股神经山东大学医学院组织学与胚胎学教研室课件

Lowerlimb 山东大学医学院解剖教研室李振华 Contents AnteriorandMedialRegionofThigh股前内侧区AnteriorandLateralCruralRegion小腿前外侧区GlutealRegion臀区BackofThigh股后区BackofLeg小腿后区 Partsandregionsofthelowerlimb Glutealregion臀区 betweeniliaccrestsuperiorlyandglutealfoldinferiorlyThigh股 betweenhipandkneeKnee膝 jointbetweenlegandthighLeg小腿 betweenkneeandfootAnkle踝Foot足 Surfaceanatomyoflowerlimb LandmarksoflowerlimbGlutealregionandthighanteriorsuperioriliacspines髂前上棘anteriorinferioriliacspines髂前下棘tubercleofiliaccrest髂结节ischialtuberosity坐骨结节greatertrochanter大转子pubictubercle耻骨结节pubiccrest耻骨嵴superiorborderofpubicsymphysis耻骨联合上缘Kneepatellaligament髌韧带tuberosityoftibia胫骨粗隆medialandlateralcondyles内 外 侧髁medialandlateralepicondyles内 外 上髁 tendonofbicepsfemoris股二头肌腱tendonsofsemitendinosusandsemimembranosus半腱 半膜 肌腱Leganteriorborderoftibia胫骨前缘headoffibula腓骨头neckoffibula腓骨颈Ankleandfootmedialandlateralmalleolus内 外 侧踝calcanealtuberosity跟骨结节tuberosityofnavicularbone舟骨粗隆tuberosityoffifthmetatarsalbone第五跖骨粗隆 Surfaceanatomyoflowerlimb Nelaton slineAlinedrawnfromtheanteriorsuperiorlilacspinetotheischialtuberosity passingoverornearthetopofthegreatertrochanterThetrochantercanbefeltsuperiortothislineinapersonwhichadislocatedhiporafracturedfemoralneck Surfaceanatomyoflowerlimb Kaplanpoint Surfaceanatomyoflowerlimb Coxavara髋内翻 abnormallydecreasedangleofinclination itoccursinfracturesoftheneckofthefemurandslippingofthefemoralepiphysis Coxavalga髋外翻 abnormallyincreasedangleofinclination incasesofcongenitaldislocationofthehip 颈干角Normalangleofinclination1250 1300 Normalalignment Genuvarum bowleg 膝内翻 Genuvalgum膝外翻 1700 1700 1700 Surfaceprojections Superiorgluteala v n 臀上动 静脉和神经Inferiorgluteala v n 臀下动 静脉和神经 Surfaceprojections Sciaticnerve坐骨神经 Surfaceprojections Femorala 股动脉Popliteala 腘动脉Anteriortibiala 胫前动脉Posteriortibiala 胫后动脉Dorsala offood足背动脉 AnteriorandMedialRegionofThigh股前内侧区 Superficialstructures Greatsaphenousvein大隐静脉DrainsthemedialendofdorsalvenousarchoffootPassesupwarddirectlyinfrontofthemedialmalleolus Thenascendsonmedialsideoftheleg Passesbehindthekneeandcurvesforwardaroundthemedialsideofthethigh Passesthroughthesaphenoushiatusinthedeepfasciaandjoinsthefemoralveinabout4cmbelowandlateraltothepubictubercle Superficialstructures Tributaries Superficiallateralfemoralv 股外侧浅静脉Superficialmedialfemoralv 股内侧浅静脉Externalpudendalv 阴部外静脉Superficialepigastricv 腹壁浅静脉Superficialiliaccircumflexv 旋髂浅静脉 Superficiallateralfemoralv Superficialmedialfemoralv Varicoseveins Superficialstructures Superficialarteries superficialepigastrica 腹壁浅动脉superficialiliaccircumflexa 旋髂浅动脉externalpudendala 阴部外动脉Cutaneousnerves lateralfemoralcutaneousn 股外侧皮神经anteriorcutaneousbranchesoffemoraln 股前皮神经medialcutaneousbranchesoffemoraln 股内侧皮神经cutaneousbranchesofobturatorn 闭孔神经皮支 lateralfemoralcutaneousn anteriorandmedialcutaneousbranchesoffemoraln Cutaneousbranchesofobturatorn Superficialstructures Superficialinguinallymphnodes腹股沟浅淋巴结Superiorgroup LiesjustdistaltotheinguinalligamentReceivelymphvesselsfromanteriorabdominalwallbelowumbilicus glutealregion perinealregion externalgenitalorgansInferiorgroup