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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,上肢局部解剖,(Regional anatomy of the upper limb),中南大学湘雅医学院 人体解剖学与神经生物学系,张 建 伟,肘、腕、手,(Elbow 、wrist and Hand),主要内容:,(一)肘部:肘窝,(二)腕部:腕管,解剖学“鼻烟壶”,(三)手部:层次,骨筋膜鞘,筋膜间隙,一、肘部,1.境界:,肱骨内上髁,上界:肱骨内、外上髁,连线的上方两横,指的环形线,下界:肱骨内、外上髁,连线的下方两横,指的环形线,头静脉 Cephalic vein,贵要静脉 Basilic vein,肘正中静脉 Median cubital vein,头静脉,贵要静脉,肘正中静脉,The cubital fossa,指位于肘前区的尖朝向上肢远端的三角形凹陷,(1)定义:,(2)境界:,上界:肱骨内外上髁的连线,A line connecting the two,humeral epicondyles,下外侧界:肱桡肌,Brachioradialis,下内侧界:旋前圆肌,Pronator teres,顶Roof: 皮肤,浅筋膜,肘前区深筋膜,Deep fascia,肱二头肌肌腱腱膜,Aponeurosis of biceps,底Floor:肱肌,Brachialis,旋后肌,Supinator,肘关节囊,3.内容:,肱二头肌腱,Tendon of biceps,肱及其分支,肱V 及其属支,正中神经,Median nerve,1.境界:,上界:尺、桡骨茎,突近侧 2 横,指的环形线,下界:屈肌支持带,下缘水平,二、腕部,Wrist,anterior region of wrist,深层结构,腕掌侧韧带,Volar carpal ligament,屈肌支持带,Flexor retinacum,腕尺侧管,Ulnar carpal canal,腕桡侧管,Radial carpal canal,尺神经,尺动脉,桡侧腕屈肌腱,腕管,Carpal canal,定义:由屈肌支持带和腕骨沟共同围成的管道,管内通过的结构:,指浅屈肌腱及其腱鞘,(4),指深屈肌腱及其腱鞘,(4),拇长屈肌腱及其腱鞘,(1),正中神经,9条肌腱,1条神经,腕管综合征,Carpal canal syndrome,posterior,region of wrist,(1)解剖学“鼻烟壶”,Anatomical,snuffbox,桡侧界-拇长展肌腱、拇短伸肌腱,尺侧界-拇长伸肌腱,近侧界-桡骨茎突,底-手舟骨、大多角骨,拇长伸肌,拇短伸肌,拇长展肌,边界:,“鼻烟壶”,(2)解剖学“鼻烟壶”窝内通,过的结构:,桡动脉,(3)临床意义:,手的骨(腕骨),三、手部,Hand,掌面观,背面观,掌面观,背面观,手的骨(掌骨和指骨),手的关节,(尺侧),腕关节,拇腕掌关节,掌横关节,桡尺远侧关节,深层,指深屈肌,手部肌腱(掌侧屈肌群肌腱),指浅屈肌,拇长屈肌,掌长肌,中层,浅层,手部肌腱(背侧伸肌群肌腱),拇长伸肌,拇短伸肌,拇长展肌,指伸肌,小指伸肌,示指伸肌,深层,浅层,手部肌(,鱼际肌群和小鱼际肌群,),蚓状肌,手部肌(中间肌群),骨间掌侧肌,骨间背侧肌,皮肤,Skin,浅筋膜,Superficial fascia,深筋膜,Deep fascia,指蹼间隙,掌浅弓,Superficial palmar arch,正中神经,Median nerve,尺神经浅支,Superficial branch of ulnar N,指浅屈肌腱,Tendons of flexor,digitorum superficialis,指深屈肌腱,Tendons of flexor,digitorum profoundus,蚓状肌,Lumbricales,尺神经深支,Deep branch of ulnar N,掌深弓,Deep palmar arch,骨间肌,Interosseous muscles,掌骨,Metacarpal bones,(1)浅筋膜,Superficial fascia,浅层,鱼际筋膜 Thenar fascia,掌腱膜 Palmar aponeurosis,小鱼际筋膜Hypothenar fascia,(2)深筋膜 Deep fascia,骨间掌侧筋膜,Palmar interosseorus fascia,拇收肌筋膜,Fascia of abductor pollicis,深层,(3)肌间隔,掌外侧肌间隔,Lateral intermuscular septum of palm,掌内侧肌间隔,Medial intermuscular septum of palm,掌中隔,Palmar intermediate septum,中间鞘,Intermediate compartment,外侧鞘(鱼际鞘),Lateral compartment,内侧鞘(小鱼际鞘),Medial compartment,(4)骨筋膜鞘,(4)筋膜间隙,掌中间隙,Midpalmar space,鱼际间隙,Thenar space,纤维鞘,滑膜鞘,AAnnular pulley,环行滑车,C Cruciform Pulley,交叉滑车,狭窄性腱鞘炎,7.指 髓,切 口,断指再植,THANKS,
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