局部解剖學(xué)教學(xué)課件：2.The Lower Limb

1、CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009The superficial layer ： Grea

2、t Saphenous vein and its tributaries lateral femoral cutaneous n. Saphenous nerve Superficial peroneal n. Dorsal a. of foot淺層：淺層： 大隱靜脈及其屬支大隱靜脈及其屬支 股外側(cè)皮神經(jīng)、股外側(cè)皮神經(jīng)、 隱神經(jīng)隱神經(jīng) 、 腓淺神經(jīng)、腓淺神經(jīng)、 足背動(dòng)脈足背動(dòng)脈CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMING

3、FENG 2009CHENMINGFENG 2009大隱靜脈和屬支大隱靜脈和屬支Great Saphenous veinSuperficial structures of lower limb CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009 Superficial veins Great saphenous v. 大隱靜脈大隱靜脈 Begins the medial en

4、d of dorsal venous arch of foot 足背靜脈弓 Anterior to the medial malleolus內(nèi)踝前方 Ascends on the medial side of the leg小腿內(nèi)側(cè), Behind the knee膝關(guān)節(jié)內(nèi)側(cè) Curves forward around the medial side of the thigh大腿內(nèi)側(cè). Inclines anteriorly through the thigh to enter the femoral vein through the saphenous opening隱靜脈裂孔.CHENMI

5、NGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009 Cutaneous nerves 皮神經(jīng)皮神經(jīng) lateral femoral cutaneous n.股外側(cè)皮神經(jīng)CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGF

6、ENG 2009CHENMINGFENG 2009 Cutaneous nerves 皮神經(jīng)皮神經(jīng) Saphenous nerve隱神經(jīng)隱神經(jīng)CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009 Cutaneous nerves 皮神經(jīng)皮神經(jīng) Superficial peroneal/fibular nerve腓淺神經(jīng)腓淺神經(jīng)CHENMINGFENG 2009CHENMINGF

7、ENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009Contents of Anterior and Medial Region of Thigh MUSCLESNERVESVESSELSOTHERSCHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2

8、009CHENMINGFENG 2009Anterior tibial a. 脛前動(dòng)脈 Dorsal a. of foot 足背動(dòng)脈 Tibialis anterior 脛骨前肌Extensor hallucis longus 拇長伸肌Extensor digitorum longus趾長伸肌Deep peroneal n.腓深神經(jīng) Superficial peroneal n.腓淺神經(jīng) Contents of Anterior Region of Leg Regional anatomy of the back of lower limbCHENMINGFENG 2009CHENMINGFE

9、NG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009The back region of lower limb 臀部臀部 gluteal region 股后區(qū)股后區(qū) back of thigh 膝后區(qū)膝后區(qū) popliteal fossa 小腿后區(qū)小腿后區(qū) back of leg 踝后區(qū)踝后區(qū) back of ankle 足底足底 sole of footCHENMINGFENG 2009CHENMINGFENG 2009CHEN

10、MINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009髂嵴髂嵴 iliac crest, 髂后上棘髂后上棘 Post.sup.iliac spine, 坐骨結(jié)節(jié)坐骨結(jié)節(jié) Ischial tuberosity, 大轉(zhuǎn)子大轉(zhuǎn)子 Greater trochanterBoney markersCHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009C

11、HENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009Lower limb - incisionsTurn the cadaver into the prone position and refer to figure.Make a skin incision from the anterior superior iliac spine along the iliac crest to posterior iliac spine;Make a transverse incision around the lower border of the gl

12、uteal region;Make a cut at the midline over the sacrum and turn over all of the skin from the gluteal region;Make one horizontal incision about 5 cm below popliteal fossa;Make a transverse incision around the upper part of the ankle;Make a cut along the midline of the thigh and leg from the gluteal

13、fold to the heel, then turn over the skin completely from the lower limb and place connective tissue in the tissue container. Skin incision Superior gluteal n.臀上皮神經(jīng)臀上皮神經(jīng) Medial gluteal n.臀內(nèi)側(cè)皮神經(jīng)臀內(nèi)側(cè)皮神經(jīng) Inferior gluteal n.臀下皮神經(jīng)臀下皮神經(jīng) Superficial Structures （1）Skin（2）Superficial fascia Cutaneous nerves T

14、he gluteal region 臀區(qū)臀區(qū)Superficial layeriliohypogastric nerve. Lateral branch 髂腹下神經(jīng)外側(cè)皮支髂腹下神經(jīng)外側(cè)皮支CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 20091. Skin2. Superficial fascia3. Posterior femoral cutaneous nerve 股后皮神

