局部解剖學(xué)課件：8-1-腕和手

1、Wrist and Hand 山東大學(xué)醫(yī)學(xué)院 解剖教研室Surface anatomy of wrist and hand Anatomical “snuff box” 鼻煙壺 Medial: tendon of the extensor pollicis longus 拇長伸肌腱Lateral: tendons of the abductor pollicis longus 拇長展肌腱and extensor pollicis brevis 拇短伸肌腱Proximal: styloid process of radius 橈骨莖突Floor: scaphoid and trapezium b

2、ones手舟骨和大多角骨Radial a. crosses the floor of the snuff, so may fell the radial pulse in this fossaAnatomical “snuff box”Anterior region of wrist 腕前區(qū)Deep fascia of the wrist Palmar carpal ligament 腕掌側(cè)韌帶Flexor retinaculum 屈肌支持帶Thickening of deep fascia in the handAttached laterally to scaphoid and trape

3、zium and medially to pisiform and hamateUlnar carpal canal 腕尺側(cè)管Formed by the distal part of palmar carpal ligament and flexor reticulum Transmit the ulnar a., v. and n.Radial carpal canal 腕橈側(cè)管The radial end of flexor reticulum is attached to the tubercles of scaphoid and trapeziumTransmit tendon of

4、flexor carpi radialis Anterior region of wrist 腕前區(qū)Carpal tunnel 腕管Composition: Formed by flexor retinaculum 屈肌支持帶 and carpal groove 腕骨溝Structures passing through the carpal tunnel Median n. 正中神經(jīng)Tendons of flexor digitorum superficialis 指淺屈肌and flexor digitorum profundus 指深屈肌enclosed by common flexor

5、 synovial sheath 屈肌總腱鞘Tendon of flexor pollicis longus 拇長屈肌enclosed by synovial sheath for flexor pollicis longus 拇長屈肌腱鞘Anterior region of wrist 腕前區(qū)Common flexor synovial sheath屈肌總腱鞘Synovial sheath for flexor pollicis longus 拇長屈肌腱鞘Carpal tunnel 腕管Anterior region of wrist 腕前區(qū)Median mon flexor synovia

6、l sheathTendon of flexor pollicis longus enclosed by synovial sheath for flexor pollicis longus Tendons of flexor digitorum superficialisTendons of flexor digitorum profundusPosterior region of wrist 腕后區(qū)Extensor retinaculum 伸肌支持帶Thickening of deep fascia of forearm a wristAttached laterally to radiu

7、s and medially to styloid process of ulna and triquetral boneForms six fibrous compartments for extensor tendons passing from forearm into handPosterior region of wrist 腕后區(qū) tendons of abductor pollicis longus and extensor pollicis brevis and their synovial sheaths; tendons of extensor carpi radialis

8、 longus and brevis and their synovial sheaths; tendon of extensor pollicis longus and its synovial sheath; tendons of extensor digitorum, extensor indicis and their synovial sheaths; tendon of extensor digiti minimi and its synovial sheaths; tendon of extensor carpi ulnaris and its synovial sheaths

9、Palm of hand 手掌Deep fascia of the palm Superficial layerThenar fascia 魚際筋膜Hypothenar fascia 小魚際筋膜Palmar aponeurosis 掌腱膜 Thick triangular membrane Deep layerPalmar interosseous fascia 骨間掌側(cè)筋膜Palm of hand 手掌Osseofascial compartments of palm 手掌骨筋膜鞘Lateral compartment 外側(cè)鞘Medial compartment 內(nèi)側(cè)鞘Intermediat

10、e compartment 中間鞘Laeral intermuscular septumMedial intermuscular septumPalmar aponeurosisPalmar interosseous fasciaAdductor pollicisHypothenar fasciaThenar fasciaPalm of hand 手掌Intermediate compartment 中間鞘Boundaries Palmar aponeurosis 掌腱膜Lateral and medial intermuscular septum of palm 掌內(nèi)、外側(cè)肌間隔Palmar

11、 interosseous fascia 骨間掌側(cè)筋膜ContentsSuperficial palmar arch, a., v.,n. 掌淺弓及其分支Tendons of flexor digitorum superficialis and profundus 指淺、深屈肌腱Lumbricales （4）蚓狀肌Common flexor sheath屈肌總腱鞘Fascia spaces 筋膜間隙Thenar space 魚際間隙: located between the fascia of the adductor pollicis and flexor tendon of the ind

