上肢解剖课件

Theupperlimb山东大学医学院解剖教研室李振华Theupperlimb山东大学医学院解剖教研室1ThemusclesofbackSuperficialgroupTrapezius

斜方肌Latissimusdorsi

背阔肌Levatorscapulae肩胛提肌Rhomboideus菱形肌Deepgroup

Erectorspinae竖脊肌Splenius夹肌Thoracolumbarfascia胸腰筋膜ThemusclesofbackSuperficial2ThemusclesofthoraxExtrinsicmusclesPectoralismajor

胸大肌Pectoralisminor

胸小肌Serratusanterior前锯肌IntrinsicmusclesIntercostalesexterni

肋间外肌Intercostalesinterni

肋间内肌Intercostalesintimi肋间最内肌ThemusclesofthoraxExtrinsic3MajormusclesofthetrunkTrapeziusOrigin:superiornuchalline,externaloccipitalprotuberance,ligamentumnuchaeandspinousprocessesofseventhcervicalandallthoracicvertebraeInsertion:lateralthirdofclavicle,acromion,andspineofscapularteryActon:upperfiberselevatescapula,lowerfibersdepressscapula;ifscapulaisfixed,onesideactingalong,drawsheadtowardthesameside,andturnfacetooppositeside;bothsidestogether,drawheaddirectlybackwardMajormusclesofthetrunkTrap4LatissimusdorsiOrigin:spinousprocessesoflowersixthoracicandalllumbarvertebrae,mediansacralcrest,andposteriorpartofiliaccrest.Insertion:floorofintertuberculargrooveofhumerus.Action:trunkfixed,extends,adductsandmediallyrotatesarm;armfixed,elevatestrunk.Latissimusdorsi5ErectorspinaePosition:fillsthevertebralgrooveoneachsideofthespineAction:extendsvertebralcolumn(drawheadbackwar)Erectorspinae6PectoralismajorOrigin:medialhalfofclavicle,sternum,1th-6thcostalcartilages.Insertion:crestofgreatertubercleofhumerus.Action:flexes,adductsandrotatesarmmedially;armfixed,elevatestrunk;elevatesribs1-6,aiddinginforcedinspiration.Pectoralismajor7TheMusclesofUpperLimb

MusclesofshoulderDeltoidsupraspinatusInfraspinatusTeresminorTeresmajorsubscapularisTheMusclesofUpperLimb

Musc8MusclesofarmAntereriorgroupBicepsbrachii肱二头肌Coracobrachialis喙肱肌Brachialis肱肌Posteriorgroup–tricepsbrachii肱三头肌Musclesofarm9Musclesofforearm

SuperficiallayerBrachioradialis肱桡肌Pronatorteres旋前圆肌Flexorcarpiradialis桡侧腕屈肌Palmarislongus掌长肌Flexorcarpiulnaris尺侧腕屈肌Musclesofforearm

Superficial10ThirdlayerFlexordigitorumprofundus指深屈肌Flexorpollicislongus拇长屈肌Fourthlayer－pronatorquadratus

