項(xiàng)背部肩胛區(qū)解剖 (2)ppt課件

1、 項(xiàng)背部、肩胛區(qū)解剖項(xiàng)背部、肩胛區(qū)解剖 The scapular region and the back vertebral region (1)(1)自枕外隆凸至尾骨尖做一自枕外隆凸至尾骨尖做一縱行切口縱行切口(2)(2)自枕外隆凸沿上項(xiàng)線至乳自枕外隆凸沿上項(xiàng)線至乳突做一橫切口突做一橫切口(3)(3)自隆椎棘突向外橫向切至自隆椎棘突向外橫向切至肩峰肩峰翻皮：沿以上切口將皮膚向翻皮：沿以上切口將皮膚向外翻開外翻開一、皮膚一、皮膚skin切口切口incisions :1.1.皮神經(jīng)皮神經(jīng)cutaneous nervescutaneous nerves頸、胸、腰神經(jīng)后支的皮支頸、胸、腰神經(jīng)后支的皮

2、支, ,第第2 2頸神頸神經(jīng)經(jīng)后支的皮支粗大稱為枕大神經(jīng)后支的皮支粗大稱為枕大神經(jīng)greater greater occipital n.,occipital n.,第第3 3頸神經(jīng)后支的分支頸神經(jīng)后支的分支粗大粗大稱為第三枕神經(jīng)稱為第三枕神經(jīng)third occipital n.third occipital n.2.2.淺血管淺血管 superficial blood vessel superficial blood vessel肋間后動(dòng)、靜脈的后支肋間后動(dòng)、靜脈的后支腰動(dòng)、靜脈的后支腰動(dòng)、靜脈的后支 二、淺筋膜二、淺筋膜superficial fascia 三、深筋膜三、深筋膜deep f

3、ascia項(xiàng)筋膜項(xiàng)筋膜nuchal fascia胸腰筋膜胸腰筋膜thoracolumbar fascia上部的深筋膜較淺，下部的深筋上部的深筋膜較淺，下部的深筋膜較厚，呈菱形，稱胸腰筋膜，膜較厚，呈菱形，稱胸腰筋膜，分為三層，包繞豎棘肌。分為三層，包繞豎棘肌。前層前層anterior layer中層中層middle layer后層后層posterior layer斜方肌斜方肌TrapeziusTrapezius副神經(jīng)副神經(jīng)背闊肌背闊肌Latissimus dorsiLatissimus dorsi胸背胸背N N菱形肌菱形肌rhomboideus rhomboideus 肩胛背肩胛背N N肩胛提

4、肌肩胛提肌levator scapulaelevator scapulae肩肩胛背胛背N N四、肌層四、肌層muscular layer淺層淺層superficial layer斜方肌斜方肌Trapezius 背闊肌背闊肌Latissimus dorsi1.項(xiàng)背部肌項(xiàng)背部肌the muscles of the back肩胛提肌肩胛提肌levator scapulae菱形肌菱形肌rhomboideus深層deep layer 豎脊肌erector spinae作用：使脊柱后伸和仰作用：使脊柱后伸和仰頭，一側(cè)收縮使脊柱側(cè)頭，一側(cè)收縮使脊柱側(cè)屈。屈。神經(jīng)支配：頸、胸、腰神經(jīng)支配：頸、胸、腰神經(jīng)的后支

5、。神經(jīng)的后支。為背肌中最長、最大為背肌中最長、最大的肌，縱列于脊柱兩的肌，縱列于脊柱兩側(cè)的溝內(nèi)。包括髂肋側(cè)的溝內(nèi)。包括髂肋肌肌iliocostalis、最長、最長肌肌longissimus、棘、棘肌肌spinalis。髂肋肌髂肋肌iliocostalis最長肌最長肌longissimus、棘肌棘肌spinalis三角肌Deltoid 腋N岡上Supraspinatus 肩胛上N岡下Infraspinatus 肩胛上N小圓肌Teres minor 腋N大圓肌Teres major 肩胛下N肩胛下肌Subscapularis肩胛下N2.肩胛區(qū)肌肩胛區(qū)肌 Muscles of the shoulde

