系统解剖学系统解剖学systematicanatomy主讲人侯一平教授兰州课件

颈部一、概述二、浅层结构三、颈部深筋膜四、颈前区五、胸锁乳突肌区六、颈根部七、颈侧区January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈部一、概述一、概述境界：内容：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

一、概述境界：January,2007Copyright颈部分区：项部固有颈部（颈部）颈前区胸锁乳突肌区颈侧区January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈部分区：项部January,2007Copyright

舌骨上区:下颌下三角颏下三角舌骨下区:颈动脉三角肌三角颈前区：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

舌骨上区:颈前区：January,2007Cop胸锁乳突肌区颈侧区：

枕三角锁骨上大窝January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

胸锁乳突肌区January,2007Copyright©二、浅层结构1.颈阔肌2.浅静脉3.皮神经

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

二、浅层结构1.颈阔肌January,2007Copy1.颈阔肌起点：三角肌和胸大肌表面的筋膜。止点：口角颈阔肌深面有浅静脉和皮神经。

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

1.颈阔肌起点：三角肌和胸大肌表面的筋膜。January,2.浅静脉

①颈前静脉注入颈外静脉②颈外静脉注入锁骨下静脉或静脉角January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

2.浅静脉①颈前静脉January,2007Co3.皮神经(1)为颈丛的皮支:①颈横神经②耳大神经③枕小神经④锁骨上神经颈部麻醉点：(2)面神经颈支January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

3.皮神经(1)为颈丛的皮支:January,2007三、颈部深筋膜分浅、中、深三层。

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

三、颈部深筋膜分浅、中、深三层。January,2包裹二肌二腺，形成肌鞘和腺鞘。二肌：斜方肌胸锁乳突肌二腺：下颌下腺腮腺

1.深筋膜浅层（封套筋膜）January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

包裹二肌二腺，形成肌鞘和腺鞘。1.深筋膜浅层（封位于舌骨下肌群的后方，上附于舌骨，下续纤维性心包，分二层包绕甲状腺，形成甲状腺鞘。2.深筋膜中层（气管前筋膜）January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于舌骨下肌群的后方，上附于舌骨，下续纤维性心包，分二层上自颅底，下续前纵韧带与胸内筋膜，并向下外包绕腋血管及臂丛，形成腋鞘。3.深层（椎前筋膜）

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

上自颅底，下续前纵韧带与胸内筋膜，并向下外包绕腋血管及臂为包绕颈部大血管和迷走神经的筋膜鞘。颈动脉鞘：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

为包绕颈部大血管和迷走神经的筋膜鞘。颈动脉鞘：Janua颈动脉鞘内上部有颈内动脉、下部有颈总动脉，颈内静脉位于动脉的外侧，迷走神经位于两者之间的后方。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈动脉鞘内上部有颈内动脉、下部有颈总动脉，颈内静脉位于动颈部的筋膜间隙：主要有：

(1)胸骨上间隙(2)气管前间隙(3)咽后间隙(4)椎前间隙January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈部的筋膜间隙：主要有：January,2007Co位于胸骨柄上方深筋膜浅层的二层之间。内有颈前静脉下段、颈静脉弓、淋巴结、脂肪组织等。(1)胸骨上间隙January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于胸骨柄上方深筋膜浅层的二层之间。(1)胸骨上间位于气管前筋膜与气管之间。通向：向下通上纵隔。(2)气管前间隙January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于气管前筋膜与气管之间。(2)气管前间隙Januar①甲状腺下静脉②奇静脉丛③头臂干④甲状腺最下动脉⑤左头臂静脉⑥小儿有胸腺上部

