《局部解剖学》课件：第八章 下肢

1、2016-3,广西医科大学杨伯宁,第八章 下 肢,第一节 概述 一、 境界与分区 上界：髂嵴、腹股沟、 股会阴沟 分区：臀部、股部、膝部、小腿、足,2016-3,广西医科大学杨伯宁,二、 表面解剖（一）体表标志,髂嵴、髂前/后上棘，髂结节，坐骨结节，耻骨结节 股骨大转子股骨内、外侧髁，胫骨内、外侧髁： 髌骨，髌韧带： 胫骨粗隆，胫骨内侧面，内踝，腓骨头，腓骨颈，外踝 臀大肌，股四头肌， 半腱肌腱、半膜肌腱，股二头肌腱 腓肠肌两个头，跟腱 臀股沟，腘窝横纹,The lower limb,Section 1 Intruction,1. Boundaries and divisions,2. Sur

2、face anatomy,(1) The surface landmarks,Boundaries: Inguinal grooves, iliac crest, pudendal-thigh sulcus. Divisions: The lower limb is divided into the gluteal region (buttock), thigh, knee, leg, ankle and foot.,2016-3,广西医科大学杨伯宁,iliac crest anterior superior iliac spine posterior superior iliac spine

3、 tubercle of iliac crest ischial tuberosity greater trochanter pubic symphysis pubic crest pubic tubercle inguinal ligament,Gluteal region and thigh,2016-3,广西医科大学杨伯宁,Knee,Patella patella ligament tibial tuberosity lateral and medial condyles of femur lateral and medial epicondyles of femur Adductor

4、tubercle lateral and medial condyles of tibia Fibular head tendon of biceps femoris tendons of semitendinosus and semimembranosus,2016-3,广西医科大学杨伯宁,2016-3,广西医科大学杨伯宁,2016-3,广西医科大学杨伯宁,Leg, Ankle and foot,anterior border of tibia head of fibula neck of fibula medial and lateral malleolus calcaneal tuber

5、osity tuberosity of navicular bone tuberosity of fifth metatarsal bone,2016-3,广西医科大学杨伯宁,1,2,3,3,4,4,5,6,7,2016-3,广西医科大学杨伯宁,（二）对比关系,1、Nelaton 线 (Nelatons Line(also known as theRoser-Nlaton line) 侧卧，髋关节半屈位。自坐骨结 节至髂前上棘的连线。 此线恰通过股骨大转子尖，若大转子尖向此线上方或下方移位，多见于髋关节脱位或股骨颈骨折,法国,2016-3,广西医科大学杨伯宁,2、Kaplan 交点,仰卧位，两

6、腿伸直并扰，两髂前上棘处有同一平面，由左、右大转子尖经过同侧髂前上棘作延长线。,2016-3,广西医科大学杨伯宁,颈干角,颈干角125-130度 大于：髋外翻 小于：髋内翻,2016-3,广西医科大学杨伯宁,膝外翻角,外侧夹角170度 小于：膝外翻，X 大于：膝内翻，O,2016-3,广西医科大学杨伯宁,（四）体表投影,臀上动、静脉与神经 臀下动、静脉与神经 坐骨神经 股动脉 腘动脉 胫前动脉 胫后动脉 足背动脉,2016-3,广西医科大学杨伯宁,臀上动、静脉和神经,髂后上棘与股骨大转子尖连线的中、内/3 交点为臀上动、静脉和神经出入盆腔的投影点,2016-3,广西医科大学杨伯宁,臀下动、静脉

7、和神经,髂后上棘与坐骨结节连线的中点为臀下动、静脉和神经出入盆腔的投影点。,2016-3,广西医科大学杨伯宁,坐骨神经,坐骨神经出盆腔的投影点 在髂后上棘与坐骨结节连线的中点外侧2-3cm处。,2016-3,广西医科大学杨伯宁,坐骨神经干在臀部和股后部的投影位置 为股骨大转子与坐骨结节连线的中、内1/3 交点至- 股骨内、外侧髁之间中点（或腘窝上角）的连线。,1,2,2016-3,广西医科大学杨伯宁,股动脉,由髂前上棘至耻骨联合连线的中点 至收肌结节连线的上 段,1,2,3,2016-3,广西医科大学杨伯宁,足背动脉,内、外踝前面连线的中点至第 跖骨底外侧缘的连线 拇长肌腱和趾长肌腱之间 位置