Liesverticalalongtheterminalgreatsaphenousv Receivesallsuperficiallymphvesselsoflowerlimb exceptforthosefromtheposterolateralpartofcalfEfferentvesselsdrainintothedeepinguinalln orexternaliliacln Deepfasciaofthethigh Fascialata阔筋膜Thedeepfasciaenclosesthethighlikeatrouserleg Saphenoushiatus隐静脉裂孔Agapinthedeepfasicawhichliesabout4cmbelowandlateraltothepubictubercle Thefalciformmargin镰状缘isthelowerlateralborderoftheopening whichliesanteriortothefemoralvessels Filledwithlooseconnectivetissuecalledthecribriformfascia筛筋膜 Deepfasciaofthethigh Fascialata阔筋膜Iliotibialtract髂胫束laterallythedeepfasciaformsathickbandfromtheiliactubercletothelateralcondyleoftibialThefascialatasendsintermuscularseptatothelineaasperaofthefemur Theseseparatethethighintothreecompartmentseachofwhichcontainsagroupofmuscles thevesselsandthenerves Contentsofanteriorcompartmentsofthigh Iliopsoas髂腰肌 Iliacus髂肌 Psoasmajo腰大肌 Sartorius缝匠肌 Quadricepsfemoris股四头肌 Vastusintermedius股中间肌 Vastuslateralis股外侧肌 Rectusfemoris股直肌 Vastusmedialis股内侧肌 Contentsofanteriorcompartmentsofthigh Pectineus耻骨肌 Adductorlongus长收肌 Adductorbrevis短收肌 Adductormagnus大收肌 Gracilis股薄肌 Adductortendinousopening收肌腱裂孔 Lacunamusculorum肌腔隙 Boundaries Anteriorly lateralportionofinguinalligamentPosterolaterally iliumMedially iliopectinalarchContents Iliopsoas髂腰肌femoraln 股神经lateralfemoralcutaneousn 股外侧皮神经 lateralfemoralcutaneousn Iliopsoas iliopectinalarch femoraln Lacunavasorum血管腔隙 Boundaries Anteriorly medialportionofinguinalligamentPosteriorly fasciaofpecteineusandpectinealligamentMedially lacunarligamentLaterally iliopectinalarchContents Femoralsheath股鞘Femorala andv 股动 静脉Genitalbranchofgenitofemoraln 生殖股神经股支Lymphaticvessels Femoraltriangle股三角 PositionAtriangulardepressedareaSituatedintheupperpartofthemedialaspectofthethighjustbelowtheinguinalligamentBoundariesSuperiorly base inguinalligament腹股沟韧带Laterally medialborderofsartorius缝匠肌内侧缘Medially medialborderofadductorlongus长收肌内侧缘Apex continuouswithadductorcanal收肌管Anteriorwall fascialata阔筋膜Posteriorwall consistsofiliopsoas髂腰肌 pectineus耻骨肌andadductorlongus长收肌fromlateraltomedialside Femoraltriangle股三角 Contents frommedialtolateralFemoraln 股神经Femoralsheath股鞘Femorala 股动脉Femoralv 股静脉Femoralcanal股管Deepinguinallymphnodes腹股沟深淋巴结Fattytissue脂肪组织 Femoraltriangle股三角 Femoralsheath股鞘Afunnel shapedsheathDerivedfromtransversalisfasciaanteriorlyandiliacfasciaposteriorlyItsurroumdsthefemoralvesselsandlymphaticabout2 5cmbelowertheinguinalligamemt ItslowerenddisappearsatthelowermarginofthesaphenousopeningwherethesheathfuseswiththeadventitiaofthevesselsDividedintothreecompartmentsbytwofibroussepta Femoraltriangle股三角 Femoralsheath股鞘ContentsLateralcompartment femorala 股动脉Middlecompartment femoralv 股静脉Medialcompartment femoralcanal股管 Femoraltriangle股三角 femoralcanal股管GeneralfeaturesAbout1 3cmlongContens alittleloosefattytissue asmalllymphnode andsomelymphvesselsFemoralring股环 upperopeningoffemoralcanalTheboundariesofthefemoralringAnteriorly inguinalligamentMedially lacunarlig 腔隙韧带Posteriorly pecteneallig 耻骨梳韧带Laterally femoralv 股静脉Superior coveredbyfemoralseptum股环隔 