局部解剖学局解课件3下肢中文

1、SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUASDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA下肢的境界与分区下肢的境界与分区n臀区臀区 Gluteal region qbetween iliac crest superiorly and gluteal fold inferiorly n股股 Thigh qbetween hip and kneen膝膝 Knee qjoint between leg and thighn小腿小腿 Leg qbetween knee and footn踝踝 Ankle n足足 Foot

2、SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA体表标志体表标志 nGluteal region and thighq髂前上棘髂前上棘 anterior superior iliac spinesq髂前下棘髂前下棘 anterior inferior iliac spines q髂结节髂结节 tubercle of iliac crest q坐骨结节坐骨结节I schial tuberosity q大转子大转子greater trochanter q耻骨结节耻骨结节 pubic tubercle q耻骨嵴耻骨嵴 pubic crest q耻骨联合上缘耻骨联合

3、上缘 superior border of pubic symphysis nKneeq髌骨髌骨 patellaq髌韧带髌韧带 patella ligament q胫骨粗隆胫骨粗隆 tuberosity of tibiaq内内(外外)侧髁侧髁 medial and lateral condyles q内内(外外)上髁上髁 medial and lateral epicondyles q股二头肌腱股二头肌腱 tendon of biceps femoris q半腱半腱(半膜半膜)肌腱肌腱 tendons of semitendinosus and semimembranosus nLegq胫骨前

4、缘胫骨前缘 anterior border of tibia q腓骨头腓骨头 head of fibula q腓骨颈腓骨颈 neck of fibula nAnkle and footq内内(外外)侧踝侧踝 medial and lateral malleolus q跟骨结节跟骨结节 calcaneal tuberosity q舟骨粗隆舟骨粗隆 tuberosity of navicular bone q第五跖骨粗隆第五跖骨粗隆 tuberosity of fifth metatarsal bone SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA对比关系对

5、比关系nNelaton 线线q侧卧，髋关节屈90120，自髂前上棘至坐骨结节的连线 q正常情况下该线通过股骨大转子尖，如果髋关节脱位或股骨颈骨折,大转子尖可移位于此线上方SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA对比关系对比关系nKaplan点 q仰卧，两下肢并拢伸直，当两髂前上棘处于同一平面时，由两侧大转子尖经同侧髂前上棘作一延长线。正常时两延长线相交于脐或脐以上，相交点称Kaplan点。q当髋关节脱位或股骨颈骨折时，此点偏移至脐下，并偏向健侧。SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA颈干角颈干角髋内翻髋内

6、翻Coxa vara (abnormally decreased angle of inclination, it occurs in fractures of the neck of the femur and slipping of the femoral epiphysis )髋外翻髋外翻Coxa valga (abnormally increased angle of inclination, in cases of congenital dislocation of the hip)颈干角颈干角Normal angle of inclination 1250-1300 SDU. SD

7、U. SDU. LIZHENHUALIZHENHUALIZHENHUA膝外翻角膝外翻角Normal alignment正常正常Genu varum (bowleg)膝内翻膝内翻 Genu valgum膝外翻膝外翻1700 17001700SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA体表投影体表投影n臀上动、静脉和神经臀上动、静脉和神经 superior gluteal a., v. ,n. q出入骨盆的投影点位于髂后上棘与股骨大转子尖连线的中、内1/3交点 n臀下动、静脉和神经臀下动、静脉和神经 inferior gluteal a., v. ,n. q

8、出入骨盆的投影点位于髂后上棘与坐骨结节连线的中点SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA体表投影体表投影n坐骨神经坐骨神经 sciatic nerve q出骨盆的投影点：位于髂后上棘至坐股结节连线的中点外侧约23cm处。q坐骨神经干的体表投影：股骨大转子与坐骨结节连线的中、内1/3交点至股骨内、外侧髁之间的中点之连线SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA体表投影体表投影n股动脉股动脉 femoral a. q大腿微屈并外展、外旋时，自髂前上棘与耻骨联合连线的中点至收肌结节连线的上2/3段SDU. SDU.

