（醫(yī)學(xué)課件）解剖_顱骨.ppt

Skull顱,The skull is composed of 23 bones Cerebral cranium 腦顱 Facial cranium 面顱,1,2018,2,2018,Frontal bone,Zygomatic bone,Nasal bone,Maxilla,Mandible,Sphenoid bone,parietal bone,Temporal bone,Occipital bone,3,2018,4,2018,5,2018,6,2018,7,2018,Skull顱,Cerebral cranium 腦顱 (8) larger, upper and posterior part, contains and protects the brain Single bones: frontal bone 額骨 ethmoid bone 篩骨 sphenoid bone 蝶骨 occipital bone 枕骨 Paired bones: temporal bone 顳骨 parietal bone 頂骨,8,2018,frontal bone 額骨,parietal bone 頂骨,temporal bone 顳骨,occipital bone 枕骨,sphenoid bone 蝶骨,ethmoid bone 篩骨,9,2018,10,2018,11,2018,12,2018,13,2018,14,2018,15,2018,16,2018,17,2018,ethmoid bone 篩骨,篩骨迷路 ethmoidal labyrinth,篩骨垂直板 perpendicular plate of ethmoid,雞冠 crista galli,篩板cribriform plate,18,2018,19,2018,sphenoid bone 蝶骨,翼突 pterygoid process,greater wing of sphenoid bone蝶骨大翼,lesser wing of sphenoid bone蝶骨小翼,蝶骨體 Corpus sphenoidale,20,2018,21,2018,22,2018,23,2018,24,2018,25,2018,temporal bone 顳骨,顳骨鱗部 squamous part of temporal bone,顳骨巖部 petrous part of tempordl bone,鼓部Tympanic part,Lateral view,Medial view,26,2018,Skull顱,Facial cranium 面顱 (15) smaller, lower, and anterior part, contains bones that surrounded the eye, nose and mouth Single bones: mandible下頜骨 vomer 犁骨 hyoid bone 舌骨,27,2018,Skull顱,Facial cranium 面顱 Paired bones: maxilla 上頜骨 nasal bone 鼻骨 lacrimal bone 淚骨 palatine bone 腭骨 zygomatic bone 顴骨 inferior nasal concha 下鼻甲,28,2018,Bones of facial cranium 面顱骨,面顱上頜為中心，上鼻淚，下下頜， 外顴內(nèi)甲后犁腭，舌骨頸前單落腳。,29,2018,Mandible下頜骨,Body of mandible 下頜體 Alveolar arch 牙槽弓 Base of mandible 下頜底 Mental protuberance 頦隆凸 Mental foramen 頦孔 Mental spine 頦棘 Digastric fossa 二腹肌窩,30,2018,Mandible下頜骨,Ramus of mandible 下頜支 Coronoid process 冠突 Condylar process 髁突 head of mandible下頜頭 neck of mandible下頜頸 Mandibular notch下頜切跡 Mandibular foramen 下頜孔 Mandibular lingula下頜小舌 Angle of mandible下頜角 Masseteric tuberosity 咬肌粗隆 pterygoid tuberosity翼肌粗隆,31,2018,The skull as a whole 顱的整體觀,32,2018,Superior surface of skull,Bones: frontal bone 額骨 paired parietal bone 頂骨 occipital bone 枕骨 Sutures縫: Coronal suture 冠狀縫 Sagittal suture 矢狀縫 Lambdoid suture 人字縫 parietal tuber 頂結(jié)節(jié) parietal foramen 頂孔,33,2018,Posterior surface of skull,External occipital protuberance 枕外隆凸 Superior nuchal line 上項線 Inferior nuchal line 下項線,34,2018,Internal surface of calvaria,Sulcus for superior sagittal sinus上矢狀竇溝 Granular