The inguinal canal is formed by what. Inguinal canal, canalis inguinalis. Autoplastic methods of strengthening the anterior wall of the inguinal canal

The inguinal canal is a kind of gap located in the lower part of the abdominal wall, namely above the inguinal ligament. In men, it contains the spermatic cord, and in women, it has a round ligament in the uterus. The direction of the canal is certainly oblique. Above, namely, above its section of the upper branch, the superficial groin ring is located. A little lower - the groin ring is deep. And between them, the inguinal canal is located obliquely laterally.

The inguinal canal, the anatomy of which is quite complex, has the following walls: anterior (aponeurosis of the oblique external and posterior (transverse fascia of the abdomen), as well as the lower (groove of the inguinal ligament) and upper (lower edge of the oblique internal muscle and the lower edge of the transverse abdominal muscle).

The length of the inguinal canal does not exceed five centimeters. In the vicinity of this canal is the inner inguinal ring (deep), located above the inguinal ligament at a distance of two centimeters from about the middle of this ligament. In that place, namely in a kind of gap where the fibers of the external oblique muscle of the abdominal cavity diverge from each other, there is a superficial inguinal ring. It is called so due to the fact that it is located above the inguinal ligament, or more precisely, above its medial part.

The slightly tucked edge of the aponeurosis of the oblique external muscle of the abdominal cavity is the inguinal ligament, which serves as a connective tissue for the oblique abdominal muscle and the transverse fascia of the abdomen. It is she who forms the lower channel wall.

The aponeurosis of the external oblique muscle, which very often limits the anterior wall, is not a compact plate at all, but a reticular one. But the upper wall is formed by several lower edges of the transverse and internal oblique muscles of the abdominal cavity.

Starting at the lower edge of the internal oblique muscle, in men, a small, definite muscle bundle is separated, forming a muscle such as the testicular levator. It reaches the testicle itself, leaving the inguinal canal through the existing external opening. The posterior wall, which is formed by the transverse fascia of the abdominal cavity, grows together with the inguinal ligament, not even with the ligament itself, but with its posterior edge.

The superficial groin ring, located above the inguinal ligament, is itself and is rather limited due to the divergence of the tendon into two legs: lateral and medial. The first of them has grown to the pubic tubercle, and the second to the symphysis, and the left is located in front of the right. This means that the further it is from the symphysis, the wider the inguinal canal (its opening) will be.

Only thanks to this feature is it possible to determine the predisposition to the emergence and development. Of course, this is quite easy to determine with the help of X-rays. On the lateral side, the slit is reinforced with fibers that connect the tissue between the legs

The hole, which does not have any abnormalities, should allow the tip of the little finger to pass through. At larger sizes, it is evaluated as extended. This hole can be easily examined by inspection. If with the little finger (its tip) to protrude the skin of the scrotum upward, and then laterally, then it is quite realistic to probe the entrance directly to the inguinal canal, the walls of which in a normal healthy state are always in good shape.

Deep ring the groin is slightly higher from the middle of the inguinal ligament itself by about 1 centimeter. It looks like a free opening, because it contains the intravaginated transverse fascia of the abdomen. It is located around either the spermatic cord (in men), or around the round-shaped ligament of the uterus (in women).

It is through this channel that, when a congenital inguinal hernia (oblique) occurs, all its contents descend into the scrotum, which leads to undesirable consequences.

Inguinal canal .. Has 4 walls and 2 holes (external and internal) ,. * upper edge - the lower edges of the internal oblique and transverse abdominal muscles.

*. the lower edge is the inguinal ligament (the edge of the aponeurosis of the external oblique muscle of the abdomen).

*. outside - the aponeurosis of the external oblique muscle of the abdomen ..

*. inside - transverse fascia ..

*. internal opening - the posterior surface of the anterior abdominal wall - projection - lateral fossa ..

*. external opening - between the legs of the aponeurosis of the external oblique muscle of the abdomen (.laterally - tuberculum pubicum,. medially - pubic articulation,. below - reflected ligament,. above - interphase fibers). projection-medial fossa.

