Presentation on theme: "Regional anatomy of the lower limb"— Presentation transcript:
1Regional anatomy of the lower limb 山东大学医学院 解剖教研室李振华
2Parts and regions of the lower limb Gluteal region－between iliac crest superiorly and gluteal fold inferiorlyThigh－between hip and kneeknee－joint between leg and thighLeg－between knee and footAnkleFoot
3Surface anatomy of lower limb Leganterior border of tibianeck of fibulaAnkle and footmedial and lateral malleoluscalcaneal tuberositytuberosity of navicular bonetuberosity of fifth metatarsal boneGluteal region and thighanterior superior and inferior iliac spinestubercle of iliac crestischial tuberositygreater trochanterpubic tuberclepubic crestsuperior border of pubic symphysisKneepatella ligamenttuberosity of tibiamedial and lateral condyles and epicondylestendon of biceps femoristendons of semitendinosus and semimembranosushead of fibula
4Nelaton’s linea line drawn from the anterior 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.
6Normal angleof inclinationCoxa valga 髋外翻(abnormally increased angle of inclination, in cases of congenital dislocation of the hip)Coxa vara 髋内翻(abnormally decreased angle of inclination, it occurs in fractures of the neck of the femur and slipping of the femoral epiphysis )颈干角
9Skin incisionsMake the skin incisions indicated in figure and reflect the skin flaps.
10Superficial structures Great saphenous vein 大隐静脉Drains the medial end of dorsal venous arch of footPasses upward directly in front of the medial malleolus.Then ascends on medial side of the leg.Passes behind the knee and curves forward around 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.
11Superficial 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. 阴部外静脉Superficial epigastric v. 腹壁浅静脉Superficial iliac circumflex v. 旋髂浅静脉
12Superficial epigastric v. Superficial circumflex iliac v.External pudendal v.Superficial lateral femoral v.Superficial medial femoral v.Great saphenous v.
14Superficial structures Superficial fasciaSuperficial arteries:superficial epigastric a.superficial iliac circumflex a.external pudendal a.Cutaneous nerves:lateral femoral cutaneous n.anterior and medial cutaneous branches of femoral n.cutaneous branches of obturator n.
15lateral femoral cutaneous n. anterior and medial cutaneous branches of femoral n.Cutaneous branches of obturator n.
16Superficial structures Superficial inguinal lymph nodes 腹股沟浅淋巴结Superior group:Lies just distal to the inguinal ligamentReceive lymph vessels from anterior abdominal wall below umbilicus, gluteal region, perineal region, external genital organsInferior group:Lies vertical along the terminal great saphenous v.Receives all superficial lymph vessels of lower limb, except for those from the posterolateral part of calfEfferent vessels drain into the deep inguinal ln. or external iliac ln.
17Deep fascia of the thigh Fascia lata 阔筋膜 The deep fascia encloses the thigh like a trouser leg.Saphenous 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
18Deep fascia of the thigh 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 group of muscles, the vessels and the nerves.
19Contents of the anterior fascial compartments of the thigh Psoas majo腰大肌Iliopsoas髂腰肌Iliacus 髂肌Sartorius 缝匠肌Vastus lateralis 股外侧肌Quadriceps femoris股四头肌Rectus femoris 股直肌Vastusintermedius 股中间肌Vastus medialis 股内侧肌
20Contents of the medial fascial compartments of the thigh Pectineus 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
22Lacuna vasorum 血管腔隙 Boundaries: Contents: Anteriorly: medial portion of inguinal ligamentPosteriorly: fascia of pecteineus and pectineal ligamentMedially: lacunar ligamentLaterally: iliopectinal archContents:Femoral sheathFemoral a. and v.Genital branch of genitofemoral n.Lymphatic vesselsFemoral a.Femoral v.Femoral ring
23Femoral triangle 股三角 Boundaries A triangular depressed area situated in the upper part of the medial aspect of the thigh just below the inguinal ligamentBoundariesSuperiorly (base) : the inguinal ligamentLaterally: medial border of sartoriusMedially: medial border of adductor longusApex: continuous with adductor canalAnterior wall: fascia lataPosterior wall: consists of iliopsoas, pectineus and adductor longus from lateral to medial side
24Femoral triangle 股三角 Contents Femoral n. Femoral sheath Femoral a. and its branchesFemoral vein and its tributaries.Femoral canalDeep inguinal lymph nodesFatty tissue
25Femoral triangle 股三角 Femoral sheath 股鞘 A funnel- shaped sheath Derived from transversalis fascia anteriorly and iliac fascia posteriorlyIt 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.
26Femoral sheath 股鞘 Femoral sheath 股鞘 Lateral compartment: femoral a. Divided into three compartments by two fibrous septaLateral compartment: femoral a.Middle compartment: femoral v.Medial compartment: femoral canal 股管
27The femoral canal 股管About 1.3cm long , and its upper opening is called the femoral ring 股环Contains: a little loose fatty tissue, a small lymph node, and some lymph vessels.The boundaries of the femoral ringAnteriorly: the inguinal ligamentMedially: the lacunar ligament 腔隙韧带Posteriorly: the pecten of pubisLaterally: the femoral veinSuperior: covered by femoral septum 股环隔
28Femoral hernia股疝If a loop of intestine is forced into the 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 ).