foveola 顆粒小凹 Sulcus for middle meningeal artery 腦膜中動脈溝,35,2018,Internal surface of base of skull,Base of skull forms three fossae Anterior cranial fossa 顱前窩 Middle cranial fossa 顱中窩 Posterior cranial fossa 顱后窩,36,2018,37,2018,38,2018,39,2018,40,2018,各孔出入的血管、神經(jīng),圓孔：上頜神經(jīng)（三叉神經(jīng)第二支) 卵圓孔:下頜神經(jīng)（三叉神經(jīng)第三支) 破裂孔：頸內(nèi)動脈、破裂孔導(dǎo)血管 頸靜脈孔：舌咽神經(jīng)、迷走神經(jīng)、副神經(jīng)、頸內(nèi)靜脈,41,2018,42,2018,顱底解剖,顱底內(nèi)面可明顯地區(qū)分出顱前、中、后三窩。此區(qū)結(jié)構(gòu)上的特點是窩內(nèi)硬腦膜與顱底骨緊密相連，有許多血管和神經(jīng)穿過顱底，顱底骨質(zhì)本身厚薄不一，承受的壓力和張力也不一致。因此，顱底薄弱處最易骨折，多伴有硬腦膜撕裂，損傷血管及神經(jīng)。 ,43,2018,44,2018,45,2018,Anterior cranial fossa 顱前窩,Formed by orbital part of frontal bone, cribriform plate of ethmoid, and lesser wings of sphenoid frontal crest 額嵴 foramen cecum 盲孔 crista galli 雞冠 cribriform plate 篩板 cribriform foramina 篩孔(有嗅絲通過）,46,2018,顱前窩,顱前窩容納大腦額葉、嗅球和嗅束，外側(cè)以較薄的眶板與眶腔相鄰，內(nèi)側(cè)以更薄且多孔的篩板與鼻腔相鄰，有嗅神經(jīng)(II)穿篩孔入顱。由于骨質(zhì)最薄，骨折易發(fā)生于顱前窩。傷及眶板時，易造成眶內(nèi)或結(jié)膜下血腫；傷及篩板時，易造成鼻腔內(nèi)出血和腦脊液鼻漏，同時可能喪失嗅覺。,47,2018,Middle cranial fossa 顱中窩,Formed by the body and greater wings of sphenoid, petrous part of temporal Body of sphenoid bone 蝶骨體 Hypophysial fossa 垂體窩 Optic canal 視神經(jīng)管 Anterior clinoid process 前床突 Tuberculum sellae 鞍結(jié)節(jié) Dorsum sellae 鞍背 Posterior clinoid process 后床突 Sella turcica 蝶鞍 Carotid sulcus 頸動脈溝,48,2018,Meddle cranial fossa 顱中窩,Superior orbital fissure 眶上裂 Foramen rotundum 圓孔 Foramen ovale 卵圓孔 Foramen spinosum 棘孔 Sulcus for middle meningeal artery 腦膜中動脈溝 Foramen lacerum 破裂孔 Internal opening of carotid canal 頸動脈管內(nèi)口 Trigeminal impression 三叉神經(jīng)壓跡 Arcuate eminence 弓狀隆起 Tegmen tympani 鼓室蓋,49,2018,顱中窩-1,顱中窩兩側(cè)容納大腦顳葉，中部容納垂體。兩側(cè)窩內(nèi)，從前向后呈弧形排列著一系列孔和裂：即 眶上裂：其中通過動眼神經(jīng)()、滑車神經(jīng)()、眼神經(jīng)(v，)、展神經(jīng)()和眼靜脈； 視神經(jīng)管：其中通過視神經(jīng)()和眼動脈； 圓孔：其中通過上頜神經(jīng)(v：)； 卵圓孔：其中通過下頜神經(jīng)(V。)和導(dǎo)靜脈； 棘孔：其中通過腦膜中動脈。 在垂體窩兩側(cè)還有破裂孔，其中有頸內(nèi)動脈通過。,50,2018,顱中窩-2,顱中窩中部的垂體窩底，即蝶竇的上壁，因蝶竇與鼻腔相通，故垂體腫瘤，可經(jīng)鼻腔蝶竇入路切除。通?？蓮娘B的側(cè)位x一線片上測量蝶鞍的大小，判斷垂體是否有腫瘤。一般蝶鞍的前后徑為1112mm，深徑為9 10mm。 顱中窩的骨質(zhì)也厚薄不一，有許多孔裂，垂體窩和鼓室蓋處的骨質(zhì)較薄，其下方分別為蝶竇和鼓室，從結(jié)構(gòu)力學(xué)分析，這些部位容易發(fā)生骨折。如損傷上述孔裂內(nèi)的神經(jīng)，易產(chǎn)生相應(yīng)的體征。,51,2018,顱中窩-3,如傷及眶上裂內(nèi)四條神經(jīng)，則會出現(xiàn)眶上裂綜合征表現(xiàn)為患側(cè)眼球固定于正中位不能轉(zhuǎn)動，上瞼下垂，瞳孔擴大，角膜反射消失，額部皮膚感覺消失等體征。 鼓室蓋的骨折，血液和腦脊液可流入鼓室，并可經(jīng)咽鼓管流入咽腔。如鼓膜破裂，還可從外耳道流出。中耳的炎癥可向上蔓延，引起耳源性腦膜炎。 骨折損及垂體窩時，血液與腦脊液可經(jīng)蝶竇流入鼻腔。