气管前间隙内有January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

①甲状腺下静脉气管前间隙内有January,2007C位于椎前筋膜与咽颅底筋膜之间。内有淋巴结及结缔组织。咽壁侧方的部分为咽旁间隙。(3)咽后间隙January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于椎前筋膜与咽颅底筋膜之间。内有淋巴结及结缔组织。咽壁位于脊柱颈段与椎前筋膜之间。颈椎结核脓肿多积于此间隙。向下通后纵隔。(4)椎前间隙January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于脊柱颈段与椎前筋膜之间。颈椎结核脓肿多积于此间隙。（一）舌骨上区下颌下三角颏下三角（二）舌骨下区颈动脉三角肌三角四、颈前区January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（一）舌骨上区四、颈前区January,2007Co（一）舌骨上区1.下颌下三角周界：位于下颌骨下缘与二腹肌前、后腹之间。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（一）舌骨上区1.下颌下三角January,2007

主要为下颌下腺及其周围的血管神经。

内容January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

主要为下颌下腺及其周围的血管神经。内容Ja

浅面有：面静脉深面有：面动脉内下方有：舌下神经舌动脉、舌静脉内上方有：舌神经下颌下神经节

下颌下腺周围的结构：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

浅面有：面静脉下颌下腺周围的结构：January,（二）舌骨下区颈动脉三角肌三角January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（二）舌骨下区颈动脉三角肌三角January,20071.颈动脉三角境界：胸锁乳突肌前缘上份二腹肌后腹肩胛舌骨肌上腹January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

1.颈动脉三角境界：January,2007Copyrig

颈总动脉及其分支颈内静脉及其属支迷走神经副神经舌下神经主要内容：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈总动脉及其分支主要内容：January,2

颈外动脉颈内动脉

颈总动脉及其分支：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈外动脉颈总动脉及其分支：January,2

甲状腺上动脉舌动脉面动脉枕动脉

颈外动脉的分支：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲状腺上动脉颈外动脉的分支：January,2.肌三角

周界：颈前正中线肩胛舌骨肌上腹胸锁乳突肌前缘January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

2.肌三角周界：January,200肌肉：舌骨下肌群4对功能:下降舌骨和喉胸骨舌骨肌肩胛舌骨肌胸骨甲状肌甲状舌骨肌January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

肌肉：舌骨下肌群4对功能:下降舌骨和喉胸骨①甲状腺②甲状旁腺③气管颈段④食管颈段内容：

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

①甲状腺内容：January,2007Copyrigh

甲状腺thyroidgland

1.外形:

“H”形有二个侧叶和一个峡部。一半以上（约70%）的人有锥状叶。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲状腺thyroidgland1.外

甲状腺位于喉下部和气管上部的两侧。侧叶上端平甲状软骨中部，下端达第6气管软骨环；峡部位于第2~4气管软骨环的前面。2.位置January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲状腺位于喉下部和气管上部的两侧。侧叶3.甲状腺的被膜

甲状腺的表面包有内、外层被膜，即：内层：纤维囊（真被膜）外层：甲状腺鞘（假被膜）

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

3.甲状腺的被膜甲状腺的表面包有内、外层被膜，即假被膜增厚形成的甲状腺悬韧带将甲状腺连于喉和气管，故吞咽时，甲状腺可随喉上、下移动。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

假被膜增厚形成的甲状腺悬韧带将甲状腺连于喉和气管，故吞咽4.甲状腺的毗邻甲状腺前面邻(层次）皮肤浅筋膜深筋膜浅层舌骨下肌群January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

4.甲状腺的毗邻甲状腺前面邻(层次）January,200

喉气管咽食管喉返神经甲状腺侧叶内侧邻：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

喉甲状腺侧叶内侧邻：January

颈鞘及其内容

颈交感干

甲状腺侧叶后外侧邻：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈鞘及其内容甲状腺侧叶后外侧邻：January

5.甲状腺的动脉与喉的神经的关系

甲状腺上动脉与喉上神经外支伴行，在距腺上极约1cm处，二者又分开，故甲状腺手术结扎甲状腺上动脉时应紧贴腺上极进行。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

