The invention relates to medicine, namely to surgery in the surgical treatment of defects in the aponeurosis of the external oblique muscle of the abdomen. The method includes suturing the stratified aponeurosis without forming a duplication in the transverse direction. The aponeurosis is sutured from the crest level ilium towards the outer inguinal ring. Non-absorbable materials are used for suturing. The sutures are placed in a checkerboard pattern at a distance of 0.5 cm to 2 cm from each other without the formation of tension in the tendon fibers, which creates an additional strengthening of the stratified aponeurosis and further growth of the connective tissue.
The invention relates to medicine, namely to surgery, and can be used in the surgical treatment of defects in the aponeurosis of the external oblique muscle of the abdomen. Modern studies have shown that the diagnosis and treatment of groin pathology problems that occur mainly in professional athletes present significant difficulties. In recent years, thanks to the studies of various authors, it has become clear that, in addition to the microtraumatization of the adductor muscles of the thigh, well-known to traumatologists, a defect in the aponeurosis of the external oblique muscle of the abdomen can serve as a cause of pain. Researchers in different countries have long been interested in the nature and method of treating pain in the inguinal region. In the 60-80s. of the last century, these pains were unambiguously associated with the so-called. ARS syndrome (adductus rectuc syndrome). D. Shoylev (1986) explained pain in the groin and lower abdomen in athletes by the presence of enthesopathy or myoenthesitis of the adductor muscles of the thigh and the proximal part of the rectus abdominis muscles due to their microtraumatization. Since the beginning of the 90s. the term ARS has disappeared from scientific publications. Most often, damage to the inguinal region occurs in professional football players, hockey players, less often in rugby players, tennis players, fencers, and hurdler athletes. According to Orchard J., James E., Alcott S. et al. athletes, groin injuries were observed in 38 people (7.2%). In professional hockey players playing in the NHL, according to Nicholas SJ & Tyier TF (2002), such injuries account for about 10% of all pathology. Prevention, timely diagnosis and treatment of muscle pathology is a very urgent problem, primarily for professional football players, as they put them out of action for a long time. So, according to Hawkins D., Hunse M., Wilkinson C. et al. (2001), as well as Orchard J., Real J.W., Verrall G.M. et al. (2000) each player's muscle injury took an average of 21-24.2 days to heal and resulted in missing up to 12 games per season. Thus, damage to the inguinal region presents significant difficulties for the diagnosis and treatment of athletes, causing significant damage to sports. It has now been established that the presence of pain in the inguinal region that prevents athletes from training and competitive loads is due to degeneration and destruction of the aponeurosis of the oblique abdominal muscles (up to up to the separation of part of the fibers) and the involvement in the pathological process of the neurovascular bundles passing through their thickness, containing the terminal branches of n.iliohipogastricus. The essence of the method lies in the fact that it includes tying knots and bringing the free ends of the tied threads out through the skin wound. At the same time, interrupted sutures are applied at a distance of 1.5-2 cm from each other, and the capture of the aponeurosis is carried out 1-2 cm away from its edges, the second knots are tied with the formation of bow loops, a monolithic thread is passed through the loops and the loops are tightened on it .The closest analogue (prototype) is the Mayo aponeurosis defect plasty method, including suturing the aponeurosis tissues with the formation of a duplication in the transverse direction (Borodin I.F. et al., Surgery of postoperative abdominal hernias - Minsk, "Belarus", 1986, p. 49, 50). The disadvantages of the analogue and prototype are the adverse consequences of the formation of a duplication, leading to a divergence of weakened tissues located near the duplication formed by suturing, which may be due to an increase in intra-abdominal pressure during coughing, constipation, physical exertion, etc. A positive result of the claimed invention is to increase the efficiency of plastic surgery of the defect of the aponeurosis of the external oblique muscle of the abdomen by reducing the risk of complications and relapses, eliminating chronic pain in the groin and reducing the period rehabilitation period.The claimed positive result is achieved as follows. The method of plastic surgery of the aponeurosis of the external oblique muscle of the abdomen includes suturing the stratified aponeurosis without the formation of duplication in the transverse direction. The aponeurosis is sutured from the level of the iliac crest towards the external inguinal ring. For suturing, non-absorbable materials are used (threads 4-0, 5-0). The sutures are placed in a checkerboard pattern at a distance of 0.5 cm to 2 cm from each other without the formation of tension on the tendon fibers. Due to this, an additional strengthening of the stratified aponeurosis is created and, in the future, an increase in the connective tissue. The proposed method was tested in clinical conditions on 15 patients. A survey of patients involved in sports revealed that the provoking moment was training and high physical activity during sports competitions. Pain, as a rule, was observed for several months or years. They were localized in the ilio-inguinal region and the inner surface of the thigh. An example of the implementation of the method. Patient X., aged 19, was admitted for treatment with complaints of pain in the groin during exercise. For examination, the patient standing leaned back on the doctor's left hand. The doctor performed palpation with the fingertips of the inguinal regions. On examination, defects of the aponeurosis were revealed, consisting in the prolapse of the tissues of the anterior abdominal wall. The operation was carried out according to the claimed method. The incision was made exactly over the localization of pain, which was determined before the operation. During the operation, 5 linear defects were found - fiberization of the aponeurosis tissue at different levels of the external oblique muscle of the abdomen. Hernial protrusion was not detected. The operation was performed by suturing from the level of the iliac crest towards the external inguinal ring. Non-absorbable 4-0 sutures were used for suturing. The sutures were placed in a checkerboard pattern at a distance of 0.5 to 2 cm from each other without the formation of tension in the tendon fibers. After the operation, restriction of physical activity was prescribed. In the postoperative period, for 2 weeks, the patient performed walking exercises, physical exercises in the pool ( running exercises, swimming in different styles), in the gym - exercises for healthy parts of the body using simulators, training on a bicycle ergometer. One month after the operation, the patient began running training. No complications and relapses were observed over the next 2 years. The effectiveness of the proposed method is to eliminate chronic pain in the groin and achieve a short rehabilitation period. The claimed method is especially effective for athletes and people engaged in physical labor, involving heavy loads on the muscles.
Claim
Method for plasty of the aponeurosis of the external oblique muscle of the abdomen, including suturing the stratified aponeurosis, characterized in that the aponeurosis is sutured without duplication in the transverse direction from the level of the iliac crest in the direction of the external inguinal ring with non-absorbable threads with staggered suturing at a distance of 0.5-2 cm apart without tension on the tendon fibers.
105. 1- aponeurosis of the external oblique muscle of the abdomen is sewn edge to edge without tension;
2- Thomson's plate is sutured with separate vicryl sutures;
3- apply cosmetic skin sutures.
106. 1 - discharge of the hernial sac ;
2 - processing his neck .
107. 1 - plastic surgery of the inguinal canal according to Ru - T. P. Krasnobaev ;
2 - according to A.V. Martynov .
108. 1 - femoral ;
2 - inguinal .
109. 1- there is the possibility of visual control of the surgical field in order to prevent damage to the formations surrounding the femoral ring (femoral vein, obturator artery in the "crown of death", round ligament of the uterus, etc.).
110. 1 - the hernial orifice is closed by suturing the pectinate ligament to the inguinal ligament ;
2 - sometimes the previous method of hernioplasty is combined with suturing the falciform edge of the wide fascia of the thigh to the pectinate fascia .
111. 1 - in suturing the inguinal ligament to the pectinate ligament from the side of the inguinal canal .
112. 1 - there is an increase in the height of the inguinal gap (which creates the possibility of an inguinal hernia) .
113. 1 - according to Parlaveccio, the deep opening of the femoral canal and the inguinal gap are simultaneously closed, eliminating the possibility of the formation of a direct inguinal hernia in the future) ;
2 - after closing the deep femoral ring, the inguinal gap is eliminated by suturing the lower edges of the internal oblique and transverse muscles to the pectinate ligament .
