骨纖維孔上外側(cè)界課件

1、1要求一、掌握1、脊柱區(qū)體表標(biāo)志2、頸、胸、腰椎和骶骨的形態(tài)特征；脊柱整體觀。3、脊柱的連結(jié)；棘上韌帶、黃韌帶的結(jié)構(gòu)和臨床意義。4、椎管、骶管的構(gòu)成、形態(tài)特征、內(nèi)容；椎間孔、骶后孔、骶管裂孔的解剖學(xué)特征及臨床意義。5、脊髓三層被膜的特征。6、硬膜外腔的境界、內(nèi)容、分部；椎內(nèi)靜脈叢的組成7、蛛網(wǎng)膜下腔的境界；腦脊液的容量、壓力和性質(zhì)8、脊柱不同節(jié)段硬膜外穿刺、腰下段蛛網(wǎng)膜下腔穿刺及高、低位骶管穿刺的麻醉解剖學(xué)要點(diǎn)9、脊神經(jīng)根的分段與脊髓被膜的關(guān)系 2二、熟悉1、脊柱區(qū)深筋膜的分部及其特點(diǎn)。2、枕下三角、腰上、下三角的境界與內(nèi)容。3、骨纖維管、骨纖維孔的組成及臨床意義。三、了解1、脊柱區(qū)深部的血管

2、和神經(jīng)分布。2、椎骨異常和脊柱畸形 3Section 1 Instruction 1、boundaries上界：下界：兩側(cè)界：枕外隆凸、上項(xiàng)線。尾骨尖斜方肌前緣、腋后線、髂嵴后份、髂后上棘與尾骨尖的連線。42、division項(xiàng)區(qū) nuchal region胸背區(qū) thoracdorsal region腰區(qū) lumbar region骶尾區(qū) sacral coccyx region53、superficial markers 棘突 spinous process 骶管裂孔和骶角 髂嵴和髂后上棘 肩胛岡和肩胛骨下角 豎脊肌和脊肋角6如果要計(jì)數(shù)椎骨，有哪些方法？確定C7棘突確定T3棘突確定T7棘突

3、確定L4棘突項(xiàng)部最隆起的棘突平兩側(cè)肩胛骨內(nèi)側(cè)端的連線平兩側(cè)肩胛下角的連線平兩側(cè)髂嵴最高點(diǎn)的連線7Section 2 Soft Tissue一、淺層結(jié)構(gòu)1、皮膚2、淺筋膜3、皮神經(jīng) 來(lái)自脊神經(jīng)后支 臀上皮神經(jīng)4、淺血管8Superficial Blood VesselsNuchalOccipital arterySuperficial cervical arterydorsal scapular arteryThoracic dorsal Posterior intercostals arterydorsal scapular arterythoracodorsal arteryLumber L

4、umbar arterySacrococcygealSuperior Cluneal arteryInferior cluneal artery9二、深筋膜1、項(xiàng)筋膜2、胸腰筋膜 thoracolarmbar fascia 10Thoracolumbar Fasciaa deep investing membrane which covers the deep muscles of the back of the trunk 3 layers in lumbar region11Trapeziuslevator scapulaeRhomboid minorRhomboid majorLatis

5、simus dorsiSuperficial Group三、肌層12Triangle Of Auscultation13Serratus posterior superiorSerratus posterior inferiorIntermediate Group14DEEP GROUPSpinotransversales MusclesSplenius CapitisSplenius CervicisErector Spine MusclesIliocostalisLongissimus Spinalis15DEEP GROUPTransversospinales musclesSemisp

6、inalisRotatoresMultifidusSegmental back musclesLevatores costarumInterspinalesIntertransversariiP5916DEEP GROUPSuboccipital MusclesRectus Capitis Posterior MinorRectus Capitis Posterior MajorSuperior Oblique Inferior Oblique17ecRtus Capitis Posterior MajorSuperior Rectus ObliqueInferior Rectus Obliq

7、ueVertebral ArterySuboccipital N (Dorsal Ramus Of C)Suboccipital Triangle 183）枕下三角內(nèi)上界：外上界：下 界：頂：底：內(nèi)容：意義：頭后大直肌頭上斜肌頭下斜肌夾肌、半棘肌、枕大神經(jīng)寰椎后弓、環(huán)枕后膜椎動(dòng)脈第3段、枕下神經(jīng)頭部過(guò)度旋轉(zhuǎn)或枕下肌痙攣時(shí)，可壓迫椎動(dòng)脈，使顱內(nèi)供血不足， 麻醉頭位處理時(shí)應(yīng)注意19Superior Lumbar Triangle(Triangle Of Grynfeltt-Lesshaft )twelfth ribSerratus posterior inferior Erector spinae

