Aponeurosis

Aponeuroses of the anterior abdominal wall (indicated in blue) and the linea alba

Aponeurosis(other Greek. ἀπο- - a prefix with the meaning of removal or separation, completion, reverse or return, negation, termination, transformation + νεῦρον "vein, tendon, nerve") - a wide tendon plate, formed from dense collagen and elastic fibers. Aponeuroses have a shiny, white-silver appearance. According to the histological structure, aponeuroses are similar to tendons, but are practically devoid of blood vessels and nerve endings. From a clinical point of view, the most significant are the aponeuroses of the anterior abdominal wall, the posterior lumbar region, and the palmar aponeuroses.

Aponeuroses of the anterior abdominal wall

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 muscle, the aponeuroses of all three muscles pass to the anterior wall of the vagina.

Aponeuroses of the posterior lumbar region

The aponeuroses of the posterior 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

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

Skull aponeurosis

The supracranial aponeurosis, or tendon helmet (lat. galea aponeurotica) - 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.

see also

Links

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

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Synonyms:

See what "Aponeurosis" is in other dictionaries:

Aponeurosis... Spelling Dictionary

- (from the 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

Connective tissue plate, with which the muscles are fixed. In humans, the aponeurosis is also called the fascia of the sole and palm penetrated by tendon threads ... Big Encyclopedic Dictionary

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

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

- (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

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).

In most cases, this problem is considered from the angle of sports pathology, among professional football players, hockey players, and also among ballet dancers. For the first time mentions of inguinal pain in athletes appeared in the second half of the last century. The occurrence of such pain was associated with the pathology of the adductor muscles of the thigh and microtrauma of the muscles of the anterior abdominal wall, mainly the rectus abdominis.

In the 90s of the last century, even the special term "athlete's hernia" was introduced, which describes the weakness or violation of the integrity of the posterior wall of the inguinal canal. Gilmor describes a triad of symptoms: rupture of the aponeurosis of the external oblique muscle leading to expansion of the external inguinal ring, rupture of the inguinal falx, and gaping between the inguinal ligament and inguinal falx.

However, among patients with inguinal pain, there are also patients with an acquired defect in the NCCM aponeurosis as a result of a previous appendectomy or surgery for ectopic pregnancy.

- a defect of a linear nature - the inclusion in the region of the defect of the terminal branches n. iliohypogastricus - “muscular hernia” - fibers of the internal oblique muscle of the abdomen protruding into the defect area - an anomaly in the development of the inguinal sickle, when there are almost no tendon fibers in this area.

Typical complaints in patients with aponeurotic defects are groin pains, worse after sudden movement, such as hitting a ball, turning in bed, coughing or sneezing, during sex and when climbing stairs. The complexity of diagnosis lies in the ambiguous interpretation of the ultrasound study in the study of pathology in this area.

And this is precisely the reason for all unsuccessful attempts at conservative treatment of this kind of inguinal pain by specialists who do not have the necessary qualifications and experience in the surgical treatment of aponeurosis defects. However, these specialists can and should suspect such a problem in the absence of demonstrative symptoms of a gynecological or urological disease, or in the absence of long-term unsuccessful treatment of such.

According to our results of surgical treatment of NCCM aponeurosis defect in 54 patients, all patients noted complete (52 patients or 96.3%) or almost complete (2 patients or 3.7%) disappearance of pain and restoration of motor functions, which were impaired due to pain syndrome. In most cases, after the operation, no special rehabilitation methods were required, except for exercise therapy.

Close interaction of gynecologists, urologists, surgeons with a specialist in the treatment of inguinal pain and early diagnosis of the causes of their occurrence is the key to successful treatment and early rehabilitation with the restoration of all motor functions. And most importantly - getting rid of the patient from constant pain.

The muscles of the abdomen are formed from the muscles of the press. They, in turn, are divided into straight, oblique and transverse. Classification is carried out on the basis of the anatomical location of the muscle fibers in the anterior abdominal wall.

A feature of the aponeurosis is the fact that it even visually differs from the surrounding tissues. The tendon plate has a shiny, whitish-silver color. This structure contrasts against the background of red muscle fibers. Their color is caused by excellent blood supply and tissue nutrition, which perceive huge loads.

Participates in many important functions of the human body:

• body tilts to the sides;
• rotational movements;
• abdominal tension.