旋前方肌Action:flexradiocarpaljointandfingers,pronateforearmThirdlayer11Secondlayer－flexordigitorumsuperficials指浅屈肌Secondlayer－flexo12Posteriorgroup(10)Superficiallayer(5)Extensorcarpiradialislongus桡侧腕长伸肌Extensorcarpiradialisbrevis桡侧腕短伸肌Extensordigitorum指伸肌Extensordigitiminimi小指伸肌Extensorcarpiulnaris尺侧腕屈肌Posteriorgroup(10)13Deeplayer(5)Supinator旋后肌Abductorpollicislongus拇长展肌Extensorpollicisbrevis拇短伸肌Extensorpollicislongus拇长伸肌Extensorindicis示指伸肌Action:extendradiocapraljointandfingers,andsupinateforearmDeeplayer(5)14MusclesofhandLateralgroup－thenar鱼际(4)Abductorpollicisbrevis拇短展肌Flexorpollicisbrevis拇短屈肌Opponenspollicis拇对掌肌Adductorpollicis拇收肌Action:flex,abduct,adductandopposethumbMedialgroup－hypothenar(3)Abductordigitiminimi小指展肌Flexordigitiminimibrevis小指短屈肌Opponensdigitiminimi小指对掌肌Action:flex,abduct,andopposelittlefingerMusclesofhand15IntermedialgroupLumbricales蚓状肌(4)－flexfingersatMPjoints;extendfingersatIPjointsPalmarinterossei骨间掌侧肌(3)－adductfingerstowardsmiddlefingeratMPjointsDorsalinterossei骨间背侧肌(3)－abductfingersawayfrommiddlefingeratMPjointsIntermedialgroup16MajormusclesofupperlimbDeltoidOrigin:lateralthirdofclavicle,acromion,andspineofscapulaInsertion:deltoidtuberosityofhumerusAction:abducts，flexesandmedicallyrotates,extends,andlaterallyrotatesarmMajormusclesofupperlimbDel17TeresmajorOrigin:dorsalsurfaceofinferiorangleofscapulaInsertion:crestoflessertubercleofhumerusAction:mediallyrotatesandadductsarmTeresmajor18BicepsbrachiiOrigin:longhead,supraglenoidtubercle;shorthead,coracoidprocessInsertion:radicaltuberosityAction:supinatorofforearm,flexorofelbowjoint,weakflexorofshouldjointPronatorteresOrigin:medicalepicondyleofhumerusanddeepfasciaofforearmInsertion:middleoflateralsurfaceofradiusAction:pronationofforearmandflexionofelbowBicepsbrachii19TricepsbrachiiOrigin:longhead,infraglenoidtubercle;lateralhead,abovegrooveforradicaln.,medicalhead,belowgrooveforradicaln.Insertion:olecranonofulnaAction:extendselbowjoint),longheadcanextendandadductshoulderjointTricepsbrachii20SupinatorOrigin:lateralepicondyleofhumerusandupperpartoflateralborderofulnaInsertion:upperthirdofanteriorsurfaceofradiusAction:supinationofforearmSupinator21ArteriesofupperlimbAxillaryartery

ContinuationofsubclavianarteryatlateralborderoffirstribBecomesbrachialarteryatlowerborderofteresmajorDividedintothreepartsbyoverlyingpectoralisminorFirstportion,abovemuscle－givesrisetothoracoacromiala.胸肩峰动脉Secondportion,behindmuscle－givesrisetolateralthoracica.胸外侧动脉Thirdportion,belowmuscle－givesrisetosubscapulara.肩胛下动脉,anteriorandposteriorhumeralcircumflexa.旋肱前、后动脉;theformerthendividesintothrocodorsala.胸背动脉andcircumflexscapulara.旋肩胛动脉ArteriesofupperlimbAxillary22上肢解剖课件23BrachialarteryContinuationofaxillaryarteryDividesintoradialandulnararteriesatlevelofneckofradiusBranchesDeepbrachiala.肱深动脉－accompanieswithradialnerveSuperiorulnarcollaerala.尺侧上副动脉－accompanieswithulnarnerveInferiorulnarcollaterala.尺侧下副动脉Brachialartery24Radialarteryandbranches

Radialrecurrenta.桡侧返动脉Superficalpalmarbranch掌浅支Principalarteryofthumb拇主要动脉UlnararteryandbranchesUlnarrecurrenta.尺侧返动脉Commoninterosseousartery骨间总动脉Anteriorinterossousa.骨间前动脉Posteriorinterosseousa.骨间后动脉Deeppalmarbranch掌深支Radialarteryandbranches25Superficialpalmararch掌浅弓FormedbyulnararteryandsuperficialpalmarbranchofradialarteryCurveofarchliesacrossthepalm,levelwiththedistalborderoffullyextendedthumbGivesrisetothreecommonpalmardigitalarterieseachthendividesintotwoproperpalmardigitalarteriesSuperficialpalmararch掌浅弓26Deeppalmararch掌深弓FormedbyradialarteryanddeeppalmarbranchofulnararteryCurveofarchliesacrossupperpartofpalmaratlevelwithproximalborderofextendedthumbGivesrisetothreepalmarmetacarpalarteries

