局部解剖学课件：第八章 下肢

2016-3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ThelowerlimbSection1Intruction1.Boundariesanddivisions2.Surfaceanatomy(1)ThesurfacelandmarksBoundaries:

Inguinalgrooves,iliaccrest,pudendal-thighsulcus.Divisions:

Thelowerlimbisdividedintotheglutealregion(buttock),thigh,knee,leg,ankleandfoot.2016-3iliaccrestanteriorsuperioriliacspineposteriorsuperioriliacspinetubercleofiliaccrestischialtuberositygreatertrochanterpubicsymphysispubiccrestpubictubercleinguinalligamentGlutealregionandthigh2016-3KneePatellapatellaligamenttibialtuberositylateralandmedialcondylesoffemurlateralandmedialepicondylesoffemurAdductortuberclelateralandmedialcondylesoftibiaFibularheadtendonofbicepsfemoristendonsofsemitendinosusandsemimembranosus2016-32016-32016-3Leg,Ankleandfootanteriorborderoftibiaheadoffibulaneckoffibulamedialandlateralmalleoluscalcanealtuberosity

tuberosityofnavicularbonetuberosityoffifthmetatarsalbone

2016-31233445672016-3（二）对比关系1、Nelaton线(Nelaton'sLine

(alsoknownasthe

Roser-Nélatonline)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2016-32、Kaplan交点仰卧位，两腿伸直并扰，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颈干角颈干角125-130度大于：髋外翻小于：髋内翻2016-3膝外翻角外侧夹角170度小于：膝外翻，X大于：膝内翻，O2016-3

（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臀上动、静脉和神经髂后上棘与股骨大转子尖连线的中、内１/3交点为臀上动、静脉和神经出入盆腔的投影点2016-3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。122016-3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２／３段1232016-3足背动脉内、外踝前面连线的中点至第１跖骨底外侧缘的连线拇长肌腱和趾长肌腱之间位置表浅，其搏动易于触摸2016-31.Superiorgluteala.,v.,andn.2.Inferiorgluteala.,v.,andn.3.Sciaticn.4.Femorala.andv.5.Popliteala.6.Anteriortibiala.7.Posteriortibiala.

8.DorsalarteryoffootTheprojectionsofthebloodvesselsandnerves2016-3less-than1250:

coxavara髋内翻(itoccursinfracturesoftheneckofthefemurandslippingofthefemoralepiphysis)greaterthan

1300:

coxavalga髋外翻(incasesofcongenital先天性的dislocationofthehip)Normalangleofinclination1250-1300

neck-shaftangle2016-3NormalalignmentGenuvarum(bowleg)膝内翻

Genuvalgum膝外翻1700

>1700<17002016-3TheorientationofthepelvisinthestandingpositionInthestandingpositiontheplaneofthelineaterminalisisusuallyinclinedatanangleofabout600tothehorizontal.Theanteriorsuperiorspineandthepubicsymphysisareinapproximatelythesameverticalplane.2016-3alsoknownastheRoser-Nélatonlinealinedrawnfromtheanteriorsuperiorlilacspinetotheischialtuberosity,passingoverornearthetopofthegreatertrochanter.Thetrochantercanbefeltsuperiortothislineinapersonwhichdislocatedhipjointorfracturedfemoralneck.

Nelaton’slinenormalabnormal2016-32.Kapian’spoint(shoemaker’ssign)Thepatientliessupinewithstretchedlegs.Joinalinefromtheapexofthegreatertrochantertotheanteiorsuperioriliacspine.Normally,itsprolongedlinepassesthroughorabovetheumbilicus.Ifthelinepassesbelowtheumbilicus,itindicatesthepresenceofsuperiordisplacementofthegreatertrochanter.normalabnormal2016-3Bryantlineandbryanttriangle2016-32016-3一、股部(1)：股前内侧区1.皮肤2.浅筋膜2016-3大隐静脉greatsaphenousvein起始：足背静脉弓的内侧端。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2016-32016-3临床意义：

