四肢前面的深層

1、四肢前面深層解剖廖 華南方醫(yī)科大學(xué)解剖教研室2016.09,上肢的深部解剖,胸 肌,Extrinsic musclesPectoralis major 胸大肌 Pectoralis minor 胸小肌 Serratus anterior 前鋸肌Intrinsic musclesIntercostales externi 肋間外肌Intercostales interni

2、 肋間內(nèi)肌Intercostales intimi 肋間最內(nèi)肌,,胸大肌Origin: medial half of clavicle,sternum,1th-6th costal cartilages.Insertion: crest of greater tubercle of humerus.Action: flexes, adducts and rotates arm media

3、lly; arm fixed, elevates trunk; elevates ribs 1-6,aidding in forced inspiration.,上肢肌,Muscles of shoulder 肩肌DeltoidsupraspinatusInfraspinatusTeres minorTeres majorsubscapularis,,,Muscles of arm 臂肌Antererior groupB

4、iceps brachii 肱二頭肌Coracobrachialis喙肱肌Brachialis 肱肌Posterior group – triceps brachii肱三頭肌,,,,前臂肌,Superficial layer（第一層）Brachioradialis 肱橈肌Pronator teres 旋前圓肌Flexor carpi radialis 橈側(cè)腕屈肌Palmaris longus 掌長(zhǎng)肌

5、Flexor carpi ulnaris 尺側(cè)腕屈肌,Second layer （第二層） － flexor digitorum superficials 指淺屈肌,,Third layer （第三層）Flexor digitorum profundus 指深屈肌Flexor pollicis longus 拇長(zhǎng)屈肌Fourth layer （第四層） － pronator quadratus

6、 旋前方肌Action: flex radiocarpal joint and fingers, pronate forearm,,,腋窩周界及內(nèi)容,周界: 頂 底 四壁,Axillary fossa 腋窩,The axillary fossa is a pyramid-shaped space through which major neurovascular structures p

7、ass between the thorax and upper extremity,Boundaries 邊界 The apex is a triangular space limited by the first rib, the scapula, and the middle third of clavicle. The base－skin and fascia of the axillary fossa,觀察鎖胸筋膜（鎖骨下

8、肌、胸小肌及喙突之間）及穿行的結(jié)構(gòu)（頭V，胸肩峰A和胸外側(cè)N），并修潔之；修潔胸小?。?The anterior wall 前壁Pectoralis major, pectoralis minor and subclavius muscles 胸大、小肌，鎖骨下肌Clavipectoral fascia 鎖胸筋膜The deep faxcia which extends between subclavius, coracoid

9、 process and pectoralis minor musclesThe structures pass through the clavipectoral faxcia 穿鎖胸筋膜的結(jié)構(gòu)Cephalic v. 頭靜脈Thoracoacromial a.胸肩峰動(dòng)脈Lateral pectoral n. 胸外側(cè)神經(jīng),Axillary sheath 腋鞘－extension of deep cervical fascia o

10、f the neck, forming a tubular sheath that surrounds axillary a. and v., and brachial plexus,腋動(dòng)脈 axillary A,被胸小肌分為三段。 第一段 第一肋與胸小肌上緣 （發(fā)出 胸上A）第二段 胸小肌后方(發(fā)出 胸肩峰A、胸外側(cè)A)第三段 胸小肌下緣至大圓肌下緣（發(fā)出 旋肱前、后A、肩胛下A）,上肢的動(dòng)脈,Axillary ar

11、tery 腋動(dòng)脈Continuation of subclavian artery at lateral border of first ribBecomes brachial artery at lower border of teres majorDivided into three parts by overlying pectoralis minorFirst portion, above muscle－gives ri

12、se to thoracoacromial a. 胸肩峰動(dòng)脈Second portion, behind muscle－gives rise to lateral thoracic a. 胸外側(cè)動(dòng)脈Third portion, below muscle－gives rise to subscapular a. 肩胛下動(dòng)脈, anterior and posterior humeral circumflex a. 旋肱前、后動(dòng)脈; t

13、he former then divides into throcodorsal a. 胸背動(dòng)脈 and circumflex scapular a. 旋肩胛動(dòng)脈,臂叢的主要分支,外側(cè)束分支 肌皮神經(jīng)、胸外側(cè)神經(jīng) 正中神經(jīng)外側(cè)根內(nèi)側(cè)束分支胸內(nèi)側(cè)神經(jīng)、臂內(nèi)側(cè)皮神經(jīng)、前臂內(nèi)側(cè)皮神經(jīng)、尺神經(jīng)、正中神經(jīng)內(nèi)側(cè)根后束的分支肩胛下神經(jīng)、腋神經(jīng)、橈神經(jīng)、胸背神經(jīng)、胸長(zhǎng)神經(jīng),,深層結(jié)構(gòu)觀察胸前筋膜及腋筋膜，并去除之；修潔胸大肌，

