Inner ring of the femoral canal. Single channel (canalis femoralis). Topography of the femoral canal. Femoral canal openings. Thigh ring. The walls of the femoral canal. Femoral hernia and how to correct it

MUSCULAR AND VASCULAR LACKS

Behind the inguinal ligament are muscle and vascular lacunae, which are separated by the ilio-comb arch. The arch extends from the inguinal ligament to the ilio-pubic eminence.

Muscle lacuna located laterally from this arch, bounded in front and above by the inguinal ligament, behind by the ilium, and on the medial side by the ilio-comb arch. Through the muscle lacuna, the iliopsoas muscle along with the femoral nerve emerges from the pelvic cavity into the anterior region of the thigh.

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

On the front of the thigh, there is femoral triangle (Scarpa's triangle), bounded at the top by the inguinal ligament, from the lateral side by the sartorius muscle, medially by the long adductor muscle. Within the femoral triangle, under the superficial leaflet of the wide fascia of the thigh, a well-defined ilio-comb groove (fossa) is visible, limited from the medial side by the comb, and from the lateral side - by the ilio-lumbar muscles covered with the ilio-comb fascia (deep plate of the wide fascia of the thigh) ... In the distal direction, the specified groove continues into the so-called femoral groove, from the medial side it is limited by the long and large adductor muscles, and from the lateral side - by the medial broad muscle of the thigh. Below, at the apex of the femoral triangle, the femoral groove passes into the adductor canal, the inlet of which is hidden under the sartorius muscle.

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

Control questions for the lecture:

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

2. Anatomy of the white line of the abdomen.

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

4. The process of formation of the inguinal canal in connection with the descent of the sex gland.

5. The structure of the inguinal canal.

6. The process of forming straight and oblique inguinal hernias.

7. The structure of the lacunae: vascular and muscular; scheme.

8. The structure of the femoral canal.

Normally, this is a slit-like space called femoral ring, filled with loose connective tissue tissue medial to the vascular lacuna.

· Closed from above by a lymph node.

· From the side of the abdomen, it is closed by the peritoneum, which in this place forms a fossa - fossa femoralis.

Thigh ring(annulus femoralis) is formed:

laterally- femoral vein (v. femoralis),

top and front- lig. inguinale and upper horn (cornu superius) of the crescent edge of fascia lata,

medially- a continuation of the lateral leg lig. inguinale, rolled down - lacunar ligament(lig. lacunare),

bottom and back- continuation of the lacunar ligament along os pubis - comb ligament (lig.pectineale).

With the formation of a femoral hernia, a canal is formed, which will have three walls and two holes - internal and external.

· Femoral canal walls:

lateral- femoral vein (v. femoralis);

back- deep leaf fascia lata;

front- lig. inguinale and cornu superius crescent edge fascia lata.

Femoral canal openings:

- inner hole(entrance) - this is the femoral ring described above, corresponds to the location of the lateral inguinal fossa on the peritoneum of the anterior abdominal wall.

- outer hole(output) - corresponds to the subcutaneous fissure (area of the oval fossa), limited:

laterally - crescent edge (margo falciformis),

above - the upper horn of the crescent edge (cornu superius margo falciformis)

from below - the lower horn of the crescent edge (cornu inferius margo falciformis)

The anatomical and physiological prerequisites for the occurrence of femoral hernias are the stretching of the ligamentous apparatus of the femoral canal region, which, first of all, is facilitated by an increase in intra-abdominal pressure caused by repeated pregnancies, coughs, constipation, obesity and hard physical labor. Of particular importance is the weakening of the lacunar ligament, which in older women often looks flabby, saggy and easily yields to the pressure of the hernial protrusion.

In the occurrence of rare forms of femoral hernias, the main role is played by a congenital predisposition in the form of defects in the ligamentous-aponeurotic apparatus and protrusions of the peritoneum. Of some importance is trauma, in particular dislocation of the hip or reduction of congenital dislocation of the hip.

