Femoral canal. Its walls and rings (deep and subcutaneous). Practical significance. Subcutaneous fissure (“oval” fossa) What forms the subcutaneous opening of the femoral canal

The femoral canal (canalis femoralis) is 1-3 cm long and has three walls. The lateral wall of the canal is formed by the femoral vein, the anterior wall by the crescent-shaped edge and the superior horn of the fascia lata (thigh). The posteromedial wall of the canal is formed by a deep layer of fascia lata, covering the pectineus muscle in this place. The subcutaneous ring (anulus saphenus) of the femoral canal is limited on the lateral side by a crescent-shaped edge and closed by a thin ethmoid fascia (fascia cribrosa). The deep femoral ring, which normally contains a small amount of loose tissue and the Pirogov-Rosenmüller lymph node, has four walls. The anterior wall of the deep ring is the inguinal ligament, the lateral wall is the femoral vein, the medial wall is the lacunar ligament (lig.lacunare), the posterior wall is the pectineal ligament (lig.peclinale), which is a periosteum reinforced by fibrous fibers in the crest of the pubic bone. The lacunar ligament is formed by connective tissue fibers that extend from the medial end of the inguinal ligament posteriorly and laterally along the edge of the superior ramus of the pubis. These fibrous fibers round off the acute angle between the medial end of the inguinal ligament and the pubic bone.

There are important topographic formations on the anterior surface of the thigh. It is primarily the femoral triangle, bounded by the adductor longus muscle (medially), the sartorius muscle (laterally), and the inguinal ligament (superior). Through this triangle under the skin and under the superficial layer of the fascia lata of the thigh passes iliopectineal groove(sulcus iliopectineus), limited on the lateral side by the iliopsoas muscle, and on the medial side by the pectineus muscle. The femoral artery and femoral vein are adjacent to this groove. The groove continues downward into the femoral-popliteal, or adductor (gunter) canal (canalis adductorius), through which the femoral artery, vein and saphenous nerve pass. The walls of the adductor canal are the vastus medialis (laterally) and the adductor magnus (medially). The anterior wall of the adductor canal is a fibrous plate stretched between these muscles (lamina vastoadductoria, BNA). This plate has an opening - the tendon gap (hiatus tendineus), through which the saphenous nerve and the descending genicular artery emerge from the canal onto its anteromedial wall. The femoral artery and vein pass through the lower opening of the canal, formed by the tendon of the adductor magnus muscle and the posterior surface of the femur and opening into the popliteal fossa from above. The muscles on the thigh are covered by fascia lata.

MUSCULAR AND VASCULAR LACUNA

Behind the inguinal ligament there are muscular and vascular lacunae, which are separated by the iliopectineal arch. The arc extends from the inguinal ligament to the iliopubic eminence.

Muscle lacuna located lateral to this arch, limited anteriorly and superiorly by the inguinal ligament, posteriorly by the ilium, and on the medial side by the iliopectineal arch. Through the muscle lacuna, the iliopsoas muscle exits from the pelvic cavity into the anterior region of the thigh along with the femoral nerve.

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

On the anterior surface of the thigh there is femoral triangle (Scarpa's triangle), bounded above by the inguinal ligament, on the lateral side by the sartorius muscle, and medially by the adductor longus muscle. Within the femoral triangle, under the superficial layer of the fascia lata of the thigh, a well-defined iliopectineal groove (fossa) is visible, bounded on the medial side by the pectineus muscle, and on the lateral side by the iliopsoas muscles, covered by the iliopectineal fascia (deep plate of the fascia lata of the thigh) . In the distal direction, this groove continues into the so-called femoral groove, on the medial side it is limited by the long and large adductor muscles, and on the lateral side by the vastus medialis muscle. 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 area of the femoral triangle during the development of a femoral hernia. This is a short section medial to the femoral vein, extending from the femoral internal ring to the saphenous fissure, which, in the presence of a hernia, becomes the external opening of the canal. The internal femoral ring is located in the medial part of the vascular lacuna. Its walls are anteriorly - the inguinal ligament, posteriorly - the pectineal ligament, medially - the lacunar ligament, and 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. The femoral canal has 3 walls: the anterior - the inguinal ligament and the upper horn of the falcate edge of the fascia lata fused with it, the lateral - the femoral vein, the posterior - the deep plate of the fascia lata covering the pectineus muscle.

Test 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 gonad.

5. Structure of the inguinal canal.

6. The process of formation of direct and oblique inguinal hernias.

7. Structure of lacunae: vascular and muscular; scheme.

8. Structure of the femoral canal.

MUSCULAR AND VASCULAR LACUNA

Behind the inguinal ligament there are muscular and vascular lacunae, which are separated by the iliopectineal arch. The arc extends from the inguinal ligament to the iliopubic eminence.

Test 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 gonad.

5. Structure of the inguinal canal.

6. The process of formation of direct and oblique inguinal hernias.

7. Structure of lacunae: vascular and muscular; scheme.

8. Structure of the femoral canal.

Femoral canal located between the superficial and deep layers of the fascia lata. Femoral canal has two holes- deep and superficial, and three walls. The deep opening of the femoral canal is projected onto the inner third of the inguinal ligament. The superficial opening of the femoral canal, or subcutaneous fissure, hiatus saphenus, is projected 1-2 cm downward from this part of the inguinal ligament.