Femoraltriangle股三角 Femoralhernia股疝Ifaloopofintestineisforcedintothefemoralring itexpandstoformaswellingintheupperpartofthethigh Suchaconditionisknownasafemoralhernia股疝 Afemoralherniaismorecommoninwomenthaninmen possiblybecausetheirwiderpelvisandfemoralcanal Femoraltriangle股三角 Femorala 股动脉CourseContinuationoftheexternaliliaca BeginsmidpointofinguinalligamentEndsattheadductortendinousopeningbyenteringthepoplitealfossaasthepoplitealarteryPrincipalbranch deepfemerala 股深动脉arisesfromtheposterolateralsurfaceofthefemoralarteryabout5cmbelowtheinguinalligament Medialfemoralcircumflex旋股内侧动脉lateralfemoralcircumflex旋股外侧动脉Fourperforatingarteries穿动脉 Femoraltriangle股三角 Profundafemoris股深动脉Arisesfromtheposterolateralsurfaceofthefemoralarteryabout5cmbelowtheinguinalligamentBranches Lateralcircumflexartery旋股外侧动脉Medialcircumflexartery旋股内侧动脉Perforatingarteries穿动脉 deepfemerala Lateralcircumflexa Medialcircumflexa perforatingarteries Femoraltriangle股三角 Femoralvein股静脉BeginsattheadductortendinousopeningContinuesasexternaliliacveindeeptoinguinalligamentContainsseveralvalves Femoraltriangle股三角 Thedeepinguinallymphnodes腹股沟深淋巴结Liemedialtothefemoralv Receivedeeplymphaticsoflowerlimb perinealregion andefferentlymphaticsfromthesuperficialinguinalln Drainintotheexternaliliacln Femoraltriangle股三角 Femoralnerve股神经Arisesfromthelumbarplexusintheabdomen andentersthethighposteriortotheinguinalligamentandlateraltothefemoralartery Itendsbydividingintoanumberofbranches2cmbelowtheinguinalligament Femoraltriangle股三角 Femoralnerve股神经BranchesMuscularbrancheto pectineus sartorius quadricepsfemorisCutaneousbranchesSaphenousnerve隐神经IsthelongestbranchofthefemoralnerveItaccompaniesthefemoralvesselsintheadductorcanal thenaccompaniesthegreatsaphenousveintothemedialsideofthelegandfood Saphenousnerve Adductorcanal收肌管 PositionAnintermuscularcleftsituatedonthemedialaspectofthemiddlethirdofthethighbeneaththesartorius ExtendsfromapexoffemoraltriangletoadductortendinousopeningBoundariesAnteriorwall adductorlamina大收肌腱板andsartorius缝匠肌Lateralwall vastusmedialis股内侧肌Posteomedialwall adductorlongus长收肌andadductormagmus大收肌ContentsSaphenousn 隐神经Femorala andfemoralv 股动 静脉lymphaticvesselsandlooseconnectivetissue Bloodvesselsandnervesofmedialsideofthigh Obturatora 闭孔动脉ArisesfrominternaliliacarteryinthelesserpelvispassesthroughtheobturatorcanalwhereitdividesintoanteriorandposteriorbranchesObturatorn 闭孔神经Arisesfromthelumbarplexusintheabdomen Entersthethighthroughtheobturatorcanalwhereitdividesintoanteriorandposteriorbranches Suppliesmedialgroupofmusclesofthigh obturatorexternus andskinofmedialsideofthigh AnteriorandLateralCruralRegion小腿前外侧区 Anteriorcruralregion小腿前区 SuperficialstructuresGreatsaphenousv 大隐静脉Drainsthemedialendofdorsalvenousarchoffoodandpassesupwarddirectlyinfrontofthemedialmalleolus Thenascendsincompanywiththesaphenousn inthesuperficialfasciaoverthemedialsideoftheleg Anteriorcruralregion小腿前区 CutaneousnervesBranchesoflateralcutaneousn 腓肠外侧皮神经SuppliestheskinontheupperpartoftheanterolateralsurfaceofthelegSuperficialperonealn 腓浅神经SuppliestheskinofthelowerpartoftheanterolateralsurfaceofthelegSaphenousn 