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;
• cesarean 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.

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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.

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.

If we talk about the aponeurosis of the transverse abdominal muscle, then it is the site of the third, deepest layer of the abdominal muscles and plays an important role in the formation of an inguinal hernia. 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. Some experts believe that it is more appropriate to treat the pathology with the help of conservative therapy, however, in reality, such therapeutic measures are ineffective and one cannot do without surgery.

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. However, if pain is still present, then you should visit a doctor so that timely treatment is prescribed. If the symptoms are ignored from the very beginning, one should be prepared for the fact that over time the pain will intensify.

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 level of the iliac crest towards the external inguinal ring.

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 abdominal muscle.

Modern research has shown that the diagnosis and treatment of groin pathology problems, which 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, which is well known to traumatologists, a defect in the aponeurosis of the external oblique muscle of the abdomen can also be the cause of pain.

Researchers in different countries have long been interested in the nature and method of treating pain in the groin. Vgg. 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.

According to Orchard J., James E., Alcott S. et al., (2002), who studied pathology in 527 athletes, groin injuries were observed in 38 people (7.2%).

For professional hockey players playing in the NHL, such injuries are according to Nicholas SJ (amp)amp; Tyier TF (2002) about 10% of all pathology. Prevention, timely diagnosis and treatment muscle pathology represent a very urgent problem for professional football players because they are permanently disabled.

So, according to Hawkins D., Hunse M., Wilkinson C. et al. (2001), as well as Orchard J., Real J.W., Verrall G.M. and etc.

(2000) each player's muscle injury took an average of 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 the sport.

It has now been established that the presence of pain in the inguinal region, which prevents athletes from training and competitive loads, is due to degeneration and destruction of the aponeurosis of the oblique abdominal muscles (up to the separation of part of the fibers) and the involvement in the pathological process of neurovascular bundles passing through their thickness, containing terminal branches. n. iliohipogastricus.

The prior art method of applying aponeurotic sutures RU, A 61 B 17/00, 18.09.97 - similar. 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 , fifty).

The disadvantages of the analogue and the 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 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.

Diagnosis and treatment

Above this line, the anterior wall of the vagina is formed by the bundles of the aponeurosis of the external oblique muscle of the abdomen and the anterior plate of the aponeurosis of the internal oblique muscle, the posterior wall - by the posterior plate of the aponeurosis of the internal oblique muscle and the aponeurosis of the transverse abdominal muscle and in the uppermost section - by the muscle bundles of the transverse muscle.

The white line of the abdomen, linea alba, has the appearance of a tendon strip running from the xiphoid process to the pubic fusion. The white line is formed by interlacing bundles of aponeuroses of all three pairs broad muscles abdominal wall. In the upper section, where the white line is thinner and wider, gaps remain between the interlacing bundles of aponeuroses, which can be the site of the formation of hernias of the white line of the abdomen.

Fascia of the abdomen. The superficial fascia of the abdomen is distinguished by the presence of elastic fibers. Along the midline, the superficial fascia grows together with the white line, and below - with the inguinal ligament.

The transverse fascia covers the inner surface of the transverse abdominal muscle and the inner surface of the posterior leaf of the sheath of the rectus muscle, and below the linea arcuata, the inner, posterior, surface of the rectus muscle. From top to bottom, it fuses with the edge of the inguinal ligament. In the region of the navel, the fascia transversalis is denser and is called the umbilical fascia. In the region of the lower part of the white line, due to the concentration of longitudinal beams, a support of the white line is formed.

In the inguinal region, the transverse fascia forms a funnel-shaped protrusion - the internal seminal fascia. To inner surface the subperitoneal fascia is adjacent to the peritoneum, peritoneum. On the peritoneum of the anterior abdominal wall there is a series of folds corresponding to the course of the ligaments and vessels in the preperitoneal tissue.

Between plica umbilicalis medialis and plica umbilicalis lateralis there is a medial inguinal fossa, corresponding to the outer ring of the inguinal canal. Between the medial and median umbilical folds there is a supravesical fossa. These pits can be the places where hernias begin, which then, after passing through the abdominal wall, go out through the external inguinal ring.

1 - external oblique muscle;

2 - internal oblique muscle;

3 - muscle that raises the testicle;

Depending on the location of the lesion, diagnosis can be complicated and should be carried out by several specialists at the same time. To establish the diagnosis, an ultrasound, x-ray is prescribed.

Plantar aponeurosis, palmar, epicranial, and abdominal muscles require surgical intervention in 95% of cases.

In 5% of cases, a person consults a doctor in a timely manner and the disease is diagnosed at an early stage, which allows stopping the inflammation process and preventing complications.

To relieve inflammation, traditional methods are used: 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.

Surgical intervention is carried out in order to remove the healed area of ​​the fascia and give the anatomically correct position of 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.

ethnoscience

Traditional medicine cannot cope with the treatment of the root cause of aponeurosis and can only help relieve the symptoms of inflammation for a short period.

The recipe is simple: squeeze a few cloves of garlic onto a gauze bandage, fixing it on the affected area for several hours.

