In the waist area lower limb Distinguish suprapiriform opening (foramen suprapiriforme); pear-shaped hole (foramen infrapiriforme); obturator canal (canalis obturatorius); muscle gap (lacuna musculorum); vascular lacuna (lacuna vasorum).

Suprapiriform foramen (foramen suprapiriforme)and piriform hole ( foramen infrapiriforme) located above and below piriformis muscle(m. piriformis) in a large sciatic foramen. Arteries, veins and nerves pass through the suprapiriform and subpiriform openings.

obturator canal located in the upper part of the obturator foramen between the obturator groove of the superior branch of the pubic bone and the upper edge of the obturator internus muscle and the obturator membrane. In the obturator canal are the vessels and nerves of the same name. The obturator canal connects the pelvic cavity with the medial region of the thigh.

Muscular lacuna (lacuna musculorum) and vascular lacuna (lacuna vasorum) are formed as a result of the division of the space under the inguinal ligament by a section of the iliac fascia, which is called . This arch is fused from above with the inguinal ligament, from below - with the periosteum of the pubic bone. Outside of the arcus iliopectineus is a muscular lacuna (lacuna musculorum), it contains the iliopsoas muscle (musculus iliopsoas) and the femoral nerve (nervus femoralis). Inward from arcus iliopectineus is a vascular lacuna (lacuna vasorum), limited on the medial side lacunar ligament (ligamentum lacunare, Zhimbernatova), on the lateral side - iliopectineal arch (arcus iliopectineus), above - inguinal ligament, below - comb ligament (lig. pectineale). The lacuna contains the femoral artery (arteria femoralis) (laterally) and the femoral vein (vena femoralis) (medially).

Through muscular and vascular lacunae, the cavity of the large pelvis communicates with the anterior region of the thigh.

In the thigh area, the femoral triangle (trigonum femorale) is distinguished; subcutaneous fissure (hiatus saphenus); femoral canal (canalis femoralis) (in the event of femoral hernia); iliopectineal groove (sulcus iliopectineus), anterior femoral groove (sulcus femoralis anterior); adductor canal (canalis adductorius).

Femoral triangle (trigonum femorale) stands out on the anterior surface of the thigh. Its borders: inguinal ligament (ligamentum inguinale) (top), tailor muscle (musculus sartorius) (lateral) and the edge of the long adductor muscle (musculus adductor longus) (medially).

Hypodermic fissure (hiatus saphenus) is located below the medial part of the inguinal ligament and is represented by a small depression covered by a section of the superficial leaflet of the broad fascia of the thigh; this section of the fascia is called cribriform fascia (fascia cribrosa). The subcutaneous fissure is limited sickle-shaped edge (margo falciformis), which has upper horn (cornu superius) and lower horn (cornu inferius). In front of the lower horn is a large saphenous vein (vena saphena magna) at its confluence with the femoral vein. As a rule, a lymph node is located in the subcutaneous fissure.

Femoral canal (canalis femoralis)(normally absent, but formed when a femoral hernia occurs) is located in the medial part of the vascular lacuna (lacuna vasorum). It has 3 walls: 1 - anterior wall formed by the inguinal ligament (ligamentum inguinale) and the upper horn of the sickle-shaped edge (cornu superius margo falciformis) fused with it; 2- back wall represented by a deep leaf of the wide fascia of the thigh; 3- lateral wall formed by the femoral vein. From the side of the abdominal cavity, the femoral canal has internal femoral ring (anulus femoralis)(channel inlet); its borders: from the medial side - lacunar ligament), from the lateral side - the femoral vein, from above - the inguinal ligament, from below - the comb ligament (lig. pectineale); outer (exit) hole the femoral canal is limited by a sickle-shaped edge (margo falciformis).

Iliopectineal groove (sulcus iliopectineus) located in upper section femoral triangle and is represented by a depression between the comb muscle (medially) and the iliopsoas muscle (laterally). At the bottom of this groove (fossa) are the femoral artery, vein and saphenous nerve.

