局部解剖学课件重点总结

1、PAGE 脊柱区Muscles of BackSuperficial groupTrapezius 斜方肌Latissimus dorsi 背阔肌Levator scapulae 肩胛提肌Rhomboideus 菱形肌 Deep group Splenius 夹肌Erector spinae 竖脊肌Triangle of auscultation 听诊三角(肩胛旁三角)BoundariesLatissimus dorsiTrapeziusThe medial border of the scapulaInferior lumbar triangle 腰下三角BoundariesLower pa

2、rt of the lateral margin of latissimus dorsiPosterior free border of the obliquus externus abdominisIliac crestSuperior lumbar triangle腰上三角BoundariesSerratus posterior inferiorErector spinaeObliquus internus abdomins上肢Cephalic vein 头静脉Arises from the lateral side of the dorsal venous rete on the bac

3、k of hand Winds around the lateral border of the forearm; it then ascends into the cubital fossa and up the front of the arm on the lateral side of the biceps. It continues up in the deltopectoral groove and then to the infraclavicular fossa, where it pierces clavipectoral fascia to drain into axill

4、ary vein.Basilic vein 贵要静脉Arises from the medial side of the dorsal venous rete of hand Winds around the medial border of the forearmThen ascends into the cubital fossa and up the front of the arm on the medial side of the biceps to middle of the arm where it pierces the deep fascia and joins the br

5、achial vein or axillary veinMedian cubital vein 肘正中静脉Links cephalic vein and basilic vein in the cubital fossaIt is a frequent site for venipuncture to remove a sample of blood or add fluid to the bloodAxillary fossa 腋窝BoundariesApexMiddle 1/3 of clavicleLateral border of first ribUpper border of th

6、e scapula Base SkinSuperficial fasciaAxillary fascia 腋筋膜(cribriform fascia 筛状筋膜)The medial wallSerratus anterior Upper four ribs and intercostal spacesThe lateral wall Intertubercular grooveLong head and short head of biceps brachiiCoracobrachialis The anterior wallPectoralis major Pectoralis minor

7、SubclaviusClavipectoral fascia 锁胸筋膜The posterior wallSubscapularisTeres major Latissimus dorsiScapulaContents Axillary a. and principal branches Axillary v. and tributaries Brachial plexus and branches Axillary lymph nodes Loose connective tissue Trilateral foramen 三边孔(trilateral space 三边隙)Boundarie

8、s Superior: teres minor subscapularis lateral border of scapula, articular capsule of shoulder jointInferior: teres majorLateral: long head of triceps brachiiStructures pass through the trilateral foramenCircumflex scapular a. and v. Quadrilateral foramen 四边孔(quadrilateral space 四边隙)Boundaries Super

9、ior: teres minor subscapularis articular capsule of shoulder jointInferior: teres majorMedial: long head of triceps brachii Lateral: surgical neck of humerusStructures pass through the quadrilateral foramenAxillary n. Posterior humeral circumflex a. and v.Axillary artery Begins at the at lateral bor

10、der of first rib as a continuation of subclavian artery At the lower border of teres major it becomes the brachial artery.Divided into three parts by overlying pectoralis minorBranchesFirst partsuperior thoracic a.thoracoacromial a. Second part lateral thoracic a. Third part subscapular a. throcodor

11、sal a. circumflex scapular a. anterior humeral circumflex a. posterior humeral circumflex a. Brachial artery 肱动脉Begins at the lower border of the teres major as a continuation of axillary arteryTerminates opposite the neck of radius by dividing into radial and ulnar arteries Branches Deep brachial a

12、. 肱深动脉 Follows the radial nerve into the spinal groove of the humerusSuperior ulnar collaeral a. 尺侧上副动脉 follows the ulnar nerveInferior ulnar collateral a.尺侧下副动脉 Takes part in the anastomosis around the elbow joint. Median nerve 正中神经OriginArises from the medial and lateral cord of the brachial plexu