9、 SDU. LIZHENHUALIZHENHUALIZHENHUA体表投影体表投影n腘动脉腘动脉 popliteal a. q股后面中、下1/3交界线，与股后正中线交点内侧约2.5cm处至腘窝中点连线为腘动脉斜行段投影。q腘窝中点至腘窝下角连线为腘动脉垂直段投影 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA体表投影体表投影n胫前动脉胫前动脉 anterior tibial a. q腓骨头到胫骨粗隆连线的中点与内、外踝前面连线中点的连线n胫后动脉胫后动脉 posterior tibial a. q腘窝下角至跟腱内缘与内踝之间中点的连线 n足背动脉足背动脉

10、dorsal a. of food q内、外踝经足背连线的中点至第1、2跖骨底间之的连线 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股前内侧区股前内侧区SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股前内侧区浅层结构股前内侧区浅层结构大隐静脉大隐静脉Great saphenous vein n行程行程 course q在足背的内侧缘处起自足背静脉弓q向上行经内踝前方q沿小腿内侧与隐神经相伴行q经股骨内侧髁后方约2cm处，进入大腿内侧部，渐斜向上前方q在耻骨结节外下方34cm处，穿过隐静脉裂孔汇入股静脉 n属支属支

11、tributaries q股外侧浅静脉股外侧浅静脉 superficial lateral femoral v. q股内侧浅静脉股内侧浅静脉 superficial medial femoral v. q阴部外静脉阴部外静脉 external pudendal v. q腹壁浅静脉腹壁浅静脉 superficial epigastric v. q旋髂浅静脉旋髂浅静脉 superficial iliac circumflex v. SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA腹壁浅静脉阴部外静脉大隐静脉股外侧浅静脉股内侧浅静脉旋髂浅静脉SDU. SDU. S

12、DU. LIZHENHUALIZHENHUALIZHENHUAVaricose veinsSDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股前内侧区浅层结构股前内侧区浅层结构n浅动脉浅动脉 Superficial arteries q腹壁浅动脉腹壁浅动脉 superficial epigastric a. q旋髂浅动脉旋髂浅动脉 superficial iliac circumflex a. q阴部外动脉阴部外动脉 external pudendal a. n皮神经皮神经Cutaneous nerves q股外侧皮神经股外侧皮神经 lateral femor

13、al cutaneous n. q股股神经神经前皮支前皮支 anterior cutaneous branches of femoral n. q股神经内侧皮支股神经内侧皮支 medial cutaneous branches of femoral n. q闭孔神经皮支闭孔神经皮支 cutaneous branches of obturator n. SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股前内侧区浅层结构股前内侧区浅层结构 腹股沟浅淋巴结腹股沟浅淋巴结 Superficial inguinal ln.n上群上群: q沿腹股沟韧带下方并与其平行排列

14、q收纳来自脐以下腹壁浅层、臀部、外生殖器、会阴以及肛管和子宫的淋巴 n下群下群 q沿大隐静脉近侧段两侧纵行排列q收纳下肢浅淋巴管、会阴和外生殖器的部分淋巴 n输出管: 注入腹股沟深淋巴结或髂外淋巴结 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股前内侧区深层结构股前内侧区深层结构深筋膜深筋膜阔筋膜阔筋膜n 髂胫束髂胫束 Iliotibial tract q起自髂嵴前份，上部分为二层，包裹阔筋膜张肌q止于胫骨外侧髁、腓骨头和膝关节囊下部n 隐静脉裂孔隐静脉裂孔(卵圆窝卵圆窝) Saphenous hiatus q腹股沟韧带中内1/3交点下方1横指处 q孔的

15、外侧缘锐利而明显，称镰状缘镰状缘 falciform marginq隐静脉裂孔的表面覆盖着一层多孔的疏松结缔组织，称筛筋膜 cribriform fascia n股筋膜鞘股筋膜鞘 q阔筋膜发出股内侧、股后和股外侧肌间隔，伸入各肌群之间，附于股骨粗线q前、后、内骨筋膜鞘 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA前骨筋膜鞘前骨筋膜鞘髂腰肌髂腰肌 Iliopsoas髂肌髂肌 Iliacus腰大肌腰大肌 Psoas majo缝匠肌缝匠肌Sartorius股四头肌股四头肌Quadriceps femoris 股中间肌股中间肌 Vastusintermedius

16、股外侧肌股外侧肌 Vastus lateralis 股直肌股直肌 Rectus femoris 股内侧肌股内侧肌 Vastus medialis SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA前骨筋膜鞘前骨筋膜鞘n股动脉n股静脉n股神经n腹股沟深淋巴结SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA 肌腔隙肌腔隙 Lacuna musculorum n境界境界q前界：腹股沟韧带外侧部 q后外界：髂骨q内侧界：髂耻弓 n通过结构通过结构 q髂腰肌 Iliopsoas q股神经 femoral n. q股外侧皮神经 late