A disinfectant effect in the event of abscesses is provided by baths based on herbal decoctions (nettle, plantain, cabbage and maple leaves, chamomile).

The use of folk remedies can only be allowed in combination with traditional medicine.

Gynecologists, urologists, surgeons periodically face such a problem of their patients as inguinal pain. Timely and correct diagnosis of the causes of their occurrence is the key to successful treatment. Studies show that in more than 20% of cases, the cause of inguinal pain is a defect in the aponeurosis of the NCMF (external oblique abdominal muscles).

Moreover, such a defect can be both congenital and acquired. It should be noted that most of the pain in this area with similar symptoms is due to muscle damage with the development of myofascial syndrome, which requires careful differential diagnosis and other therapeutic approaches.

Inclusion in the defect area of ​​the terminal branches n. iliohypogastricus

- “muscular hernia” - fibers of the internal oblique muscle of the abdomen protruding into the defect area

Anomaly in the development of the inguinal sickle, when there are almost no tendon fibers in this area.

1. Predisposing. Conditions that create conditions for the formation of a hernia include congenital defects of the Spigelian line, traumatic injuries and operations on abdominal cavity, a decrease in muscle extensibility against the background of aging.
2. Producing. These factors cause a prolonged increase in intra-abdominal pressure and weakening of the abdominal muscles. These include excessive physical activity, weightlifting, chronic constipation, frequent hacking cough as a result of smoker's bronchitis and other lung diseases, ascites, overweight. Multiple pregnancy and severe protracted labor contribute to the weakening of the muscles of the Spigelian zone, a sharp jump in pressure in the abdominal cavity during attempts.

Difficulties in diagnosing hernial protrusion of the lunate line are associated with a long absence of symptoms of the disease, insufficient diagnostic experience of abdominal surgeons due to the low prevalence of the disease. To confirm the diagnosis, it is necessary to undergo the following examinations:

• Surgeon's examination. The specialist will conduct standard studies and prescribe additional diagnostic methods. Of great importance is the study of the anamnesis of the patient's life (lifestyle, sports, place of work).
• Abdominal ultrasound. With the help of an echographic examination, it is possible to evaluate the work of the abdominal organs and detect a hernial sac with contents.
• CT scan of the abdominal organs. It is carried out with contrast for better visualization of the hernial protrusion. Allows you to determine the exact location and size of the hernia, as well as the composition of the hernial sac.

In the absence of complications, laboratory diagnostics is uninformative. The disease is differentiated from benign and malignant neoplasms of the abdomen. In this case, instrumental research methods help to make the correct diagnosis. The bulging of the Spigelian zone is differentiated with hernias of other localization (hernia of the white line of the abdomen, inguinal hernia).

The invention relates to surgery for ventral hernias. The rounded defect is given a slit-like shape by applying two-row corrugated sutures to the abdominal wall on both sides of the defect in the horizontal direction. In this case, the first row of sutures is started at a distance equal to the size of the aponeurosis defect, increasing the width of the grip in the form of a triangle with its base facing the defect.

The invention relates to medicine, namely to surgery, and can be used for the treatment of ventral hernias of large areas.

Ventral hernias in the meso- and hypogastric regions are a frequent complication after emergency and elective surgeries. According to M.S. Deriugina after obstetric and gynecological operations, they occur in 53.8% of patients, and relapses according to B.A. Barkov and N.I. Shpakovsky from 32-60% of cases.

A known method of plastic defect of the aponeurosis of the anterior wall of the abdominal cavity according to Mayo, which consists in creating a duplication in the transverse direction (Borodin I.F., Skobey E.V., Akulik V.P. Surgery of postoperative hernias of the abdomen. - Minsk, "Belarus", 1986 , pp. 49 and 50).

However, due to the inferiority of the tissues around the sutured defect, as well as the remaining large tensile loads in the suture area with a sudden increase in intra-abdominal pressure (cough, constipation, paresis.), the known method is ineffective.

The closest in terms of the achieved positive result (prototype) is the method of plasty of the defect of the aponeurosis of the anterior abdominal wall, which consists in excising all the cicatricial tissues of the aponeurosis and crossing the rectus abdominis muscles in the transverse direction (“Surgery”, M., 1984, 12, Polyansky B.A. , with.).

A positive result of the claimed invention is to increase the efficiency of plastic surgery of an anterior abdominal wall aponeurosis defect by reducing complications and recurrences in extensive surgical ventral hernias.

ethnoscience

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 thing effective treatment- an operation involving the 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.

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, during a blow to the head, damage to the tendon helmet is possible (this is how the aponeurosis of the head is called), as a result of which a rather large hematoma is often formed, 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 of age, 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.

Doctors explain the problem as follows: normally, the aponeurosis acts as a shock absorber, supporting the arch of the foot, but with excessive load, microcracks and microruptures form in this tendon plate, the healing of which takes quite a long time. It is these injuries that cause pain in case of non-compliance with the regime of work and rest, as well as in the process of professional running.

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.

The cause of the pathology is a defect in the connective tissue. The fact is that it is depleted and expands, which causes the appearance of slit-like holes. In children, the main factor in the development of education is the physiological hypoplasia of the aponeurosis.

