1、Lower limb,山东大学医学院 解剖教研室 李振华,Contents,Anterior and Medial Region of Thigh 股前内侧区 Anterior and Lateral Crural Region 小腿前外侧区 Gluteal Region 臀区 Back of Thigh 股后区 Back of Leg 小腿后区,Parts and regions of the lower limb,Gluteal region 臀区between iliac crest superiorly and gluteal fold inferiorly Thigh 股betwee
2、n hip and knee Knee 膝joint between leg and thigh Leg 小腿between knee and foot Ankle 踝 Foot 足,Surface anatomy of lower limb,Landmarks of lower limb Gluteal region and thigh anterior superior iliac spines髂前上棘 anterior inferior iliac spines 髂前下棘 tubercle of iliac crest 髂结节 ischial tuberosity 坐骨结节 greate
3、r trochanter 大转子 pubic tubercle 耻骨结节 pubic crest 耻骨嵴 superior border of pubic symphysis 耻骨联合上缘 Knee patella ligament 髌韧带 tuberosity of tibia 胫骨粗隆 medial and lateral condyles 内(外)侧髁 medial and lateral epicondyles 内(外)上髁,tendon of biceps femoris 股二头肌腱 tendons of semitendinosus and semimembranosus 半腱(半
4、膜)肌腱 Leg anterior border of tibia 胫骨前缘 head of fibula 腓骨头 neck of fibula 腓骨颈 Ankle and foot medial and lateral malleolus 内(外)侧踝 calcaneal tuberosity 跟骨结节 tuberosity of navicular bone 舟骨粗隆 tuberosity of fifth metatarsal bone 第五跖骨粗隆,Surface anatomy of lower limb,Nelatons line A line drawn from the ant
5、erior superior lilac spine to the ischial tuberosity, passing over or near the top of the greater trochanter The trochanter can be felt superior to this line in a person which a dislocated hip or a fractured femoral neck,Surface anatomy of lower limb,Kaplan point,Surface anatomy of lower limb,Coxa v
6、ara 髋内翻 (abnormally decreased angle of inclination, it occurs in fractures of the neck of the femur and slipping of the femoral epiphysis ),Coxa valga 髋外翻(abnormally increased angle of inclination, in cases of congenital dislocation of the hip),颈干角Normal angle of inclination 1250-1300,Normal alignme
7、nt,Genu varum (bowleg) 膝内翻,Genu valgum 膝外翻,1700,1700,1700,Surface projections,Superior gluteal a., v. ,n.臀上动、静脉和神经 Inferior gluteal a., v. ,n.臀下动、静脉和神经,Surface projections,Sciatic nerve 坐骨神经,Surface projections,Femoral a. 股动脉 Popliteal a. 腘动脉 Anterior tibial a. 胫前动脉 Posterior tibial a. 胫后动脉 Dorsal a
8、. of food 足背动脉,Anterior and Medial Region of Thigh 股前内侧区,Superficial structures,Great saphenous vein 大隐静脉 Drains the medial end of dorsal venous arch of foot Passes upward directly in front of the medial malleolus. Then ascends on medial side of the leg. Passes behind the knee and curves forward aro
9、und the medial side of the thigh. Passes through the saphenous hiatus in the deep fascia and joins the femoral vein about 4 cm below and lateral to the pubic tubercle.,Superficial structures,Tributaries: Superficial lateral femoral v. 股外侧浅静脉 Superficial medial femoral v. 股内侧浅静脉 External pudendal v.