114. 1 - vertical skin incision along the midline. They start a few cm above the navel, go around the navel on the left and continue the incision 3-4 cm down ;
2 - semilunar incision bordering the hernial protrusion from below .
115. 1 - the deformed navel is excised in agreement with the patient .
116. 1 - the imposition of a purse-string suture on the edges of the umbilical ring in the longitudinal direction under the control of a finger inserted into the umbilical ring .
117. Creation of duplication due to sheets of the white line of the abdomen
1 - a skin incision is made along the midline of the abdominal wall, bordering the hernial protrusion. Open (for the purpose of revision) and remove the hernial sac. The umbilical ring is expanded up and down to full tissues. Scar-modified areas of the white line are sparingly excised. After careful hemostasis, doubling of the aponeurosis ("white line") ;
2 - the left edge of the aponeurosis is retracted to the left and the right edge is sutured to its base, the free left edge of the aponeurosis is placed over the right edge and sutured with separate sutures .
118. The principle of the operation is to create a duplication of anoneurosis in the area of the umbilical ring ;
1 - the umbilical ring is dissected with a horizontal incision. The lower edge of the incision of the aponeurosis with "P"-shaped sutures is moved under the upper ;
2 - the free upper edge of the incision of the aponeurosis is placed on the lower one and fixed with the second row of sutures .
119. 1 - violation of the blood supply to the organ, followed by gangrene and the development of peritonitis ;
2 - in the deep opening of the inguinal canal ;
3 - in the superficial opening of the inguinal canal .
120. 1 - produce a skin and subcutaneous incision common for inguinal hernia operations basics ;
2 - after dissection, the aponeurosis of the external oblique muscle of the abdomen is isolated from the hernial sac ;
3 - open the hernial sac, fix the strangulated organ ;
4 - after which the infringing ring is dissected - most often the aponeurosis of the external oblique muscle of the abdomen. Less often, infringement occurs in the internal opening of the inguinal canal. The strangulated organ is covered with napkins soaked in warm saline and observed for 5-7 minutes. If after this time the restrained part of the organ has not acquired signs of vital activity, it is resected. The further stages of the operation are the same as for an unstrapped hernia. .
121. 1 - up and ;
2 - laterally .
122. 1 - in the medial direction ;
2 - lacunar ligament ;
3 - obturator artery in the "crown of death" .
123. 1 - “laparotomy” or “ventiotomy” - opening of the abdominal cavity (“relaparotomy” - re-opening of the abdominal cavity) ;
2 - therapeutic (laparotomia vera) - operational access to the abdominal organs in order to perform an operative reception ;
3 - diagnostic, trial (laparotomia probatoria).
124. 1 - longitudinal ;
2 - oblique ;
3 - corner ;
4 - transverse ;
5 - combined .
125. In relation to the midline and the rectus abdominis muscle, the following incisions are distinguished :
1 - median ;
2 - paramedian ;
3 - transrectal ;
4 - pararectal .
126. 1 - median incision .
127. 1 - upper midline laparotomy ;
2 - lower midline laparotomy .
128. 1 - provide wide access to the organs of the abdominal cavity (beneficial in emergency operations for acute surgical diseases of the abdomen and penetrating wounds) ;
2 - blood vessels and nerves of the anterior-lateral abdominal wall are not damaged ;
3 - the incision can be widened up and down ;
4 - slow scar formation ;
5 - wound dehiscence in debilitated patients.
129. 1 - in order to exclude damage to the umbilical vein located in the round ligament of the liver (the ligament is directed from top to bottom, from right to left, from back to front). If necessary, hemostatic clamps are applied to the ligament, dissected between them and bandaged.
130. 1 - the medial edge of the rectus abdominis muscle is displaced to the lateral side ;
2 - the lateral edge of the rectus abdominis muscle is displaced to the medial side .
131. 1 - the rectus abdominis is not damaged ;
2 - the line of incisions of the anterior and posterior walls of the aponeurotic sheath of the rectus muscle is not coincide ("step-like" access) ;
3 - there is a prerequisite for damage to the branches of the intercostal nerves located on the back wall of the vagina to the rectus muscle. V. I. Dobrotvorsky modified the Lennander operative approach: the posterior wall of the sheath of the rectus abdominis muscle is cut not vertically, but obliquely - in the direction of the intercostal nerves .
132. 1 - delaminate along the fibers in the longitudinal direction ;
2 - due to damage to the branches of the intercostal nerves that innervate the muscle .
133. 1 - liver ;
2 - ;
3 – spleen.
134. 1 - caecum c ;
2 - appendix ;
3 - sigmoid colon .
135. 1- oblique - along the fibers of the aponeurosis of the external oblique muscle of the abdomen (parallel to the inguinal ligament) ;
2 - variable - changing the direction of the operative approach, taking into account the course of the fibers of the internal oblique and transverse abdominal muscles ;
3 - the edges of the internal oblique and transverse muscles are bred stupidly with Farabef hooks (as the backstage is opened). The transverse fascia and parietal peritoneum are dissected in the transverse direction .
136. 1 - the layers of the anterior-lateral abdominal wall are separated along the fibers of the aponeurosis and muscles, i.e. in different directions. When suturing the wound, the lines of connection of the layers of the abdominal wall will not match. ;
2 - blood vessels and nerves are not damaged ;
3 - the incision ensures minimal wound depth;
137. 1 - limited visibility of the surgical field .
138. 1 - S. P. Fedorov. An incision along the midline, (3-5 cm from the xiphoid process down), then parallel to the right costal arch, 3-4 cm away from it, cross the rectus abdominis muscle ;
2 - T. Kocher. The incision is parallel to the right costal arch and 2 cm down from it .
139. 1 - Mack - Burney, N. M. Volkovich - P. I. Dyakonov. Oblique variable rocker cut ;
2 - Lennander (modified by V. I. Dobrotvorsky). Right-sided pararectal incision with a dissection of the posterior wall of the vagina of the rectus abdominis muscle in an oblique direction .
140. 1 - for transverse incisions above the navel, the rectus abdominis muscles are pulled to the sides (if necessary, the rectus muscles can be dissected in the transverse direction).
141. 1 - Pfannenstiel ;
2 - skin ;
3 - subcutaneous tissue ;
4 - superficial fascia ;
5 - white line of the abdomen ;
6 - transverse fascia ;
7 - preperitoneal tissue ;
8 - parietal peritoneum .
142. 1 - liver ;
2 - gallbladder (and extrahepatic bile ducts) ;
3 - spleen .
143. 1 - cardia of the stomach ;
2 - abdominal part of the esophagus
.
3 -liver.
144. 1 - the parietal peritoneum in the middle of the wound is captured with two anatomical tweezers, a fold is formed, which is dissected with scissors. The edges of the peritoneal incision, together with the overlaying towels, are grasped with Mikulich clamps. The peritoneum is dissected along the entire length of the wound, lifting it with the index and middle fingers of the left hand inserted into the abdominal cavity .
145. 1 - lamellar hooks (Farabefa) ;
2 - mechanical retractor ;
3 - first, closed fingers are inserted into the abdominal cavity. Hooks (retractor) inserted between the abdominal wall and fingers .
146. 1 - as a hemostasis ;
2 - in the absence of a foreign body in the abdominal cavity .
147. 1- three ;
2 - peritoneal suture ;
3 - suture of the aponeurosis (white line of the abdomen);
4 - skin suture (with subcutaneous base) .
148. 1 - preperitoneal tissue ;
2 - transverse fascia ;
3 - continuous twisting (Reverden-M.P. Multanovsky) ;
4 - catgut .
