大體老師 無語良師 大體解剖學實驗 HUMAN DISSECTION THE LOWER LIMB DISSECTION IV 盧家鋒 助理教授 臺北醫學大學醫學系 解剖學暨細胞生物學科 臺北醫學大學醫學院 轉譯影像研究中心 http://www.ym.edu.tw/~cflu REFERENCES • Dissector‘s guide • [1] Dissection Guide for Gray's Human Anatomy, 2ed, 2006 • [2] Grant’s Dissector, 15ed, 2012 • Photographic Dissector • [3] Gray's Clinical Photographic Dissector of the Human Body, 2013 • Human Atlas • [4] Gray's Atlas of Anatomy, 2ed, 2014 • [5] Grant's Atlas of Anatomy 13ed, 2012 • [6] Color Atlas of Anatomy: A Photographic Study of the Human Body, 7ed, 2011 • [7] Atlas of Human Anatomy, 6ed, 2014 http://www.ym.edu.tw/~cflu 2 VARIATION OF SCIATIC NERVE 89.8% 6.1% 0.7% 0.7% ‐‐ 0.7% Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M, Koebke J. Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome. Surgical and Radiologic Anatomy. 2014 Apr 1;36(3):273‐80. VARIATION OF SCIATIC NERVE • Number of extremities studied, 1510. • A: Usual relationships with the sciatic nerve passing from the pelvis beneath piriformis m.. • B: Piriformis m. divided into two parts with the peroneal division of the sciatic nerve passing between the two parts of piriformis. • C: The peroneal division of the sciatic nerve passes over m. piriformis and the tibial division passes beneath the undivided muscle. • D: In these cases the entire nerve passes through the divided m. piriformis. 4 Beaton, L.E. and B.J. Anson. The relation of the sciatic nerve and its subdivisions to the piriformis muscle. Anat. Rec. 70:1‐5, 1938 LOWER LIMB (4/4) Hip joint • Joints of the lower limb Knee joint 僅在卸下的腿進行關節解剖! Ankle joint http://www.ym.edu.tw/~cflu 5 JOINTS OF THE LOWER LIMB 下肢關節 http://www.ym.edu.tw/~cflu 6 HIP JOINT ‐ OSTEOLOGY • Three bones form the acetabulum: ilium, ischium, and pubis. Anterior view Posterior view Greater trochanter Head of femur Neck of femur Intertrochanteric line Intertrochanteric Crest Lesser trochanter http://www.ym.edu.tw/~cflu 7 http://boneandspine.com/hip‐bone‐anatomy/ HIP JOINT Anterior surface Joint Capsule Pubofemoral ligament Iliofemoral ligament http://www.ym.edu.tw/~cflu 8 HIP JOINT Posterior surface Obturator internus m. Superior gemellus m. Inferior gemellus m. Iliofemoral ligament Joint Capsule Ischiofemoral ligament Iliotibial tract http://www.ym.edu.tw/~cflu 9 Anterior surface HIP JOINT 寬臼窩 寬臼唇 http://www.ym.edu.tw/~cflu 10 Medial view KNEE JOINT Medial View • Cut the sartorius muscle at the level of apex of femoral triangle. Reflect the lower part inferiorly. • Cut the tendons of gracillis and semitendinosus muscles Medial patellar at medial surface of the tibia retinaculum and reflect them superiorly. Joint capsule Tibial collateral ligament http://www.ym.edu.tw/~cflu 11 Lateral view KNEE JOINT Lateral View • Cut the long and short heads of biceps femoris tendons (lower end) and reflect them superiorly. Short head Lateral patellar retinaculum Joint capsule Popliteus m. Fibular collateral ligament http://www.ym.edu.tw/~cflu 12 COLLATERAL LIGAMENT Posterior view Anterior view • Note that the tibial collateral ligament is attached to the medial meniscus through the joint capsule. • Note that the fibular collateral ligament is not attached to the external surface of the joint capsule. • Observe that the popliteus tendon passes between the fibular collateral ligament and the joint capsule. http://www.ym.edu.tw/~cflu 13 KNEE JOINT Posterior View • Remove the popliteal vessels, the tibial nerve, Joint capsule and the common fibular Oblique popliteal nerve. ligament • Free the both heads of Arcuate popliteal ligament the gastrocnemius popliteus m. muscle and plantaris muscle from the joint capsule. http://www.ym.edu.tw/~cflu 14 KNEE JOINT Posterior View Open the posterior wall of the joint capsule to expose the joint cavity. Joint capsule http://www.ym.edu.tw/~cflu 15 Ref. [5] p.418 KNEE JOINT Anterior View • Observe that the quadriceps femoris tendon has patellar retinacula that help to keep the patella centered. • Reflect the patella and patellar ligament inferiorly. • Open the joint capsule and verify that the cruciate ligaments cross each other. Ref. [5] p.417 http://www.ym.edu.tw/~cflu 16 ANKLE JOINT Medial View Medial ligament of ankle http://www.ym.edu.tw/~cflu 17 Superior extensor ANKLE JOINT retinaculum Medial View Flexor retinaculum Medial ligament of ankle Inferior extensor retinaculum Anterior tibiotalar ligament Posterior tibiotalar ligament Tibiocalcaneal ligament Tibionavicular ligament http://www.ym.edu.tw/~cflu 18 ANKLE JOINT Lateral View Lateral ligament of ankle http://www.ym.edu.tw/~cflu 19 Superior extensor ANKLE JOINT retinaculum Lateral View Posterior talofibular ligament Lateral ligament of ankle Anterior talofibular ligament Calcaneofibular ligament Superior Fibular retinaculum Inferior Fibular retinaculum http://www.ym.edu.tw/~cflu 20 THE END [email protected] (TMU EXT. 3273) http://www.ym.edu.tw/~cflu 21.