| | | | 2.2.3. Apaks topografiskie veidojumi un to saturs Topogr: mugurpusé Foramen suprapiriforme izveidojas__iegurna mugurpusé, bumbierveida muskulim (m. piriformis) izejot pa foramen ischiadicum majus; ta savieno iegurna dobumu ar regio glutea. Foramen suprapiriforme norobezo: no augsas — foramen ischiadicum majus, bet no apaksas — m. piriformis augseja mala, Pa So atveri iet n. gluteus superior, a. glutea superior, v. glutea superior: Foramen infrapiriforme atrodas zem m. piriformis. To norobezo: no apakéas ~ foramen ischiadicum majus, bet no augsas—m. piriformis apakSéja mala. Pa foramen infrapiriforme iet n. ischiadicus, n. cutaneus femoris posterior, n. gluteus inferior, plexus sacralis zari, kas inervé m. piriformis, m. obturatorius internus, m. gemellus superior et inferior un m. quadratus femoris; a. glutea inferior, v. glutea inferior, n. pudendus, a. pudenda interna, wv. pudendae internae. ie veidojumi apak’éjas ekstremitates Foramen ischiadicum minus norobez0 lig. sacrotuberale, lig. sacrospinale un incisura ischiadica minor. Si atvere savieno iegurma dobumu ar fossa ischioanalis. Pa to iet m. obturatorius. internus, 1 pudendus, a. pudenda interna, ve, pudendae internae. Fossa ischioanalis. Piltuvveidiga diaphragma pelvis izveido wz m. levator ani apakSéjas virsmas abpuséju padzijinajumu. Lateral to norobeso tuber ischiadicum, m. obturatorius internus un t& fascija, mediali~m. levator ani ar fascia diaphragmatis pelvis inferior un m. sphincter ani externus, mugurpusé ~ m. gluteus maximus apak8éja mala. Fossa ischioanalis pilda taukaudi un saistaudi - corpus adiposum fossae ischioanalis. Pa tas lateralo sienu fascia obturatoria dublikatiir’ (canalis pudendalis) iet n. pudendus un vasa pudenda interna. Topografiskie veidojumi apakSéjas ekstremitates priekSpusé Sledzejkanals (canalis obturatorius) ir 2-3 cm gars kanal, kas savieno ieguma dobumu ar augsstilba prieksejo virsmu. No augSpuses to norobezo ramus superior ossis pubis (ar sulcus obturatorius), no apakSpuses — membrana obturatoria, m. obturatorius internus un m. obturatorius externus augséja mala. Kanals beidzas dorsali no m. pectineus — starp to un m. adductor brevis. Cauri kanalam iet n. obturatorius, a. obturatoria, vv. obturatoriae. CILVEKA ANATOMIJA: roka un kaja 2.2.3. Topographical formations of the lower limb and its contents Topographical formations on the posterior region of the lower limb Foramen suprapiriforme is placed on the posterior side of the gluteal region above m. piriformis. It unites the pelvic cavity and the gluteal region. The ischium bone limits the upper margin of foramen suprapiriforme and m. piriformis (upper margin) limits the lower margin of foramen suprapiriforme. N. gluteus superior, a. glutea superior, v. glutea superior pass through foramen suprapiriforme. Foramen infrapiriforme is placed below m. piri- ‘formis and is larger then the foramen suprapiriforme. ‘The ischium bone limits the lower part of foramen infrapiriforme and m. piriformis (lower margin) limits the lower margin of foramen infrapiriforme. N. ishiadicus, rn, cutaneus femoris posterior, n. gluteus inferior, plexus sacralis branches that innervate. m._piriformis, m. obturatorius internus, m. gemellus superior et inferior and m. quadratus femoris; a. glutea inferior, v. glutea inferior, n. pudendus, a. pudenda interna, vv. pudendae internae pass through foramen infrapiriforme. Foramen ishiadicum minus is surrounded by ligamentum sacrotuberale, ligamentum sacrospinale and incisura ishiadica minor. It unites the pelvic cavity and fossa ischioanalis, M. obturatorius intermus, n. pudendus, a. pudenda interna, vv. pudendae internae pass through it, Fossa ischioanalis is a conic shape formation that is limited by diaphragma pelvis and the m. levator ani. Fossa ischioanalis is surrounded by tuber ischiadicum, ‘m. obturatorius internus and its fascia (laterally), m. levator ani with fascia diaphragmatis pelvis inferior, m. sphincter ani externus (medially) and lower margin of m. gluteus maximus (posteriorly). There is fat body of ischio-anal fossa (corpus adiposum fossae ishioanalis) in ischio-anal fossa. N. pudendus and vasa pudenda interna pass along the lateral wall into the dublicature of the fascia obturatoria (canalis pudendalis). Topographical formations on the anterior region of the lower limb The obturator canal (canalis obturatorius) is about 2-3 em long. It unites the pelvic cavity and the anterior region of the thigh. Canalis obturatorius is. surrounded by the pubis — ramus superior assis pubis (there is sulcus obturatorius) from above. Membrana obturatoria, m. ob ratorius intermus, m. obturatorius externus upper mangin limit canatis obturatorius from the lower part. The terminate part of the channel is placed dorsally between m. pectineus and m. adductor brevis, N, obturatorius, a. obturatoria, vw: obturatoriae pass through the canalis obturatoriusAPAKSEJA EKSTREMITATE / LOWER LIMB / mem 76. att. Musculi lumbricales et musculi interossei pedis.154 Asinsvadu sprauga (lacuna vasorum). Spraugu starp os coxae un lig. inguinale zarnkaula muskula fascijas (fascia iliaca) sabiezinajums (arcus ilio- pectineus) sadala divas telpas: lacuna musculorum ~ laterali un lacuna vasorum ~ mediali Lacuna vasorum norobezo: augSa un priekSpusé — ligamentum inguinale; \eji un mugurpusé — lig. pectineale, pecten ossis pubis, ramus superior ossis pubis; laterali — arcus iliopectineus; mediali — lig. lacunare. Sas lakiinas saturs ir a. femoralis, ramus femoralis n. genitofemoralis, v. femoralis (lateromediala seciba). Lakinas mediailaja treSdala atrodas anulus femoralis, kuru no védera dobuma puses sedz septum femorale un nodus Iymphoideus inguinalis profundus Pirogovi (Cloquet, Rosenmiilleri). Muskuju sprauga (lacuna musculorum) ir sprauga zem lig. inguinale. To norobezo: augsa un priekSpusé — lig. inguinale, laterali — ala ossis ilit, mediali — arcus iliopectineus. Pa 80 lakinu iet 7. femoralis, n. cutaneus femoris lateralis, m. iliopsoas. Augistilba jeb ciskas trisstdris (trigonum femorale) it trisstirveida padzilinajums aug’stilba priekSéja virsma. Tam ir Sadas malas: margo superior — lig. inguinale, margo medialis — m. adductor longus, ‘margo lateralis ~ m. sartorius. Trisstira pamatu veido ‘m. iliopsoas unm. pectineus, starp kuriem veidojas sulcus iliopectineus $. fossa iliopectinea, kura iegu| (mediolaterala sectba) v. femoralis, a. femoralis un n. _femoralis. Ciskas trisstirt zem lig. inguinale mediala gala plata fascija (fascia lata) ir plana un caurumota, izveidojot hiatus saphenus. To klaj caurumota fascija (fascia eribrosa) un norobezo sirpiveida mala (margo falciformis), kurai iz3kir cornu superius et cornu inferius. Hiatus saphenus var k\t par canalis femoralis aréjo atveri. Seit cauri fascia cribrosa iet limfvadi, seklds vénas (lielaka no tim — v. saphena magna) unr femoralis n. genitofemoralis. Lejpus® trigonum femorale pAriet priekSej8 augsstilba rieva (sulcus “femoralis anterior), ko priekspus® sedz m. sartorius. Rievai ir mediala un laterala mala: margo medialis norobez m. adductor longus et magnus, bet margo lateralis - m. vastus medialis. PriekSéja. augSstilba rieva atrodas a. femoralis, n, femoralis un n. saphenus; distala virziend tie ieiet aduktora kanal. Aduktora kanals (canalis adductorius) it apm. 7 cm gar’. Tam ir vairakas sienas: paries medialis veido m. adductor magnus, paries lateralis ~ m. vastus ‘medialis, bet paries anterior ~ lamina vastoadductoria (fascia lata dala). CILVEKA ANATOMIJA: roka un kaja Vascular space (lacuna vasorum). There is a split between os coxae and lig. inguinale. The thickening of the fascia iliaca (arcus iliopectineus) subdivides it into two parts: laterally — Jacuna musculorum, medially — lacuna vasorum. Lacuna vasorum is surrounded by ligamentum inguinale anteriorly and upwards, ligamentum pecti- neale, pecten ossis pubis, ramus superior ossis pubis ~ posteriorly and downwards, arcus iliopectineus — laterally and ligamentum lacunare ~ medially. The following structures pass through the vascular space: a, femoralis, ramus femoralis n. genitofemoralis, x. femoralis (lateromedial succession). There is a femoral ring (anulus femoralis) at the medial third of lacuna vasorum, that is closed by femoral septum (septum femorale) and nodus lymphoideus inguinalis profundus Pirogovi (Cloquet, Rosenmiilleri) from the abdominal cavity. The muscular space (lacuna musculorum) is a split below lig. inguinale. It is surrounded by ligamentum inguinale — anteriorlly and upwards, ala ossis ilti— laterally and arcus ileopectineus — medially. The following structures pass through Jacuna musculorum: n. femoralis, n. cutaneus femoris lateralis, m. iliopsoas. Femoral triangle (trigonum femorale) is a triangular depression on the anterior surface of the thigh. The borders of the trigonum femorale are: margo superior — lig. inguinale, margo medialis —_m. adductor longus, margo lateralis — m. sartorius. M. iliopsoas and m. pectineus form the basement of the trigonum femorale. Sulcus iliopectineus s. fossa iliopectinea, is a groove between these muscles. The following structures pass into it: v. femoralis, a. femoralis, n. _femoralis (medial-lateral succession). Hiatus saphenus is placed in the medial comer of the femoral triangle, where fascia lata is thin and perforated — fascia cribrosa. There are lymphatics, vv. testiculares, ¥. saphena magna, r. femoralis n. genitofemoralis that penetrate fascia cribrosa This place can be an external exit of canalis femoralis, possible site for hernification. Sulcus femoralis anterior passes downwards from trigonum femorale. M. sartorius covers the groove from the anterior side. The groove has the following borders: margo medialis — m. adductor longus et ‘magnus, margo lateralis — m.vastus medialis. A, femoralis, n. femoralis, n. saphenus pass into sulcus ‘femoralis anterior. These structures continue their course further into canalis adductorius. Adductor canal (canalis adductorius) is about 7 cm long. It is surrounded by the following walls: aries medialis ~m. adductor magnus, paries lateralis ~ m. vastus medialis, paries anterior ~ lamina vasto- ‘adductoria (part of fascia lata).APAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 155 1. gluteus superior 4. et wv gluteae superiores foramen suprapiriforme foramen ischiadicum majus ‘m. piriformis foramen infrapiriforme 4a. et gluteae inferiores ‘foramen ischiadicum minus ‘m. obturatorius intermus in. gluteus inferior 1. ischiadicus crotuberale’ 1. eutaneus femoris inferior lig. sacrospinale 77. att. Foramen suprapiriforme et infrapiriforme. Aspectus dorsolateralis.156 Pa kandla augséjo atveri iet_m. saphenus, a. femoralis un v. femoralis; pa nelielu priekSéjo atveri iet n. saphenus, a, descendens genus un v. descendens genus; pa apakséjo atveri, kas atrodas paceles bedré, iet a. femoralis un v: femoralis. Paceles bedre (fossa poplitea) atrodas cela locttavas muguréja virsma. Tai ir rombveida forma. Paceles bedres malas: margo superior medialis veido ‘m. semimembranosus un m, semitendinosus, margo superior lateralis — m. biceps femoris, margo inferior medialis — caput mediale m. gastrocnemii, bet margo inferior lateralis — caput laterale m. gastrocnemii. Paceles bedres pamatu veido facies poplitea femoris, capsula articularis un m. popliteus. Dorsali bedri sedz fascia poplitea, bet taja atrodas taukaudi — corpus adiposum popliteum. Fossa poplitea apvidii iz8kir divas rievas: sulcus opliteus medialis, ko norobezo m. semimembranosus un caput mediale m. gastrocnemii; sulcus popliteus lateralis, ko norobezo m. biceps femoris un caput laterale m. gastrocnemii Paceles bedre augSéji stir? savienojas ar canalis adductorius, bet apakseja stiri — ar canalis cruropopliteus. Paceles bedré atrodas (muguréji priek8&ja secTba) n. tibialis, v. poplitea, a. poplitea un nodi lymphoidei poplitei. Fossa poplitea apvidi paceles vend (poplitea) ieplist v. saphena parva. Apakistilba un paceles bedres kanals (canalis cruropopliteus) atrodas apaksstilba muguréja virsma. Ta paries anterior veido m. tibialis posterior un m. flexor digitorum longus, bet paries posterior ~ m. soleus. Kanal atrodas n, tibialis, a. tibialis posterior, vy. tibiales posteriores, a. tibialis anterior (sikumdala), mm. tibiales anteriores (beigu dala), a. peronea (sakumdala). MuskuJu un maz lielakaula augséjais kanals (canalis_ musculoperoneus superior) atrodas zem caput fibulae. TA paries medialis veido fibula, bet aries lateralis ~ m. peroneus longus Kandla atrodas n. peroneus superficialis. MuskuJu un maza lielakaula apakSejais kanals (canalis musculoperoneus inferior) atzarojas_ no canalis cruropopliteus. Ta paries anterior veido fibula, bet paries posterior — m. tibialis posterior un m. flexor hallucis longus CILVEKA ANATOMIJA: roka un kaja N. saphenus, a. femoralis,v. femoralis enter through the upper orifice of the adductor canal; n. saphenus, a. descendens genus, v. descendens genus leave the canal through the small anterior orifice; a. femoralis, x: femoralis pass through the lower orifice of the canal and continue their course into the popliteal fossa on the posterior aspect of the art.genu. Popliteal fossa (fossa poplitea) is a homboidal shape formation on the posterior surface of the knee joint. Its borders are: margo superior medialis, formed by m. semimembranosus et m. semitendinosus, margo superior lateralis ~ m. biceps femoris, margo inferior medialis — caput mediale musculi gastrocnemii. ‘margo inferior lateralis — caput laterale musculi ‘gastrocnemii The basement of popliteal fossa is formed by facies poplitea femoris, capsula articularis and m. popliteus. Dorsally popliteal fossa covers fascia poplitea. There is fat tissue in the popliteal fossa — corpus adiposum popliteum. There are two grooves in the popliteal fossa: sulcus popliteus medialis, which is between m. semimembranosus and caput mediale m. gastrocnemii; sulcus popliteus lateralis, which is between m. biceps femoris and caput laterale m. gastrocnemii. At the upper part of the popliteal fossa there is canalis adductorius, at the lower part of the popliteal