Inguinal canal

is projected over the inner half of the inguinal cannula (PS).

Content : spermatic cord (covered with transverse fascia and peritoneum, consists of ductusdeferens, s-dov, r.genitalisn.genitofemoralis), in women - a crusty ligament of the liver. N.ilioinguinalis passes in front of them.

Surface ring (projected onto the lateral fossa) - formed by the medial and lateral legs of the aponeurosis of the NSCM, between them fibraeintercrurales (outside) and lig.reflexum (medially) are thrown. It is wider in men than in women.

Deep ring (projected into the medial fossa) - formed by a hole in the transverse fascia (it is carried away by the spermatic cord in P.K.), and limited by falxinguinalis (connected tendon of PopMZh and ECMZH) and lig.interfoveolare (St. Gesselbach).

Inguinal triangle bounded by PS, the outer edge of the permanent residence and a horizontal line passing through the border between the upper and middle third of the PS.

Inguinal gap - m-du upper and lower walls of P.K., medially nah-Xia PrMZh.

The walls of the inguinal canal :

1). Anterior - aponeurosis of the NKMZH, fibers of the ECMZH and, in the upper part of the PS. - PopMZH.

2). Posterior - transverse fascia.

3). The lower - inguinal ligament - formed by tucking the aponeurosis of the NKMZH.

4). Upper - lower edges of PopMZH and partially ECMZH.

Groin canal: walls - in front of the aposis of oblique muscles, back from transverse f, top from transverse muscles, bottom from groin st. With a hernia, in front of only the nar. Oblique muscle, and the top of the vn. and cross. muscles. Outer ring from the splitting of the oblique muscle, above fibraintercruralis, below lig.reflexum. Inner ring from transverse f, fastened with ligaments m-du pits in front of the wall

79 The concept of hernias

This is the passage under the skin of the abdominal organs together with the parietal leaf of the peritoneum through weak points in the musculo-aponeurotic layer of the anterior abdominal wall.

Classification:

Hernia of the white line of the abdomen.

Hernia of the umbilical ring.

Femoral hernia.

Inguinal hernia:

Straight.

Hernia.oblique... h-w honey pit, deep ring - channel - outside. ring - under the outside. this fascia. rope on the front. more hernias. bag. Plastic - to strengthen the front. wall-ku. straight... h-z lat. fossa, pulls f.transversa- outward. ring, does not come out into the scrotum, plastic - strengthening the back wall. this the cord lies outwards.

80 Autoplastic methods of strengthening the anterior wall of the inguinal canal

Plastic by :.

*. Martynov - sew the upper flap to the inguinal ligament. Sew the lower flap to the upper one with the formation of the external opening of the inguinal canal - duplication ..

*. Girard - 3 rows of stitches: 1st stitch the edges of the muscles and sew them to the inguinal ligament. further along Martynov.

*. Spaso-Kukotsky - to sew the upper flap of the aponeurosis. then the muscles and all this to the inguinal ligament. suturing the lower flap ..

*. Kimbarovsky - injected above the stitching of the aponeurosis of the muscles. then bypass the muscle with a needle and inject into the aponeurosis at the edge and then suture to the inguinal ligament ..

* Lichtenstein - reinforced the posterior wall of the groin canal with a 6x8 cm polypropylene mesh, which is fixed behind the spermatic cord, completely covering the entire inguinal gap.

Inguinal canal, canalis inguinalis, is a slit through which the spermatic cord, funiculus spermaticus, in men and the round ligament of the uterus, lig. teres uteri, in women. It is placed in the lower part of the abdominal wall on either side of the abdomen, immediately above the inguinal ligament, and goes from top to bottom, from outside to inside, from back to front. Its length is 4.5 cm. It is formed as follows: the internal oblique and transverse muscles grow to the outer two-thirds of the groove of the inguinal ligament, but throughout the medial third of the ligament they do not have this fusion and freely spread over the spermatic cord or the round ligament.