Anterior femoral sulcus is the distal continuation of the iliopectineal sulcus. Its walls are formed by the long adductor and large adductor muscles (m. adductor longus et m. adductor magnus) (medially) and the wide medial muscle of the thigh (m. vastus medialis) (laterally). In front, the femoral groove is covered with a tailor's muscle (m. sartorius).

Adductor canal (canalis adductorius, Gunterov)- continuation of the femoral groove from top to bottom. It has three walls: 1 - lateral wall formed by the medial broad muscle of the thigh (m. vastus medialis); 2- medial wall, represented by a large adductor muscle (m. adductor magnus); 3- front wall, which is a section of the wide fascia of the thigh, passing from the medial wide muscle of the thigh to the large adductor muscle and is called lamina vastoadductoria. The leading channel has 3 holes: 1 - top hole limited by the same formations as the walls of the adducting channel; 2- bottom hole presented tendon gap (hiatus tendineus) in the tendon of the large adductor muscle; 3- front opening - a small gap in the anterior wall of the adductor canal through which the descending artery of the knee and the saphenous nerve exit. The femoral artery, vein and saphenous nerve (partially) pass through the canal.

III. Leg muscles

posterior muscle group

There is a space between the inguinal ligament and the pelvic bones, which, with the help of the iliac crest ligament, is divided into two lacunae: muscular (lacuna musculorum) and vascular (lacuna vasorum). The muscular lacuna is located outwards. Through it, the iliopsoas muscle and the femoral nerve pass to the thigh. The common sheath for the muscle and nerve is formed by the iliac fascia, which is firmly fused with both the inguinal ligament and the periosteum of the pelvic bones, forming a powerful delimiting barrier between the abdominal cavity and the thigh area. As a result, hernias through the muscle gap come out very rarely. The vascular lacuna is located medially and is bounded anteriorly by the inguinal ligament, posteriorly by the Cooper (pubic), medially by the lacunar and laterally by the iliocectal ligaments. The femoral artery, femoral vein, nerves (n. genitofemoralis, n. ilioinguinalis) and lymphatic vessels. The neurovascular bundle is enclosed in a thin fascial sheath, which originates from the transverse fascia.

The vascular lacuna is the main site for the formation of femoral hernias. Its “weakest” department is the femoral ring, located in the medial part of the lacuna and limited medially by the lacunar (gimbernate) ligament, in front by the inguinal (pupart) ligament, posteriorly by the iliac-pubic (Cooper) ligament, laterally by the sheath of the femoral vein. The femoral ring is filled with fatty tissue. There is also a large lymph node of Rosenmuller - Pirogov. The diameter of the femoral ring in women reaches 1.8 cm, in men - 1.2 cm.

Muscular and vascular lacunae under normal conditions do not have free spaces and crevices that are formed under certain pathological conditions. It is here that the femoral canal occurs during the formation of a hernia. The inner opening of the femoral canal is the femoral ring, the outer one is the oval fossa: an opening in the wide fascia of the thigh through which the great saphenous vein passes. The oval fossa is delimited by the crescent-shaped fold legs and looks like a semi-oval elongated in the transverse direction. In front, the oval fossa is closed by a cribriform plate (lamina cribrosa fascia latae), which collapses during the passage of a hernia.

The femoral canal has a triangular shape. Its walls are: in front - the posterior inferior surface of the inguinal ligament and the posterior surface of the superficial leaf of the wide fascia of the thigh, behind - the deep leaf of the wide fascia, outside - the medial wall of the femoral vein and its fascial sheath. The femoral canal has an almost vertical direction, its length is 2–3 cm.

femoral canal

Biology and genetics

The deep ring of the femoral canal is located in the medial part of the vascular lacuna under the inguinal ligament and is limited: from above by the inguinal ligament at the place of its attachment to the pubic tubercle and symphysis; from below by the pubic crest and the pectinate ligament covering it; medially lacunar ligament filling the inner corner of the vascular lacunae; laterally by the wall of the femoral vein. 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 ...

femoral canal

The femoral canal refers to the femoral triangle, which is located in the anterior region of the thigh and is formed medially by the long adductor muscle, laterally by the sartorius muscle, and above by the inguinal ligament. The wide fascia within the triangle forms two sheets: superficial and deep.

