Topography of the lower limb. suprapiriform opening (foramen suprapiriforme) - a slit-shaped opening between the upper edge of the piriformis muscle and the greater sciatic notch

The sciatic foramen is located in the posterior region of the small pelvis and consists of several elements. In anatomy, it is customary to distinguish a large and a small opening, which are represented by 2 pairs - the inlet and outlet passage. Nervous and vascular systems pass through them, which determines the main function of this element - nutrition and innervation of the lower extremities, as well as individual parts of the small pelvis.

Anatomical features

The small sciatic foramen is located below, in the posterior region of the pelvic wall, formed by the sacrotuberous ligament and the lesser sciatic notch. The pudendal nerve and pudendal arteries with a vein pass through it, at the exit they rush into the cavity of the small pelvis.

The topography of the large sciatic foramen differs from the topography of the small one. It is formed by the sciatic notch and the sacrospinous joint, is located in the lower part of the pelvic wall and is represented by a pair of outlets. The piriformis muscle passes through it, as well as the internal pudendal arteries and veins. Additionally, it is cut through by the nerve of the sacral plexus.

Muscular structures

The parietal pelvic muscles pass through the large and small sciatic foramen:

• pear-shaped - starts from the surface of the sacrum and exits through a large opening, separating the suprapiriform and subpiri-shaped entrances. Through the hole located above the muscle, the vascular and nerve bundle of the upper type passes, and through the lower one - the bundle of the lower type, as well as the pudendal nerves and veins. The posterior cutaneous nerve of the thigh and the sciatic fiber are also located here;
• obturator internus muscle - departs through the inner surface of the canal and rushes through a small opening. It does not mate with accessory arteries.

The innervation in this area is of particular interest, since all the fibers are located in close proximity, very tightly to each other.

Nerve endings

The gluteal region is innervated by the sciatic nerve, which runs parallel to the femoral cutaneous nerve from the lumbar vertebrae. It is the largest and longest sensory fiber in the body. It continuously stretches from the pear-shaped cavity to the feet.

Along the CH are thousands of small vaginal capsules. On the outside, the pudendal neurovascular bundle is located, passing to the small opening of the rectal fossa. Vessels on the outside are separated by fascia.

Fascia is a special film that covers organs and nerves with connective tissue with blood vessels and small sensitive roots.

The genital bundle of nerves and blood vessels passes through the piriform cavity and rushes to the ligamentous apparatus located between the spine and the sacrum. It lies in the small tubule of the tuberous surface of the ischium.

By the number of nerve plexuses located in one area, the sciatic foramen has few analogues in the body. Here, along the suprapiriform canal, a bundle of pudendal nerves passes, leaving the holes in the direction of the perineum. Along the edges of the suprapiriform fissure lie the upper gluteal nerve endings and lymphatic glands.

Circulatory system

The blood supply is represented by the upper gluteal veins and arteries, which cross the suprapiriform part of the hole and are divided into several parts in the buttocks area. They connect with arteries:

• external femoral;
• lateral sacral;
• ilio-lumbar and lumbar;
• lower buttocks.

Many outgoing aortas and small capillaries are concentrated in this zone. This is due to the fact that when large feeding channels are blocked, the main functions of the blood supply are transferred to small bundles of vessels. The pudendal vessels, veins and arteries are connected through a small gap with the pelvic circulatory system.

Possible diseases

If any disorders occur in the ischial openings, most often associated with improper functioning of the nerves and the circulatory system, the patient experiences excessive sensitivity, or numbness, constant burning, severe pain. This results in lameness and muscle atrophy. Most often, the consequences of violations in the area of ​​the ischial fissure are caused by a pinched nerve.

Pathology of the sciatic nerve

Compression of the nerve fiber is accompanied by pain, but pinching is diagnosed only if the myelin sheath is not damaged. There is a pinching just in the lumen of the sciatic foramen, where the piriformis muscle passes. Sometimes the pathology is caused by violations in the structure of the intervertebral discs.

In most cases, the infringement affects one branch of the sensory fiber, so the symptoms are found in one limb.

The most complex clinical pictures are accompanied by sciatica - inflammation of the nerve rod. Its main symptom is unbearable pain that radiates along the entire length of the leg. Sometimes inflammation of the piriformis muscle joins it.

Main causes of violation

Pinching of the sciatic nerve with subsequent limitation of mobility and pain is observed in various diseases. Very often it occurs due to the destruction of the intervertebral discs, protrusion of the fibrous ring: hernia, osteochondrosis, trauma and displacement of the vertebrae.

Pathology can be provoked by emerging neoplasms along the sciatic nerve. Heavy lifting and excessive physical activity negatively affect fiber function.

Various lesions of the pelvic organs, including trauma, tumors, inflammatory and infectious processes, can cause infringement of nerve endings. Viral and bacterial lesions of various systems located along the course of the nerve are another cause of the disorder. Advanced cases include an abscess in the fiber area.

Less often, pain and inflammation are observed when the myelin sheath is destroyed, which is characteristic of multiple sclerosis. Additional causes of the disease include:

• bone tuberculosis;
• hypothermia;
• malaria, rubella;
• thrombosis;
• inflammatory processes in muscle structures.

Pregnancy can provoke an unpleasant condition. Due to the expansion of the uterus and squeezing of the organs, blood vessels, veins, and nerve fibers suffer. A similar effect on the body is observed with a lack of vitamins and minerals, obesity, shingles. Even poisoning with salts of heavy metals and alcohol can provoke pathology.

The sciatic foramen is a structural element of the human body, which has a miniature size, but performs the most important communication functions, providing innervation and blood supply to the pelvic organs and lower extremities. With any violations and inflammations of the nerve fibers or blood vessels in this area, unbearable pain appears and serious diseases can develop.

The piriformis muscle begins on the pelvic surface of the sacrum from the fascia pelvina sacri, passes through the for. ischiadicum majus and attaches to the trochanter major of the femur. Through this muscle, the large sciatic foramen is divided into two holes: supra-piriform and subpiri-shaped. n., a., v. gluteae superiores, through the pear-shaped - n., a., v. gluteae inferiores, n. ischiadicus a. pudenda interna, n. pudendus.

All arteries and nerves of the gluteal region exit the pelvic cavity through the large sciatic foramen, through the supra- and subpiri-shaped foramen.

From the supra-piriform opening (between the lower edge of the gluteus medius and the upper edge of the piriformis), the superior gluteal neurovascular bundle emerges. Superior gluteal artery, a. glutea superior, departs from the posterior trunk of the internal iliac artery in the pelvic cavity.

