頸部一、概述二、淺層結(jié)構(gòu)三、頸部深筋膜四、頸前區(qū)五、胸鎖乳突肌區(qū)六、頸根部七、頸側(cè)區(qū)January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸部一、概述一、概述境界：內(nèi)容：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

一、概述境界：January,2007Copyright頸部分區(qū)：項(xiàng)部固有頸部（頸部）頸前區(qū)胸鎖乳突肌區(qū)頸側(cè)區(qū)January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸部分區(qū)：項(xiàng)部January,2007Copyright

舌骨上區(qū):下頜下三角頦下三角舌骨下區(qū):頸動(dòng)脈三角肌三角頸前區(qū)：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

舌骨上區(qū):頸前區(qū)：January,2007Cop胸鎖乳突肌區(qū)頸側(cè)區(qū)：

枕三角鎖骨上大窩January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

胸鎖乳突肌區(qū)January,2007Copyright?二、淺層結(jié)構(gòu)1.頸闊肌2.淺靜脈3.皮神經(jīng)

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

二、淺層結(jié)構(gòu)1.頸闊肌January,2007Copy1.頸闊肌起點(diǎn)：三角肌和胸大肌表面的筋膜。止點(diǎn)：口角頸闊肌深面有淺靜脈和皮神經(jīng)。

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

1.頸闊肌起點(diǎn)：三角肌和胸大肌表面的筋膜。January,2.淺靜脈

①頸前靜脈注入頸外靜脈②頸外靜脈注入鎖骨下靜脈或靜脈角January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

2.淺靜脈①頸前靜脈January,2007Co3.皮神經(jīng)(1)為頸叢的皮支:①頸橫神經(jīng)②耳大神經(jīng)③枕小神經(jīng)④鎖骨上神經(jīng)頸部麻醉點(diǎn)：(2)面神經(jīng)頸支January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

3.皮神經(jīng)(1)為頸叢的皮支:January,2007三、頸部深筋膜分淺、中、深三層。

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

三、頸部深筋膜分淺、中、深三層。January,2包裹二肌二腺，形成肌鞘和腺鞘。二肌：斜方肌胸鎖乳突肌二腺：下頜下腺腮腺

1.深筋膜淺層（封套筋膜）January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

包裹二肌二腺，形成肌鞘和腺鞘。1.深筋膜淺層（封位于舌骨下肌群的后方，上附于舌骨，下續(xù)纖維性心包，分二層包繞甲狀腺，形成甲狀腺鞘。2.深筋膜中層（氣管前筋膜）January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于舌骨下肌群的后方，上附于舌骨，下續(xù)纖維性心包，分二層上自顱底，下續(xù)前縱韌帶與胸內(nèi)筋膜，并向下外包繞腋血管及臂叢，形成腋鞘。3.深層（椎前筋膜）

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

上自顱底，下續(xù)前縱韌帶與胸內(nèi)筋膜，并向下外包繞腋血管及臂為包繞頸部大血管和迷走神經(jīng)的筋膜鞘。頸動(dòng)脈鞘：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

為包繞頸部大血管和迷走神經(jīng)的筋膜鞘。頸動(dòng)脈鞘：Janua頸動(dòng)脈鞘內(nèi)上部有頸內(nèi)動(dòng)脈、下部有頸總動(dòng)脈，頸內(nèi)靜脈位于動(dòng)脈的外側(cè)，迷走神經(jīng)位于兩者之間的后方。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸動(dòng)脈鞘內(nèi)上部有頸內(nèi)動(dòng)脈、下部有頸總動(dòng)脈，頸內(nèi)靜脈位于動(dòng)頸部的筋膜間隙：主要有：

