Inervasi Lumbal, Sakral, Panggul
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Transcript of Inervasi Lumbal, Sakral, Panggul
YOSEPH A. N.13 .144
FKUPNVJ 2013
Inervasi Lumbal
PLEXUS LUMBAL
Lumbal
Fungsi Inervasi Lumbal
(L1) Iliohypogastric & Ilio-inguinal
Cabang utama L1 memanjang melewati pinggiran lateral dari otot Psoas Mayor
Cabang utama ini bercabang lagi menjadi iliohypogastric dan ilio-inguinal
Cabang Iliohipograstrik
Melewati bagian permukaan depan otot quadratus lumborum, dan bagian belakang ginjal
Berfungsi motorik pada otot transversus abdominis dan berlanjut lewat bagian depan sekeliling tubuh di antara otot transversus abdominis dan otot oblique internal
Lateral cutaneous branch (cabang lateral) yang berada di atas iliac crest mempersarafi otot oblique internal dan eksternal, serta mensuplai daerah posterolateral kulit gluteus
Cabang Iliohipograstrik
Anterior cutaneous branch (cabang anterior) berlanjut dari bagian depan, mempersarafi otot oblique internal ke arah bawah tengah
Semakin dekat ke kulit, saraf memanjang pada superfisial dari inguinal ring setelah melewati aponeurosis pada otot oblique eksternal
Lalu mempersarafi bagian kulit pada regio pubis
Cabang Ilio-inguinal
Cabang ilio-inguinal berukuran lebih kecil dan posisinya lebih posterior dari iliohypogastric
Jalur yang dilewati cabang ini lebih curam dari iliohypogastric dan menyebrangi otot iliaka untuk sampai ke iliac crest
Dekat bagian akhir anterior dari iliac crest, cabang ini mempersarafi otot transversus abdominis, lalu otot oblique internal, setelah itu memasuki inguinal canal
Cabang Ilio-inguinal
Kemudian cabang ini melewati superficial inguinal ring bersamaan dengan spermatic cord dan menginervasi bagian selangkangan, akar penis, serta permukaan depan scrotum pada pria, mons pubis dan labium majus pada wanita
(L1 & L2) Genitofemoral Nerve
Berasal dari percabangan L1 dan L2Berjalan ke arah bawah melewati otot psoas
mayor sampai bagian permukaan depannyaKemudian turun di permukaan otot, pada
bagian retroperitoneal, melewati bagian belakang sampai pada ureter
Biasanya terbagi menjadi cabang genital dan femoral
Cabang Genital
Cabang genital terus mengarah turun dan masuk melewati kanal inguinal dan inguinal ring
Pada Pria, mempersarafi otot cremasteric dan berakhir pada kulit bagian atas anterior dari skrotum
Pada Wanita, beriringan dengan ligamen uterus dan berakhir pada kulit mons pubis dan labium majus
Cabang Femoral
Cabang Femoral memanjang turun pada sisi samping arteri iliaka eksterna dan melewati ligamen inguinal bagian posterior, memasuki sarung femoral lateral sampai ke arteri femoral
Mempersarafi kulit bagian anterior atas daerah selangkangan
(L2 & L3) Lateral Cutaneous Nerve of Thigh
Berasal dari L2 and Memanjang dari tepi lateral otot psoas
mayor, curam ke bawah melewati otot iliakaKemudian melewati bagian posterior sampai
ke ligamen inguinal dan memasuki daerah selangkangan
Mempersarafi kulit daerah anterior dan lateral selangkangan sampai pada lutut
(L2 L4) Obturator Nerve
Berasal dari percabangan L2 sampai L4 Ke arah bawah melewati otot psoas mayor,
berjalan terus melewati dinding lateral rongga pelvis dan memasuki kanal obturator untuk mempersarafi bagian medial daerah selangkangan
(L2 L4) Obturator Nerve
Pada kanal obturator, saraf ini terbagi menadi cabang anterior dan posterior
Ketika memasuki daerah selangkangan, dua cabang ini terbagi oleh otot obturator eksternus dan adductor brevis, kedua cabang ini mempersarafi: Cabang persendian paha Cabang otot ke obturator externus, pectineus, adductor
longus, gracilis, adductor brevis, and adductor magnus Cabang daerah medial selangkangan Bersamaan dengan saraf saphenous, mempersarafi
bagian atas kaki dan persendian lutut
(L2 L4) Femoral Nerve
Percabangan dari L2 sampai L4Cabang ke arah bawah melewati otot psoas mayor
pada bagian samping tepi bawahSaraf femoral berada di antara tepi lateral psoas
mayor dan permukaan anterior otot iliaka, makin ke dalam melewati bagian lateral arteri femoral dan melewati bagian posterior dari ligamen inguinal, lalu memasuki bagian depan dari selangkangan
Ketika memasuki daerah selangkangan, saraf ini terbagi menjadi beberapa cabang
Saraf Saphenous mempersarafi permukaan medial kaki
PLEXUS SAKRAL
Sakral
Sciatic Nerve
The sciatic nerve is the largest nerve of the body and carries contributions from L4 to S3. It:
forms on the anterior surface of the piriformis muscle and leaves the pelvic cavity through the greater sciatic foramen inferior to piriformis
passes through the gluteal region into the thigh, where it divides into its two major branches, the common fibular nerve (common peroneal nerve) and the tibial nerve-dorsal divisions of L4, L5, S1, and S2 are carried in the common fibular part of the nerve and the ventral divisions of L4, L5, S1, S2, and S3 are carried in the tibial part
innervates muscles in the posterior compartment of the thigh and muscles in the leg and foot
carries sensory fibers from the skin of the foot and lateral leg
Pudendal nerve
The pudendal nerve forms anteriorly to the lower part of piriformis muscle from ventral divisions of S2 to S4. It:
leaves the pelvic cavity through the greater sciatic foramen, inferior to the piriformis muscle, and enters the gluteal region
courses into the perineum by immediately passing around the sacrospinous ligament, where the ligament joins the ischial spine, and through the lesser sciatic foramen (this course takes the nerve out of the pelvic cavity, around the peripheral attachment of the pelvic floor, and into the perineum)
is accompanied throughout its course by the internal pudendal vessels
innervates skin and skeletal muscles of the perineum, including the external anal and external urethral sphincters
Other branches
The superior gluteal nerve, formed by branches from the dorsal divisions of L4 to S1, leaves the pelvic cavity through the greater sciatic foramen superior to piriformis muscle and supplies muscles in the gluteal region-gluteus medius, gluteus minimus, and tensor fasciae latae (tensor of fascia lata) muscles
The inferior gluteal nerve, formed by branches from the dorsal divisions of L5 to S2, leaves the pelvic cavity through the greater sciatic foramen inferior to the piriformis muscle and supplies the gluteus maximus, the largest muscle in the gluteal region
Both superior and inferior gluteal nerves are accompanied by corresponding arteries.
Other branches
The nerve to the obturator internus and the associated superior gemellus muscle originates from the ventral divisions of L5 to S2 and leaves the pelvic cavity through the greater sciatic foramen inferior to the piriformis muscle. Like the pudendal nerve, it passes around the ischial spine and through the lesser sciatic foramen to enter the perineum and supply the obturator internus muscle from the medial side of the muscle, inferior to the attachment of the levator ani muscle.
Other branches
The nerve to the quadratus femoris muscle and the inferior gemellus muscle, and the posterior cutaneous nerve of the thigh (posterior femoral cutaneous nerve) also leave the pelvic cavity through the greater sciatic foramen inferior to the piriformis muscle and course to muscles and skin, respectively, in the lower limb.
Other branches
Unlike most of the other nerves originating from the sacral plexus, which leave the pelvic cavity through the greater sciatic foramen either above or below the piriformis muscle, the perforating cutaneous nerve leaves the pelvic cavity by penetrating directly through the sacrotuberous ligament and then courses to skin over the inferior aspect of the buttocks.
Other branches
The nerve to the piriformis and a number of small nerves to the levator ani and coccygeus muscles originate from the sacral plexus and pass directly into their target muscles without leaving the pelvic cavity.
Other branches
The obturator nerve (L2 to L4) is a branch of the lumbar plexus. It passes inferiorly along the posterior abdominal wall within the psoas muscle, emerges from the medial surface of the psoas, passes posteriorly to the common iliac artery and medially to the internal artery at the pelvic inlet, and then courses along the lateral pelvic wall. It leaves the pelvic cavity by traveling through the obturator canal and supplies the adductor region of the thigh.
Coccygeal plexus
The small coccygeal plexus has a minor contribution from S4 and is formed mainly by the anterior rami of S5 and Co, which originate inferiorly to the pelvic floor. They penetrate the coccygeus muscle to enter the pelvic cavity and join with the anterior ramus of S4 to form a single trunk, from which small anococcygeal nerves originate. These nerves penetrate the muscle and the overlying sacrospinous and sacrotuberous ligaments and pass superficially to innervate skin in the anal triangle of the perineum.
