局部解剖学 3 Regional anatomy of the upper limb for 8yrs2 学习资料

Regionalanatomyofupperlimb

丁兆习山东大学医学院人体解剖学教研室Office:1205dingzhaoxi@Partsandregions

Shoulderregion－junctionofarmandtrunkArm－betweenshouldandelbowElbow－bendofarm,jointbetweenarmandforearmForearm－betweenelbowandhandHand★SurfaceanatomyShoulderregion:acromion,spineofscapula,coracoidprocess,greatertubercle,anteriorandposterioraxillaryfoldsArm:medialandlateralbicepsbrachiifurrow,deltoidtuberosity

Elbow:medialandlateralepicondylesofhumerus,headofradius,olecranon,tendonofbicepsbrachiiForearmHand:styloidprocess,dorsaltubercleMensuration

Carringangle

提携角Whentheelbowisextendedwiththeforearmsupinated(anatomicalposition),theforearmisdirectedsomewhatlaterally,formingacarryingangleofabout10º~15º.Thesupplementary

angleisabout165ºinthefemaleand175ºinthemale直肘straightelbow

：carryingangleisbetween0º~10º。肘内翻inversionofelbow

：carryingangleissmallerthan0º~-10º。肘外翻enversionofelbow：carryingangleislargerthan20º。Mensuration

Posteriorcubitaltriangle

Whentheelbowisbeentoarightangle,theolecranon,medialandlateralepicondylesofthehumerusformanisoscelestriangle(Posterior

cubitaltriangle).Whentheelbowisstraightedouttoafullextension,theylieinthesamehoriaontalplaneDuringthedislocationofelbowjoint,theirrelativepositionwillbechanged.Lateralcubitaltriangle：Inflexion900,lateralepicondylesandtheheadofradiusandthetopoftheolecranonprocessformtheboundariesofanequilateraltriangleSurfaceprojectionAxillarya.andbrachiala.whenthearmisabductedtoarightangle,thelinedrawingfromthemidpointofclavicletoapoint2cmbelowthemidpointofanteriorcubitalgrainoftheelbow.在锁骨中点至肘前横纹中点远侧2cm处的连线上。

Radiala.alinedrawingfromthepoint2cmbelowthemidpointofanteriorcubitalgrainoftheelbowtothestyloidprocessofradius.肘前横纹中点远侧2cm处至桡骨茎突的连线上。SurfaceprojectionUlnara：Thelinedrawingfromapoint2cmbeyondthecenterofthebendoftheelbowcurvesdownwardstotheradialborderofthepisiform.肘前横纹中点远侧2cm处至豌豆骨桡侧的连线上。

Mediann：

ThecourseofmedianN.inthearmissimilartothatofthebrachiala.intheforearm,Itispresentedbyalinefromthepointmedialtothepulsationofthebrachaiala.attheelbowtothepointbetweenthetendonofpalmaris

longusandflexorcapi

radialisatthewrist在臂部与肱动脉一致，在前臂位于内上髁与肱二头肌腱连线中点至腕横纹中点。UlnarN.：Mappedbyalinedrawingfromapointmedialtothecorocobrachalisatthelowerborderoftheteremajortothemedialepicondyleofhumerusattheelnbow,andtothelateralborderofthepisiformboneatthewrist.大圆肌下缘与喙肱肌交点内侧至肘窝肱骨内上髁，再到豌豆股外侧缘的连线SurfaceprojectionAnatomicalsnuffbox

鼻烟壶Whenthethumbisabductedandextended,atriangularhollowappearsbetweenthetendonoftheextensorpollicislongsmediallyandthetendonsoftheextensorpollicis

brevisandabductorpollicis

longuslaterally.Thefloorofthesnuffboxisthescaphoidandtrapeziumbonesandcrossedbytheradiala.SuperficialstructuresSkinSuperficialfasciamammaryglandsCephalicv.Supraclaviclularn.Ant.cutaneousbr.ofintercostaln.lat.cutaneousbr.ofintercostaln.DeepstructuresPectoralismajorPectoralisminorClavipectoralfasciaAnteriorregionofthorax

Mamma乳房PositionLieinsuperficialfasciaoverthepectoralsmajorandpectoralfasciaExtendfrom3rdto7thribsvertically,andfromparasternallinetomidaxillarylinetransversallyClinicaltips：腋突axillaryprocessofmamma

