Femoral triangle contents. Femoral triangle (trigonum femorale)

The femoral triangle is formed: above– inguinal ligament (base of the femoral triangle); laterally– tailor muscle; medially– adductor longus muscle. Under the superficial layer of the fascia lata in the femoral triangle, surrounded by a common vagina, pass the femoral artery and vein.

At the base of the triangle femoral vein lies medially,femoral artery– laterally, femoral nerve– outward from the artery under the deep layer of fascia lata. Towards the apex of the femoral triangle, the vein deviates posteriorly from the femoral artery.

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

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

Bottom of the femoral triangle are ileo-

psoas and pectineus muscles, the edges of which form the sulcus iliopectineus. It passes into the sulcus femoralis anterior in

middle third of the thigh. Here they pass under their own fascia

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

Adductor canal(canalis adductorius) is a continuation

by pressing the anterior groove of the thigh. It is located under the fascia lata and is covered in front by the sartorius muscle. Front wall canal – aponeurotic plate (lamina vastoadductoria)

between m. vastus medialis and m. adductor magnus; lateral wall– m. vastus medialis; medial– m. adductor magnus.

The channel has three holes. Through top(input) hole canal pass through the femoral artery and femoral vein

and n. saphenus. The lamina vastoadductoria contains anterior from-

Version, through which n exit the channel. saphenusia. genusdescendents.

In the adductor canal in relation to the femoral artery n. saphenus lies on its anterior wall; the femoral vein is located behind and lateral to the artery.

The femoral vessels leave the adductor canal into the popliteal fossa through the tendon gap of the adductor major muscle (hiatus adductorius), which is lower(on weekends)

hole channel.

The adductor canal can serve place of transition of purulent processes from the front to the back of the thigh, the sub-patellar fossa and back. For example, pus from the hip joint, adenophlegmon from the femoral triangle and from the popliteal fossa through the lower opening can spread here.

Obturator canal(osseous-fibrous)formed bo-rozdoy on the lower surface of the pubic bone and attaches

along its edges obturator membrane. External opening

sti The canal is located behind the pectineus muscle, 1.5 cm inferior to the medial part of the inguinal ligament. Glubokoe(pelvic) hole canal faces the prevesical cellular space of the pelvis. Channel length – 2-3 cm. Through the obturator canal, the vessels and nerve of the same name exit into the adductor muscles onto the thigh.

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Femoral triangle, Skarpovsky, or, more correctly, Scarpa's triangle, limited with lateral side sartorius muscle, m. sartorius, with medial- long adductor muscle, m. adductor longus; his vertex formed by the intersection of these muscles, and base- inguinal ligament. The height of the femoral triangle is 15-20 cm.

Layers of the anterior thigh area. Superficial arteries and veins in the femoral triangle

The skin in the area of the femoral triangle is thin and mobile.

The subcutaneous tissue contains blood vessels, lymphatic vessels and nodes, and cutaneous nerves. Superficial arteries (an exception to the rule; most named arteries are located under the fascia propria) emerge from under the fascia propria through the fascia cribrosa in the area subcutaneous fissure, hiatus saphenus(Fig. 4.2).

Superficial epigastric artery, a. epigastrica superficialis, runs in the subcutaneous tissue of the thigh to the middle of the projection of the inguinal ligament and then in the subcutaneous tissue of the anterior abdominal wall towards the navel.

Superficial circumflex iliac artery, a. circumflexa ilium superficialis, directed from the subcutaneous fissure to the superior anterior iliac spine parallel to the inguinal ligament.

Superficial external pudendal artery, a. pudenda externa superficialis, goes inward, to the perineal area.

Arteries, as usual, are accompanied by veins of the same name (these veins are involved in the formation of portacaval and cavo-caval anastomoses).

The femoral triangle is limited externally by the sartorius muscle, m. sartorius, from the inside - by the long adductor muscle, m. adductor lon-gus; its apex is formed by the intersection of these muscles, and its base by the inguinal ligament. The height of the femoral triangle is 15 - 20 cm. At its bottom there is a deep triangle, or fossa, fossa iliopectinea, the walls of which are m. iliopsoas, etc. pectineus (attached to the lesser trochanter).

The skin in the area of the femoral triangle is thin, tender, and mobile. The subcutaneous tissue contains blood vessels, lymph nodes and cutaneous nerves. Superficial arteries exit through a loosened area of the fascia lata in the area of the subcutaneous fissure, hiatus saphenus (Fig. 35). Superficial epigastric artery, a. epigastrica superficialis, runs in the subcutaneous tissue of the anterior abdominal wall from the middle of the inguinal ligament to the navel. The superficial circumflex iliac artery runs from the subcutaneous fissure to the superior anterior iliac spine parallel to the inguinal ligament. External genital arteries, aa. pudendae externae, only two, go inward, located anterior to the femoral vein above or, sometimes, below the place where the great saphenous vein of the leg enters it, v. saphena magna.