10、阴部外静脉 Superficial epigastric v. 腹壁浅静脉 Superficial iliac circumflex v. 旋髂浅静脉,Superficial lateral femoral v.,Superficial medial femoral v.,Varicose veins,Superficial structures,Superficial arteries: superficial epigastric a. 腹壁浅动脉 superficial iliac circumflex a. 旋髂浅动脉 external pudendal a. 阴部外动脉 Cutane
11、ous nerves: lateral femoral cutaneous n. 股外侧皮神经 anterior cutaneous branches of femoral n. 股前皮神经 medial cutaneous branches of femoral n. 股内侧皮神经 cutaneous branches of obturator n. 闭孔神经皮支,lateral femoral cutaneous n.,anterior and medial cutaneous branches of femoral n.,Cutaneous branches of obturator n
12、.,Superficial structures,Superficial inguinal lymph nodes 腹股沟浅淋巴结 Superior group: Lies just distal to the inguinal ligament Receive lymph vessels from anterior abdominal wall below umbilicus, gluteal region, perineal region, external genital organs Inferior group: Lies vertical along the terminal gr
13、eat saphenous v. Receives all superficial lymph vessels of lower limb, except for those from the posterolateral part of calf Efferent vessels drain into the deep inguinal ln. or external iliac ln.,Deep fascia of the thigh,Fascia lata 阔筋膜 The deep fascia encloses the thigh like a trouser leg. Sapheno
14、us hiatus 隐静脉裂孔 A gap in the deep fasica which lies about 4 cm below and lateral to the pubic tubercle. The falciform margin 镰状缘 is the lower lateral border of the opening, which lies anterior to the femoral vessels. Filled with loose connective tissue called the cribriform fascia 筛筋膜,Deep fascia of
15、 the thigh,Fascia lata 阔筋膜 Iliotibial tract 髂胫束 laterally the deep fascia forms a thick band from the iliac tubercle to the lateral condyle of tibial The fascia lata sends intermuscular septa to the linea aspera of the femur. These separate the thigh into three compartments each of which contains a
16、group of muscles, the vessels and the nerves,Contents of anterior compartments of thigh,Iliopsoas髂腰肌,Iliacus 髂肌,Psoas majo腰大肌,Sartorius 缝匠肌,Quadriceps femoris 股四头肌,Vastusintermedius 股中间肌,Vastus lateralis 股外侧肌,Rectus femoris 股直肌,Vastus medialis 股内侧肌,Contents of anterior compartments of thigh,Pectineu
17、s 耻骨肌,Adductor longus 长收肌,Adductor brevis 短收肌,Adductor magnus 大收肌,Gracilis 股薄肌,Adductor tendinous opening 收肌腱裂孔,Lacuna musculorum 肌腔隙,Boundaries: Anteriorly: lateral portion of inguinal ligament Posterolaterally: ilium Medially: iliopectinal arch Contents: Iliopsoas 髂腰肌 femoral n.股神经 lateral femoral
18、 cutaneous n. 股外侧皮神经,lateral femoral cutaneous n.,Iliopsoas,iliopectinal arch,femoral n.,Lacuna vasorum 血管腔隙,Boundaries: Anteriorly: medial portion of inguinal ligament Posteriorly: fascia of pecteineus and pectineal ligament Medially: lacunar ligament Laterally: iliopectinal arch Contents: Femoral
19、sheath 股鞘 Femoral a. and v. 股动、静脉 Genital branch of genitofemoral n. 生殖股神经股支 Lymphatic vessels,Femoral triangle 股三角,Position A triangular depressed area Situated in the upper part of the medial aspect of the thigh just below the inguinal ligament Boundaries Superiorly (base) : inguinal ligament 腹股沟韧
20、带 Laterally: medial border of sartorius 缝匠肌内侧缘 Medially: medial border of adductor longus 长收肌内侧缘 Apex: continuous with adductor canal 收肌管 Anterior wall: fascia lata 阔筋膜 Posterior wall: consists of iliopsoas 髂腰肌, pectineus 耻骨肌 and adductor longus 长收肌 from lateral to medial side,Femoral triangle 股三角,C
21、ontents：from medial to lateral Femoral n. 股神经 Femoral sheath 股鞘 Femoral a. 股动脉 Femoral v. 股静脉 Femoral canal 股管 Deep inguinal lymph nodes 腹股沟深淋巴结 Fatty tissue 脂肪组织,Femoral triangle 股三角,Femoral sheath 股鞘 A funnel- shaped sheath Derived from transversalis fascia anteriorly and iliac fascia posteriorly
22、It surroumds the femoral vessels and lymphatic about 2.5cm belower the inguinal ligamemt. Its lower end disappears at the lower margin of the saphenous opening where the sheath fuses with the adventitia of the vessels Divided into three compartments by two fibrous septa,Femoral triangle 股三角,Femoral
23、sheath 股鞘 Contents Lateral compartment: femoral a. 股动脉 Middle compartment: femoral v. 股静脉 Medial compartment: femoral canal 股管,Femoral triangle 股三角,femoral canal 股管 General features About 1.3cm long Contens: a little loose fatty tissue, a small lymph node, and some lymph vessels Femoral ring 股环: upp
