1. Regional anatomy of the lower limb
山东大学医学院 解剖教研室
李振华

2. Parts and regions of the lower limb
Gluteal region－between iliac crest superiorly and gluteal fold inferiorly
Thigh－between hip and knee
knee－joint between leg and thigh
Leg－between knee and foot
Ankle
Foot

3. Surface anatomy of lower limb
Leg
anterior border of tibia
neck of fibula
Ankle and foot
medial and lateral malleolus
calcaneal tuberosity
tuberosity of navicular bone
tuberosity of fifth metatarsal bone
Gluteal region and thigh
anterior superior and inferior iliac spines
tubercle of iliac crest
ischial tuberosity
greater trochanter
pubic tubercle
pubic crest
superior border of pubic symphysis
Knee
patella ligament
tuberosity of tibia
medial and lateral condyles and epicondyles
tendon of biceps femoris
tendons of semitendinosus and semimembranosus
head of fibula

4. Nelaton’s line
a 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.

5. Kaplan point

6. Normal angle
of inclination
Coxa 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

7. 1700
<1700
>1700
Normal alignment
Genu varum (bowleg)
膝内翻
Genu valgum
膝外翻

8. Anterior and Medial Region of Thigh

9. Skin incisions
Make the skin incisions indicated in figure and reflect the skin flaps.

10. 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 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.

11. 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. 阴部外静脉
Superficial epigastric v. 腹壁浅静脉
Superficial iliac circumflex v. 旋髂浅静脉

12. Superficial epigastric v.
Superficial circumflex iliac v.
External pudendal v.
Superficial lateral femoral v.
Superficial medial femoral v.
Great saphenous v.

13. Varicose veins

14. Superficial structures
Superficial fascia
Superficial 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.

15. lateral femoral cutaneous n.
anterior and medial cutaneous branches of femoral n.
Cutaneous branches of obturator n.

16. 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 great 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.

17. Deep 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

18. Deep 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.

19. Contents 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

20. Contents 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

21. Lacuna musculorum 肌腔隙 Boundaries: Contents:
Anteriorly: lateral portion of inguinal ligament
Posterolaterally: ilium
Medially: iliopectinal arch
Contents:
Iliopsoas
femoral n.
lateral femoral cutaneous n.
Lateral femoral cutaneous n.
Iliopsoas
Iliopectinal arch
Femoral n.

22. Lacuna vasorum 血管腔隙 Boundaries: Contents:
Anteriorly: medial portion of inguinal ligament
Posteriorly: fascia of pecteineus and pectineal ligament
Medially: lacunar ligament
Laterally: iliopectinal arch
Contents:
Femoral sheath
Femoral a. and v.
Genital branch of genitofemoral n.
Lymphatic vessels
Femoral a.
Femoral v.
Femoral ring

23. Femoral 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 ligament
Boundaries
Superiorly (base) : the inguinal ligament
Laterally: medial border of sartorius
Medially: medial border of adductor longus
Apex: continuous with adductor canal
Anterior wall: fascia lata
Posterior wall: consists of iliopsoas, pectineus and adductor longus from lateral to medial side

24. Femoral triangle 股三角 Contents Femoral n. Femoral sheath
Femoral a. and its branches
Femoral vein and its tributaries.
Femoral canal
Deep inguinal lymph nodes
Fatty tissue

25. Femoral triangle 股三角 Femoral sheath 股鞘 A funnel- shaped sheath
Derived from transversalis fascia anteriorly and iliac fascia posteriorly
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.

26. Femoral sheath 股鞘 Femoral sheath 股鞘 Lateral compartment: femoral a.
Divided into three compartments by two fibrous septa
Lateral compartment: femoral a.
Middle compartment: femoral v.
Medial compartment: femoral canal 股管

27. The 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 ring
Anteriorly: the inguinal ligament
Medially: the lacunar ligament 腔隙韧带
Posteriorly: the pecten of pubis
Laterally: the femoral vein
Superior: covered by femoral septum 股环隔

28. Femoral 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 ).

29. Femoral artery 股动脉 Femoral a. 股动脉
Continuation of the external iliac a.
Begins midpoint of inguinal ligament
Ends at the adductor tendinous opening by entering the popliteal fossa as the popliteal artery
Principal 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

30. 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 旋股内侧动脉.
Perforating arteries 穿动脉

31. deep femeral a.
Medial circumflex a.
Lateral circumflex a.
perforating arteries

32. Femoral vein 股静脉 Begins at the adductor tendinous opening
Continues as external iliac vein deep to inguinal ligament
Contains several valves

33. The 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.

34. Femoral 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

35. Femoral nerve 股神经 Cutaneous branches:
Anterior cutaneous nerves of the thigh
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.
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.

36. Femoral n.
Femoral a.
Femoral v.
Saphenous nerve

37. Adductor 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 opening
Boundies
Anterior wall: adductor lamina and sartorius
Lateral wall : vastus medialis
Posteomedial wall: adductors longus and magmus
Contents
Saphenous n.
Femoral a. and femoral v.
lymphatic vessels and loose connective tissue

38. Blood vessels and nerve 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.
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

39. Obturator n.

40. Anterolateral crural region and dorsum of the foot

41. Anterolateral crural region
Superficial veins
Dorsal 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.

42. Anterolateral crural region
Cutaneous nerves
Lateral cutaneous n. of the calf: supplies the skin on the upper part of the anterolateral surface of the leg
Superficial peroneal n. supplies the skin of the lower part of the anterolateral surface of the leg and dorsum of the foot
Saphenous n. supplies the skin on the anteromedial surface of the leg
Deep peroneal n. supplies the skin of the adjacent sides of the big and second toes

43. Deep fascia
Surrounds 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

44. Contents of the anterior fascial compartment of the leg
Muscles:
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Peroneus tertius
Blood supply: Anterior tibial a.
Nerve supply: Deep peroneal n.

45. Contents 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.

46. Contents 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 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 nerve 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.

47. Contents of the lateral fascial compartment of the leg
Muscles
Peroneus longus
Peroneus brevis
Blood supply: branches from the peroneal artey
Nerve supply: superficial peroneal n.

48. Contents 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

49. Anterior tibial a.
Superficial peroneal n.
Tibialis anterior
Deep peroneal n.
Extensor digitorum longus
Extensor hallucis longus
Dorsal a. of foot

50. Injury 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.

51. Dorsum 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 nerve
Divides 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.

52. You must identify follow structures！
Anterior and Medial Region of Thigh
Muscles
Psoas Iliacus
Sartorius
Quadriceps femoris
Rectus femoris
Vastus medialis
Vastus lateralis
Vastus intermedius
Patellar ligament
Pectineus
Adductor longus
Adductor brevis,
Adductor magnus
Gracilis
Vessels
Great saphenous v.
Femoral a.
Deep femoral a.
Nerves
femoral n.
Saphenous n.
Obturator n.

53. You must identify follow structures！
Anterolateral crural region and dorsum of the foot
Muscles
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Peroneus longus
Peroneus brevis
Vessels
Great saphenous v.
Anterior tibial a.
Dorsalis pedis a.
Nerves
Common peroneal n.
Deep peroneal n.
Superficial peroneal n.