fossa — canalis cruropopliteus. The following structures are placed in the politeal fossa: n. tibialis, v. poplitea, a. poplitea (postero- anterior aspect), nodi lymphoidi poplitei. In the popliteal fossa v: saphena parva flows into v: poplitea. Cruropopliteal canal (canalis cruropopliteus) localises on the posterior region of the lower leg Its walls are formed by: paries anterior ~ m. tibialis posterior and m. flexor digitorum longus; paries posterior ~ m. soleus. ‘There are the following structures into the canalis cruropopliteus: n. tibialis, a. tibialis posterior, vv. tibiales posteriores, a. tibialis anterior (initial part), vv. tibiales anteriores (terminate part), a. peronea(initial part). Upper musculoperoneal canal (canalis musculo- peroneus superior) is placed below the head of the fibula (caput fibulae). The canal has two walls, which are formed by: paries medialis — fibula; paries laterals — m. peroneus longus. N. peroneus superficialis passes through this canal, Lower musculoperoneal canal (canalis musculo- peroneus inferior) derivates from the lower part of canalis cruropopliteus. The canal has two walls, which are formed by: paries anterior — fibula; paries posterior ~ 1m. tibialis posterior and m. flexor hallucis longus.APAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 157 ‘m. psoas major. im. iliacus lig. inguinale lacuna musculorum. —arcus iliopectineus ‘m. iliopsoas u femoralis — a. femoralis lacuna vasorum 78, att. Lacuna vasorum et lacuna musculorum. Aspectus ventralis.158 Kandla atrodas a. peronea un vv. peroneae. Padas topografiskie veidojumi Pédas apakseja virsma ~ medidlaja un laterdlaja pusé — izveidojas divas rievas. Pédas plantard medial rieva (sulcus plantaris medialis) veidojas starp kajas Tkska_muskuliem un pédas vidgjds grupas muskuliem. To norobezo mediali —m. abductor hallucis, bet laterali ~ m. flexor digitorum brevis. Pédas plantiraja medidlaja rieva atrodas n. plantaris ‘medialis, a. plantaris medialis un vw. plantares mediales. Pédas plantara laterala rieva (sulcus plantaris lateralis) veidojas starp pédas vidas grupas muskujiem un maza pirksta muskuJiem. To norobeZo mediali — m. flexor digitorum brevis, bet later ‘m. abductor digiti minimi. Pédas plantaraja laterdlaja rieva atrodas n. plantaris lateralis, a. plantaris lateralis un vv. plantares laterales. 2.2.4. Apak8éjas ekstremitates fas: (fasciae membri inferioris) legurna joslas fascijas (fasciae cinguli membri inferioris) Zarnkaula muskula fascija (fascia iliaca) védera apvidi klaj m. iliacus. Ta veido kopéjas védera dobuma fascijas (fascia subperitonealis) dalu. Fascijai saaugot ar os coxae, t& veido muskulim osteofibrozu maksti. Paejot zem lig. inguinale, fascia iliaca veido arcus iliopectineus. Sledz8jmuskula faseija (fascia obturatoria) klaj m. obturatorius internus iekS8jo virsmu un, pieaugot pie iegurpa kauliem, veido tam osteofibrozu makst. Ga%as muskula fascijai (fascia glutea) ir divas lapinas: sekla (lamina superficialis) un dzilé (lamina profunda). Lamina superficialis Ij m. gluteus ‘maccimus Gréjo virsmu un lejpusé pariet augistilba plataja fascija (fascia lata). Lamina profunda, atdalot m. gluteus maximus no dzilak esoSajiem muskuliem, veido tam fibrozu maksti, bet dziJajiem muskuliem — osteofibrozu maksti Tadgjadi fibrozaja makstt (vagina fibrosa) atrodas tikaim.gluteus maximus, bet osteofibrozaja. maksti (vagina osteofibrosa) — vairaki muskuli: m. gluteus ‘medius, m. gluteus minimus, m. piriformis, m. gemellus CILVEKA ANATOMIJA: roka un kaja The following structures pass into the canalis musculoperoneus inferior: a. peronea, vv. peroneae. ‘Topographical formations of the foot There are two grooves on the plantar side of the foot — on the medial part — medial plantar groove (sulcus plantaris medialis) and on the lateral part — lateral plantar groove (sulcus plantaris lateralis). The medial plantar groove (sulcus plantaris medialis) is formed between the muscles of the great toe and the muscles of the central group of the sole. It is bordered by: m. abductor hallucis — medially, m. flexor digitorum brevis — laterally. The following structures pass into the medial plantar groove: 7. plantaris medialis, a. plantaris medialis, wv. plantares mediales. The lateral plantar groove (sulcus plantaris lateralis) is formed between the muscles of the little toe and the muscles of the central group of the sole. It is bordered by: m. flexor digitorum brevis ~ medially, ‘m. abductor digiti minimi — laterally. The following structures pass into the lateral plantar groove: n. plantaris lateralis, a. plantaris lateralis, vv. plantares laterales. 2.2.4. Fasciae of the lower (fasciae membri inferioris) Fasciae of the pelvic girdle (fasciae cinguli membri inferioris) Iliac fascia (fascia iliaca) covers m. iliopsoas. The iliac fascia is a part of the endo-abdominal or internal investing of deep fascia — fascia subperitonealis. Fascia is attached to the hip bone (os coxae) and form the osteofibrous sheath for the muscle. Fascia iliaca continues downwards below lig. inguinale and forms arcus iliopectineus. Obturator fascia (fascia obturatoria) covers ‘m. obturatorius internus from the inner side and is attached to the hip bone. It forms an osteofibrous sheath for the muscle. Gluteal fascia (fascia glutea) has two layers: the superficial layer (Jamina superficialis) and the deep layer (lamina profunda). Lamina superficialis covers m. gluteus maximus externally and continues downwards to the thigh region as fascia lata. Lamina profunda separates m. gluteus maximus from the deep muscles and forms the fibrous sheath for m. gluteus maximus and the osteofibrous sheath for the deep muscles. The fibrous sheath (vagina fibrosa) is formed for m. gluteus maximus, but the osteofibrous sheath (vagina osteofibrosa) — for m. gluteus medius, m. gluteus minimus, m. piriformis, m. gemellus superiorAPAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 159 fossa ischioanalis ‘m. gluteus maximus fossa ischioanalis rectum 79, att. Datortomografijas 3-d un 2-d rekonstrukeija. Fossa ischioanalis.160 superior et inferior, m. obturatorius internus, m. quadratus femoris. ApakSéjas brivas ekstremitates fascijas (fasciae membri inferioris liberi) Plata faseija (fascia lata) apyem visus aug’ muskulus. Kaudald virziend t& priekSpusé turpinds ka apakistilba fascija (fascia cruris), bet mugurpusé — ki paceles fascija (fascia poplitea). Augsstilba laterdlaja virsma fascia lata veido sabiezinajumu — tractus iliotibialis, kas lejasda|a saaug ar condylus lateralis tibiae. Augistilba kaula virziena fascia lata veido starpsienas: * septum intermusculare femoris mediale, kas pieaug pie labium mediale lineae asperae un atdala augistilba priekSéjos muskulus no medialas grupas muskuliem; * septum intermusculare femoris laterale, kas pieaug pie labium laterale lineae asperae tun atdala augistilba priekSéjos_muskulus no muguréjs grupas muskuliem; + septum intermusculare femoris posterius, kas pieaug pie /abium mediale lineae asperae un atdala augstilba medialos muskujus no muguréjas grupas muskuliem. Trigonum femorale apvidi fascia lata veido dzilo lapinu (lamina profunda s. fascia iliopectinea), kas izklaj fossa iliopectinea un, saaugot ar fascia lata seklo lapinu, veido fibrozu maksti augistilba asinsvadiem (a. et v. femoralis). Fibrozas makstis izveidojas art ap m. sartorius, m. gracilis un m. tensor fasciae atae. Kopuma fascia lata izveido 3 osteofibrozas un 4 fibrozas makstis. Augistilba osteofibrozas_makstis osteofibrosae femoris) it Sidas + vagina osteofibrosa anterior — ietver m. quadri- ceps femoris; * vagina osteofibrosa medialis ~ ietver augsstilba medialés grupas muskulus (m. pectineus, m. ‘adductor longus, m. adductor brevis, m. adductor magnus); + vagina osteofibrosa posterior — ietver augistilba muguréjas grupas muskulus (m. biceps femoris, m. semimembranosus, m. semitendinosus). Augistilba fibrozis makstis (vaginae fibrosae femoris) ir Sadiem veidojumiem: m. sartorius, m. gracilis, m. tensor fasciae latae, a. et v. femoralis. Paceles fascija (fascia poplitea) kia paceles bedri AugSpusé td pariet par fascia lata, bet lejpusé — par fascia cruris. Apakistilba faseija (fascia cruris) klaj apakéstilba muskulus no visam pusém, ciesi saaugot ar lield lielakaula priek$&jo malu. Laterdlajé virsma fascia (vaginae CILVEKA ANATOMIJA: roka un kaja et inferior, m. obturatorius internus, m. quadratus femoris. Fasciae of free lower limb (fasciae membri inferioris liberi) ‘The fascia lata (fascia lata) embraces all muscles of the thigh and continues downwards anteriorly as the deep fascia of the leg (fascia cruris), but downwards posteriorly as popliteal fascia (fascia poplitea) in popliteal fossa. Fascia lata makesthickening iliootibial tract (tractus iliotibialis) in the lateral region of the thigh that downward attaches to condylus lateralis tibiae. Fascia lata gives off three intermuscular septa: * septum intermusculare femoris mediale, which attaches to labium mediale lineae asperae and separates the anterior muscles of the thigh and the medial muscles of the thigh; * septum intermusculare femoris laterale which attaches to the labium laterale lineae asperae and separates the anterior muscles of the thigh and the posterior muscles of the thigh; * septum intermusculare femoris posterius which attaches to the Jabium mediale lineae asperae and separates the medial muscles of the thigh and the posterior muscles of the thigh. In the region of trigonum femorale fascia lata forms the deep layer (lamina profunda s. fascia iliopectinea), that forms the floor of the fassa iliopectinea. It fuses to the superficial layer of fascia lata and forms fibrous sheath (vagina fibrosa) for a. et v. femoralis. Fascia Jata forms fibrous sheaths also for the muscles: m. sartorius, m. gracilis and m. tensor fasciae latae. In total fascia lata forms three osteofibrous and four fibrous sheaths. Osteofibrous sheaths of the thigh (vaginae osteofibrosae femoris): * vagina osteofibrosa anterior ~ for m. quadriceps femoris; + vagina osteofibrosa medialis ~ for the medial muscles of the thigh — m. pectineus, m. adductor longus, m. adductor brevis, m. adductor magnus; * vagina osteofibrosa posterior — for the dorsal muscles of the thigh — m. biceps femoris, m. semimembranosus, m. semitendinosus. Fibrous sheaths of the thigh (vaginae fibrosae femoris) are for the following structures: m. sartorius, ‘m. gracilis, m. tensor fasciae latae, a. et v. femoralis. Popliteal fascia (fascia poplitea) forms the floor of the popliteal fossa. Upwards it continues to the fascia Jata, downwards — it continues to fascia cruris. Deep fascia of leg (fascia eruris) surrounds the muscles of the lower leg and it fuses with the anterior margin of the tibia. Fascia cruris projects twoAPAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 161 — lig. inguinale —m. sartorius 1m. adductor magnus 1m. adductor longus | m.sartorius nervu un asinsvadu kalitis | m. vastus medialis im. vastus medialis 'm. sartorius lamina vastoadductoria ‘m. adductor magnus 80, att. Trigonum femorale, sulcus femoralis anterior et canalis adductorius. Aspectus ventralis.162 cruris veido divas muskulu starpsienas, kas saaug ar mazo lielakaulu: septum intermusculare cruris anterius, kas atdala apakistilba priekSgjo_muskulu grupu no lateralas grupas, un septum intermusculare crurisposterius, kas atdala apakSstilba muskulu muguréjo grupu no laterdlds grupas. Mugurpusé fascia cruris veido dzilo lapinu (lamina profunda), kas atdala m. triceps surae no apaksstilba muguréjas grupas muskuliem. Apakistilba izveidojas tris osteofibrozas un viena fibroza maksts. Vaginae osteofibrosae: + vagina osteofibrosa anterior, kur atrodas riek8@jas grupas muskuli ~ m. tibialis anterior, ‘m. extensor digitorum longus, m. extensor hallucis longus; * vagina osteofibrosa lateralis, Kura atrodas m. peroneus longus et m. peroneus brevis; + vagina osteofibrosa posterior, kuri atrodas m. opliteus, m. tibialis posterior, m, flexor digitorum Jongus un m. flexor hallucis longus. Vagina fibrosa ietver m. triceps surae un m. plantaris. Parejot uz pédu, fascia cruris veido piecus saist- audu sabiezinajumus (retinacula). Zem tiem izveidojas kanali un tiem cauri iet muskulu cipslas. Retinaculum musculorum extensorum superius atrodas apakstilba priek3@ja virsma uz robezZas ar pédu starp mazo un lielo lielakaulu. Zem ta izveidojas viens kandls apakSstilba priekSéjas muskulu grupas cipslim. Retinaculum musculorum extensorum inferius atrodas nedaudz zemak ~ art. talocruralis priekSpusé. Zem 18 izveidojas Setri osteofibrozi kanali Sidiem veidojumiem: = 1.—m. tibialis anterior, + 2.—m. extensor hallucis longus, + 3.—a.et x. dorsalis pedis, n. peroneus profundus, + 4.—m. extensor digitorum longus. Retinaculum musculorum flexorum atrodas aiz ‘malleolus medialis. Zem t izveidojas éetri osteofibrozi kanali Sadiem veidojumiem: + 1. ~m tibialis posterior, = 2.—m. flexor digitorum longus, + 3.—a ety. tibialis posterior, n. tibialis, + 4.—m. flexor hallucis longus. Retinaculum musculorum peroneorum superius atrodas aiz lateralas potites. Zem t izveidojas viens osteofibrozs kanals divu muskulu cipslam: ‘+m. peroneus longus et m. peroneus brevis. CILVEKA ANATOMIJA: roka un kija intermuscular septa that fuse with the fibula: septum intermusculare cruris anterius, which separates the anterior group and lateral group of the lower leg muscles; septum intermusculare posterius, which separates the flexor group (posterior group) of the lower leg and the peroneal group (lateral group). Fascia cruris gives off the deep layer (lamina profunda), which separates m. triceps surae from the ‘other muscles of the posterior group of the lower leg. There are 3 osteofibrous sheaths and 1 fibrous sheath. Vaginae osteofibrosae: + vagina osteofibrosa anterior, the extensors (muscles of the anterior group) are placed into it — m. tibialis anterior, m. extensor digitorum Jongus, m. extensor hallucis longus + vagina osteofibrosa lateralis, the peroneal muscles, (muscles of the lateral group) are placed into it — ‘m. peroneus longus et m. peroneus brevis «vagina osteofibrosa posterior, the flexors (muscles of the posterior group) are placed into it — m. popliteus, m.tibialis posterior, m. flexor digitorum Tongus et m. flexor hallucis longus. Vagina fibrosa surrounds m. triceps surae et m. plantaris. In the ankle region fascia cruris forms 5 fibrous bands or thickened portions (retinacula). The channels for the tendons of the muscles of the lower leg are placed below retinacula. Retinaculum musculorum extensorum superius is placed in the anterior region of the ankle region between fibula and tibia. There is one channel below it where the tendons of extensors (muscles of the anterior group) of the lower leg pass. ‘Retinaculum musculorum extensorum inferius is placed below the retinaculum musculorum extensorum inferius in front of the ankle joint (art. Talocruralis). There are 4 osteofibrous canals through which the following structures pass: + 1.