Lacuna anatomy. Vascular and muscular lacuna. Walls, contents, clinical significance. The practical significance of these laws

Within the framework of the pelvic girdle and the free lower limb, the muscles limit the topographic and anatomical formations (lacunae, triangles, canals, pits and grooves) in which the neurovascular bundles pass, is of great practical importance
piriformis muscle, m. piriformis - passing through the foramen ischiadicurr. majus, does not fill the hole completely, but leaves two holes: supra-pear and pear-shaped.
supra-pear hole, foramen suprapiriforme - part of the large gluteal opening located above the piriformis muscle. The upper gluteal vessels and nerve pass through the openings. According to L. B. Simonova, part of the large gluteal foramen must be considered a suprapiriform canal. It is formed from above by the upper edge of the gluteus maximus tenderloin, and from below and on the sides by the fascia of the piriformis, middle and small sciatic muscles. The length of the suprapiriform canal is 4-5 s.
width 0.5-1 cm. It connects the pelvic cavity with the fascial cell spaces of the gluteal region.
Sub-pear hole, foramen infrapiriforme - limited to the lower edge of the piriformis muscle, lig. sacrotuberale, and the upper twin muscle. Through the pear-shaped opening from the small pelvis exit: the sciatic nerve, the posterior cutaneous nerve of the thigh, the lower gluteal neurovascular bundle (a. glutea inferior, the veins and nerve of the same name) and the genital neurovascular bundle (a. pudenda interna, the veins of the same name and n. pudendus).
obturator canal, canalis obturatorius (BNA) - located in the outer upper edge of the obturator foramen. It is directed from back to front. The canal is formed outside and above by the obturator groove of the pubic bone, and from the middle and downwards by the upper outer edge of the membrana obturatoria. In the canal pass: the obturator artery, with the veins of the same name and the obturator nerve.
Muscular and vascular lacunae. The space under the inguinal ligament and pelvic bones is divided by the iliopectineal arch, arcus iliopectineus, into two lacunae: muscular, lacuna musculorum, and vascular, lacuna vasorum.
muscle gap, lacuna musculorum - limited to: the iliac crest (outside), the inguinal ligament (front), the body of the ilium and the supra-globular cavity (behind) and the iliopectineal arch (inside). Iliopectineal arch, arcus iliopectineus (old name lig. Iliopectineum), originating from lig. inguinale and attaches to eminentia iliopectinea. It is directed obliquely from front to back, from outside to inside and is closely intertwined with the fascia by the iliopsoas muscle. The shape of the muscle gap is oval, the diameter of the gap is on average 8-9 cm. The content of the gap is the iliopsoas muscle and the femoral nerve.
Vascular lacuna, lacuna vasorum - limited: in front - inguinal ligament, behind - lig. pectineale (old name lig. pubicum Cooperi), outside - iliac crested arch, and inside - lig. lacunar. The vascular lacuna has a triangular shape, it contains the femoral artery and vein, n. genitofemoralis, lymph node and fiber.
femoral canal, canalis femoralis - located in the vascular lacuna under the medial inguinal ligament, to the middle of the femoral vein. This term refers to the path that the femoral hernia passes (in the absence of a hernia, the channel does not exist). The femoral canal has the shape of a trihedral pyramid, 0.5-1 cm long.
The walls of the femoral canal are: outside - the femoral vein, in front - the superficial sheet of the broad fascia of the thigh and the upper horn of the sickle-shaped edge, behind - the deep sheet of the wide fascia (Gimbernati). The inner wall is formed by the fusion of two sheets of the fascia lata of the thigh and the fascia of the comb muscle.
The femoral canal has two rings (holes): deep, anulus femoralis internus, and superficial, anulus femoralis externus. The deep canal ring is bounded in front by the inguinal ligament, lig. inguinale (Pouparti), outside - femoral vein, v. femoralis, behind - combed ligament, lig. pectineale, medially - lig. lacunare (Gimbernati). The opening is closed by the transverse fascia of the abdomen. Naturally, the deeper the ring, that is, the wider the distance from lig. lacunare (Gimbernati) in the femoral vein, the better conditions for the exit of femoral hernias. This distance in men is on average 1.2 cm, and in women - 1.8 cm, so femoral hernia occurs much more often in women than in men. The outer opening of the canal is the subcutaneous fissure, hiatus saphenus s. ovalis (BNA), which is limited by a sickle-shaped edge, maigo falcitormis, and its upper and lower angles.
The subcutaneous fissure is covered with a lattice loose plate, a lymph node (Pirogov-Rosenmühler) and the mouth of the great saphenous vein and the veins that flow into it. Loosening the broad fascia of the thigh in the area of the oval fossa contributes to the release of the femoral hernia.
There are anatomical variants when the deep opening of the femoral canal is limited on all sides by blood vessels. This is observed when a. obturatoria departs from the inferior supra-abdominal artery, and outside the opening is the femoral vein, from the inside - the obturator artery and ramus pubicus of the inferior supra-abdominal artery, which runs along the posterior surface of the lig. lacunar. In clinical practice, this arrangement of blood vessels has been called the "crown of death", corona mortis, which must be taken into account during surgical interventions for femoral hernias.
femoral triangle, trigonum femorale (Scarpa's triangle, Scarpa), - is located within the upper third of the thigh. The triangle is limited: outside - by the medial edge m. sartorius, from the middle - the lateral edge of m. adductor longus, from above - inguinal ligament. The apex of the femoral triangle is the point of collision of the inner edge of the clavicular muscle with the outer edge of the adductor longus muscle. The height of the femoral triangle is on average 8-10 cm. Within the femoral triangle is the iliac crest groove, which is limited by the medial crest muscle, and from the side by the iliopsoas muscle. The iliac crested groove passes into the femoral groove, which at the top of the femoral triangle passes into the drive canal. Blood vessels (femoral artery and vein) pass through the iliac crest groove.
drive channel, canalis adductorius (femoral-popliteal, or Gunther canal) 1 - connects the front surface of the thigh with the popliteal fossa. It is a triangular slit-like gap, which is directed from front to back and from the middle outwards. The channel is limited by three walls: medial - m. adductor magnus, lateral - m. vastus medialis, and the anterior aponeurotic plate, lamina vastoadductoria, located between these muscles. Lamina vastoadductoria is covered by sartorius muscle. The channel has a length of 6-7 cm.
The drive channel has three holes: top, bottom and front. The upper opening is the end part of the funnel-shaped space of the femoral triangle, covered by the sartorius muscle. Through this opening, femoral vessels enter the canal from the cavity of the femoral triangle. The lower opening of the drive canal is called the tendon gap, hiatus tendineus, which is located on the back of the thigh, in the popliteal fossa. The anterior opening of the channel is located in a fibrous plate, which has 1-2 holes through which pass: a. genu descendens, accompanied by a vein, and n. saphenus. In the adductor canal pass: femoral artery, femoral vein and saphenous (hidden) nerve, n. saphenus.
Popliteal fossa, fossa poplitea - has a diamond shape, the upper sides of the diamond are longer than the lower ones. The upper angle of the popliteal fossa is limited on the medial side by the semimembranosus muscle, and on the lateral side by the biceps femoris muscle. The lower angle is located between the medial and lateral heads of the gastrocnemius muscle. The bottom of the popliteal fossa is formed by the popliteal surface of the femur, fades poplitae femoris, the capsule of the knee joint, lig. popliteum obliquum, lig. popliteum arcuatum. Behind the popliteal fossa is closed by the own fascia of the posterior part of the knee. The popliteal fossa is filled with fatty tissue, lymphatic vessels and nodes, and a neurovascular bundle (according to the anatomical code "NEVA" - n. tibialis, vena et a. poplitea).
Ankle-popliteal canal, canalis cruropopliteus (BNA) (Gruber's canal) 1 - occupies the gap between the superficial and deep muscle groups of the lower leg. The tibial popliteal canal has three openings: one inlet and two outlets. The anterior wall of the canal in the upper section is formed by mm. tibialis posterior and flexor digitorum longus, and in the lower section - mm. flexor digitorum longus and flexor hallucis longus. The back wall is formed by the soleus muscle. The channel is calculated: the final section of the popliteal artery, the initial section of the anterior tibial artery, the posterior tibial artery, the accompanying veins, the tibial nerve and fiber. The inlet is a gap between the arcus tendineus m. solei and m. popliteus. The popliteal artery and tibial nerve enter this gap. The upper inlet is a triangular gap between the neck of the fibula (outside), m. popliteus (top) and m. tibialis posterior (middle and bottom). Through this opening, the anterior tibial artery is obtained from the canal into the anterior bed of the leg. The lower outlet is a narrow fascial gap between the superficial and deep leaf of the own fascia of the leg. This gap is located on the border of the middle and lower thirds of the lower leg at the lower inner edge of the soleus muscle. Here, the posterior tibial neurovascular bundle emerges from the canal. The lower leg popliteal canal, during the course of the neurovascular bundle, connects with the popliteal fossa, ossicular, calcaneal and plantar canals.
Inferior musculoperoneal canal, canalis musculoperoneus inferior - departs from the ankle popliteal canal in the middle third of the lower leg in the lateral direction. The walls of the canal are: in front - the posterior surface of the fibula, behind - the long flexor of the big toe. The peroneal artery and the veins that accompany it pass through the canal.
Superior musculoperoneal canal, canalis musculoperoneus superior - located in the upper third of the lower leg, limited by the lateral surface of the fibula and the long peroneal muscle. The superficial peroneal nerve passes through the canal.
Stone canal, canalis malleolaris - located in the medial malleolus between retinaculum mm. flexorum and calcaneus. The upper border of the ossicular canal is the base of the medial malleolus, the lower border is the upper edge of the abductor thumb muscle. The outer wall of the canal is formed by the medial malleolus, the capsule of the ankle joint, and the calcaneus. The inner wall is formed by the holder of the flexor muscles, retinaculum musculorum flexorum. The ossicular canal contains the flexor tendons and the neurovascular bundle. There are two grooves on the plantar surface of the foot: the medial plantar groove, sulcus plantaris medialis, and the lateral plantar groove, sulcus plantaris lateralis. The medial plantar groove is located between mm. flexor digitorum brevis et abductor hallucis. The lateral plantar sulcus is located between the flexor digitorum brevis et abductor digiti minimi. In the plantar grooves are neurovascular bundles.

