骨纤维孔上外侧界课件

1、1要求一、掌握1、脊柱区体表标志2、颈、胸、腰椎和骶骨的形态特征；脊柱整体观。3、脊柱的连结；棘上韧带、黄韧带的结构和临床意义。4、椎管、骶管的构成、形态特征、内容；椎间孔、骶后孔、骶管裂孔的解剖学特征及临床意义。5、脊髓三层被膜的特征。6、硬膜外腔的境界、内容、分部；椎内静脉丛的组成7、蛛网膜下腔的境界；脑脊液的容量、压力和性质8、脊柱不同节段硬膜外穿刺、腰下段蛛网膜下腔穿刺及高、低位骶管穿刺的麻醉解剖学要点9、脊神经根的分段与脊髓被膜的关系 2二、熟悉1、脊柱区深筋膜的分部及其特点。2、枕下三角、腰上、下三角的境界与内容。3、骨纤维管、骨纤维孔的组成及临床意义。三、了解1、脊柱区深部的血管

2、和神经分布。2、椎骨异常和脊柱畸形 3Section 1 Instruction 1、boundaries上界：下界：两侧界：枕外隆凸、上项线。尾骨尖斜方肌前缘、腋后线、髂嵴后份、髂后上棘与尾骨尖的连线。42、division项区 nuchal region胸背区 thoracdorsal region腰区 lumbar region骶尾区 sacral coccyx region53、superficial markers 棘突 spinous process 骶管裂孔和骶角 髂嵴和髂后上棘 肩胛冈和肩胛骨下角 竖脊肌和脊肋角6如果要计数椎骨，有哪些方法？确定C7棘突确定T3棘突确定T7棘突

3、确定L4棘突项部最隆起的棘突平两侧肩胛骨内侧端的连线平两侧肩胛下角的连线平两侧髂嵴最高点的连线7Section 2 Soft Tissue一、浅层结构1、皮肤2、浅筋膜3、皮神经 来自脊神经后支 臀上皮神经4、浅血管8Superficial Blood VesselsNuchalOccipital arterySuperficial cervical arterydorsal scapular arteryThoracic dorsal Posterior intercostals arterydorsal scapular arterythoracodorsal arteryLumber L

4、umbar arterySacrococcygealSuperior Cluneal arteryInferior cluneal artery9二、深筋膜1、项筋膜2、胸腰筋膜 thoracolarmbar fascia 10Thoracolumbar Fasciaa deep investing membrane which covers the deep muscles of the back of the trunk 3 layers in lumbar region11Trapeziuslevator scapulaeRhomboid minorRhomboid majorLatis

5、simus dorsiSuperficial Group三、肌层12Triangle Of Auscultation13Serratus posterior superiorSerratus posterior inferiorIntermediate Group14DEEP GROUPSpinotransversales MusclesSplenius CapitisSplenius CervicisErector Spine MusclesIliocostalisLongissimus Spinalis15DEEP GROUPTransversospinales musclesSemisp

6、inalisRotatoresMultifidusSegmental back musclesLevatores costarumInterspinalesIntertransversariiP5916DEEP GROUPSuboccipital MusclesRectus Capitis Posterior MinorRectus Capitis Posterior MajorSuperior Oblique Inferior Oblique17ecRtus Capitis Posterior MajorSuperior Rectus ObliqueInferior Rectus Obliq

7、ueVertebral ArterySuboccipital N (Dorsal Ramus Of C)Suboccipital Triangle 183）枕下三角内上界：外上界：下 界：顶：底：内容：意义：头后大直肌头上斜肌头下斜肌夹肌、半棘肌、枕大神经寰椎后弓、环枕后膜椎动脉第3段、枕下神经头部过度旋转或枕下肌痉挛时，可压迫椎动脉，使颅内供血不足， 麻醉头位处理时应注意19Superior Lumbar Triangle(Triangle Of Grynfeltt-Lesshaft )twelfth ribSerratus posterior inferior Erector spinae

