肌学总论、头颈肌、躯干肌

1、第三章 肌 学,全身肌由于构造不同可分为平滑肌、心肌和骨骼肌。 骨骼肌skeletal muscle具有收缩的特性，是运动系统的动力部分，其收缩受神经支配，接受人的意志控制，故称随意肌。 全身有600余块肌，占体重40%。 每块肌都是一个器官：有一定形态、构造，有血管、淋巴管，受神经支配，执行一定功能。,肌学总论,总论,一、骨骼肌的形态和构造,2. classification of skeletal muscle： long muscle short muscle flat muscle orbicular muscle,1.construction of skeletal muscle ：

2、 belly tendon aponeurosis,二 肌的起止、配布、作用,1、起于一块骨，止于另一块骨跨过一个或多个关节。 2、起点（定点）、止点（动点），动定可互换。 3、肌在关节周围配布的方式和多少与关节的运动类型密切相关。 4、沿一个运动轴周围应配布相对 应的两组肌。,三、肌的分部和命名,分部： 头颈肌：头肌、颈肌 躯干肌：背肌、胸肌、腹肌、 膈、会阴肌 四肢肌：上肢肌、下肢肌,命名： 按肌的形态、大小、位置、 起止或 作用进行命名。,肌的辅助结构,1、浅筋膜superficial fascia -于真皮之下，又称皮下筋膜， 包被全身，由疏松结缔组织构成，富含脂肪。内有浅动脉、浅静脉

3、、皮神经和浅淋巴管穿行。,2、深筋膜deep fascia：,又称固有筋膜，致密结缔组织构成，位于浅筋膜深面，包被体壁、四肢的肌和血管神经等。形成肌间隔、血管神经鞘 滑膜囊 synovial bursa：为封闭的结缔组织囊。,腱鞘 tendinous sheath:,包围在肌腱外的鞘管， 存在于腕、踝、手指 和足指处。 腱纤维鞘、 腱滑膜鞘 脏层 壁层 腱系膜,腱纤维鞘,腱滑膜鞘脏层,腱滑膜鞘壁层,腱系膜,腱,指骨,头 肌,可分为面肌和咀嚼肌 （一） 面肌 facial muscles 又称 表情肌：主要分布于面部裂孔周围，呈环状和放射状分布。大体可分为四群： 颅顶肌 epicranius：枕

4、额肌：枕腹、额腹 、帽状腱膜 眼轮匝肌 orbicularis oculi：使睑裂闭合 口周围肌 orbicularis oris：口轮匝肌、提上唇肌 提口角肌、降下唇肌、降口角肌、 颊肌 鼻肌 nasalis,颊肌,Facial muscles 面肌,咀 嚼 肌masticatory muscles Masseter 咬肌 Origininferior border and medial surface of zygomatic arch Insertionlateral surface of ramus of mandible and angle of mandible Actionele

5、vates mandible Temporalis 颞肌 Origintemporal fossa Insertioncoronoid process of mandible Actionelevates and retracts mandible,翼外肌Lateral pterygoid 收缩时拉下颌关节的关节盘连同下颌头向前至关节结节的下方，作张口运动。 一侧作用时使下颌移向对侧 翼内肌Medial pterygoid 收缩时上提下颌骨，并使其向前运动。 一侧作用时使下颌移向对侧,The muscles of neck颈肌,一、颈浅层肌和颈外侧肌 1. Platysma 颈阔肌，菲薄的皮肌

6、，起自胸大肌和三角肌的筋膜，向内上止于口角。可拉口角向下。,2. Sternocleidomastoid 胸锁乳突肌 origin: Anterior surface of manubrium and sternal end of clavical insertion: Mastoid process of temporal bone Acton: one side acting alone, draws head toward the same side, and turn face to opposite side; both sides together, draw head direc

7、tly backward,颈前肌,1.舌骨上肌群 Suprahyoid muscles Digastric 二腹肌 Mylohyoid 下颌舌骨肌 Stylohyoid 茎突舌骨肌 Geniohyoid 颏舌骨肌,作用：当舌骨固定时，拉下颌骨向下而张口 吞咽时，下颌骨固定，上提舌骨。,2.舌骨下肌群Infrahyoid muscle Sternohyoid 胸骨舌骨肌 Thyrohyoid 甲状舌骨肌 Sternothyroid 胸骨甲状肌 Omohyoid 肩胛舌骨肌 -下降舌骨和喉.,颈前肌,Muscles of the neck,颈深肌群Deep group 位于脊柱颈部两侧和前方。 L