13、sCourseDescends on the lateral side of brachial arteryHalfway down the arm, it crosses the brachial artery to reach its medial sideHumeromuscular tunnel 肱骨肌管CompositionFormed by triceps brachii 肱三头肌and groove for radial nerve of humerus 肱骨桡神经沟Structures passing through the tunnelRadial nerve 桡神经Deep

14、 brachial a. and v. 肱深动静脉Radial collateral a. 桡侧副 动脉Middle collateral a. 中副动脉Cubital fossa 肘窝Boundaries Laterally: brachioradialis肱桡肌Medially: pronator teres旋前圆肌 Roof: skin, superficial facia, deep fascia and aponeurosis of bicepsFloor: brachialis 肱肌, supinator 旋后肌and capsule of elbow joint 肘关节囊Cont

15、ents biceps brachii tendon 肱二头肌腱Medial to biceps brachii tendonBrachial a. 肱动脉divides into radial and ulnar a., usually at apex of fossaBrachial v. 肱静脉Median n. 正中神经Lateral to the biceps brachii tendonRadial n. 桡神经Lateral antebrachial cutaneous n. 前臂外侧皮神经Deep cubital lymph nodes Carpal canal 腕管Compo

16、sition: 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 synovial sheath 屈肌总腱鞘Tendon of flexor pollicis longus 拇长屈肌enclosed by

17、synovial sheath for flexor pollicis longus 拇长屈肌腱鞘Superficial palmar arch 掌浅弓Formed by ulnar artery and superficial palmar 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 (eac

18、h then divides into two proper palmar digital arteries 指掌侧固有动脉) and one ulnar palmar artery of quinary finger 小指尺掌侧动脉Deep palmar arch 掌深弓Formed by radial artery and deep palmar branch of ulnar arteryThe curve of arch lies across upper part of palmar at level with proximal border of extended thumbGiv

19、es rise to three palmar metacarpal arteries 掌心动脉 to joint the distal ends of the corresponding common palmar digital arteriesMedian 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

20、radial three and one-half fingers, including middle and distal fingers on dorsum Recurrent branch of the median nerve正中神经返支 lies deep to the skin and deep fascia overlying the anterior margin of the thenar near the midline of the palmUlnar n. 尺神经Muscular branches supply hypothenar muscles, interosse

21、i, 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 two and one-half fingers 下肢Landmarks of lower limbGluteal region and thighanterior superior iliac spi

22、nes anterior inferior iliac spines 髂前下棘tubercle of iliac crest 髂结节ischial tuberosity 坐骨结节greater trochanter 大转子pubic tubercle 耻骨结节pubic crest 耻骨嵴superior border of pubic symphysis Kneepatella ligament 髌韧带tuberosity of tibia 胫骨粗隆medial and lateral condyles 内外侧髁medial and lateral epicondyles 内、外上髁tend

23、on of biceps femoris 股二头肌腱tendons of semitendinosus and semimembranosus 半腱、半膜肌腱Leganterior border of tibia 胫骨前缘head of fibula 腓骨头neck of fibula 腓骨颈Ankle and footmedial and lateral malleolus 内、外侧踝calcaneal tuberosity 跟骨结节tuberosity of navicular bone 舟骨粗隆tuberosity of fifth metatarsal bone 第五跖骨粗隆Super

24、ficial veins:Great saphenous vein 大隐静脉Drains the medial end of dorsal venous arch of foot and passes upward directly in front of the medial malleolus.Then ascends in company with the saphenous n. in the superficial fascia over the medial side of the leg. Small saphenous v. 小隐静脉Arises from the latera

25、l part of the dorsal venous arch of footAscends behind lateral malleolus and then runs up the midline of the back of the leg Pierces the deep fascia and enters the popliteal v.Drains the lateral side of the foot and ankle and the back of the legStructures passing through suprapiriform foramen (from

26、lateral to medial side)Superior gluteal n. 臀上神经Superior gluteal a. 臀上动脉Superior gluteal v. 臀上静脉Structures passing through infrapiriform foramen (from lateral to medial side)Sciatic n. 坐骨神经Posterior femoral cutaneous n. 股后皮神经Inferior gluteal n. 臀下神经Inferior gluteal a., v. 臀下动、静脉Internal pudendal v.,

