THE LOWER LIMB
Bones of the Lower Limb
p.317
Hip bone (Coxal bone)
Ilium
Ischium
Pubis
Triradiate cartilage
p.319
Ilium
ala (wing)
iliac crest
anterior superior iliac spine
iliac fossa
gluteal surface
gluteal lines -- anterior,
posterior & inferior
greater sciatic notch#
p.321
Ilium
ala (wing)
iliac crest
anterior superior iliac spine
iliac fossa
gluteal surface
gluteal lines -- anterior,
posterior & inferior
greater sciatic notch#
p.321
Ischium
body
greater sciatic notch#
ischial spine
lesser sciatic notch
ischial tuberosity
-- 坐著時身體的重量皆在此處
ramus*
Ischium
body
greater sciatic notch#
ischial spine
lesser sciatic notch
ischial tuberosity
-- 坐著時身體的重量皆
在此處
ramus*
Pubis
body
symphyseal surface -pubic symphysis
pubic crest
pubic tubercle
superior ramus
inferior ramus*
*ischiopubic ramus
Pubis
body
symphyseal surface -pubic symphysis
pubic tubercle
pubic crest
superior ramus
inferior ramus*
*ischiopubic ramus
Obturator Foramen
bounded by the pubis & ischium
絕大部份被obturator membrane所覆蓋
Acetabulum
articulate with the head of the femur
lunate surface
acetabular notch
acetabular fossa
Anatomical Position
anterior superior iliac spine和pubic
tubercle位在同一垂直平面
ischial spine與pubis symphysis的上
緣在同一水平面
pubis的symphyseal surface為垂直
方向，與正中面平行
pubic body的內表面幾乎朝向正上
方
acetabulum朝向inferolaterally
obturator foramen位在acetabulum
的inferomedial side
Femur
the longest & heaviest
bone
站立時將體重由hip bone
傳送至tibia
approximately the 1/4
the length of a
person’s height
Femur
head
fovea capitis --為
ligamentum teres附著處
neck
greater trochanter
lesser trochanter
intertrochanteric line
intertrochanteric crest
Femur
body
linea aspera
gluteal tuberosity
medial & lateral condyles
adductor tubercle
Femur
angle of inclination (115-140o)：股骨的head + neck
與body的角度
Patella
三角形，apex朝下
為最大的seasmoid bone
與任何bone皆無接觸
Tibia
support the body weight
其前內側位於皮下；最細的
地方是中間1/3與下方1/3 的
交界處
為全身中最常骨折的長骨
Tibia
medial & lateral condyles
body : medial, interosseus (lateral) & posterior surfaces (∆)
tibial tuberosity -- patellar ligament附著處
soleal line
medial malleolus
@ Interosseous
memebrane
Fibula
lateral malleolus -- help hold the talus in its socket
serves only for the attachment of muscles (doesn’t
transmit body weight)
provide stability to the ankle joint；故腓骨骨折多因腳
踝過度內翻（inversion）所致
為 bone graft 最常使用者，移除後下肢動作皆無問題
Tarsus
Calcaneum=calcaneus
Talus
Navicular
Cuboid
Cuneiform(3)
Tarsus
Calcaneum=calcaneus
-- transmits most of the body
weight from the talus to the
ground
calcaneal tuberosity
Tarsus
Talus
-- the only one which articulates with
tibia & fibula in the foot
-- transmit the body weight from the tibia
-- the only tarsal bone that has no
muscular or tendinous attachement
head
trochlear
Tarsus
Navicular -- tuberosity
Cuboid -- tuberosity
Cuneiform (3) -- medial
(1st) (largest), intermediate (2nd) (smallest) & lateral (3rd)
Metatarsus (5)
-- medial & lateral seasmoid
bones on the plantar
surface of the head of the 1st
Phalanges (14)
Superficial Structures
Superficial Fascia
Superficial vein
Cutaneous nerve
Deep Fascia
Fascia Lata (Deep fascia
of the thigh)
iliotibial tract
--為 tensor of fascia
lata & gluteus
maximus
兩塊肌
肉的止點
Deep Fascia
Fascia Lata (Deep fascia of
the thigh)
iliotibial tract
--為 tensor of fascia
lata & gluteus maximus
兩塊肌肉的止點
fascial intermuscular septa
-- attached to linea
aspera of femur
-- 將大腿分成 anterior,
medial & posterior
compartments
Deep Fascia
Fascia Lata (Deep fascia of the thigh)
saphenous opening
-- 由great saphenous vein進入大腿所造成
-- cribriform fascia；falciform margins
Crural Fascia
(Deep fascia of the leg)
extensor retinaculum
interosseous membrane
crural intermuscular septa
-- 將小腿分成 anterior, lateral &
posterior compartments
transverse intermuscular septum
--再將小腿 posterior compartment
分成superficial & deep parts
Cutaneous Innervation
DERMATOME
p.334
Cutaneous Innervation
subcostal n.
genitofemoral n. (L2,3)
ilioinguinal n. (L1)
lateral femoral
cutaneous n. (L2,3)
anterior femoral
cutaneous n. (L2,3,4)
obturator n. (L2,3,4)
p.334
Cutaneous Innervation
saphenous n.
lateral sural
cutaneous n.
superficial fibular n.
p.334
Cutaneous Innervation
iliohypogastric n. (L1)
superior clunial n.