Deeppalmararch掌深弓27VeinsoftheupperlimbDeepveins:accompanythearteriesofthesameregionandbearsimilarnamesSuperficialveinsCephalicvein头静脉

ArisesfromthelateralsideofthedorsalvenousreteofhandAscendsonradialsideoftheforearmtotheelbowandtheninthelateralsideofbicepsbrachiifurrow,continuesupthearminthedeltopectoralgrooveandthentotheinfraclavicularfossa,whereitpiercesclavipectoralfasciatodrainintoaxillaryveinVeinsoftheupperlimbDeepve28Basilicvein

贵要静脉ArisesfromthemedialsideofthedorsalvenousreteofhandAscendsontheulnarsideofforearmtotheelbowandtheninthemedialbicepitalbrachiifurrowtomiddleofthearmwhereitpiercesthedeepfasciaandjoinsthebrachialveinoraxillaryveinMediancubitalvein肘正中静脉linkscephalicveinandbasilicveininthecubitalfossa.ItisafrequentsiteforvenipuncturetoremoveasampleofbloodoraddfluidtothebloodBasilicvein贵要静脉29Thelymphaticdrainageofupperlimb

LymphaticvesselsSuperficial－followthesuperficialveins,drainintosupratrochlearandaxillarylymphnodesDeep－accompanymainvessels,endinaxillarylymphnodes

lymphnodesCubitallymphnode:liesabovemedialepicondyleofhumerusAxillarylymphnode－arrangedinfivegroupsThelymphaticdrainageofuppe30Axillarylymphnodes腋淋巴结－arrangedinfivegroupsLaterallymphnodes外侧淋巴结－liearoundthedistalendofaxillaryvein,receivingdrainagefromthearm,forearm,andhandPectorallymphnodes胸肌淋巴结－liealonglateralthoracicvessels,receiveafferentsfromanteriorthoracicwallincludingcentralandlateralportionofmammaSubscapularlymphnode肩胛下淋巴结－alongsubscapularvessels,receivelymphfromnapeandscapularregionEfferentsabovethreegroupspasstocentrallymphnodeAxillarylymphnodes腋淋巴结－arran31Centrallymphnode中央淋巴结－lieinfatofaxillaryfossa,receivedrainagefromalltheabovenodes,efferentspasstoapicallymphnodeApicallymphnode尖淋巴结Lieintheapexoftheaxilla,alongtheproximalendofaxillaryvesselsReceivedrainagechieflyfromcentrallymphnode,upperportionofmammaEfferentsformsubclaviantrunk,therightsubclaviantrunkjointstherightlymphaticduct;leftusuallydrainsdirectlyintothoracicductCentrallymphnode中央淋巴结－liein32Brachialplexus臂丛

Formation:Fiveroots:formedbyanteriorramiofC5-C8andT1spinalnerves,rootsC5～C7giverisetolongthoracicn.胸长神经ThreetrunksTheuppertrunkisformedbythejoiningofrootC4,C5,C6.ThemiddletrunkisthecontinuationofrootC7.ThelowertrunkisformedbythejoiningofrootC8andT1.Sixdivisions:aboveclavicle,trunksformanteriorandposteriordivisionsThreecords:belowclavicle,divisionsformthreecordsthatsurroundthesecondportionofaxillarya.Brachialplexus臂丛

