WordNet

of or relating to or near the part of the back between the ribs and the hipbones; "lumbar vertebrae"
a network of intersecting blood vessels or intersecting nerves or intersecting lymph vessels (同)rete

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腰の,腰部の
(神経・血管などの)網状組織

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/09/06 11:04:21」(JST)

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The lumbar plexus is a nervous plexus in the lumbar region of the body which forms part of the lumbosacral plexus. It is formed by the divisions of the first four lumbar nerves (L1-L4) and from contributions of the subcostal nerve (T12), which is the last thoracic nerve. Additionally, the ventral rami of the fourth lumbar nerve pass communicating branches, the lumbosacral trunk, to the sacral plexus. The nerves of the lumbar plexus pass in front of the hip joint and mainly support the anterior part of the thigh.^[1]

The plexus is formed lateral to the intervertebral foramina and passes through psoas major. Its smaller motor branches are distributed directly to psoas major, while the larger branches leave the muscle at various sites to run obliquely downward through the pelvic area to leave the pelvis under the inguinal ligament, with the exception of the obturator nerve which exits the pelvis through the obturator foramen.^[1]

Branches[edit source | edit]

The iliohypogastric nerve^[2] runs anterior to the psoas major on its proximal lateral border to run laterally and obliquely on the anterior side of quadratus lumborum. Lateral to this muscle, it pierces the transversus abdominis to run above the iliac crest between that muscle and abdominal internal oblique. It gives off several motor branches to these muscles and a sensory branch to the skin of the lateral hip. Its terminal branch then runs parallel to the inguinal ligament to exit the aponeurosis of the abdominal external oblique above the external inguinal ring where it supplies the skin above the inguinal ligament (i.e. the hypogastric region) with the anterior cutaneous branch. ^[3]

The ilioinguinal nerve closely follows the iliohypogastric nerve on the quadratus lumborum, but then passes below it to run at the level of the iliac crest. It pierces the lateral abdominal wall and runs medially at the level of the inguinal ligament where it supplies motor branches to both transversus abdominis and sensory branches through the external inguinal ring to the skin over the pubic symphysis and the lateral aspect of the labia majora or scrotum. ^[3]

The genitofemoral nerve pierces psoas major anteriorly below the former two nerves to immediately split into two branches that run downward on the anterior side of the muscle. The lateral femoral branch is purely sensory. It pierces the vascular lacuna near the saphenous hiatus and supplies the skin below the inguinal ligament (i.e. proximal, lateral aspect of femoral triangle). The genital branch differs in males and females. In males it runs in the spermatic cord and in females in the inguinal canal together with the teres uteri ligament. It then sends sensory branches to the scrotal skin in males and the labia majora in females. In males it supplies motor innervation to the cremaster. ^[3]

The lateral cutaneous femoral nerve pierces psoas major on its lateral side and runs obliquely downward below the iliac fascia. Medial to the anterior superior iliac spine it leaves the pelvic area through the lateral muscular lacuna. In the thigh it briefly passes under the fascia lata before it breaches the fascia and supplies the skin of the anterior thigh. ^[3]

The obturator nerve leaves the lumbar plexus and descends behind psoas major on it medial side, then follows the linea terminalis into the lesser pelvis, and finally leaves the pelvic area through the obturator canal. In the thigh, it sends motor branches to obturator externus before dividing into an anterior and a posterior branch, both of which continues distally. These branches are separated by adductor brevis and supply all thigh adductors with motor innervation: pectineus, adductor longus, adductor brevis, adductor magnus, adductor minimus, and gracilis. The anterior branch contributes a terminal, sensory branch which passes along the anterior border of gracilis and supplies the skin on the medial, distal part of the thigh. ^[4]

The femoral nerve is the largest and longest of the plexus' nerves. It gives motor innervation to iliopsoas, pectineus, sartorius, and quadriceps femoris; and sensory innervation to the anterior thigh, posterior lower leg, and hindfoot. In the pelvic area, it runs in a groove between psoas major and iliacus giving off branches to both muscles, and exits the pelvis through the medial aspect of muscular lacuna. In the thigh it divides into numerous sensory and muscular branches and the saphenous nerve, its long sensory terminal branch which continues down to the foot. ^[4]

