Transcription
Don't thank you, thank you, thank you, thank you. You. The bones of the pelvis consist of two hip bones, right and left hip bones, and the sacrum. And see here and here. The ilium joins to the sacrum. The joint here and here and the anterior superior iliac spine. Articulates with the last lumbar vertebra at the sacroiliac joint. And inferiorly, it joins to the ischium. Here in the pubic symphysis, here and between the two hip bones in the pubic symphysis, there is an interpubic disc.
As an irregular bone, it has two major parts separated by a line on the medial surface. This surface is the medial surface, and this line is called the linea terminalis. The linea terminalis here, superior to the pelvic inlet. This part of the hip bone is related to the abdominal cavity, or is related to the false pelvis. And this part, inferior to the linea terminalis, is a part of the true pelvis or pelvic cavity. Here on the lateral surface of the ilium, there is a large articular facet, or acetabulum, that articulates with the head of the femur. The hip joint is formed by the acetabulum and the head of the femur.
The superior part of the ilium is the iliac crest. The iliac crest is the iliac crest. And the posterior border of the hip bone, there are two great sciatic notches, here and the lesser sciatic notch, here. Between the two sciatic notches, there is a spine, here is the ischial spine. Inferior to the lesser sciatic notch is a large elevation that is the ischial tuberosity. Here is the ischial tuberosity. The anterior margin, anterior border of the hip bone, is the anterior superior iliac spine.
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Thank you, thank you, thank you, thank you. Surfaces: medial, lateral, and articular surfaces. And borders. Two ends: superior or upper end and inferior or lower end. See here, this is the medial border. And anterior border, and posterior border. Medial surface and lower medial surface that articulates. This surface is called the auricular surface. This surface is for articulation with the lateral wall of the sacrum, or the lateral surface of the sacrum. Auricular surface here, okay. This reaches posteriorly is sharp and immediately superior to the auricular surface. The iliac surface here. The surface has a large L-shaped auricular surface for articulation with the sacrum and expanded posterior wings are for attachment. Strong.
Anteriorly, here, separating the upper and lower part of the ilium, is the linea terminalis. The linea terminalis here is the line forming the entire medial surface of the ilium between the false and true pelvis. This part is called the arcuate line. And all of this terminal line is the pelvic brim, or pelvic inlet. The pelvic part of the ilium contributes to the lesser pelvis. Here, the pelvic part of the ilium expands into the iliac fossa, the wing, which provides bony support for the lower abdomen. Or this part is called the false pelvis. Here is the false pelvis. This part of the ilium provides attachment for muscles functionally associated with the lower abdomen. This is the attachment site for muscles. The gluteal surface of the ilium is concave and forms the iliac fossa. Here is the iliac fossa. This surface of the gluteal surface, external surface, has anterior gluteal line, posterior gluteal line, and inferior gluteal line. Anterior, posterior, and inferior gluteal lines that you studied in the lower limb. The superior margin of the ilium is the iliac crest. Here is the iliac crest. The iliac crest is concave medially. When you view it from the lateral view, it is convex. So, convex. But you see from the superior view, it is S-shaped. Okay.
Anterior crest here, attachment of external abdominal muscles, internal abdominal muscles, and transversus abdominis muscle. External oblique abdominal muscle, internal oblique abdominal muscle, and transversus abdominis muscle. And the posterior part is for the attachment of posterior or back and lower limb muscles. Superiorly, posterior to the anterior superior spine, there is a tubercle on the crest. This tubercle is called the tubercle of the iliac crest. Between the tubercle of the iliac crest and the anterior superior spine on the lateral border of the ilium.
Here are the anterior inferior spine. This structure serves as the point for attachment of the rectus femoris muscle. I told you this is the attachment site of the quadriceps femoris. This elevation is called the posterior superior iliac spine. And this is the posterior inferior iliac spine.
Surface of the ilium. And here, here, inferior to the anterior inferior spine.
A sample of bone marrow must be obtained to stage and assess the severity of the problem. The iliac crest is often used for such biopsies because it is close to the surface and easily palpated.
A bone marrow aspiration is performed by injecting local anesthetic into the skin and passing a cutting needle through the cortical bone of the iliac crest. The bone marrow is aspirated and viewed under a microscope. Samples can also be used for bone grafting. Bone grafting, for example, in the facial bones, you can use the iliac crest. The anterior and inferior parts of the pelvis.
The ischium has one body and two rami. One body, anterior and superior ramus, and inferior ramus. The body of the ischium is flattened. And articulates in the pubic symphysis. The body has a pubic crest. The superior border of the body is prominent, and that is called the pubic tubercle. I told you I will tell you about the pubic tubercle. This is the pubic tubercle. Okay. This is the pubic crest on the superior surface, superior border of the body. And the pubic tubercle. If you remember, the external oblique muscle attaches from the anterior superior iliac spine to the pubic tubercle. From the superior pubic ramus.