—m. tibialis anterior, «2. —m. extensor hallucis longus, = 3.—a et. dorsalis pedis, n. peroneus profundus, + 4.—m. extensor digitorum longus. Retinaculum musculorum flexorum is placed behind malleolus medialis. There are 4 osteofibrous canals through which pass such structures: + 1m tibialis posterior, + 2.—m flexor digitorum longus, + 3.—a. et tibialis posterior, n. tibialis, + 4.—m. flexor hallucis longus. Retinaculum musculorum peroneorum superius is placed behind malleolus lateralis. There is 1 osteo- fibrous canal through which passes =m. peroneus longus et m. peroneus brevis.APAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 163 ‘m. abductor digiti minimi sulcus plantaris lateralis ~m. flexor digitorum brevis sulcus plantaris medialis m. adductor hallucis 81. att, Sulcus plantaris medialis et lateralis.164 CILVEKA ANATOMIJA: roka un kaja fascia glutea fascia iliaca fascia glutea BM arnina superficialis EA fascia giutea tonne ofinds sy fascia iliaca vagina fibrosa m. glutei maximi ‘fascia glutea~ lamina superficialis ‘fascia glutea- Tamina profunda ey sc ‘obturatoria fascia iliaca fascia glutea ~ lamina superficialis fascia ‘obturatoria fascia iliaca fascia glutea fascia iliaca ‘82. att. Fasciae cinguli membri inferioris.APAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 165 vagina osteofibrosa medialis vagina fibrosa m. gracilis vagina fibrosa m. sartorii aes gin eceylisoen vagina fibrosa a. et v. femoralis | vagina osteofibrosa posterior 83. att. Fascia lata; vaginae fibrosae et osteofibrosae femoris.166 Retinaculum musculorum peroneorum inferius atrodas nedaudz zemak par iepriekSéjo. Zem 18 izveidojas divi atseviski osteofibrozi kandli — katra muskula cipslai savs: + 1.—m. peroneus brevis, + 2.—m. peroneus longus. Pedas fascijas (fasciae pedis). I78kir pédas dorsalo fasciju (fascia dorsalis pedis) un p&das plantaro fasciju (fascia plantaris pedis). Pédas dorsala faseija (fascia dorsalis pedis) klaj pédas dorsdlas virsmas muskulus. Tas dziJa lapina (lamina profunda) klaj mm. interossei_dorsales, veidojot tiem osteofibrozas makstis. Pedas plantara fascija (fascia plantaris pedis) Kaj p&das plantirds virsmas muskulus, izveidojot vidusdalA sabiezingjumu (aponeurosis plantaris). No aponeirozes malim uz metatarsdlajiem kauliem atiet divas starpsienas: septum intermusculare mediale uz Ul metatarsalo kaulu un septum intermusculare laterale — uz V metatarsalo kaulu. Fascijas dzila lapina (lamina profunda) k\aj mm. interossei plantares, veidojot tiem osteofibrozas makstis. Rezultatd peda izveidojas Eetras fibrozas un Getras osteofibrozas makstis: + vagina fibrosa dorsalis atrodas _tendines musculorum extensorum cruris, m. extensor digitorum brevis un m. extensor hallucis brevis; * vagina fibrosa plantaris medialis atrodasm. abductor hallucis, m. flexor hallucis brevis, m. adductor hallucis un tendo m. flexoris hallucis longi; + vagina fibrosa plantaris lateralis atrodas_m. abductor digiti minimi, m. flexor digiti minimi brevis un m. opponens digiti minimi; + vagina fibrosa plantaris media atrodas m. flexor digitorum brevis, m. quadratus plantae, mm. lumbricales un tendinea m. flexoris digitorum longi. Vaginae osteofibrosae pedis norobezo abu pédas fasciju lamina profunda un ossa metatarsalia, Tajas atrodas mm. interossei dorsales et mm. interossei plantares. Pédas cipslu makstis (vaginae tendinum pedis) Pédas dorsdlaja virsma ir septipas cipslu makstis. Zem retinaculuim musculorum extensorum superius et inferius atrodas tris sinovialas makstis: + vagina tendinis m. tibialis anterioris, + vagina tendinis m. extensoris hallucis longi, * vagina tendinum m. extensoris digitorum longi. CILVEKA ANATOMIJA: roka un kija Retinaculum musculorum peroneorum inferius is placed below the previous retinaculum. There are 2 osteofibrous canals through which pass the following structures: = 1. —m. peroneus brevis, + 2.—m. peroneus longus. Foot fascia (fasciae pedis) is divided into the fascia on the dorsum of the foot (fascia dorsalis pedis) and the fascia on the sole of the foot (fascia plantaris pedis). Dorsal fascia of the foot (fascia dorsalis pedis) covers the muscles of the dorsum of the foot and gives off the deep layer (lamina profunda), which lined mm. interossei dorsales, and form the osteofibrous sheaths for them. Plantar fascia of the foot (fascia plantaris pedis) covers the muscles of the sole of the foot, and forms the thickened dense part in the middle (aponeurosis plantaris). There are two septa projet from the aponeurossis to the metatarsal bones — septum inter- ‘musculare mediale that attaches to the I metatarsal bone and septum intermusculare laterale that attaches to the V metatarsal bone. The deep layer (lamina profunda) is lined mm. interossei plantares, and forms osteofibrous sheaths for them. There are 4 fibrous sheaths 4 osteofibrous sheaths on the foot. + vagina fibrosa dorsalis, surrounds tendines musculorum extensorum cruris, m. extensor digitorum brevis et m. extensor hallucis brevis. + vagina fibrosa plantaris medialis, that surrounds m. abductor hallucis, m. flexor hallucis brevis, m. adductor hallucis et tendo musculi flexoris hallucis longi. + vagina fibrosa plantaris lateralis, that surrounds m. abductor digiti minimi, m. flexor digiti minimi brevis et m. opponens digiti minimi. + vagina fibrosa plantaris media, that surrounds m. flexor digitorum brevis, m. quadratus plantae, mm. lumbricales et tendinea musculi flexoris digitorum longi. Vaginae osteofibrosae pedis are formed between lamina profunda fascia’ dorsalis pedis et fascia plantaris pedis and ossa metatarsalia. Mm. interossei dorsales et mm. interossei plantares are placed in vaginae osteofibrosae pedis. Tendinons sheaths of the foot (vaginae tendinum pedis) On the dorsum of the foot there are seven tendinons sheaths. Below retinaculum —musculorum _extensorum superius et inferius are placed three synovial sheaths: + vagina tendinis m. tibialis anterioris, + vagina tendinis m. extensoris hallucis longi,APAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 167 cormu superius, ‘marginis falciformis hiatus saphenus. ‘margo falciformis: cornu inferius ‘marginis falciformis 1 saphena magna. tractus iliotibialis 84. att. Datortomografijas 3-d rekonstrukcija, Hiatus saphenus.168 Zem retinaculum musculorum flexorum atrodas tris, sinovialas makstis: + vagina tendinis m. tibialis posterioris, + vagina tendinis m. flexoris hallucis longi, + vagina tendinum m. flexoris digitorum longi. Zem retinaculum musculorum peroneorum superius et inferius atrodas viena sinoviala maksts: * vagina communis tendinum musculorum perone- orum. Pédas plantaraja virsma ir seSas sinovidlas makstis: + piecas vaginae synoviales digitorum pedis, kas ietver pirkstu Iso un garo saliecgjmuskulu cipslas; + vagina plantaris tendinis m. peronei longi, kas ietver m. peroneus longus cipslas beigu dalu pédas plantaraja virsma. 2.3. ApakSéjas ekstremitates nervi (nervi membri inferioris) 2.3.1. Jostas nervi (nervi jumbales), krustu nervi un astes nervs (nervi sacrales et nervus (rami ventrales et dorsales) Katrs spinalais nervs (n. spinalis), izejot pa foramen intervertebral, dalis resndkaji ventralaja zara (r ventralis) un sikika — muguréja zara (r. dorsalis). Prieks&jie zari (re ventrales) savienojas sava starpa ar cilpam (ansae) un veido jostas un krustu pinumu (plexus lumbosacralis), kuram vél_pievienojas_ 7. subcostalis Skiedras, ka ari n. coccygeus. Sis pinums inervé apak8@jo ekstremitati, starpeni un daléji rumpja Jeb viduma adu apakseja dala Plexus lumbosacralis iedala divos pinumos. Tie ir + jostas pinums (plexus lumbalis), + krustu pinums (plexus sacralis). Jostas un krustu nervu mugurgjie zari ir siki, tie sazarojas muguras dzilajos muskulos. LL, muguréjie zari izveido das nervus — nn.clunium superiores, bet 5,-S, muguréjie zari — nn. clunium medii, kas inervé regio glutea Adu. 2.3.2. Jostas pinums (plexus lumbalis) Jostas pinumu veido pirmo tris jostas nervu L~L, prieksgjie zari un daléji Th,, un L, priekS@jie zari. CILVEKA ANATOMIJA: roka un kaja + vagina tendinum m. extensoris digitorum longi. Below retinaculum musculorum flexorum are placed three synovial sheaths: + vagina tendinis m. tibialis posterioris, + vagina tendinis m. flexoris hallucis longi, + vagina tendinum m. flexoris digitorum longi. Below retinaculum musculorum peroneorum su- perius et inferius are placed one synovial sheath: * vagina communis tendinum musculorum perone- orum. On the sole of the foot there are 6 synovial sheaths: + 5 vaginae synoviales tendinum digitorum pedis, which surrounds the tendons of the flexor digi- torum brevis and flexor digitorum longus, * vagina tendinis musculi peronei plantaris, which surrounds the tendon of m. peroneus longus on the sole of thye foot. 2.3. Nerves of lower limb (nervi membri inferioris) 2.3.1. Lumbar nerves (nervi lumbales), sacral nerves and coccygeal nerve (nervi sacrales and nervus coccygeus) — their ventral and dorsal branches (rami ventrales and rami dorsales) Every spinal nerve (n. spinalis) leaves the spinal channel through foramen intervertebrale and divides into a larger ventral branch (r: ventralis) and a smaller dorsal branch (: dorsalis. The ventral branches (rr. ventrales) unite and form loops (ansae) which later are organised into the lumbo- sacral plexus (plexus lumbosacralis). N. subcostalis and n. coccygeus join to plexus lumbosacralis. Plexus Jumbosacralis innervates the lower extremity, perineum. and partly the skin of the lower part of the trunk. Plexus lumbosacralis is divided into two parts (plexus): + the lumbar plexus (plexus lumbalis), + the sacral plexus (plexus sacralis). The dorsal branches of the lumbar and sacral nerves are small in size. They ramify into the deep muscles of the back. Rr: dorsales of L,-L, form the s clunium superiores, but rr. dorsales of S,-S, form nn. clunium medit. They innervate the skin in the gluteal region. nerves nn, 2.3.2. The lumbar plexus (plexus Jumbalis) The lumbar plexus is formed by the ventral branches of L,-L, and partly by the ventral branches of 7/,, andTE / LOWER LIMB / membrum inferius 169 APAKSEJA EKSTREM! retinaculum musculorum extensorum superius retinaculum musculorum / extensorum superius vag. tendinum ‘mm. peroneorum vag. tendinis m. tibialis communis. anterioris, 7 / vag. tendinis m.extensoris hhallucis longi vag. tendinis im. tibialis anterioris 7 retinaculum m. extensorum inferius retinaculum mm. eroneorum ~ superius ~~ vag. tendlnis retinaculum im. tibialis posterioris ‘musculorum. ‘flexorum| retinaculum m, extensorum inferius _ vag. tendinis m. extensoris hallucis Tongi vag. tendinis retinaculum min. mm. flexoris peroneorum hhallucis longi inferius J vag. tendinum m. , retinaculum mm. flexoris digitorum longi cextensorum inferius vag. plantaris“ tendinis m. peronei longi vag. tendinum digitales pedis 85. att. Retinacula et vaginae tendinis pedis.170 Pinums atrodas m. psoas major masa, kur no ti atzarojas Tsi motoriski nervi uz m. psoas major, m. ‘psoas minor unm. quadratus lumborum. Pargjie seki plexus lumbalis zavi ir gari nervi Augistilba jeb ciskas nerys (n. femoralis, LL.) ir gardkais, resnakais un svarigakais $4 pinuma nervs. Tas ir jaukts nervs. N. femoralis paradas rieva starp ‘m. psoas major un m. iliacus, t& stkie zari inervé gizas locitavu. No iegura nervs iziet pa lacuna ‘musculorum, Augistilba tas novietojas laterali no a. femoralis un ar rr. musculares inervé m. quadriceps femoris, m. sartorius un m. pectineus (to inervé art ‘n. obturatorius). Augistilba apvidd no n. femoralis atdalas juSanas zari — rr. cutanei anteriores, kas inervé augistilba un cela locTtavas priekSéjas virsmas adu. N. femoralis tie’s turpindjums ir kajas Adas garais nerys (n. saphenus), ko prickSpusé sedz m. sartorius. LN. saphenus ieiet aduktora kanal (canalis adductorius) kopa ar a. femoralis, bet iziet no ta pa atveri priek8eja siend kopd ar a. descendens genus. P&c tam, apliecoties ap condylus medialis femoris no mugurpuses, n. saphenus nondk apakistilba medialaja virsma, iet kopa ar v. saphena magna un inervé du apaksstilba medidlaja virsma. Talak nervs iet priekSpusé medidlai potitei un beidzas pEdas mediala mala, inervéjot tas du lidz pat Tk8ka pamatnei, Laterdlais augitilba Sdas nervs (n. cutaneus femoris lateralis, LL, it otts gardkais plexus lumbalis nervs ; tam ir tikai jusanas Skiedras. Virspusé nervs iziet pie m. psoas major lateralis malas, iet slipi uz priekSu pa m. iliacus priekSejo virsmu, labajl pus® aiz aklas zarnas (caecum), bet kreisaja aiz lejupejo8as zarnas (colon descendens). Medial no spina iliaca anterior superior tas iziet no ieguma pa lacuna musculorum un nonak augistilba laterdlaja virsma. Caururbjot fascia lata, tas ar vairdkiem zariem inervé augSstilba laterals virsmas du lidz pat cela locitavas apvidum. Genitaliju un augstilba nervs (n. genifofemoralis, L-L,) ir vienigais plexus lumbalis nervs, kas, caururbjot m. psoas major, paradas ta priek8@ja virsma un sadalis divos zaros : + ramus femoralis ~ juSanas zars; iet lateral no a. femoralis cauri lacuna vasorum, caururbj fascia lata hiatus saphenus rajona, inervejot Adu trigonum femorale apvidi; = ramus genitalis — jaukts zars; ieiet cirkSna kanal (canalis inguinalis) cauri ti muguréjai sienai un inervé virietim fuuniculus spermaticus apvalkus un scrotum du, bet sievietei — lig. teres uteri un CILVEKA ANATOMIJA: roka un kaja L,, Plexus lumbalis is placed into the mass of m. psoas major. Its short motor branches innervate m. psoas major, m. psoas minor and m. quadratus lumborum. The long nerves are six in number. The femoral nerve (n. femoralis, L;-L,) is the largest, thiknest and most important nerve of the lumbar plexus. It is a mixed nerve. N. femoralis is placed in the groove between m. psoas major and ‘m. iliacus. The nerve gives off short branches for innervating the hip joint, then it leaves the pelvic cavity through lacuna musculorum. On the femur it is placed in trigonum femorale laterally from a. femoralis. Here it gives off rr. musculares to m. quadriceps femoris, ‘m. sartorius and m. pectineus (it gets innervation also from n. obturatorius). N. femoralis gives off cutaneous branches (rr: cutanei anteriores) that innervate the skin of the anterior femoral region and the skin of the anterior region of the knee joint. N, femoralis continues downward as the saphenous nerve (n. saphenus), passes behind m. sartorius. It farther enters the adductor canal (canalis adductorius) together with a. femoralis, penetrates the anterior wall of the channel and comes out from it together with a. descendens genus. N. saphenus tums around condylus medialis femoris (posteriorly) and reaches the medial side of the lower leg, where it passes together with » saphena magna and innervates the skin at the medial region of the lower leg. Then n. saphenus crosses malleolus medialis in front of it and terminates on the medial edge of the foot, innervating the skin as far as the base of the great toe. The lateral femoral cutaneous nerve (n. cufaneus femoris lateralis, L;-L,) is the second longest branch of plexus Iumbalis. It contains only sensory fibers. The nerve comes out at the lateral edge of m. psoas ‘major, it crosses m. iliacus and caecum (caecum) on the right side, but on the left side — descending colon (colon descendens). It penetrates the abdominal wall near spina iliaca anterior superior and passes through lacuna musculorum to the lateral region of the thigh, then it penetrates fascia lata and innervates the skin at the lateral part of the thigh as far as the knee joint. The genitofemoral nerve (n. genitofemoralis, Lj-L,) is the only nerve of plexus lumbalis, that penetrates m. psoas major and comes out on its anterior surface. The nerve divides into two branches: + ramus femoralis ~ a sensory branch, it is placed laterally from a, femoralis, passes through lacuna vasorum and penetrates fascia lata at the region of hiatus saphenus. Ramus femoralis innervates the skin of rrigonum femorale; + ramus genitalis — a mixed branch; it penetrates the dorsal wall of the inguinal channel (canalis inguinalis) and. gives innervation to funiculusAPAKSEJA EKSTREMITATE / LOWER LIMB / memrum inferius 71 86. att. Plexus lumbalis. Aspectus ventralis.172 labia majora pudendi idu. Sledz8jnervs (n. obturatorius, L,-L,) ir vientgais plexus lumbalis nervs, kas iziet virspusé pie m. psoas ‘major medial’s malas. Ejot lejup, tas 8kérso linea terminalis, iet pa maz iegurpa sienu un kopa ar a. et ¥. obturatoria ieiet sl&dz8jkanala (canalis obturatorius), kur dalas divos zaros: + ramus anterior, kas ir resndks un iet starp m. adductor longus un m. adductor brevis, inervéjot tos, kA ati m. pectineus un m. gracilis. AugSstilba vido tas caururbj fascia lata un ka ramus cutaneus inervé augistilba medialas virsmas Adu dz pat cela locttavai; + ramus posterior iet aiz m. adductor brevis un inervé_m. adductor magnus, m. obturatorius externus (bieZi to caururbj) un art. coxae. Tegurna un pavéderes nervs (n. iliohypogastricus, Th,, et L,) ir jaukts nervs. Tas iziet no jostas pinuma m. psoas major lateralaja mala, iet pa m. quadratus Jumborum priekSéjo.virsmu paraléli n. subcostalis. Nesasniedzot crista iliaca, caururbj m. transversus abdominis un iet starp m. transversus abdominis un m. obliquus internus abdominis, inervéjot tos, péc tam — starp m. obliquus internus abdominis un m. obliquus externus abdominis. Izurbjoties cauri_m. obliquus externus abdominis aponeirozei virs anulus inguinalis superficialis, k& ramus cutaneus anterior inerve regio inguinalis un regio pubica Adu. Virs crista iliaca vidus no 18 atzarojas ramus cutaneus lateralis, kas inervé du giizas apvida. Tegurna un cirk’na nervs (n. ilioinguinalis, L,), tpat ka iepriek8@jais, iet pa m. quadratus lumborum priekSjo virsmu aiz nieres (nedaudz zemak par n. iliohypogastricus) starp_m. transversusabdominis un m. obliquus internus abdominis un nondk canalis inguinalis, kur novietojas funiculus spermaticus priekSpusé. Iznakot no kandla pa anulus inguinalis superficialis, tas beidzas virietim ka mn. scrotales anteriores, bet sievietei ki nn. labiales anteriores un inervé attiecigi Adu scrotum priekS@ja virsma vai labia majora pudendi du, Ka ari regio pubica du un nelielu apvidu femur medialas virsmas aug&dala. Bez tam no 1. ilioinguinalis atzarojas rr. musculares, kas inervé védera laterals grupas muskulu apakSgjo dalu, CILVEKA ANATOMIJA: roka un k spermaticus and the skin of scrotum in a male. In a female it innervates lig. teres uteri and the skin of labia majora pudendi. The obturator nerve (n. obturatorius, L,-L,) is the only nerve of plexus lumbalis that comes out from the medial side of m. psoas major, crosses linea terminalis, then it passes the lateral wall of the lesser pelvis. The nerve is accompanied by a. ef v. obturatoria in the obturator channel (canalis obturatorius) and divides into two branches: + ramus anterior, which is larger than the other branch, passes between m. adductors brevis and ‘m. adductor longus, innervating them, as well as m. pectineus and m. gracilis. It penetrates fascia ata at the middle third of the medial surface of the thigh as ramus cufaneus and innervates the skin at the medial part of the thigh as far as the knee joint; + ramus posterior passes behind m.adductor brevis and innervates m. adductor magnus, m. obturatorius externus and art. coxae. The iliohypogastrie nerve (n. iliohypogastricus, Th,, et L,) is a mixed nerve. It comes out from the lateral side of m. psoas major, passes over the anterior surface of m. quadratus lumborum parallel to n. subcostalis. Above crista iliaca penetrates m. transversus abdominis, then it passes between m. transversus abdominis and_m. obliguus internus abdominis, supplying them. Then the iliohypogastric nerve passes between m. obliquus internus abdominis and m. obliquus externus abdominis. It gives off the cutaneous branches: ramus cutaneus anterior and ramus cutaneus lateralis. Ramus cutaneus anterior penetrates aponeuerosis of m. obliquus externus abdominis at the level of anulus inguinalis superficialis and innervates the skin of regio inguinalis and regio pubica. Ramus cutaneus lateralis innervates the skin below crista iliaca and in the gluteal area, The ilioinguinal nerve (n. iioinguinalis, L,) runs over the anterior surface of m. quadratus lumborum somewhat lower than n. ilighypogastricus behind the kidney between m. transversus abdominis and m. obliquus internus abdominis. Then it enters canalis inquinalis and passes ventrally from _funiculus spermaticus in a male or lig. teres uteri in a female. It comes out from the inguinal channel through anulus inquinalis superficialis and gives off the terminal branches ~ nm. scrotales anteriores in a male or nn. labiales anteriores in a female. They innervate the skin of the external genitals, regio pubica and the upper third of the medial surface of the thigh. N. ilioinguinalis gives off rr: musculares for the innervation of the lower part of the lateral abdominal muscles.be SopoutaS Wa S940TAOTUD ‘44 ‘S27 Sayouds "uu SBa0}aaquD “44 rr cutanei anteriores |_n, saphenus 87. att. Plexus lumbalis. Aspectus ventralis. APAKSBJA EKSTREMITATE / LOWER LIMB / membrum inferius 173 1. iliohypogastricus 3 1 illoingunall. ” 2 s rn. cutaneus femoris lateralis" \ ‘cwtaneus : anterior E be \ 77. musculares174 2.3.3. Krustu pinums (plexus sacralis) Krustu pinumu veido dafgji jostas (L,) un pilntba visu paréjo zemak esoSo nervu priekSejie zari (L., 5, S,, Coce). Ceturta jostas nerva priekseja zara kaudala dala savienojas ar piekté nerva prickSéjo zaru_un izveido resnu stumbru — truncus lumbosacralis, kas atrodas lateral no foramina intervertebralia, Skérsojot linea terminalis, stumbrs nondk mazaja iegumi, kur savienojas ar plexus sacralis apakSéjo dalu. Pinuma apakSéjis dalas resnie priekSgjie zari, iznakot pa foramina sacralia pelvina, izveido trisstirveida nervu platniti, kuras apakSéjais stiris pariet cilvéka lielakaja nerva ~ s&Zas nerva (n. ischiadicus). Plexus sacralis atrodas uz krustu kaula iegurpa virsmas (facies pelvina ossis sacri) un m. piriformis priekS@jas virsmas. Tam izSkir Tsus un garus nervus. Plexus sacralis isie zari Plexus sacralis sie zari inervé iegurpa joslas muskujus, starpenes muskulus un du, ka art aréjos dzimumorganus. + Muskulzari (rr. musculares) (LL, S,-S,) inervé m. piriformis, m. obturatorius internus, m. ‘gemellus superior et m. gemellus inferior un m. quadratus femoris. + Giza augsejais nervs (n. gluteus superior) (L--L, S,) it motorisks nervs. Tas iznak kopa ar 4. glutea superior pa foramen suprapiriforme, iet starp m. gluteus medius un m. gluteus minimus, inervéjot tos, ka ati m. tensor fasciae latae! + Gitas apakiejais nervs (n. gluteus inferior) (L, S;-8,) it galvenokart motorisks nervs. Tas iznak kopa ar a. glutea inferior pa foramen infrapiriforme, ieurbjas m. gluteus maximus priekSéjas virsmas vidi un inervé to. Dazi juSanas zari inervé giizas locitavu (art. coxae). + Kaunuma nervs (n pudendus’) (S,-S,) ir gan motorisks, gan sensibls nervs. No iegurpa tas iziet kop ar a. pudenda interna pa foramen infrapiriforme, apliecas no mugurpuses ap spina ischiadica un pa foramen ischiadicum minus nonak fossa ischioanalis, kur iet pa bedres lateralo sienu. Talak nervs iet pa fascia obturatoria dublikatiras izveidotu kanalu — " Tadarot intramuskularoinjekciju, adata jaiedur regio ‘glutea augseja lateralajé kvadranta, lai neskartu nervus un asinsvadus. N. pudendus ir svarigikais starpenes nervs. Tas inerv8 starpenes muskuJus, Adu, argjos dzimumorganus un maz iegua orgdnus (saistits ar vegetativo pinumu — plexus ypogastricus inferior). CILVEKA ANATOMIJA: roka un kaja 2.3.3. The sacral plexus (plexus sacralis) The sacral plexus is formed by the part of the ventral branches of L, and all ventral branches of L,, S;-S, and Coce spinal nerves. The ventral branches of the lumbar IV and V spinal nerves join and form a thick Iumbo-sacral trunk — truncus lumbosacralis, which is placed laterally from the intervertebral orifices (foramina intervertebralia). Truncus lumbosacralis crosses linea terminalis and joins the lower part of the sacral plexus in the lesser pelvis. The thick ventral branches of the lower part of the sacral plexus come ‘out through foramina sacralia pelvina and form a triangular plate that further continues as the schiatic nerve (n. ischiadicus). Plexus sacralis is placed on the pelvic surface of the sacral bone (facies pelvina ossis sacri) and on the anterior surface of m. piriformis. There are short branches and long nerves in plexus sacralis. Plexus sacralis short branches Short branhes of the sacral plexus innervate the muscles of the pelvic girdle, the perineal muscles and the skin of the external genitals. * Muscular branches (rr. musculares) (LL, S;-S,) supply m. piriformis, m. obturatorius imternus, m. gemellus superior, m. gemellus inferior and m. quadratus femoris. + Superior gluteal nerve (n. gluteus superior) (L.— L,, S,) is a motor nerve. It passes together with a. glutea superior through foramen suprapiriforme and loges between m. gluteus medius and m. gluteus minimus. It supplies m. gluteus medius, m. gluteus minimus and m. tensor fasciae latae’. + Inferior gluteal nerve (n. gluteus inferior) (L, S,-S,) is mostly a motor nerve. It passes together with a. glutea inferior through foramen infrapiriforme; innervates m. gluteus maximus and gives off sensory innervation to art. coxae. + Pudendal nerve (n. pudendus’) (SS, is a mixed nerve. It passes together with a. pudenda interna through foramen infrapiriforme, then it tums round spina ischiadica and through foramen ischiadicum minus reaches fossa ischioanalis where it passes along the lateral wall. Then the nerve passes between two layers of fascia obturatoria which forms the channel ~ canalis Intramuscular injection region is the upper lateral square of regio glutea, not to damage the nerves and vessels. N. pudendus is the most important nerve for perineum innervation. It gives off branches to perineal muscles, skin, external genitals and organs of the lesser pelvis. It has communicating branches to vegetative plexus — plexus hypogastricus inferior.APAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 175 1. gluteus superior- 1. gluteus superior 1. gluteus inferior lig. sacrospinale in. gluteus inferior lig. sacrotuberale rn. cutaneus femoris posterio —n. ischiadicus 1. ischiadicus rn. cutaneus femoris posterior rn. tibialis 1. peroneus communis rn. suralis. —__n. peroneus superficialis rn, tibialis rn peroneus profundus 88. att. Plexus sacralis. Aspectus dorsolateralis.176 canalis pudendalis (Alcock), tad wz priekSu pam. transversus perinei profundus nondk zem. symphysis pubica. Talak virietim tas iet pa dorsum penis, bet sievietei — pa dorsum clitoridis, attiecigi ka n. dorsalis penis vain. dorsalis clitoridis. N. dorsalis penis (n. dorsalis clitoridis) (S.