(1)胸骨上間隙(2)氣管前間隙(3)咽后間隙(4)椎前間隙January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸部的筋膜間隙：主要有：January,2007Co位于胸骨柄上方深筋膜淺層的二層之間。內(nèi)有頸前靜脈下段、頸靜脈弓、淋巴結(jié)、脂肪組織等。(1)胸骨上間隙January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于胸骨柄上方深筋膜淺層的二層之間。(1)胸骨上間位于氣管前筋膜與氣管之間。通向：向下通上縱隔。(2)氣管前間隙January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于氣管前筋膜與氣管之間。(2)氣管前間隙Januar①甲狀腺下靜脈②奇靜脈叢③頭臂干④甲狀腺最下動(dòng)脈⑤左頭臂靜脈⑥小兒有胸腺上部

氣管前間隙內(nèi)有January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

①甲狀腺下靜脈氣管前間隙內(nèi)有January,2007C位于椎前筋膜與咽顱底筋膜之間。內(nèi)有淋巴結(jié)及結(jié)締組織。咽壁側(cè)方的部分為咽旁間隙。(3)咽后間隙January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于椎前筋膜與咽顱底筋膜之間。內(nèi)有淋巴結(jié)及結(jié)締組織。咽壁位于脊柱頸段與椎前筋膜之間。頸椎結(jié)核膿腫多積于此間隙。向下通后縱隔。(4)椎前間隙January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于脊柱頸段與椎前筋膜之間。頸椎結(jié)核膿腫多積于此間隙。（一）舌骨上區(qū)下頜下三角頦下三角（二）舌骨下區(qū)頸動(dòng)脈三角肌三角四、頸前區(qū)January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（一）舌骨上區(qū)四、頸前區(qū)January,2007Co（一）舌骨上區(qū)1.下頜下三角周界：位于下頜骨下緣與二腹肌前、后腹之間。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（一）舌骨上區(qū)1.下頜下三角January,2007

主要為下頜下腺及其周圍的血管神經(jīng)。

內(nèi)容January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

主要為下頜下腺及其周圍的血管神經(jīng)。內(nèi)容Ja

淺面有：面靜脈深面有：面動(dòng)脈內(nèi)下方有：舌下神經(jīng)舌動(dòng)脈、舌靜脈內(nèi)上方有：舌神經(jīng)下頜下神經(jīng)節(jié)

下頜下腺周圍的結(jié)構(gòu)：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

淺面有：面靜脈下頜下腺周圍的結(jié)構(gòu)：January,（二）舌骨下區(qū)頸動(dòng)脈三角肌三角January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（二）舌骨下區(qū)頸動(dòng)脈三角肌三角January,20071.頸動(dòng)脈三角境界：胸鎖乳突肌前緣上份二腹肌后腹肩胛舌骨肌上腹January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

1.頸動(dòng)脈三角境界：January,2007Copyrig

頸總動(dòng)脈及其分支頸內(nèi)靜脈及其屬支迷走神經(jīng)副神經(jīng)舌下神經(jīng)主要內(nèi)容：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸總動(dòng)脈及其分支主要內(nèi)容：January,2

頸外動(dòng)脈頸內(nèi)動(dòng)脈

頸總動(dòng)脈及其分支：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸外動(dòng)脈頸總動(dòng)脈及其分支：January,2

甲狀腺上動(dòng)脈舌動(dòng)脈面動(dòng)脈枕動(dòng)脈

頸外動(dòng)脈的分支：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲狀腺上動(dòng)脈頸外動(dòng)脈的分支：January,2.肌三角

周界：頸前正中線肩胛舌骨肌上腹胸鎖乳突肌前緣January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

2.肌三角周界：January,200肌肉：舌骨下肌群4對(duì)功能:下降舌骨和喉胸骨舌骨肌肩胛舌骨肌胸骨甲狀肌甲狀舌骨肌January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

肌肉：舌骨下肌群4對(duì)功能:下降舌骨和喉胸骨①甲狀腺②甲狀旁腺③氣管頸段④食管頸段內(nèi)容：

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

①甲狀腺內(nèi)容：January,2007Copyrigh

甲狀腺thyroidgland

1.外形:

“H”形有二個(gè)側(cè)葉和一個(gè)峽部。一半以上（約70%）的人有錐狀葉。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲狀腺thyroidgland1.外

甲狀腺位于喉下部和氣管上部的兩側(cè)。側(cè)葉上端平甲狀軟骨中部，下端達(dá)第6氣管軟骨環(huán)；峽部位于第2~4氣管軟骨環(huán)的前面。2.位置January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲狀腺位于喉下部和氣管上部的兩側(cè)。側(cè)葉3.甲狀腺的被膜

甲狀腺的表面包有內(nèi)、外層被膜，即：內(nèi)層：纖維囊（真被膜）外層：甲狀腺鞘（假被膜）

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

3.甲狀腺的被膜甲狀腺的表面包有內(nèi)、外層被膜，即假被膜增厚形成的甲狀腺懸韌帶將甲狀腺連于喉和氣管，故吞咽時(shí)，甲狀腺可隨喉上、下移動(dòng)。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

假被膜增厚形成的甲狀腺懸韌帶將甲狀腺連于喉和氣管，故吞咽4.甲狀腺的毗鄰甲狀腺前面鄰(層次）皮膚淺筋膜深筋膜淺層舌骨下肌群January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

4.甲狀腺的毗鄰甲狀腺前面鄰(層次）January,200

喉氣管咽食管喉返神經(jīng)甲狀腺側(cè)葉內(nèi)側(cè)鄰：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

喉甲狀腺側(cè)葉內(nèi)側(cè)鄰：January

頸鞘及其內(nèi)容

頸交感干

甲狀腺側(cè)葉后外側(cè)鄰：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸鞘及其內(nèi)容甲狀腺側(cè)葉后外側(cè)鄰：January

5.甲狀腺的動(dòng)脈與喉的神經(jīng)的關(guān)系

甲狀腺上動(dòng)脈與喉上神經(jīng)外支伴行，在距腺上極約1cm處，二者又分開，故甲狀腺手術(shù)結(jié)扎甲狀腺上動(dòng)脈時(shí)應(yīng)緊貼腺上極進(jìn)行。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

5.甲狀腺的動(dòng)脈與喉的神經(jīng)的關(guān)系甲狀腺上動(dòng)脈甲狀腺下動(dòng)脈與喉返神經(jīng)的關(guān)系：

甲狀腺下動(dòng)脈與喉返神經(jīng)關(guān)系密切，左側(cè)喉返神經(jīng)位置較深，多經(jīng)動(dòng)脈后方上行；右側(cè)喉返神經(jīng)位置較淺，多經(jīng)動(dòng)脈前方。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲狀腺下動(dòng)脈與喉返神經(jīng)的關(guān)系：甲狀腺下動(dòng)脈與喉返神

左右喉返神經(jīng)入喉之前都經(jīng)環(huán)甲關(guān)節(jié)后方，故甲狀軟骨下角可作為尋找喉返神經(jīng)的標(biāo)志。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

左右喉返神經(jīng)入喉之前都經(jīng)環(huán)甲關(guān)節(jié)后方，故甲狀

在甲狀腺手術(shù)結(jié)扎甲狀腺下動(dòng)脈時(shí)應(yīng)遠(yuǎn)離腺的下極，避免傷及喉返神經(jīng)，引起聲音嘶啞。同時(shí)要注意保留甲旁狀腺。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

在甲狀腺手術(shù)結(jié)扎甲狀腺下動(dòng)脈時(shí)應(yīng)遠(yuǎn)離腺的下6.甲狀腺的靜脈

有三對(duì)：甲狀腺上靜脈甲狀腺中靜脈甲狀腺下靜脈

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

6.甲狀腺的靜脈有三對(duì)：January,2007Cop作甲狀腺手術(shù)切口所經(jīng)過的層次①皮膚②淺筋膜③深筋膜淺層④舌骨下肌群⑤氣管前筋膜January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