①大隐静脉切开②大隐静脉曲张

2016-3浅动脉

superficialartery腹壁浅动脉superficialepigastricartery旋髂浅动脉superficialcircumflexiliacartery阴部外浅动脉Superficialexternalpudendalartery2016-3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③皮神经

cutaneousnerve股外侧皮神经生殖股神经股支髂腹股沟神经股前皮神经髂腹下神经生殖股神经闭孔神经股内侧皮神经隐神经腓浅神经股外侧皮神经生殖股神经股支股前皮神经髂腹股沟神经股内侧神经隐神经腓肠外侧皮神经腓浅神经前面观2016-3股内侧皮神经腓肠内侧皮神经腓肠神经足底外侧神经足底内侧神经腓肠外侧皮神经股后皮神经股外侧皮神经髂腹下神经臀上皮神经臀内侧皮神经臀下皮神经闭孔神经股部皮神经有：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③皮神经股内侧皮神经股后皮神经股外侧皮神经闭孔神经

隐神经

腓肠内侧皮神经

腓总神经

腓肠外侧皮神经后面观2016-3④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。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。Superficialstructure1.Skin2.Superficialfascia2016-3Superficialarteries:Superficialepigastrica.2.Superficialiliaccircumflexa.3.Superficial

externalpudendala.1232016-3SuperficialveinsgreatsaphenousveinOrigin:fromthemedialsidesofadorsalvenousarchinthefoot.

Course:passesupwarddirectlyinfrontofthemedialmalleolus,thenascendsonthemedialsideoftheleg,knee,andthightopassthroughthesaphenoushiatusindeepfasciaandjoinwiththefemoralvein.2016-3Tributariesofthegreatsaphenousvein

①Superficialiliaccircumflexv.②Superficialepigastricv.

③Externalpudendalv.④Superficialmedialfemoralv.

⑤Superficiallateralfemoralv.①②③④⑤2016-3Typesoftributariesofthegreatsaphenousvein2016-3临床意义：

①大隐静脉切开②大隐静脉曲张

Varicoseveinsnormalabnormal2016-3腔镜下交通支结扎术微创刨吸术2016-3Origin:fromthelateralsidesofadorsalvenousarchinthefoot.

Course:passesbehindthedistalendofthefibula(lateralmalleolus)andupthebackofthelegtopenetratedeepfasciaandjointhepoplitealveinposteriortotheknee.Smallsaphenousvein

2016-3⑧⑦①④Superficialperonealn.②⑤Cutaneousnerves:股部皮神经有：anteriorfemoralcutaneousn.medialfemoralcutaneousn.lateralfemoralcutaneousn.cutaneousbr.ofobturatorn.

saphenousn.femoralbr.ofgenitofemoraln.iliohypogastricn.ilioinguinaln.③⑥2016-3Lateralsuralcutaneousn.⑧⑦①④Superficialperonealn.②⑤Cutaneousnerves:股部皮神经有：anteriorfemoralcutaneousn.medialfemoralcutaneousn.lateralfemoralcutaneousn.cutaneousbr.ofobturatorn.

saphenousn.femoralbr.ofgenitofemoraln.iliohypogastricn.ilioinguinaln.③⑥2016-3Superficialinguinallymphnodes:

superiorgroupinferiorgroupreceivelymphdrainagefromtheentirelowerlimb,thesuperficialstructuresoftheperineumandabdominalwallbelowtheumbilicus.Efferentvesselsdrainintothedeepinguinalorexternaliliaclymphnodes.2016-32016-3股前内侧区深层结构一、深筋膜:阔筋膜,

fascialata

,大腿的深筋膜的特称。为全身最厚的深筋膜，致密坚韧。2016-3阔筋膜在股部形成下列三种结构:股后肌间隔股外侧肌间隔股内侧肌间隔（1）髂胫束（2）隐静脉裂孔(卵圆窝)（3）三个肌间隔2016-3分别容纳各群的肌肉、血管和神经。二、骨筋膜鞘Osteofascial

compartments;fascial

compartments

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骨筋膜鞘综合症：腔内压力大于30mmHg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2016-3vastusmedialisvastuslateralisrectusfemoris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quadricepsfemoris（股直肌、股内侧肌、股外侧肌、股中间肌）

缝匠肌sartoriusmuscle2、神经支配：股神经3、营养血管：股A2016-3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123452542016-3神经血管前：股A、V、N内：闭孔A、V、N2016-3局部结构肌腔隙与血管腔隙股三角收肌管2016-3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

