局部解剖學課件：4-膝關(guān)節(jié)小腿后區(qū)和踝

1、Popliteal Fossa , Back of Leg and Malleolar canal 山東大學醫(yī)學院 解剖教研室Popliteal fossa 腘窩1.skin2.Superficial structuresBoundariesSuperolaterally: Biceps femoris 股二頭肌 Superomedially: semimembranosus and semitendinosus 半腱肌和半膜肌Inferiorly: lateral and medial heads of gastrocnemius 腓腸肌內(nèi)、外側(cè)頭Roof: deep fascia Floo

2、r: popliteal surface of the femurposterior capsule of the knee jointfascia covering popliteus 3.Deep structuresContents NervesTibial nerve 脛神經(jīng)Common peroneal nerve 腓總神經(jīng)Popliteal vein and its tributaries 腘靜脈及屬支Popliteal artery and its branches 腘動脈及分支Popliteal lymph nodes 腘淋巴結(jié)Popliteal artery 腘動脈Cours

3、eBegins at the adductor tendinous opening here it is continuous with the femoral arteryEnds at the lower border of the popliteus where it divides into anterior and posterior tibial arteriesBranchesMedial superior genicular a. 膝上內(nèi)側(cè)動脈Lateral superior genicular a. 膝上外側(cè)動脈Medial inferior genicular a. 膝下內(nèi)

4、側(cè)動脈Lateral inferior genicular a. 膝下外側(cè)動脈Middle genicular a. 膝中動脈 Popliteal vein 腘靜脈Formed by the junction of the anterior and posterior tibial veins near the lower border of the popliteus muscle Popliteal lymph nodes 腘淋巴結(jié)May be one or two nodes just under the deep fascia, close to the popliteal fossa

5、 vesselsDrain the deep tissues of the leg and foot and the knee jointAlso receive superficial lymph vessels from the lateral side of the foot, the heel, and the back of the calfDrain along the line of the small saphenous vein into deep inguinal ln. Genicular articular rete 膝關(guān)節(jié)網(wǎng)Descending branch of l

6、ateral circumflex femeral a. 旋股外側(cè)動脈降支Descending genicular a. 膝降動脈Articular branches of popliteal a. 腘動脈關(guān)節(jié)支Anterior tibial recurrent a. 脛前返動脈Back of LegBack of legSmall saphenous v. 小隱靜脈Arises from the lateral part of the dorsal venous arch of footAscends behind lateral malleolus and then runs up the

7、 midline of the back of the leg Pierces the deep fascia and enters the popliteal v.Drains the lateral side of the foot and ankle and the back of the leg1.skin2.Superficial structuresBack of legCutaneous nervesMedial sural cutaneous nerve 腓腸內(nèi)側(cè)皮神經(jīng)Peroneal communicating n. 腓神經(jīng)交通支Sural nerve 腓腸神經(jīng)Content

8、s of the posterior osseofascial compartment of the legSuperficial group muscles Gastrocnemius 腓腸肌 Soleus 比目魚肌Plantaris 跖肌Deep group musclesPopliteus 腘肌Flexor digitorum longus 趾長屈肌Tibialis posterior 脛骨后肌 Flexor hallucis longus 拇長屈肌Blood supplyPosterior tibial a.Nerve supplyTibial nerveMuscles of back

9、 of leg Gastrocnemius腓腸肌 Soleus比目魚肌Plantaris跖肌Flexor hallucis longus拇長屈肌Popliteus 腘肌 Flexor digitorum longus趾長屈肌Tibialis posterior脛骨后肌 Tendo calcaneus跟腱Back of legPosterior tibial artery 脛后動脈Course Begin at level of the lower border of the popliteus Passes downwards deep to gastrocnemius and soleusP

10、asses behind medial malleolus and terminates by dividing into medial and lateral plantar arteriesMain branchesperoneal a. 腓動脈medial plantar a. 足底內(nèi)側(cè)動脈 lateral plantar a. 足底外側(cè)動脈 Back of legTibial nerve 脛神經(jīng)Runs inferiorly with posterior tibial vessels and terminates beneath flexor retinaculum by dividi

11、ng into medial and lateral plantar nervesSupplies posterior muscles of leg and knee jointMalleolar canal 踝管BoundariesFormed by medial surface of calcaneus, flexor retinaculum and medial malleolusStructures passing through the malleolar canalTibialis posterior 脛骨后肌Flexor digitirum longus 趾長屈肌Posterior tibial a. v. 脛后動脈、靜脈Tibial n. 脛神經(jīng)Flexor hallucis longus 拇長屈肌Skin incisionsMake the skin incisions shown in figure and reflect the skin flapsYou must identify follow structures！Muscles Gastrocnemius 腓腸肌Soleus 比目魚肌Tendo calcaneus 跟腱Flexor digitorum longus 趾長屈肌Tibialis poste