Adductor canal

The adductor canal, also known as the subsartorial canal or Hunter's canal, is an aponeurotic tunnel in the middle third of the thigh that transmits the femoral artery, the femoral vein and two branches of the femoral nerve.收肌管（adductor canal）又称缝匠肌下管或 Hunter 管，是大腿中段三分之一内的腱膜性管道，内有股动脉、股静脉与股神经的两条分支。

It runs from the apex of the femoral triangle to the adductor hiatus, and cadaveric series place its mean length at about 10.5 cm.该管自股三角尖延伸至收肌腱裂孔，多个尸体测量系列将其平均长度定在 10.5 cm 左右。

Structure

• The canal is an intermuscular cleft on the medial side of the anterior compartment of the thigh, overlapped by the sartorius muscle, which is why it also carries the name subsartorial canal.该管位于大腿前间室内侧面的肌间裂隙内，表面被缝匠肌（sartorius）覆盖，因此又有缝匠肌下管之名。
• Its anterior wall is formed by the vastus medialis, while the posterior wall belongs to the adductor longus and adductor magnus.前壁由股内侧肌构成，后壁则由长收肌（adductor longus）与大收肌（adductor magnus）围成。
• Medially the canal is roofed by a strong aponeurosis, the vastoadductor membrane, which stretches from the vastus medialis across the femoral vessels to the two adductor muscles.管的内侧覆以强韧的股内收肌膜，该腱膜自股内侧肌跨过股血管延伸至上述两块收肌。
• In cross-section the space is triangular rather than round, bounded proximally by the vastus medialis and posteriorly by the adductor longus and magnus.横断面上此间隙呈三角形而非圆形，近侧由股内侧肌围成，后侧由长收肌与大收肌围成。
• The femoral artery, the femoral vein and the saphenous nerve enter the canal through its proximal opening at the apex of the femoral triangle.股动脉、股静脉与隐神经（saphenous nerve）经股三角尖处的近侧开口进入该管。
• The saphenous nerve and the saphenous branch of the descending genicular artery leave through an anterior opening by piercing the vastoadductor membrane.隐神经与膝降动脉的隐支穿股内收肌膜，经前侧开口离开该管。
• The femoral artery and vein exit distally through the adductor hiatus, an opening in the adductor magnus, and continue into the popliteal fossa as the popliteal vessels.股动脉与股静脉经大收肌上的收肌腱裂孔自远侧离开，续为腘血管进入腘窝。
• The same 40-limb series placed the proximal foramen a mean of 25 cm from the anterior superior iliac spine and the distal foramen 8.5 cm from the base of the patella.同一项 40 例尸肢系列还测得，近侧孔距髂前上棘平均 25 cm，远侧孔距髌骨底平均 8.5 cm。^[1]
• A cadaveric study of 40 formalin-fixed limbs reported a mean canal length of 10.5 cm, with the proximal foramen lying 3 cm distal to the mid-thigh in 36 limbs (90%).一项 40 例福尔马林固定尸肢的研究测得管长平均 10.5 cm，其中 36 例（90%）的近侧孔位于大腿中点远侧 3 cm。^[1]

Function

• The canal works as a conduit that guides the femoral vessels from the front of the thigh to the popliteal fossa behind the knee.该管充当通道，引导股血管自大腿前方走向膝后的腘窝。
• It also shelters the purely sensory saphenous nerve along its subsartorial course, keeping that nerve apart from the motor branches of the femoral nerve.它还在缝匠肌下庇护纯感觉性的隐神经，使其与股神经的运动支彼此分离。
• The nerve to the vastus medialis travels within the canal and supplies the muscle that stabilises the patella from the medial side.股内侧肌神经在管内走行，支配从内侧稳定髌骨的那块肌肉。
• Because the canal is a confined space, its walls protect the femoral vessels from external compression during movement of the thigh.由于该管是有限空间，其管壁在大腿活动时保护股血管免受外来压迫。

Vasculature and innervation

• The femoral artery traverses the canal and gives off the descending genicular artery, whose saphenous branch accompanies the nerve out through the anterior opening.股动脉行经该管并发出膝降动脉，其隐支伴隐神经一同经前侧开口离开。
• The femoral vein runs beside the artery and receives the venous companions of the genicular branches inside the canal.股静脉与动脉伴行，在管内接收膝支的伴行静脉。
• The saphenous nerve is the largest branch of the femoral nerve and crosses the canal without supplying any muscle along the way.隐神经是股神经最大的分支，穿过该管途中不支配任何肌肉。
• The nerve to the vastus medialis, also from the femoral nerve, enters the canal and reaches the medial part of that muscle.股内侧肌神经同属股神经，进入该管后抵达该肌的内侧部。
• The subsartorial position of these vessels makes the canal the target of the adductor canal block used for analgesia after knee surgery.这些血管的缝匠肌下位置使该管成为膝关节术后镇痛的收肌管阻滞靶点。