隆胸breastimplantMamma乳房Structuresskin,mammaryglandsandadiposetissueEachbreasthasabout15～20lobesofmammaryglandEachloberadiatesoutfromthenippleandhasalactiferousduct输乳管

whichopensseparatelyonthesummitofthenippleandpossessesadilatedlactiferoussinuses输乳管窦

justpriortoitsterminationClinicaltips：乳腺炎mastitisMamma乳房Suspensoryligamentsofbreast乳房悬韧带(Cooper’sligaments)－strandsofconnectivetissuerunsbetweenskinanddeepfasciaandservetosupportthemammaryglandsClinicaltips：桔皮样变orangeskin★Lymphdrainageofbreastlateralandcentralpartsofbreastpectoralln.superiorpartofbreastapicalandsupraclavicular

ln.medialpartofbreastparasternal

ln.deeppartofbreastIntointerpectoral

ln.andsuperiorphrenic

ln.ThelymphaticcapillariesofbothbreastformananastomosingnetworkacrossthemidlineandwiththatoftheabdominalwallClinicaltips：乳腺癌breastcarcinomaAxillaryregion腋区TheAxillaisapyramidregionsituatedbetweenthelateralsurfaceoftheupperchestwallandthemedailsideofthearm.Theskinundertheshoulderjointisconvexupwards,termedaxillary

fossa(armpit)Axillarycavityisapyramid-shapedspacedeeptothearmpit,throughwhichmajorneurovascularstructurespassbetweenthethoraxandupperextremity★BoundariesoftheAxillaryCavityAnteriorwall:

Pectoralismajor,pectoralisminorandsubclaviusmuscles,ClavipectoralfasciaPosteriorwall:

latissimus

dorsi,teresmajor,subscapularisandscapulaMedialwall:

serratusanterior，intercostalmusclesandupperfourribsLateralwall:

coracobrachialis,bicepsbrachiiandintertuberculargroove★BoundariesoftheAxillaryCavityApex

atriangularspacelimitedbythefirstrib,thescapula,andthemiddlethirdofclavicle.Baseskinandfasciaofaxillary

fossastretchingbetweentheanteriorandposteriorwallsBoundariesoftheAxillaryCavityTheanteriorwallpectoralismajorpectoralisminorsubclaviusmuscles★Clavipectoralfascia

锁胸筋膜Thedeepfasciawhichextendsbetweensubclavius,coracoidprocessandpectoralisminormusclesThestructurespassthroughtheclavipectoralfasciaCephalicv.头静脉Thoracoacromiala.胸肩峰动脉Lateralpectoraln.胸外侧神经BoundariesoftheAxillaryCavityPectoralismajor

Location:anteriortotheupperpartofthechestOrigin:medialhalfoftheclavicle,anteriorsurfaceofthesternumand1-6thcostalcartilagesInsertion:crestofthegreatertubercleAction:

flexes,adductsrotatesthehumerusmediallydrawthebodyupward(armfixed)elevatestheribs(scapulafixed)BoundariesoftheAxillaryCavityPectoralisminor

Location:deeptothepectoralismajorOrigin:3-5thribInsertion:

acromoidprocessAction:drawtheshoulderforwardBoundariesoftheAxillaryCavityTheposteriorwallSubscapularis

肩胛下肌Teresmajor大圆肌Latissimus

dorsi

背阔肌Scapula肩胛骨

BoundariesoftheAxillaryCavityTheposteriorwall★Trilateralforamen三边孔Spaceboundedbyteresminor,subscapularissuperiorly;teresmajorinferiorlyandlongheadoftricepsbrachiilaterallyTransmitcircumflexscapulara.v.★Quadrilateralforamen

四边孔

Spaceboundedbyteresminor,subscapularissuperiorly;teresmajorinferiorlyandlongheadoftricepsbrachiimediallyandsurgicalneckofhumeruslaterally.Transmittheposteriorhumeralcircumflexa.v.andaxillaryn.BoundariesoftheAxillaryCavityThemedialwall(broad)serratusanteriorintercostalmusclesupperfourribsBoundariesoftheAxillaryCavitySerratusanterior