149. 1 - from the bottom ;
2 - Reverden's spatula (a silver tablespoon, or a napkin, which is removed before the wound is completely closed) ;
3 - the edges of the aponeurosis are first brought together with several strong silk sutures .
150. 1 - knotted silk ;
2 - continuous wrapping (or continuous mattress). Continuous aponeurosis sutures have an advantage over nodal sutures, since they disrupt tissue trophism less. The general requirement for the suture of the aponeurosis is thoroughness in comparison of edges, excluding fat interposition (V. M. Buyanov et al., 1993) .
3 - in recent years, most surgeons for the suture of the aponeurosis recommend absorbable monofilaments: maxon, polydioxanone.
151. 1 -elimination of cardiovascular and respiratory failure by removing ascitic fluid ;
2 - in the midline of the abdomen, midway between the umbilicus and the pubis ;
3 - to exclude damage to the bladder and the occurrence of urinary peritonitis .
152. 1 - to facilitate the introduction of the trocar (the skin is sclerosed!);
2 - perpendicular to the surface of the skin of the abdomen .
153. 1 -the liquid is removed in portions, periodically closing the opening of the trocar. To prevent a sharp decrease in intra-abdominal pressure due to the removal of fluid, the anterior abdominal wall is squeezed with a towel or sheet. .
154. 1 - pubic tubercle ;
2 - spermatic cord ;
3 - round ligament of uterus .
155. 1 - imposition of pneumoperitoneum (2500-4500 ml of air is injected through sterile cotton wool with a Janet syringe with a capacity of 150-200 ml under the control of intra-abdominal pressure, which should be 6-8 mm Hg) ;
2 - puncture of the abdominal cavity with a trocar and insertion of a laparoscope ;
3 - examination of the abdominal organs ;
4 - point on the border of the middle and lower third of the right spinous-umbilical line ;
5 - 2 transverse fingers to the left of the midline and above the navel ;
6 - 2 fingers below the navel near the midline .
156. 1 - organs are examined in a certain order - an approximate examination begins from the upper right quadrant and, moving clockwise, returns to its original place. After that, all attention is concentrated on the suspicious area. Inspection is performed not only in the horizontal position of the patient, but also in other positions, which greatly expands the diagnostic capabilities of this method. After the study, air is released. Stitches are placed at the laparocentesis site. .
616.75:611.749
STRUCTURE OF THE APONEUROSIS OF THE ANTERIOR ABDOMINAL WALL OF THE HUMAN IN NORM AND IN PATHOLOGY
A.A. GRIGORYUK*
Using the methods of light and electron microscopy, organometric and morphological studies of the structure of the aponeurosis of the anterior abdominal wall in persons aged 21 to 50 years were carried out. The control group - "practically healthy". Experimental group - patients with inguinal, umbilical and postoperative ventral hernias. A change in the architectonics of the aponeurosis in patients with hernias was revealed, its trophic function was reduced due to the reduction of the microcirculatory bed, which contributes to atrophic and destructive changes in the connective tissue. Key words: aponeurosis, hernia, electron microscopy.
The variety of functions performed by the anterior abdominal wall (ABS) and a large number of surgical access to the abdominal organs makes this area relevant for study. In works on morphology and surgery, the authors mainly focused their attention on its anatomical and topographic features. The present study is devoted to the study of the structure of the aponeurosis in the "weak spots" of the PBS in order to better understand the pathogenesis of hernia formation and the possibility of preventing the mechanism of their occurrence.
Hernias of the anterior abdominal wall occur in 3-7% of the population, which is 50 per 10,000 people. A hernia can form in the inguinal region (inguinal canal), in the white line of the abdomen (gap in the aponeurosis), in the umbilical ring, in postoperative scars. These parts are known in surgery as "weak spots" due to the fact that they are more likely to herniate. The reasons leading to the formation of a hernia are varied. In addition to local predisposing factors, which are based on changes in the topographic and anatomical location of the tissues of the area where the hernia occurred, there are general factors that contribute to their appearance, such as metabolic disorders, impaired collagen synthesis, dysplastic processes, etc. .
The purpose of the study was to study the structure of the aponeurosis of the anterior abdominal wall in "weak places" in normal conditions and in the formation of hernias.
Materials and research methods. The object of the study was the tissues of the linea alba, the umbilical ring and the aponeurosis of the external oblique muscle in the area of the inguinal canal in persons aged 21-50 years.
As a control group, 8 people, defined as "practically healthy", were studied. Experimental group - having pathology: inguinal (7), umbilical (5) and postoperative ventral hernias (8).
Histological examination of the material was carried out on paraffin sections stained with hematoxylin and eosin, Sudan and Mallory. The material was obtained from autopsies within
24 hours after death. For scanning electron microscopy (SEM), standard pieces (0.3 * 0.3 cm) of the aponeurotic tissue of the PBS taken during the operation were fixed for 2 hours in a 2.5% solution of glutaraldehyde prepared in a 0.1 M solution of phosphate buffer (pH=7.4), additionally fixed in 1% OsO4 solution for an hour. SEM preparations were dried in a Hitachi HCP-2 apparatus, sputtered twice with aluminum, and examined on a Hitachi S-405A scanning electron microscope.
For transmission electron microscopy (TEM), the material was fixed in a 2% solution of glutaraldehyde on
0.1 M phosphate buffer (рН=7.4) during the day, additionally fixed in 1% OSO4 solution for an hour and placed in araldite. Ultrathin sections were counterstained with uranyl acetate and lead citrate and viewed under a ShM-100V electron microscope at different magnifications. Statistical processing of the obtained digital data was carried out using the program "Biostatistics, version 4.03"
Results and its discussion. Organometric and morphological studies of the white line of the abdomen in patients of the control group showed that its size varies throughout. The average width of the white line in the epigastrium is
* Vladivostok State medical University, Vladivostok, Ostryakov Ave. 2 tel. 45-17-19, Department of Histology, Cytology and Embryology tel. 45-34-18
2.1±0.2 cm, thickness 1348.2±64.3 µm. In the mesogastric region in the projection of the umbilical ring, the width of the white line was 2.5±0.2 cm, the thickness was 1391.3±58.3 µm. The umbilical ring is an opening limited by compacted tendon fibers of the white line. The superficial fibers are connected with the fibers of the aponeuroses of the external and internal oblique muscles of the abdomen, the deeper ones have a circular direction. The width of the white line in the hypogastric region is 0.7±0.1 cm, the thickness is 1810.1±19.3 µm. The main substance of the white line of the abdomen consists of numerous collagen fibers with longitudinal and transverse orientation and cellular elements. Collagen fibers are combined into bundles from 50 to 100 microns, between which lie fibroblasts and fibrocytes. In a small amount, elastic fibers are found, having an unequal thickness from 700 to 800 nm, woven into collagen bundles.
The study of the white line of the abdomen using scanning electron microscopy made it possible to see the surfaces of cells and non-cellular structures in a three-dimensional image. Bundles of collagen fibers are usually arranged in several layers and run in one direction parallel to each other, having a wave-like curved shape. Between the beams there are free gaps from 10 to 25 µm, communicating with each other. In bundles, collagen fibers branch and pass from one layer to another, linking the layers and opposite bundles together. Collagen fibers are a complete level of collagen organization; they consist of striated collagen fibrils that run parallel to the fiber axis, intertwining with each other, forming the "skeleton" of the aponeurosis, which performs a structural and supporting role. Collagen fibers are closely interconnected with adjacent fibroblasts through collagen fibrils. Fibrils extending from the cell in different directions into the ground substance look in space as cylindrical formations with a diameter of 700 ± 44 nm. Fibroblasts in the connective tissue of the white line of the abdomen also resemble a cylinder with a diameter of 15-
25 µm, one process departs from the pole of each cell.
