《肢前面的深层》PPT课件.ppt

四肢前面深层解剖廖 华南方医科大学解剖教研室2016.09,上肢的深部解剖,胸 肌,Extrinsic musclesPectoralis major 胸大肌 Pectoralis minor 胸小肌 Serratus anterior 前锯肌Intrinsic musclesIntercostales externi 肋间外肌Intercostales interni 肋间内肌Intercostales intimi 肋间最内肌,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 medially;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 groupBiceps brachii 肱二头肌Coracobrachialis喙肱肌Brachialis 肱肌Posterior group triceps brachii肱三头肌,前臂肌,Superficial layer（第一层）Brachioradialis 肱桡肌Pronator teres 旋前圆肌Flexor carpi radialis 桡侧腕屈肌Palmaris longus 掌长肌Flexor carpi ulnaris 尺侧腕屈肌,Second layer（第二层）flexor digitorum superficials 指浅屈肌,Third layer（第三层）Flexor digitorum profundus 指深屈肌Flexor pollicis longus 拇长屈肌Fourth layer（第四层）pronator quadratus 旋前方肌Action:flex radiocarpal joint and fingers,pronate forearm,腋窝周界及内容,周界:顶 底 四壁,Axillary fossa 腋窝,The axillary fossa is a pyramid-shaped space through which major neurovascular structures pass between the thorax and upper extremity,Boundaries 边界 The apex is a triangular space limited by the first rib,the scapula,and the middle third of clavicle.The baseskin and fascia of the axillary fossa,观察锁胸筋膜（锁骨下肌、胸小肌及喙突之间）及穿行的结构（头V，胸肩峰A和胸外侧N），并修洁之；修洁胸小肌；,The anterior wall 前壁Pectoralis major,pectoralis minor and subclavius muscles 胸大、小肌，锁骨下肌Clavipectoral fascia 锁胸筋膜The deep faxcia which extends between subclavius,coracoid process and pectoralis minor musclesThe structures pass through the clavipectoral faxcia 穿锁胸筋膜的结构Cephalic v.头静脉Thoracoacromial a.胸肩峰动脉Lateral pectoral n.胸外侧神经,Axillary sheath 腋鞘extension of deep cervical fascia of the neck,forming a tubular sheath that surrounds axillary a.and v.,and brachial plexus,腋动脉 axillary A,被胸小肌分为三段。第一段 第一肋与胸小肌上缘（发出 胸上A）第二段 胸小肌后方(发出 胸肩峰A、胸外侧A)第三段 胸小肌下缘至大圆肌下缘（发出 旋肱前、后A、肩胛下A）,上肢的动脉,Axillary artery 腋动脉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 musclegives rise to thoracoacromial a.胸肩峰动脉Second portion,behind musclegives rise to lateral thoracic a.胸外侧动脉Third portion,below musclegives rise to subscapular a.肩胛下动脉,anterior and posterior humeral circumflex a.旋肱前、后动脉;the former then divides into throcodorsal a.胸背动脉 and circumflex scapular a.旋肩胛动脉,臂丛的主要分支,外侧束分支 肌皮神经、胸外侧神经 正中神经外侧根内侧束分支胸内侧神经、臂内侧皮神经、前臂内侧皮神经、尺神经、正中神经内侧根后束的分支肩胛下神经、腋神经、桡神经、胸背神经、胸长神经,深层结构观察胸前筋膜及腋筋膜，并去除之；修洁胸大肌，在距起点2cm处弧形切断该肌，割断胸内侧神经和胸外侧神经，并向外上翻至其止点。,在胸小肌的起点处切断，并向外上翻；观察穿过胸小肌的胸内侧神经。解剖腋淋巴结，并去除之。观察腋鞘。解剖腋鞘内结构。,臂前区解剖,1、保留浅静脉和皮神经，去除浅筋膜；2、去除深筋膜，修洁臂前群肌；3、解剖肱二头肌内侧沟内结构；4、解剖肌皮神经；,Musculocutaneous n.,肘前区解剖,1、保留浅静脉和皮神经，去除浅筋膜；2、去除深筋膜，修洁肱二头肌腱膜；3、修洁构成肘窝境界的肌肉；4、剪断肱二头肌腱膜；5、解剖肱二头肌腱膜深面的肱动脉及其分支、正中神经；6、追踪前臂外侧皮神经至肱二头肌深面；7、在肱肌与肱桡肌之间寻找桡神经，向下追踪并寻找出桡神经深支和桡神经浅支。