上肢局部解剖学.ppt

Theupperlimb,山东大学医学院解剖教研室李振华,Themusclesofback,SuperficialgroupTrapezius斜方肌Latissimusdorsi背阔肌Levatorscapulae肩胛提肌Rhomboideus菱形肌DeepgroupErectorspinae竖脊肌Splenius夹肌Thoracolumbarfascia胸腰筋膜,Themusclesofthorax,ExtrinsicmusclesPectoralismajor胸大肌Pectoralisminor胸小肌Serratusanterior前锯肌IntrinsicmusclesIntercostalesexterni肋间外肌Intercostalesinterni肋间内肌Intercostalesintimi肋间最内肌,Majormusclesofthetrunk,TrapeziusOrigin:superiornuchalline,externaloccipitalprotuberance,ligamentumnuchaeandspinousprocessesofseventhcervicalandallthoracicvertebraeInsertion:lateralthirdofclavicle,acromion,andspineofscapularteryActon:upperfiberselevatescapula,lowerfibersdepressscapula;ifscapulaisfixed,onesideactingalong,drawsheadtowardthesameside,andturnfacetooppositeside;bothsidestogether,drawheaddirectlybackward,LatissimusdorsiOrigin:spinousprocessesoflowersixthoracicandalllumbarvertebrae,mediansacralcrest,andposteriorpartofiliaccrest.Insertion:floorofintertuberculargrooveofhumerus.Action:trunkfixed,extends,adductsandmediallyrotatesarm;armfixed,elevatestrunk.,ErectorspinaePosition:fillsthevertebralgrooveoneachsideofthespineAction:extendsvertebralcolumn(drawheadbackwar),PectoralismajorOrigin:medialhalfofclavicle,sternum,1th-6thcostalcartilages.Insertion:crestofgreatertubercleofhumerus.Action:flexes,adductsandrotatesarmmedially;armfixed,elevatestrunk;elevatesribs1-6,aiddinginforcedinspiration.,TheMusclesofUpperLimb,MusclesofshoulderDeltoidsupraspinatusInfraspinatusTeresminorTeresmajorsubscapularis,MusclesofarmAntereriorgroupBicepsbrachii肱二头肌Coracobrachialis喙肱肌Brachialis肱肌Posteriorgrouptricepsbrachii肱三头肌,Musclesofforearm,SuperficiallayerBrachioradialis肱桡肌Pronatorteres旋前圆肌Flexorcarpiradialis桡侧腕屈肌Palmarislongus掌长肌Flexorcarpiulnaris尺侧腕屈肌,ThirdlayerFlexordigitorumprofundus指深屈肌Flexorpollicislongus拇长屈肌Fourthlayerpronatorquadratus旋前方肌Action:flexradiocarpaljointandfingers,pronateforearm,Secondlayerflexordigitorumsuperficials指浅屈肌,Posteriorgroup(10)Superficiallayer(5)Extensorcarpiradialislongus桡侧腕长伸肌Extensorcarpiradialisbrevis桡侧腕短伸肌Extensordigitorum指伸肌Extensordigitiminimi小指伸肌Extensorcarpiulnaris尺侧腕屈肌,Deeplayer(5)Supinator旋后肌Abductorpollicislongus拇长展肌Extensorpollicisbrevis拇短伸肌Extensorpollicislongus拇长伸肌Extensorindicis示指伸肌Action:extendradiocapraljointandfingers,andsupinateforearm,MusclesofhandLateralgroupthenar鱼际(4)Abductorpollicisbrevis拇短展肌Flexorpollicisbrevis拇短屈肌Opponenspollicis拇对掌肌Adductorpollicis拇收肌Action:flex,abduct,adductandopposethumbMedialgrouphypothenar(3)Abductordigitiminimi小指展肌Flexordigitiminimibrevis小指短屈肌Opponensdigitiminimi小指对掌肌Action:flex,abduct,andopposelittlefinger,IntermedialgroupLumbricales蚓状肌(4)flexfingersatMPjoints;extendfingersatIPjointsPalmarinterossei骨间掌侧肌(3)adductfingerstowardsmiddlefingeratMPjointsDorsalinterossei骨间背侧肌(3)abductfingersawayfrommiddlefingeratMPjoints,Majormusclesofupperlimb,DeltoidOrigin:lateralthirdofclavicle,acromion,andspineofscapulaInsertion:deltoidtuberosityofhumerusAction:abducts，flexesandmedicallyrotates,extends,andlaterallyrotatesarm,TeresmajorOrigin:dorsalsurfaceofinferiorangleofscapulaInsertion:crestoflessertubercleofhumerusAction:mediallyrotatesandadductsarm,BicepsbrachiiOrigin