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：腔隙韧带外侧界：髂耻弓2016-3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：①股动脉②股静脉③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。股神经股动脉股静脉淋巴结缝匠肌髂腰肌耻骨肌长收肌2016-3（１）股动脉femoralartery: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: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

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1︰17在442例股疝中，女性有327例，占74％2016-3股疝特点●女性发病率高于男性●股疝容易嵌顿An87year-oldwomanpresentedwithapainfulleftgroinbulge.Becausethebulgewasmostlybelowalinedrawnbetweentheanteriorsuperioriliacspineandthepubictubercle,adiagnosisoffemoralheriawasmade.Agentleattemptatreductionwasunsuccessful.sacofparietalperitoneum2016-3Foursuturesof2-0prolenewereplacedfrombelowtheinguinalligament.Inguinalligamentandiliopubictractweresuturedtothepectineusfasciadirectlyposteriorly,closingthefemoralcanal.Thecompletedrepairisshown.2016-32016-3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通过结构及位置关系

从前向后为:隐神经saphenousnerve股动脉femoralartery股静脉femoralvein2016-3股内侧区的血管、神经闭孔动脉obturatorartery闭孔神经obturatornerveThedeepstructuresDeepfascia–fascialata

P352

2016-3Thestructuresformedbyfascialata:

（1）Iliotibialtract（2）Saphenoushiatus--falciformmargin--cribriformfascia（3）threeintermuscularseptaAnt.osseofascialcompartmentsMedialintermuscularseptaposteriorintermuscularseptaLateralintermuscularseptaMed.osseofascialcompartmentsPost.osseofascialcompartments2016-3ThelacunamusculorumandlacunavasorumPosition：thegapbetweeninguinalligamentandhipbone.Ailiopectinealarchextendingfromtheinguinalligamenttotheiliopectnealeminence.LacunamusculorumlacunavasorumLacunamusculorumlacunavasorumiliopectinealarch2016-3Boundies：anteriorly:

inguinalligament

posterolaterally:

iliumMedially:Theiliopectinealarch

ThelacunamusculorumContents:

Theiliopsoas

Thefemoralnerve

Thelateralfemoralcutaneousn.2016-3Boundies:anteriorly:inguinalligamentposteromedially:fasciaofpectineusandpectinealligamentmedially:lacunarligamentlaterally:iliopectinalarchlacunavasorumContents:FemoralsheathFemorala.,v.andfemoralcanal

Femeralbranchofgenitofemoraln.

Lymphaticvessels股神经股动脉股静脉股管2016-3femoraltriangleTheboundaries：Superiorly:inguinalligamentInfralaterally:med.borderofthesartoriusmedially:med.borderoftheadductorlongusanteriorwall:

fascialataposteriorwall:adductorlongus,pectineusandiliopsoas2016-3ThestructurespassthroughtheMuscularlacuna:

iliopsoasfemoraln.lateralfemoralcutaneousn.Contentsofthefemoraltriangle股神经股动脉股静脉股管缝匠肌髂腰肌耻骨肌长收肌2016-3Contentsofthefemoraltrianglefromlateraltomedialside：femorala.femoralv.femoralcanal股神经股动脉股静脉股管缝匠肌髂腰肌耻骨肌长收肌Thestructurespassthroughthevascularlacuna:femoralsheathisaafunnel-shapedsheath,derivedfromtransversalisfasciaanteriorlyandiliacfasciaposteriorly.Itsurroumdsthefemoralvesselsandlymphaticabout2.5cmbelowertheinguinalligamemt.2016-3股外侧皮神经生殖股神经股支股前皮神经髂腹股沟神经股内侧神经隐神经腓肠外侧皮神经腓浅神经Femoralnerve

(L2,L3,L4)：Muscularbranche:Suppliesthemusclesoftheanteriorcompartmentofthethigh,includingpectineusandiliopsoas.Cutaneousbranches:

Anteriorcutaneousn.ofthethighSaphenousn.。2016-3

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。deepinguinallymphnodes2016-3Theadductorcanal(Hunter管)位置:

anaponeurotictunnelinthemiddlethirdofthethigh,extendingfromtheapexofthefemoraltriangletotheopeningintheAdductormagnus,theAdductorhiatus.2016-3femoralcanalItisthemedialcompartmentofthefemoralsheathabout2

cmlong.containslymphaticvessels,alymphnodeandsmallamountofloosefattytissue.Itsupperopeningiscalledthefemoralring.Thefemoralcanalisbordered:Anteriorlybytheinguinallig.Posteriorlybythepectineallig.Mediallybythelacunarlig.Laterallybythefemoralvein2016-3FemoralherniaIfaloopofintestineisforcedintothefemoralring,itexpandstoformaswellingintheupperpartofthethigh.2016-3An87year-oldwomanpresentedwithapainfulleftgroinbulge.Becausethebulgewasmostlybelowalinedrawnbetweentheanteriorsuperioriliacspineandthepubictubercle,adiagnosisoffemoralheriawasmade.Agentleattemptatreductionwasunsuccessful.sacofparietalperitoneum2016-3knuckleofdeadbowelsacofparietalperitoneum2016-3Foursuturesof2-0prolenewereplacedfrombelowtheinguinalligament.Inguinalligamentandiliopubictractweresuturedtothepectineusfasciadirectlyposteriorly,closingthefemoralcanal.Thecompletedrepairisshown.2016-3Theadductorcanal(Hunter管)上口:

接股三角尖下口:

收肌腱裂孔，通腘窝。Boundaries:Anteriorly:sartoriusandadductorlaminaAnterolaterally:vastusmedialisPosteriorly:adductorlongusand

adductormagnus2016-3

通过结构及位置关系：

从前向后为:

saphenousn.

femorala.

femoralv.2016-3Bloodvesselsandnerveofmedialsideofthigh

Obturatora.

Obturatorn.

2016-32016-3膝前区浅层结构深层结构皮肤浅筋膜髌前皮下囊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鹅足pesanserinustendon2016-3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小腿前外侧区

一、浅层结构（一）浅静脉大隐静脉greatsaphenousvein隐神经saphenousnerve2016-3二、深层结构骨筋膜鞘Osteofascial

compartments;fascial

compartments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

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deepfibularnerve

2016-32.外侧骨筋膜鞘（1）肌肉腓骨长肌腓骨短肌（2）腓浅神经Superficialfibularnerve:

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Lesionsofthecommonfibularnerve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。Dropfoot2016-3TheAnteriorandLateralRegionsofTheLeg1.Thesuperficialstructures

（1）Thesuperficialfascia

SuperficialveinsandnervesThegreatsaphenousv.Thesaphenousn.Superficialperonealn.2016-3Thedeepfascia:Surroundsthelegandformsanteriorandposteriorintermuscularseptatobeattachedtothefibula.Dividedthelegintothreecompartments:anterior,lateralandposterior,eachofwhichcontainsagroupofmuscles,thevesselsandthenerves.2.Thedeepstructurescruralinterosseousmembrane2016-3Thecontentoftheanteriorosseofascialcompartment(Osteofascial

compartments,fascial

compartments)（1）muscles①tibialisanterior②extensorhallucislongus③extensordigitorumlongus

④peroneustertius（2）血管神经

anteriortibiala.andv.dorsalarteryoffootdeepperonealnerve(deepfibularnerve)2016-3Thecontentofthelateralosseofascialcompartment（1）muscles

Theperoneuslongus

Theperoneusbrevis（2）superficialperonealn.(superficialfibularnerve)

suppliesperoneuslongusandbrevisandskinonanteriorsurfaceofleganddorsumoffoot2016-3Injurytothecommonperonealnerve

(commonfibularnerve)Thelossofeversionofthefootanddorsiflexionoftheanklecausesfoot-drop.

thepatienthasahighstepping(‘steppage”)gait,raisingthefootashighasnecessarytokeepthetoesfromhittingtheground.2016-3Youmustidentifyfollowstructures！AnteriorandMedialRegionofThighMusclesPsoasIliacusSartoriusQuadricepsfemorisRectusfemorisVastusmedialisVastuslateralisVastusintermediusPatellarligamentPectineusAdductorlongusAdductorbrevis,AdductormagnusGracilisVesselsGreatsaphenousv.Femorala.Deepfemorala.Nervesfemoraln.Saphenousn.Obturatorn.2016-3Youmustidentifyfollowstructures！AnterolateralcruralregionanddorsumofthefootMusclesTibialisanteriorExtensorhallucislongusExtensordigitorumlongusPeroneuslongusPeroneusbrevisVesselsGreatsaphenousv.Anteriortibiala.Dorsalispedis

