局解英文总结

1、第一章 头部Osseous marks眉弓 superciliary arch 眶上切迹 supraorbital notch 眶下孔 infraorbital foramen颏孔 mental foramen翼点 pterion颧弓 zygomatic arch 耳屏 tragus髁突 condylar process乳突 mastoid process 前囟点 bregma人字点 lambda枕外隆突 external occipital protuberanceParotid duct 腮腺管 Arises front anterior border of gland Lies 1.5

2、cm below and parallel to zygomatic arch Passes forward over masseter, pierces the buccinator and oral mucosa to open opposite second upper molar toothStructures vertical passing through the parotid gland External carotid a. 颈外动脉Superficial temporal a. 颞浅动脉Superficial temporal v. 颞浅静脉Retromandibular

3、vein 下颌后静脉Auriculotemporal n. 耳颞神经Structures transversal passing through the parotid gland Maxillary a. & v. 上颌动、静脉Transverse facial a. & v. 面横动、静脉Branches of facial n. 面神经的分支The structures from superficial to deepBranches of facial nerve 面神经的分支Retromandibular vein 下颌后静脉External carotid a. 颈外动脉 and

4、Auriculotemporal n. 耳颞神经Facial a.面动脉 Branch of external caroteid a. Runs forward deep to digastric and submandibular glandCurving around the inferior border of the mandible just anterior to the masseter, where its pulse can be feltPasses along the side of the mouth and nose and terminates as angular

5、 a.内眦动脉at the medial angle of eye Lies deep to most facial musclesSuperficial temporal a.颞浅动脉Terminal branch of external carotid a.Ascends in front of ear (where it is palpable) to supply temporal and anterior portion of scalpTransverse facial a.面横动脉 runs above parotid duct to supply the cheek regio

6、nFacial vein 面静脉Begins at medial angle of eye (angular vein 内眦静脉)Runs downward and backward through the face, posterior to the facial arteryBelow angle of mandible, joins anterior branch of retromandibular vein 下颌后静脉 to form common facial vein 面总静脉, which drains into internal jugular vein 颈内静脉Facial

7、 vein 面静脉Connections with cavernous sinus 海绵窦 through the ophthalmic vein 眼静脉, and also through pteygoid veous plexus 翼静脉丛 via the deep facial vein 面深静脉 Layers of frontoparietooccipital region Consists of five layers The superficial 3 layer are closely knit together, called scalp 头皮1. Skin 皮肤 thick

8、and hair bearing and contains numerous sebaceous glands 皮厚、腺多、血运丰富2. The superficial fascia 浅筋膜 Dense connective tissue that binds the skin to the underlying epicranial aponeurosis The vasculature of the scalp runs primarily in this layer. It is rich and widely anastomosis.Wounds of the scalp bleed

9、profusely but heal well. a. v. and n. in superficial fasciaAnterior groupSupratrochlear a. v. n. 滑车上动、静脉和神经Supraorbital a. v. n. 眶上动、静脉和神经Posterior groupOccipital a. v. 枕动、静脉Greater occipital n. 枕大神经3. Epicranial aponeurosis and occipitofrontalis 帽状腱膜和枕额肌It is interposed between the frontalis and oc

10、cipitalis portions of the occipitofrontalis muscle.These muscles place the aponeurosis under tension so that deep transverse lacerations of the scalp gape widely 坚韧致密，前连额腹，后连枕腹，4. Subaponeurotic loose connective tissue(space)腱膜下疏松结缔组织(间隙)Contains a rich network of deep arteries and veins. Therefore,

11、 this layer has been called the “dangerous area”. Infection may spread to the substance of the bones, to venous channels within the cranial cavity, or to the brain.5. Pericranium 颅骨外膜Fuses firmly with bone at the sutures and with the periosteum of the adjacent bone, thus limiting the subperiosteal s

12、pace.薄而致密，易于颅骨分离，如有血肿，与骨一致Hypophysis and hypiphyseal fossa 垂体与垂体窝Shape and positionPea-sized organ, attached by infundibulum to hypothalamus, lies in hypophysial fossaConsists of two parts:AdenohypophysisNeurohypophysis RelationshipAnteriortuberculum sellae Posteriordorsum sellaeAnterolateralyoptic

