Hip

Thigh (regio femoris) - Department of the lower limbs, front and top distinguished from the lower abdomen by a line connecting the front top of the iliac spine (spina iliaca ant. sup.) with a mound pubic bone (tuberculum pubicum); the back and top - from gluteal region buttock crease; bottom - from a knee joint circular line drawn on two cross fingers above the kneecap.

Fig. 1. Thigh and start and attachment of muscles in the front () and back (b): 1 - m. vastus medialis; 2 - m. iliopsoas; 3 - m. articularis genus; 4 - m. adductor magnus; b - capsula articularis genus; in - m. the gastrocnemius muscle (caput lat.); 7 - m. vastus intermedius; 8 - m. vastus lat.; 9 - m. gluteus minimus; 10 - m. gluteus medius; 11 - m. piriformis; 12 - capsula articularis coxae; 13 - m. obturator ext.; 14 - m. quadratus femoris; 15 - m. gluteus maximus; 16 - m. biceps femoris; 17 - m. plantaris; 18 - m. the gastrocnemius muscle (caput mediale); 19 - m. adductor longus; 20-m. adductor brevis; 21 - m. pectineus; 22 - lig. capitis femoris.
Anatomy. Skeleton hip - thigh bone (femur) (Fig. 1). The diaphysis its multiple twisted-axis and curved front.
The length of the thigh is determined by the distance between the greater trochanter (trochanter major) and the outer margin of the joint space of the knee joint. Hip divided into front and rear area (regiones femoris ant. et post.), limited two vertical lines from Razmyslov hips (epicondylus med. et lat.) during the muscles that bend the bow wide fascia of the thigh and tender muscles (m. tensor fasciae latae, m. gracilis) to the big spit and symphysis. On the front of the thigh distinguish two triangles - internal and external; the first is facing the ground up, the second one-to the bottom. Within the inner triangle is located femoral triangle (trigonum femorale), limited from above the inguinal ligament (lig. inguinale), outside inner edge of the tailoring muscles (m. sartorius), inside the outer margin of the long lead muscles (m. adductor longus). On the front-inner thigh distinguish furrow located between the quadriceps muscle of thigh (m. quadriceps femoris) and cause the muscles. This groove, well expressed in the lean people, is a projection of the femoral vessels (N. I. Pirogov).
Leather thigh mobile, especially on the inner surface. Subcutaneous tissue hip separated by two sheets superficial fascia, between which the front occur following nerves: the hip branch sex-femoral nerve (r. femoralis n. genitofemoralis), lateral cutaneous nerve of thigh (n. cutaneus femoris lat.), front cutaneous branches of femoral nerve (rr. cutanei ant. n. femoralis). There are also branches of femoral artery (printing. table, Fig. 3): surface epigastric artery (a. epigastrica superficialis), surface, envelope Ilium (a. circumflexa ilium superficialis), outdoor private parts (a. pudenda externa). Above the surface of the piece wide fascia (printing. table, Fig. 1) are superficial inguinal lymph nodes (lymphonodi inguinales superficiales), and below it a deep inguinal lymph nodes (lymphonodi inguinales profundi).


Fig. 1. The lymph system in the femoral triangle: 1 - noduli lymphatici inguinales superficiales; 2 - foramen ovale; 3 - v. saphena magna; 4 - nodulus lymphaticus subinguinalis superficialis. Fig. 2. Muscle and vascular gaps: 1 - lig. inguinale; 2 - arcus iliopectineus; 3 - m. iliopsoas; 4 - n. femoralis; 5 - a. femoralis; 6 - v. lemoralis; 7 - anulus femoralis; 8 - m. pectlneus. Fig. 3. Subcutaneous blood vessels and nerves front of the thigh: 1 - vasa circumflexa ilium superficialia; 2 - vasa epigastrica superficial; 3 - n. cutaneus femoris lat.; 4 - r. femoralis n. genitofemoralis; 5 - hiatus saphenus margo et falclformls; 6 - a. femoralis; 7 - v. femoralis; 8 - vasa pudenda ext.; 9 - v. saphena magna; 10 - rr. cutanei ant. n. femoralis. Fig. 4. The deep layers of the femoral triangle: 1 - fascia lata; 2 - m. sartorius; 3 - n. femoralis; 4 - a. femoralis; 5 - v. femoralis; 6 - fatty cellulose; 7 - m. pectineus; 8 - a. circumflexa femoris med.; 9 - ram. adductores; 10 - n. obturatorius.