After leaving the suprapiriform opening, it supplies blood to the piriformis muscle, large, middle and small gluteal muscles. The veins of the same name, forming a plexus, cover the superior gluteal artery, and the superior gluteal nerve, n. gluteus superior, is located downward and outward in relation to the vessels and innervates the muscles listed above. Through the subpiriform opening (between the lower edge of the piriformis muscle and the upper gemellus muscle), the sciatic nerve, the lower gluteal and genital neurovascular bundles enter the subgluteal space.

The n is located most laterally in this hole. ischiadicus, the largest nerve in the human body. The sciatic nerve is the most visible, so it can be considered as an internal landmark for finding the subpiriform foramen and other neurovascular bundles. Medially from the sciatic nerve are the posterior cutaneous nerve of the thigh, n. cutaneus femoris posterior, and the artery accompanying the sciatic nerve, a. comitans n. ischiadici, arising from the inferior gluteal artery. Further, the sciatic nerve goes downward, while in front of it from top to bottom are the upper twin muscle, the tendon of the obturator internus, the lower twin muscle and the square muscle of the thigh. Behind the nerve lies the gluteus maximus muscle. Coming out from under the lower edge of the gluteus maximus muscle, the sciatic nerve is located superficially and is covered only by the wide fascia. Here, at the point of intersection of the gluteal fold and the contour of the lower edge of the t. gluteus maximus, conduction anesthesia of the sciatic nerve can be performed. To find the point of insertion of the needle, you can also use the projection of the nerve on the skin, presented above.

Inferior gluteal artery, a. glutea inferior, 2-3 times thinner than the superior gluteal artery. The artery is surrounded by veins of the same name and branches of the lower gluteal nerve, n. gluteus inferior.

In the subpiriform opening, this bundle lies medially from the sciatic nerve and the posterior cutaneous nerve of the thigh. Upon exiting the subpiriform opening, the artery and nerve split into branches that penetrate into the thickness of the gluteus maximus muscle and into the piriformis muscle, where the inferior and superior gluteal arteries anastomose.

Genital neurovascular bundle Genital neurovascular bundle (a. et v. pudendae internae and n. pudendus) is located in the subpiriform opening most medially. Upon exiting the subpiriform opening, the genital neurovascular bundle lies on the sacrospinous ligament, lig. sacrospinal, and the spine of the ischium, forming the upper edge of the small sciatic foramen (see Fig. 4.11). Then the bundle passes through the small sciatic foramen under the sacro-tuberous ligament, lig. sacrotuberale, on the inner surface of the ischial tuberosity. The latter is part of the lateral wall of the ischio-anal fossa and is covered by the obturator internus muscle and its fascia. The splitting of this fascia forms the so-called Olcock canal, in which the genital neurovascular bundle passes. N. pudendus in it is located downward and medially from the vessels.

The sacral plexus, plexus sacralis, is formed by the anterior branches of the V lumbar (Lv), the upper four sacral (Si-Siv) and part of the anterior branch of the IV lumbar (Lfv) spinal nerves. The anterior branch of the V lumbar spinal nerve, as well as the part of the anterior branch of the IV lumbar nerve that joins it, forms the lumbosacral trunk, truncus lumbosacralis. It descends into the pelvic cavity and, on the anterior surface of the piriformis muscle, connects with the anterior branches of the I, II, III and IV sacral spinal nerves. In general, the sacral plexus resembles a triangle in shape, the base of which is located at the pelvic sacral openings, and the apex is at the lower edge of the large sciatic foramen, through which the largest branches of this plexus exit the pelvic cavity. The sacral plexus is located between two connective tissue plates. Behind the plexus lies the piriformis fascia, and in front is the superior pelvic fascia. The branches of the sacral plexus are divided into short and long.

Short branches end in the pelvic girdle, long branches go to the muscles, joints, skin of the free part of the limb (Fig. 190). Short branches of the sacral plexus. The short branches of the sacral plexus include the internal obturator and piriformis nerves, the quadratus femoris nerve, the superior and inferior gluteal nerves, and the pudendal nerve. The first three nerves: 1. N. (musculi obturatdrii interni] obtura-torius internus (Liv-Si); 2. N. piriformis (Si-Sn); 3. N. musculi quadrdti femoris (Li-Siv), go to the same muscles through the piriformis opening.

4 The superior gluteal nerve, n. gluteus superior (Liv-Lv, Si), leaves the pelvic cavity through the suprapiriform opening together with the superior gluteal artery and next to the vein of the same name into the gluteal region, where it passes between the small and middle gluteal muscles (Fig. 191) . Innervates the middle and small gluteal muscles, as well as the muscle that strains the wide fascia of the thigh. 5 The lower gluteal nerve, n. gluteus inferior (Lv, Si-Sn), is the longest nerve among the short branches of the sacral plexus. This nerve leaves the pelvic cavity through the subpiriform opening along with the artery of the same name and next to the vein, the sciatic nerve, the posterior cutaneous nerve of the thigh, and the pudendal nerve. Branches of the inferior gluteal nerve lead to the gluteus maximus muscle.

6. The pudendal nerve, n. pudendus (Si-Siv), leaves the pelvic cavity through the piriform opening, goes around the sciatic spine behind and enters the ischiorectal fossa through the small sciatic foramen. In the ischiorectal fossa, this nerve lies on its lateral wall, goes forward in the thickness of the fascia covering the obturator internus muscle, and divides into terminal branches. In the sciatic-rectal fossa, the pudendal nerve departs: lower rectal nerves, pp. reddles inferiores, heading to the external sphincter of the anus and to the skin in the anus; perineal nerves, nn. perineales, which innervate mm. ischiocavernosus, bulbospongiosus, transversi perinei (superficialis et profundus), the skin of the perineum, as well as the skin of the posterior surface of the scrotum in men - the posterior scrotal nerves, nn. scrotdles posteriores, or labia majora - posterior labial nerves, nn. labiates posteriores, in women. The final branch of the pudendal nerve - the dorsal nerve of the penis (clitoris), p. dorsalis penis (clitoridis), together with the dorsal artery of the penis (clitoris) passes through the urogenital diaphragm and follows to the penis (clitoris). This nerve gives branches to the cavernous bodies, the glans penis (clitoris), the skin of the penis in men, the labia majora and labia minora in women, as well as branches to the deep transverse perineal muscle and urethral sphincter.

