Posterior region of lower limb

1. Regional anatomy of lower limb Posterior region of lower limb Ling Shucai

2. 1. Surface anatomy 表面解剖 2. The superficial structures 浅层结构 Superficial veins 浅淋巴管 Superficial lymph vessels 浅静脉 Cutaneous nerves 皮神经 3. The deep structures 深层结构 The deep fascia 深筋膜 The muscles 肌 The vessels 血管 The nerves 神经 4. Regional anatomy 局部解剖 Gluteal region 臀区 suprapiriform foramen and infrapiriform foramen 梨状肌上孔和梨状肌下孔 Popliteal fossa 腘窝 Posterior region of the leg 小腿后区 Ankle 踝区 Main contents

3. Surface anatomy

4. Surface Anatomy: Posterior Pelvis

5. Surface Anatomy: Posterior Leg

6. The superficial structures

7. Superior cluneal n. 臀上皮神经 Medial cluneal n. 臀中皮神经 Inferior cluneal n. 臀下皮神经 Cutaneous Nerves

8. Medial sural cutaneous n.腓肠内侧神经 • Lateral sural cutaneous n.腓肠外侧神经 • Communicating nerve吻合支 • Sural n.腓肠神经

9. Distribution of Cutaneous Nerves

10. Superficial veins Small saphenous v. • Arises from the lateral part of the dorsal venous arch of foot • Ascends behind lateral malleolus and then passes upward to the midline of the clft • Pierces the deep fascia and enters the popliteal v. • It drains the lateral side of the foot and ankle and the back of the leg.

11. Varices 静脉曲张

12. The deep structures

13. 2 3 4 • Muscles of gluteal region • 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 • Quadratus femoris 股方肌 • Obturator externus 闭孔外肌 1 5 6

14. Posterior group of muscles of the thigh • Biceps femoris 股二头肌 • Semitendinosus 半腱肌 • Semimembranosus 半膜肌 flex the leg at knee joint extend the thigh at hip joint 3 2 1

15. Posterior group of muscles of the leg • Superficial lager Triceps surae小腿三头肌 • Gastrocnemius腓肠肌 • Soleus比目鱼肌 • 跟腱 1 1 2 3 3

16. Posterior group of muscles of the leg • Deep layer • Popliteus 腘肌 • Flexor digitorum longus趾长屈肌 • Flexor hallucis longus 拇长屈肌 • Tibialis posterior 胫骨后肌 1 4 3 2

17. Muscles of foot • Muscles on dorsum: extensor digitorumbrevis • Muscles in sole: medial, lateral and intermediate groups 足底腱膜 趾短屈肌 足底方肌

18. Arteries of lower limb Femoral a. 股动脉 • Continuation of the external iliac a. • Begins midpoint of inguinal ligament • Principal branch deep femeral a.股深动脉: medial femoral circumflex a. 旋股内侧动脉 lateral femoral circumflex a. 旋股外侧动脉 perforating arteries 穿动脉

19. Popliteal a. 腘动脉 • Continuation of femoral a. at adductor hiatus • Divided into anterior and posterior tibial arteries at lower border of poplitus Posterior tibial a. 胫后动脉 • Branches: peroneal a. 腓动脉 medial plantar a. 足底内侧动脉 lateral plantar a. 足底外侧动脉

20. Popliteal artery • It begins at the adductor tendinous opening in. Here it is continuous with the femoral artery. It ends at the lower border of the popliteus muscle （腘肌）where it divides into anterior and posterior tibial arteries. • Branches: 1. Superior, inferior, and middle genicular arteries 2. Muscular branches

21. Popliteal vein • This is formed by the junction of the anterior and posterior tibial veins near the lower border of the popliteus muscle. Popliteal lymph nodes • There may be one or two nodes just under 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.

22. Innervation of posterior region of lower limb • Superior gluteal n. 臀上神经 • Inferior gluteal n. 臀下神经 • Posterior femoral cutaneous: 股后皮神经 • Sciatic n. 坐骨神经

23. Sacral plexus 骶丛

24. Sciatic n. 坐骨神经 • Leaves pelvis through infrapiriform foramen to enter gluteal region, runs inferiorly laterally deep to gluteus maximus, passing midway between the greater trochanter of femur and ischial tuberosity to back of thigh, lying deep to long head of biceps femoris, normally divided into tibial and common peroneal nerves just above popliteal fossa • Innervates semitendinosus, semimembranosus and biceps femoris and has articular branches to hip and knee joints

26. Tibial n. 胫神经 • Runs inferiorly with posterior tibial vessels and terminates beneath flexor retinaculum by dividing into medial and lateral plantar nerves 足底内、外侧神经 • Supplies posterior muscles of leg and knee joint

27. Regional anatomy

28. Parts and regions • Gluteal region 臀区 • Back of the thigh 股后区 • Popliteal fossa 腘窝 • Posterior region of the leg 小腿后区 • Ankle 踝区 • Sole of the foot 足底

29. suprapiriform foramen infrapiriform foramen Gluteal Region 臀区

30. Structures passing suprapiriform foramen • Superior gluteal n., a., v. from lateral to medial side Structures passing infrapiriform foramen • Sciatic n., posterior femoral cutaneous n., inferior gluteal n., a.,v., internal pudendal v., a., and pudendal n. from lateral to medial side

31. Pudendal nerve, internal pudendal artery • These structures enter the gluteal region through the infrapiriform foramen. • They then curve forwards to enter the perineum through the lesser sciatic foramen.

32. ★ Sciatic nerve • Course: It arises from the sacral plexus and passes through infrapiriform foramen into the gluteal region, deep to gluteus maximus, passing midway between the greater trochanter of femur and ischial tuberosity to back of thigh, the nerve lies deep to the long head of biceps on the posterior surface of adductor magnus. The sciatic nerve usually ends half-way down the back of the thigh by dividing into the common peroneal and tibial nerves. • Distribution: semitendinosus, semimembranosus and biceps femoris and has articular branches to hip and knee joints

33. Relationship of sciatic n. to the piriformis

34. Boundaries of the popliteal fossa 腘窝 • Diamond-shaped • Upper lateral boundary: Biceps femoris • Upper medial boundary: semimembranosus and semitendinosus • Two lower boundaries are the heads of gastrocnemius • Posterior wall: deep fascia • Anterior wall: popliteal surface of the femur, the posterior capsule of the knee joint, and the fascia covering poplitells

35. Contents of the popliteal fossa • Tibial and common peroneal nerves and their branches • Popliteal vein and its tributaries • Popliteal artery and its branches • Popliteal lympn nodes • Fatty tissue

36. Posterior region of the leg 小腿后区 • Gastrocnemius腓肠肌 • Soleus比目鱼肌 • Plantaris 跖肌 • Tibial nerve 胫神经 • Popliteal artery 腘动脉 • Popliteus腘肌 • Flexor hallucis longus • Flexor digitorum longus • Tibialis posterior

37. Ankle 踝区 Malleolar canal 踝管 • Formed by midial surface of calcaneus跟骨, flexor retinaculum屈肌支持带 and medial malleolus内踝 Structures passing Malleolar canal • Tibialis posterior • Flexor digitirum longus • Posterior tibial a. v. • Posterior tibial n. • Flexor hallucis longus “景致动人么”