8、表浅，其搏动易于触摸,2016-3,广西医科大学杨伯宁,1. Superior gluteal a.,v.,and n. 2. Inferior gluteal a.,v.,and n. 3. Sciatic n. 4. Femoral a. and v. 5. Popliteal a. 6. Anterior tibial a. 7. Posterior tibial a. 8. Dorsal artery of foot,The projections of the blood vessels and nerves,2016-3,广西医科大学杨伯宁,less-than 1250: coxa

9、 vara 髋内翻 (it occurs in fractures of the neck of the femur and slipping of the femoral epiphysis ),greater than 1300: coxa valga 髋外翻 (in cases of congenital先天性的dislocation of the hip),Normal angle of inclination 1250-1300,neck-shaft angle,2016-3,广西医科大学杨伯宁,Normal alignment,Genu varum (bowleg) 膝内翻,Gen

10、u valgum 膝外翻,1700,1700,1700,2016-3,广西医科大学杨伯宁,The orientation of the pelvis in the standing position,In the standing position the plane of the linea terminalis is usually inclined at an angle of about 600 to the horizontal. The anterior superior spine and the pubic symphysis are in approximately the

11、same vertical plane.,2016-3,广西医科大学杨伯宁,also known as the Roser-Nlaton 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 dislocated hip joint or

12、fractured femoral neck.,Nelatons line,normal,abnormal,2016-3,广西医科大学杨伯宁,2. Kapians point (shoemakers sign),The patient lies supine with stretched legs. Join a line from the apex of the greater trochanter to the anteior superior iliac spine. Normally, its prolonged line passes through or above the umb

13、ilicus. If the line passes below the umbilicus, it indicates the presence of superior displacement of the greater trochanter.,normal,abnormal,2016-3,广西医科大学杨伯宁,Bryant line and bryant triangle,2016-3,广西医科大学杨伯宁,2016-3,广西医科大学杨伯宁,一、股部(1)：股前内侧区,1. 皮肤 2. 浅筋膜,2016-3,广西医科大学杨伯宁,大隐静脉great saphenous vein,起始：足背静

14、脉弓的内侧端。 行程：内踝前方、股骨内侧髁后方约2cm、耻骨结节外下方穿隐静脉裂孔注入股静脉。,2016-3,广西医科大学杨伯宁,大隐静脉的高位属支： 旋髂浅静脉 腹壁浅静脉 阴部外浅静脉 股内侧浅静脉 股外侧浅静脉,2016-3,广西医科大学杨伯宁,2016-3,广西医科大学杨伯宁,临床意义：,大隐静脉切开 大隐静脉曲张,2016-3,广西医科大学杨伯宁,浅动脉 superficial artery,腹壁浅动脉 superficial epigastric artery 旋髂浅动脉 superficial circumflex iliac artery 阴部外浅动脉 Superficial

15、external pudendal artery,2016-3,广西医科大学杨伯宁,股部皮神经有： 股前皮神经 股内侧皮神经 股外侧皮神经 闭孔神经皮支 生殖股神经股支 髂腹股沟神经 隐神经 股后皮神经 腓肠内侧皮神经 腓肠外侧皮神经, 皮神经cutaneous nerve,前面观,2016-3,广西医科大学杨伯宁,股部皮神经有： 股前皮神经 股内侧皮神经 股外侧皮神经 闭孔神经皮支 生殖股神经股支 髂腹股沟神经 隐神经 股后皮神经 腓肠内侧皮神经 腓肠外侧皮神经, 皮神经,后面观,2016-3,广西医科大学杨伯宁,淋巴管,腹股沟浅淋巴结 上群收纳脐以下腹壁、臀部、会阴、外生殖器、肛门的淋巴。

16、 下群收纳足和小腿内侧，大腿的浅淋巴、臀部、会阴的部分淋巴。,腹股沟浅淋巴结的输出管注入腹股沟深淋巴结或髂外淋巴结。,Superficial structure,1.Skin 2.Superficial fascia,2016-3,广西医科大学杨伯宁,Superficial arteries:,Superficial epigastric a. 2. Superficial iliac circumflex a. 3. Superficial external pudendal a.,1,2,3,2016-3,广西医科大学杨伯宁,Superficial veins,great saphenou