8、ateral Scalenus anterior 前斜角肌 Scalenus medius 中斜角肌 Scalenus posterior 后斜角肌 Medial longus capitis 头长肌 longus colli 颈长肌 一侧肌收缩,使颈侧屈;两侧肌同时收缩可上提第1、2肋助吸气.,Scalene fissure 斜角肌间隙 Boundaries first rib scalenus anterior and medius Structures passing through scalene fissure brachial plexus 臂丛 subclavian a. 锁骨下

9、动脉,Muscles of trunk 躯干肌,Muscles of back背肌 Muscles of thorax胸肌 Diaphragm膈 Muscles of abdomen腹肌 muscles of perineum会阴肌,The Muscles of Back,浅层Superficial group 斜方肌Trapezius 肩胛提肌Levator scapulae 菱形肌 Rhomboideus 背阔肌Latissimus dorsi 深层 deep group Erector spinae 竖脊肌 Splenius 夹肌,The Muscles of Back,Deep gro

10、up Splenius 夹肌 Erector spinae 竖脊肌 Position: fills the vertebral groove on each side of the spine Action: both sides together extends vertebral column and head. acting along, flex the vertebral column laterally.,Major Muscles of Back,Trapezius 斜方肌 Origin: superior nuchal line, external occipital prot

11、uberance, ligamentum nuchae and spinous processes of seventh cervical and all thoracic vertebrae Insertion: lateral third of clavicle, acromion, and spine of scapular Acton: draw the scapula toward vertebral column. supper fibers elevate scapula, lower fibers depress scapula; if scapula is fixed, on

12、e side acting along, draws head toward the same side, and turn face to opposite side; both sides together, draw head directly backward,Major Muscles of Back,Latissimus dorsi 背阔肌 Origin: Spinous processes of lower six thoracic and all lumbar vertebrae Median sacral crest Posterior part of iliac crest

13、 Insertion: crest of lesser tubercle Action: trunk fixed, extends, adducts and medially rotates arm; arm fixed, elevates trunk,Thoracolumbar Fascia 胸腰筋膜,Posterior layer,Middle layer,Anterior layer,指在竖脊肌周围的筋膜，在腰部可分为三层： 后层：竖脊肌后面； 中层：分隔竖脊肌 和腰方肌； 深层：覆盖在腰方 肌前面,Muscles of thorax,Muscles connecting the upp

14、er limb to the thoracic wall Pectoralis major 胸大肌 Pectoralis minor 胸小肌 Serratus anterior 前锯肌, Major muscles of thorax,Pectoralis Major 胸大肌 Origin: medial half of clavicle, sternum, upper six costal cartilages. Insertion: crest of greater tubercle Action: adducts the arm and rotates it medially; the

15、clavicular fibers also flex the arm; with the arm above the head, raise the body as in climbing,The muscles of thorax,Extrinsic muscles Pectoralis major Pectoralis minor Serratus anterior Intrinsic muscles Intercostales externi 肋间外肌 Intercostales interni 肋间内肌 Intercostales intimi 肋间最内肌 Transversus t

16、horacis 胸横肌,Major muscles of thorax,Intercostales externi 肋间外肌 Origin: inferior border of rib above Insertion: superior border of rib below Replaced anteriorly by external intercostals membrane Action: raise ribs adding in forced inspiration, Major muscles of thorax,Intercostales interni 肋间内肌 Origin

17、: superior border of rib below Insertion: inferior border of rib above Replaced posteriorly by internal intercostals membrane. Action: depress ribs for forced expiration,Intercostales intimi 肋间最内肌, Diaphragm 膈,Shape and position dome-shaped between thorax and abdomen consists of a peripheral muscula

18、r part and a central tendon Origin Sternal part: arising from xiphoid process Costal part: arising from lower six and costal cartilages Lumbar part: arising by two crura from upper 2-3 lumbar vertebrae, medial and lateral arcuate ligaments Insertion: central tendon, Diaphragm 膈,Weak areas: Lumbocost