,52,2018,Posterior cranial fossa 顱后窩,Formed by occipital and the petrous part of temporal bone foramen magnum 枕骨大孔 clivus 斜坡 internal opening of hypoglossal canal 舌下神經(jīng)管內(nèi)口 internal occipital protuberance 枕內(nèi)隆凸 internal occipital crest 枕內(nèi)嵴 sulcus for transverse sinus 橫竇溝 sulcus for sigmoid sinus 乙狀竇溝 jugular foramen 頸靜脈孔 internal acoustic pore 內(nèi)耳門 internal acoustic meatus 內(nèi)耳道,53,2018,顱后窩-1,顱后窩的骨質(zhì)較厚，由顳骨和枕骨組成，兩側(cè)容納小腦半球。枕骨大孔前面的斜坡承托腦橋和延髓。枕骨大孔除脊髓外，還有椎動脈和副神經(jīng)脊髓根通過。舌下神經(jīng)管，其中有舌下神經(jīng)()通過。再向外側(cè)的顳骨巖部中央有內(nèi)耳門和內(nèi)耳道，其中有面神經(jīng)()和前庭蝸神經(jīng)()通過。內(nèi)耳門后下方有頸靜脈孔，其中有頸內(nèi)靜脈、舌咽神經(jīng)()、迷走神經(jīng)(x)和副神經(jīng)()通過。頸靜脈孔向后外側(cè)延續(xù)為乙狀竇溝，然后轉(zhuǎn)向內(nèi)后續(xù)為橫竇溝，溝中分別有乙狀竇和橫竇經(jīng)過。頸內(nèi)靜脈起始與乙狀竇中部常有導(dǎo)靜脈（分別為髁導(dǎo)靜脈與乳突導(dǎo)靜脈）與顱外枕靜脈相連，這是顱內(nèi)外腫瘤或炎癥相互轉(zhuǎn)移或蔓延的一個途徑。,54,2018,顱后窩-2,顱后窩一旦骨折，多后果嚴(yán)重。因為血腫可壓迫延髓出現(xiàn)呼吸抑制而死亡。如傷及頸靜脈孔的神經(jīng)時，可出現(xiàn)頸靜脈孔綜合征，表現(xiàn)為舌音語言障礙，腭弓麻痹伴有鼻音，聲音嘶啞，逐漸發(fā)生吞咽困難，導(dǎo)致吸入性肺炎。這種綜合征也出現(xiàn)于頸靜脈孔處轉(zhuǎn)移腫瘤的壓迫。,55,2018,56,2018,Internal surface of base of skull,57,2018,58,2018,59,2018,頦孔位于下頜第二前磨牙或第二前磨牙與第一磨牙之間的下頜體中部，其中有頦神經(jīng)、頦動脈和頦靜脈通過。此處是下頜部局部的注射部位。,60,2018,61,2018,62,2018,External surface of base of skull,alveolar arch 牙槽弓 bony palate 骨腭 median palatine suture 腭中縫 incisive foramina 切牙孔 incisive canal 切牙管 greater palatine foramen 腭大孔 posterior nasal apertures 鼻后孔 lateral pterygoid plate翼突外側(cè)板 medial pterygoid plate翼突內(nèi)側(cè)板 Pterygoid fossa翼突窩 mandibular fossa 下頜窩 articular tubercle 關(guān)節(jié)結(jié)節(jié) styloid process 莖突 stylomastoid foramen 莖乳孔 occipital condyle 枕髁 jugular foramen 頸靜脈孔 external opening of carotid canal 頸動脈管外口 external opening of hypoglossal canal 舌下神經(jīng)管外口,63,2018,Lateral surface of skull,External acoustic pore 外耳門 Mastoid process 乳突 Zygomatic arch 顴弓 Temporal fossa 顳窩 Superior temporal line 上顳線 Pterion 翼點 a point near the sphenoid fontanel of the skull, at the junction of the greater wing of the sphenoid, temporal, frontal, and parietal bones. It is situated a little above the level of the zygomatic process. It is known as the weakest part of the skull, and also intersects the course of the anterior division of the middle meningeal artery,64,2018,Lateral surface of skull,Infratemporal fossa 顳下窩 Pterygomaxillary fissure 翼上頜裂 Pterygopalatine fossa 翼腭窩 Sphenopalatine foramen 蝶腭孔,65,2018,66,2018,Anterior