5.甲状腺的动脉与喉的神经的关系甲状腺上动脉甲状腺下动脉与喉返神经的关系：

甲状腺下动脉与喉返神经关系密切，左侧喉返神经位置较深，多经动脉后方上行；右侧喉返神经位置较浅，多经动脉前方。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲状腺下动脉与喉返神经的关系：甲状腺下动脉与喉返神

左右喉返神经入喉之前都经环甲关节后方，故甲状软骨下角可作为寻找喉返神经的标志。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

左右喉返神经入喉之前都经环甲关节后方，故甲状

在甲状腺手术结扎甲状腺下动脉时应远离腺的下极，避免伤及喉返神经，引起声音嘶哑。同时要注意保留甲旁状腺。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

在甲状腺手术结扎甲状腺下动脉时应远离腺的下6.甲状腺的静脉

有三对：甲状腺上静脉甲状腺中静脉甲状腺下静脉

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

6.甲状腺的静脉有三对：January,2007Cop作甲状腺手术切口所经过的层次①皮肤②浅筋膜③深筋膜浅层④舌骨下肌群⑤气管前筋膜January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

作甲状腺手术切口所经过的层次①皮肤January,2007气管颈部有一定的移动性，上段位置表浅，下段位置深。故常规气管切开术应保持头正中位，并尽量后仰。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

气管颈部有一定的移动性，上段位置表浅，下气管切开经过层次：①皮肤②浅筋膜③深筋膜浅层④胸骨上间隙⑤舌骨下肌群⑥气管前筋膜January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

气管切开经过层次：①皮肤January,2007Copy气管颈部的毗邻：

两侧：甲状腺侧叶后方：食管气管食管沟内有喉返神经后外侧：颈动脉鞘颈交感干January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

气管颈部的毗邻：两侧：甲状腺侧叶January,2007六、胸锁乳突肌区位置：主要结构：颈袢January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

六、胸锁乳突肌区位置：January,2007Copyri组成:由颈袢上、下根在第6颈椎平面汇合成袢。

颈袢January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

组成:颈袢January,2007Copyright颈袢上根：由颈1前支构成。颈袢下根：由颈2、3前支经颈丛发出下行构成。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈袢上根：由颈1前支构成。January,2007Copy分布:颈1发支至甲状舌骨肌，袢上发支至其余3个舌骨下肌群。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

分布:January,2007Copyright©Dep七、颈根部

位置：颈部和胸部之间的过渡区。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

七、颈根部位置：January,2007Copyrig纵行结构横行结构

以前斜角肌为标志分为：结构：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

纵行结构横行结构以前斜角肌为标志分为：结构：Januar

在前斜角肌的前内侧，为来源于颈、胸之间的结构。

纵行结构：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

在前斜角肌的前内侧，为来源于颈、胸之间的结构

①颈内静脉②颈总动脉③膈神经④迷走神经⑤颈交感干⑥胸膜顶⑦胸导管及右淋巴导管

纵行结构有：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

①颈内静脉纵行结构有：January,2007C

在前斜角肌的前、后方和外侧，主要是来源于颈、胸与上肢之间的结构。

横行结构：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

在前斜角肌的前、后方和外侧，主要是来源于颈、胸与上肢

①锁骨下动脉及其分支②锁骨下静脉及其属支③臂丛横行结构有January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

①锁骨下动脉及其分支横行结构有January,2007锁骨下动脉：

被前斜角肌分为三段。主要分支有：

①椎动脉②胸廓内动脉③甲状颈干甲状腺下动脉

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

锁骨下动脉：被前斜角肌分为三段。January,20胸导管注入左静脉角，右淋巴导管注入右静脉角。胸导管及右淋巴导管：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

