The anterior and medial The anterior and medial regions regions

of the thighof the thigh

Regional anatomy of lower limb

Ling ShucaiLing Shucai

1. Surface anatomy 1. Surface anatomy 表面解剖表面解剖2. The superficial structures 2. The superficial structures 浅层结构浅层结构

Superficial veins Superficial veins 浅静脉浅静脉Superficial lymph vessels Superficial lymph vessels 浅淋巴结浅淋巴结Cutaneous nerves Cutaneous nerves 皮神经皮神经

3. The deep structures 3. The deep structures 深层结构深层结构The deep fascia The deep fascia 深筋膜深筋膜The muscles The muscles 肌肉肌肉The vessels The vessels 血管血管The nerves The nerves 神经神经

4. Regional anatomy 4. Regional anatomy 局部解剖局部解剖Lacuna musculorum and lcuna vasorum Lacuna musculorum and lcuna vasorum 肌腔隙和血肌腔隙和血管腔隙管腔隙Femoral triangle Femoral triangle 股三角股三角Adductor canal Adductor canal 收肌管收肌管

Main ContentsMain Contents

1. The superficial structures

Superficial arteries: superficial epigastric a. 腹壁浅动脉 superficial iliac circumflex a. 旋髂浅动脉 external pudendal a. 阴部外动脉

Superficial veins － great saphenous v. 大隐静脉 superficial epigastric v. 腹壁浅静脉 superficial iliac circumflex v. 旋髂浅静脉 external pudendal v. 阴部外静脉 superficial medial femoral v. 股内侧浅静脉 superficial lateral femoral v. 股外侧浅静脉

Superficial inguinal lymph nodes: 腹股沟浅淋巴结 superior group 上组 inferior group 下组

Cutaneous nerves: lateral femoral cutaneous n. 股外侧皮神经 anterior and medial cutaneous branches of femoral n. 股神经前、

内侧皮支

Superficial structures － superficial fascia

Superficial epigastric v.

External pudendal v.

Superficial circumflex iliac v.

Great saphenous v.

Superficial lateral femoral v. Superficial medial femoral v.

2. The deep structures

Fascia lata and iliotibial tractFascia lata and iliotibial tract 大腿阔筋膜和髂胫束大腿阔筋膜和髂胫束

Muscles Muscles

Deep vessels, nerves and lymph nodesDeep vessels, nerves and lymph nodes

Deep structures

Iliotibial tract 髂胫束Saphenous hiatus 隐静脉裂孔

falciform margin 镰状缘cribriform fascia 筛筋膜

Fascia lata and iliotibial tract 大腿阔筋膜和髂胫束

MusclesMuscles

Muscles of hipanterior group

Iliopsoas 髂腰肌 psoas minor 腰小肌 tensor fasciae

latae 阔筋膜张肌

Muscles of thigh

Anterior groupAnterior group

Sartorius Sartorius 缝匠肌缝匠肌

Quadriceps Quadriceps 股四头肌股四头肌 Rectus femoris Rectus femoris 股直肌股直肌 Vastus medialis Vastus medialis 股内侧肌股内侧肌 Vastus lateralis Vastus lateralis 股外侧肌股外侧肌 Vastus intermedius Vastus intermedius 股中间股中间

肌肌

Medial groupMedial group

Pectineus Pectineus 耻骨肌耻骨肌

Adductor longus Adductor longus 长收肌长收肌

Adductor brevis Adductor brevis 短收肌短收肌

Adductor magnusAdductor magnus 大收肌大收肌

Gracilis Gracilis 股薄肌股薄肌

adduct thigh at hip jointadduct thigh at hip joint

Deep arteriesDeep arteries

Femoral a. Femoral a. 股动脉股动脉 deep femeral a. deep femeral a. 股深动脉股深动脉 medial and lateral femoral medial and lateral femoral

circumflex circumflex 旋股内、外侧动脉旋股内、外侧动脉 perforating arteries perforating arteries 穿动脉穿动脉

deep femeral a.

Deep veinsDeep veins

external iliac v.external iliac v.

femoral v.femoral v.

popliteal v. popliteal v.

anterior and posterior anterior and posterior tibial v. tibial v.

NerveNerve

ssFemoral n.

Obturator n.

3. Regional anatomy

Lacuna musculorumLacuna musculorum 肌肌腔隙腔隙Bounded by lateral Bounded by lateral

portion of inguinal portion of inguinal

ligament anteriorly, ligament anteriorly,

ilium posterolaterally, ilium posterolaterally,

iliopectinal arch mediallyiliopectinal arch medially

Contents: iliopsoas, Contents: iliopsoas,

femoral n. and lateral femoral n. and lateral

femoral cutaneous n. femoral cutaneous n.

Iliopectinal arch

Femoral n.Iliopsoas

Lateral femoral cutaneous n.

