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人体解剖学椎管及其人体解剖学椎管及其内容物内容物Vertebral canalSacrum&sacral canalNormal vertebral column and spinal cordSpinal cord in situ 2 enlargements medullary cone terminal filum cauda equinav medullary conev cauda equina v filum terminale Vertebra,intervertebral foramen,spinal cord,&spinal nerve The spinal segment31 segments of spinal cord The spinal cord is consisted of 31 segments in corresponding to the spinal nerves.8 cervical segments,8 cervical segments,12 thoracic,5 lumbar,5 12 thoracic,5 lumbar,5 sacral and 1 coccygeal.sacral and 1 coccygeal.Relationship of the spinal cord and spinal nervesEach of pair of spinal nerve leaves the spinal canal at the same number of the intervertebral foramen(corresponding intervertebral foramina)Each of pair of the spinal nerve is attached to spinal cord by anterior and posterior roots.Relationship between the segments of spinal cord and vertebral column Spinal cordVertebral columnC14CV1CV4C58CV4CV6T1T4CV7TV3T5T8TV3TV6T9T12TV6TV9L15TV10TV12S15 and CoLV1Coverings of the spinal cord1.vertebral canal 2.meninges of spinal cord dura mater arachnoid mater pia materSpinal meningeal coveringsvDura matervArachnoid matervPia materSpinal cord,spinal nerves,and spinal meningesSpaces Associated with the Spinal MeningesEpidural space Subdural space Subarachnoid space denticulate ligaments dural root sheaths Inferior end of spinal dural sacEpidural Blocks&Spinal BlocksBlood supply of spinal cordVertebral arteryAscending cervical arteryIntercostal arteryLumbar artery Vertebral artery:SAArterial supplies of the spinal cord3 longitudinal vessels run the length of the spinal cord.An anterior spinal a.paired posterior spinal a.Segmental medullary a.&radicular a.Segmental medullary arteries and radicular arteries derived from segmental vessels,including the ascending cervical,intercostal and lumbar arteriesMajor anterior medullary a.Segmental medullary a.&radicular a.Arterial supply of spinal cordBlood supply of vertebraeVenous drainage of the spinal cordFollows a basically similar pattern to arteries supply Six longitudinal interconnecting venous channels exist.These consist of anterior and posterior veins which run in the midline.More irregular sometimes incomplete bilateral paired anteriolateral and posterolateral veins are situated near the lines of attachement of the dorsal and ventral nerve roots.Venous drainage of the spinal cordl 6 longitudinal interconnecting venous channels exist.l Anterior,posterior veins,anteriolateral,and posteriolateral veinsl radicular veinsVein of spinal cord&vertebral venous plexusVertebral venous plexus Spinal veinsVenous drainage of the spinal cordAll of these vessels drain via anterior and posterior radicular veins into the internal vertebral venous plexus in epidural space The internal venous plexus communicates with an external venous plexus and hence with the ascending lumbar veins,the azygos and hemiazygos veins.Venous drainage of vertebral columnInnervation of periosteum and ligaments of vertebral column and of meningesOutline of vertebral canalNormal cervical vertebral column and spinal cordNormal cervical vertebral column and spinal cord患者可能有颅内出血，医生拟进行腰椎穿刺以确诊。在何位置进针？为何选取这些椎骨位置？此位置在婴儿安全吗？为什么在进行腰椎穿刺的时候要病人的背部尽量屈曲？病例分析病例分析病例分析病例分析患者60岁，男性，主诉腹部脉搏搏动显著增强，感觉像是第二个心脏，并伴腹部、背部和腹股沟区疼痛。X线片发现患者腹主动脉钙质沉积并伴有动脉瘤表现。CT示直径11cm的腹主动脉瘤。住院治疗前，患者在回家途中遭遇小型车祸。患者被立即送往医院行破裂性动脉瘤修复术。手术中患者的主动脉多处被移位，并结扎了几支节段性动脉。虽然使用聚酯纤维对动脉进行了成功的修复，患者在术后仍发生了截瘫和阳痿，膀胱和直肠的功能也丧失了意识支配。患者术后发生症状的解剖学基础是什么？一18岁女性从马上摔落，由于落地时颈部处于过伸位导致脊髓受损。虽然患者通过正确的方式被迅速送往医院，但仍在约5分钟后死亡。尸检显示：数块颈椎发生骨折，寰椎两侧椎动脉沟处发现骨折线，C6、C7存在多发性骨折。脊髓严重受损，颈部软组织广泛出血。上述哪些损伤可能由椎骨骨折引起？脊柱的哪些相关结构也可能发生了破裂？通常能够考虑到颈髓横断会导致四肢瘫痪，但导致该患者死亡的原因是什么？颈椎骨折通常会导致死亡吗？病例分析病例分析谢谢
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