Fig. 5. The front of the thigh (after removal of the fascia): 1 - a. et v. femoralis; 2 - m. pectineus; 3 - m. adductor longus; 4 - m. gracilis; 5 - m. adductor magnus; 6 - lamina vastoadductoria; 7 - a. genu descendens; 8 - n. saphenus; 9 - m. vastus medialis; 10 - m. sartorius; 11 - m. vastus lat.; 12 - tractus iliotibialis; 13 - m. rectus femoris; 14 - m. tensor fasciae latae; 15 - n. femoralis. Fig. 6. Hamstring (after removal of the fascia): 1 - n. ischiadicus; 2 - fascia lata; 3 - caput longum m. bicipitls femoris; 4 - n. peroneus communis; 5 - n. tibialis; 6 - m. semitendinosus; 7 - m. semimembranosus. Fig. 7. Cross-cut in the middle third of the right thigh: 1 - m. rectus femoris; 2 - rr. cutanei ant. n. femoralis; 3 - m. vastus medialis; 4 - n. saphenus; 5 - a. et v. femoralis; 6 - m. sartorius; 7 - v. saphena magna; 8 - m. adductor longus; 9 - m. adductor magnus; 10 - m. gracilis; 11 - m. semimembranosus; 12 - m. semltendinosus; 13 - caput longum m. bicipitis femoris; 14 - n. ischiadicus; a. et v. comitans n. ischiadic!; 15 - caput breve m. bicipitis femoris; 16 - m. vastus lat.; 17 - vasa profunda femoris; 18 - femur; 19 - m. vastus Intermedius. Fig. 8. Cross-cutting right thigh at the level of the lower third of: 1 - m. tendo recti femoris; 2 - femur; 3 - m. vastus medialis; 4 - a. et v. femoralis; 5 - n. saphenus et a. genu suprema with accompanying her veins; 6 - m. adductor longus; 7 - m. sartorius; 8 - v. saphena magna; 9 - m. gracilis; 10 - m. semimembranosus; 11 - m. semitendinosus; 12 - caput longum m. bicipitis; 13 - nn. tibialis et peroneus communis with accompanying vessels; 14 - caput breve m. bicipitis femoris; 15 - m. vastus lat.