Lacuna musculorum and lcuna vasorum 肌腔隙和血管腔隙

Lacuna vasorum Lacuna vasorum 血管腔隙血管腔隙

BoundedBounded by medial by medial portion of inguinal portion of inguinal ligament anteriorly, ligament anteriorly, pectineal ligament pectineal ligament posteromedially, lacunar posteromedially, lacunar ligament medially, and ligament medially, and iliopectinal arch iliopectinal arch posterolaterallyposterolaterally

Contents:Contents:

femoral sheathfemoral sheath, femoral , femoral a. and v., genital branch a. and v., genital branch of genitofemoral n. and of genitofemoral n. and lymphatic vessels, lymphatic vessels, femoral ringfemoral ring

Femoral a.

Femoral v.

Femoral ring

Femoral triangle Femoral triangle 股三角股三角

This triangle is This triangle is boundedbounded by: the by: the inguinal ligament (base) inguinal ligament (base) superiorly; the medial border of superiorly; the medial border of sartorius laterally; the medial sartorius laterally; the medial border of adductor longus border of adductor longus medially. Inferiorly, the apex of medially. Inferiorly, the apex of the triangle is continuous with the triangle is continuous with adductor canal.adductor canal.

The The anterior wallanterior wall is is fascia latafascia lata

The The posterior wallposterior wall consists of consists of adductor longus, pectineus and adductor longus, pectineus and iliopsoas , from medial to lateral iliopsoas , from medial to lateral side. side.

Contents of the femoral triangleContents of the femoral triangle

1. The femoral artery and its 1. The femoral artery and its branchesbranches －－ the profunda the profunda femoris arteryfemoris artery ，， The lateral The lateral and medial circumflex and medial circumflex arteriesarteries ，， The deep external The deep external pudendalpudendal ．．

2. The femoral vein and its 2. The femoral vein and its tributaries.tributaries.

3. Three or four deep inguinal 3. Three or four deep inguinal lymph nodes lie along the lymph nodes lie along the medial side of the femoral medial side of the femoral vein. vein.

4. The femoral nerve.4. The femoral nerve.

5. The femoral canal.5. The femoral canal.

Femoral sheathFemoral sheath 股鞘股鞘

The femoral sheath is a The femoral sheath is a funnel- shaped sheath , funnel- shaped sheath , derived from transversalis derived from transversalis fascia anteriorly and iliac fascia fascia anteriorly and iliac fascia posteriorly. It surrounds the posteriorly. It surrounds the femoral vessels and lymphatic femoral vessels and lymphatic about 2.5cm belower the about 2.5cm belower the inguinal ligament. Its lower end inguinal ligament. Its lower end disappears at the lower margin disappears at the lower margin of the saphenous opening of the saphenous opening where the sheath fuses with where the sheath fuses with the adventitia of the vessels. the adventitia of the vessels.

The femoral sheath is divided into The femoral sheath is divided into three three compartmentscompartments by two fibrous septa. The femoral by two fibrous septa. The femoral artery occupies the artery occupies the lateral compartmentlateral compartment of the of the sheath. The femoral vein lies the sheath. The femoral vein lies the middle middle compartmentcompartment. The . The medial compartmentmedial compartment is small, is small, called the called the femoral canalfemoral canal. .

The femoral canal The femoral canal 股管股管

It is about 1.3cm long , and its It is about 1.3cm long , and its upper opening is called the upper opening is called the femoral ringfemoral ring 股环股环 ..

The The boundaries of the boundaries of the femoral ring femoral ring are: are:

inguinal ligament inguinal ligament 腹股沟韧带腹股沟韧带 lacunar ligament lacunar ligament 腔隙韧带 腔隙韧带

pecten of pubis pecten of pubis 耻骨梳耻骨梳 femoral vein femoral vein 股静脉股静脉

The canal contains a little loose The canal contains a little loose fatty tissue, a small lymph fatty tissue, a small lymph node, and some lymph vessels.node, and some lymph vessels.

Femoral hernia Femoral hernia 股疝股疝 A femoral hernia is common in women than in men A femoral hernia is common in women than in men

(possibly due to a wider pelvis and femoral canal ). If a (possibly due to a wider pelvis and femoral canal ). If a loop of intestine is forced into the femoral ring, it expands loop of intestine is forced into the femoral ring, it expands to form a swelling in the upper part of the thigh. to form a swelling in the upper part of the thigh.

Adductor canal Adductor canal 收肌管收肌管

Extends from apex of femoral Extends from apex of femoral

triangle to adductor hiatustriangle to adductor hiatus

Bounded by vastus medialis Bounded by vastus medialis

laterally, adductors longus and laterally, adductors longus and

magmus posteriorly, and magmus posteriorly, and

adductor lamina and sartorius adductor lamina and sartorius

anteriorlyanteriorly

Contents – saphenous nerve, Contents – saphenous nerve,

femoral a., femoral v., lymphatic femoral a., femoral v., lymphatic

vessels, and loose connective vessels, and loose connective

tissue tissue

思考题思考题1. 试述大隐静脉的注入部位、主要属支及其收集范围。2. 试述股三角的境界（上、外、内侧、前壁、底）各有哪些结

构，通过股三角的血管神经有哪些？3. 试述股动脉的主要分支。4. 试述股部肌肉的分群、神经支配及损伤表现。5. 试述肌腔隙和血管腔隙的境界及通过的结构。6. 名词解释：股鞘、股管、股环、股疝