6、r三角肌三角肌Deltoid 岡上肌岡上肌 Supraspinatus 岡下肌岡下肌 Infraspinatus 小圓肌小圓肌 Teres minor 大圓肌大圓肌 Teres major肩胛下肌肩胛下肌subscapularis 肱三頭肌肱三頭肌 Triceps brachii長頭長頭Long head 外側(cè)頭外側(cè)頭Lateral head 內(nèi)側(cè)頭內(nèi)側(cè)頭medial head 五、血管五、血管blood vesselsblood vessels1.肩胛上動(dòng)脈肩胛上動(dòng)脈Suprascapular a. 2.肩胛背動(dòng)脈肩胛背動(dòng)脈Dorsal scapular a.3.頸橫動(dòng)脈頸橫動(dòng)脈Transv

7、erse cervical a. 4.頸淺動(dòng)脈頸淺動(dòng)脈Superficial cervical a. 5.旋肩胛動(dòng)脈旋肩胛動(dòng)脈Circumflex scapular a. 6.旋肱前動(dòng)脈旋肱前動(dòng)脈Anterior circumflex humeral a7.旋肱后動(dòng)脈旋肱后動(dòng)脈Posterior circumflex humeral a.肩胛上動(dòng)脈肩胛上動(dòng)脈Suprascapular a. 旋肱后動(dòng)脈旋肱后動(dòng)脈Posterior circumflex humeral a.旋肩胛動(dòng)脈旋肩胛動(dòng)脈Circumflex scapular a. 肩胛背動(dòng)脈肩胛背動(dòng)脈Dorsal scapular a.肩

8、胛上動(dòng)脈肩胛上動(dòng)脈Suprascapular a.頸橫動(dòng)脈頸橫動(dòng)脈 transverse cervical a. 肩胛背動(dòng)脈肩胛背動(dòng)脈dosal scapula a. 頸淺動(dòng)脈頸淺動(dòng)脈superficial cervical a. 甲狀頸干甲狀頸干 thyrocervical trunk六、神經(jīng)六、神經(jīng) nerves nerves 1.肩胛上神經(jīng)肩胛上神經(jīng)suprascapular n.2.肩胛背神經(jīng)肩胛背神經(jīng)dosal scapula n.3.腋神經(jīng)腋神經(jīng)axillary n.4.副神經(jīng)副神經(jīng) accessory n.肩胛背神經(jīng)肩胛背神經(jīng)dosal scapula n.肩胛上神經(jīng)肩胛上神經(jīng)s

9、uprascapular n.腋神經(jīng)腋神經(jīng)Axillary n.1.1.三邊孔三邊孔Triangular foramenTriangular foramen上上superiorsuperior：小圓?。盒A肌Teres Teres minorminor下下inferiorinferior：大圓?。捍髨A肌Teres Teres majormajor外外laterallateral：肱三頭肌長頭：肱三頭肌長頭Long Long head of the triceps head of the triceps 內(nèi)容內(nèi)容Contents Contents ：旋肩胛血管：旋肩胛血管circumflex s

10、capular a.circumflex scapular a.旋肩胛動(dòng)、靜脈旋肩胛動(dòng)、靜脈Circumflex scapular a、v. 七、部分構(gòu)造七、部分構(gòu)造 regional structure regional structure 2.四邊孔Quadrangular foramen上上Superior :Superior :小圓肌小圓肌Teres Teres minorminor下下inferiorinferior：大圓?。捍髨A肌Teres Teres major major 內(nèi)內(nèi)MedialMedial：肱三頭肌長頭：肱三頭肌長頭Long Long head of the triceps head of the triceps 外外LateralLateral：肱骨：肱骨HumerusHumerus經(jīng)過內(nèi)容：腋神經(jīng)、旋肱后血經(jīng)過內(nèi)容：腋神經(jīng)、旋肱后血管管Axillary nerveAxillary nervePosterier circumflex Posterier circumflex humeral a.v.humeral a.v.腋神經(jīng)腋神經(jīng)Axillary n 、旋肱后血管、旋肱后血管Posterior circumflex humeral a.v.3.聽診三角聽診三角triangle of auscultation:上上Superior：斜方肌外下緣：