胸导管注入左静脉角，右淋巴导管注入右静脉角斜角肌间隙：由前、中斜角肌和第1肋之间的空隙。通过结构：臂丛锁骨下动脉

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

斜角肌间隙：由前、中斜角肌和第1肋之间的空隙。January八、颈侧区

枕三角锁骨上三角January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

八、颈侧区枕三角January,2007Copyrigh枕三角：主要结构：

颈丛皮神经臂丛分支

副神经支配：胸锁乳突肌斜方肌

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

枕三角：主要结构：January,2007Copyrig锁骨上三角：主要结构：锁骨下动脉锁骨下静脉静脉角臂丛January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

锁骨上三角：主要结构：January,2007Copyri锁骨下静脉：

位于锁骨内侧段上方，锁骨下动脉前面，直径1~2cm。

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

锁骨下静脉：位于锁骨内侧段上方，锁骨下动脉

左侧有胸导管的注入，右侧有右淋巴导管的注入。静脉角January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

左侧有胸导管的注入，右侧有右淋巴导管的注入臂丛从颈部斜角肌间隙经锁骨中点后方到腋窝，临床上作臂丛阻滞麻醉常在锁骨中点上方进行。臂丛January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

臂丛从颈部斜角肌间隙经锁骨中点后方到腋窝，临床上小结1.颈部深筋膜的配布及筋膜间隙。2.颈动脉鞘。2.甲状腺的毗邻。3.甲状腺手术及气管切开手术经过的层次。

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

小结1.颈部深筋膜的配布及筋膜间隙。January,20

颈部一、概述二、浅层结构三、颈部深筋膜四、颈前区五、胸锁乳突肌区六、颈根部七、颈侧区January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈部一、概述一、概述境界：内容：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

一、概述境界：January,2007Copyright颈部分区：项部固有颈部（颈部）颈前区胸锁乳突肌区颈侧区January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈部分区：项部January,2007Copyright

舌骨上区:下颌下三角颏下三角舌骨下区:颈动脉三角肌三角颈前区：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

舌骨上区:颈前区：January,2007Cop胸锁乳突肌区颈侧区：

枕三角锁骨上大窝January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

胸锁乳突肌区January,2007Copyright©二、浅层结构1.颈阔肌2.浅静脉3.皮神经

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

二、浅层结构1.颈阔肌January,2007Copy1.颈阔肌起点：三角肌和胸大肌表面的筋膜。止点：口角颈阔肌深面有浅静脉和皮神经。

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

1.颈阔肌起点：三角肌和胸大肌表面的筋膜。January,2.浅静脉

①颈前静脉注入颈外静脉②颈外静脉注入锁骨下静脉或静脉角January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

2.浅静脉①颈前静脉January,2007Co3.皮神经(1)为颈丛的皮支:①颈横神经②耳大神经③枕小神经④锁骨上神经颈部麻醉点：(2)面神经颈支January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

3.皮神经(1)为颈丛的皮支:January,2007三、颈部深筋膜分浅、中、深三层。

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

三、颈部深筋膜分浅、中、深三层。January,2包裹二肌二腺，形成肌鞘和腺鞘。二肌：斜方肌胸锁乳突肌二腺：下颌下腺腮腺

1.深筋膜浅层（封套筋膜）January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

包裹二肌二腺，形成肌鞘和腺鞘。1.深筋膜浅层（封位于舌骨下肌群的后方，上附于舌骨，下续纤维性心包，分二层包绕甲状腺，形成甲状腺鞘。2.深筋膜中层（气管前筋膜）January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于舌骨下肌群的后方，上附于舌骨，下续纤维性心包，分二层上自颅底，下续前纵韧带与胸内筋膜，并向下外包绕腋血管及臂丛，形成腋鞘。3.深层（椎前筋膜）

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

上自颅底，下续前纵韧带与胸内筋膜，并向下外包绕腋血管及臂为包绕颈部大血管和迷走神经的筋膜鞘。颈动脉鞘：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

