颈部应用解剖学课件.ppt

1、颈部颈部neck颈部颈部Neck境界境界Boundaries 上界Superior下颌底、下颌角、乳突、上项线、枕外隆突inferior border of mandible,angle of mandible,tip of mastoid process,superior nuchal line,external occipital protuberance下界Inferior颈静脉切迹、胸锁关节、锁骨上缘、肩峰、第七颈椎棘突jugular notch,sternoclavicular joint,superior border of clavicle,acromion,spinous pr

2、ocesses of C7体表标志体表标志Landmarks舌骨Hyoid bone甲状软骨Thyroid cartilage环状软骨Cricoid cartilage颈动脉结节Carotid tubercle胸锁乳突肌Sternocleidomastoid 胸骨上窝Suprasternal fossa锁骨上大窝Greater supraclaviclar fossa颈部分区Division of neck固有颈部固有颈部Proper neck颈前区颈前区Anterior region舌骨上区舌骨上区Suprahyoid region：颏下三角颏下三角Submental triangle下颌下

3、三角下颌下三角Submandibular triangle舌骨下区舌骨下区Infrahyoid region：颈动脉三角颈动脉三角Carotid triangle肌三角肌三角Muscular triangle胸锁乳突肌区胸锁乳突肌区Sternocleidomastoid region颈外侧区颈外侧区Lateral region枕三角枕三角Occipital triangle锁骨上三角锁骨上三角supraclavicular triangle Greater supraclavicular fossa项部项部posterior portion（nape）皮肤Skin浅筋膜Superficial

4、fascia深筋膜Deep fascia肌Muscles血管Blood vessels,淋巴管Lymphatic ducts神经Nerves咽、喉、食管、气管、甲状腺、甲状旁腺Pharynx,larynx and esophagua and tracheaThyroid gland,parathyroid gland 皮肤皮肤Skin 皮肤薄、移动性大、皮纹呈横向分布。The natural line of cleavage of the skin are constant and run almost horizontally around the neck浅筋膜浅筋膜Superficial

5、 fasciaContents 颈阔肌Platysma浅静脉Superficial veins颈前静脉Anterior jugular v.颈外静脉External jugular v.皮神经Cutaneous nerves枕小神经Lesser occipital n.耳大神经Greet auricular n.颈横神经Transverse nerve of neck锁骨上神经Supraclavicular n.面神经颈支Cervical branch of facial n.颈筋膜颈筋膜Cervical fascia浅层Superficial layer(investing fascia 封

6、套筋膜)气管前筋膜Pretrachial layer椎前筋膜Prevertebral layerprevertebral fasciainvesting fasciapretracheal fascia颈动脉鞘颈动脉鞘Carotid sheathFormed by components of all three layers of deep cervical fascia内容Contains颈总动脉common carotid arteries颈内动脉internal carotid arteries颈内静脉internal jugular vein迷走神经vagus nerveAnsa ce

7、rvicalis located on its anterior surface筋膜间隙Spaces among fascia胸骨上间隙胸骨上间隙Suprasternal space气管前间隙气管前间隙Pretracheal space 咽后间隙咽后间隙Retropharyngeal space椎前间隙椎前间隙Prevertebral space颈前区颈前区anterior regions of the neck下颌下三角Submandibular triangle境界：二腹肌前、后腹和下颌骨体下缘围成。浅面Roof:皮肤、浅筋膜、颈阔肌、封套筋膜。底Floor:下颌舌骨肌、舌骨舌肌和咽中缩肌

8、mylohyoid,hyoglossus and middle constrictor of pharynx内容Contents下颌下腺submandibular gland面血管facial a.and v.舌血管lingual a.and v.舌神经lingual n.舌下神经hypoglossal n.下颌下神经节submandibular ganglion 下颌下淋巴结submandibular lymph nodesOne glandTwo blood vesslesTwo nervesfacial a.and v.:deep to the gland lingual a.and v

9、.:medially to the lower part of the glandhypoglossal n.：medially to the lower part of the glandlingual n.：medially to the upper part of the glandsubmandibular ganglion：medially to the upper part of the glandsubmandibular lymph nodes：around the gland颏下三角颏下三角Submental triangle境界：两侧二腹肌前腹和舌骨围成。顶：皮肤、浅筋膜、

