英文原條目：https://en.wikipedia.org/wiki/Pudendal_nerve
中文條目：https://zh.wikipedia.org/wiki/%E9%99%B0%E9%83%A8%E7%A5%9E%E7%B6%93
（本條目來自英文優良條目，純屬個人嘗試，歡迎參與翻譯及校對）
The pudendal nerve is the main nerve of the perineum.[1]:274 It carries sensation from theexternal genitalia of both sexes and the skin around the anus and perineum, as well themotor supply to various pelvic muscles, including the male or female external urethral sphincter and the external anal sphincter. If damaged, most commonly by childbirth, lesions may cause sensory loss or fecal incontinence. The nerve may also be temporarily blocked as part of an anaesthetic procedure.
The pudendal canal is also known by the eponymous term "Alcock’s canal", after Benjamin Alcock, an Irish anatomist who documented the canal in 1836.
陰部神經（pudendal nerve）為會陰部的主要神經[1]:274。在感覺方面，該神經負責傳送男性及女性外陰部、肛門周圍，以及會陰的感覺信息；運動信息方面，則支配了男性及女性的尿道括約肌，和外肛門括約肌。一旦損傷則可能導致排糞失禁，這類損傷常見於分娩後遺症，麻醉也可能造成類似的症狀。
陰部神經會經過閉孔內肌上的陰部管。1836年，愛爾蘭解剖學家班傑明·阿爾科克首次描述陰部管，故該管又稱阿爾科克氏管（Alcock’s canal）。
Image showing the greater sciatic foramen (large foramen), and thelesser sciatic foramen, separated by the sacrospinous ligament. The pudendal nerve exits the pelvis through the greater sciatic foramen, passes over the ligament, and then reenters the pelvis through the lesser sciatic foramen.
圖中可看到{{le|坐骨大孔|Greater sciatic foramen}}及{{le|坐骨小孔|Lesser sciatic foramen}}，兩者以{{le|骶棘韧带|Sacrospinous ligament}}隔開。陰部神經由坐骨大孔離開骨盆，越過韧带，再經由坐骨小孔進入骨盆。
The pudendal nerve is paired, meaning there are two nerves, one on the left and one on the right side of the body. Each is formed as three roots immediately converge above the upper border of the sacrotuberous ligament and the coccygeus muscle.[2] The three roots become two cords when the middle and lower root join to form the lower cord, and these in turn unite to form the pudendal nerve proper just proximal to the sacrospinous ligament.[3] The three roots are derived from the ventral rami of the second, third, and fourth sacral spinal nerves, with the primary contribution coming from the fourth.[2][4]:215[5]:157
陰部神經共有一對，分別在身體的左右側。每一邊的神經都是由三根神經在{{le|骶棘韧带|sacrotuberous ligament}}及{{le|尾骨肌|coccygeus muscle}}的上邊界上方合成一根神經[2]。這三根神經中，中間的及下方的神經合成下方的神经索，因此變成二條神经索，再在骶棘韧带附近聯合成一條陰部神經[3]。這三條神經源自第2, 3, 4對{{le|脊神經|Spinal nerve|骶部脊神經}}的{{le|腹支|Anterior ramus of spinal nerve}}，主要是來自第4對骶部脊神經[2][4]:215[5]:157。
The pudendal nerve passes between the piriformis muscle and coccygeus (ischiococcygeus) muscles and leaves the pelvis through the lower part of the greater sciatic foramen.[2] It crosses over the lateral part of the sacrospinous ligament and reenters the pelvis through the lesser sciatic foramen. After reentering the pelvis, it accompanies the internal pudendal artery andinternal pudendal vein upwards and forwards along the lateral wall of the ischiorectal fossa, being contained in a sheath of the obturator fascia termed the pudendal canal, along with the internal pudendal blood vessels.[6]:8
