临床颅脑外伤相关应用解剖

PARTTHREE脑血管的应用解剖PARTTOW颅骨与脑的应用解剖PARTONE头皮的应用解剖/01

头皮的应用解剖头皮局麻时肾上腺亲配用方法参考《MCDEX中国医师的师临床用指南第2版》

盐酸肾上腺素注射液

1ml:1mg.总量不超过・.3mg配

局

有

药

浓

康:

2

~

5

/

m老用100m生理盐水配,“上程.2~0.3ml

若用50生现尘水

化上腺素.

1~.5m皮下层Hair

头发Sin(1)皮

肤Connectivetisue(2)结

缔

组

织Btenionofepicranial帽

状

腱

膜

的aponeurosis(3)

延

伸Temporalfacia(4)颞

筋

膜Temporalismuce(5)颞

肌Pricranium(6)颅骨骨

膜Muscleof

auricde耳

肌Zygomutieach

颧

弓Cfrmoandproce下颌骨冠状突Fig.3.7

Layers

of

the

soft

tissue

in

the

temple.颞部软组织层次1.1、浅筋膜层与局麻Layersof

soft

tissue

in

templefrontalisMusceSupraorbital

Nerve

(V1)Orbicularis

Oculi

Muscle

ZygomaticofacalkinTissueInfraorbitalNerveV2)OrbicularisOrs

MuscleFatPadGreaterMental

Nerve

(V3)ugurveBuccalNervePlatyunaTranverseCervicalNerve(C2-3)Supracdawicular

Nerve(C3-4)Frontals

MuscleTemporoparietal

FasciaSubcutaneous

TissueTemporalisMuscularFasciaPalpebral

BranchofLacrimal

NerveFrontal

DwislonofFacial

Muscie(cut)SuperficialTemporalArteryfcut)Zygomatk+ArchParoto-kZygomaticusMinor

MusceZygomaticusMajor

MusceMarginalFacial

NerveExternalugularVeinSternocdeidomastoldMuwcleariFaxcmasat1.2、

帽状腱膜-颞顶筋膜，张力所FIG.1.2.A:Musclesof

the

face

and

scalp.(From

CheneyMLFacia/Surgery:PlasticandReconstructive.Baltimore:Wiliam&Wi

kins,1991,with

permission)Facial

ArteryLablal

ArterySubdermalVascular

PexunMalarFat

PadMental

NerveGaleaMalar1.3、疏松结缔组织层与皮瓣转移中间脂肪垫Intermediate

fat

pad-

颞深筋膜Deep

temporal

fascia颞

深

脂

肪

垫bocoptemporalfatpod-颞

肌Tomporalsmusce颊脂肪垫Bichats

fat

pad一咬

肌

Massetermuscle—

腮

腺Parotid

gland—1.4、

颞肌筋膜=颞深筋膜=颞筋膜Facialnerve面神经—Zygomaticarch

颧

弓Skin皮肤SMAS浅表肌肉腱膜

系统IntermediatetemporalfasciaSuperficialtemporalfascia中间颞筋膜题浅筋膜—Frontalis

muscle

额肌浅脂肪垫Temporal.fascia

properSuperficialfat

pad颞筋膜面神经颞支颞浅动脉额支颧弓额肌Front.M.一眼轮匝肌orble.Ocul

M—额肌

Front.

M

.——蹶上线Sup.Temp.

Lno筋膜间

Interfascial

Fat

Pad—脂肪垫面神经颞支Galea帽状腱膜Sup.Temp.

Line

颞上线

CNVIl

m).B3.面神经颞支—Temp.

FasclaDeopLayer—

Temp

.FasolaSuperf.L

ayer通过从耳屏

(tragus)

下方0.5cm

点到外眉

(lateraleyebrow)