The superior ramus of the pubis has a sharp superior margin, a sharp superior margin. This superior margin is called the pectineal line or pecten pubis. Okay. This is the superior ramus of the pubis. It has three surfaces: anterior surface, posterior or pelvic surface, and inferior or obturator surface. And between the anterior and posterior surfaces is the superior border. The linea terminalis. If you remember, I told you the medial surface of the ilium has a line here. The arcuate line. The arcuate line posteriorly, that is formed by the iliac fossa. The pubic bone here, the pubic crest, the pubic tubercle, and the pubic ramus. All make the linea terminalis. The linea terminalis. Anteriorly, the pubic bone continues with the pubic crest. Also, it is a part of the linea terminalis and the pelvic inlet. I told you the superior pubic ramus is marked on its inferior surface by the obturator groove. If you remember, this foramen is called the obturator foramen. And this membrane is the obturator membrane.
The inferior border or lower border of the superior ramus of the pubis is the obturator crest. The inferior ramus of the pubis continues with the inferior ramus of the ischium and the body of the pubis to form the pubic arch.
Okay, Dr. Abdullah Jabbar, Dr. Muhammad Saad. Okay. Yes, yes. Makoun Hassan Muslim. Okay, Dr. Abdullah Jabbar. Your connection is not working. Why is it not working? Well, type it if you want to say something. Type it. Okay, type it then. If you have any questions, type them.
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If I told you, the superior pubic ramus is the superior part. The inferior part is the inferior ramus. And the inferior part is the ischium. And the inferior part of the pelvic bone or hip bone. It has a large body. Hello, are you in class? Well, why are they sending me so many messages? I didn't tell them not to send messages when I'm talking. Now, look, one of them is named Superman. Tell him to kick Superman out of class. Now, this Superman, Superman, whoever wrote that, tell them to kick them out of class. Kick them out. Go take a break. I'm talking. They keep sending break, please. Break, please. Rest. Break. I know what I'm doing. Kick this Superman out of class. Muhammad Sahbati. [Music]
The acetabulum is the socket. That is called the acetabulum. The ilium, ischium, and pubic parts attach together. And after years, after birth, eight years after birth, these three parts fuse together completely and become fused together and form the posterior wall of the pelvis. There are two bones: the sacrum and the coccyx. The sacrum is a triangular bone formed by the fusion of five sacral vertebrae. The base articulates with the last lumbar vertebra. And attaches to the ilium. You see here, on the lateral surface of the sacrum, there is an auricular surface. If you remember, I told you there is an auricular surface on the ilium. This auricular surface of the sacrum joins with the auricular surface of the ilium and makes the sacroiliac joint or SI joint. Okay. You see here, from here and here is the sacral promontory. The sacral canal. On the lateral surface of the superior part of the lateral surface. The articular surface. Posterior to the articular surface is a large roughened area for attachment of the sacrotuberous ligament. The sacroiliac ligament attaches here posteriorly and anteriorly. I told you the superior surface is characterized by the superior aspect of the body of the sacral vertebra. And each side of this body, the articular element, the transverse process of the sacral vertebrae fuse together. And form the superior surface. The first body of the first sacral vertebra. This area is the promontory. The promontory here is concave. And here is the transverse fusion lines. Fusion lines are here. And the attachment on each side of the attachment of the body of the sacral vertebrae, there are four pairs of anterior sacral foramina. Anterior sacral foramina. Posterior surface of the sacrum is convex. Convex on the midline here, there is the attachment, fusion of the spinous processes of the sacral vertebrae. This fusion line makes the median sacral crest. Here is the median sacral crest. On each side of the median sacral crest, there is the fusion of the laminae and the transverse processes of the sacral vertebrae. And on the side of this fusion, fusion area, there is a line that is called the intermediate sacral crest. Intermediate sacral crest here is formed by the articular processes of the sacral vertebrae. Lateral to the intermediate sacral crest, there are four posterior sacral foramina. And lateral to this, there is the lateral sacral crest that is formed by the transverse processes of the sacral vertebrae. The sacral canal is a continuation of the vertebral canal that terminates at the sacral hiatus on the posterior surface of the sacrum. The sacrum or the fused sacral vertebrae have a notch or hiatus. The sacral canal here is small. Terminal vertebral fusion makes this. Here it has an anterior surface, posterior surface, base, and apex. The base of the coccyx joins to the apex of the sacrum. Superior articular facets. Superior surface of the sacrum has two cornua or two horns that attach to the inferior articular facets of the last lumbar vertebra. No, present.