The cause of the pathology is a defect in the connective tissue. The fact is that it is depleted and expanded, and this causes the appearance of slit-like holes. In children, the main factor in the development of education is considered to be physiological underdevelopment and weakness of the aponeurosis.

In general, the main reasons that have a negative impact on the condition of the connective tissues of the white line of the abdomen include:

• hereditary predisposition;
• abdominal trauma;
• excessive body weight;
• surgical operations on the abdominal organs.

It is worth noting that the weakening of the muscles and tissues of the abdomen is not always a factor in the development of the disease. In some cases, a hernia appears due to increased intraperitoneal pressure. This occurs when:

• chronic constipation;
• pregnancy;
• difficult natural childbirth;
• weight lifting;
• physical stress;
• strong cough;
• difficult urination;
• strong and prolonged crying in infants.

Most often, the disease develops in men under the age of 30, and in women 40-50 years old, but it can also affect women.

Education may be supra-umbilical. In this case, a hernia occurs above the navel. Formed in 80% of cases. Paraumbilical hernias are located near the navel and are observed in 18% of cases of hernia of the white line of the abdomen. The most rare are sub-umbilical hernias, which are diagnosed in only 2% of all cases.

Symptoms of the disease

With the development of a hernia of the white line of the abdomen, the symptoms may not disturb the patient for a long time. The main sign of pathology is the appearance of a bulge in this area, when pressed, discomfort and even pain often appear. In some cases, the formation is reduced, and it also disappears in a horizontal position on the back. If this does not happen, then the hernia is called irreducible and there is a high risk of infringement.

The main symptoms of an uncomplicated hernia include:

1. Nausea that is not related to eating errors. In some cases, turning into vomiting.
2. The presence of a painful or painless soft protrusion in the area of ​​the white line of the abdomen.
3. Formation of muscle stretch along middle line.
4. Pain in the abdomen, which most often occurs after eating.
5. The occurrence of pain and discomfort when walking, sudden movements, bending or turning.
6. The appearance of symptoms such as hiccups, heartburn or belching.
7. On palpation in the region of the white line, a hole is clearly felt, which is called the hernial ring.

With a strangulated hernia of the white line of the abdomen, the following symptoms may be added to the above symptoms:

• vomiting torments constantly;
• the presence of blood in the stool;
• pain in the abdomen is constantly present and becomes unbearable;
• painful formation in the hernia.

A strangulated hernia requires immediate hospitalization for surgical treatment for surgical intervention. This condition occurs when the contents of the hernia are compressed by the hernial orifice. In this regard, a person constantly feels pain, therefore, immediate elimination of the pathology is required.

Diagnostics

To diagnose the pathology, you must contact the surgeon. In addition to a visual examination of the patient, taking an anamnesis and palpation of the abdomen, an additional examination may be prescribed. The most effective methods for diagnosing the disease include:

• x-ray of the stomach and duodenum with contrast;
• gastroscopy;
• computed tomography of the abdominal cavity.

Usually, the diagnosis is not difficult, the doctor needs a simple examination. The hernia is clearly visible, it can be palpated, as well as the contents of the hernial sac. In difficult situations, additional methods are carried out. In case of infringement, the diagnosis is reduced to a minimum, since the patient's life is at stake.

Treatment of the disease

With the appearance of a hernia of the white line of the abdomen, treatment is reduced only to an operation with plastic hernia gate. This is the best method of eliminating the problem, allowing you to forget about the disease once and for all. Modern surgery offers several types of surgical correction of a hernia, each of which has a number of advantages and is prescribed for certain indications. Among them:

1. Use of synthetic mesh. Aponeurosis defect is corrected with a special mesh, which is made of non-toxic and hypoallergenic materials. First, the defect of the rectus muscles is excised, after which the hole is closed with a special mesh. Thus, the risk of recurrence of pathology is minimal. The mesh can be made from a material that is completely absorbable, or it can be preserved, gradually overgrown with tissues. The question of using such an auxiliary object is decided after assessing the condition of the patient's muscles. Therefore, most often such a decision is made during the operation.
2. Use of patient tissues. This operation consists in removing the diastasis of the muscles and suturing the hernial ring. The main disadvantage is the high risk of recurrence.
3. A strangulated hernia of the linea alba is treated surgically, and may include a large area of ​​resection.

There are several methods of surgical intervention, the choice of which depends on the individual characteristics of the patient and the course of the disease. These methods include:

• open operation. It consists in making an incision, the length of which corresponds to the size of the protrusion. This method rarely performed due to long postoperative care and the likelihood of complications;
• laparoscopic surgery. During the use of this method, three small punctures are made through which instruments and video surveillance are inserted;
• preperitoneal surgery. It is carried out through small punctures with the help of special tools and video surveillance. The difference of this method is the absence of the need for penetration into the abdominal cavity. There is a detachment of the peritoneum by introducing a balloon-dissector with gas.

