regional anatomy of the lower limb 山东大学医学院解剖教研室李振华

SDU. SDU. LIZHENHUALIZHENHUA

Regional anatomy of the lower limb

山东大学医学院解剖教研室李振华


Parts and regions of the lower limb

Gluteal region － between iliac crest superiorly and gluteal fold inferiorly

Thigh － between hip and knee knee － joint between leg and thigh Leg － between knee and foot Ankle Foot


Surface anatomy of lower limb Gluteal region and thigh

anterior superior and inferior iliac spines

tubercle of iliac crest ischial tuberosity greater trochanter pubic tubercle pubic crest superior border of pubic symphysis

Knee patella ligament tuberosity of tibia medial and lateral condyles and epic

ondyles tendon of biceps femoris tendons of semitendinosus and semi

membranosus head of fibula

Leg anterior border of tibia neck of fibula

Ankle and foot medial and lateral malleolus calcaneal tuberosity tuberosity of navicular bone tuberosity of fifth metatarsal bone


Nelaton’s 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 a dislocated hip or a frac

tured femoral neck.


Kaplan point


Coxa vara 髋内翻(abnormally decreased angle of inclination, it occurs in fractures of the neck of the femur and slipping of the femoral epiphysis )

Coxa valga 髋外翻 (abnormally increased angle of inclination, in cases of congenital dislocation of the hip)

Normal angle of inclination 1250-1300

颈干角


Normal alignment Genu varum (bowleg)

膝内翻

Genu valgum膝外翻

1700 >1700 <1700


Anterior and Medial Region of Thigh


Skin incisions

Make the skin incisions indicated in figure and reflect the skin flaps.


Superficial structures

Great saphenous vein 大隐静脉 Drains the medial end of dorsal venous arch

of foot Passes upward directly in front of the medial

malleolus. Then ascends on medial side of the leg. Passes behind the knee and curves forward

around the medial side of the thigh. Passes through the saphenous hiatus in the

deep fascia and joins the femoral vein about 4 cm below and lateral to the pubic tubercle.


Superficial structures Tributaries:

Superficial lateral femoral v. 股外侧浅静脉 Superficial medial femoral v. 股内侧浅静脉 External pudendal v. 阴部外静脉 Superficial epigastric v. 腹壁浅静脉 Superficial iliac circumflex v. 旋髂浅静脉


Superficial epigastric v.

External pudendal v.

Superficial circumflex iliac v.

Great saphenous v.

Superficial lateral femoral v.Superficial medial femoral v.


Varicose veins


Superficial structures

Superficial fascia Superficial arteries:

superficial epigastric a. superficial iliac circumflex a. external pudendal a.

Cutaneous nerves: lateral femoral cutaneous n. anterior and medial cutaneous branches of

femoral n. cutaneous branches of obturator n.


lateral femoral cutaneous n.

anterior and medial cutaneous branches of femoral n.

Cutaneous branches of obturator n.


Superficial structuresSuperficial inguinal lymph nodes

腹股沟浅淋巴结 Superior group:

Lies just distal to the inguinal ligament Receive lymph vessels from anterior abdo

minal wall below umbilicus, gluteal region, perineal region, external genital organs

Inferior group: Lies vertical along the terminal great saphe

nous v. Receives all superficial lymph vessels of lo

wer limb, except for those from the posterolateral part of calf

Efferent vessels drain into the deep inguinal ln. or external iliac ln.


Deep fascia of the thigh

Fascia lata 阔筋膜 The deep fascia encloses the thigh like a trouser leg.

Saphenous hiatus 隐静脉裂孔 A gap in the deep fasica which lies about 4 cm b

elow and lateral to the pubic tubercle. The falciform margin 镰状缘 is the lower lateral border of the opening, which lies anterior to the femoral vessels.

Filled with loose connective tissue called the cribriform fascia 筛筋膜


Deep fascia of the thigh

Iliotibial tract 髂胫束 laterally the deep fascia forms a thick band, from the iliac tubercle to the lateral condyle of tibial.

The fascia lata sends intermuscular septa to the linea aspera of the femur. These separate the thigh into three compartments each of which contains a group of muscles, the vessels and the nerves.


Contents of the anterior fascial compartments of the thigh

Iliopsoas 髂腰肌Iliacus 髂肌

Psoas majo 腰大肌

Sartorius 缝匠肌

Quadriceps femoris 股四头肌 Vastusintermedius 股中间肌

Vastus lateralis 股外侧肌Rectus femoris 股直肌

Vastus medialis 股内侧肌


Contents of the medial fascial compartments of the thigh

Pectineus 耻骨肌

Adductor longus 长收肌

Adductor brevis 短收肌

Adductor magnus 大收肌

Gracilis 股薄肌

Adductor tendinous opening 收肌腱裂孔


Lacuna musculorum 肌腔隙

Boundaries: Anteriorly: lateral portion of ingu

inal ligament Posterolaterally: ilium Medially: iliopectinal arch

Contents: Iliopsoas femoral n. lateral femoral cutaneous n.

