局部解剖学（双语） 精品课程 课件pptlimbs

Regional Anatomy,Based on the organization of the body into parts: the head, neck, thorax, abdomen, pelvis, and paired upper and lower limbs.Emphasis is placed on the relationships of various systemic structures (e.g., muscles, nerves, and arteries) within the region. Each region is not an isolated part and must be put into the context of adjacent regions and of the body as a whole. Surface anatomy is an essential part of the regional approach, providing a knowledge of what structures are visible and/or palpable (perceptible to touch) in the living body at rest and in action. The physical examination of patients is the clinical extension of surface anatomy. In people with stab wounds, for example, the healthcare worker must be able to visualize the deep structures that might be injured.,Upper Limb,Regions: Axilla, Arm, Cubital fossa, Forearm, Hand,I. Surface markers of upper limb bones,II. Superficial Structures of Upper Limb,skin superficial fascia (subcutaneous tissue ) containing:fatCutaneous Nerves Superficial Vessels (veins, lymph) deep fasciasurrounding the muscles,Osseofibrous sheath= deep facia + Intermuscular septum + bone + interosseus membrane,III. Superficial Vessels of Upper Limb,The cephalic and basilic veins and their tributariesThe median cubital v. superficial lymphatic drainage to the lymph nodes: cubital lymph nodes axillary lymph nodes The dorsal venous network of hand,IV. Axilla,The axilla is the pyramidal space inferior to the glenohumeral joint and superior to the skin and axillary fascia at the junction of the arm and thorax The apex is the cervicoaxillary canal, the passageway between the neck and the axilla. The arteries, veins, lymphatics, and nerves traverse this superior opening to pass to or from the arm.The base is formed by the concave skin, subcutaneous tissue, and axillary (deep) fascia extending from the arm to the thoracic wall forming the axillary fossa (armpit).The anterior wall is formed by the pectoralis major and minor and the pectoral and clavipectoral fascia associated with them. The anterior axillary fold is the inferiormost part that may be grasped. The posterior wall is formed chiefly by the scapula and subscapularis. The posterior axillary fold is the inferiormost part that may be grasped. The medial wall is formed by the thoracic wall (1st4th ribs and intercostal muscles).The lateral wall is the narrow bony wall formed by the in the humerus.,1. Location and walls of axilla,2. Axilla contains,Axillary artery & veinBrachial plexus: 3 cords 5 nervesMusclesPectoralis majorPectoralis minorDeltoidBiceps brachii subscapularis intercostalisSerratus anteriorbones ClavicleScapulaHumerusRibs,3. Axillary lymphatics,Many lymph nodes are found in the axillary fat. There are five principal groups of axillary lymph nodes: pectoral subscapular humeralCentralapical,Brachial artery & veinMedian n. & Ulnar n.Muscles,V. Arm- anterior part,V. Arm- posterior part,Posterior circumflex humeral a. & axillary nDeep a. of arm & radial n.muscles,VI. Cubital fossa,Superficial dissection,Deep dissection,VII. Forearm,Radial a. & Radial n.Median n.Ulnar a. & Ulnar nmuscles,VIII. Hand,The thenar & midpalmar spacesThe fascia of the palm the palmar aponeurosisFibrous digital sheathsDigital ns. & vesselsMuscles,I. Surface markers of lower limb bones,II. Superficial Structures of Lower Limb,Deep faciaCribriform facia in saphenous openingFacia lataIliotibial faciaExtensor retinaculaGreat saphenous v.Muscle sheath,III. Superficial Vessels of Lower Limb,Varicose Veins, Thrombosis, and Thromboembolism,Varicose veins form when the valves that usually prevent blood flow from the deep veins through the perforating veins to the superficial veins are incompetent. As a result, the superficial veins become varicose (dilated so that their cusps do not close) and tortuousvaricose veins.The veins of the lower limb are subject to venous thrombosis (blood clotting)for example, after a bone fracture, muscular inactivity, and external pressure on the veins (tight cast). A thrombus that breaks free from a lower limb vein and travels to the lungs results in a pulmonary thromboembolism (obstruction of the pulmonary artery).,IV. Thigh,Femoral angle: linguinal lig.+sartorius+gracilisFemoral n., a. v.muscles,V. Gluteal area,Surface anatomy of gluteal bones, muscles & nerves,VI. Gluteal & Posterior thigh,Piriformis mSuperior gluteal a. & n.Inferior gluteal a. & n.Internal pudenal a. & n.Sciatic nTibial nCommon fibular n.muscles,VII. Popliteal fossa,The surface anatomy is demonstrated. diamond-shaped gap in the muscles overlying the fossaContains:Popliteal a. & v.Tibial n.Common fibular n.The genicular anastomosis,VIII. Leg & foot-ant. part,Anterior tibial a. & deep fibular n.Superficial fibular n.Superficial anatomy of dorsal footExtensor retinaculummuscles,VIII. Leg & foot-lat. part,A. The muscles of the leg and footB. The surface anatomy C. The retinacula and synovial sheaths of the tendons (blue) at the ankle,A. deep dissection, most of the soleus is cut away to show:Post. Tibial a.Tibial n.B. The structures of the ankle and sole of the foot C. The retinacula and synovial sheaths of the tendons at the ankle.,VIII. Leg & foot-post. part,Alignment of lower limb bones.,normal Q-angle: The femur is placed diagonally within the thigh, whereas the tibia is almost vertica