24、er opening of femoral canal The boundaries of the femoral ring Anteriorly: inguinal ligament Medially: lacunar lig. 腔隙韧带 Posteriorly: pecteneal lig. 耻骨梳韧带 Laterally: femoral v. 股静脉 Superior: covered by femoral septum 股环隔,Femoral triangle 股三角,Femoral hernia 股疝 If a loop of intestine is forced into th
25、e femoral ring, it expands to form a swelling in the upper part of the thigh. Such a condition is known as a femoral hernia 股疝. A femoral hernia is more common in women than in men (possibly because their wider pelvis and femoral canal ).,Femoral triangle 股三角,Femoral a. 股动脉 Course Continuation of th
26、e external iliac a. Begins midpoint of inguinal ligament Ends at the adductor tendinous opening by entering the popliteal fossa as the popliteal artery Principal branchdeep femeral a. 股深动脉 arises from the posterolateral surface of the femoral artery about 5 cm below the inguinal ligament. Medial fem
27、oral circumflex 旋股内侧动脉 lateral femoral circumflex 旋股外侧动脉 Four perforating arteries 穿动脉,Femoral triangle 股三角,Profunda femoris 股深动脉 Arises from the posterolateral surface of the femoral artery about 5 cm below the inguinal ligament Branches: Lateral circumflex artery 旋股外侧动脉 Medial circumflex artery 旋股
28、内侧动脉 Perforating arteries 穿动脉,deep femeral a.,Lateral circumflex a.,Medial circumflex a.,perforating arteries,Femoral triangle 股三角,Femoral vein 股静脉 Begins at the adductor tendinous opening Continues as external iliac vein deep to inguinal ligament Contains several valves,Femoral triangle 股三角,The dee
29、p inguinal lymph nodes 腹股沟深淋巴结 Lie medial to the femoral v. Receive deep lymphatics of lower limb, perineal region, and efferent lymphatics from the superficial inguinal ln. Drain into the external iliac ln.,Femoral triangle 股三角,Femoral nerve 股神经 Arises from the lumbar plexus in the abdomen, and ent
30、ers the thigh posterior to the inguinal ligament and lateral to the femoral artery. It ends by dividing into a number of branches 2 cm below the inguinal ligament.,Femoral triangle 股三角,Femoral nerve 股神经 Branches Muscular branche to: pectineus, sartorius, quadriceps femoris Cutaneous branches Sapheno
31、us nerve 隐神经 Is the longest branch of the femoral nerve It accompanies the femoral vessels in the adductor canal, then accompanies the great saphenous vein to the medial side of the leg and food,Saphenous nerve,Adductor canal 收肌管,Position An intermuscular cleft situated on the medial aspect of the m
32、iddle third of the thigh beneath the sartorius. Extends from apex of femoral triangle to adductor tendinous opening Boundaries Anterior wall: adductor lamina大收肌腱板 and sartorius 缝匠肌 Lateral wall : vastus medialis 股内侧肌 Posteomedial wall: adductor longus 长收肌 and adductor magmus 大收肌 Contents Saphenous n
33、. 隐神经 Femoral a. and femoral v. 股动、静脉 lymphatic vessels and loose connective tissue,Blood vessels and nerves of medial side of thigh,Obturator a. 闭孔动脉 Arises from internal iliac artery in the lesser pelvis passes through the obturator canal where it divides into anterior and posterior branches Obtur
34、ator n. 闭孔神经 Arises from the lumbar plexus in the abdomen. Enters the thigh through the obturator canal where it divides into anterior and posterior branches. Supplies medial group of muscles of thigh, obturator externus, and skin of medial side of thigh,Anterior and Lateral Crural Region 小腿前外侧区,Ant
35、erior crural region 小腿前区,Superficial structures Great saphenous v. 大隐静脉 Drains the medial end of dorsal venous arch of food and passes upward directly in front of the medial malleolus. Then ascends in company with the saphenous n. in the superficial fascia over the medial side of the leg,Anterior cr
36、ural region 小腿前区,Cutaneous nerves Branches of lateral cutaneous n. 腓肠外侧皮神经 Supplies the skin on the upper part of the anterolateral surface of the leg Superficial peroneal n. 腓浅神经 Supplies the skin of the lower part of the anterolateral surface of the leg Saphenous n. 隐神经 Supplies the skin on the an