8、 internal oblique20External Abdominal ObliqueLatissimus Dorsi Iliac CrestInferior Lumbar Triangle(Petits Lumbar Triangle)212、四個(gè)三角1）聽(tīng)診三角底為薄層脂肪組織、筋膜和第6肋間隙，表面覆以皮膚和筋膜，是背部聽(tīng)診呼吸音最清楚之處2）腰下三角 可發(fā)生腰疝 盲腸后位闌尾炎時(shí)， 右腰下三角區(qū)可有明 顯壓痛224）腰上三角 內(nèi)側(cè)界：外下界：上界：底：頂：意義： 腎手術(shù)時(shí)注意保護(hù)神經(jīng)腎周膿腫可在此切開(kāi)引流腎囊封閉常用的進(jìn)針部位腹后壁的薄弱，可形成腰疝豎脊肌外側(cè)緣腹內(nèi)斜肌后緣第12肋

9、腹橫肌腱膜，腱膜深面有3條平行的神經(jīng)皮膚、淺筋膜、背闊肌23四、深部的血管和神經(jīng)1、血管項(xiàng)區(qū)主要由枕動(dòng)脈、頸橫動(dòng)脈和椎動(dòng)脈等供血胸背區(qū)由肋間后動(dòng)脈、胸背動(dòng)脈和肩胛背動(dòng)脈供血腰區(qū)由腰動(dòng)脈和肋下動(dòng)脈供血骶尾區(qū)由臀上、下動(dòng)脈等供血24Deep ArteriesNuchal RegionOccipital ArterySuperficial Cervical ArteryDorsal Scapular ArteryVertebral ArteryThoracic RegionPosterior Intercostals ArteryDorsal Scapular ArteryThoracodorsal

10、 ArteryLumber RegionLumbar ArterySubcostal ArterySacrococcygeal RegionSuperior Cluneal ArteryInferior Cluneal Artery25NuchalVertebral veinInternal jugular veinSubclavian veinThoracicPosterior Intercostals vein azygos veinSubclavian veinAxillary veinLumberLumbar vein inferior vena cavaSacrococcygeal

11、Internal iliac veinDEEP VEINS26Deep NerversDorsal rami of spinal nerveAccessory nerveThoracodorsal nerveDorsal scapular nerve27Dorsal Rami of Spinal Nerve28Accessory Nerve29Thoracodorsal Nerve30Dorsal Scapular Nerve31VERTEBRAL CANAL32CONSTRUCTIONAnterior Wall: Vertebral ColumnPosterior Border Of Int

12、ervertebral Disc Posterior Longitudinal Ligament Posterior Wall: Lamina Ligament Flava;Zygapophysial Joints Bilateral Wall: PedicleIntervertebral Foramina3334CONTENTSSpinal CordMeningesSpinal Nerve RootCauda EquinaBlood VesselsNerves Lymphatic VesselsConnective Tissues35MENINGESSpinal dura materSpin

13、al arachnoid materSpinal pia mater36MENINGES37Denticulate LigamentAverage 21 pairsAttach pia mater to the arachnoid and dura matersProvide stability for the spinal cord 38PACES SEpidural spaceSubdural spaceSubarachnoid space3940Epidural AnesthesiaL441Epidural Venous Plexus424344Lumbar CisternLUMBAR

14、PUNCTURE45SPINAL NERVE ROOTS46Relationship with intervertebral foramen & disc47OPERATING DECOMPRESSION484950Segmental Artery51VEINS52Spinal CordVertebraC1-4C1-4C5-8, T1-4Cn-1T5-8Tn-2T9-12Tn-3L1-5T10-11S1-5, CoccygealT12, L1Segments of Spinal Cord53C1-C4head and neck.C3-C5diaphragm (chest and breathi

15、ng)C5-T1shoulders, arms and handsT2-T12chest and abdomen (excluding internal organs)L1-L4abdomen (excluding internal organs), buttocks, genitals, and upper legsL4-S1legsS2-S4genitals and muscles of the perineumDISTRIBUTION 5455A man has a herniated intervertebral disk between the fourth and fifth lumbar vertebrae. If this disk compresses the spinal nerve in the intervertebral foramen immediately posterior to this disk, which spinal nerve would be affected? L 3 L 4 L 5 S 1 S 2565758596061鉤椎關(guān)節(jié)（Luschka關(guān)節(jié)）： 3rd-7th頸椎 下位椎體鉤與上位椎體的唇緣組成62632、神經(jīng)脊柱區(qū)的神經(jīng)主要來(lái)自31對(duì)脊神經(jīng)后支、副神經(jīng)、肩胛背神經(jīng)和胸背神經(jīng)腰