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

1. from above - the inguinal ligament at the place of its attachment to the pubic tubercle and symphysis;
2. from below - by the pubic crest and the pectinate ligament covering it;
3. medially - lacunar ligament filling the inner corner of the vascular lacuna;
4. laterally - by 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 to deep ring belongs parietal peritoneum, forming a small depression - the femoral fossa.

The superficial ring (subcutaneous fissure) lies in the femoral triangle below the inguinal ligament by 5-6 cm. It is called subcutaneous and corresponds to a hidden fissure (oval fossa) located in the superficial layer of the fascia lata, which forms a thickened crescent-shaped edge with upper and lower borders around the subcutaneous fissure. horns. The arched edge is convexly turned to the lateral side, and its horns are directed medially. The gap itself is filled with ethmoid fascia, passing through its openings the branches of the femoral artery - the superficial genital, superficial epigastric, superficial surrounding iliac bone, large hidden (saphenous) vein, bringing medial lymphatic vessels, anterior cutaneous branches femoral nerve and hidden nerve. Because of what the fascia becomes perforated.

The subcutaneous fissure (surface ring) is well palpable in the form of an 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 a healthy person, only rings are present in the femoral canal: superficial and deep. The channel appears in the patient when a femoral hernia develops.

Its walls are:

1. anterior - superficial leaf of the fascia lata;
2. back - a deep leaf of a wide fascia;
3. lateral - fascial sheath of the femoral vein.

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 one 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 options have been known in practice since the Middle Ages as the “crown of death”, capable of causing severe bleeding and death of the patient with inept operation.

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

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Iliac fascia (fascia iliaca) covers the iliopsoas muscle (is part of the subperitoneal fascia). Below the inguinal ligament, the iliac fascia passes into the wide fascia of the thigh.

Wide fascia of the thigh (fascia lata). Covers the muscles of the thigh.

Below the inguinal ligament, within the femoral triangle, fascia lata split into two layers.

- deep layer passes behind the femoral vessels.

- Surface layer passes in front of the vessels of the thigh and on the side of the femoral vein ends in a free crescent edge.

- crescent edge (margo falciformis) top and bottom limits the recess - subcutaneous fissure (hiatus saphenus), ( or oval hole -Fossa ovalis)

The subcutaneous tissue is covered cribriform fascia (fascia cribrosa).

In the sickle-shaped edge, there are:

lower horn(cornu inferius) is part of the surface leaf fascia lata;

upper horn(cornu superius), is attached to the inguinal ligament and, bending under it, fuses with lacunar ligament.

- Fascia lata, gives deep intermuscular processes attached to the bone:

- lateral intermuscular septum of the thigh (septum intermusculare femoris laterale) separates the vastus lateralis muscle of the thigh ( m. vastus lateralis) from the posterior thigh muscles.

- medial intermuscular septum of the thigh (septum intermusculare femoris mediale) separates the vastus medialis muscle of the thigh ( m. vastus medialis) from medially adductor muscles.

- Fascia lata on the lateral surface of the thigh forms a thickened strip - iliotibial tract (tractus iliotibialis),

Serves as a tendon for the tensor fascia lata of the thigh and gluteus maximus muscle,

It runs along the entire length of the thigh and distally passes to the anterior surface of the knee and into the fascia of the lower leg, from behind it continues into the popliteal fascia covering the popliteal fossa.

