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Topography of the fascia and cell spaces of the chest. Department of Operative Surgery and Clinical Anatomy with a course of innovative technologies Thoracic triangle

Borders (with the abducted hand): in front - the lower edge of the pectoralis major muscle; behind - the lower edge of the broad dorsi muscle and the large round muscle; medially - a conditional line drawn on the chest between the indicated muscles in the place where they depart from the chest; laterally - the line connecting the same muscles on the medial surface of the shoulder.


The skin is thin, mobile, covered with hair, contains sweat, sebaceous and apocrine glands. The subcutaneous tissue contains small veins, arteries, lymphatic vessels and cutaneous nerves.

The axillary fascia (fascia axillaris) is dense along the periphery and looser in the center due to the small vessels and nerves passing through it, has a dome-shaped retraction, due to the interweaving of the clavicular-thoracic fascia into it.

After removal of the fascia, it opens armpit, which, with the abducted hand, is a tetrahedral pyramid with a base facing outward and downward, and a top directed upward and inward and located at the clavicle and I rib.

The walls of the armpit are formed by: the anterior pectoralis major and minor and the clavicular-pectoral fascia; the back - the subscapularis muscle, the broad muscle of the back and the large round muscle with the fascia covering them; medial - the serratus anterior muscle and the lateral surface of the chest to the level of the IV rib; lateral - the medial surfaces of the humerus, coracohumeral muscle and the short head of the biceps brachii.

Three triangles are projected onto the anterior wall of the armpit: the upper medial - the clavicular-thoracic triangle (trigonum clavipectorale), located between the clavicle and the superior medial edge of the pectoralis minor; middle - pectoral triangle (trigonum res-torale), located behind the pectoralis minor, and externally - lateral - pectoral triangle (trigonum subpecto-rale), lying between the inferolateral edges of the pectoralis major and minor.

On the back wall armpit there are four-sided and three-sided openings that allow vessels and nerves to pass through. The four-sided foramen (foramen quadrilaterum) is located laterally and is bounded from above by the subscapularis and small round muscles, from below by the large round muscle, from the lateral side by the surgical neck of the humerus, with the medial side by the long head of the triceps muscle of the shoulder. The three-sided opening (foramen trilaterum) is located medially and slightly lower from the first.

Rice. 13. The neurovascular bundle of the armpit, adjacent to the back of the subclavian region. Right, front view (1/2).
The same as in fig. 12. In addition, the pectoralis minor muscle, claviothoracic fascia and fatty tissue of the armpit, covering the neurovascular bundle in front, were partially removed. The fascia covering the serratus anterior, external oblique, and intercostal muscles have been removed. The rectus sheath was opened.

Rice. 14. Fiber and subcutaneous vessels of the axillary region. Right, bottom view (9/10).
The hand is set aside. Only the skin has been removed.

It is formed by: from above - the subscapularis and the small round muscles, from the bottom - the large round muscle, from the lateral side - the long head of the triceps muscle of the shoulder.

The contents of the armpit are the neurovascular bundle, lymph nodes and adipose tissue.


The neurovascular bundle (axillary artery and vein and brachial plexus) penetrates into the axillary cavity from the lateral region of the neck between the clavicle and the 1st rib. In the axillary region, the neurovascular bundle is located at the inner-posterior edge of the coracobrachial muscle and is projected onto the skin at the border of the anterior and middle third of the axillary width or at the level of the anterior edge of hair growth.
The topography of the neurovascular bundle is different at individual levels of the armpit. In trigonum clavipectorale below, medial and in front of the axillary artery is v. axillaris. Adjoining directly to the subclavian fascia (part of the claviothoracic fascia), the vein wall is fixed to it and does not collapse if damaged, which can lead to dangerous air embolism. The brachial plexus is located above and posterior to the axillary artery. From the axillary artery here departs a. thoracica suprema, branching in the two upper intercostal spaces.

In trigonum pectorale below and medially located axillary vein, above and lateral to it - an artery. The brachial plexus at this level is divided into three bundles: fasciculus lateralis - lies lateral and above the artery, fasciculus posterior - behind the artery and fasciculus medialis - medial and below the artery and behind the axillary vein. From the axillary artery a. thoraco-acromialis and a. thoracica lateralis. The first goes around the pectoralis minor from the medial side and is divided by rr. clavicu-laris, pectorales, deltoideus, acromialis, which, passing through the clavicothoracic fascia, supply blood to the pectoral, subclavian and deltoid muscles. The second goes down and forward along the serratus anterior muscle and supplies blood to it, the surrounding tissue and the mammary gland. Behind the lateral thoracic artery, n goes down the surface of the serratus anterior muscle. thoracicus longus.

Rice. 15. Axillary fascia, subcutaneous vessels and nerves that pierce the axillary fascia. Right, bottom view (9/10).
The same as in fig. 14. In addition, the subcutaneous adipose tissue is removed to the axillary fascia

In trigonum subpectorale below, medial and most superficially located axillary vein... Above and lateral to it lies the axillary artery, in front of which is located n. Medianus, laterally - n. Musculocuta-neus, behind - n. radialis and axillaris and medial and below - pp. ulnaris, cutaneus antebrachii medialis, and cutaneus brachii me-dialis. The axillary nerve, together with the posterior artery surrounding the shoulder, leaves the area through the quadrilateral opening. Under the axillary fascia, approximately at the border of the middle and posterior third of the width of the base of the armpit, nn are located. intercostobrachiales, which are lateral branches of the II and often III intercostal nerves and together with the item cutaneus brachii medialis receiving
participation in the innervation of the skin of the armpit and the medial surface of the shoulder.

Rice. 16. Vessels and nerves of the armpit and breast triangle. Right, bottom view (9/10).
The same as in fig. 15. In addition, the axillary fascia and tissue were removed, the neurovascular bundle was prepared

The axillary artery gives off a large a here. subscapularis, which soon divides into a. thoracodorsalis and a. circumflexa scapulae. The first of them, with the nerve of the same name, goes down and supplies the subscapularis, serratus anterior and major round muscles and the broad muscle of the back. The second, through a three-sided opening, penetrates into the scapular region. A. circumflexa humeri posterior departs from the axillary artery, goes back, being located lateral to the axillary nerve, and together with it penetrates the quadrilateral opening, and then bends around the back of the surgical neck of the shoulder, supplying blood to the shoulder joint and deltoid muscle. A. circumflexa humeri anterior, also being a branch of a. axillaris, bends around the neck of the humerus in front.

On the anterior surface of the subscapularis muscle, nn are located. subscapularis n thoracodorsalis, originating from the brachial plexus, and sometimes from n. axillaris. The first of them innervates the subscapularis and large circular muscles, the second - the broad muscle of the back.

Rice. 17. Vessels and nerves of the armpit, pectoral and thoracic triangles. Right, bottom view (9/10).
The same as in fig. 16. In addition, the pectoralis major muscle is dissected and retracted upward and to the sides, the coracohumeral and pectoralis minor muscles are raised. The armpit veins were removed.

