四肢局部解剖优秀PPT.ppt

Southern Medical UniversitySouthern Medical University四肢局部解剖总结局部解剖学局部解剖学南方医科高校人体解剖教研室南方医科高校人体解剖教研室戴戴 景景 兴兴Southern Medical UniversitySouthern Medical University内容提要内容提要v腋窝的局部解剖v臂丛的局部解剖v乳房的局部解剖v肘关节动脉网v梨状肌四周的局部解剖v大隐静脉的局部解剖v股三角的局部解剖v膝关节的局部解剖v踝管的局部解剖Southern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical University1、腋窝、腋窝尖、底和四个壁v尖为腋腔上口，由第一肋骨、锁骨和肩胛骨上缘所围成v底朝下外，被筋膜和皮肤所封闭v前壁由浅入深为皮肤、浅筋膜、深筋膜、胸大肌、胸小肌及锁胸筋膜组成v内侧壁由胸廓上五个肋骨及肋间肌和前锯肌所组成v后壁由肩胛下肌、大圆肌及背阔肌所组成v外侧壁由肱骨近侧段肱二头肌短头和喙肱肌所组成Southern Medical UniversitySouthern Medical University腋腋窝窝前前面面观观Southern Medical UniversitySouthern Medical University腋腋窝窝前前面面观观Southern Medical UniversitySouthern Medical University腋腋窝窝前前面面观观Southern Medical UniversitySouthern Medical University腋腋窝窝前前面面观观Southern Medical UniversitySouthern Medical University2、臂丛、臂丛根 C5-T1干 上、中、下股 前股、后股束 内侧束 外侧束 后束Southern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical University2007年年5月月13日陈晓旭因日陈晓旭因乳腺癌医治无效去世乳腺癌医治无效去世Southern Medical UniversitySouthern Medical University部分患乳腺肿瘤的名人部分患乳腺肿瘤的名人叶凡叶凡 2007年年11月月27日病逝日病逝李媛媛李媛媛02年年10月月20日病逝日病逝凯莉凯莉米洛米洛 2005年患乳腺癌年患乳腺癌南希南希里根里根 1987年患乳腺癌年患乳腺癌汪明荃接受乳房肿瘤手术汪明荃接受乳房肿瘤手术蔡琴接受乳房肿瘤手术蔡琴接受乳房肿瘤手术Southern Medical UniversitySouthern Medical University3、乳房的局部解剖、乳房的局部解剖v位置位置v形态结构形态结构v血管及神经血管及神经v淋巴回流淋巴回流v临床要点临床要点Southern Medical UniversitySouthern Medical University乳房的位置及形态结构乳房的位置及形态结构v在胸大肌和胸筋膜的表面在胸大肌和胸筋膜的表面v居第居第36肋之间肋之间v内侧至胸骨旁线内侧至胸骨旁线v外侧可达腋中线外侧可达腋中线Southern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical University乳房的形态结构乳房的形态结构v皮肤、纤维组织、脂肪组织和乳腺v每侧乳腺含1520个乳腺叶v每个乳腺叶内有1条输乳管，开口于乳头v乳腺四周的纤维组织向浅面和深面发出很多小的乳房悬韧带Southern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical University酒窝征酒窝征橘皮样变更橘皮样变更Southern Medical UniversitySouthern Medical University乳房的血管神经乳房的血管神经乳房的动脉供应：u胸外侧动脉u胸廓内动脉u胸肩峰动脉u胸背动脉u第24肋间动脉外侧支Southern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical University乳房的静脉：乳房的静脉：浅静脉浅静脉向向 