This vein is the main landmark in the subcutaneous tissue of the femoral triangle. Here, at the exit from the vascular lacuna, the femoral branch of the genitofemoral nerve, n. genitofemoralis, branches, innervating the skin under the medial part of the inguinal ligament. Near the superior anterior iliac spine, first in the thickness of the fascia lata, and below in the subcutaneous tissue, the lateral cutaneous nerve of the thigh, n. cutaneus femoris lateralis, passes, and along the inner edge of the m. sartorius pierce the fascia lata by the anterior cutaneous branches of the femoral nerve, rr. cutanei anteriores.

The cutaneous branch of the obturator nerve, i.e. cutaneus n. obturatorii, lying in the small pelvis on its lateral wall formed by the acetabulum, corresponding to the ovarian platform, reaches along the inner surface of the thigh to the level of the patella. This is the cause of pain that sometimes occurs in the knee joint during inflammatory processes in the hip joint or uterine appendages.

In the superficial superolateral and superomedial inguinal lymph nodes, lymph flows from the anterior abdominal wall below the umbilical horizontal, from the external genitalia, the skin of the anal triangle of the perineum, as well as from the fundus of the uterus (along the blood vessels of the round ligament of the uterus), lumbar and gluteal regions.

Lymph flows from the skin of the lower limb into the lower superficial inguinal lymph nodes. The efferent vessels of the superficial lymph nodes of the femoral triangle go to the deep inguinal nodes lying along the femoral artery under the superficial leaf of the fascia lata, numbering 3 - 7. From here the lymph flows into the nodi lymphatici iliaci externi, located around a. iliaca externa in the pelvic cavity.

The wide fascia, fascia lata, is especially dense on the outer surface of the thigh, where the iliotibial tract (tractus iliotibialis) is formed. It gives off three intermuscular septa: external, internal and posterior, septa intermuscularia femoris laterale, mediale et posterior, which are attached to the femur along the rough line, linea aspera, and divide the entire subfascial space of the thigh into three fascial beds: anterior, containing extensor muscles lower legs, posterior - flexors and medial bed, in which the adductor muscles of the thigh are located.

In the area of the femoral triangle, the fascia lata at the inner edge of the sartorius muscle is divided into two plates. The deep plate runs medially behind the femoral vessels and connects to the fascia of the iliopsoas and pectineus muscles. The superficial plate runs in front of the femoral vessels and connects with the inguinal ligament at the top. It is heterogeneous in its structure: dense in the outer part, covering the femoral artery, forming a crescent-shaped edge, margo falciformis, and loose, perforated in the medial part, above the femoral vein - the ethmoid fascia, fascia cribrosa. In margo falciformis, there are upper and lower horns, cornua superius et inferius, limiting the subcutaneous ring of the femoral canal, hiatus saphenus. The lower horn is easily identified by the v bending over it. saphena magna, which, within the hiatus saphenus, flows into the femoral vein (see Fig. 35).

The cellular space of the femoral triangle, located between the superficial and deep plates of the fascia lata, contains the femoral artery and vein. It communicates along the course of the femoral vessels through the vascular lacuna, lacuna vasorum, with the subperitoneal floor of the pelvis; along the superficial branches of the femoral vessels through the holes in the ethmoidal fascia filling the hiatus saphenus - with the subcutaneous tissue of the femoral triangle; along the lateral artery surrounding the thigh - with the outer region of the hip joint; along the medial artery surrounding the thigh - with the bed of the adductor muscles; along the perforating arteries, through the holes in the tendons of the adductor muscles - with the posterior bed of the thigh and along the femoral vessels - with the adductor canal.

Fascia lata, along with the fascial bed of the femoral vessels, forms cases for the muscles of the superficial layer: m. tensor fasciae latae, inward from it - for mm. sartorius et adductor longus, and even more medially - for m. gracilis.

In the deep layer of the femoral triangle there are two muscles: outward lies m. iliopsoas, attached to the lesser trochanter, medially - m. pectineus, starting from pecten ossis pubis and also attached to the lesser trochanter. On m. pectineus, anterior to arcus iliopectineus, the femoral vessels pass through the vascular lacuna: artery on the outside, vein on the inside. Together with m. iliopsoas, under its fascia and arcus iliopectineus, the femoral nerve passes through the muscle lacuna, which divides into branches 2 - 3 cm below the inguinal ligament.

In topographic anatomy, the femoral triangle is a section of the thigh located in its upper part and resembling a triangular figure along its boundaries. In this area of the lower limb, muscles, arteries and veins, lymph nodes and nerve endings intertwine.