There are three groups of muscles of the hip: front - extensor - quadriceps muscle of thigh; rear - flexor - biceps muscle of thigh, paliperidonesee and poluchila (mm. biceps femoris, semitendinosus et semimembranosus); inner - leading muscles: Grebeshkova, tender, resulting in long, short, big and small (mm. pectineus, gracilis, adductores longus, brevis, minimus et magnus) (printing. table, Fig. 5-8). Each of these groups of muscles located in a separate fascial sheath. In front fascial bed, in addition to the quadriceps muscle, are femoral nerve (n. femoralis), a large part of the anterior of the femoral diaphysis at the top - separate fascial space for iliopsoas muscle (m. iliopsoas). In the back fascial bed, in addition to the flexor, lie sciatic nerve and its feeder artery (n. ischiadicus et a. comitans n. ischiadici). In the internal fascial bed are leading the muscles locking artery, Vienna and nerve (A., v. et n. obturatorii). Between front and internal fascial lodges are femoral vessels (a. et v. femorales) and the nerve (n. saphenus). Besides these three fascial spaces, wide fascia (fascia lata) forms a separate cases for tailoring, tender muscles and the muscles that bend the bow wide fascia (m. tensor fasciae latae).
Purulent leakages in complicated wounds thighs spread in the tissue surrounding the vessels, nerves, and fascial spaces. In front fascial the bed between direct thigh muscle (m. rectus femoris) and medium wide thigh muscle (m. vastus intermedius), and between the last arm and thigh lies cellulose, which can be located deep leakages. In the process of surgical treatment of wounds front fascial bed longitudinal cut by broken section prednamerennoe surface; back - on a back surface; inner - front-internal and zadnemotorny of the thigh (Fig. 2).
Wide fascia, forming a case for tailoring muscles, is divided into two pieces: superficial and deep expressed better in the top third of the front of the thigh. Surface leaflet this fascia covering the femoral vessels that attaches at the top to inguinal ligament, and medially goes on Grebeshkova muscle and merges with deep leaf wide fascia of the thigh. Great saphenous vein (v. saphena magna) and lymphatic vessels perforate the tunica loosened surface sheet (fascia cribrosa) and into the hole of the oval form (hiatus saphenus), or oval hole [fossa ovalis (BNA)], a limited top broad front edge (margo falciformis). Sometimes there is an extension saphenous vein (v. saphena accessoria),pouring into the large subcutaneous vein. The space between the inguinal ligament, pubic and iliac bones, shares arched thickening iliac fascia (arcus iliopectineus) on two departments: internal - vascular lacuna (lacuna vasorum) and the outer muscle lacuna (lacuna musculorum, printing. table, Fig. 2). Muscle lacuna contains iliopsoas muscle (m. iliopsoas), femoral nerve and outer cutaneous nerve of thigh (n. cutaneus femoris lat.). This lacuna is reported from the front surface of the thigh under Grebeshkova fascia where can descend from pelvic cavity cold abscesses (in tuberculous spondylitis) along the iliac-psoas muscle. Vascular lacuna contains femoral vessels lying in the fascial sheath, separated by a partition; the artery is located outwards, and Vienna is medially. Vascular lacuna reported from the front surface of the thigh in the field oval holes on Grebeshkova fascia, which descends from under the inguinal ligament hernial SAC at the femoral hernia.
In a healthy person the internal vascular gaps made by the loose tissue, lymph node and corresponds to the inner thigh ring (anulus femoralis). It is closed from the side of the abdominal cavity plate loosened cross fascia (septum femorale). Inner thigh ring is limited to the front of the inguinal ligament (lig. inguinale), rear Grebeshkova (lig. pectineale), inside lacunar (lig. lacunare), and outside the fascial sheath femoral vein; the width of the ring in women more than men, because of the large size of the female pelvis. In this regard, femoral hernias occur more often in women. Outer thigh ring represents an oval hole.
Between Grebeshkova and short lead muscles outlet is located locking channel (canalis obturatorius)coming out of the pelvic cavity containing locking artery, a vein and the nerve (a., v. et n.ohturatorii).
In the femoral triangle beneath the leaf wide fascia, between iliopsoas and Grebeshkova muscles in face-Grebeshkova hole (fossa iliopectinea) are femoral artery, vein, and outwards from the femoral artery in deep leaf wide fascia - femoral nerve (printing. table, Fig. 4). Last exit from under the inguinal ligament is divided into muscle and skin branches; most of them long branch - saphenous nerve (n. saphenus) should in the course of the femoral artery. Muscle branches of femoral nerve nerviruet tailoring, quadriceps and Grebeshkova muscles.
On 3-4 cm below the inguinal ligament from the femoral artery leaves the largest branch - deep artery hips (a. profunda femoris)providing collateral blood flow in the peripheral parts of the limbs. In this regard, the femoral artery ligation above the place of discharge deep artery hips more dangerous than below origin.
At the top of the femoral triangle vessels from the iliac-Grebeshkova pits come in the front furrow hips (sulcus femoralis ant.), limited outside the middle wide thigh muscle (m. vastus medialis), within a long and big lead, and in front of tailor muscles. However femoral vein deviate outwards and backwards from the arteries, and below is behind it. Femoral vessels come into the channel (canalis adductorius) triangular shape, the length of which is in adults $ 5-7 see the Channel is limited to front and inside lamina vastoadductoria and tailoring muscle, front and outside wide internal muscle, internal intermuscular wall, inside and behind the big causes muscle. Femoral vessels passing through the lower hole channel (hiatus tendineus), enter into the popliteal fossa. Through the front opening of the canal, located in the lamina vastoadductoria, are saphenous nerve and branch of femoral arteries - descending artery knee (a. genu descendens).
Femoral artery is conventionally divided into three sections: upper - from inguinal ligament to the place of discharge deep artery hips; middle - from the place of discharge deep artery hips before the entry of the femoral artery in the channel; the lower during canalis adductorius. Projection femoral artery is determined by the line of CWANA coming from the middle of the distance between the front top of the iliac spine and symphysis to internal namesake hips. Projection line corresponds to go femoral artery only in the position of the rotation of the hips outwards and bend limbs in the hip and knee joints.
Within the back of the thigh is determined formed by the rear group of muscles bulge, which moves outwards in a groove, separating wide outer thigh muscle from the biceps. Through this groove is on-line access to the diaphysis hips. The skin of the back of the thigh innerviruetsya branches back and outdoor cutaneous nerve of thigh (nn. cutaneus femoris post, et lat.), sex-femoral and locking nerves. Under a wide fascia b are flexing muscles of the leg. In the groove, formed by the double-headed outside, from the inside polosuhinskoj (m. semitendinosiis) and paliperidonesee (m. semimembranosus), and in front of the big causes the muscles located sciatic nerve (n. iscbiadicus), who came out from under the long head of the biceps, descends and is divided in the lower third of the back surface B. in two branches: tibial nerve (n. tibialis) and the common peroneal nerve (n. peroneus communis). Sometimes there is a high division of the sciatic nerve; in such cases the branches out of the above - and podruchnogo holes (foramina supra - et infrapiriforme) separate trunks, separated from each other Piriform muscle (m. piriformis).
The projection of the sciatic nerve is determined by the line going from the middle of the distance between the greater trochanter and the buttock to the middle of the distance between the inner and outer nezmyselne hips. Branch of the sciatic nerve nerviruet flexors and most leading muscle. On the tissue surrounding the sciatic nerve may be subject to inflammatory processes up in the gluteal region and down in the popliteal fossa.

Of inflammatory processes in soft tissues hips are observed: boils, carbuncles, abscesses, cellulitis (Fig. 3 and 4) and other purulent processes.
From tumors of soft tissues hip marked benign - lipoma, fibroma, angiofibroma, hemangioma, neuroma and malignant - rhabdomyosarcoma, fibrosarcoma, and others Among benign tumors of the femur osteoma, chondroma, osteochondroma and other Solitary chondroma mineralogo Department of the femur is prone to malignancy. Malignant tumours of the femur include fibrosarcoma, chondrosarcoma, and osteosarcoma. In the thigh may be metastases vaginal cancer, prostate cancer, breast cancer and other
The damage. When injuries hips can be subcutaneous, subfascial, intramuscular intramuscular and hemorrhage. A conservative treatment, as in the case of joining of infection and the formation of abscesses is operational. When excessive voltage observed breaks fascia, muscles and tendons. More often damaged muscles: tailoring, straight and bend wide fascia. Sometimes the muscles off with sinew and bone plate; when substantial or complete tear of the muscle shown surgery to stop bleeding and closure of the muscles.