Fascia of the lower leg(fascia cruris)

This fascia covers the outside of the anterior, lateral and posterior muscle groups in the form of a dense case.

On the back side of the leg, it consists of superficial and deep leaves.

Surface sheet covers mm. gastrocnemius and soleus, and the deep leaf is located between these and deep muscles

On the lateral side, the fascia of the lower leg gives two muscular septa that attach to the fibula.

- anterior intermuscular septum of the leg(septum intermusculare cruris anterius) goes in front of the peroneal muscles;

- posterior intermuscular septum of the leg(septum intermusculare cruris posterius) goes behind the peroneal muscles.

On the anterior surface of the lower leg above the ankles, fibrous fibers are woven into the fascia, forming, superior extensor tendon retinaculum(retinaculum musculorum extensorum superius). This ligament presses the tendons of the anterior muscles of the lower leg to the bones.

- Distal and anterior to the ankle joint inferior extensor tendon retinaculum(retinaculum musculorum extensorum inferius). This holder has two Y-shaped legs.

In places, the retainer is divided into superficial and deep plates, forming four fibrous canal:

The lateral canal passes the tendon m m. extensor digitorum longus and peroneus tertius.

The second channel passes tendon m. extensor hallucis longus.

The third, most medial, contains tendon m. tibialis anterior.

The fourth channel, lying behind the middle one, contains the vessels and the nerve.

Tendons, passing through the canals, are surrounded by synovial sheaths.

Behind the ankles are thickenings of the fascia that press the tendons to the bones.

Thickening on the medial side forms flexor tendon retinaculum(retinaculum musculorum flexorum), spreading to the medial malleolus from the calcaneus. It gives off septa and forms three bone-fibrous canals and one fibrous (superficial) canal.

The anterior canal contains tendon m. tibialis posterior.

The middle channel contains tendon m. flexor digitorum longus.

The posterior canal contains tendon m. flexor hallucis longus.

The superficial canal contains arteries and a nerve.

The tendons in the canals under the ligament are enclosed in three separate sheaths.

Thickening on the lateral side behind the lateral malleolus upper, lower peroneal tendon retinaculum(retinaculum musculorum fibularium superius, inferius).

The upper retainer extends from the ankle to the calcaneus over the tendons of mm. fibularis longus and brevis, which lie under it in one bone-fibrous canal.

Distally and inferiorly, the tendons pass under the lower retainer, which is attached to the lateral surface of the calcaneus. The space under it is divided by a partition into two channels, passing each tendon separately.

The tendons of the peroneal muscles are enclosed in one common synovial sheath, which is divided into two parts below according to two channels.

Dorsal fascia of the foot (fascia dorsalis pedis)

This fascia is located distal to the retinaculum m. extensor inferior and has two layers.

The superficial layer covers the tendons of the extensor muscles.

The deep layer covers the interosseous muscles.

plantar aponeurosis(aponeurosis plantaris)

It passes It passes from the calcaneal tuber to the base of the toes, expanding and dividing into five bundles, between which the transverse fibers pass.

Along the edges of the aponeurosis, two vertical partitions extend into the depth between the muscles and pass upward between the muscles. These partitions divide the sole into three receptacles corresponding to three muscle groups.

The thigh (regio femoris) is a section of the lower limb, in front and above delimited from the lower abdomen by a line connecting the anterior superior iliac spine (spina iliaca ant. Sup.) with the tubercle of the pubic bone (tuberculum pubicum); behind and above - from the gluteal region with the gluteal fold; below - from the area knee joint a circular line drawn two transverse fingers above the patella.

Anatomy. The skeleton of the thigh is the femur (femur) (Fig. 1). Its diaphysis is somewhat twisted along the axis and bent anteriorly.