10、封套筋膜Covered by skin,superficial fascia and investing fascia 底Floor下颌锁骨肌mylohyoid muscles内容Contents颏淋巴结submental lymph nodes颈动脉三角颈动脉三角Carotid triangle境界境界Bounded胸锁乳突肌前缘、二腹肌胸锁乳突肌前缘、二腹肌后腹、肩胛舌骨肌上腹后腹、肩胛舌骨肌上腹 by anterior border of sternocleidomastoid,superior belly of omohyoid and posterior belly of digas

11、tic muscles顶顶Covered皮肤、浅筋膜、颈阔肌、封皮肤、浅筋膜、颈阔肌、封套筋膜套筋膜 by skin,superficial fascia,platysma and investing fascia底底Floor椎前筋膜、咽侧壁prevertebral fascia and lateral wall of pharynxContents内容内容Contents 颈总动脉及其分支common carotid a.and its branches 颈外动脉及其分支external carotid a.and its branches 颈内静脉及其属支internal jugular

12、 v.and its tributaries,舌下神经hypoglossal n.with its descending branches,副神经accessory nerve 迷走神经vagus nerve 颈外侧深淋巴结part of the chain of deep cervical lymph nodesThe common carotid a.,external carotid a.,internal jugular v.,and vagus nerve are enclosed in Carotid Sheath二腹肌后腹二腹肌后腹Posterior belly of digas

13、tic muscle浅面浅面Superficial:耳大神经耳大神经 great auricular n.,下颌后静脉retromandibular v.,面神经颈支 cervical branch of facial n.深深Deep:颈内动脉、颈外动脉、颈内静脉、颈内动脉、颈外动脉、颈内静脉、迷走神经、副神经、舌下神经、颈交感迷走神经、副神经、舌下神经、颈交感干干 internal and external carotid a.,internal jugular v.,vagus n.accessory n.hypoglossal n.and cervical part of sympat

14、hetic trunk上上Superior:耳后动脉耳后动脉 posterior auricular a.,面动脉facial a.and舌咽神经 glossopharyngeal n.下下Infeior:枕动脉occipital a.and舌下神经 hypoglossal n.肌三角肌三角Muscular triangle 境界：颈部前正中线、肩胛舌骨境界：颈部前正中线、肩胛舌骨肌上腹、胸锁乳突肌前缘。肌上腹、胸锁乳突肌前缘。.顶：皮肤、浅筋膜、颈阔肌、颈顶：皮肤、浅筋膜、颈阔肌、颈前静脉、皮神经、封套筋膜前静脉、皮神经、封套筋膜Covered by skin,superficial fas

15、cia,platysma,anterior jugular v.,coutaneous n.and investing fascia底底Floor椎前筋膜prevertebral fascia 内容内容Contents内容内容Contents胸骨舌骨肌Sternohyoid肩胛舌骨肌上腹superior belly of omohyoid胸骨甲状肌Sternothyroid甲状舌骨肌Thyrohyoid甲状腺thyroid gland甲状旁腺parathyroid gland咽Pharynx喉Larynx 气管颈段cervical part of trachea 食管颈段cervical pa

16、rt of esophagus喉的神经、血管Blood vessels and nerves to larynxThyroid gland 甲状腺甲状腺甲状腺甲状腺Thyroid gland形态与位置形态与位置Shape and positionH-shape侧叶Left and right lobes:位于喉的下部和气管上部两侧，上极平甲状软骨中部，下极平第六气管软骨环；高度约第5至7颈椎峡Isthmus:横过第2-4气管软骨环overlies 2nd to 4th tracheal cartilage ring锥状叶Pyramidal lobe:多与峡部相连some times arise

17、s from isthmus Coverings 甲状腺鞘（假被囊）由气管前筋膜形成，其后部增厚附着于甲状软骨和环状软骨弓，有固定甲状腺的作用。the posterior part thickened(suspensory lig.of throid gland)and attached to arch of cricoid and thyroid cartilages,hence,the thyroid gland moves with larynx during swallowing and oscillates during speaking纤维囊（真被囊）其与甲状腺鞘之间含有甲状旁腺和

18、血管、神经。Space between the sheathcontains parathyroid gland,blood vessels and nerve甲状腺动脉和喉的神经甲状腺动脉和喉的神经甲状腺上动脉甲状腺上动脉Superior thyroid a.Branch of external carotid a.与喉上神经伴行Runs superficial and parallel to the external branch of superior laryngeal n.and separate from each other near(0.51.0cm)the upper pol

