《颈部解剖》PPT课件.ppt

January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,一、概述,境界：内容：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,胸锁乳突肌区颈侧区：枕三角 锁骨上大窝,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,二、浅层结构,1.颈阔肌2.浅静脉 3.皮神经,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,1.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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,2.浅静脉,颈前静脉 注入颈外静脉 颈外静脉 注入锁骨下静脉或静脉角,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,3.皮神经,(1)为颈丛的皮支:颈横神经 耳大神经 枕小神经 锁骨上神经 颈部麻醉点：(2)面神经颈支,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,三、颈部深筋膜,分浅、中、深 三层。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,为包绕颈部大血管和迷走神经的筋膜鞘。,颈动脉鞘：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,甲状腺下静脉 奇静脉丛 头臂干甲状腺最下动脉 左头臂静脉 小儿有胸腺上部,气管前间隙内有,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,主要为下颌下腺及其周围的血管神经。,内容,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,（二）舌骨下区,颈动脉三角,肌三角,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,1.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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,颈外动脉 颈内动脉,颈总动脉及其分支：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,甲状腺上动脉 舌动脉 面动脉 枕动脉,颈外动脉的分支：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,甲状腺 甲状旁腺 气管颈段食管颈段,内容：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,甲状腺 thyroid gland,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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24气管软骨环的前面。,2.位置,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,喉 气管 咽 食管 喉返神经,甲状腺侧叶内侧邻：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,颈鞘及其内容 颈交感干,甲状腺侧叶后外侧邻：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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1 cm 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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,作甲状腺手术切口所经过的层次,皮肤浅筋膜 深筋膜浅层 舌骨下肌群 气管前筋膜,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,气管切开经过层次：,皮肤 浅筋膜 深筋膜浅层胸骨上间隙舌骨下肌群气管前筋膜,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,六、胸锁乳突肌区,位置：主要结构：颈袢,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,组成:由颈袢上、下根在第6颈椎平面汇合成袢。,颈袢,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,七、颈根部,位置：颈部和胸部之间的过渡区。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,纵行结构,横行结构,以前斜角肌为标志分为：,结构：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,颈内静脉 颈总动脉 膈神经 迷走神经 颈交感干 胸膜顶胸导管及右 淋巴导管,纵行结构有：,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,锁骨下动脉及其分支 锁骨下静脉及其属支 臂丛,横行结构有,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,锁骨下动脉：,被前斜角肌分为三段。主要分支有：椎动脉 胸廓内动脉 甲状颈干 甲状腺下动脉,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,八、颈侧区,枕三角 锁骨上三角,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,锁骨下静脉：,位于锁骨内侧段上方，锁骨下动脉前面，直径12cm。,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,左侧有胸导管的注入，右侧 有右淋巴导管的注入。,静脉角,January,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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,2007,Copyright Depart.Anatomy,School of Medicine,Lanzhou University.All right reserved by YP HOU and YF SONG,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。,