The internal oblique muscle also "forces" the chest to move down. It starts from the womb and ends near the costal arch. The direction of its fibers is downward from the iliac crest, in appearance it resembles a fan.

The internal aponeurosis on the opposite side is connected to the same structures, forming a reliable weaving to fix the muscle. It is also attached to the linea alba.

Directed from top to bottom. It is attached near the ribs, on the opposite side - at the iliac crest, pubic symphysis. The direction of the fibers is at a slight inclination relative to the axis.

The aponeurosis and tendons of the external oblique muscle form the white line of the abdomen. The width of this structure is variable, ranging from 0.5-2.5 cm. The white line is also formed by the internal oblique and transverse muscles.

In the center is a hole - the umbilical ring. In this zone, there is minimal motor activity of the skin. This is achieved by the presence of fasciae - jumpers formed from connective fibers.

A defect in the aponeurosis of the anterior abdominal wall is a common problem for surgeons, urologists, and gynecologists. Pathology is both congenital and acquired. Needs careful diagnosis for successful treatment.

If symptoms of aponeurosis of the external oblique muscle of the abdomen or a peritoneal-perineal defect appear, the patient must undergo a detailed examination. Such signs are also characteristic of muscle lesions with myofascial syndrome.

Aponeurosis defects are usually found among professional athletes - football players, hockey players, dancers. The appearance of inguinal pain is associated with microtrauma in the abdominal muscles. The development of the aponeurosis of the anterior abdominal wall occurs after operations:

• with an ectopic pregnancy;
• appendectomy;
• C-section.

The appearance of pathology after surgery is explained by the patient's non-compliance with the doctor's recommendations regarding the recovery period. A person too early exposes the body to intense physical activity or lifts weights. As a result, the cut fibers do not have time to recover, which most often leads to the formation of hernias.

The problem also arises with non-professional performance of surgical intervention. If the operation is performed to treat a hernia, a special mesh is applied to the weakened tissue area. It strengthens the abdominal wall. The mesh is installed "with a margin", overlapping healthy areas of the body. If its edge does not extend far enough, misalignment or inefficient performance may occur.

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.

taking non-steroidal anti-inflammatory drugs, corticosteroids, intramuscular injections.

To restore the motor ability of the arms, legs, abdominal wall, head and neck, physiotherapy is prescribed at the rehabilitation stage: massage, electrophoresis, gymnastics.

Physiotherapy does not stop even after the patient has fully recovered and is carried out regularly as a preventive measure.

is carried out in order to remove the healed area of ​​the fascia and give an anatomically correct position to the damaged surface.

If the aponeurosis is the result of tissue rupture, then the surgeon will restore the integrity of the tendon plate.

As a result of surgery, a person may lose his ability to work for the recovery period - up to 4-6 months.

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.).

• oblique muscle of the abdomen;
• transverse abdominal muscle.

Aponeurosis of the palm

The palmar aponeurosis is the strands that cover the surface of the palm of the human hand. When a pathology such as Dupuytren's contracture is detected in a patient, this often indicates the fact of an anomaly of the tendon plate. A person with such a problem has a cicatricial contraction of the aponeurosis, which occurs due to the formation of nodes, strands on it. That is why contracture appears, due to which the finger (or several) is constantly in a bent position.

As a rule, the palmar aponeurosis is found in men, but the cause of its occurrence is still unknown. Most experts are of the opinion that hand injuries provoke pathology, but in this case, by the age of forty, everyone would have such a contracture. The disease progresses slowly, over time affecting both hands.

The only effective treatment is surgery, which involves excision of the palmar aponeurosis. If we consider other serious anomalies of the upper limbs of this type, then no less problems are caused by the pathology of the biceps of the shoulder, against which the 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. Nevertheless, 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 strain along the midline.
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 is 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 introduced;
• 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.

Symptoms of a hernia of the Spigelian line of the abdomen

1. Predisposing. The conditions that create conditions for the formation of a hernia include congenital defects of the Spigelian line, traumatic injuries and operations on the abdominal cavity, a decrease in muscle extensibility against the background of aging of the body.
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.

Not only parents went through the diagnosis of “umbilical hernia in a child”. And for each baby, the story with this sore ended in its own way, and for some, unfortunately, it has not been resolved so far. The prevalence and popularity of this pathology, but the low level of objective awareness of parents and susceptibility to rumors, often lead to a frivolous attitude and postponing treatment to the “far shelf”.