Sartorius, m. sartorius.

Beginning: spina iliaca anterior superior.

Attachment: tuberositas tibia.

Function: leads the thigh and rotates it outward.

Innervation: n. femoralis.

Blood supply: a. circumflexa femoris lateralis, a. femoralis, a. descendensgeninularis.

four-headed muscle

m. quadriceps femoris: Rectus femoris, m. rectus femoris, Lateral wide, m. vastus lateralis, Medial wide, Intermediate wide.

Start: 1 - spina iliaca anterior inferior, 2 - greater skewer and linia aspera (l.g.), 3 - anterior surface of the femur, distal to the intertrochanteric line, linia aspera (medial lip), 4 - anterior surface of the body of the femur. Attachment: lig. patella, which is attached to tuberositas tibiae. Function: flexes the thigh, unbends the lower leg - 1, unbends the lower leg - 2,3,4. Innervation: n. femoralis. Blood supply: a. femoralis, a. profunda femoris.

fascia lata

fascia lata, thick, has a tendon structure. In the form of a dense case, it covers the thigh muscles from all sides. Attaches proximally to the iliac crest, inguinal ligament, pubic symphysis, and ischium. On the back surface of the lower limb, it connects to the gluteal fascia.

In the top third anterior region of the thigh, within the femoral triangle, the fascia lata of the thigh consists of two records- deep and superficial. The deep plate that covers the pectineus muscle and the distal iliopsoas muscle in front is called the iliopectineal fascia.

Behind the inguinal ligament are muscular and vascular lacunae, which separate iliac-combing arch,arcus iliopectineus.

The arc is thrown from the inguinal ligament to the iliopubic eminence.

muscle gap

lacuna muscutorum, located laterally from this arc, bounded in front and above by the inguinal ligament, behind - by the ilium, on the medial side - by the iliac crested arch. Through the muscle gap from the cavity of the large pelvis to the anterior region of the thigh, the iliopsoas muscle exits along with the femoral nerve.

Vascular lacuna

lacuna vasorum located medially from the iliopectineal arch; it is limited in front and above by the inguinal ligament, behind and below by the pectinate ligament, on the lateral side by the iliopectineal arch, and on the medial side by the lacunar ligament. The femoral artery and vein, lymphatic vessels pass through the vascular lacuna.

Behind the inguinal ligament are the muscular and vascular lacunae, which are separated by the iliopectineal arch. The arc is thrown from the inguinal ligament to the iliopubic eminence.

muscle gap located laterally from this arc, bounded in front and above by the inguinal ligament, behind - by the ilium, on the medial side - by the iliopectineal arch. Through the muscle gap from the cavity of the large pelvis to the anterior region of the thigh, the iliopsoas muscle exits along with the femoral nerve.

Vascular lacuna located medially from the iliopectineal arch; it is limited in front and above by the inguinal ligament, behind and below by the pectinate ligament, on the lateral side by the iliopectineal arch, and on the medial side by the lacunar ligament. The femoral artery and vein, lymphatic vessels pass through the vascular lacuna.

FEMORAL CANAL

On the anterior surface of the thigh femoral triangle (Scarpa's triangle), bounded at the top by the inguinal ligament, on the lateral side by the sartorius muscle, medially by the long adductor muscle. Within the femoral triangle, under the superficial sheet of the fascia lata, a well-defined iliopectineal groove (fossa) is visible, bounded on the medial side by the pectinate, and on the lateral side by the iliopsoas muscles covered by the iliopectineal fascia (deep plate of the wide fascia of the thigh) . In the distal direction, this groove continues into the so-called femoral groove, on the medial side it is limited by the long and large adductor muscles, and on the lateral side - by the medial wide muscle of the thigh. Below, at the top of the femoral triangle, the femoral groove passes into the adductor canal, the inlet of which is hidden under the tailor's muscle.

femoral canal is formed in the region of the femoral triangle during the development of a femoral hernia. This is a short section medial to the femoral vein, extending from the femoral inner ring to the subcutaneous fissure, which, in the presence of a hernia, becomes the external opening of the canal. The inner femoral ring is located in the medial part of the vascular lacunae. Its walls are in front - the inguinal ligament, behind - the pectinate ligament, medially - the lacunar ligament, laterally - the femoral vein. From the side of the abdominal cavity, the femoral ring is closed by a section of the transverse fascia of the abdomen. At the femoral canal, 3 walls are distinguished: the anterior - inguinal ligament and the upper horn of the falciform edge of the wide fascia of the thigh fused with it, the lateral - the femoral vein, the posterior - a deep plate of the wide fascia covering the comb muscle.

Control questions for the lecture:

1. Anatomy of the abdominal muscles: attachment and function.

2. Anatomy of the white line of the abdomen.

3. Relief of the posterior surface of the anterior abdominal wall.

4. The process of formation of the inguinal canal in connection with the lowering of the gonad.

5. The structure of the inguinal canal.

6. The process of formation of direct and oblique inguinal hernias.

7. Structure of lacunae: vascular and muscular; scheme.

8. The structure of the femoral canal.

Lecture No. 9

Soft core.