Rice. 18. Vessels and nerves in the axilla, scapular and subclavian regions. Right, side and top view (3/8).
The kosha, subcutaneous tissue and its own fascia were removed from the lateral region of the neck, deltoid, subclavian and scapular regions. The clavicle is dissected out in the acromioclavicular joint and, with the muscles attached to it, is retracted anteriorly. The acromial process and the upper end of the humerus have been removed, and the muscles attached to them are retracted. The vessels and nerves were prepared.

Rice. 19. Variants of division of the axillary artery into branches.
1 - a. axillaris; 2 - a. circumllexa humeri anterior; 3 - a. circumllexa humeri posterior; 4 - rr. subscapulares; 5 - a. thoracoacromialis; 6 - r. deltoideus; 7 - r. acromialis; 8 - a. thoracica suprema; 9 - rr. pectorales; 10 - a. thoracica lateralis; 11 - a. subscapularis; 12 - a. thoracodorsalis; 13 - a. circumflexa scapulae; 14 - a. profunda brachii; 15 - a. suprascapularis; 16 - a. collateral is ulnaris superior; 17 - a. transversa colli.

In the lymph nodes of the armpit, lymph flows from the upper limb, from a significant part of the chest and from the superficial layers of the upper part of the anterior abdominal wall. Axillary nodes are located in loose fatty tissue and are separated from the neurovascular bundle by its vagina.

There are five groups of nodi lymphatici axillares. In the middle of the base of the armpit there are 1-10 (on average 3) nodi lymphatici axillares centrales. Some of these nodes may be located superficially under the axillary fascia under the subcutaneous tissue. The superficial lymphatic vessels of the upper limb, chest, back and mammary gland flow into the central nodes.

Rice. 20. View of the axillary cavity, subclavian and scapular regions on a sagittal cut made medial to the coracoid process of the scapula through the lateral edge of the II rib. Right view, outside (1 / 1.1).

Lateral to the central nodes along the medial surface of the neurovascular bundle under the lower edge of the pectoralis major muscle lie 3-7 nodi lymphatici axillares laterales, receiving lymph from the upper limb. On the posterior wall of the armpit, along the subscapularis vessels, there are 2-12 nodi lymphatici axillares subscapulares. The lymphatic vessels of the scapular and subscapular regions, the shoulder joint and part of the vessels of the posterior region of the neck flow into them. On the medial and anterior walls of the armpit to the level of the upper edge of the pectoralis minor along a. thoracica lateralis lie from 5 to 19 nodi lymphatici axillares pectorales, receiving lymph from the mammary gland, pectoral muscles and from the integument of the anterolateral surface of the chest and upper abdomen. At the apex of the armpit in the trigonum clavipectorale, respectively, the first and second intercostal spaces, 1-9 nodi lymphatici axillares apicales lie along the neurovascular bundle.
Lymph flows into these lymph nodes from all previous groups of nodes, as well as from the pectoralis major and minor muscles and the mammary gland. From the nodes of the armpit, lymph flows through the truncus subclavius. The latter on the left in half of the cases flows into the thoracic duct, and in the other half - independently into the left venous angle or left subclavian vein. On the right, in 4/5 of all cases, the subclavian trunk with one, rarely with two orifices independently flows into the veins of the right venous angle and in 1/5 of cases merges with the jugular trunk, forming ductus lymphaticus dexter.

Rice. 21. View of the armpit, subclavian and scapular regions on a sagittal cut made through the coracoid process of the scapula. Right view, outside.

Rice. 22. View of the armpit on a sagittal cut made at the level of the shoulder joint with the arm slightly retracted to the side. Right view, outside.
The head of the humerus was removed from the articular capsule.

The spaces between the neurovascular bundle and the walls of the armpit are filled with fiber. The latter can be the object of surgical interventions: firstly, it is removed along with the lymph nodes and vessels located in it during operations for breast cancer, and secondly, during operations for suppurative processes developing in it (phlegmon, adenophlegmon, abscesses, etc. etc.). With wounds and injuries in the fiber of the armpit, hematomas can form. On the other hand, of practical interest are the contacts of the tissue of the axillary fossa with adjacent cellular spaces, since pus (blood) can spread to neighboring areas and form streaks.

The fiber of the armpit is widely communicated with the fiber of the neighboring regions both along the neurovascular bundles of the region, and by direct transition to the fiber of the neighboring regions. In the course of the axillary, and then the subclavian arteries and veins and the brachial plexus, the fiber of the axillary cavity is associated with the fiber of the lateral region of the neck and the fiber of the prescale and interscalene spaces. Downward and laterally along the brachial vessels and the median and ulnar nerves, the fiber of the armpit is connected with the fiber of the anterior region of the shoulder, along the course of the radial nerve and the deep artery of the shoulder - with the fiber of the posterior region of the shoulder. Through the four-sided and three-sided openings located in the posterior wall of the armpit, along the posterior artery surrounding the shoulder, the axillary nerve and the artery surrounding the scapula, the fiber of the axillary cavity is connected to the fiber of the subdeltoid space, the posterior surface of the scapular region and the fiber lying under the broad muscle of the back. The fiber in the armpit at the posterior wall directly passes into the fiber located between the subscapularis muscle in the back and the serratus anterior muscle in the front. Along the branches of a. thoracoacromialis, n. pectoralis medialis and v. cephalica, perforating the clavicular-pectoral fascia, the fiber of the apex of the armpit communicates with the fiber located under the pectoralis major muscle, as well as with the fiber located in the fascial sheaths of the pectoralis minor and major muscles.

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Distinguish on the upper limb areas: scapular, deltoid, subclavian, axillary, shoulder (front and back), elbow (front and back), forearm (front and back), hand (wrist, metacarpus and fingers).

Between the deltoid and pectoralis major muscles is deltoid-thoracic sulcus (sulcusdeltoideopectoralis) , in the area of ​​which the deltoid and thoracic fascia are connected to each other, the lateral saphenous vein of the hand (vena cephalica) runs in the groove.

In the upper section, the furrow passes into deltoid-thoracic triangle (trigonumdeltoideopectorale) , which is bounded from above by the lower part of the clavicle, medially by the pectoralis major muscle, laterally by the deltoid muscle.

On the skin, the triangle corresponds subclavian fossa (fossainfraclavicularis), or Morenheim's fossa, in the depth of which the coracoid process of the scapula can be palpated.

In the region of the upper edge of the scapula, there is a suprascapular opening formed by the notch of the scapula and the upper transverse ligament of the scapula stretched over it. This hole connects the neck area to the scapula area. The suprascapular nerve passes through the opening, the suprascapular artery and vein, as a rule, pass over the transverse ligament of the scapula.