Formation:33Position:passesthroughthescalenefissuretoposterosuperiorofsubclavianartery,thenenterstheaxillatoformlateral,medialandposteriorcordsMainbranchesLateralcordMusculocutaneousn.肌皮神经Lateralroottomediann.正中神经外侧根MedialcordMedialroottomediann.正中神经内侧根Ulnarn.尺神经Medialbrachialcutaneousn.臂内侧皮神经Medialantebrachialcutaneousn.前臂内侧皮神经Position:34Posteriorcordradialn.桡神经axillaryn.腋神经thoracodorsaln.胸背神经Posteriorcord35Musculocutaneous

肌皮神经Distribution:Bicepsbrachii,brachalisandcoracobrachialis‘BBCnerve’;skinonanterioraspectofforearmMusculocutaneous肌皮神经36Median

正中神经Distribution:Flexorofforearmexceptbrachioradialis,flexorcarpiulnarisandulnarhalfofflexordigitorumprofundus,thenarexceptadductorpollicis,firsttwolumbricals;skinofthenar,centralpartofpalm,palmaraspectofradialthreeandone-halffingers,includingmiddleanddistalfingersondorsum

Injury:Apehand猿手producessignofbenediction,inwhichtheindexandmiddlefingerscannotbeflexedandthethumbcannotbeopposed

Median正中神经37Ulnarnerve

Distribution:Flexorcarpiulnaris,ulnarhalfofflexordigitorumprofundus,hypothenarmuscles,interossei,3rdand4thlumbricalsandadductorpollicis;skinofhypothenar,palmarsurfaceofulnaroneandone-halffingers,ulnarhalfofdorsumofhand,posterioraspectofulnartwoandone-halffingersInjury:clawhandUlnarnerve38Radial

桡神经Distribution:Extensormusclesofarmandforearm,brachioradialis;skinonbackofarm,forearm,andradialsideofdorsumofhandandradialtwoandone-halffingersInjury:WristdropRadial桡神经39Axillary腋神经

Distribution:Deltoidandteresminormuscle;skinoverdeltoidandupperposterioraspectofarmInjury:resultindeltoidandteresminorparalysis(lossofshoulserabdutionandweelexternalrotation)withlossofsensationoverthedeltoid

Axillary腋神经40Regionalanatomyofupperlimb山东大学医学院解剖教研室李振华Regionalanatomyofupperlimb41Partsandregions

Shoulderregion－junctionofarmandtrunkArm－betweenshouldandelbowElbow－bendofarm,jointbetweenarmandforearmForearm－betweenelbowandhandHandPartsandregions

Shoulderre42SurfaceanatomyShoulderregion:acromion,spineofscapula,coracoidprocess,greatertubercle,anteriorandposterioraxillaryfoldsArm－medialandlateralbicepsbrachiifurrow,deltoidtuberosityElbow－medialandlateralepicondyles,headofradius,olecranon,tendonofbicepsbrachiiForearm－betweenelbowandhandHand－styloidprocess,dorsaltubercleSurfaceanatomyShoulderregion43Anatomicalsnuffbox鼻烟壶Whenthethumbisabductedandextended,atriangularhollowappearsbetweenthetendonoftheextensorpollicislongsmediallyandthetendonsoftheextensorpollicisbrevisandabductorpollicislonguslaterally.Thefloorofthesnuffboxisthescaphoidandtrapeziumbonesandcrossedbytheradiala..Anatomicalsnuffbox鼻烟壶441650～1700Carringangle提携角1650～1700Carringangle提携角45

