躯干骨、关节、肌及胸腹壁层次结构.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,运动系统：躯干,躯干骨,躯干骨的连接：脊柱、胸廓,躯干肌：背肌、胸肌、膈、腹肌,胸腹部标志线和分区,胸腹部标志线和分区,腹部的境界和腹前外侧壁层次,胸部的境界和胸壁层次,胸腹部标志线和分区,一、躯干骨,Bones of Trunk,1.,一般特征,Vertebral body,Pedicle of vertebral arch,Lamina of vertebral arch,Vertebral foramen,Spinous,process,Transverseprocess,（,一）椎骨,Vertebrae,2.,各部椎骨的特征,（,1,）颈椎,Cervical Vertebrae,：,transverse foramen,1,）有横突孔,2,）棘突末端分叉,齿突,Dens,寰椎,Atlas,枢椎,Axis,（,2,）胸椎,Thoracic Vertebrae,：,1,）有肋凹,Costal facets,2,）棘突长，斜向后下方,（,3,）腰椎,Lumbar Vertebrae,1,）椎体粗壮,2,）棘突短宽，水平伸向后方,（,4,）骶骨,Sacrum,、,尾骨,Coccyx,：,骶管裂孔,Sacral hiatus,骶角,Sacral,cornu,岬,Promontory,（,二）胸骨,Sternum,1.,区分,颈静脉切迹,Jugular notch,胸骨角,2.,胸骨角,Sternal,Angle,Manubrium,sterni,Body of sternum,Xiphoid,process,（,三）肋,Ribs,由肋骨与肋软骨,Corstal,cartilage,构成，共,12,对。,2.,肋弓,Costal arch,：,第,810,肋软骨依次与上位肋软骨连接成,1.,区分,二、躯干骨的连结,（,一）脊柱,Vertebral Column,1.,椎骨间的连结,（,1,）椎体间的连结,1,）椎间盘,Intervertebral,Disc,髓核,Nucleus,pulposus,纤维环,Annulus,fibrosus,3,）后纵韧带,Posterior longitudinal ligament,2,）前纵韧带,Anterior longitudinal ligament,（,2,）椎弓间的连结,1,）黄韧带,Ligamenta,flava,2,）棘间韧带,3,）棘上韧带和项韧带,4,）横突间韧带,5,）关节突关节,项韧带,关节突关节,（,3,）寰椎与枕骨及枢椎的关节,1,）寰枕关节,2,）寰椎关节,2.,脊柱的整体观和运动,（,1,）整体观,（,2,）脊柱的运动,（二）胸廓,Thorax,肋头关节,肋横突关节,1.,肋椎关节,Costovertebraljoint,2.,胸肋关节,Sternocostal,joint,3.,胸廓的整体观及其运动,胸廓上口,胸廓下口,前壁,后壁,外侧壁,胸骨下角,Infrasternal,angle,肋间隙,Intercostal,space,（一）背肌,Muscle of back,1.,斜方肌,Trapezius,2.,背阔肌,Latissimus,dorsi,3.,竖脊肌,Erector,spinea,三、躯干肌,（二）胸肌,Muscles of thorax,1,、胸上肢肌,胸大肌,Pectoralis,major,胸小肌,Pectoralis,minor,前锯肌,Serratus,anterior,2,、胸固有肌,肋间外肌,Intercostales,Externi,肋间内肌,Intercostales,Interni,（三）膈,Diaphragm,主动脉裂孔,Aortic hiatus,食管裂孔,Esophageal hiatus,腔静脉孔,Vena,caval,foramen,T8,T10,T12,位置及通过的结构：,Action,Contraction,:the dome moving downward,increases the volume of thoracic cavity which results in inspiration,at the same time the intra-abdominal pressure is increased assists in defecation,vomiting or child birth.,Relaxation,:the