:longhead,supraglenoidtubercle;shorthead,coracoidprocessInsertion:radicaltuberosityAction:supinatorofforearm,flexorofelbowjoint,weakflexorofshouldjointPronatorteresOrigin:medicalepicondyleofhumerusanddeepfasciaofforearmInsertion:middleoflateralsurfaceofradiusAction:pronationofforearmandflexionofelbow,TricepsbrachiiOrigin:longhead,infraglenoidtubercle;lateralhead,abovegrooveforradicaln.,medicalhead,belowgrooveforradicaln.Insertion:olecranonofulnaAction:extendselbowjoint),longheadcanextendandadductshoulderjoint,SupinatorOrigin:lateralepicondyleofhumerusandupperpartoflateralborderofulnaInsertion:upperthirdofanteriorsurfaceofradiusAction:supinationofforearm,Arteriesofupperlimb,AxillaryarteryContinuationofsubclavianarteryatlateralborderoffirstribBecomesbrachialarteryatlowerborderofteresmajorDividedintothreepartsbyoverlyingpectoralisminorFirstportion,abovemusclegivesrisetothoracoacromiala.胸肩峰动脉Secondportion,behindmusclegivesrisetolateralthoracica.胸外侧动脉Thirdportion,belowmusclegivesrisetosubscapulara.肩胛下动脉,anteriorandposteriorhumeralcircumflexa.旋肱前、后动脉;theformerthendividesintothrocodorsala.胸背动脉andcircumflexscapulara.旋肩胛动脉,BrachialarteryContinuationofaxillaryarteryDividesintoradialandulnararteriesatlevelofneckofradiusBranchesDeepbrachiala.肱深动脉accompanieswithradialnerveSuperiorulnarcollaerala.尺侧上副动脉accompanieswithulnarnerveInferiorulnarcollaterala.尺侧下副动脉,RadialarteryandbranchesRadialrecurrenta.桡侧返动脉Superficalpalmarbranch掌浅支Principalarteryofthumb拇主要动脉UlnararteryandbranchesUlnarrecurrenta.尺侧返动脉Commoninterosseousartery骨间总动脉Anteriorinterossousa.骨间前动脉Posteriorinterosseousa.骨间后动脉Deeppalmarbranch掌深支,Superficialpalmararch掌浅弓FormedbyulnararteryandsuperficialpalmarbranchofradialarteryCurveofarchliesacrossthepalm,levelwiththedistalborderoffullyextendedthumbGivesrisetothreecommonpalmardigitalarterieseachthendividesintotwoproperpalmardigitalarteries,Deeppalmararch掌深弓FormedbyradialarteryanddeeppalmarbranchofulnararteryCurveofarchliesacrossupperpartofpalmaratlevelwithproximalborderofextendedthumbGivesrisetothreepalmarmetacarpalarteries,Veinsoftheupperlimb,Deepveins:accompanythearteriesofthesameregionandbearsimilarnamesSuperficialveinsCephalicvein头静脉ArisesfromthelateralsideofthedorsalvenousreteofhandAscendsonradialsideoftheforearmtotheelbowandtheninthelateralsideofbicepsbrachiifurrow,continuesupthearminthedeltopectoralgrooveandthentotheinfraclavicularfossa,whereitpiercesclavipectoralfasciatodrainintoaxillaryvein,Basilicvein贵要静脉ArisesfromthemedialsideofthedorsalvenousreteofhandAscendsontheulnarsideofforearmtotheelbowandtheninthemedialbicepitalbrachiifurrowtomiddleofthearmwhereitpiercesthedeepfasciaandjoinsthebrachialveinoraxillaryveinMediancubitalvein肘正中静脉linkscephalicveinandbasilicveininthecubitalfossa.Itisafrequentsiteforvenipuncturetoremoveasampleofbloodoraddfluidtotheblood,Thelymphaticdrainageofupperlimb,LymphaticvesselsSuperficialfollowthesuperficialveins,drainintosupratrochlearandaxillarylymphnodesDeepaccompanymainvessels,endinaxillarylymphnodeslymphnodesCubitallymphnode:liesabovemedialepicondyleofhumerusAxillarylymphnodearrangedinfivegroups,Axillarylymphnodes腋淋巴结arrangedinfivegroupsLaterallymphnodes外侧淋巴结liearoundthedistalendofaxillaryvein,receivingdrainagefromthearm,forearm,andhandPectorallymphnodes胸肌淋巴结liealonglateralthoracicvessels,receiveafferentsfromanteriorthoracicwallincludingcentralandlateralportionofmammaSubscapularlymphnode肩胛下淋巴结alongsubscapularvessels,receivelymphfromnapeandscapularregionEfferentsabovethreegroupspasstocentrallymphnode,Centrallymphnode中央淋巴结lieinfatofaxillaryfossa,receivedrainagefromalltheabovenodes,efferentspasstoapicallymphnodeApicallymphnode尖淋巴结Lieintheapexoftheaxilla,alongtheproximalendofaxillaryvesselsReceivedrainagechieflyfromcentrallymphnode,upperportionofmammaEfferentsformsubclaviantrunk,therightsubclaviantrunkjointstherightlymphaticduct;leftusuallydrainsdirectlyintothoracicduct,Brachialplexus臂丛,Formation:Fiveroots:formedbyanteriorramiofC5-C8andT1spinalnerves,rootsC5C7giverisetolongthoracicn.胸长神经ThreetrunksTheuppertrunkisformedbythejoiningofrootC4,C5,C6.ThemiddletrunkisthecontinuationofrootC7.ThelowertrunkisformedbythejoiningofrootC8andT1.Sixdivisions:aboveclavicle,trunksformanteriorandposteriordivisionsThreecords:belowclavicle,divisionsformthreecordsthatsurroundthesecondportionofaxillarya.,Position:passesthroughthescalenefissuretoposterosuperiorofsubclavianartery,thenenterstheaxillatoformlateral,medialandposteriorcordsMainbranchesLateralcordMusculocutaneousn.肌皮神经Lateralroottomediann.正中神经外侧根MedialcordMedialroottomediann.正中神经内侧根Ulnarn.尺神经Medialbrachialcutaneousn.臂内侧皮神经Medialantebrachialcutaneousn.前臂内侧皮神经,Posteriorcordradialn.桡神经axillaryn.腋神经thoracodorsaln.胸背神经,Musculocutaneous肌皮神经Distribution:Bicepsbrachii,brachalisandcoracobrachialisBBCnerve;skinonanterioraspectofforearm,Median正中神经Distribution:Flexorofforearmexceptbrachioradialis,flexorcarpiulnarisandulnarhalfofflexordigitorumprofundus,thenarexceptadductorpollicis,firsttwolumbricals;skinofthenar,centralpartofpalm,palmaraspectofradialthreeandone-halffingers,includingmiddleanddistalfingersondorsumInjury:Apehand猿手producessignofbenediction,inwhichtheindexandmiddlefingerscannotbeflexedandthethumbcannotbeopposed,UlnarnerveDistribution:Flexorcarpiulnaris,ulnarhalfofflexordigitorumprofundus,hypothenarmuscles,interossei,3rdand4thlumbricalsandadductorpollicis;skinofhypothenar,palmarsurfaceofulnaroneandone-halffingers,ulnarhalfofdorsumofhand,posterioraspectofulnartwoandone-halffingersInjury:clawhand,Radial桡神经Distribution:Extensormusclesofarmandforearm,brachioradialis;skinonbackofarm,forearm,andradialsideofdorsumofhandandradialtwoandone-halffingersInjury:Wristdrop,Axillary腋神经Distribution:Deltoidandteresminormuscle;skinoverdeltoidandupperposterioraspectofarmInjury:resultindeltoidandteresminorparalysis(lossofshoulserabdutionandweelexternalrotation)withlossofsensationoverthedeltoid,Regionalanatomyofupperlimb,山东大学医学院解剖教研室李振华,Partsandregions,ShoulderregionjunctionofarmandtrunkArmbetweenshouldandelbowElbowbendofarm,jointbetweenarmandforearmForearmbetweenelbowandhandHand,Surfaceanatomy,Shoulderregion:acromion,spineofscapula,coracoidprocess,greatertubercle,anteriorandposterioraxillaryfoldsArmmedialandlateralbicepsbrachiifurrow,deltoidtuberosityElbowmedialandlateralepicondyles,headofradius,olecranon,tendonofbicepsbrachiiForearmbetweenelbowandhandHandstyloidprocess,dorsaltubercle,Anatomicalsnuffbox鼻烟壶Whenthethumbisabductedandextended,atriangularhollowappearsbetweenthetendonoftheextensorpollicislongsmediallyandthetendonsoftheextensorpollicisbrevisandabductorpollicislonguslaterally.Thefloorofthesnuffboxisthescaphoidandtrapeziumbonesandcrossedbytheradiala.,16501700,Carringangle提携角,Mamma乳房,PositionLieinsuperficialfasciaoverthepectoralsmajorandpectoralfasciaExtendfrom3rdto7thribsvertically,andfromparasternallinetomidaxillarylinetransversally,Structurescontainsskin,mammaryglandsandadiposetissueEachbresthasabout1520lobesofmammaryglandEachloberadiatesoutfromthenippleandhasalactiferousduct输乳管whichopensseparatelyonthesummitofthenippleandpossessesadilatedlactiferoussinuses输乳管窦justpriortoitstermination,Suspensoryligamentsofbreast乳房悬韧带(coopersligaments)strandsofconnectivetissuerunsbetweenskinanddeepfasciaandservetosupportthemammaryglands,Axillaryfossa腋窝,Theaxillaryfossaisapyramid-shapedspacethroughwhichmajorneurovascularstructurespassbetweenthethoraxandupperextremity,BoundariesTheapexisatriangularspacelimitedbythefirstrib,thescapula,andthemiddlethirdofclavicle.Thebaseskinandfasciaoftheaxillaryfossa,TheanteriorwallPectoralismajor,pectoralisminorandsubclaviusmusclesClavipectoralfascia锁胸筋膜Thedeepfaxciawhichextendsbetweensubclavius,coracoidprocessandpectoralisminormusclesThestructurespassthroughtheclavipectoralfaxciaCephalicv.Thoracoacromiala.Lateralpectoraln.,Theposteriorwallteresmajor,latissimusdorsi,subscapularisandscapulaTrilateralandquadrilateralforamina三边孔和四边孔Betweenthesubscapularisandteresmajor,thereisalongtriangularspacewhoselateralsideissurgicalneckofhumerus.Thelongheadoftricepsbrachiisubdividesthisspaceintoamedialtrilateralforamenandalateralquadrilateralforamen.Theposteriorhumeralcircumflexa.andaxillaryn.passthroughthequadrilateralforamen.Thecircumflexscapulara.passesthroughthetriangularspacetoreachthedorsumofthescapula.,Thebroadmedialwallserratusanterior，intercostalmusclesandupperfourribsThenarrowlateralwallcoracobrachialis,bicepsbrachiiandintertuberculargrooveContentsBrachialplexus,axillarya.andprincipalbranches,axillaryv.andtributaries,axillarylymphnodesandlooseconnectivetissue,Brachialplexus臂丛,Formation:Fiveroots:formedbyanteriorramiofC5-C8andT1spinalnerves,rootsC5C7giverisetolongthoracicn.胸长神经ThreetrunksTheuppertrunkisformedbythejoiningofrootC4,C5,C6.ThemiddletrunkisthecontinuationofrootC7.ThelowertrunkisformedbythejoiningofrootC8andT1.Sixdivisions:aboveclavicle,trunksformanteriorandposteriordivisionsThreecords:belowclavicle,divisionsformthreecordsthatsurroundthesecondportionofaxillarya.,Position:passesthroughthescalenefissuretoposterosuperiorofsubclavianartery,thenenterstheaxillatoformlateral,medialandposteriorcordsMainbranchesLateralcordMusculocutaneousn.肌皮神经Lateralroottomediann.正中神经外侧根MedialcordMedialroottomediann.正中神经内侧根Ulnarn.尺神经Medialbrachialcutaneousn.臂内侧皮神经Medialantebrachialcutaneousn.前臂内侧皮神经,Posteriorcordradialn.桡神经axillaryn.腋神经thoracodorsaln.