17、s vein Origin: from the medial sides of a dorsal venous arch in the foot. Course: passes upward directly in front of the medial malleolus, then ascends on the medial side of the leg, knee, and thigh to pass through the saphenous hiatus in deep fascia and join with the femoral vein.,2016-3,广西医科大学杨伯宁,

18、Tributaries of the great saphenous vein Superficial iliac circumflex v. Superficial epigastric v. External pudendal v. Superficial medial femoral v. Superficial lateral femoral v.,2016-3,广西医科大学杨伯宁,Types of tributaries of the great saphenous vein,2016-3,广西医科大学杨伯宁,临床意义：,大隐静脉切开 大隐静脉曲张,Varicose veins,no

19、rmal,abnormal,2016-3,广西医科大学杨伯宁,腔镜下交通支结扎术,微创刨吸术,2016-3,广西医科大学杨伯宁,Origin: from the lateral sides of a dorsal venous arch in the foot. Course: passes behind the distal end of the fibula (lateral malleolus) and up the back of the leg to penetrate deep fascia and join the popliteal vein posterior to the

20、knee.,Small saphenous vein,2016-3,广西医科大学杨伯宁,Superficial peroneal n.,Cutaneous nerves:,股部皮神经有： anterior femoral cutaneous n. medial femoral cutaneous n. lateral femoral cutaneous n. cutaneous br. of obturator n. saphenous n. femoral br. of genitofemoral n. iliohypogastric n. ilioinguinal n.,2016-3,广西

21、医科大学杨伯宁,Lateral sural cutaneous n.,Superficial peroneal n.,Cutaneous nerves:,股部皮神经有： anterior femoral cutaneous n. medial femoral cutaneous n. lateral femoral cutaneous n. cutaneous br. of obturator n. saphenous n. femoral br. of genitofemoral n. iliohypogastric n. ilioinguinal n.,2016-3,广西医科大学杨伯宁,S

22、uperficial inguinal lymph nodes:,superior group inferior group,receive lymph drainage from the entire lower limb, the superficial structures of the perineum and abdominal wall below the umbilicus. Efferent vessels drain into the deep inguinal or external iliac lymph nodes.,2016-3,广西医科大学杨伯宁,2016-3,广西

23、医科大学杨伯宁,股前内侧区深层结构,一、深筋膜: 阔筋膜, fascia lata ,大腿的深筋膜的特称。为全身最厚的深筋膜，致密坚韧。,2016-3,广西医科大学杨伯宁,阔筋膜在股部形成下列三种结构:,（1）髂胫束 （2）隐静脉裂孔(卵圆窝) （3）三个肌间隔,2016-3,广西医科大学杨伯宁,分别容纳各群的肌肉、血管和神经。,二、骨筋膜鞘 Osteofascialcompartments; fascialcompartments,由阔筋膜、三个肌间隔及股骨骨膜共同围成三个骨筋膜鞘。 前骨筋膜鞘 内侧骨筋膜鞘 后骨筋膜鞘,2016-3,广西医科大学杨伯宁,骨筋膜鞘综合症： 腔内压力大于30m

24、mHg必须积极治疗， 超过24小时造成功能损害； 超过72小时只能截肢,2016-3,广西医科大学杨伯宁,vastus medialis,vastus lateralis,rectus femoris,大腿肌（前群、内侧群后群）及神经、血管,1、大腿肌前群： 股四头肌quadriceps femoris（股直肌、股内侧肌、股外侧肌、股中间肌） 缝匠肌 sartorius muscle 2、神经支配：股神经 3、营养血管：股A,2016-3,广西医科大学杨伯宁,肌肉： 耻骨肌 长收肌 短收肌 大收肌 股薄肌 神经支配：闭孔N 血液供应：闭孔AV,大腿肌内侧群及神经、血管,1,2,3,4,5,2,

25、5,4,2016-3,广西医科大学杨伯宁,神经血管,前：股A、V、N 内：闭孔A、V、N,2016-3,广西医科大学杨伯宁,局部结构,肌腔隙与血管腔隙 股三角 收肌管,2016-3,广西医科大学杨伯宁,位置：位于腹股沟韧带与髋骨之间。 是腹、盆腔与股前区的重要通道，被髂耻弓分为二部： 1、肌腔隙 2、血管腔隙,1、肌腔隙与血管腔隙,2016-3,广西医科大学杨伯宁,肌腔隙：,境界： 前界: 腹股沟韧带 后界: 髂骨 内侧界: 髂耻弓 肌腔隙通过的结构: 髂腰肌 股神经 股外侧皮神经,2016-3,广西医科大学杨伯宁,血管腔隙：,境界： 前界：腹股沟韧带 后界：耻骨肌筋膜及耻骨梳韧带 内侧界：腔