Iliopectinal arch

Femoral n.

Iliopsoas

Lateral femoral cutaneous n.


Lacuna vasorum 血管腔隙

Boundaries: Anteriorly: medial portion of ing

uinal ligament Posteriorly: fascia of pecteineu

s and pectineal ligament Medially: lacunar ligament Laterally: iliopectinal arch

Contents: Femoral sheath Femoral a. and v. Genital branch of genitofemoral

n. Lymphatic vessels

Femoral a.

Femoral v.

Femoral ring


Femoral triangle 股三角 A triangular depressed area situated in the upper

part of the medial aspect of the thigh just below the inguinal ligament

Boundaries Superiorly (base) : the inguinal ligament Laterally: medial border of sartorius Medially: medial border of adductor longus Apex: continuous with adductor canal Anterior wall: fascia lata Posterior wall: consists of iliopsoas, pectineus

and adductor longus from lateral to medial side


Femoral triangle 股三角Contents Femoral n. Femoral sheath Femoral a. and its branches Femoral vein and its tributaries. Femoral canal Deep inguinal lymph nodes Fatty tissue


Femoral triangle 股三角Femoral sheath 股鞘 A funnel- shaped sheath Derived from transversalis fascia ante

riorly and iliac fascia posteriorly It surroumds the femoral vessels and

lymphatic about 2.5cm belower the inguinal ligamemt.

Its lower end disappears at the lower margin of the saphenous opening where the sheath fuses with the adventitia of the vessels.


Femoral sheath 股鞘Femoral sheath 股鞘Divided into three compartments by two fibrous septa

Lateral compartment: femoral a. Middle compartment: femoral v. Medial compartment: femoral canal 股管


The femoral canal 股管 About 1.3cm long , and its upper openin

g is called the femoral ring 股环 Contains: a little loose fatty tissue, a sm

all lymph node, and some lymph vessels.

The boundaries of the femoral ring Anteriorly: the inguinal ligament Medially: the lacunar ligament 腔隙韧带 Posteriorly: the pecten of pubis Laterally: the femoral vein Superior: covered by femoral septum

股环隔


Femoral hernia 股疝 If a loop of intestine is forced into the f

emoral ring, it expands to form a swelling in the upper part of the thigh. Such a condition is known as a femoral hernia 股疝 .

A femoral hernia is more common in women than in men (possibly because their wider pelvis and femoral canal ).


Femoral artery 股动脉 Femoral a. 股动脉 Continuation of the external iliac a. Begins midpoint of inguinal ligament Ends at the adductor tendinous opening by e

ntering the popliteal fossa as the popliteal artery

Principal branch － deep femeral a. 股深动脉 arises from the posterolateral surface of the femoral

artery about 5 cm below the inguinal ligament. Medial femoral circumflex 旋股内侧动脉 lateral femoral circumflex 旋股外侧动脉 Four perforating arteries 穿动脉


Profunda femoris 股深动脉 Arises from the posterolateral surface

of the femoral artery about 5 cm below the inguinal ligament.

Branches: Lateral circumflex artery 旋股外侧动脉 . Medial circumflex artery 旋股内侧动脉 . Perforating arteries 穿动脉


deep femeral a.

Lateral circumflex a. Medial circumflex a.

perforating arteries


Femoral vein 股静脉

Begins at the adductor tendinous opening

Continues as external iliac vein deep to inguinal ligament

Contains several valves


The deep inguinal lymph nodes腹股沟深淋巴结

Lie medial to the femoral v. Receive deep lymphatics of lower

limb, perineal region, and efferent lymphatics from the superficial inguinal ln.

Drain into the external iliac ln.


Femoral nerve 股神经 Arises from the lumbar plexus in the abd

omen, and enters the thigh posterior to the inguinal ligament and lateral to the femoral artery.

It ends by dividing into a number of branches 2 cm below the inguinal ligament.

Muscular branche to: pectineus, sartoriu

s, quadriceps femoris


Femoral nerve 股神经 Cutaneous branches:

Anterior cutaneous nerves of the thigh

Saphenous nerve 隐神经 is the longest branch of the femoral nerve. It accompanies the femoral vessels in the adductor canal, then accompanies the great saphenous vein to the medial side of the leg and food.


Femoral n.

Femoral a.

Femoral v.

Saphenous nerve


Adductor canal 收肌管 An intermuscular cleft situated on the medial aspect

of the middle third of the thigh beneath the sartorius.

