下肢的前面解剖

DepartmentofAnatomy，MedicalCollege，QingdaoUniversity下肢前面的解剖概述下肢前面可分为四个区域：股前区、膝前区、小腿前区、足背。本次课主要操作股前区和小腿前区。股前区与腹、盆腔之间有许多结构是相互延续的。这些结构往往通过二个重要的通道：肌腔隙与血管腔隙。小腿前外侧区深筋膜较致密。在胫侧，与胫骨体内侧面的骨膜紧密融合；在腓侧，发出前、后肌间隔止于腓骨骨膜。这样，前、后肌间隔，胫、腓骨骨膜与骨间膜共同围成前、外侧骨筋膜鞘，容纳相应肌群及血管、神经。

CLINICALANATOMYOFFEMORALHEADANDNECK

三个途径

1、关节囊的小动脉

（1）动脉环

三个途径

1、关节囊的小动脉

（2）四组：

上动脉：骺外侧动脉、干骺端上侧动脉

下动脉：骺内侧动脉、干骺端下侧动脉

股骨颈前动脉

股骨颈后动脉

2、股骨干滋养动脉升支

3、股骨头韧带的小动脉

股前内侧区（一）浅层结构1、皮肤薄厚不均，内侧较薄而柔软，外侧较厚。2、浅筋膜——浅筋膜近腹股沟处分为两层，浅层为脂肪层，与腹前下壁的脂肪层（Camper筋膜）相续；深层为膜性层，与腹前下壁的膜性层（Scarpa筋膜）相续。膜性层在腹股沟韧带下方约1cm处于股部深筋膜（阔筋膜）相融合。（1）浅动脉：旋髂浅动脉、腹壁浅动脉、阴部外动脉（2）浅静脉：大隐静脉及其5条属支旋髂浅静脉、腹壁浅静脉、阴部外静脉、股外侧浅静脉、股内侧浅静脉（3）浅皮神经：股外侧皮神经——来自腰丛股神经前皮支——来自股神经股神经内侧皮支——来自股神经Thecourseofgreatsaphenousvein

Thegreatsaphenousvein,thelongestveininthebody,islocatedinthesuperficialfascia,

itbeginsatthemedialendofthedorsalvenousarchofthefootandendsinthefemoralveinabout3cmbelowtheinguinalligament.

Thecourseof

greatsaphenousveinItascendsinfrontofthemedialmalleolusandalongthemedialsideoftheleginrelationwiththesaphenousnerve.Itrunsupwardbehindthemedialcondylesofthetibiaandfemurandalongthemedialsideofthethighand,passingthroughthefossaovalis,endsinthefemoralvein.Clinicalnote:First,inemergency,greatsaphenousveinmaybeopenedsurgicallyforintravenousdripforthepatientssufferingfrominsufficiencyofbodyfluid.Clinicalnote:SSecond,itprovidesanatomicalbasisforhighligatureofgreatsaphenousveinforpatientwithvaricosevein.Clinicalnote:Third,greatsaphenousveinasvenousgraftcanbeusedinthecoronarybypasssurgeryforcoronaryheartdisease.

SurfaceprojectionofgreatsaphenousveinSurfaceviewofgreatsaphenousveinTributaries:Attheankleitreceivesbranchesfromthesoleofthefootthroughthemedialmarginalvein;inthelegitanastomosesfreelywiththesmallsaphenousvein,communicateswiththeanteriorandposteriortibialveinsandreceivesmanycutaneousveins;inthethighitcommunicateswiththefemoralveinandreceivesnumeroustributaries;nearthefossaovalisitisjoinedbytheSuperficialcircumflexiliacvein,Superficialepigastricvein,Superficiallateralthighvein,Superficialmedialthighvein,ExternalpudendalveinTributariesneartheendofgreatsaphenousveinSuperficialcircumflexiliacveinSuperficialepigastricveinSuperficiallateralthighveinSuperficialmedialthighveinExternalpudendalveinVariationsoftributariesofgreatsaphenousveinSaphenousopeningSaphenousopening（4）浅淋巴结：上群（近侧群、斜群）——2~6个淋巴结，位于腹股沟韧带的下方，又可分为内、外侧两组下群（远侧群、纵群）——2~7个淋巴结，沿大隐静脉末段纵行排列又可分为内、外侧两组腹股沟浅淋巴结输出管注入腹股沟深淋巴结或髂外淋巴结。（二）深层结构1、深筋膜——大腿的深筋膜称阔筋膜或大腿固有筋膜，上方附于腹股沟韧带及髂嵴，与臀筋膜和会阴筋膜相续，下方与小腿筋膜、腘筋膜相续。阔筋膜坚韧致密，在大腿外侧份增厚，形成髂胫束。（1）髂胫束：后缘与臀大肌肌间相续；下端附与胫骨外侧髁、腓骨头和膝关节囊下部。上份分为两层，包裹阔筋膜张肌。临床上常用髂胫束作为体壁缺损、薄弱部位和膝关节交叉韧带修补重建的材料。（2）隐静脉裂孔：为腹股沟韧带中、内1/3交点下方约1横指处阔筋膜的卵圆形薄弱区。表面覆盖一层疏松结缔组织称筛筋膜（外筛板），有大隐静脉及其属支进入。2、前、内侧骨筋膜鞘阔筋膜向大腿深部发出股内侧、股外侧和股后3个肌间隔，附着于股骨粗线，与骨膜及阔筋膜共同形成3个股筋膜鞘。分别容纳相应的肌肉、血管、神经。3.肌腔隙和血管腔隙：腹股沟韧带与髋骨间被髂耻弓分隔为内侧部的血管腔隙和外侧部的肌腔隙。（1）肌腔隙：前界：腹股沟韧带外侧部；后外界：髂骨；内侧界：髂耻弓。内容：髂腰肌、股神经和股外侧皮神经。FEMORALSHEATH（2）血管腔隙：前界：腹股沟韧带内侧部；后内界：耻骨肌筋膜及耻骨梳韧带；内侧界：腔隙韧带；后外界：髂耻弓。内容：股鞘、股、动静脉，生殖股神经和淋巴管4、股三角（1）境界:上界:腹股沟韧带外侧界:缝匠肌内测缘内侧界:长收肌外侧缘前壁:阔筋膜后壁凹陷,髂腰肌、耻骨肌及其筋膜（或长收肌及其筋膜）（2）内容有股鞘、股管、股动脉、股静脉、股神经、腹股沟深淋巴结、淋巴管及脂肪组织。①股鞘：