肌学总论头颈肌躯干肌

全身肌由于构造不同可分为平滑肌、心肌和骨骼肌。骨骼肌skeletalmuscle具有收缩的特性，是运动系统的动力部分，其收缩受神经支配，接受人的意志控制，故称随意肌。全身有600余块肌，占体重40%。每块肌都是一个器官：有一定形态、构造，有血管、淋巴管，受神经支配，执行一定功能。肌学总论总论

一、骨骼肌的形态和构造2.

classificationofskeletalmuscle：longmuscleshortmuscleflatmuscleorbicularmuscle1..constructionofskeletalmuscle：bellytendonaponeurosis二肌的起止、配布、作用1、起于一块骨，止于另一块骨跨过一个或多个关节。

2、起点（定点）、止点（动点），动定可互换。

3、肌在关节周围配布的方式和多少与关节的运动类型密切相关。

4、沿一个运动轴周围应配布相对应的两组肌。

三、肌的分部和命名分部：

头颈肌：头肌、颈肌

躯干肌：背肌、胸肌、腹肌、膈、会阴肌

四肢肌：上肢肌、下肢肌命名：

按肌的形态、大小、位置、起止或作用进行命名。肌的辅助结构1、浅筋膜superficialfascia---于真皮之下，又称皮下筋膜，包被全身，由疏松结缔组织构成，富含脂肪。内有浅动脉、浅静脉、皮神经和浅淋巴管穿行。2、深筋膜deepfascia：又称固有筋膜，致密结缔组织构成，位于浅筋膜深面，包被体壁、四肢的肌和血管神经等。形成肌间隔、血管神经鞘

滑膜囊synovial

bursa：为封闭的结缔组织囊。腱鞘tendinoussheath:包围在肌腱外的鞘管，存在于腕、踝、手指和足指处。腱纤维鞘、腱滑膜鞘脏层壁层腱系膜腱纤维鞘腱滑膜鞘脏层腱滑膜鞘壁层腱系膜腱指骨头肌可分为面肌和咀嚼肌（一）面肌facialmuscles又称表情肌：主要分布于面部裂孔周围，呈环状和放射状分布。大体可分为四群：

颅顶肌epicranius：枕额肌：枕腹、额腹、帽状腱膜

眼轮匝肌orbicularisoculi：使睑裂闭合

口周围肌orbicularisoris：口轮匝肌、提上唇肌提口角肌、降下唇肌、降口角肌、

颊肌

鼻肌nasalis

颊肌Facialmuscles面肌咀嚼肌

masticatorymuscles

Masseter咬肌Origin－inferiorborderandmedialsurfaceofzygomaticarchInsertion－lateralsurfaceoframusofmandibleandangleofmandibleAction－elevatesmandibleTemporalis颞肌Origin－temporalfossaInsertion－coronoidprocessofmandibleAction－elevatesandretractsmandible翼外肌Lateralpterygoid收缩时拉下颌关节的关节盘连同下颌头向前至关节结节的下方，作张口运动。一侧作用时使下颌移向对侧翼内肌Medialpterygoid收缩时上提下颌骨，并使其向前运动。一侧作用时使下颌移向对侧Themusclesofneck颈肌一、颈浅层肌和颈外侧肌1.Platysma颈阔肌，菲薄的皮肌，起自胸大肌和三角肌的筋膜，向内上止于口角。可拉口角向下。

2.Sternocleidomastoid胸锁乳突肌origin:Anteriorsurfaceofmanubriumandsternalendofclavicalinsertion:

MastoidprocessoftemporalboneActon:onesideactingalone,drawsheadtowardthesameside,andturnfacetooppositeside;bothsidestogether,drawheaddirectlybackward颈前肌1.舌骨上肌群SuprahyoidmusclesDigastric二腹肌Mylohyoid下颌舌骨肌Stylohyoid茎突舌骨肌Geniohyoid颏舌骨肌