13、canalAbovediaphragm sellae, optic chiasma and optic nerve Laterallycavernous sinusBelowsphenoid sinus 临床意义：当垂体瘤向上扩展时，可将鞍隔推向上方，压迫视交叉，出现视野的缺损。垂体肿瘤可突入第三脑室，发生脑脊液循环障碍，引起脑脊液循环障碍。当垂体瘤向两侧扩展时，可压迫海绵窦，产生海绵窦淤血及脑神经受损的症状。经鼻垂体瘤手术时注意避免损伤视神经、视交叉、海绵窦、颈内动脉和脑组织的损伤。Cavernous sinus 海绵窦Position: lies on each side of sella

14、 turcicaTraversing the cavernous sinusinternal carotid artery 颈内动脉abducent nerve 展神经Traversing the lateral wall of the cavernous sinusoculomotor nerve 动眼神经trochlear nerve 滑车神经ophthalmic nerve 眼神经maxillary nerve 上颌神经第二章 颈部Landmarks of the neckHyoid bone 舌骨:平对3、4颈椎椎间盘平面。Thyroid cartilage 甲状软骨：上缘平第四颈椎上

15、缘。Cricoid cartilage 环状软骨：下缘平第6颈椎体下缘，是喉与气管、咽与食管的分界标志。Catotid tubercle 颈动脉结节：第6颈椎横突前结节，颈总动脉行经其前方。Sternocleidomastoid 胸锁乳突肌：其起始两头之间称为锁骨上小窝。Suprasternal fossa 胸骨上窝：颈静脉切迹上方的凹陷，是触诊气管的地方。Greater supraclaviclar fossa ：锁骨上大窝 窝底可摸到第一肋、臂丛和锁骨下动脉的搏动。Cervical fascia 颈筋膜Superficial layer of cervical fascia 颈筋膜浅层 (

16、investing fascia 封套筋膜)Encloses trapezius, sternocleidomastoid, posterior belly of digastric and parotid and submandibular glandsAttached to bony landmarks of upper and lower boundaries of neck and zygomatic arch of facePretracheal layer 气管前层Pretracheal fascia气管前筋膜Buccopharyngeal fascia颊咽筋膜：覆盖于咽的后壁和颊

17、肌外面向下与食管筋膜相续。Lies deep to the infrahyoid muscle Extends from arch of cricoid cartilage, thyroid cartilage and hyoid bone to fibrous pericardium of superior mediastinum Encloses viscera of neck: pharynx, larynx, trachea, esophagus, thyroid gland and parathyroid glandsCompletely surrounds thyroid glan

18、d, forming a sheath for it, and bind the gland to larynx to form suspensory ligament of thyroid gland 甲状腺悬韧带Prevertebral fascia椎前筋膜 (Prevertebral layer 椎前层）Lies anterior to bodies of cervical vertebrae and prevertebral muscles; extends from base of skull downward into the superior mediastinum, fuse

19、with anterior longitudinal lig. and continuous with endothoracic fasciaCovers subclavian vessels and roots of brachial plexus Extends into upper limb as axillary sheath *Carotid sheath 颈动脉鞘Formed by components of all three layers of deep cervical fasciaContains common and internal carotid arteries,

20、internal jugular vein, and vagus nerveSubmandibular triangle下颌下三角Boundaries Anterior and posterior bellies of digastricLower border of the mandibleCovered by skin, superficial fascia, platysma and investing fasciaFloor mylohyoid, hyoglossus and middle constrictor of pharynxContentssubmandibular glan

21、d, facial a., v., hypoglossal n. lingual a. v. and n., submandibular ganglion and submandibular lymph nodes Carotid triangle 颈动脉三角 BoundariesAnterior border of sternocleidomastoidSuperior belly of omohyoid Posterior belly of digasticCovered by skin, superficial fascia, platysma and investing fasciaD

22、eepprevertebral fascia Medial lateral wall of pharynx ContentsCommon carotid a. and its branchesInternal jugular v. and its tributaries Hypoglossal n. with its descending branchesVagus nerve Accessory nerve Deep cervical lymph nodesMuscular triangle 肌三角Bounded by midline of the neck, superior belly

23、of the omohyoid and anterior border of the sternocleidomastoid.Covered by skin, superficial fascia, platysma, anterior jugular v., and investing fasciaDeepprevertebral fascia ContentsSuperior belly of omohyoid SternohyoidSternothyroid ThyrohyoidThyroid glandParathyroid glandLarynx and pharynxCervica

24、l part of trachea and esophagus Thyroid gland 甲状腺Shape and positionH-shapeLeft and right lobes: lie on either side of inferior part of larynx and superior part of trachea, extend from middle of thyroid cartilage to level of sixth trachea cartilageIsthmus: overlies 2nd to 4th tracheal cartilagePyrami