Treatment of a hernia is impossible without surgery. There are methods that help slow down the development of pathology, but sooner or later the hernia will be infringed. Conservative methods include a bandage that slows down the process of defect expansion. However, it can become a substitute for surgical intervention only if such a patient is contraindicated. Surgery for surgical treatment of a hernia is contraindicated:

• during pregnancy;
• with severe cardiovascular pathology;
• in the presence of an acute focus of infection in the body;
• cancer patients;
• people suffering from kidney and liver failure.

If the operation is not possible, the only way to relieve pain is to take antispasmodic drugs - they eliminate muscle tension and the contents “leave” into the abdominal cavity. Taking painkillers can disrupt the clinical picture, complicate the diagnosis in case of infringement. However, they will not get rid of the main problem, but will only improve the condition for a while. Therefore, in the case when there are no contraindications, it is recommended to agree to surgical treatment.

What is aponeurosis and how to treat it

Many people experience discomfort in the foot after a long walk, playing sports, wearing uncomfortable shoes. However, not everyone thinks that this may be a signal of the onset of the inflammatory process, which is caused by the problem of the heel spur.

Aponeurosis can disturb a person not only in the foot area, but also in the palms, abdominal muscles, and head. What is aponeurosis and how to treat it we will tell in this article.

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.

Causes

For inflammation of the plantar aponeurosis, risk factors are:

• redundant body fat;
• clubfoot or valgus foot;
• wearing uncomfortable shoes;
• prolonged standing;
• active sports;
• hypertonicity calf muscle;
• middle and old age.

The risk group of people most often exposed to foot aponeurosis includes people of mature age, professional athletes and dancers, salespeople, teachers, workers of industrial enterprises.

The cause of sexual predisposition could not be established, however, foot disease is more often seen in women, and palmar aponeurosis in men.

Aponeurosis is localized in the ankle, inguinal zone, in the abdominal muscles, lower back, palms, and skull. The most commonly observed aponeurosis of the abdominal muscles, palms and feet.

Inflammation of the tendons occurs as a result of prolonged physical impact and subsequent rupture.

Most people, when the first symptoms appear, do not seek the help of a doctor, hoping that everything will go away on their own, thereby allowing the disease to progress to the stage when the pain becomes unbearable.

In order to avoid serious consequences, you should consult a doctor in time.

A hernia of the white line of the abdomen is a protrusion of the abdominal organs through defects in the aponeurosis, which is located along the midline of the abdominal press. Pathology develops in patients of various groups, but is most often diagnosed in overweight young men or after surgery in this place. The development of the disease is slow and most often asymptomatic.

The formation of a hernia begins with the penetration of fatty tissue through the gaps of the aponeurosis. Only after this is a protrusion of the peritoneum formed and the occurrence of a true hernia, which can contain most often the walls of the stomach, intestines and other internal organs. Removal of a hernia of the white line of the abdomen is possible only with the help of surgery. Other treatments are ineffective and even dangerous.

Treatment of the disease

Aesthetic deformation of the anterior abdominal wall is a discrepancy between the mental image of the shape of the abdomen and its present state.

The ideal shape of a woman's belly appears to us as follows. 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.

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).

The disease is more common in women. The predominant form is diastasis of the rectus abdominis muscles after childbirth. The most dangerous time for this is the first months. The likelihood of developing pathology increases after cesarean section, since the integrity of the muscle aponeurosis is violated, and its ability to contract decreases.

The connective tissue, which, in particular, consists of the aponeurosis of the abdominal muscles, becomes looser under the influence of hormones during pregnancy. This allows the ligaments of the pelvis to prepare for the passage of the baby through the birth canal. In addition, stretching the muscles is necessary for the normal growth of the baby in the uterus.

After the birth of a baby, the connective tissue spontaneously strengthens, the shape of the abdomen is restored within a year. If you do not give the body time to rehabilitate and start intense training or do hard physical work, the connective tissue will not contract and will be fixed in a stretched position. There will be a divergence of the rectus abdominis muscles.

Obesity contributes to the appearance of this disease, as well as a rapid decrease in body weight, when the aponeurosis does not have time to contract behind the muscles that have lost volume, as a result of which its “surplus” is formed.

Muscle divergence can be facilitated by any factor that increases pressure in the abdominal cavity: persistent hacking cough, hard work, sports associated with weight lifting, chronic constipation.

Finally, in medicine there is such a thing as connective tissue dysplasia. This is a congenital condition characterized by an altered structure of the ligaments, tendons and other elements that make up the basis of the body. Dysplasia is manifested, in particular, by increased extensibility of the connective tissue. Therefore, hernias of different localization and muscle diastasis can occur.

The causes of diastasis of the abdominal muscles in men are all of the above factors, of course, except for pregnancy.

photo of diastasis of the rectus abdominis muscles

The aponeuroses of the muscles of the anterior abdominal wall form the sheath of the rectus abdominis muscle. The vagina has an anterior and a posterior plate, 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 are in contact with the transverse fascia with their back surface.

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; the back wall is the posterior plate of the aponeurosis of the internal oblique muscle and the aponeurosis of the transverse abdominal muscle. In the lower third of the rectus aponeurosis of all three muscles pass to the anterior wall of the vagina.

