局部解剖学课件：8-1-腕和手

1、Wrist and Hand 山东大学医学院 解剖教研室Surface anatomy of wrist and hand Anatomical “snuff box” 鼻烟壶 Medial: tendon of the extensor pollicis longus 拇长伸肌腱Lateral: tendons of the abductor pollicis longus 拇长展肌腱and extensor pollicis brevis 拇短伸肌腱Proximal: styloid process of radius 桡骨茎突Floor: scaphoid and trapezium b

2、ones手舟骨和大多角骨Radial a. crosses the floor of the snuff, so may fell the radial pulse in this fossaAnatomical “snuff box”Anterior region of wrist 腕前区Deep fascia of the wrist Palmar carpal ligament 腕掌侧韧带Flexor retinaculum 屈肌支持带Thickening of deep fascia in the handAttached laterally to scaphoid and trape

3、zium and medially to pisiform and hamateUlnar carpal canal 腕尺侧管Formed by the distal part of palmar carpal ligament and flexor reticulum Transmit the ulnar a., v. and n.Radial carpal canal 腕桡侧管The radial end of flexor reticulum is attached to the tubercles of scaphoid and trapeziumTransmit tendon of

4、flexor carpi radialis Anterior region of wrist 腕前区Carpal tunnel 腕管Composition: Formed by flexor retinaculum 屈肌支持带 and carpal groove 腕骨沟Structures passing through the carpal tunnel Median n. 正中神经Tendons of flexor digitorum superficialis 指浅屈肌and flexor digitorum profundus 指深屈肌enclosed by common flexor

5、 synovial sheath 屈肌总腱鞘Tendon of flexor pollicis longus 拇长屈肌enclosed by synovial sheath for flexor pollicis longus 拇长屈肌腱鞘Anterior region of wrist 腕前区Common flexor synovial sheath屈肌总腱鞘Synovial sheath for flexor pollicis longus 拇长屈肌腱鞘Carpal tunnel 腕管Anterior region of wrist 腕前区Median mon flexor synovia

6、l sheathTendon of flexor pollicis longus enclosed by synovial sheath for flexor pollicis longus Tendons of flexor digitorum superficialisTendons of flexor digitorum profundusPosterior region of wrist 腕后区Extensor retinaculum 伸肌支持带Thickening of deep fascia of forearm a wristAttached laterally to radiu

7、s and medially to styloid process of ulna and triquetral boneForms six fibrous compartments for extensor tendons passing from forearm into handPosterior region of wrist 腕后区 tendons of abductor pollicis longus and extensor pollicis brevis and their synovial sheaths; tendons of extensor carpi radialis

8、 longus and brevis and their synovial sheaths; tendon of extensor pollicis longus and its synovial sheath; tendons of extensor digitorum, extensor indicis and their synovial sheaths; tendon of extensor digiti minimi and its synovial sheaths; tendon of extensor carpi ulnaris and its synovial sheaths

9、Palm of hand 手掌Deep fascia of the palm Superficial layerThenar fascia 鱼际筋膜Hypothenar fascia 小鱼际筋膜Palmar aponeurosis 掌腱膜 Thick triangular membrane Deep layerPalmar interosseous fascia 骨间掌侧筋膜Palm of hand 手掌Osseofascial compartments of palm 手掌骨筋膜鞘Lateral compartment 外侧鞘Medial compartment 内侧鞘Intermediat

10、e compartment 中间鞘Laeral intermuscular septumMedial intermuscular septumPalmar aponeurosisPalmar interosseous fasciaAdductor pollicisHypothenar fasciaThenar fasciaPalm of hand 手掌Intermediate compartment 中间鞘Boundaries Palmar aponeurosis 掌腱膜Lateral and medial intermuscular septum of palm 掌内、外侧肌间隔Palmar

11、 interosseous fascia 骨间掌侧筋膜ContentsSuperficial palmar arch, a., v.,n. 掌浅弓及其分支Tendons of flexor digitorum superficialis and profundus 指浅、深屈肌腱Lumbricales （4）蚓状肌Common flexor sheath屈肌总腱鞘Fascia spaces 筋膜间隙Thenar space 鱼际间隙: located between the fascia of the adductor pollicis and flexor tendon of the ind