(L1,2,3)
middle clunial n.
(S1,2,3)
posterior femoral
cutaneous n. (S1,2,3)
inferior clunial n.
sural n.
p.334
Superficial Veins
great saphenous vein
起於 dorsal venous arch
ascend anterior to medial malleolus
pass posterior to medial condyle of femur (approximately a
hand’s breadth posterior to patella)
穿過 saphenous opening in fascia lata 注入femoral vein
p.332
Superficial Veins
small saphenous vein
起於dorsal venous arch
ascend posterior to lateral malleolus
ascend between the heads of gastrocnemius
注入 popliteal vein
p.332
perforating vein
connect superficial veins &
deep veins
contain valves, only allow
blood to flow from the
superficial vein to deep vein
musculovenous pump
-- 藉由肌肉收縮所產生的力
量將血液以抵抗重力的
方向推回心臟
Varicose veins (靜脈曲張)
因瓣膜無法完全關閉，而
使得血液被重力下拉而造
成靜脈擴張
最常發生在posteromedial
parts of lower limb
Lymphatic Drainage
superficial inguinal lymph nodes
external iliac lymph
nodes or deep inguinal
lymph nodes
p.332
Lymphatic Drainage
deep inguinal lymph nodes
-- along the medial side of the femoral v.
deep structures of lower limb
external iliac lymph nodes
THE PELVIS
骨盆腔(pelvic cavity)為一漏斗狀的構造
pelvic inlet：為較寬的上方開口
pelvis outlet：為較窄的下方開口
Pelvic Inlet
pubic symphysis的上緣
pubic crest的後緣
pecten pubis
arcuate line of ilium
sacrum ala的前緣
sacral promomtory
p.206
Pelvic Outlet
pubic symphysis的下緣
pubic inferior ramus & ischial
tuberosity
sacrotuberosity ligament
coccyx tip
通常可分為兩個部份：
通常可分為兩個部份：
Greater (false) pelvis：
pelvis：由ilium的上方部份以及後方
ilium的上方部份以及後方sacrum
的上方部份以及後方sacrum的上方部
sacrum的上方部
份所圍成的空間。
份所圍成的空間。此實際上為腹腔的下方部份
Lesser (true) pelvis：
pelvis：較深層處的空間，
較深層處的空間，由obturator foramen的邊
foramen的邊
緣、ischial spine以及
spine以及sacrum
以及sacrum的下半部所包圍而成
sacrum的下半部所包圍而成。
的下半部所包圍而成。其內含有真正屬
於骨盆腔的構造，
於骨盆腔的構造，如膀胱、
如膀胱、生殖器官等
兩者藉由arcuate
兩者藉由arcuate line of ilium約略加以區分
ilium約略加以區分
p.206
pelvis wall
lateral – obturator internus
posterior - pirifromis
p.214
pelvis diaphragm
為封閉pelvis outlet處的構造
由levator ani (包括pubococcygeus &
iliococcygeus)和coccygeus所構成
可支持骨盆腔內的器官並將其加以固定
Inclined angle
在解剖位置時，anterior superior iliac spine在pubic
symphysis的正上方，所以使得骨盆上緣朝前方傾斜約4550度左右
男性骨盆與女性骨盆的差異
p.208
Pelvic fracture
weak areas of pelvis：
pubic rami
acetabulum
sacroiliac joint
ala of ilium
最常是因為車禍或直接撞擊骨盆腔骨骼造成壓擠所致，或者是由於
下肢承受過大的力道所致
當骨盆腔的骨骼骨折時，通常都會傷害到位在骨盆腔內的臟器、血
管以及神經等，故情況都較為複雜
Ligaments
Sacrococcygeal ligament
Sacroiliac ligament
-- 連接vertebral column
(sacrum) 與pelvis
-- sacroiliac joint是將來自下
肢與骨盆的力量傳遞至中
軸的重要關節
Iliolumbar ligament -- 連
接L5的transverse process與
iliac crest
Pubic symphysis -- 為連
接兩pubis的
fibrocartilaginous disk
Ligaments
Sacrospinous ligament -- 連接ischial spine與sacrum
Sacrotuberous ligament -- 連接sacrum & coccyx與
ischial tuberosity
Pelvic Vasculature
• internal iliac a.