为包绕颈部大血管和迷走神经的筋膜鞘。颈动脉鞘：Janua颈动脉鞘内上部有颈内动脉、下部有颈总动脉，颈内静脉位于动脉的外侧，迷走神经位于两者之间的后方。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈动脉鞘内上部有颈内动脉、下部有颈总动脉，颈内静脉位于动颈部的筋膜间隙：主要有：

(1)胸骨上间隙(2)气管前间隙(3)咽后间隙(4)椎前间隙January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈部的筋膜间隙：主要有：January,2007Co位于胸骨柄上方深筋膜浅层的二层之间。内有颈前静脉下段、颈静脉弓、淋巴结、脂肪组织等。(1)胸骨上间隙January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于胸骨柄上方深筋膜浅层的二层之间。(1)胸骨上间位于气管前筋膜与气管之间。通向：向下通上纵隔。(2)气管前间隙January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于气管前筋膜与气管之间。(2)气管前间隙Januar①甲状腺下静脉②奇静脉丛③头臂干④甲状腺最下动脉⑤左头臂静脉⑥小儿有胸腺上部

气管前间隙内有January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

①甲状腺下静脉气管前间隙内有January,2007C位于椎前筋膜与咽颅底筋膜之间。内有淋巴结及结缔组织。咽壁侧方的部分为咽旁间隙。(3)咽后间隙January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于椎前筋膜与咽颅底筋膜之间。内有淋巴结及结缔组织。咽壁位于脊柱颈段与椎前筋膜之间。颈椎结核脓肿多积于此间隙。向下通后纵隔。(4)椎前间隙January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于脊柱颈段与椎前筋膜之间。颈椎结核脓肿多积于此间隙。（一）舌骨上区下颌下三角颏下三角（二）舌骨下区颈动脉三角肌三角四、颈前区January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（一）舌骨上区四、颈前区January,2007Co（一）舌骨上区1.下颌下三角周界：位于下颌骨下缘与二腹肌前、后腹之间。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（一）舌骨上区1.下颌下三角January,2007

主要为下颌下腺及其周围的血管神经。

内容January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

主要为下颌下腺及其周围的血管神经。内容Ja

浅面有：面静脉深面有：面动脉内下方有：舌下神经舌动脉、舌静脉内上方有：舌神经下颌下神经节

下颌下腺周围的结构：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

浅面有：面静脉下颌下腺周围的结构：January,（二）舌骨下区颈动脉三角肌三角January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（二）舌骨下区颈动脉三角肌三角January,20071.颈动脉三角境界：胸锁乳突肌前缘上份二腹肌后腹肩胛舌骨肌上腹January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

1.颈动脉三角境界：January,2007Copyrig

颈总动脉及其分支颈内静脉及其属支迷走神经副神经舌下神经主要内容：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈总动脉及其分支主要内容：January,2

颈外动脉颈内动脉

颈总动脉及其分支：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈外动脉颈总动脉及其分支：January,2

甲状腺上动脉舌动脉面动脉枕动脉

颈外动脉的分支：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲状腺上动脉颈外动脉的分支：January,2.肌三角

周界：颈前正中线肩胛舌骨肌上腹胸锁乳突肌前缘January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

2.肌三角周界：January,200肌肉：舌骨下肌群4对功能:下降舌骨和喉胸骨舌骨肌肩胛舌骨肌胸骨甲状肌甲状舌骨肌January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

肌肉：舌骨下肌群4对功能:下降舌骨和喉胸骨①甲状腺②甲状旁腺③气管颈段④食管颈段内容：

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

①甲状腺内容：January,2007Copyrigh

甲状腺thyroidgland

1.外形:

“H”形有二个侧叶和一个峡部。一半以上（约70%）的人有锥状叶。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲状腺thyroidgland1.外

甲状腺位于喉下部和气管上部的两侧。侧叶上端平甲状软骨中部，下端达第6气管软骨环；峡部位于第2~4气管软骨环的前面。2.位置January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲状腺位于喉下部和气管上部的两侧。侧叶3.甲状腺的被膜