Location:lateraltothechestOrigin:1-8/9thribInsertion:ScapulaAction:DrawthescapulaforwardBoundariesoftheAxillaryCavityThelateralwall(narrow)CoracobrachialisBicepsbrachii

IntertuberculargrooveBoundariesoftheAxillaryCavityMusculotendinouscuff肌腱袖Thenamegiventothetendonsofsupraspinatus

冈上肌,infraspinatus

冈下肌,teresminormuscles小圆肌,andsubscapularis

肩胛下肌，whicharefusedtotheunderlyingcapsuleoftheshoulderjointontheanterior,superiorandposteriorwall.Thecuffisimportantinstabilizingtheshoulderjoint★

Contentsinaxillary

fosssaAxillarya.andprincipalbranchesAxillaryv.andtributariesBrachialplexusandbranchesAxillarylymphnodes

LooseconnectivetissueAxillarysheath★AxillaryarteryContinuationofsubclavianarteryatlateralborderoffirstribBecomesbrachialarteryatlowerborderofteresmajorDividedintothreepartsbyoverlyingpectoralisminorsuperiorthoracica.

胸上动脉

thoracoacromiala.胸肩峰动脉lateralthoracica.

胸外侧动脉subscapulara.肩胛下动脉throcodorsala.胸背动脉

circumflexscapulara.旋肩胛动脉anteriorcircumflexhumerala.旋肱前动脉posteriorcircumflexhumerala.旋肱后动脉★AxillaryarteryRelationshipofaxillarya.1stsegmentAnterior:

pectoralismajor,Clavipectoralfascia,andthestructurespassthroughtheclavipectoral

fascia(Cephalic

v.,Thoracoacromiala.andv.,Lateralpectoraln.)Posterior:Medialcordofbrachialplexus,longusthoracicnerveLateral:LateralandPosteriorcordofbrachialplexusMedial:axillaryv,superiorthoracica,apicallymphnodes★Axillaryartery2ndsegmentAnterior:

pectoralismajor,pectoralisminorPosterior:

Posteriorcordofbrachialplexus,subscapularisLateral:

Lateralcord,Medial:

medialcordofbrachialplexus,axillaryv,★Axillaryartery3rdsegmentAnterior:

pectoralismajor,medialrootofmediann.Posterior:

radialn.,axillaryn.posteriorcircumflexhumerala.andv.,subscapularis,latissimus

dorsi,tendonofteresmajor

Lateral:

Lateralrootofmediann.,Musculocutaneousn.bicepsbrachii(shorthead),coracobrachialis

Medial:

axillaryv,

ulnarn.,Medialantebrachial

cutaneousn.Axillaryvein腋静脉Axillaryvein

腋静脉Continuedwithbrachialveinatthelowerborderoftheteresmajor.Runsupwardonthemedialsideoftheaxillary

artery.EndsatthelateralborderofthefirstribbybecomingthesubclavianveinRelationship:Laterally:

axillarya.,medialcordofbrachialplexus,ulnarn.andantebrachial

cutaneousn.Medially:medialbrachialcutaneousn.Brachialplexus臂丛

FormationFiverootsformedbyanteriorramiofC5-C8andT1spinalnerves.ThreetrunksTheuppertrunkisformedbythejoiningofrootC4,C5,C6.ThemiddletrunkisthecontinuationofrootC7.ThelowertrunkisformedbythejoiningofrootC8andT1.Sixdivisions:aboveclavicle,trunksformanteriorandposteriordivisionsThreecords:belowclavicle,divisionsformthreecordsthatsurroundthesecondportionofaxillarya.Brachialplexus臂丛

Position

Passesthroughthescalenefissureposterosuperiortosubclavianartery,thenenterstheaxillatoformthreecordsBrachialplexus臂丛MainbranchesofSupraclavicularpartLongthoracicn.

胸长神经ArisefromRootsC5～C7companieswiththelateralthoracica.,suppliesserratusanteriorParalysisoftheserratusanterior:Whentheserratusanteriorparalyzedbecauseofinjurytothelongthoracicnerve,themedialborderofthescapulamoveslaterallyandposteriorlyawayfromthethoracicwall,givingthescapulatheappearanceofawing.Suprascapularn.肩胛上神经

Arisefromsuperiortrunktosupraspinous

fossaBrachialplexus臂丛MainbranchesofinfraclavicularpartLateralcord

Musculocutaneousn.肌皮神经Lateralroottomediann.正中神经外侧根Lateralthoracicn.胸外侧神经Medialcord

Medialroottomediann.正中神经内侧根Ulnarn.尺神经medialthoracicn.胸内侧神经Medialbrachialcutaneousn.臂内侧皮神经Medialantebrachial

cutaneousn.前臂内侧皮神经Posteriorcord

axillaryn.腋神经radialn.桡神经thoracodorsaln.胸背神经subscapularn.