Aponeurosis posteriorly lumbar region cover the longitudinal muscles of the lower back: the muscle that straightens the body (lat. m. erector spinae) and the multifidus muscle (lat. m. multifidus)

Palmar aponeuroses cover the muscles of the palmar surface of the hands.

The supracranial aponeurosis, or tendon helmet (Latin galea aponeurotica) is an aponeurosis located between the skin and the periosteum and covering the cranial vault; is an integral part of the occipital-frontal muscle, combining its occipital and frontal belly.

Symptoms of a hernia of the white line of the abdomen

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.

Damage to the fascia in the palms is 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, aggravated during physical exertion, coughing and sneezing, in women during the period of ovulation.

Damage is typical for the internal oblique muscle, anterior abdominal and transverse muscles. Due to the violation of the integrity of the tendons and fascia that hold the muscle corset, hernial protrusions are formed that pose a danger to the patient's life.

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.

Infringement occurs with a sudden compression of the elements of the hernial contents in the hernia gate. In this case, there are sharp, rapidly growing pains in the abdomen, nausea and vomiting, retention of stools and gases, blood in the stool, hernia unreduced by lightly pressing the hand in the supine position.

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.

Classification and stages of development of deformation of the anterior abdominal wall

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; the back wall is the posterior plate of the aponeurosis of the internal oblique muscle and the aponeurosis of the transverse abdominal muscle. In the lower third of the rectus muscle, the aponeuroses of all three muscles pass to the anterior wall of the vagina.

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; the back wall is the posterior plate of the aponeurosis of the internal oblique muscle and the aponeurosis of the transverse abdominal muscle. In the lower third of the rectus muscle, the aponeuroses of all three muscles pass to the anterior wall of the vagina.

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 based on anatomical location muscle fibers within 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, in appearance it resembles a fan.

Internal aponeurosis on the opposite side, it connects to the same structures, forming a reliable weave for fixing 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 minimal motor activity of the 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 method is illustrated with schematic drawings of the operation (see Fig.1 - 5).

The method is carried out as follows.

During the operation, under general anesthesia in the area of ​​the hernial protrusion, a transverse elliptical incision of the skin and fatty tissue is performed, while excess tissue is removed. Then the hernial sac is opened, its revision is carried out, if necessary, enterolysis, resection of the omentum, the walls of the hernial sac are excised with a preliminary reduction of its contents into the abdominal cavity (Fig. 1).

After that, corrugated sutures are applied horizontally to the abdominal wall (figure 2) on both sides, and the beginning of the sutures outside the defect at a distance equal to the size of the aponeurosis defect. The grip width increases in the form of a triangle with its base facing the defect and equal to half of its size.

The second row of corrugated seams closes the remaining half of the defect (Fig. 3). Upon completion of suturing, the defect from a round or oval shape acquires a slit-like shape and is easily closed with separate interrupted sutures with the creation of a duplication without significant tissue tension (Fig. 4, 4a). The postoperative wound is sutured in layers leaving active drains brought out through separate counter-openings. The drains are removed after the termination of their function (figure 5).

Patient K., aged 60, was admitted in a planned manner. Clinical diagnosis: extensive postoperative ventral hernia in the mesogastric region, obesity of the III degree, sagging abdomen, hypertension II stage. She had a history of surgery two years ago for calculous cholecystitis. On examination: a hernial protrusion of 150x180 mm, when the hernia is reduced in the supine position, an aponeurosis defect of 80x100 mm is determined with thinning of the surrounding tissues.

When spirography - a violation of bronchial patency. With repeated spirography with dosed pneumocompression - worsening of bronchial patency compared to the original. An operation was performed according to the claimed method by plasty of the defect in the transverse direction with the imposition of unloading sutures, excision of the fatty apron and plastic of the defect itself duplicatively.

After the operation, antibiotic treatment was prescribed for 4-5 days. The sutures were removed on the 9th day. The postoperative period proceeded without complications. The control spirography revealed no violations of the ventilation function of the lungs. On the 10th day the patient was discharged in a satisfactory condition. Six months later, a follow-up examination was carried out - there was no recurrence.

The effectiveness of the proposed method is to improve the results of surgical treatment of ventral hernias in the meso- and hypogastric region by transverse plasty with the imposition of unloading corrugated sutures outside the area of ​​the abdominal wall defect. At the same time, the thinned, defective near-hernial area is strengthened, a sufficient reserve of tissues is created for duplication of the defect, and breaking loads on the sutures directly in the area of ​​the defect are reduced.

Since there is no decrease in the transverse dimensions of the anterior abdominal wall, and the decrease in the volume of the abdominal cavity is slightly compensated by the lateral sections that are not involved in plastic surgery, as in the case of longitudinal variants, respiratory excursions and indicators of the function of external respiration do not change.

The claimed method is especially effective in aged patients with flabby abdominal wall, ptosis of varying degrees and concomitant pathology of the cardiopulmonary system.

A method for plasty of an anterior abdominal wall aponeurosis defect, including creating a duplication in the transverse direction, characterized in that a rounded defect is given a slit-like shape by applying two-row corrugated sutures to the abdominal wall on both sides of the defect in the horizontal direction, the first row of sutures starting at a distance equal to the size defect of the aponeurosis, increasing the width of the grip in the form of a triangle facing the base to the defect, then a second row of horizontal sutures is applied, after which the defect of the aponeurosis is sutured.

