頸部的局部解剖與操作

局部解剖學(xué)（九）頸部的局部解剖與操作（1）現(xiàn)在是1頁\一共有57頁\編輯于星期四頸部Neck概述introduction淺層結(jié)構(gòu)superificalstructures下頜下三角submandibulartriangle頦下三角submentaltriangle現(xiàn)在是2頁\一共有57頁\編輯于星期四一、概述Introduction境界和分區(qū)boundaryandregions表面解剖surfaceanatomy表面標(biāo)志surfacelandmark體表投影surfaceprojection現(xiàn)在是3頁\一共有57頁\編輯于星期四上界：為下頜骨下緣、下頜角、乳突、上項(xiàng)線與枕外隆突的連線。Superiorly：anlinelinkingwiththelowerborderofmandible,theangleofmandible,themastoidprocess,thesuperiornuchallineandtheexternaloccipitalprotuberance;

下界：由胸骨上緣、鎖骨和肩峰至第7頸椎棘突的連線。Inferiorly：bytheupperborderofsternum,theclavicleandalineextendingfromtheacromiontothespineof7thcervicalvertebra.1.頸部的境界boundaryoftheneck現(xiàn)在是4頁\一共有57頁\編輯于星期四2.頸部分區(qū)頸部:分為固有頸部（properneck）和項(xiàng)部（nape）。固有頸部:又可分為頸前區(qū)anteriorregion、胸鎖乳突肌區(qū)sternocleidomastoidregion和頸外側(cè)區(qū)lateralregion?，F(xiàn)在是5頁\一共有57頁\編輯于星期四頸前區(qū)：被舌骨hyoid分為舌骨上區(qū)suprahyoidregion（包括2個(gè)下頜下三角和1個(gè)頦下三角）和舌骨下區(qū)infrahyoidregion（包括成對(duì)的頸動(dòng)脈三角和肌三角）。頸外側(cè)區(qū)：被肩胛舌骨肌下腹分為枕三角和鎖骨上三角?，F(xiàn)在是6頁\一共有57頁\編輯于星期四3.表面標(biāo)志surfacelandmarkLessersupraclavicularfossa(Greater)supraclavicularfossaSuprasternalfossa現(xiàn)在是7頁\一共有57頁\編輯于星期四表面標(biāo)志

SurfaceLandmark舌骨Hyhoid(H)甲狀軟骨Thyroidcartilage(T)喉結(jié)節(jié)Laryngealprominence(P)環(huán)狀軟骨Cricoidcartilage(C)第1氣管環(huán)Thefirsttrachealringe(1)甲狀腺峽Isthmus(S)現(xiàn)在是8頁\一共有57頁\編輯于星期四環(huán)狀軟骨(弓)的意義第6頸椎水平Thelevelofthe6thcervicalvertebra.喉與氣管交界Thejunctionofthelarynxwiththetrachea.咽與食管交界Thejunctionofthepharynxwiththeesophagus.現(xiàn)在是9頁\一共有57頁\編輯于星期四Thelevelatwhichthevertebralarteryentersthetransverseforamenofthe6thcervicalvertebra.Thesiteatwhichthecarotidarterycanbepressedagainstthecarotidtubercleofthe6thcervicalvertebra.現(xiàn)在是10頁\一共有57頁\編輯于星期四Thelevelatwhichtheinferiorthyroidarteryandthemiddlethyroidveinenterorleavethethyroidgland.現(xiàn)在是11頁\一共有57頁\編輯于星期四Thelevelatwhichthesuperiorbellyoftheomohyoidmusclecrossesthecarotidsheath.現(xiàn)在是12頁\一共有57頁\編輯于星期四Thelevelofthemiddlesympatheticganglion.現(xiàn)在是13頁\一共有57頁\編輯于星期四二、頸部淺層結(jié)構(gòu)

Thesuperficialstructuresoftheneck皮膚Theskin(thinandpliable)淺筋膜及其內(nèi)容Thesuperficialfasciaanditscontentsathinlayeroffatasheetofplatysmatheanteriorjugularveinthelateraljugularveinthesuperficial(lateralandanerior)cervicallymphnodesthecutaneousbranchesofthecervicalplexusthecervicalbranchofthefacialnerve現(xiàn)在是14頁\一共有57頁\編輯于星期四1.頸闊肌