Mamma乳房PositionLieinsuperficialfasciaoverthepectoralsmajorandpectoralfasciaExtendfrom3rdto7thribsvertically,andfromparasternallinetomidaxillarylinetransversallyMamma乳房Position46Structures－containsskin,mammaryglandsandadiposetissueEachbresthasabout15～20lobesofmammaryglandEachloberadiatesoutfromthenippleandhasalactiferousduct输乳管whichopensseparatelyonthesummitofthenippleandpossessesadilatedlactiferoussinuses输乳管窦justpriortoitsterminationStructures－containsskin,mamm47Suspensoryligamentsofbreast乳房悬韧带(cooper’sligaments)－strandsofconnectivetissuerunsbetweenskinanddeepfasciaandservetosupportthemammaryglandsSuspensoryligamentsofbreast48Axillaryfossa腋窝Theaxillaryfossaisapyramid-shapedspacethroughwhichmajorneurovascularstructurespassbetweenthethoraxandupperextremityAxillaryfossa腋窝Theaxillary49BoundariesTheapexisatriangularspacelimitedbythefirstrib,thescapula,andthemiddlethirdofclavicle.Thebase－skinandfasciaoftheaxillaryfossaBoundaries50TheanteriorwallPectoralismajor,pectoralisminorandsubclaviusmusclesClavipectoralfascia

锁胸筋膜Thedeepfaxciawhichextendsbetweensubclavius,coracoidprocessandpectoralisminormusclesThestructurespassthroughtheclavipectoralfaxciaCephalicv.Thoracoacromiala.Lateralpectoraln.

Theanteriorwall51Theposteriorwall－teresmajor,latissimusdorsi,subscapularisandscapula

Trilateralandquadrilateralforamina

三边孔和四边孔Betweenthesubscapularisandteresmajor,thereisalongtriangularspacewhoselateralsideissurgicalneckofhumerus.Thelongheadoftricepsbrachiisubdividesthisspaceintoamedialtrilateralforamenandalateralquadrilateralforamen.Theposteriorhumeralcircumflexa.andaxillaryn.passthroughthequadrilateralforamen.Thecircumflexscapulara.passesthroughthetriangularspacetoreachthedorsumofthescapula.Theposteriorwall－teresmajor52Thebroadmedialwall－serratusanterior，intercostalmusclesandupperfourribsThenarrowlateralwall－coracobrachialis,bicepsbrachiiandintertuberculargrooveContentsBrachialplexus,axillarya.andprincipalbranches,axillaryv.andtributaries,axillarylymphnodesandlooseconnectivetissueThebroadmedialwall－serratus53Brachialplexus臂丛

Formation:Fiveroots:formedbyanteriorramiofC5-C8andT1spinalnerves,rootsC5～C7giverisetolongthoracicn.胸长神经ThreetrunksTheuppertrunkisformedbythejoiningofrootC4,C5,C6.ThemiddletrunkisthecontinuationofrootC7.ThelowertrunkisformedbythejoiningofrootC8andT1.Sixdivisions:aboveclavicle,trunksformanteriorandposteriordivisionsThreecords:belowclavicle,divisionsformthreecordsthatsurroundthesecondportionofaxillarya.Brachialplexus臂丛

Formation:54Position:passesthroughthescalenefissuretoposterosuperiorofsubclavianartery,thenenterstheaxillatoformlateral,medialandposteriorcordsMainbranchesLateralcordMusculocutaneousn.肌皮神经Lateralroottomediann.正中神经外侧根MedialcordMedialroottomediann.正中神经内侧根Ulnarn.尺神经Medialbrachialcutaneousn.臂内侧皮神经Medialantebrachialcutaneousn.前臂内侧皮神经Position:55Posteriorcordradialn.桡神经axillaryn.腋神经thoracodorsaln.胸背神经Posteriorcord56Axillarysheath

腋鞘－extensionofdeepcervicalfasciaoftheneck,formingatubularsheaththatsurroundsaxillarya.andv.,andbrachialplexusAxillarysheath腋鞘－extensiono57Axillaryartery