Inside the pudendal canal, the nerve divides into branches, first giving off the inferior anal nerve, then the perineal nerve, before continuing as the dorsal nerve of the penis (in males) or the dorsal nerve of the clitoris (in females).[6]:34
陰部神經通過{{le|梨狀肌|piriformis muscle}}及{{le|尾骨|coccygeus}}之間的部位，從{{le|坐骨大孔|greater sciatic foramen}}的下方離開骨盆[2]。陰部神經通過骶棘韧带的外側，從{{le|坐骨小孔| lesser sciatic foramen}}再進入骨盆，之後會伴隨著{{le|陰部內動脈|internal pudendal artery}}及{{le||陰部內靜脈|internal pudendal vein}}，沿著{{le|坐骨直腸窩|Ischioanal fossa}}的側壁往上往前，和內動脈和內靜脈包覆在{{le|閉孔肌筋膜| obturator fascia}}的鞘中，稱為{{le|阴部管|pudendal canal}}[6]:8。
陰部神經在陰部管內會分支，先分支為{{le|內直腸神經|inferior anal nerve}}，之後是{{le|會陰神經|perineal nerve}}，最後是男性的{{le|陰莖背神經|dorsal nerve of the penis}}或是女性的{{le|陰蒂的背神經|Dorsal nerve of the clitoris}}[6]:34
Nucleus
The nerve is a major branch of the sacral plexus,[7]:950 with fibers originating in Onuf’s nucleus in the sacral region of the spinal cord.[3]
神經核 (已移動到維基百科)
此神經是{{le|骶叢|Sacral plexus}}的主要分支之一[7]:950，神經纖維起源自[[骶骨]]段[[脊髓]]的{{le|
Onuf神經核|Onuf’s nucleus}}[3]。
Variation
The pudendal nerve may vary in its origins. For example, the pudendal nerve may actually originate off of the sciatic nerve.[8]Consequently, damage to the sciatic nerve can affect the pudendal nerve as well. Sometimes dorsal rami of the first sacral nervecontribute fibers to the pudendal nerve, and even more rarely S5.[3]
變異 (已移動到維基百科)
陰部神經源自的神經位置也可能會變化，例如有些人的陰部神經可能是源自{{le|坐骨神經|Sciatic nerve}}[8]，因此坐骨神經的損傷也會影響陰部神經。有時第1節骶神經的後支也可能發展成為陰部神經，甚至是更少見的第5節骶神經[3]。
The pudendal nerve has both motor and sensory functions. It does not carry parasympathetic fibers, but does carry sympathetic fibers.[9]:1738
陰部神經具有運動及感覺二種機能，陰部神經有交感神經的神經纖維，沒有[[副交感神經]]的纖維[9]:1738。
The pudendal nerve supplies sensation to the penis in males and the clitoris in females, through the branches dorsal nerve of penis anddorsal nerve of clitoris. The posterior scrotum in males and the labia in females are also supplied, via the posterior scrotal nerves(males) or posterior labial nerves (females). The pudendal nerve is one of several nerves supplying sensation to these areas.[11]Branches also supply sensation to the anal canal.[6]:8 By providing sensation to the penis and the clitoris, the pudendal nerve is responsible for the afferent component of penile erection and clitoral erection.[12] :147 It is also responsible for ejaculation.[13]
男性的陰部神經會分出{{le|陰莖背神經|dorsal nerve of penis}}支配[[陰莖]]的感覺，女性則會分出{{le|陰蒂背神經|dorsal nerve of clitoris}}支配[[陰蒂]]感覺[10]:422。男性的[[陰囊]]後側由{{le|陰囊後神經|Posterior scrotal nerves}}支配其感覺，女性對應的{{le|陰唇後神經|Posterior labial nerves}}會支配[[陰唇]]的感覺。這些部位有許多神經傳導其感覺，陰部神經即為其中之一[11]。 陰部神經也傳導{{le|肛管|anal canal}}部位的感覺[6]:8。陰部神經會傳導陰莖及陰蒂的感覺，因此也是在陰莖[[勃起]]及{{le|陰蒂勃起|Clitoral erection}}過程中的传入神经[12]:147。陰部神經也負責[[射精]]相關的功能[13]。