作用：当舌骨固定时，拉下颌骨向下而张口吞咽时，下颌骨固定，上提舌骨。

2.舌骨下肌群InfrahyoidmuscleSternohyoid胸骨舌骨肌Thyrohyoid甲状舌骨肌Sternothyroid胸骨甲状肌Omohyoid肩胛舌骨肌--下降舌骨和喉.颈前肌Musclesoftheneck颈深肌群Deepgroup位于脊柱颈部两侧和前方。LateralScalenusanterior前斜角肌Scalenusmedius中斜角肌Scalenusposterior后斜角肌Mediallonguscapitis头长肌

longuscolli颈长肌一侧肌收缩,使颈侧屈;两侧肌同时收缩可上提第1、2肋助吸气.Scalenefissure

斜角肌间隙Boundaries

firstribscalenusanteriorandmediusStructurespassingthroughscalenefissurebrachialplexus臂丛subclaviana.锁骨下动脉Musclesoftrunk躯干肌Musclesofback背肌Musclesofthorax胸肌Diaphragm膈Musclesofabdomen腹肌musclesofperineum会阴肌TheMusclesofBack浅层Superficialgroup斜方肌Trapezius肩胛提肌Levatorscapulae菱形肌Rhomboideus背阔肌Latissimusdorsi深层deepgroupErectorspinae竖脊肌Splenius夹肌TheMusclesofBackDeepgroup

Splenius

夹肌Erectorspinae

竖脊肌Position:fillsthevertebralgrooveoneachsideofthespineAction:bothsidestogetherextendsvertebralcolumnandhead.actingalong,flexthevertebralcolumnlaterally.MajorMusclesofBackTrapezius

斜方肌Origin:superiornuchalline,externaloccipitalprotuberance,ligamentumnuchaeandspinousprocessesofseventhcervicalandallthoracicvertebraeInsertion:lateralthirdofclavicle,acromion,andspineofscapularActon:drawthescapulatowardvertebralcolumn.supperfiberselevatescapula,lowerfibersdepressscapula;ifscapulaisfixed,onesideactingalong,drawsheadtowardthesameside,andturnfacetooppositeside;bothsidestogether,drawheaddirectlybackwardMajorMusclesofBackLatissimusdorsi

背阔肌Origin:SpinousprocessesoflowersixthoracicandalllumbarvertebraeMediansacralcrestPosteriorpartofiliaccrestInsertion:crestoflessertubercleAction:trunkfixed,extends,adductsandmediallyrotatesarm;armfixed,elevatestrunkThoracolumbarFascia胸腰筋膜

PosteriorlayerMiddlelayerAnteriorlayer指在竖脊肌周围的筋膜，在腰部可分为三层：后层：竖脊肌后面；中层：分隔竖脊肌和腰方肌；深层：覆盖在腰方肌前面MusclesofthoraxMusclesconnectingtheupperlimbtothethoracicwallPectoralismajor

胸大肌

Pectoralisminor

胸小肌

Serratusanterior

前锯肌★Major

musclesofthorax

PectoralisMajor

胸大肌★Origin:medialhalfofclavicle,sternum,uppersixcostalcartilages.Insertion:crestofgreatertubercleAction:adductsthearmandrotatesitmedially;theclavicularfibersalsoflexthearm;withthearmabovethehead,raisethebodyasinclimbingThemusclesofthorax

ExtrinsicmusclesPectoralismajorPectoralisminorSerratusanteriorIntrinsicmusclesIntercostalesexterni肋间外肌Intercostalesinterni肋间内肌Intercostalesintimi肋间最内肌Transversusthoracis胸横肌Major

musclesofthorax

Intercostalesexterni

肋间外肌Origin:inferiorborderofribaboveInsertion:superiorborderofribbelowReplacedanteriorlybyexternalintercostalsmembrane

Action:raiseribsaddinginforcedinspiration★Majormusclesofthorax

Intercostalesinterni

肋间内肌★Origin:superiorborderofribbelowInsertion:inferiorborderofribaboveReplacedposteriorlybyinternalintercostalsmembrane.Action:depressribsforforcedexpirationIntercostalesintimi肋间最内肌★Diaphragm膈Shapeandpositiondome-shapedbetweenthoraxandabdomenconsistsofaperipheralmuscularpartandacentraltendonOriginSternalpart:arisingfromxiphoidprocessCostalpart:arisingfromlowersixandcostalcartilagesLumbarpart:arisingbytwocrurafromupper2-3lumbarvertebrae,medialandlateralarcuateligamentsInsertion:centraltendon★Diaphragm膈Weakareas:

LumbocostaltriangleSternocostaltriangleOpeningsinthediaphragmAortichiatus主动脉裂孔－liesanteriortothebodyofthe12ththoracicvertebrabetweenthecrura.Ittransmitstheaorta,thoracicductEsophagealhiatus食管裂孔－foresophagusandvagusnervesatlevelofT10.Venacavaforamen腔静脉孔－forinferiorvenacava,throughcentraltendonatT8levelT8T10T12Action:Contraction:thedomemovingdownward,increasesthevolumeofthoraciccavitywhichresultsininspiration,atthesametimetheintra-abdominalpressureisincreasedassistsindefecation排便,vomiting呕吐orchildbirth.Relaxation:thedomereturnstotheformerposition,reducesthevolumetothethoraciccavity,resultinginexpiration.

四、腹肌MusclesofabdomenAnterolateralgroupObliquusexternusabdominis腹外斜肌Oblequusenternusabdominis腹内斜肌Transversusabdominis腹横肌Rectusabdominis腹直肌腹外斜肌腹内斜肌Posteriorgroup

Quadratuslumborum腰方肌Psoasmajor腰大肌髂肌iliacusObliquusexternusabdominis腹外斜肌Generaldirectionoffibers:downward,forwardStructuresInguinalligament

腹股沟韧带Lacunarligament

腔隙韧带pectinealligament耻骨梳韧带Superficialinguinalring

腹股沟管浅环－triangular-shapeddefect缺损inaponeurosisofobliquusexternusabdominisabovepubictubercleObliquusinternusabdominis腹内斜肌Position:deeptoobliquusexternusabdominisGeneraldirectionoffibres:upwards,forwardsTransversusabdominis

腹横肌Position:deeptoobliquusinternusGeneraldirectionoffibres:runmoreorlesshorizontally.腹外斜肌腹内斜肌腹横肌腹横肌腹内斜肌腹直肌Inguinalfalx腹股沟镰:archoverspermaticcord,insertedwithtransversesabdominisfiberintomedialpartofpectenofpubisCremaster提睾肌:aroundthespermaticcord精索andtestis睾丸腹股沟镰Rectusabdominis腹直肌

Position:lieontoeitherofmidlineOrigin:pubiccrestandsymphysisInsertion:xiphoidand5th-7thcostalcartilagesHas3-4tendinousintersections

腱划

Similarfunctionsforabovefourpairsofmuscles1.Supportandcompresstheabdominalviscera2.Increaseintra-abdominalpressure,aidinvomiting呕吐,coughing,sneezing,defecation排便,urination排尿andchildbirth.3.Depressribs,assistin(theactofforce(4)expiration.4.Flex,lateralflex,androtatevertebralcolumn.Sheathofrectusabdominis

腹直肌鞘Antlayer－formedbyfusionofaponeurosisofobliquusexternusabdominisandanteriorleafofaponeurosisofobliquusinternusabdominisPostlayerFormedbyfusionofposterionleafofaponeurosisofobliquusinternusabdominisandaponeurosisoftransversesabdominisAbsentinabout4-5cmbelowtheumbilicus,whereaponeurosesofallthreemusclesformanteriorlayerthelowerfreebordernamedarcuatelineBelowthislinerectusabdominisincontactwithtransversefasciaLineaalba白线－tendinousraphe缝betweenrightandleftrectifromxiphoidtopubicsymphysis.Inguinalcanal

腹股沟管Position:obliquepassage,4cmlong,located1.5cmabovemedialhalfofinguinallig.BoundariesAnteriorwallAponeurosisofobliquusexternusabdominisObliquusinternusabdominis(lateralthirdofwall)PosteriorwallTransversefasciaInguinalfalxmediallySuperiorwall－archedlowerfibersofobliquusinternusandtransversuaabdominisinferiorwall－inguinallig．TwoopeningsSuperficialinguinalring腹股沟管浅环Deepinguinalring腹股沟管深环－defectintransversefascia1.5cmabovemidpointofinguinalligamentStructurespassingthroughtheinguinalcanalSpermaticcord

精索

andilioinguinalnerve髂腹股沟神经

inmalesRoundligamentofuterus

子宫圆韧带andilioinguinalnerve髂腹股沟神经

infemales

InguinalTriangle(ofHesselbach)腹股沟三角

Boundaries

InguinalligamentinferiorlyLateralborderofrectusabdominismediallyInferiorepigastricarterylaterally内面观Teachingoutline1