(21) Application registration number: 0/14

(22) Application date: 2000.12.05

(24) Starting date of the patent term: 2000.12.05

Palmar aponeuroses

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.

Complications

If the surgeon is not consulted in time, the aponeurosis progresses rapidly, spreading to both limbs, affecting additional fascia of the muscles of the abdomen, palms, feet or skull.

The formation of contractures and bone growths at the sites of damage promises the occurrence of severe pain, loss of the physiological functions of the damaged areas.

Plantar and palmar disease negatively affects the health of the joints, creating a risk of their deformation.

In advanced cases, inflammation provokes abscesses, which are dangerous for blood poisoning and purulent formations.

One of the most common complications (40-60% of cases) is hernia incarceration, which requires urgent surgical care. The frequent occurrence of this condition is associated with the anatomical narrowness of the hernial orifice and the slight plasticity of their edges. If untreated, ischemia and necrosis of the strangulated part of the intestine develops.

Prolonged presence of the intestinal loop in the hernial sac leads to coprostasis. Prolonged stagnation of feces causes intestinal obstruction. When the hernial sac or its contents are infected, an inflammatory process and suppuration of the hernia (phlegmon of the hernial sac) develops. The lack of timely surgical intervention can lead to the development of peritonitis and sepsis.

Prevention of inflammation

As a prophylaxis of aponeurosis, a constant tone should be maintained muscle corset, resorting to moderate physical activity, monitor the health of the joints, after long walks or a hard day's work, do relaxing baths and compresses.

For the health of the feet, it is very important to choose the right shoes and orthopedic insoles, as well as regularly massage and joint gymnastics, stretching.

The prognosis of the disease depends on the size of the hernial bulge and the presence of complications. With timely hernioplasty of complicated and uncomplicated hernia, the prognosis is favorable. Relapses after surgery occur in 3-5% of cases. The development of complications worsens the prognosis and lengthens the rehabilitation period after surgery.

Links

• Aponeurosis // Encyclopedic Dictionary of Brockhaus and Efron: In 86 volumes (82 volumes and 4 additional). - St. Petersburg. , 1890-1907.

Wikimedia Foundation. 2010 .

aponeurosis - aponeurosis ... Spelling dictionary-reference

APONEUROSIS - (from Greek apo from, and neuron nerve, muscle). Connecting membranes that attach muscles to bones. Dictionary of foreign words included in the Russian language. Chudinov A.N., 1910. APONEUROSIS is a tendon membrane that attaches muscles to bones. ... ... Dictionary of foreign words of the Russian language

Aponeurosis - connective tissue plate, with the help of which the muscles are fixed. In humans, the aponeurosis is also called the fascia of the sole and palm penetrated by tendon filaments ... Big Encyclopedic Dictionary

APONEUROSIS - (from apo. and Greek. neuron lived), a wide tendon plate of vertebrates, consisting of dense collagen and elastic fibers, through which some wide muscles are attached to the bones or other tissues of the body. A. naz. also fascia, ... ... Biological Encyclopedic Dictionary

aponeurosis - noun, number of synonyms: 5 disease (995) plate (47) sprain (14) ... Synonym dictionary

aponeurosis - a, m. aponévrose (amp) amp; LT; apo from, from neuron tendon. honey. A wide shiny connective tissue plate, through which the muscles are attached to the bones. Krysin 1998. Lex. SIS 1964: aponeuros / z ... Historical Dictionary of Gallicisms of the Russian Language

APONEUROSIS - (from the Greek aro from and neuron tendon, nerve), term, original. denoting the area of ​​\u200b\u200bthe muscle located where the muscle fibers pass into the tendon. In a crust, time A. is usually called b. or m. a wide connective tissue plate, ... ... Big Medical Encyclopedia

aponeurosis - a connective tissue plate with which muscles are fixed. In humans, the aponeurosis is also called the fascia of the sole and palm penetrated by tendon threads. * * * APONEUROSIS APONEUROSIS, a connective tissue plate, with the help of which ... ... Encyclopedic Dictionary

APONEUROSIS - (aponeurosis) a thin, but strong enough lobe of dense, formed fibrous connective tissue, replacing flat leaf-shaped tendons in muscles that are attached to bones for a considerable length (for example, external aponeurosis ... ... Explanatory Dictionary of Medicine

aponeurosis - (aponeurosis, PNA, BNA, JNA; Greek aponeurosis; ano neuron vein, tendon, nerve; syn. tendon stretch) 1) a wide connective tissue plate, consisting of dense collagen and elastic fibers, which are located larger ... ... Big Medical Dictionary

Conclusion

Aponeurosis of the limbs, abdominal wall, skull or lumbar entail extreme consequences for human health. With untimely treatment, a person risks losing the function of the joints, muscles and fascia of the injured area.

Avoiding injury to the tendons and fascia throughout life is quite simple: it is important to pay attention to your lifestyle, choice of physical activity and professional activity, timely rest and replenish strength, regularly diagnose the health of the whole body. And most importantly - in the event of a characteristic pain syndrome, consult a doctor in time.

