regional anatomy of the lower...

Regional anatomy

of the lower limb

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

Surface anatomy of lower limb

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

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

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.

Kaplan point

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 )

Coxa valga 髋外翻(abnormally increased

angle of inclination, in

cases of congenital

dislocation of the hip)

Normal angle

of inclination

1250-1300

颈干角

Normal alignment Genu varum (bowleg)

膝内翻

Genu valgum

膝外翻

1700 >1700 <1700

Anterior and Medial

Region of Thigh

Skin incisions

Make the skin incisions indicated in

figure and reflect the skin flaps.

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.


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

Superficial epigastric v.

External pudendal v.

Superficial circumflex iliac v.

Great saphenous v.

Superficial lateral femoral v.

Superficial medial femoral v.

Varicose veins


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.


anterior and medial

cutaneous branches of

femoral n.

Cutaneous branches of

obturator n.


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.

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

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.

Contents of the anterior fascial

compartments of the thigh

Iliopsoas髂腰肌 Iliacus 髂肌

Psoas majo腰大肌

Sartorius 缝匠肌

Quadriceps

femoris 股四头肌 Vastus intermedius 股中间肌

Vastus lateralis 股外侧肌

Rectus femoris 股直肌

Vastus medialis 股内侧肌

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

Lacuna musculorum 肌腔隙

Boundaries:

Anteriorly: lateral portion of

inguinal ligament

Posterolaterally: ilium

Medially: iliopectinal arch

Contents:

Iliopsoas

femoral n.


Iliopectinal arch

Femoral n.

Iliopsoas

Lateral femoral cutaneous n.

Lacuna vasorum 血管腔隙

Boundaries:

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. Femora branch of genitofemoral

n. Lymphatic vessels

Femoral a.

Femoral v.

Femoral ring

Femoral triangle 股三角 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

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

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.



Divided into three compartments by two fibrous septa

Lateral compartment: femoral a.

Middle compartment: femoral v.

Medial compartment: femoral canal 股管

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

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 ).

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

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

deep femeral a.

Lateral circumflex a. Medial circumflex a.

perforating arteries

Femoral vein 股静脉

Begins at the adductor tendinous

opening

Continues as external iliac vein deep

to inguinal ligament

Contains several valves

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.

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

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.

Femoral n.

Femoral a.

Femoral v.

Saphenous nerve

Adductor canal 收肌管

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

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

Obturator n.

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.

Gluteal Region and Posterior

Region of Thigh

Skin incisions

Make the skin incisions shown

in figure and reflect the skin

flaps

regional anatomy of the lower...

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