25、dal lobe: some times arises from isthmus Coverings of the thyroid glandFalse capsule: a sheath of pretracheal fascia which is attached to arch of cricoid and thyroid cartilages to form the suspensory ligament of thyroid gland, hence, the thyroid gland moves with larynx during swallowing and oscillat

26、es during speakingTrue capsule: fibrous capsuleSpace between sheath and capsule of thyroid gland: there are loose connective tissue, vessels, nerves and parathyroid glandsRelations of the thyroid gland Anteriorly: Skinsuperficial fascia investing fasciaInfrahyoid muscles and pretracheal fascia Poste

27、romedially:Larynx and tracheaPharynx and esophagusRecurrent laryngeal nervePosterolaterally:Carotid sheath with common carotid a. internal jugular v. and vagus n.Cervical sympathetic trunkArteries of the thyroid gland Superior thyroid a. 甲状腺上动脉 Branch of external carotid a.Runs superficial and paral

28、lel to the external branch of superior laryngeal n. to reach the upper pole of thyroid glandGives off superior laryngeal a. in company with internal branch of superior laryngeal n.Inferior thyroid artery 甲状腺下动脉Branch of thyrocervical trunk of subclavian a.Turns medially and downward, reaches the pos

29、terior border of the thyroid gland, where it is closely related to the recurrent laryngeal n. Supplies inferior pole of thyroid glandArteria thyroidea ima (lowest thyroid artery)甲状腺最下动脉May arise (4%) from the brachiocephalic a. or aortic archSuperior laryngeal n. 喉上神经Internal branch 内支：which pierces

30、 thyrohyoid membrane to innervates mucous membrane of larynx above fissure of glottisExternal branch 外支：is fine n., which descends in company with the superior thyroid a. and innervates cricothyroid Recurrent laryngeal nerves 喉返神经Ascend in tracheo-esophageal groovePass deep to the lobe of the thyroi

31、d gland and come into close relationship with the inferior thyroid a.Cross either in front of or behind the arteryNerves enter larynx posterior to cricothyroid joint, the nerve is now called inferior laryngeal nerve喉下神经Innervations: laryngeal mucosa below fissure of glottis, all laryngeal laryngeal

32、muscles except cricothyroid Relationship of arteries to the laryngeal nervesThe superior thyroid a. is closely related near its origin to the superior laryngeal n.Section of the nerve would anaesthetise the laryngeal mucosa and abolish the cough reflex, so increasing the risk of food or a foreign bo

33、dy entering the trachea.The inferior thyroid a. is closely related to the recurrent laryngeal n. as it enters the gland.Section of the nerve would result in paralysis of muscles that move the vocal cords on that side. Relations of cervical part of trachea AnteriorlySkinSuperficial fasciaInvesting fa

34、sciaSuprasternal space and jugular archInfrahyoid muscles and pretracheal fasciaIsthmus of thyroid gland ( in front of the 2nd to 4th tracheal cartilage)Inferior thyroid v. and unpaired thyroid venous plexusArteria thyroid ima (if present)Thymus, left brachiocephalic v. and aortic arch in childSuper

35、olaterally lobes of the thyroid gland (down as far as the sixth ring) PosteriorlyEsophagusR. & L. recurrent laryngeal nervesPosterlaterallyCervical sympathetic trunkCarotid sheath气管切开术的解剖要点 气管切开术是将气管颈部前壁切开，插入气管套管，重新建立通畅呼吸道的手术，多为解除严重喉梗阻而行。另外对于昏迷病人、神经系统病人、外伤等患者引起的下呼吸道分泌物阻塞，也需行气管切开，进行吸引，以解除分泌物的梗阻。 手术时患

36、者取仰卧位，肩下垫一小枕使头呈后仰位，使气管更加贴近皮肤，便于术中暴露气管。在体表，上为环状软骨，两侧为胸锁乳突肌前缘，尖向颈静脉切迹的三角为气管切开的安全三角。手术时自环状软骨下缘向下至胸骨上窝处沿颈前中线作一正中切口，依次切开皮肤、颈浅筋膜、颈筋膜浅层（包括胸骨上间隙的前、后两层），向两侧分开舌骨下肌群，再切开气管前筋膜，即可暴露气管。可在第34气管软骨环，插入气管套管。新的呼吸通道即可建立。手术时应注意分离保护甲状腺峡。甲状腺峡一般位于第24气管软骨环前方，应沿其下缘稍行分离，向上牵拉暴露气管，若较宽可将其切断结扎，以充分暴露第3、4气管软骨环。要避免损伤胸骨上间隙内的奇静脉弓必要时可结

