TOPOGRAPHY OF THE BUTTLE REGION
TOPOGRAPHIC ANATOMY OF THE LOWER LIMB
Layer-by-layer topography - skin. subcutaneous fatty tissue with connective tissue bridges, superficial fascia. gluteal fascia
- superficial leaf. gluteus maximus muscle with fascial processes. deep layer of the gluteal fascia. middle gluteal fascia. piriformis muscle. superior gemellus muscle. obturator internus, gemellus inferior, quadratus femoris muscle. gluteus minimus muscle. obturator externus muscle.
With the primary localization of phlegmon in the tissue of the gluteal region, pus can spread into the tissue of the small pelvis through the infrapiriform opening. into the ischiorectal fossa through the lesser sciatic foramen. downwards along the sciatic nerve - into the tissue of the posterior bed of the thigh. anteriorly - into the tissue of the medial bed of the thigh along the branches of the obturator artery.
1). The skin is thick, covered with hair in the intergluteal fold and has many sebaceous and sweat glands. Connective tissue bridges are connected through the pancreas to the fascia.
2). PZhK – thick. In the upper outer part, the spur of the superficial fascia is divided into 2 layers: deep - passes into the lumbar region (massa adiposa lumboglutealis) and superficial. The PGC contains the nn.cluneum super., medius et inf., branches of the superior and inferior gluteal arteries and veins.
3). The superficial fascia is weakly expressed and separates 2 layers of the pancreas.
4). Gluteal fascia (proprietary) - starts from the sacrum and the iliac crest, covers the gluteus medius muscle in the superolateral section, then becomes the home for the gluteus maximus muscle. Upwards it becomes f.thoracolumbalis, downwards - into f. lata.
5). Muscles - lie in 3 layers:
A). surface layer
– large and upper part of the middle gluteal muscle. BYAM began from the crest of the podvzd. bones and goes down, outward and forward (forming tr. iliotibialis).
b). middle layer
– from top to bottom: SYAM, piriformis, internal obturator with gemini, quadratus femoris. The internal obturator muscle comes from the pelvis through the lesser sciatic foramen along with n. pudendus and av pudendae int. Under the tendons of some muscle tissues there are synovial bursae.
The pyriform muscle divides the greater sciatic foramen into
- for. suprapiriforme - formed by the lower edge of the SMN and the upper edge of the pyriform muscle.
From here comes the superior gluteal artery (medially and above), vein and nerve (latin).
- for. infrapiriforme – surrounded by the lower edge of the pyriform muscle and the sacrospinous muscle.
From it emerge the pudendal nerve and internal pudendal nerves (medially), the inferior gluteal nerve, the posterior cutaneous nerve of the thigh, the inferior gluteal nerves and the sciatic nerve (laterally).
V). deep layer
– above the MYM, below – the external obturator muscle.
The sciatic nerve - at the lower edge of the MU lies under the superficial fascia vertically, passing between the inner and middle third of the line connecting the greater trochanter and the saddle. tubercle
It then goes under the long head of the biceps femoris.
The internal pudendal nerves and the pudendal nerve bend around the sciatic spine and through the lesser sciatic foramen enter the perineal area, reaching the fossa ischiorectalis.
The inferior gluteal nerve innervates the BLM.
The inferior gluteal artery immediately divides into branches to the gluteal muscles and to the sciatic nerve (r. comitans n. ischiadici). This artery widely anastomoses with its neighbors.
Fiber of the gluteal region:
located between the BNM and the deep layers of the mc, it is reported:
1). through the large sciatic foramen (more precisely, the infrapiriform) - with pelvic tissue.
2). through the lesser sciatic foramen with tissue fossa ischiorectalis.
3). from below it passes into the tissue surrounding the sciatic nerve (and further into the popliteal region).
4). anteriorly along the posterior branch of the obturator artery - with deep tissue in the area of the adductor mc.
Internal iliac artery
A. ilíaca intérna (see Fig. 230), starting from the lower end of the common iliac artery at the level of the sacroiliac joint, descends into the small pelvis and extends to the upper edge of the greater sciatic foramen. Its division into branches, parietal and visceral, is subject to significant individual variations, but most often it is divided at the level of the upper edge of the greater sciatic foramen, first into two main trunks - the posterior one, giving aa. iliolumbális, sacralis lateralis, glútea supérior, and the anterior one, from which all other branches of a. ilíacae internae. On its way a. The iliac intérna is covered by the peritoneum, and the ureter descends along it in front, which is important to take into account during the operation so as not to ligate it instead of the artery; behind lies v. ilíaca interna.