肩胛下神经Brachialplexus臂丛Posteriorcord

axillaryn.腋神经radialn.桡神经thoracodorsaln.胸背神经subscapularn.

肩胛下神经★Axillarysheath腋鞘Extensionofdeepcervicalfasciaoftheneckintotheaxillaandformingatubularsheaththatsurroundsaxillarya.,axillaryv.andbrachialplexusClinicaltips：

Brachialplexusanesthesia锁骨下臂丛麻醉

Spreadofinflammation感染蔓延★AxillarylymphnodearrangedinfivegroupsLaterallymphnodesliearoundthedistalendofaxillaryarteryveinreceiveafferentvesselsfromupperlimb.Pectorallymphnodesliealonglateralthoracicvessels,receiveafferentsfromanteriorthoracicwallincludingcentralandlateralportionofmammaSubscapularlymphnodealongsubscapularvesselsreceivelymphfromnapeandscapularregionEfferentsofabovethreegroupspasstocentrallymphnode★AxillarylymphnodeCentrallymphnodelieinfatofaxillary

fossareceivelymphfromalltheabovenodes,efferentspasstoapicallymphnodeApicallymphnodelieintheapexoftheaxilla,alongtheproximalendofaxillaryvesselsreceiveafferentschieflyfromcentrallymphnode,upperportionofmammaefferentsoftheapicalln.formsubclaviantrunk.Therightsubclaviantrunkjointstherightlymphaticduct,leftoneusuallydrainsdirectlyintothoracicductAnteriorbrachialregion臂前区SuperficialstructuresSkinSuperficialfasciaCephalicvBasilicvCutaneousn.Sup.Lat.brachialcutaneousn.臂外侧上皮神经(fromaxillaryn.)Inf.Lat.brachialcutaneousn.臂外侧下皮神经(fromradialn.)Intercoastobrachialn.肋间臂神经Medialbrachialcutaneousn.臂内侧皮神经Medialantebrachial

cutaneousn.前臂内侧皮神经Superficial

veinsoftheupperlimb

★

Cephalicvein

头静脉Arisesfromthelateralsideofthedorsalvenousreteofhand

Windsaroundthelateralborderoftheforearm;itthenascendsintothecubital

fossaandupthefrontofthearmonthelateralsideofthebicepsbrachiiItcontinuesupinthedeltopectoralgrooveandthenpiercesdeepfasciatodraininto

axillaryveinorsubclavianvein头静脉贵要静脉肘正中静脉前臂正中静脉头静脉Superficial

veinsoftheupperlimb★

Basilicvein贵要静脉ArisesfromthemedialsideofthedorsalvenousreteofhandWindsaroundthemedialborderoftheforearmThenascendsintothecubital

fossaandupthefrontofthearmonthemedialsideofthebicepstomiddleofthearmwhereitpiercesthedeepfasciaandjoinsthebrachialveinoraxillaryvein头静脉贵要静脉肘正中静脉前臂正中静脉头静脉DeepstructuresDeepfascia

EnclosesthearmandsendsintermuscularseptabetweenthevariousgroupsofmusclestoallowthemtoslideoneachotherandtogiveanincreasedareaoforiginfortheirfibersThelateralandmedialintermuscularseptadividethedistalpartofthearmintoanteriorandposteriorosseofascialcompartments

Contentsofanteriorosseofascialcompartmentofthearm

Muscles肱二头肌bicepsbrachii

喙肱肌coracobrachialis

肱肌brachialis

brachiala.andv.deepbrachiala.andv.superiorulnarcollaterala.inferiorulnarcollaterala.musculocutaneousn.

Lateralantebrachial

cutaneousn.Mediann.Ulnarn.medialbrachialcutaneousn.medialantebrachial

cutaneousn.