The pelvic brim. The pelvic brim. The pelvic inlet. The pelvic inlet is here. This heart-shaped or circular inlet. Posteriorly is formed by the body of the sacrum, S1. This is the sacral promontory here.
Okay.
I told you. There are many joints between the pelvic bones. Pelvic bones and the sacrum. Here is this joint, the sacroiliac joint or sacral joint. Here between the sacrum and the ilium. There is the sacroiliac joint. Between the body of the pubis and the pubis, there is the pubic symphysis. Here, see here. Circular, heart-shaped. The false pelvis and the true pelvis.
The pelvic inlet. The pelvic inlet posteriorly is bordered by the body of the sacrum, S1. As you know, on the superior surface of the body of S1, anteriorly, there is the sacral promontory. Here is the sacral promontory. And to the side of the body, here is the ala of the sacrum, or wing of the sacrum. And this line on each side is called the linea terminalis. The linea terminalis is formed by the arcuate line. The arcuate line posteriorly, that is formed by the iliac fossa. The iliac eminence is here. The pubic bone here, the pubic crest, the pubic tubercle, and the pubic ramus. All of them make the linea terminalis. During childbirth, the fetus passes through the pelvic inlet from the abdomen into the uterus, into the pelvis. And passes through the pelvic outlet. The walls of the true pelvis. The walls of the pelvis consist predominantly of bones and muscles. The inferior half of the pelvic bones forming much of them. You see here, the walls of the pelvis. Pelvic lateral wall and lateral wall. There are two ligaments: the sacrotuberous ligament and the sacrospinous ligament. The sacrospinous ligament is a triangular ligament between the posterior superior iliac spine and the lateral border of the sacrum. And the sacrotuberous ligament attaches to the posterior surface of the ilium and the lateral border of the sacrum. And converts the greater sciatic notch and lesser sciatic notch into the greater sciatic foramen and lesser sciatic foramen by the sacrum and sacrotuberous ligament. The sacrospinous ligament is also a triangular ligament and superficial to the sacrotuberous ligament. Its base has a broad attachment that from the posterior surface of the superior part of the ilium. The dorsal aspect of the lateral margin of the ilium. And into the lateral surface of the sacrum. And laterally, it attaches to the coccyx. The sacrotuberous and sacrospinous ligaments. Anterior to the sacrotuberous ligament is the sacrospinous ligament. You see here, the sacrum and sacrospinous ligament make the greater sciatic foramen and lesser sciatic foramen. The lesser sciatic foramen lies inferior to the ischial spine and the sacrospinous ligament. Between the sacrum and the sacrospinous ligament. Here is the pelvic outlet. The pelvic outlet is diamond-shaped. And anteriorly, it is limited by the pubic symphysis. And laterally, by the ischial tuberosities. The anterior borders of the pelvic outlet are formed by the ischial rami on the sides. And posteriorly, the posterior border of the pelvic outlet is formed by the sacrotuberous ligaments. The sacrotuberous ligaments and the two inferior borders of the pubic rami make the posterior border of the pelvic outlet. In anatomical position, the pelvis is oriented so that the anterior superior spines are in the vertical plane. And the anterior superior spines are located in the same vertical plane. The pelvic inlet marks the entrance of the pelvic cavity. It is tilted to face anteriorly. And the body of the pubic bones and the pubic arch are positioned in a near horizontal plane. Inferiorly. The pelvic inlet in anatomical position has an angle of about 60 degrees with the pelvic outlet. And the pelvic outlet has an angle of about 10 degrees. See here, this is the angle of the pelvic inlet, 60 degrees. And this is the angle of the pelvic outlet, that is about 10 degrees. And in women, in a number of ways, many of which have to do with the passage of the baby through the woman's pelvic cavity during childbirth. The pelvic inlet. The pelvic inlet in women is circular compared with the heart shape of the male pelvis. [Music]
The subpubic angle is the inferior pubic angle. In females, this angle is about 90 degrees. And in males, it is about 50 degrees. Generally, the sacral promontory projects medially into the pelvic cavity in males. Okay. In women, there is aversion of the ischial spines. But in men, there is inversion of the ischial spines. You see here, the greater sciatic notch in females is larger than in males, about 90 degrees. The angle of the superior and inferior borders of the pubic arch is about 90 degrees. But in males, there is about 50 degrees. The pelvic outlet in women is larger than in men. All diameters of the pelvic outlet are larger in females because of the delivery of the fetus. You see here, many differences between the male and female pelvis. In the pelvis, there are many measurements that are very important: transverse and anteroposterior measurements of the pelvis. They help in vaginal delivery. The sacral inlet, between the promontory and the top of the pubic symphysis. From the promontory.