局部解剖学 下肢后区

RegionalanatomyoflowerlimbPosteriorregionoflowerlimb1.Surfaceanatomy表面解剖2.Thesuperficialstructures浅层结构Superficialveins浅淋巴管Superficiallymphvessels浅静脉Cutaneousnerves皮神经3.Thedeepstructures深层结构Thedeepfascia深筋膜Themuscles肌Thevessels血管Thenerves神经4.Regionalanatomy局部解剖Glutealregion臀区

suprapiriformforamenandinfrapiriformforamen梨状肌上孔和梨状肌下孔Poplitealfossa腘窝Posteriorregionoftheleg小腿后区Ankle踝区Maincontents2Surfaceanatomy3SurfaceAnatomy:PosteriorPelvis4SurfaceAnatomy:PosteriorLeg5Thesuperficialstructures6CutaneousNervesSuperiorclunealn.臀上皮神经Medialclunealn.臀中皮神经Inferiorclunealn.臀下皮神经7Medialsuralcutaneousn.

腓肠内侧神经Lateralsuralcutaneousn.

腓肠外侧神经Communicatingnerve

吻合支Suraln.

腓肠神经8DistributionofCutaneousNerves9Smallsaphenousv.ArisesfromthelateralpartofthedorsalvenousarchoffootAscendsbehindlateralmalleolusandthenpassesupwardtothemidlineoftheclftPiercesthedeepfasciaandentersthepoplitealv.Itdrainsthelateralsideofthefootandankleandthebackoftheleg.Superficialveins10Varices静脉曲张11Thedeepstructures12MusclesofglutealregionGluteusmaximus

臀大肌Gluteusmedius臀中肌Gluteusminimus臀小肌Piriformis

梨状肌Obturatorinternus闭孔内肌Quadratusfemoris股方肌Obturatorexternus闭孔外肌13MusclesofglutealregionGluteusmaximus

臀大肌Gluteusmedius臀中肌Gluteusminimus臀小肌Piriformis

梨状肌Obturatorinternus闭孔内肌Quadratusfemoris股方肌Obturatorexternus闭孔外肌14PosteriorgroupofmusclesofthethighBicepsfemoris股二头肌Semitendinosus半腱肌

Semimembranosus半膜肌

flexthelegatkneejointextendthethighathipjoint15

Posteriorgroupofmusclesoftheleg

Superficiallager

Tricepssurae小腿三头肌Gastrocnemius

腓肠肌Soleus

比目鱼肌16

Posteriorgroupofmusclesoftheleg

Deeplayer

Popliteus腘肌Flexordigitorumlongus趾长屈肌Flexorhallucislongus拇长屈肌Tibialisposterior胫骨后肌17MusclesoffootMusclesondorsum:extensordigitorumbrevisMusclesinsole:medial,lateralandintermediategroups18Arteriesoflowerlimb

Femorala.股动脉Continuationoftheexternaliliaca.BeginsmidpointofinguinalligamentPrincipalbranchdeepfemerala.股深动脉:medialfemoralcircumflexa.

旋股内侧动脉

lateralfemoralcircumflexa.

旋股外侧动脉

perforatingarteries

穿动脉19Popliteala.腘动脉

Continuationoffemorala.atadductorhiatusDividedintoanteriorandposteriortibialarteriesatlowerborderofpoplitusPosteriortibiala.胫后动脉Branches:peroneala.腓动脉

medialplantara.足底内侧动脉

lateralplantara.足底外侧动脉20PoplitealarteryItbeginsattheadductortendinousopeningin.Hereitiscontinuouswiththefemoralartery.Itendsatthelowerborderofthepopliteusmuscle（腘肌）whereitdividesintoanteriorandposteriortibialarteries.Branches:1.Superior,inferior,andmiddlegeniculararteries2.Muscularbranches21PoplitealveinThisisformedbythejunctionoftheanteriorandposteriortibialveinsnearthelowerborderofthepopliteusmuscle.Popliteallymphnodes

Theremaybeoneortwonodesjustunderthedeepfascia,closetothepoplitealfossavessels.Theydrainthedeeptissuesofthelegandfootandthekneejoint.Theyalsoreceivesuperficiallymphvesselsfromthelateralsideofthefoot,theheel,andthebackofthecalf.Thesedrainalongthelineofthesmallsaphenousvein.22Superiorglutealn.

臀上神经Inferiorglutealn.

臀下神经Posteriorfemoralcutaneous:

股后皮神经

Sciaticn.

坐骨神经Innervationofposteriorregionoflowerlimb23Sacralplexus骶丛24Sciaticn.坐骨神经Leavespelvisthroughinfrapiriformforamentoenterglutealregion,runsinferiorlylaterallydeeptogluteusmaximus,passingmidwaybetweenthegreatertrochanteroffemurandischialtuberositytobackofthigh,lyingdeeptolongheadofbicepsfemoris,normallydividedintotibialandcommonperonealnervesjustabovepoplitealfossaInnervatessemitendinosus,semimembranosusandbicepsfemorisandhasarticularbranchestohipandkneejoints2526Tibialn.胫神经

Runsinferiorlywithposteriortibialvesselsandterminatesbeneathflexorretinaculumbydividingintomedialandlateralplantarnerves足底内、外侧神经Suppliesposteriormusclesoflegandkneejoint27Regionalanatomy28Partsandregions

Glutealregion臀区Backofthethigh股后区Poplitealfossa腘窝Posteriorregionoftheleg

小腿后区Ankle踝区Soleofthefoot足底29suprapiriformforameninfrapiriformforamenGlutealRegion臀区30StructurespassingsuprapiriformforamenSuperiorglutealn.,a.,v.fromlateraltomedialsideStructurespassinginfrapiriformforamenSciaticn.,posteriorfemoralcutaneousn.,inferiorglutealn.,a.,v.,internalpudendalv.,a.,andpudendaln.fromlateraltomedialside

31Pudendalnerve,internalpudendalartery

Thesestructuresentertheglutealregionthroughtheinfrapiriformforamen.Theythencurveforwardstoentertheperineumthroughthelessersciaticforamen.32★Sciaticnerve

Course:Itarisesfromthesacralplexusandpassesthroughinfrapiriformforamenintotheglutealregion,deeptogluteusmaximus,passingmidwaybetweenthegreatertrochanteroffemurandischialtuberositytobackofthigh,thenerveliesdeeptothelongheadofbicepsontheposteriorsurfaceofadductormagnus.Thesciaticnerveusuallyendshalf-waydownthebackofthethighbydividingintothecommonperonealandtibialnerves.Distribution:semitendinosus,semimembranosusandbicepsfemorisandhasarticularbranchestohipandkneejoints33Relationshipofsciaticn.tothepiriformis34Boundariesofthepoplitealfossa腘窝Diamond-shapedUpperlateralboundary:BicepsfemorisUppermedialboundary:semimembranosusandsemitendinosusTwolowerboundariesaretheheadsofgastrocnemiusPosteriorwall:deepfasciaAnteriorwall:poplitealsurfaceofthefemur,theposteriorcapsuleofthekneejoint,andthefasciacoveringpoplitell