上方2

cm点画第一条线。

第二条线

沿着颧骨

(zygoma)画到眶外侧缘

(lateralorbitalrim)。第三条线

从眉毛

(eyebrow)上方的点开始，穿过眉毛的外侧端，

一直延伸到颧骨。这三条线定义了一个三角形

(右图示：其中面神经颞支位于颞顶筋膜-SMAS层的下表面，很容

易受到损伤)。1.5、面神经额颞支、脂肪垫颞筋膜

深层颞筋膜

浅层1.6、颞肌的保护P-DIAM-DTNTMP-TNMNFoLPM1.7、骨膜可作为颅底修补的重要材/02

颅骨的应用解剖A

BC2.1、认识骨缝利于骨折的辨认Serrate

suturesuturePlaneopisthion一baselinesigmoidsinus

sella

turcicaTabke1.3

Dinenskns

from▶

Fig.1.6Dimemsion(

Fg.1.6)DeseriptionLower

imit

(mm)Average(mm)Upper

limit

(mm)DIkngthoffroetzal

hom

anerior

to

FM25D2dstancefromckus

to

fhoorof

4轴h

venrick

at

kvel

of

fastigium²33.336.140.0D3kngth

of4h

ventricke

at

kevel

of

fasigim²10.014.619.0D4dstance

fron

fastygiunm²to

opisthion30.032.640.02.2、颅骨标志与脑的定位关系sL

ke8-

i-

7-dF

nle

dwm

V

kaD

D44ai

DFrankturplaneposteriorear

line

condylarline2cm4.Fe18gb

hicentrasulcussgumabrtal赣臂鳞部额中缝sutua

metopkcaasspraiari经鸢最突额骨鳞部squamarbntalis颞线2omporalis额骨颧突proc0ssuszygomabous√

鳞部×1√

鼻部×1

√

眶板×2

√

颧突×22.3.1、各颅骨特点——额骨筛切迹inoisuraehmoidaspars

orbtais

眶部ANATOMY

STANDARDANATOMY

STANDARD图片来自：

https//wwanatomystandavd

com/Cranum/Neurocranum/Frontalhtmlpro005503腔上切迹

supraobtais额骨顶缘mrgopanietais眶部parsorblalis新切造inoisura

fortahs降辣tpina

nasalszygomaicusmargo

nasalsforamenspraottalenci

s

ura■

Two

surfaces:external

andinternal.■

Four

borders:superior

(sagittal),inferior,anterior,and

posterior.■Fourangles:frontal,sphenoidal,occipital,and

mastoid.2.3.2、各颅骨特点——顶骨2.3.3、各颅骨特点——枕骨■

不规则■含气骨■位于颅骨两侧和颅底■

纵向骨折、横向骨折咽鼓管Tubuauditiva颈内动脉inten耳蜗Cochles面神经N.facdalis蜗

神

经N.

cochlearis前庭神经N.vestibularis耳前庭Vestbulum蜗小管

cochleae内淋巴囊Slya

sa

i

-Canalis后半规管se

si

rlarisoutecirpomsoudkntemphccu鼓室Cavitas

tympaniMalleus锤骨Incus砧

骨前半规管dircularisanteriorMeatusacusticus外

耳

道Canalisseml-

外半规管

circularis

lateralis

l

ai

eae乳突小房Auricu耳廓

soideus

乙状窦gmnusiSidestolulaemC2.3.4、各颅骨特点——颞骨extenus2.3.5、各颅骨特点——蝶骨视神经管Opticcanal眶上裂Superior

orbitalfissure

圆孔Foramenrotundum卵圆孔Foramenovale棘孔ForamenspinosumBody

体Lesserwing小

翼

Greaterwing大

翼

Pterygoidprocess翼突翼突外板Lateralplate翼突内板MedialplateCribriformplateAnteriorcranial

fossaBhmoid

bone,orbitalplate上鼻甲

conchaMiddleMiddleethmoid

cellsOstium

of中鼻甲MiddleInferiormeatus下鼻甲

MaxillarymolararhiocronnfecI■位于两个眶腔之间的非成对的

易碎骨。■筛骨之所以这样命名，是因为

它具有一个呈筛子一样的多孔

骨板，即筛板。2.3.6、各颅骨特点——筛骨Ehmoidbone,

perpendicularplateSuperiormeatusOrbitUncinate

process

钩突MaxillarysinusPalatineprocess

of

maxillaFrontalsinusCristagalliVomer2.4、颅骨与硬脑膜结构脑血管应用解剖3.1、浅静脉■皮层静脉■

侧裂静脉■

Labbe静脉■桥静脉Fig.5

Schematic

illustration

displaying

the

inferior

tentorial

BVs,in-

cludingthepetrosalBVsasseenfromacaudalview.Itshows

some

of

themanypossiblevenousanatomicconfigurations,notnecessarilycoexistinginoneindividual天幕下桥静脉，包括从尾侧观察的岩部桥静脉。它显示了许多可能的静脉解剖结构，不一定同时存在于一个个休中。image

from:Baltsavlas

G,Parthasarat

hi

V,Aydin

E,et

al.Cranialdural

arteriovenous

shunts.

Part1.Anatomy

and

embryology

of

thebridging

andemissary

veinsJ].NeurosurgicalReview,2015,38(2):253.Fig.1

Schematic

illustration

focusing

onthe

superior

cerebralBVs,medialandlateral,connectedtothesuperiorsagittal

sinusandthe

BVsoftheinfeniorsagittalsinus.ThegalenicBVis

also

illustrated连于上矢状窦和下矢状窦的大脑上内侧和外侧桥静脉。image

from:Baltsavia