Transcript 凌树才
Regional anatomy of lower limb The anterior and medial regions of the thigh Ling Shucai Main Contents 1. Surface anatomy 表面解剖 2. The superficial structures 浅层结构 Superficial veins 浅静脉 Superficial lymph vessels 浅淋巴结 Cutaneous nerves 皮神经 3. The deep structures 深层结构 The deep fascia 深筋膜 The muscles 肌肉 The vessels 血管 The nerves 神经 4. Regional anatomy 局部解剖 Lacuna musculorum and lcuna vasorum 肌腔隙和血管腔隙 Femoral triangle 股三角 Adductor canal 收肌管 1. The superficial structures Superficial structures－superficial fascia 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 Superficial veins－great saphenous v. 大隐静脉 superficial epigastric v. 腹壁浅静脉 superficial iliac circumflex v. 旋髂浅静脉 external pudendal v. 阴部外静脉 superficial medial femoral v. 股内侧浅静脉 superficial lateral femoral v. 股外侧浅静脉 Superficial inguinal lymph nodes: 腹股沟浅淋巴结 superior group 上组 inferior group 下组 Cutaneous nerves: lateral femoral cutaneous n. 股外侧皮神经 anterior and medial cutaneous branches of femoral n. 股神经前、 内侧皮支 Superficial epigastric v. Superficial circumflex iliac v. External pudendal v. Superficial medial femoral v. Superficial lateral femoral v. Great saphenous v. 2. The deep structures Deep structures Fascia lata and iliotibial tract 大腿阔筋膜和髂胫束 Muscles Deep vessels, nerves and lymph nodes Fascia lata and iliotibial tract 大腿阔筋膜和髂胫束 Iliotibial tract 髂胫束 Saphenous hiatus 隐静脉裂孔 falciform margin 镰状缘 cribriform fascia 筛筋膜 Muscles Muscles of hip anterior group Iliopsoas 髂腰肌 psoas minor 腰小肌 tensor fasciae latae 阔筋膜张肌 Muscles of thigh Anterior group Sartorius 缝匠肌 Quadriceps 股四头肌 Rectus femoris 股直肌 Vastus medialis 股内侧肌 Vastus lateralis 股外侧肌 Vastus intermedius 股中间肌 Medial group Pectineus 耻骨肌 Adductor longus 长收肌 Adductor brevis 短收肌 Adductor magnus大收肌 Gracilis 股薄肌 adduct thigh at hip joint Deep arteries Femoral a. 股动脉 deep femeral a. 股深动脉 medial and lateral femoral circumflex 旋股内、外侧动脉 perforating arteries 穿动脉 deep femeral a. Deep veins external iliac v. femoral v. popliteal v. anterior and posterior tibial v. Nerves Femoral n. Obturator n. 3. Regional anatomy Lacuna musculorum and lcuna vasorum 肌腔隙和血管腔隙 Lacuna musculorum 肌腔隙 Bounded by lateral portion of inguinal ligament anteriorly, ilium posterolaterally, iliopectinal arch medially Contents: iliopsoas, femoral n. and lateral femoral cutaneous n. Lateral femoral cutaneous n. Iliopsoas Femoral n. Iliopectinal arch Lacuna vasorum 血管腔隙 Femoral a. Femoral v. Femoral ring Bounded by medial portion of inguinal ligament anteriorly, pectineal ligament posteromedially, lacunar ligament medially, and iliopectinal arch posterolaterally Contents: femoral sheath, femoral a. and v., genital branch of genitofemoral n. and lymphatic vessels, femoral ring Femoral triangle 股三角 This triangle is bounded by: the inguinal ligament (base) superiorly; the medial border of sartorius laterally; the medial border of adductor longus medially. Inferiorly, the apex of the triangle is continuous with adductor canal. The anterior wall is fascia lata The posterior wall consists of adductor longus, pectineus and iliopsoas , from medial to lateral side. Contents of the femoral triangle 1. The femoral artery and its branches－the profunda femoris artery，The lateral and medial circumflex arteries， The deep external pudendal． 2. The femoral vein and its tributaries. 3. Three or four deep inguinal lymph nodes lie along the medial side of the femoral vein. 4. The femoral nerve. 5. The femoral canal. Femoral sheath 股鞘 The femoral sheath is a funnelshaped sheath , derived from transversalis fascia anteriorly and iliac fascia posteriorly. It surrounds the femoral vessels and lymphatic about 2.5cm belower the inguinal ligament. Its lower end disappears at the lower margin of the saphenous opening where the sheath fuses with the adventitia of the vessels. The femoral sheath is divided into three compartments by two fibrous septa. The femoral artery occupies the lateral compartment of the sheath. The femoral vein lies the middle compartment. The medial compartment is small, called the femoral canal. The femoral canal 股管 It is about 1.3cm long , and its upper opening is called the femoral ring 股环. The boundaries of the femoral ring are: inguinal ligament 腹股沟韧带 lacunar ligament 腔隙韧带 pecten of pubis 耻骨梳 femoral vein 股静脉 The canal contains a little loose fatty tissue, a small lymph node, and some lymph vessels. Femoral hernia 股疝 A femoral hernia is common in women than in men (possibly due to a wider pelvis and femoral canal ). If a loop of intestine is forced into the femoral ring, it expands to form a swelling in the upper part of the thigh. Adductor canal 收肌管 Extends from apex of femoral triangle to adductor hiatus Bounded by vastus medialis laterally, adductors longus and magmus posteriorly, and adductor lamina and sartorius anteriorly Contents – saphenous nerve, femoral a., femoral v., lymphatic vessels, and loose connective tissue 思考题 1. 试述大隐静脉的注入部位、主要属支及其收集范围。 2. 试述股三角的境界（上、外、内侧、前壁、底）各有哪些 结构，通过股三角的血管神经有哪些？ 3. 试述股动脉的主要分支。 4. 试述股部肌肉的分群、神经支配及损伤表现。 5. 试述肌腔隙和血管腔隙的境界及通过的结构。 6. 名词解释：股鞘、股管、股环、股疝