Axillary fossa (fossaaxillaris). When the upper limb is retracted, the axillary region has the shape of a fossa, which, after removing the skin and fascia, turns into a cavity.

Axillary fossa boundaries:

front- a fold of skin corresponding to the lower edge of the pectoralis major muscle;

back- a fold of skin corresponding to the lower edge of the latissimus dorsi muscle;

medial- a conditional line connecting the edges of these muscles on the lateral surface of the chest;

lateral- a conditional line connecting the same muscles on the inner surface of the shoulder.

Axillary cavity (cavitasaxillaris) has 4 walls and 2 holes (apertures).

Axillary walls:

1) front wall formed by the large and small pectoral muscles and the clavicular-pectoral fascia (fascia clavipectoralis);

2) back wall formed by the broadest muscle of the back, the large circular and subscapularis muscles;

3) medial wall formed by the first four ribs, intercostal muscles, the upper part of the serratus anterior muscle;

4) lateral wall very narrow, since the anterior and posterior walls of the axillary cavity in the lateral direction converge; it is formed by the sulcus intertubercularis of the humerus, covered by the biceps of the shoulder and the coracohumeral muscle.

Axillary openings.

1. Top hole (aperturasuperior) , directed upward and medially, limited in front clavicle, behind- the upper edge of the scapula, medially- the first rib, connects the axillary cavity with the base of the neck, blood vessels and nerves pass through it; the upper opening is also called the cervical-axillary canal.

2. Bottom hole (aperturainferior) directed downward and laterally, corresponds to the boundaries of the axillary fossa.

Axillary content:

Axillary artery (a.axillaris) and its branches;

Axillary vein (v.axillaris) and its tributaries;

Brachial plexus (plexus brachialis) with nerves extending from it;

Lymph nodes and lymphatic vessels;

Loose adipose tissue;

In most cases, part of the mammary gland;

Cutaneous branches of the II and III intercostal nerve.

For a more accurate description of the topography of the branches of the axillary artery on the anterior wall of the axillary cavity, three triangles:

1) clavicothoracic triangle (trigonumclavipectorale), bounded from above by the clavicle, from below - by the upper edge of the pectoralis minor;

2) chest triangle (trigonumpectorale), corresponds to the contours of the pectoralis minor;

3) chest triangle (trigonumsubpectorale) bounded from above by the lower edge of the pectoralis minor, from below by the lower edge of the pectoralis major muscle.

On the back wall of the axillary cavity there are two holes for the passage of blood vessels and nerves:

1) three-way hole (foramentrilaterum) limited above the lower edge of the subscapularis muscle , below- a large round muscle, laterally- the long head of the triceps muscle;

Pass through the three-way hole the artery surrounding the scapula ( a . circumflexa scapulae ), and accompanying veins of the same name ;

2) four-sided hole (foramenquadrilaterum) limited above the lower edge of the subscapularis muscle, from below- a large round muscle, medially- the long head of the triceps muscle, laterally- surgical neck of the humerus;

Pass through the four-sided hole axillary nerve ( n . axillaris ), the posterior artery surrounding the humerus ( a . circumflexa humeri posterior ), and accompanying veins of the same name.

Behind the upper border of both holes is formed by a small round muscle.

Shoulder topography.

The boundaries of the shoulder are considered to be the upper line connecting the lower edges of the pectoralis major and broadest muscles of the back on the shoulder, below the line passing two transverse fingers above the epicondyle of the humerus.

The area is divided into anterior and posterior by two vertical lines drawn upward of their epicondyles.

In the anterior region of the shoulder, on both sides of the biceps brachii, there are two grooves:

medial groove of the shoulder (sulcusbicipitalismedialis);

lateral groove of the shoulder (sulcusbicipitalislateralis).

The medial groove above communicates with the axillary cavity, below with the medial anterior ulnar groove, contains the main neurovascular bundle of the shoulder.

In the lateral groove in the lower third of the shoulder, the radial nerve is projected, the groove continues into the lateral anterior ulnar groove.

On the back surface of the shoulder between the heads of the triceps brachii on one side and the radial nerve groove (sulcus nervi radialis) on the other radial nerve canal (canalisnerviradialis).

Channel inlet located on the medial side at the border of the upper and middle third of the shoulder, it is limited above the lower edge of the large round muscle, laterally- the body of the humerus , medially- the long head of the triceps brachii.

Channel outlet located on the lateral side on the border between the lower and middle thirds of the shoulder in the depth of the lateral anterior ulnar groove.

In the channel pass radial nerve ( n . radialis ) and deep shoulder artery ( a . profunda brachii ).

The back is the entire posterior surface of the human body, the upper border of which is the outer superior nuchal line and the occipital protuberance, and the coccyx and the sacroiliac joints serve as the lower border. On the sides, the back is limited by the shoulder girdle, axillary fossa, and also by the lateral surfaces of the chest and abdomen along the posterior axillary lines. For prevention, drink Transfer Factor. On the back of a person there are two fascia: superficial and deep.

The superficial fascia is located over the outer surface of the trapezius and latissimus dorsi and covers them. This fascia is poorly developed as it is part of the superficial fascia of the body. She takes part in the formation of the breast capsule, sending connective tissue septa deep into its tissues. These septa divide the mammary gland into lobes. The fascia bundles that extend from the connective tissue capsule of the mammary gland to the clavicle are called the ligaments that support the mammary gland.

The deep fascia is called the pectoral fascia. This fascia covers the deep muscles of a person's back. The pectoral fascia is located under the superficial fascia and reaches its greatest development in the lumbar region, where its two leaves or plates are especially pronounced. These are superficial and deep sheets that form the sheath of the pectoralis major muscle. Near the lateral edge of the muscle that straightens the spinal column, the superficial and deep layers of the thoracic fascia fuse into one. The superficial leaflet from the medial side is connected to the spinous processes of the lumbar vertebrae, the supraspinous ligaments and the median sacral ridge. This leaf extends laterally into the deltoid fascia, which passes downward into the axillary fascia. In women, the superficial layer of the pectoral fascia separates the pectoralis major muscle and the mammary gland.

A deep leaf of the pectoral fascia is located between the pectoral muscles. It originates from the transverse processes of the lumbar vertebrae and extends between the XII rib and the iliac crest and is located on the posterior surface of the pectoralis major muscle. In the upper part, within the clavicothoracic triangle, between the upper edge of the pectoralis minor and the clavicle, the deep leaf of the pectoral fascia becomes denser and is called the clavicothoracic fascia.

Three triangles are distinguished behind the pectoralis minor and pectoralis major. The clavicle-pectoral triangle is located between the clavicle at the top and the upper edge of the pectoralis minor muscle at the bottom and corresponds to the location of the clavicular-pectoral fascia. The pectoral triangle corresponds to the outlines of the pectoralis minor. The pectoralis triangle is located between the lower edges of the pectoralis minor and pectoralis major muscles. In the area of ​​the sternum, the pectoral fascia grows together with the periosteum of the sternum and forms a dense connective tissue plate - the anterior membrane of the sternum.