17、ral femoral cutaneous n. 股外侧皮神经髂腰肌髂耻弓股神经SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA 血管腔隙血管腔隙 Lacuna vasorum n境界境界q前界：腹股沟韧带内侧部q后界：耻骨肌筋膜及耻骨梳韧带q内侧界：腔隙韧带（陷窝韧带）q外侧界：髂耻弓 n通过结构通过结构 q股鞘股鞘 Femoral sheathn股动、静脉股动、静脉 Femoral a. and v. n生殖股神经股支生殖股神经股支 Genital branch of genitofemoral n. n淋巴管淋巴管 Lymphatic vessels

18、股动脉股静脉股环SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA 股三角股三角Femoral triangle n位置位置q位于股前内侧区上1/3部 n境界境界q上界：腹股沟韧带q外下界：缝匠肌内侧缘q内下界：长收肌内侧缘q前壁：阔筋膜q后壁：髂腰肌、耻骨肌和长收肌及其筋膜 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股三角股三角Femoral triangle n内容内容（从外向内） q股神经股神经 femoral n. q股鞘股鞘 femoral sheath n股动脉股动脉 femoral a. n股静脉股静脉

19、femoral v. n股管股管 femoral canal n腹股沟深淋巴结腹股沟深淋巴结 deep inguinal lymph nodes n脂肪组织脂肪组织 fatty tissue SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股三角股三角Femoral triangle股鞘股鞘 femoral sheath n为腹横筋膜与髂筋膜向下延续包绕与股动、静脉上部形成的筋膜鞘，呈漏斗形，长约34cm，向下与股血管的外膜融合，移行为股血管鞘 n股鞘借纵行的纤维隔分为外、中、内三部分q外侧部：容纳股动脉q中间部：容纳股静脉q内侧部：股管 SDU. SDU.

20、 SDU. LIZHENHUALIZHENHUALIZHENHUA股三角股三角Femoral triangle 股管股管femoral canal n位置位置：为股鞘内侧份漏斗状的筋膜间隙，长约11.5cm n构成构成q前壁：腹股沟韧带、腹横筋膜、隐静脉裂孔镰状缘的上端和筛筋膜q后壁：髂腰筋膜、耻骨梳韧带、耻骨肌及其筋膜q内侧壁：腔隙韧带及股鞘内侧壁q外侧壁：股静脉内侧的纤维隔q下端：为盲端，称股管下角q上口：股环，上面覆盖股环隔 n内容内容q腹股沟深淋巴结、脂肪组织SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股三角股三角Femoral triangle

21、股环股环 femoral ring q前界：腹股沟韧带q后界：耻骨梳韧带q内侧界：腔隙韧带q外侧界：股静脉内侧的纤维隔SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股三角股三角Femoral triangle股疝股疝 femoral hernia n腹内压增高腹腔脏器经股环股管隐静脉裂孔突出n女性较男性多见n股疝修补术时，在腔隙韧带附近应注意变异的闭孔动脉SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股三角股三角Femoral triangle 股动脉股动脉 femoral a. n行程行程q在腹股沟韧带中点的深面由髂

22、外动脉延续而来q经股三角下行至其尖部进入收肌管q穿收肌腱裂孔至腘窝，续于腘动脉n主要分支主要分支股深动脉股深动脉 q在腹股沟韧带下方约35cm处起自股动脉后外侧壁 q分支分支n旋股内侧动脉n旋股外侧动脉n穿动脉4条SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUADeep femeral a. 股深动脉Lateral circumflex a. 旋股外侧动脉Medial circumflex a.旋股内侧动脉 Perforating arteries穿动脉SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股三角股三角Femor

23、al triangle股静脉股静脉 femoral vein n为腘静脉向上的延续n始于收肌腱裂孔处，伴股动脉内侧上行，在股三角尖处行于股动脉的后外侧，后转至动脉的内侧n穿血管腔隙移行为髂外静脉 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股三角股三角Femoral triangle腹股沟深淋巴结腹股沟深淋巴结deep inguinal lymph nodesn在股静脉近侧段内侧，有34个n收纳下肢、会阴部的深、浅淋巴n输出管注入髂外淋巴结 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股三角股三角Femoral t