Nerves of the lumbar plexus^[3]
Nerve	Segment	Innervated muscles	Cutaneous branches
Iliohypogastric	T12-L1	• Transversus abdominis • Abdominal internal oblique	• Anterior cutaneous ramus • Lateral cutaneous ramus
Ilioinguinal	L1	• Transversus abdominis • Abdominal internal oblique	• Anterior scrotal nerves in males • Anterior labial nerves in females
Genitofemoral	L1, L2	• Cremaster in males	• Femoral ramus • Genital ramus
Lateral femoral cutaneous	L2, L3		• Lateral femoral cutaneous
Obturator	L2-L4	• Obturator externus • Adductor longus • Adductor brevis • Gracilis • Pectineus • Adductor magnus	• Cutaneous ramus
Femoral	L2-L4	• Iliopsoas • Pectineus • Sartorius • Quadriceps femoris	• Anterior cutaneous branches • Saphenous
Short, direct muscular branches	T12-L4	• Psoas major • Quadratus lumborum • Iliacus • Lumbar intertransverse

Similar to lumbar plexus there is brachial plexus in upper limb.

Additional images[edit source | edit]

The right sympathetic chain and its connections with the thoracic, abdominal, and pelvic plexuses.
Lumbar plexus after dissection
Lumbar plexus after dissection
Schematic diagram of the lumbar plexus

Notes[edit source | edit]

^ ^a ^b Thieme Atlas of anatomy (2006), pp 470-471
^ For etymology see ilium and hypogastrium.
^ ^a ^b ^c ^d ^e Thieme Atlas of anatomy (2006), pp 472-473
^ ^a ^b Thieme Atlas of anatomy (2006), pp 474-475

References[edit source | edit]

Thieme Atlas of Anatomy: General Anatomy and Musculoskeletal System. Thieme. 2006. ISBN 1-58890-419-9.

External links[edit source | edit]

Wikimedia Commons has media related to: Lumbar plexus

Duke Orthopedics lumbar_plexus

UpToDate Contents

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1. 腰仙部神経叢症候群 lumbosacral plexus syndromes
2. 末梢神経ブロック：手技 peripheral nerve block techniques
3. Lower extremity nerve blocks: Techniques

English Journal

Grafted murine induced pluripotent stem cells prevent death of injured rat motoneurons otherwise destined to die.

Pajer K1, Nemes C2, Berzsenyi S2, Kovács KA2, Pirity MK2, Pajenda G3, Nógrádi A4, Dinnyés A5.
Experimental neurology.Exp Neurol.2015 Jul;269:188-201. doi: 10.1016/j.expneurol.2015.03.031. Epub 2015 Apr 16.
Human plexus injuries often include the avulsion of one or more ventral roots, resulting in debilitating conditions. In this study the effects of undifferentiated murine iPSCs on damaged motoneurons were investigated following avulsion of the lumbar 4 (L4) ventral root, an injury known to induce the
PMID 25889458

Tumefactive appearance of peripheral nerve involvement in hematologic malignancies: a new imaging association.

Capek S1, Hébert-Blouin MN, Puffer RC, Martinoli C, Frick MA, Amrami KK, Spinner RJ.
Skeletal radiology.Skeletal Radiol.2015 Jul;44(7):1001-9. doi: 10.1007/s00256-015-2151-3. Epub 2015 Apr 29.
OBJECTIVE: In neurolymphomatosis (NL), the affected nerves are typically described to be enlarged and hyperintense on T2W MR sequences and to avidly enhance on gadolinium-enhanced T1WI. This pattern is highly non-specific. We recently became aware of a "tumefactive pattern" of NL, neuroleukemiosis (
PMID 25920386

Dose delivered to the lumbosacral plexus from high-dose-rate brachytherapy for cervical cancer.

Rash D1, Durbin-Johnson B, Lim J, Dieterich S, Huddleston A, Yi S, Mayadev J.
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society.Int J Gynecol Cancer.2015 Jun;25(5):897-902. doi: 10.1097/IGC.0000000000000427.
OBJECTIVE: To calculate dose delivered to the lumbosacral plexus (LSP) with cervical brachytherapy using 3-dimensional imaging, and to compare this with the position of the tandem in the pelvis using bony landmarks. We also report long-term LSP toxicity outcomes.METHODS AND MATERIALS: Treatment plan
PMID 25768077