• obturator a.
• superior gluteal a.
• inferior gluteal a.
• internal pudendal a.
Pelvic Nerve Supply
1. 髖臼
髖臼（
（acetabulum）
acetabulum）的組成骨頭不
包括下列何者？
包括下列何者？
（A）恥骨
（B）薦骨
（C）坐骨
（D）髂骨
2. 脛骨、
脛骨、腓骨與下列何者形成屈戍
關節（
關節（hinge joint）？
joint）？
（A）舟狀骨
（B）距骨
（C）跟骨
（D）骰骨
3. 在解剖學的姿勢下，
在解剖學的姿勢下，恥骨嵴
恥骨嵴與下列
與下列那
一構造的連
一構造的連線， 在同一垂直面上？
在同一垂直面上？
（A）薦岬
（B）坐骨棘
（C）髂前上棘
（D）坐骨粗隆
坐骨粗隆
4. 下列何者與髖骨（
何者與髖骨（hip bone）
bone）組
成骨性骨盆（
成骨性骨盆（bone pelvis）？
pelvis）？
(A)腸骨
(A)腸骨
(B)腰椎
(B)腰椎
(C)薦椎
(C)薦椎
(D)坐骨
(D)坐骨
5.股骨
5.股骨不
股骨不具有下列
具有下列何者？
何者？
(A)粗線
(A)粗線
(B)大結節
(B)大結節
(C)大轉子
(C)大轉子
(D)恥骨線
(D)恥骨線
Hip Joint
Articular surfaces
acetabular fossa -- 有fat
位於其中，可被擠壓
以適應femur head運動
時在其內的改變
acetabular labrum -- 增加
acetabulum的深度
acetabular notch -transverse acetabular
ligament
Articular capsule
Fibrous capsule
絕大部份成螺旋狀走向
attach proximally to
acetabulum & transverse
acetabular ligament
attach distally to neck
of femur only anteriorly
at the intertrochanteric
line & greater
trochanter
Articular capsule
Fibrous capsule
orbicular zone -- 環繞著femur neck，help to
hold the femoral head in the acetabulum
Articular capsule
Fibrous capsule
retinacula -- 為深層的縱走纖維，contain reticular blood
vessels that supply head and neck of femur
Capsular ligaments
-- 為fibrous capsule的增厚部份
-- allow considerable flexion but restrict extension to
10 to 20o beyond the vertical position
iliofemoral lig.
pubofemoral lig.
ischiofemoral lig.
Iliofemoral ligament
attach to anterior inferior
iliac spine & acetabular rim
proximally and
intertrochanteric line
distally
站立時防止
hyperextension of hip
joint
Pubofemoral ligament
arise from obturator crest
of pubis
tighten during extension
and abduction of hip joint
防止 overabduction of hip
joint
Ischiofemoral ligament
arise from ischial part of
acetabular rim & spiral
superolaterally to greater
trochanter
防止 hyperextension of
hip joint
Ligament of the head of the femur
( ligamentum teres of femur)
attach from acetabular notch & transverse acetabular lig. to
femur head
非capsular ligament
通常含有一小動脈 (來自obturator artery)
Synovial membrane
neck of femur介於fibrous capsule & articular cartilage of
head之間
nonarticular area of acetabulum
providing a covering for ligament of femoral head
Movements
flexion/extension
-- the degree of flexion & extension depends on the position of the
knee
【If the knee is flexed relaxing the hamstrings, the thigh can be
moved toward the anterior abdominal wall. During extension, the
fibrous capsule, especially the iliofemoral ligament, is taut; therefore,
the hip can usually be extended only slightly beyond the vertical.】
abduction/adduction
-- abduction is usually freer than adduction
rotation
-- 1/6 circle when the thigh is extended and more when it is flexed
-- lateral rotation is much powerful than medial rotation
circumduction
Blood supply
medial & lateral circumflex femoral arteries femoral artery
-- main blood supply of hip joint
artery to femur head obturator artery
Nerve supply
femoral n.
anterior division of
obturator n.
superior gluteal n.
nerve to quadratus
femoris
Fracture of neck of femur
-- 為最麻煩的骨折種類
-- 常會傷及medial circumflex femoral artery，若不
加以治療則會形成aseptic vascular necrosis
（無菌性壞死）
Dislocation of hip joint
-- congenital dislocation發生率
約萬分之15，兩側的約佔一
半。特徵是inability to abduct
the thigh
-- acquired dislocation不常見，
若發生時最常見者為posterior
dislocation；有時也會傷及
sciatic nerve