内内胸廓内静脉胸廓内静脉向向 外外胸腹壁静脉胸腹壁静脉胸外侧静脉胸外侧静脉左侧乳房的浅静脉左侧乳房的浅静脉右侧乳房的浅静脉右侧乳房的浅静脉深静脉与同名动脉伴行深静脉与同名动脉伴行Southern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical University乳房的神经支配乳房的神经支配第第3、4颈神经组成的锁骨上神经颈神经组成的锁骨上神经第第26肋间神经的外侧支的前皮支肋间神经的外侧支的前皮支第第26肋间神经的外侧支的外侧皮支肋间神经的外侧支的外侧皮支Southern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical University乳房的淋巴回流乳房的淋巴回流u乳房外侧部及中心部的淋巴，向外上注入胸乳房外侧部及中心部的淋巴，向外上注入胸肌淋巴结和中心淋巴结肌淋巴结和中心淋巴结u乳房上部的淋巴管穿胸大肌向上注入尖淋巴乳房上部的淋巴管穿胸大肌向上注入尖淋巴结或锁骨上淋巴结结或锁骨上淋巴结u乳房内侧部的淋巴管向内穿第乳房内侧部的淋巴管向内穿第1-5肋间隙，注肋间隙，注入胸骨旁淋巴结入胸骨旁淋巴结u乳房内下部的淋巴管可向下通过腹壁和膈下乳房内下部的淋巴管可向下通过腹壁和膈下的淋巴管与肝的淋巴管交通的淋巴管与肝的淋巴管交通u乳房皮肤的淋巴管与对侧乳房皮肤的淋巴管乳房皮肤的淋巴管与对侧乳房皮肤的淋巴管交通交通Southern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical University腋窝淋巴结腋窝淋巴结n胸肌淋巴结胸肌淋巴结 n外侧淋巴结外侧淋巴结 n肩胛下淋巴结肩胛下淋巴结n中心淋巴结中心淋巴结n尖淋巴结尖淋巴结Southern Medical UniversitySouthern Medical University乳房的临床要点乳房的临床要点n乳腺癌手术治疗乳腺癌手术治疗乳腺癌根治术乳腺癌根治术乳腺癌扩大根治术乳腺癌扩大根治术乳腺癌简化根治术乳腺癌简化根治术全乳房切除术全乳房切除术保留乳房的乳腺癌切除术保留乳房的乳腺癌切除术n隆乳术隆乳术Southern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical University4、肘肘关关节节动动脉脉网网Southern Medical UniversitySouthern Medical University5、三边孔与四边孔、三边孔与四边孔v三边孔上界为肩胛下肌和小圆肌，下界为大圆肌，外侧界即肱三头长头。旋肩胛动脉穿过间隙v四边孔上界为肩胛下肌和小圆肌，下界是大圆肌、背阔肌，内侧界为肱三头肌长头，外侧界为肱骨外科颈。有腋神经和旋肱后动、静脉通过 Southern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical University5、手掌的局部解剖、手掌的局部解剖解剖层次v浅层结构v中层结构v深层结构 手掌的间隙v掌中间隙v鱼际间隙Southern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical University6 6、梨状肌上、下孔、梨状肌上、下孔穿经梨状肌上孔的血穿经梨状肌上孔的血管和神经管和神经臀上神经、动脉和静臀上神经、动脉和静脉脉穿经梨状肌下孔的血穿经梨状肌下孔的血管和神经管和神经坐骨神经坐骨神经股后皮神经股后皮神经 臀下神经、动脉和静臀下神经、动脉和静脉脉 阴部内静脉、动脉和阴部内静脉、动脉和阴部神经阴部神经Southern Medical UniversitySouthern Medical University坐骨神经的行径及其与梨坐骨神经的行径及其与梨状肌的关系状肌的关系Southern Medical UniversitySouthern Medical University属支属支在卵圆窝旁边大隐静脉的五在卵圆窝旁边大隐静脉的五条属支条属支腹壁浅静脉腹壁浅静脉旋髂浅静脉旋髂浅静脉 阴部外浅静脉阴部外浅静脉 股内侧浅静脉股内侧浅静脉 股外侧浅静脉股外侧浅静脉7、大隐静脉及其属支、大隐静脉及其属支Southern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical University8、股三角、股三角及其及其内容物内容物n股三角境界股三角境界:上上-腹股沟韧带腹股沟韧带 内内-长收肌的内侧缘长收肌的内侧缘外外-缝匠肌的内侧缘缝匠肌的内侧缘底底-髂腰肌和耻骨肌髂腰肌和耻骨肌 n内容物内容物:股动、静脉及其分支及股动、静脉及其分支及属支，以及股神经等属支，以及股神经等Southern Medical UniversitySouthern Medical University股三角解剖股三角解剖1.