The purpose of the lecture. To acquaint students with the current state of the issue of connective tissue structures of the human body.

lecture plan:

1. General characteristics of the soft core. Classification of human fasciae.

2. General characteristics of the distribution of fascial formations in the human body.

3. The main patterns of the distribution of fascial formations in the limbs of a person.

4. Clinical significance of fascial cases; the role of domestic scientists in their study.

The history of the study of fascial cases of muscles, vessels and nerves begins with the work of the brilliant Russian surgeon and topographic anatomist N.I. Pirogov, who, on the basis of a study of cuts of frozen corpses, revealed topographic and anatomical patterns in the structure of vascular fascial sheaths, which he summarized in three laws:

1. All major vessels and nerves have connective tissue sheaths.
2. On a transverse section of the limb, these sheaths have the shape of a trihedral prism, one of the walls of which is simultaneously the posterior wall of the fascial sheath of the muscle.
3. The top of the vascular sheath is directly or indirectly connected with the bone.

Compaction of the own fascia of muscle groups leads to the formation aponeuroses. The aponeurosis holds the muscles in a certain position, determines the lateral resistance and increases the support and strength of the muscles. P.F. Lesgaft wrote that "the aponeurosis is as independent an organ as an independent bone, which makes up a solid and strong stand of the human body, and its flexible continuation is fascia." Fascial formations should be considered as a soft, flexible frame of the human body, complementing the bone frame, which plays a supporting role. Therefore, it was called the soft skeleton of the human body.

A correct understanding of the fascia and aponeuroses is the basis for understanding the dynamics of the spread of hematoma in trauma, the development of deep phlegmon, and also for substantiating case novocaine anesthesia.

I. D. Kirpatovsky defines fasciae as thin translucent connective tissue membranes that cover some organs, muscles and blood vessels and form cases for them.

Under aponeuroses This refers to denser connective tissue plates, "tendon sprains", consisting of tendon fibers adjacent to each other, often serving as a continuation of the tendons and delimiting anatomical formations from each other, such as, for example, the palmar and plantar aponeuroses. The aponeuroses are tightly fused with the fascial plates covering them, which beyond their boundaries form a continuation of the walls of the fascial sheaths.

CLASSIFICATION OF FASCIA

According to the structural and functional features, superficial fascia, deep fascia and organ fascia are distinguished.
Superficial (subcutaneous) fasciae , fasciae superficiales s. subcutaneae, lie under the skin and represent a thickening of the subcutaneous tissue, surround the entire musculature of this area, are morphologically and functionally associated with the subcutaneous tissue and skin, and together with them provide elastic support for the body. The superficial fascia forms a sheath for the entire body as a whole.

deep fasciae, fasciae profundae, cover a group of synergistic muscles (i.e., performing a homogeneous function) or each individual muscle (own fascia, fascia propria). If the muscle's own fascia is damaged, the latter protrudes in this place, forming a muscle hernia.

Own fascia(fascia of organs) cover and isolate a separate muscle or organ, forming a case.

Own fasciae, separating one muscle group from another, give deep processes, intermuscular septa, septa intermuscularia, penetrating between adjacent muscle groups and attaching to the bones, as a result of which each muscle group and individual muscles have their own fascial beds. So, for example, the own fascia of the shoulder gives the outer and inner intermuscular septa to the humerus, as a result of which two muscle beds are formed: the anterior one for the flexor muscles and the posterior one for the extensor muscles. At the same time, the internal muscular septum, splitting into two sheets, forms two walls of the sheath of the neurovascular bundle of the shoulder.

Own fascia of the forearm, being a case of the first order, gives off intermuscular septa, dividing the forearm into three fascial spaces: superficial, medium and deep. These fascial spaces have three corresponding cellular gaps. The superficial cellular space is located under the fascia of the first layer of muscles; the middle cellular gap extends between the ulnar flexor and the deep flexor of the hand, distally this cellular gap passes into the deep space described by P.I. Pirogov. The median cellular space is connected with the ulnar region and with the median cellular space of the palmar surface of the hand along the median nerve.

In the end, according to V. V. Kovanov, “ fascial formations should be considered as a flexible skeleton of the human body, significantly complementing the bone skeleton, which, as you know, plays a supporting role. "Detailing this provision, we can say that in functional terms fasciae act as a flexible tissue support especially muscles. All parts of the human flexible skeleton are built from the same histological elements - collagen and elastic fibers - and differ from each other only in their quantitative content and orientation of the fibers. In the aponeuroses, the connective tissue fibers have a strict direction and are grouped into 3-4 layers; in the fascia, there are a significantly smaller number of layers of oriented collagen fibers. If we consider the fascia in layers, then the superficial fascia are an appendage of the subcutaneous tissue, they contain the saphenous veins and cutaneous nerves; own fascia of the limbs are strong connective tissue formations covering the muscles of the limbs.

FASCIA OF THE ABDOMINAL

Three fasciae are distinguished on the abdomen: superficial, proper and transverse.

superficial fascia separates the abdominal muscles from the subcutaneous tissue in the upper sections is weakly expressed.

own fascia(fascia propria) forms three plates: superficial, medium and deep. surface plate covers the outside of the external oblique muscle of the abdomen and is most strongly developed. In the region of the superficial ring of the inguinal canal, the connective tissue fibers of this plate form interpeduncular fibers (fibrae intercrurales). Attached to the outer lip of the iliac crest and to the inguinal ligament, the superficial plate covers the spermatic cord and continues into the fascia of the muscle that lifts the testicle (fascia cremasterica). Medium and deep plates own fascia cover the front and back of the internal oblique muscle of the abdomen, are less pronounced.

transverse fascia(fascia transversalis) covers the inner surface of the transverse muscle, and below the navel covers the back of the rectus abdominis muscle. At the level of the lower border of the abdomen, it is attached to the inguinal ligament and the inner lip of the iliac crest. The transverse fascia lines the anterior and lateral walls of the abdominal cavity from the inside, forming most of the intra-abdominal fascia (fascia endoabdominalis). Medially, at the lower segment of the white line of the abdomen, it is reinforced with longitudinally oriented bundles, which form the so-called support of the white line. This fascia, lining the walls of the abdominal cavity from the inside, according to the formations that it covers, receives special names (fascia diaphragmatica, fascia psoatis, fascia iliaca).

Case structure of the fascia.

The superficial fascia forms a kind of case for the entire human body as a whole. Own fasciae make up cases for individual muscles and organs. The case principle of the structure of fascial receptacles is characteristic of the fascia of all parts of the body (torso, head and limbs) and organs of the abdominal, thoracic and pelvic cavities; especially in detail it was studied in relation to the limbs by N. I. Pirogov.

Each section of the limb has several cases, or fascial bags, located around one bone (on the shoulder and thigh) or two (on the forearm and lower leg). So, for example, in the proximal forearm, 7-8 fascial cases can be distinguished, and in the distal - 14.

Distinguish main case (case of the first order), formed by the fascia going around the entire limb, and second order cases containing various muscles, vessels and nerves. The theory of N. I. Pirogov about the sheath structure of the fascia of the extremities is important for understanding the spread of purulent streaks, blood during hemorrhage, as well as for local (case) anesthesia.

In addition to the sheath structure of the fascia, recently there has been an idea of fascial nodes , which play a supporting and restrictive role. The supporting role is expressed in the connection of the fascial nodes with the bone or periosteum, due to which the fascia contribute to the traction of the muscles. Fascial nodes strengthen the sheaths of blood vessels and nerves, glands, etc., promoting blood and lymph flow.