29Femoral artery 股动脉 Femoral a. 股动脉 Continuation of the external iliac a.Begins midpoint of inguinal ligamentEnds at the adductor tendinous opening by entering the popliteal fossa as the popliteal arteryPrincipal branch－deep femeral a. 股深动脉arises from the posterolateral surface of the femoral artery about 5 cm below the inguinal ligament.Medial femoral circumflex 旋股内侧动脉lateral femoral circumflex 旋股外侧动脉Four perforating arteries 穿动脉
30Profunda 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 旋股内侧动脉.Perforating arteries 穿动脉
32Femoral vein 股静脉 Begins at the adductor tendinous opening Continues as external iliac vein deep to inguinal ligamentContains several valves
33The deep 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.
34Femoral nerve 股神经Arises from the lumbar plexus in the abdomen, and enters 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.Muscular branche to: pectineus, sartorius, quadriceps femoris
35Femoral nerve 股神经 Cutaneous branches: Anterior cutaneous nerves of the thighSaphenous 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 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.
37Adductor canal 收肌管 Boundies Contents An intermuscular cleft situated on the medial aspect of the middle third of the thigh beneath the sartorius.Extends from apex of femoral triangle to adductor tendinous openingBoundiesAnterior wall: adductor lamina and sartoriusLateral wall : vastus medialisPosteomedial wall: adductors longus and magmusContentsSaphenous n.Femoral a. and femoral v.lymphatic vessels and loose connective tissue
38Blood vessels and nerve of medial side of thigh Obturator a. 闭孔动脉Arises from internal iliac artery in the lesser pelvispasses through the obturator canal where it divides into anterior and posterior branches.Obturator 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
40Anterolateral crural region and dorsum of the foot
41Anterolateral crural region Superficial veinsDorsal venous arch: lies in the subcutaneous tissue over the heads of the metatarsal bones and drains on the medial side into the great saphenous v. and on the lateral side into the small saphenous v.Great saphenous v.: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.
42Anterolateral crural region Cutaneous nervesLateral cutaneous n. of the calf: supplies the skin on the upper part of the anterolateral surface of the legSuperficial peroneal n. supplies the skin of the lower part of the anterolateral surface of the leg and dorsum of the footSaphenous n. supplies the skin on the anteromedial surface of the legDeep peroneal n. supplies the skin of the adjacent sides of the big and second toes
43Deep fasciaSurrounds the leg and forms two intermuscular septa to be attached to the fibula.Divided the leg into three compartments－anterior, lateral and posterior－each of which contains a group of muscles, the vessels and the nerves.Superior extensor retinaculum 伸肌上支持带Inferior extensor retinaculum 伸肌下支持带
44Contents of the anterior fascial compartment of the leg Muscles:Tibialis anteriorExtensor digitorum longusExtensor hallucis longusPeroneus tertiusBlood supply: Anterior tibial a.Nerve supply: Deep peroneal n.
45Contents of the anterior fascial compartment of the leg Anterior tibial artery 胫前动脉Beginning: Arises from the popliteai 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 are closely applied to the artery.
46Contents of the anterior fascial compartment of the leg Common peroneal n. 腓总神经Passes over posterior aspect of head of fibula and then winds around neck of fibulaDeep to peroneus longus, where it divides into deep and superficial peroneal nervesDeep peroneal nerve 腓深神经Arises from the common peroneal nerve between the neck of the fibula and the peroneus longus muscleDescends 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.
47Contents of the lateral fascial compartment of the leg MusclesPeroneus longusPeroneus brevisBlood supply: branches from the peroneal arteyNerve supply: superficial peroneal n.
48Contents of the lateral fascial compartment of the leg Superficial peroneal n. 腓浅神经 supplies peroneus longus and brevis and skin on anterior surface of leg and dorsum of foot
49Anterior tibial a.Superficial peroneal n.Tibialis anteriorDeep peroneal n.Extensor digitorum longusExtensor hallucis longusDorsal a. of foot
50Injury to the common peroneal nerve The common fibular 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 dorsiflexion 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.
51Dorsum of the foot Dorsalis pedis artery 足背动脉 Begins on the anterior surface of the ankle joint and runs with the deep peroneal nerveDivides into the arcuate artery and the first dorsal metatarsal artery at the proximal end of the first intermetatarsal space.On the dorsum of the foot it lies on the tarsal bones and is readily palpated against them between the tendons of extensor hallucis longus and extensor digitorum longus.
52You must identify follow structures！ Anterior and Medial Region of ThighMusclesPsoas IliacusSartoriusQuadriceps femorisRectus femorisVastus medialisVastus lateralisVastus intermediusPatellar ligamentPectineusAdductor longusAdductor brevis,Adductor magnusGracilisVesselsGreat saphenous v.Femoral a.Deep femoral a.Nervesfemoral n.Saphenous n.Obturator n.
53You must identify follow structures！ Anterolateral crural region and dorsum of the footMusclesTibialis anteriorExtensor hallucis longusExtensor digitorum longusPeroneus longusPeroneus brevisVesselsGreat saphenous v.Anterior tibial a.Dorsalis pedis a.NervesCommon peroneal n.Deep peroneal n.Superficial peroneal n.