Branches also innervate muscles of the perineum and pelvic floor; namely the bulbospongiosus and ischiocavernosus muscles,[11] thelevator ani muscle (including the Iliococcygeus, pubococcygeus, puborectalis and either pubovaginalis in females or pubourethralis in males),[10]:422[14] the external anal sphincter (via the inferior anal branch),[6]:7 and male or female external urethral sphincter.[10]:424–425
陰部神經的分支也支配[[會陰]]及{{le|骨盆底|Pelvic floor}}的肌肉，例如{{le|球海绵体肌|Bulbospongiosus muscle}}及{{le|坐骨海绵体肌|Ischiocavernosus muscle}}[11]、{{le|提肛肌|Levator ani}}（包括腸骨尾骨肌、{{le|恥骨尾骨肌|Pubococcygeus muscle}}、{{le|耻骨直肠肌|puborectalis}}、女性的恥骨陰道肌或是男性的前列腺提肌）、{{le|外肛門括約肌|External anal sphincter}}（透過下肛門分支）[6]:7、以及{{le|男性尿道外括約肌|External sphincter muscle of male urethra}}或{{le|女性尿道外括約肌|External sphincter muscle of female urethra}}[10]:424-425。
As it functions to innervate the External Urethral Sphincter it is responsible for the tone of the sphincter mediated via acetylcholine release. This means that during periods of increased acetylcholine release the skeletal muscle in the external urethral sphincter contracts, causing urinary retention. Whereas in periods of decreased acetylcholine release the skeletal muscle in the external urethral sphincter relaxes, allowing voiding of the bladder to occur.[15] (Clarification: Unlike the internal sphincter muscle, the external sphincter is made of skeletal muscle, therefore it is under voluntary control of the somatic nervous system.)
麻醉/Anesthesia (已移動到維基百科)
A pudendal nerve block, also known as a saddle nerve block, is a local anesthesia technique used in a obstetric procedure to anesthetize the perineum during labor.[16] In this procedure, an anesthetic agent such as lidocaine is injected through the inner wall of the vaginaabout the pudendal nerve.[17]
{{le|陰部麻醉|Pudendal anesthesia}}也稱為阴部神经阻滞，或鞍神经阻滞，是產科使用的{{le|局部麻醉|Local anesthesia|}}，可在[[分娩]]時麻醉陰部[16]。此麻醉方式會在陰道內壁注射[[利多卡因]]，目的是要影響陰部神經[17]。
損傷 Damage (已移動到維基百科)
The pudendal nerve can be compressed or stretched, resulting in temporary or permanent neuropathy. Irreversible nerve injury may occur when nerves are stretched by 12% or more of their normal length.[6]:655 If the pelvic floor is over-stretched, acutely (e.g. prolonged or difficult childbirth) or chronically (e.g. chronic straining during defecation caused by constipation), the pudendal nerve is vulnerable to stretch-induced neuropathy.[6]:655 Pudendal nerve entrapment, also known as Alcock canal syndrome, is very rare and is associated with professional cycling.[18] Systemic diseases such as diabetes and multiple sclerosis can damage the pudendal nerve via demyelination or other mechanisms.[6]:37 A pelvic tumor (most notably a large sacrococcygeal teratoma), or surgery to remove the tumor, can also cause permanent damage.[19]
Unilateral pudendal nerve neuropathy inconsistently causes fecal incontinence in some, but not others. This is because crossover innervation of the external anal sphincter occurs in some individuals.[6]:34