A hernia emerging from the abdominal cavity enters the canal through deep hole - thigh ring, anulus femoralis. It is located in the very medial part of the vascular lacuna and has four edges.

Front thigh ring limited by the inguinal ligament, posteriorly by the pectineal ligament, lig. pectineale, or Cooper's ligament, located on the crest of the pubic bone (pecten ossis pubis), medial lacunar ligament, lig. lacunare, located in the angle between the inguinal ligament and the crest of the pubic bone. On the lateral side it is limited by the femoral vein.

Thigh ring facing the pelvic cavity and on the inner surface of the abdominal wall is covered by the transverse fascia, which here has the appearance of a thin plate, septum femorale. Within the ring is the deep inguinal lymph node Pirogov-Rosenmüller.

Superficial ring of the femoral canal (hole) is subcutaneous fissure, hiatus saphenus, a defect in the superficial layer of the fascia lata. The hole is closed by the cribriform fascia, fascia cribrosa (Fig. 4.8).

Walls of the femoral canal

Walls of the femoral canal They are a three-sided pyramid.

Anterior wall of the femoral canal formed by the superficial layer of the fascia lata between the inguinal ligament and the upper horn of the subcutaneous fissure - cornu superius.

Lateral wall of the femoral canal- medial semicircle of the femoral vein.

Posterior wall of the femoral canal- a deep layer of fascia lata, which is also called fascia iliopectinea.

Medial wall of the femoral canal no, since the superficial and deep layers of fascia at the long adductor muscle grow together.

Femoral canal length(the distance from the inguinal ligament to the superior horn of hiatus saphenus) ranges from 1 to 3 cm.

Obturator canal (canalis obturatorius). Topography of the obturator canal. Openings of the obturator canal. Contents of the obturator canal.

Obturator canal It is a groove on the lower surface of the pubic bone, limited from below by the obturator membrane and muscles attached to its edges.

External opening of the obturator canal is projected 1.2-1.5 cm downward from the inguinal ligament and 2.0-2.5 cm outward from the pubic tubercle.

Deep (pelvic) opening of the obturator canal facing the prevesical cellular space of the small pelvis. The external opening of the obturator canal is located at the upper edge of the external obturator muscle. It is covered by the pectineus muscle, which must be dissected when accessing the obturator canal. Obturator canal length- 2-3 cm, the vessels and nerve of the same name pass through it. The obturator artery anastomoses with the medial circumflex femoral artery and the inferior gluteal artery.

Anterior and posterior branches of the obturator nerve innervate the adductor and gracilis muscles, as well as the skin of the medial surface of the thigh.

Anterior groove of the thigh (sulcus femoris anterior). Topography of the anterior femoral groove. Contents of the anterior femoral groove. What passes in the anterior groove of the thigh?

Inferiorly, the femoral triangle passes with its apex into anterior femoral groove, sulcus femoris anterior, located in its middle third between the adductor muscles and m. quadriceps femoris.

The fascia lata forms for superficially located muscles, mm. rectus femoris, sartorius et gracilis, cases. The fascia gives off to the femur the internal intermuscular septum, septum intermusculare femoris mediale, covering the anterior surface of the adductor muscles and separating the anterior bed of the thigh from the medial one. Another septum, septum intermusculare femoris laterale, separates the anterior bed from the posterior one.

In the anterior fascial bed of the thigh, compartimentum femoris anterius, are the heads of the quadriceps muscle: rectus, m. rectus femoris, vastus medialis, vastus medialis, vastus lateralis, m. vastus lateralis, and vastus intermedius muscle, m. vastus intermedius, which unite downwards into one tendon, passing onto the patella, and then attaching to the tuberositas tibiae. In the medial bed of the thigh, compartimentum femoris mediale, there are the long, short and magnus adductor muscles, mm. adductores longus, brevis et magnus.

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

· Closed at the top by a lymph node.

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

Thigh ring(annulus femoralis) formed:

laterally- femoral vein (v. femoralis),

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

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

below and behind– continuation of the lacunar ligament along os pubis - pectineal ligament (lig. pectineale).

When a femoral hernia forms, a canal is formed that will have three walls and two openings - internal and external.

· Walls of the femoral canal:

lateral- femoral vein (v. femoralis);

back- deep leaf fascia lata;

front– lig. inguinale and cornu superius of the crescent-shaped edge of the fascia lata.

Femoral canal openings:

- internal hole(input) - 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 to:

laterally – crescent-shaped edge (margo falciformis),

above – upper horn of the falciform edge (cornu superius margo falciformis)

from below – lower horn of the falciform edge (cornu inferius margo falciformis)

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

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

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

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

2) incomplete (canal), when the hernial protrusion does not extend beyond the surfaces of the fascia, does not penetrate the subcutaneous fatty tissue of Scarpa's triangle, but is located near the vascular bundle. With this form of hernia, searching for the hernial sac during surgery usually causes difficulties;

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

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

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