Long branches of the sacral plexus. The long branches of the sacral plexus include the posterior femoral cutaneous nerve and the sciatic nerve. 1 The posterior cutaneous nerve of the thigh, p. cutaneus femoris posterior (Si-Sin), is a sensitive branch of the sacral plexus. Having left the pelvic cavity through the subpiriform opening, the nerve goes down and exits from under the lower edge of the gluteus maximus muscle approximately halfway between the greater trochanter and the ischial tuberosity. On the thigh, the nerve is located under the broad fascia, in the groove between the semitendinosus and biceps femoris. Its branches pierce the fascia and branch out in the skin of the posteromedial surface of the thigh up to the popliteal fossa. At the lower edge of the gluteus maximus muscle, the lower nerves of the buttocks depart from the posterior cutaneous nerve of the thigh, pp. [gg.] clunium inferiores, which go around the edge of this muscle and innervate the skin of the gluteal region. Perineal branches, rr. perineales, go to the skin of the perineum. 2 The sciatic nerve, n. ischiadicus (Liv - Lv), (Si-Sin), is the largest nerve of the human body. In its formation, the anterior branches of the sacral and two lower lumbar nerves take part, which, as it were, continue into the sciatic nerve. The sciatic nerve enters the gluteal region from the pelvic cavity through the subpiriform opening. Then it goes down, first under the gluteus maximus, then between the adductor maximus and the long head of the biceps femoris. In the lower part of the thigh, the sciatic nerve is divided into two branches: a larger medially lying branch - the tibial nerve, n. tibialis, and a thinner lateral branch - the common peroneal nerve, n. peroneus communis (Fig. 192). Often the division of the sciatic nerve into two terminal branches occurs in the upper third of the thigh or even directly at the sacral plexus, and sometimes in the popliteal fossa. In the pelvic region and on the thigh, muscle branches depart from the sciatic nerve to the obturator internus and gemelli muscles, to the quadratus femoris, the semitendinosus and semimembranosus muscles, the long head of the biceps femoris, and the posterior part of the adductor magnus.

A number of bone and muscle landmarks are noticeable on the lower limb. This is the bulge of the gluteal region, which is separated from the thigh by the gluteal groove, in the depth of which the ischial tuberosity is palpated in the middle. The iliac crest is palpated in the upper part of the gluteal region. In normosteic on the thigh, the inguinal fold and the iliac crest fossa are visible in front, where the femoral artery is palpated. The contours of the quadriceps femoris are clearly visible. In the anterior knee region, the nakolinok is clearly visible, and on the sides of it there are two fossae. Palpated at the middle and lateral condyle of the femur. In the posterior knee region, the popliteal fossa is determined. On the anterior surface of the lower leg, the anterior edge of the tibia is contoured, on the posterior surface, the gastrocnemius muscle passes into the calcaneal tendon, which is attached to the calcaneus. On the sides of the ankle joint, the contours of the lateral and medial malleoli are clearly visible. Normally, at the average edge of the foot, its longitudinal arch is noticeable.

The thickness of the skin on the lower limb depends on the function of a particular segment and the amount of pressure on it. So, the skin of the buttocks, the anterior knee area and especially the soles is thick. The skin of the thigh, posterior knee area, lower leg and rear of the foot is thin, mobile. Subcutaneous fatty tissue is especially developed in the gluteal region, where it consists of two layers - superficial and deep. The deep layer passes at the top into the fiber of the lumbar region, forming a common fat body - the lumbar-gluteal fat mass. Branches of the gluteal artery, veins and nerves lie in the subcutaneous tissue. The superficial fascia is poorly developed; it is a continuation of the superficial fascia of the body.

As you know, the muscles of the pelvic girdle start from the lumbar and sacral spine, as well as the hip bones, therefore, their own fascia of these muscles are associated with the fascia lining the walls of the abdominal cavity and pelvis.

Lumboiliac fascia, which is also called iliac fascia(fascia iliopsoas seu fascia iliaca), as part of the intra-abdominal fascia covering the front of the back wall of the abdominal cavity, the club-lumbar muscle. This fascia consists of two parts: the lumbar part (pars psoatica) and iliac part (pars iliaca), which cover the corresponding parts of the iliopsoas muscle. On the lateral wall of the abdomen, the lumboiliac fascia passes into the transverse fascia.

Lumbar(pars psoatica) The lumboiliac fascia is covered in front by the psoas major muscle. Its middle edge is attached to the interspinal discs, protrude above the edges of the bodies of the lumbar vertebrae, and to the base of the sacrum. The lateral edge of the fascia is connected to the fascia covering the square muscle of the lower back. With an average section of the fascia, spreads from the transverse process of the II lumbar vertebra to the body and lumbar vertebra, is called medial arcuate ligament (lig. Atvuafum mediale). Down the lumbar part of the fascia passes into the iliac part of the lumboiliac fascia.

Iliac frequent(pars iliaca) The lumboiliac fascia is attached to the inner lip of the iliac crest, the arcuate line of the ilium, the iliopubic elevation and up to the pubic crest. Going down under the inguinal ligament, the fascia grows together with a deep leaf of the own fascia of the thigh. Laterally, passing into the transverse fascia, the iliac part of the lumboiliac fascia fuses with the posterior edge of the inguinal ligament. In the middle, this fascia, moving from the inguinal ligament to the club-pubic elevation, thickens and forms iliac crested arch (arcus iliopectineus). Thus, this arc divides the entire space under the flank ligament into muscular and vascular bays. (Fig. 165).

muscular bay(lacuna muscle) located on the side. It is bordered: in front and above - by the inguinal ligament; from below and behind - the ilium; in the middle - iliac crested arch. Through the muscular bay, the iliopsoas muscle and the femoral nerve exit to the anterior region of the thigh.

Vascular bay (lacuna vasorum) located in the middle of the muscular bay and bordered: in front and above - by the inguinal ligament; from below and behind - by the upper branch of the pubic bone from the side - club-combed arc; in the middle - Zatokovy ligament (lig. lacunare). The femoral artery (on the side) and vein (in the middle) pass through the vascular bay.

pelvic fascia (fascia pelvis) is a continuation of the intra-abdominal fascia, covering the inside of the pelvic wall and intra-pelvic muscles. Numerous membranes extend from it to the internal organs of the small pelvis. Downward, the pelvic fascia joins with the fascia of the perineum.