An umbilical hernia is a hole in the aponeurosis (its defect) of the umbilical region, through which the abdominal organs exit.

In other words, the hernia exits through the umbilical ring.

An umbilical hernia is divided into 2 types, depending on when it appeared in a child: it was already at birth (congenital) or appeared in the process of growth and development (acquired).

Congenital is found even in the maternity hospital: in the area of ​​​​attachment of the umbilical cord, a wide spherical protrusion is clearly visible, which increases with a cry.

The causes of an acquired hernia can be: congenital weakness of the aponeurotic tissue (there is a hereditary predisposition for the formation of hernias), a prolonged increase in intra-abdominal pressure as a result of various diseases (bronchitis, whooping cough, constipation, phimosis, whooping cough)

Firstly, this should be done by a pediatric surgeon. Such a diagnosis may be made at his first examination after birth, or at one of his regular examinations during preschool or school age. It all depends on how the hernia formed and when it formed. If you yourself want to verify the presence of a hernia or suspect its presence, then the detection of one of the following criteria should prompt you to consult a doctor.

1. The presence of a tumor-like soft protrusion in the navel, or "increase in size" of the navel. By itself, a hernia in this area can have a different size and shape. It depends on how big the hole in the aponeurosis is. Also, the size of the hernia can increase with an increase in intra-abdominal pressure (lifting weights, after feeding), and then return to the original.
2. The found protrusion can completely go away, hide in the lying position of the child and appear standing up, during physical exertion or straining.
3. In the area of ​​the detected hernia, if it is set, you can find a hole of various sizes through which it exits. This is the so-called defect in the aponeurosis.
4. Sometimes the baby may complain of pulling pains or just discomfort in the navel, but this may not be the case.
5. The child often has so-called intestinal colic, which disappear on their own or after the use of antispasmodic drugs (no-shpy).

In some cases, an umbilical hernia in a baby can be combined with a divergence (diastasis) of the rectus abdominis muscles.

Diagnostics

The surgeon makes a diagnosis on the basis of examining the child, feeling the umbilical region, determining the size of the hernia, aponeurosis defect and, if possible, the contents of the hernial sac (what organs come out). Most often, the contents are the omentum or the small intestine, and the doctor distinguishes them by the presence or absence of characteristic intestinal rumbling. Children are examined in two positions: standing (if they can already stand), straining, and lying down.

In the presence of an umbilical hernia, the child may not present any complaints. In this connection, parents often believe that it is not necessary to treat it.

It is believed that up to 1 year from the moment of birth, the hernial opening can heal on its own, which is associated with a high regenerative capacity of tissues (the ability to self-repair and heal). But this is only possible if the hernia is kept in a permanently reduced state, preventing organs from entering the hernial sac.

This can be achieved with the help of special hypoallergenic patches, bandage or other devices. Such tightening patches are applied by a pediatric surgeon only after the umbilical wound has completely healed (not earlier than 7 days). In addition, before feeding, the child must be laid out on the tummy so that the air that collects in the stomach comes out, and after food enters it, intra-abdominal pressure does not increase.

If the conservative methods used were ineffective, then the baby is prescribed surgical treatment, leading to a complete recovery. In this case, the navel is not removed, but on the contrary, after the operation it has an even more aesthetic appearance.

In order to understand the need for hernia treatment, it is necessary to be aware of the complications that may arise when it is present.

1. Infringement of a hernia. When a hernia is infringed, those organs that are in the hernial sac are compressed. After compression, the blood stops flowing to these organs and after a short period of time their necrosis (necrosis) occurs, which subsequently requires not only a hernia repair, but also the removal of dead sections of the intestine or omentum. That is why in case of pain in a child in the area of ​​a hernia, the appearance of its irreducibility, it is necessary to immediately contact the surgeon in the emergency room or call an ambulance team.
2. Coprostasis, constipation. It often occurs if the hernia is large enough and contains bowel loops.

That is why it is necessary to engage in active treatment of a hernia from the moment it is discovered. After all, who, if not us, will take care of the health of our children.