-S,) ir jaukts n. pudendus gala zars. Tas inervé penis (clitor) adu, ar rr. musculares — ‘m. transversus perinei profundus un m. sphincter urethrae, bet at re urethrales — urinizvadkanala glotidu. N. pudendus simu zari: mn. rectales inferiores (S,-S,) it jaukti = motoriski un sensibli —' un atiet fossa ischioanalis rajona. Kopi ar tida pasa nosaukuma asinsvadiem tie iet cauri corpus adiposum fossae ischioanalis analis atveres virziend un inervé m. sphincter ani externus un ‘m. levator ani, ka ari starpenes (perineum) adu analaja apvi © nn. perineales' (S;-S,) ~ motoriski un sensibli. Tie iet sekli ventrala virziend pa trigonum urogenitale, inervéjot_m. transversus perinei superficialis, m. bulbospongiosus unm. ischiocavernosus. Virietim tie beidzas ka ‘nn. scrotales posteriores, bet sievietei kA nn. labiales posteriores, inervejot attiecigo apvidu Adu. N pudendus dzilie starpenes juSanas zari, kas uztver temperatiiras un taustes sajitu, inervé ari vaginas apakséjo dalu. Plexus sacralis garie zari Krusta pinumam ir divi garie zari: n. cutaneus femoris posterior un n. ischiadicus. Tie inervé visus apakséjas brivas ekstremitates muskulus un adu. + Augistilba ddas muguréjais nervs (n. cutaneus femoris posterior) (S,-S,) iziet no iegurna pa ‘foramen infrapiriforme kop’ ar n. ischiadicus, atrodoties mediali no ta. Talak nm. cutaneus femoris posterior iet \ejup gar m. obturatorius internus, m. gemellus superior, m. gemellus inferior un m. quadratus femoris dorsalo virsmu, bet to sedz m. gluteus maximus. Kaudali nervs iet pa augstilba muguréjas virsmas vidu zem fascia Jata, tad, izurbjoties tai cauri, sazarojas un inervé Adu augsstilba dorsdlaja virsma Itdz pat paceles "Anastomozé ar rr perineales non. cutaneus femoris posterior. CILVEKA ANATOMIJA: roka un kaja pudendalis (Alcock), then it passes forwards along m. transversus perinei profundus and reaches symphysis pubica. In a male it runs along dorsum penis as n. dorsalis penis, innervates skin of the penis and gives off remusculares to m. transversus perinei profundus and m. sphincter urethrae, rr. urethrales innervates the mucous membrane of the urethra. In a female it passes along dorsum clitordiis as n. dorsalis clitoridis. It innervates the skin of the clitoris and gives off rrmusculares to m. transversus perinei ‘profundus and m. sphincter urethrae, rr. urethrales innervates the mucosa of the urethrae. N. pudendus gives off the following side branches: * nn. rectales inferiores (S,-S,) are mixed nerves, they arise in the area of fossa ischioanalis, pass together with a. ef vv. rectales inferiores through corpus adiposum fossae ischioanalis to the anus where they supply m. sphincter ani externus, m. levator ani and the skin of the perineum in the anal region. * nn. perineales! (S;-S,) are mixed nerves. They are located superficially and pass in trigonum urogenitale in the ventral direction. They supply the superficial muscles of diaphragma urogenitalis: m. transversus perinei superficialis, m. ischiocavernosus and ‘m. bulbospongiosus. Nn. perineales termi- nate the skin of perineum in a male as nn. scrotales posteriores, but in a female as nn. labiales posteriors and innervate the skin in ‘corresponding region. The lower part of the vagina gets innervation from rn. pudendus ~ deep sensory perineal branches; they are responsible for temperature and touch sensation. Plexus sacralis long branches The long branches of the sacral plexus innervate the free lower extremity. They are n. cutaneus fremoris posterior and n. ischiadicus. + The posterior femoral cutaneous nerve (n. cutaneus femoris posterior) (S,-S,) comes out from the pelvis through foramen infrapiriforme and is placed medially from n. ischiadicus. N. cutaneus femoris posterior passes downwards along the dorsal surface of m. obturatorius internus, m. gemellus superior, m. gemellus inferior and m. quadratus femoris. M. gluteus maximus covers it. The nerve penetrates fascia Jata and supplies the skin at the dorsal side of the thigh till popliteal fossa (fossa poplitea). ' Anastomosed with rr perineales from n. cutaneus femoris posterior.APAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 177 rn, clunium mediales inn. clunium inferiores — foramen ischiadicun majus— foramen ischiadicum minus. rn. cutaneus femoris posterior 1. ischiadicus rn. gluteus superior foramen supra et infrapiriforme 1nn, clunium inferiores rn cutaneus femoris posterior 1. ischiadicus 89. att. Plexus sacralis. Aspectus dorsolateralis.178 bedrei (fossa poplitea). Pie m. gluteus maximus apakséjas malas 2-3 nerva zari — nn. clunium inferiores — apliecas ap to, iet augSup un inervé Adu regio glutea apak8éji dajé. Bez tam non. cutaneus femoris posterior atzarojas starpenes zari (rr. perineales), kuti, apliecoties lokveida ap tuber ischiadicum, inervé starpenes Adu, anastomoz@jot ar nn. perineales no n. pudendus. + Stias nervs (n. ischiadicus) (L-L, S-S,) it resndkais nervs cilvéka organisma. Tas ir jaukts nervs un ir tie’s plexus sacralis turpindjums kaudala virziend. No iegurpa tas iziet pa foramen infrapiriforme un iet gar m. obturatorius internus, m. gemellus superior, m. gemellus inferior, m. quadratus femoris dorsilo virsmu. No mugurpuses to sedz m. gluteus maximus. 38 muskula apakséjas malas limeni 7. ischiadicus atrodas uz Iinijas, kas savieno tuber ischiadicum ar trochanter major, punkti starp tas medidilo un vidgjo treSdalu. Tad nervs pariet uz m. adductor magnus muguréjo virsmu, atrodoties zem augistilba. muguréjés _grupas _muskuliem. Nesasniedzot fossa poplitea augséjo stiri, dalas gala zaros: resndkaja —n. tibialis un tievakaja — 7. peroneus communis. ischiadicus gaita no ta atzarojas motoriskie zari, erve © iegumpa jostas muguréjos muskulus—m. pir ‘m. obturatorius internus, m. gemellus superior, m. -gemellus inferior, m. quadratus femoris; © augistilba mugurgjos muskulus — m. biceps femoris, m. semitendinosus, m. semimembranosus tun dalgji m. adductor magnus. Tibidlais nervs (n. tibialis) (L-L, S-S,) ir jaukts nervs. Tas virzas lejup pa paceles bedres vidu ka seklakais veidojums asinsvadu un nervu kali (Ne-V-A' — no sekluma uz dziluma pusi, no lateralis puses uz medialo), Talak tas atrodas ventrali no arcus tendineus musculi solei un kop at vasa tibialia posteriora iet lejup pa canalis cruropopliteus starp apakSstilba fleksoru seklo un dzilo slani un aiz medialas s nonak zem retinaculum musculorum flexorum treSaja osteofibrozaja kanala kopa ar a. et vv. tibiales posteriores. Tiilit zem malleolus medialis nervs sadalas galazaros: n. plantaris medialis un n. plantaris lateralis. N. tibialis ir vairaki simu zari: ° N. cutaneus surae medialis atiet fossa poplitea augsdali, iet distali starp abam m. gastrocnemius galvam; kopa ar v. saphena parva to klaj fascia cruris. Aptuveni apakstilba vidi tas caururbj fascia cruris un, + Neva — upes nosaukums. CILVEKA ANATOMIJA: roka un kaja Near the lower margin of m. gluteus maximus n. cutaneus femoris posterior gives off branches — nn. clunium inferiores (2-3) that turn around the edge of m. gluteus maximus, pass upwards and supply the skin at the lower part of regio gluta. Rr perineales turn around tuber ischiadicum and supply the skin of perineum and make anastomosis with nn. perineales from n. pudends + The sciatic nerve (n. ischiadicus) (LL, S,-S,) is the largest nerve in the human body. It is a direct continuation of the sacral plexus. It comes out from the pelvis through foramen infrapiriforme and passes down along the dorsal surface of m. obturatorius internus, m. gemellus superior, m. gemellus inferior and m. quadratus femoris. M. gluteus maximus covers the nerve. NY. ischiadicus can be found on the imagined line between tuber ischiadicum and trochanter major at the fixed point between the medial and the middle third on the level of the lower edge of m. gluteus maximus. Further the nerve runs between the muscles of the dorsal femoral group and m. adductor magnus. Above fossa poplitea it splits into two terminal nerves: n. tibialis ~ a larger and rn peroneus communis ~ a smaller nerve. N. ischiadicus gives off side motor branches that supply: * muscles of the pelvic girdle ~ m. piriformis, m. obturatorius internus, m. gemellus superior, m. -gemellus inferior and m. quadratus femoris; * muscles of the upper leg -m. biceps femoris, m. semitendinosus, m. semimembranosus and partly m. adductor magnus. Tibial nerve (n. tibialis) (LL, S,-S,) is a mixed nerve. It passes along the middle of the popliteal fossa and is placed superficially and laterally from the blood vessels (a. ef v. poplitea). The tibial nerve is placed ventrally from arcus tendineus musculi solei, it runs together with vasa tibialia posteriora between the superficial and deep flexor muscles. It turns round the ‘medial malleolus, then it passes below retinaculum ‘musculorum flexorum into the 3rd osteofibrous channel (together with a. et. »: tibialis posterior) and divides into two terminal branches: n. plantaris medialis et n. plantaris lateralis. N. tibialis gives off several side branches: +N. cutaneus surae medialis arises at the upper region of fossa poplitea, then passes distally between the two heads of m. gastrocnemius and runs together with v. saphena parva beneath fascia cruris. At the middle of the lower leg it penetrates fascia cruris and joins with n. cutaneus surae lateralis (from n.APAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 179 1. ischiadicus rn. peroneus 1n. cutaneus surae lateralis —{ 1n. peroneus superficialis—| rn. peroneus rofundus 1. ischiadicus musculares—, 1. peroneus profundus 1. peroneus superficialis 1. interosseus cruris 90. att. N. ischiadicus. Aspectus dorsomedialis. . ;180 anastomozéjot ar n. cutaneus surae lateralis (n. ‘peroneus communis zars), izveido n. suralis. Ejot dorsali no malleolus lateralis, n. suralis inervé apakstilba laterdlas virsmas Adu, dod rr. calcanei laterales wz papéza lateralo virsmu tun ar gala zaru ~n. cutaneus dorsalis lateralis — inervé pEdas un piektd pirksta laterdlas malas Adu. * Rr. articulares paceles bedres apvidi inervé art, genus, bet apakSstilba apakSéja treSdala — art. talocruralis. * Rr. musculares inervé apakéstilba muguréjas ‘gtupas seklos un dzilos muskulus. © Rr. calcanei mediales inervé papéza medialas virsmas adu. N. plantaris medialis ir viens no n. tibialis gala zariem. Tas iet pa sulcus plantaris medialis kopa ar vasa plantaria medialia. Ta inervéjamie muskuli un das apvidi ir tdi pasi ka n. medianus plauksta. N. plantaris medialis inervé pEdas medialas grupas muskulus (iznemot m. adductor hallucis): m. abductor hallucis, m. flexor hallucis brevis, no pedas vi grupas muskuliem — m. flexor digitorum brevis, mm. lumbricales I et II. ‘Nervs beidzas ar nn. digitales plantares communes (3) un nn. digitales plantares proprii (7), inervéjot pédas plantaras virsmas adu un adu I-IIT un TV pirksta medialo virsmu, bet dorsdlaja virsma art adu gala falangu apvido. N. plantaris lateralis — otrs n. tibialis galazars — iet pa ssulcus plantaris lateralis kopa ar vasa plantaria lateralia, Inervacijas zona tada pati kan, ulnaris plaukstd N. plantaris lateralis sadalis par ramus superficialis, kas dod mn. digitales plantares communes, kuri talak sadalas par 1nn, digitales plantares proprii un inervé m. flexor digitt ‘minimi brevis, mm. lumbricales III et IV un pédas plantaris virsmas Adu 1,5 pirksta platuma. R. profimdus iet kopa ar arcus plantaris profundus un inervé m. adductor hallucis, 1m. opponens digiti minimi, m. quadratus plantae, Ka ati visus mm. interossi dorsales et plantares. * Kop@jais fibularais nervs (n._peroneus communis) (LL, S-S,) ir jaukts nervs. Tas iet lejup gar m. biceps femoris medidlo malu un nonak zemada collum fibulae apvida, kur dalas gala zaros: n. peroneus superficialis un n. peroneus profundus. Pirms tam no n. peroneus communis atzarojas divi sanu zari: © rr: articulares cela locttavai un ® n. cutaneus surae lateralis, kas iet gar caput laterale m. gastrocnemii zem fascia cruris. Tzurbjoties cauri fascijai (da24da augstuma), savienojas ar n. cutaneus surae medialis (n. tibialis zars) un izveido n. suralis. CILVEKA ANATOMIJA: roka un kaja peroneus communis) and forms n. suralis. N. suralis runs downwards and innervates the skin of the dorsal and lateral side of the lower leg. N. suralis gives off rr calcanei laterales to the lateral surface of calcaneus and the terminal branch n. cutaneus dorsalis lateralis, that innervates the lateral side of the foot and the lateral side of the Sth toe. * Rr-articulares — arise at the level of fossa poplitea and innervate art. genus; at the level of the lower third of the lower leg art. talocruralis. © Rr musculares innervate the superficial and the deep dorsal muscles of the lower leg. © Rr. calcanei mediales innervate the medial part, of the calcaneus region skin. N. plantaris medialis is one of the terminal branches of n. tibialis. It runs into sulcus plantaris medialis together with vasa plantaria medialia. N. plantaris medialis inervates medial group muscles of the foot (except m. adductor hallucis): m. abductor hallucis, m. flexor hallucis brevis and middle group muscles — mflexor digitorum brevis, mm. lumbricales I et Il. The nerve ends with 3 nn. digitales plantares ‘communes and 7 nn. digitales plantares proprii, that innervate the skin of the plantar side of the foot and the skin of I — III and the medial surface of IV toe. N. plantaris lateralis runs into sulcus plantaris lateralis together with vasa plantaria lateralia and divides into ramus superficialis and ramus profundus. Ramus superficialis gives off nn. digitales plantares communes, which divide into 3 nn. digitales plantares proprii and innervate m. flexor digiti minimi brevis, ‘mm. lumbricales III et IV, the plantar skin of the ‘4 4th and Sth toes. Ramus profundus accompanies arcus plantaris profundus and innervates m. adductor hallucis, m. opponens digiti minimi, m. quadratus plantae and mm. interossi dorsales et plantares. + Common peroneal nerve (n. _peroneus communis) (L;-L, S,-S,) is &-mixed nerve. It passes along the medial edge of m. biceps femoris under the skin to the region of collum fibulae and divides into the terminal branches: n. peroneus profundus and n. peroneus superficialis. N. peroneus communis gives off two side branches before it divides into the terminal branches: © rr. articulares that innervate art. genus, © n. cutaneus surae lateralis which passes along caput laterale m. gastrocnemii below fascia cruris, then penetrates fascia cruris and