Rice. 1. Femur and places of origin and attachment of muscles in front (a) and behind (b): 1 - m. vastus medialis; 2 - m. iliopsoas; 3 - m. articularis genus; 4 - m. adductor magnus; b - capsula articularis genus; in - m. gastrocnemius (caput lat.); 7 - m. vastus intermedius; 8 - m. vastus lat.; 9 - m. gluteus minimus; 10-m. gluteus medius; 11 - m. piriformis; 12 - capsula articularis coxae; 13 - m. obturator ext.; 14 - m. quadratus femoris; 15 - m. gluteus maximus; 16 - m. biceps femoris; 17 - m. plantaris; 18 - m. gastrocnemius (caput mediale); 19 - m. adductor longus; 20-m. adductor brevis; 21 - m. pectineus; 22-lig. capitis femoris.

The length of the thigh is determined by the distance between the greater trochanter (trochanter major) and the outer edge of the joint space of the knee joint. The thigh is divided into anterior and posterior regions (regiones femoris ant. et post.), bounded by two vertical lines drawn from the epicondyles of the thigh (epicondylus med. et lat.) along the muscle stretching the wide fascia of the thigh, and the tender muscle (m. tensor fasciae latae, m. gracilis) to the greater trochanter and symphysis. On the front surface of the thigh, two triangles are distinguished - internal and external; the first is turned with the base up, the second down. Within the inner triangle is the femoral triangle (trigonum femorale), bounded from above by the inguinal ligament (lig. inguinale), from the outside by the inner edge of the sartorius muscle (m. sartorius), from the inside by the outer edge of the long adductor muscle (m. adductor longus). On the front inner surface the hips distinguish a groove located between the quadriceps femoris muscle (m. quadriceps femoris) and the adductor muscles. This groove, well expressed in thin people, is a projection of the femoral vessels (N. I. Pirogov).

The skin of the thigh is mobile, especially on the inner surface. The subcutaneous tissue of the thigh is divided by two sheets of superficial fascia, between which the following nerves lie in front: the femoral branch of the pudendal nerve (r. femoralis n. genitofemoralis), the lateral cutaneous nerve of the thigh (n. cutaneus femoris lat.), the anterior cutaneous branches of the femoral nerve ( rr. cutanei ant. n. femoralis). Branches of the femoral artery also pass there (printing table, Fig. 3): superficial epigastric artery (a. epigastrica superficialis), superficial circumflex ilium (a. circumflexa ilium superficialis), external shameful (a. pudenda externa). Above the superficial sheet of the fascia lata (printing table, Fig. 1) are superficial inguinal lymph nodes (lymphonodi inguinales superficiales), and below it are deep inguinal lymph nodes (lymphonodi inguinales profundi).

Rice. one. lymphatic system in the area of ​​the femoral triangle: 1 - noduli lymphatici inguinales superficiales; 2 - foramen ovale; 3-v. saphena magna; 4 - nodulus lymphaticus subinguinalis superficialis. Rice. 2. Muscular and vascular gaps: 1 - lig. inguinale; 2 - arcus iliopectineus; 3 - m. iliopsoas; 4 - n. femoralis; 5-a. femoralis; 6-v. lemoralis; 7 - anulus femoralis; 8 - m. pectinneus. Rice. 3. Subcutaneous vessels and nerves of the anterior surface of the thigh: 1 - vasa circumflexa ilium superficialia; 2 - vasa epigastrica superficial; 3 - n. cutaneus femoris lat.; 4-r. femoralis n. genitofemoralis; 5 - hiatus saphenus et margo falclformls; 6-a. femoralis; 7-v. femoralis; 8 - vasa pudenda ext.; 9-v. saphena magna; 10-rr. cutanei ant. n. femoralis. Rice. 4. Deep layers of the femoral triangle: 1 - fascia lata; 2 - m. sartorius; 3 - n. femoralis; 4-a. femoralis; 5-v. femoralis; 6 - fatty tissue; 7 - m. pectineus; 8-a. circumflexa femoris med.; 9 - ram. adductores; 10-n. obturatorius.