The white line of the abdomen (linea alba) is formed by tightly adjacent bundles of fibrous fibers of the aponeuroses of the rectus abdominis muscles. It passes in the form of a flat thickened tendon strip along the midline of the abdomen from the xiphoid process of the sternum through the navel to the pubic joint. The width of the white line of the abdomen is normally 1-2.5 cm, below the navel it narrows to 0.2-0.3 cm.

A hernia of the white line of the abdomen is formed when the bundles of the aponeurosis diverge and protrude through the formed defect of the peritoneum and internal organs - intestinal loops and omentum. With the formation of a hernia of the white line of the abdomen, the divergence of the tendon fibers can reach cm. Hernial gates can be round, oval or diamond-shaped, more often they are relatively narrow - up to 5-6 cm, thereby increasing the risk of hernia incarceration.

Factors leading to a weakening of the connective tissue of the white line of the abdomen can be hereditary predisposition, obesity, abdominal trauma, scars after surgery. Provoke the formation of a hernia of the white line of the abdomen can also be situations associated with a sharp increase in intra-abdominal pressure - physical effort, pregnancy, difficult childbirth, constipation, ascites;

At the first stage, preperitoneal tissue comes out through a slit-like defect in the tendon fibers with the formation of a preperitoneal lipoma. At the initial stage, a hernial sac is formed, the contents of which are part of the omentum or a section of the small intestine. At the stage of a formed hernia, all components of the disease are present - a hernial orifice, a hernial sac with hernial contents, which may include an omentum, loops of the small intestine, an umbilical-hepatic ligament, a transverse colon, and a stomach wall. At the stage of final formation, the hernia of the white line of the abdomen is well defined visually and by palpation.

A hernia of the white line of the abdomen rarely reaches a large size, sometimes the process stops at the stage of preperitoneal lipoma: the protrusion does not protrude beyond the white line, is hidden and does not progress further.

According to the level of location relative to the navel, the following types of hernia of the white line of the abdomen are found:

• supraumbilical (epigastric, epigastric) - are formed above the navel, are most common (80%)
• paraumbilical (paraumbilical) - located near the umbilical ring (1%)
• subumbilical (hypogastric) - located below the navel (9%)

More often, hernias of the white line of the abdomen are single, less often - multiple, located one above the other.

The soreness of the formation increases after eating, during exercise, and other situations associated with an increase in intra-abdominal pressure. The tension of the omentum fixed to the hernial sac, the pressure of the parietal peritoneum on the nerves, or the temporary infringement of the hernia can contribute to increased pain. Pain with a hernia of the white line of the abdomen may be accompanied by irradiation in the hypochondrium, scapula, lower back.

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.

To clarify the anatomical structures involved in the hernial process, radiography of the stomach with barium, gastroscopy (esophagogastroduodenoscopy), ultrasound of the hernial protrusion, and MSCT of the abdominal organs are performed. In some cases, herniography is performed - an X-ray contrast study of a hernia.

Differential diagnosis of a hernia of the white line of the abdomen is carried out with peptic ulcer of the stomach and duodenum, pancreatitis, cholecystitis.

A feature of the surgery of hernias of the white line of the abdomen is the need for mandatory elimination of diastasis of the rectus abdominis muscles. Depending on the methods of surgical treatment for hernias of the white line of the abdomen, plastic with local tissues (tension) or synthetic prostheses (non-tension) can be used.

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 aponeuroses of the posterior 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.

METHOD FOR REPLACING ABDOMINAL WALL APONEUROSIS 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. , from.).

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.

A positive result is achieved by the fact that to evenly distribute the load on the sutures on the abdominal wall outside the aponeurosis defect, corrugated sutures are applied on both sides of the defect, and the beginning of the sutures is equal to the size of the aponeurosis defect.

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 of the II degree. 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.

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

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.

Palmar aponeurosis: signs of the disease

In addition to the plantar aponeurosis, there are other varieties of this disease. For example, palmar is aponeurosis. What is it and how does this type of disease manifest itself? This disease occurs on the palmar part of the entire human hand. And if the patient has manifested such a disease as Dupuytren's contracture, then it makes sense to talk about the pathology of the aponeurosis of the palm.

With this disease, cicatricial contraction of this formation is observed. This is due to the fact that strands and nodes appear on it. As a result, contracture develops. This is when one or more fingers are bent all the time. Most of all, representatives of the stronger sex are affected by this disease. However, the reason has not yet been established. Some are used to thinking that it lies in hand injuries. But then every person of forty years old would be the owner of such a disease.