gives skin innervation to the lateral side of the lower leg till malleolus lateralis, it joins with n. cutaneus surae medialis and forms n. suralis.APAKSEJA EKSTREMITATE / LOWER LIMB / memlrw inferius 181 1. peroneus communis 1n. saphenus nn cutaneus surae lateralis. \____n. tibialis 1. peroneus profuundus 1. peroneus superficialis rn. suralis 1. interosseus cruris rami calcanei_ laterales .n. cutaneus dorsalis medialis. rami caleanei — .n. cutaneus dorsalis intermedius mediales in plantaris Ln. cutaneus dorsalis lateralis" medialis 1n plantaris lateralis. inn. digitales dorsales pedis a inn. digitales dorsales hallucis lateralis et digiti secundi medialis ee J ‘nn. digitales plantares proprii 91. att. N. tibialis et n. peroneus communis. A - Aspectus ventralis. B - Aspectus dorsamedialis.182 CILVEKA ANATOMIJA: roka un kaja ‘ramus cutaneus lateralis n.iliohypogastrici ‘ramus cutaneus anterior n iliohypogastrici inn. scrotales /labiales anteriores n.ilioinguinalis ‘ramus genitalis n. genitofemoralis 1n. dorsalis penis /clitoridis ‘ramus femoralis n. genitofemoralis | rami cutanei anteriores n, femoralis ramus cutaneus lateralis 1. iliohypogastrici inn. clunium superiores. inn. clunium mediales rn. cutaneus surae lateralis nn, clunium inferiores 1. saphenus rn. cutaneus femoris lateralis 1. cutaneus femoris posterior: ramus cutaneus n. obturatorii rami cutanei cruris medialis n. saphenus rn cutaneus surae lateralis 92. att. Adas inervacija. A - Aspectus ventralis. B - Aspectus dorsalis.APAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 183 ramus cutaneus n. obturatori rn. cutaneus femoris posterior. ‘n. cutaneus surae medialis (n. tibialis) 1n. cutaneus surae lateralis (n. peroneus communis). rami cutanei cruris mediales n. sapheni 1 eutaneus femoris anterior ramus cutaneus n. obturatorii rn cutaneus dorsalis | nm ewtaneus dorsalis lateralis (n. suralis) bch ssgaipater rami calcanei laterales (n. suralis) n. plantaris lateralis. n-plantaris medialis (n. tibialis) ‘rami cutanei cruris medialis n. sapheni rn, eutaneus surae lateralis (n. peroneus communis) rami calcanei mediales n. tibialis rn. eutaneus dorsalis lateralis (n. suralis) 1. cutaneus dorsalis intermedius (n. peroneus superficialis) rn. cutaneus dorsalis medialis (n. peroneus superficialis) nn, digitales dorsales, hallucis lateralis et digiti secundi medialis (n. peroneus profundus) 93. att. Apakéstilba adas inerva A- Aspectus dorsalis. B - Aspectus ventromedialis.184 + Virspusejais fibularais nervs (n. peroneus superficialis) (LL, S,) ir jaukts nervs. Ta motoriskis Skiedras — rr musculares inervé tikai m. peroneus longus et m. peroneus brevis. Nervs izurbjas cauri m. peroneus longus, talk iet starp m. peroneus longus un m. peroneus brevis un pa m. extensor digitorum longus laterdlovirsmu, Apakistilba apaks@ja tresdala tas izrubjas cauri fascia cruris un sadalas divos zaros — n. cutaneus dorsalis medialis un n. cutaneus dorsalis intermedius, kuri ar 7 nn. digitales dorsales inervé Adu pédas un pirkstu dorsilaja virsma, iznemot p&das medialo malu, ko inervé n. saphenus, pirmas_pirkststarpas du, ko inervé n. peroneus profundus, kA ari pédas un piekta pirksta laterdlo malu, ko inervé rn. suralis galazars - n. cutaneus dorsalis lateralis. *+ Dzilais fibularais nervs (n. peroneus profundus) (L-L, ,) it galvenokart motorisks nervs, tam ir maz juSanas skiedru. N. peroneus profundus atrodas proksimali no n. peroneus superficialis, tas piegu| pie caput fibulae, caururbj m. peroneus Jongus un m. extensor digitorum longus cipslaino sikumu, Nonakot_ membrana interossea cruris priekSejavirsma, tas iet distli kop ar vasa tibialia anteriora: sikuma nervs iet starp_m. extensor digitorum longus un m. tibialis anterior, bet vairak distali ~starp m. tibialis anterior un m. extensor hallucis longus. Paejot zem retinaculum ‘musculorum extensorum superius et inferius (kopa ar vasa dorsalia pedis), nervs nonak pédas dorsdlaja virsma, kur tas atrodas zem m. extensor hallucis brevis cipslas. N. peroneus profundus galazars nonak pirkststarpa starp ik8ki un otro pirkstu un inervé tur au. Apakistilbii n. peroneus profundus inervé visus _priekS&jés__grupas ‘muskulus, bet p&da — dorsalas grupas muskulus. Ar rr: articulares inervé pédas locitavas. 2.4. ApakSéjas ekstremitates artérijas (arteriae membri inferioris) ‘Vedera aorta (aorta abdominalis) atrodas pie védera dobuma muguréjas sienas pa kreisi no v. cava inferior un L, liment sadalis (bifurcatio aortae) par a. iliaca communis dextra un a. iliaca communis sinistra. Abas kop@jas iegurna artérijas iet kaudali un laterali gar m. psoas major medialo malu lidz art. sacroiliaca Timenim. Seit katra no tam dalas par a. iliaca externa CILVEKA ANATOMIJA: roka un kaja + Superficial peroneal nerve (n. peroneus super- ficialis) (L;-L, S,) is a mixed nerve. Its motor fibres — rz: musculares innervate only m. peroneus longus et m. peroneus brevis. N. peroneus -superficialis penetrates m. peroneus longus, passes between m. peroneus longus et m. peroneus brevis. It runs along the lateral surface of m. extensor digitorum longus. At the middle of the lower leg n. eroneus superficialis penetrates fascia cruris and divides into two branches — n. cutaneus dorsalis ‘medialis and n, cutaneus dorsalis intermedius. They form 7 nn digitales dorsales that innervate the skin of dorsum pedis, except the space between the Ist and 2nd toe, and the lateral side of the 5 toe. The medial surface of the skin of the foot is innervated by 7. saphenus, but the lateral surface of the foot and the Sth toe is innervated by the terminal branch of n. suralis — n. cutaneus dorsalis lateralis. The skin of the space between the Ist and 2nd toe is innervated by n. peroneus profindus. + Deep peroneal nerve (n. peroneus profundus) (L— L, S,) is mostly a motor nerve. It lies proximally from n. peroneus superficialis near caput fibulae, then it penetrates m. peroneus longus and m. extensor digitorum longus. It passes together with vasa tibialia anteriora along the anterior surface of ‘membrana interossea cruris. In the proximal part n. peroneus profundus is placed between m. extensor digitorum longus and mitibialis anterior, at the distal part it passes between m. tibialis anterior and ‘m. extensor hallucis longus. N. peroneus profundus runs below retinaculum mm. extensorum superius and inferius together with vasa dorsalia pedis to the dorsal side of the foot. N. peroneus priofiundus is placed below the tendon of m. extensor hallucis brevis. The terminal branches of n. peroneus profindus (2 nn. digitales dorsalses) reach the the Ist interdigital space and innervate the skin. N. peroneus profundus gives off rr: musculares to the anterior group of the muscle of the lower leg and r7: musculares to the dorsal group of the foot muscles. It also gives off rz articulares that innervate the joints of the foot. 2.4. Arteries of the lower limb (arteriae membri inferioris) The abdominal aorta (aorta abdominalis) is placed on the dorsal wall of the abdominal cavity left from x. cava inferior At the level of L, it forms aortic ifurcation (bifurcatio aortae), where it divides into a. iliaca communis dextra and a. iliaca communis sinistra. A. iliaca communis dextra et sinistra run in the caudal and lateral direction along the medial borderAPAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 185 r:iliacus a, iliolumbalis- 1 lumbalis a. iliolumbalis. , EF. iliaca interna 4a. glutea superior a. sacralis mediana- . 3 a. iliolumbalis |r tumbalis | 4. sacralis lateralis: ‘a. glutea superior 4. glutea superior. = i a. circumflexa iliaca profunda ‘aa, vesicales superiores a. ductus deferentis a. obturatoria 94. att. Aa. cinguli membri inferioris. A - Aspectus ventralis. B - Aspectus ventrolateralis.. | |186 un a. iliaca interna. Abu a. iliaca communis priekSpus® iet urinvadi, bet tam aizmuguré — tida paSa nosaukuma vénas (». iliaca communis dextra et sinistra). Kopéjas iegurna artérijas ir magistrali asinsvadi, tam nav sinu zaru, bet tikai stki zaripi uz véderplévi un limfmezgliem. legurna aréja arterija (a. iliaca externa) A. iliaca externa iet ka a. iliaca communis turpinajums uz leju gar m. psoas major medialo malu. ‘Tas proksimala dala atrodas priekipus® tada pasa nosaukuma vénai (v. iliaca externa), bet distal — laterali no tas. Apméram lig. inguinale vidusdala a. iliaca externa iziet cauri lacuna vasorum uz augéstilbu, kur turpinds ka a. femoralis. A. iliaca externa dod tikai divus zarus, kuri atiet ties virs ig. inguinal. + A. epigastrica inferior iet kraniali pa plica umbilicalis lateralis, caururbjot vagina m. recti abdominis muguréjo lapinu, pa 8% muskula ‘muguréjo virsmu un virs nabas anastomoz® ar a. epigastrica superior (no a. thoracica interna), Vaskulariz€ védera priekSéjas sienas muskulus. A. epigastrica inferior dod S8dus simu zarus: ® nm pubicus anulus femoralis Vimeni iet pa ramus superior ossis pubis wz simfizi_ un 20% gadijumu dod lejupejosu zaru — r. obturatorius, kas anastomoz® ar r. pubicus a obturatoriae. Si anastomoze ir labi attistita un SAdu variaciju saue par corona mortis. Tzdarot triiéu operdcijas, kirurgam jaatceras par Sidas anastomozes iespéjamibu; ° a cremasterica (virietim) iet pa funiculus spermaticus, vaskularizéjot_ m. cremaster, ductus deferens un t& apvalkus; anastomoz® ar a. testicularis; ° a ligamenti teretis uteri (sievietei) ieiet canalis inguinalis un apasino lig. teres uteri. + A. circumflexa ilium profunda sikas no a. iliaca externa tieSi iepretim a. epigastrica inferior atieSanas vietai, iet aiz lig. inguinale laterali un uz augSu zem fascia iliaca uz spina iliaca anterior superior apvidu un vaskulariz® védera muskulus un m. iliacus. Anastomozé ar r. iliacus a. iliolumbalis (no a. iliaca interna). CILVEKA ANATOMIJA: roka un kaja of m. psoas major and at the level of art. sacroiliaca divide into a. iliaca externa and a. iliaca interna. The ureter crosses a.iliaca communis anteriorly, x. iliaca communis is placed posteriorly. A. iliaca communis is a main blood vessel, it gives off only small branches to the peritoneum and lymph nodes. External iliac artery (a. iliaca externa) A, iliaca externa is a continuation of a. iliaca communis. It passes down along the medial border of ‘m. psoas major. The proximal part of a. iliaca externa is placed ventrally from . iliaca externa, but the distal part - laterally from »: iliaca externa. Approximately at the midpoint of lig. inguinale a. iliaca externa leaves the pelvic cavity through /acuna vasorum and continues to the femoral region as a. femoralis. A. iliaca externa gives off only two branches that arise over lig. inguinale. + A. epigastrica inferior passes upwards (cranially) along the anterior wall of the abdomen, along plica umbilicalis lateralis. A. epigastrica inferior penetrates the posterior layer of vagina m. recti abdominis and runs along the dorsal side of m. rectus abdominis up till the umbilicus, where it makes anasthomosis with a. epigastrica superior (from a. thoracica interna), supplying the muscles of the anterior abdominal wall. 4. epigastrica inferior gives off such side branches: * r pubicus arises at the level of anulus femoralis, runs along ramus superior ossis pubis to the pubic region; in 20% of cases it gives off the descending branch — r: obturatorius that makes anasthomosis with branch of a. obturatoria — pubicus. This anasthomosis known as corona ‘mortis. The surgeons performing hernia repairs must keep this common variation in mind. © a cremasterica (for a male) passes along funiculus spermaticus and supplies m. cremaster, ductus deferens and its coverings; it forms anasthomosis with a. testicularis. © a, ligamenti teretis uteri (for a female) passes along canalis inguinalis and supplies lig. teres uteri. + A. circumflexa ilium profunda arises from a. iliaca externa at the same level as a. epigastrica inferior, then runs laterally and upwards along, the lateral wall of the abdominal cavity beneath ‘fascia iliaca till the level of spina iliaca anterior superior, where it Supplies the muscles of the lateral wall of the abdominal cavity and m. iliacus. Wt forms anasthomosis with r. iliacus a. iliolumbalis (ftom a. iliaca interna).APAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 187 riliacus 1 lumbalis —, 1. spinalis. 