanov V. V. and Travin A. A. Surgical anatomy of the lower extremities, page 163, M., 1963; M. B. and Fedorov E. A. Crawl. Main neuropathological syndromes, M., 1966; A. Yu. Livamyag and P about p about in to and N of E. M. K to a question of formation of a lumbosacral texture of a baboon, a hamadryad and the person, in book: A morphogenesis and regeneration, under the editorship of K. K. Kulchitsky, etc., century 4, page 146, Kiev, 1972; The Multivolume guide to neurology, under the editorship of S. N. Davidenkov, t. 3, book 1, page 13, M., 1962; Popelyansky Ya. Yu. Ver-tebrogenvye of a disease of a nervous system, t. 1 — 3, Kazan — Yoshkar-Ola, 1974 — 1981; Triumphs And. B. Topical diagnosis of diseases of a nervous system, page 97, L., 1974; Bernhardt M. Die Erkrankungen der peripherischen Ner-ven, Wien, 1902; Roger G. H., Wi-d a 1 F. et Teissier P. J. Nouveau traite de medecine, p. 99, P., 1927.


I. P. Antonov; P.F. Stepanov (An.).

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