隐神经Suppliestheskinontheanteromedialsurfaceoftheleg Deepfascia深筋膜 SurroundsthelegandformstwointermuscularseptatobeattachedtothefibulaDividedthelegintothreecompartments anterior lateralandposterior eachofwhichcontainsagroupofmuscles thevesselsandthenerves Contentsofanteriorcompartmentofleg MusclesTibialisanterior胫骨前肌Extensorhallucislongus拇长伸肌Extensordigitorumlongus趾长伸肌Peroneustertius第三腓骨肌BloodsupplyAnteriortibiala 胫前动脉NervesupplyDeepperonealn 腓深神经 Contentsofanteriorcompartmentofleg Anteriortibialartery胫前动脉Beginning Arisesfromthepopliteaiarteryatthelowerborderofpopliteus Itpassesforwardsabovetheinterosseousmembrane andturnsdownwardsontheanteriorsurfaceofthatmembranewiththedeepperonealnerve Ending Infrontofanklejointbecomesthedorsalispedisa Theanteriortibialveins胫前静脉Closelyappliedtotheartery Contentsofanteriorcompartmentofleg Commonperonealn 腓总神经PassesoverposterioraspectofheadoffibulaandthenwindsaroundneckoffibulaDeeptoperoneuslongus whereitdividesintodeepandsuperficialperonealnervesDeepperonealnerve腓深神经ArisesfromthecommonperonealnervebetweentheneckofthefibulaandtheperoneuslongusmuscleDescendsintheanteriorcompartmentofthelegwiththeanteriortibialvesselsSuppliesallthemusclesoftheanteriorcompartmentofthelegandextensordigitorumbrevis Contentsoflateralcompartmentofleg MusclesPeroneuslongus腓骨长肌Peroneusbrevis腓骨短肌BloodsupplyBranchesfromtheperoneala 腓动脉NervesupplySuperficialperonealn 腓浅神经suppliesperoneuslongusandbrevisandskinonanteriorsurfaceofleganddorsumoffoot Deepperonealn Superficialperonealn Injurytothecommonperonealnerve Thecommonfibularnervemaybeseveredduringfractureofthefibulaneckorseverelystretchedwhenthekneejointisinjuredofdislocated Severanceofthecommonfibularn resultsinparalysisofallmusclesintheanteriorandlateralcompartmentsoftheleg Thelossofeversionofthefootanddorsiflexionoftheanklecausesfoot drop Thefootdropsandthetoesdragofthefloorwhenwalking Becauseitisimpossibletomaketheheelstrikethegroundfirst thepatienthasahighstepping steppage gait raisingthefootashighasnecessarytokeepthetoesfromhittingtheground Anteriortalocruralregionanddorsumoffoot踝前区和足背 SperficialstructuresDorsalvenousarch足背静脉弓LiesinthesubcutaneoustissueovertheheadsofthemetatarsalbonesDrainsonthemedialsideintothegreatsaphenousv andonthelateralsideintothesmallsaphenousv Superficialperonealn 腓浅神经SuppliestheskinofdorsumofthefootSaphenousn 隐神经SuppliestheskinonthemedialborderoffootDeepperonealn 腓深神经Suppliestheskinoftheadjacentsidesofthebigandsecondtoes Anteriortalocruralregionanddorsumoffoot踝前区和足背 DeepstructuresSuperiorextensorretinaculum伸肌上支持带Inferiorextensorretinaculum伸肌下支持带Dorsalarteryoffoot足背动脉Continuationsofanteriortibiala atanklejoint passesbeneathextensorretinavulumRunswiththedeepperonealnervebetweenthetendonsofextensorhallucislongusandextensordigitorumlongusBranchesMedialandlateraltarsalaa Arcuatea Firstdorsalmetatarsala Deepbranchofplantara Anteriortalocruralregionanddorsumoffoot踝前区和足背 Deepperonealn 腓深神经SuppliesmusclesondorsumoffootSuppliesskinoftheadjacentsidesofthebigandsecondtoes GlutealRegion臀区 Glutealregion臀区 