The parietal plate of the pelvic fascia is called parietal fascia of the pelvis, or intrapelvic fascia (fascia pelvis parietalis seu fascia endopelvina). The part of this fascia that covers the internal obturator muscle is called the obturator fascia. (fascia obturatoria), and the piriformis muscle is covered by the fascia of the piriformis m "muscle (fascia musculi piriformis).

Gluteal fascia (fascia gjlutea) dense, is a continuation of the thoracolumbar fascia and covers the outside of the large and partially middle gluteal muscles. The fascia originates from the dorsal surface of the sacrum and the outer lip of the iliac crest. Numerous partitions extend from it deep into, passing between the muscle bundles. A deep sheet of the gluteal fascia separates the gluteus maximus muscle of the middle sidno-

Rice. 165. muscular and vascular bay(rights)

th muscles and muscles - taut fascia lata. The gluteal fascia from below and from the side passes into the wide fascia.

As mentioned above, two strong ties stretched between the sacrum and ischial tuberosity - sacro-hump connection, and between the sacrum and ischial spine - sacro-spinal connections, along with a large ischial notch large sciatic foramen (foramen ischiadicum majus). Passing through this hole, the piriformis muscle divides it into two parts: the upper - pear-like hole (foramen suprapiriformis), and bottom- pear-shaped hole (foramen infrapiriformis). the upper neurovascular bundle passes through the supra-pear opening - the upper gluteal artery, vein and nerve. The lower neurovascular bundle passes through the pear-like opening - the lower gluteal artery, vein and nerve, as well as the internal shameful artery, the pudendal nerve, the posterior cutaneous nerve of the thigh and the sciatic nerve. At the level of the lower edge of the gluteus maximus muscle, the sciatic nerve is located superficially, it is covered only by the skin and fascia lata.

obturator canal(canalis obturotorius) has a length of 2-2.5 cm, the obturator sulcus of the pubic bone is bordered on top, and the obturator membrane and the internal obturator muscle are below. The obturator blood vessels and nerve pass through the canal.

Within the framework of the anterior femoral areas, a number of important topographic formations are distinguished: the femoral triangle, the iliac crested and anterior femoral sulci, and the adductor canal.

femoral triangle(trigonum femorale) - Scarpa Triangle, fringing from above with the inguinal ligament, from the side - by the tailor muscle, in the middle - by the long adductor muscle. Within this triangle are the femoral artery and vein, the great saphenous vein, the branches of the femoral nerve, and the inguinal lymph nodes.

The vascular bay continues onto the thigh at iliac-combed groove(sulcus iliopectineus), which is located between two muscles - the iliopsoas (sideways) and the comb (in the middle). The iliac crested groove descends into anterior femoral groove(sulcus femoralis anterior), which is bordered by the sides in the middle with a wide muscle, and in the middle - with long and large adductor muscles.

In these grooves pass the femoral artery and vein, as well as the saphenous nerve.

At the bottom of the femoral triangle, the anterior femoral groove passes into driving channel(canalis adductorius), which is also called unter channel. It runs along the lower third of the thigh into the popliteal fossa. The driving channel has three walls: the lateral wall is formed with an average wide muscle; with the middle wall - with a large adductor muscle; the anterior wall is formed wide-drive intermuscular septum (septum intermusculare vastoadductorium femoris), which is stretched between the large adductor muscle and the medial wide muscle.

The driving channel opens into the popliteal fossa through drive rosette (hiatus adductorius), which is located between the tendon bundles of the large adductor muscle and the femur. In the adductor canal, the saphenous nerve passes in front of the femoral artery, and the femoral vein behind it. In the lower part of the wide-drive intermuscular septum there is an opening through which the saphenous nerve and the descending genicular artery, which is a branch of the femoral artery, exit from the drive canal.

fascia lata(fascia lata) envelops all the muscles of the thigh. Ahead and above the wide fascia attached

Rice. 166. Muscles and fascia of the thigh(transverse section at the level of the middle of the right thigh, view from below)

to the iliac crest, inguinal ligament, pubic symphysis and ischium. Behind this fascia passes in gluteal fascia, and down at the level of the knee joint it continues into the fascia of the lower leg (Fig. 166).

In front, the broad fascia forms a sheath for the tailor's muscle and in the region of the femoral triangle is divided into superficial and deep plates. The deep plate covers the distal iliopsoas muscle and the comb muscle, from above this plate passes into the iliac part of the lumbar-iliac fascia. Between the superficial and deep plates are the femoral artery and vein, inguinal lymph nodes and fatty tissue. At the medial edge of the comb muscle, the deep and superficial plates fuse again.

In the superficial plate of the fascia lata just below the inguinal ligament is an oval opening - subcutaneous rostvir (hiatus saphenus), through which the great saphenous vein flows into the femoral vein. This framing is top, side and bottom sickle-shaped edge (margo falciformis) broad fascia. The pointed upper part of the sickle-shaped edge is called upper corner (comb superius), which is woven into the inguinal connection, and its lower part - lower corner (honeycomb inferius). Subcutaneous rostvir closed loose fascia (fascia cribrosa), in which there are numerous openings for the passage of blood vessels and nerves.

On the lateral surface of the thigh, the fascia lata thickens significantly, and its longitudinal connective tissue fibers form ilio-tibial complex (tractus iliotibialis). It is at the same time a tendon of a muscle - stretched by a wide fascia. The fascia lata forms separate fascial sheaths for the muscle - the stretched fascia lata, tailor's and thin muscles.

Numerous septa extend from the fascia lata, which form fascial sheaths for individual muscles and their groups, as well as for neurovascular bundles. The thickest of them are two intermuscular septa of the thigh - lateral and medial, which are attached lengthwise to the femur. (see Fig. 126, 166).

Lateral intermuscular septum of the thigh (septum intermusculare femoris laterale) attached to the lateral lip of the rough line of the femur and separates the posterior thigh muscle group from the anterior one.

With an average intermuscular septum of the thigh (septum intermusculare femoris mediale) attached to the medial lip of the rough line of the femur and separates the quadriceps femoris muscle from the adductor muscles (with the middle muscle group). Sometimes there is a posterior intermuscular septum of the thigh on the thigh, which separates the adductor muscles from the posterior thigh muscle group.

femoral canal (canalis femoralis) normally does not exist, it occurs only with the formation of femoral hernias. This channel has a length of 2-3 cm and extends from its internal opening - the femoral ring, to the subcutaneous opening, which becomes the external opening of the canal in case of femoral hernia. Through subcutaneous rostvir, a femoral hernia can go under the skin of the thigh.

