Transcript 幻灯片 1

Lower Limbs
Lu Xiaoli
Regional Anatomy & Operative Surgery
China Medical University

32 Bones
Hip Bone (1)
 Femur (1)
 Patella (1)
 Tibia (1)
 Fibula (1)
 Tarsals (8)
 Metatarsals (5)
 Proximal Phalanges (5)
 Intermediate
Phalanges (5)
 Distal Phalanges (4)

Hip
Femoral Bone
Patella
Tibia & Fibula
Proximal End of Left Tibia
Gluteal Region
Iliac Crest
Gluteal Crease

Superficial Layers
Skin
 Superficial Fascia


Deep Layers
Deep Fascia
 Muscles
 Suprapiriform & Infrapiriform Foramen
 Lesser Sciatic Foramen

 Hip Joint
Superficial Fascia
the middle part is thinnest
 Contains Superficial blood vessels,
lymphatic vessels and cutaneous nerves

Bedsore (Decubitus Ulcer)
Arteries
Superficial branches of
 4th
lumbar artery
 Inferior gluteal artery
 Lateral sacral artery
 Superior gluteal artery
 Inferior gluteal artery
Cutaneous Nerves
branches of the
subcostal nerve (T12)
 dorsal rami of lumbar
nerves
 dorsal rami of sacral
nerves
 inferior cluneal nerves
 posterior femoral
cutaneous nerve

Deep Fascia
Attach to iliac crest superiorly
 Invest gluteus maximus
 Attach to Sacral bone and coccyx
medially
 Continuous with fascia lata laterally

Muscles
Superficial
Gluteus Maximus
Tensor Fasciae Latae
Middle
Glluteus Medius
Piriformis
Superior Gemellus
Obturator Internus
Inferior Gemellus
Quadratus Femoris
Deep
Gluteus Minimus
Obturator Externus
Gluteus Maxinus
 Tensor Fasciae
Latae

Glluteus Medius
 Piriformis
 Superior Gemellus
 Obturator Internus
 Inferior Gemellus
 Quadratus Femoris

Gluteus Minimus
 Obturator
Externus

Suprapiriform Foramen
Infrapiriform Foramen
Sciatic n.
 Tibial n.
 Common Fibular n.

66.3%
6.4%
27.3%
Tibial n.
Common Fibular n.
Piriformis
Syndrome
Pain radiates
down the back of
the leg
Iliac crest
Ischial
tuberosity
Lesser Sciatic Foramen

Boundaries
front: tuberosity of ischium
 above: spine of ischium & sacrospinous lig.
 behind: sacrotuberous lig.


Contents
tendon of Obturator internus
 internal pudendal a.
 internal pudendal v.
 pudendal n.

Hip
Anterior
Posterior

It is based on this capsular attachment
that fractures of the neck of femur are
classified as:



INTRACAPSULAR: within the capsular
attachment.
EXTRACAPSULAR: outside the attachment
of the capsule
Mixed
Intracapsular
Lig. of head
of femur
 Transverse
acetabular
lig.

Extracapsular
(Anterior)
Iliofemoral lig.
 Pubofemoral lig.

Extracapsular
(posterior)
Ischiofemoral
lig.
 Zona
orbicularis

Blood Supply
Superior gluteal a.
 Inferior gluteal a.
 Lateral circumflex femoral a.
 Medial Circumflex femoral a.
 Branches of Obturator a.
 1st perforating branches of deep femoral
a.
 Femoral nutrient a.

Superior gluteal
a.
 Inferior gluteal a.
 1st perforating
branches of deep
femoral a.

Superior retinacular a.
 Anterior retinacular a.
 Inferior retinacular a.

Medial Circumflex
femoral a.
 Lateral circumflex
femoral a.

Branches of
Obturator a.

Femoral
nutrient a.
If the head of the femur is
dislocated postero-medially, compression
of which nerve is likely to result?
A.
B.
C.
D.
E.
Femoral
Lumbosacral trunk
Obturator
Sciatic
Superior gluteal
What muscle passes through the
lesser sciatic foramen?
A.
B.
C.
D.
E.
Gluteus minimus
Obturator internus
Piriformis
Quadratus femoris
Superior gemellus
In order to avoid injury to the sciatic
nerve, intramuscular injections should be
given in which quadrant of the buttock?
A.
B.
C.
D.
E.
upper medial
upper lateral
lower medial
lower lateral
middle
Of the branches of the internal iliac
artery, the one exiting from the greater
sciatic foramen superior to the piriformis
muscle is the:
A.
B.
C.
D.
Iliolumbar artery
Internal pudendal artery
Lateral sacral artery
Superior gluteal artery
Thigh
 Anterior
compartment
 Posterior compartment
Superficial iliac circumflex a.
 Superficial epigastric a.
 External pudendal a.
 Superficial lateral femoral a.
 Superficial medial femoral a.