作甲狀腺手術(shù)切口所經(jīng)過的層次①皮膚January,2007氣管頸部有一定的移動(dòng)性，上段位置表淺，下段位置深。故常規(guī)氣管切開術(shù)應(yīng)保持頭正中位，并盡量后仰。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

氣管頸部有一定的移動(dòng)性，上段位置表淺，下氣管切開經(jīng)過層次：①皮膚②淺筋膜③深筋膜淺層④胸骨上間隙⑤舌骨下肌群⑥氣管前筋膜January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

氣管切開經(jīng)過層次：①皮膚January,2007Copy氣管頸部的毗鄰：

兩側(cè)：甲狀腺側(cè)葉后方：食管氣管食管溝內(nèi)有喉返神經(jīng)后外側(cè)：頸動(dòng)脈鞘頸交感干January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

氣管頸部的毗鄰：兩側(cè)：甲狀腺側(cè)葉January,2007六、胸鎖乳突肌區(qū)位置：主要結(jié)構(gòu)：頸袢January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

六、胸鎖乳突肌區(qū)位置：January,2007Copyri組成:由頸袢上、下根在第6頸椎平面匯合成袢。

頸袢January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

組成:頸袢January,2007Copyright頸袢上根：由頸1前支構(gòu)成。頸袢下根：由頸2、3前支經(jīng)頸叢發(fā)出下行構(gòu)成。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸袢上根：由頸1前支構(gòu)成。January,2007Copy分布:頸1發(fā)支至甲狀舌骨肌，袢上發(fā)支至其余3個(gè)舌骨下肌群。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

分布:January,2007Copyright?Dep七、頸根部

位置：頸部和胸部之間的過渡區(qū)。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

七、頸根部位置：January,2007Copyrig縱行結(jié)構(gòu)橫行結(jié)構(gòu)

以前斜角肌為標(biāo)志分為：結(jié)構(gòu)：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

縱行結(jié)構(gòu)橫行結(jié)構(gòu)以前斜角肌為標(biāo)志分為：結(jié)構(gòu)：Januar

在前斜角肌的前內(nèi)側(cè)，為來源于頸、胸之間的結(jié)構(gòu)。

縱行結(jié)構(gòu)：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

在前斜角肌的前內(nèi)側(cè)，為來源于頸、胸之間的結(jié)構(gòu)

①頸內(nèi)靜脈②頸總動(dòng)脈③膈神經(jīng)④迷走神經(jīng)⑤頸交感干⑥胸膜頂⑦胸導(dǎo)管及右淋巴導(dǎo)管

縱行結(jié)構(gòu)有：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

①頸內(nèi)靜脈縱行結(jié)構(gòu)有：January,2007C

在前斜角肌的前、后方和外側(cè)，主要是來源于頸、胸與上肢之間的結(jié)構(gòu)。

橫行結(jié)構(gòu)：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

在前斜角肌的前、后方和外側(cè)，主要是來源于頸、胸與上肢

①鎖骨下動(dòng)脈及其分支②鎖骨下靜脈及其屬支③臂叢橫行結(jié)構(gòu)有January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

①鎖骨下動(dòng)脈及其分支橫行結(jié)構(gòu)有January,2007鎖骨下動(dòng)脈：

被前斜角肌分為三段。主要分支有：

①椎動(dòng)脈②胸廓內(nèi)動(dòng)脈③甲狀頸干甲狀腺下動(dòng)脈

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

鎖骨下動(dòng)脈：被前斜角肌分為三段。January,20胸導(dǎo)管注入左靜脈角，右淋巴導(dǎo)管注入右靜脈角。胸導(dǎo)管及右淋巴導(dǎo)管：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

胸導(dǎo)管注入左靜脈角，右淋巴導(dǎo)管注入右靜脈角斜角肌間隙：由前、中斜角肌和第1肋之間的空隙。通過結(jié)構(gòu)：臂叢鎖骨下動(dòng)脈

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

斜角肌間隙：由前、中斜角肌和第1肋之間的空隙。January八、頸側(cè)區(qū)