37、扎切断；要始终沿气管前正中线进行手术，以免偏离正中线损伤颈部大血管导致大出血。幼儿因其胸腺和头臂静脉主动脉弓等结构位于气管颈部下端前方，高出颈静脉切迹，故在幼儿气管切开时应注意保护。Carotid sheath 颈动脉鞘Formed by components of all three layers of deep cervical fasciaContains common and internal carotid arteries, internal jugular vein, and vagus nerveScalene fissure 斜角肌间隙Formed by scalenus a

38、nterior, scalenus medius, and 1st ribStructures passing through: brachial plexussubclavian artery 第三章 胸部Landmarks of thoraxJugular notch corresponds withThe 2th thoracic vertebra in male, the 3th thoracic vertebra in female Sternal angle corresponds with Connects 2nd costal cartilage laterally The l

39、ower border of 4th thoracic vertebra The bifurcation of trachea in the adultThe beginning of aortic arch which ends posteriorly at the same level The esophagus is crossed by the left main bronchusXiphoid processxiphisternal synchondrosis lies opposite the body of the 9th thoracic vertebraClavicleInf

40、erior fossa of clavicle Coracoid processRibs and intercostal spacesCostal arch Infrasternal angle 胸骨下角 Xiphocostal angle 剑肋角Mammary papilla 乳头 Thoracic wall 胸壁（层次）Superficial structuresSkin Superficial fascia Superficial n.Supraclavicular n.Anterior and lateral cutaneou sbranches of intercostal n. T

41、2 Sternal angle T4 Nipple T6 Xiphoid process T8 Costal arch T10 Umbilicus T12 Midpoint between umbilicus and symphysis pubisSuperficial a.Superficial v.Thoracoepigastric v.胸腹壁静脉Lateral thoracic v.Mamma 乳房StructuresContains skin, mammary glands and adipose tissueConsists of 15 to 20 Lobes of mammary

42、gland 乳腺小叶 that radiate outward from the nipple lactiferous duct 输乳管 lactiferous sinus 输乳管窦 Suspensory ligaments of breast 乳房悬韧带(coopers ligaments): connective tissue septa that extend from the skin to the deep fasciaLymphatic drainage of breastInto pectoral ln. from lateral and central parts of bre

43、astInto apical and supraclavicular ln. from superior part of breastInto parasternal ln. from medial part of breast Into interpectoral ln. from deep part of breastThe lymphatic capillaries of breast form an anastomosing network which is continuous across the midline with that of the opposite side and

44、 with that of the abdominal wallDeep structuresDeep fasciaSuperficial layerDeep layerclavipectoral fasciaMuscles of thoraxPectoralis major 胸大肌Pectoralis minor 胸小肌Subclavius 锁骨下肌Serratus anterior 前锯肌Intercostales externi 肋间外肌Intercostales interni 肋间内肌Intercostales intimi 肋间最内肌Transverses thoracis 胸横肌

45、Endothoracic fascia 胸内筋膜 A thin layer of connective tissue Separates the parietal pleura from the thoracic wallIntercostal spaceEleven spaces between ribsIntercostal musclesIntercostales externi 肋间外肌Extends down and anteriorly from rib above to rib belowReplaced anteriorly by external intercostal me

46、mbrane Action: raise ribs for forced inspirationIntercostales interni 肋间内肌Extends up and anteriorly from rib below to rib aboveReplaced posteriorly by external intercostals membraneAction: depress ribs for forced expirationIntercostales intimi 肋间最内肌 Incomplete, thin, closely applied to intercostales

47、 interni Intercostal a. and v.Posterior intercostals arteries 肋间后动脉subcostal artery 肋下动脉 Intercostal n.Intercostal nerves 肋间神经(anterior rami of T1- T11) Subcostal nerve 肋下神经 (anterior ramus of T12)from superior to inferior: vein, artery, nerve (VAN) 肋间隙结构及血管、神经走行的排列关系及其临床意义肋间后动脉、静脉和肋间神经从脊柱至肋角一段走行不恒定

48、，为避免损伤肋间血管和神经，不宜在肋角内侧进行胸膜腔穿刺。在肋角的外侧，肋间神经上支与肋间后血管伴行，共同走行于肋沟中，其位置自上而下排列顺序为肋间后静脉、肋间后动脉肋间神经上支，肋间神经与肋间后血管的下支共同走行于下位肋上缘，其位置自上而下为排列顺序为肋间神经下支、肋间后动脉下支、肋间后静脉下支。在腋中线以后进行胸膜腔穿刺时应沿下位肋的上缘进针，在腋中线及以前穿刺时，应在肋间隙中部进针。不可在第9肋间隙以下穿刺，可通过膈损伤腹腔器官。临床行胸膜腔穿刺术常选在肩胛线或腋后线第7或8肋间隙进针。Internal thoracic vesselsInternal thoracic a. 胸廓内动脉