37、teromedial surface of the leg,Deep fascia 深筋膜,Surrounds the leg and forms two intermuscular septa to be attached to the fibula Divided the leg into three compartments：anterior, lateral and posterioreach of which contains a group of muscles, the vessels and the nerves,Contents of anterior compartment
38、 of leg,Muscles Tibialis anterior 胫骨前肌 Extensor hallucis longus 拇长伸肌 Extensor digitorum longus 趾长伸肌 Peroneus tertius 第三腓骨肌 Blood supply Anterior tibial a. 胫前动脉 Nerve supply Deep peroneal n. 腓深神经,Contents of anterior compartment of leg,Anterior tibial artery 胫前动脉 Beginning: Arises from the popliteai
39、artery at the lower border of popliteus. It passes forwards above the interosseous membrane, and turns downwards on the anterior surface of that membrane with the deep peroneal nerve. Ending: In front of ankle joint becomes the dorsalis pedis a. The anterior tibial veins 胫前静脉 Closely applied to the
40、artery,Contents of anterior compartment of leg,Common peroneal n. 腓总神经 Passes over posterior aspect of head of fibula and then winds around neck of fibula Deep to peroneus longus, where it divides into deep and superficial peroneal nerves Deep peroneal nerve 腓深神经 Arises from the common peroneal nerv
41、e between the neck of the fibula and the peroneus longus muscle Descends in the anterior compartment of the leg with the anterior tibial vessels Supplies all the muscles of the anterior compartment of the leg and extensor digitorum brevis,Contents of lateral compartment of leg,Muscles Peroneus longu
42、s 腓骨长肌 Peroneus brevis 腓骨短肌 Blood supply Branches from the peroneal a. 腓动脉 Nerve supply Superficial peroneal n. 腓浅神经 supplies peroneus longus and brevis and skin on anterior surface of leg and dorsum of foot,Deep peroneal n.,Superficial peroneal n.,Injury to the common peroneal nerve,The common fibu
43、lar nerve may be severed during fracture of the fibula neck or severely stretched when the knee joint is injured of dislocated. Severance of the common fibular n. results in paralysis of all muscles in the anterior and lateral compartments of the leg. The loss of eversion of the foot and dorsiflexio
44、n of the ankle causes foot-drop. The foot drops and the toes drag of the floor when walking. Because it is impossible to make the heel strike the ground first, the patient has a high stepping (steppage”) gait, raising the foot as high as necessary to keep the toes from hitting the ground.,Anterior t
45、alocrural region and dorsum of foot 踝前区和足背,Sperficial structures Dorsal venous arch 足背静脉弓 Lies in the subcutaneous tissue over the heads of the metatarsal bones Drains on the medial side into the great saphenous v. and on the lateral side into the small saphenous v. Superficial peroneal n. 腓浅神经 Supp
46、lies the skin of dorsum of the foot Saphenous n. 隐神经 Supplies the skin on the medial border of foot Deep peroneal n. 腓深神经 Supplies the skin of the adjacent sides of the big and second toes,Anterior talocrural region and dorsum of foot 踝前区和足背,Deep structures Superior extensor retinaculum 伸肌上支持带 Infer
47、ior extensor retinaculum 伸肌下支持带 Dorsal artery of foot足背动脉 Continuations of anterior tibial a. at ankle joint, passes beneath extensor retinavulum Runs with the deep peroneal nerve between the tendons of extensor hallucis longus and extensor digitorum longus Branches Medial and lateral tarsal aa. Arc
48、uate a. First dorsal metatarsal a. Deep branch of plantar a.,Anterior talocrural region and dorsum of foot 踝前区和足背,Deep peroneal n. 腓深神经 Supplies muscles on dorsum of foot Supplies skin of the adjacent sides of the big and second toes,Gluteal Region 臀区,Gluteal region 臀区,Boundaries: Superiorly: iliac
49、crest Inferiorly: fold of buttock Medially: lateral borders of sacrum and coccyx Laterally: a line joining anterior superior iliac spine and great trochanter,Gluteal region 臀区,Superior cluneal n.,Medial cluneal n.,Cutaneous nerves,Muscles of hip 髋肌,Posterior group Gluteus maximus 臀大肌 Gluteus medius 臀中肌 Gluteus minimus 臀小肌 Piriformis 梨状肌 Gemellus superior 上孖肌 Obturator internus 闭孔内肌 Gemellus inferior 下孖肌 Obturator externus 闭孔外肌 Quadratus femoris 股方肌,