股动脉及其分支：股动脉及其分支：找股动脉的关键点腹找股动脉的关键点腹股沟韧带中点股沟韧带中点 股动脉主要的分支：股动脉主要的分支：股深动脉常起自股动脉股深动脉常起自股动脉后外侧，距腹股沟韧带后外侧，距腹股沟韧带约约3 35 5厘米。股深动脉厘米。股深动脉在股三角主要分支有旋在股三角主要分支有旋股内侧动脉、旋股外侧股内侧动脉、旋股外侧动脉和三到四支穿动脉动脉和三到四支穿动脉。Southern Medical UniversitySouthern Medical University股三角解剖股三角解剖2.2.股静脉：股静脉：在股三角内，在股三角内，股静脉位于股动股静脉位于股动脉的内侧。它收脉的内侧。它收集股动脉分支伴集股动脉分支伴行的静脉，并在行的静脉，并在卵圆孔处接受大卵圆孔处接受大隐静脉的汇入。隐静脉的汇入。Southern Medical UniversitySouthern Medical University3.3.股鞘、股管、股环：股鞘、股管、股环：股鞘股鞘:包袱股血管和股包袱股血管和股管的一个漏斗形股筋管的一个漏斗形股筋膜鞘，由腹横筋膜和膜鞘，由腹横筋膜和髂筋膜向下延长形成髂筋膜向下延长形成外侧腔外侧腔-股动脉股动脉 中间腔中间腔-股静脉股静脉内侧腔内侧腔-股管股管 股管股管:股鞘内侧腔股鞘内侧腔 上口是股环上口是股环外外-股静脉股静脉后后-耻骨梳韧带耻骨梳韧带 内内-陷窝韧带陷窝韧带前前-腹股沟韧带腹股沟韧带 股三角解剖股三角解剖Southern Medical UniversitySouthern Medical University4.4.股神经股神经 在腹股沟韧带以在腹股沟韧带以下，股动脉外侧下，股动脉外侧 分成很多细支，分成很多细支，形如马尾。形如马尾。隐神经隐神经:在股神经中在股神经中有一支特殊长，伴有一支特殊长，伴行股动脉进入收肌行股动脉进入收肌管的一支。管的一支。股三角解剖股三角解剖Southern Medical UniversitySouthern Medical University肌腔隙和血管腔隙肌腔隙和血管腔隙肌腔隙肌腔隙 :前前 -腹股沟韧带腹股沟韧带后外后外-髂骨髂骨内内 -髂耻弓髂耻弓 穿经结构穿经结构髂腰肌和股神经。髂腰肌和股神经。股神经股神经股动脉股动脉股静脉股静脉股管股管腰大肌腰大肌耻骨肌耻骨肌腰大肌腰大肌股鞘股鞘腹股沟韧带腹股沟韧带陷窝韧带陷窝韧带Southern Medical UniversitySouthern Medical University血管腔隙血管腔隙:前前-腹股沟韧带腹股沟韧带后后-耻骨梳韧带耻骨梳韧带 外外-髂耻弓髂耻弓内内-陷窝韧带陷窝韧带 穿经结构穿经结构股动脉、股静脉、股动脉、股静脉、股管、淋巴管和股管、淋巴管和淋巴结淋巴结股神经股神经股动脉股动脉股静脉股静脉股管股管腰大肌腰大肌耻骨肌耻骨肌腰大肌腰大肌股鞘股鞘腹股沟韧带腹股沟韧带陷窝韧带陷窝韧带Southern Medical UniversitySouthern Medical University9 9、膝关节、膝关节骨性结构韧带、半月板及滑膜囊 韧带 囊外韧带 胫侧副韧带、腓侧副韧 带、髌韧带、髌支持带 囊内韧带 膝交叉韧带 半月板 滑膜囊及脂肪垫 髌上滑膜襞 髌内滑膜襞 髌下滑膜襞膝关节动脉网 Southern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical UniversitySouthern Medical University1010、踝管、踝管踝管内从前向后依次为胫骨胫骨后肌腱、趾长后肌腱、趾长屈肌腱、胫后屈肌腱、胫后动脉动脉及其伴行静脉、胫神经静脉、胫神经和母长屈肌腱长屈肌腱等结构。Southern Medical UniversitySouthern Medical University