局部解剖学课件：4-膝关节小腿后区和踝

1、Popliteal Fossa , Back of Leg and Malleolar canal 山东大学医学院 解剖教研室Popliteal fossa 腘窝1.skin2.Superficial structuresBoundariesSuperolaterally: Biceps femoris 股二头肌 Superomedially: semimembranosus and semitendinosus 半腱肌和半膜肌Inferiorly: lateral and medial heads of gastrocnemius 腓肠肌内、外侧头Roof: deep fascia Floo

2、r: popliteal surface of the femurposterior capsule of the knee jointfascia covering popliteus 3.Deep structuresContents NervesTibial nerve 胫神经Common peroneal nerve 腓总神经Popliteal vein and its tributaries 腘静脉及属支Popliteal artery and its branches 腘动脉及分支Popliteal lymph nodes 腘淋巴结Popliteal artery 腘动脉Cours

3、eBegins at the adductor tendinous opening here it is continuous with the femoral arteryEnds at the lower border of the popliteus where it divides into anterior and posterior tibial arteriesBranchesMedial superior genicular a. 膝上内侧动脉Lateral superior genicular a. 膝上外侧动脉Medial inferior genicular a. 膝下内

4、侧动脉Lateral inferior genicular a. 膝下外侧动脉Middle genicular a. 膝中动脉 Popliteal vein 腘静脉Formed by the junction of the anterior and posterior tibial veins near the lower border of the popliteus muscle Popliteal lymph nodes 腘淋巴结May be one or two nodes just under the deep fascia, close to the popliteal fossa

5、 vesselsDrain the deep tissues of the leg and foot and the knee jointAlso receive superficial lymph vessels from the lateral side of the foot, the heel, and the back of the calfDrain along the line of the small saphenous vein into deep inguinal ln. Genicular articular rete 膝关节网Descending branch of l

6、ateral circumflex femeral a. 旋股外侧动脉降支Descending genicular a. 膝降动脉Articular branches of popliteal a. 腘动脉关节支Anterior tibial recurrent a. 胫前返动脉Back of LegBack of legSmall saphenous v. 小隐静脉Arises from the lateral part of the dorsal venous arch of footAscends behind lateral malleolus and then runs up the

7、 midline of the back of the leg Pierces the deep fascia and enters the popliteal v.Drains the lateral side of the foot and ankle and the back of the leg1.skin2.Superficial structuresBack of legCutaneous nervesMedial sural cutaneous nerve 腓肠内侧皮神经Peroneal communicating n. 腓神经交通支Sural nerve 腓肠神经Content

8、s of the posterior osseofascial compartment of the legSuperficial group muscles Gastrocnemius 腓肠肌 Soleus 比目鱼肌Plantaris 跖肌Deep group musclesPopliteus 腘肌Flexor digitorum longus 趾长屈肌Tibialis posterior 胫骨后肌 Flexor hallucis longus 拇长屈肌Blood supplyPosterior tibial a.Nerve supplyTibial nerveMuscles of back

9、 of leg Gastrocnemius腓肠肌 Soleus比目鱼肌Plantaris跖肌Flexor hallucis longus拇长屈肌Popliteus 腘肌 Flexor digitorum longus趾长屈肌Tibialis posterior胫骨后肌 Tendo calcaneus跟腱Back of legPosterior tibial artery 胫后动脉Course Begin at level of the lower border of the popliteus Passes downwards deep to gastrocnemius and soleusP

10、asses behind medial malleolus and terminates by dividing into medial and lateral plantar arteriesMain branchesperoneal a. 腓动脉medial plantar a. 足底内侧动脉 lateral plantar a. 足底外侧动脉 Back of legTibial nerve 胫神经Runs inferiorly with posterior tibial vessels and terminates beneath flexor retinaculum by dividi

11、ng into medial and lateral plantar nervesSupplies posterior muscles of leg and knee jointMalleolar canal 踝管BoundariesFormed by medial surface of calcaneus, flexor retinaculum and medial malleolusStructures passing through the malleolar canalTibialis posterior 胫骨后肌Flexor digitirum longus 趾长屈肌Posterior tibial a. v. 胫后动脉、静脉Tibial n. 胫神经Flexor hallucis longus 拇长屈肌Skin incisionsMake the skin incisions shown in figure and reflect the skin flapsYou must identify follow structures！Muscles Gastrocnemius 腓肠肌Soleus 比目鱼肌Tendo calcaneus 跟腱Flexor digitorum longus 趾长屈肌Tibialis poste