Boundaries Superiorly iliaccrestInferiorly foldofbuttockMedially lateralbordersofsacrumandcoccyxLaterally alinejoininganteriorsuperioriliacspineandgreattrochanter Glutealregion臀区 Superiorclunealn Medialclunealn Cutaneousnerves Musclesofhip髋肌 PosteriorgroupGluteusmaximus臀大肌Gluteusmedius臀中肌Gluteusminimus臀小肌Piriformis梨状肌Gemellussuperior上孖肌Obturatorinternus闭孔内肌Gemellusinferior下孖肌Obturatorexternus闭孔外肌Quadratusfemoris股方肌 Glutealregion臀区 suprapiriformforamen infrapiriformforamen Glutealregion臀区 Structurespassingthroughsuprapiriformforamen fromlateraltomedial Superiorglutealn 臀上神经Superiorgluteala 臀上动脉Superiorglutealv 臀上静脉 Glutealregion臀区 Structurespassingthroughinfrapiriformforamen fromlateraltomedial Sciaticn 坐骨神经Posteriorfemoralcutaneousn 股后皮神经Inferiorglutealn 臀下神经Inferiorgluteala v 臀下动 静脉Internalpudendalv a 阴部内动 静脉Pudendaln 阴部神经 Theythencurveforwardstoentertheperineumthroughthelessersciaticforamen Glutealregion臀区 Anastomosisofarteriesaroundhipjoint髋周围动脉网Medialcircumflexfemorala 旋股内侧动脉Lateralcircumflexfemorala 旋股外侧动脉Superiorgluteala 臀上动脉Inferiorgluteala 臀下动脉Firstperforatinga 第一穿动脉 BackofThigh股后区 Contentsofposteriorcompartmentofthigh MusclesBicepsfemoris股二头肌Semitendinosus半腱肌Semimembranosus半膜肌BloodsupplyBranchesofthedeepfemoralarteryNervesupplySciaticnerve坐骨神经 Musclesofposteriorregionofthigh Semitendinosus半腱肌 Semimembranosus半膜肌 Longheadofbicepsfemoris股二头肌长头 Shortheadofbicepsfemoris股二头肌短头 Sciaticnerve坐骨神经 CourseArisesfromthesacralplexusLeavespelvisthroughinfrapiriformforamentoenterglutealregionRunsinferiorlylaterallydeeptogluteusmaximusPassingmidwaybetweenthegreatertrochanteroffemurandischialtuberositytobackofthighLyingdeeptolongheadofbicepsfemoris NormallydividedintotibialandcommonperonealnervesjustabovepoplitealfossaInnervatesSemitendinosus半腱肌Semimembranosus半膜肌Bicepsfemoris股二头肌Hipandkneejoints髋关节和膝关节 Relationshipofsciaticn tothepiriformis Poplitealfossa腘窝 BoundariesSuperolaterally Bicepsfemoris股二头肌Superomedially semimembranosusandsemitendinosus半腱肌和半膜肌Inferiorly lateralandmedialheadsofgastrocnemius腓肠肌内 外侧头Roof deepfasciaFloor poplitealsurfaceofthefemurposteriorcapsuleofthekneejointfasciacoveringpopliteus Poplitealfossa腘窝 ContentsNervesTibialnerve胫神经Commonperonealnerve腓总神经Poplitealveinanditstributaries腘静脉及属支Poplitealarteryanditsbranches腘动脉及分支Deeppopliteallymphnodes腘淋巴结 Poplitealfossa腘窝 Poplitealartery腘动脉CourseBeginsattheadductortendinousopeninghereitiscontinuouswiththefemoralarteryEndsatthelowerborderofthepopliteuswhereitdividesintoanteriorandposteriortibialarteriesBranchesMedialsuperiorgeniculara 膝上内侧动脉Lateralsuperiorgeniculara 膝上外侧动脉Medialinferiorgeniculara 膝下内侧动脉Lateralinferiorgeniculara 膝下外侧动脉Middlegeniculara 膝中动脉 Poplitealfossa腘窝 Poplitealvein腘静脉FormedbythejunctionoftheanteriorandposteriortibialveinsnearthelowerborderofthepopliteusmuscleDeeppopliteallymphnodes腘深淋巴结Maybe4 5nodesjustunderthedeepfascia closetothepoplitealfossavesselsDrainthedeeptissuesofthelegandfootandthekneejointAlsoreceivesuperficiallymphvesselsfromthelateralsideofthefoot theheel andthebackofthecalfEfferentspasstothedeepinguinallymphnode Genic