surface of skull,Frontal region: Frontal squama 額鱗 Frontal tuber 額結(jié)節(jié) Superciliary arch 眉弓 Glabella 眉間,67,2018,Orbit 眶,pyramid-shaped paired cavities Base: supraorbital notch/foramen 眶上切跡/眶上孔 infraorbital foramen 眶下孔 Apex: optic canal 視神經(jīng)管 Walls Superior: fossa for lacrimal gland 淚腺窩 Superior orbital fissuer 眶上裂 Medial: fossa for lacrimal sac 淚囊窩 Inferior: Inferior orbital fissure 眶下裂 infraorbital groove 眶下溝 infraorbital canal 眶下管,left,68,2018,眶上孔或眶上切跡supraorbital notch/ foramen,眶下孔 infraorbital foramen,視神經(jīng)管optic canal,淚腺窩 fossa for lacrimal gland,淚囊窩 fossa for lacrimal sac,眶下裂inferior orbital fissure,眶上裂Superior orbital fissure,眶下溝 infraorbital groove,69,2018,眶上切跡（孔） 位于眶上緣內(nèi)、中i/3交界處，其中有眶上神經(jīng)、眶上動脈和眶上靜脈通過。此處是額部局部麻醉的注射部位。 眶下孔位于眶下緣中點下方0.51cm處，其中有眶下神經(jīng)、眶下動脈和眶下靜脈通過。此處是眼和口之間局部麻醉的注射部位。,70,2018,71,2018,72,2018,Bony nasal cavity 骨性鼻腔,Roof cribriform plate of ethmoid bone Floor bony palate Medial wall bony septum of nose Lateral wall Nasal conchae鼻甲 Anterior piriform aperture 梨狀孔 Posterior posterior nasal aperture 鼻后孔,73,2018,Lateral wall Superior, middle and inferior nasal conchae 上、中、下鼻甲 Superior, middle and inferior nasal meatus 上、中、下鼻道(underlying each concha) Sphenoethmoidal recess 蝶篩隱窩 Sphenopalatine foramen 蝶腭孔,74,2018,Paranasal sinuses 鼻旁竇,Air contained space in bones around the nasal cavity. Frontal sinus 額竇 Maxillary sinus 上頜竇 Sphenoidal sinus 蝶竇 Ethmoidal sinus/cellules 篩竇/篩小房,75,2018,Paranasal sinuses 鼻旁竇, Sphenoidal sinus 蝶竇 Lies in body of sphenoid bone Drain into sphenoethmoidal recess,76,2018,77,2018,Paranasal sinuses 鼻旁竇,Frontal sinus 額竇 Lies in frontal bone, deep to superciliary arch Drain to anterior part of middle nasal meatus,78,2018,Paranasal sinuses 鼻旁竇,Maxillary sinus 上頜竇 Largest paired sinus, lie in the body of maxilla; Opening into middle nasal meatus,79,2018,Paranasal sinuses 鼻旁竇, Ethmoidal sinus/cellules 篩竇/篩小房 Lie in ethmoidal bone, contains large number of air cells, divided into anterior, middle and posterior groups Anterior and middle groups drain into middle nasal meatus, while posterior group drains into superior nasal meatus,80,2018,81,2018,鼻旁竇(或稱副鼻竇),鼻旁竇(或稱副鼻竇)由骨性鼻旁竇襯以粘膜而成，能調(diào)節(jié)吸入空氣的溫濕度，對發(fā)音起共鳴作用。 鼻旁竇包括上頜竇、額竇、篩竇和蝶襄四對，分別位于同名的顱骨內(nèi)。 上頜竇、額竇和前篩竇、中篩竇都開口于中鼻道； 后篩竇開口于上鼻道； 蝶竇開口于蝶篩隱窩。 由于鼻旁竇粘膜與鼻腔粘膜褶延續(xù)，故鼻腔炎癥易引起鼻旁竇發(fā)炎。 上頜竇是鼻旁竇中最大的一對，因開口位于其內(nèi)側(cè)壁最高處，遠高于竇底，故引流不暢，同時竇腔大，竇底鄰接上頜