ContentsofanteriorosseofascialcompartmentofthearmBicepsbrachii

肱二头肌

Coracobrachialis

喙肱肌Brachialis

肱肌ContentsofanteriorosseofascialcompartmentofthearmBrachialartery

肱动脉BeginsatthelowerborderoftheteresmajorasacontinuationofaxillaryarteryTerminatesoppositetheneckofradiusbydividingintoradialandulnararteriesBranchesDeepbrachiala.

肱深动脉

FollowstheradialnerveintothespinalgrooveofthehumerusSuperiorulnar

collaerala.

尺侧上副动脉

followstheulnarnerveInferiorulnarcollaterala.尺侧下副动脉

Takespartintheanastomosisaroundtheelbowjoint.Clinicaltips:presstostopbloodflowContentsofanteriorosseofascialcompartmentofthearmMusculocutaneousnerve

肌皮神经Origin:arisesfromthelateralcordofthebrachialplexus.Distribution:

BicepsbrachiiBrachalis

BBCnerve

Coracobrachialis

lateralantebrachial

cutaneousn.前臂外侧皮神经

Atthelateralmarginofbicepstendonitpiercesthedeepfasciajustabovetheelbow,thenrunsdownthelateralaspectoftheforearmSupplyskinonanterioraspectofforearmContentsofanteriorosseofascialcompartmentofthearmMediannerve

正中神经Origin：ArisesfromthemedialandlateralcordofthebrachialplexusCourseDescendsonthelateralsideofbrachialarteryHalfwaydownthearm,itcrossesthebrachialarterytoreachitsmedialsideContentsofanteriorosseofascialcompartmentofthearmUlnarnerve

尺神经OriginArisesfromthemedialcordofthebrachialplexusCourseDescendsonthemedialsideofbrachiala.Atthemiddleofthearm,itpiercesthemedialintermuscularseptumandpassesdownbehindthemedialepicondyleofthehumerusAnteriorregionoftheelbowSuperficialstructuresSkinSuperficialfasciaCephalicvBasilicvMediancubitalvLateralantebrachial

cutaneousn.Medialantebrachial

cutaneousn.SupratrochlearlymphnodesClinicaltips：thesupericialveinsarebig,fixedandsuperficial,aoptimalsiteforIntravenouspuncture静脉穿刺andcatheterization导管插入术DeepStructures★

Cubital

fossa

肘窝★

Boundaries

Base－linedrawnthroughepicondylesofhumerusApex－brachioradialislaterallyandpronator

teresmediallyRoof－skin,superficialfascia,deepfasciaandaponeurosisofbicepsbrachiiFloor－brachialis,supinatorandcapsuleofelbowjoint★ContentsMiddle:Tendonofbicepsbrachii,

aponeurosisofbicepsbrachiiMedialtothebicepsbrachiitendon－fromlateraltomedialBrachiala.

－dividesintoradialandulnara.attheapexoffossaBrachialv.Mediann.Lateraltothebicepsbrachiitendonradialn.lateralantebrachial

cutaneousn.AnteriorregionoftheforearmSkinSuperficialfascia★Cephalicv.★Basilicv.Medianantebrachialv.Lateralantebrachial

cutaneousn.Medialantebrachial

cutaneousn.SuperficialstructuresDeepstructuresDeepfasciaintermuscularseptumandosseofibroussheathContentsofanterior

osseofascialsheathoftheforearmMuscle(9)Bloodsupplytothemuscles:ulnararteryandveinradialarteryandveinNervesupplytothemuscles:mediannerveulnarnerve

RadialnerveDeepbranchSuperficialbranchContentsofanterior

osseofascialsheathoftheforearmMuscle(9)Bloodsupplytothemuscles:ulnararteryandveinradialarteryandveinNervesupplytothemuscles:mediannerveulnarnerve

Contentsofanterior

osseofascialsheathoftheforearmMusclesinforearm(anterior)SuperficiallayerBrachioradialis