The restrictive role is manifested in the fact that the fascial nodes delimit some fascial cases from others and delay the progress of pus, which spreads unhindered when the fascial nodes are destroyed.

Allocate fascial nodes:

1) aponeurotic (lumbar);

2) fascial-cellular;

3) mixed.

Surrounding the muscles and separating them from each other, fasciae contribute to their isolated contraction. Thus, the fasciae both separate and connect the muscles. According to the strength of the muscle, the fascia that covers it also thickens. Above the neurovascular bundles, the fasciae thicken, forming tendon arches.

Deep fascia, which form the integument of organs, in particular, the own fascia of the muscles, are fixed on the skeleton intermuscular septa or fascial nodes. With the participation of these fascia, the sheaths of the neurovascular bundles are built. These formations, as if continuing the skeleton, serve as a support for organs, muscles, blood vessels, nerves and are an intermediate link between fiber and aponeuroses, so they can be considered as the soft skeleton of the human body.

Have the same meaning synovial bags , bursae synoviales, located in various places under the muscles and tendons, mainly near their attachment. Some of them, as has been pointed out in arthrology, are connected to the articular cavity. In those places where the tendon of the muscle changes its direction, the so-called block, trochlea, through which the tendon is thrown like a belt over a pulley. Distinguish bone blocks when the tendon is thrown over the bones, and the surface of the bone is lined with cartilage, and a synovial bag is located between the bone and the tendon, and fibrous blocks formed by fascial ligaments.

The auxiliary apparatus of muscles also includes sesamoid bones ossa sesamoidea. They are formed in the thickness of the tendons at the places of their attachment to the bone, where it is required to increase the shoulder of muscle strength and thereby increase the moment of its rotation.

The practical significance of these laws:

The presence of a vascular fascial sheath should be taken into account during the operation of exposing the vessels during their projection. When ligating a vessel, it is impossible to apply a ligature until its fascial case is opened.
The presence of an adjacent wall between the muscular and vascular fascial sheaths should be taken into account when conducting extra-projective access to the limb vessels. When a vessel is injured, the edges of its fascial sheath, turning inward, can contribute to the spontaneous stop of bleeding.

Control questions for the lecture:

1. General characteristics of the soft core.

2. Classification of the abdominal fascia.

3. General characteristics of the distribution of fascial formations in the human body.

4. The main patterns of the distribution of fascial formations in the limbs of a person.

Semester

Lecture #1

Functional anatomy of the digestive system.

The purpose of the lecture. Consider functional anatomy and anomalies in the development of the digestive system.

lecture plan:

1. Consider the functional anatomy of the pharynx.

2. Consider the act of sucking and swallowing.

3. Consider anomalies in the development of the pharynx.

4. Consider the functional anatomy of the esophagus.

5 Consider anomalies in the development of the esophagus.

6. Consider the functional anatomy of the stomach.

7. Consider anomalies in the development of the stomach.

8. Open the development of the peritoneum and its derivatives.

9. Reveal anomalies in the development of the maxillofacial region.

10. Open anomalies in the position of the caecum and appendix.

11 Consider anomalies in the development of the intestine and its mesentery.

12. Consider Meckel's diverticulum and its practical significance.

Splankhnologiya - the doctrine of the entrails (organs).

viscera, viscera s. splanchna, are called organs that lie mainly in the body cavities (thoracic, abdominal and pelvic). These include the digestive, respiratory, and genitourinary systems. The insides are involved in the metabolism; the exception is the genitals, which carry the function of reproduction. These processes are also characteristic of plants, which is why the entrails are also called organs of plant life.

PHARYNX

The pharynx is the initial section of the digestive tract and at the same time is part of the respiratory tract. The development of the pharynx is closely related to the development of neighboring organs. Gill arches are laid in the walls of the primary pharynx of the embryo, from which many anatomical formations develop. This determines the anatomical connection and close topographic relationship of the pharynx with various organs of the head and neck.

Secreted in the pharynx nose, communicating through the choanae with the nasal cavity and through the auditory tube with the tympanic cavity of the middle ear; the oral part into which the pharynx opens; laryngeal part, where the entrance to the larynx and the esophageal mouth are located. The pharynx is firmly fixed to the base of the skull by means of the pharyngeal-basilar fascia. The mucous membrane of the pharynx contains glands, accumulations of lymphoid tissue that form the tonsils. The muscular membrane consists of striated muscles, which are divided into constrictors (upper, middle and lower) and muscles that raise the pharynx (palato-pharyngeal, stylo-pharyngeal, tubal-pharyngeal).

The nasal part of the pharynx has a large sagittal size and low height, corresponding to the poor development of the nasal cavity. The pharyngeal opening of the auditory tube is in the newborn very close to the soft palate and at a distance of 4-5 cm from the nostrils. The tube itself has a horizontal direction, which facilitates its catheterization through the nasal cavity. At the opening of the pipe is located tubal tonsil , with hypertrophy of which the hole is compressed, and hearing loss occurs. In the nasal part of the pharynx, at the point of transition of the arch of the pharynx into its posterior wall, is located pharyngeal tonsil . In newborns, it is poorly developed, and in the first year of life it increases and, with hypertrophy, can close the choanae. The amygdala continues to grow during first and second childhood, and then it undergoes involution, but often persists into adults.

Oral part of the pharynx located in newborns higher than in adults, at the level of I - II cervical vertebrae, and the laryngeal part of the pharynx corresponds to II - III cervical vertebrae. The root of the tongue protrudes into the oral part of the pharynx, in the mucous membrane of which lies lingual tonsil . At the entrance to the pharynx, on both sides of the pharynx are the palatine tonsils. Each tonsil lies in the tonsil fossa formed by the palatoglossal and palatopharyngeal arches. The anteroinferior part of the palatine tonsil is covered with a triangular mucosal fold. The growth of the tonsils is uneven. The fastest growth is observed up to a year, at the age of 4-6 years, slower growth occurs up to 10 years, when the weight of the amygdala reaches 1 g. In adults, the amygdala weighs an average of 1.5 g.

Pharyngeal, tubal, palatine, lingual tonsils form pharyngeal ring of lymphoid formations, which surrounds the beginning of the food and respiratory tract. The role of the tonsils is that microbes and dust particles are deposited and neutralized here. Lymphoid formations are important for the development of immunity, they are classified as organs of the immune system. This explains why the tonsils are poorly developed in newborns, who have natural immunity transmitted from the mother, and grow rapidly in the first years of life, when contact with infectious agents increases and immunity develops. By the onset of puberty, the growth of the tonsils stops, and in the elderly and senile age, their atrophy occurs.

The oral cavity and pharynx carry out the vital acts of sucking and swallowing.

Sucking includes 2 phases. In the 1st of them, the lips capture the nipple. The tongue is pulled back, acting like a syringe plunger to suck up fluid, and the back of the tongue forms a groove through which the fluid drains to the root of the tongue. The contraction of the maxillohyoid muscle lowers the lower jaw, resulting in a negative pressure in the oral cavity. This ensures absorption. In the 2nd phase, the lower jaw rises, the alveolar arches squeeze the nipple, suction stops and swallowing begins.

swallowing in general, it consists of 2 phases. With movements of the tongue, food is not only fed to the cutting surface of the teeth, but also mixed with saliva. Further, the muscles of the floor of the mouth are reduced; the hyoid bone and larynx rise, the tongue rises and presses the food from front to back against the hard and soft palate. This movement pushes the food to the pharynx. By contraction of the stylo-pharyngeal muscles, the tongue moves backward and, like a piston, pushes food through the opening of the pharynx into the pharynx. Immediately after this, the muscles that compress the pharynx contract, and a part (sip) is separated from the food that is in the oral cavity. At the same time, the muscles that lift and strain the palatine curtain are reduced. The palatine curtain rises and stretches, and the upper constrictor of the pharynx contracts towards it, forming the so-called Passavan roller. In this case, the nasal part of the pharynx is separated from the oral and laryngeal, food goes down. The hyoid bone, thyroid and cricoid cartilages, the muscles of the floor of the mouth simultaneously press the epiglottis to the edges of the opening leading from the pharynx to the larynx, and food is sent to the laryngeal part of the pharynx, and then further into the esophagus.