Rice. 5. Front surface of the thigh (after removal of the fascia): 1 - a. et v. femoralis; 2 - m. pectineus; 3 - m. adductor longus; 4 - m. gracilis; 5 - m. adductor magnus; 6 - lamina vastoadductoria; 7-a. Genu descendens; 8-n. saphenus; 9 - m. vastus medialis; 10 - m. sartorius; 11 - m. vastus lat.; 12 - tractus iliotibialis; 13 - m. rectus femoris; 14 - m. tensor fasciae latae; 15 - n. femoralis. Rice. 6. Back surface of the thigh (after removal of the fascia): 1 - n. ischiadicus; 2 - fascia lata; 3 - caput longum m. bicipitls femoris; 4 - n. peroneus communis; 5 - n. tibialis; 6 - m. semitendinosus; 7 - m. semimembranosus. Rice. 7. Cross cut in the middle third of the right thigh: 1 - m. rectus femoris; 2-rr. cutanei ant. n. femoralis; 3 - m. vastus medialis; 4 - n. saphenus; 5-a. et v. femoralis; 6 - m. sartorius; 7-v. saphena magna; 8 - m. adductor longus; 9 - m. adductor magnus; 10 - m. gracilis; 11 - m. semimembranosus; 12 - m. semltendinosus; 13 - caput longum m. bicipitis femoris; 14 - n. ischiadicus; a. et v. comitans n. ischiadic!; 15 - caput breve m. bicipitis femoris; 16 - m. vastus lat.; 17 - vasa profunda femoris; 18 - femur; 19 - m. vastus Intermedius. Rice. 8. Cross section of the right thigh at the level of the lower third: 1 - m. tendo recti femoris; 2 - femur; 3 - m. vastus medialis; 4-a. et v. femoralis; 5 - n. saphenus et a. genu suprema with accompanying veins; 6 - m. adductor longus; 7 - m. sartorius; 8-v. saphena magna; 9 - m. gracilis; 10 - m. semimembranosus; 11 - m. semitendinosus; 12 - caput longum m. bicipitis; 13 - nn. tibialis et peroneus communis with accompanying vessels; 14 - caput breve m. bicipitis femoris; 15 - m. vastus lat.

There are three groups of thigh muscles: anterior - extensors - quadriceps femoris; back - flexors - biceps femoris, semimembranosus and semitendinosus (mm. biceps femoris, semitendinosus et semimembranosus); internal - adductor muscles: comb, tender, adductor long, short, large and small (mm. pectineus, gracilis, adductores longus, brevis, minimus et magnus) (printing table, Fig. 5-8). Each of these muscle groups is in a separate fascial sheath. In the anterior fascial bed, in addition to the quadriceps muscle, there is the femoral nerve (n. femoralis), most of the anterior part of the femoral diaphysis, at the top - a separate fascial space for the iliopsoas muscle (m. iliopsoas). In the posterior fascial bed, in addition to the flexors, lie sciatic nerve and arteries feeding it (n. ischiadicus et a. comitans n. ischiadici). In the internal fascial bed adductor muscles, obturator artery, vein and nerve (a., v. et n. obturatorii) are located. Between the anterior and internal fascial beds are the femoral vessels (a. et v. femorales) and the nerve (n. saphenus). In addition to the three fascial spaces described, the fascia lata (fascia lata) forms separate cases for the tailor, tender muscles and the muscle that stretches the fascia lata (m. tensor fasciae latae).

Purulent streaks in complicated thigh wounds spread through the tissue surrounding the vessels, nerves, and through the fascial spaces. In the anterior fascial bed between the rectus femoris muscle (m. rectus femoris) and the middle broad muscle of the thigh (m. vastus intermedius), as well as between the last muscle and femur cellulose lies, in which deep streaks can be located. In progress surgical treatment the wounds of the anterior fascial bed are dissected by a longitudinal intermittent incision along the anterior surface; back - on the back surface; internal - along the anterior-internal and posterior-internal surface of the thigh (Fig. 2).