The blood of the above-described fascia also contains the thoracic fascia itself and the intrathoracic fascia. The pectoral fascia itself covers the outside of the external intercostal muscles and ribs, growing together with their periosteum. The intrathoracic fascia covers the chest cavity from the inside, adjacent from the inside to the internal intercostal muscles, the transverse muscle of the chest, and also to the inner surfaces of the ribs.

On the surface of the chest walls, the jugular notch of the sternum is determined in the form of bony landmarks, the clavicle to the right and left of it, below is the xiphoid process of the sternum, as well as the ribs and costal arches. The jugular notch of the sternum corresponds to the lower edge of the II thoracic vertebra. The lower border of the sternum body is at the level of the IX thoracic vertebra. The angle of the sternum is projected onto the intervertebral disc between the IV and V thoracic vertebrae. On the surface of the chest walls, the contours of the pectoralis major muscle and the deltoid-pectoral groove (in men) are determined. In women, at the level of the III-VI ribs, the mammary glands are located, separated by a gap. On the lateral surface of the chest, a dentate line is visible, formed by the initial teeth of the serratus anterior muscle and the external oblique muscle of the abdomen. The skin of the chest is thin; in men, there is hair in the area of ​​the sternum and shoulder blades. Sweat and sebaceous glands are most numerous in the area of ​​the sternum, shoulder blades, on the lateral surfaces of the chest. Subcutaneous tissue is moderately expressed, more in women. Superficial veins, terminal branches of arteries (internal thoracic, intercostal, lateral thoracic), anterior and lateral branches of intercostal nerves pass through the tissue.

The superficial fascia, which is part of the superficial fascia of the body, is poorly developed. She participates in the formation of the mammary gland capsule, extending deep into its connective tissue septa, dividing the gland into lobes. The fascia bundles extending from the connective tissue capsule of the mammary gland to the clavicle are called the ligament that supports the mammary gland (lig. Suspensorium mammae).

The pectoral fascia (fascia pectoralis), lying under the surface, has two sheets (plates) - superficial and deep, which form the sheath of the pectoralis major muscle.

Superficial lamina of the thoracic fascia at the top it is attached to the clavicle, medially - fuses with the periosteum of the anterior surface of the sternum. This plate extends laterally into the deltoid fascia, which passes downward into the axillary fascia.

Deep plate of pectoral fascia located on the back surface of the pectoralis major muscle, between it and the pectoralis minor. It forms the sheath of the pectoralis minor. Above, within the clavicothoracic triangle (between the upper edge of the pectoralis minor and the clavicle), the deep plate is compacted and becomes the name of the clavicular-pectoral fascia (fascia clavipectoralis). Laterally and downward from the pectoralis minor muscle, the deep plate of the pectoral fascia grows together with the superficial plate of this fascia. Three triangles are distinguished behind the small and large pectoral muscles. Clavicothoracic triangle located between the clavicle at the top and the upper edge of the pectoralis minor at the bottom. This triangle corresponds to the location of the clavo-thoracic fascia. The pectoral triangle corresponds to the outlines of the pectoralis minor. The pectoralis triangle is located between the lower edges of the pectoralis minor and pectoralis major muscles. In the area of ​​the sternum, the pectoral fascia grows together with the periosteum of the sternum and forms a dense connective tissue plate - the anterior membrane of the sternum.

Between both pectoral muscles lying in the fascial sheaths is located inframammary cellular space. Under the pectoralis minor muscle - deep chest space. Both are filled with a thin layer of fatty tissue.

In addition to these fascia, the thoracic and intrathoracic fascia are also distinguished. The pectoral fascia itself (fascia thoracica) covers the outside of the external intercostal muscles, as well as the ribs, growing together with their periosteum. The intrathoracic fascia (fascia endothoracica) lines the chest cavity from the inside, i.e. adjoins from the inside to the internal intercostal muscles, the transverse muscle of the chest and the inner surfaces of the ribs.


Part I. TOPOGRAPHY OF THE UPPER LIMB

1. UNDERMPUS CAVITY

1.1. LOCATION OF THE UNDERMUSCLE

Axillary fossa- This is a depression between the lateral surface of the chest and the upper part of the shoulder, which opens when it is abducted (Fig. 1). The axillary fossa is limited:


  • anterior skin fold covering the edge of the pectoralis major muscle;

  • the posterior fold of skin covering the latissimus dorsi.


^ Rice. 1. Skin relief of the axillary fossa:

1 - axillary fossa, 2 - edge of the pectoralis major muscle, 3 - edge of the latissimus muscle;

Axillary cavity, cavum axillare – this is the intermuscular space that opens after removing the skin, fascia and adipose tissue from the axillary fossa (Fig. 2). The cavity has a pyramidal shape and is distinguished in it:


  • four walls: anterior, posterior, medial and lateral;

  • two holes: upper aperture and lower aperture


Rice. 2. Axillary cavity (A), its upper (B) and lower (C) apertures (highlighted in black and white dotted lines). Front view.

1 - serratus anterior muscle (medial wall of the axillary cavity), 2 - pectoralis major muscle (cut off), 3 - clavicle, 4 - pectoralis minor (cut off), 5 - subscapularis muscle (posterior wall of the axillary cavity), 6 - corabrachial muscle, 7 - biceps brachii (both muscles form the lateral wall of the cavity), 8 - triceps brachii, 9 - latissimus dorsi

Lower axillary aperture limited to:


  • in front - the edge of the pectoralis major muscle;

  • behind - the edge of the latissimus dorsi;

  • medially - a conditional line connecting the edges of the pectoralis major and broadest muscles along the line of the third rib;

  • laterally - with the beak-brachial muscle and the humerus;

  • bottom - closed by axillary fascia

Upper axillary aperture limited to:


  • from below - by the 1st edge;

  • from above - the collarbone;

  • behind - the upper edge of the scapula.

Vessels and nerves pass through the upper aperture into the armpit: the axillary artery and vein and the trunks of the brachial plexus.

^ 1.2. THE WALLS OF THE UNDERMUSCLE

The medial wall is formed:


  • serratus anterior

The lateral wall is formed:


  • beak-brachialis muscle

  • biceps brachii;

The back wall is formed:


  • the broadest muscle of the back;

  • large round muscle;

  • subscapularis muscle;

Front wall(see Fig. 3, which shows a sagittal section through the outer third of the clavicle) formed:


  • pectoralis major muscle

  • pectoralis minor

  • deep leaf of the pectoral fascia.