19、e of thyroid gland and reach itGives off superior laryngeal a.in company with internal branch of superior laryngeal n.喉上神经分为喉内支与喉外支甲状腺下动脉甲状腺下动脉Inferior thyroid artery起自锁骨下动脉的甲状颈干Branch of thyrocervical trunk of subclavian a.在甲状腺下及与喉返神经关系密切。Turns medially and downward,reaches the posterior border of

20、the thyroid gland and is closely related to the recurrent laryngeal n.Supplies inferior pole of thyroid gland甲状腺最下动脉甲状腺最下动脉lowest thyroid artery(arteria thyroidea ima)起自头臂干或主动脉弓。may arise(613%)from the brachiocephalic a.or aortic arch静脉回流静脉回流Venous drainage甲状腺上静脉甲状腺上静脉superior thyroid veins 回流至颈内静脉d

21、rains into internal jugular vein甲状腺中静脉甲状腺中静脉middle thyroid veins 回流支颈内静脉drains into internal jugular vein甲状腺下静脉甲状腺下静脉inferior thyroid veins 回流至头臂静脉drains into left brachiocephalic vein喉上神经喉上神经 Superior laryngeal nerve内支内支Internal branch which pierces thyrohyoid membrane to innervates mucous membrane

22、 of larynx above fissure of glottis外支外支External branch is fine n.,which descends in company with the superior thyroid a.and supplies cricothyroid喉返神经喉返神经Recurrent laryngeal nerves Ascend in tracheo-esophageal groove,pass deep to the lobe of the thyroid gland and come into close relationship with the

23、 inferior thyroid a.Cross either in front of or behind the artery or may pass between its branchesNerves enter larynx posterior to cricothyroid joint,then is called 喉下神经inferior laryngeal nerveInnervations:laryngeal mucosa below fissure of glottis,all laryngeal muscles except cricothyroid R N A甲状腺的毗

24、邻Neighborhood 前（浅面）Anteriorlly皮肤Skin浅筋膜superficial fascia封套筋膜investing fascia舌骨下肌群infrahyoid muscles 气管前筋膜pretracheal layer of cervical fascia后内侧Posteromedialy 喉和气管；咽和食管；喉返神经larynx and trachea,pharynx and esophagus,recurrent laryngeal n.（Difficulty in Breathing,Swallowing and phonation ）后外侧Posterola

25、teraly颈动脉鞘和颈交感干carotid sheath and cervical part of sympathetic trunk（Horners syndrom）甲状旁腺甲状旁腺Parathyroid gland黄褐色、卵圆形小体Yellowish-brown,ovoid bodies位置PositionTwo superior parathyroid glands:lie at junction of superior and middle third of posterior border of thyroid glandTwo inferior parathyroid gland

26、s:lie near the inferior thyroid artery,close to the inferior poles of thyroid gland功能Function:调节钙磷平衡regulate calcium and phosphate balance and is therefore essential for life气管颈部气管颈部Cervical part of tracheaBegins at lower end of larynx at the level of C6 vertebra to the jugular notchConsists of a se

27、ries of incomplete cartilage ringsExtends into thorax毗邻Relations in the neck前Anteriorly-皮肤skin-浅筋膜superficial fascia-封套筋膜investing fascia-胸骨上间隙和颈静脉弓suprasternal space and jugular arch-舌骨下肌群infrahyoid muscles-气管前筋膜pretracheal fascia-甲状腺峡isthmus of thyroid gland(in front of the 2nd to 4th tracheal car

28、tilage)-甲状腺下静脉和奇静脉丛inferior thyroid v.and unpaired thyroid venous plexus-甲状腺最下动脉arteria thyroid ima(if present)-左头臂静脉left brachiocephalic v.in child外侧外侧Laterally 甲状腺侧叶、甲状旁腺、颈动脉鞘The lobes of the thyroid gland(down as far as the sixth ring)，parathyroid gland and the carotid sheath后后Posteriorly 食管、喉返神经

29、the esophagus，the recurrent laryngeal nerves,食管颈部食管颈部Cervical part of esophagusConnecting the pharynx at level of C6 vertebra 毗邻Relations in the nack前Anteriorly 气管、喉返神经Trachea,recurrent laryngeal n.后Posteriorly 椎前筋膜、脊柱、颈长肌Prevertebral layer of cervical fascia,vertebral column,and longus colli外侧Later