Food enters the wide part of the pharynx, and constrictors contract above it. At the same time, the stylo-pharyngeal muscles contract; by their action, the pharynx is pulled over the food bolus, like a stocking on a leg. The food bolus is pushed into the esophagus by successive contractions of the constrictors of the pharynx, after which the palatine curtain falls, the tongue and larynx move down.

Next comes the musculature of the esophagus. A wave of contractions spreads along it, first of the longitudinal, and then of the circular muscles. Where the longitudinal muscles contract, food enters the dilated portion of the esophagus, and above this point the esophagus narrows, pushing the food towards the stomach. The esophagus opens gradually, segment by segment.

The first phase of swallowing is associated with the action of the tongue and the muscles of the floor of the mouth (arbitrary phase). As soon as food passes the pharynx, swallowing becomes involuntary. The first phase of swallowing is instantaneous. In the esophagus, the act of swallowing proceeds more slowly. The first phase of swallowing takes 0.7-1 s, and the second (passage of food through the esophagus) takes 4-6 and even 8 s. Thus, swallowing movements are a complex act in which a number of motor apparatuses are involved. The structure of the tongue, soft palate, pharynx and esophagus is very finely adapted to the swallowing function.

Anomalies in the development of the pharynx

Anomalies in the development of the pharynx are numerous and varied. Here are just some of the most common or clinically important malformations.

1. Choan atresia (syn.: posterior atresia) - absence or narrowing of the choanae, may be complete or partial, unilateral or bilateral, membranous, cartilaginous or bone, usually combined with other defects.

2. Diverticulum of the pharynx - characteristic localization - pharyngeal pockets on the border with the larynx. May turn into a cyst.

3. Pharyngeal bag (syn.: Thornwald's disease) - a cyst-like formation of the nasopharynx, located in the midline near the pharyngeal tonsil, associated with the lacing of a part of the endoderm in the dorsal chord in the embryonic period.

4. Fistula of the pharynx - a congenital opening on the neck leading to the pharynx. Represents the remains of one of the gill slits.

ESOPHAGUS

The esophagus is a tubular organ that carries food to the stomach. The esophagus begins at the neck, passes through the posterior mediastinum, and passes through the esophageal opening of the diaphragm into the abdominal cavity. The length of the esophagus in newborns is 11-16 cm, by 1 year it increases to 18 cm, by 3 years it reaches 21 cm, in adults - 25 cm. It is practically important to know the distance from the alveolar (dental) arches to the entrance to the stomach; this size is 16-20 cm in newborns, 22-25 cm in early childhood, 26-29 cm in the first period of childhood, 27-34 cm in the second childhood, 40-42 cm in adults. At such a distance, adding 3.5 cm to it, you need to advance the probe to insert it into the stomach.

In newborns, a higher beginning of the esophagus is noted - at the level of cartilage between the III and IV cervical vertebrae. At the age of 2 years, the upper border of the esophagus descends to IV-V vertebrae, and by the age of 12 it is established as in an adult at the level of VI-VII cervical vertebrae. The lower end of the esophagus in all age groups corresponds to the X-XI thoracic vertebrae.

In the esophagus distinguish between cervical, thoracic and abdominal parts . The cervical part (from the lower edge of the VI cervical vertebra to the III thoracic vertebra) has a length of 5 cm in adults. The thoracic part extends from the III to the IX thoracic vertebra. The abdominal part is the shortest (2-3 cm).

The esophagus has an irregularly cylindrical shape and is characterized by the presence of three anatomical constrictions . First (pharyngeal ) the narrowing is located at the point of transition of the pharynx into the esophagus (at the level of the VI-VII cervical vertebrae). Second (bronchial ) the narrowing is at the level of intersection with the left main bronchus (at the level of IV - V thoracic vertebrae), the third ( diaphragmatic) - at the place of passage through the diaphragm (at the level of IX - X thoracic vertebrae). In addition, there is two physiological constrictions due to the tone of the muscular membrane of the esophagus. First ( aortic) located at the intersection of the esophagus with the aortic arch (at the level of the III thoracic vertebra), the second (cardiac) - at the junction of the esophagus to the stomach (at the level of the XI thoracic vertebra).

The diameter of the lumen of the esophagus at the level of constrictions is 4–9 mm in newborns, 12–15 mm in early childhood, and reaches 13–18 mm in the second period of childhood. In wider places, the esophagus in adults is 18-22 mm in diameter. When swallowed, it can stretch up to 3.5 cm.

The development of the muscles of the esophagus continues until the age of 13-14. Muscle fibers have a spiral course. In the outer layer, they go in an oblique direction and continue into the inner layer, where they are located in an oblique transverse direction. A wave of peristalsis passes through the esophagus after swallowing for 18-27 s.

In the final section of the esophagus, muscle fibers acquire a horizontal spiral course and form the esophageal-cardiac sphincter. With swallowing movements, the esophagus either lengthens or shortens. When an organ is elongated, muscle fibers tighten and close its lumen. When the esophagus shortens, its lumen opens. Closes the lower end of the esophagus submucosal venous plexus forming an elastic cushion.

Anomalies in the development of the esophagus

Abnormalities in the development of the esophagus are numerous and varied. Here are just some of the most common or clinically important malformations.

1. Esophageal agenesis - complete absence of the esophagus, is extremely rare and is combined with other severe developmental disorders.

2. Esophageal atresia - a characteristic feature is the formation of congenital anastomoses (fistulas) between the esophagus and the respiratory tract. The development of atresias and tracheoesophageal fistulas is based on a violation of the formation of the laryngotracheal septum in the process of dividing the foregut into the esophagus and trachea. Often, esophageal atresia is combined with other malformations, in particular with congenital malformations of the heart, gastrointestinal tract, urogenital apparatus, skeleton, central nervous system, with facial clefts. The population frequency is 0.3: 1000. Depending on the presence or absence of tracheoesophageal fistulas and their localization, several forms are distinguished:

A) Atresia of the esophagus without tracheoesophageal fistulas - the proximal and distal ends end blindly or the entire esophagus is replaced by a cord devoid of lumen (7-9%).

B) Esophageal atresia with tracheoesophageal fistula between the proximal esophagus and trachea (0.5%).

C) Esophageal atresia with tracheoesophageal fistula between the distal segment of the esophagus and the trachea (85-95%).

D) Atresia of the esophagus with tracheoesophageal fistulas between both ends of the esophagus and the trachea (1%).

3. Hypoplasia of the esophagus (syn.: microesophagus) - manifested by shortening of the esophagus. Can lead to hernial protrusion of the stomach into the chest cavity.

4. Macroesophagus (syn.: megaesophagus) - an increase in the length and diameter of the esophagus due to its hypertrophy.

5. Doubling the esophagus(syn.: diaesophagia) - tubular forms are extremely rare, diverticula and cysts are found somewhat more often. The latter are usually located in the posterior mediastinum, more often at the level of the upper third of the esophagus.

STOMACH

The stomach is the most expanded and most complex section of the digestive tract. At the time of birth, the stomach has the shape of a bag. Then the walls of the stomach collapse, and it becomes cylindrical. In infancy, the entrance to the stomach is wide, so young children often spit up. The fundus of the stomach is not expressed, and its pyloric part is relatively longer than in an adult.

