肌学总论、头颈肌、躯干肌.ppt

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1、第三章第三章 肌肌 学学 全身肌由于构造不同可分为平滑肌、心肌和骨骼肌。全身肌由于构造不同可分为平滑肌、心肌和骨骼肌。骨骼肌骨骼肌skeletal muscleskeletal muscle具有收缩的特性，是运动系统的具有收缩的特性，是运动系统的动力部分，其收缩受神经支配，接受人的意志控制，故称动力部分，其收缩受神经支配，接受人的意志控制，故称随意肌。随意肌。全身有全身有600600余块肌，占体重余块肌，占体重40%40%。每块肌都是一个器官：有一定形态、构造，有血管、淋每块肌都是一个器官：有一定形态、构造，有血管、淋巴管，受神经支配，执行一定功能。巴管，受神经支配，执行一定功能。肌学总论总论

2、总论一、骨骼肌的形态和构造2.classification of skeletal muscle：long muscleshort muscleflat muscleorbicular muscle1.construction of skeletal muscle：bellytendonaponeurosis二 肌的起止、配布、作用 1 1、起于一块骨，止于另一块骨跨、起于一块骨，止于另一块骨跨过一个或多个关节。过一个或多个关节。2 2、起点（定点）、止点（动点）、起点（定点）、止点（动点），动定可互换。，动定可互换。3 3、肌在关节周围配布的方式和、肌在关节周围配布的方式和多少与关节的运动类

3、型密切相关。多少与关节的运动类型密切相关。4 4、沿一个运动轴周围应配布相、沿一个运动轴周围应配布相对对 应的两组肌。应的两组肌。三、肌的分部和命名三、肌的分部和命名分部：分部：头颈肌头颈肌：头肌、颈肌 躯干肌躯干肌：背肌、胸肌、腹肌、膈、会阴肌 四肢肌四肢肌：上肢肌、下肢肌命名：命名：按肌的形态、大小、位置、起止或 作用进行命名。肌的辅助结构肌的辅助结构1、浅筋膜浅筋膜superficial fasciasuperficial fascia-于真皮之下，又称于真皮之下，又称皮下筋膜，皮下筋膜，包被全身，包被全身，由疏松结缔组织构成，由疏松结缔组织构成，富含脂肪。内有浅动富含脂肪。内有浅动脉、

4、浅静脉、皮神经脉、浅静脉、皮神经和浅淋巴管穿行。和浅淋巴管穿行。2、深筋膜深筋膜deep fasciadeep fascia：又称固有筋膜，致密结缔组织构成，位于浅筋膜深面，包被体壁、四肢的肌和血管神经等。形成肌间隔、血管神经鞘 滑膜囊滑膜囊 synovial synovial bursabursa：为封闭的结缔组织囊。腱鞘腱鞘 tendinous sheathtendinous sheath:包围在肌腱外的鞘管，包围在肌腱外的鞘管，存在于腕、踝、手指存在于腕、踝、手指和足指处。和足指处。腱纤维鞘、腱纤维鞘、腱滑膜鞘腱滑膜鞘 脏层脏层 壁层壁层 腱系膜腱系膜腱纤维鞘腱纤维鞘腱滑膜鞘脏层腱滑膜鞘

5、脏层腱滑膜鞘壁层腱滑膜鞘壁层腱系膜腱系膜腱腱指骨指骨头头 肌肌可分为面肌面肌和咀嚼肌咀嚼肌（一）（一）面肌面肌 facial muscles facial muscles 又称 表情肌：表情肌：主要分布于面部裂孔周围，呈环状和放射状分布。大体可分为四群：颅顶肌颅顶肌 epicraniusepicranius：枕额肌枕额肌：枕腹、额腹、帽状腱膜帽状腱膜 眼轮匝肌眼轮匝肌 orbicularis oculiorbicularis oculi：使睑裂闭合 口周围肌口周围肌 orbicularis orisorbicularis oris：口轮匝肌口轮匝肌、提上唇肌 提口角肌、降下唇肌、降口角肌、颊肌