,肘前区解剖,1、剪断肱二头肌腱膜；2、解剖肱二头肌腱膜深面的肱动脉及其分支、正中神经；3、追踪前臂外侧皮神经至肱二头肌深面；4、在肱肌与肱桡肌之间寻找桡神经，向下追踪并寻找出桡神经深支和桡神经浅支。,前臂前区解剖,1、保留浅静脉和皮神经，去除浅筋膜；2、去除深筋膜，修洁前臂前群肌的浅层各肌；桡侧到尺侧依次为：肱桡肌、旋前圆肌、桡侧腕屈肌、掌长肌、指浅屈肌、尺侧腕屈肌,前臂前区解剖,1、解剖桡血管、神经束；2、切断指浅屈肌外侧头，解剖正中神经血管束；3、解剖尺血管、神经束；4、解剖骨间前血管、神经束；5、观察前臂前群肌深层各肌及其神经支配情况。6、观察腕管内容,腕横韧带,Muscolocutaneous n.,下肢前部深层解剖 关键结构,目的与要求 了解股部深筋膜的特点及其所形成的阔筋膜、髂胫束、肌间隔、隐静脉裂孔等结构;掌握股三角、收肌管和股管的位置、构成及其内容；掌握股动脉的行径及主要分支、股神经和闭孔神经的分支分布;掌握股前、股内侧肌群的名称和位置关系；掌握胫前动脉的行径及主要分支；腓总神经与胫、腓骨的关系；腓浅神经和腓深神经的行径与分布；小腿前肌群和外侧肌群的名称、位置、腱滑液鞘；,深筋膜及肌间隔股前深筋膜增厚特称阔筋膜，外侧份形成髂胫束，耻骨节结外下方3-4cm处形成卵圆形的薄弱区卵圆窝（隐静脉裂孔）。,Lacuna musculorum 肌腔隙,Boundaries:Anteriorly:lateral portion of inguinal ligamentPosterolaterally:ilium Medially:iliopectinal 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 ligamentPosteriorly:fascia of pecteineus and pectineal ligamentMedially:lacunar ligamentLaterally:iliopectinal archContents:Femoral sheathFemoral a.and v.Genital branch of genitofemoral n.Lymphatic vessels,股三角,境界：上界为腹股沟韧带，外下界缝匠肌内侧缘，内下界长收肌内侧缘；前壁为阔筋膜，后壁自外向内依次为髂腰肌、耻骨肌、长收肌及其筋膜。内容：由外向内依次：股神经、股鞘及其包含的股动静脉、股管,股鞘和股管,股鞘 腹横筋膜与髂筋膜向下延续包绕股动静脉上部形成的筋膜鞘，呈漏斗形，长3-4cm。鞘内有两个纤维隔，将鞘分隔成三部分：外侧部容纳股动脉 中间部容纳股静脉 内侧部称股管 有腹股沟深淋巴结和脂肪股管 前方为腹股沟韧带，后方为耻骨肌及其筋膜，外侧为股静脉；内侧为腔隙韧带。,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 hernia 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 又称Hunter管1 构成：前壁：股内侧肌及大收肌间的收肌腱板，浅面覆缝匠肌 外侧壁：股内侧肌 后内侧壁：长收肌与大收肌 上口：股三角尖端 下口：收肌腱裂孔通腘窝2 内容：由前向后 隐神经、股动脉、股静脉,股动脉分支、股神经皮支、闭孔神经前、后支,操 作 步 骤,(一）股前内侧区解剖1.去除浅筋膜，保留浅血管、皮神经2.去除阔筋膜，保留髂胫束。3.修洁股前群肌：股四头肌、缝匠肌4.解剖股三角及其内容（1）观察股三角的边界（2）在股鞘前壁作三个纵行切口，显露其腔内的股动脉、股静脉和股管。探察股管内容物和股环的边界。,5.解剖收肌管及其内容 纵行切开收肌腱板，修洁收肌管内的隐神经、股动脉、股静脉等。6.解剖股动脉及其分支（股深动脉、旋股内侧动脉和旋股外侧动脉、穿动脉）7.解剖股静脉及其属支8.解剖股神经及其分支9.解剖股内侧群肌：修洁耻骨肌、长收肌、大收肌、股薄肌；暴露其深面的短收肌；修洁短收肌浅面的闭孔血管、神经前支；找到其深面的闭孔血管、神经后支,Saphenous nerve,deep femeral a.,Lateral circumflex a.,Medial circumflex a.,perforating arteries,股前、股内侧肌群,Deep fascia of the thigh,Iliotibial tract 髂胫束 laterally the deep fascia forms a thick band,from the iliac tubercle to the lateral condyle of 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、外侧群肌肉,伸肌上支持带,伸肌下支持带,腓骨上支持带,腓骨下支持带,小腿前区,1.去除浅筋膜，保留浅血管、皮神经。2.去除小腿深筋膜，保留伸肌上、下支持带。3.解剖小腿前群肌：修洁胫骨前肌、拇长伸肌、趾长伸肌和第三腓骨肌。4.解剖胫前血管和腓深神经：在小腿上部，钝性分离胫骨前肌与趾长伸肌，在两肌之间、小腿骨间膜前方寻找并清理胫前血管和腓深神经；在小腿下部，钝性分离胫骨前肌与拇长伸肌，在两肌之间、小腿骨间膜前方寻找并清理胫前血管和腓深神经。,小腿外侧区,1.去除浅筋膜，保留浅血管、皮神经。2.去除小腿深筋膜，保留腓骨肌上、下支持带。3.解剖小腿外侧群肌：修洁腓骨长、短肌。4.解剖腓总神经及其分支：在腓骨颈外侧找出腓总神经；用止血钳沿腓总神经方向向前插入腓骨长肌内，沿腓总神经的走向，切断该肌，显露腓总神经及其分支；追踪腓浅神经和腓深神经达足背。,Deep peroneal n.,Superficial peroneal n.,