27、a.阴部内动、静脉Pudendal n. 阴部神经Structures passing through small sciatic foramen (from lateral to medial side)Internal pudendal v., a.阴部内动、静脉Pudendal n. 阴部神经Superficial inguinal lymph nodesSuperior group: Lies just distal to the inguinal ligamentReceive lymph vessels from anterior abdominal wall below umbi

28、licus, gluteal region, perineal region, external genital organsInferior group: Lies vertical along the terminal great saphenous v.Receives all superficial lymph vessels of lower limb, except for those from the posterolateral part of calf Efferent vessels drain into the deep inguinal ln. or external

29、iliac ln.Fascia lata 阔筋膜Iliotibial tract 髂胫束 laterally the deep fascia forms a thick bandfrom the iliac tubercle to the lateral condyle of tibialSaphenous hiatus 隐静脉裂孔 A gap in the deep fasica which lies about 4 cm below and lateral to the pubic tubercle. The falciform margin 镰状缘 is the lower latera

30、l border of the opening, which lies anterior to the femoral vessels.Filled with loose connective tissue called the cribriform fascia 筛筋膜Lacuna musculorum 肌腔隙Boundaries:Anteriorly: lateral portion of inguinal ligamentPosterolaterally: ilium Medially: iliopectinal arch Contents: Iliopsoas 髂腰肌femoral n

31、. 股神经lateral femoral cutaneous n. 股外侧皮神经 Lacuna vasorum 血管腔隙Boundaries:Anteriorly: medial portion of inguinal ligamentPosteriorly: fascia of pecteineus and pectineal ligamentMedially: lacuna ligamentLaterally: iliopectinal archContents: Femoral sheath 股鞘Femoral a. and v. 股动、静脉Femoral branch of genit

32、ofemoral n. 生殖股神经股支Lymphatic vesselsFemoral triangle 股三角Boundaries Superiorly (base) : inguinal ligament 腹股沟韧带Laterally: medial border of sartorius 缝匠肌内侧缘Medially: medial border of adductor longus 长收肌内侧缘Apex: continuous with adductor canal 收肌管Anterior wall: fascia lata 阔筋膜Posterior wall: consists of

33、 iliopsoas 髂腰肌, pectineus 耻骨肌 and adductor longus 长收肌 from lateral to medial sideContents：from lateral to medialFemoral n. 股神经Femoral sheath 股鞘Femoral a. 股动脉Femoral v. 股静脉Femoral canal 股管Deep inguinal lymph nodes 腹股沟深淋巴结Fatty tissue 脂肪组织Femoral canal 股管 Femoral ring 股环Anteriorly:inguinal ligamentMed

34、ially: lacuna lig. 腔隙韧带Posteriorly: pecteneal lig. 耻骨梳韧带Laterally: femoral v. 股静脉Superior: covered by femoral septum 股环隔Adductor canal 收肌管BoundiesAnterior wall: adductor lamina大收肌腱板 and sartorius 缝匠肌 Lateral wall: vastus medialis 股内侧肌Posteomedial wall: adductor longus 长收肌 and adductor magmus 大收肌Cont

35、ents Saphenous n. 隐神经Femoral a. and femoral v. 股动、静脉lymphatic vessels and loose connective tissueSciatic nerve 坐骨神经CourseArises from the sacral plexusLeaves pelvis through infrapiriform foramen to enter gluteal regionRuns inferiorly laterally deep to gluteus maximusPassing midway between the greater

36、 trochanter of femur and ischial tuberosity to back of thighLying deep to long head of biceps femoris, Normally divided into tibial and common peroneal nerves just above popliteal fossaInnervatesSemitendinosus 半腱肌Semimembranosus 半膜肌 Biceps femoris 股二头肌Hip and knee joints 髋关节和膝关节Popliteal fossaBounda

37、ries:Superolaterally: Biceps femoris 股二头肌 Superomedially: semitendinosus and semimembranosus 半腱肌和半膜肌Inferiorly: lateral and medial heads of gastrocnemius 腓肠肌内、外侧头Roof: deep fascia Floor: popliteal surface of the femurposterior capsule of the knee jointfascia covering popliteusContents NervesTibial n