On ultramicrographs of a mature fibroblast, the nucleus is clearly distinguished, poor in chromatin, but with a large nucleolus. The cytoplasm is moderately basophilic, the granular endoplasmic reticulum occupies up to 70% of its volume. Narrow and moderately widened profiles of cisterns with fine-grained contents predominate, with one or two rows of ribosomes attached to membranes. The Golgi apparatus, which forms proteoglycans, is represented by big amount dictyosomes located throughout the cell. A small number of large mitochondria are evenly distributed throughout the cytoplasm. In mitochondria many parallel oriented cristae are revealed.
In addition to cellular elements, collagen and elastic fibers in the white line of the abdomen, there are microvessels and bundles of non-fleshy nerve conductors. Conductor axons are oriented parallel to collagen fibers (Fig. 1). Unmyelinated axons are partially or completely covered with a sheath of Schwann cells, contain mitochondria, electron-dense bodies, and a few vesicles with light content. Microvessels of round and oval shape, their endotheliocytes are flattened cells with a round, well-structured nucleus. The height of endotheliocytes is from 2 to 4 microns. Their cytoplasm contains a moderate number of organelles. More often than others, elements of the granular endoplasmic reticulum, mitochondria, lysosomes, polysomes and free ribosomes are found here. Intracellular membrane structures are concentrated mainly around the nucleus and in adjacent areas of the cytoplasm. Interaction between adjacent endotheliocytes is carried out using contacts that differ from each other in the shape of the junction line. The width of intercellular spaces in the endothelium does not exceed 10-15 nm.
The study of the connective tissue framework of the aponeurosis of the external oblique muscle of the abdomen in the inguinal region showed that its average thickness is 540.2±20.3 µm. It is represented by a network of predominantly cylindrical collagen fibers having a wavy shape. Bundles of collagen fibers with a width of 40 to 70 microns run parallel to each other along the long axis of the aponeurosis, coinciding with the direction of the main mechanical stresses arising in it. Collagen fibers branch, anastomosing with other fibers. Thin binders
elements combine both fibers located in the same plane and fibers of adjacent layers, forming a three-dimensional network. Elastic fibers up to 1 µm in diameter are located mainly along the collagen fibers. Between the bundles there are gaps that communicate with each other, in which lipocytes, fibroblasts, vessels and nerve conductors are located.
Rice. 1. Aponeurosis of the anterior abdominal wall is normal with an unmyelinated nerve fiber, an electron diffraction pattern of 10000x.
When studying the structure of tissue sections taken from the edge of the hernia orifice in patients with postoperative ventral hernias, median localization (hernial protrusion from 10 to 15 cm), some features of its structure and microrelief were revealed. Muscle fibers lose their striated striation. Rough connective tissue grows between the muscle bundles, consisting of hyalinized bundles of collagen and fibrocytes. The average thickness of the white line of the abdomen in the epigastrium was 1118.2±86.3 µm, in the mesogastric region 1092.3±88.3 µm, in the hypogastrium 1380.1±59.3 µm. The fibrous skeleton of the aponeurosis is represented by a large number of amorphously arranged collagen fibers running in different directions and planes. There are almost no elastic fibers. Collagen bundles branch into individual thin fibers 1–2 μm thick, the latter consisting of transversely striated fibrils. Along with cylindrical fibers, there are also flattened ones, having the shape of a slightly twisted spiral, which have lost fibrillarity. Such fibers were not found in "practically healthy" individuals. The thickness of the beams is from 30 to 200 microns. The gaps between the bundles look widened, forming defibration, which is much larger than the diameter of the bundles. The spaces are filled with loose connective tissue, and in the elderly with fatty inclusions (Fig. 2). It can be assumed that the loss of architectonics in the aponeurosis is associated with a disordered arrangement of collagen fibers running in different directions and planes. Between the bundles of collagen fibers there are spindle-shaped fibrocytes, their directed linear arrangement in a normal healthy aponeurosis is broken, as a result of which the cells form small groups of 3-5 elements.
Vessels in the scar tissue are oval and slit-like (mainly in the form of strokes) in shape. The number of oval vessels is from 3 to 5 in the field of view (Fig. 3), slit-shaped from 4 to 7, respectively. The oval ones are filled with the plasma part of the blood and are surrounded by loose connective tissue. In the slit-like contents is not determined, around them edema of the surrounding tissues with fibrosis and hyalinosis of the connective tissue predominates. Endotheliocytes of microvessels contain an increased number of pinocytic vesicles, mitochondria, free ribosomes, and polysomes. The transverse diameter of endothelial cells almost doubles, which in some cases reaches 10-15 µm (average 7.7±1.3 µm). The structure of interendothelial contacts is disturbed. Intercellular gaps expand. Forming large cavities, they contribute to the development of edema of the subendothelial layer. As a result, the thickness of the subendothelium significantly increases (3.0±0.5 µm). Six months after laparotomy, a nerve fiber is determined in the scar (Fig. 4).
Rice. 2. a - the structure of the aponeurosis of the anterior abdominal wall is normal; b - structure of the aponeurosis of the anterior abdominal wall, taken from the edge of the hernial ring. Coloring with Sudan UV 400x.
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Rice. 3. Vessels in the aponeurosis of the anterior abdominal wall, taken from the edge of the hernial orifice. Stained with hematoxylin and eosin uv.400x.
There was no noticeable difference in the picture of the microrelief in umbilical and PVG.
Similar changes in the structural organization of the aponeurosis were observed in patients with inguinal hernias. The thickness of the aponeurosis of the external oblique abdominal muscle in the inguinal region is 440.2±50.3 µm. The variability in size, location and shape of collagen fibers was revealed. Most, up to 68% of the fibers, are irregularly crimped. Bundles of connective tissue fibers are separated by large interfiber gaps ranging in size from 100 to 200 microns. There was a reduction in the capillary bed, thickening of small arteries and veins due to intimal hyperplasia. Blood capillaries changed, their wall thickened, the basal layer was lost among the rapidly growing collagen fibers.
Rice. 4. Nerve fiber in dense unformed connective tissue, electron diffraction pattern 10000x.
In the present work, a complex light-optical and ultrastructural study of the aponeurosis of the PBS in the “weak spots” of the abdomen in “practically healthy” individuals showed that the connective tissue framework consists of cells and intercellular substance similar in architectonics, structure, density of arrangement with unchanged connective tissue. Between the collagen bundles there are free spaces filled with loose connective tissue with blood vessels and nerve fibers. The compact arrangement of cells and intercellular substance prevents the exit of internal organs through the "weak spots" of the anterior abdominal wall in "healthy" patients with an increase in intra-abdominal pressure and can resist the formation of a hernia, which is consistent with clinical observations.
The results of a morphological study of muscle sections and aponeurosis taken during operations for hernias of the anterior abdominal wall showed that necrobiosis of muscle fibers occurs and scar fibrous connective tissue is formed in their place with extremely limited number microvessels. There was a reduction of the capillary bed, thickening of the walls of small arteries due to intimal hyperplasia. The remaining capillaries had a thickened or atrophied wall, their basal layer merged with intensively growing collagen fibers. The structure of the aponeurosis in the area of the hernia gate also changed. It became thinner, collagen bundles split, and spaces filled with adipose tissue appeared between its fibers. In general, the architectonics of the scar had multidirectional collagen and elastic fibers running in different planes, which resembled the structure of dense unformed connective tissue.
Thus, both with light and electron microscopy in patients with hernias of the PBS in the structure of the aponeurosis scar, remodeling of muscle and connective tissue occurs as a result of dystrophic and regenerative processes. The latter is considered as compensatory replacement processes in response to partial death of aponeurosis tissue. The resulting spaces between the fibers of the collagen bundles are filled with adipose tissue. The trophic function of the aponeurosis is reduced due to the reduction of the microvasculature, which contributes to atrophic and destructive changes in the connective tissue. All this affects the strength of the anterior abdominal wall, reduces its adaptation to mechanical stress and probably contributes to the formation of hernias.