Japanese Journal

タペンタドールと腰神経叢ブロックにより除痛が得られた悪性腸腰筋症候群の1例

佐藤哲観,伊藤磨矢,浅利三和子,島田恵子
Palliative Care Research 10(1), 510-514, 2015
【緒言】悪性腸腰筋症候群（以下，MPS）は，悪性腫瘍によって腰神経叢が障害されて生じる腰下肢の痛み，知覚障害，脱力によって特徴づけられ，典型的な神経障害性疼痛を伴い，痛みの緩和に難渋する場合も少なくない．【症例】患者は67歳の女性．左側傍腰椎の悪性リンパ腫により左MPSを生じた．オキシコドンからタペンタドールへのオピオイドスイッチと鎮痛補助薬による薬物療法と腰神経叢ブロックを行って良好な除痛効果を …
NAID 130004943683

超音波ガイド下神経ブロック (2)下肢の神経ブロックの実際I（腰神経叢ブロック，大腿神経ブロック，閉鎖神経ブロック，腸骨筋膜下ブロック）

佐藤裕
日本臨床麻酔学会誌 33(4), 598-605, 2013
本稿で取り上げる神経ブロックは，腰神経叢の主要分枝をブロックすることで下肢の手術麻酔および術後鎮痛，ペインクリニックに頻用される代表的なものである．まず腰神経叢の解剖を概説し，次いで各神経ブロックの手技のポイントを述べる．
NAID 130004450165

術後逆行性射精をきたした後腹膜傍神経節腫の１例

上小鶴弘孝,大木岳志,須佐真由子,金子由香,山本雅一,木村伯子
日本外科系連合学会誌 37(4), 876-881, 2012
40歳，男性，健康診断の腹部超音波検査で左側腹部腫瘤を指摘され，当科紹介受診となった．血液生化学所見ではノルアドレナリンの軽度上昇のみであり，腹部CTで左側腹部に径８cmの辺縁が強く造影される腫瘤を認め，腹部MRIではT2強調画像で高信号，PET-CTで同腫瘤のみに集積を認めた．以上より後腹膜原発の悪性腫瘍と診断し摘出術を施行した．摘出には下腸間膜動脈根部での結紮を要したが，腸管切除は必要としなか …
NAID 130004838633

Related Pictures

★リンクテーブル★

リンク元	「腰神経叢」「sacral plexus」
関連記事	「lumbar」「plexus」「plexuses」

「腰神経叢」

Nerve: Lumbar plexus
	Plan of lumbar plexus.
	The lumbar plexus and its branches.
Latin	plexus lumbalis
Gray's	subject #212 949
From	T12, L1-L4
MeSH	Lumbosacral+Plexus

　　[★]

英: lumbar plexus
ラ: plexus lumbalis
関: 腰仙骨神経幹、仙骨神経叢

腰神経叢

	T12	L1	L2	L3	L4	走行(M.181)	機能（Ｍ.181)
肋下神経	○					外側弓状靱帯の後方を通って腹部に入り、外下方に走り、腰方形筋の前面を横切る。腹横筋と内腹斜筋を通り抜けて外腹斜筋と腹壁前外側面の皮膚に分布	外腹斜筋と腹壁前外側面の皮膚を支配
腸骨下腹神経	○	○				内側弓状靱帯の後方で腹部に入り、下外方に走って腰方形筋の前面を通る。腹壁の筋を上腸骨棘の近くで貫き、内腹斜筋と外腹斜筋を貫いて恥骨上部に分布	恥骨上部
腸骨鼡径神経		○	○			内側弓状靱帯の後方で腹部に入り、下外方に走って腰方形筋の前面を通る。腹壁の筋を上腸骨棘の近くで貫き、内腹斜筋と外腹斜筋を貫いて鼡径領域に分布	鼡径領域
陰部大腿神経		○	○			大腰筋の前面を貫き、下方に走り、腰筋筋膜の深層に潜る。総・外腸骨動脈の外側で分岐し大腿枝と陰部枝に分岐する
外側大腿皮神経			○	○		腸骨筋の表面を下外方に走り、鼡径靱帯の深層かつ上前腸骨棘のすぐ内側で大腿に入る	代替の前外側面の皮膚
大腿神経			○	○	○
閉鎖神経			○	○	○	大腰筋の内側縁に沿って下行。閉鎖孔の閉鎖管を抜ける。前枝と後枝に分かれる。	筋枝(外閉鎖筋、長内転筋、短内転筋、大内転筋、恥骨筋、薄筋)皮枝(閉鎖神経皮枝)