ContinuationofsubclavianarteryatlateralborderoffirstribBecomesbrachialarteryatlowerborderofteresmajorDividedintothreepartsbyoverlyingpectoralisminorFirstportion,abovemuscle－givesrisetothoracoacromiala.胸肩峰动脉Secondportion,behindmuscle－givesrisetolateralthoracica.胸外侧动脉Thirdportion,belowmuscle－givesrisetosubscapulara.肩胛下动脉,anteriorandposteriorhumeralcircumflexa.旋肱前、后动脉;theformerthendividesintothrocodorsala.胸背动脉andcircumflexscapulara.旋肩胛动脉Axillaryartery58Axillarylymphnode－arrangedinfivegroupsLaterallymphnodes－liearoundthedistalendofaxillaryarteryvein,receiveafferentvesselsfromupperlimb.Pectorallymphnodes－liealonglateralthoracicvessels,receiveafferentsfromanteriorthoracicwallincludingcentralandlateralportionofmammaSubscapularlymphnode－alongsubscapularvessels,receivelymphfromnapeandscapularregionEfferentsabovethreegroupspasstocentrallymphnodeCentrallymphnode－lieinfatofaxillaryfossa,receivelymphfromalltheabovenodes,efferentspasstoapicallymphnodeApicallymphnode－lieintheapexoftheaxilla,alongtheproximalendofaxillaryvessels,receiveafferentschieflyfromcentrallymphnode,upperportionofmamma;efferentsformsubclaviantrunk,therightsubclaviantrunkjointstherightlymphaticduct;leftusuallydrainsdirectlyintothoracicductAxillarylymphnode－arrangedi59Cubiralfossa肘窝BoundariesBase－linedrawnthroughepicondylesofhumerusApex－brachioradialislaterallyandpronatorteresmediallyRoof－skin,superficialfaxcia,deepfaxciaandaponeurosisofbicepsFloor－brachialis,supinatorandcapsuleofelbowjointCubiralfossa肘窝Boundaries60Contents－fromlateraltomedialBicepsbrachiitendonBrachiala.－dividesintoradialandulnara.,usuallyatapexoffossaMediann.Lateraltothebicepsbrachiitendon－radialn.andlateralantebrachialcutaneousn.Contents－fromlateraltomedia61Carpaltunnel

腕管FlexorretinaculumThickeningofdeepfasciainthehandAttachedlaterallytoscaphoidandtrapeziunandmediallytopisiformandhamateFormanosseofibroustunnel(carpaltunnel)withcarpalgroove－transmitsmediann.,flexordigitorumsupericialis,flexordigitorumprofundus,andflexorpollicuslongusfromforearmintohandCarpaltunnel腕管Flexorretinac62CommonflexorsheathTeninoussheathofflexorpollicislongusCommonflexorsheathTeninouss63上肢解剖课件64SkinincisionsSkinincisions65Cephalicv.LateralcutaneousbranchAnteriorcutaneousbranchSuperficialfascia

Cephalicv.Lateralcutaneousb66Clavipectoralfascia

锁胸筋膜Thedeepfaxciawhichextendsbetweensubclavius,coracoidprocessandpectoralisminormusclesThestructurespassthroughtheclavipectoralfaxciaCephalicv.Thoracoacromiala.Lateralpectoraln.Clavipectoralfascia锁胸筋67Axillarya.

Thoracoacromiala.

Musculocutaneousn.Mediann.Medialantebrachialcutaneousn.Ulnarn.Medialbrachialcutaneousn.Intercostobrachialn.Thoracodorsaln.&a.Longthoracicn.&lateralthoracica.Lateralpectoraln.Axillarya.Thoracoacromiala.68Posteriorhumeralcircumflexa.&axillaryn.Radialn.Circumflexscapulara.Posteriorhumeralcircumflexa69Musculocutaneousn.Mediann.Medialbrachialcutaneousn.Ulnarn.Medialantebrachialcutaneousn.Superiorulnarcoleterala.Deepbrachiala.Musculocutaneousn.Mediann.Me70Musculocutaneousn.Mediann.Axillarya.Brachiala.Medialantebrachialcutaneousn.Medialbrachialcutaneousn.Deepbrachiala.Superiorulnarcoleterala.&Ulnarn.Inferiorulnarcoleterala.Musculocutaneousn.Mediann.Ax71Mediancubitalv.Lateralanterachialcutaneousn.&cephelicv.Medialinterracialcutaneousn.&basiicv.Mediancubitalv.Lateralanter72Radialrecurrenta.Radiala.Radialn.Mediann.Ulnarn.Ulnara.Ulnarrecurrenta.Ulnarn.Brachiala.Radialrecurrenta.Radiala.Ra73Muscolocutaneousn.Brachiala.Radialn.Radialrecurrenta.Radiala.Mediann.Ulnarrecurrenta.Commoninterosseousa.Ulnara.,v.&n.Muscolocutaneousn.Brachiala.74PalmaraponeurosisPalmaraponeurosis75Superficialpalmara.recurrentn.