Literature
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THE STRUCTURE OF APONEEUROSIS THE ANTERIOR ABDOMINAL WALL RIGHTS IN NORM AND PATHOLOGY
Vladivostok State Medical University
By light and electron microscopy organometric and morphological studying the structure of anterior abdominal wall aponeurosis in patients aged 21 to 50 years was carried out. The control group was "practically healthy patients". The experimental group of patients with inguinal, umbilical and postoperative ventral hernias. The change of the architectonics of aponeurosis was revealed in patients with hernias, as well as the decrease of its trophic function at the expense of microcirculation reducing, which cause atrophy and destructive changes in connective tissue.
Key words: aponeurosis, hernia, electronic microscopy.
UDC 616.8-018+629.73]:616-001.28/.29
NEUROMORPHOLOGICAL CORRELATES OF THE PSYCHONEUROLOGICAL STATUS OF AVIATION SPECIALISTS AFTER THE PERFORMANCE OF WORK IN A RADIOACTIVELY CONTAMINATED TERRITORY
O.P. GUNDAROVA*
Retrospective analysis of the health status of pilots
The muscles of the abdomen are formed from the muscles of the press. They, in turn, are divided into straight, oblique and transverse. Classification is carried out on the basis of the anatomical location of the muscle fibers in the anterior abdominal wall.
A feature of the aponeurosis is the fact that it even visually differs from the surrounding tissues. The tendon plate has a shiny, whitish-silver color. This structure contrasts against the background of red muscle fibers. Their color is caused by excellent blood supply and tissue nutrition, which perceive huge loads.
Participates in many important functions of the human body:
- body tilts to the sides;
- rotational movements;
- abdominal tension.
The internal oblique muscle also "forces" the chest to move down. It starts from the womb and ends near the costal arch. The direction of its fibers is downward from the iliac crest, along appearance resembles a fan.
The internal aponeurosis on the opposite side is connected to the same structures, forming a reliable weaving to fix the muscle. It is also attached to the linea alba.
Directed from top to bottom. It is attached near the ribs, on the opposite side - at the iliac crest, pubic symphysis. The direction of the fibers is at a slight inclination relative to the axis.
The aponeurosis and tendons of the external oblique muscle form the white line of the abdomen. The width of this structure is variable, ranging from 0.5-2.5 cm. The white line is also formed by the internal oblique and transverse muscles.
In the center is a hole - the umbilical ring. In this zone, there is a minimum physical activity skin. This is achieved by the presence of fasciae - jumpers formed from connective fibers.
According to the classification of the prolapse of the tissues of the anterior abdominal wall (abdominoptosis) in the standing position according to A. Matarasso, the following degrees are distinguished:
I degree (minimum) - stretching of the skin without the formation of a skin-fat fold;
II degree (medium) - the formation of a small skin-fat fold, which clearly hangs down in the "diver" position;
III degree (moderate) - skin-fat apron within the flanks, hanging in a vertical position, "pinch" less than 10 cm;
IV degree (pronounced) - skin-fat apron within the lumbar region, "pinch" more than 10 cm, combined with skin-fat folds in the subscapularis.
Diastasis (divergence) of the rectus abdominis muscles is the weakening and expansion of more than 2 cm of the white line, which leads to an increase in the distance between the rectus abdominis muscles. The indication for surgery is the expansion of the white line by more than 4 cm. Externally, muscle diastasis manifests itself as a longitudinal bulge-like bulge along the midline in the middle and upper abdomen with tension of the rectus muscles and an increase in intra-abdominal pressure.
A hernia of the anterior abdominal wall is a chronically developing defect in the muscular-aponeurotic complex of the abdomen with the release of organs from the abdominal cavity without depressurization. A hernia looks like a protrusion on the surface of the abdomen, while there may be a feeling of discomfort, pain in its area when walking, running and other physical exertion.
By origin, hernias are congenital and acquired (primary, postoperative, recurrent). The causes of hernia disease and weakening of the white line are a combination of factors, the main of which is an increase in intra-abdominal pressure (physical activity, frequent cough and chronic constipation, pregnancy, etc.).
The aponeuroses of the muscles of the anterior abdominal wall form the sheath of the rectus abdominis muscle. The vagina has anterior and posterior plates, while the posterior wall of the vagina at the level of the lower third of the rectus muscle is absent, and the rectus abdominis muscles rear surface in contact with the transverse fascia.
In the upper two-thirds of the rectus muscle, the anterior wall of the vagina is formed by the bundles of the aponeurosis of the external oblique muscle and the anterior plate of the aponeurosis of the internal oblique muscle; posterior wall - the posterior plate of the aponeurosis of the internal oblique muscle and the aponeurosis transverse muscle belly. In the lower third of the rectus aponeurosis of all three muscles pass to the anterior wall of the vagina.
Aponeurosis plantar: features
Plantar aponeurosis - what is it? The popular name for this disease is heel spur. The definition is accurate because the site of the lesion is located at the junction of the plantar aponeurosis and the calcaneus. It manifests itself in the form of severe pain in the heel area. Usually, pain provokes support on the leg or walking.
The plantar aponeurosis attacks people 40-60 years old or those who, by the nature of their activities, spend a lot of time on their feet.
The cause of the disease can be argued by the fact that in the normal state, the aponeurosis is assigned the function of a shock absorber, supporting the arch of the feet. But when there is a heavy load on the legs, small cracks and tears appear at the location of this formation. They can heal for a long time. That's where the pain comes from.
Such pathologies in most cases can be corrected only by surgical intervention. Although sometimes they resort to conservative therapy. In no case should you try to independently prescribe treatment for yourself.
Pain occurs frequently. Usually, the pain worsens when trying to stand up with support on the legs and when walking. Plantar aponeurosis can cause inability to move, as well as lead to disability. Due to the therapeutic effect, pain can be reduced. Then comes the remission. Some cases even ended in clinical recovery. Only now the bone outgrowth that has appeared will remain until the end of life.
Possible pathologies
Description: Aponeurosis: what is it, what does such an anomaly lead to? It is a tendon plate that can be located in different parts of the body. Its anomaly causes various complications that significantly complicate a person's life. They are rarely cured with conservative therapy, and surgery is often necessary.
When they talk about aponeurosis, they mean a tendon plate, which is of considerable size and consists of dense fibers of elastin and collagen. Regardless of their type, all aponeuroses have a silvery-white tint.
If we talk about their structure, then it is in many ways similar in structure to tendons, but there are almost no nerves or vessels in them.
There are a certain number of such zones in the human body, but only a few of them are considered to be especially significant.
Aponeurosis of the palm
The palmar aponeurosis is the strands that cover the surface of the palm of the human hand. When a pathology such as Dupuytren's contracture is detected in a patient, this often indicates the fact of an anomaly of the tendon plate.
A person with such a problem has a cicatricial contraction of the aponeurosis, which occurs due to the formation of nodes, strands on it.
That is why contracture appears, due to which the finger (or several) is constantly in a bent position.
As a rule, the palmar aponeurosis is found in men, but the cause of its occurrence is still unknown. Most experts are of the opinion that hand injuries provoke pathology, but in this case, by the age of forty, everyone would have such a contracture.
The disease progresses slowly, over time affecting both hands. The only effective treatment is surgery, which involves excision of the palmar aponeurosis.
If we consider other serious anomalies of the upper limbs of this type, then no less problems are caused by the pathology of the biceps muscle of the shoulder, against which shoulder joints also lose their normal functions.
Often surgeons, gynecologists, urologists deal with complaints of pain in the groin area. It is worth noting: in almost 50% of complaints, the reason lies in the defect in the aponeurosis of the abdominal muscles.