26、隙韧带 外侧界：髂耻弓,2016-3,广西医科大学杨伯宁,血管腔隙通过的结构:,股鞘：腹横筋膜与髂筋膜向下延续包绕于股动、静脉上部形成的筋膜鞘呈漏斗形，包围下列结构： 股动脉 股静脉 股管：股管的开口为股环，其外为股静脉，后为耻骨，仅前、内为韧带，是扩大股管的部位。,2016-3,广西医科大学杨伯宁,股三角,境界： 上界：腹股沟韧带 下外界：缝匠肌内侧缘 下内界：长收肌内侧缘 前壁：阔筋膜 后壁：髂腰肌、耻骨肌、长收肌 向下通收肌管。,2016-3,广西医科大学杨伯宁,股三角内容：,肌腔隙通过的结构: 髂腰肌 、股神经、股外侧皮神经,从外向内依次为： 股动脉 股静脉 股管,股鞘为腹横筋膜和髂筋

27、膜向下延伸的筋膜鞘,被二个纵向的纤维隔分为外、中、内三部分。,2016-3,广西医科大学杨伯宁,（）股动脉 femoral artery: 是股三角内的中心结构，有四大分支。 向前发出三条动脉即：腹壁浅动脉、旋髂浅动脉和阴部外动脉。 向后发出股深动脉， 股深动脉又发出旋股内、外侧动脉和穿动脉，股动脉与股深动脉几乎处于同一垂线上。,2016-3,广西医科大学杨伯宁,股管,位置：股鞘最内侧，长约1-2cm。下端为盲端，适对隐静脉裂孔。上口为股环，被薄层疏松结缔组织覆盖，称股环隔，上面衬有腹膜。 从腹腔面观察，此处有一小凹，称股凹，位置高与管环约1cm。,股环周界: 前界: 腹股沟韧带 ；内侧界:

28、腔隙韧带 后界: 耻骨梳韧带；外侧界: 股静脉内侧的纤维隔,2016-3,广西医科大学杨伯宁,腹内压升高时，腹盆腔脏器可被推向股凹，经股环至股管而形成股疝，以老年女性为多见。,股疝的形成:,股疝 在8407个疝患者中，股疝有442例，占5。3 它与腹股沟疝比约为117 在442例股疝中，女性有327例，占74,2016-3,广西医科大学杨伯宁,股疝特点 女性发病率高于男性,股疝容易嵌顿,An 87 year-old woman presented with a painful left groin bulge. Because the bulge was mostly below a line

29、 drawn between the anterior superior iliac spine and the pubic tubercle, a diagnosis of femoral heria was made. A gentle attempt at reduction was unsuccessful.,sac of parietal peritoneum,2016-3,广西医科大学杨伯宁,Four sutures of 2-0 prolene were placed from below the inguinal ligament. Inguinal ligament and

30、iliopubic tract were sutured to the pectineus fascia directly posteriorly, closing the femoral canal.,The completed repair is shown.,2016-3,广西医科大学杨伯宁,2016-3,广西医科大学杨伯宁,腹股沟深淋巴结,位于股静脉上部周围和股管内。收纳下肢、会阴部、臀部等处的淋巴，其输出管注入髂外淋巴结。,2016-3,广西医科大学杨伯宁,收肌管(Hunter管),位置：股前内侧区中1/3段，长约15cm。 境界： 前内侧壁: 缝匠肌及大收肌腱板 前外侧壁: 股内侧

31、肌 后壁: 长收肌、大收肌 上口: 接股三角（尖） 下口: 收肌腱裂孔，通腘窝,又称股腘管。,2016-3,广西医科大学杨伯宁,通过结构及位置关系,从前向后为: 隐神经 saphenous nerve 股动脉femoral artery 股静脉femoral vein,2016-3,广西医科大学杨伯宁,股内侧区的血管、神经,闭孔动脉obturator artery 闭孔神经obturator nerve,The deep structures,Deep fascia fascia lata,P352,2016-3,广西医科大学杨伯宁,The structures formed by fasci