Autonomic nerve
Sympathetic Diagram
Thoracolumbar Outflow All preganglionic fibers of sympathetic division arise from
cell bodies of preganglionic neurons located in spinal cord segments T1-L2
Preganglionic sympathetic neurons in grey matter of spinal cord produces lateral horns Sympathetic neurons leave spinal cord via the ventral root and
passes through white ramus communicans (rami communicantes) to enter paravertebral ganglion (forms part of sympathetic trunk)
Once a preganglionic axon reaches a paravertebral ganglion it can...... Synapse with a post ganglionic neuron within the same ganglion Ascend/descend within sympathetic trunk to synapse with
another paravertebral ganglion Pass through the ganglion and emerge from the sympathetic
chain without synapsing
Sympathetic Diagram
Synapses in Paravertebral (sympathetic chain) Ganglion: Postganglionic axons enter the ventral ramus of the joining spinal nerves via communicating branches called gray rami communicantes
Preganglionic fiber serving head, neck, and thorax emerge from spinal cord segments T1-T6 and ascend the sympathetic chain to synapse with postganglionic neurons within cervical ganglia (inferior, middle, and superior) Superior cervical ganglion:
Stimulates dilator muscles of irises Inhibits nasal and salivary glands Stimulates copious sweating Stimulates arrector pili muscle to contract Causes blood vessel vasodilation Provides branches to carotid body (oxygen sensor) and larynx & pharynx
Middle cervical ganglia - innervates heart and skin Inferior cervical ganglia (stellate ganglion) innervates heart, aorta, dilates
bronchioles, constrict esophageal sphincter
Sympathetic Diagram
Synapses in Prevertebral (Collateral) Ganglion: Preganglionic fibers of T5-L2 synapse in prevertebral ganglia. Fibers enter and leave without synapsing and form several nerves collectively called splanchnic nerves (greater, lesser, and lumbar)
Splanchnic nerves synapse at abdominal aortic plexus that clings to surface of abdominal aorta
Synapses occur at ganglia of plexus: Greater splanchnic nerve
Celiac ganglion - innervates stomach (decrease muscle activity/constricts pyloric sphincter), adrenal medulla (secretes epinephrine/norepinephrine), liver (epinephrine stimulates liver to release glucose), kidney (vasoconstriction, decrease urine output), intestine (decrease smooth muscle activity)
Lesser splanchnic nerve Superior mesenteric (via celiac) ganglion - innervates small intestine
Lumbar splanchnic nerve Inferior mesenteric ganglion - innervates large intestine
Lumbar splanchnic nerve Hypogastric ganglion - innervates bladder and urethra (causes relaxation of smooth
muscle of bladder wall and constricts urethral sphincter/inhibits voiding), genitalia (causes ejaculation in males and vaginal contractions in females)
Parsympathetic Diagram(Craniosacral Division)
Oculomotor nerve (III) Preganglionic fibers from oculomotor nuclei in the midbrain synapses in the
ciliary ganglion (in eye), postganglionic fiber innervates smooth muscle of eye Pupil constriction and lens movement to cause focusing
Facial nerve (VII) Preganglionic fibers from lacrimal nuclei in the pons synapses in the
pterygopalatine ganglia, postganglionic fiber innervates lacrimal glands of eye Lubrication of eye and tear formation
Preganglonic fibers from superior salivatory nuclei in the pons synapses in the submandibular ganglia, postganglionic fibers innervate submandibular and sublingual salivary glands Production of saliva and secretion of salivary enzymes
Glossopharyngeal nerve (IX) Preganglionic fibers from the inferior salivary nuclei in the medulla synapses
in the otic ganglia, postganglionic fibers innervate the parotid salivary glandCranial Outflow
Parsympathetic Diagram(Craniosacral Division)
Vagus nerve (X) Preganglionic fibers from the dorsal motor nuclei of
the medulla synapses in terminal ganglia located within the walls of the target organ Intramural ganglia ....effects:
Heart -decreases/steadies heart rate and constricts coronary veins
Lung - constricts bronchioles Gall bladder - expel bile Stomach - stimulates secretion of enzymes Intestines - increase motility (peristalsis) and relaxes
sphincters Cranial Outflow
Parsympathetic Diagram(Craniosacral Division)
Preganglionic fibers from lateral gray matter of spinal cord in segments S2-S4 synapse in terminal ganglia within walls of the target organ Intramural ganglia....effects:
Distal large intestines - relaxes sphincters Bladder - contraction of smooth muscle of bladder wall;
relaxes urethral sphincter - promotes voiding Genitalia - causes penile and clitoral erection
Sacral Outflow
Referensi
Gray’s Anatomy for Students, 2nd ed., 2009Snell, Richard S.: Clinical Anatomy by
Regions, 9th ed. 2012