Physiological capacity the stomach of a newborn does not exceed 7 ml, during the first day it doubles, and by the end of the 1st month it is 80 ml. The physiological capacity of the stomach of an adult is 1000-2000 ml. The average length of the stomach of an adult is 25-30 cm, its diameter is about 12-14 cm.

mucous membrane forms numerous folds. The surface of the mucous membrane in a newborn is only 40-50 cm 2, in postnatal life it increases to 750 cm 2. The mucous membrane is covered with elevations with a diameter of 1 to 6 mm, called gastric fields. They have numerous dimples 0.2 mm in diameter, into which the gastric glands open. The number of gastric pits is up to 5 million. The number of glands in an adult reaches 35-40 million. They have a length of 0.3-1.5 mm, a diameter of 30-50 microns, there are about 100 of them per 1 mm 2 of the surface of the mucous membrane. These glands secrete up to 1.5 liters of gastric juice per day, containing 0.5% hydrochloric acid. However, up to 2.5 years, the glands do not produce hydrochloric acid.

There are three types of stomach glands: own glands of the stomach (fundic), cardiac and pyloric.

Own glands of the stomach the most numerous, their secretory surface reaches 4 m 2 . They include five types of cells: chief (secrete pepsinogen), parietal or parietal (produce hydrochloric acid), mucous and cervical (secrete mucus), endocrine (produce biologically active substances - gastrin, serotonin, histamine, somatostatin, etc., these substances are tissue hormones that affect local and general processes of regulation of functions in the body).

cardiac glands(glands of the body of the stomach) mainly consist of mucous and chief cells.

Pyloric glands contain predominantly mucous cells that produce mucus. It should be noted that mucus provides not only mechanical protection of the mucous membrane, but also contains antipepsin, which protects the stomach wall from self-digestion.

Muscular layer of the stomach formed by circular and longitudinal fibers. The pyloric sphincter is well expressed. The development of muscles continues up to 15-20 years. Longitudinal muscles are formed mainly along the curvatures of the stomach, they regulate the length of the organ. The tone of the muscles of the stomach depends on the intake of food. When the organ is filled, peristalsis waves begin in the middle of its body and after 20 seconds. reach the gatekeeper.

The shape, size and position of the stomach in a healthy person are extremely diverse. They are determined by its filling, the degree of muscle contraction, they depend on respiratory movements, body position, the state of the abdominal wall, intestinal filling. In a living person, 3 forms of the stomach are radiologically distinguished: in the form of a hook, a bull's horn, and an elongated shape. There is a connection between the forms of the stomach, age, gender and body type. In childhood, the stomach is often found in the form of a bull's horn. In dolichomorphic people, especially women, the stomach is usually elongated, with a brachymorphic type, a stomach in the form of a bull's horn is observed. The lower border of the stomach during its filling is at the level of III-IV lumbar vertebrae. With the prolapse of the stomach, gastroptosis, it can reach the entrance to the small pelvis. In old age, there is a decrease in the tone of the longitudinal muscles, as a result of which the stomach is stretched.

Abnormalities in the development of the stomach

Abnormalities in the development of the stomach are numerous and varied. Here are just some of the most common or clinically important malformations.

1. Agenesia of the stomach - the absence of a stomach, an extremely rare defect, combined with severe anomalies in the development of other organs.

2. Atresia of the stomach - usually localized in the pyloric region. In most cases, with atresia, the exit from the stomach is closed by a diaphragm localized in the antrum or pylorus. Most of the membranes are perforated and represent a fold of the mucous membrane without involvement of the muscular one.

3. Hypoplasia of the stomach (syn.: congenital microgastria) - the small size of the stomach. Macroscopically, the stomach has a tubular shape, its segments are not differentiated.

4. Pyloric stenosis congenital hypertrophic stomach (syn.: hypertrophic pyloric stenosis) - narrowing of the lumen of the pyloric canal due to anomalies in the development of the stomach in the form of hypertrophy, hyperplasia and impaired innervation of the pyloric muscles, manifested by a violation of the patency of its opening in the first 12-14 days of a child's life. The population frequency is from 0.5:1000 to 3:1000.

5. doubling of the stomach (syn.: double stomach) - the presence of a hollow formation isolated or communicating with the stomach or duodenum, often located on the greater curvature or on the posterior surface of the stomach. It accounts for about 3% of all cases of duplications of the gastrointestinal tract. The presence of an additional organ located parallel to the main one is casuistry. A case of "mirror" doubling of the stomach is described, the accessory stomach was located along the lesser curvature, having a common muscular wall with the main stomach, the lesser omentum was absent.

SMALL INTESTINE

This is the longest part of the digestive tract, divided into the duodenum, jejunum and ileum. The last two are characterized by the presence of a mesentery in them and, therefore, the sign is allocated to the mesenteric part of the small intestine, located intraperitoneally. The duodenum is devoid of a mesentery and, with the exception of the initial section, lies extraperitoneally. The structure of the small intestine to the greatest extent corresponds to the general plan for the design of hollow organs.

Duodenum

It has a length of 17-21 cm in a living person. Its initial and final parts lie at the level of the 1st lumbar vertebra. The shape of the intestine is most often annular, the bends are weakly expressed and form after 6 months. The position of the intestine depends on the filling of the stomach. On an empty stomach, she

Sartorius, m. sartorius. Beginning: spina iliaca anterior superior. Attachment: tuberositas tibia. Function: leads the thigh and rotates it outward. Innervation: n. femoralis. Blood supply: a. circumflexa femoris lateralis, a. femoralis, a. descendensgeninularis.

Quadriceps, m. quadriceps femoris: Rectus femoris, m. rectus femoris, Lateral wide, m. vastus lateralis, Medial wide, Intermediate wide. Start: 1 - spina iliaca anterior inferior, 2 - greater trochanter and linia aspera (l.g.), 3 - anterior surface of the femur, distal to the intertrochanteric line, linia aspera (medial lip), 4 - anterior surface of the body of the femur. Attachment: lig. patella, which is attached to tuberositas tibiae. Function: flexes the thigh, unbends the lower leg - 1, unbends the lower leg - 2,3,4. Innervation: n. femoralis. Blood supply: a. femoralis, a. profunda femoris.

broad fascia,fascia lata, thick, has a tendon structure. In the form of a dense case, it covers the thigh muscles from all sides. Attaches proximally to the iliac crest, inguinal ligament, pubic symphysis, and ischium. On the back surface of the lower limb, it connects to the gluteal fascia.

In the top third anterior region of the thigh, within the femoral triangle, the fascia lata of the thigh consists of two records- deep and superficial. The deep plate covering the comb muscle and the distal iliopsoas muscle in front is called iliopectineal fascia.

Behind the inguinal ligament are muscular and vascular lacunae, which separate iliac-combing arch,arcus iliopectineus. The arc is thrown from the inguinal ligament to the iliopubic eminence. muscle gap,lacuna muscle, located laterally from this arc, bounded in front and above by the inguinal ligament, behind - by the ilium, on the medial side - by the iliac crested arch. Through the muscle gap from the cavity of the large pelvis to the anterior region of the thigh, the iliopsoas muscle exits along with the femoral nerve. vascular lacuna,lacuna vasorum located medially from the iliopectineal arch; it is limited in front and above by the inguinal ligament, behind and below by the pectinate ligament, on the lateral side by the iliopectineal arch, and on the medial side by the lacunar ligament. The femoral artery and vein, lymphatic vessels pass through the vascular lacuna.