32、a lata:,（1） Iliotibial tract （2） Saphenous hiatus - falciform margin - cribriform fascia （3）three intermuscular septa,Ant. osseofascial compartments,Med. osseofascial compartments,Post. osseofascial compartments,2016-3,广西医科大学杨伯宁,The lacuna musculorum and lacuna vasorum,Position：the gap between ingui

33、nal ligament and hip bone. A iliopectineal arch extending from the inguinal ligament to the iliopectneal eminence.,Lacuna musculorum,lacuna vasorum,Lacuna musculorum,lacuna vasorum,iliopectineal arch,2016-3,广西医科大学杨伯宁,Boundies： anteriorly: inguinal ligament posterolaterally: ilium Medially:The iliope

34、ctineal arch,The lacuna musculorum,Contents: The iliopsoas The femoral nerve The lateral femoral cutaneous n.,2016-3,广西医科大学杨伯宁,Boundies: anteriorly: inguinal ligament posteromedially: fascia of pectineus and pectineal ligament medially: lacunar ligament laterally: iliopectinal arch,lacuna vasorum,Co

35、ntents: Femoral sheath Femoral a., v. and femoral canal Femeral branch of genitofemoral n. Lymphatic vessels,2016-3,广西医科大学杨伯宁,femoral triangle,The boundaries： Superiorly: inguinal ligament Infralaterally: med. border of the sartorius medially: med. border of the adductor longus anterior wall: fascia

36、 lata posterior wall: adductor longus, pectineus and iliopsoas,2016-3,广西医科大学杨伯宁,The structures pass through the Muscular lacuna : iliopsoas femoral n. lateral femoral cutaneous n.,Contents of the femoral triangle,2016-3,广西医科大学杨伯宁,Contents of the femoral triangle,from lateral to medial side ： femoral

37、 a. femoral v. femoral canal,The structures pass through the vascular lacuna:,femoral sheath is a 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.,2016-3,广西医科

38、大学杨伯宁,Femoral nerve (L2,L3,L4) ： Muscular branche: Supplies the muscles of the anterior compartment of the thigh, including pectineus and iliopsoas. Cutaneous branches: Anterior cutaneous n. of the thigh Saphenous n.。,2016-3,广西医科大学杨伯宁,位于股静脉上部周围和股管内。收纳下肢、会阴部、臀部等处的淋巴，其输出管注入髂外淋巴结。,deep inguinal lymph n

39、odes,2016-3,广西医科大学杨伯宁,The adductor canal (Hunter管),位置: an aponeurotic tunnel in the middle third of the thigh, extending from the apex of the femoral triangle to the opening in the Adductor magnus, the Adductor hiatus.,2016-3,广西医科大学杨伯宁,femoral canal,It is the medial compartment of the femoral sheath

40、 about 2cm long. contains lymphatic vessels, a lymph node and small amount of loose fatty tissue. Its upper opening is called the femoral ring.,The femoral canal is bordered: Anteriorly by the inguinal lig. Posteriorly by the pectineal lig. Medially by the lacunar lig. Laterally by the femoral vein,

41、2016-3,广西医科大学杨伯宁,Femoral hernia,If a loop of intestine is forced into the femoral ring, it expands to form a swelling in the upper part of the thigh.,2016-3,广西医科大学杨伯宁,An 87 year-old woman presented with a painful left groin bulge. Because the bulge was mostly below a line drawn between the anterior

42、superior iliac spine and the pubic tubercle, a diagnosis of femoral heria was made. A gentle attempt at reduction was unsuccessful.,sac of parietal peritoneum,2016-3,广西医科大学杨伯宁,knuckle of dead bowel,sac of parietal peritoneum,2016-3,广西医科大学杨伯宁,Four sutures of 2-0 prolene were placed from below the ing

43、uinal ligament. Inguinal ligament and iliopubic tract were sutured to the pectineus fascia directly posteriorly, closing the femoral canal.,The completed repair is shown.,2016-3,广西医科大学杨伯宁,The adductor canal (Hunter管),上口: 接股三角尖 下口: 收肌腱裂孔，通腘窝。,Boundaries: Anteriorly: sartorius and adductor lamina Ante