枕三角鎖骨上三角January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

八、頸側(cè)區(qū)枕三角January,2007Copyrigh枕三角：主要結(jié)構(gòu)：

頸叢皮神經(jīng)臂叢分支

副神經(jīng)支配：胸鎖乳突肌斜方肌

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

枕三角：主要結(jié)構(gòu)：January,2007Copyrig鎖骨上三角：主要結(jié)構(gòu)：鎖骨下動(dòng)脈鎖骨下靜脈靜脈角臂叢January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

鎖骨上三角：主要結(jié)構(gòu)：January,2007Copyri鎖骨下靜脈：

位于鎖骨內(nèi)側(cè)段上方，鎖骨下動(dòng)脈前面，直徑1~2cm。

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

鎖骨下靜脈：位于鎖骨內(nèi)側(cè)段上方，鎖骨下動(dòng)脈

左側(cè)有胸導(dǎo)管的注入，右側(cè)有右淋巴導(dǎo)管的注入。靜脈角January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

左側(cè)有胸導(dǎo)管的注入，右側(cè)有右淋巴導(dǎo)管的注入臂叢從頸部斜角肌間隙經(jīng)鎖骨中點(diǎn)后方到腋窩，臨床上作臂叢阻滯麻醉常在鎖骨中點(diǎn)上方進(jìn)行。臂叢January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

臂叢從頸部斜角肌間隙經(jīng)鎖骨中點(diǎn)后方到腋窩，臨床上小結(jié)1.頸部深筋膜的配布及筋膜間隙。2.頸動(dòng)脈鞘。2.甲狀腺的毗鄰。3.甲狀腺手術(shù)及氣管切開手術(shù)經(jīng)過的層次。

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

小結(jié)1.頸部深筋膜的配布及筋膜間隙。January,20

頸部一、概述二、淺層結(jié)構(gòu)三、頸部深筋膜四、頸前區(qū)五、胸鎖乳突肌區(qū)六、頸根部七、頸側(cè)區(qū)January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸部一、概述一、概述境界：內(nèi)容：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

一、概述境界：January,2007Copyright頸部分區(qū)：項(xiàng)部固有頸部（頸部）頸前區(qū)胸鎖乳突肌區(qū)頸側(cè)區(qū)January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸部分區(qū)：項(xiàng)部January,2007Copyright

舌骨上區(qū):下頜下三角頦下三角舌骨下區(qū):頸動(dòng)脈三角肌三角頸前區(qū)：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

舌骨上區(qū):頸前區(qū)：January,2007Cop胸鎖乳突肌區(qū)頸側(cè)區(qū)：

枕三角鎖骨上大窩January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

胸鎖乳突肌區(qū)January,2007Copyright?二、淺層結(jié)構(gòu)1.頸闊肌2.淺靜脈3.皮神經(jīng)

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

二、淺層結(jié)構(gòu)1.頸闊肌January,2007Copy1.頸闊肌起點(diǎn)：三角肌和胸大肌表面的筋膜。止點(diǎn)：口角頸闊肌深面有淺靜脈和皮神經(jīng)。

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

1.頸闊肌起點(diǎn)：三角肌和胸大肌表面的筋膜。January,2.淺靜脈

①頸前靜脈注入頸外靜脈②頸外靜脈注入鎖骨下靜脈或靜脈角January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

2.淺靜脈①頸前靜脈January,2007Co3.皮神經(jīng)(1)為頸叢的皮支:①頸橫神經(jīng)②耳大神經(jīng)③枕小神經(jīng)④鎖骨上神經(jīng)頸部麻醉點(diǎn)：(2)面神經(jīng)頸支January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