38、erve 胫神经Common peroneal nerve 腓总神经Popliteal vein and its tributaries 腘静脉及属支Popliteal artery and its branches 腘动脉及分支Popliteal lymph nodes 腘淋巴结Malleolar canal 踝管BoundariesFormed by medial surface of calcaneus, flexor retinaculum and medial malleolusStructures passing through the malleolar canalTibiali

39、s posterior 胫骨后肌Flexor digitirum longus 趾长屈肌Posterior tibial a. v. and n. 胫后动脉、静脉Tibial n. 胫神经Flexor hallucis longus 长屈肌头部眉弓 superciliary arch 眶上切迹 supraorbital notch 眶下孔 infraorbital foramen颏孔 mental foramen翼点 pterion颧弓 zygomatic arch 耳屏 tragus髁突 condylar process乳突 mastoid process 前囟点 bregma人字点 lam

40、bda枕外隆突 external occipital protuberanceParotid duct 腮腺管 Arises front anterior border of gland Lies 1.5 cm below and parallel to zygomatic arch Passes forward over masseter, pierces the buccinator and oral mucosa to open opposite second upper molar toothStructures vertical passing through the parotid

41、 gland External carotid a. 颈外动脉Superficial temporal a. 颞浅动脉Superficial temporal v. 颞浅静脉Retromandibular vein 下颌后静脉Auriculotemporal n. 耳颞神经Structures transversal passing through the parotid gland Maxillary a. & v. 上颌动、静脉Transverse facial a. & v. 面横动、静脉Branches of facial n. 面神经的分支The structures from su

42、perficial to deepBranches of facial nerve 面神经的分支Retromandibular vein 下颌后静脉External carotid a. 颈外动脉 and Auriculotemporal n. 耳颞神经Layers of frontoparietooccipital region Consists of five layers The superficial 3 layer are closely knit together, called scalp 头皮1. Skin 皮肤 thick and hair bearing and conta

43、ins numerous sebaceous glands 皮厚、腺多、血运丰富2. The superficial fascia 浅筋膜 Dense connective tissue that binds the skin to the underlying epicranial aponeurosis The vasculature of the scalp runs primarily in this layer. It is rich and widely anastomosis.Wounds of the scalp bleed profusely but heal well. a

44、. v. and n. in superficial fasciaAnterior groupSupratrochlear a. v. n. 滑车上动、静脉和神经Supraorbital a. v. n. 眶上动、静脉和神经Posterior groupOccipital a. v. 枕动、静脉Greater occipital n. 枕大神经3. Epicranial aponeurosis and occipitofrontalis 帽状腱膜和枕额肌It is interposed between the frontalis and occipitalis portions of the

45、occipitofrontalis muscle.These muscles place the aponeurosis under tension so that deep transverse lacerations of the scalp gape widely 坚韧致密，前连额腹，后连枕腹，4. Subaponeurotic loose connective tissue(space)腱膜下疏松结缔组织(间隙)Contains a rich network of deep arteries and veins. Therefore, this layer has been calle

46、d the “dangerous area”. Infection may spread to the substance of the bones, to venous channels within the cranial cavity, or to the brain.5. Pericranium 颅骨外膜Fuses firmly with bone at the sutures and with the periosteum of the adjacent bone, thus limiting the subperiosteal space.薄而致密，易于颅骨分离，如有血肿，与骨一致

47、Hypophysis and hypiphyseal fossa 垂体与垂体窝Shape and positionPea-sized organ, attached by infundibulum to hypothalamus, lies in hypophysial fossaConsists of two parts:AdenohypophysisNeurohypophysis RelationshipAnteriortuberculum sellae Posteriordorsum sellaeAnterolateralyoptic canalAbovediaphragm sellae

48、, optic chiasma and optic nerve Laterallycavernous sinusBelowsphenoid sinus Cavernous sinus 海绵窦Position: lies on each side of sella turcicaTraversing the cavernous sinusinternal carotid artery 颈内动脉abducent nerve 展神经Traversing the lateral wall of the cavernous sinusoculomotor nerve 动眼神经trochlear nerv