44、rolaterally: vastus medialis Posteriorly: adductor longus and adductor magnus,2016-3,广西医科大学杨伯宁,通过结构及位置关系： 从前向后为: saphenous n. femoral a. femoral v.,2016-3,广西医科大学杨伯宁,Blood vessels and nerve of medial side of thigh,Obturator a. Obturator n.,2016-3,广西医科大学杨伯宁,2016-3,广西医科大学杨伯宁,膝前区,浅层结构,深层结构,皮肤 浅筋膜 髌前皮下囊,

45、髌韧带 髌支持带 髌上囊,膝前区,浅层结构,深层结构,皮肤 浅筋膜 髌前皮下囊,鹅足 髌韧带 髌内、外侧支持带 髌上囊,2016-3,广西医科大学杨伯宁,鹅足 pes anserinus tendon,2016-3,广西医科大学杨伯宁,是缝匠肌、股薄肌、半腱肌三块肌肉之腱性部分在胫骨近段内侧的附着点，外形类似鹅足，故称鹅足。 在其下与胫骨之间有一滑囊称鹅足腱囊。 由于反复应力的作用，如活动过多 等，可造成此处产生无菌性炎症，称之为鹅足炎或鹅足腱囊炎。,鹅足腱,2016-3,广西医科大学杨伯宁,小腿前外侧区,一、浅层结构 （一）浅静脉 大隐静脉 great saphenous vein 隐神经

46、saphenous nerve,2016-3,广西医科大学杨伯宁,二、深层结构,骨筋膜鞘Osteofascialcompartments; fascialcompartments 小腿骨间膜及前、后肌间隔将小腿为三个骨筋膜鞘，即： 前骨筋膜鞘 外侧骨筋膜鞘 后骨筋膜鞘,2016-3,广西医科大学杨伯宁,1. 前骨筋膜鞘,（1）肌肉 胫骨前肌 拇长伸肌 趾长伸肌 腓骨第三肌 （2）血管和神经支配 胫前动脉-足背动脉 腓深神经 deep fibular nerve,2016-3,广西医科大学杨伯宁,2.外侧骨筋膜鞘,（1）肌肉 腓骨长肌 腓骨短肌 （2）腓浅神经Superficial fibula

47、r nerve: 分布于小腿外侧群肌肉、小腿外侧及足背皮肤。,腓总神经损伤 Lesions of the common fibular nerve,马蹄内翻足 畸形,足不能背屈，足下垂、内翻，趾不能伸，“马蹄”内翻足， 感觉障碍在小腿外侧和足背明显。Drop foot,2016-3,广西医科大学杨伯宁,The Anterior and Lateral Regions of The Leg,1. The superficial structures （1）The superficial fascia Superficial veins and nerves The great saphenous

48、 v. The saphenous n. Superficial peroneal n.,2016-3,广西医科大学杨伯宁,The deep fascia: Surrounds the leg and forms anterior and posterior intermuscular septa to be attached to the fibula. Divided the leg into three compartments: anterior, lateral and posterior, each of which contains a group of muscles, the

49、 vessels and the nerves.,2. The deep structures,2016-3,广西医科大学杨伯宁,The content of the anterior osseofascial compartment (Osteofascialcompartments, fascialcompartments),（1）muscles tibialis anterior extensor hallucis longus extensor digitorum longus peroneus tertius （2）血管神经 anterior tibial a. and v.- do

50、rsal artery of foot deep peroneal nerve (deep fibular nerve),2016-3,广西医科大学杨伯宁,The content of the lateral osseofascial compartment,（1）muscles The peroneus longus The peroneus brevis （2）superficial peroneal n. (superficial fibular nerve),supplies peroneus longus and brevis and skin on anterior surface

51、 of leg and dorsum of foot,2016-3,广西医科大学杨伯宁,Injury to the common peroneal nerve(common fibular nerve),The loss of eversion of the foot and dorsiflexion of the ankle causes foot-drop. the patient has a high stepping (steppage”) gait, raising the foot as high as necessary to keep the toes from hitting

52、 the ground.,2016-3,广西医科大学杨伯宁,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 Gr

53、acilis,Vessels Great saphenous v. Femoral a. Deep femoral a. Nerves femoral n. Saphenous n. Obturator n.,2016-3,广西医科大学杨伯宁,You must identify follow structures！,Anterolateral crural region and dorsum of the foot Muscles Tibialis anterior Extensor hallucis longus Extensor digitorum longus Peroneus long