4. iliolumbalis a. iliaca interna a. glutea superior A) scram rie epgatrica inferior Pe cburatoria epigastric superficial 1 obturatorius (corona mortis) «a. circumflexa ilium superficialis rm viscerales. a, iliacae int. ‘a. femoralis ‘aa, pudendae externae |__rr serotales /labiales posteriore® 4: bulb pens /bulbi vestbul vaginae— rami a. pudendae internae 4. profunda penis /clitoridis |__ a dorsalis penis /clite 95. att. Aa. cinguli membri inferioris. Sectio mediana. Aspectus ventrolateralis.188 (a. iliaca interna) Atrodas priekSpusé tdda pasa nosaukuma vénai. Krustojot linea terminalis, nondk mazaja iegurnt, kur iet lidz foramen ischiadicum majus aug88jai malai un sadalas parietdlajos un viscerdlajos zaros (a. iliaca interna zara atieSanas vietas ir Joti variablas). A. iliaca interna parietalas artérijas. + A. iliolumbalis 88180 art. sacroiliaca wn truncus Jumbosacralis no priekSpuses un iet dz m. psoas ‘major medidlai malai, kur dalas divos zaros: Jumbalis un r:iliacus. R. lumbalis iet aiz.m. psoas ‘major, apasino to un m. quadratus lumborum. R. iliacus art iet aiz m. psoas major, sasniedz m. iliacus un apasino to, ka ar védera muskulus. R. iliacus anastomoz8 ar a. circumflexa ilium rofuunda. + Aa. sacrales laterales (parasti divas) iet lejup pa facies pelvina ossis sacri, pa plexus sacralis priekSpusi — laterdli no truncus sympathicus, bet mediali no foramina sacralia pelvina. Aa. sacrales laterales veido arterial tiklojumu kopa ar a. sacralis mediana, apasinojot ieguma un starpenes muskulus. Sava gaita tas dod rr spinales, kas iet pa foramina sacralia pelvina un apasino muguras smadzenu cauda equina, ka atl krustu apvidus adu. + A. glutea superior ix diametra lielakais a. iliaca interna mugur@jais zars. let starp truncus lumbosacralis un S, ramus anterior. No ieguma 1G iziet pa foramen suprapiriforme un sadalas seklaji un dzilaja zara. Vaskulariz® visus mm. glutei, m. tensor fasciae latae, m. piriformis un art. coxae. A. glutea superior anastomozé ar a, glutea inferior un a. circumflexa femoris lateralis, + A. glutea inferior iet starp plexus sacralis S, un S, priekSéjiem zariem, iziet no iegumna pa foramen infrapiriforme wn sazarojas starp m. ‘gluteus maximus, m. piriformis, m. obturatorius internus, mm. gemelli un m. quadratus femoris. A. glutea inferior dod zaru uz séZas nervu - a. comitans n. ischiadici. Anastomoz8 ar a. glutea superior un a, circumflexa femoris medialis. A. obturatoria iet pa mazd iegurna lateralo sienuzem linea terminalis, iziet_ pa canalis obturatorius uz augsstilbu un sadalas par anterior un 7: posterior, kas apasino augsstilba medialas grupas muskulus unm. obturatorius externus. A. obturatoria dod divus sanu zarus — 1: acetabularis un r. pubicus. R. acetabularis iet cauri incisura acetabuli, sasniedz lig. capitis femoris un vaskulariz’ caput femoris. R. pubicus iet uz augSu un anastomozé ar 7: pubicus no a. epigastrica inferior (corona mortis) legurna iekSéja artér CILVEKA ANATOMIJA: roka un kaja Internal iliac artery (a. iliaca interna) A. iliaca interna is placed ventrally from v. iliaca interna, It crosses linea terminalis and passes to the lesser pelvis through the upper part of foramen ischiadicum majus, where it gives off the parietal and visceral branches. A. iliaca interna gives off the parietal branches. + A. iliolumbalis crossses art. sacroiliaca and truncus lumbosacralis ventrally, then it runs along the medial border of m. psoas major, where it divides into two branches: r /umbalis andr: iliacus. R. lumbalis runs dorsally from. m. psoas major and gives off blood supplying to ‘m. psoas major and m. quadratus lumborum. R. iliacus also passes backward to m. psoas major till m. iliacus and gives off blood supplying the abdominal muscles and m. iliacus. It makes anasthomosis with a. circumflexa ilium profuunda, + Aa. sacrales laterales (usually two) pass downwards along facies pelvina ossis sacri in front of plexus sacralis — laterally from truncus sympathicus and medially from foramina sacralia pelvina. They form the arterial network together with a. sacralis mediana. Aa. sacrales laterales give off blood supplying to the pelvic and perineal muscles and rr: spinales, which pass through foramina sacralia pelvina and supply cauda equina, and the skin at the sacral region. + A. glutea superior is the largest dorsal branch of a. iliaca interna. It passes between truncus lumbosacralis and ramus anterior S,. It leaves the pelvic cavity through foramen suprapiriforme and ramifies to superficial and deep branches. A. glutea superior supplies mm. glutei, m. tensor fasciae latae and m. piriformis and art. coxae. ‘A. glutea superior forms anasthomosis with a, glutea inferior and a. circumflexa femoris lateralis. + A. glutea inferior passes between the ventral roots S, and S, of plexus sacralis. It leaves the pelvic cavity through foramen infrapiriforme, ramifies between m. gluteus maximus, m. piriformis, ‘m. obtuatorius internus, mm, gemelli and m. quadratus femoris and supplies them. A. glutea inferior gives off a branch to n. ischiadicus — 4. comitans n, ischiadici, A. glutea inferior forms anasthomosis with a, glutea superior and a. circumflexa femoris medialis. + A. obturatoria passes along the lateral wall of the lesser pelvis, leaves the pelvic cavity through canalis obturatorius and runs to the thigh, where it gives off anterior and r: posterior to the medial group muscles and m. obturatorius externus. A. obturatoria gives off two sideAPAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius a. iliaca communis 4. iliaca interna 4. iliaca externa «a. glutea superior. a. circumflexa ilium profunda 1. epigastrica inferior- 1. obturatorius. — «a. obturatoria. 1. ascendens a. circumflexa femorais lateralis oper i r descendens ‘ 1. profunda femoris «a. perforans Il ‘a. circumflexé femoris medialis, «a. descendens genicularis 96. att. A. iliaca et a. femoralis. Aspectus ventralis.190 A. iliaca interna viscerals artérijas. + A. umbilicalis funkcioné tikai placentaras asinsrites laika. Ta iet pa védera dobuma priekSgjés sienas mugurgjo virsmu _anulus umbilicalis virgen’ un tilak pa funiculus umbilicalis uz. placentu; taj& plist jauktas asinis. Vederpléve, parklajot abu puSu artérijas, veido krokas — plicae umbilicales mediales. Péc dziméanas artérija aizaug un parvérsas par lig. umbilicale mediale. Saglabajas tikai artérijas sakumdala, no kuras atiet aa. vesicales superiores uz urinpigla virsotni un kermeni (apex et corpus vesicae). + A. vesicalis inferior apasino urinpis|a pamatni (fundus vesicae), bet virieSiem (rr: prostatici) — ari priekSdziedzeri un séklas pilus. + A. rectalis media iet uz. taisnds zarnas videjo treSdaju, viriesiem atl uz priekSdziedzeri (rr prostatici), bet sieviet&m — uz maksti (rr vaginales). Anastomoz8 ar a. rectalis superior (a. ‘mesenterica inferior zars) un a. rectalis inferior (a. pudenda interna zars). + A. uterina ir tikai sievietei. Ta iet uz leju gar maz iegurpa laterdlo sienu, péc tam starp lig. Jatum uteri lapinm kopa ar lig. cardinale uteri un ureter wz dzemdes kaklu, dodot a. vaginalis, kas iet lejup gar maksts laterdlo sienu. Ejot talak wz augiu, a. uterina spirdlveida izliecas parametrija un sasniedz fundus uteri. Pie angulus uteri no dzemdes artérijas atzarojas 7. ovaricus, kas iet pa lig. ovarii proprium uz olnicu un anastomozé ar 4. ovarica (aorta abdominalis zars); r. tubarius, kas iet pa mesosalpinx un apasino olvadu un rr: ureterici — wz utinvadu apak8éjo tre8daju. Virietim ir homologs asinsvads ~ a. ductus deferentis, kas iet lejup funiculus spermaticus sastva un apasino ductus deferens, vesiculae seminales un ar rr ureterici urinvada apakS8jo treSdalu. + A. pudenda interna iziet no iegurpa pa foramen infrapiriforme. Talit p&c tam apliecas no mugurpuses ap spina ischiadica un kop ar n. pudendus iet wz priekSu pa fossa ischioanalis laterdlo sienu, ietverta fascia obturatoria. Pie diaphragma —urogenitalis muguréjis malas artérija sadalas gala zaros: virietim ~ a. profunda penis un a. dorsalis penis, bet sievietei — a. profunda clitoridis un a. dorsalis clitoridis. Fossa ischioanalis apvidii no artérijas atiet sinu zari: © a. rectalis inferior apasino taisnas zarnas apakSéjo tre8dalu un anastomozé ar a. rectalis ‘media (a. iliaca interna zars); © @. perinealis apasino starpenes muskulatiru, bez tam dod rr: scrotales posteriores (virietim), kas apasino scrotum muguréjo virsmu, vai re labiales posteriores (sievietei), kas apasino CILVEKA ANATOMIJA: roka un kaja branches: r acetabularis andr pubicus. R. acetabularis passes through incisura acetabuli to lig. capitis femoris and gives off blood supplying caput femoris. R. pubicus ascendes and forms anasthomosis with r: pubicus from a. epigastrica inferior (corona mortis). A. iliaca interna gives off the visceral branches. + A. umbilicalis acts only in the time of the placental blood circulation. A. umbilicalis passes along the anterior wall of the abdominal cavity to the anulus umbilicalis and further in the composition of the funiculus umbilicalis to the placenta, it contains mixed blood. The peritoneum, covering arteries of both sides, forms folds — plicae umbilicales mediales. After the birth a. umbilicalis obliterates at its distal portion after the birth and forms lig. umbilicale mediale, but its proximal part gives off aa. vesicales superiores, it what — supplies the urinary bladder (apex et corpus vesicae). + A. vesicalis inferior supplies the base of the urinary bladder (fundus vesicae), but in male (rr prostatici) — supplying the prostate and the seminal glands. + A. rectalis media supplies the middle part of the rectum, in the male also the prostata (rr prostatici), in the female ~ the vagina (rr: vaginales). It forms anasthomosis with a. rectalis superior (from a. mesenterica inferior) and a. rectalis inferior (from a. pudenda interna). + A.uterina (fora female) descends along the lateral wall of the lesser pelvis, then — within lig. latum uteri together with lig.cardinale uteri and ureter to cervix uteri. Further it turns upwards and runs in parametrium, where it has a spiral-like course till fundus uteri. A. uterina gives off a. vaginalis which arises at the level of collum uteri and runs downward along the lateral wall of the vagina. At the level of angulus uteri a. uterina gives off 1: ovaricus that passes along lig. ovarii proprium to the ovarium, where it forms anasthomosis with a. ovarica (from aorta abdominalis) and supplies the ovarium. R. tubarius arises at the level of angulus uteri and passes within mesosalpinx and supplies the uterine tube. Rr ureterici supply the lower third of the ureter. A. ductus deferentis (for a male) passes downwards in the composition of funiculus spermaticus and gives off blood supplying to ductus deferens, vesiculae seminales and the lower third of the ureter (rr: ureterici).. + A. pudenda interna leaves the pelvic cavity through foramen infrapiriforme, turns around spina ischiadica and passes forwards together with nm. pudendus along the lateral wall of fossa ischioanalis, encircled in fascia obturatoria.APAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 191 Fa. glutea superior a. glutea inferior 1: profundus a. circumflexae ‘Jemobimethale 4. superior lateralis ge a. superior lateralis genu 97. att. Arteriae cinguli membri inferioris et arteriae membri inferioris liberi. Aspectus dorsalis.192 labia majora pudendi muguréjo dalu; * a. urethralis ieiet corpus spongiosum penis, kur apasino urinizvadkanalu un anastomozé ar 4a. profunda penis; * a. bulbi penis (vitietim) apasino bulbus penis un m. bulbospongiosus; a bulbi vestibuli (ievietei) apasino bulbus vestibuli. Augistilba jeb ciskas artérija (a. femoralis) A. femoralis ir tie8s a. iliaca externa turpinajums, kad ta pa lacuna vasorum iziet uz augistilba priek$jo virsmu, atrodoties laterali nov. femoralis. Talak a. femoralis iet pa sulcus iliopectineus, péc tam pa sulcus femoralis anterior un nonak canalis adductorius. No andla artérija iznak pa t& apak§éjo atveri (hiatus adductorius) un nonak fossa poplitea, kur to sauc par a. poplitea. A. femoralis it éetti seklie zari. + A. epigastrica superficialis — sika artérija, atrodas zemada. Skérso pa priekSpusi lig. inguinale un iet uz nabas apvidu; apasino seklos védera dobuma priekSéjas sienas veidojumus. + A. circumflexa ilium superficialis iet gar lig. inguinale apakS8jo malu uz spina iliaca anterior superior; apasino Adu, zemadu, fasciju. + Aa. pudendae externae iet medidli wz regio pubica apvidu, rgjm genitalijam un beidzas ka rm. scrotales anteriores (vitietim) vai rr: labiales anteriores (sievietei). + Rr. inguinales apasino cirksna limfmezglus. A, femoralis dzilie zari. + A, profunda femoris — visresndkais zars (gandriz a. femoralis resnuma). Atiet no a. femoralis muguréjis virsmas 4-6 cm zem lig. inguinale, iet distali aiz a. femoralis, caururbj m. adductor ‘magnus un beidzas kA a. perforans tertia. Tai ir vairaki zari: ° a circumflexa femoris lateralis kopuma apasino augistilba priekSéjas grupas muskulus, CILVEKA ANATOMIJA: roka un kaja In a male at the level of posterior margin of diaphragma urogenitalis a. pudenda interna gives off two terminal branches: a. profuunda penis and a. dorsalis penis, in a female — a. profunda clitoridis and a. dorsalis clitoridis. In the region of fossa ischioanalis a. pudenda interna gives off the following side branches: © arectalis inferior, that supplies the lower third of the rectum, anasthomosis with a. rectalis media (from a. iliaca interna); * rm perineales, that supplies the perineal muscles, and gives off rr. scrotales posteriores (for a male) that supply the posterior part of the scrotum or rr: labiales posteriores (for a female) that supply the posterior part of labia majora pudendi; * a urethralis, passes in corpus spongiosum penis and gives off blood supplying to the urethra, it forms anasthomosis with a. profunda penis; © bulbi penis (for a male) supplies bulbus penis and m. bulbospongiosus, a. bulbi vestibuli (for a female) supplies bulbus vestibuli. Femoral artery (a. femoralis) A. femoralis is a continuation of a. iliaca externa, it traverses lacuna vasorum and reaches the anterior surface of the thigh laterally from v: femoralis. It runs in the groove — sulcus iliopectineus and further it passes along sulcus femoralis anterior. A. femoralis. enters canalis adductorius, where it comes out through the lower opening of the channel ~ hiatus adductorius and reaches fossa poplitea, where its name is a. poplitea. A. femoralis gives off four superficial branches. + A. epigastrica superficialis is a small sub- cutaneous artery. It crosses anteriorly lig. inguinale and reaches the umbilical region, where it supplies the superficial structures of the anterior abdominal wall. + A. circumflexa ilium superficialis passes laterally along the lower edge of lig. inguinale to spina iliaca anterior superior and supplies the skin, the subcutaneous and the fascia at that region. + Aa. pudendae externae pass medially to regio pubica and supply the external genitals, they terminate as rr: scrotales anteriores in a male or rr labiales anteriores in/a female. * Rr. inguinales supply lymph nodes in the inguinal region. A. femoralis gives off deep branches. + A. profunda femoris is the largest branch (it is almost as large as a. femoralis). It arises 4~6 cm below lig. inguinale and passes downwards and dorsally. It penetrates m. adductor magnus and further continues on the posterior side of theAPAKSEJA EKSTREMITATE / LOWER LIMB/ membrum inferius 193 ‘a. media genus «inferior. lateralis genus a. inferior medialis genus 1: perforans. «a. tibialis anteiror a. tibialis anterior a. malleolaris anterior tibialis post a tibialis posterior eennls a. malleolaris: anterior lateralis. 