Extends from apex of femoral triangle to adductor tendinous opening

Boundies Anterior wall: adductor lamina and sartorius Lateral wall : vastus medialis Posteomedial wall: adductors longus and magm

us Contents

Saphenous n. Femoral a. and femoral v. lymphatic vessels and loose connective tissue


Blood vessels and nerve of medial side of thigh

Obturator a. 闭孔动脉 Arises from internal iliac artery in the le

sser pelvis passes through the obturator canal whe

re it divides into anterior and posterior branches.

Obturator n. 闭孔神经 Arises from the lumbar plexus in the ab

domen. Enters the thigh through the obturator c

anal where it divides into anterior and posterior branches.

Supplies medial group of muscles of thigh, obturator externus, and skin of medial side of thigh


Obturator n.


Anterolateral crural region and dorsum of the foot


Anterolateral crural region

Superficial veins Dorsal venous arch: lies in the subcutane

ous tissue over the heads of the metatarsal bones and drains on the medial side into the great saphenous v. and on the lateral side into the small saphenous v.

Great saphenous v.: Drains the medial end of dorsal venous arch

of food and passes upward directly in front of the medial malleolus.

Then ascends in company with the saphenous n. in the superficial fascia over the medial side of the leg.


Anterolateral crural region

Cutaneous nerves Lateral cutaneous n. of the calf: su

pplies the skin on the upper part of the anterolateral surface of the leg

Superficial peroneal n. supplies the skin of the lower part of the anterolateral surface of the leg and dorsum of the foot

Saphenous n. supplies the skin on the anteromedial surface of the leg

Deep peroneal n. supplies the skin of the adjacent sides of the big and second toes


Deep fascia

Surrounds the leg and forms two 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 vessels and the nerves.

Superior extensor retinaculum 伸肌上支持带

Inferior extensor retinaculum 伸肌下支持带


Contents of the anterior fascial compartment of the leg

Muscles:

Tibialis anterior

Extensor digitorum longus

Extensor hallucis longus

Peroneus tertius

Blood supply: Anterior tibial a.

Nerve supply: Deep peroneal n.



Anterior tibial artery 胫前动脉 Beginning: Arises from the popliteai artery

at the lower border of popliteus. It passes forwards above the interosseous membrane, and turns downwards on the anterior surface of that membrane with the deep peroneal nerve.

Ending: In front of ankle joint becomes the dorsalis pedis a.

The anterior tibial veins 胫前静脉 are closely applied to the artery.



Common peroneal n. 腓总神经 Passes over posterior aspect of head of fibu

la and then winds around neck of fibula Deep to peroneus longus, where it divides i

nto deep and superficial peroneal nerves

Deep peroneal nerve 腓深神经 Arises from the common peroneal nerve betwe

en the neck of the fibula and the peroneus longus muscle

Descends in the anterior compartment of the leg with the anterior tibial vessels.

Supplies all the muscles of the anterior compartment of the leg and extensor digitorum brevis.


Contents of the lateral fascial compartment of the leg

Muscles Peroneus longus Peroneus brevis

Blood supply: branches from the peroneal artey

Nerve supply: superficial peroneal n.


Contents of the lateral fascial compartment of the leg

Superficial peroneal n. 腓浅神经 supplies peroneus longus and brevis and skin on anterior surface of leg and dorsum of foot


Anterior tibial a.

Dorsal a. of foot

Tibialis anterior

Extensor hallucis longusExtensor digitorum longus

Deep peroneal n.

Superficial peroneal n.


Injury to the common peroneal nerve

The common fibular nerve may be severed during fracture of the fibula neck or severely stretched when the knee joint is injured of dislocated.

Severance 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.

The foot drops and the toes drag of the floor when walking. Because it is impossible 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.


Dorsum of the foot

Dorsalis pedis artery 足背动脉 Begins on the anterior surface of the ankle

joint and runs with the deep peroneal nerve Divides into the arcuate artery and the first

dorsal metatarsal artery at the proximal end of the first intermetatarsal space.

On the dorsum of the foot it lies on the tarsal bones and is readily palpated against them between the tendons of extensor hallucis longus and extensor digitorum longus.


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

Gracilis

Vessels Great saphenous v.

Femoral a.

Deep femoral a.

Nerves femoral n.

Saphenous n.

Obturator n.


You must identify follow structures ！Anterolateral crural region and dorsum of the foot Muscles

Tibialis anterior Extensor hallucis longus Extensor digitorum longus Peroneus longus Peroneus brevis

Vessels Great saphenous v. Anterior tibial a. Dorsalis pedis a.

Nerves Common peroneal n. Deep peroneal n. Superficial peroneal n.

regional anatomy of the lower limb 山东大学医学院 解剖教研室 李振华

Documents

regional anatomy of the lower limb 山东大学医学院解剖教研室李振华