Rice. 3. Sagittal section of the axillary cavity

A - front wall of the cavity, B - back wall

1 - clavicle, 2 - clavicle-pectoral fascia, 3 - pectoralis minor, 4 - pectoralis major, 5 - axillary fascia, 6 - latissimus dorsi, 7 - large round muscle, 8 - small round muscle, 9 - infraspinatus muscle , 10 - subscapularis muscle, 11 - supraspinatus muscle, 12 - neurovascular bundle of the armpit, 13 - trapezius muscle

^ 1.3. SEPARATE TOPOGRAPHANATOMIC FORMATIONS ON THE WALLS OF THE UNDERMUSCLE

On the anterior wall of the axillary cavity there are three triangles that are related to the topography of the vessels and nerves: the clavicular-thoracic, thoracic, and sub-chest triangles (Fig. 4).

These triangles are limited:

A. Clavicular-thoracic triangle:


  • Above - the clavicle

  • Below - the upper edge of the pectoralis minor;
B. Thoracic triangle:

  • Top - the upper edge of the pectoralis minor

  • Below - the lower edge of the pectoralis minor (corresponds to the contours of this muscle);
V ... Sternal triangle:

  • Above - the lower edge of the pectoralis minor

  • Below - the lower edge of the pectoralis major muscle.


Rice. 4. Triangles of the anterior wall of the armpit. A - clavicular-thoracic triangle, B - thoracic triangle, C - inframammary triangle

1 - pectoralis major muscle (opened), 2 - clavicle, 3 - pectoralis minor

^ On the back wall of the axillary cavity two holes are formed, through which vessels and nerves also exit. These are 3-way and 4-way holes (fig. 6):

^ T
Rice. 5. Openings of the posterior wall of the armpit. A - three-sided hole, B - four-sided hole

1 - infraspinatus muscle, 2 - small round muscle, 3 - head of the humerus, 4 - surgical neck of the humerus, 5 - long head of the triceps muscle of the shoulder, 6 - large round muscle
reversible hole (A) is limited to:


  • Above - the edge of the small round muscle

  • Below - the edge of the large round muscle;

  • Laterally - by the long head of the triceps brachii;

Four-way hole (B) is limited to:


  • Medially - by the long head of the triceps brachii;

  • Laterally - by the surgical neck of the humerus;

  • Above - the edge of the small round muscle;

  • Below - the edge of the large round muscle
^ 2. FURROWS AND CHANNELS IN THE SHOULDER AREA

2.1. MEDIAL SHOULDER BEARROW

M single shoulder groove, sulcus bicipitalis medialis (Fig. 6), is located on the medial surface of the shoulder, starting from the lower border of the axillary cavity and ending in the cubital fossa.

The medial groove of the shoulder is limited:


  • In front - the biceps of the shoulder;

  • Behind - the triceps muscle of the shoulder;

  • From the lateral side - the beak-brachial and brachial muscles.

Rice. 6. Medial shoulder groove (highlighted in black and white dotted line).

A - medial shoulder groove, B - axillary cavity, C - cubital fossa.

1 - biceps brachii muscle, 2 - corabrachial muscle, 3 - three-sided opening, 4 - lower border of the axillary cavity, 5 - triceps brachii muscle (long head), 6 - medial head of the same muscle, 7 - brachial muscle

^ 2.2. Brachomuscular canal

NS hematomuscular canal (radial nerve canal), canalis humeromuscularis, is located in the back of the shoulder, bypassing the humerus in a spiral. This channel has: an inlet, walls and an outlet (Fig. 7).

^ Channel inlet formed between the inner edges of the medial and lateral heads of the triceps brachii ;

Outlet located in the lateral intermuscular septum of the shoulder, between the brachial muscle and the initial section of the brachioradialis muscle.

Channel walls formed:


  • the groove of the radial nerve on the diaphysis of the humerus;

  • the lateral head of the triceps brachii;

  • the medial head of the triceps brachii.


Rice. 7. Brachomuscular canal with open walls (highlighted by a dotted line)

1 - long head of the triceps brachii muscle, 2 - medial head, 3 - lateral head (cut and turned away), 4 - inlet of the brachomuscular canal, 5 - brachomuscular canal and its neurovascular bundle, 6 - outlet of the canal, 7 - medial intermuscular septum, 8 - brachioradial muscle

Additionally, the location of the medial sulcus of the shoulder and brachomuscular canal can be seen in Figures 8 and 9.


^ Rice. 8. Location of the medial shoulder groove (the bottom of the groove is indicated by a dotted line) and the neurovascular bundle in it. Inside view.

1 - the bottom of the medial sulcus of the shoulder, 2 - the biceps muscle of the shoulder, 3 - the corabrachial muscle, 4 - the head of the triceps muscle of the shoulder, 5 - vessels and nerves



^ Rice. 9. Horizontal cut through the middle third of the shoulder. The medial groove and brachomuscular canal are highlighted with dark shading.

1 - the medial groove of the shoulder and the vessels and nerves lying in it; 2 - biceps muscle of the shoulder, 3 - brachial muscle, 4 - triceps muscle of the shoulder, 5 - brachomuscular canal

Elbow fossa fossa cubitalis, located in front of the elbow joint and limited to three muscles (Fig. 10):


  • from above - the shoulder muscle;


  • medially - round pronator.

1 - biceps muscle of the shoulder, 2 - brachioradialis muscle, 3 - brachial muscle, 4 - round pronator

^ If excised the tendon of the biceps brachii muscle and the pronator round, and then push the muscles apart, then two grooves are found along the edges of the ulnar fossa: the medial ulnar groove and the lateral ulnar groove (Fig. 11).

^ Medial ulnar groove , which is a continuation of the medial groove of the shoulder, is limited to:


  • medially - round pronator and medial epicondyle of the shoulder;

  • laterally - with the shoulder muscle;

Lateral ulnar groove, which is, as it were, a continuation of the brachomuscular canal (the radial nerve emerging from the canal lies in this groove), is limited:


Rice. 11. Grooves of the ulnar fossa (highlighted with a white dotted line). A - lateral ulnar groove, B - medial ulnar groove.

1 - biceps muscle of the shoulder, 2 - brachial muscle, 3 - brachioradial muscle, 4 - instep support, 5 - medial shoulder groove and its contents, 6 - round pronator (cut off), 7 - medial epicondyle of the shoulder, 8 - superficial flexor of the fingers

^ 4. MUSCULAR CROUSHES OF THE FOREUM

In the anterior region of the forearm, three intermuscular grooves are distinguished, which are also important for describing the topography of the vessels and nerves: the radial groove, the median groove, and the ulnar groove (Fig. 12).

Radial groove, sulcus radialis, limited to:


  • laterally - brachioradialis muscle;

  • medially radial flexor of the wrist;

Median sulcus, sulcus medianus, limited to:


  • lateral radial flexor of the wrist;

  • medially by the superficial flexor of the fingers;

Elbow sulcus, sulcus ulnaris, limited to:


  • laterally - the superficial flexor of the fingers;

  • medial ulnar flexor of the wrist


Rice. 12. Furrows of the anterior surface of the forearm. A - radial groove, B - median groove, C - ulnar groove (highlighted with dark shading).