15、經(jīng)股后皮神經(jīng) Back of Thigh - Superficial layerLower limbThe posterior cutaneous nerve innervate skin over the gluteal fold and on the posterior thigh and leg.CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009 skin superf

16、icial fascia sural n. small saphenous v.Back of Leg - Superficial layerLower limbCHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009 skin superficial fascia sural n. small saphenous v.Back of Leg - Superficial layer

17、Lower limbGluteal fascia臀筋膜臀筋膜Gluteal muscles臀肌臀肌 Deep Structuresgluteus maximus臀大肌臀大肌 Extensor of flexed femur at hip jointpiriformis梨狀肌梨狀肌Laterally rotates the extended femur at hip joint Deep Structuresgluteus medius 臀中肌臀中肌Abducts femur at hip joint gluteus minimus 臀小肌臀小肌Abducts femur at hip join

18、t suprapiriform foramen梨狀肌上孔梨狀肌上孔 infrapiriform foramen梨狀肌下孔梨狀肌下孔 Gamellus superior上孖肌Obturator internus 閉孔內(nèi)肌Gamellus inferior 下孖肌Quadratus Femoris 股方肌Obturator externus閉孔外肌CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMING

19、FENG 2009Lower limbMuscle incision Separate and turn over gluteus maximus:The dorsal surface the sacrum The side of the coccyxThe iliac crestsuprapiriform foramen梨狀肌上孔梨狀肌上孔 infrapiriform foramen梨狀肌下孔梨狀肌下孔 Piriformis梨狀肌梨狀肌 Structures passing through suprapiriform foramen 梨狀梨狀肌上孔穿行的結(jié)構(gòu)肌上孔穿行的結(jié)構(gòu) Superior

20、 gluteal n., a., v. from lateral to medial side自外側(cè)向內(nèi)側(cè)依次為有臀上神經(jīng)、臀上動(dòng)脈、臀上靜脈。 Structures passing through infrapiriform foramen 梨狀肌梨狀肌下孔穿行的結(jié)構(gòu)下孔穿行的結(jié)構(gòu) Sciatic n., posterior femoral cutaneous n., inferior gluteal n., a., v., internal pudendal v., a., and pudendal n. from lateral to medial side自外側(cè)向內(nèi)側(cè)依次為坐骨神經(jīng)、股

21、后皮神經(jīng)、臀下神經(jīng)、臀下動(dòng)脈、臀下靜脈、陰部內(nèi)動(dòng)、靜脈和陰部神經(jīng)。 From lateral to medial side : Superior gluteal n., a., v. From lateral to medial side : Sciatic n., posterior femoral cutaneous n., inferior gluteal n., a., v., internal pudendal v., a., and pudendal n. Pudendal nerve, internal pudendal artery 陰部神經(jīng)、陰陰部神經(jīng)、陰部內(nèi)動(dòng)脈部內(nèi)動(dòng)脈 T

22、hese structures enter the gluteal region through the infrapiriform foramen 梨狀肌下孔 . They then curve forwards to enter the perineum會(huì)陰 through the lesser sciatic foramen 坐骨小孔 . The back of Thigh 股后區(qū)股后區(qū) The posterior osseofascial compartment of the thigh 后骨筋膜鞘后骨筋膜鞘 Muscles Biceps femoris 股二頭肌 Semitendin

23、osus 半腱肌 Semimembranosus 半膜肌 Blood supply Branches of the deep femoral artery 股深動(dòng)脈分支Nerve supply Sciatic nerve 坐骨神經(jīng) Semitendinosus半腱肌半腱肌Long head of biceps femoris 股二頭肌長頭股二頭肌長頭CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENM

24、INGFENG 2009The posterior osseofascial compartment of the thigh 后骨筋膜鞘后骨筋膜鞘 Muscles Biceps femoris 股二頭肌 Semitendinosus 半腱肌 Semimembranosus 半膜肌 Blood supply Branches of the deep femoral artery 股深動(dòng)脈分支Nerve supply Sciatic nerve 坐骨神經(jīng) Semimembranosus半膜肌半膜肌Short head of biceps femoris 股二頭肌短頭股二頭肌短頭Sciatic n

25、.坐骨神經(jīng)坐骨神經(jīng) It arises from the sacral plexus and leaves pelvis through infrapiriform foramen to enter gluteal region, deep to gluteus maximus, passing midway between the greater trochanter of femur and ischial tuberosity to back of thigh, lying deep to long head of biceps femoris, normally divided int

