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Journal of anatomy 2022年12月18日The functional association between hip joint motion and defaecation/urinary function has attracted considerable research and clinical attention owing to the potential novel approaches for pelvic floor rehabilitation; however, the anatomical basis remains unclear. This study, therefore, aimed to analyse the anatomical basis of force transmission between the obturator internus, a muscle of the hip joint, and the levator ani, a muscle of the pelvic floor. Twenty-three cadavers were used for macroscopic and histological analyses. The three-dimensional structures of the muscles and fascia were recorded using a high-definition camera and a 3D scanner. The arrangement and attachment of the muscle fibres, tendons and fascia were visualised using histological sections stained with Masson's trichrome. The obturator internus and levator ani were in broad contact through the obturator fascia. The height of their contact area was 24.6 ± 9.1 mm. Histologically, the obturator internus and levator ani shared a large area of the obturator fascia, and the obturator fascia provided the attachment of several muscle layers of the levator ani. The contribution of hip joint motion to defaecation/urinary function can be explained by the broad 'planar' contact between the obturator internus and levator ani. This anatomical feature suggests that movement of the obturator internus creates the foundation for the function of the levator ani and contributes to pelvic floor support through the obturator fascia. This study provides an anatomical basis for the effectiveness of the hip muscles in improving defaecation/urinary function by enabling balanced and proper movements.
MISC
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関東連合産科婦人科学会誌 51(2) 307 2014年5月1日
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日本産科婦人科内視鏡学会雑誌 27(1) 251-254 2011年<B>[Objective] </B>An air-fluid level (niveau) on abdominal X-ray is usually an important sign of ileus. We experienced two cases of ileus without air-fluid level following gynecologic surgery. Both patients underwent double-balloon enteroscopy for diagnosis, followed by laparoscopic adhesiolysis.<BR><B>[Case 1] </B>The patient underwent total abdominal hysterectomy and right salpingo-oophrectomy for myoma uteri and right ovarian tumor. Five months later, she was readmitted with abdominal pain and constipation, but there was no air-fluid level on abdominal x-ray. Adhesion of the small bowel was diagnosed by enteroscopy. Laparoscopic adhesiolysis was performed. There was a 20 cm adhesion of the small bowel to the scar from the previous operation, but there was no stenosis or obstruction. Usually, a post-operative ileus is a mechanical ileus, but this case it was not only a mechanical ileus, but also a functional ileus because there was peristalsis abnormality.<BR><B>[Case 2] </B>A patient who was being treated for depression underwent right adnexectomy for torsion of a right ovarian tumor. 16 months later, she was readmitted with lower abdominal pain and constipation without air-fluid levels. We initially suspected functional ileus because the patient was on antidepressants, but conservative therapy was not effective. Diagnostic enteroscopy revealed adhesion of the small bowel. Because of the enteroscopy results, laparoscopic surgery was selected and laparoscopic adhesiolysis between the ileum and retroperitoneum was performed.<BR><B>[Conclusion] </B>When abdominal pain and constipation without air-fluid level are persistent, we must consider the possibility of ileus. Enteroscopy and laparoscopic adhesiolysis may be options in these cases.
共同研究・競争的資金等の研究課題
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日本学術振興会 科学研究費助成事業 若手研究 2021年4月 - 2026年3月