49、e 滑车神经ophthalmic nerve 眼神经maxillary nerve 上颌神经颈部Landmarks of the neckHyoid bone 舌骨Thyroid cartilage 甲状软骨Cricoid cartilage 环状软骨Catotid tubercle 颈动脉结节Sternocleidomastoid 胸锁乳突肌Suprasternal fossa 胸骨上窝Greater supraclaviclar fossa 锁骨上大窝Cervical fascia 颈筋膜Superficial layer of cervical fascia 颈筋膜浅层 (investi

50、ng fascia 封套筋膜)Encloses trapezius, sternocleidomastoid, posterior belly of digastric and parotid and submandibular glandsAttached to bony landmarks of upper and lower boundaries of neck and zygomatic arch of facePretracheal layer 气管前层Lies deep to the infrahyoid muscle Encloses viscera of neck: phary

51、nx, larynx, trachea, esophagus, thyroid gland and parathyroid glandsCompletely surrounds thyroid gland, forming a sheath for it, and bind the gland to larynx to form suspensory ligament of thyroid gland 甲状腺悬韧带Extends from arch of cricoid cartilage, thyroid cartilage and hyoid bone to fibrous pericar

52、dium of superior mediastinum Prevertebral layer 椎前层Lies anterior to bodies of cervical vertebrae and prevertebral muscles; extends from base of skull downward into the superior mediastinum, continuous with anterior longitudinal lig. and endothoracic fasciaCovers subclavian vessels and roots of brach

53、ial plexus Extends into upper limb as axillary sheath Carotid triangle 颈动脉三角 BoundariesAnterior border of sternocleidomastoidSuperior belly of omohyoid Posterior belly of digasticCovered by skin, superficial fascia, platysma and investing fasciaDeepprevertebral fascia Medial lateral wall of pharynx

54、ContentsCommon carotid a. and its branchesInternal jugular v. and its tributaries Hypoglossal n. with its descending branchesVagus nerve Accessory nerve Deep cervical lymph nodesMuscular triangle 肌三角Bounded by midline of the neck, superior belly of the omohyoid and anterior border of the sternocleid

55、omastoid.Covered by skin, superficial fascia, platysma, anterior jugular v., and investing fasciaDeepprevertebral fascia Thyroid gland 甲状腺Shape and positionH-shapeLeft and right lobes: lie on either side of inferior part of larynx and superior part of trachea, extend from middle of thyroid cartilage

56、 to level of sixth trachea cartilageIsthmus: overlies 2nd to 4th tracheal cartilagePyramidal lobe: some times arises from isthmus Coverings of the thyroid glandFalse capsule: a sheath of pretracheal fascia which is attached to arch of cricoid and thyroid cartilages to form the suspensory ligament of

57、 thyroid gland, hence, the thyroid gland moves with larynx during swallowing and oscillates during speakingTrue capsule: fibrous capsuleSpace between sheath and capsule of thyroid gland: there are loose connective tissue, vessels, nerves and parathyroid glandsRelations of the thyroid gland Anteriorl

58、y: Skinsuperficial fascia investing fasciaInfrahyoid muscles and pretracheal fascia Posteromedially:Larynx and tracheaPharynx and esophagusRecurrent laryngeal nervePosterolaterally:Carotid sheath with common carotid a., internal jugular v., and vagus n.Cervical sympathetic trunkArteries of the thyro

59、id gland Superior thyroid a. 甲状腺上动脉 Branch of external carotid a.Runs superficial and parallel to the external branch of superior laryngeal n. to reach the upper pole of thyroid glandGives off superior laryngeal a. in company with internal branch of superior laryngeal n.Inferior thyroid artery 甲状腺下动

60、脉Branch of thyrocervical trunk of subclavian a.Turns medially and downward, reaches the posterior border of the thyroid gland, where it is closely related to the recurrent laryngeal n. Supplies inferior pole of thyroid glandArteria thyroidea ima 甲状腺最下动脉May arise (4%) from the brachiocephalic a. or a