54、us Peroneus brevis Vessels Great saphenous v. Anterior tibial a. Dorsalis pedis a. Nerves Common peroneal n. Deep peroneal n. Superficial peroneal n.,2016-3,广西医科大学杨伯宁,2016-3,广西医科大学杨伯宁,下肢后区,臀部Gluteal region 股后区 膝部后（腘窝） 小腿后区 足底,2016-3,广西医科大学杨伯宁,二、 表面解剖（一）体表标志,臀裂、臀沟 髂嵴（两侧髂嵴最高点的连线平对第4腰椎棘突）后上棘，髂结节，坐骨结节，股

55、骨大转子： 内踝，腓骨头，腓骨颈，外踝 臀大肌 半腱肌腱、半膜肌腱，股二头肌腱 腓肠肌两个头，跟腱 臀股沟，腘窝横纹,2016-3,广西医科大学杨伯宁,1、境界：髂嵴、臀裂、臀沟 2、浅层结构 3、深层结构 深筋膜、肌、N、血管,一、臀部,Surface anatomy,Gluteal region and thigh posterior superior and inferior iliac spines tubercle of iliac crest ischial tuberosity 坐骨结节 Median sacral crest 骶正中嵴 Sacral cornu 骶角 Sacra

56、l hiatus 骶管裂孔,Surface anatomy,Gluteal region and thigh posterior superior and inferior iliac spines tubercle of iliac crest ischial tuberosity 坐骨结节 Median sacral crest 骶正中嵴 Sacral cornu 骶角 Sacral hiatus 骶管裂孔,1,2,3,2016-3,广西医科大学杨伯宁,natal cleft ：intergluteal cleft； butt crack； 臀裂 gluteal sulcus 臀沟： al

57、so known as the gluteal fold or horizontal gluteal crease,back of the knee - popliteal fossa,tendon of biceps femoris tendon of semitendinosus tendon of semimembranosus,2016-3,广西医科大学杨伯宁,1、境界 2、浅层结构 3、深层结构 深筋膜、肌、N、血管,一、臀部,2016-3,广西医科大学杨伯宁,臀部的浅层结构,皮肤厚而坚韧，富于皮脂腺和汗腺，易患疖、痈， 浅筋膜很发达，有许多纤维束连接皮肤与深筋膜，其间充满丰富的皮下

58、脂肪，形成软垫，承受坐位时的压力。,2016-3,广西医科大学杨伯宁,臀上动、静脉和神经体表投影,髂后上棘与股骨大转子尖连线的中、内/3 交点为臀上动、静脉和神经出入盆腔的投影点,2016-3,广西医科大学杨伯宁,臀下动、静脉和神经,髂后上棘与坐骨结节连线的中点为臀下动、静脉和神经出入盆腔的投影点。,2016-3,广西医科大学杨伯宁,坐骨神经,坐骨神经出盆腔的投影点在髂后上棘与坐骨结节连线的中点外侧2-3cm处。 坐骨神经干在臀部和股后部的投影位置为股骨大转子与坐骨结节连线的中、内1/3 交点至股骨内、外侧髁之间中点（或腘窝上角）的连线。,2016-3,广西医科大学杨伯宁,健美的臀部是个体美的

59、重要标志之一,臀围是显示人体曲线美的重要三围之一，尤其于女性美显得更为重要。 一般据女性臀部的形态，体积和皮肤的弹性，分为四型,2016-3,广西医科大学杨伯宁,1上翘型： 2标准型： 3下垂型： 4扁平型：,2016-3,广西医科大学杨伯宁,臀部脂肪沉积的类型,2016-3,广西医科大学杨伯宁,臀区的浅筋膜内含有四组皮神经,（1）臀上皮神经：L13 （2）臀中皮神经：S13 （3）臀下皮神经：发自股后皮神经 （4）髂腹下神经的外侧皮支：布于臀前部的皮肤。 臀部行去脂术时，勿损伤这些神经，以免影响感觉,2016-3,广西医科大学杨伯宁,臀部的皮血管主要有2支,臀上动脉皮支：从梨状肌上缘和臀中肌后缘之间浅出，主要供应臀大肌上部及相应的皮肤。 臀下动脉皮支：于臀大肌下缘浅出，主要供应臀中、下部的皮肤。 臀部吸脂术的相对禁区,superior clu