Thus, between the lower edges of the internal oblique and transverse muscles from above and the medial part of the inguinal ligament from below, a triangular or oval slit is obtained, into which one of the mentioned formations is embedded. This gap is the so-called inguinal canal. From the lower edge of the internal oblique and transverse muscles hanging over the spermatic cord, a bundle of muscle fibers departs to the latter, accompanying the cord to the scrotum, m. cremaster (muscle lifting the testicle).

The slot of the inguinal canal is closed in front by the aponeurosis of the external oblique muscle of the abdomen, passing below into the inguinal ligament, and behind it is covered by the fascia transversalis.

Thus, four walls can be distinguished in the inguinal canal. The anterior wall is formed by the aponeurosis of the external oblique muscle of the abdomen, and the posterior wall is formed by the fascia transversalis; the upper wall of the canal is represented by the lower edge of the internal oblique and transverse muscles, and the lower one - by the inguinal ligament. In the anterior and posterior walls of the inguinal canal there is an opening, called the inguinal ring, superficial and deep.

The superficial inguinal ring, annulus inguinalis snperficialis (in the anterior wall), is formed by the divergence of the fibers of the aponeurosis of the external oblique muscle into two legs, of which one, crus laterale, attaches to the tuberculum pubicum, and the other, crus mediale, to the pubic symphysis. In addition to these two legs, a third (posterior) leg of the superficial ring, lig. reflexum, which lies already in the inguinal canal itself behind the spermatic cord. This leg is formed by the lower fibers of the aponeurosis m. obliquus externus abdominis of the opposite side, which, crossing the midline, pass behind the crus mediale and merge with the fibers of the inguinal ligament. The limited crus mediale and crus laterale superficial inguinal ring has the shape of an oblique triangular slit. The acute lateral angle of the gap is rounded off by arcuate tendon fibers, fibrae intercrurales, originating from the fasia covering m. obliquus externus abdominis. The same fascia in the form of a thin film descends from the edges of the superficial inguinal ring to the spermatic cord, accompanying the latter into the scrotum called fascia cremasterica.

The deep inguinal ring, annulus inguinalis profundus, is located in the region of the posterior wall of the inguinal canal formed by the fascia transversalis, which extends from the edges of the ring to the spermatic cord, forming a shell surrounding it with the testicle, fascia spermatica interna. In addition, the posterior wall of the inguinal canal is reinforced in its medial section by tendon fibers extending from the aponeurotic extension of m. transversus abdominis and descending along the edge of the rectus muscle down to the inguinal ligament. This is the so-called falx inguinalis.

The peritoneum covering this wall forms two inguinal fossae, fossae inguinales, separated from each other by vertical folds of the peritoneum, called the umbilical. These folds are as follows: the most lateral - plica umbilicalis lateralis - is formed by raising the peritoneum passing under it a. epigastrica inferior; medial - plica umbilicalis medialis - contains ligamentum umbilicale mediate, i.e., overgrown a. umbilicalis of the embryo; median - plica umbilicalis mediana - covers lig. umbilicale medianum, overgrown urinary tract (urachus) of the embryo.

The lateral inguinal fossa, fossa inguinalis lateralis, located laterally from the plica umbilicalis lateralis, just corresponds to the deep inguinal ring; the medial fossa, fossa inguinalis medialis, lying between plica umbilicalis lateralis and plica umbilicalis medialis, corresponds to the weakest part of the posterior wall of the inguinal canal and is placed just opposite the superficial inguinal ring. Through these fossae, inguinal hernias can protrude into the inguinal canal, and a lateral (external) oblique hernia passes through the lateral fossa, and a medial (internal) straight hernia passes through the medial fossa.

The origin of the inguinal canal is associated with the so-called descent of the testicle, descensus testis, and the formation of the procesus vaginalis of the peritoneum in the embryonic period.

The inguinal canal is the gap between the broad abdominal muscles above the medial half of the inguinal ligament. Recall that the term "inguinal ligament", adopted in surgery, implies two ligamentous formations: the true inguinal ligament and the parallel but deeper (behind) ilio-pubic tract. Both of these formations are closely adjacent to each other, but there is a very narrow gap between them. The inguinal canal has an oblique direction: from top to bottom, from outside to inside and from back to front. Its length in men is 4-5 cm; in women it is somewhat longer, but narrower than in men.