Groin Flap
Great Saphenous V.
70 ～80 cm
femoral v.
fossa ovalis
medial side of thigh
medial condyles of tibia & femur
medial side of leg
medial malleolus
dorsal venous arch of foot
Tributaries
Superficial iliac
circumflex v.
 Superficial epigastric v.
 External pudendal v.
 Superficial lateral
femoral v.
 Superficial medial
femoral v.

in emergency, great saphenous vein
may be opened surgically for
intravenous drip for the patients
suffering from insufficiency of
body fluid.
 great saphenous vein as venous
graft can be used in the coronary
bypass surgery for coronary heart
disease.

one-way valves
become weak & don't close properly
Superficial inguinal LN
Horizontal groups
 Vertical groups

Fascia Lata
Iliotibial tract
 Saphenous hiatus (fossa ovalis )
 fascia cribrosa
 Falciform margin

Lacuna musculorum & vasorum

between inguinal lig. and hip bone, and
separated by iliopectineal arch


lateral: lacuna musculorum
medial: lacuna vasorum
Lacuna musculorum

Boundaries:
ant.：inguinal lig.
 post.：ilium
 med.：iliopectineal arch


Contents:
iliopsoas
 lat. femoral cutaneous n.
 femoral n.

Lacuna vasorum

Boundaries:
ant.：inguinal lig.
 post.：pectineal lig.
 med.：lacunar lig.
 lat.： iliopectineal arch


Contents:
femoral
 femoral
 femoral
 femoral

sheath
a., v.
canal
br. of genitofemoral n.
Femoral
sheath
Femoral canal
1-1.5 cm
 Boundaries:

Ant. : inguinal lig. superior corner of
falciform margin and femoral septum
 Post. : pectineal lig., pectineus
 Lat. : fibrous septum of femoral v.

femoral ring
A 63-year-old female patient says
that she has pain in her groin and upper
thigh. Upon examination, you palpate a
lump located below the inguinal ligament
lateral to its attachment to the pubic
tubercle. You suspect that this may be a
hernia passing through the:
A.
B.
C.
D.
E.
femoral canal
adductor hiatus
obturator canal
deep inguinal ring
superficial inguinal ring
The femoral canal contains the:
A.
B.
C.
D.
E.
Deep inguinal lymph node(s)
Femoral artery
Femoral nerve
Femoral vein
Ilioinguinal nerve
The pulse of the femoral artery is
best felt at which superficial reference
point?
A.
B.
C.
D.
E.
Anterior to the ankle joint
Femoral triangle
Mid-thigh
Popliteal fossa
Right lateral portion of the
hypogastrium
At which site could one expect to
enter the femoral vein with a simple
percutaneous
(through
the
skin)
introduction of an instrument?
A.
B.
C.
D.
E.
Above the middle of the inguinal
ligament
Lateral to the femoral arterial pulse
Lateral to the pubic tubercle
Medial to the femoral arterial pulse
Medial to the pubic tubercle
A serious complication of fractures of
the femoral neck is avascular necrosis of
the femoral head. This usually results
from rupture of which artery?
A.
B.
C.
D.
E.
Acetabular branch of obturator
Deep circumflex iliac
Descending branch of lateral
circumflex femoral
Medial circumflex femoral
Second perforating branch of lateral
circumflex
A ruptured aneurysm in the most
proximal portion of the deep femoral
artery would result in a hematoma located
initially in the:
A.
B.
C.
D.
E.
Adductor canal.
Femoral canal.
Femoral triangle.
Inguinal canal.
Popliteal fossa.
Childhood
immunizations
are
sometimes
given
via
intramuscular
injections into the quadriceps muscles of
the anterior thigh. At the mid-thigh level,
a needle passing into the space deep to
the sartorius muscle might pierce the
femoral vessels as they lie in the:
A.
B.
C.
D.
E.
Adductor canal
Adductor hiatus
Adductor triangle
Femoral canal
Femoral ring
Which of the following is
located within the adductor canal?
A.
B.
C.
D.
E.
Saphenous nerve
Femoral artery
Nerve to vastus medialis
Femoral vein
Deep femoral artery
NOT