The development of the disease is slow. The affected area occupies two hands. There is only one way to cure the palmar aponeurosis - surgery. So with the manifestation of pain in the palms, it is necessary to contact specialists, and not self-medicate.

How to treat heel spurs?

Treatment is conservative in nature, and it will take a lot of time. If all procedures are done on time, then a stable remission will come.

During therapy, it is prohibited:

• long walk;
• stand on feet;
• carry heavy things;
• make movements in pain.

You will have to temporarily use special orthopedic products. Along with this, the doctor will prescribe an analgesic, a non-steroidal anti-inflammatory drug.

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 beginning 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.

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, aponeurosis is also called the fascia of the sole and palm penetrated by tendon threads ... 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

Causes of a hernia of the white line of the abdomen

For inflammation of the plantar aponeurosis, risk factors are.

The aponeurosis of the rectus abdominis muscle is a dense fibrous structure that connects and supports the muscles of the press. Most often, this area is called the white line, as it is represented by a thin light plate passing from the solar plexus to the womb.

Since the contractility of the aponeurotic system is rather low, such a pathology as divergence (diastasis) of the abdominal muscles often occurs. The disease leads to displacement of internal organs and muscle fibers, significantly worsening the quality of life.

Diagnosis and symptoms

Diastasis occurs mainly in women, but men are also at risk.

The cause of stretching is the physical factors that put pressure on the press:

• Pregnancy and childbirth;
• Resumption of active physical exercises in the early postpartum period;
• constipation and chronic cough;
• Active power loads;
• A sharp change in weight, which reduces the tone of soft tissues;
• Congenital pathological processes caused by degenerative changes in the connective tissue.

The symptomatic picture depends on the degree of muscle displacement. If the distance between muscle groups does not exceed 7 cm, then only some discomfort is possible, which is eliminated by exercise therapy. With a more pronounced defect, obvious manifestations of the disease are noted:

• Dyspnea;
• constipation;
• Pain in the abdomen and lower back;
• genitourinary disorders;
• Hernia formation.

A simple test will help determine the presence of a defect on your own. It is enough to lie on the floor and rest your legs bent at the knees on the floor. You should tighten the press and palpate the line from the solar plexus to the navel to determine the perforation of the muscular skeleton.

It is important to consult a doctor when initial signs appear, since the pathological process is prone to the progressive development of degenerative changes.

Treatment

After the examination, the doctor determines the severity of the disease and recommends appropriate treatment.

The initial degree is corrected by specially selected physical exercises. Most often recommended running, swimming and walking.

Stretching more than 5 cm is eliminated only by surgical intervention.

The surgeon sutures the aponeurosis of the rectus abdominis muscle and additionally strengthens the area of ​​weakened fibers with a mesh frame made of synthetic material.

As a result, not only the return of the original position of the tissues occurs, but also the exclusion of postoperative complications and relapses.

Depending on the anatomical data and the wishes of the patient, such accompanying manipulations as liposuction and skin tightening can be performed.

Dr. Guzal Melisovna Isamutdinova will help you choose the best intervention to restore health and eliminate cosmetic defects.

Sign up for a free consultation to get all the information you need.

Excitability, conductivity, contractility, elasticity and extensibility, that is, all the properties of an adult muscle. Elasticity and strength increase, elasticity decreases.

Question No. 38 Topography of the anterolateral wall of the abdomen. Surgical access to the organs of the abdominal cavity.

Question number 65 Bones, ligaments, muscles of the pelvis. Lateral cellular spaces of the pelvis. Blockade of the lumbar and sacral plexuses according to Shkolnikov-Selivanov