Rice. 2. Incisions for opening fascial spaces: a - in front: 1 - extensors; 2 - tailor's muscle; 3 - iliopsoas muscle; 4 - adductor muscles; b - behind: 1 - adductor muscles; 2 - flexors; 3 - extensors.

The broad fascia, having formed a case for the tailor's muscle, is divided into two sheets: superficial and deep, expressed better in the upper third of the anterior surface of the thigh. The superficial sheet of this fascia covers the femoral vessels, attaches at the top to the inguinal ligament, and medially passes to the comb muscle and merges with the deep sheet of the wide fascia of the thigh. Great saphenous vein (v. saphena magna) and lymphatic vessels pierce the loosened superficial sheet (fascia cribrosa) and enter an oval-shaped hole (hiatus saphenus), or oval fossalimited from above in front by a sickle-shaped edge (margo falciformis). Sometimes there is an additional saphenous vein (v. saphena accessoria), flowing into the great saphenous vein. The space located between the inguinal ligament, pubic and iliac bones is divided by an arcuate thickening of the iliac fascia (arcus iliopectineus) into two sections: the inner one is the vascular lacuna (lacuna vasorum) and the outer one is the muscular lacuna (lacuna musculorum, color table, Fig. 2) . The muscular lacuna contains the iliopsoas muscle (m. iliopsoas), the femoral nerve and the external cutaneous nerve of the thigh (n. cutaneus femoris lat.). This lacuna communicates with the anterior surface of the thigh under the pectineal fascia, where cold abscesses (with tuberculous spondylitis) can descend from the pelvic cavity along the iliopsoas muscle. The vascular lacuna contains the femoral vessels lying in the fascial sheath, separated by a septum; the artery is located outward, and the vein is inward. The vascular lacuna communicates with the anterior surface of the thigh in the region of the oval fossa above the pectineal fascia, where the hernial sac descends from under the inguinal ligament in case of femoral hernia.

In a healthy person, the inner part of the vascular lacunae is filled with loose fiber, lymph node and corresponds to the inner femoral ring (anulus femoralis). It is closed from the side of the abdominal cavity by a loosened plate of the transverse fascia (septum femorale). The inner femoral ring is bounded in front by the inguinal ligament (lig. inguinale), behind the comb (lig. pectineale), from the inside by the lacunar (lig. lacunare), and outside by the fascial sheath of the femoral vein; the width of the ring in women is greater than in men, due to the large size female pelvis. In this regard, femoral hernias are observed more often in women. The outer femoral ring corresponds to the oval fossa.

Between the scallop and short adductor muscles is the outlet of the obturator canal (canalis obturatorius), which emerges from the pelvic cavity and contains the obturator artery, vein and nerve (a., v. et n.ohturatorii).

In the region of the femoral triangle, under the superficial sheet of the fascia lata, between the iliopsoas and pectineal muscles, in the iliac pectoral fossa (fossa iliopectinea), the femoral artery, vein are located, and outwards from the femoral artery under the deep sheet of the fascia lata is the femoral nerve (printing table). , Fig. 4). The latter, upon exiting from under the inguinal ligament, is divided into muscle and skin branches; of these, the longest branch - the saphenous nerve (n. saphenus) follows along the course of the femoral artery. The muscular branches of the femoral nerve innervate the sartorius, quadriceps, and pectineal muscles.

3-4 cm below the inguinal ligament, the largest branch departs from the femoral artery - the deep artery of the thigh (a. profunda femoris), which provides collateral circulation in the peripheral parts of the limb. In this regard, the ligation of the femoral artery above the place of origin of the deep artery of the thigh is more dangerous than below its discharge.