Medial and posterior muscles and fascia of the thigh: their topography, functions, blood supply and innervation. "leading" channel.

biceps femoris, m. biceps femoris: long head - 1, short head - 2. Beginning: ischial tubercle - 1, lateral lip of the rough line -2. Attachment: caput fibulae. Function: unbends and frees the thigh, rotates it outward - 1, flexes the lower leg and - 1.2 rotates it outward. Innervation: 1 - n. tibialis, 2–n. fibularis communis. Blood supply: a. circumflexa femoris medialis, aa. perforantes.

Semitendinosus, m. semitendinosus. Beginning: ischial tuberosity. Attachment: tuberosity of a tibia. Function: unbends, adducts the thigh and rotates it inwards, stretches the capsule of the knee joint. Innervation: n. tibialis. Blood supply: aa. perforantes.

semimembranosus muscle, m. semimembranalis. Beginning: ischial tuberosity. Insertion: medial condyle of the tibia. Function: unbends, brings the thigh and rotates it inside. Innervation: n. tibialis. Blood supply: a. circumflexa femoris medialis, aa. perforantes, a. poplitea.

thin muscle, m. gracilis. Beginning: the lower branch of the pubic bone, near the symphysis. Attachment: a fascia of a shin, near a tuberosity of a tibia. Function: adducts the thigh, flexes the lower leg. Innervation: n. obturatorius. Blood supply: a. abturatoria, a. pudenta externa, a. profunda femoris.

comb muscle, m. pectineus. Beginning: superior branch and crest of the pubic bone, lig. pubicum superior. Attachment: linea pectiniae of the femur (comb line). Function: lead the thigh, bend it. Innervation: n. obturatorius. Blood supply: a. abturatoria, a. pudenta externa, a. profunda femoris.

adductor longus muscle, m. adductor longus. Beginning: near the pubic symphysis. Attachment: medial lip, linea aspera. Function: adducts and flexes the thigh. Innervation: n. obturatorius. Blood supply: a. abturatoria, a. pudenta externa, a. profunda femoris.

short adductor muscle, m. adductor brevis. Beginning: the lower branch of the pubic bone. Insertion: medial line of the rough line. Function: leads, bends and rotates the thigh outward. Innervation: n. obturatorius. Blood supply: a. abturatoria, aa. perforantes.

Adductor major muscle, m. adductor magnus. Beginning: branches of the pubic and ischial bones. Attachment: medial lip, linea aspera. Function: adducts and flexes the thigh. Innervation: n. obturatorius, n. ischiadicus. Blood supply: a. abturatoria, aa. perforantes.

lead channel,canalis adductorius(femoral-popliteal, or Gunter's canal), connects the anterior region of the thigh with the popliteal fossa. The medial wall of this canal is a large adductor muscle, the lateral wall is the vastus medialis muscle of the thigh, and the anterior wall is a fibrous plate that is thrown between these muscles. The channel has three holes. The first is the input, which is, as it were, a continuation of the femoral groove. The second, lower, is the outlet of the adductor canal, called the tendon gap (large adductor muscle). The outlet is located on the back of the thigh, in the popliteal fossa, between the tendon bundles of the adductor large muscle, which are attached to the lower segment of the inner lip of the rough line of the thigh and to the medial epicondyle. The third (anterior) opening of the adducting canal is located in the fibrous plate. The adductor canal contains the femoral artery and vein and the saphenous nerve. Wide fascia of the thigh,fascia lata, has a tendon structure. In the form of a dense case, it covers the thigh muscles from all sides. Attaches proximally to the iliac crest, inguinal ligament, pubic symphysis, and ischium. On the back surface of the lower limb, it connects to the gluteal fascia.

In the upper third of the anterior region of the thigh, within the femoral triangle, the fascia lata of the thigh consists of two records- deep and superficial. The deep plate that covers the pectineus muscle and the distal iliopsoas muscle in front is called the iliopectineal fascia.

The space between the inguinal ligament and the pubic, iliac bones is divided by the iliopectineal arch (ligament) into gaps - medially located vascular and lateral - muscular. Femoral vessels pass through the vascular lacuna: vein, artery, efferent lymphatic vessels. The femoral nerve and the iliopsoas muscle pass through the muscle gap.

lead channel,canalisadductorius Femoral-popliteal (adductor) canal.

The channel is formed by the following structures:

· medial wall - a large adductor muscle;

· lateral- wide medial muscle;

· front - fibrous plate (lamina vasto-adductoria) - from a deep sheet of the broad fascia, stretched between the above muscles.

Input (upper) the opening of the canal lies under the sartorius muscle, output (lower) located in the popliteal fossa in the form of a gap in the tendon of the large adductor; the anterior opening is located in the fibrous plate (vastoadductor) at the level of the lower third of the thigh. The lower opening (the exit from the canal) opens into the popliteal fossa.

The femoral artery, vein, large hidden nerve pass through the iliopectineal, femoral grooves and the adductor canal, and the hidden nerve and the branch of the femoral artery - the descending knee - leave the canal through the anterior opening.

№ 47 Femoral canal, its walls and rings (deep and subcutaneous). Practical value. Subcutaneous fissure ("oval" fossa).

femoral canal,canalisfemoralis, is formed in the region of the femoral triangle during the development of a femoral hernia. This is a short section medially from the femoral vein, it extends from the femoral (internal) ring of this canal to the subcutaneous fissure, which, in the presence of a hernia, becomes the external opening of the canal.

Inner femoral ring (subcutaneous),anulus femoralis, located in the medial part of the vascular lacuna. It is bounded anteriorly by the inguinal ligament, posteriorly by the pectinate ligament, medially by the lacunar ligament, and laterally by the femoral vein. From the side of the abdominal cavity, the femoral ring is closed by a section of the loosened transverse fascia of the abdomen - the femoral septum, septumfemorale.

At the femoral canal, they secrete three walls : anterior, lateral and posterior. The anterior wall of the canal is the inguinal ligament and the superior horn of the falciform margin of the fascia lata fused with it. The lateral wall is formed by the femoral vein, and the posterior wall is formed by a deep plate of the broad fascia covering the comb muscle.

deep ring the femoral canal is located in the medial part of the vascular lacuna under the inguinal ligament and is limited by:

· above- inguinal ligament at the place of its attachment to the pubic tubercle and symphysis;

· from below- the pubic crest and the pectinate ligament covering it;

· medially- lacunar ligament filling the inner corner of the vascular lacuna;

· laterally- the wall of the femoral vein.

The diameter of the ring does not exceed 1 cm, it is filled with a connective tissue membrane; belonging to the broad fascia of the thigh. The ring often contains a deep lymph node. From the side of the abdominal cavity, the parietal peritoneum is adjacent to the deep ring, forming a small depression - femoral fossa.

subcutaneous fissure (surface ring)well palpable as oval fossa, which is found in the anterior region of the thigh (femoral triangle) 5-7 cm below the inguinal ligament. A superficial lymph node is palpated next to it.

In practice, a well-palpable inguinal ligament acts as an important clinical and anatomical landmark that makes it possible to distinguish a femoral hernia from an inguinal hernia, since the femoral hernial sac lies under the inguinal ligament on the thigh, and the inguinal hernia sac lies above the ligament on the anterior abdominal wall.

Around the deep femoral ring, 30% of people have a vascular anomaly, when the obturator artery, starting from the lower epigastric, is adjacent to the ring from above. In another variant, a vascular anastomosis occurs around the ring between the obturator and inferior epigastric arteries. Both variants have been known in practice since the Middle Ages as " crown of death ”, capable of causing severe bleeding and death of the patient with inept operation.

№ 48 Medial and posterior muscles and fascia of the thigh: their topography.

semimembranosus muscle, m. semimembranalis. Beginning: ischial tuberosity. Insertion: medial condyle of the tibia. Function: unbends, brings the thigh and rotates it inside.