Muscle tissue

The base of the femoral triangle in anatomy is formed by the inguinal ligament, behind which there are vascular and muscular lacunae, and femoral hernias can occur under it. The adductor longus muscle passes medially, and the sartorius muscle passes laterally. The apex of this section is located 10 cm from the inguinal ligament.

The lower part of the triangle is limited by the iliopsoas and pectineus muscles. Between these fibers an empty space is formed, which is called the iliopectineal fossa.

Arteries and veins

According to topography, the femoral triangle is endowed with the following vascular beds passing through the hiatus saphenus gap:

Great saphenous vein (saphena magna).
Superficial arteries.
Genital and epigastric femoral vessels.
The femoral artery and femoral vein are located between the superficial and deep layers of the fascia lata.
Deep artery of the femur.

A femoral canal is formed next to the vein.

Nerve endings

The triangle in question contains the femoral-genital nerve, which is responsible for the innervation of the skin in the area of the medial surface of the inguinal ligament. A little lower, the lateral cutaneous nerve passes through the fascia lata. Then the anterior cutaneous branches of the femoral nerve run along the sartorius muscle tissue.

In the inner thigh there is the obturator nerve canal, which goes to the knee.

Muscle training

To strengthen and maintain muscle tone, you need to do special physical exercises aimed at the femoral part of the legs. Training is carried out both at home and in gyms using exercise equipment.

Before the main exercises, a light warm-up is required.

When the muscles are ready, they move directly to exercise. There are a huge number of exercises, so the complex is compiled individually.

The effectiveness of muscle training is observed when using the following actions:

Lie on your back, place your arms along your body, bend your legs at the knee joint. Then lift your pelvis up. Having reached the maximum position, you should linger for a few seconds and slowly lower to the original state.
Stand up straight, take one leg back, bend at the knee, grab it with your hand and pull it towards your buttocks. Hold this position for a while, then repeat the exercise with the other leg.
Lie on your side, lift your leg up. Then turn over to the other side and continue manipulating the second limb.
Stand up straight and do regular squats.

In addition to a set of exercises, sports activities such as running, swimming, and cycling are good for developing muscles.

You need to start strengthening your leg muscles the right way. The set of exercises must be adjusted. At first, simple actions are required, then the complexity gradually increases as the hips adapt to the load. Subsequently, for the greatest effect, training is carried out with weights.

The femoral triangle, as is known, is bounded by the Pupart ligament, sartorius muscle, and adductor longus muscle. When studying the superficial layers of the area, attention is drawn to the presence of two layers (superficial, deep) of the superficial fascia and two layers of fiber. Lymph nodes, as well as superficial vessels, nerves, in particular v. saphena magna, located in the layer of fiber between two layers of fascia. This circumstance must be remembered when finding a vein for its ligation (Troyanova).

The fascia lata in the femoral triangle has two leaves. The deep leaf is located behind the femoral vessels, the superficial one - in front of them. Somewhat below the Poupartian ligament in the superficial layer there is an oval foramen, through which pass the superficial branches of the vessels of the femur, v. saphena magna, superficial nerves (cutaneous branches of the femoral nerve and n. lumboinguinalis).

Under the Pupart ligament there are two lacunae, separated by the iliopectineal ligament (lig. iliopectineum): lacuna musculorum, lacuna vasorum. The iliopectineal ligament is a thickening of the iliac fascia covering m. iliopsoas, which fills the muscle lacuna. The femoral nerve is also located in the muscle lacuna, directly adjacent to the lig. iliopectineum.

Through lacuna musculorum The leaks may spread (along the m. psoas) with tuberculous lesions of the upper lumbar or lower thoracic vertebrae.

Internal part of the space under the ligament of the pupart - lacuna vasorum- filled with vessels and lymph nodes. Outside lies the femoral artery, inward from it is the vein; both vessels have a common fascial sheath and are separated from each other by a septum.

The medial section of the vascular lacuna, which is the inner ring of the femoral canal, is filled with fiber and sometimes with the Rosenmüller lymph node.

At the femoral triangle, the femoral nerve divides into many branches, and the femoral artery gives off a number of small branches and the deep femoral artery, the main highway supplying the thigh area. The femoral artery and deep femoral artery are widely anastomosed due to a dense network of intramuscular vessels.

The obturator canal can be accessed through the bottom of the femoral triangle. If you cut off the pectineus muscle from the pubic bone and turn it outward, the external opening of the obturator canal with the neurovascular bundle passing through it is exposed. After exiting the canal, the obturator nerve divides into anterior and posterior branches that innervate the adductor muscles of the thigh.

In case of spastic paralysis (adductive spasm), A. S. Vishnevsky proposed exposing the obturator nerve for neurotomy here. He considered this approach the most rational and contrasts it with intrapelvic neurotomy of the obturator nerve according to Zelig. However, experience shows that the latter method of operation has significant advantages.