肱桡肌Pronator

teres

旋前圆肌Flexorcarpi

radialis

桡侧腕屈肌Palmaris

longus

掌长肌Flexorcarpi

ulnaris

尺侧腕屈肌Secondlayer指浅屈肌flexordigitorum

superficialisContentsofanterior

osseofascialsheathoftheforearmSecondlayerflexordigitorum

superficialis

指浅屈肌Thirdlayerflexordigitorum

profundus指深屈肌flexorpollicis

longus拇长屈肌FourthlayerPronator

quadratus旋前方肌Contentsofanterior

osseofascialsheathoftheforearmRadialartery

桡动脉Begins:branchofbrachiala.attheleveloftheneckofradiusinthecubital

fossa

Course:

passesdownwardandlaterallybetweentheBrachioradialisandPronatorteres(upper1/3),Flexorcarpi

radialis(lower2/3)BranchesRadialrecurrenta.桡侧返动脉Superfical

palmarbranch

掌浅支Principalarteryofthumb

拇主要动脉Contentsofanterior

osseofascialsheathoftheforearmUlnarartery

尺动脉Begins：branchofbrachiala.attheleveloftheneckofradiusinthecubital

fossa

Course:passesdownwardandmediallydeeptothepronator

teres,flexordigitorum

superficialis(upper1/3)，thenbetweenflexordigitorum

superficialisandFlexorcarpi

ulnaris(lower2/3)BranchesUlnarrecurrenta.

尺侧返动脉Commoninterosseousa.

骨间总动脉Anteriorinterossousa.骨间前动脉Posteriorinterosseousa.骨间后动脉Deeppalmarbranch

掌深支Contentsofanterior

osseofascialsheathoftheforearmMedian正中神经CoursePassesbetweenthetwoheadsofthepronator

tereswheregivesrisetotheanteriorinterosseousnerve.Itcontinuesdownwarddeeptotheflexordigitorum

superficialisAtthewrist,itrunsdeeptopalmaris

longusandbetweenthetendonsofflexordigitorum

superficialisandflexorcarpi

radialis,thenentersthepalmbypassingbehindtheflexorretinaculumDistributionFlexorofforearmexceptbrachioradialis,flexorcarpi

ulnarisandulnarhalfofflexordigitorum

profundusContentsofanterior

osseofascialsheathoftheforearmUlnarnerve尺神经

CoursePassesfrombehindthemedialepicondyleofthehumerus,andentersthefrontoftheforearmbypassingbetweenthetwoheadsoftheflexorcapiulnaris.Inthedistaltwo-thirdoftheforearm,theulnararteryliesonthelateralsideoftheulnarnerve.Atthewrist,itentersthepalmofthehandpassinginfrontoftheflexorretinaculumandlateraltothepisiformboneDistributionFlexorcarpi

ulnarisandulnarhalfofflexordigitorum

profundusContentsofanterior

osseofascialsheathoftheforearmSuperficialbranchoftheradialnerve桡神经浅支CourseRunsdownonthelateralsideoftheradialarteryInthedistalpartoftheforearm,itleavesthearteryandpassesbackward,reachestheposteriorsurfaceofthewristandhandDistribution:

brachioradialis

Contentsofanterior

osseofascialsheathoftheforearm★

Nerve-bloodvesselboundsinforearmUlnarn.andbloodvesselboundulnarnerveulnararteryandulnarvein.Radialn.andbloodvesselboundsuperificalbranchofradialnerveradialarteryandradialveinMediann.andbloodvesselboundmediann.mediaa.andv.Anteriorinterosseousn.bloodvesselboundanteriorinterosseousnerveanteriorinterosseousarteryandveinAnteriorRegionofWristSuperficialstructureDeepstructureDeepfasciaSuperficiallayer

-palmarcarpallig.(volarcarpallig.)

coversallofthelongtendonsofthisregionDeeplayer

-flexorretinaculum（transversecarpallig.）Thickeningpartofdeepfasciainthehand.Attachedlaterallytoscaphoidandtrapeziunandmediallytopisiformandhamate，enclosesthelongtendonsofforearmexceptthepalmaris

longusandtheflexorcarpi

ulnaris★

Carpalcanal

腕管Anosseofibroustunnelformedbyflexorretinaculumandthegrooveofthecarpalbonestransmits

mediann.,tendonsofflexordigitorum

supericialis,tendonsofflexordigitorum

profundus,andtendonofflexorpollicus

longusfromforearmintohandAnteriorRegionofWristAnteriorRegionofWristUlnarcarpalcanal:theulnarendoftheflexorretinacumattachedtothepisiformandthehookofhamateandformstheulnarcarpalcanalwiththedistalpartofpalmarcarpal