a.NervesCommonperonealn.Deepperonealn.Superficialperonealn.2016-32016-3下肢后区臀部Glutealregion股后区膝部后（腘窝）小腿后区足底2016-3二、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2016-31、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SurfaceanatomyGlutealregionandthighposteriorsuperiorandinferioriliacspinestubercleofiliaccrestischialtuberosity坐骨结节Mediansacralcrest骶正中嵴Sacralcornu骶角Sacralhiatus骶管裂孔SurfaceanatomyGlutealregionandthighposteriorsuperiorandinferioriliacspinestubercleofiliaccrestischialtuberosity坐骨结节Mediansacralcrest骶正中嵴Sacralcornu骶角Sacralhiatus骶管裂孔1232016-3natalcleft：interglutealcleft；

buttcrack；

臀裂glutealsulcus臀沟：alsoknownastheglutealfoldorhorizontalglutealcreasebackoftheknee-poplitealfossatendonofbicepsfemoristendonofsemitendinosustendonofsemimembranosus2016-31、境界2、浅层结构3、深层结构

深筋膜、肌、N、血管一、臀部2016-3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脂肪，形成软垫，承受坐位时的压力。2016-3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１/3交点为臀上动、静脉和神经出入盆腔的投影点2016-3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健美的臀部是个体美的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2016-31．上翘型：2．标准型：3．下垂型：4．扁平型：2016-3臀部脂肪沉积的类型

2016-3臀区的浅筋膜内含有四组皮神经（1）臀上皮神经：L1－3（2）臀中皮神经：S1－3（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

superiorclunealn.medialclunealninferiorclunealn.lateralfemoralcutaneousn.posteriorcutaneousn.ofthighcutaneousbr.ofobturatorn.medialsuralcutaneousn.lateralsuralcutaneousn.suralnerve⑨Cutaneousnerves:⑧⑦①④②⑤③⑥2016-3monperonealn.Cutaneousnerves:

superiorclunealn.medialclunealninferiorclunealn.lateralfemoralcutaneousn.posteriorcutaneousn.ofthighcutaneousbr.ofobturatorn.medialsuralcutaneousn.lateralsuralcutaneousn.suralnerve③⑥④⑤⑧⑦2016-32016-33、深层结构1、臀部的深筋膜称臀筋膜，上方附于髂嵴，向下续于阔筋膜。

Thedeepfascia–theglutealfascia

2016-3肌层分三层:

浅层:臀大肌、阔筋膜张肌中层:臀中肌、梨状肌深层:臀小肌、上孖肌、闭孔内肌、下孖肌

3layersGluteusmaximus,tensorfasciaelatae

Gluteusmedius,Piriformis,quadratusfemorisgluteusminimusThemusclesoftheglutealregion2016-3梨状肌

piriformis起于第2、3、4骶椎前面，分布于小骨盆的内面，穿出坐骨大孔，而将其分成梨状肌上孔与下孔，止于股骨大转子后面。主要是协同其它肌肉完成大的外旋动作。

RegionalstructuresGreatersciaticforamenSuprapiriformforameninfrapiriformforamenLessersciaticforamen2016-3梨状肌上、下孔穿行的结构为盆腔血管神经至臀部和下肢的通路。梨状肌上孔－臀上NAV梨状肌下孔－坐骨N、股后皮N、臀下NAV、阴部内AV、阴部N坐骨小孔－阴部内A、V、阴部Nsuprapiriformandinfrapiriformforamensuprapiriformforamen:

superiorglutealn.,a.andv.Infrapiriformforamen:

sciaticn.

,posteriorfemoralcutaneousn.

inferiorglutealn.,ernalpudendala.andv.,pudendaln.Lessersciaticforamen:internalpudendala.andv.,pudendaln.