6、颊肌 鼻肌鼻肌 nasalis nasalis 颊肌颊肌Facial muscles 面肌面肌咀咀 嚼嚼 肌肌masticatory musclesmasticatory musclesMasseter 咬肌咬肌Origininferior border and medial surface of zygomatic archInsertionlateral surface of ramus of mandible and angle of mandibleActionelevates mandibleTemporalis 颞肌颞肌Origintemporal fossaInsertionco

7、ronoid process of mandibleActionelevates and retracts mandible翼外肌翼外肌Lateral pterygoid收缩时拉下颌关节的关节盘连同下颌头收缩时拉下颌关节的关节盘连同下颌头向前至关节结节的下方，作张口运动。向前至关节结节的下方，作张口运动。一侧作用时使下颌移向对侧一侧作用时使下颌移向对侧翼内肌翼内肌Medial pterygoid收缩时上提下颌骨，并使其向前运动收缩时上提下颌骨，并使其向前运动。一侧作用时使下颌移向对侧一侧作用时使下颌移向对侧The muscles of neck颈肌颈肌一、颈浅层肌和颈外侧肌一、颈浅层肌和颈外侧

8、肌1.Platysma 颈阔肌颈阔肌，菲薄的皮肌，起自胸大肌和三角肌的筋膜，向内上止于口角。可拉口角向下。n 2.Sternocleidomastoid 胸胸锁乳突肌锁乳突肌origin:Anterior surface of manubrium and sternal end of clavicalninsertion:Mastoid process of temporal bonenActon:one side acting alone,draws head toward the same side,and turn face to opposite side;both sides tog

9、ether,draw head directly backward颈前肌1.舌骨上肌群舌骨上肌群 Suprahyoid muscles Digastric 二腹肌二腹肌Mylohyoid 下颌舌骨肌下颌舌骨肌Stylohyoid 茎突舌骨肌茎突舌骨肌Geniohyoid 颏舌骨肌颏舌骨肌 作用：当舌骨固定时，拉下颌骨向下而张口吞咽时，下颌骨固定，上提舌骨。2.舌骨下肌群舌骨下肌群Infrahyoid muscleSternohyoid 胸骨舌骨肌胸骨舌骨肌Thyrohyoid 甲状舌骨肌甲状舌骨肌Sternothyroid 胸骨甲状肌胸骨甲状肌Omohyoid 肩胛舌骨肌肩胛舌骨肌-下降舌骨和

10、喉下降舌骨和喉.颈前肌Muscles of the neck颈深肌群颈深肌群Deep group位于脊柱颈部两侧和前方。LateralScalenus anterior 前斜角肌前斜角肌Scalenus medius 中斜角肌中斜角肌Scalenus posterior 后斜角肌后斜角肌Medial longus capitis 头长肌头长肌 longus colli 颈长肌颈长肌 一侧肌收缩,使颈侧屈;两侧肌同时收缩可上提第1、2肋助吸气.Scalene fissure 斜角肌间隙斜角肌间隙Boundaries first ribscalenus anterior and mediusStr

11、uctures passing through scalene fissure brachial plexus 臂丛臂丛subclavian a.锁骨下动脉锁骨下动脉Muscles of trunk 躯干肌躯干肌Muscles of back背肌Muscles of thorax胸肌Diaphragm膈Muscles of abdomen腹肌muscles of perineum会阴肌会阴肌The Muscles of Back浅层浅层Superficial group斜方肌斜方肌Trapezius肩胛提肌肩胛提肌Levator scapulae菱形肌菱形肌 Rhomboideus背阔肌背阔肌

12、Latissimus dorsi深层深层 deep groupErector spinae 竖脊肌竖脊肌Splenius 夹肌夹肌The Muscles of BackDeep group Splenius 夹肌夹肌Erector spinae 竖脊肌竖脊肌Position:fills the vertebral groove on each side of the spine Action:both sides together extends vertebral column and head.acting along,flex the vertebral column laterally

13、.Major Muscles of BackTrapezius 斜方肌斜方肌Origin:superior nuchal line,external occipital protuberance,ligamentum nuchae and spinous processes of seventh cervical and all thoracic vertebraeInsertion:lateral third of clavicle,acromion,and spine of scapularActon:draw the scapula toward vertebral column.sup