30、ally 甲状腺侧叶、颈动脉鞘Lobe of the thyroid gland and carotid sheath 后外侧Posterolateraly颈交感干Sympathetic trunk胸锁乳突肌区胸锁乳突肌区Sternocleidomastoid regionposition Covered by sternocleidomastoid Contents 颈袢Ansa cervicalis 颈动脉鞘Carotid sheath 颈丛Cervical plexus颈交感干Cervical part of sympathetic trunk颈动脉鞘颈动脉鞘carotid sheath

31、Formed by components of all three layers of deep cervical fascia内容Contents颈总动脉common carotid arteries-posteromedially颈内动脉internal carotid arteries-posteromedially颈内静脉internal jugular vein-anterolaterally迷走神经vagus nerve-behind and between the a.and v.颈袢Ansa cervicalis位于颈动脉鞘前面located on the anterior s

32、urface of carotid sheath上根来自舌下神经Formed by superior root from hypoglossal n.and 下根来自第2、3颈神经前支inferior root from C2,3 cervical n.颈丛cervical plexus位置position：胸锁乳突肌上部和中斜角肌之间located between the sternoclavicomastoid and Salenus anterior surface 分支branches：皮神经cutaneous nerves肌支Muscular branches膈神经Phrenic n

33、erve颈交感干cervical part of symphathetic trunk位于脊柱两侧、椎前筋膜深面Located beside the vertebral column and deep to the vertebra layer of cervical fascia.有三个神经节Composed of three(superior,middle and lower)ganglia。Send off cervical cardiac branches from each ganglion颈根部颈根部Root of neck指颈部与胸部接壤的区域，由进出胸廓上口的诸结构占据。For

34、med at thoracic inlet by前Anteriorly胸骨柄manubrium sterni后Posteriorly第一胸椎体body of first thoracic vertebra外侧Laterally第1肋first rib and costal cartilage内容内容Contents 胸膜顶Cupula of pleuraextends up into the neck,over the apex of lung,23cm above the medial third of clavicle.Suprapleural membrane:fascia connec

35、t the cupula to transverse process of 7th vertebra,body of 1st thoracic vertebra and neck of 1st rib,serves as suspenssory lig.锁骨下静脉Subclavian v.锁骨下动脉Subclavian a.胸导管Thoracic duct 右淋巴导管Right lymphatic duct迷走神经Vagus n.膈神经Phrenic n.前斜角肌Scalenus anterior毗邻毗邻Relationship of the scalenus anterior前内侧前内侧An

36、teriorTransverse:颈横动脉、锁骨下静脉颈横动脉、锁骨下静脉transverse cervical a.,subclavian v.thoracic duct(left)纵行的纵行的Vertical:颈总动脉、颈内静脉、迷走神颈总动脉、颈内静脉、迷走神经、膈神经、胸膜顶经、膈神经、胸膜顶、颈交感干、颈交感干jugular v.phrenic n.后后Posterior锁骨下动脉第锁骨下动脉第2段段2nd part of subclavian A.臂丛臂丛Roots and trunks of brachial plexuesSalenus anterior:the main st

37、ructure in this region锁骨下动脉subclavian A左起自主动脉弓、右起头臂干，于第1肋外侧续于腋动脉。pathway：runs laterally anterior to the Cupula of pleura,then behind the scalenus anterior and pass through scalene fissure to continue with axillary at the lateral border of 1st rib.1st segment 位于胸膜顶的前上方、前斜角肌的内侧，左侧前方有膈神经及胸导管颈部，右侧前方有迷走神

38、经。分支有：椎动脉、胸廓内动脉，甲状颈干（常分为甲状腺下动脉、肩胛上动脉和颈横动脉）、肋颈干（颈深动脉颈深肌，肋间最上动脉第1、2肋间隙）2nd Segment ：位于前斜角肌的后方，上方紧邻臂丛各干，下方跨越胸膜顶。3rd segment：位于前斜角肌外侧，第1肋上方，前下方有锁骨下静脉，外上方为臂丛。此段有时发出颈横动脉或肩胛上动脉。锁骨下静脉subclavian V.：前方有锁骨下肌和锁骨，下方邻第1肋；后方与前斜角肌、膈神经和胸膜顶相邻；后上方为锁骨下动脉和臂丛。胸导管thoracic duct：胸导管弓（平C7高度，向左跨越胸膜顶形成）经颈动脉鞘后方，椎动、静脉的前方，注入左静脉角。