In the process of formation, a femoral hernia goes through three stages:

1) initial, when the hernial protrusion does not extend beyond the inner femoral ring. This stage of hernia is clinically difficult to distinguish, and at the same time, insidious parietal (Richter) infringements can be noted at this stage,

2) incomplete (canal), when the hernial protrusion does not go beyond the surfaces of the fascia, does not penetrate into the subcutaneous fatty tissue of the Scarpa triangle, but is located near the vascular bundle. With this form of hernia, the search for the hernial sac during surgery is usually difficult;

3) complete, when the hernia passes through the entire femoral canal, its internal and external opening and enters the subcutaneous tissue of the thigh. This stage of hernia is most often observed.

The contents of femoral hernias are usually small bowel loops or omentum. Less often, a large intestine is found in the hernial sac, on the left - the sigmoid, on the right - the blind. Sometimes the bladder comes out into the hernia. Occasionally, the contents of a femoral hernia can be an ovary with an appendage, and in men, a testicle.

According to the passage of the vessels and nerves, the following grooves and channels are distinguished on the lower limb:

Femoral canal, canalis femoralis does not exist normally and is formed

in the formation of a femoral hernia. The entrance hole for this hernia

serves as a gap in the medial corner of the lacuna vasorum, the so-called femoral

ring, anulus femoralis, limited on the lateral side of the femoral

noah, front and top lig. inguinale, behind - lig. pectineale and medially - lig.

lacunare. The femoral ring is made of connective tissue (loosened

transverse fascia, fascia transversalis) and covered outside by lymph nodes

crowbar, and from the side of the abdominal cavity with a sheet of peritoneum, which, sagging over

the edges of the femoral ring forms femoral fossa, fossa femoralis. After passing

on the thigh, the hernia comes out through the outlet of the femoral canal, called

required subcutaneous fissure, hiatus saphenus.

Hiatus saphenus- this is a hole in the wide fascia of the thigh, surrounded by a tone

coy, loose (with holes) plate occupying an oval-shaped area

(fascia cribrosa). It separates from the rest of the denser part of the surface

leg leaf of the fascia lata of the thigh using the so-called sickle

edges, margo falciformis, which distinguishes upper and lower horns, cornu

superius and cornu inferius. Through the lower horn, cornu inferius is thrown

great saphenous vein, v. saphena magna and flows into the femoral vein, v.

In case of femoral hernia formation the walls of the femoral canal are

are: v. femoralis (lateral wall), a deep leaf of the fascia lata

thighs (back wall), cornu superius (front wall). At a low confluence v.

saphena magna in v. femoralis, the anterior wall will be superficial

leaflet of the fascia lata of the thigh.

INTRODUCTION - E. S. Okolokulak ………………………………… ... 4

Principles of the structure of hollow organs …………………….… 5

Principles of the structure of parenchymal organs ……… ..… 8

DIGESTIVE SYSTEM. - E. S. Okolokulak 9

General data ………………………………………… .......… 9

Oral cavity ………………………………………………… ... 9

Language …………………………………………………………… 10

Teeth……………………………………………………………. eleven

Glands of the mouth …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… [[/ about him his himself his he himself his himself his he himself only himself his man himself) …………………………………………………………………………………………………………………………………………………………………………………………………………………… 11

Pharynx ………………… .. ……………………………………… 12

Esophagus ………………… .. …………………………………… 13

Abdominal cavity ………… ... ………………………………… 14

Stomach ……………………… .. ……………………………… 15

Small intestine …………………. ……………………………… 16

Large intestine ……………………………………………… 17

Liver …………………………. ……………………………… 19

Gallbladder ……………………………………………… 21

Pancreas ……… .. ……………………………… 22

Peritoneum …………………………. …………………………… 23

Development of the digestive system. Developmental anomalies ... 25

RESPIRATORY SYSTEM. - K. M. Kovalevich 26

General data ………………………………………………… 26

Upper respiratory tract ………………………………… .. 27

Nose ………………………………………………………… ....... 27

Nasal cavity …………………………………………… .......... 28

The paranasal (paranasal) sinuses of the nose …………………. 29

Lower respiratory tract ………………………………… ... 30

Larynx ………………………………………………………… 30

Laryngeal cavity ……………………………………………. 33

Trachea ………………………………………………………… .. 34

Main bronchi …………………………………………… .. 34

Lungs…………………………………………………………. 34

Pleura…………………………………………………………. 37

Mediastinum …………………………………………………… 38

Respiratory development. Developmental anomalies …………… 39

UROGENITAL SYSTEM - E. S. Okolokulak 40

Total information................................................ ........................... 40