TheplatysmaIsabroad,thinsheetofmuscleinthesubcutaneoustissue.Coverstheanterolateralaspectoftheneck.Aariseinfasciacoveringsuperiorpartsofthedeltoidandpectoralismajormusclesandsweepsuperomediallyovertheclavicletotheinferiorborderofthemandible,skin,andsubcutaneoustissueoflowerface.Isoneofthemusclesoffacialexpression.Isinnervatedbythecervicalbranchofthefacialnerve.現(xiàn)在是15頁\一共有57頁\編輯于星期四Thesuperficialcervicalveinsandnervesarelocateddeeptotheplatysma.現(xiàn)在是16頁\一共有57頁\編輯于星期四Themainactionoftheplatysma:①drawscornersofmouthinferiorlyandwidensitasinexpressionsofsadnessandfright;②drawstheskinofnecksuperiorlywhenteethare“clenched”.現(xiàn)在是17頁\一共有57頁\編輯于星期四2.頸前靜脈或頸前正中靜脈、頸外靜脈現(xiàn)在是18頁\一共有57頁\編輯于星期四頸靜脈弓Jugularvenousarch現(xiàn)在是19頁\一共有57頁\編輯于星期四3.頸淺淋巴結(jié)Superficialcervicallymphnodes現(xiàn)在是20頁\一共有57頁\編輯于星期四4.SuperficialcervicalnervesCutaneousbranchesofthecervicalplexusNervepointofneckCervicalbranchofthefacialnerve現(xiàn)在是21頁\一共有57頁\編輯于星期四面神經(jīng)的頸支Cervicalbranchoffacialnerve現(xiàn)在是22頁\一共有57頁\編輯于星期四三、頸筋膜及筋膜間隙

CervicalFasciaandFascialSpace

現(xiàn)在是23頁\一共有57頁\編輯于星期四1.

頸筋膜CervicalFascia

頸深筋膜分為三層

Deepcervicalfasciaconsistsofthreefasciallayers:淺層Superficiallayer封套筋膜Investingfascia中層Middlelayer氣管前筋膜Prechachealfascia內(nèi)臟筋膜Visceralfascia深層Deeplayer椎前筋膜Prevertebralfascia現(xiàn)在是24頁\一共有57頁\編輯于星期四現(xiàn)在是25頁\一共有57頁\編輯于星期四封套筋膜、氣管前筋膜、椎前筋膜現(xiàn)在是26頁\一共有57頁\編輯于星期四頸動(dòng)脈鞘、氣管前筋膜、甲狀腺鞘、甲狀腺懸韌帶現(xiàn)在是27頁\一共有57頁\編輯于星期四2.頸筋膜間隙

CervicalFascialSpaces胸骨上間隙Suprasternalspace咽后間隙Retropharyngealspace氣管前間隙Prechachealspace椎前間隙Prevertebralspace現(xiàn)在是28頁\一共有57頁\編輯于星期四胸骨上間隙、咽后間隙、氣管前間隙、椎前間隙現(xiàn)在是29頁\一共有57頁\編輯于星期四現(xiàn)在是30頁\一共有57頁\編輯于星期四胸骨上間隙的內(nèi)容

ContentsoftheSuprasternalspaceIncludethe:頸前筋膜下端Inferiorendsoftheanteriorjugularveins頸靜脈弓Jugularvenousarch疏松結(jié)締組織Looseconnectivetissue1~2個(gè)淋巴結(jié)Oneortwodeeplymphnodes

胸鎖乳突胸骨頭Sternalheadsoftheternocleidomastoid鎖骨間韌帶Interclavicularligament現(xiàn)在是31頁\一共有57頁\編輯于星期四鎖骨上間隙的內(nèi)容

ContentsofthesupraclavicularspaceIncludethe:頸外靜脈Apartoftheexternaljugularvein鎖骨上神經(jīng)Supraclavicularnerves

頸橫靜脈Transversecervicalvein肩胛上靜脈Suprascapularvein淋巴管Afewlymphvessels現(xiàn)在是32頁\一共有57頁\編輯于星期四四、頦下三角

SubmentalTriangle

境界Boundary內(nèi)容Contents現(xiàn)在是33頁\一共有57頁\編輯于星期四頦下三角BoundarisofsubmentaltriangleBodyofhyoidbone現(xiàn)在是34頁\一共有57頁\編輯于星期四頦下三角的內(nèi)容

ContentsofthesubmentaltriangleIncludethe:幾個(gè)小的頦下淋巴結(jié)Severalsmallsubmentallymphnodes.幾條小靜脈，匯合成頸前靜脈Smallveinsthatunitetoformtheanteriorjugularvein.現(xiàn)在是35頁\一共有57頁\編輯于星期四五、下頜下三角