24、riangle 股神经股神经 femoral nerve n发自腰丛，经肌腔隙进入股三角内，位于股动脉外侧n在腹股沟韧带稍下方分成数支q肌支支配耻骨肌、股四头肌和缝匠肌q关节支至髋、膝关节q皮支供应股前内侧区的皮肤。n隐神经 saphenous nerve在股三角内伴行于股动脉的外侧n在膝关节内侧穿深筋膜，伴大隐静脉沿小腿内侧面下降，直至足内侧缘，沿途分布于小腿内侧面和足内侧缘的皮肤 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股神经股动脉股静脉隐神经SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA 收肌管收肌管Add

25、uctor canal n位置位置q位于股中1/3段前内侧，缝匠肌的深面，大收肌和股内侧肌之间 n境界境界q前壁：缝匠肌和收肌腱板q外侧壁：股内侧肌q后内侧壁：长收肌及大收肌q上口：通股三角q下口：收肌腱裂孔，通腘窝上角n通过结构通过结构q由前向后：隐神经、股动脉和股静脉及淋巴管和疏松结缔组织 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA内侧骨筋膜鞘内侧骨筋膜鞘耻骨肌耻骨肌 Pectineus长收肌长收肌 Adductor longus 短收肌短收肌 Adductor brevis 大收肌大收肌 Adductor magnus 股薄肌股薄肌 Gracil

26、is收肌腱裂孔收肌腱裂孔 Adductor tendinous opening SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA内侧骨筋膜鞘内侧骨筋膜鞘n闭孔动脉闭孔动脉 obturator a. q在盆腔内发自髂内动脉，穿闭膜管至股内侧区，分成前后二支 n闭孔神经闭孔神经 obturator n. q起自腰丛，伴闭孔血管一起穿闭膜管，在管内分为前、后两支，向下分别行于短收肌的前、后面q临床上用股薄肌代替肛门外括约肌的手术中，应注意保留至此肌的闭孔神经的分支 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUAObturato

27、r n.闭孔神经闭孔神经SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA小腿前外侧区小腿前外侧区SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA小腿前外侧区小腿前外侧区浅层结构浅层结构n皮肤 skin n大隐静脉 great saphenous v. n皮神经 cutaneous nervesq腓肠外侧皮神经Branches of lateral cutaneous n. nSupplies the skin on the upper part of the anterolateral surface of the leg

28、q腓浅神经 superficial peroneal n. nSupplies the skin of the lower part of the anterolateral surface of the legq隐神经 saphenous n. nSupplies the skin on the anteromedial surface of the legSDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA小腿前外侧区小腿前外侧区深筋膜深筋膜deep fascia n较致密，并与胫骨体内侧面的骨膜紧密融合；在腓侧向深面发出前、后两个肌间隔分别附着于腓骨前、后

29、缘的骨膜。n小腿深筋膜和前、后肌间隔，胫、腓骨骨膜及骨间膜之间共同围成前、外侧和后骨筋膜鞘，容纳相应肌群及血管、神经 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA小腿前骨筋膜鞘小腿前骨筋膜鞘nMusclesq胫骨前肌胫骨前肌 Tibialis anterior q拇长伸肌拇长伸肌 Extensor hallucis longus q趾长伸肌趾长伸肌 Extensor digitorum longus q第三腓骨肌第三腓骨肌 Peroneus tertius nBlood supplyq胫前动脉胫前动脉 Anterior tibial a. nNerve

30、supply q腓深神经腓深神经 Deep peroneal n. SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA小腿前骨筋膜鞘小腿前骨筋膜鞘 胫前动脉胫前动脉 Anterior tibial artery n行程行程q于腘肌下缘发自腘动脉，向前穿骨间膜上端进入小腿前骨筋膜鞘，紧贴骨间膜前面伴腓深神经下行。先行于胫骨前肌与趾长伸肌之间，后行于胫骨前肌与拇长伸肌之间。q至伸肌上支持带下缘处移行为足背动脉 q主要分支主要分支n胫前返动脉 Anterior tibial recurrent a. n胫前静脉胫前静脉 The anterior tibial vei

31、ns q2支，伴随同名动脉走行 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA小腿前骨筋膜鞘小腿前骨筋膜鞘腓深神经腓深神经 Deep peroneal nerve n由腓总神经在腓骨颈的外侧发出，走在腓骨长肌起始部的深面，穿小腿前肌间隔进入前骨筋膜鞘与胫前血管伴行。发肌支支配小腿前群肌和足背肌。皮支分布于第1、2趾相对面的背侧皮肤。n腓深神经损伤可导致足下垂及不能伸趾 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA小腿外侧骨筋膜鞘小腿外侧骨筋膜鞘nMusclesq腓骨长肌腓骨长肌 Peroneus longus q腓骨