2016-3坐骨神经与梨状肌的关系2016-32016-3PiriformisSyndrome

指由于梨状肌损伤而压迫坐骨神经所引起的一侧臀腿疼痛为主的病症。2016-3PiriformisSyndrome

isaneuromusculardisorderthatoccurswhenthesciaticnerveiscompressedorotherwiseirritatedbythepiriformismusclecausingpain,tinglingandnumbnessinthebuttocksandalongthepathofthesciaticnervedescendingthelowerthighandintotheleg.臀上神经髂后下棘坐骨神经坐骨结节大转子髂前上棘臀中肌髂结节大转子坐骨神经髂结节臀中肌髂前上棘臀上神经臀部肌肉注射部位2016-3髋关节动脉网

以“臀部十字吻合”为重要，位于臀大肌深面。组成：①两侧为旋股内、外侧动脉的分支②上部为臀上、下动脉的分支③下部为第一穿动脉

2016-3

临床意义：手术结扎一侧的髂内动脉，通过此动脉吻合建立侧支循环，血液仍可到达髂内动脉的分布区。2016-3二、股后区1、肌肉：股二头肌半腱肌半膜肌bicepsfemorissemitendinosussemimembranosus2016-33、大腿肌后群：（外侧→内侧）股二头肌、半腱肌、半膜肌bicepsfemoris

semitendinosussemimembranosusThebackofthethigh1.Themuscles:bicepsfemorissemitendinosussemimembranosus.2016-3

2.股后区的血管神经血管：主要为股深动脉-旋股内、外侧动脉-3-4个穿动脉神经：坐骨神经：于股二头肌长头与大收肌之间下降至腘窝上角分为胫神经和腓总神经。坐骨神经分支至股后群肌（半腱肌、半膜肌、股二头肌长头、大收肌）。股二头肌短头由腓总神经支配。Thesciaticnerve：2.Bloodvesselsandnerves

Itarisesfromthesacralplexusandpassesthroughinfrapiriformforamenintotheglutealregion,passingmidwaybetweenthegreatertrochanteroffemurandischialtuberositytobackofthigh,itusuallyendshalf-waydownthebackofthethighbydividingintothecommonperonealandtibialnerves.Distribution:semitendinosus,semimembranosus,thebicepsfemorisandhipandkneejointsPerforatingarteries2016-3股后区的动脉吻合①由臀下动脉，旋股内、外侧动脉和第1穿动脉形成的十字吻合。②各穿动脉之间的吻合。③由股深动脉的终支与腘动脉肌支形成的吻合。2016-3压痛点(薄弱区)臀大肌下缘与股二头肌长头外侧缘的夹角处。2016-3三、膝后区（P239）1、腘窝poplitealfossa境界：上外侧壁:股二头肌上内侧壁:半腱肌、半膜肌下内、外侧壁:腓肠肌内、外侧头顶:腘筋膜底:股骨腘面、膝关节囊后部腘斜韧带、腘肌2016-32.腘窝内容及位置

中央由浅到深为：胫神经腘静脉腘动脉腘窝外上缘有：腓总神经

血管周围有：腘深淋巴结

临床上股骨下端骨折易损伤腘动脉。2016-3腘动脉的分支：（1）肌支

（2）5条关节支膝上内、外侧动脉膝中动脉膝下内、外侧动脉2016-3二、膝关节动脉网组成：①腘动脉的5条关节支②旋股外侧动脉的降支③膝降动脉(股动脉在收肌管内的分支)④胫前返动脉⑤第3、4穿动脉意义：若腘动脉阻塞，此动脉网有一定的代偿作用。PoplitealFossaTheboundaries:Upperlateral:

BicepsfemorisUppermedial:

SemitendinosusandsemimembranosusLowerlateral:

lateralheadofthe

gastrocnemiusLowermedial:

medialheadofthegastrocnemiusRoof:

poplitealfasciaFloor:

Poplitealsurfaceoffemur,jointcapsuleofthekneejoint,obliquepoplitealligament,andpopliteuswithitsfasciasuperficialtodeepincentral：

Tibialn.

Poplitealv.

Popliteala.Commonperonealn.Poplitealdeeplymphnodes2.Contents临床上股骨下端骨折易损伤腘动脉。

2016-3腓总神经：行程：腓骨颈(易受损伤)。分支：

腓肠外侧皮神经

腓浅神经腓深神经2016-3四、小腿后区（P244）（一）浅层结构小隐静脉腓肠内侧皮神经腓肠外侧皮神经腓肠神经2016-3（二）深层结构

（1）肌肉腓肠肌、比目鱼肌、[跖肌(zhí)]腘肌趾长屈肌拇长屈肌胫骨后肌2016-33、小腿肌后群（浅层）：小腿三头肌:腓肠肌Gastrocnemius比