Femoral ring (anulus femoralis)η is located at the middle part of the vascular bay and bordered: in front - inguinal ligament; behind - a pubic crest, which is covered with a thickened periosteum - a combed ligament; in the middle - Zatokovy bunch; on the side - the femoral vein.

In the femoral canal, wall games are isolated; front, back and side. front wall the femoral canal forms the inguinal ligament and the upper corner of the sickle-shaped edge of the wide fascia fused with it; back wall- a deep plate of the broad fascia covering the comb muscle in this place side wall canal is the femoral vein.

There are several synovial bags in the knee region:

- Antero-link subcutaneous bursa (bursa subcutanea prepatellaris)

- Pidnakolinkova subcutaneous bursa (bursa subcutanea infrapatellaris)

- Subcutaneous bursa of tibial tuberosity (bursa subcutanea tuberositatis tibiae)

- Anteriolinka pidfascial bag (bursa subfascialis prepatellaris), located under its own fascia;

- Nadnakolinkova bag (bursa suprapatellaris), located between the tendon of the quadriceps femoris and the femur; it communicates with the cavity of the knee joint.

Popliteal fossa (fossa poplitea), located in the back of the knee (see Fig. 158), bordered: from above and outside - by the biceps femoris; above and near the middle - pivsukhozhilkovym and pivperetin part of the muscles; from below and outside - by the lateral head of the gastrocnemius muscle; from below and in the middle - with the medial head of the gastrocnemius muscle. This fossa has the appearance of a diamond-shaped depression, it is filled with adipose tissue and loose connective tissue. The bottom of the popliteal fossa is formed by the popliteal surface of the femur and the capsule of the knee joint. The fossa is covered behind by its own fascia, which is a continuation of the fascia lata.

A neurovascular bundle passes in the popliteal fossa: the tibial nerve lies directly under the fascia, deeper and more centrally - the popliteal vein, deeper and more centrally - the popliteal artery. In the fossa there are 1-3 popliteal superficial and deep lymph nodes, superficial lymph nodes are located on the floor of the popliteal fascia. Often there are only one popliteal lymph node.

The cellular space of the popliteal fossa is combined with the posterior muscle bed of the thigh, passes into the deep cellular space of the gluteal region, and also, due to the drive canal, with the femoral triangle.

tibial popliteal canal(canalis cruropopliteus) located between the superficial and deep parts of the posterior muscle group of the lower leg. In front are the posterior tibial muscle and the long flexor muscle of the thumb, and behind the soleus muscle. The tibial nerve, as well as the posterior tibial artery and veins, pass through this canal. The inlet of this canal is bordered in front by the popliteal muscle, and behind - by the tendinous arch.

The tibial popliteal canal has three openings. Through the upper (inlet) opening of the borders in front of the TENDOUS arch of the soleus muscles, and behind the popliteal muscle, the posterior neurovascular bundle of the lower leg passes into the canal from the popliteal fossa. In this bundle, the posterior tibial artery and two veins are located in the middle, and the tibial nerve is located on the side. Through the lower opening of the canal, in front of the posterior tibial muscle, and behind - with the calcaneal tendon, the neurovascular bundle at the back of the middle bone passes to the sole. Through the rosette in the interosseous membrane of the leg, the anterior tibial artery enters the anterior part of the leg.

Superior musculoperoneal canal(canalis musculoperoneus superior) located in the upper third of the lower leg between the fibula and the long peroneal muscle. The canal is surrounded by the head of the long peroneal muscle, the head of the fibula, and the lateral condyle of the tibia. The common peroneal nerve passes through this canal, which branches into the superficial (located on the side) and deep (located in the middle) peroneal nerves.

In the middle third of the lower leg, the ankle popliteal canal branches off inferior muscular peroneal canal(canalis musculoperoneus inferior), that the fringes are in front of the fibula and the posterior tibial muscle, and behind - the long flexor muscle of the thumb. The walls of the inferior musculoperoneal canal are: in front - the fibula and the posterior tibial muscle, and behind - the long flexor muscle of the thumb. In this channel are peroneal artery and veins (a. Et vv. Fibulares).

The thin skin of the anterior tibia directly covers the tibia. Subcutaneous tissue is absent here. In the subcutaneous tissue at the middle surface of the lower leg passes a large saphenous vein and saphenous nerve. In the subcutaneous tissue of the posterior surface of the lower leg, the small saphenous vein passes, which flows into the popliteal vein.

Rice. 167. Muscles and fascia of the lower leg(transverse section at the level of the middle of the right lower leg, top view)

Fascia of the lower leg (fascia cruris), which is a continuation of the broad fascia, covers the outside of all the muscles of the lower leg, fuses with the periosteum of the anterior edge and the medial surface of the tibia. Numerous partitions extend deep from the fascia, which form fascial sheaths for individual muscles and their groups. (Fig. 167). The densest and most durable of them are the anterior and posterior intermuscular septa of the lower leg:

- Anterior intermuscular septum of the leg (septum intermusculare cruris anterius) attached to the anterior edge of the fibula and separates the lateral muscle group of the lower leg from the anterior group;

- Posterior intermuscular septum of the leg (septum intermusculare cruris posterius) attaches to the posterior edge of the fibula and separates the posterior muscle group of the lower leg from the lateral group.

In the posterior part of the lower leg, the fascia of the lower leg is divided into deep and superficial plates. The deep lamina separates the calf triceps from the flexor digitorum longus, flexor pollicis longus, and tibialis posterior. The surface plate is covered from the outside by the triceps muscle of the calf.

Thus, three fascial beds are formed in the tibial region, corresponding to the three sections of the lower leg - anterior, lateral and posterior.

AT anterior fascial bed, that is surrounded by the fascia of the lower leg, the posterior intermuscular septum of the lower leg, the fibula, the interosseous membrane of the lower leg and the lateral surface of the tibia, the following muscles are located: the anterior tibial muscle (in the middle), the long muscle - the rostrum of the fingers (on the side), and in the lower third of the lower leg between two muscles located the extensor muscle of the thumb.

On the anterior surface of the interosseous membrane of the lower leg passes the neurovascular bundle - the anterior tibial artery and two veins, as well as the deep peroneal nerve. This bundle is located in the upper third of the lower leg between the anterior tibial muscle and the long extensor muscle of the fingers. In the lower third of the lower leg, the neurovascular bundle is located between the anterior tibial muscle and the long extensor muscle of the thumb. The deep peroneal nerve in the upper third of the lower leg runs along the side of the anterior tibial artery, in the middle third - in front of it, and in the lower third of the lower leg - in the middle of the artery. The anterior tibial artery and veins penetrate into the anterior part of the lower leg through the rostvir into the interosseous membrane of the lower leg, located 4-5 cm below the level of the head of the fibula from its medial edge.