4 walls are distinguished in the inguinal canal:

- Front wall the inguinal canal is formed by the aponeurosis of the external oblique abdominal muscle.

- Back wall The inguinal canal is formed by the transverse fascia. In the medial part, it is reinforced with an inguinal sickle, falx inguinalis (Henle's ligament), connected by aponeuroses of the internal oblique and transverse abdominal muscles. At the lateral edge of the rectus abdominis muscle, the sickle is curved downward and attached at the pubic tubercle, connecting with the ilio-pubic tract. In the area between the medial and lateral inguinal fossa, the transverse fascia (the posterior wall of the canal) is reinforced by the intercellular ligament, lig. interfoveolare. Part of the posterior wall of the inguinal canal medially from a. et v. epigastricae inferiores are called the Hesselbach triangle. Its boundaries are from below - the inguinal ligament (ilio-pubic tract), laterally - the lower epigastric vessels, medially - the outer edge of the rectus abdominis muscle. Straight inguinal hernias emerge through this triangle. Thus, the posterior wall of the inguinal canal does indeed consist of the transverse fascia, but it is not as thin a plate as it appears in other parts of the abdominal wall. It is compacted and reinforced with tendon elements, although the lower edge of the internal oblique muscle of the abdomen plays the main role in its strengthening.

- Top wall the inguinal canal is formed by the lower free edges of the internal oblique and transverse abdominal muscles. The lower edge of the internal oblique muscle of the abdomen, as a rule, is located slightly below the transverse. From this, as already mentioned, the height of the inguinal gap and, accordingly, the height of the posterior wall of the inguinal canal depend.

- Bottom wall The inguinal canal are the inguinal ligament and the ilio-pubic tract.

In the inguinal canal, 2 rings are distinguished:

- Superficial inguinal ring, anulus inguinalis superficialis, is formed by two diverging legs of the aponeurosis of the external oblique abdominal muscle, the medial of which is attached near the symphysis, and the external one - to the pubic tubercle. The outer part of the ring is reinforced by arcuate inter-pedicle fibers, fibrae intercrurales. Sometimes there is a third, posterior, leg - it is made up of a bent ligament, lig. reflexum fColles], which passes into the fibers of the external oblique muscle of the opposite side. The superficial ring looks like an irregular oval, its longitudinal size is 2-3 cm, the transverse one is 1-2 cm. When examined externally through the skin, the superficial ring normally passes the end of the little finger. In women, the size of the superficial ring is half that.

- Deep groin ring, anulus inguinalis profundus, is a funnel-shaped depression in the transverse fascia, that is, it is not a hole with smooth edges like a buttonhole, but a protrusion of the fascia into the inguinal canal in the form of a finger from a rubber glove. It is easier to imagine if you remember that the testicle, descending into the scrotum, protrudes in front of itself all the layers of the anterior abdominal wall, including the transverse fascia. In this regard, the protrusion, surrounding the vas deferens and other elements of the spermatic cord, is its shell, fascia spermatica interna. Along the course of the cord, this fascia reaches the scrotum in men and along the round ligament of the uterus to the labia majora in women. The lateral inguinal fossa corresponds to the deep inguinal ring from the side of the peritoneal cavity. The ring is located 1-1.5 cm above the middle of the inguinal ligament. From the medial side, the initial section a is adjacent to it. epigastrica inferior. At the deep inguinal ring, the elements of the spermatic cord converge, entering (vasa testicularia) and leaving (ductus deferens, v. Testicularis) from the inguinal canal.

Inguinal canal, (canalis ingvinalis), paired, located on the right and left in the lower inguinal region, above the medial half of the inguinal ligament. This is a gap, 4-5 cm long, passing through the thickness of the anterior abdominal wall, obliquely from top to bottom and medially, from the inside (from the deep inguinal ring) outward (to the superficial, subcutaneous inguinal ring).

Through the inguinal canal men passes the spermatic cord, in women - the round ligament of the uterus.

