课件：颈部解剖.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、颈侧区 七、颈根部,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,上界：为下颌骨下缘、下颌角、乳突、上项线与枕外隆突的连线。,下界：由胸骨上缘、锁骨和肩峰至第7颈椎棘突的连线。,颈部的境界与分区,一、概述,颈部:分为固有颈部和项部。 固有颈部:又可分为颈前区、胸锁乳突肌区和颈外侧区。,颈前区：被舌骨分为舌骨上区（包括2个下颌下三角和1个颏下三角）和舌骨下区（包括成对的颈动脉三角和肌三角）。 颈外侧区：被肩胛舌骨肌下腹分为枕三角和锁骨上三角。,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. 皮肤 2. 浅筋膜及其内容颈阔肌 浅静脉 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,颈深筋膜分为三层 浅层：封套筋膜 中层：气管前筋膜或内脏筋膜 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,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）,圆桶形环绕颈部 前 左右延续 后 附于项韧带和C7棘突 上 附于下颌体下缘、颧 弓、乳突基底、上项线 及枕外隆凸 下 附于胸骨柄上缘、锁 骨、肩峰,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,在胸骨颈静脉切迹上方35cm处分两层附于颈静脉切迹前、后缘，成胸骨上间隙，内含颈静脉弓。 向上分两层包绕下颌下腺，形成下颌下间隙的顶，内含下颌下淋巴结、面动脉、面静脉，延续为腮腺咬肌筋膜。,深筋膜浅层 （封套筋膜）续,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）,在甲状腺与气管、食管上端邻接处，腺鞘后层增厚形成甲状腺悬韧带,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。,4.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,四、 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 1.下颌下三角 周界： 位于下颌骨下缘与二腹肌前、后腹之间。 内容：主要为下颌下腺及其周围的血管神经。,五、颈前区,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,1. 在下颌下腺的浅面有： 面静脉、面神经的颈支、下颌下淋巴结,Cervical branches of facial nerve,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,下颌舌骨肌,2. 被下颌舌骨肌分为浅深两部，下颌下腺管由腺深部的前端发出，在下颌舌骨肌的深面前行，开口于口底粘膜的舌下阜。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,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,3.下颌下腺深部的结构：,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,2 、 颏下三角,境界：两侧二腹肌前腹和舌骨体围成 底：下颌舌骨肌 顶：颈深筋膜浅层 内容：颏下淋巴结，收集下唇、颏部、口 腔底、下颌切牙、舌尖的淋巴，注 入下颌下淋巴结或颈外侧上深淋巴结。,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,前 甲状腺上动脉 舌动脉 面动脉 后 枕动脉 耳后动脉 内 咽升动脉 终支 颞浅动脉 上颌动脉,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,颈内静脉,位置：位于胸锁乳突肌前缘深面、颈总动脉或颈内动脉的外侧。 属支：面（总）静脉、舌静脉、甲状腺上静脉和甲状腺中静脉。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,舌下神经 在下颌下三角上角处经二腹肌后腹中部下缘穿出，弓形跨过颈内、外动脉浅面，进入下颌下三角。发出颈袢上根，与颈丛的颈袢下根合成颈袢，发支支配舌骨下肌群。 副神经 迷走神经,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,二腹肌后腹,意义：是颈动脉三角与下颌下三角的分界标志；是颈部及颌面部手术的主要标志； 毗邻关系 深面有颈内动、静脉，颈外动脉和、对脑神经及颈交感干。 下缘有枕动脉和舌下神经。,Occipital artery,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。,2.位置：,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。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,甲状腺假被膜,囊鞘间隙,甲状腺真被膜,甲状腺悬韧带,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,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,甲状旁腺,两对，扁圆形小体 多位于甲状腺侧叶的后面，真假被膜之间的结缔组织（囊鞘间隙）内。 上甲状旁腺多位于甲状腺内缘后方的上、中1/3交界处；下甲状旁腺位于甲状腺侧叶下1/3的后面。,January, 2007,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SON