12、ex finger.Proximal: blindDistally: continuous with the back of the index finger by the fist lumbrical canal Midpalmar space掌中间隙: lies posterior to common flexor sheathProximal: continous with the posterior space of the antebrachial flexor through the carpl canalDistally: continuous with the appropri

13、ate lumbrical canals Midpalmar spaceThenar spacePalmar intermediate septumMuscles of handLateral groupthenar (4)Medial grouphypothenar (3)Intermedial groupLumbricals 蚓状肌 (4)Palmar interossei 骨间掌侧肌 (3)Dorsal interossei 骨间背侧肌 (4)Muscles of handLateral groupthenar 鱼际 (4)Abductor pollicis brevis拇短展肌Flex

14、or pollicis brevis 拇短屈肌Opponens pollicis 拇对掌肌Adductor pollicis 拇收肌Action: flex, abduct, adduct and oppose thumbNerve supply: median n. except adductor pollicis which is supplied by ulnar n.Muscles of handMedial grouphypothenar 小鱼际 (3)Abductor digiti minimi 小指展肌Flexor digiti minimi brevis 小指短屈肌Oppone

15、ns digiti minimi 小指对掌肌Action: flex, abduct , and oppose little fingerNerve supply: ulnar n.Muscles of handIntermedial groupLumbricals 蚓状肌 (4) Action: flex fingers at MP joints; extend fingers at IP jointsNerve supply: first two lumbricals supplied by median n., and 3rd and 4th lumbricals supplied by

16、 ulnar n.Muscles of handIntermedial groupPalmar interossei (3)骨间掌侧肌 adduct fingers towards middle finger at MP jointsDorsal interossei (4) 骨间背侧肌abduct fingers away from middle finger at MP joints Nerve supply: ulnar n.Palm of hand 手掌Superficial palmar arch 掌浅弓Formed by ulnar artery and superficial p

17、almar branch of radial arteryThe curve of arch lies across the palm, level with the distal border of fully extended thumb Gives rise to three common palmar digital arteries 指掌侧总动脉 each then divides into two proper palmar digital arteries 指掌侧固有动脉Palm of hand 手掌Deep palmar arch 掌深弓Formed by radial art

18、ery and deep palmar branch of ulnar arteryThe curve of arch lies across upper part of palmar at level with proximal border of extended thumbGives rise to three palmar metacarpal arteries to joint the distal ends of the corresponding common palmar digital arteries Visualizing the position of the supe

19、rficial and deep palmar arches Palm of hand 手掌Median n. 正中神经Muscular branches: supply thenar except adductor pollicis, first two lumbricalesCutaneus branches: supply skin of thenar, central part of palm, palmar aspect of radial three and one-half fingers, including middle and distal fingers on dorsu

20、m Recurrent branchPalm of hand 手掌Ulnar n. 尺神经Muscular branches supply hypothenar muscles, interossei, 3rd and 4th lumbricales and adductor pollicisCutaneus branches supply skin of hypothenar, palmar surface of ulnar one and one-half fingers, ulnar half of dorsum of hand, posterior aspect of ulnar tw

21、o and one-half fingers Radial n. 桡神经Skin of radial side of dorsum of hand Posterior aspect of radial two and one-half fingers Dorsum of hand 手背Fascia of the dorsal handThe superficial fasciaDorsal venous rete of handSuperficial lymph vesselsSuperficial branches of radial n. and doesal branch of ulna

22、r n.Deep fasciathe dorsal fascia of handSuperficial layer-dorsal aponeurosis 手背腱膜Deep layer-dorsal interosseous fascia 骨间背侧筋膜Dorsum of hand 手背Two spacesThe dorsal subcutaneous space 手背皮下间隙The dorsal subaponeurotic space 手背腱膜下间隙Superficial fasciaDorsal aponeurosisDorsal interosseous fasciaDorsal subcutaneous spaceDorsal subaponeurotic spaceFingers 手指Pulp space of the fingers 指髓间隙 Th