陰部神經可能會被壓縮或是伸展，造成暫時或是永久的[[神经病_(神经系统疾病)|神經病變]]。若陰部神經拉伸了原來長度的12%，可能會造成不可逆的神經受損[6]:655。若盆腔底急性過度拉伸（例如滯產或是難產）或慢性過度拉伸（因[[便秘]]造成[[排便]]時的慢性拉伸），可能會讓陰部神經出現拉伸造成的神經病變[6]:655。{{le|陰部神經卡壓|Pudendal nerve entrapment}}也稱為Alcock canal syndrome，是非常少見的疾病，多半發生在職業的[[自行车运动|自行車選手]]身上[18]。像[[糖尿病]]及[[多发性硬化症]]等系統性疾病也可能透過{{le|脫髓鞘病|Demyelinating disease}}或是其他機制使陰部神經受損[6]:37。骨盆腔的腫瘤（最著名的是大型的{{le|骶尾部畸胎瘤|Sacrococcygeal teratoma}}）或是去除腫瘤的手術都可能造成神經永久的受損[19]。若單側的陰部神經病變可能會造成[[糞便失禁]]，但也有例外。
影像 Imaging (已移動到維基百科)
The pudendal nerve is difficult to visualize on routine CT or MR imaging, however under CT guidance, a needle may be placed adjacent to the pudendal neurovascular bundle. The ischial spine, an easily identifiable structure on CT, is used as the level of injection. A spinal needle is advanced via the gluteal muscles and advanced within several millimeters of the ischial spine. Contrast (X-ray dye) is then injected, highlighting the nerve in the canal and allowing for confirmation of correct needle placement. The nerve may then be injected with cortisone and local anesthetic to confirm and also treat chronic pain of the external genitalia (known as vulvodynia in females), pelvic and anorectal pain.[20][21]
用一般的[[X射线计算机断层成像|斷層掃描]]或是[[核磁共振成像]]，很難對陰部神經顯像。不過透過斷層掃描的引導，可以將針插到鄰近陰部{{le|神經血管束|Neurovascular bundle}}的部位。{{le|坐骨棘|schial spine}}在斷層掃描時很容易識別，因此會插在此一部位。脊椎針會通過{{le|臀肌|Gluteal muscles}}前進，在坐骨棘上前進幾個毫米。之後會注射X光的顯影劑，讓阴部管內的神經更加清楚，也可以確認針插入的位置是否正確。然後會注射[[可的松]]到神經中，進行局部麻醉進行確認，也治療外陰部的慢性疼痛（女性稱為[[外阴疼痛]]）、骨盆疼痛和肛門直腸疼痛等[20][21]。
神經傳導潛伏期試驗 Nerve latency testing (已移動到維基百科)
The time taken for a muscle supplied by the pudendal nerve to contract in response to an electrical stimulus applied to the sensory and motor fibers can be quantified. Increased conduction time (terminal motor latency) signifies damage to the nerve.[22]:46 2 stimulating electrodes and 2 measuring electrodes are mounted on the examiner’s gloved finger ("St Mark’s electrode").[22]:46
陰部神經的延遲時間可以量化，具體的定義是從在感覺神經給電剌激的時間起，到運動神經有訊號使陰部肌肉收縮的時間，時間太長代表神經受損[22]:46。測試時會有兩個固定在手指端的刺激電極及兩個量測電極（St Mark電極）[22]:46。
The term pudendal comes from Latin pudenda, meaning external genitals, derived from pudendum, meaning "parts to be ashamed of".[23]The pudendal canal is also known by the eponymous term "Alcock’s canal", after Benjamin Alcock, an Irish anatomist who documented the canal in 1836. Alcock documented the existence of the canal and pudendal nerve in a contribution about iliac arteries in Robert Bentley Todd’s "The Cyclopaedia of Anatomy and Physiology".[24]
陰部神經的英文為「pudendal nerve」。「Pudendal」一詞來自[[拉丁文]]的「’’{{lang|la|pudenda}}’’」，意即「外陰部」，該詞是源自「pudendum」，意思是「帶來羞恥的部份」[23]。{{le|陰部管|pudendal canal}}也稱為阿尔科克氏管，得名自1836年首次紀錄此一部位的愛爾蘭解剖學家{{le|班傑明·阿爾科克|Benjamin Alcock}}。阿爾科克在{{le|羅伯特·本特利·托德|Robert Bentley Todd}}的’’The Cyclopaedia of Anatomy and Physiology" 一書中，在提及{{le|髂動脈群|Iliac artery}}時首次提及陰部神經及陰部管[24]。