Download Introduction of the nervous system

Regional Anatomy
Ling Shucai
局
部
解
剖
学
Regional Anatomy
（
）
① Head
头部
② Neck
颈部
③ Thorax
胸部
④ Abdomen
腹部
⑤ Pelvis
盆部
⑥ Limbs
四肢
⑦ Back
背部
⑧ Vertebral region
脊柱区
Regional anatomy of upper limb
The pectoral region and
axillary region
Ling Shucai
Ⅰ. The pectoral region
Main contents
1. Surface anatomy
表面解剖
2. The superficial structures
浅层结构
Superficial veins 浅静脉
Superficial lymph vessels 浅淋巴管
Cutaneous nerves 皮神经
3. The deep structures 深层结构
The deep fascia 深筋膜
The muscles 肌肉
The vessels 血管
The nerves 神经
4. Regional anatomy 局部解剖
The breast (mamma) 乳房
The clavipectoral fascia 锁胸筋膜
1. Surface anatomy
剑 肋 角
Skin incisions
2. The superficial structures
Superficial Structures



The cutaneous nerves
皮神经
The superficial blood
vessels 浅血管
The superficial
lymphatic vessels
浅淋巴管

The breast 乳房
Cephalic v.
Lateral cutaneous branch
Anterior cutaneous branch
3. The deep structures
The muscles of thorax
Extrinsic muscles
Pectoralis major 胸大肌
Pectoralis minor 胸小肌
Serratus anterior 前锯肌
Intrinsic muscles
Intercostales externi
肋间外肌
Intercostales interni
肋间内肌
Intercostales intimi
肋间最内肌
4. Regional anatomy
Mamma 乳房
Position
Lie in superficial fascia
over the pectorals major
and pectoral fascia
Extend from 3rd to 7th
ribs vertically, and from
parasternal line to
midaxillary line
transversally
Structures
－contains skin, mammary
glands and adipose tissue
Each brest has about 15～20
lobes of mammary gland
Each lobe radiates out from
the nipple and has a
lactiferous duct 输乳管
which opens separately on
the summit of the nipple and
possesses a dilated
lactiferous sinuses 输乳管
窦 just prior to its termination
Suspensory ligaments
of breast 乳房悬韧带
(cooper’s ligaments )
－strands of connective
tissue runs between skin
and deep fascia and
serve to support the
mammary glands
Clavipectoral fascia 锁胸筋膜
The deep faxcia which
extends between
subclavius, coracoid
process and pectoralis
minor muscles
The structures pass
through the
clavipectoral faxcia

Cephalic v.

Thoracoacromial a.

Lateral pectoral n.
Clavipectoral fascia
Suspensory ligament of axilla
锁胸筋膜及其穿行结构
Clavipectoral fascia
is pierced by the cephalic vein 头静脉, lymphatic vessels淋巴
管,thoracoacromial artery and vein 胸肩峰动、静脉, lateral
pectoral nerve胸外侧神经. “二进二出”
锁胸筋膜及其穿行结构
Ⅱ. The axillary region
Main contents
1.
Boundaries of the axilla
2.
Contents of the axilla
3.
Regional anatomy
1. Boundaries of the axilla
The axillary fossa is a
pyramid-shaped space
through which major
neurovascular structures
pass between the thorax
and upper extremity
Axillary fossa 腋窝
一尖一底四个壁
Boundaries of the axilla
The apex is a triangular
space limited by the first
rib, the scapula, and the
middle third of clavicle.
The base－skin and
fascia of the axillary fossa
The anterior wall


Pectoralis major, pectoralis minor and subclavius muscles
Clavipectoral fascia 锁胸筋膜
The broad medial wall－serratus anterior，intercostal
muscles and upper four ribs
The narrow lateral wall－coracobrachialis, biceps
brachii and intertubercular groove
The posterior wall
subscapularis 肩胛下肌,
teres major 大圆肌
latissimus dorsi 背阔肌,
scapula 肩胛骨
Boundaries of the axilla
Apex
Base：axillary fascia 腋筋膜
Anterior wall：pectoralis major and pectoralis minor 胸大、小肌
subclavius muscles 锁骨下肌
clavipectoral fascia 锁胸筋膜
Posterior wall：subscapularis肩胛下肌, teres major大圆肌
latissimus dorsi背阔肌, scapula 肩胛骨
Medial wall： serratus anterior 前锯肌，
intercostal muscles 肋间内肌
and upper four ribs
Lateral wall： coracobrachialis 喙肱肌, biceps brachii 肱二头肌
intertubercular groove 结节间沟
2. Contents of the axilla
Axillary artery
Axillary vein
Infraclavicular part of brachial plexus
Axillary sheath
Axillary lymph nodes
Axillary artery
Continuation of subclavian artery at
lateral border of first rib
Becomes brachial artery at lower
border of teres major
Divided into three parts by overlying
pectoralis minor