49、Internal thoracic v. 胸廓内静脉Cupula of pleura 胸膜顶: extends up into the neck, over the apex of lung, 2.5cm above the medial third of claviclePleural cavity 胸膜腔Potential space between visceral and parietal pleural Contains a small amount of pleural fluidSubatmospheric pressure in itPleura recesses 胸膜隐窝Po

50、tential spaces of pleural cavity which lungs are not occupied in quiet respirationCostodiaphragmatic recess 肋膈隐窝slit-like space between costal and diaphragmatic pleurae on each sideThe lowest area of pleural cavityCostomediastinal recess 肋纵隔隐窝On the left side between the mediastinal pleural and cost

51、al pleuraLower margins of pleura cross the 8th, 10th, 11th ribs, and 12th ribs at the midclavicular lines, the midaxillary lines, scapular line, and the sides of the vertebral column, respectively.Hilum of lung 肺门middle of medial surface, which is a depression where the bronchi, vessels, and nerves

52、enter the lungRoot of lung 肺根ContentsPrincipal bronchusPulmonary artery and veinNerves and lymphatic vesselsSurrounded by connective tissue Order of structures in the root of lung From before backward: V. A. B.From above downward: L: A. B. V.R: B. A. V. Relations of left root of lungAnterior: phreni

53、c n .and pericardiacophrenic vesselsPosterior: thoracic aorta and vagus n.Superior: aortic archInferior: pulmonary lig.Relations of right root of lungAnterior: phrenic n., pericardiacophrenic vessels, superior vena cava, part pericardium, and right atriumPosterior: vagus n.Superior: azygos v.Inferio

54、r: pulmonary lig.The Mediastinum 纵隔ConceptA broad central partition that separates the two laterally placed pleural cavities. It extends from the sternum to the bodies of the vertebrae, and from the superior thoracic aperture to the diaphragm.Subdivisions of mediastinum Superior mediastinum 上纵隔 Loca

55、tingfrom inlet of thorax to plane extending from level of sternal angle anteriorly to lower border of T4 vertebra posteriorlyContentsSuperficial layerThymusThree veins Left brachiocephalic v.Right brachiocephalic v.Superior vena cavaMiddle layer Aotic arch and its three branchesPhrenic n.Vagus n.Pos

56、terior layerTrachea Esophagus Thoracic ductInferior mediastinum下纵隔Anterior mediastinum 前纵隔Location Posterior to body of sternum and attached costal cartilages, Anterior to heart and pericardiumMiddle mediastinum 中纵隔Locationbetween anterior mediastinum and posterior mediastinumPosterior mediastinum 后

57、纵隔Location Posterior to heart and pericardium, Anterior to vertebrae T5T12Relations of aortic archAnteriorly and to the left PleuraLungPhrenic n. Pericardiacophrenic vessels Vagus n.Posteriorly and to the right TracheaEsophagusLeft recurrent laryngeal n.Thoracic ductDeep cardiac plexusSuperiorlyIts

58、three branchesLeft brachiocephalic v. thymusInferiorlyPulmonary a.Arterial ligament Left recurrent n.Left principal bronchus Superficial cardiac plexusTriangle of ductus arteriosus 动脉导管三角BoundariesLeft phrenic n.Left vagus n. Left pulmonary a. ContentsArterial ligamentLeft recurrent n. Superficial c

59、ardiac plexusesRelations of esophagus(胸段) AnteriorlyTrachea Bifurcation of tracheaLeft principal branchusLeft recurrent laryngeal n.Anterior esophageal plexusPericardiumLeft atriumDiaphragm PosteriorlyPosterior esophageal plexusThoracic aortaThoracic ductAzygos v.Hemiazygos v.Accessory hemiazygos v.

60、Right posterior intercostal a.LeftLeft subclavian a. Aortic archSuperior part of thoracic duct Left mediastinal pleuraThoracic aorta RightArch of azygos v.Right mediastinal pleura第四章 腹部Landmarks of abdomenXiphoid process 剑突Costal arch 肋弓Anterior superior iliac spine 髂前上棘Iliac crest 髂嵴Pubic symphysis