Thinmuscle, m. gracilis. Beginning: the lower branch of the pubic bone, near the symphysis. Attachment: a fascia of a shin, near a tuberosity of a tibia. Function: adducts the thigh, flexes the lower leg.

comb muscle, m. pectineus. Beginning: superior branches of the crest of the pubic bone, lig. pubicum superior. Insertion: liniapectiniae of the femur (comb line). Function: lead the thigh, bend it.

adductor longus muscle, m. adductor longus. Beginning: near the pubic symphysis. Attachment: medial lip, liniaaspera. Function: adducts and flexes the thigh.

short adductor muscle, m. adductor brevis. Beginning: the lower branch of the pubic bone. Insertion: medial line of the rough line. Function: leads, bends and rotates the thigh outward.

Adductor major muscle, m. adductor magnus. Beginning: branches of the pubic and ischial bones. Attachment: medial lip, liniaaspera. Function: adducts and flexes the thigh.

Wide fascia of the thigh,fascialata, has a tendon structure. In the form of a dense case, it covers the thigh muscles from all sides. Attaches proximally to the iliac crest, inguinal ligament, pubic symphysis, and ischium. On the back surface of the lower limb, it connects to the gluteal fascia.

The superficial plate of the fascia lata immediately below the inguinal ligament has an oval thinned area, called the subcutaneous fissure, hiatussaphenus through which the great saphenous vein passes and flows into the femoral vein. From the wide fascia deep into, to the femur, depart dense plates that delimit the muscle groups of the thigh - the lateral and medial intermuscular septa of the thigh. They are involved in the formation of osteo-fascial receptacles for these muscle groups.

Lateral intermuscular septum of the thigh, septum intermuscular femoris laterale, separating the quadriceps femoris muscle from the posterior thigh muscle group. Medial intermuscular septum of the thigh septum intermuscular femoris mediale, separates the quadriceps femoris muscle from the adductor muscles.

The fascia lata forms fascial sheaths for the tensor fascia lata, sartorius muscle, and gracilis muscle.

№ 49 Muscles and fascia of the lower leg and foot. Their topography and functions.

Shin.

Anterior tibial, m. tibialis anterior. Origin: lateral surface of the tibiae, interosseous membrane. Attachment: medial sphenoid and 1st metatarsal bones. Function: unbends the foot, raises its medial edge.

Long finger extensor, m. extensor digitirum longus. Origin: lateral condyle of the femur, fibula, interosseous membrane. Attachment: foot. Function: unbends fingers and foot, raises the lateral edge of the foot.

extensor hallucis longus, m. extensor hallucis longus. Beginning: interosseous membrane, fibula. Attachment: nail phalanx of the 1st finger. Function: breaks the foot and thumb.

Triceps muscle of the leg, m. triceps surae: Calf muscle, m. gastrocnemius: lateral head (1), medial head (2), soleus muscle, (3) m. soleus. Beginning: above the lateral condyle of the femur (1), above the medial condyle of the femur (2), head and upper third of the posterior surface of the fibula (3). Attachment: tendocalcaneus (calcaneal, Achilles tendon), calcaneal tuberosity. Function: flexes the lower leg and foot and supinates it - 1.2, flexes and supinates the foot - 3.

plantar, m. plantaris. Beginning: above the lateral condyle of the femur. Insertion: calcaneal tendon. Function: stretches the capsule of the knee joint, flexes the lower leg and foot.

Hamstring, m. popliteus. Beginning: outer surface of the lateral condyle of the thigh. Attachment: a back surface of a tibia. Function: flexes the lower leg, turning it outward, stretches the capsule of the knee joint.

Long finger flexor, m. flexor digitorum longus. Beginning: tibia. Attachment: distal phalanges of 2-5 fingers. Function: flexes and supinates the foot, flexes the fingers.

Long flexor of the big toe, m. flexor hallucis longus. Beginning: fibula. Insertion: distal phalanx of the thumb. Function: flexes and supinates the foot, flexes the thumb.

Tibialis posterior, m. tibialis posterior. Beginning: tibia, fibia, interosseous membrane. Attachment: foot. Function: flexes and supinates the foot.

Peroneus longus muscle, m. fibularis longus. Beginning: fibula. Attachment: foot. Function: flexes and pronates the foot.

Peroneus brevis, m. fibularis brevis. Beginning: distal 2/3 fibulae. Attachment: tuberosity of the 5th metacarpal bone. Function: flexes and pronates the foot.

Fascia of the lower leg, fasciacruris, fuses with the periosteum of the anterior margin and the medial surface of the tibia, covers the outside of the anterior, lateral and posterior muscle groups of the leg in the form of a dense case, from which the intermuscular septa extend.

Foot.

Short wrist extensor m. extensordigitorumbrevis. Beginning: front sections of the upper lateral surface of the calcaneus. Insertion: bases of middle and distal phalanges. Function: unbends the toes.

extensor hallucis brevis, m. extensor hallucis brevis. Beginning: an upper surface of a calcaneus. Insertion: dorsal surface of the base of the proximal phalanx of the big toe. Function: unbends the big toe.

Muscle that abducts the big toe, m. abductor hallucis. Origin: calcaneal tuberosity, inferior flexor retinaculum, plantar aponeurosis. Insertion: medial side of the base of the proximal phalanx of the big toe. Function: removes the big toe from the median line of the sole.

flexor hallucis brevis, m. flexor hallucis brevis. Beginning: medial side of the plantar surface of the cuboid bone, cuneiform bones, ligaments on the sole of the foot. Insertion: sesamoid bone, proximal phalanx of the thumb. Function: flexes the big toe.

Muscle that adducts the big toe, m. adductor hallucis. Beginning: oblique head - cuboid bone, lateral sphenoid bone, bases of II, III, IV metatarsal bones, tendons of the long peroneal muscle. The transverse head is the capsule of the metatarsophalangeal joints of the III-V fingers. Insertion: base of the proximal phalanx of the big toe, lateral sesamoid bone. Function: leads the thumb to the median line of the foot, flexes the big toe.

Muscle that abducts the little toe of the foot, m. abductor digitiminimi. Beginning: plantar surface of the calcaneal tuberosity, tuberosity of the V lusial bone, plantar aponeurosis. Insertion: lateral side of the proximal phalanx of the little finger. Function: flexes the proximal phalanx.

Short little finger flexor, m. flexordigitiminimibrevis. Beginning: the medial side of the plantar surface of the fifth metatarsal bone, the tendon sheath of the long peroneal muscle, the long plantar ligament. Attachment: proximal phalanx of the little finger. Function: bends the little finger.

Muscle that opposes the little finger, m. opponens digitiminimi. Origin: long plantar ligament. Attachment: V metatarsal bone. Function: strengthens the lateral longitudinal arch of the foot.

Short finger flexor, m. flexordigitorumbrevis. Beginning: anterior part of the calcaneal tubercle, plantar aponeurosis. Function: bends II-V fingers.

vermiform muscles, mm. lumbricales. Beginning: surfaces of tendons of a long flexor of fingers. Function: flexes the proximal and unbends the middle and distal phalanges of the II-V fingers.

plantar interosseous muscles, m. interosseiplantares. Beginning: base and medial surface of the bodies of the III-V metatarsal bones. Insertion: medial surface of the proximal phalanges III-V of the toes. Function: bring III-V fingers to the hoof, bend the proximal phalanges of these fingers.

Dorsal interosseous muscles, mm. interosseidorsales. Beginning: surfaces of metatarsal bones. Insertion: bases of the proximal phalanges, tendons of the long extensor of the fingers. Function: abducts the toes, flexes the proximal phalanges.