Parietal branches a. ilíacae internae:
1. A. iliolumbális, iliopsoas artery , enters the fossa ilíaca, where it anastomoses with. a. circumflexa ílii profúnda from a. ilíaca externa.
2. A. sacralis lateralis, lateral sacral artery , supplies blood mm. levator áni and pirifórmis, nerve trunks of the sacral plexus.
3. A. glutea supérior, superior gluteal artery , represents a continuation of the posterior trunk of the internal iliac artery, exits the pelvis through the foramen suprapirifórme to the gluteal muscles, accompanying n. gluteus superior.
4. A. obturatoria, obturator artery , goes to the obturator foramen. Upon exiting the obturator canal, it supplies m. obturatorius extérnus, adductors and gives rámus acetabularis
. This latter penetrates the hip joint through the incisura acetabuli and nourishes the lig. capitis femoris and the head of the femur.
5. A. glútea inférior, inferior gluteal artery , passes through the forámen infrapirifórme together with a. Pudénda interna i n. ischiádicus, to which she gives a long thin branch - a. comitans n. ischiadici
. Coming out of the pelvic cavity, a. glútea inférior gives muscle branches to the gluteal and other nearby muscles.
Visceral branches a. ilíaca interna:
1. A. umbilicalis, umbilical artery , retains lumen in an adult only for a short distance - from the beginning to the place where the superior vesical artery departs from it; the rest of its trunk to the umbilicus is obliterated and turns into lig. umbilicale mediale.
2. Rámi ureterici - to the ureter (can extend from a. umbilicális).
3. Aa. vesicáles supérior et inférior : the superior cystic artery begins from the non-obliterated part of a. umbilicalis and branches in the upper part of the bladder; The inferior cystic artery starts from a. ilíaca intérna and supplies the ureter and the bottom of the bladder, and also gives branches to the vagina (in women), the prostate gland and seminal vesicles (in men).
4. A. dúctus deferentis, the artery of the vas deferens (in men), goes to the dúctus deferens and, accompanied by it, extends to the testis, to which it also gives off branches.
5. A. uterina, uterine artery (in women), arises from either the trunk of a. ilíaca interna, or from the initial part of a. umbilicalis, goes to the medial side, crosses the ureter and, reaching between the two leaves of the lig. látum úteri of the lateral side of the cervix, gives a branch downwards - a. vaginalis
(can extend from the a. ilíaca intérna directly) to the walls of the vagina, itself turning upward, along the line of attachment of the broad ligament to the uterus.
Gives branches to the fallopian tube - rámus tubárius
and to the ovary -
rámus ováricus
, a. The uterina becomes sharply tortuous after childbirth.
6. A. rectalis media, middle rectal artery , arises from either a. ilíaca interna, or from a. vesicalis inférior, branches in the walls of the rectum, anastomosing with aa. rectáles supérior et inférior, also gives branches to the ureter and bladder, prostate gland, seminal vesicles, and in women - to the vagina.
Chapter 10. TOPOGRAPHIC ANATOMY OF THE LOWER LIMB
The boundaries of the lower limb run anteriorly along the inguinal fold, and posteriorly along the crest of the iliac spine. On the lower limb there are: the gluteal region; areas of the thigh, knee, lower leg, ankle area; foot area. External landmarks and external relief of the lower limb, shown in Fig. 10.1 will be described by limb region.
10.1. BUTTAL REGION
Region boundaries.
The gluteal region
(regio glutealis)
is limited: from above - by the iliac crest; below - gluteal skin fold; laterally - a vertical line; running from the anterior superior iliac spine to the greater trochanter; medially - the sacrum and coccyx.
External relief
This area is formed by the gluteal eminence, formed by the gluteus maximus muscle and subcutaneous tissue, the gluteal fold, the intergluteal gap and bone elevations: the iliac crest, the anterior superior iliac spine, the posterior superior iliac spine, the ischial tubercle, the greater trochanter of the femur, the sacrum, the coccyx.
Layers. Leather
The gluteal region is uniformly thick.