Ulnara.Superficialpalmara.recurrent76Posteriorregionofupperlimb山东大学医学院解剖教研室李振华Posteriorregionofupperlimb77Skinincisions

Skinincisions78Cutaneousn.and

superificialv.Cutaneousn.and

superificia79Trapezium

Deltoid

TriangleofausculationLatissimusdorsiThoracolumbarfasciaLevatorscapularRhomboideusTrapeziumDeltoidTriangleof80Axillaryn.Posteriohumeralcircumflexa.Deepbrachiala.Radialn.Suprascapularn.&a.Supraspinatus

InfraspinatusTeresminorTeresmajorAxillaryn.Posteriohumeralci81Radialn.Deepbrachiala.Radialn.Deepbrachiala.82Posteriorinterosseousa.Posteriorinterosseousn.Posteriorinterosseousa.Poster83上肢解剖课件84Hand

山东大学医学院解剖教研室李振华Hand山东大学医学院解剖教研室85Palmofhand手掌Flexorretinaculum屈肌支持带ThickeningofdeepfasciainthehandAttachedlaterallytoscaphoidandtrapeziunandmediallytopisiformandhamateCarpaltunnel

腕管Formedbyflexorretinaculum

andcarpalgrooveTransmitsMediann.FlexordigitorumsuperficialisandflexordigitorumprofundusenclosedbycommonflexorsheathFlexorpollicuslongusenclosedbytendinoussheathofflexorpollicuslongusPalmofhand手掌Flexorretinac86CommonflexorsheathTendinoussheathofflexorpollicislongusCommonflexorsheathTendinous87上肢解剖课件88Deeppalmarfascia

掌部深筋膜SuperficiallayerThenarfascia鱼际筋膜Hypothenarfascia小鱼际筋膜Palmaraponeurosis掌腱膜thicktriangularmembraneDeeplayer－palmarinterosseousfascia骨间掌侧筋膜Deeppalmarfascia

掌部深筋膜S89Osseofascialcompartmentsofpalm

手掌骨筋膜鞘Lateralcompartment外侧鞘Medialcompartment内侧鞘Intermediatecompartment中间鞘LaeralintermuscularseptumMedial

intermuscularseptumPalmaraponeurosisPalmarinterosseousfasciaAdductorpollicisHypothenarfasciaThenarfasciaOsseofascialcompartmentsofp90Intermediatecompartment中间鞘Formedby

palmaraponeurosis,Laeralandmedialintermuscularseptum,palmarinterosseousfasciaContents:superficialpalmararch,a.,v.,n.,tendonsofflexordigitorumsuperficialisandprofundus,lumbricales,commonflexorsheathIntermediatecompartment中间鞘91Fasciaspaces筋膜间隙Thenarspace鱼际间隙Midpalmarspace掌中间隙MidpalmarspaceThenarspaceMidplmarseptum掌中隔Fasciaspaces筋膜间隙Thenarspace92Dorsumofhand