4. Lower edges of the internal oblique and transverse muscles

5. Inguinal ligament

69. The back wall of the inguinal canal is formed by:

1. Parietal peritoneum

2. Inguinal ligament

Transverse fascia

4. Aponeurosis of the external oblique muscle of the abdomen

70. The lower wall of the inguinal canal is formed by:

1. The lower edges of the internal oblique and transverse muscles

inguinal ligament

3. Comb fascia

4. Parietal peritoneum

5. Aponeurosis of the external oblique muscle of the abdomen

71. The upper wall of the inguinal canal is formed by:

1. Transverse muscle

2. Internal oblique abdominal muscle

The lower edges of the internal oblique and transverse muscles

4. Parietal peritoneum

5. Transverse fascia

72. The transverse fascia is the wall of the inguinal canal:

1. Top

rear

4. Front

73. The inguinal ligament is the wall of the inguinal canal:

1. Top

Lower

4. Front

74. Aponeurosis of the external oblique muscle of the abdomen is the wall of the inguinal canal:

1. Top

Front

75. The lower edges of the internal oblique and transverse muscles are the wall of the inguinal canal:

Upper

4. Front

76. The content of the inguinal canal in men is:

spermatic cord

ilioinguinal nerve

3. Sexual nerve

77. The content of the inguinal canal in women is:

Round ligament of uterus

ilioinguinal nerve

3. Sexual nerve

Genital branch of the genitofemoral nerve

5. Femoral branch of the genitofemoral nerve

78. The composition of the spermatic cord includes three of the five given anatomical elements:

vas deferens

2. Urinary duct

Vessels and nerves of the vas deferens and testis

Remains of the vaginal process of the peritoneum

5. Ilio-hypogastric nerve

79. The composition of the spermatic cord includes:

1. Deferent duct

2. Arteries, veins and nerves of the vas deferens

3. Testicular artery

4. Venous pampiniform plexus

5. Lymphatic vessels of the testis

6. The muscle that raises the testicle

All of the above educations

80. The superficial inguinal ring is formed by:

1. Transverse fascia

Divergent peduncles of the aponeurosis of the external oblique muscle of the abdomen

Interpeduncular fibers

81. The dimensions of the superficial inguinal ring in men are normally equal to:

82. Deep inguinal ring is:

1. Hole in the transverse fascia

Bulging of the transverse fascia

3. Hole in the aponeurosis of the external oblique muscle of the abdomen

4. Hole in the transverse abdominis muscle

83. Inguinal hernias are most often:

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 a control group, 8 people, defined as "practically healthy", were studied. Experimental group - having pathology: inguinal (7), umbilical (5) and postoperative ventral hernias (8).

Histological examination of the material was carried out on paraffin sections stained with hematoxylin and eosin, Sudan and Mallory. The material was obtained from autopsies within

24 hours after death. For scanning electron microscopy (SEM), standard pieces (0.3 * 0.3 cm) of the 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.

■* " * V) /*>

Fri \ " V L. / " * / - * ■

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 comprehensive light-optical and ultrastructural study of the aponeurosis of the PBS in the “weak spots” of the abdomen in “practically healthy” individuals showed that the connective tissue framework consists of cells and intercellular substance similar in architectonics, structure, density of arrangement with unchanged connective tissue. Between the collagen bundles there are free spaces filled with loose connective tissue with blood vessels and nerve fibers. The compact arrangement of cells and intercellular substance prevents the exit of internal organs through the “weak spots” of the anterior abdominal wall in “healthy” patients with an increase in intra-abdominal pressure and can resist the formation of a hernia, which is consistent with clinical observations.

The results of a morphological study of muscle sections and aponeurosis taken during operations for hernias of the anterior abdominal wall showed that necrobiosis of muscle fibers occurs and scar fibrous connective tissue 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.

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THE STRUCTURE OF APONEEUROSIS THE ANTERIOR ABDOMINAL WALL RIGHTS IN NORM AND PATHOLOGY

Vladivostok State Medical University

By light and electron microscopy organometric and morphological studying the structure of anterior abdominal wall aponeurosis in patients aged 21 to 50 years was carried out. The control group was "practically healthy patients". The experimental group of patients with inguinal, umbilical and postoperative ventral hernias. The change of the architectonics of aponeurosis was revealed in patients with hernias, as well as the decrease of its trophic function at the expense of microcirculation reducing, which cause atrophy and destructive changes in connective tissue.

Key words: aponeurosis, hernia, electronic microscopy.

UDC 616.8-018+629.73]:616-001.28/.29

NEUROMORPHOLOGICAL CORRELATES OF THE PSYCHONEUROLOGICAL STATUS OF AVIATION SPECIALISTS AFTER THE PERFORMANCE OF WORK IN A RADIOACTIVELY CONTAMINATED TERRITORY

O.P. GUNDAROVA*

Retrospective analysis of the health status of pilots