12、ex finger.Proximal: blindDistally: continuous with the back of the index finger by the fist lumbrical canal Midpalmar space掌中間隙: lies posterior to common flexor sheathProximal: continous with the posterior space of the antebrachial flexor through the carpl canalDistally: continuous with the appropri

13、ate lumbrical canals Midpalmar spaceThenar spacePalmar intermediate septumMuscles of handLateral groupthenar (4)Medial grouphypothenar (3)Intermedial groupLumbricals 蚓狀肌 (4)Palmar interossei 骨間掌側(cè)肌 (3)Dorsal interossei 骨間背側(cè)肌 (4)Muscles of handLateral groupthenar 魚際 (4)Abductor pollicis brevis拇短展肌Flex

14、or pollicis brevis 拇短屈肌Opponens pollicis 拇對掌肌Adductor pollicis 拇收肌Action: flex, abduct, adduct and oppose thumbNerve supply: median n. except adductor pollicis which is supplied by ulnar n.Muscles of handMedial grouphypothenar 小魚際 (3)Abductor digiti minimi 小指展肌Flexor digiti minimi brevis 小指短屈肌Oppone

15、ns digiti minimi 小指對掌肌Action: flex, abduct , and oppose little fingerNerve supply: ulnar n.Muscles of handIntermedial groupLumbricals 蚓狀肌 (4) Action: flex fingers at MP joints; extend fingers at IP jointsNerve supply: first two lumbricals supplied by median n., and 3rd and 4th lumbricals supplied by

16、 ulnar n.Muscles of handIntermedial groupPalmar interossei (3)骨間掌側(cè)肌 adduct fingers towards middle finger at MP jointsDorsal interossei (4) 骨間背側(cè)肌abduct fingers away from middle finger at MP joints Nerve supply: ulnar n.Palm of hand 手掌Superficial palmar arch 掌淺弓Formed by ulnar artery and superficial p

17、almar branch of radial arteryThe curve of arch lies across the palm, level with the distal border of fully extended thumb Gives rise to three common palmar digital arteries 指掌側(cè)總動脈 each then divides into two proper palmar digital arteries 指掌側(cè)固有動脈Palm of hand 手掌Deep palmar arch 掌深弓Formed by radial art

18、ery and deep palmar branch of ulnar arteryThe curve of arch lies across upper part of palmar at level with proximal border of extended thumbGives rise to three palmar metacarpal arteries to joint the distal ends of the corresponding common palmar digital arteries Visualizing the position of the supe

19、rficial and deep palmar arches Palm of hand 手掌Median n. 正中神經(jīng)Muscular branches: supply thenar except adductor pollicis, first two lumbricalesCutaneus branches: supply skin of thenar, central part of palm, palmar aspect of radial three and one-half fingers, including middle and distal fingers on dorsu

20、m Recurrent branchPalm of hand 手掌Ulnar n. 尺神經(jīng)Muscular branches supply hypothenar muscles, interossei, 3rd and 4th lumbricales and adductor pollicisCutaneus branches supply skin of hypothenar, palmar surface of ulnar one and one-half fingers, ulnar half of dorsum of hand, posterior aspect of ulnar tw

21、o and one-half fingers Radial n. 橈神經(jīng)Skin of radial side of dorsum of hand Posterior aspect of radial two and one-half fingers Dorsum of hand 手背Fascia of the dorsal handThe superficial fasciaDorsal venous rete of handSuperficial lymph vesselsSuperficial branches of radial n. and doesal branch of ulna

22、r n.Deep fasciathe dorsal fascia of handSuperficial layer-dorsal aponeurosis 手背腱膜Deep layer-dorsal interosseous fascia 骨間背側(cè)筋膜Dorsum of hand 手背Two spacesThe dorsal subcutaneous space 手背皮下間隙The dorsal subaponeurotic space 手背腱膜下間隙Superficial fasciaDorsal aponeurosisDorsal interosseous fasciaDorsal subcutaneous spaceDorsal subaponeurotic spaceFingers 手指Pulp space of the fingers 指髓間隙 Th