The subcutaneous tissue
is well developed, reaching 1.5-2 cm or more in thickness. At the upper edge of the gluteus maximus muscle, above the gluteus medius muscle, deeper than the subcutaneous tissue, there is an additional layer of fat - the so-called lumbogluteal fat pad, extending into the lumbar region
Fascial beds and cellular spaces.
The gluteal fascia is divided into two layers - superficial and deep, which, connecting with each other and with the bones of the pelvis, form a superficial and deep fascial bed. The superficial fascial bed is actually a case for the gluteus maximus muscle, formed by the superficial and deep layers of the gluteal fascia and the closed
Rice. 10.1.
General relief of the lower limb of a man: a - front view: 1 - sartorius muscle; 2 - adductor muscles of the thigh; 3 - rectus femoris muscle; 4 - vastus medialis; 5 - patella; 6 - patellar ligament; 7 - medial head of the gastrocnemius muscle; 8 - medial surface of the tibia; 9 - medial malleolus; 10 - tendon of the long extensor of the big toe; 11 - extensor digitorum longus tendon; 12 - lateral malleolus; 13 - tibialis anterior muscle; 14 — tuberosity of the tibia; 15 - tendon of the quadriceps femoris muscle; 16 - vastus lateralis muscle; b — rear view: 1 — gluteus maximus muscle; 2 - gluteal fold; 3 - biceps femoris muscle; 4 - lateral groove of the popliteal fossa; 5 - transverse skin folds of the popliteal fossa; 6 - lateral head of the gastrocnemius muscle; 7 - lateral retromalleolar fossa; 8 - lateral malleolus; 9 - calcaneal tendon; 10 - calcaneal tubercle; 11 - medial retromalleolar fossa; 12 - medial malleolus; 13 - medial head of the gastrocnemius muscle; 14 - medial groove of the popliteal fossa; 15 - semitendinosus muscle; 16 - intergluteal gap
Topographic anatomy of the gluteal region. Topography of the supra- and infrapiriform foramina.
For internal use)
MINISTRY OF HEALTH OF THE REPUBLIC OF BELARUS
EDUCATIONAL INSTITUTION
"GOMEL STATE MEDICAL UNIVERSITY"
Operative surgery course
and topographic anatomy
Faculty of Medical Diagnostics 3rd year
Approved at a department meeting
Protocol No._____ dated “____” 2006
TOPIC:
TOPOGRAPHIC ANATOMY OF THE BUTTLE REGION, HIGH AND POPELLETIUM REGION, TOPOGRAPHY OF THE HIP JOINT
Educational and methodological manual for students
Authors: candidate of medical sciences, associate professor Doroshkevich S.V.
Candidate of Medical Sciences, Associate Professor Doroshkevich E.Yu.
assistant Yakunin Z.A.
GOMEL 2006
I. Relevance of the topic:
The study of the topographic anatomy of the gluteal region and hip joint is of great practical importance in the clinic. Based on the topographic-anatomical patterns of the location of blood vessels and nerves, injections are made in the gluteal region and the anterior thigh. At the same time, the anterior region of the thigh can serve as a place for hernias to exit into the subcutaneous fat. These areas contain a number of canals, large muscle layers, and cellular spaces, which creates conditions for the occurrence of foci of anaerobic infection.
II. Purpose of the lesson:
Study the topography of the gluteal region, thigh area, hip joint, popliteal fossa.
III. Lesson objectives:
1. Know external landmarks, projections of neurovascular bundles, topography of the gluteal region, anterior thigh, topographic-anatomical features of the hip joint, topography of the popliteal fossa.
2. Be able to explain the position of bone fragments during a fracture of the femur.
3. Master the preparation of neurovascular bundles and anatomical formations in this area. Operative access for ligation of the internal iliac artery.
IV. Basic study questions
:
1. External landmarks and projections in the gluteal and thigh areas.
2. Topographic anatomy of the gluteal region. Topography of the supra- and infrapiriform foramina.
3. The hip joint, its topographic and anatomical features.
4. Surgical anatomy of the femoral triangle.
5. Surgical anatomy of the femoral canal.
6. Topography of the obturator canal.
7. Topography of the Gunter Canal.
8. Topography of the posterior thigh area.
9. Topography and projections of the neurovascular bundles of the thigh.
10. Topographic anatomy of the popliteal fossa, features of the location of the sodysonervous bundle in it.
V. Auxiliary