SubmandibularTriangle境界Boundary內(nèi)容Contents現(xiàn)在是36頁\一共有57頁\編輯于星期四1.下頜下三角

Boundarisofthesubmandibulartriangle現(xiàn)在是37頁\一共有57頁\編輯于星期四Aroofofthesubmandibulartriangleisformedbytheskin,superficialfascia,platysmaandinvestingfascia.現(xiàn)在是38頁\一共有57頁\編輯于星期四Afloorofthesubmandibulartriangleisformedbythemylohyoid,hyoglossusandmiddlepharyngealconstrictor.MiddlepharyngealconstrictorMylohyoidHyoglossus現(xiàn)在是39頁\一共有57頁\編輯于星期四下頜下三角的底現(xiàn)在是40頁\一共有57頁\編輯于星期四下頜下三角的頂與底現(xiàn)在是41頁\一共有57頁\編輯于星期四2.下頜下三角的主要結(jié)構(gòu)

Maincontentsofthesubmandibulartriangle下頜腺及其導(dǎo)管Submandibularglandanditsduct

面靜脈Facialvein面神經(jīng)的頸支Cervicalbranchoffacialnerve下頜下淋巴結(jié)Submandibularlymphnodes

面動(dòng)脈Facialartery頦下動(dòng)、靜脈Submentalarteryandvein下頜舌骨肌神經(jīng)Mylohyoidnerve舌下神經(jīng)Hypoglossalnerve舌動(dòng)、靜脈Lingualarteryandvein舌神經(jīng)LingualNerve,下頜下神經(jīng)節(jié)Submandibularganglion現(xiàn)在是42頁\一共有57頁\編輯于星期四1.在下頜下腺的淺面有：

面靜脈、面神經(jīng)的頸支、下頜下淋巴結(jié)Cervicalbranchesoffacialnerve現(xiàn)在是43頁\一共有57頁\編輯于星期四Mylohyoid2.

Thesubmandibularglandisdividedintothesuperficialanddeeppartsbytheposteriorborderofmylohyoid,itsductemergesfromthedeepoftheglandandthenopensonthesublingualpapilla.現(xiàn)在是44頁\一共有57頁\編輯于星期四3.在下頜下腺的深面：①在下頜舌骨肌淺面的結(jié)構(gòu)有頦下動(dòng)脈和靜脈、下頜舌骨肌神經(jīng)；②在舌骨舌肌淺面的結(jié)構(gòu)有舌靜脈、面動(dòng)脈、舌下神經(jīng)、下頜下神經(jīng)節(jié)和舌神經(jīng)；③在舌骨舌肌深面的結(jié)構(gòu)有舌動(dòng)脈?，F(xiàn)在是45頁\一共有57頁\編輯于星期四現(xiàn)在是46頁\一共有57頁\編輯于星期四4.下頜下腺深部及其導(dǎo)管的毗鄰：自上而下為舌神經(jīng)、下頜下神經(jīng)節(jié)、下頜下腺及其導(dǎo)管、舌下神經(jīng)、舌動(dòng)脈和靜脈?，F(xiàn)在是47頁\一共有57頁\編輯于星期四六、解剖與觀察

DissectionandObservation

1.Makeamedianskinincision2.Reflecttheskinflaps3.Reflecttheplatysma4.Dissectthesuperficialstructures5.Dissectthesubmentaltriangle6.Dissectthesubmandibulartriangle現(xiàn)在是48頁\一共有57頁\編輯于星期四1.Makeamedianskinincisionfromthementalsymphysistothesuprasternalnotch.現(xiàn)在是49頁\一共有57頁\編輯于星期四2.Reflecttheskinflapslaterallytotheanteriorborderofthetrapeziustoexposetheplatysmadirectly.

3.Dividetheplatysmaalongtheupperborderoftheclavicleandreflectitupwardstothemandible.Donotdamagetheunderlyingstructures.現(xiàn)在是50頁\一共有57頁\編輯于星期四4.Lookforandexposethesuperficialstructuresoftheneck.現(xiàn)在是51頁\一共有57頁\編輯于星期四5.Cleanboundarisofthesubmentaltriangle現(xiàn)在是52頁\一共有57頁\編輯于星期四6.Cutthroughtheinvestingfasciatoexopsethesubmandibulargland,thefacialvein,thecervicalbranchesofthefacialnerveandsubmandibularlymphnodes.現(xiàn)在是53頁\一共有57頁\編輯于星期四Identifythefacialarteryandfollowittoitsorigin.D