thoracoacromial a. 胸肩峰动脉

lateral thoracic a. 胸外侧动脉

subscapular a. 肩胛下动脉,


throcodorsal a. 胸背动脉 and
circumflex scapular a. 旋肩胛动脉
anterior and posterior humeral
circumflex a. 旋肱前、后动脉;
Axillary artery were divided into three parts:
Axillary vein
Axillary a.
Thoracoacromial a.
Lateral pectoral n.
Musculocutaneous n.
Medial antebrachial cutaneous n.
Median n.
Ulnar n.
Medial brachial cutaneous n.
Intercostobrachial n.
Thoracodorsal n. & a.
Long thoracic n. & lateral thoracic a.
Brachial plexus 臂丛
Formation: （根、干、股、束）
Five roots: formed by anterior
rami of C5-C8 and T1 spinal
nerves, roots C5～C7give rise
to long thoracic n. 胸长神经
Three trunks
Six divisions
Three cords: below clavicle,
divisions form three cords that
surround the second portion
of axillary a.
Main branches
Lateral cord
 Musculocutaneous n.
肌皮神经

Lateral root to median n.
正中神经外侧根
Medial cord
 Medial root to median n.
正中神经内侧根

Ulnar n.
尺神经

Medial brachial cutaneous n.
臂内侧皮神经

Medial antebrachial cutaneous n.
前臂内侧皮神经
Posterior cord



radial n.
桡神经
axillary n.
腋神经
thoracodorsal n.
胸背神经
Musculocutaneous
肌皮神经
Median nerve 正中神经

Distribution

Injury:
ape-like hand 猿掌
Ulnar nerve 尺神经

Distribution

Injury:
clawhand 爪形手
Radial nerve 桡神经

Distribution:

Injury:
Wristdrop 垂腕
Axillary nerve


Distribution:
Injury: result in
deltoid and teres
minor paralysis
Axillary lymph nodes
－arranged in five groups
Lateral lymph nodes
外侧淋巴结
Pectoral lymph nodes
胸肌淋巴结
Subscapular lymph node
肩胛下淋巴结
Efferents above three groups
pass to central lymph node
中央淋巴结
Central lymph node
中央淋巴结
Apical lymph node
尖淋巴结
3. Regional anatomy
Trilateral and quadrilateral foramina 三边孔和四边孔
Axillary sheath 腋鞘
Lymph vessels and node of mammary gland
Trilateral and quadrilateral foramina
三边孔和四边孔
posterior humeral circumflex a.
and axillary n. pass through the
quadrilateral foramen.
The circumflex scapular a.
passes through the triangular
space to reach the dorsum of the
scapula.
Axillary sheath 腋鞘
－ extension of deep
cervical fascia （颈深筋
膜）of the neck, forming
a tubular sheath that
surrounds axillary a. and
v., and brachial plexus
乳
房
的
淋
巴
引
流
The superficial structures of anterior and
medial regions of the thigh
Dissection
Superficial epigastric v.
Superficial circumflex iliac v.
Lateral cutaneous n. of thigh
External pudendal v.
Anterior cutaneous n. of thigh
Superficial lateral femoral v.
Superficial medial femoral v
Great saphenous v.
思考题
1. 试述腋腔的境界、内容及排列关系。
2. 肱二头肌内侧沟内有哪些结构走行，其位置关系如何？
3. 试述腋动脉的分段，各段有哪些分支？
4. 试述臂丛的三个束的位置及主要分支。
5. 试述正中神经、肌皮神经、尺神经、桡神经和腋神经的支配情
况及其损伤表现。
6. 试述腋淋巴结的分群及回流途径，思考乳腺癌的淋巴转移途径。
7. 名词解释：锁胸筋膜、腋鞘、三边孔、四边孔