14、per fibers elevate scapula,lower fibers depress scapula;if scapula is fixed,one side acting along,draws head toward the same side,and turn face to opposite side;both sides together,draw head directly backward Major Muscles of BackLatissimus dorsi 背阔肌背阔肌Origin:Spinous processes of lower six thoracic

15、and all lumbar vertebraeMedian sacral crestPosterior part of iliac crestInsertion:crest of lesser tubercleAction:trunk fixed,extends,adducts and medially rotates arm;arm fixed,elevates trunkThoracolumbar Fascia 胸腰筋膜胸腰筋膜Posterior layerMiddle layerAnterior layer指在竖脊肌周围的筋膜，在腰部可分为三层：后层：竖脊肌后面；中层：分隔竖脊肌 和腰

16、方肌；深层：覆盖在腰方 肌前面Muscles of thoraxMuscles connecting the upper limb to the thoracic wallPectoralis major 胸大肌胸大肌 Pectoralis minor 胸小肌胸小肌 Serratus anterior 前锯肌前锯肌 Major muscles of thoraxPectoralis Major 胸大肌胸大肌Origin:medial half of clavicle,sternum,upper six costal cartilages.Insertion:crest of greater t

17、ubercleAction:adducts the arm and rotates it medially;the clavicular fibers also flex the arm;with the arm above the head,raise the body as in climbing The muscles of thoraxExtrinsic musclesPectoralis major Pectoralis minorSerratus anteriorIntrinsic musclesIntercostales externi 肋间外肌肋间外肌Intercostales

18、 interni 肋间内肌肋间内肌Intercostales intimi 肋间最内肋间最内肌肌Transversus thoracis 胸横肌胸横肌 Major muscles of thoraxIntercostales externi 肋间外肌肋间外肌Origin:inferior border of rib aboveInsertion:superior border of rib belowReplaced anteriorly by external intercostals membrane Action:raise ribs adding in forced inspirati

19、on Major muscles of thoraxIntercostales interni 肋间内肌肋间内肌Origin:superior border of rib belowInsertion:inferior border of rib above Replaced posteriorly by internal intercostals membrane.Action:depress ribs for forced expirationIntercostales intimi 肋间最内肌肋间最内肌 Diaphragm 膈膈Shape and positiondome-shaped

20、between thorax and abdomenconsists of a peripheral muscular part and a central tendonOriginSternal part:arising from xiphoid processCostal part:arising from lower six and costal cartilagesLumbar part:arising by two crura from upper 2-3 lumbar vertebrae,medial and lateral arcuate ligamentsInsertion:c

21、entral tendon Diaphragm 膈膈Weak areas:Lumbocostal triangle Sternocostal triangleOpenings in the diaphragmAortic hiatus主动脉裂孔主动脉裂孔lies anterior to the body of the 12th thoracic vertebra between the crura.It transmits the aorta,thoracic ductEsophageal hiatus 食管裂孔食管裂孔for esophagus and vagus nerves at lev

22、el of T10.Vena cava foramen 腔静脉孔腔静脉孔for inferior vena cava,through central tendon at T8 levelT8T10T12Action:Contraction:the dome moving downward,increases the volume of thoracic cavity which results in inspiration,at the same time the intra-abdominal pressure is increased assists in defecation排便,vom

23、iting呕吐or child birth.Relaxation:the dome returns to the former position,reduces the volume to the thoracic cavity,resulting in expiration.四、腹肌四、腹肌Muscles of abdomenAnterolateral groupObliquus externus abdominis 腹外斜肌腹外斜肌Oblequus enternus abdominis腹内斜肌腹内斜肌Transversus abdominis腹横肌腹横肌Rectus abdominis 腹

24、直腹直肌肌腹外斜肌腹外斜肌腹内斜肌腹内斜肌Posterior group Quadratus lumborum 腰方肌腰方肌Psoas major 腰大肌腰大肌髂肌iliacusObliquus externus abdominis 腹腹外斜肌外斜肌General direction of fibers:downward,forwardStructuresInguinal ligament 腹股沟韧带腹股沟韧带Lacunar ligament 腔隙韧带腔隙韧带pectineal ligament耻骨梳韧带耻骨梳韧带Superficial inguinal ring 腹股腹股沟管浅环沟管浅环 t

