SDU. SDU. LIZHENHUA LIZHENHUA Gluteal Region and Posterio r Region of Thigh and Leg 山山山山山山山 山山山山山 山山山
Jan 15, 2016
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Gluteal Region and Posterior Region of Thigh and Leg
山东大学医学院 解剖教研室李振华
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Skin incisions
Make the skin incisions shown in figure and reflect the skin flaps
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Gluteal region
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The gluteal region
Boundaries: Superiorly: iliac crest Inferiorly: fold of buttock Medially: lateral borders of sacrum and
coccyx Laterally: a line joining anterior superior
iliac spine and great trochanter
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Cutaneous nerves
Superior cluneal n.
Medial cluneal n.
Inferior cluneal n.
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Muscles of hip
Posterior group Gluteus maximus 臀大肌 Gluteus medius 臀中肌 Gluteus minimus 臀小肌 Piriformis 梨状肌 Obturator internus 闭孔内肌 Obturator externus 闭孔外肌 Quadratus femoris 股方肌
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Muscles of the gluteal region
Gluteus medius 臀中肌
Gluteus minimus 臀小肌
Piriformis 梨状肌
Obturator internus 闭孔内肌
Obturator externus 闭孔外肌
Quadratus femoris 股方肌
Gluteus maximus臀大肌
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The gluteal region
suprapiriform foramen
infrapiriform foramen
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Structures passing through suprapiriform foramen
From lateral to medial side Superior gluteal n. 臀上神经 Superior gluteal a. 臀上动脉 Superior gluteal v. 臀上静脉
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Structures passing through infrapiriform foramen
From lateral to medial side Sciatic n. 坐骨神经 Posterior femoral cutaneous n. 股后皮神经 Inferior gluteal n. 臀下神经 Inferior gluteal a., v. 臀下动、静脉 Internal pudendal v., a.
阴部内动、静脉 Pudendal n. 阴部神经
They then curve forwards to enter the perineum through the lesser sciatic foramen
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Posterior Region of Thigh and Leg
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Contents of the posterior osseofascial compartment of the thigh
Muscles Biceps femoris Semitendinosus Semimembranosus
Blood supply Branches of the deep femoral artery
Nerve supply Sciatic nerve
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Muscles of posterior region of thigh
Semitendinosus 半腱肌
Semimembranosus半膜肌
Long head of biceps femoris 股二头肌长头
Short head of biceps femoris 股二头肌短头
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Sciatic nerve 坐骨神经Course: Arises from the sacral plexus Leaves pelvis through infrapiriform foramen to enter glutea
l region Runs inferiorly laterally deep to gluteus maximus Passing midway between the greater trochanter of femur a
nd ischial tuberosity to back of thigh Lying deep to long head of biceps femoris, Normally divided into tibial and common peroneal nerves j
ust above popliteal fossa
Innervates: Semitendinosus Semimembranosus Biceps femoris Hip and knee joints
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Relationship of sciatic n. to the piriformis
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Popliteal fossa 腘窝Boundaries Superolaterally: Biceps femoris Superomedially: semimembranosus an
d semitendinosus Inferiorly: lateral and medial heads of ga
strocnemius Roof: deep fascia Floor: popliteal surface of the femur, the
posterior capsule of the knee joint, and the fascia covering popliteus
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Popliteal fossa 腘窝
Contents Nerves
Tibial nerve 胫神经 common peroneal nerve 腓总神经
Popliteal vein and its tributaries Popliteal artery and its branches Popliteal lympn nodes
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Popliteal artery 腘动脉 Course:
Begins at the adductor tendinous opening Here it is continuous with the femoral artery.
Ends at the lower border of the popliteus where it divides into anterior and posterior tibial arteries
Branches: Medial superior genicular a. 膝上内侧动脉 Lateral superior genicular a. 膝上外侧动脉 Medial inferior genicular a. 膝下内侧动脉 Lateral inferior genicular a. 膝下外侧动脉 Middle genicular a. 膝中动脉
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Popliteal vein 腘静脉
This is formed by the junction of the anterior and posterior tibial veins near the lower border of the popliteus muscle.
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Popliteal lymph nodes 腘淋巴结 There may be one or two nodes just unde
r the deep fascia, close to the popliteal fossa vessels.
They drain the deep tissues of the leg and foot and the knee joint. They also receive superficial lymph vessels from the lateral side of the foot, the heel, and the back of the calf. These drain along the line of the small saphenous vein.
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The back of the legThe back of the leg
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Superficial veins
Small saphenous v. 小隐静脉 Arises from the lateral part of the dorsal
venous arch of foot Ascends behind lateral malleolus and th
en runs up the 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 leg.
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Cutaneous nerves of the back of the leg
Medial 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
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Contents of the posterior osseofascial compartment of the leg
Superficial group muscles Gastrocnemius 腓肠肌 Soleus 比目鱼肌 Plantaris 跖肌Deep group muscles Popliteus 腘肌 Flexor digitorum longus
趾长屈肌 Tibialis posterior 胫骨后肌 Flexor hallucis longus
拇长屈肌Blood supply: Posterior tibi
al a.Nerve supply: Tibial nerve
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Muscles of posterior crural region
Gastrocnemius腓肠肌 Soleus 比目鱼肌
Plantaris 跖肌
Flexor hallucis longus拇屈伸肌
Popliteus 腘肌
Flexor digitorum longus趾长屈肌
Tibialis posterior 胫骨后肌
Tendo calcaneus跟腱
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Posterior tibial artery 胫后动脉
Begin at level of the lower border of the popliteus
Passes downwards deep to gastrocnemius and soleus
Passes behind medial malleolus and terminates by dividing into medial and lateral plantar arteries
Main branches: peroneal a. 腓动脉 medial plantar a. 足底内侧动脉 lateral plantar a. 足底外侧动脉
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Tibial nerve 胫神经
Runs inferiorly with posterior tibial vessels and terminates beneath flexor retinaculum by dividing into medial and lateral plantar nerves
Supplies posterior muscles of leg and knee joint
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Malleolar canal 踝管Boundaries Formed by medial surface of c
alcaneus, flexor retinaculum and medial malleolus
Structures passing through the malleolar canal Tibialis posterior Flexor digitirum longus Posterior tibial a. v. and n. Flexor hallucis longus
景致动人么
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You must identify follow structures !
Muscles of gluteal region, posterior thigh and leg Gluteus maximus Gluteus medius Gluteus minimus Piriformis Obturator internus Quadratus femoris Biceps femoris Semitendinosus Semimembranosus Gastrocnemius Soleus Tendo calcaneus Flexor digitorum longus Tibialis posterior Flexor hallucis longus
Nerves and vessels Sciatic n. Superior gluteal n. and vessels Inferior gluteal n. and vessels Internal pudendal vessels Pudendal n. Tibial n. Common peroneal n. Popliteal v. Popliteal a. Small saphenous v. Tibial a. and v.