14、在距起點(diǎn)2cm處弧形切斷該肌，割斷胸內(nèi)側(cè)神經(jīng)和胸外側(cè)神經(jīng)，并向外上翻至其止點(diǎn)。,在胸小肌的起點(diǎn)處切斷，并向外上翻；觀察穿過(guò)胸小肌的胸內(nèi)側(cè)神經(jīng)。解剖腋淋巴結(jié)，并去除之。觀察腋鞘。解剖腋鞘內(nèi)結(jié)構(gòu)。,臂前區(qū)解剖,1、保留淺靜脈和皮神經(jīng)，去除淺筋膜；2、去除深筋膜，修潔臂前群?。?、解剖肱二頭肌內(nèi)側(cè)溝內(nèi)結(jié)構(gòu)；4、解剖肌皮神經(jīng)；,,Musculocutaneous n.,,肘前區(qū)解剖,1、保留淺靜脈和皮神經(jīng)，去除淺筋膜；2、去

15、除深筋膜，修潔肱二頭肌腱膜；3、修潔構(gòu)成肘窩境界的肌肉；4、剪斷肱二頭肌腱膜；5、解剖肱二頭肌腱膜深面的肱動(dòng)脈及其分支、正中神經(jīng)；6、追蹤前臂外側(cè)皮神經(jīng)至肱二頭肌深面；7、在肱肌與肱橈肌之間尋找橈神經(jīng)，向下追蹤并尋找出橈神經(jīng)深支和橈神經(jīng)淺支。,肘前區(qū)解剖,1、剪斷肱二頭肌腱膜；2、解剖肱二頭肌腱膜深面的肱動(dòng)脈及其分支、正中神經(jīng)；3、追蹤前臂外側(cè)皮神經(jīng)至肱二頭肌深面；4、在肱肌與肱橈肌之間尋找橈神經(jīng)，向下追蹤并尋找出橈神經(jīng)

16、深支和橈神經(jīng)淺支。,前臂前區(qū)解剖,1、保留淺靜脈和皮神經(jīng)，去除淺筋膜；2、去除深筋膜，修潔前臂前群肌的淺層各?。粯飩?cè)到尺側(cè)依次為： 肱橈肌、旋前圓肌、 橈側(cè)腕屈肌、掌長(zhǎng)肌、指淺屈肌、尺側(cè)腕屈肌,前臂前區(qū)解剖,1、解剖橈血管、神經(jīng)束；2、切斷指淺屈肌外側(cè)頭，解剖正中神經(jīng)血管束；3、解剖尺血管、神經(jīng)束；4、解剖骨間前血管、神經(jīng)束；5、觀察前臂前群肌深層各肌及其神經(jīng)支配情況。6、觀察腕管內(nèi)容,腕橫韌帶,,Mus

17、colocutaneous n.,下肢前部深層解剖－ 關(guān)鍵結(jié)構(gòu),目的與要求 了解股部深筋膜的特點(diǎn)及其所形成的闊筋膜、髂脛束、肌間隔、隱靜脈裂孔等結(jié)構(gòu);掌握股三角、收肌管和股管的位置、構(gòu)成及其內(nèi)容；掌握股動(dòng)脈的行徑及主要分支、股神經(jīng)和閉孔神經(jīng)的分支分布;掌握股前、股內(nèi)側(cè)肌群的名稱(chēng)和位置關(guān)系；掌握脛前動(dòng)脈的行徑及主要分支；腓總神經(jīng)與脛、腓骨的關(guān)系；腓淺神經(jīng)和腓深神經(jīng)的行徑與

18、分布；小腿前肌群和外側(cè)肌群的名稱(chēng)、位置、腱滑液鞘；,深筋膜及肌間隔股前深筋膜增厚特稱(chēng)闊筋膜，外側(cè)份形成髂脛束，恥骨節(jié)結(jié)外下方3-4cm處形成卵圓形的薄弱區(qū)——卵圓窩（隱靜脈裂孔）。,,Lacuna musculorum 肌腔隙,Boundaries:Anteriorly: lateral portion of inguinal ligamentPosterolaterally: ilium Medially: iliopec

19、tinal arch Contents: Iliopsoasfemoral n. lateral femoral cutaneous n.,,Iliopectinal arch,Femoral n.,,Iliopsoas,,Lateral femoral cutaneous n.,,,Lacuna vasorum 血管腔隙,Boundaries:Anteriorly: medial portion of inguinal li

20、gamentPosteriorly: fascia of pecteineus and pectineal ligamentMedially: lacunar ligamentLaterally: iliopectinal archContents: Femoral sheathFemoral a. and v.Genital branch of genitofemoral n. Lymphatic vessels,,股