3.皮神經(jīng)(1)為頸叢的皮支:January,2007三、頸部深筋膜分淺、中、深三層。

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

三、頸部深筋膜分淺、中、深三層。January,2包裹二肌二腺，形成肌鞘和腺鞘。二?。盒狈郊⌒劓i乳突肌二腺：下頜下腺腮腺

1.深筋膜淺層（封套筋膜）January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

包裹二肌二腺，形成肌鞘和腺鞘。1.深筋膜淺層（封位于舌骨下肌群的后方，上附于舌骨，下續(xù)纖維性心包，分二層包繞甲狀腺，形成甲狀腺鞘。2.深筋膜中層（氣管前筋膜）January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于舌骨下肌群的后方，上附于舌骨，下續(xù)纖維性心包，分二層上自顱底，下續(xù)前縱韌帶與胸內(nèi)筋膜，并向下外包繞腋血管及臂叢，形成腋鞘。3.深層（椎前筋膜）

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

上自顱底，下續(xù)前縱韌帶與胸內(nèi)筋膜，并向下外包繞腋血管及臂為包繞頸部大血管和迷走神經(jīng)的筋膜鞘。頸動(dòng)脈鞘：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

為包繞頸部大血管和迷走神經(jīng)的筋膜鞘。頸動(dòng)脈鞘：Janua頸動(dòng)脈鞘內(nèi)上部有頸內(nèi)動(dòng)脈、下部有頸總動(dòng)脈，頸內(nèi)靜脈位于動(dòng)脈的外側(cè)，迷走神經(jīng)位于兩者之間的后方。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸動(dòng)脈鞘內(nèi)上部有頸內(nèi)動(dòng)脈、下部有頸總動(dòng)脈，頸內(nèi)靜脈位于動(dòng)頸部的筋膜間隙：主要有：

(1)胸骨上間隙(2)氣管前間隙(3)咽后間隙(4)椎前間隙January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸部的筋膜間隙：主要有：January,2007Co位于胸骨柄上方深筋膜淺層的二層之間。內(nèi)有頸前靜脈下段、頸靜脈弓、淋巴結(jié)、脂肪組織等。(1)胸骨上間隙January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于胸骨柄上方深筋膜淺層的二層之間。(1)胸骨上間位于氣管前筋膜與氣管之間。通向：向下通上縱隔。(2)氣管前間隙January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于氣管前筋膜與氣管之間。(2)氣管前間隙Januar①甲狀腺下靜脈②奇靜脈叢③頭臂干④甲狀腺最下動(dòng)脈⑤左頭臂靜脈⑥小兒有胸腺上部

氣管前間隙內(nèi)有January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

①甲狀腺下靜脈氣管前間隙內(nèi)有January,2007C位于椎前筋膜與咽顱底筋膜之間。內(nèi)有淋巴結(jié)及結(jié)締組織。咽壁側(cè)方的部分為咽旁間隙。(3)咽后間隙January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于椎前筋膜與咽顱底筋膜之間。內(nèi)有淋巴結(jié)及結(jié)締組織。咽壁位于脊柱頸段與椎前筋膜之間。頸椎結(jié)核膿腫多積于此間隙。向下通后縱隔。(4)椎前間隙January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

位于脊柱頸段與椎前筋膜之間。頸椎結(jié)核膿腫多積于此間隙。（一）舌骨上區(qū)下頜下三角頦下三角（二）舌骨下區(qū)頸動(dòng)脈三角肌三角四、頸前區(qū)January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（一）舌骨上區(qū)四、頸前區(qū)January,2007Co（一）舌骨上區(qū)1.下頜下三角周界：位于下頜骨下緣與二腹肌前、后腹之間。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（一）舌骨上區(qū)1.下頜下三角January,2007

主要為下頜下腺及其周圍的血管神經(jīng)。

內(nèi)容January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

主要為下頜下腺及其周圍的血管神經(jīng)。內(nèi)容Ja

淺面有：面靜脈深面有：面動(dòng)脈內(nèi)下方有：舌下神經(jīng)舌動(dòng)脈、舌靜脈內(nèi)上方有：舌神經(jīng)下頜下神經(jīng)節(jié)