This anomaly is either congenital or acquired. Most of the complaints of people with this problem come down to constant pain, which, in addition, tends to increase after intense physical activity, as well as during coughing or sneezing.
Often, aponeurosis causes particular discomfort:
- oblique muscle of the abdomen;
- transverse abdominal muscle.
As a rule, the pathology of the external oblique muscle is especially unpleasant. It should be noted that the transformation of muscles into aponeurosis proceeds diagonally, running from the costal arch to the womb. The muscles provide strength to the wall of the peritoneum and are located in front, in the inguinal zone.
Structural threads of the aponeurosis run horizontally, intertwining into a whitish line of the abdomen. In addition, they form a certain layer of the vagina.
Only in 10% of visits with such a problem is it found that the structural threads of the aponeurosis are combined with the transverse muscle, which leads to the formation of a combined aponeurosis.
The muscles are transformed into an aponeurosis along a line that combines the obvious costal angle with the inguinal ring.
The transition area often varies in such a way that, as a result, one of the levels simultaneously includes muscle fibers and structural components of the aponeurosis.
Nevertheless, in practice, diagnosing this defect is not easy, since doctors of various specializations are required to take part in the diagnosis.
Only surgical treatment guarantees tissue restoration, as a result of which it can be argued with a high degree of probability that the pain will disappear. Statistical data point to the fact that it is surgical treatment in 95% of cases that leads to the complete recovery of the patient.
The aponeurosis of the external oblique muscle is the most common cause of pain in the groin. Naturally, if a person does not have such a pathology, there will also be no manifestations of it.
If the symptoms are ignored from the very beginning, one should be prepared for the fact that over time the pain will intensify.
head injury
Traumatic brain injuries are very common in humans. However, it is often believed that if the skull is not broken or there is no concussion, then nothing serious has happened.
However, damage to the head is possible during a blow to the head. tendon helmet(this is how the aponeurosis of the head is called), as a result of which a rather large hematoma will often form, resembling a dent in the skull.
With such an anomaly, a person feels a very strong pain, and the hematoma itself has a dark red color, then it turns blue, then turns green, and at the final stage it turns yellow. These metamorphoses are associated with the breakdown of hemoglobin accumulated in the area of hemorrhage.
The supracranial aponeurosis (this is the second designation of the tendon helmet, which resembles a helmet in its shape) connects the frontal, occipital, and supracranial muscles into one whole. It is attached to the skin above the nose, eyes and is very important for the implementation of facial expressions (for example, it helps to raise eyebrows, wrinkle the skin of the forehead).
Foot ailments
If we consider the plantar aponeurosis, then it should be noted that this is a common pathology of runners or people who love long walks. Inflammation in the area of the heel and sole is associated with the plantar aponeurosis.
Often, the disease manifests itself in people aged 40-60 years, as well as in those who, due to professional duties, spend all day on their feet.
The main symptom of the problem is pain in the heel, which worries when the load on the lower limbs and at complete rest.
In almost all cases of such an ailment, the only effective treatment is surgery (dissection, resection, removal of the pathological site). Only in some cases it is possible to use conservative methods of treatment. Self-medication in such cases is not at all permissible.
A defect in the aponeurosis of the anterior abdominal wall is a common problem for surgeons, urologists, and gynecologists. Pathology is both congenital and acquired. Needs careful diagnosis for successful treatment.
If symptoms of aponeurosis of the external oblique muscle of the abdomen or a peritoneal-perineal defect appear, the patient must undergo a detailed examination. Such signs are also characteristic of muscle lesions with myofascial syndrome.
Aponeurosis defects are usually found among professional athletes - football players, hockey players, dancers. The appearance of inguinal pain is associated with microtrauma in the abdominal muscles. The development of the aponeurosis of the anterior abdominal wall occurs after operations:
- with an ectopic pregnancy;
- appendectomy;
- C-section.
The appearance of pathology after surgery is explained by the patient's non-compliance with the doctor's recommendations regarding the recovery period. A person too early exposes the body to intense physical activity or lifts weights. As a result, the cut fibers do not have time to recover, which most often leads to the formation of hernias.
The problem also arises with non-professional performance of surgical intervention. If the operation is performed to treat a hernia, a special mesh is applied to the weakened tissue area. It strengthens the abdominal wall. The mesh is installed "with a margin", overlapping healthy areas of the body. If its edge does not extend far enough, misalignment or inefficient performance may occur.
How to treat heel spurs?
Treatment is conservative in nature, and it will take a lot of time. If all procedures are done on time, then a stable remission will come.
During therapy, it is prohibited:
- long walk;
- stand on feet;
- carry heavy things;
- make movements in pain.
You will have to temporarily use special orthopedic products. Along with this, the doctor will prescribe an analgesic, a non-steroidal anti-inflammatory drug.
Aponeurosis is a wide tendon with parallel connecting fibers. In the human body, it is designed to connect muscles with a broad base or attachment to bone and other tissues.
Symptoms of the pathology of the aponeurosis are most often severe pain at the location of this tendon. Different kinds diseases have their causes.
Plantar aponeurosis can develop in people who engage in active training for a long time (running, group programs, gymnastics, dancing), as well as in those who constantly wear shoes with high heels or thin soles. The risk group includes the elderly and those who spend the whole day on their feet.
Aponeurosis of the skull may be the result of traumatic brain injuries and hematomas of the head.
The cause of the aponeurosis of the anterior abdominal wall may be a congenital defect in this area.
foot aponeurosis
Depending on the type of disorder, a specific treatment regimen should be chosen in order to forget about unpleasant sensations in the future. Those who, after a long walk, constantly feel pain in the foot, know firsthand what the aponeurosis of the lower extremities is, but not everyone is in a hurry to go to the doctor for advice and treatment.
Symptoms of aponeurosis are most often severe pain
The disease often begins with the appearance of a heel spur, and only then develops into plantar fasciitis. If you start the disease, it can lead to weakness in lower limbs, lameness and impaired movement.
Important! If the patient feels pain in the heel for a long time, which grows and gradually covers the entire area of the foot, this indicates a disease of the aponeurosis of the foot.
You can determine the disease using x-rays, MRI and computer diagnostics. Based on these procedures, the doctor identifies the cause of the disease and selects the optimal treatment regimen. Often common causes of foot pathology are damage to the heel and pinched nerve.
If left untreated, the plantar aponeurosis can cause serious consequences. The pain will rise higher, respectively, and the inflammation will increase the area covered.
Treatment of this disease begins with the elimination of pain. To do this, for a while it is necessary to provide rest to the legs, up to full bed rest. If this is not possible, it is advisable not to step on and eliminate pressure on the affected area, stop playing sports and any physical activity for a while.
Also, the patient must take painkillers prescribed by the doctor in the form of tablets or apply gels. These include Naproxen, Ibuprofen, Prednisolone, Diclofenac and others.
Physiotherapy is the next step in treatment. This includes all procedures that warm the foot, as well as laser therapy and ultrasound. Due to heat, blood circulation in the foot becomes more intense, inflammation gradually disappears.
On your own, anesthesia of the affected area can be done with pieces of ice. If medical treatment does not help the patient, doctors recommend using a shock wave. With the help of this procedure, the area of salt accumulated in the foot is broken.
ethnoscience It is also widely used to relieve heel pain. Here the emphasis is on compresses from decoctions of medicinal herbs. The compress should be applied to the sore spot. After a few hours, the pain should go away. The duration of the course of compresses is from 7 days.
Prevention
To prevent aponeurosis of the feet and prevent the recurrence of the disease, pay attention to following rules:
- if work is connected with loads on the legs, you need to find time to rest;
- after training, athletes can do a heel massage and hold their legs in a bath with warm water;
- If you experience unexplained pain in your legs, the first thing to do is to see a doctor.