1 - ulnar fossa, 2 - brachioradial muscle, 3 - round pronator, 4 - radial flexor of the wrist, 5 - long palmar muscle, 6 - superficial flexor of the fingers, 7 - ulnar flexor of the wrist

^ 5. TOPOGRAPHIC ELEMENTS OF THE BRUSH

5.1. ANATOMICAL TOBACCO

T This is the name of the triangular depression located between the styloid process of the radius and the base of the 1st metacarpal bone (see Fig. 13). It got its name from the fact that snuff was poured into this place before it was sucked into the nose.

The anatomical snuffbox is limited by the tendons of the short (2) and long (4) extensors of the thumb and the tendon retainer (7).


^ Rice. 13. Anatomical snuffbox (highlighted by a dotted line)

1 - base of the I metacarpal bone, 2 - tendon of the short extensor of the thumb, 3 - radial artery at the bottom of the snuff box, 4 - tendon of the long extensor of the thumb, 5 - interosseous muscles, 6 - superficial branch of the radial nerve, 7 - extensor retinaculum

^ 5.2. WRIST CHANNEL

Carpal tunnel(Fig. 14) serves to pass the flexor tendons of the fingers to the hand. It forms above the palmar surface of the wrist bones and is limited to:


  • from the inside - by the bones of the wrist;

  • outside - flexor tendon retainer;

  • laterally - tubercles of the scaphoid and trapezium bones;

  • medially crocheted hooked bone


Rice. 14. Canal of the wrist. Horizontal section at the level of the trapezoid bone

1 - flexor tendon retainer, 2 - common synovial sheath of the flexor tendons of the fingers, 3 - tendons of the superficial flexor of the fingers, 4 - tendons of the deep flexor of the fingers, 5 - tendon of the long flexor of the thumb, 6 - tendon of the radial flexor of the wrist, 7 - bone-trapezium, 8 - extensor tendons of the fingers, 9 - hooked bone, 10 - tendon of the elbow wrist flexor

^ 5.3. PALM APONEUROSIS AND CELLULAR SPACES OF THE PALM

Palmar aponeurosis (Fig. 15) is a thickened intrinsic fascia of the hand, which has acquired a tendon structure to strengthen the skin of the palm. It has the shape of a triangle, the apex of which is located in the area of ​​the flexor tendon retainer (where the tendon of the palmaris longus is woven into it), and the base is facing the fingers. Aponeurosis is formed by longitudinal and transverse fibers.

Longitudinal fibers are combined into 4 bundles, heading to the bases of the II-V fingers. In the distal aponeurosis there are transverse bundles. In the intervals between longitudinal and


^ Rice. 15. Palmar aponeurosis (A).

1 - muscles of the eminence of the little finger, 2 - muscles of the eminence of the thumb, 3 - longitudinal bundles of the palmar aponeurosis, 4 - transverse bundles, 5 - commissural holes

transverse bundles are formed commissural holes. These holes are filled with fatty tissue that protrudes under the skin in the form of pads. Through these holes, the inflammatory process can spread into the deep tissue spaces of the hand.

From the palmar aponeurosis, two fascial septa - lateral and medial - extend inward.


  • ^ Lateral intermuscular septum attaches to the third metacarpal bone;

  • Medial intermuscular septum attaches to the V metacarpal bone.
These partitions divide the inner space of the palm into three fascial beds: lateral, median and medial (Fig. 16).

The medial bed (hypotenar bed) is limited:


  • own fascia of the palm;

  • V metacarpal bone;

  • medial intermuscular septum

The lateral bed (thenar bed) is limited:


  • own fascia of the palm;

  • deep fascia and II metacarpal bone;

  • lateral intermuscular septum;

The middle bed is limited:


  • outside - palmar aponeurosis;

  • from the inside - deep fascia of the palm;

  • lateral - lateral intermuscular septum;

  • medial - medial intermuscular septum.

In the middle bed of the palm are the flexor tendons of the fingers and the worm-like muscles. These structures divide the bed into two cellular clefts: superficial (subgaleal) and deep (tendinous).

The superficial fissure of the median palm bed is limited:


  • Outside - palmar aponeurosis;

  • From the inside - the flexor tendons of the fingers;

The deep gap is limited:


  • Outside - flexor tendons of the fingers and worm-like muscles;

  • Inside - deep palmar fascia covering the metacarpal bones and interosseous muscles


Rice. 16. Cellular spaces of the palm. Horizontal slice.

A - medial fascial bed (hypotenar space);

B - median fascial bed:

8 - superficial cellular tissue gap of the median fascial bed (highlighted by round dots),

^ 15 - deep cellular fissure of the median fascial bed (highlighted by dotted filling);

B - lateral fascial bed (thenar space).

1 - medial intermuscular septum, 2 - lateral intermuscular septum, 3 - tendons of the superficial and deep flexors of the fingers to the little finger (in the synovial vagina), 4 - vermiform muscles, 5 - flexor tendons to the 4th finger, 6 - palmar aponeurosis, 7 - flexor tendons to the third finger; 9 - flexor tendons to the II finger; 10 - the tendon of the long flexor of the first finger in the synovial sheath, 11 - the muscles of the eminence of the thumb, 12 - the metacarpal bones, 13 - the interosseous muscles, 14 - the extensor tendons of the fingers, 16 - the deep palmar fascia.

^ 5.4. SYNOVIAL VAGINA OF THE FENDER FENDER TENDONS

Synovial sheaths are a muscle accessory apparatus designed to eliminate friction where tendons pass through narrow fibrous bone canals. They are closed sacs formed by two synovial layers wrapped around the tendons (Fig. 17).

NS
Of critical importance is knowledge of the topography of the synovial sheaths of the flexors of the fingers, since they can get an infection that penetrates through the microtrauma of the hand. When an infection enters the vagina, a purulent-inflammatory process develops in its cavity, extending to its entire length and capable of breaking through further, into the deep cellular spaces of the palm and forearm.

The following synovial sheaths are distinguished on the hand (Fig. 18):


  1. ^ Common vagina flexors located in the canal of the wrist and surrounding the tendons of the superficial and deep flexors of the fingers. The proximal wall of this vagina faces the deep cellular space of the forearm, and the distal one - into the median fascial bed;

  2. ^ Flexor hallucis sheath , also continuing to the forearm. In a certain percentage of cases, it communicates with the common flexor sheath;

  3. Tendon sheaths II - IV fingers... These vaginas are isolated, extending only the length of the fingers. The proximal walls of these sheaths border on the median fascial bed;

  4. V-finger tendon sheath... This vagina almost always communicates with the common flexor sheath.

T Thus, as follows from consideration of the anatomy of the vaginas, the most dangerous is the inflammatory lesion of the vaginas of the I and V fingers, because through these vaginas the infection can easily spread to the deep cellular spaces of not only the palms, but also the forearms.


