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The suprapiriform and infrapiriform foramen




The piriform muscle passes through the greater sciatic foramen. The suprapiriform and infrapiriform foramen (foramen suprapiriforme, infrapiriforme /надгрушевидное, подгрушевидное отверстие) remain above and below which narrow openings. They transmit the gluteal nerves and vessels.

The obturator canal

The obturator groove of the pubic bone is supplemented below by the obturator membrane and thus converted to the obturator canal (canalis obturatorius /запирательный канал), transmiting the obturator vessels and nerves.

 

Topography of the thigh

 

· The fascia iliaca passes in the space between the inguinal ligament and hip bone. It fuses in its lateral part with the inguinal ligament, while its medial part diverges from the ligament and attaches to the iliopubioc eminence. This part is distinguished artificially under the name of the iliopectineal arch (arcus iliopectineus /подвдошно-гребенчатая дуга).

· The iliopectineal arch divides the space below the inguinal ligament into two parts:

- The muscular space (lacuna musculorum /мышечная лакуна) lodging the iliopsoas muscle and the femoral nerve.

- The vascular space (lacuna vasorum /сосудистая лакуна) for passage of the femoral artery and vein (lies medially).

· From vascular space the vessels pass to the thigh, leg and foot. According to the passage of the vessels and nerves, the folloving grooves and canals are distinguished:

- The vascular space continues with the iliopectineal groove (sulcus iliopectineus /подвздошно-гребенчатая борозда). It lies between the iliopsoas (laterally) and pectineus (laterally) muscles and then continues with the anterior femoral groove.

- The anterior femoral groove (sulcus femoralis anterior /передняя бедренная борозда) is bounded by the vastus medialis (laterally) and the adductor longus and magnus (medially) muscles. Both grooves are in the femoral triangle (trigonum femorale /бедренный треугольник). It is bounded by the inguinal ligament superiorly, the sartorius muscle laterally and the adductor longus muscle medially. The floor of this triangle is the iliopsoas and pectineus muscles. The anterior femoral groove continues with the adductor canal.

- The adductor canal (canalis adductorius /приводящий канал) passes on the lower third of the thigh into popliteal fossa. The canal is formed by the vastus medialis muscle laterally, the adductor magnus muscle medially and the anteromedial intermuacular septum (septum intermusculare vasoadductorium /), running over them anteriorly. The canal has three openings:

- The proximal opening (inlet) is bounded by the adductor magnus, vastus medialis muscles and the anteromedial intermuacular septum.

- The distal opening (outlet) is called the adductor hiatus (hiatus adductorius /сухожильная щель) and formed by the diverging bundles of the adductor magnus tendon.

- The anterior opening is in the anteromedial intermuacular septum.

The femoral canal (canalis femoralis /бедренный канал)

· The femoral canal is bounded by the femoral vein laterally, the deep layer of the fascia lata posteriorly and the inguinal ligament and the superior horn of the falciform margin anteriorly.

· The femoral canal has two openings:

- The femoral ring (annulus femoralis /бедренное кольцо) is the internal opening (inlet). The ring is bounded by the femoral vein laterally, by the inguinal ligament anteriorly and superiorly, by the lacunar ligament medially, by the pectineal ligament posteriorly. The lacunar ligament is a continuation of the inguinal ligament, the pectineal ligament is a continuation of the lacunar ligament on the pubic bone.

- The external opening (outlet) is the saphenous opening.

· Under normal conditions the femoral canal does not exist, there is the femoral ring only.

 

 

Muscles of the leg

The anterior group

Tibialis anterior (m. tibialis anterior /передняя большеберцовая мышца)

· Origin. From the lateral surface of the tibia.

· Insertion. To the base of the 1 st metatarsal and the medial cuneiform.

· Actions. Dorsiflexion and inversion of the foot.

· Nerve supply. Deep peronal nerve.

Extensor hallucis longus (m. extensor hallucis longus /длинный разгибатель большого пальца стопы)

· Origin. From the middle third of the shaft of the fibula.

· Insertion. To the base of the distal phalanx of the big toe.

· Actions. Extension of the big toe and dorsiflexion of the foot.

· Nerve supply. Deep peroneal nerve.

Extensor digitorum longus (m. extensor digitorum longus /длинный разгибатель пальцев)

· Origin. From the shaft of the fibula.

· Insertion. To the bases of the middle and distal phalanges of the four lateral toes via the dorsal extensor expansions.

· Actions. Fxtension of the toes and dorsiflexion of the foot.

· Nerve supply. Deep peroneal nerve.

Fibularis tertius (m. fibularis tertius /третья малоберцовая мышца)

· Origin. Formed by the lower part of extensor digitorum longus.

· Insertion. Into the base of the 5th metatarsal.

· Action. Dorsiflexion of the foot.

· Nerve supply. Deep peroneal nerve.

The lateral group

Fibularis longus (m. fibularis longus /длинная малоберцовая мышца)

· Origin. From the upper two-thirds of the lateral surface of the shaft of the fibula.

· Insertion. To the base of the 1st metatarsal and the medial cuneiform.via the groove on the cuboid.

· Action. Eversion of the foot.

· Nerve supply. Superficial peroneal nerve.

Fibularis brevis (m. fibularis brevis /короткая малоберцовая мышца)

· Origin. From the lower two-thirds of the shaft of the fibula.

· Insertion. To the base of the 5th metatarsal.

· Action. Eversion of the foot.

· Nerve supply. Superficial peroneal nerve.

The posterior group

The superficial layer

Gastrocnemius (m. gastrocnemius /икроножная мышца)

· Origin. From the femur just above both femoral condyles.

· Insertion. To the middle third of the back of the calcaneus via the calcaneal tendon.

· Actions. Plantar flexion of the foot; weak flexion of the knee.

· Nerve supply. Tibial nerve.

Soleus (m. soleus /камбаловидная мышца)

· Origin. From the soleal line of the tibia and the upper part of the back of the fibula.

· Insertion. To the middle third of the back of the calcaneus via the calcaneal tendon in common with the gastrocnemius.

· Actions. Plantar flexion of the foot. Is the main factor in the ‘muscle pump’.

· Nerve supply. Tibial nerve.

Plantaris (m. plantaris /подошвенная мышца)

· A detached piece of the lateral head of gastrocnemius with similar properties.

Popliteus (m. popliteus /подколенная мышца)

· Origin. From the back of the tibia above the soleal line.

· Insertion. To the lateral condyle of the femur.

· Actions. Flexion and medial rotation of the leg (thus ‘unlocking’ the extended knee joint).

· Nerve supply. Tibial nerve.

The deep layer

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