AT lateral fascial bed, that is surrounded by the fascia of the lower leg, the anterior and posterior intermuscular septa of the lower leg and the lateral surface of the fibula, located long and short peroneal muscles.

AT posterior fascial bed, which is surrounded by the fascia of the lower leg, the posterior intermuscular septum of the lower leg, the posterior and medial surfaces of the fibula, the interosseous membrane of the lower leg and the posterior surface of the tibia, the muscles of the posterior part of the lower leg, which are divided into superficial and deep parts by the deep plate of the fascia of the lower leg. The superficial part contains the triceps calf and plantar muscles, and the deep part contains the popliteal muscle, the long flexor of the fingers, the long muscle of the thumb and the tibialis posterior. As mentioned above, between the superficial and deep parts of the posterior muscle group of the lower leg passes tibial popliteal canal (canalis cruropopliteus). In the area of ​​the ankle joint at the level of the bases, with the middle and lateral bones, the fascia of the lower leg is compacted by transverse connective tissue bundles and forms muscle holders: the upper and lower holders of the extensor muscles, the holder of the flexor muscles, the upper and lower holders of the peroneal muscles (Fig. 168, 169). Behind the ankle joint, the calf fascia splits and forms a sheath for the calcaneal tendon of the triceps calf muscle.

Flexor Muscle Holder (retinaculum musculorum flexorum) located medially, spreads from the medial malleolus to the medial surface of the calcaneus. Connective tissue bundles extend from the holder to the silted bones, dividing the space under the holder of the flexor muscles into three bone-fibrous channels:

In the first canal, which is located immediately behind and below, when the middle bone passes tibialis posterior tendon sheath

In the second channel, which is located behind and somewhat to the side of the first channel, passes tendon sheath of the long flexor muscle of the fingers (vagina tendinum musculi flexoris digitorum longi)

In the third channel, located behind the first two channels, passes long tendon sheath

Rice. 168. Sheath of the tendons of the muscles of the right leg. BUT- front view. B- view from the middle side

Rice. 169. Sheath of the tendons of the muscles of the right leg in the plantar region of the foot

flexor muscle of the thumb (vagina tendinum musculi flexoris hallucis longi).

In a separate fibrous canal, located between the sheath of the tendons of the long flexor muscle of the fingers and the long flexor muscle of the thumb, pass from the posterior part of the lower leg to the sole of the posterior neurovascular bundle of the lower leg - the posterior tibial artery and two veins, as well as the tibial nerve.

Suspension of the extensor muscles(retinaculum musculorum extensorum superius) located in the lower part of the anterior part of the lower leg, it is stretched between the anterior edge of the tibia and the lateral surface of the fibula. Beneath this holder are the tendons of the tibialis anterior, extensor pollicis longus, and extensor myasa longus.

Lower extensor muscle holder(retinaculum musculorum extensorum inferius) located below the previous one, thrown over the tendons of the muscles of the anterior group of the lower leg at the place of their transition to the rear of the foot. It starts from the lateral surface of the calcaneus and is divided into two legs: the upper one is attached to the iris-medial bone, and the lower one is attached to the navicular and medial sphenoid bones. From the lower holder of the extensor muscles to the bones of the foot, partitions extend, dividing the space under the holder into four bone-fibrous channels:

In the middle channel passes tendon sheath of the anterior tibial muscle (vagina tendinis musculi tibialis anterioris), which extends from the superior edge of the superior extensor mandible to the level of the apex of the medial malleolus;

In the middle channel is placed sheath of the tendon of the long extensor muscle of the thumb (vagina tendinis musculi extensoris hallucis longi)

- In the next, third canal, the dorsal artery and veins of the foot, as well as the deep peroneal nerve, pass;

Located in the side channel tendon sheath of the long extensor muscle of the fingers (vagina tendinum musculi extensoris digitorum longi).

The sheaths of the tendons of the long extensor muscle of the thumb and the long extensor muscle of the fingers run on the back of the foot to the level of the bases of the metatarsal bones.

Behind and below the lateral bone are the upper and lower holders of the peroneal muscles.

Suspension of the peroneal muscles (retinaculum musculorum fibularium superius) runs from the lateral bone to the lateral surface of the calcaneus.

Lower peroneal holder(retinaculum musculorum fibularium inferius) attached to the lateral surface of the calcaneus.

In the bone-fibrous canal under the holders of the peroneal muscles passes joint sheath of the tendons of the peroneal muscles (vagina communis tendinum musculorum fibularium). First, the tendons of both peroneal muscles are located in one sheath, which, at the level of the lower holder of the peroneal muscles, is divided into two sheaths for the tendons of each muscle. The tendon sheath of the short peroneal muscle ends at the level of the lower edge of the lower holder of the peroneal muscles. The tendon sheath of the long peroneal muscle is longer and ends at the lateral edge of the foot at the level of its transition on the plantar surface.

On the plantar surface of the foot is still separate plantar sheath of the tendon of the long peroneal muscle (vagina plantaris tendinis musculi fibularis longi). It passes in the groove of the tendon of the long peroneal muscle of the cuboid bone, goes forward and medially to the level of the bases of the first two metatarsal bones and the medial sphenoid bone.

The fascia of the lower leg at the level of the ankle joint passes into dorsal fascia of the foot (fascia dorsalis pedis), which has two plates - superficial and deep. The superficial plate of the fascia is very thin. The deep plate of the dorsal fascia of the foot covers the dorsal interosseous muscles and fuses with the periosteum of the metatarsal bones. Between both plates of the dorsal fascia of the foot are the tendons of the long and short extensor muscles of the fingers, the dorsal artery and veins of the foot, and the deep peroneal nerve.

On the sole, the skin is very thick and, with the help of connective tissue bundles, is connected to plantar aponeurosis (aponeurosis plantaris), which is a derivative of the superficial plate of the plantar fascia of the foot. The plantar aponeurosis is built from thick longitudinal connective tissue bundles starting from the plantar surface of the calcaneal tubercle. This aponeurosis grows together with the lower surface of the short flexor muscle of the fingers.