32、短肌腓骨短肌 Peroneus brevis nBlood supplyq腓动脉腓动脉 Branches from the peroneal a. nNerve supply q腓浅神经腓浅神经 Superficial peroneal n. n在腓骨颈外侧由腓总神经发出，下行于腓骨长、短肌之间，发肌支支配此二肌。至小腿外侧中、下 1/3交点处穿出深筋膜行于皮下。n腓浅神经损伤常导致足不能外翻 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUAAnterior tibial a. 胫前动脉Dorsal a. of foot足背动脉Tibialis anteri

33、or 胫骨前肌Extensor hallucis longus拇长伸肌Extensor digitorum longus趾长伸肌Deep peroneal n. 腓深神经Superficial peroneal n.腓浅神经SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA腓总神经损伤腓总神经损伤nThe common fibular nerve may be severed during fracture of the fibula neck or severely stretched when the knee joint is injured of di

34、slocated. nSeverance of the common fibular n. results in paralysis of all muscles in the anterior and lateral compartments of the leg. The loss of eversion of the foot and dorsiflexion of the ankle causes foot-drop. nThe foot drops and the toes drag of the floor when walking. Because it is impossibl

35、e to make the heel strike the ground first, the patient has a high stepping (steppage”) gait, raising the foot as high as necessary to keep the toes from hitting the ground.SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA踝前区和足背踝前区和足背浅层结构浅层结构n足背静脉弓足背静脉弓 Dorsal venous arch n腓浅神经腓浅神经 Superficial peroneal n.

36、qSupplies the skin of dorsum of the foot n隐神经隐神经S aphenous n. qSupplies the skin on the medial border of foot n腓深神经腓深神经 Deep peroneal n. qSupplies the skin of the adjacent sides of the big and second toesSDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA踝前区和足背踝前区和足背深层结构深层结构n伸肌上支持带伸肌上支持带 Superior extensor re

37、tinaculum q位于踝关节上方q附着于胫、腓骨下端前缘之间n伸肌下支持带伸肌下支持带 Inferior extensor retinaculum q位于伸肌上支持带的下方，多呈横的“Y”字形q外侧端附着于跟骨外侧面，内侧端分两束，分别附着于内踝及足底深筋膜 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA踝前区和足背踝前区和足背足背动脉足背动脉 Dorsal a. of foot q行程行程n于伸肌上支持带下缘处续于胫前动脉，在踝关节前方行于拇长伸肌腱和趾长伸肌腱之间，位置表浅，体表易摸到搏动。 q分支分支n跗内、外侧动脉跗内、外侧动脉 Medial

38、and lateral tarsal aa. n弓状动脉弓状动脉 Arcuate a.n第第1趾背动脉趾背动脉 First dorsal metatarsal a. n足底深支足底深支 Deep branch of plantar a. n腓深神经腓深神经 Deep peroneal n. q伴足背动脉走行 q支配足背肌、第1、2趾背侧相对面的皮肤SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA臀区臀区SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA臀区臀区Gluteal region 境界境界n上界：髂嵴n下界：臀沟n外

39、侧界：髂前上棘至股骨大转子之连线n内侧界：骶、尾骨的外侧缘 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA臀区臀区Gluteal region Superior cluneal n.臀上皮神经Medial cluneal n.臀中皮神经Inferior cluneal n.臀下皮神经SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA臀区臀区Gluteal regionn髋肌后群髋肌后群q臀大肌臀大肌 gluteus maximus q臀中肌臀中肌 gluteus medius q臀小肌臀小肌 gluteus minimus

40、 q梨状肌梨状肌 piriformisq上孖肌上孖肌 gemellus superior q闭孔内肌闭孔内肌 obturator internusq下孖肌下孖肌 gemellus inferior q闭孔外肌闭孔外肌 obturator externus q股方肌股方肌 quadratus femoris SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA臀区臀区Gluteal regionq阔筋膜张肌阔筋膜张肌 tensor fasciae latae SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA臀区臀区Gluteal

41、 region梨状肌上孔梨状肌上孔suprapiriform foramen梨状肌下孔梨状肌下孔infrapiriform foramen 坐骨小孔坐骨小孔lesser sciatic foramenSDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA臀区臀区Gluteal region穿经梨状肌上孔的结构穿经梨状肌上孔的结构（从外向内）q臀上神经臀上神经 Superior gluteal n. q臀上动脉臀上动脉 Superior gluteal a. q臀上静脉臀上静脉 Superior gluteal v. SDU. SDU. SDU. LIZHENHUA

