Gluteal Region and Posterior

Region of Thigh

Skin incisions

Make the skin incisions shown

in figure and reflect the skin

flaps

Gluteal region

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

Cutaneous nerves

Superior cluneal n.

Medial cluneal n.

Inferior cluneal n.

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

Muscles of the gluteal region

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

Gluteus maximus臀大肌

The gluteal region

suprapiriform foramen

infrapiriform foramen

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

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

髋关节动脉网thigh joint arterial rete ：

组成：

①两侧为旋股内、外侧动脉；

②上部为臀上、下动脉；

③下部为第一穿动脉。

以“臀部十字吻合”为

重要，位于臀大肌深面。

臀部肌肉注射buttocks intramuscular injection

①十字法：自臀裂的顶点向左(或右)侧画一水平线，在髂嵴最高点画一垂直线，外上方1/4为注射区。

②连线法：将髂前上棘与尾骨尖连线分为3等份，外上1/3处为注射区。

Posterior Region of Thigh and Leg

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

Muscles of posterior region of thigh

Semitendinosus半腱肌

Semimembranosus 半膜肌

Long head of biceps

femoris 股二头肌长头 Short head of biceps

femoris 股二头肌短头

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

Relationship of sciatic n. to the piriformis

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

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

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

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.

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.

You must identify follow structures！

Muscles of gluteal region, posterior thigh and leg

Gluteus maximus

Gluteus medius

Gluteus minimus

Piriformis

Obturator internus

Quadratus femoris

Biceps femoris

Semitendinosus

Semimembranosus

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.

The back of the leg

Skin incisions

Make the skin incisions indicated in

figure and reflect the skin flaps.

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.

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

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

Muscles of posterior crural region

Gastrocnemius

腓肠肌

Soleus比目鱼肌

Plantaris跖肌

Flexor hallucis longus 拇屈伸肌

Popliteus 腘肌

Flexor digitorum longus 趾长屈肌

Tibialis posterior胫骨后肌

Tendo calcaneus 跟腱

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

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

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

You must identify follow structures！

Muscles of posterior leg

Gastrocnemius

Soleus

Tendo calcaneus

Flexor digitorum longus

Tibialis posterior

Flexor hallucis longus

Nerves and vessels

Tibial n.

Common peroneal n.

Popliteal v.

Popliteal a.

Small saphenous v.

Tibial a. and v.