^ Rice. 18. Synovial sheaths of the flexor tendons of the fingers.

1 - the tendon of the deep flexor of the fingers, 2 - the tendon of the superficial flexor of the fingers, 3 - the flexor retainer, 4 - the common synovial vagina of the flexors, 5 - the vagina of the V finger, 6 - the vagina of the long flexor of the first finger, 7 - the vagina of the II - IV fingers, 8 - muscles of the eminence of the first finger, 9 - muscles of the eminence of the little finger

Part II. LOWER LIMB TOPOGRAPHY

^ 1. FEMAL TRIANGLE

Femoral triangle, trigonum femorale, formed in the upper third of the thigh on its front surface (Fig. 19). It is limited to the following structures:


  1. Above - the inguinal ligament;

  2. Laterally - by the sartorius muscle;

  3. Medially - by the long adductor muscle.


Rice. 19. Borders of the femoral triangle (highlighted by a dotted line) and subcutaneous cleft (removed the skin and subcutaneous tissue up to the fascia lata)

1 - inguinal ligament, 2 - broad fascia, 3 - crescent edge of the broad fascia, 4 - upper horn of the crescent edge, 5 - subcutaneous cleft, closed by the perforated fascia, 6 - spermatic cord, 7 - long adductor muscle, 8 - lower horn of the crescent edge , 9 - sartorius muscle

Within the femoral triangle, the own fascia of the thigh (fascia lata) forms an opening closed by a loose connective tissue plate - subcutaneous cleft, hiatus saphenus. This cleft from the lateral side is limited by the thickened edge of the wide fascia - the crescent edge having an arcuate shape. Above, under the inguinal ligament, the sickle-shaped edge forms the upper horn, and below, above the sartorius muscle, the lower horn.

If we consider the area of ​​the femoral triangle after removal of the fascia lata and preparation of the muscles, the following is found (Fig. 20):


^ Rice. 20. The area of ​​the femoral triangle (highlighted by a dotted line) after the preparation of the muscles.

1 - inguinal ligament, 2 - long adductor muscle, 3 - sartorius muscle, 4 - comb muscle, 5 - ilio-comb sulcus, 6 - iliopsoas muscle

^ The bottom of the femoral triangle form two muscles:


  1. iliopsoas muscle

  2. the comb muscle, covered with a deep leaf of the broad fascia of the thigh - the iliac-comb fascia.
Between these muscles is formed iliac crestal sulcus continuing downward into the femoral sulcus.

In the upper part of the triangle, under the inguinal ligament, two spaces are formed - muscle and vascular lacunae (Fig. 21).


^ Rice. 21. Vascular (A) and muscle (B) lacunae

1 - inguinal ligament, 2 - ilio-comb arch, 3 - femoral artery, 4 - femoral vein, 5 - deep femoral ring, 6 - lacunar ligament, 7 - comb fascia, 8 - comb muscle, 9 - iliopsoas muscle, 10 - femoral nerve

Vascular lacuna(A) limited to:


  • from above - the inguinal ligament;

  • from below - the iliac-comb fascia;

  • Laterally - the ilio-comb arch;

  • medially - lacunar ligament.
Muscle lacuna(B) limited to:

  • laterally and from below - by the ilium;

  • from above - the inguinal ligament;

  • medial - ilio-comb arch

Through the muscle lacuna, the iliopsoas muscle and the femoral nerve go out to the thigh, through the vascular lacuna - the femoral vessels (artery and vein).

In the medial corner of the vascular lacuna, one of the weak points of the abdominal wall is formed - deep femoral ring. This ring (fig. 21, 22) is limited to:


  • from above - the inguinal ligament;

  • laterally - by the femoral vein;

  • medially - lacunar ligament;

  • from below - by the comb ligament (thickening of the iliac-comb fascia).

Fine this ring is closed by the transverse fascia and lymph nodes, but under certain conditions, femoral hernias can emerge through it. In this case, the hernial sac, going out onto the thigh, forms a new structure that does not exist normally - femoral canal(fig. 23). Its walls are:


  • From the inside - the iliac-comb fascia;

  • Lateral femoral vein;

  • In front - the inguinal ligament and the upper horn of the sickle-shaped edge of the fascia wide.

The subcutaneous cleft becomes the outer opening of the femoral canal. Therefore, when examining a patient with acute abdominal pain, it is imperative to examine the area of ​​the femoral triangle so as not to miss a strangulated femoral hernia.


^ Rice. 22. Deep femoral ring (dotted line). Inside view

1 - inguinal ligament, 2 - lacunar ligament, 3 - pubic bone, 4 - femoral vein, 5 - vas deferens, 6 - deep femoral ring


Rice. 23. Femoral canal (dotted line)

1 - inguinal ligament (dissected), 2 - upper horn of the crescent edge of the broad fascia (dissected), 3 - iliac-comb fascia, 4 - lower horn of the crescent edge of the broad fascia, 5 - femoral vein, 6 - spermatic cord, 7 - adductor cleft (external opening of the femoral canal; conventionally indicated by a white dotted line)

^ 2. LEADING CHANNEL

NS leading channel, canalis adductorius, is a continuation of the femoral sulcus (Fig. 24) and connects the anterior region of the thigh with the popliteal fossa.

Femoral groove, which is a continuation of the ilio-comb groove of the femoral triangle (see Fig. 21), limited to:


  • Medially - long and large adductor muscles;

  • Lateral - medial broad muscle of the thigh


Rice. 24. Femoral groove and adductor canal. The passage of the adducting canal is marked with a white dotted line.

1 - femoral groove (highlighted by a dotted line), 2 - long adductor muscle, 3 - short adductor muscle, 3 - large adductor muscle, 4 - superior opening of the adductor canal, 5 - broad medial muscle, 6 - lamina vastoadductoria, 7 - anterior opening of the adductor channel, 8 - the lower opening of the channel (adductor cleft), 9 - semimembranous muscle

^ The leading channel has three walls and three openings: inlet (top), outlet (bottom) and front. The walls of the leading channel are:


  • Medially - a large adductor muscle;

  • Laterally - the medial broad muscle of the thigh (part of the quadriceps muscle);

  • In front is a fibrous plate (lamina vastoadductoria), which is thrown between these two muscles.

^ Top hole the canal continues the femoral groove;

Front hole located in the fibrous plate;

Bottom hole(see Fig. 25), opening into the popliteal fossa, is located in adductor cleft- the interval between the bundles of the adductor muscle, attached to the rough line and the bundle, attached to the medial epicondyle of the thigh


^ Rice. 25. The adducting cleft - the lower opening of the adducting canal (highlighted by a dotted line)

1 - large adductor muscle, 2 - semimembranosus muscle, 3 - semitendinosus muscle, 4 - tendon of the great adductor muscle, attaching to the medial epicondyle of the thigh, 5 - medial epicondyle of the thigh, 6 - biceps femoris (long head), 7 - short head of the biceps muscles, 8 - popliteal vessels, 9 - gastrocnemius muscle

^ 3. LOCKING CHANNEL

Locking channel, canalis obturatorius, formed in the wall of the small pelvis, at the upper edge of the obturator opening.