1: perforans 4. arcuata rr perforantes = aa. metatarsales dorsales aa, digitales dorsales 98. att. A — Arteriae cruris. Aspectus dorsalis. B - Arteriae pedis. Aspectus dorsalis.194 giias un cela locitavu. Ta atiet no a. profunda femoris trigonum femorale apvidi, iet aiz ‘m. rectus femoris un, sasniedzot trochanter ‘major, sadalas trijos zaros: r. ascendens, kas iet zem m. tensor fascia latae un m, gluteus ‘medius un anastomoz8 ar a, glutea superior; 1 descendens, kas iet zem m. rectus femoris uz Ieju lidz cela apvidum un anastomoz® ar cela locitavas artérijam, unr: transversus, kas ‘anastomozé ar r: transversus no a. circumflexa femoris medialis; ° a circumflexa femoris medialis kopum’ apasipo augistilba medialas grupas muskulus un gizas locitavu. Ta atiet no a. profunda femoris trigonum femorale apvida un iet starp ‘m. iliopsoas un m. pectineus uz trochanter minor. Tur artBrija sadalas divos zaros: transversus, kas iet wz augsstilba medidas grupas muskujiem un anastomoz ar Iidzigu zaru no a. circumflexa femoris lateralis, unr. ascendens, kas apasino art. coxae un anastomozé ar a. glutea inferior. + Aa. perforantes it vairakas: * a. perforans prima (starp m. pectineus un m. adductor longus augséjo malu), © a. perforans secunda (gar m. adductor brevis augsejo malu), © a. perforans tertia (virs vai zem m.adductor Jongus piestiprinasanas vietas). Visas aa. perforantes apasino augistilba muguréjas un daleji medialas grupas muskulus. = A. descendens genus sikas no a. femoralis canalis adductorius distilaja treSdala. Kopa ar n. saphenus iznak pa kanala priekSéjo atveri un piedalas cela locitavas arteriala tikla (rete articulare genus) veidosana. Paceles artérija (a. poplitea) A. poplitea ir a. femoralis ties turpinajums zem hiatus adductorius. Paceles bedré (fossa poplitea) ‘8 ir novietota vismedialak un visdzi tibialis ~ v. poplitea ~ a. poplitea (labakai iegaum@Sanai: ne-v-a). CILVEKA ANATOMIJA roka un kaja thigh as a. perforans tertia. It gives off several branches: © a circumflexa femoris lateralis supplies the anterior muscle group of the thigh, hip joint and knee joint. It arises from a. profunda “femoris at the region of trigonum femorale. It passes behind m. rectus femoris till trochanter ‘major, where it divides into three branches: r ascendens, that passes below m. tensor fasciae latae and m. gluteus medius and forms anastomosis with a. glutea superior, r descendens, that passes below m. rectus femoris till the knee joint and it forms anasthomosis with the knee joint arteries, and r: transverses, that forms anasthomosis with r. transversus from a.circumflexa femoris medialis; * a. circumflexa femoris medialis supplies the ‘medial muscle group of the thigh and hip joint. It arises from a. profunda femoris at the region of trigonum femorale and passes between ‘m. iliopsoas and m. pectineus to trochanter minor, where it divides into two branches : r transversus, that supplies the medial muscle group of the thigh and forms anasthomosis with the branch from a. circumflexa femoris lateralis andr: ascendens, that supplies art. coxae and forms anasthomosis with a. glutea inferior. + Aa, perforantes are several; they are: ° a. perforans prima (passes between m. pectineus and the upper margin of m. adductor longus); * a. perforans secunda (passes along the upper margin of m. adductor brevis); * a. perforans tertia (passes above or below the attachment of m. adductor longus). All aa. perforantes give off blood supply to the posterior muscle group of the thigh and partly to the ‘medial muscle group of the thigh. + A. descendens genus arises from a. femoralis at the distal third of canalis adductorius. It comes out through the anterior opening of the channel together with n. saphenus and supplies the knee joint, where it takes part in the formation of rete articulare genus. Popliteal artery (a. poplitea) A. poplitea is the continuation of a. femoralis below hiatus adductorius. A. poplitea passes in fossa poplitea, it is placed medially and deeply from the vein, The structures in fosa poplitea are placed in such consequence - n. tibialis - v. poplitea - a. poplitea (in short: ne-v-a)APAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 195 a, digitales plantares propriae J ‘aa, digitales plantares communes ‘aa, metatarsales plantares arcus plantaris profiundus ‘ramus superficialis ‘ramus profundus a. plantaris lateralis: a. plantaris medialis 4. tibialis posterior 99. att. Arteriae pedis. Aspectus plantaris.196 Artérija dod nelielus zarus, kuri, savstarp@ji anasto- mozéjot, piedalas rete articulare genus veidoSana. Tie it + a. superior lateralis et medialis genus (art. genus locitavas sominas augSmalas liment); + a. inferior lateralis et medialis genus (art. genus locttavas sominas apak8éjas malas liment, kur a. ‘poplitea iet pa m. popliteus dorsalo virsmu); + a media genus atiet cela locitavas spraugas iment un apasino ligg. cruciata genus, meniskus un sinovialo apvalku; + aa. surales (parasti divas) atiet tiesi pirms a. poplitea distilas dalas, kur t& atrodas ventrali no arcus tendineus musculi solei un apasino m. triceps surae un m. popliteus. M. popliteus apakS@j4s malas liment a. poplitea beidzas, sazarojoties divas gala artérijas — a. tibialis anterior et a. tibialis posterior. Priek’ 4 lielakaula artérija (a. tibialis anterior) A. tibialis anterior sikas no a. poplitea canalis cruropopliteus augSejas atveres Iment un sdkotnéji iet pa So kanalu. Péc tam artérija kopa ar vy, tibiales anteriores un n. peroneus profundus izurbjas cauri ‘membrana interossea cruris tas augsgald. Visi Sie veidojumi iet pa membrinas priek8éjo virsmu, atrodoties aiz apakSstilba priek8&jas grupas muskuliem. Nonakot retinaculum musculorum extensorum inferius iment, a. tibialis anterior turpinas k& a. dorsalis pedis. A. tibialis anterior it pieci zariz * a recurrens tibialis posterior (nepastaviga!) atiet virs kaulstarpas membranas atveres un pa canalis cruropopliteus atgriezas paceles bedré, kur piedalis rete articulare genus veidoSand; + @ recurrens tibialis anterior - atiet artérijas priek8@ja virsma un, tpat ka iepriek$eja artérija, atgrieZas paceles bedré un piedalas rete articulare genus veidoSand; + rr, musculares vaskulariz® apakéstilba priekSéjas grupas muskulus; + a malleolaris anterior medialis atiet potisu liment, piedalas rete malleolare_mediale veidoSand un apasino medialas potites apvidu, ka ari art. talocruralis un ossa tarsalia, + a. malleolaris anterior lateralis atietpotisu Timent un kopa ar paréjiem zariem piedalas rete malleolare laterale veidoSana un apasino lateralas potites apvidu, ka art art. talocruralis un ossa tarsi CILVEKA ANATOMIJA: roka un kaja It gives off small side branches that anasthomosis and make rete articulare genus: + a superior lateralis et medialis genus (at the upper level of the knee joint articular capsule); + a inferior lateralis et medialis genus (at the lower level of the knee joint articular capsule where a. poplitea passes along the dorsal surface of m. popliteus); + a. media genus arises at the level of the knee joint split and supplies ligg. cruciata genus, the menisci and synovial folds; = aa. surales (usually two) arise from the distal part of a. poplitea, then pass downward ventrally from arcus tendineus musculi solei and supply m. triceps surae and m. popliteus. A. poplitea divides into terminal branches at the lower part of fossa poplitea: a. tibialis anterior and a, tibialis posterior. Anterior tibial artery (a. tibialis anterior) A. tibialis anterior arises from a. poplitea at the level of the upper opening of canalis cruropopliteus and further passes into it. Then the artery penetrates ‘membrana interossea cruris in its upper part and arrives at the anterior side of the lower leg. The artery is accompanied by vi: tibiales anteriores and 1. peroneus profundus. All structures pass along the anterior surface of the membrana interossea cruris behind the muscles of the anterior group of the lower leg. A. tibialis anterior beneath retinaculum musculorum inferius continues as a. dorsalis pedis on the dorsal side of the foot. A. tibialis anterior gives off five branches: “a. recurrens tibialis posterior (changeable!) arises from a. tibialis anterior before it penetrates the interosseous membrane of the lower leg and returns back to fossa poplitea along canalis cruropopliteus and terminates in rete articulare genus; * a recurrens tibialis anterior arises from a. tibialis anterior and passes upwards to popliteal fossa and terminates in rete articulare genus, + rr. musculares supply the muscles of the anterior group of the lower leg; + a. malleolaris anterior medialis arises at the level of the malleolus and tums round the medial malleolus, where forms rete malleolare mediale. It supplies the region of medial malleolus, art. talocruralis and ossa tarsalia. + a, malleolaris anterior lateralis arises at the level of the malleolus, turns round the lateral malleolus and forms rete malleolare laterale. It supplies the region of lateral malleolus, art. talocruralis and ossa tarsi. formAPAKSEJA EKSTREMITATE / LOWER LIMB / membrum inferius 197 4. poplitea rr descendes. ba a. circumflexae femoris lateralis 4. descendens genicularis a. superior medialis genus 4. inferior lateralis genus. 1: circumflexus fibularis. «a. recurrens tibialis posterior — .. tibialis posterior 4. recurrens tibialis anterior «a. tibialis anterior a. tibialis posterior 100. att. Rete articulare genus. Aspectus dorsalis. j | 7198 Pédas dorsala artérija (a. dorsalis pedis) A. dorsalis pedis ir a. tibialis anterior gala zars, kur sakas vidusdaja starp malleolus medialis et lateralis zem retinaculum musculorum extensorum inferius, A. dorsalis pedis pulsu var viegli sataustit laterali no m. extensor hallucis longus cipslas. Pédas dorsdla artérija caput tali iment dod zaru ~ a. tarsalis lateralis, tad iet uz pirmas pirkststarpas apvidu, kur sadalis divos zaros: a. plantaris profunda un a. arcuata, * @ arcuata iet laterali gar Il, Il, IV un V metatarsili aula pamatném zem m. extensor digitorum longus cipslim un dod I, II un IV ‘aa, metatarsales dorsales, kas katra sadalis par divam aa, digitales dorsales uz. attiecigajam pirkstu starpam, + a. plantaris profunda, No tas atzarojas pirma a, metatarsalis dorsalis, kura sadalas trijés aa. digitales dorsales, kamér pati artérija anastomozé ar a. plantaris lateralis galu un piedalas arcus plantaris profundus veidosana. Sava gaiti a. dorsalis pedis dod vai zarus: + a. tarsalis lateralis atiet caput tali liment, Skérs0 pédas laterdlo virsmu zem m. extensor digitorum brevis un pie V metatarsali kaula pamatnes anastomozé ar a. arcuata; = aa. tarsales mediales ir sikas artérijas, kas apasino pédas medidlo malu un dalgji Tkika muskulus. A. dorsalis pedis, a. arcuata un a. tarsea lateralis sav starpa anastomozé un apasino pédas un pirkstu dorsalo virsmu. cus siinu Muguréja liela lielakaula artérija (a. tibialis posterior) A. tibialis posterior ir lielaka pat a, tibialis anterior un ir tie’s a. poplitea turpindjums. Ta iet kopa ar divam wv. fibiales posteriores un n. tibialis pa canalis cruropopliteus, nonak aiz malleolus medialis un paiet zem retinaculum musculorum flexorum. Pédas plantrajé virsma ta dalés gala zaros: a: plantaris medialis et a. plantaris lateralis. Celi a. tibialis posterior dod vairakus sinu zarus: n circumflexus fibularis, kas atgriezas paceles bedré, apliecas ap caput fibulae un piedalas rete articulare genus veidosand; + rr musculares apasino apakistilba muguréjas grupas muskulus; + rr. malleolares mediales apliecas ap medialo pot un piedalas rete malleolare mediale veidoSana; + a. nutritia tibiae apasino tibia, + rm calcanei Kopi ar a. peronea tida pasa nosaukuma zariem (rr calcanei) veido rete calcaneum; CILVEKA ANATOMIJA: roka un kaja Dorsalis pedis artery (a. dorsalis pedis) The terminal branch of a. tibialis anterior - a. dorsalis pedis begins midway between malleolus medialis et lateralis, deep to retinaculum musculorum extensorum inferius. On the dorsal side of the foot laterally from the tendon of m. extensor hallucis longus a. dorsalis pedis pulses may be palpated. 4. dorsalis pedis gives off a. tarsalis lateralis and then passes distally to the Ist interosseous space, where it divides into a. plantaris profunda and a. arcuata, +a arcuata runs laterally from the Ist interosseous space across the basis of four lateral metatarsals, deep to the tendons of m. extensor digitorum longus and gives off Il, Il and IV aa. ‘metatarsaels dorsales, which run to the clefts of the toes, where each of them divides into two aa. digitales dorsales. + a, plantaris profunda gives rise to the I dorsal ‘metatarsal artery (a. metatarsalis dorsalis), which divides into three aa. digitales dorsales and then joins arcus plantaris profundus. A. dorsalis pedis gives off several side branches: * a. tarsalis lateralis arises at the level of caput tali, runs an arched course laterally beneath m. extensor digitorum brevis crosses to anastomose with a. arcuata at the level of base of the Sth metatarsal bone; * aa. tarsales mediales are small arteries, that supply the medial side of the foot and partly the muscles of the toe. A. dorsalis pedis, a. arcuata and a. tarsea lateralis anasthomosis and supply the dorsal surface of the foot and the toes. Posterior tibial artery (a. tibialis posterior) A. tibialis posterior is larger then a. tibialis anterior and is a direct continuation of a. poplitea. It passes in canalis cruopopliteus together with two w. tibiales osteriores and n. tibialis. After exiting from the channel artery it lodges behind malleolus medialis and then runs beneath retinaculum musculorum flexorum. On the plantar surface a. tibialis posterior gives off two terminal branches: a. plantaris medialis and a. plantaris lateralis. A. tibialis posterior gives off several side branches: +r circumflexus fibulae, that passes upwards to the popliteal fossa, turns around caput fibulae and forms rete articulare genus; + rm musculares supply the muscles of the posterior group of the lower leg; + 1, malleolares mediales tum around the medial malleolus and forms rete malleolare mediale, + a, nutritia tibiae ~ supplies tibia; + rr. caleanei together with rr. calcanei from a peronea form rete calcaneum;