单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,下肢后面浅层、臀区深层解剖,Posterior superifical dissection of lower limb,deep dissection of gluteal region,下肢后面浅层、臀区深层解剖Posterior superif,1,皮肤切口,：,一、皮肤,skin,皮肤切口：一、皮肤skin,2,二、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.,二、浅筋膜superficial fascia1、皮神经cu,3,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.,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,4,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：三、臀肌gluteu,5,臀大肌,gluteus maximus,阔筋膜张肌,tensor fasciae latae,髂胫束,iliotibial tract,臀大肌gluteus maximus阔筋膜张肌tensor,6,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,中层middle layer:在臀中肌的中部切断该肌并翻开,7,gluteus medius,gluteus medius,8,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,深层deep layer臀小肌gluteus minimu,9,四、臀区的,血管神经,blood vessel and nerves of gulteal region,Lesser sciatic foramen,Infrapiriform foramen,Suprapiriform foramen,Great sciatic foramen,四、臀区的血管神经blood vessel and nerv,10,1.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,1.穿经梨状肌上孔的血管神经The structures t,11,Superior gluteal v,Superior gluteal v,The vessels through,Suprapiriform foramen,Superior gluteal vSuperior gl,12,2.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.,、,2.穿经梨状肌下孔的血管神经The structures t,13,Inferior gluteal a,Inferior gluteal n,Inferior gluteal v,inferior gluteal v,The vessels through Infrapiriform foramen,Internal pudendal a and v,Inferior gluteal aInferior glu,14,五.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,五.股后群肌Posterior group muscles,15,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,来源：最粗大的神经,发自骶丛六.坐骨神经Sciatic N,16,七.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,七.股后区的动脉The artery of back o,17,八.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,八.小腿后群肌posterior group muscle,18,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,作用：使踝关节跖屈深层deep layer：腘肌 popli,19,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,.,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,20,足底内侧动脉、神经,medial plantar a.n.,足底外侧动脉、神经,lateral plantar a.n.,足底内侧动脉、神经足底外侧动脉、神经,21,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,分支：3、胫神经 tibial nerve起源：为坐骨神经本,22,十.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,:,十.腘窝 popiteal fossa位置location,23,3.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,3.内容contents(由前向后):十一.踝管mal,24,