Gluteal Region and Posterior Region of Thigh and Leg

1. Gluteal Region and Posterior Region of Thigh and Leg 山东大学医学院 解剖教研室 李振华

2. Skin incisions • Make the skin incisions shown in figure and reflect the skin flaps

3. Gluteal region

4. 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

5. Inferior cluneal n. Cutaneous nerves Superior cluneal n. Medial cluneal n.

6. 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

7. Muscles of the gluteal region Gluteus medius 臀中肌 Gluteus maximus臀大肌 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

8. The gluteal region suprapiriform foramen infrapiriform foramen

9. 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

10. 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

11. Posterior Region of Thigh and Leg

12. 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

13. Muscles of posterior region of thigh Semimembranosus 半膜肌 Semitendinosus半腱肌 Long head of biceps femoris 股二头肌长头 Short head of biceps femoris 股二头肌短头

14. Sciatic nerve坐骨神经 Course: • Arises from the sacral plexus • 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 • Biceps femoris • Hip and knee joints

15. Relationship of sciatic n. to the piriformis

16. Popliteal fossa 腘窝 Boundaries • Superolaterally: Biceps femoris • Superomedially: semimembranosus and semitendinosus • Inferiorly: lateral and medial heads of gastrocnemius • Roof: deep fascia • Floor: popliteal surface of the femur, the posterior capsule of the knee joint, and the fascia covering popliteus

17. 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

18. 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

19. 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.

20. Popliteal lymph nodes 腘淋巴结 • 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.

21. The back of the leg

22. 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 then 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.

23. 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

24. 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 tibial a. Nerve supply: Tibial nerve

25. Muscles of posterior crural region Plantaris跖肌 Popliteus 腘肌 Gastrocnemius腓肠肌 Flexor digitorum longus 趾长屈肌 Soleus比目鱼肌 Tibialis posterior胫骨后肌 Flexor hallucis longus 拇屈伸肌 Tendo calcaneus 跟腱

26. 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

27. 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

28. Malleolar canal 踝管 Boundaries • Formed by medial surface of calcaneus, 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

29. 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. You must identify follow structures！