At the level of the middle of the metatarsal bones, the plantar aponeurosis expands, becomes thinner and is divided into five flat bundles that go to the toes and are woven into their fibrous sheaths. The longitudinal bundles of the plantar aponeurosis at the level of the heads of the metatarsal bones are reinforced with transverse bundles (fasciculi transversi), forming superficial transverse metatarsal connection (lig. Metatarsale transversum superficiale).

The deep plate of the plantar fascia covers the square, vermiform and plantar interosseous muscles.

On the sole along both edges of the short myaz-flexor of the fingers there are two furrows - at the middle and lateral soles of the furrow. Middle plantar sulcus (sulcus plantaris medialis) located between the short muscle-zgiiach of the fingers (sideways) and the abductor muscle of the thumb (middle). In this groove passes at the middle neurovascular bundle - the medial soles of the artery and nerve. Lateral pidoiivova furrow (sulcus plantaris lateralis) located between the short flexor muscle of the fingers (in the middle) and the abductor muscle of the little finger (on the side). In this groove passes the lateral neurovascular bundle - the lateral soles of the artery and nerve.

From the plantar aponeurosis in the arrow planes, two intermuscular septa extend to the deep fascial plate, separating the middle muscle group of the sole from the medial and lateral, forming three muscle beds:

In the middle fascial bed, the abductor and adductor muscles of the thumb are located, the short flexor muscle of the thumb in this bed passes through the middle neurovascular bundle;

The middle fascial bed is divided by the fascial plate into deep (upper) and superficial (lower) fascial beds; in the deep bed are placed the soles of the interosseous muscles, worm-like muscles, tendons of the long flexor muscle of the fingers, as well as the tendons of the long peroneal muscle, surrounded by its own synovial sheath; in the superficial bed there is a short flexor muscle of the fingers and a square muscle of the sole

In the lateral fascial bed are located the abductor muscle of the little finger and the short flexor muscle of the little finger.

Through the median fascial bed between the short flexor muscle of the fingers (on the side) and the square muscle of the sole (in the middle), the lateral neurovascular bundle passes. At the level of the bases of the metatarsal bones, the lateral plantar artery returns medially, forming a plantar arch, from which the soles of the metatarsal arteries depart.

On the dorsal surface of the phalanges of the toes, the tendons of the extensor muscles expand and form the dorsal aponeurosis of the fingers.

On the plantar surface of the phalanges of the toes are located tendon sheaths of the toes (vaginae tendinum digitorum pedis), each of which consists of outer and inner layers.

The outer layer of the scabbard is presented fibrous sheaths of the toes (vaginae fibrosae digitorum pedis ) , which at the level of the bodies of the phalanges consist of the annular part of the fibrous vagina (pars anularis vaginae fibrosae), and at the turnip of the interphalangeal joints - from the cruciform part of the fibrous vagina (pars cruciformis vaginae fibmsae). The inner layer of the tendon sheath of the toes is formed by the synovial sheath of the toes (vaginae synoviales digitorum pedis).

In the synovial sheath of the thumb passes the tendon of the flexor muscle of the thumb, which extends from the level of the middle of the first metatarsal bone to the base of the terminal phalanx. In the synovial sheath of the II-V fingers, two tendons pass - the tendons of the long and short flexor muscles of the fingers, which extend from the level of the heads of the metatarsal bones to the base of the terminal phalanges.

In the pelvis and on the lower limb between the muscles, a number of channels, pits and furrows are localized, through which the vessels and nerves pass.

In the pelvic region, forr is distinguished. ischiadica majus et minus. The large sciatic foramen is formed by the greater sciatic notch and the sacrospinous ligament, the small foramen is limited by the lesser sciatic notch, lig. sacrospinale et lig. sacrotuberale. The piriformis muscle leaves the pelvis through the large sciatic foramen, which does not completely fill this hole. Therefore, there are gaps above and below the muscle: forr. supra-et infrapiriforme. Through them, arteries, veins and nerves exit the pelvic cavity to its posterior surface for innervation and blood supply to the gluteal muscles and skin. From the small pelvis, the obturator canal (canalis obturatorius) 2-2.5 cm long passes to the thigh. Its walls are limited by the obturator groove of the pubic bone, internal and external obturator muscles. Through the canal, the obturator nerve and blood vessels penetrate the medial part of the thigh, innervating and supplying blood to the medial muscles of the pelvis.

In the cavity of the large pelvis there is an iliac fossa, which occupies the inner surface of the wing of the ilium. The fossa is partially filled with the iliac muscle; in most cases, the caecum with the vermiform appendix is ​​located in it on the right in most cases. Below, the cavity of the large pelvis communicates with the anterior surface of the thigh through a wide opening, bounded in front by the inguinal ligament stretched between the spina iliaca anterior superior and tuberculum pubicum, and behind the pelvic bone. This hole is divided by lig. iliopectineum into two parts: lacuna musculorum - laterally and lacuna vasorum - medially. Arteries, veins, and lymphatics pass through the lacuna vasorum. A femoral canal may form in this space.

femoral canal. Normally, the femoral canal does not exist; only in the case of the exit of the internal organs or the greater omentum from the abdominal cavity in the regio subinguinalis does the femoral canal appear, having an internal and external opening, with a constant topography. Therefore, in a course of normal anatomy, attention is paid only to the way in which the internal organs can penetrate from the abdominal cavity to the anterior surface of the thigh.

The place where the internal organs from the side of the abdominal cavity penetrate the canal is called the femoral ring (anulus femoralis); it is limited in front lig. inguinale, behind - f. pectinea, laterally - femoral vein, medially - lig. lacunare (Fig. 203), representing a ligament stretched between the inguinal ligament and the pubic bone. The femoral canal is 2-2.5 cm long and is located between the inguinal ligament, the femoral vein and the fascia covering the pectineus muscle (Fig. 204). The hiatus saphenus becomes the external opening of the femoral canal (see below), which limits the margo falciformis with two legs: cornu superius et inferius. V passes through the hiatus saphenus. saphena magna.

203. The inner surface of the anterior wall of the abdomen and pelvis (according to V. P. Vorobyov).
1 - m. transverse abdominis; 2-f. transversa; 3-f. iliaca; 4 - m. iliacus; 4 - m. fliacus; 5 - m. psoas major; 6-a. femoralis; 7-v. femoralis; 8 - m. obturatorius internus; 9-lig. lacunar; 10 - anulus femoralis; 11-lig. interfoveolare; 12 - ductus deferens, passing through the inguinal canal; 13 - m. rectus abodominis.