Development

• The canal forms as a secondary space within the thigh musculature rather than from a discrete embryonic anlage.该管作为大腿肌群内的继发间隙形成，而非来自独立的胚胎原基。
• Its walls are laid down by myoblasts of the anterior compartment and the adductor group as they migrate from the somites.管壁由前间室与收肌群的成肌细胞在自體節迁出时定植而成。
• The femoral vessels grow into the limb bud along the axis that later becomes the canal, and the aponeurotic roof is completed as the muscles differentiate.股血管沿肢体芽内的轴向生长，该轴后来成为该管，腱膜顶随肌肉分化而最终成形。
• The adductor hiatus appears when the fibres of the adductor magnus split around the femoral vessels during the second and third months.收肌腱裂孔出现于第 2 至第 3 个月，由大收肌纤维在股血管周围裂开形成。

Clinical significance

• The saphenous nerve may be compressed within the canal, producing pain and numbness along the medial side of the leg.隐神经可在管内受压，引起沿小腿内侧的疼痛与麻木。
• An adductor canal block, in which local anaesthetic is injected into the canal, is used both to treat this compression and to relieve pain after knee surgery.向管内注射局部麻醉药的收肌管阻滞，既用于治疗此种压迫，也用于缓解膝关节术后疼痛。
• Under ultrasound guidance the needle is placed in the distal half of the canal, where the saphenous nerve has already left the femoral artery.超声引导下穿刺针置于管的远侧半，此处隐神经已离开股动脉。
• A Chinese study combining cadaveric and clinical work measured the canal at 10.0±2.1 cm and located its entrance, its exit and the point where the nerve pierces the membrane at 54.7±3.0%, 76.0±3.8% and 74.1±3.2% of sartorius length.中国一项结合尸体与临床的研究测得管长 10.0±2.1 cm，其入口与出口位于缝匠肌长度的 54.7±3.0% 与 76.0±3.8% 处，神经穿膜点则在 74.1±3.2% 处。^[2]
• In total knee arthroplasty a block at this level preserves quadriceps strength better than a femoral nerve block and lowers the risk of falls.在膝关节置换术中，该水平的阻滞比股神经阻滞更能保留股四头肌肌力，并降低跌倒风险。
• Pain from knee osteoarthritis is one of the indications, since the infrapatellar branch of the saphenous nerve supplies the inferomedial side of the joint.膝关节骨关节炎疼痛也是适应证之一，因为隐神经的髌下支支配关节的内下侧。
• Continuous catheters placed in the canal have been compared at proximal and distal positions, with comparable analgesia reported in a randomised trial.置于该管的连续导管曾在近侧与远侧位置间作比较，一项随机试验报告两者镇痛效果相当。^[3]

Comparative anatomy

• The subsartorial course of the femoral vessels is conserved in mammals whose adductor mass remains undivided.在收肌群保持未分的哺乳动物中，股血管的缝匠肌下走行是保守的。
• In quadrupeds the canal runs more horizontally because the adductor longus arises more proximally on the pelvis.四足动物的该管走行更接近水平，因为长收肌在骨盆上的起点更靠近侧。
• No homologous named canal exists in birds, whose thigh adductors are dominated by the ambiens and femorotibialis groups.鸟类没有同名的对应管道，其大腿收肌以栖肌（ambiens）与股胫肌群为主。
• The adductor hiatus is present in most mammals but is widest in species with a large popliteal artery, such as the dog.收肌腱裂孔见于多数哺乳动物，在腘动脉粗大的物种如犬中最宽。

History

• The eponym Hunter's canal honours the Scottish surgeon John Hunter, who described the region in the eighteenth century.Hunter 管这一名号纪念 18 世纪描述该区域的苏格兰外科医生 John Hunter。
• The term subsartorial canal entered use in the nineteenth century to stress the muscle that covers the space.「缝匠肌下管」一词在 19 世纪开始使用，以强调覆盖该间隙的那块肌肉。
• The Terminologia Anatomica records the space as canalis adductorius, replacing older phrases such as Hunter's femoral canal.《解剖学名词》（TA）将该管记为（canalis adductorius），取代了 Hunter 股管等旧称。
• Gray's Anatomy described the canal from its first edition in 1858 and refined its boundaries in later editions.自 1858 年第 1 版起，Gray's Anatomy 即载有该管的描述，并在后续版次中细化其边界。
• The neutral name adductor canal became standard in the twentieth century as eponyms fell out of favour in anatomy.随着专属名在 20 世纪解剖学界逐渐失宠，中性的「收肌管」成为标准名称。

Research and controversies

• Ultrasound studies of the canal have produced conflicting maps of where the saphenous nerve leaves the femoral artery.该管的超声研究对隐神经在何处离开股动脉给出了互不一致的图谱。
• One group places the division in the distal third of the canal, while another locates it at the adductor hiatus itself, a difference that matters for where a block catheter is best left.一派认为分处在管的远三分之一，另一派则定位于收肌腱裂孔处，这一分歧关系到阻滞导管的最佳留置位置。
• Defining the canal by ultrasound was itself challenged after 2017, when authors disagreed on which fascial plane marks its lateral wall.2017 年之后，以超声定义该管的做法本身也受到质疑，因为作者们对哪一筋膜平面构成其外侧壁各执一词。^[4]
• Whether the nerve to the vastus medialis always lies inside the canal remains unsettled, since some series found it outside the vastoadductor membrane.股内侧肌神经是否总在管内尚无定论，因为部分研究系列发现它位于股内收肌膜之外。