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Health & Medicine |
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Theme: «Lumbar triangle(Petit’s
triangle) and it’s anatomical
characteristics»
Done By: Myrzakhanov Yerik
4course GMF 451 group
Check By: Aldyngurov Daulet
Kadirovich
Semey 2014
Plan: Introduction. Jean Louis Petit
Petit triangle, boundaries
Lumbar hernia, Treatment
Surgical significance
List of references
Introduction
Jean-Louis Petit (13 March 1674 – 20 April 1750)
was a French surgeon. He was first enthusiastic
about anatomy, received a master's certificate in
surgery in Paris in 1700. He became a member of the
French Royal Academy of Sciences, and was named
director of the French Royal Academy of Surgery by
the king when it was created. Offered ways of hernia
repair, enterography, amputations; invented a variety
of tools and devices (such as a tourniquet, the unit for
the treatment of foot deformities).
Introduction
His name is associated the name of the lumbar triangle (trigonum lumbale Petiti). Also wrote about the injuries of the skull, the treatment of cleft lip, gallstones, and many other issues in surgery.
Known for his work on the Achilles tendon rupture, dislocation of the jaw, he first described about osteomalation. Just the first to describe the relaxation of the diaphragm , implying that the notion of complete relaxation domes and its high standing.
Boundaries (borders) of
lumbar triangle The triangle of Petit
(trigonum lumbale, PNA, BNA, JNA; syn .: Petit triangle lumbar triangle) – site of the posterior abdominal wall. Bounded above and medial with tendon node latissimus dorsi, and laterally and left back edge of the external oblique muscle of the abdomen, extending from theXII rib, below with the iliac crest, the bottom is the internal oblique and transverse abdominal muscles.
The initial division of the latissimus dorsi muscle
(as well as the site of attachment of the external
oblique abdominal muscles to iliac crest) is divide
to individual differences, so the shape of the
lumbar triangle changeable. It resembles a narrow
hole between the edges of forming his latissimus
dorsi and external oblique abdominal muscles.
According by P. F. Lesgaft, lumbar triangle is
found only in 75% of people.
The bottom of the triangle is the internal
oblique muscle, covered by fascia, weakness
which may cause the appearance of lumbar
hernia.
Lumbar hernia
Lumbar hernia(h. Lumbalis) - hernial protrusion on the back and side walls of the abdomen in the lumbar region. They are congenital and acquired (traumatic, muscle atrophy and etc.).
Place their output is lower and upper lumbar triangles between the XII rib and the iliac crest to the lateral edge of the latissimus dorsi muscle (m. Latissimus dorsi), as well as defects in the aponeurosis without specific localization due to rupture or inflammation.
Hernial ring at the lower lumbar hernia are
within the lower lumbar triangle (Petit).
Hernial ring at the upper lumbar hernia are
within the upper lumbar triangle (Grynfeltt-
Lesshaft)*. The base of the triangle, the apex
facing down is the transversus abdominis, the
outside is covered with a broad back muscles.
*
The superior lumbar (Grynfeltt-Lesshaft)
triangle is formed medially by the quadratus
lumborum muscle, laterally by the internal
abdominal oblique muscle, and superiorly by
the 12th rib. The floor of the superior lumbar
triangle is the transversalis fascia and its roof
is the external abdominal oblique muscle.
The mostly, the contents of a typical lumbar
hernia is small intestine, while sliding hernia -
ascending or descending colon. Often lumbar
hernia have no hernia sac, and through the
hernial ring out retroperitoneal fat, sometimes
kidney. In this case, the hernia will be false.
Treatment
Surgical - resection of the hernial sac, closure
of hernial ring, the reconstruction of the
transversal abdominal muscles. When lumbar
hernia with large hernial ring used to close the
defect synthetic materials or muscle flaps.
Surgical significances of triangle
of Petit
At peritonitis abdominal establish drainage through lumbar triangles of Petit by a cross-section of the skin, subcutaneous tissue, superficial fascia and private over the iliac crest at the intersection, with its posterior axillary line, with a further dislocation of internal oblique abdominal muscles in the course of its fibers and introduce of all drainages on the parietal peritoneum posterior wall of the abdominal cavity in the mesenteric sinuses under the root of the mesentery of the transverse colon.
Surgical significances of triangle
of Petit
Symptom Joure-Rozanov - pain when finger
pressure in the triangle of Petit. Used in the
diagnosis of acute appendicitis. In that case
peritoneum in this department is relatively
superficial.
Surgical significances of triangle
of Petit
At retrocecal appendicitis in this area can be
detected positive symptom Gabai – the sharp
increases of pain when palpated quickly
remove your hands after pressing, as the
symptoms of Shchetkina - Blumberg.
Surgical significances of triangle
of Petit
Extraperitoneal laparoscopic approach to
the adrenal glands.
In the angle between the rib XII and
sacrospinous muscle (m. Sacrospinalis) (the
so-called triangle of Petit) performed a cut
length of 15 mm. In this incision the surgeon
can accurately enter your finger to create
access to the retroperitoneal paranephral
space.
List of references: Анатомия человека: В 2 томах / Под ред.
М.Р.Сапина. – М.: Медицина, 1997.- Т.1.- 544 с.
http://en.wikipedia.org/wiki/Jean_Louis_Petit
http://en.wikipedia.org/wiki/Lumbar_triangle
Aguirre DA, Santosa AC, Casola G et-al. Abdominal wall hernias: imaging features, complications, and diagnostic pitfalls at multi-detector row CT. Radiographics. 2005;25 (6): 1501-20.
MILLARD DG. A Richter's hernia through the inferior lumbar triangle of petit. A radiographic demonstration. Br J Radiol. 1959;32 (382): 693-5
Большаков О.П., Семенов Г.М. Лекции по оперативной хирургии и клинической анатомии. –СПб.: Питер, 2000. – 480 с.