下頜下腺周圍的結(jié)構(gòu)：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

淺面有：面靜脈下頜下腺周圍的結(jié)構(gòu)：January,（二）舌骨下區(qū)頸動(dòng)脈三角肌三角January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

（二）舌骨下區(qū)頸動(dòng)脈三角肌三角January,20071.頸動(dòng)脈三角境界：胸鎖乳突肌前緣上份二腹肌后腹肩胛舌骨肌上腹January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

1.頸動(dòng)脈三角境界：January,2007Copyrig

頸總動(dòng)脈及其分支頸內(nèi)靜脈及其屬支迷走神經(jīng)副神經(jīng)舌下神經(jīng)主要內(nèi)容：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸總動(dòng)脈及其分支主要內(nèi)容：January,2

頸外動(dòng)脈頸內(nèi)動(dòng)脈

頸總動(dòng)脈及其分支：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸外動(dòng)脈頸總動(dòng)脈及其分支：January,2

甲狀腺上動(dòng)脈舌動(dòng)脈面動(dòng)脈枕動(dòng)脈

頸外動(dòng)脈的分支：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲狀腺上動(dòng)脈頸外動(dòng)脈的分支：January,2.肌三角

周界：頸前正中線肩胛舌骨肌上腹胸鎖乳突肌前緣January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

2.肌三角周界：January,200肌肉：舌骨下肌群4對(duì)功能:下降舌骨和喉胸骨舌骨肌肩胛舌骨肌胸骨甲狀肌甲狀舌骨肌January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

肌肉：舌骨下肌群4對(duì)功能:下降舌骨和喉胸骨①甲狀腺②甲狀旁腺③氣管頸段④食管頸段內(nèi)容：

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

①甲狀腺內(nèi)容：January,2007Copyrigh

甲狀腺thyroidgland

1.外形:

“H”形有二個(gè)側(cè)葉和一個(gè)峽部。一半以上（約70%）的人有錐狀葉。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲狀腺thyroidgland1.外

甲狀腺位于喉下部和氣管上部的兩側(cè)。側(cè)葉上端平甲狀軟骨中部，下端達(dá)第6氣管軟骨環(huán)；峽部位于第2~4氣管軟骨環(huán)的前面。2.位置January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲狀腺位于喉下部和氣管上部的兩側(cè)。側(cè)葉3.甲狀腺的被膜

甲狀腺的表面包有內(nèi)、外層被膜，即：內(nèi)層：纖維囊（真被膜）外層：甲狀腺鞘（假被膜）

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

3.甲狀腺的被膜甲狀腺的表面包有內(nèi)、外層被膜，即假被膜增厚形成的甲狀腺懸韌帶將甲狀腺連于喉和氣管，故吞咽時(shí)，甲狀腺可隨喉上、下移動(dòng)。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

假被膜增厚形成的甲狀腺懸韌帶將甲狀腺連于喉和氣管，故吞咽4.甲狀腺的毗鄰甲狀腺前面鄰(層次）皮膚淺筋膜深筋膜淺層舌骨下肌群January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

4.甲狀腺的毗鄰甲狀腺前面鄰(層次）January,200

喉氣管咽食管喉返神經(jīng)甲狀腺側(cè)葉內(nèi)側(cè)鄰：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

喉甲狀腺側(cè)葉內(nèi)側(cè)鄰：January

頸鞘及其內(nèi)容

頸交感干

甲狀腺側(cè)葉后外側(cè)鄰：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸鞘及其內(nèi)容甲狀腺側(cè)葉后外側(cè)鄰：January

5.甲狀腺的動(dòng)脈與喉的神經(jīng)的關(guān)系

甲狀腺上動(dòng)脈與喉上神經(jīng)外支伴行，在距腺上極約1cm處，二者又分開，故甲狀腺手術(shù)結(jié)扎甲狀腺上動(dòng)脈時(shí)應(yīng)緊貼腺上極進(jìn)行。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