204. Right inguinal region. Location of the femoral canal.
1-lig. inguinale: 2 - lig. iliopectineum; 3-a. femoralis; 4-v. femoralis; 5 - anulus femoralis; 6-lig. lacunar; 7 - funiculus spermaticus; 8 - m. iliopsoas; 10-n. femoralis.

The vascular lacuna (lacuna vasorum) continues to the anterior surface of the thigh, where it passes into the iliopectineal groove (sulcus iliopectineus), which continues into the anterior femoral groove (sulcus femoralis anterior). The first - the iliac-comb groove - is limited to m. pectineus and m. iliopsoas, the second - m. adductor longus et magnus and m. vastus medialis. In the lower third of the thigh, the anterior femoral groove passes into the adductor canal (canalis adductorius) 6-7 cm long, communicating the anterior surface of the thigh with the popliteal fossa. The upper opening of the channel is limited: in front - a thickened fascial plate (lamina vastoadductoria), stretched between m. adductor longus and m. vastus medialis, laterally - m. vastus medialis, medially - m. adductor magnus. The lower opening of the adducting canal (hiatus tendineus) is limited by the tendon ring in the lower part of m. adductor magnus. The femoral artery passes through the canal into the popliteal fossa, and the popliteal vein passes from the fossa to the thigh. Through the upper opening, along with the vessels, n enters. saphenus, which deviates forward in the canal and leaves it through a narrow gap that opens near the medial condyle. Therefore, the canalis adductorius has an upper and two lower openings. If you remove f. lata and f. subinguinalis, then the femoral triangle (trigonum femorale) will be visible, bounded from above by lig. inguinale, laterally m. sartorius, medially - m. adductor longus.

On the back surface of the knee area there is a deep popliteal fossa filled with a large lump of adipose tissue. The popliteal fossa is limited from above by m. biceps femoris and m. semimembranosus, below - two heads of the gastrocnemius muscle. The popliteal fossa below communicates with the ankle-popliteal canal (canalis cruropopliteus). The anterior wall of the canal is limited by the popliteal muscle, behind - by the tendon arch, from which m. soleus. The channel passes between m. tibialis posterior and m. soleus, has upper and lower openings. The upper hole opens into the popliteal fossa, and the lower one is at the level of the beginning of the tendon m. soleus. Vessels and nerves for the posterior, lateral and anterior muscles of the leg pass through the canal.

The canalis musculoperoneus inferior runs along the middle third of the fibula, limited behind mm. flexor hallucis longus and tibialis posterior, and in front - fibula. This canal communicates with canalis cruropopliteus and contains a. peronea. In the upper third of the lower leg there is canalis musculoperoneus superior, through which passes n. peroneus superficialis. It is located between the fibula and m. peroneus longus.

On the plantar side of the foot, the medial groove (sulcus plantaris medialis) is limited by m. flexor digitorum brevis and m. abductor hallucis; the lateral furrow passes between m. flexor digitorum brevis and m. abductor hallucis.

Each groove contains a plantar artery, vein, and nerve.

The large sciatic foramen is located on the sides of the walls of the small pelvis, adjacent to the small one. The structure and location of soft tissues passing in these anatomical planes is complex, pathologies in this area require immediate treatment.

Location

The sciatic foramen is one of two elements in the lower posterior region of the true (small) pelvis. In anatomy, a pair of a large opening and a small one are distinguished, each of them represents natural openings along which elements of the nervous and vascular systems go.

The large opening is limited by the sciatic notch and the ligamentous element of the sacral region, which connects the sacrum to the pelvic spine, while the small one has restrictive landmarks - part of the sciatic notch and the ligamentous element connecting the sacrum and the tubercle of the ischium.

Through both of these limited cavities, blood vessels and muscles pass from the lumbar region, and nerve fibers from the sacrum.

For reference! The awn is called a pointed formation on the surface of the bone.

Muscular branches

The piriformis muscle runs through the large opening, separating it vertically. Through the resulting cracks or openings, blood supply and innervation occur - the connection of the central nervous system with organs and tissues through nerve fibers.

Together with the pear-shaped through this natural opening, the following muscle elements lie:

1. Gluteus maximus. It tends through the suprapiriform part, that is, through a kind of tubule that connects the organs located in the true pelvis with a layer of fiber in the buttocks area. From below, the suprapiriform part is covered by the gluteus medius muscle.
2. Small gluteal muscle. It tends through the piriform part, which is bounded from below by the twin muscle.

All muscle elements tend from the lumbar through a large opening to a smaller one.

Nerves

The gluteal region is innervated primarily by the sciatic nerve, the largest of all. It is located so that from the lumbar vertebrae it passes through a large limited cavity along with the cutaneous femoral nerve, which enters it from above. The largest nerve in the piriform cavity tends to the area under the buttocks and further to the feet.

The nerve is enveloped by vaginal capsules. From the proximal side of the shell, along the suprapiriform fissure, there is a lower gluteal neurovascular bundle. On the outside of the vessels, which are separated by the fascia, one can observe the pudendal neurovascular bundle, which is directed into a small opening to the fiber of the rectal fossa.

For reference! Fascia covers organs, vessels and nerves with a connective tissue sheath. It is rich in blood vessels and nerves.

The genital vascular nerve bundle runs through the subpiriform cavity, tending to the ligamentous element between the sacrum and the spine, along the small canaliculus to the tuberous surface of the ischium.

The pudendal nerve goes through the suprapiriform canal to the ligaments of the sacrum and through and through the small sciatic foramen reaches the perineum. Upper gluteal nerve fibers pass through the suprapiriform fissure. This is where the lymph glands are located.

Circulatory system

The superior gluteal artery and vein, which is also named, pass through the supra-piriform part and in the gluteal zone are divided into several branches that connect with such arteries:

• lumbar;
• iliac-lumbar;
• lateral sacral;
• lower buttocks;
• femoral external.

Many arteries and capillaries in this area are not accidental - in this way the body prevents the lack of blood circulation when large arteries are clogged.

Through the piriform part, the lower gluteal capillaries from below the pudendal artery are connected to the external and proximal vessels located in the thigh.

Fact! The pudendal vessels passing nearby, falling through a small gap, fall into the pelvis.

The anatomy of the pelvic components is quite complex, but knowing the location of the entire capillary network and other components of this zone will help to avoid a lot of problems. For example, ischial hernias, which protrude precisely through the lateral fissures, occur in 45% of cases in older women. Its treatment occurs only in an operative way, for this it is necessary to find out the individual characteristics of the organism, the size of the interosseous cavities and the presence of vascular and nerves passing nearby.