The inguinal canal has 4 walls: front, back, top and bottom. Front the wall is formed aponeurosis of the external oblique m. abdomen. Back the wall is formed transverse fascia and parietal peritoneum. Lower the wall is formed inguinal ligament(bent downward edge of the aponeurosis of the external oblique m. of the abdomen). Upper the wall is formed lower free edges of the internal oblique and transverse muscles belly. Deep ring the inguinal canal is on the posterior wall of the canal (on the transverse fascia), above the middle of the inguinal ligament, this is a funnel-shaped depression, corresponds to the lateral fossa of the abdominal wall.Surface ring lies under the skin, on the front wall of the canal, in the place where the aponeurosis of the external oblique m... belly diverges into two legs, ring limited medial and lateral legs of the aponeurosis, interpeduncular fibers and curved ligament.Surface ring corresponds to medial fossa of the anterior abdominal wall... The fossae are the weak points of the anterior abdominal wall; they are the exit point for inguinal hernias. In men, the inguinal canal is wider, which is associated with the process of lowering the testicle, so inguinal hernias are more common in men.

Vascular and muscle lacunae.

Muscle and vascular lacunae are spaces between the inguinal ligament above and the pelvic bone below, separated by the iliac-comb lip. Inguinal ligament stretches from the anterior superior iliac spine to the pubic symphysis (see abdominal muscles). Iliac-comb arch stretches from the inguinal ligament to the ilio-pubic junction of the pelvic bone. The muscle lacuna is located lateral, the vascular lacuna is medial. Through the muscular lacuna goes to the thigh iliopsoas muscle and femoral nerve(from the lumbar plexus). Through the vascular lacuna, large vessels emerge from the pelvic cavity onto the thigh - the femoral artery, the femoral vein, as well as the femoral branch of the femoral-pudendal nerve (from the lumbar plexus). In the medial part of the vascular lacuna, limited by the lacunar (Jimbernat) ligament, there is a deep ring of the femoral canal, where a large lymph node is located (Pirogov-Rosenmüller).

?? (if asked) The deep ring is bounded from above by the inguinal ligament, from below by the comb ligament (part of the fascia of the comb muscle), medially by the lacunar ligament, and laterally by the femoral vein. Through this ring can go femoral hernia; they come out under the skin through the subcutaneous fissure, hiatus safenus, here great saphenous vein the leg flows into the femoral vein.

The muscles of the shoulder girdle, innervation.

The muscles of the shoulder girdle surround the shoulder joint in front, above, and behind. The muscles of the shoulder girdle include deltoid, supraspinatus, infraspinatus, large and small round and subscapularis muscles. The muscles of the shoulder girdle begin at the bones of the shoulder girdle (clavicle and scapula) and attach to different parts of the humerus. These muscles flex and extend the shoulder, turn it outward and inward, and bring the shoulder in and out. Innervation: supraspinatus and infraspinatus – suprascapular nerve deltoid and small round – axillary nerve large and subscapularis muscles – subscapularis nerve all nerves from the brachial plexus (short branches).

Deltoid m... originates at the acromial end of the clavicle, acromion and spine of the scapula and attaches to the deltoid tuberosity of the humerus - takes the arm away from the body, bends the front part, the back part unbends the shoulder. Supraspinatus m.- from the supraspinatus fossa goes to the large tubercle of the shoulders of the bone and to the capsule of the shoulder joint, pulls the capsule off the shoulder. Subostnaya m.- from the infraspinatus fossa, small round from the lateral edge of the scapula, both muscles go to the large tubercle of the humerus and turn the shoulder outward ...

Three-way and four-way holes and their contents.

On the back wall of the axillary cavity between the muscles there are two large openings through which vessels and nerves pass from the neurovascular bundle to the posterior surface of the shoulder and scapula. 3-way hole formed from above subscapularis muscle from below - large round muscle, laterally - the long head of the triceps muscle. It takes place scapula artery(a branch of the subscapularis and. from the axillary artery).

Four-way hole it is also formed by the subscapularis, large circular muscles and the long head of the triceps m. and surgical neck of the shoulder. In the four-sided hole pass axillary nerve(from the brachial plexus) and posterior artery of the humerus(from the axillary artery).