Channel inlet located on the inner wall of the small pelvis (Fig. 26);

Channel walls are formed:


  • Obturator groove of the pubic bone;

  • The upper edge of the internal obturator muscle;

  • The upper edge of the external obturator muscle.
Outlet is located in the area of ​​the femoral triangle, between the comb and short adductor muscles (Fig. 27).


^ Rice. 26. The inlet of the obturator channel (highlighted by a dotted line).

1 - pubic bone, 2 - internal opening of the canal in the obturator fascia, 3 - pubic symphysis, 4 - obturator fascia, covering the internal obturator muscle, 5 - piriformis muscle, 6 - muscle that lifts the anus

The obturator artery and nerve pass through the obturator canal. In rare cases, it can become a site for the formation of obturator hernias.


^ Rice. 27. Outlet of the obturator channel (highlighted by a white line and an arrow)

1 - iliopsoas muscle, 2 - comb muscle (opened), 3 - broad medial muscle, 4 - pubic bone, 5 - external obturator muscle, 6 - obturator nerve, 7 - adductor short muscle, 8 - long adductor muscle

^ 4. SUSPENDED AND SUSPENDED HOLES

NS These holes are formed along the edges of the large sciatic foramen when the piriformis muscle passes through it (Fig. 28)


^ Rice. 28. Supiriform (A) and underpiriform (B) holes (highlighted by a dotted line)

1 - piriformis muscle, 2 - sacro-tuberous ligament, 3 - sacrospinous ligament, 4 - internal obturator muscle, 5 - gluteus medius muscle, 6 - gluteus minimus

Supra-shaped opening (A) limited to:


  • The upper edge of the piriformis muscle

  • The upper edge of the large sciatic foramen;
Piriform hole (B) limited to:

  • The lower edge of the piriformis muscle

  • The lower edge of the large sciatic foramen
^ 5. Lying of the sciatic nerve

WITH in three words, such an object is not included in the nomenclature of topographic anatomical formations of the lower extremity. Nevertheless, this cellular space should be allocated for orientation in the topography of the largest nerve in the human body. It is located in the gluteal region and in the back of the thigh (Fig. 29).

In the gluteal region, the sciatic nerve bed is limited:


  • Behind - the gluteus maximus muscle;

  • In front - by the muscles of the pelvis:

    • Piriformis muscle

    • Internal obturator muscle

    • Square femoris


Rice. 29. Sciatic nerve bed. The path of the nerve is indicated by a dotted line.

1 - gluteus maximus muscle (opened), 2 - piriformis muscle, 3 - internal obturator muscle, 4 - square femoris muscle, 5 - sciatic tubercle, 6 - adductor maximus, 7 - broad lateral muscle, 8 - short head of the biceps femoris , 9 - long head of the biceps femoris muscle (cut off), 10 - semimembranosus muscle, 11 - semitendinosus muscle (cut off), 12 - popliteal fossa

In the posterior region of the thigh, the sciatic nerve bed is limited:


  • In front - a large adductor muscle;

  • Medial - semimembranosus muscle;

  • Laterally - by the biceps femoris.
At the bottom, the sciatic nerve bed communicates with popliteal fossa.

^ 6. PENDANT FOOL

Popliteal fossa, fossa poplitea, located posterior to the knee joint, has a diamond shape and is limited by the following structures:

The popliteal fossa is reported:


  • Above - with the adductor canal (through the adductor cleft) and with the sciatic nerve bed;

  • Below - with ankle-popliteal canal.
^ 7. ANCIENT AND LOWER MUSCULAR-FIBERAL CANALS


Rice. 31. Projection of the course of the ankle-popliteal canal. The holes are highlighted with dotted lines.

1 - canal inlet, 2 - soleus muscle, 3 - gastrocnemius muscle (cut off), 4 - Achilles tendon, 5 - canal outlet
^ Rice. 32. The ankle-popliteal (A) and lower muscular-peroneal (B) canals (marked with a dotted line).

1 - soleus muscle (cut off), 2 - upper opening of the ankle-popliteal canal, 3 - long flexor of the fingers, 4 - posterior tibial muscle, 5 - long flexor of the thumb

^ Calf-popliteal canal, canalis cruropopliteus (Fig. 31, 32), located in the posterior region of the lower leg. It has front and back walls, as well as three openings: top (inlet), front and bottom (outlet).

Top hole limited:


  • In front - the popliteal muscle;

  • Behind - the tendon arch of the soleus muscle;

NS anterior opening(Fig. 33): located in the interosseous membrane at the level of the head of the fibula;

Bottom hole:


  • Located at the level of the beginning of the Achilles tendon;

  • Represented by the gap between the tendon and deep muscles.

The channel walls are formed:


  • WITH
    Rice. 33. Anterior opening of the ankle-popliteal canal

    1 - anterior opening, 2 - popliteal muscle, 3 - head of the fibula, 4 - soleus muscle (cut off), 5 - posterior tibial muscle

    in front - by the posterior tibial muscle and the long flexor of the thumb;

  • Behind - soleus muscle.

Inferior peroneal canal branches off from the ankle-popliteal canal and goes laterally - downward. Channel walls are formed:


  • In front - fibula;

  • Behind - the long flexor of the big toe.
^ 8. UPPER MUSCULAR-FIBERIAL CANAL

The superior peroneal canal is located on the lateral surface of the lower leg, bypassing the fibula in a spiral (Fig. 34):


^ Rice. 34. Projection of the course of the superior muscular-peroneal canal (indicated by the dotted line).

A. side view:

1 - the upper opening of the canal, 2 - the head of the fibula, 3 - the long peroneal muscle, 4 - the lower opening of the canal, 5 - the short peroneal muscle, 6 - the anterior tibial muscle, 7 - the long extensor of the fingers;

^ B. Front view:

1 - the upper opening of the canal, 2 - the long peroneal muscle, 3 - the lower opening of the canal, 4 - the short peroneal muscle, 5 - the long extensor of the fingers, 6 - the anterior tibial muscle.

The canal begins with an upper opening along the line of the beginning of the long peroneal muscle from the fibula (Fig. 35).

WITH channel shadows are formed:


  • From the inside - by the lateral surface of the fibula;

  • Outside - by the long peroneal muscle.

The inferior opening of the canal is located between the peroneal longus muscle and the extensor digitorum longus.

The superficial peroneal nerve passes through the canal.


Rice. 35. The superior opening of the superior musculocutaneous peroneal canal (highlighted in white dotted line)

1 - the head of the fibula, 2 - the long peroneal muscle, 3 - the opening of the canal, 4 - soleus muscle (cut off)