手背Extensorretinaculum伸肌支持带ThickeningofdeepfaxciaofforearmawristAttachedlaterallytoradiusandmediallytostyloidprocessofulnaandtriquetrumFormssixfibrouscompartmentsforextensortendonspassingfromforearmintohand:Dorsumofhand手背Extensorreti93①tendonsofabductorpollicislongusandextensorpollicisbrevisandtheirsynovialsheaths;②tendonsofextensorcarpiradialislongusandbrevisandtheirsynovialsheaths;③tendonofpollicislongusanditssynovialsheath;④tendonsofextensordigitorum,extensorindicisandtheirsynovialsheaths;⑤tendonofextensordigitiminimianditssynovialsheaths;⑥tendonofextensorcarpiulnarisanditssynovialsheaths①tendonsofabductorpollicis94FasciaofthedorsalhandThesuperficialfasciaDeepfascia－thedorsalfasciaofhandSuperficiallayer(dorsalaponeurosis)手背腱膜Deeplayer(dorsalinterosseousfascia)骨间背侧筋膜Fasciaofthedorsalhand95TwospacesThedorsalsubcutaneousspace手背皮下间隙Thedorsalsubaponeuroticspace手背腱膜下间隙SuperficialfasciaDorsalaponeurosisDorsalinterosseousfasciaDorsalsubcutaneousspaceDorsalsubaponeuroticspaceTwospacesSuperficialfasciaDo96Nervesofhand

Mediann.－thenarexceptadductorpollicis,firsttwolumbricals;skinofthenar,centralpartofpalm,palmaraspectofradialthreeandone-halffingers,includingmiddleanddistalfingersondorsumUlnarn.－hypothenarmuscles,interossei,3rdand4thlumbricalsandadductorpollicis;skinofhypothenar,palmarsurfaceofulnaroneandone-halffingersNervesofhandMediann.－thena97Radialn.－skinofradialsideofdorsumofhandandradialtwoandone-halffingersRadialn.－skinofradialside98Fingers手指Pulpspace指髓间隙Onthepalmarsideofthetipsofthefingersandthumb.Theycontainfattytissuethatisdividedintonumerouscompartmentsbyfibrousseptathatpassbetweenthedistalphalanxandtheskin.Thepulpspaceislimitedproximallybythefirmadherenceofskinandthedistalflexioncreasetotheunderlyingtissue;thispreventspulpinfectionfromspreadingproximallyalongthefinger.Fingers手指Pulpspace指髓间隙99vessels:

有2条指掌侧固有动脉和2条指背动脉，分别走行于手指的两侧。Nerves：

神经与同名动脉伴行。上肢解剖课件100Theupperlimb山东大学医学院解剖教研室李振华Theupperlimb山东大学医学院解剖教研室101ThemusclesofbackSuperficialgroupTrapezius

斜方肌Latissimusdorsi

背阔肌Levatorscapulae肩胛提肌Rhomboideus菱形肌Deepgroup

Erectorspinae竖脊肌Splenius夹肌Thoracolumbarfascia胸腰筋膜ThemusclesofbackSuperficial102ThemusclesofthoraxExtrinsicmusclesPectoralismajor

胸大肌Pectoralisminor

胸小肌Serratusanterior前锯肌IntrinsicmusclesIntercostalesexterni

肋间外肌Intercostalesinterni

肋间内肌Intercostalesintimi肋间最内肌ThemusclesofthoraxExtrinsic103MajormusclesofthetrunkTrapeziusOrigin:superiornuchalline,externaloccipitalprotuberance,ligamentumnuchaeandspinousprocessesofseventhcervicalandallthoracicvertebraeInsertion:lateralthirdofclavicle,acromion,andspineofscapularteryActon:upperfiberselevatescapula,lowerfibersdepressscapula;ifscapulaisfixed,onesideactingalong,drawsheadtowardthesameside,andturnfacetooppositeside;bothsidestogether,drawheaddirectlybackwardMajormusclesofthetrunkTrap104LatissimusdorsiOrigin:spinousprocessesoflowersixthoracicandalllumbarvertebrae,mediansacralcrest,andposteriorpartofiliaccrest.Insertion:floorofintertuberculargrooveofhumerus.Action:trunkfixed,extends,adductsandmediallyrotatesarm;armfixed,elevatestrunk.Latissimusdorsi105ErectorspinaePosition:fills