Urinary organs ................................................ ....................... 41

Malformations of the urinary organs ......................................... 46

Genital organs ................................................ ........................ 47

Male genital organs ............................................... .47

Female genital organs ............................................... .. 49

Development of the genitals ............................................... ........ 54

The mechanism of descent of the testicle ............................................... ....... 55

Malformations of male genital organs .......................... 55

Malformations of female genital organs ........................... 56

Crotch................................................. ............................. 56

THE TEACHING ABOUT THE VASCULAR SYSTEM - ANGIOLO-

GIA (ANGIOLOGIA) ………………………………………….

HEART AND BLOOD VESSELS (ARTERIES) -

P. M. Lozhko ………………………………………………….

General data ………………………………………………… .. 59

Heart …………………………………………………………… 59

Pericardium ………………………………………………………… 64

Heart development …………………………………………………. 65

Vessels of the small (pulmonary) circle of blood circulation ………… 65

Blood vessels of the systemic circulation ... ... ... 66

VENOUS AND LYMPHATIC SYSTEMS - S. A.

Sidorovich ………………………………………………………

Venous system General information ……………………………. 77

Veins of a large circle of blood circulation ……………………… .. 78

Brachiocephalic veins ………………………………………… 78

Veins of the head and neck …………………………………………… ... 78

Veins of the upper extremity ……………………………………… 79

Chest veins …………………………………………… 81

The system of the inferior vena cava ………………………………… ... 82

Veins of the pelvis and lower extremities ………………………………. 83

Abdominal veins ………………………………………………… .. 84

Fetal circulation ………………………………………… 85

Lymphatic system …………………………………………. 87

Lymph nodes of certain areas of the body ……………… 91

Central organs of the immune system …………………… .. 93

Peripheral organs of the immune system ………………… 94

TEACHING ABOUT THE NERVOUS SYSTEM - NEUROLOGY

(NEVROLOGIA) …………………………………………….

General information - M. N. Shcherbakova ………………………… .. 97

CENTRAL NERVOUS SYSTEM - M.N. Shcherba-

kova ………………………………………………………………

Spinal cord ………………………………………………… 97

Brain ………………………………………………… ... 103

Hindbrain …………………………………………………… ... 104

Midbrain ……………………………………………………. 108

Forebrain ………………………………………………… ... 109

The membranes of the brain …………………………………… ... 115

The pathways of the nervous system ……………………………. 116

PERIPHERAL NERVOUS SYSTEM ……………… ... 120

SPINAL NERVES - Ect. Goncharova ........ ……. 120

Cervical plexus ................................................ .......... ………… ... 121

Brachial plexus ................................................ .....................… .. 122

Anterior branches of the pectoral nerves .............................................. ....... 122

Lumbar plexus ................................................ ...................... 123

Sacral plexus ................................................ ........ ………… 124

Coccygeal plexus ................................................ .............. ……. 126

CRANIAL NERVES - J.E. Silently ................................... ... .. 126

VEGETATIVE NERVOUS SYSTEM - M.N. Shcherba-

kova .......... ………………………………………………. ……… ..