25、riangular-shaped defect缺损in aponeurosis of obliquus externus abdominis above pubic tubercleObliquus internus abdominis 腹内斜肌腹内斜肌Position:deep to obliquus externus abdominisGeneral direction of fibres:upwards,forwards Transversus abdominis 腹横肌腹横肌Position:deep to obliquus internus General direction of

26、fibres:run more or less horizontally.腹外斜肌腹外斜肌腹内斜肌腹内斜肌腹横肌腹横肌腹横肌腹横肌腹内斜肌腹内斜肌腹直肌腹直肌Inguinal falx 腹股沟镰腹股沟镰:arch over spermatic cord,inserted with transverses abdominis fiber into medial part of pecten of pubis Cremaster 提睾肌提睾肌:around the spermatic cord精索and testis睾丸腹股沟镰腹股沟镰Rectus abdominis 腹直肌腹直肌Position

27、:lie on to either of midlineOrigin:pubic crest and symphysisInsertion:xiphoid and 5th-7th costal cartilagesHas 3-4 tendinous intersections 腱划腱划 Similar functions for above four pairs of muscles1.Support and compress the abdominal viscera2.Increase intra-abdominal pressure,aid in vomiting呕吐,coughing,

28、sneezing,defecation排便,urination排尿and childbirth.3.Depress ribs,assist in(the act of force(4)expiration.4.Flex,lateral flex,and rotate vertebral column.Sheath of rectus abdominis 腹直肌鞘腹直肌鞘Ant layerformed by fusion of aponeurosis of obliquus externus abdominis and anterior leaf of aponeurosis of obliqu

29、us internus abdominisPost layerFormed by fusion of posterion leaf of aponeurosis of obliquus internus abdominis and aponeurosis of transverses abdominisAbsent in about 4-5cm below the umbilicus,where aponeuroses of all three muscles form anterior layer the lower free border named arcuate lineBelow t

30、his line rectus abdominis in contact with transverse fasciaLinea alba 白线白线tendinous raphe缝between right and left recti from xiphoid to pubic symphysis.Inguinal canal 腹股沟管腹股沟管Position:oblique passage,4cm long,located 1.5cm above medial half of inguinal lig.BoundariesAnterior wallAponeurosis of obliqu

31、us externus abdominisObliquus internus abdominis(lateral third of wall)Posterior wallTransverse fascia Inguinal falx mediallySuperior wallarched lower fibers of obliquus internus and transversua abdominisinferior wallinguinal ligTwo openingsSuperficial inguinal ring 腹股沟管浅环腹股沟管浅环Deep inguinal ring 腹股

32、沟管深腹股沟管深环环 defect in transverse fascia 1.5cm above midpoint of inguinal ligamentStructures passing through the inguinal canal Spermatic cord 精索精索 and ilioinguinal nerve髂腹股沟神经髂腹股沟神经 in males Round ligament of uterus 子宫圆韧带子宫圆韧带and ilioinguinal nerve髂腹股沟神经髂腹股沟神经 in females Inguinal Triangle(of Hesselba

33、ch)腹股沟三角腹股沟三角 Boundaries Inguinal ligament inferiorlyLateral border of rectus abdominis medially Inferior epigastric artery laterally内面观Teaching outline1.Master the composition of the muscles of the mastication,the position and action of the masseter,temporalis.2.Master the origin,insertion,and acti

34、ons of the sternocleidmastoid.Master the formation of scalene fissure and the structures which pass through it3.Master the origin,insertion,and actions of the trapezius,latissimus dorsi,the position and actions of the erector spinae.4.Master the composition of the muscles of thorax,the origin,insert

35、ion,and actions of the pectoralis major.5.Master the position and action of the intrinsic muscles of thorax.6.Master the position,shape,structural features(central tendon,three hiatus or foramen and the structures which pass through,)and the function of the diaphragm.7.Master the composition of the

36、muscles of abdomen,master the position,layer,direction of the fibers,and action of the anterolateral group,master the structures which formed by the anterolateral group.8.Master the composition and structural features of the sheath of rectus abdominis.Lacunar ligament 腔隙韧带腔隙韧带pectineal ligament耻骨梳韧耻骨梳韧带带