21、三角,境界：上界為腹股溝韌帶，外下界縫匠肌內(nèi)側(cè)緣，內(nèi)下界長(zhǎng)收肌內(nèi)側(cè)緣；前壁為闊筋膜，后壁自外向內(nèi)依次為髂腰肌、恥骨肌、長(zhǎng)收肌及其筋膜。內(nèi)容：由外向內(nèi)依次：股神經(jīng)、股鞘及其包含的股動(dòng)靜脈、股管,股鞘和股管,股鞘 腹橫筋膜與髂筋膜向下延續(xù)包繞股動(dòng)靜脈上部形成的筋膜鞘，呈漏斗形，長(zhǎng)3-4cm。鞘內(nèi)有兩個(gè)纖維隔，將鞘分隔成三部分： 外側(cè)部容納股動(dòng)脈 中間部容納股靜脈 內(nèi)側(cè)部稱(chēng)股管 有腹股溝深淋巴結(jié)和脂肪

22、股管 前方為腹股溝韌帶，后方為恥骨肌及其筋膜，外側(cè)為股靜脈；內(nèi)側(cè)為腔隙韌帶。,Femoral hernia股疝,If a loop of intestine is forced into the femoral ring, it expands to form a swelling in the upper part of the thigh. Such a condition is known as a femoral herni

23、a 股疝.A femoral hernia is more common in women than in men (possibly because their wider pelvis and femoral canal ).,收肌管,收肌管 又稱(chēng)Hunter管1 構(gòu)成： 前壁：股內(nèi)側(cè)肌及大收肌間的收肌腱板，淺面覆縫匠肌 外側(cè)壁：股內(nèi)側(cè)肌 后內(nèi)側(cè)壁：長(zhǎng)收肌與大收肌 上口：股三角尖端 下口：收肌腱裂孔通腘窩

24、2 內(nèi)容：由前向后 隱神經(jīng)、股動(dòng)脈、股靜脈,股動(dòng)脈分支、股神經(jīng)皮支、閉孔神經(jīng)前、后支,操 作 步 驟,(一）股前內(nèi)側(cè)區(qū)解剖1.去除淺筋膜，保留淺血管、皮神經(jīng)2.去除闊筋膜，保留髂脛束。3.修潔股前群?。汗伤念^肌、縫匠肌4.解剖股三角及其內(nèi)容（1）觀察股三角的邊界（2）在股鞘前壁作三個(gè)縱行切口，顯露其腔內(nèi)的股動(dòng)脈、股靜脈和股管。探察股管內(nèi)容物和股環(huán)的邊界。,,5.解剖收肌管及其內(nèi)容 縱行切開(kāi)收肌腱板，修潔收肌管內(nèi)的隱

25、神經(jīng)、股動(dòng)脈、股靜脈等。6.解剖股動(dòng)脈及其分支（股深動(dòng)脈、旋股內(nèi)側(cè)動(dòng)脈和旋股外側(cè)動(dòng)脈、穿動(dòng)脈）7.解剖股靜脈及其屬支8.解剖股神經(jīng)及其分支9.解剖股內(nèi)側(cè)群?。盒逎崘u骨肌、長(zhǎng)收肌、大收肌、股薄??；暴露其深面的短收?。恍逎嵍淌占\面的閉孔血管、神經(jīng)前支；找到其深面的閉孔血管、神經(jīng)后支,,Saphenous nerve,,deep femeral a.,,Lateral circumflex a.,,,Medial circumfl

26、ex a.,,,,,perforating arteries,股前、股內(nèi)側(cè)肌群,Deep fascia of the thigh,Iliotibial tract 髂脛束 laterally the deep fascia forms a thick band, from the iliac tubercle to the lateral condyle o

27、f tibial. The fascia lata sends intermuscular septa to the linea aspera of the femur. These separate the thigh into three compartments each of which contains a group of muscles, the vessels and the nerves.,,小腿前群、外側(cè)群肌肉,

28、,,,伸肌上支持帶,伸肌下支持帶,腓骨上支持帶,腓骨下支持帶,小腿前區(qū),1.去除淺筋膜，保留淺血管、皮神經(jīng)。2.去除小腿深筋膜，保留伸肌上、下支持帶。3.解剖小腿前群?。盒逎嵜劰乔凹?、拇長(zhǎng)伸肌、趾長(zhǎng)伸肌和第三腓骨肌。4.解剖脛前血管和腓深神經(jīng)：在小腿上部，鈍性分離脛骨前肌與趾長(zhǎng)伸肌，在兩肌之間、小腿骨間膜前方尋找并清理脛前血管和腓深神經(jīng)；在小腿下部，鈍性分離脛骨前肌與拇長(zhǎng)伸肌，在兩肌之間、小腿骨間膜前方尋找并清理脛前血管和腓深神經(jīng)