The sympathetic division of the vegetative nervous system.............…. 138

Parasympathetic division of the autonomic nervous system .......... 142

Vegetative innervation of organs ............................................ ... .. . 144

ORGANS OF SENSES - J.A. Chavel .................................. ... ... 148

The organ of vision ................................................ ..................................… 148

The organ of hearing and balance .............................................. ..............…. 149

Olfactory organ................................................ .............................…. 153

The organ of taste ................................................ ................................... ... .. 153

General cover ................................................ ...............................…. 153

LITERATURE…………………………………………………….. 154

THE TEACHING ABOUT THE INTERIOR - SPLANCHNOLOGY

(SPLANCHNOLOGIA)

INTRODUCTION

Splanchnology is the doctrine of the viscera. Insides, viscera

seu splanchna - these are organs, for the most part located inside

human body cavities. As you know, body cavities are in the area

chest and abdomen. The main organs of the chest cavity are the heart,

lungs, thymus gland, esophagus. Most organs are contained in

the abdominal cavity is the stomach, liver, pancreas, thin

intestine, colon, spleen, kidneys, adrenal glands, ureters,

chevy bladder, prostate gland (in men); uterus, ovaries, uterine

nye pipes (for women). However, not all organs are located within cavities.

bodies, some of them are located outside. These bodies include

Xia external genital organs in men and women. Some of the organs lie in

head and neck area. In the neck area there are such internal organs,

as the larynx, pharynx, thyroid, parathyroid glands, as well as part

esophagus. In the head area are the tongue, teeth, salivary glands, etc.

Judging by the listed organs, organs are referred to the viscera

digestive, respiratory, genitourinary systems, part of the endo-

krinny system and the heart, as the central organ of the cardiovascular

systems. The brain and spinal cord are currently not

The listed organs have various shapes, sizes and, in most

in most cases, perform specific functions. Internal

structure, many organs can be divided into two groups: tubular and pa-

renchymal. Tubular, or hollow, organs are fundamentally

a similar structure of the wall and contain a cavity inside. Such bodies are

are: esophagus, stomach, small intestine, ureter, etc.

renchymal organs are organs built from the same con-

mass (parenchymal) systems such as liver, kidney, pancreas

iron, etc. Only a few organs differ in their specific structure

niya. These include: tongue - a muscular organ; teeth built from

hard tissues; the prostate gland is a mixed organ

(muscle-parenchymal-tubular).

Given the complex structure of internal organs, it is proposed to

dimensional plan for the study of organs:

1) external morphological data of the organ: shape, configuration; once-

measures; density (consistency); weight; 2) the external structure of the organ: hour-

ty, departments; surfaces; edges, poles, furrows; 3) internal structure

organ: spatial organization of tissues (histotopography); structure

building elements (structural units); 4) organ topography: holotho-

pia (projection of an organ onto the surface of the body - skin); skeletotopy (projection

organ on the skeleton); syntopy (attitude towards neighboring organs); 5) data

intravital morphological research methods of a specific

oprana: X-ray anatomy; echolocation; computer and magnetic

resonance tomography, etc. 6) organ function; 7) circulatory and lim-

phatic vessels; 8) innervation of the organ.

Issues of blood supply and innervation of internal organs will

considered in the sections "Angiology" and "Anatomy of the peripheral

nervous system ".

The shape, external structure and position of internal organs are subject to

wife and individual variability. In addition, when examining pain

and surgical interventions, it is necessary to take into account the age

features of the structure of organs. Sexual differences in size, shape and

organ structures primarily concern the genitourinary system.

The position of the organs is largely determined by the body type of the person.

love. So, for example, with normosthenic, or mesomorphic, type

physique, the stomach has the shape of a hook, with asthenic, or

homorphic, - it is elongated and located vertically in the form of stockings

ka, but with a hypersthenic, or brachymorphic, physique, the stomach

lies transversely in the shape of a horn.

The femoral canal does not exist normally... It is formed when femoral hernias emerge through the femoral ring, then between the lamellar fascia of the thigh and through the hiatus saphenus under the skin. This canal leads from the abdominal cavity to the anterior surface of the thigh and has two holes and three walls.

Inner hole the femoral canal (femoral ring) is limited: in front- inguinal ligament; outside- the vagina of the femoral vein; from within- lacunar ligament (lig. Gimbernati); behind- comb ligament (lig.pubicum Cooperi).

