胸部課前介紹李峰解剖學(xué)第1頁/共37頁*Thethoraxliesbetweenneckandabdomen.*Thethoraxincludesthoracicwallandthoraciccavity.*Thethoracicwallconsistsofskin,fascia,musclesandbones.*Thethoraciccavitycontainsheart,lungs,trachea,esophagusandsoon.第2頁/共37頁

Boundariesofthethorax

Superiorly:jugularnotch,sternoclavicularjoint,superiorborderofclavicle,acromion,spinousprocessofC7vertebra

Inferiorly:xiphoidprocess,costalarch,11thand12thribs,T12vertebra第3頁/共37頁1.Skeletonofthoracicwall

12pairsofribs12pairsofcostalcartilages(true,false,floatingribs)12thoracicvertebraeandintervertebraldiscs1sternum(manubrium,body,xiphoidprocess)第4頁/共37頁Inletofthorax:

upperborderofmanubrium,firstrib，

vertebraT1Outletofthorax:

T12vertebra,11thand12thribs,costalarch，

xiphoidprocess第5頁/共37頁2.ThoracicwallSkinSuperficialfasciaDeepfasciaPectoralm.BonythoraxIntercostalspacesandcontentsEndothoracicfascia第6頁/共37頁

Pectoralmuscles1thlayer:pectoralismajorexternalobliqueabdominalm.rectusabdominalm.2thlayer:pectoralisminorsubclavicularm.serratusanterior3thlayer:intercostalm.4thlayer:transversethoracis第7頁/共37頁4thlayer:transversethoracis第8頁/共37頁Serratusanterior第9頁/共37頁Intercostalm.Externalintercostalm.:Themuscularfibersrundownwardandforward.Thefleshym.arereplacedbyexternalintercostalmembranesanteriorly.Internalintercostalm.

Innermostintercostalm.第10頁/共37頁Internalintercostalm.

Themuscularfibersrunupwardandforward.Thefleshym.arereplacedbyinternalintercostalmembranesposteriorly.第11頁/共37頁IntercostalspacesandcontentsIntercostalvessels:intercostala.thoracicaortaintercostalv.azygosv.hemiazygosv.

accessoryhemiazygos

v.Intercostal

nerves:

spinalcord

第12頁/共37頁ercostaln.

Nearanglesofribs:ercostaln.collateraln.第13頁/共37頁ercostaln.

ThoracocentesisTheneedleisinsertedintopleuralcavity.Posteriorly:superiortoribAnteriorly:betweentworibs第14頁/共37頁3.Thediaphragm

Location:separatesthoraciccavityfromabdominalcavity3Parts:

costalpartsternalpartlumbarpart3hiatus:

第15頁/共37頁

3hiatus:

aortichiatus:thoracicaorta,thoracicduct

esophagealhiatus:esophagus,vagusn.

venacavalforamen:inferiorvenacava,rightphrenicn.第16頁/共37頁4.PleuraandpleuralcavityThoraciccavity:threecompartments2pulmonarycavities1mediastinum

pulmonarycavitylungspleura

mediastinumhearttracheaesophagus第17頁/共37頁P(yáng)leuraVisceralpleura:investslungs,continuouswithparietalpleuraatrootoflungParietalpleura:linespulmonarycavity

Pleuralcavity*liesbetween

visceralandparietalpleurae;

*containsasmallamountofpleuralfluid;lung第18頁/共37頁

Divisionofparietalpleura

Pleuralcupula:enclosesapexoflungs

Costalpleura:linesinnersurfaceofthoracicwall

Mediastinalpleura:coverslateralaspectsofmediastinum

Diaphragmaticpleura:linesoverdiaphragmoneachsideofmediastinum

第19頁/共37頁P(yáng)leuralrecessThelungsdonotcompletelyoccupypleuralcavityduringexpiration.

CostodiaphragmaticrecessThediaphrgmaticpleuraisincontactwiththelowermostpartofcostalpleura.

CostomediastinalrecessThecostalpleuraisincontactwithmediastinalpleura.

第20頁/共37頁5.Thelungs

Shapeoflungs:

Apex:extendsintorootofneck

Base:restsondiaphragm

Threesurfaces:

*costal:relatedtothoracicwall

*mediastinal:relatedtomediastinum

*diaphragmatic:

restonthediaphragm

Threeborders:anterior(cardiacnotch)posteriorborderinferiorborder第21頁/共37頁FissuresandlobesObliquefissure:divideslungsintosup.andinf.lobes.Horizontalfissure:dividesrightlungintosup.andmid.andinf.lobes.第22頁/共37頁Hilumoflungareawherestructuresenterandleavelungs.Rootoflungprimarybronchuspulmonaryarteryandvein

lymphaticvesselsnerves

第23頁/共37頁Bronchialtreetracheaprimarybronchilobarbronchisegmentalbronchi(bronchopulmonarysegment)第24頁/共37頁6.Themediastinum*extends

fromsup.thoracicaperturetodiaphragm.*extends

from

sternumtothoracicvertebrae.*containsallstructuresbetweentheleftandrightmediastinalpleurae第25頁/共37頁Division

ofmediastinum

transversethoracicplane:

fromsternalangletolowermarginof4th

thoracicvertebra

superiormediastimun

inferiormediastinum

anteriormediastinummiddlemediastinumposteriormediastinum第26頁/共37頁Superiormediastinumextendsfromsup.thoracicaperturetotransversethoracicplane.Contentssuperficiallayer,middlelayer,thedeepestlayer第27頁/共37頁Structuresinsuperficiallayer:

thymusbrachiocephalicveinsup.venacava第28頁/共37頁Structuresinmiddlelayer:

archofaortaanditsthreebranches(brachiocephalictrunk,commoncarotida.,subclaviana.)phrenicn.vagusn.第29頁/共37頁Structuresinthedeepestlayer:recurrentlaryngealn.(vagusn.)tracheaesophagus

thoracicduct(chylecistern)第30頁/共37頁InferiormediastinumItissubdividedbypericardiuminto:Anteriormediastinumboundedbypost.surfaceofsternumandcostalcartilagesandant.surfacepericardium.

thymusconnectivetissueMiddlemediastinumPosteriormediastinum第31頁/共37頁MiddlemediastinumItisboundedbypericardium.

pericardiumheartgreatvesselsarcho