lig.totransmittheulnarnerveandbloodvesselsRadialcarpalcanal:theradialendoftheflexorretinacumdividedintotwolayersandattachedtothetubercleofscaphoidandtrapezium,andformstheradialcarpalcanaltotransmitthetendonandtendoneoussheathoftheflexorcarpi

radialisAnteriorRegionofWristCommonflexorsheathTeninoussheathofflexorpollicis

longusAnteriorRegionofWrist手掌palmSkinSuperficialfasciaDeepfasciaTheosseofascialcompartmentofpalmMusclesofthehandBloodvesselsNervesPalmar

fascialspace手掌palmSkinSuperificialfasciaPalmar

cutaneous

brancheofulnarn.Palmar

cutaneous

brancheofmediann.Superficialbranchofradialn.Lateralantebrachial

cutaneousn.手掌palmDeepfasciaeThesuperficiallayerofdeepfasciaPalmar

aponeurosisThenarfasciaHypothenarfasciaWebspaceThedeeplayerofdeepfasciaPalmar

interosseousfasciaFasciaofadductorpollicisSeptumLateralintermuscularseptumofpalmMedialintermuscularseptumofpalm★

TheosseofascialcompartmentsofpalmLateral(thenar)compartment:外侧鞘(鱼际鞘)thenar

muscle(exceptfortheadductorpollicis)Tendonandtendinoussheathofflexorpollicis

longusBloodvesselsandnervesofthethumb★

Intermediate(central)compartment

中间鞘tendonsofflexordigitorum

superficialisandprofundus,andlumbricalescommonflexorsheathsuperficialpalmararchbranchesofmediann.andulnarn.palmarfasciaspaceMedial(hypothenar)compartment内侧鞘(小鱼际鞘)HypothenarmusclesBloodvesselsandnervesofthelittlefinger

Theosseofascialcompartmentsofpalm★

PalmarfasciaspaceLocatedintheintermediatecompartmentofpalmonthefasciaofinterosseiandadductorpollicis.Thepalmar

intermediate(midpalmar)septumpassthemedialsideofflexortendonsofindexfingerandthefirstlumbricalmuscletothethirdmetarcarpalboneanddividesthespaceintotwoportionsThemidpalmarspace掌中间隙

proximallycommunicatewiththedeepspaceofforearmthroughthecarpalcanal,distallycommunicatewiththe2,3,4lumbricalcanalstotheweb’sspaceandthebackofthefingersThethenarspace鱼际间隙

blindatproximalend,distallycommunicatewiththebackoftheindexfingerbythefirstlumbricalcanal.手掌palmMusclesofthehandLateralgroup－thenar鱼际(4)Abductorpollicis

brevis拇短展肌Flexorpollicis

brevis

拇短屈肌Opponens

pollicis

拇对掌肌Adductorpollicis

拇收肌Medialgroup－hypothenar小鱼际(3)Abductordigiti

minimi

小指展肌Flexordigiti

minimi

brevis小指短屈肌Opponens

digiti

minimi小指对掌肌IntermedialgroupLumbricales(4)蚓状肌Palmar

interossei(3)骨间掌侧肌Dorsalinterossei(4)骨间背侧肌手掌palmBloodvesslesSuperficialpalmararch掌浅弓Formedby

ulnara.andSuperficialpalmarbranchofradialartery.Crosstheflexortendonanddigitalbranchesofmediann.superficially.Branchescommonpalmardigitalarteries指掌侧总动脉properpalmardigitalarteries指掌侧固有动脉properpalmardigitalarteryof5thfinger小指掌侧固有动脉手掌palmDeeppalmararch

掌深弓Formedbyradiala.anddeeppalmarbranchofulnara.Liesacrossthemetacarpalbonesjustdistaltotheirbases,accompaniedbythedeepbrabchesofulnarn.andv.Branchespalmarmetacarpalarteries掌心动脉手掌palmNervesofthehandTheulnarnerveDeepbranchSuperficialbranchesCommonpalmardigitaln.--properpalmardigitaln.Supply--

hypothenarmuscles,interossei,3rdand4thlumbricalsandadductorpollicis;skinofhypothenar,palmarsurfaceofulnaroneandone-halffingersMediannerveRecurentbranchCommonpalmardigitaln.--properpalmardigita