甲状腺的表面包有内、外层被膜，即：内层：纤维囊（真被膜）外层：甲状腺鞘（假被膜）

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

3.甲状腺的被膜甲状腺的表面包有内、外层被膜，即假被膜增厚形成的甲状腺悬韧带将甲状腺连于喉和气管，故吞咽时，甲状腺可随喉上、下移动。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

假被膜增厚形成的甲状腺悬韧带将甲状腺连于喉和气管，故吞咽4.甲状腺的毗邻甲状腺前面邻(层次）皮肤浅筋膜深筋膜浅层舌骨下肌群January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

4.甲状腺的毗邻甲状腺前面邻(层次）January,200

喉气管咽食管喉返神经甲状腺侧叶内侧邻：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

喉甲状腺侧叶内侧邻：January

颈鞘及其内容

颈交感干

甲状腺侧叶后外侧邻：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈鞘及其内容甲状腺侧叶后外侧邻：January

5.甲状腺的动脉与喉的神经的关系

甲状腺上动脉与喉上神经外支伴行，在距腺上极约1cm处，二者又分开，故甲状腺手术结扎甲状腺上动脉时应紧贴腺上极进行。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

5.甲状腺的动脉与喉的神经的关系甲状腺上动脉甲状腺下动脉与喉返神经的关系：

甲状腺下动脉与喉返神经关系密切，左侧喉返神经位置较深，多经动脉后方上行；右侧喉返神经位置较浅，多经动脉前方。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲状腺下动脉与喉返神经的关系：甲状腺下动脉与喉返神

左右喉返神经入喉之前都经环甲关节后方，故甲状软骨下角可作为寻找喉返神经的标志。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

左右喉返神经入喉之前都经环甲关节后方，故甲状

在甲状腺手术结扎甲状腺下动脉时应远离腺的下极，避免伤及喉返神经，引起声音嘶哑。同时要注意保留甲旁状腺。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

在甲状腺手术结扎甲状腺下动脉时应远离腺的下6.甲状腺的静脉

有三对：甲状腺上静脉甲状腺中静脉甲状腺下静脉

January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

6.甲状腺的静脉有三对：January,2007Cop作甲状腺手术切口所经过的层次①皮肤②浅筋膜③深筋膜浅层④舌骨下肌群⑤气管前筋膜January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

作甲状腺手术切口所经过的层次①皮肤January,2007气管颈部有一定的移动性，上段位置表浅，下段位置深。故常规气管切开术应保持头正中位，并尽量后仰。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

气管颈部有一定的移动性，上段位置表浅，下气管切开经过层次：①皮肤②浅筋膜③深筋膜浅层④胸骨上间隙⑤舌骨下肌群⑥气管前筋膜January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

气管切开经过层次：①皮肤January,2007Copy气管颈部的毗邻：

两侧：甲状腺侧叶后方：食管气管食管沟内有喉返神经后外侧：颈动脉鞘颈交感干January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

气管颈部的毗邻：两侧：甲状腺侧叶January,2007六、胸锁乳突肌区位置：主要结构：颈袢January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

六、胸锁乳突肌区位置：January,2007Copyri组成:由颈袢上、下根在第6颈椎平面汇合成袢。

颈袢January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

组成:颈袢January,2007Copyright颈袢上根：由颈1前支构成。颈袢下根：由颈2、3前支经颈丛发出下行构成。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

颈袢上根：由颈1前支构成。January,2007Copy分布:颈1发支至甲状舌骨肌，袢上发支至其余3个舌骨下肌群。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

分布:January,2007Copyright©Dep七、颈根部

位置：颈部和胸部之间的过渡区。January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

七、颈根部位置：January,2007Copyrig纵行结构横行结构

以前斜角肌为标志分为：结构：January,2007Copyright©Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

纵行结构横行结构以前斜角肌为标志分为：