19、al triangle Sternocostal triangle,Openings in the diaphragm Aortic hiatus主动脉裂孔lies anterior to the body of the 12th thoracic vertebra between the crura. It transmits the aorta, thoracic duct Esophageal hiatus 食管裂孔for esophagus and vagus nerves at level of T10. Vena cava foramen 腔静脉孔for inferior vena

20、 cava, through central tendon at T8 level,T8,T10,T12,Action: Contraction: the dome moving downward, increases the volume of thoracic cavity which results in inspiration, at the same time the intra-abdominal pressure is increased assists in defecation排便, vomiting呕吐or child birth. Relaxation: the dome

21、 returns to the former position, reduces the volume to the thoracic cavity, resulting in expiration.,四、腹肌Muscles of abdomen,Anterolateral group Obliquus externus abdominis 腹外斜肌 Oblequus enternus abdominis腹内斜肌 Transversus abdominis腹横肌 Rectus abdominis 腹直肌,腹外斜肌,腹内斜肌,Posterior group Quadratus lumborum

22、腰方肌 Psoas major 腰大肌,髂肌iliacus,Obliquus externus abdominis 腹外斜肌,General direction of fibers: downward, forward Structures Inguinal ligament 腹股沟韧带 Lacunar ligament 腔隙韧带 pectineal ligament耻骨梳韧带 Superficial inguinal ring 腹股沟管浅环 triangular-shaped defect缺损in aponeurosis of obliquus externus abdominis abov

23、e pubic tubercle,Obliquus internus abdominis 腹内斜肌,Position:deep to obliquus externus abdominis General direction of fibres: upwards, forwards,Transversus abdominis 腹横肌,Position:deep to obliquus internus,General direction of fibres:run more or less horizontally.,腹外斜肌,腹内斜肌,腹横肌,腹横肌,腹内斜肌,腹直肌,Inguinal fa

24、lx 腹股沟镰: arch over spermatic cord, inserted with transverses abdominis fiber into medial part of pecten of pubis Cremaster 提睾肌: around the spermatic cord精索and testis睾丸,腹股沟镰,Rectus abdominis 腹直肌,Position: lie on to either of midline Origin: pubic crest and symphysis Insertion: xiphoid and 5th-7th cos

25、tal cartilages Has 3-4 tendinous intersections 腱划,Similar functions for above four pairs of muscles,1.Support and compress the abdominal viscera 2.Increase intra-abdominal pressure, aid in vomiting呕吐, coughing, sneezing, defecation排便, urination排尿and childbirth. 3.Depress ribs, assist in (the act of

26、force(4)expiration. 4.Flex, lateral flex, and rotate vertebral column.,Sheath of rectus abdominis 腹直肌鞘,Ant layerformed by fusion of aponeurosis of obliquus externus abdominis and anterior leaf of aponeurosis of obliquus internus abdominis Post layer Formed by fusion of posterion leaf of aponeurosis

27、of obliquus internus abdominis and aponeurosis of transverses abdominis Absent in about 4-5cm below the umbilicus, where aponeuroses of all three muscles form anterior layer the lower free border named arcuate line Below this line rectus abdominis in contact with transverse fascia,Linea alba 白线 tend

28、inous raphe缝between right and left recti from xiphoid to pubic symphysis.,Inguinal canal 腹股沟管,Position: oblique passage, 4cm long, located 1.5cm above medial half of inguinal lig.,Boundaries Anterior wall Aponeurosis of obliquus externus abdominis Obliquus internus abdominis (lateral third of wall),

29、Posterior wall Transverse fascia Inguinal falx medially Superior wallarched lower fibers of obliquus internus and transversua abdominis inferior wallinguinal lig,Two openings Superficial inguinal ring 腹股沟管浅环 Deep inguinal ring 腹股沟管深环 defect in transverse fascia 1.5cm above midpoint of inguinal ligam

30、ent,Structures passing through the inguinal canal Spermatic cord 精索 and ilioinguinal nerve髂腹股沟神经 in males Round ligament of uterus 子宫圆韧带and ilioinguinal nerve髂腹股沟神经 in females,Inguinal Triangle (of Hesselbach) 腹股沟三角,Boundaries Inguinal ligament inferiorly Lateral border of rectus abdominis medially Inferior epigastric artery laterally,内面观,Teaching outline,1.Master the composition of the muscles of the mastication, the