dome returns to the former position,reduces the volume to the thoracic cavity,resulting in expiration.,（四）腹肌,The Muscles of abdomen,1,、前外侧群,（,1,）,腹外斜肌,Obliquus,Externus,Abdominis,及形成的结构,腹股沟韧带,Inguinal ligament,腹股沟管浅（皮下）环,Superficial inguinal ring,腹股沟管,Inguinal canal,Reflected ligament,：,外侧脚的纤维经精索后方向内上行至白线。,Lacunar,ligament,：,腹股沟韧带内侧端的部分纤维向后下方反,转，附着于耻骨梳内侧端。,Pectineal,ligament,：,腔隙韧带沿耻骨梳向外延续。,（,3,）,腹横肌,Transversus,abdominis,（,2,）,腹内斜肌,Obliquus,internus,abdominis,腹内斜肌与腹横肌形成的结构：,Inguinal,falx,：,腹内斜肌和腹横肌下缘在腹直肌外缘处形成的腱性结合,Cremaster,muscle,（,4,）,腹直肌,Rectus,abdominis,腹直肌鞘,Rectus sheath,：弓状线,Arcuate,line,（,半环线）,白线,Linea alba,Linea alba,tendinous,fibers of sheath blending between right and left side from,xiphoid,to pubic,symphysis,.,Rectus sheath,Ant layer,formed by fusion of,aponeurosis,of external oblique and anterior leaf of,aponeurosis,of internal oblique,Post layer,Formed by fusion of,posterion,leaf of,aponeurosis,of internal oblique and,aponeurosis,of,transversus,abdominis,Absent in about 4-5cm below the umbilicus,where,aponeuroses,of all three muscles form anterior layer the lower free border named,arcuate,line,Below this line rectus,abdominis,in contact with,transversalis,fascia,腹股沟三角,Inguinal triangle,：,腹壁下动脉、腹直肌外缘、腹股沟韧带内侧半围城。腹壁下动脉是腹股沟深环与此三角的分界标志。,腹股沟区,Inguinal region,腹股沟区指下腹部两侧的三角区，内侧界为腹直肌外侧缘，上界为髂前上棘至腹直肌外侧缘的水平线，下界为腹股沟韧带。,Descent of testes,Seven-week embryo showing the,testis before its descent from the,dorsal abdominal wall,腹股沟管,Inguinal canal,Fetus at 28 week the testis passing,through the inguinal canal,Newborn,Posterior wall,：腹横筋膜、腹股沟镰,Superior wall,：腹内斜肌与腹横肌的弓状缘,Inferior wall,：腹股沟韧带,Anterior wall,：腹外斜肌腱膜和腹内斜肌起始部的部分纤维,开口：,Deep inguinal ring,：,腹壁下动脉的外侧,Superficial inguinal ring,：,位于耻骨结节外上方,内容,：,精索,Spermatic cord,：,由输精管、输精管动脉,.,、睾丸动脉、蔓状静脉丛、生殖股神经生殖支、淋巴管和腹膜鞘突构成。,子宫圆韧带,腹股沟疝,Inguinal hernias,1,）,腹股沟斜疝,肠管由腹股沟管深环进入腹股沟管，再经浅环出管入阴囊，称为腹股沟斜疝。疝囊在精索的三层被膜内。,2,）腹股沟直疝,肠管从腹壁下动脉内侧，经腹股沟三角，将腹股沟管的后壁顶出，为直疝。