5.甲狀腺的動(dòng)脈與喉的神經(jīng)的關(guān)系甲狀腺上動(dòng)脈甲狀腺下動(dòng)脈與喉返神經(jīng)的關(guān)系：

甲狀腺下動(dòng)脈與喉返神經(jīng)關(guān)系密切，左側(cè)喉返神經(jīng)位置較深，多經(jīng)動(dòng)脈后方上行；右側(cè)喉返神經(jīng)位置較淺，多經(jīng)動(dòng)脈前方。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

甲狀腺下動(dòng)脈與喉返神經(jīng)的關(guān)系：甲狀腺下動(dòng)脈與喉返神

左右喉返神經(jīng)入喉之前都經(jīng)環(huán)甲關(guān)節(jié)后方，故甲狀軟骨下角可作為尋找喉返神經(jīng)的標(biāo)志。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

左右喉返神經(jīng)入喉之前都經(jīng)環(huán)甲關(guān)節(jié)后方，故甲狀

在甲狀腺手術(shù)結(jié)扎甲狀腺下動(dòng)脈時(shí)應(yīng)遠(yuǎn)離腺的下極，避免傷及喉返神經(jīng)，引起聲音嘶啞。同時(shí)要注意保留甲旁狀腺。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

在甲狀腺手術(shù)結(jié)扎甲狀腺下動(dòng)脈時(shí)應(yīng)遠(yuǎn)離腺的下6.甲狀腺的靜脈

有三對(duì)：甲狀腺上靜脈甲狀腺中靜脈甲狀腺下靜脈

January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

6.甲狀腺的靜脈有三對(duì)：January,2007Cop作甲狀腺手術(shù)切口所經(jīng)過的層次①皮膚②淺筋膜③深筋膜淺層④舌骨下肌群⑤氣管前筋膜January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

作甲狀腺手術(shù)切口所經(jīng)過的層次①皮膚January,2007氣管頸部有一定的移動(dòng)性，上段位置表淺，下段位置深。故常規(guī)氣管切開術(shù)應(yīng)保持頭正中位，并盡量后仰。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

氣管頸部有一定的移動(dòng)性，上段位置表淺，下氣管切開經(jīng)過層次：①皮膚②淺筋膜③深筋膜淺層④胸骨上間隙⑤舌骨下肌群⑥氣管前筋膜January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

氣管切開經(jīng)過層次：①皮膚January,2007Copy氣管頸部的毗鄰：

兩側(cè)：甲狀腺側(cè)葉后方：食管氣管食管溝內(nèi)有喉返神經(jīng)后外側(cè)：頸動(dòng)脈鞘頸交感干January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

氣管頸部的毗鄰：兩側(cè)：甲狀腺側(cè)葉January,2007六、胸鎖乳突肌區(qū)位置：主要結(jié)構(gòu)：頸袢January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

六、胸鎖乳突肌區(qū)位置：January,2007Copyri組成:由頸袢上、下根在第6頸椎平面匯合成袢。

頸袢January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

組成:頸袢January,2007Copyright頸袢上根：由頸1前支構(gòu)成。頸袢下根：由頸2、3前支經(jīng)頸叢發(fā)出下行構(gòu)成。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

頸袢上根：由頸1前支構(gòu)成。January,2007Copy分布:頸1發(fā)支至甲狀舌骨肌，袢上發(fā)支至其余3個(gè)舌骨下肌群。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

分布:January,2007Copyright?Dep七、頸根部

位置：頸部和胸部之間的過渡區(qū)。January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

七、頸根部位置：January,2007Copyrig縱行結(jié)構(gòu)橫行結(jié)構(gòu)

以前斜角肌為標(biāo)志分為：結(jié)構(gòu)：January,2007Copyright?Depart.Anatomy,SchoolofMedicine,LanzhouUniversity.AllrightreservedbyYPHOUandYFSONG

縱行結(jié)構(gòu)橫行結(jié)構(gòu)以前斜角肌為標(biāo)志分為：