39、右淋巴导管right lymphatic duct：接受3个淋巴干，注入右静脉角。vagus N.：右迷走神经在锁骨动脉下第1段前面发出喉返神经phrenic N.：起自颈丛，经前斜角肌上份外侧缘向内下沿前斜角肌表面下降，再经锁骨下动、静脉之间入胸腔。椎动脉三角椎动脉三角Triangle of the vertebral a.Boundaries 内侧Medially颈长肌longus colli外侧Laterally前斜角肌scalenus anterior 下Inferiorly锁骨下动脉第1段first part of subclavian a.尖Apex第6颈椎横突transvese

40、process of C6后Posteriorly第7颈椎横突transvese process of C7,第8颈神经前支前Anteriorly颈动脉鞘、膈神经、胸导管弓carotid sheath,phrenic n.and arch of thoracic duct(left)内容Contents 胸膜顶cupula of pleura,椎动脉Vertebral a.甲状腺下动脉Inferior thyroid a.颈交感干Cervical part of sympathetic trunk颈胸神经节Cevicothoracic ganglion颈外侧区颈外侧区Lateral regio

41、n of neckBounded by posterior border of sternocleidomastoid,anterior border of trapezius and middle third of clavicleDivided by inferior belly of omohyoid into occipital and supraclavicular triangles 枕三角枕三角Occipital triangleBounded by posterior border of sternocleidomastoid,anterior border of trapez

42、ius and superior border of inferior belly of omohyoid Covered by skin,superficial fascia,and investing fasciaFloorprevertebral fascia and scalenus anterior,scalenus medius,scalenus posterior,splenius capitis and levator scapulaeConentsAccessory n.emerges above the middle of the posterior border of s

43、ternocleidomastoid and crosses the occipital triangle to trapeziusCervical and brachial plexuses-肩胛上N、胸长N等。走出部位在胸锁乳突肌后缘中点附近锁骨上三角锁骨上三角Supraclavicular triangleBounded by posterior border of sternocleidomastoid,inferior belly of omohyoid and middle third of clavicleCovered by skin,superficial fascia,an

44、d investing fasciaFloorprevertebral fascia and inferior parts of scalenusConentsSubclavian v.and venous angle Subclavian a.-肩胛上动脉、颈横动脉、肩胛背动脉Brachial plexuslymph nodes of the headLymph nodes of neck颈前淋巴结Anterior cervical lymph nodesSuperficial anterior cervical lymph nodesDeep anterior cervical lymph

45、 nodes颈外侧淋巴结Lateral cervical lymph node Superficial lateral cervical lymph nodeslie along the external jugular veinDeep lateral cervical lymph nodes颈外侧深淋巴结颈外侧深淋巴结Deep lateral cervical lymph nodesextend along the internal jugular vein from the base of skull to the root of neckdivide into superior dee

46、p lateral cervical lymph nodes and inferior deep lateral cervical lymph nodesreceive lymphatic vessels from head,neck,tongue,larynx,cervical parts of esophagus and trachea,thyroid gland,upper parts of the thoracic wall and breastefferent vessels form the jugular trunkthe left jugular trunk joins the

47、 thoracic duct and right may joint the right lymphatic ductSuperior deep lateral cervical lymph nodes 颈外侧上深淋巴结颈外侧上深淋巴结Jugulodigastric lymph node 颈内静脉二颈内静脉二腹肌淋巴结腹肌淋巴结:lies at the junction of posterior belly of digastric and internal jugular veinInferior deep lateral cervical lymph nodes 颈外侧下深淋巴结颈外侧下深

48、淋巴结Juguloomohyoid lymph node 颈内静脉肩颈内静脉肩胛舌骨肌淋巴结胛舌骨肌淋巴结:lies at the junction of the intermediate tendon of omohyoid and internal jugular veinSupraclavicular lymph nodes 锁骨上淋锁骨上淋巴结巴结:lie along the subclavian arterySuperficial layer(investing fascia 封套筋膜)Encloses trapezius,sternocleidomastoid,posterior

49、belly of digastric and parotid and submandibular glandsAttached to bony landmarks of upper and lower boundaries of neck and zygomatic arch of facePrevertebral layer 气管前层气管前层Encloses viscera of neck:pharynx,larynx,trachea,esophagus,thyroid gland and parathyroid glandsCompletely surrounds thyroid glan

50、d,forming a sheet for it,and bind the gland to larynx Extends from hyoid bone to fibrous pericardium of superior mediastinum Prevertebral layer 椎前层椎前层Lies anterior to bodies of cervical vertebrae and prevertebral muscles;extends from base of skull downward into the superior mediastinum,continuous wi