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歐陽品教 授 12/01/2015 Lower Limb 3: Gluteal Region Gluteal region: posterior to the pelvis and inferior to the level of the iliac crest
Surface anatomy
line between 2 iliac crests-----L4
line between 2 post. Sup. Iliac spines -----S2
tip of coccyx------- level with greater trochenter
ischial tuberosity------at level with lesser trochanter
Hip bones (Os Coxae): fused at 16th year
1. Ilium
Dorsum ilium (alae) : origin of gluteal muscles from gluteal lines
Iliac crest
iliac fosssa
anterior superior iliac spine (ASIS): sartorius m.
anterior inferior iliac spine (AIIS) : origin of rectus femoris m.
posterior superior iliac spine
posterior inferior iliac spine
greater and lesser sciatic notch
2. ischium
ischial tuberosity: sacrotubulous ligament
ischial spine: sacrospinous ligament
ramus: part of ischiopubic ramus
3. pubis
pubic crest
pubic tubercle
superior ramus
pectin pubis: part of brim of pelvis minor, give rise to pectinus m.
inferior ramus
1. Acetabulum
acetabulum fossa: central non‐articular part, formed mainly by ischium
acetabulum notch: missing inferior segment of acetabular rim
transverse acetabular ligament : covert notch into acetabular foramen
acetabulum labrum : attaches to acetabulum ring and transcerse acetabular
ligament, forms a complete ring around the femur head
2. ligament of head (ligamentum teres) : synovial membrane transmits blood vessels to the head of the femur
3. fibrous capsule and ligaments
iliofemoral ligament : attach to ant. Inf. Iliac spine and intertrochanteric line of femur, deep to origin of rectus femoris m., prevent hyperextension
pubofemoral ligament
ischiofemoral ligament: weakest one
4. blood supply
medial and lateral femoral circumflex a.
obturator a.
Movements of the Hip Joint
Gateway to the lower limb: a review
Superficial structure: abductor and medial rotators of the thigh
1. gluteus maximus m.
origin : line between post. sup. iliac spine and coccyx
insertion : gluteal tuberosity (deep part) and iliotibila tract (superficial part)
innervation : inferior gluteal n.
function : great extensor of the hip joint
2. glutei medius and minimus m.
3. tensor fascia lata m.
4. Clunial (superficial gluteal ) n.
superior clunial n.
middle clunial n.
inferior clunial n.
Deep structure
1. greater sciatic foramen : main door for the passage of structure from pelvis to gluteal region
2. lesser sciatic foramen
piriformis m.
* superior gluteal n. and a. : supply 3 abductor m.
# inferior gluteal n. and a.
# sciatic n.
# posterior cutaneous n. of thigh
# n. to quadratus femoris m.
@ n. to obturator internus m.
@ internal pudendal vessels
@ pudendal n. : behind sacrospinous ligament
* above piriformis m.
# and @ below piriformis m.
@ via lesser sciatic foramen to ischiorectal fossa
3. lateral rotators quadratus femoris
obturator internus
superior gemelli
inferior gemelli
obturator externus
Relationship of Sciatic Nerve to Piriformis Muscle Intragluteal Injection