42、LIZHENHUALIZHENHUA臀区臀区Gluteal region穿经梨状肌下孔的结构穿经梨状肌下孔的结构（从外向内）q坐骨神经坐骨神经 sciatic n. q股后皮神经股后皮神经 posterior femoral cutaneous n. q臀下神经臀下神经 inferior gluteal n. q臀下动、静脉臀下动、静脉 inferior gluteal a., v. q阴部内动、静脉阴部内动、静脉 internal pudendal v., a. q阴部神经阴部神经 pudendal n. 穿经坐骨小孔的结构穿经坐骨小孔的结构q阴部内动、静脉阴部内动、静脉 internal

43、pudendal v., a. q阴部神经阴部神经 pudendal n. SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA坐骨神经坐骨神经Sciatic nerveSDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA臀区臀区Gluteal regionn髋周围动脉网髋周围动脉网q臀上动脉 superior gluteal a. q臀下动脉 inferior gluteal a. q旋股内侧动脉 medial circumflex femoral a. q旋股外侧动脉 lateral circumflex femoral a.

44、 q第一穿动脉 first perforating a. SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股后区股后区SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA股后区股后区Back of Thigh后骨筋膜鞘后骨筋膜鞘nMuscles q股二头肌股二头肌 biceps femoris q半腱肌半腱肌 semitendinosus q半膜肌半膜肌 semimembranosus nBlood supplyq股深动脉的分支股深动脉的分支 nNerve supplyq坐骨神经坐骨神经 sciatic nerve SDU.

45、SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA大腿肌后群大腿肌后群半腱肌Semitendinosus半膜肌Semimembranosus股二头肌长头Long head of biceps femoris股二头肌短头Short head of biceps femorisSDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA 坐骨神经坐骨神经Sciatic nerve n行程行程q起于骶丛q经梨状肌下孔出盆q在臀大肌深面，坐骨结节与大转子之间进入股后区，行于股二头肌长头和大收肌之间q至腘窝上角处分为胫神经和腓总神经 n支配支配q半腱肌 s

46、emitendinosusq半膜肌 semimembranosus q股二头肌 biceps femoris q髋关节和膝关节 hip and knee joints SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA腘腘窝窝 Popliteal fossa 境界境界n上外侧界：股二头肌n上内侧界：半腱肌和半膜肌n下外侧界：腓肠肌外侧头n下内侧界：腓肠肌内侧头n顶（浅面）：腘筋膜n底（自上而下）：股骨腘面、膝关节囊后部及腘斜韧带、腘肌及其筋膜 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA腘腘窝窝 Popliteal fo

47、ssa 内容内容（浅深） n神经q胫神经q腓总神经 n腘静脉及属支 n腘动脉及分支n腘深淋巴结SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA腘腘窝窝 Popliteal fossa 腘动脉腘动脉 popliteal artery n行程行程q在收肌腱裂孔处续于股动脉q至腘肌下缘处分为胫前动脉和胫后动脉 n分支分支q膝上内侧动脉 medial superior genicular a. q膝上外侧动脉 lateral superior genicular a. q膝下内侧动脉 medial inferior genicular a. q膝下外侧动脉 linf

48、erior genicular a. q膝中动脉 middle genicular a. SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA 腘腘窝窝 Popliteal fossa n腘静脉 Popliteal vein q与腘动脉伴行，位于动脉浅面 n腘深淋巴结 Deep popliteal lymph nodes q位于腘血管鞘附近的腘窝脂肪内，常有45个，收纳由足外侧缘及小腿后外侧部来的浅淋巴管以及足和小腿的深淋巴管。q其输出管与股血管伴行，向上注入腹股沟深淋巴结。 SDU. SDU. SDU. LIZHENHUALIZHENHUALIZHENHUA膝

49、关节网膝关节网Genicular articular rete n旋股外侧动脉降支 descending branch of lateral circumflex femeral a. n膝降动脉 descending genicular a. n膝上内侧动脉 medial superior genicular a. n膝上外侧动脉 lateral superior genicular a. n膝下内侧动脉 medial inferior genicular a. n膝下外侧动脉 lateral inferior genicular a. n膝中动脉 middle genicular a. n第3穿动脉 third perforating a. n胫前返动脉 anterior tibial recurrent a. SDU. SDU. SDU.