26、o tibial and common peroneal nerves just above popliteal fossa 起自骶叢，穿梨狀肌下孔臀大肌深面坐骨結(jié)節(jié)與股骨大轉(zhuǎn)子之間股二頭肌長頭與大收肌之間腘窩上角，分為脛神經(jīng)和腓總神經(jīng)。 Sciatic n.坐骨神經(jīng)坐骨神經(jīng) Innervates semitendinosus, semimembranosus and biceps femoris and has articular branches to hip and knee joints 支配股二頭肌長頭、半腱肌、半膜?。还啥^肌短頭由腓總神經(jīng)支配。 CHENMINGFENG 2009

27、CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009Relationship of sciatic n. to the piriformisThe popliteal fossa 腘窩腘窩 Diamond-shaped Upper lateral boundary上外側(cè)壁: Biceps femoris股二頭肌 Upper medial boundary上內(nèi)側(cè)壁: semimembranosus and sem

28、itendinosus ：半腱肌和半膜肌BoundaryThe popliteal fossa 腘窩腘窩 Two lower boundaries 下內(nèi)外側(cè)壁 are the heads of gastrocnemius 腓腸肌內(nèi)外側(cè)頭 Roof 頂: deep fascia 腘筋膜 Floor 底: popliteal surface of the femur 股骨腘面, the posterior capsule of the knee joint 膝關(guān)節(jié)囊后部, and the fascia covering poplitells 腘肌及其筋膜.BoundaryContents Tibi

29、al and common peroneal nerves and their branches脛神經(jīng)、腓總神經(jīng) Popliteal vein and its tributaries腘靜脈 Popliteal artery and its branches腘動(dòng)脈 Popliteal lymph nodes腘深淋巴結(jié) Fatty tissueThe popliteal fossa 腘窩腘窩 Tibial n.脛神經(jīng)脛神經(jīng) Runs inferiorly with posterior tibial vessels and terminates beneath flexor retinaculum

30、by dividing into medial and lateral plantar nerves Supplies posterior muscles of leg and knee joint CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009Common peroneal/ fibular n.腓總神經(jīng)腓總神經(jīng) Lying between the tendon of

31、biceps femoris and the lateral head of gastrocnemius, then curves lateral to the neck of the fibula lying on the bone deep to fibularis longus Supplies anterior & lateral muscles of leg, knee joint and most of the dorsum of the foot . Popliteal artery 腘動(dòng)脈腘動(dòng)脈 It is continuous with the femoral artery

32、and ends at the lower border of the popliteus muscle where it divides into anterior and posterior tibial arteries.Branches: 1. Superior, inferior, and middle genicular arteries 2. Muscular branches PopliteusPopliteal vein 腘靜脈腘靜脈Popliteal lymph nodes腘淋巴結(jié)腘淋巴結(jié)CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGF

33、ENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009CHENMINGFENG 2009The back of the leg小腿后區(qū)小腿后區(qū) Small saphenous v.小隱小隱靜脈靜脈 Arises from the lateral part of the dorsal venous arch of foot Ascends behind lateral malleolus and then passes upward to the midline of the leg. Pierce

34、s the deep fascia and enters the popliteal v. The back of the leg-Superficial layer Medial sural cutaneous nerve 腓腸內(nèi)側(cè)皮神經(jīng)腓腸內(nèi)側(cè)皮神經(jīng) lateral sural cutaneous nerve 腓腸外側(cè)皮神經(jīng)腓腸外側(cè)皮神經(jīng) Sural nerve 腓腸神經(jīng)腓腸神經(jīng) skin on the lower posterolateral surface of the leg and the lateral side of the foot and little toe. It in

35、nervates skin on the lower posterolateral surface of the leg and the lateral side of the foot and little toe. The back of the leg-Superficial layerThe posterior osseofascial compartment of the leg 后骨筋膜鞘后骨筋膜鞘 Superficial group muscles Gastrocnemius 腓腸肌腓腸肌 Soleus 比目魚肌比目魚肌Plantaris 跖肌跖肌Deep group muscl

36、esPopliteus 腘肌腘肌Flexor digitorum longus 趾長趾長屈肌屈肌Tibialis posterior 脛骨后肌脛骨后肌 Flexor hallucis longus 拇長拇長屈肌屈肌Blood supply: Posterior tibial a.脛后動(dòng)脈脛后動(dòng)脈 Nerve supply: Tibial nerve Gastrocnemius腓腸肌腓腸肌 Soleus比目魚肌比目魚肌Plantaris跖肌跖肌Flexor hallucis longus拇屈伸肌拇屈伸肌Popliteus 腘肌腘肌 Flexor digitorum longus趾長屈肌趾長屈肌Tibialis posterior脛骨后肌脛骨后肌 Tendo calcaneus跟腱跟腱 Tibial nerve脛神經(jīng)脛神經(jīng) Post