At the apex of the femoral triangle, the vessels from the iliac crest fossa enter the anterior sulcus of the thigh (sulcus femoralis ant.), bounded from the outside by the broad middle muscle of the thigh (m. vastus medialis), from the inside by the long and large adductor muscles, and in front by the tailor muscles. In this case, the femoral vein begins to deviate outwards and backwards from the artery, and below it is located behind it. The femoral vessels enter the canal (canalis adductorius) of a trihedral shape, the length of which in an adult is 5-7 cm. muscle. The femoral vessels, having passed through the lower opening of the canal (hiatus tendineus), enter the popliteal fossa. Through the anterior opening of the canal, located in the lamina vastoadductoria, pass the saphenous nerve and a branch of the femoral artery - the descending artery of the knee (a. genu descendens).

The femoral artery is conditionally divided into three segments: the upper one - from the inguinal ligament to the place where the deep artery of the thigh originates; middle - from the place of origin of the deep femoral artery to the entry of the femoral artery into the canal; lower - throughout the canalis adductorius. The projection of the femoral artery is determined along the line of Quane, running from the middle of the distances between the anterior superior iliac spine and the symphysis to the internal epicondyle of the thigh. The projection line corresponds to the course of the femoral artery only in the position of outward rotation of the thigh and flexion of the limb in the hip and knee joints.

Within the posterior surface of the thigh, the formed rear group muscle bulge, which outwardly passes into the groove that separates the wide external muscle thigh from the biceps. Through this groove, operational access to the femoral diaphysis is carried out. The skin of the posterior thigh is innervated by the branches of the posterior and external cutaneous nerves of the thigh (nn. cutaneus femoris post, et lat.), pudendal and obturator nerves. Under the broad fascia of the thigh are the flexors of the lower leg. In the groove formed outside the biceps, inside the semitendinosus (m. semitendinosiis) and semimembranosus (m. semimembranosus), and in front of the large adductor muscles, there is the sciatic nerve (n. iscbiadicus), which, coming out from under the long head of the biceps muscle, goes down and is divided in the lower third of the back of the thigh into two branches: the tibial nerve (n. tibialis) and the common peroneal nerve (n. peroneus communis). Sometimes there is a high division of the sciatic nerve; in such cases, its branches come out of the supra- and sub-pear holes (foramina supra- et infrapiriforme) with separate trunks separated from each other by the piriformis muscle (m. piriformis).

The projection of the sciatic nerve is determined along a line running from the middle of the distance between the greater trochanter and the ischial tuberosity to the middle of the distance between the inner and outer epicondyles of the thigh. Branches of the sciatic nerve innervate the flexors and adductor magnus. In the tissue surrounding the sciatic nerve, inflammatory processes can spread upward - into gluteal region and down into the popliteal fossa.

From inflammatory processes v soft tissues thighs are observed: furuncle, carbuncle, abscess, phlegmon (Fig. 3 and 4) and other purulent processes.

Of the soft tissue tumors of the thigh, benign ones are noted - lipoma, fibroma, angiofibroma, hemangioma, neurinoma and malignant ones - rhabdomyosarcoma, fibrosarcoma, etc. Among benign tumors femur - osteoma, chondroma, osteochondroma, etc. Solitary chondroma of the intertrochanteric femur is prone to malignancy. TO malignant tumors of the femur include fibrosarcoma, chondrosarcoma, and osteosarcoma. Metastases of hypernephroma, cancer can be observed in the femur prostate, breast cancer, etc.

Damage. With hip bruises, there may be subcutaneous, subfascial, intermuscular and intramuscular hemorrhages. Treatment is conservative, and in case of infection and abscess formation, surgical treatment. With excessive stress, ruptures of the fascia, muscles and tendons are observed. The most commonly injured muscles are the sartorius, the rectus fascia, and the tensor fascia lata. Sometimes the muscles are torn off along with the tendon and the bone plate; with a significant or complete rupture of the muscle, an operation is indicated - stopping bleeding and suturing the muscle.