Classification and manifestations

Like other types of hernias, hernias of the semilunar line can be small and large, unilateral and bilateral (extremely rare), uncomplicated and strangulated. Depending on the location relative to the anatomical structures, three types of hernias of the Spigelian line of the abdomen can be distinguished:

• Subcutaneous (simple). The hernial protrusion is located under the skin, passing through the tendon plate of the external oblique muscle, the transverse and oblique muscles.
• Interstitial. The hernial bag, passing through the transverse and internal oblique muscles, remains covered by the aponeurosis of the external oblique muscle.
• Properitoneal (preperitoneal). The hernial sac prolapses into the preperitoneal tissue located between the transverse fascia and the peritoneum.

Depending on the clinical signs, the following degrees of diastasis of the rectus abdominis muscles are sufficiently conventionally distinguished:

1. The distance between the edges of the muscle cords, measured in the middle between the navel and the lower edge (xiphoid process) of the sternum, does not exceed 7 cm. The condition is observed in women after childbirth and usually does not change appearance belly. Symptoms accompanying this stage are dull pain in the epigastric region, of weak strength, nausea, sometimes bloating and constipation, as well as discomfort and shortness of breath when walking.
2. Diastasis is from 7 to 10 cm. At the same time, they begin to relax lateral muscles, the shape of the abdomen changes, it sags, a vertical protrusion is determined in the middle, and a deepening in the prone position.
3. The pronounced discrepancy is more than 10 cm. There is a significant cosmetic defect. The muscles of the press weaken. Prolapse of organs develops, which is accompanied by various manifestations - constipation, abdominal pain, shortness of breath, disorders of the genitourinary system. At the same time, hernias of the white line or navel appear - protrusions of the aponeurosis through which intestinal loops or omentum sections penetrate. Incarcerated hernia requires urgent surgery and may be complicated by peritonitis.

So, the progression of the disease can lead to serious consequences. Therefore, when it appears, you need to consult a doctor.

How to determine the presence of diastasis of the rectus abdominis muscles at home?

To do this, lie on the floor and raise your head, looking at your stomach. In this case, the abdominal muscles should be slightly reduced. With the appearance of a vertical roller in the middle of the abdomen, one can assume the presence of diastasis. With severe obesity, the tension of the abdominal muscles, on the contrary, will manifest itself as a deepening of the depression between the rectus muscles.

Additional diagnostics is based on the data of ultrasound examination of the soft tissues of the abdominal wall. Data on diastasis can also be obtained during the study of the abdominal cavity for another reason, for example, using computed tomography.

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

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Editorial response 10 days ago

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Sonya 10 days ago

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Margo 8 days ago

Has anyone tried folk methods joint treatment? Grandmother does not trust pills, the poor woman has been suffering from pain for many years ...

Andrew a week ago

What kind of folk remedies I have not tried, nothing helped, it only got worse ...

Table of contents of the subject "Anatomy of Hernias of the Anterior Abdominal Wall.":
1. Basic concepts: aponeurosis, fascia, ligament, hernia, hernial orifice, hernial sac.
2. Inguinal region. Scarpovskaya fascia. Nameless fascia.
3. External oblique abdominal muscle and its aponeurosis. Inguinal ligament. Lacunar ligament.
4. Internal oblique abdominal muscle and its aponeurosis. The transverse abdominal muscle and its aponeurosis. The ileo-pubic tract. Groin sickle.
5. Transverse fascia. Cooper's link. Rectus abdominis. Ligament of Henle.
6. The main vessels of the inguinal region. Crown of death.
7. The main nerves of the inguinal region.
8. Femoral region. Femoral fascia. femoral canal.
9. Inguinal canal. Walls of the inguinal canal.
10. Superficial inguinal ring.
11. Deep inguinal ring.

Internal oblique abdominal muscle and its aponeurosis. The transverse abdominal muscle and its aponeurosis. The ileo-pubic tract. Groin sickle.

Internal oblique abdominal muscle and its aponeurosis

The muscle passes into its aponeurosis along an oblique line running from the womb to the costal arch. This muscle provides strength to the anterior abdominal wall in the groin area. As a rule, in the inguinal region there is both a muscle and its aponeurosis. Inferior muscle fibers originate from the iliac fascia and iliopectinal arch next to the anterior-superior iliac spine, forming fibers covering the spermatic cord in the lateral third of the inguinal canal (m.cremaster). Medially, these fibers are woven into the musculoaponeurotic arch of the transverse abdominal muscle. Aponeurotic fibers run horizontally, weaving into the linea alba, forming one of the layers of the sheath of the rectus abdominis.

Very rarely (about 10% of cases) aponeurotic fibers connect with the transverse muscle and form the so-called joint aponeurosis.

