下肢后面浅层、臀区深层课件.ppt

下肢后面浅层、臀区深层解剖Posterior superifical dissection of lower limb,deep dissection of gluteal region,皮肤切口：,一、皮肤skin,二、浅筋膜superficial fascia,1、皮神经cutaneous n.,臀上皮神经superior gluteal cutaneous n.,臀下皮神经inferior gluteal cutaneous n.,股后皮神经posterior femoral cutaneous n.,臀中皮神经middle gluteal cutaneous n.,臀上皮神经superior gluteal cutaneous n.,臀中皮神经middle gluteal cutaneous n.,臀下皮神经inferior gluteal cutaneous n.,股后皮神经posterior femoral cutaneous n.,起自足背静脉弓外侧端，经外踝后方，上行至小腿后面，穿腘筋膜注入腘静脉。,腓肠内侧皮神经medial cural cutaneous n.,腓肠外侧皮神经lateral cural cutaneous n.,腓肠神经sural n.,腓肠内侧皮神经medial cural cutaneous n.,腓肠外侧皮神经lateral cural cutaneous n.,腓肠神经sural n.,2、小隐静脉small saphenous v.,小隐静脉small saphenous v.,臀大肌gluteus maximus：作用：使髋关节后伸和外旋。神经支配：臀下神经。,三、臀肌gluteus:三层three layer,浅层superficial layer:,沿臀大肌起点处切断该肌，注意勿损伤其深面的骶结节韧带，将肌向外侧翻开。靠近臀大肌处切断进入该肌的血管和神经。,阔筋膜张肌tensor fasciae latae,作用：屈髋关节和伸膝神经支配：臀上神经。,臀大肌gluteus maximus,阔筋膜张肌tensor fasciae latae,髂胫束iliotibial tract,中层middle layer:,在臀中肌的中部切断该肌并翻开,神经支配：臀中肌臀上神经梨状肌、上孖肌、闭孔内肌、下孖肌、股 方肌骶丛的肌支,臀中肌gluteus medius,梨状肌piriformis,上孖肌、下孖肌superior、inferior gemellus,闭孔内肌obturator internus,股方肌quadrarus femoris,Gluteus medius,Piriformis,Obturator internus,Quadratus femoris,gluteus medius,深层deep layer,臀小肌gluteus minimus,闭孔外肌obturator internus,神经支配：臀小肌臀上神经闭孔外肌闭孔神经,臀小肌gluteus minimus,四、臀区的血管神经blood vessel and nerves of gulteal region,Lesser sciatic foramen,Infrapiriform foramen,Suprapiriform foramen,Great sciatic foramen,1.穿经梨状肌上孔的血管神经The structures through Suprapiriform foramen,臀上动脉superior gluteal artery,臀上静脉 superior gluteal vein,臀上神经 superior gluteal nerve,The vessels throughSuprapiriform foramen,2.穿经梨状肌下孔的血管神经The structures through Infrapiriform foramen,从外侧向内侧依次为：,坐骨神经 sciatic n.,股后皮神经 posterior femoral cutaneous n.,臀下神经inferior gluteal n.,臀下动脉及静脉inferior gluteal a/v.,阴部内动脉及静脉Internal pudendal a./v.,阴部神经pudendal n.,、,Inferior gluteal a,Inferior gluteal n,Inferior gluteal v,inferior gluteal v,The vessels through Infrapiriform foramen,五.股后群肌Posterior group muscles of thigh,作用：伸髋屈膝 神经支配：坐骨神经,内侧medial：,半膜肌Semimembranosus（深层deep layer）,外侧lateral：,股二头肌Biceps femoris,半腱肌Semitendinosus（浅层superficial layer）,半腱肌Semitendinosus,半膜肌Semimembranosus,股二头肌Biceps femoris,来源：最粗大的神经,发自骶丛行程：在臀大肌深面，经坐骨结节与股骨大转子之间至股后，在股二头肌深面下降。分支：一般在腘窝上方分为胫神经和腓总神经，在股后部发出肌支支配大腿后群肌。,六.坐骨神经Sciatic N,坐骨神经Sciatic N,胫神经Tibial N,腓总神经Commom peroneal n,七.股后区的动脉The artery of back of thigh,主要来自股深动脉，该动脉发出34条穿动脉。,Perforating artery 穿动脉,八.小腿后群肌posterior group muscle of leg,作用：使踝关节跖屈神经支配：胫神经,浅层 superficial layer：,跖肌 plantaris,腓肠肌 Gastrocnemius,比目鱼肌 Soleus,腓肠肌 Gastrocnemius,比目鱼肌 Soleus,跖肌 plantaris,作用：使踝关节跖屈神经支配：胫神经,深层deep layer：,腘肌 popliteus,趾长屈肌 Flexor digitorum longus,胫骨后肌 Tibialis posterior,踇长屈肌 Flexor hallucis longus,腘肌 popliteus,趾长屈肌 Flexor digitorum longus,胫骨后肌 Tibialis posterior,踇长屈肌 Flexor hallucis longus,行程：与胫神经伴行，向下行于浅、深两层肌之间，下行经踝管入足底，分为足底内侧动脉和足底外侧动脉。主要分支：腓动脉。,九.小腿后区的血管、神经 blood vessel、nerve of posterior region of leg,1、胫前动脉anterior tibial a.,2、胫后动脉 posterior tibial a.,胫后动脉 posterior tibial a,腓动脉peroneal a,胫前动脉anterior tibial a.,足底内侧动脉、神经medial plantar a.n.,足底外侧动脉、神经lateral plantar a.n.,分支：关节支：分布于膝关节。肌支：支配小腿后群肌。皮支：为腓肠内侧皮神经。,3、胫神经 tibial nerve,起源：为坐骨神经本干的直接延续。,行程：在腘窝内与腘血管伴行，在小腿经比目鱼肌深面伴胫后动脉下降，经踝管入足底，分为足底内侧神经和足底外侧神经二终支。,胫神经 tibial nerve,十.腘窝 popiteal fossa,位置location：位于膝后的菱形肌间隙,上外-股二头肌 上内-半腱肌和半膜肌 下外-腓肠肌外侧头 下内-腓肠肌内侧头 窝顶-腘筋膜 股骨的腘面 窝底（前壁）膝关节囊 腘肌,由浅到深为胫神经与腓总神 经、腘静脉、腘动脉及其周围淋巴结,境界Boundary:,内容contents:,3.内容contents(由前向后):,十一.踝管malleolar canal,1、位置location：位于踝关节内侧,2、构成consist：,内踝屈肌支持带跟骨内侧面,胫骨后肌腱 Tendon of tibialis posterior趾长屈肌腱 Flexor digitorum longus 胫后动、静脉 Tibial a、v.胫神经 Tibial n.踇长屈肌腱 Flexor hallucis longus,