Under certain conditions, preperitoneal lipomas can penetrate here, which is a prerequisite for the formation of femoral hernias. When performing femoral hernia operations, remember that the medial wall of the femoral ring can bend around a. obturatoria with her atypical departure from. epigastrica inferior (approximately in "/ 3 cases). This gave rise to calling this option coronamortis("Crown of death"), since damage to the obturator artery is accompanied by severe internal bleeding.

Outer hole femoral canal - hiatus saphenus

- is a subcutaneous fissure in the superficial layer of the wide fascia of the thigh, closed by a lattice plate, through which blood and lymphatic vessels pass. The edges hiatus saphenus formed by the crescent edge of the wide fascia of the thigh, the lower and upper horns of the wide fascia.

The femoral canal has the shape of a trihedral prism in cross section. Front his wall formed by a superficial lamina of a wide fascia; lateral- the connective tissue sheath of the femoral vein; back- a deep leaf of the wide fascia of the thigh (fascia pectinea). The length of the femoral canal within 1-2cm.

Femoral triangle

The femoral triangle is formed by: above- inguinal ligament (base of the femoral triangle); laterally- tailor muscle; medially- the long adductor muscle. Under the superficial leaflet of the fascia lata in the femoral triangle, the femoral artery and vein are surrounded by a common sheath.

At the base of the triangle femoral vein lies medialbut, femoral artery - laterally, femoral nerve - outward from the artery under the deep leaf of the broad fascia. To the apex of the femoral triangle, the vein deviates posteriorly from the femoral artery.

Femoral nerve 3-4 cm downward from the inguinal ligament is divided into muscle and skin branches. The largest cutaneous branch of the femoral nerve is n.saphenus, which further accompanies the femoral artery.

Femoral artery is a continuation of the external iliac artery. In the vascular lacuna, it is located on the pubic bone, where bleeding from its branches can be pressed. From the femoral artery in the triangle departs deep thigh artery– the main collateral in the development of roundabout blood circulation. Its branches are a. circumflexa femoris lateralis and a. circumflexa femoris medialis.

Femoral bottomtriangle are the iliopsoas and comb muscles, the edges of which form the sulcus iliopectineus. It passes into the sulcus femoralis anterior in the middle third of the thigh. Under their own fascia they pass here

femoral vessels and saphenus, covered by the sartorius muscle. Three perforating arteries branch off from the deep artery of the thigh, which go through the intermuscular septa into the posterior fascial bed of the thigh.

Leading channel(canalis adductorius) is a continuation of the anterior groove of the thigh. It is located underfascia la-ta and is covered in front by the sartorius muscle. Frontwall channel - aponeurotic plate (lamina vastoadductoria) between m. vastus medialis and m. adductor magnus; lateral wall- m. vastus medialis; medial- m. adductor magnus.

The channel has three holes... Across top(input) hole the channel is the femoral artery, the femoral vein and n. saphenus. Вlamina vastoadductoria is located front opening through which n exit the channel. saphenus and a. genus descendens.

In the adductor canal in relation to the femoral artery

n. saphenus lies on its anterior wall, behind the ileal artery, the femoral vein is defined.

The femoral vessels leave the adductor canal into the popliteal fossa through the tendon fissure of the adductor major muscle (hiatus adductorius), which is lower(weekend) hole channel.

The leading channel can serve place of transition of purulent processes from the front to the back of the thigh, the popliteal fossa and back. For example, pus from the hip joint, adenophlegmon from the femoral triangle and from the popliteal fossa through the inferior opening can spread here.

Locking channel(osteo-fibrous) formed furrowed on the lower surface of the pubic bone and attached along its edges obturator diaphragm. External hole the canal is located behind the comb muscle 1.5 cm downward from the medial part of the inguinal ligament. Deep(pelvic) hole the canal faces the prevesical cellular space of the pelvis. Channel length - 2-3 cm... Through the obturator canal on the thigh, the vessels of the same name and the nerve leave the adductor muscles.