8、 internal oblique20External Abdominal ObliqueLatissimus Dorsi Iliac CrestInferior Lumbar Triangle(Petits Lumbar Triangle)212、四个三角1）听诊三角底为薄层脂肪组织、筋膜和第6肋间隙，表面覆以皮肤和筋膜，是背部听诊呼吸音最清楚之处2）腰下三角 可发生腰疝 盲肠后位阑尾炎时， 右腰下三角区可有明 显压痛224）腰上三角 内侧界：外下界：上界：底：顶：意义： 肾手术时注意保护神经肾周脓肿可在此切开引流肾囊封闭常用的进针部位腹后壁的薄弱，可形成腰疝竖脊肌外侧缘腹内斜肌后缘第12肋

9、腹横肌腱膜，腱膜深面有3条平行的神经皮肤、浅筋膜、背阔肌23四、深部的血管和神经1、血管项区主要由枕动脉、颈横动脉和椎动脉等供血胸背区由肋间后动脉、胸背动脉和肩胛背动脉供血腰区由腰动脉和肋下动脉供血骶尾区由臀上、下动脉等供血24Deep ArteriesNuchal RegionOccipital ArterySuperficial Cervical ArteryDorsal Scapular ArteryVertebral ArteryThoracic RegionPosterior Intercostals ArteryDorsal Scapular ArteryThoracodorsal

10、 ArteryLumber RegionLumbar ArterySubcostal ArterySacrococcygeal RegionSuperior Cluneal ArteryInferior Cluneal Artery25NuchalVertebral veinInternal jugular veinSubclavian veinThoracicPosterior Intercostals vein azygos veinSubclavian veinAxillary veinLumberLumbar vein inferior vena cavaSacrococcygeal

11、Internal iliac veinDEEP VEINS26Deep NerversDorsal rami of spinal nerveAccessory nerveThoracodorsal nerveDorsal scapular nerve27Dorsal Rami of Spinal Nerve28Accessory Nerve29Thoracodorsal Nerve30Dorsal Scapular Nerve31VERTEBRAL CANAL32CONSTRUCTIONAnterior Wall: Vertebral ColumnPosterior Border Of Int

12、ervertebral Disc Posterior Longitudinal Ligament Posterior Wall: Lamina Ligament Flava;Zygapophysial Joints Bilateral Wall: PedicleIntervertebral Foramina3334CONTENTSSpinal CordMeningesSpinal Nerve RootCauda EquinaBlood VesselsNerves Lymphatic VesselsConnective Tissues35MENINGESSpinal dura materSpin

13、al arachnoid materSpinal pia mater36MENINGES37Denticulate LigamentAverage 21 pairsAttach pia mater to the arachnoid and dura matersProvide stability for the spinal cord 38PACES SEpidural spaceSubdural spaceSubarachnoid space3940Epidural AnesthesiaL441Epidural Venous Plexus424344Lumbar CisternLUMBAR

14、PUNCTURE45SPINAL NERVE ROOTS46Relationship with intervertebral foramen & disc47OPERATING DECOMPRESSION484950Segmental Artery51VEINS52Spinal CordVertebraC1-4C1-4C5-8, T1-4Cn-1T5-8Tn-2T9-12Tn-3L1-5T10-11S1-5, CoccygealT12, L1Segments of Spinal Cord53C1-C4head and neck.C3-C5diaphragm (chest and breathi

15、ng)C5-T1shoulders, arms and handsT2-T12chest and abdomen (excluding internal organs)L1-L4abdomen (excluding internal organs), buttocks, genitals, and upper legsL4-S1legsS2-S4genitals and muscles of the perineumDISTRIBUTION 5455A man has a herniated intervertebral disk between the fourth and fifth lumbar vertebrae. If this disk compresses the spinal nerve in the intervertebral foramen immediately posterior to this disk, which spinal nerve would be affected? L 3 L 4 L 5 S 1 S 2565758596061钩椎关节（Luschka关节）： 3rd-7th颈椎 下位椎体钩与上位椎体的唇缘组成62632、神经脊柱区的神经主要来自31对脊神经后支、副神经、肩胛背神经和胸背神经腰