Following these rules, you can significantly reduce the likelihood of developing aponeurosis of the foot.
Attention! With a prompt response, the disease can be quickly and effectively cured, as well as prevent development in the future.
Skull aponeurosis
Another area human body where the aponeurosis is present is the skull. The aponeurosis covers almost the entire region of the cranial vault and adheres tightly to the scalp. This area moves along with the supracranial muscle. Most often, the aponeurosis of the skull occurs due to head injuries.
Palmar aponeurosis: signs of the disease
In addition to the plantar aponeurosis, there are other varieties of this disease. For example, palmar is aponeurosis. What is it and how does this type of disease manifest itself? This disease occurs on the palmar part of the entire human hand. And if the patient has manifested such a disease as Dupuytren's contracture, then it makes sense to talk about the pathology of the aponeurosis of the palm.
With this disease, cicatricial contraction of this formation is observed. This is due to the fact that strands and nodes appear on it. As a result, contracture develops. This is when one or more fingers are bent all the time. Most of all, representatives of the stronger sex are affected by this disease. However, the reason has not yet been established. Some are used to thinking that it lies in hand injuries. But then every person of forty years old would be the owner of such a disease.
The development of the disease is slow. The affected area occupies two hands. There is only one way to cure the palmar aponeurosis - surgery. So with the manifestation of pain in the palms, it is necessary to contact specialists, and not self-medicate.
Aesthetic deformation of the anterior abdominal wall is a discrepancy between the mental image of the shape of the abdomen and its present state.
Ideal Shape the abdomen of a woman seems to us next. Retracted lateral surfaces (flanks) of the body, which pass into the inguinal and lumbosacral regions, emphasizing the waist. The lateral surfaces of the abdomen smoothly pass into the grooves running from the costal arches to the inguinal ligament along the semilunar line from both sides. Below the umbilical ring, a slightly convex surface merges into a less convex surface above the umbilical ring. The latter is divided along the midline from the xiphoid process to the umbilical region by an indistinct and smoothed groove.
Changes in the anterior abdominal wall normally occur with age, the degree of their severity is influenced by the nature and diet, metabolism and hormonal background (during pregnancy), individual characteristics of the organism. In addition, injuries and diseases can lead to changes in the shape of the abdomen. All causes of abdominal wall deformation can be divided into direct and indirect.
Indirect reasons are:
- obesity of internal organs;
- flatulence, etc.
Direct causes of abdominal deformity include:
- skin condition (stretching, flabbiness, scars, gravitational sagging);
- subcutaneous tissue (local fat deposition, skin-fat fold, scars);
- muscular-aponeurotic complex of the abdomen (stretching, divergence and hernial defects).
Probably, many have heard the medical term "aponeurosis". What it is, not everyone knows. Aponeurosis is a tendon plate that has a large width. It consists of dense fibers of collagen, elastin.
Whatever the aponeurosis, it will be a brilliant white-silver color. If we talk about its structure, then it looks like tendons, but they lack blood vessels and nerves.
The human body has several places where aponeurosis can be, but only a few are considered important.
Palmar aponeuroses cover the muscles of the palmar surface of the hands.
Pain in the groin
Urologists, gynecologists and surgeons sometimes have to observe the patient's condition when pain in the groin area appears. Most often, there is only one diagnosis - the aponeurosis of the abdominal muscles. The problem can be acquired and congenital.
Patients with this diagnosis complain of pain. Most often, painful sensations appear throughout the entire time. Unfortunately, it is not so easy to detect the aponeurosis of the abdominal muscles. Doctors of various specialties should participate in the diagnosis of the disease.
Many people think that such a problem can be solved only by conservative methods. Practice says otherwise, in this case, the operation is inevitable. When the tissue goes through a period of surgical repair, you can talk about the fact that the person will not have to experience pain again. According to statistics, the aponeurosis of the abdomen can be completely cured only by surgery. This happens in at least 95% of cases.
The aponeurosis of the external oblique muscle of the abdomen causes the most trouble.
The aponeurosis of the external oblique muscle of the abdomen causes the most trouble.
External oblique muscle
Before proceeding to consider the topic of the aponeurosis of the abdominal muscles, it is worth having an idea about their structure as a whole. The abdominal muscles are involved in the formation of posture in children and adults. In addition, this muscle group helps to hold the internal organs in a physiologically correct position. Performs a protective function, forms the abdominal wall.
The muscles of the press are represented by the following:
- straight;
- oblique - subdivided into external and internal;
- transverse.
Separation occurs in accordance with the anatomical arrangement of muscle fibers.
What is aponeurosis
Aponeuroses of the anterior abdominal wall (indicated in blue) and the white line of the abdomen.
The word aponeurosis is of ancient Greek origin. The literal translation sounds complicated and confusing, in fact it is an extensive plate consisting of collagen fibers, resembling tendons in structure.
The peculiarity of this tissue is that it has practically no blood vessels, nerve endings. The aponeurosis of the white line of the abdomen can be determined even visually. The reason for such a vivid rendering is in color. Muscle tissue is colored red, heavy loads require good nutrition, nutrition is provided by blood vessels.
Part of the abdominal muscles, called the aponeurosis, is white.
The main function of the structure is the attachment of the muscles. Aponeurosis is not just a continuation of the muscles; everything is interconnected in the complex biomechanism of our body. Every department interacts. A complex aponeurotic mesh envelops the muscles of the peritoneum, layers, intertwines, thereby providing a reliable muscular frame of the region.
It is difficult to diagnose pathology, consultations of doctors of different profiles are required. Conservative treatment is ineffective in most cases.
The use of surgical methods of treatment helps to cope with the situation. There is also a plantar aponeurosis.
The intrinsic muscle of the abdomen belongs to the group of broad muscles of the abdominal wall. Participates in tilting the body to the sides, performing rotational movements, tension (compression) of the abdomen, causes the chest to move downwards.
Pathology, weak development of the zone leads to:
- limited mobility of the body,
- posture problems,
- decrease in respiratory functions (shallow breathing, further provoking oxygen starvation of tissues and organs),
- problems with digestion, stool.
The muscle starts from the womb, continuing to the internal costal arch. The direction of the fibers comes from below the region of the iliac crest. The arrangement of structures resembles a fan. The internal aponeurosis is connected to the same one on the opposite side, forming a reliable fixing weave.
The aponeurosis of the internal oblique muscle is woven into the white line of the abdomen. Pathological changes in the cellular structure of collagen fibers cause the formation of hernias in this area. It is interesting to read the inguinal ligaments.
The external muscle is directed from top to bottom. The upper edge is attached in the region of 5-12 ribs, the lower one is at the iliac crest, white line, pubic symphysis. This is another representative of the group of wide own abdominal muscles. It is a continuation of the external intercostal muscles, the direction of the fibers is oblique. The tendons and aponeurosis of the external oblique muscle of the abdomen are involved in the formation of the white line.
The white line of the abdomen is formed by tendon fibers and aponeuroses of the wide muscles of the peritoneum. These include:
- external oblique,
- internal oblique,
- transverse.
The width of the line is not constant, it varies in size from 0.2 to 2.5 cm. In the center, in the region of the navel, there is a hole - the umbilical ring. Small mobility of the skin in the navel area is provided by connective tissue jumpers - fascia, originating from the tendons, aponeurosis of the white line.
A defect, congenital or acquired, of the aponeurosis of the anterior abdominal wall leads to the formation of hernias. Pinched sections of the intestine, other vital organs in the hernial ring requires immediate medical intervention. In 98% of cases, surgery is required. Unfortunately, only inguinal hernias can be operated on with a closed method, in other cases an open intervention is performed.