Internal oblique muscle in the groin. External oblique muscle removed:
1 - external oblique muscle;
2 - internal oblique muscle;
3 - muscle that raises the testicle;
4 - inguinal ligament

Transverse abdominal muscle and its aponeurosis

It is the third and deepest layer of abdominal muscles, the most important in the formation of inguinal hernias. The transition of the muscle into the aponeurosis occurs along the line connecting the xiphoid angle and the deep inguinal ring. The transition zone is quite variable, and muscle and aponeurotic fibers can occur simultaneously at the same level. Bottom part This layer forms the posterior wall of the inguinal canal. The lower edge of the muscle forms a curved arcuate line - a transverse arch. This arch is covered behind only by the transverse fascia (Fig. 2.8).

United aponeurosis- this is an aponeurosis of only the transverse abdominal muscle, very rarely it is also formed from the aponeurosis of the internal oblique muscle.

ileo-pubic tract- a dense plate emanating from the aponeurosis of the transverse muscle, which bridges over the external iliac vessels from the ileopectineal arch to the upper branch of the pubic bone. Very variable in thickness and strength. In the lateral part, it partially coincides along the course with the inguinal ligament, which is more superficial than it. Medially - separated from the inguinal ligament. The tract goes below the deep inguinal ring, forming the lower aponeurotic border of this opening. After it crosses the iliac vessels, it forms a line where the transverse fascia passes into the femoral fascia. The iliopubic tract curves medially backwards and downwards to form the medial wall of the femoral canal.

Transverse abdominal muscle in the groin:
1 - external oblique muscle;
2 - internal oblique muscle;
3 - transverse abdominal muscle;
4 - muscle that raises the testicle;
5 - internal seminal fascia;
6 - aponeurotic arch of the transverse muscle;
7 - transverse fascia

It is important to distinguish what inguinal ligament~ a derivative of the external oblique muscle and its aponeurosis, and the ileo-pubic tract is a derivative of the transverse muscle and its aponeurosis.

Groin sickle- this is a continuation of the aponeurotic bundles of the lower part of the transverse muscle, which bend down, weaving into the periosteum of the upper branch of the pubic bone. This connection can be located at a different distance from the lateral edge of the rectus muscle. The sickle consists of both aponeurotic fibers of the transverse muscle and muscle fibers of the rectus abdominis muscle.

When approaching this zone from the front, the sickle cannot be seen, it is only accessible from behind.

Scheme of the structure of the anterior abdominal wall (posterior view), inguinal sickle:
1 - deep inguinal ring with the spermatic cord forming at this level. Place of exit of oblique inguinal hernia;
2 - the place of exit of a direct inguinal hernia;
3 - the place of exit of the femoral hernia;
4 - a bunch of Cooper;
5 - inguinal sickle;
6 - external and internal oblique and transverse abdominal muscles;
7 - transverse fascia;
8 - rectus abdominis muscles;
9 - peritoneum and preperitoneal tissue;
10 - external iliac vessels;
11 - obturator foramen and obturator vessels

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 anterior abdominal wall aponeurosis 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 approaches to the abdominal organs make 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 control group studied 8 people defined as "practically healthy". 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 PBS aponeurotic tissue 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 a large number of dictyosomes located throughout the cell volume. 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 AJ aponeurosis 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 with an extremely limited number of microvessels is formed in their place. 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 in light and electron microscopy in patients with AJ hernias 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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2. Restoration of the integrity of the anterior abdominal wall and innervation of internal organs / Ed. ed. D.M. Golub. Minsk: Science and technology, 1994.- 77 p.

3. Gorbunov N.S. Laparotomy and layered structure of the anterior abdominal wall / Gorbunov N.S., Kirgizov I.V., Samotesov P.A. - Krasnoyarsk, 2002. - 100 p.

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6. Kazantsev O.I. The structure of the median fascial node of the ventral wall of the abdomen and its congenital malformations (author's dissertation ... candidate of medical sciences.) / I.O. Kazantsev.- Astrakhan, 1981.- 21 p.

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8. Potekhin PP. Applied aspect of data on the ratio of the broad abdominal muscles in the hypogastric region / P.P. Potekhin // Proceedings of the II All-Union Symposium. Gorky, 1973.- S. 81-83.

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12. Kebe M., Cowppli-Bony K. La gaine des muscles grand droits del, abdomen. Ann. Univ. Abidjen. Ved. 1976. No. 10. P. 41-45.

13. Skulstad SM., Kiserud T., Rasmussen S. Degree of fetal umbilical venous constriction at the abdominal wall in a low-risk hjhulation at 20-40 weeks of gestation. Prenat. Diagn. 2002. Vol.22, No.11. P.1022-1027.

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

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 keep 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.

For convenience, these muscles are additionally divided into groups:

• front;
• lateral;
• back.

Separation occurs in accordance with the anatomical arrangement of muscle fibers.

Internal oblique muscle

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:

• restriction of body mobility;
• posture problems;
• decrease in respiratory function ( 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. Interesting to read -.

extrinsic muscle directed from top to bottom. The upper edge is attached in the region of 5-12 ribs, the lower one - 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 hernia it is possible to operate with a closed method, in other cases an open intervention is performed. In modern surgical practice, correction by the method of tissue tension has been abandoned; the defect is eliminated with specially designed medical meshes, a kind of patches.

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 the 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 a flap fascia lata hips through the hole made in the soft tissues covering 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.