胸背神经,Axillarysheath腋鞘extensionofdeepcervicalfasciaoftheneck,formingatubularsheaththatsurroundsaxillarya.andv.,andbrachialplexus,AxillaryarteryContinuationofsubclavianarteryatlateralborderoffirstribBecomesbrachialarteryatlowerborderofteresmajorDividedintothreepartsbyoverlyingpectoralisminorFirstportion,abovemusclegivesrisetothoracoacromiala.胸肩峰动脉Secondportion,behindmusclegivesrisetolateralthoracica.胸外侧动脉Thirdportion,belowmusclegivesrisetosubscapulara.肩胛下动脉,anteriorandposteriorhumeralcircumflexa.旋肱前、后动脉;theformerthendividesintothrocodorsala.胸背动脉andcircumflexscapulara.旋肩胛动脉,AxillarylymphnodearrangedinfivegroupsLaterallymphnodesliearoundthedistalendofaxillaryarteryvein,receiveafferentvesselsfromupperlimb.Pectorallymphnodesliealonglateralthoracicvessels,receiveafferentsfromanteriorthoracicwallincludingcentralandlateralportionofmammaSubscapularlymphnodealongsubscapularvessels,receivelymphfromnapeandscapularregionEfferentsabovethreegroupspasstocentrallymphnodeCentrallymphnodelieinfatofaxillaryfossa,receivelymphfromalltheabovenodes,efferentspasstoapicallymphnodeApicallymphnodelieintheapexoftheaxilla,alongtheproximalendofaxillaryvessels,receiveafferentschieflyfromcentrallymphnode,upperportionofmamma;efferentsformsubclaviantrunk,therightsubclaviantrunkjointstherightlymphaticduct;leftusuallydrainsdirectlyintothoracicduct,Cubiralfossa肘窝,BoundariesBaselinedrawnthroughepicondylesofhumerusApexbrachioradialislaterallyandpronatorteresmediallyRoofskin,superficialfaxcia,deepfaxciaandaponeurosisofbicepsFloorbrachialis,supinatorandcapsuleofelbowjoint,ContentsfromlateraltomedialBicepsbrachiitendonBrachiala.dividesintoradialandulnara.,usuallyatapexoffossaMediann.Lateraltothebicepsbrachiitendonradialn.andlateralantebrachialcutaneousn.,Carpaltunnel腕管,FlexorretinaculumThickeningofdeepfasciainthehandAttachedlaterallytoscaphoidandtrapeziunandmediallytopisiformandhamateFormanosseofibroustunnel(carpaltunnel)withcarpalgroovetransmitsmediann.,flexordigitorumsupericialis,flexordigitorumprofundus,andflexorpollicuslongusfromforearmintohand,Skinincisions,Superficialfascia,Clavipectoralfascia锁胸筋膜Thedeepfaxciawhichextendsbetweensubclavius,coracoidprocessandpectoralisminormusclesThestructurespassthroughtheclavipectoralfaxciaCephalicv.Thoracoacromiala.Lateralpectoraln.,Musculocutaneousn.,Muscolocutaneousn.,Posteriorregionofupperlimb,山东大学医学院解剖教研室李振华,Skinincisions,Cutaneousn.andsuperificialv.,Hand,山东大学医学院解剖教研室李振华,Palmofhand手掌,Flexorretinaculum屈肌支持带ThickeningofdeepfasciainthehandAttachedlaterallytoscaphoidandtrapeziunandmediallytopisiformandhamateCarpaltunnel腕管FormedbyflexorretinaculumandcarpalgrooveTransmitsMediann.FlexordigitorumsuperficialisandflexordigitorumprofundusenclosedbycommonflexorsheathFlexorpollicuslongusenclosedbytendinoussheathofflexorpollicuslongus,Deeppalmarfascia掌部深筋膜,SuperficiallayerThenarfascia鱼际筋膜Hypothenarfascia小鱼际筋膜Palmaraponeurosis掌腱膜thicktriangularmembraneDeeplayerpalmarinterosseousfascia骨间掌侧筋膜,Osseofascialcompartmentsofpalm手掌骨筋膜鞘,Lateralcompartment外侧鞘Medialcompartment内侧鞘Intermediatecompartment中间鞘,Laeralintermuscularseptum,Medialintermuscularseptum,Intermediatecompartment中间鞘Formedbypalmaraponeurosis,Laeralandmedialintermuscularseptum,palmarinterosseousfasciaContents:superficialpalmararch,a.,v.,n.,tendonsofflexordigitorumsuperficial