The transition of the muscle into its aponeurosis is carried out along an oblique line that runs from the womb to the costal arch. The muscle is responsible for the strength of the abdominal wall, it is located in front, in the groin area. Aponeurosis fibers are located in a horizontal position. They are also braided into the white line of the abdomen and form one of the layers of the sheath of the rectus abdominis.
Only in 10% of cases, aponeurotic fibers have a connection with the transverse muscle. This leads to the formation of what is called a joint aponeurosis.
It is the site of the third and deepest layer of the abdominal muscles and plays an important role in the formation of an inguinal hernia. The muscle passes into the aponeurosis along the line that connects the xiphoid angle with the deep inguinal ring. The transition zone can vary so that one level can contain both muscle fibers, and aponeurotic.
Aponeurosis - what is it and where can it develop? We talked about this in detail in the article. So if you feel pain in these areas, be sure to visit a doctor. The sooner you get on the operating table, the better for you.
Symptoms
The plantar aponeurosis can be detected as a result of pain syndrome when walking, a long vertical position resting on the legs. In extreme cases, the disease creates the inability to move independently, the person partially loses his ability to work.
accompanied by scarring and the formation of a contracture that prevents extension of the fingers. Outwardly, the symptoms of palmar fasciitis are manifested in constantly half-bent fingers, compacted palmar tendons.
Cicatricial contraction gradually progresses and spreads to both palms. A person experiences pain when trying to perform grasping and extensor movements. Significant loss of ability to use fine motor skills hands
The aponeurosis of the abdominal muscles makes itself felt with a characteristic pain syndrome in the groin, which intensifies during physical activity, coughing and sneezing, in women during ovulation.
Damage is typical for the internal oblique muscle, anterior abdominal and transverse muscles. Due to a violation of the integrity of the tendons and fascia that hold muscle corset, hernial protrusions are formed that pose a danger to the life of the patient.
The supracranial aponeurosis is formed as a result of a head injury and provokes severe pain on the surface of the skull. As a result of damage, a hematoma and a dent are formed at the site of injury, facial expressions become difficult, and the mobility of the neck and head becomes limited.
Treatment
Plantar aponeurosis, palmar, epicranial, and abdominal muscles require surgical intervention in 95% of cases.
taking non-steroidal anti-inflammatory drugs, corticosteroids, intramuscular injections.
Recovery motor ability arms, legs, abdominal wall, head and neck, physiotherapy is prescribed at the rehabilitation stage: massage, electrophoresis, gymnastics.
Physiotherapy does not stop even after the patient has fully recovered and is carried out regularly as a preventive measure.
is carried out in order to remove the healed area of the fascia and give an anatomically correct position to the damaged surface.
If the aponeurosis is the result of tissue rupture, then the surgeon will restore the integrity of the tendon plate.
As a result of surgery, a person may lose his ability to work for the recovery period - up to 4-6 months.
megan92 2 weeks ago
Tell me, who is struggling with pain in the joints? My knees hurt terribly ((I drink painkillers, but I understand that I am struggling with the consequence, and not with the cause ... Nifiga does not help!
Daria 2 weeks ago
I struggled with my sore joints for several years until I read this article by some Chinese doctor. And for a long time I forgot about the "incurable" joints. Such are the things
megan92 13 days ago
Daria 12 days ago
megan92, so I wrote in my first comment) Well, I'll duplicate it, it's not difficult for me, catch - link to professor's article.
Sonya 10 days ago
Isn't this a divorce? Why the Internet sell ah?
Yulek26 10 days ago
Sonya, what country do you live in? .. They sell on the Internet, because shops and pharmacies set their margins brutal. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. Yes, and now everything is sold on the Internet - from clothes to TVs, furniture and cars.
Editorial response 10 days ago
Sonya, hello. This drug for the treatment of joints is really not sold through the pharmacy network in order to avoid inflated prices. Currently, you can only order Official site. Be healthy!
Sonya 10 days ago
Sorry, I didn't notice at first the information about the cash on delivery. Then, it's OK! Everything is in order - exactly, if payment upon receipt. Thanks a lot!!))
Margo 8 days ago
Has anyone tried traditional methods of treating joints? Grandmother does not trust pills, the poor woman has been suffering from pain for many years ...
Andrew a week ago
What only folk remedies I didn't try anything, nothing helped, it only got worse...
Ekaterina a week ago
I tried to drink a decoction of bay leaves, to no avail, only ruined my stomach !! I no longer believe in these folk methods - complete nonsense !!
Maria 5 days ago
Recently I watched a program on the first channel, there is also about this Federal program for the fight against diseases of the joints spoke. It is also headed by some well-known Chinese professor. They say they have found a way to permanently cure the joints and back, and the state fully finances the treatment for each patient
Using flaps on the leg
Operations for femoral hernia
G. G. Karavanov (1952) proposed a method of operation, which consists in closing the femoral ring with a “veil-septum”, which is formed from the aponeurosis of the external oblique muscle under the inguinal ligament at the level of the femoral canal. The aponeurosis flap is cut out with a width of 1-1.5 cm with a base at the superficial inguinal ring, and after moving the spermatic cord or round ligament of the uterus, it is captured with a forceps from the side of the thigh and brought to the thigh through the femoral canal. This flap is sutured to the lacunar ligament, to the pectineal fascia and muscle, and to the pupart ligament. At the same time, the lateral edge of the flap is sutured to the sheath of the vessels, which we consider unacceptable because of the possibility of injury to the vein and unjustified as a measure that strengthens the femoral ring. The gap in the aponeurosis after excision of the flap is sutured with knotted sutures.
P.Ya.Ilchenko (1955) fixes an aponeurotic flap 8-10 cm long and 1.5 cm wide in front of the inguinal ligament to the pectineal ligament, followed by suturing the remaining part of the aponeurotic flap to the inguinal ligament.
Currently, operations are not used in which the approach of the inguinal ligament to the upper branch of the pubic bone is carried out with U-shaped metal brackets (operation Roux, 1899).
The method of passing a bronze-aluminum wire through the inguinal ligament and specially drilled holes in the pubic bone to close the femoral ring (P. A. Herzen, 1904; A. P. Morkovitin, 1904) also did not become widespread.
Proposed by R. R. Vreden, the insertion of a flap of the aponeurosis of the external oblique muscle using a Deschamp needle or a curved forceps under the scallop muscle from the medial edge of the femoral vein to the medial edge of the scallop muscle, followed by suturing it to the pubic tubercle, is practically inapplicable due to the great trauma and technical complexity.
The proposals of V. N. Shevkunenko and N. F. Mikuli are similar. All these techniques, tested in the sectional, turned out to be complex and physiologically unreasonable. These also include the operation proposed by T. S. Zatsepin (1903), the essence of which is to fix the inguinal ligament with a silk thread, carried out around the horizontal (upper) branch of the pubic bone. After tying the two ends of the thread, the inguinal ligament should be pressed tightly against the bone and close the femoral ring.
The principle of T. S. Zatsepin was used by T. V. Zolotareva (1961), who proposed to carry out a flap of the fascia lata of the thigh through a hole made in the soft tissues that cover the obturator foramen. P. A. Herzen considered it not indifferent for the patient to operate behind the horizontal branch of the pubic bone with sutures through the bone or, even worse, under this bone through the obturator foramen.
These modifications were also tested in the dissecting room, and we were convinced of their anatomical groundlessness and extreme trauma.
Operations of femoral hernias by intraperitoneal route. With free uncomplicated femoral hernias, operations by the intra-abdominal route have not received distribution. The recommendation of the intra-abdominal approach is available from Zudek (1928). He also joins Eleker's demand to perform the elimination of the existing hernia in all laparotomies in the lower abdomen. However, A.P. Krymov believed that abdominotomy for intervention for femoral hernia has always been and will be more dangerous than simple hernia repair. We fully subscribe to the opinion of A.P. Krymov.