疝囊在精索被膜之外。,2,、后群：腰大肌、腰方肌,四、胸部的标志线和腹部分区,4,区或,9,区,左右侧髂结节连线,第,10,肋最低点连线,腹股沟韧带中点,anterior,axillary,line,scapular line,paravertebral,line,posterior median line,(,midvertebral,line),五、胸部的境界和胸壁层次,胸部介于颈、腹部之间。,Superior boundary,Inferior boundary,胸壁和膈围城胸腔。,境界,胸壁,Thoracic wall,胸廓与附着或覆盖在其皮肤、肌肉、筋膜、血管等软组织一起构成胸壁。,胸壁可分为浅、深两层。浅层结构包括皮肤、浅筋膜。深层结构包括深筋膜、胸上肢肌、背肌、腹肌、肋间肌、胸内筋膜和胸廓内血管。,1.Superficial Structure,（,1,）,Skin,（,2,）,Superficial fascia,：,3)The Breast,（,mammary gland,）,Position,：,位于第,2,第,6,肋高度的浅、深筋膜之间。,乳房由乳腺、脂肪和皮肤等构成。乳腺位于浅筋膜的浅、深两层之间，被结缔组织隔分成,1520,个小叶，每叶有,1,条输乳管，呈放射状排列。,乳房悬韧带,Suspensory,ligaments of breast,(,Coopers ligaments,),strands of connective tissue runs between skin and deep fascia and serve to support the mammary glands.,乳房结构,乳腺脓肿切开引流时，应做放射状切口。乳房基底部与胸肌筋膜间有乳房后间隙。脓肿时，脓汁可向下扩散，宜做低位弧形切口引流。,乳腺癌时乳房悬韧带缩短，牵引皮肤内陷，形成桔皮样变。,乳房临床,乳房淋巴回流,Lymph drainage,乳房的淋巴主要注入腋淋巴结，部分至胸骨旁淋巴结、胸肌间淋巴结和膈淋巴结等。,2.Deep Structures,(1)Deep Fascia,：,分浅、深层,1,）,Superficial layer,：,覆盖胸大肌,与腹部和,背部深筋膜相延续。,2）Deep layer：,包绕锁骨下肌和胸小肌，并形成锁胸筋膜。,(2)Muscles,(3),肋间隙,Intercostal,Space:,为肋与肋之间的间隙，内有筋膜、肋间肌、血管和神经等,胸内筋膜：衬于肋和肋间隙内面的致密结缔组织膜。,胸膜腔穿刺和进入的层次,：皮肤、浅筋膜、深筋膜及胸壁浅层肌、切断肋骨经肋骨床（或切开肋间肌经肋 间隙）、胸内筋膜、壁胸膜。,六、腹部的境界和腹前外侧壁层次,Boundaries of abdominal part,superior,：剑突、肋弓、第,11,肋前端、第,12,肋下缘和第,12,胸椎围成，即胸廓下口。,inferior,：耻骨联合上缘、耻骨嵴、耻骨结节、腹股沟韧带、髂嵴至第,5,腰椎下缘的连线。,（,2,）,Superficial Fascia,：,1,）,下腹部（脐平面以下）的层次：,浅层称,Camper,筋膜，富合脂肪，与股部的浅筋膜延续；深层为膜样层，称,Scarpa,筋膜，向下在腹股沟韧带下方附着于阔筋膜，在中线附着于白线、也可以与会阴浅筋膜（,Colles,筋膜）相连。,腹前外侧壁层次,1.Superficial Structures,（,1,）,Skin,：,除腹股沟附近的皮肤外，其它部位的皮肤移动性较大。,2.Deep Structures,Subcostal,incision,McBurneys,incision,Transverse incisionMedian or midline incision,Left,paramedian,incision,Layers,?,Suprapubic,incision,掌握内容：,躯干骨的组成，椎骨的一般特征和各部椎骨的主要特征，胸骨角、肋弓的概念，椎骨的连结，脊柱的组成及整体观的特点，胸廓上、下口的组成，斜方肌、背阔肌、竖脊肌的位置和作用，胸肌和腹肌前外侧群肌的名称、位置和作用，膈的位置、作用和裂孔，胸壁的层次，乳腺的淋巴回流，腹壁的层次，腹直肌鞘形成，腹股沟区和三角的境界，腹股沟管形成和内容。,运动系统：躯干,了解内容：,胸腹部的主要体表标志，胸骨的分部，肋的区分和组成，肋骨的形态特点，胸肋关节和肋椎关节的组成，脊柱的运动，胸廓的组成、形态及运动，腹后群肌，腹白线的形成及特点。,